春季结膜炎穹窿结膜的临床病理

证明春季结膜炎在穹窿结膜的临床病理。方法：详细记载球（角膜缘）、睑及穹窿结膜的临床表现;对３８眼（２１例）的穹窿结膜（上穹窿３４眼、下穹窿４眼）进行活检,组织切片ＨＥ染色,光学显微镜下观察病理改变。结果：结膜上皮不同程度增生,上皮下淋巴细胞、浆细胞浸润或胶元纤维增生,３８眼标本中３２眼有嗜酸性白细胞、１眼有嗜碱性白细胞浸润。一极轻病例双眼下穹窿结膜只有很少几个淋巴细胞,其中却散在个别嗜酸性白细胞。结论：春季结膜炎的临床病理改变包括穹窿结膜。     

睑板下注射曲安奈德改善活动期春季角结膜炎患者眼表症状的临床研究

目的 对比观察春季角结膜炎活动期患者睑板下注射曲安奈德后的眼表症状、泪膜及泪液蛋白的特点.方法 收集2010年8月至2014年6月眼科门诊确诊为春季角结膜炎活动期患者20例(24眼),随机分为A、B两组(各12眼),A组行睑板下注射曲安奈德(每次20 mg,共注射1次),B组行妥布霉素地塞米松眼液滴眼,每天3次,连续1个月.分别对两组患者治疗前与治疗后2周、1个月眼表症状评分、泪膜四项检查及泪液各蛋白测定结果并进行对比.结果 两组患者治疗前眼表症状评分、泪膜四项(泪膜破裂时间、基础泪液分泌试验、泪河高度降低及角膜荧光素染色)、泪液蛋白、乳铁蛋白、溶菌酶比较,差异均无统计学意义(均为P＞0.05);治疗14 d后,A组患者干眼症状眼数增多,眼表指数增高、泪膜破裂时间减短、基础泪液分泌试验增高、泪河高度降低、角膜荧光素染色增强,总蛋白、乳铁蛋白、溶菌酶较B组均明显降低,且差异均有统计学意义(均为P＜0.05).治疗1个月后,A组患者眼表指数、泪膜破裂时间、基础泪液分泌、泪河高度均减少,角膜荧光素染色增强,而B组患者眼表指数、泪膜破裂时间、基础泪液分泌、泪河高度及角膜荧光素染色均降低,差异均有统计学意义(均为P ＜0.05),并且A组较B组眼表指数减少,泪膜破裂时间、基础泪液分泌、泪河高度、角膜荧光素染色均明显增加(P＜0.05).结论 曲安奈德睑板下注射治疗能提高春季角结膜炎活动期患者泪膜稳定性,升高泪液蛋白含量.     

曲安缩松球结膜下注射治疗春季卡他性结膜炎

我科自 1998年 8月～ 2 0 0 0年 4月应用曲安缩松混悬液(意大利产 ,规格 :每支 40 mg/ 1ml)球结膜下注射治疗春季卡他性结膜炎 2 9例 ,均获明显效果 ,现将治疗情况报告如下。一、对象和方法1.一般资料 ,本文治疗 2 9例 ,均为双眼发病 ,男 18例 ,女 11例 ,最大 2 8岁 ,最小 8岁。其中睑结膜型 12例 ,球结膜型 11例 ,混合型 6例。发病最长者 8年 ,最短者 2个月 ,都具有春季卡他性结膜炎的临床特征 :(1)患者眼部奇痒难忍 ,有异物感 ,严重者有畏光、溢泪症状。(2 )病变分三型 :a.睑结膜型 ,以上睑为主 ,在充血的结膜上出现大小不一的扁平乳头状…     

结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的效果

目的：评价经结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿患者的临床效果。
　　方法：选取本院2014-10/2015-10收治的葡萄膜炎继发黄斑水肿患者68例82眼,并其按随机数字表法分为对照组和试验组,每组34例41眼患者。对照组患者采用经球内注射曲安奈德,试验组患者采用经结膜下注射曲安奈德。对比两组患者治疗后临床效果,黄斑中心凹视网膜厚度( CMT)变化,不良反应发生的情况。
　　结果：两组患者治疗前黄斑中心凹视网膜厚度及最佳矫正视力比较无统计学意义(P>0.05);但试验组治疗后黄斑中心凹视网膜厚度(214.26±65.54μl)明显低于对照组(256.47±84.52μl);试验组治疗后最佳矫正视力(4.8±1.3)明显优于对照组的(4.0±1.4),差异具有统计学意义(P<0.05);试验组患者治疗后的总有效率(98%)明显高于对照组的(83%),差异具有统计学意义(P<0.05);试验组患者治疗后不良反应的总发生率(37%)明显低于对照组的(59%),差异具有统计学有意义(P<0.05)。
　　结论：葡萄膜炎继发黄斑水肿患者采用结膜下注射曲安奈德可以有效地改善患者视力及减轻黄斑水肿的情况,减少眼压升高、结膜出血等并发症发生。     

曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的疗效观察

目的：观察曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的临床疗效。方法回顾性病例系列。前部巩膜炎患者12例（14只眼）,弥漫性2例,结节性10例。曲安奈德4～8 mg巩膜病灶处结膜下注射,小于二象限做1点注射,大于二象限做2点注射。观察治疗方法的有效性及局部和全身的不良反应。结果注射后病变轻者1周显效,重者2周显效,一次注射后均治愈。结论曲安奈德结膜下注射治疗前部非坏死性巩膜炎简单安全有效。     

曲安奈德联合地塞米松上睑板内注射治疗小儿春季角结膜炎

马来西亚理科大学5a来使用曲安奈德混悬型注射液与地塞米松磷酸钠治疗小儿春季角结膜炎(VKC)的疗效研究。10例联合注射治疗患者注射1mo后症状有所改善。其中4例患者主要并发症为眼压增高。6mo内有4例患者复发。研究发现上睑板联合注射两种皮质类固醇治疗春季角膜炎的临床效果与文献报道使用单一皮质类固醇剂非常相似。然而,该治疗方法眼压升高的风险较大。     

结膜下注射曲安奈德治疗非感染性葡萄膜炎继发黄斑水肿的Meta分析

目的:系统评价结膜下与玻璃体腔注射曲安奈德(TA)治疗非感染性葡萄膜炎继发黄斑水肿的有效性和安全性。方法:检索数据库包括万方数据库、中国知网(CNKI)、维普数据库、中国生物医学文献服务系统(CBM)、美国国立医学图书馆(PubMed)、荷兰医学文摘(Embase)、Cochrane图书馆、Web of Science,检索时间为建库至2022-05。纳入以TA治疗非感染性葡萄膜炎继发黄斑水肿的临床随机对照试验(RCT),试验组采用结膜下注射TA,对照组采用玻璃体腔注射曲安奈德(IVTA)。采用Review Manager 5.4和Stata15软件对治疗后的最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、总有效率、不良反应进行Meta分析,应用比值比(OR)、加权平均数(MD)及95%可信区间(CI)进行评价。结果:最终纳入8项RCT研究进行统计分析。Meta分析结果显示：结膜下注射TA在提高BCVA(MD=0.81,95%CI:0.60～1.01,P<0.0001)、降低CMT(MD=-48.35,95%CI:-58.82～-37.88,P<0.0001)、总...     

临床表现罕见的流行性角结膜炎1例：腺病毒角结膜上皮炎

腺病毒角结膜炎，由腺病毒血清型8，19，37引起。腺病毒结膜炎典型的体征包括耳前淋巴结病变，结膜充血水肿，结膜下出血，结膜滤泡。腺病毒角结膜炎角膜受累情况各不相同，多数患者有弥散的轻微的浅层角膜炎，局部隆起的点状上皮损害，随后形成上皮下混浊。我们报道一例罕见的腺病毒角结膜上皮炎，为临床表现特殊的流行性角结膜炎（EKC），并回顾相关特殊病例文献。患者，男，35岁，患腺病毒结膜炎，临床表现罕见，表现为角结膜上皮炎形式，这种病例文献未见报道。经过保守治疗患者痊愈。角结膜上皮炎可以是临床表现特殊的腺病毒角结膜炎。     

结膜乳头磨削术治疗重度春季角结膜炎的临床研究

目的:观察并评估结膜乳头磨削术治疗重度春季角结膜炎巨大结膜乳头的安全性和有效性。方法:前瞻性、对照性临床病例研究。比较结膜乳头磨削术(8例12眼)与结膜乳头切除术(9例12眼)两种方法治疗巨大结膜乳头,手术前后的眼痒、流泪、畏光、异物感等症状和结膜乳头、角膜上皮等体征的变化情况。结果:两组病例术后1,2,4wk不适症状、体征明显改善,与术前相比统计学差异有显著性意义(P<0.01)。但术后1,2,4wk巨大结膜乳头体征、术后2wk角膜损伤修复情况等评分,磨削治疗组治疗效果优于手术切除组(P<0.05)。结论:结膜乳头磨削术能使粗糙的结膜创面快速变平,减轻不适症状,促进角结膜上皮修复,是治疗重度春季角结膜炎巨大结膜乳头的简单、安全、有效的治疗方式。     

临床表现罕见的流行性角结膜炎1例:腺病毒角结膜上皮炎(英文)

腺病毒角结膜炎,由腺病毒血清型8,19,37引起。腺病毒结膜炎典型的体征包括耳前淋巴结病变,结膜充血水肿,结膜下出血,结膜滤泡。腺病毒角结膜炎角膜受累情况各不相同,多数患者有弥散的轻微的浅层角膜炎,局部隆起的点状上皮损害,随后形成上皮下混浊。我们报道一例罕见的腺病毒角结膜上皮炎,为临床表现特殊的流行性角结膜炎(EKC),并回顾相关特殊病例文献。患者,男,35岁,患腺病毒结膜炎,临床表现罕见,表现为角结膜上皮炎形式,这种病例文献未见报道。经过保守治疗患者痊愈。角结膜上皮炎可以是临床表现特殊的腺病毒角结膜炎。     

A Case of Herpetic Keratitis after Subconjunctival Triamcinolone Acetonide Injection

Purpose

We report a case of herpetic epithelial keratitis that developed after subconjunctival triamcinolone acetonide injection (STI).

Methods

A 65-year-old female with anterior uveitis and hypotony in her right eye was given a STI (2 mg/0.5 ml). After the injection, she developed redness and an ocular discharge. A clinical examination was performed and real-time polymerase chain reaction (PCR) was used to amplify the viral DNA in a corneal scraping.

Results

Slit-lamp biomicroscopy revealed a severe purulent discharge, conjunctival injection, and a geographic corneal ulcer in the right eye. Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR. Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started. The inflammation subsided with this medication.

Conclusion

We encountered a case of herpetic epithelial keratitis after a STI.Key words: Herpetic keratitis, Subconjunctival triamcinolone acetonide injection, Anterior uveitis, Polymerase chain reaction, Hypotony     

Intravitreal Triamcinolone Acetonide Injection for the Treatment of Posterior Uveitis

Purpose: To assess the efficacy and complications of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of posterior uveitis and to compare the outcomes with patients who had received systemic corticosteroids. Methods: This prospective, interventional, clinical case series study included 11 eyes of 9 patients who received 8 mg/0.2 ml of IVTA injection for posterior uveitis that involved vitreous inflammation (group 1). Control group (group 2) consisted of 15 eyes of 12 patients who had received systemic corticosteroids for treatment of posterior uveitis with vitreous inflammation. The main outcome measures included best-corrected visual acuity, vitreous inflammation score and intraocular pressure. Results: In group 1, mean visual acuity improved significantly (P < 0.001) from a mean logarithm of the minimum angle of resolution (LogMAR) value of 2.05 ± 0.82 at baseline to a maximum of 0.33 ± 0.22 during the follow-up period of 5.0 ± 2.8 months. In control group, mean LogMAR visual acuity before systemic corticosteroid therapy was 1.82 ± 0.78, and it has reached a maximum of 0.40 ± 0.22 after treatment (P < 0.001). The mean inflammatory scores decreased significantly in both groups when compared with preinjection values (for each, P < 0.05). There were no statistically significant differences between group 1 and group 2 when pre-and posttreatment visual acuities and inflammatory scores at 1-, 3-, and 5-month follow-up examinations were compared (for each, P > 0.05). In group 1, mean intraocular pressure (IOP) increased significantly from 13.4 ± 2.6 mmHg to a mean maximal value of 19.3 ± 4.3 mmHg (P < 0.001), but there was no statistically significant difference between mean IOP at 5-month after IVTA injection and pretreatment value (P = 0.06). Cataract progression was observed in one eye. Conclusions: IVTA application may be an alternative therapeutic option for the treatment of acute posterior uveitis that involves vitreous inflammation, especially in patients who carry risks for systemic corticosteroid therapy.     

曲安奈德玻璃体腔内注射治疗黄斑水肿的疗效观察

目的探讨曲安奈德(Triamcinolone acetonide,TA)玻璃体腔内注射治疗黄斑水肿的临床疗效.方法回顾分析21例黄斑水肿患者玻璃体腔内注射TA前后的视力、荧光素眼底血管造影(fundus fluorescence angiography,FFA)、光相干断层扫描(optical coherence tomography,OCT)的检查资料及并发症.结果治疗前平均视力0.10±0.04;治疗后平均视力0.26±0.18(P＜0.01).视力提高者18例,不变者3例.治疗3个月后FFA检查显示黄斑区毛细血管渗漏明显减轻者14例,渗漏轻度减轻者4例,无改变者3例,黄斑水肿消减率达85.71%,OCT检查显示黄斑区视网膜厚度降低150μm以上者18例,无改变者3例.治疗后并发症眼压升高、玻璃体积血、视网膜脱离等.行对症治疗后症状消除.视网膜脱离患者手术后视功能未改善.结论选择合适的适应证,玻璃体腔内注射TA对治疗黄斑水肿有明显的疗效.     

曲安奈德玻璃体腔注射在视网膜疾病中的应用

从动物实验以及临床观察,误将糖皮质激素注入玻璃体的病例,未见它对视网膜有毒性作用,因而认为曲安奈德注入眼内是安全的。1979年Machemer将糖皮质激素注入玻璃体腔治疗增殖性玻璃体视网膜病变。近年更兴起曲安奈德玻璃体腔注射治疗各种眼底疾病的高潮。我们自2003年开始使用,至今已治疗200多例。现将我们的经验并结合文献作综合报道。     

Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection

Purpose

To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure.

Methods

Patients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography.

Results

Forty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected.

Conclusions

Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.     

Trans-Tenon's Retrobulbar Injection of Triamcinolone Acetonide for Diffuse Diabetic Macular Edema

Purpose To determine whether a trans-Tenon's retrobulbar injection of triamcinolone acetonide (TA) is a safe and effective treatment for diffuse diabetic macular edema. Methods Thirty-nine eyes of 30 diabetic patients with persistent macular edema were treated with 20 mg of TA injection. Central macular thickness (CMT) determined by optical coherence tomography (OCT) and visual acuity were evaluated before the injection and at 1, 2, 3, and 6 months, and up to 1 year in some eyes, after the injection. Results The CMT decreased significantly from 478 ± 129 μm (mean ± SD) before injection to 316 ± 102 μm at 1 month, 307 ± 104 μm at 2 months, and 275 ± 89 μm at 3 months after a single injection of TA. A 20% reduction of CMT from the initial value was maintained by a single injection of TA in 27 of 39 eyes (69.2%) at 3 months, in 14 of 22 eyes (63.6%) at 6 months, and in 5 of 7 eyes at 12 months. A recurrence of macular edema was observed in 10% of the eyes at 3 months, and in 22.7% at 6 months. The 17 eyes in which vitrectomy had been carried out had a more significant improvement in CMT than the eyes without vitrectomy. Conclusion A 20-mg trans-Tenon's retrobulbar TA injection is a safe and effective treatment for diabetic macular edema. Jpn J Ophthalmol 2005;49:509–515 ? Japanese Ophthalmological Society 2005