间歇性外斜视患者眼外肌及其本体感受器的病理学改变

目的 研究间歇性外斜视患者眼外肌及其本体感受器的超微结构,以期探讨间歇性外斜视的病因及发病机制.方法　选取20例间歇性外斜视患者非注视眼内直肌附着点后长约4～5mm、宽约10mm的眼外肌制作病理标本(光镜10例、透射电镜10例),选取同期角膜移植供体的健康人眼内直肌10条作为正常对照(光镜5条、透射电镜5条),光镜及透射电镜下观察比较间歇性外斜视患者和正常人肌纤维及眼外肌本体感受器超微结构的差异.结果 同正常人比较,间歇性外斜视患者眼外肌纤维排列紊乱,部分纤维萎缩、水肿,线粒体变性,眼外肌本体感受器结构出现明显异常,内囊、外囊不完整,梭内肌纤维排列紊乱,有髓神经轴浆内有残体形成,线粒体缺如,内膜与神经末梢间可见粗大致密的胶原纤维增生,神经纤维内微丝、微管等细胞器减少,严重者可见有髓神经脱髓鞘.结论 间歇性外斜视患者弱侧眼外肌内直肌及其本体感受器发生了病理性改变,可能与间歇性外斜视病因及发病机制有关.     

先天性双上转肌麻痹的临床表现和手术治疗探讨

目的 探讨先天性双上转肌麻痹的临床表现和不同手术方式的疗效.方法 回顾性分析1987年10月～2011年1月收治的先天性双上转肌麻痹的病例.结果 共20例,临床表现和相关检查结果分别为(例/例):弱视:16/20;真、假性、混合性上睑下垂:4、8、1;代偿头位:3/20;合并水平斜视:13/20;同视机检查同时视、融合和立体视:10/20,7/20,4/20;随机点图立体视检查8例仅1例阳性.17例接受下直肌徙后或/和上斜肌鞘内切腱术为主选术式共计25次手术.结论 对视力和双眼视机能损害较重,应尽早手术.分期手术为常规.下直肌徙后或/和上斜肌鞘内切腱联合垂直肌手术疗效满意.     

甲状腺相关性眼病的临床特征

目的回顾性分析56例甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO),提出TAO不典型病例的临床特征,为早期进行临床诊断提供依据.方法总结56例TAO患者的主诉、眼征、斜视度、眼球运动等临床特征和眼外肌的影像学检查结果,进行统计学分析.结果本组有94.7%的患者表现为眼球运动受限,83.9%的病例以复视为主诉就诊,53.6%出现眼球突出,46.4%出现眼睑退缩和迟落.TAO以多条眼外肌受累为特点,眼外肌厚度增加以上直肌最为明显,以上转运动受限频率最高(69.6%).本组TAO的发生先于甲状腺功能异常23人(41.1%),其中有9人(16.1%)是TAO发生1年以上才发生甲状腺功能异常的.结论大多数TAO患者依据其临床表现易于确诊,对不典型患者应注意眼征特点,分析眼外肌受累的情况,并排除其他原因引起的限制性斜视.牵拉试验和影像学检查对确诊有重大意义.     

Effect of botulinum toxin on extraocular muscle proprioception

Injections of botulinum toxin type A (BoTox) in one extraocular muscle (EOM) induce long lasting paretic lengthening of the muscle permitting realignment to occur in strabismus, while eye movements appear to be unaffected after the transitory period of induced paresis. It has been hypothesized a BoTox-induced change in the spindle discharge of EOMs to explain the effect in EOM length. In decerebrate lambs and goats, first order neurons of eye muscle spindles were identified in a cellular pool located in the medial dorsolateral portion of the semilunar ganglion. The belly of the muscle to which the recorded unit belonged was infiltrated with BoTox. A decrease in afferent discharge of the spindle and in its stretch sensitivity was observed. This effect began 10–15 minutes after the injection. There was no corresponding decrease in muscle tension during the first 45 minutes. This finding suggests that the block of release of acetylcholine at motor endings is earlier and more efficacious in - than in -motoneurons. As a result of the proprioceptive input reduction, an unbalance between the agonist and antagonist muscles should occur favouring the ocular realignment.     

眼眶骨折修复手术后残余复视的手术矫正

目的 探讨眼眶骨折修复手术后主要功能视野内消除复视的手术时机、方法和效果。方法 筛选眼眶骨折修复手术后,对残余复视进行手术矫正的40全（40眼）进行回顾性研究。分析不同患者复视的成因,手术时机及手术方法的选择。术后随访6个月对手术疗效进行评价。结果 40例术前存在Ⅲ级复视,行眼外肌手术。根据被动牵拉试验结果,选择直肌后徒悬吊、截除以及Jensen联结、眶骨膜固定等术式。术中25例角膜映光基本正位,主要功能视野内无复视,10例略过矫,5例欠矫。术后6月观察,27例主要功能视野无复视;7例正前方无复视,但下方视野残留复视;6例第一眼位残留复视,给予配戴压贴三棱镜后复视改善。结论 眼眶骨折修复术后消除主要功能视野复视的手术方法应根据术前和术中牵拉试验结果以及眼球运动检查来选择,合理的手术方式可有效地消除复视、改善眼球运动功能。     

甲状腺相关眼病眼外肌组织病理及超微结构

目的:观察甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)眼外肌光学显微镜病理和透射电子显微镜超微结构的改变.方法:手术获得眼外肌分为两组:正常组和TAO组.采用光学显微镜和透射电子显微镜对其进行结构观察.结果:光镜检查显示,正常组未见特殊变化.TAO组眼外肌间质纤维组织增生,大量淋巴细胞和浆细胞浸润.间质内血管组织增生.部分组织纤维瘢痕形成.透射电镜检查显示,正常组眼外肌组织结构清晰.TAO组眼外肌肌原纤维部分Z线紊乱、消失.肌原纤维部分溶解破坏、形成空泡.重者可见肌细胞完全破坏,纤维化.可见肌纤维母细胞.间质血管内皮细胞肿胀,胞浆成空泡样变,内皮细胞间连接增宽,毛细血管周围可见多个巨噬细胞聚集.结论:TAO眼外肌细胞有不同程度的破坏,提示眼外肌可能是甲状腺相关眼病的主要靶组织之一.     

眼外型皮脂腺癌一例

患者,女,27岁。因头皮斑块2个月就诊。组织病理示：肿瘤呈水平及垂直方向生长,累及表皮、真皮至脂肪组织浅层。可见细胞异型性及病理性核分裂相。肿物扩大切除术后再次行组织病理示表皮内肿瘤细胞呈paget病样生长,一侧切缘仍有肿瘤细胞残留。免疫组织化学：肿瘤细胞EMA(+)、AR(-),CAE(-)、ER(-),Ki67增殖指数为30%。诊断：皮脂腺癌。拟再次行切除术并辅以放疗或化疗。     

Diffusion tensor imaging of horizontal extraocular muscles in patients with concomitant and paralytic esotropia

AIM: To assess metrics of diffusion tensor imagining (DTI) in evaluating microstructural abnormalities of horizontal extraocular muscles (EOM) in esotropia. METHODS: Six adult concomitant esotropia patients, 5 unilateral abducent paralysis patients and 2 healthy volunteers were enrolled. Conventional magnetic resonance imaging (MRI) and DTI were performed on all subjects using 3T MR scanner. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of medial and lateral rectus muscles were measured and compared between patients group and control group. RESULTS: Medial rectus MD and RD within the adducted eye of concomitant patients was significantly greater than that in unilateral abducent paralysis patients (0.259×10-2 mm2/s vs 0.207×10-2 mm2/s, P=0.014; 0.182×10-2 mm2/s vs 0.152×10-2 mm2/s, P=0.017). Both strabismus patients showed a significantly decreased MD and AD than that obtained in normal controls for lateral rectus muscles (P<0.05). Medial rectus MD of the adducted eye in concomitant strabismus patients was significantly decreased than that in healthy controls (0.259×10-2 mm2/s vs 0.266×10-2 mm2/s, P=0.010). Lateral rectus AD of the adducted eye in concomitant strabismus patients was significantly decreased as compared with that in healthy controls (0.515×10-2 mm2/s vs 0.593×10-2 mm2/s, P=0.013). No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients. CONCLUSION: DTI represents a feasible technique to assess tissue characteristics of EOM. The effects of eye position changes on DTI parameters are subtle. Decreased MD and RD could be evidence for remodeling of the medial rectus muscle contracture. Lower medial and lateral recuts MD of concomitant esotropia patients indicates a thinner fibrous structure of the EOM. Lower MD and AD should be general character of esotropia.     

Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

AIM: To investigate the difference of medial rectus (MR) and lateral rectus (LR) between acute acquired concomitant esotropia (AACE) and the healthy controls (HCs) detected by magnetic resonance imaging (MRI). METHODS: A case-control study. Eighteen subjects with AACE and eighteen HCs were enrolled. MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner. Extraocular muscles (EOMs) were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator. To form posterior partial volumes (PPVs), the LR and MR cross-sections in the image planes 8, 10, 12, and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness. The data were classified according to the right eye, left eye, dominant eye, and non-dominant eye, and the differences in mean cross-sectional area, maximum cross-sectional area, and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively. RESULTS: There were no significant differences between the two groups of demographic characteristics. The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes (P=0.028). The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group (P=0.009, P=0.016). For the dominant eye, the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group (P=0.013), but not in the MR muscle (P=0.698). CONCLUSION: The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia. The LR muscle become larger to compensate for the enhanced convergence in the AACE.