Retinal vasculitis associated with Crohn's disease.

Although systemic vasculitis can be a complication of inflammatory bowel disease at several locations (skin, eyes, brain, mesentery, and lung) the association of retinal vasculitis with Crohn''s disease is rare. We studied a 26-year-old woman with biopsy-demonstrated Crohn''s disease who developed a severe bilateral retinal arteritis and phlebitis, with acute loss of vision.     

Tuberculous retinal vasculitis

A patient who was referred to the eye department for routine ocular assessment prior to commencement of antituberculous therapy was found to have periphlebitis in both eyes despite being visually asymptomatic. Fluorescein angiography confirms the presence of vasculitis without any retinal oedema or areas of non-perfusion, which may sometimes accompany the condition. Within 2 months of systemic treatment, the ocular signs regressed without any permanent effect on vision. This case highlights a rare ocular complication associated with systemic tuberculosis which fortunately did not result in loss of vision due to prompt treatment.     

OPTIC DISC VASCULITIS REPORT OF 42 CASES

Optic disc vasculitis may be of 2 different types, hence the fundus may show either marked edema of the optic disc or signs of central retinal vein obstruction without other ocular or systemic abnormality. 42 cases of this disease (si eyes) are presented and analysed in this paper.     

Atypical Cogan’s syndrome associated with coronary disease

Cogan’s syndrome (CS) is a rare inflammatory disorder characterized by interstitial keratitis and vestibuloauditory abnormalities often associated with various systemic manifestations. Involvement of cardiovascular system resembling systemic vasculitis may lead to severe complications and death. The present report describes a case of a female patient with atypical Cogan’s syndrome presented with systemic manifestations and severe coronary and femoral artery stenosis. Despite the clinical improvement after glucocorticoids and cyclophosphamide, the patient required double aortocoronal bypass grafting one year letter. During three years follow-up, she was in stable condition, without stenocardial symptoms and claudication and her inflammatory parameters remain normal. This case highlights the rare involvement of coronary arteries without associated large-vessel vasculitis of the aortic arch in CS. 

     

大鼠局限性炎性肉芽肿模型的建立

目的探讨建立实验性大鼠肝内和皮下局限性炎性肉芽肿模型的实验方法。方法应用正常Wistar大鼠,开腹直视下肝内和皮下分别注射卡介苗、破壁和未破壁灵芝孢子粉溶液,处理后4和8周时进行病理形态学观察和分析。结果各实验组大鼠在造模前后生命体征均良好,造模后4和8周时肝内和皮下均可见到局限性的炎性肉芽肿病变,但8周时即可出现较重纤维化。结论应用卡介苗和灵芝孢子粉局部注射,可在对机体无明显危害情况下,在大鼠肝内和皮下成功建立局限的炎性肉芽肿模型。     

The efficacy of topical administration of brimonidine to reduce ischaemia in the very early stage of diabetic retinopathy in good controlled type-2 diabetes mellitus

It is now proved that diabetic micro-angiopathy is caused by ischaemia at the capillary bed of retina due to reduced capillary blood flow in long standing type-2 diabetes mellitus. Deranged metabolic process due to chronic hypoxia at the tissue level produces visual and vascular dysfunction. Brimonidine tartrate, an alpha-2 agonist which is commonly used in glaucoma to protect retinal ganglion cells from pressure related ischaemia induced cell apoptosis, is administered in very early stage of non-proliferative diabetic retinopathy to reduce ischaemia at the capillary bed of retina. Improved visual acuity and decreased micro-aneurysm formation, which indicate elimination of ischaemic stimulus at the tissue level, are seen in long standing type-2 diabetes mellitus.     

Retinal vasculitis--an initial presentation of systemic lupus erythematosus

Retinal vasculitis is an intra-ocular inflammatory condition with diverse aetiology and a rare manifestation of systemic lupus erythematosus, often associated with antiphospholipid antibodies. A 13 years male presented with fever for 20 days associated with photosensitive skin rashes. Three years back he had suffered painless, progressive dimness of vision. Then a clinical diagnosis of retinal vascular occlusion was made. Examination revealed his visual acuity was reduced to finger counting at 3 metres distance and extensive retinal vasculitis in the right eye. His serum antinuclear factor was positive in high titre. A final diagnosis was made as systemic lupus erythematosus. He was treated with methylprednisolone. His fever subsided, skin rashes healed and vision did not deteriorate further.     

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

Background  Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.

Methods  It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4⁺ T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients).

Results  Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4⁺ T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6±25.3) ×10⁶/L (range, (0–85) ×10⁶/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.

Conclusions  CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.

     

增殖性玻璃体视网膜病变发病因素的研究进展

增殖性玻璃体视网膜病变(PVR)是孔源性视网膜脱离手术失败的最主要原因,也是眼外伤、糖尿病及血管性、炎症性视网膜病变的一种结局,是眼科常见的致盲性疾病之一。其发生、发展是多种因素共同作用的结果,如视网膜色素上皮细胞、神经胶质细胞和一些炎性细胞因子的参与等。这些细胞和因子在视网膜表面和玻璃体内游走、附着、增殖,形成纤维膜并且收缩,造成牵拉性视网膜脱离。     

静脉高压对微血管床病理变化的实验研究

目的 建立适合静脉高压病理机制研究的动物模型,观察毛细血管内皮细胞Duffy抗原趋化因子受体(DARC)在静脉高压炎症反应中的作用.方法 选取SD大鼠,分别建立股动静脉瘘和髂静脉缩窄静脉高压模型,另设阴性对照和空白对照,HE染色和免疫组织化学染色法观察术后大鼠后肢肌肉及皮下组织毛细血管管腔面积的变化,并利用选出的模型观察毛细血管内皮细胞DARC表达的变化.结果 术后不同时间点股动静脉瘘模型大鼠较髂静脉缩窄模型大鼠后肢肌肉及皮下组织毛细血管管腔扩张明显且持续时间长,股动静脉瘘模型大鼠毛细血管内皮细胞DARC表达随时间延长而增加.结论 大鼠股动静脉瘘模型较适合静脉高压病理机制研究,毛细血管内皮细胞DARC的表达与静脉高压炎症反应有关.     

静脉高压对微血管床病理变化的实验研究

目的建立适合静脉高压病理机制研究的动物模型,观察毛细血管内皮细胞Duffy抗原趋化因子受体（DARC）在静脉高压炎症反应中的作用。方法选取SD大鼠,分别建立股动静脉瘘和髂静脉缩窄静脉高压模型,另设阴性对照和空白对照,HE染色和免疫组织化学染色法观察术后大鼠后肢肌肉及皮下组织毛细血管管腔面积的变化,并利用选出的模型观察毛细血管内皮细胞DARC表达的变化。结果术后不同时间点股动静脉瘘模型大鼠较髂静脉缩窄模型大鼠后肢肌肉及皮下组织毛细血管管腔扩张明显且持续时间长,股动静脉瘘模型大鼠毛细血管内皮细胞DARC表达随时间延长而增加。结论大鼠股动静脉瘘模型较适合静脉高压病理机制研究,毛细血管内皮细胞DARC的表达与静脉高压炎症反应有关。     

康柏西普联合玻璃体切割术治疗视网膜血管瘤引起的 视网膜脱离的疗效观察

目的 回顾性分析视网膜毛细血管瘤(RCH)引起的视网膜脱离患者行单纯玻璃体切割手术或玻璃体腔注射康柏西普联合玻璃体切割手术的治疗效果。 方法 采用23 G玻璃体切割术和激光凝固和(或)冷冻疗法治疗15例(15眼)由RCH引起的视网膜脱离患者,其中6例(6眼)玻璃体腔内注射康柏西普7 d后行玻璃体切割术(注射组),9例(9眼)单纯行玻璃体切割术(未注射组)。记录手术时间、最佳矫正视力(BCVA)、眼底情况、荧光素血管造影(FFA)结果以及全身情况,并进行比较分析。 结果 未注射组中,7眼视网膜平复、肿瘤消退,1眼出现新的RCH,1眼复发视网膜脱离。注射组中,5眼术后视网膜平复、肿瘤消退,1眼复发视网膜脱离。 结论 23 G玻璃体切割联合玻璃体腔注射康柏西普,对RCH引起的严重的出血性视网膜脱离有较好的疗效,可明显减少手术时间及术中出血,减少手术次数。根据FFA的结果行激光光凝和(或)冷冻治疗是治疗成功的重要因素。     

ANCA相关性小血管炎20例诊治探讨

目的探讨抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎的临床特点及诊治方法。方法对20例确诊为ANCA相关性小血管炎患者的临床资料进行总结分析。结果ANCA相关性小血管炎临床表现复杂,全身各系统均可受累,以肾、肺受累为主。ANCA对其诊断具有重要意义。结论ANCA相关性小血管炎临床表现缺乏特异性,早期诊断,早期适当治疗是改善预后的关键。     

TLR4-/- 抑制小鼠氧诱导视网膜新生血管生成的作用机制

目的通过建立氧诱导视网膜血管病变（OIR）模型,探讨Toll样受体4(TLR4)在视网膜新生血管中的作用及其机制。方法使用7日龄新生TLR4基因敲除（TLR4-/-）C57BL／6J小鼠和7日龄新生C57BL／6J小鼠建立OIR模型。分别于小鼠第12天（P12）、17天（P17）和21天（P21）时通过小鼠视网膜荧光灌注铺片观察新生血管面积,评估新生血管情况。通过免疫荧光染色,观察TLR4在小鼠视网膜中的表达情况。通过Real-Time PCR检测两组OIR小鼠P12和P17视网膜组织中核因子-κB(NF-κB)、血管内皮细胞生长因子(VEGF)和促炎因子白细胞介素-6(IL-6)的mRNA表达水平。结果在OIR模型中,通过视网膜荧光灌注铺片发现P12两组小鼠视网膜出现无血管区,P17均出现无血管区和新生血管簇,而且新生血管面积达到最高峰。P12、P17和P21时,TLR4-/- OIR小鼠中的视网膜新生血管面积均明显比正常OIR小鼠减少,差异有统计学意义（P<0.05)。通过免疫荧光检测发现TLR4在小鼠视网膜上广泛表达,与未建立OIR模型的正常小鼠相比,在P17时正常OIR小鼠视网膜的TLR4表达明显升高。对比正常OIR小鼠,TLR4-/- OIR小鼠视网膜组织的NF-κB、VEGF和促炎因子IL-6的表达水平明显降低,差异均有统计学意义（P<0.05)。结论TLR4在视网膜新生血管形成过程中起到重要作用,TLR4基因缺失通过抑制NF-κB信号通路,减少血管生成因子和炎性因子的释放,抑制OIR小鼠视网膜新生血管的生成。     

Optic neuritis and retinal vasculitis as primary manifestations of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a common multisystem disorder. However, retinal vasculitis as a primary manifestation of SLE is uncommon, accounting for only 4% of causes of retinal vasculitis. The postulated mechanism appeared to be vaso-occlusion of the retinal arterioles by thrombosis, with resultant ischaemia. Optic neuropathy in SLE is also rare, with a prevalence of 1%. This is a case report of a young lady who presented to us with retinal vasculitis as her initial presentation of SLE. Interestingly, the pathologic mechanism appeared to be inflammatory and not vaso-occlusive.     

Systemic Wegener's granulomatosis with severe orbito-ocular involvement

Orbito-ocular involvement in Wegener's granulomatosis is the result of both focal ischaemic vasculitis and granulomatous soft tissue inflammation. Necrotising keratoscleritis and orbital inflammation are two most characteristic ophthalmic presentations. We describe a 56-year-old man with systemic limited Wegener's granulomatosis, presenting with pulmonary fibrosis, pansinusitis and left mastoiditis. This was complicated by the development of a left severe necrotising anterior scleritis, peripheral ulcerative keratitis and orbital apex syndrome. Both c-ANCA and anti-PR3 were positive. Despite mainstay systemic immunosuppressive therapy with cyclophosphamide and prednisolone, the visual prognosis remained very poor. This was largely due to the presence of an irreversible ischaemic optic neuropathy, extensive corneoscleral melt and corneal neovascularisation. This case highlights the possible extent of orbital and ocular surface involvement in Wegener's granulomatosis, and hence the importance of vigilance by the physician.     

牛视网膜微血管内皮细胞培养方法的研究

目的 探求一种简单、易行的体外培养牛视网膜微血管内皮细胞的方法。方法 采用胶原酶消化获得细胞，并用低浓度人血浆提纯细胞。加入视网膜提取液促进细胞生长。结果 经过多次探索、观察，比较成功的进行了视网膜血管内皮细胞的培养，并成功的进行了鉴定。结论 此方法适合一般实验室开展视网膜血管内皮细胞培养。     

抗中性粒细胞胞浆抗体相关性肺血管炎的诊治(附19例报告)

目的探讨抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,,ANCA)相关性肺血管炎的临床表现及早期诊断要点.方法采用回顾性方法对19例ANCA相关性肺血管炎患者的临床资料进行分析.结果本组19例均有肺损伤,肾脏损害13例,肝脏损害5例,皮肤损害5例,心脏损害3例;胸部CT示11例有双肺弥漫性病变.血沉为(89.20±19.82)mm/1h,C-反应蛋白为(55.33±34.12)mg/L.ANCA及特异性靶抗原[髓过氧化物酶(MPO)及蛋白酶3(PR3)]检查阳性.应用糖皮质激素及免疫抑制剂治疗,7例肺部病变完全吸收,血尿、蛋白尿减轻6例,肾功能改善3例;其他脏器功能情况好转或趋于稳定,1例肾衰竭患者需血液透析支持治疗.结论ANCA相关性肺血管炎临床表现复杂,除肺部病变外,常累及多器官、多系统,ANCA及相应的特异性靶抗原检查有助于该病的早期诊断.早期给予糖皮质激素及免疫抑制剂干预治疗,能延长患者的生存时间,改善预后.     

Refractory and Active Ulcerative Colitis Complicated by Venous Thrombosis：a Case Report

ULCERATIVE colitis is a chronic inflammatorydisease characterized by diffuse mucosalinflammation involving the rectum and extendingproximally to involve all or part of the colon. Astep-up approach for medical therapy is routinely applied,from 5-aminosalicylic acid （ASA） compounds, corticosteroids,immunomodulators, and biologics.1 Thrombosis, mainlyvenous, is a rare and well-recognized extra-intestinalmanifestation of inflammatory bowel disease.2 In thisarticle, we report the use of thrombolytic and antithrombotictherapy for the venous thrombosis in a 55-year-old malepatient with refractory and active ulcerative colitis withexcellent outcome.     

视网膜血管阻塞

本文对1987年至1989年期间我院诊治可查证的视网膜血管塞78例患者进行了回顾研究。视网膜静脉阻塞较视网膜动脉阻塞多六倍。视网膜中央动脉，静脉阻塞患者各发现一例。视网膜血管阻塞年龄分布以青年与老年较多，性别无差异。40岁以下的青年人与血管炎有关；40岁以上的老年人与高血压，糖尿病等全身病有极密切关系。并对其发病机理及治疗原则进行了探讨。