Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology

AIM:To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology(VNIO) over a period of 12y(2002-2013).· METHODS:Records of patients who had undergone corneal transplantation at VNIO from January 1,2002 to January 1,2014 were reviewed to determine the indication for and type of corneal transplant performed.Patient age,gender,indication for corneal transplantation and surgical technique were recorded and analyzed.· RESULTS:Corneal transplantation were underwent in1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review.The most common indication was infectious corneal ulcer(n =670;48.2%),followed by corneal scar(n =333,24.0%),corneal dystrophy(n=138,9.9%) and failed graft(n=112,8.1%).Nearly all procedures performed were penetrating keratoplasty(n=1300,93.5%),with a few lamellar keratoplasty procedures performed:lamellar keratoplasty(n=52,3.7%),Descemet's stripping automated endothelial keratoplasty(n =27,1.9%) and deep anterior lamellar keratoplasty(n =11,0.8%).· CONCLUSION:While the most common indication for keratoplasty was infectious keratitis,nearly all indications for corneal transplantation were managed with penetrating keratoplasty.However,lamellar keratoplasty techniques,including deep anterior lamellar keratoplasty and Descemet's stripping automated endothelial keratoplasty,are being performed with increasing frequency for isolated stromal and endothelial disorders,respectively.

Ultrasonographic visualization of lower eyelid structures and dynamic motion analysis

AIM:To define the ultrasonographic structure of normal lower eyelid anatomic compartments and their spacial relationship in dynamic motion.METHODS:High resolution ultrasound(15MHz) was performed on the lower eyelids of 7 normal subjects.Movements of the lower eyelid and its compartments were visualized with ultrasound.In addition,the maximal excursion area of the lower eyelid fat compartments and retractor motions was measured before and after motion.RESULTS:The orbicularis muscle could be seen as an echolucent structure between the dermis and the echodence fat pads.Lower eyelid fat pad seems to be divided into 2 compartments as range of motion and direction of movement of each of them varies.It seems that these compartments have also different behavior.The measured profile area of the visible normal lower eyelid fat pads during movement of globe from up-gaze to down-gaze decreased by 50%.Order of movement of lower eyelid structures seems to be as follows:after globe movement fist we see retractor movement,anterior orbital fat pad,then skin and septum,and finally movement of inferior fat pad.CONCLUSION:Ultrasound represents a noninvasive tool for the visualization of lower eyelid morphology.Expanding its application could help us understand the compartmental changes in physiological eyelid movement,in aging and diseased study populations,as well as assess operative outcomes.

Infectious keratitis in Vietnam:etiology,organisms,and management at Vietnam National Eye Hospital

AIM:To report the etiologies,risk factors,treatments,and outcomes of infectious keratitis(IK)at a major Vietnamese eye hospital.METHODS:This is a retrospective review of all cases of IK at Vietnam National Eye Hospital(VNEH)in Hanoi,Vietnam.Medical histories,demographics,clinical features,microbiological results,and treatment outcomes were reviewed.RESULTS:IK was diagnosed in 1974 eyes of 1952 patients,with ocular trauma being the greatest risk factor for IK(34.2%),frequently resulting from an agriculturerelated injur y(53.3%).The mean duration between symptom onset and presentation to VNEH was 19.3±14.4 d,and 98.7%of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH.Based on smear results of 1706 samples,the most common organisms identified were bacteria(n=1107,64.9%)and fungi(n=1092,64.0%),with identification of both bacteria and fungi in 614(36.0%)eyes.Fifty-five of 374 bacterial cultures(14.7%)and 426 of 838 fungal cultures(50.8%)were positive,with the most commonly cultured pathogens being Pseudomonas aeruginosa,Streptococcus pneumonia,Fusarium spp.,and Aspergillus spp.Corneal perforation and descemetocele developed in 391(19.8%)and 93(4.7%)eyes,respectively.Medical treatment was successful in resolving IK in 50.4%eyes,while 337(17.1%)eyes underwent penetrating or anterior lamellar keratoplasty.Evisceration was performed in 7.1%of eyes,most commonly in the setting of fungal keratitis.CONCLUSION:Ocular trauma is a major risk factor for IK in Vietnam,which is diagnosed in almost 400 patients each year at VNEH.Given this,and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration,greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Jules Stein眼科研究所1999—2003年眶肿块性病变的临床表现

BACKGROUND AND OBJECTIVE: To describe the clinical manifestations,diagnoses,treatments,and outcomes of orbital mass lesions at a tertiary care referral center. PATIENTS AND METHODS: All cases of newly diagnosed or referred orbital tumors at the Jules Stein Eye Institute from 1999 to 2003 were reviewed retrospectively. Demographic and clinical data were extracted from the electronic oculoplastics registry of the Division of Orbital and Ophthalmic Plastic Surgery. RESULTS: Three hundred sixty-nine cases of orbital mass lesions were evaluated (167 males and 202 females; mean age=48 years). The most common presenting symptoms were mass/proptosis,pain,swelling,inflammation,and diplopia. The most common categories of diagnosis were cystic or structural lesions,benign tumors,inflammatory processes,neuronal processes,and fibrous processes. Increasing age was associated with an increased incidence of primary and metastatic malignant tumors. Half of all cases required surgical intervention consisting of excision,debulking,or exenteration; 20% to 30% of cases were managed conservatively. CONCLUSIONS: The differential diagnosis of orbital mass lesions differs across age groups. No clinical sign or symptom is specific for the underlying diagnosis and the biological behavior of the abnormal process may be misleading. Therefore,a careful diagnostic approach that considers the benefit of imaging studies must be undertaken. Almost 50% of these mass lesions can be managed with nonsurgical intervention.

Role of Phacoemulsification in Angle Closure Glaucoma

Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP).Conventionally,medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However,recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.

Effect of periocular injection of celecoxib and propranolol on ocular level of vascular endothelial growth factor in a diabetic mouse model

AIM: To investigate the effects of periocular injection of propranolol and celecoxib on ocular levels of vascular endothelial growth factor(VEGF) in a diabetic mouse model.METHODS: Forty 4-6wk BALB-C male mice weighing20-25 g were used. The study groups included: non-diabetic control(group 1), diabetic control(group 2),diabetic propranolol(group 3), and diabetic celecoxib(group 4). After induction of type 1 diabetes by streptozotocin, propranolol(10 μg) and celecoxib(200 μg dissolved in carboxymethylcellulose 0.5%) were injected periocularly. The ocular level of VEGF was measured in all the study groups using enzyme-linked immuno sorbent assay(ELISA) method. RESULTS: Ocular VEGF level was significantly increased(1.25 fold) in the diabetic control group when compared to the non-diabetic group one week after induction with streptozotocin(P =0.002). Both periocular propranolol and celecoxib significantly reduced ocular VEGF levels(P =0.047 and P <0.001, respectively). The effect was more pronounced with celecoxib. CONCLUSION: The periocular administration of propranolol and celecoxib can significantly reduce ocular VEGF levels in a diabetic mouse model.

Bruch's membrane opening-minimum rim width and visual field loss in glaucoma:a broken stick analysis

AIM:To determine the Bruch's membrane opening-minimum rim width(BMO-MRW) tipping point where corresponding visual field(VF) damages become detectable.METHODS:A total of 85 normal subjects and 83 glaucoma patients(one eye per participant) were recruited for the study.All of the patients had VF examinations and spectral-domain optical coherence tomography to measure the BMO-MRW.Total deviation values for 52 VF points were allocated to the corresponding sector according to the Garway-Heath distribution map.To evaluate the relationship between VF loss and BMOMRW measurements,a "broken-stick" statistical model was used.The tipping point where the VF values started to sharply decrease as a function of BMO-MRW measurements was estimated and the slopes above and below this tipping point were compared.RESULTS:A 25.9% global BMO-MRW loss from normative value was required for the VF loss to be detectable.Sectorally,substantial BMO-MRW thinning in inferotemporal sector(33.1%) and relatively less BMO-MRW thinning in the superotemporal sector(8.9%) were necessary for the detection of the VF loss.Beyond the tipping point,the slopes were close to zero throughout all of the sectors and the VF loss was unrelated to the BMO-MRW loss.The VF loss was related to the BMO-MRW loss below the tipping point.The difference between the two slopes was statistically significant(P≤0.002).CONCLUSION:Substantial BMO-MRW loss appears to be necessary for VF loss to be detectable in patients with open angle glaucoma with standard achromatic perimetry.

Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma： a one-year comparative study

AIM:To compare the efficacy of single-session 360-degree selective laser trabeculoplasty(SLT) for reduction of intraocular pressure(IOP) in patients with pseudoexfoliative glaucoma(PXFG) and primary open angle glaucoma(POAG).· METHODS:This is a single-center,prospective,nonrandomized comparative study.Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included.The primary outcome measure changed in IOP from baseline.Success was defined as IOP reduction ≥20%from baseline without any additional IOP-lowering medication.All patients were examined at 1d,1wk,1,3,6,9,12 mo after SLT.· RESULTS:Nineteen patients(20 eyes) with PXFG and27 patients(28 eyes) with POAG were included in the study.In the visual fields mean deviation was-2.88(±1.67)in the POAG and-3.1(±1.69) in the PXFG groups(P=0.3).The mean(±SD) IOP was 22.9(±3.7) mm Hg in the POAG group and 25.7(±4.4) mm Hg in the PXFG group at baseline and decreased to 18.4(±3.2) and 18.0(±3.9) mm Hg in the POAG group(P<0.001 and P=0.02),and to 17.9(±4.0) and 21.0(±6.6) mm Hg in the PXFG group(P<0.001 and P=0.47) at 6 and 12 mo,respectively.The number of medications was 2.6(±0.8) in the POAG group and 2.5(±0.8) in the PXFG group at baseline,and did not change at all follow-up visits in both groups(P =0.16 in POAG and 0.57 in PXFG).Based on Kaplan-Meier survival analysis,the success rate was 75%in the POAG group compared to 94.1%in the PXFG group(P=0.08;Log-rank test) at 6mo,and 29.1%and 25.0%at 12 mo,respectively(P=0.9;Log-rank).· CONCLUSION:The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications.The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up.

在眼眶减压术当时及以后行上睑退缩矫正术对治疗甲状腺性眼眶病的疗效比较

Purpose: To evaluate the outcome of eyelid retraction surgery in thyroid-rela ted orbitopathy (TRO) patients in 2 different surgical settings: done simultaneo usly with orbital decompression or as a staged procedure after orbital decompres sion. Design: Retrospective, comparative, nonrandomized clinical study. Particip ants: Ninety-six patients (158 eyes). Methods: A review of electronic medical r ecords of TRO patients who underwent surgery for upper eyelid retraction and orb ital decompression at the Jules Stein Eye Institute in 1999 to 2003 was performe d. Data regarding eyelid position, comprehensive eye examination, surgical outco me, and complications were analyzed. Main Outcome Measures: Anatomical and funct ional success based on margin reflex distance (MRD1; ≤5 mm was graded as mild r etraction; > 5mm and < 7 mm, moderate; and > 7 mm, severe), and patients’discom fort. Results: One hundred fifty-eight eyelid retraction surgeries were perform ed on 96 TRO patients (18 male and 78 female; mean age, 48 years); mean follow u p time was 15 (±12) months. Group 1 consisted of patients undergoing simultaneo us eyelid retraction surgery and orbital decompression and comprised 97 cases (s urgeries). Group 2 included 61 cases of staged surgery: orbital decompression an d eyelid retraction at a later stage. The groups had similar surgical outcomes, and >85%had a better eyelid position postoperatively. Reoperation rates for res idual or recurrent eyelid retraction were similar, overcorrection was higher in group 2 (5%vs. 0%, P=0.03). Changes in MRD1, lagophthalmos, and exophthalmos w ere similar (P>0.05, independent samples t test). Correction of eyelid retractio n was effective in treating patients’discomfort and exposure keratopathy (P=0.0 4, χ2). No severe complications occurred after orbital decompression or eyelid retraction surgery in this group of patients. Conclusions: Transconjunctival M ller’s muscle recession for correction of eyelid retraction in mild to moderate TRO patients, performed simultaneously with deep lateral wall orbital decompres sion, resulted in acceptable eyelid position in two thirds of our patients. Over correction and consecutive ptosis occurred less often after combined orbital dec ompression and eyelid retraction surgery than after isolated eyelid repositionin g surgery. If confirmed in prospective controlled studies, eyelid-repositioning surgery performed at the time of orbital decompression may decrease the number of total procedures and compress the time needed for surgical rehabilitation.

高分辨率磁共振成像揭示巩膜扣带术后发生严重斜视的多重机制

Purpose: Strabismus occurring after scleral buckling for retinal detachment typically is attributed to scarring, but this is not the only mechanism. We investigated use of magnetic resonance imaging (MRI) to identify a spectrum of mechanisms of strabismus occurring after scleral buckling. Design:Prospective, noncomparative, observational case series in an academic referral setting. Participants: Six patients with longstanding, large- angle strabismus after monocular or binocular scleral buckling. Horizontal and vertical preoperative deviations, present from 8 to 120 months, ranged from 25 prism diopters to more than 90 prism diopters. Methods: Multipositional high- resolution- MRI of both orbits was performed using surface coils in multiple, controlled gaze positions. Coronal, sagittal, and axial images were obtained as clinically appropriate. Main Outcome Measures: Different mechanisms of pathologic characteristics of the extraocularmuscles (EOMs) in complicated strabismus after scleral buckling. Results: Magnetic resonance imaging readily demonstrated EOM size and contractility, as well as features of scleral buckle hardware such as grooves and junctions and relationships of EOMs to the buckle and sclera. Imaging demonstrated that 5 rectus EOMs were disinserted from the globe at the buckle: 2 superior rectus, 2 medial rectus, and 1 lateral rectus. One patient with suspected inferior rectus muscle disinsertion had restrictive strabismus as a result of interference by a meridional explant and myopic staphyloma. Magnetic resonance imaging demonstrated anterior migration and transection by the silicone element through rectus EOMs in 3 patients. Disinserted EOMs were retrieved successfully by transconjunctival surgery in 4 patients and by orbitotomy in 1 patient, markedly improving alignment even as long as 5 years after EOM disinsertion. Conclusions: Multipositional high- resolution MRI provides valuable information such as location and contractile potential of disinserted EOMs, as well as mass effect from the scleral buckle. Preoperative orbital MRI may be a useful tool to distinguish multiple mechanisms of persistent severe strabismus after scleral buckling and is helpful in surgical planning.

高度近视眼中植入0 D晶体的有效性和安全性的初步研究

PURPOSE: To report the preliminary efficacy and safety of zero diopter (D) intraocular lens implantation in highly myopic eyes. DESIGN: Retrospective surgical case series. METHODS: Three highly myopic eyes with axial lengths greater than 30 mm were implanted with zero D Alcon model MA60MA 3-piece acrylic posterior chamber lenses at the time of cataract surgery. RESULTS: Uncorrected visual acuity improved from counting fingers to 20/20-and 20/40-in two eyes. Bestcorrected visual acuity improved from 20/80 and 20/60+to 20/20-in the same eyes. A third eye was at counting fingers before and after surgery, because of a staphyloma. The range of preoperative, intended postoperative, and achieved postoperative spherical equivalent refractive errors was-15.1 to-25.0 diopters,-0.20 to-1.44 diopters, and +0.13 to +0.50 diopters respectively. CONCLUSIONS: All eyes experienced mild hyperopic refractive errors after surgery. No retinal detachments occurred during the follow-up interval.

27-gauge vitrectomy--an update on recent surgical outcomes

The introduction of transconjunctival sutureless microincision vitrectomy surgery(MIVS)with 23-and25-gauge(23 and 25 G)instrumentation has virtually replaced the more antiquated 20-gauge equivalents,resulting in shorter operation time,reduced

Effect of Anterior Capsule Polishing on the Need for Laser Capsulotomy

Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angles, California, USA. Methods: This study involved a retrospective review of eyes that underwent phacoemulsification and intraocular lens implantation between September 1991 and June 1999. Lens epithelial cells in the 763 study eyes were mechanically debrided or polished from the inside surface of the anterior capsules using a pair of Shepherd-Rentsch (Morning STAAR Inc.) capsule polishers. The 484 control eyes that had surgery earlier in the series were not polished. The rate of laser capsulotomy in the ACP and the non-ACP groups was compared using a Kaplan-Meier survival analysis. Multivariate regression was performed to determine if variables other than ACP influenced the need for laser posterior capsulotomy. Results: We identified 763 eyes that had ACP and 484 that did not. At the 24-month follow-up interval, 26.6% of the eyes in the ACP group had received a capsulotomy versus 19.50% in the non-APC. Next, a separate study was done using only one eye per patient, taking the patient as the unit of analysis. Again the capsulotomy rate was higher in the ACP group compared to the non-ACP (1.02 per 100 person-months of follow-up vs. 0.74 per 100 person-months of follow-up). Finally, a third Kaplan-Meier analysis was done on 52 patients that had one eye treated with the ACP procedure and the other eye with the non-ACP procedure. Although the log-rank test showed the statistical significant of this analysis to be borderline, the results again favored the non-ACP group with a lower capsulotomy rate. Multivariate analysis showed very similar results to the above univariate studies. The mean time to capsulotomy was 46 months for the polished group and 70 months for the unpolished group. The severity of cataract (p = 0.46) and the type of haptics (p = 0.86) did not influence the rate of capsulotomy. Plate haptic IOLS had a higher rate of capsulotomy than loop haptic IOLS (p = 0.001). Conclusions: Polishing of the anterior capsule with Shepherd-Rentsch polishers may unexpectedly increase the rate of posterior capsule opacification in eyes with round-edge silicone lenses.

Risk Factors for Postoperative Retinal Detachment Following Cataract Surgery

Purpose: To determine the relation between patients’ age and degree of myopia on the risk of postoperative retinal detachment following cataract surgery. Setting: University-based cataract referral practice. Patients and methods: This is a retrospective study. The chart of all patients in the practice of 1 surgeon (K.M.M) who had cataract surgery by the Kelman phacoemulsification technique between 1991 and 2010, were reviewed to identify patients (those who had retinal detachment) was associated with 4-control who didn’t detach but had surgery around the same time. Result: Forty-three cases of retinal detachment were identified, the mean age at time of cataract surgery for the RD cases was 57.3 ± 14.7 years (range: 4 to 96 years) and for the control was 69.8 ± 12.9 years (range: 9 to 75 years), p Conclusion: The study shows that risk of retinal detachment and the degree of myopia is linear up to 12.00 diopters of myopia then starting to decline, and the risk of retinal detachment is the highest in age group between 50 to 59 years.

Pediatric neuro-ophthalmology:not simply neuro-ophthalmology for small adults

Pediatric neuro-ophthalmology is a subspecialty within neuro-ophthalmology.Pediatric neuro-ophthalmic diseases must be considered separate from their adult counterparts,due to the distinctive nature of the examination,clinical presentations,and management choices.This manuscript will highlight four common pediatric neuro-ophthalmic disorders by describing common clinical presentations,recommended management,and highlighting recent developments.Diseases discussed include pediatric idiopathic intracranial hypertension(IIH),pseudopapilledema,optic neuritis(ON)and optic pathway gliomas(OPG).The demographics,diagnosis and management of common pediatric neuro-ophthalmic disease require a working knowledge of the current research presented herein.Special attention should be placed on the differences between pediatric and adult entities such that children can be appropriately diagnosed and treated.

Complications from Plaque versus Proton Beam Therapy for Choroidal Melanoma: A Qualitative Systematic Review

Plaque brachytherapy has been a mainstay of treatment for choroidal melanoma to achieve intraocular tumor control. The most common radioisotopes used for treating smaller sized tumors are Iodine-125 in North America and Ruthenium-106 in Europe. Proton beam radiotherapy is available at a few centers and may also be used to achieve local tumor control. Both plaque and proton beam therapy are known to be associated with a range of complications that may affect visual outcome and quality of life. These include radiation retinopathy, optic neuropathy, neovascular glaucoma and local treatment failure, requiring enucleation. While differences in the rates of these complications have not been well established in the literature for patients treated with plaque versus proton beam therapy for choroidal melanoma, certain geographic regions prefer one treatment modality over the other. The purpose of this qualitative systematic review was to compare and contrast reported complications that developed with plaque and proton beam therapy for the treatment of choroidal melanoma in studies published over a ten-year period. Reported rates suggest that patients with proton beam therapy had potentially higher rates of complications, including vision loss, enucleation, and neovascular glaucoma compared to those with plaque therapy. The rates of optic neuropathy, radiation retinopathy, and cataract formation were widely variable for the two treatment modalities and rates of metastasis and metastasis-free survival appeared similar with both treatments. The most common reported predictors of ocular complications following both types of therapy were tumor distance from the optic nerve, tumor thickness, and radiation dose, suggesting that inherent tumor characteristics play a role in visual prognosis.

外伤后的假性近视分析(英文)

目的 :许多临床医师发现 ,一些患者在脑外伤 (TBI)后 ,会出现近视。面对此类患者 ,是马上为其下负镜矫正处方还是继续治疗 ,以期让患者恢复到以前的视力 ,这个问题让临床医师颇为为难。我们的目的是通过总结此类患者的病历 ,并对这种假性近视的性质进行归纳分类 ,以期更好地指导临床医师对患者进行有效的治疗。方法 :对患者的病历进行收集 ,并从三个方面进行分析。根据近视的波动情况以及三种不同治疗方案的疗效进行分类。这些治疗方法包括缓解调节痉挛 (包括阿托品 ) ,传统的方法以放松调节系统 ,以及屈光矫正。结果 :外伤后的假性近视一般有以下三种表现形式 :①症状短暂 ,偶尔出现。②症状较顽固 ,滴用睫状肌麻痹剂后消失 ,但药效过后马上出现。③极少数情况下 ,一些患者的近视度数一直在增加。结论 :假性近视是TBI后出现的后遗症之一。了解外伤后出现的假性近视及其处理方法有助于临床医师更好地处理这些病例。处理中要有一定的灵活度 ,因为患者具有个体差异 ,处理方法也不一样。掌握患者的病史并对可能出现的后果给予解释 ,有助于患者更好地理解自己的病情。

Choriocapillaris in non-neovascular age-related macular degeneration as evaluated by optical coherence tomography angiography

Dramatic advances in retinal imaging technology over the last two decades have significantly improved our understanding of the natural history and pathophysiology of non-neovascular age-related macular degeneration(AMD).Currently,aside from micronutrient supplements,there are no proven treatments for non-neovascular or dry AMD.Recently,a number of pharmacological agents have been evaluated or are under evaluation for treatment of patients with end-stage dry AMD manifesting as geographic atrophy(GA).It may preferable,however,to intervene earlier in the disease before the development of irreversible loss of visual function.Earlier intervention would require a more precise understanding of biomarkers which may increase the risk of progression from early and intermediate stages to the late stage of the disease.The development of optical coherence tomography angiography(OCTA)has allowed the layers of the retinal microcirculation and choriocapillaris(CC)to be visualized and quantified.Flow deficits in the CC have been observed to increase with age,particularly centrally,and these flow deficits appear to worsen with development and progression of AMD.As such,OCTA-based CC assessment appears to be a valuable new biomarker in our assessment and risk-stratification of AMD.Alterations in the CC may also provide new insights into the pathophysiology of the disease.Enhancement of choriocapillaris function may also prove to be a target of future therapeutic strategies or as a biomarker to monitor the effectiveness of therapy.As such,CC imaging may be anticipated to be an integral tool in the management of dry AMD.

Combination therapy for retinopathy of prematurity

Toy et al.described 17 infants(33 eyes)who were treated with intravitreal bevacizumab(0.625 mg)injection for type 1 retinopathy of prematurity(ROP)followed by subsequent exam under anesthesia and fluorescein angiography(FA)taken after 50 weeks of gestational age(1).All eyes had a“scalloped regression”pattern of the peripheral retina on FA.Recurrence or chronic vascular arrest based on FA findings were noted in 30 eyes(91%)for which secondary laser was added to areas of persistent non-perfusion.