降纤酶治疗视网膜动脉阻塞的临床研究

目的观察降纤酶治疗视网膜动脉阻塞的疗效及血液流变学变化。方法视网膜动脉阻塞患者49例，分为2组：治疗组25例，应用降纤酶治疗；对照组24例，应用低分子右旋糖酐治疗；其它治疗方法相同。2组治疗前后均分别检查视力及眼底变化以判断疗效，同时检查血液流变学变化。结果治疗组显效率为72．0％，总有效率为88．0％，对照组显效率为20．8％，总有效率为58．3％，2组相比有显著差异（P〈0．01，P〈0．05）。治疗组治疗后纤维蛋白原、血浆黏度、全血黏度下降明显，与治疗前及对照组相比差异显著（P〈0．01，P〈0．05）。结论降纤酶能改善血液流变，降低纤维蛋白原，改善血液循环，治疗视网膜动脉阻塞的疗效显著。     

川芎嗪对原发性开角型青光眼患者的治疗作用

目的 探讨中药川芎嗪对原发性开角型青光眼的血液流变学、眼底荧光血管造影以及视功能的影响。方法 采有自身对照的方法对眼压已控制的原发性开角型青光眼患者１１例（１９）眼进行川芎嗪治疗前后血液流变学测定、眼底蓉光血管造影、Ｈrmphrey视野检查以及图形视诱发电位（ＰＶＥＰ）检测。结果 用磷酸川芎嗪治疗后患者血液流变学各指标明显下降（Ｐ＜０．０５～０．００１）;眼底荧光血管造影臂－脉络膜循环时间从隧的１４．６     

400例儿童弱视同视机治疗观察

目的：评估儿童弱视应用同视机治疗的疗效。方法：随机选择日常门诊年龄在3－12岁、视力低于正常同龄儿童者，充分睫状肌麻痹后客观检影法检查屈光状态，矫正视力≤0．8者，并排除眼器质性病变。以确诊为弱视并能坚持应用同视机治疗超过3个月的400例（718只眼）做为观察对象，坚持每天应用同视机治疗。分别从患儿年龄、弱视程度及疗程长短三方面评估它们与疗效之间的关系。结果：基本治愈率为42．76％，总有效率88．72％。其中3－5岁年龄组基本治愈率为51．25％，在各年龄组中治愈率最高，与6－8岁年龄组及9－12岁年龄组均有显著性差异（P＜0．05）。轻度弱视治愈率64．97％，总有率97．46％，其基本治愈率与中主度及重度弱视均差异显著（P＜0．05）。治疗时间坚持在12个月以上者治愈率位于各疗程组之首，为54．61％，总有效率为97．05％。疗程＞12月与疗程7－12月组及疗程3－6月之间均存在显著性差异（P＜0．05）。结论：同视机治疗儿童弱视，疗效是肯定的、治疗年龄越小，弱视程度越轻，治疗12个月以上者，疗效最好。提示早期发现，坚持合理治疗是弱视的关键。     

氦氖激光血管内照射治疗单纯型糖尿病视网膜病变的临床研究

目的 探讨低能量氦氖激光血管内照射疗法（ＩＬＩＢ）治疗单纯型糖尿病视网膜病变（ＤＲ）的临床价值。方法 用ＩＬＩＢ治疗单纯型ＤＲ患者３８例，设对照组３２例不用ＩＬＩＢ。共治疗３个疗程，每个疗程１０天，疗程间隔１０天。观察治疗前后的血液流变学和眼底变化。结果 与对照组相比，治疗组的显效率（１３．１６％）和总有效率（５７．８９％）均显著高于对照组（分别为０％，Ｐ〈０．０５，９．４％Ｐ〈０．０１），治疗前后血流变学指标较治疗前明显下降（Ｐ〈０．０１）。结论 ＩＬＩＢ能明显降低ＤＲ患者的血液粘度，改善和稳定其眼底病变。     

阿托品联合短时遮盖治疗小儿弱视的临床疗效及安全性

目的：探讨10 g／L阿托品联合短时遮盖治疗小儿弱视的临床疗效及其安全性。方法：将2011－02／2014－02入住我院的88例88眼弱视患儿按照治疗方法分为对照组（44眼）与观察组（44眼）,对照组仅采用短时遮盖疗法,观察组在此基础上给予10 g／L阿托品治疗。比较两组患者临床疗效、治疗依从性、视力、弱视眼球矫正球镜度数及不良反应发生情况。结果：经治疗,观察组临床总有效率为95％（42／44）,显著高于对照组（80％,35／44,P＜0．05）;观察组患儿治疗依从性优良率为95％（42／44）,显著高于对照组（82％,36／44, P＜0．05）;两组患儿初诊视力差异无统计学意义（ P＞0.05）,但观察组患儿视力提高行数与弱视眼球矫正球镜度数均显著高于对照组（P＜0．05）;观察组不良反应总发生率为9％（4／44）,显著低于对照组（23％,10／44,P＜0.05）。结论：10 g／L阿托品联合短时遮盖治疗小儿弱视的临床疗效显著,安全性较高。     

青光康片对眼压已控制的原发性晚期青光眼临床疗效观察

小梁切除术后２──４６个月５１侧（５８只眼）原发性晚期青光眼患者，随机分为青光康治疗组（２５例２９只眼）和对照组（２６例２９只眼）。治疗组服用青光康２片，对照组服用安慰剂２片，均每天３次×６月，两组每月复诊１次，结果如下：治疗组治疗前及治疗后各疗程视野计分方差分析，差别有高度显著性（Ｐ＜０．０１），两两比较结果表明：第四疗程达最好疗效；对照组治疗前后视野计分方差分析差别无显著性（Ｐ＞０．０５）。两组间各疗程视野计分净增值成组ｔ检验，差别均有显著性（Ｐ＜０．０１）。６疗程后，治疗组视野进步率为９３．１０％，对照组为１０．３４％（Ｐ＜０．０５）。治疗组视野计分净增值与疗程、术后眼压下降幅度、术后眼压峰值呈显著性线性相关，相关系数（ｒ）分别为０．９４６、０．８４１５、－０．５９３９（Ｐ均＜０．０１）。治疗组与对照组视力进步率、Ｃ／Ｄ比值、血压、心率、全血粘度、血浆粘度、红细胞压积、血沉、红细胞聚集指数、血常规、血尿素氮等治疗前后差别均无显著性（Ｐ＞０．０５）。     

灯盏生脉胶囊对缺血性视神经病变的疗效

目的探讨灯盏生脉胶囊对气虚血瘀型非动脉炎性前部缺血性视神经病变（NAION）的临床疗效。方法随机对照试验。将120例NAION患者分为对照组和治疗组,对照组60例（84眼）,治疗组60例（85眼）。对照组给予复方樟柳碱注射液颞浅动脉旁注射,2 ml/次,1次/d。治疗组患者在上述治疗的基础上,加用灯盏生脉胶囊（口服,0.36 g/次,3次/d）进行治疗。治疗3个月后,观察并分析2组患者的总体疗效、视力、视野平均光敏感度以及血液流变学指标的改善情况。采用Wilcoxon 秩和检验、独立样本t检验、配对t检验进行数据分析。结果最终对照组和治疗组分别有49例（70眼）和51例（72眼）完成研究。治疗后,和对照组比较,治疗组患者视力（t=-5.223,P＜0.05）、视野平均敏感度（t=-3.690,P<0.05）较高;治疗组患者的血浆黏度、全血高切黏度、低切黏度、红细胞压积指数及血浆纤维蛋白原水平均较对照组低（t=1.224、3.114、7.458、9.153、2.105,P＜0.05）。治疗组患者视神经病变的总有效率为88%,显著高于对照组（71%）（Z=2.890,P＜0.01）。结论复方樟柳碱注射液联合灯盏生脉胶囊可显著改善NAION患者的视力、视野及血液流变学指标。     

雷珠单抗注射联合Ex-PRESS引流器对新生血管性青光眼的疗效

目的：研究雷珠单抗注射联合Ex－PRESS引流器治疗新生血管性青光眼的近期和远期疗效。方法：选取2012－01／2014－12我院眼科收治的51例62眼新生血管性青光眼患者为研究对象,在统一入组条件、统一测量方法的前提下,按目前实际诊疗状况并结合医生的判断进行分组,对照组23例28眼,观察组28例34眼。观察组患者接受雷珠单抗注射联合Ex－PRESS引流器植入术,对照组患者单纯给予Ex－PRESS引流器植入术。比较两组患者治疗前后视力水平及眼压,同时比较两组治疗有效率及不良反应发生率。结果：治疗前,两组患者眼压比较,差异无统计学意义（P＞0．05）。治疗后,两组患者眼压均显著降低,组内比较差异有统计学意义（P＜0．05）,且观察组治疗后1、4wk时眼压显著低于对照组,组间比较差异有统计学意义（P＜0．05）。治疗前,两组视力分布比较,差异无统计学意义（P＞0．05）。治疗后,对照组视力升高2例3眼,维持平稳18例22眼,下降3例3眼;观察组视力提高12例12眼,维持平稳15例21眼,下降1例1眼,两组视力分布比较差异有统计学意义（ P＜0．05）。观察组治疗有效率为85．3％,对照组为60．7％,观察组高于对照组,两组比较差异有统计学意义（ P＜0．05）。观察组前房出血4例4眼,角膜内皮功能失代偿2例2眼,术后并发症发生率为18％;对照组角膜水肿3例3眼,术后并发症发生率为11％,两组比较差异无统计学意义（ P＞0．05）。结论：对于新生血管性青光眼患者,采用雷珠单抗注射联合Ex－PRESS引流器植入术能够有效降低眼压、改善视功能或者延缓患者视功能衰退,具有疗效确切、安全性高等特点,值得临床上推广应用。     

硝酸甘油对妊高征患者血液流变学、血小板聚集的影响

目的 本研究拟用硝酸甘油（NG）治疗妊高征（PIH），评价其对PIH患者血液流变学、血小板聚集的影响。方法 选取晚期正常妊娠妇女（正常组Ⅰ组：11例），中、重度妊高征患者34例（PIH组），其中单用硫酸镁（Mg）治疗（Ⅱ组）：11例；单用硝酸甘油（NG）治疗（Ⅲ组）：11例；联合用药（Mg NG）治疗（Ⅳ组）：12例。采用血液粘度仪在高、低切变率下测血液流变学，硫酸铵沉淀法测纤维蛋白原（Fg)，魏式法测红细胞压积（Hct),血小板聚集仪测血小板聚集（PAg)。结果 1．血液流变学：Ⅲ、Ⅳ组治疗后BV、ESR、Kesr、Fg下降，差异显著（P＜0．05），余下指标及Ⅱ组各指标改变不明显。2．血小板聚集：Ⅲ、Ⅳ组治疗后降低，差异显著（P＜0．01），Ⅱ组指标改变不明显。结论 硝酸甘油作为NO供体治疗妊高征时，能改变血流变，抑制血小板聚集。     

自体血清治疗严重眼化学烧伤的临床研究

目的探讨自体血清治疗严重眼化学烧伤的疗效。方法将22例30眼严重眼化学烧伤患者随机分为2组，治疗组11例15眼使用自体血清治疗，对照组11例15眼未加用自体血清，余治疗方法同治疗组，对2组进行临床疗效分析。结果治疗组治愈率80％，有效率100％；对照组治愈率33．3％，有效率93．3％；差异有统计学意义（P〈0.05）。治疗组平均疗程比对照组缩短8d，有显著统计学差异（P〈0．01）。结论使用自体血清治疗严重眼化学烧伤安全、有效、无毒副作用，值得临床推广应用。     

Comparative antiproliferative and cytotoxic profile of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on different ocular cells

Aim To compare the antiproliferative and cytotoxic properties of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (Lucentis) on human retinal pigment epithelium (ARPE19) cells, rat retinal ganglion cells (RGC5) and pig choroidal endothelial cells (CEC). Methods Monolayer cultures of ARPE19, RGC5 and CEC were used. Bevacizumab (0.1–0.3 mg/ml), pegaptanib (0.025–0.08 mg/ml) or ranibizumab (0.04–0.125 mg/ml) diluted in culture medium were added to the cells. Expression of VEGF-receptors (VEGFR1 and VEGFR2) and von Willebrand factor (a marker for endothelial cells) were analysed by immunohistochemistry. CEC cells were stimulated with VEGF. Cellular proliferative activity was monitored by BrdU-incorporation into cellular DNA. For cytotoxicity assays cells were grown to confluence and then cultured in a serum-depleted medium to ensure a static milieu. MTT-test was performed after one day. Results CEC and ARPE19 cells stained positively for VEGFR1 and VEGFR2. More than 95% of the CEC cells were positive for von Willebrand factor. Ranibizumab reduced CEC cell proliferation by 44.1%, bevacizumab by 38.2% and pegaptanib by 35.1% when the drugs were used at their established clinical doses. The differences, however, between the three drugs in respect to cell growth inhibition were not statistically significant. Only a mild antiproliferative effect of bevacizumab or pegaptanib on ARPE19 cells could be observed. Ranibizumab did not alter ARPE19 cell proliferation. No cytotoxicity on RGC5, CEC and ARPE19 cells could be seen. Conclusions Bevacizumab, pegaptanib and ranibizumab significantly suppress choroidal endothelial cell proliferation. However, when used at the currently established doses none of the drugs was superior over the others in respect to endothelial cell growth inhibition. The biocompatibility of all three drugs — including the off-label bevacizumab — seems to be excellent when used at the currently recommended intravitreal dose. This work is presented on behalf of the Tuebingen Bevacizumab Study Group.     

Intravitreal use of bevacizumab (Avastin) for choroidal neovascularization due to ARMD: a preliminary multifocal-ERG and OCT study

Purpose To evaluate by MFERG and OCT the macular function before and after intravitreal use of bevacizumab (Avastin) in eyes suffering from CNV due to ARMD. Methods Eighteen eyes with subfoveal CNV due to ARMD were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow up was three months. Results Before treatment, OCT shows an increase of the retinal thickening of the fovea and the electrical response densities in the fovea and parafovea were decreased in all patients. Three months after treatment, OCT showed a real resolution of the subretinal fluid. The electrical responses in the fovea and parafovea remained the same or slightly improved in some cases. The intraocular pressure remained normal and no inflammation was observed. Conclusion The intravitreal use of bevacizumab may provide anatomical correlates that support the concept of disease amelioration but the functional improvement of the macula three months after treatment is not obvious. However the method is promising and needs further evaluation.     

Distribution,markers, and functions of retinal microglia

Retinal microglia originate from hemopoietic cells and invade the retina from the retinal margin and the optic disc, most likely via the blood vessels of the ciliary body and iris, and the retinal vasculature, respectively. The microglial precursors that appear in the retina prior to vascularization are major histocompatibility complex (MHC) class I- and II-positive and express the CD 45 marker, but lack specific macrophage markers. They differentiate into ramified parenchymal microglia in the adult retina. A second category of microglial precursors, which do express specific macrophage markers, migrate into the retina along with vascular precursors. They appear around blood vessels in the adult retina and are similar to macrophages or cells of the mononuclear phagocyte series (MPS). Microglia are distributed in the outer plexiform layer (OPL), outer nuclear layer (ONL), inner plexiform layer (IPL), ganglion cell layer (GCL), and nerve fiber layer (NFL) of the primate retina. The pattern of microglial distribution in the avascular retina of the quail indicates that blood vessels are not responsible for the final location of microglia in the retina. In the human retina, microglia express MHC class I, MHC class II, CD 45 , CD68, and S22 markers. In the rat and mouse retina, OX 41 , OX 42 , OX 3 , OX6, OX18, ED1, Mac-1, F 4 /80, 5 D 4 anti-keratan sulfate, and lectins are used to recognize microglia. Microglial cells play an important role in host defense against invading microorganisms, immunoregulation, and tissue repair. During neurodegeneration, activated microglial cells participate in the phagocytosis of debris and facilitate regenerative processes. In autoimmune disease, microglia have dual functions: initiating uveoretinitis, but also limiting subsequent inflammation. Retinal microglia may be associated with vitreoretinopathy, diabetic retinopathy, glaucoma, and age-related macular degeneration. The goal of this article was to review the present knowledge about retinal microglia and the function of retinal microglia in pathological conditions.     

视网膜血管瘤增殖一年龄相关性黄斑变性的特殊类型

本文总结了年龄相关性黄斑变性的特殊类型—视网膜血管瘤增殖(RAP)的临床和造影表现及分期。RAP是起源于黄斑旁视网膜深层毛细血管的、以伴发多灶小片视网膜内出血及盘变前期即有视网膜-脉络膜血管吻合(RCA)形成为特征的新生血管性AMD。     

近视及散光眼LASIK后非接触眼压计测量值的影响因素及其预测

目的 比较近视和(或)散光患者在LASIK手术前后非接触眼压计测量结果的差异及其影响因素,并得到预计眼压的计算公式.方法 对2005年12月至2006年11月在北京协和医院准分子激光手术中心行初次准分子激光原位角膜磨镶术(LASIK)矫正近视和(或)散光的患者进行回顾性研究,共93例(183只眼),采用非接触眼压计(NCT)测量术前和术后2周、1个月、3个月的眼压值,计算眼压变化值并分析其与各种变量之间的相关性,应用多元线性回归从相关变量得到术后预计的测量眼压值及眼压变化值.结果 患者术后3个月眼压较术前平均下降(5.74±2.03)mmHg,其变化与性别、年龄均不相关,但与术前屈光度有明显的关系.多元线性回归分析得到术后实际测量的眼压与术前眼压呈正性相关,而与手术切削量呈负相关(R2=0.442,P<0.001),术后预计测量眼压=5.175+0.411×术前眼压-0.0205×切削量,手术后眼压测量下降值0.589×术前眼压+0.0205×切削量-5.175.结论 通过术后实际测量眼压值与预测值比较,可以及时发现高眼压的患者,避免低估眼压以致漏诊青光眼而造成患者视功能损失.虽然可以通过预测公式来判断实际测量眼压值是否在正常范围.但更有效的方法是使用不受角膜变化影响的眼压计测定眼压.     

30天连续配戴硬性透氧性角膜接触镜的安全性研究

目的为了评价Menicon Z硬性接触镜30 d连续配戴的安全性与有效性,进行了两个为期一年的临床比较试验.方法分别选用了可以7 d连续配戴的Hydrogel材料的Acuvue(1)及可以30 d连续配戴的Si H材料的Focus Night & Day(2)软性接触镜作为对照镜片.结果临床试验(Ⅰ)中,317人参加了Menicon Z组群,313人参加了Acuvue组群.Menicon Z组群有258人(占81.4%)完成了为期一年的试验,而Acuvue组群仅有210人(占67.1%).Acuvue组群中比较常见的副作用为浸润性角膜炎与细菌性结膜炎.相比之下,Menicon Z组群常见的不适症状是由异物飞入角膜造成角膜上皮擦伤所致的.各有50人参加了临床试验(Ⅱ)的Menicon Z组群与Night & Day组群.Menicon Z组群有35人(占70.0%)完成了为期一年的试验,Night & Day组群有33人(占66.0%).Menicon Z组群中常见的副作用表现为3～9点角膜染色,Night & Day组群为接触镜相关性充血、接触镜性角膜周边溃疡、乳头性结膜炎、角膜上方弓状损伤与细菌性角膜炎.结论Menicon Z 30 d连续配戴具有安全性.     

Assessing hydroxychloroquine toxicity by the multifocal ERG

Twenty patients on Plaquenil treatment were evaluated for retinal toxicity using the (EOG) and the mfERG. Group 1 comprises 15 patients (30 eyes) with normal EOG. From these patients 11 (22 eyes) showed normal RRD of mfERG in area 1 and area 2. The rest four patients (8 eyes) the RRD were reduced. Six months after interruption of HC, the mfERG improved in three cases. Group 2 comprises 5 patients (10 eyes) with subnormal EOG. Four (8 eyes) of these showed a decrease of RRD of the mfERG in area 1 and 2. In the rest one (2 eyes) the RRD were normal. Six months after interruption of HC the mfERG and the EOG improved in 2 cases. These results postulate that the mfERG may be used as an alternative method, perhaps more sensitive, for the detection of the HC retinopathy and the follow up of the patients on hydroxychloroquine.     

糖尿病患者的视网膜电图分析

目的分析糖尿病(DR)患者视网膜电图(F-ERG)的振幅、峰潜时、OPS总和振幅及其与病程的相关性.方法将53例102眼糖尿病患者分为三组(NDR、BDR、PDR),并采用美国UATA-2000型视觉电生理仪对53DR例进行F-ERG检查,主要分析其a、b波峰潜时、振幅、OPS总和振幅.结果随着DR病情的加重,ERG及OPS无波的情况所占比例增大.a波峰潜时BDR组和正常组比较差异有极显著性(P<0.01),BDR组和DM无DR组比较差异有显著性(P[WTBZ〗<0.05);a波振幅正常对照组与其他各组比较差异均有极显著性(P<0.01).b波振幅正常对照组与BDR、PDR间以及DM无DR组与BDR、PDR组间均有极显著性差异(P<0.01).OPS总和振幅除了BDR与PDR间外,其他各组比较差异均有极显著性(P<0.01).结论OPS、ERG之a、b波振幅,尤其是b波振幅,可以作为早期诊断DR患者以及估计预后的敏感指标;良好的血糖控制,可以延缓DM的病情发展.     

多次经瞳孔温热疗法的湿性年龄相关性黄斑变性视网膜色素上皮和脉络膜萎缩:病例报告

目的:报告1例湿性年龄相关性黄斑变性(AMD)在多次经瞳孔温热疗法(TTT)后,脉络膜新生血管(CNV)消退,但发生了视网膜色素上皮(PRE)和脉络膜的萎缩并伴低视力.方法:复习包括眼底照相、眼底荧光素血管造影(FFA)、靛青绿血管造影和干涉光断层扫描在内的临床资料.结果:男性72岁主诉左眼视物模糊,FFA证实为黄斑部息肉状脉络膜血管病变.其左眼的CNV未经任何治疗在6 a间保持0.1的视力.约2 a后,右眼出现一片CNV.在此后3a内,病灶保持或大(3×5 PD)或小(1×2 PD)并伴有明显渗出和出血,先后做了7次TTT,参数为80～280 mW、2 mm光斑、曝光60 s,每次间隔3 mo以上.CNV病灶最终消退,但黄斑部遗留白色区,视力由0.3降至0.04.结论:TTT可使CNV病灶消退,但可发生明显的RPE和脉络膜萎缩,这无益于视力.如果对亚洲患者应用TTT,其参数可低于120 mW/mm,限于2次.