脑出血

reductionoffluorescenceleakage．OCTindicatedthesubretinalfluidabsorptionandreductionofCNVOnepatientfeltpainfulinwaistandbackduringvisudyneinjectionanditlastedtillthecompletionofinjectionprocess．7patientsappearedconjunctivalcongestionorsubconjunctivalhemorrhageandallsymptomsdisappearedoneweekafterpostoperativeantibioticeyedrops．Therewerenoocularorsystemicadverseeventsobservedinotherpatients．ConclusionsThecombinationtreatmentofPDTwithintravitrealBevacizumabinjectioniseffectiveandsafeforthepatientswithAMD．1tcaneffectivelylcadtoclosedCNVandabsorptionoffundushemorrhageandexudation，anditalsodecreasestheincidenceofrecurrentCNV,reducestheeconomicburdenforpatientsandtheincidenceofcomplications．PLAOphthalmiccenter,WuhanGeneralHospitalofGuangzhouMilitaryCommand，Wuhan430070玻璃体腔注射贝伐单抗与氩激光治疗视网膜分支静脉阻塞伴黄斑水肿的手术方式选择及疗效观察刘厌淮刘肖艺目的探讨玻璃体腔重复注射抗血管内皮生长因子单克隆抗体bevacizumab与单次注射联合氩激光治疗视网膜分支静脉阻塞(BRVO)继发的黄斑水肿(ME)的手术方式选择及临床疗效观察。选取2009年6月至2010年2月来门诊就诊的BRVO伴ME患者17例17R眼，男11人女6人，平均年龄为(59．1士11．4)岁，最佳矫正视力均低于0．5，病程超过3个月，光相干断层扫描(OCT)和荧光素眼底血管造影(FFA)证实为非缺血型的黄斑水肿，未经过眼底激光和玻璃体腔注射药物治疗。按严格的无菌操作原则行玻璃体腔注射bevacizumab1．25mg，于手术后1周和1、3、6个月观察并记录视力、眼压、ME情况，手术后l、3、6个月行OCT检查，手术后1、6个月行FFA检查。若术后复查时视力无提高、OCT和FFA检查显示，黄斑水肿无变化或复发，则再次注射bevacizumab或补充氩激光治疗。结果治疗前黄斑区中心厚度平均为(540．82-4-146．47)pm，平均视力LogMAR为0．92士0．58，手术后1个月FFA及眼底检查见ME明显减轻3只眼，无变化或水肿复发14只眼，9例给予再次注射(为重复注射组)，5例行黄斑区氩激光光凝(为联合激光组)。至治疗6个月后，黄斑区中心厚度：重复注射组为(256．89+71．34)p．m，联合激光组为(31O．6士171．9)lam，与治疗前相比差异有统计学意义，但是两组间没有差异。视力都有不同程度的提高，黄斑区的水肿和渗漏明显减轻，未见视网膜新生血管，也没有观察到眼压升高、玻璃体出血、眼内炎等并发症。结论玻璃体腔注射bevacizumab后能够明显减轻BRVO继发的ME，但是维持时间不长，重复多次注射或联合氩激光治疗都可以巩固疗效，持续减轻ME，且后一种方式更经济、安全性也更高，随访6个月视力稳定并提高，但长期效果仍需进一步观察。一36一作者单位：210029南京医科大学第一附属医院眼科ThechoiceofoperationmethodandobservationofeffecttointravitrealinjectionwithBevacizumabandargonlaserphotocoagulationtotreatbranchretinalveinocclusionLIUQing-huai，LIUXiao-yiObjectiveToinvestigatetheclinicaleffectsofrepeatedintravitrcalinjectionofBevacizumabandsingleinjectionassociatedwithargonlaserphotocoagulationtotreatbranchretinalveinocclusion(BRVO)withmacularedema(ME)．Methods17patientsofBRVOwithMEfromJune2009toFebruary2010wereenrolled，1lMalesand6Females，withaverageage59．I士1I．4．Thebestcorrectedvisualacuity(BCVAlwereunder0．5withnonischemicMEconfirmedbyOCTandFFA．Visualacuity,IOPandMEwererecordedatlweek，lmonth，3monthsand6monthsafterintravitrealinjectionwithBevacizumab1．25rag．OCTweredoneafterlmonth．3monthsand6monthsandFFAweredoneafter1monthand6months．AnotherinjectionofBevacizumaborargonlaserphotocoagulationwasgiveniftherewasnoimprovementofVAornochangesinOCTandFFAorMEworsed．ResultsTheaverageretinalthicknessofcentralfoveaofmaculawas(540．82土146．47)Ixm，andtheaveragevisionLogMARwasO．92士0．58。FFAandfundsexaminationafterlmonthshowedreliefofMEin3eyes，nochangeorrelapseofMEin14eyes，injeetionswererepeatedin9eyes(therepeatinjectiongroup)，andmacularlaserphotocoagulationweregivento5eyes(thephotocoagulationgroup)．After6months．theretinalthicknessofcentralfoveaofmaculawas(256．89-士71．34)umintheteamofrepeatinjection，(3l0．6士I71．9)umintheteamofassociatedwithphotocoagulationTherewerestatisticalsignificantdifferencesbeforeandaftertreatment，butnodifferenceswerefoundbetweentwogroups．Therewereincreasesofvisionwithdifferentdegrees，obviousrelieveofedemaandleakageinmacula,noretinalneovascularizationorcomplicationssuchaslOPelevation，vitreoushemorrhageandendophthalmitiswererecored．ConclusionsIntravitreaiinjectionwithBevacizumabcanrelieveMEcausedbyBRVO．RepeatedinjectionsoradjunctiveargonlaserphotoeoagulationCallenhancetheeffect,andthelattercOFDF-In一。A敝bstr汇ac编ts辜鼍9嚣喜耄嚣主慕二中华医学会眼科学分会眼底病学组。．一一——————————————————————1。。。。。。’。。。。。。_。。。。__-。I_--_____●I____---__--。’_____。-●__________-___-___________●___________________●______●-●___●______-____一ismoreeconomicalandsafer；thevisionisstableandimprovedin6monthsfollowup，butfurtherobserveisnecessarytoconfirmlongtermeffect．DepartmentofOphthalmoIogy’ThefirstAffiliatedHospitalofNanjingMedicalUniversity,Nanjing210029MaeulartraetioHaIretinosehisisinproliferativediabeticretinopathy—elinicalmanifestationsandsurgicalresultsChung-MayYang，Chien-ChiaSuobjeetiveToevaluatetheclinicaJmanifestationsandsurgicalprognosisofmaculartractionalretinoschisisinproliferativediabeticretinopathy．MethodsTwentyeases(20eyesinl8patients)withmaculartractionalretinoschisisofproliferativediabeticrctinopathyconfirmedbyopticalcoherencetomography(OCT)atasingleinstitutionbetween2007／1and2010／3wereretrospectivelyreviewed．Clinicalrecordsincludingbasicdata,imagingstudywerecollectedforall20cases．Sixteencases(15patients)hadvitreoussurgery．Meanfollow-uptimewas25．3lmonths．ResultsMaculartraetionalretinoschisiscouldbeclassifiedinto3groups：diffuseelevation，localizedelevation，andmoreelevationatperiphcry．Tissuesplittingoccurredinouterneurosensoryretinainallcases．Theconditiontendedtooccurineyeswithfibrousproliferationratherthanactivefibrovascularproliferation．Associatedmacularabnormalitiesincludedcysticchange，lamellarhole，fovealdetachment，andmacularhole．SequentialOCTinsomecasesshowedmacularstructuresmightalterovertime．Visualacuityimprovedstatisticallyaftersurgery．Sixof16casesshowedpersistentresidualschisisonpostoperative0CT．Therewasnorecurrenceoftractionalretinoschisisaftersurgery．ConclusionsUniquefeaturesexistillmaculartraetionalretinoschisisinproliferativediabeticretinopathy．Viscoussurgerymayimprovevisualfunctiondespitepersistentschisisinsomecases．NationalTaiwanUniversityHospital建立中国眼底病II缶床评价研究平台的设想许迅眼底病是中国和世界难治性盲的首位原因，眼底病的临床研究和治疗新药成为国际国内研究热点，我国也出现了自主知识产权研发的新药。目前，眼底病的I临床研究和新药临床试验研究中最大的制约因素是缺乏客观疗效评价指标。现有诊断、治疗眼底病新药的评价和评价体系，都由国外机构建立，国内尚属空白。因此，构筑基于中国人眼病特征、与国际接轨的新药临床评价研究平台系统，将为临床研究和新药研发提供重要的技术支撑。总体设想：建立具有自主知识产权、符合亚洲人群特别是中国人生理、病理特征的眼底病临床研究和眼底病新药评价体系。技术：(1)建立符合国际的眼底病新药临床试验多中心形态学资料评价平台；(2)建立符合国际规范的眼底病新药临床试验数据多中心功能学资料评价平台；(3)建立符合国际规范的眼底病临床试验、质量保证和控制综合体系平台和眼科临床试验现场组织管理平台；(4)建立符合国际规范的数据管理和统计分析平台；(5)建立符合国际规范的人体生物医学伦理平台。作者单位：200080上海交通大学附属第一人民医院眼科AtentativeplanofconstructingaclinicalevaluatingandresearchingplatformforocularfundusdiseaseinChinaXUXunOcularfundusdiseaseistheprimarycauseofrefractoryblindnessinChinaandworld-wide．Theclinicalandnewdrugresearchforocularfundusdiseaseisadomesticandinternationalhotsubject．Nowadays，inChina,therearealsonewdrugswithindependentintellectualpropertyright．Lackofobjectiveevaluationindicesbecomesthebiggestrestrictingfactorinclinicalresearchandnewdrugclinicalthairesearchforocularfundusdisease．Alltheevaluationsystemsfordiagnosisandtherapyofocularfondusdiseaseareintroducedfromabroad,withsofarablankinChina．Thereisnodoubtthatconstructingainternationalizedplatformforclinicalresearchandnewdrugevaluation，whichisChineseoculardiseasecharacterized，willoffersubstantialtechniquesupportforclinicalresearchandnewdrugdevelopment．Overallconstruction：toconstructanintellectualpropertyrightindependentsystemforclinicalresearchandnewdrugevaluationforocularfundusdisease，thisfitsthephysiologicalandpathologicalcharacteristicsofAsia,especiallytheChinese．Techniqueproposals：(1)Toconstructaninternationalstandardizedplatformtoevaluatemorphologicalmaterialsofmulti-centerclinicaltrialsfornewdrugs；(2)Toconstructaninternationalstandardizedplatformtoevaluatethefunctionalmaterialsofmulti—centerclinicaltrialsfornewdrugs；(3)Toconstructallinternationalstandardizedplatformforthedesign，qualityassuranceandcontrolofmulti-centerclinicaltrialsfornewdrugs，andaplatformfortheorganizationandmanagementofophthalmologicalclinicaltrials；(4)Toconstructaninternational一37—