感染性眼内炎导致眼球丧失的危险因素调查

目的:探讨感染性眼内炎导致眼球丧失的相关危险因素。方法:对1993-02/2002-12收治的116例(117眼)感染性眼内炎患者进行回顾分析。结果:21例(21眼)行眼球摘除或眼内容物剜出,发生率为17.9%。其中视力无光感的眼内炎病例中眼球丧失的发生率是80%(P=0.0001,OR=73.6);内源性眼内炎的发生率是45.4%(P=0.0125,OR=4.69);眼球破裂伤的发生率是41.7%(P=0.0031,OR=6.78);女性眼内炎的发生率是35.3%(P=0.002,OR=4.48)。前、后5a眼球摘除或眼内容物剜出的发生率分别是26.5%及11.8%(P =0.040)。结论:眼内炎病例中视力无光感、内源性眼内炎、眼球破裂伤是导致眼球摘除或眼内容物剜出的危险因素。眼球摘除或眼内容物剜出的发生率逐年减少。     

Enucleation and evisceration:indications, complications and clinicopathological correlations

AIM:To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.METHODS: A total of 107 subjects who underwent enucleation and/or evisceration and received hydroxyapatite implants (Scleral wrap or mesh) were assessed. For each patient clinicopathological data was collected which included demographic information, clinical history, primary clinical diagnosis, main cause of ophthalmic surgery (traumatic, non-traumatic), type of surgical procedure (enucleation, evisceration) and pathological report. Patients’ postoperative clinical visits were checked for procedure-related complications during first year after surgery.RESULTS:One hundred and seven patients (male:65.4%; mean age:26y) underwent enucleation (n=100) or evisceration (n=7) due to traumatic (n=41) and non-traumatic (n=66) causes. Disfiguring painful blind eye was the most common indication of surgery (66.4%), followed by leukocoria (19.6%) and endophthalmitis (4.7%). The main types of injury included ?recracker, traf?c and work accidents, and sharp object perforating injury. In 53 (80.3%) subjects in non-traumatic group the initial clinical diagnosis matched the histopathological results. Malignant tumors (retinoblastoma:47.5%, malignant melanoma:27.3%) were the most common pathological diagnoses followed by phthisis bulbi (25.8%). The most common procedure-related complications were major eye discharge (39.6%), and implant exposure and discharge (20.8%).CONCLUSION: Trauma and malignant tumors are the leading causes of enucleation-evisceration. Despite developing new techniques and materials, enucleation is still associated with considerable postoperative complications.     

Evisceration and Enucleation

Evisceration and enucleation are delicate procedures that result in psychological trauma and physical disability. The preparation is as important as the surgery itself to assure that the patient will return to a productive life. The procedure must be performed in a way to provide the best conditions for a perfect prosthesis, which should look similar to the fellow eye, follow its movements, be comfortable and aesthetically pleasing. Indications and contra-indications, surgical techniques, pre- and post-operative care and complications are discussed in this paper.     

Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.     

Enucleation versus evisceration

Removal of the eye may be necessary after severe ocular trauma, to control pain in a blind eye, to treat some intraocular malignancies, in endophthalmitis unresponsive to medical therapy, and for cosmetic improvement of a disfigured eye. The choice of procedure to accomplish this is best made by an informed patient. Enucleation and evisceration can each achieve the desired goals, but several factors must be considered in choosing the most appropriate procedure.     

眼球穿孔伴化脓性眼内炎导致的交感性眼炎

目的：总结分析眼球穿孔伴化脓性眼内炎导致的交感性眼炎的临床特征、诊断及可能的发病原因。方法：对1993-2002年本院收治交感性眼炎87例中伴有化脓性眼内炎病史的交感性眼炎3例患者的临床资料作回顾性分析总结。结果：1993-2002年本院收治的眼球穿通伤及眼球破裂伤的病人5253例，同期收治的交感性眼炎87例，交感性眼炎的发生率为1．65％。其中3例发病前有眼球穿孔合并化脓性眼内炎的病史，3例眼底荧光血管造影检查结果均符合交感性眼炎改变；1例组织病理学检查报告为典型交感性眼炎改变。结论：眼球穿孔伴化脓性眼内炎仍可能发生交感性眼炎，应引起注意。眼科学报2003；19：75-78     

外伤性眼内炎对眼免疫赦免状态的影响

目的研究外伤后眼内炎症对眼免疫赦免状态的影响。方法在Ｗｉｓｔａｒ大鼠和新西兰白兔建立外伤性眼内炎模型。将牛血清白蛋白分别接种于受伤眼和正常眼玻璃体腔。接受附加佐剂的牛血清白蛋白免疫方案１周后,评价其诱导玻璃体腔相关免疫偏离的能力,并观察受伤眼组织病理学改变。结果眼外伤后５～７天发生中度到重度炎症反应。常规免疫组动物均出现抗原特异性迟发型超敏反应（ＤＴＨ）阳性;单纯玻璃体腔抗原接种组动物均显示ＤＴＨ阴性;受伤眼玻璃体腔抗原接种组和受伤眼玻璃体抗原接种后对侧正常眼玻璃体抗原接种组均显示ＤＴＨ阳性。结论外伤性眼内炎导致受伤眼和正常眼免疫偏离诱导的失败。眼相关免疫偏离的消失可能参与了交感性眼炎的发病过程。     

Study of the indications and changing trends of enucleation and evisceration in West Malaysia

AIM: To study the demographic pattern and indications for enucleation and evisceration in West Malaysia, and to evaluate the changing trends of the same over the past three decades. · METHODS: In a retrospective hospital based study, case records of all patients who underwent enucleation and evisceration at University of Malaya Medical Centre over a period of 20 years (1985/2004) were reviewed. Age, gender, ethnicity of patients, indications for enucleation and evisceration were evaluated. · RESULTS: Out of 160 patients, enucleation was done in one eye in 85 patients and evisceration was done in one eye in 75 patients during the study period. The mean age of patients was 36.4 years with a range of 6 months to 90 years. In our study, panophthalmitis (26.9%) and retinoblastoma (18.8%) were the most common causes of evisceration and enucleation respectively. Infections of the eye contributed to 72.0% of eviscerations while tumors contributed to 51.8% of enucleations. There was a significant decrease in the removal of eyes over the past three decades in our hospital. The number of removal of eyes for glaucoma and trauma-related causes significantly reduced while removal for infection- related causes and painful blind eyes significantly increased when compared to the figures reported three decades ago from our hospital. · CONCLUSION: Panophthalmitis and intraocular tumors are the major indications for the removal of eyes. Although the frequency of removal of eye has significantly decreased over time in our country, the indications for the same suggest that there is a need of further improvement of eye care services in Malaysia.     

Autologous dermis graft at the time of evisceration or enucleation

Aim

To present a new technique using autologous dermis graft at the time of enucleation or evisceration to replace the ocular surface area lost when the corneal scleral button is excised.

Methods

A retrospective, interventional, non‐comparative case series of patients who had an autologous dermis graft placed to assist in closure of Tenon''s capsule and conjunctiva at the time of enucleation or evisceration. Medical records were reviewed and the following variables were recorded: age, sex, history of previous ocular surgery or radiation treatment, indication for surgery, type of surgery, laterality, type of orbital implant, size of implant, length of follow up, and complications.

Results

Nine patients were identified (three male, six female) Five had enucleation with implant placement and four had evisceration with implant placement. Four individuals received unwrapped porous polyethylene spherical implants, three received silicone implants, and two received hydroxylapatite implants. Follow up ranged from 30 to 112 weeks (mean (SD), 61 (28) weeks). No operative or early complications were observed. One patient who had enucleation after two rounds of brachytherapy for uveal melanoma developed subsequent late exposure of the implant. There were no complications involving the graft donor site.

Conclusions

This small series shows that the use of a dermis graft is a safe and effective new technique to facilitate orbital rehabilitation. It is hypothesised that the extra surface area produced with a dermis graft preserves the fornices and allows a larger implant. It may also allow the implant to be placed more anteriorly which assists with both implant and prosthesis motility.     

马来西亚西部眼球摘除术和眼内容摘除术的手术适应证及其变化趋势

目的:通过研究近30a马来西亚西部地区眼球摘除术和眼内容物摘除术的数据统计和手术适应证,观察其近30a的动态变化趋势.方法:通过回顾研究20a(1985/2004)在马来亚大学医学中心接受眼球摘除术和眼球内容摘除术病例资料,对患者的年龄、性别、种族及其手术适应证进行分析.结果:在全部160名患者中,85例单眼行眼球摘除术,75例单眼行眼内容摘除术,患者平均36.4岁(6mo～90岁).全眼球炎(26.9%)和视网膜母细胞瘤(18.8%)是眼球摘除术和眼球内容摘除术共同的病因,72.0%因眼部感染行眼球摘除术,51.8%因眼部肿瘤行眼内容摘除术.与30a前的统计数据相比较,我们医院近30a的眼球摘除率显著降低,因青光眼和眼创伤疾病导致眼球摘除的数量显著减少,而因感染和疼痛性盲眼导致的眼球摘除数量则有显著增加.结论:全眼球炎和眼内肿瘤是眼球摘除术的主要手术适应证,尽管现在在我国需要行眼球摘除术的病例数量较以前有显著降低,但手术适应证比例的变化提示我们,在马来群岛眼部的护理仍需要很大的改进.     

Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence,Clinical Presentations and Outcomes of a Rare Disease

Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries

Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes.

Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye

Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia     

Thirty-year History of Sympathetic Ophthalmia

A spontaneous corneal perforation followed by granulomatous uveitis occurred in a 10-month-old female infant with bilateral anterior segment anomalies. The histopathologic findings in the enucleated right eye and the 30-year course of intraocular inflammation in her left eye are consistent with sympathetic ophthalmia. This case illustrates that sympathetic ophthalmia can be overlooked for years unless the diagnosis is considered and periodic anterior segment biomicroscopy and indirect ophthalmoscopy are performed in patients who have had perforating ocular injuries. A lensectomy-vitrectomy procedure was successful in restoring ambulatory vision in this patient.     

Choice of Procedure: Enucleation,Evisceration, or Prosthetic Fitting Over Globes

Enucleation is more likely to be associated with certain intraoperative and postoperative complications but remains the procedure of choice in cases where detailed histopathologic examination of the globe is required, in many cases of intraocular neoplasm, and in selected cases of ocular trauma with visual loss. In many patients, evisceration results in enhanced cosmesis compared to enucleation and is a technically simpler and faster operation. Evisceration may be indicated in patients with blind and unsightly or painful eyes and in selected instances of ocular trauma following discussion of the risk of sympathetic ophthalmia with the patient. It is contraindicated in patients with possible intraocular malignancy. In appropriate cases, a cosmetic shell or contact lens may constitute an alternative to enucleation or evisceration, and may provide superior cosmesis. Management of patients requiring these procedures should be tailored to the particular clinical situation with consideration of the wishes of the well-informed patient.     

羟基磷灰石微粒在眼内容摘除术中的应用

目的观察羟基磷灰石微粒在眼内容摘除术中应用的手术方法和临床效果。方法对52例(52眼)严重眼球裂伤、绝对期青光眼以及眼球萎缩患者行眼内容摘除联合巩膜腔内植入羟基磷灰石微粒术。结果术后早期患眼多有不同程度的眼睑及结膜水肿,大多于术后5~7天明显减轻或消退。未见羟基磷灰石微粒暴露、脱出、感染或排异反应发生。配戴仿真义眼片后患眼外形满意。结论对严重眼球裂伤、绝对期青光眼以及眼球萎缩患者采取眼内容摘除联合巩膜腔内羟基磷灰石微粒植入术,效果良好。     

22例眼内容剜出的原因及病理学分析

目的分析眼内容剜出的病理学分类以进一步探讨眼内容剜出的原因。方法对本院2001年1月至2007年8月眼病理室存档的22例（22只眼）眼内容剜出病例进行临床分析及组织病理学分析。结果感染性眼内炎12例（54．55％）,其中真菌性眼内炎7例;眼球萎缩7例（31．82％）;角巩膜葡萄肿2例（9．09％）;绝对期青光眼1例（4．55％）。结论感染性眼内炎尤其是真菌性眼内炎是眼内容剜出的首要原因,早期正确的诊治可避免眼内容剜出。     

外伤性眼内炎手术治疗

目的　探讨外伤性眼内炎玻璃体切除手术治疗效果 ,并分析相关因素。方法　因外伤性眼内炎接受玻璃体切除手术治疗 2 1例 ( 2 1眼 ) ,其中硅油填充 18眼 ,C3 F8填充 2眼 ,无填充物 1眼。术前视力光感至 0 1。眼压平均为 7mmHg( 5～ 2 5mmHg) ( 1mmHg =0 13 3kPa)。平均随访 18月 ( 3～ 43月 )。结果　术后视力无光感至 0 8,视力提高 15眼 ( 71 43 % ) ,不变 4眼( 19 95 % ) ,视力下降 2眼 ( 9 42 % )。眼压平均为 18mmHg( 10～ 2 2mmHg) ,显著高于术前眼压 (P <0 0 5 )。并发症主要包括前房炎性渗出 ( 19眼 ) ,术后短暂高眼压 ( 4眼 ) ,视网膜脱离 ( 3眼 ) ,眼球萎缩 ( 2眼 )。结论　玻璃体切除手术是治疗外伤性眼内炎的安全有效的方法。     

Enucleation versus Evisceration in Ocular Trauma: A Retrospective Review and Study of Current Literature

Abstract

Purpose: To compare variables and outcomes from ocular trauma leading to either enucleation or evisceration to better inform surgical decision making.

Design: Retrospective chart review.

Methods: We reviewed 441 patients between 2001 and 2012 presenting with ocular trauma to a Level 1 trauma center in Queens, New York; of these, there were 16 enucleations and 6 eviscerations. Retrospective chart review noted age, gender, mechanism of injury, initial and final visual acuity, time to surgery, length of follow-up, pain, degree of motility, and complications. A review of literature in the context of our study was performed.

Results: 20 patients were male and 2 patients were female; average age was 44 (SD: 20.0, range 18–91). 9/16 patients were enucleated to prevent sympathetic ophthalmia, whereas only 1/5 patient was eviscerated for this indication (p?=?0.1619). No cases of sympathetic ophthalmia were reported over an average follow-up of 316 days. Average length of follow-up varied significantly between the two groups, with an average of 370.4 days (SD: 566.9, range 0–1870) for enucleated eyes and 172.7 days (SD: 146.3, range 0–422) for eviscerated eyes (p?=?0.42). Medpor implants were preferred in eviscerations (5/6 eviscerations), whereas hydroxyapatite implants were preferred in enucleations (10/16 enucleations, p?=?0.04).

Conclusions: Surgical decision-making in ocular trauma is largely based on surgeon preference and experience, with minimal evidence in the literature to support either enucleation or evisceration. We recommend evisceration over enucleation in cases of reliable patient follow-up due to the low incidence of sympathetic ophthalmia.     

眼球穿孔伤80例临床分析

目的评价眼球穿孔伤的临床疗效。方法80例（80眼）眼球穿孔伤进行了手术治疗，随访0．5～3年。结果76眼得以保留眼球，60眼手术后视力提高，无一例发生交感性眼炎。结论适当合理的伤口处理联合手术治疗，可以为眼球穿孔伤保留眼球并恢复视力提供了机会。     

儿童外伤性眼内炎50例临床治疗分析

目的：探讨玻璃体切除联合抗生素治疗儿童眼内炎的手术时机和疗效。方法：对儿童外伤性眼内炎50例采用上述方法治疗，对疗效进行回顾性分析，其中合并球内异物9例，视网膜脱离11例。结果：术后随访6～12mo，45例视力光感～0．5，其中3眼视网膜脱离复发，另5眼视力无光感，眼球萎缩。结论：儿童外伤性眼内炎一经确诊应立即手术，因儿童眼外伤后增殖旺盛，视网膜脱离发生率高，手术中应进行硅油填充，尽可能保留视功能，防止眼球萎缩。