Complications of porous spherical orbital implants.
Complications of porous spherical orbital implants.
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DOI：
10.1097/00002341-199606000-00022
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发表时间：
1995-04
期刊：
影响因子：
13.7
通讯作者：
H. Remulla;P. Rubin;J. Shore;F. Sutula;D. Townsend;J. Woog;Kurt V. Jahrling
中科院分区：
文献类型：
--
作者：
H. Remulla;P. Rubin;J. Shore;F. Sutula;D. Townsend;J. Woog;Kurt V. Jahrling
目的探讨多孔球形义眼座（羟基磷灰石义眼座和多孔聚乙烯义眼座）的并发症及其影响因素。方法回顾性分析101例由5名眼科医生施行的多孔球形眶内植入术。描述了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、植入物特征和假体适配。结果101例患者中有11例发生种植体暴露。有6名男性（1名双侧受累）和4名女性患者，年龄从2岁到71岁不等。术前诊断包括创伤5例，非创伤5例，肿瘤1例。其中7人曾做过眼科手术。三名患者接受了内脏摘除术，而八名患者接受了眼球摘除术。8个羟基磷灰石和3个多孔聚乙烯植入物，直径为16至20 mm。3个未包裹，6个包裹在巩膜中，2个包裹在保留的筋膜中。暴露通常发生在1年内，分为小型（1-5 mm）、中型（6-10 mm）和大型（> 10 mm）。1例延迟病例发生在钻孔后。对小规模稳定暴露进行了保守管理。较大的暴露通过植入物翻修或置换进行管理。所有患者最终都安装了假体。组织学检查结果显示纤维血管化局限于周围，伴有中度炎症反应。结论眼内容摘除术的并发症明显高于眼球摘除术。并发症发生在未包裹或包裹在同种移植物中的植入物中。自体包裹物均未暴露。当植入物的纤维血管状态不充分时，二次手术可能会导致暴露。
PURPOSE To determine the complications observed with using porous spherical orbital implants (hydroxyapatite and porous polyethylene) and the factors leading to their occurrence. METHODS 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. RESULTS 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. CONCLUSION 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.