敬請指教

本人才疏學淺,懇請諸位先進前輩不吝指正。歡迎光臨:空中視力保健室

2007年7月28日 星期六

九宮格方位大考驗

superotemporal

* BRVO → → superotemporal最多
* Congenital tilted disc syndorme → superotemporal disc保持完整,但VF defect也以superotemporal為主(會被混淆為chiasmal lesion)
* Dominaot optic atrophy的VF defect也以superotemporal為主
* Orbital dermolipoma→ 在orbit的superotemporal最多
* Orbital dermoid cyst最常出現在superotemporal,最常在lateral eyebrow
* Lacrimal gland在orbit的superotemporal
* lacrimal gland tumor, prolapsed lacrimal gland可在superotemporal被摸到。
* orbital pseudotumor可在superotemporal被摸到。
* episcelral osseus choristoma→superotemporal最多
* ectopic lacrimal gland→superotemporal最多
* anophthalmic ptosis→源自於sphere migration往superotemporal方向。

* Tube shunt surgery(如Ahmed valve)最理想的擺放位置在superotemporal
* Subtenon injection:prefer在superotemporal quadrant下手


Superonasal

* orbital Rhabdomyosarcoma最常在Superonasal
* capillary hemangioma最常在Superonasal
* orbital tumor: mucoceles, mucopyoceles, encephaloceles, neurofibromas
* ocular trauma最常出現scleral rupture處:Superonasal quadrant靠近limbal處(其它在直肌insertion及equator處也常見)
* 往orbital apex進行optic nerve手術時,prefer由superonasal處下刀(較不易傷到(SOF處的眾多血管及cranial nerves)


superotemporal + superonasal

Orbital dermoid cyst → superotemporal(主) + superonasal
Tube shunt surgery(如Ahmed valve)最理想的擺放位置在superotemporal(空間最大,引流效果最好),其次以superonasal亦可(手術access最容易)。

orbital lymphoma→superotemporal + superonasal


Inferotemporal

* Goldenhar的epibulbar dermoid cyst → Inferotemporal最多
* Typical peripheral cystoid retinoschisis(TPCR)→ Inferotemporal最多(所引起的RD,自然也以inferotemporal為多)。
* Reticular peripheral cystoid retinoschisis(RPCR)→ Inferotemporal最多(有時也在superotemporal quadrant)
* Optic pits → lesion多在 inferotemporal quarant 或 central portion of disc
* expulsive choroid hemorrhage時,不知道出血點在哪,可以直接在* inferotemporal quadrant做sclerotomy for drainage,如果無效,再打其它地方。

* 青少年常出現的benign-lymphoid foillulosis→在inferotemporal fornix最多


Inferonasal

Typical Iris coloboma→只在Inferonasal(若在其它quadrant就叫做atypical)
Congenital Tilted disc syndrome會有Inferonasal crecent of disc
Persisted corneal epithelial defect→只要在inferonasal(或inferior)
Phakomatous choristoma(Zimmermen tumor)→lens epithelium迷路到lower eyelid的Inferonasal處。
Mittendorf's dot→在lens post. capsulre的Inferonasal處。
Congenital lacrimal fistula→Inferonasal to medial canthus
Goblets cells在tarsal conjunctiva及Inferonasal最豐富。
cornea的Inferonasal處若出現puntate epithelial defect,暗示著toxicity


Inf. temporal + Superonasal

ocular trauma之後若發生retinal dialysis→Inf. temporal 或 Superonasal
muscle surgery的incision → Inf. temporal 或 Superonasal


upward

Marfan syndrome的lens subluxation主要以upward方向為主(外上、內上皆有)


downward

Homocystinuria的lens subluxation主要以downward方向為主


眼部的choristoma之中,幾乎都是S-T quadrant(除了limbal dermoid是I-T)

* limbal dermoid → Inferotemporal (很特別!)
* orbital dermoid → superotemporal or superonasal
* Dermolipoma → superotemporal
* episcelral osseus choristoma→superotemporal最多
* ectopic lacrimal gland→superotemporal最多



orbital tumor中,以上半部為主:

Superonasal
* orbital Rhabdomyosarcoma最常在Superonasal
* capillary hemangioma最常在Superonasal
* orbital tumor: mucoceles, mucopyoceles, encephaloceles, neurofibromas

Superotemporal
* Orbital dermolipoma→ 在orbit的superotemporal最多
* Orbital dermoid cyst最常出現在superotemporal,最常在lateral eyebrow
* Lacrimal gland在orbit的superotemporal
* lacrimal gland tumor, prolapsed lacrimal gland可在superotemporal被摸到。
* orbital pseudotumor

Superotemporal+Superonasal
* orbital lymphoma
* orbital dermoid cyst

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