羟基磷灰石义眼座植入Ⅰ期钻孔的初步效果

目的 评价羟基磷灰石义眼座植入Ⅰ期钻孔放置钛钉的疗效。方法 对31例眼球摘除患者行Ⅰ期或Ⅱ期羟基磷灰石义眼座植入同时行钻孔,钻入钛钉的螺纹套子,中间放置平头钉,3～7个月后剪开,更换为球头钉,定制义眼片。结果 随访3．0～11．0个月(平均6．9个月),所有患者对义眼外观及活动度满意,无义眼座暴露、继发感染、栓钉脱出、栓钉偏斜等并发症。结论 羟基磷灰石义眼座植入Ⅰ期钻孔手术效果好,无明显增加并发症的发生机会,是一种可供选择的手术方法。     

Imaging of orbital disorders in pediatric patients

The spectrum of orbital lesions occurring in childhood is wide, including a variety of both benign and malignant disorders. Although physical examination and fundoscopy may aid in establishing the diagnosis of retro-ocular lesions, imaging remains a critical step in the evaluation of the pediatric orbit. Ultrasonography, CT, and MR imaging are the primary modalities for the evaluation of the diseased orbit, and careful observation of the characteristic radiological features usually leads to correct diagnosis; however, some of the lesions look very similar and are difficult to differentiate from each other. The purpose of this article is to review the common and unusual entities that may involve the pediatric orbit, to describe the radiological features, and to evaluate the efficacy of US, CT, and MRI in the diagnosis and management of these conditions.     

Aggressive management of orbital meningeal melanocytoma

Summary ¶Objective. Meningeal melanocytoma generally occurs in the posterior fossa. Orbital manifestation is rarely encountered. Methods. A thirty-five year-old man presented with progressive proptosis of his right eye. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) of the brain showed an expansive intraconal mass lesion occupying the superior orbital compartment, the entire orbital apex, and the optic foramen. Histological analysis and Immunohistochical staining for S-100 and HMB-45 monoclonal antibodies confirmed melanocytoma. Findings. Microsurgical removal was accomplished through a fronto-orbital craniotomy. Chemotherapy and irradiation followed the initial intervention. The patient returned for follow up two years after surgery, complaining of headache and right visual loss. A subfrontal tumor with massive edema was found on follow up CT scan. Interpretation. Meningeal melanocytomas are rare benign pigmented tumors of the central nervous system. They are predominant in the posterior fossa and spinal cord and frequently mistaken for melanomas, especially on frozen sections. Orbital presentation is rare. The natural history is poorly defined.     

Graves’ exophthalmos: Volumetric assessment of orbital expansion

INTRODUCTION:

Graves’ ophthalmopathy is characterized by an increase in the volume of orbital soft tissue contents and an associated increase in intraorbital pressure. Surgical expansion of bony orbital volume is therefore an effective method of treating moderate to severe exophthalmos. Numerous correlations between specific decompression procedures and reduction of proptosis have been made. The main emphasis of the majority of these studies, however, appears to be of a qualitative nature rather than quantitative.

OBJECTIVES:

To quantitatively examine the consequences of surgical orbital decompression in the treatment of severe Graves’ exophthalmos, with respect to changes in ocular globe projection and orbital soft tissue and bony volume.

MATERIAL AND METHODS:

A series of three patients (five orbits) with severe exophthalmos were evaluated. All patients were operated on by a single surgeon using a standard technique of orbitozygmatic osteotomy in conjunction with three-wall orbital decompression and release of periorbita. Data obtained from standardized preoperative and three-month postoperative computed tomography scans were transferred to an offline computer workstation. Scalar and volumetric parameters were quantitatively analyzed to determine changes in globe projection in relation to intraorbital volume differences.

RESULTS:

Following surgery, mean globe retrodisplacement from the lateral orbital rim and from the optic foramen were 6.7 mm and 3.3 mm, respectively. Osteotomy and decompression were effective in producing an 18.6% increase in bony orbital volume. However, the volume of intraorbital soft tissues increased substantially following surgery, with a 23.4% increase in orbital fat volume and a 12.2% increase in neurovascular tissue volume.

CONCLUSIONS:

The degree of globe retrodisplacement achieved by surgical expansion of the bony orbital cavity in patients with Graves’ ophthalmopathy may be less than anticipated, due to a post-operative increase in the intraorbital soft tissue volumes.     

高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折

目的：评估高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折的有效性。方法：选择2003年6月至2006年1月，在浙江大学附属第一医院眼科中心就诊的23例眼眶爆裂性骨折患者，进行高密度多孔聚乙烯片修复眶壁缺损并纠正眼球内陷。观察患者手术前后视力、眼球突出度、复视和眼位变化。结果：23例患者术后均未出现患眼视力明显下降和视力丧失，眼球内陷度数为（1．7±0．5）mm，与术前（3．9±1．2）mm比较，差异有统计学意义（P〈0．05）。术后1个月10例患者复视完全消失，11例患者第一眼位无复视，但仍有周边复视，2例术后第一眼位复视仍存在。术后22例患者眼球各方向运动基本正常，但有1例患者术后出现眼位上移，下转轻度受限，2周后恢复正常。结论：高密度多孔聚乙烯片填充治疗爆裂性眼眶骨折安全有效。     

儿童急性鼻窦炎并发眶壁骨膜下脓肿

目的探讨儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床特征及治疗方法的选择。方法回顾分析武汉大学人民医院耳鼻咽喉-头颈外科1996年6月至2005年10月收治的35例5~12岁儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床表现、CT扫描特征和不同治疗效果。结果13例(37.1%)仅通过药物控制感染,22例(62.8%)行鼻内窥镜下眶壁骨膜下脓肿引流。比较药物治疗组和鼻内窥镜下脓肿引流组的疗效:前者无视力下降,后者有9例视力下降;前者2例结膜水肿,后者14例;前者5例眼球移位,后者17例;前者无眼内压增加者,后者13例;前者无眼球活动受限,后者14例;CT显示前者脓肿宽明显小于后者(0.21 cmvs 1.35 cm)。结论对视力下降、眼球移位、眼球活动受限、眼内压>20 mmHg、脓肿宽>4 mm的儿童,应行鼻内窥镜下眶壁骨膜下脓肿切开引流术。     

Surgical and prosthetic treatment for microphthalmia syndromes

Our aim was to evaluate the long-term outcomes of prosthetic treatment and orbital expansion in the management of microphthalmia syndromes. We did a retrospective single-centre study of all cases of microphthalmia treated between 1989 and 2010. The patients were divided into three groups: isolated microphthalmia, microphthalmia associated with micro-orbitism, and complex microphthalmia syndrome. To evaluate the results a score was computed for each patient by assessing the length of the palpebral fissure, the depth of the conjunctival fornix, and local complications together with an evaluation of the satisfaction of patients and their families.     

An Unusual Orbital Blow-out Fracture: A Case Report

The complete dislocation of the orbital contents into the maxillary antrum as a result of trauma is an extremely rare event and requires immediate exploration and repositioning of the globe with reconstruction of the orbital floor. We present the case of a 10-year-old male who sustained trauma to the orbit and was initially suspected to have developed auto-evisceration. He underwent successful exploration and reconstruction of orbital floor with remarkable improvement.     

视神经孔位在眼外伤X线检查中的应用价值

目的 探讨视神经孔位在眼外伤Ｘ线检查中的应用价值。方法 ２年来因眼外伤摄视神经孔位３２便，均在大型Ｘ线机电视监视下拍摄。结果 ３２例视神经闰平片中发现视神经管骨折１２例占３７．５％；其中９例俣并眼眶骨折，３例为颅底骨折所致。结论 我们认为眼外伤摄取眼眶平片时，不应只摄眼眶的正侧位和切线位，还应摄取眼眶的斜位，即视神经孔位。视神经孔位应为眼外伤的常规投照位     

羥基磷灰石羲眼座植入術後球結膜裂開的因素

目的 探讨羟基磷灰石义眼座植入术后球结膜裂开的相关因素。方法 对57例患者的病例资料及术后2.5～45个月的随访情况进行总结分析。结果 术后55例外观效果满意;并发症主要有球结膜裂开(18例)、义眼座暴露(9例)及自体巩膜溶解(8例);球粘膜裂开18例中17例发生于术后4周内;球结膜裂开发生率与患者年龄、手术期别无关,与疾病种类、手术方法特别是有无自体巩膜包裹、手术熟练程度及HA义眼座品种有关;眼球萎缩和外伤后无眼球患者的发生率(7/31)较其他病种(11/26)低,眼球摘除自体巩膜包裹HA义眼座植入术16例中9例发生结膜裂开(8例伴自体巩膜溶解),眼球摘除后无包裹HA义眼座植入术36例中7例裂开。结论 眼外伤行修补术或眼球摘除术后患者二期义眼座植入的手术时间应适当推后;无包裹直接植入法的术后球结膜裂开发生率低于有包裹植入法,这一方法值得推广;自体巩膜离体后的处理方法尚需进一步探讨。