A 76-year-old man with macular degeneration.
A 76-year-old man with macular degeneration.
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76 岁男性，患有黄斑变性。
DOI：
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
J. Arroyo
中科院分区：
文献类型：
--
作者：
J. Arroyo
博士船：博士G是一个76岁的半退休外科医生。他已婚，住在纽约大都市区，有赔偿保险和医疗保险。G医生的眼科病史值得注意的是轻度近视、双侧玻璃疣和38岁时左眼自限性中心性浆液性视网膜病变。大约三年前，他注意到视力有细微的变化。这些症状在2个月内进展，他去看了他的普通眼科医生。他被发现患有轻度核性巩膜白内障（右眼大于左眼），右眼矫正视力为20/40，左眼为20/25，右眼有渗出性视网膜脱离。他被转介到视网膜专家的那一天。从那时起，G博士右眼接受了5次光动力疗法（PDT），其中两次是实验性地加入眼内曲安西龙。他的右眼视力最初显示出一些间隔改善，但最终恶化为“数手指”视力。他的病程因慢性干眼症而复杂化，为此，他一直用人工泪液和环孢霉素滴剂治疗，以及双侧核性白内障。3个月前，左眼白内障手术流产，当时他在麻醉期间持续眶内出血，需要通过外眦切开术治疗。G博士视力的丧失极大地改变了他的生活。虽然他继续教学，他停止执行手术时，他失去了深度知觉（立体视觉），因为在右眼的变化。他觉得自己没有足够的双眼视觉来安全驾驶，因此依赖于家人、朋友和公共交通工具，随之而来的是自主性的丧失。他发现变量，但偶尔严重的困难，看到足够好做小的家庭维修，弹钢琴，阅读，所有的活动，用来占用他的时间。他变得沮丧了。G医生的既往病史包括高血压、骨质疏松、轻度贫血和偏头痛。15年前，他的纯化蛋白衍生物试验转为阳性，他服用了一个疗程的异烟肼。他的手术史以胸腺切除术和胸腺切除术而闻名。他目前的药物包括：阿仑膦酸钠（每周35 mg），氢氯噻嗪（每日12.5 mg），氨氯多平（每日10 mg），阿司匹林（每隔一天80 mg），以及萘普生和米索前列醇（偏头痛需要200 μg）。他对药物不过敏。他有抽烟斗和社交饮酒的悠久历史。在他最近的眼科检查中，他的右眼视力为20/400，左眼为20/ 30。左侧眼底显示大于125 μm的大的软玻璃疣，轻度色素斑，但没有视网膜下液体或出血的证据。G医生想知道他能做些什么来避免左眼出现类似的威胁视力的变化，并询问是否有其他治疗右眼的方法可以考虑。
DR SHIP: Dr G is a 76-year-old semiretired surgeon. He is married, lives in the New York metropolitan area, and has indemnity insurance and Medicare. Dr G’s ophthalmologic history was notable for mild myopia, bilateral drusen, and an episode of self-limited central serous retinopathy in the left eye at the age of 38 years. Approximately 3 years ago, he noted subtle vision changes. These symptoms progressed over a 2-month period and he saw his general ophthalmologist. He was found to have mild nuclear sclerotic cataracts (right greater than left), corrected visual acuity of 20/40 in the right eye and 20/25 in the left eye, and an exudative retinal detachment in the right eye. He was referred to a retinal specialist that day. Since that time, Dr G has received photodynamic therapy (PDT) to the right eye 5 times, twice with the experimental addition of intraocular triamcinolone. His visual acuity in the right eye initially showed some interval improvement, but has ultimately worsened to “count fingers” vision. His course has been complicated by chronic dry eyes, for which he has been unsuccessfully treated with artificial tears and cyclosporine drops, as well as bilateral nuclear sclerotic cataracts. Cataract surgery for the left eye was aborted 3 months ago when he sustained an intraorbital hemorrhage during anesthesia that required treatment by lateral canthotomy. Dr G’s loss of visual acuity has dramatically altered his life. While he continues to teach, he stopped performing surgery when he lost depth perception (stereopsis) because of changes in the right eye. He does not feel he has adequate binocular vision to drive safely, so has become reliant on family, friends, and public transportation with the attendant loss of autonomy. He finds variable but occasionally profound difficulty seeing well enough to do small household repairs, to play the piano, and to read, all activities that used to occupy his time. He has become depressed. Dr G’s past medical history is significant for hypertension, osteopenia, mild anemia, and migraine. Fifteen years ago his purified protein derivative test converted to positive and he took a course of isoniazid. His surgical history is notable for a prostatectomy and thymectomy. His current medications include the following: alendronate (35 mg every week), hydrochlorothiazide (12.5 mg daily), amlodopine (10 mg daily), aspirin (80 mg every other day), as well as naproxen and misoprostol (200 μg as needed for migraine). He has no drug allergies. He has a remote history of pipe smoking and drinks alcohol socially. At his most recent ophthalmologic examination, his visual acuity in the right eye was 20/400, in the left eye 20/ 30. The left fundus showed large soft drusen larger than 125 μm, mild pigmentary mottling, but no evidence of subretinal fluid or hemorrhage. Dr G wonders what he can do to avoid developing similar sight-threatening changes in his left eye and asks if there are any other treatments for his right eye that he might consider.
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DOI：
10.1073/pnas.0501536102
发表时间：
2005-05-17
影响因子：
11.1
作者：
Hageman, GS;Anderson, DH;Allikmets, R
通讯作者：
Allikmets, R
影响因子：
13.7
作者：
通讯作者：
--
DOI：
10.1001/jama.1996.03540140029022
发表时间：
1996-10
期刊：
JAMA
影响因子：
--
作者：
J. Seddon;W. Willett;F. Speizer;S. Hankinson
通讯作者：
J. Seddon;W. Willett;F. Speizer;S. Hankinson
DOI：
10.1093/jnci/djh320
发表时间：
2004-12-01
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Goodman, GE;Thornquist, MD;Williams, JH
通讯作者：
Williams, JH
影响因子：
13.7
作者：
R. Klein;Michael L. Rowland;Maureen I Harris
通讯作者：
R. Klein;Michael L. Rowland;Maureen I Harris