累及视神经的脉络膜转移癌临床及影像学特征

目的探讨累及视神经的脉络膜转移癌的临床特征及影像学特点。方法收集我院所诊治的侵犯视神经的脉络膜转移癌患者5例(5眼)的临床资料,分析其眼底表现、眼部B超、彩色超声多普勒、眼底荧光血管造影、MRI等影像学检查特征。结果 5眼均可见眼底后极部累及视神经及其周围脉络膜组织的扁平实质性占位病变,视盘隆起、水肿,表面小血管扩张,动脉期即出现荧光素渗漏。B超表现为视神经附近沿眼球壁扁平隆起的病灶,视盘隆起且回声增强。眼部彩色超声多普勒可见肿块内血流信号。眼部MRI:眼球后壁视盘区局限性增厚,T1WI呈高于玻璃体的中等信号,T2WI瘤体呈低信号,累及视神经球内段及眶内段起始部,视神经增粗。结论累及视神经的脉络膜转移癌诊断需结合详细的病史、综合的影像学检查,并重视与相关视神经疾病的鉴别诊断,该类患者的视力预后及生命预后均不佳。     

脉络膜转移癌的眼底与眼底血管造影表现

随着公共卫生事业的发展和临床医师诊断水平的提高,脉络膜转移癌的确诊率明显提高.脉络膜转移癌能够提供原发癌转移的早期诊断依据,及时发现、诊断对治疗脉络膜转移癌十分重要.本研究总结脉络膜转移癌的诊疗情况.     

视网膜母细胞瘤复发,转移及患儿死亡原因分析

目的:讨论视网膜母细胞瘤(Rb)复发、转移和病人死亡的原因,并提出在视网膜母细胞瘤诊治中的注意问题。方法:对1967年7月～1992年5月在我中心诊治的Rb病人中复发、转移和死亡的46例进行分析。结果:影响Rb预后的主要因素有:①是否早期诊断。②随着视神经受累程度的增加而死亡率增加。③Rb侵犯眼眶、颅脑和脉络膜。④临床上,Rb继发性青光眼通常伴视神经受累。结论:诊断和治疗的延误导致Rb复发、转移和患者死亡。因此,早期诊断和治疗是提高存活率的关键。眼科学报 1995;11:221—223。     

图像分析技术与青光眼的诊断与随访

青光眼若能早期诊断、早期干预,其预后及患者的生活质量将得到明显改善。HRT、OCT等图像分析技术的迅速发展,使青光眼视神经损害的早期、定量检测成为可能。初步的临床诊断试验表明这些设备测得的结构指标能较好地区分青光眼和正常人,对于定量检测视神经损害进展也有一定的参考价值,但临床医生在充分了解这些测量技术优越性的同时,应清楚认识其局限性,以便使这些新技术能更好地应用于青光眼的早期诊断与随访。     

眼挫伤致视功能障碍的临床分析

目的 探讨眼挫伤致视功能障碍的各种原因,总结诊断治疗经验.方法 对129例(141眼)眼挫伤致视功能障碍的原因、治疗结果及预后进行临床分析.结果 常见的敛伤原因为拳击伤(37.59%),视功能障碍的原因:视刚膜震荡(82.98%),前房积血(44.68%),视神经挫伤(12.77%),虹膜损伤(9.93%);同时伴发的其他外伤以眶壁骨折最多为(34.04%),治疗总有效率为(82.27%).结论 眼挫伤敛视功能障碍预后不良的主要原因为视神经挫伤,早期发现,早期治疗对视功能障碍恢复至关重要.     

关注泪腺腺样囊性癌诊断和治疗中需要注意的问题

泪腺腺样囊性癌是泪腺最为常见的恶性肿瘤之一,具有较高的复发率和死亡率.此病发病机制不明,预后较差.目前,泪腺腺样囊性癌尚无标准化的诊疗方案,在临床诊疗过程中也存在着一些问题.为了提高有关泪腺腺样囊性癌的诊疗质量,本文将从泪腺腺样囊性癌的流行病学、临床表现、影像学检查方法 的选择、诊断与鉴别诊断、病理组织学改变和免疫组织化学指标、治疗方案的选择及预后等方面加以述评,以期有助于临床医师加强对该病的认识,提高早期诊断率,减少误诊率.     

视觉诱发电位在外伤视神经病变诊治中的意义

目的评价视觉诱发电位(VEP)在外伤性视神经病变诊断治疗中的作用。方法应用VEP检测临床诊断为外伤性视神经病变40眼,记录P100潜时和振幅的情况。结果外伤性视神经病变眼P100潜时延迟、振幅降低。结论VEP应用对外伤性视神经病变的诊断、预后、指导治疗及伤情鉴定等具有一定的临床价值。     

眼部(脉络膜、巩膜、视神经)转移癌的免疫组化及超微结构的诊断

本文报告一例右眼脉络腆巩膜视神经转移癌。首发症状为视蒙,诊断为“中心性视网膜炎”。4(1/2)月后始出现全身症状.1年后死亡。免疫组织化学技术及电镜观察对确定病理诊断有一定的意义。尸检报告为右肺门下腺癌广泛转移。     

视神经鞘脑膜瘤的诊断及治疗

目的 探讨视神经鞘脑膜瘤的早期诊断要点及合理的治疗方案.方法 回顾性分析12例(12只眼)原发性视神经脑膜瘤的早期临床及影像检查特征.结果 单侧眼球突出,视力减退,视盘萎缩和眼球运动障碍,是其主要表现,CT和MRI能确诊.结论 CT和MRI必须做多层面强化扫描,MRI必须做脂肪抑制技术.在早期诊断基础上,制定手术或临床观察方案.     

眼黑色素瘤眼球摘除术后死亡原因的临床及病理分析

目的 评估脉络膜或睫状体黑色素瘤眼球摘除术后死亡的预兆因素.方法 对1996年1月至2005年6月诊断为脉络膜或睫状体黑色素瘤行眼球摘除术的35例患者进行随访.通过临床及病理检查,记录肿瘤最大基底直径、肿瘤前界位置、有无巩膜外或视盘/视神经浸润、细胞病理分型及术后转移死亡例数等指标.进行2个或多个率比较的χ2检验,以及比较其转移死亡的相对危险度或称比值比(rat ratio,RR).结果黑色素瘤最大基底直径较大者死亡的危险性相对较高(0.011),肿瘤前界达到睫状体或虹膜者与位于脉络膜内者相比预后较差(0.025相似文献   

Afectación metastásica del nervio óptico en paciente con neoplasia de mama y pulmón

Metastases are the most common adult intraocular tumors. However, those located in the optic nerve are very uncommon and are usually associated with spread to other locations such as the central nervous system, which darkens the prognosis.There is a case of a 67-year-old woman who reports progressive vision loss in the right eye of 15 days of evolution. The ophthalmological examination shows a relative afferent pupil defect in this eye and a pseudoedema of the papilla with retinal hemorrhages in the fundus. Personal history and characteristics of the optic nerve suggest the diagnosis of metastatic infiltration.     

Tumors of the optic nerve head

A variety of primary and secondary tumors can involve the optic nerve head. Examples of primary optic disc tumors include capillary, cavernous and racemose hemangiomas, astrocytomas, and melanocytomas. Secondary optic disc tumors include metastatic carcinoma, leukemia, and those which invade the nerve head from adjacent structures (choroidal melanoma, retinoblastoma, and meningioma). These tumors may produce a variety of clinical features and are discussed in this review. Included also are histopathologic correlations and guidelines for management of the individual entities.     

Melanocytic Tumors of Interest to the Ophthalmologist

The principal malignant melanocytic tumors of interest to ophthalmologists are those originating in the skin of the lids, the conjunctiva, and the uveal tract. Metastasis rarely, if ever, develops from melanocytomas of the optic nerve head, tumors of the pigmented epithelia, or primary melanomas of the orbit. Malignant melanomas of the lids and conjunctiva have many more features in common with those of the skin than with the more prevalent uveal melanomas. The most important of these are the tendency to metastasize via lymphatic channels to the regional lymph nodes and the frequent occurrence of metastatic disease at the time of initial presentation. In general, melanomas of all tissues carry a worse prognosis when they are large and/or thick, they exhibit deep invasion, they are of the epithelioid cell type, mitotic activity is marked, metastatic disease is evident, and the patient is older. Histogenetic classification of uveal melanomas has not been shown to be a useful guide to prognosis of patients with such lesions.     

Neural orbital tumors

Primary tumors of the optic nerve (optic nerve sheath meningiomas and optic nerve astrocytomas) are important causes of visual morbidity. They may elude clinical detection and have the potential to be lethal. Their treatment remains controversial but often includes radiation. The optic nerve may be involved secondarily by peripheral nerve tumors in the orbit or by metastatic and infiltrative neoplasms. Optic neuropathy may also develop as a result of treatment of these tumors. Recent contributions to the literature concerning the diagnosis and management of neural orbital tumors are reviewed.     

Secondary optic nerve tumors.

Secondary tumors of the optic nerve are more common than primary optic nerve tumors. The involvement of the optic nerve may arise from direct invasion from intraocular malignancies, from hematopoietic malignancy, from meningeal carcinomatosis, or from distant primary tumors. Orbital tumors rarely invade the optic nerve, and brain tumors involve it only in their late stages.     

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

Background  

Most intraocular metastatic tumors occur in the uveal tract, while isolated metastasis to the optic nerve is rarely found. We report a case of metastasis to the optic disc from primary lung cancer, diagnosed from biopsy findings obtained during a vitrectomy.     

关于视神经鞘脑膜瘤诊断和治疗的新观点

视神经鞘脑膜瘤是视神经鞘最常见的肿瘤,占原发性视神经瘤的三分之一。随着先进的神经影像技术的发展,其发生率提高了。神经影像技术对该病的早期诊断具有重要的意义。大多数临床所见的病例诊断甚是可疑,许多病例并未做活组织检查,只是通过神经影像学支持诊断。视神经鞘脑膜瘤治疗的目的是确保一定的视力,控制肿瘤的局部增长,减少死亡率。对视力轻微下降或无视力障碍以及视力保持稳定的患者进行随访观察,分次立体定向放射疗法对进行性和早期的病例可以维持视力。外科切除术和活组织检查的致盲率比较高,适用于向外生长到硬脑膜的肿瘤。     

Isolated metastasis to optic nerve from medulloblastoma

Isolated involvement of the optic nerve with metastatic tumor is uncommon. A 19-year-old man had a midline cerebellar medulloblastoma; a gross total removal was performed. He received postoperative radiation therapy to the whole brain, posterior fossa, and craniospinal axis. A progressive optic neuropathy developed 28 months later with radiologic evidence of an enlarged optic nerve. There was no evidence of metastatic disease elsewhere. An optic nerve biopsy showed metastatic medulloblastoma. An intramedullary metastasis developed 48 months after the primary diagnosis, and the patient died 5 months later.     

眼内恶性肿瘤的治疗进展

眼内恶性肿瘤分为原发性肿瘤与转移性肿瘤,多发生于视网膜和葡萄膜,巩膜及视神经较少见。眼内恶性肿瘤是一种严重致盲性疾病,甚至可危及患者的生命。明确诊断后选择恰当的治疗措施对于保留患者视功能、延长生命十分重要。随着医疗技术的发展,眼内恶性肿瘤的治疗已不局限于手术,还包括放射治疗、激光治疗、化疗及局部抗新生血管药物注射等。本文将针对眼内恶性肿瘤治疗的方法、适应证及并发症进行综述。     

Primary radiotherapy for optic nerve sheath meningioma

Radiotherapy has recently been recognized as the treatment of choice for most primary optic nerve sheath meningiomas (ONSM). Radiotherapy is incorporated into the treatment of non optic nerve sheath meningiomas for unresectable or subtotally resected tumors. Most primary ONSM are not surgically approachable without a high risk of visual deterioration. Radiotherapy has been found to prevent or delay tumor growth for the majority of patients and improve vision in some. We review the rational and current methods of the use of radiotherapy for these tumors.