Orbital Compartment Syndrome: The Ophthalmic Surgical Emergency

Orbital compartment syndrome is an uncommon, ophthalmic surgical emergency characterized by an acute rise in orbital pressure. When intraorbital tension rises, damage to ocular and other intraorbital structures, including irreversible blindness, may occur if not promptly treated. The diagnosis of orbital compartment syndrome is completely clinical and early recognition and emergent orbital decompression (even prior to imaging) is essential in preventing permanent vision loss. Lateral canthotomy and inferior cantholysis remain the mainstays of management. More extensive incision of the orbital septum and orbital bony decompression may be necessary in unresponsive cases. This review discusses the various etiologies and mechanisms resulting in orbital compartment syndrome, clinical features, imaging findings, treatment, and prognosis.     

带血管蒂颞顶筋膜瓣移植进行眶腔重建

目的分析带血管蒂颞顶筋膜瓣转移进行眶腔重建的优缺点和适应证。方法对行眶内容摘除术后的19例患者,利用同侧颞浅动脉、静脉作为供养血管,通过皮下组织隧道将组织块移植到眶内重建眶窝,进行同期或延期带血管蒂颞顶筋膜瓣转移实施眼眶重建。结果随访观察16例,随访时间为6～120个月,平均55个月。3例局部复发,向副鼻窦蔓延;4例死于全身转移,但眼部情况基本正常;余9例正常,其中5例患者眶腔重建后出现眼睑畸形、位置异常,二期进行眼睑整形,结膜囊扩大和增加眶腔体积等手术后,外观均明显改善。3例患者失访。结论利用带血管蒂颞顶筋膜瓣转移进行眼眶重建,不需吻合血管,操作较简单,易于成活,术后外观满意,是较好的重建方法,但不能防止肿瘤复发。     

Vascular Studies of the Orbital Cavity

The orbital cavity is a dynamic region filled with pulsatile vascular structures. Newly developed ultrasonic-imaging equipment enables the physician to study the in-vivo motion of orbital tissues and their blood vessels to obtain pertinent diagnostic information relating to orbital diseases. Evidence of enhanced vascular activity is observed in endocrine ophthalmopathy and other orbital inflammatory conditions. Blood vessels within tumors help to localize the abnormalities and give clues relating to an accurate tissue diagnosis. These examinations are performed repeatedly and noninvasively in a clinical environment.     

羟基磷灰石义眼台植入术后并发症的影响因素现状

由于具备诸多优点,羟基磷灰石(hydroxyapatite,HA)义眼台自问世以来便得到广泛应用,其可作为眼球摘除术或眼内容物剜除术后填充眼眶内容积的理想材料,但其仍会引起并发症,有些并发症如严重的义眼台暴露等可能需要进行二次植入手术.本文就HA义眼台的临床应用、植入术后并发症、产生并发症的可能影响因素及常见并发症的处理方法等进行综述,以期为HA义眼台的临床应用提供一定的参考.     

Mycobacterium Abscessus Infection in a Case of Recurrent Orbital Implant Exposure

Exposure is one of the most frequent complications of porous orbital implants, while infection is rarely observed. Atypical mycobacteria are ubiquitous germs of mostly variable pathogenicity. A patient with recurrent orbital implant exposure is described, in whom a final diagnosis of Mycobacterium abscessus infection was made on culture of the orbital implant remnant at its removal.

In orbital implant exposure, infection with unexpected organisms should be considered and in these cases only the complete removal of the implant may allow the socket to settle.     

有限元方法在眼眶生物力学中的应用进展

有限元方法(FEM)是力学研究中常用的数学方法，将物体划分为离散且相互作用的有限单元。在医学研究中，有限元分析(FEA)可模拟难以开展的生物力学实验。眼眶手术极具挑战性且具有陡峭的学习曲线，给眼科医生带来了巨大挑战。FEM可模拟分析眼眶组织的力学特性，为眼眶相关疾病的诊断和治疗提供了新的方法。随着技术的发展，FEM在眼眶疾病的诊疗中愈发成熟，并成为眼眶生物力学研究的热门领域。本文综述了眼眶FEM的最新进展，包括建立眼眶FEA模型、模拟眼眶结构以及在眼眶相关疾病中的应用情况。此外，还讨论了FEM的局限性和未来的研究方向。眼眶FEA作为一种辅助诊疗数字化工具，将随着技术的发展逐渐释放其在眼眶疾病诊疗方面的潜力。     

螺旋CT影像技术在眼眶容积测量中的应用

眼眶CT技术是目前眼眶容积测量的重要方法之一。其以CT扫描数据为基础，通过眼眶边界描绘，利用几何公式计算出眶腔容积，是一种可靠的眼眶容积定量测量方法。该技术不仅提供了正常眼眶容积的范围，准确性高，并为眼眶疾病的诊断和治疗提供了可靠的参考数据，为眼眶手术的安全性和眼眶重建提供了形态学资料，已作为临床眼眶容积的常规检查。就该技术研究的现状、方式方法及前景做一综述。     

The use of computed tomography and ultrasonography in the evaluation of orbital masses

The combined use of computed tomography scans with multiplanar reformation and ultrasonography makes it possible to locate orbital masses with a high degree of accuracy, and sometimes even to determine their histological nature without surgical biopsy. One of the unique features of computed tomography is its ability to distinguish both normal and abnormal structures of various tissue densities; this has contributed to very low false positive and false negative rates. Ultrasonography, while of limited use in the detection of posterior orbital lesions or lesions involving the orbital bones, provides an excellent cost-effective screening test for anterior and midorbit disease. It is also useful for the detection of extraocular muscle enlargement secondary to thyroid disease. In this article, a review of the characteristics and techniques of computed tomography and ultrasonography is followed by discussion of the advantages and limitations of each modality in the evaluation of six common types of orbital tumefaction.     

Computed Tomography in Planning and Evaluating Orbital Surgery

Computed tomography (CT) scanning of the orbit has enhanced the diagnostic and surgical armamentarium of the orbital surgeon, localizing the lesion in the retrobulbar spaces and separating those expanding masses confined to the orbit from those that invade from adjacent structures. It relates an orbital lesion to the surgical spaces, optic nerve and globe, and bony orbital walls, guiding the operator in his surgical approach. If the lesion has escaped from the orbit into the intracranial cavity, CT scanning can detect it. In this way, the surgical teams and surgical approaches are chosen. After surgery, CT scanning can detect a local recurrence of a tumor and note if it has extended intracranially. However, invasion of the optic canal may be better detected by polytomography. There is also some difficulty in distinguishing between a tumor recurrence and postoperative inflammation. Postoperative follow-up evaluation by serial CT scanning every six months is advocated to determine these changes.     

眼眶CT呈现铸型征的临床意义

目的:回顾性阅读眼眶CT 1354例,总结、归纳CT征:铸型征的临床意义。方法:参阅1354例眼眶CT片,选择出现铸型征的CT图像,将其病因分类并讨论其在眼眶病中诊断与鉴别诊断的意义。结果:在1354例眼眶CF中,发现123例出现铸型征,按其病因大致分为:血管性疾病45例,占36.5％;恶性肿瘤40例,占29.5％;眼眶非特异性炎症和慢性炎症27例,占21.9％;其他有11例,占8.9％。结论:铸型征是眼眶CT中一种特异性征象,对眼眶病的诊断有重要价值。结合其他影像检查,对某些疾病可以做出定性诊断。     

Canthal cutdown for emergent treatment of orbital compartment syndrome

This article evaluates the use of a “canthal cutdown” technique in orbital compartment syndrome in a cadaveric model. Twelve cadaver orbits were used to simulate orbital compartment syndrome using a blood analog solution. Two pressure probes, in different orbital locations, were used to monitor orbital pressure. Pressure was monitored during successive procedures: canthotomy, cantholysis, and canthal cutdown. Orbits were then re-injected with solution, simulating an active orbital hemorrhage, and pressure measurements were recorded over a 10-minute duration. No statistically significant difference was found between the two orbital pressure monitoring devices at each measurement point (p = 0.99). Significant pressure reductions, for both probes, were observed after canthal cutdown compared to initial measurement after injection of 20 mL blood analog (p < 0.001 and p = 0.005). When comparing the orbital pressure following canthotomy and inferior cantholysis versus canthal cutdown, the cutdown procedure provided an additional 74% in orbital pressure reduction (p =0.01). After re-injection of 10 mL of solution and 10 minutes of egress, pressure returned to baseline (probe 1: baseline 7 mm Hg vs. post-cutdown at 10 minutes 7 mm Hg; p = 0.83; and probe 2: 5 mm Hg vs. 5 mm Hg; p = 0.83). The canthal cutdown technique provides further reduction in orbital pressure versus canthotomy and cantholysis alone. The technique may be effective for treatment of static orbital compartment syndrome and temporizing treatment of compartment syndrome from active orbital hemorrhages.     

眼眶占位性病变36例手术分析

目的探讨眼眶占位性病变的临床诊断，手术治疗及其组织病理学分类。方法对2004年1月～2006年5月手术治疗的36例（36眼）眼眶占位性病变的性别、年龄、眼别及病理检查结果进行分析。结果恶性肿瘤3例，良性病变33例。组织病理学检查：恶性肿瘤3例均为非何杰金氏淋巴瘤；良性者中海绵状血管瘤9例，泪腺多形性腺瘤8例，静脉性血管瘤3例，炎性假瘤3例，囊肿3例，皮脂腺囊肿2例，淋巴管瘤、视神经胶质瘤、神经纤维瘤、骨瘤及颗粒细胞瘤各1例。在泪腺多形性腺瘤中浸润性生长3例，恶变1例。结论眼眶占位性病变种类繁多，良性肿瘤中以海绵状血管瘤多见，可采用前路开眶或外侧壁开眶顺利摘除肿瘤，次为泪腺多形性腺瘤，并且容易因手术切除不彻底或术中肿瘤破碎残留肿瘤细胞而改变生长方式，甚至于恶变。炎性假瘤手术完整切除较难，多要进一步作术后治疗。神经源性肿瘤早期就对视力损伤较大。     

骨细胞凋亡与眶骨发育机制的实验研究

目的检测眶骨组织发育过程中是否有骨细胞凋亡的发生，并初步探讨骨细胞凋亡在眶骨发育过程中可能的作用。方法选用2个月龄健康新西兰白兔7只，处死后取颧骨作为眶骨组织的标本，常规脱钙后制成石蜡切片和电镜切片，分别用光镜、电镜和TUNEL检测眶骨细胞的凋亡情况。结果在正常发育的颧骨组织标本中用光镜和电镜均可检测到典型凋亡的骨细胞，用TUNEL法观察到凋亡的骨细胞在骨组织中呈散在不规则性分布。结论在眶骨发育过程中骨细胞可以发生细胞凋亡，骨细胞凋亡可能参与了眶骨组织的发育过程。     

眶壁爆裂性骨折手术治疗的临床疗效观察

目的 评价眶壁修补术治疗眶壁爆裂性骨折的疗效。方法 采用眶壁修补术治疗30例眶壁爆裂性骨折。术后随访3～6月，平均4．5月。观察术后视力、眼球突出度、眼球活动度及其并发症。结果 视力：3例因伴有眼部有它病变，严重影响视力，治疗的视力有提高；余27例手术前后视力基本不变。跟球突出度：术后增加1mm者4例；增加2mm者9例；增加3mm者9例；增加4mm者8例。眼球活动度：术前上转或外转完全受限或部分受限者，术后均得到了不同程度的改善。结论 眶壁修补术是治疗眶壁爆裂性骨折的有效方法。     

自体髂骨义眼座植入术

目的研究自体髂骨义眼座植入的手术方法，评估其临床效果。方法于髂前上嵴处手术截取自体髂骨，制作一与眼窝相适应的球形义眼座，按常规方法植入眼眶内。结果34例均一次性取骨制成类圆形骨性义眼座，植入眼窝后无一例结膜裂开或义眼座脱出，镶配义眼片后美容效果良好。结论自体髂骨适合于其他材料义眼座植入后发生排斥反应或不能承受其他材料义眼座费用的患者。     

Orbital liposarcoma: a retrospective, single-center study of thirteen patients

AIM: To explore the clinical and pathological characteristics of thirteen patients with orbital liposarcoma. METHODS: The clinical history data of thirteen patients diagnosed as orbital liposarcoma at Beijing Tongren Hospital, from 2006 to 2021 were collected and analyzed. The data includes age, gender, affected orbital side, course of disease, status of disease (primary or recurrent), clinical manifestations, preoperative visual acuity, operative treatment, the relations between liposarcoma and surrounding tissue, longest diameter of liposarcoma, histological subtype, immunohistochemical indicators, follow-up treatment and prognosis. RESULTS: The initial symptoms are diverse. Proptosis is the most frequent chief complaint and the others included vision loss, epiphora, diplopia, and eyelid palpable mass. Results of imaging examination [computed tomography (CT) or magnetic resonance imaging (MRI)] showed orbital mass. In terms of treatment, 10 patients received tumor resection, and the mean longest diameter of the tumor was 3.39±1.36 cm. The other 3 patients had optic nerve invaded, so they received orbital exenteration. Pathological examination results confirmed the diagnose of liposarcoma for 13 patients. Six patients displayed as myxoid type, and three patients in each type of dedifferentiated and well-differentiated type. One patient was verified as pleomorphic, which was a rare type of liposarcoma. All of the patients showed Vimentin positive, and most showed CD34 and S-100 positive. Besides, four patients showed smooth muscle actin positive. All thirteen patients were alive. CONCLUSION: Orbital liposarcoma is a rare disease and it has no specific clinical manifestation. The diagnosis of liposarcoma should be considered when proptosis and orbital mass occurred in orbit. It is recommended to perform pathological examination to achieve early detection and early treatment.     

眶蜂窝织炎治疗效果的临床观察

目的：探讨眶蜂窝织炎的发病特点、诊断方法及治疗原则,观察局部对因治疗配合全身综合治疗的临床疗效,为临床诊断和治疗提供理论依据。 方法：对63例眶蜂窝织炎患者的诊断及治疗进行观察和分析。 结果：全部的患者均得到较好的疗效,在2wk~1mo内痊愈,无严重的并发症发生。 结论：眶蜂窝织炎在明确诊断后,通过积极对因治疗、全身抗炎及支持治疗,将减轻患者痛苦,缩短病程,减少并发症的发生。     

Visual Outcomes Following Orbital Biopsy

Abstract

Background: The risks of orbital biopsy depend on the lesion’s location and relationship with surrounding structures. Complications include reduced vision, although visual outcomes following orbital biopsy are not widely reported.

Aims: To determine visual outcomes following orbital biopsy in Gartnavel General Hospital’s Oculoplastic and Oncology Service.

Methods: Case note review of 50 consecutive patients undergoing orbital incision or excision biopsy between January 2006 and December 2010. Data collected included preoperative clinical examination, radiological and histological features, preoperative and postoperative corrected distance visual acuity (CDVA) and surgical complications. The main outcome measure was change in CDVA. Mean follow-up duration was 1.32 years.

Results: Histological diagnoses following biopsy included idiopathic orbital inflammation (n?=?13) and lymphoma (n?=?9). Of the radiologically defined lesions, 86.7% were extraconal (13.3% intraconal). Extraconal lesions were anterior in 59.0% (41.0% posterior). Mean preoperative LogMAR CDVA was 0.10 which was maintained at day one post-biopsy, indicating the absence of immediate sight-threatening complications such as retrobulbar haemorrhage or optic nerve compression, and there was no significant reduction at one-year follow-up (p?=?0.239). Further analysis of change in CDVA showed no difference between: anterior and posterior lesions; extraconal and intraconal lesions; incision and excision biopsies; anterior and lateral surgical approaches.

Conclusions: CDVA is retained for one year following orbital biopsy. Significant visual loss is a very rare complication of this procedure.     

Primary orbital neuroblastoma with intraocular extension

Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.