折叠式人工玻璃体球囊植入在玻璃体视网膜疾病治疗中的应用

目的探讨折叠式人工玻璃体球囊(foldablecapsularvitreousbody,FCVB)治疗玻璃体视网膜疾病的临床效果。方法回顾性分析2017年9月至2019年1月行玻璃体切割联合FCBV植入术的43例(43眼)患者的临床资料。术后随访6个月,观察术后视力、眼压、视网膜复位情况和FCBV状态。结果术后6个月,43例视力无明显变化,手术前后差异无统计学意义(P=1.000)。术后6个月,4例眼压降低,39例眼压正常,手术前后差异有统计学意义(P=0.002)。眼底照相、B超、OCT检查结果显示:所有患者视网膜复位良好,FCVB在玻璃体内均匀地支撑视网膜。双眼外观对称,眼球活动正常。随访期末1例眼球轻微萎缩、1例出现角膜血管化,经治疗后情况好转。结论在患者6个月的植入期内,FCVB是安全、有效的玻璃体替代物,可以维持眼球形态和稳定眼压。     

Evaluation of a posterior vitreous detachment: a comparison of biomicroscopy,B‐scan ultrasonography and optical coherence tomography to surgical findings with chromodissection

Purpose: To find the most reliable and efficient noninvasive technique to clinically detect a posterior vitreous detachment. Methods: In a prospective study of 30 eyes in 30 patients with macular pucker or macular hole formation, the posterior vitreous cortex was examined 1 day prior to a scheduled vitrectomy. Three independent investigators classified the posterior vitreous cortex of each eye as ‘attached’ or ‘detached’ via slit‐lamp biomicroscopy (BM), 10‐MHz B‐scan ultrasonography (I³ Innovative Imaging Inc.), and optical coherence tomography [OCT III Stratus^® (Carl Zeiss Meditec Inc.) and RTVue‐100 OCT (Optovue Corp.)]. These preoperative findings were then compared during a triamcinolone acetonide‐assisted vitrectomy 1 day later. Results: Triamcinolone acetonide‐assisted vitrectomy showed in 60% a posterior vitreous detachment and in 40% an attached posterior vitreous cortex. Preoperatively conducted B‐scan ultrasonography and BM revealed the highest, correct evaluation of the posterior vitreous status. The prediction of the OCT was confirmed intraoperatively in 12.5%. In all other cases, the evaluation by OCT was not possible or was inadequate. Conclusion: The prognostic most reliable but investigator‐dependent methods to clinically detect whether the posterior vitreous cortex is detached are B‐scan ultrasonography and BM. The objective technique of the high‐resolution, two‐dimensional time‐domain OCT allows only in a few cases a clear differentiation of preretinal structures.     

Jamming of 25‐gauge instruments in the cannula during vitrectomy for vitreous haemorrhage

Purpose: To report the jamming of 25‐gauge instruments in the cannula during vitreous surgery for non‐clearing vitreous haemorrhage. Methods: Forty‐five eyes underwent vitrectomy with 25‐gauge instruments for non‐clearing vitreous haemorrhage (VH group). The incidence of 25‐gauge instruments jamming in the cannula was determined retrospectively and compared with that in 112 eyes that underwent vitrectomy for epiretinal membrane (ERM group), also using 25‐gauge instruments. Results: The 25‐gauge vitreous cutter or light pipe became jammed in the cannula in three eyes (7%) in the VH group and the instrument locked inside the cannula had to be removed with the cannula. None of the 25‐gauge instruments in the ERM group jammed (p = 0.022, Fisher's exact probability test). Two of three eyes developed giant retinal breaks near the sclerotomy but no retinal break related to the sclerotomy was detected in the ERM group. Examination of the cutter revealed blood trapped between the cutter and the cannula. Conclusions: Twenty‐five gauge instruments may become jammed in the cannula in eyes with non‐clearing vitreous haemorrhage. Clinicians should be aware of this surgical complication when 25‐gauge instruments are used in vitreous haemorrhage.     

Perimetric severity in hospital‐based and population‐based glaucoma patients

Background: The aim was to compare the severity of glaucoma among newly diagnosed patients presenting to a hospital‐based glaucoma care centre (HBGS: Sankara Nethralaya, Medical Research Foundation) with that of age matched subjects from the population‐based Chennai Glaucoma Follow‐up Study (CGFS). Methods: Newly diagnosed subjects with primary glaucoma from HBGS and age‐ and gender‐matched subjects from the urban arm of CGFS examined during the same time period were included. All subjects underwent comprehensive ocular examinations including Humphrey visual field (HVF: 24‐2 SITA Standard). Glaucoma was defined as: an intraocular pressure (IOP) of 22 or greater mmHg in either eye; vertical cup‐to‐disc ratio (VCDR) of 0.7 or greater or asymmetry 0.2 or more or the presence of focal thinning, notching or a splinter haemorrhage. All subjects had a minimum of three follow‐up visits and reliable visual fields. The IOP, vertical cup‐to‐disc ratio, mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey field measurements at the third follow‐up visit of CGFS were compared for assessing the severity of glaucoma with the HBGS group. Results: Forty‐seven age‐matched subjects from both the study populations were selected. Significantly higher (p = 0.04) IOP was noted in the HBGS population than the CGFS, with a difference in mean IOP of 2.80 mmHg (95% CI of diff: 0.14 to 5.46). The mean ± SD of the mean deviation and pattern standard deviation were ‐6.92 ± 6.53 dB and 6.05 ± 4.20 dB among the HBGS and ‐4.47 ± 4.19 dB and 3.26 ± 2.69 dB among the CGFS population, respectively, the difference in the mean deviation (p = 0.036) and pattern standard deviation (p = 0.0001) were statistically significant. The mean vertical cup‐to‐disc ratio did not vary between populations (p = 0.14). Conclusion: Patients from the HBGS group had higher IOP and more severe visual field defects than the CGFS group. Hence, results from hospital‐based studies on severity and the rates of progression should be interpreted with caution.     

A simple new technique for the induction of residual posterior vitreous cortex removal and membrane peeling

AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.     

Alteration of the blood-retinal barrier and vitreous in sickle cell retinopathy

Nineteen eyes with background sickle cell retinopathy, eleven from patients with SC disease, eight from patients with SS disease, and twelve eyes with proliferative sickle cell retinopathy were examined by direct and indirect ophthalmoscopy, slit-lamp, fluorescein angiography and vitreous fluorophotometry. Calculation of the alteration of the blood-retinal barrier (BRB) and estimation of the diffusion coefficients of fluorescein in the vitreous were performed by fluorophotometry.In background sickle cell retinopathy, the results show a normally functioning BRB in the posterior pole. Abnormally increased fluorescence values to the mid-vitreous (peripheral leakage) were found only in 3 of these 19 eyes, at the two-hour examination (all SC patients). Similarly, mid-vitreous fluorescence values at the two-hour examination were 4.19 ± 1.52 ng/ml in eyes of patients with SC disease, compared with 2.65 ± 0.56 ng/ml in eyes of patients with SS disease. All eyes with background sickle cell retinopathy, except one, showed values for the coefficient of diffusion of fluorescein within normal limits, indicating normal vitreous gel structure.In proliferative retinopathy, the mid-vitreous fluorophotometry readings were abnormally increased, correlating well with the extent of the peripheral angiographic changes (neovascularization). The coefficient of diffusion of fluorescein in the vitreous was generally increased in the eyes with proliferative retinopathy (15.0 ± 8.4 × 10^–4cm²/min) in comparison with a mean value of 5.4 ± 1.4 × 10^–4cm²/min in the eyes wi background sickle cell retinopathy, suggesting an alteration of the vitreous structure eyes with proliferative retinopathy.Fluorophotometry is considered a useful tool to follow patients with sickle cell retinopathy by quantitating peripheral retinal vascular leakage.     

Effect of human vitreous and hyalocyte-derived factors on vascular endothelial cell growth

Purpose: In the present study we have examined the effects of human vitreous and hyalocyte-conditioned medium on human umbilical vein endothelial cells (HUVEC). Methods: Human umbilical vein endothelial cells were cultured and treated in quadruplicate with human vitreous and hyalocyte-conditioned medium at different concentrations. Cell numbers were counted on days 1, 3, 5 and 7. Morphological changes and the viability of cells after treatment were also monitored. Results: The results indicate that both human vitreous and hyalocyte-conditioned medium inhibit proliferation and reduce the viability of HUVEC in vitro. These inhibitory effects were dose- and time-dependent. Conclusions: The observations suggest that human hyalo-cytes and vitreous contain anti-angiogenic factors that influence vascular endothelial cell growth. These results, combined with those of previous studies, may yield important information about the functional role of vitreous and hyalocytes in intraocular vascular regression.     

Examination of the vitreous. A comparison of biomicroscopy using the Goldmann and El Bayadi-Kajiura lenses

Vitreous examinations using the three-mirror Goldmann and the preset El Bayadi-Kajiura lenses were performed on 222 eyes. The presence of posterior vitreous detachment, vitreous traction, liquefaction, lacunae, and cells was noted. Clinical findings using the two lenses differed in 10% of the variables studied. The accuracy of the El Bayadi-Kajiura technique was confirmed by clinical and histological examination of 20 animal eyes with experimentally altered vitreous. The Goldmann lens afforded examination of peripheral vitreous and better identification of cells in the vitreous, whereas the El Bayadi-Kajiura lens permitted better visualization of complex vitreoretinal relationships.     

Squamous cell carcinoma of the conjunctiva. Value of exfoliative cytology in diagnosis

Cytologic examination is of potential value to the practicing ophthalmologist in confirming the clinical impression of cancer of the eye. Scrapings of conjunctival lesions can be prepared in the office, stained with Giemsa stain and rapidly examined. Carcinoma in situ and squamous cell carcinoma of the bulbar conjunctiva were presented as illustrations of the usefulness of exfoliative cytology in clinical ophthalmology.     

Diffuse large B‐cell lymphoma of the ocular adnexal region: A nation‐based study

Purpose: To characterize the clinicopathological features of diffuse large B‐cell lymphoma (DLBCL) of the ocular adnexal region. Methods: The present series of orbital and adnexal DLBCLs were found by searching the Danish Registry of Pathology between 1980 and 2009. Histological specimens were re‐evaluated using a panel of monoclonal antibodies. Clinical files from all patients with confirmed DLBCL were collected. Results: A total of 34 patients with DLBCL of the ocular adnexal region were identified. Eighteen of the patients were men. The patients had a median age of 78 years (range 35–97 years). Ninety‐seven per cent of the patients had unilateral ocular adnexal region involvement, and the orbit (76%) was the most frequently affected site. Nineteen patients (56%) presented with Stage I lymphoma. Of these, 18 were diagnosed with primary lymphoma. Four patients (12%) had Stage II, one patient (3%) had Stage III and ten patients (29%) presented with Stage IV lymphoma. The 5‐year overall survival (OS) rate for the whole study group was 20%. The patients with Stage I lymphoma had a significantly better 5‐year OS rate (28%) than patients in Stage II‐IV (5‐year OS rate, 9%). In Cox regression analysis, concordant bone marrow involvement and the International Prognostic Index (IPI) score were prognostic factors for OS. Conclusions: Diffuse large B‐cell lymphoma of the ocular adnexal region is mainly prevalent in elderly patients. Most patients had unilateral orbital involvement. The overall prognosis is poor. Concordant bone marrow involvement and the IPI score were independent prognostic factors for mortality.     

Conjunctival impression cytology and tear‐film changes in patients with familial Mediterranean fever

Purpose: To evaluate the ocular surface changes and tear‐film functions in patients with familial Mediterranean fever (FMF). Methods: This prospective case–control clinical study examined 35 patients with FMF (group 1) and 35 controls (group 2). All patients underwent a full ophthalmological examination. Ocular surface changes were evaluated by determining cell content of surface conjunctival epithelium using conjunctival impression cytology and tear‐film functions using Schirmer‐I, break‐up time (BUT), corneal fluorescein and Rose Bengal tests. Subjective ocular complaints were scored with a four‐point scale. Between‐group results were compared. Results: In group 1, impression cytology revealed grade 0 changes in 15 eyes, grade 1 changes in 11 eyes and grade 2 changes in nine eyes in group 1; in group 2, it revealed grade 0 changes in 27 eyes, grade 1 changes in five eyes and grade 2 changes in three eyes (p = 0.013). Mean goblet cell density was 765 ± 45 cells/mm² in group 1 and 1730 ± 100 cells/mm² in group 2 (P < 0.001). Mean results on the Schirmer‐I test results were 17.36 ± 3.18 mm in group 1 and 19.60 ± 4.17 mm in group 2 (p = 0.364). Mean BUT was 8.20 ± 1.60 seconds in group 1 and 9.93 ± 2.33 seconds in group 2 (p = 0.001). Mean corneal fluorescein and Rose Bengal staining scores were 3.26 ± 1.67 and 0.96 ± 0.71 in group 1 and 1.37 ± 0.34 and 0.40 ± 0.49 in group 2 (p = 0.037, p = 0.005). The presence of subjective ocular complaints was more frequent in group 1 than in group 2. Conclusion: Despite normal tear production, the ocular surface and tear‐film functions of FMF patients differ from those of healthy individuals. These changes may be related to the chronic inflammatory nature of FMF.     

Association of preoperative vitreous IL‐8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy

Acta Ophthalmol. 2010: 88: e311–e316

Abstract.

Purpose: To determine whether the vitreous levels of interleukin 8 (IL‐8) and vascular endothelial growth factor (VEGF) of patients with proliferative diabetic retinopathy (PDR) were associated with poor visual acuity after vitrectomy. Methods: Observational cross‐sectional study. Patient clinical characteristics and preoperative eye characteristics (63 eyes): visual acuity, iris neovascularization, vitreous haemorrhage, macular detachment, macular oedema, active retinal neovascularization, neovascularization of the disc, burned out PDR (defined as natural end stage of PDR with inactive membranes without previously performed laser photocoagulation) and panretinal photocoagulation were registered prior to vitrectomy for each patient. Vitreous VEGF and IL‐8 levels were measured using the cytometric bead array method. Poor postoperative visual acuity was defined as visual acuity of <20/200 and was checked 2 years after vitrectomy. Results: Twenty‐one of the 63 eyes (33.3%) had poor visual acuity after vitrectomy. Univariate analysis showed that vitreous levels of IL‐8, the absence of panretinal photocoagulation, preoperative macular detachment and poor preoperative visual acuity were significantly associated with poor final visual acuity after vitrectomy. A stepwise multiple logistic regression analysis showed that elevated vitreous levels of IL‐8 (p < 0.0001), macular detachment (p = 0.011) and the absence of panretinal photocoagulation (p = 0.03) were independent predictors for poor visual outcome. Conclusions: Elevated vitreous IL‐8 level could either be a marker of ischaemic inflammatory reaction, or it could play a role in deteriorating visual acuity by DR progression or both. Further studies are needed to provide better understanding of IL‐8 and inflammation involvement in visual prognosis in PDR.     

Optometry and WebCT: a student survey of the value of web‐based learning environments in optometric education

Purpose : Improvements in information and communication technology and the need for off‐campus delivery have led to the increased use of web‐based learning tools in optometry schools around the world. This study compared student‐reported preferences for traditional lecture‐based learning with their preferences when using a web‐based learning tool. Methods : One hundred and thirteen second and third year students from the School of Optometry and Vision Science at the University of New South Wales were surveyed. All students had worked with WebCT for at least two years. Students were asked to rank a range of learning tools in perceived usefulness and also to state how often they used the particular learning tools. Results : The students rated notes (lecture or WebCT delivered) and clinical laboratory sessions as their most useful learning tools. The use of specific learning tools was more diverse, with students reporting that they often used notes (lecture or WebCT delivered), the WebCT calendar tool and the WebCT discussion tool. This result highlights the valuable contribution of the communication aspect of WebCT to fostering learning communities. The least used learning tools were textbooks, websites mentioned in lectures and library print resources. Interestingly, the purchase of textbooks was high with 77 per cent of students on average reporting they had bought the recommended textbooks. Conclusion : Notes were the preferred learning tool of the optometry students at UNSW, suggesting that passive learning of content was the preferred learning style. It is hoped that the introduction of web‐based learning environments may allow students and staff to reflect on their preferred teaching and learning styles. Web‐based learning tools, such as WebCT, provide a powerful method to facilitate independent deeper learning in students with active learning styles. The current encouragement of student‐based active learning methods should see increased use of independent learning platforms, such as WebCT, in optometry schools.     

Finding,retrieving and evaluating journal and web‐based information for evidence‐based optometry

How can optometrists ensure they are basing their advice to patients on the most reliable information available? This paper discusses search tools, databases, websites and journals, which provide free, full‐text, web‐based access to evidence‐based literature. Brief tips on searching these resources are provided for the time‐poor practitioner or researcher. Criteria, such as credibility, currency and bias are used to evaluate written material and will be discussed with particular reference to the problems inherent in evaluating web pages.