不同类型青光眼的盘周脉络膜血液供应分水带比较

目的 观察不同类型青光眼患者盘周脉络膜血液供应分水带与视盘的相对位置关系.方法 临床确诊的不同类型青光眼患者98例98只眼(青光眼组)纳入研究.依据青光眼类型分为原发性开角型青光眼(POAG)组、正常眼压性青光眼(NTG)组、慢性闭角型青光眼(CACG)组,分别为34、33、31只眼.选择同期单眼钝挫伤患者37例37只对侧眼为对照(对照组).青光眼组和对照组间年龄(t=1.197)、性别(x2=3.548)、平均屈光度(t=-1.644)比较,差异均无统计学意义(P＞0.05).不同类型青光眼组间年龄(F=2.645)、性别(F=1.984)、平均屈光度(F=2.621)、视野平均缺损(MD)值(F=0.899)比较,差异均无统计学意义(P＞0.05).应用海德堡共焦激光扫描眼底血管造影仪行吲哚青绿血管造影和荧光素眼底血管造影同步造影检查.根据分水带与视盘的相对位置关系,将分水带分为3型.Ⅰ型:分水带不包围视盘或未被观察到;Ⅱ型:分水带部分包围视盘;Ⅲ型:分水带完全包围视盘.对比分析不同类型青光眼患者分水带与视盘的相对位置关系.分水带类型与年龄、视野MD行Pearson相关性分析.结果 青光眼组、对照组Ⅱ、Ⅲ型分水带合计构成比分别为81.6％、56.8％.2组Ⅱ、Ⅲ型分水带合计构成比比较,差异有统计学意义(x2=8.756,P＜0.003).POAG、NTG、CAGC组Ⅱ、Ⅲ型分水带合计构成比分别为82.4％、90.9％、71.1％.不同类型青光眼组间、不同类型青光眼组与对照组Ⅱ、Ⅲ型分水带合计构成比比较,POAG组和NTG组(x2 =1.039)、POAG组和CACG组(x2=1.166)差异均无统计学意义(P＞0.05);NTG组和CACG组差异有统计学意义(x2 =4.107,P＜0.05).POAG组和对照组(x2=5.352)、NTG组和对照组(x2=10.141)比较,差异均有统计学意义(P＜0.05);CACG组和对照组比较,差异无统计学意义(x2=1.444,P＞0.05).Pearson相关性分析结果显示,所有受检者分水带类型与年龄无相关性(r=0.114,P＞0.05).青光眼组分水带类型与视野MD呈正相关(r=0.354,P=0.000).结论 青光眼患者的盘周脉络膜分水带位置较正常眼更多地包围视盘.     

原发性闭角型青光眼患者心理个性和行为特征

目的 探讨原发性闭角型青光眼(PACG)患者心理、个性和行为特征.方法 对53例PACG患者和54名正常人分别运用焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克个性问卷(EPQ)和A型行为问卷(TABQ)进行调查评估,并对测量结果进行独立样本t检验、OneWay ANOVA分析、x2检验以及相关性分析.结果 (Ⅰ)PACG组焦虑值(SAS=42.85±7.30),精神质性(P=49.33±9.05)、时间紧迫(TH=15.23±3.24),争强好胜(CH=15.32±3.51)及TH+CH总分(TH+CH=30.55±5.97)与正常组相比差异有统计学意义(P＜0.05).(Ⅱ)急性PACG组的SAS得分与正常组差异有统计学意义(P＜0.01);急、慢性PACG组分别与正常组比较,精神质(P)与TH+CH差异有统计学意义(P＜0.05);慢性PACG组的神经质性(N)值得分与急性组、正常组比较差异均有统计学意义(P＜0.05).(Ⅲ)PACG组与正常组的TABQ量表得分经x2检验得两组A型行为比例差异有统计学意义(x2=10.912,P=0.028＜0.05).(Ⅳ)PACG组中SAS与SDS、CH、TH+CH相关性均有统计学意义(P＜0.05).EPQ测验中P值与SAS、TH、CH和TH+CH均无相关(P＞0.05).结论 PACG患者有明显的焦虑、精神质以及A型行为倾向.     

责任制整体护理干预对老年性白内障患者住院期间不良事件发生风险的影响

目的 探讨责任制整体护理干预对老年性白内障患者住院期间不良事件发生风险的影响.方法 我院于2016年2月开始实施责任制整体护理干预,以实施时间6个月分别设为观察组和对照组,比较两组患者住院期间不良事件发生率,患者和家属的护理满意度.结果 观察组患者住院期间不良事件发生率显著低于对照组,差异有统计学意义(x2=10.01,P=0.031);观察组患者护理满意度显著高于对照组,差异有统计学意义(x2=8.94,P=0.028);观察组患者家属护理满意度显著高于对照组,差异有统计学意义(x 2=10.83,P=0.033).结论 责任制整体护理干预使用于老年性白内障患者住院期间可以有效降低不良事件发生风险,提高患者及家属的护理满意度.     

无锡地区2型糖尿病患者RAGE基因Gly82Ser多态性与糖尿病视网膜病变的关联性研究

背景 晚期糖基化终末产物特异性受体(RAGE)在2型糖尿病及其微血管并发症的发病过程中发挥重要作用.RAGE基因Gly82Ser存在多态性,但其与糖尿病视网膜病变(DR)的相关性有待进一步研究. 目的 探讨无锡地区汉族人群RAGE基因Gly82Ser多态性与DR的关系. 方法 采用横断面研究方法,于2013年3月至2014年2月在无锡纳入汉族无亲缘关系的2型糖尿病患者185例,依据2002年DR国际临床分型标准将患者分为非DR(NDR)组(93例)和DR组(92例),同期纳入健康体检对照者120名.各位受检者均行眼部检查、血液生物化学指标及血脂等实验室检查和血压、体质量指数(BMI)及空腹血糖水平检测.采集受检者外周血各3 ml,采用PCR-直接测序法检测受检者的基因型及等位基因频率并进行组间差异比较.结果 DR组患者糖尿病病程明显长于NDR组,差异有统计学意义(t=2.25,P=0.01).DR组、NDR组及健康对照组受检者RAGE基因Gly82Ser位点均存在G和A2种等位基因,其多态性分布符合Hardy-Weinberg遗传平衡定律(DR组:x2=0.51,P=0.48;NDR组:x2=1.38,P=0.24;健康对照组:x2=0.20,P=0.24).DR组、NDR组患者和健康对照组受检者AA基因型频率分别为6.5％、3.2％和2.5％,DR组患者AA基因型频率高于NDR组及健康对照组,差异均有统计学意义(x2=5.146,P=0.023;x2=5.039,P=0.037);DR组受检者A等位基因频率分布明显高于NDR组及健康对照组,差异均有统计学意义(x2=5.494,P=0.019;x2=5.235,P=0.023),而GG基因型及G等位基因频率低于NDR组和健康对照组,差异均有统计学意义(GG:x2=4.260,P=0.039x2 =4.794,P=0.027;G:x2 =5.309,P=0.021;x2=5.476,P=0.032);NDR组与健康对照组间受检者各基因型及等位基因频率的差异均无统计学意义(AA:x2=5.346,P=0.127;GG:x2 =6.981,P=0.137;A;x2=5.618,P=0.082;G:x2=4.860,P=0.088). 结论 RAGE基因Gly82Ser位点单核苷酸多态性与无锡地区2型糖尿病患者DR的发生有一定的关联,A等位基因可能是促进其发病的危险因素.     

广视野系统在外伤性眼后段手术中的应用

目的 评价广视系统在外伤性眼后段手术中的应用.方法 试验组12例(12眼)外伤性视网膜脱离患者采用广视野系统联合手术显微镜直视下冷凝治疗,对照组12例(12眼)采用常规缝合金属环固定角膜接触镜联合手术显微镜直视下冷凝治疗,观察两组手术时间、视网膜解剖复位率、视力及并发症等.结果 两组一次性手术治愈差异无统计学意义(x2=0.0000,P=1.0000).两组手术时间比较差异有统计学意义(x2=11.1933,P=0.0000).两组术后脱盲率比较差异无统计学意义(x2=0.2526,P=0.6145).两组术后并发症比较差异无统计学意义(x2=0.1875,P=0.6644).结论 采用广视野镜倒像装置系统进行外伤性眼后段手术使手术方式简化,手术时间缩短.     

硫酸镍对Wistar大鼠晶状体的损伤及芪归解毒汤对其保护作用的研究

目的 探讨硫酸镍对Wistar大鼠晶状体的损伤情况及芪归解毒汤对其保护作用.方法 选用出生7～14d的Wistar大鼠,随机分为芪归解毒汤预防组、障眼明预防组、硫酸镍组、空白对照组,每组15只.芪归解毒汤预防组:芪归解毒汤按1 ml/100 g给药灌胃7d后,再同时芪归解毒汤灌胃每天2次和硫酸镍溶液皮下注射每天1次,连续45 d;障眼明预防组:障眼明溶液按0.23 g/kg给药灌胃7d后,再同时用障眼明溶液灌胃每天2次和硫酸镍溶液皮下注射每天1次,连续45d;硫酸镍对照组:用2 mg/ml的硫酸镍溶液按15 mg/kg的剂量连续皮下注射45 d;空白组:Wistar大鼠不做任何处理,同等条件下正常饲养45 d.45d后双盲法在裂隙灯显微镜下参照LOCSⅢ评价Wistar大鼠晶状体的浑浊程度.最后处死大鼠,取下完整晶状体,置于10％福尔马林溶液中4℃保存,用原子吸收分光光度计测定镍含量.用SPSS 16.0软件进行单因素方差分析或秩和检验.结果 晶状体浑浊度观察:在晶状体P区域中,硫酸镍组晶状体浑浊指数得分高于芪归解毒汤预防组、障眼明预防组及对照组,差异有统计学意义(F=35.28,P＜0.05);在晶状体N区域中,硫酸镍组晶状体浑浊指数得分高于芪归解毒汤预防组、障眼明预防组及空白对照组,差异有统计学意义(F=78.64,P＜0.05).在晶状体A、C两区域,晶状体浑浊指数得分各组之间差异无统计学意义(F=0.173,P=0.914;F=0.364,P=0.779);在晶状体A+P区域上,硫酸镍组晶状体浑浊指数得分高于芪归解毒汤预防组、障眼明预防组及空白对照组,差异有统计学意义(F=30.24,P＜0.05).晶状体A+C+N+P4个区域浑浊指数得分总和分析,硫酸镍组晶状体浑浊指数得分高于芪归解毒汤预防组、障眼明预防组及空白对照组,差异均有统计学意义(F =38.14,P＜0.05);硫酸镍含量测定:硫酸镍组高于空白对照组(Z=-3.100,P＜0.05);芪归解毒汤预防组低于硫酸镍组(Z=-3.920,P＜0.05);障眼明预防组比较,差异无统计学意义(F=0.035,P＞0.05).结论 硫酸镍皮下注射能对Wistar大鼠晶状体造成一定的损伤,芪归解毒汤能有效减轻硫酸镍对Wistar大鼠晶状体的损伤.     

RAGE基因-429T＞C多态性与无锡汉族人群糖尿病视网膜病变的相关性

目的 探讨晚期糖基化终末产物受体(RAGE)基因启动子区-429T＞C多态性与无锡地区汉族人群糖尿病视网膜病变(DR)的相关性.方法 横断面研究.收集无锡地区120例汉族正常人及185例汉族2型糖尿病患者,包括DR患者92例,无糖尿病视网膜病变(NDR)患者93例.运用聚合酶链式反应-直接测序法检测这些对象基因型.采用x2检验及独立样本t检验比较各组基因型和基因频率及生化指标.结果 DR组与NDR组间临床特征比较显示,DR组糖尿病病程明显长于NDR组(t=2.25,P＜0.05),2组间其他临床特征差异无统计学意义(P＞0.05);DR组、NDR组及对照组CC基因型频率分别为3.3％、1.1％、1.7％,C等位基因频率分别为17.5％、13.4％、15.4％,DR组CC基因型频率分布显著高于NDR组及对照组,差异有统计学意义(x2=7.938、6.119,P＜0.05);DR组C等位基因频率分布明显高于NDR组及对照组,差异有统计学意义(x2=7.317、5.456,P＜0.05).NDR组与对照组的各基因型和等位基因频率分布比较,差异无统计学意义(x2=0.295、0.329,P＞0.05).单因素logistic回归分析示,C等位基因是2型糖尿病人群DR发病的危险因素(OR=2.085,95％CI:1.216～3.574).结论 -429T＞C多态性与无锡地区DR的发生有一定的相关性,且C等位基因可能是其危险因素.     

血管内皮生长因子受体1基因单核苷酸多态性及吸烟与宁夏地区汉族、回族年龄相关性黄斑变性的相关性

背景 年龄相关性黄斑变性(AMD)是引起中心视力进行性退变的一类遗传病.研究证明,在不同群体中,血管内皮生长因子受体l(VEGFR1)基因多态性和AMD的发生有关联,但这些结果在不同的种族和地区却不相同. 目的 探讨VEGFR1基因单核苷酸多态性(SNPs)及吸烟与宁夏地区汉族、回族AMD的关联.方法 本研究采取病例对照关联分析的方法,收集2011年3月至2015年6月宁夏地区无亲缘关系的AMD患者432例作为AMD组,其中汉族325例,回族107例,并纳入同期中度年龄相关性白内障患者906例作为对照组,其中汉族698例,回族208例.采集所有受检者静脉血5 ml,提取全基因组DNA,筛选出VEGFR1基因上rs2281827、rs3936415、rs7337610、rs7981680、rs9554320、rs9554322、rs9582036和rs9943922共8个标签SNPs,利用MassARRAYTM飞行时间质谱系统对受检者各SNPs基因型进行分型.采用卡方检验和多因素Logistic回归分析法分析和比较汉族与回族AMD患者各位点等位基因频率及基因型频率分布情况.结果 宁夏地区汉族与回族AMD组与对照组间年龄比较差异均有统计学意义(汉族:P=0.000;回族:P=0.009);汉族AMD组与对照组间吸烟患者比例差异有统计学意义(P=0.000),吸烟是宁夏地区汉族AMD发病的风险因素[优势比(OR)=2.622,95％可信区间(CI):1.899 ～3.619].汉族和回族间AMD患者各SNPs位点等位基因频率比较差异均无统计学意义(均P＞0.05),各种族AMD组与对照组间rs7337610和rs9554322SNPs基因型分布及等位基因频率的比较差异均有统计学意义(均P=0.00),在汉族AMD组与对照组间rs9582036和rs9943922基因型分布比较差异均有统计学意义(P=0.002、0.00).回族AMD组与对照组间rs7337610、rs9554322基因型分布及等位基因频率分布差异均有统计学意义(均P=0.00),其中rs7337610的C等位基因是汉族和回族AMD发病的保护因素(OR=0.354,95％ CI:0.288 ～0.435;OR=0.446,95％CI:0.315 ～0.632),而rs9554322位点的C等位基因是汉族和回族AMD发病的危险因素(OR=1.671,95％ CI:1.234～2.262;OR=3.661,95％ C1:2.156～6.218),rs9582036位点A等位基因是汉族AMD患病的危险因素(OR=1.477,95％ CI:1.124 ～1.940). 结论 吸烟是宁夏汉族人群AMD发病的独立环境危险因素.rs9554322和rs7337610 SNPs与汉族和回族AMD发病有关联,而rs9582036及rs9943922 SNPs仅与汉族AMD发病有关联.     

IL-2R和IL-7R基因多态性与特发性脱髓鞘性视神经炎的相关性的初步研究

目的 研究特发性脱髓鞘性视神经炎(IDON)的遗传易感性与白介素-2受体(IL-2R)基因rs2104286和白介素-7受体(IL-7R)基因rs6897932单核苷酸多态性的关系.方法 采用前瞻性病例对照研究,连续入选IDON患者72例,对照81例,取肘静脉血提取基因组DNA,聚合酶链反应扩增目的 基因片段后,用限制性片段长度多态性方法进行IL-2R基因多态性分析,采用基因测序方法进行IL-7R基因多态性分析;统计学方法采用x2检验.结果 IDON组(AA:54/AG:15/GG:3)与对照组(AA:57/AG:20/GG:4)比较IL-2R基因rs2104286位点基因型差异无统计学意义(x2=0.410,P=0.815),等位基因型(IDON组A:123/G:21;对照组A:134/G:28)差异亦无统计学意义(x2=0.413,P=0.520);IDON组(CC:56/CT:13/TT:3)与对照组(CC:52/CT:21/TT:8)比较IL-7R基因rs689793位点基因型差异无统计学意义(x2=3.787,P=0.150);等位基因型(IDON组C:125/T:19;对照组C:125/T:37)频率比较差异有统计学意义(x2=4.743,P=0.029).结论 IL-2R基因rs2104286位点的单核苷酸多态性与IDON易患性可能不相关;IL-7R基因rs6897932位点的单核苷酸多态性可能与IDON的易患性相关,等位基因C可能是使IDON易患性增加的危险等位基因.     

雷珠单抗联合全视网膜光凝辅助玻璃体切割手术治疗糖尿病视网膜病变

目的:观察玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab,IVR)、全视网膜激光光凝(panretinal photocoagulation,PRP)及两者联合对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患眼行23G微创玻璃体切割手术(pars plana vitrectomy,PPV)的影响.方法:回顾性对照研究.将临床确诊为PDR并行23G微创玻璃体切割术的患者142例169眼纳入研究.A组:PPV术前行IVR患者35例41眼,B组:PPV术前行PRP患者34例39眼,C组:PPV术前行IVR和PRP患者32例38眼,D组:PPV术前未行IVR及PRP患者41例51眼.比较4组患眼的玻璃体切割手术时间、术中出血量、使用电凝情况、医源性裂孔、眼内硅油填充及术后1 mo最佳矫正视力(best corrected visual acuity,BCVA)、并发症的情况.结果:四组平均手术时间分别为70.03±8.91、71.13±8.89、68.60±6.73、103.23±17.44min,A、B、C组平均手术时间均明显比D组短,差异具有统计学意义(P＜0.05).四组术中发生医源性裂孔的眼数组间整体比较,差异均无统计学意义(x2=0.531,P＞0.05).四组术中使用电凝的眼数分别为8、11、7、38眼,A、B、C组术中使用电凝的眼数明显比D组少,差异均有统计学意义(x2AD=27.499 、x2BD=19.105、x2CD=27.405,均P＜0.0167);A、B、C组术中使用电凝的眼数两两比较,差异均无统计学意义(x2=1.305,P＞0.05).四组术中硅油填充的眼数分别为6、7、5、28眼,A、B、C组术中硅油填充的眼数明显比D组少,差异均有统计学意义(x2AD=15.818、x2BD=12.6982D=18.014,均P＜0.0167);A、B、C组术中硅油填充的眼数组间整体比较,差异均无统计学意义(x2 =0.360,P＞0.05).四组术中出现持续或严重出血的眼数组间整体比较,差异无统计学意义(x2=2.809,P＞0.05).PPV术后1mo,四组平均BCVA分别为0.274±0.151、0.175±0.079、0.277±0.137、0.177±0.059,A、B、C组平均BCVA均比D组提高,差异均具有统计学意义(均P＜0.05).术后1wk,四组玻璃体再次出血的眼数分别为5、5、4、20眼,A、B、C组术后玻璃体再次出血的眼数均比D组减少,差异均有统计学意义(x2AD=8.385 、x2BD=7.675 、xcD=9.100,均P＜0.0167);术后1、3mo 四组术中玻璃体再次出血眼数组间整体比较,差异均无统计学意义(x21mo=2.933、x23mo=2.249,P＞0.05).结论:PDR患眼23G微创玻璃体切割术前行IVR、PRP治疗能有效缩短手术时间,减少术中出血及电凝止血、眼内填充物的使用率,有效提高患眼视力.     

Einfluss visueller Rehabilitation auf sekundäre depressive Störungen bei altersabhängiger Makuladegeneration

Background

Age-related macular degeneration (AMD) often leads to visual impairment, loss of reading ability, reduced quality of life and secondary depression. The present study examined if visual rehabilitation has a preventive effect on secondary depression in these patients.

Material and methods

In a controlled pilot study 20 patients were randomized into 2 groups whereby 9 underwent visual rehabilitation at first examination and 11 received magnifying visual aids only after 3 months. Psychosocial status was assessed by the geriatric depression scale (GDS) and the German version of the Centre for Epidemiologic Studies depression (CES-D) scale (main outcome parameter), cognitive status by the dementia detection test (DemTecT), minimental status (MMS) and quality of life by the National Eye Institute visual function questionnaire (NEI-VFQ 25). Ophthalmological examination included reading speed measurement by standardized texts (International Reading Speed Texts; IReST).

Results

Parameters of the CES-D scale, DemTect and the subitem exercise of social roles of the NEI-VFQ 25 emerged in a divergent manner. Patients of the rehabilitation group became less depressive and improved in cognitive and social abilities and in the control group vice versa. The interactive effect of group and time was statistically significant for all three tests.

Conclusions

Visual rehabilitation has a positive impact on depression as well as cognitive status and quality of life in patients with AMD. The effects have to be confirmed in future studies with more patients and a longer observation period.     

Toric IOL矫正白内障合并角膜散光的临床效果

目的:探讨散光人工晶状体(Toric intraocular lens,Toric IOL)矫正白内障合并角膜散光的临床效果及对视功能的影响.方法:回顾性分析2013-08/2016-08在我院接受超声乳化手术的白内障合并角膜散光患者375例390眼的临床资料,根据其植入晶状体的不同分为球面IOL组和Toric IOL组,观察两组患者的治疗满意度,比较两组患者治疗前后的视力、视功能和并发症发生率.结果:两组患者治疗前视力和总和散光情况,差异无统计学意义(P>0.05).治疗后3mo,Toric IOL组患者的视力优于球面IOL组,总和散光低于球面IOL组,差异具有统计学意义(P<0.05).术后1mo和术后3mo,Toric IOL组的轴位旋转度均低于球面IOL组;两组患者治疗前视功能差异无统计学意义(P>0.05);治疗后3mo,Toric IOL组患者的最佳矫正视力(best corrected visual acuity,BCVA)、对比敏感度函数下面积(area under the log contrast sensitivity function,AULCSF)、峰值对比敏感度(contrast sensitivity maxium,Smax)和截止空间频率(cut-off spatial frequency,CutSF)水平均低于球面IOL组,差异有统计学意义(P<0.05);两组患者均未发生眼内炎、继发性青光眼、黄斑水肿和虹膜睫状体炎等并发症;两组患者治疗满意度差异无统计学意义(x2=0.002,P=0.964).结论:Toric IOL能有效矫正白内障合并角膜散光,效果优于球面IOL,并可明显改善患者的视力和视功能.     

经鼻内窥镜下泪囊鼻腔吻合术治疗急性泪囊炎的疗效观察

目的:观察经鼻内窥镜下泪囊鼻腔吻合术对急性泪囊炎的治疗效果.方法:选取急性泪囊炎患者55例55眼,根据临床表现分为红肿组和脓肿破溃组,观察两组患者术后出血、疼痛情况,评估手术效果和患者泪囊区皮肤瘢痕影响外观情况.结果:随访3mo~2a,两组患者有效率比较,差异无统计学意义(x2=0.307,P>0.05);在脓肿破溃前行手术治疗对患者外观影响最小,两组比较差异具有统计学意义(x2=12.44,P<0.05).结论:经鼻内镜下泪囊鼻腔吻合术是治疗急性泪囊炎的有效方法,早期手术具有痊愈快、面部无瘢痕、有效率高的优点.     

Visual loss and visual hallucinations in patients with age-related macular degeneration (Charles Bonnet syndrome)

PURPOSE: The condition in which visual hallucinations (VHs) are solely associated with a visual impairment is termed Charles Bonnet Syndrome (CBS). The study was undertaken to investigate whether the extent of visual acuity (VA) loss and central visual field loss predisposes a patient with age-related macular degeneration (AMD) to develop a CBS VH and, in addition, whether the progression in loss is mirrored in the complexity of the VHs reported. VH phenomenology and CBS prevalence were also examined. METHODS: Sixty-six patients (age range, 63-96 years, mean +/- SD 81.2 +/- 7.1 years) with bilateral AMD were questioned as to whether they had experienced any hallucinatory episodes exclusive to vision. The four-point primary inclusion criterion ensured that all patients had bilateral AMD, a bilateral central scotoma, best monocular VA poorer than or equal to 0.6 logMAR (logarithm of the minimum angle of resolution) and intact cognition (using the Mini Mental State Examination for the Blind and the Telephone Interview for Cognitive Status). The patients who did not report VH were classified into the non-VH group, with the remainder in the VH group. An extended Institute of Psychiatry Structural Interview characterized the phenomenology of the VH. A secondary inclusion criterion subdivided the VH group into the apparent CBS group, in which personal medical history may have contributed to VH generation, and the manifest CBS group, where VHs were solely as a result of the visual loss. RESULTS: Fifty-three patients met the primary inclusion criterion: 32 were classified into the non-VH group and 21 into the VH group. The VH group were slightly younger (median difference, 4 years, P = 0.03) and appeared to have a lower VA (median difference, 0.20 logMAR, P = 0.08) and a more extensive visual field loss (P = 0.06) than did the non-VH group. However, when these variables were evaluated simultaneously by logistic regression, only age emerged as a statistically significant predictor of VH (odds ratio 0.88, 95% confidence interval [CI] 0.8-0.99, P = 0.03). The prevalence of apparent CBS and manifest CBS in the AMD population was found to be 25% and 15%, respectively. With no clinical and phenomenological differences between the two CBS groups, the secondary inclusion criterion was withdrawn, the VH group was renamed the CBS group, and a prevalence of 40% was recalculated. Of the 82 visual phenomena experienced by the CBS group, 21 were classified as simple VHs and 39 as complex VHs, with the remainder classified as either entopic phenomena or visual inference. Patients who experienced both simple and complex VHs appeared to have a greater visual field loss (P = 0.06) compared with those patients who reported either solely simple or solely complex VHs. CONCLUSIONS: The extent of visual loss did not appear to be a predictor for the likelihood of a patient with AMD experiencing a CBS VH, nor was the progression of loss reflected in the complexity of the VHs reported.     

Ocular rigidity in patients with age-related macular degeneration

PURPOSE: To compare the ocular rigidity in vivo measurements of patients with age-related macular degeneration (AMD) and control subjects. DESIGN: Prospective comparative clinical study. METHODS: The pressure-volume relation and the ocular rigidity coefficient were compared among 32 patients with AMD (AMD group: 16 with neovascular and 16 with nonneovascular AMD) and 44 age-matched control patients (control group) who underwent operation for cataract. This was achieved by an injection of 200 microl of a balanced salt solution (in steps of 4.5 microl) through the limbus in the anterior chamber, while the intraocular pressure was monitored continually with a transducer, up to the limit of 30 mm Hg. RESULTS: The mean age (AMD group: 69.89 +/- 15.92 years vs control group: 65.28 +/- 12.34 years; P = .195), gender (AMD group: 13 female vs control group: 17 female; P = .513), eye's axial length (AMD group: 23.14 +/- 0.75 mm vs control group: 23.04 +/- 1.16 mm; P = .725) of patients with AMD and the healthy control subjects were comparable. No statistically significant difference in ocular rigidity measurements between patients with AMD and control subjects (AMD group: 0.0142 +/- 0.0077 microl(-1) vs control group: 0.0125 +/- 0.0049 microl(-1); P = .255) was found. When we examined separately the two subgroups of patients with AMD (neovascular and nonneovascular AMD), the average ocular rigidity measurements were higher in patients with neovascular AMD vs both control subjects and patients with nonneovascular AMD (neovascular AMD group: 0.0186 +/- 0.0078 microl(-1) vs control group: 0.0125 +/- 0.0048 microl(-1) [P = .014] vs nonneovascular AMD group: 0.0104 +/- 0.0053 microl(-1) [P = .004]). CONCLUSIONS: Despite the limitations placed by the small sample of the examined cases, patients with neovascular AMD who are treated (with photodynamic therapy) have increased ocular rigidity measurements compared with patients with nonneovascular AMD and control patients.     

宁夏地区翼状胬肉患病率的流行病学调查

目的:调查宁夏地区翼状胬肉的患病率,探讨翼状胬肉与年龄、性别、城乡、地理位置、种族及不同经济发展水平等人群因素间的关系。方法:利用分层、多级随机抽样的方法,抽取宁夏银川市金凤区和红寺堡两地区3001例受检对象进行眼部检查,填写翼状胬肉患病率调查表。分析宁夏地区翼状胬肉患病率及易感因素。结果:宁夏地区人群中翼状胬肉患病率为6.16%。城市和农村的患病率分别为5.74%,6.49%,两组间比较差异无统计学意义(χ2=0.717,P=0.397)。男女两组患病率分别为6.30%,6.82%,两组间比较差异无统计学意义(χ2=0.269,P=0.604)。汉族和回族患病率比较差异无统计学意义(χ2=1.641,P=0.440)。农村人群中26～45岁组,≥66岁组翼状胬肉患病率高于城市,差异有统计学意义。结论:宁夏地区翼状胬肉的患病率较高与该地区的地理位置、气候条件有关。汉族与回族、城乡之间患病率无明显差异。农村人群翼状胬肉的患病率有随年龄增长而增高的趋势。病程的长短与经济发展水平相关。     

Monovision LASIK的临床研究

目的:研究Monovision LASIK的临床疗效。方法:回顾性分析来我院接受LASIK手术屈光不正的患者110例(220眼),年龄40岁以上,术后随访1a,术后接受问卷评估。分析术前及术后1a的裸眼视力(远视力、近视力)、屈光等数据,结合问卷评估结果进行统计学分析。结果:78例接受Monovision LASIK手术,32例患者接受双眼完全矫正手术。Monovision组和完全矫正组患者术后裸眼远视力分别为1.21±0.13,1.19±0.15,两者比较统计学上差异无显著性(P=0.35)。Monovision组术后裸眼近视力(0.68±0.25)好于完全矫正组(0.43±0.21,P=0.04),两组术后屈光参差分别为1.41±0.26D,0.12±0·11D,两两比较统计学上具有显著性差异(P=0.03)。术后满意度Monovision组与完全矫正组分别为87%与85%,统计学上无显著性差异(P=0.65)。术后驾车、行走、运动等不戴镜分别为91.5%,97.2%,差异无统计学意义(P=0.55)。术后近距离工作从不佩戴老视眼镜分别为48.6%,15.6%(P=0.03),差异具有统计学意义。结论:Monovision LASIK是一种矫治老视的有效方法。     

The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients

PURPOSE: To evaluate the influence of cataract surgery on cognitive function and depressive mental status of elderly patients. DESIGN: Prospective, interventional case series. METHODS: The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI) are the measures designed to assess vision-related quality of life (QOL), cognitive impairment, and depressive mental status, respectively. These tests were performed before and two months after surgery in 102 patients undergoing phacoemulsification and intraocular lens implantation for bilateral cataract. RESULTS: The change in best-corrected visual acuity by surgery significantly correlated with the change in NEI VFQ-25 score (Pearson correlation, r = -0.310; P = .031). The change in NEI VFQ-25 score by surgery significantly correlated with the change in MMSE score (r = 0.306; P = .035) and the change in BDI score (r = -0.414; P < .001). The change in MMSE score showed significant correlation with the change in BDI score (r = -0.434; P < .001). CONCLUSIONS: Vision-related QOL, cognitive impairment, and depressive mental status are all strongly related with each other. Cataract surgery significantly improved vision-related QOL in elderly patients, and cognitive impairment and depressive mental status also improved in parallel with improvement in vision-related QOL.     

超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼

目的:探讨超声乳化人工晶状体(intraocular lens,IOL)植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效.方法:采用临床随机对照的研究方法,将临床收集的80例96眼原发性慢性闭角型青光眼患者分为观察组(40例46眼)和对照组(40例50眼).观察组给予超声乳化IOL植入联合房角分离术治疗,对照组仅给予超声乳化IOL植入术治疗.比较两组患者手术前后最佳矫正视力、眼压、视野平均缺损(mean deviation,MD)、平均视敏度值(mean sensitivity,MS)和中央前房深度改善状况,并记录患者术中、术后并发症发生状况.结果:两组患者术前最佳矫正视力、眼压、视野和中央前房深度比较,差异均无统计学意义(P>0.05);术后6mo,观察组最佳矫正视力、眼压、视野和中央前房深度与对照组相比,差异均有统计学意义(P<0.05);两组患者均无严重并发症,且差异无统计学意义(x2=2.095,P=0.351).结论:超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效优于单纯超声乳化IOL植入.     

Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration

OBJECTIVE: To examine (1) the prevalence of depressive disorders in community-dwelling adults with advanced age-related macular degeneration (AMD) and (2) the relationship in this population between depression, visual acuity, the number of comorbid medical conditions, disability caused by vision loss as measured by the National Eye Institute-Vision Function Questionnaire (NEI-VFQ) and the vision-specific Sickness Impact Profile (SIPV), and disability caused by overall health status as measured by the Sickness Impact Profile-68 (SIP). DESIGN: Analysis of cross-sectional baseline data from a randomized clinical trial. PARTICIPANTS: Participants were 151 adults aged 60 and older (mean age, 80 years) with advanced macular degeneration whose vision was 20/60 or worse in their better eye. METHODS: Subjects were interviewed using measures of depression, disability, and chronic medical conditions. Visual acuity was obtained. Nonparametric correlation analyses and linear regression analyses were performed. MAIN OUTCOME MEASURES: Structured Clinical Interview for DSM-IV (SCID-IV), Geriatric Depression Scale (GDS), NEI-VFQ, SIPV, and SIP. RESULTS: Of the participants, 32.5% (n = 49) met SCID-IV criteria for depressive disorder, twice the rate observed in previous studies of community-dwelling elderly. Over and above depression (GDS), visual acuity aided in prediction of the level of vision-specific disability (NEI-VFQ and SIPV). CONCLUSIONS: Depressive disorder is a significant problem for the elderly afflicted with advanced macular degeneration. Further research on psychopharmacologic and psychotherapeutic interventions for depressed AMD patients is warranted to improve depression and enhance functioning. Over and above depression, visual acuity aided in predicting vision-specific disability. Treatment strategies that teach patients to cope with vision loss should be developed and evaluated.