有限切开腱周内缝合法治疗新鲜闭合性跟腱断裂

目的探讨新鲜闭合性跟腱断裂有限切开腱周内缝合术的初步临床应用结果。方法对27例新鲜闭合性跟腱断裂患者采用有限切开腱周内缝合术修复跟腱。采用Amer-Lindholm疗效评定标准进行功能评价。结果平均随访32个月,无感染及跟腱再断裂,腓肠神经支配区皮肤感觉正常。功能评定：优23便（85．2％）,良4例（14．8％）。结论有限切开腱周内缝合法治疗新鲜闭合性跟腱断裂,能有效保护断端血运,创伤小,再断裂及感染机会少,功能恢复好,是治疗新鲜闭合性跟腱断裂的又一选择。     

Drug delivery techniques for treating age-related macular degeneration

Introduction: Currently, the standard therapy for neovascular age-related macular degeneration involves the use of anti-vascular endothelial growth factor (VEGF) drugs, which are delivered by repeated office-based intravitreal injections. This treatment is generally very effective in stabilizing or improving vision, although repeated injections create a burden for patients, family members and physicians. In addition, the cumulative risks of endophthalmitis and other complications increase with the number of injections.

Areas covered: In the clinic, much attention is focused on the relative efficacies of the three major anti-VEGF medications (bevacizumab, ranibizumab and aflibercept) as well as the most popular re-injection regimens (monthly, as-needed and treat-and-extend). In theory, intravitreal anti-VEGF drug delivery with sustained-release devices would offer similar visual results with fewer required re-injections. Various approaches have been studied, including noninvasive techniques, intraocular implants and colloidal carriers, such as liposomes, microparticles and nanoparticles.

Expert opinion: Despite its theoretical appeal, sustained-release drug delivery will not replace current techniques unless it offers one or more advantages in efficacy, safety, convenience or cost. Currently, many patients maintain stable vision with intravitreal injections at intervals of 2 months or longer, so sustained-release techniques will have to lengthen these intervals substantially to become widely accepted. As we continue to collect data from clinical trials, the role of sustained-release techniques will become better defined.     

DAL-1基因与肿瘤

人类DAL-1基因编码4.1B蛋白,是膜/细胞骨架相关蛋白4.1超家族成员之一,参与维持细胞正常形态和生理功能。在人类大多数肿瘤中DAL-1基因表达下调,研究表明其功能失活与该基因启动子区CpG岛甲基化密切相关。本综述将侧重DAL-1基因在肿瘤发生发展中的研究进展。     

雷公藤红素对裸鼠肝癌皮下移植瘤抑制作用的研究

目的 研究天然活性化合物雷公藤红素（celastrol）对裸鼠移植肿瘤的抑制作用。方法 建立人源肝癌HepG2细胞的裸鼠皮下移植肿瘤模型。20只裸鼠随机分为4组,即空白对照组和雷公藤红素高剂量组、中剂量组和低剂量组,每组分别按4.0 mg/kg、2.0 mg/kg、1.0 mg/kg雷公藤红素腹腔给药,每日一次,每周5 d,共给药30 d,实验中每5 d测量一次肿瘤体积的变化。结果 雷公藤红素高剂量组、中剂量组和低剂量组的体积抑瘤率分别是89.52%、65.60%和12.21%,与空白对照组相比,高剂量组、中剂量组的差异具有统计学意义（P〈0.05）。高剂量雷公藤红素给药后对裸鼠肝脏和肾脏等产生严重的毒性反应。结论 雷公藤红素对裸鼠肝癌皮下移植瘤具有良好的体内抗肿瘤效果,应进一步开展药物新剂型及分子结构优化方面的研究,减少其毒副反应。     

A Population-based Study of Corneal Arcus and its Risk Factors in Iran

Purpose: To determine the prevalence of corneal arcus, its risk factors, and its relationship to ocular and visual indices.

Methods: In this cross-sectional study, 300 clusters were randomly selected from Shahroud in the north of Iran, using multistage sampling. A total of 20 people were invited to participate from each cluster. After enrollment, all optometric, biometric and ophthalmic exams were conducted on site.

Results: Of 6311 people invited, 5190 (82.2%) participated in the study. The prevalence of corneal arcus was 23.3% (95% confidence interval, CI, 22.1–24.6), and 98.4% were bilateral cases. The prevalence of corneal arcus was higher in men (odds ratio, OR, 2.02, 95% CI 1.8–2.3, p?p?p?=?0.006), male sex (OR 1.30, p?=?0.001), diabetes (OR 0.7, p?p?=?0.003), outdoor activity (OR 1.4, p?=?0.006), systolic blood pressure (OR 1.01, p?=?0.012), and diastolic blood pressure (OR 0.99, p?=?0.016) were significantly correlated with corneal arcus. Including biometric components in another model, corneal thickness (OR 0.99, p?p?p?Conclusion: This study adds valuable information to the epidemiology of corneal arcus in Iran and the Middle East. In people aged over 60 years, nearly 50% of the study population had corneal arcus. Older age, male sex, smoking, and systolic hypertension were risk factors for corneal arcus. Corneal arcus was also associated with thin and flat corneas and shallow anterior chamber depth.     

Ranibizumab Injection for Corneal Neovascularization Refractory to Bevacizumab Treatment

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.     

Corneal spherical aberration and its impact on choosing an intraocular lens for cataract surgery

Purpose

To analyze the post operative results of targeting zero spherical aberration by selecting the best-fit aspheric intraocular lens (IOL), based on preoperative corneal spherical aberration of patients with phacoemulsification surgery.

Setting

AlHokama Eye Specialist Center, Riyadh, Saudi Arabia.

Period

From the 1st of October 2012 until the 10th of April 2013.

Methods

Fifty-three eyes, were subjected to phacoemulsification cataract surgery and divided into two groups, 34 eyes were implanted with aspheric IOLs based on their corneal spherical aberration targeting post operative zero total spherical aberration, whereas 19 eyes were implanted with neutral aspheric IOLs regardless of their corneal spherical aberrations (CSAs). As a pre and post routine examination, patients underwent: slit lamp testing, intraocular pressure (IOP) measuring, fundus examination, best spectacle corrected visual acuity (BSCVA), manifest refraction, pupillometry, axial length, contrast sensitivity, and corneal aberration measurement using Pentacam HR (OCULUS, Germany) at the 6-mm optical zone. Post operatively, visual function questionnaire (VF-14) was asked to all patients.

Results

Fifty-three eyes of 45 patients, whose age ranged from 45 to 90 years old, were available for analysis, the selected group was implanted with: Tecnis ZA9003 or ZCB00 (Abbott Medical Optics) IOLs in 17 eyes with corneal spherical aberration of more than 0.27 μm, AcrySof IQ SN60WF (Alcon Laboratories Inc.) IOLs were implanted in 4 eyes with CSA = (0.2–0.27) μm, and Rayner 970C, 920H or 620H IOLs with spherical aberration (SA) = 0 in 13 eyes with CSA less than 0.20 μm. The other group of 19 eyes was implanted with aspheric IOLs that have zero spherical aberration (Rayner 970C or 920H) regardless of their CSA. Root mean square (RMS) of total corneal aberration positively correlates to the pupil diameter (P = 0.0031, r = 0.3989). A low negative correlation was found between the corneal spherical aberration of the fourth ordered (Z40) and the axial length (r = −0.2009, P = 0.1492). There was no significant difference between the selected and non-selected group in contrast sensitivity, best spectacle corrected visual acuity, and visual satisfaction (P = 0.5316, P = 0.3919, P = 0.7667).

Conclusion

Customized selection of aspheric IOLs based on the eyes’ corneal spherical aberration has no significant importance comparing their results with the non-selected group.     

Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient''s visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery.