全景200在病理性飞蚊症患者病因筛查中的应用

目的探讨全景200激光扫描眼底镜对病理性飞蚊症患者病因筛查的可行性及临床意义。方法对164例（187眼）病理性飞蚊症患者就诊前于自然瞳孔下进行全景200眼底激光扫描,然后散瞳进行间接检眼镜、三面镜、眼部B型超声或荧光素眼底血管造影（FFA）等检查,与间接检眼镜结果进行比较。结果病理性飞蚊症主要由单纯性玻璃体液化混浊、玻璃体后脱离引起,其次是高度近视眼、视网膜血管性及炎症性病变。全景200对单纯玻璃体液化混浊、玻璃体后脱离不能显示,而对视网膜分支静脉阻塞、糖尿病视网膜病变（DR）等导致的病理性飞蚊症的病因筛查特异性好,检出率为77.53%,而间接检眼镜为67.42%,两者比较差异有统计学意义（P〈0.05）。结论全景200对病理性飞蚊症患者眼底视网膜病变显示理想,具有免散瞳、广角、简便快捷、安全性好等优点,可作为临床病理性飞蚊症眼底疾病筛查的理想工具。     

玻璃体切割术治疗飞蚊症的疗效及安全性

飞蚊症是眼科的常见病,玻璃体液化和玻璃体后脱离(PVD)是飞蚊症的主要原因.临床上,飞蚊症一直被认为不属于严重的病理性改变而建议患者采取保守治疗方法,但部分患者因飞蚊症严重影响视力而迫切需要解除症状.国外已有利用玻璃体切割术治疗飞蚊症的报道,但手术治疗的利弊尚存在争议,近年来关于玻璃体切割术治疗飞蚊症的安全性也日益引起学者们的关注.目前飞蚊症尚不是玻璃体切割术的手术适应证,因此对玻璃体切割术治疗飞蚊症的病例选择、手术方式、手术并发症及安全性、患者满意度等方面的研究进展进行综述,对于临床工作有其重要意义.     

眼飞蚊症三面镜检查结果分析

眼飞蚊症三面镜检查结果分析李世洋张利光汪泽王殿义关键词眼疾病／诊断眼底飞蚊症即自觉眼前有点、线、蝇翅、蛛网等暗影飘动，是眼科门诊常见的主诉［１，２］，有生理性与病理性之分［３］。生理性者无需处理，而病理性者可能存在有威胁视力的疾病而应给予治疗。但临床...     

玻璃体视网膜手术后继发性青光眼的病因及治疗

玻璃体视网膜疾病的手术治疗主要包括巩膜扣带术、玻璃体切割术、玻璃体腔注气或注油术等,均可能导致术后眼压升高,如未及时处理,可发展为继发性青光眼,导致永久视力丧失。玻璃体视网膜手术后继发性青光眼的病因复杂多样,并且此类继发性青光眼通常常规治疗效果不佳,属于难治性青光眼。根据患者的不同病因可以采用不同的治疗方法,早期青光眼主要采用药物或激光治疗,晚期青光眼多行手术治疗,然而传统的青光眼小梁切除术失败率高,青光眼引流阀植入术能有效降低眼压。本文主要对常见的四种玻璃体视网膜术后继发性青光眼的发病机制及目前国内外治疗的研究进展进行综述。     

玻璃体视网膜界面细胞外基质蛋白的分子生物学

玻璃体视网膜界面包括玻璃体皮质部、内界膜以及Müller细胞的末端,为透明的细胞外基质结构.细胞外基质蛋白成份改变的异常,可以引发异常性玻璃体后脱离,造成玻璃体对视网膜的牵拉,是导致特发性黄斑裂孔、黄斑前膜、孔源性视网膜脱离和增生型糖尿病视网膜病变等多种视网膜疾病的病因.了解玻璃体视网膜界面的分子生物学结构成份,认识玻璃体视网膜黏附机制,是正确阐述玻璃体视网膜疾病病因学的基础和关键,是进一步针对病因机制研究针对性的预防和治疗手段的理论基础.近年来,随着实验及成像技术的进步,对细胞外基质成份分子水平结构及相互作用研究的深入,人们对胶原蛋白本身交联结构以及与大分子糖蛋白黏附机制的认识加深,对玻璃体视网膜疾病的病因学研究也进入更高的水平.多种针对玻璃体视网膜界面黏附的酶类开始作为手术辅助药物甚至首选治疗应用于由异常玻璃体视网膜黏附所引发的黄斑区疾病,显示了一定的疗效.随着对这些疾病的病因及病理过程的深入了解,明确掌握药物的作用机制,选择适当的病例和时机应用,非手术治疗黄斑裂孔、玻璃体黄斑牵拉综合征以及黄斑前膜等玻璃体视网膜界面疾病,将会彻底改变其临床治疗的概念以及适应证.     

高度近视黄斑劈裂的研究进展

视网膜劈裂是高度近视常见并发症之一。发生在中心凹处的劈裂称为黄斑劈裂。如在其病程中同时合并有视网膜脱离、黄斑裂孔、视网膜前膜、玻璃体视网膜牵拉等疾病可导致视力下降。临床上主要借助OCT来观察其形态特征。目前有许多治疗黄斑劈裂的方法,包括玻璃体手术、巩膜手术、激光治疗等,各有优缺点。本文主要对高度近视黄斑劈裂的病因、转归及治疗新进展作一综述。     

飞蚊症的研究进展及治疗现状

飞蚊症是眼科常见病,患者常因眼前出现点片状或条索状漂浮物而就诊。大多数学者认为飞蚊症并非严重的病理性改变而建议患者保守治疗,但部分患者因飞蚊症严重影响其视力及日常生活而强烈要求去除症状。因此各种治疗方法的有效性及安全性也日益引起学者们的注意。本文从飞蚊症的病因、治疗方法等方面的研究做一综述。（国际眼科纵览,2016,40：182-186）     

重视病理性近视眼牵拉性黄斑病变玻璃体手术时机及术式选择

黄斑病变是导致病理性近视眼患者不可逆视力损伤的主要原因, 其中牵拉性黄斑病变常需要玻璃体手术治疗。牵拉性黄斑病变包括黄斑前膜、黄斑劈裂、黄斑裂孔及黄斑裂孔性视网膜脱离等。建议对Ⅱ型黄斑前膜行玻璃体切除联合内界膜剥离术, 对黄斑劈裂行保留黄斑中心凹的内界膜剥离术, 对黄斑裂孔行内界膜瓣填充术, 对难治性黄斑裂孔性视网膜脱离行玻璃体切除联合黄斑兜带术治疗。病理性近视眼牵拉性黄斑病变是一种慢性发展性疾病, 术者要准确把握手术时机, 选择合适的术式使患者得到的收益最大化。     

眼科门诊飞蚊症200例检查诊断分析

目的探讨视力正常（矫正正常）主诉飞蚊症患者内眼的生理病理改变。方法对门诊眼科主诉飞蚊症患者进行视力、验光、裂隙灯、扩瞳眼底检查、眼B型超声、血液化验等项检查。结果200例有飞蚊症的患者中,122例查出各种病理体征,占总人数的61％。78例有飞蚊症患者视力无影响,未查出病理体征,占总人数的39％。结论对门诊眼科视力正常（矫正正常）飞蚊症患者应扩瞳查找病因,不应一概而论为生理性飞蚊症,以免误诊。     

2002年玻璃体视网膜国际研讨会暨玻璃体视网膜手术国家级继续医学教育学习班通知

复旦大学附属眼耳鼻喉科医院玻璃体视网膜疾病中心将于 2 0 0 2年 1 1月 3日～ 4日在上海举办 2 0 0 2玻璃体视网膜国际研讨会 ,届时将有 5位来自美国、日本的著名玻璃体视网膜专家 ,以及北京、广州、上海等地的多位著名教授 ,共聚一堂 ,研讨玻璃体视网膜的最新进展。研讨会的议题广泛 ,包括 :老年黄斑变性、病理性近视、眼外伤、糖尿病视网膜病变、视网膜感染性疾病、黄斑转位手术、内界膜剥除手术、光学相干断层扫描 (OCT)、光动力学疗法 (PDT)、经瞳孔温热疗法 (TTT)、高速玻璃体切割机、人工角膜 (TKP)、人工视网膜等近年关于玻璃…     

Symptomatic floaters as a clue to vitreoretinal disease.

One hundred consecutive patients with symptomatic floaters without previous ocular trauma or surgery are analyzed as to the underlying cause. The most common findings were posterior vitreous detachment with and without vitreous hemorrhage, vitreous syneresis with collagen fibril clumping, diabetic retinopathy with vitreous hemorrhage, retinal tears without retinal separation, and retinal separation. Significant vitreoretinal disease occurred in 36% of the patients.     

Vitreous floaters

Floaters are a common presenting ophthalmic symptom that may accompany sight-threatening disorders. In most cases, they are often secondary to benign, degenerative changes in the vitreous. In this review, we briefly examine the anatomy of the vitreous and describe how degenerative vitreous change contributes to the development of floaters. The causality of floaters in the presence and absence of a posterior vitreous detachment is reviewed, as is the clinical significance of these symptoms and signs in relation to their predictive value for determining the presence of sight-threatening retinal tears and/or detachment. Finally, a brief review of management options for debilitating floaters is presented.     

Vitreous floaters

The vitreous changes in 148 eyes with sudden onset of floaters were evaluated biomicroscopically and documented photographically using an El Bayadi-Kajiura aspherical preset lens mounted on a photo slit lamp. Posterior vitreous detachment (PVD) was found in 83% of the eyes. In those eyes, the primary causes of floaters were prepapillary glial tissue on the posterior hyaloid membrane and minimal vitreous hemorrhage. In eyes with no PVD, intravitreous fiber-like opacities corresponding to the patient's symptoms were present in the posterior vitreous cavity near the retina. These opacities were found on the plicated membranes of Cloquet's canal, or were associated with liquefaction of the gel. The symptoms of patients 50 years of age or older were related to the acute onset of PVD in 95% of the cases. The complaint of multiple small floaters was frequently associated with vitreous hemorrhage and retinal breaks.     

Eligibility criteria for Nd-YAG laser treatment of highly symptomatic vitreous floaters

Ten eyes of nine patients were treated for very disturbing vitreous floaters with the technique of Nd-YAG laser vitreolysis. The Scanning Laser Ophthalmoscope (SLO) was used to objectivate the position, the size and the motility of the vitreous floaters with respect to the patient's visual axis, which can be precisely located with the SLO. With this technique it was possible to define more precisely some eligibility criteria for Nd-YAG laser treatment of vitreous floaters and to classify the vitreous floaters in ill-suspended and well-suspended floaters in the vitreous body, the well-suspended floaters responding better to treatment compared to the ill-suspended vitreous floaters. The treatment was performed using the Q-Switched Nd-YAG Laser type Nanolas 15S of Alcon.     

急性玻璃体后脱离导致视网膜裂孔的临床分析

目的 探讨玻璃体后脱离所致视网膜裂孔的确诊时间及不同处理对其预后的影响。方法2001年10月～2002年8月对95例(95只眼)由急性玻璃体后脱离所致视网膜裂孔眼进行临床分析，裂孔已导致视网膜脱离的行视网膜复位手术，干性视网膜裂孔行532激光封闭裂孔术。结果 59例伴有视网膜脱离的患者明确诊断时间长，经手术治疗(部分为玻璃体手术)后视功能有一定的恢复。但有些病人需多次手术。35例视网膜干性裂孔患者诊断及时，经光凝治疗后视力无明显改变。结论 玻璃体后脱离导致视网膜裂孔早期诊断、及时光凝是为患眼争取良好预后的关键。     

生理性玻璃体混浊YAG激光消融术后视网膜结构变化

目的:观察生理性玻璃体混浊患者经过YAG激光消融术治疗后的玻璃体及视网膜结构变化.方法:筛选符合条件的40例生理性玻璃体混浊患者,术前检查最佳矫正视力、非接触眼压、眼前节彩照,OCT测量黄斑中心小凹厚度(foveola thickness,FT)和视神经纤维层厚度(retinal nerve fiber layer,RNFL),由同一位操作熟练的医师进行1~2次YAG激光消融术治疗,术后予以测量非接触眼压和普拉洛芬眼液点眼qid,3d,术后2d,1wk,1、3mo复查最佳矫正视力和非接触眼压,术后3mo进行眼前节彩照,术后1wk,1、3mo复查FT和RNFL.结果:术前与术后2d,1wk,1、3mo的最佳矫正视力、非接触眼压的差异无统计学意义(P>0.05);术前眼前节彩照能够发现明显的单个或片状玻璃体混浊物,术后3mo玻璃体混浊物明显变小或者消失,玻璃体腔内未见其他异常变化;术前黄斑和视盘OCT测量数据显示,术前FT为214.60±9.35μm,术后1wk,1、3mo的FT结果分别为213.75±9.07、213.40±8.83、213.85±9.22μm;术前RNFL上方为130.26±14.23μm,下方133.15±14.46μm,鼻侧82.48±13.50μm,颞侧75.40±11.89μm;术后1wk的RNFL分别为上方130.02±14.02μm,下方132.99±14.05μm,鼻侧82.35±13.07μm,颞侧75.42±11.66μm;术后1mo的RNFL分别为上方130.28±14.43μm,下方133.08±13.99μm,鼻侧82.31±13.72μm,颞侧75.45±12.03μm;术后3mo的RNFL分别为上方130.43±14.30μm,下方133.22±14.20μm,鼻侧82.27±13.11μm,颞侧75.46±11.91μm,术前与术后各时间点分别比较,FT和RNFL的差异均无统计学意义(P>0.05).结论:YAG激光消融术对生理性玻璃体混浊患者的玻璃体和视网膜结构未造成不良影响,疗效确切安全.     

原发性玻璃体后脱离致视网膜裂孔的治疗探讨

目的 分析玻璃体后脱离所致视网膜裂孔的确诊时间及不同处理对其预后的影响。方法 2000年10月至2002年8月对95例(95眼)由急性玻璃体后脱离所致视网膜裂孔眼进行临床分析。裂孔已导致视网膜脱离的行视网膜复位手术，干性视网膜裂孔行532激光封闭裂孔术。结果 59例伴有视网膜脱离的患者明确诊断时间长，经手术治疗(部分为玻璃体手术)后视功能有一定的恢复，但有些病人需多次手术。35例视网膜干性裂孔患者诊断及时，经光凝治疗后视力无明显改变。结论 玻璃体后脱离导致视网膜裂孔早期诊断，及时光凝是为患眼争取良好预后的关键。     

Slit-lamp perimetry: a new diagnostic technique

AIM OF THE STUDY: To test a novel diagnostic technique, slit-lamp perimetry. PATIENTS AND METHODS: Slit-lamp perimetry is performed during a normal slit-lamp examination by projecting a small, round light mark onto the fundus. The light mark is moved and consecutively the patient is asked, if the light moved towards or away from the scotoma. Using the patients feedback the light mark can be placed exactly onto the retinal region corresponding to the scotoma. This method was tested on a patient with a microinfarction of a small retinal arteriole and on two patients with small preretinal parapapillary vitreous floaters. RESULTS: Slit-lamp perimetry correctly localized preretinal vitreous floaters and a fresh cotton wool spot missed on an dilated fundus examination. CONCLUSION: Slit-lamp perimetry is a novel rapid diagnostic technique to localize retinal and preretinal pathologies reponsibles for scotomas.     

Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters

PURPOSE OF STUDY: To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters. METHODS: This is a single centre retrospective study of 31 patients (42 eyes) who underwent 54 procedures, Nd:YAG vitreolysis or pars plana vitrectomy, for the treatment of vitreous floaters between January 1992 and December 2000. Main outcome measures were percentage symptomatic improvement following treatment and incidence of post-operative complications. Statistical analysis was performed using the Fisher exact test. RESULTS: Posterior vitreous detachment was the primary cause of floaters in all 42 eyes with co-existing vitreous veils in three eyes and asteroid hyalosis in two eyes. Thirty-nine of 42 eyes received Nd:YAG vitreolysis. Thirty-eight percent found Nd:YAG vitreolysis moderately improved their symptoms while 61.5% found no improvement. After an average of 14.7 months follow-up no post-operative complications were recorded. Fifteen eyes underwent a pars plana vitrectomy, one with combined phacoemulsification and posterior chamber implantation and 11 following unsuccessful laser vitreolysis. Pars plana vitrectomy resulted in full resolution of symptoms in 93.3% of eyes. One patient developed a post-operative retinal detachment which was successfully treated leaving the patient with 6/5 VA. CONCLUSION: Patients' symptoms from vitreous floaters are often underestimated resulting in no intervention. This paper shows Nd:YAG vitreolysis to be a safe but only moderately effective primary treatment conferring clinical benefit in one third of patients. Pars plana vitrectomy, while offering superior results, should be reserved for patients who remain markedly symptomatic following vitreolysis, until future studies further clarify its role in the treatment of patients with floaters and posterior vitreous detachment.