远达性创伤性视网膜病变18例临床分析

目的探讨远达性创伤性视网膜病变的病因、治疗及预后。方法对我院1994年1月～2008年10月收治的18例（26眼）远达性创伤性视网膜病变的病因、治疗及预后进行回顾性总结分析。结果18例（26眼）中胸腹部挤压伤9例（14眼）,四肢长骨骨折5例（6眼）,锁骨骨折1例（2眼）,车祸致头部震荡、挫伤3例（4眼）。远达性创伤性视网膜病变病因多样,临床表现复杂,预后与视网膜损伤的部位有密切关系。结论全身外伤后应关注是否伴有视网膜病变,及时诊断,及时治疗;临床医生应提高对远达性创伤性视网膜病变的认识,以减少此病的误诊和漏诊。     

Coats病的病理机制及治疗研究进展

Coats病是以视网膜毛细血管异常扩张和视网膜内层及外层渗出为特征,大多见于男性青少年,目前并没有完全明确的病因及病理机制。Coats病常见的治疗方法有激光光凝,冷冻疗法,药物治疗,联合治疗(抗VEGF药物联合激光),手术治疗(单纯玻璃体切除和或巩膜外放液)以及中医药等新兴治疗方法。本文主要从中西医对Coats病病因病理机制的认识及中西医治疗方法进行系统综述。     

视网膜中央静脉阻塞治疗研究进展

视网膜中央静脉阻塞是临床上常见的视网膜疾病,因严重的并发症导致视力下降甚至失明,到目前为止尚无针对其病因的确切有效的治疗方法。近年来激光光凝、激光诱导视网膜脉络膜吻合、视网膜静脉t-PA注射、玻璃体腔内注射、放射状切开等手术方法为视网膜中央静脉阻塞带来了新的观念,我们将对上述几种方法的实验和临床研究作简要综述。     

联合用药治疗视网膜静脉栓塞76例观察

0引言 视网膜静脉栓塞是眼科常见致盲的疾病之一。其病因复杂，病程冗长，并发症多，治疗棘手。目前对此病的病因和发病机制尚不清楚，但流行病学研究证实，高血压、糖尿病、动脉粥样硬化、嗜酒、青光眼、使用雌激素、脱水及禁食都是导致发病的危险因素。迄今为止，对视网膜静脉栓塞的治疗尚无特效药物。临床上主要从病因治疗和抗血栓治疗入手，运用纤维蛋白溶解酶、抗血小板凝集剂、尿激酶等，降低血液黏度，降血脂，扩张血管，改善视网膜微循环，提高视网膜供氧。我们就本院2000/2005接受丹参、胞二磷胆碱等多药联合治疗的76例视网膜静脉栓塞的患总结分析如下。     

新生血管性青光眼120例病因分析

目的:探讨分析新生血管性青光眼(neovascular glaucoma,NVG)的病因,为临床预防和治疗提供帮助。方法:对我院NVG住院患者120例127眼病因进行回顾性分析。结果:引起NVG的疾病有:视网膜中央静脉阻塞47例(39.2%),糖尿病视网膜病变31例(25.8%),其中双眼6例,颈动脉狭窄4例,视网膜静脉周围炎4例,其中双眼1例,视网膜中央动静脉阻塞3例,视网膜中央动脉阻塞3例,眼外伤后3例,Coats病2例,慢性葡萄膜炎2例,视网膜脱离2例,急性视网膜坏死1例,肺癌眼部脉络膜转移1例,原因不明17例(14.2%)。结论:NVG作为一种难治性青光眼,其病因复杂,主要由视网膜缺血性疾病引起,视网膜中央动静脉阻塞及糖尿病视网膜病变是引起NVG的主要病因,颈动脉狭窄导致NVG也是引起临床关注的病因。     

视网膜静脉阻塞治疗新进展

视网膜静脉阻塞是继糖尿病性视网膜病变之后第二个常见的视网膜血管性疾病,它的病因和发病机制目前仍不十分清楚,黄斑水肿和视网膜缺血是患者视力下降的主要原因.本文从药物、激光和手术方面阐述了视网膜静脉阻塞的治疗近况,并提出了视网膜静脉阻塞未来治疗的展望.     

早产儿视网膜病中的附加病变

论述早产儿视网膜病中附加病变的定义、诊断和病因,并揭示其与早产儿视网膜病的治疗和预后的关系.     

妊娠高血压综合征视网膜病变的研究现状

妊娠高血压综合征视网膜病变是妊娠高血压综合征的眼部并发症,其病因及发病机制尚未阐明.随着对视网膜病变的深入研究,逐渐发现脉络膜病变在其发病中有重要作用.本文对妊高征视网膜病变流行病学特征、病因、发病机制、临床表现、诊断、治疗和预后等进行综述.     

视网膜新生血管与光凝治疗

视网膜新生血管是严重危害视力的一种眼底病变,在眼内不同部位的新生血管中,视网膜新生血管的意义最为重要。与视网膜下新生血管相比,视网膜新生血管的来源、病因、病程、预后以及治疗方面均有所不同。目前光凝疗法是处理眼底新生血管最有效的方法,但对光凝原理及新生血管的病因等问题所知甚少。随着视网膜光凝术的广泛应用,光凝并发症亦屡见报道。兹据近年文献对上述几个问题综述如下。     

玻璃体切除术治疗Terson综合征视力预后相关因素分析

目的:分析影响Terson综合征手术预后的相关因素。方法:回顾性分析2000-01/2008-01间收治15例(26眼)Terson综合征患者的临床资料,分析性别、年龄、病因、病程、视网膜下出血、眼内增殖、视网膜或锯齿缘裂孔等对视力提高的影响。结果:患者的病程(P<0.01)、合并视网膜下出血(P<0.05)影响患者的视力预后,而性别、年龄、眼内增殖、病因与视力预后无关。早期手术治疗有利于发现视网膜或锯齿缘裂孔,预防视网膜脱离,有利于患者的视力预后。结论:早期的手术治疗有利于患者视力的恢复,并可以早期发现视网膜裂孔或锯齿缘离断。长期存在的视网膜下出血可以影响视功能的恢复。     

鱼雷样黄斑病变的研究现状与进展

鱼雷样黄斑病变(TM)是一种罕见的、先天性RPE损害,位于黄斑颞侧,沿水平缝走行,尖端指向中心凹,呈特征性的鱼雷样改变。该病以单眼发病为多见,不影响中心视力。根据其在OCT上的特点分为两型。Ⅰ型表现为轻微的外层视网膜紊乱不伴有外层视网膜腔隙;Ⅱ型为外层视网膜结构紊乱伴外层视网膜腔隙。与TM类似的RPE层色素改变的疾病包括先天性RPE肥大、Gardner综合征的RPE损害等,鉴别该病与其他疾病的要点是其独特的位置与形态。TM多数稳定,不需要特殊治疗;但由于其可合并神经上皮层脱离、脉络膜新生血管等,必要时需要对症治疗。     

骨髓间充质干细胞治疗视网膜新生血管性疾病的研究进展

视网膜新生血管性疾病并非独立的一种眼病,常见于许多眼病中,如早产儿视网膜病变、糖尿病视网膜病变、年龄相关性黄斑变性、视网膜中央静脉阻塞和视网膜静脉周围炎等都会形成新生血管,是严重损害视力的病变。此类疾病丧失正常血管的结构和功能,引起病理性出血、渗出、水肿和视网膜脱离等病理性改变,是视力丧失的主要原因,已经成为世界范围的致盲性疾病。目前主要的治疗方法为针对病因进行激光封闭,或行玻璃体切除术,或是反复、多次玻璃体腔注射抗血管内皮生长因子,虽然短期效果好,但不能防止复发,目前仍没有长期有效的治疗方法。干细胞治疗的出现为此提供了潜在的替代疗法。本文将对骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)在视网膜新生血管疾病中的最新应用进展作一综述,展示其移植优势和良好的临床应用前景。     

新生血管性青光眼的研究新进展

许多眼底病,如糖尿病性视网膜病变、视网膜中央静脉阻塞、视网膜中央动脉阻塞等,因其眼底缺血缺氧,最终可能导致新生血管性青光眼（ NVG）的发生。随着眼底病的发病率逐年增高,NVG的患者也逐渐增多。新生血管性青光眼属于难治性青光眼,治疗原发病,抑制新生血管的发生,控制眼压是治疗的主要原则。本文对近几年关于NVG的研究及治疗方法予以综述。     

Treatment of Eales' disease with scatter laser photocoagulation

Eales' disease is an extremely uncommon vasoproliferative retinal disease predominantly affecting otherwise healthy young men. The etiology of this condition is unknown, but its progression and clinical appearance are similar to other vasoproliferative diseases of the retina such as diabetic and sickle cell retinopathies. These similarities make Eales' disease a good prospect for inclusion in a model pattern of retinal ischemic disease and suggest that treatment by panretinal photocoagulation should be effective in this condition. We had good results in treating eight eyes diagnosed as having Eales' disease with scattered laser photocoagulation.     

Therapy for Acute Retinal Necrosis

Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis.     

Therapy for acute retinal necrosis

Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis.     

IVRAN综合征及其治疗进展

特发性视网膜血管炎、动脉瘤和视神经视网膜炎(IRVAN)综合征是一种稀有但是公认的临床疾病。该综合征主要临床表现为视网膜血管炎、分支动脉动脉瘤、视神经视网膜动脉瘤,患者视力在患病后急剧下降,目前对于该疾病的诊断和临床分期等问题许多临床医生尚不熟悉。IRVAN的治疗上尚无明确的统一的指南,多数文献为个案病例报告,患者预后视力多相差很大。目前该病主要的治疗方案为,全视网膜激光光凝、糖皮质激素口服或眼内注射治疗、抗血管内皮生长因子(VEGF)药物治疗,免疫抑制剂治疗等方法。如何在不同时期,不同病情的患者中选择合理的疗法成为临床医生面临的主要困难。本文总结了近20年国内外所有IRVAN综合征报道的相关文献,以帮助临床医生更好的诊断和治疗IRVAN综合征提供参考。     

Retinal pigment epithelial detachment

Detachment of the retinal pigment epithelium is a prominent feature of many chorio-retinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase "detachment of the retinal pigment epithelium" is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations.     

视网膜静脉阻塞的治疗趋势

视网膜静脉阻塞是仅次于糖尿病视网膜病变的常见视网膜血管病,在疾病的认识史上,它“古老”而“陌生”。致病的多因素及其慢性积累、突然发作,是此病重要特点。目前,在其病因、自然病程和治疗方面仍存在很多争议。眼科治疗的目的主要是控制黄斑水肿、新生血管形成等并发症。抗VEGF疗法的持续应用与玻璃体内注射曲安奈德以及视网膜光凝等联合疗法,形成了目前的治疗趋势。