四种手术入路对眼眶深部海绵状血管瘤患者的影响

目的：探讨经结膜入路、外侧入路、皮肤入路及外侧联合内侧结膜入路对眼眶深部海绵状血管瘤患者视力、肿瘤残余率及并发症的影响。

方法：眼眶深部海绵状血管瘤患者114例,根据手术入路分为A组(30例,经结膜入路)、B组(34例,经外侧入路)、C组(27例,经皮肤入路)及D组(23例,经外侧联合内侧结膜入路),比较四组患者视力改善效果、肿瘤残余率及术后并发症。

结果：四组患者视力改善效果无差异(P=0.918)。A组、B组、C组及D组患者术后肿瘤残余率分别为0、2.9%、3.7%、0(P>0.05)。四组患者术后并发症发生率无差异(P=0.244)。

结论：根据眼眶深部海绵状血管瘤适应证,合理选择微创手术入路均可有效维持正常视力水平,且安全性均一致。     

Optic nerve sheath meningioma with intraocular invasion--a case report]

BACKGROUND: In case a sonographically high reflective intraocular tumor is detected, some different processes with calcium embedding could be considered. PATIENT: A 56 year-old female patient was seen in our department for the first time because of secondary glaucoma of the amaurotic right eye. The left eye has had no morphological changes and visual acuity was 5/5. CASE HISTORY: More than 20 years ago the patient had noticed decreased visual acuity of the right eye for the first time. 10 years ago in a first report from another eye hospital, a large white tumor in the area of the optic disc had been described. Sonographic size was 12 x 8 mm, 5.3 mm prominence. Visual acuity was perception of light with incorrect projection. A CT scan showed an inhomgeneous structure of calcification in the area of the right optic disc which continued along the optic nerve to intracranial structures. Enucleation was performed. Histopathological examination showed meningothelial meningeoma (grade I WHO) with its origin in the dural sheath of the optic nerve and intraocular growth. A postoperative MRI confirmed the intracranial spreading of the meningeoma along the dural sheath of the optical nerve. A meningeoma of the olfactorius region was found as a second independent tumor. CONCLUSION: The intraocular spread of an optical nerve sheath meningeoma is a rare case.     

Junctional scotoma in giant cerebral aneurysm

A brain lesion located at the lateral side of the sella turcica can produce a junctional scotoma by compressing the ipsilateral optic nerve and the contralateral inferonasal nerve fiber. This study reports a female patient with a junctional scotoma caused by a cerebral aneurysm. At the initial visit, she complained of visual disturbance in both eyes and the right optic disc was atrophied. The visual field showed right blindness and left superotemporal quadrantopsia. A brain CT indicated an approximately 3 cm sized brain mass located superolateral to the sella turcica. The brain MRI showed the lesion to be more like an aneurysm than a pituitary adenoma. Therefore, 4 vessels angiography was done, and this lesion was confirmed to be a sellar variant of an aneurysm located at the right carotid siphon. Like a tumor of the optic chiasm, a cerebral aneurysm can cause visual disturbance and visual field defects. Therefore, an early differential diagnosis is important because the prognosis and treatment of an aneurysm differ.     

Optic neuropathy produced by a compressed mucocele in an Onodi cell

PURPOSE: To describe a patient with compressive optic neuropathy caused by a mucocele in an Onodi cell. DESIGN: Interventional case report. METHODS: A 73-year-old man complained of sudden visual loss in the left eye 10 days after cataract surgery. Coronal computed tomography showed a homogeneous mass in an Onodi cell. Magnetic resonance imaging revealed an oval-shaped lesion that compressed the left optic nerve. RESULTS: After endoscopic microsurgery of the paranasal sinus, visual acuity in the left eye improved. Histopathological examination of the excised specimen showed a mucocele. CONCLUSIONS: Ophthalmologists should be aware that the mucocele in the Onodi cell, an anatomical variation of the paranasal sinus, may compress the optic nerve.     

Endoscopic and trans-fornix removal of a giant orbital-ethmoidal osteoma

A 39-year old female was referred with a 2 year history of slowly progressive headache, exophthalmos, diplopia and restricted eye movements with exotropia of the right eye. Orthoptic examination revealed restricted elevation and mildly restricted adduction of the right eye. CT and MRI demonstrated a large (35 x 20 x 23 mm) calcified infraorbital lesion extending into the ethmoidal sinus. Because the visual field defects were progressive and the acuity OD dropped to 20/80 surgical intervention was necessary. The osteoma was successfully removed using an inferior and medial orbitotomy with swinging eyelid combined with an endoscopic approach. In a second procedure the orbital floor was reconstructed with a porous polyethylene (Medpor) implant. A final procedure consisted of a 3 mm recession of the left superior rectus muscle and infundibulotomy by the sinus surgeon to open the blocked maxillary sinus. After 6 months visual acuity OD had returned to 20/20. Orthoptic examination showed normal binocular function.     

Assessment of Normal Eyeball Protrusion Using Computed Tomographic Imaging and Three-Dimensional Reconstruction in Korean Adults

Purpose: The aim of the present study was to assess normal eyeball protrusion from the orbital rim using two- and three-dimensional images and demonstrate the better suitability of CT images for assessment of exophthalmos. Methods: The facial computed tomographic (CT) images of Korean adults were acquired in sagittal and transverse views. The CT images were used in reconstructing three-dimensional volume of faces using computer software. The protrusion distances from orbital rims and the diameters of eyeballs were measured in the two views of the CT image and three-dimensional volume of the face. Relative exophthalmometry was calculated by the difference in protrusion distance between the right and left sides. Results: The eyeball protrusion was 4.9 and 12.5 mm in sagittal and transverse views, respectively. The protrusion distances were 2.9 mm in the three-dimensional volume of face. There were no significant differences between right and left sides in the degree of protrusion, and the difference was within 2 mm in more than 90% of the subjects. Conclusions: The results of the present study will provide reliable criteria for precise diagnosis and postoperative monitoring using CT imaging of diseases such as thyroid-associated ophthalmopathy and orbital tumors.     

Aspergillosis presenting as an optic neuritis

A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.     

Mucoceles of the sphenoid sinus and their ophthalmological manifestations

The authors describe two cases of spheno?d sinus mucoceles, the first with a chiasmatic syndrome and the second with an oculomotor paralysis, and compare these cases with those described in the litterature. This rare benign tumor is revealed by ophthalmological complications which result from compression of adjacent structures. The main clinical findings are pain, decrease in visual acuity, proptosis, and diplopia. Plain X rays and pluridirectional tomographies are usually sufficient to make the diagnosis but CT scan is the procedure of choice for defining the extent of the lesion and thus assuring an appropriate surgical approach. The CT scan findings have been reviewed. Early and correct diagnosis is important to prevent permanent visual loss by optic nerve atrophy.     

以脉络膜转移为首发的胰尾粘液腺癌

目的:报告1例胰尾粘液腺癌表现为孤立性脉络膜转移瘤.方法:一位57岁女患者主诉右眼中心视物变形.检眼镜检查见1个位于右眼黄斑中心、长约6 PD的孤立性淡色隆起病灶.她没有特殊的既往眼科和全身病史.A/B超声检查证实在后极部黄斑内有一个实性病灶,荧光素血管造影发现中心病灶无渗漏区.结果:根据病史和临床发现,请求了FBC、血沉、LFT、胸部X线和腹部CT等检查.胸部X线发现在双肺野有多发性模糊的病灶,提示为转移性肺结节.CT发现肝内多发性结节和在胰尾的一个3.5 cm×2.6 cm病灶.进行了CT引导下的肝活检,证实为中度分化的转移性粘液腺癌.此后血液分析证实CA19-9升高.肿瘤原发部位证实为胰尾,并决定进行姑息治疗.结论:初发临床体征为孤立性脉络膜病灶经证实为胰尾癌的报告鲜见.这一病例提示,在发现未知来源实性脉络膜病灶的病例,进行详细的腹部影像学检查是重要的.     

Neuro-ophthalmological presentation of pneumosinus dilatans

Pneumosinus dilatans (PSD) is a rare disease characterized by an abnormal expansion of an air-filled paranasal sinus. Because of the pressure effect on the adjacent structures, PSD may present with several neurological signs, the ocular ones being the most common. In the present study, we describe a case of frontal PSD with diplopia, proptosis, ophthalmoplegia, and compressive optic neuropathy. Imaging showed a large amount of air in the right orbit continuous with the ipsilateral frontal sinus. Endoscopic sinus surgery was performed to eliminate a valve-like mechanism created by an increased pneumatization of the Agger nasi cell above the ostium frontalis. Surgery was effective in restoring the normal communication between the sinus and the nasal cavity, thus resulting in full recovery of severe visual impairment. The distinction between PSD, pneumocele, and hypersinus is an important one since these disorders share some clinical features, but require different treatments. PSD visual prognosis is mainly related to its associated syndromes and their surgical treatment. If PSD occurs as an idiopathic disorder with simple sinus expansion, visual prognosis is good when appropriate surgery is performed. At present, endoscopic sinus surgery is preferable to the external approach for treatment of PSD.     

Computed Tomography in Planning and Evaluating Orbital Surgery

Computed tomography (CT) scanning of the orbit has enhanced the diagnostic and surgical armamentarium of the orbital surgeon, localizing the lesion in the retrobulbar spaces and separating those expanding masses confined to the orbit from those that invade from adjacent structures. It relates an orbital lesion to the surgical spaces, optic nerve and globe, and bony orbital walls, guiding the operator in his surgical approach. If the lesion has escaped from the orbit into the intracranial cavity, CT scanning can detect it. In this way, the surgical teams and surgical approaches are chosen. After surgery, CT scanning can detect a local recurrence of a tumor and note if it has extended intracranially. However, invasion of the optic canal may be better detected by polytomography. There is also some difficulty in distinguishing between a tumor recurrence and postoperative inflammation. Postoperative follow-up evaluation by serial CT scanning every six months is advocated to determine these changes.     

Retrieval of lost medial rectus muscles with a combined ophthalmologic and otolaryngologic surgical approach

PURPOSE: To report retrieval of a medial rectus muscle completely detached from the globe and lost in the orbital tissue in four eyes. METHOD: A lost medial rectus muscle was retrieved in four eyes of four patients with either a transcutaneous medial orbitotomy approach or a transnasal endoscopic ethmoid sinus approach. RESULTS: The lost medial rectus muscle was successfully retrieved in all four patients. One patient lost the medial rectus muscle secondary to trauma, and the other three cases resulted from complications of strabismus surgery. The mean preoperative angle of exotropia was 44 prism diopters. The endoscopic approach was attempted in three patients, and the medial rectus muscle was successfully found in two of these patients. In one case in which the endoscopic approach was used, an image guidance system was used to aid in finding the lost medial rectus muscle. The endoscopic approach was abandoned in one case in which the medial rectus muscle could not be identified after extensive searching, but the muscle was subsequently found by means of the transcutaneous medial orbitotomy approach. A transcutaneous medial orbitotomy alone was used to find the lost medial rectus muscle in one of the cases. The postoperative ocular deviation for primary position at distance fixation was a mean of 24 prism diopters of exotropia. With one additional operation in two patients, the mean ocular deviation was less than 12 prism diopters. CONCLUSION: We successfully retrieved a lost medial rectus muscle in four patients with the use of nontraditional strabismus surgical techniques. We effectively combined techniques taken from both ophthalmology and otorhinolaryngology to help solve this difficult problem.     

Fronto-ethmoid sinus mucocele: a case report.

BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal sinuses filled with mucus. They develop because of scarring and obstruction of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They commonly erode the bony sinus wall and can have serious complications of brain and orbital invasion, with potential for abscess and rupture. CASE REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule above the right eye for 1 year. She recently noted a bulging right eye, nasal congestion, and occasional headaches. She was 9 years post-sinus surgery. All aspects of the afferent optic nerve function were intact. Right-sided proptosis was evident as was a right adduction and supraduction deficit, prompting immediate imaging, both with a computed tomography scan and magnetic resonance imaging of the orbits. These results showed a large right ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting an immediate surgical referral. CONCLUSION: Mucoceles may arise from any of the paranasal sinuses and, because of the close proximity of these spaces to the orbit, may initially manifest with visual and ocular signs and symptoms. Therefore, eye care providers need to be aware of this entity and the need for immediate referral or workup if a mucocele is suspected.     

Postoperative visual improvement in spheno-orbital meningioma: a case report

A 59-year-old woman complained of right eye proptosis and visual impairment (20/100) lasting 2 months. CT and MRI scans disclosed a right spheno-orbital meningioma ranging over the optic foramen and cavernous sinus. Histopathology revealed transitional meningioma. Visual acuity (20/25), visual field, and proptosis were improved after surgery at the time of the ophthalmologic examination 6 months later. We present an additional case and review the available literature concerning postoperative visual outcome.     

Mucinous adenocarcinoma of the tail of the pancreas presenting with a choroidal metastasis

AIM: To report a case of mucinous adenocarcinoma of the tail of the pancreas presenting with a solitary choroidal metastasis. ·METHODS: A 57 years old female patient presented with central metamorphosia in the right eye. Fundoscopy showed a solitary pale raised lesion in the central right macula about 6 disc diameters in length. Her past ocular and medical history was unremarkable. A B-scan confirmed a raised solid lesion in the posterior pole within the macula while fluorescein angiography revealed a central lesion with no areas of leakage. ·RESULTS: In view of the history and the clinical findings a FBC, ESR, LFT, Chest X-ray, and abdominal CT were requested .The chest X-ray revealed multiple opaque lesions in both lung fields suggestive of metastatic pulmonary nodules. The CT revealed multiple nodules in the liver and a 3.5cm x 2.6cmlesion in the tail of the pancreas. A CT guided liver biopsy was performed and it revealed moderately differentiated metastatic mucinous adenocarcinoma. Subsequent blood analysis revealed an elevated CA19-9. The primary tumour site was identified as the tail of the pancreas and was decided to instigate palliative treatment. ·CONCLUSION: There are few reports that demonstrate the significance of a solitary choroidal lesion as the initial clinical sign of cancer of the tail of the pancreas. This case highlights the importance of performing detailed abdominal imaging studies in cases where a solid choroidal lesion of unknown origin is identified.     

Ophthalmologic presentation of nasal chondromesenchymal hamartoma in an infant

A 7-month-old infant was examined for severe right ptosis, strabismus, and noisy breathing. CT revealed a right intranasal mass with areas of calcification, erosion, and extension to the cribriform plate. Surgical resection was performed. Pathologic examination confirmed the diagnosis of nasal chondromesenchymal hamartoma. Ophthalmologists may be among the first medical practitioners to encounter nasal chondromesenchymal hamartoma, a rare, benign neoplasm of the nasal and paranasal sinuses.     

Cavernous hemangioma involving the lacrimal outflow system

A 22-year-old woman, 26 weeks pregnant, presented with a right nasolacrimal duct obstruction, nasal congestion with intermittent epistaxis, right globe displacement, and choroidal folds in the right eye. Noncontrast head CT revealed a mass involving the right nasolacrimal duct, nasal cavity, ethmoid sinuses, and orbit. Transnasal endoscopic resection was performed. Histopathology revealed a cavernous hemangioma involving the nasolacrimal duct and nasal cavity. Cavernous hemangiomas may occur rarely in the nasal cavity, paranasal sinuses, and/or the nasolacrimal duct.     

眶周病变致眼球突出的MRI及CT表现分析

目的 评价ＭＲＩ及ＣＴ在眶周变致眼球突出诊断中的作用。方法 对５１例颅及副鼻窦９病变致眼球突出患者的ＣＴ及ＭＲＩ检查表现进行分析。结果 ＣＴ在揭示钙化及骨皮质上优于ＭＲＩ,但对密度差别不大的炎症肿瘤,复发性病变及瘢痕组织等不如ＭＲＩ。结论ＭＲＩ可从多方位显示软组织结构成分,对血管瘤,粘液性囊肿及纤维瘢痕等有特异性表现,ＣＴ对揭示骨结构明显优于ＭＲＩ,确定诊断必须结合表现。     

鼻内镜辅助下Medpor Titan植入治疗眶壁骨折的临床研究

目的：探讨鼻内镜辅助下经结膜切口联合Medpor Titan植入行眼眶壁骨折整复的临床疗效。

方法：对16例16眼外伤导致的眼眶内壁、下壁、内下壁骨折患者,鼻内镜辅助下经泪阜结膜切口、下穹窿结膜切口、泪阜联合下穹窿结膜切口径路分离暴露骨折区,将嵌入副鼻窦的直肌、眶脂肪还纳眶内,Medpor Titan材料修补骨折缺损区。观察术后视力、眼球突出度、眼球运动、复视情况、眼眶CT。

结果：患者16例16眼中,术后观察3mo,所有患眼视力无下降,眼球内陷矫正,眼球运动无明显受限,复视消失,眼眶CT 植入物位置满意,未见植入物移位脱出。

结论：鼻内镜下经结膜切口联合Medpor Titan植入行眼眶壁骨折整复术,具有直视操作、骨折范围暴露清晰且手术安全可靠等优点,既恢复了患者的视功能和外观,又减少了并发症的发生,同时也避免术后遗留面部瘢痕,是临床上一种安全、有效的手术方法。