光学相干断层扫描在玻璃体黄斑界面疾病中的临床应用进展

玻璃体黄斑界面疾病主要包括玻璃体黄斑牵引综合征、特发性黄斑视网膜前膜和特发性黄斑裂孔。光学相干断层扫描(optical coherence tom ography,OCT)作为一种新的能提供高分辨活体组织横截面图像的非损伤性影像学检查技术,具有独特的高分辨率、无损伤性等特点,自临床广泛应用以来,为临床玻璃体黄斑界面疾病的诊断、鉴别诊断、病情的监测以及定量评估、治疗方案的选择等方面提供了重要信息及参考价值。我们对玻璃体黄斑界面疾病在OCT图像中的解剖形态学特征的了解,促进了临床对疾病发生、发展的认识。下面我们就OCT在玻璃体黄斑界面疾病的应用进展加以综述。     

玻璃体手术治疗玻璃体黄斑牵引综合征

目的:探讨玻璃体手术治疗玻璃体黄斑牵引综合征疗效。方法:手术前后经光学相干断层扫描(optical co-herence tomography, OCT)、多焦视网膜电图(multifocal electroretinography,m ERG)、荧光素眼底血管造影(funds fluorescein angiography,FFA)等检查确诊为玻璃体黄斑牵引综合征患者12例12眼。采用标准三切口玻璃体切除手术。切除已脱离玻璃体后皮质,松解玻璃体视网膜牵引。结果:黄斑部牵引解除12眼,视力提高2行以上9眼。手术后未见明显并发症。结论:玻璃体手术是治疗玻璃体黄斑牵引综合征的有效方法。     

玻璃体黄斑牵引综合征手术前后光学相干断层扫描的对比研究

目的:对比分析玻璃体黄斑牵引综合征(vitreomacular traction syndrome,VTS)手术前后光学相干断层扫描(optical coherence tomography,OCT)的差异.方法:回顾性分析2013-01/2014-01经OCT检查确诊并接受25G玻璃体切除手术治疗的玻璃体黄斑牵引综合征患者11例11眼的临床资料.患者术后平均随访6mo,观察患者手术前后的视力及OCT检查情况,比较手术前后黄斑区视网膜厚度和局部形态的变化.结果:单纯玻璃体牵引8眼,术后6眼视力提高,2眼视力不提高;黄斑前膜牵引1眼(术中给予黄斑前膜剥除、视网膜内界膜剥除、曲安奈德玻璃体腔注射)术后视力不提高;玻璃体合并视网膜黄斑前膜牵引2眼(术中给予黄斑前膜剥除)术后视力提高.其中视力达0.1以上者所占比例由术前的46%提高至术后的73%.术前黄斑中心凹视网膜平均厚度为619.27±195.13μm,术后平均厚度为239.12±143.84μm,术后黄斑中心凹视网膜平均厚度较术前明显减少,差异有统计学意义(P<0.05).结论:玻璃体切除术能有效解除玻璃体对黄斑部的牵引,阻止患者视力进一步下降,减轻黄斑水肿,并提高部分患者视力,OCT对本组病的诊断及预后有重要的指导意义.     

基因重组纤溶酶ocriplasmin治疗玻璃体黄斑粘连的研究进展

玻璃体黄斑界面异常与多种黄斑疾病的发生和发展密切相关,目前主要的治疗方法是通过玻璃体切割术解除异常的玻璃体视网膜粘连,尤其是对黄斑的牵拉.由于玻璃体切割术的并发症及自身限制,人们一直致力于药物性玻璃体后脱离（PVD）的研究,其中以基因重组纤溶酶ocriplasmin最受关注.大量的实验研究及临床试验表明,玻璃体腔内注射ocriplasmin能形成完整的PVD,解除玻璃体黄斑粘连,在相关疾病的治疗上有广阔的应用前景.就ocriplasmin治疗玻璃体黄斑粘连的机制、药代动力学、实验和临床研究评估及不良反应的研究进展进行综述.     

玻璃体后脱离及其并发症的发病机制

在衰老过程中,玻璃体液化和玻璃体视网膜界面改变可诱发玻璃体后脱离(posterior vitreous detachment,PVD).不完全PVD及异常PVD通过玻璃体视网膜牵拉作用以及容量和化学转移可引起视网膜裂孔、孔源性视网膜脱离、视网膜前膜、黄斑水肿、年龄相关性黄斑变性、黄斑裂孔、玻璃体黄斑牵拉综合征等一系列并发症.为防止这些并发症进一步加重,减轻疾病恶化的风险,可以提前诱导完全性PVD或者采用玻璃体切除手术.目前药物性玻璃体融解术已进入临床前期研究,非酶试剂等非侵入性的治疗方法也在探索阶段.     

特发性黄斑裂孔的玻璃体手术治疗

自从Ｇａｓｓ提出黄斑部玻璃体切线方向的牵引是特发性黄斑裂孔形成的原因，玻璃体手术解除牵引，阻止黄斑裂孔发展，保存黄斑部功能已逐渐被国内外学者采纳，并取得令人鼓舞的结果。本文就玻璃体手术技术，适应证，结果及并发症等作一综述。     

玻璃体黄斑牵引综合征的临床及光相干断层 扫描图像特征

目的观察玻璃体黄斑牵引综合征的光相干断层扫描（OCT）图像特征及临床意义。方法回顾分析经OCT、荧光素眼底血管造影及B型超声检查确诊并经手术证实的25例玻璃体黄斑牵引综合征患者的临床资料，观察玻璃体黄斑牵引综合征的OCT图像特征。结果玻璃体黄斑牵引综合征的OCT图像主要表现为玻璃体反射光带牵拉视网膜，25例大致可分为5种特征，其中，玻璃体黄斑牵引综合征合并黄斑囊样水肿10例，玻璃体黄斑牵引综合征合并视网膜脱离5例，玻璃体黄斑牵引综合征合并黄斑裂孔3例，玻璃体黄斑牵引综合征合并黄斑视网膜前膜6例，玻璃体黄斑牵引综合征合并黄斑劈裂1例。结论玻璃体黄斑牵引综合征的OCT图像主要表现为玻璃体反射光带牵拉视网膜；OCT检查对玻璃体黄斑牵引综合征的诊断及追踪病情发展有重要作用。(中华眼底病杂志,2005,21:86-89)     

玻璃体黄斑牵引综合征的手术疗效观察

目的 探讨玻璃体手术治疗玻璃体黄斑牵引综合征的临床效果及光相干断层扫描、荧光素眼底造影对手术疗效的评价.方法 经裂隙灯前置镜、间接眼底镜检查、B超、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)等检查确诊为玻璃体黄斑牵引综合征行玻璃体手术的患者30例(30只眼)的临床资料进行回顾性分析.结果 30只眼经手术解除玻璃体对黄斑部的牵引.术后20只眼视力提高.术后黄斑区牵引处OCT测量高度平均减小267μm,有明显改善.术前荧光素眼底血管造影检查存在黄斑囊样水肿伴渗漏,术后明显减轻.术前合并高度近视眼者视力预后不佳.结论 玻璃体手术能够有效解除玻璃体对黄斑部的牵引,阻止患者视力进一步下降,减轻黄斑水肿及渗漏,是治疗玻璃体黄斑牵引综合征的有效方法.光相干断层扫描及荧光素眼底造影检查可以对手术疗效进行评价,有利于术后随访.

Abstract：

Objective To evaluate the efficacy of vitreous surgery for patients with vitreomacular traction syndrome. Methods Of 30 patients (30 eyes) who underwent vitrectomy for vitreomacular traction syndrome were retrospectively analyzed. Results Vitreomacular traction was released successfully, and a better visual acuity was obtained in 20 eyes. Mean macular thickness decreased by 267μ m postoperatively. The eyes showed statistically significant improvement in visual acuity and central macular thickness (P <0.05). Optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) showed macular edema gradually alleviated after vitreous surgery. Preoperative high myopia was associated with prognosis of postoperative visual acuity (P<0.05). Conclusions Vitrectomy can relieve macular traction, and is effective for decreasing macular thickness and improvement of vision in vitreomacular traction syndrome. OCT and FFA are useful for evaluation and follow-up for vitreomacular traction syndrome.     

玻璃体黄斑牵引综合征

一、基本概念玻璃体黄斑牵引综合征 (vitreomacular tractionsyndrome,VTS)是指玻璃体不完全后脱离引起的玻璃体对黄斑的持续牵引〔1〕。过去由于认识所限 ,常把这一临床情况视为黄斑裂孔前期或特发性黄斑皱褶。但近年来 ,随着检查手段和玻璃体手术的进步 ,发现它有着不同于前两种疾病的明显特点 ,所以 Smiddy等将 VTS看作一种独立疾病类型〔2～ 4〕,其最主要的特征为眼底黄斑区存在持续地前后向牵引 ,这种牵引是由特征性的玻璃体不完全后脱离引起的 ,因为玻璃体不完全后脱离保持以中心凹为中心 1～ 6PD左右的玻璃体与视网膜粘伏 ,周围…     

玻璃体黄斑牵引综合征的手术治疗

目的 :探讨玻璃体手术治疗黄斑牵引综合征的方法、疗效。方法 :经裂隙灯前置镜、接触镜 ,荧光素眼底血管造影或光学相干断层成像术确诊的玻璃体黄斑牵引综合征共 16例 (16只眼 ) ,采用标准三切口玻璃体切除术切除患眼玻璃体后皮质 ,解除玻璃体视网膜牵引。结果 :16例患眼黄斑区牵引全部解除 ,经 3～ 15个月随访无复发 ;所有视力都有提高 ,术中术后未发现明显并发症。结论 :玻璃体手术是治疗玻璃体黄斑牵引综合征的有效方法。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Current Thoughts on the Aetiology of Ocular Changes during Contact Lens Wear

ABSTRACT: Contact lenses are known to produce changes to the ocular tissues, and this review attempts to give a comprehensive assemblage of the knowledge on the aetiology of such changes. To achieve this result, the changes are categorized by structure and function, and discussed according to the temporal nature of occurrence where appropriate. Although assessment of the importance of a particular tissue change is difficult, this overview enables some degree of judgement to be made on the aetiology of the major side-effects of contact lens wear. This gives a basis on which to modify aspects of contact lens wear to ultimately increase the success rate.     

The detection of motion in chromatic stimuli: first-order and second-order spatial structure

This study provides evidence for the existence of a low-level chromatic motion mechanism and further elucidates the conditions under which its operation becomes measurable in an experimental stimulus. Observers discriminated the direction of motion of amplitude modulated (AM) gratings that were defined by luminance or chromatic variation and masked with spatiotemporally broadband luminance or chromatic noise. The size and retinal location of the stimuli were varied and the effects of broadband noise and grating masks were both compared with the cohort of stimuli. Some significant disparities in the published literature were well explained by the results. In conclusion, evidence for a chromatically sensitive motion mechanism that evades the, detrimental effects of a luminance mask was found only at the fovea and only when the stimulus was small and centrally placed.     

Local chemotherapeutic agents for the treatment of ocular malignancies

We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive.