Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

AIM:To investigate the difference of medial rectus(MR)and lateral rectus(LR)between acute acquired concomitant esotropia(AACE)and the healthy controls(HCs)detected by magnetic resonance imaging(MRI).METHODS:A case-control study.Eighteen subjects with AACE and eighteen HCs were enrolled.MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner.Extraocular muscles(EOMs)were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator.To form posterior partial volumes(PPVs),the LR and MR cross-sections in the image planes 8,10,12,and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness.The data were classified according to the right eye,left eye,dominant eye,and non-dominant eye,and the differences in mean cross-sectional area,maximum cross-sectional area,and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively.RESULTS:There were no significant differences between the two groups of demographic characteristics.The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes(P=0.028).The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group(P=0.009,P=0.016).For the dominant eye,the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group(P=0.013),but not in the MR muscle(P=0.698).CONCLUSION:The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia.The LR muscle become larger to compensate for the enhanced convergence in the AACE.

Diffusion tensor imaging of horizontal extraocular muscles in patients with concomitant and paralytic esotropia

AIM:To assess metrics of diffusion tensor imagining(DTI)in evaluating microstructural abnormalities of horizontal extraocular muscles(EOM)in esotropia.METHODS:Six adult concomitant esotropia patients,5 unilateral abducent paralysis patients and 2 healthy volunteers were enrolled.Conventional magnetic resonance imaging(MRI)and DTI were performed on all subjects using 3T MR scanner.Fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD)of medial and lateral rectus muscles were measured and compared between patients group and control group.RESULTS:Medial rectus MD and RD within the adducted eye of concomitant patients was significantly greater than that in unilateral abducent paralysis patients(0.259×10-2 mm^(2)/s vs 0.207×10-2 mm^(2)/s,P=0.014;0.182×10-2 mm^(2)/s vs 0.152×10-2 mm^(2)/s,P=0.017).Both strabismus patients showed a significantly decreased MD and AD than that obtained in normal controls for lateral rectus muscles(P<0.05).Medial rectus MD of the adducted eye in concomitant strabismus patients was significantly decreased than that in healthy controls(0.259×10-2 mm^(2)/s vs 0.266×10-2 mm^(2)/s,P=0.010).Lateral rectus AD of the adducted eye in concomitant strabismus patients was significantly decreased as compared with that in healthy controls(0.515×10-2 mm^(2)/s vs 0.593×10-2 mm^(2)/s,P=0.013).No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients.CONCLUSION:DTI represents a feasible technique to assess tissue characteristics of EOM.The effects of eye position changes on DTI parameters are subtle.Decreased MD and RD could be evidence for remodeling of the medial rectus muscle contracture.Lower medial and lateral recuts MD of concomitant esotropia patients indicates a thinner fibrous structure of the EOM.Lower MD and AD should be general character of esotropia.

Extraocular retinoblastoma in Indian children:clinical,imaging and histopathological features

AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.

Establishment of an acute extraocular muscle injury model in cats

AIM： To describe an acute extraocular muscle injury model in cats. METHODS： Seventy-two cats were randomly divided into 6 groups（12 cats per group）. Cats＇ left lateral recti were clamped using a surgical needle holder with a clamping strength of 2（Groups A and D）, 4（Groups B and E） and 6 kg（Groups C and F）. The right lateral recti were treated as controls. On the 4^（th） and 7^（th） days, hematoxylin eosin（HE） staining, immunohistochemical staining for proliferating cell nuclear antigen（PCNA）, muscle force measurements and ocular alignment changes were performed to evaluate the extent of injuries. RESULTS： The morphological changes were graded as mild, moderate or severe by HE staining in all experiment groups. PCNA immunohistochemical staining indicated repairment of muscle fibers in the damaged area. On the 4^（th） and 7^（th） days after clamping, the injured lateral muscle exhibited an elevated threshold for electric stimulation. The muscle forces among groups 2, 4 and 6 kg injury at 4 d（Groups A, B and C） were statistically significant（P0.05）, respectively. In addition, medial deviation in ocular alignment was also present to various degrees in all groups. CONCLUSION： A cat model of acute extraocular muscle injury can be established by rectus clamping. Different clamping strengths can make different degrees of muscle injury. This model may help the future study in the acute extraocular muscle injury.

Evaluation of nintedanib as a new postoperative antiscarring agent in experimental extraocular muscle surgery

AIM:To investigate the efficacy of nintedanib on reducing postoperative inflammation,fibrosis and adhesion formation following extraocular muscle surgery in rabbits in comparison with triamcinolone acetonide(TA).METHODS:Reinsertion of superior rectus muscle in right eyes of 30 New Zealand white rabbits were performed.They were randomized to receive one of the following treatments:0.9%normal saline,one of 1-,5-,and 10μmol doses of nintedanib subconjunctivally immediately after surgery and on postoperative day 1,2,3,5,and 7,and TA immediately after surgery.As a control group,unoperated left eyes(n=6)were used.On the 28 th day,six eyes from each group were enucleated and histopathologically and immunohistochemically analyzed to assess the postoperative inflammatory changes,fibrosis and adhesion.Transforming growth factor beta,matrix metalloproteinase-2 and alpha smooth muscle actin expressions were evaluated.RESULTS:Conjunctival and scleral inflammation in TA and nintedanib groups were significantly reduced compared to saline(sham)group.Conjunctival vascularity and rectus muscle fibrosis were significantly reduced in 10μmol nintedanib group.Nintedanib groups were the most effective groups in reduction of perimuscular fibrosis.Neither three nintedanib groups nor TA group differed statistically from sham group with regard to adhesion.The expressions of transforming growth factor beta,alpha smooth muscle actin and matrix metalloproteinase-2 were reduced in nintedanib groups compared to saline group.CONCLUSION:Nintedanib appears to attenuate postoperative inflammation and fibrosis after extraocular muscle surgery.Nintedanib may be a safer and stronger alternative agent in extraocular muscle surgery when compared to steroids.Further investigation is needed to prove antiadhesive effect of nintedanib.

The Suh Muscle Hook: A New Muscle Hook for Tight Extraocular Muscles during Strabismus Surgery

Purpose: To introduce an advanced muscle hook to decrease risks and create more feasible extraocular muscle surgeries for physicians. Case Report: Tight extraocular muscles during strabismus surgery could be extremely challenging even in experienced hands due to restricted globe rotation, limited view, and lack of muscle elasticity. Although a variety of surgical instruments have been introduced through the years, traditional muscle hooks such as the Jameson hook are largely unchanged and are bulky and cumbersome. Using the traditional muscle hook under situations such as pediatric strabismus surgery with smaller eyes and extraocular muscles may increase the risk of perforating the globe or even rupturing the muscles. We developed the “Suh muscle hook”, which has a 0.55 mm wide grooved track in a 1.1 mm wide horizontal bar, a semi-sharp dissecting tip, and a 30-degree bending near the handle accommodating for nasal bridge to better facilitate surgeons dealing with tight extraocular muscles and minimize risks during strabismus surgery.

Study on normal ophthalmic tissues among ocular volume and extraocular muscles structure measurement by HR-MRI

Objective: To measure the ocular volume and extraocular muscles of healthy people using the high-resolution magnetic reso-nance imaging (HR-MRI) technology, to provide parameters support for eye research, teaching and diagnosis. Methods: The study collected 100 cases of normal subjects (200 eyes) from November 2012 to December 2013, including 50 males and 50 females, accepted line HR-orbital MRI, and image processing software was applied to morphology and statistical analysis. The extraocular muscles, muscle belly level horizontal diameter and maximum diameter vertical diameter were mea-sured. Results: The volume of the vitreous cavity (4.51 ± 0.26) cm3 had no significant difference with the anatomic normal value (p= .148);The volumes of the ocular globe, the anterior chamber and the lens cavity were (5.05 ± 0.21) cm3, (0.24 ± 0.26) cm3, (0.23 ± 0.14) cm3, with no statistic differences compared with those of the anatomic normal values. The extraocular muscles of normal Chinese were symmetrical on the two sides. The relationships of the short diameters of extraocular muscles in the maximum planes were: inferior rectus muscle (IR) > medial rectus muscle (MR) > superior rectus (SR) > lateral rectus muscle (LR). Those of the long diameters of extraocular muscles were: LR > MR > SR > IR. Conclusions: MRI can be used for measuring ocular volume and sizes of extraocular muscles. Compared with the anatomic normal value, the sizes of extraocular muscles can also be assessed by the symmetry on the two sides and by observing the usual rule of extraocular muscles.

Normative Measurements of Extraocular Musculature by Multislice Computed Tomography

Objective To establish the normal measurements of diameter of extraocular muscles (EOMs) by multislice computed tomography (CT). Methods Orbits of 50 volunteers (25 male and 25 female) were scanned with a multislice CT scanner. For each subject, one axial image at the central level of the eyeball, one coronal image about 1 cm behind globe, and two oblique sagittal images respectively along the left and right optic nerve were used for measurements of the thickness and width of EOMs. The statistic significance of measurement value between male and female and between left and right eyes was evaluated. Results There were no significant differences in the thickness and width of superior muscle group, lateral rectus, medial rectus, lateral rectus, superior oblique, inferior oblique and the thickness of levator palpebrae superioris between the left and right eyes as well as between male and female groups (all P>0.05). The thickness of superior muscle group and inferior rectus had not significant difference (2.9±0.7 vs. 3.3±0.8 mm, P=0.162), while the thickness of medial rectus was significantly higher than that of lateral rectus (3.1±0.5 vs. 2.2±0.6 mm, P=0.000). Conclusions The CT measurement of extraocular musculature is simple and time-saving and can be applied in the clinical work. The normative data obtained may be useful in determining pathologic enlargement of the EOMs in both thyroid-associated orbitopathy patients and other various orbital conditions.

A型肉毒毒素与眼外肌手术治疗大角度急性共同性内斜视的疗效对比

目的:探讨A型肉毒毒素(BTA)注射和眼外肌手术治疗大角度(≥+60 PD)急性共同性内斜视(AACE)的疗效差异性。方法:回顾性分析2020-06/2022-12于我院治疗的AACE患者60例的临床资料,根据治疗方式分为2.5 IU BTA注射组(14例)、5.0 IU BTA注射组(29例)、手术组(17例)。治疗后随访6 mo,观察纳入患者屈光矫正后的斜视度、视功能、治疗有效率及BTA注射后并发症发生情况。结果:治疗后6 mo,手术组和5.0 IU BTA注射组患者的斜视度均小于2.5 IU BTA注射组(P<0.017),但手术组与5.0 IU BTA注射组患者的斜视度无显著差异(P>0.017);5.0 IU BTA注射组有效率高于2.5 IU BTA注射组(86%vs 43%,P<0.017);三组患者各级视功能均无差异(P>0.05);2.5 IU BTA注射组和5.0 IU BTA注射组治疗后并发症总发生率无显著差异(43%vs 52%,P>0.05)。结论:对于斜视度≥+60 PD的AACE患者,双眼内直肌注射5.0 IU BTA可以取得与传统眼外肌手术相当的效果,且其具有创伤小,操作简单方便的优势。

226例后天性眼外肌麻痹病因分析

目的对后天性眼外肌麻痹进行病因分析。方法回顾性分析2017年3月至2022年3月首诊收住我院的226例眼外肌麻痹患者临床资料,对其病因进行分析。结果在226例患者中121例(53.5%)神经源性,42例(18.6%)血管性疾病,26例(11.5%)肌源性。后天性眼外肌麻痹病因中前三位的疾病分别是糖尿性58例,脑梗死21例,甲状腺疾病19例。所有神经源性病例中,以动眼神经麻痹最多见,其次是外展神经,滑车神经最为少见。结论后天性眼外肌麻痹病因复杂,本研究中后天性眼外肌麻痹的前三位主要病因分别为糖尿病、脑梗死和甲状腺疾病。

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.

巩膜环扎带术后重眼综合征1例

33岁男性,因“右眼环扎带术后逐渐出现内下斜15年”就诊。视力:右眼-20.00 DS→0.1;左眼-22.00 DS/-2.0 DC×100°→0.2。双眼眼压Tn。眼位:右眼固定性内下斜视,内斜>45°,右眼低位10°。眼球运动:右眼外转、上转完全受限。裂隙灯检查:右眼颞上方角膜透明,眼内结构窥不入;左眼高度近视眼底改变,余无殊。眼眶CT显示右侧眼球下内转位,上直肌(SR)内移,外直肌(LR)下移,左侧眼球内转位,双眼高度近视表现。该患者右眼重眼综合征、右眼环扎带术后诊断明确,请眼底组专家评估其视网膜情况,拟行右眼环扎带取出联合右眼改良Yokoyama手术。但进行Yokoyama手术时发现患者LR前段及SR后段与巩膜严重粘连,遂调整手术方案为右眼内直肌(MR)后徙12 mm联合上直肌转位术(SRT)联合LR-SR联结术。术后1.5个月仍残留内斜10°,遂行左眼斜视手术:左MR后徙5 mm联合LR截除7 mm。左眼斜视术后随访3个月,眼位正,右眼外转及上转明显改善,未出现复发性视网膜脱离。讨论体会:对于环扎带术后出现的斜视,环扎带是否取出需权衡利弊,一旦取出,需密切随访视网膜情况;Yokoyama术中,发现眼外肌粘连严重时,需及时调整手术方案,此病例SRT联合SR-LR联结术也获得了较为理想的效果。

Magnetic Resonance Imaging Features of Extraocular Muscle Lymphoma in Five Cases

Lymphoma is the most common primary orbital malignant neoplasm in adults,accounting for 8-15% of extranodal non-Hodgkin＇s lymphomas and 2% of all lymphomas.Most of these tumors involve the conjunctiva,orbit,lacrimal gland,or eyelid.It is uncommon for lymphoma to originate from the extraocular muscles.The prevalence of intramuscular lymphoma is between 0.1% and 8.7% of all extranodal lymphomas.Fewer than 60 cases have been reported in the last 30 years, mostly as case reports with scant or no radiology information.

正容汤加减治疗风痰阻络型眼外肌麻痹的临床研究

目的 观察正容汤加减治疗风痰阻络型眼外肌麻痹的临床疗效。方法 选取2019年1月至2022年9月就诊于西南医科大学附属中医医院眼科的风痰阻络型眼外肌麻痹患者48例,按照随机数表法分为两组,对照组除了针对病因治疗外加用甲钴胺口服,共计3周。治疗组在对照组基础上加用正容汤加减治疗,以1周为1个疗程,进行3个疗程,共计3周。记录两组治疗前后患者的各项数据,比较两组治疗前后在斜视度、眼球运动、症状积分、中医疗效等方面的变化,评估治疗后的效果。结果 与对照组比较,治疗组患者在斜视度、眼球运动评分、临床症状积分方面有明显改善,差异有统计学意义(P <0.05)。在疗效方面治疗组高于对照组,差异有统计学意义(P <0.05)。结论 正容汤加减治疗风痰阻络型眼外肌麻痹的临床疗效确切,在改善患者临床症状、提高患者生活质量等方面效果显著。

应用揿针疗法对眼外肌麻痹患者视觉功能修复作用的临床研究

探讨揿针疗法对眼外肌麻痹患者视觉功能的修复作用。方法选择58例眼外肌麻痹患者,随机分为治疗组与对照组,各29例。治疗组采用揿针疗法联合甲钴胺片口服治疗,对照组采用单纯甲钴胺片口服治疗,2组均治疗21 d。观察并记录2组治疗前后复视、眼斜、头晕、恶心、代偿头位积分。结果治疗组总有效率(93.1%,27/29)高于对照组(71.4%,20/28)。结论揿针埋针联合甲钴胺片口服治疗眼外肌麻痹疗效显著。

多学科协同护理干预对眼外肌麻痹患者的干预效果

目的探讨多学科协同(multidisciplinary team,MDT)护理干预对眼外肌麻痹患者的作用效果。方法选取2022年3月至2023年3月医院眼科收治的80例眼外肌麻痹患者作为研究对象,随机分为两组,对照组接受常规护理模式,研究组在常规护理模式基础上联合MDT护理干预方法,分析两组视力情况、心理状态以及匹兹堡睡眠质量指数(PSQI)和并发症发生情况。结果护理后研究组视力优于对照组(P<0.05),焦虑自评量表(SAS)以及抑郁自评量表(SDS)评分低于对照组,自我护理能力测定量表(ESCA)各维度评分高于对照组,睡眠状况自评量表(SRSS)评分、PSQI评分均低于对照组(P<0.05)。研究组眼压高、感染、眼内出血、结膜炎、泪囊炎的发生率低于对照组(P<0.05)。结论相较于常规护理模式,MDT干预方法能够有效改善眼外肌麻痹患者视力和心理状态,改善睡眠状态,减少并发症发生。

眼外肌术后视网膜微观变化的研究进展

眼外肌手术作为斜视治疗最主要的方式,可以达到矫正眼位、改善外观、重建三级视功能的目的。既往研究发现眼外肌术后早期视网膜血流密度(VD)及厚度增加,并涉及多种机制参与。近年来,随着光学相干断层扫描血流成像技术(OCTA)等检测手段出现,让我们对传统眼外肌术式带来的视网膜微观改变及其机制的量化认识越来越深刻,术后早期视网膜VD增加可能与术后视功能的恢复密切相关,但目前相关研究较少,眼外肌术后视网膜微观变化与视功能之间的关联及影响机制尚需进一步明确,本文将从多角度对眼外肌术后视网膜微观变化及其机制进行综述,提高对其影响机制及与视功能之间关联的认识,以期为眼外肌手术方案的选择及相关临床研究提供借鉴。

彭清华教授应用补阳还五汤治疗眼病的临床经验

补阳还五汤由生黄芪、当归尾、川芎、赤芍、桃仁、红花、地龙7味药物组成,主要治疗气虚血瘀、脉络瘀阻诸证。彭清华教授运用益气活血利水法治疗眼病,将补阳还五汤扩大应用范围到眼科临床上,同样疗效显著。从青光眼、糖尿病视网膜病变、眼外肌麻痹以及视网膜脱离术后4个方面总结彭清华教授临床经验,凡眼疾有气虚血瘀之证候,皆可运用补阳还五汤化裁治疗。

MRI在甲状腺相关性眼病活动性评估方面的研究进展

甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO)是一种自身免疫性眼眶疾病,会影响患者容貌,甚至引起失明,使患者的生活质量下降。对TAO活动性和症状严重程度的评估是制订治疗方案的基础,临床上主要用临床活动度评分来对其分期,但存在局限性。TAO患者影像学上主要表现为眼球突出、眼外肌水肿增粗及眼眶脂肪水肿,其他表现可合并泪腺体积增大,眼睑和视神经水肿等。T2WI脂肪抑制序列、动态对比增强MRI、弥散磁共振成像、mapping、磁化传递成像等多模态MRI技术及基于MRI图像的人工智能分析等技术能从多种角度为TAO的活动性分期提供更客观的信息,本文通过总结这些技术在TAO患者的眼外肌、眼眶脂肪、泪腺、视神经等的应用并结合测量得到的参数值来确定TAO的分期,以期指导临床决策,并为将来的研究提供参考方向。