中心性浆液性脉络膜视网膜病变129例荧光素眼底血管造影分析

目的 分析中心性浆液性脉络膜视网膜病变(CSC)的临床特征和荧光素眼底血管造影(FFA)的检查结果.方法 回顾性分析129例(132只眼)CSC患者的视力,男女发病比例,FFA的表现及病变分型.结果 CSC患者中男性比女性患病率高(8.21∶1),根据FFA检查结果表现可将眼底荧光渗漏分为7种类型,患者视力与渗漏点位置及浆液性视网膜脱离范围相关.结论 FFA检查可明确诊断CSC,清晰显示病变类型,并且可以指导治疗、判断预后.     

老年性中心性浆液性视网膜神经上皮脱离18例病因分析

目的探讨老年性中心性浆液性视网膜神经上皮脱离的病因。方法回顾性分析18例（19只眼）老年性中心性浆液性视网膜神经上皮脱离患者的临床特征及其病因。结果19只患眼中,眼底检查显示黄斑中心凹反光消失18只眼,色素上皮紊乱14只眼;眼底荧光血管造影显示透见荧光点15只眼,扩散型荧光渗漏3只眼,色素上皮脱离荧光5只眼;光学相干断层扫描显示19只眼黄斑浆液性神经上皮脱离,其中5只眼伴浆液性色素上皮脱离,8只眼可见玻璃体后界膜。结论老年性中心性浆液性视网膜神经上皮脱离多数由于玻璃体急速后脱离而引起,也有可能是年龄相关性黄斑变性渗出型的早期表现,或由于视网膜外屏障损坏而引起。     

中药联合氩激光治疗中心性浆液性脉络膜视网膜病变的临床观察

目的观察中药联合氩激光治疗中心性浆液性脉络膜视网膜病变的临床疗效。方法62例患者根据中医辨证分型口服中药，其中眼底荧光血管造影显示渗漏点在距黄斑中心凹200μm以外的患者联合应用氩激光治疗。结果随访3～6个月，本组62例69眼，治愈45眼，占65．22％；显效15只眼，占21．74％；无效9只眼，占13．04％。总有效率86．96％。结论中药联合氩激光治疗中心性浆液性脉络膜视网膜病是可靠有效的疗法。     

急性中心浆液性脉络膜视网膜病变OCT检查形态学特征分析

目的探讨急性中心浆液性脉络膜视网膜病变光学相干断层成像（OCT）检查的形态学特征。方法对215例急性浆液性脉络膜视网膜病变的患者行OCT检查,主要观察患者的神经及色素上皮层的形态特征。结果经过光学相干断层成像（OCT）检查可清晰显示患者的神经和色素上皮层的脱离状态,其中单纯神经上皮层浆液性脱离182例,占总例数的84.65%;单纯色素上皮层脱离8例,占总例数的3.72%;神经上皮层合并有色素上皮层脱离的有25例,占总例数的11.63%。结论急性浆液性脉络膜视网膜病变OCT检查常见的OCT表现为单纯的神经上皮层脱离和神经上皮层合并色素上皮层脱离的形态学改变。     

多波长激光治疗中心性浆液性脉络膜视网膜病变的临床观察

中心性浆液性脉络膜视网膜病变(central se-rous chorioretinopathy,CSC)多见于20~50岁的青壮年男性,表现为突发视力下降、视物变形、变小,眼底检查黄斑区神经上皮层盘状脱离,眼底荧光血管造影(fundus fluorescence angiography,FFA)表现为早期荧光素渗漏,随时间呈墨迹样、炊烟     

中心性浆液性脉络膜视网膜病变眼底荧光血管造影与视力预后的探讨

中心性浆液性脉络膜视网膜病变 (CSC)是一种常见的眼底病 ,眼底荧光血管造影 (FFA)为此病的诊断提供依据。关于FFA各种荧光渗漏分型国内报道较多 ,但其与视力损害的关系探讨不多。笔者分析了1992年—2000年收治的120例CSC的病例和FFA检查结果 ,就FFA荧光渗漏的形态、部位、大小等情况对视力的影响进行分析 ,为临床诊治提供参考。1资料与方法1.1一般资料本组共120例 (124只眼 ) ,男84例 ,女36例 ,双眼发病4例 (占3 3 % ) ,复发者12只眼 (占9 6% )、复发2次及以上者5只眼 (占复发者的41 7 % )。年龄21～56岁 ,平均 (34 5±4)岁。FFA…     

苦碟子注射液对初诊为中心性浆液性脉络膜视网膜病变的疗效与安全性

目的评价苦碟子注射液(活血化瘀中药)治疗初诊中心性浆液性脉络膜视网膜病变患者的临床疗效与安全性。方法将初诊为中心性浆液性脉络膜视网膜病变79例患者,随机分为对照组(39例39眼)与治疗组(40例40眼)。对照组按常规治疗;在常规治疗基础上,治疗组加用苦碟子注射液。用光学相干断层扫描技术(OCT)、眼底照像及视网膜血管荧光造影、标准对数视力表等随访复诊。结果在每个疗程后,OCT检查浆液性脱离区下降高度、12周后总有效率和总显效率,治疗组与对照组比较差异有统计学意义(P<0.05)。对照组出现1例胃肠道不良反应。结论苦碟子注射液对治疗初诊中心性浆液性脉络膜视网膜病变疗效明确且安全性较好。     

眼底荧光素血管造影检查技术在中心性浆液性脉络膜视网膜病变中的应用

中心性浆液性脉络膜视网膜病变（Central Serous choroidoretinopathy,CSC）是常见的黄斑部病变,以视网膜色素上皮层功能损害、形成黄斑部及其附近视网膜神经上皮局限性浆液性脱离为特征。常见于中青年男性,确切病因不明,认为原发病理在视网膜色素上皮（RPE）和／或脉络膜毛细血管,而盘状视网膜脱离是继发病变。本文对152例（192眼）CSC患者眼底荧光血管造影（Fundus fluorescein angiography,FFA）图像进行了研究,报告如下。     

卵磷脂络合碘治疗中心性浆液性脉络膜视网膜病变

目的　观察卵磷脂络合碘治疗中心性浆液性脉络膜视网膜病变的疗效。方法　 4 2例经临床及荧光素血管造影 (FFA)确诊为中心性浆液性脉络膜视网膜病变患者随机分为两组 ,治疗组 2 3例 ,用卵磷脂络合碘 ,1 5mg/次 ,3次 /d ,共 2个月 ;对照组 19例 ,用肌苷片 ,2 0 0mg/次 ,3次 /d ,共 2个月。观察治疗前后视力、眼底变化、视野及FFA改变。结果　 1例淘汰。有效率治疗组 90 9% ,对照组 36 8% (P <0 0 1)。结论　卵磷脂络合碘对中心性浆液性脉络膜视网膜病变有明显疗效。     

SD—OCT评估护理干预对中心性浆液性脉络膜视网膜病变预后影响的研究

目的探讨SD—OCT评估护理干预在中心性浆液性脉络膜视网膜病变中的疗效。方法96例经眼底荧光血管造影及SD-OCT检查,确诊为中心性浆液性脉络膜视网膜病变患者随机分为观察组与常规组,每组48例。观察组给予常规药物治疗及针对疾病的诱发因素给予护理干预,常规组给予常规药物治疗。所有患者7、14、30、60d进行复诊,观察最佳矫正视力并比较两组患者SD—OCT影像结果。结果观察组总有效率为86．5％高常规组的60．4％,差异有统计学意义（P〈0．05）;2组均未见明显不良反应。结论护理干预对中心性浆液性脉络膜视网膜病变患者预后有良好的促进作用,有效缩短了病程,是改善患者预后生活质量的有效方法。     

Morphologic changes and visual outcomes in resolved central serous chorioretinopathy treated with ranibizumab

Context: Central serous chorioretinopathy (CSC).

Objective: To evaluate the effect of intravitreal ranibizumab injection and the correlation between foveal morphologic changes and visual outcomes in patients with resolved CSC.

Materials and methods: We measured outer nuclear layer (ONL) thickness, outer layer (OL) thickness and evaluated the integrity of the photoreceptor inner-outer segment (IS/OS) junction, the status of the external limiting membrane (ELM) at the central fovea using spectral-domain optical coherence tomography (OCT) in 35 eyes of 35 patients with resolved CSC. The eyes were divided into two groups: The initial medical treatment administered to Group1 (n?=?17) then received intravitreal ranibizumab injections, Group 2 (n?=?18) received medical treatment. Group 3 was composed of normal eyes (n?=?20, as a control). We also investigated a correlation between the ONL thickness and best corrected visual acuity (BCVA).

Results: The mean age was 45.7?±?7.2 (ranged from 27 to 55 years). The mean follow-up period was 14.2 months (minimum 6, maximum 24 months). The mean ONL and OL thickness in Group 1 were significantly thinner than Group 3 (p?r?=?0.681, p?=?0.001). Thirty-tree patients had improvement in BCVA after treatment. Discontinuity of the IS/OS junction was found in 15 eyes (88.2%) in Group 1, in 5 eyes (27.7%) in Group 2 and in no eyes in Group 3.

Discussion: We demonstrated that prolonged serous detachment results in photoreceptor cell loss (apoptosis) and thinning of the ONL. Thinning of the ONL correlates with poorer vision, which has been found by other investigators. Furthermore, vascular endothelial growth factor (VEGF) may be neuroprotective to the photoreceptors which might explain the additional thinning in the patients treated with ranibizumab. This raises the possibility that treatment with VEGF inhibitors may be unfavourable to patients with CSC, even though it speeds recovery and vision does improve.

Conclusion: Intravitreal ranibizumab injection leads to thinning of the ONL and the OL in patients with resolved CSC. The ONL thickness reduction and discontinuity of the IS/OS junction results in poor visual prognosis in resolved CSC eyes.     

Clinical efficacy of anti-VEGF medications for central serous chorioretinopathy: a meta-analysis

Background Central serous chorioretinopathy (CSC) is a widespread retinal disorder, and 30–50% of patients eventually result in retinal pigment epithelium atrophy and irreversible vision loss. Aim of the review To evaluate the effectiveness of medications based on anti-vascular endothelial growth factor (anti-VEGF) on central serous chorioretinopathy (CSC). Method A systematic search on anti-VEGF medication treatments for CSC was performed in Pubmed, Embase, and the Cochrane Library prior to May 2016. The main outcome variables were best-corrected visual acuity (BCVA) and central macular thickness (CMT). All effects were analyzed via Review Manager 5.3. Results Fourteen studies were incorporated with a total of 266 eyes, divided into a comparative group and a non-comparative group. The comparative group included acute and chronic CSC studies, while the non-comparative group included chronic CSC only. Meta-analysis revealed that for acute CSC, anti-VEGF treatment was not superior to observation at a 6-month follow-up in BCVA and CMT. For chronic CSC in the comparative group, no significant difference was observed between anti-VEGF treatment and observation in BCVA; however, the observed difference in CMT (WMD = ?67.78, 95% CI 20.17–115.38) was statistically significant. In the non-comparative group, significant differences were observed after anti-VEGF treatment in BCVA and CMT at 1, 6, and 12 months follow-ups. Conclusion Our meta-analysis partially indicated that anti-VEGF medications might be a viable choice for the treatment of chronic CSC; however, due to the self-limiting nature of CSC, care should be applied in the clinical application of anti-VEGF medications.     

Verteporfin PDT for subfoveal occult CNV in AMD: two-year results of a randomized trial

ABSTRACT

Objective: To determine whether verteporfin photodynamic therapy (PDT) can safely reduce the risk of vision loss in patients with subfoveal occult with no classic choroidal neovascularization (CNV) due to age-related macular degeneration.

Research design and methods: Eligible patients were ≥50 years of age with lesion size ≤6 disc areas and best-corrected vision 20/40–20/200. A total of 364 patients with occult with no classic CNV were randomly assigned 2 : 1 to verteporfin PDT (n?=?244) or placebo (n?=?120). The primary outcome measures were loss of ≥15 and ≥30 letters of visual acuity (VA) from baseline at 12 and 24 months.

Results: A total of 37% and 47% of verteporfin-treated patients versus 45% and 53% of placebo recipients lost ≥15 letters of VA at month 12 and month 24, respectively; 16% and 23% of verteporfin-treated patients versus 17% and 25% of placebo recipients lost ≥30 letters at month 12 and month 24, respectively. These differences were not statistically significant. Four (1.6%) verteporfin-treated patients and one placebo patient (who received verteporfin in error) experienced an acute severe VA decrease; all five patients recovered some degree of vision. No unexpected ocular or systemic adverse events were identified.

Conclusions: Verteporfin PDT in the treatment of occult with no classic CNV was safe and well-tolerated. The differences between the two groups in the primary efficacy variables were not significant. Baseline characteristics and patient selection methods may have contributed to the small treatment effect.

Trial registration: ClinicalTrials.gov identifier: NCT00121407.     

Evaluation of verteporfin pharmakokinetics--redefining the need of photosensitizers in ophthalmology

INTRODUCTION: The benzoporphyrine derivative verteporfin has lost its importance to the treatment of the most frequent neovascular eye diseases. Nevertheless, it is still mandatory to define the remaining applications, role, and potential of verteporfin in ocular photodynamic therapy (PDT), including the dosages of administration, effectiveness, and safety profile. AREAS COVERED: Although verteporfin PDT has forfeited the first-line status and value of treating subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration or pathologic myopia, the treatment remains the standard of care for choroidal haemangioma and polypoidal choroidal vasculopathy. PDT is effective in less pigmented choroidal melanoma as well as in retinal vascular proliferations and retinal angioma. Verteporfin was granted the orphan drug designation for the treatment of chronic or recurrent central serous chorioretinopathy (CSC). EXPERT OPINION: Evidence-based data regarding optimized parameters (low fluence, reduced dose, fractionated irradiation) adapted to the treated diseases (target structure, dosimetry, blood supply) are scarce. Prospective and large clinical trials are missing, although the scientific community agrees on the fact that the standard treatment protocol does not necessarily provide the optimal efficacy to the specific disease or individual patient. Within the reviewed indications, the adverse effect profile is favorable compared with other therapies.     

Photodynamic therapy combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

The aim of this research was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of triamcinolone acetonide (TA) in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathological myopia. PDT combined with intravitreal injection of TA was performed on 16 eyes of 16 patients with CNV diagnosed by visual acuity, fluorescein fundus angiography (FFA) and optical coherent tomography (OCT), including 14 eyes secondary to age-related macular degeneration and two eyes secondary to pathological myopia. TA was injected intravitreally 72 h post PDT on 12 eyes and from three months to one year (mean nine months) post PDT on four eyes respectively. All the patients were followed up for 3 to 18 months (mean 18.6 months). Best-corrected visual acuity, intraocular pressure, retinal thickness and FFA were observed. The visual acuity was improved in seven eyes (43.8%) of all the 16 eyes and stable in nine eyes (56.2%), respectively. FFA revealed complete or partial closure of CNV in all patients. OCT showed that the macular edema disappeared or was alleviated. Transient intraocular pressure elevation occurred in one patient (6.25%) of all the 16 eyes and intraocular pressure returned to the normal after a transient treatment with antiglaucoma medication. The mean number of PDTs during the first year was 1.1. PDT combined with intravitreal injection of TA for CNV is safe and effective. It can reduce the risk of visual loss and the treatment frequency. __________ Translated from Chinese Journal of Ocular Fundus Diseases, 2007, 23(1): 13–16 [译自: 中华眼底病杂志]     

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema

Objective: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.

Methods: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40?mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.

Results: Forty-one eyes of 41 patients with a mean age of 63.49?±?10.99 (55–86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p?<?0.001, p?<?0.001 and p?=?0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p?<?0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.

Conclusion: PSTA application is an effective and safe option in BRVO-related macular edema.     

准分子激光上皮瓣下角膜磨镶术的临床研究

目的评价准分子激光上皮瓣下角膜磨镶术(Laser subepithelial keratomileusis,LASEK)的临床效果。方法对143例(284眼)近视眼患者施行LASEK术,并观察术后裸眼视力及各种并发症情况。结果术后视力恢复良好,术后1个月263眼(91.0%)裸眼视力(UCVA)达术前最佳矫正视力(BCVA),但术中术后也有角膜上皮瓣异常、角膜上皮下雾状浑浊(haze)等并发症。结论LASEK术是一种安全有效的屈光手术,但也应积极地预防一些并发症的出现。     

去上皮瓣LASEK与飞秒激光辅助LASIK矫治中低度近视的比较

目的 比较去上皮瓣准分子激光上皮下角膜磨镶术（LASEK）与飞秒激光辅助准分子激光原位角膜磨镶术（FS-LASIK）治疗中低度近视患者术后的效果。方法 选择拟行近视矫正手术的低中度近视患者103例（103眼）,LASEK组51例（51眼）,FS-LASIK组52例（52眼）。比较2组患者在术前和术后1个月、3个月裸眼视力（UCVA）、最佳矫正视力（BCVA）、残余等效球镜度（SE）、总高阶像差、球差、彗差、三叶草相差等指标的变化。结果 在术后1、3个月2组UCVA、BCVA差异均无统计学意义;术后1个月LASEK组SE较FS-LASIK组升高（P＜0.05）,但术后3个月 差异无统计学意义。LASEK 组和 FS-LASIK 组术后 1 个月、3 个月总高阶像差、球差均较术前增加（P＜0.05）;FSLASIK组彗差术后1个月较术前增加（P＜0.05）,术后3个月恢复至术前水平,LASEK组彗差术后1个月、3个月与术前相比差异无统计学意义。FS-LASIK组术后1个月全眼总高阶像差和彗差均较去上皮瓣LASEK组升高（P＜0.05）;术后3个月2组差异无统计学意义。结论 去上皮瓣LASEK术式矫正近视术后早期可达到与FS-LASIK相近水平,尤其适用于低中度近视患者。     

A preliminary benefit-risk assessment of verteporfin in age-related macular degeneration.

The prevalence of neovascular age-related macular degeneration (AMD) is expected to increase significantly during the next 20 years. New treatment alternatives to laser photocoagulation are on the horizon - the first of these, photodynamic therapy (PDT) with verteporfin, was approved by the US FDA in 2000. In this article we present a preliminary risk-benefit assessment of verteporfin in AMD, focusing on the landmark randomised, double-blind, placebo-controlled studies. The TAP (Treatment of Age-related macular degeneration with Photodynamic therapy) trial established the efficacy of PDT for classic subfoveal neovascularisation in AMD at 2 years follow-up. The VIP (Verteporfin in Photodynamic therapy) study concentrated on subfoveal occult-only lesions not included in the TAP study. After 2 years, treated eyes were less likely to experience visual loss. Exploratory analyses of TAP and VIP suggest that lesion size is a more significant predictor of the treatment benefit than either lesion composition or visual activity. The VIM (Visudyne in Minimally classic) trial altered the standard PDT light fluence rate in the treatment of subfoveal minimally classic lesions. This trial again demonstrated a beneficial effect for those receiving treatment with PDT. The VIO (Visudyne in Occult) trial, evaluating PDT in occult-only lesions as a confirmatory study of the VIP trial, did not achieve its primary end-point at 2 years. Further analyses are pending.PDT with verteporfin has an excellent safety profile that has been established with >1 million treatment applications. Cost-effectiveness data are limited but suggest that PDT may be a cost-effective treatment modality. Other FDA-approved treatments (pegaptanib, ranibizumab and bevacizumab) for neovascular AMD are discussed, as well as investigational substances such as anecortave acetate.     

球后注射曲安奈德联合激光光凝治疗糖尿病弥漫性黄斑水肿的疗效观察

目的 观察曲安奈德（TA）球后注射联合格栅样光凝（MLG）治疗糖尿病性弥漫性黄斑水肿（DME）的疗效.方法 以50眼糖尿病性DME为研究对象,30眼给予球后注射TA联合MLG,20眼给予单纯MLG,治疗6个月内,观察患眼视力、黄斑水肿以及黄斑中心凹视网膜厚度.结果 TA联合MLG组患者视力提高21眼,视力不变6眼,视力下降3眼;黄斑中心凹区视网膜厚度治疗前为（598.62±198.58） μm,治疗6个月后（307.51±101.21） μm.MLG组视力提高2眼,视力不变10眼,视力下降8眼;黄斑中心凹区视网膜厚度治疗前为（574.73±187.12） μm,治疗6个月后（369.12±112.20） μm.两治疗组间治疗后有统计学差异.结论 TA球后注射联合MLG治疗糖尿病DME可改善视力、促进黄斑水肿吸收.