ciliary body

睫状体
  • 文章类型: Journal Article
    近视是由多种因素引起的视力障碍的世界性公共卫生问题,造成了巨大的社会经济负担,引起人们对危及视力的眼部并发症的担忧。维生素D,作为一种脂溶性维生素,与花时间在户外有关,广泛的研究认为与近视有潜在的关系。我们回顾了十年来发表的研究,这些研究估计了血液维生素D状态与近视的关系,并总结了所有研究文章的普遍性和个性。几篇研究文章提出了近视的已知环境危险因素,包括年龄,性别,种族,教育水平,父母和学校条件,花时间在户外,和阳光照射,最近的流行病学研究表明,维生素D水平升高,由于户外时间的延长,可能是一个重要的可改变的因素和保护作用,可以延缓儿童和青少年而不是成人的近视进展。已经进行了遗传研究,以获得基因多态性的证据来解释血清维生素D状态与近视的关联,但到目前为止,维生素D和近视的精确基因解释仍不清楚;另一方面,可能的机制有多种,如共聚机制,钙稳态和睫状肌功能调节失衡,但是几乎所有的调查人员都倾向于保持怀疑。本文回顾了与年龄相关的流行病学证据,存在的遗传学相关性,可能的潜在生物学机制和维生素D与近视之间的保护性关联的进一步价值,提供预防或推迟近视的可能性。
    Myopia is a worldwide public health problem of vision disorder caused by multiple factors, which has posed a huge socioeconomic burden, raising concerns about sight-threatening ocular complications. Vitamin D, as a kind of fat-soluble vitamin, related to time-spent-outdoors, has been considered by extensive studies to have potential relationship with myopia. We reviewed studies published in a decade which estimated the association of blood vitamin D status with myopia and summarized the universality and individuality of all research articles. Several research articles suggested the known environmental risk factors of myopia, including age, gender, ethnicity, education level, parental and school conditions, time-spent-outdoors, and sunlight exposure, and recent epidemiological studies demonstrate that increased vitamin D levels, by virtue of the extended outdoor time, may be an important modifiable factor and a protective effect that delay the progression of myopia in children and adolescents rather than in adults. The genetic studies have been conducted to get access to the evidence of gene polymorphism for explaining the association of serum vitamin D status and myopia, but the precise genetic interpretation of vitamin D and myopia remains unclear so far; on the other hand, the possible mechanisms are various like copolymerization mechanism, calcium homeostasis and imbalance of ciliary muscle function regulation, but nearly all of the investigators are inclined to remain skeptical. This article reviews the age-related epidemiological proofs, existent genetics correlations, possible underlying biological mechanisms and further values for the protective association between vitamin D and myopia, providing the possibility of prevention or postponement for myopia.
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  • 文章类型: Journal Article
    目的:眼内神经鞘瘤是一种罕见的肿瘤,经常被误诊。我们介绍了眼内神经鞘瘤患者的人口统计学和临床特征。
    方法:收集北京同仁医院2005年5月至2021年7月的回顾性病例系列。
    结果:共有28例患者经手术标本组织病理学检查确诊为眼内神经鞘瘤。中位年龄为39岁(范围:12-64)。14例患者为女性,14例为男性。在所有科目中,21/28患者(75.0%)表现为视力丧失,3/28例患者(10.7%)存在视野丧失。眼内神经鞘瘤表现为睫状体无色素肿块12/28例(42.9%),脉络膜9/28例(32.1%),纤毛脉络膜7/28例(25.0%)。眼内神经鞘瘤常被临床误诊为葡萄膜黑色素瘤,发生在16/28例患者中(57.1%)。对所有纳入的患者进行了平坦部玻璃体切除术。对于脉络膜中的肿瘤,进行了晶状体切除的内窥镜切除术,而经巩膜切除位于睫状体或睫状体的肿瘤。在12/28例中检测到透光率增加(42.9%)。在连续随访中(中位数:73个月,范围:7-193个月),未发现复发或转移性疾病病例.
    结论:眼内神经鞘瘤是一种罕见的良性肿瘤。它通常表现为无色素块,这很容易被误诊为非色素沉着的葡萄膜黑色素瘤。
    OBJECTIVE: Intraocular schwannoma is a rare tumour, which is often misdiagnosed. We presented the demographics and clinical characteristics of patients with intraocular schwannoma.
    METHODS: Retrospective case series were collected between May 2005 and July 2021 in Beijing Tongren Hospital.
    RESULTS: A total of 28 patients were diagnosed with intraocular schwannoma on histopathological examination of surgical specimen. The median age was 39 years (range: 12-64). Fourteen patients were female and 14 were male. Among the all subjects, 21/28 patients (75.0%) presented as visual loss, and 3/28 patients (10.7%) had visual field loss. Intraocular schwannoma presented as nonpigmented mass in the ciliary body in 12/28 cases (42.9%), in the choroid in 9/28 cases (32.1%), and in ciliochoroid in 7/28 cases (25.0%). Intraocular schwannoma was often clinically misdiagnosed as uveal melanoma, which occurred in 16/28 patients (57.1%). Tumour excision with pars plana vitrectomy was performed for all included patients. Endoresection with lens removal was performed for tumours in the choroid, while transscleral resection was performed for tumours located in ciliary body or ciliochoroid. Increased light transmission was detected in 12/28 cases (42.9%). In the consecutive follow-up (median: 73 months, range: 7-193 months), no cases of recurrence or metastatic disease were detected.
    CONCLUSIONS: Intraocular schwannoma is a rare benign tumour. It usually presents as nonpigmented mass, which can easily be misdiagnosed as nonpigmented uveal melanoma.
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  • 文章类型: Journal Article
    眼内肿块的最常见原因是其他肿瘤的转移。肾脏恶性肿瘤,虽然罕见,有大量的眼部转移病例,很少有人被误诊。很多时候,肾脏恶性肿瘤在初次诊断前表现为眼部表现。在这篇文章中,据我们所知,我们全面回顾了迄今为止发表的106例肾脏恶性肿瘤眼部转移病例。由于缺乏淋巴系统,眼睛是远处转移的罕见部位。与远处转移有关的最常见的眼部结构是葡萄膜,即,脉络膜,虹膜,和睫状体。转移到眼睛的最常见的肾肿瘤是肾细胞癌(RCC)。RCC占所有眼科转移的不到2%。在总共106个案例中,仅在95例中知道肾脏恶性肿瘤的类型,其中92个有碾压混凝土,1Wilm\'s肿瘤,1例横纹肌样瘤,1髓样癌。年龄范围从2周至81岁。男女比例为3.4:1。总的来说,67.4%的病例有肾癌病史,而其余的32.6%首先表现为眼科表现。治疗方式包括眼球摘除,减瘤手术后放疗和/或化疗和/或免疫疗法。
    The most common cause of intraocular mass is metastasis from other tumors. Renal malignancies, though rare, have a substantial number of cases with ocular metastasis, few of which were misdiagnosed. Many a times renal malignancies present with ocular manifestations before the primary diagnosis. Here in this article, we comprehensively reviewed 106 cases of ocular metastasis from renal malignancies published till date to the best of our knowledge. The eye is a rare site for distant metastasis because of the lack of a lymphatic system. The most common ocular structures to get involved in distant metastasis are the uveal tract, i.e., choroid, iris, and ciliary body. The most common renal tumor which metastasizes to eyes is renal cell carcinoma (RCC). RCC accounts for less than 2% of all ophthalmic metastases. Out of total 106 cases, the type of renal malignancy was known in 95 cases only, of which 92 had RCC, 1 Wilm\'s tumor, 1 rhabdoid tumor, and 1 medullary carcinoma. The age ranged widely from 2 weeks old to 81 years old. The male to female ratio was 3.4:1. In total, 67.4% of cases had a previous history of RCC, while the rest 32.6% primarily presented with ophthalmic manifestations first. Treatment modalities included enucleation of the eye, debulking surgery followed by radiotherapy and/or chemotherapy and/or immunotherapy.
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  • 文章类型: Meta-Analysis
    进行荟萃分析,比较二极管激光经巩膜睫状体光凝术(TSCPC)和睫状体疗法(CCT)治疗难治性青光眼的疗效和安全性。OvidMEDLINE的系统搜索,EMBASE,和Cochrane图书馆数据库进行了实验和观察性比较研究。比较TSCPC和CCT疗效和安全性结果。参与者种族的亚组分析,术前眼压(IOP)水平,和青光眼的潜在原因进行了研究。使用随机效应模型计算合并效应。荟萃分析包括9项研究,共668只眼睛。TSCPC组和CCT组眼压降低(IOPR%)无统计学差异,减少抗青光眼药物,有或没有药物的手术成功率,或疗效分析中的再治疗率。在亚组分析中,在非亚洲参与者中,CCT具有更好的降低IOP的作用,而在亚洲参与者中,与TSCPC相比,CCT具有更好的IOPR%。TSCPC和CCT与相似的视力下降率相关,术后视觉模拟量表,等分析术后并发症的安全性分析。在这两组中,严重并发症并不常见.二极管激光TSCPC和CCT治疗难治性青光眼的临床疗效几乎相当,而CCT在非亚洲人群中表现出更好的降低IOP的作用。两种循环破坏程序都具有可比的安全性。
    To perform a meta-analysis to compare the efficacy and safety of diode laser transscleral cyclophotocoagulation (TSCPC) and cyclocryotherapy (CCT) in the treatment of intractable glaucoma. Systemic searches of the Ovid MEDLINE, EMBASE, and Cochrane Library databases yielded experimental and observational comparative studies. TSCPC and CCT efficacy and safety outcomes were compared. Subgroup analyses of participant ethnicity, preoperative intraocular pressure (IOP) level, and underlying causes of glaucoma were conducted. The pooled effects were computed using the random-effects model. The meta-analysis included nine studies totalling 668 eyes. There was no statistically significant difference between the TSCPC and CCT groups in the IOP reduction (IOPR%), decrease in antiglaucoma medications, the operative success rate with or without medications, or retreatment rate in the efficacy analysis. In the subgroup analysis, CCT had a better IOP-lowering effect among non-Asian participants and a non-inferior IOPR% to TSCPC among Asian participants. TSCPC and CCT were associated with similar rates of deterioration in visual acuity, postoperative visual analog scale, and other analysed postoperative complications in the safety analysis. In both groups, severe complications were uncommon. Diode laser TSCPC and CCT had nearly equivalent clinical efficacy in treating intractable glaucoma, while CCT demonstrated a better IOP-lowering effect in non-Asian. Both cyclodestructive procedures have a comparable safety profile.
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  • 文章类型: Journal Article
    我们对文献进行了系统的搜索,以了解睫状体成像的各种方法。
    PubMed,科学直接,全面,系统地搜索了CochraneLibrary和GoogleScholar,以寻找与各种睫状体成像方式相关的研究。
    已经描述的各种睫状体参数是睫状体厚度,睫状体长度,睫状肌厚度,睫状突长度,睫状肌长度,睫状肌前部长度,小梁睫状突距离和虹膜睫状突距离。已经测量的各种角度,在原发性闭角型青光眼(PACG)中最重要的是虹膜睫状角,小梁睫状角,巩膜睫状突角度。各种作者以各种方式定义了它们,但存在细微的差异。高原虹膜和PACG机制,使用超声生物显微镜(UBM)对睫状体进行成像,可以更好地理解不要忘记恶性青光眼。已经描述了睫状体的前段光学相干断层扫描(ASOCT)成像,尽管有其自身的缺点。其他几个领域依赖于睫状体成像的重要性是玻璃体内注射,平坦部玻璃体切除术,可植入结缘晶状体(ICL)的测量,最重要的是,睫状体肿块的区别特征。
    对于睫状体的成像,UBM仍然优于ASOCT。仍然存在许多知识空白,必须在定义所有参数方面达成共识。未来的研究将能够进一步阐明睫状体在本综述中提到的许多眼部疾病中的作用。
    UNASSIGNED: We conducted a systematic search of literature to understand the various methods of imaging of the ciliary body.
    UNASSIGNED: PubMed, Science Direct, Cochrane Library and Google Scholar were searched comprehensively and systematically to find studies related to the various modalities of ciliary body imaging.
    UNASSIGNED: The various ciliary body parameters that have been described are Ciliary body thickness, Ciliary body length, ciliary muscle thickness, ciliary process length, ciliary muscle length, ciliary muscle anterior length, trabecular ciliary process distance and Iris ciliary process distance. The various angles which have been measured, which mostly have a significance in Primary angle closure glaucoma (PACG) are Iris ciliary angle, Trabecular ciliary angle, scleral ciliary process angle. Various authors have defined them in various ways with subtle differences. Plateau iris and PACG mechanisms, not forgetting malignant glaucoma are better understood with imaging of the ciliary body using the ultrasound biomicroscopy (UBM). The anterior segment optical coherence tomography (ASOCT) imaging of the ciliary body has been described albeit with its own disadvantages. A few other fields dependant on the importance of ciliary body imaging are intravitreal injections, pars plana vitrectomy, measurements for implantable collamer lens (ICL) and of utmost importance, the differentiating features of ciliary body masses.
    UNASSIGNED: The UBM is still preferred over the ASOCT for imaging of the ciliary body. A lot of lacunae of knowledge still exists and consensus has to be reached on defining all the parameters universally. Future studies will be able to shed more light on the role of the ciliary body in the many ocular disorders mentioned in this review.
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  • 文章类型: Case Reports
    背景:炎性肌纤维母细胞瘤肿瘤(IMT)是眼内极其罕见的肿瘤。
    方法:在裂隙灯生物显微镜检查下,一名55岁男性首次诊断为白内障,发现睫状体肿瘤。然后,该患者通过部分板层巩膜切除术和par计划玻璃体切除术进行了巩膜切除术,以去除肿块。苏木精和伊红(HE)染色和免疫组织化学结果显示,肿瘤的特征与IMT一致。
    结论:我们报道了一例罕见的眼内IMT,这是由H&E染色证实,和Vimentin的IHC阳性染色,Desmin和ALK,而SMA阴性染色,S-100,ki-67,CK,CD68和calponin。
    BACKGROUND: Inflammatory Myofibroblastoma Tumors (IMTs) are extremely tumour rare in the intraocular.
    METHODS: A ciliary body tumor was found under slit lamp biomicroscopy in a 55-year-old male first diagnosed with cataract. Then this patient underwent trans-sclera resection via partial lamellar sclerouvectomy and par plans vitrectomy to remove the mass. Hematoxylin and eosin (HE) staining and immunohistochemistry findings showed that the characteristics of the tumor were consistent with IMT.
    CONCLUSIONS: We reported a rare case of intraocular IMT, which is confirmed by H&E staining, and IHC positive staining for Vimentin, Desmin and ALK, while negative staining for SMA, S-100, ki-67, CK, CD68, and calponin.
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  • 文章类型: Journal Article
    Metastasis to the eye can involve the choroid (90%), ciliary body (2%), iris (8%), and retina, optic disc, vitreous, and/or lens capsule (<1-4%). The mean number of uveal metastasis per eye (1.7), mean tumour base (11.6 mm) and thickness (3.2 mm), tumour colour (86% yellow), and presence of subretinal fluid (72%), are all clinical features suggestive of the diagnosis. Imaging with ultrasonography demonstrates an echodense mass (80%) and optical coherence tomography shows a \"lumpy bumpy\" choroidal surface (64%), both important diagnostic features. Uveal metastases typically emanate from primary cancer of the breast (37%), lung (27%), kidney (4%), gastrointestinal tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), and other sites (3%). Occasionally, fine needle aspiration biopsy is employed if the primary site is not known. In 16% of cases, the primary site remains unknown. Rarely, metastases affect the retina, vitreous, and lens capsule, most often originating from cutaneous melanoma and in patients previously treated with checkpoint inhibitor therapy. Kaplan-Meier analysis in a series of 1111 patients with uveal metastasis revealed 32% survival at 3 years and 24% at 5 years. Patients with uveal metastasis from carcinoid tumour showed most favourable survival at 5-years (92%), whereas pancreatic and kidney cancer demonstrated least favourable survival (0%). The 5-year survival was better for females (versus (vs.) males) (31% vs. 21%) and older adults (vs. children) (40% vs. 0%). In this review, we examine several large-cohort publications on the topic of ocular metastasis.
    摘要: 肿瘤可以转移至眼的脉络膜(90%), 睫状体(2%), 虹膜(8%)和视网膜, 视盘, 玻璃体和/或晶状体囊(<1–4%)等部位。每只眼脉络膜转移的平均数量为1.7, 平均肿瘤基底部的宽度为11.6 mm, 厚度为3.2 mm, 肿瘤颜色(86%黄色), 视网膜下积液(72%)这些临床特征都是诊断依据。超声成像提示有回声肿块(80%), 光学相干断层扫描(OCT)提示脉络膜表面有“块状隆起” (64%), 为重要的诊断特征。葡萄膜的转移性肿瘤通常来源于乳腺(37%), 肺(27%), 肾(4%), 胃肠道(4%), 皮肤黑色素瘤(2%), 肺类癌(2%), 前列腺(2%), 甲状腺(1%), 胰腺(1%)和其他部位(3%)。少数原发部位未明的眼部转移肿瘤可采用细针穿刺进行活检。在16%的病例中, 转移肿瘤的原发部位仍然未知。在极少数情况下, 转移肿瘤会侵犯视网膜, 玻璃体, 晶状体囊, 这些肿瘤多数来源于皮肤黑色素瘤和既往使用免疫检查点抑制剂治疗过的病人。对1111名有葡萄膜转移肿瘤的病人使用Kaplan-Meier生存分析, 结果提示3年生存率为32%, 5年生存率为24%。其中, 类癌葡萄膜转移的病人5年生存率最高(92%),而前列腺和肾脏来源的葡萄膜肿瘤生存率最低(0%)。女性(vs.男性)(31% vs.21%)和老年人(vs.儿童)(40% vs.0%)的5年生存率更好。在这篇综述中, 我们验证了一些以眼部转移肿瘤为主题的大型队列研究的成果。.
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  • 文章类型: Journal Article
    背景:霍奇金淋巴瘤(HL)是一种以Reed-Sternberg细胞癌为特征的造血肿瘤。与公认的非HL的眼科表现相反,由于与HL的眼科表现有关,因此文献很少。我们对已发表的研究(病例报告和小病例系列)进行了全面审查,以描述HL的眼科表现。
    结论:30例患者被确定为HL的眼科表现。13人(43%)是男性,14例(46%)为女性(3例,未指定性别)。眼科就诊时的中位年龄为27岁。10例(33%)患者在眼科表现后诊断为HL,而11例(36%)病例先前诊断为HL。眼科表现可分为3组;直接浸润,炎症反应,和副肿瘤过程。7例视神经浸润。报告葡萄膜炎性反应21例。在1例肉芽肿性葡萄膜炎中已证实存在眼内Reed-Sternberg细胞。结膜和角膜反应3例。HL处于阶段2或更高,只有1例1A阶段(12例HL阶段未指定)。7例(22%)死于HD,都被诊断为晚期淋巴瘤,没有人接受化疗。
    结论:HL的眼部受累极为罕见。少数经组织病理学证实的视神经/束浸润在HL累及CNS的范围内。炎性葡萄膜炎是HL最常见的眼科关联。在先前已知的HL诊断存在的情况下,应考虑重新分类以排除复发。用于治疗HL的药物的毒性或不良反应也可能导致眼科受累。
    BACKGROUND: Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL.
    CONCLUSIONS: Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy.
    CONCLUSIONS: Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.
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  • 文章类型: Journal Article
    OBJECTIVE: Primary congenital glaucoma (PCG) is a form of childhood glaucoma caused by maldevelopment of the anterior chamber. Disease severity differs greatly amongst patients. Ultrasound biomicroscopy (UBM) is a non-invasive technique that can visualize the anterior segment in infants in vivo. The purpose of this narrative review is to make an overview of the UBM data in PCG and study the applicability of UBM in characterizing the disease.
    METHODS: An online search was performed on PubMed in December 2020. After a critical appraisal of the included articles, study and patient characteristics were summarized. The UBM measurements of the anterior segment in PCG of the different studies were analysed.
    RESULTS: Six studies were included in this review. All were cross-sectional prospective studies. A total of 221 PCG eyes were examined. PCG eyes showed a larger trabecular iris angle, decreased iris thickness, narrower or absent Schlemm\'s canal and an increased zonular length compared to controls. Abnormal tissue membrane covering the trabecular meshwork and abnormal insertion of the iris and ciliary process were frequently found. The success rate of glaucoma surgery depended on the severity of anterior segment malformations found with UBM.
    CONCLUSIONS: Malformations of the anterior segment in PCG can be demonstrated by UBM in vivo. This imaging can help to characterize disease severity and might support surgical treatment decisions.
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  • 文章类型: Journal Article
    Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.
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