Orbital Service, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2023;39(3):275-280. doi: 10.1097/IOP.0000000000002316. Epub 2023 Jan 18.
To determine the incidence of clinically detectable chorio-retinal folds (CRFs) with orbital cavernous venous malformations (OCVMs) and their recovery.
Retrospective case-note and imaging review, with estimation of odds ratios in relation to the position and volume of the mass.
Records for 402 patients were reviewed, 83 (21%) having CRFs. The mean logarithm of minimum angle of resolution acuity was similar with or without CRFs (0.37 and 0.31, respectively; p = 0.46), but induced hyperopia was commoner with CRFs (76% vs. 12%; p < 0.001), exophthalmos greater (4.52 mm vs. 2.97 mm; p < 0.001), eye movement restriction commoner (37% vs. 21%; p = 0.004), and disc swelling more prevalent (42%, vs. 17%; p < 0.001). Orbital cavernous venous malformations with CRFs were almost all intraconal (98%; odds ratio 9.96; p = 0.002), and 93% (77/83) midorbital (odds ratio 6.02; p < 0.001). The median size with CRFs was twice that of those without (3.85 ml vs. 1.92 ml; p < 0.001), and two-thirds OCVMs with folds had volumes >2.5 ml ( p < 0.001). The OCVM was excised in 76 of 83 (92%) of CRF group and 213 of 319 (67%) of those without ( p < 0.001). The postoperative acuity was improved or unchanged in 67 of 76 (88%) eyes with folds, and 184 of 213 (83%) without CRFs ( p = 0.84). The proportion recovering an acuity within 1 Snellen line (or better than) the unaffected side was 80% with CRFs and 77% in their absence ( p = 0.63). Induced hyperopia persisted in 39% of all patients, with the mean being higher with CRFs (2.22D vs. 1.02D; p = 0.017).
CRFs occur in ~25% of mid-intraconal OCVMs. Despite OCVM excision, 39% of operated patients retain significant residual hyperopia (54% if CRFs present before surgery), and 41% of such CRFs remain clinically detectable after surgery (with variable visual impairment). Earlier surgery might, therefore, be advisable in patients with CRFs and/or induced hyperopia.
确定伴有眼眶海绵状静脉畸形（OCVM）的眼窝脉络膜皱褶（CRFs）的发生率及其恢复情况。
回顾性病例记录和影像学检查，并评估肿块位置和体积与比值比的关系。
共回顾了 402 例患者的记录，其中 83 例（21%）存在 CRFs。有或无 CRFs 的最小分辨角视力对数平均值相似（分别为 0.37 和 0.31；p=0.46），但存在 CRFs 时更容易出现诱导性远视（76% vs. 12%；p<0.001），眼球突出更大（4.52mm vs. 2.97mm；p<0.001），眼运动受限更常见（37% vs. 21%；p=0.004），视盘肿胀更普遍（42% vs. 17%；p<0.001）。伴有 CRFs 的 OCVM 几乎全部位于眶内（98%；比值比 9.96；p=0.002），且 93%（77/83）位于眶中部（比值比 6.02；p<0.001）。伴有 CRFs 的 OCVM 中位数体积是无 CRFs 的两倍（3.85ml vs. 1.92ml；p<0.001），三分之二（2/3）的伴有折叠的 OCVM 体积>2.5ml（p<0.001）。83 例 CRF 组中有 76 例（92%）和 319 例无 CRF 组中有 213 例（67%）行 OCVM 切除术（p<0.001）。折叠眼术后视力改善或不变的有 67 例（88%），无 CRF 的有 184 例（83%）（p=0.84）。在有或无 CRFs 的患者中，有 80%和 77%的患者分别恢复到与未受累侧相同或更好的视力（p=0.63）。所有患者中仍有 39%存在诱导性远视，且伴有 CRFs 的患者的平均远视程度更高（2.22D vs. 1.02D；p=0.017）。
约 25%的中-眶内 OCVM 伴有 CRFs。尽管进行了 OCVM 切除术，但 39%的手术患者仍存在明显的残余远视（如果术前存在 CRFs，则为 54%），且 41%的此类 CRFs 术后仍可临床检测到（伴有不同程度的视力损害）。因此，对于伴有 CRFs 和/或诱导性远视的患者，早期手术可能更为明智。
