全视网膜冷凝联合青光眼阀植入治疗晚期新生血管性青光眼

目的:评价全视网膜冷凝联合青光眼阀植入治疗晚期新生血管性青光眼的效果。方法:回顾分析12例行全视网膜冷凝联合青光眼阀植入治疗的晚期新生血管性青光眼病例。结果:术后随访7~18mo,10例眼压控制在1.4~2.8kPa,有效率达83%,优于睫状体冷冻术。主要并发症为角膜水肿、球结膜水肿、前房纤维素性渗出、前房出血和低眼压等。结论:全视网膜冷凝联合青光眼阀植入是治疗晚期新生血管性青光眼比较有效的方法。     

白内障摘除人工晶状体植入术后的糖尿病视网膜病变激光治疗

目的:观察白内障人工晶状体植入术后糖尿病视网膜病变(DR)的氩激光光凝治疗效果及光凝后的远期效果,探讨光凝治疗的时机及影响光凝的因素.方法:采用Zeiss Visulas氩离子眼科激光治疗仪对36例58眼的光凝术方法及治疗效果进行回顾性分析.结果:42眼行广泛视网膜光凝术,16眼行局部视网膜光凝术,其中6眼伴有人工晶状体后囊混浊,先期行Nd:YAG激光切开后囊膜.24眼视力提高1～2行,占42%,其中BDR 16眼,PPDR 8眼;28眼视力无变化,占48%,其中PP-DR24眼,PDR 4眼;6眼视力下降,占10%,均为PDR.3mo后行荧光素眼底血管造影(FFA)检查,新生血管大部萎缩,视网膜水肿消退.结论:适时的白内障摘除联合IOL植入,合理及时的激光治疗,是控制糖尿病患者眼底病变继续恶化的重要手段.FFA是进行正确有效激光治疗的重要参考依据,而放置大直径IOL又是完善眼底激光治疗的先决条件.     

广域眼底成像在早产儿视网膜病变激光治疗中的应用

目的观察广域眼底成像在早产儿视网膜病变( ROP)激光治疗中的应用价值。方法选取 2017年 2月至 2020年 8月在安徽省妇幼保健院确诊为 ROP的 33例 60眼纳入研究。 60眼 ROP均在间接眼底镜下接受了初始激光光凝治疗,治疗后立即通过广域眼底成像识别所有的无血管区和激光遗漏区,并对遗漏区域补充光凝。治疗后 1周内复查,平均随访 5.5个月。随访期间主要观察光凝范围、光凝有无遗漏及病变是否消退或进展。结果激光治疗 60眼中共发现 9个激光遗漏区,主要分布在嵴周或颞侧,对遗漏区及时补充光凝。术后 1周复查,未发现光凝遗漏区,术后远期复查所有病变均消退。结论广域眼底成像实现了视网膜的可视化,准确识别初始激光可能遗漏的区域,及时补充光凝以减少 ROP因光凝不足需再次治疗的可能性。     

激光联合中药治疗糖尿病黄斑水肿的临床观察

目的探讨激光光凝联合健脾利水中药治疗糖尿病黄斑水肿的疗效。方法将47例糖尿病黄斑水肿患者(82只眼)随机分为观察组23例和对照组24例,两组均予激光光凝,而观察组在激光后再用健脾利水中药治疗,比较治疗后视力及水肿消退的情况。结果观察组视力提高及黄斑区水肿消退者35眼(89.7%),对照组有32眼(74.4%),观察组视力提高及黄斑区水肿消退优于对照组(P<0.05)。结论激光联合健脾利水中药是治疗糖尿病黄斑水肿较好的方法。     

多波长激光治疗白内障超声乳化术后糖尿病视网膜病变

目的：观察白内障超声乳化术后糖尿病视网膜病变激光光凝的治疗效果。方法收集38例56眼白内障超声乳化术后糖尿病患者进行氪激光治疗,分析其治疗效果。结果白内障术后2周～1个月内行激光光凝治疗,激光治疗后视力提高者17例19只眼（33．93％）,视力不变者21例37只眼（66．07％）,经FFA检查眼底情况好转并保持稳定。结论白内障术后2周～1个月内糖尿病患者应及时进行激光光凝,可以有效控制糖尿病视网膜病变的进展。     

Diabetic retinopathy-ocular complications of diabetes mellitus

In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the workingage population.In the next 15 years,the number of patients suffering from diabetes mellitus is expected to increase significantly.By the year 2030,about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide(prevalence 7.7%),while in 2010 there were 285 million people with diabetes mellitus(prevalence 6.4%).This accounts for an increase in patients with diabetes in industrializednations by 20% and in developing countries by 69% until the year 2030.Due to the expected rise in diabetic patients,the need for ophthalmic care of patients(i.e.,exams and treatments) will also increase and represents a challenge for eye-care providers.Development of optimized screening programs,which respect available resources of the ophthalmic infrastructure,will become even more important.Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy.Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels.Additionally,regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy.In this way,the risk of blindness can considerably be reduced.In advanced stages of diabetic retinopathy,pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment.In recent years,the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.     

玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的效果评价

目的 评价玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的疗效及安全性。方法 2013年12月至2014年5月山东省立医院眼科收治新生血管性青光眼24例(24眼), 行玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗, 比较手术前后患者视力、眼压, 观察术后并发症及手术成功率。结果 随访8.6±1.7个月, 患者术后1周、1个月、3个月、6个月时的眼压分别为10.9±2.7 mmHg、13.3±3.2 mmHg、14.0±3.4 mmHg、15.4±5.1 mmHg, 与术前相比, 眼压均明显下降(P<0.01);患者应用抗青光眼药物数量分别为(0.2±0.5)种、(0.4±0.7)种、(0.4±0.8)种、(0.5±1.0)种, 与术前相比, 用药数量明显下降(P<0.01)。随访结束时, 14例患者视力稳定, 8例患者视力提高, 2例患者视力下降。术后6个月时的手术成功率为91.7%。 结论 玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼安全、有效。     

重度Ⅱ型视盘血管炎的早期全光凝治疗

目的 研究重度Ⅱ型视盘血管炎(ODV)早期全光凝治疗的意义。方法 将重度Ⅱ型ODV 25例(25 眼)分为常规治疗组(13例)和早期激光治疗组(12例)。全部患者给予全身皮质类固醇激素,并辅以改善微循环和神经营养药物治疗。常规治疗组在随诊观察中出现虹膜新生血管后给予全视网膜光凝(PRP)治疗,早期激光治疗组在发病2周药物治疗的同时给予PRP治疗。对所有患者的视力、视野、眼压、虹膜新生血管、视乳头改变、眼底荧光血管造影等进行系统临床观察。结果 随访1年,早期激光治疗组较常规治疗组视力显著提高,新生血管性青光眼发病率显著降低。结论 重度Ⅱ型ODV患者早期PRP治疗可以提高视力,减少并发症,尤其是减少新生血管性青光眼的发生。     

Posterior sub-Tenon injection of triamcinolone acetonide as pretreatment for focal laser photocoagulation in diabetic macular edema patients

Purpose  To determine whether a posterior sub-Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is safe and effective in patients with diabetic macular edema. Methods  Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20-mg sub-Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures used were visual acuity (VA), central macular thickness (CMT) determined by optical coherence tomography (OCT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months. Results  One month after the sub-Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT on OCT. VA improved slightly. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and there was no decrease in VA in any of the patients. Conclusions  A 20-mg sub-Tenon TA injection prior to focal laser photocoagulation is a safe and beneficial treatment in patients with diabetic macular edema. An erratum to this article can be found at     

Repeated intravitreal bevacizumab (Avastin®) treatment of persistent new vessels in proliferative diabetic retinopathy after complete panretinal photocoagulation

Acta Ophthalmol. 2011: 89: 76–81

Abstract.

Purpose: To evaluate the effect of repeated intravitreal injections of bevacizumab (Avastin^®) in patients with proliferative diabetic retinopathy and persistent new vessels after panretinal photocoagulation. Methods: In this prospective study we investigated 11 eyes of 10 diabetic patients with persistent new vessels after previous complete panretinal photocoagulation. Complete ophthalmological examinations were performed at baseline and during monthly follow‐up visits until the final follow‐up at 6 months. Colour fundus photography, fluorescein angiography (FA) and macular optical coherence tomography (OCT) were performed. The area of leakage (mm²) found in the FA was used to demonstrate the effect of bevacizumab on retinal new vessels. Patients received 1.0 mg of intravitreal bevacizumab at baseline and at each of the monthly follow‐up visits when reappearance of retinal new vessels was documented. Results: At the 1‐week follow‐up visit, 73% of the treated eyes showed complete regression of retinal new vessels. Eight eyes were assigned to retreatments at the 3‐month follow‐up because of the reappearance of retinal new vessels. After 6 months, 36% of the eyes were found to have reappearance of retinal new vessels. The retreatment rate was 1.9 ± 0.7 and the mean interval to retreatment was 2.9 ± 1.0 months. The mean leakage area decreased from 7.2 ± 2.6 mm² at baseline to 1.2 ± 0.9 mm² at the final follow‐up visit. BCVA increased from 59.2 ± 14.6 Early Treatment Diabetic Retinopathy Study (ETDRS) score (range 40–80) to 70.7 ± 8.5 at the final visit (p = 0.017). Conclusion: Intravitreal bevacizumab led to a significant reduction of retinal new vessels for a mean period of 2.9 months. A 3‐monthly retreatment regime might be a valid method to control retinal new vessels in diabetic patients with persistent new vessels.