眼铁质沉着症临床分析

目的 探讨眼铁质沉着症的临床表现和发病机制。方法 对因眼内异物引起的10例（10眼）眼铁质沉着症进行X线眼内异物定位检查，2例采用巩膜外磁性试验后牵引至睫状体平坦部吸出；2例晶状体异物行白内障囊外摘出合并后房型人工晶状体植入；6例行平坦部三通道闭合式玻璃体手术摘出异物，其中2例视网膜脱离行视网膜复位手术并注入硅油。结果 2例晶状体异物的术后视力恢复到0．5和0．6；其余8例视力未见明显提高。2例玻璃体视网膜手术，分别于术后6、9月取出硅油，视网膜复位。结论 眼内铁质异物存留所致的眼铁质沉着症后果严重，造成视功能的严重障碍，且异物摘出较困难，术后视力改善不理想。因此在临床上对有异物伤病史的患者，一定要排除眼内异物的存在，一旦发现眼内铁质异物，应尽快摘出，避免铁质沉着症的发生。     

Experimental ocular siderosis after extrabulbar administration of iron.

The authors studied the penetration of iron administered extrabulbarly into the ocular tissues of rabbits. It was found that iron passes from the orbit into the eyeball and accumulates in considerable quantities in the sclera, choroid, retina, ciliary body, and even in the vitreous and corneal epithelium. However, light microscopy failed to show any damage to the ocular tissues. The mechanism by which iron penetrates into the eyeball is discussed, and comparison is made between changes in the tissues, which characterise siderosis produced by an intrabulbar iron foreign body, and those in which an extrabulbar foreign body is involved.     

Fluorescein angiographic findings in ocular siderosis

PURPOSE: To report a case of siderosis from a retained intraocular iron foreign body manifesting localized retinal capillary nonperfusion documented by fluorescein angiography. METHODS: Case Report. In a 35-year-old man with decreased vision in the left eye, studies included fundus photography, fluorescein angiography, visual field testing, and electrophysiology. Surgical foreign body extraction and histopathologic examination were performed. RESULTS: Preoperatively, in the left eye, humphrey visual fields and electrophysiology testing revealed marked depression. Fluorescein angiography demonstrated nasal capillary nonperfusion with occlusion of the second- and third-order arterioles extending along a gradient from the foreign body. Microscopic examination of the lens capsule confirmed the diagnosis of siderosis secondary to a retained iron foreign body. CONCLUSION: Extensive capillary nonperfusion may be associated with a retained iron intraocular foreign body, as documented by fluorescein angiography.     

Desferrioxamine in ocular siderosis: a long-term electrophysiological evaluation.

Fourteen rabbits received an intravitreal iron foreign body and were treated with desferrioxamine. Their electroretinographic (ERG) values were recorded and compared with those of an untreated group. With desferrioxamine treatment a delay of the siderotic damage and preservation of better ERG potentials is observed.     

铁锈症眼玻璃体视网膜手术疗效分析

目的观察铁锈症眼玻璃体视网膜手术治疗的疗效。方法回顾分析玻璃体视网膜手术治疗眼后段磁性异物诱发眼铁锈症22例22只眼的临床资料。男性21例,女性1例;年龄6～54岁,平均年龄40岁。异物存留于眼内1个月～20年。手术前最佳矫正视力（BCVA）＜0.01者15只眼,0.01～0.15者5只眼,0.1～0.2者2只眼。玻璃体腔异物18只眼,眼球壁异物4只眼。并发白内障18只眼。合并视网膜脱离3只眼。12只眼联合环扎、硅油填充,7只眼联合环扎、C3F8填充。18只眼联合白内障摘除术。2只眼联合小梁切除术。结果 22只眼内异物均手术一次成功摘除。手术后视力增加20只眼,占90.9%,不变2只眼,占9.1%。BCVA＜0.1者7只眼,0.1～0.4者8只眼,0.5～1.0者7只眼。手术中并发症,视网膜裂孔并发局限性视网膜脱离2只眼;扩大巩膜切口,玻璃体腔积血2只眼。手术后并发症,并发白内障4只眼;黄斑下异物取出手术后3个月,硅油取出时再次发生视网膜脱离1只眼,再次硅油填充视网膜复位;C3F8填充后7 d继发视网膜脱离1只眼,再次硅油填充,手术后视网膜复位。随访结束时22只眼视网膜均在位。结论铁锈症眼玻璃体视网膜手术治疗安全、有效,可避免铁离子进一步释放,改善患者视功能。     

Electroretinographic assessment of early changes in ocular siderosis

We examined a patient with an iron intraocular foreign body and recorded electroretinograms (ERGs) before and after the removal of the foreign body by vitrectomy. The amplitudes of the rod and cone ERGs and the oscillatory potentials (OPs) in the injured eye were reduced before the operation. In addition, the photopic on-responses (b wave) were more reduced than off-responses (d wave). One year after surgery, the amplitudes of the rod, cone and photopic on- and off-responses were markedly improved to within the low normal limit. However, the OP amplitudes remained unchanged with lower values. These findings suggest that iron retinotoxicity leads to a dysfunction of all layers but the changes may be reversible in the early period of the disease. The late period iron toxicity produces more severe damage to the inner retina than the outer retina.     

眼铁质沉着症诊治分析

目的：探讨眼铁质沉着症发生的相关因素,找出铁沉着症可靠体。方法：对我院12年铁沉着症51例进行回顾性分析。结果：①异物最大长径≤2.0mm,铁沉着症发生率84.31％;82.50％位于睫状体锯齿缘附近;②95.24％位于眼内下半部;③≤1.0mm异物,96％是医、患漏诊和疏忽;④2.1－3.0mm异物共6例,5例是医、患疏忽,均为巩膜穿孔伤;⑤手术前后视力比较差异无显著性（P＞0.05）;⑥手术成功率93.18％,失败6.82％;⑦51眼均见晶状体铁质沉着。结论：眼内科小异物动能小,穿 透力弱,易停留在眼内前部,因重力下沉于睫状体平担部4－8点范围,该区域隐蔽,不充分扩瞳,医师易漏诊,需作X线摄片;小异物入眼损伤小,视期视力无影响,易被患者疏忽;较大异物巩膜穿孔,易引起医、患疏忽。晶状体囊下上皮内花圈状铁质沉着斑点是铁沉着症临床诊断可靠体征。     

Application of Prussian blue staining in the diagnosis of ocular siderosis

AIM:To explore the value of Prussian blue staining in the diagnosis of ocular siderosis.METHODS: Between January 2012 and January 2013, the Prussian blue stain used in anterior lens capsule and vitreous liquid after centrifugation from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis. At the same time, give a negative control.RESULTS: Anterior lens capsule membrane and liquid of vitreous cavity from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis revealed ferric ions that stained positively with Prussian blue. In the control group, there is no positive reaction.CONCLUSION: Prussian blue staining in the diagnosis of ocular siderosis has a very significant worth, suspected cases can be definitive diagnosed.     

Functional and high resolution retinal imaging assessment in a case of ocular siderosis

Purpose

To report new findings in a case of ocular siderosis explored by high resolution angiography and adaptive optics (AO).

Methods

We report data on a 40-year-old man with an intraocular foreign body (IOFB) embedded in the sclera after hammering.

Results

Nine months after this accident, the patient presented with full-field electroretinogram (FF-ERG) abnormalities. Subsequent IOFB extraction was performed. One month after the surgery, high resolution angiography showed for the first time small iron particles all over the inner retinal surface. Spreading of these deposits was followed by inflammatory prepapillary new vessels and venous retinal vasculatis, which spontaneously resolved within a few months. ERG responses became slightly electronegative at this time. Clearance of the iron particles was followed over a year with AO and ERG recording. AO revealed an arterial tropism with a decrease in the amount of particles overtime, which may be consistent with macrophagic activity.

Conclusion

High resolution angiography and AO are new tools, combined with electrophysiology, to better understand ocular siderosis pathophysiology.     

Transscleral leiomyoma

A bluish-pink epibulbar lesion, which slowly enlarged over a period of 5 years, developed in a 31-year-old woman. The lesion initially resembled a staphyloma, based on the very thinned overlying sclera, but subsequent evaluation suggested that it was a solid mass. At the time of surgical removal, the mass appeared to have originated in the supraciliary region and to have eroded outward through the sclera. Histopathologically, the mass proved to be a leiomyoma. The authors propose theoretic possibilities to explain the location of this rare type of ocular smooth muscle tumor.     

房水铁离子含量测定与眼铁质沉着症相关性的研究

目的 :测定眼铁质沉着症房水中铁离子含量 ,探讨其对手术预后及相关影响。方法 :对 1 7只铁质沉着症眼 ,在摘取眼内异物手术前 ,取 0 2ml房水标本 ,对照组取 1 0只正常尸体眼房水 ,采用铁试剂盒 ,亚铁嗪法测定铁离子含量。结果 :1 7例房水铁离子含量平均为 2 989μg/ml。对照组平均含量为 0 63 1 μg/ml。术后视力 0 5以上者 4例 ,0 1～ 0 4者 4例 ,0 0 1～ 0 0 9者 2例 ,手动以下者 7例 ,其中眼球萎缩 3例。结论 :眼铁质沉着症房水铁离子含量明显高于对照组 ,其对眼组织的损伤与铁离子含量有直接关系 ,同时与异物的化学成分、大小、位置与有无包裹以及异物在眼内存留的时间等因素有关。     

Transscleral permeability of fluorescent-labeled antibiotics.

PURPOSE: To determine the in vitro transscleral permeability of antibiotics for posterior segment infection. METHODS: Scleral sections from moist chamber-stored human globes were mounted in a 2-compartment perfusion chamber. Fluorescent-labeled vancomycin, polymyxin B, or penicillin G was added to the episcleral surface, while the choroidal side was slowly perfused with balanced salt solution (Alcon Laboratories, Inc., Ft. Worth, TX). The perfusate was collected and fluorescence was measured using a fluorometer. From the measurements, permeability (Ktrans) was calculated. Photomicrographs were taken with a fluorescent microscope to evaluate tissue absorption. RESULTS: The Ktrans values (cm/s, mean +/- standard error) were 6.66 +/- 1.46 x 10(-7) for vancomycin, 3.90 +/- 0.59 x 10(-7) for polymyxin B, and 1.89 +/- 0.21 x 10(-6) for penicillin G. The percent of antibiotic that diffused across the sclera from the donor chamber in 24 hours was 20.6 +/- 4.2 for vancomycin, 12.6 +/- 2.0% for polymyxin B, and 50.8 +/- 4.8% for penicillin G. CONCLUSIONS: This study shows that human sclera is more permeable to lower molecular weight, water-soluble penicillin G than to vancomycin or polymyxin B. The data suggests that a local, noninvasive, transscleral drug-delivery method may be reasonable for treating intraocular infections.     

Transscleral electroretinography

We studied the electroretinogram in normal patients, patients with opacities of the anterior segment, and patients with vitreous hemorrage, using a high-intensity light stimulus delivered either through the sclera or through the pupil. We found the response obtained with transscleral stimulation a consistent indicator of gross retinal function. Since the stimulus entered the eye through the sclera, it provided a method for studying the retinal responses independent of opaque or translucent media.