Remulla H D, Rubin P A, Shore J W, Sutula F C, Townsend D J, Woog J J, Jahrling K V
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA.
Ophthalmology. 1995 Apr;102(4):586-93. doi: 10.1016/s0161-6420(95)30991-8.
To determine the complications observed with using porous spherical orbital implants (hydroxyapatite and porous polyethylene) and the factors leading to their occurrence.
A total of 101 cases of porous spherical orbital implantation by five ophthalmic surgeons were reviewed retrospectively. The demographic data, diagnosis, prior surgery, type and technique of surgery, implant characteristics and prosthesis fitting were described in patients with complications.
Eleven of the 101 patients had implant exposure. There were six male (1 with bilateral involvement) and four female patients, ranging in age from 2 to 71 years. Preoperative diagnosis included trauma in five patients, nontrauma in five, and tumor in one. Seven had prior eye surgeries. Three patients underwent evisceration, whereas eight underwent enucleation. Eight hydroxyapatite and three porous polyethylene implants were used with diameters of 16 to 20 mm. Three were unwrapped, six were wrapped in sclera, and two were wrapped in preserved fascia. Exposures, which generally occurred within 1 year, were grouped into small (1-5 mm), medium (6-10 mm), and large (> 10 mm). One delayed case occurred after drilling. Small stable exposures were managed conservatively. Larger exposures were managed either by implant revision or replacement. All patients were fit ultimately with a prosthesis. Histopathologic findings of explanted spheres showed fibrovascularization limited to the periphery with moderate inflammatory reaction.
Complications were significantly higher in cases of eviscerations than enucleations. Complications occurred in implants either unwrapped or wrapped in homologous grafts. None of the autologous wrapping had exposure. Secondary procedures may initiate exposure when fibrovascular status of implant is inadequate.
确定使用多孔球形眼眶植入物（羟基磷灰石和多孔聚乙烯）时观察到的并发症及其发生因素。
回顾性分析五位眼科医生进行的101例多孔球形眼眶植入手术病例。描述了发生并发症患者的人口统计学数据、诊断、既往手术、手术类型和技术、植入物特征及义眼适配情况。
101例患者中有11例发生植入物暴露。其中男性6例（1例双侧受累），女性4例，年龄2至71岁。术前诊断包括外伤5例、非外伤5例、肿瘤1例。7例有既往眼部手术史。3例行眼内容剜除术，8例行眼球摘除术。使用了8枚羟基磷灰石和3枚多孔聚乙烯植入物，直径为16至20毫米。3枚未包裹，6枚用巩膜包裹，2枚用保存的筋膜包裹。暴露通常发生在1年内，分为小（1 - 5毫米）、中（6 - 10毫米）、大（> 10毫米）三类。1例延迟暴露发生在钻孔后。小的稳定暴露采用保守治疗。较大的暴露通过植入物修复或更换处理。所有患者最终都适配了义眼。取出球体的组织病理学检查结果显示纤维血管化仅限于周边，伴有中度炎症反应。
眼内容剜除术病例的并发症明显高于眼球摘除术。未包裹或用同种异体移植物包裹的植入物会发生并发症。自体包裹的植入物均未发生暴露。当植入物的纤维血管状态不佳时，二次手术可能引发暴露。
