ABSTRACT
Objective: To evaluate the efficacy of transconjunctival approach for patients with orbital cavernous hemangiomas, and to understand its relationship with imaging localization. Methods: We retrospectively studied the clinical data of 39 patients with orbital cavernous hemangioma who were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas, the surgical outcomes, and the selection criteria were analyzed. Results: We noticed that all the cavernous hemangiomas in this study were just behind the globe or compressing the globe. CT and MRI showed that all the 39 hemangiomas were located in the muscle cone, round in shape and with well-defined margins. The hemangiomas of 36 patients, which showed slight adhesion and no large draining vein by image examination, were completely resected. One patient with large draining vein was also extirpated completely, but only with visual loss. In the other 2 patients with tight adhesion, most fragments of tumors were removed. The successful rate of operation was 92.3%. The visual acuity increased in 6 of 9 cases with primary visual impairment. All the 32 patients with primary proptosis had their symptoms resolved completely. The treatment outcomes were obvious in 32 (82.1%) patients, remained unchanged in 5 (12.8%) patients, and worsened in 2 (5.1%) patients. Conclusion: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, other approaches must be recommended if the tumor is closely attached to the orbital apex, adheres tightly to the retrobulbar tissues, or with large draining veins.
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Objective To evaluate the efficacy of methylprednisolone pulse therapy in the treatment of thyroid-associated oph- thalmology. Design Meta analysis. Participants Published literatures about methylprednisolone pulse therapy for thyroid-associated ophthalmopathy. Methods A meta-analysis of published randomized clinical trials was used. Published literatures were selected for study based on a computerized search of the literature and a manual search of the bibliographies of relevant papers. Studies meeting se- lected criteria were reviewed systematically by meta-analysis. Data was extracted on the basis of the intention-to-treat principle. Treat- ment effect was measnred as relative risk(RR) of response rates. Main Outcome Measures The effective rate and the relative risk(RR). Results A total of 6 articles were included in this meta-analysis. The RR (95%CI) were 7.50 (1.14, 49.26) when comparing methylpred- nisolone pulse therapy with placebo, 3.33 (0.51, 21.89) when comparing methylprednisolone pulse therapy with surgical decompression, and 1.50 (1.12, 2.00) when comparing methylprednisolone pulse therapy with oral steroids. The combination of methylprednisolone pulse therapy and orbital radiotherapy was significantly effective than oral steroids combined with orbital radiotherapy which pooled RR (95% CI) was 1.42 (1.11, 1.81). Conclusions Methylprednisolone pulse therapy appears to be an effective treatment for thyroid-associated ophthalmology, and seems to have increased effect when given with orbital radiotherapy.
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Objective To investigate the radiologic and angiographic findings of dilated superior ophthalmic vein(SOV)associat- ed with orbital arteriovenous malformations(AVM).Design Retrospective case series.Participants Six cases of orbital AVM patients, with clinical symptoms and signs mimicking a carotid cavernous fistula(CCF).Methods Examinations of the six cases,such as CT, MRI,and selective cerebral angiography,were summarized and analyzed.Main Outcome Measures Images findings and hemodynam- ics.Results All patients were found with dilated SOV on CT and MRI.Additional radiographic findings included proptosis and AVM. All six AVM were located at the orbit,and one of them was also found with AVM in brain.The main draining vein was SOV in all cas- es.The branches contributing to the fistula's blood supply were the middle meningeal artery,the internal maxillary artery,and the oph- thalmic artery.Conclusions Orbital AVM can cause similar clinical signs and radiologic features to those associated with a CCF.How- ever,the bulging cavernous sinus cannot be found in most AVM.Angiography is necessary for definitive management,non-invasive techniques have an important role in pre-angiographic diagnostic decisions.(Ophthalmol CHN,2007,16:395-398)
ABSTRACT
<p><b>BACKGROUND</b>Non-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma.</p><p><b>METHODS</b>The published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis.</p><p><b>RESULTS</b>A total of 37 articles were included in the meta-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7% (95% CI: 58.5% - 81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0% - 71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8% - 85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6% - 86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4% - 74.3%).</p><p><b>CONCLUSIONS</b>Non-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.</p>