光学相干断层成像术对Vogt-小柳原田综合征早期诊断的意义

目的评估光学相干断层成像术(OCT)对Vogt-小柳原田综合征(VKH)早期诊断的意义。方法对9例16眼VKH患者早期行OCT检查,并行彩色眼底照相,荧光素眼底血管造影(FFA)。全部病例均应用糖皮质激素冲击治疗1周后复查OCT1~2次。结果9例16眼VKH患者早期OCT检查表现为视网膜神经上皮层浆液性脱离、隆起呈泡状或多囊状,其脱离高度176~1209μm,平均高度(864·0±234·4)μm。经糖皮质激素冲击治疗1周,浆液性渗出迅速吸收,视网膜神经上皮脱离高度下降至141~220μm,平均(170·6±31·0)μm,与治疗前比较具有统计学上的差异(P<0·01)。结论在VKH早期,患眼视网膜神经上皮显著增厚、浆液性视网膜脱离,OCT在VKH早期诊断和治疗效果的观察评估中具有重要意义。     

中心性渗出性脉络膜视网膜病变的光学相干断层扫描图像特征分析

目的观察中心性渗出性脉络膜视网膜病变的光学相干断层扫描(OCT)图像特征。方法对中心性渗出性脉络膜视网膜病变患者23例(23只眼)进行OCT检查并结合眼底荧光血管造影(FFA)结果进行测量、对比、分析。结果23只眼眼底黄斑中心凹或中心凹旁均有视网膜下新生血管(CNV)存在。边界清晰者占82.6%(19只眼),边界不清晰者占17.4%(4只眼)。全部突破Bruch膜及色素上皮层在神经上皮层下生长,伴有神经上皮层间水肿者78.9%(18只眼),伴神经上皮层浆液性脱离者10.5%(3只眼),伴出血性色素上皮脱离者5.3%(2只眼)。测量CNV最大直径和厚度分别为(1339.2±1010.8)μm、(230.8±111.5)μm。结论OCT检查可以发现中心性渗出性脉络膜视网膜病变时视网膜下CNV的存在,是对FFA检查的重要补充。     

Vogt-小柳-原田综合征葡萄膜炎期的临床分析

目的分析Vogt-小柳-原田综合征（VKH）急性葡萄膜炎期视网膜脱离与睫状体和前部脉络膜脱离程度的相关性。方法VKH10例20眼，荧光素眼底血管造影（FFA）的同时行超声生物显微镜（UBM）及光学相干断层成像术（OCT）检查，对UBM检查测量的睫状体和前部脉络膜脱离的高度与OCT测量的视网膜神经上皮脱离的高度进行相关性分析。结果FFA检查20眼均有多湖样视网膜脱离，UBM检查20眼均有睫状体和前部脉络膜脱离，脱离的高度均值为（185．2±209．0）μm，OCT检查显示视网膜神经上皮和色素上皮（RPE）脱离，脱离的高度为215～967μm，平均（557．07±268．96）μm。睫状体和前部脉络膜脱离与视网膜神经上皮脱离高度呈显著正相关（r=0．867，P=0．001）。结论VKH急性葡萄膜炎期脉络膜炎性渗出液向内通过受损的RPE蓄积在视网膜神经上皮下产生视网膜脱离，向外也可蓄积在脉络膜上腔并前行至睫状体上腔而产生睫状体脉络膜脱离，二者有明显相关性。     

视网膜复位术后非屈光性视物变形患者的黄斑光学相干断层成像术检查

目的　应用光学相干断层成像术 (opticalcoherencetomography ,OCT)研究巩膜扣带术后非屈光性视物变形患者的黄斑复位情况 ,探讨视物变形的原因和预后。方法　选择 82例 ( 82眼 )原发性裂孔性视网膜脱离患者 ,均经巩膜扣带术获得视网膜解剖复位但主诉视物变形 ,验光后无法矫正 ,利用OCT对黄斑区进行经中心凹水平和垂直线形扫描。结果　OCT检查患眼黄斑区有神经上皮下积液、神经上皮水肿、神经上皮变薄、黄斑前膜、黄斑下膜和黄斑区视网膜下出血 6种异常表现。其中 ,神经上皮下积液共 67眼 ( 82 % ) ,脱离高度平均为 ( 12 1± 10 1 3 6) μm ,脱离范围从 2 46μm到整个扫描区神经上皮下积液 ;神经上皮水肿共 11眼 ,中心凹处神经上皮厚度平均为 ( 3 64± 5 8) μm ;神经上皮变薄共 9眼 ,中心凹处神经上皮厚度平均 ( 92± 13 84) μm。 结论　OCT不仅能够精确的检测巩膜扣带术后黄斑复位情况 ,解释非屈光性视物变形的原因 ,而且能够对术后黄斑进行定量测定和随访 ,对病情预后有重要意义     

中心性浆液性脉络膜视网膜病变激光治疗后黄斑形态改变与光敏感度的观察

目的利用相干光断层扫描(OCT)与自动视野仪分析激光治疗前后中心性浆液性脉络膜视网膜病变(CSC)患者的黄斑形态与黄斑敏感度的变化。方法随机抽取行激光治疗的单眼发病的CSC患者64例(64只眼),分别在行激光治疗前、治疗后2,4周行OCT及中心视野检查。用自动视野计进行双眼中心视野检查,OCT测量CSC患者黄斑区神经上皮层脱离的高度、水平范围。中心视野的检查评估黄斑区光敏感度的恢复,分析CSC的黄斑区形态学改变与黄斑敏感度的关系。结果激光治疗前CSC患眼中心10°的平均光敏感度为(21.102±7.721)d B,激光治疗后4周的平均光敏感度为(27.348±1.785)d B,(P<0.05)。患者神经上皮层脱离高度为75~598μm,平均(260.38±134.65)μm,浆液性脱离范围1123.48~5321.64,平均(3223.73±1023.44)μm。4周后,浆液性脱离范围0~1463μm,平均(894.45±786.54)μm,神经上皮层脱离高度为0~76μm,平均(21.78±23.25)μm,患者神经上皮层脱离高度及范围均明显低于治疗前(P<0.05)。结论激光治疗急性CSC能缩短病程,OCT能定量分析黄斑水肿程度,比FFA更加直观;自动视野检查治疗后的视功能恢复情况。同时应用能更好的评价治疗效果,能对CSC的愈后过程进行灵敏的追踪。     

光学相干断层扫描对黄斑疾病的诊断意义

目的 评价光学相干断层扫描（optical coherence tomography,OCT)在诊断黄斑部疾病中的价值。方法 采用OCT检测了111例126只有黄斑部病变的眼：中心性浆液性脉络膜视网膜病变20眼，黄斑裂孔20眼，老年黄斑变性20眼，黄斑水肿26眼，视网膜前膜20眼，裂孔性视钢膜脱离累及黄斑部经手术复位后20眼。结果 黄斑部疾病的OCT示黄斑区视钢膜多种形态学改变。中心性浆液性脉络膜视网膜病挛 OCT见神经上皮层脱离和（或）色素上皮层脱离；黄斑裂孔的OCT见黄斑中心凹处神经上皮层全层或部分缺损，可伴神经上皮层脱离或增厚；湿性型年龄相关性黄斑变性的OCT见神经上皮层下呈不规则的高反射层（脉络膜新生血管膜），部分伴视网膜神经上皮层和（或）色素上皮层脱离；黄斑水肿及囊性水肿的OCT见黄斑区的神经上皮层厚度增厚和（或）层间液性囊腔；视网膜前膜的OCT见视网膜内层前有一高反射的光带；视网膜脱离术后的OCT见神经上皮层与色素上皮相贴良好或有液性腔隙存在。结论 OCT对黄斑部疾病诊断有独特的临床应用价值。     

黄斑囊样水肿的OCT与FFA对比观察

目的 观察不同疾病所致黄斑囊样水肿(cystoid macular edema,CME)的光相干断层扫描(Optical coherence tomograph,OCT)特征,并与眼底荧光血管造影结果 对比分析.方法 经FFA确诊的各种原因引起的黄斑囊样水肿患眼进行OCT检查,通过黄斑中心的水平或垂直方向线性扫描.根据眼底荧光血管造影(Fundus Fluorescence angiography,FFA)对CME进行水肿分级,并根据分级情况对比分析其OCT的形态特征.结果 93例CME患者,其中糖尿病视网膜病变(DR)23例,静脉阻塞(RVO)27例,VKH,白塞病10例,AMD8例,白内障摘除及抗青光眼术后8例,视网膜脱离扣带术后5例,玻璃体黄斑牵引综合征3例,视网膜色素变性3例,特发性CME4例,黄斑板层裂孔及脉络膜血管瘤各1例.黄斑囊样水肿分为Ⅲ级.Ⅰ级:小囊泡形成,荧光素渗漏范围约1/4视乳头直径,共9例(9.7%).OCT图像显示,黄斑神经上皮增厚,中心凹变浅或消失,中心凹下神经上皮层内形成一个明显液性囊腔,两侧囊壁增厚,囊腔内淡绿色点状浆液性弱反射,隐约见淡绿色囊壁结构.Ⅱ级:黄斑区荧光素渗漏占黄斑1/2视乳头直径,共50例(53.7%),OCT图像显示:黄斑区呈"丘样"隆起.神经上皮下呈蜂窝状改变,中央囊腔较大,囊壁薄,周围囊壁较厚.Ⅲ级:黄斑荧光色素渗漏占据整个黄斑区,超过1个视乳头直径,共34例(36.6%).OCT图像黄斑区神经上皮高度隆起,囊腔的腔隙互相融合,分隔囊腔的组织断裂,或增厚呈红黄中强反射.结论 根据FFA黄斑囊样水肿分级,Ⅲ级CME的OCT图像显示黄斑区神经上皮高度隆起,水肿波及整个黄斑,神经上皮层反射增强或神经上皮下囊样结构融合消失.OCT提示Ⅲ级CME,又进而推判视力预后不佳.     

Vogt-小柳原田病的光学相干断层扫描图像特征

目的:观察和分析Vogt-小柳原田病(Vogt-Koyanagi-Hara-da,VKH)葡萄膜炎期多湖状视网膜脱离的光学相干断层扫描(OCT)图像特征。方法:对12例VKH患者24眼进行眼底荧光血管造影(fundus fluorescein angiography,FFA)和OCT检查。结果:OCT图像可见12例24眼均有视网膜神经上皮浆液性脱离,视网膜下间隔将视网膜神经上皮脱离区分成多个部分。应用激素治疗后,视网膜浆液性渗出吸收,视网膜下的间隔完全消失。结论:VKH治疗前,视网膜下间隔导致VKH多湖状视网膜脱离。     

正常国人的光学相干断层扫描测量

目的:研究正常中国人的OCT特征。方法:利用光学相干断层扫描(OCT)对正常人72例142眼进行视乳头神经纤维层(retinalnervefiberlayerofpapilla,PNFL)、黄斑部神经纤维层(nervefiberlayerofmacular,MNFL)、色素上皮/脉络膜毛细血管复合层(reti-nalpigmentepithelium/choriocapillaris,RPE/CC)及神经上皮层(retinalneurepitheliumlayer,RNE)厚度的测量。应用单因素方差分析比较其性别、眼别、年龄组间(10岁为1组)的差异性。结果:PNFL,MNFL,RPE/CC,RNE厚度与性别、眼别无关;PNFL的平均厚度为105.2±8.4μm,MNFL的平均厚度为25.5±4.7μm,RPE/CC平均厚度为74.7±10.3μm,随年龄增长逐渐变薄.以50岁以后各组间比较差异有显著性。RNE平均厚度为243.2±13.2μm,与年龄无关。结论:黄斑部神经纤维层厚度、神经上皮层厚度及色素上皮/脉络膜毛细血管复合层厚度随着年龄的增长,其厚度变薄。     

特发性中心性浆液性脉络膜视网膜病变的光学相干断层成像

目的　探讨特发性中心性浆液性脉络膜视网膜病变 ( idiopathic central serous chorioretinopathy,IC-SC)光学相干断层成像术 ( optical coherence tomography,OCT)改变的诊断特点与其临床应用价值。方法　对临床上诊断为 ICSC的 40例 ( 41只眼 )患者做 OCT和荧光素眼底血管造影检查、测量和分析。结果　 40例 ( 41只眼 ) IC-SC的 OCT图像均表现为黄斑中心的视网膜神经上皮层局限性脱离 ,脱离范围在 70 5～ 5 72 0 μm(平均 3 0 5 0 .80 49±13 3 7.5 619μm) ,高度 5 5～ 491μm(平均 2 69.85 3 7± 114.2 796μm)。 4只眼合并有色素上皮层浆液性脱离。并经统计表明脱离范围、高度与视力相关。结论　 OCT作为一种客观的无损伤的视网膜断层扫描技术 ,其高分辨率的特性在 ICSC的诊断、定量分析和病程随访中具有重要的价值和特别的优势     

Distribution,markers, and functions of retinal microglia

Retinal microglia originate from hemopoietic cells and invade the retina from the retinal margin and the optic disc, most likely via the blood vessels of the ciliary body and iris, and the retinal vasculature, respectively. The microglial precursors that appear in the retina prior to vascularization are major histocompatibility complex (MHC) class I- and II-positive and express the CD 45 marker, but lack specific macrophage markers. They differentiate into ramified parenchymal microglia in the adult retina. A second category of microglial precursors, which do express specific macrophage markers, migrate into the retina along with vascular precursors. They appear around blood vessels in the adult retina and are similar to macrophages or cells of the mononuclear phagocyte series (MPS). Microglia are distributed in the outer plexiform layer (OPL), outer nuclear layer (ONL), inner plexiform layer (IPL), ganglion cell layer (GCL), and nerve fiber layer (NFL) of the primate retina. The pattern of microglial distribution in the avascular retina of the quail indicates that blood vessels are not responsible for the final location of microglia in the retina. In the human retina, microglia express MHC class I, MHC class II, CD 45 , CD68, and S22 markers. In the rat and mouse retina, OX 41 , OX 42 , OX 3 , OX6, OX18, ED1, Mac-1, F 4 /80, 5 D 4 anti-keratan sulfate, and lectins are used to recognize microglia. Microglial cells play an important role in host defense against invading microorganisms, immunoregulation, and tissue repair. During neurodegeneration, activated microglial cells participate in the phagocytosis of debris and facilitate regenerative processes. In autoimmune disease, microglia have dual functions: initiating uveoretinitis, but also limiting subsequent inflammation. Retinal microglia may be associated with vitreoretinopathy, diabetic retinopathy, glaucoma, and age-related macular degeneration. The goal of this article was to review the present knowledge about retinal microglia and the function of retinal microglia in pathological conditions.     

Comparative antiproliferative and cytotoxic profile of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on different ocular cells

Aim To compare the antiproliferative and cytotoxic properties of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on human retinal pigment epithelium (ARPE19) cells, rat retinal ganglion cells (RGC5) and pig choroidal endothelial cells (CEC). Methods Monolayer cultures of ARPE19, RGC5 and CEC were used. Bevacizumab (0.1–0.3 mg/ml), pegaptanib (0.025–0.08 mg/ml) or ranibizumab (0.04–0.125 mg/ml) diluted in culture medium were added to the cells. Expression of VEGF-receptors (VEGFR1 and VEGFR2) and von Willebrand factor (a marker for endothelial cells) were analysed by immunohistochemistry. CEC cells were stimulated with VEGF. Cellular proliferative activity was monitored by BrdU-incorporation into cellular DNA. For cytotoxicity assays cells were grown to confluence and then cultured in a serum-depleted medium to ensure a static milieu. MTT-test was performed after one day. Results CEC and ARPE19 cells stained positively for VEGFR1 and VEGFR2. More than 95% of the CEC cells were positive for von Willebrand factor. Ranibizumab reduced CEC cell proliferation by 44.1%, bevacizumab by 38.2% and pegaptanib by 35.1% when the drugs were used at their established clinical doses. The differences, however, between the three drugs in respect to cell growth inhibition were not statistically significant. Only a mild antiproliferative effect of bevacizumab or pegaptanib on ARPE19 cells could be observed. Ranibizumab did not alter ARPE19 cell proliferation. No cytotoxicity on RGC5, CEC and ARPE19 cells could be seen. Conclusions Bevacizumab, pegaptanib and ranibizumab significantly suppress choroidal endothelial cell proliferation. However, when used at the currently established doses none of the drugs was superior over the others in respect to endothelial cell growth inhibition. The biocompatibility of all three drugs — including the off-label bevacizumab — seems to be excellent when used at the currently recommended intravitreal dose. This work is presented on behalf of the Tuebingen Bevacizumab Study Group.     

视网膜色素上皮挫伤的眼底自发荧光改变

目的 观察视网膜色素上皮挫伤时的眼底自发荧光(AF)形态改变,探讨AF检查对眼外伤造成的视网膜色素上皮挫伤的诊断意义.方法 对31例(36只眼)视网膜色素上皮挫伤的的患者,进行眼底自发荧光检查.采用海德堡激光眼底扫描系统获取自发荧光图像.与同病例的眼底检查及FFA做对比分析,得出其自发荧光特征.结果 所有病例在视网膜色素上皮挫伤区域的自发荧光普遍弥漫性增强,有色素上皮增生处大多表现为更强的自发荧光点,色素脱失处大多表现为低荧光,在总体增强区域表现为地图状的自发荧光.结论 眼球钝挫伤早期导致的视网膜色素上皮的损害会引起相应的自发荧光的改变,主要以自发荧光增强为主,反映该区域色素上皮高代谢状态或增殖活动为主,弱的AF较少,表明挫伤后短期局部的色素上皮萎缩.这些改变与一些以萎缩性病变为主的眼底病的AF有明显区别,因而AF应用于视网膜色素上皮挫伤的诊断有明显的意义.     

视网膜血管瘤增殖一年龄相关性黄斑变性的特殊类型

本文总结了年龄相关性黄斑变性的特殊类型—视网膜血管瘤增殖(RAP)的临床和造影表现及分期。RAP是起源于黄斑旁视网膜深层毛细血管的、以伴发多灶小片视网膜内出血及盘变前期即有视网膜-脉络膜血管吻合(RCA)形成为特征的新生血管性AMD。     

Intravitreal use of bevacizumab (Avastin) for choroidal neovascularization due to ARMD: a preliminary multifocal-ERG and OCT study

Purpose To evaluate by MFERG and OCT the macular function before and after intravitreal use of bevacizumab (Avastin) in eyes suffering from CNV due to ARMD. Methods Eighteen eyes with subfoveal CNV due to ARMD were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow up was three months. Results Before treatment, OCT shows an increase of the retinal thickening of the fovea and the electrical response densities in the fovea and parafovea were decreased in all patients. Three months after treatment, OCT showed a real resolution of the subretinal fluid. The electrical responses in the fovea and parafovea remained the same or slightly improved in some cases. The intraocular pressure remained normal and no inflammation was observed. Conclusion The intravitreal use of bevacizumab may provide anatomical correlates that support the concept of disease amelioration but the functional improvement of the macula three months after treatment is not obvious. However the method is promising and needs further evaluation.     

糖尿病患者的视网膜电图分析

目的分析糖尿病(DR)患者视网膜电图(F-ERG)的振幅、峰潜时、OPS总和振幅及其与病程的相关性.方法将53例102眼糖尿病患者分为三组(NDR、BDR、PDR),并采用美国UATA-2000型视觉电生理仪对53DR例进行F-ERG检查,主要分析其a、b波峰潜时、振幅、OPS总和振幅.结果随着DR病情的加重,ERG及OPS无波的情况所占比例增大.a波峰潜时BDR组和正常组比较差异有极显著性(P<0.01),BDR组和DM无DR组比较差异有显著性(P[WTBZ〗<0.05);a波振幅正常对照组与其他各组比较差异均有极显著性(P<0.01).b波振幅正常对照组与BDR、PDR间以及DM无DR组与BDR、PDR组间均有极显著性差异(P<0.01).OPS总和振幅除了BDR与PDR间外,其他各组比较差异均有极显著性(P<0.01).结论OPS、ERG之a、b波振幅,尤其是b波振幅,可以作为早期诊断DR患者以及估计预后的敏感指标;良好的血糖控制,可以延缓DM的病情发展.     

30天连续配戴硬性透氧性角膜接触镜的安全性研究

目的为了评价Menicon Z硬性接触镜30 d连续配戴的安全性与有效性,进行了两个为期一年的临床比较试验.方法分别选用了可以7 d连续配戴的Hydrogel材料的Acuvue(1)及可以30 d连续配戴的Si H材料的Focus Night & Day(2)软性接触镜作为对照镜片.结果临床试验(Ⅰ)中,317人参加了Menicon Z组群,313人参加了Acuvue组群.Menicon Z组群有258人(占81.4%)完成了为期一年的试验,而Acuvue组群仅有210人(占67.1%).Acuvue组群中比较常见的副作用为浸润性角膜炎与细菌性结膜炎.相比之下,Menicon Z组群常见的不适症状是由异物飞入角膜造成角膜上皮擦伤所致的.各有50人参加了临床试验(Ⅱ)的Menicon Z组群与Night & Day组群.Menicon Z组群有35人(占70.0%)完成了为期一年的试验,Night & Day组群有33人(占66.0%).Menicon Z组群中常见的副作用表现为3～9点角膜染色,Night & Day组群为接触镜相关性充血、接触镜性角膜周边溃疡、乳头性结膜炎、角膜上方弓状损伤与细菌性角膜炎.结论Menicon Z 30 d连续配戴具有安全性.     

The Analysis of Electroretinography of Diabetes Mellitus

Purpose: In order to get deeper understanding of Diabetic Retinopathy (DR), we analyzed and evauated the results of the amplitude and latency of F-ERG a-wave, b-wave and the total amplitudes of oscillatory potentials(OPs).Methods: F-ERG of 105 eyes from 55 cases of DM were diagnosed by the medical department from July 1997 to July 1998. The 105 eyes were examined by ophthalmoscope and fluorescing in angiography and divided into there groups: 22 eyes with DM without DR(NDR), 56 eyes with background DR(BDR)and 27 eyes with proliferate DR(PDR). In addition, 30 eyes were regard as normal control group(NCG) . We used VATA-2000 type vision electrophysiological instrument and inter-national standard for clinical ERG to do measure meat and recording automatically by computer.Results: 1. The proportion of eyes number of invisible wave of a-wave, b-wave of F-ERG and Ops increased with the development of DR. 2. There were significant differences ( P< 0. 01) in the latency of a-wave between NCG and BDR and statistic     

近视及散光眼LASIK后非接触眼压计测量值的影响因素及其预测

目的 比较近视和(或)散光患者在LASIK手术前后非接触眼压计测量结果的差异及其影响因素,并得到预计眼压的计算公式.方法 对2005年12月至2006年11月在北京协和医院准分子激光手术中心行初次准分子激光原位角膜磨镶术(LASIK)矫正近视和(或)散光的患者进行回顾性研究,共93例(183只眼),采用非接触眼压计(NCT)测量术前和术后2周、1个月、3个月的眼压值,计算眼压变化值并分析其与各种变量之间的相关性,应用多元线性回归从相关变量得到术后预计的测量眼压值及眼压变化值.结果 患者术后3个月眼压较术前平均下降(5.74±2.03)mmHg,其变化与性别、年龄均不相关,但与术前屈光度有明显的关系.多元线性回归分析得到术后实际测量的眼压与术前眼压呈正性相关,而与手术切削量呈负相关(R2=0.442,P<0.001),术后预计测量眼压=5.175+0.411×术前眼压-0.0205×切削量,手术后眼压测量下降值0.589×术前眼压+0.0205×切削量-5.175.结论 通过术后实际测量眼压值与预测值比较,可以及时发现高眼压的患者,避免低估眼压以致漏诊青光眼而造成患者视功能损失.虽然可以通过预测公式来判断实际测量眼压值是否在正常范围.但更有效的方法是使用不受角膜变化影响的眼压计测定眼压.