PDF(Pubmed)
Abstract：
Orbital implant materials have evolved greatly over the past century and include but are not limited to metal, ceramic, polymer, silicone, and glass. Knowledge of historically used materials is clinically relevant to patient care as certain materials carry a greater risk of migration, extrusion, infection, and limitations for imaging modalities utilized to visualize adjacent structures. We report an unusual case of an 80-year-old male who presented to our community hospital with seizure-like activity. CT imaging of the brain revealed several white matter and cortex lesions with the largest lesion measuring 2.5 × 2 × 1.9 cm. The patient had a history of enucleation with placement of an orbital implant following a penetrating injury to the left eye at four years of age. Hounsfield scale analysis was read by radiology as being most consistent with a thin metallic shell surrounding the orbital implant. The potential for metallic material was consistent with the implant\'s age and time of placement. Few reviews on ocular implant materials from this period exist in the current medical literature. A single case report discussing a hollow metal orbital implant with similar-appearing imaging was identified. Due to concern for possible metal implant materials, the patient underwent implant exchange so MRI imaging could safely be performed. Intraoperatively, the implant was identified as a clear, hollow, non-metallic, non-porous polymer sphere. Following surgery, the patient was able to undergo appropriate neuroimaging with subsequent diagnostic biopsy. Current literature reviewing CT or photographic imaging of ocular implant devices prior to the 1940s is limited. This case highlights the importance of detailing materials historically used in orbital implants, their effects on clinical decision-making, and the utility of Hounsfield scale values to identify a material\'s radiodensity on CT imaging.
摘要：
在过去的一个世纪中，轨道植入材料有了很大的发展，包括但不限于金属，陶瓷,聚合物，硅胶,和玻璃。历史上使用的材料的知识与患者护理临床相关，因为某些材料具有更大的迁移风险。挤压,感染,以及用于可视化相邻结构的成像模式的限制。我们报告了一个不寻常的病例，一名80岁的男性因癫痫样活动出现在我们的社区医院。大脑的CT成像显示几个白质和皮质病变，最大病变为2.5×2×1.9cm。该患者在4岁时左眼穿透性损伤后有眼球摘除史，并放置了眼眶植入物。放射学认为Hounsfield量表分析与眼眶植入物周围的薄金属外壳最一致。金属材料的潜力与植入物的年龄和放置时间一致。在当前的医学文献中，很少有关于这一时期的眼部植入物材料的评论。确定了一例病例报告，讨论了具有相似影像学表现的中空金属眼眶植入物。由于担心可能的金属植入材料，患者接受了植入物交换,因此可以安全地进行MRI成像.术中,植入物被鉴定为透明的，空心,非金属,无孔聚合物球。手术后,患者能够接受适当的神经影像学检查,随后进行诊断性活检.回顾1940年代之前眼部植入装置的CT或摄影成像的当前文献是有限的。这个案例强调了详细说明历史上用于眼眶植入物的材料的重要性，它们对临床决策的影响，以及Hounsfield标度值在CT成像中识别材料放射密度的效用。
