不同照射方式下核黄素-A波紫外线兔巩膜胶原交联术对兔巩膜成纤维细胞生物力学特性的影响

目的　研究不同照射方式下核黄素-A波紫外线兔巩膜胶原交联术对兔巩膜成纤维细胞生物力学特性的影响。方法　取健康新西兰大白兔24只，随机将兔平均分为A、B两组，每组选取左眼为实验眼，右眼为对照眼。麻醉后暴露左眼鼻上方巩膜。在该处巩膜滴加5-磷酸核黄素5 min后，用波长为370 nm的紫外线灯照射。A组的照射时间为30 min，能量密度为3.0 mW·cm^-2；B组的照射时间为9 min，能量密度为10.0 mW·cm^-2。照射期间，每2 min滴加1次5-磷酸核黄素溶液，以保持巩膜的湿润。术后60 d，处死实验兔，培养实验眼交联部位及对照眼相应部位的巩膜成纤维细胞，用细胞微管吸吮实验检测巩膜成纤维细胞的杨氏模量、表观黏性。结果　A、B两组实验眼巩膜细胞的杨氏模量、表观黏性均较各自对照眼显著增强，差异均有统计学意义（均为P＜0.05）；而A、B两组实验眼间、及对照眼间巩膜细胞的杨氏模量、表观黏性差异无统计学意义（均为P＞0.05）。以上结果表明，交联术后巩膜细胞的黏弹性发生了明显的变化，黏弹性显著升高。而两种照射方式之间巩膜细胞的黏弹性无显著差异。结论　两种不同的照射方式，均能使巩膜成纤维细胞的生物力学性能发生显著增强，而两种照射方式之间并未见明显的差别。     

Effect of rigid gas permeable contact lens on keratoconus progression: a review

The prevalence of keratoconus is 1/2000 in the general population and is high in adolescents. Keratoconus is a progressive disease, which has a great impact on patients’ quality of life and mental health. It can be managed by surgical and non-surgical means, rigid gas permeable (RGP) contact lens as its main non-surgical method is widely used in clinic. The efficacy of wearing RGP contact lens has been confirmed to some extent, but some studies have found that wearing RGP contact lens has adverse effects, which may promote disease progression. In this paper, the advantages and disadvantages of RGP contact lens in controlling keratoconus were reviewed to provide more suggestions and references for the clinical application of RGP contact lens.     

Familial Nanophthalmos Presenting with Spontaneous Uveal Effusion Syndrome

ABSTRACT

Purpose: To report two unique cases of spontaneous uveal effusion syndrome (UES) from the same family.

Methods: The patients included father (54 years old) and a daughter (23 years old). The father presented 7 years ago with bilateral exudative retinal detachment, nanophthalmic eyes (axial length 16.11 mm and 16.43 mm in right and left eyes, respectively) with hypermetropia, and a thickened sclera on MRI. The daughter presented with left eye peripheral exudative annular retinal detachment with bilateral nanophthalmos (axial length 20.7 mm and 20.33 mm, in right and left eyes, respectively), with MRI showing ciliochoroidal detachment, suprachoroidal effusion and mild thickening of the sclera in left eye.

Results: The father underwent subscleral sclerectomy in the left eye that led to resolution of submacular fluid. Scleral biopsy confirmed the deposition of glycosaminoglycans on Alcian blue stain. The daughter was kept under observation, because of absence of any macular subretinal fluid, and counselled about the familial nature of the disease and possible need for future intervention.

Conclusion: This is the first report of familial nanophthalmos presenting with spontaneous UES.     

人工晶状体睫状沟悬吊术缝线改良研究

目的探讨人工晶状体Ⅱ期睫状沟悬吊缝线改良的可行性和实用性。方法选取需Ⅱ期人工晶状体睫状沟悬吊患者32例(32只眼),采用折叠人工晶状体,利用VE2200人工晶状体植入系统,由双针各带有环形10-0非吸收聚丙烯缝线固定于睫状沟,结扎缝线关闭自创的口袋样裂隙状板层巩膜瓣,线结自行埋藏。结果患者术后植入的人工晶状体居中,裸眼视力均有不同程度的提高。术后3个月,视力>0.8的眼3只(9.4%),视力0.4~0.8眼17只(53.1%),视力<0.4的眼12只(37.5%)。术前、术后3个月平均角膜散光均值分别为(1.75±1.24)D与(1.64±1.32)D,差异无统计学意义(P>0.05)。切口闭合线结埋藏满意。结论采用双针10-0聚丙烯缝线睫状沟悬吊固定晶状体、关闭自创口袋样巩膜裂隙状板层瓣、线结埋藏一次完成,操作简捷,手术并发症少,有效可行。     

A Web-Based Survey of Oculoplastic Surgeons Regarding the Management of Lower Lid Retraction

Purpose: To survey the opinion of oculoplastic surgeons on the assessment and management of lower eyelid retraction (LLR).

Methods: A web-based survey queried oculoplastic surgeon members of Ojoplast, Spanish and Brazilian Oculoplastic Societies on the management of LLR. The frequency and percentage proportions of the responses were analyzed.

Results: One hundred ninety-six oculoplastic surgeons participated in the survey. The main cause of LLR is post-blepharoplasty (62;31.6%). The most used sign to detect LLR is scleral show. The most common approaches to managing LLR are lateral canthal surgery (164/593;27.6%), autogenous spacers (148/593; 24.9%) and retractor release (131/593;22.1%). The preferred autogenous graft material includes ear cartilage (102/260;39.2%). The majority of surgeons (161/314; 51.3%) recommend massage or steroids injection (80/314;25.5%) for early post-blepharoplasty LLR, while, 54.1% (106/196) of participants suggested waiting for at least six months prior to surgical intervention. Frost suture is used after most LLR surgeries (154/196;91.1%). Incomplete correction is the main complication (111/310;35.8%) of LLR surgery. For mild LLR, 48% of the responders prefer clinical treatment; conversely, severe cases routinely require combined surgical techniques.

Conclusions: Oculoplastic surgeons frequently diagnose LLR based on scleral show. LLR management depends on the cause and severity of lid retraction. Mild cases, in general, receive clinical treatment and severe cases need a combination of surgical techniques and grafts.     

后巩膜加固术在超长眼轴黄斑裂孔性视网膜脱离手术中的应用

目的：评价后巩膜加固术(PSR)辅助超长眼轴黄斑裂孔性视网膜脱离患者玻璃体切除手术(PPV)的临床效果。

方法：采用临床随机对照研究。纳入眼轴≥29mm的超长眼轴黄斑裂孔性视网膜脱离患者46例46眼,随机分为两组：A组采用PSR+PPV+硅油填充,B组采用单纯PPV +硅油填充。随访1a,分析各组术后BCVA、黄斑裂孔愈合情况、视网膜脱离复位率、再手术率等指标。

结果：两组治疗后平均BCVA(LogMAR视力)均较术前改善,A组由1.61±0.02提升为0.85±0.22(t=10.36,P<0.01),B组由1.59±0.04提升为1.08±0.16(t=7.92,P<0.01),其中A组改善幅度大于B组(t=-2.38,P=0.03)。两组术前术后眼轴均无明显改变(P>0.05)。A组一次手术黄斑裂孔愈合率为91%(21/23),取油前再手术率4%(1/23),取油后无再脱离患者,1a随访期内所有术眼完成了硅油取出。B组一次手术黄斑裂孔愈合率为65%(15/23),取油前再手术率35%(8/23),取油后再脱离比例26%(6/23),1a随访期取出硅油比例74%(17/23)。

结论：后巩膜加固术有助于提高病理性近视黄斑裂孔性视网膜脱离的手术成功率,减少复发及再手术的几率。     

针刺加叩刺治疗女性2型糖尿病阴虚夹瘀型患者临床观察

目的:观察针刺加扣刺治疗女性2型糖尿病阴虚夹瘀型患者的临床疗效。方法:92例女性2型糖尿病阴虚夹瘀型患者依据证候轻重特征将阴虚夹瘀患者分为瘀证为主的阴虚夹瘀型(简称组1)和阴虚为主的阴虚夹瘀型(简称组2)两组各46例。采用针刺加叩刺治疗,隔日治疗1次,持续治疗3个月。观察两组患者治疗前后空腹血糖(FPG)、空腹瘦素(FLP)、空腹胰岛素(FINS)、胰岛素敏感性指数(ISI)、胰岛素抵抗指数(Homa-IR)及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、高密度脂蛋白胆固醇(HDL-c)水平。取41例正常女性作为对照组,与两组患者治疗前后各项指标项比较。结果:治疗前两组FPG、FLP、FINS、Homa-IR、TC、TG、LDL均明显高于正常组水平;HDLC,ISI低于正常组水平。两组患者治疗后FPG、FLP、FINS、Homa-IR、TC、TG、LDL均较治疗前明显下降(P<0.01),ISI、HDL明显升高(P<0.01)。治疗后组1 TG、Homa-IR的改善优于组2(P<0.05)。组1总有效率为91.3%,组2总有效率为76.09%,两组比较差异无统计学意义(P>0.05)。结论:针刺加扣刺治疗女性2型糖尿病阴虚夹瘀型患者糖、脂质代谢及胰岛素抵抗具有良性调整作用,且以瘀证为主的阴虚夹瘀型在降低胰岛素、改善胰岛抵抗指数相关参数方面的作用优于以阴虚为主的阴虚夹瘀型患者。     

显微外路和传统外路手术治疗视网膜脱离的临床比较

目的：观察显微外路和传统外路手术治疗裂孔源性视网膜脱离的疗效。
　　方法：裂孔源性视网膜脱离患者46例46眼,其中26例行显微外路视网膜脱离手术(显微组),20例行传统外路视网膜脱离手术(传统组),由同一手术者完成。回顾分析其临床资料,对比两组的临床情况及疗效。
　　结果：显微组和传统组患者手术方式选择、冷凝反应、裂孔封闭情况和一次手术视网膜复位情况的差异均无统计学意义(P>0.05)。显微组患者术后1mo的最佳矫正视力情况较术前改善,其术后视力提高率较对照组高(P<0.05)。结论：显微外路视网膜脱离手术与传统外路视网膜脱离手术治疗裂孔源性视网膜脱离的手术效果相近,显微外路视网膜脱离手术在改善患者视力方面略有优势。