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.     

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.     

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.     

青光眼滤过泡感染及滤过泡相关性眼内炎临床分析

目的了解青光眼滤过手术后滤过泡感染和滤过泡相关性眼内炎的临床特点、危险因素、治疗方法和愈后情况。方法回顾分析1999年1月1日至2004年4月30日我院收治的全部滤过泡感染和滤过泡相关性眼内炎患者的临床资料。结果共收集18例(18只眼)患者的临床资料,其中单纯滤过泡感染6例(6只眼),急性眼内炎4例(4只眼),迟发性眼内炎8例(8只眼)。滤过泡感染和迟发性眼内炎发生时间介于术后1个月余至15年之间,均发生于薄壁滤过泡患者。急性眼内炎发生于术后1个月之内。滤过泡感染的致病菌培养阳性率为50%,以葡萄球菌为主;急性眼内炎致病菌培养阳性率为75%,病原菌为真菌和绿脓杆菌;迟发性眼内炎致病菌培养阳性率为37.5%,病原菌为革兰氏染色阳性球菌、表皮葡萄球菌、大肠杆菌。滤过泡感染患者治疗效果较好,视力均在0.1以上;早期行玻璃体手术联合全身及局部的广谱抗生素治疗可有效控制感染性眼内炎,但多数患者视力低于0.05,真菌或革兰氏阴性菌感染的患者视力预后差。结论薄壁滤过泡与滤过泡感染和迟发性眼内炎的发生关系密切。单纯滤过泡感染的视力愈后好;眼内炎患者的视力愈后与致病菌种类有关,大部分患者视力愈后差。     

眼底彩色照相和光相干断层扫描评价眼外伤玻璃体视网膜手术后黄斑前膜

目的 探讨眼底彩色照相和光相干断层扫描图像(OCT)评价眼外伤患者玻璃体视网膜手术后黄斑前膜的临床意义。 方法 采用眼底彩色照相和OCT，观察我院2003年7月至2004年9月收治的139例(139只眼) 眼外伤患者玻璃体视网膜手术后的黄斑部形态。 结果 手术后1、2、3、6、12个月眼底彩色照相分别检查出黄斑前膜5、8、17、19、20只眼，OCT检查分别为7、10、20、26、27只眼，差异无统计学意义（χ2＝0.173，P＞0.05）。OCT检查发现8只眼（29.63%）黄斑前膜与视网膜完全粘附，27只眼（44.44%）神经上皮层水肿，黄斑中心凹厚度(290.18±288.05) μm。 结论 眼底彩色照相和OCT可以用于眼外伤患者玻璃体视网膜手术后的早期和长期随访。OCT对黄斑前膜结构和状态的了解，对其治疗有重要指导意义。 (中华眼底病杂志, 2006, 22: 236-238)     

瞳孔大小对光学相干断层扫描仪测量视网膜神经纤维层厚度的影响

 【目的】探讨瞳孔状态对光学相干断层扫描仪（OCT3）测量视网膜神经纤维层（RNFL）厚度值的影响及其诊断青光眼的准确性。【方法】正常人38例72眼，原发性开角型青光眼患者19例34眼，分别在自然瞳孔（2．5～3mm）和药物散瞳下（6～8mm）用OCT3成组扫描程序（RNFL Thickness3．4）进行检查。对散瞳前后各象限RNFL厚度及全周平均值进行对比，分别计算散瞳前后RNFL厚度测量值的ROC曲线下面积。【结果】正常人散瞳前颞侧、上方、鼻侧、下方、平均的RNFL厚度（μm）分别为77±12、122±16、68±13、125±16、98±9，散瞳后相应的RNFL厚度分别是75±13、122±17、71±13、125±14、98±10，散瞳前后比较，除鼻侧外（P为0．039），其余象限及全周RNFL厚度差异无显著性（P为0．478～0．870）。原发性开角型青光眼患者散瞳前颞侧、上方、鼻侧、下方、平均的RNFL厚度（μm）分别为63±13、90±20、58±15、72±22、71±9，散瞳后相应的RNFL厚度分别是65±13、93±22、60±12、74±22、73±10，散瞳前后颞侧和全周RNFL厚度平均值差异有显著性（P分别为0．011、0．008），其余各方位差异无显著性（P为0．109～0．172）。散瞳前后平均及下方视网膜神经纤维层厚度测量值的ROC曲线下面积最大，为0．971～0．983。【结论】应用OCT3测量RNFL厚度，瞳孔大小对测量值影响不大，但瞳孔不能小于2．5mm，屈光间质混浊时应散瞳检查。自然瞳孔及散瞳下运用OCT3测量RNFL厚度诊断青光眼的准确性高，结果可靠。     

糖尿病性黄斑水肿的光学相干断层成像

目的:观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical coherence tomography,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系.方法:对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查.结果:10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚.DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0.60,P=0.000).结论:DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差.     

糖尿病视网膜病变黄斑区的光学相干断层扫描及多焦视网膜电图图像特征

为了解糖尿病视网膜病变黄斑区的组织结构的改变及其相应的视网膜功能变化的关系。我们应用了光学相干断层扫描（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）及多焦视网膜电图（ｍｕｌｔｉｆｏｃａｌ ｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｐｈｙ,ｍ－ＥＲＧ）检测了Ⅲ～Ⅳ期糖尿病视风膜病变患者３８例６０眼,结果显示ＯＣＴ图像特征大致可分五种形态,ｍ－ＥＲＧ反应密度图形可以反映出黄斑的视网膜功能并与黄斑区的组织形态的改变有较密切的关系。ＯＣＴ及ｍ－ＥＲＧ的应用为糖尿病视网膜病变患者黄斑病变的组织形态和视网膜功能的评价及随访提供可靠的检测手段。     

超声乳化白内障吸出术中前房形成困难的处理和原因分析

目的：探讨白内障超声乳化吸出术中前房形成困难和持续汪前房的术中处理方法并分析其发生原因。方法：对我院1500例（眼）超声乳化白内障吸出术患者中11例出现高眼压、浅前房的患者经过高渗剂降压、升高液压、减低吸力和流速等处理,眼压降低、前房重建后完成超声乳化白内障吸出术。结果：11例患者中,10例经过上述处理后眼压下降、前房形成。1例经上述处理仍不能形成前房,经平坦部行前段玻璃体切割后前房形成。11例均可完成超声乳化术。术后视力大于或等于0．7者4例,0．3－0．5者5例,0．05者1例,手动／眼前30cm者1例。结论：房水逆流、球后出血、脉络膜腔出血是超声乳化白内障吸出术中出现前房形成困难的常见原因。大多数患者经药物处理后可重建前房,完成手术。药物处理无效时,经平坦部行前段玻璃体切割是一种有效的方法。     

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.