局部注射长效激素在不同类型眼眶炎性假瘤治疗中的应用

发布时间：2018-09-05 08:33

【摘要】：目的为了对比局部注射长效激素在治疗不同类型眼眶炎性假瘤中的作用,我们选择三种不同类型的眼眶炎性假瘤采用局部多次注射长效激素的方法,观察并对比治疗效果和副作用。方法本文作者从1998年至2004年收治的临床诊断为眼眶炎性假瘤患者,包括眼肌型、泪腺型和眼眶特发性炎性假瘤,治疗前详细纪录临床症状并进行超声或CT/MRI检查,然后采用局部多次注射长效激素(曲安奈德或康宁克通),从20-40mg开始,间隔3-4周重复注射并逐渐减量至停止,记录患者的症状及体征,并做相应影像学检查;治疗期间严密观测患者眼压,对于眼压增高者给予降眼压药物或者停止局部注射。结果总共收治临床诊断为眼眶炎性假瘤134人178眼,其中眼肌型61眼,泪腺型98眼,眶内特发性19眼;平均随访时间36个月;平均局部注射次数5.6(4-8)次/眼/人;肿物明显消散、临床症状消失者124眼(69.7%),其中眼肌型41眼,泪腺型79眼,眶内特发性4眼;有改善者24眼(13.5%),其中眼肌型9眼,泪腺型11眼,眶内特发性4眼;无明显改善者30眼(16.8%),其中眼肌型11眼,泪腺型8眼,眶内特发性11眼。视力进步或者无变化者178眼,占100%;一过性眼压升高者9眼,占5.1%,停药后或者局部使用降眼压药物后眼压全部恢复正常;局部一过性出血15眼(8.4%),球后出血1眼(0.6%),经急诊手术后视力恢复。结论局部多次注射长效激素是治疗眶内炎性假瘤的一个有效方法,尤其是对眼肌型和泪腺型的炎性假瘤有明显效果;对视力无明显影响,操作简单,减少了全身使用激素造成的毒副作用;部分患者出现的眼压升高是可逆的,积极治疗后均可恢复正常;局部出血可对症治疗。
[Abstract]:Objective to compare the role of local injection of long-acting hormone in the treatment of different types of orbital inflammatory pseudotumor, we choose three different types of orbital inflammatory pseudotumor with local multiple injection of long-acting hormone. The therapeutic effects and side effects were observed and compared. Methods from 1998 to 2004, the patients with orbital inflammatory pseudotumor, including ocular muscle type, lacrimal gland type and orbital idiopathic inflammatory pseudotumor, were diagnosed as orbital inflammatory pseudotumor. Then local injection of long-acting hormone (triamcinolone acetonide or Corning Ketone) was used, starting with 20-40mg, repeated injection at 3-4 weeks interval and gradually reduced to stop. The symptoms and signs of the patients were recorded and the corresponding imaging examinations were made. Intraocular pressure was closely observed during treatment, and hypobaric drugs or local injections were given to those with elevated intraocular pressure. Results A total of 178 eyes of 134 patients were clinically diagnosed as orbital inflammatory pseudotumor, including 61 eyes of ocular muscle type, 98 eyes of lacrimal gland type and 19 eyes of orbital Nate. The average follow-up time was 36 months, the average number of local injections was 5.6 (4-8) times / eye / person, the tumor dissipated obviously. The clinical symptoms disappeared in 124 eyes (69.7%), including 41 eyes of ocular muscle type, 79 eyes of lacrimal gland type, 4 eyes of orbital Nate type, 24 eyes (13.5%) of which were improved, including 9 eyes of ocular muscle type, 11 eyes of lacrimal gland type and 4 eyes of orbital Nate type. There were no obvious improvement in 30 eyes (16.8%), including 11 eyes of ocular muscle type, 8 eyes of lacrimal gland type and 11 eyes of orbital Nate type. Visual acuity improved or unchanged in 178 eyes (100 eyes), transient IOP increased in 9 eyes (5.1%), IOP returned to normal after withdrawal or local use of IOP lowering drugs. Local transient hemorrhage was found in 15 eyes (8.4%) and Retrobulbar hemorrhage in 1 eye (0.6%). Visual acuity was recovered after emergency operation. Conclusion Local multiple injection of long-acting hormone is an effective method for the treatment of intraorbital inflammatory pseudotumor, especially for ocular muscle type and lacrimal gland type inflammatory pseudotumor, but has no obvious effect on visual acuity and is simple to operate. Reduce the toxic side effects caused by the use of hormones throughout the body; some patients appear increased intraocular pressure is reversible, positive treatment can be restored to normal; local hemorrhage can be symptomatic treatment.
【作者单位】：首都医科大学附属北京儿童医院眼科国家儿科学重点学科;首都医科大学同仁医院;
【分类号】：R739.7

【相似文献】