Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.     

青光眼药物的研究进展

青光眼是一类具有特异性视神经损害、眼内压过高和视野缺陷等特征的眼病。如果眼内压长期持续偏高,会使人致盲。通过查阅整理研究文献,本文综述了有关青光眼药物治疗方面的研究进展,为青光眼治疗药物的进一步开发研究提供参考。     

Septo-optic dysplasia with unilateral optic nerve hypoplasia: case report

Septo-optic dysplasia (de Morsier syndrome) is a well-described entity that includes optic nerve hypoplasia and the absence of the septum pellucidum with or without pituitary abnormalities. We describe a case with unilateral optic nerve hypoplasia and absence of a septum pellucidum. A 6-year-old boy was referred to our clinic because of poor visual acuity. His best-corrected visual acuity was counting fingers at 15 cm in the right eye and 1.0 in the left eye. Extraocular muscle movements were normal, and exotropia of 30 prism diopters by Hirschberg test in the right eye was present. The pupils were equal and reactive to light with a mild Marcus Gunn pupillary response in the right eye. Perimetry revealed small visual fields in the superior quadrants of the right eye, while the left eye was normal. Ophthalmoscopic examination showed a small pale optic disc in the right eye; the optic disc of the left eye was normal. Magnetic resonance imaging showed the absence of the septum pellucidum. Endocrine studies revealed no evidence of pituitary insufficiency.     

Goldmann氏视野计临床应用初步总结

我院采用瑞士产Goldmann氏940—st型视野计,自1985年1月—1987年6月计检查513例,832眼,眼科病452例,包括青光眼,中心性浆液性视网膜病变,视网膜色素变性,视神经病等,其他疾病61例包括颅内肿瘤等。本文介绍五个典型病例,说明该视野计的优点,既有一般视野计的特征,可测定视野缺损的范围和暗点的性质,且可测定视野缺损区光敏感度的程度,不但可以定性,而且可以定量分析,从而更有利于眼底病、视路、中枢神经系统疾病的早期诊断、病灶定位、鉴别诊断、病程进展以预后判断。     

Giant cell arteritis with panocular involvement in an Indian male

A case of giant cell arteritis with systemic and panocular involvement is reported here. This elderly Indian male presented with symptoms of unilateral temporal headache and intermittent jaw claudication for a month followed by diplopia and blurring of vision and later loss of vision in the right eye. The right eye showed some limitation of ocular movements, presence of relative afferent pupil defect, anterior segment ischaemic changes and anterior ischaemic optic neuropathy. Visual evoked potential showed an absent P1 wave while the left eye with normal 6/6 vision sowed a prolonged P1 wave. Fundus fluoresceine angiography showed delay in choroidal perfusion. His erythrocyte sedimentation rate (ESR) was 120 mm/hr and he was started on oral prednisolone. Superficial temporal artery biopsy obtained one week after starting steroids was positive for giant cell arteritis. Steroids led to the resolution of optic disc swelling, disappearance of anterior segment signs, full recovery of right ocular movements and no further deterioration of the fellow eye. On steroids, he developed insomnia and progressive myopathy which resolved and is now symptom free at lower doses of steroids.     

单仙视觉剥夺后鸽脑两侧视盖基因的差异表达

目的：探讨单侧视觉剥夺后鸽子两侧视盖基因的差异表达情况,方法：建立单眼剥夺动物模型,抽提,纯化左右视盖mRNA,利用SSH方法建立左侧视盖差异表达文库,对其中EST进行克隆,测序,反Northern杂交去除假阳性。结果：共筛选得到12个差异表达片段,经同源性检索,其中11个未发现有发高源性的基因,提示可能为新的EST,另一差异片段与CGI－31蛋白有85％的同源性,结论：视觉相关脑区差异表达序列的分析可能为视觉形成的分子机制或视觉通路的分子构筑提供有益的线索。     

Paraneoplastic optic neuropathy in nasopharyngeal carcinoma--report of a case

A 31-year-old Chinese man developed left optic neuritis with left sectorial field loss as a remote effect of nasopharyngeal carcinoma. The field defect showed interesting fluctuations in response to the dosage of systemic steroid therapy. Neuropathologic findings from an exploratory craniotomy did not show any gross tumour mass around the left optic nerve nor any histological evidence of tumour infiltration. This case illustrates that "optic neuritis" could be a paraneoplastic effect of nasopharyngeal carcinoma.     

Protective Effect of Paeoniflorin against Optic Nerve Crush

In order to evaluate the efficacy of traditional paeonia extract paeoniflorin against optic nerve crush, 16 Brown Norway rats were divided into two groups at random, with 8 rats in each group. In paeoniaflorin-treated group, 2 mg paeoniaflorin （total volum： 1 mL） was injected into rat＇s peritoneum one time a day for a period of 8 days. Rats in untreated group were given a single dose of vehicle. The optic nerve was crushed by a special forceps for 30 s in the left eye and a sham procedure was performed in the right eye on the 2nd day after the first injection. The retrograde fluorogold labeling of ganglion cells was conducted 5 days after optic nerve crush. The whole retina was flat-mounted thereafter. The ganglion cells that survived the crush were counted under fluorescent microscope by using an automatic counting software. As compared with the contralateral eye, the survival rate of ganglion cells in the left eye increased from 40.22% to 64.53% with a significant difference found between them （t=2.55, P=0.023）. The results suggested that the paeonia extract paeoniflorin possessed a protective effect against optic nerve crush.     

Leber遗传性视神经病变24例临床分析

回顾分析了 2 4例 ( 4 8眼 )Leber遗传性视神经病变的临床特征。患者年龄从 1 2岁到 44岁 ,平均 ( 2 0 3± 7 2 )岁 ,男性占 83%。发病典型者多为 1眼无痛性视力下降。视力下降程度从眼前手动到 1 2 ,其中 40眼 ( 83% )≤ 0 1。视野缺损主要为中心暗点或旁中心暗点 ,色觉障碍严重。本组部分病例发病早期有特征性眼底改变 ,包括视盘明显充血 ,视盘周围小血管扩张迂曲 ,神经纤维层水肿。眼底荧光血管造影视盘及盘缘血管无荧光素渗漏。     

脑动脉硬化对视神经血供影响的形态学研究及其临床意义

①目的 探讨视神经动脉起源、数目、分布及相关动脉的病理变化，为视神经因缺血所致视野缺损提供形态学依据。②方法 在体视显微镜扣手术显微镜下对100侧成人脑标本观察视神经动脉来源、数目和分布，对其中年龄50-70岁60侧脑标本的视神经和相关动脉进行病理切片观察。③结果 视神经动脉主要来源于颈内动脉、大脑前动脉争前交通动脉。其中单来源3侧(3％)，双来源68侧(68％)，3来源29侧(29％)。病理切片观察动脉管壁有粥样硬化改变53侧(88．3％)，其中被硬化斑块阻塞眼动脉的3侧(5、7％)。阻塞垂体上动脉的4侧(7．5％)，小动脉管腔狭窄11侧(20．8％)。与小动脉阻塞相对应的视神经切片。可见有神经纤维萎缩、变性等病理改变。硬化的颈内动脉壁压迫视神经可以形成明显的压迹。④结论 50岁以上出现不明原因的周边或中央视野缺损。脑动脉硬化导致视神经供血障碍病因不能除外。     

Protective effect of paeoniflorin against optic nerve crush

Summary In order to evaluate the efficacy of traditional paeonia extract paeoniflorin against optic nerve crush, 16 Brown Norway rats were divided into two groups at random, with 8 rats in each group. In paeoniaflorin-treated group, 2 mg paeoniaflorin (total volum: 1 mL) was injected into rat’s peritoneum one time a day for a period of 8 days. Rats in untreated group were given a single dose of vehicle. The optic nerve was crushed by a special forceps for 30 s in the left eye and a sham procedure was performed in the right eye on the 2nd day after the first injection. The retrograde fluorogold labeling of ganglion cells was conducted 5 days after optic nerve crush. The whole retina was flat-mounted thereafter. The ganglion cells that survived the crush were counted under fluorescent microscope by using an automatic counting software. As compared with the contralateral eye, the survival rate of ganglion cells in the left eye increased from 40.22% to 64.53% with a significant difference found between them (t=2.55, P=0.023). The results suggested that the paeonia extract paeoniflorin possessed a protective effect against optic nerve crush. This project was supported by the Natural Sciences Foundation of Hubei Province (No. 2007ABA135).     

家猫视神经损伤的病理学改变

目的:动态观察视神经损伤后的病理学改变。方法:选取健康成年家猫20只,以自身左眼为对照,用自制损伤器撞击右眼视神经管,建立视神经损伤模型。在光镜与电镜下观察视神经损伤后1、3、7、14d的形态学改变。结果:光镜下视神经损伤主要表现为不同程度的神经纤维空泡样变性,电镜下视神经损伤主要表现为轴突内空泡样变性、髓鞘松解、微丝微管消失等。结论:家猫外伤性视神经损伤的动物模型与人类有很强的相似性,并有可操作性。视神经震荡伤后的病理变化以变性为主,早期施行减压手术可能挽救视力。     

An unusual presentation of medial sphenoid wing meningioma

A young woman of 26 years attended eye OPD with the complaints of complete and rapid loss of vision of her righ eye and progressive dimness of vision of left eye, frontal headache and nausea for last two months. On eye examination, she was found to have no perception of light to her right eye. Ophthalmoscopy examination revealed primary optic atrophy in right eye and marked papilloedema to her left eye. CT scan of brain showed space occupying lesion in right parasellar region with sellar and suprasellar extension with involvement of right anterior clinoid process suggesting medial sphenoid wing meningioma. The patient underwent surgery and the histopathology proved the diagnosis as meningioma. The case of medial sphenoid wing meningioma in a young female producing rapid Foster Kennedy syndrome is reported for its unusual presentation.     

荧光金逆行标记评价视神经切断后视网膜节细胞存活率

目的：利用荧光金逆行标记评价视神经切断后视网膜节细胞（RGCs）的存活率。方法：将SD大鼠20只随机均分为4组，正常对照组和视神经切断后5d、7d和1dd组。用荧光金逆行标记和定量解剖学技术观察正常对照组和视神经切断后5d、7d和14d组RGCs的密度。结果：正常对照组RGCs呈放射状分布，边界清晰，可见明显细胞突起，无渗漏现象；视神经切断组RGCs随时间延长而减少，细胞分布不均匀，并且可见吞噬死亡细胞碎片和从死亡细胞渗漏的荧光金的小胶质细胞。正常对照组左眼与右眼RGCs密度差异无统计学意义（P〉0．05）；视神经切断后RGCs进行性减少，切断后5d、7d和14d组左眼RGCs密度均明显低于正常对照组（P〈0．01），视神经切断后5d、7d和14d存活率分别为53％、38％和13％。结论：荧光金逆行标记是评价视神经切断后RGCs存活率有效的方法。     

新西兰兔视神经损伤减压术后视网膜及视神经GAP-43 mRNA的表达及意义

目的:通过观察视神经损伤后,不同时段手术减压对视神经及视网膜GAP-43mRNA表达的影响,探讨视神经损伤后减压的手术时机及作用机理。方法:定量致伤条件下建立新西兰兔双侧视神经部分损伤的动物模型。根据预定减压时间的不同,将20只新西兰兔随机分为正常对照组、损伤后1d减压组(1dpi组)、损伤后7d减压组(7dpi组)和损伤后14d减压组(14dpi组)4组。以右眼为减压眼,左眼不减压作为损伤对照。利用RT-PCR法检测各组损伤后4周时视神经及视网膜组织中GAP-43mRNA的表达水平。结果:视神经开始损伤后4周时,1dpi组减压眼视网膜组织中GAP-43mRNA的表达高于未减压眼,7dpi组、14dpi组减压眼与未减压眼表达差异无统计学意义。结论:视神经损伤后早期减压可使视网膜GAP-43mRNA表达升高,可能对促进视神经轴突的修复起一定的作用。     

蝶骨嵴脑膜瘤的眼部改变及其预后

为探讨确定蝶骨嵴脑膜瘤的眼部改变特征、术前定位诊断及视功能的保护 ,对天坛医院 1 995年 1月至2 0 0 1年 6月共 45例资料完整、经手术证实的蝶骨嵴脑膜瘤进行回顾性分析。其中 3 9例 (占 87% )出现眼征 ,前床突型脑膜瘤全部有眼部改变 ,而且大部分以首发症状出现。结果提示 :头痛伴有单侧视力减退及视神经萎缩、单侧眼球突出合并眼睑水肿、单侧视野缺损、多条眼外肌麻痹等症状 ,应考虑到蝶骨嵴脑膜病的可能。早期诊断及治疗 ,有助于视功能的恢复 ,术后进行眼科治疗是必要的。     

梗阻性左半大肠癌的手术治疗经验

目的 探讨梗阻性左半大肠癌的诊断和治疗。方法 对该院５６例梗阻性左半大肠癌进行回顾性分析。结果 左半大肠癌梗阻占癌性大肠梗阻的６７％,５６例患者中,结肠脾曲１０例,降结肠２例,乙状结肠２１例,直肠２３例、ＤｕｋｅｓＢ期８例,Ｃ１期２３例,Ｃ２期１９例,Ｄ期６例,腺癌３８例,黏液腺癌６例,低分化腺癌５例,未分化癌４例,印戒细胞癌２例,淋巴瘤１例,除３例无法切除行结肠造口外,其余７例梗梗阻缓解后择期行     

VEP对高压氧治疗大鼠视神经损伤疗效的评价

目的 观察高压氧治疗成年大鼠视神经损伤疗效.方法 使用24只雌性昆明大鼠建立视神经损伤模型, 左眼为视神经损伤眼, 右眼为假手术对照眼, 按照随机数字表法随机分为实验组和对照组, 每组12只.实验组给予高压氧治疗, 每天治疗1 h, 10 d为1个疗程, 共治疗2个疗程, 对照组呼吸常压新鲜空气.分别在治疗过程中的第3、10、20 d检测实验组、对照组大鼠双眼的F-VEP并进行治疗效果评价.结果 对照组中夹持视神经损伤眼比正常眼F-VEP潜伏期延长 (P<0.05) 、波幅降低 (P<0.05) ;实验组正常眼与对照组正常眼F-VEP数据比较潜伏期、波幅均无明显差异 (P>0.05) ;实验组与对照组的视神经损伤眼F-VEP数据比较潜伏期提前 (P<0.05) 、波幅增高 (P<0.05) ;不同时间点测得的F-VEP数据比较具有统计学意义 (P<0.05) .结论 实验大鼠视神经损伤模型建立是成功的;高压氧治疗在视神经未损伤眼中不会引起差异 (P>0.05) , 高压氧治疗是有效的;随着治疗时间的延长损伤视神经恢复越好.     

神经生长因子对兔视神经挫伤修复的影响

目的:研究神经生长因子(NGF)对成年兔视神经(ON)挫伤后修复的影响。方法:通过逐级暴露钝性分离钳夹视神经法建立兔视神经挫伤模型,并向玻璃体腔内注入NGF-β1μg(右眼,治疗组),或磷酸盐缓冲液(PBS)0.1m l(左眼,对照组)。挫伤后2周、4周时分别用光镜、电镜和TUNEL技术观察视网膜神经节细胞(RGC s)、视网膜神经纤维层和视神经的改变并作视神经纤维计数。结果:兔视神经挫伤可使RGC s数量减少,表现出细胞坏死、凋亡的特征。视神经病理改变主要是轴突较正常稀疏,部分轴突明显肿胀、空泡变性,轴突与髓鞘间有腔隙形成,髓鞘结构紊乱,出现板层分离。NGF治疗组与对照组相比,前者RGC s、视神经纤维的退变较轻,数量较多,神经纤维有再生现象。同时发现治疗组4周比2周的神经纤维计数明显减少。结论:NGF能够在一定程度上防止轴突的变性坏死,从而阻断因轴突变性而激发RGC s死亡,并促进视神经纤维的再生。     

大肠癌急性肠梗阻手术治疗32例临床分析

目的探讨大肠癌肠梗阻的外科处理办法。方法分析1995-2006年32例大肠癌肠梗阻患者的外科治疗资料。结果32例患者。一期左半结肠切除吻合5例。左半结肠切除、肿瘤切除、肠造口13例。单纯结肠造口2例。术后无吻合口漏发生，切口感染2例（6．25％），围手术期死亡1例（3．13％）。结论重视对大肠癌肠梗阻的认识，合理选择手术方式，作好围手术期处理，是减少并发症，提高疗效的重要措施。