玻璃体切割联合睫状突光凝术治疗新生血管性青光眼

目的：对需行玻璃体手术且并发新生血管性青光眼的患者进行眼内睫状突光凝术,观察术后眼压控制效果及手术安全性。 方法：回顾12例14眼新生血管性青光眼患者,分别继发于糖尿病性视网膜病变、视网膜脱离术后及眼外伤。本术式主要是在玻璃体切除术后立即采用眼内光凝导管直接对睫状突进行光凝,直到睫状突出现白色萎缩或爆破音为止,曝光时间0.1~0.2ms,能量300~500mW。术后随访6mo,分别于术后1wk;1,6mo观察14只新生血管性青光眼的眼压和并发症情况。 结果：本研究发现11眼眼压出现明显下降至正常范围之内。光凝术后1wk平均眼压为16.7±14.4mmHg,1mo为15.7±8.8mmHg,6mo为12.9±4.5mmHg,与治疗前（39.6±10.0mmHg）相比差异具有统计学意义（P〈0.01）。随访期间3眼再次出现眼压升高,因其不具备再次玻璃体手术适应证而给予了经巩膜或内窥镜下睫状体突光凝术。随访期间患眼未出现眼内炎及眼球萎缩等并发症。 结论：眼内睫状突光凝与玻璃体手术同时进行,可同时处理原发疾病和青光眼。该术式可在直视下准确光凝睫状突,对治疗需要玻璃体切除术的新生血管性青光眼是一种较安全有效的方法。     

Y27632体外诱导视网膜色素上皮细胞转分化为神经元样细胞的初步研究

Objective To investigate the feasibility of Y27632 to induce transdifferentiation from human retinal pigment epithelial(hRPE)cells into neuron-like cells in vitro.Methods The third to sixth generation of primary hRPE cells were cultured with 2% fetal bovine serum+Dulbecco's modified eagle medium/F12 culture solution,with(experimental group)or without(control group)10 μmol/L Y27632.At 3,6 hours and 1,3,5,7 days after induction,the morphologic changes of RPE cells were observed by inverted microscope.The expression rate of CK18,Map2,NF200 and Pax6 at 3 days after induction in the experimental and control group were detected by immunofluorescent staining.χ2 test was employed for comparison between the two groups.Results 50.1% cells of the experimental group formed axon-like processes and interconnected each other with typical neuron-like appearance.The expression rates of CK18,Map2,NF200 and Pax6 in the experimental group were 43.88% ,31.90% ,57.45% and 65.79% .while the above indexes in the control group were 93.97% ,4.49% ,22.37% and 8.33% respectively.Compared the expression rate of CK18(χ2=64.763),Map2(χ2=23.634),NF200(χ2=21.261)and Pax6(χ2=25.946)between the two groups,the differences were significant(P＜0.01).Conclusion The hRPE cells can be trans-differentiated into neuron-like cells in vitro bv Y27632.     

25G微创玻璃体手术治疗特发性黄斑前膜

目的探讨25G玻璃体切除手术对特发性黄斑前膜的疗效。方法收集中山大学中山眼科中心43例特发性黄斑前膜手术的资料,其中23眼为传统的20G三通道经睫状体平坦部玻璃体切除手术,20眼为25G经结膜免缝合玻璃体切除手术。对两组平均手术时间、术后视力、眼部表现等进行对比分析,并观察两组术中术后并发症。结果 25G手术时间20～28min,平均25min,20G组30～40min,平均35.5min;两组术后视力改善差异无统计学意义（P〉0.05）。视物变形症状部分消失,大部分明显改善。眼底毛细血管点状出血两组大致相当,20G组1眼黄斑孔形成,无其玻璃体切除手术系统均能有效去除黄斑前膜,显著提高患者视力,并发症少见,25G玻切系统简化手术步骤,增加患者舒适度,提高了手术效率和质量。     

新生血管性青光眼的治疗动态

新生血管性青光眼是临床常见的难治性眼病,其治疗主要包括原发疾病的治疗和降眼压治疗.原发病包括糖尿病性视网膜病变、缺血型视网膜中央静脉阻塞和眼部缺血综合征等.近年来,抗血管内皮生长因子类药物(如Bevacizumab)、多点扫描激光光凝、小梁切除术联合丝裂霉素C、青光眼引流装置、玻璃体切除手术和光动力疗法的应用使新生血管性青光眼的治疗方式有了诸多选择,并取得了较好的效果.本文对新生血管性青光眼的治疗进展进行综述.     

急诊充气性视网膜固定联合气体下激光光凝术治疗视网膜脱离

目的: 探讨充气性视网膜固定术联合气体下激光光凝急诊治疗视网膜脱离的临床疗效、治疗适应证、并发症处理及操作技巧。方法: 分析2011-09/2012-06在我科住院治疗的,PVR级别低于C级、裂孔位于上方6个钟点位的单纯孔源性视网膜脱离患者45例45眼,行充气性视网膜固定术,术后24～48h行气体下裂孔激光光凝术。观察视网膜复位率、最佳矫正视力和并发症。结果: 平均随访10mo。一次手术成功率40眼(88.9%)。术后视网膜下小气泡2眼(4.4%),视网膜下液吸收延迟3眼(6.7%)。新发视网膜裂孔5眼(11.1%),发展为牵拉性视网膜脱离2眼(4.4%),白内障加重1眼(2.2%)。结论: 充气性视网膜固定术联合气下光凝术适用于上方6个钟点位视网膜裂孔和PVR低于C级的病例。与玻璃体视网膜手术或巩膜扣带术相比,该术式能在发现孔源性视网膜脱离后迅速进行视网膜裂孔封闭,治疗环境及医疗设备要求相对宽松,手术技巧难度较低,治疗费用低。其缺点是一次手术成功率较低,术后需要精确的体位控制和密切随访。     

1例春季卡他性结膜炎的循证治疗

目的针对1例难治性春季卡他性结膜炎患者,检索当前最佳的治疗证据,为临床治疗提供参考。方法以1例难治性春季卡他性结膜炎患者为例,介绍如何提出临床问题,怎样检索文献,如何对文献进行评价,怎样结合病例的具体情况和临床医生的个人经验,应用得到的证据拟定治疗方案。结果按照循证医学方法确立的以中西医结合治疗春季卡他性结膜炎2周后,患者症状得到明显改善。结论循证医学是一门非常有意义的学科,根据循证医学的原则,对患者采用中西医结合的方法治疗春季卡他性结膜炎,获得了满意的效果,解决了临床难题,不但让患者及家长满意,医师也提高了理论水平和临床能力。     

Y27632体外诱导视网膜色素上皮细胞转分化为神经元样细胞的初步研究

目的 探讨Y27632在体外诱导成人视网膜色素上皮(RPE)细胞转分化为神经元样细胞的可行性.方法 取生长良好的第3～6代成人RPE接种于6孔培养板,细胞贴壁生长后分为对照组和实验组.对照组培养基为2%胎牛血清(FBS)+Dulbecco改良Eagle培养基(DMEM)/F12培养液,实验组在此培养基中加入10 μmol/L Y27632.于诱导3、6 h和1、3、5、7 d观察细胞形态,并用细胞免疫荧光染色法鉴定诱导后3 d对照组和实验组角蛋白CK18、微管相关蛋白Map2、神经丝蛋白NF200、Pax6的阳性表达率,两组间的比较采用x2检验.结果 实验组经诱导后RPE细胞发出轴突样突起并相互连接成网状,呈现典型的神经元细胞形态,占50.1%.对照组RPE和实验组细胞角蛋白表达阳性率分别为93.97%和43.88%,两组比较差异有统计学意义(x2=64.763,P＜0.01);Map2对照组和实验组阳性率分别为4.49%和31.90%,两组比较差异有统计学意义(x2=23.634,P＜0.01);NF200对照组阳性表达率为22.37%,但阳性表达细胞形态为类圆形,实验组阳性率表达为57.45%,大量细胞发出轴突样突起,两组比较,差异有统计学意义(x2=21.261,P＜0.01);Pax6对照组和实验组细胞阳性率分别为8.33%和65.79%,两组比较,差异有统计学意义(x2=25.946,P＜0.01).结论 Y27632体外诱导成人RPE细胞出现神经元样细胞,是一种可行的诱导方法.

Abstract：

Objective To investigate the feasibility of Y27632 to induce transdifferentiation from human retinal pigment epithelial(hRPE)cells into neuron-like cells in vitro.Methods The third to sixth generation of primary hRPE cells were cultured with 2% fetal bovine serum+Dulbecco's modified eagle medium/F12 culture solution,with(experimental group)or without(control group)10 μmol/L Y27632.At 3,6 hours and 1,3,5,7 days after induction,the morphologic changes of RPE cells were observed by inverted microscope.The expression rate of CK18,Map2,NF200 and Pax6 at 3 days after induction in the experimental and control group were detected by immunofluorescent staining.χ2 test was employed for comparison between the two groups.Results 50.1% cells of the experimental group formed axon-like processes and interconnected each other with typical neuron-like appearance.The expression rates of CK18,Map2,NF200 and Pax6 in the experimental group were 43.88% ,31.90% ,57.45% and 65.79% .while the above indexes in the control group were 93.97% ,4.49% ,22.37% and 8.33% respectively.Compared the expression rate of CK18(χ2=64.763),Map2(χ2=23.634),NF200(χ2=21.261)and Pax6(χ2=25.946)between the two groups,the differences were significant(P＜0.01).Conclusion The hRPE cells can be trans-differentiated into neuron-like cells in vitro bv Y27632.     

Y27632体外诱导视网膜色素上皮细胞转分化为神经元样细胞的初步研究

Objective To investigate the feasibility of Y27632 to induce transdifferentiation from human retinal pigment epithelial(hRPE)cells into neuron-like cells in vitro.Methods The third to sixth generation of primary hRPE cells were cultured with 2% fetal bovine serum+Dulbecco's modified eagle medium/F12 culture solution,with(experimental group)or without(control group)10 μmol/L Y27632.At 3,6 hours and 1,3,5,7 days after induction,the morphologic changes of RPE cells were observed by inverted microscope.The expression rate of CK18,Map2,NF200 and Pax6 at 3 days after induction in the experimental and control group were detected by immunofluorescent staining.χ2 test was employed for comparison between the two groups.Results 50.1% cells of the experimental group formed axon-like processes and interconnected each other with typical neuron-like appearance.The expression rates of CK18,Map2,NF200 and Pax6 in the experimental group were 43.88% ,31.90% ,57.45% and 65.79% .while the above indexes in the control group were 93.97% ,4.49% ,22.37% and 8.33% respectively.Compared the expression rate of CK18(χ2=64.763),Map2(χ2=23.634),NF200(χ2=21.261)and Pax6(χ2=25.946)between the two groups,the differences were significant(P＜0.01).Conclusion The hRPE cells can be trans-differentiated into neuron-like cells in vitro bv Y27632.     

眼白化病Ⅰ型家系致病基因GPR143新突变

目的：对收集的一例眼白化病1型家系的致病基因GPR143进行突变检测。方法抽取先证者两兄弟及其母亲的5ml外周血,酚-氯仿法抽提基因组DNA,通过聚合酶链反应（polymerase chain reaction,PCR）扩增眼白化病1型致病基因GPR143外显子及其相邻的内含子,并进行直接测序。结果 PCR结果显示两眼白化病1型的兄弟第五外显子均无产物,而其他8个外显子均有产物,相同反应条件下其母亲及正常对照组所有外显子都可扩增出产物,证明该眼白化病患者的致病基因GPR143的第五外显子缺如。结论本研究在眼白化病1型的患者的致病基因中发现了整个外显子的缺失突变,扩展了OA1致病基因的突变频谱。     

花冠状常染色体显性遗传性先天性自内障致病基因初步定位

目的 初步定位具有花冠状表型的常染色体显性遗传性先天性白内障一家系的致病基因.方法 收集家系成员的资料,提取基因组DNA,据文献报道在已知先天性白内障致病基因和位点附近,选择合适的短串联重复序列多态性标记,使用LINKAGE 5.1软件计算标准LOD值,对此家系进行连锁分析.结果 此表型先天性白内障的致病基因定位在3q22.3-q25.2,即D3S3612至D3S1594之间15.2 cM范围内.在D3S1569和D3S3599处,得到与致病基因住点连锁的最大LOD值均为3.01(重组率=0.00).结论 该花冠状常染色体显性遗传性先天性白内障致病基因初步定位在第3对染色体上3q22.3-q25.2.