视网膜脱离手术后黄斑区OCT图形特征

目的:观察孔源性视网膜脱离手术后视网膜复位及视力恢复情况;黄斑区OCT图形特征。方法:77例77眼裂孔型视网膜脱离在巩膜扣带术前后,行除常规检查外,拍摄眼底像,行黄斑区OCT检查[以黄斑中心凹为中心"十"字扫描,5.62mm标准扫描线,测量中心凹神经纤维(NF)厚度,及视网膜下残液量,并打印出图像];术后1wk;1,2,3,6mo随访矫正视力、眼底及OCT。结果:本组视网膜脱离患者手术后临床复位率100%,而OCT扫描显示,术后1wk解剖复位率52%,术后1mo62%,术后2mo71%,术后3mo75%,术后6mo87%;术后视力在3～6mo内逐渐提高并稳定;黄斑区OCT图形异常提示视功能改善差。结论:OCT是视网膜脱离手术前后了解和观察病情、预测预后的可靠手段。     

巩膜外硅压联合玻璃体切割术治疗人工晶状体或无晶状体眼视网膜脱离

目的:探讨在治疗人工晶状体或无晶状体眼视网膜脱离中巩膜硅压联合玻璃体切割术比单纯巩膜硅压手术的优越性。方法:回顾性分析30例我院联合手术治疗的人工晶状体或无晶状体眼视网膜脱离患者的临床资料。各位患者均采用巩膜外硅压联合玻璃体切割手术修复脱离的视网膜,术后随诊3～14mo,对手术后的解剖复位、视力提高情况以及并发症进行考察。结果:所有患者(30眼)均1次手术复位成功并有不同程度的视力提高,没有发现任何玻璃体切割手术的并发症。结论:在治疗人工晶状体或无晶状体眼视网膜脱离中,巩膜外硅压联合玻璃体切割术比单纯巩膜硅压手术有明显的优越性,其成功率的提高与玻璃体切割术提高周边视网膜的可见度,以及减少PVR的发生相关。     

超声生物显微镜对慢性低眼压诊断和治疗的动态监测

目的:一组以UBM诊断为基础的慢性低眼压患者,经眼压、裂隙灯显微镜、眼底检查、UBM3~6mo的动态监测,了解低眼压的恢复情况,不同治疗方法的效果,说明UBM在低眼压诊断和治疗中的作用。方法:慢性低眼压45眼(眼压≤8mmHg),平均眼压为5.59(2~8)mmHg,病史超过1mo。所有患者均进行常规眼科检查,包括视力、裂隙灯、眼压检查、前房角镜、间接检眼镜、UBM检查,治疗分为药物组和手术组,于治疗后1wk;1,3和6mo进行随访检查。结果:经UBM检查有24眼(53%)为钝伤性低眼压,主要为睫状体脉络膜脱离;16眼(36%)为各种内眼手术后所致的低眼压;1例(0.04%)患者为风湿性心脏病继发双眼葡萄膜炎。基线眼压与治疗后随访眼压比较,均存在显著性差异(P<0.01)。末次眼压和基线眼压之间无相关性,而和病史及发病年龄均呈强的负相关性。42眼(93%)UBM检查有形态学结构改变,睫状体异常占87%。药物组和手术组的基线眼压分别为5.91和4.95mmHg,存在显著性差异(P<0.05),药物组病史明显长于手术组,而手术组发病年龄明显低于药物组,随访的末次眼压分别为10.42和11.25mmHg,无显著性差异。结论:经治疗两组眼压均有显著提高,手术组的患者病情明显重于药物组,治疗前眼压低,发病年龄小,但治疗后眼压效果相似。UBM无论在低眼压的诊断,还是治疗后监测中均有非常重要的作用。     

Clinical profile and long term outcomes of eyes with choroidal detachment following trabeculectomy

Purpose:To assess the long-term outcomes of choroidal detachments (CDs) in eyes following trabeculectomy.Methods:Retrospective comparative case series. Data of patients with CDs following trabeculectomy (5-year period) with or without cataract surgery with a minimum of 3 months of follow-up were included.Results:In total, 45 patients with CDs following trabeculectomy were included. The mean age was 63.27 ± 8.68 years, (M:F = 2:1); 29 of 45 eyes (64.4%) had a baseline IOP of >24 mm Hg. Patients had a median follow-up of 22.2 (IQR: 16.2–30.5) months. Further, 10 of 45 eyes (22.2%) had CDs following suture lysis. The median onset of choroidal detachment from the time of surgery was 16.0 (IQR: 11–36) days. The mean BCVA improved from 0.62 ± 0.28 to 0.24 ± 0.27 (P < 0.001) and mean IOP increased from 4.07 ± 2.66 to 11.20 ± 5.31 (P < 0.001) at last visit. The cumulative success rates were 76.4% (95% CI: 48.4–90.5) in POAG eyes and 79.3% (95% CI: 62.8–89.1) in PACG eyes (P = 0.547). Medical management was the mainstay in all patients. Four of 45 (8.88%) patients underwent subsequent choroidal drainage.Conclusion:Choroidal detachment following modern-day trabeculectomy has favorable long-term visual acuity and IOP outcomes. There was no difference in the long-term surgical success of trabeculectomy with choroidal detachments in primary angle-closure and open-angle glaucoma eyes. Long-term follow-up is essential to prevent chronic hypotony and trabeculectomy failure.     

Normative data of retinal arteriolar and venular calibre measurements determined using confocal scanning laser ophthalmoscopy system – Importance and implications for study of cardiometabolic disorders

Purpose:To determine and validate retinal vascular caliber measurements by using the confocal scanning laser ophthalmoscopy system. Retinal vasculature changes are often regarded as clinical markers for systemic disease.Methods:It was a prospective observational study conducted on 600 eyes of 300 normal subjects with no systemic or ocular illness from January 1, 2016 to June 30, 2017 in a tertiary referral eye center. Non-mydriatic infrared reflectance, blue reflectance, and blue peak blue autofluorescence fundus imaging were done on the confocal scanning laser ophthalmoscopy system. The dimensions of the retinal vessels were measured using inbuilt calipers at 1800 mm from the center of the optic disc. Internal and external dimensions were measured. Observer variation and its comparison using Image J software were assessed.Results:The median age was 29 years (18–50 years). Mean internal and external diameters for arterioles were 85.1 ± 12.4 mm and 105.0 ± 12.0 mm, and for venules were 133.8 ± 16.6 mm and 145.4 ± 16.1 mm, respectively. The mean internal and external wall thicknesses were 19.7 ± 8.0 mm and 11.0 ± 5.6 mm, and wall thickness-to-lumen ratios were 0.3 ± 0.1 and 0.1 ± 0.1, respectively. Arteriolar-to-venular ratio for lumen and vessel was 0.66 ± 0.1 and 0.74 ± 0.1, respectively. There was no statistically significant difference between age groups. Both inter- and intra-observer reproducibility was >95%. The Bland–Altman plot showed that the difference between measurements using both confocal scanning laser ophthalmoscopy and Image J software lies within the limits of agreement approximately 95% of the time.Conclusion:This is the first effort to develop a normative database by using a simple non-invasive confocal scanning laser ophthalmoscopy system with high observer reproducibility.     

New frontiers of retinal therapeutic intervention: a critical analysis of novel approaches

A recent wave of pharmacologic and technologic innovations has revolutionized our management of retinal diseases. Many of these advancements have demonstrated efficacy and can increase the quality of life while potentially reducing complications and decreasing the burden of care for patients. Some advances, such as longer-acting anti-vascular endothelial growth factor agents, port delivery systems, gene therapy, and retinal prosthetics have been approved by the US Food and Drug Administration, and are available for clinical use. Countless other therapeutics are in various stages of development, promising a bright future for further improvements in the management of the retinal disease. Herein, we have highlighted several important novel therapies and therapeutic approaches and examine the opportunities and limitations offered by these innovations at the new frontier.

KEY MESSAGES

• Numerous pharmacologic and technologic advancements have been emerging, providing a higher treatment efficacy while decreasing the burden and associated side effects.
• Anti-vascular endothelial growth factor (anti-VEGF) and its longer-acting agents have dramatically improved visual outcomes and have become a mainstay treatment in various retinal diseases.
• Gene therapy and retinal prosthesis implantation in the treatment of congenital retinal dystrophy can accomplish the partial restoration of vision and improved daily function in patients with blindness, an unprecedented success in the field of retina.

     

散血明目片对非缺血型视网膜静脉阻塞患者血液流变学的影响

目的探讨散血明目片对非缺血型视网膜静脉阻塞患者血液流变学及血清相关生化指标的影响及作用机制。方法将34例非缺血型视网膜静脉阻塞患者随机分为治疗组（17例17眼）与对照组（17例18眼）,治疗组口服散血明目片,对照组口服血栓通片,两组均同时配合其他中西医常规治疗方法。治疗2个月后比较两组临床疗效、血液流变学及血清相关生化指标的差异。结果治疗组总显效率与对照组比较,差异有显著统计学意义（P〈0.01）;治疗组治疗前后低切和高切全血比黏度、红细胞电泳、血浆黏度、红细胞聚集指数、AT-Ⅲ、lp（a）、NO、A-CL IgG阳性率、ACL IgM阳性率、LA阳性率差异有显著统计学意义（P〈0.01）;ET-1、ACL IgA阳性率差异有统计学意义（P〈0.05）。结论散血明目片是治疗非缺血型视网膜静脉阻塞的有效药物,其作用机制可能与升高AT-Ⅲ、降低lp（a）、APL在血浆中的含量、稳定ET-1/NO比值有关,在外可反映于血液流变学指标的变化。     

弱视患者视网膜厚度的差异观察

目的:探讨不同程度远视而引起的弱视患者的视网膜神经纤维层厚度的差异。方法:采用视网膜厚度分析仪(Retinal thickness analyzer RTA)测量弱视患者22例(31眼)的视网膜神经纤维层厚度,所得图象经计算机处理后得出相应的视网膜厚度值与厚度地形图,数据经SPSS统计软件包进行分析。结果:弱视患者视网膜平均厚度为176.45±27.36μm。不同程度的弱视患者各点间视网膜厚度无明显差异性。弱视患者的不同远视程度与视网膜厚度相关系数r=0.056。结论:不同程度的弱视患者各点间视网膜厚度无明显差异性。弱视患者的不同远视程度与视网膜厚度无明显相关性。     

脂褐素成分A2E诱导人视网膜色素上皮细胞自噬及损伤的研究

目的 探讨N-亚视黄基-N-视黄基-乙醇胺(A2 E)能否诱导人视网膜色素上皮细胞(ARPE-19细胞)的自噬及损伤反应,并从自噬的角度探索其与年龄相关性黄斑变性(AMD)发病相关的分子机制.方法 CCK-8法筛选A2E作用于ARPE-19细胞的最佳浓度用于后续实验.采用多重细胞因子检测技术检测A2E作用于ARPE-1...     

Clinical features of posterior microphthalmic and nanophthalmic eyes

AIM: To clinically differentiate nanophthalmos (NO) and posterior microphthalmos (PM) and to explore the mechanisms related to papillomacular folds (PMF). METHODS: Medical records of 34 unrelated patients with microphthalmos (54 eyes) from April 2009 to October 2017 were retrospectively reviewed. RESULTS: Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort (NO: 27±16y; PM: 3.7±0.6y). PMF was more likely to occur in cases with PM than in NO (25% in NO, 100% in PM). The anatomic features of PMF from optical coherence tomography (OCT) included: ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF (these were all NO eyes), rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy. CONCLUSION: Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.