论著

玻璃体切除术联合地塞米松玻璃体内植入剂治疗黄斑前膜的临床疗效分析

Clinical analysis of vitrectomy combined with dexamethasone intraveal implant in the treatment of epiretinal membrane

:113-126
 
目的:对比玻璃体切割术(pars plana vitrectomy, PPV)联合或不联合注射地塞米松玻璃体内植入剂(dexamethasone intraveal implant, DEX)治疗特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)的临床疗效。
方法: 采用回顾性研究设计,收集2022年1月—2023年6月于惠州市中心人民医院就诊,被
诊断为IMEM(Gass 2期)并行PPV联合phaco+IOL植入的患者49例(49只眼)。根据其治疗方案分为非联合注射DEX组(25例共25只眼)及联合注射DEX组(24例共24只眼)。记录所有患者术前术后的最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度(central macular thickness, CMT)、平均神经节细胞层(ganglion cell layer, GCL)厚度,椭圆体带(ellipsoidal zone, EZ)完整性。使用OCTA测量视网膜浅层毛细血管层(superficial capillary plexus, SCP)、中心区域血管密度(vessel densities, VDs)及中心凹无血管区(foveal avascular zone, FAZ)面积。使用非接触性眼压计测量患者眼压。随访至术后6个月,记录上述指标,其中BCVA及CMT随访至1年。使用SPSS 29.0软件进行数据的统计分析(独立样本t检验、Mann-Whitney U检验、Pearson χ2检验等)。使用重复测量方差检验分析各项指标的时间差异及交互差异性。采用线性回归分析CMT、平均GCL厚度、EZ完整性、VDs、FAZ面积及联合注射DEX与BCVA的相关性。
结果:本研
究两组间性别、年龄、眼压及术前各项指标差异均无统计学意义(P>0.05)。两种术式均能改善黄斑区结构、功能及微循环障碍,术后的BCVA在两组患者中均较术前有所改善,且持续至术后6个月,CMT的变化趋势同BCVA有高度一致性,而平均GCL厚度于术后3个月时开始恢复,而SCP中心凹VDs及FAZ面积于术后6个月时才有明显恢复,两种术式术后以上各指标均具有时间差异及交互差异性(P≤0.015),且6个月内联合注射DEX组表现更佳(P=0.036)。相较于非联合注射DEX组,只有联合注射DEX组在术后6个月时,EZ完整性的改善具有统计学意义(P=0.009)。但随访至1年时,两组之间BCVA及CMT差异均无统计学意义(P=0.079)。术后6个月内BCVA的改善与术后6个月的CMT、平均GCL厚度、SCP中心凹VDs、FAZ面积的改善及EZ完整性及是否注射DEX与术后6个月内BCVA的改善均有相关性。随访期间两组患者均未发生眼内炎、玻璃体积血、视网膜脱离等眼部或全身严重并发症。
结论:微创玻璃体切割术联合
玻璃体内注射DEX治疗相较于非联合注射DEX治疗组在6个月内疗效更佳。联合单次注射DEX治疗方案与非联合注射DEX治疗方案相比,在手术1年后对BCVA及CMT的改善无明显差异。
Objective: To analyze the efficacy and safety of minimally invasive vitrectomy (PPV) with or without intraoperative injection of dexamethasone intravitreal implant (DEX) for the treatment of Idiopathic Macular Epiretinal Membrane (IMEM), by comparing the relevant indicators.
Methods: A retrospective study design was used to collect 49 patients (49 eyes) who were diagnosed with IMEM (Gass2) and underwent surgical treatment(PPV+phaco+IOL implantation) at Huizhou Central People’s Hospital from January 2022 to June 2023. According to their treatment plan, they were divided into a non-combined injection DEX group (25 cases, 25 eyes) and a combined injection DEX group (24 cases,24 eyes). All patients underwent comprehensive optometry before and after surgery, and their best corrected visual acuity (BCVA) was recorded. Scan the central macular thickness (CMT) within 6x6mm of the macular area, while scanning the average ganglion cell layer (GCL) thickness. Record whether the elliptical zone (EZ) within 1x1mm of the macular area is complete and continuous. Use OCTA mode to scan the superficial capillary layer (SCP) of the retina within a range of 6x6mm, and record the measurements of vascular density (VDs) in the central area and the area of the foveal avascular zone (FAZ). Measure the patient's intraocular pressure using a non-contact tonometer. Follow up for 6 months and record the above indicators, with BCVA and CMT followed up for 1 year. Perform statistical analysis of data using SPSS 29.0 software (Independent sample t-test, Mann Whitney U-test and Pearson χ2-test). Use repeated measures ANOVA to analyze the time differences and interaction differences of various indicators. Linear regression analysis was used to examine the correlation between CMT, mean GCL thickness, EZ integrity, VDs, FAZ area, and combined injection of DEX with BCVA.
Results: There were no statistically significant differences in gender, age, intraocular pressure, and preoperative indicators between the two groups (P>0.05). Both surgical methods can improve the structure, function, and microcirculation disorders in the macular area. The postoperative BCVA in both groups of patients improved compared to before, and persisted until 6 months after surgery. The trend of CMT changes was highly consistent with BCVA, while the average GCL thickness began to recover at 3 months after surgery. The SCP fovea VDs and FAZ area did not show significant recovery until 6 months after surgery. Both surgical methods showed time differences and interaction differences in the above indicators after surgery (P=0.015), and the combined injection of DEX group performed better within 6 months (P=0.036). Compared to the non combined injection of DEX group, only the combined injection of DEX group showed statistically significant improvement in EZ integrity at 6 months after surgery (P=0.009). However, at 1 year of follow-up, there was no statistically significant difference in BCVA and CMT between the two groups (P≥0.079). The improvement of BCVA within 6 months after surgery is correlated with the improvement of CMT, average GCL thickness, SCP fovea VDs, FAZ area, EZ integrity, and injection of DEX within 6 months after surgery. During this study, no serious ocular or systemic complications such as endophthalmitis, vitreous hemorrhage, or retinal detachment occurred in either group of patients at each follow-up time point.
Conclusions: The efficacy of PPV combined with intravitreal injection of DEX is better within 6 months compared to the non-combined injection of DEX treatment group. There was no significant difference in the improvement of BCVA and CMT after one year of surgery between the combined single injection DEX treatment regimen and the non-combined injection DEX treatment regimen.
论著

经鼻内镜低位泪囊鼻腔吻合联合新型RT人工泪管置入治疗慢性泪囊炎的临床初步报告

Endonasal endoscopic lower position dacryocystorhinostomy combined with RT lacrimal stent intubation for treating chronic dacryocystitis

:27-34
 
目的:研究经鼻内镜低位泪囊鼻腔吻合术联合RT新型人工泪管置入手术的临床有效性和安全性。法:采用前瞻性随机对照研究,将临床诊断为原发性鼻泪管阻塞继发的慢性泪囊炎患者随机分为两组。研究组(A组)43例(44眼)采用低位经鼻内镜泪囊鼻腔吻合联合新型RT人工泪管置入术。对照组(B组)39例(39眼)采用常规经鼻内镜泪囊鼻腔吻合联合双泪小管置入式人工泪管置入。术后3~6个月取出人工泪管,随访时间1~12个月,平均6个月。观察术中术后的并发症,评估其安全性。结果: A组治愈42眼(95.45%),好转2眼(4.54%);B组治愈38眼(97.43%),好转1眼(2.56%),两组比较差异无统计学意义(P>0.05)。B组有12眼(30.77%)使用骨动力系统用于磨削骨质,A组未使用骨动力系统;A组手术时间为(31.88±1.64) min;B组手术时间为(48.54±4.40) min,两组比较差异有统计学意义(<0.01);B组术后人工泪管从内眦脱出2例,A组在人工泪管置入或取出时,均无管体被拉断裂的病例,无人工泪管从内眦侧脱出的病例。两组患者术后均无人工泪管导致的泪点撕裂,术后随访平均6个月,均无复发。论:低位经鼻内镜泪囊鼻腔吻合术联合RT新型人工泪管置入可以作为一种新的治疗慢性泪囊炎手术有效、安全的方法。
Objective: To study the efficacy and safety of endonasal endoscopic lower position dacryocystorhinostomy(En-LPDCR) combined with new RT lacrimal stent intubation for treating chronic dacryocystitis. Methods: In A prospective randomized controlled study, patients with chronic dacryocystitis secondary to primary nasolacrimal duct obstruction who met the inclusion criteria were randomly divided into two groups. In study group (Group A), 43 cases (44 eyes) were treated with the En-LP-DCR combined with new RT lacrimal stent intubation. Control group (Group B), 39 cases (39 eyes): conventional endoscopic dacryocystorhinostomy combined with bicanalicular intubation. The stent was removed from 3 to 6 months after surgery and followed up 6 to 12 months. Results: There was no recurrence of chronic dacryocystitis in both groups. In group A, 42 eyes (95.45%) were cured and 2 eyes (4.54%) were improved. In group B, 38 eyes were cured (97.43%) and 1 eye was improved (2.56%), there was no significant difference between the two groups (P > 0.05). In group B, 12 eyes (30.77%) With the incorporation of powered instrumentation to make bony ostium with full exposure of the lacrimal sac., while group A did not use powered dynamic system. Operation time of group A was (31.88±1.64) min; The operation time of group B was (48.54±4.40) min. The difference between the two groups was significant (< 0.01). In group B, the stent dislocated from the medial canthus in 2 cases, while in group A, there were no cases of the stent dislocated. No patient with dislocation, displacement of stent and punctum erosion founded in both groups, and no recurrence of chronic dacryocystitis was observed during the average follow-up of 6 months. Conclusion: Endonasal endoscopic lower position dacryocystorhinostomy combined with new RT lacrimal stent intubation is a new and effective method for the treatment of chronic dacryocystitis, with minimally surgical injury and faster postoperative recovery.
封面简介

Schlemm's canal 结构和功能调控的研究进展及其在青光眼治疗中的应用

Research progress on the structure and functional regulation of Schlemm's canal and its application in glaucoma treatment

:-
 
Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道,通过调节房水外排来维持眼内压的平衡,其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径,从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前,对SC发育和功能的调节机制的认识仍然有限,缺乏针对SC的特异性治疗策略。近年来,关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示,功能调控的关键分子靶标也相继被发现,这促进了对SC结构和功能调控的深入理解。此外,作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究,总结关键的分子和细胞学调控机制,归纳SC相关药物和手术疗法的最新进展,为青光眼的临床诊治提供了新的思路。
Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道,通过调节房水外排来维持眼内压的平衡,其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径,从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前,对SC发育和功能的调节机制的认识仍然有限,缺乏针对SC的特异性治疗策略。近年来,关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示,功能调控的关键分子靶标也相继被发现,这促进了对SC结构和功能调控的深入理解。此外,作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究,总结关键的分子和细胞学调控机制,归纳SC相关药物和手术疗法的最新进展,为青光眼的临床诊治提供了新的思路。
论著

胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的远期效果及眼表情况

Long-term Efficacy and Ocular Surface of Pterygium Excision Combined with Autologous Corneal Limbal Stem Cell Transplantation in Treatment of Pterygium

:101-105
 
目的:探讨胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的远期效果。
方法:2003年12月-2008年12月在我院就诊的原发性翼状胬肉患者55例57眼,均采用胬肉切除联合自体角膜缘干细胞移植治疗,术后随访2~8年,平均5.3年。观察创面愈合情况、治疗效果和并发症情况。
结果:术后早期患者均有不同程度的充血、水肿和异物感,3~5d 后症状逐渐减轻,一周左右完全消失。角膜创面完全上皮化时间为4~7d,平均4.83d。术后有持续性眼表刺激症状者7例,术后残留纤维组织者1例,角膜浅层瘢痕者4例。术后随访2~8年,平均5.3年,复发8例8眼 (复发率13.11%)。术后1年时复查OSDI 评分,所有患者较术前评分均有不同程度的降低,与术前相比,两组评分和构成比差异有统计学意义(P<0.05)。术后5年时复查OSDI评分较1年前稍有降低,但差异没有统计学意义(P>0.05)。术后1、5年时泪液基础分泌[(12.95±4.03) mm,(12.68±4.77) mm]和泪膜破裂时间 [(10.55±4.13)s, (10.03±4.64) s] 较术前[(9.48±3.34)mm,(8.14±3.57)s] 明显改善,差异有统计学意义(P<0.05)。
结论:应用胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉,术后早期症状轻、消失快,远期复发少,效果良好。
Purpose: To evaluate the long-term efficacy of pterygium excision combined with autologous corneal limbal stem cell transplantation in the treatment of pterygium.
Methods: Fifty five patients (57 eyes) diagnosed with primary pterygium undergoing pterygium excision combined with autologous corneal limbal stem cell transplantation between December 2003 and December 2008 were enrolled in this study. Postoperative follow-up endured for 2-8 years, 5.3 years on average. The wound healing, clinical efficacy and postoperative complications were observed.
Results: During early stage after surgery, all patients presented with varying degree of hyperemia, edema and sense of foreign body, which were gradually mitigated 3-5 d later and completely recovered in approximately 1 week. The corneal wound was completely epithelized within 4-7 d, 4.83 d on average. Seven patients had persistent ocular surface irritation symptoms after surgery, one case had residual fibrous tissues and four patients developed superficial corneal scars. Postoperative follow-up endured for 2-8 years, 5.3 years on average. Eight patients (8 eyes) recurred with a recurrence rate of 13.11%. In all patients,  postoperative OSDI score was significantly decreased at 1-year reexamination. OSDI score and constitution ratio significantly differed between two groups (both P<0.05).At postoperative 5 years, OSDI score was slightly lower compared with that in last year with no statistical significance(P>0.05).At post operative 1- and 5-year, basic tear secretion was (12.95 ±4.03) mm and (12.68 ±4.77) mm, tear film break-up time was (10.55±4.13)s and (10.03±4.64)s. Both indexes were significantly improved compared with (9.48±3.34) mm and (8.14±3.57)s before surgery (all P<0.05).
Conclusion: Pterygium excision combined with autologous corneal limbal stem cell transplantation is an efficacious treatment of pterygium with mild postoperative symptoms, rapid recovery, low long-term recurrence rate and high efficacy. 
论著

Smart plug泪小管塞治疗水液缺乏型干眼的长期并发症

Long-term complications of Smart plug insertion in the treatment of aqueous tear deficiency dry eye

:134-137
 
目的:评估Smart plug泪小管塞治疗水液缺乏型干眼的长期并发症。方法:收集汕头国际眼科中心2011至2016年门诊确诊的水液缺乏型干眼患者300例(600眼),进行Smart plug泪小管塞治疗,随访观察术后临床并发症,中位随访时间为术后3年(术后1~5年)。结果:3例患者(3眼)术后患有泪小管炎(0.5%),发病时间为术后1~3(中位2)年,取出泪小管塞后并给予局部抗生素滴眼液治愈。2例患者 (4眼)因植入上下泪小管塞后流泪症状不能耐受,单纯取出下泪小管塞后症状缓解(0.7%);4例患者(8眼)因只植入下泪小管塞症状未能明显好转,1个月后再次植入上泪小管塞(1.3%);291例患者干眼主观症状改善,有效率为97.5%,长期随访未发现并发症。结论:虽然Smart plug泪小管塞治疗水液 缺乏型干眼具有明确的疗效,但Smart plug泪小管塞植入后的长期并发症不容忽视,需要长期观察。
Objective: To evaluate the long-term complication associated with the use of the Smart plug in the treatment of aqueous tear deficiency dry eye. Methods: A total of 300 patients (600 eyes) were collected in Joint Shantou International Eye Center from 2011 to 2016, all the patients accepted the treatment with Smart plug, and were followed up for clinical complications. The median follow-up time was postoperative 3 years (1–5 years after surgery). Results: Three patients (3 eyes) developed canaliculitis, the rate was 0.5%. The median time from Smart plug insertion to the onset of canaliculitis was 2 (1–3) years, leaving the Smart plug and resolved the application of topical antibiotics. Two patients (4 eyes) could not suffer from implantation of the upper and lower Smart plug, removed the below, the ratio was 0.7%; 4 patients (8 eyes) need upper Smart plug insertion after implantation of the lower one month later, the rate was 1.3%; 291 cases of dry eye improved by long-term followup, the effective rate was 97.5%. Conclusion: Although the Smart plug is effective in the treatment of aqueous tear deffciency dry eye, the later complications of Smart plug insertion cannot be neglected and need the long-term follow-up.
综述

激光周边虹膜切除术在原发性房角关闭治疗中的进展

Progress of laser peripheral iridotomy in the treatment of primary angle closure

:170-176
 

青光眼是全球第二大致盲眼病,第一大不可逆性致盲眼病,其中原发性闭角型青光眼(primary angle closure glaucoma,PACG)占 25%。激光周边虹膜切除术(laser peripheral iridotomy,LPI)已成为 PACG 和原发性房角关闭的一线治疗。LPI 机制为利用激光在周边虹膜上打孔,解除 PACG 的瞳孔阻滞,加深前房,扩大房角,恢复生理性房水排出途径,从而降低眼压。研究表明 LPI 在原发性房角关闭各个疾病进程中均能比较好的控制眼压,是相对安全的治疗方法。

Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy (LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle, restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.

论著

全视网膜光凝及术后应用羟苯磺酸钙治疗糖尿病视网膜病变的疗效观察

Curative effect observation of full retinal laser photocoagulation and postoperative application of calcium dobesilate in the treatment of diabetic retinopathy

:246-250
 
目的:探讨全视网膜光凝及术后应用羟苯磺酸钙治疗糖尿病视网膜病变的疗效。方法:选取96例患者,共175只眼,随机分为对照组(48例,86只眼)和研究组(48例,89只眼)。两组均予全视网膜激光光凝治疗,其中研究组术后再予羟苯磺酸钙继续12周治疗。12周后,观察两组患者治疗前后视力、血液流变学的变化。结果:治疗后研究组在视力>1.0范围的患者明显多于对照组(χ2=6.779,P=0.009), 而2组在视力≤0.4,0.4~0.6,0.7~1.0范围患者视力差异比较分别为( χ2=0.003,P=0.955),(χ2=1.640,P=0.200),(χ2=2.148,P=0.143)。治疗后研究组患者的血浆粘度、红细胞压积、红细胞变形指数、纤维蛋白原改善均优于对照组(P<0.05)。研究组总有效率89.9%,对照组75.6%,两组差异比较(χ2 =6.302,P=0.012)。结论:全视网膜激光光凝及术后应用羟苯磺酸钙治疗糖尿病性视网膜病,能有效提高视力及临床疗效,可能与改善患者血液流变相关。
Objective: To investigate the curative effect of the postoperative retinal laser photocoagulation and calcium dobesilate in the treatment of diabetic retinopathy. Methods: Selected 96 patients, 175 eyes, randomly divided into control group (48 cases, 86 eyes) and study group (48 cases, 89 eyes). Two groups were all given retinal laser photocoagulation treatment, while the study group continued to receive calcium dobesilate for 12 weeks after treatment. After 12 weeks, observed the eyesight, change of blood rheology of the two groups. Results: After the treatment, the patients with vision >1.0 in the study group were significantly more than the control group (χ2 =6.779, P=0.009), in the vision range of ≤0.4, 0.4~0.6, 0.7~1.0, the difference between the two groups was (χ2 =0.003, P=0.955), (χ2 =1.640, P=0.200), (χ2=2.148, P=0.143), respectively. After treatment, plasma viscosity, erythrocyte deposited, erythrocyte deformation index, fibrinogen in the study group were better than those in the control group (P<0.05). The total effectiveness in the study group was 89.9%, in the control group was 75.6%, the difference was statistically significant (χ2=6.302, P=0.012). Conclusion: The whole retinal laser photocoagulation and postoperative application of calcium dobesilate in treating the diabetic retinopathy can effectively improve eyesight and clinical curative effect, which may be associated with improving blood rheology.

青光眼引流钉植入术治疗难治性开角型青光眼的疗效

Clinical outcomes of Ex-PRESS glaucoma shunt in the management of refractory open angle glaucoma

:173-177
 
目的:观察青光眼引流钉植入术治疗难治性青光眼的疗效。方法:对联合应用抗青光眼药物无法控制的难治性开角型青光眼19例19只眼行青光眼引流钉植入术,术中应用丝裂霉素(2 mg /6~8 mL,2.5~4 min)及可松解缝线。术后1天、2周和1、3、6、12个月进行随访,观察眼压、视力、滤过泡形态、前房深度、眼底C/D、降眼压药物使用情况、完全及部分成功率 及有无并发症等情况。结果:19例患者中,术后完全成功率78.9%(15例),部分成功率10.5% (2例),失败10.5%(2例)。术前用3~5种降眼压药,眼压控制于27.7±10.1 mmHg。术后随访仅三人需使用1~2种降压药物。眼压下降组间有显著性意义(P<0.001)。与术前相比,术后1天(11.8±7.7 mmHg,P<0.001),术后2周(10.1±4.2 mmHg,P<0.05),1个月(12.0±4.0 mmHg,P=0.001),6个月(12.2±3.4 mmHg,P<0.001),1年(13.1±3.3 mmHg,P=0.001)及2年随访(14.5±2.5 mmHg,P=0.001),眼压下降均具有显著性意义。术后患者视力、前房深度及C/D改变差异无显著性意 义。末次随访滤过泡弥散隆起57.9%(11例),微囊型15.8%(3例),瘢痕型21.1%(4例),包裹型5.3%(1例)。所有患者均未观察到明显的术后并发症的发生。结论:房水引流钉植入术治疗难治性开角型青光眼手术成功率高,并发症少,值得推广。
目的:观察青光眼引流钉植入术治疗难治性青光眼的疗效。方法:对联合应用抗青光眼药物无法控制的难治性开角型青光眼19例19只眼行青光眼引流钉植入术,术中应用丝裂霉素(2 mg /6~8 mL,2.5~4 min)及可松解缝线。术后1天、2周和1、3、6、12个月进行随访,观察眼压、视力、滤过泡形态、前房深度、眼底C/D、降眼压药物使用情况、完全及部分成功率 及有无并发症等情况。结果:19例患者中,术后完全成功率78.9%(15例),部分成功率10.5% (2例),失败10.5%(2例)。术前用3~5种降眼压药,眼压控制于27.7±10.1 mmHg。术后随访仅三人需使用1~2种降压药物。眼压下降组间有显著性意义(P<0.001)。与术前相比,术后1天(11.8±7.7 mmHg,P<0.001),术后2周(10.1±4.2 mmHg,P<0.05),1个月(12.0±4.0 mmHg,P=0.001),6个月(12.2±3.4 mmHg,P<0.001),1年(13.1±3.3 mmHg,P=0.001)及2年随访(14.5±2.5 mmHg,P=0.001),眼压下降均具有显著性意义。术后患者视力、前房深度及C/D改变差异无显著性意 义。末次随访滤过泡弥散隆起57.9%(11例),微囊型15.8%(3例),瘢痕型21.1%(4例),包裹型5.3%(1例)。所有患者均未观察到明显的术后并发症的发生。结论:房水引流钉植入术治疗难治性开角型青光眼手术成功率高,并发症少,值得推广。

OCT对激光周边虹膜切开术治疗原发性闭角型青光眼效果的评价

Evaluation of the effect of OCT in the treatment of primary angle closure glaucoma by laser peripheral iris

:103-106
 
目的:通过光学相干断层扫描技术(optical coherence tomography,OCT)观察不同临床类型原发性闭角型青光眼(primary angle-closure glaucoma, PACG)行激光周边虹膜切开术(laser peripheral iris, LPI)前、后前房角开放距离变化,评价治疗效果。方法:选择明确诊断为PACG患者46例50眼,其中 急性闭角型青光眼临床前期及缓解期眼26例27眼,慢性闭角型青光眼20例23眼,行LPI治疗,通过OCT分别检查术前、术后2周距巩膜突500及750 μm处前房角开放距离,采用配对t检验。结果:急性闭角型青光眼LPI术前、术后2周前房角开放距离差异有统计学意义(P<0.05);慢性闭角型青光眼术 前、术后2周前房角开放距离差异无统计学意义(P>0.05)。结论:急性闭角型青光眼LPI术后前房角开放距离增加,治疗效果较好;慢性闭角型青光眼LPI术后前房角开放距离增加不明显,术后仍存在前房角闭塞趋向。
Objective: To observe the anterior chamber angle opening distance before and after laser peripheral iris (LPI) in patients with different clinical types of primary angle closure glaucoma (PACG) by using optical coherence tomography (OCT), and evaluate the effect of the treatment. Methods: Selected 46 cases (50 eyes) of patients with PACG, including 26 cases (27 eyes) of acute angle closure glaucoma at the preclinical stage and remission phase of ocular and 20 cases (23 eyes) of chronic angle closure glaucoma, implemented LPI, examined the anterior chamber angle opening distance at the point of 500 and 750 μm from posterior to the scleral before and after surgery for 2 weeks by OCT, using a paired t-test. Results: Compared the anterior chamber angle opening distance before and after surgery for 2 weeks, the difference in patients with acute angle closure glaucoma was statistically significant (P<0.05), but not statistically significant in patients with chronic angle closure glaucoma (P>0.05). Conclusion: The opening distance of the anterior chamber angle of the patients with acute angle  closure glaucoma after LPI was increased, and the treatment effect was better; but of the patients with chronic angle closure glaucoma after LPI, the distance was not obviously increased, the tendency of anterior chamber angle occlusion still existed after LPI.

雷珠单抗和曲安奈德治疗视网膜中央静脉阻塞的黄斑水肿的配对病例研究

Comparison of ranibizumab and triamcinolone for treatment of macular edema secondary to central retinal vein occlusion

:35-39
 
目的:研究玻璃体腔注射曲安奈德(triamcinolone acetonide,TA)和雷珠单抗(Lucentis)治疗视网 膜中央静脉阻塞(central retinal vein occlusion,CRVO)的黄斑水肿的疗效。方法:配对病例对照研究。将2013年1月至2015年6月,在我院因CRVO并发黄斑水肿而接受玻璃体腔注射TA或Lucentis 的患者,根据患者基线水平的最佳矫正视力(best-corrected visual acuity,BCVA)(logMAR视力)和黄斑中心厚度(central macular thickness,CMT)将两组患者进行配对,选出12对患者,主要的观察 指标为随访1年时两组患者的BCVA和CMT。结果:TA组患者的BCVA由基线时的0.78±0.12提高到 0.55±0.24(P=0.005),CMT由基线时的(598.92±192.67) μm减少到(258.28±75.38) μm (P=0.002)。Lucentis组患者的BCVA由基线时的0.78±0.11提高到0.48±0.21(P=0.002), CMT由基线时的 (591.75±181.68) μm减少到(281.17±63.08) μm (P=0.002)。TA组和Lucentis组患者基线及最终的 BCVA和CMT直接均无显著差异。TA组的平均注药次数为(2.4±0.9)次,Lucentis组为(4.0±1.6)次, 两组有统计学差异(P=0.012)。结论:玻璃体腔注射TA或Lucentis均能减轻CRVO所致的黄斑水肿并提高视力,两者的疗效并无显著差异。TA的平均注射次数比Lucentis组少,但是TA更容易引起眼压升高。应该根据患者的综合情况制定个性化的治疗方案。
Objective: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of ranibizumab for macular edema secondary to central retinal vein occlusion (CRVO). Methods: In a retrospective assessment 12 TA-treated patients and 12 ranibizumab-treated ones with macular edema after CRVO were pairmatched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT). BCVA and CMT were the main endpoints. Results: The initial BCVA of 0.78±0.12 increased significantly to 0.55±0.24 in the TA-treated patients (P=0.005). And the initial CMT of (598.92±192.67) μm decreased significantly to (258.28±75.38) μm (P=0.002). In the ranibizumab-treated patients, the initial BCVA of 0.78±0.11 increased significantly to 0.48±0.21 (P=0.002) and the initial CMT of (591.75±181.68) μm decreased significantly to (281.17±63.08) μm (P=0.002). There was no significance between the initial and final BCVA and CMT of TAtreated patients and ranibizumab-treated patients. Conclusion: Both treatments decreased the CMT and induced an improvement in BCVA from baseline.
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  • 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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