Risk factors for orbital implant exposure after evisceration: A case control study of 93 patients
Risk factors for orbital implant exposure after evisceration: A case control study of 93 patients
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取出内脏后眼眶植入物暴露的危险因素：93 名患者的病例对照研究
DOI：
10.4103/ijo.ijo_1813_18
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发表时间：
2019
影响因子：
3.1
通讯作者：
Anjali Kiran
中科院分区：
文献类型：
--
作者：
Roshmi Gupta;P. Hari;B. Khurana;Anjali Kiran
目的：本研究旨在通过对眶内种植体外露与不外露患者的比较，分析眶内全切术后种植体外露的危险因素。方法：回顾性介入病例系列的病例对照研究；A组：摘除牙体后种植体暴露，B组：摘除牙体后随访，不暴露，随访时间匹配。样本量按80的幂计算。结果：A组有32个种植体外露的牙槽，于术后中位18个月出现；B组包括61个去骨臼，无种植体外露，中位随访36个月。计算比值比（OR）；感染眼-OR 1.3, P = 0.6；细菌性眼- OR 1.4, P = 0.43；既往多次手术- OR 1.55, P = 0.33。A组为59.3%，B组为55.7%，- OR为1.3,P = 0.5。A组平均种植体大小19.06 mm， B组平均种植体大小18.78 mm，差异无统计学意义。多元logistic回归分析显示暴露无显著危险因素。由于有多名外科医生，未分析外科医生因素。结论：这是第一个计算样本量的研究，将种植体暴露患者与对照组进行比较。多孔植入材料、存在感染、细菌性巩膜壳和既往手术均显示较高的暴露趋势（优势比bb0.1），但均无结论性结论。较大的种植体尺寸不是暴露的危险因素。排除几个因素在植入物暴露中的作用，使外科医生能够做出更好的手术选择：例如放置合适尺寸的植入物，使用外科医生选择的材料，并对患有内脏切除后角膜溃疡或眼内炎的患者进行初次植入。一个假设和建议是对手术技术的细致关注。
Purpose: The study aims to analyze risk factors for exposure of orbital implants after evisceration by comparison of patients with and without exposure of implants. Methods: This is a case control study in retrospective interventional case series; Group A- implant exposures after evisceration, Group B - Patients on follow up after evisceration with implant, without exposure, with matched duration of follow up. The sample size is calculated for a power of 80. Results: Group A comprised 32 sockets with implant exposure, presenting at median 18 months after surgery; Group B included 61 eviscerated sockets, without implant exposure, with follow up median 36 months. Odds Ratio (OR) was calculated; infected eyes -OR 1.3, P = 0.6; phthisical eye - OR 1.4, P = 0.43; multiple prior surgeries- OR 1.55, P = 0.33. Group A had 59.3% porous implants, Group B 55.7%, - OR 1.3, P = 0.5. Mean implant size in Group A 19.06 mm, Group B 18.78 mm- showed no statistical difference. Multiple logistic regression analysis showed no significant risk factor for exposure. Surgeon factor was not analyzed since there were multiple surgeons. Conclusion: This is the first study with calculated sample size, comparing implant exposure patients to a control group. Porous implant material, presence of infection, phthisical scleral shell, and prior surgery showed higher trend of exposure (Odds ratio >1), but none was conclusive. Larger size of implant was not a risk factor for exposure. Eliminating the role of several factors in implant exposure allows the surgeon to make better surgical choices: such as place an implant of appropriate size, of a material of surgeon's choice, and do primary placement of implant in a patient with evisceration post-corneal ulcer or endophthalmitis. A hypothesis and a recommendation is that meticulous attention be paid to surgical technique.