房角镜辅助的内路360°小梁切开术(Gonioscopy-Assisted Transluminal Trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术,是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm's管后,利用微导管张力全周切开小梁网及Schlemm's管内壁,重建生理性房水流出通道,避免小梁网阻力,实现房水从前房直接进入集液管,通过增加房水流出机制降低眼压。GATT适应证广泛,主要应用于开角型青光眼,包括原发型开角型青光眼和继发性开角型青光眼,同时可运用于闭角型青光眼。GATT微创、不依赖滤过泡、能明显减少降眼压药物的使用、中远期疗效稳定、安全性高、较少发生威胁视力的并发症,可作为开角型青光眼的首选手术方式。本文将对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述,以期为其临床运用提供参考。
As a modifed trabeculotomy, Gonioscopy-Assisted Transluminal Trabeculotomy (GAT) is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years. GAT inserts a microcatheter (iTrack) into the Schlemm's canal and advance the catheter through the canal circumferentially 360°, then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal. Tis method can reduce intraocular pressure by increasing the outfow of aqueous humor. Te physiological outfow pathway of aqueous humor is reconstructed, which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber. With a wide range of indications, GAT is mainly used in open-angle glaucoma, including primary open-angle glaucoma and secondary open-angle glaucoma, and is also used in primary closed- angle glaucoma. Additionally, GATT can be the preferred surgical modality for open-angle glaucoma, as it has the following advantages: minimally invasive, independent of fltration bleb, can signifcantly reduce the use of medications, stable medium- and long-term efcacy, high safety, and has fewer sight-threatening complications. In order to provide a reference for clinical application, this article reviews the indications, mechanism of action, surgical procedures, efectiveness, complication and factors afecting therapeutic efect.
马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病,约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者,因患有MFS致双眼晶状体半脱位伴双眼并发性白内障,先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术,术后保留低度近视,随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。
Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.
目的:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocular lens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至 2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。
Objective: To investigate the efficacy and safety of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens (IOL) implantation in the treatment of microspherophakia (MSP). Methods: by retrospective analysis, 37 MSP patients (37 eyes) who were treated in our hospital from January 2019 to June 2020 were randomly divided into two groups, including 20 MSP patients (20 eyes) who treated by SCSF-IOL and 17 MSP patients (17 eyes) who treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL). The best corrected vision and complications were observed. Results: the best corrected vision was significantly improved in both groups (P < 0.001), but there was no remarkable difference between the two groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd: YAG laser posterior capsulotomy was performed from 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment, and one eye (5.00%) had a decentered capsule opening. Posterior capsular opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up. Conclusions: SCSF-IOL is a simple and viable surgical option for managing MSP and is comparable with the MCTR-IOL. Nd: YAG laser posterior capsulotomy is a necessary mean to prevent residual capsule complications after the SCSF-IOL procedure.
眼健康是国民健康的重要组成部分,包括盲在内的视觉损伤严重影响人民群众的身体健康和生活质量,加重家庭和社会负担,威胁社会经济生产活动,是涉及民生的重大公共卫生问题和社会问题。弱视作为幼儿期起病的主要视觉障碍性疾病之一,是致使青少年低视力的首要因素,影响青少年自身学业和心理健康,增加致盲风险,故做好弱视的预防及康复工作刻不容缓。通过梳理研究发现,国内外对弱视的传统治疗方法有遮盖疗法、屈光矫正、压抑疗法等,知觉学习、视功能训练、电子视频游戏、针灸等则是近年逐渐新兴起并被广泛运用的弱视康复治疗方法,近年来关于年龄对弱视康复治疗影响的相关研究也较多。通过整理前人研究成果,提出建立儿童青少年视力档案、建立五位一体弱视康复治疗布局模式、进行联合临床治疗青少年弱视的对策,以期为青少年弱视提供康复治疗手段参考和选择,促进青少年弱视康复治疗眼健康事业发展。
Eye health is an important part of national health. Visual impairment, including blindness, seriously affects people’s physical health and quality of life, increases the burden on families and society, threatens social and economic production activities, and is a major public health and social problem related to people’s livelihood. Amblyopia,as one of the main visual disorders in early childhood, is the primary factor causing low vision in adolescents, which affects their academic and mental health and increases the risk of blindness. Therefore, it is urgent to do a good job in the prevention and rehabilitation of amblyopia. By summarizing existing studies, it is found that traditional treatment methods for amblyopia at home and abroad include occlusion therapy, refractive correction, and depressive therapy, while perceptual learning, visual function training, electronic video games, acupuncture and so on are gradually emerging in recent years and widely used in recent years. There are numerous studies on the impact of age on the rehabilitation of amblyopia. By sorting out the previous research results, this paper puts forward the countermeasures of establishing visual acuity files for children and adolescents, establishing the five- in-one rehabilitation treatment layout model, and combining clinical treatment for adolescent amblyopia, in order to provide reference and choice for the rehabilitation treatment of adolescent amblyopia, and promote the development of the eye health cause of adolescent amblyopia rehabilitation.
角膜基质透镜是带有一定屈光度的角膜组织,为利用激光或板层刀等在角膜基质层内雕刻出一个精确对焦点的光学透镜。随着角膜屈光手术的不断发展,术中产生了大量的角膜基质透镜, 越来越多的学者也将目光聚焦于此。我国角膜供体来源匮乏与手术量需求严重不匹配, 眼库严重缺乏供体角膜,而对角膜组织的需求却越来越大。角膜穿孔作为角膜疾病的终末阶段,严重威胁患者的视力,甚至要面临摘除眼球的风险, 是对患者身体与心理的双重打击。绝大多数的角膜穿孔需要紧急手术处理, 对于一些常规治疗无效或角膜病变更严重的,角膜移植术可能是唯一有效的手段。对原本废弃的透镜重新利用, 将其用于治疗角膜溃疡、修补角膜穿孔以及辅助治疗各类角膜疾病的危重阶段, 均观察到其取得了良好的效果, 这在一定程度上缓解了临床上角膜供体缺乏的现状。本文报道了2例由角膜白斑引起的角膜穿孔患者使用异体角膜基质透镜移植治疗的病例, 术后2名患者病情均得到稳定。同时探讨了角膜基质透镜移植的局限性, 本文并未观察到角膜透镜移植对于感染性、免疫性等其他原因造成的角膜穿孔的疗效, 因此在行角膜移植之前,要正确认识及处理原发病,尽量避免一些并发症和排斥反应的发生。
Corneal stromal lenses are corneal tissues with specific refractive power, created by precisely sculpting an optical lens within the corneal stromal layer using lasers or microkeratomes. With the ongoing development of corneal refractive surgery, a large amount of corneal stromal lenses are generated during procedures, drawing increasing attention from researchers. In China, there exists a severe mismatch between the scarcity of corneal donors and the high demand for surgical procedures. This has led to a critical shortage of donor corneas in eye banks, while the need for corneal tissue keeps rising. Corneal perforation, which is the end-stage of various corneal diseases, poses a significant threat to patients' vision and may even result in enucleation, causing considerable physical and psychological distress. Most cases of corneal perforation require urgent surgical intervention. For patients with severe conditions or those for whom conventional treatments are ineffective, corneal transplantation may be the only viable option. Reusing stromal lenses that were previously discarded to treat corneal ulcers, repair corneal perforations, and assist in managing critical stages of various corneal diseases has shown promising results. This, to some extent, helps alleviate the clinical shortage of donor corneas. This article presents two cases of corneal perforation caused by corneal leukoma, both of which were successfully treated with allogeneic corneal stromal lens transplantation. Both patients achieved stable conditions after the operation. Additionally, this paper discusses the limitations of corneal stromal lens transplantation. The efficacy of corneal lens transplantation for perforations caused by infectious or immunological etiologies was not observed in this study. Therefore, it is essential to accurately diagnose and manage the underlying disease before transplantation and to minimize the occurrence of complications and rejection reactions.
目的:观察超声乳化白内障吸除人工晶状体植入术(phacoemulsification with intraocular lens implantation, PEI)联合房角分离术(goniosynechialysis, GSL)及房角切开术(goniotomy, GT)治疗中晚期原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma , CPACG)合并白内障的安全性和有效性。方法:采用回顾性病例研究。收集2020年6月至2024年1月在成都市中西医结合医院行PEI联合GSL及GT的中晚期CPACG合并白内障患者94例133眼,观察最佳矫正视力(best corrected visual acuity, BCVA)、眼压、抗青光眼药物使用数量及术后并发症等情况。采用重复测量方差分析、Wilcoxon秩检验进行统计学处理。结果:术后1天,1周,1、3、6个月94例患者133眼的BCVA(logMAR)均较术前有所提升(P<0.05);从术后1天到6个月的所有随访时间点眼压均较术前明显下降(F = 189.79,P<0.001);术后6个月,患者使用的降眼压药物数量明显低于术前 ( Z = -2.392,P<0.001)。术后1周中31眼(23%)出现角膜水肿,15眼(11%)出现前房积血,均在1周内消退;术后1个月内1眼出现眼压反跳,予以前房穿刺放液等治疗后眼压恢复到正常范围。术后6个月,121眼(91%)手术完全成功,10眼(8%)手术条件成功。结论:PEI联合GSL及GT治疗中晚期CPACG合并白内障可有效地提高视力、降低眼压,且无严重并发症。
Objective: To observe the safety and efficacy of phacoemulsification with intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) and goniotomy (GT) in treating advanced chronic primary angle-closure glaucoma (CPACG) complicated by cataract. Methods: This was a retrospective case series study. We collected data from a total of 94 patients (133 eyes) who had advanced CPACG along with cataract and underwent PEI+GSL+GT at Chengdu Integrated TCM&Western Medicine Hospital between June 2020 and January 2024. We observed the best corrected visual acuity (BCVA), intraocular pressure (IOP), the number of anti-glaucoma drugs used, and postoperative complications. Repeated measures ANOVA and Wilcoxon rank test were used for statistical analysis. Results: The BCVA (logMAR) at 1 day, 1 week, 1, 3, and 6 months after surgery showed significant improvement compared to the pre-surgical values (F = 189.79,P < 0.001); The IOP at 1 day, 1 week, 1, 3, and 6 months post-surgery was significantly lower than that pre-surgical IOP (P < 0.001). The number of IOP-lowering drugs used at 6 months after surgery was also significantly reduced compared to the pre-surgical (Z = -2.392, P < 0.001). One week after surgery, corneal edema occurred in 31 eyes (23%) and hyphema in 15 eyes (11%) , both of which resolved spontaneously within 1 week. Within one month after surgery, 1 eye experienced an IOP spike, and the intraocular pressure returned to normal range after treatments such as anterior chamber puncture and drainage. Six months after surgery, the operation was completely successful in 121 eyes (91%), and conditionally successful in 10 eyes (8%), resulting in an overall surgical success rate of 99%. Conclusions: PEI combined with GSL and GT can effectively improve vision and reduce IOP in patients with advanced CPACG complicated by cataract, without causing serious complications.
目的:探讨眼眶泪腺导管囊肿的临床特征及手术治疗方式,提高对该疾病诊疗的认识。方法:回顾性分析天津医科大学第二医院1991年1月—2023年12月经手术后病理证实的14例眼眶泪腺导管囊肿患者的临床资料。结果:14例患者中,男性9例,女性5例;年龄8个月~59岁,平均年龄为26.5岁;均为单眼,其中左眼9例,右眼5例;多以发现眼眶肿物或眼睑肿胀隆起就诊。B超/彩色多普勒超声或CT均提示囊性占位性病变。所有患者均接受了囊肿切除术,全身麻醉手术4例,局部麻醉手术10例;其中前路皮肤切口6例,结膜切口8例,辅助外眦切开3例。术中6例囊肿破裂,囊腔内注入医用透明质酸钠凝胶,辅助完整摘除囊壁。术后病理均提示泪腺导管囊肿,其中睑叶泪腺导管囊肿4例,眶叶泪腺导管囊肿4例,副泪腺导管囊肿5例,异位泪腺导管囊肿1例。术后复查未见并发症。结论:泪腺导管囊肿是临床较少见的疾病,可以发生在眼部的任何部位,结合典型的临床及影像学表现,主泪腺导管囊肿可基本明确诊断,但仍需与上皮/结膜包含性囊肿及皮样囊肿等鉴别,最终需病理确诊。手术完整切除囊肿是治疗该病的主要方法,切除不完全,有复发可能;术中辅助应用医用透明质酸钠凝胶囊内注射有助于囊肿完整摘除。
Abstract Objective:To explore the clinical characteristics and surgical treatment for lacrimal duct cyst, aiming to enhance the diagnosis and therapeutic outcomes of this disease. Method: We conducted a retrospective analysis of the clinical data from 14 patients with lacrimal duct cysts all of which were confirmed by postoperative pathology. These patients were treated at our hospital from January 1991 to December 2023. Results: Among the 14 patients, there were 9 male and 5 females, with age ranging from 8 months to 59 years (mean: 26.5 years). All cases involved unilateral involvement, with 9 affecting the left eye and 5 affecting the right eye. The majority of patients sought medical care due to the presence of an orbital mass or eyelid swelling and protrusion. Imaging studies, including B-ultrasound, color Doppler ultrasound, or CT scans, consistently revealed cystic space-occupying lesions. All patients underwent cystectomy, with 4 cases performed under general anesthesia and 10 cases under local anesthesia. Surgical appoaches included anterior skin incision in 6 cases, conjunctival incision in 8 cases, and auxiliary lateral canthotomy in 3 cases involving. During surgery, cyst rupture occurred in 6 cases, necessitating the injection of medical sodium hyaluronate gel into the cyst cavity to facilitate the complete removal of the cyst wall. Postoperative pathological analysis confirmed the presence of lacrimal gland duct cysts, which were further classified as follows: 4 cases of eyelid lobe lacrimal gland duct cysts, 4 cases of orbital lobe lacrimal gland duct cysts, 5 cases of accessory lacrimal gland duct cysts, and 1 case of ectopic lacrimal gland duct cyst. No postoperative complications were observed in any the patients. Conclusions: Lacrimal duct cysts are relatively uncommon in clinical practice and can arise in any part of the eye. Given their typical clinical and imaging features, a primary lacrimal duct cyst can generally be diagnosed with reasonable degree of certainty. However, it is still necessary to be differentiated it from epithelial/conjunctival inclusion cysts and dermoid cysts, and other similar conditions, with the final diagnosis relying on pathological confirmation. Complete surgical resection of the cyst is the primary treatment approach for this disease, as incomplete resection may result in recurrence. Intra-capsular injection of medical sodium hyaluronate gel during surgery can aid in the complete remval of the cyst.
目的:识别新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,NVAMD)患者接受抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物治疗后出现的黄斑萎缩事件,并评估其治疗前的眼部解剖结构变化。方法:回顾 2014 全年期间由采用抗 VEGF 药物治疗的所有 NVAMD 患者,这些患者的随访时间均超过 12 个月,并评估了从首次治疗(通常在 2014 年前)至 2018 年 6 月最后一次随访期间的所有谱域光学相干断层扫描(spectral domain-optical coherence tomography, SD-OCT)图像。结果:在既定的研究流程中,共识别出 278 例 NVAMD 患者的 342 眼,其中 47 眼发生了黄斑萎缩。从治疗开始到黄斑萎缩出现的中位时间为 29.6 个月(四分位距:17.7-43.4)。在发生萎缩的区域中,发现了三种黄斑结构改变(部分眼睛存在不止一种改变):在 25 眼中观察到血管化色素上皮脱离(pigment epithelial detachment,PED)的塌陷和脉络膜新生血管(choroidal neovascularization,CNV)的消退;在 15 眼中观察到视网膜下高反射物质和(或)视网膜下纤维化的形成;在 13 眼中观察到黄斑萎缩与大玻璃膜疣及色素改变相关联,呈现出通常称为地图状萎缩的典型模式。结论:这些数据表明,在某些情况下,CNV 可能补偿脉络膜的缺血状态,而 CNV 的消退则可能使 RPE 细胞和光感受器暴露于缺血性损伤和萎缩的风险之中。
Background/Aims: To identify incident macular atrophy and evaluate antecedent anatomic alterations in eyes with neovascular age-related macular degeneration (NVAMD) that were treated with anti-vascular endothelial growth factor (anti-VEGF) agents. Methods: All patients treated with anti-VEGF agents for NVAMD by one of the authors during the 2014 calendar year who had follow up ≥ 12 months had evaluation of all SD-OCT scans from first treatment (usually prior to 2014) to last follow up through June 2018. Results: The ascertainment procedure identified 342 eyes of 278 patients with NVAMD among which 47 developed macular atrophy. The median time from treatment initiation to development of macular atrophy was 29.6 (interquartile range, 17.7 - 43.4) months. Three macular alterations were identified in areas that developed atrophy (some eyes had more than one); collapse of a vascularized pigment epithelial detachment (PED) and regression of choroidal neovascularization (CNV) in 25 eyes, development of subretinal hyper-reflective material and/or subretinal fibrosis in 15 eyes, or atrophy occurring in association with large drusen and pigmentary changes resulting in an arc of atrophy in a pattern typically referred to as geographic atrophy in 13 eyes. Conclusions: These data suggest that in some instances CNV may compensate for choroidal ischemia and the loss of CNV may expose retinal pigmented epithelial cells and photoreceptors to ischemic damage and atrophy.
目的:评估显微射频消融术治疗异位睫毛的临床疗效和安全性。方法:回顾性分析接受显微射频消融术治疗的18例异位睫毛患者资料,均采用美国Ellman公司Surgitron射频刀进行治疗,术后随访至少3个月。观察指标包括异位睫毛清除率、达到治愈所需治疗次数、并发症、患者满意度。采用Spearman等级相关分析评估患者基线特征与治疗次数的相关性。结果:共纳入18例患者30眼。显微射频消融术的术后即刻异位睫毛清除率达100%。5眼(16.7%)经单次治疗后达到治愈,11眼(36.7%)需要2次治疗达到治愈,13眼(43.3%)需要3次治疗达到治愈,1眼(3.3%)需要3次以上治疗达到治愈。主要并发症包括干眼13眼(43.3%)、睑缘炎症1眼(3.3%),未发现睑缘畸形、瘢痕等严重并发症。患者满意度调查显示非常满意16例(88.9%),基本满意2例(11.1%),总体满意度(非常满意+基本满意)达100%。相关性分析提示倒睫数量与达到治愈的治疗次数呈显著正相关(rs=0.672, P=0.002)。结论:显微射频消融术治疗异位睫毛具有精确定位、有效破坏毛囊、治疗时间短、创伤小、恢复快、安全性高等优点,患者满意度高,是治疗异位睫毛的有效方法。
Objective: To evaluate the clinical efficacy and safety of microscopic radiofrequency ablation in treating of distichiasis and aberrant lashes. Methods: We performed a retrospective analysis on 18 patients with trichiasis (distichiasis and aberrant lashes) who underwent microscopic radiofrequency ablation treatment. All patients were followed up for a minimum of 3 months after the operation. The outcome measures included trichiasis clearance rate, the number of treatment sessions needed to achieve success, complications, and patient satisfaction. Spearman rank correlation analysis was used to evaluate the correlation between the baseline characteristics of patients and the number of treatment sessions. Results: The study included 18 patients with a total of 30 eyes. Immediately after the operation, the trichiasis clearance rate achieved through microscopic radiofrequency ablation was 100%. Among the eyes, 5 eyes (16.7%) were successful treatment after just one session, 11 eyes (36.7%) required 2 treatment sessions, 13 eyes (43.3%) needed 3 treatment sessions, and 1 eye (3.3%) required more than 3 treatment sessions to achieve success. The major complications included dry eye in 13 cases (43.3%) and eyelid margin inflammation in 1 case (3.3%). Notably, no severe complications such as eyelid deformity or scarring were observed. According to the patient satisfaction survey, 16 cases (88.9%) reported being very satisfied, and 2 cases (11.1%) were basically satisfied, resulting in an overall satisfaction rate of 100%. The correlation analysis indicated that the number of trichiatic eyelashes was significantly positively correlated with the number of treatment sessions (rs=0.672, P=0.002). Conclusions: Microscopic radiofrequency ablation for distichiasis and aberrant lashes treatment boasts serveral advantages, including precise localization, effective destruction of hair follicle, short treatment duration, minimal trauma, rapid recovery, and high safety. With a high level of patient satisfaction, it serves as an effective treatment method for distichiasis and aberrant lashes.
目的:探讨蛋白A免疫吸附联合糖皮质激素治疗对MOG抗体相关视神经炎(MOG antibody-associated optic neuritis, MOG-ON)患者的临床疗效及安全性。方法:回顾性分析2022年6月—2024年12月在广东三九脑科医院神经内科确诊并接受蛋白A免疫吸附联合糖皮质激素治疗的7例MOG-ON患者。所有患者均接受蛋白A免疫吸附治疗(隔天1次,共5次为1个疗程)并同期联合糖皮质激素治疗。评估治疗前及治疗后3个月、6个月的视力变化、扩展伤残状态量表(expanded disability status scale,EDSS)评分变化及MOG抗体滴度变化,并记录不良反应。结果:治疗后6个月,6/7患者视力较治疗前改善,其中4/7视力改善显著。左眼LogMAR视力值从治疗前的0.20(0.14,0.70)改善至0.10(0.10,0.42),右眼LogMAR视力值从0.30(0.19,0.47)改善至0.18(0.10,0.21),EDSS视力评分从2.86±1.68降至1.43±1.51(P < 0.05)。治疗前血清MOG抗体滴度几何平均数为1:52.0(几何标准差GSD = 3.7),治疗后3个月降至1:8.8(GSD = 1.9)(P = 0.027),治疗后6个月降至1:13.0(GSD = 4.1)(P = 0.027)。7例患者共接受35次免疫吸附治疗,未观察到严重不良反应,仅有轻微可控的不良事件。结论:蛋白A免疫吸附联合糖皮质激素治疗能够有效降低血液中MOG抗体水平,改善MOG-ON患者的视力。
Objective: To investigate the clinical efficacy and safety of protein A immunoadsorption combined with glucocorticoid therapy in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis(MOG-ON). Methods: A retrospective analysis was conducted on 7 patients with MOG-ON who were diagnosed and treated with protein A immunoadsorption combined with glucocorticoid therapy at the Department of Neurology,Guangdong Sanjiu Brain Hospital from June 2022 to December 2024. All patients underwent protein A immunoadsorption therapy (once every other day, with 5 sessions constituting one course) in conjunction with concurrent steroid therapy. Visual acuity changes, EDSS score changes, and MOG antibody titer changes were assessed before treatment, as well as at 3 and 6 months after treatment. Additionally, adverse events were meticulously recorded. Results: At the 6 months post-treatment mark, 6 patients (85.7%) demonstrated an improvement in visual acuity compared to their baseline levels, with 4 patients (57.1%) achieving a significant improvement. The median LogMAR visual acuity values in the left eye improved from 0.20(0.14,0.70) to 0.10(0.10,0.42), and in the right eye, they improved from 0.30(0.19,0.47) to 0.18(0.10,0.21). MeanWhile, the EDSS visual score decreased from 2.86±1.68 to 1.43±1.51(P < 0.05). The geometric mean serum MOG antibody titer declined from 1:52.0(GSD = 3.7) before treatment to 1:8.8(GSD = 1.9) at 3 months after treatment(P = 0.027), and further decreased to 1:13.0(GSD = 4.1) at 6 months after treatment(P = 0.027). A total of 35 immunoadsorption sessions were administered to the 7 patients, and no serious adverse reactions were observed; only minor and manageable adverse events occurred. Conclusion: Protein A immunoadsorption combined with glucocorticoid therapy can effectively lower serum MOG antibody levels and enhance visual outcomes in patients with MOG-ON.