西班牙渗出性老年性黄斑变性的相关流行病学因素(英文)

目的:报告在西班牙Castilla-Leo地区患有渗出性老年性黄斑变性(AMD)的样本人群的流行病学特点,并与一组来自同一地区和相同年龄人群进行比较。方法:在本次观察性前瞻性调查中,我们访问了在一家地区性诊所接受光动力学疗法的AMD患者。患者报告了高血压、高血脂、吸烟的病史,检查患者虹膜颜色并分为浅色(绿色、蓝色、灰色)和深色(淡褐色、褐色、黑色)。结果:共有343名患者接受了访问,平均年龄为74.9岁(55~93岁),其中64.5%为女性,35.5%为男性,有45.1%的患者虹膜颜色被划为浅色。这些患者中,有50%有动脉性高血压,15.3%接受高胆固醇血症治疗,30.2%吸烟或者已经戒烟(女性中占80.9%)。结论:在渗出性AMD患者中,虹膜颜色为浅色的频率较高。在我们的调查中,其他渗出性AMD其他的风险因素有男性的吸烟习惯、未接受高胆固醇血症治疗、患者为女性身份等。     

经瞳孔温热疗法治疗老年黄斑变性所致黄斑中心凹下脉络膜新生血管的长期观察(英文)

目的:评价经瞳孔温热疗法(TTT)治疗年龄相关性黄斑变性(AMD)所致黄斑中心凹下脉络膜新生血管(CNV)的长期疗效。方法:AMD所致黄斑中心凹下脉络膜新生血管14例14眼。平均年龄67.1岁。记录详尽的眼科检查结果,拍摄彩色眼底相,并行黄斑部光学相干断层成像(OCT)检查。在初诊及随后的复诊中行眼底荧光素血管造影和吲哚青绿血管造影。TTT的治疗参数为:时间1min,光斑大小2 ~3mm,激光能量650 ~800mW。随诊时间5 ~64mo,平均28.6mo。结果:在14眼中,典型性CNV有10眼,典型为主性有2眼,1眼为少量典型性,1型隐匿性CNV有1眼。共4例患者出现治疗后出血,均在短期内吸收。有1眼在治疗后立刻出现了黄斑无灌注区。多数患眼在随诊中可见渗出逐渐减少。在平均28.6mo的随诊中,14只患眼,有5眼视力提高,8眼保持稳定,1眼视力下降。结论:经瞳孔温热疗法在AMD患者中能封闭黄斑中心凹下的CNV,促进网膜下积液的迅速吸收,从而稳定患者的视力。它可以作为一种治疗典型和典型为主性黄斑中心凹下脉络膜新生血管的激光治疗手段。     

光动力疗法治疗脉络膜新生血管性疾病的初步临床观察

目的:观察使用维替泊芬光动力疗法(photodynamic thera-py,PDT)治疗年龄相关性黄斑变性(age-related maculardegeneration,AMD)、病理性近视和特发性脉络膜新生血管(choroidal neovascularization,CNV)等3种主要的CNV相关疾病的临床效果。方法:对96例(109眼)经临床确诊的上述CNV患者进行PDT治疗,随访1～24(平均9.4)mo。采用最佳矫正视力、荧光素血管造影、吲哚青绿血管造影、光学相干断层成像等指标,观察治疗前后患者的视功能、CNV病灶大小及渗漏情况、以及视网膜水肿变化等,评价PDT治疗CNV的疗效。结果:本组病例包括AMD42例(54眼),病理性近视17例(18眼),特发性CNV患者37例(37眼)。AMD、病理性近视和特发性CNV的平均治疗次数分别为1.2,1.5和1.2次;视力稳定和提高者各组分别为83.3%,83.3%和86.5%;CNV渗漏停止或减少者各组分别为90.7%,83.3%和89.2%:视网膜水肿减轻者各组分别为77.8%,88.9%和86.5%。除3例AMD患者出现眼部严重不良反应外,未发现其他严重不良反应。结论:PDT可有效地改善或稳定AMD、病理性近视和特发性CNV患者的视功能,控制病变进展,近期随访结果安全有效。     

Ranibizumab治疗湿性AMD的相关研究

脉络膜新生血管(choroidal neovascularization,CNV)形成是湿性AMD导致视力丧失的重要因素。大量证据表明,血管内皮生长因子-A(vascular endothelial growth factor A,VEGF-A)是湿性AMD新生血管生成和血管渗漏的重要调质。VEGF的抑制剂已在临床中应用,其中,ranibizumab是一种重组的人源化抗VEGF单克隆抗体片段,能够结合并抑制VEGF,阻止血管渗漏和新生血管的形成,抑制CNV的发生。III期临床试验结果表明,ranibizumab不仅可以延缓患者视力的降低,同时相当一部分患者出现临床有意义视力提高。而且,在治疗过程中严重不良事件发生率低。ranibizumab很有可能首次使多数AMD患者获得良好而稳定的视力。2006-06-30ranibizumab经美国食品药物管理局批准应用于湿性AMD的治疗。本文简要回顾VEGF的生物学特点,临床应用的途径,同时对ranibizum-ab临床研究结果进行总结。     

Epiretinal prosthesis forouter retinal degenerative diseases

Age-related macular degeneration (AMD) and retinitis Pigmentosa (RP) are commonouter retinal degenerative Problems, and alsothe Predominant causesof most blinding retinal diseases. Retinal Prosthesis is a Promising solution for such PhotorecePtor degeneration diseases. Mostof current concePts for a retinal Prosthesis are basedon neuronal electrical stimulation. Inthe Pasttwenty years, retinal Prosthesis has been develoPed intwo different directions: ePiretinal Prosthesis and subretinal Prosthesis. Each Prosthesistechnique has its advantages and disadvantages. For ePiretinal Prosthesis, it is easierto be imPlanted and hasthe advantageof keePing mostofthe electronics inthe vitreous cavityoffthe retinal surface, which greatly helPs in dissiPatingthe heat generated bythe imPlant device. Inthis PaPer, a briefoverviewof retinal Prostheses concePts is introduced. Afterthat, several imPortant asPectsof ePiretinal electrical stimulation will be discussed. Moreover, some Practical ePiretinal Prosthesis devices develoPed by researchers in United States, Germany and JaPan inthe Past have been reviewed. We hoPethatthe devices will be used widely inthe near future.     

Use of fluorescein and indocyanine green angiography in polypoidal choroidal vasculopathy patients following photodynamic therapy

Background: Exudative age-related macular degeneration (AMD) is a sight-threatening event in many elderly people. Some patients have a much better outcome in visual acuity (VA) than others after treatment with photodynamic therapy (PDT) with verteporfin. The combination of fluorescein angiography (FA) and indocyanine green (ICG) angiography using the Heidelberg Retina Angiograph II (HRA 2) should make a delineation of distinct pattern(s) possible in order to better select and assess therapy.Methods: This is a retrospective, case-control, single-centre study. We identified a total of 168 eyes of 168 patients from July 2003 to June 2006, including 30 eyes of 30 patients with better visual outcome, defined in this study as VA ≤0.48 logMAR (≥20/60 Snellen chart) at the end of the study. Best-corrected VA, maximal central retinal thickness as measured by optical coherence tomography, and results of the FA/ICG angiography using the HRA 2 were analyzed. In this article, we discuss patients with polypoidal choroidal vasculopathy (PCV) and their characteristics.Results: The average follow-up time was 15.3 months (range 4–28 months). Seventeen (57%) of the 30 patients with better visual outcome had PCV. All patients in the group with better visual outcome needed fewer PDT treatments compared with our control group of patients with an exudative AMD.Interpretation: Simultaneous FA/ICG angiography using the HRA 2 allowed delineation of a subgroup of patients with PCV who showed a better visual outcome compared with those with other types of exudative AMD, after treatment with PDT.     

肼屈嗪对视网膜色素上皮细胞的抗氧化作用及其治疗老年黄斑变性的潜在作用(英文)

目的:探讨在缺氧性损害下肼屈嗪对视网膜色素上皮(ARPE-19)细胞的抗氧化效果以及活性氧(ROS)在此效果中的作用。方法:用人视网膜色素上皮细胞研究肼屈嗪对氧化应激的作用,包括特丁基氢过氧化物(t-BHP)、过氧化氢(H2O2)、叠氮化钠(NaN3),以及缺氧引起的细胞坏死。用MTT检验测试细胞活性。结果:用ROS诱导的氧化应激治疗ARPE-19细胞,肼屈嗪在抵抗t-BHP、H2O2、缺氧引起的细胞坏死中表现出浓度依赖性,但对NaN3不具有浓度依赖性。这一作用中不涉及到一氧化氮(NO)。结论:肼屈嗪在ARPE-19细胞中表现出抗氧化应激诱导的破坏,这一作用可能是因为对ROS的净化剂作用。所以肼屈嗪可能用于治疗老年黄斑变性。     

载脂蛋白E基因启动子多态性与年龄相关性黄斑变性的关系

目的:探讨载脂蛋白E(APOE)基因启动子(-219G/T)多态性与年龄相关性黄斑变性(AMD)发病危险性的关系。方法:用聚合酶链反应-限制性片断长度多态性分析法对AMD组(50例)和对照组(95例)的APOE-219G/T基因型做出鉴定。结果:两组间不存在-219G/T基因型频率分布的差异(P>0.39)。结论:APOE基因-219G/T多态性与AMD发病危险性无关。     

Projected number of Australians with visual impairment in 2000 and 2030

This study aimed to project population-based prevalence data associated with visual impairment, in order to estimate the number of affected older Australians (aged 50 or older) in the years 2000 and 2030. We used data from the Blue Mountains Eye Study (BMES) and Melbourne Visual Impairment Project (MVIP), together with Australian Bureau of Statistics population projections. Similar definitions for moderate (6/24-6/60 visual acuity) and severe (< 6/60 visual acuity) visual impairment were used. Combining age-standardized data, we estimated that in the year 2000, 38 820 (0.73%) and 25590 (0.48%) Australians aged 50 years or older will have moderate and severe visual impairment, respectively. By 2030, these rates will have more than doubled, to an estimated 85910 (0.92%) and 57930 (0.62%) Australians with moderate and severe visual impairment, respectively. Women aged 50 years or older will have a 1.8-fold and four-fold risk, respectively, of moderate and severe visual impairment compared to men. Visual impairment will affect an increasing proportion of older Australians, Newer approaches to therapy, rehabilitation and community support for persons with visual impairment will be needed to meet this challenge.     

Reading speed test for potential central vision measurement

This study examines the validity and reliability of a reading speed test as a measure of potential central vision. Reading speed was calculated in words per minute (wpm) from the time taken to read 30 words of 1.20 logMAR size text. Scores were obtained from subjects with cataract (n = 48), macular disease(n = 35), peripheral vision loss(n = 14) and normal eyes (n = 10). Subjects with macular disease (27.0 +/- 13.2 wpm) read much slower than subjects with cataract (91.9 +/- 13.6 wpm). Little difference was found between subjects with cataract, peripheral vision loss (91.5 +/- 14.7 wpm)and normal eyes (103.8 +/- 15.5 wpm). Repeat testing gave values within +/- 16% of reading speed. These results suggest that a reading speed test using large text could be useful as a potential central vision test in cataract patients.