火把花根片联合糖皮质激素治疗89例虹膜睫状体炎临床分析

目的:研究火把花根片治疗虹膜睫状体炎的疗效。方法:选择2006-01/2007-12在我院眼科住院治疗的虹膜睫状体炎患者89例,分为治疗组(火把花根片+糖皮质激素)45例,对照组(糖皮质激素+安慰剂)44例。对照组采用常规糖皮质激素治疗。治疗组为火把花根片联合糖皮质激素治疗。结果:治疗组和对照组第14d时统计其治愈率分别为88%,60%,经卡方检验,差异有统计学意义(P<0.05)。随访12mo,治疗组复发3例3眼,复发率8%;对照组复发5例5眼,复发率17%,经卡方检验,差异有统计学意义(P<0.05)。结论:火把花根片可用于虹膜睫状体炎的治疗,治愈率及复发率较单纯应用糖皮质激素好。     

肾上腺皮质激素治疗顽固性葡萄膜炎

1　资料与方法1.1　一般资料　本文观察的病例均为门诊患者共 90例180眼 ,其中男 30例 ,女 6 0例 ,年龄 35～ 5 5岁。病程 1～15 a。全葡萄膜炎 35例 ,后葡萄膜炎 40例 ,原田综合征 10例 ,Vogt-小柳综合征 5例。就诊前均在其他医院曾反复长期局部全身应用激素治疗 ,均未能控制 ,前后节炎症均明显者6 0例 ,其余 30例炎症较轻微 ,激素减量炎症复发。 180眼中4眼并发白内障 ,2眼并发青光眼 ,所有病例均呈现药源性柯兴综合征。1.2　治疗方法　观察患者均为全葡萄膜炎或后葡萄膜炎 ,给药方式以全身用药为主 ,强地松冲击疗法逐渐减量。每早8点口…     

以辨证的观点认识和治疗葡萄膜炎

唯物辩证法是关于自然界、人类社会和思维的一般规律的科学，是马列主义哲学的重要组成部分，是以联系、发展和全面的观点观察一切事物的世界观和方法论。以辨证的思维去认识和治疗葡萄膜炎之类的疾病可以从总体上把握此类疾病的本质，也可以正确指导葡萄膜炎的治疗。     

葡萄膜炎的治疗进展

葡萄膜炎(uveitis)是临床常见的累及虹膜、睫状体、玻璃体、脉络膜、视网膜及视网膜血管的一组炎症疾病,原因复杂,由于葡萄膜炎的发病机制并未阐明清楚,寻找有效治疗葡萄膜炎的药物一直是眼科研究的主要方向,除了传统的糖皮质激素、睫状肌麻痹剂、非甾体类抗炎药、免疫抑制剂对葡萄膜炎有着不错的疗效,随着分子生物学的发展,新型生物制剂、基因治疗、中医药在治疗葡萄膜炎上也占有一席之地。本文旨在对葡萄膜炎最新的治疗进展进行综述。     

内毒素诱导的SD大鼠葡萄膜炎外周血淋巴细胞凋亡的研究

目的探讨外周血淋巴细胞凋亡在内毒素诱导的SD大鼠葡萄膜炎模型炎症过程中的作用.方法将内毒素注射于SD大鼠的足底部,于注射后不同时间点抽取实验组鼠的外周血,分离淋巴细胞并制备涂片,分别用流式细胞仪和TUNEL法检测凋亡淋巴细胞的阳性百分率.结果临床观察和组织学检查结果均证实50只SD大鼠全部发生了葡萄膜炎,以前葡萄膜炎为主,炎症平均得分为4.589级±1.095级;检测结果显示在炎症高峰期(24～36h)实验组鼠外周血淋巴细胞发生大量凋亡.结论内毒素诱导外周血淋巴细胞的凋亡可能参与了炎症的迅速消退.     

霍乱弧菌内毒素诱导大鼠葡萄膜炎的组织切片研究

目的：本研究用霍乱弧菌内毒素诱导大鼠葡萄膜炎，建立全葡萄膜炎的动物模型，以期研究该病的发病机制和有效的治疗方案，方法：应用纯化后霍乱弧菌内毒素注射于Wistar大鼠，分别于注射后4，8，12，16，24h裂隙灯显微镜观察以以眼前节变化，及病理组织学观察，结果；注射内毒素后4h出现炎症，12h反应达到最重、表现为瞳孔缩小，虹膜水肿，血管充血扩张，严重者前房渗出，积血，组织学观察可见前房睫状体，虹膜水肿血管扩张充血，脉络膜水肿加剧，血细胞弥漫性渗出，视网膜有脱离，节细胞数量，视网膜厚度，节细胞大小，节细胞层血管数量及大小，内核外网层血管数量及大小都有明显的变化，结论：认为该方法用于诱导葡萄膜炎动物模型是成功的，同时还比较了内毒素和S抗原在诱导葡萄膜炎中的关系。     

葡萄膜炎的免疫学治疗进展

葡萄膜炎是中青年年龄组主要影响视力的疾病之一。葡萄膜炎分为前葡萄膜炎和后葡萄膜炎。近年来 ,对葡萄膜炎免疫过程包括T细胞激活、白细胞移行、效应器反应等的理解 ,促进了免疫特异治疗方法迅速发展。针对以上免疫过程 ,分别采用不同的免疫治疗 ,为葡萄膜炎的治疗开辟了一条崭新的道路。目前 ,抑制T细胞激活、针对细胞粘附分子、抑制效应器反应、诱导免疫耐受等方法已进入实验阶段 ,但应用于临床尚需进一步研究。以内源性后葡萄膜视网膜炎 (EPU)为例综述了葡萄膜炎免疫特异治疗的研究现状。     

Etanercept treatment in the endotoxin-induced uveitis of rats

This study was conducted to investigate therapeutic value of a soluble tumor necrosis factor-alpha (TNF-alpha) receptor, etanercept, in a rat model of endotoxin-induced uveitis (EIU). Forty-two inbred male Lewis rats were divided into seven equal groups. 200 microg of Escherichia coli 055:B55 lipopolysaccharide (LPS) was injected in one hind footpad of the Groups 2, 3, 4, 5, 6, and 7 rats. Group 5, 6, and 7 rats also received subcutaneous etanercept 24 hr prior to LPS injection at a dose of 0.4 mg kg(-1). Group 1 rats were used as controls. Eight, 24, and 48 hr after treatment clinical uveitis scores (miosis, iris hyperemia, and hypopyon) were assessed by a masked observer and the rats were euthanized. Neutrophil leukocytes, CD8+, CD4+, and CD45RO+ cells in the anterior uveal tissue were counted either after hematoxylin-eosin or monoclonal antibody staining. TNF-alpha levels were also measured in the aqueous humor samples by an ELISA method. Etanercept treatment significantly improved clinical uveitis scores at all examination points compared to the LPS injected animals. The improvement was almost complete expect for the miosis score, since no significant difference was detected between the controls and LPS + Etanercept treated animals at all examination points. Cell counts were also at significantly lower levels in LPS + Etanercept treated animals at all examination points, except for CD8+ and CD45RO+ cell counts at 24 hr examination point. There was no significant difference between the controls and LPS + Etanercept treated animals at all examination points as with CD4+ and CD45RO+ cell counts at 48 hr. Our data showed that etanercept had a definite effect on the treatment of EIU. Further studies should clarify its efficacy on clinical uveitis conditions.     

病毒性前葡萄膜炎的临床研究进展

病毒性前葡萄膜炎是临床最常见的葡萄膜炎之一,是重要的致盲性疾病。其病因复杂、机制不清,临床表现多样化,易与其他类型葡萄膜炎混淆,较难及时进行病因诊断;治疗上,由于较难针对病因治疗,常常存在不规范治疗,导致病情迁延反复。本文就疱疹病毒性、巨细胞病毒性及风疹病毒性前葡萄膜炎的临床表现、诊断及治疗进展进行综述,比较了巨细胞病毒、风疹病毒性前葡萄膜炎与疱疹病毒性前葡萄膜炎的临床特点,归纳了病毒性前葡萄膜炎的诊疗思路。     

The role of the immune system in uveitis induced in animals

The etiological diagnosis in many cases of uveitis is hampered by the lack of insight into the pathogenesis of the disease. Animal models might provide clues for the understanding of the ocular and systemic processes leading to this invalidating disease. The immune system seems to play an important role in the pathogenesis of uveitis. Four main topics i.e. autoimmune phenomena, circulating immune complexes, effects of systemic endotoxin and bacterial or viral uveitis are reviewed. Autoimmune phenomena might cause the recurrence of uveitis after presentation of slightly altered self-antigens to the immune system. The endotoxin induced uveitis might be the initial event of recurrent episodes of uveitis caused by the deposition of immune complexes. Endotoxin might play a role in the so called HLA-B27 positive uveitis, mediated through tumour necrosis factor and interleukin-1. In this paper the characteristics of these animal models are described. Attention has been paid to those situations where several of these mechanisms combine in the pathogenesis of ocular diseases.     

Treatment of uveitis with recombinant human interleukin-13

AIM—To evaluate the anti-inflammatory cytokine interleukin-13 (IL-13) for the treatment of uveitis.
METHODS—Uveitis was induced in monkeys by immunisation with human retinal S-antigen. Starting at the onset of disease, the animals were treated with IL-13 at 25 µg/kg, or vehicle control, injected subcutaneously once a day for 28 days. Intraocular inflammation was scored by indirect ophthalmoscopy for a period of 56 days. Circulating leucocyte levels were monitored.
RESULTS—Uveitis started unilaterally in all but one animal. IL-13 inhibited inflammation both in the eyes in which the disease was present when the treatment was initiated (p=0.0001), and in the contralateral initially negative eyes (p=0.0001). After cessation of therapy, there was a progressive increase of inflammation in the IL-13 treated group. However, the beneficial effect of IL-13 extended into the 4 week follow up period. IL-13 produced an increase in circulating polymorphonuclear neutrophils and a decrease in lymphocytes.
CONCLUSION—Administration of IL-13 appears to be a promising modality of treatment for severe uveitis.

Keywords: uveitis; experimental autoimmune uveitis; cytokines; IL-13     

中医药综合治疗葡萄膜炎临床评价分析

葡萄膜炎在我国是一种严重威胁青壮年视力的眼病,而目前对其的诊治中,中医药以其明显的优势已广泛应用于葡萄膜炎的治疗。我们利用我中心为国家中西医结合眼科葡萄膜炎重点专病协作组组长的优势,组织进行多中心临床治疗方案合作,研究中医药在治疗葡萄膜炎方面的疗效分析。我们研究发现中医药综合治疗方案具有明显减少复发、减少激素副作用、改善患者视功能、提高治愈率、降低致盲率等优势。     

Comparison of uveitis induced by interleukin-8 (IL-8) and endotoxin in rabbits

IL-8 is a potent chemoattractant which has been postulated to play a role in the cytokine cascade associated with uveitis. The authors studied the effect of intravitreal IL-8 on the induction of uveitis in the rabbit. IL-8 at varying concentrations (1 ng, 10 ng or 100 ng) or endotoxin (100 ng) was injected intravitreally within the rabbit eye. At 6, 24 and 48 hours following injection the induction of uveitis was evaluated by clinical scoring, anterior chamber (AC) leukocyte count, AC protein concentration and histopathology in 15 rabbits. Only the 100 ng concentration of IL-8 induced uveitis at 6 and 24 hours by clinical scoring and AC leukocyte count; the AC protein concentration remained normal. In contrast, endotoxin caused a severe uveitis with a significant increase in all the parameters evaluated. The authors conclude that intravitreal IL-8, in the concentrations studied, induces a limited uveitis which is detectable at six hours and resolves within 48 hours. It is characterized by leukocyte infiltration without an increased AC protein concentration. Thus, IL-8 may play a role in the cytokine cascade involved in the induction of uveitis     

Medical treatment of macular edema in patients with uveitis

Purpose: To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis. Methods: Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual aucity (VA) of ≥20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes). Results: Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60–70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up. Conclusions: CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups. This revised version was published online in July 2006 with corrections to the Cover Date.     

Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients

AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated uveitis. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35±12 (range 18–50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior uveitis was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.