动脉瘤性蛛网膜下腔出血致Terson综合征的发生率及其相关因素分析

目的 探讨颅内动脉瘤性蛛网膜下腔出血(SAH)所致Terson综合征的发生率及其相关危险因素.方法 临床病例系列研究.对2009年11月至2010年5月确诊的101例(202只眼)SAH患者进行连续临床观察.所有患者在首次检查时均行直接检眼镜检查,诊断为Terson综合征的患者待其病情稳定后行双眼散瞳检查并拍摄眼底彩色照片.患者性别、年龄、意识状态、格拉斯哥昏迷评分(GCS)、Hunt-Hess分级和动脉瘤位置等与Terson综合征发生的相关因素分析采用x2检验.结果 101例动脉瘤性SAH患者中,发生Terson综合征者15例(14.8％),其中女性10例(10/58,17.2％),男性5例(5/43,11.6％),性别间Terson综合征发生率差异无统计学意义(x2=0.615,P＞0.05).意识障碍组患者31例,有12例(38.7％)发生Terson综合征,其发生率明显高于神志清醒组( 3/70,4.3％),差异有统计学意义(x2=17.503,P＜0.05).GCS评分＜8者Terson综合征发生率(6/14,42.8％)明显高于GCS评分≥8者(9/87,10.3％),差异有统计学意义(x2=7.673,P＜0.05).Hunt-Hess分级＞Ⅲ级者Terson综合征发生率(7/16,43.8％)明显高于≤Ⅲ级者(8/85,9.4％),差异有统计学意义(x2=9.987,P＜0.05).由此表明意识障碍、GCS评分较低及Hunt-Hess分级较高的患者Terson综合征发生率较高;但与动脉瘤的发生位置无相关性(x2 =0.000,P＞0.05).随访期间发现有1例患者需行玻璃体切除术治疗.结论 动脉瘤性SAH患者Terson综合征的发生率较高,与患者的全身情况明显相关.对意识障碍、GCS评分较低和Hunt-Hess分级较高的患者应重视眼部常规检查.多数Terson综合征患者的眼内出血可自行吸收,仅少数患者需手术治疗.     

玻璃体切割术治疗Terson综合征的临床分析

目的:探讨Terson综合征患者玻璃体与视网膜的病变特征,评价玻璃体切割术治疗Terson综合征的疗效。方法:应用玻璃体切割术治疗Terson综合征患者9例12眼,回顾分析Terson综合征患者的临床特点及玻璃体切割术治疗后的疗效。结果:术后大部分患者玻璃体腔清晰,所有患者术后视力较术前均有2行以上的提高,本组病例随访未发现严重并发症。结论:玻璃体切割术是治疗Terson综合征安全有效的方法之一,能迅速恢复患者的视力。     

玻璃体切割术治疗Terson综合征

目的:探讨Terson综合征患者玻璃体与视网膜的病变特征,评价玻璃体切割术在治疗Terson综合征中的作用.方法:应用玻璃体切割术,部分病例配合气液交换,球内光凝等治疗Terson综合征6例10眼.结果:所有患者术后玻璃体腔清晰,视力较术前均有不同程度提高.5眼视力在0.7以上.结论:玻璃体切割术治疗Terson综合征玻璃体出血安全有效,能尽早恢复患者的视力.     

Terson综合征经玻璃体切割手术的疗效分析

目的探讨玻璃体切割术在Terson综合征中的应用疗效。方法回顾性分析2011年4月至2014年3月经我科确诊的13例Terson综合征患者的17只眼行玻璃体切割手术的疗效。结果13例患者的17只眼经玻璃体切割手术治疗后,视力均有不同程度的提高,至目前无一例发生术后并发症。结论玻璃体切割手术对于Terson综合征患者而言安全有效。故临床医生需尽早明确诊断,若病情许可,宜早日手术,以避免部分患者视力发生永久性损伤。     

48例Terson综合征临床分析

目的探讨Terson综合征的诊断、鉴别诊断及治疗。方法回顾性研究2006至2010年确诊的Ter-son综合征48例,分析其临床特点、实验室检查、影像学表现、治疗效果及预后。结果 48例患者中45例接受手术,其中25例为发病2个月内治疗,治疗上早期使用玻璃体切除加眼内激光光凝术及气液交换术效果满意,另外20例于发病2个月后手术,结果术后视力恢复较差。术后3个月视力回复到0.3以上者前组为21例,后组为0例,两组经过t检验P值﹤0.05,有统计学意义。而3例未接受手术患者经复方血栓通、沃丽汀等保守治疗后视力有一定程度提高,但玻璃体混浊无法完全清除。结论 Terson综合征是由于颅内压增高引起玻璃体积血,B超检查有价值,早期使用玻璃体切除术加眼内激光光凝术,必要时加气液交换术及硅油填充术效果满意。     

急诊入院的自发性蛛网膜下腔出血患者中Terson综合征的临床研究

目的 了解急诊入院3h内自发性蛛网膜下腔出血(SSAH)患者Terson综合征的发病情况及其相关因素,分析眼内出血与患者病情的关系.方法 前瞻性研究.74例连续的急诊入院并确诊为SSAH的患者纳入研究.患者均于入院3h内行眼底检查,情况允许者行眼底照相.首次眼底检查的同时由脑外科医师对其做Hunt-Hess分级.分别在入院后1、3、7d,2周,1、3个月时检查眼底.记录患者性别、年龄、Hunt-Hess分级、眼底出血类型、是否死亡等资料.分析Terson综合征的发病比例及其与年龄、性别、Hunt-Hess分级的关系,以及不同类型眼内出血与Hunt-Hess分级及死亡率的关系.结果 74例SSAH患者中,19例31只眼发生Terson综合征,发病比例为25.7％.Terson综合征与非Terson综合征患者性别构成比比较,差异无统计学意义(x2=0.071,P=0.790);年龄构成比比较,差异无统计学意义(P=0.203);Hunt-Hess分级构成比比较,差异有统计学意义(P=0.000).视网膜前出血与玻璃体积血的患者和视网膜内出血的患者中Hunt-Hess分级V级所占比例比较,差异有统计学意义(P=0.041).眼内出血均在首次眼底检查中发现.Terson综合征患者死亡13例,死亡率为68.4％.视网膜前出血与玻璃体积血患者和视网膜内出血患者的死亡率比较,差异有统计学意义(P=0.046).存活的6例Terson综合征患者中,4例患者眼底出血自行吸收,2例患者行玻璃体切割手术.结论 急诊入院的SSAH患者Terson综合征发病比例为25.7％.其发生与患者性别、年龄无关,与全身情况有关.眼内出血均发生在SSAH急性期.眼内出血重的患者全身情况差,死亡率高.     

影像学检查在Terson综合征眼部检查中的应用

Terson综合征不是在眼科首诊的常见疾病,但是伴随玻璃体出血的Terson综合征患者病死率却很高,所以早期诊断Terson综合征对判断预后极为重要,而超声检查在Terson综合征的诊断中有独特的价值,本文主要对影像学检查在Terson综合征眼部检查中的应用作一综述。     

双眼Terson综合征1例

0引言蛛网膜下腔出血引起的玻璃体积血称为Terson综合征。也有少部分玻璃体积血继发于硬脑膜下的出血,但这种情况少见。Terson于1900年首先报道[1],但目前许多文献认为Terson综合征的定义应扩大为各种原因所致颅内出血合并眼内出血。2012-3-22我院收治1例Terson综合征患者,行手术治疗,术后患者视力恢复较好,现报告如下。1病例报告患者,男,52岁,因"突发抽搐、昏迷10余分钟"于2012-02-23急送当地医院抢救。急查头颅CT示:蛛网膜下腔出血。患者既往高血压病史10余年,未规律服药治     

太尔松(Terson)综合征手术效果及发病机制

目的:分析太尔松(Terson)综合征手术效果及发病机制。方法:回顾性分析山西医科大学第一医院2017年9月至2019年10月玻璃体切除术治疗Terson综合征10例(18眼)的临床资料,比较术前与术后视力、不同的手术时机与疗效的关系,分析Terson综合征的发病机制。结果:术后1个月视力(BCVA,log MAR)为...     

玻璃体切除术治疗Terson综合征的临床疗效研究

目的:探讨、评价并分析玻璃体切除术治疗Terson综合征的临床疗效。方法:对11例12眼Terson综合征患者进行玻璃体切除术治疗,根据术中视网膜情况辅以剥膜、硅油充填。结果:术后所有患者12眼玻璃体腔清晰,视力较术前明显提高,其中8眼(67%)术后视力0.4～0.7。随访3mo,仅1眼发生晶状体混浊。结论:玻璃体切除术是治疗Terson综合征的有效方法。早期手术治疗,患者术后视力恢复较理想,且术后并发症发生率较低。     

Mastication Induced Retrobulbar Hemorrhage

Abstract

Retrobulbar hemorrhage is a feared potentially sight threatening complication after orbital decompression surgery. We present a patient, 36 hours after surgery, while forcefully biting, suddenly developed a retrobulbar hemorrhage arising from the temporalis muscle causing an orbital compartment syndrome. Rapid intervention with canthotomy and cantholysis was associated with recovery of vision from absent light perception to 20/20. A mastication induced retrobulbar hemorrhage has not been previously described.     

視盤周圍視網膜脈絡膜出血

目的探討視盤周圍視網膜脈胳膜出血(peripapillary retinal choroid hemorrhage,PPRCH)的發病原因及臨床特點、鑒别診斷和PPRCH患者視網膜新生血管的治療.方法對17例18眼PPRCH患者的臨床表現及眼底熒光血管造影(fundus luoresceinangiography,FFA)等臨床資料作回顧性分析.結果 17例均爲中度以下近視,平均年齡24歲,16例單眼發病.PPRCH分4種類型4例視盤表面出血.6例(7眼)視盤出血伴PPRCH.4例PPRCH,3例PPRCH伴玻璃體出血,其中出血及新生血管波及黄斑1例.FFA顯示PPRCH爲遮蔽熒光,患者2周至6個月出血全部吸收,其中1例視網膜新生血管行激光治療,半年后出血吸收.結論根據臨床及FFA表現,我們推測,PPRCH是視盤埋藏性玻璃疣的視網膜并發症.     

视网膜脱离复位术并发大量视网膜下及玻璃体积血手术治疗

目的：探讨巩膜外扣带术（scleral buckling procedures,SBP)并发大量视网膜下及玻璃体积血（subretinal and vitreous hemorrhage)手术治疗方法及疗效。方法：回顾性分析SBP并发视网膜下及玻璃体积血7例患得7只患眼,出血后2-8周经睫状体扁平部巩膜一切口玻璃体切除。剥离玻璃体后皮质,视网膜切开及清除视网膜下积血,硅油或气体填充等手术治疗后,随访时间4-12月（平均6个月）的临床资料,结果：3只患眼（42.9%)术后发生视网膜前纤维增殖,经过了二次增殖膜剥离手术治疗,最后随诊7只患眼视网膜均得到良好复位;视力≥0.1者6只眼,占85.7%,最好矫正视力为0.4。结论：玻璃体视网膜手术能有效清除SBP并发大量视网膜下及玻璃体积血,但血浆成份的不彻底清除而易发生视网膜纤维增殖。     

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage is a feared complication of all types of intraocular surgery. Although rare, it is typically associated with severe visual disability, and this has prompted efforts to better understand the pathogenesis of this condition, to identify the patients at risk for this event, and to improve treatment of patients who develop this condition either intraoperatively or postoperatively. Controversy still exists regarding the best course of treatment for these patients. Although the introduction of perfluorocarbon liquids as a surgical adjunct during vitrectomy surgery may assist in the removal of suprachoroidal hemorrhage, the visual outcomes still remain disappointing.     

Spontaneous Subperiosteal Orbital Hemorrhage

Abstract

Subperiosteal orbital hemorrhage typically results from trauma. Spontaneous subperiosteal orbital hemorrhage (SSOH) is rare and has been reported with sudden elevation of cranial venous pressure, bleeding diathesis, and sinusitis. This article presents a series of 9 patients (11 orbits) with SSOH and review the associated systemic conditions. 10 out of 11 orbits (91%) underwent surgical intervention due to advanced orbital signs or poor vision.     

Terson综合征的病理机制研究进展

Terson综合征是因外伤、颅内血管性病变等造成蛛网膜下腔出血后引起玻璃体积血的一种眼-脑综合征,目前蛛网膜下腔出血引起玻璃体积血的病理机制尚未阐明,主要有颅内出血直接进入眼内和颅压升高致眼内血管破裂出血两种学说.玻璃体出血可能是由于颅内压增高推动大量血液进入视乳头附近的玻璃体腔内所致,而眼内血液可能播散于内界膜下和视网膜内.深入了解Ter-son综合征的病理机制的研究现状,为进一步解答Terson综合症的病理机制提供研究思路,同时为该病治疗时机的选择和预后评估提供理论依据.     

Cirrhosis-related Coagulopathy Resulting in Disseminated Intravascular Coagulation and Spontaneous Orbital Hemorrhages

Abstract

A 33-year-old patient presented to our Emergency Department (ED) with left-sided eyelid ecchymoses and edema. A CT scan of the orbits demonstrated a left retrobulbar hemorrhage, prompting an ophthalmology consultation. Upon examination, the patient reported worsening eye pain and decreasing vision in the left eye. Despite aggressive management with superior and inferior lateral canthotomy/cantholysis with placement of an orbital drain, visual loss occurred, and the patient ultimately expired from her systemic condition. Coagulopathy from liver disease resulting in systemic hemorrhage is commonly seen. Orbital hemorrhage in this setting requires emergent diagnosis and management to prevent irreversible compressive optic neuropathy.     

Is Iba-1 protein expression a sensitive marker for microglia activation in experimental diabetic retinopathy?

AIM:To investigate the changes of Iba-1 and other potential markers for microglia activation in experimental diabetic retinopathy(DR).METHODS:Male Sprague-Dawley rats were rendered diabetes via intraperitoneal injection of streptozotocin.The retinas were harvested at 1 to 24 wk after diabetes onset.Hypoxia-treated mouse microglial cell line(BV2 cells)was employed as the in vitro model to mimic diabetic condition.The expressions of Iba-1,CD11 b,ICAM-1 as well as the inflammatory factors were examined with real-time polymerase chain reaction,Western blot and immunofluorescence both in vivo and in vitro.RESULTS:Compared with age-matched normal control,the number of microglia(Iba-1 positive immunostaining)in diabetic rat retinas was increased from 1 to 24 wk of diabetes,which was most obvious at 12 wk of diabetes.Iba-1 protein expression detected by Western blot was increased slightly in diabetic rat retinas compared with that in age-matched normal control;however,there was statistically significant between two groups only at 2 wk after diabetes onset.The m RNA expression of Iba-1 was decreased significantly at 2 and 4 wk of diabetic rat retinas,and remained unchanged at 8 and 12 wk of diabetes.In BV2 cells,there was no significant change for the Iba-1 protein expression between normoxia and hypoxia groups;however,its m RNA level was decreased significantly under hypoxia.To further characterize microglial activation,F4/80,CD11 b and inflammatory factors were detected both in vivo and in vitro.Compared with normal control,the expressions of F4/80 and CD11 b as well as the inflammatory factors,such as ICAM-1,i NOS,COX2,IL-1βand IL-6,were increased significantly both in vivo and in vitro.CONCLUSION:Iba-1 protein expression might not be a sensitive marker to evaluate the activation of microglia in experimental DR.However,Iba-1 immunostaining,in combination with other markers like CD11 b and ICAM-1,could be well reflect the activation of microglia.Thus,it is of great importance to explore other potential marker to evaluate the activation of microglia.