眼眶内植物性异物14例患者的临床研究

目的:分析眶内植物性异物14例患者的临床影像学特征及手术方法。方法:回顾性分析我院眼科2010-01/2019-04收治的眼眶植物性异物外伤的14例14眼患者资料,总结其临床表现、影像学特征、手术方法。结果:选取的14例14眼患者均在术中取出植物性异物。14眼患者眼眶CT三维重建检查,9眼显示异物为低密度伴周围软组织炎性反应。CT影像因异物性质不同表现各异,软质异物无特征性CT影像。外伤后手术切口Ⅰ期愈合,有不同程度的伤口瘢痕形成。结论:眶内植物性异物性质特殊,术前充分准备,制定个体化手术方案,对术中完整取出异物、降低手术难度十分重要。     

眼眶植物性异物的诊断和治疗

目的：通过对眼眶植物性异物的临床分析，该病最好的诊断和治疗方法。方法：复习我院收治的眼眶植物性异物21例,分析其各项检查及治疗方法。结果：眼眶瘘管形成占眼眶植物性异物的57．14％；B型超声检查异常者占64．70％，可提示异物存在者占41．18％；CT扫描异常者94．12％，可提示异物存在者占41．18％；2例行MRI检查均清晰地显示出异物影像，21例患者均手术取出异物，证实术前诊断。结论：眼眶植物性异物影像学检查显示率较低，对于显示异物，MRI优于超声和CT。正确诊断必须结合病史和眼部体征，尤其是眼眶瘘管的存在，手术摘出异物的同时需将瘘管一同切除，以求彻底治愈。     

泪腺炎症及淋巴细胞增生性病变的CT及磁共振成像诊断

目的研究泪腺炎症及淋巴细胞增生性病变的CT和MRI表现及其诊断价值。设计回顾性病例系列。研究对象泪腺炎症及淋巴细胞增生性病变患者46例。方法回顾分析46例经病理学或临床证实的泪腺炎症及淋巴细胞增生性病变患者的CT及MRI影像资料。主要指标病变形态、信号(密度)、累及范围。结果46例患者中炎性假瘤32例,表现为泪腺体积增大,CT示泪腺呈均匀等密度,MRI T_1WI及T_2WI呈等或低信号,1例可见多发囊变,MRI增强扫描病变强化明显。Mikulicz病4例,均为双侧泪腺弥漫增大,CT呈均匀等密度,MRI T_1WI及T_2WI均呈低信号,增强后呈明显均匀强化。反应性淋巴细胞增生5例,表现为泪腺体积增大,CT呈均匀等密度,MRI T_1WI、T_2WI呈低或等信号,1例T_2WI呈高信号,增强扫描呈明显强化。非典型性淋巴细胞增生1例,CT表现为双侧泪腺弥漫性增大,密度均匀。泪腺淋巴瘤4例(B细胞淋巴瘤3例,组织细胞肉瘤1例),表现为双侧泪腺弥漫性增大。结论泪腺炎症及淋巴细胞增生性病变的影像表现相似,CT及MRI有助于病灶与泪腺上皮性肿瘤的鉴别,并可准确显示病变累及范围。(眼科,2007,16:308-311)     

眼眶异物的临床特点和手术治疗

目的总结眼眶异物的临床特点和手术治疗方法。方法回顾性系列病例研究。分析中山大学中山眼科中心2002年1月至2013年7月期间诊治的22例眼眶异物患者的资料,对其临床表现、影像学资料和手术治疗方法进行统计。结果22例患者中,男19例,女3例;年龄3~67岁,≤14岁者占46%;右眼眶10例,左眼眶12例。植物性异物占73%,异物位置以眼眶上部最多,占41%;其次分别为内侧（27%）、外侧（18%）、下部（9%）和锥后段（4%）。术前视力损害占50%,眼球运动受限、斜视和上睑下垂占46%。眼眶CT和MRI显示植物性异物均有条状、棒状等高密度异物影或低信号异物影。全部病例均完整取出异物,其中前路开眶21例,侧壁开眶1例;21例行1次手术,1例行2次手术;所有患者术后随访期内均没有出现新增视力下降和眼球运动受限,仅2例有暂时性轻度上睑下垂。结论眼眶异物以男性儿童多见,影像检查有利于准确诊断,前路开眶手术效果好。     

多种影像方法联合诊断眼内异物及其并发症

目的 评估CT、B超、X线拍片、MRI及超声生物显微镜（UBM）联合诊断和定位眼内异物及其并发症的准确性及价值。方法 对103例眼内异物患者的临床病例资料进行回顾性研究,内容包括：致伤原因、影像学检查及临床验证。结果 CT对103例患者眼内异物的显示率达100%,能较好地显示异物位置,大致确定异物为金属或非金属,但对异物的大小和形态显示不清,低密度异物显示不良,对眼内并发症的显示率较低。B超对103例患者眼内异物的显示率为93.2%,对眼前段异物和眼球后异物显示较差（分别为11/16和4/6）,但对眼内异物的并发症如玻璃体混浊、视网膜脱离显示良好。X线正、侧位拍片可清晰地显示眼内金属异物大小和形态。MRI对眼内低密度异物显示优于CT。UBM对眼前段低密度异物显示较好。结论 在眼内异物的诊断和定位中,CT的优势在于显示较高密度异物及其与眼球壁的关系,B超的优势在于显示异物与眼球壁的关系及眼内并发症,X线拍片的优势在于显示金属异物大小和形态,MRI的优势在于显示眼部非磁性低密度异物,UBM的优势在于显示眼前段低密度和细小异物。多种影像学方法联合应用可为手术提供较为全面的信息。     

硅油填充眼的磁共振成像检查

目的探讨硅油填充眼的MRI检查方法和价值。设计前瞻性病例系列。研究对象40例(40眼)外伤后玻璃体切除眼内硅油填充患者。方法对上述患者采用眼表面线圈,行横断面FSE T_1WI、T_2WI、冠状面脂肪抑制后T_2WI、斜矢状面T_1WI、横断面T_2FLAIR扫描,观察硅油填充眼形态、信号、并发症的MRI表现,并测量眼轴。主要指标硅油填充眼形态、信号、并发症的MRI表现,眼轴。结果患侧平均眼轴为(2.18±0.21)cm,健侧(2.48±0.16)cm。眼球内硅油影均呈等或略短T_1、等或略长T_2信号,脂肪抑制序列呈低信号。MRI显示玻璃体腔积液33例,其中未合并其他异常的单纯性积液17例,合并其他异常的16例;脉络膜脱离11例,其中5例合并玻璃体腔积液,1例伴有眼球壁局限性膨出;视网膜脱离4例,其中3例合并玻璃体腔积液;重水残留1例,合并玻璃体腔积液;前房异物1例,合并玻璃体腔积液;眼球壁局限性增厚伴玻璃体腔积液1例;玻璃体腔硅油量少伴玻璃体腔积液1例。除眼球改变之外,伴眼眶骨折、眶内异物者1例。结论MRI检查能发现硅油填充术后眼球结构异常改变,能准确进行眼球生物学测量,具有重要临床应用价值。(眼科,2007,16:312-315)     

内镜在眼眶深部植物性异物摘出中的应用

目的探讨内镜在眼眶深部植物性异物摘出术中的临床应用价值。方法术前行眼眶CT或MRI冠状和水平扫描准确定位，应用硬性内窥镜沿异物窦道或皮肤切口进入眶内，沿异物长轴方向夹取异物。结果5例眼眶异物均成功摘出，同时在内窥镜下清除窦道内肉芽及坏死组织，手术后伤口均一期愈合，无手术并发症。结论应用内镜取眼眶深部异物损伤小，恢复快，异物容易取尽无残留：     

眼眶腺样囊性癌的影像学研究

目的分析眼眶腺样囊性癌(ACC)的超声、CT及MRI等影像学特征。设计回顾性病例系列。研究对象经病理诊断证实的泪腺腺样囊性癌38例和副鼻窦来源的腺样囊性癌4例。方法分析眼眶腺样囊性癌超声、CT和MRI等各种影像学检查结果,记录图像特征。主要指标标准化A/B超、CT和MRI影像。结果ACC标准化A超表现为前部高波峰,后部低波峰和不规则高低混杂波峰两种类型。B超可显示肿瘤的轮廓,对于瘤内钙化及液化坏死等病变显示优良。CT扫描显示ACC有梭形、扁平形、团块状和不规则形等四种形状,对于肿瘤的边界、空间位置,骨破坏和骨吸收等继发改变显示清晰。ACC在T_1加权像为中信号,T_2加权像有均一的等信号,等、低信号混杂和等、高信号混杂三种,多数不均匀强化。强化MRI有利于显示肿瘤的蔓延途径,泪腺ACC有多种蔓延途径。副鼻窦ACC易累及筛窦和上颌窦。结论各种影像学检查可显示眼眶ACC的不同特性。综合运用和分析各种影像学检查结果可提高诊断水平。(眼科,2007,16:391-394)     

眼眶内侧壁骨折分级标准的影像学研究

目的探讨高分辨CT和MRI对眼眶内侧壁骨折的定性和定量的价值。方法通过对120例眼眶内侧壁骨折的高分辨CT和MRI检查资料，分析其影像学表现特点。结果眼眶内侧壁骨折的高分辨CT表现为骨质的连续性中断、粉碎、凹陷，根据凹陷的程度分为3级，新鲜骨折合并球旁积气，筛窦积液等间接征象；MRI除显示直接征象外，还可显示眶周及球旁软组织内异常信号的间接征象。结论高分辨CT和MRI扫描能准确地诊断眼眶内侧壁骨折并分型及分级，并能区分新鲜骨折与陈旧骨折。     

24例眼眶异物诊断和治疗分析

目的 分析目前眼眶异物诊断和治疗中存在的问题.方法 回顾性系列病例研究.收集2002年5月至2007年5月收治的眼眶异物患者24例,根据其临床和影像学资料了解目前眼眶异物诊断和治疗中存在的问题.结果 植物性异物11例,金属异物6例,玻璃异物2例,其他5例.18例曾行清创缝合术,12例曾行异物取出术,7例曾行3次以上各类手术.诊断和治疗中存在的问题:(1)受伤情况询问不详、对眶内异物存留认识不足;(2)未进行必要的CT检查;(3)不能正确阅读CT片,CT显示异物而未能诊断;(4)急诊清创处理、以及后续的化脓性感染切开引流,均未进行必要的探查;(5)对植物性和塑料异物,仅满足术中取出一个或数个异物;(6)对眼眶解剖结构不熟悉,手术技术不熟练,不能取出异物甚至将其推向深处;(7)再次手术时未重新进行必要的CT检查;(8)麻醉方式选择不当.局部麻醉下,患者不能耐受手术.结论 眼科医师应掌握眶内解剖结构、影像学和眶内异物的诊断,熟悉眼眶手术入路,提高异物取出成功率,减少手术并发症.(中华眼群杂志,2008,44:676-680)     

眶内非金属异物25例临床分析

目的 总结眶内非金属异物的临床特征及诊治方法.方法 回顾性系列病例研究.收集2002至2009年经手术证实的眶内非金属异物患者资料25例,总结临床表现、影像学征象、治疗与随访结果.结果 外伤性异物23例,包括:植物性异物11例,玻璃、油脂和石块各3例,塑料笔头2例,爆竹残渣1例.另2例为医源性异物.特征性临床表现为眶周皮肤或结膜瘘道,共11例,发生率为44%,以植物性异物最为多见.CT征象因异物性质不同而各异.植物性异物在外伤早期呈低密度,随时间延长密度逐渐增高,压缩窗宽,异物显示更加清晰.油脂异物表现为与脂肪相近的低密度,石块和玻璃表现为高密度块影.植物性异物在MRI的T1和T2加权像均呈低信号,周围的脓液在T2加权像呈环形高信号影,异物周围的炎性组织强化明显.油脂异物在T1和T2加权像均呈高信号,脂肪抑制显像呈低信号.所有患者均在全身麻醉下接受眶内异物清除术,均经一次手术清除全部异物及周围腐烂组织,感染伤口一期不予缝合.术后半年随访,伤口愈合良好,症状改善,未见与手术相关并发症.结论 眶内非金属异物种类较多,病情复杂各异,处置不当易眶内残留.CT为首选检查方法.正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好.

Abstract：

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.     

Intraorbital wood. Detection by magnetic resonance imaging

The authors present two cases in which intraorbital wooden foreign bodies remained undetected after initial ophthalmologic examination and radiologic investigation which included plain orbital x-rays, orbital computed tomography (CT) scans, and, in one case, orbital ultrasound. In each case, subsequent magnetic resonance imaging (MRI) showed a well-delineated low-intensity lesion suggestive of a retained foreign body. Investigation of a case of suspected wooden foreign body in the orbit should include an MRI scan if there is no contraindication, and no foreign body has been defined on CT scan, ultrasound, or plain orbital films.     

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.     

眼内异物的B型超声扫描诊断分析

目的：分析眼异物在B型超声扫描探查中的声像学特点及定位的优势，为临床诊断提供依据。方法：采用眼科专用A、B型两用超声波扫描仪，对38例眼异物进行探查。结果：本组38例中32例经B超探查发现异物回声，异物检出率为84．2％（32／38）其中眼内异物22例（57．9％）；眼球壁异物9例（23．7％）；眶内异物1例（2．6％）。有30例行X光或CT检查，结果23例发现异物，异物检出率为76．6％（23／30），其中眼内异物16例（53．3％）；球壁异物4例（13．3％）；眶内异物3例（10．0％）。结论：B型超声探查对于眼内异物，特别是眼球壁异物具有特异性的诊断价值。     

Magnetic Resonance Imaging and DWI Features of Orbital Rhabdomyosarcoma

 Purpose: To describe the magnetic resonance imaging (MRI) features of orbital rhabdomyosarcoma (RMS). Methods: Thirty-nine patients with histopathologically confirmed orbital RMS were retrospectively reviewed. All patients underwent orbital conventional MRI, including axial, sagittal, and coronal T1-weighted, T2-weighted, and postcontrast T1-weighted sequences. The location, shape, margin, and MRI signal of the 39 lesions were reviewed. DWI in 15 patients and susceptibility weighted imaging (SWI) in 2 patients were also analyzed. Results: Orbital MRI was available in 39 patients and revealed a soft tissue mass in the orbital region in all cases. Of the 39 patients, the primary tumor sites were limited to the orbital proper in 31 cases, while 28 cases had extraocular muscle invasion and 8 cases had extraorbital invasion. All lesions were unilateral. Thirty-three cases were well-defined soft tissue masses and 6 cases appeared as less well-defined soft-tissue masses. Thirty-four cases showed homogeneous isointense or slightly hypointense signals on T1-weighted imaging (T1WI) and hyperintense signal on T2-weighted imaging (T2WI) compared with extraocular muscles. Five cases had heterogeneous signals with focal areas of increased signal on T1WI or decreased signal on T2WI, including 1 case with hypointense signal on SWI. The mean apparent diffusion coefficient (ADC) value of the viable part of tumors was (0.925±0.09)×10-3 mm2/s. All cases showed moderate to marked enhancement after contrast administration. Conclusion:Several MRI features—including homogeneous isointense or slightly hypointense signal on T1WI and slightly hyperintense signal on T2WI, relative low ADC values, and moderate to marked enhancement, extraocular muscles invasion, and extraorbital extension—are helpful in the diagnosis of orbital RMS.     

Anaerobic orbital abscess secondary to intraorbital wood

A case of anaerobic orbital cellulitis secondary to intraorbital wood and an approach to management are presented. Retained foreign bodies should be suspected in all penetrating orbital injuries involving wood. Computed tomography (CT) should be performed to delineate the location and size of any foreign body and to determine damage to adjacent structures. Magnetic resonance imaging (MRI) is useful in certain circumstances. Orbital infection should be anticipated and broad-spectrum antibiotic cover (including anaerobes) provided. Surgical intervention should be undertaken to remove any retained foreign bodies to prevent vision-threatening complications.     

Intraorbital organic foreign body--a diagnostic challenge

Intraorbital organic foreign bodies pose a diagnostic and management challenge to ophthalmologists. A high degree of suspicion of an orbital foreign body is needed when patients present with injuries to the eyelids and orbit. We present a case of retained intraorbital wooden foreign body which was initially undetected. A 10-year-old boy presented to the eye casualty with signs and symptoms suggestive of orbital cellulitis. He was started on intravenous antibiotics and urgent CT of the orbits did not reveal any foreign bodies. There was spontaneous extrusion of a wooden foreign body through the upper lid two days later, followed by spontaneous resolution of symptoms. Wood has a density similar to air and fat and can be difficult to distinguish from soft tissue in both a plain X-ray film and a computed tomogram. Clinicians should be alerted to the possibility of retention of an intraorbital foreign body in all patients presenting with periorbital trauma. The clinician should also obtain a careful history of the type of injury and should examine the patient in detail. In cases where a wooden foreign body is suspected, investigation by magnetic resonance imaging is preferred.