Long-term complications of different porous orbital implants: a 21-year review
Long-term complications of different porous orbital implants: a 21-year review
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DOI：
10.1136/bjophthalmol-2016-308932
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发表时间：
2017-05-01
影响因子：
4.1
通讯作者：
Liao, Shu-Lang
中科院分区：
文献类型：
--
作者：
Lin, Chao-Wen;Liao, Shu-Lang
目的分析不同类型义眼座植入术的远期疗效及真皮脂肪移植治疗义眼座大面积暴露的效果。从1994年到2015年，招募了256例在眼球摘除或内脏摘除后接受一期植入的患者，平均随访108.9个月。收集患者的详细特征，包括既往手术或创伤、手术适应症和方法、钉固定程序和植入物类型。记录长期结果。结果种植体暴露的危险因素包括取出的球型和钉状种植体。暴露率较高（羟基磷灰石（HA）为24.7%，生物陶瓷为23.5%，Medpor为76.5%），与以前的报告相比。HA、生物陶瓷和Medpor植入体的平均暴露时间分别为67.4个月、52.5个月和73.4个月。在植入物暴露的病例中，晚期暴露（术后>2年）占67%。30只大面积暴露眼采用真皮脂肪移植。24例均经一次手术成功。其他6例穹窿损失，并需要额外的重建与全层皮graft.Conclusions后期暴露的多孔眼眶植入物在长期随访中指出。植入物暴露的原因可能与钉固定手术和内脏取出有关。真皮脂肪的植入可以是一个有效的程序，用于管理大面积的植入物暴露。
Aims To analyse the long-term outcomes of different types of orbital implant and the results of dermis fat graft for the management of large-area implant exposure.Methods Retrospective case series. From 1994 to 2015, 256 patients who received primary implantation after enucleation or evisceration and were followed up for an average of 108.9 months were recruited. Detailed characteristics of patients, including previous surgery or trauma, surgical indications and methods, pegging procedure, and implant types were collected. The long-term outcomes were recorded. For patients with extensive implant exposure (diameter of tissue defect >2 cm), implant removal and dermis fat graft were performed.Results The risk factors for implant exposure included eviscerated globes and pegged implants. The exposure rates were higher (24.7% in hydroxyapatite (HA), 23.5% in bioceramic and 76.5% in Medpor) as compared with those in previous reports. The average times to exposure were 67.4 months in HA, 52.5 months in bioceramic and 73.4 months in Medpor implants. Among the cases with implant exposure, late exposure (>2 years after operation) accounted for 67% of cases. Thirty eyes with large-area exposure were managed with dermis fat grafts. Twenty-four cases were successfully treated with single surgery. The other six cases developed fornix loss and required additional reconstruction with full thickness skin graft.Conclusions Late exposures of porous orbital implants were noted during long-term follow-up. The causes of implant exposure may be associated with pegging procedures and evisceration. The implantation of dermis fat can be an effective procedure for the management of large-area implant exposure.