Choroidal Effusions

脉络膜积液
  • 文章类型: Journal Article
    目的:探讨青光眼术后脉络膜脱离患者睫状体脱离的发生率及其对临床病程的影响。管理,和预后。
    方法:前瞻性观察性病例系列研究。纳入2018-2019年青光眼手术后脉络膜脱离的患者。所有患者均接受了完整的眼科检查和超声生物显微镜检查,以评估睫状体脱离的存在和程度。随访检查包括超声生物显微镜扫描在1周,1个月,3个月,和6个月。
    结果:纳入8例患者(8只眼),4男4女,平均年龄72岁(范围60-83)。5例患者行丝裂霉素C小梁切除术(0.02%),其中1例联合超声乳化白内障摘除术;2例接受了Ahmed青光眼瓣膜植入术,1例接受了丝裂霉素C(0.02%)的ab-internoXen45凝胶支架植入。术前平均眼压为26.0±7.65mmHg,术后第一天降至6.9±2.64mmHg。从手术到诊断脉络膜脱离的平均时间为11.6±5.73天。所有患者均通过超声生物显微镜检查发现睫状体脱离,介于一到四个象限之间。所有患者均接受局部类固醇和环麻痹药治疗;三人(37.5%)接受口服类固醇。未显示脉络膜或睫状体脱离的手术干预。
    结论:在这项现实世界的前瞻性研究中,在青光眼手术后出现脉络膜脱离的所有患者中均发现并发睫状体脱离.这一观察结果可能会加深我们对青光眼手术后常见的低眼压机制的理解。
    OBJECTIVE: To examine the rate of ciliary body detachment in patients with choroidal detachment following glaucoma surgery and its effect on the clinical course, management, and prognosis.
    METHODS: A prospective observational case-series study. Patients with choroidal detachment following glaucoma surgery in 2018-2019 were included. All underwent complete ophthalmological examination and ultrasound biomicroscopy for evaluation of the presence and extent of ciliary body detachment. Follow-up examinations including ultrasound biomicroscopy scans were performed at 1 week, 1 month, 3 months, and 6 months.
    RESULTS: Eight patients (8 eyes) were enrolled, 4 male and 4 female, of mean age 72 years (range 60-83). Five patients underwent trabeculectomy with mitomycin C (0.02%), which was combined with phacoemulsification cataract extraction in one; two underwent Ahmed glaucoma valve implantations, and one underwent ab-interno Xen45 gel stent implantation with mitomycin C (0.02%). The mean intraocular pressure was 26.0 ± 7.65 mmHg preoperatively, dropping to 6.9 ± 2.64 mmHg on first postoperative day one. Mean time from surgery to diagnosis of choroidal detachment was 11.6 ± 5.73 days. Ciliary body detachment was identified by ultrasound biomicroscopy in all patients, ranging between one and four quadrants. All patients were treated with topical steroids and cycloplegics; three (37.5%) received oral steroids. No surgical intervention for the choroidal or ciliary body detachments was indicated.
    CONCLUSIONS: In this real-world prospective study, concurrent ciliary body detachment was identified in all patients who presented with choroidal detachment following glaucoma surgery. This observation may deepen our understanding of the mechanism underlying the hypotony that is often seen after glaucoma surgery.
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  • 文章类型: Case Reports
    背景:患者的双侧视网膜脱离和脉络膜脱离很少发生。在这种情况下,双侧糖尿病性视网膜病变(DR)的存在甚至更罕见,并且使病情复杂化。
    方法:在本研究中,我们记录了一个非常规VKH的案例。该患者的表现包括强烈的周边视网膜脱离和脉络膜脱离,以及类似于棉绒斑点的玻璃体混浊,同时与DR.诊断为DR可能为VKH。根据VKH方案治疗,包括大剂量皮质类固醇,产生了积极的结果。
    结论:VKH可与DR共现。VKH表现各不相同,和早期,侵略性,长期治疗至关重要。治疗的复杂性随着DR的并发而增加,需要使用免疫抑制剂。
    BACKGROUND: Bilateral retinal detachment and choroidal detachment in a patient are rare occurrences. The presence of bilateral diabetic retinopathy (DR) in such a case is even rarer and complicates the condition.
    METHODS: In this study, we document a case of unconventional VKH. Manifestations in this patient included intense peripheral retinal detachment and choroidal detachment, along with vitreous opacities akin to cotton wool spots, concurrent with DR. The diagnosis was considered as probable VKH with DR. Treatment according to VKH protocols, including high-dose corticosteroids, yielded positive results.
    CONCLUSIONS: VKH can co-occurrence with DR. VKH manifestations vary, and early, aggressive, and long-term treatment is essential. The complexity of treatment increases with concurrent DR, necessitating the use of immunosuppressants.
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  • 文章类型: Case Reports
    登革热是印度的主要健康问题。文献中有关于这种发热性疾病的眼部表现的各种报道。我们正在报道一例罕见的30多岁的女性病例,该女性发展为并存的双侧脉络膜积液综合征,并伴有与登革热相关的孤立的细胞毒性call体病变。据我们所知,这是同类案件中的第一例。它为此类双侧纤毛脉络膜积液综合征的神经系统和影像学检查提供了途径。
    Dengue fever is a major health concern in India. There are various reports in the literature regarding the ocular manifestations of this febrile illness. We are reporting a rare case of a woman in her late 30s who developed coexisting bilateral ciliochoroidal effusion syndrome with an isolated cytotoxic corpus callosum lesion associated with dengue febrile illness. To the best of our knowledge, this is the first case of its kind. It opens the avenues for neurological and radioimaging attention for such cases with bilateral ciliochoroidal effusion syndrome.
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  • 文章类型: Case Reports
    背景:脉络膜积液是青光眼手术的常见并发症。尽管大多数脉络膜积液病例随着眼内压恢复正常,仅通过观察或药物治疗即可自发消退,严重或持续性病例可能需要手术引流.在这里,我们报道一例Ahmed青光眼瓣膜植入术后长期严重脉络膜积液自发消退的病例.
    方法:一名85岁的原发性开角型青光眼未得到控制,有慢性肾病病史的男子接受了安然无恙的Ahmed青光眼瓣膜植入术。术后第8天,出现一过性低眼压,和大的360°周围脉络膜脱离发展。尽管眼压在术后第15天升高至正常水平,但脉络膜积液并未消退。超过8个月的眼底检查显示,尽管眼压控制良好,但仍存在大量脉络膜积液。在术前和随访期间进行的实验室检查显示钾和肌酐水平持续升高。术后9个月,病变自行消退,无需任何手术干预。我们发现病人的肌酐水平恢复正常,纠正了先前存在的高钾血症,因此,他的总体状况得到了改善。
    结论:考虑潜在的医疗条件可能有助于青光眼滤过手术后病因不明的持续性脉络膜积液患者。
    BACKGROUND: Choroidal effusion is a common complication of glaucoma surgery. Although most cases of choroidal effusions resolve spontaneously with observation or medical management alone as intraocular pressure normalizes, surgical drainage might be needed in severe or persistent cases. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion after Ahmed glaucoma valve implantation.
    METHODS: An 85-year-old man with uncontrolled primary open-angle glaucoma and medical history of chronic kidney disease underwent uneventful Ahmed glaucoma valve implantation. On postoperative day 8, transient hypotony occurred, and large 360° peripheral choroidal detachments developed. Although the intraocular pressure increased to normal levels on postoperative day 15, choroidal effusion did not resolve. Fundus examination over 8 months showed that the large choroidal effusion persisted despite a well-controlled intraocular pressure. Laboratory test performed at preoperatively and follow-up period revealed persistently elevated potassium and creatinine levels. On postoperative 9 months, the lesion resolved spontaneously without any surgical intervention. We found that the patient\'s creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved.
    CONCLUSIONS: Considering the underlying medical condition may be helpful in patients with persistent choroidal effusion of an unclear etiology following glaucoma filtering surgery.
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  • 文章类型: Journal Article
    背景技术视网膜和脉络膜联合脱离(RD-CD)在眼科治疗中提出了重大挑战。通常需要手术干预以获得最佳结果。选择合适的外科手术对于确保视觉恢复和整体眼睛健康至关重要。这项研究探讨了两种不同的RD-CD手术方法的治疗益处和结果:气压性视网膜固定术(PR),然后是平坦部玻璃体切除术(PPV)和单独的PPV。试图指导最佳的临床决策。材料与方法我们回顾性分析了64例诊断为RD-CD的连续患者的数据。他们分为两组:A组包括34例患者(34只眼),这些患者接受了PR作为初始治疗,随后接受了PPV,而B组,作为一个控制,包括30例仅接受PPV治疗的患者(30只眼)。结果A组应用PR显著加速眼压(IOP)升高(P.
    BACKGROUND Combined retinal and choroidal detachment (RD-CD) poses significant challenges in ophthalmic treatment, often requiring surgical intervention for optimal outcomes. The selection of the appropriate surgical procedure is crucial for ensuring visual restoration and overall eye health. This study delves into the therapeutic benefits and outcomes of two distinct surgical approaches for RD-CD: pneumatic retinopexy (PR) followed by pars plana vitrectomy (PPV) and PPV alone, in an attempt to guide optimal clinical decision-making. MATERIAL AND METHODS We retrospectively analyzed data from 64 consecutive patients diagnosed with RD-CD. They were categorized into two groups: Group A consisted of 34 patients (34 eyes) who underwent PR as an initial treatment and subsequently received PPV, while Group B, serving as a control, comprised 30 patients (30 eyes) treated solely with PPV. RESULTS The application of PR in Group A notably accelerated intraocular pressure (IOP) increase (P.
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  • 文章类型: Meta-Analysis
    目的:干细胞治疗遗传性视网膜疾病(IRD)是一种有前途的治疗方法。这项研究旨在定量检查干细胞治疗对IRD患者的有效性和安全性,包括色素性视网膜炎和Stargardt病(STGD)。
    方法:我们搜索了PubMed,EMBASE,WebofScience,Cochrane图书馆数据库,和ClinicalTrials.gov网站。最新检索时间为2023年8月20日。主要结果是最佳矫正视力(BCVA)改善的比率和平均差异(MD)。根据给药途径和干细胞类型进行亚组分析。本研究在PROSPERO(CRD42022349271)注册。
    结果:21项前瞻性研究,涉及382例患者(306例RP和76例STGD)的496只眼(404例RP和92例STGD),包括在这项研究中。对于RP,6个月和12个月时BCVA改善率分别为49%和30%,分别,治疗后6个月,手术眼的BCVA显着改善(MD=-0.12logMAR,95%CI.17至-0.06logMAR;P<0.001),而治疗后12个月无显著差异(MD=-0.06logMAR;95%CI-0.13至0.01logMAR;P=0.10)。对于STGD,6个月和12个月时BCVA改善率分别为60%和55%,分别,手术眼在6个月时BCVA显着改善(MD=-0.14logMAR,95%CI-0.22至-0.07logMAR;P=0.0002)和12个月(MD=-0.17logMAR,95%CI-0.29至-0.04logMAR;P=0.01)。亚组分析显示,脉络膜上腔注射干细胞可能对RP更有效。3项研究报告了11例与治疗相关的眼部不良事件,没有相关的全身不良事件。
    结论:本研究提示干细胞治疗对于RP或STGD患者可能是有效和安全的。RP患者的长期视力改善可能有限。脉络膜上腔注射干细胞可能是RP患者的一种有希望的给药途径。受证据等级低的限制,未来需要大样本量的随机临床试验.
    Stem cell therapy is a promising therapeutic approach for inherited retinal diseases (IRDs). This study aims to quantitatively examine the effectiveness and safety of stem cell therapy for patients with IRDs, including retinitis pigmentosa and Stargardt disease (STGD).
    We searched PubMed, EMBASE, Web of Science, Cochrane Library databases, and the ClinicalTrials.gov website. The latest retrieval time was August 20, 2023. The primary outcomes were rates and mean difference (MD) of best-corrected visual acuity (BCVA) improvement. Subgroup analyses were conducted according to administration routes and stem cell types. This study was registered with PROSPERO (CRD42022349271).
    Twenty-one prospective studies, involving 496 eyes (404 RP and 92 STGD) of 382 patients (306 RP and 76 STGD), were included in this study. For RP, the rate of BCVA improvement was 49% and 30% at 6 months and 12 months, respectively, and the BCVA was significantly improved in the operative eyes at 6 months post-treatment (MD = - 0.12 logMAR, 95% CI .17 to - 0.06 logMAR; P < 0.001), while there was no significant difference at 12 months post-treatment (MD = -0.06 logMAR; 95% CI - 0.13 to 0.01 logMAR; P = 0.10). For STGD, the rate of BCVA improvement was 60% and 55% at 6 months and 12 months, respectively, and the BCVA was significantly improved in the operative eyes at 6 months (MD = - 0.14 logMAR, 95% CI - 0.22 to - 0.07 logMAR; P = 0.0002) and 12 months (MD = - 0.17 logMAR, 95% CI - 0.29 to - 0.04 logMAR; P = 0.01). Subgroup analyses showed suprachoroidal space injection of stem cells may be more efficient for RP. Eleven treated-related ocular adverse events from three studies and no related systemic adverse events were reported.
    This study suggests stem cell therapy may be effective and safe for patients with RP or STGD. The long-term vision improvement may be limited for RP patients. Suprachoroidal space injection of stem cells may be a promising administration route for RP patients. Limited by the low grade of evidence, large sample size randomized clinical trials are required in the future.
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  • 文章类型: Case Reports
    背景:选择性激光小梁成形术(SLT)在降低眼内压(IOP)方面相对安全且有效。然而,虽然罕见,SLT后可发生并发症。本报告描述了一名患者,该患者在无前房(AC)炎症的SLT后由于低眼压而导致脉络膜脱离。
    方法:一名67岁男性因左眼IOP升高而出现晚期青光眼视野丧失。他以前被诊断出左眼患有特发性葡萄膜性青光眼,他接受了激光虹膜切开术,小梁切除术,和白内障手术。在第一次访问时,通过Goldmann眼压法测量的左眼IOP为28mmHg,尽管接受了最大限度的药物治疗.SLT是在他的左眼进行的,7天后导致7mmHg的IOP。术后3周,患者出现眼部疼痛和左眼视力下降。裂隙灯检查提示前房深,无炎症反应,但他左眼的眼压是4mmHg,眼底和B超均显示浆液性脉络膜脱离。停用所有抗青光眼药物,患者开始口服泼尼松龙和环戊洛尔滴眼液治疗。三周后,脉络膜脱离已经解决,左眼IOP稳定在8mmHg.3个月后随访显示他的左眼IOP保持稳定。
    结论:脉络膜脱离相关的低眼压是SLT的罕见并发症。SLT后可能出现的并发症应告知患者,并在进行手术时予以考虑。
    BACKGROUND: Selective laser trabeculoplasty (SLT) is relatively safe and effective in lowering intraocular pressure (IOP). However, although rare, complications can occur after SLT. This report describes a patient with choroidal detachment due to hypotony following SLT without anterior chamber (AC) inflammation.
    METHODS: A 67-year-old man was referred for elevated IOP in his left eye with advanced glaucomatous visual field loss. He had previously been diagnosed with idiopathic uveitic glaucoma in the left eye, for which he underwent laser iridotomy, trabeculectomy, and cataract surgery. At the first visit, the IOP of his left eye measured by Goldmann tonometry was 28 mmHg despite maximally tolerated medical treatment. SLT was performed in his left eye, resulting in an IOP of 7 mmHg 7 days later. At 3 weeks post-procedure, the patient experienced ocular pain and decreased visual acuity in his left eye. Slit-lamp examination revealed deep anterior chamber depth and no inflammation reaction, but the IOP in his left eye was 4 mmHg, and both fundus and B-scan ultrasonography showed serous choroidal detachment. All anti-glaucoma agents were stopped, and the patient was started on treatment with oral prednisolone and cyclopentolate eye drops. Three weeks later, choroidal detachment had resolved and the IOP in his left eye had stabilized at 8 mmHg. Follow-up 3 months later showed that the IOP in his left eye remained stable.
    CONCLUSIONS: Choroidal detachment-related hypotony is a rare complication of SLT. This possible complication following SLT should be informed to the patients and considered when performing the procedure.
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  • 文章类型: Case Reports
    含有Daratumumab的方案是治疗多发性骨髓瘤晚期病例的有效方法。总的来说,daratumumab具有良好的安全性,尽管可能会出现罕见的副作用。达雷妥单抗的罕见副作用包括脉络膜积液。开始出现眼睛肿胀等症状的患者,视力变化,眼部分泌物和视力模糊应进行紧急眼科评估,并进行达雷妥单抗输注。
    Daratumumab-containing regimens are an effective treatment for advanced cases of multiple myeloma. Overall, daratumumab has a favourable safety profile, although rare side effects can occur. Rare side effects of daratumumab include choroidal effusion. Patients who begin to experience symptoms such as eye swelling, vision changes, eye discharge and blurry vision should undergo urgent ophthalmological evaluation and their daratumumab infusions held.
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  • 文章类型: Journal Article
    孔源性视网膜脱离(RRD)伴脉络膜脱离(RRDCD)的预后通常较差且复杂。本研究旨在鉴定与RRDCD病因相关的特征性蛋白和信号通路,为RRDCD的诊断和治疗提供指导。在这项研究中,玻璃体液样本来自16例RRDCD患者,14与RRD,12患有特发性视网膜前膜(IEMM),和5个来自捐赠尸体眼睛的健康对照。采用独立于数据的采集质谱和生物信息学分析来鉴定差异表达的蛋白质(DEP)。在玻璃体液中,鉴定了14,842个肽。RRDCD患者有249个DEP(93个上调,156个下调),RRD患者89例,IEMM患者61例。GO和京都基因和基因组百科全书DEP数据库的富集分析显示与炎症和免疫相关的功能簇,蛋白质降解和吸收,细胞粘附分子(CAM),刺猬信号通路,和脂质代谢。加权基因共表达网络分析显示,RRDCD共表达阳性的DEPs参与了补体和凝血级联反应导致的免疫相关通路,而RRDCD阴性共表达的DEP参与蛋白质降解和吸收,CAM,和Hedgehog信号通路.总之,本研究为探索发病机制提供了重要线索和理论基础,programming,眼底病的预后。
    The prognosis of rhegmatogenous retinal detachment (RRD) with choroidal detachment (RRDCD) is often poor and complicated. This study focused on the identification of the characteristic proteins and signal pathways associated with the etiology of RRDCD and to provide guidance for diagnosis and treatment of RRDCD. In this study, vitreous humor samples were obtained from 16 RRDCD patients, 14 with RRD, 12 with idiopathic epiretinal macular membrane (IEMM), and 5 healthy controls from donated corpse eyes. Data-independent acquisition mass spectrometry and bioinformatics analysis were employed to identify differentially expressed proteins (DEPs). In the vitreous humor, 14,842 peptides were identified. Patients with RRDCD had 249 DEPs (93 upregulated and 156 downregulated), with 89 in patients with RRD and 61 in patients with IEMM. Enrichment analysis of the GO and Kyoto Encyclopedia of Genes and Genomes DEP databases indicated functional clusters related to inflammation and immunity, protein degradation and absorption, cell adhesion molecules (CAMs), the hedgehog signaling pathway, and lipid metabolism. Weighted gene co-expression network analysis showed that DEPs with positive co-expression of RRDCD participated in immune-related pathways led by the complement and coagulation cascade, whereas DEPs with negative co-expression of RRDCD participated in protein degradation and absorption, CAMs, and the hedgehog signaling pathway. In summary, our study provides important clues and the theoretical basis for exploring the pathogenesis, progression, and prognosis of ocular fundus disease.
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  • 文章类型: Case Reports
    出血性脉络膜脱离(HCD)是眼科手术的一种可怕的术中并发症,尽管是罕见的。已经报道了HCD的多种全身和眼部危险因素。手术期间的急性低眼压被认为是最重要的诱发因素之一。我们在此描述了平坦部玻璃体切除术手术期间的一系列事件,以治疗导致局部HCD的流变性视网膜脱离。我们认为,局部HCD的发病机理与流体空气交换后环绕元件的最终结合过程中的压缩减压力有关。
    Haemorrhagic choroidal detachment (HCD) is a dreaded intraoperative complication of ophthalmic surgery, despite being rare. Multiple systemic and ocular risk factors of HCD have been reported. Acute hypotony during surgery is considered one of the most important precipitating factors. We herein describe a series of events during pars plana vitrectomy surgery for management of rhegmatogeneous retinal detachment which lead to localised HCD. We believe that the pathogenesis of localised HCD is related to compressive decompressive forces during the final tie of the encircling element after fluid air exchange.
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