兔眼球摘除后眼眶畸形发育机制的初步研究

目的：初步探讨兔眼球摘除后眼眶畸形发育的机制。方法：选取7只1月龄、体重相近健康的新西兰幼兔，行单侧眼球摘除，另一侧作为对照。手术1个月后将兔处死，对比研究双侧眼眶的大体形态学和眶骨组织学改变，并测量反映骨吸收情况的骨计量学指标N．Oc／B．Pm。结果：眼球摘除侧眼眶发育畸形，摘除侧骨组织吸收现象活跃。结论：眼球摘除后骨吸收异常参与了眶骨的畸形发育，摘除侧眶骨自身的塑造是一个异常的过程。     

义眼台植入对眶骨组织中转化生长因子－β1表达的影响

【摘要】背景义眼台植入是防治眼球摘除术后眼眶畸形发育的主要手段，但其作用机制尚不十分清楚。研究表明骨局部生长因子在骨组织的发生、发育、损伤修复等过程中具有重要作用，转化生长因子-β1（TGF-β1）的作用更值得关注。目的检测眼球摘除和义眼台植入后眶骨组织中骨局部TGF-β1．的表达情况，探讨眼球摘除后眼眶畸形发育防治的作用机制。方法选用同龄、健康、体质量相近的新西兰幼兔21只，按随机数字表法分为眼球摘除组、义眼台植入组和正常对照组。实验兔1月龄时对眼球摘除组和义眼台植入组分别行左眼球摘除或眼球摘除联合义跟台植入术，正常对照组左眼眶作为对照。术后1个月时处死全部兔，用酶免疫组织化学法和FITC免疫荧光标记法对眼球摘除组、义眼台植入组和正常对照组兔眶骨组织中TGF-β1蛋白表达情况进行检查，利用ELISA法测定兔眶骨组织中TGF—p，蛋白的表达水平。结果术后1个月义眼台植入组和正常对照组兔眶高和眶宽的数值均明显高于眼球摘除组，差异均有统计学意义（眶高：P=0．00、P=0．00；眶宽：P=0．00、P=0．00）。免疫组织化学检测发现，义眼台植入组和正常对照组兔眶骨组织中TGF-β1，的染色强度明显高于眼球摘除组，骨组织中着色细胞多，染色较深，而义眼台植入组和正常对照组兔眶骨组织中TGF-β1的染色强度相近。TGF-β1免疫荧光法染色结果表明，义眼台植入组和正常对照组兔眶骨组织中TGF--β1的荧光细胞数量多于眼球摘除组。ELISA检测结果显示，眼球摘除组兔骨组织中TGF-β1的质量分数较义眼台植入组和正常对照组低，差异均有统计学意义（P=0．00、P=0．00），义眼台植入组和正常对照组骨组织中TGF-β1，质量分数的差异无统计学意义（P=0．41）。结论TGF-β1参与了眶骨发育过程及义眼台植入防治眼球摘除后眼眶畸形发育的过程。     

义眼台植入对兔眼眶骨细胞的影响

目的 观察眼球摘除和义眼台植入对兔眼眶骨细胞凋亡的影响,初步探讨义眼台植入对眼眶畸形发育防治的作用机制.方法 实验研究.选用同龄、健康、体重相近新西兰幼兔21只,随机分为眼球摘除组、义眼台植入组及正常对照组.1个月龄时对眼球摘除组和义眼台植入组的兔分别行左侧眼球摘除或眼球摘除联合义眼台植入术,正常对照组左侧眼眶作为参照.2个月龄时处死全部兔子,采用光镜、透射电镜和TUNEL法检测其眶骨骨细胞凋亡,并用TUNEL法计量分析3组骨细胞的凋亡情况,采用LSD法对3组骨细胞凋亡率间进行比较.结果 在3组眶骨组织中均可检测到凋亡骨细胞,用TUNEL法观察可见凋亡骨细胞呈散在不规则性分布;TUNEL法计数结果显示眼球摘除组、义眼台植入组及正常对照组骨细胞凋亡率分别为20.56%±2.13%、14.29%±3.60%、12.57%±2.40%,眼球摘除组骨细胞凋亡率与义眼台植入组及正常对照组骨细胞凋亡率之间差异有统计学意义(P<0.01),义眼台植入组和正常对照组骨细胞凋亡率之间差异无统计学意义(P>0.05).结论 眶骨细胞凋亡参与了义眼台植入防治眼球摘除后眼眶畸形发育的过程.(中华眼科杂志,2008,44:700-704)     

无眼球患儿眶内植入物手术时机的选择

正常儿童颅面部发育依赖于眼眶的生长发育,而骨性眶腔的增大与眼球发育相关。目前国内众多学者围绕发育期眼球摘除或无眼球患儿眶内植入物手术时机的选择有不少争论。有些学者认为植入物手术越早越好,而另一些学者则认为一个固定大小的眶内植入物并不能刺激眼眶发育达到正常水平,而且随着患儿的发育必将面临二次或三次手术的可能。根据儿童眼眶、眼球发育及其眶容积缺失对眶发育的影响,来论述发育期患儿眶内植入物手术时机的选择问题。     

眼台Ⅱ期植入对眼眶发育影响的实验研究

目的：探讨不同时间眼球摘除后对眼框发育的影响及眼球摘除眼台Ⅱ期植入对眼框发育的影响。方法：将18只同龄幼兔,随机分成两组,一组分别在不同兔龄行单侧眼球摘除术,另一组则均在相同兔龄行单侧眼球摘除术,并在眼球摘除后不同时间人别行Ⅱ期HA植入。两组兔均在4月龄时处死,直接解剖测量术眼和健眼的眶容积并进行对比研究。结果：眼的眶容积与术眼的眶的容积差值百分比与眼球摘除时间之间有密切的负相关（r=-0.988);健眼眶容积与眼台植入组眶容积差值百分比与眼台植入时间之间有密切的正相关（r= 0.978)。结论：在生长发育期,眼球摘除越早期眼眶发育越差;眼球摘除后眼台植入越早眼框的发育越好;眼球在眶骨发育过程中起到一种“生骨诱导中心”的作用,眼台也卢到一定的“生骨诱导中心”作用。     

眼球摘除对眼眶发育的影响及其防治研究进展

在眼科手术中 ,平均眼球摘除率为 2 8/1 0万。在成人眼球摘除后 ,常导致眼球摘除后综合征。在儿童摘除眼球后 ,不仅会导致眼球摘除综合征 ,而且导致眶骨发育迟缓 ,严重者造成颜面畸形。为此 ,本文就眼球摘除适应证、眼球摘除综合征发生机制和防治、以及眶内植入物对眶骨发育影响等方面的系统研究加以综述。     

牛骨异种移植物作为义眼座兔眼眶内植入术

目的:评价以牛骨作为义眼座在兔眼眶内植入的生物相容性。方法:在兔眼中用牛骨作为植入物,观察其生物相容性及其能否取代昂贵的人造植入物。把12只眼球内容摘除术后的新西兰白兔按眶内有没有植入牛骨分为两组:Y组(6只)为眼球摘除术后眶内没有植入牛骨,X组(6只)为眼球摘除术后植入牛骨。对12只新西兰白兔右眼行眼球内容物摘除,其中6例作为实验组行牛骨植入,6例作为对照组不植入。术后1,7,14,28,42d连续观察术眼的感染情况,植入物的移位情况,伤口愈合情况,眼球运动是否受限。术后42d,摘除实验组眼球,行组织病理检查,检测其炎性反应类型以及纤维血管增生情况。结果:连续临床观察显示:试验组和对照组在术后1d都有轻微的炎症反应,抗生素控制有效。试验组有1例在术后1d发生感染。但没有植入物的移位和脱出,没有伤口的裂开和眼球运动受限,也没有严重的感染和畸形出现。组织病理检查显示牛骨纤维生长良好,有轻微的排斥反应。结论:实验表明在兔眼中,牛骨作为义眼座植入有良好的生物相容性,而且其成本较低,易被接受。     

结膜囊内植入物对幼兔眼眶发育的影响

目的 观察眼模置入幼兔结膜囊后刺激眼眶生长发育的程度及引起眶容积的变化。方法 选取70只新西兰幼兔(1月龄),随机分为4组,其中A组、B组、C组各20只,均摘除右眼球,保留左眼,A组每隔2周更换1次更大号眼模,B组每隔4周更换1次更大号的眼模,C组不置入眼模;对照组D组10只,不作任何处理。术前和术后12周分别使用CT测双眼眼眶容积。结果 术后12周,A组、B组、C组、D组兔右眼眶容积分别为(2.81±0.23)cm3、(2.91±0.19)cm3、(2.57±0.17)cm3和(3.12±0.18)cm3,A组与B组间差异无统计学意义,其余各组间差异均有统计学意义(均为P<0.05)。术后12周兔自身左右眼眼眶容积比较,A组、B组、C组差异均有统计学意义(均为P<0.05);D组差异无统计学意义(P>0.05)。结论 结膜囊置入眼模组较不置入眼模组眼眶发育更好,结膜囊置入眼膜能在一定程度上刺激眼眶发育,是促使眶容积增大的有效方法。     

羟基磷灰石义眼台植入术的护理体会

眼球摘除或眼内容物剜除术后，眼窝凹陷畸形，儿童还会影响眼眶及同侧颜面部的发育。因此，应及时采取眶内填充物来矫治。羟基磷灰石义眼台是一种新型眶内植入物，它与以往的玻璃、塑料、金属物等填充物比较有明显的优势。1998年3月～2005年3月，我院共收治眼内容物剜除或眼球摘除术后植入HA患者96例，经过精心护理，疗效满意，现将资料报告如下。     

先天性小眼球合并眼眶囊肿诊断与治疗

目的 探讨先天性小眼球合并眼眶囊肿的临床、影像诊断及治疗方法.方法 回顾分析19例(20只眼)先天性小眼球合并眼眶囊肿的临床表现、影像学资料、手术治疗过程及术后效果,研究该病的临床、影像诊断及治疗方法.结果 通过B超、彩超、CT及MRI等影像学检查,可发现先天性小眼球合并眼眶囊肿中发育异常的小眼球、眼眶内囊性肿物,典型病例两者之间存在沟通.10例患者同时摘除小眼球与囊肿并植入羟基磷灰石义眼台,有效改善外观,未影响眶骨发育.3例单纯摘除囊肿患者,保留小眼球可填充眶内容,外观影响较小,眼球有继续发育可能.2例术后缝合睑裂者,外观受影响.2例患者采用囊内液抽吸,术后复发.结论 先天性小眼球合并眼眶囊肿可通过临床表现和特征性的影像学检查(发现小眼球与囊肿的沟通)明确诊断.手术治疗宜选同时摘除小眼球与囊肿并植入羟基磷灰石义眼台,小眼球发育较好者宜选单纯摘除囊肿+眼球修补术.     

Ethmoid osteoma, orbital cellulitis and orbital emphysema

A possibly unique association of an osteoma of the ethmoid sinus with orbital emphysema and orbital cellulitis is described. The osteoma, which had eroded through the orbital periosteum, was removed; the orbital periosteum was grafted with fascia lata and a partial external ethmoidectomy performed.     

Delayed orbital infection after endoscopic orbital decompression for dysthyroid orbitopathy

OBJECTIVE: To present a delayed complication of endoscopic orbital decompression that has not been reported previously in the literature. DESIGN: Retrospective non-comparative small case series. PARTICIPANTS: Three patients with dysthyroid orbitopathy. INTERVENTION: The medical records of patients with dysthyroid orbitopathy who underwent endoscopic orbital decompression and subsequently developed orbital infection were reviewed. RESULTS: Three patients with dysthyroid orbitopathy developed orbital infection (cellulitis or abscess) originating from the frontal sinus more than 2 years after their endoscopic orbital decompression surgery. Management required drainage of the abscess, administration of antibiotics, and creation of adequate frontal sinus drainage. CONCLUSIONS: Delayed orbital infection can occur after endoscopic orbital decompression for dysthyroid orbitopathy when the frontal sinus ostium is obstructed by orbital fat or scar tissue. Infection within the frontal sinus can cause secondary orbital cellulitis or abscess. Early signs and symptoms of a frontal sinus infection can be easily misdiagnosed as progression of the patient's thyroid eye disease. Awareness of this possible complication followed by appropriate early intervention will prevent a potentially blinding condition. Furthermore, ever since this complication was observed, the authors' surgical technique of endoscopic decompression has been modified to leave the most anterosuperior portion of the lamina papyracea to prevent fat prolapse and scar formation into the region of the frontal recess.     

A case of orbital abscess following porous orbital implant infection

PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.     

Current orbital literature

Introduction: Multiple venous abnormalities involving the orbit, head and neck regions have been previously described. We present two similar cases of low-flow orbital venous vascular malformations (VVMs) in association with multiple low-flow VVMs in the head and neck as well as in the peripheral limb. Literature search revealed that this association has not been previously reported. Methods: Retrospective review of two patients with multifocal VVMs was performed. Results: Case 1: A 46 year-old Chinese female had a history of multiple vascular lesions involving the right orbit, the tongue, right neck region, right arm and one finger. Valsalva manoeuvre resulted in distension of these lesions. CT scan of the orbits demonstrated bilateral low-flow VVMs. CT angiogram also revealed multiple developmental venous anomalies in the brain. Case 2: A 16 year-old Chinese female had a history of multiple venous malformations involving the neck, left forearm and oral region. Dynamic manoeuvres demonstrated the distensible nature of these lesions. MRI scans of the orbits showed bilateral extraconal low-flow VVMs. Similar mass lesions were seen on MRI scans of the neck. Conclusions: Multiple cervicofacial venous malformations with developmental abnormalities of the intracranial venous system have been described previously. However, their associations with similar VVMs in the peripheral limb regions have not been reported. Our cases illustrate this rare association. VVMs appear to be benign in nature with symptoms mainly due to mass effect. Management can be conservative in the absence of any sight threatening complication.     

Congenital orbital teratoma

Background: The occurrence of proptosis at birth unusual and may be associated with a variety of tumours and structural abnormalities. Congenital orbital teratoma a rare cause of congenital proptosis. Methods: A case report is presented of a female infant with gross right proptosis. Results: Computed tomography demonstrated a characteristic multicystic structure with no intracranial involvement. Histological examination found tissues derived from all three germ cell layers, consistent with a congenital orbital teratoma. The tumour was successfully removed preserving the globe and vision. Conclusions: This report is an example of how early surgical intervention may allow preservation of the globe and vision in some patients with congenital orbital teratoma.