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題名 | Enucleation with Primary Hydroxyapatite Implant in Treatment of Recalcitrant Endophthalmitis=眼球摘出合併珊瑚球立即植入對頑固性眼內炎的治療效果 |
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作者 | 沈姵妤; 廖述朗; 陳慕師; 候平康; Shen, Elizabeth P.; Liao, Shu-lang; Chen, Muh-shy; Hou, Ping-kang; |
期刊 | 中華民國眼科醫學會雜誌 |
出版日期 | 19991200 |
卷期 | 38:4 1999.12[民88.12] |
頁次 | 頁585-591 |
分類號 | 416.703 |
語文 | eng |
關鍵詞 | 眼球摘出術; 珊瑚球; 眼內炎; Endophthalmitis; Enucleation; Hydroxyapatite implant; |
中文摘要 | 眼內炎經全力治療仍無法保留任何視力且造成嚴重疼痛時,就必須考慮施行眼球 內容物剜除術(evisceration)或眼球摘出術(enucleation)。目前採用何種方法尚無定論。 過去治療這類的病患,大多採用眼球內容物剜除術,此舉的缺點是,保留下來的鞏膜因 長期處於發炎及可能遭受感染的狀態,術後若馬上裝置眼窩植入物,傷口易發炎而不癒合, 造成眼窩植入物暴露;若打算延遲裝置眼窩植入物,則必須每天打開傷口換藥,等到發炎反 應降低了才行,病人必須忍受每日換藥之苦,及再度手術裝置眼窩植入物的麻煩。 本研究提出另一種方法來治療嚴重發炎而喪失視力的眼內炎,那就是以眼球摘出術將整 顆眼球去除之後,立即植入珊瑚球。本篇收集1995年8月至1997年6月共十位病人十隻罹 患眼內炎且無視力的眼球,每位病人均接受眼球摘出術並馬上植入直徑20mm的珊瑚球。十 位病人中有一位尚未裝置義眼,此乃因在手術五週後裝入的義眼太大使得傷口裂開珊瑚球暴 露;九位裝置義眼的病人中,二位有輕微的上眼瞼溝症候群(superior sulcus syndrome)。 這九位裝置義眼的病人經回診檢查,比較好眼與義眼在外觀及眼球運動上的差別時,其中七 位認為義眼的外觀很好,二位認為不錯,沒有人認為很差;在義眼運動方面,五位評估很好, 三位不錯,一位很差。此外,這十位病人在手術後均未發生中樞神經系統感染等併發症。 由此可見,以眼球摘出術合併立即植入珊瑚球對無視力的眼內炎病人有很好的療效,此 方法可減少病人的疼痛,降低眼窩植入物暴露及感染機率,且無中樞神經系統感染的疑慮, 可說是一種非常值得採用的方法。 |
英文摘要 | The treatment of recalcitrant endophthalmitis by either evisceration or enucleation is still debatable. Evisceration with primary implant insertion or delayed primary wound closure has many problems. Primary implant insertion has a higher risk of implant infection or exposure, while the delayed wound closure technique causes tedious dressing changes and poor cost effectiveness of implant insertion as a separate operative procedure. Thus, in this study, we evaluate the appropriateness of enucleation with primary hydroxyapatite (HA) implant in the treatment of endophthalmitis. Ten cases of suppurative endophthalmitis admitted to National Taiwan University Hospital were collected from August 1995 to June 1997. All patients underwent enucleation with primary hydroxyapatite implant. Patients' records including demographic data, sphere size, wrapping material, clinical outcome, complications, and follow-up interval were noted. All ten patients underwent successful surgery. Mild superior sulcus syndrome occurred in two patients. Implant exposure occurred in one patient 5 weeks postoperatively due to overly tight prosthesis. A HA implant of 20 mm in diameter was used on all patients. Five patients had the HA implant wrapped with lyodura, four had a vicryl mesh wrapped implant and one had a scleral shell wrapped implant. All patients were followed clinically for their assessment of cosmetic results and motility of the prosthesis. Excluding the one patient with implant exposure, seven out of nine patients rated their cosmetic results to be good. As for the motility of the implant, five out of nine patients rated good while three rated fair. Patients suffering from endophthalmitis have already undergone tremendous psychological stress apart from the physical torment. Enucleation with immediate placement of HA implant reduces the agonizing experience of dressing changes and the need for implant insertion as a second surgery. Our results show that enucleation with immediate HA implant is a safe and effective alternative in treatment of recalcitrant endophthalmitis. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。