Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, UK.
Eye (Lond). 2021 Nov;35(11):3077-3086. doi: 10.1038/s41433-020-01382-0. Epub 2021 Jan 11.
BACKGROUND/OBJECTIVES: To evaluate the outcomes of orbital evisceration with primary implant placement in acutely infected/inflamed eyes, using implant exposure/extrusion as a surrogate of success. To contextualise this with previously published literature.
SUBJECTS/METHODS: A retrospective case series of all patients with acutely infected/inflamed eyes undergoing urgent orbital evisceration with primary implants, at a British tertiary centre between January 2006 and August 2018. A systematic literature review of orbital eviscerations with primary implant placement in acute endophthalmitis/infection and recent trauma.
Twenty-six eyes were eviscerated in the context of acute infection/inflammation. Twenty-four eyes had primary orbital implants. Indications for evisceration included endophthalmitis (18/26, 69%), microbial keratitis with corneal perforation (4/26, 15%), non-infectious corneal perforation (3/26, 12%), and recent trauma (1/26, 4.8%). The implants used were acrylic (15/24, 63%), MEDPOR (5/24, 21%), and silicone (4/24, 17%). The follow-up period was 15 months to 14 years. Implant exposure occurred in two (8.3%), managed with implant exchange and scleral reformation in one, and implant removal with dermis fat grafting in the other. One patient (4.2%) had conjunctival wound dehiscence with spontaneous healing. Six (25%) required further surgery for minor complications as follows: conjunctival prolapse, upper lid ptosis with slight sulcus loss, lower lid entropion with shortened fornix, and lower lid ectropion. The systematic literature review showed that the mean rate of orbital implant exposure/extrusion in this subset of patients was 7.8% (95% CI: 2.7%, 12.9%, SD 8.0%), range 0-27%.
In acutely infected/inflamed eyes, the implant exposure/extrusion rate following orbital evisceration with primary implant placement is acceptable.
背景/目的：评估在急性感染/炎症的眼睛中进行眼眶内容剜除术并同时植入义眼台的治疗效果，以义眼台暴露/脱出作为评判手术成功的替代指标。并将该结果与已发表的文献进行对比分析。
受试者/方法：本研究为回顾性病例系列研究，纳入了 2006 年 1 月至 2018 年 8 月在英国一家三级转诊中心接受紧急眼眶内容剜除术联合义眼台植入术治疗的急性感染/炎症性眼病患者。同时进行了一项关于急性眼内炎/感染和近期外伤患者行眼眶内容剜除术联合义眼台植入术的文献系统回顾。
共 26 只眼因急性感染/炎症接受了眼眶内容剜除术，其中 24 只眼行一期义眼台植入术。行眼眶内容剜除术的原因包括眼内炎（18/26，69%）、微生物性角膜炎伴角膜穿孔（4/26，15%）、非感染性角膜穿孔（3/26，12%）和近期外伤（1/26，4.8%）。术中使用的义眼台包括丙烯酸（15/24，63%）、多孔聚乙烯（5/24，21%）和硅胶（4/24，17%）。随访时间为 15 个月至 14 年。2 例（8.3%）发生义眼台暴露，1 例经义眼台更换和巩膜重建治疗，另 1 例经义眼台取出联合真皮脂肪瓣移植治疗。1 例（4.2%）发生结膜伤口裂开，自行愈合。6 例（25%）因其他轻微并发症需进一步手术治疗，包括结膜脱垂、上睑轻度下垂伴轻度睑沟消失、下睑内翻伴穹窿缩短和下睑外翻。文献系统回顾结果显示，在该亚组患者中，眼眶内容剜除术联合义眼台植入术后义眼台暴露/脱出的平均发生率为 7.8%（95%CI：2.7%，12.9%，SD 8.0%），范围为 0-27%。
在急性感染/炎症的眼睛中，眼眶内容剜除术联合一期义眼台植入术后义眼台暴露/脱出的发生率可以接受。
