玻璃体腔注射曲安奈德治疗葡萄膜炎继发黄斑水肿的临床应用

目的:通过观察玻璃体腔注射曲安奈德(TA)治疗葡萄膜炎继发黄斑水肿的临床疗效。方法:回顾性分析18例眼科常规检查及经FFA和频域OCT查均确诊为葡萄膜炎继发黄斑水肿,视力≤0.6,黄斑中心凹厚度(CMT)≥250μm的患者18只眼纳入观察,进行玻璃体腔注射TA(4mg,0.1ml)治疗。比较治疗前和治疗后1天及1,2,4,8,12周最佳矫正视力(BCVA)改变;治疗前和治疗后1,2,4,8,12周的黄斑中心凹厚度(CMT)的改变。结果:在治疗后视显提高,术后各时间点(P=0.000)均具有统计学意义,BCVA各点分别为:4周0.6537±0.1421;8周0.7438±0.1153;12周0.7139±0.2158,视力基本持平,术后1周有14例视力提高大于3行,占77.78%。CMT方面,较基线比,在治疗后CMT明显降低,术后各时间点(P=0.000)均具有统计学意义。BCVA与CMT呈负相关。结论:玻璃体腔注射TA治疗葡萄膜炎继发黄斑水肿均可明显改善,减轻黄斑水肿。BCVA与CMT呈负相关,CMT是反映治疗效果的敏感指标。     

频域OCT检查对黄斑水肿特点的分析

目的 通过频域OCT对黄斑水肿形态进行观察,了解水肿程度及分布情况,并分析水肿与视力的相关性.方法 选取患黄斑水肿患者25例29只眼,病例包括视网膜中央静脉阻塞所致为8例8只眼,视网膜分支静脉阻塞7例7只眼,葡萄膜炎4例4只眼,糖尿病性视网膜病变6例10只眼.年龄52-83(64.76±8.30)岁.最佳矫正视力(BCVA)0.05～1.0(0.35±0.12).利用最新一代频域RTVueFD-OCT对黄斑区进行扫描.结果 黄斑区15°范围内神经上皮厚度(453.00±103.12)μm,其中各区域神经上皮层厚度为:中心凹(533.10±115.23)μm,旁中心区(488.93±89.71)μm,中心凹边缘区(397.05±83.52)μm.不同区域神经上皮层厚度比较差异有统计学意义(F=2.937,P<0.01),黄斑区中心凹区神经上皮层厚度与中心凹边缘区神经上皮层厚度比较差异有统计学意义(与上、下、鼻、颞侧比较结果P<0.01,以中心凹区最厚,依次为下、上、颞、鼻侧边缘区).而中心凹神经上皮层厚度与旁中心凹区神经上皮层厚度比较差异无统计学意义与上、下、鼻、颞侧比较结果P>0.05.患者BCVA与中心凹神经上皮层厚度间存在负相关关系(r=-0.784,P<0.01),与旁中心凹区神经上皮层厚度间无相关关系(r=-0.134,P>0.05),与中心凹边缘区神经上皮层厚度间无相关关系(r=.275,P>0.05).结论 频域OCT能够精确地对黄斑水肿进行活体组织学成像,具有简便、非侵入性、重复性好等特点.     

Effect of Aging on Retinal Nerve Fiber Layer Thickness in Normal Asian Indian Eyes: A Longitudinal Study

Purpose: To determine longitudinal retinal nerve fiber layer (RNFL) thickness measurement change with aging, after a period of 3 years using spectral optical coherence tomography/scanning laser ophthalmoscope (OCT/SLO).

Methods: A total of 50 eyes of 25 normal subjects underwent RNFL thickness measurement in 2008 and again in 2011 by a single operator, using spectral OCT/SLO. Measurements were compared at baseline and at follow-up. Linear mixed model analysis was used to measure the effect of age on RNFL thickness measurements over the 3 years.

Results: Mean RNFL thickness was 107.92 ± 11.1 µm in 2008 and 106.56 ± 10.8 µm in 2011. For every year increase in age, mean RNFL thickness showed a statistically significant decrease by ?0.54 µm (95% confidence interval, ?0.76 to ?0.31; p < 0.0001). There was a statistically significant loss of peripapillary RNFL thickness in most RNFL regions, except for the temporal quadrant (p = 0.37) and corresponding 7, 8, 9, and 10 o’clock hour sectors (p = 0.72, 0.75, 0.17, 0.14, respectively).

Conclusion: RNFL thickness as measured by spectral OCT/SLO decreased significantly with advancing age over a period of 3 years, and was not uniform across the four quadrants. This age-related variation should be taken into account in RNFL thickness measurements when evaluating patients for diagnosis and follow-up of glaucoma.     

Effects of chronic methamphetamine abuse on the retinal nerve fiber layer,ganglion cell layer and Bruch’s membrane opening minimum rim width

BackgroundMethamphetamine (Meth) is a highly addictive and hallucinogenic agent which is used as the second most common illicit drug globally. Meth could affect the retina and optic nerve by inducing the release of vasoconstrictive agents such as endothelin 1 and induction of severe oxidative stress with accumulation of reactive oxygen species.AimTo evaluate the effects of chronic Meth abuse on the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and the Bruch’s membrane opening minimum rim width (MRW).MethodIn this case-control study, we recruited 55 Meth abusers and 49 healthy individuals with mean age of 44.63 ± 0.97 and 43.08 ± 0.91 years, respectively. RNFL thickness, GCL thickness and MRW were evaluated using optical coherence tomography.ResultsWe found statistically significant decrease in RNFL, MRW thickness in Meth abusers (P: 0.002 and P: 0.006, respectively). We did not detect statistically significant difference regarding GCL thickness between the groups (P = 0.320). Our results showed a weak but statistically significant correlation of Meth dose increment and decrement of RNFL thickness ((P: 0.005, r = -0.193) and MRW (P: 0.013, r = -0.174). We found no correlation between duration of Meth consumption with RNFL and MRW thickness (P: 0.205, r= -0.124; P: 0.771, r= -0.029, respectively).ConclusionWe found a statistically significant adverse association in meth abusers with RNFL thickness and MRW. These two parameters were also statistically associated with the meth dose as measured by daily dose of Meth. Although we found a decrease in the GCL thickness, it did not reach statistical significance.     

青少年近视患者视网膜神经纤维层厚度变化分析

目的：观察12～18岁青少年视网膜神经纤维层厚度(RNFLT),并分析其与眼轴长度(AL)、等效球镜(SE)的相关性。

方法：横断面研究。收集2019-07/12在我院眼科就诊的汉族青少年145例145眼(均取左眼数据分析),根据SE情况分为对照组(-0.25～+0.25D,52眼)、低度近视组(-0.5～-3.0D,60眼)、中度近视组(-3.25～-6.0D,25眼)及高度近视组(-6.25～-12.0D,8眼)。应用SD-OCT检测RNFLT,并对检测结果行光学放大效应校正,比较各组受检者的RNFLT差异,分析其与AL、SE的相关性。

结果：本研究纳入受检者年龄越大,眼轴越长,近视度数越高。低度、中度近视组校正后鼻侧和平均RNFLT均较对照组增厚; 中度、高度近视组校正后颞侧RNFLT均较对照组、低度近视组增厚; 中度、高度近视组校正后上方1：00位及颞侧2：00～4：00位RNFLT均较对照组和/或低度近视组增厚,下方6：00～7：00位均较对照组和/或低度近视组变薄; 中度近视组校正后鼻侧9：00位RNFLT较对照组增厚(均P<0.05)。相关性分析显示,本研究纳入受检者校正后颞侧及1：00～4：00位RNFLT与AL呈正相关(r=0.220、0.259、0.356、0.237、0.335,均P<0.01),与SE呈负相关(r=-0.386、-0.276、-0.307、-0.254、-0.260,均P<0.01); 6：00～7：00位RNFLT与AL呈负相关(r=-0.296、-0.327,均P<0.01),与SE呈正相关(r=0.245、0.295,均P<0.05)。

结论：青少年眼球处于塑形期,RNFLT判别有特殊性,需考虑光学放大效应、AL及SE对RNFLT的影响。当颞侧1：00～4：00位校正后RNFLT较正常变薄,应考虑青光眼可能。     

超高分辨率眼前节光学相干断层成像技术在结膜增生性疾病诊断中的应用

目的 探讨超高分辨率眼前节OCT在结膜增生性疾病诊断中的应用效果。方法 选取2017年1月～2018年12月浙江大学附属第一医院及北仑分院眼科门诊收治的150例(150眼)结膜增生性疾病患者作为研究组。另选同期在我院进行体检的结膜正常者80例(80眼)作为对照组。统计分析超高分辨率眼前节OCT在睑裂斑,翼状胬肉及鳞状上皮瘤等结膜增生性疾病中临床诊断与病理诊断的符合率。观察分析睑裂斑,翼状胬肉及鳞状上皮瘤等结膜增生性疾病的特征性表现。结果 150例(150眼)结膜增生患者临床诊断为睑裂斑患者30例(30眼),翼状胬肉患者100例(100眼),以及眼表鳞状细胞瘤的患者20例(20眼)。与病理学诊断相比,UHR-OCT诊断睑裂斑诊断符合率为100.00%(30/30),翼状胬肉诊断符合率100.00%(98/98),眼表鳞状细胞瘤诊断符合率为90.91%(20/22),经统计学处理,差异无统计学意义(P0.05)。睑裂斑患者图像特征:生长在角巩膜缘处停止,且角膜上未见隆起,与前弹力层间未见高反射信号,与巩膜间未见明显分界。翼状胬肉患者图像特征:结膜上皮厚度轻度增厚,上皮层表现为中等程度的高反射,角膜上皮与前弹力层间表现为较高程度的高反射信号。OSSN患者图像特征:结膜上皮增厚,呈高反射,结膜正常上皮与异常上皮转变突然,无过渡区域,深部组织间上皮内可见瘤变。结论 超高分辨率眼前节OCT在结膜增生性疾病的诊断中具有较高的准确性,且影像特征明显,具有广阔的临床应用前景。