激光光凝治疗视网膜病变临床体会

应用法国产Nd YAG532nm激光治疗机，对168例319眼DR进行眼底激光光凝治疗。结果151例289眼视力提高或保持不变。17例30眼视力下降。激光治疗不仅能增加和提高视力，并且黄斑水肿大部分减轻。微血管瘤消退。结论激光治疗安全有效，是消除新生血管及无灌注区重要和有效的方法。     

激光光凝治疗视网膜病变临床体会

应用法国产Nd YAG532nm激光治疗机，对168例319眼DR进行眼底激光光凝治疗。结果151例289眼视力提高或保持不变。17例30眼视力下降。激光治疗不仅能增加和提高视力，并且黄斑水肿大部分减轻。微血管瘤消退。结论激光治疗安全有效，是消除新生血管及无灌注区重要和有效的方法。     

丹红注射液联合激光光凝治疗老年糖尿病视网膜病变的效果及对视网膜神经厚度的影响

目的观察丹红注射液联合激光光凝治疗老年糖尿病视网膜病变(DR)疗效及对视网膜神经纤维层(RNFL)厚度的影响。方法采用前瞻性研究方法,选取老年DR患者82例随机分为对照组和治疗组,各41例。对照组单纯予以视网膜光凝治疗,在此基础上,治疗组加用丹红注射液治疗。观察两组临床疗效,并对比两组治疗前后眼科常规检测结果、RNFL厚度、血清细胞因子、氧化应激等指标。结果治疗组临床疗效(93.65%)明显高于对照组(68.33%,χ~2=12.96,P=0.00);治疗6 w后,治疗组视盘上方、下方、颞侧、鼻侧及全周360°RNFL厚度均明显低于对照组(P0.05);治疗组眼科检测结果视野灰度值、出血斑面积、血管瘤体积及血清β2糖蛋白(β2-GP)Ⅰ、基质细胞衍生因子(SDF)-1、血管内皮生长因子(VEGF)、内皮素(ET)-1均明显低于对照组(P0.05);治疗组超氧化物歧化酶(SOD)、总抗氧化能力(TAC)水平明显高于对照组,丙二醛(MDA)水平则明显低于对照组(P0.05)。结论丹红注射液联合激光光凝可明显减少老年DR患者RNFL厚度并阻滞视网膜血管增殖,减轻机体氧化应激反应,有助于患者整体病情的改善。     

激光光凝联合苦碟子注射液静滴治疗糖尿病视网膜病变疗效观察

目的观察激光光凝联合苦碟子注射液静滴治疗单纯型糖尿病视网膜病变(DR)的疗效。方法 51例(97眼)单纯DR患者,随机分为观察组26例(49眼)和对照组25例(48眼)。观察组采用激光光凝配合苦碟子注射液静滴治疗,对照组仅采用激光光凝治疗。结果观察组患者视力提高和黄斑区水肿消退情况均优于对照组(P均<0.05)。结论激光光凝联合苦碟子注射液静滴治疗DR疗效明显优于单纯激光光凝治疗。     

全视网膜光凝对糖尿病视网膜病变神经纤维层及黄斑厚度的影响

目的研究糖尿病视网膜病变（DR）及全视网膜激光光凝（PRP）对视乳头旁视网膜神经纤维层（RNFL）厚度及黄斑中心凹视网膜厚度的影响。方法年龄匹配的正常对照组34例66只眼,2型糖尿病（T2DM）无DR患者组20例32只眼,T2DM DR患者组39例46只眼,行PRP治疗组19例20只眼被纳入研究,应用光学相干断层扫描仪（OCT）测量视乳头旁RNFL厚度及黄斑中心凹视网膜厚度,比较各组间的差异。结果 PRP治疗后视乳头旁RNFL厚度（117.5±15.9）μm与DR组（118.7±18.7）μm比较无统计学差异;黄斑区视网膜厚度在DR中明显增厚,PRP治疗后增厚明显。结论 DR行PRP治疗后近期RNFL无明显变化,黄斑区视网膜水肿加重。     

玻璃体注药联合激光光凝治疗糖尿病视网膜病变的临床疗效

目的 研究玻璃体注药联合激光光凝治疗糖尿病视网膜病变的临床疗效.方法 选取2019年1月—2020年9月在该院确诊的糖尿病视网膜病变患者,根据治疗方案不同分为两组,观察组(玻璃体注药联合激光光凝)和对照组(单纯激光光凝),对比两组患者的治疗疗效.结果 对照组治疗前视力为(0.24±0.12),治疗后视力为(0.43±0...     

糖尿病视网膜病变采用中药联合视网膜光凝治疗的临床探讨

目的观察糖尿病视网膜病变采用中药联合视网膜光凝治疗的临床疗效。方法选取该院收治的50例(92眼)糖尿病视网膜病变患者为研究对象,将其随机分为观察组与对照组,观察组给予中药联合视网膜光凝治疗,对照组仅给予激光光凝治疗,比较两组患者的临床疗效。结果观察组总有效率高于对照组(P0.05),有统计学意义。结论糖尿病视网膜病变采用中药联合视网膜光凝治疗的临床疗效显著,值得在临床上推广。     

糖尿病患者视网膜光凝前散瞳的效果分析

散瞳是视网膜光凝前的重要准备工作,视网膜光凝要求瞳孔直径〉8mm,并能在术中维持散大状态。本研究对75例视网膜光凝患者进行观察,探讨糖尿病性视网膜病变患者散瞳后瞳孔直径是否与非糖尿病性视网膜病变患者相同。     

全视网膜激光光凝联合一次康柏西普眼内注射治疗糖尿病视网膜病变的临床疗效分析

目的 探讨全视网膜激光光凝前联合一次康柏西普眼内注射治疗糖尿病视网膜病变患者的临床疗效。方法 选取2021年12月—2022年5月在扬中明辰眼科医院眼科进行全视网膜激光光凝治疗的糖尿病性视网膜病变患者50名(50眼),随机分为观察组(25名25眼)和对照组(25名25眼),观察组采用玻璃体腔注射康柏西普1周后进行全视网膜激光光凝,对照组直接进行全视网膜激光光凝,治疗后1个月及6个月使用OCT进行黄斑区视网膜厚度检查,治疗后6个月使用眼底血管荧光造影进行视网膜无灌注区、新生血管范围、荧光渗漏区域面积测算。结果 治疗后1个月及6个月,观察组患者的视力、黄斑区视网膜厚度均优于对照组,差异有统计学意义(P<0.05)。治疗后6个月时,两组视网膜无灌注区面积、视网膜新生血管区面积、视网膜荧光渗漏面积均较术前减小,且观察组明显优于对照组,差异有统计学意义(P<0.05)。结论 增殖期糖尿病视网膜病变患者在全视网膜激光光凝前进行一次康柏西普治疗,可以更好地提高患者术后视力,减轻术后黄斑水肿,改善视网膜无灌注区、新生血管及荧光渗漏,减少术后并发症。     

Release of the angiogenesis inhibitor angiostatin in patients with proliferative diabetic retinopathy: association with retinal photocoagulation

Aims/hypothesis. Proliferative diabetic retinopathy is a major debilitating disease causing most cases of blindness in humans in the Western world. Photocoagulation is the established therapy of proliferative diabetic retinopathy, although the molecular mechanisms of its effects are still not known. Recently angiostatin has been characterized as a potent inhibitor of neovascularization. Apart from a possible down-regulation of angiogenic cytokines, release of angiostatin could initiate the anti-angiogenic effects of retinal photocoagulation.¶Methods. We investigated the regulation of angiostatin and the angiogenic cytokines vascular endothelial growth factor and basic fibroblast growth factor in vivo by comparing vitreal concentrations of 18 control patients and 34 patients with proliferative diabetic retinopathy with and without previous photocoagulation. Concentrations of basic fibroblast growth factor and angiostatin were additionally measured in serum, while vascular endothelial growth factor is known to be regulated locally in the eye. Cytokines were measured by immunological methods.¶Results. Angiostatin could be detected in 2 out of 18 control patients and in 25 out of 34 diabetic patients (p < 0.00 001). Most importantly, production of angiostatin in human vitreous correlated significantly with previous retinal photocoagulation (p < 0.0001) in patients with proliferative diabetic retinopathy. Only two patients (one control and one diabetic) had detectable serum concentrations of angiostatin. Additionally patients with proliferative diabetic retinopathy and with previous photocoagulation had significantly lower concentrations of vascular endothelial growth factor (0.9 ± 0.1 ng/ml; p < 0.0001) than diabetic patients without previous photocoagulation (4.0 ± 0.8 ng/ml). The investigation of vitreal and serum basic fibroblast growth factor concentrations yielded no significant differences between the groups.¶Conclusion/interpretation. Angiostatin is not a regularly expressed angiogenesis inhibitor in human vitreous. The alterations we observed suggest that local release of angiostatin and down-regulation of vascular endothelial growth factor mediate the therapeutic effects of retinal photocoagulation in proliferative diabetic retinopathy. [Diabetologia (2000) 43: 1404–1407]     

非离子型造影剂对24例肾功能轻度异常患者肾功能的影响

造影剂相关性肾病(CIN)是心导管术的常见并发症,随着血管造影在临床上的广泛应用,造影剂肾损伤的个案报道不断出现,因此对造影剂肾毒性的关注也不断增加。国外报道,传统离子型造影剂有15%的急性肾功能衰竭发生率[1]。也有研究指出,有基础肾脏疾病的患者在使用造影剂后,急性肾功     

A study on vascular retinal alterations in patients with coronary artery disease

The paper describes the study carried out on a sample of 27 coronary artery disease patients, aiming to determine a correlation between coronary artery disease and anomalies in the retinal circulation. Patients underwent selective coronary arteriography and fundus fluorescein angiography that allowed us to investigate the dye dynamics and to detect abnormalities of time evolution, vessel walls, and flux. During the fluorescein angiography we measured time events as the choroidal flush (t_a) the start of the laminar phase (t_b), and the end of the laminar phase (t_c) and we took pictures that were digitally processed in order to compute the ROI₁/ROI₂ value, assumed as a numerical index of ischemia of the optic disc. In the examined sample we found t_a=61±109, t_b=65±107, t_c=159±155, and ROI₁/ROI₂=0.968±0.300. Normal ranges for these parameters were determined by the fundus fluorescein angiography of a control group of 10 patients, unaffected by coronary artery disease and ischemic pathology of the retinal network; we found t_a=12±4, t_b=16±8.5, t_c=44±9.3, and ROI₁/ROI₂=0.735±0.086. Eighty-five percent of coronaropatic patients showed ischemia of the optic disc, 89% anomalies of the epi-peripapillar network, 70% anomalies of the papillo-macular network, and 89% evidence of at least two findings of ischemia; 85% of patients showed a value of ROI₁/ROI₂ out of the normal range. The unpaired Student'st-test between the coronaropatic and the control group does not show significant differences between t_a and t_b; on the contrary, those with coronary disease and the control group were statistically different for t_c (p0.02). Moreover, we have found a correlation between the numerical index of optic disc ischemia and the severity of coronary artery disease (r=0.68,p0.01). Hence, the vascular abnormalities shown by the fluorescein angiography can constitute valid noninvasive markers and can advise further cardiological tests for a coronary artery disease not yet diagnosed.     

小剂量辛伐他汀对急性心肌梗死患者 血管内皮功能的影响

目的　观察心肌梗死急性期降脂治疗对内皮依赖性血管舒张功能的作用。方法　采用超声法检测 39例急性心肌梗死 (AMI)患者和 31例无心肌梗死者肱动脉内皮依赖性舒张功能。应用随机、交叉实验设计 ,将 39例AMI受试者随机分为单纯常规治疗组和加服辛伐他汀 5mg/d或 10mg/d治疗组 ,治疗 2个月后复测其肱动脉内皮依赖性舒张功能。然后交叉 ,即单纯常规治疗组加服辛伐他汀 5mg/d或 10mg/d ;原服辛伐他汀治疗组停用 ,仅接受常规治疗 ;第 4个月再次检测肱动脉内皮依赖性舒张功能。结果　AMI患者肱动脉内皮依赖性舒张功能 [n =39,(2 .44± 3.31) % ]较对照组 [n=31,(8.13± 4.77) % ]明显降低 (P <0 .0 0 1)。AMI患者服用 5mg/d辛伐他汀 (n =19)治疗 2个月后 ,肱动脉内皮依赖性舒张功能 (4 .2 9± 2 .91) %与治疗前基础水平 (2 .5 4± 2 .5 2 ) %、常规治疗后 (2 .89±3.71) %相比差别无显著性 ;而服用 10mg/d ,辛伐他汀 (n =2 0 )治疗 2个月后 ,肱动脉内皮依赖性舒张功能 [(6 .2 4± 4.14) % ]与治疗前基础水平 [(2 .35± 3.92 ) %P <0 .0 1]、常规治疗后 [(2 .5 7± 3.5 7) %P <0 .0 5 ]相比 ,有显著性改善。同时还观察到 ,与常规治疗相比较 ,辛伐他汀 (5mg/d或 10mg/d)治疗后血总胆固醇水平有明显降低。结论     

LASIK术前近视患者眼底、视野的检查及意义

目的观察准分子激光原位角膜磨镶术（LASIK）术前近视患者眼底、视野的变化,并探讨其意义。方法对拟行LASIK的124例（248眼）近视患者术前行眼底及视野检查。结果眼底检查发现各种视网膜病变者49眼,其中视网膜变性36眼、视网膜浅层脱离4眼、视网膜裂孔8眼、眼底出血1眼;视野检查发现局限性暗点28眼、弧形暗点13眼、广泛性视野缺损8眼。结论部分近视患者存在不同类型的眼底病变及视野变化,对于近视患者特别是高度近视患者LASIK术前进行眼底及视野检查是必要的。     

早中期老年帕金森病患者眼球运动异常的临床研究

目的 研究帕金森病患者的眼球运动功能情况,并探讨其临床意义.方法 利用视频眼震电图(VNG)对14名原发性帕金森病患者(PD)和10名年龄、性别相匹配的健康人行眼球扫视运动、平稳追踪运动(SPEM)测试,比较两组间扫视潜伏期、扫视精确度和平稳追踪增益值(SPEMGain)的差异.结果 PD组眼球扫视运动的潜伏期(291.23±46.25)ms,较对照组的(244.45±23.11)ms显著延长.P＜0.05;扫视精确度87.98±6.1 6,较对照组的95.21±8.56显著下降,P＜0.05;PD组SPEMGain 0.81±0.12,也明显低于对照组的0.90±0.15,P＜0.05.结论 帕金森病患者眼球运动功能有明显异常.     

静滴合贝爽、硝酸甘油治疗不稳定型心绞痛的疗效对比研究

目的：评价合贝爽治疗不稳定性心绞痛的临床疗效。方法：92例不稳定性心绞痛患随机分为合贝爽治疗组（n=48)和硝酸甘油治疗组（n=44),两组在常规治疗基础上分别静脉滴注合贝爽和硝酸甘油,疗程为14d,结果：合贝爽减少了心弱痛发作次数,缩短了心绞痛持续时间和Holter监测心肌缺血的时间,与硝酸甘油比较有显性差异（P＜0．01）,合贝爽治疗组需要接受介入性治疗的病例数（12／48）较硝酸甘油组（18／44）少（P＜0．05）,结论：合贝爽治疗不稳定性心绞痛疗效较硝酸甘油优越,且能改善患预后。     

99例HBsAg阳性肺结核患者化疗致肝功能损害研究

目的探讨HBsAg阳性肺结核患者应用抗结核药物治疗对肝功能的影响。方法收集该院住院肺结核患者179例,根据HBsAg检测情况分为观察组和对照组,对比两组患者抗结核治疗肝功能损害情况。结果观察组药物性肝损害发生率58.24%高于对照组17.05%,且两组在轻、中、重度肝损害方面差异均有统计学意义(P0.05)。观察组AST112.8±84.3IU/L和ALT153.4±87.5IU/L明显高于对照组的86.7±70.5IU/L和103.3±71.3IU/L(P0.05)。观察组肝损害时间早于对照组。结论乙肝表面抗原阳性者在抗结核治疗过程中较阴性者更易发生肝功能损害,应当选用肝损害小的药物。