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改良提上睑肌延长术治疗甲状腺相关眼病引起的上睑退缩
Modified levator lengthening for thyroid-associated ophthalmopathy related upper eyelid retraction
 [PDF]

孙静 ,张艺丹 ,刘星彤,钟思思,王洋,周慧芳 #,范先群 #
SUN Jing
, ZHANG Yi-dan, LIU Xing-tong, ZHONG Si-si, WANG Yang, ZHOU Hui-fang#, FAN Xian-qun#

- , 2017, DOI: 10.3969/j.issn.1674-8115.2017.06.009
Abstract: 目的 · 研究旨在改进上睑退缩的手术方式,提高临床疗效。方法 · 选取 2013 年 7 月至 2014 年 12 月在上海交通大学医学院附 属第九人民医院眼科就诊的甲状腺相关眼病引起的上睑退缩 2 ~ 5 mm 的患者,应用改良的提上睑肌延长术进行矫治,观察术后眼部 不适和外观的改善情况。结果 · 共计 34 例 (43 眼 ) 上睑退缩患者接受了改良的提上睑肌延长术,其中男性 7 例,女性 27 例。术后 6 个月,25 例患者上睑退缩完全矫正,9 例患者明显改善;患者睑裂高度平均下降 3.7 mm(P=0.000),眼睑闭合不全、眼部不适、畏光 流泪等症状均获得治愈或改善。结论 · 改良的提上睑肌延长术能够有效矫正上睑退缩,改善患者外观和治疗患者眼部不适。
: Objective · To improve the surgical procedure of correcting upper eyelid retraction. Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People’s Hospital (Shanghai Jiao Tong University School of Medicine, China) from July 2013 to December 2014. Results · Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction, there were 7 males and 27 females. After 6 months, upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases. The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000). Patient’s ocular discomfort such as photophobia and tearing were either cured or improved. Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction, improve the patient's appearance and cure their ocular discomfort
Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis  [cached]
Kang H,Takahashi Y,Iwaki M,Asamura S
Clinical Ophthalmology , 2012,
Abstract: Hyera Kang,1,2 Yasuhiro Takahashi,1 Masayoshi Iwaki,1 Shinichi Asamura,3 Hirohiko Kakizaki,11Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Ophthalmology, Presbyterian Medical Center, Jeonju, Korea; 3Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, JapanAbstract: Patients with Graves' orbitopathy have a higher probability of myasthenia gravis than does the normal population. Overlapping clinical features cause diagnostic confusion in such a situation. We herein report a patient with Graves' orbitopathy and myasthenia gravis (GO-MG) with normal left eyelid height, but in whom upper eyelid retraction was shown after edrophonium chloride administration. Upper eyelid retraction in GO-MG is occasionally masked by a myasthenia effect. The upper eyelid height must be carefully monitored in patients with Graves' orbitopathy to detect the presence of concomitant myasthenia gravis.Keywords: Graves' orbitopathy, myasthenia gravis, eyelid retraction, edrophonium chloride
Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis
Kang H, Takahashi Y, Iwaki M, Asamura S, Kakizaki H
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S29408
Abstract: eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis Case report (1793) Total Article Views Authors: Kang H, Takahashi Y, Iwaki M, Asamura S, Kakizaki H Published Date May 2012 Volume 2012:6 Pages 807 - 810 DOI: http://dx.doi.org/10.2147/OPTH.S29408 Received: 23 December 2011 Accepted: 14 January 2012 Published: 28 May 2012 Hyera Kang,1,2 Yasuhiro Takahashi,1 Masayoshi Iwaki,1 Shinichi Asamura,3 Hirohiko Kakizaki,1 1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Ophthalmology, Presbyterian Medical Center, Jeonju, Korea; 3Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan Abstract: Patients with Graves' orbitopathy have a higher probability of myasthenia gravis than does the normal population. Overlapping clinical features cause diagnostic confusion in such a situation. We herein report a patient with Graves' orbitopathy and myasthenia gravis (GO-MG) with normal left eyelid height, but in whom upper eyelid retraction was shown after edrophonium chloride administration. Upper eyelid retraction in GO-MG is occasionally masked by a myasthenia effect. The upper eyelid height must be carefully monitored in patients with Graves' orbitopathy to detect the presence of concomitant myasthenia gravis.
Toxina botulínica "A" versus cirugía en la retracción palpebral de la orbitopatía tiroidea Botulinum toxin type A versus surgery in the eyelid retraction of thyroid orbitopathy  [cached]
María Cáceres Toledo,Melba Márquez Fernández,Odalys Cáceres Toledo
Revista Cubana de Oftalmolog?-a , 2010,
Abstract: INTRODUCCIóN: La retracción palpebral, es el signo más frecuente de la orbitopatía tiroidea. Se hace este estudio con el objetivo de evaluar los resultados del tratamiento de la retracción, con toxina botulínica A y compararlos con los obtenidos por la cirugía, en casos con la misma severidad clínica de la retracción. MéTODOS: Se realizó un estudio descriptivo y prospectivo, entre diciembre del 2008 a febrero de 2009, en 24 casos con retracción palpebral, divididos en dos grupos, el primero se trató con toxina botulínica A y el segundo con cirugía. RESULTADOS: En los operados con la toxina botulínica A fueron satisfactorios 8 casos (67 %), con retracción ligera y moderada, de estos, 6 en el estadio congestivo de la orbitopatía tiroidea y no satisfactorio en los 4 con retracción moderada y severa, en el estadio crónico y con fibrosis del recto inferior. Los resultados de la cirugía fueron satisfactorios en los 10 pacientes operados (83,3 %). Se muestran los milímetros de retracción antes de la inyección y su reducción en el día 7, 45 y 90. No hubo diferencias significativas, entre los milímetros de retracción corregida, por ambos tratamientos, en casos con similar afectación clínica. CONCLUSIONES: La toxina botulínica A, es una alternativa terapéutica, para la retracción palpebral ligera y moderada en el periodo congestivo de la orbitopatía tiroidea. Ambos tratamientos, corrigieron la misma cantidad de milímetros de retracción palpebral, en los casos con similar afectación. INTRODUCTION: Eyelid retraction is the most frequent sign of Thyroid Orbitopathy (TO). The objective of this study was to evaluate the results of Botulínum Toxin type A (BTA) in its correction and to compare them with those from the surgery in cases with the same clinical severity of the retraction. METHODS: A prospective and descriptive study was performed in 24 patients with eyelid retraction from December 2008 to February 2009; they were divided into two groups, being the first treated with botulinum toxin type A and the second with surgical procedure RESULTS: The results with the BTA were satisfactory in 8 cases (67 %), with slight and moderate retraction, 6 of them were in the congestive stage of the TO. The treatment was unsatisfactory in 4 cases with moderate and severe retraction in the chronic stage and fibrosis of lower rectus. The results of the surgery were satisfactory in the 10 operated patients (83.3 %). The number of retraction millimetres (mm) before the BTA injection and its reduction in the day 7th, 45th and 90th were shown. There were no significant differences in
Stades method for surgical correction of upper eyelid trichiasis-entropion: results and follow-up in 21 cases
Laus, José Luiz;Vicenti, Felipe António Mendes;Bolzan, Aline Adriana;Galera, Paula Diniz;Sanches, Rodrigo Cezar;
Ciência Rural , 2000, DOI: 10.1590/S0103-84782000000400015
Abstract: trichiasis is a condition in which lhe cuia and facial hairs grow toward lhe córnea or the conjunctiva. the hairs arising from normal sites are pointed aí an abnormal direction. this condition may be caused by prominent nasal folds, entropion, blepharospasm, slipped facial mask and dermoids. the upper eyelid trichiasis-entropion with lower eyelid entropionectropion frequentiy occurs in oíder english cocker spaniels. the ocular signs often are epiphora, blepharospasm, conjunctivitis, keratitis and comeal ulceratíon. treatment depenas on the severity ofthe condition and must eliminate the ocular contact by misdirected cuia that irritate the eyeball. this report presents a retrospective study of21 patients with bilateral diffüse trichiasis (15 english cocker spaniels; 2 basset hounds; l bloodhound; l fila brasileiro and 2 mongrel dogs). the procedure described by stades was employed m ali cases. postoperatively, topical chioramphenicol oiníment (qid) was appiied in the conjunctival soe and on the open woundfor 2 weeks. sutures were removed 10 days after surgery. correction ofpositioning ofthe upper eyelid was successfúl and its apposition to córnea was normal. in most of the cases the reepithelialiwtion was complete one month after surgery. no signs ofrecurrence werefound and there appeared to be no loss of normal fünction of the eyelid in the 21 dogs available for follow-up examination in a maximum period of 36 months.
Congenital upper eyelid coloboma with ipsilateral eyebrow hypoplasia  [PDF]
Vulovi? Dejan,Novakovi? Marijan,?arenac Tatjana,Jani?ijevi?-Petrovi? Mirjana
Vojnosanitetski Pregled , 2012, DOI: 10.2298/vsp1209809v
Abstract: Introduction. Coloboma is a Greek word, which describes the defect of all layers of the organ, and it can be congenital or as the result of an injury, operation, or some disease. Congenital upper eyelid coloboma is a rare anomaly, with the unknown incidence. The size of the defect is different, but it always involves all layers of the eyelid. This malformation is more frequent at the upper eyelid, and unilaterally, at the junction of the medial two thirds. Sometimes, it can also involve the eye, and may be a component of many syndromes (Goldenhar, Fraser, Manitoba, CHARGE, Cat eye). Case report. We are describing the case of the upper eyelid coloboma with the rare eyebrow anomaly at the three-month old girl, and the result of reconstruction. The baby was treated conservatively with lubricants and overnight patching. Pentagonal excision of the defect was performed in general anesthesia. Three layers of the eyelid were prepared: the skin, muscle and tarsoconjunctival layer. Because of orbicularis muscle malposition, reinsertion and reposition of the muscle fibres were performed. Then, lateral canthotomy was made and the suture of three layers of the eyelid. Catgut suture 7-0 was used for the conjunctiva and muscle. Nylon 6-0 was used for skin suture. Z-plasty was done on the upper part of the pentagonal excision in order to reduce skin tension at the suture line. The operation lasted about 60 minutes and the hospitalization three days. The occlusive dressing was applied for two days. The stitches were removed after seven days. The postoperative swelling of the upper and lower eyelid disappeared in five days. There were no complications in the postoperative period. Conclusion. The main principle of the treatment of eyelid coloboma is surgical reconstruction of all layers of the eyelid, in optimal period, using different surgical methods, which depends on the size of the defect. An early diagnosis is of the greatest importance, as well as the treatment of associated anomalies. Complications of the upper eyelid coloboma depend on the size of the defect, presence of the eye anomalies and the method of reconstruction.
EVALUATION OF THE DISPORT INJECTION FOR TREATMENT LID RETRACTION IN THYROID OPHTHALMOPATHY VIA SUB-CONJUNCTIVAL APPROACH  [cached]
GR Khataminia,Feghhi M,Sadegian MR,Latify M
Jundishapur Journal of Natural Pharmaceutical Products , 2009,
Abstract: lid retraction is the most common presenting sign of thyroid Ophthalmology, which can cause several ophthalmologic problems such as dry eye, redness, lacrimation, exposure keratitis, and corneal ulcer or blindness. In this study, we evaluated disport injection via sub-conjunctival for management of lid retraction. This study is a prospective, non comparative, interventional case series. The study enrolled 25 patients (38 lids) with lid retraction secondary to thyroid Ophthalmopathy. The disport was injected in sub-conjunctival space at the superior margin of the tarsal plate. One –third of the total dose (10 unite) was administrated in three points of the lid and if eyelid retraction recurs another dose of disport was injected. Patient followed up for 12 months. In this study 8 patients (10 lids) showed improvement with single injection for 12 months or more. Other cases need more than one injection. There was negative correlation between age and satisfactory outcome. So that young patients had the best response, but with increasing age, especially above 50 years, amount and duration of response have decreased. Furthermore, other factors such as sex, duration of the systemic thyroid disease and proptosis lid have no influences on drug effectiveness. Our study shows sub-conjunctival injection of disport provides an effective and safe treatment for eyelid retraction due to thyroid Ophthalmopathy.
Methotrexate for the Treatment of Thyroid Eye Disease  [PDF]
Diego Strianese,Adriana Iuliano,Mariantonia Ferrara,Chiara Comune,Immacolata Baronissi,Pasquale Napolitano,Alessia D’Alessandro,Piergiacomo Grassi,Giulio Bonavolontà,Paola Bonavolontà,Antonio Sinisi,Fausto Tranfa
Journal of Ophthalmology , 2014, DOI: 10.1155/2014/128903
Abstract: Background/Aim. To evaluate the efficacy of methotrexate for the treatment of thyroid eye disease (TED). Methods. 36 consecutive patients with active TED, previously treated with corticosteroids but stopped due to the occurrence of side effects, were commenced on methotrexate therapy. Two different weekly doses were administered depending on the weight of the patient (7.5?mg or 10?mg). Clinical activity score (7-CAS), visual acuity (VA), ocular motility, exophthalmos, and eyelid position were retrospectively evaluated at 3, 6, and 12 months and compared with baseline data. Results. There was a statistically significant improvement in 7-CAS at 3, 6, and 12 months after treatment ( ). There was no significant change in visual acuity. Ocular motility disturbances improved at 6 and 12 months ( ). There was no significant change in exophthalmos (mean 24?mm, SD 3?mm) or eyelid position (marginal reflex distance mean 6?mm, SD 1.5?mm) during the follow-up period. No side effects were registered. Conclusions. Methotrexate therapy is effective in reducing CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. Eventually, it might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids. 1. Introduction Thyroid eye disease (TED) is an autoimmune disease involving the retroocular tissues associated with Graves’ disease [1, 2]. Typical signs and symptoms include proptosis, retroorbital pain, tearing, conjunctival redness and edema, corneal lesions, impaired extraocular motility with or without diplopia, periorbital edema, visual impairment, and, rarely, blindness. Treatment options for TED include immunosuppressive agents, radiotherapy, and various surgical procedures such as orbital decompression, squint surgery, and correction of eyelid retraction [3–5]. Glucocorticoids are still the most widely used immunosuppressive agents for the treatment of TED and appear to be the most effective for associated soft tissue inflammation, optic neuropathy, and extraocular muscle impairment [6, 7]. The main disadvantages of glucocorticoid therapy are the potential recurrence of the disease after discontinuation and the side effects in long-term treatment [7]. Several alternative therapies have been proposed to manage resistant TED such as orbital radiation therapy, several other immunosuppressive agents, and biological drugs. However, the effectiveness of these treatments is still widely debated in the literature [8–15]. The aim of this study is to evaluate
Eye findings and immunological markers in probands and their euthyroid relatives from a single family with multiple cases of thyroid autoimmunity
Melissa Ardley, Thomas McCorquodale, Hooshang Laahooti, Bernard Champion, Jack R Wall
Thyroid Research , 2012, DOI: 10.1186/1756-6614-5-4
Abstract: We determined the prevalences of eye and eyelid signs and positive thyroid and orbital antibody tests in first and second degree relatives from a single family with multiple cases of Graves’ disease, ophthalmopathy and Hashimoto’s thyroiditis.The study cohort comprised 16 subjects from the same family, 4 probands namely, 3 with GD and one with Hashimoto’s thyroiditis and hypothyroidism and 12 of their euthyroid first or second degree relatives. We measured antibodies against calsequestrin (CASQ1) and collagen XIII in an enzyme-linked-immunosorbent assays and TSH-Receptor (TSH-R) antibodies as i) TSH-R binding inhibiting immunoglobulin (TBII) and ii) thyroid stimulating immunoglobulin (TSI). Eye signs were classified and quantified using the clinical activity score (CAS), NOSPECS classes, Nunery types 1 and 2 and the margin-reflex-distance (MRD) as a measure of upper eyelid retraction (UER).Whilst significant ophthalmopathy was uncommon in the relatives, mild eye signs, in particular UER, were demonstrated in about a third of them. The presence of eye signs was moderately, but not significantly, associated with the detection of CASQ1 and collagen XIII antibodies, but not TSH-R antibodies.Our study demonstrates a significant prevalence of positive orbital antibody tests and ophthalmopathy in probands with thyroid autoimmunity and their euthyroid relatives, favouring a role of genetic factors in the development of ophthalmopathy in patients with thyroid autoimmunity.
Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings  [cached]
Patil Surendra,Kale Satish,Jaiswal Sumeet,Khare Nishant
Indian Journal of Plastic Surgery , 2010,
Abstract: Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 Χ 1.5 Χ 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings.
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