糖尿病视网膜病变及糖尿病性黄斑水肿患者血清中CTRP9的表达

目的：探讨C1q/肿瘤坏死因子相关蛋白9(CTRP9)在不同分期糖尿病视网膜病变(DR)及糖尿病性黄斑水肿(DME)患者血清中的表达水平。 方法：选取2021-04/2022-04甘肃省人民医院收治的2型糖尿病患者135例作为试验组,根据免散瞳眼底照相结果分为无DR(NDR)组(n=45)、非增殖型DR(NPDR)组(n=45)、增殖型DR(PDR)组(n=45); 根据光学相干断层扫描结果将DR患者分为DME组(n=51)、非DME组(n=39); 另选取与试验组年龄、性别相匹配的健康体检者45例作为正常对照组。记录并比较各组受试者的临床资料及生化指标检测结果,分析血清CTRP9水平与其他生化指标的相关性,探讨影响DR及DME发生的危险因素。结果：正常对照组、NDR组、NPDR组、PDR组受试者血清CTRP9水平有明显差异(P<0.001),且正常对照组>NDR组>NPDR组>PDR组; DME组与非DME组患者血清CTRP9水平有明显差异(P<0.001),且非DME组>DME组。Spearman秩相关性分析显示,DR患者血清CTRP9水平与糖尿病病程病程呈负相关(rs=-0.251,P<0.05); DME患者血清CTRP9水平与空腹血糖(FBG)(rs=-0.370,P<0.05)、糖化血红蛋白(HbA1c)(rs=-0.421,P<0.05)呈负相关。Logistic多因素回归分析显示,糖尿病病程(OR=1.194,95%CI：1.068～1.335,P=0.002)、血清CTRP9水平(OR=0.936,95%CI：0.907～0.966,P<0.001)是影响DR发生的危险因素; 血清CTRP9水平是影响DME发生的危险因素(OR=0.838,95%CI：0.778～0.903,P<0.001)。结论：血清CTRP9水平降低是DR及DME发生的危险因素,可能对二者的风险评估有重要意义。     

应用超高速SS-OCTA定量评估DR患者的脉络膜毛细血管血流灌注

目的：利用超高速扫频源光学相干断层扫描血管成像(SS-OCTA)测量脉络膜毛细血管(CC)灌注密度(PFD)评估不同糖尿病视网膜病变(DR)患者脉络膜毛细血管血流特征。方法：横断面研究。选取2022-03/12在合肥市第二人民医院就诊的受试者139例139眼：包括糖尿病患者115例115眼和对照组24例24眼。根据早期糖尿病视网膜病病变研究(ETDRS)标准对彩色视网膜图像进行DR分级,将糖尿病患眼分为无DR组、非增殖性糖尿病视网膜病变(NPDR)组、NPDR合并糖尿病黄斑水肿(DME)组、增殖性糖尿病视网膜病变(PDR)组。采用超高速SS-OCTA设备扫描以黄斑中央凹为中心3mm×3mm的区域,利用系统内置软件测量CC灌注面积,计算PFD,采用多元线性回归评估CC的PFD与DR程度的相关性。结果：DR程度与CC血流灌注相关,调整各种混杂因素后,与对照组相比,NPDR组中心凹CC的PFD减少9.358个单位(95%CI -18.484～-0.232,P=0.045),旁中心凹减少9.284个单位(95%CI -18.487～-0.090,P=0.048); NPDR合并DME组中心凹CC PFD减少18.173个单位(95%CI -28.583～-7.762,P=0.001),旁中心凹减少17.032个单位(95%CI -27.521～-6.544,P=0.002); PDR组中心凹CC PFD减少28.309个单位(95%CI -39.978～-16.640,P<0.001),旁中心凹减少25.841个单位(95%CI -37.597～-14.085,P<0.001)。结论：超高速SS-OCTA测量CC血流密度可以客观量化黄斑灌注,黄斑区CC血流灌注密度与DR严重程度相关,随着DR进展黄斑区CC灌注密度降低,未来纵向研究可阐明CC灌注与DR进展之间的因果关系。     

微脉冲激光联合雷珠单抗玻璃体腔内注射治疗非缺血型BRVO继发黄斑水肿

目的：探讨微脉冲激光联合雷珠单抗玻璃体腔内注射治疗非缺血型视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)的疗效。方法：选取2020-01/2022-03在我院接受治疗的非缺血型BRVO继发ME患者200例200眼作为本次研究对象，按照随机数字表法分为对照组(100例100眼)和观察组(100例100眼)。其中对照组给予雷珠单抗玻璃体腔内注射治疗，观察组给予微脉冲激光联合雷珠单抗玻璃体腔内注射治疗。比较两组最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、黄斑中心凹下脉络膜厚度(SFCT)、总注药次数、黄斑区渗漏以及并发症发生情况。结果：治疗后两组患者的BCVA均改善，且观察组治疗后1、3、6、12mo的BCVA优于对照组(均P<0.05)。治疗后两组患者的CMT、SFCT均降低，且观察组治疗后1、3、6、12mo的CMT、SFCT低于对照组(均P<0.05)。观察组治疗期间总注药次数明显少于对照组(4.06±1.12次 vs 5.32±1.15次，t=5.852，P<0.001)。对照组和观察组治疗后12mo的渗漏率分别为69.0%、27.0%，两组比较有差异(χ2=35.337，P<0.001)。对照组和观察组患者的并发症发生率分别为11.0%、5.0%，两组比较无差异(χ2=2.446，P=0.118)。结论：微脉冲激光联合雷珠单抗玻璃体腔内注射治疗非缺血型BRVO继发ME的临床效果显著，能够提高患者的视力，改善ME，减少雷珠单抗总用药次数，且不会增加并发症发生率，安全系数高。     

改良Van Herick前房角宽度评估法的临床观察

目的：探讨在Van Herick法基础上更方便准确评估前房角宽度的方法。方法：纳入2021-01/12于我院就诊的年龄相关性白内障患者58例69眼，参考Van Herick法分为房角宽度≥1/2颞侧角膜厚度(CT)组(37例44眼)和<1/2CT组(21例25眼)，应用超声生物显微镜测量中央前房深度和周边房角度数。结果：房角宽度≥1/2CT组和<1/2CT组患者中央前房深度有明显差异(2.64±0.27 mm vs 2.23±0.29 mm，P<0.01)，且两组间上方、颞侧、下方和鼻侧象限房角度数均有明显差异(P<0.01)。房角宽度≥1/2CT组患者上方与下方象限房角度数无显著差异(P>0.05)，其余各象限房角度数均有差异(P<0.05)； 房角宽度<1/2CT组患者上方与鼻、颞侧象限，下方与颞侧象限房角度数均有差异(P<0.05)。结论：裂隙灯下采用Van Herick法评估颞侧房角宽度，同时评估下方象限房角宽度，可以更简单、快速、准确地评估前房角的整体情况。     

SD-OCT参数评估黄斑裂孔内界膜撕除术后视力改善的应用价值

目的：分析频域光学相干断层扫描(SD-OCT)参数评估黄斑裂孔内界膜撕除术后视力改善情况的应用价值。方法：回顾性分析2019-05/2021-02于我院行玻璃体切除+内界膜撕除+长效气体填充术治疗的特发性黄斑裂孔(IMH)患者82例82眼的临床资料，分析术后3mo IMH闭合情况与SD-OCT参数的相关性，并评估影响术后视力改善不良的危险因素。结果：Spearman秩相关分析显示，术后3mo IMH闭合情况与术前外界膜(ELM)缺损直径呈正相关(rs=0.308，P<0.05)，与术前黄斑裂孔指数(MHI)呈负相关(rs=-0.266，P<0.05)。Logistic回归分析显示，术前MHI≥0.5是影响术后视力改善不良的保护因素(OR=0.691，P<0.05)。结论：SD-OCT可通过检测术前MHI及ELM缺损直径等参数预测手术疗效，对判断视功能改善情况有利。     

三种不同IOL植入术后短期的视力和视觉干扰现象及脱镜率的对比

目的：对比分析单眼植入三焦点、多焦点及连续视程人工晶状体(IOL)术后短期的视力、视觉干扰现象及脱镜率。方法：回顾性分析2019-03/2022-12行超声乳化白内障吸除联合IOL植入术的白内障患者67例67眼。35例35眼植入Symfony连续视程IOL； 21例21眼植入AcrySof IQ ReSTOR+3D多焦点IOL； 11例11眼植入AcrySof IQ PanOptix三焦点IOL。记录术前及术后3 mo裸眼远视力(UDVA)、中视力(UIVA)、近视力(UNVA)，术后3 mo离焦曲线、视觉干扰现象及脱镜率。结果：术后3 mo，三组间UDVA无差异(P>0.05)； Symfony组及PanOptix组UIVA优于ReSTOR组(均P<0.01)； ReSTOR组及PanOptix组UNVA优于Symfony组(均P<0.01)。离焦曲线显示，在中视力区间(-1.00--1.50 D)，Symfony组视力优于ReSTOR组(P<0.05)； 在近视力区间(-2.50--3.50 D)，ReSTOR组视力优于Symfony组(P<0.05)； PanOptix组在近视力区间(-2.00--3.50 D)的视力优于Symfony组(P<0.05)，同时在中视力区间(-1.00--2.00 D)的视力优于ReSTOR组(P<0.05)。三组间眩光或光晕的发生率及双眼相互干扰现象发生率均无差异(P>0.05)。PanOptix组和ReSTOR组脱镜率比Symfony组高(P<0.0167)。结论：与Symfony连续视程IOL和ReSTOR多焦点IOL相比，PanOptix三焦点IOL能够兼顾远中近视力，眩光和光晕发生率不高，脱镜率较高； 单眼植入老视矫正型IOL仍需慎重。     

屈光异常弱视儿童RNFL和MRT的变化及预测疗效价值

目的：探讨屈光异常弱视儿童视网膜神经纤维层(RNFL)、黄斑区视网膜厚度(MRT)变化及预测疗效价值。方法：选取2020-01/2022-10我院收治的168例近视性屈光异常单眼弱视儿童作为观察组，其中118例轻中度弱视，50例重度弱视，另按照1：1比例同期纳入168例视力正常儿童作为对照组。统计两组儿童RNFL、MRT变化，分析屈光异常弱视儿童病情程度与RNFL、MRT的相关性，另将观察组根据疗效分为有效亚组和无效亚组，比较有效亚组和无效亚组一般资料、治疗前后RNFL及MRT，采用Logistic分析疗效的影响因素，绘制ROC曲线分析RNFL、MRT单一或联合预测疗效价值。结果：重度弱视RNFL、MRT大于轻中度弱视、对照组(均P<0.05)； 屈光异常弱视儿童病情程度与RNFL、MRT呈正相关(rs=0.745、0.724，均P<0.001)； 轻中度和重度弱视患者中，有效亚组和无效亚组初治年龄、注视形式、治疗依从性、治疗前、治疗1mo后RNFL、MRT及其差值比较均有差异(均P<0.05)； Logistic显示，初治年龄、注视性质、治疗依从性、治疗1mo后RNFL、治疗1mo后MRT是屈光异常弱视儿童疗效的影响因素(均P<0.05)； 治疗1mo后RNFL、MRT联合预测轻中重度屈光异常弱视儿童疗效的AUC明显优于单一预测。结论：屈光异常弱视患儿RNFL、MRT存在差异，且与患儿不同程度病情、疗效密切相关，治疗1mo后RNFL、MRT联合预测不同程度屈光异常弱视患儿疗效具有一定参考价值。     

屈光参差性弱视一阶光栅锐度和二阶纹理敏感度的感知能力

目的：研究单眼屈光参差性弱视患者对一阶光栅锐度和二阶纹理敏感度的感知能力。方法：收集2018-01/2022-12于我院确诊的单眼屈光参差性弱视儿童715例715眼作为弱视组，另选取矫正视力正常儿童745例745眼作为正常对照组。分别检测最佳矫正视力(BCVA)、一阶光栅锐度和(或)二阶纹理敏感度，并分析不同程度弱视患者对一阶光栅锐度和二阶纹理敏感度的感知能力。结果：弱视组与正常对照组一阶光栅锐度(11.58±6.10 vs 20.27±3.47，P<0.001)、二阶纹理敏感度(0.33±0.16 vs 0.12±0.04，P<0.001)均有明显差异，且轻中度弱视患者与重度弱视患者一阶光栅锐度(12.10±6.23 vs 8.13±3.70，P<0.001)和二阶纹理敏感度(0.32±0.16 vs 0.37±0.17，P<0.05)均有明显差异。结论：单眼屈光参差性弱视患者大脑皮层一阶视觉通路和二阶视觉通路均存在不同程度的损伤，重度弱视患者较轻中度弱视患者损伤更为严重。     

光学相干断层扫描血管成像量化分析糖尿病患者黄斑区毛细血管参数

目的：应用光学相干断层扫描血管成像技术(OCTA)量化2型糖尿病患者黄斑区毛细血管的早期变化。方法：回顾性病例研究。分别纳入49名健康受试者、52例无视网膜病变的2型糖尿病患者(noDR)和43例轻度非增殖性糖尿病视网膜病变(mNPDR)患者，并得到在黄斑区3 mm×3 mm浅层毛细血管丛和深层毛细血管丛的OCTA图像。去除大血管后分别计算毛细血管灌注密度、血管长度密度(VLD)和平均血管直径(AVD)并进行比较。应用受试者工作特征曲线评估该参数监测2型糖尿病患者视网膜微血管早期改变的能力。结果：比较三组间VLD和AVD，差异均有统计学意义(P<0.001)。与健康受试者相比，noDR组的AVD均显著增加(P<0.05)。mNPDR组患者深层及浅层的VLD较noDR组显著下降(均P<0.01)。深层AVD鉴别noDR组与健康受试者的曲线下面积(AUC)为0.796，鉴别mNPDR组和健康受试者的AUC最高为0.920，其次为深层VLD(AUC=0.899)，显著高于其他参数。结论：在糖尿病视网膜病变的临床前阶段，2型糖尿病患者的深层及浅层AVD均显著高于健康人，VLD均显著高于mNPDR患者。与健康人相比，深度AVD较其他参数更能检出noDR患者早期视网膜毛细血管的变化。     

不同程度近视散光患者TransPRK术后功能性光学区的临床分析

目的：评估术前近视散光大小及角膜前表面曲率对经上皮准分子激光角膜表面切削术(TransPRK)后功能性光学区(FOZ)的影响。方法：采用回顾性分析,选择近视及近视散光患者78例130眼应用TransPRK治疗,根据柱镜度不同分为：对照组,柱镜度0D; 中度散光组,柱镜度-0.50～-2.00D; 高度散光组,柱镜度>-2.00～<-6.00D。测量并比较术后6mo三组FOZ大小,分析拟矫屈光度、角膜前表面曲率变化、角膜像差变化、Q值变化与FOZ的相关性。结果：术后6mo,对照组平均FOZ为5.16±0.12mm,中度散光组为5.29±0.23mm,高度散光组为5.49±0.23mm(P<0.001)。高度散光组FOZ明显大于中度散光组和对照组(P<0.05,<0.001); Pearson相关分析表明,等效球镜度变化量、角膜总高阶像差(HOAs)变化量、彗差变化量、球差变化量与FOZ均呈负相关(均P<0.05); 陡峭曲率(K2)、平均曲率(Km)、角膜散光变化量、Q值变化量与FOZ均呈正相关(均P<0.01)。多元线性回归分析表明,在去除其他危险因素后,术前K2仍与FOZ呈正相关(P<0.001)。结论：高度散光患者在TransPRK后获得较大FOZ和引入较少彗差。术前陡峭曲率高近视散光眼将取得较大FOZ。     

特发性黄斑前膜术后视力与黄斑区形态结构和血流密度的相关性

目的:利用光学相干断层扫描血管成像(OCTA)观察特发性黄斑前膜(IMEM)患者术后黄斑区形态结构及血流密度的变化,分析其与视力的相关性。方法:前瞻性研究。连续收集2020-01/2021-07就诊于我院的IMEM患者45例45眼,观察术前、术后1wk, 1、3、6mo最佳矫正视力(BCVA)、中央黄斑区厚度(CMT)、中心凹无血管区(FAZ)面积、中心凹视网膜浅层毛细血管丛(SCP)血流密度的变化。结果:与术前比较,纳入患者术后1wk BCVA无明显变化(P>0.05),术后1、3、6mo均明显改善(P<0.05);术后1wk CMT明显增厚(P<0.05),术后1、3、6mo均明显降低(P<0.05);术后1wk, 1mo FAZ面积无明显变化(P>0.05),术后3、6mo明显扩大(P<0.05);术后1wk, 1、3mo SCP血流密度均无明显变化(P>0.05),术后6mo明显减少(P<0.05)。术后3、6mo纳入患者BCVA与CMT呈正相关(r=0.457、0.615,P=0.032、0.012)。结论:特发性黄斑前膜手术后...     

Surgical treatment for severe diabetic macular edema with massive hard exudates

PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. METHODS: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.     

屈光参差性弱视儿童视网膜神经纤维层和黄斑区视网膜厚度的相关性分析

目的:探究屈光参差性弱视儿童视网膜神经纤维层(RNFL)和黄斑区视网膜厚度的变化情况及其相关性。方法:选取2020-10/2021-06在我院眼科治疗的屈光参差性弱视儿童159例159眼作为研究组,选取同期、同年龄段于我院眼科检查视力正常的儿童159例159眼作为对照组。研究组在给予屈光矫正、遮盖健眼的基础上对弱视眼进行传统综合训练结合4D视觉训练。比较研究组治疗前后与对照组RNFL和黄斑区视网膜厚度,分析研究组治疗前RNFL与黄斑区视网膜厚度的相关性。结果:研究组治疗前和治疗3mo后平均、上方、下方、鼻侧、颞侧RNFL厚度均高于对照组,且研究组治疗前平均、上方、下方、鼻侧、颞侧RNFL厚度均高于治疗3mo后(P<0.05)。研究组治疗前黄斑区外环平均、下方、鼻侧、颞侧、内环鼻侧及中心区视网膜厚度均高于治疗3mo后和对照组(P<0.05)。治疗前,研究组上方RNFL厚度与黄斑中心区视网膜厚度呈负相关(r=-0.330,P<0.05),下方、鼻侧RNFL厚度与黄斑区外环和内环颞侧视网膜厚度呈正相关(均P<0.05),颞侧RNFL厚度与黄斑区外环鼻侧和颞侧视网膜厚度...     

Tomographic findings of foveal hard exudates in diabetic macular edema

PURPOSE: To report the intraretinal location of foveal hard exudates after vitrectomy to treat diabetic macular edema and to evaluate the visual outcome. METHODS: In a prospective study, the tomographic features of 11 eyes (8 patients) with diabetic macular edema were evaluated with optical coherence tomography after vitrectomy. The intraretinal location of hard exudates at the fovea (anatomic foveola) and the relationship with visual acuity were investigated. RESULTS: With optical coherence tomography, hard exudates were observed as highly reflective spots in the cross-sectional images. In six of 11 eyes (54.5%), the hard exudates were in the inner portion of the neurosensory retina; the final best-corrected visual acuity averaged 20/70 in the six eyes. In the remaining five eyes (45.5%), hard exudates were deposited not only in the neurosensory retina but also in the subretinal space. In optical coherence tomographic images, subretinal hard exudates were observed as highly reflective plaques, which were slightly elevated over the retinal pigment epithelium. The five eyes developed a serous retinal detachment at the fovea before or after vitrectomy. Subretinal hard exudates bridged the detached neurosensory retina and the retinal pigment epithelium in two eyes. The average final visual acuity level in the five eyes was 20/300. The visual outcome was significantly worse in five eyes with subretinal hard exudates than in six eyes with an intraretinal one (P <.05, Wilcoxon rank sum tests). CONCLUSIONS: If serous retinal detachment develops before or after vitrectomy for diabetic macular edema, hard exudates tend to accumulate not only in the neurosensory retina but also in the subretinal space. The visual prognosis is worse in cases of subretinal exudation.     

量化OCTA在视网膜静脉阻塞中的应用

目的:应用光学相干断层扫描血管成像技术(OCTA)测量视网膜静脉阻塞(RVO)患者黄斑区血流密度、黄斑中心凹无血管区(FAZ)面积和黄斑中心凹视网膜厚度。方法:选取RVO患者30例30眼,视网膜中央静脉阻塞(CRVO)和视网膜分支静脉阻塞(BRVO)患者各15例,双眼接受OCTA检查,获取黄斑中心3mm×3mm大小范围的血流密度、FAZ面积、黄斑中心凹视网膜厚度,以及双眼最佳矫正视力(BCVA)。比较患眼与健眼上述指标的变化及其与BCVA的相关性。结果:CRVO患者患眼黄斑区视网膜浅层毛细血管网(SVN)、深层毛细血管网(DVN)总血流密度较健眼降低[SVN:(43.07±4.95)%vs(50.09±2.86)%,DVN:(45.89±4.12)%vs(53.29±2.62)%,均P<0.01],与BCVA呈负相关(r_s=-0.6、-0.5,均P<0.05)。BRVO患者患眼SVN、DVN总血流密度较健眼降低[SVN:(45.62±3.04)%vs(52.10±2.98%),DVN:(49.21±3.80)%vs(55.52±3.33%),均P<0.01],与BCVA呈负相关(r_s=-0.5、-0.5,均P<0.05)。BRVO患眼病变区域与患眼未病变区域、健眼对应区域比较,SVN、DVN血流密度均下降(均P<0.01);患眼未病变区域DVN血流密度较健眼相应区域下降[(56.86±1.95)%vs(58.15±2.24)%,P=0.02];患眼病变区域DVN血流密度与BCVA呈负相关(r_s=-0.6,P=0.01)。CRVO、BRVO患眼SVN的FAZ面积较健眼明显扩大(CRVO:0.515±0.26mm²vs 0.27±0.08mm²,P<0.01;BRVO:0.376±0.12mm²vs 0.261±0.07mm²,P<0.01),且均与BCVA呈正相关(CRVO:r_s=0.6,P=0.01;BRVO:r_s=0.5,P=0.01)。CRVO、BRVO患眼黄斑中心凹视网膜厚度均较健眼增加(CRVO:431.2±191.3μm vs 235.5±18.2μm,P<0.01;BRVO:373.2±188.7μm vs 233.8±13.7μm,P=0.01),均与BCVA呈正相关(CRVO:r_s=0.9,P=0.01;BRVO:r_s=0.6,P=0.01)。结论:OCTA可作为测量RVO患者黄斑区血流密度、FAZ面积及黄斑中心凹视网膜厚度的有效工具。     

The influence of hard exudates on the results of vitrectomy for macular edema due to diabetic retinopathy

PURPOSE: To demonstrate surgical results of diabetic macular edema from the distribution of hard exudates. METHODS: We reviewed 485 eyes of 325 patients followed up more than 1 year who underwent vitreous surgery for diabetic macular edema. Four groups were identified from the distribution of hard exudates in the macular region: no hard exudate type, 179 eyes; hard exudate type, 211 eyes; macular deposit type, 73 eyes; and waxy type, 22 eyes. We evaluated the preoperative characteristics, the period required for absorption of macular edema, visual outcome, and postoperative complications among the four types. RESULTS: In the waxy type, the macular edema was absorbed more slowly than no hard exudate type and hard exudate type(p < 0.05) more patients had proteinurea and were treated by grid photocoagulation before surgery than the other types, and the rate of occurrence of rubeotic glaucoma and attrition by death was higher than in the other types. Visual acuity was significantly improved in all types postoperatively(p < 0.05). Preoperative and postoperative visual acuity were as follows: no hard exudate type, 0.28, 0.48; hard exudate type, 0.21, 0.33; macular deposit type, 0.10, 0.17; and waxy type, 0.04, 0.11. CONCLUSION: The distribution of hard exudates was directly related to surgical results for diabetic macular edema. The waxy type had poor prognosis.     

影响成人间歇性外斜视术后立体视功能重建情况分析

目的:调查成人间歇性外斜视术后立体视功能重建情况,并分析影响患者立体视功能重建的相关因素。方法:回顾性研究。选择2019-01/2021-01我院收治间歇性外斜视成人患者196例,所有患者均行斜视矫正手术,收集患者术前一般资料和术后患者立体视功能重建情况。结果:纳入患者196例术前均无近远立体视觉功能,术后近立体视觉功能重建率为52.6%(103/196),远立体视功能重建率为50.5%(99/196)。近立体视功能重建(103例)与未重建患者(93例)手术年龄、发病年龄、病程、术后水平斜视量等因素比较存在统计学意义(P<0.001);多因素Logistic回归分析显示发病年龄、病程、术后水平斜视量是影响近立体视功能重建的因素(P<0.05);受试者操作特征(ROC)曲线显示,发病年龄、病程、术后水平斜视量用于预测患者近立体视功能重建曲线下面积(AUC)分别为0.757、0.737、0.727(P<0.001)。远立体视功能重建(99例)与未重建患者(97例)在手术年龄、发病年龄、病程、术后水平斜视量比较存在统计学意义(P<0.001),多因素Logistic回...     

Subretinal washout for subtle subfoveal hard exudates in diabetic macular edema

PURPOSE: To evaluate the efficacy of subretinal washout for subtle subfoveal hard exudates in diabetic macular edema. METHODS: This study was done retrospectively on a series of patients with diffuse diabetic macular edema accompanied with subtle subfoveal hard exudates and operated on by one surgeon(NO). Patients ranged in age from 30 to 76 years(mean, 59 years). The postoperative follow-up interval ranged from 12 to 76 months, with a mean of 35 months. Two groups were identified. The first group contained all 26 eyes that had vitreous surgery with subretinal washout. This was compared with a second group of 51 eyes without subretinal washout. We compared the rate of occurrence of postoperative massive foveal hard exudates, visual acuity results, and complications with and without subretinal washout. RESULT: There was no significant difference in base line demographics between the two groups. Massive foveal hard exudates did not occur in eyes with subretinal washout, but occurred in 29 (57%) of the eyes without subretinal washout(p < 0.0001) and in 15 eyes which had undergone reoperation with subretinal washout. Visual acuity improved in 54% of the subretinal washout eyes and 45% of the eyes without it. Visual acuity improved to 20/30 or better in 23% of the eyes with subretinal washout and in 8% of the eyes without subretinal washout. There was no serious complication related to subretinal washout. CONCLUSION: Subretinal washout for subtle subfoveal hard exudates in diabetic macular edema may prevent massive subfoveal exudates and improve visual results. Further study is needed to investigate the pathogenesis.     

眼底荧光血管造影在1期糖尿病视网膜病变诊断中应用价值

目的 探讨糖尿病视网膜病变(DR)国际临床分类法1期病变患者眼底荧光血管造影(FFA)表现,评价FFA对早期DR的诊断价值.方法 对76例(152只眼)诊断为糖尿病视网膜病变国际临床分级标准1期病变患者进行眼底及眼底荧光血管造影检查,分析其造影表现.结果 检眼镜下152只眼眼底全部未见异常表现,FFA正常48只眼(31.58%).FFA异常104只眼(68.42%),异常表现中单纯微动脉瘤(MA)强荧光56只眼(53.84%),MA合并毛细血管扩张15只眼(14.41%),MA合并黄斑水肿5只眼(4.81%),黄斑拱环破坏3只眼(2.87%),小片状毛细血管无灌注2只眼(1.92%),窗样缺损23只眼(22.15%).结论 被诊断为DR国际临床分类法1期的患者,大部分已经出现了不同程度的FFA异常表现.因此,FFA是DR早期诊断的较好方法,能提高对DR早期诊断的准确度.

Abstract：

Objective To investigate the fundus fluorescence angiography (FFA) performance of diabetic retinopathy (DR) according to the international clinical classification of period l's patients. To evaluate the diagnostic value of FFA in early DR. Methods Fundus and fundus fluorescence angiography examination were performed and analyzed in 76 of period 1 patients (152 eyes) for the diagnosis of diabetic retinopathy according to the international clinical classification standard of. Results All 152 eyes fundus had no abnormal performance under ophthalmoscope, FFA normal 48 eyes (31.58%); FFA abnormal 104 eyes (68.42%), abnormal performance among a simple micro-aneurysms (MA), high fluorescence 56 eyes (53.84%), MA merge in telangiectasia 15 eyes (14.41%), MA merge in macular edema 5 eyes (4.81%), macular arch ring had damaged 3 eyes (2.87%), small flake with capillary nonperfusion 2 eyes (1.92%), window defect 23 eyes (22.15%).Conclusions DR is diagnosed with period 1 patients according to the international clinical classification, most of the emergence of difference degrees abnormal performance of the FFA. Therefore, FFA is the better method in early diagnosis of DR. It can increase the accurate of diagnosis for DR.