Valsalva maculopathy

The Valsalva manoeuvre comprises forcible exhalation against the closed glottis, thereby creating a sudden increase in the intrathoracic or intra‐abdominal pressure. A simultaneous rapid rise in intraocular venous pressure may result in the spontaneous rupture of perifoveal capillaries, leading to a characteristic clinical picture of a preretinal haemorrhage in an otherwise healthy eye. The haemorrhage typically occurs at the macula and in the vast majority of cases resolves without compromising visual acuity. Valsalva maculopathy is an isolated and self‐limited event. A case of Valsalva maculopathy in a young healthy male attributable to an incontrovertible Valsalva stress associated with weightlifting is presented.     

Valsalva retinopathy associated with fiberoptic gastroenteroscopy

CASE REPORT: A 45-year-old woman presented with a sudden loss of vision in her left eye, which occurred while she was having a routine upper fiberoptic gastroenteroscopy. According to the gastrointestinal specialist, the patient had performed multiple sustained Valsalva maneuvers during the procedure. Funduscopy showed a preretinal hemorrhage with a half disc diameter in the fovea of the left eye. COMMENTS: A diagnosis of Valsalva retinopathy was made on the basis of history and fundus finding. The hemorrhage resolved within 2 months without any sequelae. To our knowledge, this is the first report of the occurrence of Valsalva retinopathy following a routine upper fiberoptic gastroenteroscopy.     

23G微创玻璃体切割术治疗Valsalva视网膜病变

目的 探讨23G微创玻切手术对Valsalva视网膜病变的临床效果.方法 回顾性分析了2007年3月至2010年3月在眼科就诊的10例(10只眼)Valsalva视网膜病变病例,经过1月保守治疗无效后接受23G微创玻璃体切割手术联合内界膜剥除,分析术后的治疗效果.结果 术后1周患者最佳矫正视力BCVA 0.3～0.5者7例,0.6～0.8者3例.最后一次随访时BCVA在0.6～0.8者9例,1.0者1例.除3例患者术后出现少量结膜下出血外未见其他并发症.结论 23G微创玻璃体切割手术联合ILM剥除对于保守治疗无效、范围较大的黄斑区ILM下积血为主要表现的Valsalva视网膜病变,是安全有效的.     

Nd:YAG membranotomy for preretinal hemorrhage secondary to valsalva retinopathy

Purpose

To report four cases of premacular hemorrhage secondary to valsalva retinopathy treated with Nd:YAG membranotomy and discuss techniques as well as the literature.

Design

Retrospective case series.

Methods

A retrospective review was conducted for four patients with vision obstructing hemorrhage secondary to valsalva retinopathy. These patients were all treated with Nd:YAG membranotomy.

Results

Four patients with premacular hemorrhage secondary to valsalva retinopathy were treated with Nd:YAG laser creating a membranotomy to drain the hemorrhage. Power settings ranged from 1.7 to 3.8 mJ. Visual acuity at presentation ranged from 20/400 (1 patient) to count fingers (3 patients). Visual acuity improved in three out of four patients after laser treatment. Final visual acuity ranged from 20/20 to 20/30 in these three patients. One patient was lost to follow up after performing laser membranotomy and therefore visual acuity after treatment was not obtained. No complications were noted.

Conclusion

Nd:YAG membranotomy is a non-invasive, office-based treatment option that may be successfully used to treat premacular hemorrhage secondary to valsalva retinopathy.     

色素上皮源性因子与糖尿病性视网膜病变

研究表明眼内血管形成刺激凶子与抑制因子的失衡是糖尿病性视网膜病变（DR）发生的主要原岗，而色素上皮源性因子（PEDF）是新近发现的一种重要的新生血管抑制物，可对抗病理性血管形成，同时具有神经营养及神经保护等其他作用。有研究表明糖尿病视网膜病变患者眼内PEDF表达发生改变，在DR的发生、发展过程中起一定的促进作用：就PEDF在DR中的表达及作用进行综述。     

重度非增生型糖尿病视网膜病变mfERG的定量分析

目的研究重度非增生型糖尿病视网膜病变（NPDR）多焦视网膜电图（mfERG）的特征及临床意义。方法30例（40眼）重度NPDR患者为NPDR组和35例（35眼）正常人为对照组。以国际分期作为NPDR诊断纳入标准,mfERG记录过程遵循国际临床视觉电生理学会的标准化方案,每个受试者在接受检查前均取得知情同意。结果与对照组相比,NPDR组患者mfERG2～5环的P1波、N1波反应密度明显下降,差异均有统计学意义（P〈0.05～0.01）;mfERG第Ⅱ象限和第Ⅲ象限的P1波、N1波反应密度明显降低,差异均有统计学意义（P〈0.05～0.01）。NPDR患者mfERG3～5环P1波、N1波隐含时较对照组明显延长,差异均有统计学意义（P〈0.05～0.01）;第Ⅰ象限和第Ⅲ象限隐含时显著延迟,差异均有统计学意义（P〈0.05～0.01）。结论NPDR可导致视网膜黄斑区视功能的损伤,mfERG能够客观、定量地反映黄斑区功能损害的程度。     

糖尿病视网膜病变发病机制研究进展

糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病最常见、最主要的微血管并发症之一,已经成为当前全球致盲的重要原因。其基本病理改变是视网膜的血-视网膜屏障的破坏和视网膜新生血管形成,黄斑水肿,最终视网膜脱离,导致失明。高血糖是公认的DR发生和发展的主要危险因素,DR还与多元醇代谢、糖基化终产物、甘油二酯-蛋白激酶C系统、氧化应激和自由基、炎症反应以及细胞因子等有关,但至今其发病机制尚未完全阐明,本文就目前DR的发病机制做一系统性的综述,为DR的治疗提供新的思路。     

Effect of focal laser photocoagulation in eyes with mild to moderate non-proliferative diabetic retinopathy

AIM: To report the effect of focal laser photocoagulation on both the severity of hard exudates (HEs) and the rate of disease progression in eyes with mild to moderate non-proliferative diabetic retinopathy (NPDR). METHODS: We retrospectively reviewed the medical records of 33 patients (60 eyes) who had been diagnosed with mild to moderate NPDR between January 2006 and December 2012. The patients were divided into 2 groups: Group A (38 eyes in 20 patients treated using focal laser photocoagulation) and Group B (treated without laser photocoagulation). We also reviewed the best corrected visual acuity measurements, and the fundus photographs taken at both baseline and follow-up visits. RESULTS: In Group A, HE severity grade had decreased significantly from baseline to the final visit (P<0.05), but this was not the case in Group B (P=0.662). The cumulative probabilities of retinopathy progression at 5y were 26% in Group A and 30% in Group B. Kaplan-Meier survival curves showed no significant difference between the groups with regard to retinopathy progression (P=0.805). CONCLUSION: Focal laser photocoagulation reduced the levels of HEs in eyes with mild to moderate NPDR. However, the treatment was not able to decelerate the progression of DR.     

Pathogenesis and intervention strategies in diabetic retinopathy

Diabetic retinopathy is the leading cause of new blindness in the working‐age population. If improved treatment regimens are to be developed it is crucial that the underlying pathophysiological mechanisms responsible for diabetic retinopathy are better understood. The multifactorial nature of the many pathways implicated in diabetic retinopathy requires a very detailed approach to elucidate the key mechanisms involved and their interactions in order to develop logical strategies aimed at therapeutic intervention. Fortunately, the streptozotocin rat model of diabetes displays many of the morphological and functional changes to the retinal vasculature that are evident in human diabetic retinopathy. This study reviews some of the recent experimental work by the authors in the streptozotocin rat, compares their findings to the human pathology, and outlines potential new avenues for therapeutic intervention. In particular, the improved understanding of which layers of the inner retina have the most stringent metabolic demands has helped identify which retinal layers are most susceptible to metabolic or hypoxic/ischaemic insult. It is concluded that improved treatment outcomes may ensue if the therapy is targeted at the appropriate tissue at specific stages of the disease.     

Early electroretinographic features of streptozotocin-induced diabetic retinopathy

Background: This study set out to document the early electrophysiological and immunohistochemical changes that occur in the retina of experimentally induced diabetic rats. Methods: Diabetes was induced in rats by intraperitoneal injection of 60 mg/kg of streptozotocin (STZ). Electroretinogram readings were taken monthly under either short‐duration or long‐duration stimuli for up to 3 months after STZ. Oscillatory potentials (OP) and the amplitudes and implicit times of a‐ and b‐waves were analysed, and b‐wave amplitudes were analysed using a Naka–Rushton fit. Scotopic a‐waves were analysed with photoreceptor models, and Rmp3 (the maximum a‐wave amplitude) and S (sensitivity) were calculated. Three months after STZ injection, immunohistochemistry for glial fibrillary acidic protein was performed on the retinas of the STZ‐treated rats and age‐matched controls. Results: The implicit OP times were significantly longer in the diabetic rats as compared with the controls, and this difference was noted as early as 1 month following STZ treatment. Other electrophysiological parameters, such as OP amplitudes, a‐ and b‐wave amplitude as well as the implicit times, did not differ from controls at this stage. The sacrificed STZ‐treated rats also demonstrated marked enhancement of glial fibrillary acidic protein immunoreactivity, suggesting that at least in experimentally induced diabetic retinopathy there is increased Müller cell reactivity. Conclusion: The results of this study indicated that functional alterations in the retina develop rapidly after the onset of diabetes. Analysis of each electroretinogram component may be useful in further investigating the development mechanisms of diabetic retinopathy.     

糖尿病性视网膜病变的治疗进展

激光光凝、药物治疗、玻璃体切割术(PPV)是目前治疗糖尿病性视网膜病变(DR)的主要方法。传统激光光凝治疗具有相对安全、疗效作用持久等优势,但激光可损害患者视觉质量;PPV虽能挽救部分患者的视力,但手术风险及创伤较大;药物治疗可在DR早期应用,但糖皮质激素类药物具有明确的副作用,故不能作为主要治疗方法;抗血管内皮生长因子(VEGF)药物治疗能从发病机制上有效抑制DR的发生发展,但疗效相对较短,反复治疗的安全性和有效性目前仍需进一步大样本研究。本文旨在对DR的临床治疗进展进行综述,以期为制定有效的临床治疗方案提供参考。     

微小RNA在视网膜疾病中表达及功能的研究进展

微小RNA(miRNA)是一类内源性、非编码单链RNA,长度约为22个核苷酸,他们通过与靶mRNA的3’端非编码区结合来抑制基因的表达,参与调节组织器官的生长发育、分化、功能维持和凋亡等重要的生理过程.miRNA是近年来生命科学领域中的研究热点,越来越多的研究表明多种miRNA在眼部表达,其中超过250种miRNA在视网膜组织中表达并影响其生长、发育和功能.本文就近年来miRNA在视网膜疾病的表达及功能作一综述.     

白细胞淤滞对糖尿病视网膜病变作用的研究

目的:观察糖尿病小鼠视网膜血管内白细胞淤滞和细胞间黏附因子-1(ICAM-1)在视网膜的表达.方法:选取C57型小鼠45只,随机分为2组:糖尿病组22只、正常组23只.10wk后取视网膜,荧光显微镜计数小鼠全视网膜微血管内淤滞的白细胞数目及其含有ICAM-1表达的荧光小球数目,免疫蛋白印迹法检测视网膜血管内皮生长因子(VEGF)和ICAM-1的表达.结果:10wk后,糖尿病小鼠视网膜血管内白细胞数目及含有ICAM-1表达的荧光小球数目明显高于正常对照组(P<0.01),其视网膜内VEGF和ICAM-1明显增加,有统计学意义(P<0.05).结论:视网膜血管内白细胞淤滞与糖尿病视网膜病变(DR)早期的视网膜毛细血管无灌注有关.     

双丹明目胶囊对糖尿病视网膜病变大鼠血糖及视网膜功能的影响

目的:通过建立大鼠糖尿病视网膜病变(diabetic retinopathy,DR)模型,观察造模后大鼠的血糖以及视网膜和胰腺组织的病理变化,初步评价双丹明目胶囊对改善DR视网膜和胰腺组织结构的效应。方法:将双丹明目胶囊作用于DR大鼠,通过与正常组、模型对照组、阳性对照组的比较,观察双丹明目胶囊对DR大鼠视网膜和胰腺形态学的影响。结果:经双丹明目胶囊治疗2mo后,双丹明目组大鼠血糖和糖化血红蛋白与模型对照组比较均明显降低,血糖差异有显著意义(P<0.01)。双丹明目组病变较模型对照组轻,光感受器细胞层排列基本整齐,各层组织细胞内、细胞外水肿现象较模型对照组轻,毛细血管管腔无闭塞,周细胞轻度水肿。结论:双丹明目胶囊能有效降低DR大鼠血糖和糖化血红蛋白含量。双丹明目胶囊能有效改善DR大鼠视网膜和胰腺组织结构。     

Solar retinopathy

319 patients with a solar retinopathy were seen in an eye clinic in Nepal within 20 months. All patients had either a positive history of sun-gazing or typical circumscribed scars in the foveal area. In more than 80% of the patients the visual acuity was 6/12 or better and did not deteriorate over time. 126 (40%) patients had a history of gazing at the sun during an eclipse, 33 (10%) were sun worshipers and 4 (1%) were in both categories. Three years later 29 patients were re-examined in a follow-up study. Only 16 had had visual disturbances directly after they had gazed into the sun. No colour vision defects were seen in any of the 44 affected eyes, when tested with Panel D 15, while four patients (6 eyes) had some uncertainty with the tritan plates of the Ishihara test charts. Metamorphopsia were recorded in 11 eyes. Five German patients with solar retinopathy were examined in more detail. Colour contrast sensitivity (CCS) was tested for the central and the peripheral visual field. CCS for tritan axis was raised in all patients for the central visual field, while it was normal for the peripheral visual field. This revised version was published online in July 2006 with corrections to the Cover Date.     

Effect of light on oxygen-induced retinopathy in the rat model

The purpose of this study was to establish whether exposure to intense lighting favors the development or aggravates experimental oxygen-induced retinopathy in the new-born rat. Five groups of Wistar rats were studied. The control group was maintained for the first 14 days of life under conditions of cyclical (12L12D) lighting at 12 Lx in room air. Two other groups were subjected, for the same amount of time, to semi-darkness (2 Lx; 12L12D), one with room air and the other with supplemental 80% oxygen. The final two groups were exposed to the same room air and hyperoxic treatments under intense lighting conditions (600 Lx; 12L12D).After the treatment period, four rats were randomly chosen from each group, sacrificed and their retinas examined under electron microscope. Marked structural changes were seen only in the photoreceptor outer segments of those rats exposed to intense light.In eighty-five of the remaining rats retinal vascular morphology was examined in retinal flat mounts after intracardiac injection of India ink. Retinopathy was observed in rats treated with hyperoxia but no significant differences could be attributed to the light conditions under which the retinopathic rats had been maintained.In the rest of the rats, axonal transport along the optical pathways was evaluated after intravitreal injection of (³H) taurine. In the two groups exposed to hyperoxia, axonal transport was altered, but less markedly in those exposed to intense lighting than in those exposed to semi-darnkess. Intense illumination under conditions of normoxia favors axonal transport. Exposure to intense lighting does not seem to aggravate oxygen induced retinopathy in the rat though it does produce structural lesions of the photoreceptors.Abbreviations OIR oxygen-induced retinopathy - ROP retinopathy of prematurity     

光学相干断层扫描血管成像技术在糖尿病视网膜病变中的应用

光学相干断层扫描血管成像技术( optical coherence tomography angiography,OCTA)是近年来光学相干断层扫描( optical coherence tomography,OCT)的新兴技术,是一种无创、快速、高分辨率的眼底血管成像技术,现已被逐渐应用于各类眼底血管疾病的诊治及随访,如糖尿病视网膜病变、脉络膜新生血管等。 OCTA拥有能分层观察不同层面的视网膜脉络膜血管结构及形态和量化一定范围内的血流指数及病灶血流面积的独特优势。但OCTA存在观察视网膜范围有限、观察视网膜血管屏障功能有限、要求高固视力高配合度等不足,如果克服这些局限,将有助于我们提升对视网膜血管疾病的认识,完善对视网膜血管疾病的诊治和观察。     

眼底激光联合羟苯磺酸钙治疗糖尿病视网膜病变

目的：探讨Ⅲ～Ⅳ期糖尿病视网膜病变(diabetic retinopathy,DR)患者采用全视网膜激光光凝联合羟苯磺酸钙治疗的临床效果。

方法：选取2014-01/2015-12在本院进行治疗的120例204眼Ⅲ～Ⅳ期DR患者进行研究,均采用全视网膜激光光凝术治疗,采用随机数字表法分为研究组(66例116眼,加用羟苯磺酸钙治疗)和对照组(54例88眼,未用羟苯磺酸钙治疗),对比两组患者治疗的临床效果。

结果：术后6mo,研究组的最佳矫正视力(best corrected visual acuity,BCVA)检测值高于对照组,差异具有统计学意义(P<0.05); 术后3、6mo,研究组的视网膜新生血管荧光素渗漏面积均低于对照组,差异具有统计学意义(P<0.05); 术后3、6mo,研究组的黄斑中心凹厚度(central macular thickness,CMT)测定值均低于对照组,差异具有统计学意义(P<0.05); 研究组有4眼出现术后并发症(3.4%),与对照组(5眼,5.7%)比较,差异无统计学意义(P>0.05)。

结论：Ⅲ～Ⅳ期DR患者采用全视网膜激光光凝联合羟苯磺酸钙治疗,较单纯全视网膜激光光凝治疗能进一步改善临床效果,减轻视网膜新生血管荧光素渗漏面积及CMT。     

激光治疗对糖尿病视网膜病变患者视网膜血流动力学的影响

目的以彩色多普勒成像(colorDopplerimaging,CDI)技术探讨激光治疗对糖尿病视网膜病变(diabeticretinopathy,DR)患者视网膜血流动力学的影响。方法用CDI技术检测激光治疗前后DR患者视网膜中央动脉的收缩期峰值流速、舒张末期血流速度与阻力指数,以及激光治疗前后视力的改变,并作对照比较。结果激光治疗后DR患者视网膜中央动脉的收缩期峰值流速、舒张末期血流速度均有所增加,阻力指数稍下降,视力不同程度提高或保持不变。结论激光治疗能改善DR患者视网膜的血流灌注,对视力提高及保持原有视力有很好的临床价值。