B型超声在挫伤性前房积血患者诊断中的应用

目的 探讨B型超声在挫伤性前房积血患者眼后段病变诊断中的意义.方法 对眼钝挫伤前房积血患者75例(78只眼)进行B型超声检查,观察玻璃体及眼底的改变,并对其检查结果进行分析.结果 B型超声显示:78只眼中未见明显异常10只眼(12.82％),玻璃体混浊37只眼(47.44％),黄斑区水肿10只眼(12.82％);玻璃体积血7只眼(8.97％);玻璃体后脱离6只眼(7.69％);视网膜或脉络膜出血5只眼(6.41％);黄斑区视网膜前出血2只眼(2.56％);视乳头水肿2只眼(2.56％);后巩膜破裂伴周边部视网膜脱离及玻璃体积血1只眼(1.28％).结论 B型超声是眼后段疾病的一种重要检查方法,特别是对于眼钝挫伤所致前房积血的患者更有意义.为疾病的早期诊断及治疗提供依据.     

玻璃体后脱离的并发症

对有典型玻璃体后脱离症状的１０８例（１２７眼）进行了详细的眼底检查。发现所有受检眼均存在玻璃体后脱离，其中完全性玻璃体后脱离５９只眼，不完全性者６８只眼。并发症包括：视网膜裂孔３０只眼（周边圆孔１６只眼；马蹄形裂孔１４只眼），玻璃体积血７只眼，黄斑出血４只眼，黄斑裂孔４只眼，视网膜出血、黄斑区水肿及玻—网粘连灶各３只眼。文中对玻璃体后脱离及其并发症发生的机制进行了讨论。     

玻璃体后脱离的B型超声特点分析

目的了解不同类型玻璃体后脱离B型超声检查的形态特征及玻璃体后脱离与视网膜之间的关系。设计回顾性病例系列。研究对象玻璃体后脱离病例超声资料991例（1107眼）。方法回顾性分析玻璃体后脱离病例B型超声资料,根据玻璃体后界膜与后极部球壁的附着关系,分为完全和不完全玻璃体后脱离。主要指标玻璃体后脱离的形态及类型构成比。结果完全玻璃体后脱离710眼（64．1％）,其中伴有周边部裂孔性视网膜脱离69眼（17．3％）,且玻璃体后皮质与周边部隆起视网膜裂孔盖牵拉16眼（23．0％）。不完全玻璃体后脱离397眼（35．9％）：部分性不完全玻璃体后脱离159眼（40．0％）,其中伴有玻璃体后皮质增殖及劈裂的部分不完全玻璃体后脱离76眼（47．8％）;玻璃体后皮质与黄斑部球壁粘连者121眼（30．5％）;玻璃体后皮质与视盘处球壁粘连者117眼（29．5％）。结论超声检查可直观动态地观察不同类型玻璃体后脱离的形态特征及其与视网膜的关系,为临床诊断与治疗提供重要的形态学依据。（眼科,2009,18：118-120）     

Vogt-小柳-原田综合征葡萄膜炎期眼底病变特征

目的探讨Vogt-小柳-原田综合征（VKH）葡萄膜炎期眼底病变的临床特征。方法对首诊VKH患者71例（142眼）治疗前视力、病程、眼底及荧光素眼底血管造影（FFA）检查进行分析;25例（50眼）进行光学相干断层扫描（OCT）检查。结果71例（142眼）眼底有3种表现：32眼（22．5％）视盘水肿较重,视网膜脱离较轻（视盘型）;47眼（33．1％）视网膜脱离较重,视盘无水肿,仅表现为轻度充血（脉络膜型）;63眼（44．4％）视网膜脱离较重,视盘水肿亦较重（混合型）。3型年龄差异无统计学意义（F=2．57,P=0．084）;3型病程差异无统计学意义（F=0．91,P=0．407）;治疗前视力：视盘型与脉络膜型及混合型组间差异有统计学意义（t=4．49,P〈0．01;t=3．38,P=0．001）,脉络膜型与混合型组间差异无统计学意义（t=0．04,P=0．971）。结论VKH葡萄膜炎期的眼底表现可有3种类型。脉络膜炎性渗出及视网膜脱离是视力损害的主要因素,而视盘水肿视力损害较轻。3种类型的表现形式与年龄和病程间无相关。     

上海北新泾社区2型糖尿病患者黄斑水肿患病情况调查

目的 了解社区糖尿病视网膜病变患者黄斑水肿的患病情况。方法对上海北新泾街道社区100例（151只眼）15岁以上2型糖尿病患者进行直接检眼镜、眼底照相、超声波及相干光断层扫描（OCT）检查,并对检查结果进行统计学分析。结果实际调查对象795人,发现有糖尿病视网膜病变者215例,随机抽取100例糖尿病患者,有151只眼发生糖尿病视网膜病变,其黄斑中心凹平均厚度195．7μm;有46只眼的黄斑增厚,其中黄斑视网膜海绵样肿胀35只眼（76．1％）,黄斑囊样水肿8只眼（17．4％）,神经上皮层脱离3只眼（6．5％）。黄斑中心凹厚度与最佳矫正视力的负对数之间有相关性（r=0．2869,P=0．0004）。不同程度糖尿病视网膜病变者其黄斑水肿的患病情况有所不同（P=0．0003）。糖尿病黄斑水肿的发生与玻璃体后脱离情况的关联无统计学意义（P=0．472）。结论社区糖尿病视网膜病变患者中黄斑水肿患病率为37．1％。患眼的OCT图像归为三种类型：视网膜海绵样肿胀、黄斑囊样水肿及神经上皮层脱离。糖尿病视网膜病变的程度越重,发生黄斑水肿的可能性越大。糖尿病黄斑水肿与有无玻璃体后脱离无明显联系,与总胆固醇水平呈负相关。（中华腰科杂志．2007,43：626-630）     

玻璃体后脱离的并发平

对有典型玻璃体后脱离症状的１０８例（１２７眼）进行了详细的眼氏检查，民有受检眼均玻璃体后脱离，其中完全性玻璃体后脱离５９只眼，不完全性者６８只眼，并发症包括：视网膜裂孔３０只眼（周边圆孔１６只眼；马蹄表裂孔１４只眼），玻璃体积血７只眼，黄斑出血４只眼，黄斑裂孔４只眼，视网膜出因、黄斑区水肿及玻－网粘连灶各３只眼。 对玻璃体后脱离及其并发症发生的机制进行了讨论。     

降低视网膜脱离术后囊性黄斑水肿发病率探讨

目的 探讨降低视网膜脱离手术后囊性黄斑水肿发病率的方法。方法 ３５例３６只视网膜脱离手术成功眼，术后２周、４或６周和２～６月共三次进行荧光眼底血管造影术检查。手术：巩膜表面环扎加压和巩膜外手术联合玻璃体切除手术。严格局限中等强度冷凝于视网膜破口区，大破口或多个破口加用玻璃体切除术。结果 荧光血管造影证实３６只眼中有８只眼（２２．７％）黄斑改变，其中囊性黄斑水肿２只眼（５．５％），视网膜色素上皮脱离     

B超在穿孔性眼外伤辅助诊断中的作用

目的分析B型超声观察穿孔性眼外伤眼球中后段及眶内病变的意义。方法对临床确诊为眼球穿孔伤者,进行B超检查,观察玻璃体腔及球后的影像学变化。结果对129例（129眼）角巩膜穿孔伤,分别为锐器伤,细小异物击伤,钝物击伤,爆炸伤及原凶不明的外伤。B超探查发现轻微玻璃体浑浊73例,占56．59％;单纯玻璃体积血浑浊12例,占9．30％;眶内异物25例,占19．38％;玻璃体积血合并脉络膜脱离6例,占4．65％;玻璃体积血合并视网膜脱离6例,占4．65％;玻璃体积血合并视网膜脱离及脉络膜脱离7例,占5．43％。结论眼球穿孔伤多数伴有外伤性虹膜睫状体炎、外伤性白内障或玻璃体积血等影响眼底检查的因素,B超就成为了解这类患者眼球后段及眶内病变的重要检查方法,为临床诊断及下一步治疗提供重要的依据。     

激光光凝治疗糖尿病视网膜病变疗效观察

目的探讨激光光凝治疗糖尿病视网膜病变（DR）的治疗效果。方法 89例（178只眼）DR患者行激光光凝治疗后,定期观察视力,进行眼底及荧光素眼底血管造影（FFA）检查,记录眼底新生血管、视网膜出血渗出、玻璃体积血等情况,观察4个月至2年。结果激光治疗1个月后视力提高≥2行69只眼（38.7%）,无变化63只眼（35.3%）,视力下降≥2行35只眼（26%）。视网膜及视盘新生血管消退170只眼（95.5%）。8只眼（4.5%）发生玻璃体积血,行玻璃体切割术,术中璃体腔曲安奈德注射,补充激光治疗。结论激光光凝是治疗DR的有效方法 。     

玻璃体后脱离与视网膜分支静脉阻塞的预后

目的探讨玻璃体后脱离对视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)预后的影响。方法回顾性分析116例经荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊的BRVO患者116只患眼初诊时玻璃体检查结果与随访(10.7±2.2)个月时形成新生血管、发生黄斑水肿的临床资料,探讨玻璃体条件与眼后节新生血管形成、黄斑水肿的关系。结果FFA检查116只患眼中40只眼为缺血型改变,其中25只无玻璃体后脱离或部分性后脱离眼中,12只眼发现视网膜或(和)视盘新生血管形成,占48.0%;15只完全性玻璃体后脱离眼中只有1只眼产生新生血管,占6.7% (P＜0.05)。116只患眼中45只眼发生弥漫性黄斑水肿,占38.8%。视网膜黄斑粘连者黄斑水肿发生率为51.5%,显著高于视网膜黄斑分离者(22.0％) (P<0.01)。结论完全性玻璃体后脱离对BRVO发生眼后节新生血管和黄斑水肿具有一定阻止效应。(中华眼底病杂志,2001,17:2-4)     

Potential applications of optical coherence tomography in posterior segment trauma.

BACKGROUND AND OBJECTIVE: To describe potential clinical applications of optical coherence tomography (OCT) in diagnosis and surgical timing in eyes with posterior segment trauma. PATIENTS AND METHODS: In a noncomparative study, 7 consecutive patients who had open-globe or closed-globe injury and were found to have posterior abnormality that could also be detected by OCT are described. RESULTS: All patients had documented OCT abnormalities in the posterior segment. In one patient with a penetrating injury, two metal foreign bodies were located in the posterior segment, one in the vitreous compartment coupled with inflammatory reaction and localized posterior vitreous detachment and the other embedded in the retina. In a second patient with a penetrating injury, OCT revealed the appearance of posterior vitreous detachment 5 days after injury. A closed-globe injury in one patient resulted in anterior optic neuropathy, manifested as disc edema and thickening of the circumpapillary retinal nerve fiber layer. The other patients had received blunt trauma and were found to have either full-thickness macular holes (2 patients), retinal pigment epithelium detachment at the papillomacular bundle site (1 patient), or macular edema (1 patient). CONCLUSIONS: OCT may serve as an important adjunct imaging device in evaluation of injuries to the posterior segment, qualitatively and quantitatively. It has potential in diagnosing subtle key abnormalities and in follow-up of these injuries.     

Posterior segment manifestations of Rickettsia conorii infection

PURPOSE: To characterize and analyze the posterior segment manifestations of Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Thirty patients (60 eyes) with serologically proven MSF at the acute stage. METHODS: Patients underwent complete ophthalmic examination, including dilated biomicroscopic fundus examination, fundus photography, and fluorescein angiography. Sequential follow-up examinations were performed in patients with evidence of posterior segment involvement. RESULTS: Of 30 patients, 25 (83.3%) had unilateral (n = 5) or bilateral (n = 20) posterior segment involvement related to MSF. Of those 25 patients, 16 (64%) had no ocular symptoms, and 9 (36%) had ocular complaints. Findings included mild vitreous inflammation (45 eyes [75%]), white retinal lesions (18 eyes [30%]), focal vascular sheathing (5 eyes [8.3%]), multiple arterial plaques (1 eye [1.7%]), intraretinal hemorrhages (14 eyes [23.3%]), white-centered retinal hemorrhages (2 eyes [3.3%]), subretinal hemorrhages (2 eyes [3.3%]), serous retinal detachment (3 eyes [5%]), macular star (2 eyes [3.3%]), cystoid macular edema (1 eye [1.7%]), optic disc edema (1 eye [1.7%]), branch retinal artery occlusion (1 eye [1.7%]), optic disc staining (30 eyes [50%]), retinal vascular leakage (27 eyes [45%]), delayed filling in a branch retinal vein (1 eye [1.7%]), and multiple hypofluorescent choroidal dots (10 eyes [16.7%]). One eye (1.7%) had retinal neovascularization at the 6-month follow-up examination. All posterior segment findings at the acute stage resolved in 3 to 10 weeks, and the final visual acuity was 20/20 in 42 of 45 affected eyes (93.3%). Retinal pigment epithelium changes developed in 9 eyes (15%), with resolved full-thickness white retinal lesions. No other abnormalities were noted in the eye with retinal neovascularization over a further follow-up of 6 months. CONCLUSION: Posterior segment involvement, frequently asymptomatic, is common in patients with acute MSF. Because the diagnosis can be easily overlooked, a careful dilated funduscopic examination, complemented by fluorescein angiography in selected cases, is recommended. Mild vitritis, retinal vasculitis, optic disc staining, white retinal lesions, retinal hemorrhages, and multiple hypofluorescent choroidal dots are the most common manifestations of MSF. Posterior segment changes in a patient with fever and/or skin rash living in or returning from a specific endemic area, especially during the spring or summer, strongly suggest R. conorii infection.     

隐匿性后巩膜裂伤的B超诊断

目的探讨眼表无伤口而临床可疑后巩膜裂伤患者进行眼部B超扫描的意义。方法对临床可疑后巩膜裂伤36例（36只眼）进行常规B超检查,观察玻璃体腔及球后影像学变化。结果B超显示玻璃体明显积血浑浊者36只眼,占100％。合并出血性脉络膜脱离者29只眼,占80．56％。合并视网膜脱离者13只眼,占36．11％,8眼B超诊断后巩膜裂伤,表现为后部眼球壁弧度异常,或眼球壁回声不连续,眼球后相应部位可见大小不等的低回声眶内出血暗区。可疑部位均在中周部眼球壁。B超诊断后巩膜裂伤8眼经手术或病理证实均存在巩膜裂伤。结论对于重度眼部钝击伤,角膜及结膜无明显裂伤,但球结膜下大片出血灶,尤其是伴低眼压者,应常规行B超检查以排除后巩膜裂伤,以免贻误最佳手术时间。     

眼球钝挫伤39例临床分析

目的 初步观察和探讨眼球钝挫伤的常见原因、临床表现、治疗经过和效果.方法 对39例(53只眼)的眼球钝挫伤患者的病因、病情、治疗经过及结果进行详细记录,随访时间3～15个月,平均7个月.根据损伤的病程、部位和严重程度,结合眼底荧光m管造影(fundus fluorescence angiography,FFA)、超声生物显微镜(ultrasound biomieroscope,UBM)、眼B超、光学相干断层扫描(optical coherence tomography,OCT)、视诱发电位(visual evoked potential,VEP)等辅助检查,对其进行药物或手术治疗并观察疗效,分析眼球钝挫伤的主要原因和视力预后及其主要影响因素.结果 拳击伤是引起眼球钝挫伤的最主要原因,其次分别为物体撞击伤、车祸外伤及爆炸伤.16只眼(30.19%)损伤仪累及眼前节,表现为角膜擦伤、水肿,前房积血,虹膜睫状体炎,外伤性扩瞳,虮膜根部断离,房角后退,睫状体脱离,晶状体混浊伴(或不伴)晶状体不全或全脱位;26只眼(49.57%)损伤仅累及眼后节,表现为玻璃体积血,视网膜震荡、裂孔及脱离,脉络膜破裂,视神经水肿、萎缩;其余11只眼(20.75%)前、后节均受累.伤后初诊时最佳矫正视力(best corrected visual acuity,BCVA)0.1者占32.08%;经药物或手术治疗,末次随访时51只眼(96.23%)视力较前有所提高,13只眼(24.52%)BCVA 0.5.伤后24h内就诊的患者中,41.18%末次随访时BCVA0.5.结论 通过及时和有效的治疗,大部分眼钝挫伤患者的视功能可有所提高.视力预后与损伤部位、严重程度和伤后就诊时间有关,钝挫伤臻眼后节并发症者视力预后相对较差.     

高度近视眼黄斑视网膜劈裂光相干断层扫描观察

目的 观察高度近视眼黄斑视网膜劈裂的光相干断层扫描(OCT)图像及临床特征.方法 回顾性分析经最佳矫正视力、屈光度、前置镜、A/B型超声和OCT检查确诊的154例高度近视患者158只眼的临床资料.OCT检查主要进行黄斑部水平及垂直线性扫描.根据OCT检查后极部是否存在视网膜劈裂,将其分为劈裂组、非劈裂组.其中,劈裂组53例55只眼,占34.8%;非劈裂组101例103只眼,占65.2%.回顾分析时,对两组患者年龄、性别、屈光度、视力、眼轴长度、后巩膜葡萄肿发生率、玻璃体牵引率、视网膜脱离发生率进行比较.结果 B型超声检查显示,158只眼均有后巩膜葡萄肿.OCT检查显示,视网膜劈裂组55只眼中,内层劈裂15只眼,占27.3%;外层劈裂53只眼,占96.4%;中层劈裂7只眼,占12.7%.内外层劈裂可单独存在,也可共存于同一患眼,中层劈裂都与外层劈裂相伴.存在2种或以上类型的劈裂13只眼,占23.6%;单纯外层劈裂40只眼,占72.7%;仅有内层劈裂2只眼,占3.6%.伴视网膜脱离26只眼,占47.3%;伴黄斑裂孔13只眼,占23.6%;伴玻璃体牵引12只眼,占21.8%.非劈裂组103只眼中,伴玻璃体牵引23只眼,占22.3%;黄斑裂孔19只眼,占18.4%;视网膜脱离21只眼,占20.4%.两组患者年龄(t=0.250)、屈光度(t=1.156)、眼轴(t=0.252)、性别(X2=1.075)构成、黄斑裂孔(X2=0.598)、后巩膜葡萄肿(X2=∞)、玻璃体牵引(X2=0.05)的发生率比较.差异均无统计学意义(P>0.05);但视网膜劈裂组视力明显低于非劈裂组(X2=6.345,P<0.05);视网膜脱离的发生率明显高于非劈裂组(X2=12.400,P<0.05).结论高度近视眼黄斑视网膜劈裂存在于视网膜内中外多个层次,其中外层劈裂最常见;患者往往视力低下且常伴发其他黄斑病变,以视网膜脱离最常见.     

高度近视眼黄斑视网膜劈裂光相干断层扫描观察

目的 观察高度近视眼黄斑视网膜劈裂的光相干断层扫描(OCT)图像及临床特征.方法 回顾性分析经最佳矫正视力、屈光度、前置镜、A/B型超声和OCT检查确诊的154例高度近视患者158只眼的临床资料.OCT检查主要进行黄斑部水平及垂直线性扫描.根据OCT检查后极部是否存在视网膜劈裂,将其分为劈裂组、非劈裂组.其中,劈裂组53例55只眼,占34.8%;非劈裂组101例103只眼,占65.2%.回顾分析时,对两组患者年龄、性别、屈光度、视力、眼轴长度、后巩膜葡萄肿发生率、玻璃体牵引率、视网膜脱离发生率进行比较.结果 B型超声检查显示,158只眼均有后巩膜葡萄肿.OCT检查显示,视网膜劈裂组55只眼中,内层劈裂15只眼,占27.3%;外层劈裂53只眼,占96.4%;中层劈裂7只眼,占12.7%.内外层劈裂可单独存在,也可共存于同一患眼,中层劈裂都与外层劈裂相伴.存在2种或以上类型的劈裂13只眼,占23.6%;单纯外层劈裂40只眼,占72.7%;仅有内层劈裂2只眼,占3.6%.伴视网膜脱离26只眼,占47.3%;伴黄斑裂孔13只眼,占23.6%;伴玻璃体牵引12只眼,占21.8%.非劈裂组103只眼中,伴玻璃体牵引23只眼,占22.3%;黄斑裂孔19只眼,占18.4%;视网膜脱离21只眼,占20.4%.两组患者年龄(t=0.250)、屈光度(t=1.156)、眼轴(t=0.252)、性别(X2=1.075)构成、黄斑裂孔(X2=0.598)、后巩膜葡萄肿(X2=∞)、玻璃体牵引(X2=0.05)的发生率比较.差异均无统计学意义(P>0.05);但视网膜劈裂组视力明显低于非劈裂组(X2=6.345,P<0.05);视网膜脱离的发生率明显高于非劈裂组(X2=12.400,P<0.05).结论高度近视眼黄斑视网膜劈裂存在于视网膜内中外多个层次,其中外层劈裂最常见;患者往往视力低下且常伴发其他黄斑病变,以视网膜脱离最常见.     

Optic disc pit maculopathy after blunt ocular trauma

PURPOSE: To present a symptomatic optic pit 3 months after a blunt ocular trauma. METHODS: A 16-year-old male with unilateral decreased vision was examined with multiple cross-sectional scans using optical coherence tomography (OCT) and kinetic ultrasound at the optic disc and macula. RESULTS: Visual acuity was 20/30 OD and 20/20 OS. Fundus examination OD demonstrated an optic pit with a corresponding serous macular detachment. OCT disclosed a schisis-like separation of the inner retinal layer emanating from the optic disc and an outer layer detachment of the retina. B-scan ultrasound disclosed attached Choquet's canal at the optic pit. CONCLUSIONS: Patients with optic pit and firm adherent posterior vitreous may develop schisis-like retinal detachments after blunt ocular trauma.     

玻璃体不全后脱离所致视网膜病变的光学相干断层扫描观察

目的分析玻璃体不全后脱离的光学相干断层扫描(optical coherence tomography,OCT)图像特征,探讨玻璃体不全后脱离与所引发的玻璃体视网膜病变的关系。方法对81例(86只眼)玻璃体不全后脱离患者进行眼科常规检查、B型超声检查和OCT检查,并对所获得的OCT图像进行分析,观察玻璃体视网膜界面的异常图像特征。结果27只眼显示特发性玻璃体黄斑牵引综合征;25只眼显示特发性黄斑前膜;25只眼显示后界膜牵拉导致特发性黄斑板层裂孔及全层黄斑裂孔形成;9只眼显示玻璃体后界膜与黄斑部及视盘周视网膜神经上皮层多处牵拉粘连。结论OCT能够直观的显示玻璃体不全后脱离与所引发的黄斑部视网膜病变的进展变化,并可进行定量、定性分析与鉴别诊断。     

Vitreous findings in optic disc pit maculopathy based on optical coherence tomography

Background To assess vitreous findings in optic disc pit maculopathy using Optical Coherence Tomography (OCT). Methods Thirty-eight eyes of 38 patients (14–51 years of age) with macular detachment associated with optic disc pit maculopathy were included in the study. The patients were divided into two groups. In group 1, 16 eyes were studied by OCT at presentation and after surgical treatment. In group 2, 22 eyes were examined by OCT only after treatment. In both groups thorough vitreous examination was performed over the macula and the optic disc. All patients were operated by the macular buckling procedure. Results Vitreous abnormalities were found in 28 out of 38 eyes (74%) of both groups. In group 1, 10 of the 16 eyes had vitreous traction on the macula at presentation. The traction started from the optic disc and terminated to the macula. The posterior hyaloid that exerted the traction between the points of adhesion at the optic disc and the macula had a course parallel to the retinal surface in 9 of the 10 cases. Postoperatively, vitreous traction on the macula was not found. Of the remaining 6 eyes 4 had complete or partial posterior vitreous detachment. In group 2, 8 eyes had vitreous strands over the optic disc and 5 eyes posterior vitreous detachment. In the remaining 9 cases no vitreous involvement was noticed. Conclusions OCT was able to detect vitreous abnormalities such as vitreomacular traction, vitreous strands over the optic disc and complete or partial posterior vitreous detachment associated with optic disc pit maculopathy. Our observations support the view that the abnormal vitreous over the macula and optic disc is likely to play a role in the development of macular elevation in cases with optic disc pit. Prospective OCT studies could further assist to better understand the role of vitreous in this disease.