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Evaluating the diagnostic utility of evaporative dry eye disease markers 评价蒸发性干眼病标志物的诊断价值
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13671
M. Wang, S. Dean, A. Muntz, J. Craig
their diagnosis was revised when systemic symptoms persisted despite corticosteroid therapy. In our experience GCA is an extremely rare cause of scleritis. Patients with scleritis in combination with cephalic symptoms suggestive of GCA, should arouse suspicion of alternate vasculitides. The crossover between symptoms, laboratory results and histopathology can make this a difficult distinction. Thorough systemic review and ongoing monitoring is necessary even after commencement of corticosteroid therapy; hence, referral to rheumatology and immunology is recommended. Early immunosuppressive therapy is often more pressing in systemic vasculitides other than GCA, and can significantly impact on the patient's prognosis.
当全身性症状在皮质类固醇治疗后仍然存在时,他们的诊断被修改。根据我们的经验,GCA是一种非常罕见的巩膜炎病因。巩膜炎合并提示GCA的头侧症状的患者,应引起交替血管的怀疑。症状、实验室结果和组织病理学之间的交叉可能使这一区分变得困难。即使在皮质类固醇治疗开始后,也有必要进行全面的系统检查和持续监测;因此,建议转诊至风湿病学和免疫学。早期免疫抑制治疗通常比GCA以外的全身性血管病变更紧迫,并可显著影响患者的预后。
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引用次数: 9
Giant cell arteritis and scleritis: Does an association exist? 巨细胞动脉炎和巩膜炎:是否存在关联?
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13662
J. Lock, P. McCluskey, Richard J. Symes, C. Fraser
1. Misra SL, Craig JP, Patel DV, et al. In vivo confocal microscopy of corneal nerves: an ocular biomarker for peripheral and cardiac autonomic neuropathy in type 1 diabetes mellitus. Invest Ophthalmol Vis Sci. 2015;56(9):5060-5065. 2. Misra SL, Kersten HM, Roxburgh RH, Danesh-Meyer HV, McGhee CN. Corneal nerve microstructure in Parkinson's disease. J Clin Neurosci. 2017;39:53-58. 3. Niederer RL, McGhee CN. Clinical in vivo confocal microscopy of the human cornea in health and disease. Prog Retin Eye Res. 2010; 29(1):30-58. 4. Tavakoli M, Kallinikos P, Iqbal A, et al. Corneal confocal microscopy detects improvement in corneal nerve morphology with an improvement in risk factors for diabetic neuropathy. Diabet Med. 2011;28(10):1261-1267. 5. Yoshida S, Shime H, Funami K, et al. The anti-oxidant ergothioneine augments the immunomodulatory function of TLR agonists by direct action on macrophages. PLoS One. 2017;12(1):e0169360.
1. Misra SL, Craig JP, Patel DV,等。角膜神经的体内共聚焦显微镜:1型糖尿病周围和心脏自主神经病变的眼部生物标志物。眼科视觉科学,2015;56(9):5060-5065。2. Misra SL, Kersten HM, Roxburgh RH, Danesh-Meyer HV, McGhee CN。帕金森病的角膜神经微结构。临床神经科学杂志,2017;39:53-58。3.Niederer RL, McGhee CN。临床活体共聚焦显微镜观察人角膜的健康与疾病。中华眼科杂志,2010;(1): 29日30-58。4. Tavakoli M, Kallinikos P, Iqbal A,等。角膜共聚焦显微镜检测角膜神经形态学的改善与糖尿病神经病变的危险因素的改善。糖尿病医学,2011;28(10):1261-1267。5. 吉田S, Shime H, Funami K,等。抗氧化剂麦角硫因通过直接作用于巨噬细胞增强TLR激动剂的免疫调节功能。科学通报,2017;12(1):e0169360。
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引用次数: 2
Zoledronic acid associated orbital inflammation 唑来膦酸相关性眼眶炎症
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13659
Louis S M Han, R. Weatherhead
A 59-year-old female patient had an intravenous zoledronic acid infusion (5 mg Aclasta; Novartis New Zealand, Auckland, New Zealand) for the treatment of osteoporosis. The next day, she developed a headache, bilateral retro-orbital pain and mild photosensitivity. On the second day, she developed swelling and redness of left eyelids, along with discomfort on eye movements. This was treated as conjunctivitis with chloramphenicol eye drops in the community. It did not resolve and progressed to more swelling with pain on eye movement, and diplopia in all gaze positions other than primary. She denied any history of trauma or sinusitis, and had no recent fever. She has history of trigeminal neuralgia, for which she takes pregabalin. The visual acuities were 6/4.8 in the right eye and 6/6 in the left eye. The intraocular pressures were 22 mmHg in the right eye and 26 mmHg in the left eye. There was marked swelling of left periorbital area, with gross proptosis of 4 mm on Hertel exophthalmometry. The left eye had restricted movement in all gazes (Figure 1). The left upper lid was erythematous with mild tender swelling. On Ishihara colour plates, the patient scored equally in both eyes. There were normal pupillary reflexes, with no relative afferent pupillary defect. Slit lamp examination showed marked conjunctival chemosis, but the anterior chamber and posterior segment were quiet. There were no signs of uveitis or scleritis. Urgent blood tests were done. These showed a normal white blood cell and platelet count, but a mildly elevated Creactive protein of 29 mg/L (reference range < 5). Thyroid stimulating hormone was within the normal range. An orbital computed tomography showed extensive pre-septal oedema and retro-orbital fat stranding. The extraocular muscles were of normal sizes. The paranasal sinuses were normal (Figure 2). The diagnosis of orbital inflammation secondary to zoledronic acid was made. The patient was given intravenous 500 mg methylprednisolone. The signs and symptoms rapidly improved after initial steroid within 24 hours, and the patient was switched to oral prednisone 60 mg daily (1 mg/kg dose). She returned for review 2 weeks after the initial presentation. The left-sided orbital inflammation had completely settled, and there was a full range of eye movement, with no proptosis. The prednisone course was rapidly tapered. Zoledronic acid is a bisphosphonate medication, commonly used for prevention and treatment of osteoporosis and also hypercalcaemia, metastatic bone disease and Paget's disease of bone. Prevalence of osteoporosis in Australia is estimated to be “5.9% for men and 22.8% for women aged 50 years and over, and 12.9% for men and 42.5% for women aged 70 years and over.” Zoledronic acid is considered the first-line prevention and treatment therapy of osteoporosis. Bisphosphonates reduces bone resorption through several mechanisms. It targets osteoclasts, where it reduces recruitment to bone surfaces, inhibits the activity and
59岁女性患者静脉滴注唑来膦酸(Aclasta 5 mg;诺华新西兰,奥克兰,新西兰)治疗骨质疏松症。第二天,她出现头痛、双侧眶后疼痛和轻度光敏。第二天,患者出现左眼睑红肿,眼动不适。在社区使用氯霉素滴眼液作为结膜炎治疗。它没有消退,并发展为更大的肿胀,眼球运动疼痛,除原发眼外所有凝视位置的复视。她否认有外伤史或鼻窦炎史,近期无发热。她有三叉神经痛的历史,她年前。右眼视力6/4.8,左眼视力6/6。眼内压力22毫米汞柱的右眼和左眼26毫米汞柱。左眶周区明显肿胀,Hertel眼测肉眼突出约4mm。左眼都限制运动凝视(图1)。左边的上盖与轻度红斑的温柔的肿胀。在石原颜色板,病人得分同样在两只眼睛。有正常的瞳孔反应,没有相对的瞳孔传入障碍。裂隙灯检查显示明显结膜水肿,但前房和后段安静。没有葡萄膜炎或巩膜炎的迹象。紧急血液测试。这些显示出正常的白细胞和血小板计数,但轻度升高Creactive蛋白质29 mg / L(参考范围< 5)。促甲状腺激素是在正常范围内。轨道计算机断层扫描显示广泛的pre-septal水肿和retro-orbital脂肪搁浅。眼外肌大小正常。鼻窦正常(图2)。诊断为唑来膦酸引起的眼眶炎症。病人静脉注射甲基强的松龙500毫克。体征和症状迅速改善初始类固醇后在24小时内,和病人改用口服强的松60毫克每日剂量(1毫克/公斤)。初次就诊后2周,她又来复查。左轨道炎症已经完全解决,和有一个全方位的眼球运动,没有突出。强的松疗程迅速减少。唑来膦酸是一种双膦酸类药物,常用于预防和治疗骨质疏松症、高钙血症、转移性骨病和佩吉特骨病。据估计,澳大利亚的骨质疏松症患病率为“50岁及以上男性5.9%,女性22.8%,70岁及以上男性12.9%,女性42.5%”。唑来膦酸被认为是骨质疏松症的一线防治药物。磷酸盐通过几种机制减少骨吸收。它针对破骨细胞,在那里它减少骨表面的招募,抑制活性,缩短破骨细胞的寿命。双膦酸盐的眼部副作用并不常见。他们可以影响任何层的眼睛,会引起结膜炎,巩膜炎、葡萄膜炎。双膦酸盐相关的眼眶炎症是一种罕见的事件。炎症的机制被假定是由于二磷酸盐的促炎症亚型的性质。Zoledronic酸,
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引用次数: 6
Intraocular chemotherapy for vitreoretinal lymphoma: A review 眼内化疗治疗玻璃体视网膜淋巴瘤:综述
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13668
Michael Kvopka, Stewart R. Lake, Justine R. Smith
Vitreoretinal lymphomas are rare ocular cancers, and the subset of primary central nervous system lymphomas that are based in the posterior eye. These tumours are challenging to treat, and today management generally involves a multispecialty team coordinating a treatment protocol that may include intraocular chemotherapy, ocular irradiation, systemic chemotherapy and/or autologous stem cell transplantation. The ophthalmologist has specific responsibility for the intraocular chemotherapy, which is delivered to the eye by intravitreal injection. The most commonly injected drugs are methotrexate—an anti‐metabolite—and rituximab—an anti‐human B cell monoclonal antibody. A range of intraocular chemotherapy treatment schedules have been described in the medical literature, although to date there have been no randomized clinical trials of these schedules. In this article, we review the development and current status of intraocular chemotherapy for vitreoretinal lymphoma.
玻璃体视网膜淋巴瘤是一种罕见的眼部癌症,是原发性中枢神经系统淋巴瘤的一个亚群,主要发生在后眼。这些肿瘤的治疗具有挑战性,目前的治疗通常涉及一个多专业团队协调治疗方案,可能包括眼内化疗、眼照射、全身化疗和/或自体干细胞移植。眼科医生对眼内化疗负有特殊的责任,化疗是通过玻璃体内注射到眼睛里的。最常用的注射药物是甲氨蝶呤(一种抗代谢药物)和利妥昔单抗(一种抗人B细胞单克隆抗体)。医学文献中描述了一系列眼内化疗治疗方案,尽管迄今为止还没有这些方案的随机临床试验。本文就玻璃体视网膜淋巴瘤眼内化疗的发展及现状作一综述。
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引用次数: 22
Trochlear nerve schwannoma: A 22 year follow‐up 滑车神经鞘瘤:22年随访
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13664
J. Lock, N. Newman, V. Biousse
A healthy 57-year-old man presented with binocular vertical diplopia in 1997. There was no history of headaches, orbital pain or trauma. He adopted a left head tilt and ocular motility examination revealed a right superior oblique palsy with a right hypertropia of five prism dioptres in primary position. The rest of his cranial nerve examination was normal. Contrast-enhanced MRI of the brain and orbits was initially reported as normal. On secondary review, a focal lesion involving the cisternal right fourth nerve (CNIV) was detected. Without contrast, the lesion was isointense with brain parenchyma (Figure 1A); with contrast, the lesion enhanced intensely (Figure 1B). These radiological findings were most in keeping with a CNIV schwannoma. His ocular motility examination remained stable over the next 22 years as did the radiological appearance of the presumed CNIV schwannoma (Figure 2). As his diplopia was successfully managed with prism spectacles, strabismus surgery was not required. Trochlear nerve schwannomas are an unusual cause of isolated superior oblique palsies and are quite rare even in patients with neurofibromatosis type 2. As depicted in this case, CNIV schwannomas may be overlooked if contrast is
男性,健康,57岁,1997年患双眼垂直复视。没有头痛、眼窝疼痛或外伤史。患者通过左头倾斜和眼球运动检查发现右上斜性麻痹伴右主位五棱镜屈光不正。脑神经检查其余部分正常。大脑和眼眶的对比增强MRI最初报告为正常。在二次复查中,发现局灶性病变累及池右第四神经(CNIV)。未作对比,病变与脑实质呈等强度(图1A);相比之下,病变增强强烈(图1B)。这些影像学表现与CNIV神经鞘瘤最一致。在接下来的22年里,他的眼球运动检查和疑似CNIV神经鞘瘤的影像学表现都保持稳定(图2)。由于他的复视使用棱镜眼镜成功治疗,因此不需要斜视手术。滑车神经鞘瘤是孤立性上斜肌麻痹的罕见病因,即使在2型神经纤维瘤病患者中也相当罕见。如本例所示,如果做对比检查,CNIV神经鞘瘤可能会被忽略
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引用次数: 0
Erdheim‐Chester disease with bilateral choroidal infiltration 双侧脉络膜浸润的Erdheim - Chester病
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13665
W. Xiao, H. Ye, X. Ji, Huasheng Yang
Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis that was first described by Jakob Erdheim and William Chester in 1930. ECD frequently involves multiple systems, such as the skin, bone and central nerve system. The diagnosis of ECD is made by identifying typical histopathological findings in the context of clinical and radiological features, including the infiltration of foamy or lipid-laden histiocytes and positive immunohistochemical staining for CD68. Ocular manifestations have been documented in 25% to 30% of ECD patients, mainly presenting as xanthelasma in the eyelid and infiltration of the orbit. Patients with orbital involvement may complain of exophthalmos, retro-orbital pain or blurring of vision. ECD rarely involves intraocular structures and only less than 10 cases have been reported to date. We hereby described a case of ECD woman with concurrent bilateral choroidal and orbital infiltrates. A 41-year-old woman presented with progressive visual decrease and intermittent pain in her right eye for 2 years. Her ocular history was unremarkable, but she had a history of diabetes insipidus and recurrent pain in her bilateral lower extremities for 5 years. At presentation, her bestcorrected visual acuity was finger count on the right and 20/20 on the left. Intraocular pressure was within the normal range. Hertel exophthalmometer measurements were 16 and 19 mm on the right and left side, respectively. External eye examination revealed sporadic xanthoma in her right eyelids (Figure 1A, arrowhead). Fundoscopy showed bilateral yellowish choroidal mass in the posterior pole with overlying pigmentary clumping (Figure 1B,C).
Erdheim-Chester病(ECD)是一种罕见的非朗格汉斯细胞组织细胞增多症,由Jakob Erdheim和William Chester于1930年首次发现。ECD通常涉及多个系统,如皮肤、骨骼和中枢神经系统。ECD的诊断是通过在临床和放射学特征的背景下确定典型的组织病理学发现来做出的,包括泡沫或脂质组织细胞的浸润和CD68免疫组化染色阳性。25% ~ 30%的ECD患者有眼部表现,主要表现为眼睑黄原瘤和眼眶浸润。眼眶受累的患者可能主诉为眼球突出、眼眶后疼痛或视力模糊。ECD很少涉及眼内结构,迄今为止只有不到10例报告。我们在此报告一例女性ECD并发双侧脉络膜和眼眶浸润。女,41岁,右眼进行性视力下降,间歇性疼痛2年。患者眼部病史一般,但有尿崩症病史,双侧下肢反复疼痛5年。在介绍时,她的最佳矫正视力是右手手指数和左手20/20。眼压在正常范围内。Hertel刺眼计测量右侧16 mm,左侧19 mm。外眼检查显示右侧眼睑有散发性黄色瘤(图1A,箭头)。眼底镜检查显示双侧后极黄色脉络膜肿块伴上覆色素团块(图1B,C)。
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引用次数: 4
Xen gel stent occlusion with iris pigment epithelium Xen凝胶支架闭塞虹膜色素上皮
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13658
R. Eagle, R. Razeghinejad
directed to examine the entire course of this slender nerve. The majority of affected patients are oligosymptomatic with diplopia only and can be observed with serial contrastenhanced MRIs coupled with symptomatic management such as prism glasses or strabismus surgery. It is important to periodically monitor these patients as there is a potential for haemorrhage or growth resulting in brainstem compression. Concerning symptoms include sensory changes, paresis, ataxia and other cranial nerve palsies. Surgical resection is almost always associated with persistence or worsening of superior oblique weakness and carries the risk of stroke, intracranial haemorrhage and damage to surrounding cranial nerves. Therefore, surgery is not recommended as initial treatment of an isolated CNIV schwannoma, but may be necessary if the tumour rapidly enlarges causing mass effect. In slowly progressive cases, radiotherapy may be considered as an alternative treatment modality. In particular, gamma knife stereotactic radiosurgery has recently delivered promising results with small case series reporting reduced tumour volume and improvement of diplopia. This is the longest published follow-up period for a presumed CNIV schwannoma, demonstrating its typical extremely slow-growing nature. Clinical and radiologic observation is favoured over neurosurgical intervention in such cases.
目的是检查这条细神经的整个过程。大多数受影响的患者仅为复视的少症状,可以通过系列对比增强mri加上诸如棱镜眼镜或斜视手术等症状管理来观察。定期监测这些患者是很重要的,因为有可能出现出血或生长导致脑干压迫。相关症状包括感觉改变、神经麻痹、共济失调等脑神经麻痹。手术切除几乎总是与上斜肌无力持续或恶化相关,并有中风、颅内出血和周围颅神经损伤的风险。因此,手术不建议作为孤立的CNIV神经鞘瘤的初始治疗,但如果肿瘤迅速扩大导致肿块效应,则可能是必要的。在进展缓慢的病例中,放射治疗可以作为一种替代治疗方式。特别是,伽玛刀立体定向放射手术最近取得了令人鼓舞的结果,小病例系列报告了肿瘤体积减少和复视改善。这是对疑似CNIV神经鞘瘤的最长随访期,表明其典型的生长极慢的性质。在这种情况下,临床和放射学观察优于神经外科干预。
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引用次数: 5
New grading criterion for retinal haemorrhages in term newborns based on deep convolutional neural networks 基于深度卷积神经网络的足月新生儿视网膜出血分级新标准
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13670
J. Mao, Yuhao Luo, Kun Chen, J. Lao, Lingan Chen, Yirun Shao, Caiyun Zhang, Mingzhai Sun, Lijun Shen
To define a new quantitative grading criterion for retinal haemorrhages in term newborns based on the segmentation results of a deep convolutional neural network.
基于深度卷积神经网络分割结果,建立足月新生儿视网膜出血的定量分级标准。
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引用次数: 3
Cerebrospinal fluid and optic nerve sheath compartment syndrome: A common pathophysiological mechanism in five different cases? 脑脊液和视神经鞘室综合征:五种不同病例的共同病理生理机制?
Pub Date : 2020-03-01 DOI: 10.1111/ceo.13663
J. Hao, A. Pircher, N. Miller, J. Hsieh, L. Remonda, H. Killer
Optic nerve (ON) dysfunction is a common feature of different diseases. The pathophysiology is not yet fully understood.
视神经功能障碍是各种疾病的共同特征。病理生理学尚未完全了解。
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引用次数: 17
Two different patterns and outcome of neodymium YAG capsulotomy 两种不同的YAG钕包膜切开术模式及疗效
Pub Date : 2020-02-25 DOI: 10.29328/journal.ijceo.1001027
Sudeep Navule Siddappa, Darshan Shivaura Mahalingu, Rakesha Anjenappa, T. Joy
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引用次数: 0
期刊
Journal of Clinical & Experimental Ophthalmology
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