改良晶状体切除术在眼外伤晶状体玻璃体联合术中的应用

目的:探求一种安全有效、并发症少且更适合眼外伤时晶状体玻璃体联合手术的晶状体切除术方式.方法:对27例(27眼)眼外伤行晶状体玻璃体联合手术者进行回顾性研究.所有患者均由睫状体平坦部巩膜切口行改良晶状体切除术,保留晶状体囊,并联合玻璃体视网膜手术.结果:所有患者均成功地切除了晶状体并最大限度保留有用的晶状体囊,患者术后视力均有不同程度的提高.继发性青光眼术后眼压得到控制.结论:该改良晶状体切除术是一种安全有效、并发症少且更适合眼外伤时晶状体玻璃体联合手术的手术方式.     

Characterization and validation of a chronic retinal neovascularization rabbit model by evaluating the efficacy of anti-angiogenic and anti-inflammatory drugs

AIM:To establish a rabbit model with chronic condition of retinal neovascularization(RNV)induced by intravitreal(IVT)injection of DL-2-aminoadipic acid(DL-AAA),a retinal glial(Mül er)cell toxin,extensive characterization of DL-AAA induced angiographic features and the suitability of the model to evaluate anti-angiogenic and anti-inflammatory therapies for ocular vascular diseases.METHODS:DL-AAA(80 mmol/L)was administered IVT into both eyes of Dutch Belted rabbit.Post DL-AAA delivery,clinical ophthalmic examinations were performed weekly following modified Mc Donald-Shadduck Scoring System.Color fundus photography,fluorescein angiography(FA),and optical coherence tomography(OCT)procedures were performed every 2 or 4 wk until stable retinal vascular leakage was observed.Once stable retinal leakage(12 wk post DL-AAA administration)was established,anti-vascular endothelial growth factor(VEGF)(bevacizumab,ranibizumab and aflibercept)and anti-inflammatory(triamcinolone,TAA)drugs were tested for their efficacy after IVT administration.Fluorescein angiograms were scored before and after treatment following a novel grading system,developed for the DL-AAA rabbit model.RESULTS:Post DL-AAA administration,eyes were presented with moderate to severe retinal/choroidal inflammation which was accompanied by intense vitreous flare and presence of inflammatory cells in the vitreous humor.Retinal hemorrhage was restricted to the tips of neo-retinal vessels.FA revealed maximum retinal vascular leakage at 2 wk after DL-AAA injection and then persisted as evidenced by stable mean FA scores in weeks 8 and 12.Retinal vascular angiographic and tomographic features were stable and consistent up to 36 mo among two different staggers induced for RNV at two different occasions.Day 7,mean FA scores showed that 1μg/eye of bevacizumab,ranibizumab,aflibercept and 2μg/eye of TAA suppress 65%,90%,100%and 50%retinal vascular leakage,respectively.Day 30,bevacizumab and TAA continued to show 66%and 44%suppression while ranibizumab effect was becoming less effective(68%).In contrast,aflibercept was still able to fully(100%)suppress vascular leakage on day 30.On day 60,bevacizumab,ranibizumab and TAA showed suppression of 7%,12%,and 9%retinal vascular leakage,respectively,however,aflibercept continued to be more effective showing 50%suppression of vascular leakage.CONCLUSION:The DL-AAA rabbit model mimics RNV angiographic features like RNV and chronic retinal leakage.Based on these features the DL-AAA rabbit model provides an invaluable tool that could be used to test the therapeutic efficacy and duration of action of novel anti-angiogenic formulations,alone or in combination with anti-inflammatory compounds.     

Goldenhar综合征合并眼睑缺损及角膜白斑一例

患儿,男,2岁.因右眼结膜肿物伴闭合不全于2007年11月1日入院.患儿父母述患儿自出生时就发现右眼上睑缺损、右眼结膜肿物,且肿物随年龄增大有增长趋势.患儿为第一胎,系双胞胎(哥哥正常),足月顺产,无吸氧史,母亲孕期无药物服用史,否认家族成员中有类似遗传病史,父母非近亲结婚.     

脉络膜骨瘤1例

1 病例报告 患者,男,54岁,曾因双眼视力下降9月余,伴右眼视物变形、变暗而于5 a前就诊于我院,当时检查视力右眼0.4,左眼0.8,检查右眼黄斑区偏下方有一大小约1×2 DD、边界欠清的黄白色病灶,病灶内有边界清楚的色素条带(图1),当时接诊的医生诊断为"老年黄斑变性,干性型",因此未予特殊治疗.后患者视物变形症状略有好转,但视力一直缓慢逐渐下降,因自觉视力下降严重,而于今年再次就诊,检查视力右眼0.1,左眼0.8,黄斑区黄白色病灶扩大,周围并有神经视网膜脱离.     

Is there a primitive reflex residue underlying Marcus Gunn Syndrome? Rat electrophysiology

AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early "release hypothesis" on pathogenesis of human Marcus Gunn Syndrome(MGS). METHODS: Extracellular unit discharge recording was applied and both orthodromic and spontaneous unitary firing were recorded in the oculomotor nucleus(III), and the complex of pre-oculomotor interstitial nucleus of Cajal and Darkschewitsch nucleus(INC/DN), following electric stimulation of the ipsilateral masseter nerve(MN) in rats. RESULTS: Extracellular orthodromic unit discharges, with latencies of 3.7±1.3 and 4.7±2.9 ms, were recorded unilaterally in the III, and the INC/DN neurons, respectively. Spontaneous unit discharges were also recorded mostly in the INC/DN and less frequently in the III. Train stimulation could prompt either facilitation or inhibition on those spontaneous unit discharges. The inhibition pattern of train stimulation on the spontaneous discharging was rather different in the III and INC/DN. A slow inhibitory pattern in which spontaneous firing rate decreased further and further following repeated train stimulation was observed in the III. While, some high spontaneous firing rate units, responding promptly to the train stimuli with a short-term inhibition and recovered quickly when stimuli are off, were recorded in the INC/DN. However, orthodromic unit discharge was not recorded in the III and INC/DN in a considerable number of experiment animals. CONCLUSION: A residual neuronal circuit might exist in mammals for the primitive jaw-eyelid reflex observed in amphibians, which might not be well-developed in all experimental mammals in current study. Nonetheless, this pathway can be still considered as a neuroanatomic substrate for development of MGS in some cases among all MGS with different kind of etiology.     

上海市徐汇区西南地段眼外伤成因的流行病学调查研究

目的 通过流行病学的调查研究,了解上海市徐汇区西南地段眼外伤成因的相关因素.方法 收集近年在上海市徐汇区西南地段6家医院门诊、急诊及住院部就治的眼外伤病例(510例,526眼),进行流行病学相关因索的问卷调查及临床分析.结果 510例眼外伤中,性别、年龄、职业、致病时间、致伤地点、致伤物种类及眼外伤类型等均与眼外伤成因密切相关.结论 多种因素影响眼外伤的发生率,加强预防是降低眼外伤发生率的关键.     

儿童频繁瞬目病因分析

目的:探讨儿童眼部疾患与频繁瞬目的可能原因.方法:对60例频繁瞬目患儿,通过详细询问病史,进行视力、眼位、结膜、角膜并10g/L阿托品散瞳验光检查,裂隙灯显微镜检查,直接检眼镜检查眼底.结果:60例受检者中,存在屈光不正者为41例,占总数68%,存在结膜炎者为51例(包括屈光不正与视力正常者),其中并发结膜结石者为17例,并发浅层角膜炎者为2例,并发倒睫为13例,其余19例为无并发症的结膜炎,伴有挤眉、努嘴、歪颈等多余动作者4例.结论:儿童频繁瞬目是一个病因较为复杂的眼科常见病,受眼部疾患、生理、药物、环境等多方面因素影响,一定要认真分析原因,详细检查,才不致漏诊或误诊.     

Effect of luteolin on apoptosis and vascular endothelial growth factor in human choroidal melanoma cells

AIM:To investigate the effects of luteolin on apoptosis,the cell cycle,and the expression and secretion of vascular endothelial growth factor(VEGF)in human choroidal melanoma cells(C918 and OCM-1).METHODS:C918 and OCM-1 cells cultured in vitro were treated with various concentrations of luteolin(0,5,10,15μmol/L).Cell growth was observed with an inverted microscope,and cell cycle arrest was detected by propidium iodide(PI)staining using flow cytometry.Apoptosis was detected by Hoechst33342 staining,and apoptosis rate was determined by Annexin V-FITC/PI experiments using flow cytometry.The expression of apoptosis-related proteins Bcl-2,Bax and VEGF was analyzed using Western blots.The levels of VEGF secreted by the cells into the supernatant was analyzed using ELISA.RESULTS:After treating with 5 to 15μmol/L luteolin for 48 h,the fusion degree of C918 and OCM-1 cells decreased,and more floating apoptotic cells appeared.Luteolin treatment increased the G0-G1 phase ratio of the C918 and OCM-1 cells,blocked cell cycle progression,and increased the apoptosis rate of the C918 and OCM-1 cells.Western blot showed that luteolin decreased the expression of Bcl-2 and VEGF in the C918 and OCM-1 cells and increased the expression of Bax protein.The ELISA results showed that 10 to 15μmol/L luteolin decreased the cell secretion of VEGF.CONCLUSION:Luteolin may induce apoptosis by regulating the levels of apoptosis-related proteins in C918 and OCM-1 cells.Luteolin can induce cell cycle arrest,decrease the expression of VEGF.     

Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography

AIM:To elucidate the changes of different ganglion cell layer(GCL)thinning patterns between the optic neuritis(ON)and non-arteritic anterior ischemic optic neuropathy(NAION).METHODS:A prospective,observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography.RESULTS:Thinning on optical coherence tomography in the NAION group occurs as early as 11 d after symptomatic onset of vision loss and follows an altitudinal pattern.The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7μm in the NAION cohort compared to controls of 0.8μm(P=0.032),but not significant in the ON group compared to controls with both groups measuring 1.1μm.Global thinning was significant for the ON group compared to controls at 7.2μm(P=0.011)but not the NAION group compared to controls at 1.35μm.CONCLUSION:These findings suggest that future treatments for NAION should be given early,and possibly before 11 d in order to prevent GCL and irreversible vision loss.     

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM:To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation(phaco-vitrectomy)in idiopathic macular holes(IMH).METHODS:A total of 56 eyes with IMH(IMH group)that underwent phaco-vitrectomy and 44 eyes with age-related cataract(ARC group)that underwent cataract surgery were retrospectively reviewed.The best corrective visual acuity(BCVA),predicted refractive error(PRE),actual refractive error(ARE),axial length(AL),were measured in both groups before and 6 mo after operation.The power calculation of IOL and the predicted refractive error(PRE)were calculated according to the SRK/T formula.The difference of PRE and ARE between the two groups were compared and analyzed.RESULTS:In the IMH group,the diameters of macular holes were 271.73±75.85μm,the closure rate was 100%.The pre-and post-operative BCVA were 0.80±0.35 and 0.40±0.35 log MAR.The PRE of A-ultrasound and IOL Master in the IMH group was-0.27±0.25 and 0.10±0.66 D.The postoperative mean absolute prediction error(MAE)was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound(P=0.758).The PRE and ARE of the IMH group were 0.10±0.66 D and-0.19±0.64 D(P=0.102).The PRE and ARE of the ARC group was-0.43±0.95 and-0.31±0.93 D(P=0.383).The difference between PRE and ARE was-0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups(P=0.021).The proportion of myopic shift was 67.9%in the IMH group and 27.3%in the ARC group(P=0.004).CONCLUSION:The myopic shift can be observed in patients with IMH after phaco-vitrectomy.     

碱性成纤维细胞生长因子应用于羟基磷灰石眶内植入物的研究

目的 观察不同浓度的碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF)对羟基磷灰石（hydroxyapatite,HA）植入物纤维血管化的作用。方法 将36只新西兰白兔随机分为A、B、C、D4组,每组9只,各组均采用HA植入物植入兔眼眶。A组为对照组,B、C、D组在HA球植入术前将植入物分别浸泡于浓度为0.5、1.5及5.0g/L国产重组bFGF溶液中,术后B、D、D组术眼分别滴用上述不同浓度bFGF的眼液。各组分别于术后14、28及42d摘取HA植入物行组织学检查,并比较各组不同时间的植入物纤维血管化的情况。结果 术后14d,纤维血管从HA植入物外周长植入物内距离,C、D与A、B组比较,差异有显著性（χ^2=9.0,P=0.029）。结论 1.5及5.0g/L浓度的bFGF液对HA植术物术后早期的纤维血管化具有促进作用。     

Effect of basic fibroblast growth factor on fibrovascular ingrowth into porous polyethylene anophthalmic socket implants

To investigate the effect of basic Fibroblast Growth Factor (bFGF) on fibrovascular ingrowth into porous polyethylene orbital implants (Medpor) and to investigate any differences according to the method of administration. For the treated groups, after evisceration and Medpor implantation, bFGF was administered by soaking Medpor in the bFGF solution, and/or by injecting bFGF into the Medpor 1 week after the operation. Implants were removed 4 weeks after the operation and examined for the degrees of fibrovascular ingrowth by light microscopy. The percentages of the cross-sectional area of the implant occupied by fibrovascular ingrowth and the numbers of proliferated vessels were significantly higher in the bFGF-treated groups (Mann Whitney test, p<0.05). Administration routes had no effect on the degree of fibrovascular ingrowth (Kruskal-Wallis test, p>0.05). bFGF promoted fibrovascular ingrowth into porous polyethylene orbital implants regardless of the route of administration. Therefore, bFGF might be helpful to prevent complications such as implant exposure.     

血管内皮细胞生长因子应用于羟基磷灰石眶内植入物的研究

目的观察不同质量浓度的血管内皮生长因子（VEGF）对羟基磷灰石（HA）植入物纤维血管化的作用。方法将24只新西兰白兔随机分为A、B、C、D4组，每组6只。各组均采用自体深筋膜覆盖HA植入物植入兔眼眶。A组为对照组，B、C、D组将HA义眼台植入前分别浸泡于质量浓度为0．5、1．5、2．5g／LVEGF溶液中，术后分别点用上述不同质量浓度VEGF滴眼液，每日4次，连续28d。术后14、21、28d各组取出2个HA植入物行组织学病理学检查，比较植入物纤维血管化的情况。结果术后14d，各组间纤维血管长度的平均值差异无统计学意义（F＝34．12，P〉0．05）；术后21d，各组间纤维血管长度的平均值差异有统计学意义（F=4．21，P〈0．05）；术后28d，各组间纤维血管长度的平均值差异无统计学意义（F=27．67，P〉0．05）。术后14d，各组HA植入物纤维血管化程度级别差异无统计学意义（H=0．072，P〉0．05）；术后21d，各组HA植入物纤维血管化程度级别差异有统计学意义（H=3．684，P〈0．05）；术后28d，各组HA植入物纤维血管化程度级别差异有统计学意义（H=4．318，P〈0．05）。结论质量浓度为1．5g／L及2．5g/L的VEGF对HA植入物术后早期的纤维血管化具有促进作用。     

兔眶内植入国产珊瑚羟基磷灰石的实验研究

目的：探讨国产珊瑚羟基磷灰石（ＨＡ）眶内植入物的生物相容性以及植入兔眶内后纤维血管化情况。方法：在１８只兔眶内植入国产珊瑚ＨＡ,于术后定期取出植入物作光镜与透射电镜检查,结果：１８例中有２例出现植入物暴露,无发生植入物暴露的组织学改变显示;术后６周时植入物已全部纤维血管化,公有少许为症细胞;发生植入物暴露的组织学改变显示;植入物外围少许纤维血管长进,内围大量炎症细胞浸润。结论：①国产珊瑚ＡＨ具有良     

Effects of hyperbaric oxygen therapy on hydroxyapatite orbital implant vascularization in rabbits

PURPOSE: To deterrmine if hyperbaric oxygen therapy affects the rate of hydroxyapatite orbital implant vascularization in normal rabbit orbits. METHODS: We performed a randomized comparative experimental pilot study involving 6 rabbits. All rabbits were enucleated and implanted with hydroxyapatite orbital spheres. The animals were randomized for enucleation of the right or left eye and for treatment or nontreatment (control) with hyperbaric oxygen. The implants were removed after 3 weeks of treatment and histologically examined for fibrovascular ingrowth, inflammation, and multinucleated giant cells. Each parameter was graded on a numeric scale and analyzed. RESULTS: Hyperbaric oxygen therapy did not increase implant vascularization compared with nontreatment implants. Although treated implants had less central fibrovascular maturity compared with control implants, the difference was not statistically significant (p < 0.055). There was no significant difference in inflammation or the number of multinucleated giant cells between treated and control implants. CONCLUSIONS: In this pilot study, hyperbaric oxygen therapy did not increase hydroxyapatite vascular ingrowth and possibly delayed fibrovascular maturation in normal sockets. Further studies with more subject numbers are needed to confirm these conclusions. The effect of hyperbaric oxygen therapy in vascularly compromised sockets also needs to be determined.     

羟基磷灰石义眼台纤维血管化的MRI实验研究

目的用磁共振成像（MRI）研究兔眼眶内植入羟基磷灰石（HA）义眼台血管化过程，探讨义眼台血管化MRI的表现和特点。方法12只新西兰白兔眼眶内植入直径12mm天然HA义眼台，于术后第1、2、3、4、5、6周对所有手术兔行双眼磁共振（MR）平扫及Gd—DTPA增强扫描，计算义眼台强化区体积与义眼台体积比值（VE／VHA），对结果用方差分析（q检验）。并于第2、4周随机抽取2只，第6周对剩余动物义眼台行组织病理学检查。结果术后第1、2、3、4周VE／VHA值逐渐增加，均数间比较差异有统计学意义（F=240．654，P=0．000），第4周与第5、6周比较差异无统计学意义（F=0．686，P=0．520）。术后第2周病理显示义眼台周边有纤维血管生长，第4、6周整个义眼台完全血管化。结论MRI可直观、准确地评价义眼台血管化的程度和范围。     

The influence of hyperbaric oxygen therapy and irradiation on hydroxyapatite ocular implant exposure and fibrovascular ingrowth in New Zealand white rabbits

PURPOSE: Lack of adequate fibrovascular ingrowth has been implicated as a cause of exposure of hydroxyapatite (HA) implants in anophthalmic sockets. We investigated the vasculopathic effects of external beam irradiation, and the fibrovascular-enhancement effects of hyperbaric oxygen (HBO), on HA implant exposure and fibrovascular ingrowth in a rabbit model. METHODS: Eighteen rabbits underwent enucleation with implantation of a 12-mm HA sphere. Six rabbits received 20 Gy of external beam orbital irradiation prior to enucleation. Three irradiated and 6 nonirradiated rabbits received postoperative HBO. Three weeks postoperatively, all rabbits were evaluated clinically for evidence of implant exposure. Implants were then removed, and histopathologic analysis of fibrovascular ingrowth was performed. RESULTS: The amount of vascularization as measured by the depth of ingrowth was greater for nonirradiated (89% ingrowth) than for irradiated (71% ingrowth) animals. HA implant exposure occurred in 1 of 12 (8%) of the nonirradiated, and 4 of 6 (67%) of the irradiated rabbit orbits. HBO did not protect irradiated rabbits from exposure, but did enhance fibrovascular ingrowth in nonirradiated rabbits (100% ingrowth vs. 77% ingrowth). CONCLUSION: Impaired orbital vascularization from prior irradiation appears to retard fibrovascular ingrowth into HA implants, and is associated with an increased incidence of exposure. While HBO did not diminish the likelihood of exposure in irradiated sockets, HA fibrovascular ingrowth in normal orbits appeared to increase with HBO. This may have beneficial clinical application in cases of exposure in nonirradiated orbits.     

Fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants wrapped with acellular dermis

PURPOSE: Acellular dermis is a frequently used wrapping material for hydroxyapatite (HA) and porous polyethylene (PP) orbital implants. In an animal model, we determined by histology the extent of fibrovascular ingrowth within orbital implants wrapped in acellular dermis at 6 and 12 weeks after surgery. METHODS: Four Yucatan minipigs were used for the study. Two minipigs had HA implants and two had PP implants. Implants were harvested at 6 or 12 weeks after surgery and were examined histologically for fibrovascular ingrowth. RESULTS: There was complete fibrovascularization of HA implants harvested at both 6 and 12 weeks after surgery. The PP implant harvested at 6 weeks had incomplete fibrovascularization, whereas the PP implant harvested at 12 weeks had complete fibrovascular ingrowth. There was no histologic evidence of inflammation seen in any of the orbital implants. On gross and histologic examination, the wraps were found to persist on the surface of all orbital implants, with little histologic evidence of inflammation localized to the acellular dermis. CONCLUSIONS: Acellular dermis wraps support fibrovascularization of both HA and PP orbital implants. Additionally, acellular dermis does not incite significant inflammation in association with HA and PP orbital implants and can persist in situ for at least 12 weeks after surgery.     

Bovine hydroxyapatite orbital implant: a preliminary report

PURPOSE: To determine the safety and efficacy of bovine hydroxyapatite as an orbital implant material. METHODS: Prospective, consecutive case series of patients undergoing enucleation, evisceration, or secondary orbital implantation. A motility peg was placed in all consenting candidates. Patients were followed 1 week, 1 month, and several months after surgery for signs of inflammation, infection, extrusion, or other complication. RESULTS: Twenty-seven patients received a bovine hydroxyapatite orbital implant. Magnetic resonance imaging was obtained in 3 patients (3 orbits) approximately 4 weeks after surgery and showed signs of peripheral fibrovascular ingrowth in all three cases. Magnetic resonance imaging was obtained in 9 patients (9 orbits) 4 to 12 months after surgery and showed signs of incomplete fibrovascular ingrowth in 1 of 9 (11%) cases, subtotal fibrovascular ingrowth in 2 of 9 (22%) cases, and complete fibrovascular ingrowth in 6 of 9 (67%) of cases. Complications included postoperative chemosis in 3 cases (11%) and exposure requiring reoperation in 2 cases (7%). Motility peg placement was performed successfully in 5 patients (5 orbits). CONCLUSIONS: Bovine hydroxyapatite appears to be a safe and effective orbital implant material. The material appears to be biocompatible and nonallergenic. Bovine hydroxyapatite allows for fibrovascular integration and motility peg placement.     

羟基磷灰石义眼台纤维血管化的实验研究

目的 研究手术方式对兔眼窝植入羟基磷灰石义眼台纤维血管化的影响。方法 将36只新西兰大白兔随机分为4组，分别对其左眼实施半巩膜壳内(A组)、多孔巩膜壳内(B组)、全巩膜壳内(C组)或巩膜瓣遮盖肌锥内(D组)4种不同术式义眼台植入术。不同时间采用Tc-99MDP显像或病理检查法检测各组义眼台纤维血管化程度。结果 第1、2周及第8周，各组间平均L／R值差异无显著性意义；第4周(F=7．482，P=0．009)和第6周(F=6．676，P=0．034)，C组低于其他3组，而A、B、D组间比较差异无显著性意义。第8周病理检查各组义眼台纤维血管化程度差异无显著性意义。结论 半巩膜壳内或多孔巩膜壳内植入义眼台效果最佳。