泪膜与眼表微环境的研究进展

泪膜覆盖眼表,是眼表微环境的重要组成部分,其稳态失衡可以造成眼表其他细胞和组织结构与功能异常,从而加重眼表疾病的发生和发展。笔者旨在对泪膜与眼表微环境中其他的成分包括眼表上皮、角膜基质、角膜神经和眼表微生物群的作用方面进行综述,以期为眼表疾病的发病机制研究及诊疗提供新的思路。     

人眼表微生物群与眼表疾病研究进展

眼表微生物群是人体眼表微环境的一部分,在维持其稳定中占据重要作用。许多研究对于健康与疾病状态下眼表微生物群的组成进行探究,但研究结果基于内外因素的不同而存在差异,且微生物失调与疾病之间的关系也尚未明确。近年来,随着肠道微生物与全身性疾病的研究不断深入,眼科研究者们也从中获得了一些启发,对眼表微生物群与眼表非感染性疾病的关系有了更进一步的探讨。本文将对正常眼表核心微生物群、眼部及全身性疾病眼表微生物群的变化进行综述,并讨论微生物失调引起疾病的可能机制,希望对未来眼表微生物群的进一步研究提供参考依据。     

儿童外伤性青光眼的临床分析

目的:分析儿童外伤性青光眼的临床特征。方法:回顾性分析郑州大学第一附属医院2014年1月至2018年12月收治的1~14岁425例儿童眼外伤中继发性青光眼共67例(67只眼)的临床资料。其中闭合性眼外伤继发青光眼组52例(52只眼),开放性眼外伤继发青光眼组15例(15只眼)。分析两组患儿临床特征、治疗方法及其效果。随访时间1个月~2年。结果:425例儿童眼外伤中有251例闭合性眼外伤和174例开放性眼外伤。闭合性眼外伤继发青光眼的发生率(20.72%,52/251),高于开放性眼外伤继发青光眼的发生率(8.62%,15/174),差异有统计学意义(χ^2=11.323,P=0.001)。闭合性眼外伤继发青光眼的发病时间早于开放性眼外伤继发青光眼。前房积血是闭合性眼外伤青光眼的主要病因(40.38%,21/52),混合型机制是开放性眼外伤青光眼的主要病因(73.33%,11/15)。患者均经常规药物治疗,眼压不能控制者闭合性眼外伤青光眼组有22例行手术治疗(42.31%,22/52),开放性眼外伤继发青光眼组有3例(20.00%,3/15),两组对比无统计学意义(χ^2=2.477,P=0.116)。末次随访闭合性眼外伤青光眼组患者的平均眼压高于开放性眼外伤青光眼组(t=2.828,P=0.006)。两组患者末次随访BCVA差异无统计学意义(t=-1.244,P=0.218)。结论:闭合性眼外伤继发青光眼较开放性眼外伤继发青光眼常见。前房积血和混合型机制分别是闭合性眼外伤继发青光眼和开放性眼外伤继发青光眼的常见发病原因。药物治疗仍是首选,但滤过手术是控制闭合性眼外伤继发青光眼的有效途径。     

Ocular involvement in patients with onchocerciasis after repeated treatment with ivermectin

We assessed ocular changes after therapy at six and 12 months with ivermectin (150 micrograms/kg of body weight) in a 12-month prospective study of 29 patients with ocular onchocerciasis and 15 patients with onchocerciasis without ocular involvement. The patients lived in a hyperendemic area in Sierra Leone, West Africa, where no vector control was instituted. Five months after initial treatment, the microfilarial load in skin and eyes had decreased significantly (P less than .0000), but 28 of 44 (63%) patients had positive skin-snip test results and nine of 29 (31%) patients with ocular involvement had active ocular disease. Twelve months after initial treatment, 15 of 41 (37%) patients had positive skin-snip test results and eight of 26 (31%) showed active ocular involvement. All patients with persistent ocular disease after therapy showed evidence of active onchocerciasis at that time, which suggests that a dose of ivermectin at six-month intervals is not sufficient for intensely infested patients with severe ocular disease. We developed an ocular involvement score to evaluate the patient's total ocular status and observed a significant relation between the pretreatment severity of ocular involvement and the persistence of active ocular disease after treatment with ivermectin.     

Ocular surface inflammation is regulated by innate immunity

On the ocular surface, as in the intestines and airway, the surface epithelium serves a critical function as the front-line defense of the mucosal innate immune system. Although the detection of microbes is arguably the most important task of the immune system, an exaggerated epithelial host defense reaction to endogenous bacteria may initiate and perpetuate inflammatory mucosal responses.In this review we first describe commensal bacteria found on the ocular surface, which is in contact with the ocular surface epithelium. We also discuss the innate immunity of the ocular surface epithelium and we present the allergic reaction regulated by ocular surface epithelial cells. We address ocular surface inflammation due to disordered innate immunity and we present our hypothesis that the onset of Stevens-Johnson syndrome (SJS) with severe ocular surface complications, a devastating ocular surface inflammatory disease, is strongly associated with abnormality of the innate immune system.In this review we raise the possibility that some ocular surface inflammatory diseases are pathogenetically related with a disordered innate immune response.Focusing on the innate immunity of the ocular surface might help to elucidate the pathogenesis of various ocular surface diseases.     

Aqueous humor dynamics in alpha-chymotrypsin-induced ocular hypertensive rabbits.

Aqueous humor dynamics were studied in alpha-chymotrypsin-induced ocular hypertensive rabbits either by tonographic or two-level constant pressure perfusion techniques. A significant correlation was obtained between the values of outflow facility in alpha-chymotrypsin-induced ocular hypertensive rabbits as determined by tonography and constant pressure perfusion. The mean value of tonographic outflow facility in ocular hypertensive rabbits was not statistically different from that found in ocular normotensive rabbits. On the contrary, the estimated rate of aqueous inflow in ocular hypertensive rabbits was about 1.5-fold higher than that of ocular normotensive ones. While topical timolol lowered intraocular pressure and aqueous humor inflow in ocular hypertensive rabbits, pilocarpine did not produce any significant effect. Aqueous humor protein was significantly increased in ocular hypertensive eyes. The results of this study show that accurate measurements of outflow facility can be obtained in alpha-chymotrypsin-induced ocular hypertensive rabbits by tonographic technique. Our data suggest that the long-term ocular hypertension induced by alpha-chymotrypsin in albino rabbits may be secondary to an increase in the rate of aqueous humor inflow, likely produced by a breakdown of the blood-aqueous barrier. This finding strongly conflicts with the hypothesis of trabecular blockage as the cause of alpha-chymotrypsin-induced ocular hypertension in this species.     

Scanning electron microscopy of conjunctival surfaces in patients with ocular cicatricial pemphigoid

The conjunctival surfaces of ten patients with active, ocular cicatricial pemphigoid, three patients with drug-controlled ocular cicatricial pemphigoid, and six patients with normal conjunctivas were studied using scanning electron microscopy. A homogeneous granular sheet of amorphous mucin-like material was observed covering extensive areas of the conjunctiva in eight of ten patients with active ocular cicatricial pemphigoid. This sheet of amorphous material was absent on drug-controlled ocular cicatricial pemphigoid and normal conjunctival specimens. Our study demonstrates that patients with active ocular cicatricial pemphigoid possess ocular surface mucus that appears thicker and more continuous than normal ocular mucus when observed with scanning electron microscopy. This observation is in agreement with clinical observations of thick mucus strands in the inferior fornix of patients with active ocular cicatricial pemphigoid.     

Clinical features of ocular trauma in emergency department

This study analyzed a hospital-based study to investigate the incidence and clinical features of ocular traumatic emergencies in Korea. Over a 6-year period, 1809 patients with ocular traumatic emergency each individually underwent clinical study including subject characteristics, type of ocular emergency, disease severity, etiology of ocular trauma, injury location, cause of decreased visual acuity, management of ocular injury, and final visual acuity. The homogeneity of each finding of the clinical features of ocular traumatic emergency was tested by an X2 test at a 95% level of certainty. During follow-up periods ranging from 3 days to 23 months (mean 2.0 months), the 1809 patients with ocular traumatic emergency, 1183 males (65.4%) and 626 females (34.6%), were studied. The incidence of ocular emergencies peaked in the third decade of life, irrespective of gender (P < 0.05). Corneal abrasion was the most common etiology among 1,552 (85.8%) closed injuries, and corneal laceration among 257 (14.2%) open injuries (P < 0.05). There were 542 cases (30%) of severe ocular injury, such as penetrating ocular injury, blow out fracture, and intraocular foreign body (IOF), and 1267 (70%) of less severe ocular injury, such as superficial ocular injury or contusion. The most common etiology of severe ocular injury was penetrating ocular injury, and that of less severe injury was corneal injury (P < 0.05). The main causative activity of ocular injuries was work in 631 cases (34.9%), assault in 398 (22.0%), play in 278 (15.4%), traffic accidents in 145 (8.0%) and sports in 128 (7.1%). Five hundred and fifty-four cases (32.5%) underwent surgical intervention. There was an improvement of visual acuity in 502 cases (70.1%), no change in 122 (17.0%), and worsening in 92 (12.9%). We suggest that preventive educational measures be instigated at workplaces to reduce the incidence of ocular traumatic emergency, especially severe ocular injury.     

眼外伤所致继发性青光眼临床分析

目的:探讨眼外伤的发生、治疗、转归以及眼外伤继发青光眼的发生、治疗及预后。方法:对305例眼外伤患者的致病因素、外伤部位、外伤类型进行分析,并对眼外伤患者进行随访,分析眼外伤继发青光眼的发生率。通过对眼外伤继发青光眼的药物及手术治疗,分析继发性青光眼的预后。结果:眼外伤部位、类型与眼外伤个体病因有关,病因以异物致伤最常见,外伤类型以角膜、巩膜穿孔伤最常见;眼外伤患者经治疗后视力均有不同程度的好转;眼外伤治疗后继发性青光眼的发生率高(10.82%),经药物和手术治疗,患者眼压均有不同程度的下降。结论:眼外伤病因、类型多样,应根据患者情况进行个体化治疗。对于存在易引起眼外伤的职业应该加强职业保护,做好眼防护。眼外伤治疗后继发性青光眼的发生率高,应尽早检查诊治以减少远期视力损害。     

Increased corneal thickness in active Behçet's disease

PURPOSE: To measure central corneal thickness (CCT) in patients with Beh?et's disease (BD), particularly in the active disease. MATERIALS AND METHODS: We measured CCT by ultrasound pachymetry in 64 patients with Beh?et's disease and in 20 healthy controls. Forty-one of the patients with BD had ocular involvement and 23 none; 19 of the 41 with ocular involvement were in an active period and 22 had inactive disease. RESULTS. The mean CCT in the group with active ocular involvement was significantly higher (589+/-27 microm) than in the control group (553+/-21 microm) (p = 0.003), the group with inactive ocular involvement (560+/-26 microm) (p < 0.001), and the group with no ocular involvement (558+/-25 microm) (p < 0.001). After appropriate treatment of patients with active ocular involvement, the mean CCT returned nearly to normal (563+/-20 microm) and the difference from controls was not significant. There was no significant difference for the mean CCT between controls and the patients with no ocular involvement or with inactive ocular involvement. CONCLUSIONS. Beh?et's patients with active ocular involvement have a thicker CCT than patients with inactive ocular involvement. There was no difference in CCT between controls and patients with no ocular involvement. The CCT of patients with active ocular involvement returned to nearly normal after treatment. CCT must be taken into account when developing a managing and following approach for Behcet's patients with active ocular involvement.     

严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）眼表感染研究进展

严重急性呼吸综合征冠状病毒2型（SARS-CoV-2,又称COVID-19）经眼表传播远较经口鼻传播困难,然而现有证据认为眼表传播仍是一条可能的途径,尤其对于医护人员。本文描述了SARS-CoV-2相关的眼表症状,阐释了眼表SARS-CoV-2入胞的可能机制和与眼表相关的SARS-CoV-2传播机制,并对现有的和未来可能的研究方向进行了剖析,为从眼表考虑临床治疗SARS-CoV-2提供新的思路与方法,帮助人们研发出更多的治疗策略。     

应用临时人工角膜行前后节联合手术治疗严重眼外伤

目的 比较应用临时人工角膜行玻璃体切割联合穿透性角膜移植术治疗不同类型严重眼外伤的临床效果.方法 对伴有严重角膜混浊的眼外伤患者20例(21只眼),包括爆炸伤11例(12只眼)、眼球穿通伤9例(9只眼).术前视力为光感～眼前手动,采用临时人工角膜代替病变角膜完成闭合式玻璃体切割、白内障切除、球内异物取出、视网膜复位等眼内操作后,再用新鲜供体角膜置换人工角膜.术后随访3～36个月,平均17月,随访视力、眼压、眼球解剖完整性及并发症.结果 全部眼爆炸伤和78%的眼球穿通伤,共19只眼(90%)保存眼球解剖结构完整性.11只眼(52%)保持最佳矫正视力≥0.05,其中眼爆炸伤9只眼(9/12),穿通伤2只眼(2/9).严重影响预后的并发症有持续性低眼压、复发性视网膜脱离,均发生在眼穿通伤.结论 临时人工角膜下行前后节联合手术是治疗伴有严重角膜混浊的外伤眼的惟一有效的方法,眼爆炸伤预后好于眼球穿通伤.     

印迹细胞学在眼表疾病中的应用

印迹细胞学（IC）作为一种简单易行的眼表细胞学检查方法，已广泛用于结膜、角膜及角膜缘等疾病的研究。通过常规光镜下的不同染色、电镜观察、免疫组织化学染色、PCR分析、免疫印迹及流式细胞学等方法，研究分析各种眼表疾病的细胞病理学改变、细胞免疫表型及抗原的表达、粘蛋白等基因转录水平的调节以及眼表微生物的检测等。对其基本原理、方法、在眼表疾病诊断上的应用及一些新的研究进展作一综述。     

内窥镜下玻璃体切除术治疗低眼压的临床分析

目的:探讨眼内窥镜治疗长期低眼压的可行性。方法:回顾性分析我科从2005-06/2007-12用眼内窥镜诊治的17例眼外伤导致的长期低眼压病例眼压恢复情况。结果:手术后1,2,3mo时分别测得的平均眼压与手术前眼压相比提高明显(P<0.01),进一步比较发现手术前与手术后1,2,3mo平均眼压差异均有统计学意义(P<0.01,P<0.01,P<0.01)。17例眼外伤性长期低眼压病例,眼压恢复正常的成功率为47%,其中合并睫状体萎缩性病变的成功率为33%,而无睫状体萎缩性病变的成功率为55%两组间差异无统计学意义(P=0.620);手术前眼压<6.00mmHg的病例,眼压恢复正常的成功率为44%,而手术前眼压>6.00mmHg病例的眼压恢复正常成功率为63%,两组间差异无统计学意义(P=0.637);手术前1,2,3mo的病程与眼压恢复的相关性无统计学意义(r=-0.335,P=0.188;r=-0.310,P=0.226;r=-0.325,P=0.203)。结论:眼内窥镜辅助的玻璃体切除术能够恢复部分眼外伤性长期低眼压患者的眼压,手术前眼压、睫状体病变情况和尽快行眼内窥镜下睫状体探察手术可能是恢复部分长期低眼压的关键。     

近视眼眼球容积与眼轴关系的分析

目的通过磁共振成像（MRI）三维重建并测量近视眼眼球容积,分析其与眼轴的关系,为玻璃体手术中估算填充物的填充量提供依据。设计前瞻性病例系列。研究对象35例单眼视网膜脱离患者的对侧健眼。方法行眼前节、眼底及眼部超声检查,显然验光及MRI三维重建测量眼球容积。根据屈光度数及眼底有无病理性改变,将患者分为病理性近视组（A组）和非病理性近视组（B组）。比较两组各参数的差异及眼球容积与各参数的关系。主要指标MRI测量的眼球容积、A超眼轴、屈光度,最佳矫正视力。结果A组平均眼球容积为（9026．00±1565．94）mm^3,B组（6449．99±696．43）mm^3（z=-4．767,P=-0．000）。A组5眼眼球规则均匀增大,12眼增大以前后径为主,3眼伴颢侧变形。B组眼球形态正常。两组最佳矫正视力分别为：A组（0．63±0．37）、B组（1．07±2．84）（z=-3．209,P=-0．001）;A超眼轴分别为：A组（29．15±2．76）mm、B组（23．80±1．14）mm（z=-5．000,P=0．000）。A组眼球容积与眼轴相关性最大（r=0．86,P=0．000）,与屈光度（r=0．539,P=-0．021）相关,与最佳矫正视力（r=0．510,P=-0．031）负相关。B组眼球容积与眼轴相关（r=0．76,P=0．000）,与屈光度（r=-0．535,P=-0．060）和最佳矫正视力（r=-0．062,P=0．841）不相关。A组眼球容积与眼轴的一元线性回归方程为：眼球容积=499．75x眼轴-5544．87;B组眼球容积与眼轴的一元线性回归方程为：眼球容积=440．678x眼轴-4040．2。结论MRI可较好地应用于近视眼活体眼球容积的测量,病理性近视眼球容积与眼轴显著相关并呈线性关系,本研究提出的回归方程为玻璃体手术中估算填充量提供数据参考。（眼科,2010,19：100—103）     

Ocular surface impressions using cellulose acetate filter material. Ocular pemphigoid

A technique for obtaining ocular surface impressions using cellulose acetate filter material is described. A representative ocular surface impression obtained by this technique from a patient with cicatricial ocular pemphigoid is shown, and contrasted to a normal ocular surface impression.     

眼表组织工程种子细胞的来源及种植技术研究进展

严重的眼表疾病的治疗一直是眼科临床中的难题,组织工程眼表重建技术为治疗各种可导致失明的眼表疾病开辟了新的途径。理想的组织工程化眼表植片是以可降解材料为支架,在体外进行细胞培养,得到类似于供体的组织工程眼表植片,有效修复各种原因导致的眼表损伤。要构建组织工程化眼表植片,关键在于合适的种子细胞和可供细胞粘附生长的生物支架或细胞外基质。本文将对目前组织工程技术眼表重建在种子细胞来源、载体选择方面的研究进展作简要综述。     

Impression cytology

Impression cytology refers to the application of cellulose acetate filter material to the ocular surface to remove the superficial layers of the conjunctival epithelium. Impression cytology has been found to be useful in assessing the ocular surface in various dry eye disorders, such as keratoconjunctivitis sicca (KCS), cicatricial ocular pemphigoid, and vitamin A deficiency. The technique is noninvasive, is easy to perform, causes minimal discomfort to the patient, and can be used to follow changes in the conjunctival ocular surface over time. With this method, the morphology of the conjunctival ocular surface can be studied and the degree of squamous metaplasia assessed. A specific criteria based on the appearance of the epithelial cells and the density of the goblet cells can be used to assign a grade (0-3) to the ocular surface. The grade of the ocular surface is related to the degree of squamous metaplasia and usually parallels the severity of clinical disease. Impression cytology can also be used to differentiate between various dry eye disorders. Disorders that are extrinsic or environmental (such as KCS) often affect the exposed interpalpebral ocular surface before the more protected inferior palpebral ocular surface. Intrinsic surface disorders (such as ocular pemphigoid) affect the palpebral, as well as the bulbar ocular surfaces, early in the disease.     

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。     

千例儿童眼病中555例眼外伤分析

目的：探索儿童眼外伤发生、发展及转归的特殊规律。方法：统计眼科11年中3月至15入院儿童病例,并眼眼外伤病人进行.分批:和童眼病1106例,眼外伤555例占50．18％,主要为眼球穿孔伤257例占46．31％,外伤性白内障138例占24．86％,儿童白内障人工晶状体植入术后主要并发症为后囊浑浊及晶状体前纤维膜形成,发生率为19．51％,结论眼外伤居儿童眼病之首位,减少眼外伤是降低儿童眼病发病率的关键。儿童白内障人工晶状体植入术后葡萄膜炎症反就及纤维膜形成明显高于成人。