肥厚型脉络膜谱系疾病(pachychoroid disease spectrum,PCD)包括肥厚型脉络膜色素上皮病变(pachychoroid pigment epitheliopathy,PPE)、中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)、肥厚型脉络膜新生血管病变(pachychoroid neovasculopathy,PNV)、息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)、局灶性脉络膜凹陷(focal choroidal excavation,FCE)和盘周肥厚型脉络膜综合征(peripapillary pachychoroid syndrome,PPS)。有学者将PCD看作脉络膜功能障碍引发的一系列连续疾病过程，但关于PCD的发病机制、形态改变尚未明确。该文对PCD的脉络膜、涡静脉及巩膜相关改变做一综述。
Pachychoroid disease spectrum include pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, and peripapillary pachychoroid syndrome. Currently, some scholars regard pachychoroid disease spectrum as a series of continuous disease processes caused by choroidal dysfunction, but the pathogenesis and morphological changes of pachychoroid disease spectrum are not yet clear. This paper reviews the changes of choroid, vortex veins and sclera in pachychoroid disease spectrum.
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.
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.
目的：比较翼状胬肉两种不同手术方式后巩膜溶解的发生概率，探讨产生巩膜溶解的原因，选择合理手术方式。方法：对本院两年来263例翼状胬肉采用两种不同的手术方式，观察术后发生巩膜溶解的情况，并通过局部药物进行治疗。结果：263例翼状胬肉患者，130例采用胬肉切除+结膜瓣转位术，裸露角膜缘3 mm巩膜，术后局部滴0.02%丝裂霉素C(mitomycin C, MMC)，胬肉复发26 例，发生巩膜溶解6例；133例采用胬肉切除+角膜缘干细胞移植术，术后滴0.02% MMC，胬肉复发5例，无1例发生巩膜溶解。结论：翼状胬肉术后发生巩膜溶解，是一种严重的手术并发症，可能与术中过度烧灼巩膜面，巩膜板层暴露于MMC有关。采用胬肉切除+角膜缘干细胞移植术，植片覆盖裸露巩膜，促进巩膜表层愈合，术后避免MMC直接浸润巩膜板层故未见此并发症发生。与传统手术方式相比，复发率低，并发症少，是一种安全、有效的翼状胬肉手术方式。
Objective: To compare the occurrence probability of posterior scleral dissolution in two different surgical methods, and to explore the reasons for the dissolution of the scleral. Methods: Using two different surgical methods on 263 cases of pterygium submitted in our hospital in 2 years, observed the occurrence of scleral at postoperative, and treated with topical drugs. Results: Two hundred and sixty three cases of patients with pterygium, 130 cases of pterygium resection and conjunctival flap transposition, bare 3 mm limbus sclera, postoperative topical mitomycin C (MMC). The recurrence of pterygium in 26 cases, scleral melting in 6 cases; 133 cases of pterygium excision and limbal stem cell transplantation, MMC (0.02% MMC drip after operation, 5 cases of recurrent pterygium, no scleral melting occurred in 1 case. Conclusion: The scleral dissolution occurred after pterygium surgery is a serious complication, which may be related to the excessive burning of the scleral surface, and the lamellar exposure to MMC. Excision of pterygium and corneal limbal stem cell transplantation were used to cover the exposed scleral, promote the surface healing of the wound, and avoid the MMC direct infiltration of the lamina. Compared with the traditional operation mode, the recurrence rate is low, and the complication is little. It is a safe and effective surgical method.
