Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.     

合并成型性渗出的急性前葡萄膜炎与HLA-B27的相关性研究

目的 探讨急性渗出性前葡萄膜炎与HLA-B27的相关性。方法 对53例前房内出现成型性渗出的急性前葡萄膜炎（AAUPE）患者及61例前房内无成型性渗出的急性前葡萄膜炎（AAU）患者进行HLA-B27的检测,并结合临床表现加以分析。结果 成型性渗出的AAUPE患者的HLA-B27阳性率为100％,而无成型性渗出的AAU患者的HLA-B27阳性率仅为50.8％。二者有显著差异性（P<0.01）。两组HLA-B27阳性的病人强直性脊柱炎发生率分别为50.0％和42.9％。结论 结果进一步证实了HLA-B27与成型性渗出密切相关的论点。提示检测AAU患者HLA-B27的阳性率,发现成型性渗出裂隙灯检查似与血清法检测同样准确。     

Levodopa-carbidopa with occlusion in older children with amblyopia

PURPOSE: To study the role of levodopa-carbidopa in supplementing occlusion therapy in older children with strabismic or anisometropic amblyopia. Methods: A clinical study was performed on 40 amblyopic children (19 strabismic and 21 anisometropic), 6 to 18 years old (mean age, 10.9 years). They received an average dose of 1.86 mg/kg/day (1.33-2.36 mg/kg/day) of levodopa and carbidopa (4:1 ratio) or a placebo in 3 divided doses over a 4-week period, combined with full-time occlusion. The occlusion was continued for the study duration of 3 months. Early Treatment Diabetic Retinopathy Study visual acuity charts and Cambridge low-contrast gratings for contrast sensitivity (CS) were used to assess visual functions. Tolerance and compliance with occlusion and capsule consumption were assessed. RESULTS: Visual acuity of the nonamblyopic eye did not deteriorate during the study in either group. CS decreased by 22 units in the levodopa group and increased in the placebo group by 53 units at the first month. The CS in the levodopa group recovered later by the third month of follow-up. Both the levodopa and the placebo groups showed significant improvement in visual function in the amblyopic eye (P <.001). Overall changes in logarithm of minimum angle of resolution values and CS in the amblyopic eyes were similar in both groups (P >.05). Strabismic and anisometropic amblyopes did not behave differently. Drug tolerance, occlusion compliance, and capsule ingestion compliance were similar between the groups, with no significant side effects. CONCLUSIONS: Clinically, levodopa supplementation does not offer any advantage over occlusion alone. Moreover, the risk of occlusion amblyopia could increase with the use of drugs like levodopa that might affect the plasticity of the visual cortex.     

Phacotrabeculectomy with mitomycin C in patients with uveitis

PURPOSE: To evaluate the safety and efficacy of combined phacoemulsification, intraocular lens implantation, and trabeculectomy with mitomycin C for the management of uveitic complications. DESIGN: Retrospective case-control study. METHODS: We conducted a retrospective review of the records of 23 consecutive eyes with chronic noninfectious uveitis (uveitic group) and 43 nonuveitic eyes (control group) that had received primary phacotrabeculectomy. Mitomycin C was used in all the uveitic eyes. Considering the high preoperative intraocular pressure (IOP) of the uveitic group, nonuveitic eyes that had a preoperative IOP of >or=20 mm Hg or that had been given two or more medications were included in the control group. All patients were followed for at least one year. The main outcome measures were postoperative vision, IOP control, complications, and acute uveitis relapse rates. RESULTS: Visual outcome of the uveitic group was similar to the control group. In the uveitic group, the success rate of IOP control (91.3% at one year, 84.8% at two years) was favorable but was significantly lower than in the control group (P = .0423). Complications were comparable between the groups. Primary surgical failure in the uveitic group was associated with the postoperative acute uveitis attack. In the uveitic group, the acute uveitis attack rate showed no change after surgery (P = .283). CONCLUSION: With adequate inflammation suppression, phacotrabeculectomy with mitomycin C is an effective and safe therapeutic option for the management of secondary cataract and glaucoma in uveitic eyes. A lower surgical success rate of the uveitic group might be attributable to the postoperative inflammation recurrence.     

Epikeratoplasty with nonlyophilized tissue in children with aphakia

We studied 75 epikeratoplasty procedures using nonlyophilized tissue performed by eight ophthalmic surgeons in 70 eyes (47 patients) to correct for aphakia in children less than 8 years of age (mean age, 3.4 +/- 2.1 years). Of the 47 patients in the study, 24 were girls and 23 were boys; 23 patients had bilateral surgery. Seven of the epigrafts required removal; two were not replaced, and five underwent successful repeat epikeratoplasty. Overall, the success rate (that is, the percentage of epigrafts that remained optically and functionally clear throughout the course of this study) for the epikeratoplasty procedure was 89% (62 of 70 eyes) for initial surgery and 96% (67 of 70 eyes) for repeat surgery. The average spherical equivalent was +14.4 +/- 3.7 diopters preoperatively and +0.3 +/- 2.9 diopters one year after the operation. One year after the final surgical procedure, 42 of 56 eyes (75%) were within 3 diopters of emmetropia. In the 29 verbal patients, best-corrected visual acuity was 20/100 or better in 25 (86.2%) one year after the operation.     

滤过试验结合可拆缝线在小梁切除术中的应用

目的　探讨小梁切除术术中做滤过试验结合可拆缝线的应用对预测和控制术后滤过量及预防浅前房的疗效。方法　对 92例 ( 113眼 )原发性青光眼 ,在小梁切除术术中根据滤过试验结果来决定固定缝线和可拆缝线缝合的位置和数量。术后 1～ 7天 ,抽出可拆缝线。回顾性总结术中缝合种类、数量及术后前房深度、眼压、滤过泡、视野。结果　术中 40眼 ( 3 5 40 % )采用一针固定缝线和一至二针可拆缝线 ,5 1眼 ( 45 14 % )采用二针固定缝线和一至二针可拆缝线。术后无一例持续性浅前房。术后第 7天眼压平均 13 5± 3 3 0mmHg。追踪观察 6～ 2 4个月 ,形成功能性滤过泡 89眼( 78 76% ) ,眼压控制 <2 1mmHg 91眼 ( 80 5 3 % ) ,视野不变 98眼 ( 86 73 % )。结论　小梁切除术术中根据滤过试验的结果 ,通过对固定缝线和可拆缝线缝合的位置和数量的选择能有效预测和控制术后滤过量并预防术后浅前房     

超声乳化联合前房角分离治疗伴白内障的青光眼

目的：：观察晶状体超声乳化联合前房角分离术对伴有白内障的慢性闭角型青光眼患者的治疗效果。方法：无并发症伴有白内障的慢性闭角型青光眼50例50眼,施行晶状体超声乳化吸出人工晶状体植入联合前房角分离术。术后随访3mo,记录并比较术前及术后最佳矫正视力、眼压、前房深度及前房角。各指标均采用均数±标准差(x±s)表示,术前及术后3mo的最佳矫正视力、眼压、前房深度及前房角的情况进行比较。结果：术后3 mo的最佳矫正视力较术前明显提高,差异有统计学意义( t=8.76, P=0.001);术后3 mo 的眼压为15.63±3.11mmHg,较术前(45.12±5.30mmHg)明显下降,差异有统计学意义(t=6.27,P=0.000);术后3mo的前房深度为3.57±0.02mm,较术前(1.43±0.25mm)明显加深,差异有统计学意义(t=8.16,P=0.001);术前、术后前房角情况的比较,差异有统计学意义(Z=-4.432,P=0.000;Z=-2.432,P=0.016;Z=-4.379,P=0.000;Z=-4.538, P=0.000)。结论：晶状体超声乳化吸出人工晶状体植入联合前房角分离术治疗伴有白内障的慢性闭角型青光眼,能够有效控制眼压,提高视力,是一种安全、有效的手术方法。     

环喷托酯在屈光参差儿童散瞳验光中的应用

目的比较分析1%盐酸环喷托酯与1%阿托品对3~12岁屈光参差儿童散瞳验光效果。设计回顾性病例系列。研究对象2010年10月~2011年2月在北京同仁医院眼科斜弱视门诊就诊的3~12岁屈光参差儿童40例(80眼)。方法对以上40例患儿按年龄分成3组,即3~6岁组,7~9岁组和10~12岁组。全部患儿均首先用1%盐酸环喷托酯进行散瞳验光,待其瞳孔完全恢复正常(1周后)再行1%阿托品散瞳验光,比较两种方法的验光结果。主要指标屈光值(球镜度数、柱镜度数及轴向)。结果用1%盐酸环喷托酯散瞳验光结果(球镜:+1.18 D±4.90 D,柱镜:+1.47 D±1.16 D,散光轴向:80.50°±38.62°)与用1%阿托品散瞳验光结果(球镜:+1.20 D±4.91 D,柱镜:+1.47 D±1.15 D,散光轴向:80.06°±38.48°)比较,差异均无统计学意义(P均>0.05)。在80眼中,球镜值相同或相差≤0.50 D者77眼,符合率为96.25%;柱镜值在69眼中,结果相同或相差≤0.50 D者65眼,符合率为94.20%;散光轴向在69眼中,结果相同或相差≤5°者67眼,符合率为97.10%。三个年龄组间的球镜、柱镜和散光轴向符合率差异均无统计学意义(P均>0.05)。结论 1%盐酸环喷托酯可以替代1%阿托品用于3~12岁屈光参差儿童散瞳验光,其结果可以作为配镜的依据。     

玻璃体切除术拯救外伤后无光感眼

目的观察外伤后无光感眼采用玻璃体切除术治疗的效果。方法回顾性分析10例（10眼）行玻璃体切除术的眼外伤后无光感眼的临床资料。开放性眼外伤8例,闭合性眼外伤2例。术前并发症有视网膜脱离10眼、脉络膜脱离8眼、睫状体脱离4眼、玻璃体积血10眼、无晶状体5眼、无虹膜3眼及角膜血染1眼。所有病例均为硅油填充者。随访6个月以上。结果术后9眼视网膜解剖复位。5眼硅油填充眼压正常,2眼硅油填充眼压低,2眼取硅油后眼压正常,1眼眼球萎缩行眼球摘除术。术后视力5眼仍为无光感。2眼为手动,1眼为数指,1眼为0．05,1眼最佳矫正视力为0．2。结论玻璃体切除术可以拯救部分外伤后早期无光感眼,甚至可以恢复部分视功能。     

小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的：观察小梁切除联合超声乳化白内障吸除术在原发性闭角型青光眼(包括急性闭角型青光眼与慢性闭角型青光眼)合并白内障患者中的临床治疗效果及对并发症的影响。

方法：选取2014-01/2016-07在我院诊治的青光眼合并白内障患者60例60眼,采用随机数字方法分为对照组(30例30眼)和观察组(30例30眼)。对照组采用小梁切除术治疗,观察组采用小梁切除联合超声乳化白内障吸除治疗,比较两组临床效果及并发症发生率情况。

结果：观察组术后视力与对照组相比差异无统计学意义(P>0.05); 观察组术后眼压水平低于对照组,差异有统计学意义(P<0.05); 观察组术后前房深度大于对照组,差异有统计学意义(P<0.05); 观察组术后并发症发生率为7%,显著低于对照组的23%,差异有统计学意义(P<0.05)。

结论：原发性闭角型青光眼合并白内障患者在小梁切除术基础上联合超声乳化白内障吸除术治疗效果理想,并发症发生率相对较低。     

Phacoemulsification with intraocular lens implantation in patients with uveitis

BACKGROUND: Cataract remains a challenge for ophthalmologists in uveitic eyes. The aim of this study is to report the clinical course of phacoemulsification with intraocular lens implantation in eyes suffering from uveitis. PATIENTS AND METHODS: Patients presenting a uveitis were prospectively followed from June 2001 to June 2003. Ocular surgery was performed according to a standard protocol, autoimmune follow-up visits were focused on the early detection of complications of uveitis: increased ocular inflammation, synechiae, retraction of the rhexis, opacification of the posterior capsule or onset of cystoid macular edema. RESULTS: Thirty-two eyes of 24 patients suffering from uveitis were operated with cataract surgery between June 2001 and June 2003. The mean age at surgery was 56 years (range 24 - 86 years). Mean preoperative visual acuity in uveitis patients presenting cataract was 0.3 +/- 0.3, and final visual acuity was 0.8 +/- 0.3. Three patients presented minor postoperative complications. One patient had a cystoid macular edema that appeared 5 months after surgery and one patient had a relapse of herpetic dendritic keratopathy despite topical antiviral therapy combined with steroid drops. The latter presented a slight increase of intraocular pressure (24 mm Hg). CONCLUSIONS: In patients with uveitis requiring cataract surgery, intraocular lens implantation is safe. Visual prognosis is better when pre- and postoperative inflammation is minimized. Macular scars or other retinal lesions are poor prognostic indicators.     

雷珠单抗联合玻璃体切割术治疗DR合并新生血管性青光眼

目的：探究雷珠单抗联合玻璃体切割术治疗DR合并新生血管性青光眼(NVG)的临床效果。

方法：选取2016-01/2018-02我院眼科收治的DR合并NVG患者198例,根据治疗方案不同分为观察组(103例)和对照组(95例),观察组采用术前注射雷珠单抗联合玻璃体切割术治疗,对照组单纯采用玻璃体切割术治疗,玻璃体切割术后10～15d Ⅱ期实施Ahmed房水引流阀植入。观察两组治疗后眼压、BCVA、VEGF等指标变化情况。

结果：观察组的玻璃体切割术的手术时间、新生血管出血次数、电凝次数均低于对照组(P<0.001)。观察组在玻璃体切割术后1wk和Ⅱ期Ahmed房水引流阀植入术后1mo BCVA、眼压均低于对照组(P<0.001)。观察组Ⅱ期Ahmed房水引流阀植入术前VEGF和术后1mo视网膜黄斑中心凹厚度均低于对照组(P<0.001)。观察组总并发发生率低于对照组(10.7% vs 28.4%,P<0.05)。

结论：雷珠单抗联合玻璃体切割术治疗DR合并NVG的疗效显著,且使Ⅱ期Ahmed房水引流阀植入手术难度下降,对患者视力、眼压水平恢复较好。