眼底荧光血管造影对早期诊断糖尿病性视网膜病变的意义

目的：探讨眼底荧光血管造影对早期诊断糖尿病性视网膜病变的意义。方法选取2010年12月～2012年12月300例（273只眼）糖尿病患者的临床资料,所有患者皆用检眼镜和荧光素眼底血管造影两种检查方法。结果采用检眼镜检出病变数153例,病变率为56.05%;后经荧光素眼底血管造影检查,发现FFA检出病变数251例,病变率为91.94%,荧光素眼底血管造影的诊断正确率较高,两组比较,差异具有统计学意义（P＜0.05）。FFA检查病变种类主要包括非增生性糖尿病性视网膜病变55例,占病变数的21.91%;增生前糖尿病性视网膜病变73例,占29.08%;增生型糖尿病性视网膜病变;65例,占25.91%;糖尿病性黄斑病变35例,占13.94%;糖尿病性视神经乳头病变23例,占9.16%。结论眼底荧光血管造影能对前置镜不能发现的早期糖尿病性视网膜病变做出确诊。     

获得性免疫缺陷综合征患者早期眼底筛查的临床意义

目的探讨获得性免疫缺陷综合征患者早期进行眼底检查的临床意义。 方法92例AIDS患者随机分成两组,观察组与对照组各46例,两组患者均给予常规检查及治疗。观察组患者在常规检查和治疗基础上,还利用眼底彩色照相联合间接检眼镜进行眼底筛查,并比较两组患者的CD4⁺ T细胞计数水平。 结果观察组46例患者中20例（43.48%）眼底正常,16例（34.78%）单眼发病,10例（21.74%）双眼发病,其中14例（30.43%）患者眼底表现棉绒斑,3例（6.52%）患者眼底表现单纯视网膜出血,4例（8.7%）患者眼底表现巨细胞病毒性视网膜炎,5例（10.87%）患者眼底表现结核性视网膜脉络膜炎,分别有12例、2例、3例和4例患者病情得到控制。观察组中不同类型眼底病变患者CD4⁺ T细胞计数水平与对照组患者差异具有统计学意义（P均< 0.05）。与对照组相比,患者眼底病恶化时间平均缩短20%,差异具有统计学意义（F = 6.08、P = 0.048）。 结论眼底彩色照相联合间接检眼镜检查在AIDS患者发病早期可准确筛查出眼底病变,同时检测患者的CD4⁺ T细胞计数水平可为临床教学、科研提供宝贵资料;亦对提高AIDS眼底病患者诊断率,制定针对性治疗方案。     

干扰素治疗慢性丙型肝炎患者所致视网膜病变的特征性分析

目的观察使用干扰素治疗的慢性丙型肝炎（HCV）患者出现视网膜病变的特征。方法接受干扰素治疗后出现视网膜病变的患者共24例纳入研究。所有患者均进行矫正视力、裂隙灯显微镜、散瞳间接检眼镜、眼底彩色照相检查。眼底检查由具有丰富经验的眼底病医生完成。观察所有患者的眼底病变特征。结果本研究24例患者中男性16例,女性8例,男女比例为2：1;年龄21～78岁,平均年龄（48士14）岁。24例患者中有35只眼眼底异常,双眼发病13例,单眼发病11例。12例患者使用后出现视物模糊。眼底检查中：35只患眼中17例23只眼,占患眼的65．7％;眼底表现为单纯棉绒斑,单纯视网膜出血2例2只眼,占忠眼的5．7％;棉绒斑合并视网膜出血8例10只眼,占患眼的28．6％。棉绒斑及出血多位于视盘旁颞上或颞下血管附近,少数可散布于全后极部血管旁;其出血部位多位于棉绒斑旁,表现为后极部火焰状、点状出血或Roth斑。结论干扰素所致眼底视网膜病变最常见的特征为棉绒斑,使用后建议定期随访。     

经睫状体扁平部玻璃体切割手术治疗糖尿病视网膜病变患者玻璃体视盘牵拉的临床观察

目的探讨经睫状体扁平部玻璃体切割手术（PPV）治疗糖尿病视网膜病变患者玻璃体视盘牵拉（VPT）的手术方法和临床疗效。方法选取糖尿病视网膜病变存在VPT的患者298例382只眼,设为VPT患眼;无VPT214眼,设为对照眼。对V胛患眼实施PPV。分别于术前对V胛患眼和对照眼进行最佳矫正视力（BCVA）、裂隙灯、眼底镜、荧光素眼底血管造影（FFA）、经光学相干视网膜断层扫描（OCT）、视觉诱发电位（VEP）及视野等眼科相关检查,术后1个月、3个月时分别对VPT患眼进行复查,分析各组间BCVA、盘沿视网膜厚度、VEP（P100潜伏期、振幅）、视野改变的情况。结果VPT患眼视盘区域损伤严重,主要表现为大片增殖膜,玻璃体腔混浊,视盘隆起视杯变浅或消失等。术前VPT患眼组BCVA、P100潜伏期、盘沿视网膜厚度均高于对照眼组,P—VEP振幅低于对照组,差异具有统计学意义（t=4．51±11．25,P〈0．05或P〈0．01）。术后所有患者玻璃体腔清晰,视盘牵拉解除,视神经纤维贴附,视盘生理凹陷形态逐渐恢复,视网膜脱离者均复位,视野检查生理盲点扩大或向心性缩小情况改善．视力较术前均有2行以上的提高。术前、术后1个月、术后3个月临近两时点比较,BCVA、P100潜伏期、盘沿视网膜厚度均逐渐降低．P—VEP振幅逐渐增高,差异具有统计学意义（t=3．59～9．11,P〈O．05或P〈0．01）。结论糖尿病视网膜病变中玻璃体视盘牵拉综合征的存在具有一定的普遍性和严重性．早期PPV可有效解除玻璃体视网膜交界面的牵拉,恢复视神经的形态和功能,对患者视野、视力具有较好的改善作用,对糖尿病视网膜病变中玻璃体视盘牵拉的早期识别和处理具有一定的指导借鉴意义。     

成人股骨头缺血性坏死患者眼底荧光血管造影的研究

目的探讨早期股骨头缺血性坏死的发病机制及眼底微循环的变化,为早期诊断股骨头缺血性坏死提供一种新的方法。本研究的目的在于了解早期股骨头缺血性坏死患者眼底微循环的变化与早期股骨头坏死发病机制的关系。方法选择2000--2007年我院磁共振确诊的早期股骨头缺血性坏死患者,共40例。40例（共56髋）,拍片并进行Ficat分期,对每一位患者进行荧光素眼底血管造影,拍摄不同时期的眼底照片,分析眼底血管变化。同时以同期40例健康查体者作为对照,用SPSS13．0软件处理所得数据。结果40例股骨头坏死患者中,视网膜微循环均有变化,最常见的视网膜病变为微循环静脉期时间延长及血管渗漏,与对照组40例正常人比较,差异有统计学意义。结论股骨头坏死系全身微循环障碍在股骨头的局部表现,主要为静脉淤滞及渗漏造成;股骨头坏死患者的眼底变化,为诊断早期股骨头坏死患者提供了一种新的办法。     

非动脉炎性前部缺血性视神经病变合并隐匿的视网膜分支静脉阻塞 9 例临床特征观察

目的 观察非动脉炎性前部缺血性视神经病变（NAION）合并隐匿的视网膜分支静脉阻塞（BRVO）患者的临床特征。方法 选取2019年10月-2021年10月天津市眼科医院收治的9例（9眼）确诊为NAION合并隐匿的BRVO患者为研究对象，均行最佳矫正视力（BCVA）、间接检眼镜、视野、荧光素眼底血管造影检查，并给予全身改善循环治疗。观察治疗前后视力、视野缺损MD）及敏感度（MS）变化。结果 9例患者治疗后末次检查BCVA为0.5~1.0，平均BCVA（0.72±0.24），平均MD（9.20±2.35），平均MS（17.87±2.20）；治疗1个疗程后患者视野缺损得到改善，治疗结束后患者视力均提高2行以上，视野较前改善；治疗后随访7个月发现，患者视野已基本恢复。结论 临床对于NAION合并隐匿的BRVO诊断需要借助于FFA检查，经早期积极治疗一般预后良好。     

眼底血管荧光造影在评估视网膜挫伤预后方面临床研究

目的：评价眼底血管荧光造影（FFA）在视网膜挫伤预后评价中的应用。方法选取视网膜挫伤患者51例为研究对象,分别采用视觉诱发电位（VEP）、FFA进行检查,并全部随访51例患者的视力变化。结果挫伤的眼睛其VEP P100波振幅明显降低,潜伏期明显延迟;治疗后VEP P100波振幅、潜伏期均明显改善（P＜0.05）;FFA检查混合性损伤32眼,单纯性损伤19眼,其中38眼表现为视网膜震荡,14眼表现为视网膜出血,5眼表现为脉络膜裂伤,4眼表现为黄斑裂孔,8眼表现为视神经挫伤。治疗后1个月复查眼底血管荧光造影显示,51眼中,视盘渗漏1眼,周边视网膜血管仍有渗漏者3眼,视网膜新生血管未退行1眼。结论VEP、F-ERG及FFA检查均可对眼挫伤患者进行有效的诊断及预后评估,临床应用中可根据患者情况联合或单独应用。     

糖尿病患者眼底检查的时间与病情状况相关性的调查

目的 探讨糖尿病患者眼底检查的时间与糖尿病不同程度之间的相关意义.方法 选择在2009年1月~2011年1月住院治疗的347例（694只眼）2型糖尿病患者的临床资料及所有患者的眼底检测记录.采用自己问卷的方式,对眼底检查到糖尿病确诊的时间,眼科初诊时视网膜病变的情况,受教育程度等资料进行相关性分析.结果 眼底检查距离确诊糖尿病的时间,糖尿病病程越长者相对越晚（P ＜0.05）;眼科查眼底距离确诊糖尿病时间与受教育程度的关系在1～2年,3～5年段明显差异;教育程度高的患者眼科严查较早,有统计学意义（P ＜0.05）.其他两组不具统计学意义（P ＞0.05）.眼底检查距离确诊糖尿病的时间与病程呈显著正相关关系,但眼底检查距离确诊糖尿病的时间与教育程度呈显著负相关关系.结论 糖尿病严重程度越重,视网膜的病变机率越大.尽早确定视网膜的病变程度,来指导糖尿病患者的治疗,有一定的临床意义.     

糖尿病患者眼部首诊视网膜病变程度分析及干预对策

目的了解糖尿病患者首诊眼科时视网膜病变严重程度及原因，提出干预对策，以减缓病情进展。方法查阅765例糖尿病首诊眼部患者眼底血管造影检查结果，自设问卷调查相关原因。结果765例糖尿病患者中视网膜病变程度非增殖期442例（57．8％），增殖期323例（42．2％）。首诊晚的原因主要是缺乏相关知识586例（76．6％）、回避心理374例（48．9％）、内科医生未告知346例（45．2％）、没条件检查264例（34．5％）。结论糖尿病视网膜病变严重程度与患者首诊晚、未定期检查眼底有关，应加强健康教育与服务、早期治疗及制订定期检查计划等防治措施，促进患者康复和减缓病情进展。     

肾性高血压的眼底变化

眼底动脉是全身细小动脉中唯一能直接观察之血管,通过观察眼底血管、视乳头、视网膜、视网膜血管及黄斑部的改变可帮助了解肾脏病变损害的程度。因此眼底检查可作为肾脏病变的一种辅助检查手段。 本组共观察肾性高血压30例,其中男性18例,女性12例,32～40岁9例;41～50岁11例;51～60岁10例。病程0.5～18年。     

A case of atypical idiopathic choroidal effusion syndrome

Uveal effusion syndrome is characterized by annular ciliochoroidal detachment, shifting non-rhegmatogenous retinal detachment, unremarkable inflammation in the anterior eye segment and normal intraocular pressure. A 36-year-old Caucasian hypermetropic male presented in the eye casualty with a week history of curtain like effect in front of his left eye associated with worsening of vision and flashing lights. Left fundus examination revealed retinal detachment with smooth shaped elevation superonasaly and detached retina inferiorly confirmed on ultrasound B-scan with no tobacco dust in the anterior vitreous. Diagnosis of uveal effusion syndrome was made. Lamellar sclerectomies in the two quadrants were performed. Fourteen months postoperatively, the left eye choroidal effusion gradually settled down and at 18 months the retina flattened. Early diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain visual function in such patients.     

Effect of sildenafil on ocular hemodynamics in 3 months regular use

The aim of this study was to evaluate the effect of sildenafil on ocular hemodynamics in a group of men with erectile dysfunction in 3 months regular use. A total of 15 patients with erectile dysfunction were included in this prospective study. All patients received 50 mg doses of sildenafil (Viagra, Pfizer) two times per week regularly for 3 months. The following examinations were performed on both eyes before and after sildenafil treatment: best-corrected visual acuity (BCVA), intraocular pressure (IOP), color vision, anterior segment, and fundus examination. Using color Doppler imaging, we measured hemodynamic variables in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA). No significant changes in BCVA, color vision and IOP were found after sildenafil treatment. The anterior segment and fundus examinations showed no abnormalities. All Doppler parameters of OA, CRA, and SPCA remained nonsignificant for both eyes after sildenafil treatment. Oral sildenafil in 3 months regular use seems to have no effect on ocular hemodynamics.     

Optical coherence tomography impacts the evaluation of visual pathway tumors

The objective of this systematic literature review is to assess the role of retinal optical coherence tomography (OCT) in the evaluation of patients with tumors of the visual pathway. We performed a PubMed database search according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was restricted to articles published in English between 2000 and 2016, with at least 10 human adult participants enrolled. Twenty-seven articles met the eligibility criteria. All studies investigated tumors of the anterior visual pathway. Both time-domain and spectral-domain OCT technologies were used and the role of OCT as diagnostic and/or prognostic tool was studied. Retinal OCT provides structural information about ganglion cell axon integrity and is complementary to visual function examination. OCT is a prognostic factor for post-operative visual outcome.     

Clinical presentation and outcome of chorioretinitis sclopetaria: A case series study

Purpose

To report the clinical presentation, treatment approach and natural course of a series of chorioretinitis sclopetaria patients.

Methods

Thirteen consecutive patients with clinical diagnosis of chorioretinitis sclopetaria were included in a case series study during 2000-2006. All patients underwent clinical examination, including the best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, funduscopy and fundus photography.Three-port standard vitrectomy was performed in two patients due to dense vitreous haemorrhage and suspected retinal detachment in both cases. All patients were followed up at week 4, months 2 and 6 and then every 6 months.

Results

The mean age of the patients was 16 ± 6 (range: 5-27) years and 11 patients (84.6%) were male. The mean follow-up period was 37 ± 18 (range: 17-82) months.Baseline best-corrected visual acuity ranged from no light perception (NLP) to 20/1600, and final visual acuity range was from NLP to 20/1200. Only one patient developed acute retinal detachment, and the retina remained attached in others through follow-up.

Conclusion

In spite of severe retinal and choroidal injuries in chorioretinitis sclopetaria, retinal detachment does not usually occur, probably due to spontaneous retinopexy and scar formation. Whilst dealing with chorioretinitis sclopetaria, it is important to make an accurate diagnosis to prevent unwarranted surgical intervention.     

糖尿病性黄斑水肿的诊断和治疗进展

糖尿病的主要微血管并发症是糖尿病性视网膜病变（DR），DR所导致的视力低下和盲症已成 为影响糖尿病患者恢复的重要因素。糖尿病性黄斑水肿（DME）以影响中心视力为主，可发生在DR的任 何一期。随着对DME发病机制研究的不断深入，在应用眼底彩色照相、光学相干断层扫描（OCT）和传 统激光等对DME进行诊治的同时，多种新兴的检查和治疗方法随之出现。本文将对现有DME的诊断和治 疗方法进行综述，以期对未来DME诊疗提供参考。     

Morphologic and Functional Changes of Macula and Optic Nerve Head in Adult Kidney Transplant Recipient

AimTo assess macular and optic nerve head characteristics in patients after kidney transplantation using noninvasive optical coherence tomography (OCT) imaging.MethodsThe study had a prospective character and was performed during period from November 2019 to November 2020 at the University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina, and included 59 patients with renal graft who underwent OCT. The obtained OCT images, pathologic changes on the fundus, including macula and optic nerve, were analyzed by reviewing nonparametric measures such as scanning laser ophthalmoscope, B-scan, 3D display, as well as parametric measurements such as central macular thickness, optic nerve head excavation, and retinal nerve thickness fiber (RNFL).ResultsThere is a statistically significant difference in RNFL values (P = 0.031) and cup to disc (P = 0.002) ratio in relation to duration of graft. The highest average values of RNFL was in patients with creatinine clearance <30 mL/min, while average cup to disc ratio was lowest in patients with creatinine clearance >60 mL/min.Optic nerve head edema was bilateral in 9 and unilateral in 5 patients. Fundus examination also revealed changes on posterior segment, including retinal detachment (1 patient), bilateral macular edema (9 patients), unilateral macular edema (3 patients), central serous chorioretinopathy (2 patients), and macular pseudo hole (3 patients).ConclusionsDifferent retinal pathology is present in high incidence in patients secondary to renal transplant. Immunosuppressive therapy, older age, and comorbidities are the usual causes of these changes.