孔源性视网膜脱离外路显微手术的临床观察

目的观察孔源性视网膜脱离外路显微手术的临床效果。方法对32例孔源性视网膜脱离患者的32只眼，在手术显微镜直视下进行视网膜放液或不放液，视网膜裂孔及变性区冷凝，硅胶块填压和／或环扎，术后观察视力恢复及视网膜复位情况。结果手术显微镜下患眼视网膜冷凝呈灰白色均清晰可见，无严重手术并发症。1次手术后视网膜完全复位30只眼，占93．4％，再次外路手术复位2只眼。结论孔源性视网膜脱离行外路显微镜直视下手术，具有简单方便直观、效果良好、成功率高等优点。     

超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离12例

目的：评价超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离的疗效和可行性。方法：采用超声乳化白内障吸除联合间接眼底镜下巩膜外冷凝裂孔术，治疗白内障合并视网膜脱离12例（12只眼）。结果：术后所有病例白内障一次性摘除干净，10例视网膜复位，复位病例视力不同程度得到提高。结论：白内障超声乳化与巩膜外冷凝联合术是治疗白内障合并视网膜脱离行之有效的手术方法。     

最小量手术治疗单纯孔源性视网膜脱离的临床研究

目的探讨治疗单纯孔源性视网膜脱离的最优手术方案。方法将2015年9月至2018年1月我院收治的新发、单个或裂孔位于1个钟点位内的上方孔源性视网膜脱离患者82例(82眼)按照手术方式的不同分为3组:采用巩膜外扣带术的患者为A组,采用玻璃体腔消毒空气填充后裂孔周围激光封闭的患者为B组,采用巩膜外冷凝及玻璃体腔消毒空气填充封闭裂孔的患者为C组。观察3组患者手术前后最佳矫正视力、屈光度、眼压、视网膜脱离复位率、前节炎症反应等指标,并定期随访。结果与术前相比,3组患者术后视力、屈光度有不同程度改善,差异有统计学意义(P 0. 05),眼压差异不明显。3组患者术后视力、屈光度、眼压比较,差异无统计学意义(P 0. 05)。术后A组和C组患者眼前节炎症反应较重,3组间差异有统计学意义(P=0. 000);术后2周之内,3组患者复位率均为90%以上;随访2周、1个月、3个月、6个月、12个月,B组有2例患者术后1个月再次发生视网膜脱离或视网膜脱离未复位,另行巩膜外扣带术后视网膜完全复位,其余患者均无视网膜脱离复发及严重并发症发生。结论激光或冷凝封闭裂孔联合玻璃体腔消毒空气填充术是新发、上方孔源性视网膜脱离治疗有效的最小量手术方式,但需要把握适应证。     

白内障术后糖尿病视网膜病变的综合治疗

目的观察激光光凝联合复方樟柳碱综合治疗白内障术后糖尿病视网膜病变（DR）的疗效。方法对50例（76眼）白内障术后DR患者施行激光光凝同时予复方樟柳碱注射液颞浅动脉旁皮下注射，以视力和眼底改变为疗效判断指标。结果白内障术后糖尿病视网膜病变稳定，黄斑水肿减轻或消退，视力稳定。结论白内障术后DR患者具有光凝指征应尽早综合治疗，对于控制糖尿病视网膜病变进展，提高白内障远期复明效果有重要意义。     

激光光凝手术治疗眼底疾病的临床效果研究

目的观察应用激光光凝手术治疗眼底疾病的临床疗效和并发症情况,评价其临床应用价值遥方法选择我院2014 年5 月~2016 年1 月收治的100 例眼底疾病患者,根据治疗方式分成两组,对照组50 例患者选择临床常规治疗,实验组50 例患者 选择激光光凝手术治疗,分析两组患者的临床疗效和并发症发生情况遥结果实验组的临床治疗总有效率显著高于对照组,两 者比较差异有统计学意义（约0.05）曰实验组的并发症发生率显著低于对照组,两者比较差异有统计学意义（约0.05）遥结论在 对眼底疾病患者进行治疗时,激光光凝手术治疗能提高临床疗效,降低并发症发生率,具有临床应用价值遥     

频域光学相干断层扫描增强技术观察糖尿病视网膜病变激光光凝术前后黄斑区脉络膜体积的变化

目的：应用频域光学相干断层扫描增强技术(enhanced-depth imaging optical coherence tomography, OCT)观察糖尿病视网膜病变(diabetic retinopathy,DR)在视网膜激光光凝术前后黄斑区脉络膜体积(macular choroidal volume,MCV)的变化情况。方法：经眼底血管造影(fundus fluorescein angiography,FFA)和光学相干断层扫描(optical coherence tomography,OCT)确诊重度非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)和早期增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)伴黄斑水肿(diabetic macular edema,DME)的患者30例(51只眼)纳入研究。所有患眼均先行黄斑区格栅样激光光凝治疗,然后1周后行全视网膜激光光凝术(panretinal photocoagulation,PRP)。治疗前、黄斑区格栅样激光光凝完成后1周及PRP全部治疗完成后1个月和三个月,分别采用频域OCT增强深部成像技术(enhanced-depth imaging,EDI)技术对所有患眼黄斑区脉络膜进行水平扫描,测量计算出MCV值。结果：治疗前MCV值为(6.38±0.69) mm3,黄斑区格栅样激光光凝术后1周MCV值为(7.79±0.70) mm3,较治疗前增大(1.56±0.32) mm3,差异有统计学意义(t=3.265,P<0.05),PRP术后一个月MCV值为(7.01±0.71) mm3,较治疗前增大(1.21±0.31) mm3,差异有统计学意义(t=3.237,P<0.05),PRP术后3个月MCV值为(6.11±0.57) mm3,较治疗前减小(0.87±0.22) mm3,差异有统计学意义(t=3.305,P<0.05)。结论：黄斑区格栅激光后1周及PRP术后1个月DR患者MCV值增大,3个月MCV值减小。OCT-EDI可以无创地、直观地观察到黄斑区脉络膜结构的变化。     

微波热凝治疗长年性变应性鼻炎的疗效观察

一、资料与方法 1.临床资料:本组病例选自1999年12月至2001年12月间来院就诊,以喷嚏、流清水样涕、鼻塞为主要症状,确诊为长年性变应性鼻炎者,且经过药物治疗或脱敏治疗效果不良的患者,共60例。其中男28例,女32例。年龄17～60岁,平均31.5岁。病程短者2年,病程长者46年。术后随访3～12个月。     

532激光联合曲安奈德治疗糖尿病视网膜病变的临床观察

目的评价倍频532激光联合曲安奈德治疗伴有黄斑水肿的糖尿病视网膜病变的疗效。方法对52例87眼伴有弥漫性黄斑水肿的糖尿病视网膜病变患者采用532激光进行黄斑格栅样光凝联合全视网膜光凝，同时球后注射曲安奈德20mg，1～3次，间隔1周，分析患者视力、黄斑水肿及并发症情况。结果激光治疗后随访6～18个月，87眼中51（59％）眼视力稳定，视力提高者30（35％）眼，视力下降者6（7％）眼；眼底荧光血管造影检查，光凝后水肿完全消退者50（57％）眼，部分消退者32（37％）眼，不变者5（6％）眼，晶状体混浊加重者5眼，4只眼眼压升高。结论532倍频激光联合曲安奈德治疗糖尿病视网膜病变有助于黄斑水肿消退，提高视力。     

白内障合并增生性糖尿病视网膜病变的联合手术治疗

目的探讨超声乳化和晶体切除术联合玻璃体切除在白内障合并增生性糖尿病视网膜病变（PDR）治疗中的临床疗效。方法分析79例PDR,共105眼,随机分2组,术式1组56只眼,为白内障超声乳化术后,行闭合式三通道玻璃体切除,囊袋内植入后房型人工晶体;术式2组49只眼,为经扁平部玻璃体联合晶体切除术,保留前囊、人工晶体植入前囊上、睫状体沟内。结果术后随访2个月～3年,术式1组视力改善46只眼,占82．1％;术式2组视力改善31只眼,占63．2％,两组术后视力改善眼数比较差异显著（χ^2=4．762,P〈0．05）。术式1组术后发生虹膜新生血管（INV）1只眼,占1．8％;术式2组术后发生INV 7只眼,占14．3％,两组术后INV发生率比较差异显著（χ^2=5．835,P〈0．05）。结论在治疗白内障合并PDR患者中,术式1组优于术式2组,其术后并发症和INV的发生率也明显低,可使大多数患者的视力改善。     

25G针头穿刺引流治疗原发性视网膜脱离

目的总结原发性视网膜脱离外路手术中,采用25G针头经巩膜直接穿刺引流视网膜下液体的临床效果。方法在54例原发性视网膜脱离的外路手术中,23例采用25G针头经巩膜直接穿刺引流视网膜下液体(25GND组),31例采用传统巩膜切开引流(CD组)。比较2组的术后并发症、初次手术复位率和功能性预后。结果全部病例顺利完成视网膜下液体引流,2组的初次手术复位率差异无显著性。与CD相比,25GND明显减少了术后并发症的发生(χ2=4.729,P<0.05)并改善预后视力(χ2=5.183,P<0.05)。结论25G针头经巩膜直接穿刺引流视网膜下液体,简便、安全、有助于视网膜复位和视力提高。     

A new case of osteogenesis imperfecta type VIII and retinal detachment

Osteogenesis imperfecta (OI) type VIII (OMIM: 610915) is a rare autosomal recessive disorder characterized by white sclerae, severe growth deficiency, and bone fragility. This condition results from pathogenic variants of P3H1, a gene that codes for P3H1, an important protein involved in the prolyl‐3‐hydroxylation complex required for collagen type I folding. Here, we described a woman with OI type VIII due to a homozygous mutation of c.1914+1G>C (NM_001243246.1) in P3H1 and retinal detachment. We compared our case to five severe OI and retinal detachment cases reported in the literature. The only case previously reported with a molecular diagnosis had a similar mutation in P3H1 c.1914+1G>A and a giant retinal detachment. We suggest that individuals with OI type VIII should be submitted to careful fundoscopic examination.     

Phenotypic delineation of the retinal arterial macroaneurysms with supravalvular pulmonic stenosis syndrome

Retinal arterial macroaneurysms with supravalvular pulmonic stenosis (RAMSVPS), also known as Familial Retinal Arterial Macroaneurysms (FRAM) syndrome, is a very rare multisystem disorder. Here, we present a case series comprising ophthalmologic and systemic evaluation of patients homozygous for RAMSVPS syndrome causative IGFBP7 variant. New clinical details on 22 previously published and 8 previously unpublished patients are described. Age at first presentation ranged from 1 to 34 years. The classical feature of macroaneurysms and vascular beading involving the retinal arteries was universal. Follow up extending up to 14 years after initial diagnosis revealed recurrent episodes of bleeding and leakage from macroaneurysms in 55% and 59% of patients, respectively. The majority of patients who underwent echocardiography (18/23) showed evidence of heart involvement, most characteristically pulmonary (valvular or supravalvular) stenosis, often requiring surgical correction (12/18). Four patients died in the course of the study from complications of pulmonary stenosis, cerebral hemorrhage, and cardiac complications. Liver involvement (usually cirrhosis) was observed in eight patients. Cerebral vascular involvement was observed in one patient, and stroke was observed in two. We conclude that RAMSVPS is a recognizable syndrome characterized by a high burden of ocular and systemic morbidity, and risk of premature death. Recommendations are proposed for early detection and management of these complications.     

Short-term effects of 308-nm xenon-chloride excimer laser and narrow-band ultraviolet B in the treatment of vitiligo: a comparative study

We compared the clinical efficacy of a short-term intervention of 308-nm excimer laser with that of narrow-band UVB (NBUVB) phototherapy for vitiligo patients to see the early response. Twenty-three symmetrically patterned patches of vitiligo on 8 patients were selected. Vitiligo patches on one side of the body were treated 2 times per week for a maximum of 20 treatments with the excimer laser, and NBUVB phototherapy was used on patches on the other side. Improvement (repigmentation) was assessed on a visual scale via serial photographs taken every five treatments and scored as follows: 0,< or =1% improvement; 1,< or =25% improvement; 2, 26-50% improvement; 3, 51-75% improvement; and 4, > or =75% improvement. At five treatments, the excimer laser-treated patches had an average score of 0.26, compared with 0.04 for patches treated with NBUVB phototherapy. A slightly higher repigmentation (p>0.05) in the excimer treated area was thus observed. At 10, 15, or 20 treatments, the differences between the average scores were significant: 0.83, 1.17, and 1.39 for the excimer-treated patches, and 0.17, 0.30, and 0.74 for the NBUVB phototherapy-treated areas (p<0.05). In conclusion, the 308-nm excimer laser appears to be more effective than NBUVB phototherapy, as it produces more rapid and profound repigmentation.     

二氧化碳激光联合5-氟脲嘧啶治疗尖锐湿疣的疗效观察

目的 尖锐湿疣(CA)是人乳头瘤病毒(HPV)感染所引起的常见性传播性疾病.由于尚无直接用于抗人乳头瘤病毒的药物,目前更多趋向于包括化学疗法、外科疗法、物理疗法、免疫疗法等联合疗法,但各种方法均不能避免CA的复发.本研究旨在探讨采用CO2激光联合5-氟脲嘧啶(5-FU)治疗CA的临床疗效.方法 采用激光手术去除疣体,以5% 5-FU注射液外用湿敷患处,观察疗效.结果 将激光与5% 5-FU注射液2种手段的治疗效用叠加,起到了互补的作用;同时,5% 5-FU注射液药价低廉,便于患者回家后独立使用,可以极大地降低患者的治疗成本.结论 采用CO2激光联合5%5-氟脲嘧啶注射液外用湿敷,加以规范的使用指导及预防措施,对于尖锐湿疣的治疗可以起到有效、廉价、实用的作用,值得临床推广.     

A simulation method for the study of laser transillumination of biological tissues

The Monte-Carlo method is employed to simulate the illumination of a blood slab by a continuous laser. It is assumed that the geometry of the medium is bidimensional and that scattering or absorption takes place only when a photon strikes a red blood cell. The parameters involved in the calculations concern the photons free path lengths between two collisions, the scattering angles and the absorption probability at collision. These parameters are assessed according to experimental or literature data. Fortran programs allow the computation of diffuse and collimated transmittances (T_d and T_c, respectively), of transmittance measured with an optic fiber T_f and of reflectance R. The variations of T_c and T_f with blood thickness are in accordance with established laws. Moreover, measured and computed reflectances change with hematocrit ratio in a similar way. This work demonstrates that the Monte-Carlo method is a simple reliable tool which can be used to provide a realistic model of laser penetration in complex biological structures. Moreover, this method will permit investigations in laser tomospectrometry by providing a useful simulation of the interaction of ultrashort light pulses with biological media.     

Significant photoreceptor rescue by treatment with a combination of antioxidants in an animal model for retinal degeneration

The purpose of this study was to investigate the presence of oxidative DNA damage in the photoreceptors of the rd1 mouse, an animal model for retinitis pigmentosa, and to determine if antioxidants could delay the progress of photoreceptor cell death. Retinas of rd1 mice and congenic wild type controls were examined for DNA oxidation and fragmentation. To study the rescue effect of antioxidants on retinal degeneration, rd1 retinas were studied in vitro and in vivo using lutein, zeaxanthin, alpha lipoic acid and reduced l-glutathione. For the in vitro studies, antioxidants were added to the culture medium. For the in vivo studies, postnatal day (PN3) pups of rd1 mice were fed antioxidants either individually or in combination and control rd1 animals received vehicle alone. Histological evaluation was performed using hematoxylin/eosin and avidin staining, as well as terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Many of the rd1 rod photoreceptors at PN11 displayed oxidative DNA damage and TUNEL positive reaction which co-localized in a subset of rod photoreceptors. Avidin-labeled rod photoreceptors were more abundant than the TUNEL positive photoreceptors of the rd1 mouse, indicating that oxidative DNA damage precedes fragmentation. The number of TUNEL positive and avidin positive cells was considerably decreased upon treatment with the combination of the antioxidants. Rescue of rd1 photoreceptors was significant at PN18 and PN17, respectively, in the in vitro and in vivo studies. In conclusion individual antioxidants had no significant rescue effect but the combination slowed down the rd1 rod photoreceptor degeneration, indicating an additive or synergistic effect.     

The safety and efficacy of gene therapy treatment for monogenic retinal and optic nerve diseases: A systematic review

PurposeThis study aimed to systematically review and summarize gene therapy treatment for monogenic retinal and optic nerve diseases.MethodsThis review was prospectively registered (CRD42021229812). A comprehensive literature search was performed in Ovid MEDLINE, Ovid Embase, Cochrane Central, and clinical trial registries (February 2021). Clinical studies describing DNA-based gene therapy treatments for monogenic posterior ocular diseases were eligible for inclusion. Risk of bias evaluation was performed. Data synthesis was undertaken applying Synthesis Without Meta-analysis guidelines.ResultsThis study identified 47 full-text publications, 50 conference abstracts, and 54 clinical trial registry entries describing DNA-based ocular gene therapy treatments for 16 different genetic variants. Study summaries and visual representations of safety and efficacy outcomes are presented for 20 unique full-text publications in RPE65-mediated retinal dystrophies, choroideremia, Leber hereditary optic neuropathy, rod-cone dystrophy, achromatopsia, and X-linked retinoschisis. The most common adverse events were related to lid/ocular surface/cornea abnormalities in subretinal gene therapy trials and anterior uveitis in intravitreal gene therapy trials.ConclusionThere is a high degree of variability in ocular monogenic gene therapy trials with respect to study design, statistical methodology, and reporting of safety and efficacy outcomes. This review improves the accessibility and transparency in interpreting gene therapy trials to date.