129例眼内肿瘤的临床病理和误诊分析

目的 通过分析眼内肿瘤的临床特征、病理分类和误诊原因，为临床提供诊断和治疗依据。方法 对我院病理科于1980-12002．6期间收检的129例临床诊断为眼内肿瘤的病例资料进行回顾性分析。结果 经病理证实为恶性肿瘤102例，其中视网膜母细胞瘤64例，葡萄膜恶性黑色素瘤36例，脉络膜转移性瘤2例；良性肿瘤7例；非肿瘤性病变20例，误诊率为20．93％(27／129)。结论 对眼内肿瘤进行临床和病理分析，有助于眼科临床医师作出正确的诊断和治疗。     

眼内异物的B型超声扫描诊断分析

目的：分析眼异物在B型超声扫描探查中的声像学特点及定位的优势，为临床诊断提供依据。方法：采用眼科专用A、B型两用超声波扫描仪，对38例眼异物进行探查。结果：本组38例中32例经B超探查发现异物回声，异物检出率为84．2％（32／38）其中眼内异物22例（57．9％）；眼球壁异物9例（23．7％）；眶内异物1例（2．6％）。有30例行X光或CT检查，结果23例发现异物，异物检出率为76．6％（23／30），其中眼内异物16例（53．3％）；球壁异物4例（13．3％）；眶内异物3例（10．0％）。结论：B型超声探查对于眼内异物，特别是眼球壁异物具有特异性的诊断价值。     

视网膜母细胞瘤的彩色多普勒超声诊断分析

视网膜母细胞瘤的彩色多普勒超声诊断分析王兰杨文利胡士敏王景昭【关键词】视网膜母细胞瘤／超声检查超声检查，多普勒，彩色中国图书资料分类法分类号Ｒ７３９．７Ｒ７７０．４２６．４３视网膜母细胞瘤（ｒｅｔｉｎｏｂｌａｓｔｏｍａ，ＲＢ）是婴幼儿常见的眼内恶性肿...     

视网膜母细胞瘤的CT表现及临床价值

目的 探讨视网膜母细胞瘤的CT表现在其诊断、鉴别诊断中的价值。方法 回顾分析27例经病理或临床证实的视网膜母细胞瘤的CT表现。结果 视网膜母细胞瘤CT表现：27例均以眼球后部软组织肿块为特征，其中24例(25只眼)肿块内伴钙化；3例肿块无钙化，可见斑点状、斑片状低密度坏死及囊变。结论 CT可以显示肿瘤的形态、大小、内部特征及累及范围，有助于诊断和鉴别诊断。     

38例视网膜母细胞瘤的临床和误诊分析

目的 探讨视网膜母细胞瘤（retinoblastoma，RB）的临床特征、病理分类和误诊原因，尽可能减少错误的临床诊治。方法 对我科于1999-2004年间收集的38例临床诊断为视网膜母细胞瘤（retinoblastoma，RB）的病例资料进行回顾性分析。结果在38例疑似病例中，34例病理诊断为视网膜母细胞瘤，4例为Coats病。结论掌握相关的影像学知识和综合分析疑难病例的临床资料将有助于视网膜母细胞瘤的正确诊断和处理。     

氩激光治疗缺血型视网膜分支静脉阻塞

目的探讨氩激光治疗缺血性视网膜分支静脉阻塞的临床疗效。方法应用美国科以人公司氩激光对经荧光素眼底血管造影（FFA）检查确诊的86例（86只眼）缺血型视网膜分支静脉阻塞进行光凝治疗，3个月后复查FFA。结果86例（86只眼）经视网膜光凝后，视网膜出血Ⅱ度以上吸收73只眼（84．88％），Ⅳ度吸收10只眼（11．63％），不变或加重3只眼（3．49％）；黄斑水肿吸收76只眼，占88．37％，不变10只眼，占11．63％；视力增加者69只眼（80．23％），不变14只眼（16．27％），下降3只眼（3．49％）。FFA复查渗漏及毛细血管无灌注区消失77只眼（89．53％）。结论视网膜激光光凝治疗能减少缺血型视网膜静脉阻塞引起的新生血管，并能促使黄斑水肿消退，从而不同程度地改善视功能。     

眼科常见病彩超诊断的经验

目的探讨彩色多普勒超声检查在眼部常见疾病诊断中的价值。方法对108例眼部疾病进行彩色多普勒超声检查，并经手术和病理证实的检查结果进行分析。结果晶状体浑浊32例，检出率为90．63％；眼内异物13例，检出率为94．31％；视网膜脱离36例，检出率为94．44％；玻璃体浑浊25例，检出率为100％；视网膜母细胞瘤2例，全部检出。结论彩色超声在眼科疾病中诊断准确率较高，检查迅速且无痛苦，对许多病例可作为眼科的首选检查方法。     

视网膜脱离和脉络膜脱离的超声鉴别诊断

目的探讨视网膜脱离和脉络膜脱离的超声鉴别诊断。方法对77例视网膜脱离和38例脉络膜脱离的B型超声图像进行比较分析。结果两者在光带起止部位、形态、后运动、回声强度等方面各有其特征性。结论根据B型超声声像图的各种特征,能鉴别视网膜脱离和脉络膜脱离两种疾病。     

后部眼球壁灰褐色隆起物声像学诊断

目的：研究后部眼球壁灰褐色隆起物－脉络膜血肿及脉络膜黑色素瘤的声像学表现,以便对其进行声像学鉴别诊断。方法：对FFA确诊为脉络膜血肿和手术病理证实为脉络黑色素瘤的17例患者B超检查所见,进行声像学分析。结果：9例脉络膜血肿患者,B超检查表现为：6例后极部球壁局限性增厚,随增益降低出现层间透声裂隙,增益越低透声裂隙越明显,裂隙中散在弱回声光点;3例病变范围大、隆起高,与浅层视网膜脱离相似,但其光带较厚,缺乏后运动,且膜下见细小弱回声光点。8例脉络膜黑色素瘤中5例表现为球壁半球形实性隆起物,3例为蘑菇形。肿物在声像图上均表现为前缘光滑锐利,内回声前方多而强,向后渐少而弱,见脉络膜凹陷及后方声影,3例蘑菇形肿物均见头部周围及附近视网膜浅层脱离。结论：脉络膜血肿与脉络膜黑色素瘤的声像学表现有明显差异。     

眼球壁先天异常声像图表现

目的：探讨眼球壁先天异常声像学表现及其诊断价值。方法：回顾性分析78例（126眼）眼球壁先天异常声像学表现。结果：先天性脉络膜缺损声像图表现为自视盘上缘或下缘向下的局限性球壁向后膨突；膨突后缘陡峭、前缘平滑，与极周边球壁无明显界限。先天性视盘缺损和牵牛花综合征声像图上视盘处球壁弧形光带中断，该区眶内梯形低回声区，视神经回声与梯形区底部相连，二者间为强回声带状物并伴彗星征。先天性小眼球合并眼眶囊肿表现为眼球各径线缩短，眼眶内见大的无回声液性暗区，透声良好，可压缩性明显。结论：声像学检查可为眼球壁先天异常的诊断提供依据。     

B-scan ultrasonography in the diagnosis of atypical retinoblastomas.

Contact B- scan ultrasonography (Bronson-Turner unit) was performed on fourteen patients with retinoblastoma. In ten cases, the patient presented with leukocoria, and ultrasonography was helpful in confirming the clinical diagnosis. In four atypical cases contact B-scan ultrasonography was instrumental in making the diagnosis. The ultrasonographic pattern for retinoblastoma is characteristic but not pathognomic. There is a solid intraocular echo corresponding to the tumor and within it are numerous dense focal echoes which persist at lower sensitivities, suggesting calcification. Calcification was demonstrated ultrasonographically and confirmed histologically in all four of these atypical cases, but routine skull x-rays failed to demonstrate calcium in three of the four children. Contact B- scan ultrasonography is a safe and simple procedure which may provide valuable diagnostic information in children with suspected retinoblastoma.     

B超、CT及MRI检查在视网膜母细胞瘤诊断中的价值

目的 比较B超、CT及MRI检查在视网膜母细胞瘤诊断中的价值.方法 选择2010年4月至2011年10月在我院进行检查治疗的视网膜母细胞瘤患者130例(195眼),采用B超检查者71例(99眼)、CT检查者42例(70眼)、MRI检查者17例(26眼),记录各组的图像特点以判断肿瘤分期,并将各组的检查结果与病理学诊断结果进行对比分析.结果 行B超、CT及MRI检查患者中,分别有82眼(82.8％)、35眼(50.0％)、11眼(42.3％)显示有钙化斑,13眼(13.1％)、21眼(30.0％)、3眼(11.5％)显示视神经增粗,3眼(3.0％)、6眼(8.6％)、8眼(30.8％)提示肿瘤向眶内蔓延,差异均有统计学意义(均为P＜0.05).行B超、CT及MRI检查患者中,分别有83眼、53眼、15眼显示为I期,13眼、11眼、3眼为Ⅱ期,3眼、6眼、8眼为Ⅲ期,与病理学检查分期改变相符合分别为25眼(25.3％)、27眼(38.6％)、4眼(15.4％),差异均有统计学意义(均为P＜0.05).结论 B超、CT及MRI检查在视网膜母细胞瘤诊断中各有其优势之处,应根据患者的具体病情,注重联合检查,以提高诊断的正确率.     

Ultrasonic findings in intraocular retinoblastoma and correlation with histopathologic diagnosis

A and B-scan ultrasonographic records of 132 eyes of 126 patients with suspected retinoblastoma were evaluated retrospectively. Six patients had bilateral lesions. The results were compared with the histopathologic diagnoses obtained after enucleation in 129 cases and with the indirect ophthalmoscopic examination in 3 bilateral cases. Ultrasonographic diagnosis was correct in 115 cases (87.12%), false-negative in 12 cases (9.09%) and falsepositive in 5 cases (3.79%). Echographic tumor typing was made in 88 cases and the mixed tumor type was the most frequent with 74 cases (84.09%). Cystic, solid and diffuse infiltrating types were the other echographic diagnoses. Our experience confirms the accuracy of ultrasonography in the diagnosis of retinoblastoma.     

眼弓蛔虫病诊断与鉴别诊断的临床研究

目的探讨眼弓蛔虫病(OT)诊断与鉴别诊断的方法。 方法收集2016年11月至2021年2月就诊于西安市人民医院(西安市第四医院)眼科，曾在外院误诊的OT患者11例(11只眼)进行研究。其中，男性7例(7只眼)，女性4例(4只眼)；年龄4~47岁，平均年龄(21.4±13.8)岁。采集患者病史，收集临床表现，就诊过程，影像学检查结果，眼内液检测结果。年龄和眼压以 ±s描述。职业、居住地、猫狗接触史、主诉、既往病史、视力、眼部表现、影像学检查结果、眼内液检测结果、诊断及鉴别诊断采用例数(眼数)和百分比进行描述。随访6个月，观察临床诊断是否有修正。 结果11例均为单眼患病。其中，18岁以下者6例(6只眼)，占54.55%(6/11)；18岁以上者5例(5只眼)，占45.45%(5/11)。有玻璃体混浊者11例(11只眼)，占100.00%(11/11)；玻璃体机化分层者7例(7只眼)，占63.64%(7/11)；玻璃体增殖及牵拉性视网膜脱离者4例(4只眼)，占36.36%(4/11)。超声生物显微镜(UBM)检查显示前部玻璃体混浊者4例(4只眼)，占36.36%(4/11)；睫状体后有异常高回声者3例(3只眼)，占27.27%(3/11)，提示周边肉芽肿形成。B型超声检查玻璃体可见异常回声者9例(9只眼)，占81.82%(9/11)。其中，表现为特异性的条索状或带状分层回声者5例(5只眼)，占45.45%(5/11)；表现为点团状回声者4例(4只眼)，占36.36%(4/11)。B型超声显示有牵拉性视网膜脱离者6例(6只眼)，占54.55%(6/11)。荧光素眼底血管造影(FFA)显示视盘着染、荧光素渗漏及视网膜血管显著渗漏者6例(6只眼)，占54.55%(6/11)。其中，表现出视网膜毛细血管"羊齿蕨样"渗漏者3例(3只眼)，占27.27%(3/11)。光学相干断层扫描(OCT)检查结果显示显著黄斑水肿者3例(3只眼)，占27.27%(3/11)。首诊外院误诊为非感染性葡萄膜炎者4例(4只眼)，占36.36%(4/11)；陈旧性视网膜脱离者2例(2只眼)，占18.18%(2/11)；永存原始玻璃体增生症者2例(2只眼)，占18.18%(2/11)；视网膜母细胞瘤者1例(1只眼)，占9.09%(1/11)；黄斑水肿者1例(1只眼)，占9.09%(1/9)；Coat′s病伴新生血管型青光眼者1例(1只眼)，占9.09%(1/11)。眼内液弓蛔虫免疫球蛋白(Ig)G均远高于3U者7例(7只眼)，占63.64%(7/11)。11例(11只眼)OT分型为典型者9例(9只眼)，占81.82%(9/11)。其中，后极部肉芽肿型2例(2只眼)，占18.18%(2/11)；周边肉芽肿型4例(4只眼)，占36.36%(4/11)；眼内炎型3例(3只眼)，占27.27%(3/11)。OT分型为非典型者2例(2只眼)，占18.18%(2/11)。随访6个月以上，临床诊断无修正。 结论OT多为单眼发病，儿童和成人均可患病。OT临床表现复杂多样，可有后极部和(或)周边肉芽肿、眼内炎及玻璃体视网膜增殖等典型表现，B型超声和UBM检查可辅助诊断。也可仅表现为全葡萄膜炎或中间葡萄膜炎，伴黄斑水肿和视网膜毛细血管"羊齿蕨样"渗漏等非典型改变。眼内液弓蛔虫抗体检测对OT诊断具有重要价值。     

Diffuse anterior retinoblastoma: A review

Diffuse anterior retinoblastoma is a rare variant of diffuse infiltrating retinoblastoma which occurs in up to 1–2% of cases of retinoblastoma. In diffuse anterior retinoblastoma there is a small focus of tumor in the peripheral retina from which free tumor cells enter the aqueous humor and implant on the ciliary body, iris, lens and trabecular meshwork. Patients most commonly present with pseudouveitis, pseudohypopyon and increased intraocular pressure. The differential diagnosis is broad and all of the reported cases relied upon aspirates from the aqueous humor in order to make the diagnosis prior to proceeding with treatment. Treatment involves enucleation and, depending upon the extent of the tumor, may require systemic chemotherapy or external beam radiation. This review summarizes the 7 previously reported cases of diffuse anterior retinoblastoma, discusses pathologic features, and addresses the challenges of early diagnosis and future directions.     

视网膜母细胞瘤28例的CT诊断

目的探讨CT诊断视网膜母细胞瘤(retinoblastoma,RB)的临床价值。方法回顾性分析资料完整的28例(28眼)RB的CT、临床、手术病理检查资料。结果RB瘤体内钙化斑点是特征性CT表现,CT与病理诊断符合率96％(27/28);眼外期5眼CT诊断为视神经增粗提示球外转移,CT与病理诊断符合率100％(5/5);临床误诊率14％(4/28),CT误诊率4％(1/28)。结论CT扫描不但在诊断、鉴别诊断RB上有重要价值,而且在决定治疗方案和预后上有重要价值。     

Current treatment of retinoblastoma. 153 children treated between 1995 and 1998

PURPOSE: Treatment of retinoblastoma has changed significantly over the past few years. There are fewer indications for external beam radiation and a new treatment modality, chemotherapy, has appeared. MATERIAL: and methods: We reviewed a series of 153 children treated for retinoblastoma between 1995 and 1998. There were 67 boys and 86 girls: 76 unilateral and 77 bilateral retinoblastomas. Indications for treatments and outcome were reviewed for 230 eyes and for each tumor. Age at diagnosis varied from 0 to 94 months with a median age of 12 months. A family history of retinoblastoma was found in 24 cases. Three children were seen for treatment of recurrence. RESULTS: Among the 76 cases of unilateral retinoblastoma, 56 were enucleated and 20 were treated conservatively (5 with external beam radiation). Among the 154 eyes with bilateral retinoblastoma, 48 were enucleated and 106 were treated conservatively (49 by external beam radiation). Local treatments included chemothermotherapy, laser alone, cryotherapy, and (125)I plaques. Conservative management other than external beam radiation was used for 81 eyes and was successful in 72 (89%). CONCLUSION: We discuss the indications and results of primary chemotherapy and local treatments. External beam radiation is still often indicated in bilaterally advanced cases. In other forms of retinoblastoma, chemothermotherapy is a very reliable and useful treatment.     

Retinoblastoma in Taiwan: survival and clinical characteristics 1978-2000

PURPOSE: Few estimates of the survival rates ofwas retinoblastoma have been reported from the Asia region. In this study, we aim to describe the survival and clinical characteristics of 96 retinoblastoma cases treated at Chang Gung Medical Center, Taipei, between 1978 and 2000.METHODS: We retrospectively analyzed the clinical records of 96 children (116 eyes) diagnosed with retinoblastoma and treated between 1978 and 2000. Information on sex, laterality, age at diagnosis, presenting signs, spread of tumor, treatment modality, survival rate, and family history were collected.RESULTS: Seventy-six (79.2%) cases were unilateral and 20 (20.8%) were bilateral. The mean age overall at the time of diagnosis was 24.7 months; in unilateral cases, 27.1 months; and in bilateral cases, 15.6 months. The most common presenting signs were leukocoria (75 cases, 78.1.0%), buphthalmos (34 cases, 35.4%), proptosis (16 cases, 16.7%), and strabismus (12 cases, 12.5%). Forty-two eyes had orbital extension, 27 patients had central nervous system invasion, 16 cases exhibited bone marrow involvement, and 3 cases had liver metastasis. Three (3.1%) patients had a family history of retinoblastoma. None of the cases developed a secondary neoplasm. The 3-year cumulative survival rate of the 96 patients was 64.41% (unilateral, 71.97%; bilateral 40.01%).CONCLUSIONS: The mortality was much higher than that in reports on Western and Japanese patients. Delayed diagnosis with frequent extraocular spread at the time of diagnosis caused the low survival rate. Fewer familial cases were encountered in our study than in other studies.     

脉络膜黑色素瘤的B型超声和病理检查分析

目的探讨B型超声检查在脉络膜黑色素瘤诊断中的作用。方法对经眼科B型超声检查诊断为脉络膜黑色素瘤的24眼在眼科B型超声检查中的形态学表现进行分析;对患眼手术摘除后病理检查并进行病理统计分型与B型超声检查诊断结果进行比较分析。结果24眼肿瘤生长部位位于鼻侧部8例,颞侧3例,下方2例,后极部5例,睫状体部5例,1例肿瘤充满眼球内并伴有球壁破坏和视神经增粗。肿瘤平均高度-基底比率0.93(SD=0.32)。19例呈蕈样生长,4例呈圆顶形生长。22例呈中到低回声,2例呈高回声,伴挖空征17例,凹陷征11例。24例中19例有继发性视网膜脱离,平均脱离高度2.92mm。病理检查结果:混合细胞型7例,上皮细胞型13例,梭形细胞型2例,坏死型1例,1例被证实为转移性腺癌。与病理检查对照,B型超声诊断正确率为95.8%。结论脉络膜黑色素瘤在B型超声检查中有特征性的表现。眼科B型超声检查对脉络膜黑色素瘤有较高的诊断价值。