糖尿病视网膜脱离激光治疗后脉络膜脱离一例

患者,男,61 岁,因“右眼视力下降半月余”来我院就诊。既往糖尿病病史15 余年,目前药物治疗血糖控制尚可。否认其他疾病、外伤及手术史。眼部检查：右眼视力0.1（矫正无提高）,左眼0.6（矫正无提高）。双眼角膜透亮,前房中深,虹膜纹理清,瞳孔圆,对光反射存在,晶状体皮质混浊。右眼下方玻璃体混浊伴积血。眼底镜检查示右眼眼底可见视盘边清色可,各象限视网膜可见微血管瘤、出血、硬性渗出及纤维增殖膜,鼻侧纤维增殖膜牵拉视网膜轻隆起;左眼眼底可见视盘边清色可,各象限视网膜可见微血管瘤、出血、硬性渗出及棉絮斑。眼科B超示右眼玻璃体混浊机化、玻璃体积血,局部牵拉性视网膜脱离（见图1A）,左眼玻璃体混浊。眼科诊断：①双眼糖尿病视网膜病变（右眼Ⅵ期,左眼Ⅲ期）;②双眼年龄相关性白内障（含并发因素）。建议患者行右眼玻璃体手术。就诊当天给予患者右眼可见范围内视网膜激光光凝,参数如下：能量240～360 mW;光斑直径200～500 μm;曝光时间0.1～0.3 s,激光点数1 020。上述激光参数遵照治疗指南选择[1,2]。术后第2 天彩色眼底照相检查发现实性棕色隆起（见图2）。眼B超示不与视盘相连的与眼球壁弧形相对的弧形条状回声,条状光带与后壁回声间为无回声暗区（见图1B）。考虑脉络膜脱离,拟行“右眼玻璃体切割联合内界膜剥除+激光光凝+硅油注入+超声乳化白内障吸除及人工晶状体植入术”。术中见后极部黄白色增殖膜,鼻侧视网膜苍白、隆起,存在治疗性激光斑,手术顺利。术后1 周复查视网膜及脉络膜平伏,复位良好。     

特发性息肉样脉络膜血管病变一例报告

目的：报道1例特发性息肉样脉络膜血管病变的眼底荧光血管造影与吲哚青绿血管造影的临床特点。方法：常规眼科检查、眼底照相、荧光血管造影、吲哚青绿血管造影分析以及文献复习。结果：特发性息肉样脉络膜血管病变患者缺乏典型的玻璃疣,但可在视乳头与黄斑间出现大量泥沙样黄色渗出,眼底荧光血管造影中没有老年性黄斑变性样的新生血管,吲哚青绿血管造影中可见典型的息肉样脉络膜血管扩张,可单眼发病。结论：特发性息肉样脉络膜血管病变在临床表现以及眼底血管造影方面均有特征性改变。区分特发性息肉样脉络膜血管病变与老年性黄斑变性在疾病的视力预后、转归以及治疗处理上都有实际的临床意义。     

Choroidal Neovascular Membrane Formation and Retinochoroidopathy in a Patient with Systemic Langerhans Cell Histiocytosis: A Case Report and Review of the Literature

We report a case of bilateral atrophic retinochoroidopathy with choroidal neovascular membrane (CNVM) formation in a patient with systemic Langerhans cell histiocytosis (LCH). A 35-year-old female, diagnosed with LCH at the age of 3, experienced an episode of acute vision loss in her right eye. Visual acuity was counting fingers. Dilated fundus exam and fluorescein angiography revealed the presence of CNVM along with bilateral widespread areas of chorioretinal atrophy. The patient underwent removal of CNVM with excellent postoperative visual acuity (20/25); however, indolent progression of her disease led to gradual deterioration of visual acuity (20/80 in the right eye and 20/320 in the left). This case shows that in contrast to previous reports, intraocular involvement of LCH does not need to be dramatic and clinically evident but it can acquire a chronic degenerative form. This report aims to raise awareness among ophthalmologists concerning the potential intraocular sequelae of LCH.Key Words: Langerhans cell histiocytosis, Choroidal neovascular membrane, Intraocular involvement     

Optic Nerve Sheath Meningioma in a Patient with Choroidal Malignant Melanoma: A Case Report of a Complex Neurocristopathy

Purpose: To describe the clinical findings in a patient who had developed choroidal melanoma and was incidentally found to have meningioma of the optic nerve in the same side.

Methods: Clinical and histopathological findings of the case are reviewed and presented.

Results: The patient had a choroidal melanoma of the left eye for which she had initially declined surgery and 2 years later when she underwent an examination, an optic nerve sheath meningioma was incidentally found histologic examination. Both tumours are derived from neural crest cells.

Conclusion: Complex neurocristopathy, a disorder resulting from aberrations in the growth and development of neural crest derived structures has been very rarely described in the eye and orbit. To the best of our knowledge there has been only one previous case report of a combination of neurofibroma in the right upper lid, meningioma in the right middle cranial fossa and uveal malignant melanoma in the left eye. (However in this patient the tumours were at 3 different sites.)     

Vitrectomy for Tractional Retinal Detachment with Twin Retinal Capillary Hemangiomas in a Patient with Von Hippel-Lindau Disease: A Case Report

PurposeThe purpose of this study was to report a case of Von Hippel-Lindau disease (VHL) with twin retinal capillary hemangiomas that was successfully treated by vitreous surgery for tractional retinal detachment following laser photocoagulation.CaseA 44-year-old male presented at our university hospital after noticing decreased visual acuity in his right eye. The patient had previously undergone multiple operations for cerebellar, thoracic, and lumbar spine hemangioblastomas when he was approximately 19 years old. Upon initial examination, ocular findings revealed twin connected retinal capillary hemangiomas around the temporal upper area of the patient''s right eye. The patient was subsequently diagnosed with VHL based on his medical history and current observations of the ocular fundus. Tractional retinal detachment had occurred as the result of the formation of proliferative membranes following laser photocoagulation. The patient underwent vitreous surgery to treat the tractional retinal detachment, resulting in a successful postoperative outcome.ConclusionThe findings of this study show the possibility that proliferative changes and tractional retinal detachment can arise following photocoagulation for retinal capillary hemangiomas in patients with VHL.     

Photodynamic Therapy Combined with Intravitreal Bevacizumab in a Patient with Choroidal Neovascularization Secondary to Choroidal Osteoma

Choroidal osteoma is a benign ossified tumor that is found predominantly in healthy young women during their second and third decades of life. The lesions are white-to-cream or orange in color, are located in the peripapillary and macular areas, and are unilateral in most patients. The symptoms of choroidal osteoma include decreased visual acuity and metamorphopsia or scotoma corresponding to the location of the osteoma, but some patients have no symptoms. Prognosis of vision varies according to tumor location, retinal pigment epithelial and sensory retinal degeneration, subretinal fluid and hemorrhage, and development of a subretinal neovascular membrane.     

Rare and Unusual Choroidal Abnormalities in a Patient with Systemic Lupus Erythematosus

Purpose

To report a case of rare and unusual choroidal abnormalities in a 42-year-old woman with systemic lupus erythematosus (SLE).

Methods

Images were obtained using fundus photography, fluorescein angiography, near-infrared reflectance (NIR) imaging, and optical coherence tomography (OCT).

Results

The patient had a history of SLE and central retinal artery occlusion in her right eye. Fundus examination showed no specific retinochoroidal abnormalities, with the exception of optic disc atrophy in her right eye and a peripapillary small hemorrhage in her left eye. However, NIR revealed multiple bright patchy lesions in the choroid of the posterior pole and the mid-periphery of the fundus in both eyes. OCT demonstrated irregular hyperreflectivity at the lesion sites.

Conclusions

The observed choroidal abnormalities are highly specific findings and therefore indicative of neurofibromatosis type 1 (NF1). Since the coexistence of SLE and NF1 is extremely rare, this case provided the chance to examine the relationship between SLE and NF1.Key words: Systemic lupus erythematosus, Choroidal abnormality, Near-infrared reflectance, Neurofibromatosis type 1     

Choroidal Detachment: Clinical Manifestation,Therapy and Mechanism of Formation

One hundred and twelve eyes of 103 patients were analyzed during a 9½-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1–3) ; (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.     

单眼视网膜多发性囊肿合并视网膜脱离一例

患者,男,67岁,退休人员,2019年11月初因双眼视 力下降来青岛市市立医院眼科中心就诊,自述双眼为高 度近视,未行系统眼科检查。全身体检无异常。眼科检 查：右眼视力为指数/10 cm,矫正无提高;左眼为0.07,矫 正为-20.0 DS-2.50 DC×20=0.5。右眼眼压为17 mmHg （1 mmHg=0.133 kPa）,左眼为16 mmHg。双眼角膜透明,前 房深度适中,房水清,双眼对光反应灵敏。双眼晶状体皮质 不均匀,为灰白色混浊,核呈棕黄色,后囊下混浊。眼底检 查：右眼眼底模糊,隐约见视盘边清,颜色淡红,颞侧周边 部视网膜灰白色隆起,余细节窥不清;左眼眼底模糊,隐约 见视盘界清,颜色淡红,可见区视网膜未见出血渗出。B超 检查显示右眼晶状体后囊回声正常,玻璃体内可探及大量 点状弱回声,运动及后运动（+）,颞侧可探及条带状强回声, 与视盘相连（见图1）,条带中间靠上见3个大小不一的椭圆 状强回声（见图2）,呈囊样,其内为无回声,运动（±）,后 运动（-）,球壁不规则,球后未见明显异常回声;左眼晶状 体后囊回声正常,玻璃体内可探及大量点状弱回声,运动及 后运动（+）,球壁不规则,球后未见明显异常回声。     

晶状体内异物合并原发性孔源性视网膜脱离一例

患者,男,52岁,工人。因工作时右眼被铁屑溅入自觉异物感伴视物模糊2 d后就诊。眼部检查：右眼视力0.5（矫正视力不提高）,左眼1.0。右眼结膜无充血,角膜中央可见约2 mm大穿通伤口,伤口已自闭,前房深,Tyn（-）,瞳孔等大等圆,晶状体内可见一枚金属异物嵌顿于前囊膜下,部分突出于晶状体前表面,异物周围晶状体皮质混浊（见图1A）。玻璃体混浊,散瞳后眼底见颞上方视网膜青灰色隆起,未波及黄斑,颞上方赤道前可见1枚约1/3 PD大圆孔,视盘界清（见图1B）。左眼角膜透明,前房（-）,瞳孔等大等圆,晶状体透明,玻璃体混浊,散瞳后眼底见颞上方可见格子样变性,视盘界清,视网膜平伏。右眼眼压17 mmHg （1 mmHg=0.133 kPa）,左眼16 mmHg。眼及眼眶CT：右眼晶状体异物（见图1C）。右眼B超：右眼玻璃体腔内可见点状及条状中高回声,可见视网膜脱离光带（见图1D）。诊断：右眼角膜穿通伤、右眼晶状体异物、右眼外伤性白内障、右眼孔源性视网膜脱离。     

Sturge-Weber Syndrome Associated with Early Diffuse Choroidal Hemangiaoma： A Case Report

Purpose:To report indocyanine green angiography (ICGA) findings in one patient of diffuse choroidal hemangioma associated with Struge-Weber syndrome. Methods: Color fundus photography, fluorescein angiography (FA) and ICGA were performed in a patient with diffuse choroidal hemangioma associated with Sturge-Weber syndrome, Results: Three findings were unveiled by ICGA : rapid filling of diffuse choroidal hemangio‘s vascular network in the early stages; diffuse hyperfluorescence visual up to the late phase; no “wash-out“ phenomenon was observed in the late phase. Conclusion:Indocyanine green angiography can provide information that is not detected by clinical or fluorescence angiographic examination in the patient with Sturge-Weber syndrome. ICGA may be important and sensitive in detecting the diffuse choroidal hamangioma associated with Sturge-Weber syndrome. Eye Science 2004:20:168-170     

The Therapeutic Effects of Intravitreal Bevacizumab in a Patient with Recalcitrant Idiopathic Polypoidal Choroidal Vasculopathy

We describe the clinical course of a patient with therapy refractory polypoidal choroidal vasculopathy (PCV) who was treated with intravitreal bevacizumab (IVB). Prior treatments included photodynamic therapy and intravitreal pegaptanib with poor therapeutic response. Within four weeks of follow-up after a single IVB, the visual acuity improved from count fingers to 20/400 coincident to resolution of subretinal fluid. The visual acuity demonstrated sustained improvement and the macula remained without exudation for 12 months post treatment. Intravitreal injection of bevacizumab should be studied as an effective and relatively inexpensive option for patients with active polypoidal choroidal vasculopathy.     

Juvenile Cataracts in a Patient with Histidinuria: Case Report

Background: Altered iron metabolism and transferrin expression were associated with neurodegenerations including age-related macular degeneration (AMD) and Alzheimer’s disease (AD). Carriers of transferrin C2 allele alone or in combination with the hemochromatosis C282Y variant may have increased risk for developing AD. We aim to assess if these alleles also predispose to AMD.

Methods: DNA was collected from 290 AMD patients and 157 unaffected, age-matched, controls. Genotyping was performed for transferrin C1/C2 alleles and hemochromatosis C282Y allele, and association with AMD was evaluated.

Results: There was no association between the C1/C2 transferrin alleles and AMD. Hemochromatosis C282Y variant was identified in four individuals; one was an AMD patient and three were unaffected.

Conclusion: Transferrin C2 and hemochromatosis C282Y alleles are not associated with increased risk for developing AMD in Israel.     

脉络膜脱离型视网膜脱离术后黄斑中心凹下脉络膜厚度的变化

目的观察脉络膜脱离型视网膜脱离（RRDCD）患者接受玻璃体切割（PPV）复位视网膜后硅油填充状态下黄斑中心凹下脉络膜厚度（SCT）的变化。方法回顾性病例对照研究。2016年1月至2017年10月在武汉大学人民医院眼科中心就诊的35例首次接受PPV成功复位视网膜的RRDCD患者纳入研究（作为RRDCD组）。记录患者术后1d、1周、1个月、3个月的最佳矫正视力（BCVA）（LogMAR）、眼压,采用光学相干断层扫描（OCT）测量SCT。36例首次接受PPV成功复位视网膜的单纯孔源性视网膜脱离（RRD）患者作为RRD组及40例医院的体检者作为正常组。数据采用秩和检验（H检验）、重复测量方差分析、独立样本t检验、卡方检验等进行分析。结果术后1d、1周,RRDCD组、RRD组SCT均较正常组厚（术后1d：t=9.220,P<0.001;t=6.826,P<0.001。术后1周：t=4.341,P=0.011;t=2.849,P=0.034）,而这2个时间点RRDCD组和RRD组间的SCT差异无统计学意义。术后3个月,RRD组SCT与正常组比较差异无统计学意义（t=1.597,P=0.646）,而RRDCD组SCT相对正常组及RRD组都要薄,差异有统计学意义（t=-3.144,P=0.028;t=-6.207,P=0.010）。术后RRDCD组和RRD组SCT均呈持续降低趋势。相关性分析显示术后3个月,RRDCD组SCT与BCVA呈正相关（r=0.399,P=0.017）,RRD组SCT与BCVA无相关性（r=0.109,P=0.529）。结论RRDCD术后黄斑SCT变薄,且SCT与BCVA相关。SCT可以作为评估RRDCD术后视力的临床指标。     

玻璃体切割术治疗视网膜脱离合并脉络膜脱离

目的探讨玻璃体切割术治疗视网膜脱离合并脉络膜脱离的临床疗效及适应证.方法对23例(23眼)视网膜脱离合并脉络膜脱离的患者,术前7 d即开始口服强的松,采用标准平坦部三切口玻璃体切割及眼内填充(C3F8或硅油),酌情联合巩膜扣带术,术后随访6～12个月.结果术中新发现裂孔 5个(21.74%);术后6个月,视网膜完全复位20眼(86.96%),部分复位2眼(8.70%),未复位1眼(4.35%);术后视力有不同程度的提高,其中0.1以上为5眼(21.74%);术后并发症较少,增生性玻璃体视网膜病变(proliferativevitreore tinopathy,PVR)的发生率较低.结论对眼内增殖明显,视网膜裂孔位于大范围脉络膜脱离区或术前未发现裂孔的视网膜脱离合并脉络膜脱离,玻璃体切割术是可以优先考虑的术式.