玻璃体腔内注射曲安奈德治疗视网膜分支静脉阻塞

Purpose. To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion. Methods. The prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20- 25mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7± 4.4 months. Results. In the study group, mean visual acuity increased significantly (P=0.02) from 0.27± 0.11 preoperatively to a best postoperative visual acuity of 0.45± 0.27. Visual acuity measurements determined 1 month after the injection were significantly (P=0.027) higher than baseline values. Nine (90% ) eyes gained in visual acuity, with six (60% ) eyes showing an increase in visual acuity of at least two Snellen lines. In the ischaemic subgroup, visual acuity did not change significantly (0.18± 0.18 to 0.13± 0.04; P=0.66), while, in the nonischaemic subgroup, visual acuity increased significantly (P=0.012) from the baseline value to the best postoperative measurement (0.29± 0.09 to 0.53± 0.24). In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (P=0.27). Comparing the study and control groups with each other, the gain in visual acuity was significantly higher in the study group at 1 month (P=0.016) and 2 months (P=0.012) after baseline. Conclusions. Intravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion.

视盘大小与屈光不正相关

Purpose: To evaluate for which range of refracAbstract:tive error the optic disk size depends on,or is independent of, the refractive error. Design: Clinical observational study. Methods: The study included 1999 eyes of 1011 subjectswith a mean refractive error of- 0.97± 2.72 diopters (range,- 24.25 to + 9.4 diopters). Optic disk photographs were morphometrically evaluated. Results: The relation between optic disk area and refractive error showed a curvilinear shape, with a steep increase toward high myopia starting at- 8 diopters, and a decrease toward high hyperopia starting at + 4 diopters. Conclusion: The optic disk size depends on the refractive error with an increase in highly myopic eyes beyond- 8 diopters and a decrease in highly hyperopic eyes beyond + 4 diopters. Confirming histomorphometric studies, the limits of- 8 diopters and + 4 diopters may be discussed to refine the definitions of high hyperopia and high myopia.

玻璃体内注射曲安奈德治疗渗出性老年性黄斑变性非随机前瞻性对比研究

Purpose: To report on visual outcome of patients receiving an intravitreal inj ection of triamcinolone acetonide as treatment of progressive exudative age-rel ated macular degeneration. Methods: The prospective comparative nonrandomized clinical interventional study included 187 consecutive patients with progressive exudative age-related macular degeneration, divided into a study group of 115 patients receiving an intravitreal injection of 25 mg triamcinolone acetonide, and a control group of 72 patients without treatment. The mean follow-up was 6.0± 4.2 months. Results: Visual acuity increased significantly (P=0.03) in the study group, and decreased significantly (P=0.01) in the control group, at 1 month an d 3 months after start of the study. Between the study group and control group, the differences in change of visual acuity were significant (P=0.001). In the st udy group, the number of patients with an increase in visual acuity of 2 or more Snellen lines was significantly (P=0.001) larger than in the control group. Cor respondingly, the number of patients with a decrease of 2 or more Snellen lines was significantly (P=0.007) smaller in the study group. In all, 43 (37.4%) pati ents of the study group experienced an increase in best visual acuity by 2 or mo re Snellen lines. Conclusions: Visual acuity increased in patients with exudativ e age-related macular degeneration at 1 month and 3 months after an intravitrea l injection of 25 mg triamcinolone acetonide.

与人单疱病毒6急性感染有关的双侧视神经病变和单侧强直性瞳孔1例

Background: Human herpesvirus 6 (HHV-6), a widesp- read virus and causative agent of exanthema subitum in children, has been asso ciated with a number of neurologic disorders including cranial nerve palsies, se izures, encephalitis, meningitis, and multiple sclerosis. Patient: A 31-year-old man presented with bilateral optic neuropathy, disc edema, and unilateral ton ic pupil, which were found to be associated with acute HHV-6 infection. The pat ient had been suffering from juvenile diabetes for 5 years. One week after onset of intravenous antiviral therapy with foscarnet, disc edema subsided, and tonic pupil reaction was no longer detectable. Conclusions: HHV6 infection may play a role as a causative agent in patients with optic neuropathy and tonic pupil.

玻璃体腔注射曲安奈德后眼压升高

Purpose: To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide. Design: Meta-analysis of previously reported data and case series studies. Participants: The study included 272 patients (305 eyes ) receiving an intravitreal injection of approximately 20 mg triamcinolone aceto nide as treatment for diffuse diabetic macular edema (n=84 patients), exudative age-related macular degeneration (n=181 patients), retinal vein occlusions (n=2 0 patients), uveitis (n=9), pseudophakic cystoid macular edema (n=6), and other reasons (n=5). Mean follow-up was 10.4±6.7 months (median, 7.9 months; range, 3.0-35.7 months). Intervention: Intravitreal injection of approximately 20 mg t riamcinolone acetonide. Main Outcome Measure: Intraocular pressure. Results: Int raocular pressure readings higher than 21 mmHg, 30 mmHg, 35 mmHg, and 40 mmHg, r espectively, were measured in 112 (41.2%) patients, 31 (11.4%) patients, 15 (5 .5%) patients, and 5 (1.8%) patients, respectively. Triamcinolone-induced IOP elevation was treated by antiglaucoma medication in all but 3 (1.0%) eyes, for which filtering surgery was performed. Mean IOP started to rise 1 week after in jection and returned to baseline values approximately 8 to 9 months after inject ion. Younger age (P=0.029)was significantly associated with triamcinolone-induc ed ocular hypertension. Triamcinolone responders and triamcinolone nonresponders did not vary significantly in gender (P=0.42), refractive error (P=0.86), diabe tes mellitus status (P=0.74), and reason for treatment. Conclusions: These findi ngs may be useful for comparing risks and benefits of intravitreal triamcinolone acetonide therapy.

糖尿病性黄斑水肿单眼玻璃体内注射曲安奈德后双眼的比较研究

To report on visual outcome of patients receiving intravitreal triamcinolone a cetonide for treatment of diffuse diabetic macular edema. Prospective, comparati ve clinical interventional study. setting: Institutional. patient population: Th e study included 25 consecutive patients (50 eyes) with bilateral diabetic macul ar edema. intervention procedure: Unilateral intravitreal injection of about 20 mg triamcinolone acetonide into the eye (study group) more severely affected by diabetic maculopathy. The contralateral eyes served as control group. Mean follo w-up was 7.1 ±.4.1 months. main outcome measure: Visual acuity, intraocular pr essure. In the study group, visual acuity increased significantly (P ≤. 001) by 3.0 ±.2.6 Snellen lines to a peak at two to six months after the injection, an d decreased significantly (P=. 001) towards the end of follow up. At the end of follow-up, visual acuity was higher, not significantly (P=. 18) higher, than at baseline. An increase in visual acuity was found in 23 eyes (92%)-. In the co ntrol group, differences between visual acuity at baseline and at any of the re -examinations during follow-up were not significant (P > . 10). In an intra-i ndividual intereye comparison, gain in visual acuity was significantly (P < . 05 ) higher in the injected eyes, for the measurements obtained up to four months a fter injection. Intravitreal triamcinolone acetonide may temporarily increase vi sual acuity in eyes with diabetic macular edema.

单次眼压测量和1d内的眼压分布图

PURPOSE: To evaluate the probability of a single intraocular pressure measurem ent to be the highest measurement within a diurnal intraocular pressure profile. DESIGN: Hospital-based clinical, observational study. METHODS: The study inclu ded 3,025 day-and-night intraocular pressure profiles measured on 1,072 eyes o f 547 Caucasian glaucoma patients or glaucoma suspects. Applanation tonometrywas performed at 7 am, noon, 5 pm, 9 pm, and midnight. RESULTS: Intraocular pressure measurements were highest at 7 am, noon, 5 pm, 9 pm, and midnight, respectively, in 20.4%, 17.8%, 21.3%13.9 %, and 26.7%of the profiles, respectively. The measurement taken at 7 am was s ignificantly (P< .001) closest to the maximal value of the profile. CONCLUSIONS: Any single intraocular pressure measurement taken between 7 am and 9 pm has a h igher than 75%chance to miss the highest point of a diurnal curve. Intraocular pressure may be measured at different times of the day to have the best chance o f observing the maximal value.

玻璃体内大剂量反复注射曲安奈德的安全性

To report side effects after intravitreal high-dose reinjections of triamcino lone acetonide. Clinical interventional case series. Forty-six patients (47 eye s) received at least two intravitreal injections of approximately 20 to 25 mg tr iamcinolone acetonide for treatment of diabetic macular edema (n=6 eyes), exudat ive age-related macular degeneration (n=23), and other diseases. Intervals betw een injections were 6.7 ±3.4 months, 8.0 ±4.6 months, and 10.2 months, respect ively, before the second (n=47 eyes), third (n=9), and fourth (n=2) injection. M ean follow-up was 20.7±8.9 months. After no reinjection were complications det ected, other than those known to occur after a single intravitreal injection. Af ter the first, second, and third injection, respectively, intraocular pressure r emained normal in 24 (51%), 25 (53%), and 26(56%)eyes. Intravitreal high-dos age reinjections of triamcinolone acetonide may be tolerated within a mean follo w-up of approximately 21 months.

玻璃体腔注射曲安奈德治疗弥漫性糖尿病性黄斑水肿:一项对照的、非随机性研究

Aim: To report on visual outcome of patients receiving an intravitreal injecti on of triamcinolone acetonide for treatment of diffuse diabetic macular oedema. Methods: Prospective, comparative, non-randomised clinical interventional study included 136 patients with diffuse diabetic macular oedema. Patients of the stu dy group (97 eyes) received an intravitreal injection of 20-25 mg of triamcinol one acetonide and no other retinal treatment. Patients of the control group (69 eyes) received focal or panretinal laser treatment if indicated. Mean (standard deviation) follow up was 8.4 (SD 6.0) months (range 1.03-25.2 months). Results: Visual acuity (VA) increased significantly (p< 0.001) in the study group with 6 6 (68%) eyes gaining in VA by at least two Snellen lines. In the control group, VA did not change significantly during the first 4 months of follow up, and dec reased significantly (p< 0.001) towards the end of the follow up. Difference in change of best VA was significant (p< 0.001) between both groups. Correspondingl y, the number of patients with VA improvement of two or more Snellen lines and v isual loss of two or more Snellen lines, respectively, was significantly (p< 0.0 01) higher and lower, respectively, in the study group. Conclusions: Intravitrea l triamcinolone acetonide can temporarily increase VA in some patients with diff use diabetic macular oedema.