ERα受体基因多态性与女性原发性急性闭角型青光眼的相关研究

目的 探讨雌激素受体α(estrogen receptorα,ERα)基因多态性与女性原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)之间的相关性.方法 采集113例女性APACG患者(APACG组)和96例年龄匹配的正常女性(对照组)静脉血,应用聚合酶链反应-限制性片段长度多态性技术,检测受试对象ERα基因PvuⅡ和Xba Ⅰ基因多态性的分布情况;分析PvuⅡ和Xba Ⅰ基因多态性与女性APACG发病之间的相关关系.结果 所选研究对象基因型分布频率符合Handy-Weinberg平衡定律.APACG组ERα基因Xba Ⅰ XX基因型频率为1.8％,而对照组为9.4％,两组之间Xba Ⅰ酶切位点多态性差异具有统计学意义(x2=8.910,P=0.012),两组之间X等位基因频率分别为19.0％和30.7％,相对于x等位基因,暴露于X等位基因的OR值为0.530(OR =0.530,95％CI:0.337 ～0.832).PvuⅡ多态性的分布差异无统计学意义(x2=0.200,P=0.905).结论 ERα基因Xba Ⅰ酶切多态性与女性APACG发病之间具有相关性,且X等位基因有可能是其保护性因素.     

绝经后干眼症妇女泪液与血清雌激素质量浓度的分析

目的测定绝经后干眼症妇女泪液与血清中雌二醇的质量浓度,探讨与干眼症发病的关系。方法取绝经后干眼症32例,正常对照30例,均检测右眼。用化学发光法测定绝经后干眼症患者泪液和血清中的雌二醇的质量浓度,所得数据用非参数检验的Mann-Whitney检验和Spearman秩相关分析。采用印迹细胞学法取得被测定者的球结膜上皮细胞,用扫描电镜观察眼表的超微结构变化。结果绝经后干眼症组泪液和血清的雌二醇质量浓度较正常对照组差异均有统计学意义（P=0.001）。正常对照组泪液与血清中的雌二醇质量浓度呈正相关。绝经后干眼症组泪液与血清中的雌二醇质量浓度无明显相关。绝经后干眼症患者眼表出现明显的病理变化。结论绝经后干眼症患者泪液中雌二醇质量浓度较正常对照组明显降低。血清和泪液中的雌二醇质量浓度在绝经前存在正相关性,而绝经后二者无相关性。     

中国人群渗出性年龄相关性黄斑变性与线粒体基因A4917G多态性的相关性分析

目的研究线粒体基因A4917G多态性改变与中国人群渗出性年龄相关性黄斑变性（AMD）的相关性,寻找中国人群渗出性AMD发病的易感基因。设计病例对照研究。研究对象来自北京同仁医院的渗出性AMD患者158例和健康对照者117例。方法应用聚合酶链反应（PCR）并结合限制性内切酶酶切分析和DNA序列测定方法对线粒体基因A4917G多态性改变进行检测。主要指标线粒体基因A4917G多态性。结果AMD患者组与对照组比较,两组间年龄（P=10．614）与性N（P=0．427）差异无统计学意义。AMD患者及对照人群线粒体基因4917位点的碱基全部为A,两组中均未见变异型4917G。在本研究人群中线粒体基因A4917G多态性改变与渗出性AMD不存在相关性。结论线粒体基因A4917G多态性在中国人中罕见,与中国人群渗出性AMD发病无明显相关性。     

维生素D受体TaqⅠ基因多态性与糖尿病视网膜病变的关系

目的 探讨维生素D受体(VDR)TaqⅠ基因多态性与糖尿病视网膜病变(DR)的关系。 方法 应用片段长度差异等位基因特异性多聚酶链反应(FLDAS-PCR)技术，检测158例DR患者和198名正常对照者的VDRTaqⅠ基因多态性。 结果 VDRTaqⅠ基因型在DR患者中的分布为TT型106例，占67.1%,Tt型33例，占20.9%,tt型19例，占12.0%;在正常对照者中的分布为TT型165例，占83.3%，Tt型23例，占11.6%,tt型10例占5.1%。DR患者与正常对照者TT、Tt、tt基因型分布差异有统计学意义(P<0.05)。结论 DR与维生素D受体TaqⅠ基因多态性有一定的关系。 (中华眼底病杂志， 2006， 22： 94-96)     

病理性近视与HLA—DPB1基因相关性的初步探讨

目的研究病理性近视与ＨＬＡ－ＤＰＢ１基因的相关性,以便得到其易感或抵抗基因。方法用多聚酶链反应（ｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ,ＰＣＲ）扩增４０例患者ＨＬＡ－ＤＰＢ１基因的第二个外显子后,用Ｂｓｐ１２８６Ⅰ,ＦｏｋⅠ,ＤｄｅⅠ,ＢｓａＪⅠ,ＢｓＨⅡ,ＲｓａⅠ,ＡｖａⅡ和ＥｃｏＮⅠ共８种等位基因特异的限制性内切酶酶切,依据限制性片段长度多态性（ｒｅｓｔｒｉｃｔｉｏｎｆｒａｇｍｅｎｔｌｅｎｇｔｈｐｏｌｙｍｏｒｐｈｉｓｍ,ＲＦＬＰ）格局对每例患者进行基因型确定,然后计算各等位基因频率并与正常人进行比较。结果ＨＬＡ－ＤＰＢ１＊０３０１等位基因的频率显著低于正常对照组（Ｙａｔｅｓ校正χ２＝４．３２,Ｆｉｓｈｅｒ确切Ｐ＜０．０５）,ＦｉｓｈｅｒＰ值经所比较的等位基因数修正后,Ｐｃｏｒ＞０．０５;ＨＬＡ－ＤＰＢ１＊０５０１／０５０１纯合子的比率与正常人差异有显著性（ｕ＝２．２７,Ｐ＜０．０５）。结论病理性近视在ＨＬＡ－ＤＰＢ１基因座位不存在易感或抵抗基因。ＨＬＡ－ＤＰＢ１＊０５０１／０５０１纯合子的频率在患者中显著升高可能为一种连锁信号。     

双氯芬酸钠联合玻璃酸钠治疗眼科术后干眼症的临床分析

目的:观察双氯芬酸钠联合玻璃酸钠治疗眼科术后干眼症的临床疗效.方法:选择我院眼科术后不同程度干眼症患者94例94眼,并将其随机分为研究组和对照组各47例47眼,对照组患者在常规治疗的基础上联合玻璃酸钠滴眼液治疗,研究组患者在对照组的基础上配合双氯芬酸钠滴眼液治疗.比较两组患者治疗效果、干眼症状调查问卷评分、检测角膜荧光染色(corneal fluorescein staining,CFS)、泪膜破裂时间 (tear film break-up time,BUT)及泪液分泌(Schirmer Ⅰ test,SⅠt)情况.结果:治疗后两组患者干眼症临床症状调查得分、CFS得分均明显低于治疗前,差异具有统计学意义(P<0.05),BUT及SⅠt情况比治疗前增加,差异具有统计学意义(P<0.05);研究组患者在治疗后干眼症临床症状调查得分、CFS得分、BUT及SⅠt结果均优于对照组患者,两组之间差异具有统计学意义(P<0.05).研究组患者的治疗总有效率(98%)明显优于对照组(74%),差异具有统计学意义(P<0.05).结论:对眼科手术后干眼症患者在常规治疗基础上给予双氯芬酸钠眼液联合玻璃酸钠眼液治疗可以有效缓解患者干眼的临床症状,减少角膜荧光染色情况,增加泪膜破裂时间及泪液分泌量.     

病理性近视与人类白细胞抗原-DQB1基因的关联性研究

目的 研究病理性近视（pathologic myopia,PM)与人类白细胞抗原（human leucocyte antigen HLA)-DQB1 基因的相关性,以探讨PM的发病机制。方法 抽提66例PM患者的基因组DNA,用聚合酶链反应－限制性片段长度多态性方法扩增HLAⅡ类基因DQB1的第2个外显子,扩增产物用HaeⅢ、BasHⅡ,ApaⅠ,BsaHⅠ,HaeⅡ,HpaⅡ,RsaⅠ,Bsp1286Ⅰ特异性的限制性内切酶酶切分型,检测HLA－DQB1的16个等位基因的分布频率,并与正常人进行比较。结果 PM患者HLA－DQB1的＊0301和＊0303等位基因分布频率明显高于正常人（P＜0．0001）;PM患者HLA－DQB1的＊0601和＊0602等位基因分布频率明显低于正常人（P＜0．0001）。结论 HLA－DQB1的＊0301和＊0303等位基因为PM的易感基因,可能与其发病有关;HLA－DQB1的＊0601和＊0602等位基因为抵抗基因,可能具有保护作用。     

圆锥角膜配戴透气性角膜接触镜相关性干眼疗效评价

目的 观察维生素A棕榈酸酯眼用凝胶对圆锥角膜配戴硬性透气性角膜接触镜(RGP)相关性干眼症的临床疗效.方法 将90例透气性角膜接触镜相关性干眼症圆锥角膜患者随机分为3组,每组30例(60眼):A组使用人工泪液滴眼液,6次,d,1滴/次;B组使用维生素A棕榈酸酯眼用凝胶,3次,d,1滴/次;C组在使用人工泪液滴眼液(6次/d,1滴/次)后15min再用维生素A棕榈酸酯眼用凝胶(3次/d,1滴/次).观察各组患者用药前1天与用药后第3、7、14天的眼部症状评分、泪膜破裂时间(BUT)、Schirmer Ⅰ试验(S Ⅰ T)、角膜荧光染色(Fl)评分变化.结果 在用药7天后三组患者的干眼症状、BUT和Fl染色均较治疗前有明显改善(P＜0.05),三组患者SⅠT值治疗前后差异均无统计学意义(P＞0.05).各组患者在治疗14天后和治疗7天时测得的各项指标差异无统计学意义(P＞0.05).A组与B组对眼部症状、BUT和SⅠT的改善作用差异无统计学意义(P＞0.05);B组较A组改善角膜Fl染色作用更明显,差异有统计学意义(P＜0.05).C组对改善干眼症状、BUT和Fl染色作用优于A组(P＜0.05).SⅠT和Fl染色治疗前后比较,C组和B组,差异无统计学意义(P＞0.05),C组对改善干眼症状和BUT作用优于B组(P＜0.05).结论 维生素A棕榈酸酯眼用凝胶能够促进角膜上皮损伤愈合,缓解圆锥角膜患者配戴硬性透气性角膜接触镜所致干眼症状,具有临床应用价值.     

干眼症患者对比敏感度的测定

目的:研究干眼症对比敏感度的变化及通过对比敏感度测试来评价人工泪液对干眼症患者视功能的影响。方法:确诊为干眼症患者25例50眼和正常人15例29眼,分别测量BUT(泪膜破裂时间)、SⅠt(泪液分泌基础实验)和泪膜干涉图像,并采用OPTEC6500视功能测试仪分别测量干眼症患者和正常人应用人工泪液前后的对比敏感度。主要观察指标包括BUT、SⅠt、泪膜干涉图像及低、中、高频CS。结果:本研究中按临床症状、BUT,SⅠt和泪膜干涉图像试验结果将受试者分为干眼症组和正常对照组,两组年龄比较无统计学差异。干眼症患者低、中、高频CS均低于正常组(P<0.05)。应用人工泪液5min后,发现干眼症组低、中、高频CS都有显著提高(P<0.05);且干眼症组应用人工泪液后的对比敏感度与对照组相近。结论:干眼症的低对比敏感度可以通过人工泪液的使用加以改善,通过人工泪液治疗不但可以缓解症状而且使干眼症的视觉质量接近正常人标准;另外,对比敏感度测试可以作为一种客观的非接触的评价泪膜质量的方法,为干眼症的治疗疗效提供客观依据。     

bFGF滴眼液与羟糖甘滴眼液对年龄相关性白内障术后泪膜稳定性及干眼症状的影响

目的:比较分析重组牛碱性成纤维细胞生长因子(bFGF)滴眼液与羟糖甘滴眼液对年龄相关性白内障患者术后泪膜稳定性及干眼症状的影响.方法:随机数字法将115例115眼年龄相关性白内障术后干眼患者分为bFGF组、羟糖甘组及空白对照组,空白对照组仅给予常规抗炎治疗,bFGF组、羟糖甘组在空白对照组基础上分别加以bFGF滴眼液、羟糖甘滴眼液治疗,比较各组临床疗效、不良反应、不同时间点干眼症状评分、基础泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)、角膜荧光素染色(CFS)评分变化情况.结果:bFGF组治疗总显效率89.5%比羟糖甘组的70.3%、空白对照组的47.5%高,差异有统计学意义(P<0.05);三组患者术后2、5 wk干眼症状评分、CFS评分、SⅠt、BUT比较差异有统计学意义(P<0.05),且bFGF组术后2、5 wk上述指标均显著优于羟糖甘组及空白对照组,羟糖甘组上述指标均显著优于空白对照组,差异具有统计学意义(P<0.05);三组患者均无明显不良反应发生.结论:年龄相关性白内障术后早期泪膜不稳定,出现干眼症状,bFGF滴眼液、羟糖甘滴眼液干预均能有效恢复患者泪膜稳定性,显著改善干眼症状,其中bFGF滴眼液效果更显著.     

MUC1 and estrogen receptor alpha gene polymorphisms in dry eye patients

Dry eye syndrome is a collection of common disorders of multifactorial etiology. Although the epidemiology of dry eye has been well studied, reports of genetic patterns that might influence susceptibility to dry eye are few. We reported that the frequency of non-Sjögren's aqueous-deficient dry eye patients expressing only the MUC1/A splice variant of the mucin MUC1 may be lower than that of a normal control group [Imbert, Y., Darling, D.S., Jumblatt, M.M., Foulks, G.N., Couzin, E.G., Steele, P.S., Young, W.W., Jr., 2006. MUC1 splice variants in human ocular surface tissues: possible differences between dry eye patients and normal controls. Exp. Eye Res. 83, 493-501]. Also, He et al. [He, Y., Li, X., Bao, Y., Sun, J., Liu, J., 2006. The correlation of polymorphism of estrogen receptor gene to dry eye syndrome in postmenopausal women. Yan. Ke. Xue. Bao. 22, 233-236] reported a difference between Chinese dry eye and control groups in the frequency of a polymorphism in estrogen receptor α (ERα). In the present study we determined the statistical significance and generality of these observations and tested if the MUC1 splice variant difference between subject groups reflected a difference in the MUC1 variable number of tandem repeat (VNTR) size class. There was a perfect correlation between the MUC1/A or MUC1/B splice variant pattern and the SNP genotype frequency of the SNP (rs4072037) controlling that splicing event. In contrast, western and Southern blotting indicated that MUC1 VNTR size class corresponded to the MUC1 SNP genotype in only 80% of cases. We determined the status of the MUC1 SNP in normal and dry eye populations all of whom were female Caucasians. The MUC1 SNP genotype frequency of the normal control group was statistically different from both the non-Sjögren's aqueous-deficient dry eye group with ocular surface staining (P = 0.017) and the evaporative dry eye group (P = 0.015). We also tested SNP rs2234693 to analyze the polymorphism in the ERα gene and found no significant difference in the SNP genotype frequency between the control group and either of the dry eye subtypes. Thus, among Caucasians there is no evidence for an association of the ERα gene polymorphism with dry eye syndrome as previously described in a Chinese population. In conclusion, the etiologies of evaporative dry eye and non-Sjögren's aqueous-deficient dry eye are known to be different. However, our results suggest that both of these subtypes of dry eye disease may share a common mechanism or factor related to MUC1 genotypic differences that affects susceptibility to ocular surface damage. This altered susceptibility may not be related to the MUC1 VNTR size class. Therefore, mechanisms influencing protection of the ocular surface against inflammation and damage in different types of dry eye disease warrant further investigation particularly in relation to MUC1 genotype.     

Esterified estrogens combined with methyltestosterone raise intraocular pressure in postmenopausal women

PURPOSE: To investigate the effect of esterified estrogens combined with methyltestosterone (EECM) (Estratest, Solvay, Pharmaceuticals, Inc, Baudette, Minnesota, USA) on intraocular pressure (IOP) in postmenopausal women. DESIGN: Observational case series. METHODS: The IOP of 13 consecutive postmenopausal women with dry eye syndrome were recorded before and during EECM therapy (1.25 mg of esterified estrogens and 2.5 mg of methyltestosterone for several months). RESULTS: The mean IOP increased from a baseline of 15.0 mm Hg before treatment to 18.2 mm Hg on EECM therapy (P < .0001) after a median duration of 11.3 months (range, 0.9 to 24 months). The increase in IOP was statistically significant at the 0.05 level of significance within three months and continued over 12 months. Two patients whose pressures increased (>4 mm Hg) returned to baseline levels after EECM was discontinued. CONCLUSIONS: Esterified estrogens combined with methyltestosterone produce a clinically significant increase in IOP in postmenopausal women with dry eye syndrome.     

A 0,05% cyclosporine treatment of the advanced dry eye syndrome

PURPOSE: The purpose of our study has been to present the results obtained from the treatment with 0.05% cyclosporine solution in drops in patients with severe aggravation of dry eye syndrome manifestations who otherwise did not suffer from any systemic disease (a three-month treatment). Another group in whom we used the same treatment were those who suffered from dry eye syndrome, which developed in the course of Sjogren's syndrome, and graft versus host disease following bone marrow transplantation (a six-month treatment). MATERIAL AND METHODS: The study comprised 15 dry eye syndrome patients (30 eyes), who were divided into three groups. In Group I were those with severe aggravation of dry eye syndrome manifestations without concomitant systemic diseases (3 women), aged 54 to 59 years (mean 57). Group II comprised the patients with Sjogren's syndrome (8 women, 1 man), aged 45 to 59 years (mean 55.5) with graft versus host disease. In Group III, there were 3 women, aged 52 to 59 years (mean 55) with graft versus host disease. All the patients were administered 0.05% cyclosporine topically twice daily. The Group I patients were given 0.05% cyclosporine solution for 3 months, those in Groups II and III for 6 months. Subjective complaints were classified according to the protocol of Dr. Mann Pharma/Bausch & Lomb. RESULTS: The effectiveness of the therapy with 0.05% cyclosporine solution was evaluated by the mean number of points in a five-point Schirmer II test score, measured before and after the treatment. The Group I patients (dry eye syndrome without systemic diseases) were found to have the highest mean number of points - 4. In the Sjogren's syndrome Group, the mean number of points was 3.1; and in Group III (graft vs host disease) the mean value was 2 points. Since the number of patients was different in particular groups, the findings have not been compared between themselves. CONCLUSIONS: Using 0.05% cyclosporine solution is effective in treating patients with dry eye syndrome but without systemic diseases. In such cases a short, three-month treatment is sufficient. The 0.05% cyclosporine treatment is just as effective in patients with dry eye syndrome and Sjogren's syndrome or graft versus host disease. Yet in such cases the treatment has to be longer and take six months. We observed a mean increase points in the five-point Schirmer II test score in all our patients.     

Reduced corneal thickness values in postmenopausal women with dry eye

PURPOSE: To study and compare the corneal thickness values of postmenopausal women with dry eye and postmenopausal women without dry eye. METHODS: The corneal thickness value of 30 postmenopausal women with dry eye (dry eye group; aged 52 to 55 years) and 32 postmenopausal women without dry eye (normal group; aged 51 to 55 years) was analyzed with the Orbscan Topography System II. Each woman underwent a tear breakup test, the Schirmer test, fluorescein staining of the cornea, and an analysis of the meibomian gland by slit lamp before corneal thickness measurement. The statistical analysis was performed by means of the unpaired Student t test. RESULTS: The mean corneal thickness value was significantly decreased in postmenopausal women with dry eye (P < 0.001 at each corneal location). The central cornea had the thinnest mean values in dry eyes and normal eyes (533.10 +/- 4.74 microm and 547.63 +/- 15.11 microm, respectively), whereas superonasal cornea had thicker mean values in both groups (632.43 +/- 6.11 microm and 648.78 +/- 14.98 microm in dry eye and normal eyes, respectively). CONCLUSIONS: Postmenopausal women with dry eye have lower corneal thickness values than postmenopausal women without dry eye. Special care must be taken with these reduced corneal thickness values when selecting postmenopausal women for surgery involving corneal photoablation.     

角膜瓣蒂部位置对LASIK术后角膜知觉和泪膜的影响

目的了解颞侧蒂角膜瓣对准分子激光原位角膜磨镶术(LASIK)后的角膜知觉和泪膜的影响。方法将双眼屈光度相近的近视患者194例的左右眼角膜瓣蒂部随机置于角膜上方或颞侧,随后进行常规LASIK手术。分别在术前、术后1d、1周、1月、3月及6月时询问干眼症状,检测中央角膜知觉、荧光素试验、虎红染色、泪膜破裂时间和Schirmer’sⅠ试验。结果干涩感:在术后1周和1月时,上方蒂组的干涩感明显严重于颞侧蒂组(P<0.01)。异物感:两组间在术后1d和1周时存在差异(P<0.05)。灼烧感:两组间在术后1周时存在差异(P=0.025)。荧光素试验:两组间在术后1周时存在差异(P=0.003)。泪膜破裂时间:在术后所有时间点组间均存在差异(P<0.01)。虎红染色:在术后1周时,上方蒂组的虎红着色点明显多于颞侧蒂组(P=0.002)。Schirmer’sⅠ试验:两组间在术后1d、1周和1月时(P<0.01)。中央角膜知觉:两组间在术后1d、1周、1月和3月时(P<0.01)。结论颞侧蒂角膜瓣可保持较高的角膜敏感度,部分缓解干眼症。     

干眼患者超声乳化术前人工泪液干预的临床研究

目的观察干眼患者超声乳化手术前使用人工泪液对术后泪膜的影响。方法将52例（60眼）行超声乳化的干眼患者随机分为两组：A组27例（30眼）。术前未用泪然眼液滴眼;B组25例（30眼）,术前使用泪然眼液。两组术后联合使用典必殊和泪然眼液滴眼,分别于术前第15天、术后第1天、第1周、第1个月、第3个月行干眼主观症状问卷调查、基础泪液分泌试验（Sehirmer I test,SIt I）、泪膜破裂时间break—up time,BUT）和角膜荧光素染色（cornea fluorescein staining,CFS）检查。采用SPSS10．O统计软件,对数据进行f检验分析。结果①术前第15天：两组干眼症状评分、SitI试验、BUT、CFS评分差异均无统计学意义（P0．05）。②术后第1天：B组干眼主观症状、CFS评分小于A组．且BUT较A组长,差异有统计学意义（P〈0．05）;SItI试验检查B组虽有延长,但差异无统计学意义（P〉0．05）。（3）术后第1周：B组干眼主观症状、CFS评分小于A组,且BUT较A组长,差异有统计学意义（P〈0．05）;SItI检查差异无统计学意义（P〉0．05）。（4）术后第1个月：B组CFS评分小于A组,且BUT较A组长,差异有统计学意义P〈0．05）;干眼主观症状、SitI检查两组差异无统计学意义（P〉0．05）。（5）术后第3个月,两组的干眼主观症状、SItI检查、BUT、CFS评分差异均无统计学意义抄0．05）。结论干眼患者超声乳化白内障术前使用人工泪液有利于术后旱期干眼症状的改善及泪膜恢复。     

Tear osmolality and ferning patterns in postmenopausal women.

PURPOSE: To compare tear osmolality and ferning patterns in postmenopausal women (PMW) with and without dry eye symptoms. METHODS: Thirty-seven healthy PMW (>50 years of age), not on hormone replacement therapy, were categorized as being symptomatic or asymptomatic of dry eye based on their responses to an Allergan "Single-Item Score Dry Eye Questionnaire" (SIDEQ). They subsequently completed the Allergan "Ocular Surface Disease Index" (OSDI) questionnaire. Tear samples were collected from participants to evaluate osmolality and ferning patterns. A novel freezing point depression osmometer (Advanced Instruments Inc., Model 3100 Tear Osmometer), was used to measure the osmolality of the tear film. The tear ferning test was performed and evaluated for the quality of ferning based on the Rolando grading system. RESULTS: SIDEQ responses revealed 21 symptomatic and 16 asymptomatic participants. The OSDI total score was 6.5 +/- 5.9 for the non-dry-eyed (NDE) group and 25.7 +/- 12.4 for the dry-eyed (DE) group. The subscores for the DE group were significantly greater than the NDE group (p < 0.001). Osmolality values in DE individuals were significantly different from NDE (328.1 +/- 20.8 vs. 315.1 +/- 11.3 mOsm/kg; p = 0.02). Fifty percent of the DE participants showed type II ferning patterns and 29% of the DE participants showed type III ferning patterns, whereas the NDE participants showed either type I (44%) or II (66%) ferning patterns. There was a significant difference between the DE and NDE participants for the ferning patterns (p = 0.019). There was no significant correlation between tear osmolality and tear ferning (DE: r = 0.12; p > 0.05, NDE: r = -0.17; p > 0.05). CONCLUSIONS: Osmolality in mild and moderately DE PMW is higher than in NDE PMW and tear ferning is a rapid, simple, noninvasive laboratory procedure that indicates altered tear quality in PMW with symptoms of dry eye.     

复方王不留行片联合人工泪液治疗更年期女性眼干燥症的疗效观察

目的 观察复方王不留行片联合人工泪液治疗更年期女性眼干燥症的临床疗效,探讨雌激素在眼干燥症治疗中的作用机制.方法 选取2010年4月至12月在新乡医学院眼科医院门诊就诊的更年期女性眼干燥症患者40例80眼,随机分为两组:治疗组20例40眼局部滴用人工泪液复方右旋糖酐70滴眼液每日4～6次,同时口服复方王不留行片;对照组20例40眼仅局部滴用复方右旋糖酐70滴眼液每日4～6次.探讨用药后各组患者的临床眼干燥症问卷调查、泪液分泌试验Ⅰ( Schirmer Ⅰtest,SIt)、泪膜破裂时间(break up time,BUT)和角膜荧光素染色(corneal fluorescein staining,CFS)情况.结果 治疗4周后两组患者局部及全身均未出现不良反应.治疗组患者在治疗前后各项检查的比较差异均有统计学意义(眼干燥症症状评分比较:t=12.66,P＜0.01;SIt:t - 10.43,P＜0.01;BUT:t -5.70,P＜0.01;CFS:t=13.66,P＜0.01).对照组患者在治疗前后各项检测指标的比较显示眼干燥症症状评分、BUT、CFS差异均有统计学意义(眼干燥症症状评分比较=6.49,P＜0.01;BUT:t=-4.27,P ＜0.01;CFS:t =5.25,P＜0.01),局部应用人工泪液使患者的眼干燥症症状以及BUT、CFS检查结果好转;治疗前后SIt的比较差异无统计学意义(t=-0.46,P＞0.05).两组患者治疗后各项检查结果的比较表明,两组患者在经过不同的治疗后眼干燥症症状评分、BUT、CFS的比较差异均有统计学意义(眼干燥症症状评分比较t=-2.17,P＜0.05;BUT:t=1.95,P＜0.05;CFS:t=-2.33,P ＜0.05);SIt比较差异亦有统计学意义(t=7.32,P＜0.01).治疗组中显效6眼,好转28眼,无效6眼,有效率为85％;对照组中显效0眼,好转26眼,无效14眼,有效率为65％,两组总有效率比较差异有统计学意义(P＜0.05).结论 复方王不留行片与人工泪液的联合应用更好地改善了更年期女性眼干燥症患者的症状.     

Altered corneal nerves in aqueous tear deficiency viewed by in vivo confocal microscopy

PURPOSE: To define the alterations of corneal nerves in aqueous tear deficiency dry eye patients with or without Sj?gren syndrome and to identify the relationship between the morphologic changes of corneal nerves and the extent of dry eye. METHODS: Confocal microscopy was used to examine 38 consecutive aqueous tear deficiency patients (8 Sj?gren syndrome and 30 non-Sj?gren syndrome) and 30 age- and gender-matched normal controls. Images taken by Confocal2 slit-scanning microscope at subbasal epithelial cell layer of central cornea were analyzed. The number and density of corneal nerves and their size, beads, tortuosity, and branching pattern were compared. These data were correlated with age and the degree of dry eye. RESULTS: Sj?gren syndrome patients showed a significant increase in average nerve number and tortuosity as compared with normal controls (P = 0.031 and 0.021, respectively). Severe nerve tortuosity (grade 4) and nerve branching appeared more frequently in aqueous tear deficiency than in normal subjects (P = 0.024 and 0.042, respectively). A decreased nerve number was observed with age in the normal controls (P = 0.002). However, such a correlation did not exist in aqueous tear deficiency. In aqueous tear deficiency, rose bengal staining score correlated positively with nerve density (P = 0.048) and nerve number (P = 0.001). Corneal fluorescein staining score was also positively correlated with nerve number (P = 0.027). CONCLUSIONS: Abnormal morphologic changes are observed in aqueous tear deficiency that are more severe in Sj?gren syndrome. The distinct changes of corneal nerves include increased nerve number, tortuosity, and chances of branching, suggesting an attempted nerve regeneration. A strong correlation exists between the changes of nerve morphology and the degree of dry eye. These results provide some possible evidence for the abnormal corneal sensation in dry eye.