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卷 13, 编号 4 (2020)
- 年: 2020
- 文章: 11
- URL: https://journals.rcsi.science/ov/issue/view/2677
- DOI: https://doi.org/10.17816/OV20204
Original researches
湿性老年性黄斑病变抗血管生成治疗效果的预测
摘要
目的：揭示湿性老年性黄斑病变（AMD）患者玻璃体内注射阿伯西普治疗效果的预后因素。
材料和方法：该研究中纳入了36例（45只眼,26名女性和10名男性，平均年龄在74.4±10.9岁）先前治疗失败的湿性AMD患者。所有患者均接受了每月3次阿伯西普玻璃体注射以及之后再次注射4次（每次间隔为2个月）。评估了人口学特征、初始最佳矫正视力（BCVA）、中心视网膜厚度（CMT）和光学相干断层扫描（OCT）的结构变化，以判断在10个月的随访中与BCVA的相关性。
结果：在观察期结束时，初始视力从31.0±15.0（~0.32）个字符增加到37.0±14.0（~0.4）个字符（p=0.003）。治疗开始时和随访结束时的CMT分别为357±110和269±70μm（p<0.001）。最终BCVA与初始视力（r=0.62；p<0.0001）、初始CMT（r=-0.48；p=0.001）以及从症状出现到开始治疗的时长（r=-0.32；p=0.03）在统计学上有显著相关性。OCT图像上黄斑结构的变化与最终BCVA无关，除了椭圆体带状态（p<0.001）。男性的最终BCVA在统计学上明显低于女性（分别为34.7±14.0（~0.4）和45.0±9.2（~0.63）个字符，p=0.03）。
结论：初始视力、性别、CMT、从发病到开始治疗的时长和椭圆体带状态是湿性AMD患者抗血管生成治疗效果的预测因素。
7-13
减压术前后人工晶状体计算结果的对比
摘要
目的：对比不同减压术前后人工晶状体（IOL）计算结果。
材料和方法：该研究包括115例患者，并将其分为三组。第1组患者接受了小梁切除术（n=86），第2组患者植入了Ex-PRESS引流器（n=19），第3组患者植入了青光眼引流阀（Ahmed）（n=10）。所有研究对象在减压手术前一天都在IOL-Master 500设备上进行了生物测量，并根据Barrett Universal II公式（目标屈光度-正视）计算人工晶状体的屈光率。最初的数据与减压术后6个月后获得的类似研究结果进行了比较，以评估其对生物测量参数的影响和人工晶状体屈光率计算的准确性。
结果：尽管光解剖学参数发生了重大变化，但减压手术前后的平均目标屈光度值并无明显差异：各组分别为0.00±0.03与0.03±0.52 D（p=0.628），0.00±0.10与0.19±0.61 D（p=0.173），-0.04±0.08与0.11±0.42 D（p=0.269）。然而，有一个明显的趋势，即目标屈光度的分散性增加。
结论。青光眼手术会导致眼部的生物测量参数发生变化，降低人工晶状体计算的准确性。因此，在选择人工晶状体时，应以减压术后的测量为准。
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高眼压对眼球内部结构应力状态变化影响的模拟
摘要
目的：本研究旨在超声乳化术中眼前房压力升高对眼球不同结构应力状态变化影响的模拟和评估。
材料和方法：通过有限元法建立了一个简化的眼球轴对称解剖模型。使用Deform软件包，可以通过计算超声乳化过程中，眼球前房内多余压力的重新分布对眼球各个结构应力状态的变化，解决了眼球变形问题。
结果：在处理模拟结果的过程中，获得了应用于眼球前房的超压在眼球后极部方向减少重新分布的数据。压力水平为施加的超压的0.85％。获得的数据从少数动物实验中得到了证实。
结论：我们提出的眼压增高对眼球不同结构应力状态变化影响的模拟表明，眼球血流维持在恒定水平的自动调节机制包括玻璃体的弹性特性导致眼压急剧上升的补偿机制。这个模拟可以计算出眼球不同部位的压力再分配，这取决于玻璃体弹性特性的状态，以及无玻璃体眼和硅油填充的情况。
21-27
Study on dependence of phacoemulsification of senile cataract parameters on features of hydrodissection
摘要
The aim was to study the dependence of senile cataract phacoemulsification (PE) parameters on hydrodissection (HD) features.
Materials and methods. 64 patients (64 eyes) who underwent PE of senile cataract using either viscodissection (VD) (main group) or regular HD (control group). Time parameters — VD and HD duration, cortex aspiration, and total time of PE, — along with calculation of mean volume of BSS in both groups were studied.
Results. It took 1.8 times more time to perform VD compared to HD duration. The cortex aspiration step required 2.4 times less time in the eyes of main group in comparison with control group, as 10 eyes (31.2%) of the main group had spontaneous full cortex evacuation through ultrasound tip at epinucleus removal. Other 22 eyes (78.8%) of the main group needed aspiration of cortex, which occupied 1/6–1/3 capsule circumference. Though surgery time was comparable in both groups, mean volume of BSS spent was justifiably 1.5 times higher in the control group.
Conclusion. Performed analysis showed that VD is an effective method which provides optimization of PE of senile cataract. Use of VD allowed exclusion of cortex aspiration in 31.2% of eyes in the main group and decrease of its duration by 2.4 times in comparison with the control group.
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慢性中央浆液性脉络膜病变和卵黄状营养不良成年患者的鉴别诊断方法
摘要
研究目的：优化成年患者发生的慢性中央浆液性脉络膜病变（CSCR）和卵黄状营养不良（VD）的鉴别诊断。
研究任务：在多模式诊断的基础上研究VD和CSCR的特征，通过数学建模来开发诊所不同设施条件下的鉴别诊断方法。
材料和方法：该研究包括61名患有长期神经上皮脱落的患者（90只眼睛）。收集了所有患者的病史，包括家族史，并进行了常规眼科检查：测量最佳矫正视力、裂隙灯检查和眼底照相、视网膜光学相干断层扫描（OCT）和血管造影光学相干断层扫描（OCTA）、短波自发荧光（SW-AF）、视网膜荧光血管造影（FAG）、吲哚菁绿视网膜血管成像（ICGA）。将患者分为2组：30名（30只眼睛）患有卵黄状营养不良的患者和31名（31只眼睛）患有慢性中央浆液性脉络膜病变的患者。采用二元逻辑回归法来评估患病概率。
结果：研究了两组中出现的诊断预测因素，获得了估计检测疾病概率的数学模型。考虑到获得的计算疾病检测概率的公式，包括不同研究组合的标准，制定了鉴别诊断的方法：OCT（曲线下面积0.946）；SW-AF（曲线下面积0.955），OCT和SW-AF（曲线下面积0.980）；SW-AF、FAG和ICGA（曲线下面积0.989）。
结论：获得的模型可以在不同条件下的诊所对卵黄样营养不良和慢性中央浆液性脉络膜病变进行鉴别诊断。
35-46
Reviews
Standardized ophthalmic tests for evaluating reading parameters: a brief historical review
摘要
In the review, the analysis of the most common ophthalmic standardized tests for evaluating reading was carried out: Bailey–Lovie Word Reading Charts, MNREAD Acuity Chart, Radner reading chart, Smith–Kettlewell Reading Test (SKread), IReST, Salzburg Reading Desk, Ramulu test, Radner paragraph optotypes, Balsam Alabdulkader–Leat (BAL) chart, Chinese Reading Acuity Charts (C-READ), chart for reading threshold and reading speed evaluation by T.S. Egorova. The following parameters were considered: maximum reading speed, reading threshold, reading acuity, reading accessibility index, threshold reading speed. Recovering the ability to read fluently is one of the criteria for assessing the success of treatment, as well as quality of life for patients of various age groups
47-55
Paracentral acute middle maculopathy: from diagnosis toward clinical perspectives
摘要
In this review of literature, we reviewed the current state of knowledge on paracentral acute middle maculopathy (PAMM). The diversity of clinical manifestations, a variety of related cardiovascular and ocular conditions, as well as reported idiopathic cases, allow considering PAMM as a distinct clinical phenomenon or a syndrome. Taking into account already described and potential associations with systemic and ocular morbidity, PAMM may apply for a place of an important clinical biomarker not only for ocular but for systemic disorders in a broad cohort of patients. However, the understanding of the pathophysiology of PAMM and of its actual clinical significance is far from complete, and further studies are warranted.
57-66
Case reports
Initial positive first-hand experience of acute keratoconus treatment using platelet-rich serums
摘要
Presentation of a clinical case of acute keratoconus treatment by the intracameral platelet-rich plasma administration. Clinical and morphological improvement was registered from the first postoperative day, corneal edema and bullous changes completely resolved during 3 weeks. No side effects were observed. The outcome is confirmed by anterior segment optical coherence tomography data Intracameral platelet-rich autologous plasma administration is a safe and effective method of acute keratoconus treatment.
67-72
In ophthalmology practitioners
Reasons for anti-vegf treatment discontinuation in real clinical practice: results of a phone survey of patients with macular diseases
摘要
Background. Anti-VEGF therapy is currently regarded as the “gold standard” for the treatment of many macular diseases, while the results of its application in real clinical practice are often inferior to those from randomized clinical trials.
Materials and methods. A study group was formed on the basis of a retrospective analysis of the medical data of patients who received anti-VEGF therapy with ranibizumab and/or aflibercept according to registered indications, and who discontinued their follow-up in the clinic (n = 214). A phone survey of patients concerning the reasons for loss to follow-up with a statistical analysis of the obtained data was carried out.
Results. The majority of patients (81.3%) discontinued observation in the clinic within two years from the start of therapy (the median duration of treatment was 7 (3; 18) months). Patients with all considered diseases had an increase in best corrected visual acuity during treatment (p < 0.000001), which confirms the high efficiency of the method. According to the results of the phone survey, the following categories of respondents were identified: complete cessation of treatment – 120 (56.1%) patients, change of clinic – 20 (9.3%), death – 23 (10.7%), status not established – 51 (23.8%). The most frequent reasons for stopping treatment were dissatisfaction with its results (59 cases; 49.2%), financial burden (49; 40.8%), and systemic comorbidities (24; 20.0%).
Conclusion. Searching approaches to increase patients’ treatment adherence is one of the priorities for improving anti-VEGF therapy.
73-82
Anti-vegf therapy in treatment of vitreous hemorrhage due to proliferative diabetic retinopathy
摘要
Purpose. To investigate the possibility of anti-VEGF therapy use in treatment of vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction.
Materials and methods. In this case series study, 8 patients with severe vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction were treated with intravitreal ranibizumab injections using treat-and-extend regimen. Patients were followed for 12–54 months.
Results. . Intravitreal ranibizumab injections using treat-and-extend regimen promoted a complete resolution of vitreous hemorrhage in one month after the 2nd or the 3rd monthly ranibizumab injection, followed by a significant visual acuity improvement.
Conclusion. Anti-VEGF therapy using treat-and-extend regimen could be recommended for treatment of vitreous hemorrhage due to proliferative diabetic retinopathy without signs of vitreoretinal traction.
83-88
Obituary
In memory of professor V. F. Danilichev
摘要
The article is dedicated to the memory of Honored Scientist of the Russian Federation, Professor V.F. Danilichev. The authors reviewed his life path, clinical, scientific and educational activities.
90-95