目的:评价不同操作者使用视网膜自动图像分析(automated retinal image analyzer,ARIA)软件测量糖尿病患者视网膜血管管径和迂曲度的重复性和再现性.方法:采用前瞻性诊断性试验研究设计,由2名熟练操作者应用ARIA软件对49名糖尿病患者以视盘为中心的45°数码眼底彩照进行视网膜血管半自动分析.通过测量距离视盘0.5～1.0个视盘直径内的视网膜动静脉血管参数,各选取6条最粗的动静脉综合计算得到中央动脉管径当量(central retinal artery equivalent,CRAE)、视网膜中央静脉管径当量(central retinal vein equivalent,CRVE)、视网膜动静脉比值(arteriole-to-venule ratio,AVR)、平均视网膜动脉迂曲度(mean retinal arteriolar tortuosity,MRAT)、平均视网膜静脉迂曲度(mean retinal venular tortuosity,MRVT).在此基础上,评价同一操作者与不同操作者间测量结果的重复性和再现性,并绘制Bland-Altman图进行一致性分析.结果:操作者A两次测量的CRAE、CRVE、AVR差异无统计学意义(t=?0.089、?1.425、1.214,均P>0.05),重复性良好(ICC≥0.725)且高度正相关(r≥0.721).操作者A与操作者B对同一受试者2次测量的CRAE、CRVE、AVR差异无统计学意义(t=?1.169、?0.050、0.941,均P>0.05),再现性良好(ICC≥0.750)且高度正相关(r≥0.697).同一操作者和不同操作者间的MRAT、MRVT差异无统计学意义(P≥0.05),Spearman非参数相关性分析重复性和再现性较好(r≥0.571,r≥0.588,均P<0.01).结论:利用ARIA软件测量糖尿病患者视网膜血管管径及迂曲度具有良好的重复性和再现性.
玻璃体切割术联合硅油填充是治疗复杂视网膜脱离伴增生性玻璃体视网膜病变的有效方法,通常需在术后3～6个月充分评估后将硅油取出.近年来,部分文献报道了一部分患者在硅油取出术后出现不明原因的视力下降,无法采用常规临床检查结果进行解释,严重影响疗效和患者满意度.该文主要针对硅油取出术后不明原因的视力下降问题,对其流行病学、电生理表现、病理生理学机制及影响因素等相关国内外研究现状及发展情况进行综述,为相关病例临床诊疗及判断预后提供参考.
Objective To find out a new method to diagnose and.treat functional epiphora caused by loose lower lid. Methods Ten patients suspected of functional epiphora caused by loose lower lid were diagnosed by adhesive plaster sticking method,and were treated by lateral tarsal strip procedure.Adhesive plaster sticking method:A piece of tape with 15mm-20mm width and 80mm length was applied to the patients,from the cheek toward the upper and lateral canthus at 45 degree angle bilaterally.Symptom and sign changes after adhesive plaster sticking were recorded within 20 minutes.Results Epiphora in all of the ten patients disappeared and tear immersed line of lateral canthus skin disappeared under slit lamp in five minutes after taping.Lower eyelid became tightened,and epiphora disappeared in all ten patients after surgery,however,symptom recurred in two patients after 2 months.Conclusions "Lower lid tightening test" with adhesive plaster is a simple and easy test to diagnose functional epiphora caused by loose lower lid.Lateral tarsal strip procedure can enhance the tension of lower eyelid and tighten external palpebral ligament,it is an effective method to treat epiphora caused by loose lower lid.
<正>眼是具有特异性免疫位点的器官,系统性红斑狼疮(systemic lupus erythematosus,SLE)会影响眼球的各个部位,很多SLE患者有眼部并发症,如果不加处理会导致严重的视力损害甚至失明。有时SLE的眼部表现先于SLE诊断出现,病情严重,对
