急性视网膜坏死综合征临床治疗42眼

目的探讨急性视网膜坏死综合征(ARNS)的治疗方法并评价其治疗效果。方法对急性视网膜坏死综合征42眼进行药物、激光及手术综合治疗。所有患者均给予无环鸟苷及糖皮质激素治疗，对于药物治疗病情无好转或就诊时已有严重玻璃体混浊或已并发视网膜脱离患者，及时行玻璃体视网膜联合手术。随访6～24个月，分析其治疗效果。结果42眼炎症均得到有效控制，单眼发病患者对侧眼未出现发病。37眼视力有不同程度改善,其中23眼视力≥0.1，最好视力为0.8。40眼视网膜完全复位，部分复位1眼。结论急性视网膜坏死综合征是一种严重致盲性眼病，早期易被误诊，视网膜脱离是其常见的严重并发症。早期足量的抗病毒、皮质类固醇激素的应用以及玻璃体视网膜联合手术是治疗急性视网膜坏死综合征的有效方法。     

内分泌性恶性突眼症的手术治疗

内分泌性恶性突眼症一般认为与甲状腺垂体轴的功能失调有关。所有病例都有甲亢病史,眼部表现常在诊断甲亢后几周～35年发生。毒性甲状腺肿患者约有1～2%可发展为恶性突眼症,表现为严重角膜炎、复视、眼球固定和视力减退。其发病机理认为是眶后脂肪中粘多糖量明显增加,由于粘多糖的亲水性和眶内缺乏淋巴引流致脂肪组织张力增加,外眼肌氧气供应减少,可使肌反应性肥大达正常的12倍。眶内压持续增加造成突眼和结膜水肿,当眼睑不能闭合时即成暴露性角膜炎,眼球活动受限亦将随疾病的发展而出现。作者指出,凡恶性突眼经适当内科治疗而视力仍进行性下降和面容畸形者均为手术——眼眶减压术治疗的适应症。Kronlein(1888)用切除眶外侧壁后使眶内脂肪疝入颞窝的方法,但此仅能提供一小的间隙减压。N affziger(1932)采     

变应性鼻炎患者眼部症状的临床特点分析

目的：探讨变应性鼻炎（AR）患者眼部症状的临床特点以及眼部症状对患者生活质量的影响。方法：采集AR患者病史及临床资料,从中抽取伴及不伴眼部症状的成年患者各100例,使用鼻结膜炎相关生活质量问卷进行生活质量评估。结果：共收集AR患者1 119例,伴眼部症状859例（有眼症组）,其中眼部症状轻度582例,中度234例,重度43例;余260例为无眼症组。眼部症状最常见的为眼痒,其余依次为流泪、充血及肿胀。有眼症组AR病史长于无眼症组（P〈0.05）。眼部与鼻部症状呈正相关性（P〈0.01）,有眼症组鼻部症状评分高于无眼症组（P〈0.01）,中重度AR患者眼部症状评分高于轻度AR患者（P〈0.01）。女性患者眼部症状的发生率以及评分高于男性（P〈0.05）。〈10岁的患儿眼部症状发生率以及评分较低,而≥50岁患者眼部症状发生率及评分有增高趋势。有眼症组及无眼症组在变应原的分布特点及数量上差异无统计学意义。有眼症组患者的生活质量在非鼻结膜炎症状、相关行为、眼部症状、情感反应4个维度以及总分方面评分高于无眼症组。结论：AR患者多伴有眼部症状,且眼部症状对生活质量有明显的影响,因此在AR的诊疗中,眼部症状的控制不容忽视。     

急性视网膜坏死综合征12例临床治疗观察

目的观察治疗急性视网膜坏死综合征(ARNS)的临床疗效.方法回顾分析急性视网膜坏死综合征12例、17眼的临床资料,包括临床表现、辅助检查(荧光素眼底血管造影、视网膜电图)以及治疗过程.结果4例6眼行预防性激光光凝术,3个月后视力0.81眼、0.61眼、0.42眼、0.31眼,1例、1眼病情加重,建议手术治疗,4例、4眼行预防性玻璃体视网膜手术,出院后随访6个月病情稳定,视力恢复为0.61眼、0.41眼、0.32眼,5例、6眼行玻璃体切除注入硅油加光凝加巩膜环扎术,取硅油后随访3～6个月,视力0.151眼,0.061眼,CF/50cm2眼,HM眼前1眼,光感1眼.结论急性视网膜坏死综合征是一种严重损害视功能的眼内感染疾病,早期诊断和抗病毒药物治疗是改善其预后的关键.     

正确判读眼缺血综合征预警信号,提高诊断水平

眼缺血综合征(OIS)是由颈动脉狭窄或闭塞引起的一系列眼前部及/或眼后部缺血性疾病,早期临床表现隐匿,详细地问诊有助于疾病的早期诊断;因眼部供血血管堵塞位置和程度不同,患者的体征也千差万别,追根溯源十分重要;不同血管成像模式的检查方法可用来评估颈动脉供血、侧支循环和脑灌注,需要了解不同技术的特性,有针对性地选择检查手段,正确判读OIS预警信号,多学科合作精准诊断,挽救OIS患者视力。     

Vogt-Koyanagi-Harada综合征的眼科影像学特征

目的 探讨Vogt-Koyanagi-Harada (VKH)综合征患者的眼科影像学特征.方法 回顾分析1997年10月至2011年5月在青岛眼科医院确诊为VKH综合征的50例(100眼)患者的荧光素眼底血管造影(FFA)、光学相干断层扫描(OCT)、眼部B型超声等眼科影像学检查结果,观察VKH综合征患者眼部的医学影像学特征.结果 FFA检查提示94眼造影早期视盘呈边界不清强荧光,晚期增强,早期后极部多处点状强荧光,晚期多灶性荧光渗漏,呈墨渍样扩大并彼此融合,其中85眼后期形成多灶性、大小不一的泡状荧光积存,7眼伴斑驳状荧光,9眼见条状低荧光.OCT检查发现85眼表现为黄斑区神经上皮层多灶性渗出性脱离,9眼黄斑中心凹处神经上皮层局限性渗出性浅脱离,8眼黄斑区神经上皮层多灶性脱离、渗出不明显但伴有视网膜色素上皮细胞层及脉络膜毛细血管层波浪样隆起.眼部B超检查发现100眼均表现为后极部脉络膜弥漫性增厚,65眼见玻璃体内大量细小弱回声点,96眼见视盘隆起,85眼见后极部多发渗出性视网膜脱离并累及黄斑区,10眼伴周边部睫状体脉络膜扁平脱离,3眼仅见黄斑区视网膜局限性浅脱离.结论 VKH综合征患者的FFA、OCT、眼部B超等影像学检查均有特征性表现,根据患者眼部及全身情况,合理选用上述检查,可提高VKH综合征的确诊率.     

G综合征及其耳鼻喉科的表现

自Qpitz 1969年首次报告被称为G综合征的同胞四兄弟病例以来,20年中关于该综合征报道的病例约有30例。这是一种家族性多发性先天畸形疾病。其表现轻重不一,包括眼距增宽,枕部和前额突出,舌系带过短,喘鸣、哭声嘶哑,喉气管食管(LTE)裂,尿道下裂和隐睾,并有近1/3患者有唇裂和/或腭裂。当     

双侧前庭性疾病

双侧前庭性疾病 (ｂｉｌａｔｅｒａｌｖｅｓｔｉｂｕｌｏｐａｔｈｙ)不是一种独立的疾病。其发生于双侧内耳的平衡部分受到损害 ,可为急性如中毒或代谢等原因引起 ;可为慢性疾病或双侧前庭功能先后丧失。双侧前庭性疾病表现为Ｄａｎｄｙ’ｓ综合征 ,典型症状包括失衡和视觉症状。因靠视觉和本体感觉维持平衡 ,故在暗处或地面不平处失衡尤为明显。由于前庭 眼反射消失 ,不能固定于视靶 ,头动时出现振动幻视 ,快速头动时视觉模糊。双侧前庭性疾病占头晕患者的 5 %〔1〕。1　双侧前庭性疾病的病因很多情况下 ,双侧前庭性疾病是由于耳毒性药物所…     

穴位埋线治疗面瘫后暴露性角膜炎1例

因神经炎症引起的面瘫造成患者眼睑闭合不全,角膜失去眼睑的保护进而继发感染,经发现中医“针刺”可以促进面神经损伤修复。而穴位埋线是在传统针灸治疗的基础上延伸而来的,穴位埋线疗法是针灸学中的一个治疗方法,是将人体可吸收的生物蛋白线通过埋线针埋植在穴位里,一段时间后生物蛋白线被周围组织吸收而起到治疗疾病的作用。暴露性角膜炎是多种原因致眼睑闭合不全而引起的眼部疾病,严重者多采用手术治疗。本病例运用中医穴位埋线联合滴眼液点眼治疗一例周围性面瘫后暴露性角膜炎,取得了良好的治疗效果,特此报道。     

肺炎克雷伯杆菌性肝脓肿眼内炎31例

目的 探讨肺炎克雷伯杆菌性肝脓肿眼内炎的临床特征。 方法 收集来自眼科、肝胆外科、内分泌科、血液内科及呼吸内科收治的肺炎克雷伯杆菌性肝脓肿眼内炎的患者共31例(37眼)临床资料,分析患者一般资料、眼部查体、辅助检查、治疗及预后情况。 结果 患者主要为中老年男性,多数合并糖尿病。10眼无眼部症状,在行眼部检查时发现眼内炎表现。22眼行玻璃体腔注药术,12眼行玻璃体切除联合硅油填充术,10眼经治疗后视力提升,6眼最终行眼内容剜除术。 结论 肺炎克雷伯杆菌性肝脓肿眼内炎早期症状不典型,糖尿病及全身感染较重是其危险因素。部分患者早期无眼部症状,在行眼科检查时发现眼内炎表现,及时给予有效治疗从而得以保留较好视力。对无眼部症状的肝脓肿患者行眼科检查对于发现无症状眼内炎患者并给予及时有效治疗有重要意义,有助于保存视力,改善预后。     

Nasolacrimal duct obstruction after toxic epidermal necrolysis

Toxic epidermal necrolysis also known as Lyell's syndrome is acute dermatomyositis as an adverse drug reactions. It is characterized by erosions of skin over 30% of total body surface area and is associated with significant mortality of 25%-50% of cases. The conjunctival mucosa involvement could result in cornea erosion and ulceration. Other ocular complications are: purulent conjunctivitis with pseudomembrane formation, entropion, symblefaron and synechiae with nasolacrimal duct obstruction or punctual stenosis. The authors present a very rare complication of nasolacrimal duct obstruction after toxic epidermal necrolysis in young girl. The endoscopic dacricystorhinostomy with one lacrimal point intubation was performed. Early ophthalmic assessment and frequent follow-up could be helpful to avoid metaplasia of epithelium, vascular neoplasia in conjunctiva and cornea. This will protect from dysfunction of tears secretion causing nasolacrimal duct or lacrimal point obliteration. If there is a permanent epiphora the endoscopic dacriocystorhinostomy, with silicone tube intubation could be the method of choice. A satisfactory results are also obtained after opening a passage of only one occluded lacrimal point.     

Stevens-Johnson syndrome: Twenty-three cases and their otolaryngologic significance.

Stevens-Johnson syndrome is a symptom complex characterized by mucosal, ocular, and cutaneous lesions. Prodromal symptoms of upper respiratory infection or pharyngitis are most common. These are followed by target lesions of skin, sloughing of musous membranes, and ocular inflammation. Twenty-three cases are presented. Most patients (61 percent) were between 10 and 39 years of age. Relapses occurred in three patients. Five patients developed pneumonia, and there were two fatalities. Over one-half of the patients had serious ocular complications. The etiology of this syndrome is uncertain. Multiple allergic factors, drugs (especially long-acting sulfonamides), and infectious agents (most recently mycoplasma pneumoniae) have been implicated. This study does not support any single cause. The use of systemic steroids is generally accepted by most authors. The death rate in this study (10 percent) is essentially unchanged from early reports on patients without steroid therapy. The complications rate directly attributable to steroids is significant in this study group. The major complications of this syndrome are ocular. Aggressive topical management of ocular inflammation is required; however, the morbidity rate remains high despite these measures. The otolaryngologist should be aware of this syndrome as the early symptoms, and the acute complications may require his awareness of the natural and treated courses of this disease.     

Seltene Differenzialdiagnose bei einem 40-j?hrigen Patienten mit Schlafapnoe-Syndrom

Respiratory disorders are common and important complications in acromegaly. The prevalence of sleep apnea syndrome (SAS) in this group of patients is high (20%-50%). Consequences of SAS are serious and associated with increased morbidity and mortality, mainly as a result of cardiovascular complications. The symptoms of sleep apnea are often reversible with treatment. We report on an acromegaly patient presenting with excessive snoring and severe headaches caused by sleep apnea.     

Dental implant treatment for renal failure patients on dialysis:a clinical guideline

Chronic kidney disease (CKD) is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections,bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.     

Tracheostomy in infants and young children.

Seventy-three tracheostomies performed in children three years of age and under in a 52-month period are discussed. Thirty-six were under one year of age. Forty-one were performed for upper airway obstruction, 23 for ventilation or suction, and nine for a combination of upper airway obstruction and lower bronchopulmonary disease. Operative complications developed in 10 patients, and postoperative complications in 16. The most common complication was interstitial air; the most deadly was obstruction of the cannula. There were 20 deaths. Sixteen were due to the patients' diseases; four were due to complications of tracheostomy. If serious operative and postoperative complications are avoided, the important factors determining prognosis are the patient's age and the condition for which the tracheostomy was done. The long term results in these patients show this to be true for both survival and duration of tracheostomy.     

Complications of the adeno-tonsillectomy

Adeno-tonsillectomy is the most frequent surgical intervention of de the head and neck in paediatrics in the industrialised countries and one of the most common operations in Mayor Day Case Surgery; although is not void of risks which can be fatal. Complications can be surgical or anaesthetics in nature, one of the most serious complications being postoperative bleed. Among risk factors we can highlight: age younger then three, female gender, duration of surgery, incomplete haemostasis, coagulophaties. These could be related to delayed oral intake. Postoperative bleed could not related to technique or haemostasis applied. We carry out a revision of this subject.     

Subconjunctival ecchymosis due to rhinoplasty.

Orbital complications of rhinoplasty show a wide range from minor complications like periorbital edema and ecchymosis to severe complications like blindness. Also, subconjunctival ecchymosis is one of the orbital complications due to rhinoplasty. A prospective study was set out to assess the incidence and progression of subconjunctival ecchymosis and to find out mechanisms of this complication. The incidence of subconjunctival ecchymosis was found to be 19.1%. Typically it appeared unilaterally or bilaterally over the temporal subconjunctival area in the first two days after the operation. Complete resolution of subconjunctival ecchymosis took approximately 11 +/- 3 days. No other ocular symptoms were found. Subconjunctival ecchymosis only prolonged the recovery period of the patient from the rhinoplasty.     

Laser surgery for Zenker’s diverticulum: European combined study

Surgical intervention is the gold standard of treatment for Zenker’s diverticulum. The aim of this study was to examine the role of laser surgery in a large number of patients with this pathological entity. The data of 91 consecutive patients treated due to Zenker’s diverticulum with the aid of CO2 laser in three institutions (Homburg/Saar and Marburg, Germany/Athens, Greece) during the last 10 years were retrospectively analyzed. Parameters examined were sex, age, preoperative symptoms, length of operation and complications, revision surgery necessity and degree of patient satisfaction. All patients had a minimum follow-up of one year. Dysphagia was the most common preoperative symptom (78 %). The most common minor complication was dental injury (6.6 %), but a serious complication in form of emphysema was observed in only two patients (2.2 %). A surgical revision was necessary in 8 (8.8 %) of the treated patients. The majority of treated patients was free of symptoms (86.8 %), or presented mild symptoms (9.9 %) one year after intervention, and only three patients (3.3 %) were dissatisfied. Our study shows that laser treatment of Zenker’s diverticulum is an efficient operative technique associated with low complications rates and significant improvement of patients’ symptoms in most of the examined cases.     

A comparative analysis of endotracheal intubation in neonates, children and adults: complications, prevention and treatment

The use of endotracheal tube to provide a prolonged airway and as an adjunct to artificial ventilation continues to be a controversial subject. With this controversy in mind, a six-year survey was undertaken in utilizing three private hospitals to evaluate the number of patients requiring prolonged endotracheal intubation, their incidence of complication, and particularly to record the diagnosis for which this form of artificial airway was required. At the same time, primary and secondary tracheostomies were evaluated as to mortality, morbidity, and complications. There were 205 premature and newborns evaluated, with 108 of these neonates requiring endotracheal intubation for 48 hours or longer. The average duration was five and one-half days. There were 26 survivors of 108 infants with one serious complication, or an incidence of 4 percent. The incidence of mortality and morbidity for tracheostomy in the neonate is much higher than that of endotracheal intubation and intubation should be the method of choice. Over 500 children requiring intensive care were evaluated. Of these, 64 cases required endotracheal intubation of 24 hours or longer with 43 survivors. There was one death with a mortality of 1.4 percent. In evaluating the diagnoses requiring endotracheal intubation, it is statistically significant that those patients other than post-surgical or medically clean had an incidence of complication of 23 percent. There were over 1,200 adult patients who required some form of artificial ventilation with 454 requiring endotracheal intubation of 24 hours duration or longer. The average duration was 61 hours. Immediate and minor complications, such as cord granulomas, lacerations, laryngeal edema, etc., were not included. There were 11 adult complications which could be classified as serious with stenotic changes of the larynx or trachea. This gives an overall incidence of complication of 2.4 percent with no mortality. These statistics are better than those for tracheostomy; however, the severely anoxic, toxic, or infected patient was the one which had a significant incidence of complications. The suicide patient had an incidence of 17.5 percent, patients with pulmonary infection 12.3 percent, and the stroke patient, 5.6 percent. A comparative study of tracheostomies continues to indicate that there is a higher incidence of mortality and early complications in tracheostomy than endotracheal intubation; however, both endotracheal intubation and secondary tracheostomies following prolonged intubation show a much higher incidence of delayed complications. Treatment should be one of prevention with the proper choice of tube and cuff, more than just adequate nursing care with definite proper follow-up of those patients who have had prolonged intubation. Frequent use of endoscopy and indirect laryngoscopy in these patients is mandatory for early treatment of delayed complications. Once these complications have manifested themselves, then treatment should follow the course as prescribed by the various authors finding success in the treatment of these lesions.     

Transnasal endoscopic drainage of a medial subperiosteal orbital abscess

The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery. Received: 7 February 1997 / Accepted: 12 November 1997