眼外肌内肿瘤的诊断治疗及预后分析

目的 了解眼外肌内肿瘤的种类、临床表现及诊治方法.方法 回顾性系列病例研究.收集经病理学确诊的11例眼外肌内肿瘤患者资料,分析其临床表现、影像学征象、治疗与预后情况.结果 眼外肌内肿瘤病种包括:纤维瘤病3例,肌间血管瘤和颗粒细胞瘤各2例,横纹肌肉瘤、转移性腺癌、淋巴瘤和炎性肌纤维母细胞瘤各1例.眼球运动障碍、眼球突出和移位是其常见体征.CT和MRI等影像学检查可显示肌肉形态改变,肌肉可呈梭形、球形和不规则形增粗,直径均超过1 cm.累及下直肌、内直肌、外直肌和下斜肌.根据累及肌肉的不同采用不同手术进路.病理结果是制定治疗方案的依据.结论 眼外肌内肿瘤病种多样,临床表现和影像学检查有特征性,应积极活检明确病理诊断,预后与治疗方案的选择以及肿瘤性质有关.(中华眼科杂志,2009,45:56-60)     

眼外肌肥大的影像学诊断意义

目的总结眼外肌肥大的病因，并对影像学检查的诊断价值进行探讨。方法对249例CT或MRI检查显示眼外肌肥大的病例进行回顾性分析，并对病因进行分析和分类。结果炎症、血管畸形、肿瘤、感染、外伤等皆可是眼外肌肥大的病因。导致眼外肌肥大的疾病按发病率由高到低依次为甲状腺相关眼病、眼眶炎性假瘤、颈动脉海绵窦瘘、眶蜂窝织炎、转移性肿瘤、静脉曲张、眶骨骨折等。甲状腺相关眼病的哏外肌肥大以肌腹肥大为主，肌腱止点一般正常。炎性假瘤受累肌肉呈不规则增粗，边缘模糊，病变大多累及肌肉的止点。颈动脉海绵窦瘘通常为单眼眼外肌呈弥漫梭形肥厚。结论影像学检查包括CT和MRI扫描能够揭示眼外肌肥大的病因特征，并可作为鉴别诊断的依据。     

垂直直肌移位术治疗外直肌全麻痹的疗效

目的 探讨垂直直肌移位治疗外直肌全麻痹的临床疗效.方法 对12例外直肌全麻痹的内斜视患者,采取垂直直肌全移位术治疗,术后随访观察手术疗效.结果 术后1周,12例患者第一眼位均为正位,功能视野复视消失,麻痹眼外转均可过中线;术后1 a,9例患者眼位正位,2例患者欠矫10Δ～20Δ,1例患者欠矫>20Δ.12例患者麻痹眼外转功能均较术前明显改善.结论 垂直直肌全移位术治疗外直肌全麻痹效果明显,可有效改善麻痹眼外转功能.     

影像检查在眼外肌占位中的诊断价值

目的 探讨B超、CDI、CT和MRI检查对眼外肌占位病变的影像学诊断价值。方法 对1991至2010年共25例经临床病理证实的眼外肌占位病变的影像检查资料进行回顾性分析。结果 25例患者中,眼外肌内猪囊尾蚴病12例、眼外肌内原发肿瘤10例、眼外肌内转移癌2例、眼外内植入性囊肿1例。其影像学表现各有不同。结论 影像检查为眼外肌内猪囊尾蚴病提供特征性的诊断依据,其中超声检查为首选,能特征性的显示眼外肌内寄生虫囊泡和囊尾蚴蠕动影,而CT和MRI可作为补充检查手段;B超、CDI、CT和MRI检查在眼外肌内肿瘤的诊断和鉴别诊断同样具有重要价值。     

眼外肌移位术在眼科临床的应用

眼外肌移位术是指将叭外肌的肌腱或肌肉部分移开其自然作用方向。眼外肌移位术同常规的眼外肌加强术或减弱术不同,其主要目的不是改变肌肉的力量,而是改变肌肉的作用方向及位置,从而达到特殊的治疗目的。目前临床上常用的眼外肌移位术有如下几种。一、治疗单眼垂直性斜视:单眼垂直性斜视多同时伴有水平性斜视,故可在矫治水平性斜视的同时,将内、外直肌等量地上移或下移,从而一举两得,顺便矫治了垂直性斜视,减少病人的手术次数及痛苦。上述术式的变法是眼外肌边缘切开术,如果将一条水平眼外肌(内直肌或外直肌)上缘和下缘分别切开半个肌腹,使其上方切口距肌肉附     

垂直肌水平移位治疗外旋斜视体会

目的 探讨垂直肌水平移位手术治疗外旋斜视的临床疗效.方法 回顾经垂直肌水平移位手术治疗的7例外旋斜视患者,2例患者行上直肌向颞侧移位一个肌腹宽度,联合下直肌向鼻侧移位一个肌腹宽度手术;5例患者合并正前方垂直斜视,行下直肌后徙同时向鼻侧移位一个肌腹宽度.所有患者随访超过6个月.结果 同时移位上下直肌平均矫正正前方外旋11°,下直肌后徙联合鼻侧移位一个肌腹宽度矫正正前方外旋7°,7例患者在各个注视位均获得双眼单视,复视和代偿头位消失,随访旋转斜度稳定.结论 垂直肌水平移位手术治疗外旋斜视有确切的效果.     

外斜Ⅴ征的手术治疗

目的探讨外斜V征不同术式的手术效果。方法48例外斜V征,32例行下斜肌部分切除或后退术,联合外直肌后退及内直肌缩短,16例行水平直肌垂直移位术,联合外直肌后退及内直肌缩短（其中4例联合上直肌肌止端向鼻侧移位）,观察手术前后的眼位、下斜肌功能和双眼视觉的情况。结果术后第一眼位正位者45例,V征消失或缓解者43例,双眼视恢复者17例。结论下斜肌部分切除或后退术适用于下斜肌功能亢进的外斜V征,水平直肌垂直移位术适用于无下斜肌功能亢进的外斜V征。     

视网膜毛细血管瘤手术切除及激光光凝治疗观察

目的 探讨视网膜毛细血管瘤(retinal capillary hemangioma,RCH;)激光光凝及血管瘤切除手术适应证及治疗效果.方法 回顾性分析8例(9只眼)RCH患者,采用激光光凝治疗以及玻璃体切除联合血管瘤切除手术治疗前后临床资料,根据肿瘤生长部位、大小以及生长特点采用不同治疗方法.其中2例中周边部RCH患者采用单纯激光光凝肿瘤及滋养血管治疗;1例行单纯玻璃体切除术后激光治疗,1例激光治疗后又作玻璃体切除术中冷冻治疗;4例5只眼行玻璃体切除联合肿瘤切除术.结果 位于后极部及中周部瘤体较小(约<1.5PD)的RCH激光光凝可以使瘤体萎缩.明显凸出于玻璃体内生长的RCH采用玻璃体切除联合血管瘤体切除术,顺利摘除肿瘤.结论 RCH瘤体<1.5PD或外生型RCH,均可激光光凝治疗,内生型RCH,尤其瘤体直径>1.5PD时手术切除肿瘤更合适,安全有效.     

继发于眼眶疾病的眼底病变18例临床分析

目的 探讨眼眶疾病合并眼底改变的临床特征以及二者的关系.方法 回顾分析合并眼底改变的18例眼眶疾病,其中甲状腺相关眼病3例,眼眶炎性假瘤2例,泪腺多形性腺瘤3例,眼眶视神经胶质瘤2例,视神经脑膜瘤2例,眼眶神经鞘瘤l例,眼眶副神经节瘤1例,眼眶非霍奇金淋巴瘤l例,眼眶海绵状血管瘤1例,眼眶脉管瘤并出血1例,后巩膜炎l例.结果 18例眼眶疾病的患眼均有不同程度的眼底改变.甲状腺相关眼病的眼底特征为视盘瘀血性水肿和黄斑皱褶;眼眶炎性假瘤的眼底特征为视盘水肿炎症;眼眶肿瘤的眼底改变表现为肿瘤压迫导致的脉络膜视网膜皱褶和隆起;若肿瘤位于视神经则易合并视乳头肿胀改变;累及眶尖部位则易形成眶内血液回流障碍,出现明显的眼底视网膜静脉扩张迂曲.结论 眼眶疾病引起的眼底改变主要为眶内肿物轻度压迫引起的脉络膜视网膜皱褶和明显压迫引起的脉络膜视网膜局部隆起;当眶内病变累及球后近端视神经则易导致视乳头肿胀,累及眶尖部位则易出现视网膜静脉扩张迂曲.眶内疾病合并眼底改变可能与其原发疾病性质、位置有关.     

首发于眼结膜的淋巴瘤MRI特征分析

目的 分析眼结膜淋巴瘤影像学表现,了解其MRI特征。设计 回顾性病例系列。研究对象 首诊于北京同仁医院眼科的21例眼结膜淋巴瘤患者。方法 分析21例患者临床表现、MRI影像学特征和病理诊断。主要指标 眼结膜淋巴瘤原发部位、范围及MRI特征。结果 21例（25眼）患者中,病变位于上睑结膜4眼,下睑结膜7眼,上下睑结膜同时受累14眼;病变局限于结膜或眼睑19眼,侵及眼眶6眼（2眼累及肌锥外间隙、眼外肌和泪腺,3眼累及眼上肌群,1眼累及Tenon囊及视神经）;边界欠清晰15眼,清晰10眼;17眼病变包绕眼球生长,8眼表现为眼球前部结节影。与眼外肌相比,所有病变T1WI均显示等信号,T2WI 18眼显示等信号,7眼显示稍高信号;18眼信号均匀,7眼不均匀或欠均匀。13例（15眼）进行增强扫描的病变均呈轻至中度强化,强化均匀8眼,不均匀7眼。7例（8眼）行动态增强扫描的病变,动态增强曲线表现为平台型6眼,流出型2眼。结论 眼结膜淋巴瘤MRI特征是呈等T1等或稍高T2信号,信号多均匀,增强呈轻中度强化,动态增强曲线呈平台型。（眼科,2013, 22：320-323）     

以眼外肌肥大为主要CT征的眼眶病分析

目的 多种眼眶病表现为以眼外肌肥大为主要的临床特征,根据不同的眼外肌肥大CT表现特点,可为临床诊断和治疗提供依据.方法 自2004年1月至2007年12月,对CT表现有不同特征的眼外肌肥大的连续就诊患者共225例,据其表现特点,明确病因并鉴别诊断.结果 计有8种眼眶病.甲状腺相关眼病(TAO)175例,肌炎型炎性假瘤26例,颈动脉海绵窦漏(CCF)8例,转移性眼外肌肿瘤4例,肌肉静脉血管瘤4例,眶内恶性淋巴瘤6例,眼外肌血肿1例,眼外肌植物性异物1例.结论 根据眼外肌肥大的CT特征,结合病史及临床表现能做出正确的诊断.     

Inferior rectus muscle metastasis as a presenting sign of renal cell carcinoma: case report

Proptosis and diplopia due to enlargement of extraocular muscles represent important presenting signs of many orbital disorders. Although dysthyroid ophthalmopathy is the most common cause of enlargement of extraocular muscles, the differential diagnosis is extensive. We report a patient with a 3-month history of diplopia and unilateral proptosis and a markedly enlarged inferior rectus muscle on imaging studies. A biopsy of the lesion followed by systemic evaluation established the diagnosis of metastatic renal cell carcinoma. There are few cases of metastatic tumors to the extraocular muscles reported in the literature and thus our objective is to report a new case, review the literature and reiterate the inclusion of this disorder in the differential diagnosis of enlargement of the extraocular muscles.     

Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists

purpose To report our experience with extraocular myocysticercosis, to highlight the role of ultrasound and orbital computerized tomography (CT) scan in these cases and to discuss the management. methods This is retrospective study of 35 cases of orbital myocysticercosis confirmed on ultrasound and CT scan of the orbit. results There were 18 males and 17 females. The average age of these patients was 19.6 years. The most common presenting feature was restricted ocular motility with diplopia and recurrent pain and redness. Ultrasound examination and CT scan of the orbit done for all these patients identified the cyst and the affected muscle. All extraocular muscles were noted to be involved in myocysticercosis. However the lateral rectus, medial rectus and the superior oblique were affected to a greater extent. All cases dramatically improved on treatment with albendazole and oral steroids. Surgical excision of cyst was done in 6 cases. conclusion A high index of suspicion should be entertained for extraocular muscle cysticercosis, especially in cases of acquired ocular motility disorder with recurrent ocular congestion. Ultrasound and CT scans of orbit play a vital role in diagnosis. Medical therapy with albendazole under cover of steroids is effective in most of the cases.     

Correlation of CT Scanning and Pathologic Features of Ophthalmic Graves' Disease

Correlating the CT scan features of patients with orbital Graves' disease with histopathologic observations allows one to focus more specifically on the distinguishing features of this disease with future research implications. Both CT scanning and pathologic studies have shown clearly that the extraocular muscles are the primary focus of the disease. Swelling of the extraocular muscles generally occurs within their bellys with sparing of the tendons. This contrasts with idiopathic inflammation of the muscles or myositis, which tends to involve the tendon as well. All of the associated findings in orbital Graves' disease probably flow from the enlarged volume of the extraocular muscles: proptosis, bowing of the medial lamina papyracea to accommodate the swollen belly of the medial rectus muscle, venous engorgement from stasis induced by direct compression of the orbital venous drainage, conjunctival and lid swelling, and lacrimal gland enlargement. Both radiographic and pathologic changes in the orbital fat are secondary and comparatively insignificant. While there appears to be no selective inflammation of the optic nerve meninges or the perineural connective tissues, enlargement of the extraocular muscle bellys where they converge at the crowded orbital apex brings about compression of the optic nerve, impairs its function, and causes visual decrease. Lymphocytic and plasmacytic infiltration along with edema within the endomysium of the extraocular muscles leads to the activation of fibroblasts with the production of acid mucopolysaccharides and progressive fibrosis. It is not known what attracts the lymphocytes to the extraocular muscles, why certain extraocular muscles are affected preferentially, why the disease may be asymmetrically unilateral, and whether a defect in T cell or B cell functions (or both) is immunologically at fault.     

B型超声对眼外肌的观察

目的:了解正常人及不同眼外肌疾病患者的眼外肌B型超声的图像特点。方法:回顾性分析我院2007-10/2010-10间利用10MHzB型超声进行眼外肌检查的情况,归纳总结正常人群眼外肌的厚度以及不同眼外肌疾病B超声像图特点。结果:正常人群双眼对称眼外肌厚度无明显差别;4条直肌中,内直肌最厚;20岁之前4条眼外肌厚度随年龄增大而增厚。不同眼外肌疾病眼外肌B超表现各不相同。结论:B型超声可以较好的显示4条眼外肌的形态,便于眼外肌疾病的随诊观察。B型超声是检查眼外肌的有效手段。     

Extraocular Muscle Involvement in MALT Lymphomas

We report 3 cases of extraocular muscle involvement by MALT (mucosa-associated lymphoid tissue) lymphoma. The first case was a 68-year-old woman who presented with mild proptosis of the left eye and diplopia caused by a lymphoma in the medial rectus. The other two cases presented with ptosis caused by a lymphoma in the most anterior aspect of the levator muscle. MALT lymphoma may involve extraocular muscles, either as a primary or secondary presentation. Although localization of orbital lymphoma in extraocular muscles is rare, this possibility should be considered in the differential diagnosis with other conditions involving extraocular musculature.     

Extraocular muscle involvement in MALT lymphomas

We report 3 cases of extraocular muscle involvement by MALT (mucosa-associated lymphoid tissue) lymphoma. The first case was a 68-year-old woman who presented with mild proptosis of the left eye and diplopia caused by a lymphoma in the medial rectus. The other two cases presented with ptosis caused by a lymphoma in the most anterior aspect of the levator muscle. MALT lymphoma may involve extraocular muscles, either as a primary or secondary presentation. Although localization of orbital lymphoma in extraocular muscles is rare, this possibility should be considered in the differential diagnosis with other conditions involving extraocular musculature.