在眼眶减压术当时及以后行上睑退缩矫正术对治疗甲状腺性眼眶病的疗效比较

Purpose: To evaluate the outcome of eyelid retraction surgery in thyroid-rela ted orbitopathy (TRO) patients in 2 different surgical settings: done simultaneo usly with orbital decompression or as a staged procedure after orbital decompres sion. Design: Retrospective, comparative, nonrandomized clinical study. Particip ants: Ninety-six patients (158 eyes). Methods: A review of electronic medical r ecords of TRO patients who underwent surgery for upper eyelid retraction and orb ital decompression at the Jules Stein Eye Institute in 1999 to 2003 was performe d. Data regarding eyelid position, comprehensive eye examination, surgical outco me, and complications were analyzed. Main Outcome Measures: Anatomical and funct ional success based on margin reflex distance (MRD1; ≤5 mm was graded as mild r etraction; > 5mm and < 7 mm, moderate; and > 7 mm, severe), and patients’discom fort. Results: One hundred fifty-eight eyelid retraction surgeries were perform ed on 96 TRO patients (18 male and 78 female; mean age, 48 years); mean follow u p time was 15 (±12) months. Group 1 consisted of patients undergoing simultaneo us eyelid retraction surgery and orbital decompression and comprised 97 cases (s urgeries). Group 2 included 61 cases of staged surgery: orbital decompression an d eyelid retraction at a later stage. The groups had similar surgical outcomes, and >85%had a better eyelid position postoperatively. Reoperation rates for res idual or recurrent eyelid retraction were similar, overcorrection was higher in group 2 (5%vs. 0%, P=0.03). Changes in MRD1, lagophthalmos, and exophthalmos w ere similar (P>0.05, independent samples t test). Correction of eyelid retractio n was effective in treating patients’discomfort and exposure keratopathy (P=0.0 4, χ2). No severe complications occurred after orbital decompression or eyelid retraction surgery in this group of patients. Conclusions: Transconjunctival M ller’s muscle recession for correction of eyelid retraction in mild to moderate TRO patients, performed simultaneously with deep lateral wall orbital decompres sion, resulted in acceptable eyelid position in two thirds of our patients. Over correction and consecutive ptosis occurred less often after combined orbital dec ompression and eyelid retraction surgery than after isolated eyelid repositionin g surgery. If confirmed in prospective controlled studies, eyelid-repositioning surgery performed at the time of orbital decompression may decrease the number of total procedures and compress the time needed for surgical rehabilitation.

硬化治疗可作为眼眶低血流性血管病变的一线疗法

PURPOSE: To evaluate the outcome of sodium morrhuate 5%injections in patients with low flow vascular lesions, which consist of orbital lymphangiomas, and in one patient with intraosseous cavernous hemangioma. DESIGN: Pros-pective, interventional consecutive case series. METHODS: Intralesional sodium morrhuate 5%was injected under direct visualization or under radiographic guidance to six patients with orbital lymphangiomas and one patient with intraosseous cavernous hemangioma. Comprehensive eye examination and follow-up imaging studies were performed. MAINOUTCOME MEASURES: Lesion size was evaluated by orbital imaging and clinical examination, visual acuity, exophthalmos, and posttreatment complications. RESULTS: Seven patients (four female, three male; average age, 33 years) were included. Six patients were diagnosed with orbital lymphangioma, and one patient was diagnosed with intraosseous cavernous hemangioma. Patients received an average of 2.6 ±2 intralesional injections of sodium morrhuate, with a range of one to six injections and a mean volume of 0.9 ±0.8 ml (range, 0.2 to 2.1 ml). Lesions showed a decrease in size an average of 50%(33%) and ranged from minimal (10%) to near total resolution (85%). Visual acuity and intraocular pressure remained unchanged; exophthalmos decreased an average of 1.5 ±1.8 mm. Complications included one case of orbital hemorrhage that resolved spontaneously and transient keratopathy in all patients with anterior orbital lesions. CONCLUSION: Intralesional sclerosing therapy with sodium morrhuate 5%is effective in tumor debulking in patients with orbital lymphangioma and is not associated with vision-threatening complications. It may be a better alternative to surgery for low flow orbital tumors, which includes lymphangioma.

外路(睫毛线下方)与内路(经结膜)手术修复退化性睑内翻的比较研究

PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs exter nal (subciliary) involutional entropion repair. DESIGN: Retrospective, consecuti ve case series. METHODS: Electronic medical record review of all patients who un derwent involutional entropion repair at the Jules Stein Eye Institute over a 4 -year period was performed. main outcome measures: Anatomic and functional succ ess, recurrence rate, and complications. .RESULTS: Forty-nine eyes (39 patients ) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical out come (on a scale of 1 to 4) (r=.76, P< .001). Forty-two cases (84%) achieved g ood surgical repair and improvement in symptoms. Recurrence was noticed in 4 eye s (8.2%). Recurrence was higher with the internal approach (15%vs 3%with subc iliary incision), but this was not statistically significant (P=.14). Complicati ons included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external ap proach, two of which lateral canthal resuspension was not performed), and two ca ses (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgic al correction of involutional entropion by reinsertion of lower eyelid retractor s has similar outcome with internal (transconjunctival) and external (subcilliar y) approaches. Although not statistically significant, internal repair may resul t in a higher recurrence rate, whereas external repair may show more postoperati ve ectropion, most probably attributable to scarring of the anterior lamella. La teral canthal resuspension, when needed, may reduce the rate of postoperative ec tropion.

额肌的异常收缩及肉毒菌A毒素在永久性额肌动力功能中的作用

Purpose: To report 7 patients with paradoxical use of the frontalis muscle des pite postsurgical correction of ptosis with good postoperative eyelid position. Successful treatment with botulinumA toxin facilitated motor relearning and cess ation of muscle contraction. Design: Interventional case series. Participants: S even patients, in 2 eye-plastic clinics, who underwent successful surgical corr ection of upper eyelid ptosis. Methods: Review of clinical history, clinical pho tographs, treatment, and follow-up. Main Outcome Measures: Frontalis muscle con traction and upper eyelid position. Results: Patients underwent successful surgi cal correction of ptosis but continued using the frontalis muscle despite good e yelid position postoperatively. Frontalis contraction ceased spontaneously in 2 patients, but required botulinum A toxin injection in 5. The effects of a single treatment of botulinum A toxin lasted from 3 months to 2 years, longer than the expected effect of the toxin. Conclusion: Patients with long-standing eyelid p tosis may paradoxically continue utilizing the frontalis after successful surgic al correction and despite good postoperative eyelid position. Cessation of front alis contraction can be achieved with a single injection of botulinum A toxin. W e hypothesize that chemodenervation, achieved with the toxin, may influence the central nervous system to relearn the set point for muscle contraction and may b e associated with permanent motor relearning. Spontaneous resolution of muscle c ontraction can occur in the first months after surgery.

曲安奈德囊肿内注射治疗初发及复发性睑板腺囊肿是否有效

Purpose: To evaluate the safety and efficacy of intralesional triamcinolone ac etonide (TA) injection in primary and recurrent chalazia. Design: Retrospective, interventional, consecutive case series. Participants: One hundred forty-seven patients with primary or recurrent chalazia (155 cases) treated at the oculopla stic clinic at the Jules Stein Eye Institute between January 1, 2000, and Decemb er 31, 2003. Methods: Patients received an intralesional injection of 0.1 to 0.2 ml TA (40 mg/ml). Data regarding lesion size, including digital color photograp hy, lesion regression or recurrence, and complete ophthalmic examination, were r ecorded at the time of injection and at different intervals until resolution or surgical excision. Success was defined as at least an 80%decrease in size with no recurrence. If the lesion recurred or regression was minimal (< 50%), furthe r injections were given as needed. Patients who declined injection or who did no t respond to 2 to 3 injections were referred for surgical excision and drainage. Main Outcome Measures: Lesion size, clinical resolution,

白内障术中对已经存在的散光进行矫正:对侧透明角膜切开和单侧透明角膜切开的疗效比较研究

Background: Opposite clear corneal incisions (OCCIs) have been reported to red uce pre-existing astigmatism (PEA) during cataract surgery. Our goal was to eva luate the effect of OCCIs on correcting PEA in cataract surgery. Methods: Nonran domized prospective study. Thirty-four patients with PEA of greater than 1.5 di opters (D) underwent clear cornea phacoemulsification cataract extraction with 3 .2-mm OCCIs (OCCI group). The control group consisted of 23 successive patients with PEA < 1.5 D who underwent cataract extraction without OCCI. Best-correcte d visual acuity, keratometry and refraction were recorded for all patients pre- operatively and post-operatively. Results: Using keratometric findings, mean as tigmatism correction was 1.3 D (±0.9 SD; decreased from 2.6 D preoperatively to 1.4 D post-operatively) in the OCCI group but only 0.4 D in the control group (P < 0.005), 8 months postoperatively. Vector analysis of astigmatism correction showed greater change for OCCI patients (1.8 D vs 1.0 D, P=0.002). Using the Ho lladay method for calculating surgically induced refractive change (SIRC), the O CCI group showed a higher value of SIRC (-1.6 D vs-0.97 D), but this was not s tatistically significant. The OCCI patients showed a greater and significant cha nge in refraction spherical equivalent than the controls. No complications relat ed to OCCI or cataract surgery occurred during the follow-up period. Conclusion s: Opposite clear cornea incision seems to be a simple, predictable, safe and ef fective procedure in reducing pre-existing corneal astigmatism in cataract surg ery. It has an enhanced effect in correcting astigmatism compared to a single cl ear cornea incision when using keratometric findings value but not when using re fractive data. Future studies are needed to document the long-term effect of OC CI and to evaluate the correlation between incisions of different size and astig matism correction.