特发性视网膜血管炎综合治疗的疗效分析

目的分析特发性视网膜血管炎的治疗效果。方法对126例（197眼）确诊为特发性视网膜血管炎的患者进行药物、激光或玻璃体手术治疗进行回顾性分析,包括1年内的视力、光学相干断层扫描（OCT）检查、荧光素眼底血管造影（FFA）结果。结果早期药物治疗110眼,其中视力改善者61眼（55．5％）,需激光或手术治疗者36眼（32．7％）。激光治疗累计71例（119眼）,视力改善者88跟（73．9％）。20眼接受玻璃体手术,视力改善者9眼（45％）。接受激光与玻璃体手术治疗的疗效比较差异有统计学意义（x^2=6．80,P〈0．05）。非玻璃体出血与玻璃体出血者激光治疗后视力改善眼数的差异有统计学意义（x^2=6．53,P〈0．05）。对视力改善者,OCT和FFA均提示黄斑水肿明显改善。结论视网膜激光光凝对特发性视网膜血管炎是重要的治疗手段,不同治疗方法适应证的选择和治疗期间的密切随访对于改善治疗效果至关重要。     

视网膜血管炎的临床分析

目的探讨视网膜血管炎的患病因素及治疗效果。方法回顾性分析视网膜血管炎患者14例（16只眼）的临床表现、检查、诊治和随访结果。结果所有患者眼后段均有不同程度的炎性改变，经过药物治疗、激光和手术治疗后，最终视力提高共10只眼（62．5％）。结论本病眼底表现复杂，以血管白鞘、视网膜出血和黄斑水肿最为多见，病因尚不明确，诊断以临床表现为主，早期、足量的抗病毒、皮质类固醇激素的应用，以及预防性视网膜光凝、必要联合玻璃体手术是控制病变的关键。     

玻璃体内注射曲安奈德治疗早期特发性视网膜血管炎

目的观察玻璃体内注射曲安奈德（TA）治疗早期特发性视网膜血管炎的疗效。方法17例19眼经眼底检查,荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）确诊的早期特发性视网膜血管炎患者接受玻璃体内注射40mg/1ml的TA0.1ml治疗,平均随访7m,对比观察治疗前后患眼视力、眼压及黄斑区视网膜厚度、视网膜血管荧光素渗漏情况。结果随访3m19眼,除1眼视力无变化外,其余视力均有不同程度的提高;平均视力上升0.21。全部治疗眼临床检查均显示黄斑水肿减轻或消退,OCT示治疗前后平均厚度分别为（668.74±212.20）、（527.17±202.58）μm,与治疗前比较差异有统计学意义（t值分别为2.906、4.812P值均〈0.01）;随访6m,FFA示荧光素渗漏16眼消失或减轻,占84.2%;5眼眼压升高发生于用药后1w至2m,经局部用β受体阻滞剂眼压控制正常。1眼白内障发展。结论玻璃体内注射曲安奈德（TA）是治疗早期特发性视网膜血管炎的有效手段,可避免全身应用糖皮质激素的副作用。     

女性Eales病八例

目的：评价女性Eales病的临床特征及对持久的玻璃体出血和牵拉性视网膜脱离的玻璃体手术效果。 方法：复习本科1993年4月至1994年12月经玻璃体手术治疗的该病患者的病历记录。 结果：8例（11只眼）女性患者占同期该病患者的22%，年龄19~35岁，平均病史10.8个月，急性发病后持久出血及视力严重丧失，伴视盘和周边部新生血管膜及黄斑水肿。10只眼玻璃手术后视力明显改善8只眼，0.2~1.0者6只眼。1眼有早期周边部血管白鞘，经氩激光光凝。 结论：女性Eales病的特点可能包括年龄轻，病史短，急性发作，有持久出血和新生血管膜形成。玻璃手术能有效改善多数眼的视力。 （中华眼底病杂志，1996，12：51-52）
     

激光光凝治疗增殖期糖尿病视网膜病变

目的探讨全视网膜光凝术(panretinalphotocoagulationPRP)对增殖期糖尿病性视网膜病变(proliferativediabeticretinopathy,PDR)的治疗效果。方法对我院438例603眼PDR患者行PRP术,3m后进行眼底荧光血管造影,复查眼底新生血管及玻璃体出血等情况。患者每2w～4w复查,观察期为6m～5y,并记录视力及眼底。结果285眼视力提高≥2行,占47.26%,206眼视力无变化,占34.16%,112眼视力下降,占18.57%(其中71眼因白内障发展而视力下降)。16眼新生血管未消退,占2.65%。14眼发生玻璃体出血,2.32%,后行玻璃体切割手术,术中补激光。新生血管性青光眼9眼中,8眼虹膜新生血管消退,眼压恢复至正常,占88.89%。结论PRP通过抑制新生血管生成及玻璃体出血,是治疗PDR的有效手段。     

玻璃体视网膜手术治疗老年黄斑变性的疗效评价

为探讨玻璃体切除术及视网膜下手术治疗湿性型老年黄斑变性（ＡＭＤ）的疗效和估价，对２６眼因ＡＭＤ玻璃体出血混浊施玻璃体切除术；６眼黄斑中心凹处新生血管膜形成、出血行视网膜下手术。结果为玻璃体切除术组，术后全部看清眼底，发现黄斑区视网膜下出血１３眼，有新生血管膜及疤痕１０眼，两者同时存在３眼，术后视力提高２２眼，不变及减退各２眼，视力在０．０５以上仅８眼；视网膜下手术组，成功取出视网膜下新生血管膜３眼，出血冲洗干净３眼，术后视力进步４眼，不变及减退各１眼。结论：玻璃体切除术虽然能清除玻璃体出血及混浊，但不能阻止ＡＭＤ病变的发展和治疗视网膜下病变及恢复视功能；视网膜下手术能清除部分视网膜下病灶，亦不能恢复色素上皮和感光细胞功能。因此，视网膜移植可能是治疗湿性型ＡＭＤ的新途径     

氪黄绿激光治疗糖尿病视网膜病变疗效分析

目的：研究氪黄绿激光全视网膜光凝术治疗糖尿病视网膜病变的疗效。方法：根据眼底荧光血管造影（FFA）的结果。用氪黄绿激光全视网膜光凝术治疗1998年3月至2001年1月在我中心确诊为糖尿病视网膜病变的患者212例330眼,轻度白内障95眼,轻度白内障伴玻璃体混浊76眼,随访视力、眼底,FFA。结果：视力增进62眼占18.8%;视力无变化167眼占50.9%;视力下降101眼占30.6%,FFA结果有效246眼,有效率74.5%,需补充光凝78眼,4眼光弹簧过程中眼底出血,改行玻璃体切割手术。结论：氪黄绿激光全视网膜光凝治疗糖尿病视网膜病变不仅对屈光间质清晰者效果好,而且对屈光间质轻度混浊的病例效果也较满意。     

早期玻璃体手术联合激光治疗视网膜血管炎

目的 回顾分析应用视网膜激光及早期玻璃体手术治疗31例(35只眼)视网膜血管炎患者的疗效.方法 采集1999～2006年31例(35只眼)视网膜血管炎患者的连续病历资料,所有病例伴有玻璃体出血,经药物治疗1月后无效,行标准三切口玻璃体切除术,术中及术后行视网膜激光治疗.术后定期随访.结果 术后视力提高29只眼(82.9%),13例术后再补充激光治疗,无一例再出现玻璃体出血.结论 视网膜血管炎伴发玻璃体出血早期积极治疗可以有效的预防及控制PVR形成,保留更好视力.     

视网膜静脉周围炎的临床特征及治疗探讨

目的探讨视网膜静脉周围炎的临床特征及治疗方法。方法回顾性分析1989至2003年经眼底检查和荧光素眼底血管造影(FFA)诊断为视网膜静脉周围炎的31(41只眼)例患者的临床资料。结果患者以男性轻壮年为主,占47.6%,双眼发病,16只眼伴玻璃体积血,6只眼有玻璃体积血伴视网膜脱离。29只眼单纯用激光治疗,12只眼做了玻璃体切割和激光综合手术,所有治疗过的眼均做了随访。29只单纯用激光治疗的眼,大部分都获得了视力的提高。在做了玻璃体切割和激光综合手术的眼中,87%的眼视力有提高,在视网膜脱离患者中5只眼复位成功。结论激光及玻璃体切割手术是治疗视网膜静脉周围炎的有效手段,能提高大部分患者的视力。     

增殖性糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的临床观察

目的：探讨增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR)玻璃体视网膜手术严重玻璃体出血的原因，并发症及处理方法。方法：对我院1997年1月至2001年3月住院行玻璃体视网膜手术治疗PDR的182例（198只眼）患者中术后发生严重玻璃体出血的16例（17只眼）患者进行回顾性分析。结果：术后玻璃体出血中52.9%出现于术后第一天，出血原因包括纤维血管膜残端出血，视网膜新生血管膜渗血，视网膜切开，视网膜裂孔，前玻璃体纤维血管增殖等；出血并发症包括继发性青光眼，增殖膜形成等。结论：PDR玻璃体切割术后玻璃体出血为术后常见的并发症；对于出血量大、难于吸收及出现并发症的病例，积极治疗可改善视力预力预后。     

玻璃体切除治疗视网膜分支静脉阻塞引起玻璃体积血的临床效果

目的:探讨玻璃体切除手术治疗视网膜分支静脉阻塞引起的玻璃体积血的临床效果。方法:回顾分析28例28眼视网膜分支静脉阻塞引起的玻璃体积血患者进行闭合式玻璃体切除,联合增殖膜剥离、眼内激光光凝及玻璃体腔长效气体、硅油或灌注液填充手术的临床疗效。结果:该28例患者术中均可见视网膜分支静脉阻塞闭锁呈白线状。视网膜静脉阻塞颞上方20例,颞下方8例。合并视盘新生血管2例,18例阻塞区可见视网膜新生血管及交通支。并发视网膜脱离7例,患者术前及术后视力比较有统计学差异(P<0.05)。结论:玻璃体切除是视网膜分支阻塞的有效手术方法,术中应谨慎去除阻塞区增殖病灶,光凝视网膜无灌注区,术后注意观察阻塞部位的视网膜复位及增殖情况。     

A long-term follow-up of Eales’ disease

Purpose: To provide long-term follow-up information on Eales’ patients. Methods: Eales’ patients, who had been examined at varying periods between the years 1970 and 1991 with a minimum five-year follow-up, were included in the study. Results: A total of 130 patients were followed up for a minimum of five and a maximum of 26.5 years. The retinal lesions found during the first examination included vascular sheathing, disc and/or retinal neovascularization, vitreous hemorrhage, branch retinal vein occlusion, retinitis proliferans, and retinal detachment. Visual acuity improved in 37 (20%) of the 185 treated eyes, was maintained in 79 (43%), and worsened in 69 (37%). The complications were tractional detachment, cataract, rubeosis iridis, neovascular glaucoma, and phthisis bulbi. Conclusion: The most important elements in dealing with Eales’ disease are periodic follow-up, a good and adequate laser treatment, pars plana vitrectomy combined with procedures for nonclearing vitreous hemorrhage, and retinal vasoproliferative changes to stabilize the retinal lesions and maintain functional levels of vision.     

Visualization of retinal vasculitis in Eales' disease

Between 1970 and 1991 the authors examined 466 patients with Eales' disease. The mean age at diagnosis was 30, ranging between 14 and 55 years. The mean follow-up period was 43.5 months. At the initial examination, 356 cases were bilateral and 110 cases were unilateral (822 eyes). Vitreous hemorrhage was present in 257 of the 822 eyes. In the remaining 565 eyes, the major retinal lesions were retinal neovascularization (40.7%), vascular sheathing (20.7%), vascular sheathing and retinal hemorrhages (10.6%), retinitis proliferans (9.4%), disc neovascularization (9.0%), branch vein occlusion (3.2%), tractional retinal detachment (2.4%), central vein occlusion (1.8%), central vascular sheathing (1.1%), obliterated vessels (1.1%). Forty-nine out of the 110 initially unilateral cases eventually developed bilateral involvement after a mean period of 42 months. The percentage of eyes with a vision of 0.1 and better rose from 68.1% in the initial examination to 77.9% in the final examination. Fluorescein angiograms of the affected eyes show dye leakage with retinal staining, microaneurysms, capillary non-perfusion and neovascularization. Fundus changes are characteristic of Eales' disease. Unilateral cases should be closely followed because of the risk of involvement of the other eye. Fluorescein angiography is a requirement for early identification of vascular changes and for proper follow-up in Eales' disease.     

眼内激光光凝术在视网膜血管性疾病的玻璃体手术中的应用

目的：探讨眼内激光在视网膜血管性疾病的玻璃体切除术中的应用及有效性。方法：将眼内激光应用于24例(28只眼)视网膜血管性疾病的玻璃体手术中。眼内光凝的方式：全视网膜光凝21只眼；环形激光视网膜拦截并封闭视网膜裂孔2只眼：局限性光凝5只眼。结果：术后随访1～24个月(平均9个月)，3只眼术后再次视网膜出血，其余25只眼均视网膜平伏、裂孔封闭、视力不同程度提高，未再有玻璃体积血发生，治愈率达89．2％。结论：眼内激光光凝是现代玻璃体手术中重要的辅助工具，是视网膜血管性疾病玻璃体切除手术中一个重要而有效的步骤。     

Pars planitis: epidemiology and clinical outcome in a large community hospital in Mexico city

Medical records of 51 patients with a diagnosis of pars planitis (97 eyes) were reviewed. Based upon the severity of vitreous inflammation, in 34 eyes (35) the condition was classified as mild, in 38 (39) as moderate, and in 25 eyes (26) as severe. Vascular sheathing was present in 51 eyes (53), snowballs in 42 (43), snowbanks in 29 (30), cataract in 19 (20), cystoid macular edema in 26 (27), retinal detachment in 4 (4) and glaucoma in 3 (3) eyes. Treatment consisted of prednisone and periocular injections of deposteroids or immunosuppressive agents; 13 patients required surgery for retinal repair, glaucoma, vitreous opacities or cataract. After treatment the visual acuity improved in 58 of the eyes, did not change in 33, and worsened in 9.     

Vitrectomy for nondiabetic vitreous hemorrhage. Retinal and choroidal vascular disorders

The results and complications of pars plana vitrectomy for nondiabetic vitreous hemorrhage due to retinal and choroidal vascular disorders were studied in 68 eyes of 66 patients. Diagnoses included: retinal branch vein obstruction (34 eyes), choroidal neovascularization (15 eyes), central retinal vein occlusion (5 eyes), Eales' disease (10 eyes), pars planitis (3 eyes), and hemoglobin S-C retinopathy (1 eye). The duration of the vitreous hemorrhage was 6 months or more in 48 eyes (71%), and averaged 17.8 months. Preoperative visual acuity was less than 5/200 in 57 eyes (84%). Best postoperative visual acuity was 5/200 or better in 55 patients (81%), and vision improved two or more lines after vitrectomy in 54 eyes (80%). Patients with retinal branch vein obstruction, Eales' disease, or pars planitis had the best prognosis. Those with central retinal vein obstruction or choroidal neovascularization had the worst prognosis.     

PCR-positive tubercular retinal vasculitis: clinical characteristics and management

BACKGROUND: Inflammation of retinal vessels is a known association of systemic tuberculosis. Patients with retinal vasculitis are subjected to extensive but unrewarding systemic workup. Polymerase chain reaction (PCR) is now commonly used to detect DNA of infective organisms including Mycobacterium tuberculosis. This study was undertaken to characterize the clinical characteristics of PCR-positive tubercular retinal vasculitis, so as to determine the clinical presentation, associated systemic features, management, and course of this form of vasculitis. METHODS: The clinical records of 13 patients seen between 1997 and 1999 with the diagnosis of PCR-positive tubercular retinal vasculitis from the aqueous or vitreous humor were reviewed. Recorded data included age, sex, race, visual acuity, anterior and posterior segment findings, and results of diagnostic evaluations. All received antituberculosis therapy with or without concomitant corticosteroids. Laser scatter photocoagulation was done in eyes with neovascularization. One eye with vitreous hemorrhage was subjected to pars plana vitrectomy. RESULTS: There were 9 (69.2%) male and 4 (30.7%) female patients with a median age of 20 years. The disease was bilateral in seven. The most consistent finding was the presence of vitritis in all the eyes followed by vitreous snowball opacities in 17 eyes (89.4%), neovascularization in 11 eyes (57.8%), retinal hemorrhages in 10 eyes (52.6%), neuroretinitis in 10 eyes (52.6%), focal choroiditis in 9 eyes (47.3%), vitreous/preretinal hemorrhage in 5 eyes (26.3%), and serous retinal detachment in 3 eyes (15.7%). Over a median follow-up of 12 months, all showed resolution of vasculitis with no recurrences. CONCLUSIONS: Polymerase chain reaction-positive tubercular retinal vasculitis had varied associated fundus findings. Its recognition is important so as to order only relevant diagnostic tests.     

Central retinal vein occlusion in young adults (papillophlebitis).

We performed a retrospective study of 103 cases of central retinal vein occlusion (CRVO) in young, nondiabetic adults that were followed for at least six months. Of these patients, 64% were men and 36% were women. While visual acuity was usually good, 33 eyes (32%) had a final visual acuity of 20/200 or worse, including 6 eyes (6%) with a final visual acuity of no light perception. Ocular complications included chronic cystoid macular edema, macular pigmentary changes (37%), sheathing of retinal vessels (22%), venous collaterals of the disc (33%), macular hole formation (1%), neovascularization of the disc (1%), retina (1%), and iris (19%), neovascular glaucoma (8%), and vitreous hemorrhage (7%).     

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.     

玻璃体积血的病因分析及手术治疗的疗效

目的：探讨玻璃体积血的病因及行玻璃体切割术治疗的临床疗效。

方法：对162例173眼玻璃体积血患者进行病因分析,采用玻璃体切割术治疗。

结果：术后诊断：173眼中增殖期糖尿病视网膜病变83眼(48.0%),视网膜分支静脉阻塞24眼(13.9%),Eales病13眼(7.5%),视网膜中央静脉阻塞10眼(5.8%),外伤性玻璃体积血9眼(5.2%),视网膜裂孔8眼(4.6%),视网膜脱离9眼(5.2%),增生性玻璃体视网膜病变7眼(4.0%),单纯玻璃体积血4眼(2.3%),视网膜大动脉瘤2眼(1.2%),息肉样脉络膜血管病变2眼(1.2%),脉络膜视网膜炎1眼(0.6%),年龄相关性黄斑病变1眼(0.6%)。不同年龄病因分布不同,术后随访3～15mo,术前与术后视力相比,41眼(23.7%)视力不变,115眼(66.5%)视力提高,17眼(9.8%)视力下降。术后视力与术前相比差异具有统计学意义( P<0.05)。

结论：增殖期糖尿病视网膜病变、视网膜分支静脉阻塞、Eales 病是导致玻璃体积血的主要原因。玻璃体切割联合术手术并发症少,能在一定程度上提高患者视力,是治疗玻璃体积血安全有效的方法。