巩膜扣带术治疗陈旧性视网膜脱离的疗效观察

目的 观察采用巩膜扣带术治疗增生性玻璃体视网膜病变（PVR）分级在C3和D1的陈旧性视网膜脱离的效果。设计 回顾性病例系列。研究对象 2013年3月到2014年5月在北京同仁医院经巩膜扣带术治疗的陈旧性视网膜脱离16例16眼。方法 回顾性分析16例（16眼）PVR分级在C3（9眼）和D1（7眼）的陈旧性视网膜脱离患者的临床资料、手术方式和疗效。主要指标 PVR分级、视力、视网膜复位状况。结果 16眼均采用巩膜外冷冻-硅胶外加压-环扎术,一次手术视网膜复位成功15眼（93.8%）。术后视力均有不同程度提高,提高2行以上者6眼。结论 对于部分PVR分级在C3和D1的陈旧视网膜脱离,巩膜扣带术治疗可获得满意的效果。     

视网膜母细胞瘤肿瘤干细胞的研究进展

随着近年来肿瘤干细胞学说的兴起,越来越多的研究提示肿瘤干细胞很可能是视网膜母细胞瘤形成、复发、转移和耐药产生的根源.对于视网膜母细胞瘤肿瘤干细胞的分离、鉴定和生物学特性的研究已取得一定进展,为降低视网膜母细胞瘤化疗后复发和转移、增强化疗效果提供了新的思路.     

视网膜母细胞瘤患者全身化学药物治疗联合眼部治疗的临床疗效观察

目的：观察视网膜母细胞瘤（RB）患者全身化学药物治疗（化疗） 联合眼部治疗的 临床效果。 方法：回顾分析37例56只眼行全身化疗联合眼部治疗的RB患 者的生存率、眼球保留 率以及病情得到良好控制的情况。病情得到良好控制的标准为：（1）眼部肿瘤缩小乃至消 失，肿瘤病灶呈软乳酪样改变或出现钙化和瘢痕化；（2）眼球摘除者未出现眼眶肿瘤复发 ；（3）临床检查未见肿瘤转移。所有患者均至少有一只肿瘤眼分期为Ⅲb期或以上并接受化 疗。根据肿瘤对化疗的反应情况，一般接受6轮全身化疗，每轮化疗间隔3~4周。化疗药物组 成为：长春新碱、环磷酰胺、依托泊甙(VP16)、卡铂。另外,根据情况分别联合激光光凝、 冷冻、经瞳孔温热疗法（TTT）、钌¹⁰⁶放射敷贴器局部放射治疗以及眼球摘除等眼部 治疗。 治疗和观察时间2~59个月，平均观察时间为35个月。 结果：除1例双眼发 病患者眼球摘除手术 后失访外，观察期内30例患者存活，占83.3%；6例患者死亡，占16.6%。30例存活患者的45 只肿瘤眼中，肿瘤分期为I-Ⅱ期(早期)、Ⅲ-Ⅳ期(中期)和Ⅴ期(晚期)者眼球保存率分 别为100%（10只眼）、7 0.0%（10只眼）和14.3%（21只眼），随访期内病情均得到良好控制。6例死亡患者均为肿瘤 分期Ⅳ期 以上，最终死于肿瘤脑转移。 结论：全身化疗联合多种眼部治疗可以有效地治疗RB。     

玻璃体切割手术完毕注射康柏西普辅助治疗增生型糖尿病视网膜病变玻璃体积血的疗效观察

目的观察手术完毕玻璃体腔注射康柏西普辅助微创玻璃体切割手术(PPV)治疗增生型糖尿病视网膜病变(PDR)合并玻璃体积血(VH)的有效性和安全性。方法前瞻性临床研究。2017年10月至2018年3月于天津医科大学眼科医院检查确诊的PDR合并VH患者50例50只眼纳入研究。采用国际标准视力表行BCVA检查,统计时换算为logMAR视力。依据随机表随机分组原则将患眼分为手术完毕注药组(注药组)和对照组,均为25例25只眼。所有患眼后极部未见增生性改变和牵引性视网膜脱离。两组患者年龄比较,差异有统计学意义(t=-24.697,P=0.030);性别构成比(χ^2=0.330)、糖尿病病程(t=-1.144)、logMAR BCVA(t=-0.148)、晶状体状态(χ^2=0.397)、是否行全视网膜激光光凝(PRP)眼数(χ^2=1.333)比较,差异均无统计学意义(P=0.564、0.258、0.883、0.529、0.248)。所有患眼均接受27G PPV治疗。注药组患眼于手术完毕时玻璃体腔注射10 mg/ml康柏西普0.05 ml(含康柏西普0.5 mg)。手术后1周,1、3、6个月采用手术前相同设备和方法行相关检查,观察BCVA、VH复发情况、眼压、黄斑中心凹视网膜厚度(CRT)以及手术后并发症发生和病情进展情况。结果手术后1周,1、3、6个月,注药组、对照组患眼logMAR BCVA比较,差异均有统计学意义(t=-4.980、-4.840、-4.892、-5.439,P<0.001)。手术后3、6个月,注药组患眼VH复发率均低于对照组,差异无统计学意义(χ^2=3.030、4.153,P=0.192、0.103)。手术后1周,1、3、6个月,注药组患眼CRT均低于对照组,差异有统计学意义(t=-2.622、-2.638、-3.613、-3.037,P=0.012、0.010、0.001、0.004、0.005)。手术后所有患眼均未发生脉络膜脱离、增生性玻璃体视网膜病变、视网膜脱离、虹膜红变及新生血管性青光眼等并发症。结论手术完毕玻璃体腔注射康柏西普辅助治疗PDR可有效降低PPV后VH复发,改善BCVA;安全性较好。     

氩激光治疗糖尿病视网膜病变的疗效观察

目的:观察氩激光视网膜光凝治疗糖尿病视网膜病变的治疗效果.方法:选择经眼底血管荧光造影(FFA)确诊为增殖前期及增殖期的糖尿病视网膜病变患者56例(81眼),根据眼底荧光造影(FFA)的结果行标准全视网膜光凝,有临床意义的黄斑水肿者先行格栅样光凝,再行全视网膜光凝,治疗后3～12 mo分别行眼底荧光造影,对需要者进一步补充光凝.观察治疗前后的视力、眼底荧光造影了解视网膜血管渗漏情况以及新生血管的变化.结果:全视网膜光凝81眼治疗后视力提高者22眼,占27%,视力不变52眼,占64%,有效率达91%,视力下降7眼,占9%.增生性糖尿病视网膜病变有6眼新生血管完全消退,占23%,15眼部分消退,占57%,增殖前期视网膜出血、渗出完全吸收13眼,23%,部分吸收35眼,64%,7眼不变,占13%.13眼合并有黄斑水肿者部分或完全消退7眼,占54%.结论:及时行氩激光全视网膜光凝治疗对于改善糖尿病视网膜病变的视功能有重要作用,无明显并发症发生.     

半导体激光经巩膜睫状体光凝术治疗难治性青光眼的远期疗效观察

目的:评价半导体激光经巩膜睫状体光凝术(diode laser transcleral cyclophotocoagulation,DL Tscpc)治疗难治性青光眼的远期疗效.方法:对431眼难治性青光眼采用低能量1.5～2.5W,多点数26～34的DL Tscpc,术后随访观察并记录眼压,视力,眼部自觉症状以及并发症,随访时间36mo以上.结果:术前甲均眼压(56.2±12.7)mmHg,最后随访平均眼压为(17.3±8.8)mmHg,经配对资料t检验,术前眼压与术后眼压相比,差别具有统计学意义(P＜0.05).手术有效率97.5%.术后399眼视力无变化,30眼视力提高,2眼视力下降.术前有眼痛的患者眼痛均消失或缓解,并发症少,程度轻,主要有色素膜炎,前房出血等,2眼眼球萎缩.结论:经长期随访观察,DL Tscpc 是治疗难治性青光眼的一种简单,安全有效的方法.     

Iodine-I25 episcleral plaque therapy in uveal melanoma

Purpose : To assess the efficacy of iodine‐125 (I‐125) episcleral plaque therapy in the management of uveal melanoma with regard to local control, survival, globe preservation and visual outcome. Methods : Between January 1985 and January 1997, 50 patients with the diagnosis of uveal melanoma were treated with I‐125 episcleral plaques. The mean initial tumour height was 5.5 mm (range, 2.0–9.5 mm) and basal diameter 9.5 mm (range, 4.0–14.5 mm). I‐125 seeds with a mean activity of 1259.1 MBq were used. The mean apical dose was 80.5 Gy (range, 68.0–95.0 Gy). Scleral dose ranged from 225.0 to 940.0 Gy. Pretreatment visual acuity was 6/60 or better in 43 patients. Results : One patient was lost to follow up and excluded from analysis. The remaining 49 patients had a mean follow up of 39.5 months. There were seven local failures, with a mean duration to tumour progression of 16.7 months. All seven patients were successfully managed with enucleation. Five other enucleations were performed for treatment‐ related complications. At the time of analysis, 10 patients have died, five of metastatic melanoma. Of the patients with preserved globes, corrected visual acuity was 6/60 or better in 31 patients. Conclusions : Good local tumour control and survival can be achieved with episcleral plaque therapy. Globe preservation with useful vision was possible in the majority of cases. Our findings are in keeping with other reported series.     

上巩膜静脉压力计的临床应用

本文通过测量正常人及Graves眼病患者的上巩膜静脉压力（EVP）值,对上巩膜静脉压力计的临床应用作初步的探讨。方法：对74例（110眼）正常人及35例（55眼）甲状腺相关性眼病（Graves眼病）患者分别进行眼科常规检查、眼压测定及EVP检测等。结果:正常眼EVP值与年龄、眼别无关;Graves眼病继发青光眼与EVP升高有关,其眼压（Pi）与EVP（Pe）的关系符合方程Pi=6.27 0.77Pe。结论：应用上巩膜静脉压力计有助于房水动力学的研究,并且可协助诊断伴有EVP升高的青光眼。     

Episcleral plaque radiotherapy for uveal melanoma

The use of radioactive Iodine, Ruthenium, Iridium and Cobalt plaques of varying dimensions to treat choroidal and ciliochoroidal melanomas is discussed and placed in perspective with other treatment modalities. The regression pattern following plaque treatment appears to be more rapid for tumours that are more poorly differentiated. The visual results following plaque brachytherapy compare very favourably with those following local resection and external beam radiation. Ocular complications are significantly greater for tumours whose initial thickness exceeds 8 mm. The survival rater after plaque treatment is compared with that for patients who have had primary enucleation for equivalent-sized tumours.     

巩膜敷贴放射治疗后葡萄膜黑色素瘤的退行及其与预后的关系

葡萄膜黑色素瘤是成年人眼内最常见的恶性肿瘤.巩膜敷贴放射治疗是葡萄膜黑色素瘤临床保留眼球的主要治疗方式,能有效控制肿瘤生长,但放疗后肿瘤退行反应异质性明显.有研究提出巩膜敷贴放疗后肿瘤退行速度可作为巩膜敷贴放射治疗预后因素,退行速度越快预后越差.一些学者研究发现,肿瘤初始高度、3号染色体单体化、GEP分型与巩膜敷贴放疗...     

Episcleral plaque radiotherapy for retinoblastoma

The authors report their preliminary results of episcleral plaque radiotherapy (cobalt 60, iridium 192, ruthenium 106, and iodine 125 plaques) in 50 selected patients with retinoblastoma. There were 97 plaque applications to 51 affected eyes in these 50 patients. The plaque was used as primary treatment in 15 eyes and as secondary treatment after failure of external beam radiotherapy, photocoagulation, and/or cryotherapy in 36 eyes. Vitreous seeding of tumor cells was evident ophthalmoscopically in 49 of the 51 eyes, negating the possibility of ultimate success by further photocoagulation or cryotherapy. In 18 patients, the contralateral eye had been enucleated and the remaining eye was being considered for enucleation because all other treatment modalities had failed. In 2 of these 18 patients (11%), the remaining eye was salvaged with plaque radiotherapy and some vision was preserved. In 33 eyes with less advanced tumors, 31 had some degree of vitreous seeding by tumor cells. The eye has been retained in all 33 of these patients and useful vision preserved in most. On the basis of these preliminary observations, the authors conclude that plaque radiotherapy can be used successfully as a primary treatment for selected cases of unilateral or bilateral retinoblastoma or as a supplemental treatment after other treatment methods have failed. The current indications for plaque radiotherapy and its advantages over other therapeutic modalities are discussed.     

New developments in external beam radiotherapy for retinoblastoma: from lens to normal tissue-sparing techniques

Historically, retinoblastoma was treated with external beam radiotherapy (EBR) and for many years this was the accepted standard of care. With greater knowledge of radiation-induced morbidity and mortality, the trend over the past decade has shifted towards primary chemotherapy for most globe conservative treatments. Such a radical change in treatment modalities has restrained EBR to second-line and salvage indications with little consensus regarding dose, timing and techniques. New radiotherapy options now allow for more focused radiation to the globe with further sparing of adjacent structures in such a way that their role in the management of retinoblastoma need to be reappraised. In this perspective paper, first the historical techniques of using EBR primarily with linear accelerated photons are reviewed. Then modern approaches are described, such as stereotactic conformal radiotherapy using a micromultileaf collimator, and proton therapy using a fixed horizontal beam and tantalum localization, or a rotating ganthry with spot scanning. For the first time, to the authors' knowledge, the benefits of these new irradiation modalities over conventional EBR are illustrated with six successfully treated pilot cases. Finally, some guidelines are provided regarding indications to modern radiation therapy in patients requiring second-line or salvage treatment for intraocular retinoblastoma, as well as adjuvant therapy for orbital involvement.     

Non-contiguous recurrence or secondary choroidal melanoma following plaque radiotherapy

Non-contiguous local recurrence of posterior uveal melanoma occurs rarely after plaque therapy. A 50-year-old white first presented with choroidal melanoma. He underwent therapy with episcleral iodine-125 radioactive plaque therapy. Nine years later fundus evaluation revealed a new pigmented lesion in the inferotemporal equatorial area. Patient was considered to have a non-contiguous recurrent melanoma and the eye was enucleated. Histologic microscopic examination disclosed a 3 x 1.8 mm densely pigmented tumour internal to the choroid at the equator. The tumour was composed of large round cells with round nuclei, prominent nucleoli, abundant cytoplasm and spindle-shaped cells with spindle-shaped nuclei and prominent nucleoli. The tumour extended through the retina. The superior nasal area of plaque therapy had extensive chorioretinal atrophy with loss of retinal pigment epithelium, thinning of the retina and thinning and depigmentation of the choroids. Within this area of atrophy, there was a pigmented lesion composed by densely packed, spindle-shaped cells with spindle-shaped nuclei. Our patient illustrated non-contiguous recurrence of choroidal melanoma, such finding raises concerns about physiopathology and treatment of choroidal melanoma.     

Autologous fat graft in irradiated orbit postenucleation for retinoblastoma

Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.     

视网膜母细胞瘤眼球摘除术后放化疗对生存预后影响的研究

目的探讨视网膜母细胞瘤（Rb）眼球摘除术后辅助治疗对预后的影响研究。方法随访中山大学中山眼科中心1997年1月-2001年12月Rb 102例眼球摘除术或眶内容摘除术,术后进行辅助治疗的64例的生存情况,术后放疗、化疗对生存预后影响的研究。结果筛板后侵犯者25例,进行辅助治疗19例,21例存活,4例死亡;视神经断端侵犯者7例,均给以术后辅助治疗,1例存活,6例死亡;小部分脉络膜侵犯44例,35例术后给以辅助治疗,36例存活,8例死亡;大部分脉络膜侵犯6例,3例进行术后辅助治疗,3例存活,3例死亡;眼前段受侵犯16例,8例术后给以辅助治疗,10例存活,6例死亡;眶组织侵犯12例,辅助治疗11例,4例存活,8例死亡。结论视神经断端侵犯者预后很差,术后积极的辅助治疗生存率很低;眶组织侵犯者眶内容摘除术后放疗对生存预后有帮助;单纯眼前段侵犯者术后辅助治疗要审慎;脉络膜侵犯和视神经近端侵犯者的术后辅助治疗仍需进一步研究。     

鼻咽癌放疗术后眼部并发症的临床分析

目的：探讨鼻咽癌放疗术后眼部并发症的临床特点、荧光素及吲哚菁绿血管造影特征、影响因素及其诊治方法。

方法：回顾性分析2007-03/2012-03我院眼科收治的因鼻咽癌放疗后视力下降的患者33例63眼的临床资料。

结果：所有患者均以进行性、无痛性单眼或双眼视力下降为主要临床表现。放射性视网膜病变48眼,其中视网膜中央动脉阻塞2眼,视网膜中央静脉阻塞3眼,色素上皮改变2眼,黄斑前膜1眼,其余40眼均出现后极部棉絮斑及出血。放射性视神经病变36眼,其中视神经边界清晰27眼,视神经边界不清9眼。黄斑区典型性脉络膜新生血管2眼,脉络膜转移灶1眼,脉络膜循环异常4眼,前部葡萄膜炎2眼,玻璃体积血7眼。

结论：鼻咽癌放疗术后眼部并发症复杂多样,最常见放射性视网膜病变和放射性视神经病变,少数表现为黄斑部脉络膜新生血管、动静脉阻塞、脉络膜循环异常等。