普拉洛芬对糖尿病患者白内障术后视力和黄斑厚度的影响

目的　探讨普拉洛芬对合并糖尿病的白内障超声乳化术后视力及黄斑厚度的影响。方法　前瞻性单中心随机临床观察研究。收集行白内障超声乳化摘出联合人工晶状体植入术的不伴有视网膜病变的糖尿病患者44例（66眼）随机分为两组。对照组术前3 d常规应用左氧氟沙星滴眼液，试验组在对照组的基础上加用普拉洛芬滴眼液。对比手术前后两组最佳矫正视力、黄斑厚度、黄斑水肿情况。必要时对患眼行光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）检查。结果　两组患者术前基本情况及术中有效超声乳化时间差异均无统计学意义（均为P>0.05）。术后1周，试验组最佳矫正视力为（0.10±0.23）logMAR，对照组为（0.31±0.35）logMAR，两组相比差异有统计学意义（P=0.005），试验组视力优于对照组。术后1个月，试验组黄斑厚度为（249.09±22.89）μm，与术前（241.39±17.42）μm相比差异无统计学意义（P=0.150）；对照组黄斑厚度为（256.70±40.84）μm，与术前（232.80±20.10）μm相比显著增厚，差异有统计学意义（P=0.003）。术后1个月时对照组5眼行OCTA检查，其中3眼可观察到黄斑区微血管瘤和无灌注区，1眼存在明显的黄斑囊样水肿；试验组2眼行OCTA检查，均未见明显微血管瘤及无灌注区。结论　术前应用普拉洛芬可减少术后1个月黄斑区视网膜增厚，有助于术后早期视功能的尽快恢复。     

Optical coherence tomography angiography assessment of 577 nm laser effect on severe non-proliferative diabetic retinopathy with diabetic macular edema

AIM: To quantitatively evaluate the effect of the combined use of 577-nm subthreshold micropulse macular laser (SML) and multi-point mode pan retinal laser photocoagulation (PRP) on severe non-proliferative diabetic retinopathy (NPDR) with central-involved diabetic macular edema (CIDME) using optical coherence tomography angiography (OCTA). METHODS: In this observational clinical study, 86 eyes of 86 NPDR patients with CIDME who underwent SML and PRP treatment were included. Images were obtained 1d before laser and post-laser (1d, 1wk, 1, 3, and 6mo) using AngioVue software 2.0. Best corrected visual acuity (BCVA, LogMAR), foveal avascular zone area (FAZ), choriocapillary flow area (ChF), parafoveal vessel density (PVD), capillary density inside disc (CDD), peripapillary capillary density (PCD), macular ganglion cell complex thickness (mGCCT), central macular thickness (CMT), and subfoveal choroidal thickness (ChT) were compared between pre- and post-laser treatment. RESULTS: BCVA remained stable during 6mo post-laser therapy (pre-laser vs 6mo post-laser: 0.53±0.21 vs 0.5±0.15, P>0.05). PVD, ChF, ChT, CMT, and mGCCT significantly increased 1d post-laser therapy [pre-laser vs 1d post-laser: superficial PVD (%), 40.51±3.42 vs 42.43±4.68; deep PVD (%), 42.66±3.67 vs 44.78±4.52; ChF, 1.72±0.21 vs 1.9±0.12 mm2; ChT, 302.45±69.74 vs 319.38±70.93 μm; CMT, 301.65±110.78 vs 320.86±105.62 μm; mGCCT, 105.71±10.72 vs 115.46±9.64 μm; P<0.05]. However, PVD, ChF and ChT decreased to less than baseline level at 6mo post-laser therapy (pre-laser vs 6mo post-laser: superficial PVD (%), 40.51±3.42 vs 36.32±4.19; deep PVD (%), 42.66±3.67 vs 38.76±3.74; ChF, 1.72±0.21 vs 1.62±0.09 mm2; ChT, 302.45±69.74 vs 289.61±67.55 μm; P<0.05), whereas CMT and mGCCT decreased to baseline level at 6mo post-laser therapy (CMT, 301.65±110.78 vs 297.77±90.23 μm; mGCCT, 105.71±10.72 vs 107.05±11.81 μm; P>0.05). Moreover, FAZ continuously increased while CDD and PCD continuously decreased in 6mo after laser therapy. CMT and ChT had a significant positive correlation with ChF and PVD in most post-laser stages. CONCLUSION: During a 6-month follow-up period after combined use of SML and PRP therapy, BCVA remained stable and there was a decreased trend in macular edema. Blood flow increased at 1d post-laser therapy and reduced at 6mo post-laser therapy.     

抗病毒药联合甲基强的松龙治疗病毒性视神经炎

目的：比较更昔洛韦联合甲基强的松龙综合疗法和甲基强的松龙综合疗法治疗病毒性视神经炎(optic neuritis,ON)的疗效。 方法：将41例60眼病毒抗体检测阳性的ON患者随机分为治疗组（更昔洛韦组,21例30眼）和对照组（20例30眼）。于治疗前和治疗后3,7,14,30,90,180d观察两组患者的视力、视觉诱发电位(visual evoked potential,VEP)。 结果：两组患者的视力、LP₁₀₀随时间得到改善（P＜0.01）。两组患者视力在治疗的第3d开始恢复,治疗30d时治疗组视力明显优于对照组（P=0.009）,治疗180d时两组视力改善无差异（P＞0.05）;两组LP₁₀₀在治疗初期(14d内),恢复速率均快,与治疗前差异具有统计学意义（P＜0.01）,但LP₁₀₀的近期恢复效果治疗组优于对照组,远期差别减小。 结论: 更昔洛韦联合甲基强的松龙综合疗法较单纯甲基强的松龙综合疗法治疗ON能更快提高患者视力,增强视神经电活动,改善患者视觉质量。     

A self-made disposable iris retractor in small pupil phacoemulsification

AIM: To explore a simple and low-cost self-made disposable flexible iris retractor and study its clinical efficacy and safety in small pupil phacoemulsification.     

五种检查仪器对角膜水平直径测量的对比分析

目的：分析五种角膜直径测量方法对角膜水平直径测量的相关性和一致性。

方法：纳入2018-02/03在四川大学华西医院眼科行双眼ICL植入的患者25例50眼,术前分别采用规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM 5种方法测量角膜水平直径,比较5种方法测量结果的相关性及一致性。

结果：规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM测量的角膜水平直径分别为11.54±0.30、11.77±0.33、11.98±0.33、11.63±0.35、11.53±0.34mm(P<0.05),q检验结果显示规尺法与UBM法、眼前节OCT法,UBM法与眼前节OCT法测量的WTW值之间均无差异(P>0.05),直线相关分析发现五种检查方法测量值之间均具有显著相关性,Bland-Altman分析发现,规尺与SIRIUS、UBM、眼前节OCT检查值的95%LoA上下限绝对值均≤0.50mm。

结论：五种测量角膜水平直径的结果,规尺与SIRIUS,UBM和前节OCT的结果可以互换,其他结果不能互换。IOL Master500测量值最大,不宜作为测量角膜水平直径大小的诊断依据,其他测量设备检查结果应结合临床实践。     

波前像差及对比敏感度在评价白内障术后视觉质量中的应用

波前像差及对比敏感度测试是评估白内障术后整体视觉质量的有效方法。本文回顾了波前像差及对比敏感度的概念与临床应用,以及各因素之间的相互关系。综合评估波前像差及对比敏感度在评价白内障术后视觉质量中的全面性及客观性。     

玻璃体腔内植入装置在玻璃体视网膜疾病的临床应用

因血-视网膜屏障的存在,玻璃体视网膜疾病的给药方法常受到限制,玻璃体腔内注射药物直接作用于玻璃体和视网膜,是其有效治疗方法,但对慢性反复发作性疾病,需频繁注射以达到有效药物浓度。玻璃体腔内植入装置既避开了血-视网膜屏障,又延长了药物的作用时间,是治疗玻璃体视网膜疾病的新方法,因其装载的药物不同而治疗不同的疾病。抗病毒药物植入装置能有效治疗获得性免疫缺陷综合征患者的巨细胞病毒性视网膜炎。激素类植入装置能有效治疗眼底慢性炎性疾病如黄斑水肿、非感染性葡萄膜炎,主要副作用为眼压升高和白内障形成。睫状神经营养因子和抗血管内皮生长因子植入装置可能是老年性黄斑变性的有效治疗药物。本文将综述目前常见的玻璃体腔内植入装置在玻璃体视网膜疾病中的临床应用。     

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses:a meta-analysis

AIM: To assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.METHODS:Potential prospective controlled trials that comparing aspheric multifocal IOL implantation with spherical multifocal IOL group were extracted from the computer database. The statistical analysis was carried out using Stata 10 software. Standardized mean differences with 95% confidence intervals (CIs) were calculated for continuous variables. The pooled estimates were computed in the use of a random-effects model.RESULTS:A systematic review identified five prospective nonrandomized controlled trials, including 178 aspheric multifocal IOL and 164 spherical multifocal IOL. There was no significant difference in uncorrected distance visual acuity (95%CI, -0.248 to 0.152;P=0.641) and uncorrected near visual acuity (95%CI, -0.210 to 0.428;P=0.504) between aspheric multifocal IOL and spherical multifocal IOL. Statistically significant differences were detected less spherical aberration in aspheric multifocal IOL (95%CI, -1.111 to -0.472; P＜0.001) when compared to spherical multifocal IOL. Spherical multifocal IOL showed a greater higher order aberration compared to the aspheric multifocal IOL (95%CI, -1.024 to-0.293; P＜0.001). Sensitivity analysis suggested that the results were relatively reliable.CONCLUSION:The overall findings indicated that aspheric multifocal IOL and spherical multifocal IOL provided similar visual acuity at near and distance. Patients implanted with aspheric multifocal IOL had less spherical aberration and higher order aberration than patients with spherical multifocal IOL. Further well-organized, prospective controlled trials involving larger patient numbers are needed.     

Assessment of the effects of induced anisometropia on binocularity with glasses-free 3D technique

AIM: To assess the effect of experimentally induced anisometropia on binocularity in normal adults with glasses-free three-dimensional (3D) technique. METHODS: Totally 54 healthy medical students with normal binocularity in the cross-sectional study were enrolled. Anisometropia was induced by placing trail lenses over the right eye, in 0.5 D steps including lenses of -0.5, -1, -1.5, -2, -2.5 D (hyperopic anisometropia) and lenses of +0.5, +1, +1.5, +2, +2.5 D (myopic anisometropia). The glasses-free 3D technique was used to evaluated not only fine stereopsis, but also coarse stereopsis, dynamic stereopsis, foveal suppression, and peripheral suppression in these subjects. One-way analysis of variance was used to compare quantitative data such as fine stereopsis, coarse stereopsis. Pearson’s Chi-square test was performed to compare categorical data such as dynamic stereopsis, foveal suppression and peripheral suppression. RESULTS: The subjects showed a statistically significant decline in fine stereopsis, coarse stereopsis, and dynamic stereopsis with increasing levels of anisometropia (P<0.001). Binocularity was affected when induced anisometropia was more than 1 D (P<0.05). Foveal suppression and peripheral suppression were evident and increased in proportion to anisometropia (P<0.001). CONCLUSION: The relatively low degrees of anisometropia may have a potentially significant effect on high-grade binocular interaction. The mechanisms underlying the defect of binocularity seem to involve not only foveal suppression, but also peripheral suppression.     

Influencing factors of fear of falling among glaucoma patients in west China: a cross-sectional study

AIM: To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China. METHODS: In this cross-sectional study, glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data, visual acuity, visual field, activities of daily living, risk of falling, fear of falling and psychological states. Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables. RESULTS: The mean score of the Chinese version modified Fall Efficacy Scale (MFES) was 7.52±2.09 points. Univariate analysis and multivariate analysis showed that the history of falls within one year, visual acuity, visual field, risk of falling, activities of daily living and psychological states had statistically difference on fear of falling (P<0.05). CONCLUSION: Glaucoma patients in west China have relatively high risk of fear of falling. History of falling within 1y, severe visual function impairment, high risk of falling, incapable of independence of daily living, and abnormal psychological state are risk factors of fear of falling among glaucoma patients.