糖尿病患者白内障与老年性白内障超声乳化术前后房水蛋白浓度变化的比较

目的　通过检测老年性白内障与糖尿病患者白内障超声乳化白内障吸除并人工晶体植入手术前后房水蛋白浓度的变化 ,评估该手术对眼血 -房水屏障的影响。方法　对 60例 (64眼 )老年性白内障患者及 5 2例 (5 6眼 )伴发糖尿病的白内障患者 (3 4眼非增殖型糖尿病性视网膜病变 ,2 2眼伴增殖型糖尿病性视网膜病变 ) ,应用激光闪光细胞检测仪 (Laserflarecellmeter ,LFCM )定量检测超声乳化白内障吸除并人工晶体植入术前、术后前房蛋白浓度。结果　术前 ,伴增殖型糖尿病性视网膜病变患者的前房蛋白浓度高于老年性白内障和非增殖型糖尿病性视网膜病变白内障患者 ,且差异有显著性 (P <0 0 5 ) ;而老年性白内障和非增殖型糖尿病性视网膜病变白内障患者间的房水蛋白浓度无明显差别。各组术后 1天、 7天及 3 0天的房水蛋白浓度均较术前高 ,并有显著性差别 (P <0 0 5 )。术后 90天时 ,老年性白内障和非增殖型糖尿病性视网膜病变白内障患者的房水蛋白浓度与术前无显著性差别 ;但伴增殖型糖尿病性视网膜病变患者的仍高于术前水平 ,且差异有显著性 (P <0 0 5 )。结论　对于老年性白内障患者与非增殖型糖尿病性视网膜病变的白内障患者 ,超声乳化吸除并折叠式人工晶体植入手术后眼血 -房水屏障功能均可在短期内恢复 ,而对     

αB-晶状体蛋白在糖尿病视网膜病变患者晶状体上皮细胞中的表达

目的　探究糖尿病视网膜病变（DR）患者晶状体上皮细胞（LEC）中αB-晶状体蛋白的表达及其与DR发生发展的关系。方法　选取东南大学附属中大医院眼科2018年5月至2019年4月收治的年龄相关性白内障和糖尿病并发性白内障患者98例（98眼）,根据血糖及眼底检查将其分为非糖尿病（NDM）组、非糖尿病视网膜病变（NDR）组、非增生型糖尿病视网膜病变（NPDR）组和增生型糖尿病视网膜病变（PDR）组,均进行超声乳化白内障吸除联合人工晶状体植入术,分别收集四组患者晶状体前囊膜,采用免疫荧光染色检测、Western blot检测患者LEC中αB-晶状体蛋白的分布及表达水平。结果　αB-晶状体蛋白在LEC细胞核及细胞质中均有表达。免疫荧光染色结果显示,NDM组、NDR组、NPDR组、PDR组患者LEC中αB-晶状体蛋白的阳性表达率逐渐增高（P<0.001）;与NDM组相比,NPDR组、PDR组患者LEC中αB-晶状体蛋白的阳性表达率均显著升高,差异均有统计学意义（均为P<0.05）;PDR组患者LEC中αB-晶状体蛋白的阳性表达率高于NDR组,差异有统计学意义（P<0.05）;余组间两两比较差异均无统计学意义（均为P>0.05）。Western blot检测结果显示,NDM组、NDR组、NPDR组和PDR组患者LEC中αB-晶状体蛋白的相对表达量分别为2.02±0.83、2.30±0.79、3.94±1.15和 5.69±1.23,四组患者间差异有统计学意义（P<0.01);NDR组患者与NDM组患者LEC中αB-晶状体蛋白相对表达量差异无统计学意义（P>0.05）; NPDR组患者LEC中αB-晶状体蛋白相对表达量均明显高于NDM、NDR组,差异均有统计学意义（均为P<0.05）;而PDR组患者LEC中αB-晶状体蛋白相对表达量均高于其余三组,差异均有统计学意义（均为P<0.05）。结论　LEC中αB-晶状体蛋白的表达水平与DR的发生发展正相关。αB-晶状体蛋白可能通过参与眼内新生血管的形成,对DR的发生发展起促进作用。     

超声乳化白内障吸除术对血-房水屏障功能的影响

目的　观察小切口超声乳化白内障吸除人工晶状体植入术及相关因素对血 房水屏障功能的影响。方法　使用激光蛋白细胞检测仪对 60例 (64只眼 )白内障患者超声乳化白内障吸除人工晶状体植入术前、后的房水蛋白浓度进行定量检测 ,记录并比较闪光值。术后随访时间为 3个月。结果　超声乳化白内障吸除人工晶状体植入术前 ,术后 1d、1周、1个月及 3个月术眼房水的平均闪光值分别为 (6 94± 0 3 4 )、(2 6 2 7± 1 3 7)、(13 96± 1 0 5)、(9 0 7± 0 43 )及 (7 16± 0 2 7)光粒子数 /ms ,其中术后 1d、1周及 1个月高于术前 ,且差异均有显著意义 (P <0 0 5) ;术后 3个月与术前比较 ,差异无显著意义 (P >0 0 5)。术后早期术眼房水蛋白浓度与患者年龄呈正相关 (r =0 40 0 ,P =0 0 0 1) ,与患者的性别和眼别均无相关。术中虹膜脱出者术后 1d和 1周血 房水屏障功能破坏严重。结论　超声乳化白内障吸除人工晶状体植入术在术后短期内影响术眼的血 房水屏障功能 ;激光蛋白细胞检测仪可动态评价超声乳化白内障吸除术对血 房水屏障功能的影响。 (中华眼科杂志 ,2 0 0 4,40 :2 6 2 9)     

Anterior chamber inflammation following cataract surgery in patients with non-insulin-dependent diabetes mellitus

PURPOSE: The aim of the study was to estimate the early breakdown of the blood-aqueous barrier (BAB) following uneventful cataract surgery in patients with non-insulin dependent diabetes mellitus. MATERIAL AND METHODS: Aqueous flare was estimated in 54 diabetic eyes before and after cataract surgery. Fifteen eyes underwent uneventful ECCE (extracapsular cataract extraction with "can opener" capsulotomy) and 39 phacoemulsification with continuous curvilinear capsulorhexis. All procedures were performed by experienced surgeons. Fifty six eyes of age-matched healthy patients undergoing uncomplicated cataract surgery served, as control. Anterior chamber flare was quantified preoperatively, 1 and 3 days postoperatively, using laser-flare meter (Kowa FM-500). Laser flare values were expressed in photon counts/millisecond. RESULTS: Mean preoperative anterior chamber flare in diabetes type 2 was as follows: normal fundus--6.7, background retinopathy--8.6 and proliferative retinopathy--14.1 (p < 0.01 vs NF group). Significantly lower anterior chamber flare measurements following phacoemulsification (25.0-1 day, 17.8-3 days post surgery), than after ECCE (63.7 and 45.6, respectively) (p < 0.01) were observed in diabetic eyes. In phaco group, we noted lower flare values in eyes without retinopathy; 25.2-1 day, 14.0-3 days post surgery, than in proliferative retinopathy (31.5 and 28.4, respectively) (p < 0.05 vs no retinopathy group). CONCLUSIONS: Phacoemulsification, as a less traumatising technique produces less BAB breakdown and seems to be more suitable than ECCE in diabetic eyes. Following phacoemulsification, eyes with proliferative retinopathy had significantly higher flare values than eyes without retinopathy.     

青光眼滤过手术患者超声乳化白内障吸除术后血-房水屏障功能的改变

目的从血房水屏障功能方面评价青光眼滤过手术后白内障患者行超声乳化白内障吸除人工晶状体植入术的安全性。方法分别对40例(46只眼)青光眼滤过手术后白内障患者(试验组)和60例(64只眼)老年性白内障患者(对照组)行超声乳化白内障吸除人工晶状体植入术,使用激光蛋白细胞检测仪(LFCM)定量检测术前和术后1、7、30、90d房水蛋白浓度的变化,并进行比较。结果超声乳化白内障吸除人工晶状体植入术前及术后1、7、30、90d术眼平均房水闪光值试验组分别为(1512±287)、(4024±375)、(2433±338)、(2118±177)、(1651±170)光粒子数(PC)/ms,差异有统计学意义(P<005);对照组分别为(694±234)、(2627±1021)、(1396±644)、(907±267)、(716±189)PC/ms,差异有统计学意义(P<005)。其中2组术后1、7、30d均高于术前(P<005);术后90d与术前比较,差异均无统计学意义(P>005)。术前和术后1、7、30、90d2组平均房水闪光值比较,差异均有统计学意义(P<005)。试验组术后1d和30d与术前平均房水闪光值的差值均高于对照组(P<005)。结论青光眼滤过手术后患者血房水屏障功能紊乱;超声乳化白内障吸除人工晶状体植入术治疗青光眼滤过手术后白内障患者具有安全性,但加强抗炎性反应治疗,减轻手术损伤,是保证手术安全性的关键。     

Increased permeability of the blood-aqueous barrier after panretinal photocoagulation for proliferative diabetic retinopathy.

PURPOSE: To measure the permeability of the blood-aqueous barrier before and after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy. METHODS: Twenty patients with diabetic proliferative retinopathy in one eye and background retinopathy in the other eye were included. PRP was performed in the proliferative eye, while the other eye served as control. Aqueous flare intensity was measured with a laser flare cell meter before, 10 and 90 days after treatment. RESULTS: The flare was stable in the control eye with a flare of 4.5+/-2.3, 4.4+/-2.4, and 4.5+/-1.7 photon counts/ms (mean+/-standard deviation) on Day 0, 10 and 90. In the laser treated eye corresponding figures were 5.2+/-2.4, 9.6+/-3.3, and 7.1+/-2.8 photon counts/ms, with a significant increase in aqueous flare at 10 days (p<0.001) and 90 days (p=0.002). CONCLUSION: A significant increase in aqueous flare was found 10 days after PRP, indicating a breakdown of the blood-aqueous barrier after retinal laser treatment. The breakdown was still present, however, less pronounced, after 3 months.     

Cataract surgery on diabetic patients. A prospective evaluation of risk factors and complications

PURPOSE: This study presents an evaluation of cataract surgery on diabetic patients. One experienced surgeon carried out phaco emulsification on all subjects and the same surface-coated one-piece PMMA-lens-type was implanted. The lens fluorescence and the blood-aqueous barrier (BAB) were then evaluated as experimental preoperative risk indicators. RESULTS: During follow-up, 10 out of 39 diabetic patients progressed unilaterally in diabetic retinopathy or developed macular oedema, a significant relative risk. Neither lens fluorescence, BAB, HbA1c, level of retinopathy, type/duration of diabetes, diabetes treatment or antihypertensive treatment differed significantly between the group of patients with postoperative progression of retinopathy/macular oedema and those without. Results indicated NIDDM (non-insulin-dependent diabetes mellitus/type 2 diabetes) patients might have increased risk of a postoperative macular oedema. CONCLUSION: When diabetic retinopathy (DR) is not in a proliferative phase it should not be regarded as a contraindication to modern cataract surgery. Neither lens fluorescence nor BAB is valuable as a risk indicator for postoperative progression of DR.     

脉络膜厚度对糖尿病患者视网膜病变病情影响的研究

目的研究脉络膜厚度对糖尿病患者视网膜病变病情的影响。方法选取于我院2013年1月至2015年12月收治的90例糖尿病患者作为治疗对象,早期糖尿病视网膜病变(DR)治疗研究(ETDRS)标准规定DR可分为5类:无DR无糖尿病黄斑水肿(DR-/DME-)组17例(17只眼);非增生型糖尿病视网膜病变(NPDR)无糖尿病黄斑水肿(NPDR+/DME-)组23例(23只眼);增生型糖尿病视网膜病变(PDR)无糖尿病黄斑水肿(PDR+/DME-)组10例(10只眼);NPDR伴糖尿病黄斑水肿(NPDR+/DME+)组34例(34只眼);PDR伴糖尿病黄斑水肿(PDR+/DME+)组6例(6只眼)。对照组选取同期在我院体检中心进行体检的90例健康体检者。全部研究对象进行增强深部成像相干光断层扫描(EDI-OCT)。对中心凹下脉络膜厚度(SFCT)进行比较,判断其在不同阶段DR中存在的差异,分析脉络膜厚度对DR病情的影响。结果对照组、无DR无糖尿病黄斑水肿组、NPDR无糖尿病黄斑水肿组、PDR无糖尿病黄斑水肿组、NPDR伴糖尿病黄斑水肿组、PDR伴糖尿病黄斑水肿的SFCT平均值分别为(273士24)、(272±23)、(260±26)、(244士25)、(227±27)、(214±30);对照组各组SFCT均大于观察组,差异具有统计学意义(P<0.05),其中PDR无糖尿病黄斑水肿(PDR+/DME-)组SFCT值小于无DR无糖尿病黄斑水肿(DR-/DME-)组,差异具有统计学意义(P<0.05),NPDR伴糖尿病黄斑水肿(NPDR+/DME+)组SFCT值小于PDR无糖尿病黄斑水肿(PDR+/DME-)组,差异具有统计学意义(P<0.05)。结论脉络膜厚度的变化与DR之间存在联系,二者相互影响,使病情加重,对患者脉络膜厚度进行监测,将有助于综合分析糖尿病患者的视网膜病变情况。     

Concentration of haemodynamic and inflammatory related cytokines in diabetic retinopathy

AIM: There are changes in blood flow during the clinical stages of diabetic retinopathy with increasing leukostasis and secondary elaboration of cytokines. This study evaluated the vitreous concentrations of haemodynamic-related (endothelin-1 (ET-1) and nitric oxide (NO)), inflammatory and anti-inflammatory (interleukin-1 receptor antagonist, IL-1 Ra) cytokines in the diabetic patients (with nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR)), compared them with those of control patients (full thickness macular hole, FTMH) and correlated to macular structural indices. METHOD: Vitreous samples from five FTMH patients representing normal controls were analysed together with the vitreous samples of 15 patients with NPDR and five with PDR. The vitreous concentrations of nitrite (total NO), ET-1, and prostacyclin was determined using ELISA kits (R&D Systems, Minneapolis, MN, USA) according to the manufacturer's instructions. A sandwich luminescent immunoassay technique was used to determine IL-1beta and IL-1 Ra concentrations. RESULTS: In the different clinical groups, there were no differences in the vitreous NO and prostacyclin concentrations. In NPDR, the median ET-1 concentration (0.7 pg/ml SD +/-0.8 pg/ml) was significantly reduced (P<0.05), compared to PDR (6.35 pg/ml SD +/-0.6 pg/ml) and FTMH (3.6 pg/ml SD +/-0.14 pg/ml). Its concentration also positively correlated with foveal thickness and macular volume (P<0.05) in patients with NPDR and macular oedema. IL-1 beta was detected in PDR, and diabetic patients demonstrated a lower concentration of the anti-inflammatory cytokine IL-1 Ra. CONCLUSION: Reduced concentrations of ET-1 in NPDR may reflect the haemodynamic changes of NPDR. The IL-1 Ra concentration suggests a change in the anti-inflammatory environment of the diabetic retina.     

Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.