Utility of Optical Coherence Tomography in the Diagnosis and Management of Optic Neuropathy in Patients with Fibrous Dysplasia

Optic neuropathy (ON) is a highly disabling complication of fibrous dysplasia (FD). The optimal test for identifying and monitoring ON in FD is unknown. Optical coherence tomography (OCT) is an imaging modality that detects retinal nerve fiber layer (RNFL) thinning, a sign of optic nerve atrophy. The purpose of this study was to (i) assess the ability of OCT RNFL thickness measurements to identify ON in FD; (ii) compare the performance of RNFL thickness to computed tomography measurements; and (iii) examine changes in RNFL thickness over time to assess disease progression. A retrospective cohort study was performed to assess subjects (n = 70) who underwent neuro-ophthalmologic examination, including OCT. The diagnostic utility of RNFL thickness was determined using receiver operator characteristic (ROC) curve analysis, and the accuracy was compared with computed tomography measurements. The relationship between RNFL thickness and age was assessed cross-sectionally, using generalized estimating equation methodology, and longitudinally, using a generalized mixed model. Eleven subjects were identified with ON. RNFL thickness identified ON (area under curve = 0.997, p < 0.0001) with sensitivity and specificity of 100% and 95%, respectively, when using the diagnostic criterion of ≤71 μm. RNFL thickness outperformed computed tomography measurements of optic canal narrowing and optic nerve stretch. Subjects with ON exhibited a greater decrease in RNFL thickness with each year of age (−0.70 μm/year, p < 0.001) than subjects with normal vision (−0.16 μm/year, p < 0.05). When assessed longitudinally, subjects with normal vision demonstrated an increase in RNFL thickness until approximately age 20 years that decreased thereafter. In contrast, subjects with ON exhibited an earlier decrease in RNFL thickness during adolescence. In conclusion, RNFL thickness of ≤71 μm accurately identified ON in this population. By establishing the difference in rate of RNFL thinning in patients with and without ON, clinicians may distinguish between patients at risk for ON and intervene before irreversible damage. © 2020 American Society for Bone and Mineral Research.     

染料激光光斑变换模式与光凝效果的关系

以齐焦点式（ｐａｒｆｏｃａｌｔｙｐｅ）及散焦点式（ｄｅｆｏｃａｌｔｙｐｅ）染料激光的四种波长（５７７、５９０、６１０、６３０ｎｍ）分别对有色家兔视网膜及虹膜进行中等能量光凝固，然后用光学显微镜及扫描电镜观察各波长光凝组织的凝固反应，发现在相同光凝条件下，齐焦点式染料激光的光凝组织反应具有波长特性，而散焦点式染料激光则波长特性很不明显，提示照射光斑大小的变换模式不同可造成组织光凝效果的明显差异。本文就这种差异在眼组织激光治疗中的临床意义及中心过度光凝现象（ｈｏｔｓｐｏｔ）的原因进行了初步探讨。     

中医治疗黄斑出血临床疗效观察

黄斑出血是一种见于多种眼底病的临床体征,常造成严重的视功能障碍,目前尚无特效疗法。我科在辨证论治的基础上,结合三期治疗,观察了22例26眼,有效率达88.5%,取得了比较满意的疗效.     

糖尿病视网膜病变中医证候与西医分期的关系研究

【目的】研究糖尿病视网膜病变患者中医证候演变特征。【方法】对245例糖尿病视网膜病变患者不同分期的中医证候进行分析。【结果】经计数资料的相关分析表明，糖尿病视网膜病变的中医证候及其合并证候与病变的分期和病程均存在相关性（均P=0．0000）。①气阴两虚证、阴虚内热证、脾虚湿热证在亚临床期、单纯期分别占33．85％、33．00％、32．30％、25．00％、21．54％、26．00％；与同期脾虚痰湿证、阴阳两虚证相比较，差异有统计学意义（P〈0．05或P〈0．01）；在增殖期，气阴两虚证、脾虚痰湿证、阴阳两虚证分别占39．74％、26．92％、19．23％，与阴虚内热证、脾虚湿热证相比较，差异均有统计学意义（P〈0．05），阴阳两虚证在增殖期所占比例与单纯期、亚临床期比较，差异均有统计学意义（P〈0．05）；②病程在5年以下者，气虚证占85．48％为最多见，其次是阴虚证；病程在15年以上者，血瘀证型、痰湿证型达100％。【结论】糖尿病视网膜病变的中医证候在各期、各病程阶段是动态变化的。     

Influence of Cross-Linker Concentration on the Functionality of Carbodiimide Cross-Linked Gelatin Membranes for Retinal Sheet Carriers

Carbodiimide cross-linking can easily regulate the functionality of gelatin carriers used for retinal sheet delivery. This paper investigates the effect of cross-linker concentrations (0–0.4 mmol EDC/mg gelatin membrane (GM)) on the properties of the chemically-modified GMs. ATR–FT-IR and ninhydrin analyses results consistently indicated that the EDC cross-linking reaction approaches saturation at concentrations around 0.02 mmol EDC/mg GM. The thermal stability and resistance to water dissolution and collagenase digestion were significantly enhanced with increasing cross-linker concentration from 0.001 to 0.02 mmol EDC/mg GM. In addition, the chemical cross-linking did not affect the ability to form a tissue-encapsulating structure at 37°C. Irrespective of their cross-linking degree, the GMs had an appropriate degradation rate sufficient to allow tissue integration. It was noted that, although high cross-linker concentrations can be used to improve the delivery efficiency of gelatin samples, the treatment with 0.1–0.4 mmol EDC/mg GM may lead to poor biocompatibility. Results of Live/Dead and pro-inflammatory cytokine expression analyses showed that the exposure of ARPE-19 cultures to the test materials cross-linked with a concentration ≥0.1 mmol EDC/mg GM induces significant cytotoxicity and high levels of interleukin-1β and interleukin-6. However, the presence of EDC cross-linked gelatin membranes in the culture medium had no effect on the glutamate uptake capacity. It is concluded that among the cross-linked gelatin samples studied, 0.02 mmol EDC/mg GM is the best cross-linker concentration for preparation of retinal sheet delivery carriers.     

远达性创伤性视网膜血管病变(附1例病例报告)

远达性创伤性视网膜血管病变(Purtscher 病)是由身体远隔部位遭受损伤后在眼球发生的一种特殊的视网膜病变。Purtscher 病的眼底改变,以渗出、出血、水肿和黄斑改变为特征。本病尚属少见,且无特殊疗法。本文报道运用中西医结合疗法治疗1例远达性创伤性视网膜血管病变,中医治以活血祛瘀、补益肝肾,方用桃红四物汤加二至丸、石菖蒲、北芪,配合西药多种维生素、肌苷等,治疗26天,患者视力提高,眼底出血已吸收,黄斑部水肿消失,疗效较为满意。     

高度近视的震荡电位分析

对８５眼高度近视进行的震荡电位分析的结果表明：高度近视震荡电位的总波幅及其他各小波的波幅改正常值明显降低，在揭示视功能损害方面，震荡电位的总波幅比视网膜电图的ａ波、ｂ波振幅及ａ波潜时更为重要。     

低能量激光结合中药治疗顽固性中心性浆液性视网膜脉络膜病变

利用低能量染料激光光凝渗漏点，结合中药治疗按常规中西药连续治疗２个月至半年，而仍难于奏效的顽固性中心性浆液性视网膜脉络膜病变患者１２例１２眼。结果：治愈１０眼．好转１眼，无效１眼，总有效率达９１．７％。说明运用激光结合中药治疗该病，视力恢复明显，疗程缩短，疗效满意。     

针刺对实验性糖尿病大鼠视网膜病变的影响及其作用机理的研究

本研究对糖尿病大鼠的视网膜血管铺片进行了观察。与以往结论不同，本实验在３个月病程的糖尿病大鼠即发现其具有毛细血管曲张、管径不规则、微血管瘤和无细胞毛细血管等糖尿病性视网膜病变（ＤＲＰ）特征，病程至６个月时，各种病变进一步加重。针刺后观察，其微血管病变得到改善。有关机理研究的结果表明：针刺防治ＤＲＰ的作用机理是改善微循环、减轻血栓形成倾向、提高红细胞变形能力、降血糖等综合效应的结果。