Objective:To observe the efficacy and safety of vitrectomy combined with subretinal injection of alteplase (tPA) and intravitreal injection of Conbercept in the treatment of large area submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV).Methods:A retrospective clinical study. From January to September 2021, 32 eyes of 32 patients with massive SMH secondary to PCV diagnosed in the Affiliated Eye Hospital of Nanchang University were included in the study. Large SMH was defined as hemorrhage diameter ≥4 optic disc diameter (DD). There were 32 patients (32 eyes), 20 males and 12 females. The mean age was (72.36±8.62) years. All patients had unilateral disease.The duration from onset of symptoms to treatment was (7.21±3.36) days. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA examination was performed using the international standard visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The central macular thickness (CMT) was measured by spectral domain-OCT. The average size of SMH was (6.82±1.53) DD. The logMAR BCVA 1.73±0.44; CMT was (727.96±236.40) μm. All patients were treated with 23G pars plana vitrectomy combined with subretinal injection of tPA and intravitreal injection of Conbercept. At 1, 3, 6 and 12 months after treatment, the same equipment and methods were used for relevant examinations before treatment. The changes of BCVA and CMT, the clearance rate of macular hemorrhage, and the complications during and after surgery were observed. BCVA and CMT before and after treatment were compared by repeated measures analysis of variance.Results:Compared with before treatment, BCVA gradually increased at 1, 3, 6 and 12 months after treatment, and the differences were statistically significant ( F=77.402, P<0.001). There was no significant difference in BCVA between any two groups at different time points after treatment ( P>0.05). Correlation analysis showed that BCVA at 12 months after treatment was negatively correlated with the course of disease ( r=-0.053, P=0.774). One week after treatment, macular hemorrhage was completely cleared in 30 eyes (93.75%, 30/32). The CMT was (458.56±246.21), (356.18±261.46), (345.82±212.38) and (334.64±165.54) μm at 1, 3, 6 and 12 months after treatment, respectively. Compared with before treatment, CMT decreased gradually after treatment, and the difference was statistically significant ( F=112.480, P<0.001). There were statistically significant differences in different follow-up time before and after treatment ( P<0.001). The number of treatments combined with Conbercept during and after surgery was (4.2±1.8) times. At the last follow-up, there was no recurrence of SMH, retinal interlamellar effusion and other complications. Conclusion:Subretinal injection of tPA combined with intravitreal injection of Conbercept is safe and effective in the treatment of large SMH secondary to PCV, and it can significantly improve the visual acuity of patients.
AIM: To observe and quantitatively analyze the thickness of macular ganglion cell inner plexiform layer(GCIPL)and the characteristics of superficial retinal capillaries vessel density in different stages of diabetic retinopathy(DR)by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA).METHODS: A retrospective case-control study. Thirty-three patients with diabetic(54 eyes)were selected as the DR group from December 2019 to May 2020. Among them, six patients(8 eyes)as non-diabetic retinopathy(NDR)group, eighteen patients(28 eyes)as non-proliferative diabetic retinopathy(NPDR)group and nine patients(18 eyes)as proliferative diabetic retinopathy(PDR)group according to fundus conditions. Eighteen healthy volunteers(26 eyes)without eye disease were selected as the normal group. The macular GCIPL thickness and the values of vascular linear density(vascular density, VD)and density of vascular perfusion(perfusion density, PD)in the superficial retinal capillaries vessels in each quadrant of macular region were observed and quantitatively analyzed in DR patients with different stages. RESULTS: The VD, PD and minimum thickness of GCIPL in each quadrant of DR group was lower than that of the healthy control group(P<0.05). The minimum thickness of GCIPL in macular area and the VD of superficial retinal capillaries in each quadrant decreased significantly in patients with different stages of diabetic retinopathy(P<0.01). The inferior VD of superficial retinal capillaries vessels had the highest diagnostic value for DR(AUC=0.807, optimal diagnostic threshold value of 18.60 mm-1, sensitivity of 0.923, specificity of 0.648). The minimum thickness of GCIPL in macular area of DR patients was positively correlated with VD of superficial retinal capillaries vessels in each quadrant(r=0.342, 0.480, 0.384, 0.342, all P<0.05). CONCLUSION: OCT combined with OCTA can provide repeatable and quantifiable detection methods and monitoring indicators for early assessment and regular follow-up of DR progress.
Objective To observe the clinical manifestations of a Wagner syndrome(WS)family.Methods A retrospective clinical study.Four patients(the proband,his father,sister,and brother)and one family member(the proband's mother)from a WS family diagnosed by clinical examination in Chengdu Aidi Eye Hospital in June 2023 were included in the study.The proband's medical history was examined in detail,followed by best corrected visual acuity(BCVA),fundus color photography,optical coherence tomography(OCT),and OCT angiography(OCTA).The proband underwent full field electroretinogram(ERG)examination.The proband and his sister and brother underwent blood glucose,blood pressure,hearing,face,joint,exercise and general physical examination at the same time.Peripheral venous blood was collected from the proband and 4 other family members.The proband extracts genomic DNA samples,conducts target region capture,library construction and high-throughput sequencing after qualified quality control.The suspected pathogenic mutation sites were verified by Sanger.According to the selected mutation sites,other family members in this family were co-isolated and verified.The pathogenicity of the mutation site was analyzed using the guidelines of the American College of Medical Genetics and Genomics(ACMG).Results Proband(Ⅱ-1)was 23 years old female.Both eyes BCVA were 0.1.The waveforms of ERG in both eyes were basically normal,and some amplitudes were reduced.Sister of the proband(Ⅱ-2)was 20 years old.Both eyes BCVA 1.0.Fundus examination showed no obvious abnormality.Brother of the proband(Ⅱ-3)was 19 years old.The left eye underwent pars plana vitrectomy combined with silicone oil filling 2 years ago due to retinal detachment and severe vitreous hyperplasia.BCVA light sensitivity,complicated cataract,and fundus opacity were observed.Right eye BCVA was 0.1.The lenses of the proband and his younger sister and brother were pointed and wedged,and the younger brother was heavier.Vitreous cavity of lens.The retina color of both eyes and the right eye of the younger brother of the protor was dark,with flaky dark areas on the side of the nose and the posterior pole,and the symmetrical retinal veil membrane hyperplasia and pulling on the periphery,showing small retinal splits.The choroidal retina showed focal and segmental symmetrically large atrophy.The optic disc was tilted.By OCT examination,the ellipsoid band was partially missing and broken,and the thickness of the choroid layer was reduced.Retinal cortical atrophy in 1 eye(younger brother of proband).By OCTA examination,the mesovascular layer of choroid was atrophied seriously and the blood density decreased.The results of laboratory and general examination of the three siblings showed no obvious abnormalities.The results of genetic testing showed that the proband,his father(Ⅱ-1),his sister and his brother carried a heterozygous mutation of the VCAN gene c.9264A＞G(p.Pro3088=).According to ACMG guidelines,the pathogenicity of this variant was unknown.The mother of proband(Ⅰ-2)was wild type.Conclusions The abnormal manifestations of WS eyes are diverse,and both anterior and posterior segments could be involved.The pathogenicity of the heterozygous variation of VCAN gene c.9264A＞G(P.RO3088=)in this family is unknown.
Age-related macular degeneration (AMD) is the main cause of low vision and even blindness in the elderly. With the aging of our population, the number of AMD patients will continue to rise. In the past decade, the rapid development of ocular fundus imaging technology has provided a new perspective and approach for the classification, diagnosis and follow-up of AMD. The advent of new drugs has provided more diverse intervention and treatment methods for AMD, especially for neovascular AMD, and the emphasis on accurate and individualized treatment has put forward higher requirements for retinal specialists. Therefore, based on the latest evidence-based medical information, combined with the international guidelines and the current situation of China′s social and economic development, experts from the Chinese Vitreo-Retinal Society of Chinese Medical Association, the Fundus Disease Group of Chinese Ophthalmologist Association, and the National Clinical Research Center for Eye Diseases gave recommendations around eight clinical problems and formed China′s guidelines for the clinical diagnosis and treatment of AMD. With the implementation of these guidelines, we can standardize the diagnosis, treatment, prevention and follow-up of AMD in China. (This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on April 6, 2023)
外周渗出性出血性脉络膜视网膜病变(PEHCR)是以视网膜下出血和(或)视网膜色素上皮下出血或渗出为主要特征的周边视网膜疾病,常被误诊为老年性黄斑变性、息肉样脉络膜血管病变或脉络膜黑色素瘤等.随着多模式影像学发展,PEHCR在B型超声、荧光素眼底血管造影、光相干断层扫描等检查中表现出不同特征,据此可与上述疾病鉴别.该病治疗方法包括激光光凝治疗、玻璃体腔注射抗血管内皮生长因子药物和玻璃体切割手术等,但目前尚无统一治疗标准.未来仍需进一步深入了解PEHCR临床特征、治疗方案及预后,最大程度避免临床漏诊与误诊,提高治疗效率.
患者男,18岁.因双眼突然视力下降2d,于2022年4月至济宁医学院附属医院眼科就诊.1个月前体检测得血压145/95 mm Hg(1 mm Hg=0.133 kPa),未治疗;1 周前复查血压150/90 mmHg,口服吲达帕胺片(2.5mg/次,1次/d)控制血压.眼部检查:右眼、左眼视力均为0.02、矫正视力分别为 0.6、1.0.
目的 观察非增生型糖尿病视网膜病变(NPDR)患眼黄斑区外层视网膜光密度(ORR)改变及其与视网膜血流密度的相关性.方法 回顾性临床研究.2021年8月至2022年3月于广东省人民医院眼科检查确诊的NPDR患者63例63只眼(NPDR组)纳入研究.其中,男性39例39只眼,女性24例24只眼;年龄60(52,68)岁.选取同期年龄、性别匹配的健康志愿者66名66只眼作为对照组.其中,男性40名40只眼,女性26名26只眼;年龄58(52,67)岁.所有患眼均行光相干断层扫描(OCT)、OCT血管成像(OCTA)检查.OCT检查:采用Image J软件计算ORR,包括椭圆体带(EZ)、光感受器外节(OS)、光感受器内节(IS)、外核层(ONL)光密度.采样位点为水平、垂直扫描黄斑中心凹以及鼻侧、颞侧、上方、下方分别距离黄斑中心凹500 μm(鼻侧500、颞侧500、上方500、下方500)、1000 μm(鼻侧1000、颞侧1000、上方1000、下方1000)、2 000 μm(鼻侧2000、颞侧2000、上方S2000、下方2000)区域.黄斑区OCTA检查:软件自动将黄斑中心凹6 mm范围内视网膜划分为直径为1mm的中心凹区,1～3mm的旁中心凹区,3～6mm的中心凹周围区.采用设备自带软件测量黄斑区6mm×6mm范围内不同分区浅层毛细血管丛、深层毛细血管丛血流密度.采用Spearman相关性分析法分析ORR与血流密度的相关性.结果 与对照组比较,NPDR组EZ光密度在除中心凹外的其他位点均显著降低,OS光密度在鼻侧2000、颞侧2000、上方2000、上方1000处显著降低,1S光密度在上方1000、上方500、下方500处显著降低,ONL光密度在黄斑中心凹处显著降低,差异均有统计学意义(P＜0.05).ORR与血流密度普遍呈正相关,NPDR组相关系数比对照组低.多因素线性回归分析结果显示,上方、颞侧部分ORR与血流密度相关(P＜0.05).结论 与对照组比较,NPDR患眼ORR与视网膜血流密度的相关性降低;ORR在颞侧和上方更易受视网膜血流密度的影响.
患者男,49岁.因右眼视网膜脱离修复手术后眼压反复升高5年,于2021年2月17日到四川大学华西医院眼科就诊.患者5年前因右眼视网膜脱离于外院行玻璃体切割手术(PPV)+视网膜激光光凝+硅油填充手术.
目的 观察抗胶质纤维酸性蛋白(GFAP)抗体阳性4例患者的临床特征.方法 回顾性研究.2017年1月至2021年12月于空军军医大学西京医院眼科和神经内科住院治疗的抗GFAP抗体阳性患者4例纳入研究,包括视神经炎(ON)3例,脊髓/脑病变1例.患者均为女性;平均年龄35岁.3例ON患者接受最佳矫正视力(BCVA)、光相干断层扫描、视觉诱发电位、头颅和眼眶核磁共振成像(MRI)检查;1例脊髓/脑病变患者行头颅、颈椎、胸椎MRI检查.所有患者接受血清脱髓鞘抗体检测,脊髓/脑病变者同时接受脑脊液脱髓鞘抗体检测.ON患者急性期给予静脉滴注甲泼尼龙琥珀酸钠治疗;脊髓/脑病变患者给予糖皮质激素及免疫抑制剂治疗.结果 ON患者首发症状均为右眼突发性视物模糊伴眼球转动痛;BCVA分别为手动/眼前、0.2和0.12;血清抗GFAP抗体均为阳性;MRI检查,1例视神经毛糙、增粗.BCVA手动/眼前者,出院时BCVA提高至数指/30cm;2例BCVA无变化.出院2～3年后电话随访BCVA均提高至0.6以上.脊髓/脑病变患者无视神经受累,首发症状为肢体麻木无力及抽搐;血清抗GFAP抗体阴性,脑脊液抗GFAP抗体阳性;MRI检查,小脑及脊髓硬膜均有强化.出院时症状缓解;出院后电话随访症状消失.结论 抗GFAP抗体阳性患者多见于中青年女性;以单眼ON多见,表现为突发性视物模糊伴眼球转动痛,血清抗GFAP抗体阳性,个别患者MRI检查显示视神经毛糙及增粗,对糖皮质激素治疗敏感,预后较好.
患儿女,4岁.因体检发现右眼视力不佳2个月,于2022年1月25日到中南大学湘雅二医院眼科门诊就诊.既往无眼外伤史及眼部手术史,无传染病及寄生虫接触史,无食物药物过敏史,无全身其他疾病史.眼科检查:右眼裸眼视力数指/50 cm(颞侧),+8.50 DS/+1.25 DC × 70°→0.02-;左眼裸眼视力0.06,+7.50 DS/+0.75 DC× 120°→0.2.双眼眼压15 mm Hg(1 mm Hg=0.133 kPa).
在全面反映我国眼底病学科专业领先的临床和基础研究成果的办刊宗旨指导下,如何有效配置资源,统筹各种要素,尽量满足读者多元化的阅读诉求和作者日渐趋同的发表功利是本刊不断探索的重要问题之一.通过专题号的形式集中反映眼底病临床和基础研究的热点难点,满足读者阅读兴趣诉求的同时,体现杂志的学术导向,推动学术进步和学科发展是本刊近年为解决这一问题而形成的特色方法.
目的 观察并分析非动脉炎性前部缺血性视神经病变(NAION)患者的临床特征和误诊原因.方法 回顾性病例研究.2014年11月至2022年7月于兰州市第一人民医院眼科检查确诊的NAION患者49例49只眼纳入研究.所有患者首诊均被误诊为其他眼部疾病.所有患眼均行最佳矫正视力(BCVA)、相对性传入性瞳孔障碍(RAPD)、眼底彩色照相、眼眶核磁共振成像(MRI)、视野、光相干断层扫描(OCT)、图形视觉诱发电位(P-VEP)检查.同时行荧光素眼底血管造影(FFA)检查32只眼.回顾分析患者临床及MRI、视野、P-VEP、FFA等特征.结果 49例患者中,男性31例,女性18例;均为单眼发病;年龄(59.3±7.8)岁.均主诉单眼无痛性视力下降或视物遮挡感.出现症状至就诊时病程＞2个月、≤2个月分别为12(24.5％,12/49)、37(75.6％,37/49)例.49只眼中,误诊为视神经炎、正常眼压性青光眼(NTG)或疑似青光眼、视盘血管炎、白内障、糖尿病视网膜病变、外伤性视神经病变、中毒性视神经病变分别为28(57.1％,28/49)、11(22.4％,11/49)、5(10.2％,5/49)、2(4.1％,2/49)、1(2.0％,1/49)、1(2.0％,1/49)、1(2.0％,1/49)只眼.BCVA＜0.1、0.1～0.5、＞0.5者分别为24(49.0％,24/49)、16(32.7％,16/49)、9(18.4％,9/49)只眼.RAPD阳性45只眼(91.8％,45/49).伴、不伴视盘水肿分别为37(75.6％,37/49)、12(24.5％,12/49)只眼;伴有视盘表面及视盘周围(盘周)出血15只眼(30.6％,15/49).MRI检查,所有患眼视神经段未见明显异常.OCT检查伴视盘水肿的37只眼视网膜神经纤维层增厚,为(307.1±62.1)μm.视野检查,表现为典型的与生理盲点相连的绕过中心注视点的下方视野缺损24只眼(49.0％,24/49),与生理盲点相连的局限性视野缺损6只眼(12.2％,6/49),弥漫性视野缺损19只眼(38.8％,19/49).P-VEP检查,所有患眼P100波振幅中至重度下降;峰时轻度延迟24只眼(49.0％,24/49),峰时中度延迟11只眼(22.4％,11/49).行FFA检查的32只眼,动脉早期盘周局限或弥漫性充盈延迟,中期相应区域荧光素渗漏.结论 NAION患者以单眼无痛性视力下降或视物遮挡感为主要症状,临床主要特征为视野缺损、视网膜神经纤维层增厚及视觉电生理异常.急性或亚急性视力下降并伴有视盘水肿和(或)出血的NAION患者易被误诊为视神经炎、视神经血管炎、其他类型视神经病变等;病程＞2个月易误诊为NTG.
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黄斑区是形成空间视力和色觉的关键解剖结构,黄斑疾病严重威胁患者的视觉功能及生活质量.非人灵长类动物(NHP)是唯一拥有类似人类黄斑结构的哺乳动物,因此在研究黄斑疾病方面具有重要价值.目前,多种方法包括自发性、基因编辑、药物诱导、光诱导及机械性损伤等,可用于筛选和构建NHP模型,用于研究眼皮肤白化病、全色盲、视网膜色素变性、老年性黄斑变性及一些罕见的眼部综合征.在构建NHP模型时,应充分考虑其他动物模型,以实现模型之间的互补研究.此外,应充分发挥NHP的资源优势,创建具有可控遗传背景的灵长类品系,有助于早日实现可持续利用的目标.
目的 观察白细胞介素-8(IL-8)对视网膜血管内皮细胞(RCEC)黏附和迁移的影响.方法 细胞实验研究.将人RCEC(hRCEC)分为正常对照组(N组)、糖基化终末产物(AGE)处理组(AGE组)、AGE诱导联合IL-8抑制剂SB225002处理组(AGE+SB组).采用蛋白质免疫印迹法观察AGE对hRCEC中IL-8表达水平的影响;细胞划痕实验观察SB225002对hRCEC迁移的影响;流式细胞仪检测SB225002对hRCEC上白细胞黏附、活性氧(ROS)产生的影响.两组间比较行Student-t检验;三组间比较行单因素方差分析.结果 与N组比较,AGE组细胞中IL-8表达水平显著升高,差异有统计学意义(t=25.661,P＜0.001).与N组、AGE+SB组比较,AGE组细胞迁移率显著升高(F=29.776),白细胞黏附数量明显增多(F=38.159、38.556),ROS表达水平显著增高(F=22.336),差异均有统计学意义(P＜0.05).结论 IL-8拮抗剂SB225002可能通过抑制ROS的表达而下调hRCEC的黏附和迁移.
视神经脊髓炎谱系疾病(NMOSD)是一种免疫介导的中枢神经系统炎性脱髓鞘性疾病.血脑屏障(BBB)破坏作为NMOSD发病机制中的重要环节,对疾病的发生、发展以及预后转归具有重要影响.外周血循环中产生的水通道蛋白4抗体通过BBB后对中枢神经系统造成损伤,NMOSD疾病发生和发展过程中存在参与破坏BBB的成分.目前对于NMOSD中BBB破坏的分子机制知之甚少,且缺乏系统化理论,进一步研究探索NMOSD疾病中BBB通透性调节机制及屏障破坏的表现,对于了解NMOSD发病机制,进而达到早期诊断,以及发现新的治疗和预防靶点具有重要意义.
目的 了解缺血性视神经病变(ION)领域研究现状、热点及未来发展趋势.方法 以"缺血性视神经病变"或"ischemic optic neuropathy"为主题词或关键词检索中文、英文数据库中相关文献,检索时间为2000年1月1日至2022年12月31日.应用文献计量学方法与软件构建作者、研究机构、关键词共现、爆发词突现及关键词聚类可视化图谱.结果 共纳入1 203篇ION相关文献,其中中文、英文文献分别为1 106、97篇.该领域近20年年发文量整体呈波动上升趋势,以中文文献为主,英文文献呈低态势增长.中文文献共计2 171名作者,英文文献中共计368名中国作者;高产作者中形成了以王润生、魏世辉、钟勇、韦企平教授等为代表的核心团队.中文文献共涉及799家研究机构,英文文献涵盖119家中国机构;西安市第一医院、首都医科大学附属北京同仁医院分别位居中文、英文文献发文量之首.确定中文、英文高频关键词121、23个,除"缺血性视神经病变"外,"复方樟柳碱、视野、视力、治疗、危险因素、pathogenesis、optic nerve、rAION"等出现频次也较高.突现分析后,中文文献得到突现词13个;英文文献因文献量较少,无突现词出现.英文文献关键词形成11个聚类.中文、英文文献均以非动脉炎性前部缺血性视神经病变(NAION)临床疗效观察性研究为主.结论 近20年我国ION研究文献呈增长趋势;主要以NAION治疗、危险因素、辅助检查在疾病诊断中的应用研究为主;联合用药、光相干断层扫描血管成像在疾病中诊断中的应用及发病机制研究仍是未来研究趋势.
患者女,54岁.因右眼视力下降、眼痛半个月于2021年7月28日到山东第一医科大学附属青岛眼科医院就诊.患者1个月前有低热,头痛和踝关节、膝关节疼痛,伴食欲差、上腹部不适,无咳嗽.既往身体健康.眼部检查:右眼视力0.25,矫正不能提高;左眼视力1.0.右眼、左眼眼压分别为11.3、11.4 mm Hg(1 mm Hg=0.133 kPa).双眼眼前节正常.
