近视性黄斑出血24例的临床观察

目的：观察和探讨近视性黄斑出血的临床特点。 方法：对确诊为近视性黄斑出血的24例患者的30只眼作视力、眼前节、眼底、A/B超声仪、眼底荧光血管造影(fundus fluorecein angiography，FFA)等检查，中西药物治疗并随访观察3～18个月(平均12个月)。 结果：作FFA检查的26只眼中22只眼为单纯型黄斑出血，其中19只眼伴有漆裂样纹，出血多在1～3个月吸收；另外4只眼FFA检查发现为脉络膜新生血管出血，视力预后均较差，且均伴有后葡萄肿。 结论；近视性黄斑出血可分为单纯型和脉络膜新生血管膜型，前者出血吸收快，后者反复出血视力预后较差。 （中华眼底病杂志，1996，12：220-222）     

高度近视性黄斑出血的临床观察

目的：观察高度近视性黄斑出血的临床特点和探讨其治疗方法。方法：对确诊为高度近视黄斑出血的28列32眼分别作视力、矫正视力、眼前节、眼底、A／B超、眼底彩照和眼底荧光血管造影（fundus fluorecein angiography,FFA)等检查,给予中西药物治疗,随访观察2－26个月（平均16个月。）结果：经FFA检查32眼中28眼（87．5％）为单纯型黄斑出血,其中25眼（89．3％）伴有漆裂样纹。出血经治疗多在15天至2个月吸收。另外4眼FFA显示为脉络膜新生血管出血,最终均因反复出血,后巩膜葡萄肿和脉络膜萎缩而预后较差。结论：高度近视性黄斑出血分单纯型和脉络膜新生血管型,前者出现吸收快,后者反复出血严重损害中心视力而预后不良。     

单纯型高度近视黄斑出血的眼底特征分析

目的：探讨单纯型高度近视黄斑出血的出血原因及其眼底改变特征。方法：对32例（33只眼）单纯型高度近视黄斑出血患者采用眼底彩色照相和荧光素眼底血管造影（fundus fluorescein angiogra-phy,FFA）格了眼底形态改变的随访观察，其中9例（9只眼）作了吲哚青绿血管造影（indocyanine green angiography,ICGA）检查，所有患眼至少随访3个月以上，随访时间3－21个月，平均5.2个月。结果：单纯型高度近视黄斑出血的眼底特征为：①出血灶呈类圆形，大小一般不超过1PD，周围无渗出、水肿；②81.8%的单纯型黄斑出血在出血吸收后于原出血的下方可见新的漆样裂纹形成；③部分患眼ICGA可透过因发现呈弱荧光条索的早期漆样裂纹。④出血吸收后视力均有明显增进，绝大部分患眼的视力可恢复到出血前水平。结论：单纯型高度近高黄斑因的原因是因为新漆样裂纹过程中Bruch膜裂开牵拉其下的脉络膜毛细血管破裂出血所致。绝大部分患眼视力预后良好。     

黄斑出血的病因诊断

目的：对不明原因的黄斑出血作进一步病因诊断。方法：对27例(28只眼)患者常规检查未发现明显原因的黄斑出血的眼底，眼底荧光血管造影和必要的吲哚青绿血管造影检查进行分析，判断引起黄斑出血的原因。结果：16例(17只眼)为高度近视引起，平均年龄为47．4岁，其中2例发生脉络膜新生血管膜；9例(9只眼)为老年性黄斑变性，平均年龄为62．7岁，其中脉络膜新生血管膜7例，2只眼为黄斑地图样变性；1例(1只眼)黄斑部血管异常而引起出血；1例(1只眼)为脉络膜肿物。结论：老年患者的不明原因的黄斑出血的发病原因以老年性黄斑变性较多见，而年轻患者以高度近视为主。     

高度近视眼后极部眼底病理改变

目的：通过眼底荧光血管造影(FFA)和吲哚青绿血管造影(ICGA)观察21例高度近视眼底后极部漆裂纹状病变、黄斑出血、Fuchs斑，以探讨高度近视眼底后极部的病理改变。方法：回顾分析21例(42只眼)，屈光度为-6D以上的高度近视眼底。均行彩色眼底照相、FFA、ICGA检查。将病例分为黄斑无出血组、黄斑出血组。结果：无出血组29只眼在FFA检查中4只眼有漆裂纹，占13．79％，在ICGA检查中有漆裂纹者9只眼，占31．03％，其中ICGA所见漆裂纹比FFA中数目更多且更长。出血组13只眼中FFA显示有漆裂纹7只眼占53．85％，ICGA显示有漆裂纹9只眼，占69．23％，该组中有1只眼ICGA未发现有脉络膜新生血管膜与漆裂纹。另有3例黄斑出血的对侧眼有眼底后极部萎缩斑或Fucks斑。结论：高度近视眼黄斑出血是病程发展的自然过程，漆裂纹常预示有出血产生的可能。黄斑出血由于脉络膜新生血管向视网膜生长；也可能只有视网膜黄斑部毛细血管出血而非脉络膜新生血管形成。晚期新生血管膜机化，色素上皮细胞增殖、聚集形成Fuchs斑。     

漆样裂纹性高度近视黄斑出血的眼底特征及视力预后

目的 探讨不伴脉络膜新生血管(CNV)的高度近视黄斑出血的眼底改变特征和视力预后。方法 对37例(38眼)不伴CNV的高度近视黄斑出血患者行眼底彩色照相和荧光素眼底血管造影(FFA)及矫正视力的随访观察，其中11例(11眼)行吲哚菁绿血管造影(ICGA)检查。结果84．2％的患眼在出血吸收后于原出血下方可见新的漆样裂纹形成；行ICGA的11只患眼中，7眼(63．6％)于ICGA可透过出血发现呈弱荧光条索的早期漆样裂纹。81．6％的患眼于出血吸收后视力均有明显增进。结论 不伴CNV的高度近视黄斑出血与新漆样裂纹形成相关，建议称之为漆样裂纹性黄斑出血。大部分患眼视力预后良好。     

黄斑部出血的鉴别诊断

目的 分析黄斑部出血的病因及眼底血管造影在诊断中的作用.方法 对142例152只眼黄斑部出血患者的眼底荧光血管造影和吲哚青绿血管造影,结合病史、临床检查结果进行分析:结果90例98只眼黄斑部出血患者的眼底血管造影结果显示有脉络膜新生血管(CNV),其中老年黄斑变性湿性型39例44只眼,中心性渗出性脉络膜视网膜病变(特发性CNV)23例23只眼,高度近视22例25只眼,息肉状脉络膜血管病变4例4只眼,多灶性脉络膜炎1例1只眼,诊断不明1例.在非脉络膜新生血管所致的52例54只眼中,高度近视漆裂纹出血17例19只眼,视网膜大动脉瘤12例12只眼,黄斑区小分支静脉阻塞8例8只眼,黄斑前膜5例5只眼,脉络膜外伤4例4只眼,脉络膜血管瘤4例4只眼,诊断不明2例.结论 眼底血管造影对黄斑部出血疾病病因的鉴别诊断有重要价值,对治疗有指导意义.     

眼底血管样条纹13例眼底荧光造影特征与临床表现

目的:分析眼底血管样条纹(angioid streaks,AS)的临床特征与眼底荧光造影(fundus fluorescein angiography,FFA)表现,并发症及治疗预后。方法:分析13例26眼血管样条纹患者的临床表现,全身状况及眼底荧光造影表现。结果:有11眼视力≤0.3(42%);眼底表现:26眼后极部均可见类似血管样的放射状条纹,5眼(19%)斑驳状(桔皮状)外观,15眼(58%)条纹通过黄斑,10眼(38%)可见黄斑区视网膜下出血、硬性渗出及新生血管膜,1眼(4%)合并眼外伤致多发性脉络膜破裂出血。FFA:26眼血管样条纹均表现为透见荧光,11眼黄斑在造影早期见脉络膜新生血管(choroidal neovascularization,CNV)影,其亮度逐渐增强,后期渗漏明显。结论:眼底血管样条纹患者的眼底及FFA表现典型,FFA结果有助于诊断分期及指导治疗。     

黄斑下脉络膜新生血管膜的手术治疗及随访观察

目的探讨黄斑下脉络膜新生血管膜手术治疗后的远期效果。方法经睫状体平部行闭路式玻璃体切除术后，切开视网膜，取出黄斑下脉络膜新生血管膜瘢痕组织。７例（７只眼）手术前、后均行视力、矫正视力、眼底及眼底血管荧光素造影检查，并进行长期随诊观察。结果随诊观察１年以上，６只眼黄斑下脉络膜新生血管膜消失，１只眼脉络膜新生血管膜复发。６只眼手术后视力均有不同程度增进，其中２只眼视力提高到０．５以上；１只眼视力减退，黄斑机化组织形成；１只眼发生继发性黄斑前膜。结论黄斑下脉络膜新生血管膜手术切除后，大多数眼视力有所提高，视力提高大小与黄斑下脉络膜新生血管膜瘢痕组织对色素上皮及神经上皮的损害程度有关，手术操作对色素上皮及神经上皮的影响亦有一定关系。     

高度近视眼荧光素眼底血管造影与吲哚青绿血管造影分析

目的 探讨高度近视眼荧光素眼底血管造影（fundus fluorescein angiography，FFA）和吲哚青绿血管造影（indocyanine green angiography，ICGA）同步检查的影像学特征及其临床意义。 方法 随机选择屈光状态-6 D以上的高度近视患 者30例57只眼，进行FFA和ICGA同步检查，对比分析其FFA和ICGA检查图像。 结果 57只眼中FFA显示早期背景 荧光减弱25只眼，晚期显示新生血管形成10只眼，漆纹样裂纹形成40只眼；ICGA显示睫状后短动脉8只眼，背景荧光减弱35 只眼，脉络膜新生血管形成8只眼，漆纹样裂纹形成52只眼。 结论 高度近视眼的FFA和ICGA 检查的影像学特征主要表现为背景荧光减弱，漆纹样裂纹及脉络膜新生血管形成。FFA 和ICGA 同步检查能更全面地了解高度近视患者眼底视网膜与脉络膜的病理变化，有助于全面地了解病情和指导进一步治疗。 （中华眼底病杂志，2003，19：87-89）     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.