Vahdani Kaveh, Rose Geoffrey E
Orbital Service, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2023;39(1):40-43. doi: 10.1097/IOP.0000000000002232. Epub 2022 Jun 14.
The aim of this study was to determine the incidence and recovery rate for pupillary abnormalities after excision of orbital cavernous venous malformations (OCVMs).
Retrospective case-note and imaging review for patients with OCVMs, with an estimation of odds ratios (ORs) in relation to the position of the mass and surgical approach.
The 287 included patients (176 female; 61%) presented at a mean age of 46.5 years: 243/287 (85%) OCVMs were intraconal, 253/287 (88%) located in the posterior two-thirds of the orbit, and 29/287 (11%) wedged tightly in the apex. Pupillary changes-varying from minor sectoral paresis (only evident on slit-lamp examination) to a marked mydriasis-were noted in 21% (60/287) of patients and were strongly associated with removal of intraconal (60/243 [25%]; p < 0.001), apical (14/29 [48%]; OR, 4.3; p < 0.001), inferior or inferotemporal (41/105 [39%]; OR, 5.5; p < 0.001) masses. Lateral approaches-either with (23/129; 18%) or without (30/71; 42%) osteotomy-were associated with 88% (53/60) of all abnormalities (OR, 4.1; p < 0.001). Where known, the abnormalities improved in 43/50 (86%), although 15/43 (35%) had a persistent tonic pupil.
Pupillary abnormalities after excision of OCVMs can occur in up to a quarter of intraconal lesions-particularly those located inferotemporally or inferiorly-and in about a half of apical lesions. Lateral or inferolateral orbital approaches that disrupt the inferior intraconal fat appear to be associated with a higher risk. Most changes resolve or improve markedly, although a third of those affected may have a persistent tonic pupil.
本研究旨在确定眼眶海绵状静脉畸形（OCVM）切除术后瞳孔异常的发生率及恢复率。
对OCVM患者进行回顾性病例记录及影像学检查，评估与肿块位置及手术入路相关的比值比（OR）。
纳入研究的287例患者（176例女性，占61%），平均年龄46.5岁：287例中有243例（85%）OCVM位于肌锥内，287例中有253例（88%）位于眼眶后三分之二，287例中有29例（11%）紧密楔入眶尖。21%（60/287）的患者出现瞳孔变化，从轻微扇形麻痹（仅在裂隙灯检查时明显）到明显瞳孔散大，且与肌锥内（60/243 [25%]；p < 0.001）、眶尖（14/29 [48%]；OR，4.3；p < 0.001）、下方或颞下（41/105 [39%]；OR，5.5；p < 0.001）肿块的切除密切相关。外侧入路（有（23/129；18%）或无（3）眶切开术）与所有异常的88%（53/60）相关（OR，4.1；p < 0.001）。已知的情况下，43/50（86%）的异常情况有所改善，尽管15/43（35%）患者存在持续性强直性瞳孔。
OCVM切除术后瞳孔异常在高达四分之一的肌锥内病变中出现，特别是那些位于颞下或下方的病变，以及约一半的眶尖病变中出现。破坏肌锥内下方脂肪的外侧或颞外侧眼眶入路似乎与较高风险相关。大多数变化会消退或明显改善，尽管三分之一受影响的患者可能会有持续性强直性瞳孔。
