形觉剥夺性高度近视豚鼠巩膜形态改变及缺氧诱导因子-1α和氧自由基在高度近视中的作用

目的　观察形觉剥夺性高度近视（form deprivation high myopia，FDHM）豚鼠巩膜形态变化，探讨缺氧诱导因子-1α（hypoxia-inducible factor-1α，HIF-1α）及氧自由基在高度近视中的作用。方法　将豚鼠适应性饲养1周后，随机分为空白对照组（25只）和模型组（25只）。模型组豚鼠右眼行眼睑缝合，所有模型组豚鼠均选择右眼作为FDHM组，对侧眼为自身对照组。空白对照组豚鼠不做任何处理。于造模前及造模后8周采用检影镜测量屈光度，A超进行生物测量。形觉剥夺8周以后处死豚鼠，观察巩膜形态和超微结构的变化，测定巩膜HIF-1α相对表达量，超氧化物歧化酶（superoxide dismutase，SOD）活力及丙二醛（malondialdehyde，MDA）的含量。结果　豚鼠形觉剥夺8周以后，FDHM组屈光度从（+3.59±0.33）D变为（-7.96±0.55）D，明显高于空白对照组（+0.89±0.32）D、自身对照组（-0.55±0.49）D（均为P<0.05）；玻璃体腔深度为（4.12±0.13）mm明显高于空白对照组（3.71±0.23）mm和自身对照组（3.93±0.04）mm（均为P<0.05）；眼轴长度为（8.93±0.22）mm明显长于空白对照组（7.95±0.37）mm和自身对照组（8.01±0.15）mm（均为P<0.05）。巩膜组织明显变薄，细胞外基质增多，成纤维细胞密度降低，胶原纤维平均直径减小。FDHM组巩膜中HIF-1α相对表达量、MDA含量明显高于空白对照组和自身对照组，SOD活力明显低于空白对照组和自身对照组（均为P<0.05）。结论　形觉剥夺8周后，豚鼠FDHM眼近视度数明显增加，玻璃体腔深度增加，眼轴延长，巩膜形态发生病理性变化；HIF-1α、SOD、MDA可能参与了FDHM的形成。     

Ocular anatomy and physiology relevant to anaesthesia

An understanding of the anatomy of the orbit is essential for performing regional anaesthesia for ophthalmic surgery. This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles.     

玻璃体切割联合后巩膜加固术治疗高度近视眼黄斑裂孔性视网膜脱离

目的：探讨玻璃体切割联合后巩膜加固治疗高度近视眼黄斑裂孔伴视网膜脱离的方法与疗效。
　　方法：于2012-01/2013-12间收集高度近视性黄斑裂孔伴视网膜脱离患者45例45眼,分为玻璃体切割内界膜撕除联合后巩膜加固组( A组)28眼和玻璃体切割内界膜撕除组( B组)17眼。术前分别行视力、眼压、间接检眼镜、OCT检查,术后随访6~12mo,行视力、OCT检查,分别对视力、视网膜复位情况、黄斑裂孔闭合情况进行统计比较。
　　结果：(1)视力检查：术后视力：A 组1.19±0.39, B 组1.51±0.34,二者比较有显著性差异(P<0.05);(2)术后视网膜复位率：A组100%,B组88.24%,两者比较无统计学差异;(3)术后黄斑裂孔闭合率：A 组82%,B 组53%,两者比较有统计学差异(P<0.05)。
　　结论：玻璃体切割术联合后巩膜加固术治疗高度近视眼黄斑裂孔伴视网膜脱离的手术方法安全可行,可更好的改善视力,提高黄斑裂孔的闭合率。     

Complement factors C1q, C3 and C5b-9 in the posterior sclera of guinea pigs with negative lens-defocused myopia

AIM

To investigate the expression of complement factors in the posterior scleral fibroblasts of guinea pigs with negative lens-defocused myopia.

METHODS

Eighteen guinea pigs were assigned randomly to two groups: the negative lens-defocused group (NLD group, n=9) and the normal control without treatment group (NC group, n=9). The effect of myopic induction was compared in three subgroups: eyes treated with a -10.00 D negative lens in the NLD group (NL group), eyes treated with a plano (0 D) lens in the NLD group (PL group), and untreated right eyes in the NC group (NC group). The following analyses were conducted at four weeks: examination of the refractive error via retinoscopy, assessment of complement C5b-9 expression in the posterior scleral fibroblasts using immunohistochemistry, and measurements of complement C1q and C3 protein levels in the posterior sclera by Western blot.

RESULTS

After an induction period of four weeks, a significant myopic shift was detected in the eyes of the NL group, relative to that of the PL and NC groups (P<0.05). Data analysis showed a significant increase in the percentage of C5b-9 immunopositive fibroblasts in the posterior sclera of the NL group eyes, compared to the PL group (q=11.50, P<0.001). Significantly higher levels of C1q (q=4.94, P=0.01) and C3 (q=4.07, P=0.03) protein were detected in the posterior sclera of NL group eyes, compared to the PL group. There were no significant difference between the PL and NC groups for C5b-9 (q=2.44, P=0.10), C1q (q=1.55, P=0.53) and C3 (q=0.98, P=0.77) in the posterior sclera.

CONCLUSION

The data from present study provide evidence of the up-regulation of C5b-9, C1q and C3 in the posterior scleral fibroblasts in a NLD myopic animal model. The results suggest that the complement system may be involved in the development of myopia.     

Keratoglobus: An experience at a tertiary eye care center in India

Context:

This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease.

Aims:

We report our experience with patients having keratoglobus at a tertiary eye care center in India.

Settings and Design:

Retrospective study.

Materials and Methods:

We analyzed adults and pediatric patients (<16 years) with keratoglobus, seen during 2008–2012. The age, gender, consanguinity, presenting ocular signs, ocular and systemic associations, visual acuity, corneal topography, and surgeries were documented.

Results:

Forty-eight patients (mean age 22 ± 15 years, 31 males) having keratoglobus were analyzed. 21 patients (42 eyes) were <16 years. Twelve eyes (16 events) had positive history of trauma. The presenting clinical signs were corneal scars/scars of tear repair (15 eyes), hydrops, healed and acute (14 eyes) and corneal or globe rupture (9 eyes). Best-corrected visual acuity was >20/40 in 6/42 (14.3%) pediatric eyes and 15/53 (28.30%) adults. Visual acuity ranging from counting of fingers to no light perception was noted in 20/53 (37.74%) adults and 21/42 (50%) pediatric patients; 13/20 (65%) with blue sclera and 8/22 eyes (36.37%) without blue sclera. Vernal keratoconjunctivitis was present in one pediatric patient. Choroidal osteoma, retinitis pigmentosa, and retinal detachment were present in adults. Surgeries performed were corneal tear repair (5 eyes), tissue adhesive application (2 eyes), descematopexy (4 eyes) and penetrating keratoplasty (PK - 8 eyes: Three had post-PK glaucoma, graft failure-one eye, 4 patients wore scleral lens - prosthetic replacement of the ocular surface ecosystem).

Conclusions:

About 50% of pediatric eyes (65% having blue sclera) had no functional vision. Trivial trauma was responsible for corneal rupture indicating need for protective glasses. About 50% patients had post-PK glaucoma though grafts were clear.     

25G辅助巩膜外加压术治疗硅油眼视网膜脱离的疗效观察

目的：观察25G辅助巩膜外加压术治疗硅油眼视网膜脱离的疗效。

方法：回顾性分析硅油填充术后出现视网膜脱离的患者15例15眼行25G辅助直视下巩膜外加压术后3～6mo患者的视网膜复位、最佳矫正视力(best corrected visual acuity，BCVA)及眼压情况。

结果：术前患者15 例15眼均存在3：00～9：00位范围内的视网膜脱离； 术后视网膜解剖复位13例13眼，未复位2 例2眼。术后1mo最佳矫正视力提高1行以上者11例11眼，视力变化1行以内者3例3眼，视力下降1行以上者1例1眼。术后早期部分患者存在眼压升高现象，药物控制后可恢复正常。

结论：25G辅助直视下巩膜外加压术治疗硅油眼视网膜脱离疗效确切。     

孔源性视网膜脱离行巩膜外环扎和巩膜外加压术对眼球结构和眼压的影响

目的：观察巩膜外环扎术和巩膜外环扎联合巩膜外加压术对孔源性视网膜脱离(rhegmatogenous retinal detachment，RRD)患者眼球结构和眼压的影响。

方法：选取2014-05/2017-05在我院住院行手术治疗的RRD患者240例240眼，其中接受巩膜外环扎术100眼(巩膜外环扎术组)，接受巩膜外环扎联合巩膜外加压术140眼(联合组)。术前、术后2、4、12wk，检测眼压、角膜厚度、角膜水平和垂直曲率、前房深度、晶状体厚度、眼轴长度、睫状体厚度及小梁虹膜夹角度数。

结果：术后12wk，两组患者240眼均获得解剖复位。术后2wk，两组眼压、角膜厚度、角膜水平和垂直曲率、晶状体厚度、睫状体厚度均较术前显著增加，前房深度及小梁虹膜夹角度数均较术前明显减小，差异均有统计学意义(P<0.05)。两组患者术后视力均较术前改善，且术后2wk联合组视力明显优于巩膜外环扎术组，差异均有统计学意义(P<0.05)。

结论：巩膜外环扎术和巩膜外环扎联合巩膜外加压术对角膜、前房、房角、晶状体厚度及小梁虹膜夹角度数在早期均有显著影响，巩膜外环扎联合巩膜外加压术对眼压的影响时间长，应予以关注。     

后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性分析

目的　探讨后巩膜加固术治疗高度近视性视网膜病变的安全性和有效性。方法　随访2 a观察41例76眼患有高度近视性视网膜病变行后巩膜加固术患者术前术后眼轴长度、最佳矫正视力、视网膜劈裂的贴附情况和并发症情况。结果　术后3 d、1个月、3个月、6个月眼轴长度分别为（27.71±1.60）mm、（28.11±1.62）mm、(28.58±1.80)mm和（29.01±1.92）mm,均较术前的（30.29±2.01）mm缩短，且差异均有统计学意义（均为P=0.000）。术后1 a眼轴长度逐渐增长至术前水平，术后2 a眼轴长度与术前相比差异无统计学意义（P=0.300）。术后1个月最佳矫正视力即得到提高，但与术前相比差异无统计学意义（P=0.080）。术后3个月、6个月、1 a、2 a最佳矫正视力持续提高，且与术前相比差异均有统计学意义（均为P<0.05）。34眼术前伴视网膜劈裂者，术后27眼（79.41%）视网膜完全贴附；4眼（11.76%）基本贴附；3眼（8.82%）改善。术中未见并发症发生，术后有结膜刺激征、高眼压、眶内炎症反应、浅前房、复视及视物变形、黄斑出血复发等并发症发生，均在3个月内恢复。结论　后巩膜加固术是高度近视性视网膜病变的一种安全有效的治疗方法，它可以有效地控制病理性近视的进展。     

Skeletons of the Eye: An Evolutionary and Developmental Perspective

The ocular skeleton, composed of the scleral cartilage and scleral ossicles, is present in many vertebrates. The morphology of the scleral cartilage and ossicles varies within different extant reptiles (including birds) and also varies dramatically from the morphology in extant teleosts. This incredible range of diverse morphologies is the result of millions of years of evolution. Both the position of these elements within the eye and the timing of development vary amongst different vertebrates. While the development of both the scleral cartilage and scleral ossicles is somewhat understood in reptiles and in teleosts, the functional advantage of these elements is still debated. Most reptiles have a multi-component scleral ossicle ring composed of a series of flat bone plates and a scleral cartilage cup lining the retina, some sharks have calcified cartilage plates, and some teleosts have two bones while most others only have a ring of scleral cartilage. The data presented shows that different vertebrates have adapted to similar selective pressures in different ways. However, the reason why sarcopterygians have a series of overlapping bones in the sclera remains unclear. A better understanding of the ocular skeletal diversity in Reptilia as well as a better understanding of the mechanisms of vision within different environments (i.e., air vs. water) and that used by secondarily aquatic organisms is needed. This review discusses the observed variation in morphology and development of the ocular skeleton in the context of evolution and highlights our knowledge gaps in these areas. Anat Rec, 2018. © 2018 American Association for Anatomy.     

交联型异体脱细胞巩膜行眼部修复的试验研究

目的 将交联型异体脱细胞巩膜植入眼睑,研究其组织相容性及抗原性变化.方法 将20只新西兰大白兔随机平均分为两组,去除睑板后,分别植入兔交联型脱细胞巩膜和异体巩膜,于植入后1、4、8、12周观察全身及局部光镜和免疫学变化.结果 脱细胞巩膜和异体巩膜植入眼睑后第1周、4周、8周,两组间外周血IgG、IgA、IgM、C3、C4和CD4+T细胞、CD8+T细胞定量均无明显差异.术后1周、4周、8周、12周,植入局部的光镜显示:脱细胞巩膜组的炎症反应和淋巴细胞浸润要小于异体巩膜组,8周后植入的异体巩膜组织中央部发生少量坏死溶解现象,术后12周两组成纤维细胞及血管完全长入植片.术后1、4、8周,局部CD4+T及CD8+T细胞计数显示脱细胞巩膜组明显少于异体巩膜组.结论 兔脱细胞巩膜植入眼睑后引起的免疫反应较同种异体巩膜小.