CT眼眶结构定量分析在甲状腺相关性眼病活动性评价中的作用

 目的 通过便于操作的方法分析CT图像眼外肌增粗情况,评估其与甲状腺相关性眼病（TAO）活动性的相关性,以提供客观的评价指标。设计 回顾性病例对照研究。研究对象 116例TAO患者及30例正常对照眼眶CT影像学资料。方法 利用autoCAD软件计算球后2 mm处各条眼外肌横截面积、眼眶面积以及眼球突出度,分析其与临床活动性评分（CAS）的相关性,通过受试者工作特征曲线（ROC）明确其对于疾病活动性的诊断价值。主要指标 眼外肌总横截面积/眼眶面积（OM/TOA）、眼球突出度、CAS评分。结果 TAO组患者球后2 mm处上直肌、下直肌、内直肌、外直肌横截面积以及OM/TOA比值分别为（56.39±22.77）mm²、（43.72±16.63）mm²、（43.51±13.70）mm²、（34.15±7.05）mm²和0.21±0.043,均大于正常对照组的（28.47±2.30）mm²、（22.53±2.5）mm²、（28.21±1.66）mm²、（28.21±1.66）mm²和0.15±0.017（P均<0.001）。OM/TOA比值与CAS评分成正相关（r=0.593,P<0.001）,眼球突出度与CAS评分无相关性（r=0.086,P=0.361）。依据ROC曲线下面积,得出上述比值≥0.18时判断TAO处于活动期的诊断效果最优,其敏感度为89.0%,特异度为53.5%（曲线下面积=0.761,P<0.001）。结论 CT图像上球后2 mm处OM/TOA比值作为一种客观的定量指标,可以对TAO的活动性进行判别,且操作相对简单,联合CAS评分,可较准确地评估病情。（眼科,2018, 27： 333-337）     

甲状腺相关眼病患者97例回顾性分析

目的探讨甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)的临床特征、病情特点及影响因素,为临床早期诊断和治疗提供依据。方法对我院2007年1月至2009年12月诊治的97例(171眼)TAO患者的临床资料进行回顾性分析。结果 97例TAO患者平均发病年龄(44.6±12.8)岁,女性多见,多为双眼发病,以眼球突出为主要就诊原因。78例(144眼)患者伴有甲状腺功能异常。眼睑退缩127眼(73.2%),上睑迟落116眼(63.9%),闭合不全54眼(33.0%),眼睑肿胀76眼(42.3%),球结膜充血及水肿65眼(37.1%);眼球突出119眼(70.1%),眼球运动受限116眼(69.1%),CT测量眼外肌肥厚132眼(77.2%),下直肌受累124眼(72.5%),眼压增高34眼(27.8%),视神经病变21眼(13.4%)。结论 TAO的发病多伴甲状腺功能的异常,其临床特征有其自身的特点,早期正确的临床诊断及病情分析对疾病的治疗有重要意义。     

鼻源性眼球突出的MRI及CT表现分析

通过对５６例鼻源性眼球突出的ＣＴ及ＭＲＩ检查表现分析，认为ＣＴ在揭示钙化及骨皮质上优于ＭＲＩ，但对密度差别不大者如炎症与肿瘤，复发性病变与疤痕组织等不易区分。ＭＲＩ从多方位显示病变，并可良好揭示软组织特点成分，对炎症，血管瘤，粘液性囊肿，纤维疤痕等可有效较异表现，ＣＴ对揭示骨结构明显优于磁共振，确定诊断必须结合临床表现，必要时两者联合应用，提高诊断正确率。     

A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema.

We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.     

Bilateral exophthalmos: Report of a case and review of a fibroblast growth factor receptor 2 mutation associated with non‐penetrant Crouzon syndrome

The differential diagnosis of exophthalmos requires careful examination to identify potentially serious aetiologies. We present the case of a child with exophthalmos in whom genetic analysis identified a mutation in the fibroblast growth factor receptor 2 associated with Crouzon syndrome. The variable presentation should remind paediatricians to consider mutations in fibroblast growth factor receptor 2 among the aetiologies of exophthalmos.     

Outcomes of orbital decompression using surgical navigation in thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy can result in proptosis. In such cases, orbital decompression surgery is often warranted to reduce the adverse impact on patient quality of life. Due to the anatomical complexity of the orbit, navigation can be of considerable assistance during orbital decompression. The objective of this study was to evaluate the benefits of using a surgical navigation device in orbital decompression surgery. A retrospective study was performed based on patients who underwent decompression surgery with (N+) or without (N−) a navigation device between 1997 and 2017. Included patients had undergone unilateral or bilateral orbital decompression by resection of the orbital floor and medial wall of the orbit. Criteria assessed were the presence of debilitating postoperative diplopia, postoperative proptosis reduction, symmetry of protrusion of the eyeballs, and the duration of surgery. Three hundred and fifty eyes were analysed (191 patients): 205 in the N+ group and 145 in the N− group. Use of the surgical navigation system resulted in a greater proptosis reduction, and this result was statistically significant for the right eyeball (P = 0.03). The surgical navigation system had no effect on symmetry of protrusion of the eyeballs or on postoperative diplopia. Setting up the navigation device increased the duration of surgery by 40 minutes on average.     

大剂量甲基强的松龙冲击治疗浸润性突眼的观察与护理

目的 探讨大剂量甲基强的松龙冲击治疗浸润性突眼疗效及有效护理方法.方法 收集安徽医科大学第一附属医院内分泌科2008年1月至2011年3月浸润性突眼住院患者54例,应用大剂量甲基强的松龙冲击治疗,患者心理、饮食、眼睛等多方面积极完备的护理,进行疗效评价及分析.结果 配合落实多项护理措施,15例(27.8％)患者经甲基强...     

CT features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy

AIM:To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO).METHODS:A total of605 eyes of 325 patients with exophthalmos due to TAO were classified as grade I (mild exophthalmos) or II (severe exophthalmos) based on orbital CT imaging. The increased orbital volume features, such as changes from extraocular muscles, orbital fat, or both, were analyzed.RESULTS: A total of 605 eyes were analyzed, among them 62.98% presented grade I exophthalmos, while 36.02% showed grade II exophthalmos.#$TAB In grade I, 56.69% showed orbital fat change, and in grade II, 89.29% exhibited extraocular muscle enlargement.CONCLUSION: Orbital fat and extraocular muscle enlargement are likely to be observed on CTs of subjects with mild and severe exophthalmos, respectively. Our results suggest that CT findings may guide TAO clinical therapy recommendations and prognosis.     

Factors affecting the success rate of the Quickert and Wies procedures for lower lid entropion

Isolated orbital neurofibroma (INO) without systemic neurofibromatosis is rare. Previous reports including MRI with elaboration of the ultrastructural features of the cellular and extracellular components in INO do not exist. A 44-year-old male presented with painless, slowly progressive proptosis (6 mm) and downward displacement (3 mm) of the left eye of two years duration. MRI revealed a suprabulbar mass hypointense to fat, isointense to brain on T1-weighted images with small hyperintense areas following contrast enhancement. T2-weighted images showed a predominantly hyperintense mass with a few hypointense islands. The lesion was excised using an anterior superior transseptal orbitotomy. Histopathologically, large areas of a paucicellular myxoid stroma containing mucopolysaccharides made up approximately three-quarters of the mass. Focal hypercellular areas showed marked collagen deposition. Blood vessels were distributed at the periphery of the lesion and in association with nodules of nerve sheath cells. Ultrastructurally, perineural and fibroblast-like cells were loosely arranged in a myxoid stroma. Schwann cells were embedded in a dense collagenous matrix. Variable differentiation of Schwann cells, perineural cells and fibroblast-like cells associated with a more solid (collagenous) or loose (myxoid) extracellular matrix may determine the characteristic, though not specific, MRI features in isolated neurofibromas of the orbit.