结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

PURPOSE\nTo measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age.\n\n\nDESIGN\nRetrospective, observational case series.\n\n\nMETHODS\nEDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age.\n\n\nRESULTS\nThe mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life.\n\n\nCONCLUSIONS\nChoroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Normal Eyes

This case is submitted by Drs. Francisco J. Ascaso, Maria Rojo, and Enrique Minguez from the Department of Ophthalmology, “Lozano Blesa” University Clinic Hospital, Zaragoza, Spain, for the Diagnostic and Therapeutic Challenges Section of Retina; and commented by Dr. Steven M. Cohen, Clearwater, Flo

/pdf/diagnostic-and-therapeutic-challenges-3ami9htzlk.pdf

Diagnostic and therapeutic challenges.

The application of optical coherence tomography angiography in uveitis and inflammatory eye diseases.

Choriocapillaris: Fundamentals and advancements

Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

/pdf/structural-changes-of-the-choroid-in-sarcoid-and-yelcbzmhvz.pdf

Aim The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). Methods Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a sixmonth period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. Results The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller’s

Structural changes of the choroid in sarcoid- and tuberculosis-related

Notwithstanding Allbutt's observation eight years previously that: ‘the number of physicians who are working with the ophthalmoscope today in England may, I believe, be counted on the fingers of one hand’,3 Gowers championed the new technology. In the same spirit, we should welcome the introduction of modern advances (including apps such as PEEK, iExaminer, and OphthalmicDocs Fundus), while adding our own note of caution: until such devices have been validated, we must maintain the bedside skill base to recognise cardinal eye signs. As UK specialist services become more centralised, doctors in clinics, wards and Emergency Departments frequently have no out-of-hours access to an ophthalmologist, and must be confident in performing ophthalmoscopy independently. Juniors themselves appear unequivocal. We audited our FY1s in 2012 and found them unanimous in desiring more ophthalmoscopy teaching. The teaching that followed resulted in a 22% increase in these FY1s’ use of ophthalmoscopy when assessing ‘red flag’ headaches and severe hypertension (Bremner et al, 2012, unpublished data). Moreover, in our audit of 100 medical students undertaking clinical attachments, 99% considered ophthalmoscopy an important skill, 43% felt confident in performing ophthalmoscopy, and 69% wanted more training. When students are calling for improved training in core ophthalmic examination skills, it would be a dereliction not to respond. In doing so, could we also light a spark in the minds of gifted students who had never previously considered a career in ophthalmology? (Gallagher K, 2015, unpublished data). The promise of high-tech devices is real, but they remain works-in-progress. Meanwhile, for the sake of timely assessment of acute medical patients with diagnostic eye signs, we must do more (not less) to ensure that all undergraduates acquire this vital skill.

/pdf/direct-ophthalmoscopy-should-be-taught-to-undergraduate-30qt81ou1f.pdf

Direct ophthalmoscopy should be taught to undergraduate medical students.

Retinal laser parameters-the relationship between laser spot spacing and maximum burn number.

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Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

Structural changes of the choroid in sarcoid- and tuberculosis-related

Direct ophthalmoscopy should be taught to undergraduate medical students.

Retinal laser parameters-the relationship between laser spot spacing and maximum burn number.