老年黄斑变性的治疗研究进展

老年黄斑变性是一种严重威胁老年人视功能的眼底疾病,针对其危险因素、早期诊断及治疗,国内外展开了大量的研究。本文将总结近年来国内外对老年黄斑变性的新的治疗手段和方法。     

老年黄斑变性早期中央25°暗视敏感度研究

目的 :研究老年黄斑变性早期患者眼底后极部暗视敏感度的变化。方法 :在 2 5例老年黄斑变性早期患者和 16例正常老年人分别检测中央 2 5°81个位点暗视敏感度和明视敏感度 ,比较两组暗视和明视敏感度。暗视敏感度检测是暗适应后用蓝光刺激 (W 47b 45 0nm )、 0背景光 ;明视敏感度用白光刺激、背景光 3 1 4asb。结果 :老年黄斑变性组暗视和明视敏感度比正常老年对照组降低 ,但暗视敏感度降低更明显 ,暗视敏感度降低随离心度增加而减少 ,在距中心凹 2 5°～ 5°下降最明显。结论 :老年黄斑变性早期视杆细胞功能下降 ,中心凹旁下降最明显 ,进一步验证视杆细胞易感性学说。老年黄斑变性暗视敏感度检测 ,可作为早期诊断和病程监测一个有用的检查手段。     

老年黄斑变性合并白内障患者行超声乳化术疗效分析

目的 探讨老年黄斑变性合并白内障患者行超声乳化手术联合人工晶状体植入的临床效果及安全性、可行性.方法 对40例52只眼老年黄斑变性合并白内障患者,行超声乳化联合人丁晶状体植入术,其中干性老年黄斑变性者45只眼,湿性老年黄斑变性者7只眼.收集其资料进行回顾性分析,观察患者术后视力改善情况及有无并发症发生.结果 术后3月时,90.38%患者视力不同程度提高,视力无明显提高甚至下降者5只眼,均为湿性黄斑变性患者.最佳矫正视力0.3-0.6者12只眼(其中达0.6者8只眼),0.1-0.3者35只眼,<0.1者5只眼.4例术中后囊破裂,3例术后角膜雾状水肿.术后1年,7只眼湿性黄斑变性均有不同程度的加重,干性黄斑变性患者未发现眼底新生血管之类改变.结论 超声乳化联合人工晶状体植入术可明显提高老年黄斑变性合并白内障患者术后视力,但对于湿性黄斑变性患者手术应慎重.     

老年性黄斑变性的早期诊断

由于老年性黄斑变性在我国的发病率有上升的趋势，该病的早期诊断、早期治疗对其预后起着非常重要的作用，而目前尚无统一且有效的早期诊断方法，常需综合多种检查结果。判断其发展趋势。我们就目前常用的一些有关老年性黄斑变性的早期诊断方法及诊断标准作一综述。     

老年黄斑变性43例光学相干断层扫描分析

目的:研究老年黄斑变性的光学相干断层扫描(optical coherence tomography,OCT)特征.方法:对经眼底荧光造影(fundus fluorescein angiography,FFA)确诊的老年黄斑变性患者43例45眼,其中湿性型28例30眼、干性型15例15眼,按年龄匹配的正常人30例43眼利用OCT分别进行检测.观察黄斑部神经纤维层(nerve fiber layer of macular,MNFL)、色素上皮/脉络膜毛细血管复合层(retinal pigment epithelium/choriocapillaris,RPE/CC)及视网膜神经上皮层(retinal neurepithelium layer,RNE)的厚度变化.应用秩和检验比较其差异性.结果:MNFL厚度:湿性型老年黄斑变性组为76.5±51.7 μm、干性型老年黄斑变性组为32.5±7.6 μm、正常对照组为27.7±6.4 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RNE厚度:湿性型老年黄斑变性组为307.1±130.8 μm、正常对照组为239.9±13.4 μm、干性型老年黄斑变性组为223.4±22.6 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RPE/CC厚度:湿性型老年黄斑变性组为115.3±30.6 μm、干性型老年黄斑变性组为81.7±20.4 μm、正常对照组为76.4±11.5 μm,湿性型组与其他组比较差异有显著性(P＜0.05).结论:黄斑部神经纤维层厚度、视网膜神经上皮层厚度及色素上皮/脉络膜毛细血管复合层厚度随着老年黄斑变性病程的发展,其厚度增加.OCT可以作为湿性型老年黄斑变性发生与发展的监测工具之一.     

左眼球转移性绒毛膜上皮癌一例

报告23例(46眼)Stargardt病及黄色斑点状眼底病变的眼底荧光血管造影所见.其中单纯黄斑变性16例,中心凹周围有斑点的黄斑变性5例,黄斑变性伴后极部弥散性黄色斑点1例,无黄斑变性的后极部弥散斑点1例.黄斑变性区表现为密集点状透见荧光,夹杂点状遮蔽荧光.大多数黄色斑点呈透见荧光,少数呈遮蔽荧光.4例显示脉络膜湮没征象.所有病例均未见荧光素渗漏.眼底荧光血管造影检查对于早期诊断具有十分重要的意义. （中华眼底病杂志，1993，9：93-94）     

藏族和汉族的老年黄斑变性

本文对50-90岁的藏族和汉族老年人进行了致盲眼病-老年黄斑变性的流行病学调查。藏、汉族的老年黄斑变性患病率分别为15.59%和6.41%。并比较了两民族间老年黄斑变性的患病率差异,及与本病发生可能有关的危险因素,表明对老年黄斑变性的预防和发病研究是至关重要的。     

老年性黄斑变性的黄斑部光敏感度检测

目的　探讨老年性黄斑变性早期患者黄斑暗视敏感度的变化。方法　用Octopus10 1型视野计 ,对早期老年性黄斑变性组 2 0例 30眼 ,对照组正常人 2 1例 2 6眼进行暗视和明视敏感度检测 ,应用tM2 测试程序 ,将中心 30°视野内视网膜暗视和明视敏感度进行比较和分析。结果　老年性黄斑变性组暗视和明视敏感度较正常组均降低 ,且暗视敏感度降低值大于明视敏感度降低值 ,差异显著 (P <0 .0 5 )。结论黄斑暗视敏感度检测可作为老年性黄斑变性早期诊断和检测指标。     

正常眼和老年黄斑变性眼的局部视网膜电图

以全视野亮背景及４５′视角的红色闪光作刺激，采用带中孔的角膜接触镜电极，记录了局部视网膜电图。测得２２只正常眼的黄斑中心对盲点区的局部ＥＲＧ振幅之比值为３．５４±１．３５，而３１只老年黄斑变性眼的比值是１．３９±０．５４，两者差异显著（Ｐ＜０．０１），两组全视野明适应ＥＲＧ间无意义，表明此法建立的局部ＥＲＧ记录技术对早期老年黄斑变性病人具有一定诊断价值。     

早期老年黄斑变性黄斑光敏度与Amsler表检查

Amsler表用于测定固视中心10°的视野,很多作者用来发现老年黄斑变性(SMD)的视网膜下新生血管膜(NVMS),并用于SMD的早期视功能监测,认为Amsler表在SMD的早期诊断具有一定价值。Fine等指出对已行光凝治疗的视网膜下NVMS形成的患者,为了早期发现复发,可用Am-sler表每日监测中心视野。本文对103例(121眼)早期SMD及晚期SMD患者采用Humphrey视野分析仪黄斑阈值测定,比较黄斑光敏度与Amsler表检查的关系。     

Retinopathy of prematurity: a review of risk factors and their clinical significance

Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.     

年龄相关性黄斑变性相关危险因素的研究进展

年龄相关性黄斑变性(AMD)是全球主要的致盲性眼部疾病之一,但是其发病机制尚未完全明确。国内外研究学者普遍认为,个体因素、环境因素、全身因素及遗传因素为其主要的致病危险因素,如年龄、性别、种族、吸烟及全身相关疾病等。目前,全球对AMD流行病学相关危险因素的研究均有较大进展,故本文就AMD发病相关危险因素进行综述。     

内眼手术前患眼结膜囊细菌耐药性的影响因素的研究

目的探讨内眼手术前患眼结膜囊细菌对眼科常用抗生素的敏感性及耐药菌株的产生与患者全身免疫状况与眼睑、结膜病变的关系。方法手术前根据患者全身免疫状况及眼睑和结膜的表现确定有无全身或局部危险因素。在用任何抗生素之前采集结膜囊标本做培养、鉴定和药物敏感性试验。对5种及5种以上的抗生素耐药的菌株称为多重耐药菌株(MR)。结果在110例(110眼)中,有全身危险因素者51例,其中带有MR者27例(52.94%),与无全身危险因素(59例)而带MR者(15例,25.42%)相比差异有统计学意义(P=0.003);有局部危险因素者47例,其中带有MR者23例(48.94%),与无局部危险因素(63例)而带MR者(17例,26.98%)相比差异有统计学意义(P=0.018);既有全身又有局部危险因素者22例,其中带有MR者14例(63.64%),与既无全身又无局部危险因素(34例)而带MR者(7例,20.59%)相比差异有统计学意义(P=0.001)。结论带有全身或/和局部危险因素的患者眼表细菌的耐药性强,对这类特殊人群加强预防措施是必要的。     

年龄相关性黄斑变性发病危险因素研究进展

年龄相关性黄斑变性（age-related macular degeneration,AMD）是一种主要的全球性致盲眼病之一。AMD是一种多因素的疾病,主要的危险因素包括年龄,吸烟,白内障手术史,环境因素,营养因素,遗传标志,包括基因调节补体,脂质,血管生成和细胞外基质的途径。除了治疗外,AMD的流行病学,危险因素和遗传学研究已有重大进展。本文将AMD发病的危险因素作简要综述。     

The new epidemiology of cataract

Cataract is the leading cause of blindness worldwide. Smoking, diabetes, and exposure to UVB light consistently have been identified as risk factors for cataract development. Recently, new factors have been identified. Further research into other previously identified risk factors has suggested that these initial associations ma indeed not exist. This article reviews the current state of knowledge on risk factors for development of age-related cataract formation.     

Risk factors of primary angle closure glaucoma

Primary angle closure glaucoma is one of the common diseases causing blindness. The pathogenesis inducing primary angle closure glaucoma has not been entirely clear. Traditionally identified risk factors include shallow anterior chamber, short axial length and thicker lens. Recent studies begin to pay attention to other new risk factors, not only including static anatomical factors, such as anterior chamber volume, iris curvature and lens vault, but also including dynamic changing factors, such as dynamic dilation of iris volume and choroidal effusion. Comprehensive assessment of these risk factors is of great significance for early diagnosis and treatment of angle closure glaucoma. This article briefly reviews research advances in risk factors of primary angle closure glaucoma.     

提高对年龄相关性黄斑变性危险因素的认识

年龄相关性黄斑变性(AMD)是老年人的致盲性眼病,严重影响其独立生活能力.流行病学研究资料显示,AMD存在各种危险因素,除了年龄、遗传、种族等不可改变的因素之外,还包括生活方式、眼部情况、全身疾病等可改变因素.然而,公众对AMD危险因素的了解,甚至广大眼科医师对AMD危险因素的重视程度也不尽如人意.对AMD的危险因素进行了复习,以期提高对AMD致病危险因素的认识,扩展AMD的研究思路及指导临床工作.     

Genetic, environmental and other risk factors for progression of retinitis pigmentosa

Retinitis pigmentosa (RP) is a commonly inherited disease of the retina, which is characterized by progressive loss of visual function due to specific genetic mutations. There are many risk factors that may have effect on the progression of RP, such as inheritance patterns, genotype, gender, age, smoking, physical activity, and other demographic and environmental factors. Baseline visual field conditions, changes of ellipsoid zone, photoreceptor layer thickness, and choroidal structure are reported to be the phenotype risk factors for RP progression. Moreover, aqueous flare and high-sensitivity C-reactive protein are probable inflammation biomarkers for assessing the progression of RP. Increased oxidative stress is considered to be one of the potential factors for the existence of RP. The risk factors can be combined to form a corresponding prediction model to predict disease progression. This review is to summarize the current literature that studies the genetic, environmental, phenotypic, demographic, inflammatory and other risk factors of RP progression and discuss the most reliable risk factors that could provide predictive models.     

Clinical studies of ocular motility disturbances: Part 2. ischemic ocular motor nerve palsy risk factors

A case-control study of 46 Japanese patients who were diagnosed by exclusion as having ischemic ocular motor nerve palsy and who exhibited spontaneous recovery within 4 months was done to evaluate the risk factors involved. We also evaluated the association between the number of risk factors and the spontaneous recovery or recurrence periods. Ischemic ocular motor nerve palsy is closely related to diabetes mellitus and coronary artery disease. Patients tended to be obese; many had two or more risk factors. Aging, in combination with two or more risk factors, seems to increase the likelihood of developing this disease. Diabetes mellitus is a particularly significant risk factor for this type of palsy, especially in combination with hypertension.     

原发性开角型青光眼进展的危险因素研究概况

原发性开角型青光眼(POAG)进展的危险因素包括全身性及眼部因素,眼部因素包括眼压及非眼压因素.在以往的多中心研究中,眼压对于由高眼压症发展为POAG及其在POAG进展中的作用已经明确,而目前降低眼压也是临床惟一有效地延缓、控制青光眼视神经损害进展的主要因素.制定目标眼压,进行降眼压治疗尤其是控制昼夜眼压波动对于阻止青光眼进展非常重要.非眼压危险因素包括高龄、中央角膜厚度增厚、视乳头出血、晶状体囊膜剥脱征、初始的青光眼严重程度及双眼罹患青光眼等.其他因素包括近视、青光眼家族史、眼部低灌注压、低血压、心血管疾病、高血压、高血脂等血管或血液性因素.POAG进展的危险因素研究在一定程度上揭示了POAG的发病机制及临床发病规律,对于指导临床医师决定随诊频率、选择治疗方案及提高治疗效率意义重大.