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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。
Objective To compare the effect of topical injection of long-acting hormones in the treatment of different types of orbital inflammatory pseudotumor, we selected three different types of orbital inflammatory pseudotumor by local injection of long-acting hormones method to observe and compare the therapeutic effect and side effect. Methods The clinical diagnosis of orbital inflammatory pseudotumor from 1998 to 2004, including ocular muscle type, lacrimal gland type, and orbital idiopathic inflammatory pseudotumor, was recorded before the treatment. The clinical symptoms were recorded in detail and analyzed by ultrasound or CT / MRI and then use local injection of long-acting hormone (triamcinolone acetonide or Corningcom), starting from 20-40mg, repeated 3-4 weeks intervals repeated injection and gradually reduced to stop recording the patient’s symptoms and signs and Do the appropriate imaging examination; during treatment closely observed intraocular pressure in patients with intraocular pressure for intraocular hypotensive drugs or stop local injection. Results A total of 178 eyes were diagnosed as orbital inflammatory pseudotumor in 134 eyes, including 61 eyes of ocular type, 98 of lacrimal gland type and 19 eyes of idiopathic idiopathic trauma. The average follow-up time was 36 months. The average number of intra-abdominal injection was 5.6 (4 -8) times / eye / person; the tumor was obviously dissipated; 124 eyes (69.7%) had disappeared clinical symptoms, including 41 eyes of ocular type, 79 eyes of lacrimal gland type and 4 eyes of idiopathic orbital; (13.5%), including 9 eyes of ocular type, 11 of lacrimal gland type and 4 of idiopathic idiopathic larynx. There were 30 eyes (16.8%) with no improvement, including 11 eyes of ocular type, 8 of lacrimal gland type, Idiopathic 11 eyes. Visual acuity improved or no change in 178 eyes, accounting for 100%; 9 cases of transient elevated intraocular pressure, accounting for 5.1%, after stopping or topical intraocular pressure lowering drugs all returned to normal; local transient bleeding 15 eyes (8.4%), 1 eyeball bleeding (0.6%), visual acuity after emergency surgery. Conclusion Local injection of long-acting hormones is an effective method for the treatment of orbital inflammatory pseudotumor, especially for ocular and lacrimal gland type inflammatory pseudotumor. It has no obvious effect on visual acuity, simple operation and less Systemic side effects caused by the use of hormones; some patients appear intraocular pressure is reversible, positive treatment can return to normal; local bleeding symptomatic treatment.