经眼动脉溶栓治疗糖尿病视网膜病变玻璃体切除术后视网膜中央动脉阻塞2例
摘要： 视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)是一种严重致盲性眼病.糖尿病性视网膜病变玻璃体切除联合眼内光凝术后中央动脉阻塞的临床表现及预后有其特点.南通大学附属医院收治的2例糖尿病性视网膜病变患者在经过玻璃体切除联合眼内光凝术后出现CRAO.本文通过回顾2例患者的临床病例资料,讨论及分析其CRAO的原因、危险因素及诊疗方法.
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Features Associated with Recurrence of Idiopathic Orbital Inflammatory Pseudotumor
Purpose: To explore factors which lead to recurrence of idiopathic orbital inflammatory pseudotumor (IOIP).Methods: Idiopathic orbital inflammatory pseudotumor in 209 cases between Jan 1,1978 and Dec 31, 1999 in our hospital was evaluated retrospectively. The comparison of clinical and pathological parameters between patients with at least one episode of recurrence and those with no recurrence at all was performed and analyzed using logistic regression method.Results: Follow-up results (with a mean follow-up time of 3.4 years, ranging from 0.5 year to 21.0 years) showed that the recurrence rate of IOIP was 41%. Sex and proptosis were associated with the recurrence of IOIP. Male gender was more likely to relapse than female counterparts, with the male being 52% and female being 25%.The severer the proptosis is, the higher the rate of recurrence. Among the clinical subtypes of IOIP, the rate of recurrence (17%) in cases with dacryoadinitis was the lowest, followed by anterior local orbital mass (44%), posterior orbital mass (54%),myositis (75%) and diffuse subtype (100%). However, the clinical subtypes did not show significant relationship with the recurrence of IOIP.Conclusions: Male gender and severe proptosis are associated with a higher recurrent rate in patients with IOIP.
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硅油填充术在不伴有视网膜脱离外伤性感染性眼内炎的临床应用
目的:观察玻璃体切除联合眼内注药或硅油填充术对眼球穿通伤后合并感染性眼内炎不伴视网膜脱离的疗效.方法:应用经睫状体平坦部玻璃体切除术,以联合眼内注药或硅油填充术分组治疗30只眼球穿通伤并发感染性眼内炎不伴有视网膜脱离患者,术后予以静脉、结膜下及眼药水途径给予抗感染抗炎治疗.结果:玻璃体切除术后追踪随访3～12个月,2组30只眼细菌性感染全部控制,术后视力较术前视力有显著性提高,联合眼内注药组19只眼,其中4只眼(21.1%)发生视网膜脱离;联合硅油填充组11只眼,其中术后1只眼(9%)发生视网膜脱离.两组术后并发症发生率均无明显差异(P＞0.05).结论:玻璃体切除联合硅油填充术能有效控制炎症,稳定视网膜功能,对一些视网膜情况不佳或炎症难以控制的患者可以考虑术中应用硅油.
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视乳头结构即时测量新法——+78D前置镜合并目镜刻度尺法
目的:探讨+78D前置镜合并目镜刻度尺测量法作为新的视乳头结构即时测量方法的测量一致性,并和直接眼底镜进行测量一致性比较.方法:两名检查者分别使用直接检眼镜和+78D前置镜合并目镜刻度尺法对所有受检眼(477眼)测量视神经垂直杯盘比比值,计算仪器间的测量可重复性.对前100只眼,两名测量者均采用+78D前置镜合并目镜刻度尺法测量垂直杯盘比、视盘直径和视杯直径,均采用直接检眼镜测量垂直杯盘比,计算同一测量仪器的检查者间可重复性.结果:本研究受检者有257名(477眼).两名检查者利用+78D前置镜合并目镜刻度尺法测量视盘直径、视杯直径和垂直杯盘比得出95%一致性区间分别为-4.3～+4.5、-7.2～+6.2和-2.2～+2.8,没有成比例偏倚,而直接检眼镜的95%一致性区间为-0.33～+0.38.两种测量方法进行比较发现直接眼底镜倾向于高估垂直杯盘比值,没有成比例偏倚.结论:+78D前置镜合并目镜刻度尺测量垂直杯盘比的检查者间一致性测量结果较好,测量值变异比直接检眼镜小,并且直接眼底镜倾向于高估垂直杯盘比值.建议+78D前置镜合并目镜刻度尺用于临床检查即时判断以及基层和社区青光眼筛查.
关键词： 一致性测量 视盘/形态学/垂直杯盘比 +78D前置镜 目镜刻度尺 -
非球面人工晶状体植入术后早期视功能的临床研究
目的:初步评估非球面人工晶状体植入术后早期视功能情况.方法:将88例(91只眼)白内障患者随机分为AcrySof(R)IQ(SN60WF)、KS-3Ai和AcrySof Natural(SN60AT)人工晶状体组.观察患者术后1 d、1周和1月佳矫正视力和术后1月对比敏感度及主观视觉等视功能情况.结果:术后第1天KS-3Ai组佳矫正视力明显优于其余两组(P＜0.05),术后1周、1月三组佳矫正视力差异均无显著性意义(P＞0.05).AcrySof(R)IQ和KS-3Ai组中、低频区对比敏感度在瞳孔直径2.5 mm～4.0 mm及5.0 mm～6.0 mm时均优于AcrySof Natural组(P＜0.05),而AcrySof(R)IQ和KS-3Ai两组比较无显著性意义(P＞0.05).采用VF/QOL问卷调查显示AcrySof(R)IQ和KS-3Ai组患者的总体满意度好.结论:非球面人工晶状体能明显提高白内障患者术后对比敏感度,改善患者术后视觉质量.
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视网膜脱离巩膜外路显微手术的临床探讨
目的:探讨手术显微镜下行视网膜脱离外路手术的方法及治疗效果.方法:对21例(21眼)孔源性视网膜脱离患者,行视网膜脱离外路手术,术中对裂孔的定位,放视网膜下液,及巩膜外顶压冷凝均在手术显微镜下进行.6例同时行环扎术.术后随访3～9个月.结果:手术显微镜直视下患眼视网膜冷凝反应均清晰可见.轻度屈光间质混浊不影响眼底病变观察,无严重的手术并发症.21眼中视网膜复位20例,再次手术复位1例,视力均有不同程度提高,视力≥0.3者15例占71.42%.结论:视网膜脱离显微外路手术具有方便、可靠、安全、快捷等优点,提高手术成功率.
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系统性红斑性狼疮脉络膜视网膜炎吲哚菁绿血管造影表现:随访一例
目的:用眼底荧光血管造影(fundus fluorescein angiography,FFA)和吲哚菁绿血管造影(indocyanine green angiography,ICGA)随访一例系统性红斑性狼疮(systemic lupus erythematosus,SLE)脉络膜视网膜炎患者.方法:回顾性研究随访1例SLE脉络膜视网膜炎患者临床和眼底造影影像学特征.结果:本病例ICGA特征包括造影早期脉络膜血管模糊弥漫性高荧光、局灶性低荧光,造影晚期点状脉络膜高荧光.经泼尼松治疗后,造影晚期点状脉络膜点状高荧光随着视网膜小血管阻塞出现而增加,当视网膜出现新生血管时点状高荧光消失.结论:ICGA可以揭示SLE脉络膜病变临床和FFA不能发现的信息.免疫复合物沉积在脉络膜毛细血管可能是SLE脉络膜炎发病机制的重要因素.眼科学报 2006;22:224-228.
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Effect of Topical FK506 Used alone or Combined with Keratoplasty on Patients with Recurrent Mooren's Corneal Ulcer
Purpose: To evaluate the efficacy of topical 0.1% FK506 used alone or combined with keratoplasty on patients with recurrent Mooren's ulcer.Methods: This is a retrospective interventional consecutive case series. Nine patients(15 eyes) with recurrent Mooren's ulcer were treated with topical 0.1% FK506 alone or combined with keratoplasty. Two eyes with ulcers involving less than half the corneal limbus were treated with topical 0.1% FK506. Of the other 13 eyes with ulcers involving more than half the limbus, twelve were treated with excision of the ulcer and adjacent conjunctiva combined with lamellar keratoplasty. One eye with a central impending corneal perforation was treated with penetrating keratoplasty.Topical0.1% FK506 was given post-operatively to all thirteen eyes after re-epithelia-lisation of the cornea. FK506 levels in the surgically resected cornea and conjunctiva of the operated eyes were measured using enzyme immunoassay procedures. Twelve patients(17 eyes) with recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone were taken as the control. The main measure of the outcome was the recurrence of Mooren's ulcer in the patients.Results: Nine patients (15 eyes) with recurrent Mooren's ulcer were all successfully treated. Vision in 5 eyes improved by two lines or better after treatment. No recurrence was observed during the follow up period of 12 to 22 months. After topical application of 0.1% FK506, concentrations of 30～350 ng/g of FK506 were found in the cornea and conjunctiva. Seven eyes of Mooren's ulcer in the control group recurred during the follow up period.Conclusion: Topical 0.1% FK506 used alone or combined with keratoplasty is a safe and effective therapy for patients with recurrent Mooren's ulcer.
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玻璃体切割在梅毒性葡萄膜炎中的试探性应用:附病例报告一例
目的:报道玻璃体切割在梅毒性葡萄膜炎中的应用.观察其治疗效果及安全性.方法:文献复习及病例报道.结果:一双眼梅毒性葡萄膜炎患者经药物治疗后,左眼视力明显提高而右眼停滞不前.右眼经标准三切口玻璃体手术后半个月,右眼视力大幅提高并超过左眼.结论:玻璃体切割手术在部分晚期梅毒性葡萄膜炎患者的治疗中有积极作用.尽管在本例患者中未见任何并发症,但其安全性及作用机制仍有待进一步研究证实.
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LASEK与LASIK治疗高度近视
目的:对比观察准分子激光上皮瓣下角膜磨削术(LASEK)与准分子激光原位角膜磨削术(LASIK)治疗高度近视的临床疗效.评估2种手术的安全性和有效性.方法:对行LASEK治疗的39例75只眼和同期行LASIK治疗的41例79只眼高度近视分别进行6个月以上的临床观察.结果:LASEK组术后1周至1个月达佳矫正视力,术后3个月部分出现视力回退,术后6个月裸眼视力达术前矫正视力占95.83%,主要并发症有术后高眼压及Haze形成;LASIK组术后6个月裸眼视力达术前矫正视力占94.35%,主要并发症为屈光回退,角膜上皮内生或角膜瓣皱折等.结论:LASIK与LASEK均能安全、有效地矫正高度近视.
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Purpose: To evaluate the role and the anatomic and visual results of primary pars plana vitrectomy (PPV) in treating cases with rhegmatogenous retinal detachment associated with choroidal detachment.Methods: All patients were divided into 2 groups. Each group included 23 consecutive eyes with rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C. In the study group, controlled removal of vitreous traction was achieved by primary vitrectomy and augmented by scleral buckling if needed. The breaks were treated by focused endolaser coagulation.Postoperative tamponade was done by SF6 or C3F8 gas. In the control group, all patients underwent regular scleral buckling procedure. The cases were followed up for 6 to 12 months.Results: In the study group, retinal reattachment could be achieved in 21 cases (91.30%) after the first operation and in all cases after the second procedure. No occurrence of choroidal detachment occurred after the first procedure. Retinal reattachment rate and visual results tended to be better compared with conventional surgical techniques in the control group.Conclusion: Primary vitrectomy represents a safe, effective method in the management of rhegmatogenous retinal detachment associated with choroidal detachment.
