Habib Larissa A, Yoon Michael K
Department of Ophthalmology, Yale School of Medicine, New Haven, CT, USA.
Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Am J Ophthalmol Case Rep. 2021 Oct 19;24:101222. doi: 10.1016/j.ajoc.2021.101222. eCollection 2021 Dec.
Successful repair of the orbital skeleton restores function and cosmesis by normalizing globe position and allowing full motility of the extraocular muscles. Routine repairs are successful with standard implants. However, defects that are irregular or cause volume deficiency can be challenging to repair. The development of patient specific implants (PSI) offers an additional tool in complex cases. Herein, we report our experience using PSI for orbital reconstruction.
An IRB-approved review was conducted of consecutive patients who received PSI from 8/2016-9/2018. Demographic and examination findings were recorded. PSI was designed using high-density porous polyethylene or polyetheretherketone (PEEK) and implanted for repair. The postoperative course was reviewed for outcomes and complications.
Eight patients were identified. Two had silent sinus syndrome, 3 were complex facial fracture revisions, and 3 were post-oncologic reconstruction. Seven received porous polyethylene implants, and 1 had a PEEK implant. Mean follow up time was 10.2 months (3.3-28.3). All had an improved functional and aesthetic result. Diplopia and enophthalmos completely resolved in 60% of fracture and silent sinus patients. All fracture and silent sinus patients were orthotropic without diplopia in primary gaze at last follow up. Tumor patients had improvement in symmetry and functionality. There were no complications.
Complex orbital skeleton derangements can be difficult to repair and standard implants may incompletely resolve the anatomic problem. In challenging cases, PSI may better achieve an aesthetically and anatomically successful outcome and improve functionality.
成功修复眼眶骨骼可通过使眼球位置正常化并允许眼外肌充分活动来恢复功能和美观。常规修复使用标准植入物即可成功。然而，不规则或导致体积不足的缺损修复起来可能具有挑战性。定制植入物（PSI）的开发为复杂病例提供了一种额外的工具。在此，我们报告我们使用PSI进行眼眶重建的经验。
对2016年8月至2018年9月期间接受PSI的连续患者进行了一项经机构审查委员会批准的回顾性研究。记录人口统计学和检查结果。使用高密度多孔聚乙烯或聚醚醚酮（PEEK）设计PSI并植入进行修复。回顾术后过程以了解结果和并发症。
共确定8例患者。2例患有寂静性窦综合征，3例为复杂面部骨折翻修，3例为肿瘤切除术后重建。7例接受多孔聚乙烯植入物，1例接受PEEK植入物。平均随访时间为10.2个月（3.3 - 28.3个月）。所有患者的功能和美学效果均有改善。60%的骨折和寂静性窦综合征患者复视和眼球内陷完全消失。所有骨折和寂静性窦综合征患者在最后一次随访时第一眼位均为正视且无复视。肿瘤患者的对称性和功能有所改善。无并发症发生。
复杂的眼眶骨骼紊乱可能难以修复，标准植入物可能无法完全解决解剖问题。在具有挑战性的病例中，PSI可能更好地实现美学和解剖学上的成功结果并改善功能。
