Autologous sclera-muscle flaps technique in evisceration with hydroxyapatite implantation
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摘要
·AIM: To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications,we have developed a novel and simple technique for anophthalmic patients.·METHODS: All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed.· RESULTS: A total of twenty-eight patients were enrolled in the study. Eighteen were men(64.29%) and ten were women(35.71%). Ages ranged from 18 to 65y(mean age, 32 years old). Mean follow-up was 12.32mo(range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29 ±1.36 mm(range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04 ±1.45 mm horizontally(range, 7-14 mm) and 8.57 ±1.50 mm vertically(range, 5-12 mm).·CONCLUSION: The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant.
·AIM: To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications,we have developed a novel and simple technique for anophthalmic patients.·METHODS: All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed.· RESULTS: A total of twenty-eight patients were enrolled in the study. Eighteen were men(64.29%) and ten were women(35.71%). Ages ranged from 18 to 65y(mean age, 32 years old). Mean follow-up was 12.32mo(range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29 ±1.36 mm(range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04 ±1.45 mm horizontally(range, 7-14 mm) and 8.57 ±1.50 mm vertically(range, 5-12 mm).·CONCLUSION: The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant.
·AIM: To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications,we have developed a novel and simple technique for anophthalmic patients.·METHODS: All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed.· RESULTS: A total of twenty-eight patients were enrolled in the study. Eighteen were men(64.29%) and ten were women(35.71%). Ages ranged from 18 to 65y(mean age, 32 years old). Mean follow-up was 12.32mo(range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29 ±1.36 mm(range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04 ±1.45 mm horizontally(range, 7-14 mm) and 8.57 ±1.50 mm vertically(range, 5-12 mm).·CONCLUSION: The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant.
引文
1 Chalasani R,Poole-Warren L,Conway RM,Ben-Nissan B.Porous orbital implants in enucleation:a systematic review.Surv Ophthalmol2007;52(2):145-155
2 Wang J,Zhang H,Chen W,Li G.The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.Ophthal Plast Reconstr Surg 2012;28(5):324-327
3 Massry GG,Holds JB,Evisceration with scleral modification.Ophthal Plast Reconstr Surg 2001;17(1):42-47
4 Tari AS,Malihi M,Kasaee A,Tabatabaie SZ,Hamzedust K,Musavi MF,Rajabi MT.Enucleation with hydroxyapatite implantation versus evisceration plus scleral quadrisection and alloplastic implantation.Ophthal Plast Reconstr Surg 2009;25(2):130-133
5 Yousuf SJ,Jones LS,Kidwell ED Jr.Enucleation and evisceration:20years of experience.Orbit 2012;31(4):211-215
6 Nakra T,Simon GJ,Douglas RS,Schwarcz RM,Mc Cann JD,Goldberg RA.Comparing outcomes of enucleation and evisceration.Ophthalmology2006;113(12):2270-2275
7 Huang D,Yu Y,Lu R,Yang H,Cai J.A modified evisceration technique with scleral quadrisection and porous polyethylene implantation.Am J Ophthalmol 2009;147(5):924-928
8 Georgescu D,Vagefi MR,Cheng CC,Mc Cann J,Anderson RL.Evisceration with equatorial sclerotomy for phthisis bulbi and microphthalmos.Ophthal Plast Reconstr Surg 2010;26(3):165-167
9 Timothy NH,Freilich DE,Linberg JV.Evisceration versus enucleation from the ocualrist's perspective.Ophthal Plast Reconstr Surg 2003;19(6):417-420
10 Stephenson CM.Evisceration of the eye with expansion sclerotomies.Ophthal Plast Reconstr Surg 1987;3(4):249-251
11 Dresner SC,Karesh JW.Primary implant placement with evisceration in patients with endophthalmitis.Ophthalmology 2000;107(9):1661-1664
12 Smith RJ,Prazeres S,Fauquier S,Malet T.Complications of two scleral flaps evisceration technique:analysis of 201 procedures.Ophthal Plast Reconstr Surg 2011;27(4):227-231
13 Goiato MC,Haddad MF,dos Santos DM,Pesqueira AA,Ribeiro Pdo P,Moreno A.Orbital implants insertion to improve ocular prostheses motility.J Craniofac Surg 2010;21(3):870-875
14 Yoon JS,Lew H,Kim SJ,Lee SY.Exposure rate of hydroxyapatite orbital implants.Ophthalmology 2008;115(3):566-572
15 Ozgur OR,Akcay L,Dogan OK.Evisceration via superior temporal sclerotomy.Am J Ophthalmol 2005;139(1):78-86
16 Soll DB.Evisceration with eversion of the scleral shell and muscle cone positioning of the implant.Am J Ophthalmol 1987;104(3):265-269
2 Wang J,Zhang H,Chen W,Li G.The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.Ophthal Plast Reconstr Surg 2012;28(5):324-327
3 Massry GG,Holds JB,Evisceration with scleral modification.Ophthal Plast Reconstr Surg 2001;17(1):42-47
4 Tari AS,Malihi M,Kasaee A,Tabatabaie SZ,Hamzedust K,Musavi MF,Rajabi MT.Enucleation with hydroxyapatite implantation versus evisceration plus scleral quadrisection and alloplastic implantation.Ophthal Plast Reconstr Surg 2009;25(2):130-133
5 Yousuf SJ,Jones LS,Kidwell ED Jr.Enucleation and evisceration:20years of experience.Orbit 2012;31(4):211-215
6 Nakra T,Simon GJ,Douglas RS,Schwarcz RM,Mc Cann JD,Goldberg RA.Comparing outcomes of enucleation and evisceration.Ophthalmology2006;113(12):2270-2275
7 Huang D,Yu Y,Lu R,Yang H,Cai J.A modified evisceration technique with scleral quadrisection and porous polyethylene implantation.Am J Ophthalmol 2009;147(5):924-928
8 Georgescu D,Vagefi MR,Cheng CC,Mc Cann J,Anderson RL.Evisceration with equatorial sclerotomy for phthisis bulbi and microphthalmos.Ophthal Plast Reconstr Surg 2010;26(3):165-167
9 Timothy NH,Freilich DE,Linberg JV.Evisceration versus enucleation from the ocualrist's perspective.Ophthal Plast Reconstr Surg 2003;19(6):417-420
10 Stephenson CM.Evisceration of the eye with expansion sclerotomies.Ophthal Plast Reconstr Surg 1987;3(4):249-251
11 Dresner SC,Karesh JW.Primary implant placement with evisceration in patients with endophthalmitis.Ophthalmology 2000;107(9):1661-1664
12 Smith RJ,Prazeres S,Fauquier S,Malet T.Complications of two scleral flaps evisceration technique:analysis of 201 procedures.Ophthal Plast Reconstr Surg 2011;27(4):227-231
13 Goiato MC,Haddad MF,dos Santos DM,Pesqueira AA,Ribeiro Pdo P,Moreno A.Orbital implants insertion to improve ocular prostheses motility.J Craniofac Surg 2010;21(3):870-875
14 Yoon JS,Lew H,Kim SJ,Lee SY.Exposure rate of hydroxyapatite orbital implants.Ophthalmology 2008;115(3):566-572
15 Ozgur OR,Akcay L,Dogan OK.Evisceration via superior temporal sclerotomy.Am J Ophthalmol 2005;139(1):78-86
16 Soll DB.Evisceration with eversion of the scleral shell and muscle cone positioning of the implant.Am J Ophthalmol 1987;104(3):265-269