晚期视网膜母细胞瘤53例的临床挑战

目的：评价肿瘤的位置、大小、组织学以及复发率。 方法：前瞻性研究Larkana的Chandka医学院附属医院眼科的53例组织学诊断为视网膜母细胞瘤患者,肿瘤侵及眼球、眼眶、颅内以及其他组织。为研究肿瘤广泛性,检查包括：眼眶X线片,眼球B超,眼眶及头颅CT扫描／MRI,全骨扫描,胸部前后位X线片,腹部B超,腰椎穿刺,全血细胞计数,包括肝肾功能检查的血生化,根据肿瘤的位置、大小、复发及转移选择包括手术、局部放疗、系统化疗的治疗方案。有局部和系统转移的患者,由Larkana的核医学和放疗机构的肿瘤专家进行局部放疗和系统化疗。术后1,3,6,12mo复查随访,随后5a及5a以上,1a复查一次。评估肿瘤的位置、大小、组织类型和复发率。 结果：患者53例,年龄8mo～8岁。男25例（47％）,女28例（53％）。肿瘤的眼别,左眼25例（47％）,右眼19例（36％）,双眼9例（17％）。患者的首发症状,斜视3例（6％）,假性眼内炎4例（8％）,眼眶炎性假瘤6例（11％）,转移性包块7例（13％）,蕈样生长的包块8例（15％）,白瞳征12例（23％）,眼眶浸润13例（25％）。行单纯眼球摘除术19例（36％）,行眼球摘除及改良型眶内容物剜除术并局部放疗和系统化疗19例（36％）,行眼球摘除及完全型眶内容物剜除术并局部放疗和系统化疗15例（28％）。肿瘤的组织类型,含大量染色质的高分化视网膜母细胞瘤25例（47％）,高度未分化视网膜母细胞瘤28例（53％）。首次手术后,由于手术切除点以上视神经受累,眼眶浸润和系统转移,发生复发和转移37例（70％）。 结论：儿童红眼或白瞳征在确诊之前应怀疑视网膜母细胞瘤,应该及时经眼科专家检查,因为患者在肿瘤初期的早期表现提示会降低肿瘤的扩散、复发和死亡率。     

非特异性炎症致眶尖综合征临床特征分析

目的 总结眶尖非特异炎症导致眶尖综合征患者的临床特征。设计 回顾性病例系列。研究对象 2016年6月至2019年5月北京同仁医院神经眼科及北京市普仁医院眼科眼眶非特异性炎症致眶尖综合征15例（16眼）。方法 回顾患者的临床症状、体征、化验及影像学检查、激素治疗效果及病情转归。主要指标 临床表现、眼眶及头颅CT、MRI表现。结果 15例中男性8例,平均年龄（53±16）岁。14/15例单眼发病。病灶均局限于眶尖区,7例同时累及海绵窦。首先出现患侧眼眶疼痛,相继出现眶尖综合征表现。眼眶MRI均显示眶尖部条片状不规则实性病灶,呈等T1WI、等T2WI信号,均匀强化。经全身或眼球局部糖皮质激素治疗后14眼（87.5%）眼痛完全消失,13眼（81.3%）上睑下垂改善,11眼（68.8%）眼球运动及复视症状改善。3个月后复查眼眶MRI病灶均缩小。仅一半患者治疗后视力提高,其余8眼（50.0%）视力无改善。随访过程中2例（12.5%）病变复发。结论 局限于眶尖的非特异炎症可导致严重的眶尖综合征。早期无眼红肿等炎症表现,眼球突出亦不明显,表现为眶周疼痛、眼球运动障碍,继而视力进行性损伤,易被误诊。临床表现和神经影像学是诊断主要依据。糖皮质激素治疗能有效改善眼球运动障碍和疼痛,但视力恢复困难,且病变有复发可能。（眼科,2021,30： 56-61）     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶骨海绵状血管瘤1例

患者，女，31岁，因左眼视物模糊、眼球突出1a余，于2006年5月15日入院。眼部检查：视力：右1．0．左0．1（-2．00DS→0．6）；眼压：右15mmHg（1kPa=7．5mmHg），左18mmHg；右眼前后节检查未见异常；左眼眼眶上外侧骨壁明显增厚，眼球向下方移位，较健眼低2mm，眼球向上运动受限，眶压偏高，眼球突出度：右眼15mm，左眼19mm。眼眶CT示：左眼眶上外侧骨壁明显增厚，骨质膨胀，皮质变薄，密度不均，突入眼眶，眶内容物受压向下移位。患者于2006年5月18日在全身麻醉下行左眼前路开眶取瘤术，设计眉弓切口。术中可见肿瘤来源于额骨，暗红色，呈血窦样，边界不清，与颅底硬脑膜及眶周膜黏连，血供丰富，质脆。分离肿瘤表面骨膜显露其边缘，用颅钻在眶外侧壁钻孔，用Styke电锯锯断外侧壁，后用铣刀沿肿瘤边缘锯开额骨至眶切迹内侧，     

眼眶爆裂性骨折的CT评估

目的分析眼眶爆裂性骨折的临床表现及CT所见,探讨陈旧性眼眶骨折的CT征象鉴别。方法对239例（241眼）眼眶爆裂性骨折的临床症状和体征以及CT征象进行回顾性分析。结果本组单纯眼眶内侧壁骨折130例（132眼,55．77％）,单纯眶下壁骨折31例（31眼,12．86％）,双眶壁骨折63例（63眼,26．14％）,混合型骨折15例（15眼,6．22％）。眼外肌增粗182条,眼眶内容物疝入副鼻窦28例,眶内出血43例,眶内积气39例,副鼻窦积液142例,眼睑及眶周软组织肿胀176例。发生复视86例,发生眼肌活动障碍125例,发生眼球内陷27例。本组病例中,受伤超过3个月者复查22例（22眼）,发生眶壁骨质凹陷共30眶壁,眶腔扩大伴眼球内陷13例,眼外肌增粗共21条。结论CT扫描是评估眼眶爆裂骨折及其预后的首选检查方法。眼眶内侧壁骨折最为常见;眼眶陈旧性骨折眶壁呈凹陷性改变;骨折程度严重可致眶腔增大、眼球内陷;眼外肌增粗可长期存在。     

先天性小眼球合并眼眶囊肿的临床分析

目的 :探讨先天性小眼球合并眼眶囊肿的临床表现、诊断及鉴别诊断。方法 :回顾并分析 14例 (15只眼 )先天性小眼球合并眼眶囊肿诊断治疗的临床资料。结果 :该病临床表现复杂多样 ,运用B超、CT及MRI等影像学检查可发现眶内囊肿和萎缩的小眼球。结论 :通过特征性的临床表现和影像学检查 ,该病可与多种眼和眼眶疾病相鉴别。影像学检查对于制定手术方案很有帮助。     

晚期视网膜母细胞瘤53例的临床挑战(英文)

目的:评价肿瘤的位置、大小、组织学以及复发率。方法:前瞻性研究Larkana的Chandka医学院附属医院眼科的53例组织学诊断为视网膜母细胞瘤患者,肿瘤侵及眼球、眼眶、颅内以及其他组织。为研究肿瘤广泛性,检查包括:眼眶X线片,眼球B超,眼眶及头颅CT扫描/MRI,全骨扫描,胸部前后位X线片,腹部B超,腰椎穿刺,全血细胞计数,包括肝肾功能检查的血生化,根据肿瘤的位置、大小、复发及转移选择包括手术、局部放疗、系统化疗的治疗方案。有局部和系统转移的患者,由Larkana的核医学和放疗机构的肿瘤专家进行局部放疗和系统化疗。术后1,3,6,12mo复查随访,随后5a及5a以上,1a复查一次。评估肿瘤的位置、大小、组织类型和复发率。结果:患者53例,年龄8mo~8岁。男25例(47%),女28例(53%)。肿瘤的眼别,左眼25例(47%),右眼19例(36%),双眼9例(17%)。患者的首发症状,斜视3例(6%),假性眼内炎4例(8%),眼眶炎性假瘤6例(11%),转移性包块7例(13%),蕈样生长的包块8例(15%),白瞳征12例(23%),眼眶浸润13例(25%)。行单纯眼球摘除术19例(36%),行眼球摘除及改良型眶内容物剜除术并局部放疗和系统化疗19例(36%),行眼球摘除及完全型眶内容物剜除术并局部放疗和系统化疗15例(28%)。肿瘤的组织类型,含大量染色质的高分化视网膜母细胞瘤25例(47%),高度未分化视网膜母细胞瘤28例(53%)。首次手术后,由于手术切除点以上视神经受累,眼眶浸润和系统转移,发生复发和转移37例(70%)。结论:儿童红眼或白瞳征在确诊之前应怀疑视网膜母细胞瘤,应该及时经眼科专家检查,因为患者在肿瘤初期的早期表现提示会降低肿瘤的扩散、复发和死亡率。     

眼眶、上颌骨骨折的处置

目的 Medpor和微型钛板在眼眶及颜面外伤中的应用。方法 394例眶壁、颌面部、额骨骨折,伤后用钛板作眶缘及颌骨内固定,重建眶缘的完整性,并用Medpor修补。结果眼球内陷89例（89眼）中42例（42眼）眼球内陷完全矫正,31例（31眼）眼球轻度内陷,16例（16眼）无明显改善。复视95例中,68例复视消失,9例周边视野有复视,18例无改善。眼位下移12例（12眼）中术后角膜映光正位9例（9眼）,3例（3眼）改善。结论联合处理眼眶及颜面外伤应用Medpor和微型钛板,对恢复眼球位置、改善面部畸形有不可比拟的优越性。     

鼻咽癌眼眶转移临床分析

目的分析、总结11例鼻咽癌（NPC）眼眶转移患者的临床特点和预后。方法回顾性分析1991至2003年间在中山大学中山眼科中心进行诊治的11例NPC眼眶转移患者的一般情况、临床表现、影像学检查、病理检查、治疗及随访情况。结果11例患者中男性9例,女性2例;平均年龄45．5岁;发生左眼眶转移10例,右眼眶转移1例。有明确NPC病史7例,无NPC病史4例;自NPC确诊至出现眼部症状平均12．7个月（2．0～60．0个月）;就诊时眼部症状平均持续10．3个月（0．7～36．0个月）。眼眶有1处转移灶9例,2处转移灶2例;肿物主体位于眶鼻侧8例,颞侧2例,眶尖处1例,位于眶前部8例。手术将肿物全部取出或部分切除并送病理检查,结果提示鳞癌4例,淋巴上皮癌2例,未分化型5例。5例患者死于NPC远处转移,自确诊NPC眼眶转移至死亡间隔时间平均21个月;1例死因及存活时间不明;3例仍存活,未发现活动性病灶并继续接受治疗;2例失访。结论NPC眼眶转移临床很少见,但于中山眼科中心就诊的眼眶转移癌患者中原发于NPC者所占比例最高。转移病灶多数位于眼眶前部及鼻侧。患者预后较差。     

Gasserian ganglion schwannoma with orbital extension

A patient with painless proptosis and no associated neurologic symptoms was found to have a cystic retrobulbar orbital mass. The initial computed tomography (CT) scan did not demonstrate any intracranial involvement. On orbital biopsy a schwannoma was encountered and repeat CT scan with contrast revealed a large middle cranial fossa mass with extension into the orbit through the optic canal and superior orbital fissure. On lateral transfrontal craniotomy the lesion was noted to arise from the gasserian ganglion and to involve the right cavernous sinus. Subtotal resection was performed, and the patient has remained asymptomatic and free of recurrence for 18 months.     

Orbital involvement in juvenile nasopharyngeal angiofibroma: prevalence and treatment

PURPOSE: To assess the prevalence of orbital invasion by juvenile nasoangiofibroma and to discuss its surgical treatment. METHODS: A retrospective review of the medical records and tomographic scans of a case series of 19 patients with juvenile nasoangiofibroma was performed. All scans were reviewed by a radiologist and an orbital surgeon. The presence of the tumor was assessed in the pterygopalatine fossa, nasal cavity, nasopharynx, paranasal sinuses, inferior orbital fissure, orbit, and middle cranial fossa. RESULTS: The most common structures invaded were pterygopalatine fossa (100%), nasal cavity (94.7%), sphenoid sinus (84.2%), and nasopharynx (73.7%). The orbit was invaded in 6 (31.6%) patients. In 5 of these patients, the tumor extended in the orbit through the inferior orbital fissure. Four patients with orbital invasion were successfully operated with the Le Fort I approach. CONCLUSIONS: Orbital involvement is relatively common in the setting of juvenile nasoangiofibroma extension. The main route of orbital invasion is the inferior orbital fissure. The Le Fort I osteotomy is an adequate approach for managing juvenile nasoangiofibroma when it invades the orbit.     

Herpes zoster ophthalmicus presenting as orbital abscess along with superior orbital fissure syndrome: A case report

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5-year-old-male child secondary to herpes zoster infection. He presented with a 5-day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids.     

60例眶颅沟通肿瘤的诊断分析

目的探讨眶颅沟通肿瘤的临床特征、种类及诊断方法。方法选择60例手术后经病理或随访结果证实的眶颅沟通肿瘤患者,所有患者均行CT扫描,54例行MR I扫描,其中增强扫描42例。20例摄视神经管X光像。结果最常见的阳性体征是眼球突出(58/60)、眶压升高(39/60)和视力下降(36/60),最常见的症状是头痛(22/60)。较多见的眶颅沟通肿瘤是脑膜瘤(20/60)、骨纤维异常增殖症(5/60)和转移癌(5/60)。眶颅沟通肿瘤的CT、MR I扫描及视神经孔X光像有一定影像学特征。眶颅沟通途径包括:视神经管、眶上裂和眶颅交界骨壁。结论掌握眶颅沟通肿瘤的临床特征、病种分类,综合运用CT、MR I和X光等检查方法可提高诊断和鉴别诊断水平。     

Nuclear magnetic resonance tomography study in orbital diseases with surface coils

MRI of the orbit with surface coils was performed in 40 patients. In 35 cases the findings were pathologic. The most frequent (n = 9) were malignant melanomas of the choroid, which were distinguishable from hemorrhages (n = 2) by the characteristic signal intensity pattern. MRI only offered advantages over CT in lesions of the orbital apex, the upper part of the orbit, and in the diagnosis of inflammatory processes. In most of the cases of orbital tumors, and particularly where there was involvement of bony structures, CT was equal to or better than MRI.     

Esophageal Adenocarcinoma and Urothelial Carcinoma Orbital Metastases Masquerading as Infection

Orbital metastases can masquerade as other orbital processes. We present two cases of orbital metastases, the first being the first reported adenocarcinoma of the esophagus presenting as an orbital metastasis prior to the primary being known, and the other as the first urothelial carcinoma to present as orbital cellulitis. The first patient presented with left upper eyelid pain. CT scan identified a superolateral subperiosteal fluid collection without concomitant sinus disease, which was drained in the operating room. Two weeks later repeat CT scan showed recurrent orbital subperiosteal fluid. It was drained and a biopsy showed necrotic adenocarcinoma. The second case presented with a painless right proptosis, decreased vision, and globally decreased ocular motility 3 days after bladder resection for urothelial carcinoma. CT scan demonstrated pan sinusitis with a soft tissue mass in the apex of the right orbit with extension through the superior orbital fissure. After no improvement on antibiotics endoscopic drainage was performed. Pathology revealed metastatic urothelial carcinoma within the orbital fat.     

可吸收眶底板在眼眶骨折手术中的应用

目的:评价可吸收眶底板在眼眶骨折修复手术中的临床应用效果。方法:回顾性分析眼眶骨折患者48例48眼的临床资料,所有患者均采用可吸收眶底板进行眼眶骨折修复,术中充分暴露骨折缺损范围后还纳疝出的眶内组织,根据缺损范围塑形可吸收眶底板,植入眶内并以可吸收螺钉固定。手术前后通过眼部检查和眼眶CT扫描评价可吸收眶底板在眼眶骨折修复手术中应用的可行性和精确性。结果:本组患者均顺利完成手术,均未出现严重的并发症,CT扫描可见眼眶骨折均得到良好的解剖复位。术后1a复查,术前18眼眼球运动障碍患者中1眼好转(6%),17眼治愈(94%);术前30例复视患者中12例好转(40%),18例治愈(60%);术前32眼眼球凹陷患者中10眼好转(31%),22眼治愈(69%);术前40眼眶下神经分布区麻木患者中33眼好转(82%),7眼治愈(18%)。本组患者中1眼术前出现下睑内翻、倒睫,术后得以恢复。结论:可吸收眶底板在眶壁骨折修复术中应用效果良好,是一种较好的眼眶修复材料。     

Distensible venous malformations of the orbit: clinical and hemodynamic features and a new technique of management.

OBJECTIVE: To investigate distensible venous malformations of the orbit (DVMO) as part of a spectrum of orbital vascular malformations, including some that involved periorbital skin, extraorbital sites (central nervous system or nasal sinuses), or combinations of these. The authors also investigated the effectiveness of a new technique of management for selected cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty patients had distensible venous anomalies, of which four were combined distensible venous-lymphatic vascular malformations. Distensible lesions were defined as those showing clinical or radiographic expansion with Valsalva maneuver or when the head was placed in a dependent position. These lesions were then classified as superficial (anterior to the equator of the globe), deep (posterior to the globe's equator), combined (deep and superficial), or complex (with intracranial or major extraorbital involvement). INTERVENTION: Surgery was performed on 15 patients (50%), mainly for pain or for cosmetic indications. Six patients underwent this new technique, which involved intraoperative direct venography with control of outflow via pressure at the superior or inferior orbital fissure. The venous malformation was then embolized (by use of cyanoacrylate glue) and excised. RESULTS: The mean age at presentation was 28.2 years (range, 8 months to 75 years). Sixty-six percent of cases involved the left orbit. Superior and medial orbital involvement was most common. Three cases (10%) were classified as superficial, and 13 (43%) as deep. Six patients (20%) had combined superficial and deep components. Eight (27%) had major extraorbital involvement (4 intracranial, 2 facial, and 2 paranasal sinus). Direct venography demonstrated complex multichannel anomalies draining to various sites, including the face and pterygopalatine fossa, without necessarily having a direct connection to the major orbital venous circulation. CONCLUSIONS: Distensible venous malformations of the orbit are part of a spectrum of developmental venous malformations that may be localized to the orbit or involve it as part of a more extensive lesion. The authors describe their clinical and radiologic features and report a new technique of management for selected cases. This method of vascular isolation and embolization of lesions may greatly facilitate excision.