隐匿性巩膜裂伤47例临床分析

目的:探讨隐匿性巩膜裂伤临床表现和手术方法方法:总结2000-05/2004-05因隐匿性巩膜裂伤而行手术治疗的47例(47眼),分析其致伤原因、临床表现、手术方法及结果。结果:术后视力≥0.05者20眼,视力<0.05者12眼,眼球萎缩10眼,眼球摘除5眼。结论:隐匿性巩膜裂伤主要由眼挫伤引起,应及时根据临床表现进行手术探查,缝合伤口,预防并发症发生。     

1例眼型Graves病的眶减压术治疗

Graves病是一种原因不明,侵犯多个系统的疾病。凡临床表现甲状腺机能亢进伴有甲状腺弥漫性增生,浸润性眼部病变和浸润性皮肤病变,具有以上三项者称Graves病;而只有眼征而无周身征状者称为Graves眼病。本院曾遇1例眼型Graves病,行眼眶减压术,术后眼征缓解,视力增进。国     

脉络膜脱离型视网膜脱离的玻璃体手术治疗

目的:探讨玻璃体手术治疗脉络膜脱离型视网膜脱离及术后早期临床表现。方法:脉络膜脱离型视网膜脱离患者17例17眼,应用糖皮质激素及玻璃体切除联合硅油填充术治疗,分析手术前后临床表现及早期疗效。结果:患者17眼早期间接眼底镜及B超检查视网膜及脉络膜脱离达到解剖复位;术后眼压略高,之后趋于稳定;炎症反应较轻;视力均有不同程度提高。结论:脉络膜脱离型视网膜脱离采用玻璃体切割联合硅油填充术能够获得良好的早期解剖复位。术前使用糖皮质激素有助于减轻炎症,为手术创造条件,提高手术成功率。术后早期眼压可控制在相对安全范围内。该类患者视力恢复普遍较差。     

隐匿性巩膜破裂伤临床分析

目的　探讨隐匿性巩膜破裂伤的临床表现和手术方法。方法　总结 1986年 5月～ 2 0 0 1年 12月因隐匿性巩膜破裂而行手术治疗的 3 2例 3 2眼。分析其致伤原因、临床表现、手术方法及结果。结果　术后视力≥ 0 .0 5者 19眼 ,视力 <0 .0 5者 5眼 ,眼球萎缩 4眼 ,眼球摘除 4眼。结论　隐匿性巩膜破裂伤主要由眼挫伤引起 ,应及时根据临床表现进行手术探查 ,缝合伤口 ,预防并发症发生。     

眼外伤早期继发青光眼的临床分析

目的探讨眼外伤患者早期继发青光眼的分类和治疗方法.方法收集139例(139只眼)眼外伤早期继发青光眼患者的临床资料,对患者的临床表现及治疗方法进行分型和分析.结果根据临床表现将眼外伤早期继发青光眼分为5种类型眼内积血型、房角挫伤型、晶状体相关型、粘连增殖型和眼内炎型.单纯药物治疗37例(37只眼)(26.62%);药物治疗联合前房穿刺或冲洗32例(32只眼)(23.02%);其他手术治疗(包括玻璃体切除、滤过手术和联合手术)70例(70只眼)(50.36%).治疗后随访3～6个月,未用降眼压药物、眼压正常患者(6 mm Hg≤眼压≤21 mm Hg)121例(121只眼)(87.05%),眼压>21 mm Hg者13例(13只眼)(9.35%),眼压<6 mm Hg者5例(5只眼)(3.60%).视力下降或丧失7例(7只眼),余132例(132只眼)视力与术前相同或提高.术中和术后眼出血8例(8只眼),视网膜脱离2例(2只眼).结论眼外伤早期继发青光眼患者临床表现复杂,对每种病例应采取具体有针对性的治疗方法.     

中心性浆液性脉络膜视网膜病变荧光造影与视力探讨

目的探讨中心性浆液性脉络膜网膜病变(Central Serous Chorioretinopathy,CSC)荧光血管造影渗漏情况与视力关系.方法用Zeiss FF450眼底荧光造影摄像机对74例CSC患者进行眼底荧光血管造影,并结合临床进行分析.结果渗漏点位于黄斑中心区者16眼占20.51%,平均视力0.15;位于黄斑旁中心者53眼占67.95%,平均视力0.64;位于周围黄斑区者9眼占11.54%,平均为0.82.在同一眼内只有一个渗漏点者52眼占66.67%;有2个渗漏点者26眼占33.33%.圆点扩大型或墨渍弥散型29眼占37.18%,视力0.1～1.2,平均0.52;喷出型9眼占11.54%,视力0.1～0.5,平均0.21;窗样缺损型22眼占28.20%,视力0.3～1.2,平均0.62;混合型18眼占23.08%,视力0.2～1.2,平均0.64.渗漏面积大小,≤1/2 PD者42眼占53.85%,＞1/2PD者36眼占46.15%.结论渗漏点部位与视力有密切关系;渗漏点多对局部的损害较大有关;渗漏点类型对视力影响,以喷出型的为重;渗漏面积越大,视力损害越大(P＜0.05).     

Stargardt''''s病的临床观察(附69例报道)

目的探讨Stargardt's病的临床表现. 方法回顾性分析69例138眼Stargardt's病的临床和眼底荧光素血管造影(fundusfluorescein angiographyFFA)资料,分析其视力损害程度、年龄分布状态及病灶表现形态.结果视力0.02～0.1者115眼(83.33%),0.2～0.5者23眼(16.66%);近视力最高Jr=2、最低Jr=0.其中10岁前起病者33例、11～20岁起病者26例、21～30岁起病4例、31～40岁起病6例.病灶形态①单纯黄斑病灶型24例48眼;②黄斑病灶联合眼底黄色斑点型29例54眼;③黄斑病灶与后极部色素脱失相融合型16例32眼.第三型病灶形态与前两型病灶在起病年龄与病程长短方面差别无明显意义(P＞0.05).三种病灶形态的病变程度差别亦无意义(P＞0.05).结论①Stargardt's病对视力的影响较大,但暂未见到视力全部丧失的病人;②Stargardt's病主要出现于青少年时期,亦可在成年人后期发病;③黄斑病灶与后极部色素脱失融合为一体的特殊病灶可能是Stargardt's病的另一种特殊的FFA变异形态.     

鼻咽癌放疗后放射性视网膜病变的临床分析

为探讨放射性视网膜病变 ( Radiation Retinopathy,RR)的临床表现及光凝治疗的效果 ,对鼻咽癌外照射后发生的 13例 ( 2 6只眼 ) RR患者的临床表现、彩色眼底照相、眼底萤光血管造影 ( Fundus Fluorescein Angiography,FFA)和氩激光光凝治疗黄斑水肿 3眼进行回顾性分析。结果 :13例 RR患者 2 6只眼 ( 10 0 % )眼底改变为黄斑部毛细血管扩张和 /或微血管瘤 ,另外单独或同时伴视盘颜色变淡 11只眼 ,水肿、出血 6只眼 ;视网膜出血 2 2只眼 ,广泛性视网膜小血管闭塞 7只眼 ;黄斑水肿 11只眼 ,深层出血 1只眼。81% ( 2 1/ 2 6) RR患眼视力下降。光凝治疗后 6个月 10 0 % ( 3 / 3 )患眼视力提高及黄斑水肿消退。结论 :RR最早期和最常见表现为黄斑部毛细血管扩张和 /或微血管瘤。RR患者视力下降是由于黄斑部水肿、黄斑部毛细血管闭塞、视盘缺血等原因所致。氩激光光凝可有助于放射性黄斑水肿消退 ,视力提高而获得满意的疗效     

非缺血型视网膜中央静脉阻塞的长期随访研究

目的了解非缺血型视网膜中央静脉阻塞（CRVO）患者的临床特征、长期预后及发病相关因素.方法对随访3年以上的非缺血型CRVO患者进行回顾性分析,包括患者视力、眼底彩色图像及荧光素眼底血管造影资料.结果共35例（37只眼）非缺血型CRVO患者,随访时间3～15年,平均4.5年.男性14例（40%）,女性21例（60%）.末次随访,视力提高者仅2只眼（5%）,不变者11只眼（30%）,下降者24只眼（65%）;28只眼（75%）最终视力为0.1或以下;患者视力预后与初诊视力及年龄有关（P＜0.05）.9只眼（24%）转变成缺血型CRVO,其中5只眼继发新生血管性青光眼.黄斑部并发症：慢性黄斑囊样水肿13只眼,黄斑前膜3只眼,黄斑萎缩和黄斑区视网膜下增生膜各2只眼,黄斑裂孔1只眼;黄斑部并发症是视力预后差的主要原因.2例CRVO患者伴有原发性慢性闭角型青光眼和部分视神经萎缩,视力预后相对较好.结论CRVO严重损害患者视力,其主要原因为黄斑部的并发症.部分视神经萎缩对CRVO可能有保护作用.     

LASIK术后角膜上皮植入的原因及分型

目的分析准分子激光原位角膜磨镶术（LASIK）后角膜上皮植入的原因及分型。设计回顾性病例系列。研究对象45例LASIK术后角膜上皮植入处理后随诊半年以上患者共49眼。方法分析北京协和医院门诊收治的外院转来时角膜上皮植入患者,上皮植入时间6～31天,最佳矫正视力为手动-0．6,除眼部刺激症状外,多数患者伴有不同程度的角膜瓣水肿、混浊、融解。掀开角膜瓣治疗43眼。根据上皮植入的位置、发展速度进行分类。按上皮植入距角膜中央的距离和范围分为周边型、旁中央型、中央型,分别为7眼、32眼、10眼。按照发展的速度分为进展性、稳定性、静止性,分别为31眼、4眼、4眼。主要指标LASIK术后角膜上皮植入手术史、视力、角膜瓣对合、伤口愈合情况。结果引起上皮植入的主要原因：（1）角膜上皮水肿、剥脱;（2）角膜瓣状况不良;（3）角膜瓣对合异常,分别为15眼、21眼、13眼。对视力影响程度由重到轻依次为中央型〉旁中央型〉周边型;进展的旁中央和中央型上皮植入超过1周者,92％可导致角膜瓣基质融解,严重影响视力。治疗方案：密切观察,原瓣掀开刮除植入上皮29眼,上皮刮除联合治疗性角膜屈光手术（PTK）14眼,非掀瓣保守观察治疗6眼。角膜瓣再次掀开者角膜伤口均一期愈合,未见再次植入病例。34眼达到了术前预期视力,7眼低于术前视力1行以内,8眼低于术前预期视力2行及其以上。结论角膜上皮和角膜瓣水肿是导致LASIK术后角膜上皮植入的主要原因,92％进展的中央型和旁中央型的上皮植入者,1周左右可致角膜瓣融解,严重影响视力。积极掀瓣刮除植入上皮和局部PTK治疗是使患者恢复视力的首选治疗手段。     

Ocular rosacea

The demographic, clinical, and histopathologic characteristics of ocular rosacea are reviewed, with emphasis on examination of the skin in patients with external ocular disease. Since no single clinical or pathological hallmark of rosacea exists, a proposed point system for diagnosis is presented. Studies of pathogenesis reveal that no single unifying hypothesis accounts for all the expressions of ocular rosacea. Reports of treatment with tetracycline and other antibiotics demonstrate efficacy, although the mechanisms of action of these drugs are not known. More recently, other classes of drugs, including isotretinoin and hexachlorocyclohexane, have proven to be effective in dermatologic manifestations of rosacea, but effects on ocular manifestations are unknown.     

The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics

PURPOSE: To describe and compare the ocular signs in patients diagnosed with acne rosacea by the ophthalmologist with the ocular signs in the patients diagnosed with rosacea by the dermatologist. METHODS: We reviewed the medical records of 176 randomly selected patients diagnosed with rosacea at the University of California, Davis, Medical Center: 88 patients each from the Department of Dermatology and the Department of Ophthalmology. Of the 88 patients diagnosed with acne rosacea by a dermatologist, 22 (25%) had an ophthalmologic evaluation done prior to the study. In those patients without an ophthalmologic assessment, ocular complaints noted by the dermatologist were recorded. We recorded ocular signs including lid, conjunctival, corneal, episcleral, and scleral manifestations as well as charted observations of the iris, lens, intraocular pressures (IOPs), best corrected visual acuity (VA), and funduscopic examination. Age and sex were recorded from the initial ophthalmologic evaluation. The analysis was designed to compare the prevalence of signs and symptoms in two clinical settings. RESULTS: The prevalence of documented meibomian gland dysfunction (p < 0.001), telangiectasia (p = 0.004), and anterior blepharitis (p = 0.008) was significantly higher in ophthalmology patients when compared with dermatology patients. Of the conjunctival signs evaluated, only the presence of interpalpebral conjunctival hyperemia (p = 0.005) was found to be significantly higher in ophthalmology patients. The corneal, episcleral, scleral, and lens findings did not demonstrate a statistically significant difference between groups. CONCLUSION: The major and most easily observable ocular problems in rosacea patients presenting either to ophthalmology or dermatology are lid disease-related manifestations. As might be expected, eye signs and symptoms are more commonly noted in the eye clinic. A clinician's increased awareness of the common ocular findings of rosacea, however, may aid in earlier diagnosis and treatment of ocular rosacea.     

Ocular rosacea

Rosacea is a common skin disease that frequently involves the eye. Although the pathogenesis of the disease remains undefined, recent findings suggest that an altered inflammatory response plays an important role in both cutaneous and ocular rosacea. Ocular manifestations include lid and ocular surface alterations. Chronic inflammation can lead to corneal vascularization, which may compromise vision. Treatment of ocular rosacea is aimed at preventing irritation of the ocular surface (e.g., lubricants, lid hygiene) and controlling inflammation with topical and systemic anti-inflammatory drugs. Systemic tetracyclines are the mainstay of treatment. These drugs act multifactorially by decreasing bacterial flora and the expression of matrix metalloproteinases, altering meibum secretion, inhibiting the production of bacterial lipases, and providing an immunomodulatory effect.     

Fungal keratitis associated with ocular rosacea

In order to report fungal keratitis in patients of ocular rosacea, a retrospective review of all cases of fungal keratitis was undertaken. Cases in which ocular rosacea coexisted were identified and included in the study. The clinical course of patients thus identified was studied from the medical records and outcomes were evaluated. A total of three cases of fungal keratitis with coexisting ocular rosacea were identified. All three patients were known cases of acne rosacea with an intermittent, irregular treatment for the same. Previous history of contact lens use, ocular surgery or trauma was not present in any of the cases. Microbiological evaluation revealed Aspergillus flavus as the causative organism in two patients and an unidentified hyaline fungus in the third. Patients received simultaneous therapy for fungal keratitis and ocular rosacea. The ocular surface completely stabilized and the infiltrate resolved in all three cases. The chronic ocular surface changes and induced inflammation in ocular rosacea, along with the instillation of topical steroids for therapy, may create an environmental milieu favorable for fungal keratitis. Microbiological evaluation should be considered, even in cases of suspected sterile keratitis, prior to treatment with topical steroids, so as to prevent the possible worsening of an associated infective corneal condition.     

Ocular rosacea: an update on pathogenesis and therapy

PURPOSE OF REVIEW: Ocular rosacea is a common and potentially blinding eye disorder with an uncertain etiology. Therapies currently in vogue for ocular rosacea have not been rigorously studied with regards to specific indications, optimal dosing regimens, or treatment efficacy. This review will summarize the recent literature with regards to etiology and therapy of ocular rosacea, and will also examine current thinking about the parent disorder, acne rosacea. RECENT FINDINGS: Comparatively few papers on ocular rosacea were published in the past year. Recent articles on the prevalence of ocular rosacea in patients with acne rosacea suggested that between 6 and 18% of acne rosacea patients have signs or symptoms of ocular rosacea, but few cases were confirmed by an ophthalmologist. Recent articles on the pathogenesis of ocular rosacea have focused on the role of bacterial lipases, and interleukin-1alpha and matrix metalloproteinases in the blepharitis and corneal epitheliopathy, respectively. Other reports highlighted the presence of the disorder in children, and the lack of masked, placebo-controlled studies for those therapies currently in common use. SUMMARY: The epidemiology, etiology, and optimal therapy of ocular rosacea remain to be determined, and will require a more concerted effort to delineate.     

Ocular rosacea in blacks

In three black men (57, 64, and 61 years old) with the ocular manifestations of rosacea, the diagnosis was not initially suspected because the pathognomonic skin changes of rosacea were obscured by the skin hyperpigmentation. Ocular involvement ranged from blepharitis and conjunctival hyperemia to sight-threatening problems such as corneal neovascularization, thinning, ulceration, and perforation. Treatment with oral tetracycline and topical corticosteroids appeared to be as effective in these patients as in previously described white patients.     

Alkaline tear pH in ocular rosacea

We compared the tear pH values of 44 normal, healthy volunteers, 20 patients with ocular disorders other than rosacea, seven patients with untreated, active ocular rosacea, and five patients with tetracycline-treated ocular rosacea. The group with untreated, active ocular rosacea had significantly more alkaline tear pH values than the other groups tested. In patients with tetracycline-treated ocular rosacea, tear pH values were not significantly different from those of normal subjects.     

Oral tetracyclines for ocular rosacea: an evidence-based review of the literature

PURPOSE: To review the basis for the use of oral tetracyclines in ocular rosacea. METHODS: Review of the published literature. RESULTS: Two prospective, masked, and placebo-controlled studies of oxytetracycline for ocular rosacea demonstrated a modest treatment benefit. Studies performed with tetracycline and doxycycline for ocular rosacea were not placebo controlled, and the optimal drug, dose, and schedule of administration were not evaluated. CONCLUSIONS: Available evidence supports a moderate treatment benefit in ocular rosacea for oxytetracycline, a tetracycline derivative not currently available in the United States. The efficacies of doxycycline and tetracycline, including treatment effect, optimal dose, duration of therapy, and side effects when used for ocular rosacea have not been established.     

面部红斑痤疮患者眼部损害的表现及其治疗

目的 探讨面部红斑痤疮患者眼部损害的特征及治疗方法。设计 回顾性病例系列。研究对象 2010年1月-2012 年12月在沈阳军区总医院眼科就诊的伴有眼部损害的面部红斑痤疮患者16例,年龄16~56岁。方法 除肉眼观察外,以裂隙灯显微镜检查眼部,并用其弥散光线扫描观察面部皮肤的细微改变,特别是血管的异常。对12例眼干涩的患者进行泪液分泌试验及泪膜破裂时间测定。对面部及鼻部皮肤进行螨虫检查。对睑缘进行微生物学镜检及培养。患者口服盐酸米诺环素50 mg,2次/日,维持3～6个月;联合氯替泼诺混悬滴眼液点眼3次/日,左氧氟沙星眼液点眼3次/日,直到眼部体征改善后2周。随访12个月。主要指标  皮肤改变,眼部改变,泪液分泌试验及泪膜破裂时间。结果 面部皮肤红斑血管扩张16例（100.0%）,结膜充血及球结膜血管扩张变形或增生16例（100.0%）,睑缘结膜炎14例（87.5%）,干眼12例（75.0%）,下方角膜舌状、树状血管翳4例（25.0%）,面部肥大性酒渣鼻6例（37.5%）,角膜溃疡4例（25.0%）,表层巩膜炎4例（25.0%）,虹膜睫状体炎2例（12.5%）。治疗后,皮肤及眼部病变均明显改善,面部及鼻部皮肤红斑消退,角膜血管翳消退、角膜浸润灶消失,结膜充血消失。结论 面部红斑痤疮患者眼部损害表现常不典型、难于辨认,血管改变是基本依据,常需结合面部血管改变明确诊断。全身应用盐酸米诺环素联合局部皮质类固醇对伴有眼部损害的面部红斑痤疮患者效果显著。（眼科,2014, 23： 121-125）     

Impression cytology and ocular characteristics in ocular rosacea

PURPOSE: To examine clinical findings and histologic changes on the conjunctival surface in ocular rosacea. METHODS: Thirty-five patients with ocular rosacea and 30 normal subjects underwent dermatologic and ocular examinations. Tear film break-up time, Schirmer tests with and without topical anesthesia, and conjunctival impression cytology were done. Patients were divided into the following groups according to quantity of ocular signs: mild (Group 1), moderate (Group 2), and severe (Group 3). Impression cytology was performed on both upper-bulbar and intrapalpebral inferonasal-bulbar conjunctiva. RESULTS: Patients had significant cell alteration on the conjunctival surface compared with normal eyes. The most frequent ocular signs and symptoms were feelings of dryness and blepharitis. Average tear break-up times for patients with ocular rosacea were 8.2 seconds in Group 1, 5.69 seconds in Group 2, and 5 seconds in Group 3 (17.2 seconds in normal subjects). Schirmer test results with anesthesia were 11.5 mm, 7.6 mm, and 5.0 mm, and without anesthesia were 14.8 mm, 13.6 mm, and 7.0 mm, in Groups 1, 2, and 3, respectively. These results were 18.7 mm with anesthesia and 24.7 mm without anesthesia in normal controls. Schirmer tests and tear film break-up time were significantly lower in patients with ocular rosacea than in normal controls (p < 0.05). Impression cytology showed that both upper bulbar and inferonasal interpalpebral bulbar ocular surface had significant cell alterations compared with those obtained from normal subjects. CONCLUSIONS: Patients with ocular rosacea not only had decreased tear production but also tear instability. Ocular surface epithelium had significant degeneration in patients compared with normal subjects.