Are Patients With Twin‐Twin Transfusion Syndrome and a Very Short Cervix Candidates for Laser Surgery?

Objectives. The purpose of this study was to determine the relationship between cervical length (CL) and perinatal outcomes in cases of twin‐twin transfusion syndrome (TTTS) treated with laser surgery and to assess whether patients with a very short cervix (0.5–1.9 cm) are appropriate candidates for laser surgery. Methods. All women who underwent laser surgery for TTTS from March 2006 to April 2008 at the study institution were evaluated consecutively. Patients were grouped according to pre‐operative CL: greater than 2.5, 2 to 2.5, and 0.5 to 1.9 cm. The gestational age at delivery, latency from laser surgery to delivery, and 30‐day neonatal survival were documented prospectively and compared among these groups. Results. The 99 women in the study population were grouped by CL: greater than 2.5 cm (n = 76), 2 to 2.5 cm (n = 13), and 0.5 to 1.9 cm (n = 10). For these groups, the median gestational ages at delivery were 34, 32.29, and 31.86 weeks, respectively (P = .411). The median latencies from laser surgery to delivery were 12.79, 11, and 11.07 weeks (P = .424). The frequency rates of at least 1 surviving twin were 69 of 76 (91%), 13 of 13 (100%), and 8 of 10 (80%) (P = .254). Finally, dual survivors were observed in 54 of 76 (71%), 12 of 13 (92%), and 5 of 10 (50%) (P = .08). Conclusions. In cases of TTTS complicated by a very short cervix (0.5–1.9 cm), treatment with laser surgery resulted in perinatal outcomes that were sufficiently favorable to justify the surgery, suggesting that these patients should not be excluded from undergoing laser surgery for TTTS.     

活血利水方联合532激光对糖尿病黄斑水肿视功能与形态学变化的影响

目的观察活血利水方联合532激光对糖尿病黄斑水肿视功能与形态学变化的影响。方法将90例（147眼）糖尿病黄斑水肿患者随机分为中药组30例（47眼）、光凝组30例（48眼）和联合组30例（52眼）,分别采用活血利水方、532激光以及中药联合激光治疗;治疗后及疗程结束后6个月观察各组最佳矫正视力、FFA及OCT变化情况。结果中药组治疗前后视力差异有统计学意义（P〈0.05）,但随访时（疗程结束后6个月）较治疗前无提高（P〉0.05）;光凝组、联合组治疗后和随访时视力较治疗前均有提高（P〈0.05）。中药组治疗后和随访时视网膜厚度较治疗前无明显变化（P〉0.05）,光凝组、联合组治疗后和随访时视网膜厚度较治疗前差异均有统计学意义（P〈0.05）。中药组治疗后和随访时黄斑水肿渗漏有效率分别为40.42%和36.17%,光凝组分别为66.67%和60.41%,联合组分别为88.46%和80.77%。联合组、光凝组与中药组视力、视网膜厚度、黄斑水肿渗漏情况治疗后及随访时比较差异有统计学意义（P〈0.05）,联合组与光凝组治疗后及随访时比较差异有统计学意义（P〈0.05）。结论活血利水方联合532激光治疗糖尿病黄斑水肿疗效好,可明显提高患者的视力,改善视网膜病变和黄斑水肿渗漏。     

糖尿病视网膜病变肾透析患者进行眼底激光治疗的疗效分析

目的：探讨糖尿病肾病合并视网膜病变的肾透析患者进行全视网膜激光光凝治疗的安全性和疗效分析。方法：对50例（100眼）经中西医临床确诊的糖尿病肾病合并增殖前期和增殖期糖尿病视网膜病变,需长期持续肾透析的患者进行眼底激光治疗,随访半年至1年,复查眼底荧光造影,观察视力和视网膜的变化情况,以及不良反应和并发症的发生情况。结果：50例（100眼）患者激光治疗后显效有12例,占24％（24／100）,有效33例,占66％（66／100）,无效5例,占10％（10／100）。患者激光前后视力构成比差异有统计学意义（P〈0．05）,激光前后均未出现严重不良反应和并发症。结论：糖尿病肾病合并糖尿病视网膜病变的肾透析患者进行全视网膜激光光凝治疗是安全和有效的。     

中医辨证论治治疗糖尿病视网膜病变视网膜光凝术后126例体会

目的比较视网膜光凝后中医辨证论治与单纯用西药治疗糖尿病性视网膜病变的疗效。方法对126例(242眼)糖尿病性视网膜病变患者进行观察。54例(104眼)西药治疗,72例(138眼)采用中医辨证论治,全部病例随访3年。观察两组治疗后视力,眼底的变化。结果中医辨证论治治疗组患者视力提高优于单纯西药组,眼底出血、黄斑水肿及渗出的吸收时间较单纯西药组缩短。结论中医辨证论治治疗糖尿病性视网膜病变效果优于单纯西药治疗。     

白内障摘除联合人工晶体植入术后糖尿病视网膜病变的激光治疗

目的:探讨白内障摘除联合人工晶体植入术后糖尿病(DM)视网膜病变的激光治疗效果。方法:白内障摘除联合人工晶状体置入术后120例DM网膜病变患者(180眼)均采用经眼底荧光血管造影(FFA)确定为增殖前期DM视网膜病变(PPDR)40眼、增殖期DM视网膜病变(PDR)140眼,采用全视网膜光凝治疗,随访6～24个月。结果:患者视力、视网膜病变改善的有效率为73.9%、76.1%。3个月后复查视力、眼底、FFA及彩色眼底像,新生血管大部分萎缩,视网膜水肿消退,无灌注区残留补充激光光凝。无黄斑水肿组治疗后的视力显著优于有黄斑水肿组,P<0.05。结论:白内障摘除联合人工晶状体置入,及时合理的激光治疗是确保DR患者视力稳定,降低致盲率的关键。     

Prophylactic juxtapapillary laser photocoagulation in pediatric morning glory syndrome

AIM: To determine the anatomic and visual outcomes of prophylactic juxtapapillary laser photocoagulation treatment alone in the prevention of retinal detachment (RD) in a cohort of pediatric patients diagnosed with morning glory syndrome (MGS). METHODS: A total of 24 eyes of 22 consecutive patients aged 0-15y diagnosed with MGS treated with prophylactic juxtapapillary laser photocoagulation alone were reviewed. Data including demographics, ocular examination, anatomic and visual outcomes, following treatment and complications were collected. RESULTS: Two patients had bilateral laser treatment and 20 had monocular laser treatment. The age at treatment of 13 (59.1%) patients was less than 12mo. The presenting symptoms included strabismus (6/22, 27.3%), decreased vision (2/22, 9.1%), and routine fundus screening (14/22, 63.6%). Fifteen (68.2%) patients underwent cranial magnetic resonance imaging (MRI) examinations, and 3 of those 15 (20.0%) had abnormal findings in the nervous system. Based on preoperative wide-field fundus photography and B-scan echography, all (100.0%) eyes had no obvious RD. On postoperative 1mo and 6mo and the following follow-ups, the anatomic outcomes of all eyes remained stable. The mean follow-up duration was 27.7±17.5mo. No severe complications were found. Preoperative visual acuity acquired from 2 (9.1%) patients ranged from light perception to 20/200. Postoperative acuity acquired from 11 (50.0%) patients ranged from light perception to 20/125. CONCLUSION: The preliminary anatomic and visual outcomes of prophylactic juxtapapillary laser treatment alone in pediatric MGS patients are relatively stable in a short-term follow-up. Further long-term clinical observation will be needed to confirm its efficacy and safety.     

Treatment of amblyopia after loss of vision in the healthy eye

In the years 1958 to 1978, 23 patients with amblyopia were treated because of loss or impending loss of vision in the healthy eye. the age range was 8 to 72 years, the mean age being 30.5 years. Fourteen patients lost vision in their healthy eye while nine patients had impending loss of vision but the good eye was finally saved. the therapy consisted of pleoptic treatment according to Bangerter. the number of treatment sessions per patient varied from 15 to 121, the mean being 54. the average duration of each treatment session was 1.5 hours. Before treatment the mean visual acuity was of the same magnitude in all age groups. the best results were obtained in the 8-20 age group, but visual acuity improved to a similar degree even in the 21-40 and 41-60 age groups. the mean observation periods varied from 4.4 in the youngest age group to 9.5 years in the 41-60 year group. No significant decline of vision occurred during the observation period in the group in which the healthy eye was lost. On the contrary, in the group in which the healthy eye was finally saved significant long-term improvement was found only in the group aged 20 years or less. the patients who were older than 21 years showed slight initial improvement, but the visual acuities returned to pretreatment level. After treatment, all patients in the 8-20 age group were able to continue their studies or return to work. 75% of the patients in the 21-40 age group were able to return to their previous work.     

Optical properties of human sclera, and their consequences for transscleral laser applications

The spectral dependence of the optical properties of human sclera adjacent to the limbus was investigated and related to the potentials of transscleral photocoagulation. The total transmission, absorption, and reflection, as well as the angular distribution of the transmitted and reflected light were measured at five laser wavelengths (442 nm, 514 nm, 633 nm, 804 nm, and 1,064 nm), both for noncontact and contact applications. Absorption and scattering coefficients were determined using the Kubelka-Munk model for light propagation through a scattering tissue. The scleral transmission is only 6% at 442 nm but increases to 35% at 804 nm and to 53% at 1,064 nm. The absorption is high at short wavelengths with 40% at 442 nm but it is only 6% at 804 nm and 1,064 nm. The reflection is generally higher than 40% and shows little wavelength dependence. The transmitted light is scattered diffusely at short wavelengths, but at 804 nm and 1,064 nm it exhibits a fairly narrow angular distribution in forward direction. Fiber contact leads to an increase of transmission, with a factor of 3.5 at 442 nm, of 2.0 at 804 nm, and 1.5 at 1,064 nm. Our results indicate that the diode laser (804 nm) and the Nd:YAG laser (1,064 nm) with contact delivery are best suited for transscleral photocoagulation.     

Grid laser photocoagulation for macular oedema in uveitis or the Irvine-Gass syndrome

AIMS—To determine the effect of modified macular grid photocoagulation in patients with refractory macular oedema due to uveitis or cataract extraction.
METHODS—In this study 20 patients with macular oedema underwent modified macular grid laser photocoagulation and were followed by means of standardised examinations (day 0, months 2, 6, and 12) consisting of best corrected visual acuity and fluorescein angiography.
RESULTS—The mean visual acuity increased from 0.16 before to 0.3 after laser treatment (p=0.013), and fluorescein leakage was significantly reduced (p=0.005). Visual prognosis was influenced by duration of the uveitis, not by sex or age.
CONCLUSION—Modified macular grid laser photocoagulation had a beneficial effect on macular oedema caused by uveitis or the Irvine-Gass syndrome. A prospective, randomised study is needed to determine the exact place of modified macular grid photocoagulation in the treatment of patients with inflammatory or postsurgical macular oedema.

Keywords: macular grid photocoagulation; Irvine-Gass syndrome; macular oedema