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.     

近视眼眼球突出度及相关研究

目的探讨眼球突出度、等效球镜度数、眼轴长度之间的相关性。方法近视患者及正视者189例,散瞳检影验光进行屈光度检查,采用Hertel眼球突出计测量眼球突出度,相干光生物测量仪（IOL—master）测量角膜曲率、眼轴长度。按眼轴长度不同分正视及轻度近视组、中度近视组、高度近视组。均取右眼进行各组之间眼球突出度比较,分析眼球突出度、等效球镜度数、眼轴长度三者之间关系。结果正视及轻度近视组眼轴〈25．00mm,平均（23．54±0．73）mm,等效球镜度数为（-0．76±1．29）D。中度近视组眼轴长度25．00～27．00mm,平均（25．77±0．53）mm,等效球镜度数为（-5．33±237）D。高度近视组眼轴≥27．00mm,平均（30.08±209）mm,等效球镜度数为（-15．92±5．12）D。正视及轻度近视组平均眼球突出度为10．50～19．50mm,平均（14．66±1．94）mm,中度近视组平均眼球突出度为13．00～19．50mm,平均（16．16±1．40）mm,高度近视组平均眼球突出度为14．00～23．00mm,平均（18．30±1．63）mm。高度近视组眼球突出度分别大于中度近视组、正视及轻度近视组（P〈0．01）。中度近视组眼球突出度大于正视及轻度近视组（P〈0．01）。眼球突出度、等效球镜度数、眼轴三者之间存在线性相关关系,一元线性回归方程分别为眼球突出度=0．616×AL（眼轴长度）（R^2=0．990,F=18450．30,P〈0．01）;眼球突出度=14．65—0．227×SE（等效球镜度数）（R^2=0．500,F=187．05,P〈0．01）;等效球镜度数=52．06—2．24×AL（眼轴长度）（R^2=0．892,F=1537．83,P〈0．01）。结论随着眼轴长度、等效球镜度数增加,近视眼眼球突出度随之线性增加。随着眼轴增长眼球向后扩张、眼球向前突出,眼球向前突出更为明显。（中华腰科杂志,2007,43：525-529）     

Graves眼病眶部生长抑素受体显像研究

目的用99Tcm-奥曲肽(octreotide)SPECT眼眶显像评价Graves眼病活动度和预测免疫抑制疗效。方法Graves眼病患者39例,静脉注射925MBq99Tcmoctreotide后3h进行SPECT眼眶显像,利用感兴趣区技术,计算双侧眼眶(O)枕叶(OC)放射性比值。然后所有患者接受甲基强的松龙冲击治疗,计算治疗前和治疗1个月时的眼病指数(GOI)和临床活动度评分(CAS)。结果有效组34例,OOC比值为1.76±0.17;无效组5例,OOC比值为1.26±0.19(P<0.001)。OOC比值与治疗前CAS呈正相关(r=0.47,P<0.001),与治疗前后眼病指数差值(疗效)呈正相关(r=0.55,P<0.001)。OOC比值接受器工作特性(ROC)曲线下面积为0.971,当OOC比值取1.37时,阳性预测值为97%,阴性预测值为80%。结论OOC比值可反映Graves眼病患者眼病活动度和预测其免疫抑制疗效。     

桥本甲状腺炎性甲亢行硒联合抑亢丸、甲巯咪唑治疗效果及突眼改善情况

目的 研究分析硒联合抑亢丸、甲巯咪唑治疗桥本甲状腺性甲亢的治疗效果及突眼的改善情况.方法 整群选择该院2014年9月—2015年9月期间进行治疗的118例桥本甲状腺性甲亢患者,应用随机数字双盲法进行平均分组,对照组59例患者应用抑亢丸与甲巯咪唑联合治疗;试验组59例患者应用硒联合抑亢丸、甲巯咪唑进行治疗. 结果 试验组患者的总有效率94.92%(56/59)显著大于对照组的81.36%(48/59),差异有统计学意义(P<0.05). 试验组患者的突眼程度(16.32±1.48)mm显著优于对照组的(18.84±1.53)mm,差异有统计学意义(P<0.05). 结论 桥本甲状腺性甲亢行硒联合抑亢丸、甲巯咪唑治疗的效果甚佳,可有效改善突眼症状,且联合用药的安全性较高,具有重要的临床应用价值及推广前景.     

Primary granulocytic sarcoma in the sphenoidal bone and orbit

Case report We report a case of a primary cranial chloroma in boy aged 2 years and 8 months. The symptoms were progressive bilateral exophthalmos, right abducens palsy, and bilateral papilledema. The tumor was partially calcified and was a round mass located in the bilateral sphenoidal bone extending into the orbit. Laboratory study did not show hematological abnormality. The tumor was partially removed by bilateral frontotemporal craniotomy and a diagnosis of primary granulocytic sarcoma was made from the surgical specimen. Progressive deterioration of visual acuity was seen and chemotherapy started on the 11th postoperative day followed by local cranium irradiation (24 Gy). The patient has been in complete remission for 37 months. The visual acuity recovered partially and follow-up magnetic resonance imaging showed a significant decrease in the size of the tumor.Discussion Radiological diagnosis of primary intracranial granulocytic sarcoma is difficult. Surgical removal may be an option for progressive neurological deterioration but chemotherapy is more important for both neurological stabilization and induction of remission.     

CT诊断眶内占位性病变的价值

在对眼球突出的32例病例进行电子计算机断层扫描(CT)中,发现主要病因为眶内原发性肿瘤,共24例;其次为Graves病及眶内炎症。通过介绍各类眶内占位性病变的CT所见,说明电子计算机断层扫描是诊断眶内占位性病变的最有效方法。     

Steroid Induced Exophthalmos A Case Report

A case of steroid induced exophthalmos in a patient with systemic lupus erythematosus with renal involvement is described. Computed Tomography was used to demonstrate the increased retro-orbital fat.     

以突眼起病的儿童非霍奇金淋巴瘤11例

目的 了解以突眼起病儿童非霍奇金淋巴瘤的临床、病理、影像学特点及其疗效和预后.方法 对中山大学附属肿瘤防治中心儿童肿瘤科2004年4月至2010年10月收治的11例以突眼起病的非霍奇金淋巴瘤患儿资料进行临床分析.结果 11例患儿首发症状为单眼眼球突出或双眼眼球突出,有或无其他伴随症状.11例患儿病变部位病理活检均符合淋巴瘤改变.经化疗、手术及放疗等综合治疗,81.8%(9/11)的患儿完全缓解并生存至今.中位随访82个月,死亡2例,均死于肿瘤进展,1例左眼失明,2例右眼失明.1例原发颅内间变大细胞性淋巴瘤的患儿出现颅脑迟发性反射性损伤.结论 眼球突出是儿童非霍奇金淋巴瘤的特殊临床表现,疾病早期容易误诊,怀疑本病应尽早行病理活检以明确诊断,如及早确诊并综合治疗,预后良好.