前后20年对照眼球摘除病因变化分析

目的 探讨眼球摘除的病因及不同时期的变化。方法 将眼球按病理诊断分类,回顾性分析前10a(1965-1974年）与后10a(1989-1998年）眼球摘除病因变化,计算其构成比。结果 眼球摘除总数后10a较前10a下降32．1％,主要因为眼球摘除适应证从严,因角膜病、绝对期青光眼、葡萄膜炎和Coat's病而摘降例数减少。眼外伤仍是眼球摘除的第1位原因。眼肿瘤为眼球摘除的第2位因素,其中视网膜母细胞瘤占第1位。结论 角膜病和青光眼等疾病诊治水平的提高使眼球摘除率有所下降。眼外伤的防治仍是临床保护眼球的重点。提高眼肿瘤的早期诊断,探索新的治疗手段十分重要。     

眼球摘除相关因素16年来的变化趋势分析研究

目的探讨16年来导致眼球摘除相关因素的变化趋势，为今后减少和避免眼球摘除提供依据。方法对1990年5月-2006年4月的16年间在我院行眼球摘除术的236例（236眼），进行前8年与后8年相关因素临床对比分析。结果近8年与前8年对比，眼球摘除例数增加，主要病因为眼外伤和青光眼，但眼外伤眼球摘除所占比例有所下降（P〈0．05）；青光眼眼球摘除比例增大（P〈0．05）；因角膜溃疡摘除所占比例下降（P〈0．05）；因肿瘤、角巩膜葡萄肿摘除所占比例无明显变化（P〉0．05）；8年来职业结构均主要为农民，但所占比例有所下降（P〈0．05）；工人和干部所占比例增加（P〈0．05）；学生所占比例无明显变化（P〉0．05）。结论目前眼球摘除原因仍以眼外伤和青光眼为主。其中眼外伤所占比例呈下降趋势，而青光眼比例趋于上升，职业结构中工人、干部比例有上升趋势。     

眼球摘出术加肋软骨植入术的探讨

在日常生活中，经常有一些意外造成严重的眼外伤，有时必须进行眼球摘除。此外，青光眼绝对期及视网膜母细胞瘤也常需眼球摘出。手术后眼眶组织萎缩，义眼内陷，我们采用肋软骨植入充填，取得较好效果。报告如下：一般资料：1993年以来，我科收治眼球摘除术科例，其中男12例，女2例。年龄最大的为61岁，最小的为3岁，平均22岁。病因：外伤所致占绝大多数，为10例；碱烧伤所致三列；青光眼绝对期2例；视网膜母细胞瘤1例。手术方法：采用硬膜外麻醉加局麻，小儿采用全麻。在患者右胸部第七、八肋处斜形切开皮肤，逐层切开露出肋软骨弓，用刀切…     

眼球摘除病因分析

本文分析１２２例眼球摘除病因。因眼肿瘤摘除５４例（４４．３％）占首位原因，第二位原因是绝对期青光眼２４例（１９．７％），第三位原因是眼球破裂伤２１例（１７．２％）。文中简单介绍减少眼球摘除手术的点滴体会。     

眼球摘除107例临床分析

目的:分析眼球摘除的相关因素.方法:收集2005-07/2009-07在我院眼科住院,接受眼球摘除术的所有患者资料共107例,把资料分别按原始病因和是否伴有眼球创伤史分类,进行临床分析.结果:继发性青光眼绝对期是眼球摘除的首位原始病因;有眼创伤的49例中,青光眼滤过手术或白内障摘除手术的并发症是导致眼球摘除的首要原因;否认眼创伤的58例中,各种青光眼绝对期是导致眼球摘除的首要原因.结论:加强青光眼病知识的宣传;眼外伤后应及时正确处理;对基层眼科医生应该加强技能培训,这些是减少患者眼球摘除的关键.     

200例眼球摘除原因分析

16年来，我院在严格掌握眼球摘除适应证的前提下，共施行眼球摘除术200例，现就其摘除原因进行分析：一股情况：本组眼球摘除术共200例200眼，其中右眼119例，左眼81例；男134例，女66例；最大82岁，最小2岁。2－10岁5例，11－20岁17例，21岁以上178例。农民117例，工人对例，干部6例，学生5例，幼儿3例，其它36例。眼球摘除原因：眼外伤138例（田％），绝对期青光眼26例（13％），角巩膜葡萄肿12例（6％），眼球萎缩8例（4％），全眼球炎11例（5．5％），恶性肿瘤5例（2．5％）。在眼外伤因素中，lot例是由于外伤造成眼球严重破裂，限内容…     

农村地区老年人眼球摘除91例分析

目的探讨农村地区老年人眼球摘除的病因及防治措施。方法对91例老年人眼球摘除的资料进行研究分析。结果绝对期青光眼、眼内炎和眼外伤是农村地区老年人眼球摘除的主要病因。结论改善医疗环境，提高技术水平可以降低老年人眼球摘除的风险。     

眼球摘除459例统计分析

对四所综合性医院眼科４５９例眼球摘除的病例用统计分析，结果表明：该手术占同期住院病人数的２％左右，其中占首位的是各种原因引起的严重眼外伤，其次是青光眼、严重角膜溃疡大穿孔、眼内炎、视网膜母细胞瘤、角膜葡萄肿、眼球萎缩等。与中国传统眼球摘除适应症相比较其顺序和构成均已有明显改变。提示眼球摘除可以通过宣传预防及随着医疗卫生保健事业的发展而减少。     

眼球摘除病例的临床病理分析

本文对摘除后经病理检查的２７１只眼球的疾病进行了分析，摘除的眼球中最多的疾病是视网膜母细胞瘤１１１例；其次有：眼外伤５５例，眼内炎３２例和绝对期青光眼２４例等。对其年龄，性别，眼别和病因等进行了分析。     

眼球摘除459例统计分析

对四所综合性医院眼科４５９例眼球摘除的病例用统计分析，结果表明，该手术占同期住院病人数的２％左右，其中占首位的是各种原因引起的严重眼外伤，其次是青光眼，严重角膜溃疡大穿孔，眼内炎，视网膜母细胞瘤，角膜葡萄肿，眼球萎缩等。     

Clinical indications for enucleation in the material of Department of Ophthalmology, Medical Academy in Białystok in the years 1982-2002

PURPOSE: To evaluate the current clinical indications for enucleation in the material of Department of Ophthalmology, Medical Academy in Bia?ystok. MATERIAL AND METHODS: We retrospectively reviewed all enucleations performed between the years 1982 and 2002. Into analysis were included 367 patients (226 males and 141 females) at the age from 18 to 94 years. They were divided into seven groups according to the causes leading to enucleation: trauma, intraocular tumor, glaucoma, phthisis bulbi, endophthalmitis, complications of ocular surgery and corneal diseases. RESULTS: In our series trauma was the most frequent cause of enucleation (36%), followed by malignant tumor (20.7%), glaucoma (19.6%), phthisis bulbi (9%) and endophthalmitis (8.1%). The majority of intraocular tumors with histological confirmation were melanomas (92.1%). There were significantly more enucleation for trauma in males (p < 0.0001). Patients aged less than 30 years constituted 83.8% of all enucleations for trauma. The total number of eye removals decreased significantly (p < 0.005) over seven-year periods from 149 in 1982-1988, 121 in 1989-1995 to 97 in 1996-2002. CONCLUSIONS: Improved new diagnostic and therapeutic methods, widespread use of photocoagulation in vascular disorders and methods of vitreoretinal surgery in traumas, effective antimicrobial treatment have contributed to the decreasing frequency of enucleation.     

Clinical indications for enucleation--a review of the literature

Enucleation is an acceptable therapeutic modality used for end-stage ocular diseases unresponsive to another treatment. The most often indications for enucleation are trauma, intraocular tumors, secondary glaucoma, phthisis bulbi and cosmetically disfigured eyes. Although, indications for enucleation are similar in most ophthalmic clinics, the pathologic conditions leading to this procedure differ from place to place. The aim of this paper is to present the current knowledge about the clinical indications for enucleation in different parts of the world.     

Clinicopathological review of 1146 enucleations (1980-90).

The clinicopathological data of 1146 enucleated eyes obtained from 1146 patients (485 females and 661 males; mean age 57.4 (SD 21.6) years) between 1980 and 1990 were reviewed. The most common underlying diseases included trauma (37.4%), malignant tumours (19.6%), systemic diseases (diabetes, vascular diseases) (17.1%), surgical diseases (retinal detachment, glaucoma, cataract, corneal dystrophy) (14.1%), infection and inflammation (7%). The most frequent indications for enucleation were secondary angle closure glaucoma (34.9%), ocular malignant tumours (21.7%), atrophia or phthisis bulbi (18.7%), ocular infectious or inflammatory disease (14.7%), and recent trauma (enucleation was performed within the first month after trauma) (11.2%). Histopathologically, diagnoses included secondary angle closure (691 eyes or 60.3%), rubeosis iridis (550 or 48%), endothelialisation of the iridocorneal angle (198 or 17.3%), and retrocorneal membrane (143 or 12.5%). These data indicate that rubeosis iridis, often followed by irreversible secondary angle closure, represents the most common pathogenetic reason for enucleating eyes. Management procedures must be directed towards the prevention or consequent therapy of rubeosis iridis.     

Current indications and resultant complications of evisceration

PURPOSE: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. METHODS: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. RESULTS: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. CONCLUSION: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center.     

Current Indications and Resultant Complications of Evisceration

Purpose: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. Methods: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. Results: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. Conclusion: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center.     

Phthisis bulbi in retinoblastoma

Background: Phthisis bulbi is a relatively uncommon and atypical clinical presentation of retinoblastoma. Design: Retrospective study conducted at a tertiary care hospital. Participants: Eighteen consecutive retinoblastoma patients with primary phthisis bulbi. Methods: Retrospective analysis of clinical, imaging and histopathological features of all retinoblastoma patients with primary phthisis bulbi, treated at our centre between January 2005 and December 2009. Main outcome Measure: Clinical and histopathology features. Results: Eighteen (3.5%) retinoblastoma patients developed primary phthisis bulbi. The median age of presentation was 1.5 years. The median duration of symptoms before presentation was 6 months. In total, 15 out of 18 (83%) cases had bilateral disease. Among these, 80% (12/15) had advanced intraocular disease in the fellow eye. Most common first symptom was white reflex. History of orbital inflammation was present in 12/18 cases. Computed tomographic scan of orbit showed intraocular mass with calcific densities in 16 eyes. In two cases, hyperdense mass was seen without any calcification. On histopathology, residual viable tumour cells with characteristics of poorly differentiated retinoblastoma were found in 67% (12/18) eyes. High‐risk factors were present in six cases with microscopic residual disease in three cases. Conclusions: This is the largest case series of retinoblastoma patients with primary phthisis bulbi. Phthisis bulbi in retinoblastoma may be associated with bilateral disease in most cases and advanced intraocular disease in the fellow eye in a significant number of cases. Regression is incomplete in majority of these cases; therefore, enucleation must definitely be done in all cases of retinoblastoma presenting with phthisis bulbi.     

Removal of the eye in a tertiary care center of China:a retrospective study on 573 cases in 20 years

AIM:To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration.METHODS: A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed.RESULTS:Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%.CONCLUSION:Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.     

Porous polyethylene (Medpor) orbital implant. Prospective study of 75 primary implantations

PURPOSE: To examine the incidence of orbital complications in patients who underwent primary placement of a porous polyethylene implant (Medpor) after enucleation. MATERIAL AND METHOD: Prospective non randomized case series of 75 consecutive patients in whom a porous polyethylene (PP) spherical implant wrapped with homologous sclera was implanted after enucleation. RESULTS: The mean age at the time of enucleation was 42.7 years (range, 1.4 to 80 years). The histopathological diagnoses after enucleation included uveal melanoma in 28 patients, retinoblastoma in 11 patients, phthisis bulbi in 23 patients, neovascular glaucoma in 5 patients, endophthalmitis in 3 patients, ruptured traumatic globe in 2 patients, microphthalmos in two patients, and medulloepithelioma in one patient. Thirty-four patients (45%) had had prior ocular surgery. The prosthesis was fitted after a mean interval of 4.5 weeks (range, 3 to 10 weeks). After a mean follow-up of 20 months (range, 3 to 33 months), there was one case (1%) of conjunctival dehiscence with material exposure secondary to massive postoperative orbital hemorrhage 2 weeks after enucleation. There was no case of orbital cellulitis, implant extrusion, or significant inflammatory response. No PP implant was drilled for peg placement. DISCUSSION-CONCLUSIONS: The anteriorly wrapped porous polyethylene orbital (Medpor) sphere appears to be well tolerated by all age groups with no major complication in primary implantation after enucleation.     

Retrobulbar alcohol injection in blind painful eyes.

We studied 39 blind painful eyes in 39 patients who were treated with retrobulbar injection of absolute (96%) alcohol for their severe ocular pain at the King Khaled Eye Specialist Hospital from January 1984 to January 1987. There were 21 (54%) male and 18 (46%) female patients; all were followed for at least three months. The protracted ocular pain was mainly due to: end-stage (absolute) glaucoma in 31 (80%) eyes, uveitis or endophthalmitis in four (10%) eyes, or corneal ulcer in two (5%) eyes. One eye had painful phthisis bulbi, and one eye had infraorbital neuralgia. The complications encountered were transient and included blepharoptosis in eight (21%) eyes, external ophthalmoplegia, and corneal epithelial defect. The effective time of the injection to relieve pain ranged from two weeks to two years (mean, 29 weeks). The authors believe that there is still a place for retrobulbar alcohol injection for blind painful eyes when enucleation or evisceration is not possible.     

Persistent hyperplastic primary vitreous. A clinicopathologic study of 62 cases and review of the literature

This is a clinicopathologic study of 62 cases of persistent hyperplastic primary vitreous (PHPV). The cases were divided into two main groups. Group 1 consisted of 55 unilateral cases not associated with any systemic abnormalities, including 36 eyes (58%) which were considered “pure cases” (Group 1A) and 19 (31%) which disclosed other ocular abnormalities in addition to PHPV (Group 1B). Group 2 consisted of 7 (11%) bilateral cases of PHPV accompanied by other ocular and systemic malformations. The most common presenting clinical signs are leukocoria, microphthalmia and cataract. The main histopathologic features of this condition are outlined, including those responsible for the disastrous to the eye (retinal detachment, glaucoma, phthisis bulbi). Several clinical entities, usually mistaken for or associated with PHPV, such as retinoblastoma, congenital cataract, retinal dysplasia, trisomy 13 syndrome, and falciform retinal folds are discussed briefly.