白内障合并年龄相关性黄斑变性患者行超声乳化晶状体吸出术临床疗效

目的探讨超声乳化晶状体吸出术治疗白内障合并年龄相关性黄斑变性(age-related macular degeneration,AMD)患者的疗效及对黄斑中心凹视网膜厚度的影响。方法回顾分析我院行超声乳化晶状体吸出术的白内障患者72例(80眼),其中单纯白内障患者40例(44眼),合并AMD患者32例(36眼);于我院门诊就诊确诊近期不行手术合并AMD的白内障患者30例(32眼)。分别于术前,术后1d、1周、4周、3个月检测患者的最佳矫正视力、黄斑中心凹视网膜厚度及黄斑区组织变化情况,并作比较。结果单纯白内障组和合并AMD组分别有43眼(97.73%)和25眼(69.44%)术后视力较术前有不同程度提高;AMD未手术组12眼(37.50%)视力有不同程度下降,未发现视力提高者。单纯白内障组和合并AMD组术后黄斑中心凹视网膜厚度均较术前增加,但仅在术后4周与术前比较差异有统计学意义(t=2.567,P=0.012;t=3.076,P=0.003),且与单纯白内障组相比,合并AMD组术后4周时黄斑中心凹视网膜厚度增加更为明显,差异有统计学意义(t=2.044,P=0.044);AMD未手术组术后黄斑中心凹视网膜厚度与术前比较,差异无统计学意义(P>0.05)。单纯白内障组有5眼视网膜厚度明显增加,1眼于术后4周出现黄斑囊样水肿;合并AMD组有8眼视网膜厚度明显增加,2眼出现黄斑囊样水肿,未发现脉络膜新生血管产生者;AMD未手术组观察期内未发现黄斑区明显改变者。结论合并AMD的白内障患者经超声乳化晶状体吸出术后视力可有不同程度提高,手术本身并不诱导脉络膜新生血管的产生。超声乳化晶状体吸出术对于合并AMD的白内障患者是一种相对安全的手术方法。     

白内障手术对年龄相关性黄斑变性的影响

年龄相关性白内障和年龄相关性黄斑变性(age-related macular degeneration,AMD)是导致老年人视力损害的重要眼病,而老年人常会同时患这两种年龄相关性眼病.早期研究认为白内障术后可促进AMD的进展.但随着对疾病的认识逐渐加深以及治疗策略的不断进步,白内障手术是否对AMD有较大影响尚存争议.本文将对两种疾病的发病率、白内障手术治疗与AMD进展的关系,以及如何在白内障手术后有效降低AMD的手术风险进行综述.     

湿性年龄相关性黄斑变性玻璃体注射雷珠单抗治疗一年后视力的影响因素

目的 观察湿性年龄相关性黄斑变性（wAMD）玻璃体注射雷珠单抗治疗1年后视力及其影响因素。设计 回顾性病例系列。研究对象 郑州市第二人民医院眼科2015年5月至2017年2月wAMD患者50例（50眼）。方法  所有患者均接受最佳矫正视力（BCVA）、眼底彩色照相、荧光素眼底血管造影（FFA）、相干光断层扫描（OCT）及相干光断层扫描血管成像（OCT-A）检查。所有患眼均采用每月注射 1 次连续注射 3 个月后按需治疗的方案行玻璃体注射雷珠单抗治疗。观察治疗1年后的BCVA。分析治疗1年后的终末BCVA及提高程度与基线特征年龄、性别、基线BCVA、黄斑下视网膜出血、视网膜内液、视网膜下液、视网膜色素上皮脱离、黄斑中心凹视网膜厚度（CFT）、脉络膜新生血管（CNV）面积及CNV的类型（经典为主型、微小经典型、隐匿型）的相关性。主要指标  BCVA、黄斑下视网膜出血、视网膜内液、视网膜下液、视网膜色素上皮脱离、CFT、CNV的面积,CNV的类型。结果 治疗前BCVA为（53.4±14.5）个字母,治疗1年后BCVA为（61.3±20.5）个字母,提高（7.9±8.5）个字母（t=-6.564,P<0.01）。治疗1年后的终末BCVA与基线BCVA正相关（B=0.483,P=0.001）,与治疗前CNV面积和CNV的类型负相关（B=-0.211,P=0.005;B=-0.202, P=0.005）;治疗1年后BCVA的提高程度与治疗前CNV面积和CNV类型负相关（B =-0.509,P=0.005;B=-0.488, P=0.005）。三种类型的CNV中,经典为主型CNV治疗1年后的BCVA较差,隐匿型的终末BCVA较好,经典为主型BCVA提高程度较少,微小经典型提高程度较大（P＜0.05)。结论 经典为主型CNV、CNV面积大者,玻璃体注射雷珠单抗1年后视力改善较小、预后差;基线视力较好者会有较好的终末视力。     

年龄相关黄斑变性白内障患者超声乳化人工晶状体植入术后疗效分析

目的:探讨白内障手术对伴有年龄相关黄斑变性(agerelated macular degeneration,AMD)的白内障患者的治疗效果,评价手术的价值。方法:对31例37眼同时伴有AMD的白内障患者行超声乳化人工晶状体植入术,术后随访3～6mo,分析其临床效果。结果:术后所有患者的视力均有不同程度的提高,其中指数2眼(5%),0.01～0.08者11眼(30%),0.1～0.2者12眼(32%),0.3者8眼(22%),0.4～0.5者4眼(11%);术后有1眼(3%)AMD病变加重,为湿性AMD。结论:对于同时伴有AMD的白内障患者,综合考虑其黄斑和晶状体情况,在白内障严重影响视力的情况下,为了提高患者的生活质量,应该积极地进行白内障手术。     

湿性年龄相关性黄斑变性危险因素的研究进展

年龄相关性黄斑变性(age-related macular degeneration,ARMD)是全球主要的老年性致盲眼病之一,其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wARMD)造成视功能损害较严重。在我国,由于人口趋于老龄化,与年龄相关的退行性疾病构成严重的医疗负担。随着国内外学者对wARMD危险因素的深入研究,wARMD的防控已成为重要研究课题。因此,通过对wARMD危险因素的研究,从而采取有效的预防措施,有望降低wARMD的发病率和延缓疾病发展。本文就wARMD相关危险因素的研究进展进行综述。     

光损伤对白内障术后年龄相关性黄斑变性的影响

随着年龄的增加,人类正常的晶状体逐渐变黄。变黄的晶状体能减弱蓝光、紫外线等一些有害光线到达视网膜,进而减少这些有害光线对视网膜的损伤。然而,变黄的晶状体因超声乳化晶状体吸出术被透明的人工晶状体取代时就相应地增加了这些有害光线对视网膜的损伤。过多暴露于这些光线对视网膜的破坏主要表现在视网膜色素上皮细胞、光感受器细胞等受损。这些组织的病变与年龄相关性黄斑变性的发展或进展有一定的关联。本文就超声乳化晶状体吸出术后年龄相关性黄斑变性的发展及一些诱发因素加以阐述。     

湿性年龄相关性黄斑变性的治疗进展

年龄相关性黄斑变性( age-related macular degeneration, AMD)是WHO现阶段三大防盲重点眼病之一,是50岁以上人群主要的致盲眼病之一,65岁以上的人群中,约2%因患本病而导致单眼失明,随着人口老龄化,我国AMD的患病率也在增加。 AMD就其临床表现分为干性 AMD和湿性AMD,湿性AMD对患者的视力危害最大,目前AMD的治疗很多(主要是针对湿性AMD),主要包括激光治疗、药物治疗、手术治疗、基因治疗等,以下对近年来湿性AMD的治疗作一综述。     

CCR3在湿性年龄相关性黄斑变性中的研究进展

研究显示,趋化因子受体3(chemokine receptor 3,CCR3)在眼部主要分布于视网膜色素上皮细胞中,亦表达于脉络膜血管内皮细胞(CECs)中。CCR3的特异性高表达在湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)中被发现,并被证明在湿性AMD患者脉络膜新生血管(choroidal neovascularization,CNV)的产生中具有重要作用。本文拟对CCR3的结构、功能、目前研究存在的问题及未来的研究方向做一综述。相信随着对CCR3研究的进一步深入,必将帮助我们寻找到一种湿性AMD诊断和治疗的新方法,同时也可能对其它CNV性疾病研究以及新的抗CNV药物提供重要参考。     

年龄相关性黄斑变性合并白内障手术治疗的研究进展

年龄相关性黄斑变性(age-related macular degeneration, AMD)与白内障是世界范围内最常见的导致低视力的疾病.目前对于合并AMD的白内障患者是否应该实施手术和手术的时机问题尚存争议.本综述的目的在于评估白内障手术对于AMD发生和发展的影响,分析其影响因素,探讨合并AMD的白内障手术时机和联合抗VEGF等治疗,还包括人工晶状体的研究进展和应用,以期选择综合治疗措施,避免和减缓白内障手术后黄斑变性的发生和发展,以保证患者获得良好的视力转归.     

Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration

BACKGROUND: The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract. METHODS: The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores. RESULTS: The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye. INTERPRETATION: An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract.     

康柏西普对提高湿性老年性黄斑变性患者视力的临床效果分析

目的：观察康柏西普对提高湿性老年性黄斑变性患者视力的临床效果。

方法：临床纳入湿性老年性黄斑变性患者70例70眼,根据治疗方案的不同分为研究组与对照组。对照组给予曲安奈德注射液玻璃体腔注射,研究组给予康柏西普注射液玻璃体腔注射。观察两组患者治疗前后裸眼视力变化情况、阅读能力评分、视网膜黄斑色素密度等。

结果：治疗后6mo,1a,研究组视力分别为0.47±0.11、0.60±0.14,对照组视力分别为0.27±0.09、0.30±0.15,两组比较差异有统计学意义(P<0.05); 治疗后6mo,1a,研究组黄斑中心凹视网膜厚度分别为336.8±65.4、301.5±76.8μm,对照组黄斑中心凹视网膜厚度分别为379.4±88.2、368.6±81.3μm,两组比较差异有统计学意义(P<0.05); 治疗后6mo,1a,研究组视网膜黄斑色素密度分别为0.19±0.07、0.25±0.09DU; 对照组视网膜黄斑色素密度分别为0.12±0.05、0.14±0.05DU,两组比较差异有统计学意义(P<0.05)。

结论：玻璃体腔注射康柏西普注射液治疗湿性老年性黄斑变性,具有较好的临床效果,能够显著提高患者裸眼视力,值得推广。     

Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration

Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.     

Combined cataract surgery and vitrectomy for vitreous haemorrhage secondary to age-related macular degeneration

Purpose: To report on the functional outcome of surgery on patients with concurrent cataract and breakthrough vitreous haemorrhage from age‐related macular degeneration (ARMD). Methods: Retrospective case series. Results: Five eyes were included in the study. The post operative follow‐up interval ranged from 9 to 12 months. Preoperative visual acuity ranged from hand motion to perception of light. Two surgeries were complicated by iatrogenic breaks, and a further surgery was required to re‐attach the retina in one of these eyes. Only one of the five eyes experienced an improvement in visual functioning. Conclusion: In this series, the outcome of surgery for combined cataract and breakthrough vitreous haemorrhage, secondary to ARMD was poor. The functional outcome of surgery for combined cataract and vitreous haemorrhage secondary to ARMD in this series was poor.     

Visual acuity and structural findings in old age-related macular degeneration

Background Although exudative age-related macular degeneration (AMD) leads to a substantial visual loss in most patients there is still significant variation in the end- stage visual acuity level. We analysed lesions in eyes with long-standing AMD in order to find contributing factors for this variation.Methods Sixty-one out of 121 patients examined for exudative AMD and still alive 4.8–9.2 (mean 6.8) years after the acute phase were re-examined. The lesion size, area of subretinal fibrosis, geographic atrophy, presence of a persistent exudative process, and shortest distance to normal looking retina were measured from digital fundus photographs taken at the re-examination and correlated with visual acuity.Results Lesion size, the presence of a continuing exudative process, or subretinal fibrosis were independent predictors for poor vision. Better vision in the other eye was connected with poor vision in the affected study eye.Conclusions In addition to lesion size, the presence of a continuing exudative process and subretinal fibrosis also have deleterious effects on long-term visual acuity after exudative AMD.Aila Riusala and Ilkka Immonen have full control of all primary data. They agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review the data if requested.The research was supported by grants to Aila Riusala from the Mary ja Georg C. Ehrnrooth, Paulo, Silmä- ja kudospankki- and Sokeain Ystävät Foundations, Helsinki, Finland and research funds of the Helsinki University Hospital, Helsinki, Finland.No proprietary or commercial interests were involved.     

SD-OCT morphological changes in wet age-related macular degeneration patients after bevacizumab treatment

目的：研究频域光学相干断层成像(spectral domain optical coherence tomography, SD-OCT)定量和定性检测指标在接受玻璃体腔内注射贝伐单抗的年龄相关性黄斑变性(age-related macular degeneration, AMD)患者人群中的变化,以评估这些指标是否可以用于预测治疗后视力情况。

方法：回顾性分析66眼61例未进行过AMD相关治疗的患者接受至少3mo玻璃体腔内注射贝伐单抗治疗的情况。治疗前后SD-OCT定量检测指标\〖中央视网膜厚度(central foveal thickness, CFT),外界膜(external limiting membrane, ELM)和椭圆区(ellipsoid zone, EZ)长度\〗和定性检测指标进行分析和比较。同时,分析这些指标和治疗前后的视力的相关性。

结果：平均视力(Log MAR)、CFT、ELM和EZ长度治疗前为0.62±0.41、419.3±110.0μm、378.2±377.2μm和156.4±253.7μm,治疗后为0.53±0.44、325.8±117.9μm、547.1±421.5μm和173.1±207.1μm。治疗前视力和CFT(rs=0.27)、ELM长度(rs=-0.30)及ELM断裂(rs=0.43)有相关性。治疗后视力同样和治疗后ELM长度相关(rs=-0.40)。治疗后视力和治疗前视力(rs=0.66)、ELM长度(rs=-0.35)和ELM断裂(rs=0.46)相关。

结论：研究显示：治疗前视力、ELM长度和ELM断裂可以用于预测治疗后视力。