改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

绝对期青光眼视网膜神经纤维层活体影像学观察

尽管青光眼是多因素疾病，但最终均为视网膜神经节细胞的凋亡、变性和视神经的损害。Quigiey等的研究表明，青光眼患者的视网膜神经节细胞(RGC)丢失40％左右将出现临床可检测的视野损害。然而，临床绝对期青光眼视功能完全丧失时RGC是否完全丧失?本研究应用光学相干断层扫描仪(optic coherence tomograph，OCT)对绝对期青光眼的视网膜神经纤维层(retinal nerve fiber layer，RNFL)进行了定量观察，以间接了解RGC在绝对期青光眼患者的丢失情况。     

毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响

目的：探讨抗青光眼药物毛果芸香碱和布林佐胺滴眼液及各自的防腐剂三氯叔丁醇和氯化苯甲烃胺（BAC）对兔眼表组织的影响。方法:选取新西兰大白兔15只，分为正常对照组（3只）、毛果芸香碱组（A组，6只）和布林佐胺组（B组，6只）。用药组右眼使用青光眼药物毛果芸香碱或布林佐胺滴眼液，左眼使用对应的防腐剂三氯叔丁醇或BAC，连续用药30 d。取球结膜组织行苏木素－伊红（HE）染色计数结膜上皮层炎症细胞数；角膜行扫描电镜检测并进行上皮损害分级评分。结果:与正常对照组比较，布林佐胺滴眼液（P<0.01）和防腐剂BAC（P<0.01）导致球结膜上皮层炎症细胞浸润增多；毛果芸香碱滴眼液（P>0.05）和三氯叔丁醇（P>0.05）引起的球结膜炎症细胞增多不明显。布林佐胺滴眼液导致球结膜炎症细胞增加的程度较毛果芸香碱滴眼液严重（P<0.01）。青光眼药物和防腐剂均可导致兔角膜上皮超微结构的损伤，表现为角膜上皮细胞六边形结构变为不规则、边界不清、细胞膜皱缩、细胞间距增宽、上皮细胞表面的微绒毛丢失、细胞空洞和暗细胞增加。布林佐胺滴眼液和BAC引起的角膜损害较毛果芸香碱滴眼液（P<0.01）和三氯叔丁醇明显（P<0.05）。各组左右两眼的球结膜炎症细胞数和角膜损害评分均无显著差异。结论:布林佐胺滴眼液和防腐剂BAC使用1个月后可导致兔球结膜炎症细胞增加和角膜上皮细胞损伤，毛果芸香碱滴眼液和三氯叔丁醇主要引起角膜上皮超微结构的变化；防腐剂是引起眼表损伤的主要原因。布林佐胺滴眼液对兔眼表的损伤较毛果芸香碱滴眼液严重。     

特发性黄斑裂孔的光学相干断层扫描图像特征

目的 观察特发性黄斑裂孔的光学相干断层扫描(optical coherence tomography,OCT)图像的形态特征。 方法 对65例直接检眼镜或三面镜检查诊断为特发性黄斑裂孔的患者的70只患眼进行OCT、眼底彩色照相和/或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,结合临床特征对OCT图像进行分析。 结果 70只眼中,1,2,3,4期黄斑裂孔分别为11,12,36,11只眼。OCT图像特征1期者表现为黄斑中心凹变浅或消失,神经上皮层浅脱离,中心凹平均厚度为(324.55±139.92)μm;2期者为视网膜表层部分缺失伴小的视网膜组织全层缺损,裂孔的表面有一个可贴附的盖,裂孔平均孔径为(241.75±107.08)μm;3期者为神经上皮层全层缺损,游离盖或无盖,裂孔周围可伴有不同程度囊样水肿,裂孔孔径为(699.78±160.99)μm;4期者图像特征与3期相似,但伴黄斑区和视盘玻璃体后脱离,裂孔孔径(631.36±243.46)μm。 结论 OCT能直观、清晰地显示特发性黄斑裂孔的横截面形态特征,同时能精确地测量裂孔的大小。 (中华眼底病杂志, 1999, 15: 205-208)     

丝裂霉素C与青光眼滤过泡并发症的相关关系

目的分析小梁切除术中应用丝裂霉素C(mitomycin-C,MMC)与青光眼滤过泡相关并发症的关系。方法对31例36只眼在小梁切除术中应用了MMC而导致的滤过泡相关并发症的患眼进行临床分析,分析其滤过泡形态、眼压、视力的改变和黄斑水肿的发生及与术中MMC的浓度、放置时间、放置部位之间的关系。结果31例36只眼中发生滤过泡渗漏11只眼、滤过泡感染1只眼、巨大薄壁滤过泡7只眼、单纯薄壁滤过泡7只眼、低眼压合并黄斑囊样水肿10眼;并发症的发生时间平均(1724±2000)m;平均视力下降2行以上;并发症的发生与MMC放置的位置显著相关,与时间呈正相关,与浓度无关;眼压下降与MMC浓度呈负相关。结论小梁切除术后滤过泡并发症的发生与MMC的应用密切相关,结膜瓣下与巩膜瓣下同时放置、放置时间长者比较容易发生并发症;高浓度者容易造成低眼压。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

原发性开角型青光眼眼底荧光血管造影与血液粘度及其它因素的关系

探讨原发性开角型青光眼眼底荧光血管造影与血液粘度及其它因素的关系。方法将１２２只原发性开角型青光眼的眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）的臂－脉络膜充盈时间〔ａｒｍ－ｃｈｏｒｏｉｄｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＣＴ）、臂－视网膜动脉充盈时间（ａｒｍ－ｒｅｔｉｎａｌａｒｔｅｒｙｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＡＴ）和视网膜动－静脉充盈时间（ｒｅｔｉｎａｌａｒｔｅｒｙ－ｖｅｎｏｕｓｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＶＴ）与高、中和低切变率下全血表观粘度、血浆粘度及红细胞压积进行逐步回归分析，将７０只眼ＦＦＡ的Ａ－ＡＴ、Ａ－ＶＴ与收缩压、舒张压、年龄和低切变率下全血表现粘度进行逐步回归分析。结果低切变率下全血表观粘度可明显影响Ａ－ＣＴ和Ａ－ＡＴ，而红细胞压积可明显影响Ａ－ＶＴ。低切变率下全血表现粘度和年龄均可影响Ａ－ＡＴ和Ａ－ＶＴ，尤以低切变率下全血表观粘度影响为大。结论血液粘度可明显影响原发性开角型青光眼ＦＦＡ各循环时间。     

睫状体恶性髓上皮瘤一例

睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤,易因其伪装特性而被漏诊和误诊.本文报道了1例3岁9个月的男性患儿,眼部表现似晶状体破裂,经部分肿物切除活检,病理诊断为睫状体恶性髓上皮瘤.     

综合教学方法应用于临床医学专业留学生眼科学见习教学初探

临床医学专业留学生与国内学生之间存在较多差异,传统的教学方法并不适合临床医学专业留学生的临床学科教学.在临床医学专业留学生的眼科学见习教学中,根据他们的具体情况和眼科学本身的特点,综合运用兴趣激发教学方法、情景教学方法、以问题为基础学习教学方法和集中教学与分散教学结合教学方法,营造活泼的教学氛围,提高留学生在教学过程中主动参与和积极思考的意识,取得了良好的教学效果.