视网膜母细胞瘤眼球摘除、羟基磷灰石义眼座Ⅰ期植入临床观察

目的 评价视网膜母细胞瘤眼球摘除，羟基磷灰石（hydroxyopatite，HA）义眼座Ⅰ期植入术后的临床效果。方法 对27例（27眼）Rb患者行眼球摘除眶内HA义眼座Ⅰ期植入术后进行临床观察。结果 术后随访12～36个月，平均18个月。义眼座活动度良好。24例结膜创口Ⅰ期愈合，2例结膜变薄，1例结膜创口裂开，HA义眼座暴露。1例Rb复发。结论 Rb患者眶内HA义眼座Ⅰ期植入有助于眼眶发育和美容。     

视网膜母细胞瘤眼球摘除术后羟基磷灰石义眼座植入的临床观察

视网膜母细胞瘤 (ｒｅｔｉｎｏｂｌａｓｔｏｍａ ,Ｒｂ)是婴幼儿最常见的眼内恶性肿瘤 ,目前常用治疗方法为患眼眼球摘除术。羟基磷灰石 (ｈｙｄｒｏｘｙｏｐａｔｉｔｅ ,ＨＡ)义眼座现已广泛应用于临床 ,但对Ｒｂ患者眼球摘除术后是否植入ＨＡ义眼座 ,在临床上尚有争论。现将我院 1995～ 1998年 78例Ｒｂ患者眼球摘除术后植入ＨＡ义眼座的临床效果进行分析。一、资料与方法1 对象∶Ｒｂ患者 78例 ,男性 43例 ,女性 35例。年龄4个月至 5 4岁 ,平均 3 2岁。均行眼球摘除术及Ⅰ期ＨＡ义眼座植入术。其中 14例视神经末端肿瘤扩散者加用钴60 放…     

视网膜母细胞瘤眼球摘除并放疗后Ⅱ期义眼座植入的临床观察

目的观察RB眼球摘除并放疗后Ⅱ期义眼座植入的临床效果。方法回顾分析27例RB眼球摘除并放疗后义眼座Ⅱ期植入的临床资料,并观察其疗效。结果27例患者术后眼窝塌陷和义眼运动都得以明显改善和恢复,24眼动度较好,3眼动度较差。追踪随访1月￣5年,无1例复发、感染;2例义眼座暴露,4例上睑板沟轻度凹陷,1例上睑下垂。结论RB眼球摘除并放疗后义眼座Ⅱ期植入可获得良好效果,应尽可能早期手术,并注意手术方法与技巧。     

视网膜母细胞瘤术后羟基磷灰石眼座Ⅰ期植入

目的评价视网膜母细胞瘤(Rb)眼球摘除后羟基磷灰石(hydroxyapatite,HA)义眼座Ⅰ期植入术的疗效.方法儿童Rb27例27眼眶内HA义眼座Ⅰ期植入.需要放疗者术后1月进行.结果术后义眼座活动度良好.并发症义眼座暴露2眼,睑球粘连1眼.结论Rb患儿眶内HA义眼座Ⅰ期植入有助于眼眶发育和美容.放疗者易发生睑球粘连.     

视网膜母细胞瘤眼球摘除术后羟基磷灰石义眼座Ⅰ期植入

视网膜母细胞瘤(retinoblastoma,RB)是婴幼儿时期最常见的眼内恶性肿瘤,其发病率约为1/15000~1/28000[1],目前我国大部分地区对RB的治疗仍以眼球摘除为主。近年来,羟基磷灰石(hydroxyapatite,HA)义眼座植入已广泛开展,但对RB患者术后是否植入义眼座尤其I期植入,一直存在很大争议。现将2000年1月~2005年5月间的21例RB眼球摘除术后I期植入HA义眼座的临床效果进行分析。1资料与方法1.1一般资料21例(21眼)RB患者,男13例,女8例,年龄6月~5岁,平均3.3岁。左眼12例,右眼9例。就诊原因:白瞳症14例,斜视6例,视力下降1例。所有患儿术前均经CT或…     

视网膜母细胞瘤术后羟基磷灰石眼座I期植入

目的 评价视网膜母细胞瘤(Rb)眼球摘除后羟基磷灰石(hydroxyapatite，HA)义眼座I期植入术的疗效。方法 儿童Rb27例27眼眶内HA义眼座I期植入。需要放疗者术后1月进行。结果 术后义眼座活动度良好。并发症：义跟座暴露2眼，睑球粘连1眼。结论 Rb患儿眶内HA义眼座1期植入有助于眼眶发育和美容。放疗者易发生睑球粘连。     

视网膜母细胞瘤眼球摘除术后羟基磷灰石义眼座I期植入的临床观察

目的探讨视网膜母细胞瘤(RB)眼球摘除术后羟基磷灰石(HA)义眼座Ⅰ期植入的可行性。方法回顾分析21例(21只眼)RB眼球摘除术后HA义眼座Ⅰ期植入的临床效果。结果21例患者术后48小时内眼睑轻度肿胀,球结膜不同程度水肿,眼部胀痛,2天后明显减轻;1周后球结膜伤口愈合,义眼座动度良好。追踪随访1月～5年,复发1例,所有患者均无感染、义眼座暴露及上睑板沟凹陷。结论RB眼球摘除术后HA义眼座Ⅰ期植入是可行的,但要掌握好适应证的选择。     

视网膜母细胞瘤摘除术后羟基磷灰石义眼座Ⅰ期和Ⅱ期植入临床观察

目的 比较视网膜母细胞瘤摘除术后羟基磷灰石义眼座Ⅰ期植入和Ⅱ期植入的临床效果。方法 对11例视网膜母细胞瘤患者进行观察．6例行羟基磷灰石义眼座Ⅰ期植入．5例行Ⅱ期植入和颜面部整复术。结果 术后随访3～36个月，6例Ⅰ期植入者，术后结膜无裂开、感染、结膜囊狭窄等并发症；5例Ⅱ期植入者，HA活动度较Ⅰ期差．1例见结膜创口裂开，羟基磷灰石义眼座暴露。结论 视网膜母细胞瘤摘除术后Ⅰ期植入羟基磷灰石义眼座．在治疗和美容效果上明显优于Ⅱ期植入者，视网膜母细胞瘤摘除术后尽可能Ⅰ期植入眼座是可行的。     

带预置缝线HA义眼座Ⅱ期植入加结膜囊成形术

因眼外伤、炎症、肿瘤及其它眼病所致的眼球丧失 ,由于条件限制不能当时安装义眼 ,待病情稳定或条件允许后再行整容手术时常有结膜囊形态改变。按传统的方法需分两次手术 ,二者间隔半年以上 ,给患者造成不便。我院自 1997年 2月至 2 0 0 2年 6月对无眼球伴结膜囊缩窄 46例 (4 6眼 )行带预置缝线的羟基磷灰石义眼座Ⅱ期植入加结膜囊成形术 ,取得了良好效果 ,现报告如下。临床资料本组共 46例 (4 6眼 ) ,其中男 2 6例 (2 6眼 ) ,女 2 0例 (2 0眼 ) ;年龄 2～ 64岁。视网膜母细胞瘤 6眼 ,眼外伤 3 0眼 ,眼内炎 5眼 ,其它 5眼。眼球摘除 3 5眼 ,…     

外伤性眼内炎HA义眼座Ⅰ期植入临床观察

目的 观察外伤性眼内炎羟基磷灰石（HA）义眼座Ⅰ期植入的效果。方法 住院病例分析和随访观察。结果 2000年因眼内炎眼内容摘除和HA义眼座Ⅰ期植入10例。义眼座植入肌锥内或后部开孔的巩膜腔内。术后大剂量有效抗生素、皮质类固醇全身和局部应用5－7天,加压包扎3－5天。8例Ⅰ期愈合,随访至少3月以上,未见并发症;另2例术后4天和8天发现感染而取出义眼座,其中1例术前眼眶或眶周化脓性炎症、1例为真菌感染。结论 外伤后非特异性化脓性眼内炎可行眼内容摘除HA义眼座Ⅰ期植入,而合并眶内和眶周感染、难以控制的细菌感染或真菌感染应慎重。     

Porous orbital implant after enucleation in retinoblastoma patients: indications and complications

This study aims to identify risk factors associated with complications in retinoblastoma patients following primary and secondary enucleations with porous implant placement.

A retrospective case-control study was performed between 2010 and 2015. Data pertaining to subjects’ demographics, medical history, clinical, and pathological findings, implant characteristics and complications were collected.

The analysis included 103 eyes of 101 patients age 27.8 ± 21.9 months undergoing enucleation for retinoblastoma. Postoperatively, 19/103 (18%) eyes developed exposure, extrusion, or hematoma requiring subsequent surgery. Exposure was the most common postoperative complication (12/19, 63%). Age at enucleation 24 months or younger, Hispanic ethnicity, female gender, and intravenous chemotherapy prior to enucleation were associated with increased odds of implant complications. In contrast, patients who were given intravitreal melphalan (IM), subtenons carboplatin (SC), or external beam radiation therapy (EBRT) did not demonstrate an increased risk of complications.

In this cohort of retinoblastoma patients undergoing primary or secondary enucleation with porous implants, implant exposure was the most common postoperative complication. Our findings suggest that female gender, Hispanic ethnicity, age at enucleation 24 months or younger, and intravenous chemotherapy prior to enucleation may increase the risk of complications.     

Analysis of aqueous humour proteins in patients with retinoblastoma

Background: To investigate aqueous humour protein composition from retinoblastoma patients. Design: Prospective, hospital‐based study. Participants: Eighteen retinoblastoma patients (Reese–Ellsworth stage V or ABC classification group E RB) undergoing ocular enucleation, and 10 normal subjects undergoing cataract surgery. Five of 18 patients presented with associated secondary glaucoma whereas 13 had no secondary glaucoma; 5 of 13 patients with no secondary glaucoma received chemotherapeutical treatment with melphalan. Methods: Aqueous humour samples were collected by limbal paracentesis of the anterior chamber after ocular enucleation in patients and after the stab peripheral corneal incision in controls. Total protein concentration according to Bradford method and sodium dodecyl sulphate‐polyacrylamide gel electrophoresis of the samples were performed. Main Outcome Measure: Aqueous humour protein concentration. Results: Aqueous humour protein concentration was significantly higher in retinoblastoma patients than controls (P < 0.01); patients with secondary glaucoma presented the highest values (P < 0.05 vs. controls); patients treated with melphalan presented a significant decrease (P < 0.01) versus non‐treated; controls did not significantly differ from treated patients. Sodium dodecyl sulphate‐polyacrylamide gel electrophoresis pattern in retinoblastoma patients who did not receive any treatment was very different either from treated or from controls. Conclusion: This study represents a preliminary step towards a more accurate two dimensional electrophoresis (2DE) pattern, which will be combined with mass spectrometry analysis to clarify the potential role of specific proteins in tumour development and progression; although these results suggest that aqueous humour protein pattern in retinoblastoma is characteristic, several aspects of the study are still under investigation.     

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。     

两种不同术式义眼台Ⅰ期植入方法的比较

目的观察不同术式羟基磷灰石义眼台Ⅰ期植入的临床效果。方法对23例患者采用两种不同术式Ⅰ期植入羟基磷灰石义眼台，植入方法分别为眼球摘除联合自体巩膜包裹义眼台植入术及眼内容物剜除联合巩膜花瓣状成形义眼台植入术。结果23例患者术后均无义眼台脱出及暴露等严重并发症，但术式一的术后反应偏重，义眼活动性稍差，术式二的眼球较术前偏小。结论两种术式各有其优缺点及适用范围，均能取得较满意的临床效果；但术式二对眶内结构损伤轻，术后义眼片活动性更佳。     

Necrotic intraocular retinoblastoma associated with orbital cellulitis

Orbital cellulitis associated with retinoblastoma is uncommon and is characterized by noninfectious inflammation of the periorbital structures. The underlying mechanism is thought to be necrosis of the intraocular tumor, leading to intraocular and periorbital inflammation. We report 2 retinoblastoma patients who presented with an orbital cellulitis-like picture and discuss clinical characteristics, histopathologic features, and treatment.     

Case series: effect of dermis-fat implants in different late onset socket problems encountered in retinoblastoma patients

Background: Cosmetic dissatisfaction, pain, and chronic discharge may present months till years after enucleation in patients operated because of retinoblastoma. If noninvasive treatment modalities are insufficient, socket reconstruction can be considered. In this study, we discuss the results of dermis-fat exchange to treat these problems.

Method: Four patients with late onset post enucleation socket problems with a request for treatment were included in this prospective study. Socket inspection was documented and pictures at baseline and at a follow-up of at least 6 months were taken. To quantify the problem ‘pain’, a VAS score at baseline and at follow up was used. For the problem ‘cosmetic dissatisfaction’ standardized questionnaires were used.

Results: Two patients were included because of cosmetic dissatisfaction; one was included with chronic pain and one with chronic discharge. Reconstruction of the socket using autologous dermis-fat insertion was done in all four. In one of them, severe shrinking of the fat developed. This patient was treated with additional injectable fillers. Both of them, ultimately, had satisfactory results. Autologous fat transplantation also solved the problem of chronic discharge and pain in the two other patients.

Conclusion: Socket reconstruction by autologous dermis-fat exchange may solve different post enucleation socket problems. However, shrinking of the transplanted fat may occur and require additional procedures.     

国人视网膜母细胞瘤患者RB1基因突变的特性

目的:检测国人RB患者体细胞中RB1基因突变,分析我国RB1基因突变的特性,探讨RB1基因突变的分子生物学机制。方法:应用PCR—SSCP技术筛查28例RB患者及亲属的白细胞基因组DNA,测序分析确定突变。结果:共确定7例RB1基因生殖细胞性突变。结论:本组RB1基因生殖细胞性突变的方式为点突变和小缺失,这些突变改变了RB1基因的遗传信息,致使异常的RB1基因蛋白产生,导致视网膜母细胞瘤的发生。中国RB1基因突变方式主要是以微小突变为主,但复杂突变的比例相对较高。