臺灣博碩士論文加值系統

在狗有許多疾病如青光眼、眼球創傷及先天疾病等可以全眼摘除進行治療。然而，自從1977年Brightmann將眼球內容物剜除術搭配鞏膜內球體植入引進獸醫界後、便幾乎取代全眼摘除術。但是此手術無法在有角膜疾病或變形的眼球施行。而且由於虹彩的移除、術後雙眼的外觀差異尤其在虹彩顏色較淡的狗更為明顯不協調。本實驗之目的係將人類的義眼手術技術改良並以實例應用在5隻有適合眼球疾病的狗（n=6個眼球），術後並評估其改良手術價值及眼球外觀接受度。來自中興大學獸醫教學醫院患犬，在手術前進行詳盡的理學檢查、眼科學檢查，並徵求畜主同意後進行手術。在6個眼球處置中、有一顆眼球是將眼內容物及角膜去除後、再將壓克力球植入鞏膜中。最後以捐贈者的鞏膜替代原先受損的角膜。其餘5顆眼球是將眼內容物及角膜去除後將壓克力或矽膠球植入於鞏膜後方。術後一個月將訂製的義眼片置於眼瞼囊中並觀察與記錄任何併發症。最後，以問卷調查畜主對於義眼片的真實性、手術前後的美容外觀差異及對義眼及全眼摘除兩種手術治療的偏好程度，並統計畜主養狗數量與發現義眼的能力間有無線性相關
。在以鞏膜後球體植入治療的5個眼球中，僅有一個眼球發生植入球體脫出的併發症（n=1），該眼球屬於一隻因眼球脫出而就診的西施犬。除此以外便無發生其他的併發症。裝置義眼片後每隻狗都有不等程度的眼分泌物增加。調查反應所有患犬的主人對於美容結果皆表示滿意。在3隻術後可配合做為問卷的受觀察狗中
、有一隻狗的平均義眼不可辨識分數及平均義眼真實度皆顯著小於其餘兩犬、意即該犬的義眼片較容易被發現。在3隻狗間的手術前後美容差異皆無顯著差異、意即所有的受訪畜主都認為狗的術後外觀有明顯改善。受訪畜主飼養狗的數量與發現義眼的能力間沒有線性相關。在不考慮價錢及麻醉風險的前提下、所有畜主都偏好為愛犬裝置義眼而不願全眼摘除。在本實驗中眼球脫出的原因無法確定，然而植入球體的大小可能是主要的原因；裝置義眼片後增加的眼分泌物是由義眼片與結膜之間蓄積淚液的空腔而來，加厚義眼片減少空腔或是經常清洗義眼片也許可以改善此問題。在義眼真實度及美容度上分數都較低的狗本身已有小眼症情形，因此導致眼眶外的組織縮小而使得義眼看來較對側的正常眼小。本實驗中提出的新義眼手術方法由於不需要角膜且可適用在變形的鞏膜、對於無法選用鞏膜內球體植入術的狗而言、是在全眼摘除術外可供考慮的優質選擇。

Various ophthalmic diseases in dogs such as glaucoma, ocular trauma and congenital defects may be treated with enucleation. Evisceration with intrascleral implant is a preferred surgical technique which almost replaced enucleation since its introduction into veterinary medicine by Brightmann in 1977. However, limitations like perforated cornea, deformed globe, etc. are major contraindications of evisceration. Since iris is removed, the different appearance between the treated eye and the normal opposite eye is cognoscible especially in dogs with light-colored iris. Thus, the aim of this study was to seek for alternative methods for better evisceration approach and post-surgery cosmetic effect. We applied techniques modified from human medicine to five dogs (six globes) with suitable indications. These techniques do not require normal cornea tissue. Patients (n=5) of NCHU veterinary teaching hospital were examined for physical and ophthalmic conditions. Owners’ approval were obtained prior to the surgery. Among the 6 globes, one was treated with evisceration followed by intrascleral acrylic ball implantation with a donor’s sclera patch replacing the damaged cornea. The other 5 globes were treated with evisceration followed by removal of the cornea and retroscleral acrylic/silicone ball implantation. Custom made artificial eye shell was inserted into the conjunctival sac one month after surgery. Any complications occurred was observed and recorded. The reality of artificial eye shell, the cosmetic effect and the tendency of choosing retroscleral implantaion instead of enucleation was surveyed using questionary among owners. Of the 5 globes treated with retroscleral implantation technique, protrusion of the implant occurred only in one globe that had been suffered from a prolapsed globe in a Shi-Tzu. Besides, no other major complications were detected except that there was various amount of increased ocular discharge after applying artificial eye shell. All owners are satisfied with the cosmetic result. Of the 3 dogs that were evaluated by random owners using questionnaires, one dog had a significant lower mean artificial eye identification score and mean artificial eye realistic score, indicating that it is easier to identify the dog’s artificial eye as fake eye. There were no significant differences between the mean cosmetic effect score of all 3 dogs, indicating that all participants considered the appearance has been greatly improved after the surgery. When cost and risk of anaesthesia are not considered, all participants prefer to choose prosthesis rather then enucleation if their dogs encountered suitable indications. There were no linear correlation between the number of dogs the participants owned and the ability of the participants to identify the artificial eye. The cause of the protrusion was not determined. However, implant size may play an important role. The increasing ocular discharge is formed by tears trapped in space between artificial eye shell and conjunctiva. This may be managed either by making a thicker eye shell to reduce dead space, or by constant cleansing of the shell. One dog’s eye having poor realistic score and cosmetic effect score is due to microphthalmia, in which not only the globe but also the outer orbit tissue is decreased in its size. This modified technique provides an optimal alternative for dogs who do not meet the requirement for evisceration/intrascleral implantation surgery.

第一章 緒言 1
第二章 文獻探討 2
第一節 人類義眼 2
（一） 義眼材料的演進 2
（二） 近代義眼 – 珊瑚球 3
（三） 珊瑚球與非連接式膠球體之比較 5
（四） 鞏膜後球體植入術 9
第二節 獸醫義眼 10
（一） 全眼摘除術之適應症 10
（二） 獸醫義眼手術的演變 12
（三） 鞏膜內球體植入術 14
第三節 犬眼球與人類眼球解剖構造、功能及醫療行為的差異 16
（一） 犬基本眼球解剖構造及功能 16
（二） 犬與人類眼球結構的異同 19
（三） 犬與人類醫療行為的差異 20
第三章 材料與方法 22
第一節 材料 22
（一） 實驗動物 22
（二） 藥品 22
（三） 器材與耗材 23
第二節 方法 24
（一） 基礎資料 24
（二） 眼科學檢查 24
（三） 鞏膜內球體植入術搭配捐贈者鞏膜 25
（四） 鞏膜後球體植入術 27
（五） 術後評估 28
（六） 問卷調查 28
第三節 分析與統計 29
第四章 結果 32
第一節 實驗動物基礎資料及檢查結果 32
（一） 基礎資料及一般檢查結果 32
（二） 眼科學檢查結果 33
第二節 球體植入手術 35
（一） 鞏膜內球體植入術搭配捐贈者鞏膜 35
（二） 鞏膜後球體植入術 35
第三節 術後評估 36
（一） 術後併發症 36
（二） 義眼片相關併發症 36
第四節 問卷調查 41
（一） 義眼不可辨識性 42
（二） 義眼真實性 43
（三） 義眼手術美容效果 44
（四） 受訪者飼養狗數量與發現義眼能力之關係 44
（五） 選擇義眼手術意願 44
第五章 討論 45
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