玻璃体腔内注射TA与雷珠单抗治疗CRVO继发黄斑水肿的对照研究

目的：比较曲安奈德(TA)与雷珠单抗(ranibizumab)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发黄斑水肿的的临床疗效及安全性。

方法：回顾性分析继发黄斑水肿的CRVO患者40例40眼。其中20例20眼接受玻璃体腔注射TA(1mg,0.1mL)治疗,其余20例20眼接受玻璃体腔注射雷珠单抗(0.5mg,0.05mL)治疗。观察两组治疗前及治疗后1,2wk; 1,2,3,6mo患者最佳矫正视力、黄斑中心凹厚度(CMT)及眼压的改变。

结果：TA组及雷珠单抗组于玻璃体腔注药1,2wk; 1,2,3,6mo后最佳矫正视力较治疗前明显提高(P<0.05); 但两组之间无明显差异(P>0.05)。两组于玻璃体注药后1,2wk; 1,2,3,6mo,CMT较治疗前有明显降低(P<0.05),但两组之间无明显差异(P>0.05)。TA组玻璃体腔注药后2wk及4wk眼压较治疗前明显升高(P<0.05)。雷珠单抗组玻璃体腔注药后各时间点眼压均无明显升高(P>0.05)。注药后第1,2wk; 2,3,6mo,TA组眼压改变与雷珠单抗组无明显差异(P>0.05),注药后1mo,TA组眼压改变要明显高于雷珠单抗组(P<0.05)。

结论：玻璃体腔内注射雷珠单抗是目前CRVO继发黄斑水肿的有效而且安全的治疗手段。与TA相比其在提高最佳矫正视力及降低CMT的同时几乎不会发生眼部及全身并发症。     

非缺血型视网膜分支静脉阻塞黄斑水肿抗VEGF治疗的疗效研究

目的：探究雷珠单抗与康柏西普治疗非缺血型视网膜分支静脉阻塞黄斑水肿的疗效及安全性。

方法：选取我院于2014-03/2018-05收治的非缺血型视网膜分支静脉阻塞黄斑水肿患者80例80眼,随机分为A组(40例)和B组(40例),分别行玻璃体腔内注射雷珠单抗和康柏西普治疗。随访3mo,比较治疗前后两组患者的眼压、CMT、黄斑中心体积(CMV)、BCVA、玻璃体腔注射次数和并发症发生情况。

结果：治疗后2wk,1、2、3mo,B组患者CMT、CMV、BCVA均明显优于A组(P<0.05)。随访3mo,B组患者视力提高比例显著高于A组(65% vs 38%,P<0.05),玻璃体腔注射次数显著低于A组(P<0.05),但两组患者并发症发生情况(5% vs 0%)无明显差异(P=0.999)。

结论：与雷珠单抗比较,康柏西普治疗非缺血型视网膜分支静脉阻塞黄斑水肿在改善视力,降低CMT和CMV,减少玻璃体腔注射次数方面具有一定优势。     

曲安奈德与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿比较

目的： 比较曲安奈德(Triamcinolone Acetonide,TA)与雷珠单抗(Lucentis,LU)治疗视网膜静脉阻塞性黄斑水肿的临床疗效。

方法：回顾性分析40例最佳矫正视力(BCVA,小数视力)≤0.6,黄斑中心凹厚度(CMT)≥250μm的视网膜静脉阻塞性黄斑水肿患者,分别进行玻璃体腔注射TA(22例,4mg,0.1mL)或LU(18例,0.5mg,0.05mL)治疗。比较两种药物治疗前和治疗后1, 2wk; 1, 2, 3,6mo两组CMT与BCVA的改变情况

结果：两组在治疗后视力明显提高,术后各时间点均较术前具有显著改变(P<0.05), TA组治疗后1mo视力最好(BCVA,logMAR=0.30±0.20),LU组治疗后2mo视力最好(BCVA,logMAR=0.21±0.10),两组在治疗后黄斑水肿明显减轻,CMT明显降低,术后各时间点均具有统计学意义(P<0.05),两组治疗后2mo时黄斑水肿程度最低(TA组CMT=274.45±141.81μm,LU组CMT=225.83±22.86μm)。BCVA(小数视力)与CMT呈负相关。各项指标两组间均无统计学差异。

结论： 玻璃体腔注射TA及LU治疗视网膜静脉阻塞性黄斑水肿均可减轻黄斑水肿和改善视力,两者治疗效果无显著差异。     

玻璃体腔注射雷珠单抗联合光凝治疗BRVO继发黄斑水肿

目的：观察玻璃体腔注射雷珠单抗联合视网膜激光光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床疗效。

方法：收集我院2013-08/2016-03收治的经散瞳眼底检查、眼底荧光血管造影(FFA)及光学相干断层扫描(OCT)检查确诊的BRVO继发黄斑水肿患者,随机分为2组,最终回访3mo时共47例47眼。观察组采用玻璃体注射雷珠单抗2wk后联合静脉回流区视网膜激光光凝治疗25例25眼,对照组采用单纯玻璃体注射雷珠单抗治疗22例22眼。比较两组患者治疗后1mo的最佳矫正视力(BCVA)、眼压(IOP)、黄斑中心视网膜厚度(CMT)以及并发症情况。

结果：两组治疗后1mo BCVA、CMT与治疗前比较,差异均有统计学意义(P<0.01),而IOP与治疗前比较无统计学意义(P>0.05); 治疗后1mo两组间BCVA、IOP比较差异均无统计学意义(P>0.05),而组间CMT比较差异有统计学意义(P<0.01)。

结论：玻璃体注射雷珠单抗联合阻塞静脉回流区视网膜光凝治疗BRVO的临床疗效明显优于单纯玻璃体注射雷珠单抗治疗,且激光治疗过程中不刺激黄斑,安全性较高。     

激光光凝联合雷珠单抗治疗糖尿病性黄斑水肿

目的：比较激光光凝与激光光凝联合雷珠单抗治疗糖尿病性黄斑水肿的疗效。

方法：随机对照研究。纳入糖尿病性黄斑水肿患者134例180眼,随机分为试验组和对照组。两组患者年龄、性别、病程、BCVA、IOP、CMT均无差异(P>0.05)。试验组接受黄斑格栅光凝联合玻璃体腔注射雷珠单抗,对照组接受黄斑格栅光凝。治疗后1wk,3mo测量两组BCVA、IOP、CMT并进行比较。

结果：治疗前、治疗后1wk,3mo,两组IOP比较均无差异(P>0.05)。治疗1wk,3mo,试验组CMT均低于对照组(t=-7.83、-8.80,均P<0.05)。治疗1wk,3mo,试验组BCVA均优于对照组(t=-3.76、-4.09,均P<0.05),治疗1wk试验组BCVA即显著提高(t=1.97,P<0.05)。试验组复发率低于对照组(χ²=4.59,P=0.032)。两组早期高眼压发生率无差异(χ²=0.03,P=0.87)。均未出现视网膜脱离、眼内炎。

结论：激光光凝联合雷珠单抗比单用激光光凝显著降低术后CMT,并较早提高BCVA,降低复发率。     

疏血通联合玻璃体腔内注射雷珠单抗和激光光凝治疗BRVO伴黄斑水肿

目的：探讨疏血通注射液联合玻璃体腔内注射雷珠单抗、激光光凝治疗视网膜分支膜静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿(macular edema,ME)的疗效。

方法：将2015-01/2016-12就诊的BRVO继发ME患者70例70眼采用随机数字表法分为对照组和观察组,每组各35例35眼。对照组行玻璃体腔内注射雷珠单抗联合激光光凝治疗,观察组在对照组基础上加用疏血通注射液。比较两组治疗3mo临床疗效、并发症。治疗1wk,1、3mo复查最佳矫正视力(BCVA,LogMAR)、黄斑中心凹视网膜厚度(central macular thickness,CMT)。

结果：观察组总有效率为91%,略高于对照组的80%,但差异无统计学意义(P>0.05); 观察组显效率为43%,高于对照组的20%,差异有统计学意义(P<0.05)。两组治疗后1wk,1、3mo BCVA水平、CMT均降低,较治疗前比较差异均有统计学意义(P<0.05); 观察组治疗后1wk,1、3mo LogMAR BCVA水平、CMT低于对照组同期,差异均有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。

结论：疏血通注射液联合玻璃体腔内注射雷珠单抗、激光光凝治疗BRVO继发ME可有效降低CMT,提高视力水平,且安全性高。     

康柏西普联合曲安奈德球内注射治疗糖尿病黄斑水肿

目的：探讨康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿的疗效。

方法：回顾性队列研究。合并黄斑水肿的糖尿病患者40例43眼,治疗前记录BCVA、IOP和OCT检查。根据治疗方式分为两组,A组患者给予玻璃体腔注射康柏西普联合曲安奈德治疗,B组给予玻璃体腔注射康柏西普治疗。分别于治疗后1d,1、4、8、12、24wk记录BCVA、IOP和CMT及并发症等情况。

结果：A组治疗后不同时间点的视力与治疗前(0.83±0.03)相比均有差异(P<0.05),治疗8wk时达到最佳视力(0.23±0.04); 治疗后CMT与治疗前(612.4±47.6μm)有差异(P<0.05); 24wk内平均注射次数2.7次。B组治疗后不同时间点视力与治疗前(0.79±0.09)有差异(P<0.05),治疗4wk时达到最佳视力(0.25±0.06)。治疗后CMT与治疗前(597.8±62.4μm)有差异(P<0.05),24wk内平均注射次数3.6次。两组患者第一针与第二针治疗间隔时间有差异(P<0.05)。两组患者治疗前后眼压无差异(P>0.05)。

结论：康柏西普联合曲安奈德球内注射治疗糖尿病性黄斑水肿安全、有效、见效快,但疗效更持久,且可降低打针频率。     

雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿

目的：观察雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿(DME)的临床疗效。

方法：选取2016-06/2019-09就诊于广西壮族自治区人民医院确诊为重度DME的患者52例52眼,随机分为观察组(26例26眼,予雷珠单抗联合577nm微脉冲激光治疗)和对照组(26例26眼,仅予雷珠单抗治疗)。两组患者均予“3+PRN”方案行玻璃体腔注射雷珠单抗治疗。治疗(首次玻璃体腔注射)后随访9mo,观察黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)情况及玻璃体腔注射雷珠单抗次数。

结果：与治疗前相比,两组患者治疗后各时间点CMT、BCVA均明显改善(均P<0.001),但两组间均无差异(P>0.05)。随访期间,观察组玻璃体腔雷珠单抗注射次数明显少于对照组(5.88±1.24次 vs 7.12±1.24次,P=0.001)。

结论：雷珠单抗联合577nm微脉冲激光和单用雷珠单抗均能有效降低重度DME患者黄斑水肿程度,改善视力,但联合治疗可减少雷珠单抗的注射次数。     

玻璃体腔注射康柏西普对湿性ARMD的疗效分析

目的：探讨玻璃体腔注射康柏西普对湿性年龄相关性黄斑变性(ARMD)的疗效及对脉络膜厚度的影响。

方法：回顾性研究。选取本院于2014-03/2017-12收治的213例345眼湿性ARMD患者,根据治疗方式不同分为两组,对照组(106眼176眼)行玻璃体腔注射曲安奈德治疗,观察组(107例169眼)行玻璃体腔注射康柏西普治疗。分析两组患者的疗效及脉络膜厚度变化。

结果：两组患者注射前BCVA、黄斑中央区厚度(CMT)均无差异(P>0.05)。观察组第3次注射后的BCVA优于对照组,且CMT值低于对照组(P<0.05)。两组患者间治疗前和治疗后1、3、6mo的中央视网膜厚度、脉络膜厚度无差异(P>0.05)。但两组患者治疗后6mo的中央视网膜厚度、脉络膜厚度显著低于治疗前和治疗后1、3mo(P<0.05)。经治疗后,观察组与对照组的并发症总发生率分别为5.7%、7.7%(P>0.05)。

结论：玻璃体腔注射康柏西普与注射曲安奈德的效果同样好,不仅可以改善和稳定患者视力,还能有效降低患者的中央视网膜厚度和脉络膜厚度,其疗效显著,安全性较高。     

玻璃体腔注射康柏西普治疗高度近视黄斑脉络膜新生血管的疗效

目的：探究玻璃体腔注射康柏西普治疗高度近视黄斑脉络膜新生血管(CNV)的疗效。

方法：回顾性选取2017-06/2019-12我院眼科收治的因高度近视导致CNV的患者56例56眼作为研究对象,根据治疗方式分为对照组和观察组,对照组28例28眼行玻璃体腔注射雷珠单抗治疗,观察组28例28眼行玻璃体腔注射康柏西普治疗。末次治疗后随访3mo,记录患者眼压、最佳矫正视力(BCVA)及并发症发生情况,采用光学相干断层扫描(OCT)测定黄斑中心凹视网膜厚度(CMT),采用OCT仪水平线性扫描测量CNV面积。

结果：治疗后两组患者BCVA均较治疗前改善,且观察组BCVA优于对照组(均P<0.05)。治疗后3mo两组患者眼压、CNV面积及CMT均较治疗前降低,且观察组改善情况优于对照组(均P<0.05)。随访期间,观察组并发症发生率(4%)低于对照组(18%)。

结论：玻璃体腔注射康柏西普治疗高度近视CNV疗效优于雷珠单抗,可有效改善BCVA,降低CMT,减少术后并发症,提高临床疗效。     

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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Current Thoughts on the Aetiology of Ocular Changes during Contact Lens Wear

ABSTRACT: Contact lenses are known to produce changes to the ocular tissues, and this review attempts to give a comprehensive assemblage of the knowledge on the aetiology of such changes. To achieve this result, the changes are categorized by structure and function, and discussed according to the temporal nature of occurrence where appropriate. Although assessment of the importance of a particular tissue change is difficult, this overview enables some degree of judgement to be made on the aetiology of the major side-effects of contact lens wear. This gives a basis on which to modify aspects of contact lens wear to ultimately increase the success rate.     

The detection of motion in chromatic stimuli: first-order and second-order spatial structure

This study provides evidence for the existence of a low-level chromatic motion mechanism and further elucidates the conditions under which its operation becomes measurable in an experimental stimulus. Observers discriminated the direction of motion of amplitude modulated (AM) gratings that were defined by luminance or chromatic variation and masked with spatiotemporally broadband luminance or chromatic noise. The size and retinal location of the stimuli were varied and the effects of broadband noise and grating masks were both compared with the cohort of stimuli. Some significant disparities in the published literature were well explained by the results. In conclusion, evidence for a chromatically sensitive motion mechanism that evades the, detrimental effects of a luminance mask was found only at the fovea and only when the stimulus was small and centrally placed.     

Local chemotherapeutic agents for the treatment of ocular malignancies

We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive.