眼冲击伤后视网膜组织学及组织化学的改变

本研究伤后兔眼视网膜广泛水肿,视杆锥细胞明显破坏,脉络膜血管扩张,腔内充满血细胞,视网膜SDH、LDH活性降低.提示一定能量的冲击波可导致兔眼视网膜组织明显损伤,视网膜的损害除外力的直接作用外,伤后视网膜脉络膜血液循环及组织能量代谢障碍可能也是造成视网膜组织损伤的重要原因.     

家兔眼原发性冲击伤的实验研究

用ＢＳＴ－Ⅲ型生物激波管，研究了白毛家兔在眼部局部暴露致伤的条件下，眼原发性冲击伤的特点。冲击正压在１１００ｋＰａ（３．８ｍｓ）以上，可造成眼球破裂，眼球脱出或下陷，眼眶骨折甚至死亡等严重损伤，６００ｋＰａ（１１ｍｓ）的冲击波易引起结膜破裂，房水混浊等，２３０ｋＰａ（１７ｍｓ）的冲击波作用后，伤情轻微，实验表明，结膜水肿，瞳孔缩小，眼压下降以及视网膜破裂水肿，是兔眼冲击伤的主要临床表现。     

眼冲击伤早期视网膜电图的变化

本文探讨了眼冲击伤早期视网膜电图（ERG）的变化。实验动物为成年家兔，用BST－Ⅲ型生物激波管造成轻度和重度的眼冲击伤，冲击波超压峰值分别为429±38．8kPa和834±16．47kPa。于伤前和伤后0．5h，3h，6h和24h；临床观察并检测伤眼和对侧健眼的ERG变化。结果提示：伤后轻、重伤两组伤眼的a波和b波波幅值均明显下降，a波峰潜时延长；2组健服的a、b波幅值也有下降。表明眼冲击伤后早期，伤眼的伤情不论轻重，视功能的障碍均是严重的，并影响对侧眼。     

兔眼脉络膜上腔出血模型建立及自然转归的研究

目的建立兔眼脉络膜上腔出血（SCH）模型,观察其自然转归。方法经隧道式巩膜全层切口注入兔眼脉络膜上腔自体抗凝血建立SCH模型,并行检眼镜、B型超声及组织病理学观察。结果术后实验组兔眼均出现了SCH。术后1h视网膜及脉络膜呈明显红色隆起,边界清楚,出血范围为8～10个视盘直径;术后1d出血范围扩大、隆起度降低,术后3d出血开始吸收,术后7d大部分吸收,术后14d基本吸收,术后21d完全吸收。术后1～3d脉络膜上腔炎性细胞浸润,术后7d脉络膜上腔血液部分溶血,术后14d完全溶血,光感受器层发生空泡变性,睫状体萎缩。结论经隧道式巩膜全层切口注入兔眼脉络膜上腔自体抗凝血建立SCH模型的方法简单实用、安全可靠、重复性较好,为视网膜受损及相关治疗提供依据。     

视觉眼电图在视网膜挫伤中的应用

视网膜挫伤的眼电图检查在国内还未见报道,笔者把视觉眼电图(EOG)引入到视网膜挫伤的检查与诊断中,现报告如下。资料与方法一、一般性资料1.患者组随机收集临床诊断为视网膜挫伤患者共21例221眼,其中男20例,女1例。年龄14～46岁。工作中致伤7例,非工作中误伤5例,纠纷或意外他伤9例。视力:光感～0.09者13眼,0.1～0.3者4眼,0.4～0.9者3眼,1.0～1.5者2眼,伪盲试验(一)。伤情分级:Ⅰ级、单纯视网膜水肿,10眼;Ⅱ级、视网膜水肿伴出血,2眼;Ⅲ级、脉络膜裂伤或玻璃体出血,8眼;Ⅳ级、视网膜脱离或脉网膜萎缩,2眼。22眼中4眼合并外伤性视神经萎缩,8眼合并角膜裂伤、前房出血、瞳孔散大、白     

眼球挫伤致眼底周边部损伤(摘要)

本文报道从1978年至1987年的眼球挫伤致眼底周边部损伤收治40例40眼,男性37例,女性3例;多由高速物体致伤。外眼检查可见球结膜充血水肿,角膜水肿,瞳孔縮小或扩大,前房玻璃体出血,检眼镜及三面镜检查眼底周边部可见睫状体、脉络膜、视网膜撕裂(22眼),早期视网膜呈局限性扁平脱离,晚期形成睫状体脉络膜视网膜脱离及锯齿缘稍后处不规则裂孔。(2) 脉络膜破裂(7例),与锯齿缘平行,裂孔常被视网膜下出血所遮盖。典型裂孔呈黄棕色条纹,边缘有色素,表面视网膜水肿、出血,并     

玻璃体切除术中气体灌注对兔眼视网膜的损伤

目的探讨玻璃体切除术中气体灌注对兔眼视网膜形态结构及生理功能的影响,以期明确玻璃体切除术后视功能受损的机制。方法将24只灰兔随机分成3组行玻璃体切除术,A、B两组分别在25和40mmHg(1mmHg=0．133kpa)的气体灌注压下行气液交换,对照组不做气液交换。术后行临床观察及视网膜电图检查,6周后摘除眼球行光镜及透射电镜检查。结果临床观察各组兔眼未见明显异常体征。术后1d,A、B两组视网膜电图bA比值与对照组相比差异均有显著意义,术后6周B组bA比值仍显著降低。光镜下可见B组兔眼灌注后对侧视网膜结构紊乱伴部分组织缺失,视网膜厚度与对照组相比有明显差异,其中外层视网膜厚度降低更加明显。电镜下可见B组兔眼灌注后对侧视网膜有较明显的神经纤维及光感受器细胞损伤,A组兔眼损伤表现轻微。各组兔眼灌注侧视网膜未见异常。结论玻璃体切除术中气体灌注可造成兔眼视网膜的不可逆损伤,气体灌注可能是玻璃体切除术后视功能受损的主要原因之一。（中华眼科杂志,2004,40：760—764)     

基于二氯代环二聚体的微电极阵列芯片兔眼脉络膜上腔植入术的实验研究

目的 探讨基于二氯代环二聚体的微电极阵列(microelectrode array,MEA)芯片兔眼脉络膜上腔植入的手术方法及并发症和该芯片的组织相容性.方法 12只健康成年青紫兰兔,左眼为术眼,右眼为对照眼,于鼻下方角膜缘后6.0 mm处切开巩膜,暴露脉络膜,将MEA芯片放置于兔眼脉络膜上腔,术后3 d、14 d、1个月时用裂隙灯显微镜观察眼前节情况,用间接检眼镜观察玻璃体、视网膜及芯片情况,用OCT进行眼底扫描及眼底照相.结果 12眼均成功植入MEA芯片,其中1眼发生脉络膜、视网膜破裂,缝合切口后在另一眼植入芯片;5眼在术中发生脉络膜出血,待出血停止后再切除血块继续手术;2眼发生芯片前端折叠,取出芯片展平后重新植入.术后眼底检查、OCT检查及组织病理学检查发现芯片位置稳定,未见明显的视网膜、脉络膜损伤.结论 兔眼脉络膜上腔MEA芯片植入术是一种安全有效的MEA芯片植入方式,二氟代环二聚体MEA芯片组织相容性良好.     

暴发性脉络膜上腔出血的模型改良及其病理学研究

背景暴发性脉络膜上腔出血是内眼手术过程中最严重的并发症,目前多为个案报告。建立理想的暴发性脉络膜上腔出血动物模型对研究其自然病程、预防和治疗具有重要意义。目的对已有的暴发性脉络膜上腔出血动物模型的建立方法进行改良,并探讨暴发性脉络膜上腔出血的病因、发病机制、相关危险因素及其对视网膜组织和视功能的损害情况。方法采用改良的Zauberman结扎涡静脉法结扎15只成年家兔的巩膜涡静脉,同时用耳缘静脉快速滴注生理盐水法迅速升高眼压,然后经角膜缘切口快速降低眼压,制备暴发性脉络膜上腔出血动物模型。于术后即刻及术后1、2、4周行B型超声检查脉络膜出血情况和视网膜脱离情况,同时光学显微镜下观察上述各时间点视网膜组织和细胞的病理形态学改变。结果暴发性脉络膜上腔出血动物模型制备的成功率为100％,其病程与临床自然转归相符。B型超声检查确定了脉络膜出血的形态、部位和性质,显示出血和视网膜脱离随着时间的延长逐渐好转。眼球组织病理学检查显示Bruch膜和视网膜色素细胞层破裂,大量红细胞进入脉络膜上腔和玻璃体内,术后1周视网膜的组织学改变以细胞变性、水肿和坏死为主,术后4周以纤维母细胞及胶原纤维增生等修复性改变为主。结论采用改良的Zauberman结扎涡静脉配合静脉快速滴注生理盐水法建立暴发性脉络膜上腔出血模型的成功率高。高眼压持续后的眼压骤降是暴发性脉络膜上腔出血的主要危险因素。暴发性脉络膜上腔出血可造成脉络膜和视网膜组织细胞的严重破坏。     

激光性黄斑病变的OCT图像特征

目的:观察激光导致的黄斑区视网膜损伤的眼底改变及其光学相干断层扫描仪(OCT)图像特征.方法:收集2002年4月-2009年12月因激光照射致视力下降的患者4例(4眼).所有患者均行眼部常规检查、眼底照相及OCT检查.结果:4例患者的眼底表现各不相同.1例表现为黄斑区板层裂孔,残留薄层外层视网膜,相应部位光感受器内外节连接光带消失及视网膜色素上皮光带消失,脉络膜光带下陷并反射略增强,周围视网膜前膜形成,玻璃体腔积血;1例表现为黄斑区全层裂孔伴周围视网膜水肿;1例表现为黄斑区视网膜神经上皮层局限性浆液性浅脱离;1例表现为黄斑区视网膜内层团状高反射(出血).结论:激光致黄斑区视网膜损伤的眼底表现多种多样,OCT能够清晰显示其视网膜损伤的层次及形态改变.     

Use of amphoteric rinsing solution for treatment of ocular tissues exposed to nitrogen mustard

Purpose: Ocular exposure to mustard agents may cause severe and prolonged injury to the anterior segment tissues. Effective decontamination of the external eye surface after exposure is of paramount importance. The purpose of the present study was to assess the effectiveness of Diphoterine rinsing solution (DRS) in reducing ocular damage after exposure to nitrogen mustard (NM) and to compare it with normal saline solution. Methods: One eye of 16 New Zealand albino rabbits was exposed to 2% NM. Immediate thorough irrigation was performed with either 500 ml of DRS (treated group) or with 500 ml of normal saline (control group). The magnitude of ocular injury and response to treatment were assessed by examiners masked to the treatment assignment during 22 days following the exposure. Results: Immediate ocular irrigation with DRS was more effective compared with saline in reducing corneal, iris and anterior chamber injury. In the DRS‐treated group, the corneal opacity and corneal neovascularization were less severe, and development of iris atrophy was delayed. Intraocular pressure (mmHg) was better maintained when compared to the control group (day 7 24.3 versus 14.8, p = 0.003; day 12 28 versus 15, p = 0.003; day 22 33.5 versus 21.8, p = 0.014, respectively). Systemic oxidative stress associated with exposure to NM was significantly higher in the saline‐treated group than in DRS‐treated group (p < 0.011). Conclusions: The findings of this study indicate the effectiveness of DRS in reducing of NM‐induced ocular injuries. Its use should be considered as an immediate treatment modality following exposure to mustard agents to reduce potential ocular injury.     

眼动脉瘤眼部表现的临床探讨

目的:探讨眼动脉瘤所引起的眼部改变。方法:回顾性分析2003-08/2009-03首都医科大学附属北京天坛医院神经外科收治的44例眼动脉瘤患者的临床资料。结果:眼动脉瘤患者44例以眼部改变为首发者14例(32%)。视力下降者12例(27%),其中单眼者10例(23%),双眼者2例(5%);视野缺损者10例(23%)(双眼2例,单眼8例);复视者2例(5%);上睑下垂者4例(9%);误诊为球后视神经炎2例,青光眼1例。结论:眼动脉动脉瘤患者可引起眼部改变,最常见的表现为视力下降和视野缺损。     

眼外伤后视网膜脱离15例的法医学鉴定分析

目的:探讨视网膜脱离的形成机制、鉴别诊断、鉴定方法等相关问题。方法:对15例视网膜脱离的临床法医学鉴定资料进行回顾性研究。结果:15例视网膜脱离案例中,10例为外伤性视网膜脱离,其他5例存在不同程度的眼球组织结构病变,为非外伤性视网膜脱离;鉴定时间在3～14mo,其中轻微伤2例,轻伤5例,重伤8例。结论:外伤性视网膜脱离要有明确的眼部外伤史,且损伤程度重,玻璃体、视网膜未见明显变性改变;而非外伤性视网膜脱离的主要特点为外伤程度轻,多以外眼损伤为主,存在玻璃体、视网膜变性;损伤程度应在诊断明确及进行相关治疗后,主要依据中心视力或视野损害情况确定。     

眼球穿通伤玻璃体切除术后低眼压的临床分析

目的:探讨眼球穿通伤玻璃体切除术后,低眼压的发生率和危险因素。方法:对64例70眼因眼球穿通伤而行玻璃体切除术的临床资料进行回顾性分析,低眼压的诊断标准为眼压<5mmHg,并随访时间>6mo。结果:64例70眼因眼球穿通伤而行玻璃体切除术后发生低眼压14眼(20%);其中术前有眼内炎和无眼内炎眼术后低眼压发生率分别为40%和9%,两组之间比较差异有显著性意义(χ2=9.73,P<0.05);行视网膜切开术和未行视网膜切开术后低眼压者发生率分别为58%和12%,两组比较差异有显著性意义(χ2=10.57,P<0.05);前部增生性玻璃体视网膜病变者和无前部增生性玻璃体视网膜病变者术后低眼压者发生率分别为50%和14%,两组比较差异有显著性意义(χ2=6.04,P<0.05)。结论:低眼压是眼球穿通伤玻璃体切除术后的一个并发症,术前有眼内炎,术中行视网膜切开以及严重的前部增生性玻璃体视网膜病变是发生低眼压的危险因素。     

眼球钝挫伤眼压异常分析

目的:分析眼球钝挫伤患者的眼压变化。方法:眼球钝挫伤患者181例,就诊时以眼压>24mmHg为高眼压,<10mmHg为低眼压,并对眼压异常的原因进行分类分析。结果:眼球钝挫伤患者181例中眼压异常者120例(66.3%),其中高眼压98例(81.7%),低眼压22例(18.3%),其眼压变化可由多种原因引起,主要原因有前房出血、玻璃体出血、瞳孔放大、虹膜根部离断、房角后退、晶状体脱位、玻璃体涌前房、视网膜挫伤、睫状体脱离等。结论:眼球钝挫伤常导致眼压异常变化,眼科医生应引起足够重视。     

Ocular hypertensive and anti-inflammatory responses to different dosages of topical dexamethasone in children: a randomized trial

BACKGROUND: The purpose of the present study was to investigate the ocular hypertensive and anti-inflammatory responses to two different dosage schedules of 0.1% topical dexamethasone in a population of Chinese children undergoing strabismus surgery. METHODS: Children undergoing bilateral strabismus surgeries were randomly assigned to receive topical 0.1% dexamethasone eye drops four times daily (group A) or twice daily (group B) for 4 weeks. Intraocular pressure (IOP) and anti-inflammatory responses were monitored for 8 weeks. RESULTS: A total of 137 children with mean age 6.5 years (SD, 1.9 years; range, 3-10 years) participated in the study. The IOP increased significantly after 4 weeks in both groups compared to the preoperative values (P < 0.001). Peak IOP ranged from 14.0 to 50.3 mmHg in group A and 11.0-41.3 mmHg in group B. Cases in group A (mean, 13.8 mmHg; SD, 8.4 mmHg) had a greater net increase in IOP than cases in group B (mean, 10.2 mmHg; SD, 6.2 mmHg; P = 0.004). Younger-aged children had higher peak IOP (r = -0.244, P = 0.048), and attained the peak IOP earlier (r = 0.252, P = 0.041) in group A. There was no significant difference in ocular inflammatory response between the two groups. CONCLUSION: Ocular hypertensive effect to topical 0.1% dexamethasone is dose and age dependent in children. Twice-daily 0.1% topical dexamethasone eye drops control inflammation after strabismus surgery as effectively as four-times-daily dosage, but induces less increase in IOP, and may be a better treatment schedule.     

正常人中央角膜厚度与Goldmann压平眼压的关系

目的:了解正常人中央角膜厚度(central corneal thickness,CCT)的分布特点并探讨其与压平眼压测量值的关系。方法:采用光学角膜测厚仪及Goldmann压平眼压计检测169名正常人CCT和压平眼压。结果:169名受检者右眼平均CCT为0.547mm(95%可信区间0.443~0.651mm),左眼0.551mm(95%可信区间0.453~0·649)。压平眼压右眼平均15.8mmHg,左眼15.5mmHg。CCT与年龄无相关关系,但与压平眼压测量值显著相关。线性回归分析表明,CCT每增加0.018mm,压平眼压增加1mmHg。结论:CCT变异是眼压测量误差的主要来源。CCT较厚的正常个体可表现"眼压增高"被误诊为高眼压症,而CCT偏薄的原发性开角型青光眼患者则可能因眼压测量"正常"被误诊为正常眼压性青光眼。在诊断青光眼或高眼压症时,特别是在眼压值与其他临床表现不符时,应考虑CCT有无变异。     

Glaucoma after open globe injury

Ocular trauma remains a core root of avoidable blindness worldwide. Corneal scarring, lens injury, glaucoma, vitreous hemorrhage, retinal or choroidal detachment and endophthalmitis are sequel to ocular trauma that can lead to blindness. Very few studies have been published to tackle the risk of developing post-traumatic glaucoma after open globe injuries (OGI), however, there are many articles discussing closed eye injury. This review article aims to cover the incidence, risk factors, causes and treatment of glaucoma after open globe injury.     

Profile of ocular trauma in Papua New Guinea

Background: Ocular trauma is a significant cause of blindness in Papua New Guinea (PNG). This study was done to determine the pattem and rates of ocular and adnexal injuries so as to determine the size and extent of the problem. Methods: A retrospective study of 4157 cases presenting with ocular trauma in three regions of PNG was carried out. The data were analysed with respect to the age, sex, province, type and cause of injury, time interval between injury and presentation to the hospital and the final visual outcome after treatment. Results: Ocular trauma rates in PNG were alarmingly high (39.1 per 100 000). The commonest cause of injury in the younger age group was due to lime. Alcohol-related violence and fights resulted in injuries in the adult age group. Most of the injuries were grievous and 60.7% of patients were left with a visual acuity of less than 6/60 in the injured eye. In addition, 78.7% of the patients were under 30 years of age. Conclusions: Ocular injuries in PNG are an important cause of visual disability. Some specific injuries, such as those due to lime in children, can easily be prevented by health education.     

眼外伤150例临床统计分析

目的探讨常熟市眼外伤发生特点、致伤原因、治疗、结果。方法对150例（157眼）眼外伤者性别、年龄、致伤原因、并发症及治疗前后视力等资料进行回顾性统计学分析。结果150例眼外伤中,男女比例为3．55：1。各年龄段均有眼外伤。开放性眼外伤80例（80眼）,眼球挫伤70例（77眼）。致伤原因以木块弹伤、金属丝刺伤、金属碎屑溅伤、混凝土块击伤常见。并发症中以前房积血、外伤性白内障、晶状体半脱位、玻璃体积血多见。治疗前盲目率为64．3％,治疗后为22．3％,明显下降。结论眼外伤多发生在户外建筑施工或工厂机械制造工作中,绝大多数是可以预防的,及时有效的诊治、加强生产生活安全教育和工作防护是预防眼外伤的重要环节。