眼眶肿瘤及瘤样病变患者699例的临床组织病理学构成分析

目的:分析眼眶肿瘤及瘤样病变的临床组织病理学构成情况。方法:回顾性系列病例研究。连续收集2010-01/2020-12天津市眼科医院眼眶病眼整形科收治的眼眶肿瘤及瘤样病变患者699例707眼的临床组织病理学资料,参考美国癌症联合会第8版眼肿瘤分期标准和WHO2018版眼部肿瘤分类标准,将诊断结果分为良性、交界性及恶性三类。将全部患者按照年龄划分为0~17、18~39、40~59和60岁及以上共4组。对各组组织病理学诊断构成情况进行分析。结果:纳入699例患者707眼中男311例316眼,女388例391眼。就诊年龄为1~84(平均39.9±2.2)岁。右侧眼眶307例,左侧眼眶384例,双侧8例。良性肿瘤及瘤样病变598例604眼(85.6%),交界性肿瘤7例7眼(1.0%),恶性肿瘤94例96眼(13.4%)。在良性肿瘤及瘤样病变中,位于前5位的依次为海绵状血管瘤(110例,15.7%),皮样囊肿(96例,13.7%),多形性腺瘤(54例,7.7%),炎性假瘤(38例,5.4%),神经鞘瘤(29例,4.1%);交界性及恶性肿瘤中,位于前5位的依次为非霍奇金淋巴瘤(42例,41.6%),孤立性纤维性肿瘤(12例,11.9%),腺样囊性癌(11例,10.9%),转移癌(9例,8.9%),横纹肌肉瘤(8例,7.9%)。在常见的眼眶良性肿瘤及瘤样病变中,海绵状血管瘤和多形性腺瘤中女性患者明显多于男性。在常见的眼眶交界性和恶性肿瘤中,非霍奇金淋巴瘤和间叶性软骨肉瘤中男性患者多于女性。0~17岁患者中最常见的良、恶性肿瘤分别是皮样囊肿和横纹肌肉瘤,18~39岁中最常见的良、恶性肿瘤分别为皮样囊肿和孤立性纤维性肿瘤,40~59岁中最常见的良、恶性肿瘤分别为海绵状血管瘤和非霍奇金淋巴瘤,60岁以上最常见的良、恶性肿瘤分别为海绵状血管瘤和非霍奇金淋巴瘤。结论:眼眶肿瘤及瘤样病变中多数为良性。其中良性肿物以海绵状血管瘤和皮样囊肿多见。恶性肿瘤以非霍奇金淋巴瘤多见。

电刺激在视网膜退行性疾病治疗中的研究进展

视网膜病变和视神经损伤导致视觉信息无法正常传递到视觉中枢,对患者的视觉功能以及生活质量产生严重影响。临床工作中常见的眼部疾病如青光眼、外伤性视神经病变、视网膜色素变性等均伴有视网膜神经元和/或视神经的退行性病变,而目前临床上常用的神经保护疗法疗效非常有限。近年研究表明,电刺激对视网膜和视神经具有神经保护和促进再生的作用。本文通过对电刺激在眼科应用的进展进行综述,总结电刺激治疗的相关机制,推动电刺激在眼科疾病研究和应用中的发展。

A retrospective study of 2228 cases with eyelid tumors

AIM： To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015. METHODS： In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin： epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location. RESULTS： Most eyelid tumors were epidermal in origin（1080, 48.5%）, followed by miscellaneous（885, 39.7%） and adnexal tumors（263, 11.8%）. Among all the tumors, 292（13.1%） were malignant lesions, 1910（85.7%） benign and 26（1.1%） premalignant lesions. Most malignant tumors originated from epidermal cells（60.0%）, followed by adnexal cells（34.6%）. The most common malignant tumors were basal cell carcinomas（56.5%） followed by sebaceous carcinoma（34.6%）, squamous cell carcinomas（3.8%） and lymphoma/plasmocytoma（1.7%）. The benign and premalignant eyelid lesions mostly originated from epidermal cells（46.4%） followed by miscellaneous cell sources（45.2%）, including melanocytic nevus（33.8%）, seborrheic keratosis（13.7%）, squamous cell papilloma（13.0%） and epidermal cysts（11.5%）. CONCLUSION： Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Repeatability of Ophtha Top topography and comparison with IOL-Master and Lenstar LS900 in cataract patients

AIM：To determine the repeatability of Ophtha Top topography and assess the consistency with intraocular lens（IOL）-Master and Lenstar LS900（Lenstar）in measuring corneal parameters among cataract patients.METHODS：Totally 125 eyes were enrolled.Corneas were successively measured with Ophtha Top,IOL-Master and Lenstar at least three times.The flattest meridian power（Kf）,the steepest meridian power（Ks）,mean power（Km）,J0 and J45 were recorded.Intra-class correlation coefficients（ICCs）,the coefficient of variance（COV）,within subject standard deviation（Sw）,and test-retest repeatability（2.77Sw）were adopted to determine the repeatability.The 95%limit of agreement（95%LOA）and Bland-Altman plots were used to assess comparability.RESULTS：Repeatability of Ophtha Top topography for measuring corneal parameters showed the ICCs were all above 0.93,2.77Sw was lower than 0.31,and the COV of the Kf and Ks was lower than 0.25.The keratometric readings with Ophtha Top topography were flatter than with the IOLMaster and Lenstar devices,while the Pearson correlation coefficients were over 0.97.The J0 and J45 with Ophtha Top topography were smaller compared with Lenstar and IOL-Master,while was comparable between Lenstar and IOL-Master.CONCLUSION：Ophtha Top topography shows excellent repeatability for measuring corneal parameters.However,differences between the Ophtha TOP topography and Lenstar,IOL-Master both in cornea curvature and the astigmatism should be noted clinically.

Multimodal therapy in the management of primary orbital mesenchymal chondrosarcoma

AIM:To evaluate the ophthalmic manifestations,radiographic features,and prognosis of Chinese patients with primary orbital mesenchymal chondrosarcoma(MCS).METHODS:The study included 6 cases with primary orbital MCS treated at Tianjin Eye Hospital from January 2009 to December 2019.Patitent ophthalmic manifestations,radiographic features,diagnosis,pathology,therapeutic regimens,and prognosis were retrospectively reviewed.RESULTS:Six patitents with primary orbital MCS were identified.The mean age at the first visit was 33y(range,25-42y).All six patients displayed manifestations of exophthalmos,diplopia,limitation of eye displacement,upper eyelid oedema,decreased visual acuity and ptosis.The mean disease history and range were 5 and 2-8mo,respectively.The tumors were located in the superonasal extraconal compartment(2/6,33.3%),intraconal compartment(2/6,33.3%),and bitemporal extraconal compartment(2/6,33.3%),respectively.Radiographic features were a well-defined,orbital mass with calcification and ossification on computed tomography(CT),and marked heterogenous enhancement on dynamic magnetic resonance imaging(MRI).Five patients were treated with tumor resection and one patient received orbital exenteration.Five patients in the cohort received postoperative radiation therapy,two patients received chemotherapy,and one patient did not receive postoperative adjuvant therapy because he refused.The histopathologic classification revealed a tumour composed of a mixture of mature chondroid tissue surrounded by small,round,and undifferentiated mesenchymal cells.Immunohistochemistry revealed Bcl-2,vimetin,CD99,and S-100 were expressed were expressed.After surgeries,two patients have developed a local recurrence.The median recurrence time of 58 mo(52-64 mo).One patient had distant recurrence included the lungs occurred 52mo after the initial surgery.CONCLUSION:The possibilty of orbital MCS need to be considered when a painless,slowly growing orbital mass with calcification and ossification.From our experience,trimodality treatment of radiation therapy,chemotherapy and surgery maybe the best option.Orbital MCS has a high tendency for late recurrence,regular long-term follow-up after complete excision is mandatory.

Anterior segment OCT application in quantifying posterior capsule opacification severity with varied intraocular lens designs

AIM:To evaluate the application of anterior segmentoptical coherence tomography(AS-OCT)in posterior capsule opacification(PCO)severity assessment and analyse the relationship between PCO severity and intraocular lens(IOL)characters.METHODS:PCO patients were prospectively recruited.Cross-sectional images of the anterior segment at horizontal and vertical meridians were acquired with AS-OCT.The area of the IOL-PC(posterior capsular)space and PCO severity(area,thickness,and density at 3 mm and 5 mm IOL optic regions)were measured.The relationship between PCO severity and visual acuity,comparisons of PCO severity and IOL-PC space using varied IOL designs were analysed.RESULTS:One hundred PCO eyes were enrolled.IOL-PC space,PCO thickness and area were positively correlated with axial length.In addition,PCO area and thickness were positively correlated with visual acuity when it was≤0.52 log MAR.The cut-off level of visual acuity should be 0.52 log MAR.With varied IOL designs,3-piece C haptic IOL showed a smaller PCO area and thickness than the 1-piece 3 haptic IOL and 1-piece 4 haptic IOL.PCO area and thickness values for an IOL with a diameter≤11.0 mm was greater than for an IOL with a diameter of 12.5 mm,and the differences were statistically significant.PCO area and thickness increased when IOL haptic angulation increased(from 0 to 12 degrees).CONCLUSION:In PCO eyes,cut-off level of visual acuity is 0.52 log MAR.With more severe PCO,visual acuity maybenot enough to describe the visual function impairment.PCO severity and IOL-PC space are significantly correlated with axial length and IOL design and material.

Comparable effects of Jiedu Granule, a compound Chinese herbal medicine, and sorafenib for advanced hepatocellular carcinoma: A prospective multicenter cohort study

Objective:Sorafenib has been extensively used for the treatment of advanced hepatocellular carcinoma(HCC),and Chinese herbal medicine has also been used to manage advanced HCC.The present work evaluates the effectiveness and safety of Jiedu(JD)Granule,a compound of traditional Chinese herbal medicine,side-by-side with sorafenib for the treatment of advance HCC.Methods:Patients with advanced HCC receiving treatment with JD Granule or sorafenib were enrolled from December 2014 to March 2018.The primary endpoint was overall survival(OS).The secondary endpoints were progression-free survival(PFS)and safety.Propensity score matching(PSM)analysis was used to control for possible selection bias from the study group allocation process.Results:Of the 325 patients included,161 received JD Granule and 164 received sorafenib.No significant differences were found in OS or PFS among patients receiving JD Granule compared to sorafenib(P>0.05).Median OS of the two study groups was 6.83 months(95%confidence interval[CI]:5.83–9.47)in the group receiving JD Granule and 8 months(95%CI:6.67–9.80)in the group receiving sorafenib,with half-,1-and 2-year survival rates of 53.6%,31.2%and 13.2%vs 60.1%,35.5%and 14.2%,respectively.Even after PSM,the median survival time did not differ between the JD Granule group(9.03 months;95%CI:6.37–14.2)and the sorafenib group(7.93 months;95%CI:6.5–9.97),with comparable half-,1-and 2-year survival rates.The most common adverse events(AEs)were diarrhea(13.7%)and fatigue(5.6%)in the JD Granule group,and hand-foot skin reaction(46.3%)and diarrhea(36.6%)in the sorafenib group.The JD Granule was more cost-effective than sorafenib treatment for advanced HCC.Conclusion:Compared to sorafenib,JD Granule was more cost-effective and caused fewer AEs for the treatment of Chinese patients with advanced HCC.