不同程度近视患者视网膜神经纤维层厚度和神经节细胞复合体参数的变化

目的:比较低度、中度和高度近视非青光眼受试者通过光谱域光学相干断层扫描技术(SD-OCT)测量的视网膜神经纤维层(RNFL)和黄斑神经节细胞复合体(GCC)参数的变化。方法:选择2019-12/2022-11期间在我院就诊的近视受试者400例400眼参与本研究,根据受试者近视程度分为：低度近视组(142例142眼,35.5%)、中度近视组(139例139眼,34.8%)和高度近视组(119例119眼,29.8%)。测量RNFL厚度,包括均值、上方、下方、鼻侧、颞侧RNFL厚度。测量GCC参数,包括均值、上方、颞上方、下方、颞下方、鼻上方、鼻下方。评估OCT测量的RNFL厚度、GCC参数均值与眼轴长度之间的相关性。结果:低度近视组和中度近视组的上方、下方、鼻侧、平均RNFL厚度明显高于高度近视组,颞侧RNFL厚度明显低于高度近视组(均P<0.05);低度近视组和中度近视组的上方、颞上方、下方、颞下方、鼻上方、鼻下方、平均GCC厚度明显高于高度近视组(均P<0.05);在中度近视组中,RNFL和GCC厚度均值与眼轴长度均呈负相关(r=-0.387、-0.309,均P<0....     

正常眼黄斑区视网膜神经上皮厚度相干光断层扫描测量

目的应用相干光断层成像技术(OCT)测量正常眼黄斑区视网膜神经上皮层的厚度。方法应用哥白尼Soct对75只正常眼进行经黄斑中心凹的星状扫描,扫描长度7 mm,测量黄斑中心小凹,颞侧、颞上方、上方、鼻上方、鼻侧、鼻下方、下方、颞下方八个方向,分别距中心小凹距离50、150、500、1000、1500μm的视网膜神经上皮的厚度,共计3075个数据,进行统计学计算和检验。结果正常眼黄斑中心小凹的视网膜神经上皮厚度为(143.15±13.57)μm,正常眼黄斑区神经上皮厚度左右眼别之间,男女之间在1000μm处颞侧、上方、鼻侧、鼻下方、下方、颞下方的神经上皮厚度在统计学上有差异。中心小凹1000μm外鼻侧视网膜神经上皮厚度大于颞侧神经上皮厚度。结论 OCT能够精确测量正常活体黄斑视网膜厚度,正常值的测定结果有利于对黄斑疾病的诊断治疗提供客观、定量分析。     

近视眼黄斑视网膜厚度最值的研究

目的 探讨无后极部眼底病变的近视眼黄斑视网膜厚度最值的变化.方法 除眼底视盘旁近视弧外无其他眼部异常的近视患者122例,年龄17～50岁,平均(27.3±7.2)岁,等效球镜度数-1.50～-15.25 D,平均(-6.18±2.61)D,随机选取每人一眼受检.所有受检眼均予屈光检查和眼轴长度测定.将黄斑区分为颞侧、上方、鼻侧、下方4个区域,测定各区黄斑视网膜厚度最值后,与屈光度数及眼轴长度进行相关性分析、直线回归分析等统计学处理.结果 本组受检者黄斑中心凹视网膜厚度最小值为(142.84±16.23)μm,与年龄、近视度数、眼轴长度均无相关性.4个区域视网膜厚度最大值与年龄无关;鼻侧和上方的视网膜较厚,分别为(282.04±13.53)μm和(281.99±14.01)μm,下方和颞侧的视网膜较薄,分别为(279.63±12.87)μm和(268.52±12.97)μm;随眼轴长度增加,视网膜厚度最大值均减小,减小的趋势为上方＞鼻侧＞下方＞颞侧.结论 随着近视度数和眼轴长度增加,除黄斑中心凹最薄点的视网膜厚度无变化外,黄斑区的视网膜在变薄的同时变得平坦.     

高度近视眼黄斑部视网膜神经上皮层厚度的分区测量研究

目的:研究高度近视眼黄斑部各区域视网膜神经上皮层厚度的分布特点,并分析其与性别、年龄、眼压、等效球镜度数和眼轴长度之间的相关性。方法:除眼底视盘旁近视弧外无其他眼部异常和眼底病变的高度近视患者102例,随机选取每例患者1眼受检。所有受检眼均予眼压、屈光检查、眼轴长度测定、9个区域的黄斑视网膜神经上皮层平均厚度和黄斑中心凹视网膜厚度最小值测定。将黄斑部各区域视网膜神经上皮层平均厚度和黄斑中心凹视网膜厚度最小值与性别、年龄、眼压、等效球镜度数及眼轴长度进行相关性分析和偏相关分析。各区黄斑视网膜神经上皮层平均厚度和黄斑中心凹视网膜厚度最小值进行多配对样本的Friedman检验。结果:本组受检者黄斑中心凹视网膜厚度最小值为175.34±29.01μm。各区黄斑视网膜神经上皮层平均厚度分布存在显著差异:内环区视网膜神经上皮层厚度较外环区厚;鼻侧和上下方视网膜神经上皮层较厚,颞侧较薄;中央区和中心小凹最薄。随着眼轴的延长,中央区视网膜神经上皮层厚度增厚,外环区上方视网膜神经上皮层变薄。结论:眼轴长度增加所致的黄斑视网膜神经上皮层厚度改变可能是高度近视黄斑变性发生发展的病理基础。     

不同程度近视眼黄斑区OCT的观察

目的了解不同程度近视眼黄斑区各区域视网膜厚度及其变化特征。方法收集我院屈光门诊18～32岁的近视患者68例(101眼),受试者分为中低度近视组23例(40眼)、高度近视组24例(40眼)、正常对照组正视眼21例(21眼)。分别进行Zeiss-Humphrey光学相干断层成像仪(Cirrus Hd-OCT4000)测量,对被检眼的黄斑区进行OCT快速扫描,将黄斑区分为9个区域:中心凹区(A1)、上方内圈(A2)、颞侧内圈(A3)、下方内圈(A4)、鼻侧内圈(A5)、上方外圈(A6)、颞侧外圈(A7)、下方外圈(A8)、鼻侧外圈(A9),分别测定各区域的视网膜厚度,再比较三组之间的差别。结果 A1、A5区视网膜厚度在三组之间差异均无统计学意义(均为P>0.05);A2、A3区视网膜厚度正常对照组[(322.48±18.90)μm、(306.43±14.98)μm]、中低度近视组[(320.80±15.67)μm、(305.50±15.71)μm]分别与高度近视组[(311.98±16.14)μm、(296.85±18.32)μm]之间比较,差异均有统计学意义(均为P<0.05);正常对照组、中低度近视组A4、A6、A7、A8、A9区视网膜厚度分别与高度近视组之间比较差异均有显著统计学意义(均为P<0.01)。正常对照组与中低度近视组各值差异均无统计学意义(均为P>0.05)。结论黄斑区域视网膜厚度分布存在区域特异性,随屈光度的增加出现区域选择性变薄,高度近视眼的视网膜变薄是确实存在的,主要在旁中心凹区。     

青年近视患者神经纤维层厚度的临床研究

目的 探讨青年近视患者的神经纤维层(RNFL)厚度分布特性及其影响因素.方法 横断面研究.选取准分子激光角膜屈光手术前的青年近视患者162例(162眼),平均年龄(27.0±4.6)岁,等效球镜度-0.75～-11.00 D,平均(-4.98±2.64)D.其中,低度近视组54例,平均等效球镜度为(-2.27±0.64)D;中度近视组55例,平均等效球镜度为(-4.54±0.79)D;高度组53例,平均等效球镜度为(-8.19±1.51)D.采用光学相干断层扫描(OCT)仪检查视盘周围神经纤维层厚度,用偏相关分析RNFL厚度与患者年龄、性别、等效球镜度、眼轴、角膜中央厚度及角膜曲率的相关性.结果 本组入选患者视盘周围平均RNFL厚度:全周为(103.6±9.5)μm,上方为(128.7±16.8)μm,鼻侧为(67.8± 16.5)μm,下方为(125.9± 17.2)μm,颞侧为(91.9±16.9)μm.各RNFL厚度参数与年龄、性别、角膜曲率、中央角膜厚度无相关性,全周、上方、鼻侧、下方的平均RNFL厚度与眼轴呈负相关(r=-0.379、-0.297、-0.180 、-0.291,P＜0.05),颞侧的平均RNFL厚度则与眼轴无相关性,鼻侧、下方的平均RNFL厚度与等效球镜度呈负相关(r=-0.233、-0.163,P＜0.05),颞侧平均RNFL厚度与等效球镜度则呈正相关(r=0.159,P＜0.05).结论 青年近视患者视盘周围平均RNFL厚度上方＞下方＞颞侧＞鼻侧,全周、鼻侧、上方、下方平均RNFL厚度随眼轴的增长而变薄,下方和鼻侧RNFL厚度随等效球镜度增加而变薄,颞侧平均RNFL厚度随着等效球镜度增加而增厚.     

相干光断层扫描仪检测视网膜神经纤维层厚度影响因素分析

目的运用相干光断层扫描仪(OCT)测量正常人视网膜神经纤维层(RNFL)厚度并探讨其影响因素。方法运有Stratus OCT 4.0测量202例不同年龄及不同屈光度正常人(年龄8～74岁,屈光度-8～ 4D)各钟点、象限及平均RNEL厚度,建立多元线性回归方程探讨年龄、屈光度、性别及视盘面积对RNEL厚度的影响。结果①正常人RNFL平均厚度为108.63±9.70μm,下方象限RNFL(I):139.17±15.79μm最厚,其次为上方象限(S):134.61±17.80μm,颞侧象限(T):85.37±21.25μm,鼻侧象限(N):75.19±17.06μm最薄,即I>S>T>N。②平均及上、下、颞侧象限RNFL厚度均随年龄增长而变薄,40岁以后趋势明显,50岁以上者显著变薄,仅鼻侧象限RNFL厚度与年龄无关;平均及上、下、鼻侧象限RNFL厚度均随近视度数增加而变薄,且高度近视者显著薄于正视者。而颞侧象限RNFL厚度却随近视度数增加而变厚,高度近视者显著薄于正视者。而颞侧象限RNFL厚度却随近视度数增加而变厚,高度近视者显著厚于正视者;平均及各象限RNFL厚度除下方外均与性别无关,仅下方像限女性较男性厚;应用机器自动辨认视盘边界时,未发现RNFL厚度与视盘面积有关。结论OCT测得的正常RNFL厚度主要与年龄、屈光度有关;仅下方象限RNFL厚度与性别有关;应用机器自动辨认视盘边界时,未发现RNFL厚度与视盘面积有关;儿童可以较好地配合OCT检查并获得较为可靠的测理结果;应用规范、统一的OCT测量标准,建立人群为基础的并经相关影响因素校正的中国人RNFLJE常值数据库对青光眼的早期诊断是非常必要的。     

近视及近视性弱视儿童视网膜神经纤维层OCT检测及分析

目的分析近视及近视性弱视儿童视网膜光学相干断层扫描（OCT）各项指标的变化,研究近视及近视性弱视儿童的视网膜结构的变化特征。方法对52只眼近视性弱视组和32只眼单纯近视组行视网膜OCT检查,记录黄斑中心凹中心视网膜厚度和视盘上方、下方、鼻侧、颞侧及平均视网膜神经纤维层（RNFL）厚度,并与32只眼正常对照组进行比较。结果近视性弱视组和正常对照组比较,视盘下方和视盘周围平均RNFL厚度变薄,且有统计学意义（P〈0.05）,而视盘上方、颞侧和鼻侧RNFL厚度和黄斑中心凹中心视网膜厚度均无显著差异（P〉0.05）。单纯近视组和正常对照组比较,视盘周围RNFL厚度和黄斑中心凹视网膜厚度均无显著差异（P〉0.05）。近视性弱视组高度近视儿童的视盘上方、下方、鼻侧和视网膜平均RNFL厚度较健眼变薄（P〈0.05）,而颞侧和黄斑中心凹中心视网膜厚度无明显变化（P〉0.05）,单纯近视组中高度近视儿童的视盘颞侧RNFL层厚度和黄斑中心凹中心视网膜厚度增加明显（P〈0.05）。结论近视及近视性弱视儿童的视网膜结构存在异常。     

高度近视眼黄斑区视网膜厚度的相关因素分析

目的：探讨黄斑区视网膜厚度与屈光度、主导眼、眼轴长度的关系。 方法：入选高度近视组患者128例180眼,其中主导眼79眼,非主导眼101眼,应用OCT测量黄斑区及周围视网膜厚度及应用A超测量眼轴长度,另设正视眼组112人180眼,其中主导眼106眼,非主导眼74眼作为对照,获得数据进行统计学分析。 结果：高度近视患者的平均眼轴长度29.57依1.57 mm与正常组患者的平均眼轴长度（24.13依0.90mm）相比显著延长（P〈0.05）。眼轴长度与黄斑中心凹内环区（距黄斑中心凹1～3mm区）上方（ S1）、下方（ I1）、颞侧（ T1）及黄斑中心凹外环区（距黄斑中心凹3～6mm区）上方（ S2）、下方（I2）、鼻侧（N2）、颞侧（T2）视网膜厚度存在相关性,与黄斑中心区及黄斑中心凹内环区鼻侧（ N1）视网膜厚度无相关性。高度近视眼组黄斑中心区及各个分区均较正视眼组明显变薄（P〈0.05）。高度近视主导眼与非主导眼黄斑区视网膜厚度相比,无统计学意义（ P〉0.05）。 结论：高度近视患者黄斑区视网膜厚度OCT的检测值低于正视眼组。高度近视组眼轴长度与黄斑区上方（ S1）、下方（I1）、颞侧（T1）、上方（S2）、下方（I2）、鼻侧（N2）、颞侧（ T2）视网膜厚度存在负相关关系。高度近视眼中主导眼黄斑区视网膜厚度与非主导眼黄斑区视网膜厚度无差异性。     

近视人群视盘旁神经纤维层厚度和视盘形态学相关性研究

目的：应用OCT研究近视人群视盘旁神经纤维层厚度和视盘形态学变化以及两者的关系。

方法：前瞻性研究。共纳入近视患者61例95眼,平均年龄27.76±7.05岁; 对照组15例30眼,平均年龄28.33±3.08岁。根据屈光度将近视患者分为中低度近视组14眼(-3D≤屈光度<-6D)、高度近视组56眼(-6D≤屈光度≤-9D)和超高度近视组25眼(屈光度>-9D)。所有受试者均行标准综合验光(SE)、眼轴长度(AL)、眼压(IOP)、散瞳眼底和OCT检查。分析视盘旁平均视网膜神经纤维层厚度和上、下、鼻、颞四个象限的神经纤维层厚度,以及视盘旁萎缩灶面积(PPA)、视盘椭圆度(OI)和视盘水平倾斜角(HOT)。

结果：各象限的神经纤维层厚度,四组受试者均有差异(均P<0.01)。平均神经纤维层厚度、上方和鼻侧神经纤维层厚度比较,对照组显著高于三个近视组(均P<0.05)。颞侧神经纤维层厚度比较,对照组低于高度近视组和超高度近视组(P<0.001、0.002),中低度近视组亦低于超高度近视组(P=0.043); 四组受试者PPA比较有差异(P<0.001),其中超高度近视组和高度近视组大于中低度近视组和对照组(均P<0.01); 四组受试者HOT有差异(P=0.020),其中高度近视组和超高度近视组高于对照组(P<0.001)。上、下象限神经纤维层厚度与OI、HOT和PPA均呈负相关(均P<0.05),而颞侧神经纤维层厚度与OI、HOT和PPA均呈正相关(均P<0.05)。

结论：近视患者平均和上、下方神经纤维层厚度变薄,颞侧变厚,鼻侧无变化。高度近视患者HOT和PPA增大,且与神经纤维层厚度有密切联系。     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

p53 expression in pterygium in two climatic regions in Turkey

Purpose:

To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey.

Materials and Methods:

Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson''s chi-square test was used to compare the p53 immunoreactivity.

Results:

The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group (P<0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 (P= 0.060).

Conclusion:

The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.     

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews. Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49 D and the median refractive cylinder was ‐0.50 D (range zero to ‐4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore

Purpose: To report the trends in etiology of patients with anterior uveitis (AU) in Singapore over 6 years.

Methods: A retrospective review of the clinical records of all new patients who presented with anterior uveitis to the uveitis subspecialty clinic from 2005 to 2010 at Tan Tock Seng Hospital, Singapore.

Results: There were 552 new cases of AU. This comprised 59.5% of a total of 928 new patients diagnosed with uveitis from 2005 to 2010. The mean age was 48.0?±?17.2 years. There was a male predominance (62.5%), with a male:female ratio of 1.7:1. The majority were of Chinese ethnicity (69%), followed by Malays (13.2%). Most cases were unilateral (79.5%) and idiopathic (50.4%). Common etiological causes included Fuchs heterochromic iridocyclitis (FHI) (5.6%), ankylosing spondylitis (AS)-related AU (5.1%), herpes simplex virus (HSV) (4.7%), and herpes zoster virus (HZV) (4.5%). There were increasing trends in AS-related AU from 3.2% in 2008 to 6.5% in 2010, and psoriasis-associated AU from 1.7% in 2005 to 4.0% in 2008. There were decreasing trends in the incidence of FHI from 10.6% in 2006 to 4.7% in 2009. No change in incidence of viral etiologies was noted, but cytomegalovirus-related immune-recovery uveitis (IRU) comprised 7.4%. IRU showed an increasing trend from 1.7% in 2005 to 11.9% in 2007, then decreased to 3.3% in 2010. Using the Pearson chi-square test, there was no statistically significant association between ethnicities (Chinese, Malay, Indian) comparing infectious and noninfectious cases (p?=?0.788), idiopathic and nonidiopathic cases (p?=?0.170), or between the various etiologies of uveitis (p?=?0.168).

Conclusions: AU was the predominant form of uveitis seen at our centers. Infectious etiologies (18.5%) are the most common among nonidiopathic cases, with herpes viruses (9.2%) being most prevalent. Despite increased use of polymerase chain reaction (PCR) in the detection of microbial and viral DNA, there was no overall increase in detection of infectious causes for uveitis. The changes in CMV-related immune recovery uveitis from 2005 to 2010 could reflect a change in HIV management in Singapore.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

弱视眼底光学相干断层扫描的研究进展

弱视是由于视觉发育关键期内各种异常的视觉经验导致单眼或双眼最佳矫正远视力低于正常同龄儿童,而眼部无明显器质性病变。目前普遍观点认为,弱视的发病机理主要源于视皮层。近年来,光学相干断层扫描（OCT）作为一种先进的活体成像技术,促进了对视网膜形态结构的大量研究,同时也被应用到弱视的研究领域。陆续有不同的研究人员利用OCT发现弱视患者眼底视网膜、脉络膜等眼部结构存在改变。笔者将对弱视眼底OCT的研究进展做一综述。     

内毒素诱导的大鼠葡萄膜炎的巨噬细胞中Toll样受体4的表达

目的 探讨在内毒素诱导的Wistar大鼠葡萄膜炎中Toll样受体4(TLR4)阳性细胞与虹膜组织中巨噬细胞的动态变化和分布.方法 实验研究.Wistar大鼠50只,用随机数字法随机分为5组,每组10只,分别为正常对照(0 h)组、6 h组、12 h组、24 h组及48 h组.除0 h组外其余各组均足垫部注射霍乱弧菌内毒素200μg,注射后于裂隙灯显微镜下观察双眼前节炎症反应变化.按实验分组于0、6、12、24、48 h处死大鼠.取虹膜一睫状体及脉络膜组织.通过葡萄膜铺片免疫组织化学方法检测TLR4和巨噬细胞的标记CD163的表达.人工计数虹膜中TLR4~+与CD163~+的细胞并计算细胞密度,计算圆形和多形性的CD163~+细胞占所有CD163~+细胞的百分比.进一步采用免疫荧光双标记检测TLR4和CD163共表达的情况.通过单因素方差分析分别对大鼠虹膜内阳性细胞密度以及圆形、多形性CD163~+细胞的百分比进行统计学检验.结果 正常大鼠虹膜睫状体组织不表达TLR4.6 h组有2只大鼠虹膜内可见少量TLR4~+细胞,12～48 h组所有大鼠虹膜内TLR4~+细胞明显增多(F=167.2,P＜0.001),虹膜内TLR4~+细胞密度分别为(506.1±39.5)个/mm~2(12 h组)、(492.3±54.5)个/mm~2(24 h组)及(663.8±150.2)个/mm~2 (48 h组).在注射LPS后12～48 h期间TLR4~+细胞形态无明显变化.0～48 h组大鼠虹膜内均有CD163~+细胞,0 h组圆形和多形性CD163~+细胞百分比为13%,12～48 h组其百分比约为80%,且圆形细胞主要位于虹膜基质层.免疫荧光双标记可见TLR4和CD163的共表达,TLR4位于细胞膜,CD163位于细胞质.5组大鼠脉络膜内均未见TLR4表达.结论 内毒素诱导的大鼠葡萄膜炎中虹膜内TLR4表达增高,部分虹膜固有巨噬细胞表达TLR4.TLR4可能在葡萄膜炎的发生发展中起一定作用.