全视网膜光凝联合雷珠单抗与曲安奈德治疗糖尿病黄斑水肿的疗效及费用比较

目的：比较分析全视网膜光凝联合雷珠单抗与曲安奈德(TA)玻璃体腔注射治疗糖尿病黄斑水肿的疗效及医疗费用。

方法：收集我院糖尿病视网膜病变伴黄斑水肿患者48例48眼。所有患者行全视网膜激光光凝后随机分为两组。雷珠单抗组：玻璃体腔注射雷珠单抗0.5mg,4wk 1次。共3次。TA组：注射曲安奈德4mg/0.1mL。治疗12wk后若黄斑中心凹视网膜厚度(CMT)≥400μm,则再次注射各组对应药物。随访6mo,对比观察两组患者治疗前及注射药物后的最佳矫正视力(BCVA)、CMT、眼压及相关治疗费用。

结果：两组患者BCVA和CMT均无显著统计学差异(P>0.05),不同测量时间点BCVA和CMT具有显著统计学差异,不同治疗方法和时间点BCVA及CMT均存在交互作用(P<0.05)。除了TA组注药后1wk时BCVA较治疗前无明显提高(P=0.33),其余各时间点两组BCVA均较治疗前提高(P<0.05)。治疗12、16wk雷珠单抗组BCVA提高较TA组明显,两组差异有统计学意义(P=0.03、0.045)。雷珠单抗组及TA组CMT注药后较注药前均有降低(P<0.05)。注射后1wk两组之间CMT差异有统计学意义(P<0.01)。除了1例患者需使用降眼压药物,其余两组患者眼压均在正常范围内。治疗12wk内本研究相关诊疗平均费用雷珠单抗组患者为38 736元,TA组为5 790元。治疗24wk两组平均费用分别为42 564元及7 053元。

结论：短期内全视网膜光凝联合雷珠单抗与曲安奈德玻璃体腔注射均能有效控制DME,两组治疗方法无显著差异,但全视网膜激光联合玻璃体腔注射曲安奈德治疗DME更经济。     

曲安奈德与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿比较

目的： 比较曲安奈德(Triamcinolone Acetonide,TA)与雷珠单抗(Lucentis,LU)治疗视网膜静脉阻塞性黄斑水肿的临床疗效。

方法：回顾性分析40例最佳矫正视力(BCVA,小数视力)≤0.6,黄斑中心凹厚度(CMT)≥250μm的视网膜静脉阻塞性黄斑水肿患者,分别进行玻璃体腔注射TA(22例,4mg,0.1mL)或LU(18例,0.5mg,0.05mL)治疗。比较两种药物治疗前和治疗后1, 2wk; 1, 2, 3,6mo两组CMT与BCVA的改变情况

结果：两组在治疗后视力明显提高,术后各时间点均较术前具有显著改变(P<0.05), TA组治疗后1mo视力最好(BCVA,logMAR=0.30±0.20),LU组治疗后2mo视力最好(BCVA,logMAR=0.21±0.10),两组在治疗后黄斑水肿明显减轻,CMT明显降低,术后各时间点均具有统计学意义(P<0.05),两组治疗后2mo时黄斑水肿程度最低(TA组CMT=274.45±141.81μm,LU组CMT=225.83±22.86μm)。BCVA(小数视力)与CMT呈负相关。各项指标两组间均无统计学差异。

结论： 玻璃体腔注射TA及LU治疗视网膜静脉阻塞性黄斑水肿均可减轻黄斑水肿和改善视力,两者治疗效果无显著差异。     

玻璃体腔内注射TA与雷珠单抗治疗CRVO继发黄斑水肿的对照研究

目的：比较曲安奈德(TA)与雷珠单抗(ranibizumab)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发黄斑水肿的的临床疗效及安全性。

方法：回顾性分析继发黄斑水肿的CRVO患者40例40眼。其中20例20眼接受玻璃体腔注射TA(1mg,0.1mL)治疗,其余20例20眼接受玻璃体腔注射雷珠单抗(0.5mg,0.05mL)治疗。观察两组治疗前及治疗后1,2wk; 1,2,3,6mo患者最佳矫正视力、黄斑中心凹厚度(CMT)及眼压的改变。

结果：TA组及雷珠单抗组于玻璃体腔注药1,2wk; 1,2,3,6mo后最佳矫正视力较治疗前明显提高(P<0.05); 但两组之间无明显差异(P>0.05)。两组于玻璃体注药后1,2wk; 1,2,3,6mo,CMT较治疗前有明显降低(P<0.05),但两组之间无明显差异(P>0.05)。TA组玻璃体腔注药后2wk及4wk眼压较治疗前明显升高(P<0.05)。雷珠单抗组玻璃体腔注药后各时间点眼压均无明显升高(P>0.05)。注药后第1,2wk; 2,3,6mo,TA组眼压改变与雷珠单抗组无明显差异(P>0.05),注药后1mo,TA组眼压改变要明显高于雷珠单抗组(P<0.05)。

结论：玻璃体腔内注射雷珠单抗是目前CRVO继发黄斑水肿的有效而且安全的治疗手段。与TA相比其在提高最佳矫正视力及降低CMT的同时几乎不会发生眼部及全身并发症。     

PDR行玻璃体手术前注射雷珠单抗或曲安奈德后玻璃体腔内细胞因子的变化

目的：比较增生型糖尿病视网膜病变(PDR)行玻璃体切割术前用雷珠单抗或曲安奈德玻璃体腔内注射前后玻璃体腔内细胞因子的变化。

方法：前瞻性研究。将2015-05/2017-02我院收治的PDR患者88例112眼纳入研究。依照随机方法分为行玻璃体切割术前玻璃体腔注射0.5mg/0.05mL雷珠单抗组(43例57眼)、行玻璃体切割术前玻璃体腔注射4mg/0.1mL曲安奈德组(45例55眼),两组患者分别在玻璃体腔注射药物前抽取0.5mL玻璃体液后于玻璃体腔内注射雷珠单抗或曲安奈德。注药后7d行玻璃体切割术术前再次抽取玻璃体液0.5mL。采用双抗酶联免疫吸附试验(ELISA)测定玻璃体液的胎盘生长因子(PIGF)。用Luminex200液相芯片分析系统检测单核细胞趋化蛋白1(MCP-1)、单核细胞趋化蛋白3(MCP-3)、白介素-6(IL-6)、白介素-8(IL-8)、血小板源性生长因子-AB/BB(PDGF-AB/BB)和血管内皮生长因子-A(VEGF-A)浓度。

结果：雷珠单抗组玻璃体腔内PIGF与VEGF-A水平注射后较注射前均明显降低,而IL-6、IL-8水平增高(PIGF：65.36±15.16 vs 19.42±6.34pg/mL; VEGF-A：315.16±14.34 vs 21.32±2.54pg/mL,IL-6：37.32±4.04 vs 52.42±5.32pg/mL; IL-8：111.723±21.32 vs 198.73±19.03pg/mL,P<0.001)。而MCP-1、MCP-3及PDGF-AB/BB的水平无明显变化(P>0.05)。曲安奈德组玻璃体腔内PIGF水平显著增加(74.28±17.34 vs 136.12±15.34pg/mL,P<0.05)。而MCP-1水平明显减少(2789.32±143.54 vs 2038.21±105.34pg/mL,P<0.05)。MCP-3、IL-6、IL-8、PDGF-AB/BB、VEGF-A表达均无明显改变(P>0.05)。两组患者治疗后进行对比,雷珠单抗注射后玻璃体中PIGF、VEGF-A含量明显低于曲安奈德注射后含量(P<0.01),IL-8、MCP-1水平则显著增加(P<0.05)。此外,雷珠单抗组术中出血情况明显低于曲安奈德组(P<0.05)。

结论：玻璃体腔注射雷珠单抗能显著降低PIGF、VEGF-A表达,同时促进IL-6、IL-8水平增加; 而玻璃体腔内注射曲安奈德能减少MCP-1表达,促进PIGF水平增加。     

不同方法注射曲安奈德联合光凝治疗糖尿病性黄斑水肿

目的：评估曲安奈德(triamcinolone acetonide,TA)玻璃体腔和球后注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿的临床疗效和安全性。

方法： 将52例62眼糖尿病性黄斑水肿患者随机分为璃体腔(0.1mL/4mg)注射TA组31眼和球后(1mL/40mg)注射TA组31眼,注药1mo后行黄斑部格栅样光凝,随访9mo观察视力、黄斑水肿情况及并发症。

结果： 两组患者治疗后1,3,6,9mo 4个随访时间点平均最佳矫正视力提高、黄斑水肿减轻,同治疗前比较均有统计学差异(P<0.05),组间差异均无统计学意义(P>0.05)。球后注射组并发症低于玻璃体腔注射组,组间差异有统计学意义(P<0.05)。

结论： TA球后注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿,同玻璃体腔注射的疗效无明显差异,且更安全。     

球后与玻璃体腔注射曲安奈德联合激光治疗糖尿病黄斑水肿的疗效比较

目的：探讨球后及玻璃体腔注射曲安奈德联合激光治疗糖尿病黄斑性水肿(DME)的临床疗效及其疗效对比。

方法：将40例62眼DME患者随机分两组,每组31眼,一组采用球后注射曲安奈德(RBTA)进行治疗,另一组采用玻璃体腔注射曲安奈德(IVTA),两组均在1mo后采用法国光太532nm眼底激光仪对局限性黄斑水肿进行局部视网膜激光治疗,对弥散性黄斑水肿及囊样黄斑水肿进行格栅样视网膜激光治疗,随访1wk,1、3、6mo观察视力、眼压、眼底、黄斑水肿情况及其并发症。

结果：两组患者治疗后随访1wk,1、3、6mo过程中平均最佳矫正视力提高、黄斑水肿减轻,同治疗前比较差异有统计学意义(P<0.05),组间差异均无统计学意义(P>0.05)。其中RBTA组患者中显效12眼,有效16眼,无效3眼; IVTA组患者中显效12眼,有效17眼,无效2眼; RBTA组显效率39%,总有效率90%; IVTA组显效率39%,总有效率94%。随访期间无视网膜脱离、眼内炎、眼内出血及其他并发症发生。

结论：曲安奈德联合激光治疗DME具有一定疗效,不良反应少,能够有效地提高患者视力、减轻黄斑水肿等特点,是治疗DME的有效方法之一。球后注射与玻璃体腔注射曲安奈德两种注射方式对治疗DME的疗效无明显差异。     

玻璃体腔注射康柏西普对湿性ARMD的疗效分析

目的：探讨玻璃体腔注射康柏西普对湿性年龄相关性黄斑变性(ARMD)的疗效及对脉络膜厚度的影响。

方法：回顾性研究。选取本院于2014-03/2017-12收治的213例345眼湿性ARMD患者,根据治疗方式不同分为两组,对照组(106眼176眼)行玻璃体腔注射曲安奈德治疗,观察组(107例169眼)行玻璃体腔注射康柏西普治疗。分析两组患者的疗效及脉络膜厚度变化。

结果：两组患者注射前BCVA、黄斑中央区厚度(CMT)均无差异(P>0.05)。观察组第3次注射后的BCVA优于对照组,且CMT值低于对照组(P<0.05)。两组患者间治疗前和治疗后1、3、6mo的中央视网膜厚度、脉络膜厚度无差异(P>0.05)。但两组患者治疗后6mo的中央视网膜厚度、脉络膜厚度显著低于治疗前和治疗后1、3mo(P<0.05)。经治疗后,观察组与对照组的并发症总发生率分别为5.7%、7.7%(P>0.05)。

结论：玻璃体腔注射康柏西普与注射曲安奈德的效果同样好,不仅可以改善和稳定患者视力,还能有效降低患者的中央视网膜厚度和脉络膜厚度,其疗效显著,安全性较高。     

曲安奈德在玻璃体切割术中的临床应用

目的：探讨玻璃体切割术(PPV)中应用曲安奈德(Triamcinolone Acetonide, TA)识别玻璃体后皮质(PVC)且辅助有效清除残余玻璃体后皮质的临床意义。

方法：收集2009-03/2013-03行玻璃体切割术患者35例35眼,术中分次各注射TA 0.1mL。以帮助辨认玻璃体后皮质、视网膜前增殖膜、黄斑前膜,并有效清除。16例硅油填充,9例C₂F₆填充。术后随访6～12mo。

结果：所有病例经玻璃体腔TA注射后,明显改善玻璃体后皮质、视网膜前膜、内界膜的辨认情况。其中,13例为玻璃体后皮质残留,19例为玻璃体后脱离(posterior detachment of vitreous,PVD)。经过有效的清除后,黄斑裂孔闭合率100%。视网膜复位率84.6%。

结论：利用曲安奈德在玻璃体切割术中的良好可视性能有效识别玻璃体后皮质的残留、减少视网膜损伤、提高手术成功率。没有发现与TA有关的副作用。     

曲安奈德玻璃体腔内注射辅助治疗脉络膜脱离型视网膜脱离

目的:评价玻璃体手术前1d玻璃体腔内注射曲安奈德治疗脉络膜脱离型视网膜脱离的疗效和安全性。方法:对28例(28眼)脉络膜脱离型视网膜脱离患者于玻璃体手术前1d玻璃体腔注射曲安奈德混悬液0.1mL(4mg)。手术方式为巩膜环扎联合玻璃体切除,术后C3F8或硅油充填。24眼随访6～17(平均8.9)mo。结果:28眼注射曲安奈德后葡萄膜炎症减轻。24眼单次手术视网膜解剖复位率87.5%(21/24)。结论:在玻璃体手术治疗脉络膜脱离型视网膜脱离前1d玻璃体注射曲安奈德使手术难度降低,提高了视网膜复位率。     

不同剂量曲安奈德玻璃体腔注射治疗视网膜静脉阻塞性黄斑水肿

目的：比较不同剂量曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射治疗视网膜静脉阻塞性黄斑水肿的临床疗效和相关并发症,探讨有效安全的注射剂量。

方法：回顾性研究我院2015-01/2017-05收治的视网膜静脉阻塞性黄斑水肿患者62例62眼,根据注射剂量不同,分为1mg组、2mg组和4mg组,其中1mg组18例,2mg组22例,4mg组22例。分别予玻璃体腔注射曲安奈德1mg/0.025mL,2mg/0.05mL,4mg/0.1mL。于注射后1、3、6mo三个时间点进行随访,检查并比较三组患眼的最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心区视网膜厚度(central macular thickness,CMT)、眼压及并发症发生情况。

结果：三组患者注射前年龄、性别、病程、BCVA、CMT、眼压等方面比较,差异均无统计学意义(P>0.05)。1mg IVTA组在注射后1、3mo时,BCVA和CMT较治疗前均有改善(P<0.05)。2mg IVTA组、4mg IVTA组BCVA和CMT在注射后1、3、6mo时均优于治疗前(P<0.05)。注射后3mo和6mo时,2mg IVTA组和4mg IVTA组间BCVA和CMT比较,差异无统计学意义(P>0.05),都优于1mg IVTA组(P<0.05)。 2mg IVTA组和4mg IVTA组分别有2例、6例患者发生眼压升高(≥22mmHg),给予β-受体阻滞剂降眼压处理后,6mo随访期末除4mg IVTA组仍有1例需药物降压治疗外,其余均恢复正常(≤21mmHg)。

结论：2mg曲安奈德可能是玻璃体腔内注射治疗视网膜静脉阻塞性黄斑水肿比较合适的剂量。     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

Vitrectomy in traumatic cataracts and in the complications of surgery in congenital cataract in children

Vitrectomies were carried out in 35 children with traumatic cataracts and complications of surgery for cataracts, caused by injury to the posterior lenticular capsule and incorporation of its fragments to the vitreous. Complete removal of lenticular rudiments rapidly eliminated phacogenic iridocyclitis and improved visual acuity. Improvement of visual functions was attained in 66.6% cases; in 33.4% cases visual acuity did not change. Hemorrhages to the vitreous cavity occurred in 4 cases with pronounced iridocyclitis; therefore, a corneal approach is preferable for cases with pronounced iridocyclitis.     

Refractive error in children in a rural population in India

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. METHODS: Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in seven clusters. RESULTS: A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. CONCLUSIONS: Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.