AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases wi...AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases with EOM dysplasia between 2004 and 2016 were retrospectively reviewed and clinical data were recorded including family history,age at onset,age at surgery,visual acuity,cycloplegic refraction,ocular alignment and motility,stereoacuity,exophthalmos,anterior segment and fundus,orbital computed tomography(CT)or magnetic resonance imaging(MRI)scan,surgical methods and final outcomes.RESULTS:All 5 cases(1 male,4 females)were unilateral(3 right,2 left eyes).The average age was 5.4y(range 4-6y)with no family history.Patients had unilateral strabismus(horizontal and vertical),restricted eye movement,and eyelid changes(abnormal fissures,lagophthalmos,and/or entropion)in the affected eye.None had proptosis;1 had 2-mm enophthalmos.Orbital CT/MRI showed irregular,ill-defined masses in EOM.Two anterior orbitotomies and 3 strabismus surgeries were performed,and pathology confirmed EOM dysplasia.After surgery,horizontal deviations,which ranged from exotropia(XT)10 prism diopter(PD)to esotropia(ET)10 PD(average 6 PD),decreased by an average of 18 PD,while vertical deviations,which ranged from 4 PD to 20 PD(mean 9.8 PD),decreased by an average of 23.2 PD.CONCLUSION:SOL from EOM dysplasia is non-familial and typically presenting unilaterally characterized by an irregular,diffusely infiltrating mass within the EOM.EOM involvement causes strabismus,restricted eye movement,eyelid changes,and enophthalmos likely due to cicatricial processes.展开更多
AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along w...AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along with patient medical records,were retrospectively collected from 3244 cases.Diagnostic models were constructed using logistic regression(LR),decision tree(DT),support vector machine(SVM),extreme gradient boosting(XGBoost),and deep learning(DL)algorithms.A total of 2757 diplopia images were randomly selected as training data,while the test dataset contained 487 diplopia images.The optimal diagnostic model was evaluated using test set accuracy,confusion matrix,and precision-recall curve(P-R curve).RESULTS:The test set accuracy of the LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.762,0.811,0.818,0.812,0.858 and 0.858,respectively.The accuracy in the training set was 0.785,0.815,0.998,0.965,0.968,and 0.967,respectively.The weighted precision of LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.74,0.77,0.83,0.80,0.85,and 0.85,respectively;weighted recall was 0.76,0.81,0.82,0.81,0.86,and 0.86,respectively;weighted F1 score was 0.74,0.79,0.82,0.80,0.85,and 0.85,respectively.CONCLUSION:In this study,the 7 machine learning algorithms all achieve automatic diagnosis of extraocular muscle palsy.The DL(64 categories)and DL(6 binary classifications)algorithms have a significant advantage over other machine learning algorithms regarding diagnostic accuracy on the test set,with a high level of consistency with clinical diagnoses made by physicians.Therefore,it can be used as a reference for diagnosis.展开更多
AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at Fir...AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.展开更多
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-con...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.展开更多
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 profile...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.展开更多
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 h...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.展开更多
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 C...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.展开更多
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 abdu...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.展开更多
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).METHO...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.展开更多
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...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.展开更多
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...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.展开更多
先天性眼外肌纤维化(congenital fibrosis of extraocular muscles,CFEOM)综合征是一种具有遗传倾向的先天性眼外肌功能障碍性疾病,患者典型表现为先天性非进展性眼外肌麻痹、限制性眼球固定及上睑下垂,发病率为1/23万~1/25万。本文报...先天性眼外肌纤维化(congenital fibrosis of extraocular muscles,CFEOM)综合征是一种具有遗传倾向的先天性眼外肌功能障碍性疾病,患者典型表现为先天性非进展性眼外肌麻痹、限制性眼球固定及上睑下垂,发病率为1/23万~1/25万。本文报告中南大学湘雅二医院收治的1个CFEOM 3型家系,先证者为10岁女性患儿,临床表现为右眼向内偏斜合并右眼上睑下垂。全外显子组测序发现患者在TUBB3基因上发生c.904G>A杂合突变。对家系中其他成员检测的结果提示患者母亲也携带相同突变,表现为左眼眼睑下垂。先后予患儿斜视矫正手术、上睑下垂矫正手术,术后症状得到明显改善。对于出现先天性眼外肌运动障碍及上睑下垂的患者,应高度重视遗传学检测在确诊及家系分析中的价值;同时,个体化的手术干预可显著改善患者的功能及外观。展开更多
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 subje...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.展开更多
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 ...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.展开更多
基金Supported by the National Natural Science Foundation of China(No.81670885).
文摘AIM:To describe the clinical manifestations,imaging features and surgical treatments in 5 cases of extraocular muscle(EOM)dysplasia presenting as orbital spaceoccupying lesions(SOL).METHODS:Records from the 5 cases with EOM dysplasia between 2004 and 2016 were retrospectively reviewed and clinical data were recorded including family history,age at onset,age at surgery,visual acuity,cycloplegic refraction,ocular alignment and motility,stereoacuity,exophthalmos,anterior segment and fundus,orbital computed tomography(CT)or magnetic resonance imaging(MRI)scan,surgical methods and final outcomes.RESULTS:All 5 cases(1 male,4 females)were unilateral(3 right,2 left eyes).The average age was 5.4y(range 4-6y)with no family history.Patients had unilateral strabismus(horizontal and vertical),restricted eye movement,and eyelid changes(abnormal fissures,lagophthalmos,and/or entropion)in the affected eye.None had proptosis;1 had 2-mm enophthalmos.Orbital CT/MRI showed irregular,ill-defined masses in EOM.Two anterior orbitotomies and 3 strabismus surgeries were performed,and pathology confirmed EOM dysplasia.After surgery,horizontal deviations,which ranged from exotropia(XT)10 prism diopter(PD)to esotropia(ET)10 PD(average 6 PD),decreased by an average of 18 PD,while vertical deviations,which ranged from 4 PD to 20 PD(mean 9.8 PD),decreased by an average of 23.2 PD.CONCLUSION:SOL from EOM dysplasia is non-familial and typically presenting unilaterally characterized by an irregular,diffusely infiltrating mass within the EOM.EOM involvement causes strabismus,restricted eye movement,eyelid changes,and enophthalmos likely due to cicatricial processes.
基金Supported by National Natural Science Foundation of China(No.82074524)Harbin Medical University Graduate Research and Practice Innovation Project(No.YJSCX2023-50HYD).
文摘AIM:To develop different machine learning models to train and test diplopia images and data generated by the computerized diplopia test.METHODS:Diplopia images and data generated by computerized diplopia tests,along with patient medical records,were retrospectively collected from 3244 cases.Diagnostic models were constructed using logistic regression(LR),decision tree(DT),support vector machine(SVM),extreme gradient boosting(XGBoost),and deep learning(DL)algorithms.A total of 2757 diplopia images were randomly selected as training data,while the test dataset contained 487 diplopia images.The optimal diagnostic model was evaluated using test set accuracy,confusion matrix,and precision-recall curve(P-R curve).RESULTS:The test set accuracy of the LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.762,0.811,0.818,0.812,0.858 and 0.858,respectively.The accuracy in the training set was 0.785,0.815,0.998,0.965,0.968,and 0.967,respectively.The weighted precision of LR,SVM,DT,XGBoost,DL(64 categories),and DL(6 binary classifications)algorithms was 0.74,0.77,0.83,0.80,0.85,and 0.85,respectively;weighted recall was 0.76,0.81,0.82,0.81,0.86,and 0.86,respectively;weighted F1 score was 0.74,0.79,0.82,0.80,0.85,and 0.85,respectively.CONCLUSION:In this study,the 7 machine learning algorithms all achieve automatic diagnosis of extraocular muscle palsy.The DL(64 categories)and DL(6 binary classifications)algorithms have a significant advantage over other machine learning algorithms regarding diagnostic accuracy on the test set,with a high level of consistency with clinical diagnoses made by physicians.Therefore,it can be used as a reference for diagnosis.
文摘AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.
基金Supported by National Natural Science Foundation of China(No.82070998)Young Scientists Fund of the National Natural Science Foundation of China(No.82101174)+3 种基金Program of Beijing Hospitals Authority(No.XMLX202103)Program of Beijing Municipal Science&Technology Commission(No.Z201100005520044)Capital Health Development Research Special Project(No.2022-1-2053)Beijing Hospitals Authority Youth Programme(No.QML20230205).
文摘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.
文摘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.
基金Supported by the Natural Science Research Foundation of Shaanxi Province,China(No.SJ08C241)
文摘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.
文摘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.
文摘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.
基金Supported by Kocaeli University Scientific Research Projects Unit Fund(No.2019/029)。
文摘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.
文摘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.
文摘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.
基金This work was supported by grants from National Natural Science Foundation of China （No. 30371520） and Funds for Clinical-Basic Cooperation of Capital Medical University （No. 09JL36）.
文摘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.
基金The study was supported by grants from the Beijing Training Project for the Leading Talents in S ＆ T （No. Z141107001514002）, and the Beijing Scholar 2015, and Beijing Municipal Administration of Hospitals＇ Mission Plan （No. SML 20150101 ）, and the Beijing Natural Science Foundation （No.7112030）.
文摘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.
