眼眶囊性病变134例临床诊治分析

目的 描述眼眶囊性病变病例的临床表现、诊断和治疗.方法 回顾性研究2001年1月至2009年3月期间诊治的眼眶囊性病变134例,分析其临床特征,影像学表现和手术治疗效果等.结果 134例眼眶囊性病变中,男性68例;女性66例,右眶63例;左眶71例;年龄6个月至84岁,平均42岁.最常见症状为肿块、眼球突出和复视等.超声波检查示肿物多呈边界清楚的无回声或低回声区,内部无明显血流信号.CT示囊肿内密度较均匀,CT值-198Hu～77.5Hu,增强扫描示囊壁增强,而囊内容物不被强化.MRI检查T1WI为低或等信号,T2WI呈高信号.全部病例经手术完整切除或部分切除等治疗.术后病理诊断眼眶皮样囊肿46例,表皮样囊肿58例,黏液囊肿11例,单纯性眼眶血肿12例,眼眶脓肿3例,寄生虫性囊肿2例,泪腺起源的单纯性上皮细胞囊肿及先天性囊性眼各1例.术后随访3月至8年,平均2.10年,治愈率98.50%,复发率1.50%.结论 眼眶囊性病变的诊断应综合病史和临床表现,影像学检查有助于准确的诊断,手术治疗效果好.     

多层螺旋CT低剂量扫描在眼眶部外伤检查中的应用

目的 探讨眼眶部外伤检查时MSCT扫描的最适低剂量.方法 选择30例眶壁骨折患者的横轴面骨折层面影像,通过图像空间添加噪声软件模拟出30、70、100、140、170、200 mA 6种低剂量影像,根据影像质量及骨折等显示情况进行评价,找出满足诊断需求的最适球管电流量后进行临床应用.同时记录容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)、有效剂量(ED).影像质量按影像层次、噪声、解剖结构及能否满足诊断要求的显示情况而采用好、较好、一般、差、很差的5级制评价.等级资料使用秩和检验进行统计分析,计数资料采用X2检验.结果 在使用常规剂量300 mA扫描条件时30例眼眶外伤患者图像中显示眶骨骨折30例、眶内气肿19例、眼肌损伤12例、眶内异物1例.在低剂最模拟图像中,不同剂量的图像质量差异有统计学意义(X2=102.009,P=0.000).当剂量降低至70 mA时上述所有临床征象仍可清晰显示和准确诊断,但图像质量评价为好1例、较好8例、一般21例,无差及很差.当模拟剂量管电流降低至100 mA时,图像质量评价为好9例、较好17例、一般4例,无差及很差;且同常规剂量差异无统计学意义(P>0.05).临床实际应用100 mA管电流检查20例眼眶外伤患者,所得图像质量为好5例、较好13例、一般2例,无差及很差.CTDIvol、DLP、ED分别为20.84 mGy、125.04 mGy·cm、0.29 mSv.与常规剂量(300 mA)CTDIvol、DLP、ED分别为62.53 mGy、375.18 mGy·cm、0.86 mSv,比较管电流100 mA进行扫描时,ED下降了70%.结论 眼眶部外伤进行MSCT扫描时,管电流为100 mA所得图像即可满足临床诊断要求,又可明显降低对患者的辐射剂量.     

眶周注射曲安奈德治疗Graves眼病的临床研究

目的评价长效糖皮质激素曲安奈德治疗Graves眼病的临床效果。方法用曲安奈德40 mg行患眼眶周注射,每3周1次,4次为1个疗程,治疗前和疗程结束后3个月观察记录症状、体征情况。结果治疗117例256眼,治疗后眼球突出回退率为81.3%(208/256);睑裂高度回缩率为82.4%(211/256);73只视力下降眼中,61只眼(83.6%)视力改善;61例斜视和复视者,13例(21.3%)消失,33例(54.1%)得到改善,15例(24.6%)无明显变化;83眼(32.4%)畏光流泪、眼胀眼痛等症状消失,156眼(60.9%)改善;73眼(28.5%)结膜充血水肿、眼睑水肿等体征消失,144眼(56.3%)改善。结论眶周注射曲安奈德对Graves眼病的眼征具有明显改善或消除作用,不良反应小,安全性高。     

伽玛刀治疗22例原发视神经鞘脑膜瘤的疗效分析

目的 探讨采用伽玛刀进行低分割、高剂量的分次立体定向放射治疗（FSRT）治疗原发性视神经鞘脑膜瘤的疗效。方法2004年8月至2010年3月收治原发性视神经鞘脑膜瘤22例患者,均采用Hyper SGSI型立体定向体部伽玛射线放射治疗系统进行FSRT治疗,1例进行常规分割,单次剂量2Gy;21例行低分割、高剂量的FSRT治疗,单次剂量3～5Gy靶区累积剂量为36～40Gy。治疗后6个月随访1次,中位随访时间25个月,观察患者的临床症状改善情况、视力保全率及肿瘤控制情况。 结果 截止于末次随访,全组患者的视力控制率为77.3％（17／22）,其中视力改善4例,稳定13例,下降3例,失明2例。视力控制率随时间变化略有下降,1年视力控制率为95.0％（19／20）,2年视力控制率为75.0％（9／12）,但差异无统计学意义（P＞0.05）。肿瘤控制率为100.0％,最大径缩小＞50％的8例（36.4％）,缩小25％～50％的11例（50.0％）,缩小＜10％～25％的3例（13.6％）。突眼症状改善率为100.0％,治疗前突眼度为（17.3±2.7）mm,治疗后突眼度为（14.9±1.5）mm（P＜0.05）。有10例患者出现治疗相关反应,对症治疗可恢复。 结论 采用低分割、高剂量的FSRT治疗原发视神经鞘脑膜瘤的疗效确切,但视力改善不明显,对于确切分割模式及剂量尚需进一步探讨。     

甲状腺相关眼病眼眶组织的病理改变

目的 了解甲状腺相关眼病(TAO)患者眼眶组织的病理形态学表现.方法 为回顾性系列病例研究.对138份TAO患者标本(包括77份眶脂肪标本、41份眶骨膜标本和20份泪腺标本)进行病理学、免疫组织化学染色,观察组织形态学改变.结果 77份眶脂肪组织中的73份以及20份泪腺组织中的12份标本其脂肪组织增生明显;眶骨膜标本除纤维组织增生外,部分有肌肉组织化生.结论 TAO患者眶脂肪和泪腺组织中脂肪组织增生是一个常见的病理改变.     

Periorbital necrotising fasciitis: delay in diagnosis results in loss of lower eyelid

Necrotising fasciitis (NF) is an extremely rare skin and soft tissue infection with extensive necrosis of the subcutaneous tissue and underlying fascia, which usually affects the limbs and trunk. It rarely affects the head and neck region because of the excellent blood supply in this region. We report a case of NF initially misdiagnosed as a traumatic pre-septal cellulitis following self-puncture of a hordeolum externum (stye) and its resistance to aggressive antibiotic therapy resulting in the loss of the lower eyelid.     

The surgical management of strabismus with large angle in patients with Graves’ ophthalmopathy

Background Strabismus with large deviation in Graves’ ophthalmopathy is relatively common in developing countries, such as China. However, little information is available in the literature on this condition. We report here our surgical results of strabismus with large deviation in Graves’ ophthalmopathy. Patients and methods The surgical management of strabismus in 27 patients with Graves’ ophthalmopathy with large angle (≥25°) were retrospectively analyzed. The strabismus surgery included recession or free tenotomy of involved rectus muscle, recession of rectus plus resection of ipsilateral antagonist, and recession of rectus plus recession of contralateral antagonist. The patients were followed up for an average of 1.2 years. Results Among 27 patients, 17 were male and 10 were female, with their age ranging from 28 to 68 years old (mean: 51.9 years). There were 12 cases with excellent results, 10 with good results, 3 with fair results, and 2 with poor results. Only one surgery was required in all cases except three who needed re-operation. Based on the rectus muscles involved, just one rectus muscle recession combined with traction suture could correct the strabismus with large angle in 20 patients; two muscles were required in 9 patients and three in 1 patient. Four patients had surgical overcorrection of strabismus. Eight patients had complicated eyelid retraction postoperatively. Conclusions The surgical management of strabismus with large deviation in patients with Graves’ ophthalmopathy was remarkably good. Just one rectus muscle recession combined with traction suture could correct the large angle strabismus in 74% (20/27) of cases. The choice of surgical procedure and some special attention in performing surgery are discussed.     

侵犯眶内鼻窦囊肿的手术治疗

目的探讨改良眉弓径路联合鼻内镜技术在侵犯眶内的哑铃形筛窦囊肿手术中的应用及疗效分析。方法2002年8月N2012年4月我科收治的7例侵犯眼眶的哑铃形巨大筛窦囊肿患者,全麻下采用改良眉弓切口,鼻内镜辅助下沿眶壁分离并切除眶内囊肿,然后采用鼻内镜囊肿造袋术,切除囊肿。结果7例患者术中眶内及鼻窦囊肿均能充分暴露,并在直视下全部去除。术后无脑脊液鼻漏、眶筋膜损伤和眶内、颅内感染等并发症。术后随访6-18个月,均未见复发。结论采用改良眉弓径路联合鼻内镜行侵犯眶内的哑铃形筛窦囊肿手术,增加了手术的精确性和安全性,切口短,瘢痕小,切除彻底,降低复发率,减少对面部美观的影响,是治疗侵犯眶内的巨大哑铃形筛窦囊肿的有效术式之一。     

Lymphatic Malformations of the Orbit

Objectives

Lymphatic malformations of the orbit are rare lesions that constitute approximately 1% to 8% of all orbital masses. They are difficult to treat since they do not remain within anatomic boundaries and tend to penetrate into normal orbital structures. The aim was to analyze clinical courses and therapy options in patients with lymphatic malformations of the orbit.

Methods

Thirteen patients with orbital lymphatic malformations confirmed by magnetic resonance imaging between 1998 and 2009 were enrolled in this study. Patients'' charts were retrospectively reviewed to analyze clinical courses and treatment options.

Results

Four patients suffered from isolated intraorbital lymphatic malformations without conjunctival involvement, in three of them the masses were completely resected, in one patient close controls were performed. Three patients had isolated intraorbital lymphatic malformations with conjunctival involvement. Surgical volume reduction of the exterior parts of the lymphatic malformation were performed without any complications and satisfying outcome in these cases. Six patients suffered from intra- and periorbital lymphatic malformations. In 3 patients a watch-and-wait strategy was initiated. In the other 3 patients a surgical therapy was performed, one patient additionally received sclerotherapy with OK-432; however, these 3 patients suffered from residual lymphatic malformations.

Conclusion

The presented cases underline the inconsistencies in the malformations behavior and underscore the inability to make specific recommendations regarding treatment. The treatment decision should be based on the size and location of the lymphatic malformation. The untreated patient must be watched for signs of visual detoriation, which may signal the need for therapeutic intervention.