Serous macular detachment due to nasally located optic disc pit-coloboma

Dear Editor,We present the first reported case of nasal optic disc pit resulting in serous detachment of the macula. Optic disc pit is a rare congenital anomaly occurring in one out of 11 000 people. The appearance is a localized round or oval depression in that is grey, yellow or black in colour depending on the amount of glial tissue present.

Vascular changes in age-related macular degeneration

Age-related macular degeneration(AMD)is considered one of the principal causes of vision impairment among older individuals in developed countries.Assuming this,new technologies which may increment insights elucidating the morphological characteristics of this disorder are expected to improve the visual prognosis in AMD.The development of optical coherence tomography angiography(OCTA)has outstandingly extended our knowledge on the AMD pathophysiology.

Improving refractive outcomes in cataract surgery: A global perspective

This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.

TOPOGRAPHIC MEASUREMENTS OF RETINAL VASCULATURE WITH A SCAN-NING LASER OPHTHALMOSCOPE IN PRI-MARY OPEN ANGLE GLAUCOMA

Purpose: This study evaluates peripapillary retinal vasculature in primary open angle glaucoma (POAG) using automated analysis of Heidelberg Retina Tomograph (HRT) images. Methods: The width and contour of retinal vessels surrounding the optic disc, and vessel parameters relating to optic disc morphology were analyzed using automated software for each HRT

原发性开角型青光眼视野进行性缺损的危险因素

Purpose: The aim of this study was to evaluate routine ophthalmic data to iden tify clinically useful risk factors for progressive visual field loss in patient swith primary open-angle glaucoma (POAG) already receiving intraocular pressure -lowering treatments. Methods: A retrospective cohort study design was used. Ro utine ophthalmic data for all subjects were obtained from case records with the knowledge that baseline clinical data had been collected in a standardised manne r. Progression was defined according to the AGIS visual field defect scoring sys tem. Variables evaluated as candidate risk factors for progression were assessed by survival analysis. Factors exerting a significant effect on survival were su bsequently tested in a Cox proportional hazards model. Results: A cohort of 108 eligible POAG patients was followed over an average of 3.6 years, with an averag e visual field intertest interval of 8months. The incidence rate of progressive loss among the cohort was 5.4 cases per 100 person years. Increasing age was fou nd to be independently associated with a small but significantly increased risk of glaucomatous visual field defect progression (hazard ratio 1.07, P=0.022), an d a borderline association was also demonstrated with being male (hazard ratio 2 .76, P=0.057). Conclusions: This retrospective investigation has provided prelim inary information on factors associated with increased risk of progressive glauc omatous visual field loss that may inform clinical care strategies. Lack of conc ordance with other studies suggests that further prospective investigations are needed if risk stratification strategies are to be employed in caring for patien ts with chronic open-angle glaucoma.

眼周全厚皮肤移植部位并发症的发生率

Aim: To evaluate the complications of periocular full thickness skin grafts (FTSG) in patients treated with Mohs’ micrographic surgery (MMS) for periocular malignancy. Method: This prospective, multicentre case series included all patients in Australia treated with MMS for periocular malignancy followed by reconstruction with FTSG, who were monitored by the Skin and Cancer Foundation, between 1993 and 1999. The parameters recorded were patient demographics, reason for referral, histological classification of malignancy and evidence of perineural invasion, duration of tumour, site, recurrences prior to MMS, preoperative tumour size, and postoperative defect size. FTSG donor sites included upper lid, preauricular, retroauricular, inner brachial, and supraclavicular. The primary outcome measures were FTSG host site complications (partial/complete graft failure, graft infection, acute bleeding/haematoma, graft hypertrophy, and graft contracture). Results:397 patients (229 males, 168 females), mean age 60 (SD 15) years (range 20- 91 years). 92.7% were diagnosed with basal call carcinoma, 2.0% with Bowen’ s disease, and 3.3% with squamous cell carcinoma. Medial canthus was involved in 66.5% of patients, lower eyelid in 28.0% , and upper eyelid in 5.5% . Postoperative complications were recorded in 62 patients (15.6% of all patients), and consisted of graft hypertrophy (45.1% of complications), graft contraction (29.1% ), and partial graft failure (12.9% ). The only statistically significant association found was a higher rate of graft hypertrophy in medial canthal reconstruction (P=0.007). Conclusion: Host site complications of periocular FTSG are not common. Graft hypertrophy accounted for most complications and was more common in the medial canthal area. No other variables such as patient demographics, tumour characteristics, or donor site factors were associated with a higher risk of complications.

对采用Humphrey Matrix 24-2阈值方案的倍频技术视野检查法的临床评价

Aims: To evaluate performance of frequency doubling technology (FDT) perimetry using the Humphrey Matrix 24-2 thresholding program in a hospital eye service (HES) glaucoma clinic. Methods: A random sample or individuals referred consecut ively to the HES for suspected glaucoma were examined with 24-2 threshold FDT i n addition to routine clinical tests. The discriminatory power of FDTand standar d automated perimetry (SAP) were assessed using glaucomatous optic nerve head ap pearance as the reference gold standard. Results: 48 of 62 eligible referred ind ividualswere recruited. Glaucoma prevalence was 31%. Median test duration per e ye was 5 minutes 16 seconds for FDT and 5 minutes 9 seconds for SAP. There was n o significant difference (p=0.184) between proportions of individuals with relia ble test results (FDT 75%, SAP 63%). Using a clinically appropriate binary criterion for abnormal visual field, sensitivity and specificity levels were 100%and 26%respectively for FDT and 80%and 52%f or SAP. Both tests had higher negative than positive predictive values with marg inal differences between tests. Criterion free receiver operator characteristic analysis revealed minimal discriminatory power differences. Conclusions: In a HE S glaucoma clinic in which new referrals are evaluated, threshold 24-2 FDT test ing with the Humphrey Matrix has performance characteristics similar to SAP. The se findings suggest threshold testing using the FDT Matrix and SAP is comparable when the 24-2 test pattern is used.

环孢霉素与他克莫司治疗后部和中部脉络膜炎的疗效比较

Objective: To compare the efficacy and tolerability of tacrolimus and cyclosporine therapy for noninfectious posterior segment intraocular inflammation and to evaluate their effect on peripheral blood CD4+T-cell phenotype and activation status. Method: Thirty-seven patients who required secondline immunosuppression for posterior segment intraocular inflammation were enrolled in this prospective randomized trial of tacrolimus vs cyclosporine therapy. The main outcome measures were visual acuity, binocular indirect ophthalmoscopy score, adverse effects, and quality of life. In addition, peripheral blood CD4+T-cell phenotype and activation status were evaluated by flow cytometry before treatment and at 2, 4, and 12 weeks using CD69, chemokine receptor (CCR4, CCR5, and CXCR3), and intracellular cytokine (tumor necrosis factor α, interferon-γ, and interleukin 10) expression. Results: Thirteen patients (68%) taking tacrolimus and 12 patients (67%) taking cyclosporine responded to treatment. Cyclosporine therapy was associated with a higher incidence of reported adverse effects. Mean arterial pressure and serum cholesterol level were significantly higher at 3 months in the cyclosporine group than the tacrolimus group. No significant difference was detected with regard to effect on quality of life or CD4+T-cell phenotype. Conclusion: Tacrolimus and cyclosporine were similar with regard to ef-ficacy for posterior segment intraocular inflammation, but the results suggested a more favorable safety profile for tacrolimus therapy.

无防腐剂0.1%T-GEL眼用凝胶(单剂)和含防腐剂0.1%T-GEL(多剂)对高眼压症和青光眼的疗效比较

Aim:This comparative,open design,phase III study was to assess the non-inferiority of the non-preserved T-Gel 0.1% single dose unit(SDU)versus its preserved multidose(MD)reference.Methods:175 patients with bilateral POAG or OHT were randomised:87 patients were to receive one drop daily of T-Gel 0.1% MD and 88 patients were to receive one drop daily of T-Gel 0.1% SDU,for a treatment period of 12 weeks.The primary efficacy variable was the change in intraocular pressure(IOP)in the worse eye between the baseline and the last assessment.Subjective and objective ocular signs as well as adverse events were recorded for safety.Global tolerance was assessed by the investigator and by the patient.Results:The mean percentage reduction from baseline IOP was 24% for both treatments groups,which was consistent with previous studies.The safety results were comparable in both treatment groups.Because of gel formulation,mild short lasting episodes of blurred vision occurred for about 20% of patients.The global tolerance assessment reported that both treatments were well tolerated.Conclusion:The overall study results demonstrated that T-Gel 0.1% SDU is not inferior to T-Gel 0.1% MD.

中间葡萄膜炎患者的生存质量与视功能

Aims: To assess visual function, vision related quality of life (VR-QOL), and general health related quality of life (HRQOL) in intermediate uveitis (IU). Methods: VR-QOL and HR-QOL were evaluated in 42 patientswith IUusing theVCM1 and SF- 36 questionnaires, respectively. LogMAR visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Farnsworth-Munsell 100 hue colour vision (CV), and Estermann visual field (VF) were recorded monocularly and binocularly. Results: Median (interquartile range) visual acuity (VA) and CS of 72 affected eyes were 0.1 (0.015- 0.3) and 1.55 (1.35- 1.65), respectively. 9.5% of patients had a VCM1 score of more than 2.0, indicating “ more than a little” concern over vision. Worse eye VA (p=0.045) and CS (p=0.042) were predictive of a VCM1 score ofmore than 2.0 independently of age, sex, uveitis duration, laterality and activity, systemic uveitis therapy, and medical co-morbidity. The physical and mental component summary scores of the SF- 36 were significantly worse in those who reported significant impairment of vision on the VCM1 than those who did not. Conclusions: The majority of patients with IU maintain good visual function and quality of life. VRQOL impairment in IU correlates with vision in the worse eye and is associated with impaired HR-QOL.

新生儿眼结膜炎的处理

一名1周大的婴儿因眼睛发红、双侧有轻度脓性分泌物去看全科医生。该婴儿足月出生,经阴道自然分娩,生后无并发症。经检查,发现双眼有黄色分泌物,并有轻度结膜炎。婴儿的父母担心其眼睛发红的情况。该患者应如何处理?

暗视力下降的原因

1名70多岁的男性患者,近8个月来出现双眼进行性视力下降。起初,他在明亮的环境下视力正常,但在光线昏暗时出现视力减退。此后,其周边视野逐渐变暗,最后,在明亮或昏暗的条件下均表现严重视力减退。该患者有先天性耳聋,通过手语交流,既往没有视力问题。其父母和两个兄弟姐妹也有先天性耳聋,但没有家庭成员有视力障碍。在过去1年中,尽管患者饮食健康均衡,但其体重减轻约13 kg,伴有长期腹部不适,并经常排泄苍白色不成形大便。既往检查提示小细胞性贫血,铁蛋白降低(14μg/L,正常范围33~490μg/L)。CT结肠成像和胸部X线检查结果正常,患者正等待门诊行上消化道内窥镜检查。患者唯一的用药史是5年前诊断巨细胞性贫血后应用维生素B12注射液。体格检查示:患者双眼视力下降至只能看清手指,视野严重缩窄(图1)。瞳孔反射正常,眼底检查也正常。腹部查体未触及肿大的器官或浅表淋巴结。血液检查显示患者存在贫血及多种维生素缺乏(表1)。