Management challenges for chronic dysimmune neuropathies during the COVID-19 pandemic

Since March 2020, the COVID-19 pandemic has led to the need to re-think the delivery of services to patients with chronic dysimmune neuropathies. Telephone/video consultations have become widespread but have compounded concerns about objective evaluation. Therapeutic decisions need, more than ever before, to be considered in the best interests of both patients, and society, while not denying function-preserving/restoring treatment. Immunoglobulin therapy and plasma exchange, for those treated outside of the home, expose patients to the hazards of hospital or outpatient infusion centers. Steroid therapy initiation and continuation pose increased infectious risk. Immunosuppressant therapy similarly becomes highly problematic, with the risks of treatment continuation enhanced by uncertainties regarding duration of the pandemic. The required processes necessitate considerable time and effort especially as resources and staff are re-deployed to face the pandemic, but are essential for protecting this group of patients and as an integral part of wider public health actions.     

隧道巩膜切口与透明角膜切口超声乳化白内障手术的临床效果分析

目的探讨老年性白内障摘除人工晶状体植入术两种不同术式的临床疗效;评价隧道巩膜切口与透明角膜切口的疗效差异。方法对年龄60～80岁,平均(68.4±9.1)岁的老年性白内障患者按前后阶段分成两组,A组98例(109只眼),行隧道巩膜切口白内障超声乳化摘除联合人工晶状体植入术;B组216例(258只眼)行透明角膜切口白内障超声乳化摘除联合折叠式人工晶状体植入术。分析两种不同切口及相应不同类型人工晶状体植入方式的优缺点。结果术后视力：两组术后1周、1个月、3个月的裸眼视力及最佳矫正视力存在显著性差异。术后并发症有轻度角膜内皮水肿、重度角膜内皮水肿、重度前段葡萄膜反应、人工晶状体夹持等。结论角膜透明切口白内障超声乳化摘除联合折叠式人工晶状体植入术术后散光小,并发症少,视力恢复好。     

常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病的颅脑MRI表现

目的 提高对常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病(CADASIL)的颅脑MRI表现的认识.方法 对一家系2代5例患者进行头颅常规MR和MR血管成像(MRA)检查.对经Notch3基因检查或皮肤组织活检超微病理检查确诊的3例和经MRI与临床诊断的1例CADASIL的MRI资料进行分析.结果 MR检查的5例中4例CADASIL均获得明确诊断,1例排除诊断.4例CADASIL均见两侧颞叶、额叶和顶叶大致对称性皮层下与侧脑室旁白质病灶,呈长T1、长T2信号,但枕叶累及甚少且皮层不受累;O'Sullivan征阳性4例,皮层下腔隙性损害(SLLs)征阳性2例;3例半卵圆中心可见多发圆形或卵圆形囊性梗死即"黑洞",4例均见多发圆点状血管周间隙即"胡椒罐盖"样征象;4例全部显示胼胝体单发或多发斑片状显著长T1、长T2信号,其中2例伴萎缩;内囊前肢与外囊均受累,呈"人"字征;基底节和脑干可见单发或多发陈旧性腔隙性梗死灶;1例伴右侧小脑小片状梗死灶;4例全部有轻度至中度的脑干、小脑和大脑萎缩;MRA颅内Ⅰ-Ⅲ级较大动脉均未见明显异常.结论 CADASIL的颅脑MRI表现具有一定的特征性,可为CADASIL的初诊和筛选提供重要依据.     

特发性视网膜前膜患者的多焦视网膜电图改变

目的:应用多焦视网膜电图(multifocalelectroretinogram,mfERG)对正常对照眼和特发性视网膜前膜眼进行检测并比较两者之间的差异。方法:用VERISScience4.0视诱发反应图像系统对17例(20只眼)正常对照者和15例(19只眼)特发性视网膜前膜患者进行检测。结果:特发性视网膜前膜患者皆出现程度不同多焦视网膜电图异常,与正常对照组的比较显示视网膜前膜组1～6环的P1波反应密度值和1～6环的N1波潜伏期与正常对照组有显著性差异,视力与第一环振幅无相关但与第一环的潜伏期存在相关。结论:多焦视网膜电图可用于对特发性视网膜前膜患者进行视功能评估。     

高度近视白内障晶状体超声乳化人工晶状体植入术的临床观察

目的 观察晶状体超声乳化吸出联合折叠式人工晶状体植入术治疗白内障合并高度近视的临床效果.方法 对27例(47眼)白内障合并高度近视行晶状体超声乳化吸出,低度数丙烯酸酯折叠式人工晶状体植入术,观察术中、术后并发症,术后视力及屈光状态,术后随访>6月.结果 术中有后囊破裂1眼(2.13%),角膜水肿7眼(14.89%),葡萄膜炎症1眼(2.13%).术后1月-3月矫正视力<0.1者1眼(2.13%),0.1-0.4者12眼(25.53%),0.5-0.8者30眼(63.83%),1.0-1.5者4眼(8.51%).晶状体后囊浑浊6眼(12.77%).观察2年无视网膜脱离者.结论 晶状体超声.乳化吸出,低度数丙烯酸酯折叠式人工晶状体植入治疗白内障合并高度近视安全并且效果良好.     

ReSTOR SV25T0与ReSTOR SN6AD1多焦点人工晶状体植入术后临床疗效对比

目的　对比观察ＲｅＳＴＯＲＳＶ２５Ｔ０与ＲｅＳＴＯＲＳＮ６ＡＤ１多焦点人工晶状体（ｍｏｌｔｉｆｏｃａｌｉｎｔｒａｏｃｕｌａｒｌｅｎｓ,ＭＩＯＬ）植入术后的临床视觉效果。方法　行白内障超声乳化吸出联合ＭＩＯＬ植入术的白内障患者４１例（４３眼）,根据植入的ＭＩＯＬ不同分为两组:ＳＮ６ＡＤ１组２０例（２２眼）植入ＲｅＳＴＯＲＳＮ６ＡＤ１ＭＩＯＬ,ＳＶ２５Ｔ０组２１例（２１眼）植入ＲｅＳＴＯＲＳＶ２５Ｔ０ＭＩＯＬ,观察两组患者术前及术后３个月裸眼近视力、裸眼中距离视力（５０ｃｍ、７０ｃｍ）及裸眼远视力,绘制离焦曲线,并进行对比敏感度检查、视觉质量及满意度问卷调查。结果　术后３个月两组患者５ｍ裸眼远视力对比差异无统计学意义（Ｐ＞０．０５）;ＳＶ２５Ｔ０组患者５０ｃｍ及７０ｃｍ的裸眼中距离视力分别为（０．１２±０．０７）ｌｏｇＭＡＲ和（０．１７±０．０８）ｌｏｇＭＡＲ,均明显优于ＳＮ６ＡＤ１组患者的（０．１８±０．０８）ｌｏｇＭＡＲ和（０．２４±０．０９）ｌｏｇＭＡＲ（均为Ｐ＜０．０５）,而ＳＮ６ＡＤ１组患者３３ｃｍ的裸眼近距离视力为（０．１１±０．０８）ｌｏｇＭＡＲ,高于ＳＶ２５Ｔ０组患者的（０．１６±０．０８）ｌｏｇＭＡＲ（Ｐ＜０．０５）;ＳＶ２５Ｔ０组术后暗视下３．０ｃ·ｄ－１及６．０ｃ·ｄ－１空间频率的对比敏感度优于ＳＮ６ＡＤ１组,差异均有统计学意义（均为Ｐ＜０．０５）;术后问卷调查示两组患者均未出现明显视觉干扰,ＳＶ２５Ｔ０组患者在近距离视力的视近满意度较ＳＮ６ＡＤ１组低,在中距离和远距离下满意度稍高,但是两组间差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＲｅＳＴＯＲＳＶ２５Ｔ０与ＳＮ６ＡＤ１ＭＩＯＬ均能改善白内障患者术后视力及对比敏感度,ＲｅＳＴＯＲＳＶ２５Ｔ０在中距离视力的表现优于ＲｅＳＴＯＲＳＮ６ＡＤ１。     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.     

黔东南少数民族地区小切口白内障囊外摘出人工晶状体植入1134例临床报道

目的探讨适合少数民族地区白内障安全有效的手术方式。方法回顾性分析小切口白内障囊外摘出联合人工晶状体植入1134例（1190眼）临床资料。结果术后1-3 d裸眼视力0.1-0.3者206眼（17.31%）,视力0.4-0.6者669眼（56.22%）,视力≥0.8者315眼（26.47%）。术后1-3个月复查326眼,其中视力0.1-0.3者76眼,0.4-1.2者250眼（76.69%）。术后角膜内皮水肿28眼（2.35%）,前房积血2眼（0.17%）,前房虹膜渗出性反应20眼（1.68%）。结论小切口白内障囊外摘出联合人工晶状体植入术疗效好,手术时间短,术后并发症少,医疗费低,在边远农村少数民族地区为首选复明手术。