23例眼球后退综合征的临床分析

目的 探讨眼球后退综合征的临床特点和治疗方法.方法 对23例26眼眼球后退综合征病例根据其分型分别选择单眼内直肌后退,双眼内直肌后退,单眼内、外直肌后退等术式进行治疗.结果 23例患者中8例斜视大部分矫正,外转及内转功能好转(34.78%);12例斜视代偿头位部分改善(52.17%);3例(13.05%)第一眼位无异常的病例,未做手术.结论 眼球后退综合征诊断及分型是治疗的关键,一旦诊断明确则选择手术治疗.主要采取水平肌肉后徙术式,如伴有斜肌功能异常、出现代偿头位时也要考虑做斜肌联合手术,尽量避免眼外肌的缩短.     

眼球后退综合征的手术选择

背景：Duane眼球后退综合征是婴儿出生时眼部神经错误支配的特例，目前还没有对因治疗的方法。第一凝视位显斜和存在代偿头位以获得双眼单视的病例需行眼肌手术治疗。不同类型的Duane眼球后退综合征需要不同的手术方法，多数是在受累眼进行手术，也可以在对侧眼进行手术，这在文献中都有报道。方法：本研究回顾性分析了1999—2004年间因Duane眼球后退综合征接受手术治疗的55例患者的术前及术后表现。并对手术操作方法的选择、眼球后退综合征的类型、第一凝视位复位的角度以及代偿头位的恢复进行评估。结果：37例患者为初次手术，其中25例患者所接受的手术为患眼单纯内直肌（16例）或外直肌（9例）后退术。单一肌肉后退时手术量与效果的关系为：第一凝视位平均后退1mm斜视角减小2pdpt（cm／m）。后退1mm头位平均减少1．5。10例患者接受了患眼联合手术，斜视角与后退距离的对应关系为每后退1mm斜视角度数减少3pdpt（cm／m）。结论：手术方法的选择取决于眼球后退综合征的类型、第一凝视位斜视角的角度、代偿头位和眼球退缩情况，其目的是解除Duane眼球后退综合征给患者带来的痛苦。     

手术治疗眼球后退综合征10例

目的探讨Duane眼球后退综合征手术治疗的方法。方法对10例已行手术治疗的眼球后退综合征患者的临床表现、手术治疗方式和效果进行回顾性总结。结果 10例眼球综合征的患者6例行外直肌后徙,4例行内直肌后徙。术后正前方眼位正位,代偿头位消失或减轻,眼球后退、睑裂变化明显改善。结论术中牵拉试验及彻底消除牵制因素是手术成功的关键。     

Duane眼球后退综合征1例病案报道

Duane眼球后退综合征亦称Duane征、眼球后退综合征、Stilling-Turk-Duane征、内直肌神经支配矛盾、后退性斜视等.临床上,在原在眼位时,呈正位视或内斜视者较常见,呈外斜视者很少[1].2009年10月我院收治以外斜视为首发症状的Duane眼球后退综合征1例,报告如下.     

手术治疗眼球后退综合征(附13例报告)

眼球后退综合征(Duane’s retractionsyndrone-DRS)是一种先天性眼外肌异常的病症。临床特点为眼球外转受限,内转时眼球后退,睑裂变窄。手术治疗各家意见不一致,但本症又不少见。作者总结了13例手术治疗此综合征的经验与教训,报告如下:     

频发性室性早搏核磁共振检查的临床意义

目的:研究经动态心电图、超声心电图和冠状动脉造影未发现器质性心脏病患者核磁共振(MRI)检查的临床意义。方法:52例经动态心电图、超声心电图和冠状动脉造影排除了器质性心脏病的频发性室性早搏患者和40例偶发室性早搏患者行核磁共振检查,比较两组间心室结构异常的发生率。结果:频发性室性早搏组心室结构异常的发生率明显高于偶发室性早搏,分别为32.7％和10.0％。结论:经常规检查甚至冠状动脉造影未发现器质性心脏病的频发性室性早博患者行核磁共振检查对发现室性早搏患者的病理基础可能具有重要的临床意义。     

Duane眼球后退综合征8例报告

Duane眼球后退综合征(Duane’s retrac tion syndrome,drs)是一种先天性眼球运动异常。现将本人所见8例报告如下。     

UBM在眼球钝挫伤的临床应用

目的:通过对242例眼球钝挫伤患眼的眼前节UBM观察结果,分析前节结构损伤状况。方法:对我院门诊诊治的242例眼球钝挫伤患眼应用超声生物显微镜对眼前节结构,主要是房角、虹膜、睫状体进行检查。总结易损伤部位。结果:107例患眼发生房角后退;67例前房不同程度积血;38例患眼发生虹膜根部离断;30例患眼发生睫状体离断。结论:眼球钝挫伤最易受损的结构是房角,最常见房角后退;其次是前房积血和虹膜根部离断;最后是睫状体离断。     

204例眼球挫伤性前房角后退的观察

前房角后退是眼球挫伤的常见并发症。由眼球挫伤继发的单侧开角型青光眼发生机制与房角后退有关。因此,眼球挫伤后前房角的观察和随访越来越引起人们     

两种不同的内直肌后退术对儿童部分调节性内斜视效果的观察

目的探讨用不同的内直肌后退术对儿童部分调节性内斜视的远期疗效。方法按随机数字表法把部分调节性内斜视儿童80例随机分为传统的内直肌后退组和内直肌悬吊后退组并进行手术治疗,术后进行眼位观察并比较分析。结果两组手术戴镜后正位效果比较用X^2检验分析,术前和术后的平均内斜度比较用秩和检验分析,两组间两组正位率及术前、术后1周和术后6个月的平均内斜度均无明显差异P〉0．05。结论内直肌悬吊后退术是一个安全的、有效的方法,可作为常规的儿童部分调节性内斜视内直肌后退术。     

Magnetic resonance imaging of unilateral vertical retraction syndrome with atypical strabismus

We report two patients with unilateral vertical retraction syndrome. Magnetic resonance imaging (MRI) of the orbits of the two cases showed similar size and location of the orbital structure, but with dramatically different strabismus type. MRI sagittal reconstruction of the orbits suggested that abnormal muscle tissue arised from the inferior rectus, which might be associated with retraction and narrowing of the palpebral fissure and atypical strabismus as well.

     

Vertical deviation and A pattern of type III Duane retraction syndrome

Background  Researches in ocular electromyography (EMG) and Magnetic resonance imaging (MRI) of patients with Duane retraction syndrome (DRS) suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease.

Methods  Superior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed.

Results  All subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves (CN6) were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve (CN3) innervating the lateral rectus (LR) in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10Δ consecutive esotropia postoperatively.

Conclusion  The results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type III. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type III.

     

Magnetic resonance imaging of the extraocular muscles and corresponding cranial nerves in patients with special forms of strabismus

Background With the technical advances, magnetic resonance imaging （MRI） is now sensitive enough to detect subtle structural abnormalities of ocular motor nerves arising from the brainstem and orbits of living subjects. This study was designed to delineate the MRI characteristics in patients with special forms of strabismus. Methods A total of 29 patients with special forms of strabismus underwent orbital and intracalvafium MRI. Imaging of the ocular motor nerves in the brainstem was performed in 0.8 mm thickness image planes using the three-dimensional fast imaging employing steady-state acquisition （3D-FIESTA） sequence. Nerves to extraocular muscles （EOMs）, EOMs and their associated connective tissues were imaged with T1 weighting in tri-planar scans by dual-phased coils within 2.0 mm thick planes. Results Patients with congenital fibrosis of the extraocular muscles exhibited hypoplasia of the oculomotor （CN3）, abducens （CN6）, trochlear （CN4） nerves, and the EOMs; hypoplasia of CN6 in the brainstem and an extra branch of the inferior division of CN3 to the lateral rectus were the most common but not the only presentation of Duane＇s retraction syndrome. Hypoplasia of CN6, facial （CN7） and hypoglossal （CN12） nerves were revealed in patients with MSbius syndrome. In a rare case of bilateral synergistic convergence and divergence, an enlarged branch of CN3 to the medial rectus and a questionable branch of CN3 to the inferior rectus bilaterally were found. Conclusion MRI can reveal subtle structures of the ocular motor nerves and their corresponding EOMs. This can provide valuable information regarding pathogenesis in some special forms of strabismus.     

深外侧壁眼眶减压术治疗甲状腺相关眼病的疗效观察

目的:观察深外侧壁眼眶减压术治疗甲状腺相关眼病的效果及安全性。方法:选择2016年1月至2018年1月行深外侧眼眶减压术治疗的甲状腺相关眼病病人作为研究对象。比较病人术前和术后3个月的眼球突眼度,最佳矫正视力,眼压,上、下睑缘至角膜映光点的距离,复视情况和眼球运动受限情况。结果:共纳入23例（35眼）病人,其中男9例（12眼）,女14例（23眼）,平均年龄（41.5±14.4）岁。深外侧壁减压可使术后眼球回退（3.7±0.9）mm,差异有统计学意义（P<0.01）。2眼伴压迫性视神经病变的病人中,术后最佳矫正视力均有明显提高。术后眼压平均下降（1.9±1.6）mmHg,上睑和下睑退缩平均改善1.0 mm,差异有统计学意义（P<0.01）。术后2例病人原有复视加重,3例病人复视缓解,6眼眼球运动障碍缓解,无眼球运动障碍加重。结论:深外侧壁眼眶减压术可有效扩大眼眶容积,眼球明显回退的同时术后复视发生率低,视力恢复佳,并改善上睑和下睑退缩,眶内损伤小,并发症少。     

不同术式治疗儿童基本型或假性外展过强型间歇性外斜视的临床对照研究

目的 探讨双眼外直肌后徙术与单眼一退一截术治疗儿童基本型或假性外展过强型间歇性外斜视的临床效果。方法 选取2016年2月—2018年4月青岛妇女儿童医院接受手术治疗的基本型或假性外展过强型间歇性外斜视儿童90例为研究对象。其中,40例行双眼外直肌后徙术治疗（BLR-rec组）;50例单眼一退一截术治疗（RR组）。比较两组患者术后1?d,以及1、6、12和24个月时的手术成功情况、斜视度,观察两组患者术后24个月时不同斜视度范围内手术病例成功情况。记录两组患者术后外斜漂移发生的情况。结果 两组患者术后1?d,以及1、6、12和24个月时手术成功率无差异（P?>0.05）,但从术后1个月开始随着时间的推移,两组成功率呈下降趋势（P?<0.05）。在6?m眼位下,不同时间点两组患者斜视度有差异（P?<0.05）,BLR-rec组与RR组斜视度无差异（P?>0.05）,两组斜视度随时间变化的趋势有差异（P?<0.05）;在33?cm眼位下,不同 时间点两组患者斜视度有差异（P?<0.05）,BLR-rec组与RR组斜视度无差异（P?>0.05）,两组斜视度随时间 变化的趋势有差异（P?<0.05）;两组患者术后24个月时不同斜视度范围内手术成功率无差异（P?>0.05）;两组 患者最大外斜漂移发生于术后1?d至1个月,RR组术后1?d至1个月的外斜漂移量为（5.3±4.2）,BLR-rec组 为（5.2±4.0）,差异无统计学意义（P?>0.05）;但术后1?d至12个月内RR组外斜漂移量为（12.4±3.7）,BLR- rec组为（7.4±3.1）,差异有统计学意义（P?<0.05）,RR组高于BLR-rec组。结论 采用RR或BLR-rec 2种 手术方式治疗外斜视有着一致的远期手术成功率,随着时间的延长,成功率会下降,单眼一退一截术治疗的外协漂移发生率更高,双眼外直肌后徙术的远期疗效要优于单眼一退一截术。     

肝良恶性肿瘤包膜回缩征影像表现及其病理基础

目的：探讨肝良恶性肿瘤引起包膜回缩征的CT和MRI表现及其病理基础。方法：回顾性分析经病理证实 的50例肝良恶性肿瘤肝包膜回缩征的CT和MRI表现及病理特点。通过影像归档和通信系统观察、比较包膜下肝良恶 性肿瘤形态、大小及肝包膜回缩宽度、深度、边缘情况、肝包膜下是否有积液的异同,显微镜下分析肿瘤内部及周 围结构、分化程度及纤维组织增生量。结果：肝恶性肿瘤44例,良性肿瘤6例。良性肿瘤与高、中、低三个不同分化 等级的恶性肿瘤肝包膜回缩边缘光整或毛糙差异有统计学意义(均P<0.05)。纤维组织增生量不同的肿瘤肝包膜回缩 宽度、深度差异有统计学意义(均P<0.05)。肿瘤直径大小与肝包膜回缩宽度、深度呈正相关(分别r=0.557,0.309,均 P<0.05)。结论：肝良恶性肿瘤均可出现肝包膜回缩征,但两者形态有差异,与肿瘤大小、分化程度及瘤内纤维组织 增生程度等密切相关。     

Duane眼球后退综合征28例临床分析

目的：探讨Duane眼球后退综合征（DRS）的临床特点和治疗方法。方法：回顾性分析28例DRS患者临床资料,20例内斜视患者行内直肌后徙术,5例外斜视患者行外直肌后徙术,3例Ⅲ型患者因原在位维持在正位,没有明显的代偿头位,未行手术治疗。结果：术后眼球后退、睑裂变小体征改善或消失。20例内斜视患者术后17例斜视度数≤10度,3例斜视度数〉10度,3例患者术后眼球后退、内转时睑裂变小体征仍严重且眼球内转时急速上、下转现象仍明显,行对侧直肌后固定缝线术后体征改善或消失。5例外斜视患者3例术后斜视度数≤10度,2例术后斜视度数均〉10度,1例外斜视者伴有下斜肌功能亢进,同时行下斜肌截腱术或转位术。随访3个月～1年,疗效稳定。结论：不同类型DRS的临床表现不同,其部分临床表现和眼外肌受累情况有时很难与先天性广泛纤维化区分,如上睑下垂、大度数斜视等,需进行更为深入细致的研究。     

单卵双胎儿表型不一致性共同性斜视

①目的通过分析单卵双胎儿表型不一致性共同性斜视发病因素,探讨其发病机制。②方法回顾性分析在我院就诊的表型不一致性斜视单卵双胎儿7对14例,记录出生后体质量、产期,有无家族发病史、外伤史或神经系统疾病史。检查屈光、斜视角、眼球运动等以确定斜视类型。③结果外斜视与正位视结合5对,内斜视与正位视结合2对。7对单卵双胎儿中6对早产,13例体质量低于2 500 g。斜视表型病儿体质量明显低于非斜视病儿(P=0.039 1)。7例弱视中的5例见于斜视表型,另2例见于非斜视表型。所有伴斜肌异常、分离性垂直斜视或眼球震颤者均见于斜视表型。④结论发生于单卵双胎儿的不一致性斜视揭示了环境因素在斜视发生中所起的作用。出生时低体质量、早产可能与不一致性共同性斜视的发生有关。     

眼外肌的断层解剖学研究

目的 :为眼外肌疾病及其并发症的诊断及治疗提供形态学资料。方法 :将低温冷冻的固定健康成人眼眶沿标志线以 0 .5cm层厚 ,利用国产 MJ- 346B型电动带锯做连续断层。结果 :观察和测量了正常人眼外肌在眶尖平面至眼球后极 5个连续断面上的宽、厚、横断面积及其与视神经、眶壁的位置关系。结论 :眼外肌的正常位置及此 5个断面上的一些测量值在斜视和眼型 Graves′病的严重并发症 -视神经病变的诊断中有重要应用价值     

Concomitant bilateral orbital and brain abscesses--unusual complications of pediatric rhinosinusitis

Rhinosinusitis is a common medical problem. Complications involving the orbits or brain are not frequently met. Concomitant involvement of both orbits and the brain is very rare. We here describe a 6-year-old girl who suffered from acute rhinosinusitis and initially, subperiosteal abscesses in both orbits. Bilateral functional endoscopic sinus surgery and drainage of the subperiosteal abscesses through the upper eyelids were done. Pus cultures showed methicillin-resistant Staphylococcus aureus. The brain abscesses were found under magnetic resonance imaging (MRI) and were treated conservatively with vancomycin and rifampin for 7 weeks. The patient was free of ouular and necurologic sequelae at the 1-year follow up. Retrograde thrombophlebitis instead of anatomic dehiscence was the most likely route for the spread of infection. Multidisciplinary approaches are necessary in managing ophthalmologic and intracranial complications of sinusitis.