黄斑前膜剥除术联合地塞米松缓释剂（Ozurdex）玻璃体内注射治疗4期黄斑前膜的疗效分析

目的　评价黄斑前膜（ERM）剥除术联合地塞米松缓释剂（Ozurdex）玻璃体内注射治疗4期ERM患者的效果和安全性。方法　回顾性研究。纳入2019年3月至2021年6月在郑州大学第一附属医院眼科诊断为4期ERM并于ERM剥除术中联合应用Ozurdex玻璃体内注射的患者26例（26眼），分析手术前和术后1个月、3个月、6个月的最佳矫正视力（BCVA）、黄斑中心厚度（CMT）、眼压及术后黄斑区视网膜结构变化和术后并发症情况。结果　患者手术前和术后1个月、3个月、6个月的BCVA（logMAR）分别为0.70（0.52，1.08）、0.52（0.37，1.00）、0.46（0.28，0.70）和0.40（0.28，0.70），术后各时间点的BCVA较术前均有好转（均为P<0.05）；手术前和术后1个月、3个月、6个月的CMT分别为651.50 μm（538.30 μm，790.80 μm）、387.00 μm（342.80 μm，423.30 μm）、363.50 μm（321.80 μm，419.30 μm）和339.50 μm（305.80 μm，374.80 μm），术后各时间点的CMT较术前均有明显改善（均为P<0.001）；手术前后的眼压差异无统计学意义（P=0.094），其中6例患者眼压升高，且≥25 mmHg（1 kPa=7.5 mmHg）；术后6个月，ERM由4期改善为1期者2眼（7.7%），改善至3期者9眼（34.6%），仍为4期者有15眼（57.7%），但其黄斑区视网膜结构紊乱程度较术前减轻；术前BCVA与术后6个月的BCVA呈正相关（r=0.713，P<0.001）；7例(26.9%)患者在随访期内出现黄斑水肿，未发生眼部或全身严重并发症。结论　ERM剥除术联合Ozurdex玻璃体内注射可改善4期ERM患者视力，并促进黄斑区视网膜解剖结构的恢复。     

Acute mental change and hemiplegia after autologous fat injection

Autologous fat injection is a common procedure used for skin augmentation. It is known to be safe and simple, but severe complications have been reported at times. The authors observed a patient with acute large cerebral infarction including the territories of the anterior and middle cerebral arteries and optic nerve infarction developing after autologous fat transplantation. A 32-year-old woman was referred to the emergency room of our hospital due to sudden stupor. Thirty minutes earlier, she was undergoing cosmetic autologous fat injection into the glabella area by a plastic surgeon at a private clinic. The cause was confirmed to be anterior and middle cerebral arteries infarction on brain imaging studies. When a patient presents abrupt mental change, hemiplegia, ocular pain, or blindness after autologous fat particle injection, physicians must consider cerebral infarction and combined retinal artery occlusion.     

Multimodality imaging in macular telangiectasia 2: A clue to its pathogenesis

Macular telangiectasia type 2 also known as idiopathic perifoveal telangiectasia and juxtafoveolar retinal telangiectasis type 2A is an acquired bilateral neurodegenerative macular disease that manifests itself during the fifth or sixth decades of life. It is characterized by minimal dilatation of the parafoveal capillaries with graying of the retinal area involved, a lack of lipid exudation, right-angled retinal venules, refractile deposits in the superficial retina, hyperplasia of the retinal pigment epithelium, foveal atrophy, and subretinal neovascularization (SRNV). Our understanding of the disease has paralleled advances in multimodality imaging of the fundus. Optical coherence tomography (OCT) images typically demonstrate the presence of intraretinal hyporeflective spaces that are usually not related to retinal thickening or fluorescein leakage. The typical fluorescein angiographic (FA) finding is a deep intraretinal hyperfluorescent staining in the temporal parafoveal area. With time, the staining may involve the whole parafoveal area but does not extend to the center of the fovea. Long-term prognosis for central vision is poor, because of the development of SRNV or macular atrophy. Its pathogenesis remains unclear but multimodality imaging with FA, spectral domain OCT, adaptive optics, confocal blue reflectance and short wave fundus autofluorescence implicate Müller cells and macular pigment. Currently, there is no known treatment for this condition.     

中西药治疗脉络膜新生血管性疾病疗效观察

目的:观察黄斑方联合抗氧化剂治疗脉络膜新生血管性疾病(CNV)的临床疗效。方法:对2004年至2015年就诊的31例(35只眼)视力、眼底彩照进行回顾性分析,并将视力与眼底形态学改变进行相关分析。结果:视力平均值治疗前与治疗后3、6、12个月时比较差异有统计学意义(P0.05);治疗后3个月时与治疗后6个月时比较,差异也有统计学意义(P0.05);治疗后6个月时与治疗后12个月时比较,差异无统计学意义(P0.05)。CNV总面积平均值治疗前与治疗后3个月时比较,差异无统计学意义(P0.05);治疗前与治疗后6、12月时比较,差异有统计学意义(P0.05);治疗后3个月时与治疗后6、12个月时比较,差异有统计学意义(P0.05);治疗后6个月时与治疗后12个月时比较,差异有统计学意义(P0.05)。治疗后12个月时视力提高19只眼(54.3%),视力稳定14只眼(40.0%),视力下降2只眼(5.7%)。CNV最大病灶面积与视力在治疗前无相关性,在治疗后3、6、12个月时均呈负相关。结论:黄斑方联合抗氧化剂治疗脉络膜新生血管性疾病能有效缩小病灶及减少荧光素渗漏。