Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure

Aims/Purpose

To determine and correlate the long-term changes in retinal nerve fibre layer (RNFL) thickness, optic nerve head (ONH) morphology, and visual fields after a single episode of acute primary angle closure (APAC).

Methods

This was a cross-sectional comparative study of patients at National University Hospital (Singapore) from 2000 to 2006 after an episode of unilateral APAC. The peripapillary and macular RNFL were measured using Stratus optical coherence tomography (OCT) and ONH configuration was assessed using Heidelberg Retina Tomography (HRT)-III. Humphrey perimetry was also performed, and the presence of disc pallor was noted. APAC eyes were compared with fellow eyes as matched controls.

Results

Twenty-five patients were assessed at a median of 33 months (range, 11–85 months) after APAC. OCT showed that there was a reduction in the peripapillary and outer macular RNFL thickness in APAC eyes compared with controls. Humphrey perimetry revealed significantly reduced mean deviation (P=0.006) and increased pattern standard deviation (P=0.045) in APAC eyes compared with controls. HRT-III showed no difference in mean rim area, rim volume, or cup–disc ratio between APAC eyes and controls. Disc pallor was present in nine APAC eyes (36%) but was absent in fellow eyes (P=0.002), and was associated with peripapillary RNFL thinning, visual field loss, and an increased interval between the onset of symptoms and normalization of intraocular pressure (P=0.023).

Conclusion

APAC results in peripapillary and outer macular RNFL loss, visual field defects, and optic disc pallor, even in cases in which the ONH configuration remains unchanged.     

Simultaneous Conjunctival,Uveal, and Orbital Involvement as the Initial Sign of Acute Lymphoblastic Leukemia

Background

A case of acute lymphoblastic leukemia with an initial presentation of unilateral simultaneous conjunctival, uveal, and orbital infiltration is reported.

Case

A 9-year-old girl presented with mild proptosis and chemosis and total exudative retinal detachment in the right eye.

Observations

B-mode ultrasonography showed diffuse uveal thickening and a retrobulbar mass. Magnetic resonance imaging scans demonstrated a well-circumscribed peribulbar orbital mass. Incisional biopsy from the conjunctiva and bone marrow sampling established the diagnosis of acute lymphoblastic leukemia L1 type.

Conclusion

Blast-cell infiltration of three distinct ocular structures simultaneously in the absence of any peripheral signs is an extremely rare initial manifestation of acute lymphoblastic leukemia.?Jpn J Ophthalmol 2007;51:139–141 © Japanese Ophthalmological Society 2007

     

先天性泪囊膨出诊断和治疗及病因探讨

目的：回顾性研究我院接诊的先天性泪囊膨出患者,并讨论该类疾病产生的病因和临床处理方案。方法：系统回顾我院2002-01-01/2011-12-31就诊的先天性泪囊膨出患儿共9例10眼,其中男4例4眼,女5例6眼,均在出生后立即发现泪囊区肿块,对所有患者进行全身抗生素使用和局部泪囊冲洗注入抗生素。结果：对经空心泪道探针抽取泪囊内脓液的7眼进行细菌培养,病菌检出率为90%。检出分别是G-菌3株,G＋菌6株。G-菌对左氧氟沙星、环丙沙星最为敏感,G＋菌对左氧氟沙星和妥布霉素最为敏感。细菌对红霉素的敏感性均最低。2眼在以上治疗后采用泪道探通术。结论：先天性泪囊膨出有典型的临床表现,新生儿科及眼科医生可早期发现,多合并胎儿先天性泪道阻塞,多转归成急性泪囊炎,出生后应积极治疗避免并发症出现。     

Treatment of Acute Purulent Dacryocystitis by Early Bicanalicular Silicone Intubation: Safety,Efficacy, and Outcomes

Purpose: To evaluate the safety, efficacy, and outcomes of early bicanalicular silicone intubation in the treatment of acute purulent dacryocystitis. Methods: This prospective interventional case series focused on acute purulent dacryocystitis from February 2010 to March 2014. Of the 21 cases, 16 cases were treated at the Fujian Provincial Hospital, and five cases were treated at the Lianjiang Hospital. Bicanalicular silicone intubation was inserted in the original lacrimal duct within 10 days after abscess decompression by pus aspiration method and systemic antibiotic application. Data collection included demographic profiles, perioperative and postoperative complications, and revision surgery. Resolution of signs and symptoms of acute purulent dacryocystitis, as well as successful anatomical patency assessed by irrigation, was evaluated. Follow-up times were more than 12 months, and ranged from 14 to 63 months.

Results: All patients showed remarkable improvement of pain and swelling within 48 hours. Resolution of the erythema and edema was observed within one week after bicanalicular silicone intubation combined with topical antibiotic lavage. No intraoperative and postoperative complications were observed. After initial bicanalicular silicone intubation, anatomical success was observed in 66.7% (14/21) of the patients. Of the remaining seven patients who presented with severe reflux in irrigation, two patients chose re-intubation and five patients underwent standard external dacryocystorhinostomy. All patients had anatomical success at last follow-up. Conclusion: Early bicanalicular silicone intubation appears to be a safe, effective, and simple procedure, which offers a reasonable option in the treatment of acute purulent dacryocystitis, especially for those developing and underdeveloped areas.     

Wegener's granulomatosis,pituitary adenoma and BARN

A 53-year-old man with Wegener's granulomatosis and a co-existing pituitary adenoma developed bilateral acute retinal necrosis (BARN), probably secondary to varicella-zoster virus (VZV) infection as IgM antibodies were detected in the serum. Intravenous acyclovir and ganciclovir limited the spread of necrosis, but to prevent recurrence he was maintained on oral acyclovir. A left cataract developed 17 months later which was extracted and replaced with a heparin surface modified intraocular lens. Intraocular specimens removed at the time of surgery were analysed by the polymerase chain reaction (PCR) using primers specific for a number of the herpes group of viruses, but no herpesviral DNA could be detected.     

糖尿病患者血清胱抑素C和急性反应指标与视网膜病变严重程度相关性研究

目的：评估糖尿病视网膜病变(DR)严重程度与血清胱抑素C和急性时相反应指标的相关性,包括红细胞沉降率(ESR)和超敏C反应蛋白(hs-CRP)。

方法：研究纳入了1mo内就诊的所有糖尿病视网膜病患者。患者均记录人口统计学数据。行眼科检查,同时检测糖化血红蛋白(HbA1c)、ESR、hs-CRP和血清胱抑素C水平。

结果：研究包括67例糖尿病患者,其中19例(28.3%)无视网膜病变患者,22例(32.8%)非增殖型视网膜病变患者和26例(38.8%)增殖型视网膜病变患者。三组间平均年龄、性别分布、平均糖尿病病程、高血压和血脂异常患病率、吸烟状况以及HbA1c水平无明显差异。随着视网膜病变发展,平均血清胱抑素C水平显著提高,三组分别为1.1±0.48,1.22±0.38,1.71±0.92(P=0.007)。在多元回归分析中,仅血清胱抑素C与糖尿病视网膜病变严重程度有关(P=0.025)。

结论：研究表明,在独立于急性时相反应指标,血清胱抑素C水平随DR加重升高。因此,该结论可作为初级医护人员区分高危患者的标志。     

Acute haemorrhagic keratoconjunctivitis following laser in situ keratomileusis

We report two cases of acute haemorrhagic keratoconjunctivitis which occurred following laser in situ keratomileusis (LASIK) during an ongoing epidemic. Both cases underwent preoperative investigation and surgery on the same day. The possible sources of contamination include the paramedical staff, the contact instruments used for performing preoperative investigation, surgeon, nurse, surgical instruments and eye drops. However, the flap was intact with no haze or regression and at 1 year follow up, the visual acuity was maintained at 6/6 in both the patients. We recommend greater caution while performing contact investigations and strict surgical asepsis during LASIK surgery, routinely as well as during epidemics of conjunctivitis.     

White Dot Syndromes: A 20-year Study of Incidence,Clinical Features,and Outcomes

Purpose: To measure the incidence of white dot syndromes (WDS) in a community-based population and to report clinical features and outcomes.

Methods: Multicenter retrospective study using the Rochester Epidemiology Project medical records linkage system of Olmsted County, Minnesota. Databases were searched to identify all patients with WDS from January 1, 1988 through December 31, 2008.

Results: Mean ophthalmic follow-up was 4.5 years and mean general medical follow-up was 9.1 years. The incidence of WDS was 0.45 per 100,000 per year (95% CI 0.19–0.71). Incidence rates for specific disease entities were also calculated. The authors report some associated autoimmune diseases in this series. Multiple evanescent white dot syndrome (MEWDS) was more common in females, and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was more common in males. Both MEWDS and APMPPE generally carried a good visual prognosis. Fifty percent of cases with APMPPE had a positive history of psoriasis. The only punctuate inner choroidopathy (PIC) case carried that diagnosis as well.

Conclusions: WDS are rare diseases and may be associated with other autoimmune diseases. Further studies with more patients and longer follow-up periods are needed to draw conclusions about visual prognosis, development of other ocular conditions, and associated medical diseases.     

Behçet's disease and antibody titers to various heat-shock protein 60s

It has been suggested that the 65 kDa heat-shock protein (HSP) of Streptococcus in recurrent aphthae within the oral cavity may be involved in the uveoretinitis of Behçet's disease, possibly through sensitization of the immune system. To investigate this possibility, we examined serum antibody titers for various members of the 60 kDa family of HSPs and their implications with regard to a role for HSP60s in Behçet's disease. We isolated HSP60 of Streptococcus pyogenes from the margin of oral aphthae in one Behçet's disease patient with severe uveoretinitis and the HSP60s of Yersinia enterocolitica, retinoblastoma cell line clone Y79, and bovine retinal extract and investigated the reaction of each of these HSP60s with 100-fold diluted serum samples from 20 Behçet's disease patients using anti-HSP60 antibody titers determined by ELISA. The anti- Streptococcus HSP60 antibody and anti-retinal HSP60 antibody titers of the 100-fold diluted serum samples from the Behçet's disease patients were both significantly higher than those of similarly diluted serum samples from healthy donors. The results of the ELISA antibody titer assay showed that, although the various HSP60s share a common basic antigenicity, they differed in reactivity to the anti-HSP60 antibodies in the sera of the Behçet's disease patients. The results indicate that subtle but significant differences exist in the antigenicity of the various HSP60s tested, all of which share a common basic antigenicity and are of approximately the same molecular weight, and suggest that an immuno-cross-reaction between retinal and streptococcal HSPs and a related autoimmune response may be involved in the development of Behçet's disease.     

穿透角膜移植术治疗急性圆锥角膜水肿的效果评价

目的评价穿透角膜移植术(PKP)治疗急性圆锥角膜的屈光增视效果.方法对急性圆锥角膜水肿共21例21眼,术时行双极电凝处理,与稳定期圆锥角膜18例22眼在同等条件下行PKP术.术后7天、1,3,6,12,15月分别以角膜地形图等方法测得角膜屈光状态与增视效果.结果急性圆锥角膜水肿术后7天裸眼视力0.42±0.16,最佳矫正视力0.61±0.22,术后15个月裸眼视力0.6±0.15(≥0.5者90.9%),矫正视力0.93±0.18(≥0.5者100%),模拟角膜计读数43.43D±2.53D,角膜非对称指数0.78±0.27,角膜散光2.25D±1.77D,等效球镜-1.76D±3.16D,每个时间点的屈光结果与稳定期圆锥角膜无统计学差异(P＞0.05).结论急性圆锥角膜水肿与稳定期圆锥角膜行PKP术,同样可以获得迅速稳定的屈光增视效果.     

Acute zonal occult outer retinopathy

Acute zonal occult outer retinopathy (AZOOR) is a rare unilateral or bilateral disease of unknown etiology characterized by focal degeneration of photoreceptors. A total of 131 cases of AZOOR (205 eyes), including the variant known as acute annular outer retinopathy, have been reported in the English language literature. In this group of predominantly white individuals, average age at presentation was 36.7 years, and the male:female ratio was 1:3.2. The majority of patients complained of the acute onset of a scotoma, which was associated with photopsia. Visual acuity was 20/40 or better in 74% of tested eyes, and fundus examination was unremarkable in 76% of eyes. Blind spot enlargement, with or without other field defects, was observed in 75% of the visual fields examined, and electroretinographic abnormalities were recorded in 99% of patients tested. Typically patients retained good visual acuity, although retinal pigment epithelial disturbances commonly developed over time. It was unusual for visual field loss to continue beyond six months. Various treatments have been attempted in patients with AZOOR—including systemic corticosteroids, other systemic immunosuppressive agents, and different antimicrobials—but none have been proven effective.     

急性闭角型青光眼前房角分离术的初步应用

目的探讨一种新的急性闭角型青光眼手术的技术效果。方法运用前房角分离技术或联合白内障摘出治疗28例(28眼)药物不能控制眼压的急性闭角型青光眼,并测量术后1周、10月的眼压。结果术后1周眼压均低于21mm-Hg;10月复查,患病1年之内的21例中眼压控制18例(85.71%),患病1年之上的7例中眼压控制5例(71.43%)。结论前房角分离术是将前粘连的周边虹膜从前房角上分离开,恢复小梁的功能,充分运用其生理性的房水循环通道,该术式损伤小,术后恢复快,再发生粘连可以重复手术,小梁功能丧失后可以重新做眼外引流手术。     

急性砷中毒对眼部的损害

目的了解急性砷中毒对眼部的损害。方法对多起共147例(294眼)急性三氧化二砷(ATO)中毒后眼部损害检查并系统观察。结果急性ATO中毒引起眼畏光,流泪,结膜充血,视力下降,视神经炎及视野缩小。结论急性砷中毒危害眼睛,应加强职业防护。     

大剂量甲泼尼龙冲击疗法治疗急性视神经炎

目的:探讨甲泼尼龙冲击疗法治疗急性视神经炎(AON)疗效。方法:分析近4a我科治疗急性视神经炎患者57例69眼的临床资料。结果:及时采用以静脉滴注大剂量甲泼尼龙为主的综合治疗后,治愈率为68%,总有效率达91%。结论:大剂量甲泼尼龙冲击疗法治疗AON合理有效,缩短了患者的病程,减少了激素总用量,从而避免了因长期用药可能带来的副作用及并发症。     

急性闭角型青光眼误诊分析

目的:探讨急性闭角型青光眼误诊的经过与结果。方法:回顾性分析15例被误诊的急性闭角型青光眼诊断和治疗的临床资料。结果:其中3例自行用药治疗导致误诊;12例首诊内科导致误诊。误诊为结膜炎2例,胃肠疾病6例,心脑血管病7例。14例手术治疗,1例保守治疗。视力>0.3者5例,0.1～0.3者3例,<0.1者7例,其中<0.05者5例。结论:患者的认识错误,是其延误诊治的主观原因,内科医师应加强对青光眼基本知识的学习,以避免误诊。     

Treatment of acute ocular chemical burns

Ocular chemical burns are an ophthalmic emergency and are responsible for 11.5%–22.1% of ocular injuries. Immediate copious irrigation is universally recommended in acute ocular burns to remove the offending agent and minimize damage. Conventional medical therapy consists of the use of agents that promote epithelialization, minimize inflammation, and prevent cicatricial complications. Biological fluids such as autologous serum, umbilical cord blood serum, platelet-rich plasma, and amniotic membrane suspension are a rich source of growth factors and promote healing when used as adjuncts to conventional therapy. Surgical treatment of acute ocular burns includes the debridement of the necrotic tissue, application of tissue adhesives, tenoplasty, and tectonic keratoplasty. Amniotic membrane transplantation is a novel surgical treatment that is increasingly being used as an adjunct to conventional treatment to promote epithelial healing, minimize pain, and restore visual acuity. Various experimental treatments that aim to promote wound healing and minimize inflammation are being evaluated such as human mesenchymal and adipose stem cells, beta-1,3 glucan, angiotensin-converting enzyme inhibitors, cultivated fibroblasts, zinc desferrioxamine, antifibrinolytic agents, antioxidants, collagen cross-linking, and inhibitors of corneal neovascularization.     

急性闭角型青光眼彩色多谱勒眼血流动力学研究

目的　了解急性闭角型青光眼 (AACG)急性发作期和临床前期眼血流动力学变化及其在视功能损害中的作用。方法　应用彩色超声多谱勒检测急性闭角型青光眼急性发作期 33眼 ,临床前期 19眼 ,正常对照 6 6眼。结果　与正常组比较 ,急性发作期组视网膜中央动脉 (CRA)、睫状后动脉 (PCA)、眼动脉 (OA)的舒张末期峰值速度 (EDV)明显降低 ,PCA、OA的阻力指数 (RI)明显增高 (P <0 0 1) ;临床前期组PCA、OA的EDV明显下降 ,RI显著增高 (P <0 0 1)。结论　AACG急性发作期眼局部血液循环障碍是造成视功能损害的原因之一 ,临床前期眼存在PCA和OA循环障碍。     

伴有免疫功能受损的急性视网膜坏死综合征的临床特征及预后

目的 观察长期应用免疫抑制药物后发生的急性视网膜坏死综合征（ARNS）患者的临床特征及预后。 方法 回顾分析经裂隙灯显微镜、前置镜、血清学检查、荧光素眼底血管造影检查明确ARN诊断，病史及相关检查证实伴有全身免疫功能受损的患者8例12只眼的临床资料。患者中男性2例，女性6例，年龄35～54岁，平均年龄44.2岁。伴有血液病2例、胸腺肿瘤2例（1例合并脑炎)、脑膜脑炎2例、系统性红斑狼疮（SLE）1例、急性肺炎1例；发病前均长期应用免疫抑制药物。5只眼视力低于0.05，占41.7%；3只眼视力为0.05～0.3，占25.0%；4只眼视力为0.3～1.0，占33.3%。确诊ARN后根据不同病情行抗病毒药物、激光光凝和（或）手术治疗。治疗后随访3～36个月，平均随访时间10.8个月。 结果 所有患者发病时眼部症状及葡萄膜炎表现较轻，视网膜血管炎和坏死灶进展较慢。7只眼视网膜血管炎累及4个象限，2只眼介于1～2个象限,3只眼不超过1个象限。10只眼视网膜坏死灶侵及周边部及中周部视网膜，占83.4％；2只眼视网膜坏死灶侵及周边部至后极部，占16.6%。随访结束时7只眼视力不同程度提高，最终视力0.05以下者4只眼，占33.3%； 0.05～0.3者2只眼，占16.7%；0.3～1.0者6只眼，占50.0%。 结论 伴有全身免疫功能受损的ARN患者病史明确，临床特征典型，但眼部症状及葡萄膜炎表现较轻，视网膜血管炎和坏死灶进展较慢；及时确诊和治疗可以使患者获得有用视力。