吲哚青绿辅助下玻璃体切除术治疗特发性黄斑裂孔后视网膜神经纤维层的分析研究

Purpose: To analyze retinal nerve fiber layer (RNFL) thickness in eyes with or without visual field (VF) defects after indocyanine green-assisted vitrectomy for idiopathic macular holes using optical coherence tomography (OCT) and to investigate the relationship between postoperative VF defects and RNFL damage. Design: Retrospective interventional case series. Participants: Thirty-four eyes of 32 patients with idiopathic macular holes that underwent vitrectomy between January 2001 and March 2003 were included in this study. Eyes were divided into 3 groups according to the occurrence of postoperative VF defects and the use of indocyanine green for internal limiting membrane peeling during surgery: 11 eyes with VF defects after indocyanine green-assisted vitrectomy (group 1),9 eyes without VF defects despite the use of indocyanine green (group 2),and 14 eyes without VF defects that underwent vitrectomy without indocyanine green (group 3). Methods: Retinal nerve fiber layer thickness in each of 4 quadrants (superior,inferior,nasal,temporal)was measured with OCT. Main OutcomeMeasure: Retinal nerve fiber layer thickness around the optic disc. Results: The mean RNFL thickness in 3 of 4 quadrants (superior,nasal,inferior) in group 1 was significantly less than that in the corresponding quadrant in groups 2 and 3 (P < 0.01). In the temporal quadrant,there was a significant difference between groups 1 and 3 (P=0.02),but not between groups 1 and 2. The RNFL thickness in group 1 was significantly less in 3 quadrants in operated eyes than in fellow eyes (P< 0.05). Conclusions: The RNFL thickness was reduced in eyes with VF defects after indocyanine green-assisted vitrectomy for macular holes,suggesting that the postoperativeVF defectsmay have been caused by RNFL damage relating to the use of indocyanine green.

青光眼和高眼压症患者使用拉坦前列素、曲沃前列素、比马前列素降低昼夜眼压的比较研究

Purpose: To compare 24-hour reduction in intraocular pressure (IOP) by latanoprost 0.005% ,travoprost 0.004% ,and bimatoprost 0.03% in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH). Design: Randomized,double-masked,crossover study. Participants: Twenty-four patients with POAG and 20 with OH. Methods: Patients were treated with latanoprost,travoprost,and bimatoprost for 1 month. The treatment sequence was randomized,and washout lasted 30 days for each trial drug. Four 24-hour tonometric curves were recorded for each patient: 1 at baseline and 1 after each treatment period. Main Outcome Measures: Intraocular pressure was measured at 3,6,and 9 am; noon; 3,6,and 9 pm; and midnight by 2 treatment-masked well-trained evaluators using a handheld electronic tonometer with the patient in supine and sitting positions and a Goldmann applanation tonometer with the patient sitting at the slit lamp. Supine systemic blood pressure was recorded at the same times. A randomized-blocks analysis of variance was used to analyze data. Results: All 3 drugs were highly effective in reducing IOP when compared to baseline. Mean IOP reductions were similar after the 3 prostaglandin analogs,and none of the differences among treatments reached statistical significance. The drugs’ effect was significantly greater during the daytime (9 am-9 pm) than during the nighttime (midnight-6 am) with all prostaglandin analogs. In 7 of 44 patients (16% ),nocturnal IOP was significantly higher than diurnal IOP,both at baseline and under the 3 prostaglandin analogs. Conclusions: From a clinical point of view,the overall results seem to indicate that the 3 prostaglandin analogs are powerful agents in controlling round-the-clock IOP in POAG and OH patients.

评估年龄相关性黄斑变性的临床分级系统

Objective: To evaluate a clinical classification system,the Clinical Age-Related Maculopathy Staging (CARMS) system,for age-related maculopathy (ARM) using a simple grading scale designed for clinical practice and clinical research protocols. Participants: Two hundred forty-six male and female participants with various stages of ARM who were enrolled during the first 4 years of a longitudinal study were selected for the evaluation of the CARMS system. Design: Cross-sectional comparison study. Methods: The CARMS system divides patients into 5 mutually exclusive categories based on slit-lamp assessment of drusen,retinal pigment epithelial irregularities,geographic atrophy,retinal pigment epithelial detachment,and choroidal neovascularization. Fundus photographs and clinical data of the subjects were used to evaluate this scale. Clinical grades assigned for 492 eyes of 246 patients with varying stages of ARMwere compared with grades obtained from photographs evaluated by a reading center. To compare grades obtained from an inexperienced grader with those of an experienced grader,observations based on photographs from 50 randomly selected patients were reviewed. To quantify intraobserver agreement for photographic grades,observations from one observer were compared with those made at a later date by the same observer. Main Outcome Measures: Reliability and validity of the CARMS system in grading various stages of ARM based on clinical examination and photography. Results: The degree of overall agreement between the clinically assigned grade and photographic assessment for 492 eyes was substantial (exact overall agreement,75% ; unweighted κ ,0.63; weighted κ ,0.78). For advanced age-related macular degeneration,the sensitivity was 0.83,and specificity was 0.97. When assessing photographic grades,the degree of agreement between an inexperienced and an experienced grader was very high (unweighted κ ,0.79; weighted κ ,0.86),and the degree of intraobserver agreement was excellent (unweighted κ ,0.92; weighted κ ,0.97). Conclusions: The CARMS system,a 5-level clinical scale,is a valid and reliable staging system that can be used in both clinical practice and in clinical research protocols involving patients with all stages of ARM.

角膜内皮炎患者的房水中发现巨细胞病毒

PURPOSE: To report cytomegalovirus (CMV) DNA in aqueous humor from a patient with unilateral corneal endotheliitis. DESIGN: Case report. METHODS: A 51-year-old man presented with unilateral corneal endotheliitis with linear keratic precipitates and coin-shaped lesions. Tear and aqueous humor samples were subjected to polymerase chain reaction to look for DNA from herpes simplex virus (HSV),varicella zoster virus (VZV),and CMV. RESULTS: Aqueous humor from the diseased eye contained DNA from CMV but not HSV or VZV. Its specificity was confirmed by Southern blot tests. Intravenous ganciclovir treatment resulted in the localization of his corneal edema and the reduction in keratic precipitates. There was severe destruction of corneal endothelial cells. CMV DNA was not detected in tears or control samples. CONCLUSIONS: In this healthy man with corneal endotheliitis,we detected CMV DNA in aqueous humor from the affected eye,but not HSV or VZV. This suggests that CMV may cause corneal endotheliitis in patients without immunodeficiency.

非糖尿病患者的视网膜病表现是否可作为糖尿病发病的预测因子

Background/aims: Isolated retinopathy signs are common in non-diabetic individuals and have been shown to be associated with impaired glucose metabolism. In a cohort of people without diabetes,the association of these retinopathy signs and subsequent development of diabetes were examined. Methods: A population based cohort study of 7992 people aged 49-73 years without diabetes was conducted. Retinal photographs of these participants were evaluated for the presence of retinopathy signs according to a standardised protocol. Incident cases of diabetes were identified prospectively. Results: After a follow up of 3 years,291 (3.6% ) people developed incident diabetes. In the total cohort,retinopathy was not significantly associated with incident diabetes (4.7% v 3.6% ,multivariable adjusted odds ratio (OR) 1.1,95% confidence intervals (CI),0.7 to 1.9). However,among participants with a positive family history of diabetes,retinopathy was associated with incident diabetes (10.4% v 4.8% ,multivariable adjusted OR 2.3,95% CI,1.0 to 5.3). Among participants without a family history of diabetes,retinopathy was not associated with incident diabetes Conclusions: In individuals with a family history of diabetes,retinopathy signs predict subsequent risk of clinical diabetes.

异波帕明滴眼对玻璃体视网膜手术、葡萄膜炎和眼部穿通伤引起的慢性低眼压的疗效研究

PURPOSE: To study whether topical ibopamine effectively increases the intraocular pressure in patients with ocular hypotony after vitreoretinal surgery,uveitis,or penetrating trauma. DESIGN: A prospective randomized,double-blind,placebo controlled,crossover study. METHODS: In ten patients with ocular hypotony,an ibopamine 2% solution or placebo eyedrop was administered at 8 am and frequent applanation tonometry was performed during 10 hours on 2 days,2 weeks apart. RESULTS: The mean IOP integral after administration of ibopamine was 2.4 mm Hg higher (95% CI for median difference in AUC over 480 minutes .010) compared with placebo. CONCLUSIONS: The results of the study show that an ibopamine 2% eyedrop twice a day may increase the IOP for a period of over 8 hours in patients with hypotony.

OCT测量视网膜厚度时的误差

Objective: To report the frequency and severity of optical coherence tomography (OCT) retinal thickness measurement errors and to describe parameters that predict these errors. Design: Observational case series. Participants: Two hundred consecutive patients undergoing OCT imaging. Methods: One eye (primary) from each of 200 consecutive patients undergoing Stratus OCT imaging (Carl Zeiss Meditec,Dublin,CA) with radial lines or fast macular thickness-based acquisition protocols was selected for review by 2 graders. On each of the line scans,graders evaluated the position of the automated retinal boundary lines (inner retinal surface and retinal pigment epithelium band) used by the OCT machine for thickness calculations and graded the positioning on a 6-point subjective,categorical error scale to generate an error score. The presence of thickness errors was correlated with various parameters,including the analysis confidence assessment reported by the OCT software,disease diagnosis,retinal morphologic features,the foveal center thickness standard deviation (FCTSD),and the FCTSD-to-foveal center thickness (FCT) ratio. Main Outcome Measure: Average OCT retinal thickness error score. Results: Errors of retinal boundary detection and thickness measurement were observed in 92% of eyes,but were severe in only 13.5% of eyes. The identification of an error or low analysis confidence by the OCT software was strongly associated with the severity of the retinal thickness errors. A higher FCTSD-to-FCT ratio and presence of subretinal fluid also were associated with more severe errors. Retinal cysts and a diagnosis of retinal vascular disease such as diabetic macular edema were less likely to be associated with significant errors. Conclusions: Retinal thickness measurement errors occur frequently with current OCT segmentation and analysis algorithms. Severe errors are more frequent in eyes with subretinal pathologic features,but generally are detected by the OCT software. A high FCTSD-to-FCT ratio ( > 0.1) also may alert the clinician to the possibility of thickness errors. Clinical studies,particularly those pertaining to subretinal diseases,should consider these errors when incorporating OCT imaging in the study design.

高度近视患者房角关闭

Purpose: Patients with angle-closure glaucoma and high myopia are uncommon. We evaluated the clinical characteristics of all patients with angle closure and high myopia in our database and propose possible mechanisms for angle closure in these atypical patients. Design: Retrospective noncomparative case series. Participants: Our database of 17938 patients was searched for patients with myopia of spherical equivalent of more than-6.0 diopters and angle closure. Data recorded included age at time of initial consultation,gender,slit-lamp examination results,gonioscopy results,biometric parameters,ultrasound biomicroscopy results (from 1993 onward),clinical diagnosis,and therapy. Results: Twenty patients (11 females,9 males) were identified. Mean age at the time of consultation was 52.9± 19.3 years. Angle-closure diagnoses included primary pupillary block (9 patients),pupillary block in an eye with keratoconus (1 patient),pupillary block secondary to a pupillary membrane associated with retinopathy of prematurity (1 patient),plateau iris configuration and syndrome (3 patients),phacomorphic glaucoma in Weill-Marchesani syndrome (2 patients),malignant glaucoma secondary to a scleral buckle (2 patients),miotic-induced angle closure (1 patient),and Marfan syndrome (1 patient). Conclusions: Angle closure can occur in eyes with high myopia. Causes of angle closure other than relative pupillary block are more common than in the general angle-closure glaucoma population. Careful gonioscopy accompanied by biometry and ultrasound biomicroscopy can lead to the correct diagnosis and individualized management in these eyes.

人群研究载脂蛋白E基因与早期年龄相关性黄斑变性的相关性:动脉粥样硬化的发病风险

Objective: To examine the association between the apolipo-protein E (APOE) gene and early age-related maculopathy (ARM) in middle-aged persons. Design: Population-based cross-sectional study. Participants: Participants from the Atherosclerosis Risk in Communities Study (n=10 139; age range,49-73 years). Methods: Retinal photographywas performed on 1 randomly selected eye,and grading for presence of ARMwas carried out using a modification of the Wisconsin ARM Grading System. Early ARM was defined as the presence of either soft drusen alone,retinal pigment epithelial depigmentation alone,or a combination of soft drusen with increased retinal pigment and/or depigmentation. DNA extracted from blood samples of participants were analyzed for common allelic variants of the APOE gene ( 2, 3,and  4). Main Outcome Measures: Presence of early ARM on retinal photographs. Results: The prevalence of early ARM was similar in participants with differentAPOE genotypes:  2/ 2 (5.9% ), 2/ 3 (5.2% ), 2/ 4 (3.2% ), 3/ 3 (5.2% ), 3/ 4 (4.9% ),and  4/ 4 (4.1% ). After controlling for age,gender,race,cigarette smoking,and other factors,early ARM was not associated with APOE genotypes,with an odds ratio (OR) of 1.35 (95% confidence interval CI,0.54-3.38) for  2/ 2 genotype,an OR of 1.06 (95% CI,0.80-1.40) for  2/ 3 genotype,an OR of 0.63 (95% CI,0.32-1.24) for  2/ 4 genotype,an OR of 0.99 (95% CI,0.80-1.24) for  3/ 4 genotype,and an OR of 0.88 (95% CI,0.47-1.63) for  4/ 4 genotype,as compared with 3/3 genotype (reference). No associations were found for specific early ARM signs or in analyses stratified by age,gender,race,or cigarette smoking status. Conclusions: These data provide no evidence of a strong association between the APOE gene and early ARM in middle-aged persons. This suggests that APOE is not likely a major determinant of the early stages of ARM in younger people. However,our study does not exclude the possibility of a weaker association or that APOE may influence only the development of late ARM in older populations,as reported in other studies.

深部巩膜切除术和低剂量的丝裂霉素C的关系:非洲西部随机前瞻性的临床试验

Aim: To study the efficacy and safety of deep sclerectomy (DS) augmented with intraoperative low dose mitomycin C (MMC) in a west African population. Methods: Prospective,randomised,controlled trial. Trial participants were Nigerian patients with medically uncontrolled primary open angle glaucoma undergoing primary surgery at Maja Hospital,Lagos,Nigeria. 39 eyes of 39 patients undergoing DS were randomised into receiving intraoperative MMC 0.25 mg/ml for 2 minutes at the end of procedure (DS-MMC) and a control group (DSnoMMC). Results: There were 21 patients in the DS-noMMC and 18 in the DS-AAMC group with no difference in the preoperative characteristics of the groups. Mean follow up was 16.4 (SD 11.3) months. The probability of maintaining an intraocular pressure less than 18 mm Hg with or without additional medications (95% confidence intervals) at 1 year was 70% (47-92% ,95% ) and 79% (57-100% ),and at 18 months was 35% (8-62% ) and 38% (7-69% ) for the DS-noMMC and DS-MMC groups,respectively,with no difference in success rates (p = 0.6). An IOP of less than 18 mm Hg without additional medication was maintained in 65% (41-89% ) and 73% (49-96% ) at 1 year and 24% (8-48% ) and 13% (13-46% ) at 18 months for the DS-noMMC and DS-MMC groups,respectively (p = 0.5). There were no serious complications related to the procedure. Conclusions: The success rates of DS in black west African glaucoma patients,as performed in this study,were low. The study did not achieve sufficient power to detect whether low dose intraoperative MMCapplication can increase success rates of DS.

甲状腺眼病的屈光改变(被疏忽的临床表现)

Background/aims: The literature on refractive change in thyroid eye disease (TED) is limited. This study documents the refractive change in patients with TED undergoing orbital decompression. The authors propose possible mechanisms for their acquired refractive error. Methods: This is a retrospective observational case study of five patients with progressive TED. Their detailed eye examinations including refractive state preoperatively and postoperatively are presented. Results: An acquired hypermetropic shift with active TED before orbital decompression of up to 3.75D spherical equivalent refraction (SER) is reported in one patient. Post-orbital decompression,an induced myopic shift of between 1.00-2.50D SER for all patients is observed,noted to range from 1 day following surgery to up to 9 months,dependent on the availability of data. Axial length increased in two cases corresponding to postoperative myopic shift. Magnetic resonance imaging findings of one patient demonstrate flattening of the posterior pole as a cause of the acquired preoperative hypermetropia. Conclusions: TED has a significant effect on the refractive state of patients. The proposed mechanism of acquired hypermetropia relates to increased volume of orbital contents with flattening of the posterior globe. This is reversed with successful orbital decompression. Documentation of refractive error in all cases of progressive TED is recommended. Progressive acquired hypermetropiamay be suggestive of TED activity.

特应性角膜结膜炎的首发时间对泪液功能和眼表征象的影响

PURPOSE: To investigate the tear and ocular surface findings between controls,children,and adults with atopic keratoconjunctivitis (AKC). DESIGN: Prospective comparative study. METHODS: Twenty eyes of 10 childhood-onset,10 eyes of five adult-onset,AKC adult patients,and 12 eyes of six children with infantile-onset AKC,14 eyes of seven normal adults and seven normal children were recruited. Corneal aesthesiometry,Schirmer test,tear film break-up time (BUT),vital staining,and conjunctival impression cytology were performed. RESULTS: The Schirmer and Rose Bengal scores in childhood-onset adult AKC patients were considerably worse than adult-onset adult AKC patients,pediatric subjects,and the controls (P < .05). The same significant relation was observed in impression cytology parameters. CONCLUSIONS: Ocular surface disease in childhood-onset adult AKC patients was characterized by greater ocular surface epithelial damage. Prolonged inflammation may be important in the evolution and progression of ocular surface disease in patients with longstanding activeAKC.

Malattia Leventinese吲哚青绿血管造影的特征

Background/aim: Malattia leventinese (ML) is an inherited macular degeneration characterised by the presence of small radial drusen. Despite extensive descriptions of this study of the fundus,angiographic features of ML have been inadequately described. The aimis to describe the indocyanine green angiography (ICG) features observed in ML. Methods: 10 eyes from five consecutive ML patients (aged 27-44 years) were prospectively included. A complete ophthalmological examination including colour fundus photographs,autofluorescence,fluorescein angiography (FA),and ICG was performed. Results: ICG differentiated two types of drusen. Large round aggregated drusen were consistently hypofluorescent in the early phases and presented as hyperfluorescent spots surrounded by halos of hypofluorescence in the late phases. Conversely,small radial drusen were mostly hyperfluorescent in the early phases with decreased fluorescence in the late phases of the ICG sequence. FA also showed differences in staining between the two types of drusen. Conclusions: ICG angiography revealed marked differences between the large round and small radial drusen observed in ML. The large central drusen presented with an unusual pustuliform feature on the late phases of the ICG sequence. This distinct feature may be useful in the diagnosis of late stage disease when drusen consolidation could obscure the radia l drusen.

手术祛除黄斑下脉络膜新生血管后2D重建与荧光血管造影表现的对照研究:15号SST报道

Objectives: To compare topographic features of surgically excised subfoveal choroidal neovascularization with preoperative and postoperative fluorescein angiographic features from Submacular Surgery Trials (SST) patients,and to compare histological and angiographic features with preoperative and postoperative visual acuities (VAs). Methods: Patients enrolled in the SST GroupsN,B,and H trials between October 1999 and September 2001 and assigned to the surgery arm had surgically removed choroidal neovascularization sent to the SST Pathology Center. Grossly intact specimens were sectioned serially for 2-dimensional reconstruction and were assigned to growth pattern groups based on topographic mapping of the location of cellular components relative to the retinal pigment epithelium (RPE): sub-RPE,subretinal,combined,or indeterminate. These features were compared with preoperative fluorescein angiographic features. The histological choroidal neovascularization growth pattern was compared with preoperative VAs. Results: Two-dimensional reconstructions of surgically excised choroidal neovascularization could not be matched point for point to fluorescein angiographic features. Among the 52 specimens selected,the growth pattern could be determined by 2-dimensional reconstruction in 34 instances (65% ),including 28 (80% ) of 35 Group N specimens,2 (40% ) of 5 Group B specimens,and 4 (33% ) of 12 Group H specimens. Among the choroidal neovascularization growth patterns that could be determined from specimens submitted,the majority of GroupN specimens were combined,and the majority of Group H specimenswere subretinal. In most instances for GroupBspecimens,the growth pattern was indeterminate. The postoperative abnormalities on fluorescein angiography were generally larger than measurements of excised specimens. The subretinal growth pattern was associated with the smallest decrease in 3-month postoperative average VA. Conclusions: Among the 52 specimens from the SST with adequate tissue to try to evaluate the growth pattern of the neovascular lesion,34 had patterns that could be determined. The subretinal growth pattern tended to correspond with lesions that were classic choroidal neovascularization without occult choroidal neovascularization on fluorescein angiography. The most favorable visual outcome occurred if the choroidal neovascularization had a subretinal growth pattern. The combined growth pattern tended to correspond with lesions on fluorescein angiography that had both classic choroidal neovascularization and occult choroidal neovascularization. The conclusions must be viewed within the context that 18 (35% ) of the 52 participants could not be characterized for histologic growth pattern.

一种防止泪点塞自发性丢失的方法

PURPOSE: To describe a technique for the prevention of spontaneous loss of lacrimal punctal plugs. DESIGN: Interventional case series. METHODS: Four consecutive patients (10 puncta in seven eyes) with severe dry eyes who experienced repeated spontaneous plug loss underwent punctal occlusion by suturing plugs with 10-0 polypropylene sutures. RESULTS: All punctal plugs were fitted to lacrimal puncta by anchoring the sutures. Plug retention rate was 80% at 6 months after the procedure. CONCLUSION: Suturing punctal plugs is effective in the production of long-term punctal closure in patients with repeated spontaneous plug loss.

染色体12q15-q23中间缺失和周边角膜异常患者的临床和分子特征

PURPOSE: To describe the ocular features of a patient with an interstitial deletion of chromosome 12 and to determine the molecular boundaries of the deletion. DESIGN: Observational case report and laboratory investigation. METHODS: A patient with an interstitial deletion of chromosome 12 was clinically examined for ocular abnormalities. DNA samples were used for molecular studies to define the deletion boundaries. RESULTS: Ocular examination showed abnormalities of the anterior segment consistent with a diagnosis of cornea plana. Molecular analyses showed the deletion included the KERA gene,the SLRP (small leucine repeat protein) gene cluster,the genetic loci for autosomal-dominant (CNA1) and autosomalrecessive (CNA2) cornea plana,and a portion of the mapped locus for high myopia (MYP3). CONCLUSIONS: These results,combined with previous genetic linkage studies,identifies a 3-cM region located between microsatellite markers D12S82 and D12S351 that is likely to contain a gene responsible for CNA1.

一种疑难性复视

A 38-year-old man experienced double vision with pupillary abnormalities and convergence retraction nystagmus. A mass, which responded to radiation therapy, was seen as the cause of his dorsal midbrain syndrome. The neural control of vertical eye movements is reviewed and the management of a third ventricular-pineal region mass discussed.

光动力疗法治疗脉络膜新生血管后OCT与眼底荧光血管造影的相关性

Aims: To assess the correlation between optical coherence tomography (OCT) and leakage on fundus fluorescein angiography (FFA) following photodynamic therapy (PDT) with verteporfin for choroidal neovascularisation (CNV). Methods: Retrospective comparative observational case series of patients who were treated with PDT for CNV from one centre. All patients had 3 monthly FFA and OCT following initial PDT to assess if further treatment was required. A pair of FFA and OCT images from the same visit at a random follow up date were taken from each patient’ s series and assessed separately by different observers. The presence of pigment epithelial detachment,subretinal fluid,vitreomacular traction,intraretinal fluid,absence of foveal depression,and the retinal thickness on OCT were correlated with presence of leaks on FFA. Results: A total of 121 eyes of 121 patients were included. The presence of subretinal fluid,gross cystoid macular oedema,sponge-like retinal thickening and retinal thickness of more than 350 μ mon OCT correlated well with leak on FFA (p value < 0.01). The likelihood ratios were 3.0,5.7,2.7,and 3.6,respectively. The presence of a solitary foveal cyst did not correlate well with leaks on FFA. Conclusions: The presence of subretinal fluid,intraretinal fluid in the form of gross cystoid macular oedema,or sponge-like retinal thickening,or a retinal thickness more than 350 μ m correlates with leaks on FFA and so suggests the need for repeat PDT.