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Keratoconus in a 4-year-old Girl with a Strong Family History of Keratoconus 圆锥角膜家族史的4岁女童一例
Pub Date : 2018-01-01 DOI: 10.17925/usor.2018.11.1.56
Mohammad M. Shehadeh, M. Akkawi, Ammar A. Aghbar
Purpose: To present the diagnosis and management of the youngest-described keratoconus patient, despite the absence of any systemic or local risk factors except the presence of a strongly positive family history of keratoconus. Methods: A retrospective case report. Results: A 4-year-old female child with free past medical and ocular histories, and a strongly positive family history of keratoconus, presented with deterioration in her vision in the previous 6 months as observed by the family. Objective/subjective refraction showed high astigmatism. Corneal tomography using the Scheimpflug camera Pentacam® HR confirmed the diagnosis of keratoconus in both eyes. Conventional corneal collagen crosslinking (CXL) procedure was performed shortly with a stabilization effect observed over a 1-year follow up period. Conclusion: Keratoconus onset may occur in early childhood, especially in patients with strong family history of the disease even in the absence of systemic or ocular risk factors. So, early screening before the age of 4 years should be done for all children of a family history of keratoconus. Crosslinking may be an effective and safe procedure for very young patients diagnosed with keratoconus.
目的:介绍最年轻的圆锥角膜患者的诊断和治疗,尽管除了存在强烈阳性的圆锥角膜家族史外,没有任何全身或局部危险因素。方法:回顾性病例报告。结果:1例4岁女童,无既往病史和眼部病史,家族史呈圆锥角膜阳性,经家人观察,视力在过去6个月出现恶化。客观/主观屈光表现为高度散光。使用Scheimpflug相机Pentacam®HR进行角膜断层扫描,确诊为双眼圆锥角膜。常规角膜胶原交联(CXL)手术在1年随访期间观察到稳定效果。结论:圆锥角膜可发生在儿童早期,特别是有强烈家族史的患者,即使没有全身或眼部危险因素。因此,所有有圆锥角膜家族史的儿童都应该在4岁前进行早期筛查。交联可能是一个有效和安全的程序,非常年轻的患者诊断圆锥角膜。
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引用次数: 3
Gel Stent Implantation—Recommendations for Preoperative Assessment, Surgical Technique, and Postoperative Management 凝胶支架植入-术前评估,手术技术和术后管理的建议
Pub Date : 2018-01-01 DOI: 10.17925/usor.2018.11.1.38
Vanessa Vera, I. Ahmed, I. Stalmans, H. Reitsamer
T he surgical management of glaucoma offers the potential to lower intraocular pressure (IOP) independent of patients’ compliance with their medication regimen. Procedures such as trabeculectomy and tube shunt placement often yield large magnitudes of IOP reduction, but may be associated with shortand long-term complications. Microinvasive glaucoma surgery (MIGS) offers an alternative surgical approach that is inherently less invasive; however, most devices that fit in this category are associated with a lesser degree of IOP-lowering efficacy compared with traditional glaucoma surgeries. A newer MIGS device, a gel stent that facilitates drainage to the subconjunctival space, appears to offer similar IOP reduction to trabeculectomy, but with much less tissue manipulation; better predictability; and less sight-threatening complications, thus making it a potentially safer and more predictable surgical option in appropriate patients. The following proposed protocol, based on evidence-based practices and augmented where necessary by the opinions of experienced surgeons, provides guidance for the pre-, intra-, and postoperative management of patients receiving a gel stent implant. The goal of this protocol is to provide a framework for better patient selection and preparation, surgical pearls, and how best to assess and manage patients in the postoperative period.
青光眼的手术治疗提供了降低眼压(IOP)的潜力,而不依赖于患者对其药物治疗方案的依从性。小梁切除术和置管分流术等手术通常可大幅度降低IOP,但可能伴有短期和长期并发症。微创青光眼手术(MIGS)提供了一种替代手术方法,其本身侵入性较小;然而,与传统的青光眼手术相比,大多数适合这一类的设备降低眼压的效果程度较低。一种较新的MIGS装置,一种凝胶支架,可以促进结膜下间隙的引流,似乎可以提供与小梁切除术相似的IOP降低,但需要较少的组织操作;更好的可预测性;并且更少的威胁视力的并发症,因此使其成为一种潜在的更安全、更可预测的手术选择,适用于合适的患者。以下建议的方案基于循证实践,并在必要时由经验丰富的外科医生的意见进行补充,为接受凝胶支架植入的患者的术前、术中和术后管理提供指导。本协议的目标是为更好的患者选择和准备,手术珍珠,以及如何最好地评估和管理术后患者提供一个框架。
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引用次数: 19
Optical Coherence Tomography Angiography 光学相干断层血管造影术
Pub Date : 2018-01-01 DOI: 10.17925/USOR.2018.11.2.91
M. Nagpal, Gujarat India
Optical coherence tomography angiography (OCTA) is a new revolutionary non-invasive imaging modality, built on the platform of optical coherence tomography (OCT). This technique works on the principle of ‘decorrelation’ and is still a nascent technology in its infancy with tremendous potential applicability for diagnosing retinal and choroidal vascular diseases. Its non-invasive nature, and the ability to generate images of retinal and choroidal vasculature, allows it to replace and/or supplement the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA), if not in all but certainly in most retinal and choroidal pathologies. Still, there exists a major challenge in terms of its wide-scale availability, equipment and processing techniques, presence of artifacts, limitations of imaging capability, and lack of common vocabulary among retinal specialists for interpretation. In this review we intend to describe this novel technique by highlighting its key features, and comparing it with FA and ICGA. We will also discuss its applicability in various clinical scenarios such as diabetic retinopathy, age-related macular degeneration, retinal venous occlusion, choroiditis, and in routine practice. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.
光学相干断层扫描血管成像(OCTA)是建立在光学相干断层扫描(OCT)平台上的一种革命性的无创成像方式。该技术基于“去相关”原理工作,在诊断视网膜和脉络膜血管疾病方面仍是一项处于起步阶段的新兴技术,具有巨大的应用潜力。它的非侵入性,以及生成视网膜和脉络膜血管图像的能力,使其能够取代和/或补充目前的血管造影金标准,荧光素血管造影(FA)和吲吲吲胺绿血管造影(ICGA),如果不是全部,但肯定在大多数视网膜和脉络膜病变。然而,就其大规模可用性、设备和处理技术、人工制品的存在、成像能力的限制以及视网膜专家之间缺乏通用的解释词汇等方面而言,仍存在重大挑战。在这篇综述中,我们打算通过强调其主要特征来描述这种新技术,并将其与FA和ICGA进行比较。我们还将讨论其在各种临床情况下的适用性,如糖尿病视网膜病变、年龄相关性黄斑变性、视网膜静脉阻塞、脉络膜炎和常规实践。需要进一步的研究来更明确地确定OCTA在临床环境中的效用,并确定该技术是否可以提供一种非侵入性的视网膜血管详细可视化选择。
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引用次数: 0
Pearls for Treating Retinoblastoma 治疗视网膜母细胞瘤的珍珠
Pub Date : 2018-01-01 DOI: 10.17925/USOR.2018.11.2.79
Sona N Shah, J. Berry
Retinoblastoma is a primary intraocular cancer that develops in the eyes of children. The vast majority of retinoblastoma tumorigenesis is initiated by a mutation in the RB1 gene on chromosome 13q. This practice pearl will discuss the current treatment modalities for this pediatric tumor, with the primary goal of saving the child's life. With recent treatment advances, more emphasis has been placed on successfully saving the eye, often with useful vision.
视网膜母细胞瘤是一种发生在儿童眼睛的原发性眼内癌。绝大多数视网膜母细胞瘤的发生是由染色体13q上RB1基因的突变引起的。本实践珍珠将讨论目前的治疗方式为儿童肿瘤,以挽救儿童的生命为主要目标。随着最近的治疗进展,更多的重点放在成功地挽救眼睛,通常是有用的视力。
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引用次数: 2
Updates and Challenges in Refractive Lens Exchange 折射透镜交换的最新进展和挑战
Pub Date : 2018-01-01 DOI: 10.17925/USOR.2018.11.1.17
D. Dhaliwal
Support: No external funding was received in the publication of this article. Refractive lens exchange (RLE) is frequently used as a refractive surgical procedure for the correction of high presbyopia and high hyperopia, for which laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK) or phakic intraocular lens (IOL) refractive surgery is unsuitable. In an expert interview, Deepinder K Dhaliwal, Professor of Ophthalmology at the University of Pittsburgh School of Medicine, Director of Cornea and Refractive Surgery at the UPMC Eye Center, and Associate Medical Director of the Charles T Campbell Ocular Microbiology Laboratory, discusses the challenges of refractive lens exchange and other aspects of refractive surgery.
支持:本文的出版没有收到外部资助。屈光性晶状体置换术(RLE)经常被用作高度老花眼和高度远视的矫正手术,而激光辅助原位角膜磨除术(LASIK)、光屈光性角膜切除术(PRK)或有晶状体人工晶状体(IOL)的屈光手术不适合这种手术。在一次专家访谈中,匹兹堡大学医学院眼科学教授、UPMC眼科中心角膜和屈光手术主任、Charles T Campbell眼部微生物实验室副医学主任Deepinder K Dhaliwal讨论了屈光晶状体置换和屈光手术其他方面的挑战。
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引用次数: 0
Advances in Age-related Macular Degeneration Understanding and Therapy. 老年性黄斑变性的认识与治疗进展。
Pub Date : 2017-01-01 DOI: 10.17925/USOR.2017.10.02.119
Joan W Miller, Saghar Bagheri, Demetrios G Vavvas

While the development of anti-vascular endothelial growth factor (anti-VEGF) as a therapy for neovascular age-related macular degeneration (AMD) was a great success, the pathologic processes underlying dry AMD that eventually leads to photoreceptor dysfunction, death, and vision loss remain elusive to date, with a lack of effective therapies and increasing prevalence of the disease. There is an overwhelming need to improve the classification system of AMD, to increase our understanding of cell death mechanisms involved in both neovascular and non-neovascular AMD, and to develop better biomarkers and clinical endpoints to eventually be able to identify better therapeutic targets-especially early in the disease process. There is no doubt that it is a matter of time before progress will be made and better therapies will be developed for non-neovascular AMD.

虽然抗血管内皮生长因子(anti-VEGF)作为一种治疗新生血管性年龄相关性黄斑变性(AMD)的疗法取得了巨大成功,但干性AMD的病理过程最终导致光感受器功能障碍、死亡和视力丧失,迄今为止仍然难以捉摸,缺乏有效的治疗方法,且该疾病的患病率不断上升。我们迫切需要改进AMD的分类系统,增加我们对新血管性和非血管性AMD的细胞死亡机制的理解,并开发更好的生物标志物和临床终点,最终能够确定更好的治疗靶点,特别是在疾病过程的早期。毫无疑问,在取得进展和开发出更好的治疗非血管性AMD的方法之前,这只是时间问题。
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引用次数: 54
Minimally Invasive Glaucoma Surgery and CyPass® Micro-Stent—A New Era in Glaucoma Surgery 微创青光眼手术和CyPass®微支架——青光眼手术的新时代
Pub Date : 2017-01-01 DOI: 10.17925/USOR.2017.10.01.39
S. Mosaed
I n the largest randomized clinical trial to date on a minimally invasive glaucoma surgery device, the CyPass ® Micro-Stent was able to lower intraocular pressure (IOP) more than was modern cataract surgery (phacoemulsification and intraocular lens implantation) alone, and should be considered for patients with mild to moderate glaucoma already scheduled to undergo phacoemulsification surgery. The two-year outcomes of the COMPASS study found mean IOP reductions of 7.4 mmHg in the CyPass Micro-Stent group and no vision-threatening adverse events; more than 98% of subjects in the CyPass Micro-Stent group achieved 20/40 or better best-corrected visual acuity.
在迄今为止关于微创青光眼手术装置的最大随机临床试验中,CyPass®微型支架能够比单独的现代白内障手术(超声乳化和人工晶状体植入术)更能降低眼压(IOP),对于已经计划进行超声乳化手术的轻中度青光眼患者应该考虑。COMPASS研究的两年结果发现,CyPass微型支架组平均眼压降低7.4 mmHg,无视力威胁不良事件;CyPass微型支架组98%以上的受试者达到20/40或更好的最佳矫正视力。
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引用次数: 3
The Value of Area Under the Curve Analysis as an Outcome Measure in the Assessment of a Continuous Microdosing Fluocinolone Acetonide Implant (ILUVIEN 曲线下面积分析在连续微剂量醋酸氟西诺酮种植体评价中的价值
Pub Date : 2017-01-01 DOI: 10.17925/USOR.2017.10.01.46
Sepehr Bahadorani, M. Singer
T he treatment of diabetic macular edema (DME) has become one of the most challenging management issues faced by ophthalmologists in daily practice. This is partly due to the multifactorial nature of DME, progression of the disease and the clinical capacity needed to administer intravitreal injections. In recent years, the treatment options for DME have expanded to include intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents and steroids, and most recently, the use of intravitreal implants. In determining clinically relevant endpoints for clinical studies of these treatments, it is important to consider the patient’s journey and experience with a treatment over a specific time-period rather than isolated outcomes at a pre-specified time-point. Area under the curve (AUC) is an ideal tool for data analysis particularly when it comes to sustained release therapies such as dexamethasone (Ozurdex®, Allergan Inc., California, US) and intravitreal fluocinolone acetonide implant (0.2μg/day FAc implant; Iluvien®, Alimera Sciences Inc., Georgia, US). Unlike single time-point outcomes, AUC analysis provides the average letters gained per day over the entire treatment period, providing a better measure of long-term effectiveness. A recent analysis using the AUC approach highlights the significant visual acuity benefit resulting from the 0.2μg/day fluocinolone acetonide (FAc) implant during the FAME (Fluocinolone Acetonide for Macular Edema) trials. A step-by-step instruction is included in this article that allows statistical analysis of the AUC data from both functional and anatomical outcomes, using a free software tool to further facilitate the use of this technique for future investigators.
糖尿病性黄斑水肿(DME)的治疗已成为眼科医生在日常实践中面临的最具挑战性的管理问题之一。这部分是由于二甲醚的多因素性质、疾病的进展以及进行玻璃体内注射所需的临床能力。近年来,二甲醚的治疗选择已经扩大到包括玻璃体内注射抗血管内皮生长因子(VEGF)药物和类固醇,以及最近使用的玻璃体内植入物。在确定这些治疗的临床研究的临床相关终点时,重要的是要考虑患者在特定时间段内的治疗过程和经历,而不是在预先指定的时间点上的孤立结果。曲线下面积(AUC)是数据分析的理想工具,特别是当涉及到持续释放疗法,如地塞米松(Ozurdex®,Allergan Inc., California, US)和玻璃体内氟西诺酮醋酸酯植入物(0.2μg/day FAc植入物;Iluvien®,Alimera Sciences Inc., Georgia, US)。与单一时间点结果不同,AUC分析提供了整个治疗期间每天获得的平均字母数,从而更好地衡量了长期有效性。最近一项使用AUC方法的分析强调了在FAME(用于黄斑水肿的氟西诺酮)试验中,每天0.2μg的醋酸氟西诺酮(FAc)植入物对视力的显著改善。本文中包含了一步一步的指导,允许对功能和解剖结果的AUC数据进行统计分析,使用免费软件工具进一步促进该技术的使用,供未来的研究者使用。
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引用次数: 1
The Role of Anti-vascular Endothelial Growth Factor Agents in the Management of Retinopathy of Prematurity 抗血管内皮生长因子在早产儿视网膜病变治疗中的作用
Pub Date : 2017-01-01 DOI: 10.17925/USOR.2017.10.01.57
Christopher D Conrady, M. Hartnett
Acknowledgements: This work was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Utah’s Department of Ophthalmology and Visual Sciences and National Eye Institute R01 grants EY015130 and EY017011 to MEH. M. Elizabeth Hartnett has received NIH grant support as principal investigator for the following: R01EY015130, R01EY017011, T35EY026511. The authors would also like to thank Lane Bennion for the medical renderings.
致谢:这项工作部分得到了美国犹他大学眼科学与视觉科学系预防失明研究中心和美国国家眼科研究所R01基金EY015130和EY017011对MEH的无限制资助。M. Elizabeth Hartnett已获得NIH拨款支持,担任以下项目的首席研究员:R01EY015130, R01EY017011, T35EY026511。作者还想感谢Lane Bennion提供的医学渲染图。
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引用次数: 6
Recent Advances in the Understanding and Treatment of Glaucoma 青光眼的认识与治疗新进展
Pub Date : 2017-01-01 DOI: 10.17925/USOR.2017.10.02.89
Brandon J. Baartman, John P Berdahl
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引用次数: 0
期刊
US ophthalmic review
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