AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repe...AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.展开更多
目的:对比Dixon和频率选择脂肪预饱和(frequency-selective fat-saturation,Fat-Sat)技术对眼眶T2加权成像(T2-weighted imaging,T2WI)的压脂效果和综合图像质量。方法:前瞻性纳入35例健康受试者,进行眼眶Dixon-T2WI(Dixon组)和Fat-Sat-...目的:对比Dixon和频率选择脂肪预饱和(frequency-selective fat-saturation,Fat-Sat)技术对眼眶T2加权成像(T2-weighted imaging,T2WI)的压脂效果和综合图像质量。方法:前瞻性纳入35例健康受试者,进行眼眶Dixon-T2WI(Dixon组)和Fat-Sat-T2WI(Fat-Sat组)扫描。对两组图像的脂肪抑制效果和综合图像质量进行主观评分。基于两组图像分别测量眼外肌和颞肌的信号强度,并计算信号强度比(signal intensity ratio,SIR)。采用Wilcoxon检验对两组图像主观评分进行比较。采用配对样本t检验对信号强度和SIR进行组间比较。结果:Dixon组的脂肪抑制效果高于Fat-Sat组(3.86±0.36 vs. 2.91±0.56,P <0.001),综合图像质量也高于Fat-Sat组(3.83±0.38 vs. 3.26±0.56,P <0.001)。Dixon组眼外肌信号强度高于Fat-Sat组(362.33±107.73 vs. 286.59±78.84,P <0.001),颞肌信号强度也高于Fat-Sat组(207.26±63.41 vs. 170.19±51.93,P <0.001),而两组图像的SIR差异无统计学意义(1.83±0.54 vs. 1.77±0.49,P=0.239)。结论:与Fat-Sat技术比较,基于Dixon技术的眼眶T2WI压脂效果和图像质量更优,而SIR相仿,可以为临床提供更可靠的诊断依据。展开更多
Orbital injury and complications are commonly encountered in endoscopic sinus surgery (ESS) despite advances in techniques and instrumentation. For the recent 10 years, we summarized the experience of the rhinology un...Orbital injury and complications are commonly encountered in endoscopic sinus surgery (ESS) despite advances in techniques and instrumentation. For the recent 10 years, we summarized the experience of the rhinology unit of our department regarding orbital injury and complications of ESS for sinonasal inflammatory disorders. One thousand seventy-three patients (1869 sides) from January 1, 2003 to December 31, 2012 undergoing ESS for sinonasal inflammatory diseases were enrolled in the present study. The age of the patients ranged from 8 to 81 years, mean age 49 years. Orbital injury and complications were observed in 13 patients (13 sides), which corresponded to 0.7% of the operated sides and 1.2% of the patients. Eight patients showed herniation of orbital fat alone through the injury of the lamina papyracea. The protruding orbital fat was snipped and cut using forceps in 2 patients. Removal of exposed orbital fat using powered instruments was performed in 3 patients, two of whom transiently showed periorbital edema postoperatively. No permanent complications were observed. Meticulous preoperative and perioperative planning is critical to prevent orbital complications. Especially, exposure of the periorbit and herniation of orbital fat after lamina injury with powered instrumentation dramatically increases the potential for more severe complications.展开更多
目的探讨结膜下眼眶脂肪脱垂(subconjunctival herniated orbital fat prolapse)的临床及病理学特征、治疗及预后。方法对2020年1月—12月江阴市中医院确诊的3例结膜下眼眶脂肪脱垂临床特征、形态学及免疫组织化学表型进行分析。结果肿...目的探讨结膜下眼眶脂肪脱垂(subconjunctival herniated orbital fat prolapse)的临床及病理学特征、治疗及预后。方法对2020年1月—12月江阴市中医院确诊的3例结膜下眼眶脂肪脱垂临床特征、形态学及免疫组织化学表型进行分析。结果肿物均位于眼眶结膜下,镜下主要表现为成熟脂肪组织中见花环样细胞及核空泡化的Lochkern细胞。免疫组织化学染色显示花环样细胞和Lochkern细胞S-100阳性,CD34和CD68阴性。结论结膜下眼眶脂肪脱垂是一种较少报道的假恶性病变,显微镜下需要与非典型脂肪瘤样肿瘤鉴别。展开更多
目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)...目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。展开更多
文摘AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.
文摘目的:对比Dixon和频率选择脂肪预饱和(frequency-selective fat-saturation,Fat-Sat)技术对眼眶T2加权成像(T2-weighted imaging,T2WI)的压脂效果和综合图像质量。方法:前瞻性纳入35例健康受试者,进行眼眶Dixon-T2WI(Dixon组)和Fat-Sat-T2WI(Fat-Sat组)扫描。对两组图像的脂肪抑制效果和综合图像质量进行主观评分。基于两组图像分别测量眼外肌和颞肌的信号强度,并计算信号强度比(signal intensity ratio,SIR)。采用Wilcoxon检验对两组图像主观评分进行比较。采用配对样本t检验对信号强度和SIR进行组间比较。结果:Dixon组的脂肪抑制效果高于Fat-Sat组(3.86±0.36 vs. 2.91±0.56,P <0.001),综合图像质量也高于Fat-Sat组(3.83±0.38 vs. 3.26±0.56,P <0.001)。Dixon组眼外肌信号强度高于Fat-Sat组(362.33±107.73 vs. 286.59±78.84,P <0.001),颞肌信号强度也高于Fat-Sat组(207.26±63.41 vs. 170.19±51.93,P <0.001),而两组图像的SIR差异无统计学意义(1.83±0.54 vs. 1.77±0.49,P=0.239)。结论:与Fat-Sat技术比较,基于Dixon技术的眼眶T2WI压脂效果和图像质量更优,而SIR相仿,可以为临床提供更可靠的诊断依据。
文摘Orbital injury and complications are commonly encountered in endoscopic sinus surgery (ESS) despite advances in techniques and instrumentation. For the recent 10 years, we summarized the experience of the rhinology unit of our department regarding orbital injury and complications of ESS for sinonasal inflammatory disorders. One thousand seventy-three patients (1869 sides) from January 1, 2003 to December 31, 2012 undergoing ESS for sinonasal inflammatory diseases were enrolled in the present study. The age of the patients ranged from 8 to 81 years, mean age 49 years. Orbital injury and complications were observed in 13 patients (13 sides), which corresponded to 0.7% of the operated sides and 1.2% of the patients. Eight patients showed herniation of orbital fat alone through the injury of the lamina papyracea. The protruding orbital fat was snipped and cut using forceps in 2 patients. Removal of exposed orbital fat using powered instruments was performed in 3 patients, two of whom transiently showed periorbital edema postoperatively. No permanent complications were observed. Meticulous preoperative and perioperative planning is critical to prevent orbital complications. Especially, exposure of the periorbit and herniation of orbital fat after lamina injury with powered instrumentation dramatically increases the potential for more severe complications.
文摘目的探讨结膜下眼眶脂肪脱垂(subconjunctival herniated orbital fat prolapse)的临床及病理学特征、治疗及预后。方法对2020年1月—12月江阴市中医院确诊的3例结膜下眼眶脂肪脱垂临床特征、形态学及免疫组织化学表型进行分析。结果肿物均位于眼眶结膜下,镜下主要表现为成熟脂肪组织中见花环样细胞及核空泡化的Lochkern细胞。免疫组织化学染色显示花环样细胞和Lochkern细胞S-100阳性,CD34和CD68阴性。结论结膜下眼眶脂肪脱垂是一种较少报道的假恶性病变,显微镜下需要与非典型脂肪瘤样肿瘤鉴别。
文摘目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。
