1492例眼眶占位性病变临床病理学分析

目的探讨北京同仁医院眼科中心眼眶占位性病变的疾病谱系和发病情况。设计回顾性病例系列。研究对象自1997年1月至2006年12月间北京同仁医院眼科中心病理室存档的1492例眼眶占位性病变。方法分析1492例眼眶占位性病变的临床病理资料,基本情况包括患者的年龄、性别及肿物的病理诊断。主要指标眼眶占位性病变的疾病谱系和发病情况。结果眼眶占位性病变依据组织来源主要分为15大类:囊肿性病变、脉管性病变、周围神经病变、视神经和脑膜病变、纤维组织病变、骨和软骨病变、脂肪组织病变、肌组织病变、泪腺病变、炎性病变、色素性病变、转移性肿瘤、淋巴增生性病变、继发性肿瘤、白血病和组织细胞系统病变、其它病变。其中良性病变1318例(88.3%),恶性病变174例(11.7%)。位于良性病变前5位的分别是皮样囊肿及表皮样囊肿、海绵状血管瘤、淋巴管瘤、泪腺混合瘤、慢性炎症和炎性假瘤;位于恶性肿瘤前5位的分别是淋巴瘤、泪腺囊腺癌、横纹肌肉瘤、黑色素瘤、皮脂腺腺癌。结论眼眶占位性病变涉及不同组织来源的病变。横纹肌肉瘤是儿童最常见的眶内恶性肿瘤,淋巴瘤是老年人最常见的眶内恶性肿瘤。(眼科,2007,16:398-402)     

原发性眼内良性病变的分析(英文)

目的:研究原发性眼内良性病变的表现形式并指出其常见诱因。方法:从1997-07/2001-08,研究在真纳研究生医学中心眼科进行。2001-09在钱德拉医科大学医院眼科。研究只涉及患有原发性眼内良性病变的患者,他们均有院外住院病史。诊断基于患者的表征,临床检查,调查及切除肿块的组织病理学。共68名患者,年龄2mo ～60岁,男27例(39.7%),女41例(60.3%),35例(51.5%)左眼患病,33例(48.5%)右眼患病。结果:原发性眼内良性病变患者68例中,26例(38.2%)为眼睑浅表性毛细管血管瘤,5例(7.4%)为深部眼内血管瘤,5例(7.4%)为神经纤维瘤,4例(5.9%)为多发性神经纤维瘤,2例(2.9%)为神经瘤, 5例(7.4%)为多形性泪腺瘤(良性混合型细胞肿瘤)。结论:尽早住院检查,正确诊断和治疗可以避免并发症对患者视力甚至生命的威胁。     

Mycobacterium of an unknown strain causing a primary tumoral process of the orbital roof

PURPOSE . To report an unidentified species of atypical Mycobacterium as the causative agent of a primary orbital roof infection. METHOD . Review of a case from the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. RESULTS . The patient had a negative history for eye trauma. Computed tomography (CT) of the brain and right orbit confirmed the presence of soft tissue swelling and erosive changes in the orbital roof bone, with intact globe and external ocular muscles. Biopsy of the lesion showed non-caseating, granulomatous osteomyelitis. Various stains of the sample were negative. Since our institution could not identify the causative organism, a biopsy sample was sent to Bioscientia Laboratory in Germany; the culture grew an atypical Mycobacterium of unknown species. Their sensitivity study showed the organism to be resistant to pyrazinamide, isoniazide and streptomycin, but sensitive to rifampicin, ethambutol, and prothionamide. Systemic checkup and investigation ruled out any other systemic involvement. CONCLUSION . A new species of atypical Mycobacterium was recovered from a primary orbital infection. The infection responded to combined antituberculous therapy.     

眼眶间叶性软骨肉瘤——病例报告与文献复习(英文)

目的:报道1例罕见的眼眶间叶性软骨肉瘤,探讨其临床表现、病理特点、治疗以及预后。方法:详细报告1例眼眶间叶性软骨肉瘤病例的临床资料,并检索迄今国内所有该病例报道,结合国外文献进行分析总结。结果:该病例非常罕见,迄今国外报道仅18例,国内报道仅8例。本文报告的1例36岁女性患者,2次手术,1次误诊为血管外皮瘤,2a后因复发行2次手术,术后病理检查:肿瘤组织由未分化的间叶瘤细胞及岛状的软骨细胞组成,免疫组织化学检查:Vimentin(++),S-100(+),病理报告为右眼眶间叶性软骨肉瘤。结论:间叶性软骨肉瘤是发生于有成软骨潜能的原始间叶组织的恶性肿瘤,发生于眼眶者罕见,综合治疗(手术、化学治疗以及放射治疗)可减少复发、提高长期生存率。     

Mesenchymal chondrosarcoma of the orbit: report of a case and review of the literature

AIM: To report a rare case of mesenchymal chondrosarcoma in the orbit and to explore its clinic manifestations, pathologic characters, management and prognosis. METHODS: We report a case of mesenchymal chondrosarcoma of the orbit. The clinical materials, including ophthalmological examination, computed tomography scan of the orbit, histopathology and immunohistochemistry of the biopsy specimen were reported, and its pertinent literatures were reviewed. RESULTS: A 36-year-old female was seen with proptosis and decreased vision. Histopathology demonstrated an admixture of undifferentiated mesenchymal cells and islands of mature hyaline cartilage. Immunohistochemical studies revealed positivity for vimentin and S-100, which was consistent with the diagnosis of mesenchymal chondrosarcoma. · CONCLUSION: Mesenchymal chondrosarcoma in the orbit is extremely rare malignant tumor. Multi-modality treatments (surgery, chemotherapy and radiotherapy) may lead to long-term survival.     

如何正确看待眼眶肿瘤复发

眼眶肿瘤种类繁多，治疗复杂。部分肿瘤术后复发率较高，且再次治疗难度很大，预后不良。本文试图分析眼眶肿瘤复发原因，找出解决方法，减少肿瘤复发，提高治疗成功率。     

Ophthalmic manifestations in the COVID-19 clinical spectrum

Purpose:The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19.Methods:This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed.Results:A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis.Conclusion:Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.     

眼眶动静脉畸形致眼上静脉扩张的影像学表现

目的探讨眼眶动静脉畸形(AVM)致眼上静脉(SOV)扩张的影像学及血管造影表现。设计回顾性病例系列。研究对象6例临床表现与硬脑膜海绵窦瘘(CCF)相似的眼眶AVM患者。方法总结分析所有患者的影像学检查结果,如CT、MRI和选择性脑血管造影。主要指标影像学征象及血流动力学。结果CT和MRI均可显示所有患者的SOV扩张。另外,尚存在眼球突出、AVM畸形血管团等征象。所有6例AVM均位于眼眶内,1例尚合并颅内AVM。所有患者的主要引流静脉均为SOV,动脉包括脑膜中动脉、上颌动脉和眼动脉。结论眼眶AVM可引起与CCF相似的临床和影像学征象,但AVM通常不引起海绵窦膨大,血管造影仍是确诊的必需手段,而无创技术是辅助血管造影进行明确诊断的重要手段。(眼科,2007,16:395-398)     

开拓创新 努力发展我国眼眶病事业

眼眶病是一个涉及多学科的专业,近年来我国的眼眶病研究尤其是临床研究有了较大进展,在静脉曲张介入治疗、眼眶骨折整体修复等方面具有较好的创新性,且取得了良好效果。(眼科,2007,16:363-364)     

义眼台植入术后残存上睑沟凹陷的处理

目的 针对义眼台眶内植入术后上睑沟凹陷的不同原因研究处理方法,评估治疗效果。设计 回顾性病例系列。研究对象 自 2005年 12月至2011年6月羟基磷灰石义眼台植入术后残存上睑沟凹陷的患者55例（55眼）,平均年龄（32.3±8.9）岁。方法 术前测量评估上睑沟凹陷程度及病因,分别采取上睑自体真皮脂肪移植、羟基磷灰石半球眶内充填、眶壁骨折整复羟基磷灰石骨块或复合人工骨板充填进行治疗。观察术后上睑沟凹陷程度改善情况,评价术后效果。主要指标 手术前后患眼的上睑沟凹陷程度及外观。结果55例患者中6例接受自体真皮脂肪移植术,术后早期上睑沟凹陷均有明显改善,3个月后上睑皮下组织均有不同程度的吸收,最终5例效果满意,1例仍有轻度上睑沟凹陷;10例行羟基磷灰石半球填充,37例行眶壁骨折整复联合眶内填充,患者上睑沟凹陷均明显改善;2例行眶壁骨折整复联合真皮脂肪填充,效果满意。结论 针对羟基磷灰石义眼台植入术后残存上睑沟凹陷程度轻重及病因选择适当的治疗方案,可获得较满意的治疗效果。     

Localized surgical debridement for the management of orbital mucormycosis

Purpose:To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration.Methods:The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months.Results:The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication.Conclusion:Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.     

The role of orbital exenteration in choroidal melanoma with extrascleral extension

The management of choroidal melanoma with extrascleral extension has been a subject of controversy with some proposing orbital exenteration whenever extrascleral extension is demonstrated and others feeling it to be of no value in increasing survival. We reviewed the cases of 43 patients with extrascleral extension of choroidal melanoma. Although five-year survival had previously been demonstrated to be significantly improved in patients undergoing early orbital exenteration at our institution, extended follow-up in 16 consecutive cases revealed ultimate tumor related mortality to approach that of patients refusing exenteration. Only in cases with nonencapsulated or surgically transected extension did exenteration appear to improve survival. In ten cases with delayed recurrence of tumor in the orbit, exenteration proved to be palliative rather than curative.     

眼眶复发性皮样囊肿的临床特征与治疗

目的 总结复发性皮样囊肿的临床特征及诊治方法.方法 回顾性系列病例研究.收集30例经病理学确诊的复发性皮样囊肿患者资料,总结病史特点、复发因素、临床表现及影像学征象、治疗与预后.结果 患者初次手术距最后就诊时间间隔1个月至36.0年,中位数时间2.5年.既往有1、2、3次手术史的例数分别为:20例、9例及1例.特征性临床表现有:眶周肿物,伴红肿及触痛16例;眶周皮肤瘘管4例;上睑皮肤与眶缘骨膜粘连,眼睑外翻4例.常见导致复发的因素有:部分切除囊壁或未清理残存在眶骨缝中的囊壁16例;误诊为皮下肿物盲目手术11例;术前未行影像学检查8例等.所有患者行CT检查,显示囊肿可呈低或中等密度,常见征象有:囊肿发生在颧额缝附近,呈哑铃形8例,骨内隧道盲端细长迂曲6例,眶壁大面积骨质呈波浪状压迹6例.28例行手术治疗,彻底清除囊壁和内容物后,随访1至9年,均无再次复发,保守观察2例,所有患者无严重并发症.结论 眼眶皮样囊肿复发与术者经验不足、手术不彻底等因素有关,具有典型的临床表现和影像学特征.根据影像学检查精确定位,术中综合运用多种手术技巧,可有效避免复发.     

眶上裂外侧区和中央区的手术应用显微解剖

目的　为眶上裂区手术提供应用显微解剖学基础。方法　观测 3 0例 ( 60眼 )成人头颅干标本眶上裂骨性结构 ;在手术显微镜下观测 2 0例 ( 4 0眼 )成人头颅湿标本眶上裂区穿行的神经、血管位置及毗邻关系。结果　眶上裂外壁上、下半边夹角为 14 4 2 7°± 2 0 0 3° ;滑车神经和动眼神经上支距眶上裂上壁下缘分别为 ( 0 3 5± 0 12 )mm和 ( 0 3 9± 0 2 2 )mm ;眼上静脉颅中窝段具有静脉窦结构。结论　眶上裂穿行结构的位置恒定 ,对该区外伤及肿瘤的手术诊治有参考意义。     

眼眶血肿的临床和影像学分析

目的:研究眼眶血肿的临床和影像学表现,为临床诊断和治疗提供依据。方法:收集我科近4a(2006-08/2010-10)住院患者,对其病因、临床特点及影像学表现进行分析。结果:眼眶血肿患者10例,其中1例有明确外伤史,所有患者均表现为眼球突出,不同程度的视力下降,眼球运动障碍。血肿位于肌锥内CT表现为锥形高密度影,前部则表现为类圆形。B超4d内显示为密集回声的实性病变,>4d则表现为低回声区,个别内部有回声间隔,CDFI肿瘤内部无血流信号,1例行MRI符合亚急性出血表现。出血7d内手术的患者血肿内可见血凝块。结论:眼眶血肿起病突然,多无明确诱因,结合病史、症状、体征和CT和B超及MRI检查基本可以确诊,对于保守治疗症状无好转的患者,可以手术治疗,预后良好。     

Primary replacement for the management of exposed orbital implant

Purpose: We present a series of primary orbital implant replacement for cases of implant exposure to describe our experience of this one-staged surgical approach.

Methods: This study reports on a one-stage technique which involved the removal of the exposed implant or dermis fat graft (DFG) and insertion of a secondary (replacement) in the same procedure, with a variety of materials, including autologous tissue. Re-exposure in a socket where a DFG was placed was defined as a new defect in the newly epithelialized conjunctiva or dehiscence of the dermis-conjunctiva junction. All cases of primary replacement for the management of exposed orbital implant, porous and non-porous, were included, even when there were clinical signs suggestive of infection. The primary outcome was the rate of re-exposure, requiring additional surgical procedures. Infection following primary replacement was a secondary outcome.

Results: Seventy-eight patients had primary replacement for the management of an exposed orbital implant. 6.4% had re-exposure at a mean follow-up of 49.7 months (9.1% for ball implants and 4.5% for DFG). The rate of exposure was higher in those with prior signs of infection than those without (8% vs. 3.6%). Re-exposure occurred in 4.5% of cases with DFG implantation, 4.3% of cases with non-porous implants and in 20% of cases with porous implants.

Conclusion: Primary replacement for management of exposed orbital implant, porous and non-porous, has a high rate of successful outcome even in cases with presumed or confirmed infection.     

65例眼眶转移性肿瘤原发病灶的回顾性分析

目的 研究眼眶转移性肿瘤的原发疾病种类、临床特征及预后。设计 回顾性病例系列。研究对象 2005-2017年解放军第三医学中心经病理学确诊的眼眶转移性肿瘤患者65例。方法 回顾分析患者的临床资料。主要指标 性别、年龄、眼别、原发肿瘤部位。结果 65例患者中,男性38例。就诊时中位数年龄46岁（0.6~83岁）。右眼26例,左眼29例,双眼10例（神经母细胞瘤3例、白血病3例、乳腺癌3例、胃肠道肿瘤1例）。肿瘤原发部位分别为乳腺12例、肺部11例、白血病10例、肾上腺8例、胃肠道6例、肝脏4例、肾脏2例、胸腺2例,膀胱、前列腺、子宫、关节、皮肤各1例,5例来源不明。成年人原发肿瘤较多的为乳腺癌、肺癌和胃肠道肿瘤。结论 本研究中眼眶转移性肿瘤患者年龄分布较广,成年人前三位原发肿瘤为乳腺癌、肺癌和胃肠道肿瘤。（眼科, 2020, 29： 396-399）     

羟基磷灰石义眼座Ⅰ期与Ⅱ期钻孔效果的比较

目的比较羟基磷灰石义眼座植入Ⅰ期钻孔与Ⅱ期钻孔放置钛钉的手术效果。方法对101例羟基磷灰石义眼座Ⅰ期钻孔及158例羟基磷灰石义眼座Ⅱ期钻孔放置钛钉者行回顾性研究。结果Ⅰ期与Ⅱ期钻孔者对其外观及活动度均满意,无义眼座暴露、继发感染或栓钉脱出等并发症。Ⅰ期钻孔101例,随访3～50月,义眼的活动度为44.8°±2.9°。Ⅱ期钻孔158例,随防6～60月,活动度为42.4°±3.8°。结论Ⅰ期和Ⅱ期钻孔手术在效果和并发症上无明显差别。     

眼眶淋巴瘤的磁共振成像特征

目的 分析眼眶淋巴瘤在MR常规序列、DWI及动态增强检查中的影像特征,探讨磁共振对眼眶淋巴瘤诊断的价值。设计 回顾性病例系列。研究对象 21例病理证实为原发性眼眶淋巴瘤患者的眼眶磁共振资料。 方法 所有患者均行T1WI、T2WI及T1WI压脂增强检查,8例（9眶）行动态增强、3例（4眶）行DWI检查。主要指标 病灶位置及范围、形态、界限、与周围结构关系、信号特征、动态增强曲线特征。 结果  单侧发病17例、双侧发病4例,共25眶;16眶病变范围局限、9眶病变弥漫;病变位于眶隔前区6眶,泪腺区7眶,肌锥内6眶,肌锥区4眶,肌锥外12眶,视神经区2眶,骨膜下区1眶;病灶呈结节状10眶、铸型9眶、条片状2眶,7眶为眼外肌或视神经增粗或被包绕;病变界限清楚者13眶、界限不清者12眶;T1WI等信号23眶、稍低信号2眶,T2WI等信号19眶、稍高信号1眶、稍低信号5眶;4眶病灶DWI均呈等信号;增强扫描均匀明显强化者24眶,裂隙状不均匀明显强化者1眶;动态增强时间信号曲线呈平台型7眶,流入-流出型9眶,以上两种类型混合存在1眶。 结论  MR常规序列能够清晰显示眼眶淋巴瘤的位置、形态、内部特征及与周围器官的关系。DWI及动态增强可反映病灶的良恶性及恶性程度。（眼科, 2016, 25: 371-375）     

Predicting the prognosis of primary orbital lymphoma by clinical characteristics and imaging features

AIM: To analyze the 5-year disease-free survival (DFS) of primary orbital lymphoma (POL) by clinical characteristics and imaging features. METHODS: A total of 72 patients, 43 males and 29 females, with histologically confirmed POL, were retrospectively recruited between January 2012 and May 2017. The information on clinical characteristics, imaging features, and 5-year DFS was obtained. Univariate and multivariate forward logistic regression analyses were used to identify the variables significantly associated with 5-year DFS. Kaplan-Meier was applied for survival analysis. RESULTS: Univariate analysis revealed that uni- or bilateral orbital involvement, single or multiple lesions, treatment methods, and contrast enhancement pattern on images were significant for 5-year DFS (P=0.022, 0.042, <0.001, and 0.028, respectively), while in multivariate logistic regression analysis, only uni- or bilateral orbital involvement, treatment methods and contrast enhancement pattern on images were significant (r=0.453, 0.897, and 0.556, P=0.038, <0.001 and 0.022, respectively). The survival curves for DFS were obtained. CONCLUSION: The majority of POL are B-cell lymphomas. Unilateral orbital involvement, homogeneous contrast enhancement on images, and the appropriate treatment schemes result to be significant factors for a good prognosis for POL.