Reversible anterior segment ischaemia after carotid endarterectomy

Carotid artery disease has long been implicated in ocular ischaemic syndrome. The classical changes of ocular ischaemic syndrome have not been described to resolve with carotid endarterectomy. Herein, a case of documented carotid artery disease presenting with anterior segment ischaemia and retinal artery emboli is described. Prompt carotid endarterectomy resulted in resolution of most of the anterior segment ischaemic signs within a few days.     

兔眼前段缺血诱发虹膜新生血管的研究

目的 建立兔虹膜新生血管(NVI)模型,检测房水中血管内皮生长因子(VEGF)的质量浓度.方法 5只有色家兔任一眼切断上下内外4条直肌,另一眼作为对照,术后每日在裂隙灯显微镜下观察眼前段炎症反应及新生血管形成情况;术后7 d眼前段血管荧光造影观察荧光素渗漏情况.ELISA法测定术前对照眼和术眼术后4、7、11、14 d房水中VEGF的质量浓度.结果 术后1 d实验眼全结膜充血,房水略混浊;术后3 d房水混浊,可见尘样KP,虹膜表面开始出现新生血管;第7 d所有实验眼虹膜表面均可见新生血管,耳缘静脉注射10%荧光素钠后实验眼房水变绿,30 s后荧光激发眼前段血管荧光造影显示明显的高荧光素渗漏,术后第4 d,房水中的VEGF质量浓度升高,第7 d达高峰,第14 d时较对照眼低.结论 切断兔上下内外4条直肌引起眼前段缺血综合征,能够有效地诱发NVI的形成;房水中VEGF质量浓度随着新生血管的形成先增高后降低,2周时低于正常水平.     

PIGMENTARY GLAUCOMA: A CLINICAL REVIEW OF ANTERIOR SEGMENT PIGMENT DISPERSAL SYNDROME

Sixty-eight cases (44 males, 24 females) of anterior segment pigment dispersal syndrome are reviewed. Five patients had no rise in intraocular pressure, 38 had ocular hypertension and 25 had glaucoma as shown by optic disc cupping and field loss. All cases had heavy deposition of pigment in the drainage angle together with Krukenberg spindles and/or light reflux through the iris. Other evidence of anterior segment pigment dispersal was common. The condition was commonest in young adult males, but could present at any age and in women. Medical treatment was often successful initially, but continued to control pressure in only 17 of 42 patients.
Laser trabeculoplasty helped some patients. Drainage operations of various types were successful in 19 of 23 cases. Iris angiography showed evidence of vascular hypoperfusion of the iris which probably precedes pigment dispersal and suggests that the ultimate aetiology may be a congenital deficiency of the mesodermal support tissues of the iris. Some degree of iris stromal atrophy is also common and may become marked. Pigment dispersal from the pigment epithelium of the iris occurs in susceptible individuals and may be associated with the insertion of the dilator muscle. The term anterior segment pigment dispersal seems appropriate as the condition is limited to the anterior segment.     

Anterior segment fluorescein angiography in the diagnosis of scleral inflammation

Anterior segment fluorescein angiography was performed on 135 patients with scleritis and episcleritis and on several normal subjects. It was confirmed that the coats of the eye anterior to the extraocular muscles derive their blood supply from perforating ciliary vessels. Characteristic patterns were detected which could distinguish the various forms of scleritis and episcleritis. Fluorescein angiography was found to be particularly useful in the detection of those patients who have early, but not clinically recognisable, necrotizing scleritis. The fluorescein angiographic appearances have been used to help to determine whether treatment should be given with nonsteroidal anti-inflammatory drugs, with systemic steroids or other immunosuppressive agents.     

眼前节分析系统房角检查

目的 对眼前节分析系统和裂隙灯显微镜房角镜2种眼前房角检查方法进行比较。方法 对8例16眼的眼前房角分别用眼前节分析系统和裂隙灯显微镜房角镜2种方法进行检查，采用Spaeth分级系统记录结果，采用线性相关和等级相关方法对2种方法所得结果进行统计学分析。结果 2种检查方法在判断房角入口角度、虹膜根部附着点和周边虹膜形态3个方面均有相关性，其中房角入口角度相关性最好；窄角状态时结果一致性较差。结论 眼前节分析系统房角检查基本不受照明光和机械作用干扰，能定量测量房角入口角度，对周边虹膜形态判断准确，信息保存方便，在闭角型青光眼的诊断和疗效评价方面有一定价值。     

Longitudinal study of anterior segment inflammation by ultrasound biomicroscopy in patients with acute anterior uveitis

Purpose: This study aimed to investigate dynamic changes in the anterior segment in patients with acute anterior uveitis (AAU) using ultrasound biomicroscopy (UBM). Methods: Acute anterior uveitis was diagnosed in 18 patients according to history and ocular examinations. Ultrasound biomicroscopy was performed and the results at three time‐points (within 2 weeks of the uveitis attack, and at 2?4 weeks and 6 weeks after it) were analysed. The relationships between clinical manifestations and UBM findings were also evaluated. Results: All investigated AAU patients showed severe ciliary injection, numerous dust keratic precipitates (KPs), aqueous flare and inflammatory cells, and were treated predominantly with corticosteroid and cycloplegic eyedrops. Ultrasound biomicroscopy showed a large number of cells in the anterior and posterior chamber, marked oedema and exudates in and around the iris and ciliary body within 2 weeks of AAU onset. These abnormalities were dramatically improved at 2?4 weeks and almost resolved at 6 weeks and thereafter. Conclusions: Ultrasound biomicroscopy reveals severe inflammatory changes in and around the ciliary body in patients with AAU. These signs rapidly resolve upon treatment.     

EAS-1000型眼前节图像分析系统的临床应用

EAS-1000型眼前节图像分析系统是基于Scheimpflug原理研制的用于研究眼前节参数的光学仪器,采集的生物参数包括房角度数、角膜前曲率半径、角膜厚度、前房深度、晶状体曲率半径、晶状体厚度及晶状体密度等。与以往测量方法比较,优点在于简单快捷,有量化指标,重复性好,图像输入计算机便于分析与交流;缺点是灰白图像分辨力尚难做到更一步的量化。但是,可以预见该系统必将在临床及科研中有着更广泛的应用。     

Diagnostic ultrasound: an aid in the differentiation of anterior segment lesions of the eye

Because the part of the globe in direct contact with the transducer cannot be visualised and focussed transducers have poor imaging qualities at a distance less than 5–8 mm from their surface, diagnostic ultrasound of the anterior eye segment has been treated in a stepmotherly way.With a simplified immersion technique we can visualize quite accurately a variety of pathologic conditions of the cornea, anterior chamber, iris, lens and ciliary body.The B-mode information is superior to the A-mode in this part of the eye.     

25G玻璃体切割系统在眼前节手术中的应用进展

25 G经结膜无缝合玻璃体切割系统的出现,标志着微创玻璃体切割手术取得了突破性进展,该系统在一些眼底疾病的治疗中已取得令人满意的疗效,随着对其不断改进,目前已逐步应用到眼前节手术中,尤其在儿童白内障手术中经角巩膜缘或扁平部行后囊膜切开联合前段玻璃体切割术更突显其微创优势.本文就25 G玻璃体切割系统的工作原理和优点、在眼前节手术中的临床应用及其潜在并发症等作一综述.     

三维前房分析仪对40岁以上人群前房形态测量的初步研究

目的分析三维前房分析仪测量的40岁以上社区人群的前房形态参数。设计横断面调查研究。研究对象对10例受试者作三维前房分析仪重复性检验。连续选取社区40岁以上受试者共92例，分为40～49岁、50～59岁、60～69岁、70岁以上四个年龄组，每组男、女至少10例。方法对10例受试者进行3次重复性前房形态检查，评价前房测量的可重复性。社区受检人群检查包括视力、裂隙灯显微镜、数码眼底照像及前房分析仪检查。凡前房轴深小于2mm者到北京同仁医院接受进一步检查。主要指标前房轴深、前房夹角、前房容积。结果前房轴深、前房夹角、前房容积的平均变异系数分别为0．4％、3．9％、2．6％。前房轴深、前房容积与性别、年龄因素有显著相关性，女性前房轴深较男性浅(P=0．044)、前房容积小(P=0．002)。随年龄增长前房轴深变浅、容积变小。前房夹角与性别、年龄因素无显著相关性。筛查中前房轴深小于2mm者共8例，4例确诊为青光眼。结论前房轴深与前房容积测量的可重复性好，前房夹角检测的可重复性略差。前房轴深、前房容积号性别、年龄因素相关。     

Changes of the vasculature and innervation in the anterior segment of the RCS rat eye

Investigating the anterior eye segment vasculature and innervation of dystrophic RCS rats, two major unique findings were observed: in the iris, young adult animals with retinal dystrophy showed an increase in substance P nerve fibres and a dilation of arterioles and capillaries. This finding continued during ageing. In the pars plana region, the surface covered by venules decreased continuously with age. In older animals, this decrease was parallelled by a local decrease of sympathetic TH-positive nerve fibres supplying these venules. For both conditions, no comparable data exists so far in the literature. They might point to a unique situation in the anterior eye segment of the dystrophic RCS rat.     

Pentacam眼前节检查的护理配合

目的:更好地配合医生完成Pentacam眼前节检查。方法:对280例临床患者进行了Pentacam眼前节检查,检查前了解受检者眼的状态,指导受检者的坐姿,安全散瞳,进行受检眼的固视及瞬目指导,在实际工作中总结该项检查中的护理配合要点和注意事项。结果:在检查前了解检查的目的,受检眼的状态,受检者的坐姿,安全散瞳,重视受检眼的固视及瞬目指导,取得了患者的良好配合,有利于护士顺利配合医生完成该项检查。结论:护士的精确指导和患者的良好配合是Pentacam检查顺利进行的重要保障。     

眼前节图像分析系统与A超测量前房深度及晶状体厚度的比较

目的比较眼前节图像分析系统(EAS-1000)与A超测量前房深度及晶状体厚度的差异,以评价前者在眼前节参数测量中的准确性,为前者的临床应用提供依据。方法对正常人165例(312眼)分别用眼前节图像分析系统与A超测量散瞳前后中央前房深度及晶状体厚度。结果眼前节图像分析系统的测量中央前房深度为(2.80±0.24)mm,A超测量结果为(2.91±0.64)mm,u检验P<0.01,差异有显著性;眼前节图像分析系统的测量散瞳后晶体厚度为(4.18±0.31)mm,A超测量结果为(4.32±0.51)mm,u检验P<0.01,差异有显著性。结论眼前节图像分析系统与A超的测量结果存在一定差异,且在两者所测值的稳定性方面也不相同。     

Indocyanine green anterior segment angiography for studying conjunctival vascular changes after trabeculectomy

Background : The aim of the study was to evaluate the use of indocyanine green (ICG) for angiography of the anterior segment to characterize conjunctival and episcleral vasculature changes after trabeculectomy. Methods : This was a prospective evaluation of anterior segment ICG angiography in 10 eyes of 10 patients undergoing trabeculectomy for the first time. Trabeculectomy was performed with intraoperative sponge application of 5‐ fluorouracil (5 cases) or mitomycin C (5 cases). Anterior segment ICG angiography was performed prior to surgery, then at 2 weeks and 2 months after surgery. Results : With ICG, the anterior segment vessels were well delineated, including deep episcleral veins, which have not been clearly shown in previous angiographic techniques. Late phases of the angiogram could also be studied. The vascular alterations after trabeculectomy noted included loss of vascularity over the bleb area and vascular anastomoses along the perimeter of the avascular bleb. Conclusions : Angiography using ICG has potential as an investigative tool to study the conjunctival and episcleral vasculature changes after trabeculectomy.     

裂隙灯眼前段处理系统在眼科的临床应用

目的:探讨裂隙灯眼前段处理系统在眼科临床工作中的各种实际应用状况及操作技巧。方法:应用配置佳能PowerShotA720IS型数码照相机(1200万像素)SLM型裂隙灯显微镜检查眼部病变情况,并在裂隙灯下根据不同的病变位置,在不同色彩、角度下进行照相(放大倍率×10;×16;×20)。结果:采集不同种类疾病具有代表性照片:眼睑及结膜肿物、结膜裂伤、角膜炎、角膜异物、翼状胬肉、前房积血、前房角异物等如图示。结论:裂隙灯眼前段处理系统的应用为临床医疗文献提供直接定性依据,给患者了解自身病情带来便利,照片直观、经济,在眼科领域的临床应用具有广阔的前景。     

Ultrasound biomicroscopy of the anterior segment of the enucleated chicken eye during accommodation

Ultrasound biomicroscopy produces real-time two-dimensional images of ocular structures measured non-invasively. Given recent work which shows that lenses from myopic eyes show shorter focal lengths and reduced accommodative amplitudes compared with controls, this study was undertaken to determine the structural characteristics of the anterior segment of chicken eyes during accommodation using the ultrasound biomicroscope (UBM). Form-deprivation myopia and hyperopia were induced in hatching chicks by the application of either translucent or +15 D defocus goggles. After 7 days, eyes were enucleated and ultrasound biomicrographs of the eye, at rest and during ciliary nerve-stimulated accommodation, were collected. For all eyes, accommodation was associated with a decrease in anterior chamber depth, an increase in lenticular thickness and a steepening of the front lenticular surface curvature. Changes related to refractive error were more difficult to detect. Myopic eyes showed deeper anterior chamber depths and differences in lenticular thicknesses just above the resolution limit for detection. In +15 D lens-treated eyes, anterior chamber differences were opposite but smaller, just at the limit of resolution, while differences in mean lenticular thickness were not resolvable at a pixel or above. The UBM is a good tool for measuring robust changes during accommodation, but is limited in its ability to detect subtle changes associated with experimentally induced ametropias.     

首次发生急性原发性房角关闭患者发作眼与对侧眼前节生物学参数的对比分析

目的　采用光学相干断层扫描比较首次发生急性原发性房角关闭（ａｃｕｔｅｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅ,ＡＰＡＣ）患者的发作眼与对侧可疑原发性房角关闭（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｓｕｓｐｅｃｔ,ＰＡＣＳ）眼的眼前节生物学参数差异并分析发病相关危险因素。方法　收集２０１３年８月至２０１４年８月于北京协和医院眼科就诊的首次单眼发生ＡＰＡＣ且对侧眼为ＰＡＣＳ的患者共计３０例（发作眼３０眼,对侧眼３０眼）,采用光学相干断层扫描仪测量双眼的中央角膜厚度、瞳孔直径、中央前房深度、晶状体拱高、前房宽度、距离巩膜突５００μｍ和７５０μｍ处的房角开放距离（ａｎｇｌｅｏｐｅｎｄｉｓｔａｎｃｅ,ＡＯＤ５００、ＡＯＤ７５０）及小梁网虹膜间面积（ｔｒａｂｅｃｕｌａｒｉｒｉｓａｒｅａ, ＴＩＳＡ５００、ＴＩＳＡ７５０）、巩膜突角度。采用配对ｔ检验比较双眼各参数之间的差异,条件Ｌｏｇｉｓｔｉｃ回归分析发病相关因素。结果　对侧眼组与发作眼组的中央角膜厚度分别为（５２２．７±３１．３）ｍｍ和（５５７．３±４２．７）ｍｍ,瞳孔直径分别为（２．９０±１．１９）ｍｍ和（３．７８±１．２９）ｍｍ,晶状体拱高分别为（１．０８±０．３６）ｍｍ和（１．２４±０．４２）ｍｍ,发作眼组均较大（均为Ｐ＜０．０１）;中央前房深度分别为（１．８１±０．４５）ｍｍ和（１．６４±０．４４）ｍｍ,ＡＯＤ５００分别为（０．０９７±０．０６５）ｍｍ和（０．０５９±０．０３９）ｍｍ,ＡＯＤ７５０分别为（０．１５７±０．１００）ｍｍ和（０．１２０±０．０６８）ｍｍ,ＴＩＳＡ５００分别为（０．０３６±０．０２１）ｍｍ２和（０．０２０±０．０１６）ｍｍ２,ＴＩＳＡ７５０中位数分别为０．０６５ｍｍ２和０．０４１ｍｍ２,巩膜突角度分别为１１．１３°±６．９２°和６．６８°±４．４３°,发作眼组均较小（均为Ｐ＜０．０５）。条件Ｌｏｇｉｓｔｉｃ回归分析结果显示晶状体拱高的增加与急性房角关闭具有强相关性（ＯＲ＝４０．２５９［１．０２１,１７７９．１９３］,Ｐ＝０．０１４）。结论　晶状体拱高的增加是ＡＰＡＣ发作眼与对侧ＰＡＣＳ眼相比最突出的危险因素,可能在ＰＡＣＳ发展成为ＡＰＡＣ的过程中起关键作用。