眼上静脉扩张的影像学诊断意义

目的：探讨超声,CT及MRI检查在眼上静脉扩张及其病因诊断中的意义。方法：对1984－2000年临床资料完善的116例（232只眼）伴眼上静脉扩张患者进行回顾性分析。结果：发现多种疾病均可引起眼上静脉扩张,颈动脉－海绵窦瘘是导致眼上静脉扩张的主要疾病。其中颈动脉－海绵窦瘘92例（包括高和低流瘘）,眼型Graves病14例,眶尖炎症2例,Tolosa-Hunt综合征2例,眼部血管畸形2例,眶炎性假瘤、眶内血肿、海绵窦肿瘤及海绵窦血栓形成各1例。扩张的眼上静脉直径为3．5－7．0mm,各病种眼上静脉管径扩张大小无明显差异,但颈动脉－海绵窦瘘眼上静脉最粗7．0mm。影像学检查同时能发现眼外肌肥大、眶部病变及海绵窦膨大等相关影像学表现。结论：超声、CT及MRI检查均能良好显示眼上静脉扩张,综合其他影像学表现,可确定眼上静脉扩张的病因。     

眼眶动静脉畸形的诊断与治疗

眼眶动静脉畸形的诊断与治疗湖南医科大学附属第三医院眼科（４１００１３）陈国平聂爱光徐丽明唐仁泓由颈外动脉系统的某一动脉分支畸形扩张所致的眼眶动静脉畸形的诊断和治疗国内尚未见报道，现将我院近来收治的３例病人报告如下：临床资料１．一般资料：我院自１９９３...     

经眼上静脉治疗海绵窦动静脉瘘二例

海绵窦动静脉瘘 ,又称颈动脉海绵窦瘘 (caroridcavernoussi nusfistula)患者因眼部症状就诊眼科时偶而被漏诊或误诊。本文就我科最近接诊的两例海绵窦动静脉瘘患者的诊治进行报告。患者 1,男 ,53岁。因双眼复视 ,左眼球突出 2月 ,于 2 0 0 1年10月 8日入院。入院查体见视力双眼均为 1 0 ,左眼外展受限 ,左眼睑可闻及吹风样杂音 ,球结膜充血 ,屈光间质透明。眼底 :C/D为 0 3 ,视网膜无水肿出血 ,血管无异常改变。右眼未见异常。眼球突出度 :右眼 14mm ,左眼 19mm ,眶距 10 0mm。眼部B超提示左眼静脉血管瘘。眼部MRI检查提示眼上静脉曲张…     

眼眶静脉畸形发病机制研究进展

眼眶静脉畸形(OVM)是成人最常见的眼部脉管畸形,可导致患者外观和视力损害。TIE2、PI3KCA等基因突变与信号传导通路异常激活,使血管内皮细胞和多种细胞外基质蛋白结构异常,与静脉畸形的发生密切相关。本文通过对基因突变、信号通路在静脉畸形发生中的作用进行回顾,系统总结静脉畸形的发病机制研究。     

眼眶静脉畸形的治疗进展

眼眶静脉畸形临床上可分为扩张型和非扩张型。眼眶静脉畸形的治疗除了手术切除外,栓塞治疗、硬化剂治疗和翻瓣激光治疗是近几年发展起来的微创治疗方法,本文就眼眶静脉畸形的治疗进展作一综述。     

右眼内眦复杂动静脉畸形影像学诊断一例

患者女, 39岁,发现右眼内眦肿块并逐渐增大 14年。2个月前发现肿块压痛,眼肿胀不适,易流泪。查体:右眼内眦上方可见结节状扁平隆起,直径 1~2cm,表皮颜色正常,触及柔软,有搏动感,眉弓上方也可触及皮下迂曲扩张的血管并有搏动感,可闻及吹风样血管杂音。彩色超声检查示右眼内眦有一 10mm×9mm无回声区,其后方有一最宽处约 5mm管状回声与无回声区相连。彩色多普勒血流显像检查探及无回声区内为高速低阻动脉频谱。螺旋CT示脑组织正常,右眼球内上方见一不规则软组织密度影,呈不均匀明显强化,CT值 135 2Hu,临近骨质结构正常,右眼环完整。左右…     

眼眶静脉畸形及淋巴管瘤的诊断治疗进展

静脉畸形是最常见的眼眶血管性病变之一,淋巴管畸形相对罕见.但二者具有共同的静脉起源.根据1999年国际眼眶病学会依据血流动力学特点对眼眶血管畸形的新分类方法,眼眶静脉畸形和淋巴管畸形分别属于静脉血流和无血流来源的血管畸形.诊断方法包括B超、CT、MRI、静脉造影等,随着现代影像学技术的进步,不仅丰富和提高了传统的影像诊断技术,DSA、CTA、MRA等更先进影像学手段应用于临床,也促进了介入栓塞技术的发展和应用,治疗已从过去单一的手术切除转向多联合栓塞、多学科综合治疗模式.在对病变认识更清楚直观的基础上,治疗更安全.     

手术联合掺钕钇铝石榴石激光治疗眼眶静脉畸形

目的 探讨手术切除联合掺钕钇铝石榴石激光(Nd:YAG)凝固治疗眼眶静脉畸形的有效性和安全性.方法 回顾性系列病例研究.采用手术切除联合激光凝固的方法治疗眼眶静脉畸形患者17例.全身麻醉,根据瘤体部位、大小、与眼外肌和毗邻神经的关系,选择适当的手术径路,充分暴露瘤体,手术切除和激光凝固交替进行.激光凝固方式包括小剂量短时光凝和连续光凝,前者能量密度设定为60～80 J/cm2,后者能量密度不超过90～100 J/cm2.体积小、病变深,周围有重要的神经或血管时采用小剂量短时光凝;体积大、易暴露,且距重要的组织较远时用连续光凝.光凝后立即用低温生理盐水冲洗光凝部位予以降温,防止损伤周围正常组织.结果 术后随访12～26个月,17例患者中疗效显著15例(88.24%),有效2例(11.76%),总有效率100%.术后所有患者无视力下降(2例视力提高),眼球突出完全矫正,其中4例出现眼球内陷,眼球运动明显改善.并发症包括:上斜肌麻痹1例,上睑下垂1例.随访期内无一例复发或残存病变增大.结论 手术联合Nd:YAG激光治疗眼眶静脉畸形是安全和有效的.激光凝固可减少术中出血,简便手术操作,降低手术风险,提高手术疗效.(中华眼科杂志,2008,44:681-686)     

眼眶畸形整复联合义眼座Ⅱ期植入的临床研究

目的通过对眼球摘除后伴眼眶畸形患者的手术及术后随访观察,研究眼眶畸形整复联合义眼座Ⅱ期植入的临床可行性。方法对17例(17只眼)眼球摘除术后伴眼眶畸形的患者实施Ⅱ期义眼座植入,并同期利用自体或人工修复填充材料同期行眼眶畸形整复术。结果 17例患者术后眼眶饱满,效果满意。无植入物排斥、感染、暴露等并发症产生。结论眼眶整复术联合义眼座Ⅱ期植入具有临床可行性。     

Septic superior ophthalmic vein thrombosis

An illustrative case of septic superior ophthalmic vein thrombosis secondary to a staphylococcus orbital cellulitis is presented and correlated with autopsy findings. A literature review and discussion of the risks and benefits of anti­coagulation in this setting is outlined.     

Spontaneous superior ophthalmic vein thrombosis: a rare entity with potentially devastating consequences

Purpose

Spontaneous superior ophthalmic vein thrombosis (SOVT) is a rare entity. We describe three patients with spontaneous ophthalmic vein thrombosis, each with various risk factors.

Patients and Methods

A retrospective review of three patients with a diagnosis of superior ophthalmic vein thrombosis. Clinical characteristics, radiographic features, management techniques and outcomes are described.

Results

All patients presented with unilateral painful proptosis. Two patients had intact light perception, whereas one patient presented with absent light perception. All patients had identifiable risk factors for thrombosis, which included sickle cell trait, hereditary hemorrhagic telangectasia and colon cancer with recurrent deep vein thrombosis. Anticoagulation was initiated in two patients. Resolution of proptosis was seen in all patients, with no recovery of vision in one patient.

Conclusions

Risk factors for spontaneous superior ophthalmic vein thrombosis are multifactorial. MRI and MRV confirm the diagnosis of SOVT. Despite urgent intervention devastating visual loss may occur.     

Impact of superior ophthalmic vein thrombosis: a case series and literature review

Purpose: To present nine new cases of superior ophthalmic vein thrombosis (SOVT) and compare these with the literature, and to assess the impact of SOVT for the clinician.

Methods: Using the data bases of the Department of Ophthalmology of the AMC, we searched for patients with radiologically evidenced SOVT between January 2006 and December 2014. In addition, a PubMed search, using the mesh term ‘superior ophthalmic vein thrombosis’, was done.

Results: We found nine patients with SOVT. In three patients, SOVT was related to dural arteriovenous fistulae. In one patient, it was caused by the acute reversal of warfarin by vitamin K. In two patients, an infectious cause was found. In three patients, the cause of SOVT was not found despite screening for coagulation and other disorders. All patients presented with eyelid swelling, proptosis, and/or motility impairment. We found complete recovery in four patients. Three patients had mild sequelae and two patients had severe visual impairment. In the literature, we found 60 cases reporting on SOVT with various aetiologies. Clinical presentation, treatment modalities, and outcomes were comparable to our findings.

Conclusion: Our case series and literature review show that SOVT can occur simultaneously with cavernous sinus thrombosis (CST) but can also be a separate entity. Clinical presentation can mimic orbital cellulitis (OC) or CST and when no signs of OC can be found, an alternative cause for SOVT should be sought. When timely and adequate treatment is conducted, the prognosis is predominantly favourable.     

Embolization of carotid cavernous fistulas via the superior ophthalmic vein

Background: Carotid cavernous fistulae are treatable by various means, one of which is embolization via the superior ophthalmic vein (SOV). The use of this technique over the past 12 years at the Royal Melbourne Hospital, Victoria, Australia, is reviewed.
Methods: Five patients with carotid cavernous fistulas were treated with embolization of the fistula via the surgically isolated SOV.
Results: Each patient had successful endovascular closure of the fistula using embolization via the SOV approach.
Conclusions: Treatment of certain types of carotid cavernous fistulas that cannot be closed by the conventional endovascular (arterial and venous) approaches can be successfully closed by using a transvenous approach through the SOV     

经眼上静脉栓塞治疗难治性颈内动脉海绵窦瘘的短期疗效观察

目的 探讨经眼上静脉栓塞治疗难治性颈内动脉海绵窦瘘的临床疗效.设计回顾性病例系列.研究对象11例经全脑血管数字减影确诊的颈内动脉海绵窦瘘患者,均为传统动脉入路治疗失败或复发者.方法 所有患者均行经眼上静脉微弹簧圈或液体胶栓塞治疗.主要指标视力、眼球突出度、眼球运动、复视、结膜充血、眼底改变.结果 随访1周～3个月,11例患者均临床治愈.6例患者突眼消失,5例改善;8例结膜充血消失,3例减轻;3例视力下降患者中,1例恢复正常,2例提高;颅内杂音及复视全部消失,眼球运动恢复正常.结论 多学科合作经眼上静脉栓塞介入治疗难治性颈内动脉海绵窦瘘是一种安全、有效的治疗方法.     

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。     

Color Doppler imaging of the superior ophthalmic vein in different clinical forms of Graves’ orbitopathy

Purpose  To compare color Doppler imaging (CDI) parameters of the superior ophthalmic vein (SOV) in patients with Graves’ orbitopathy (GO) and in normal controls. Methods  Forty-three GO patients and 14 normal controls underwent CDI of the SOV. Patients had either fibrotic (lipogenic or myogenic) or congestive orbitopathy. The findings for each group were compared. Results  Fifty-eight orbits with fibrotic orbitopathy, 28 with congestive orbitopathy, and 28 from controls, were studied. In the congestive group, SOV flow was detected in 13, undetectable in 11, and reversed in four orbits; in the fibrotic group, it was present in 41 and undetectable in 17 orbits. In normal controls, SOV flow was detected in 25 and undetectable in three orbits. The differences among the three groups were significant. There was also a significant difference between controls and the congestive GO orbits but not between the fibrotic group and the other two groups. Fibrotic myogenic orbitopathy patients displayed a significantly smaller SOV flow than patients with lipogenic orbitopathy. Conclusions  SOV was significantly reduced in orbits with congestive GO or with myogenic fibrotic GO, but not in orbits with fibrotic lipogenic orbitopathy. SOV congestion may be a contributing pathogenic factor in both congestive and fibrotic myogenic Graves’ orbitopathy.     

Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy

AIM: To evaluate the efficacy and safety of orbital decomposition (OD) surgery in combination with horse chestnut seed extract (HCSE), as compared to OD alone, in patients with thyroid-associated ophthalmopathy (TAO). METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD+HCSE at 1:1 ratio (31 received OD alone, 31 received OD+HCSE). Forty-two orbits from 21 healthy subjects were used as controls. Complete ophthalmic examination and color Doppler flow imaging (CDFI) were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients. CDFI were also performed on the 42 control orbits. The effect of OD+HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow (SOVBF) parameters, subjective assessment, soft tissue involvement, lid retraction, diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters. RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement, decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD+HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity (P<0.0001). CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis. OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.