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。     

玻璃体腔药物注射联合玻璃体手术治疗脉络膜脱离型视网膜脱离的探讨

目的 探讨术前玻璃体腔注射曲安奈德及healon联合玻璃体手术治疗脉络膜脱离型视网膜脱离的疗效及安全性.方法 选择未经有效治疗的脉络膜脱离型视网膜脱离患者11例(1 1只眼),于手术前经睫状体平坦部向玻璃体腔内注入曲安奈德混悬液和healon,注药后观察眼压葡萄膜炎反应及脉络膜脱离消失情况,并于5日之内行玻璃体手术.结果 注药后11只眼眼压均恢复良好,葡萄膜炎反应症状均不同程度减轻,10只眼脉络膜脱离眼于注药后5日内消失,所有病例均行玻璃体手术,术后11只眼均视力有不同程度提高,10只眼视网膜复位良好.结论 术前玻璃体腔注射曲安奈德和healon联合玻璃体手术是一种安全有效地治疗脉络膜脱离型视网膜脱离的方法.     

光学相干断层扫描在中间葡萄膜炎性黄斑病变中的诊断应用

目的 探讨光学相干断层扫描（OCT）图像在中间葡萄膜炎黄斑病变中的诊断应用。方法 用OCT检测中间葡萄膜炎合并黄斑病变患者17例33只眼并进行资料分析。结果 11例22只眼呈现程度不同的黄斑囊样水肿（CME）特征;3只眼可见黄斑区视网膜前膜增生,同时合并神经上皮层增厚及CME病变;2只眼出现黄斑裂孔;6只眼黄斑区可见玻璃体部分后脱离,并能清晰地显示出玻璃体对视网膜的细小牵引。结论 OCT能客观、精确、有效、方便地对中间葡萄膜炎黄斑病变进行类似病理学的检查。     

曲安奈德玻璃体腔注射治疗脉络膜脱离型视网膜脱离的初步研究

目的探讨玻璃体腔注射曲安奈德治疗脉络膜脱离型视网膜脱离的疗效及安全性。方法选择未经有效治疗的脉络膜脱离型视网膜脱离患者,于手术前经睫状体平坦部向玻璃体腔内注入曲安奈德混悬液0．1ml(4mg),注药后观察葡萄膜炎反应及脉络膜脱离消失情况,并于5—10d后行视网膜脱离复位手术。结果有葡萄膜炎反应的13只眼其症状均不同程度减轻,裂孔检出率由注药前的2／13只眼提高至注药后的7／13只眼,绝大多数脉络膜脱离眼于注药后10d内消失,5只眼采用巩膜扣带术,6只眼采用玻璃体切除联合眼内填充术,2例患者放弃手术治疗。手术后平均随访4．45个月,接受手术者最终视网膜全部复位,无1例出现全身应用糖皮质激素的副作用。结论玻璃体腔注射曲安奈德能迅速、安全、有效地治疗脉络膜脱离型视网膜脱离,减轻葡萄膜炎反应,提高脉络膜脱离型视网膜脱离的手术复位率。(中华眼科杂志,2005,41：606-609)     

拟眼组织胞浆菌病

随着对外层视网膜病变认识的深入，越来越多的眼科医师关注到拟眼组织胞浆菌病。组织胞浆菌可致组织胞浆菌病，拟眼组织胞浆菌病可能是组织胞浆菌病在眼部的表现。拟眼组织胞浆菌病的发病机理尚不清楚，临床表现为三联征：黄斑区或中周部孤立分散的萎缩性脉络膜视网膜瘢痕（组织斑或穿凿样病变）、视盘旁脉络膜视网膜萎缩、脉络膜新生血管或遗留的盘状瘢痕，以及一项阴性体征：不伴玻璃体和房水的炎性反应。需与其他的白点综合征疾病（多灶性脉络膜炎伴全葡萄膜炎、点状内层脉络膜病变、多发性一过性白点综合征、急性后极部多发性鳞状色素上皮病变、鸟枪弹样视网膜脉络膜病变、弥漫性视网膜下纤维化和匐行性脉络膜病变等）鉴别。治疗主要是针对脉络膜新生血管。（眼科， 2019， 28： 386-391）     

黄斑部出血的鉴别诊断

目的 分析黄斑部出血的病因及眼底血管造影在诊断中的作用.方法 对142例152只眼黄斑部出血患者的眼底荧光血管造影和吲哚青绿血管造影,结合病史、临床检查结果进行分析:结果90例98只眼黄斑部出血患者的眼底血管造影结果显示有脉络膜新生血管(CNV),其中老年黄斑变性湿性型39例44只眼,中心性渗出性脉络膜视网膜病变(特发性CNV)23例23只眼,高度近视22例25只眼,息肉状脉络膜血管病变4例4只眼,多灶性脉络膜炎1例1只眼,诊断不明1例.在非脉络膜新生血管所致的52例54只眼中,高度近视漆裂纹出血17例19只眼,视网膜大动脉瘤12例12只眼,黄斑区小分支静脉阻塞8例8只眼,黄斑前膜5例5只眼,脉络膜外伤4例4只眼,脉络膜血管瘤4例4只眼,诊断不明2例.结论 眼底血管造影对黄斑部出血疾病病因的鉴别诊断有重要价值,对治疗有指导意义.     

单疱病毒性视网膜脉络膜炎

单纯疱疹性视网膜脉络膜炎常合并有全身性炎症。但是无全身性疱疹病变患者的单疱病毒性视网膜脉络膜炎的诊断则是困难的。这是由于难于直接确定病因。因此作者认为在选择性的病例中,在适当的安全操作下,应该考虑施行视网膜脉络膜活检,以便明确诊断。本文报告一例健康成人的Ⅰ型单疱病毒性视网膜脉络膜炎。由于进行了视网膜脉络膜活体组织学检查而确诊。患者男,20岁,初诊时检查:双眼视力20/16,左限前房闪光及细胞中度,玻璃体细胞中度。眼底周边部和赤道部有多灶性视网膜脉络膜病变,急性病变的视网膜深层有水肿形成的絮状混浊区,无出血及血管白鞘。慢性病变为明显的视网膜色素上皮和脉络膜萎缩,衬有多色素性斑块。视盘轻度水肿,黄斑未受累。右     

匐行性地图状脉络膜炎(附14例报告)

1932年Junius报告3例名为视乳头旁——中心性视网膜脉络膜炎的疾病,并对其特点作了描述,随后国外不少学者相继报告。本病命名甚多,如匐行性脉络膜炎、匐行性脉络膜病变、盘周脉络膜炎、地图状色素上皮症、地图状脉络膜血管症、地图状螺旋状盘周脉络膜炎等。其基本病变是由于脉络膜血管闭塞所致的色素上皮及视网膜感觉层的改变。部位从后极部开始向赤道部发展。国内未见报导,我们将两年来观察的14例21眼总结报告于后。     

合并脉络膜脱离的裂孔性视网膜脱离曲安奈德玻璃体腔注射的疗效评价

目的通过曲安奈德玻璃体腔注射寻求治疗合并脉络膜脱离的裂孔性视网膜脱离的有效方法。方法对19例(19只眼)合并脉络膜脱离的裂孔性视网膜脱离,给予曲安奈德玻璃体腔注射4mg,并对病人症状、眼压、手术条件的改善以及术后增殖性玻璃体视网膜病变的发生进行观察。结果曲安奈德成功注入18只眼的玻璃体腔,1只眼误入脉络膜上腔。注药后所有患者的症状都有缓解;前房闪辉、浮游细胞及玻璃体情况改善;17只眼眼压回升,UBM检查脉络膜、睫状体复位;2只眼眼压不升,UBM检查脉络膜、睫状体未能复位;视网膜复位手术一次性成功17只眼(89.5%),2只眼需行二次手术。随访2个月至13个月,18只眼视网膜复位。1只眼发生增殖性玻璃体视网膜病变需再次手术治疗。结论曲安奈德玻璃体腔注射能迅速减轻患者症状,对合并脉络膜脱离的裂孔性视网膜脱离的治疗及预后的改善具有积极的辅助作用。     

全葡萄膜炎的荧光素眼底血管造影及吲哚菁绿血管造影特征

目的 观察全葡萄膜炎的荧光素眼底血管造影(FFA)及吲哚菁绿血管造影(ICGA)特征.方法 对22例(22只眼)全葡萄膜炎患者的28只眼按常规方法 做FFA检查.其中4例(8只眼)做ICGA检查.结果 16例活动性病变的FFA均出现视盘及附近视网膜高荧渗漏,其中4例(6只眼)视网膜血管充盈延迟,狭窄或闭塞,管壁染色渗漏为主,6例(9只眼)毛细血管荧光素渗漏,7只眼视网膜色素上皮荧光素渗漏;6只眼黄斑点状荧光素渗漏,4例(6只眼)黄斑囊样水肿,3例(4只眼)伴视网膜出血及棉绒斑.6例(6只眼)陈旧性全葡萄膜炎见视网膜弥漫斑驳样荧光部分合并小的遮蔽荧光.4例吲哚菁绿造影中1例特发性全葡萄膜炎表现为脉络膜毛细血管扩张及高荧光,1例VKH早期脉络膜血管无异常,后期脉络膜不均匀的荧光渗漏.1例白塞病2只眼表现为脉络膜毛细血管充盈不良、低荧光遮蔽,1例白塞病患者双眼脉络膜及血管未见异常.结论 全葡萄膜炎的FFA特征为视盘、视网膜色素上皮、视网膜血管和黄斑出现不同程度的荧光素渗漏.ICGA以脉络膜的低荧光和(或)高荧光表现为主、早期脉络膜血管可以无变化.FFA及ICCG能客观地反映葡萄膜炎对视网膜组织的损害,对确定葡萄膜炎的类型及病程提供诊断和治疗依据.     

玻璃体手术中巩膜穿刺孔脱出物的 组织病理学检查

目的研究玻璃体手术中巩膜穿刺孔脱出物的组织病理学表现。方法标准的睫状体平坦部三通道玻璃体手术中,用剪刀平巩膜面剪取巩膜穿刺孔脱出的眼内组织,石蜡包埋切片或涂在干净玻璃片上,苏木素伊红染色,光学显微镜检查。共收集到20例标本,裂孔性视网膜脱离9例,外伤性视网膜脱离1例,各种原因的玻璃体积血6例,眼内异物4例。结果巩膜穿刺孔脱出组织光学显微镜检查发现为视网膜4例,睫状体1例,视网膜和睫状体组织 1例,葡萄膜组织1例,玻璃体组织13例。玻璃体组织内含有各种形态的细胞和含色素细胞及色素颗粒。结论巩膜穿刺孔脱出物中既含有玻璃体、睫状体上皮和色素上皮细胞,也可有睫状体、视网膜和葡萄膜组织,这些嵌顿的细胞和组织可能与一些临床并发症的发生有关。(中华眼底病杂志,2001,17:99-101)     

严重外伤性玻璃体积血玻璃体切除疗效观察

目的 探讨严重外伤性玻璃体积血的玻璃体切除手术的效果。方法 对37例（37眼）严重外伤性玻璃体积血不同时期的玻璃体切除术进行回顾性分析。结果 玻璃体积血37例中积血和视网膜粘连者共有13例，这是主要并发症。行单纯玻璃体切除13例，联合手术24例。术后视力下降2眼，占5．40％，无变化3眼，占8．11％，其余32眼较术前不同程度提高，占86．49％。结论 玻璃体切除是治疗严重外伤性玻璃体积血的有效方法，伤后应根据积血和网膜情况尽早手术。     

Review for disease of the year: differential diagnosis of ocular toxoplasmosis

The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.     

Diode laser photocoagulation for retinopathy of prematurity: a histopathologic study

Laser photocoagulation has largely supplanted cryotherapy as an effective treatment for retinopathy of prematurity. This case describes the ocular histopathologic findings of a pair of eyes in a severely premature male infant treated with diode laser photocoagulation for bilateral stage 3 retinopathy of prematurity (ROP) for 360 degrees in zone 1 with severe plus disease. The right eye responded to treatment; the left eye developed persistent vitreous hemorrhage and total retinal detachment. The histopathologic examination of laser burns in the right eye disclosed segmental areas of chorioretinal scarring with retinal atrophy and gliosis, loss of RPE and extensive atrophy of the choroid and its vasculature, which involved both the choriocapillaris and larger vessels. The left eye had iris neovascularization, a chronic organized vitreous hemorrhage and a totally detached retina. The histopathologic findings in an eye of a premature infant with threshold ROP treated with diode laser photocoagulation resembled those reported after transsceral cryotherapy. Diode laser photocoagulation may produce less severe chorioretinal damage.     

Gyrate atrophy of choroid and retina complicated by vitreous hemorrhage

We describe two patients with gyrate atrophy of the choroid and retina who suffered from vitreous hemorrhages in adolescence. The diagnosis of gyrate atrophy was confirmed biochemically and clinically; hyperornithinemia and a deficiency of ornithine ketoacid transaminase were confirmed biochemically. Typical fundus changes of scalloped chorioretinal atrophies with sharp margins, deteriorated dark adaptation, non-recordable electroretinogram, flat electrooculogram, and constricted visual fields were noted. We believe that the vitreous hemorrhage is an ocular complication in this disorder.     

The ultrastructural pathology of congenital murine toxoplasmic retinochoroiditis. Part II: The morphology of the inflammatory changes

A congenital murine model of toxoplasmic retinochoroiditis was employed to study the ultrastructural pathology of retinal parasitization by Toxoplasma gondii. Forty-two eyes from infected mice (18-22-weeks-old) and 24 eyes from control animals were studied by light microscopy (semithin sections). Twenty-six of the eyes from infected animals and six from the control group were subsequently selected for transmission electron microscopy. Control tissues showed no significant abnormality. The pathological changes in diseased tissues ranged in severity from low-grade mononuclear cell infiltration in the subretinal space to complete destruction of the outer retina, the retinal pigment epithelium and the choroid in the presence of a granulomatous inflammatory reaction. Phagocytosis of photoreceptor outer segments by macrophages was observed. Both macrophages and lymphocytes appeared to mediate photoreceptor lysis in eyes which were moderately affected by the disease. Severely affected eyes exhibited vasculitis and inflammatory cell invasion into the vitreous. A lymphoplasmacytoid cell infiltrate was present in the outer retina and choroid in these eyes. There was no evidence that Toxoplasma cysts provided foci for inflammatory cell attack.     

A study of the ability of tissue plasminogen activator to diffuse into the subretinal space after intravitreal injection in rabbits

PURPOSE: Intravitreal injections of tissue plasminogen activator have been used to lyse fibrin from blood in the subretinal space, despite the lack of proof that tissue plasminogen activator can diffuse across the retina. We tested whether tissue plasminogen activator injected into the vitreous could penetrate the neural retina and enter the subretinal space. METHODS: We injected a mixture of 50 microg of tissue plasminogen activator (70 kD) labeled with fluorescein isothiocyanate and rhodamine B isothiocyanate-labeled dextran, which has a lower molecular weight (20 kD), into the midvitreous cavity of one eye in each of 18 rabbits. The eyes were enucleated after 3, 6, and 24 hours, and cryosections were examined with epifluorescent microscopy to determine the distribution of the labeled molecules. We also evaluated tissue plasminogen activator pharmacokinetics in one eye each of 18 rabbits in which a subretinal clot was induced by injecting autologous blood (50 microL) into the subretinal space through the sclera. Fluorescein isothiocyanate-labeled tissue plasminogen activator was injected into the vitreous 2 days after induction of the subretinal clot. RESULTS: Fluorescein isothiocyanate-labeled tissue plasminogen activator was present at the vitreal surface of the retina in a linear array in all 36 eyes studied, whereas the rhodamine B isothiocyanate-labeled dextran had diffused throughout the neural retina in the same sections. No fluorescein isothiocyanate signal was observed in the neural retina or in the subretinal clot. Vitreous hemorrhage caused by retinal perforation was observed in all eyes with intraretinal hemorrhage in which fluorescein isothiocyanate fluorescence was seen in the neural retina and inside the clot. CONCLUSION: Intravitreal tissue plasminogen activator did not diffuse through the intact neural retina to reach a subretinal clot. This study demonstrates no scientific rationale for the intravitreal tissue plasminogen activator treatment of submacular hemorrhage without vitreous hemorrhage presumably caused by an overlying retinal break.     

A murine model of congenital toxoplasmic retinochoroiditis

A histopathological study of toxoplasmic retinochoroiditis in 39 eyes of mice infected in utero with Toxoplasma gondii and sacrificed at 16 weeks post-partum showed a wide variation in the pattern of tissue destruction. The changes in individual eyes were graded from mild to severe; Toxoplasma cysts were present in the retina and optic nerve in each grade. In the least affected eyes, Toxoplasma cysts were rarely seen and the disease was limited to a low grade uveitis and retinal lymphocytic perivasculitis. In the more severely affected eyes, there was focal, sectorial or total retinal destruction with secondary degeneration in the lens. In some eyes inflammatory destruction of the outer retina was associated either with a paucity of cells, or with lymphocytic infiltration or with plasma cell infiltration; giant cell granulomatous reactions were rare. In the most severely affected eyes the retina was necrotic and calcified. The findings illustrate the complexity of toxoplasmic retinochoroiditis and suggest that autoimmunity may play a part in the disease process.     

Intentional complete interruption of a retinal vein after vitrectomy might improve the rate of successful chorioretinal venous anastomosis formation in central retinal vein occlusion

BACKGROUND: Laser or surgical chorioretinal venous anastomosis has not become widespread as suitable treatment for central retinal vein occlusion (CRVO). We report here the effectiveness of cutting off a retinal vein with vitrectomy in making a chorioretinal venous anastomosis in CRVO. METHODS: We performed a vitrectomy accompanied by a chorioretinal venous anastomosis procedure for seven consecutive patients with CRVO. These patients had shown no improvement in their visual acuity in the month following their first visit to our hospital and had a visual acuity of less than 20/200. Their preoperative visual acuity ranged from counting fingers to 20/300. The procedure included the complete cutting of the affected retinal vein, and the making of a small incision at both sides of the vein interruption through the full thickness of the retina, the retinal pigment epithelium and Bruch's membrane. RESULTS: In five of the seven patients, successful chorioretinal venous anastomosis was observed. All five patients showed an improvement of two or more lines in visual acuity 6 months postoperatively. In three of the five, visual acuity was 20/100 or better. A postoperative complication of recurrent vitreous hemorrhage and fibrous proliferation was observed in one patient, and a second operation was necessary. CONCLUSIONS: Surgical interruption of an affected vein was a feasible procedure and could raise the rate of successful chorioretinal venous anastomosis in CRVO.