经瞳孔温热疗法治疗老年性黄斑变性的隐匿性CNV:前瞻性、随机对照初步研究

Purpose:To evaluate whether transpupillary thermotherapy(TTT)reduces the risk of moderate visual loss in patients with occult choroidal neovascularization(CNV)secondary to agerelated macular degeneration(AMD).Methods:A group of 25 patients were recruited and randomized in to TTT or placebo groups.Patients were included if they had a subfoveal purely or predominantly(> 50%)occult CNV secondary to AMD with best corrected visual acuity(BCVA)of 6/60 or better and the lesion was not larger than 4.5 mm.Treatment was carried out using an 810-nm Oculight diode laser with a fixed spot size covering the whole lesion according to the standard protocol.The same procedure was used for the control group,except that the power was set at zero.The patients were followed up at 6 weeks,3 months and then every 6 months for up to 2 years.A maximum of three treatments were administered in both groups if there was evidence of persistent leakage from CNV.Results:At the 12-month follow-up,there was no significant difference in the mean values for BCVA distance and near or contrast sensitivity between the treatment and control groups.The Mann-Whitney test was used to assess the differences in BCVA and contrast sensitivity between the groups,both at baseline and at the 12-month follow-up.No statistically significant difference was found;both groups lost on average two lines of BCVA.Conclusion:Transpupillary thermotherapy appeared to have been of no benefit in preventing further visual loss in patients with occult CNV in this pilot study.

玻璃体内注射曲安西龙治疗视网膜中央静脉阻塞所致的黄斑水肿

Purpose:To investigate the efficacy of intravitreal triamcinolone as treatment for macular oedema in central retinal vein occlusion(CRVO).Methods:We conducted a retrospective comparative case series of nine patients with macular oedema associated with CRVO(six non-ischaemic and three ischaemic)treated with an intravitreal injection of 4 mg triamcinolone acetonide,compared with 10 control(observation)patients(six non-ischaemic and four ischaemic).Examination included visual acuity(VA)tests and complete ophthalmic examinations at baseline,1,2 and 6 months postoperatively.Results:The mean baseline VA was 20/161 for CRVO treatment group patients and 20/75 for observation group patients(P=0.15).No significant difference in VA between CRVO treatment group patients(20/99)and controls(20/282)was observed at the final 6-month visit(p=0.33).Subgroup analysis of the non-ischaemic CRVO treatment patients compared with the non-ischaemic controls also showed no significant difference at the 6-month visit(20/59 and 20/100,respectively;p=0.20).At 6 months,five of the six nonischaemic treated patients had VA≥ 20/100,compared with five of the six non-ischaemic control patients.All patients tolerated the procedure well,but there was a significant increase in intraocular pressure by the 2-month visit(P=0.015).Conclusions:Intravitreal injection of triamcinolone may not be effective for treatment of macular oedema in all CRVO patients or all nonischaemic CRVO patients.A trend towards VA improvement was noted but was not statistically significant.Although our treatment was not hindered by severe complications,there was a significant increase in IOP in the 2 months following treatment.

1组脉络膜恶性黑色素瘤病例的脉络膜新生血管

Purpose:To examine a series of choroidal melanoma specimens to determine the frequency of overlying choroidal neovascularization(CNV)and to ascertain whether CNV over choroidal malignant melanoma is associated with any particular histological tumour characteristics.Methods:We carried out a retrospective histological analysis of globes containing choroidal melanomas for evidence of choroidal neovascular membranes.Results:Microscopic evidence of choroidal neovascular membranes was evident in 6% of cases.Choroidal neovascularization was not associated with any particular histological tumour characteristic.Conclusion:Choroidal neovascularization over choroidal malignant melanoma is not an infrequent occurrence and possibly appears as frequently as CNV over choroidal naevi.The presence of a choroidal neovascular membrane over a pigmented fundal lesion should not be taken as reassurance that the lesion is benign.

伴或不伴增生性玻璃体视网膜病变的视网膜脱离患者细胞因子基因多态性的初步研究

Purpose:Cytokines and other growth factors such as interleukins play an important role in the pathogenesis of proliferative vitreoretinopathy(PVR).Interindividual variations in cytokine production seem to correlate with some cytokine gene polymorphisms.The purpose of this study was to analyse the distribution of these cytokine gene variants in patients with rhegmatogenous retinal detachment(RD)with and without PVR.Methods:Single nucleotide polymorphisms were analysed for five cytokines:tumour necrosis factor-α(TNF-α),transforming growth factor-β 1(TGF-β 1),interferon-γ(IFN-γ),interleukin-6(IL-6)and interleukin-10(IL-10).Patients were divided into two surgically treated groups of RD patients:group RD had 27 patients with RD,and group PVR had 31 patients with RD complicated by PVR.A control group was composed of 46 ethnically matched healthy individuals.Results:The genotype distribution of the TGF-β 1 codon 10 polymorphism differed between PVR and RD patients(p=0.018)and between PVR patients and controls in codon 25(p =0.011).There was a higher frequency of TGF-β 1 codon 10 allele T in PVR patients compared with RD patients(p=0.023).No statistically significant differences between groups were observed for the other polymorphisms examined.Conclusion:An association between the TGF-β 1 genetic profile and the development of PVR was detected in this study.Further studies are necessary to confirm this finding and to establish its clinical relevance.