眼内异物CT眼球横扫联合子午面重建定位法

目的　探讨眼内异物CT定位新方法。方法　筛选 2 6例后极以外眼球壁和视网膜表面粘连异物 ,予CT“眼球平扫”和“眼球横扫”后 ,分别行眼球横扫联合子午面重建定位法 (新法 )、眼球平扫联合眼球横扫定位法 (传统方法Ⅰ )和眼球平扫直角坐标定位法 (传统方法Ⅱ )定位。以术中间接检眼镜监视下定位或术中直接看到的异物位置为验证标准 ,分别测量依据以上 3种CT定位数据确立的异物球表定点位置的经、纬向误差。结果　 2 6例异物球表定点位置的经、纬向平均误差分别为 1 5 3、1 64mm(新法 ) ,1 3 7、1 64mm(传统方法Ⅰ )和 2 0 2、2 5 5mm(传统方法Ⅱ )。经配对t检验 ,新法较传统方法Ⅰ差异无统计意义 (经向 :P >0 6,纬向 :P =1) ;新法较传统方法Ⅱ差异有统计意义 (经向 :P <0 0 5 ,纬向 :P <0 0 1)。结论　新法较传统方法更简便、更直观、更富发展前景。     

眼球壁异物X线、B超和CT定位诊断的评价

目的 分析X线、B超和CT对眼球壁异物定位的准确性,探讨较可靠的球壁异物定位方案。方法 对1993年6月～2000年12月间入院治疗的236例眼球壁异物进行临床回顾分析。以异物的术中定位为“金标准”分析B超、X线和CT对眼球壁异物的诊断阳性率,以及X线、CT对异物的空间定位准确性。并分析辅助检查准确性与异物大小、位置的关系。结果 X线、B超和CT判断异物与球壁关系的准确性依次为:CT>B超>X线;对异物是否穿出球壁的判断以CT最为灵敏,而B超的误诊率最低。结论 推荐X线作为眼球异物诊断的筛选方法,当定位片提示异物位于眼球壁附近时,应首选CT做进一步的确认;CT联合B超诊断眼球壁异物是目前最佳的诊断方法组合。     

CT诊断眼球内小异物的应用

X 线定位法对过小异物或低密度的眼内异物,常因难于显影而致漏诊。至于异物位于球壁附近,究竟在球内、球外或球壁上,有时更难确定。上述一系列难题,借助CT扫描均可得到有效的帮助。因CT 是高分辨薄层扫描,不仅可以识别与组织密度差极为根近的异物,而且可做直观定位摄片,为传统球内异物定位方法提供了重要的补充。我们用常规X 线定位不准的3例球内异物,用CT 扫描都得到解决,报告如下。例1 男性22岁住院号26467586年4月铁屑自右眼颞侧周边角膜穿入眼球,伤口自然愈合,晶体混浊。当时眼底检查,视盘颞下缘可疑有细小异物。巴金氏异物定位,异物位于5点经线,距角膜缘后21mm,距中心2mm,见1mm 异物阴影。因手术困难,2个月后转入我院。视力手动(?)     

多层螺旋CT在眼球异物立体精确定位的临床应用

目的探讨多层螺旋CT眼球异物立体定位方法及临床应用价值。方法98例眼外伤中35只眼球内、39枚异物行多层螺旋CT扫描立体定位,以入院术中取出为“金标准”来衡量多层螺旋CT对眼球异物立体定位的准确率,球内壁、球外壁空间定位的精确性。结果多层螺旋CT对39枚球内异物的诊断,35枚完全符合,符合率89.7%,4例非金属异物于眼球前部未显示而不符,达10.3%。35枚异物的方位及角巩膜缘距,对照术中定位准确率100%;异物位于球内壁、球外壁的判断的空间精确率（18/18）100%;同时明确球内并发症及周围解剖关系。结论多层螺旋CT对所能显示的异物的精确定位,具有简便准确可靠特点,因此有条件尽可能用多层螺旋CT一次性解决眼球内异物定位。     

函数表法辅助x线眼内异物定位诊断

为克服X线眼内异物定位诊断不能同时显示眼球壁的缺点,在CT及眼科专用B超尚不普及的情况下,我们设计了不同长度眼球球壁表面函数值表,并将其用于辅助X线眼内异物定位诊断,报告如下。(一)不同长度眼球球壁表面函数值     

眼内异物定位的失误

例1 刘××男21岁左眼被手榴弹炸伤4天入院。入院后,眼眶X 光摄片疑为眼球内异物。异物定位(使用吸盘式异物定位器)结果见异物位于眼球中心水平线上3mm,距角巩缘8.5mm。按此定位结果进行手术。在异物床相应部位切开球壁,用电磁铁吸引无反应,停止手术。术后第6天再次进行异物定位,测量异物位于眼球中心水平线上10mm,距角巩缘8mm。再次手术,手术切口与第一次手术切口相距2.5mm,切开球壁后即见灰白色异物。顺利摘除一个1×2×1mm 异物。经化验为是铝合金,无磁性反应。术后复习两次定位照片,发现第二次定位片与第一次定位片的异物经线位置相差15°,深度差7mm。     

简易眼球内异物定位法

眼内异物定位法种类繁多(1),作者根据眼球壁切面的曲线方程,结合临床实践设计了一种简易的眼内异物定位法。实践效果良好。介绍如下: (一)原理:眼球可被看作是两个球缺之组合(即角膜部分及巩膜部分)。小球缺半径为7.8mm,大球缺半径通过计算为11.56     

160例眼球后段磁性异物临床分析

本文分析了160例眼球后段磁性异物病人的治疗情况.结果发现:眼球后段磁性异物多数比较小,<2mm的占61.2%;异物接近球壁的占73.7%(<2mm).20例病人同时联合玻璃体切割术,110例做了单纯摘除异物.疗效的好坏取决于眼球损伤的程度、异物定位的准确性以及有无发生手术并发症.异物进入眼球的创口在角膜或角巩缘的占77.6%,这是术后影响病人视力的重要原因之一.     

作图校正眼球偏位时X光片异物影像位置

本文根据异物在X光片中影像移位的规律性,应用解剖学和定位环中心与眼球内异物,当限球转动时同步旋转且角量相等的原理,由三度定理和异物影像在正、侧、轴三位图中同一坐标长对应相等的关系,几何作图校正当眼球(定位环)偏位时异物在X光片中的移位影像复位从而得到异物在眼内的正确位置。     

眼球深部枪钉一例

1病例患者男,27岁。因进行房屋装修使用气枪钉时不慎溅入左眼,患者当即左眼疼痛,视力骤降,2天后到我院就诊。入院查:左眼视力手动/30cm,右眼1.5。左眼睑水肿,结膜充血、水肿。颞侧角膜缘4点位见约0.5mm穿孔伤道,角膜透明。前房深浅正常,房水闪光( ),瞳孔3mm,圆,对光反射存在。晶状体浑浊,以后囊下浑浊为主,玻璃体浑浊,眼底不能窥入。眼眶CT水平位平扫显示:眼球(眶)内高密度影,尖端穿透眼球后壁,提示眼内金属异物(图1)。眼眶正侧位x片示:眼球深部金属异物(图2)。入院诊断:右眼球穿孔伤,眼内异物,外伤性白内障。入院后给予散瞳,全身和局部使…     

Clinical Application of X-ray, B-scan, and CT in the Diagnosis of Ocular Foreign Bodies

 PURPOSE:To analyze the sensitivity and specificity of X-ray, B-ultrasound, and CT scan in diagnosing ocular foreign bodies, and to compare the accuracy of  these three imaging tools in locating these foreign bodies. METHODS:A retrospective review was conducted of radiographic and clinical eye examination data from 62 patients (66 eyes), suspected of having ocular foreign bodies at time of first presentation to the Zhongshan Ophthalmic Center (Guangzhou, China) between August 2007 and October 2011. The sensitivity and specificity of X-ray, B-ultrasound and CT scan in the diagnosis of ocular foreign bodies were investigated and their accuracy in locating these foreign bodies was compared. RESULTS:A total of 75.8% (n = 47) subjects had ocular foreign bodies; 66% of these were metallic. Patients with intraocular, eye wall, and extraocular foreign bodies accounted for 46, 28, and 26% of the total, respectively. The sensitivities ofX-ray, CT scan, and B-ultrasound in the diagnosis of ocular foreign bodies were 58.3%, 61.7%, and 75%, the specificityies were 63.3%, 100%, and 87.5%, and the accuracy in locating foreign bodies was 73.4%, 94.7%, and 86.5%, respectively. The properties of foreign bodies affected the diagnosistic accuracy of X-ray, but exerted little impact upon B-ultrasound and CT scan.  CONCLUSION:A fairly high incidence of ocular foreign bodies was noted in patients suspected with ocular foreign bodies at their first presentations. X-ray combined with CT scan or X-ray in combination with B ultrasound showed a relatively high sensitivity and specificity in diagnosing ocular foreign bodies. CT scan had the highest accuracy in locating ocular foreign bodies.     

Orbital helical computed tomography in the diagnosis and management of eye trauma

OBJECTIVE: To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION: All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES: The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS: Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS: Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.     

Helical and conventional CT in the imaging of metallic foreign bodies in the orbit

PURPOSE: To compare helical CT to conventional CT imaging in the assessment of orbital metallic foreign bodies with regard to image quality, scanning time, and radiation exposure. METHODS: Twenty-four standardized metallic foreign bodies, placed into the orbit (anterior, epibulbar, posterior) of cadaver heads were studied. Helical CT scanning in the axial plane with multiplanar reconstruction of coronal and sagittal images was performed as well as conventional CT imaging with direct scanning in the axial and the coronal planes (Tomoscan SR 7000, Philips, The Netherlands). Two masked observers consensually graded the studies using 5 predetermined criteria. Radiation dose delivered to the lens and scanning time were measured for the helical and the conventional CT imaging workup. RESULTS: Helical CT imaging scored statistically significantly better with regard to overall accuracy of foreign body localization and presence of beam-hardening streak artifacts from dental fillings. Conventional CT scored significantly better with regard to stair-step artifacts. The radiation dose delivered to the lens was 35.4 mGy for helical CT imaging and 73.9 mGy for conventional CT workup (axial and coronal scanning). Total scanning time was 18 seconds for helical CT axial scanning and 104 seconds for conventional CT axial and coronal scanning. CONCLUSION: Helical CT is superior to conventional CT imaging, because it can provide adequate information about orbital metallic foreign bodies with a single acquisition, thus reducing both the number of examinations and the radiation exposure for the patient.     

豚鼠形觉剥夺性近视眼后极部巩膜IGF-Ⅰ/IGF-ⅡmRNA的表达

目的目的观察豚鼠形觉剥夺性近视眼后极部巩膜IGF-Ⅰ/IGF-ⅡmRNA表达的变化,以探讨IGFs与形觉剥夺性近视发生的关系。方法实验用三色豚鼠30只,于出生后第2d,将左眼以半透明眼罩遮盖作为形觉剥夺眼,右眼不做任何处理为对照眼。测量实验前、遮盖4周、遮盖8周时遮盖眼和对照眼的屈光度、眼轴长度。遮盖8周实验结束时,RT-PCR检测后极部巩膜IGF-Ⅰ/IGF-ⅡmRNA的表达水平。结果形觉剥夺使遮盖眼后极部巩膜IGF-Ⅰ/IGF-ⅡmRNA表达升高,与对照眼相比差异有显著性意义（P〈0.05）。结论豚鼠巩膜可以自分泌/旁分泌IGF-Ⅰ、IGF-Ⅱ。形觉剥夺使遮盖眼后极部巩膜IGF-Ⅰ/IGF-ⅡmRNA表达升高,IGFs参与豚鼠形觉剥夺性近视形成中巩膜重塑的过程。     

眼眶植物性异物的影像学表现

目的分析眼眶植物性异物的影像学表现,为临床治疗提供帮助。设计回顾性病例系列。研究对象手术证实眼眶内植物性异物患者10例。方法对10例眼眶植物性异物患者行CT检查,轴位CT扫描5例、冠位CT扫描1例,轴位 冠位CT扫描4例。2例行MRI。对上述病例的影像学表现进行回顾性分析。主要指标眼眶植物性异物的急性期、亚急性期和慢性期的CT和MRI表现。结果急性期2例CT显示植物性异物为低密度,周围无软组织增生;亚急性期4例(包括1例上述急性期病例转为亚急性期者)CT显示植物性异物为低密度伴周围炎性软组织增生;慢性期6例(包括1例上述急性期病例转为慢性期者)CT显示植物性异物为高密度机化影,周围有炎性肉芽肿包裹。1例亚急性期异物MRI在T_1WI、T_2WI显示偏低信号,1例慢性期肉芽肿在T_1WI、T_2WI显示为中等信号。结论CT扫描对于急性期、亚急性和慢性期植物性异物均能明确诊断,MRI没有明显优势。(眼科,2007,16:323-325)     

豚鼠进展性近视眼巩膜中Smad3和Ⅰ型胶原的动态表达变化

背景 巩膜重塑过程中导致眼轴的伸长是轴性近视进展的主要病理机制之一.研究证实转化生长因子β1(TGF-β1)参与巩膜重塑过程,而Smad3是TGF-β1的下游信号转录基因之一,探讨其在近视眼巩膜重塑过程中的作用对于近视发病机制和防治研究具有重要意义. 目的 研究近视眼巩膜重塑过程中Smad3和Ⅰ型胶原的表达情况,探讨TGF-β1-Smad3-Collagen Ⅰ信号途径在近视巩膜胶原重塑中的作用.方法 将出生后7d的豚鼠75只任意分为空白对照组(25只)和形觉剥夺性近视(FDM)组(50只).FDM组豚鼠采用半透明乳胶遮盖左眼的方法制备单眼FDM模型,右侧未遮盖眼作为自身对照.FDM组分别遮盖2、4、6周,另一组动物遮盖4周后去遮盖1周,分别于遮盖前及上述时间点采用检影法测量各组豚鼠双眼屈光度,采用A型超声手动模式测量豚鼠眼轴长度.于上述时间点分别处死5只豚鼠并制备巩膜组织切片,分别采用免疫组织化学法及逆转录PCR法检测各组豚鼠巩膜组织中Smad3和Ⅰ型胶原蛋白及其mRNA的相对表达量.结果 遮盖前空白对照组与FDM组豚鼠屈光度均为远视状态,差异无统计学意义(P＞0.05),空白对照组豚鼠远视屈光度逐渐下降,而FDM组豚鼠在遮盖前,遮盖2、4、6周及遮盖4周后去遮盖1周屈光度从(+2.09±0.31)D逐渐改变为(-1.23±0.69)、(-4.17±0.59)、(-7.07±0.56)和(-4.30±0.58)D,眼轴长度从(5.93±0.39)mm逐渐改变为(6.62±0.36)、(7.30±0.34)、(7.99±0.32)和(7.21±0.36) mm,与空白对照组比较,遮盖后各时间点FDM组豚鼠近视度明显升高,眼轴测量值明显增加,差异均有统计学意义(均P＜0.01).与自身对照组比较,遮盖2周、4周、遮盖4周后去遮盖1周及遮盖6周时FDM组近视度均明显升高,眼轴明显增长,差异均有统计学意义(均P＜0.05).遮盖前空白对照组与FDM组豚鼠后极部巩膜组织中Ⅰ型胶原和Smad3蛋白及其mRNA相对表达量的差异均无统计学意义(均P＞0.05),FDM组豚鼠遮盖2、4、6周及遮盖4周后去遮盖1周巩膜组织中Ⅰ型胶原和Smad3蛋白及其mRNA相对表达量均明显低于空白对照组和自身对照组,差异均有统计学意义(均P＜0.05).豚鼠巩膜组织中Ⅰ型胶原蛋白与Smad3蛋白及其mRNA相对表达量均呈明显正相关(蛋白:r=0.993,P＜0.05;mRNA:r =0.954,P＜0.05). 结论 FDM豚鼠模型眼随着遮盖时间的延长近视度明显增加,眼轴明显增长,豚鼠巩膜组织中Smad3和Ⅰ型胶原的表达相应减弱,且Smad3和Ⅰ型胶原表达量的变化趋势高度一致.Smad3和Ⅰ型胶原可能通过TGF-β1-Smad3-Collagen Ⅰ信号途径参与近视眼巩膜重塑过程的调控.     

内镜在眼眶深部植物性异物摘出中的应用

目的探讨内镜在眼眶深部植物性异物摘出术中的临床应用价值。方法术前行眼眶CT或MRI冠状和水平扫描准确定位，应用硬性内窥镜沿异物窦道或皮肤切口进入眶内，沿异物长轴方向夹取异物。结果5例眼眶异物均成功摘出，同时在内窥镜下清除窦道内肉芽及坏死组织，手术后伤口均一期愈合，无手术并发症。结论应用内镜取眼眶深部异物损伤小，恢复快，异物容易取尽无残留：     

The change in ocular refractive components after cycloplegia in children

PURPOSE: To study the change in ocular refractive components after cycloplegia in children. METHODS: Anterior chamber depth, lens thickness, vitreous chamber length, and ocular axial length were measured in 135 Chinese children (270 eyes) before and after cycloplegia. The corneal curvatures of 136 selected eyes were studied before and after cycloplegia with a computerized video keratoscope. RESULTS: Anterior chamber depth increased (P <.001) while both lens thickness and vitreous chamber length decreased (P <.001) significantly after cycloplegia regardless of the refractive state. However, axial length increased in hyperopic eyes (P =.027) but decreased in myopic eyes (P =.008) after cycloplegia. Mean corneal power of zones 3 mm (MD3, P =.009) and keratometer K1 readings increased (P =.025) in hyperopic eyes, while MD3 (P =.033), K1 (P =.039) and K2 (P =.003) readings decreased in myopic eyes significantly after cycloplegia. Similarly, mean corneal power of zones 5 mm and 7 mm in myopic eyes decreased dramatically (P 相似文献   

超声生物显微镜在非金属巩膜异物诊断中的应用

目的:探讨超声生物显微镜在非金属巩膜异物诊断中的作用及应用。方法:回顾性分析我院2009-01/2012-11收治的有反复发作的局部眼红眼痛的症状及体征的非金属球壁异物患者15例15眼,全部为非急性期。进行数字化裂隙灯眼表照相,经过UBM检查确诊为巩膜异物,手术后证实为非金属异物。结果:有明确的植物眼外伤史10例10眼,病史不详5例5眼。病程1～6mo,均表现局部反复出现的眼红眼痛,药物治疗好转,停药后再次发作。裂隙灯下见局部的隆起,轻或重的充血,角膜无水肿。UBM检查见结膜下巩膜有高密度影,其后组织不显影声影,诊断:巩膜可疑异物。术后取出异物,11例11眼为植物异物,2例2眼为煤渣样异物,1例1眼为玻璃异物,1例1眼为石子异物。结论:超声生物显微镜能及时、尽早发现非金属巩膜异物,减少误诊。针对巩膜长期局部反复充血的患者,无论有无外伤史,均应应用UBM检查有否巩膜异物的存在。