Mucoepidermoid Carcinoma of the Eyelid： A Case Report and Review of the Literature

Purpose: To report the clinical features, therapeutic method, and histopathological findings of a case of mucoepidermoid carcinoma in the lower eyelid and review the literature about the mucoepidermoid carcinoma arising from the eye. Methods : Case report and review of the literature. Results: An 88-year-old man developed a painless, indurated nodule in the left lower eyelid for two years and ulceration of the skin existed for a year. He underwent tumor resection and reconstruction of the eyelid. By histopathology, tumor cells showed an admixture of epidermoid and mucus-secreting cells, which was consistent with mucoepidermoid carcinoma. Mucoepidermoid carcinoma is a common malignant tumor of the salivary glands, but rare in the eye tissues among which conjunctiva and lacrimal gland are most commonly involved. It has a higher degree of malignancy than basal cell carcinoma and squamous cell carcinoma. It displays an unusual capacity of aggressive local invasion and recurs easily after simple excision and tumors may require enucleation or exenteration because of the involvement of the intraocular structures and/or orbit. Frequent follow-up is necessary for the patient after operation. Conclusions: Mucoepidermoid carcinoma arising from the eye is rare and has a high degree of malignancy. It should be differentiated from other neoplasms such as basal cell carcinoma and squamous cell carcinoma. Eye Science 2005;21:152-157.     

Graves眼病合并急性球后视神经炎1例

患者女,46岁。因左眼眼球突出14个月,于2002年8月6日入院。患者于2001年3月开始,出现心慌、乏力、体重下降,曾查T3、T4增高,诊断为“甲亢”。2001年6月份开始发现眼球突出,当地医院给予强地松50mg／d,逐渐减量。2002年8月4日左眼视力急剧下降,8月6日下降至光感,遂来我院治疗。既往无肺结核,无糖尿病,无其他传染病病史。     

适形放射治疗Graves眼病71例临床观察

目的:分析适形放射治疗Graves眼病的临床疗效.方法:1999/2006年Graves眼病患者71例接受球后适形放射治疗,200cGy/次,1次/d,5次/wL总剂量为2 000cGy.随访期为6～65mo.结果:照射后病情明显改善和部分改善的患者分别有35.2%和42.3%,病情稳定15.5%,病情进展7.0%.有软组织及角膜受累的病例放疗后症状改善最明显(P＜0.05).结论:适形放射治疗可有效控制Graves眼病病情进展,疗效较好,对于轻度突眼患者疗效更显著,副反应少.     

黄斑中心凹赘生物1例

1病例报告 患者,女,24岁。因双眼视力下降1mo就诊于2009—02-25来我院就诊。眼部检查：视力：右0．2,-2．25DS矫正至1．0,左：0．3,．2．00DS矫正至1．0。双眼前节未见异常。眼底：视盘界清,色淡红,视网膜未见出血及渗出,黄斑中心凹可见点状黄白色物,反光弥散。黄斑区未见异常。视野：右眼相对中心暗点。左眼：未见异常。频域光学相干断层扫描（OCT）检查（网1）：     

Sturge-Weber Syndrome Associated with Early Diffuse Choroidal Hemangiaoma： A Case Report

Purpose:To report indocyanine green angiography (ICGA) findings in one patient of diffuse choroidal hemangioma associated with Struge-Weber syndrome. Methods: Color fundus photography, fluorescein angiography (FA) and ICGA were performed in a patient with diffuse choroidal hemangioma associated with Sturge-Weber syndrome, Results: Three findings were unveiled by ICGA : rapid filling of diffuse choroidal hemangio‘s vascular network in the early stages; diffuse hyperfluorescence visual up to the late phase; no “wash-out“ phenomenon was observed in the late phase. Conclusion:Indocyanine green angiography can provide information that is not detected by clinical or fluorescence angiographic examination in the patient with Sturge-Weber syndrome. ICGA may be important and sensitive in detecting the diffuse choroidal hamangioma associated with Sturge-Weber syndrome. Eye Science 2004:20:168-170     

氨基葡聚糖:Graves眼病活动度的指标

目的 :检测正常人及Graves眼病患者 2 4小时尿氨基葡聚糖 (glycosaminoglycan ,GAG)的含量 ,探讨其作为Graves眼病活动性指标的意义。方法 :按照年龄段检测正常人 2 4小时GAG的含量 ,获得正常人 2 4小时尿GAG值 ,同时检测活动期Graves眼病 (GravesOphthalmopathy ,GO)患者的 2 4小时GAG含量 ,对其中参与治疗的 5例GO患者随诊其治疗前后GAG值。结果 :6 0例正常人 2 4小时尿中GAG总量为 (19 70± 9 72 )mg/2 4h。性别、年龄之间GAG值无显著性差异。活动期GO患者 2 3例 ,2 4小时尿中GAG的总量平均为 (35 5± 11 4)mg/2 4h ,与正常人组比较有显著性差异 (P <0 0 5 )。检测 5例GO患者治疗前 /后的尿GAG含量 ,分别为 :97 3/5 0 6 ,5 2 3/18 5 ,33 2 /5 4,31 2 /15 8,31 6 /11 1(mg/2 4h)。结论 :2 4小时尿氨基葡聚糖可作为GO活动度的一项指标     

2019甲状腺相关性眼病管理实用指南解读

甲状腺相关性眼病(Graves ophthalmopathy, GO)是一种自身免疫性疾病,常伴有眼眶组织炎症。本实用指南由一组不同学科领域成员组成的研究小组负责编写。本文将对该指南进行全面解读,希望能为GO的日常临床实践的诊断提供指导,从而改善患者的治疗效果,提高医疗服务质量。     

Graves眼病患者球后组织免疫组化研究

目的：为了探讨Ｇｒａｖｅｓ眼病的确切发病机制。方法：应用单克降抗体人类白细胞ＤＲ抗原（ＨＬＡ－ＤＲ）、巨噬细胞（ＣＤ６８）、第八因子相关性抗原（Ｆ８／８６）、Ｔ细胞（ＣＤ３）、辅助性／诱导Ｔ细胞（ＣＤ４）、抑制性／细胞毒Ｔ细胞（ＣＤ８）、Ｂ细胞（ＣＤ２０）对１４例Ｇｒａｖｅｓ眼病患者球后组织主要为眼餐肌标本冰并或石蜡切用碱性磷酸酶－抗碱磷酸酶（ＡＰＡＡＰ）法进行免疫组织化学研究，５例正常人眼外肌作     

Tocilizumab for the Management of Corticosteroid-Resistant Mild to Severe Graves’ Ophthalmopathy,a Report of Three Cases

ABSTRACT

Purpose: To discuss the use of tocilizumab in mild to severe Graves’ ophthalmopathy as corticosteroid-adjunctive therapy.

Methods: Retrospective case reports.

Results: Three patients with corticosteroid-resistant or advanced diplopia-associated Graves’ ophthalmopathy were subsequently treated with monthly intravenous tocilizumab at a dose of 8 mg/kg. None reported a past or present history of dysthyroidism. The adjunction of interleukin-6-receptor monoclonal antibody treatment was associated with a significant improvement in ocular symptoms, notably diplopia and proptosis, and functional prognosis in all patients, with one relapse approximately two months after the end of the treatment.

Conclusion: These clinical reports confirm the relative efficacy and tolerability profile of intravenous tocilizumab in severe or corticosteroid-resistant Graves’ ophthalmopathy.     

A型肉毒毒素辅助治疗Graves眼病的临床观察

目的通过对存在恶性突眼的Graves眼病患者受累眼外肌进行A型肉毒毒素注射治疗,观察注射后眼位偏斜及复视恢复的情况,探讨A型肉毒毒素辅助治疗Graves眼病的机理及实用价值。方法选取我院确诊为伴有恶性突眼的Graves眼病合并眼位偏斜的患者31例(其中伴有水平偏斜者15例,伴有垂直偏斜者30例)。患者进行眼眶CT扫描、同视机、HESS屏和斜视度测定等检查后,对其所受累的眼外肌(下直肌24条,内直肌11条,上直肌6条,上睑提肌4条)在肌电图的指引下进行多次重复的A型肉毒毒素肌腹内注射。定期随诊观察注射后的眼位变化及复视程度的变化。结果31例接受A型肉毒毒素眼外肌注射的患者中,在经过重复注射2~6次后,其斜视度及复视程度均有不同程度的减轻。总体显效率41.9%,有效率51.6%,无效率6.5%.结论A型肉毒毒素眼外肌内注射是一种能有效缓解Graves眼病患者眼外肌挛缩和减轻复视症状及斜视度的治疗方法。在疾病早期及时应用A型肉毒毒素进行受累眼外肌注射,并适当联合全身或局部激素、免疫抑制剂治疗,对于控制Graves眼病的临床症状可以收到满意的疗效。     

眼眶放射治疗对Graves眼病疗效的Meta分析

目的 系统评价眼眶放疗治疗Graves眼病的疗效.方法 应用计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库和万方数据库,检索时间截止至2011年3月,并辅以手工检索、因特网搜索,全面查找符合纳入标准的随机对照试验(RCT),进行质量评价和资料提取后,采用RevMan5.0软件进行Meta分析.结果 共纳入5个RCT,合计289例患者.Meta分析结果显示:2项研究表明与假放疗相比眼眶放疗可以有效 治疗Graves眼病,2项研究表明眼眶放疗与口服糖皮质激素的治疗效果相当,2项研究表明眼眶放疗对突眼的症状改善无明显效果,它们的合并效应(合并OR值、合并OR值、合并均数差)分别为0.32[0.16,0.64]、0.89 [0.40,1.94]、-0.30 [-0.69,0.l0].结论 眼眶放疗能有效改善Graves眼病治疗的总体有效率,其疗效与口服糖皮质激素的作用相当.     

儿童Graves眼病的临床观察

目的 观察儿童Graves眼病的临床特征及治疗的频率。方法 回顾1994～2004年18岁和18岁以下诊断为Graves眼病患儿的一组资料。结果 32例Graves眼病儿童，其中女25例（78．1％），男7例（21．9％）。初诊时，5例患儿（15．6％）有甲状腺功能亢进，1例患儿（3．1％）有甲状腺功能减退，26例患儿（81．3％）甲状腺功能正常。诊断为甲状腺功能障碍的平均年龄为13岁（3～18岁）。诊断为Graves眼病的平均年龄为15岁（5～18岁）。28例患儿（87．5％）仅用支持疗法，1例患儿（3．1％）行眼睑手术，3例患儿（9．4％）行眶脂减压术。追踪观察5年（1～10年），有1例患儿（3．1％）实施了眼肌手术。结论 儿童Graves眼病临床表现相对来说不很严重，很少需要手术治疗。     

儿童及青少年Graves眼病的临床特点及疗效分析

背景 儿童及青少年Graves眼病发病率低,临床上较为少见,故相关研究报道较少,对儿童及青少年Graves眼病的临床特点及疗效进行总结和分析对于其临床诊治有一定的指导意义. 目的 总结并分析儿童及青少年Graves眼病的临床表现、治疗及预后. 方法 采用回顾性病例分析方法,连续收集2007年1月至2012年12月于上海长征医院诊断为Graves眼病的儿童及青少年患者29例54眼的临床资料,对患者的眼部检查、甲状腺功能检查和影像学检查结果进行分析,采用临床活动度评分(CAS)对患眼进行临床评分.根据患者的病情采用不同的治疗方案进行治疗并进行随访,24例其中CAS≤2分患者44眼接受人工泪液点眼,3例CAS≥3分患者接受糖皮质激素静脉滴注疗法,2例3眼分别接受双侧眶减压术和Müller肌切除术.患者接受随访1.5～6年,评估儿童及青少年Graves眼病的治疗效果,以眼球突出度及上睑退缩变化程度作为判断疗效的标准. 结果 29例患者中男5例,女24例;患者年龄5 ～18岁,平均12.9岁.患者的临床表现主要为眼球突出、眼睑退缩和眼睑肿胀,可伴有结膜充血、眼睑闭合不全.所有患眼最佳矫正视力(BCVA)均≥ 0.8.CAS评分为0～2分者26例48眼,≥3分者(活动期)3例6眼.CT/MRI检查显示患眼眼眶脂肪组织容积增加,部分患眼可见眼外肌肌腹增粗.实验室检查显示甲状腺功能正常者12例,占41.4％;甲状腺功能亢进者15例,占51.7％;甲状腺功能减退者2例,占6.9％.随访期间11例20眼症状好转,占37.9％;16例29眼病情稳定,占55.2％;2例4眼病情加重,占6.9％. 结论 儿童及青少年Graves眼病中女性明显多于男性.儿童及青少年Graves眼病临床症状较轻,病情活动性较低,预后较好.     

Blood Count-derived Immunoinflammatory Markers in Thyroidassociated Ophthalmopathy

PurposeTo investigate the diagnostic and prognostic significance of the blood-count derived systemic immunoinflammatory parameters in patients with thyroid-associated ophthalmopathy (TAO).MethodsIn this retrospective case-control study, the blood-count parameters and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic immune-inflammatory index (SII), thyroid peroxidase antibody, and anti-thyroglobulin antibody were evaluated in 46 patients with TAO and 46 matched controls. The associations of the immunoinflammatory parameters with clinical outcomes were analyzed among TAO patients.ResultsSignificant differences were found in NLR, PLR, SII, and lymphocyte count between the controls and the TAO group (p < 0.05 for all). In logistic regression analysis, these inflammatory parameters did not have any prognostic effect on the clinical outcomes of the TAO (p > 0.05 for all). The patients, who needed systemic treatment due to any ocular involvement of TAO during the follow-up period, had significantly lower platelet count (p = 0.001) and PLR (p = 0.02) at the time of initial diagnosis when compared to the no treatment-needed group of the TAO patients. The initial platelet count was significantly associated with the subsequent steroid need due to TAO during the follow-up period (β = −0.02, p = 0.03).ConclusionsNLR, PLR, and SII may serve as potential inflammatory markers in the identification of the TAO, although they have no evident prognostic significance in TAO. However, the relatively lower platelet count at initial diagnosis may be associated with the need for systemic therapy during the follow-up in patients with TAO.