500例妊娠高血压综合征眼底改变临床分析

目的　探讨妊娠高血压综合征 (PIHS)患者的血压、蛋白尿和水肿与眼底改变的关系。方法　回顾性分析眼底改变与 PIHS的血压、蛋白尿、水肿的关系 ,眼底改变用直接眼底镜进行检查。结果　在 5 0 0例患者中 ,眼底正常为 32 2例 (6 4 .4 % ) ,眼底异常 178例 (35 .6 % ) ,在轻、中、重 PIHS患者中其眼底改变的百分比分别为10 .8%、39.8%、5 9.6 % ,而且 PIHS越严重 ,其眼底改变越严重 (P <0 .0 1)。结论　 PIHS眼底改变与 PIHS的血压高低程度相一致 ,而眼底改变越严重 ,蛋白尿、水肿的发生率越高 ,说明眼底改变是反映全身多处器官受损的一项重要指标。     

妊娠期高血压综合征治疗中眼底观察的临床意义

目的:探讨妊娠期高血压综合征患者眼底观察的临床意义。方法:对妊娠期高血压疾病患者产前、产后的眼底观察情况进行分析。结果:患者599例中眼底正常152例(25.4%),眼底改变447例(74.6%),其中妊娠期高血压眼底改变率为63.9%,子痫前期轻度眼底改变率为80.4%,子痫前期重度眼底变率为98.8%,子痫眼底改变率为100%,视网膜病变III期69例中12例合并视网膜脱离。视网膜病变发病率及严重程度与妊娠期高血压综合征疾病程度成正比,血压越高,蛋白尿越高,红细胞压积越高,视网膜病变发生率越高。产后子痫,与重度妊娠期高血压合并视网膜病变有关。结论:眼底观察对判断妊娠期高血压综合征病情程度,制订治疗方案,对防止产后子痫及防止严重视网膜病变都具有重要意义。     

妊娠高血压眼底改变的临床意义

妊娠高血压综合征主要表现为妊娠20周后发生高血压、水肿和蛋白尿症候群,故又称之为水肿、蛋白尿、高血压综合征(简称EPH综合征),严重时可发生抽搐和昏迷,故也称“子痫前期”.此病对孕妇及胎儿威胁很大,为了解其眼底改变的临床意义,本文将近五年来在我院妇产科住院治疗的75例妊娠高血压综合征病人做了眼底检查,并以30例正常妊娠的眼底作对照,现报告如下.     

妊娠性高血压视网膜变化的临床研究

目的:研究妊娠性高血压(PIH)患者视网膜变化的患病率,视网膜变化与疾病严重程度的相关性. 方法:横断面研究.共收集2014-12/2015-05妊娠性高血压患者100例.所有患者均行眼底检查.单眼或双眼眼底发生变化视为阳性.妊娠性高血压分级为轻度子痫前期(血压>140/90~160/90 mmHg),重度子痫前期(血压>160/90 mmHg)和子痫前期(重度子痫前期和抽搐).结果:患者平均年龄为23.05(19~34)岁.妊娠期为28~41wk.其中62例初产妇以及38例经产妇.轻度子痫前期,重度子痫前期和子痫前期患者占比分别为62%,26%,12%.8例患者发生视网膜变化.观察得出:高血压性视网膜病变Ⅰ级(1%),Ⅱ级(0%),Ⅲ级(2%),Ⅳ级(2%),浆液性视网膜脱离(1%)和中心性浆液性脉络膜视网膜病变(2%).视网膜变化与PIH严重程度呈正相关,有统计学意义(P=0.0001).结论:8%的PIH患者视网膜发生变化,视网膜变化与PIH严重程度呈正相关.     

妊娠高血压综合征眼底改变分析及新分级法的建议

妊娠高血压综合症习惯称为妊娠中毒症。近年来国内外妇产科专家意见称为水肿、蛋白尿、高血压综合症(edema-proti-enura-hypertension syndrome 简称EPH综合症)或称妊娠高血压综合症。妊娠高血压综合症(以下简称妊高症)为产科重症之一,常并发眼底改变。眼底检查可反映病情轻重并提供治疗依据。本文通过重度妊高症168例眼底改变的分析,探讨眼底改变发生率以及与高血压、蛋白尿等各因素的关系,并提出新的二级分级方法。     

OCT对妊娠高血压综合征眼底病变的分析

目的 通过光学相干断层扫描（OCT）分析妊娠高血压综合征（简称妊高征）眼底改变的情况,评估OCT在妊高征诊治中的作用。方法 前瞻性研究。对132例（264眼）妊高征患者行眼部检查,包括视力、验光、裂隙灯显微镜、眼底、OCT检查,并将OCT中显示视网膜脱离的情况与患者血压、水肿程度、蛋白尿之间的关系应用卡方检验及Spearman相关进行统计学分析。结果 ①眼底检查示232眼（87.9%）存在妊高征眼底病变,其中Ⅰ期16眼（6.9%）;Ⅱ期31眼（13.4%）;Ⅲ期185眼（79.7%）。②OCT检查有异常172眼（65.2%）,其中视网膜神经上皮层浆液性脱离94眼（54.6%）,色素上皮层及IS/OS层改变40眼（23.3%）,视盘水肿及视网膜出血等改变38眼（22.1%）。③高血压、水肿、蛋白尿是视网膜脱离的危险因素,血压越高,蛋白尿越重,水肿越重,视网膜脱离的风险越高（r=0.156、0.208、0.296,P<0.05）。结论 OCT具有的非接触、非侵入性断层成像技术可为较重的妊高征眼底改变提供客观、准确的检查图像。     

先兆子痫视网膜改变的临床观察

妊娠高血压综合征是产科常见的疾病,也是孕、产妇和围产儿死亡的主要原因之一,尤其是重度妊高征对母婴的危害更大。其基本病理生理变化为全身小动脉痉挛。主要临床特征除高血压、蛋白尿、水肿外,常发生视网膜改变。本文通过对34例先兆子痫眼底观察、初步探讨视网膜改变与高血压、蛋白尿、先兆症状出现时间等因素的关系。     

妊娠高血压综合征眼底改变214例临床分析

作者观察312例妊娠高血压综合征患者的眼底情况，有眼底改变者214例，占68.6%.用二级分级法进行分析。结果提示：血压愈高、蛋白尿程度愈严重、病程愈长，眼底改变的发生率也愈高(P值分别为P<0.01，P<0.01，P<0.01)。眼底改变愈严重，孕产妇的预后愈严重，围产儿的死亡率也愈高(P<0.01)。对二级分级法的临床应用价值进行了重点讨论。 （中华眼底病杂志，1995，11：267-269）     

妊娠高血压综合征患者共焦激光扫描炫彩眼底成像和光相干断层扫描图像特征

目的观察妊娠高血压综合征(PIHS)患者共焦激光扫描炫彩眼底成像(MSLI)和OCT图像特征。方法2016年5月至2017年5月于天津市第一中心医院产科确诊的PIHS患者112例224只眼纳入研究。患者平均年龄(27.00±2.14)岁。平均PIHS病程(15.00±8.27)d。自觉有视物模糊、眼花、视觉疲劳87例174只眼。均行BCVA、直接检眼镜、B型超声、共焦激光扫描检眼镜(cSLO)、频域OCT(SD-OCT)检查。采用德国Heidelberg公司Spectralis HRA+OCT仪行SD-OCT检查,采集断层扫描图像。应用基于cSLO的海德堡炫彩程序,按照标准方法进行操作,1次扫描同时获得基于488 nm的蓝光反射、515 nm绿光反射、820 nm红外反射成像,合成MSLI像。将眼底异常表现分为动脉痉挛期(Ⅰ期)、动脉硬化期(Ⅱ期)、视网膜病变期(Ⅲ期)。根据视网膜形态、厚度等有无异常分为表现正常和异常。结果224只眼中,直接检眼镜检查眼底表现正常68只眼(30.36%);眼底表现异常156只眼(69.64%)。其中,Ⅰ期28只眼(17.95%);Ⅱ期40只眼(25.64%);Ⅲ期88只眼(56.41%)。SD-OCT检查,眼底表现正常36只眼(16.07%);表现异常188只眼(83.93%)。眼底表现异常的188只眼中,视网膜神经上皮层浆液性脱离86只眼(45.74%);RPE层脱离56只眼(29.79%);视盘水肿、隆起及视网膜神经纤维层局部反射增强和(或)厚度增加等46只眼(24.47%)。MSLI像中,眼底表现正常48只眼(21.43%);表现异常176只眼(78.57%)。视网膜水肿、浆液性视网膜神经上皮层和RPE层脱离、视网膜神经纤维层增厚等伴有视网膜局部凸起结构改变在MSLI上以绿色呈现。凸起程度越高,颜色越深。与SD-OCT检查显示的视网膜水肿范围一致。结论PIHS患者MSLI与SD-OCT图像显示的病变高度一致;MSLI可更清晰显示视网膜浅层及深层病变。     

妊娠高血压综合征继发双眼视网膜脱离一例

妊娠高血压综合征（pregnancyinducedhypertension．PIH），多发生于妊娠后期。所有患者均有血压增高及伴随症状，如水肿、蛋白尿和眼底改变等。眼底改变的发生率较高。在眼底改变中以小动脉痉孪和狭窄最常见。视网膜病变次之，合并视网膜脱离的病例较少。我院于2012年6月6日收治PIH继发双眼视网膜脱离l例，现报告如下。     

Fundus changes in pregnancy induced hypertension

AIM: To determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and blood pressure, proteinuria, and severity of the disease. METHODS: All the patients admitted with diagnosis of PIH were included in this study. Age, race, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. After taking history for any eye symptoms, fundus examination was done after dilating the pupils with direct ophthalmoscope in the ward itself. All the findings were noted on a data sheet, and were analyzed using SPSS programme. RESULTS: A total of 78 patients of PIH were examined. Majority (75.6%) were Malays. The mean age of patients was 30.2 years (range 21-45 years). The gestation period ranged from 25 weeks to 41 weeks; 34 (43.5%) were primi gravida. Thirty (38.4%) patients had mild preeclampsia, 46 (59%) had severe preeclampsia and 2 (2.5%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 46 (59%) patients --- grade I in 41 (52.6%) and grade II in 5 (6.4%). Haemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P =0.001), proteinuria (P =0.018) and severity of the PIH (P =0.024). CONCLUSION: Retinal changes (grade I and II hypertensive retinopathy) were seen in 59% of patients with PIH and they were significantly associated with blood pressure, proteinuria and severity of the disease. Fundus examination helps in assessing the severity of PIH.     

妊娠期高血压疾病眼底病变的研究进展

妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)是产科常见的严重并发症。全身小血管痉挛、血管内皮损伤及局部缺血是其基本病理生理变化,进而引起视网膜缺血、缺氧,血管通透性增高而发生HDCP眼底病变,出现视网膜水肿、出血及视网膜脱离等。HDCP眼底病变分为动脉痉挛期、动脉硬化期和视网膜病变期。除眼底像外,OCT可见视网膜厚度及其他结构变化,如多发性浅层视网膜脱离、视网膜外侧高反射亮点、Elschnig斑及脉络膜厚度的改变等。HDCP患者出现眼底病变及与眼底病变严重程度相关的影响因素有血压、血清白蛋白、蛋白尿及尿酸等。出现眼底病变的HDCP患者,低体重儿(<2.5 kg)出生的发生率增加,但其对早产儿视网膜病变的影响尚无定论。(国际眼科纵览,2022,46:351-355)     

Ophthalmological study on the M-strain of stroke-prone spontaneously hypertensive rat (M-SHRSP) (1). Classification of hypertensive fundus changes in M-SHRSP

To differentiate the functional changes from the organic changes in malignant hypertension, the author studied the changes in the blood vessel of ocular fundus by ophthalmoscopical and histopathological methods using malignant strain of stroke-prone spontaneously hypertensive rat (M-SHRSP; Okamoto, K et al., 1986), an animal model of human juvenile malignant hypertension, in which the systolic blood pressure elevates rapidly with age and death appeared by the 15th month of life, if they are untreated. Fundus changes progressed with age and duration of hypertension and they altered from functional changes to organic ones. In M-SHRSPs with age of 8 weeks, systolic blood pressure was 220mmHg or more and retinal arterioles showed generalised narrowing but no dye leakage was recognized by fluorescein angiography (FAG). Dye leakage was observed on the 9th week of age. Death of M-SHRSP appeared, after the 13th week of age, coincidentally with appearance of wide retinal edema. Papilledema appeared often in this period. Little histological change was found in the retinal arterioles in spite of severe and marked ophthalmoscopic changes. No feature of angionecrosis was observed in the retina while it was recognized in choroidal arteriole with thrombosis. The fundus changes in M-SHRSP were ophthalmoscopically classified by using scores as following. Grade 0: normal fundi, Grade I (score 1): slight generalized narrowing, caliber irregularity and tortuosity of the retinal arterioles, slight retinal edema and choroidal changes. Grade II (score 2): moderate generalised narrowing, caliber irregularity, tortuosity of the retinal arterioles, moderate retinal edema and choroidal ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Distribution of pigment epithelium autofluorescence in retinal disease state recorded in vivo and its change over time

· Background: Recently a technique of imaging the retinal pigment epithelium (RPE) has been developed that takes advantages of its intrinsic fluorescence derived from lipofuscin. The purpose of this study was to document the distribution of fundus autofluorescence in patients with various retinal diseases and its change over time. · Methods: The intensity and spatial distribution of fundus autofluorescence was documented in 318 eyes from 159 patients with various retinal diseases using a confocal Laser Scanning Ophthalmoscope. Thirty patients with macular dystrophies and 30 with age-related macular disease underwent serial examinations over a period of 1–3 years in order to monitor the changes over time of fundus autofluorescence. · Results: Absent autofluorescence corresponded well spatially with outer retinal atrophy in eyes with retinitis pigmentosa and rod-cone dystrophy. Abnormally high background autofluorescence was seen in the macular region in some patients with dominant and recessive retinitis pigmentosa and rod-cone dystrophies. In areas of macular edema fundus autofluorescence was abnormal. Fundus autofluorescence showed changes over time in most of the eyes with retinal diseases studied. · Conclusion: Fundus autofluorescence allows documentation of areas of photoreceptor cell loss in eyes with retinitis pigmentosa and rod-cone dystrophies. If abnormal high background autofluorescence in the surviving areas occurs only in some patients with retinitis pigmentosa, the technique may serve to distinguish the regional from the diffuse type of disease. Over time, fundus autofluorescence may demonstrate change or may remain stable. Received: 14 August 1997 Revised version received: 28 January 1998 Accepted: 4 March 1998     

妊娠高血压综合征视网膜病变的临床分析

目的：评价妊高征视网膜病变的临床意义。方法：对120例妊高征患者进行眼底检查，将眼底检查的情况与患者的水肿、蛋白尿、血浆内皮素和病程进行分析。结果：(1)妊高征患者视网膜病变的发病率为91．7％；(2)视网膜病变的发生及严重程度与妊高征患者的高血压、蛋白尿、血浆内皮素水平及病程成正比例关系。结论：眼底检查可以估测病情，作为妊高征的诊断、处理及预后的可靠依据。     

青岛开发区糖尿病性视网膜病变流行病学调查及相关因素

目的:分析青岛市开发区社区人群糖尿病性视网膜病变临床流行病学状况及其早期干预。方法:免费普查社区登记的确诊糖尿病患者600例,进行眼科检查,并对检查结果进行统计学分析,及对确诊为糖尿病性视网膜病变病例进行早期干预及治疗。结果:为600例糖尿病患者进行眼科检查,检出糖尿病性视网膜病变107例,患病率17.8%。并对这107例患者进行眼底荧光造影检查,其中确诊病例中有非增殖期病变者79例(73.8%),增殖期病变28例(26.2%)。对糖尿病病程、血糖控制情况、血压、血脂、糖尿病肾病的相关因素进行分析,在确诊的糖尿病视网膜病变患者中,糖尿病病程<10a者12例(11.2%),>10a者95例(88.8%);合并高血压者75例(70.1%);合并高血脂者66例(61.7%);合并糖尿病肾病者37例(34.5%)。结论:通过分析得出糖尿病病程长、空腹血糖高、合并高血压、高血脂、及糖尿病肾病者均属糖尿病视网膜病变发生的高危人群,高危糖尿患者群的密切监测及定期眼底检查是社区患者防治糖尿病视网膜病变的关键。