彩色多普勒血流显像评价正常眼压性青光眼眼部血供

目的：探讨正常眼压性青光眼与眼部血流的可能关系。方法：用彩色多普勒血流显像检测18例正常眼压性青光眼患眼的眼动脉和视网膜中央动脉血供情况,并与ll例正常人对照。结果：正常眼压性青光眼患眼的眼动脉收缩期峰值流速(Vmax)减少、舒张末期流速(Vmin)减少、搏动指数(PI)减低和阻力指数(RI)增大;视网膜中央动脉的砌与正常人比较差异也有显著性。结论：正常眼压性青光眼的眼部血流动力学异常和局部血管病变可能提示其发病机制。     

彩色多普勒血流显像评价正常眼压性青光眼眼部血供

目的:探讨正常眼压性青光眼与眼部血流的可能关系.方法:用彩色多普勒血流显像检测18例正常眼压性青光眼患眼的眼动脉和视网膜中央动脉血供情况,并与11例正常人对照.结果:正常眼压性青光眼患眼的眼动脉收缩期峰值流速(Vmax)减少、舒张末期流速(Vmin)减少、搏动指数(PI)减低和阻力指数(RI)增大;视网膜中央动脉的RI与正常人比较差异也有显著性.结论:正常眼压性青光眼的眼部血流动力学异常和局部血管病变可能提示其发病机制.     

前部增生性玻璃体视网膜病变与慢性低眼压

前部增生性玻璃体视网膜病变是发生于玻璃体基底部附近的增殖性病变 ,是玻璃体切割术后视网膜再次脱离的主要原因。临床上病情复杂 ,而且常常引起慢性低眼压的发生。本文通过对前部PVR的病理分析 ,综述其引起慢性低眼压的可能发病机制 ,并提出进一步研究这一机制的重要意义。     

青光眼视神经损伤机制的研究进展

青光眼是目前全球范围内致盲性最高的疾病之一,是以进行性视网膜神经节细胞丧失、不可逆的视野损害等病理性改变为特征,最终导致视神经萎缩及视功能丧失的疾病。目前青光眼的发病机制并不完全清楚,其中视神经损伤的机制有多种学说,包括眼压因素及非眼压因素,非眼压因素包括血管因素、免疫作用、远端轴突病变、氧化应激作用、细胞因子的变化及自噬等机制。本文综述了有关青光眼视神经损伤机制的研究进展,为进一步研究青光眼视神经病变提供依据。     

眼球穿通伤玻璃体切除术后低眼压的临床分析

目的:探讨眼球穿通伤玻璃体切除术后,低眼压的发生率和危险因素。方法:对64例70眼因眼球穿通伤而行玻璃体切除术的临床资料进行回顾性分析,低眼压的诊断标准为眼压<5mmHg,并随访时间>6mo。结果:64例70眼因眼球穿通伤而行玻璃体切除术后发生低眼压14眼(20%);其中术前有眼内炎和无眼内炎眼术后低眼压发生率分别为40%和9%,两组之间比较差异有显著性意义(χ2=9.73,P<0.05);行视网膜切开术和未行视网膜切开术后低眼压者发生率分别为58%和12%,两组比较差异有显著性意义(χ2=10.57,P<0.05);前部增生性玻璃体视网膜病变者和无前部增生性玻璃体视网膜病变者术后低眼压者发生率分别为50%和14%,两组比较差异有显著性意义(χ2=6.04,P<0.05)。结论:低眼压是眼球穿通伤玻璃体切除术后的一个并发症,术前有眼内炎,术中行视网膜切开以及严重的前部增生性玻璃体视网膜病变是发生低眼压的危险因素。     

松弛性视网膜切开术治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变

目的探讨松弛性周边视网膜切开术联合眼内激光治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变的效果。方法对４４例视网膜脱离合并严重前增殖性玻璃体视网膜病变的患者行松弛性周边视网膜切开术，联合眼内激光和硅油填充治疗。观察术后视网膜解剖复位、视功能及术后眼压变化情况。其中２２例取出了硅油。结果４４例全部获得视网膜复位（其中８例合并皱褶），３８例获得不同程度的视力改善。２２例取出硅油后，有２１例视网膜保持复位。部分患者术后眼压偏低。１例患者黄斑移位。结论松弛性周边视网膜切开术是治疗严重前增殖性玻璃体视网膜病变的有效方法之一。视网膜下膜的清除有利于视网膜展平复位。部分患者出现术后眼压偏低和黄斑移位现象，因此应严格掌握手术适应证，术中尽可能避免黄斑移位，同时应在视网膜复位、眼压正常时再取出硅油。     

前部增生性玻璃体视网膜病变与慢性低眼压

前部增生性玻璃体视网膜病变是发生于玻璃体基底部的附近的增殖性病变,是玻璃体切割术后视网膜再次脱离的主要原因。临床上病情复杂,而且常常引起慢性低眼压的发生。本文通过对前部ＰＶＲ的病理分析,综述其引起慢性低眼压的可能发病机制,并提出阱一步研究这一机制的重要意义。     

人工晶体植入术后致浆液性黄斑病变

业已报道白内障术后发生眼后节并发症者颇多。如黄斑囊样水肿、视网膜水肿、视网膜出血,进行性老年性黄斑变性、视神经病变,视网膜中央动脉、静脉阻塞,术后低眼压性视网膜病变,黄斑皱褶、视网膜前膜、玻璃体视网膜牵引     

兴奋性氨基酸与青光眼

近年来随着对青光眼性视神经病变机制的深入研究,已证实兴奋性氨基酸与青光眼视网膜神经节细胞凋亡密切相关。21世纪青光眼的治疗模式正从传统的单纯降眼压向降眼压的同时从其他途径进一步加强神经保护转变,基础实验及部分临床研究证实干扰兴奋性氨基酸产生神经毒性的各环节均对神经元有保护作用,由此可以推测通过对兴奋性氨基酸的研究有望实现青光眼治疗史上的重大突破。     

玻璃体内注射曲安奈德治疗糖尿病视网膜病变及其并发症

玻璃体内注射曲安奈德被越来越多地应用于糖尿病视网膜病变中,如糖尿病黄斑水肿、增生性糖尿病性视网膜病变、由增生性糖尿病性视网膜病变引起的新生血管性青光眼和糖尿病性视网膜病变手术后持续性低眼压的并发症等。同时随着应用的日益广泛,其产生的并发症也越来越不容忽视,其并发症主要有眼压升高、眼内感染等。我们总结介绍了玻璃体内注射曲安奈德在糖尿病视网膜病变方面的运用,并就其产生的常见并发症作一扼要综述。     

Ocular decompression retinopathy: A review

Ocular decompression retinopathy (ODR) presents as retinal hemorrhages following acute lowering of the intraocular pressure (IOP). We review 32 articles published from 1992 to 2011 and address the pathogenesis, clinical features, management, and outcomes of ODR. ODR is defined as a multifocal hemorrhagic retinopathy that results from acute lowering of IOP and is not explained by another process. Hemorrhages occur in all retinal layers, and most patients are asymptomatic. The mean drop in IOP in ODR is 33.2 ± 15.8 mm Hg (range, 4–57 mm Hg). Eighty-two percent are diagnosed by the first postoperative day, all within 2 weeks. ODR resolved in a mean of 13 ± 12.4 weeks (range, 2–72 weeks). Vitrectomy was required for vitreous and subhyaloid hemorrhage in 14% of cases. Visual outcomes are generally good, with 85% of eyes returning to baseline vision. Although ODR infrequently results in significant ocular morbidity, gradual reduction in IOP might prevent this complication.     

Ocular decompression retinopathy following post-trabeculectomy suture lysis and management with triamcinolone acetonide

Ocular decompression retinopathy (ODR) is a rare complication of sudden lowering of intraocular pressure (IOP) in glaucoma and ocular hypertension. An 80-year-male, a known case of chronic open-angle glaucoma for 13 years, had his IOP controlled by multiple topical antiglaucoma medications. There was an increase in IOP, progression of optic disc cupping and visual field loss along with cataract over the past 6 months. The patient underwent uneventful phacoemulsification with posterior chamber intraocular lens (PCIOL) and penetrating trabeculectomy. Postoperatively, the trabeculectomy bleb was flat and IOP was 44 mmHg and was not controlled by bleb massage. Bleb needling and suture lysis were performed after 2 weeks. The IOP dropped from 44 to 6 mmHg. Three days later the patient presented with a sudden decline in visual acuity (VA) from 0.5 to 1.225 logMAR. The fundus showed multiple retinal haemorrhages resembling ODR. Choroidal detachment also occurred after 3 weeks. Optical coherence tomography confirmed the presence of macular oedema which was treated with an orbital floor triamcinolone acetonide injection (OFTA). The haemorrhages, choroidal detachment and macular oedema resolved and VA improved in 6 months. This is the first case report of ODR following suture lysis and needling after an uneventful combined phacoemulsification with PCIOL implant and trabeculectomy. It also highlights the role of OFTA injections in the management of ODR.     

多焦视网膜电图及彩色多普勒在糖尿病视网膜病变早期诊断中的应用比较

目的 比较多焦视网膜电图（mfERG）与彩色多普勒在糖尿病视网膜病变（DR）早期诊断中的应用.方法 采用横断面研究,运用mfERLG检测正常对照组22例（22眼）、糖尿病无DR组52例（52眼）及DR单纯期组32例（32眼）.在上述患者中运用彩色多普勒测量视网膜中央动脉（CRA）的血流.采用单因素方差分析方法以及S-N-K法进行统计学分析.结果 糖尿病患者中,无DR组mfERG环1至环3中P1波反应密度低于正常对照组（P＜0.05）;CRA的血流则无异常变化（P＞0.05）.在DR单纯期组,mfERG除上述指标异常以外,Pt波潜伏期也出现延长（P＜0.05）.CRA的流速比正常对照组及无DR组降低（P＜0.05）.结论 在DR的临床早期诊断中,mfERG比彩色多普勒检测CRA血流的方法更敏感.     

Automatic retinal oximetry

PURPOSE: To measure hemoglobin oxygen saturation (SO(2)) in retinal vessels and to test the reproducibility and sensitivity of an automatic spectrophotometric oximeter. METHODS: Specialized software automatically identifies the retinal blood vessels on fundus images, which are obtained with four different wavelengths of light. The software calculates optical density ratios (ODRs) for each vessel. The reproducibility was evaluated by analyzing five repeated measurements of the same vessels. A linear relationship between SO(2) and ODR was assumed and a linear model derived. After calibration, reproducibility and sensitivity were calculated in terms of SO(2). Systemic hyperoxia (n = 16) was induced in healthy volunteers by changing the O(2) concentration in inhaled air from 21% to 100%. RESULTS: The automatic software enhanced reproducibility, and the mean SD for repeated measurements was 3.7% for arterioles and 5.3% venules, in terms of percentage of SO(2) (five repeats, 10 individuals). The model derived for calibration was SO(2) = 125 - 142 . ODR. The arterial SO(2) measured 96% +/- 9% (mean +/- SD) during normoxia and 101% +/- 8% during hyperoxia (n = 16). The difference between normoxia and hyperoxia was significant (P = 0.0027, paired t-test). Corresponding numbers for venules were 55% +/- 14% and 78% +/- 15% (P < 0.0001). SO(2) is displayed as a pseudocolor map drawn on fundus images. CONCLUSIONS: The retinal oximeter is reliable, easy to use, and sensitive to changes in SO(2) when concentration of O(2) in inhaled air is changed.     

Blood pressure and retinopathy in type I diabetes

The relationship between blood pressure and diabetic retinopathy was evaluated in 249 young subjects with type I diabetes. Although hypertension is known to be associated with an increased risk for retinopathy, the effects of high-normal blood pressure are unknown. Retinopathy (158 of 249 subjects, 63%) is considerably more common in a young diabetic population than is hypertension (7 of 249 subjects, 2%). Thus, if blood pressure is important in the etiology or progression of diabetic retinopathy, levels below the hypertensive range (less than 141/90 mmHg) must be considered. The combined effect of hypertension and high-normal blood pressure (greater than 90th percentile but less than 141/90 mmHg) was studied. Elevation in diastolic blood pressure, alone, and in combination with elevated systolic blood pressure, correlated significantly (P less than 0.03) with retinopathy. The presence of high-normal blood pressure resulted in a prospectively higher occurrence of retinopathy and of progression of preexisting retinopathy. Glycohemoglobin (HbA1) and duration of diabetes also correlated with retinopathy. Both good glycemic control and maintenance of diastolic blood pressure below the 90th percentile for age may be important in relation to diabetic retinopathy.     

Glycosylated hemoglobin and monitoring of diabetic retinopathy

The value of glycosylated hemoglobin (HbA1) has been determined in diabetic patients with simple or proliferative retinopathy and in those without retinopathy. The mean value of HbA1 is significantly more highly elevated in patients with retinopathy than in those without retinopathy. Progressive augmentation of the value of HbA1 signifies a risk of deterioration of the retinopathy, whether it is a simple retinopathy or proliferative retinopathy.     

老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

Z–2 aldose reductase allele and diabetic retinopathy in India

Genetic factors have been identified that regulate the severity and the rapidity of onset of retinopathy in diabetic patients. Polymorphisms in (CA) n present upstream of the promoter of the aldose reductase ( ALR2 ) gene have been shown to be associated with retinopathy in different ethnic populations. We aimed to study the association between the (CA) n polymorphism and type 2 diabetic patients with and without retinopathy in the Asian Indian population. We screened 105 diabetic patients with retinopathy (DR) and 109 diabetic patients without retinopathy (DNR) for the (CA) n polymorphism and compared the results with those of an unrelated healthy control group (CT). We identified 13 alleles in our diabetic population. The Z–2 allele (136bp) showed an association with the DR group (13.81%) with a significant p value (p = 0.029) when compared with the DNR group (7.34%). The Z–2 allele also showed a significant association with those DR patients who had proliferative retinopathy (PDR) and maculopathy (MAC) (p = 0.004). The Z–2 allele is, therefore, a high-risk allele for diabetic retinopathy in the Asian Indian patients.     

糖尿病视网膜病变黄斑无血管区图像定量研究

目的：研究糖尿病视网膜病变diabetic retinopathy，DR)患者黄斑无血管区(foveal avascualr zone,FAZ)的大小与形态可发生的改变。 方法：运用计算机图像处理系统，对糖尿病视网膜病变98只眼和健康人120只正常眼的眼底荧光血管造影(fundus fluorescein angiography,FFA)负片进行定量研究．测量FAZ面积与视盘面积的比值。 结果：DR组的FAZ面帜与视盘面积的比值显著大于正常对照组；且增值型DR组的FAZ面积与视盘面积的比值显著大于单纯型DR组．在DR组中，有35只眼的FAZ形态不规则，边缘断裂，周围有微动脉瘤。 结论：DR可出现FAZ面积扩大、形态不规则和边缘断裂，其周围可有微动脉瘤。 （中华眼底病杂志，1995，11：229-231）     

糖尿病神经病变与视网膜病变的相关性研究

目的:探讨糖尿病患者发生微循环障碍时,外周神经病变(DPN)与视网膜病变之间是否有相关性,及二者在2型糖尿病中的危险指数。方法:本研究包括100例(男性51例,女性49例)门诊的糖尿病患者,均为非胰岛素依赖的糖尿病患者(NIDDM),观察患者的外周神经病变及视网膜病变进展情况,随访时间18mo。结果:视网膜病变的患者78.1%同时有外周神经病变,患有外周神经病变的患者79.1%同时有视网膜病变,统计学分析表明外周神经病变与视网膜病变之间并没有明显的相关性。但是,90.9%患有增殖性糖尿病视网膜病变的患者同时有外周神经病变,而27.8%患有视网膜病变的患者同时有外周神经病变,单因素及多因素logistic回归分析均表明它们之间有明显的相关性(r=0.42,P=0.02)。结论:严重的糖尿病视网膜病变与糖尿病性神经病变有相关性。本研究表明糖尿病神经病变可作为糖尿病视网膜病变进程的预警信号,出现神经病变的患者需要更细致广泛的眼科检查,特别是对于病程较长的糖尿病患者。