McNab A
Royal Victorian Eye and Ear Hospital, Royal Melbourne Hospital.
Aust N Z J Ophthalmol. 1995 May;23(2):117-23. doi: 10.1111/j.1442-9071.1995.tb00139.x.
The hydroxyapatite (HA) intraorbital implant is a relatively new implant made from the porous skeleton of a coral species which allows fibrovascular ingrowth and therefore tissue integration. After fibrovascular ingrowth, a hole can be drilled in the implant and a motility peg inserted to increase movements of the prosthesis by coupling the implant to the prosthesis.
The records of the first 100 cases of HA intraorbital implants inserted by the one surgeon were analysed for complications, pain and nausea postoperatively, length of hospital stay, and further surgical procedures required. A series of acrylic implants inserted by the same surgeon was used for comparison.
Twenty-five primary and 75 secondary HA implants were performed in patients ranging from six to 74 years of age. All were covered in donor sclera. Follow-up was three to 34 months (mean 16.9, median 17.0). Complications occurred in 15 patients and included too large an implant (seven cases) requiring surgical reduction, scleral exposure in three (repair required in one), an early small exposure of the coral in one case, late thinning of the conjunctiva and later exposure of the implant in one, and shallowing of the inferior fornix requiring mucous membrane grafting in three. No implants migrated, extruded or became infected. Of 80 patients beyond six months follow-up, 28 (35%) had insertion of motility pegs, and six (7.5%) of these suffered minor complications related to the peg. Compared to patients having acrylic implants, the postoperative analgesic requirements and length of hospital stay were significantly greater for the HA patients.
Hydroxyapatite intraorbital implants represent a significant advance over other implants and offer a more stable, safe alternative. They also offer the possibility of improved prosthesis motility. The additional cost of the implant, prolonged hospital stay and postoperative pain, should be considered in recommending such implants to patients either as primary or secondary implants.
羟基磷灰石（HA）眶内植入物是一种相对较新的植入物，由一种珊瑚物种的多孔骨架制成，允许纤维血管向内生长，从而实现组织整合。在纤维血管向内生长后，可以在植入物上钻孔并插入活动栓，通过将植入物与假体连接来增加假体的活动度。
分析由同一位外科医生植入的首批100例HA眶内植入物的记录，包括并发症、术后疼痛和恶心、住院时间以及所需的进一步手术程序。使用同一位外科医生植入的一系列丙烯酸植入物作为对照。
对年龄在6岁至74岁之间的患者进行了25例初次和75例二次HA植入。所有植入物均覆盖供体巩膜。随访时间为3至34个月（平均16.9个月，中位数17.0个月）。15例患者出现并发症，包括植入物过大（7例）需要手术缩小，3例巩膜暴露（1例需要修复），1例早期珊瑚小面积暴露，1例结膜晚期变薄和植入物晚期暴露，3例下穹窿变浅需要黏膜移植。没有植入物迁移、挤出或感染。在随访超过6个月的80例患者中，28例（35%）插入了活动栓，其中6例（7.5%）出现与栓相关的轻微并发症。与接受丙烯酸植入物的患者相比，HA患者术后镇痛需求和住院时间明显更长。
羟基磷灰石眶内植入物相对于其他植入物有显著进步，提供了更稳定、安全的选择。它们还提供了改善假体活动度的可能性。在向患者推荐此类植入物作为初次或二次植入物时，应考虑植入物的额外成本、延长的住院时间和术后疼痛。
