眼底血管造影联合频域光相干断层扫描同步检查法对渗出性老年性黄斑变性脉络膜新生血管的诊断价值

Objective To evaluate the diagnostic value of Heidelberg retinal angiography(HRA) combined with optical coherence tomography (OCT) to detect neovascularization (CNV) in exudative age-related macular degeneration (AMD) patients. Methods This is a cross-sectional study of a series of clinical cases. AMD diagnosis was established by international standard vision chart, Slit lamp microscope, direct or indirect ophthalmoscope examination. A total of 50 eyes (42 cases) of exudative AMD received HRA and frequency domain OCT scan. All 50 eyes received fundus fluorescein angiography (FFA) and frequency-domain OCT simultaneously, and among them 15 eyes also received indocyanine green angiography (ICGA) at the same time. FFA and ICGA were carried out by conventional methods, CNV was localized by real-time Localization technology of frequency domain OCT. In the radial and grid-like section from the areas with strong fluorescence, image acquisition settings are 7 μm fault for each frame, 30° intervals for radialsection, 10 vertical and 10 horizontal scan lines for grid-like section. CNV can be divided into 4 types (typical CNV, partial typical CNV, occult CNV, CNV scarring) according to their boundaries demonstrated in FFA. Based on the features of the OCT images, there were 3 types of integrated image (sub-RPE type, sub-retinal type and mixed type). Results CNV was detected in all 50 eyes. There were 4 eyes (8%) of typical CNV, 11 eyes (22%) of partial typical CNV, 32 eyes (64 %, including 27 eyes of RPE detachment and 5 eyes of passive late leakage) of occult CNV and 3 eyes (6%) of CNV scarring. There were 4 eyes (8%) of sub-RPE type (CNV under the RPE light band) , 16 eyes (32%) of sub-retinal type(interrupted light band of RPE and choroid capillary layer) and 30 eyes (60%) of mixed type of integrated image. Conclusion The image integration technology of the HRA and frequency domain OCT system provide a valuable tool to classify and measure CNV, which will benefit the clinical treatment of AMD patients.     

眼底血管造影联合频域光相干断层扫描同步检查法对渗出性老年性黄斑变性脉络膜新生血管的诊断价值

Objective To evaluate the diagnostic value of Heidelberg retinal angiography(HRA) combined with optical coherence tomography (OCT) to detect neovascularization (CNV) in exudative age-related macular degeneration (AMD) patients. Methods This is a cross-sectional study of a series of clinical cases. AMD diagnosis was established by international standard vision chart, Slit lamp microscope, direct or indirect ophthalmoscope examination. A total of 50 eyes (42 cases) of exudative AMD received HRA and frequency domain OCT scan. All 50 eyes received fundus fluorescein angiography (FFA) and frequency-domain OCT simultaneously, and among them 15 eyes also received indocyanine green angiography (ICGA) at the same time. FFA and ICGA were carried out by conventional methods, CNV was localized by real-time Localization technology of frequency domain OCT. In the radial and grid-like section from the areas with strong fluorescence, image acquisition settings are 7 μm fault for each frame, 30° intervals for radialsection, 10 vertical and 10 horizontal scan lines for grid-like section. CNV can be divided into 4 types (typical CNV, partial typical CNV, occult CNV, CNV scarring) according to their boundaries demonstrated in FFA. Based on the features of the OCT images, there were 3 types of integrated image (sub-RPE type, sub-retinal type and mixed type). Results CNV was detected in all 50 eyes. There were 4 eyes (8%) of typical CNV, 11 eyes (22%) of partial typical CNV, 32 eyes (64 %, including 27 eyes of RPE detachment and 5 eyes of passive late leakage) of occult CNV and 3 eyes (6%) of CNV scarring. There were 4 eyes (8%) of sub-RPE type (CNV under the RPE light band) , 16 eyes (32%) of sub-retinal type(interrupted light band of RPE and choroid capillary layer) and 30 eyes (60%) of mixed type of integrated image. Conclusion The image integration technology of the HRA and frequency domain OCT system provide a valuable tool to classify and measure CNV, which will benefit the clinical treatment of AMD patients.     

眼底血管造影联合频域光相干断层扫描同步检查法对渗出性老年性黄斑变性脉络膜新生血管的诊断价值

Objective To evaluate the diagnostic value of Heidelberg retinal angiography(HRA) combined with optical coherence tomography (OCT) to detect neovascularization (CNV) in exudative age-related macular degeneration (AMD) patients. Methods This is a cross-sectional study of a series of clinical cases. AMD diagnosis was established by international standard vision chart, Slit lamp microscope, direct or indirect ophthalmoscope examination. A total of 50 eyes (42 cases) of exudative AMD received HRA and frequency domain OCT scan. All 50 eyes received fundus fluorescein angiography (FFA) and frequency-domain OCT simultaneously, and among them 15 eyes also received indocyanine green angiography (ICGA) at the same time. FFA and ICGA were carried out by conventional methods, CNV was localized by real-time Localization technology of frequency domain OCT. In the radial and grid-like section from the areas with strong fluorescence, image acquisition settings are 7 μm fault for each frame, 30° intervals for radialsection, 10 vertical and 10 horizontal scan lines for grid-like section. CNV can be divided into 4 types (typical CNV, partial typical CNV, occult CNV, CNV scarring) according to their boundaries demonstrated in FFA. Based on the features of the OCT images, there were 3 types of integrated image (sub-RPE type, sub-retinal type and mixed type). Results CNV was detected in all 50 eyes. There were 4 eyes (8%) of typical CNV, 11 eyes (22%) of partial typical CNV, 32 eyes (64 %, including 27 eyes of RPE detachment and 5 eyes of passive late leakage) of occult CNV and 3 eyes (6%) of CNV scarring. There were 4 eyes (8%) of sub-RPE type (CNV under the RPE light band) , 16 eyes (32%) of sub-retinal type(interrupted light band of RPE and choroid capillary layer) and 30 eyes (60%) of mixed type of integrated image. Conclusion The image integration technology of the HRA and frequency domain OCT system provide a valuable tool to classify and measure CNV, which will benefit the clinical treatment of AMD patients.     

1例生物蛋白胶致过敏性休克病人的抢救及护理

目前,医用生物蛋白胶以其止血效果好,术后预防组织粘连等作用广泛应用于临床。少部分病例会对生物蛋白胶有过敏反应,但产生过敏性休克病例尚没有文献报道。2009年10月我院1例哮喘病人手术中应用生物蛋白胶进行止血时出现过敏性休克,经过紧急抢救,病人转危为安。现将抢救及护理报告如下。     

肝细胞生长因子在糖尿病新生血管性青光眼玻璃体内含量的对比研究

目的研究糖尿病新生血管性青光眼(NVG)患者玻璃体内肝细胞生长因子(HGF)的含量改变及其与血管内皮生长因子(VEGF)的相关性。设计前瞻性病例系列。研究对象糖尿病NVG患者14例(14眼),不伴虹膜新生血管的增生性糖尿病视网膜病变(PDR)患者22例(22眼),特发性黄斑裂孔(IMH)患者19例(19眼)。方法采用双抗体夹心酶联免疫吸附分析法(ELISA)检测三种疾病(三组)患者玻璃体内HGF及VEGF浓度改变。主要指标同一标本内HGF和VEGF浓度。结果NVG组、PDR组及IMH组的玻璃体内HGF浓度分别为(12908．42±2946．46)、(9770．86±3802．99)、(4160．54±2044．80)pg/ml(Kruskal-Walls检验,X~2=32．36,P=0．000),HGF浓度组间两两比较,差异均有统计学意义(P均＜0．01);三组的玻璃体内VEGF浓度分别为(823．50±718．58)、(821．82±786．27)、(22．73±3．20)pg/ml(X~2=28．30,P=0．000)。各组同一标本的HGF浓度与VEGF浓度之间无相关性(P均＞0．05)。结论糖尿病NVG玻璃体内HGF浓度明显高于不伴虹膜新生血管的PDR及LMH者,提示HGF可能参与NVG发病过程中视网膜及虹膜新生血管的形成过程。但其玻璃体内HGF与VEGF浓度水平无相关性。(眼科,2007,16:40-43)     

海德堡视网膜断层扫描仪对黄斑疾病的检查分析

目的观察分析海德堡视网膜断层扫描仪(HRT-Ⅱ)对黄斑疾病的检查应用。设计回顾性病例观察研究。研究对象110例黄斑疾病患者201眼。方法用HRT-Ⅱ的黄斑水肿程序(MEM)检查分析正常眼52只、黄斑水肿眼74只、黄斑裂孔眼23只、黄斑前膜眼31只、老年黄斑变性合并脉络膜新生血管(CNV)眼21只。主要指标水肿指数E和信号宽度W及反射图的形态特征。结果正常眼黄斑部分区域水肿指数E和信号宽度W与年龄呈部分相关(r=0.207~0.359)。黄斑疾病各组E值和W值与正常组比较均有极显著性差异(P均=0.000),其中,黄斑水肿组差异最大。HRT-Ⅱ的反射图可显示黄斑囊样水肿的囊腔、黄斑裂孔的形态和大小、黄斑前膜的范围及和血管的关系以及老年黄斑变性中的玻璃膜疣和视网膜下新生血管。结论HRT-Ⅱ不仅可通过反射图显示不同黄斑疾病形态改变,其定量指标E值和W值在黄斑区发生病理改变时不同于正常眼。尤其是中央部E值,代表了黄斑区视网膜厚度和光强反射的共同变化,在黄斑水肿时改变最明显。     

广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中的应用价值

目的 评价广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中的应用价值。 方法 将24例临床诊断为脉络膜黑色素瘤的患者随机分为两组，分别应用激光扫描检眼镜的广角接触镜系统和非接触镜成像镜头对其行荧光素眼底血管造影和吲哚青绿血管造影的全景造影扫描，获得150°广角视野图像和30°视野图像资料，并对其成像质量进行综合评定。 结果 24例患者均获得满意的影像资料。广角成像系统提供了病变位置与其他解剖结构准确的毗邻关系，提供了病变的大小和造影过程中瘤体血管充盈情况的全面信息。同时将传统造影视野范围提高了3～5倍，有助于周边病变的筛查。 结论 广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中有重要的应用价值。 (中华眼底病杂志, 2006, 22: 166-169)     

海德堡黄斑区视网膜分析系统参数的评价

目的评价海德堡视网膜断层扫描仪黄斑区视网膜分析系统(macular edema module,MEM)的三个技术参数,了解其变异性及可重复性来判断其临床应用价值。方法对78例(78只眼)正常健康志愿者应用海德堡视网膜断层扫描仪黄斑区视网膜分析系统进行检查。分析扫描深度值(Z)、视网膜信号宽度值(W)、水肿指数值(E)三参数的均值及变异系数,并分析黄斑反射图、地形图、信号宽度图、水肿指数图的图像特征。结果黄斑中心0．5mm范围内视网膜扫描深度均值(Z)为1．4430848,变异系数55．6％。W值为795．27±193．53,变异系数17．6％。E值为1．13±0．35,变异系数27．8％。不同个体三参数差异有高度显著性(P<0．01),个体变异较大。不同时间段三参数测量差异无显著性(P>0．05)。结论MEM可对黄斑区视网膜厚度进行量化分析,个体变异较大,但重复性好,HRT-Ⅱ检查适合黄斑疾病的个体随诊观察。     

玻璃体切割术后白内障超声乳化吸除术相关因素分析

目的探讨玻璃体切割术后白内障的超声乳化吸除术手术治疗的临床效果。方法将289例(352眼)玻璃体切割术后白内障患者半随机分为眼内灌注组和无灌注组。并对其原发眼底病类型、手术并发症、术后视力、白内障类型进行相关分析。结果眼底病类型、手术并发症、术后视力、白内障类型各因素中,,低眼压与脉络膜上腔出血与术式选择相关。本组研究中发生脉络膜上腔出血眼均为多次玻璃体视网膜手术后眼(P=0.017),且行白内障手术未做后节眼内灌注。术后低眼压在无灌注组更为多见(P=0.021)。对于其他并发症及术后视力恢复,两组病例并无统计学意义。结论超声乳化吸除术治疗玻璃体切割术后白内障减少了术中低眼压的危险性。对于核性白内障尤其是硬核白内障,放置后节眼内灌注是安全而有效的。     

晶体乳化联合滤过手术24例临床分析

由于年龄、长期用药及手术因素等,青光眼与白内障常同时发展,传统的白内障联合小梁切除术效果确实,但仍存在切口大,散光大,并发症多等缺点。我们自1993年以来采用超声乳化人工晶体植入联合小梁切除术治疗青光眼并发白内障,收到良好效果,现报告如下。1　一般资料资料来自1993-1998年我院门诊及住院病人24例(25只眼),其中男性10例,女性14例。年龄51～80岁。青光眼类型:慢性开角型青光眼10例(11只眼),慢性闭角型青光眼9例(9只眼),抗青光眼术后3例(3只眼),继发性青光眼2例(2只眼)。视力:光感～01者9只眼,01～03者10只眼,03以上者6只眼。晶体核分…