本期导读

本期主要内容是关于神经眼科与眼眶疾病的诊断与治疗方面临床进展情况。专家述评栏目,视神经炎与多发性硬化是神经眼科常见疾病之一,国内同行在概念和诊断治疗上尚存在很多争议和误区,有关脱髓鞘病变引起的视神经炎与多发性硬化的诊断和进展情况在本期中有较为详细的介绍。眼眶病是一个涉及多学科的专业,近年我国在眼眶病研究尤其是在静脉曲张介入治疗、眼眶骨折整体修复等方面具有创新性,有关眼眶病的诊断与治疗方面的现况及进展本期有精彩点评。眼整形外科包括眼部美容、眼部整形和眼眶外科     

第五届眼整形手术进展学习班将在长沙举办

2005年继续教育项目“眼整形手术进展”学习班将于2005年5月30日至6月5日在湖南省长沙市中南大学湘雅二医院举办，上海第二医科大学附属第九人民医院眼科主办，面向全国招收学员。近30年来，上海第二医科大学附属第九人民医院眼科一直致力于眼整形和眼美容手术的临床研究工作，包括：眼美容手术、眼睑整形、眦角成形、眼窝再造、眼座植入、眼表重建、眼眶骨折修复重建、先天性眼眶畸形整复及眼眶减压等系列临床研究，并取得了良好的临床效果。     

眼眶爆裂性骨折致伤原因及眼部损伤状况分析

目的:了解眼眶爆裂性骨折的常见致伤原因及发生眼部损伤的概率和特点。方法:对九龙医院2009-01/2011-03收治的63例67眼眼眶骨折住院患者进行了回顾性分析。结果:眼眶骨折患者63例致伤原因中,拳击伤28例29眼,车祸伤17例20眼,钝器击伤9例9眼,摔伤5例5眼,坠落伤2例2眼,其他2例2眼。患者合并眼部损伤共57例61眼,其中眼睑皮下淤血、肿胀45例49眼;眼睑裂伤16例18眼;结膜下淤血25例26眼;角膜异物、上皮缺损9例9眼;前房出血5例5眼;眶下神经麻痹或感觉迟钝4例4眼;玻璃体出血4例4眼;视神经损伤3例3眼;泪小管断离2例2眼;眼球破裂2例2眼;视网膜裂孔1例1眼;晶状体半脱位1例1眼。结论:拳击伤和车祸伤是眼眶爆裂性骨折的主要致伤原因,拳击伤多引起单纯性眼眶骨折,车祸伤和钝器击伤易导致复合性眼眶骨折,并多伴有眼部损伤。在眼眶爆裂性骨折合并的眼部损伤中,眼睑损伤发生率最高,角膜、结膜及房角损伤也较常见,比较严重的眼部损伤如视神经损伤、眼球破裂、视网膜裂孔相对少见。     

人工智能在眼整形外科中的应用

计算机的进步和数据的爆发使得人类迎来了第三次人工智能(AI)浪潮。AI是一门综合性的交叉学科，是汇集新思想、新理论、新技术等的新兴学科。AI给眼科学带来了便利，也推动了眼科学的智能化、精准化和微创化发展。现阶段，AI已经在眼科学多个领域中都得到了广泛的应用，尤其在眼整形外科领域中，AI在图像检测、面部识别等方面取得了快速进展，其性能及准确度在某些方面甚至已经超越了人类。本文综述了AI在上睑下垂、单睑、眼袋、眼睑肿物及眼球突出等眼整形外科中的相关研究和应用，探讨了当前AI在眼整形外科临床应用中面临的挑战与机遇，并对其未来发展前景进行展望，旨在为眼整形外科AI的发展提供新思路。     

重视我国眼整形眼眶病专业的发展

眼整形眼眶病是一门年轻而发展迅猛的眼科学分支专业,包括眼整形、眼美容和眼眶外科.近年来,眼整形眼眶病领域的新技术和新手术不断涌现,技术创新和学科交叉使其对眼睑和眼眶等疾病的治疗力求达到功能重建及形态修复的完美结合.我国眼整形眼眶病专业起步较晚,但立足于创新性研究,积极开展学科交叉、医工合作和国际学术交流,取得了快速发展.针对目前我国眼整形眼眶外科发展中存在的问题,必须规范专业化人才培养、加强国内外多渠道交流、重视基础与临床转化研究,进一步促进眼整形眼眶病专业的发展.

Abstract：

Ophthalmic plastics and orbital diseases have developed rapidly as a young branch of ophthalmology in recent years. The current situation and development of ophthalmic aesthetics,plastics and orbital surgery are discussed in this paper. The functional reconstruction and appearance rehabilitation are both important to the ophthalmic plastic surgery. Although the ophthalmic plastics and orbital surgery started late in China,it developmented rapidly. The development of this branch is based on innovative research,active interdisciplinary,medical-engineering cooperation and academic exchange. However,there are still some problems about ophthalmic plastics and orbital surgery in China. To promote the development of ophthalmic plastic and orbital surgery,we should regulate the training of ophthalmic plastic surgeons,and pay attention to the clinical translational research.     

我国眼整形外科近五年研究进展

我国眼整形外科起步较晚,但在全国眼科医生的共同努力下,近5年来已取得了空前发展.对于生物材料的研究和临床应用极大促进了眼整形外科的发展,而利用组织工程方法构建新生骨组织以修复眼眶骨缺损,目前已处于组织构建与缺损修复的前沿.伴随着眼科学、颌面外科、显微外科的发展及内镜技术、计算机等技术的应用,眼整形外科手术技术有了极大提高,治疗范畴业已有了前所未有的扩大.我们期待在未来5～10年中,眼整形外科能够不断发展壮大.     

《Kanski临床眼科学》(第8版)出版

由张明昌、刘欣主译的《Kanski临床眼科学》(第8版)由人民卫生出版社出版发行全书共分21章:包括眼睑、泪道系统、眼眶病、干眼、结膜、角膜病、角膜及屈光手术、表层巩膜和巩膜、晶状体疾病、青光眼、葡萄膜炎、眼肿瘤、视网膜血管病变、获得性黄斑疾病、遗传性眼底营养不良、视网膜脱离、玻璃体混浊、斜视、神经眼科学、全身药物治疗的眼部不良反应、外伤等。     

全国眼眶病及眼整形专题讲座及研讨会将在成都召开

由中华医学会中华眼科杂志编委会主办的“全果眼眶病及眼整形专题讲座及研讨会”定于 2 0 0 3年 10月在四川省成都市召开 ,届时将邀请我国从事眼眶病、眼整形基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼眶病的影像学诊断方法 ;(2 )眼眶肿瘤的病理学诊断 ;(3)眼眶肿瘤的临床特点 ;(4)眼眶肿瘤手术技术 ;(5 )眼眶血管瘤畸形诊断及治疗 ;(6 )甲状腺相关眼病的诊断及治疗 ;(7)眼整形的手术原则和手术方法 ;(8)眼部美容手术原则及方法 ;(9)眼部皮片和皮瓣移植术 ;(10 )活动性义眼座和钛钉…     

全国眼眶病及眼整形专题讲座及研讨会将在海口市召开

由中华医学会中华眼科杂志编委会主办的“全国眼眶病及眼整形专题讲座及研讨会”定于 2 0 0 3年 1 2月 6～ 1 2日在海南省海口市召开 ,届时将邀请我国从事眼眶病、眼整形基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1 )眼眶病的影像学诊断方法 ;(2 )眼眶肿瘤的病理学诊断 ;(3)眼眶肿瘤的临床特点 ;(4)眼眶肿瘤手术技术 ;(5)眼眶血管瘤畸形诊断及治疗 ;(6)甲状腺相关眼病的诊断及治疗 ;(7)眼整形的手术原则和手术方法 ;(8)眼部美容手术原则及方法 ;(9)眼部皮片和皮瓣移植术 ;(1 0 )活动性…     

全国眼眶病及眼整形专题讲座及研讨会将在海口市召开

由中华医学会中华眼科杂志编委会主办的“全国眼眶病及眼整形专题讲座及研讨会”定于 2 0 0 3年 12月 6目～ 10日在海南省海口市召开 ,届时将邀请我国从事眼眶病、眼整形基础及临床研究的知名专家和学科带头人进行专题讲座 ,欢迎全国眼科医师踊跃报名参加。讲座内容 :(1)眼眶病的影像学诊断方法 ;(2 )眼眶肿瘤的病理学诊断 ;(3)眼眶肿瘤的临床特点 ;(4)眼眶肿瘤手术技术 ;(5 )眼眶血管瘤畸形诊断及治疗 ;(6 )甲状腺相关眼病的诊断及治疗 ;(7)眼整形的手术原则和手术方法 ;(8)眼部美容手术原则及方法 ;(9)眼部皮片和皮瓣移植术 ;(10 )活动性…     

Rhegmatogenous Retinal Detachments in Patients with Acquired Immunodeficiency Syndrome

Lower eyelid blepharoplasty surgery has undergone a dramatic evolution over the last decade. As more patients have requested cosmetic lower eyelid surgery, this has been accompanied by a greater number of surgeons performing the surgery and a greater number of patients with complications of a varied nature. Ophthalmologists, the surgeons most familiar with the anatomy of the eyelids, orbit, ocular structures, and adjacent face, have been called on more and more regularly to evaluate patients before their having cosmetic surgery, performed by other specialists, and then to manage complications ranging from minor ocular irritation to severe visually threatening ocular and periocular problems after surgery. In addition, more ophthalmologists are performing cosmetic eyelid surgery today than ever. Lower eyelid surgery has always instilled fear in the hearts of cosmetic surgeons because of the unacceptably high frequency of lower eyelid malpositions after surgery and the difficulty of correcting these problems. Transconjunctival blepharoplasty, particularly in conjunction with laser skin resurfacing, has reduced these problems. Lateral canthal tendon-tightening procedures will frequently reposition the lower eyelid back to its normal anatomic position. In cases of severe lower eyelid retraction, hard palate mucosal grafts, in conjunction with eyelid tightening, can reposition the eyelid satisfactorily. Other complications, including lacrimal drainage-system lacerations, extraocular muscle injury with postoperative diplopia, and wound dehiscence, need to be prevented and, if they occur, need to be able to be treated by the cosmetic eyelid surgeon. Certain difficult postoperative problems, such as chemosis or lymphedema, will occasionally occur and, although their anatomic origin is not yet understood, they must be properly medically evaluated and treated.     

Cosmetic eyelid and facial surgery

The goal of cosmetic surgery is to reverse anatomical changes that occur in the face with aging. It is a rapidly growing subdiscipline of ophthalmic plastic surgery and includes forehead, eyelid, mid-face, lower face, and neck surgery, most performed by ophthalmic plastic surgeons. The current article reviews updates in cosmetic eyelid and facial surgery, including minimally invasive techniques such as cable suspensions, injections, and fillers.     

Prosthetic rehabilitation after orbital exenteration: A case series

Orbital exenteration is executed by the ophthalmic surgeon to treat various neoplasms or non-malignant diseases. But it leads to several functional, esthetic and psychological problems for the patients. Orbital prosthesis is a good alternative for cosmetic and psychological rehabilitation, if reconstructive surgery is not possible or not desired by the patient. In the following article, different materials and retentive aids for fabrication of an orbital prosthesis given in the literature along with few novel methods have been discussed for four patients who underwent orbital exenteration. Factors that an ophthalmic surgeon should consider during surgery, which may later on help the prosthodontist to obtain good cosmetic results, are also discussed briefly. Remarkable results can be obtained if both work as a team for one common goal i.e. improvement of quality of life of the patient after orbital exenteration.     

Cosmetic orbital surgery

PURPOSE: Current indications for orbital surgery primarily aimed at improving cosmesis are considered in the context of subspecialist orbital practice by an ophthalmologist. SCOPE: Thyroid eye disease, orbital vascular anomalies, and dermolipomas are common orbital diseases in which the symptoms can be purely cosmetic. Accurate anatomical awareness, preoperative scanning, control of medical factors including smoking and thyroid status, and endoscopic techniques have all contributed to the aesthetic outcome of orbital surgery. The threshold for performing reconstructive orbital surgery has also been lowered by public demand. CONCLUSIONS: Orbital surgeons can therefore offer the familiar techniques, such as orbital decompression, for pure cosmesis. Sensitive history taking and awareness of the psychological element are of paramount importance for the orbital surgeon who develops a cosmetic practice.     

Anthrax as the cause of preseptal cellulitis and cicatricial ectropion

A 54-year-old female farmer with anthrax infection of the eyelids is presented. She was initially managed with high dose intravenous penicillin G treatment. Following complete healing of the eyelid lesions, significant cicatricial ectropion resulted. Her right lower eyelid ectropion was corrected by surgical reconstruction using full thickness skin graft after a period of 6 months during which the cicatrization process stabilized. Satisfactory cosmetic and functional improvement was achieved. Anthrax of the eyelid must be considered in the differential diagnosis of preseptal or orbital cellulitis and any reconstructive procedure should be attempted only after the cessation of the healing process.     

Surgical treatment of the sequelae of Basedow's ophthalmopathy

Functional and cosmetic ophthalmic complications of Graves' disease are exophthalmos, eyelid retraction and oculomotor disturbances. This paper describes and takes over the surgical procedures used when these complications are associated. In severe exophthalmos, we used an orbital decompression of the orbital floor sometimes combined with the medial wall by an anterior approach. In eyelid retraction, we perform a recession of the levator muscle with scleral graft implantation. In incomitant strabismus, surgery is usually limited to recessions of the involved muscles, most of the surgery is directed to the inferior rectus and medial rectus, as these are the most commonly affected muscles. The indications depend on the status of the patient at the time of referral. For severe exophthalmos with true retraction of the upper eyelid, we begin at the first stage by treatment of the retraction and if it is not sufficient, we perform an orbital decompression at the second stage. For severe exophthalmos with oculomotor disturbances, we perform at the first stage the orbital decompression and at the second stage the strabismus surgery. For oculomotor disturbances with eyelid retraction, we perform the strabismus surgery at the first stage and the eyelid retraction at the second stage. When there is the association of exophthalmos, eyelid retraction and oculomotor disturbances, the indication and the choice of treatment are difficult and depend on numerous factors. If an orbital decompression is indicated, it will be done first, followed by the strabismus surgery and at a later stage, the eyelid retraction. If only the eyelid retraction is treated, it will be done after the strabismus surgery. The chronology of the treatment depends on the modification we observed on the other components of the ophthalmopathy when one stage treatment is performed on one component: for example orbital decompression can modify the oculomotor disturbance and oculomotor surgery can modify eyelid retraction.     

Technology of new methods for adaptation of skin flaps, by using compression plates during reparative operations in the eyelid area and its adjacent tissues

Oligocarbonate methacrylate-based hexahedral compression plates (CPs) are proposed for adjustment of wound edges and skin grafts during reconstructive operations in the eyelid area and its adjacent tissues. A hundred and twenty-eight reparative operations in the eyelid and its adjacent tissues, by employing various plastic repairs, were analyzed to make a clinical evaluation of the efficiency of the soft tissue adjustment technique, by applying CPs. The CPs proposed for the adjustment of wound edges and skin grafts to the adjacent tissues were used in 70% of cases. There is evidence for the reliable fixation of wound edges and skin grafts to the adjacent structures by means of CPs without negative effects of mimic and chewing muscles. In the presence of complex orbital and periorbital relief, microanatomic structures, and tissue deficiency, CPs provide a valid connection of the edges of skin wounds throughout healing and permanent microdraining of the postoperative space, reduce the number of complications, and ensure an uncomplicated course of reparative processes, by forming a fine delicate scar in 98.89% of cases. The proposed way of adjusting wound edges and skin grafts to the adjacent tissues improves the cosmetic and functional results of reconstructive operations in the orbital and periorbital areas.     

The mysterious second temporal fat pad

Temporal eyelid fullness due to residual herniation of orbital fat is a complication of cosmetic oculoplastic surgery. It frequently occurs despite the surgeon's excision of temporal herniated orbital fat and requires a second surgical procedure to remove. Anatomists have demonstrated three lower eyelid fat pads, temporally, centrally, and nasally. I have found a second temporal fat pad that was not evident until the first had been removed. Searching for and excising the second temporal fat pad have eliminated the complication of residual temporal lower, eyelid fat herniation following cosmetic eyelid surgery.     

CO2- und Erbium-YAG-Laser in der Lidchirurgie Ein Vergleich

BACKGROUND: Lasers are finding increasing use in cosmetic and reconstructive plastic surgery. We compared the erbium-YAG laser and the CO2 laser to conventional eyelid surgery with a scalpel. MATERIAL AND METHODS: We operated on 58 patients using the erbium-YAG laser and on 32 using the CO2 laser. Surgeries were benign tumor excisions and removal, xanthelasma removal, lower and upper eyelid blepharoplasties, and skin resurfacing in the area of the lower eyelid. RESULTS: Wound healing with the CO2 laser was significantly slower because of its larger thermal necrosis zone, but the hemostasis with the CO2 laser makes removal of deeper lesions easier. Advantages are the wide application spectrum for incisional and ablative surgery. The erbium-YAG laser is an excellent for ablating superficial benign lesions, including that in the area of the lid margin and close to the lacrimal puncta without scars. SUMMARY: The application spectrums of the erbium-YAG and CO2 lasers complement one another. The erbium-YAG laser is superior for esthetic skin resurfacing and ablation of superficial lesions, and the CO2 laser allows hemorrhage-free noncontact incisional surgery.     

Tarsomarginal graft. Indication and results in palpebral surgery

A tarsomarginal graft is indicated in eyelid reconstructive surgery particularly after tumor resection. We reported the results of a retrospective study during the past 13 years with 58 grafts. We found a predominance of basal cell carcinomas localised in the lateral third portion of the lid (42%) and in the lower eyelid (76%). The mean size was 14mm for the tumor and 9.81mm for the graft. Grafts were used to cover a defect larger than 5mm. Complications were rare, and mainly involved suture looseness. The Hubner technique gave good results; repairing the eyelid without having to make a tarsorraphy and providing good cosmetic results. The graft must be covered by a skin flap.