先天性上睑下垂弱视眼治疗前后光学相干断层扫描的分析

目的 探讨单眼先天性上睑下垂形觉剥夺性弱视眼治疗前后,黄斑中心及各分区视网膜厚度特征。方法 收集2018年1月至2020年12月我院就诊的单眼先天性上睑下垂导致的剥夺性弱视患者30例,术前行黄斑部光学相干断层扫描（OCT）检查,患儿行上睑下垂矫正术后并行弱视综合治疗,6个月后再次行OCT检查,分析弱视眼治疗前后的变化。结果弱视眼黄斑中心区视网膜厚度为（165.06±11.12）μm,对照组的黄斑中心区视网膜厚度为（156.31±8.46）μm,弱视眼与对照组比较,差异有统计学意义（P<0.05）,弱视眼治疗后黄斑中心区视网膜厚度为（157.35±9.61）μm,弱视眼治疗后较治疗前视网膜厚度下降,弱视眼治疗前后比较,差异有统计学意义（P<0.05）,弱视眼黄斑部内、外环的上方、下方、鼻侧、颞侧的视网膜厚度与正常眼及弱视眼治疗后的比较,差异无统计学意义（P>0.05）。结论 先天性上睑下垂引起的形觉剥夺性弱视黄斑中心区视网膜厚度较正常眼厚,弱视眼治疗后黄斑中心区视网膜厚度变薄。     

调节训练加入传统疗法治疗屈光参差性弱视儿童的疗效

目的 探讨调节训练加入传统疗法治疗屈光参差性弱视儿童的临床疗效,为临床诊疗提供参考。方法 2017年12月至2019年12月就诊的3～12岁屈光参差性弱视儿童254例(254眼),随机分成2组。对照组127例(127眼)采用传统治疗方法,观察组127例(127眼)在此基础上加入调节训练。比较12个月后2组患儿弱视眼视力提升的治疗效果,治疗前后弱视眼调节功能的变化,双眼屈光状态及近立体视的变化。结果 观察组患儿弱视眼的矫正视力达“进步”、“基本治愈”所用平均时间[(5.28±2.17)月、(8.58±1.63)月]短于对照组[(6.36±2.09)月、(9.60±1.61)月],差异有统计学意义(P<0.05)。12个月后,观察组患儿弱视眼矫正视力提升的有效率(88.19%)高于对照组(71.65%)(P<0.05);按年龄、程度、屈光分类比较,观察组10～12岁、重度弱视、远视性屈光参差性弱视患儿弱视眼矫正视力提升的有效率明显高于对照组,差异有统计学意义(P<0.05)。训练前2组调节功能及立体视功能均无差异,训练12个月后观察组调节幅度[(15.39±0.72)D]...     

不同类型弱视儿童对比敏感度差异的分析

目的比较三种类型弱视儿童弱视眼和非弱视眼的对比敏感度(CS),探讨不同类型弱视的弱视眼和非弱视眼CS的差异。方法使用OPTEC6500视功能测试仪对103例弱视患儿的弱视眼和非弱视眼进行CS测量。结果在弱视眼视力程度一致的情况下,屈光不正性患儿的弱视眼CS在各空间频率上均优于斜视性和屈光参差性患儿的弱视眼;屈光参差性患儿的非弱视眼CS在各空间频率上均优于斜视性和屈光不正性患儿的非弱视眼。结论结合立体视觉的分析,本研究认为双眼异常的交互作用是引起不同类型弱视儿童CS差异的重要因素。     

黄斑厚度与儿童屈光性弱视眼的相关性研究

目的 探究黄斑厚度与儿童屈光性弱视眼的相关性.方法 选择2017年5月至2019年6月荆门市中医医院眼科就诊的非斜视性屈光参差性单眼弱视者53例(53眼)作为弱视组,另选择同期55例(55眼,均取右眼)正常体检儿童作为对照组.应用光学生物测量仪(IOL Master)和光学相干断层扫描(OCT)检测受试者受视眼屈光度、...     

曲安奈德治疗糖尿病性黄斑水肿的临床效果分析

目的探究曲安奈德治疗糖尿病性黄斑水肿(diabetic macular edema,DME)的临床效果。方法选取2013年4月至2014年4月收治的糖尿病性黄斑水肿患者50例(56眼),应用曲安奈德进行治疗,比较分析治疗前与治疗后1、3、6个月患者的视力、黄斑区视网膜厚度的变化。结果与治疗前的平均视力(0.07±0.03)相比,治疗后1个月(0.14±0.10)、3个月(0.15±0.11)、6个月(0.13±0.10)患者的视力均显著提高(P<0.01);治疗后1、3、6个月,患者的黄斑区视网膜平均厚度由治疗前(588.6±128.2)μm分别降低到(252.5±70.4)μm、(246.8±71.5)μm、(250.5±70.8)μm,与治疗前相比差异均具有统计学意义(P<0.01)。结论曲安奈德治疗糖尿病性黄斑水肿效果良好,具有临床推广价值。     

阿托品联合部分遮盖法治疗大龄儿童屈光参差性弱视

目的探讨阿托品联合部分遮盖法对大龄儿童屈光参差性弱视的治疗效果。方法 39例10～16岁屈光参差性弱视儿童,男23例,女16例,在适宜的屈光矫正基础上,健眼涂阿托品眼膏并部分时间完全遮盖,配合弱视眼精细目力训练。每月随访,记录最佳矫正视力（best corrected visual acuity,BCVA）对应的LogMAR对数变换值,弱视眼视力连续3个月不再提高后,停用阿托品眼膏,缩短完全遮盖时间。结果全部39例患儿视力均明显提高,治疗前弱视眼BCVA平均0.21±0.19（LogMAR）,治疗后平均0.62±0.32（LogMAR）,差异具有统计学意义（P〈0.01）。遮盖时间平均（9.1±4.4）个月,在治疗开始后的前6个月内视力提高最快。10～12岁组视力提高程度与15～16岁组,差异具有统计学意义（P〈0.05）,与13～14岁组差异无统计学意义（P〉0.05）。中度弱视眼视力提高程度高于重度弱视眼,差异具有统计学意义（P〈0.05）。结论大龄儿童屈光参差性弱视仍有可能治愈,阿托品联合部分遮盖法提高了治疗的依从性,效果好。     

糖尿病患者视神经纤维层病变的研究

目的 分析糖尿病患者在未出现糖尿病视网膜病变前的眼部光学相干断层扫描（OCT）神经纤维层缺损变化.方法 对52例（104眼）未出现糖尿病视网膜病变的糖尿病患者及52例（104眼）正常人眼的OCT临床资料进行对比分析.结果 104眼糖尿病患者中视神经纤维平均厚度（77.62±13.29）μm较正常组（98.38±11.76）μm变薄,差异有统计学意义（P〈0.05）.结论 糖尿病视网膜病变临床前期即出现神经纤维层变薄,OCT检查对糖尿病视神经病变的早期诊断有重要意义.     

30例屈光参差性弱视患儿的综合治疗疗效观察

弱视是较为常见的儿童眼病,仅发生在视觉尚未发育成熟的幼儿期.屈光参差是影响双眼单视,导致儿童弱视的常见原因之一.为了观察综合治疗法对屈光参差性弱视的治疗效果,现对我院收治的30例(52眼)屈光参差性弱视患儿的临床资料分析如下.     

弱视患儿黄斑部OCT改变

目的：利用相干光学断层扫描(optical coherence tomography, OCT)了解弱视儿童黄斑部变化。方法4~12岁患儿共42例(68眼)根据检查结果分为弱视组(18例,28眼)和非弱视组(24例,40眼),比较两组OCT检查结果。结果弱视组黄斑鼻侧,颞侧及黄斑中心部视网膜厚度高于非弱视组,差异有统计学意义(P<0.05)。结论弱视儿童黄斑部视网膜较厚, OCT可以快速检测黄斑结构。     

短时遮盖加乒乓球训练治疗大龄儿童远视性屈光参差性弱视的疗效探讨

目的研究大龄儿童远视性屈光参差性弱视患儿分别采用单纯遮盖与短时遮盖加乒乓球训练治疗的临床效果。方法74例(74只眼)大龄儿童远视性屈光参差性弱视患儿,根据患儿对乒乓球训练的爱好程度的不同分成治疗组和对照组,各37例(37只眼)。治疗组采用短时遮盖加乒乓球训练治疗,对照组采用单纯短时遮盖治疗。对比两组的基本治愈率。结果随访1年后,治疗组基本治愈率为75.68%,对照组基本治愈率为40.54%,治疗组基本治愈率高于对照组,差异有统计学意义(P<0.05)。结论对于大龄儿童远视性屈光参差性弱视患儿,采用短时遮盖加乒乓球训练治疗,可以明显提高治愈率,缩短治愈时间。     

兔视网膜挫伤后视网膜水肿和水通道蛋白4表达

目的观察兔实验性视网膜挫伤后视网膜水肿与视网膜神经上皮水通道蛋白4（Aquaporin-4,AQP-4）表达动态变化特点,以期通过探讨视网膜水肿与视网膜神经上皮水通道蛋白4表达的相关性,进一步了解视网膜挫伤的发病机制。方法健康成年大白兔84只,以重击法制备兔眼视网膜挫伤模型,致伤能量约为2.87J（E=mgh）,分别于挫伤后1h、3h、1d、3d、7d及14d处死受试兔,摘除眼球并取材,称重法测定视网膜含水量、免疫组化法检测AQP-4在视网膜神经上皮的表达情况。结果①与对照组相比较,各组视网膜含水量在视网膜挫伤后均明显升高（均P〈0.05）,并呈现动态变化：伤后1h组即明显高于对照组（P〈0.01）,24h组达到最高值,3d组开始下降,7d组明显下降,14d组仍高于对照组（P〈0.05）;并且视网膜挫伤各组间视网膜含水量有明显差异（P〈0.05）。②受试各组家兔视网膜神经上皮均有AQP-4表达。与对照组相比较,AQP-4表达在视网膜挫伤后各组均明显升高（均P〈0.05）;伤后1h组即高于对照组（P〈0.05）,3h组明显升高,24h组AQP-4表达最强,3d组AQP-4表达明显下降,挫伤后7d组表达下降更为明显,14d组AQP-4表达仍高于对照组（P〈0.05）;各个挫伤组AQP-4表达也存在明显差异（P〈0.01）;伤后视网膜含水量和AQP-4表达的动态变化呈现明显相关性（r=0.924,P〈0.05）。结论兔实验性视网膜挫伤后视网膜神经上皮AQP-4表达迅速升高,并随着伤后视网膜含水量的变化而变化;推测AQP-4是视网膜水肿病理过程的一个重要机制。     

应用光学相干断层扫描仪对视乳头水肿患者的临床研究

目的应用光学相干断层扫描（optical coherence tomography,OCT）观察视乳头水肿患者的视网膜神经纤维层厚度与形态的改变。方法采用OCT追踪测量30例有视乳头水肿的患者其在首诊,第1周,第1个月,第2个月,第3个月视盘周围视网膜神经纤维层厚度。动态观察视网膜神经纤维层厚度的改变,OCT图像特征和变化。结果视乳头水肿患者的视盘周围视网膜神经纤维层厚度呈先增厚再萎缩变薄的过程,并发现在水肿的神经纤维层下存在一个低反射区。结论OCT能定性、定量动态地观察到视乳头水肿的病情演变。     

The effect of cigarette smoking on retinal nerve fiber layer thickness in patients with migraine

Context: Migraine is a frequent and disabling chronic neurological condition with complex pathophysiology. Both cigarette smoking and migraine may cause damage to the optic nerve. Objective: The primary objective of this study was to investigate the effect of cigarette smoking on retinal nerve fiber layer (RNFL) thickness in patients with migraine.

Materials and methods: Eighty-four consecutive patients diagnosed with migraine (34 smokers and 50 nonsmokers) and 66 age- and gender-matched healthy non-smoker controls were enrolled for this observational cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography (OCT) and then RNFL thickness in patients with migraine who smoke was compared to nonsmoking patients with migraine and healthy subjects.

Results: The average, superior, nasal and inferior RNFL thicknesses were significantly thinner in patients with migraine compared to the control group (p?<?0.001, p?=?0.02, p?<?0.001 and p?=?0.04, respectively). The average and inferior RNFL thicknesses were significantly reduced in smoker patients with migraine compared to the nonsmokers (p?=?0.011, p?=?0.045, respectively). Nonsmoker patients with migraine had significantly thinner average and nasal RNFL thicknesses than the control group (p?=?0.001, p?=?0.001, respectively).

Conclusion: Cigarette smoking may cause significant RNFL thinning in patients with migraine. OCT may be a feasible technique for determination of smoking-induced ocular damage in patients with migraine.     

近视眼神经纤维层厚度光学相干断层扫描分析

目的研究人视网膜神经纤维层(RNFL)厚度随近视眼屈光度加深而变化的特点及临床意义。方法将近视眼108例(197眼)和正常对照者42例(60眼)分为低度近视组、中度近视组、高度近视组和正常对照组,应用光学相干断层扫描仪(OCT)进行以视乳头为中心,直径3．46mm圆周的RNFL厚度测量,计算各组平均RNFL厚度及鼻、颞、上、下四个象限的RNFL厚度,各近视组分别与正常组对比,并进行统计学分析。结果低度、中度近视眼平均神经纤维层厚度变薄但与正常对照无显著性差异(P＞0．05),高度近视眼平均神经纤维层厚度明显变薄,与正常对照相比具有显著性差异(P＜0．01)。近视眼各象限RNFL最早变薄的是鼻象限,低度近视即与正常人有显著性差异(P＜0．01)。高度近视跟鼻、下、上象限RNFL均明显变薄(P＜0．01),而颞象限RNFL反而增厚,与正常人相比有显著性差异(P＜0．01)。结论近视眼平均RNFL厚度呈变薄的改变,随着近视度数的加深,近视跟RNFL厚度变薄越来越明显。分区分析上、下、鼻象限变化与平均相一致,而颞象限增厚,这可能是近视眼RNFL的特点。这些特点对临床疾病的诊断具指导意义。     

Evaluation of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer measurements in patients with iron deficiency anemia with optical coherence tomography

Objective: To evaluate the thickness of the peripapillary retinal fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCL+) using optical coherence tomography (OCT) in patients with iron deficiency (ID) anemia.

Methods: This study included 73 eyes of 39 patients with ID anemia and 68 eyes of 34 age- and sex-matched healthy subjects. The measurements included the peripapillary RNFL thicknesses as average, 4 quadrant and 12 clock-hour (CH) based and macula GCL+ thicknesses as average and 6 quadrant based. All measurements were completed with Cirrus HD-OCT and the results were compared between the groups.

Results: A total of 73 eyes of 39 patients with ID anemia and 68 eyes of 34 healthy subjects were included to the study. Regarding peripapillary RNFL thicknesses of the study and control patients, the values of average and quadrants revealed no significant differences between the groups. In CH sectors comparison, peripapillary RNFL thicknesses were significantly decreased only in CH4 (68.7?±?14.5?μm in study versus 72.0?±?13.4?μm in control patients, p?=?0.049) and CH5 (93.4?±?20.0μm in study versus 102.2?±?20.1?μm in control patients, p?=?0.01) sectors. All measured quadrants were statistically similar, when macula GCL+ thicknesses were compared between the groups. When the correlations between peripapillary RNFL and macula GCL+ thicknesses and serum hemoglobin and ferritin levels of study and control patients were calculated, the only statistically significant parameter was the correlation of peripapillary RNFL thickness in CH10 sector with serum ferritin level (p?=?0.032, Spearman correlation coefficient: 0.369).

Conclusion: The study revealed that peripapillary RNFL is thinner in nasal-inferior quadrant in patients with ID anemia. The measurements of macula GCL+ thicknesses were similar between the groups. Analyzing the retinal layers using OCT may provide valuable information in neurodegenerative events.     

Evaluation of retinal nerve fiber layer thickness in vernal keratoconjunctivitis patients under long-term topical corticosteroid therapy

Purpose: The aim of this study was to evaluate the retinal nerve fiber layer (RNFL) thickness in vernal keratoconjunctivitis (VKC) patients who were under long-term topical corticosteroid therapy.

Methods: Thirty-six eyes of 36 VKC patients with clear cornea and normal videokeratography and 40 eyes of 40 age- and gender-matched normal children were included in the study. Clinical and demographic characteristics of the patients were noted and detailed ophthalmological examination was performed. Visual acuity (VA), spherical equivalent (SE), axial length (AL) and RNFL thickness measurements were compared between the groups. To correct ocular magnification effect on RNFL, we used Littmann’s formula.

Results: All VKC patients had history of topical corticosteroid use and the mean duration of the topical corticosteroid use was 23.8?±?9.09 months. There was no significant difference between the groups in terms of intraocular pressure (IOP). VKC group had significantly worse VA, greater SE and AL and thinner mean global, superior and inferior RNFL thickness. There were significant negative correlations between the duration of topical corticosteroid use and the mean global, superior and temporal RNFL thickness in VKC group. After correction of magnification effect, VKC group still had thinner mean global, superior and inferior RNFL thickness, and significant difference between the groups in inferior RNFL thickness did not disappear.

Conclusion: Significant RNFL thickness difference between the groups suggests a possible effect of long-term corticosteroid use in VKC patients. Because visual field (VF) analysis in pediatric patients is difficult to perform and IOP may be illusive, RNFL thickness measurements in addition to routine examinations in VKC patients may help clinicians in their practice.     

血浆胰岛素水平与视盘周围血管密度和视网膜神经纤维层厚度的关系

目的探讨视盘周围血管密度(cpVD)和视网膜神经纤维层( RNFL)厚度与血浆胰岛素水平的关系。方法选取 2020年 7月至 2021年 7月西安市人民医院收治的 2型糖尿病病人 123例(123只眼)进行回顾性研究，根据是否发生糖尿病视网膜病变( DR)将病人分为: 2型糖尿病非视网膜病变( NDR)组( 50只眼)和非增生性糖尿病视网膜病变( NPDR)组( 73只眼)，此外选取 58例( 58只眼)正常眼(于该院进行健康体检)作为对照组。收集研究对象一般资料，包括年龄、性别、身体质量指数( BMI)、总胆固醇(TC)、三酰甘油( TG)高密度脂蛋白胆固醇( HDL-C)低密度脂蛋白胆固醇( LDL-C)、收缩压( SBP)、舒张压( DBP)并进行比较；采用酶联免疫( ELISA)、法检测血浆胰岛素水平；应用光、学相干断层扫描血管成像(OCTA)观察cpVD和RNF，L厚度；受试者操作特征( ROC)曲线评价 cpVD与 RNFL厚度对 DR发生的预测价值。通过 logistic回归分析 DR发生的影响因素。结果与对照组比较， NDR组和 NPDR组病人 RNFL厚度显著变薄［( 96.66±10.47)比( 81.75±9.59)、(90.56±10.33)μm］cpVD显著降低，胰岛素水平显著降低(均 P<0.05)；与 NPDR组相比， NDR组病人糖尿病病程及 BMI、SBP、DBP水平均升高( P<0.0，5)； NDR组和 NPDR组病人血浆胰岛素水平与 cpVD呈正相关( r=0.26，P<0.05)，与 RNFL厚度呈正相关( r=0.24，P<0.05)，cpVD与 RNFL厚度呈正相关( r=0.30，P<0.05)； NDR组和 NPDR组病人 cpVD、RNFL厚度与糖尿病病程、 BMI、SBP、DBP均呈负相关( P<0.05)； logistic回归分析显示胰岛素水平、糖尿病病程是影响 DR发生的因素(P<0.05)； ROC结果显示，胰岛素、 cpVD与 RNFL厚度 NPDR发生的曲线下面积( AUC)及 95%CI分别为 0.71(0.62，0.79)、 0.62(0.53，0.71)、 0.86(0.78，0.79)，对应的灵敏度分别为83.56%、80.00%、88.00%，特异度分别为 56.00%、41.10%、71.23%。三者联合 NPDR发生的 AUC 95%CI为 0.89(0.83，0.94)灵敏度为 87.67%，特异度为 80.00%。结论 2型糖尿病病人血浆胰岛素水平与 cpVD和 RNFL厚度均呈正相关。血浆胰岛素水平，可能作为预测视网膜功能的早期指标， RNFL厚度以及 cpVD可作为诊断 DR的指标。     

单纯性近视眼鼻侧视网膜神经纤维层厚度变化影响因素研究

目的 探讨单纯性近视眼鼻侧视网膜神经纤维层厚度变化的影响因素.方法 选择2013年2月至2015年2月在我院眼科接受检查的近视眼患者122例(236眼),根据患者等效球镜度数分为低度近视眼组、中度近视眼组和高度近视眼组.进行眼科常规检查,以及等效球镜、眼压、眼轴长度和视野检查,并进行相关性分析.结果 三组间性别和年龄没有统计学差异(P＞0.05);随着近视程度的增加眼轴长度和等效球镜度数显著增加(P＜0.05);全周平均、上象限、下象限和鼻侧象限的视网膜神经纤维层厚度随着近视程度的增加而显著降低(P＜0.05);低度近视眼组、中度近视眼组和高度近视眼组鼻侧象限视网膜神经纤维层厚度与等效球镜度数和眼轴长度呈负相关.结论 单纯性近视眼患者鼻侧象限视网膜神经纤维层厚度与等效球镜度数和眼轴长度呈负相关.     

Assessment of macular choroidal thickness,central macular thickness and retinal nerve fiber layer in patients receiving oral isotretinoin treatment

Abstract

Purpose

To investigate the impact of oral isotretinoin therapy in choroidal thickness, central macular thickness (CMT), and retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT).     

Follow up of retinal nerve fiber layer thickness with optic coherence tomography in patients receiving anti-tubercular treatment may reveal early optic neuropathy

Purpose: To evaluate the effect of anti-tubercular treatment on retinal nerve fiber layer (RNFL) thickness and the efficiency of optic coherence tomography (OCT) on early diagnosis of optic neuropathy.

Methods: Twenty patients diagnosed with either pulmonary or extra-pulmonary tuberculosis which were treated with anti-tubercular treatment (isoniazid (INH), rifampicin, ethambutol (ETM), and pyrazinamide) were enrolled in the study. RNFL thicknesses of the patients were measured via OCT, at baseline (before starting anti-tubercular treatment) and after the two-month treatment period. Standard ophthalmologic examinations were also performed.

Results: Compared to baseline values, after the two-month treatment period, thinning was detected in the right eye’s average and superior quadrant RNFLs (p?=?0.024 and p?=?0.006 respectively) and in the left eye’s average, superior quadrant, and inferior quadrant RNFLs (p?=?0.001, p?=?0.008, p?Conclusion: We displayed that patients receiving INH and ETM, which were the basic medicines of anti-tubercular treatment, experienced thinning in RNFL after the two-month treatment period. Patients receiving these drugs can be followed via OCT in terms of reduction in RNFL thicknesses for early diagnose of INH and ETM toxicity.