脉络膜破裂-Erlangen眼球挫伤后住院登记(EO-CR)的分析

Background: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by ac ute subretinal haemorrhage. We analysed possible predictive factors and function al results of eyeballs with rupture of the choroid after ocular contusion. Patie nts and Methods: We performed a retrospective study of 376 consecutive inpatient s (Erlangen Ocular Contusion Registry-EOCR, over a 10-year period), who were t reated because of a blunt eye injury at our eye hospital (86%males). Detailed n otes regarding the anterior and posterior segments were extracted from the stand ardised charts. Mean age was 28.8±16.1 years (4 to 84 years). Eyes with previou s trauma or globe ruptures were excluded. Results: Twenty-six of 376 patients d eveloped choroidal rupture due to ocular contusion (6.9%). A choroidal rupture was more frequent in females (9.4%) than in males (6.5%). Patients with choroi dal rupture were treated as inpatients 5 days longer than patients without (10.7 vs 5.5 days; P< 0.001). Twenty-two percent of the injuries occurred during wor k time. Main causes of choroidal ruptures were water jet (19%), fireworks (12% ), elastic cords (12%), metal pieces (12%), gotcha (8%) and champagne corks ( 8%). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninetytwo percent of choroidal ruptures wer e located at the posterior pole and concentric, 40%were submacular, 12%outside the large temporal vessels (4%were located both centrally and peripherally). I nitial visual acuity (VA) and VA at discharge were decreased significantly in ey es with rupture of the choroid (20/200 and 20/60) in contrast to eye swithout (2 0/40 and 20/25; P< 0.001). Choroidal ruptures were often associated with iridodi alysis, lens dislocation and contusion cataract (3 x), vitreous haemorrhage (4 x ), complete retinal defects (6 x), ciliary body clefts (7 x) or hyphema rebleedi ng (4 x). No association between the height of hyphema and choroidal ruptures wa s found. The predictive level of choroidal ruptures was 40%in eyes with a combi nation of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55%of ruptures submacularly. In contrast to this, eyes with VA >20/200 developed 26 %submacul ar choroidal ruptures. Conclusions: Additional severe traumatic changes of the a nterior and posterior II segment were found 2-7 times more frequently in eyes w ith choroidal ruptures compared to eyes without those ruptures. The visual impro vement was limited due to submacular ruptures. Frequent ophthalmological control s are recommended to III minimise the risk of choroidal neovascularisation in a submacular location.

视盘大小对激光扫描旋光分析视网膜神经纤维参数的影响

Purpose:The aim of the study was to evaluate the influence of optic disc size on the variables of laser scanning polarimetry(GDx).Patients and methods:One hundred and nineteen healthy controls and 161 patients with ocular hypertension(OHT)received detailed ophthalmologic investigation with respect to glaucoma including retinal nerve fiber analysis with GDx(Version 3.0.05× 1;Laser Diagnostic Technologies Europe).Optic disc size was measured with planimetry using 15° optic disc photographs.With respect to frequency of optic disc size in the normal population patients were divided in quartiles of equal sample size.Results:The ratio between retinal nerve fiber layer thickness in the superior and inferior areas in relation to the nasal and temporal regions decreases significantly with increasing optic disc size and the difference between the highest and lowest retinal nerve fiber layer thickness decreases significantly with increasing optic disc size.The results of multivariate neural network analysis increased with larger optic disc size in controls as well as in patients with OHT.Linear regression analysis showed an increase of 9 units(the Number)per 1 mm2 of optic disc size.A Number above 30,which indicates suspected glaucoma,was detected in more than a third of the normal population investigated if the optic disc area was larger than 3.5 mm2.Overall,patients with OHT had a higher Number than controls(20.5± 11.5 vs.18.1± 10.4;p >0.05),but the difference between the two groups did not reach a significant level.Conclusions:Retinal nerve fiber analysis in patients with an optic disc size larger than 3.5mm2 should be interpreted carefully;the Number in particular requires corrections for optic disc size.

眼球转动对环面人工晶体轴向定位分析的影响:对环面人工晶体旋转稳定性的最佳评价法

Background:After the implantation of toric intraocular lenses(tIOLs)significant postoperative tIOL rotation angles were measured occasionally.We investigated the rotational stability of eyes during standardized photography and recommend two methods for an enhanced evaluation of tIOL rotation.Patients and Methods:1.The cyclororation of the eye was investigated using standard fundus photography.A sequence of two fundus photographic slides was taken in 550 phakic eyes of 275 consecutive patients with a time interval of at least 6 months.With characteristic markers on the fundus photograph,the axial orientation of the eyes was defined and the cyclorotation between the two slides of each eye was measured.2.Using bifocal photography(HRA II-Heidelberg Retina Angiograph),a sequence of anterior segment and fundus images was taken considering stable head position in 19 pairs of photographs of eyes with implanted tIOLs.The angle between reference fundus axis and tIOL axis was measured at both time stages(mean:after 3 months).The difference of the angle between bifocal-image samples was defined as the real tIOL rotation angle.3.Ten pairs of anterior segment photographs of eyes with a tIOL were investigated using the Axenfeld loop analysis.In each photograph,the angle between the axis connecting two Axenfeld loops and the tIOL axiswasmeasured.The difference of two angles of two photographs was defined as the rotational tIOL angle.Results:1.The mean absolute eye’ s rotation angle was 2.3± 1.7(range:0 to 11.5)in all 550 eyes.Only 9.1% of the eyes did not rotate.In 57.3% of the eyes a rotation of less than 3° and in 33.6% of more than or equal to 3 was detected.The eye’ s cyclorotation correlated(p < 0.04)with an age older than 39 years and higher astigmatism(> 1.5 D).Because of the significant amount of spontaneous globe rotation we developed the following enhanced methods to minimize measurement errors of tIOL rotation:2.Bifocal photography:Comparing the 19 HRA anterior segment images,the amount of mean tIOL rotation was 5.4± 4.8°(range:0-20.0°).Using the bifocal photography,the mean tIOL rotation was 1.9± 1.3°(range:0-5.0°).The overestimated rotation of the tIOL(only anterior segment tIOL comparison)correlated with higher amounts of the eye’ s cyclorotation(r=0.94;p=0.01)and higher corneal astigmatism(r=0.54;p=0.05).3.The simultaneous analysis of Axenfeld loops revealed significantly smaller amounts of tIOL rotation(2.3± 2.5° range:0-7.0°)in 10 pairs of anterior segment photographs in contrast to the single analysis of tIOL axis(5.5± 4.8° range:1-13.0° p=0.09).A reduction of up to 18.0° tIOL rotation measurement failure was possible in single cases by applying the bifocal photography or simultaneous Axenfeld loop analysis.Conclusions:Head inclination,head rotation,and incyclo-or excyclorotation of the eye may have a significant impact on the tIOL axis evaluation.Besides the bifocal photography the simultaneous Axenfeld loop analysis could be a promising alternative to the conventional axis evaluation of tIOLs.