Comparing approaches to screening for angle closure in older Chinese adults

Aims

Primary angle-closure glaucoma is expected to account for nearly 50% of bilateral glaucoma blindness by 2020. This study was conducted to assess the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and limbal anterior chamber depth (LACD) as screening methods for angle closure.

Methods

This study assessed two clinical populations to compare SPAC, LACD, and gonioscopy: the Zhongshan Angle-closure Prevention Trial, from which 370 patients were eligible as closed-angle participants and the Liwan Eye Study, from which 72 patients were selected as open-angle controls. Eligible participants were assessed by SPAC, LACD, and gonioscopy.

Results

Angle status was defined by gonioscopy. Area under the receiver operating characteristic curve (AUROC) for SPAC was 0.92 (0.89–0.95) whereas AUROC for LACD was 0.94 (0.92–0.97). Using conventional cutoff points, sensitivity/specificity was 93.0%/70.8% for SPAC and 94.1%/87.5% for LACD. Sequential testing using both SPAC and LACD increased the specificity to 94.4% and decreased the sensitivity to 87.0%.

Conclusion

SPAC has significantly lower specificity than LACD measurement using conventional cutoffs but interpretation of the findings can be performed by modestly trained personnel.     

眼前段光学相干断层扫描仪与超声生物显微镜测量中央前房深度的比较

目的 比较眼前段光学相干断层扫描仪(AS-OCT)与超声生物显微镜(UBM)测量中央前房深度(ACD)的差异和两者的可重复性.方法 分别用AS-OCT和UBM测量急性原发性闭角型青光眼(APACG)患者29例55眼(发作眼32眼,未发作眼23眼),慢性原发性闭角型青光眼(CPACG)患者4l例74眼的ACD.采用配对t检验进行不同仪器ACD测量值比较;相关分析法分析两种仪器测量值之间的相关性.完全随机法选择1只眼分别用AS-OCT和UBM依次重复测量ACD 10次,比较测量的可重复性.结果 APACG发作眼用AS-OCT测量的ACD值与UBM的测量值之间差异无统计学意义.APACG对侧眼、CPACG眼的AS-OCT测量值比UBM测量值大[(1.923+0.287)mm比(1.860±0.243)mm,(2.017±0.054)mm比(1.913±0.052)mm,均P=0.012].AS-OCT和UBM的ACD测量值呈正相关(r=0.928,P<0.001).AS-OCT与UBM测量ACD的变异系数分别为0.66%和0.82%.结论 AS-OCT比UBM测量的ACD值大,两种仪器测量值相关性良好.AA-OCT的可重复性优于UBM.     

A randomized comparison of midazolam and diazepam injectable emulsion in cataract surgery

The purpose of this study was to compare the psychomotor recovery of patients sedated with either midazolam or Diazemuls using the digit symbol substitution test and the Trieger test. Sixty patients were allocated in random double-blind fashion to receive either midazolam or diazepam in oil emulsion (Diazemuls) as intravenous sedation for cataract surgery. Both groups received fentanyl 0.5 μg· kg^?1 IV. Tests of cognition were performed by the patients prior to sedation and at half-hourly intervals for three hours after cataract surgery. In a dose ratio of 1:4, midazolam was found to produce better sedation but more prolonged recovery than Diazemuls. Anterograde amnesia was comparable in the two groups, while more patients in the Diazemuls group developed episodes of apnoea and venous irritation.     

超声诊断视盘凹陷在评价重症化学性眼外伤手术预后中的价值

目的 评价术前超声诊断视盘凹陷在重症化学伤患者复明手术预后中的临床价值.方法 回顾性分析2010年1月-2013年6月在本院因重症化学性眼外伤晚期欲行Boston Ⅰ型人工角膜移植术复明的住院患者共28例（28眼）病例资料,所有患者术前进行闪光视觉诱发电位检查和常规B型超声观察视盘凹陷.根据超声下视盘处球壁形态超声诊断结果分为有/无视盘凹陷.所有病例均一期完成Boston Ⅰ型人工角膜移植术.术后两周检查最佳矫正视力,分析超声诊断视盘凹陷在重症化学伤患者复明手术预后中的价值.结果 28例中,术前超声诊断有视盘凹陷5例,术后最佳矫正视力（1例0.05,1例0.1,1例0.12,2例指数/眼前）.术前超声诊断无视盘凹陷23例,术后最佳矫正视力范围为0.1 ～ 0.8（0.5±0.36）.结论 术前超声诊断视盘凹陷可以准确判断重症化学性眼外伤患者复明手术预后视力较差.     

三种立体视觉检查方法在招飞体检中的应用

目的 探讨3种不同立体视锐度检查方法在海军招飞体检中的应用价值.方法 274例视力正常的海军航空学院报考者根据眼位分为正常组(242例)和斜视组(32例),应用Titmus 立体图、TNO立体视觉检查图及数字化立体视觉检查图(颜氏图)3种方法进行立体视锐度测定.结果 3种方法检测所得正常组中立体视觉正常者(立体视锐度≤60″)所占百分率分别为Titmus 98.34%,TNO92.98%,颜氏图97.52%.Titmus方法所得结果与颜氏图检测结果比较差异无统计学意义,二者分别与TNO检测结果比较,差异均有统计学意义(Z=-3.272、-3.314,P＜0.05).斜视组3种方法检测所得立体视觉正常者所占百分率分别为Titmus 90.63%,TNO 71.88%,颜氏图75.00%,TNO检测与颜氏图检测结果比较,差异无统计学意义,二者分别与Titmus检测结果比较,差异均有统计学意义(Z=-2.825、-2.428,P＜0.05).结论 颜氏图检测结合Titmus立体图检测应用于招飞体检可以获得较为理想的立体视觉检查结果. Abstract： Objective To evaluate the practicability of three stereovision tests in the stereoacuity examination for Navy aviator recruiting.Methods The stereoacuity was measured both for the group of normal position of eye (242 subjects) and strabismus group (32 subjects) by Titmus,TNO test for stereoscopic vision (TNO) and Yan's Digital Stereovision tests.Results The percentage of normal stereovision (stereoacuity≤60″) in normal group was respectively 98.34% by Titmus, 92.98% by TNO and 97.52% by Yan's.There was no significant difference between the measurements of Titmus and Yan's test but the significance was found in TNO test compared with other teszs (Z=- 3.272、- 3.314, P＜ 0.05).In strabismus group, the percentage of normal stereovision was respectively 90.63% by Titmus, 71.88% by TNO and 75.00% by Yan's.Testing by TNO or Yan's had no statistic difference but for the testing by Titmus (Z= -2.825、-2.428, P＜0.05).Conclusions The Yan's Digital Stereovision test combined with Titmus test could be appropriate to stereoacuity examination for pilot recruitment.     

硅油填充眼核磁共振成像与A型超声测量结果比较

目的 观察并探讨核磁共振成像(MRI)用于硅油填充眼眼球视轴测量的可行性及其优缺点.方法 32例32只硅油填充眼纳入本研究.采用MRI横断面T1加权像(T1 WI)、T2加权像(T2WI)检测硅油前后间隙,以脂肪抑制后T2WI成像测量眼球视轴;以角膜顶点至黄斑中心凹距离作为视轴长度,此连线上测量硅油后间隙的厚度.A型超声采取坐位及仰卧位检查,坐位测量眼球视轴长度,改变超声传播速度以修正眼球视轴长度;仰卧位检测硅油后间隙.结果 MRI检测结果显示,硅油在T1WI像中信号较对侧玻璃体高,T2WI像中信号较玻璃体低,加脂肪抑制后硅油信号降低,化学位移伪影减少;受检眼玻璃体腔内均存在不同程度的硅油前后间隙,玻璃体后间隙厚度为(2.47±1.31)mm.A型超声检测结果显示,18只眼可检测到硅油后间隙,占56.25%.MRI、A型超声测量本组患者硅油填充眼视轴长度分别为(23.52±4.67)、(20.57±5.32)mm,两者比较,其差异有统计学意义(t=30.17,P＜0.05).结论 MRI能够用于硅油填充眼视轴测量,并对硅油前后间隙进行观察和测量.

Abstract：

Objective To investigate the feasibility of using magnetic resonance imaging (MRI) to measure the visual axis length in silicone oil filled eyeballs. Methods Thirty-two silicone oil-filled eyes of 32 patients were studied. The ante-silicone oil spaces (ASS) and retro-silicone oil spaces (RSS) on the visual axis was measured on the cross-sectional T1 weighted images (T1 WI) and T2WI, the length of the visual axis was measured on the fat-suppressed T2WI. The length of the visual axis was the distance from the corneal vertex to the macular foves, and it was also measured by A-mode ultrasound in sitting position with different ultrasonic velocity. The post-oil gap was also measured by A-mode ultrasound in supine position.Results Compared with the signal of the contralateral vitreous body, the silicone oil signal was higher on T1WI images, lower on T2WI images. After fat suppression, the silicone oil signal and chemical shift artifact were reduced. There were different levels of ASS and RSS in the vitreous cavity of all 32 cases, the RSS depth was (2. 47 ± 1.31) mm on average by MRI. However, RSS was detected in only 56.25%(18 cases) eyeballs by A-mode ultrasound. The visual axis length of silicone oil-filled eyes was (23.52 ±4.67) mm by MRI, and (20. 57±5.32) mm by A-mode ultrasound in sitting position. The differences between two measurements was statistically significant (t= 30. 17, P＜0. 05). Conclusions In addition to A-mode ultrasound, MRI might be another effective method to detect RSS and ASS, and to measure the axial length of silicone oil-filled eyes.     

青光眼诊断新技术需要临床应用评价

海德堡视网膜断层扫描仪、相干光断层扫描仪及偏振光激光扫描仪等检测技术广泛应用于青光眼临床诊断已有多年,但其实用价值和临床意义尚缺少明确而规范的评判标准.每种检测仪器均需要进行诊断试验评价,而评价方法应当正确、规范而严谨,重在早期诊断和不同指标诊断性能的具体分析.诊断技术只有在临床应用与应用评价相结合时,才能获得真正的发展,并进而解决实际问题.     

眼部成纤维细胞在眼科疾病中的研究进展

眼部成纤维细胞的增生、变性是诸多眼部疾病的发病机制之一,如结膜松弛症、翼状胬肉、角膜疾病、青光眼滤过术后的瘢痕化、视网膜疾病、基底细胞癌及Graves眼病等.对眼部成纤维细胞进行体外培养、传代及纯化成功后可广泛应用于相关的实验研究.本文就眼部成纤维细胞的生物学特征、体外培养的方法及其在眼科疾病中的研究进展作一综述.