老年糖尿病性眼肌麻痹的临床分析

目的探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法对57例(57只眼)进行常规的眼科检查和眼肌学检查,以内科检查及实验室血生化检查确诊糖尿病;部分患者行头颅影像学检查。结果 57例老年糖尿病患者均为单眼患病,受累颅神经以动眼神经最多,占53%为30只眼,外展神经麻痹占24%为14只眼,滑车神经麻痹占16%为9只眼。复合颅神经(Ⅲ,Ⅳ)麻痹占7%为4只眼。动眼神经麻痹中7例为伴随上睑下垂和瞳孔变化的完全性动眼神经麻痹。大多数患者合并有高血压,高血脂症。结论老年糖尿病患者易合并眼肌麻痹,其微血管病变是临床发病的病理基础。     

糖尿病性眼肌麻痹临床分析

目的　探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法　常规眼科检查和眼肌专科检查及实验室生化检查确诊为糖尿病性眼肌麻痹 2 4例 (2 4只眼 ) ,部分病例辅以影像学检查。结果　 2 4例均匀单眼发病 ,受累颅神经以动眼神经最多见 13例 (13只眼 ) ,其次为外展神经 9只眼 ,滑车神经 1只眼。结论　老年人糖尿病患者易合并眼肌麻痹 ,其发病可能与微血管病变有关     

糖尿病性眼肌麻痹临床分析

目的 探讨糖尿病性眼肌麻痹的临床特点.方法 对25例(25只眼)经常规眼科检查,眼肌检查及实验室生化检查后,确诊为糖尿病性眼肌麻痹进行分析.结果 25只眼均单眼发病,受累神经以动眼神经麻痹多见,为15例,其次外展神经麻痹6例,滑车神经麻痹3例,复合神经(Ⅲ+Ⅳ)麻痹1例.结论 中老年糖尿病患者易并发眼肌麻痹,糖尿病性微循环病变是导致神经缺血缺氧以致变性的病理基础.     

80例以复视为首发症状的眼外肌麻痹病因分析

目的：探讨以复视为首发症状的眼肌麻痹患者的临床特征、鉴别诊断,探讨其病因及发病机制。方法回顾分析2008至2013年我院神经内科收治以复视症状为主症的眼肌麻痹患者80例,根据病史、详细的查体和眼部检查,分析其发病原因。结果80例病例中,糖尿病性眼肌麻痹24例（动眼神经麻痹16例,外展神经麻痹6例,合并动眼神经、外展神经麻痹2例）,脑血管病20例,动脉粥样硬化性动眼神经、外展神经麻痹18例,颅内动脉瘤者10例,重症肌无力眼肌型2例,躯体形式障碍1例,颅内肿瘤2例,多发性硬化1例,神经梅毒1例,脑干脑炎1例。结论很多神经系统疾病可引起复视的神经眼科体征,其中糖尿病性眼肌麻痹为最主要病因,脑血管病、动脉瘤眼肌麻痹、动脉粥样硬化也是重要原因,其他还有重症肌无力（眼肌型）、躯体形式障碍、颅内占位等。以复视为首发症状的急性眼外肌麻痹病因复杂,容易误诊,临床医生应高度重视,明确诊断,以达到正确治疗。     

糖尿病性眼肌麻痹35例

我院自1989年7月～2005年10月收治以复视为主诉并确诊为眼肌麻痹的病人中，有35例无自述糖尿病史，经全面检查，确诊为糖尿病性眼肌麻痹，现报告如下。1临床资料1．1一般资料本组共35例，男21例，女14例，年龄40～45岁7例，51～60岁14例，60岁以上14例。临床表现：动眼神经麻痹25例，表现较为复杂；其中4例4眼为完全动眼神经麻痹，表现为上睑下垂，眼球外下斜位、向内、向上、向下运动均受限，瞳孔散大，对光反射迟钝和（或）消失，近点反射存在；     

眼肌麻痹的病因及治疗

目的探讨眼肌麻痹患者的病因及治疗。方法回顾性分析46例有眼肌麻痹症状，且经眼科、神经内外科检查、实验室和影像学检查的住院病例。结果眼肌麻痹的病因以动脉瘤最多（34．8％，16／46），其次为痛性眼肌麻痹（17．4％，8／46）及糖尿病性眼肌麻痹（17．4％，8／46），其它依次为：颅脑外伤（13．0％。6／46）、颅内感染（8．6％，4／46）、内直肌损伤（4．3％，2／46）。累及的神经以动眼神经最多（73．9％，34／46）。其次为外展神经（30．4％，14／46），滑车神经受累及较少（4．3％，2／46）。明确诊断后，针对原发病治疗可取得较好效果。结论眼肌麻痹的病因复杂，应仔细分析临床特点，并针对原发病进行积极治疗。     

糖尿病眼肌麻痹的相关危险因素分析

目的：研究糖尿病眼肌麻痹发生的相关危险因素。

方法：回顾性分析2008-06/2017-06就诊于青岛市市立医院眼科的糖尿病眼肌麻痹患者120例120眼的临床资料,根据颅神经受累部位分为动眼神经麻痹组(Ⅲ组,66例)、外展神经麻痹组(Ⅵ组,41例)、复合神经麻痹组(Ⅲ+Ⅵ组,13例)。收集所有患者的临床资料并进行统计分析,筛选糖尿病眼肌麻痹的相关危险因素。

结果：年龄、性别、糖尿病病程、糖化血红蛋白(HbA1c)水平、合并糖尿病视网膜病变(DR)和高血压情况与糖尿病眼肌麻痹的发生相关,其中年龄≥45岁,男性,糖尿病病程≥10a,合并DR,HbA1c>7%是糖尿病眼肌麻痹发生的独立危险因素。

结论：糖尿病眼肌麻痹的发生与糖尿病患者的年龄、性别、糖尿病病程、是否合并DR及HbA1c水平相关。     

首发为动眼神经麻痹糖尿病的临床分析

目的 探讨以动眼神经麻痹为首发症状的糖尿病性动眼神经麻痹的临床特征，以提高对该病的重视，达到及早治疗。方法 对24例糖尿病性动眼神经麻痹的临床资料进行回顾性分析。结果 24例患者均以动眼神经麻痹为首发，缺乏糖尿病的典型症状，均为单眼受累，动眼神经眼外肌麻痹16例，合并跟内肌麻痹8例，其中不完全动跟神经麻痹16例（66．7％），完全性麻痹8例（33．3％），24例患者经过及时治疗均完全恢复。结论 1．本病突然发病，其发病机制与微血管病变及代谢障碍有关，多为单侧不完全性动眼神经麻痹。2．眼科医师要重视病因检查，及时诊治，有利于功能早期恢复。     

糖尿病性眼肌麻痹36例临床分析

目的探讨糖尿病性眼肌麻痹的临床特点、治疗方法并观察其疗效。方法回顾对36例糖尿病性眼肌麻痹患者采用中西医结合治疗的方法及疗效。结果治愈率80.55%;好转率13.89%;未愈率5.56%;总有效率为94.44%。结论糖尿病性眼肌麻痹中动眼神经麻痹最多,其次是外展神经,中西医结合治疗对其有显著疗效。     

老年人糖尿病性眼肌麻痹的临床观察

目的:观察老年人糖尿病性眼肌麻痹的临床表现及治疗效果,并探讨其发病机制.方法:对20例眼肌麻痹的老年患者行常规眼科检查和眼肌功能检查,并进行全身及血生化检查确诊为糖尿病后,给予降血糖、对伴高血压者控制血压,同时肌注维生素B1、B12并口服血管扩张剂和小剂量皮质类固醇.结果:所有患者治疗6～12wk后眼球运动正常,复视消失,随访6～8mo,有2例分别在3mo和5mo时复发.结论:老年人糖尿病性眼肌麻痹的主要表现为复视及上睑下垂,经控制血糖及其它对症支持治疗后,眼肌麻痹均能治愈,但有少数患者在治愈后复发.     

儿童眼肌型重症肌无力发生眼肌麻痹的相关因素研究

目的:探讨儿童眼肌型重症肌无力(OMG)患儿发生眼肌麻痹的相关因素。方法:回顾性分析2011-11/2020-05期间就诊于我院的203例儿童OMG患儿,将其分为眼肌麻痹组97例和非眼肌麻痹组106例,对两组患儿的临床资料进行单因素统计分析,对有统计学差异的指标进一步行多因素回归分析。结果:纳入的203例儿童OMG患儿发生眼肌麻痹者97例(47.8%),69例(71.1%)表现为斜视,其次为歪头视物(18例,18.6%)。97例患儿中单眼79例(81.4%),单条眼外肌受累53例(54.6%),其中内直肌19例(35.8%)。眼肌麻痹组和非眼肌麻痹组患儿年龄,血清免疫球蛋白M(IgM),血清游离三碘甲状腺原氨酸(FT3),血清甲状腺球蛋白(TG),采用激素联合治疗(72.2%vs 38.7%)均有统计学意义(P<0.05)。血清FT3水平(OR=2.006,95%CI:1.233~3.263)和采用激素联合治疗(OR=4.328,95%CI:1.936~9.677)是影响儿童OMG患儿发生眼肌麻痹的相关因素。结论:儿童OMG患儿发生眼肌麻痹较常见,单眼多发,内直肌最易受累,较少出现复视。血清FT3可作为评估儿童OMG患儿发生眼肌麻痹的重要免疫指标。     

Ocular complications following excision of cerebellopontine angle tumours

The incidence of ocular complications in 91 patients who underwent excision of cerebellopontine angle tumours was reviewed. Facial nerve paralysis occurred postoperatively in 40 of 88 patients (45.5%). Sixty-four percent of these patients recovered; thus the final count was 86% of patients with facial nerve function following tumour removal. Patients who sustained a delayed facial paralysis recovered well. In patients who sustained an immediate paralysis when the nerve was left anatomically intact postoperatively, recovery was again excellent if paralysis was incomplete, and varied if the paralysis was complete. Not surprisingly, postoperative facial paralysis was more common in patients who had had large tumours. Corneal hypoesthesia and a poor Bell's phenomenon were the most important factors in predicting corneal complications as a result of facial nerve paralysis. Eye complications in 45% of the patients who suffered facial nerve paralysis were managed conservatively with ocular lubricants and an eye shield only; the others received some form of eyelid surgery.     

Subject Index

INTRODUCTION AND PURPOSE: In most children referred to our department with a diagnosis of dyslexia, we have found an ocular disorder that had not been detected during previous ophthalmologic examinations. Exophoria and/or hypoaccommodation were the most common cause. Some of these children needed eye muscle surgery to improve the reading problems. However, these patients represent a selection. Therefore, we performed a field study to determine the percentage of children with reading disability caused by ocular disorders and the percentage of children with real dyslexia in a normal population. This was made possible by an examination of most pupils in the 4th grade of the three primary schools in a small German town. The co-author and a very experienced orthoptist performed all of the examinations. RESULTS: Eighty-nine out of 127 children were examined. Of these, 16 (18%) had reading problems (2 girls and 14 boys). Most of them had accommodation problems: six (6.7%) suffered from an uncorrected hypoaccommodation, three children did not wear their prescribed glasses, one child had not been prescribed any glasses yet and one child had the wrong glasses. Two children suffered from pathophoria: one from eso- and the other from exophoria compensated by accommodative convergence. In 3 (3.4%) children no ocular cause could be found. These children may have true dyslexia. CONCLUSION: Of the 89 children examined, 16 (18%) had reading problems and only 3/16 had no detectable ophthalmologic explanation. Hypoaccommodation was the most common cause of reading problems (in 6 of 16). In most of the cases it had not been diagnosed before. In all of these children the reading ability improved markedly with the proper refractive correction, bifocals or prisms.     

儿童眼外伤127例临床分析

目的:研究儿童眼外伤的致病原因、人口统计学特征、临床特点及评价视力恢复情况。方法:将我院2006-01/2009-01收治的127例<14岁的儿童眼外伤患者进行回顾性分析。分析统计患者的人口统计学特征、致病原因、临床特点,比较治疗前后的视力情况。结果:儿童眼外伤具有以下特点:男儿童明显多发(72.4%);农村儿童(78.0%)比例明显大于城市儿童(22.0%),受伤儿童大多数>3岁(88.2%);致伤原因中位列前3位的分别是:塑料子弹(27例,21.3%)、瓶盖(15例,11.8%)、鞭炮(15例,11.8%)。闭合性眼外伤(78.0%)明显多于开放性眼外伤(15.8%);盲目率从23.6%下降至7.9%。结论:儿童眼外伤重在预防,多数的儿童眼外伤特别是塑料子弹伤、瓶盖击伤、鞭炮炸伤等都是可以预防的。积极治疗儿童眼外伤可以明显降低眼外伤的致盲率。     

先天性单侧上斜肌麻痹的手术方式分析

目的：探讨先天性单侧上斜肌麻痹的手术治疗方法。

方法：本研究回顾分析对68例先天性单侧上斜肌麻痹患者,根据患眼的下斜肌功能亢进程度和原在位垂直斜度大小选择下斜肌切断并部分切除、下斜肌切断并前转位、下斜肌部分切除联合对侧眼下直肌或同侧眼直肌手术。伴有水平斜视者按水平斜视矫正原则一期或分期手术矫正。

结果：治愈58例,治愈率85.3%,好转7例,好转率10.3%,无效3例,无效率4.4%。

结论：根据下斜肌亢进程度、垂直斜视度及水平斜度选择不同手术方式,通过一期或分期手术,可有效获得较高治愈率。     

Polytetrafluoroethylene in the surgery of cases with severe limitation of abduction Long-term results

Background: In cases of severe palsy or paralysis of eye muscles, it is sometimes necessary to extensively weaken the homolateral antagonist. Large recessions reduce the ocular motility by shortening the arc of contact between muscle and sclera. The lengthening of the muscle tendon with Fascia lata, Lyo-Dura®, or the free transplantation of an excided piece of autologous eye muscle tendon does not ensure predictable precise results. We used polytetrafluoroethylene (PTFE, Gore-Tex®) for seven years and report on our results. Method: A new technique is introduced in which the muscle is lengthened by PTFE. Ten patients (7 sixth nerve palsies, 1 strabismus fixus, 2 Duane’s retraction syndromes) underwent lengthening of the medial rectus muscle with a Gore-Tex® soft tissue patch between 8 and 14mm in size. The two patients with the Duane's retraction syndrome were not operated on the rectus externus muscle. All other patients had a resection of the paralytic muscle. Results: In most cases, good results were obtained: binocular single vision in primary head position within a small field of fusion. Histological examination of a specimen of Gore-Tex® four years after surgery showed an excellent integration of the graft into the tissue. Fibrous connective tissue wrapped the Gore-Tex® like a capsule. There were no signs of inflammation or graft reaction. Conclusions: PTFE (Gore-Tex® Soft Tissue Patch) is a suitable material for complicated strabismus surgery. Main advantages: availability at any time in the operation theater; high biocompatibility; form stability; and no diminution of operative results.     

Study of aging macular degeneration

Aging macular degeneration (AMD) is an important ocular disease causing blind. The study of epidemiology, pathogenetic factors and visual function of AMD show that it has become a disease worth noticing in aged. Although most AMD cases were of the dry type and the patients had rather good visual acuity, various determination of visual function showed different degrees of impairment. Controlling light exposure and improving trace element metabolism may be helpful for early prevention and treatment of AMD. It will also be an important factor in the prevention of blindness in Asian nations.     

老年人糖尿病并发动眼神经不全麻痹分析

目的探讨老年人糖尿病合并动眼神经不全麻痹的临床特点及诊治。方法对14例(14只眼)老年人糖尿病并发动眼神经不全麻痹患者的临床资料进行分析。结果14例中8例以单侧眼睑下垂、6例以复视为首发表现,伴头痛、眼球运动受限,但瞳孔未受累。14例均治愈,治愈时间3～10周。结论该病多为急性发病,疗效与血糖水平及病程无关,积极治疗原发病及对症处理神经系统病变可取得满意效果。