内眼手术患者血液和房水梅毒抗体检测的对比研究

目的 探讨内眼手术患者中发生梅毒的阳性率,并通过梅毒患者房水中特异性和非特异性抗体的检测,寻找梅毒是否通过房水传播的理论依据.方法 对2004年以来准备接受内眼手术的4075例患者进行常规的传染四项检查,包括乙肝表面抗原(HBsAg),丙型肝炎抗体(HCV抗体),梅毒抗体(TP抗体),艾滋病抗体(HIV抗体)四项指标,并统计梅毒发生的阳性率;应用特异性抗体试验-梅毒螺旋体血球凝结试验(TPHA)和非特异性抗体试验-快速血浆反应素环状卡片试验(RPR)检测梅毒患者血清及房水中的抗体.结果 4075例内眼手术患者有58例患者血液中存在梅毒抗体,阳性率1.42%.58例梅毒患者血液中TPHA阳性检出率为100%(58例),房水中为32.76%(19例)两者比较差异有统计学意义(P＜0.05);而同组患者血液中RPR阳性检出率为51.72%(30例).房水中为8.62%(5例)两者比较差异有统计学意义(P＜0.05).结论 近年来梅毒感染阳性率相对稳定并且梅毒可能不通过房水传播.     

葡萄膜炎患者血清淀粉样蛋白A的测定及临床意义

目的 探讨血清淀粉样蛋白A(Serum amyloid protein A,SAA)与葡萄膜炎的关系及临床意义.方法 对38例葡萄膜炎患者(葡萄膜炎组)和31名健康体检者(对照组),采用乳胶增强速率散射比浊法检测血清中SAA和C反应蛋白(C-reactive pro-tein,CRP),并用魏氏法检测血沉(erythrocyte sedimentation rate,ESR).结果 葡萄膜炎患者SAA、CRP和ESR水平[分别为(20.59±22.85)mg·L-1、(4.77±4.50)mg·L-1、(20.97±27.80)mm·h-1]均显著高于对照组[(2.33±0.94)mg·L-1、(1.63±0.75)mg·L-1、(10.14±8.24)mm·h-1;均为P<0.05],葡萄膜炎患者SAA阳性率较CRP、ESR阳性率显著增高(均为P<0.05).SAA与CRP水平呈明显正相关.将葡萄膜炎患者按是否患自身免疫病分为2组后得出,2组SAA、CRP和ESR水平均显著高于对照组(均为P<0.05),2组间各指标比较差异均无统计学意义(均为P>0.05),但各组内SAA阳性率均显著高于本组CRP、ESR阳性率(均为P<0.05).将葡萄膜炎患者按是否首次患病分为2组后得出,2组SAA、CRP和ESR水平均显著高于对照组(均为P<0.05),2组间相比差异均无统计学意义(均为P>0.05),但各组SAA阳性率均显著高于本组CRP、ESR阳性率(均为P<0.05).结论 SAA与葡萄膜炎密切相关,且较CRP、ESR更灵敏,可做为葡萄膜炎的一项客观且敏感的观察指标.     

以眼后段为主要表现的眼部梅毒临床分析

目的观察首诊于眼科以后葡萄膜炎表现为主的眼部梅毒的临床表现和治疗。方法对我院2007年1月至2011年4月期间以眼部表现为首发症状就诊于我院眼科,经临床及血清学检查确诊的梅毒性眼病28例(37只眼)患者的临床资料进行回顾性分析,总结其临床特征及治疗预后。结果所有28例(37只眼)患者均以视力下降、眼前黑影飘动或视野遮挡感等为起病症状或主要症状首诊于眼科而被确诊为梅毒。其中男21例,女7例,年龄30～74岁,平均51岁。双眼发病9例,单眼发病19例。梅毒血清学检查梅毒螺旋体颗粒凝集试验(TP-PA)和梅毒快速血浆反应素试验(RPR)均为阳性,RPR的滴度由1:8至1:256。所有患者HIV检测均为阴性。结合眼部表现、眼底检查和荧光素眼底血管造影(FFA)检查诊断为视神经炎5只眼,视网膜血管炎7只眼,视神经视网膜炎8只眼,脉络膜视网膜炎17只眼。诊断明确后行正规驱梅治疗,患者眼部炎症均控制,视力提高,眼底病变消退,RPR转阴或滴度降低。结论梅毒性眼病临床表现形式多样,缺乏特异性表现,诊断存在一定困难。因此,对于病因不明的葡萄膜炎患者,应及时进行相关的血清学检查。一经确诊梅毒,给予及时对症、对因的治疗。     

激素冲击联合奥曲肽球后注射治疗甲状腺相关眼病

目的：探讨甲基强的松龙冲击联合奥曲肽球后注射治疗甲状腺相关眼病的临床效果。
　　方法：对51例96眼甲状腺相关眼病患者以甲基强的松龙500 mg静滴,连用3 d;后改用奥曲肽0.1 mg球后注射1次,连续注射3次。疗程结束后1,3 mo随访观察记录患者自觉症状及眼部体征。
　　结果：患者49例症状均有明显改善或消失。治疗后患眼平均眼球突出度下降3.1±1.4mm,睑裂高度下降2.4±0.9mm ,治疗前后差异均有统计学意义(P<0.05)。
　　结论：激素冲击联合奥曲肽球后注射治疗甲状腺相关眼病效果明显,不良反应小,安全可靠。     

梅毒性眼病的临床分析

目的：探讨以眼后节表现为主的梅毒性眼病的临床特点。

方法：回顾性病例研究。回顾性分析2007-01/2012-01本院收治的首诊于眼科的梅毒性眼病13例23眼,分析其临床表现、治疗方法、预后等。13例患者按神经梅毒除1例因青霉素过敏予静滴头孢曲松治疗,其余全部予静滴青霉素治疗。

结果：患者13例中,9例17眼患者表现为脉络膜视网膜炎,2例3眼患者表现为视神经视网膜炎,1例1眼患者表现为视神经炎,1例2眼患者表现为渗出性视网膜脱离。抗梅毒治疗后,所有炎症消退,12例22眼患者视力提高,平均视力0.56±0.23。患者RPR滴度下降4倍,平均1：16.6。

结论：梅毒性眼病表现多样,容易漏诊、误诊,临床上应提高警惕,及早发现,及早治疗。     

术前PVEP联合PERG检查对评价老年性白内障患者术后视功能的意义

目的：探讨术前综合视觉电生理检测在评估老年性白内障患者术后视觉功能中的临床意义。
　　方法：选取2013-01/2014-01期间在我院治疗的老年性白内障患者102例126眼,对术前图形视觉诱发电位( PVEP)、图形视网膜电流图( PERG)和PVEP联合PERG的检测结果与术后最佳矫正视力( BCVA)进行比较。
　　结果：PVEP联合PERG检测一致率达到91.3%,PVEP检测为63.5%,差异有统计学意义(χ2=27.773,P=0.000);Spearman秩相关分析发现, PVEP检查结果与术后BCVA无显著相关性( r=0.241, P>0.05),而PERG联合 PVEP的检测结果与术后BCVA呈正相关(r=0.773,P<0.05)。术前PVEP检测正常者占51.6%,而术后占65.1%,差异有统计学意义( P<0.05),而术前PVEP和PERG联合检测正常者占80.9%,术后占84.1%,差异无统计学意义( P>0.05),说明PVEP和PERG联合检测评估术后视功能的稳定性好。
　　结论：老年性白内障患者术前PVEP联合PERG检查能有效、客观的评估患者术后患眼视功能恢复情况。     

血清淀粉样蛋白A检测对感染性眼内炎诊断的临床价值

目的：探讨血清淀粉样蛋白A(SAA)在感染性眼内炎诊断中的临床应用价值。

方法：收集2016-06/2019-03我院就诊的270例患者,其中116例感染性眼内炎患者作为研究组,154例非感染性患者作为对照组。采用胶体金免疫层析法检测SAA水平,用受试者工作特征(ROC)曲线分析诊断效能。

结果：感染性眼内炎患者和对照组SAA值中位数分别为14.98、2.56mg/L,两组比较有差异(P<0.001); CRP值和WBC值中位数两组比较均有差异(P<0.001)。SAA、CRP和WBC计数诊断感染性眼内炎的ROC曲线下面积分别为0.772、0.638、0.618,SAA检测取Youden指数最大值所对应的最佳临界值为6.975mg/L,其灵敏度为63.79%,特异度为84.42%。

结论：SAA联合CRP和WBC计数有助于提高感染性眼内炎的诊断效能。SAA可为感染性眼内炎的辅助诊断提供有用的参考信息。     

血清AQP4-Ab在视神经炎患者中的表达

目的：探讨血清水通道蛋白4抗体( AQP4-Ab )在视神经炎患者中的阳性表达率及其意义。
　　方法：选取2012-01/2015-12本院眼科中心确诊的98例128眼视神经炎患者进行研究,检测患者的血清AQP4-Ab、抗核抗体( ANAs )的阳性率,根据AQP4-Ab表达进行分组,对比两组间最佳矫正视力、盘周视网膜神经纤维层厚度( pRNFL )、黄斑容积、黄斑部RNFL ( mRNFL )、黄斑部内核层容积( mINL)测定值。
　　结果：确诊的视神经炎患者98例128眼,经过检查发现AQP4-Ab 阳性患者22例(22%),阴性患者76例(78%);ANAs 阳性患者21例(21%),阴性患者77例(79%);视神经炎患者的血清AQP4-Ab阳性率与ANAs阳性率具有显著的相关关系(r=0.707,P<0.01);经过检查发现AQP4-Ab阳性患者和阴性患者的最佳矫正视力差异无统计学意义( P>0.05);经过检查发现AQP4-Ab阳性患者的pRNFL、黄斑容积测定值均显著地小于阴性患者,差异均具有统计学意义( P<0.05);AQP4-Ab阳性患者和阴性患者的mRNFL、mINL测定值差异均无统计学意义(P>0.05)。
　　结论：AQP4-Ab在视神经炎患者中的阳性表达与ANAs存在显著的相关性, AQP4-Ab 阳性视神经炎患者的pRNFL变薄、黄斑容积下降明显。     

发光二级管诱发VEP对视神经萎缩患者临床应用探讨

对正常人及视神经萎缩患者进行瞬态发光二级管VEP(TLED-VEP)和氇定发光二极管VEP(SLED-VEP)联合检测，分析两种刺激状态下各检测指标的灵敏性和所能反应的视觉信息。 结果：异常阳性率TLED-VEP为33.33%，SLED-VEP检测指标光驱动临界频率(critical frequency of photic driving,CFPD)为88.24%，两者联合检测异常阳性率达96.08%．视力与CFPD及TLED-VEP的P₁₀₀振幅值正相关，与N₇₀、P₁₀₀潜时无关．对CFPDE及TLED-VEP检测指标所反应的生理基础和视功能信息进行丁探讨. （中华眼底病杂志，1995，11：172-174）     

小梁切除术联合复方血栓通胶囊对急性闭角型青光眼患者视功能的影响

目的：探讨小梁切除术联合复方血栓通胶囊对急性闭角型青光眼患者视功能损害的影响。
　　方法：选取2010-03/2014-10期间我院收治的100例120眼急性闭角型青光眼患者,按照双盲法将其分为观察组和对照组,观察组患者52例60眼行小梁切除术联合复方血栓通胶囊治疗,对照组患者48例60眼行单纯小梁切除术治疗,观察并对比术后3 lo两组患者的视力及视野恢复情况。
　　结果：术后3lo,所有患者眼压降至正常范围,观察组视力较术前增加(0.16±0.02),而对照组增加(0.09±0.01),差异具有统计学意义(P<0.05);观察组的视力疗效总有效率(96.7%)显著高于对照组(83.3%),差异具有统计学意义( P<0.05);观察组视野疗效总有效率为96.7%,明显高于对照组的83.3%,差异具有统计学意义(P<0.05)。观察组并发症发生率(1.7%)明显低于对照组(16.7%),差异具有统计学意义(P<0.05)。
　　结论：小梁切除术联合复方血栓通胶囊治疗急性闭角型青光眼患者,能有效提高其视力、改善视野、降低并发症发生率。     

Role of thrombocytosis in diagnosis of giant cell arteritis and differentiation of arteritic from non-arteritic anterior ischemic optic neuropathy

PURPOSE: To investigate the role of thrombocytosis in the diagnosis of giant cell arteritis (GCA), and differentiation of arteritic (A-AION) from non-arteritic (NA-AION) anterior ischemic optic neuropathy; and comparison of the sensitivity and specificity of platelet count to that of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and some other hematologic variables in the diagnosis of GCA. METHODS: This retrospective study is based on 121 temporal artery biopsy confirmed GCA patients and 287 patients with NA-AION seen in our clinic. For inclusion in this study, all GCA patients, at their initial visit, prior to the initiation of corticosteroid therapy, must have had ESR (Westergren), platelet count and complete blood count, and temporal artery biopsy. From 1985 onwards CRP estimation was done. For inclusion in this study, all NA-AION patients at the initial visit must have undergone evaluation similar to that described above for GCA, except for temporal artery biopsy. Wilcoxon rank-sum test and the two-sample t-test were used to compare hematologic variables between GCA patients with and without visual loss, between those with and without systemic symptoms, and also between GCA and NA-AION patients. Pearson correlation coefficient was computed to measure the association of platelet counts and the other hematologic variables with ESR. Receiver operating characteristic (ROC) curves were constructed for ESR, CRP, platelet count, combinations of ESR and platelet count, and CRP and platelet count, hemoglobin, hematocrit, and white blood cell (WBC) count and the area under the curve (AUC) were compared. RESULTS: Comparison of ESR, CRP, and hematologic variables of GCA patients and of A-AION with the NA-AION group, showed significantly (p <0.0001) higher median levels of ESR, CRP, platelet count, and WBC count and lower levels of hemoglobin and hematocrit in the GCA patients and A-AION than in NA-AION. Comparing AUC of the ROC curve between ESR and platelet count, ESR was a better predictor of GCA compared to platelet count (AUC of 0.946 vs. 0.834). There was a slight improvement in prediction of GCA using the combination of ESR and platelet count (AUC=0.953). The other hematologic variables had an AUC that was smaller than platelet count (0.854 for hemoglobin; 0.841 for hematocrit), with WBC being the least predictive of GCA (AUC=0.666). The AUC of the ROC curve for CRP was 0.978. There was no improvement in prediction of GCA using platelet count in combination with CRP (AUC=0.976). CONCLUSIONS: Patients with GCA had significantly (p <0.0001) higher values of platelet count, ESR, CRP and WBC but lower values for hemoglobin and hematocrit compared to the NA-AION group. Predictive ability of an elevated platelet count did not surpass elevated ESR or CRP as a diagnostic marker for GCA. Thrombocytosis may complement ESR. Hemoglobin, hematocrit and WBC were much less predictive of GCA. Elevated CRP had a greater predictive ability for GCA compared to ESR or the other hematologic parameters; thrombocytosis in combination with CRP did not yield an improvement in prediction of GCA.     

获得性免疫缺陷综合征合并梅毒患者的眼底病变构成分析

目的 分析获得性免疫缺陷综合征（AIDS）合并梅毒患者的眼底病变构成特点。设计 回顾性病例系列。研究对象 2012-2019年北京佑安医院AIDS患者395例。方法 根据是否合并梅毒分为AIDS组和AIDS合并梅毒组。患者进行最佳矫正视力(BCVA)、裂隙灯、眼压、散瞳眼底检查及彩色眼底照相等眼科检查,并行艾滋病、梅毒相关全身检查。主要指标 BCVA、眼前节反应、眼底病变情况、高效抗逆转录病毒治疗（HAART）状态、CD4+T细胞计数、血HIV-RNA载量以及血CMV-DNA。结果 AIDS组患者266例,眼底异常者163例（61.3%）,其中男性149例（91.4%）,HIV相关视网膜微血管病变66例（40.5%),巨细胞病毒视网膜炎94例（57.7%),血CD4+T细胞计数中位数27个/μl; AIDS合并梅毒组患者129例,眼底异常者93例（72.1%）,与AIDS组比较,差异有统计学意义（P=0.035）,其中男性92例（P=0.014）,HIV相关视网膜微血管病变40例（31.0%）,梅毒相关眼底改变26例（20.2%）,巨细胞病毒视网膜炎25例（19.4%）,眼前节阳性反应者23例 (P=0.010),63例（67.7%）患者眼底病变位置为中央型（P=0.040）,血CD4+T细胞计数中位数33.5个/μl（P=0.007）,均明显高于AIDS组。结论 AIDS合并梅毒患者眼底病变患病率高于单纯AIDS组患者,且血CD4+T细胞计数更高。     

Clinical Manifestations and Cerebrospinal Fluid Status in Ocular Syphilis

Purpose: To review the clinical manifestations, cerebrospinal fluid findings and outcomes of patients diagnosed with ocular syphilis.

Methods: Retrospective case review of all patients treated with ocular syphilis at Groote Schuur Hospital in Cape Town, South Africa between January 2008 and January 2013.

Results: A total of 77 eyes of 49 patients were included. Panuveitis was the most common presenting sign (48.9%). A lumbar puncture was performed on 37 patients (75.5%) and 64.8% (24/37) of samples had positive treponemal testing (CSF-FTA) while 24.3% (9/37) had positive non-treponemal testing (CSF-VDRL). Elevated CSF lymphocyte cell count was a strong predictor of neurosyphilis (p = 0.06 for CSF-FTA positive samples and p = 0.03 for CSF-VDRL positive samples).

Conclusion: The majority of patients (64.8%) who underwent lumbar puncture had cerebrospinal fluid findings suggestive of neurosyphilis. Elevated CSF lymphocyte cell count and total protein count are highly suggestive of neurosyphilis.     

获得性梅毒的眼后节表现及治疗预后

目的 观察首诊于眼科的以眼后节表现为主的眼部梅毒的临床特点及治疗预后。方法 回顾分析24例就诊于本院眼科,由眼科首先诊断为梅毒，并经梅毒螺旋体颗粒凝集试验（TPPA）和快速血浆反应素试验（RPR）检查证实为活动性眼部梅毒患者的临床资料。其中，男性17例，女性7例。年龄30至63岁，平均年龄为47.6岁。病程3 d至2年，平均病程5.8个月。病程小于等于1个月的有7例，1至3月的有5例，3至6月的5例，病程大于6月的7例。双眼发病18例，单眼发病6例。HIV检查均为阴性。除1例青霉素过敏患者采用口服红霉素治疗以外，均行全身青霉素治疗。治疗前平均视力为0.17±0.19，平均RPR滴度为1:84。治疗后随访半年，观察患眼视力和炎症消退情况。 结果 24例患者中，眼部表现为脉络膜视网膜炎者17例，其中1例为单眼发病；视网膜血管炎和视神经视网膜炎者各2例，均为单眼发病；视神经炎3例，1例为单眼。治疗后半年随访时所有患眼炎症消退，视力提高至0.60±0.29，RPR滴度下降4倍以上，平均为1:18.8。早期诊断治疗的患者中，视力完全恢复。结论 梅毒在眼后段的主要表现是脉络膜视网膜炎；在眼后段炎症性疾病的鉴别诊断中，应注意排除包括梅毒在内的感染性因素；及时的血清学检查、有效的青霉素治疗，有利于患者获得很好的视力预后。     

玻璃体视网膜术治疗复杂性眼外伤的临床疗效

目的:探讨玻璃体视网膜手术治疗复杂性眼外伤的临床疗效。方法:随机选取我院2009-12/2011-01复杂性眼外伤患者59例107眼,根据治疗方法不同分为两组,采用玻璃体视网膜手术(观察组31例54眼)和采用常规手术(对照组28例53眼),回顾性分析两组患者的视力、并发症等。结果:两组患者手术前视力情况无显著差异,治疗后观察组患者视力水平正常率(视力正常:>0.1)为31.5%,明显高于手术前与对照组手术后;手术成功率包括功能治愈和解剖治愈:观察组患者手术成功率为87.1%,观察组患者发生继发性青光眼3眼(5.6%),角膜变性3眼(5.6%),视神经萎缩2眼(3.7%),并发症发生率为14.9%,与对照组比较,差异均具有统计学意义(P<0.05)。结论:玻璃体视网膜手术明显提高了复杂性眼外伤的治疗效果,有效降低了致盲率,是较为有效的复杂性眼外伤手术方式。     

Immunoblot and Polymerase Chain Reaction to Diagnose Ocular Syphilis and Neurosyphilis in HIV-positive and HIV-negative Patients

ABSTRACT

Purpose: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis.

Methods: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens.

Results: Thirteen of 106 cases had positive syphilis serology of which 69.2% were HIV+ (median CD4+ = 181 cells/µL). Four cases met CDC criteria for neurosyphilis (3 confirmed, 1 probable) and 2 additional cases required neurosyphilis treatment according to UpToDate algorithms. All AH and CSF samples tested PCR negative. Five cases were CSF IB+ and 3 cases AH IB+. Using our classification, eight patients had confirmed neurosyphilis, one had probable neurosyphilis, three had confirmed ocular syphilis and nine had probable ocular syphilis.

Conclusion: Our findings suggest that IB of AH and CSF provides additional evidence to diagnose ocular and neurosyphilis and allows us to classify them as probable or confirmed.     

角膜塑形镜对青少年近视的相对周边屈光度影响

目的:观察配戴角膜塑形镜后的相对周边屈光度变化,探讨该变化与眼轴改变之间的关系。方法:选取2016-05/2018-11就诊的-1.00~-6.00D的青少年近视患者104例,随机分为试验组(配戴角膜塑形镜)及对照组(配戴框架眼镜)。随访观察患者治疗1a期间的眼轴、相对周边屈光度(鼻侧30°~颞侧30°)。结果:试验组戴镜后各时间点的相对周边屈光度呈现近视漂移状态(P<0.05),这种变化在戴镜1mo内最为明显(P<0.05),1mo后基本趋于稳定(P>0.05)。对照组相对周边屈光度呈现远视程度增加。1a后两组患者的眼轴及各径线相对周边屈光度的变化差异均具有统计学意义(P<0.001)。试验组治疗前后眼轴差与相对周边屈光度差值呈正相关关系(P<0.001)。结论:青少年近视患者配戴角膜塑形镜后,眼轴增长变慢,相对周边屈光度呈现近视漂移(1mo内最为明显),两者之间存在相关关系。     

Giant cell arteritis in a neuro-ophthalmology clinic in Saskatoon, 1998-2003

Background: We present a retrospective review of all biopsy-positive cases of giant cell arteritis (GCA) presenting to a neuro-ophthalmology practice in Saskatoon, Saskatchewan.Methods: Records of 141 consecutive patients who underwent temporal artery biopsy at the Saskatoon Eye Centre from July 1998 through June 2003 were reviewed. Patients that were biopsy-positive for GCA were studied and an estimated regional incidence was calculated. Study variables included age at diagnosis, sex, ethnicity, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level.Results: Of 141 patients, 37 (26%) had a positive biopsy result for GCA; 11 underwent a second biopsy for a total of 152 biopsies. The average age of the biopsy-positive patients was 76.5 (SD 8.2) years, and the female-to-male ratio was 2.4:1. There were 35 patients (95%) of European descent and 2 patients (5%) of Aboriginal descent. Twenty-three patients had both ESR and CRP testing done before starting steroids. The ESR was elevated in 19 (83%) and the CRP in 22 (96%). The estimated incidence of GCA for Saskatoon and area was 9.4 per 100 000 for people over the age of 50 years.Interpretation: GCA occurs primarily in people of European descent; however, it can affect North American people of Aboriginal descent. Sensitivity for the detection of GCA is higher in CRP than in ESR. The estimated incidence of GCA in Saskatoon and surrounding referral area is moderate compared with other northern areas.