Metastatic tumor to the iris and ciliary body as an initial sign of lung cancer: a case report

The most common sites of lung cancer metastases are pleura, bone, brain,pericardium and liver. Tumor metastasis to the eye is a rare complication of lung cancer. Metastatic cancer to the ocular region most often involves the uveal tract, however, most uveal metastases occur in the posterior uvea, and iris metastases are relatively rare. We describe a patient with adenocarcinoma of the lung metastatic to the iris as the first clinical sign without symptoms of lung cancer.     

康柏西普联合玻璃体切割术治疗视网膜血管瘤引起的 视网膜脱离的疗效观察

目的 回顾性分析视网膜毛细血管瘤(RCH)引起的视网膜脱离患者行单纯玻璃体切割手术或玻璃体腔注射康柏西普联合玻璃体切割手术的治疗效果。 方法 采用23 G玻璃体切割术和激光凝固和(或)冷冻疗法治疗15例(15眼)由RCH引起的视网膜脱离患者,其中6例(6眼)玻璃体腔内注射康柏西普7 d后行玻璃体切割术(注射组),9例(9眼)单纯行玻璃体切割术(未注射组)。记录手术时间、最佳矫正视力(BCVA)、眼底情况、荧光素血管造影(FFA)结果以及全身情况,并进行比较分析。 结果 未注射组中,7眼视网膜平复、肿瘤消退,1眼出现新的RCH,1眼复发视网膜脱离。注射组中,5眼术后视网膜平复、肿瘤消退,1眼复发视网膜脱离。 结论 23 G玻璃体切割联合玻璃体腔注射康柏西普,对RCH引起的严重的出血性视网膜脱离有较好的疗效,可明显减少手术时间及术中出血,减少手术次数。根据FFA的结果行激光光凝和(或)冷冻治疗是治疗成功的重要因素。     

玻切手术治疗脉脱型视网膜脱离

目的:探讨合并严重增殖的脉脱型视网膜脱离(PVR)的患者,行玻璃体切除的手术效果.方法:回顾性分析1998～2001年在我院就诊,最初术式选择为玻切手术的41例脉脱型视网膜脱离患者(PVR均为C级以上)的术前及术后的详细临床资料.结果:初次玻切手术后38眼网膜复位(92.6%),3眼短期出现再次脱离.网膜复位的38眼中,随访25眼,随访时间为1～18月(平均8.6个月),19眼(76%)最终复位,6眼再次出现视网膜脱离.玻切手术中裂孔的发现率明显高于术前.结论:玻璃体切除术是治疗PVR严重的脉脱型视网膜脱离有效方法,可提高视网膜复位的成功率.     

息肉状脉络膜血管病变

目的 观察息肉状脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）的发病率及其临床特征。方法 回顾性分析1997～2003年诊断为渗出型AMD163例157眼脉络膜新生血管（choroidal neovascu larization，CNV）的眼底血管造影资料。结果 54例55眼符合PCV，分别占本组CNV患者163例157眼的33％和35％。除1例为双眼发病外，其余均为单眼。男性36例36眼、女性18例19眼，经统计学分析男女发病率无明显差别（t=1．847，P〉0．05）。年龄47～75岁，平均61．8岁。网膜下出血部位主要位于后极部，39眼可见橘红色病灶，其中34眼合并黄白色脂质渗出，13眼合并玻璃体积血。荧光素眼底血管造影（fundus fluorescein angiographv，FFA）显示：22眼出血性色素上皮脱离，12眼网膜下出血联合浆液性色素上皮脱离，9眼出血性色素上皮脱离联合浆液性神经上皮脱离。2眼浆液性色素上皮脱离。8眼仅表现为网膜下出血遮蔽伴息肉状斑点样高荧光而无色素上皮和或神经上皮脱离；息肉状斑点样高荧光位置：黄斑区32眼，混合区（黄斑区＋血管弓区、黄斑＋乳头旁、视盘旁＋血管弓区）7眼，血管弓区5眼，视盘旁区3眼，中周区1眼，7眼未显现斑点样高荧光。结论 PCV多见于老年病人，大部分为单眼发病，男女发病率差异不明显，通过临床上见到的后极部大片网膜下出血性合并橘红色病灶和（或）黄白色脂质渗出以及FFA所显示的脉络膜斑点状或花簇状高荧光及其位置，可作出初步诊断。     

Perfluorocarbon liquid-assisted external drainage in the management of central serous chorioretinopathy with bullous serous retinal detachment

The differential diagnosis of serous retinal detachment (RD) includes Vogt-Koyanagi-Harada syndrome, severe hypertensive choroidopathy, posterior scleritis, multifocal choroiditis, metastatic tumor, and uveal effusion. Some cases of serous retinal detachment occur as a result of central serous chorioretinopathy (CSCR). Typical CSCR generally affects healthy middle-aged males and is characterized by localized serous RD of the neurosensory retina and retinal pigment epithelium in the macula that often spontaneously improve within 2 to 3 months. On rare occasions, variant CSCR with bullous RD occurs which is frequently misdiagnosed. We report on a case of variant CSCR with severe bullous serous retinal detachment in the left eye that was initially treated at another hospital under the misdiagnosis of rhegmatogenous retinal detachment. Because the retinal detachment developed so fast that a laser could not be applied to all leaking spots, we performed a pars plana vitrectomy, pertluorocarbon liquid-assisted external drainage, and final treatment with an endolaser. The retina was well attached after this management.     

玻璃体切除手术的疾病构成分析

目的：探讨一种可用于对玻璃体切除手术病例进行大样本临床研究的疾病分类方法。方法对429例玻璃体切除手术连续病例的全部ICD-10编码进行分析和归类,统计方法使用描述性统计、频次分析。结果将全部玻璃体切除手术疾病分为相互独立的10类：（1）眼外伤,（2）糖尿病相关眼病,（3）眼内肿瘤,（4）非外伤性眼内炎,（5）视网膜脱离,（6）无视网膜脱离的玻璃体视网膜病变,（7）黄斑病变,（8）白内障/晶体病变,（9）青光眼,（10）其他。ICD编码的出现频次和条目数分别反映了各类疾病在玻璃体切除手术病例中的普遍性和内在病变多样性。结论基于ICD编码的手术疾病分类方法简明、合理,反映了玻璃体切除手术的疾病特征和复杂性,可有效用于对玻璃体切除手术病例的大样本临床研究。     

393例儿童视网膜脱离的原发疾病及其分布的临床特征

  目的   研究儿童视网膜脱离的原发疾病以及其分布的临床特点。   方法   回顾性分析从2015年1月?2020年12月因视网膜脱离而就诊于四川大学华西医院且年龄小于15岁患者的病历资料。记录患者的年龄、性别、病史、视网膜脱离范围以及预后。   结果   在纳入的393例（464只眼）儿童视网膜脱离患者中,男性261例（312只眼）,女性132例（152只眼）,男女比例为1.98∶1。儿童视网膜脱离最常见的原发疾病为眼部发育异常（57.8%,227例）,其次为眼外伤（19.8%,78例）和近视（14.2%,56例）。婴幼儿期、学龄前期视网膜脱离主要的原发疾病为眼部发育异常,比例分别81.8%（126例）、55.8%（43例）;学龄期的主要原发疾病为眼部发育异常（35.8%,58例）、近视（30.2%,49例）和眼外伤（26.5%,43例）。儿童视网膜脱离最常见的类型为孔源性视网膜脱离（46.8%,184例）,其中眼外伤（37.5%,69/184）和近视（30.4%,56/184）是其常见的两种原发疾病;其次为牵拉性视网膜脱离（43.3%,170例）,其中家族性渗出性玻璃体视网膜病变（familial exudative vitreoretinopathy, FEVER）占47.6%（81/170）,为常见原发疾病;渗出性视网膜病变最少见（9.9%,39例）,其中Coats病占71.8%（28/39）为常见原发疾病。与牵拉性全视网膜脱离相比,孔源性全视网膜脱离的首次术后效果较佳（|Z|=3.026,P=0.002）。儿童孔源性视网膜脱离,裂孔常见的位置为颞侧。原发疾病为眼外伤的视网膜脱离最常见的裂孔为视网膜撕裂孔,其次为锯齿缘离断;近视所导致的孔源性视网膜脱离其裂孔最常见的位置为变性区的圆孔。   结论   在本研究中视网膜脱离患者男生人数多于女生,眼部发育异常、眼外伤、近视是儿童视网膜脱离的主要原发疾病。应根据不同的年龄段,开展不同的宣传教育。      

H1N1流感疫苗注射后出现渗出性视网膜脱离伴葡萄膜炎两例

Objective: To report two cases of exudative retinal detachment and uveitis following vaccination of H1N1 influenza. Methods: The data of two patients with exudative retinal detachment and uveitis following vaccination of H1N1 influenza who underwent systemic steroid treatment in our department were retrospectively analyzed. Results: Case1 was a 10-year-old boy and develop vitreous opacity and exudative retinal detachment at 10 days after vaccination of H1N1 influenza. Intravenous use of 500 mg methylprednisolone for 5 days following by oral prednisone (130mg; 5 mg decreasing each week). One month after treatment, vitreous got clear, subretinal fluid disappeared, and his visual acuity increased. Case2 was a 47-year-old female with type2 diabetes. At 2 days after she underwent the vaccination of H1N1 influenza, she suffered from a fever. One month later, she encountered bilateral headache and decreasing vision. Visual acuity was 0.02 (right) and 0.12 (left). In both eyes, mutton fat keratic precipitates, slightly positive Tyndall phenomenon, congestion of optic disc and exudative retinal detachment at posterior pole were observed. Intravenous use of 1000 mg methylprednisolone for 3 days, following by oral prednisone (130mg; 5 mg decreasing each week) was given. One month after treatment, subretinal fluid disappeared while choroidal hyperfluorescence was observed. Her visual acuity was 0.01 and IOP was 14mmHg in both eyes. Conclusions: In the current hot time of worldwide vaccination of H1N1 influenza, ophthalmologist should be aware of this rare complication. Early use of systemic steroid may be associated with a better prognosis.     

玻璃体切割术联合内界膜剥离术治疗黄斑裂孔性视网膜脱离的临床观察

目的探讨玻璃体切割术联合内界膜剥离术治疗黄斑裂孔性视网膜脱离的临床疗效。方法采用玻璃体切割术治疗联合内界膜剥离术治疗23例黄斑裂孔性视网膜脱离,观察1月、3月术前、术后黄斑区OCT检查结果情况及视力变化。结果①23例黄斑裂孔性视网膜脱离患者中,OCT检查21眼黄斑裂孔已封闭,黄斑裂孔及视网膜总解剖复位率91.30%。②23例MHRD患者解剖复位的21眼中,视力改善19只眼,2眼视力无变化。结论应用玻璃体切割术联合内界膜剥离术治疗黄斑裂孔性视网膜脱离术后解剖复位率高,并发症少,视力得到一定程度的改善。     

玻璃体手术治疗伴脉络膜脱离的孔源性视网膜脱离临床研究

目的评价玻璃体手术联合眼内填充硅油治疗合并脉络膜脱离的孔源性视网膜脱离的效果。方法临床确诊的孔源性视网膜脱离合并脉络膜脱离的患者共21例（2l眼）纳入研究。在非接触式广角镜下,患者均行闭合式玻璃体手术及硅油填充,部分患者联合晶状体手术。观察手术前后视力变化、眼压变化以及术后视网膜复位率等情况。结果一次手术视网膜复位15眼（71．5％）,多次手术最终视网膜复位19眼（90．5％）。最终视力〉0．1者7眼（33．3％）,手术后视力提高者共17眼（80．9％）。术前眼压平均6．1mmHg,术后眼压平均14．8mmHg,术后眼压明显改善,两者相比差异有统计学意义。结论合并脉络膜脱离的孔源性视网膜脱离玻璃体手术处理得当可获得较好的效果。     

经赤道部裂孔气液交换在玻璃体手术中的应用

目的 探讨玻璃体手术中用笛形针经赤道部裂孔引流视网膜下液的可行性及效果. 方法 对2006-05-2008-01在本院行玻璃体手术的64例64只眼伴有赤道部裂孔需行玻璃体切除的患眼作回顾性分析.其中合并严重增生性玻璃体视网膜病变27只眼,巨大裂孔性视网膜脱离2只眼(180°以上裂孔),合并脉络膜脱离5只眼,复发性视网膜脱离4只眼.手术方法包括经平坦部玻璃体切除,剥除增生膜,松解牵引,笛形针经赤道部裂孔引流视网膜下液,眼内激光光凝,硅油或C3F8填充.手术操作均在130°全视野镜下进行. 结果 除3例周边部裂孔、2例巨大裂孔及3例大范围视网膜切开患者外,其他56例均能经赤道部裂孔引流达到视网膜复位. 结论 在全视网膜镜下经赤道部裂孔气液交换能达到良好的视网膜复位的效果,避免术中行后极部视网膜造孔内引流或使用全氟化碳液体,简化了手术操作,同时也减轻了患者经济负担,具有一定的实用价值.     

Two cases of exudative retina detachment and uveitis following H1N1 influenza vaccination

Uveitis was a rare adverse event of vaccination. We met two cases of acute uveitis with exudative retinal detachment following vaccination of H1N1 influenza. Case 1 was a 10-year-old boy who was admitted for bilateral blurred vision at 10 days after vaccination of H1N1 influenza. Vitreous opacity was obvious in both eyes. Broad exudative retinal detachment was observed in the right eye. Case 2 was a 47-year-old female who suffered from an acute high fever at 2 days after the vaccination of H1N1 influenza. Later, she encountered bilateral headache and decreasing vision. In both eyes, mutton fat keratic precipitates, positive Tyndall phenomenon, congestion of optic disc and exudative retinal detachment were observed.

     

药物治疗中心性渗出性脉络膜视网膜病变效果探讨

目的探讨药物治疗中心性渗出性脉络膜视网膜病变的方法及疗效。方法选择我院确诊的中心性渗出性脉络膜视网膜病变患者35例(均为单眼发病),采用中西医结合治疗,观察治疗效果。结果 35例患者中,治愈12例(34.29%),好转20例(57.14%),无效3例(8.57%),总有效率为91.43%。结论中西医结合治疗中心性渗出性脉络膜视网膜病变有较好的疗效。     

11例巩膜扣带术后复发性视网膜脱离原因分析和处理

目的 巩膜扣带术后复发性视网膜脱离是严重危害患者视力的复杂性视网膜脱离,其原因很多,本研究回顾性分析11例巩膜扣带术后复发性视网膜脱离的患者,研究复发性视网膜脱离的原因和处理方法,为此类患者的治疗提供临床依据。 方法 收集2016年1月—2017年12月中国科学技术大学附属第一医院收治的11例(11只眼)巩膜扣带术后复发性视网膜脱离患者的临床资料,通过收集眼底检查、再次手术方式和视力情况,分析复发原因和手术方式选择及视功能恢复情况。 结果 复发性视网膜脱离患者中原裂孔哆开的为3只眼,新发裂孔的为8只眼,合并人工晶体眼2例2只眼,高度近视3例3只眼,PVR B级的为1眼,C1级的为8眼,C2级的2眼,具有陈旧性视网膜脱离特征的共5例5只眼。再次施行巩膜扣带术1只眼;玻璃体切除(简称“玻切”)+C3F8填充1只眼;玻切+硅油填充的9只眼。术后视网膜均已复位。术后患者平均最佳矫正视力为3.61±1.20,与术前平均最佳矫正视力(3.26±1.14)比较明显提高,差异有统计学意义(t=-3.121,P<0.05,95%CI:-0.592~-0.098)。 结论 原裂孔哆开、视网膜增殖导致新发裂孔、术中冷冻过强等原因是巩膜扣带术后复发视网膜脱离的主要原因。对于年轻人,无PVR,局限性视网膜脱离尽量再次选择巩膜扣带术;玻切术中尽量以激光封闭裂孔为主,可预防性眼内嵴后或360°赤道部3~4排激光;PVR C2级以上患者,尽量选择硅油填充。      

Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel–Lindau disease

Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed.     

Von Hippel angioma

We report a three year follow up of a 35-year-old Indian gentleman who presented with sudden, painless blurring of left (L) eye vision with initial visual acuity (VA) of 6/60. Fundoscopy revealed (L) vitreous haemorrhage and subsequently confirmed a (L) inferotemporal capillary haemangioma. The adjacent area of capillary haemangioma was treated with barricade argon laser photocoagulation to prevent progression of exudative retinal detachment inferiorly. Subsequent follow up showed mild regression of capillary haemangioma with maintenance of (L) eye vision at 6/9.     

巩膜扣带联合注气术治疗玻璃体切除术后非增殖性视网膜脱离的临床分析

目的总结巩膜扣带联合玻璃体腔注气术治疗玻璃体切除术后非增殖性视网膜脱离的临床疗效。方法回顾性分析2007年1月至2011年12月收治的玻璃体切除术后非增殖性视网膜脱离7例患者,共7只眼行巩膜扣带联合玻璃体腔注气术。手术后随诊4～19个月,观察术后视网膜复位、术后视力恢复及并发症发生情况。结果所有7只眼治愈（100％）,7例患眼视网膜裂孔均封闭,视网膜复位。2眼术后发现裂孔周围冷冻瘢形成不理想,于术后5～10d眼内气体填充状态下补充眼底激光治疗后裂孔封闭。1眼于扣带术后37d发现另一象限周边视网膜小裂孔,局限视网膜脱离经再次巩膜扣带联合玻璃体腔内注气术后,视网膜完全复位,未发生其他并发症。结论巩膜扣带联合玻璃体腔注气术治疗玻璃体切除术后非增殖性视网膜脱离,可避免再次玻璃体切除手术对眼内结构损伤,有利于视功能较快恢复,具有安全、有效、易于操作等特点,可作为治疗玻璃体切除术后非增殖性视网膜脱离的术式之一。     

乳腺癌眼转移的诊治探讨

目的探讨乳腺癌患者眼葡萄膜转移的诊治。方法回顾性分析重庆医科大学附属第一医院2007年1月至2011年8月收治的2400例乳腺癌中2例眼葡萄膜转移患者的症状、体征、辅助检查、诊治经过及预后等资料。结果2例均以视物模糊、视力下降为主要症状,行眼底检查、眼底血管荧光造影均为单眼脉络膜转移（发现率为0．08％）。例l在乳腺癌确诊前发现眼转移,例2在乳腺癌术后第4疗程辅助化疗期间发现眼转移。2例患者在治疗期均未见其他部位转移,予以TEC方案化疗后眼部症状明显改善。结论眼葡萄膜转移可发生在乳腺癌的各期;及时发现与诊治,可有效控制病变进展,保护视力和改善生活质量;乳腺癌患者尤其是出现视物模糊、视力下降等眼部症状时应行眼部检查。     

手术治疗高度近视眼黄斑裂孔视网膜脱离临床观察

目的评价高度近视眼黄斑裂孔视网膜脱离手术的成功率并分析有关因素。方法对15例高度近视眼黄斑裂孔视网膜脱离患者行玻璃体切除联合眼内填充18％C3F8或硅油手术。术后严格俯卧位至少2周以上。结果13只眼黄斑裂孔闭合视网膜复位，13只眼术后视力提高，2只眼术后视力无变化。术后主要并发症为晶状体核轻度硬化2只眼，眼压升高1只眼，纤维素性渗出2只眼，双眼复视1只眼。结论玻璃体切割联合眼内填充18％C3F8或硅油是治疗高度近视眼黄斑裂孔视网膜脱离安全有效的方法之一。术前详细检查眼底、正确设计手术方案及良好的手术技术是治疗本病的关键。     

视网膜裂孔和视网膜脱离伴玻璃体积血的治疗

目的 观察视网膜裂孔和视网膜脱离伴玻璃体积血的治疗效果。方法 回顾性分析应用双眼遮盖、激光光凝及手术治疗视网膜裂孔和视网膜脱离伴玻璃体积43例（43眼）血病人的临床资料。结果 经双眼遮盖治疗1～14d（平均4．6d）,眼底可视度增加。其中24眼行激光光凝封闭视网膜裂孔,4眼行局部巩膜外垫压术,术后视网膜复位,裂孔封闭,无再出血。15眼行三通道闭合式玻璃体切除术,术后视网膜脱离复发1例。结论 视网膜裂孔和视网膜脱离伴玻璃体积血时,双眼遮盖并及时行激光光凝封闭视网膜裂孔以及早期手术是争取较好视力预后的关键。