双眼视觉功能缺乏的患者体位对眼球旋转位的影响

Purpose: Positionally induced cyclotorsion could be an important factor concerning correction of astigmatism in refractive surgery. Previous studies have shown no influence of body position on cycloposition in healthy subjectswith normal binocular vision. Methods: 10 subjects (median value of age 44.2 years) without binocular vision due to an organic eye disease or to strabismus were examined using three-dimensional videooculography (3D-VOG). This non-invasive method can record changes in the position of both eyes simultaneously in the x-,y-and z-axes. The cycloposition of the eyes was recorded first in a seated position with both eyes open (test 1),then in a supine position with the right eye closed (test 2),then in a supine position with occlusion of both eyes (test 3),and then in a supine position with both eyes open (test 4). In each of these 4 situations,the eyes were recorded for 1 minute. Cyclovergence was calculated as the difference between the right and the left eye positions. Results: The range of cycloposition of the right and left eye in all 4 tests was very small. 95% confidence intervals for cycloposition of the right and left eyes and for cyclovergence: cycloposition right eye/cycloposition left eye/cyclovergence: 0.72;0.76/-0.07;0.01/0.71;0.79 (test 1),0.23;0.29/0.19;0.33/-0.81;-0.63 (test 2),-0.92;0.7/-0.51;-0.37/-0.79;-0.45 (test 3),0.14;0.52/-0.07;0.31/0.59;0.21 (test 4). There was no statistically significant difference of the cycloposition between the 4 test situations. Conclusions: The cycloposition of the eyes does not significantly change between seated and supine positions of the body,either in subjects with,or without binocular vision. This means for refractive surgery that a correction of astigmatism,to be performed in the supine position of the patient,can be based on a measurement of the axis of astigmatism obtained in the seated position.

外伤性白内障后晶体前人工晶体植入术后的长期结果

Background: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. Material and Methods: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by parsplana lensectomy and vitrectomy. Results: Themean follow-up was 27.4 months. Eight eyes (72.7% ) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. Conclusions: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.

广州管圆线虫导致的坏死性视网膜炎

PURPOSE: To describe a case of bilateral necrotizing retinitis induced by Angiostrongylus cantonensis. DESIGN: Interventional case report. METHODS: A 52-year-old Asian woman developed eosinophilic meningitis after eating several undercooked snails. One week later,sudden onset of vision loss was noted in both eyes. Widespread yellow retinal exudates were accompanied by bullous retinal detachment in both eyes. RESULTS: Angiostrongylus cantonensis infection was con-firmed by positive enzyme-linked immunosorbent assay of the serum and cerebrospinal fluid,and a positive Western blot test of the subretinal fluid. After treatment with mebendazole,levamisole,and corticosteroid,these necrotizing patches regressed gradually. However,the final visual acuity was no light perception. CONCLUSIONS: Angiostrongylus cantonensis infection should be considered as one of the causes of necrotizing retinitis.

吲哚青绿引导下光栓疗法联合玻璃体腔注射曲安奈德治疗老年性黄斑变性的中心凹下脉络膜新生血管

Background: There is a need for alternative treatments for the management of exudative age-related macular degeneration (AMD). The purpose of this paper is to determine the feasibility, safety, and clinical effect of indocyanine green (ICG)-mediated photothrombosis (IMP) combined with intravitreal triamcinolone acetonide (TA) in patients with subfoveal choroidal neovascularization (CNV) in AMD. Methods: Thirty-one eyes of 26 patients who were treatedwith IMP immediately followed by an intravitreal injection of 4 mg of TA were investigated in the study. The patients had a mean follow-up of 9 months (range 3 months to 26 months). Patients underwent one to four sessions of IMP combined with intravitreal TA. Results: Visual acuity showed stability in 19 eyes (61.3%), improvement of visual acuity (VA) in seven eyes (22.6%), and worsening of VA in five eyes (16.1%). A significant regression of the CNV, and diminishing of subretinal fluid, was demonstrated with fluorescein angiography and optical coherence tomography. We found no complications associated with the intravitreal injection procedure or IMP. Five (16.1%) eyes developed an increase in intraocular pressure related to the presence of TA in the vitreous cavity. However, it was medically controlled with topical antiglaucoma medications. Nineteen of 31 eyes (61.2%) required at least one re-treatment (mean 1.7; range 1-4) during the study period. Conclusions: Combined IMP and intravitreal TA may provide stability or improvement in visual acuity and fundus findings in choroidal neovascularization. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.

年龄相关性黄斑变性患者经光动力治疗后光学相干断层扫描检查的早期变化

PURPOSE: To evaluate early changes after photodynamic therapy (PDT) in patients with age-related macular degeneration (AMD) by optical coherence tomography (OCT). DESIGN: Prospective interventional case series. METHODS: PDT was performed on 20 eyes of 20 patients who presented with subfoveal choroidal neovascularization (CNV) attributable to AMD. OCT was used to evaluate changes at 2,12,and 24 hours and at 3,7,15,and 30 days after therapy. RESULTS: In the first 24 hours,OCT showed an increase in the subretinal fluid (SF) in all eyes and an increase in intraretinal fluid (IF) in 13 eyes. On the 15th day and the 30th day after therapy,reduction of SF and IF was observed in almost all eyes. CONCLUSIONS: Serial OCT evaluation of patients with subfoveal CNV attributable to AMD suggests that the initial response after PDT is an increase in SF and IF.

感染性玻璃体炎临床评估与多聚酶链反应检测之间的关系

PURPOSE: To compare polymerase chain reaction (PCR) results to presumptive clinical diagnosis in patients with vitritis. DESIGN:Retrospective review of PCR laboratory records from vitreous samples. METHODS: Fifty consecutive laboratory records of vitreous samples sent for PCR testing were reviewed. Three reviewers with uveitis training ranked the clinical suspicion of a specific diagnosis using a classification system (scale of 1 to 4) and were masked to the PCR results. RESULTS: The degree of clinical suspicion of a particular diagnosis was significantly associated with a positive PCR result (P=.048). Higher clinical suspicion was significantly more associated with a positive PCR result compared with cases with lower clinical suspicion (P=.01). CONCLUSIONS: If the clinical suspicion of a specific diagnosis is low,the PCR for any infectious etiology is unlikely to be positive.

玻璃体内注射曲安奈德后发生的严重的激素性青光眼

PURPOSE: To report a case of severe corticosteroid-induced glaucoma after intravitreal injection of triamcinolone acetate in a 34-year-old man without a history of glaucoma. DESIGN: Observational case report. METHODS: Retrospective review of a clinical case. RESULTS: A 34-year-old man acquired visual field defects and severe vision loss in both eyes after intravitreal injection of triamcinolone for diabetic macular edema. CONCLUSIONS: Intravitreal injection of triamcinolone is a commonly performed treatment for many retinal conditions. This treatment has the potential to cause severe vision loss as a result of intractable corticosteroid-induced glaucoma.

术后可疑性细菌性眼内炎患者玻璃体腔内注射地塞米松对万古霉素浓度的影响

Purpose: To study intravitreal dexamethasone and vancomycin concentrations,when used together in patients with suspected postoperative bacterial endophthal mitis. Animal studies had suggested that dexamethasone might decrease the concentration of vancomycin. Design: Prospective randomized clinical trial in a tertiary referral center. Methods: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin,0.05 mg gentamicin) and 400 μ g dexamethasone or placebo. After 3-4 days,the intravitreal injection of antibiotics and dexamethasone or placebo was repeated. In 18 patients,a second biopsy was taken for repeat culture and measurement of vancomycin and dexamethasone concentrations. Results: In 20/29 patients (69% ) the first vitreous cultures were positive; the second culture was negative in all cases. Thirteen outof 29 patients received dexamethasone. Dexamethasone concentrations showed an average of 25 ng/ml 3 days after injection,with an estimated half-life of 5.5 h. Vancomycin concentrations in patients given dexamethasone tended to be higher compared with those in the placebo group (P=0.061). Conclusion: Intravitreal dexamethasone does not lead to decreased vancomycin concentrations,when given simultaneously in the treatment of patients with suspected bacterial endophthalmitis.

斜视手术和遮盖疗法后斜视性弱视的患儿对视物变形的适应——遮盖疗法与视物变形

Background: Reduced visual acuity and deficient binocularity are well-known symptoms of amblyopia. Distortions of visual space perception were reportedmore recently in strabismic amblyopia. This study investigated whether strabismus surgery and occlusion therapy have an influence on these deficits in amblyopic children. Materials and Methods: Two aspects of vertical alignment of amblyopic eyes,namely spatial distortion and spatial uncertainty,were investigated prospectively in 13 children (mean age 6 years 9 months) before and after strabismus surgery and in 12 children (mean age 6 years 11 months) during 6 months of occlusion therapy. Results: A different impact of the two types of therapeutic intervention was observed: a slight (statistically not significant) increase of uncertainty was the only change noticed postoperatively after 1 week,spatial distortions were not affected. During occlusion treatment,both clear shifts of alignment and a decrease of uncertainty occurred. Conclusions: The geometry of visual space of amblyopic children showed modifications due to altered visual experience during treatment,most obviously during occlusion therapy. These changes are evidence for unknown features of plasticity of the amblyopic visual system initiated by treatment.

玻璃体内注射高剂量的曲安奈德后的感染性和非感染性眼内炎

PURPOSE: To evaluate the rate of infectious and noninfectious endophthalmitis after intravitreal injection of a high-dosage of triamcinolone acetonide. DESIGN: Clinical interventional case-series study. METHODS: The study included 1135 intravitreal injections of approximately 20 mg triamcinolone performed for 915 eyes with diabetic macular edema (n=257),exudative age-related macular degeneration (n=561),retinal vein occlusions (n=82),and other reasons. Among the injections were 220 reinjections. Triamcinolone was filtered to remove the solvent agent. Mean follow-up was 8.1± 7.4 months. RESULTS: In none of the eyes,signs of an infectious or noninfectious endophthalmitis were observed such as noncrystalline hypopyon,cellular infiltration,or amorphous opacification of the vitreous,retinal infiltration,or pain. One patient developed infectious endophthalmitis 2 days after a traumatic rupture of a previous corneoscleral cataract incision. CONCLUSIONS: The rate of infectious or noninfectious endophthalmitis after an intravitreal high-dosage triamcinolone injection may be approximately 1:1000,if the solvent agent was removed.

慢性难治性特发性血小板减少性紫癜患者双侧大量玻璃体视网膜出血

Background: We describe a patient with chronic,refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. Methods: A 49-year-old woman complained of an acute decrease of vision,and ophthalmoscopy revealed bilateral preretinal and subretinal hemorrhages around the optic disc. Her platelet counts were less than 5000/μ l in spite of repetitive administration of corticosteroids and immunoglobulins with splenectomy for the chronic refractory ITP. One month later,she developed massive vitreoretinal hemorrhages bilaterally,and vision decreased to hand-motion. Results: Vitrectomy was performed on both eyes after medical treatment to increase platelet counts. The intraretinal hemorrhages were absorbed from the area around the disc and vision recovered to 20/100 in the right eye and 20/2000 in the left after one month. Conclusion: Massive vitreoretinal hemorrhages can develop in patients with chronic refractory ITP,and vitrectomy can be beneficial for this condition.

儿童期的眼眶疾病

Background: Orbital diseases in childhood are rare and differ from orbital lesions occuring in adults. Most paediatric orbital tumours are benign,but rapid tumour growth can nevertheless threaten vision or lives. Patients: Retrospectively,we analyzed data of 41 consecutive patients with orbital disease,treated in our hospital between 2000 and 2004. The data was evaluated using descriptive statistics and case reports. Results: All children (from neonatals up to 16 years of age) with orbital disease were included in the study. The most common benign disease of the entire collective was an epidermal cyst (n=18),followed by orbital capillary haemangioma (n=4) in children under 3 years,and preseptal cellulitis in children older than 3 years. 5 patients were treated for malignant tumours,of which one patient under 3 years had an orbital metastasis of an abdominal neuroblastoma. Conclusion: Awareness of orbital diseases in childhood,as a rare entity,is crucial for timely diagnosis and appropriate treatment,to save the vision and lives of affected children.

光学相干断层扫描在急性早产儿视网膜疾病治疗中的应用

PURPOSE: To demonstrate the microscopic changes,in vivo,accompanying stage 4 retinopathy of prematurity. DESIGN: Interventional case study. METHODS: Optical coherence tomography (OCT) of the macula was performed in a baby with presumed stage 4a retinopathy of prematurity (retinopathy of prematurity). The findings were correlated with clinical staging and video indirect ophthalmoscopy. RESULTS: OCT changed the staging of retinopathy of prematurity from 4a to 4b,demonstrated intraretinal edema,and objectively confirmed the clinical impression of disease progression. CONCLUSIONS: OCT could be valuable as a new strategy in the staging and surgical management of retinopathy of prematurity.

持续性外斜视的治疗——手术治疗和复视试验

Purpose: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/resect advancement procedures and their constancy. Methods: A retrospective evaluation of 62 operative cases of consecutive exotropia performed from 2001 to 2003 was carried out. Diplopia after prismatic correction and after converging by minus glasses was tested. In 47 cases a unilateral recess/resect procedure and in 15 cases an advancement of the medial rectus muscle were performed. The postoperative resultswere controlled oneweek and three months after operation by measuring the angle of squint by a prism cover test looking in five metres and in 33 cm. Results: 22 patients (36% ) had neither diplopia after prismatic correction of angle of squint nor after operation. The other 40 patients (64% ) experienced diplopia,but were not troubled by it. In all patients the whole amount of angle of squint was operated. Immediately after operation,14 patients (23% ) experienced diplopia temporarily,which remained after 3months in 9 patients,but all of themwere not disturbed by it. In all patients the mean preoperative angle of-19 was corrected by a mean operative amount of 11 mm,the mean postoperative angles were + 1.5 after one week and-2.6 after three months with considerable variations of the results (standard deviations were about 5). In 15 cases with advancement of the medial rectus muscle the dose-effect relation was 2 per mm operative amount. After three months these patients become more divergent,the mean value was-6 ,the dose-effect relation was reduced to 1.4/mm. The unilateral recess/resect operations were more constant: these became more divergent of 2.5 only and their dose-effect relation remained more constant (after one week: 1.9° /mm,after 3 months: 1.7° /mm). Conclusions: The diagnostic value of preoperative prismatic correction of the deviation is very limited. Even if diplopia can be provoked,the chance of disturbing diplopia is very low. Nevertheless,some guidelines for pre-and postoperative care are necessary to prevent double vision. The postoperative outcome is favourable for the patient after one operation. In cases of relapsing divergence a second operation is easily possible.

通过H.-J.Haase测量和校正方法的棱柱性校正小度数内斜视的可行性

Background: The “ Measuring and Correcting Methodology after H.-J. Haase” is based on the assumption that a minute deviation from the orthovergence position (fixation disparity)-indicates a difficulty to overcome a larger “ vergence angle of rest” . Objective recordings have,however,revealed that the subjective tests applied in the “ Measuring and Correcting Methodology after H.-J. Haase” can mislead to the assumption of a fixation disparity,although both eyes are aligned exactly to the fixation point. Question: How do patients with an inconspicuosly small,yet objectively verified strabismus react to the “ Measuring and Correcting Methodology by H.-J. Haase” ? Methods: Eight patients with amicroesotropia between 0.5 and 3° were subjected to the “ Measuring and Correcting Methodology after H.-J. Haase” . Results: In all 8 patients,the prisms determined with the Cross-,Pointer-and Rectangle Tests increased the angle of squint,without reaching a full correction: the original angle prevailed. In the Stereobalance Test,prisms did not reduce the 100% preponderance of the non-squinting eye. The stereoscopic threshold was between 36 and 1170 arcsec in 7 out of the 8 subjects,and above 4000 arcsec in 1 subject. Conclusions: (1) In all 8 patients,prisms determined with the “ Measuring and Correcting Methodology by H.-J. Haase” increased the angle of strabismus,without reaching bifoveal vision. This uniform result suggests that primary microesotropia cannot be corrected with the “ Measuring and Correcting Methodology after H.-J. Haase” (2) A lacking contribution of the strabismic eye to the recognition of a lateral off-set between stereo objects,as determined with the Stereobalance Test,does not imply a lack of binocular stereopsis.

卵黄状黄斑营养不良患者吲哚氰绿血管造影显示的周边异常

Purpose:To report the peripheral abnormalities seen only with indocyanine green angiography in patients with vitelliform macular dystrophy(Best disease,caused by a mutation in the bestrophin gene).Design:Observational case report series.Methods:Eight eyes of four patients,two with only a central macular lesion and two with multifocal lesions,were studied.Results of indocyanine green angiography were compared with findings from ophthalmoscopy and fluorescein angiography.Results:Throughout the fundus periphery,indocyanine green angiography demonstrated a number of hyperfluorescent spots in all eight eyes.The spots were observed in the midperiphery and the periphery in areas with no abnormality visible by ophthalmoscopy or fluorescein angiography.Conclusions:Although Best disease generally causes lesions visible in the posterior pole,the extensive distribution of the hyperfluorescent spots is consistent with the wide-ranging abnormalities of the retinal pigment epithelium,Bruch membrane,and the choroid as seen histopathologically.

中等程度的眼内压改变对青光眼患者的共焦扫描激光断层摄影地形图测量结果的影响

Objective:To evaluate optic disc topography changes after intraocular pressure(IOP)modulation in patients with glaucoma.Methods:Twenty-three patients with glaucoma were studied.Three mean optic disc topography images were obtained with the Heidelberg Retina Tomograph II at baseline and weeks 1,2,4,and 8(visits 1,2,3,4,and 5,respectively).Topical medications were discontinued in the study eye after visit 1 and resumed after visit 4 but maintained in the contralateral control eye.Central corneal thickness was measured at the last visit.Topographic changes were determined by stereometric parameters(rim area and mean cup depth)and at discrete topographic locations using the Topographic Change Analysis program(from the Heidelberg Retina Tomograph II).Results:In the study eyes,IOP increased significantly(5.4 mm Hg at visit 4;P<.001)after withdrawal of topical medications but returned to baseline levels after resuming medications;no statistically significant topographic changes,however,were observed.Moreover,no relationship between change in IOP and stereometric parameters was observed.Central corneal thickness was not associated with changes in optic disc topography induced by IOP modulation.Conclusion:In patients with glaucoma,significant but relatively moderate IOP increases and decreases on the order of 5 mm Hg did not appear to have an effect on optic disc topography.