视网膜脱离伴有的增殖性玻璃体视网膜病变

PVR是视网膜脱离手术手术失败的主要原因。本对视网膜脱离伴有PVR的发生率、形成机制、参与的细胞类型、危险因素、最新分类及预防和治疗进行了综述。随着对该病认识的加深和治疗的进步，PVR的防治水平将会逐步提高。     

维甲酸与增殖性玻璃体视网膜病变

增殖性玻璃体视网膜病变（PVR）是导致视网膜复位手术失败的主要原因，减少术后PVR的发生是手术成功的重要环节。维甲酸具有抑制视网膜色素上皮（RPE）细胞增殖的作用，多种给药途径表明，维甲酸无细胞毒性，安全范围大，抗增殖能力强，是防治术后PVR的有效药物。     

增生性玻璃体视网膜病变的研究进展

增生性玻璃体视网膜病变(PVR)是裂孔源性视网膜脱离手术失败最常见的原因。研究结果表明，PVR是视网膜脱离手术后的创伤愈合反应。随着视网膜的创伤，活化的视网膜色素上皮细胞，胶质细胞，纤维母细胞等增殖、迁移，与细胞外间质共同形成了PVR膜而导致牵引性视网膜脱离。就PVR的治疗而言，早期在于控制炎症，中期主要是抑制细胞增殖，晚期着重于防止纤维化的形成。着重就PVR的危险因素、临床分类、病理、手术处理以及最新的药物治疗进展做综合归纳。     

增生性玻璃体视网膜病变的药物治疗进展

孔源性视网膜脱离并发的增生性玻璃体视网膜病变(proliferative vineoretinopathy，PVR)为一系列的细胞活动，即去分化细胞的形成、迁移、粘附及增殖，形成视网膜表面膜并收缩，导致视网膜脱离手术失败。临床上对于PVR的手术治疗效果尚不理想。药物治疗包括柔红霉素、5-氟尿嘧啶和维甲酸等的应用。文章就PVR药物治疗的种类和不同给药途径作一简要回顾。     

增生性玻璃体视网膜病变的药物治疗

增生性玻璃体视网膜病变（PVR）常由于裂孔源性视网膜脱离、眼穿孔伤或眼内手术造成血-视网膜屏障受损,视网膜色素上皮（RPE）细胞进入玻璃体,继而引起RPE细胞、神经胶质细胞、成纤维细胞等在玻璃体内增生,形成以细胞为主的纤维膜。临床上治疗和预防PVR以手术为主,但效果不佳。近来有许多药物治疗PVR的研究报道,就PVR药物治疗研究进展进行综述。     

外伤性增生性玻璃体视网膜病变防治的研究进展

外伤性增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)是视网膜脱离手术失败的主要原因,治疗棘手.玻璃体视网膜手术中内界膜的剥除、松解性视网膜切开术、玻璃体腔填充使用的全氟化碳液体、联合重轻型硅油填充等成为外伤性PVR手术治疗的新方向;药物治疗包括抗代谢药物、糖皮质激素、抑制纤维素生成药物等.新的药物治疗进展有基因治疗、免疫抑制剂、磷酸化糖蛋白等.可通过缓释微粒治疗等新疗法降低PVR发病率和严重程度.     

孔源性视网膜脱离术后增生性玻璃体视网膜病变因素的分析

目的：探讨孔源性视网膜脱离术后因增生性玻璃体视网膜病变（PVR） 而使手术失败的各种因素。方法：对21例（21只眼）视网膜脱离术前情况、手术方式进行回顾分析。结果：21只眼均因严重的PVR使手术失败视网膜脱离复发，时间为10天－2月。结论：视网膜脱离术后发生严重的PVR与断裂孔的数目、大小，术前PVR的情况，术式的选择，手术操作等因素均有关。     

药物在增生性玻璃体视网膜病变治疗中的应用

增生性玻璃体视网膜病变(proliferative vitreoretinopathy，PVR)是引起视力障碍甚至失明的主要眼病之一，随着医疗科技的飞速发展，现代玻璃体切割术治疗PVR的成功率大大提高。但手术不能阻止PVR的复发。因此，手术联合药物治疗PVR成为临床治疗的探索方向。目前，大部分药物治疗仅限于动物实验阶段。本文对PVR的发病机制和新的观点及已经应用于临床的治疗药物作一综述。     

增生性玻璃体视网膜病变的治疗进展

增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)描述孔源性视网膜脱离(rhegmatogenous retinal detachment, RRD)等疾病后玻璃体和/或视网膜表面特异细胞增殖形成纤维膜继而收缩、牵拉引起相关疾病的过程。玻璃体切割手术是目前临床治疗PVR的标准方法。基于对各种细胞和生长因子在PVR致病过程中作用的逐渐了解,涌现出很多新兴的药物治疗方法,主要包括抗炎药物、抗肿瘤药物和抗生长因子药物等。     

增生性玻璃体视网膜病变的危险因素

增生性玻璃体视网膜病变（PVR）是导致视网膜脱离手术失败的主要原因，严重影响患视力预后。目前，通过药物干预PVR发生已经逐渐成为有效措施。因此正确评估手术后PVR发生危险因素，筛选PVR高危患进行有的放矢的治疗，具有重要的临床意义。本回顾近20年来PVR的危险因素研究情况。     

Criteria for success of surgical treatment of glaucoma

Outcome measures for studies of the surgical treatment of glaucoma include intraocular pressure, functional status (usually with visual field measurements), and structural status of the optic nerve or nerve fiber layer. Older studies relied heavily and almost solely on intraocular pressure as a surrogate measure for expected glaucomatous damage, but the situation is improving. It is clear that functional outcomes must be used in the evaluation of surgical therapy (indeed, of all therapy) for glaucoma whenever feasible. Measurements of structural damage are also important in patients with early or suspected damage. Structural evaluations probably do not provide information beyond that derived from visual field measurements in patients with advanced glaucomatous damage. This paper surveys the criteria and methods used to determine success in recent studies of glaucoma surgery and makes recommendations about the most appropriate outcome measures for surgical studies of glaucoma treatment.     

Treatment of cytomegalovirus retinitis with the intraocular ganciclovir implant

The treatment of cytomegalovirus retinitis (CMV-R) has improved considerably in the past two years. Local ocular therapy has proved to be effective and provides significant advantages over systemic therapy with regards to better control, preventing progression, avoiding bone marrow and renal toxicity. Direct intraocular injections of anti-CMV drugs and the sustained-release ganciclovir device are the mainstay of local therapy. The ganciclovir intraocular device has undergone rigorous testing and has recently been approved for clinical use. This review describes the surgical procedure, recommendations for use, and exchange and management of associated retinal detachment. In addition, the results of the initial studies and the multicenter, randomized clinical trial are discussed. Current data available from the Study for the Ocular Complications of AIDS (SOCA) and AIDS Clinical Trials Group (ACTG) studies are summarized in the context of CMV-R management.     

8. Orbital Cellulitis

Orbital cellulitis secondary to sinusitis has been the most common cause of proptosis in children. A case report is presented which emphasizes that the signs and laboratory findings in orbital Cellulitis may be confusing, especially when modified by prior antibiotics. When orbital cellulitis is a possibility, adequate antibiotic therapy should be instituted while diagnostic studies are being performed. CT scanning is a new and useful modality for the evaluation of these patients, but cautious and experienced interpretation is essential. In patients who do not respond promptly to appropriate medical therapy, surgical intervention is indicated for drainage and biopsy.     

Clinical specular microscopy

Clinical specular microscopy (CSM) has recently been introduced as a means of qualitative and quantitative examination of the human corneal endothelium at high magnification. With the aid of CSM, a decline in endothelial cell density with age has been documented and several endothelial abnormalities from disease or trauma can be detected. Donor material for corneal grafting can be examined by CSM and keratoplasty procedures can be designed to decrease endothelial damage. Cataract surgical procedures can cause endothelial cell loss. According to most studies, intracapsular extraction causes less cell loss than does phacoemulsification, and cataract extraction with intraocular lens (IOL) insertion causes the greatest loss. Cell loss from IOL can be minimized by decreasing lens-corneal contact. Elevated intraocular pressure may lead to endothelial cell loss, as may therapy with epinephrine. Endothelial toxicity of other drugs and solutions can be studied by CSM. While long term studies are necessary to correlate the morphologic changes detected by CSM with future endothelial function, shortterm studies can be helpful in developing medical and surgical techniques that minimize corneal endothelial trauma.     

Artificial drainage devices in glaucoma

During the last two decades, glaucoma drainage devices (GDD) have been increasingly applied to the treatment of complicated glaucoma in which standard surgical therapy has failed. Most GDD's consist of a segment of silicone rubber attached to a rigid plastic or flexible rubber explant and evolved from the Molteno glaucoma implant, on which clinical studies first appeared in 1969. GDD's should be reserved for the most difficult cases because of the difficulty of the surgical procedure and the complications that can attend their use.     

Needle revision of filtering blebs

The modern version of trabeculectomy is associated with a very high success rate. As time progresses after surgery, failure of filtration, however, is common, as are problems with filtering blebs such as leaks and dysesthesia. Needle revision of filtering blebs is a useful adjunct to failed, failing, leaking, or dysesthetic trabeculectomy filters and can be performed in a variety of settings and techniques with fairly good results. Although varied techniques have been reported, there is no definitive "best" surgical approach. Needle revision should be considered before more aggressive surgical intervention, and in some cases before additional medical therapy. Owing to the paucity of rigorously conducted clinical studies, this review focuses on clinical experience with bleb needle revision.     

Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma

PURPOSE: To succinctly update information on the pathogenesis, etiology, diagnosis, and treatment of neovascular glaucoma based on a systematic review of available literature and to provide summary recommendations rated for their importance to clinical outcome. CLINICAL RELEVANCE: Neovascular glaucoma is a devastating ocular disease that often results in loss of vision. The current standard of care includes retinal ablation and control of increased intraocular pressure with medical and surgical therapy. LITERATURE REVIEW METHODOLOGY: The authors conducted a MEDLINE literature search of articles published in English from 1966 to the present. Each article reviewed was rated as to the strength of evidence it provided, and summary ratings for the strength of evidence supporting clinical recommendations were generated. RESULTS: Level A (most important to patient outcome) recommendations for the diagnosis of neovascular glaucoma include a high index of suspicion, a full ocular examination including undilated gonioscopy, and pupil examination. In regard to treatment, Level A recommendations include treatment of the underlying disease origin, complete panretinal photocoagulation (if retinal ischemia is a factor), and medical control of both elevated intraocular pressure and inflammation. Level B recommendations (moderately important to patient outcome) encompass glaucoma surgery to control intraocular pressure when medical therapy is unsuccessful, although the ideal surgical procedure is unknown. Currently, trabeculectomy with antimetabolite therapy, aqueous shunt implants, and diode laser cyclophotocoagulation are the preferred surgical treatment options. CONCLUSIONS: The current literature on neovascular glaucoma has few articles that provide strong evidence in support of therapy recommendations (level I). Future research studies are needed to address areas in which the current evidence is moderately strong (level II) or weak, consisting only of a consensus of expert opinion (level III). Whenever practicable, these studies should be prospective, randomized clinical trials.     

Topisches Mitomycin C als Therapie konjunktivaler Tumore

Surgical excision with tumour free margins is the gold standard for squamous cell and melanocytic tumours of the conjunctiva. In cases of diffuse and extensive tumours a complete surgical excision is sometimes not possible. Therefore, alternative or adjuvant therapies are required. Topical chemotherapy with mitomycin C (MMC) is increasingly finding use in clinical practice. MMC has several advantages such as good tolerability and mild side effects. Present studies have shown that mitomycin C is a good option in squamous cell neoplasia of the conjunctiva. However, further multi-centre studies and long-term follow-up are needed.The results in treating melanocytic tumours of the conjunctiva with MMC are less convincing. MMC seems to be an option for the treatment of primary acquired melanosis (PAM); but, if the tumour is suspicious for melanoma primary chemotherapy with MMC is obsolete. In these cases MMC can only be used as an adjuvant therapy, otherwise tumour control is not assured. However, prospective randomized controlled trials are necessary for a final evaluation of MMC therapy in melanocytic tumours of the conjunctiva.     

Acanthamoeba keratitis--a rare and often late diagnosed disease

In 83-93% of the cases of acanthamoeba keratitis the patients are contact lens wearers. Acanthamoeba keratitis is diagnosed--with descending order of sensitivity and specificity--through polymerase chain reaction (PCR), confocal biomicroscopy, in-vitro cultivation and histopathological examination. The typical clinical appearance of acanthamoeba keratitis includes pseudodendritic epitheliopathy, perineuritis, ring infiltrate or multifocal stromal infiltrates and in some cases limbitis with infiltration of the conjunctiva and/or sterile anterior uveitis. Information on reliability and efficacy of the medical/surgical therapy for acanthamoeba keratitis has only been published for case series and It has not been verified through randomised controlled clinical studies so far. By early diagnosis, using triple-topical therapy (polyhexamid, propamidinisoethionat, neomycin) acanthamoeba keratitis often heals appropriately. However, even if diagnosed early, topical therapy should be continued for 1 year. In therapy-resistant cases cryotherapy, amniotic membrane transplantation, cross-linking therapy, and therapeutic keratoplasty are performed. The prognosis of keratoplasty following acanthamoeba keratitis is more favourable when there were no signs of infection at least during the preceding 3 months.     

The management of subfoveal choroidal neovascular membranes and hemorrhage

At the beginning of the past decade (1990), the Macular Photocoagulation Studies (MPS) were underway evaluating the efficacy of the treatment of subfoveal choroidal neovascularization (CNV) with conventional lasers. When this proved to limit the loss of vision and give little chance for improving vision, vitreoretinal surgeons turned to surgical approaches to treating these lesions. The surgical excision of subfoveal CNV has been under study for the remainder of the decade with the recent addition of macular/retinal translocation to attempt vision improvement for these patients. Other modalities including interferon therapy and external beam irradiation have proven ineffective, but new laser studies may offer promise with photosensitizing chemicals. Despite much study a single therapy that can reliably return sight to the majority of patients has not been developed. This article reviews the various therapies of the 1990s and renders some thoughts for the future.