Functional and morphological changes in diabetic macular edema over the course of anti‐vascular endothelial growth factor treatment

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti‐vascular endothelial growth factor (VEGF) treatment with Ranibizumab. Methods:  A consecutive series of 39 study eyes with centre‐involving DME were included in this study. In all subjects, best‐corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD‐OCT) cross‐sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross‐sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = ?1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = ?3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = ?4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = ?1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = ?0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = ?2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti‐VEGF therapy with Ranibizumab in patients with DME.     

[In Press] Optical coherence tomography with or without enhanced depth imaging for peripapillary retinal nerve fiber layer and choroidal thickness

AIM: To assess peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness obtained with enhanced depth imaging (EDI) mode compared with those obtained without EDI mode using Heidelberg Spectralis optical coherence tomography (OCT). METHODS: Fifty eyes of 25 normal healthy subjects and 32 eyes of 20 patients with different eye diseases were included in the study. All subjects underwent 3.4 mm diameter peripapillary circular OCT scan centered on the optic disc using both the conventional and the EDI OCT protocols. The visualization of RNFL and choroidoscleral junction was assessed using an ordinal scoring scale. The paired t-test, intraclass correlation coefficient (ICC), 95% limits of agreement (LoA), and Bland and Altman plots were used to test the agreement of measurements. RESULTS: The visibility score of RNFL obtained with and without EDI was of no significant difference(P=0.532), the visualization of choroidoscleral junction was better using EDI protocol than conventional protocol (P＜0.001). Peripapillary RNFL thickness obtained with EDI was slightly thicker than that obtained without EDI (103.25±9.42 μm vs 101.87±8.78 μm, P=0.010). The ICC of the two protocols was excellent with the value of 0.867 to 0.924, the 95% LoA of global RNFL thickness was between -10.0 to 7.4 μm. Peripapillary choroidal thickness obtained with EDI was slightly thinner than that obtained without EDI (147.23±51.04 μm vs 150.90±51.84 μm, P＜0.001). The ICC was also excellent with the value of 0.960 to 0.987, the 95% LoA of global choroidal thickness was between -12.5 to 19.8 μm. CONCLUSION: Peripapillary circular OCT scan with or without EDI mode shows comparable results in the measurement of peripapillary RNFL and choroidal thickness.     

玻璃体切割联合改良倒置内界膜瓣覆盖及自体血封闭术治疗难治性黄斑裂孔

目的 观察玻璃体切割(PPV)联合改良倒置内界膜(ILM)瓣覆盖及自体血封闭术治疗难治性黄斑裂孔(MH)患者的临床疗效.方法 回顾性病例研究.选取2019年1月至2020年6月在南京医科大学眼科医院确诊并行PPV联合改良倒置ILM瓣覆盖及自体血封闭术治疗的难治性MH患者14例14眼纳入研究.所有入组患者均接受经睫状体扁...     

特发性黄斑裂孔术中填充物的探讨

目的:探讨如何选择特发性黄斑裂孔术中的填充物.方法:回顾性分析特发性黄斑裂孔手术患者46例46眼的临床资料.A组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+硅油注入术,B组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+C2F6(20％)注入术,术前应用频域光学相干断层扫描及其深度增强成像技术(EDI-OCT)测量黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)以明确分组.对手术前后最佳矫正视力(best corrected visual acuity,BCVA)、裂孔闭合率、IS/OS破坏直径及手术并发症等进行临床观察.结果:术后随访至少12mo.随访期末A组术后BCVA与术前相比,差异有统计学意义(t=7.659,P＜0.05).B组术后BCVA与术前相比,差异有统计学意义(t=11.648,P＜0.05).A组裂孔闭合率100％,B组裂孔闭合率为95.2％.A组术后IS/OS破坏直径与术前相比差异有统计学意义(t=12.252,P＜0.05),B组术后IS/OS破坏直径与术前相比差异有统计学意义(t=13.257,P＜0.05).并发症:A组术后4眼发生高眼压,B组术后1眼裂孔未闭合继发视网膜脱离,再次行硅油注入术后裂孔闭合.B组术后2眼出现玻璃体积血,1眼吸收,1眼再次行玻璃体腔灌洗术.结论:两种手术方式均可有效治疗特发性黄斑裂孔.A组手术方式可以更持久顶压黄斑区视网膜,利于黄斑裂孔闭合,但是需俯卧较长时间及再次手术取出硅油,增加患者身心和经济负担.B组手术方式无需再次手术取出填充物,但是存在黄斑裂孔不闭合需再次手术的风险.我们将黄斑中心凹下脉络膜厚度作为术前合理选择手术方案的标准,为患者提供个性化的治疗方案.     

应用EDI-OCT 检测NAION患者脉络膜厚度的研究

目的：评价利用光学相干断层扫描增强深部成像(enhanced depth imaging optical coherence tomography,EDI-OCT)测量非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy, NAION)脉络膜厚度的临床意义。

方法：选取2014-12/2016-10门诊就诊的NAION患者(对侧眼未受累)共30例30眼,选取与病例组性别、年龄、屈光度相匹配的正常对照组60例60眼,应用EDI-OCT分别测量患病眼、对侧眼及对照组右眼的脉络膜厚度。

结果：患病组与对照组相比,年龄、性别、屈光度无统计学差异(P>0.05)。经统计学检验,患病眼、对侧眼中心凹附近及视盘盘周各部位脉络膜厚度均小于对照组,差异有统计学意义(P<0.01),而患病眼与对侧眼脉络膜厚度比较差异无统计学意义(P>0.05)。

结论：NAION患者患病眼、对侧眼脉络膜厚度较正常对照组明显减低,提示睫状后短动脉小血管的阻塞可能影响脉络膜的血供,进而影响脉络膜厚度。     

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM: To characterize spectral-domain optical coherence tomography (SD-OCT) features of chorioretinal folds in orbital mass imaged using enhanced depth imaging (EDI). METHODS: Prospective observational case-control study was conducted in 20 eyes of 20 patients, the uninvolved eye served as a control. All the patients underwent clinical fundus photography, computed tomography, EDI SD-OCT imaging before and after surgery. Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5; the remaining patients underwent tumor excision. Patients were followed 1 to 14mo following surgery (average follow up, 5.8mo). RESULTS: Visual acuity prior to surgery ranged from 20/20 to 20/200. Following surgery, 5 patients’ visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10 (range 4 to 26 letters). Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery. Following surgical excision, photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients. CONCLUSION: Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis. Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.     

彩色多普勒成像对正常眼眶血管及其血流动力学的研究

彩色多普勒成像(CDI)是超声诊断最新进展,能用二维图象和脉冲多普勒同时显示解剖结构和血疯状态信息.本文报告利用这一新技术,对正常人74眼(37例)进行了评价.CDI可清楚地显示眼和眼眶及其血管(眼动脉(OA)、睫状后动脉(PCA)、视网膜中央动静脉(CRA、CRV等)并可直接定位作频谱形态分析和血流动力学的定量研究.测得的正常人OA、CRA、PCA的平均最高收缩期血流速度分别为31.9±5.01cm/s,11.50±2.45cm/s.14.73±3.85cm/s;平均血流速度分别为14.91±1.83cm/s,5.78±1.14cm/s,8.09±2.00cm/s;最末舒张期血流速度分别为9.04±1.15cm/s,3.73±1.06cm/s,5.46+1.61cm/s;阻力指数分别为0.715±0.04,0.68±0.04,0.63±0.04.OA、PCA、CRA的各项血流速度均随年龄增加呈降低趋势.CDI具有快速准确,无创伤性及可重复性等优点,为研究眼眶血管及其血流动力学提供有价值的可靠方法.     

磁共振成像、视诱发电位和视野检查在视神经炎的临床应用

目的 探讨MRI、视诱发电位(VEP)和视野(Vision Field，VF)在视神经炎中的临床应用价值。方法 临床诊断为视神经炎者60例分别行MRI、VEP和视野检查，每例所有检查均在一周内完成，并将检查结果进行统计学处理和分析。结果 MRI阳性率最高(96．67％)，其次是视野和VEP(86．96％和75．58％)。同时发现MRI具有定位和一定的鉴别诊断作用。结论 VEP和VF结合MRI检查，三者相辅相成，将有助于视神经炎更早、更准确地诊断和治疗。     

脂质水胶敷料结合对口引流治疗糖尿病足的疗效

目的:观察脂质水胶敷料结合对口引流技术在糖尿病足溃疡患者换药治疗中的应用效果。方法:选取2017年1月至2018年1月该院住院及门诊糖尿病足溃疡需要换药的患者150例作为研究对象,采用随机数字表法分为对照组和观察组各75例。对照组采用常规换药方法,观察组采用脂质水胶敷料对口引流换药方法。对比分析两组的治疗时间、治疗效果...