脉络膜新生血管性疾病光动力疗法治疗后中心视野光敏感度改变

目的 :观察光动力疗法治疗脉络膜新生血管 (choroidalneovascularization ,CNV)性疾病患眼早期中心视野光敏感度的改变。方法 :对 2 3例 (2 3只眼 )经荧光素眼底血管造影及吲哚青绿脉络膜血管造影证实患有脉络膜新生血管性疾病的患者进行PDT治疗 ,其中湿性型老年黄斑变性 16例 (16只眼 ) ,中心性渗出性脉络膜视网膜病变 5例 (5只眼 ) ,高度近视 2例 (2只眼 )。在PDT治疗前及治疗后 3天、7天、1个月及 3个月 ,分别采用瑞士Interzeag公司Octopus10 1型全自动静态视野仪M2黄斑阈值测试程序和 32阈值测试程序 ,对各患眼中心 10°及 30°视野平均敏感度 (meansensitivity ,MS)及平均缺损 (meandefect,MD)进行测定并比较。结果 :PDT治疗后 3个月 ,2只眼 (8 70 % )视力提高≥ 2行 ,其余各眼视力无改变。与PDT治疗前比较 ,治疗后 3天、7天、1个月及 3个月黄斑区 10°MS、MD均无显著性改变 (P >0 0 5 ) ,但 7天、1个月及 3个月中心 30°视野MS较治疗前明显提高 (P <0 0 5 ) ,MD明显下降 (P <0 0 5 )。结论 :PDT治疗CNV性疾病早期可有效改善黄斑区外的视网膜光敏感性     

病理性近视合并脉络膜新生血管患者经光动力疗法治疗后的生存质量研究

目的评价病理性近视合并脉络膜新生血管患者(CNV)经光动力疗法(PDT)治疗后的生存质量。方法对24例(24只眼)伴CNV的病理性近视患者进行PDT治疗,并随访1年。对治疗前后病理性近视患者的最佳矫正视力、生存质量进行统计分析。结果治疗1年后,87.5%的患者视力下降小于3行。治疗后,调查量表中有部分视功能有显著改变。结论PDT治疗能有效阻止伴CNV的高度近视所致的视力严重下降,提高患者的生存质量。     

光动力疗法联合抗血管内皮生长因子药物治疗脉络膜新生血管的进展

脉络膜新生血管( choroidal neovascularization, CNV)是多种眼底病致盲的主要原因,好发于黄斑区,严重影响中心视力。 CNV常用治疗包括相对选择性治疗———光动力疗法( photodynamic therapy, PDT)、选择性治疗———抗血管内皮生长因子( anti-vascular endothelial growth factor, VEGF)药物。但PDT治疗后视力不提高,还可上调VEGF的表达、继发炎症反应;抗VEGF药物需多次注射以维持疗效,进而带来不良反应的风险和经济负担。目前, PDT联合抗VEGF药物治疗CNV在基础与临床研究方面均取得一定进展,使得联合疗法成为 CNV 治疗的选择之一。为了减少治疗后的不良反应,实施联合疗法时是否变更PDT治疗参数需要进一步研究。     

经瞳孔温热疗法治疗病理性近视性脉络膜新生血管的临床观察

目的:观察经瞳孔温热疗法(TTT)治疗病理性近视合并中心凹下脉络膜新生血管(CNV)的疗效.方法:采用半导体810nm红外激光对荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查确诊的高度近视合并CNV患者15例15眼进行治疗.治疗后每月复查1次,随访1～3 mo.随访时检查视力、眼底出血和渗出吸收、CNV闭合情况.结果:15眼治疗后均无即刻视力下降或其他不适.末诊时与初诊视力相比,73.3%无变化,26.7%增加.所有病灶渗漏减少或消失,出血基本吸收,CNV部分闭塞并纤维化.OCT检查激光后CNV厚度变薄.有3例患者3眼脉络膜萎缩灶扩大,2例2眼病灶瘢痕化.结论:TTT对治疗高度近视合并CNV有一定效果,但存在病灶疤痕化及脉络膜萎缩灶较治疗前扩大的问题.     

光动力治疗脉络膜新生血管性疾病观察

目的 观察光动力疗法治疗脉络膜新生血管性疾病的临床疗效及安全性.方法 回顾性分析2010年9月至2012年6月在贵阳医学院附属医院眼科门诊采用维替泊芬光动力疗法(PDT)治疗脉络膜新生血管性疾病50例65只眼的临床效果,比较PDT治疗前后的视力、CNV范围、光学相干断层成像(OCT)、荧光素血管造影(FFA)、吲哚青绿血管造影(ICGA)等图像资料.年龄相关性黄斑变性(AMD) 35例50只眼;中心性渗出性脉络膜视网膜病变(CEC)5例5只眼;息肉状脉络膜血管病变(PCV)4例4只眼;病理性近视(PM)5例5只眼;外伤性脉络膜裂伤CNV1例1只眼.结果 全组50例65只眼PDT治疗后随访观察6个月,视力稳定和提高的AMD30只眼(60.00％)、CEC 4只眼(80.00％)、PCV 2只眼(50.00％)、PM 4只眼(80.00％)、脉络膜裂伤CNV 1只眼(100％);视力下降、CNV渗漏有进展的AMD 20只眼(40.00％)、CEC 1只眼(20.00％)、PCV 2只眼(50.00％)、PM 1只眼(20.00％).经ICGA、FFA检查发现CNV复发的30例30只眼,重复治疗2次的10例10只眼, 3次的3例3只眼.重复治疗时间:1个月者1例1只眼,3个月者8例8只眼,6个月者1例1只眼.所有病例均未见严重的不良反应.结论 PDT对治疗继发于不同病因的黄斑CNV安全、有效,可以减轻CNV的渗漏,延缓视力下降,但治疗后仍有复发需反复治疗.     

光动力疗法治疗渗出型老年性黄斑变性

光动力疗法(PDT)是目前治疗老年性黄斑变性(AMD)的脉络膜新生血管(CNV)较为安全有效的方法。本文综述了适于PDT治疗的CNV的特点和PDT的并发症。其中CNV的类型、病灶大小、位置及活动性对治疗效果影响较大,而对于AMD特殊类型如息肉状脉络膜血管病变和视网膜血管瘤样增生症的治疗方案尚需进一步探索。     

光动力疗法治疗脉络膜新生血管性疾病的多焦视网膜电图改变

目的检测脉络膜新生血管性疾病光动力疗法治疗后早期的多焦视网膜电图改变.方法对16例(17眼)经荧光素眼底血管造影(fundusfluorescein angiography,FFA)及吲哚青绿脉络膜血管造影(indocyanine green angiography,ICGA)证实患有脉络膜新生血管(choroidal neovascularization,CNV)性疾病的患者进行光动力疗法(photodynamic therapy,PDT)治疗.其中湿性型老年黄斑变性(age-related macular degeneration,AMD)11例(12眼),中心性渗出性脉络膜视网膜病变3例(3眼),高度近视2例(2眼).应用美国VERIS scienceTM 4.0视诱发反应图象系统,在PDT治疗前及治疗后3d、7d及3m,对各患眼6个环状视网膜区域的N1、P1波潜伏期和平均反应密度进行检测并比较.结果PDT治疗后7d及3m,2只视力明显提高,其余各眼视力无改变,眼底均未见新的出血.与PDT治疗前比较,治疗后3d、7d及3m各环视网膜区域的N1、P1波潜伏期和振幅密度均无明显改变(P＞0.05).结论PDT治疗CNV性疾病早期可稳定黄斑区功能,未对视网膜外层组织功能产生损伤.     

光动力疗法治疗脉络膜新生血管性疾病后导致的脉络膜低灌注

脉络膜新生血管(CNV)是引起多种眼底疾病视力障碍的主要原因.目前临床上有多种治疗方法,如光动力疗法(PDT)、抗血管内皮生长因子(VEGF)疗法、经瞳孔温热疗法(TTT)等,但都不能彻底治愈CNV,需要重复多次治疗.其中,PDT能特异性封闭CNV,但可引起脉络膜低灌注.就PDT治疗后产生的脉络膜低灌注及其影响和应对措施进行综述,回顾PDT治疗后发生脉络膜低灌注的证据,与临床效果之间的关系,评估联合治疗的作用,讨论使用低照度光动力激光治疗减少低灌注的潜力.     

光动力疗法联合玻璃体腔注射Avastin治疗脉络膜新生血管疗效观察

(P＞0.05).FFA检查18只眼荧光素渗漏消退、明显减弱或不同程度减弱,OCT检查所有患者CNV周围视网膜水肿消失.结论 PDT联合玻璃体腔注射Avastin治疗高度近视脉络膜新生血管疗效较好.能较明显提高视力,促使CNV渗漏停止或减轻,促使视网膜水肿消退或减轻,安全性高.     

重复光动力疗法治疗脉络膜新生血管的疗效观察

光动力疗法(PDT)开展以来,大量治疗结果显示了其针对黄斑部脉络膜新生血管(CNV)治疗的安全性和有效性[1,2],且可重复治疗,副作用小[3],但是,Flower等[4]认为在PDT治疗封闭CNV后,由于脉络膜毛细血管较CNV粗,灌注压高,流速快,常在治疗数周后出现CNV复发,Miller等[5]的研究结果也证实PDT治疗确实具有较高的复发率,因此对于复发的CNV需行重复PDT治疗.我院从2003年开展PDT治疗,其中部分患者因PDT治疗后CNV复发接受了重复治疗,现报告如下.     

Low Concentration Eserine Therapy for the Tonic Pupil (Adie) Syndrome

Very dilute solutions of the reversible anticholinesterase physostigmine salicylate provided varying degrees of symptomatic relief to three of five patients with the tonic pupil (Adie) syndrome. The therapeutic implications of the physiology of denervation supersensitivity and the pathophysiology of the tonic pupil are discussed.     

視網膜色素變性(RP)患者的EOG异常改變

目的探討RP患者眼電圖(EOG)的特徵以及EOG作為評估RP手術療效的客觀指標的可能性.方法采用MVT-3型視覺電生理儀的EOG采集和分析軟件,對正常對照組和RP患者組在術前與術後進行檢測.結果(1)105名RP患者的EOG曲綫大體可分為兩種類型,即彎曲型與平坦型.彎曲型EOG各項參數較接近正常組EOG,該組絕大部分患者的視野為斑駁狀;而平坦型EOG的一些主要參數(如Arden比和G比值等),明顯地低于正常組,該組患者的視野多為管狀視野或視野完全缺損.(2)在進行手術後半年以上復查EOG,則一些主要參數數值增加,有的患者(34.5%)的EOG由平坦型轉變為彎曲型.結倫RP患者的EOG具有為該病所特有的特徵,術後隨主觀癥狀的改善,EOG异常也恢復或部分恢復,這些都可作為該病診斷以及術後療效評估的客觀指標之一.     

视网膜色素变性患者手术治疗45名

目的:评估视网膜色素变性患者的手术疗效。方法:对45名视网膜色素变性患者90眼进行手术治疗,术前和术后分别对这些患者进行了视锐度、自动视野计和三种视觉电生理指标(F-ERG、EOG和P-VEP)的检测。结果:术后3～22月,患者的视锐度得到了明显的改善,视野显著扩大,视野缺损减低。术前在90眼中有73眼(81.1%)的暗视F-ERG为熄灭型,在术后3～22月期间进行复查时,有些曾消失的F-ERG波复现,暗视F-ERG为熄灭型的眼下降至66(73.3%)只(P <0.05, t检验),一些原来残存的F-ERG波的波幅增加,峰潜伏期也缩短。EOG曲线变得更为弯曲,某些EOG的参数(如Arden比和G比值)也明显的增加(P <0.05, t检验)。用棋盘格翻转刺激中央6о视野时能够记录到P-VEP的患者数目,在45例中由术前的22例在术后增加到31例。这45例的残存P100波的平均振幅由术前的1.007μV增加到术后的2.236μV,有显著的统计学差异(P<0.005, t检验)。结论:手术治疗RP是有效和安全的,并能改善患者的视觉和阻止RP病程的发展。     

成人弱视治疗和黄斑光相干断层扫描检查

目的探讨成人弱视治疗效果及成人视细胞仍具有可朔性的依据。方法对一组成人弱视患者43例50眼治疗前后做黄斑光相干断层扫描(OCT)检查,观察、比较治疗前后黄斑OCT像情况。弱视采取综合治疗方法。结果43例中38例患者OCT示黄斑结构正常,治疗前后无变化。另5例7眼OCT像示黄斑神经上皮层异常增厚,中心凹形成不良。其中的2例3眼经弱视治疗后黄斑神经上皮层变薄,中心凹明显,视力均有进步;3例4眼OCT像无变化,包括其中1例1眼视力有进步的情况。42例成人患者的弱视疗效观察,治愈24%,进步54%,无效22%,总有效率78%。结论成人视细胞仍具有一定程度可朔性,可根据OCT检查所显示黄斑情况试行弱视治疗。     

Application of the Metaireau tube (M-tube) in conjunctivodacryocystorhinostomy (CDCR)

PurposeA new tube, Metaireau tube (M-tube), was examined for its proficiency, durability, and safety for use in conjunctivodacryocystorhinostomy (CDCR). The frequent complications associated with this procedure and Jones tubes, such as tube migration, pyogenic granuloma, and tube obstruction, were particularly checked.MethodsThe study was a retrospective interventional case series conducted at a single institution between January 2009 and October 2012. An M-tube was used in 13 cases of external CDCR and four endoscopic CDCR. Ten cases were females and seven were males. Patients aged from 20 years old to 82 years old, mean 52.7 years. Six cases were complicated traumatic canalicular laceration. Five cases were replacement of lost or dislocated Jones tubes. The M-tube is flexible and slick. The tube length that remains in the nasal cavity is adjustable by scissor trimming with endoscopic observation.ResultsThe surgery was uneventful. The tear drainage function works well when the tube is in situ. Twelve cases developed dry eye requiring artificial tear postoperatively. Nasal migration of the tube is frequently encountered in the early postoperative period (5/17, 29.4%). Reposition is easy using an endoscope. The tube is pulled out from the nose and replaced in the original tract. Mild tube extrusion occurred in one case without epiphora. Granuloma developed in one case. The follow-up took place from 2 months to 36 months, mean 21.6 months.ConclusionThe M-tube is easy to use in either external or endoscopic CDCR. When dislocated, the tube is simple to reposition. Frequent follow-up in the postoperative 6 months is suggested for early detection of minor migration.     

Laserassistierte subepitheliale Keratektomie (LasEk)

Zusammenfassung Der vorliegende Beitrag bietet eine Übersicht über den aktuellen Kenntnisstand zu den Ergebnissen und Techniken der laserassistierten subepithelialen Keratektomie (LasEk). Die wenigen verfügbaren klinischen und experimentellen Studien zu dieser neuen Technik werden kritisch analysiert. Es wird außerdem der Frage nachgegangen, inwieweit hinsichtlich der Indikationsstellung eine Abgrenzung zur photorefraktiven Keratektomie (PRK) und Laser-in-situ-Keratomileusis (Lasik) sinnvoll erscheint. Dabei sind die persönlichen Ansichten und klinisch-wissenschaftlichen Erfahrungen der Autoren mit den angesprochenen Techniken in diesen Beitrag mit eingeflossen.

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Optical coherence tomography (OCT) in idiopathic polypoidal choroidal vasculopathy (IPCV)

Purpose: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a distinct clinical entity characterized by an edematous maculopathy and typical choroidal vascular change. The purpose of this study is to evaluate the use of optical coherence tomography (OCT) for diagnosing of this disease. Methods: 4 patients affected by IPVC (mean age 71–84 years) underwent biomicroscopy with a three mirror conctact lens, fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT (Humphrey Zeiss) scan. Results: in all 4 cases OCT tomograms acquired at the location of the typical choroidal abnormalities demonstrated by ICGA, revealed a characteristic hyper-reflectivity in the choroidal layers. Conclusion: ICGA is essential to diagnose IPVC, but OCT may be able to identify characteristic reflectivity patterns. This revised version was published online in July 2006 with corrections to the Cover Date.     

Treatment Options for Juvenile Idiopathic Arthritis (JIA) Associated Uveitis

Purpose: To summarize the available published data regarding the treatment of JIA-associated chronic uveitis.

Methods: Available peer-reviewed publications regarding the treatments of JIA-associated uveitis were read by multiple authors (RMA, EM, JET, and DH) and the data from these reports were synthesized for this review.

Results: Juvenile idiopathic arthritis (JIA)-associated chronic uveitis is a significant cause of ocular morbidity and visual impairment in children, often resulting in more frequent complications and worse visual outcomes than other types of pediatric uveitis. Since not all patients respond to the first medication introduced, it is useful to have a wide range of available treatment modalities to address recalcitrant disease. Treatment options for JIA-associated uveitis have increased substantially over the past decade, particularly with the availability of newer biological agents in addition to established medication classes such as anti-inflammatories (including topical and systemic corticosteroids) and antimetabolites.

Conclusions: Although data are increasing regarding biologic agents, definitive randomized prospective clinical trials would be helpful to determine their optimal dose, frequency, treatment duration, and long-term safety in children.     

Comparative antiproliferative and cytotoxic profile of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on different ocular cells

Aim To compare the antiproliferative and cytotoxic properties of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on human retinal pigment epithelium (ARPE19) cells, rat retinal ganglion cells (RGC5) and pig choroidal endothelial cells (CEC). Methods Monolayer cultures of ARPE19, RGC5 and CEC were used. Bevacizumab (0.1–0.3 mg/ml), pegaptanib (0.025–0.08 mg/ml) or ranibizumab (0.04–0.125 mg/ml) diluted in culture medium were added to the cells. Expression of VEGF-receptors (VEGFR1 and VEGFR2) and von Willebrand factor (a marker for endothelial cells) were analysed by immunohistochemistry. CEC cells were stimulated with VEGF. Cellular proliferative activity was monitored by BrdU-incorporation into cellular DNA. For cytotoxicity assays cells were grown to confluence and then cultured in a serum-depleted medium to ensure a static milieu. MTT-test was performed after one day. Results CEC and ARPE19 cells stained positively for VEGFR1 and VEGFR2. More than 95% of the CEC cells were positive for von Willebrand factor. Ranibizumab reduced CEC cell proliferation by 44.1%, bevacizumab by 38.2% and pegaptanib by 35.1% when the drugs were used at their established clinical doses. The differences, however, between the three drugs in respect to cell growth inhibition were not statistically significant. Only a mild antiproliferative effect of bevacizumab or pegaptanib on ARPE19 cells could be observed. Ranibizumab did not alter ARPE19 cell proliferation. No cytotoxicity on RGC5, CEC and ARPE19 cells could be seen. Conclusions Bevacizumab, pegaptanib and ranibizumab significantly suppress choroidal endothelial cell proliferation. However, when used at the currently established doses none of the drugs was superior over the others in respect to endothelial cell growth inhibition. The biocompatibility of all three drugs — including the off-label bevacizumab — seems to be excellent when used at the currently recommended intravitreal dose. This work is presented on behalf of the Tuebingen Bevacizumab Study Group.     

Intravitreal bevacizumab (avastin) for circumscribed choroidal hemangioma

Circumscribed choroidal hemangiomas are rare ophthalmic entities that cause diminution in vision due to accumulation of subretinal and/or intraretinal fluid in the macular area. Various treatment options ranging from conventional laser to photodynamic therapy have been employed to destroy the tumor and reduce the exudation; however, either the inability to penetrate through the exudative fluid or the collateral retinal damage induced by these treatment modalities make them unsuitable for lesions within the macula. We evaluated the role of intravitreal bevacizumab, a pan-vascular endothelial growth factor (VEGF) inhibitor, in reducing the sub- and intraretinal fluid in three patients with circumscribed choroidal hemangiomas. All the patients had complete resolution of the serous retinal detachment that was maintained till at least 12 months after the first injection. Intravitreal bevacizumab may be used in combination with thermal laser or photodynamic therapy in treating circumscribed choroidal hemangiomas with subretinal fluid.