脉络膜脱离型视网膜脱离术后黄斑中心凹下脉络膜厚度的变化

目的观察脉络膜脱离型视网膜脱离（RRDCD）患者接受玻璃体切割（PPV）复位视网膜后硅油填充状态下黄斑中心凹下脉络膜厚度（SCT）的变化。方法回顾性病例对照研究。2016年1月至2017年10月在武汉大学人民医院眼科中心就诊的35例首次接受PPV成功复位视网膜的RRDCD患者纳入研究（作为RRDCD组）。记录患者术后1d、1周、1个月、3个月的最佳矫正视力（BCVA）（LogMAR）、眼压,采用光学相干断层扫描（OCT）测量SCT。36例首次接受PPV成功复位视网膜的单纯孔源性视网膜脱离（RRD）患者作为RRD组及40例医院的体检者作为正常组。数据采用秩和检验（H检验）、重复测量方差分析、独立样本t检验、卡方检验等进行分析。结果术后1d、1周,RRDCD组、RRD组SCT均较正常组厚（术后1d：t=9.220,P<0.001;t=6.826,P<0.001。术后1周：t=4.341,P=0.011;t=2.849,P=0.034）,而这2个时间点RRDCD组和RRD组间的SCT差异无统计学意义。术后3个月,RRD组SCT与正常组比较差异无统计学意义（t=1.597,P=0.646）,而RRDCD组SCT相对正常组及RRD组都要薄,差异有统计学意义（t=-3.144,P=0.028;t=-6.207,P=0.010）。术后RRDCD组和RRD组SCT均呈持续降低趋势。相关性分析显示术后3个月,RRDCD组SCT与BCVA呈正相关（r=0.399,P=0.017）,RRD组SCT与BCVA无相关性（r=0.109,P=0.529）。结论RRDCD术后黄斑SCT变薄,且SCT与BCVA相关。SCT可以作为评估RRDCD术后视力的临床指标。     

Choroidal Detachment after Uncomplicated Small Incision Cataract Surgery

Background and Purpose

Angioedema is a well-recognized side effect of angiotensin-converting enzyme inhibitors, but is rarely associated with angiotensin II receptor blockers (ARB). Here, we report the first case of a patient on ARB therapy (telmisartan) for hypertension who developed serous choroidal detachment localized to the posterior pole after sub-Tenon anesthesia for small incision cataract surgery.

Methods and Results

An 82-year-old Japanese woman who received oral medications for hypertension underwent cataract surgery with sub-Tenon anesthesia using 2% Xylocaine^® on her left eye. Her corrected distance visual acuity improved to 20/25 on the first day after the surgery. On the fifth day, however, it decreased to 20/40 and choroidal detachment was detected at the posterior pole. We suspected an increase of choroidal vascular permeability and started oral steroid therapy. After 1 week, the area of detachment was smaller and her acuity improved to 20/20. Subsequently, she underwent cataract surgery without sub-Tenon anesthesia on her right eye, and no choroidal detachment occurred.

Conclusion:

This is the first published case of ARB-induced choroidal detachment after uncomplicated small incision cataract surgery. Sub-Tenon anesthesia may aggravate angioedema associated with ARB therapy, so ophthalmologists should be aware of this rare complication.Key Words: Choroidal detachment, Cataract surgery, Angiotensin II receptor blocker, Telmisartan, Sub-Tenon anesthesia     

糖尿病视网膜脱离激光治疗后脉络膜脱离一例

患者,男,61 岁,因“右眼视力下降半月余”来我院就诊。既往糖尿病病史15 余年,目前药物治疗血糖控制尚可。否认其他疾病、外伤及手术史。眼部检查：右眼视力0.1（矫正无提高）,左眼0.6（矫正无提高）。双眼角膜透亮,前房中深,虹膜纹理清,瞳孔圆,对光反射存在,晶状体皮质混浊。右眼下方玻璃体混浊伴积血。眼底镜检查示右眼眼底可见视盘边清色可,各象限视网膜可见微血管瘤、出血、硬性渗出及纤维增殖膜,鼻侧纤维增殖膜牵拉视网膜轻隆起;左眼眼底可见视盘边清色可,各象限视网膜可见微血管瘤、出血、硬性渗出及棉絮斑。眼科B超示右眼玻璃体混浊机化、玻璃体积血,局部牵拉性视网膜脱离（见图1A）,左眼玻璃体混浊。眼科诊断：①双眼糖尿病视网膜病变（右眼Ⅵ期,左眼Ⅲ期）;②双眼年龄相关性白内障（含并发因素）。建议患者行右眼玻璃体手术。就诊当天给予患者右眼可见范围内视网膜激光光凝,参数如下：能量240～360 mW;光斑直径200～500 μm;曝光时间0.1～0.3 s,激光点数1 020。上述激光参数遵照治疗指南选择[1,2]。术后第2 天彩色眼底照相检查发现实性棕色隆起（见图2）。眼B超示不与视盘相连的与眼球壁弧形相对的弧形条状回声,条状光带与后壁回声间为无回声暗区（见图1B）。考虑脉络膜脱离,拟行“右眼玻璃体切割联合内界膜剥除+激光光凝+硅油注入+超声乳化白内障吸除及人工晶状体植入术”。术中见后极部黄白色增殖膜,鼻侧视网膜苍白、隆起,存在治疗性激光斑,手术顺利。术后1 周复查视网膜及脉络膜平伏,复位良好。     

Computed Tomography in Choroidal Detachment

Computed tomography proved valuable in localizing and differentiating serous or hemorrhagic choroidal detachment and scleral infolding. The mean attenuation values (CT numbers) in the region of fresh hemorrhagic choroidal detachment were 74 Hounsfield units (HU). The 90% confirmation limit of the mean was 55 to 84 HU. For serosanguineous choroidal detachment, the mean was 50 HU, with a 90% confirmation limit of 46 to 54 HU. For serous choroidal detachment the mean was 46 HU, with a 90% confirmation limit of 39 to 53 HU. Inflammatory choroidal detachment showed uveoscleral enhancement, which in cross section appeared as a ring (ring sign), and subchoroidal or intrauveal accumulation of fluid. Ocular hypotony produced the characteristic CT “umbrella sign.”     

血浆纤维连接蛋白与青光眼术后脉络膜脱离的关系

随机选择47例施行青光眼眼外引流术的患者,用火箭电泳法测定血浆纤维连接蛋白(Fibronectin,Fn),发现青光眼术后伴有脉络膜脱离患者的平均血浆Fn值明显低于正常平均值,认为低水平的血浆Fn与脉络膜微血管功能障碍,进而产生术后脉络膜脱离有关。     

视网膜脱离伴脉络膜脱离的临床分析

伴脉络膜脱离的视网膜脱离发病占同期视网膜脱离的４．１５％。分析住院手术１３５眼，总痊愈率为６５．９３％与同期不含脉络脱离的视网膜脱离成功率相比，复位率低且明显差异（Ｐ〈０．０１），将１３５例脉络膜脱离分为花边，半月，球形三型，花边型组手术成功率较高，放视网膜下液有很高的意外率，封闭了裂孔，可以完成环扎术，不放水更有利。对注气要慎重，术前术后要早用、用足激素，同足激素，同时尽早手术以提高成功率。     

玻璃体切割术治疗视网膜脱离合并脉络膜脱离

目的探讨玻璃体切割术治疗视网膜脱离合并脉络膜脱离的临床疗效及适应证.方法对23例(23眼)视网膜脱离合并脉络膜脱离的患者,术前7 d即开始口服强的松,采用标准平坦部三切口玻璃体切割及眼内填充(C3F8或硅油),酌情联合巩膜扣带术,术后随访6～12个月.结果术中新发现裂孔 5个(21.74%);术后6个月,视网膜完全复位20眼(86.96%),部分复位2眼(8.70%),未复位1眼(4.35%);术后视力有不同程度的提高,其中0.1以上为5眼(21.74%);术后并发症较少,增生性玻璃体视网膜病变(proliferativevitreore tinopathy,PVR)的发生率较低.结论对眼内增殖明显,视网膜裂孔位于大范围脉络膜脱离区或术前未发现裂孔的视网膜脱离合并脉络膜脱离,玻璃体切割术是可以优先考虑的术式.     

Primary Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

Proliferative vitreoretinopathy (PVR) is the main cause of the recurrence of retinal detachment after retinal reattachment surgery. Of the factors responsible for the occurrence of P VR, preoperative choroidal detachment ( CD) is probably the most important[1-3]. Conventional buckling in eyes with combinedrhegmatogenous retinal detachment (RRD) and choroidal detachment has unfavorable prognosis, including low reattachment rate and poor visual outcome. This is primarily because of the high …     

脉络膜黑色素瘤与脉络膜脱离的超声鉴别诊断

分析了25例脉络膜黑色素瘤与75例(76眼)脉络膜脱离的超声显象特点。脉络膜黑色素瘤表现为半圆形或圆形、蘑菇形的实质性光团,肿瘤内有挖空现象,近半数有脉络膜凹陷,部分病例有声影。脉络膜脱离表现为1个至数个半球形光带或分叶的环形光带,多位于锯齿缘至赤道部之间,内部无回声,无脉络膜凹陷及声影。     

High Frequency Color Doppler Image of Choroidal Detachment

Purpose:To study the Color Doppler Image (CDI) characteristics of choroidal detachment and the applied value of CDI.Methods:Seventy-two cases (74 eyes) of choroidal detachment were studied retrospectively.Results:The typical ultragraph of chroridal detachment displayed one or several smooth hemispherical or lobuler circular thick bands, with convex side toward vitreous cavity.Most of the choroidal detachments were located before the equator, a few of them were beyond the equator.CDI displayed blood flow singnal in the band.Pulse Doppler showed the frequency spectrum features of retinal detachment band were similar to those of central retinal vessels, whereas the frequency spectum features of choroidal detachment bend resembled those of ciliary artery in some cases of retinal detachment (RD) accompanied by choroidal detachment.Conclusion:CDI could make a correct and precise diagnosis of choroidal detachment.Eye Science 2000;16:61-64.     

High Frequency Color Doppler Image of Choroidal Detachment

Purpose: To study the Color Doppler Image (GDI) characteristics of choroidaldetachment and the applied value of GDI.Methods: Seventy-two cases (74 eyes) of choroidal detachment were studiedretrospectively.Results: The typical ultragraph of chroridal detachment displayed one or severalsmooth hemispherical or lobuler circular thick bands, with convex side toward vitreouscavity. Most of the choroidal detachments were located before the equator, a few of themwere beyond the equator. GDI displayed blood flow singnal in the band. Pulse Dopplershowed the frequency spectrum features of retinal detachment band were similar to thoseof central retinal vessels, whereas the frequency spectum features of choroidaldetachment bend resembled those of ciliary artery in some cases of retinal detachment(RD) accompanied by choroidal detachment.Conclusion: GDI could make a correct and precise diagnosis of choroidal detachment.Eye Science 2000; 16: 61 - 64.     

首选玻璃体手术治疗脉络膜脱离型视网膜脱离的疗效分析

目的评估首选玻璃体手术治疗无明显PVR的脉络膜脱离型视网膜脱离的疗效。方法选取32例(32只眼)脉络膜脱离型视网膜脱离,PVR低于C1,常规应用糖皮质激素同时尽快采用玻璃体手术,放脉络膜上腔积液,硅油填充或膨胀性气体填充,并酌情联合巩膜扣带术。所有病例术后随访3个月以上。结果黄斑裂孔者17例,27例无PVD,一次手术复位率为87．5％(28/32),有2例2或3次手术成功,余下2例失败。结论对无明显PVR的脉络膜脱离型视网膜脱离首选玻璃体手术,有利于减少PVR的发生和提高手术复位率。     

Choroidal Detachment: Clinical Manifestation,Therapy and Mechanism of Formation

One hundred and twelve eyes of 103 patients were analyzed during a 9½-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1–3) ; (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.