眶内海绵状血管瘤手术前后视力分析

目的 :探讨眶内海绵状血管瘤手术前后的视力情况。方法 :对 1986～ 2 0 0 0年住院的 2 14例眶内海绵状血管瘤手术患者进行回顾性分析 ,着重分析术前术后视力变化。结果 :4 9.5 % (10 6 /2 14 )的患者就诊时视力下降。 31% (6 7/2 14 )的患者术前有视网膜与视神经受肿瘤压迫的改变。全部病例经开眶手术后 2 3% (5 0 /2 14 )术后视力增进 ,17% (36 /2 14 )术后视力减退 (其中完全丧失视力者 9例 ) ,6 0 % (12 8/2 14 )术后视力无变化。 7例作了术前术后屈光学检查 ,71% (5 /7)术后有远视减少或近视增加的趋势。结论 :眶内海绵状血管瘤可因肿瘤压迫视神经与眼球致视力下降 ,术后绝大部分患者视力保持不变或有增进。因此 ,眶内海绵状血管瘤宜尽早手术取出 ,如此术后视力预后则好

Prognosis for visual function in patients with orbital cavernous hemangioma

Objective:To study the visual prognosis of orbital cavernous hemangioma.Methods:214 patients with cavernous hemangioma referred to Zhongshan Ophthalmic Center,Sun Yat sen University of Medical Sciences,from Jan 1,1986 to Dec 31,2000,were reviewed,with special attention to visual prognosis after surgical management. All identified cases were histologically diagnosed as cavernous hemangioma. The patients had both ultrasound and computed tomography(or magnetic resonance imaging) scan before surgery. Either lateral orbitotomy or an anterior approach was performed according to each patient's imaging condition.Results:Before surgery,the best corrected vision in patients with orbital cavernous hemangioma ranged from no light perception to 20/15. 106(49.5%) patients had diminished visual acuity. Among them,thirty five patients had best corrected visual acuity of 0.7 to 0.9;fifty patients 0.1 to 0.6 and twenty one patients less than 0.1. Compressive change in the retina and optic nerve was found in 31%(67/214) of them. All patients underwent lateral or anterior orbitotomy. Postoperative visual acuity was the same or better in 178 of the 214 patients(83%). Among the patients,twenty four(11.2%) improved one to two lines,thirteen(6.1%) by three to four lines,seven(3.3%) by five to six lines and six(2.8%) by more than seven lines. The other 128 patients(60%) maintained preoperative vision. Postoperative visual acuity was reduced in 17%;among these,fourteen patients(6.5%) were reduced by one to two lines,eight(3.7%) by three to four lines,one(0.5%) by five lines,four(1.9%) by more than seven lines and nine(4.2%) had no light perception. Post and preoperative refractive exams were performed on seven patients. In five patients(71%),hyperopia decreased or myopia increased.Conclusion:Half of our patients with cavernous hemangioma had decreased visual acuity due to optic nerve or eyeball compressive changes before surgery. Postoperatively,most patients had the same or better vision than before. Therefore,patients with orbital cavernous hemangioma should be surgically managed early and postoperative visual prognosis is very good.