目的 探讨准分子激光上皮瓣下角膜磨镶术（LASEK）后角膜上皮下雾状混浊（Haze）的形成原因及防治措施。 方法 2004年2月－2011年12月期间采用LASEK治疗近视患者345 例669 只眼，屈光度?3.50～?13.5 D，平均（?6.87 ± 2.92）D；散光?0.50～?4.00 D，平均（?1.83 ± 1.32）D 。根据患者术前屈光等效球镜度数分为：中度近视组（?3.50～?5.75 D）120只眼，高度近视组（?6.00～?8.75 D）288只眼，超高度近视组（?9.00～?13.50 D） 261只眼。应用综合措施防治Haze，术中用日夜配戴的高亲水性绷带型角膜接触镜覆盖保护角膜上皮瓣，术毕频点激素眼液4次，术后使用激素类联合非甾体类抗炎眼液及降眼压药、抗生素眼液；随访6～12个月，观察术后Haze的发生率，并按Fantes（1990）标准分级，分析相关原因。 结果 LASEK术后6个月时0.5级Haze发生率14.65%（98只眼），无1级Haze。各组0.5级Haze发生率分别为中度近视组2.5%（3只眼），高度近视组11.11%（32只眼），超高度近视组24.14%（63只眼）。 结论 LASEK术后Haze的发生与术眼的屈光度呈正比，与角膜上皮瓣的活性和完整性，术后紫外线照射等有关。术后采用激素类联合非甾体类抗炎眼液及降眼压药等综合防治措施，可减少、减轻Haze的发生，使LASEK技术更安全有效。
Objective To investigate the features of optic disc formation and retinal nerve fiber layer(RNFL) changes in primary open-angle glaucoma with myopia (M-POAG). Methods On 63 eyes of 38 patients with M-POAG were imaged of the fundus,and were evaluated with the microcomputer image analyser,and were compared with the simple POAG (S-POAG) eyes. Results Variant features of the optic disc and RNFL atrophy were found in this M-POAG eyes.The shapes of the optic disc were revealed to be vertically or horizontally oval,obliquely inserted and irregular,the color of the most of optic disc was pallor.The pattern of glaucomatous cupping was saucer-like (28.6%),vertical (25.4%),oblique (23.8%),pot-like (9.5%),and focally or concentrically cupped.The quotient of the neuroretinal rim area and horizontal C/D ratio were significantly lower than those in S-POAG eyes (Plt;0.05,Plt;0.001).The focal point of the optic disc excavtions tended to be inferior.Most of the incidence in the focal atrophy of RNFL was located inferiorly,and the diffuse atrophy of RNFL was correlated positively with middle or late high-myopia POAG eyes (P＜0.005). Conclusion The variant features of the optic discs,glaucomatous cupping and RNFL atrophy formation in M-POAG eyes found in this series might be helpful in clinical diagnosis. (Chin J Ocul Fundus Dis,2000,16:81-84)
ObjectiveTo evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.MethodsA prospective, uncontrolled and non-randomized study. From April 2017 to April 2018, 21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study. There were 9 males (9 eyes, 42.86%) and 12 females (12 eyes, 57.14%), with the mean age of 35.1±13.2 years. The mean diopter was −11.30±2.35 D and the mean axial length was 28.93±5.68 mm. All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN). Regular follow-up was performed before and after treatment, and BCVA and MAIA micro-field examination were performed at each follow-up. BCVA, macular integrity index (MI), mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed. The fixation status was divided into three types: stable fixation, relatively unstable fixation, and unstable fixation. The paired-sample t-test was used to compare BCVA, MI and MS before and after treatment. The x2 test was used to compare the fixation status before and after treatment.ResultsDuring the observation period, the average number of injections was 3.5. The logMAR BCVA of the eyes before treatment and at 1, 3, and 6 months after treatment were 0.87±0.32, 0.68±0.23, 0.52±0.17, and 0.61±0.57, respectively; MI were 89.38±21.34, 88.87±17.91, 70.59±30.02, and 86.76±15.09, respectively; MS were 15.32±7.19, 21.35±8.89, 23.98±11.12, 22.32±9.04 dB, respectively. Compared with before treatment, BCVA (t=15.32, 18.65, 17.38; P＜0.01) and MS (t=4.08, 3.50, 4.26; P＜0.01) were significantly increased in the eyes 1, 3, and 6 months after treatment. There was no significant difference in the MI of the eyes before treatment and at 1, 3, and 6 months after treatment (t=0.60, 2.42, 2.58; P＞0.05). Before treatment and at 1, 3, and 6 months after treatment, the proportion of stable fixation were 28.57%, 38.10%, 38.10%, 33.33%;the proportion of relatively unstable fixation were 47.62%, 47.62%, 52.38%, 57.14% and the proportion of unstable fixation were 23.81%, 14.28%, 9.52%, 9.52%, respectively. The proportion of stable fixation and relatively unstable fixation at 1, 3 and 6 months after treatment were higher than that before treatment, but the difference was not statistically significant (x2=1.82, 1.24, 1.69; P＞0.05).ConclusionBCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.
ObjectiveTo observe the morphological characteristics of dome-shaped macula (DSM) and macular hole (MH) in high myopia by optical coherence tomography (OCT), to further explore the correlation between DSM and MH. MethodsA retrospective case-control study. From April 2021 to December 2023, 963 eyes of 503 patients with high myopia (myopic diopter ≥6.00 D) in Department of Ophthalmology of the Fourth Hospital of Hebei Medical University were enrolled in the study. The age of patients ranged from 5 to 89 years old, with the mean age of (48.91±16.69) years. Diopter was −6.00 to −26.00 (−10.49±3.15) D. All eyes were examined by OCT. The width and height of DSM, subfoveal choroidal thickness (SFCT), inner port diameter and base diameter of MH were measured by software on OCT. According to the OCT image features, DSM was divided into horizontal and vertical oval-shaped DSM, and symmetrical round DSM. According to the presence or absence of DSM, the eyes were divided into DSM group and non-DSM group. Then, the affected eyes with MH were divided into DSM with MH group and non-DSM with MH group. The incidence of DSM, the incidence of MH in the DSM group and the non-DSM group, the inner port diameter of MH, the base diameter of MH, SFCT, and the location of retinoschisis (RS) in the DSM with MH group and the non-DSM with MH group were observed. Independent sample t test or non-parametric Mann-Whitney U test was used for comparison between groups. Pearson correlation analysis was used to analyze the related factors of MH inner port diameter, base diameter and DSM width, height, height/width ratio. ResultsAmong the 963 eyes, the DSM group and the non-DSM group were 266 (27.6%, 266/963) and 697 (72.4%, 697/963) eyes. Compared with the non-DSM group, patients in the DSM group were older (Z=−11.302), had higher degree of myopia (Z=−8.944), thinner SFCT (Z=−16.244), and higher incidence of MH (χ2=8.828), and the differences were statistically significant (P＜0.05). Compared with non-DSM with MH group, the patients in DSM with MH group were older (t=2.610), higher myopia diopter (t=3.593), and thinner SFCT (t=3.505), the differences were statistically significant (P＜0.05). There was no significant difference in the number of eyes in the epiretinal membrane between the two groups (χ2=0.119, P=0.730). In the DSM with MH group, RS mostly occurred in the outer retina with a large range, while in the non-DSM with MH group, RS mostly occurred in the outer and inner retina with a small range. There was a statistically significant difference in the number of eyes at different positions of RS between the two groups (χ2=25.131, P＜0.05). The results of correlation analysis showed that there was no correlation between the inner port and base diameter of MH and the width, height, height/width ratio of DSM (P＞0.05). ConclusionsCompared with high myopia patients without DSM, patients with DSM are older, have more severe myopia and thinner SFCT. In DSM patients with MH, RS often occurs in the outer retina and has a large range. There was no significant association between DSM morphology and MH size.
ObjectiveTo evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. MethodsA prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. ResultsCompared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. ConclusionsPosterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.