PROBLEMS WITH THE HYDROXYAPATITE ORBITAL IMPLANT - EXPERIENCE WITH 250 CONSECUTIVE CASES
PROBLEMS WITH THE HYDROXYAPATITE ORBITAL IMPLANT - EXPERIENCE WITH 250 CONSECUTIVE CASES
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DOI：
10.1136/bjo.78.9.702
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发表时间：
1994-09-01
影响因子：
4.1
通讯作者：
SINGH, AD
中科院分区：
文献类型：
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作者：
SHIELDS, CL;SHIELDS, JA;SINGH, AD
珊瑚衍生的羟基磷灰石球是一种流行的、一体化的眼眶植入物，设计用于在眼球摘除术后提供更好的眼球假体活动性。虽然植入物已迅速成为广泛使用的眼科医生，很少的信息是关于这个技术的问题，在一个大系列的情况。本文回顾了250例羟基磷灰石义眼座的使用经验，并对义眼座的问题及其处理进行了专门的调查。手术原因包括葡萄膜黑色素瘤157例，视网膜母细胞瘤70例，盲痛眼22例，眼内髓上皮瘤1例。47例眼球摘除术前进行了早期治疗，包括破裂地球仪修补术（17例）、斑块放射治疗（18例）、外照射放射治疗（6例）和其他（6例）。在平均23个月的随访期间（范围6-40个月），没有可识别的与植入物相关的眼眶出血病例，也没有植入物挤出或植入物移位病例。有1例假定的眼眶感染（培养阴性），通过静脉注射抗生素解决，植入物保留在眼眶内。其他问题包括8例通过观察和假体调整治疗的结膜变薄，4例通过巩膜补片移植、结膜瓣和假体调整联合治疗的结膜糜烂。结膜糜烂是由3例假体不匹配和1例伤口裂开引起的。接受过放疗或手术的患眼的问题率没有增加。羟基磷灰石一体式眼眶植入物是一种耐受性良好的活动性植入物，没有其他活动性植入物的高挤出率和感染率。假体配合可能有助于植入物的公差。
The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.