邵长荣辨治“喘肿”经验

阐述邵长荣教授所提出＂喘肿＂的概念,并分析其病机,提出治疗＂喘肿＂具体四法：宣肺通阳利水法、温阳化饮利水法、疏肝清肺利水法、健脾纳肾法。     

In diabetic retinopathy, foveal thickness of 300 μm seems to correlate with functionally significant loss of vision

Purpose To study the relationship between foveal thickness assessed by optical coherence tomography (OCT) and foveal function measured with multi focal electroretinography (mfERG) in patients with non-proliferative diabetic retinopathy, and with no previous laser treatment. Methods Twenty-six eyes from 18 diabetic patients (13 men), aged 59 years, (range 28–79 years), diabetes duration 15 years, (range 2–27 years), with a macular thickness between 200 and 600 μm were evaluated by mfERG, visual acuity (ETDRS score) and OCT. Mean amplitudes and implicit times of the mfERG responses were analyzed within the four innermost (14 degrees) of the six concentric rings. For comparison with the results from the OCT (diameter of measured area = 6 mm) we analyzed the summed response from the first and second ring (central zone), corresponding to the central area of the OCT. The third(zone 2) and fourth (zone 3)of the four innermost of the six concentric rings measured by the mfERG corresponding to the second and third area of OCT. Results An increased macular thickness in the central area of the OCT correlated to reduced amplitudes (r = −0.541; P = 0.004) and prolonged implicit times (r = 0.548; P = 0.004) in the central zone of the mfERG, and inversely correlated with visual acuity, −0.49; P = 0.045. Retinal thickness in the second area was correlated to prolonged implicit times in the second mfERG zone (r = −0.416; P = 0.034). No correlations were found for the third area of the OCT. When macular thickness exceeded 300 μm the decrease of amplitudes and prolonged implicit times, measured by mfERG, seemed to be more pronounced. Conclusion In conclusion increased macular thickness is correlated with reduced amplitudes and prolonged implicit times on the mf ERG and worse visual acuity.     

Functional and morphological changes in diabetic macular edema over the course of anti‐vascular endothelial growth factor treatment

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti‐vascular endothelial growth factor (VEGF) treatment with Ranibizumab. Methods:  A consecutive series of 39 study eyes with centre‐involving DME were included in this study. In all subjects, best‐corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD‐OCT) cross‐sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross‐sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = ?1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = ?3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = ?4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = ?1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = ?0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = ?2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti‐VEGF therapy with Ranibizumab in patients with DME.     

视网膜静脉阻塞继发黄斑水肿的抗VEGF药物治疗进展

视网膜静脉阻塞是一种常见的眼科疾病,黄斑水肿是其重要临床表现,对视力有重要损害。血管内皮生长因子（ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ,ＶＥＧＦ）在视网膜静脉阻塞继发黄斑水肿形成中可能具有重要作用,因此,抗ＶＥＧＦ药物的应用,提供了新的治疗手段,雷珠单抗、贝伐单抗、阿柏西普、康柏西普是临床上用于玻璃体内注射的主要抗ＶＥＧＦ药物,本文就各种抗ＶＥＧＦ药物的临床疗效作一综述。     

糖尿病性黄斑水肿视网膜微结构SD-OCT改变研究进展

糖尿病性黄斑水肿( diabetic macular edema ,DME)是糖尿病患者视功能损害的主要原因,中央视网膜厚度( central retinal thickness,CRT)与DME患者视功能损害及治疗前后视功能变化密切相关,而黄斑部视网膜微结构改变与CRT变化有关。频域 OCT ( spectral-domain OCT, SD-OCT)可以定性、定量的分析黄斑各组织层次的细微结构。我们对DME患者黄斑部视网膜微结构SD-OCT改变的相关研究进展进行综述,对进一步探讨DME的发病机制、观察病情进展、指导临床治疗及判断预后情况有重要意义。     

海德堡视网膜断层扫描监测糖尿病黄斑水肿的可行性及其临床意义

目的：探讨海德堡视网膜断层扫描（HRT）监测糖尿病性黄斑水肿（DME）的可行性及其临床意义。方法：采用HRTⅡ对经裂隙灯显微镜加三面镜检查、荧光素眼底血管造影（FFA）检查确诊的DME、糖尿病无黄斑水肿（NDME）患者和无糖尿病正常对照者共77例120只眼进行黄斑中心凹水肿指数（e值）测定。其中，DME组23例40只眼，男性13例23只眼，女性10例17只眼，年龄44～68岁，平均年龄（55．17±8．26）岁；NDME组32例40只眼，男性18例22只眼，女性14例18只眼，年龄44～68岁，平均年龄（55．17±6．5）岁；正常对照组22例40只眼，男性10例19只眼，女性12例21只眼，年龄42～65岁，平均年龄（53．32±6．04）岁。3组间性别、年龄差异均无统计学意义（P〉O．05）。根据FFA检查黄斑区可疑渗漏或渗漏面积〈25％、渗漏面积在25％～66％、渗漏面积〉66％将DME分为3级。40只DME眼中FFA1、2、3级分别为9、10、21只眼。观察分析DME患眼e值与FFA渗漏面积和视力的关系以及受检组之间不同黄斑直径与e值的相互关系。结果：黄斑直径为1、2、3mm的e值行方差分析，组间差异有统计学意义（P〈0．05）。两两比较，正常对照组与NDME组e值差异无统计学意义（P〉0．05），正常对照组、NDME组分别与DME组比较，e值差异均有统计学意义（P〈O．05）。DME组视力的对数与e值存在相关性（P〈0．05）。DME组FFA1、2、3级之间的e值行方差分析，两两比较，三者之间总体有差异。FFA1级与3级、2级与3级黄斑渗漏面积差异有统计学意义（P〈0．05），1级与2级之间差异无统计学意义（P〉0．05），结果与黄斑区测定的直径大小无关。结论：HRTⅡ黄斑模块中的e值能够量化测量和客观评价DME程度。     

颌面部慢性血管神经性水肿临床观察

目的 探讨颌面部慢性血管神经性水肿的临床表现及治疗方法。方法 总结15例患者的临床表现;采用静脉滴注葡萄糖酸钙和维生素C,局部注射强的松龙的治疗方法。结果 颌面部慢性血管神经性水肿临床表现为：病变区反复肿胀,间歇期不能恢复至正常,非压陷性肿胀,皮肤色泽基本正常。治疗后15例患者中6例痊愈,7例好转,无效2例。均随访2年,随访期间痊愈和好转患者均无明显复发,治疗效果满意。结论 掌握了颌面部慢性血管神经性水肿的临床特征后,该病诊断容易,治疗效果满意。     

Specular microscopic and histologic observations in nonguttate corneal endothelial degeneration

Six phakic patients with unilateral corneal edema and clinically normal-appearing fellow eyes were examined with specular microscopy and found to have endothelial pleomorphism and reduced cell counts in the nonedematous cornea. None of these patients had any previous eye disease, trauma, inflammation, or surgery. Clinically unrecognized endothelial disease was proposed as a cause for the unilateral corneal edema and was verified by light and electron microscopic studies in five patients. These pathologic findings vary somewhat from those found in Fuchs' dystrophy and may represent either a variant or a form of endothelial cell degeneration of as yet undetermined etiology. Our studies suggest that this condition is not detectable in the nonedematous cornea by standard high magnification biomicroscopy and requires the use of the clinical specular microscope to confirm the diagnosis in suspected cases.     

首选玻璃体腔注射贝伐单抗或曲安奈德对比治疗视网膜中央静脉阻塞继发黄斑水肿疗效及安全性差异的荟萃分析

目的 综合评价首选玻璃体腔注射贝伐单抗（IVB）或曲安奈德（IVT）对比治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿时的疗效与安全性的差异。 设计 荟萃分析。 研究对象 Medline（1966~2012年）、EMbase（1966~2011年）、Cochrane图书馆（2011年）及中国生物医学文献数据库CBM（1979~2011年）有关贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究文献资料。方法 采用Cochrane系统评价的方法,检索上述文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得二者治疗CRVO继发黄斑水肿的疗效及安全性是否有差异的相关证据。 主要指标 中央黄斑厚度（CMT）,最佳矫正视力,不良反应。 结果 共纳入玻璃体腔注射贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究6项（共242眼）。Meta分析结果显示,首选IVB组与首选IVT组的患者CMT降低幅度的差异为-33.22 μm（95%CI： -74.85 μm~8.42 μm）（P=0.12）,提高BCVA幅度的差异为0.01 （95%CI： -0.13~0.14）（P=0.92）。首选IVB发生不良反应的比例低于首选IVT（合并比值比为0.03, 95%CI： 0.01~0.10）。结论 采用首选IVB与IVT对比治疗CRVO继发黄斑水肿时,在降低CMT及提高BCVA方面二者疗效相仿,但安全性方面IVT明显较IVB差。二者间谁更适合作为CRVO继发黄斑水肿的首选治疗,尚需更多前瞻性大样本的临床随机对照试验数据支持。