应用光学相干断层扫描(OCT)对激光治疗糖尿病性黄斑水肿的临床观察分析

目的应用光学相干断层扫描(OCT)观察532 nm激光格栅状黄斑区光凝治疗糖尿病性黄斑水肿的临床疗效。方法泵浦倍频532 nm激光格栅状光凝治疗临床显著糖尿病性黄斑水肿(clinically siginificant diabetic macular edema,CSDME),48例96眼,于治疗前和治疗后2³个月行OCT检查,测量以黄斑中心凹为中心1mm范围内视网膜厚度及相关视力。结果黄斑中心凹1 mm圆内平均视网膜神经上皮层厚度激光治疗前后及23个月行OCT检查,测量以黄斑中心凹为中心1mm范围内视网膜厚度及相关视力。结果黄斑中心凹1 mm圆内平均视网膜神经上皮层厚度激光治疗前后及2³个月后视网膜厚度有统计学差异(P<0.05)。结论 532 nm激光光凝后23个月后视网膜厚度有统计学差异(P<0.05)。结论 532 nm激光光凝后2³个月黄斑区视网膜神经上皮层厚度减薄,而明显的视网膜前膜或玻璃体收缩牵拉而形成的弥漫的嚢样水肿对激光治疗反应不明显。顽固性黄斑水肿即使重复激光治疗仍难以奏效,而应考虑玻璃体内药物治疗。     

复方甘草酸苷注射液相关视乳头水肿

32岁男性患者,因慢性乙型肝炎静脉给予复方甘草酸苷注射液40ml加入0.9%氯化钠注射液100ml,1次/d,静脉滴注,共11d,后增加剂量至复方甘草酸苷注射液100ml加入0.9%氯化钠注射液250ml,1次/d,共7d。患者每天在输液过程中均出现头晕、眼胀、轻度视物模糊。停药后视物模糊仍再加重。眼科检查:双眼视乳头水肿,隆起1D,视盘边界不清,有轻微出血。BP90/70mmHg。给予患者维生素B1等药物治疗,数日后患者视乳头水肿有所消退,但视物模糊未改善。     

光学相干断层扫描对氩激光治疗糖尿病性黄斑水肿的疗效观察

目的应用光学相干断层扫描观察氩激光治疗糖尿病性黄斑水肿的临床疗效。方法对糖尿病性黄斑水肿患者行氩激光光凝术。在光凝前、光凝后3个月分别进行扫描获取光学相干断层扫描图像,记录黄斑中心凹视网膜厚度,作统计学分析。结果平均随访(3.0±0.6)个月。光凝前及光凝后3个月黄斑中心凹区视网膜厚度平均值分别为(397±102)μm和(204±90)μm,差异有统计学意义。结论光学相干断层扫描检测能较准确定量测算黄斑区视网膜厚度,可对比观察氩激光光凝前后视网膜厚度变化,进而判断氩激光光凝的疗效。     

曲安奈德治疗视网膜静脉阻塞黄斑水肿的疗效及频域光学相干断层成像在其中的应用

目的 通过频域光学相干断层成像(OCT)观察曲安奈德治疗视网膜静脉阻塞黄斑水肿的临床疗效.方法 对36例视网膜静脉阻塞黄斑水肿患者应用频域OCT在曲安奈德治疗前后观察黄斑视网膜形态,术后第1天、第3天及1个月时OCT随访检查黄斑视网膜形态变化.测量以黄斑中心凹为中心,中心凹1、3、6 mm直径圆形区域视网膜平均厚度及黄斑总容积.结果 曲安奈德治疗前黄斑中心凹视网膜神经上皮内囊腔形成,视网膜外层弥漫性水肿,治疗后黄斑中心凹视网膜神经上皮内囊腔明显缩小或消失,黄斑中心凹形态恢复;治疗前黄斑中心凹1、3、6 mm直径圆形区域视网膜平均厚度分别为(824.7±197.5)、(769.1±144.6)、(423.6±82.5)μm;黄斑总容积(14.2±3.8)min3.治疗后1天黄斑中心凹1、3、6 mm直径圆形区域视网膜平均厚度分别为(347.3±75.8)、(426.0±103.2)、(283.0±90.6)μm;黄斑总容积(9.2±1.4)min3.它们分别与最佳矫正视力呈直线负相关(r=-0.178、-0.216、-0.138、-0.183,均P<0.05).结论 曲安奈德治疗视网膜静脉阻塞黄斑水肿是有效的,且安全性较理想.频域0cT能定性、定量评价曲安奈德治疗黄斑水肿的疗效.     

七叶皂苷钠治疗糖尿病视网膜病变视乳头水肿的疗效观察

目的探讨七叶皂苷钠治疗糖尿病视网膜病变视乳头水肿的疗效观察。方法将150例糖尿病视网膜病变视乳头水肿患者随机分成两组,治疗组、对照组各75例。对照组给予常规降糖药控制血糖,同时口服以羟苯磺酸钙。治疗组在对照组的基础上加用注射用七叶皂苷钠20mg加入生理盐水250m L,静脉滴注,1日1次,10d为1个疗程。观察两组治疗前后视力的提高、视乳头水肿的消除以及总有效率。结果治疗组在治疗后视力的提高、视乳头水肿的消除、总有效率等方面疗效均优于对照组,二者比较差异有显著性意义（P〈0.05）。结论七叶皂苷钠治疗糖尿病视网膜病变视乳头水肿疗效显著,无明显不良反应,值得临床推广。     

光学相干断层扫描用于视网膜静脉阻塞诊治的探讨

目的 探讨视网膜静脉阻塞黄斑水肿的光学相干断层扫描(Optical Coherence Tomography OCT)图像特征及临床诊断和治疗效果评估价值.方法 对在我院检查诊断为视网膜静脉阻塞患者30例34只眼曲安奈德球后注射治疗前后行OCT检查.结果 视网膜静脉阻塞患者的OCT图像表现为黄斑区视网膜海绵状水肿、囊样水肿、神经上皮浆液性脱离、黄斑区出血、渗出.结论 OCT可以直接客观地显示视网膜静脉阻塞黄斑病损治疗前后改变情况.为视网膜静脉阻塞黄斑水肿的临床诊断及治疗评价提供更加直观明了、准确可靠的信息.     

早期青光眼诊断应用光学相干断层成像和视野检查的临床比较

目的探究对比应用光学相干断层成像和视野检查进行早期青光眼诊断的应用效果。方法随机选取2013年4月至2015年7月于本院接受治疗的66例早期青光眼患者为研究对象,所有患者均接受光学相干断层成像以及视野检查。将光学相干断层成像检查结果作为观察组,将视野检查结果作为对照组,以假阳性率以及假阴性率<15%判断结果可靠。结果观察组颞上方RNFL阳性率为96.6%、鼻上方为64.4%、颞侧为50.7%、颞下方为95.4%、鼻下方为68.2%,与对照组相比均具有显著差异(P<0.05)。结论相较于视野检查而言,光学相干断层成像对早期青光眼的诊断效果更为理想,值得临床推广。但视野检查仍是眼科检查的重要方法,其对青光病程煎煮以及后续随访等均可提供重要参考价值。     

应用光学相干断层成像评价药物洗脱支架术后再发急性冠脉综合征患者的原因

目的探讨冠脉药物洗脱支架术后再发急性冠脉综合征（ACS）患者的可能原因。方法收集自2010年8月至2012年7月,本中心收治11例曾接受过冠脉支架介入治疗（PCI）治疗并植入药物涂层支架（DES）,再发ACS的（男性9例,女性2例）患者,对该11例患者进行回顾性分析。应用光学相干断层显像（OCT）技术对罪犯血管检查,了解罪犯血管的病变情况。结果DES植入术后再发ACS者不稳定性心绞痛（uA）多见,7例（7／11,63．6％）,非sT段抬高心肌梗死（NSTEMI）1例（1／11,9％）,sT段抬高心肌梗死（STEMI）3例（3／11,27．2％）。罪犯血管前降支（LAD）多见,8例（8／11,72．7％）,右冠脉（RCA）3例（3／11,27．2％）。STEMI患者冠脉造影（CAG）诊断为支架内血栓形成（ST）,OCT诊断为支架贴壁不良,同时存在支架内新生粥样硬化斑块（NAP）形成并破裂,NSTEMI患者CAG诊断为晚期支架内血栓形成（LST）,OCT诊断为支架内NAP形成并破裂。UA患者CAG诊断为LST,OCT诊断为NAP、支架贴壁不良。7例（63．6％）患者存在吸烟史[7例（100％）未能戒烟],8例（72．7％）患者LDL—C控制不达标。结论支架贴壁不良和支架内新生粥样硬化斑块破裂均可导致LST的发生。支架内新生动脉粥样硬化斑块是引起DES植入后再发ACS的另一主要病因。     

光学相干断层扫描技术检测弱视患者视网膜厚度的研究进展

弱视（amblyopia）是视觉发育期内由于异常视觉经验（单眼斜视、屈光参差、高度屈光不正以及形觉剥夺）引起的单眼或双眼最佳矫正视力下降,眼部检查无器质性病变。根据异常视觉经验,将弱视分为四类：斜视性弱视、屈光参差性弱视、屈光不正性弱视和形觉剥夺性弱视。斜视的患病率是2%～4%[1]。OCT是20世纪90年代初期发展起来的一种新型非接触式、无创光学影像诊断技术,是利用眼中不同组织对光（用830mm近红外光）的反射性不同,通过低相干性光干涉测量仪,比较反射光波和参照光波测定发射光波的延迟时间和反射强度,分别测出不同组织的结构及其距离,经计算和处理成像,获得被检测组织的断层结构。     

近视眼神经纤维层厚度光学相干断层扫描分析

目的研究人视网膜神经纤维层(RNFL)厚度随近视眼屈光度加深而变化的特点及临床意义。方法将近视眼108例(197眼)和正常对照者42例(60眼)分为低度近视组、中度近视组、高度近视组和正常对照组,应用光学相干断层扫描仪(OCT)进行以视乳头为中心,直径3．46mm圆周的RNFL厚度测量,计算各组平均RNFL厚度及鼻、颞、上、下四个象限的RNFL厚度,各近视组分别与正常组对比,并进行统计学分析。结果低度、中度近视眼平均神经纤维层厚度变薄但与正常对照无显著性差异(P＞0．05),高度近视眼平均神经纤维层厚度明显变薄,与正常对照相比具有显著性差异(P＜0．01)。近视眼各象限RNFL最早变薄的是鼻象限,低度近视即与正常人有显著性差异(P＜0．01)。高度近视跟鼻、下、上象限RNFL均明显变薄(P＜0．01),而颞象限RNFL反而增厚,与正常人相比有显著性差异(P＜0．01)。结论近视眼平均RNFL厚度呈变薄的改变,随着近视度数的加深,近视跟RNFL厚度变薄越来越明显。分区分析上、下、鼻象限变化与平均相一致,而颞象限增厚,这可能是近视眼RNFL的特点。这些特点对临床疾病的诊断具指导意义。     

Follow up of retinal nerve fiber layer thickness with optic coherence tomography in patients receiving anti-tubercular treatment may reveal early optic neuropathy

Purpose: To evaluate the effect of anti-tubercular treatment on retinal nerve fiber layer (RNFL) thickness and the efficiency of optic coherence tomography (OCT) on early diagnosis of optic neuropathy.

Methods: Twenty patients diagnosed with either pulmonary or extra-pulmonary tuberculosis which were treated with anti-tubercular treatment (isoniazid (INH), rifampicin, ethambutol (ETM), and pyrazinamide) were enrolled in the study. RNFL thicknesses of the patients were measured via OCT, at baseline (before starting anti-tubercular treatment) and after the two-month treatment period. Standard ophthalmologic examinations were also performed.

Results: Compared to baseline values, after the two-month treatment period, thinning was detected in the right eye’s average and superior quadrant RNFLs (p?=?0.024 and p?=?0.006 respectively) and in the left eye’s average, superior quadrant, and inferior quadrant RNFLs (p?=?0.001, p?=?0.008, p?Conclusion: We displayed that patients receiving INH and ETM, which were the basic medicines of anti-tubercular treatment, experienced thinning in RNFL after the two-month treatment period. Patients receiving these drugs can be followed via OCT in terms of reduction in RNFL thicknesses for early diagnose of INH and ETM toxicity.     

The effect of cigarette smoking on retinal nerve fiber layer thickness in patients with migraine

Context: Migraine is a frequent and disabling chronic neurological condition with complex pathophysiology. Both cigarette smoking and migraine may cause damage to the optic nerve. Objective: The primary objective of this study was to investigate the effect of cigarette smoking on retinal nerve fiber layer (RNFL) thickness in patients with migraine.

Materials and methods: Eighty-four consecutive patients diagnosed with migraine (34 smokers and 50 nonsmokers) and 66 age- and gender-matched healthy non-smoker controls were enrolled for this observational cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography (OCT) and then RNFL thickness in patients with migraine who smoke was compared to nonsmoking patients with migraine and healthy subjects.

Results: The average, superior, nasal and inferior RNFL thicknesses were significantly thinner in patients with migraine compared to the control group (p?<?0.001, p?=?0.02, p?<?0.001 and p?=?0.04, respectively). The average and inferior RNFL thicknesses were significantly reduced in smoker patients with migraine compared to the nonsmokers (p?=?0.011, p?=?0.045, respectively). Nonsmoker patients with migraine had significantly thinner average and nasal RNFL thicknesses than the control group (p?=?0.001, p?=?0.001, respectively).

Conclusion: Cigarette smoking may cause significant RNFL thinning in patients with migraine. OCT may be a feasible technique for determination of smoking-induced ocular damage in patients with migraine.     

Evaluation of retinal nerve fiber layer thickness in vernal keratoconjunctivitis patients under long-term topical corticosteroid therapy

Purpose: The aim of this study was to evaluate the retinal nerve fiber layer (RNFL) thickness in vernal keratoconjunctivitis (VKC) patients who were under long-term topical corticosteroid therapy.

Methods: Thirty-six eyes of 36 VKC patients with clear cornea and normal videokeratography and 40 eyes of 40 age- and gender-matched normal children were included in the study. Clinical and demographic characteristics of the patients were noted and detailed ophthalmological examination was performed. Visual acuity (VA), spherical equivalent (SE), axial length (AL) and RNFL thickness measurements were compared between the groups. To correct ocular magnification effect on RNFL, we used Littmann’s formula.

Results: All VKC patients had history of topical corticosteroid use and the mean duration of the topical corticosteroid use was 23.8?±?9.09 months. There was no significant difference between the groups in terms of intraocular pressure (IOP). VKC group had significantly worse VA, greater SE and AL and thinner mean global, superior and inferior RNFL thickness. There were significant negative correlations between the duration of topical corticosteroid use and the mean global, superior and temporal RNFL thickness in VKC group. After correction of magnification effect, VKC group still had thinner mean global, superior and inferior RNFL thickness, and significant difference between the groups in inferior RNFL thickness did not disappear.

Conclusion: Significant RNFL thickness difference between the groups suggests a possible effect of long-term corticosteroid use in VKC patients. Because visual field (VF) analysis in pediatric patients is difficult to perform and IOP may be illusive, RNFL thickness measurements in addition to routine examinations in VKC patients may help clinicians in their practice.     

Assessment of macular choroidal thickness,central macular thickness and retinal nerve fiber layer in patients receiving oral isotretinoin treatment

Abstract

Purpose

To investigate the impact of oral isotretinoin therapy in choroidal thickness, central macular thickness (CMT), and retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT).     

血浆胰岛素水平与视盘周围血管密度和视网膜神经纤维层厚度的关系

目的探讨视盘周围血管密度(cpVD)和视网膜神经纤维层( RNFL)厚度与血浆胰岛素水平的关系。方法选取 2020年 7月至 2021年 7月西安市人民医院收治的 2型糖尿病病人 123例(123只眼)进行回顾性研究,根据是否发生糖尿病视网膜病变( DR)将病人分为: 2型糖尿病非视网膜病变( NDR)组( 50只眼)和非增生性糖尿病视网膜病变( NPDR)组( 73只眼),此外选取 58例( 58只眼)正常眼(于该院进行健康体检)作为对照组。收集研究对象一般资料,包括年龄、性别、身体质量指数( BMI)、总胆固醇(TC)、三酰甘油( TG)高密度脂蛋白胆固醇( HDL-C)低密度脂蛋白胆固醇( LDL-C)、收缩压( SBP)、舒张压( DBP)并进行比较;采用酶联免疫( ELISA)、法检测血浆胰岛素水平;应用光、学相干断层扫描血管成像(OCTA)观察cpVD和RNF,L厚度;受试者操作特征( ROC)曲线评价 cpVD与 RNFL厚度对 DR发生的预测价值。通过 logistic回归分析 DR发生的影响因素。结果与对照组比较, NDR组和 NPDR组病人 RNFL厚度显著变薄［( 96.66±10.47)比( 81.75±9.59)、(90.56±10.33)μm］cpVD显著降低,胰岛素水平显著降低(均 P<0.05);与 NPDR组相比, NDR组病人糖尿病病程及 BMI、SBP、DBP水平均升高( P<0.0,5); NDR组和 NPDR组病人血浆胰岛素水平与 cpVD呈正相关( r=0.26,P<0.05),与 RNFL厚度呈正相关( r=0.24,P<0.05),cpVD与 RNFL厚度呈正相关( r=0.30,P<0.05); NDR组和 NPDR组病人 cpVD、RNFL厚度与糖尿病病程、 BMI、SBP、DBP均呈负相关( P<0.05); logistic回归分析显示胰岛素水平、糖尿病病程是影响 DR发生的因素(P<0.05); ROC结果显示,胰岛素、 cpVD与 RNFL厚度 NPDR发生的曲线下面积( AUC)及 95%CI分别为 0.71(0.62,0.79)、 0.62(0.53,0.71)、 0.86(0.78,0.79),对应的灵敏度分别为83.56%、80.00%、88.00%,特异度分别为 56.00%、41.10%、71.23%。三者联合 NPDR发生的 AUC 95%CI为 0.89(0.83,0.94)灵敏度为 87.67%,特异度为 80.00%。结论 2型糖尿病病人血浆胰岛素水平与 cpVD和 RNFL厚度均呈正相关。血浆胰岛素水平,可能作为预测视网膜功能的早期指标, RNFL厚度以及 cpVD可作为诊断 DR的指标。     

单纯性近视眼鼻侧视网膜神经纤维层厚度变化影响因素研究

目的 探讨单纯性近视眼鼻侧视网膜神经纤维层厚度变化的影响因素.方法 选择2013年2月至2015年2月在我院眼科接受检查的近视眼患者122例(236眼),根据患者等效球镜度数分为低度近视眼组、中度近视眼组和高度近视眼组.进行眼科常规检查,以及等效球镜、眼压、眼轴长度和视野检查,并进行相关性分析.结果 三组间性别和年龄没有统计学差异(P＞0.05);随着近视程度的增加眼轴长度和等效球镜度数显著增加(P＜0.05);全周平均、上象限、下象限和鼻侧象限的视网膜神经纤维层厚度随着近视程度的增加而显著降低(P＜0.05);低度近视眼组、中度近视眼组和高度近视眼组鼻侧象限视网膜神经纤维层厚度与等效球镜度数和眼轴长度呈负相关.结论 单纯性近视眼患者鼻侧象限视网膜神经纤维层厚度与等效球镜度数和眼轴长度呈负相关.     

儿童屈光参差性弱视三维频域光学相干断层扫描的研究

目的研究儿童屈光参差性弱视与黄斑区厚度、视神经周围视网膜神经纤维层厚度的关系,探讨屈光参差性弱视发病的外周机制。方法从门诊患者中,随机选取屈光参差性弱视儿童(4¹4岁)35例,进行双眼视力,散瞳验光查屈光度检查,使用三维频域光学相干断层扫描(3D-OCT)对黄斑区厚度及视神经周围视网膜神经纤维层厚度进行检测。比较屈光参差弱视患儿的弱视眼与优势眼的黄斑区厚度及视神经周围视网膜神经纤维层厚度的差异。结果患儿平均年龄(9.2±2.8)岁,所有图像质量评分≥6分,弱视眼平均黄斑区厚度(288±15)μm,对比优势眼平均黄斑区厚度(281±12)μm,差异具有统计学意义(P=0.002)。结论使用3D-OCT检查,儿童屈光参差性弱视眼的黄斑区平均厚度较优势眼显著增厚。但优势眼和弱视眼的黄斑中心凹厚度,黄斑中央区,内环区及外环区视网膜厚度之间无明显差异。儿童屈光参差性弱视眼的视乳头周围视网膜神经纤维层厚度较优势眼也无显著变化。     

Recurrent optic disc and retinal vasculitis in a patient with drug-induced urticarial vasculitis

The purpose of this study was to report recurrent optic disc and retinal vasculitis in a patient with drug-induced urticarial vasculitis. Complete ophthalmological examination including fluorescein angiography and visual field examination were done. A 53-year-old woman with recurrent painful urticarial skin lesions following trimethoprim sulfamethoxazole usage had the clinical and histopathological diagnosis of urticarial vasculitis. Two years after cutaneous manifestations, she began to notice visual disturbances in both eyes that recurred at 1-year intervals. Her ophthalmological findings were consistent with recurrent vasculitis of the optic nerve and retina. Treatment with high-dose corticosteroids and hydroxychloroquine resulted in the resolution of cutaneous and ocular manifestations. This patient demonstrates that recurrent occlusive vasculitis of the optic nerve and retina can occur in this rare disease. These patients should be examined periodically by ophthalmologists.