闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

复合式小梁切除术治疗抗青光眼术后眼压不降30例

目的探讨复合式小梁切除术治疗抗青光眼术后眼压不降的疗效。方法对30例抗青光眼术后眼压不降患者施行复合式小梁切除术。术后检查视力、眼压、滤过泡情况和前房深度。随访观察时间为2~33(11.80±7.40)个月。结果以眼压下降至6~21mmHg(用或不用降眼压药物)为标准,手术成功率为90%(27/30),术后视力提高、保持不变的有80%(24/30)。结论复合式小梁切除术是抗青光眼术后眼压不降再手术的一种有效治疗方法。     

急性闭角型青光眼合并前房积血一例

患者女,53岁.因双眼反复胀痛2年,右眼红痛1周于2008年1月24日收入院.患者于2年前发现双眼房角窄Ⅳ(开).因患者不愿行预防性手术而长期滴用匹罗卡品滴眼液.     

AC-OCT与OCT测量中央角膜厚度的比较

【目的】探讨眼前段光学相干断层扫描仪（AC-OCT）测量中央角膜厚度（CCT）,并与光学相干断层扫描仪（OCT）进行比较。【方法】分别用OCT和AC-OCT的高分辨单线扫描程序（High Resolution Corneal）、角膜地形图程序（Pachymetry Map）测量30例（30只眼）正常受试者的CCT。采用配对t检验对之进行比较;用相关分析方法分析两种仪器测量值之间的相关性;随机选择1只眼分别用两种OCT仪依次重复测量CCT10次,采用变异系数作为评判标准,比较测量的可重复性。【结果】OCT测量的CCT平均值为526.0（s=29.4）μm;AC-OCT角膜地形图程序测量的中央2mm区域最小值、最大值和平均值的均值分别是512.6（s=31.7）μm,522.0（s=32..3）μm和515.0（s=31.7）μm,高分辨单线扫描程序测得的CCT值为518.9（s=31.1）μm;OCT测量的CCT值比AC-OCT的各测量值分别大13.3（s=5.9）Vm（P=0.000）;3.9（s=6.3）μm（P=0.002）;11.0（s=5.9）μm（P=0.000）;7.0（s=6.4）μm（P=0.000）。OCTccT与AC-OCT各CCT值有很好的相关性（rOCT-AC-OCR Ms=0．987。rOCT-AC-OCT Mac=0．987，rOCT-AC-OCT Mam=0.988，rOCT-MC-OCT Fmp=0．986，P均=0．000）。OCT测量CCT值10次的变异系数为0．67％。AC-OCT角膜地形图中央2mm区域中的最小值、最大值和平均值以及高分辨单线扫描程序测量值的变异系数分别为0．23％，0．48％，0．20％R0．37％。【结论】OCT测量的CCT值比AC—OCT的各CCT值大。两种OCT的测量值相关性较好；AC—OCT测量CCT的可重复性稍好于OCT。     

AC-OCT与OCT测量中央角膜厚度的比较

 【目的】探讨眼前段光学相干断层扫描仪（AC-OCT）测量中央角膜厚度（CCT）,并与光学相干断层扫描仪（OCT）进行比较。【方法】分别用OCT和AC-OCT的高分辨单线扫描程序（High Resolution Corneal）、角膜地形图程序（Pachymetry Map）测量30例（30只眼）正常受试者的CCT。采用配对t检验对之进行比较;用相关分析方法分析两种仪器测量值之间的相关性;随机选择1只眼分别用两种OCT仪依次重复测量CCT10次,采用变异系数作为评判标准,比较测量的可重复性。【结果】OCT测量的CCT平均值为526.0（s=29.4）μm;AC-OCT角膜地形图程序测量的中央2mm区域最小值、最大值和平均值的均值分别是512.6（s=31.7）μm,522.0（s=32..3）μm和515.0（s=31.7）μm,高分辨单线扫描程序测得的CCT值为518.9（s=31.1）μm;OCT测量的CCT值比AC-OCT的各测量值分别大13.3（s=5.9）Vm（P=0.000）;3.9（s=6.3）μm（P=0.002）;11.0（s=5.9）μm（P=0.000）;7.0（s=6.4）μm（P=0.000）。OCTccT与AC-OCT各CCT值有很好的相关性（rOCT-AC-OCR Ms=0．987。rOCT-AC-OCT Mac=0．987，rOCT-AC-OCT Mam=0.988，rOCT-MC-OCT Fmp=0．986，P均=0．000）。OCT测量CCT值10次的变异系数为0．67％。AC-OCT角膜地形图中央2mm区域中的最小值、最大值和平均值以及高分辨单线扫描程序测量值的变异系数分别为0．23％，0．48％，0．20％R0．37％。【结论】OCT测量的CCT值比AC—OCT的各CCT值大。两种OCT的测量值相关性较好；AC—OCT测量CCT的可重复性稍好于OCT。     

中央角膜厚度对Goldmann眼压计与非接触式眼压计测量值的影响

目的探讨中央角膜厚度（CCT）对Goldmann眼压计与非接触式眼压计（NCT）眼压测量值的影响。方法分别用Goldmann眼压计与NCT测量83例（83只眼）正常人的眼压,采用光学相干断层扫描仪（OCT）测量CCT。采用配对T检验比较Goldmann眼压计与NCT眼压计眼压测量值的差异,采用线性相关分析方法分析两种眼压计眼压测量值之间的相关关系,并分析CCT对两种眼压计眼压测量值的影响。结果Goldmann眼压计测得的眼压平均值为（13.46±2.93）mmHg,NCT测得的平均值为（12.29±3.47）mmHg,两者之间差异有显著性（t=5.831,P〈0.001）;两种眼压计眼压测量值呈正相关（r=0.852,P〈0.001）。Goldmann眼压计眼压测量值和NCT眼压测量值均与CCT呈正相关,r值分别为0.424（P〈0.001）和0.568（P〈0.001）。Goldmann眼压计眼压测量值与NCT眼压测量值的差值与CCT呈负相关（r=-0.402,P〈0.001）。去除CCT因素影响后,两种眼压计眼压测量值的残差差异无显著性（t=-0.272,P=0.787）。结论Goldmann眼压计与NCT眼压计眼压测量值均受CCT的影响，CCT对NCT眼压测量值的影响更大；两种眼压计眼压测量值的差异可能来源于个体CCT的差异。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

原发性急性闭角型青光眼视网膜神经纤维层厚度变化研究

目的 观察原发性急性闭角型青光眼(APACG)首次发作后6个月内视网膜神经纤维层厚度(RNFLT)变化规律.方法 用光学相干断层扫描仪(OCT)测量首次单侧发作的APACG患者(24例)在眼压控制后3 d内、2周、1月、3月和6月时的双眼RNFLT,比较双眼各时间点RNFLT.对侧眼在发作眼眼压控制后3d内及6月时的RNFLT与正常人(55名55只眼)比较.结果 发作眼平均RNFLT在眼压控制后3 d内(121.49±23.84)μm,较对侧眼明显增加(P＜0.01);2周(107.22±24.72)μm和1月(93.58±18.37)μm与对侧眼的差异无统计学意义(P=0.31和0.08);3月(84.10±19.89)μm和6月(78.98±19.17)μm较对侧眼明显减少(P＜0.01).发作眼不同时间点的RNFLT变化均有统计学意义(P＜0.01～0.048).对侧眼在发作眼眼压控制后3 d内及6月的RNFLT和正常人比较差异无统计学意义(P=0.13～0.98).结论 APACG发作后RNFL厚度即有明显增加,发作后2周至1个月RNFL厚度趋向正常,1个月后RNFL厚度逐渐变薄,至术后6个月RNFL厚度较对侧眼和正常人明显减少.