霉菌性坏死性视网膜脉络膜炎的临床病理研究

目的　探讨霉菌性坏死性视网膜脉络膜炎的临床表现和组织病理学改变。　方法　收集因霉菌性视网膜脉络膜炎患眼失明的患者７例（７只眼）,摘除的眼球用ＨＥ、ＰＡＳ和六胺银染色,光镜观察,２例２只眼部分标本用透射电镜观察。患者血和病变组织作霉菌培养。　结果　患者球结膜深充血,房水和玻璃体明显浑浊,视网膜弥散出血和灰白色浑浊物,甚者视网膜脱离。病理学发现视网膜内出血,视网膜脉络膜组织坏死,血管内、病变区和玻璃体中有菌丝存在。４例血霉菌培养３ 例阴性,５例５ 只眼病变组织培养均阳性。　结论　机体免疫功能严重受损可引起血源性视网膜脉络膜霉菌感染,造成视网膜脉络膜严重破坏,导致患者失明。     

梅毒性急性后极部鳞状视网膜脉络膜炎一例

患者男,39岁.因左眼突发性视物不清1周于2008年12月25日来我院眼科就诊.患者既往有长期吸烟及大量饮酒史,2个月前有反复咽痛、发热史.1周前患者大量饮酒后晨起时突发左眼视物不清,眼前似有大片黑影遮挡,伴轻度眼痛、眼胀,无眼红、头痛、发热,自行休息未见好转,遂入我院就诊.全身检查未见异常.     

间接光凝法治疗中心性脉络膜视网膜病变临床观察

目的：探讨间接光涨法对中心性浆液性脉络视网膜病变的治疗效果。方法：对中心性浆液笥脉络膜视网膜病变经眼底荧光血管造影后,将渗漏点在黄斑中心凹及附近１／３ＰＤ范围的患者４８例４８只眼,随机分为间接光涨治疗组２５只眼和药物治疗对照组２３只眼,观察治疗后恢复时间、视力等变化。结果：在治疗后２个月时光凝组完全的恢复的有２１只眼（８４％）,而对照组有８只眼（３４．８％）,比较两组恢复率有显著性差异（Ｐ〈０．０     

玻璃体视网膜手术治疗晚期大泡状视网膜脱离的临床疗效观察

目的 观察玻璃体视网膜手术治疗晚期大泡状视网膜脱离的疗效。 方法 回顾分析经裂隙灯显微镜、三面镜及间接检眼镜、B型超声以及荧光素眼底血管造影检查确诊，无法进行有效激光光凝而行玻璃体视网膜手术治疗的晚期大泡状视网膜脱离患者7例9只眼的临床资料。所有患眼均在局部麻醉下巩膜穿刺放出视网膜下液后，行睫状体扁平部的闭合式三切口玻璃体切割手术。去除玻璃体及后皮质，视网膜内引流 ，吸出视网膜下液体，激光光凝封闭视网膜切开处和渗出区，气液交换后注入眼内填充物。 手术后随访3个月～8年，平均随访时间47个月。 结果 随访期内视网膜均复位。1只眼在手术后2年复查时因视网膜前增生膜牵引形成一裂孔，并有一硅油泡进入视网膜下造成局部视网膜脱离而行第二次手术治疗，手术后随访1年视网膜平复。8只眼手术后视力较手术前有不同程度提高，1只眼手术后视力无改变。 结论 晚期严重大泡状视网膜脱离患者行玻璃体视网膜手术治疗能安全有效地促进视网膜复位，挽救患眼的部分视力。 （中华眼底病杂志，2006，22：299-301）     

中心性浆液性脉络膜视网膜病变患者脉络膜充盈时间的观察

中心性浆液性脉络膜视网膜病变患者脉络膜充盈时间的观察梁仲琪刘太平关键词脉络膜视网膜炎／病理生理学脉络膜／病理生理学中心性浆液性脉络膜视网膜病变（以下简称中浆病），是一种常见眼底病，发病原因至今尚有争论。我们对１００例中浆病患者和１００名正常人进行眼底...     

脉络膜血管瘤临床病理分析

目的：探讨脉络膜血管瘤临床、病理及免疫组织化学改变。方法：回顾分析8例病理诊断为脉络膜血管瘤的临床和病理资料,并对其中7例眼球标本行VEGF、CD34等免疫组织化学检查。结果：摘除眼球前2例误诊为恶性脉络膜黑色素瘤,2例拟诊脉络膜血管瘤,4例脉络膜肿物性质待查,其中5例合并新生因管性青光眼,全部伴渗出性视网膜脱离。病理证实为脉络膜海绵状血管瘤,其间被纤维结缔组织分隔,5例瘤体表面见视网膜色素上皮细胞脱失及2例视网膜下见成簇状含有色素的巨噬细胞。免疫组织化学检查：脉络膜血管瘤内皮细胞CD34均呈强阳性,而VEGF阴性表达,2例见个别细胞呈弱阳性。结论：病史较长,各种检查提示有脉络膜肿物,伴视网膜脱离的继发性青光眼患者,应高度怀疑脉络膜血管瘤。免疫组织化学显示脉络膜血管瘤是毛细血管内皮细胞源性的良性肿瘤。     

弥漫型脉络膜黑色素瘤的临床病理特点

目的 观察弥漫型脉络膜黑色素瘤临床病理特点。方法 回顾分析119例病理学检查确诊的脉络膜黑色素瘤患者中11例弥漫型脉络膜黑色素瘤患者的临床病理资料。患者中10例因视力丧失或眼痛就诊,1例外地医院诊断Coats病,继发性青光眼和眼球萎缩要求眼球摘除。临床诊断脉络膜肿物或黑色素瘤8例,绝对期青光眼2例,Coats病、眼球萎缩1例。眼球摘除9例,眼球摘除和眶内肿物切除2例。应用Ki-67免疫组织化学染色,检测细胞增生情况。结果 11例弥漫型脉络膜黑色素瘤均为基底广泛的扁平状肿物。肿瘤基底直径12～20 mm,厚度 2～4 mm。混合细胞型9例,上皮样细胞型1例,坏死型1例。瘤细胞侵犯巩膜7例、侵犯眶内3例,继发性青光眼7例。Ki-67阳性细胞7%～13%,平均阳性细胞9%,多分布于肿瘤基底部,上皮样瘤细胞的表达高于梭形瘤细胞。结论 弥漫型脉络膜黑色素瘤具有特殊生长方式,早期临床诊断困难,有些病例容易诊断为其它脉络膜肿物或青光眼。由于肿瘤基底广泛,容易侵犯眶内和发生转移,预后较差。     

中心性浆液性脉络膜视网膜病变的光学相干断层扫描

目的 评价光学相干断层成像术(optical coherence tomography,OCT)对中心性浆液性脉络膜视网膜病变的诊断及追踪观察的临床使用价值。 方法 对30例(32只眼)中心性浆液性脉络膜视网膜病变患者分别进行检眼镜、荧光素眼底血管造影、OCT检查。部分病例进行定期的光学相干断层成像术复查。 结果 32只眼中心性浆液性脉络膜视网膜病变的OCT图像中,27只眼表现为单纯神经上皮层脱离,2只眼为单纯色素上皮层脱离,3只眼同时存在神经上皮层脱离和色素上皮层脱离。11只眼定期追踪观察的OCT均可动态地观察到液体的吸收和测量到神经上皮层脱离高度的减少。 结论 OCT是一种新的、无损伤性的、非接触性和定量的检查方法。能鉴别中心性浆液性脉络膜视网膜病变的神经上皮层脱离和色素上皮层脱离,并能进行定量的追踪观察。 (中华眼底病杂志, 1999, 15:131-134)     

297例视网膜母细胞瘤的临床病理研究

目的 探讨视网膜母细胞瘤脉络膜浸润的形态学分期标准,为在统一的上进一步对该肿瘤进行临床病理研究。方法 对摘除的２９７例原发性Ｒｂ患者的眼球组织标本,进行光镜观察。结果 肿瘤侵犯球壁组织在形态学上可分为４期（色素上皮－脉络膜分期）Ⅰ期,仅 色素上皮层受侵犯,Ｂｒｕｃｈ膜结构完整,Ⅱ期,Ｂｒｕｃｈ膜结构被各膜毛细血管层未被侵犯,Ⅲ期,肿瘤浸润深达脉络膜,靠近毛细血管层的中血管层内的小范围区域,Ⅳ期,大     

Clinicopathologic study of conjunctivochalasis

OBJECTIVE: To clarify the structural features of conjunctivochalasis histopathologically. METHODS: A biopsy of redundant conjunctiva from the same anatomic location of 44 +/- 7.5 years (mean +/- SD, 50.87 years), underwent conjunctivoplasty (termed tear meniscus reconstruction). RESULTS: In all 44 cases, histologic examination disclosed normal conjunctival epithelium and negligible inflammation and lymphocyte infiltration; 39 patients manifested microscopic lymphangiectasia. Elastica van Gieson staining demonstrated elastic fiber fragmentation and sparsely assembled collagen fibers in all 44 cases. There was no discernible difference between specimens from patients with and without complications including tear-deficient dry eye, meibomian gland dysfunction, and clinically observable lymphangiectasia and/or pinguecula. CONCLUSION: Based on our histopathologic findings, we hypothesize that mechanical forces between the lower lid and conjunctiva gradually interfered with lymphatic flow. Chronic, prolonged mechanical obstruction of lymphatic flow may result in lymphatic dilation and eventually give rise to clinical conjunctivochalasis.     

Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study

OBJECTIVES: To report the prevalence of abnormal intraocular pressure (IOP) in patients with toxoplasmosis retinochoroiditis and to determine risk factors for such abnormality. METHODS: In a retrospective clinic-based chart review, the IOP levels of 61 patients with active retinochoroiditis were recorded. Patients were separated into groups with elevated IOP, equal IOP, and lower IOP. The time taken for normalization of IOP was also recorded. Additionally, age, gender, visual acuity, anterior chamber and vitreous inflammatory activity, presence of macular lesions, keratoprecipitates, synechiae, toxoplasmosis antibody titers, and required medical and surgical treatments were noted. The IOP in 61 patients with active retinochoroiditis were also compared with the IOP in 59 age- and gender-matched control patients with unilateral anterior uveitis. RESULTS: Thirty-eight percent of patients (23/61) with active retinochoroiditis had elevated IOP > 21 mm Hg, demonstrated IOP difference > 4 mm Hg between involved and uninvolved eyes, or received on IOP-lowering medications. In the equal IOP category, 55.7% (34/61) of patients had an IOP < or = 21 mm Hg in the actively inflamed eye and had an IOP difference of < or = 3 mm Hg between the active and inactive eyes. Only 6.6% (4/61) of patients with active ocular toxoplasmosis had a decreased IOP in the affected eye. The mean IOP in patients with active retinochoroiditis was 21.2 mm Hg (SD 11.5) and 15.6 mm Hg (SD 2.9) in involved and uninvolved eyes, respectively. A statistically significant average IOP difference of 5.8 mm Hg (SD 11.6) was found between the involved and uninvolved eyes (P < 0.001 by two-tailed student T test). Of the patients with abnormal IOP, 20 patients had IOP > 21 mm Hg, 10 of whom had IOP > 30 mm Hg, 6 of whom had IOP > 40 mm Hg, and 2 of whom had IOP > 50 mm Hg. In the elevated IOP group, the average time from onset of symptoms until presentation for their IOP measurement was 13 days (median: 7 days; range: 1 to 100) with resolution of abnormal IOP occurring in 32 days (median: 28 days; range: 1 to 84 days). The average time of onset of symptoms in the normal to low IOP category was 70 days (median: 17.5 days; range: 2 to 330 days). Elevated IOP was more common in active retinochoroiditis, 23/61 (38%), when compared with anterior uveitis control group, 6/59 (10%) (odds ratio of 5.3; P < 0.001). No statistically significant predictor of elevated IOP was identified, though a trend associating anterior chamber cells with elevated IOP (P = 0.08, r = 0.25 Spearman rank correlation coefficient) was seen. CONCLUSION: Abnormal IOP is a feature in almost half of patients with active toxoplasmosis retinochoroiditis. Elevated IOP occurs in 38% and low IOP occurs in 6.6% of affected eyes. Patients with elevated IOP due to active toxoplasmosis present for earlier evaluation than patients with normal or low IOP. The IOP elevation is generally transient and concurs with the uveitic episode. Medical management of IOP is usually sufficient to treat this generally transient eye pressure rise though chronic administration of eye pressure lowering drops or glaucoma surgery may be necessary in a small proportion of patients.     

Cryotreatment of toxoplasmosis retinochoroiditis.

Cryotherapy was utilized in 5 eyes of 4 patients with recurrent toxoplasmosis retinochoroiditis. Each patient showed slow gradual improvement in vision over several months following cryotreatment where previous medical management had failed. No recurrences have been noted during the follow-up period of 3 months to 3 years.     

Toxoplasmic retinochoroiditis and hydrocephalus.

A child presenting with hydrocephalus with extensive inactive retinochoroiditis and his mother with a healed toxoplasmic scar is being discussed. Maternal ocular examination in each case of hydrocephalus is recommended, as uveitis work up of the child is often unrewarding.