眼球钝挫伤后眼底损伤的表现及分型探讨

目的:探讨眼球钝挫伤后眼底损害的表现以及分类。方法:185例(185眼)眼球钝挫伤完整资料,对直接检眼镜和眼底荧光血管造影检查结果,结合中心视力损害程度进行分析。结果:眼球钝挫伤后影响视功能的眼底常见损害有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、视网膜脱离和视神经损伤等。依据造影检查提供的视网膜组织损伤的形态学特点、部位,结合中心视力损害的程度,临床大体分为轻度、中度和重度三型。其中轻度31例,占16%;中度101例,占55%;重度53例,占29%。结论:眼球挫伤后眼底损害表现复杂多样,造影检查提供图像资料有利于对照观察和治疗。依据眼底造影图像、中心视力检查结合视网膜解剖学特点进行分型有利于判定病情,指导预后。     

中心性浆液性视网膜脉络膜病变概念质疑（附4例报告）

中心性浆液性视网膜脉络膜病变是一种病因尚不明确的以黄斑部水肿、脱离为主要体症的常见病,荧光造影表现为黄斑部动脉期或静脉早期的脉络膜,色素上皮病变引起的荧光渗漏。笔者发现除黄斑部外,周边成旁周边也可出现与中心性浆液性视网膜脉络膜病变体征相似的病变,特报告如下: 2例患者视力无异常,眼底检查发现黄斑以外有局限性视网膜水肿,荧光眼底造影见黄斑以外水肿区有与中心性浆液性视网膜脉络膜病变造影相似的荧光渗漏,并逐步扩大。(见图1、2) 2例患者有视物变形,视物不清,眼底检查有黄斑     

远达性外伤性视网膜病变

目的 探讨远达性外伤性视网膜病变的眼底、荧光素眼底血管造影(FFA)表现特点,发病机制、治疗及预后.方法 回顾分析8例(10眼)由外伤所引起的本病视网膜病变的临床资料,观察视力预后与眼底、FFA表现的关系.结果 治疗后7眼的视力有不同程度的提高.3眼永久性视力损伤,其原因是视网膜病变位于黄斑中心凹或视神经萎缩.结论 远达性外伤性视网膜病变的视力预后与视网膜脉络膜损伤的部位和程度相关,黄斑损害和视神经萎缩者预后不良.     

眼挫伤116例眼底荧光血管造影分析

目的分析眼挫伤眼底改变及眼底荧光血管造影的表现。方法对116例(145眼)眼挫伤经直接检眼镜和三面镜检查及眼底荧光血管造影检查。结果眼挫伤视功能严重受损的主要原因是视网膜、视神经受损，常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血，视网膜脱离和视神经损伤。其中以视网膜震荡多见。结论对于眼挫伤的，只要屈光间质清晰，都应检查眼底，行眼底荧光血管造影检查，以判断眼底病损伤部位及损害程度。     

眼挫伤脉络膜循环障碍

应用荧光血管造影方法确定眼挫伤病人的眼底改变。１１８例中３９例有脉络膜循环障碍。其中视网膜中央动脉较脉络膜先充盈（充盈倒置）１２例，充盈倒置并脉络膜局部缺血９例，脉络膜局部缺血１４例，脉络膜及中央血管充盈均延迟者４例。在具有脉络膜局部缺血的２３例中，２１例脉络膜有局部水肿、渗漏增强和强荧光；相应部位的ＲＰＥ亦损害显著，出现水肿染色或渗漏，加重了视网膜的病理过程。     

脉络膜新生血管性黄斑病变的临床分析

为系统观察脉络膜新生血管性黄斑病变的眼底表现和荧光血管造影的特征,进一步掌握各病变之间的内在联系及其共同特点。通过眼底检查、眼底彩色照像、眼底血管荧光造影确诊脉络膜新生血管性黄斑病变。结果：病变的发生与发展,是由于玻璃膜损伤破裂,形成新生血管膜,引发视网膜下渗漏、出血、机化以至瘢痕形成等一系列病理过程。结论：以老年性黄斑变性为主,包括中心性渗出或出血,最后形成瘢痕,使中心视力发生永久性损害。关键词：脉络膜新生血管性黄斑病变老年性黄斑变性中心性渗出性脉络膜炎眼底血管荧光造影     

眼挫伤荧光素眼底血管造影临床分析

目的 分析眼挫伤眼底改变及荧光素眼底血管造影(FFA)的表现.方法 对268例(339只眼)眼挫伤经直接检眼镜和三面镜检查及FFA检查.结果 眼挫伤视功能严重受损的主要原因是视网膜、视神经受损,常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血,视网膜脱离和视神经损伤.其中以视网膜震荡多见.结论 对于眼挫伤患者,只要屈光间质清晰,都应检查眼底,行FFA检查,以判断眼底病损伤部位及损害程度.     

视网膜脱离手术后黄斑部脉络膜新生血管形成

虽然视网膜脱离手术后的并发症多种多样,但尚无合并黄斑部脉络膜新生血管形成的报告。本文报告1例,男65岁,左眼因视网膜脱离先后2次手术治疗,最后视网膜脱离平复,矫正视力0.1,黄斑部无显著变化。8个月后视力降至0.05,眼底可见黄斑部水肿,并可见大小约2PD的新月形视网膜出血和中心凹颞下方有1PD大小的软性白斑。眼底荧光血管造影可见视网膜动脉期在软性白斑内出现淡薄的网状荧光,继而有荧光明显渗漏,软性自斑外黄斑部附近在视网膜动静脉期显示视网膜毛细血管轻度渗漏。诊断为黄斑部脉络膜新生血管形成。本例首次视网膜脱离术后第7天,眼底镜下曾见有黄斑部脉络膜出血。作者估计此种出血是由于视网膜色素上皮层下脉络膜新生血管引起的脉络膜出血或出血性视网膜色素上皮脱离,当时出     

正常人黄斑部吲哚菁绿眼底血管造影的形态特征

目的 研究正常人眼黄斑部脉络膜血循环特征。方法 对50例正常人眼行吲哚菁绿眼底血管造影（ICGA）。结果 （1）ICGA最早荧光出现时,脉络膜动脉在黄斑部最早荧光充盈,可在黄斑中心上下方或上下外侧方,也可与视盘周围脉络膜动脉同时充盈,血管呈树状外观。（2）ICGA强荧光时期黄斑部可表现黄斑中心非强荧光区或横贯黄斑的水平非强荧光带（32眼,占64％）;也可表现黄斑部与眼底后部融为一体的强荧光（18眼,占36％）。（3）ICGA荧光减弱期到荧光消退期,黄斑部渐呈现相对圆形低荧光暗区。结论 眼底黄斑部脉络膜动脉血流灌注最早;黄斑部脉络膜毛细血管最为丰富。     

眼底荧光血管造影对钝挫伤视神经病变预后判断的意义

报告１７例（１９眼）钝挫伤视神经病变的眼底荧光血管造影观察，伤后２０天内的患者，ＦＦＡ表现主要为视乳头弱荧光，视乳头周围脉络膜充盈缺损，视网膜中央动脉，静脉充盈延迟。所显示的组织受损害的层次，范围，程度与临床视力预后基本上呈直接性关系，初步认为ＦＦＡ能较准确揭示了早期视神经受损害的情况，为早期诊断及判断预后提供有用的客观依据。     

眼钝挫伤致眼底损伤的玻璃体手术治疗

目的评价玻璃体手术对眼钝挫伤引起的眼底损伤的疗效。方法对1992年10月～1998年3月连续收治的、经玻璃体手术治疗的眼球钝挫伤101例(105只眼)作回顾性研究。结果按伤情分为4组：玻璃体积血23只眼,玻璃体积血伴视网膜脉络膜破裂或视神经损伤25只眼,外伤性视网膜脱离46只眼以及视网膜巨大裂孔11只眼。手术后77只眼(73.3%)视力改善,其中0.02～0.6者占65.7%(38只眼在0.1～0.6,占55.0%),2只无光感眼恢复 了0.1以上视力,26只眼(24.8%)视力不变;2只眼(1.9%)视力下降。视网膜复位54只眼, 占视网膜脱离及视网膜巨大裂孔者的94.7%。结论严重眼球钝挫伤可造成多种眼底损害和视力丧失,适时的玻璃体手术可挽救大多数伤眼。(中华眼底病杂志,1999,15:100-102)     

眼挫伤后脉络膜病变FFA及ICGA的对比观察

目的 应用荧光素和吲哚青绿眼底血管造影，了解眼挫伤后脉络膜血管的病变。方法 应用德国Heidelberg共焦激光扫描眼底血管造影技术对眼挫伤患者16例（17眼）进行荧光素和吲哚青绿血管造影检查，观察脉络膜血管的异常变化。结果 17眼中，眼底荧光素血管造影显示视网膜血管充盈时间和血管形态大致正常，显示高网膜渗漏5眼。眼底吲哚青绿血管造影显示局限性脉络膜充盈延迟16眼、血管扩张5眼、荧光遮蔽2眼及吲哚青绿渗漏8眼。结论 由于脉络膜血管主要供应视膜外层，因此外伤性视网膜脉络膜病变对视功能影响很大，吲哚青绿血管造影提供了对各种程度脉络膜血管损害的分析依据。     

Pars plana vitrectomy with implantation of silicone oil in surgery forvery large retinal tears

The authors evaluate the results of pars plana vitrectomy (PPV) with intravitreal implantation of silicon oil (ISO) in 19 eyes of 17 patients with gigantic tears of the retina. During the mean observation period of 22 months the operation was successful in 15 of 19 eyes (78%). The retina adhered on the entire surface in 12 eyes (65%), in three eyes (15%) there remained a defined flat elevation of the retina in the periphery of the lower half of the fundus which did not go as far as the macula. In successfully operated eyes the visual acuity was 0.4 in two eyes, visual acuity of 0.3-0.1 in 7 eyes and visual acuity less than 0.1, making spatial orientation possible, in six eyes. The cause of reduced visual acuity of successfully operated eyes were macular abnormalities which were associated with the fundamental disease, degenerative myopia, injury, impaired nurture of the macula during prolonged detachment, a membrane-forming process. As to late complications of ISO, the most frequent were glaucoma in 42% and complicated cataract u 78% phakic eyes. Extraction of a cataract with iridectomy VI and supplementation of silicon oil into the intravitreal space did not cause in any of the patients a relapse of detachment of the retina. The final evaluation of PPV with ISO in the surgery of gigantic lesions of the retina will be possible only after the long-term follow up of larger groups of patients.     

Optical coherence tomographic features in a case of bilateral macular coloboma with strabismus

 Purpose:To report the optical coherence tomography (OCT) findings in a patient with bilateral macular coloboma with strabismus. Methods:A 21-year-old male presented with macular coloboma in both eyes.Fundus photography, fundus fluorescence angiography (FFA) and OCT were performed. Results:Color fundus photography showed a sharply-demarcated, round macular defect, approximately 4×4 disc diameters with bare sclera at the base and pigment clumping in both eyes. FFA showed hypofluorescence at the macula corresponding to the size of the lesion bilaterally. OCT revealed a crater-like depression at the macula, demonstrating atrophic neurosensory retina, and an absence of retinal pigment epithelium (RPE) and choroid in the lesion. Conclusion:OCT can be a beneficial tool to confirm the diagnosis of macular coloboma.     

The importance of fluorescence angiography in the examination of patients with suspected choroidal tumor

The paper describes results of examination of 31 patients aged from 19 to 63 years. Ophthalmoscopically, a grey focus with clear or vague limits, flat or prominent was seen on the eye fundus of all patients. The examination included determination of visual acuity, perimetry, ultrasound echography, fluorescence angiography of the eye fundus. By the character of changes of angiograms 5 groups were distinguished. In 20 eyes nevus of the choroid was diagnosed, in 8 eyes--melanoblastoma, in 3 eyes--central dystrophy of the retina. A conclusion is made that fluorescence angiography is of great importance in different diagnosis of choroidal new formations as well as in dispensary observation over patients with nevus of the choroid.     

A case of choroidal rupture due to blunt ocular trauma healed with proliferative tissue protruding into the vitreous cavity

BACKGROUND: Indirect choroidal rupture due to blunt ocular trauma involves rupture of the choriocapillaris or the full thickness of the choroid and Bruch's membrane. The overlying retinal pigment epithelium and the sensory retina are usually intact or atrophic, but rarely ruptured. We report a case of choroidal rupture healed with proliferative tissue protruding through the sensory retina into the vitreous cavity. CASE: A 22-year-old man was punched in the left eye. Hypotony maculopathy and choroidal rupture passing through the macula were noted. RESULTS: The intraocular pressure was normalized after suturing of the dialyzed ciliary body to the sclera and hypotony maculopathy was cured. Proliferative tissue formation protruding through the sensory retina into the vitreous cavity was observed 1 month after the injury. Corrected visual acuity was improved from 0.09 to 0.6. Optical coherence tomography showed that the site of the proliferative tissue was located immediately temporal to the fovea and that the fovea kept its normal form. CONCLUSION: Optical coherence tomography was useful in monitoring the morphological change in the macula and predicting visual acuity in a case of blunt ocular trauma involving the macular area.     

Focal retinal pigment epithelial dysplasia associated with fundus flavimaculatus.

BACKGROUND: One or more focal dysplastic lesions of the retinal pigment epithelium (RPE) occurred in 15 eyes of 10 patients with fundus flavimaculatus. METHODS: Review of patient records including an attempt to obtain follow-up information concerning a history of previous ocular trauma. RESULTS: Mild antecedent ocular trauma occurred to the eye with a dysplastic lesion in two patients. Dysplastic lesions were most frequently solitary and located temporal to the macula. Subretinal neovascularization accompanied two of the dysplastic lesions. The lesions were multifocal and present bilaterally in two patients. CONCLUSIONS: In fundus flavimaculatus, progressive lipofuscin storage is responsible for engorgement and hypertrophy of the RPE. Dysplastic lesions of the RPE probably result from reactive hyperplasia and fibrous metaplasia of RPE cells in response to acute disruption of fragile, hypertrophied RPE cells that may be enormously enlarged in the area of yellow flecks. This disruption may occur in response to trauma, focal inflammation, or other localized stimuli. Patients with fundus flavimaculatus should be cautioned concerning the possible role of trauma in causing dysplastic changes in the RPE and visual loss.     

Optical coherence tomography characteristics of a hemorrhagic detachment of the retinal pigment epithelium after blunt trauma

PURPOSE: To report traumatic, hemorrhagic detachment of the retinal pigment epithelium that was detected by optical coherence tomography. DESIGN: Observational case report. METHODS: A 17-year-old boy with hemorrhagic fundus lesions caused by blunt ocular trauma was examined by optical coherence tomography and angiography. RESULTS: Initially, two dark red, mounded lesions were seen, with one in the macula and the other adjacent to the optic disk. The lesions blocked the fluorescence on fluorescein and indocyanine green angiography. Optical coherence tomography demonstrated dome-shaped elevations of the retinal pigment epithelium at each lesion. Four months later, the retinal pigment epithelium detachments disappeared in the tomography images, and no scarring was evident ophthalmoscopically. Small choroidal ruptures were detected in each lesion by angiography. CONCLUSIONS: Optical coherence tomography was useful in evaluating the site of the hemorrhage in the chorioretinal layers caused by blunt ocular trauma.     

息肉状脉络膜血管病变的随访观察

目的 观察息肉状脉络膜血管病变(PCV)患者的临床特征及其视力预后情况.方法 回顾性病例系列研究.对经眼底彩色照相、荧光素眼底血管造影及吲哚氰绿血管造影等确诊的45例(51只眼)PCV患者的临床资料进行回顾性分析,包括患者年龄、随访前视力、有无脉络膜视网膜病变、病灶面积、病灶是否累及黄斑中心凹、随访期间病灶消退且无新病灶出现等6项因素.对患者随访期间视力变化情况进行多因素相关回归分析.结果 45例(51只眼)PCV患者随访时间6～18个月,平均随访(11.1±2.0)个月.随访期间病变区出血、渗出增多者15只眼(29.4%),出血、渗出减少者25只眼(49.0%),盘状瘢痕与萎缩改变者分别为5只眼(9.8%)和6只眼(11.8%).视力增加、稳定及下降者分别为11(21.6%)、21(41.2%)及19(37.2%)只眼.息肉状病灶累及黄斑中心凹者25只眼(49.0%),未累及者26只眼(51.0%).在病程进展过程中,息肉状病灶部分消退18只眼(35.3%),稳定不变13只眼(25.5%),扩大和新生13只眼(25.5%),消退和新生并存7只眼(13.7%).患者视力变化与年龄、随访前视力、息肉状病灶累及黄斑中心凹诸因素相关(b=-0.005,0.382,-0.430;P=0.034,0.000,0.000),视力提高与息肉状病灶累及黄斑中心凹(b=-2.957,P=0.013,OR=0.052)、息肉状病灶消退且无新病灶出现相关(b=2.259,P=0.019,OR=9.578).结论 PCV患者视力预后情况不同,年龄小者随访前视力较好;息肉状病灶未累及黄斑中心凹者随访视力相对较好,其中无新病灶出现者,随访期间视力提高的可能性较大.脉络膜视网膜病变情况和病灶面积不能作为判断预后的敏感指标.

Abstract：

Objective To observe the natural course and evaluate the prognostic factors influencing the follow-up visual acuity of polypoidal choroidal vasculopathy (PCV). Methods It was a retrospective case series. Forty-five consecutive patients (51 eyes) who were diagnosed with PCV by fundus photography,fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were followed up with (11.1 ± 2. 0 )months (mean ± SD ). Age, baseline visual acuity, the presence of pigment epithelium detachment (PED), lesion size, the polypoidal lesions involving the fovea and the regression of polypoidal lesions were recorded. Multi-factor regression analysis of visual acuity at follow up was applied with SPSS 16. 0 statistics software. Results Among the 45 patients (51 eyes), the hemorrhage or exudation were increased in 15 eyes (29. 4% ), decreased in 25 eyes (49. 0% ), 5 eyes (9. 8% ) developed macula scar and 6 eyes (11.8%) macula atrophy . During the follow-up period, the visual acuity was improved in 11 eyes (21.6%), stable in 21 (41.2%) and regressed in 19 (37. 2% ). Twenty-five eyes (49.0%)demonstrated polypoidal lesions involving the fovea and 26 eyes (51.0%) did not. ICGA revealed that the polypoidal lesions were unchanged in 18 eyes ( 35. 3% ), regressed in 13 ( 25.5% ), grew in 13 (25.5%), and mixed in 7 eyes ( 13.7% ). The changes of visual acuity at follow up were related to the age, baseline visual acuity, and polypoidal lesions involving in the fovea ( b = - 0. 005, 0. 382 and - 0. 430 ;P = 0. 034, 0. 000 and 0. 000). Improvement of visual acuity at follow up was related to the regression of polypoidal lesions ( b = 2. 259, P = 0. 019, OR = 9. 578). Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The presence of PED and the lesion size had no effect on the visual prognosis of PCV. Better visual acuity during follow-up period is correlated with younger age, better baseline visual acuity, polypoidal lesions not involving the fovea and a regression of polypoidal lesions.     

Pars plana vitrectomy for severe penetrating injury with posterior segment involvement

We studied 50 consecutive cases of severe penetrating ocular trauma with posterior segment involvement for which vitreous surgery and scleral buckling were performed as secondary reparative procedures. Eyes with a better prognosis, such as those with anterior segment injuries alone and intraocular foreign bodies, were excluded. Of 50 eyes, 31 (62%) had a successful outcome. There was a significant difference in visual outcome between those eyes that had received blunt and sharp penetrating trauma. Visual acuity of 20/50 or better was more frequently attained in eyes with sharp penetrating trauma (P = .002). Thirty-three eyes had initial retinal detachment; 17 (52%) were successfully repaired. Blunt penetrating trauma produced retinal detachment more frequently than sharp penetrating trauma (22 of 29 vs 11 of 21). Retinal detachment was more often successfully repaired after sharp penetrating trauma (8 of 11 vs 9 of 22). Contusive damage to the choroid and retina limited final visual and anatomic results after blunt rupture of the globe.