从新版美国眼科临床指南(PPP)反思特发性黄斑裂孔手术中内界膜的处理

玻璃体切除术联合眼内气体填充是治疗特发性黄斑裂孔(IMH)的主要方法。2017年美国眼科学会发布了新版IMH眼科临床指南(PPP),推荐在IMH的玻璃体手术中进行内界膜(ILM)剥除,以提高IMH的闭合率,同时减少术后复发。ILM剥除已成为IMH手术的重要改进之一。然而,ILM剥除会对视网膜结构造成损伤,并给视网膜功能造成潜在影响。关于ILM剥除仍有一系列值得反思和进一步探讨的问题。     

重基础,与时进,不断提高增生型糖尿病视网膜病变的手术疗效

增生型糖尿病视网膜病变(PDR)是一种严重致盲性眼病。PDR发展到一定阶段需玻璃体视网膜手术干预才能阻止病情加剧。PDR的手术常较复杂、技术难度高。通过深入认识PDR的病理机制和发展规律,合理运用各种手术技术,辅以新兴的手术设备和药物,方可不断提升PDR的手术疗效,更大程度帮助患者改善甚至恢复视功能。     

光学相干断层扫描对黄斑"白孔"性视网膜脱离的疗效评价

目的使用光学相干断层扫描(opticalcoherencetomography,OCT)观察用不同眼内填充物(C3F8气体或硅油)治疗伴随视网膜脱离的高度近视性黄斑“白孔”的预后。方法对由于高度近视性黄斑“白孔”而发生视网膜脱离,并接受玻璃体切除联合眼内填充物注入术的29眼(C3F8填充的10眼、硅油填充的19眼)进行随访,使用OCT评价黄斑孔的愈合情况。结果经OCT检查证实,19眼经玻璃体切除联合硅油填充术治疗后黄斑裂孔成功闭合,其中8眼是在以C3F8填充后未愈,而再次行玻璃体切除手术并改用硅油填充治疗获成功。10只患眼以玻璃体切除联合C3F8填充手术后视网膜复位,但8只患眼黄斑孔未闭合。结论使用OCT检查可以帮助评价手术疗效。适当采用玻璃体切除联合眼内硅油填充手术有助于提高黄斑裂孔的闭合成功率。     

糖尿病性视网膜病变合并白内障的手术治疗--晶状体超声乳化、玻璃体视网膜手术与眼内光凝联合手术

目的 探讨晶状体超声乳化、玻璃体视网膜手术与眼内光凝联合治疗糖尿病性视网膜病变合并白内障的临床效果。方法 对23例(24眼)糖尿病性视网膜病变合并白内障的患者行晶状体超声乳化、玻璃体切除、眼内视网膜手术、视网膜激光凝固与人工晶状体植入的联合手术治疗。结果 术后出院成功率87.5%(21/24),24眼术后随访5～38月,平均11.3月,随访成功率83.3%(20/24)。术后视力>0.05者占66.7%,随访视力>0.05者占70.8%。结论 对患糖尿病性视网膜病变合并白内障者,在条件允许的情况下采取联合手术治疗,可取得较理想的效果。     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

Objective To observe the Fourier-domain optical coherence tomography(FD-OCT) characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s, area of 6.0 mm× 6.0 mm, and mode of 512 × 128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings., no traction (9.48 %), tangential traction (84.48 %) and tangential traction with anterior-posterior traction (6.04 %). A total of 97 eyes (83.62 %) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL). A total of 14 eyes (12. 07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment j unction(Ls/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis(P>0.05), but was related with CFT(P<0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients" visual acuity.     

高度近视眼底后部血管弓旁视网膜改变的频域光学相干断层扫描特征

目的通过频域光学相干断层扫描仪（OCT）观察高度近视眼底后部血管弓旁视网膜的形态改变并探讨相关因素。方法横断面研究。177例双眼高度近视患者（屈光不正≥－8 D或眼轴 ＞26.5 mm）,随机选择其中一只眼采用频域OCT观察后部血管弓旁视网膜形态。以高度近视伴血管弓旁视网膜改变为阳性组,高度近视不伴血管弓旁视网膜改变为阴性组,比较2组患者年龄、患眼屈光度以及眼轴长度的差异行独立样本t检验,2组患者后巩膜葡萄肿例数的差异行卡方检验。结果经频域OCT扫描证实,108例患者（61.0%）存在后部血管弓旁视网膜形态改变,平均年龄（59.3±6.2）岁。108只患眼等效球镜度（-13.55±3.43）D,眼轴长度（29.57±2.06）mm。阴性组69例（39.0%）患者平均年龄（34.8±13.1）岁,等效球镜度（-9.50±3.07）D,眼轴长度（27.02±1.02）mm。2组患者年龄（t=10.466,P<0.05）、等效屈光度（t=7.454,P<0.05）以及眼轴长度（t=10.979,P<0.05）差异均有统计学意义。在阳性组中,108例患者（100.0%）伴有血管弓旁视网膜微囊肿和微皱褶,65例（60.2%）伴有视网膜板层裂隙或裂孔,53例（49.1%）伴有视网膜不同层次的劈裂,1例（0.9%）伴有牵引性视网膜脱离。所有视网膜形态改变集中分布于距离视盘2～3 PD的后巩膜葡萄肿凹陷区内。阳性组101眼伴有后巩膜葡萄肿,阴性组48眼伴有后巩膜葡萄肿,2组差异具有统计学意义（x²=16.999,P<0.05）。结论高度近视眼后部血管弓旁视网膜常见一系列细微的形态改变,玻璃体皮质牵引和后巩膜葡萄肿的发展应是其形成的重要原因。     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

目的 观察特发性黄斑前膜的光相干断层扫描（OCT）特征以及与患者视力的相互关系。方法 回顾分析2008年5月至12月间确诊的特发性黄斑前膜患者112例116只眼的临床资料。所有患者均进行最佳矫正视力、眼底和OCT检查。视力采用LogMAR视力表检查;眼底检查采用直接检眼镜和前置镜检查;OCT检查采用Zeiss HD-OCT,扫描速度27 000 A扫描/s, 扫描区域6.0 mm×6.0 mm,扫描模式为512×128。根据OCT检查所见的黄斑前膜对视网膜不同牵引情况对黄斑前膜进行分类,测量黄斑中心厚度（CFT）、体积、平均厚度以及黄斑中心凹厚度（FT）。采用SPSS16.0软件对患者的各项OCT检查指标和临床检查结果进行统计分析。结果 116只黄斑前膜眼可分为无视网膜牵引、切线方向或切线方向合并前后方向牵引3种情况,各自分别占本组患眼的9.48%、84.48%、6.04%。97只眼合并视网膜水肿,占总眼数的83.62%;水肿分别位于外核层(ONL),外网状层(OPL),内核层(INL)。14只眼合并视网膜神经纤维层(RNFL)劈裂,占总眼数的1207%;27只眼有视细胞内外节（IS/OS）损伤,占总眼数的23.28%。CFT与视力密切相关（P<0.05）,而体积、平均厚度和FT与视力无相关性（P＞0.05）。患者年龄、性别、不同种类的视网膜牵引、是否合并板层孔、IS/OS损伤和RNFL劈裂等与视力无相关性。结论 特发性黄斑前膜的OCT特征可表现为有无视网膜牵引以及视网膜水肿和视网膜神经纤维层劈裂。在CFT、体积、平均厚度以及FT等黄斑区OCT测量指标中,CFT与患者的视力关系最为密切。     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

Objective To observe the Fourier-domain optical coherence tomography(FD-OCT) characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s, area of 6.0 mm× 6.0 mm, and mode of 512 × 128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings., no traction (9.48 %), tangential traction (84.48 %) and tangential traction with anterior-posterior traction (6.04 %). A total of 97 eyes (83.62 %) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL). A total of 14 eyes (12. 07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment j unction(Ls/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis(P>0.05), but was related with CFT(P<0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients" visual acuity.     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

Objective To observe the Fourier-domain optical coherence tomography(FD-OCT) characteristic of idiopathic epiretinal membrane (ERM) and its correlation with the patients visual acuity. Methods The 116 eyes (112 patients) with idiopathic epiretinal membrane were included in this study. All the patients had undergone examination of visual acuity (LogMAR chart), ocular fundus (direct ophthalmoscope and fundus pre-set lens), and FD-OCT (Zeiss HD-OCT) with the speed of 27 000 A scan/s, area of 6.0 mm× 6.0 mm, and mode of 512 × 128. The central fovea thickness (CFT), volume (V), average thickness (AT) were collected from the OCT readings, and the fovea thickness (FT) was measured manually. Data were analyzed using SPSS 16.0. Results The traction on retina caused by ERM can be divided into 3 types according to the OCT findings., no traction (9.48 %), tangential traction (84.48 %) and tangential traction with anterior-posterior traction (6.04 %). A total of 97 eyes (83.62 %) had retinal edema (diffuse or cystoid) and the edema located at the outer nuclear layer(ONL), outer plexiform layer(OPL)and inner nuclear layer (INL). A total of 14 eyes (12. 07%) had retinal nerve fiber layer (RNFL) schisis and 27 eyes (23.28%) had inner segment/outer segment j unction(Ls/OS) impairment. Statistic analysis revealed that BCVA was not related to the age, gender, types of traction, presence of IS/OS damage or RNFL schisis(P>0.05), but was related with CFT(P<0.05). Conclusions Idiopathic ERM can exert different types of traction on the macular, and cause different types of retinal lesions. OCT is a useful tool to measure these lesions. CFT reading is closely related to patients" visual acuity.     

伏格特-小柳-原田综合征患者外周血中CD4+CD25+调节性T细胞的比例变化

目的 观察伏格特-小柳-原田（VKH）综合征患者治疗前以及治疗1个月后外周血中CD4⁺CD25⁺FOXP3⁺ T细胞的比例变化。方法 采集15例VKH综合征患者治疗前以及系统的糖皮质激素治疗1个月后的外周血，分离淋巴细胞。采用细胞表面标志物CD4、CD25以及特征性的细胞核内转录因子叉状头/翅膀状螺旋转录因子(FOXP3)的抗体标记CD4⁺CD25⁺调节性T细胞，流式细胞仪检测CD4⁺CD25⁺FOXP3⁺ T细胞的比例，并与15例以健康志愿者为正常对照组的外周血中的该亚群细胞水平进行比较。结果 外周血中CD4⁺CD25⁺FOXP3⁺ T细胞占CD4⁺细胞的比例，治疗前患者组为（0.30±0.19）%，正常对照组为（1.41±0.52）%，二者比较，差异有统计学意义（t＝7.665，P＜0.01）；治疗1个月后，患者组为（1.28±0.54）%，接近正常对照组。另有2例患者在治疗1个月后外周血中CD4⁺CD25⁺ T细胞比例异常升高。结论 VKH综合征患者外周血中CD4⁺CD25⁺FOXP3⁺ T细胞的比例治疗前显著低于正常对照组，治疗后与正常对照组接近，表明VKH综合征的发病可能与患者外周血中天然性CD4⁺CD25⁺调节性T细胞的比例下降有关。