脊髓造影图像分析早产儿视盘形态及其与缺血性脑损伤的关系

Aims:To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury.Methods:RetCam fundal images,cranial ultrasounds and magnetic resonance imaging(MRI)of 109 premature infants were analysed.The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia(PVL)and intraventricular haemorrhage(IVH).The control group consisted of infants with normal neuroimaging at term and 2 years of age.Using the image analysis software of the RetCam,optic disc diameter(ODD),optic disc area(ODA),and optic cup area(OCA)weremeasured at 33-34 weeks gestational age.As serial cranial ultrasonography had been performed,it was possible to date the brain injury in those infants with periventricular white matter(PVWM)damage.Results:Although there was a trend towards reducing ODD,ODA,and OCA with increasing severity of IVH,only the IVH 4 group differed significantly from the controls for these parameters(p=0.002,p=0.02,and p=0.04,respectively).44.4% of infants with grade 4 IVH had small discs.Only one patient had a large cup in a normal sized disc;this patient had IVH 4.In patients with PVWM damage,the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs.This difference was not significant(p=0.23).Conclusions:Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia.We found no association between disc morphology and timing of brain injury.

视网膜盘状瘢痕周围视网膜色素上皮萎缩的进展

Background/aims:Eyes with burnt out disciform scars secondary to age related macular degeneration(AMD)are regarded as visually stable.The aim of this study is to report the subsequent development of atrophy of the retinal pigment epithelium(RPE)around the scars and discuss the possible basis.Methods:20 eyes from 18 patients were observed to develop atrophy around choroidal neovascularisation(CNV).A method of measuring expansion of the atrophy over time is described using the Topcon Imagenet 2000 system.An additional 10 clinicopathological examples were reviewed.Results:Clinically CNV became surrounded initially by a ring of pallor that progressed to an expanding band of atrophy of the RPE.It developed most rapidly in the first 3 years after CNV became quiescent but then continued to expand slowly to more than three times the size of the scar.Histopathological specimens showed large choroidal vessels entering the scars directly and a reduced number of small choroidal vessels beneath and around the scar Conclusions:Disciform scars may become surrounded by an expanding band of atrophy of the RPE,postulated to result from remodelling of the choroidal circulation.The ongoing enlargement of the resulting scotoma may need to be considered when planning management and assessing treatment outcomes.

出生体重<1701g的儿童屈光状态及眼球大小的变化

Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent refractive state.Methods:293 low birth weight children who had been examined in the neonatal period were assessed at 10-12 years of age.The examination consisted of autorefraction,keratometry,and A-scan.Results of right eyes were compared with published normative data.Results:293 of the birth cohort of 572 children consented to participate.The average mean spherical equivalent(MSE)in the low birth weight cohort was+ 0.691 dioptre,significantly higher than the control data(+ 0.30D,p=0.02).The average change in MSE over the 10-12 year period was-1.00 dioptre(n=256),but only 62.1% of cases showed a shift in refractive error of the appropriate magnitude and direction.The presence of any retinopathy of prematurity(ROP)increases the risk of developing anisometropia sixfold.Conclusions:Low birth weight and ROP both significantly impact the refractive state in the long term.At age 10-12 years children born preterm have an increased prevalence of all refractive errors.In low birth weight children refractive state is relatively stable over the first decade of life with a shift towards myopia of 1 dioptre.

钌106板近距离放射治疗有临床表现的血管增生性视网膜肿瘤

Aim:To investigate the safety and efficacy of β ray brachytherapy in treatment of vasoproliferative tumours of the retina(VTR).Methods:35 consecutive patients with symptomatic VTR were treated with a ruthenium-106(106Ru)plaque.Three tumours had been treated previously(two with cryotherapy;one with transpupillary thermotherapy).32 VTR(91.4%)were located in the lower half of the retina and all of them were found between the mid-periphery and the ora serrata.The mean tumour thickness was 2.8 mm.An exudative retinal detachment was present in 25 eyes(71.4%)and in 15 cases(42.9%)hard exudates were found in the macula.The major symptom was loss of vision(77.1%).Results:Brachytherapy was well tolerated by every patient.The mean applied dose was 416 Gy at the sclera and 108 Gy at the tumour apex.In all but four eyes(88.6%),it was possible to control the VTR activity.The median follow up time was 24 months.Three of the above mentioned four eyes with treatment failure had had secondary glaucoma before therapy.There was no case of radiation induced neuropathy or retinopathy.Cataract surgery was necessary for five patients.The development of epiretinal gliosis was the most common event during follow up(n=10,28.6%).The mean visual acuity decreased slightly(0.33 before and 0.29 after brachytherapy).Multivariate analysis showed that the presence of macular pathology before treatment was associated with a 6.1-fold risk of vision of 0.25 or better(p= 0.03).Conclusions:β ray brachytherapy with 1106Ru plaques was able to control the activity of VTR and retain vision.Cases with secondary glaucoma before treatment had a very poor prognosis.

出生体重<1.5kg的婴儿是否需要额外长期眼科随访

Aim:To survey existing ophthalmic follow up protocols in the United Kingdom for very low birth weight(VLBW)children.In addition,relative risk analysis was performed using data from a cohort study to assess which factors(birth weight,gestational age,retinopathy of prematurity(ROP)status)led to a high risk of developing amblyogenic factors.Methods:Questionnaires were sent to every orthoptic department in the United Kingdom(n=288)for information on their policy on the follow up of VLBW children.Results:Responses were received from 125 departments(43%).There was a large variation in criteria used for follow up;21% of respondents using birth weight(BW)and gestational age(GA),22% using stage 3 or treated ROP,the remainder using a combination of these factors.There was no consensus regarding when follow up should commence(from 3 months to 3 years)or cease(1-8 years).Relative risk analysis revealed that birth weight under 1500 g,GA under 33 weeks,and the presence of severe ROP were significant risk factors for developing one or more amblyogenic factors.Conclusion:There is no consensus on whether VLBW children need to be reviewed.There is a greatly increased risk of ophthalmic deficits in those with severe ROP or severe neurological disorders,and also in those with mild or no ROP.Children in the latter group who are not routinely followed up,have a high risk of developing treatable refractive errors and strabismus.This raises the question of whether an additional screening examination is merited.

视盘损害相关分级、杯盘比和Heidelberg视网膜断层摄影在青光眼诊断中的作用比较

Aim:To evaluate the relative diagnostic strength of cup to disc(C/D)ratio,clinical disc damage likelihood scale(DDLS),a new clinical method of documenting glaucomatous optic disc changes,and Heidelberg retina tomograph(HRT-II)in patients with glaucoma,glaucoma suspects,and normal controls.Method:Consecutive observational case series.110 eyes from 110 patients categorised as glaucoma,glaucoma suspect,or normal were examined clinically to grade the DDLS score.HRT-II examination was performed by an examiner masked to the clinical examination findings.Optic disc parameters and Moorfields regression analysis findings were recorded.Stereophotographs of the optic disc were examined independently by two glaucoma specialists in masked fashion to determine the C/D ratio.Zeiss SITA Standard 24-2 visual fields were obtained within 3 months of HRT-II and clinical examination.For each patient,the eye with the worse mean deviation of the visual field test was enrolled in the study,and each field was additionally graded by the four level Hodapp-Parrish-II-Anderson staging.Specificity and sensitivity were calculated by receiver operating characteristic(ROC)curves.Results:Mean patient age was 58 years(SD 13.3)with 45 glaucoma patients,23 glaucoma suspects,and 42 normals.The mean deviation on Humphrey visual field assessment using SITA-Standard was-4.95 D(SD 5 D)Clinical examination using DDLS had the best predictive power with an area under the ROC curve value of 0.95 when glaucoma patients and suspects were separated from borderline or normals.This was followed by clinical examination of C/D ratio(0.84),and HRT-II Moorfields analysis(0.68).The order of diagnostic strength did not change when definite glaucoma was compared to borderline and normals.Conclusions:The DDLS grading performs well compared to C/D ratio and HRT-II evaluation.Attention to disc diameter and to rim width may increase the value of clinical optic disc examination.

环孢菌素A滴眼液治疗类固醇依赖性变应性结膜炎的随机对照研究

Aim:To evaluate the efficacy,safety,and therapeutic effect of topical ciclosporin A 0.05% as a steroid sparing agent in steroid dependent allergic conjunctivitis.Methods:Prospective,randomised,double masked,placebo controlled trial comparing signs,symptoms,and the ability to reduce or stop concurrent steroid in steroid dependent atopic keratoconjunctivitis and vernal keratoconjunctivitis using 0.05% topical ciclosporin A compared to placebo.Steroid drop usage perweek(drug score),symptoms,and clinical signs scores were the main outcome measures.Results:The study included an enrolment of 40 patients,18 with atopic keratoconjunctivitis and 22 with vernal keratoconjunctivitis.There was no statistical significant difference in drug score,symptoms,or clinical signs scores between the placebo and ciclosporin group at the end of the treatment period.No adverse reactions to any of the study formulations were encountered.Conclusions:Topical ciclosporin A 0.05% was not shown to be of any benefit over placebo as a steroid sparing agent in steroid dependent allergic eye disease.

小驼羊 救孩子

费希尔和妻子住在新西兰第二大城市克莱斯特彻奇的一个渔民区。一天，出海打鱼的费希尔在海滩上救回了一只受伤的小驼羊。他给小驼羊起了个漂亮的名字——福克斯。

小驼羊福克斯

福克斯是费希尔收养的一头小驼羊．一年前的冬天．出海捕鱼的费希尔在帕瓦努伊海滩发现了它．它躺在寒冷的海滩上瑟瑟发抖。奄奄一息。身上沾满污泥，遍布全身的脓疮致使毛发脱落大半，活像个怪物。显然，因为身患怪病．它被主人无情地遗弃了．

每一天都是特别的

多年前我跟悉尼的一位同学谈话，那时他太太刚去世不久。他告诉我说，他在整理他太太的东西的时候。发现了一条雅致、漂亮的丝质围巾。他太大一直舍不得用．她想等一个特殊的日子才用。讲到这里，他停住了．好一会后他说：“再也不要把好东西留到特别的日子才用．你活着的每一天都是特别的日子!”

坦诚求助

我是镇上最臭名昭著的捣蛋鬼。我的第一次人生转机是在一次周末活动中。所有在校生都应邀参加音乐互动游戏（MIG）训练。

享受我生命中的天籁之音

父亲一生中没有弹奏过乐器，甚至连一个音符也不懂，但他教给了我世上最美妙的乐章。 如果我闭上双目静下心来，我就能记起父亲教我听歌那个晚上的情景。那时大概有五六岁吧？那是内布拉斯加州长期干旱的年头。

巴尔塔萨的一个奇特的下午

鸟笼做成了。巴尔塔萨习惯地把它挂在房檐底下。刚吃完午饭,就听人到处在说,他做了一个全世界最漂亮的鸟笼。来瞧热闹的人多极了,巴尔塔萨房前简直门庭若市,吵吵嚷嚷的,他只得摘下鸟笼,把木工作坊的门关上。