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Clinical features of uveal metastases from lung carcinoma

ObjectiveTo observe the clinical features of uveal metastases from lung carcinoma.MethodsA retrospective case study. From 1983 to 2014, 14 patients with uveal metastases of lung cancer confirmed by ocular examination in Peking Union Medical College Hospital were included in the study. Among them, 7 were male, 7 were female; 11 were monocular and 3 were binocular. The mean age was 54.5±9.6 years. Pathologic examination showed primary bronchial lung cancer, including 13 patients of non-small cell lung cancer (10, 2 and 1 patients of lung adenocarcinoma, squamous cell carcinoma and adenosquamous cell carcinoma, respectively) and 1 patient of small cell lung cancer. Four patients (28.6%) were diagnosed with lung cancer before ophthalmology consultation, and 10 patients (71.4%) were first diagnosed with ophthalmology due to ocular symptoms. The duration from ocular symptoms to lung cancer diagnosis was 1 week to 6 months. The course from diagnosis of lung cancer to ophthalmological consultation was ranged from 10 to 60 months, and the average course was 29.5±19.0 months. There were 7, 4 and 3 patients with impaired vision, occlusion of visual objects and deformation of visual objects, respectively. All patients underwent visual acuity, slit lamp microscope, B-mode ultrasound and UBM examinations. FFA was performed in 8 eyes, and 2 eyes were examined for ICGA. Orbital MRI was performed in 5 patients. Vitreoretinal surgery was performed on 1 eye. The clinical characteristics of the patients were analyzed and observed.ResultsIn 17 eyes, there were 2 eyes with visual acuity of light perception, 3 eyes of hand movement to counting finger before the eyes, 5 eyes of 0.1-0.3, 4 eyes of 0.4-0.6, 3 eyes of greater than 0.8. Metastatic cancer was located in iris in 1 eye, it presents as a red mass with irregular shape on the surface, which is full of small nourishing blood vessels. Metastatic cancer were located in choroid in 16 eyes, they presented yellowish-white or grayish-yellow lumps under the posterior pole or equatorial retina, including 14 eyes with a single lesion and 2 eyes with 2 lesions, with retinal detachment in 8 eyes and increased intraocular pressure in 5 eyes. B-mode ultrasonography showed posterior polar flat or surface irregular wavy intraocular space occupying lesions with localized or extensive retinal detachment. FFA and ICGA showed the focal, apical and patchy fluorescence of the tumor. MRI showed that T1WI medium and high signal consistent with the vitreous body, while T2WI showed low signal.ConclusionsUveal metastatic may be the first manifestation of lung cancer, and visual impairment, part of solid mass lesions with fundus flattening may be accompanied by secondary glaucoma and retinal detachment as the main clinical manifestations. Most of the metastatic sites are located in choroid, which is more common in single eye and single lesion. Adenocarcinoma is the most common type of uveal metastasis in non-small cell lung cancer.

魚精蛋白過敏導致肺水腫一例

Clinical features and long-term follow-ups of juxtapapillary retinal capillary hemangioma

ObjectiveTo evaluate the clinical features and follow-up effect of treatment for retinal capillary hemangioma (RCH) of myopic disc.MethodsRetrospective case series studies. A total of 14 patients (15 eyes) diagnosed with juxtapapillary RCH (JRCH) at Peking Union Medical College Hospital and followed up for more than 12 months from January 2007 to December 2019 were included. Among these patients, there were 7 males (7 eyes) and 7 females (8 eyes) with the average age of 29.8 ±12.7 years. There were 6 isolated JRCH cases, all of which were monocular patients, including 1 case with a single peripheral RCH; 8 cases with von Hippel-Lindau disease, including 5 cases of binocular RCH. Out of 15 eyes, 6 eyes were merged with peripheral RCH. Three eyes were simply observed, and 12 eyes were treated with photodynamic therapy (PDT) alone or PDT combined with other treatments. The average follow-up time was 55.2 months. Its clinical characteristics and long-term treatment effects were analyzed.ResultsAt the first visit, among the 15 eyes, 3 eyes had visual acuity＜0.1, 5 eyes were 0.1-0.4, and 7 eyes were＞0.5. The endogenous and fixed exogenous JRCH were 12 (80%, 12/15) and 3 (20%, 3/15) eyes, respectively. The size of the tumor was 1/4 to 4 optic disc diameters (DD); the combined macular edema, epiretinal membrane, and macular hole were 11, 5, and 1 eyes, respectively. There were 3 eyes with tumor diameter less than 1 DD. The visual acuity at the first diagnosis was 0.6-1.0, and no treatment was given. The follow-up time was 12 months in 2 eyes and 120 months in 1 eye. At the last follow-up, his vision remained stable and the tumor did not enlarge. Six eyes with tumor diameter ranging from 1.0 to 2.5 DD, visual acuity was 0.06 to 0.6 at first diagnosis, accompanied by retinal exudation. 5 eyes were treated with PDT alone, and 1 eye was treated with PDT combined with anti-vascular endothelial growth factor drugs. The follow-up time was 12 to 84 months. At the last follow-up, the visual acuity improved or stabilized in 5 eyes and decreased in 1 eye. There were 6 eyes with peripheral RCH, including 4 eyes with retinal detachment, 2 eyes with epiretinal membrane, and 1 eye with vitreous hemorrhage. The visual acuity at the first visit was 0.02-0.6. All patients were treated with PDT combined with transpupillary thermotherapy, extrascleral drainage, and vitrectomy. The follow-up time was 12 to 132 months. At the last follow-up, all eyesight decreased.ConclusionsVisual decrease cause by JRCH often occurs at young adults. Bilateral JRCH are more common in patients with von Hippel-Lindau's disease. The tumor can cause retinal exudation, macular edema, epiretinal membrane and macular hole, resulting in gradual vision loss. PDT and/or combined anti-vascular endothelial growth factor drugs for medium sized JRCH with retinal exudation can maintain long-term vision stability. Patients with large JRCH or severe complications such as retinal detachment tend to have poor prognosis.

The fast blood flow density of intermediate choroid in endogenous Cushing syndrome: analysis of optical coherence tomography angiography

ObjectiveTo compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.MethodsThirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender, age, axial length matched healthy volunteers (control group) were enrolled in this study. For each subject, macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured. Then 3.0 mm×3.0 mm macular scan with SS-OCT angiography was performed, and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane. The grayscale images were then binarized for the analysis of FBFD.ResultsThe SCT in ECS group was (394.7±77.7) μm, which was significantly thicker than (332.1±68.1) μm in control group (t=2.923, P=0.008). The FBFD of intermediate choroid in ECS group were (76.35±14.46)%, which were significantly greater than (63.57±13.42)% in control group (t=2.775, P=0.01).ConclusionECS patients had increased FBFD at intermediate choroid level compared with healthy controls.

聯合右心房-肺動脈切口手術一期根治嬰幼兒法洛四聯癥

目的　探討聯合右心房-肺動脈切口徑路手術一期根治嬰幼兒法洛四聯癥（TOF） 的療效，總結其臨床經驗。 方法 回顧性分析 2006年1月至2012年1月解放軍第91中心醫院采用聯合右心房-肺動脈切口徑路行一期根治術治療69例嬰幼兒TOF的臨床經驗，其中男47例，女22例；年齡5個月至2歲7個月；體重5～16 kg。心臟超聲心動圖提示：左心室舒張期末容積指數（LVEDVI） 24.5～36.9 ml/m2，Nakata指數＞120 mm2/m2，McGoon比值1.15～2.20。 結果 圍術期死亡2例，死亡率2.9%，其中術后死于肺部感染1例，滲漏綜合征1例。術后患者血流動力學平穩，不需使用大劑量的血管活性藥物。呼吸機輔助呼吸時間（11.7±9.3） h，住ICU時間（38.2±20.7） h。生存的67例患者均順利出院，動脈血氧飽和度由術前平均85%上升至99%，臨床癥狀改善，活動耐量增加，心功能（NYHA分級）恢復至Ⅰ～Ⅱ級。隨訪67例，隨訪率100%，隨訪時間11～70個月。隨訪期間無死亡，1例于術后3個月因大量心包積液行心包穿刺引流，1例于術后8個月因肺動脈瓣狹窄再次行手術矯治，其余患者恢復良好，心功能（NYHA分級）Ⅰ～Ⅱ級。 結論 聯合右心房-肺動脈切口徑路手術一期根治嬰幼兒TOF安全、可行，較常規手術縮短了體外循環時間，減少了右心室創傷，避免患者遠期右心室功能衰竭、室性心律失常導致的猝死，有利于患者遠期生存，效果滿意。

雙眼急性梅毒性后部鱗狀脈絡膜視網膜炎一例

一期全腔靜脈-肺動脈連接術治療復雜先天性心臟病

目的　總結一期全腔靜脈-肺動脈連接術（TCPC）治療復雜先天性心臟病的臨床經驗。 方法　回顧性分析2002年1月至2011年5月解放軍第91中心醫院31例復雜先天性心臟病患者行一期TCPC的臨床資料，其中男19例，女12例；年齡（7.2±4.5） 歲；體重（23.2±10.7） kg。三尖瓣閉鎖19例、單心室5例、肺動脈閉鎖2例、右心室發育不良2例、右心室雙出口3例。25例采用外管道手術，6例采用心房內通道手術。 結果　術后早期死亡3例（9.7%），死亡原因：低心排血量、多器官功能衰竭、心臟驟停。術后早期并發癥發生率為22.6% （7/31），主要為肺水腫、胸腔積液、心律失常、心包積液、蛋白丟失性腸病和低心排血量。術后28例患者均得到隨訪（100%），平均隨訪26 （9～87）個月。隨訪期間再次住院率為14.3% （4/28），其中2例再次出現胸腔積液，經胸腔引流、強心、利尿治療好轉出院；2例因自行停服腸溶阿司匹林后外管道堵塞再次行手術治療，1例再次手術后因低心排血量死亡。其余患者恢復正常生活。 結論　對適應證明確的復雜先天性心臟病患者一期行TCPC治療，能獲得滿意的效果。

Neuroprotective effects of benzatropine on rat model of nonarteritic anterior ischemic optic neuropathy

ObjectiveTo investigate the neuroprotective effect of Benztropine on retinal ganglion cells (RGCs) death and optic nerve injury in rats model of non-arteritis anterior ischemic optic neuropathy (rNAION).MethodsA total of 25 Sprague-Dawley rats were randomly divided into Benztropine treatment group (n=13) and PBS control group (n=12). The right eye was set as the experimental eye. rNAION model was established by using rose Bengal combined with laser photodynamic method. The rats in the Benztropine treatment group were received intraperitoneal injection with Benztropine 10 mg/kg (0.2 ml) daily for 3 weeks, while the rats in the PBS control group were received intraperitoneal injection with an equal volume of PBS. At 1, 3 and 7 days after modeling, the retinal and optic disc conditions of the rats were observed by direct ophthalmoscopy. Retrograde labeling, fluorescence microscopy and transmission electron microscopy were used to observe the survival of RGCs and the damage of the optic nerve myelin and axon at 4 weeks after modeling. The RGCs density and survival rate of the two groups were compared by One-Way Anova.ResultsAt 1 and 3 days after modeling, the optic disc edema was observed in the rats of rNAION model group. At 7 days after modeling, the optic disc edema decreased and the boundary was blurred compared with 3 days after modeling.After 4 weeks, the RGCs density in the PBS group was 308±194/mm2 and the survival rate was 13.7%. The density of RGCs in the Benztropine group was 1173+868/mm2 and the survival rate was 47.6%. The differences of RGCs density and survival rate were significant between the two groups (F=7.552, 8.184; P=0.015, 0.012). Myelin disintegration, axon degeneration, onion-like body and gliosis were observed in the optic nerve sections of rNIAON in the PBS group, while the damage of axon and myelin structure in the Benztropine group was significantly less than that in the PBS group.ConclusionsBenztropine group showed higher RGC survival rate, less damage of axon and myelin structure on rNAION model. This study explored the potential neuroprotective effect of Benztropine.