治疗伴有无前房、白内障玻璃体混浊的葡萄膜炎继发性青光眼的手术方法

Surgical Treatment of Secondary Glaucoma in Uveitis with Extremely Shallow Anterior Chamber and Cataract#

:238-242
 
目的:探讨伴无前房、白内障的葡萄膜炎继发性青光眼的手术治疗方法。
方法:采用经角膜缘的晶状体和前段玻璃体切除或经睫状体平坦部的晶状体和玻璃体切除联合小梁切除术,对7只眼伴有无前房、白内障的葡萄膜炎继发性青光眼进行了手术治疗,观察术前术后眼压和前房深度变化、滤过泡、视力以及并发症情况,随访时间3~48个月。
结果:(1)眼压:7只眼术前平均眼压为(5.18±0.77)kPa,术后1天平均眼压为(0.95±0.29)kPa,术后1周平均眼压为(0.93±0.12)kPa,最后1次随访平均眼压为(1.14 4-0.70)kPa;(2)前房深度:所有患眼术后均形成前房,中央前房深度为3~5CT;(3)滤过泡情况:所有患眼术后均形成功能滤过泡,滤过泡形态为扁平弥散;(4)视力:1患眼术前视力0.01,术后1周视力CF/20am,最后1次随访矫正视力0.06;1患眼术前视力0.05,术后1周0.01,最后1次随访矫正视力0.1;余患者多为幼儿,不能配合视力检查但可追光;(5)术后并发症:所有患眼术后早期均有角膜水肿,瞳孔区均有纤维性渗出,房水闪辉(+~++++),但均未出现瞳孔和周切口膜闭、视网膜脱离和眼内炎等并发症。
结论:对于葡萄膜炎继发性青光眼同时伴无前房或极浅前房、白内障玻璃体混浊患者,晶状体玻璃体切除联合小梁切除手术能有效降低眼压,形成前房,无严重并发症,是一种治疗伴无前房的葡萄膜炎继发性青光眼安全有效的方法。
Purpose:To evaluate the efficacy of combined trabeculectomy,lensectomy and vitreeto—my for the management of secondary glaucoma in uveitis with extremely shallow anterior chamber and cataract.
Methods: Combined trabeculectomy, lensectomy and vitrectomy were undertaken formedically uncontrolled intraocular pressure (IOP)on 7 eyes (6 patients, aged from 4months to 20 years) with secondary glaucoma in uveitis in a retrospective cohort studybetween 2001 and 2005.
Resuls : The follow-up period ranged from 3 months to 4 years. Deep anterior chamberand functional bleb were observed in all the eyes postoperatively. The average IOP preoperatively, one day postoperatively, one week postoperatively, and the last time of fol-low-up were(5.18±0.77)kPa,(0.95 +0.29)kPa,(0.93 +0.12)kPa, and(1.14±0, 70 ) kPa respectively. No severe complication was observed postoperatively exceptfor the corneal edema and fber exudation.
Conclusions : Combined trabeculectomy, lensectomy and vitrectomy serve as effectiveand safety treatments for secondary glaucomous uveitis accompanied by extremely shal-low anterior chamber, cataract and vitreous opacity. Further intriguing study comparingthis combined surgery with combined phacoemulsification and drainage implant surgeryis warranted.
综述

Construction of databases: advances and significance in clinical research

Construction of databases: advances and significance in clinical research

:184-189
 
Widely used in clinical research, the database is a new type of data management automation technology and the most efficient tool for data management. In this article, we first explain some basic concepts, such as the definition, classification, and establishment of databases. Afterward, the workflow for establishing databases, inputting data, verifying data, and managing databases is presented. Meanwhile, by discussing the application of databases in clinical research, we illuminate the important role of databases in clinical research practice. Lastly, we introduce the reanalysis of randomized controlled trials (RCTs) and cloud computing techniques, showing the most recent advancements of databases in clinical research.
Widely used in clinical research, the database is a new type of data management automation technology and the most efficient tool for data management. In this article, we first explain some basic concepts, such as the definition, classification, and establishment of databases. Afterward, the workflow for establishing databases, inputting data, verifying data, and managing databases is presented. Meanwhile, by discussing the application of databases in clinical research, we illuminate the important role of databases in clinical research practice. Lastly, we introduce the reanalysis of randomized controlled trials (RCTs) and cloud computing techniques, showing the most recent advancements of databases in clinical research.
综述

Application of visual electrophysiology for the diagnosis and treatment of cataracts

Application of visual electrophysiology for the diagnosis and treatment of cataracts

:190-197
 
Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.
Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.
综述

Approved pharmacotherapy for myopic choroidal neovascularization: a review of randomized controlled trials in ranibizumab and aflibercept

Approved pharmacotherapy for myopic choroidal neovascularization: a review of randomized controlled trials in ranibizumab and aflibercept

:198-200
 
Myopic choroidal neovascularization (mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injections of ranibizumab and afl ibercept. These two vascular endothelial growth factor (VEGF) antagonists show superior ability to improve vision and reduce macular thickness, comparing with sham injections or verteporfin photodynamic therapy (vPDT). There is no severe ocular or systemic adverse reaction reported in studies associated with ranibizumab and afl ibercept for mCNV. Prompt treatment with these agents can lead to a better outcome.
Myopic choroidal neovascularization (mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injections of ranibizumab and afl ibercept. These two vascular endothelial growth factor (VEGF) antagonists show superior ability to improve vision and reduce macular thickness, comparing with sham injections or verteporfin photodynamic therapy (vPDT). There is no severe ocular or systemic adverse reaction reported in studies associated with ranibizumab and afl ibercept for mCNV. Prompt treatment with these agents can lead to a better outcome.
Case Report

Intravitreal aflibercept for rubeosis iridis secondary to proliferative diabetic retinopathy

Intravitreal aflibercept for rubeosis iridis secondary to proliferative diabetic retinopathy

:201-203
 
The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.
The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.
Case Report

External drainage for exudative retinal detachment secondary to central serous chorioretinopathy

External drainage for exudative retinal detachment secondary to central serous chorioretinopathy

:204-208
 
Background: To report the outcomes of external drainage of subretinal fluid (SRF) in exudative retinal detachment secondary to central serous chorioretinopathy (CSCR).
Methods: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected.
Results: Six eyes of six subjects were included with mean age of 45 years (range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months (range, 3 to 8 months). The pre-operative bestcorrected visual acuity (BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy (PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000 (counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months.
Conclusions: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.
Background: To report the outcomes of external drainage of subretinal fluid (SRF) in exudative retinal detachment secondary to central serous chorioretinopathy (CSCR).
Methods: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected.
Results: Six eyes of six subjects were included with mean age of 45 years (range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months (range, 3 to 8 months). The pre-operative bestcorrected visual acuity (BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy (PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000 (counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months.
Conclusions: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.
论著

汕头市中小学生隐性斜视现况横断面研究

Cross-sectional study of heterophoria among primary, middle and high school students in Shantou District, China

:44-50
 
目的:了解汕头地区城乡中小学生隐性斜视的患病现况,为防治斜视提供依据。方法:横断面研究,随机整群抽样调查。在汕头地区调查9所城乡中小学校,共7 537人。眼位检查采用33 cm角膜映光法,视远视近遮盖去遮盖与交替遮盖法;记录检查结果并按年级、城乡、不同类型眼位等特征进行归类,统计学方法分析总结。结果:完成调查人数共7 464人,其中男女分别为3 928和 3 536人,平均年龄11岁;本调查人群内、外隐斜视患病率分别为3.08%和60.65%,小学生内隐斜视率高于初中、高中学生内隐斜视率(P<0.001);高中学生外隐斜视率高于小学、初中学生外隐斜视率(P<0.001),特别是以高三年级学生外斜视率最高;农村学生的内、外隐斜视率均高于城市学生(P<0.05);logistic回归模型显示隐斜视率与年龄、性别无明显相关性。结论:首次报道了国内学生 中隐性斜视的分布特点,即内隐性斜视以小学生多,外隐斜视以高中生多,农村学生的隐斜率高于城市学生,可能与中国学生的屈光发育状态有关。
Objective: To investigate the prevalence of heterophoria among urban and rural students in Shantou City of Guangdong Province, China. Methods: Cluster sampling was used in randomly selecting 7 537 students from 9 schools in Shantou City. Ocular alignment was assessed by using the Hirschberg light reflex and cover test. Cover testing was performed by using fixation targets at both distance (6 m) and near (30 cm). Statistical analyses were performed using SPSS statistical software to investigate the association of age, grades and schools and different types of strabismus. Results: A total of 7 464 students were examined  (participation rate was 99.03%), including 3 928 boys and 3 536 girls, mean age 11 years. The prevalence of esophoria and exophoria were3.08% and 60.65%. Esophoria prevalence of primary school students have the signiffcant difference (P<0.001) contrast with middle school students and high school students. And prevalence of exophoria was highest in high school students and significantly higher than middle and primary school students respectively (P<0.001). Heterophoria was more prevalent in rural school students than urban school students(P<0.05). Multivariate logistic regression model indicated that the prevalence of heterophoria had no significant correlation with grades and ages. Conclusion: This survey first reported the prevalence of heterophoria in China. The prevalence of esophoria appears to be higher in primary students and exophoria was highest in high school students; Prevalence of Heterophoria in the population of this survey generally showed higher in rural school students than urban areas. These may be associated with refraction in Chinese students. 
论著

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

:39-43
 
Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.
Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens (IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by iTrace wavefront aberrometer (Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square (RMS) values of Z(3, -3), Z(3, 3), Z(3, -1), Z(3, 1), and Z(4, 0) and total high order aberration (HOA) were evaluated.
Results: The uncorrected and corrected visual acuities improve significantly (P<0.001). No significant postoperative changes were observed in spherical aberration (P=0.652). Significant changes in vertical coma and vertical trefoil (0.005±0.214 vs. -0.049±0.242, P=0.037; -0.141±0.222 vs. -0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery (0.567±0.161 vs. 0.688±0.343, P<0.001).
Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8 mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.
Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.
Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens (IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by iTrace wavefront aberrometer (Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square (RMS) values of Z(3, -3), Z(3, 3), Z(3, -1), Z(3, 1), and Z(4, 0) and total high order aberration (HOA) were evaluated.
Results: The uncorrected and corrected visual acuities improve significantly (P<0.001). No significant postoperative changes were observed in spherical aberration (P=0.652). Significant changes in vertical coma and vertical trefoil (0.005±0.214 vs. -0.049±0.242, P=0.037; -0.141±0.222 vs. -0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery (0.567±0.161 vs. 0.688±0.343, P<0.001).
Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8 mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.
论著

Surgically induced scleral staphyloma

Surgically induced scleral staphyloma

:33-38
 
Background: To report the clinical features of surgically induced scleral staphyloma and investigate the management.
Methods: Retrospective uncontrolled study.
Results: A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed. The first patient was a 3-year-old young girl underwent corneal dermoid resection. The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C (MMC). The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery. All patients performed allogeneic sclera patch graft. In the at least half a year follow-up, the best corrected visual acuity (BCVA) of all the four patients were no worse than that of preoperative. Ocular symptoms disappeared, including eye pain, foreign body sensation, and so on. Unfortunately, the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month.
Conclusions: Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid, pterygium, and cataract surgery. Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma. However sclera rejection and dissolution should be considered postoperatively.
Background: To report the clinical features of surgically induced scleral staphyloma and investigate the management.
Methods: Retrospective uncontrolled study.
Results: A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed. The first patient was a 3-year-old young girl underwent corneal dermoid resection. The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C (MMC). The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery. All patients performed allogeneic sclera patch graft. In the at least half a year follow-up, the best corrected visual acuity (BCVA) of all the four patients were no worse than that of preoperative. Ocular symptoms disappeared, including eye pain, foreign body sensation, and so on. Unfortunately, the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month.
Conclusions: Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid, pterygium, and cataract surgery. Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma. However sclera rejection and dissolution should be considered postoperatively.
Editorial

Management of subretinal hemorrhage

Management of subretinal hemorrhage

:22-24
 
Subretinal hemorrhage is a vision threatening complication of exudative age related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Timely removal or displacement of subretinal hemorrhage from the central macula, ideally within 7 to 10 days after onset, is critical to allowing potential recovery of vision. Surgical techniques with the use of a bubble to displace the subretinal hemorrhage can now be performed with tissue plasminogen activator to lyze the blood and with or without vitrectomy.
Subretinal hemorrhage is a vision threatening complication of exudative age related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Timely removal or displacement of subretinal hemorrhage from the central macula, ideally within 7 to 10 days after onset, is critical to allowing potential recovery of vision. Surgical techniques with the use of a bubble to displace the subretinal hemorrhage can now be performed with tissue plasminogen activator to lyze the blood and with or without vitrectomy.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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