伊朗 Graves 眼病的临床特点

目的:研究分析伊朗 Graves 眼病患者的临床特点.方法:回顾分析 2003/2005 年确诊为 Graves 眼病的103例患者临床资料.结果:在103例 Graves 眼病患者中,48例(46.6%)为男性,55例(53.3%)为女性(男女比例为1.1).年龄18-73(平均45)岁,95例(92.2%)表现为甲状腺机能亢进,3例(2.9%)表现为原发性甲状腺机能减退,5例(4.8%)甲状腺机能正常.出现眼部症状的时间为2～95 (平均3.2)mo,而表现出甲状腺功能障碍的时间为6～180(平均39.4)mo.12例患者单眼发病,90例(87%)患者有眼睑退缩,80例(77.6%)患者表现出眼球突出,其中30例(29%)伴有局限性眼外肌运动障碍;CT扫描显示70例患者中有52例(74%)有眼外肌肥大.6例患者(5.8%)有视神经功能障碍,22例患者(21%)表现出Graves眼病相关的青光眼.其中7例(6.7%)为正常眼压青光眼.结论:本组病例中眼睑退缩是Graves眼病最常见的临床表现.未来需要更大范围的病例研究,以评价分析Graves眼病在伊朗人群中的发病率以及不同人种之间临床表现差异.     

Commentary review on peripapillary morphological characteristics in high myopia eyes with glaucoma: diagnostic challenges and strategies

The incidences of open angle glaucoma(OAG)and high myopia are increasing concomitantly.Considering the aging population and concurrent rapid increase in the number of individuals with myopia,the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades.However,precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc,as well as extensiveβ-zone parapapillary atrophy in highly myopic eyes.Recent advances in optical coherence tomography(OCT)and OCT angiography(OCTA)technologies imply that both modalities are promising tools for the detection of highly myopic OAG.Notably,the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages(e.g.visual field defect,visual electrophysiological changes).We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.     

荷兰有色兔的虹膜异色症

一只6mo龄大的荷兰有色兔,被观察存在虹膜异色,检查发现有全身及眼部异常.该兔右眼为蓝色,伴眼底色素过少;左眼为棕色,伴眼底部分区域色素过少.该兔存在白色毛发(白色额发);尽管未行客观听力学检查,但听力障碍不明显.双眼组织学检查示:右眼虹膜基质色素细胞明显少于左眼,视网膜色素上皮和脉络膜内的色素含量也比左眼少.     

Collagen crosslinking with photoactivated riboflavin in advanced infectious keratitis with corneal melting: Electrophysiological Study

AIM: To assess the effect of photoactivated chromophore for keratitis crosslinking(PACK-CXL) in case of severe keratitis with melting on the electrophysiological function of the retina and the optic nerve.METHODS: The study included 32 eyes of 32 patients with smear positive severe infectious keratitis with corneal melting. The patients were randomly divided into two groups. Group I(control group) included 16 eyes received systemic and topical antimicrobial drugs guarded by culture and sensitivity test. Group II underwent CXL and then continued their antimicrobial treatment. Full field electroretinogram(ERG) and flash visual evoked potential(VEP) were done for each patient in both groups basically and then 1 wk, 1 and 3 mo post-treatment to assess the changes in the electrophysiological function of the retina and optic nerve.RESULTS: Healing of 10 eyes in group I in comparison to 14 eyes in group II was recorded. The mean duration of healing was 36.56±5.21 d in group I vs 20.2±4.4 d in group II(P<0.005). In group II, ERG showed an insignificant reduction of all parameters of ERG and VEP after CXL. The amplitude of scotopic rod response, oscillatory potential amplitude, flicker amplitude and photopic cone response were insignificantly decreased(P=0.4, 0.8, 0.1, and 0.3 respectively). There were insignificant prolongation of latencies of scotopic rod, oscillatory potential, flicker and photopic cone response(P=0.2, 0.7, 0.5 and 0.1). There was slight delay in latency of VEP without a significant reduction in amplitude.CONCLUSION: CXL is an effective technique in treatment of severe infectious keratitis with melting as it halts the melting process with acceptable safety on the retinal and optic nerve function.     

Foveal structure changes in infants treated with anti-VEGF therapy or laser therapy guided by optical coherence tomography angiography for retinopathy of prematurity

AIM: To evaluate foveal vessel density(VD) and foveal thickness using optical coherence tomography angiography(OCTA) in retinopathy of prematurity(ROP) children treated with laser photocoagulation or anti-vascular endothelial growth factor(VEGF) injection. Additionally, we assessed the relationship between foveal microvascular anomalies and different therapies in ROP children.METHODS: This was a single-center, retrospective study of patients with a diagnosis of type 1 ROP. Twenty-three eyes(14 patients) treated with anti-VEGF injection and twentynine eyes(17 patients) treated with laser coagulation were included in this study. The foveal VD, inner thickness and full thickness were measured at the central 0°, 2° to 8°, and 8° of the retina(centered on the fovea) using OCTA and cross-sectional OCT, respectively.RESULTS: Foveal VD, inner thickness and full thickness were significantly smaller within the central 8° of the retina in ROP children treated with anti-VEGF injection than in those treated with laser photocoagulation(P=0.013, 0.009, 0.036, respectively). The full thickness was also smaller in the anti-VEGF group than in the laser group at the central 0° of the retina(P=0.010). The grade of foveal hypoplasia is lower in the anti-VEGF group than in the laser group(P=0.045). Multivariable analysis did not find any risk factors associated with visual acuity in our study.CONCLUSION: In children with type 1 ROP, the better structural development of fovea in those who were treated with anti-VEGF injection compared with laser photocoagulation are identified. However, visual acuity outcomes are similar 70 mo after the treatments.     

A simple new technique for the induction of residual posterior vitreous cortex removal and membrane peeling

AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.     

Protective effects of human umbilical cord mesenchymal stem cells on retinal ganglion cells in mice with acute ocular hypertension

AIM:To observe the protective effect of human umbilical cord mesenchymal stem cells(huc MSCs)on retinal ganglion cel s(RGCs)injury in mice with acute ocular hypertension(AOH).METHODS:Fifty-six adult male C57 BL/6 mice were randomly divided into four groups:normal group,AOH group,huc MSCs group,normal saline(NS)group.Left eye of mice was induced by 90 mm Hg intraocular pressure for 1 h to establish AOH model.huc MSCs 1×105/μL,1μL or NS 1μL was injected into the vitreous body the next day.CMDil fluorescent dye was used to label the 3 rd generation of huc MSCs,for tracing the cells in the vitreous cavity of mice.Seven days after the model established,hematoxylin-eosin(HE)staining was used to observe the thickness of the inner retina layer in four groups.Numbers and loss rate of RGCs were evaluated by counting Brn-3 a positive cells stained by immunofluorescencein.RESULTS:On the 7 th day after AOH established,labeled huc MSCs were found in the vitreous cavity.HE staining showed that the thickness of retinal inner layer in AOH group was significantly lower than that in normal group and huc MSCs group(P<0.05),same as that in NS group(P>0.05).Compared with AOH group,the RGCs in normal group was significantly higher;RGCs number increased in huc MSCs group and the loss rate was lower(P<0.05).Injection of NS had no protective effect on RGCs.CONCLUSION:In AOH mouse model,vitreous injection of hucMSCs have shown a protection for RGCs.     

视神经炎98例病因学临床分析

目的:探讨视神经炎的发病原因.方法:回顾分析视神经炎98例170眼临床检查资料,包括病毒、免疫学、影像学、脑脊液、荧光造影、彩色多普勒血流图检查.结果:病毒抗体检测阳性率65.8%,免疫学检查81.3%免疫球蛋白升高,77.8%补体降低,磁共振1例发现脑白质脱髓鞘改变.结论:病毒感染、自身免疫反应是视神经炎发病的重要原因,其次为遗传性、系统性疾病等.     

Early results of circularity and centration of capsulotomy prepared by three different methods

AIM:To compare the difference of capsulotomy produced by precision pulse capsulotomy(PPC),manual(M-CCC),and femtosecond laser assisted capsulotomy(FLAC)in relation to intraocular lens(IOL)centration,circularity and its effect on visual outcomes.METHODS:Prospective,non-randomized comparative study conducted at LV Prasad Eye Institute,Hyderabad,India.Sixty eyes of 52 patients were grouped into 3(FLAC,PPC and M-CCC)based on capsulotomy techniques used.Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group.The main outcome measure was IOL centration in relation to capsulotomy and pupil.Secondary outcome measures were post-operative visual acuity,manifest refraction and aberration profile between groups.RESULTS:At 5 wk the visual,refractive outcomes and endothelial cell density were comparable between the 3 groups.The median circularity index of FLAC was statistically significantly different to M-CCC or PPC(1-10)groups(P<0.01)but PPC(11-20)was comparable to FLAC.Decentration of IOL center in relation to capsulotomy was seen only between the PPC(1-10)group and FLAC group(P=0.02).The IOL was well centered in relation to the pupil in all the groups(P=0.46).The quality of vision parameters like the higher order aberrations,spherical aberration,coma,trefoil,modular transfer function,and Strehl ratio were comparable between the groups.CONCLUSION:Our study shows that despite differences in the morphology of capsulotomy produced by PPC,M-CCC,FLAC a well-centered IOL can be achieved.The measured capsular morphology parameters do not affect visual outcomes.     

Clinical features and treatment outcomes of intraocular lymphoma: a single-center experience in China

AIM:To investigate the clinical manifestations,diagnostic approaches,treatments,and outcomes of intraocular lymphoma.METHODS:In this retrospective study,16 patients(28 eyes)with intraocular lymphoma were recruited in the Department of Ophthalmology,Peking Union Medical College Hospital,from 2004 to 2019.All patients underwent comprehensive ophthalmic examinations.Vitreous specimens of 13 patients were sent for cytopathology examination and other adjunctive diagnostic procedures.Three patients were diagnosed with intraocular lymphoma according to analysis of the histopathological results of systemic lymphoma by one clinician.Twenty-three eyes were treated with intravitreal administration of methotrexate,4 eyes could not receive ocular treatment due to life-threatening lymphoma,and 1 eye did not require ocular treatment because the fundus lesions regressed after systematic chemotherapy.RESULTS:In 28 eyes,25 eyes were diagnosed with vitreoretinal lymphoma,and 3 eyes were diagnosed with ciliary body lymphoma,all of which were non-Hodgkin diffuse large B cell lymphomas.The final visual acuity improved in 15 eyes(54%),remained unchanged in 5 eyes(18%),and decreased in 8 eyes(29%).Anterior segment inflammation disappeared or reduced in 8 and 5 eyes,respectively;and 15 eyes had no anterior segment reaction.Twenty eyes had mild vitreous opacity,1 eye had mild vitritis,and 7 eyes had pars plana vitrectomy combinedwith silicone oil tamponade.Fundus lesions disappeared in 9 eyes and were relieved in 5 eyes;4 eyes showed no changes,and the remaining 10 eyes’fundus were normal.CONCLUSION:The clinical manifestations of intraocular lymphoma are diverse,and the misdiagnosis rate is high.Cytopathological analysis of vitreous is one of the gold standards for the diagnosis.Immunohistochemistry,gene rearrangement and flow cytometric immunophenotypic analysis can improve the diagnostic rate.Ocular chemotherapy or radiotherapy regimens may preserve visual acuity,and a multidisciplinary team can provide individualized treatment for the patients.     

正常人对比敏感度的特征

目的:探讨正常人对比敏感度(contrast sensitivity,CS)的特征,以获得正常参考值.方法:应用法国Metrovision公司生产的Vision Monitor视觉诱发系统检查正常人40例(80眼)最佳矫正视力后暗视和明视下空间频率0.8,1.5,3,6,12,20cpd的对比敏感度,按年龄不同分成2组:A组(16～49岁)56眼、B组(50～65岁)24眼,对2组暗视和明视下各空间频率的对比敏感度结果进行比较.结果:正常人对比敏感度函数图形呈倒U形,在中频区(3cpd和6cpd)最高.随年龄的增长,暗视和明视下各空间频率的对比敏感度均逐渐下降;50岁以上年龄组对比敏感度较50岁以下年龄组显著下降(P＜0.05).50岁以下正常人暗视下较明视下在空间频率12,20cpd对比敏感度降低,差异有显著性(P＜0.05).结论:我们的研究基本上准确、客观的反映了正常人CS的特征,为临床研究提供了较可靠的正常值.     

弱视治疗新进展

弱视是一种由于先天性或在视觉发育的关键期进入眼内的光刺激不够充分,剥夺了黄斑形成清晰物象的机会和(或)两眼视觉输入不等引起的清晰物象与模糊物象之间发生竞争所造成的单眼或双眼的视力疾患.弱视是一种与发育紧密相关的眼病.目前,斜视治疗的方法主要是通过剥夺主导眼的视觉一段时间,同时对弱视眼进行不同的刺激和训练,从而可以提高弱视眼的正常视觉经验.     

非球面人工晶状体植入术后视觉质量评价

目的 评价非球面设计的人工晶状体AcrySof(R) IQ对提高老年性白内障患者术后视功能的作用.方法 采用同期临床对照研究,超声乳化白内障吸出联合人工晶状体植入术后的老年性白内障患者132例(160眼),其中植入AcrySof(R) IQ IOL 60例76眼,为IQ组;植入AcrySof(R) Natural 72例84眼,为Natural 组.观察患者的术后视力、对比敏感度和眩光敏感度、球差和并发症,问卷调查患者不良视觉症状和满意度.结果 术后3个月,IQ组裸眼视力(uncorrected visual acuity,UCVA)为4.92±0.10,最佳矫正视力(best corrected visual acuity,BCVA)为5.02±0.10; Natural组UCVA为4.89±0.12, BCVA为5.00±0.09;差异均无统计学意义(P＞0.05).低、中、高各频段对比敏感度和眩光敏感度 IQ组为47.44±10.95、27.72±6.69、7.62±2.04和40.61±10.48、22.73±6.88、6.38±1.22;Natural组为31.55±6.68、24.67±5.49、6.17±1.43、27.27±5.78、17.62±3.90、4.83±0.82,差异有统计学意义(P＜0.01).球差IQ组为(0.09±0.04)μm,Natural组为(0.52±0.17)μm,差异有统计学意义(t=22.15,P=0.000).问卷结果 显示IQ组较Natural组术后眩光、光晕的发生率低,患者满意度高.结论 非球面人工晶状体AcrySof(R)IQ在一定程度上平衡了角膜的正球差,减少了人工晶状体眼的球差,提高了对比敏感度和眩光敏感度,改善了视觉质量,获得了患者满意的效果.     

反义寡核苷酸抑制大鼠损伤视神经 Nogo-A mRNA的表达

目的:观察反义寡核苷酸对损伤视神经Nogo-A的影响.方法:实验分为对照组、随机序列组、和2,5,10μmol/L 3种Nogo-A反义寡核苷酸浓度组.大鼠视神经钳夹伤后,采用逆转录-聚合酶链反应法(RT-PCR),半定量分析反义寡核苷酸对损伤视神经Nogo-A mRNA表达量的变化.结果:反义寡核苜酸均显著降低Nogo-A mRNA的表达(P＜0.01),随机序列对Nogo-AmRNA的表达无影响(P＞0.05).结论:反义寡核苷酸对视神经损伤后Nogo-A mRNA表达有抑制作用.     

硅油小滴对人视网膜色素上皮细胞吞噬活性的影响

目的:探讨一定大小的乳化硅油小滴能否影响视网膜色素上皮(retinal pigment epithelial,RPE)细胞的吞噬能力.方法:将硅油挤压通过一种微孔滤膜制成大小相似的小滴.用酞箐蓝标记硅油小滴.培养的人RPE细胞与硅油小滴,伴或不伴有血清,共同孵育24h.被细胞内吞的小滴在显微镜下计数.测量人RPE细胞在体外吞噬硅油小滴的数量.结果:挤压通过这种微孔膜制成的硅油小滴至少稳定5d,硅油小滴的直径为4.25±0.77μm.乳化硅油浓度不同,RPE细胞吞噬硅油小滴的数量有明显剂量依赖性,随浓度增高,吞噬数量也增加.加有血清的硅油小滴使RPE细胞的吞噬能力进一步增强.结论:硅油小滴能刺激RPE细胞的吞噬能力,含有血清时对RPE细胞的吞噬能力有进一步的刺激作用.     

A novel surgical technique of internal limiting membrane peeling for high myopic foveoschisis: a wide range of whole piece consecutive peeling without preservation of epi-fovea

AIM:To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane(ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis(MF).METHODS:A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF.A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP.Next,an ILM forceps was used to catch hold of the incisal edge of the ILM flap,and the action of releasing and separating was subsequently taken toward the direction of the macular fovea.Next,the ILM forceps was used to grasp the released area,and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter.Finally,the ILM was folded backwards and peeled off in the arc direction.RESULTS:At the final visit,the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 μm.The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59.CONCLUSION:The wide range of whole piece consecutive ILM peeling without preservation of the epifovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.     

Comparison of efficacy of two different silicone hydrogel bandage contact lenses after T-PRK

AIM:To compare the efficacy between two different silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy(T-PRK).METHODS:In this randomized controlled trial,a total of 89 patients(178 eyes) who underwent T-PRK at the Qingdao Eye Hospital from October to December 2019 were selected.One random eye wore a Senofilcon A bandage contact lens after surgery,and the other eye a Balafilcon A bandage contact lens.Pain scores,uncorrected visual acuity(UCVA),spherical equivalent(SE),corneal epithelial healing status,epithelial thickness,bandage lenses deposits,lenses movement,and ocular surface conditions were measured and compared.RESULTS:There were no differences between the two groups in UCVA,SE,corneal epithelial healing status,corneal epithelial thickness,tear river heights and tear film rupture time at each follow-up visit.However,postoperative pain scores in the Senofilcon A group were significantly lower than those of the Balafilcon A group(F_intergroups=67.833,P<0.001;F_time=383.773,P<0.001;F_interaction=57.344,P<0.001).The duration of pain in eyes in the Senofilcon A group was shorter than that of the Balafilcon A group(t=-3.326,P=0.001).The surface deposition scores and movement scores of Senofilcon A bandage lenses on the first and fourth days after surgery were lower than those of Balafilcon A bandage lenses(Z=-5.385,-6.782,P<0.001;Z=-8.336,-8.906,P<0.001).CONCLUSION:Both Senofilcon A and Balafilcon A bandage lenses have good efficacy after T-PRK.Senofilcon A lenses are associated with less pain and more comfort compared to Balafilcon A.     

葡萄膜炎致特殊房角形态的继发性青光眼1例

1病例资料 患者,女,35岁.双眼胀痛、发红伴视力下降半年,于2006-12-05因加重来我院就诊.患者诉自幼因高度近视视力不佳,半年前出现双眼胀痛,伴视力进行性下降,左眼畏光、流泪等症状,来我院就诊.1mo前在当地医院曾诊断为"双眼虹膜睫状体炎",给于口服地塞米松治疗2wk,随后停服地塞米松,到另外医院就诊,诊断为"双眼青光眼",给于降眼压治疗,疗效不佳,遂来我院就诊,以"左继发性青光眼"收入院.既往史:患者患有风湿性关节炎多年,否认外伤及手术史,否认肝炎、糖尿病、高血压及心脏病史;个人史:无特殊;家族史:其姥、姨、舅均有糖尿病史,患者育有一女一男,其中男(3岁)为高度近视.眼科检查:右眼视力无光感,左眼视力0.02(-15DS矫正为0.1).眼压:右眼7.8mmHg,左眼35mmHg.     

混合型遗传性先天性白内障一家系

先证者,Ⅲ23,男,33岁.因双眼视物模糊20余年就诊.患者自10岁起发现视力下降,未诊治,近6年来视物模糊逐渐加重.眼科检查:右眼视力为数指/30 cm,左眼视力0.01,不能矫正.右眼光定位、色觉准确.双眼外观正常,角膜透明,前房中等深度.散瞳后检查,双眼晶状体混浊,深层周边及中央皮质蓝色点状混浊,周边部呈棒状放射形排列,形如花冠,左眼较著,中央部呈弥散性分布,核呈灰色混浊,右眼较左眼致密.后囊膜中央局限性致密混浊,色白如钙化状,呈星形.双眼玻璃体及眼底窥不清.诊断:双眼遗传性先天性白内障.     

急性乙醇中毒后眼部挤压伤一例

1 病例 患者男,32岁.因饮酒过量独自一人坐在马桶上,头枕于膝部昏睡,次日晨被他人发现,于2006年8月12日送往本院内科接受治疗.主诉有眼视物不见,遂请眼科会诊.