Retinal Injury Due to Industrial Laser Burns

Ocular industrial laser burns in seven patients were analyzed as to cause, severity, and type of injury. Ocular damage ranged from minimal retinal burns to extensive areas of damage with commotio retinae and vitreous hemorrhage. Visual loss ranged from complete recovery without residual defect to a profound decrease in central acuity. The kinds of lasers causing these injuries were neodymium YAG, argon, krypton, and rhodamine dye. Severity of injury was related to several factors. Some degree of carelessness was involved in all injuries.     

大泡状视网膜脱离误诊及分析

探讨减少大泡状视网膜脱离误诊的方法。方法通过对６６例１０眼误诊病例,从误诊原因,病因,疾病特点,特别是眼底荧光血管造影表现等方面进行讨论,并与类似疾病比较。结果大泡状视网膜脱离有其特殊的临床表现和ＦＦＡ表现。结论ＦＦＡ是诊断大泡状视网膜脱离及鉴别其它眼病的必要手段。     

Unilateral Acute Idiopathic Maculopathy

Purpose: To discuss the fluorescein angiographic features and diagnosis as well as differential diagnosis.Methods : In our hospital, we have found three cases of UAIM, one of them has eccentric maculopathy, another has papillitis, and the third associates with pregnancy. Each has characteristic clinical findings. We have made the diagnosis base on ophthalmoscopy and fluorescein angiography (FA).Results: Three patients with UAIM have been experienced sudden unilateral decreased visual acuity. The significant changes on fundus are retinal pigment epithelium (RPE) thickening with neurosensory retinal detachment with in the macular area. FA showed early patchy hypofluorescence and hyperfluorescence at the level of the RPE.' Bull' s eye appearance may occur in the macular area after the acute stage of the disease. The clinical findings are similar to what the foreign report described. But there were no previous reports in China. Conclusion : We can establish the diagnosis on the base of clinical and fundus f     

Indocyanine green angiography pattern of congenital grouped albinotic retinal pigment epithelial spots

Congenital grouped albinotic retinal pigment epithelial spots (CGARPES) is a rare retinal pigment epithelium disease with multiple, white spots, generally involving the peripheral retina, with variable angiographic pattern. A 46-year-old male affected by CGARPES underwent fluorescein angiography and indocyanine green videoangiography. Fluorescein angiography demonstrated an early hyperfluorescence of the spots. A peculiar pattern was revealed by indocyanine green videoangiography. Indeed, during the early phases the spots were either not detectable on the choroidal background, or presented slightly hypofluorescent, whereas during the intermediate and the late phases some spots became progressively hyperfluorecent. The angiographic behavior on indocyanine green may be explained considering a gradual staining of the lesions, with a progressive binding between the indocyanine green molecule and the abnormal retinal pigment epithelium material.     

Ring-Shaped Subretinal Fibrinous Exudate in Central Serous Chorioretinopathy

Purpose

To clarify the pathologic changes of the ring-shaped, grayish white subretinal fibrinous exudate in central serous chorioretinopathy (CSC), we examined patients with fluorescein angiography (FA) and optical coherence tomography (OCT).

Methods

Using OCT, we prospectively examined 13 consecutive patients (12 men, one woman) (13 eyes) with acute CSC. The fundi were scanned by OCT through the ring-shaped, grayish white lesion.

Results

FA showed focal dye leakage at the center of the ring-shaped, grayish white subretinal exudates. In the area of the exudates, OCT showed moderately or highly reflective masses bridging the neurosensory retina and the retinal pigment epithelium in all eyes. Because the area of the pellucid core of the ring-shaped exudate showed an optically clear space beneath the neurosensory retina, the subretinal reflective masses were separated on cross-sectional images in all 13 eyes. Pigment epithelium detachment was observed in the area of the grayish white lesion by OCT and FA in 7 of the 13 eyes.

Conclusions

In eyes with a ring-shaped, grayish white exudate in CSC, OCT and FA findings indicate that the pellucid core of the exudate is the route of the exudative fluid from the choroid into the subretinal space. A surrounding grayish white lesion seems to be fibrinous exudate that has accumulated in the subretinal space. Jpn J Ophthalmol 2005;49:516–519 © Japanese Ophthalmological Society 2005     

角膜上皮移植术联合干燥板层角膜移植术治疗陈旧性眼部烧伤

目的探讨角膜上皮移植术的应用价值。方法应用角膜上皮移植术联合干燥全板层角膜移植术（keratoepithelioplasty－lamellarkeratoplastywithdry—preservedcornea，KEP－DLKP）治疗陈旧性眼部烧伤22例，同时与新鲜供眼材料全权层角膜移植术（lamellarkeratoplastywiththematerialswerefromfreshdonor,LKP-F）18例对比研究。随访3～5（平均6．6）个月。结果KEP联合DLKP术后可促使角膜上皮的早期快速愈合，显著降低角膜新生血管的复发率和持续性角膜上皮缺损的发生率（thepersistentcornealepitheialdefect,PCED），术后角膜植片透明率达72．7％。结论角膜上皮移植术联合干燥板层角膜移植术治疗陈旧性眼部烧伤具有较好的应用价值。     

Ocular Complications in Influenza Virus Infection

Purpose: To describe a case series of ocular complications associated with upper respiratory tract infections.

Methods: Four patients aged 21–61 years (three females, one male) had confirmed ocular complications connected with a general upper respiratory tract infection with myalgia and fever. Ophthalmological examination, including a visual acuity test, a slit-lamp exam, intraocular pressure measurements, fluorescein and indocyanine green angiography, optical coherence tomography (OCT), and diagnostic tests for influenza were performed in the patients (RT-PCR, HAI).

Results: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was diagnosed in three patients and serous macular detachment (SME) in one. Influenza virus infection was confirmed by molecular biological methods (RT-PCR) or the hemagglutination inhibition test (HAI) in two patients. All patients were treated with systemic prednisone.

Conclusion: A coincidence between APMPPE and SME epitheliopathy and influenza virus infection was observed in different months of a given epidemic season.     

Central serous chorioretinopathy and bullous retinal detachment: a rare association

While idiopathic central serous retinopathy (ICSC) is a common ocular condition, bullous exudative retinal detachment associated with ICSC is a relatively rare finding. Bullous retinal detachment has been described as a severe variant of ICSC, characterised by multiple leaking pigment epithelial detachments and the presence of shifting neuro‐sensory sub‐retinal fluid. The peculiar clinical findings may present a diagnostic dilemma and lead to inappropriate treatment. Here, we describe the atypical presentation of ICSC with bullous retinal detachment and the effect of focal laser treatment on resolution of the retinal detachment. Despite ICSC being a self‐limiting condition in the majority of cases, recognition of this atypical form of ICSC is important. Failure to differentiate this condition from inflammatory disease of the retina and choroid may result in inappropriate use of corticosteroids, leading to exacerbation of the condition and permanent visual loss.     

Indocyanine green angiographic interpretation of reticular dystrophy of the retinal pigment epithelium complicated by choroidal neovascularization

A 37-year-old woman presented with flashes in her left eye and bilateral visual distortion. Fundal examination revealed a reticular 'fishnet' pattern of retinal pigmentation in both eyes consistent with reticular dystrophy of the retinal pigment epithelium. In the left eye there was a small haemorrhage and a shallow serous macular detachment. Fluorescein angiography demonstrated subfoveal choroidal neovascularization. Indocyanine green angiography (ICG) revealed more extensive involvement than fluorescein angiography, with small areas of intense hyperfluorescence amongst reticular areas of hypofluorescence. These changes, as interpreted in light of the known histopathological localization of ICG, are consistent with varying stages of dysfunction of the retinal pigment epithelium in this disease.     

建立激光诱导络网膜静脉吻合的视网膜静脉阻塞眼及其眼底血管荧光造影表现

描述成功建立脉络膜视网膜静脉吻合的视网膜静脉阻塞 (retinalveinocclusion ,RVO)眼的眼底改变和眼底血管荧光造影特征。方法 :氪红激光诱导脉络膜视网膜静脉吻合术后 ,患者每 1～ 2周复查一次 ,每次随诊均拍摄彩色眼底照片 ,并做荧光素眼底血管造影 (fundusfluoresceinangiography ,FFA)检查 ,选取成功形成脉络膜视网膜静脉吻合的 2 5例RVO 2 5眼 ,分析成功形成吻合的RVO眼的眼底及FFA特征。结果 :1吻合成功的眼底征象 :治疗部位的视网膜静脉下沉入脉络膜 ,吻合近端静脉段变细 ,主干静脉变狭窄 ,静脉逆向变粗 ,吻合近端静脉段变粗 ,吻合部位形成静脉袢。 2吻合成功的FFA征象 :①吻合局部团状高荧光 ;②视盘和吻合之间出现的逆向静脉血流 ;③静脉层流缺损。结论 :激光诱导脉络膜视网膜静脉吻合可回流部分静脉血液 ,缓解阻塞静脉的压力。     

慢性中心性浆液性脉络膜视网膜病变视网膜色素上皮细胞萎缩轨迹的临床观察

目的 探讨慢性中心性浆液性脉络膜视网膜病变(简称“中浆”)患者视网膜色素上皮(retinal pigment epithelium,RPE)细胞萎缩轨迹的临床特征及发生原因.方法 回顾分析我院36例(51眼)慢性中浆患者的视力、眼底表现、眼底荧光血管造影特征,观察RPE细胞萎缩轨迹的特点及其与视力的关系.结果 慢性中浆患者的眼底主要表现为视盘颞侧黄斑区附近不同程度的RPE色素紊乱、RPE萎缩区域大小及形态不一,可见明显的朝向下方的RPE萎缩带.眼底荧光血管造影显示,RPE细胞萎缩表现为视网膜下不同形态的强荧光区域,为RPE细胞萎缩所致的透见荧光.RPE细胞的萎缩轨迹外观呈不同形态并呈重力依赖性.视力较差的患者黄斑中心凹均位于RPE萎缩区内,反之,视力较好的患者黄斑中心凹均未累及.结论 对于渗出较多、黄斑区长期处于视网膜神经上皮脱离状态、渗出病变吸收缓慢甚至吸收不明显的患者,应该采取积极的治疗措施,防止病变进展过程中因渗出的浆液导致黄斑区RPE细胞不可逆性萎缩.     

Retinal Pigment Epithelial Tears

Retinal pigment epithelial tears have been recognized recently as a complication of retinal pigment epithelial detachments. They are characterized by sudden separation of detached from attached pigment epithelium at the margin of the detachment. Retraction of the overlying pigment epithelium occurs and exposes Bruch's membrane and choroid. Most pigment epithelial tears appear to arise spontaneously, but they also may occur following krypton red laser photocoagulation. The visual prognosis is poor in eyes in which the tear involves the subfoveolar pigment epithelium.     

Ocular toxocariasis: A presumed case of peripheral granuloma

We report a case of peripheral Toxocara granuloma in a young boy of 17. Of the 3 forms of ocular toxocariasis, macular granuloma, endophthalmitis and peripheral granuloma, the latter is the least common and is characterized by the retention of relatively good vision.A differential diagnosis was performed between an intraocular foreign body encapsulated in fibroglial tissue, toxoplasmic retinochoroiditis, retinoblastoma, intermediate uveitis and toxocariasis.Fluorescein angiography showed not only some neovascularizations at the level of the peripheral granuloma but also manifestations of inflammatory reactions at the level of the posterior pole, i.e. diffuse leakages from retinal capillaries and parietal staining of some venous segments.Among the various laboratory tests, the most significant are eosinophilia, IgE concentration and detection of specific antibodies in serum as well as in aqueous humour.     

Diagnosis of Ocular Sarcoidosis

Introduction: Sarcoidosis is a chronic inflammatory disorder with an unknown etiology characterized by noncaseating granulomas. The disorder is a multisystemic disease and affects many organs, including most often the lung, lymph nodes, skin, heart, liver, muscles, and the eye.

Matherial and Methods: Based on a review of the literature and on an algorithm generated in an international workshop on sarcoidosis, this article provides the reader with a schematic and simple approach to the diagnosis of ocular sarcoidosis.

Conclusions: In a considerable proportion of cases it is the ophthalmologist who first sees patients presenting with the ocular expression of sarcoidosis. In countries where the incidence of sarcoidosis is common, like Japan, a complete workup should be performed, whereas in countries where the incidence of the disease is less high, a noninvasive approach may be warranted at first.     

酒精中毒致视网膜色素上皮损伤观察

目的 观察急慢笥酒精中毒后视网膜色素上皮损伤情况。方法 对９例（１８眼）急慢性酒精中毒患者进行了眼底荧光血管造影（ＦＦＡ）及视觉电生理（ＥＲＧ,ＶＥＰ）检查。结果 ２例（４眼）急性酒精中毒者经药物治疗后视力完全恢复,１例（２眼０ＦＦＡ见双眼底视网膜色素上皮弥漫性损伤。慢性酒精中毒６例１２眼经药物后ＦＦＡ为双眼底视风纱上皮炎改变,ＥＲＧ,ＶＥＰ无好转。结论 急性酒精中毒引起的眼部改变大多时恢复,慢性     

一例脉络膜黑色素瘤的眼科影像学改变

目的:报道1例脉络膜黑色素瘤的眼科影像学改变。方法:回顾性分析1例经病理确诊脉络膜黑色素瘤患者的荧光素眼底血管造影(fundus fluorescein angiography,FA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)、B超、光相干断层扫描(optical coherence tomography,OCT)等特征。结果:FA检查显示造影早期左眼后极大片遮蔽荧光和散在点状高荧光,造影晚期可见病灶处呈融合加强的点片状高荧光,没有发现明显的异常粗大血管和典型的“双循环征”。ICGA 检查显示早期病灶区呈弱荧光和脉络膜毛细血管点状高荧光,晚期病灶区呈点片状强荧光, 没有发现明显的“发夹样”或“鸡冠样”等异常血管荧光征象。光相干断层扫描(OCT)检查见视网膜全层及脉络膜毛细血管层向玻璃体腔内隆起,B超检查显示左眼玻璃体后段见起自眼球后极部中强回声光团。结论:脉络膜黑色素瘤FA和ICGA可出现不同的表现形式,因此对于眼底造影特征不典型的患者,要结合其他检查共同分析,并密切随诊。     

Multifocal and recurrent (serous) choroidopathy (MARC) syndrome: A new variety of idiopathic central serous choroidopathy

Presented is a group of 110 patients with patches of granular atrophy of the retinal pigment epithelium which I believe represents a new subtype of idiopathic central serous choroidopathy (ICSC). It is designated as multifocal and recurrent (serous) choroidopathy (MARC) syndrome. Such patients are the older ICSC patients and they usually have bilateral involvement which may show marked asymmetry. The history is seldom helpful in defining previous episodes of leaking. The fundus changes are thought to represent the sequelae of multiple, recurrent, or chronic choroidopathy in the form of serous detachments of the retinal pigment epithelium and/or neurosensory retina. Such detachments may not be present at the time of a single examination, and thus the fundus picture may be puzzling without an awareness of this syndrome which exhibits a wide spectrum of severity. Difficulties in detecting the low detachments and fluorescein leaking are emphasized. There is often a marked disparity between the ophthalmoscopic and the fluorescein angiographic pictures, and examination by the latter technique is urged. I do not believe this entity progresses to senile disciform disease, but can result in marked visual loss. If extrafoveal leaking is found in the presence of decreased acuity and a macular detachment, and if there is evidence of previous attacks, photocoagulation can effectively flatten the retina. I believe photocoagulation therapy under these conditions is justifiable.     

Retinal Pigment Epithelium Detachment in Acute Vogt–Koyanagi–Harada Disease: An Unusual Finding at Presentation

Purpose: To report the cases of two patients who presented with acute Vogt–Koyanagi–Harada (VKH) disease and associated retinal pigment epithelium detachment (PED).

Methods: 2 case reports. Case 1: A 22-year-old male patient complained of acute bilateral decrease in vision. Initial best corrected visual acuity (BCVA) was 20/63, OU. There was 1+ vitreous cells, OU, exudative retinal detachment (ERD) in the right eye (RE), and a macular deep yellow lesion suggestive of PED in the left eye (LE). Case 2: A 40-year-old female patient presented with bilateral vision blurring. BCVA was 20/40 in the RE and 20/32 in the LE. There was 1+ vitreous cells OU, bilateral optic disc swelling and retinal striae.

Results: Multimodal imaging showed features of acute VKH disease with associated PED in the two patients. ERD and PED resolved under oral prednisone and cyclosporine in both cases.

Conclusion: PED may rarely occur in acute VKH disease at presentation.     

组织粘合剂粘合羊膜手术在眼烧伤中的应用

目的:评价组织粘合剂粘合羊膜手术在眼烧伤治疗中的疗效。方法:选择2002年9月～2004年6月在中山眼科中心外伤病区住院的眼烧伤患者29例34只眼。其中Ⅱ度烧伤4只眼,Ⅲ度5只眼,Ⅳ度25只眼。Ⅳ度烧伤中角膜缘100%缺血者7只眼,角膜缘缺血小于100%者18只眼;结膜严重坏死累及巩膜者12只眼。全部患者行组织粘合剂粘合羊膜手术前均予常规的药物治疗。术后随访2～6个月,观察角结膜上皮生长情况,羊膜、组织粘合剂贴附情况,炎症及视力等。结果:Ⅱ、Ⅲ度烧伤及部分Ⅳ度烧伤[角膜缘缺血小于100%有27只眼,手术后全部上皮缺损愈合,缺损愈合时间为术后8～42d,(23.9±8.0)d;Ⅳ度烧伤角膜缘100%缺血角膜溃疡溶解的7只眼,除1只眼失访外,6只眼局部溃疡静止。4只眼视力无变化,29只眼视力均有不同程度的提高。结论:组织粘合剂粘合羊膜手术可以迅速恢复烧伤眼表的完整性,有效地防止持续性角膜上皮缺损,角巩膜溃疡穿孔,睑球结膜粘连等并发症的发生;对于严重的Ⅳ度烧伤(角膜缘100%缺血),组织粘合剂粘合羊膜手术有助于阻止角巩膜溃疡穿孔,重建结膜表面,恢复眼前段血供,防止睑球粘连,但由于角膜缘干细胞完全缺陷,恢复角膜表面的完整性,尚需行角膜缘干细胞移植术。