orbital disease

眼眶疾病
  • 文章类型: Journal Article
    目的:检查临床特征,诊断和治疗,中国人群眼淀粉样变性及预后。
    方法:进行回顾性病例系列研究。收集37例眼淀粉样变性患者的临床资料,诊断和治疗,并对预后进行总结分析。
    结果:37例患者包括12例男性和25例女性,年龄在22至75岁之间。平均年龄49岁。临床体征和症状包括37例患者(100%)的结膜肿块,29例(61.9%)患者的眶周不适或疼痛,18例患者(23.8%),眼球突出或眼球移位3例(14.3%),2例患者眼球运动受限(9.52%),1例患者视力下降(4.76%),复视1例(4.76%)。共有29例患者仅结膜受累,8例患者伴有眼眶和结膜受累。结膜受累患者的主要治疗方法是手术切除。31名患者病情稳定,4名患者进展或复发,2例患者失访。
    结论:眼部淀粉样变性最常见表现为眼睑或结膜肿块或弥漫性增厚,也可表现为眼眶肿块。诊断主要依靠组织病理学检查。手术是主要的治疗方法,为了明确诊断,指导进一步的治疗,保留函数,并防止威胁视力的并发症。术后密切随访是必要的。
    OBJECTIVE: To examine the clinical characteristics, diagnosis and treatment, and prognosis of ocular amyloidosis in a Chinese population.
    METHODS: A retrospective case series study was conducted. The clinical data of 37 patients with ocular amyloidosis were collected and the clinical characteristics, diagnosis and treatment, and prognosis were summarized and analyzed.
    RESULTS: The 37 patients included 12 males and 25 females ranging in age from 22 to 75 years, with median age of 49 years. The clinical signs and symptoms included a conjunctival mass in 37 patients (100%), periorbital discomfort or pain in 29 patients (61.9%), ptosis in 18 patients (23.8%), exophthalmos or eyeball displacement in 3 patients (14.3%), restricted eye movement in 2 patients (9.52%), vision loss in 1 patient (4.76%), and diplopia in 1 patient (4.76%). A total of 29 patients had only conjunctival involvement and 8 patients had concomitant orbital and conjunctival involvement. The main treatment for patients with conjunctival involvement was surgical resection. Thirty-one patients had stable disease, 4 patients progressed or relapsed, and 2 patients were lost to follow-up.
    CONCLUSIONS: Ocular amyloidosis most commonly presents as an eyelid or conjunctival mass or diffuse thickening and can also present as an orbital mass. Diagnosis is mainly dependent on histopathological examination. Surgery is the main treatment and is done to confirm the diagnosis to guide further treatment, preserve function, and prevent complications that threaten visual acuity. Close postoperative follow-up is necessary.
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  • 文章类型: Journal Article
    吸烟是包括白内障和年龄相关性黄斑变性在内的几种眼部疾病的公认危险因素。虽然许多人被告知各种不利的健康影响,关于患者对吸烟与眼病之间关系的认识以及这可能对减少吸烟行为的潜在影响的研究有限。我们的研究结果记录了英国三级眼科单位对吸烟导致失明风险的认识水平低,并强调需要增加眼保健专业人员的参与,同时开展健康运动,教育公众吸烟的后果。
    Smoking is a well-established risk factor for several eye disorders including cataracts and age-related macular degeneration. While many individuals are informed of the various adverse health effects, there is limited research into patients\' awareness of the relationship between smoking and eye disease and the potential impact this might have on reducing smoking behaviour. Our findings document the low level of awareness of the risk of blindness from smoking at a tertiary eye unit in the United Kingdom and highlight the need for increased involvement from eye care professionals, alongside health campaigns to educate the public of this consequence of smoking.
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  • 文章类型: Journal Article
    OBJECTIVE: To analyse the ocular manifestations of patients with GPA, their treatment and outcome.
    METHODS: Retrospective cohort study performed at the National Referral Center for Vasculitis, Cochin Hospital, Paris (France), from January 2005 to December 2015. Among 308 patients with a new diagnosis of GPA in accordance with the American College of Rheumatology classification criteria and/or revised Chapel Hill nomenclature definitions, we identified those with ocular involvement and a subsequent follow up in our center.
    RESULTS: The prevalence of ocular involvement in our GPA series was 38.6%; 63 patients were analysed with a median follow-up of 50.5 months (IQR: 17.8-82.8). Scleritis (18 patients, 28.6%) and episcleritis (18 patients, 28.6%) were the most common ophthalmologic manifestations, followed by orbital disease (13 patients, 20.6%). Bilateral involvement and visual acuity loss was seen in 29.1% and 16.7% of patients, respectively. Ocular involvement was the first GPA manifestation in 9 patients (14.3%), concomitant with systemic manifestation in 36 (57.1%), and occurred only during follow-up in 18 (28.6%). The indication for GPA treatment was suggested by ocular involvement in 12 patients (19.0%), by systemic features in 40 (63.5%) and by both ocular and systemic involvement in 11 (17.5%). Remission of ocular involvement was achieved in 51 patients (80.9%). In the remaining 12 (19.1%), symptoms persisted or even worsened, finally leading to rituximab (RTX) therapy in 8 of them (66.7%). Altogether, when used as first line or for refractory disease, ocular remission was achieved in 11 of the 12 cases (91.7%) treated with RTX versus 34 of the 47 cases (72.3%) treated with CYC (P = .260). Eye disease relapsed in 14 patients (22.2%). RTX allowed achievement of remission in 8 of them (57.1%). In the remaining six, other immunosuppressive drugs were used.
    CONCLUSIONS: Scleritis and episcleritis are the most common ocular manifestations in GPA, most of the time associated with other systemic manifestations. In >40% of cases, ocular manifestations were refractory to initial treatment or recurrent and led to RTX prescription, which appeared to be useful in these situations.
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