玻璃体视网膜手术治疗老年黄斑变性的疗效评价

为探讨玻璃体切除术及视网膜下手术治疗湿性型老年黄斑变性（ＡＭＤ）的疗效和估价，对２６眼因ＡＭＤ玻璃体出血混浊施玻璃体切除术；６眼黄斑中心凹处新生血管膜形成、出血行视网膜下手术。结果为玻璃体切除术组，术后全部看清眼底，发现黄斑区视网膜下出血１３眼，有新生血管膜及疤痕１０眼，两者同时存在３眼，术后视力提高２２眼，不变及减退各２眼，视力在０．０５以上仅８眼；视网膜下手术组，成功取出视网膜下新生血管膜３眼，出血冲洗干净３眼，术后视力进步４眼，不变及减退各１眼。结论：玻璃体切除术虽然能清除玻璃体出血及混浊，但不能阻止ＡＭＤ病变的发展和治疗视网膜下病变及恢复视功能；视网膜下手术能清除部分视网膜下病灶，亦不能恢复色素上皮和感光细胞功能。因此，视网膜移植可能是治疗湿性型ＡＭＤ的新途径     

增殖性糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的临床观察

目的：探讨增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR)玻璃体视网膜手术严重玻璃体出血的原因，并发症及处理方法。方法：对我院1997年1月至2001年3月住院行玻璃体视网膜手术治疗PDR的182例（198只眼）患者中术后发生严重玻璃体出血的16例（17只眼）患者进行回顾性分析。结果：术后玻璃体出血中52.9%出现于术后第一天，出血原因包括纤维血管膜残端出血，视网膜新生血管膜渗血，视网膜切开，视网膜裂孔，前玻璃体纤维血管增殖等；出血并发症包括继发性青光眼，增殖膜形成等。结论：PDR玻璃体切割术后玻璃体出血为术后常见的并发症；对于出血量大、难于吸收及出现并发症的病例，积极治疗可改善视力预力预后。     

氩激光视网膜光凝治疗增殖型糖尿病视网膜病变的疗效

对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者270例363眼氩激光视网膜光凝疗效进行分析。光凝后新生血管消退、未再玻璃体出血者占63.6%，其中视网膜新生血管与视盘新生血管、视网膜新生血管合并视盘新生血管间疗效差异均非常显著(P<0.01)；单纯新生血管与新生血管合并玻璃体出血行间疗效差异非常显著(P<0.01)。表明氩激光视网膜光凝治疗增殖性糖尿病视网膜病变的疗效与新生血管的存在部位及是否合并玻璃体出血有关。 （中华眼底病杂志，1995，11：227-228）     

岛状膜手术在晚期增殖性糖尿病视网膜病变中的应用

目的 探讨晚期增殖性糖尿病视网膜病变伴有视盘表面或上、下血管弓表面生长的大片新生血管膜,同时合并玻璃体出血或牵拉性视网膜脱离或牵拉孔源混合性视网膜脱离的玻璃体手术,探究手术中的剥膜技巧及对此类患者玻璃体手术治疗的价值.方法 选择晚期增殖性糖尿病视网膜病变患者106例(106眼),男性47例(47眼),女性59例(59眼),年龄44-69岁.早期对膜的处理采用传统的膜钩钩膜及撕膜技术,共55例(55眼),后期采用岛状膜技术,共51例(51眼).结果 两种剥膜技术对术后视力提高岛状膜组好于撕膜组,但因为两组患者都属于晚期患者,最好视力都不超过0.12,多数视力在0.02-0.08之间.但岛状膜技术组术中、术后并发症明显减少,减少了硅油填充率,减少了二次手术的可能.结论 岛状膜清除技术处理晚期增殖性糖尿病视网膜病变优于传统撕膜技术,晚期增殖性糖尿病视网膜病变合并大片增殖膜、玻璃体出血及视网膜脱离患者行玻璃体手术后大部分仍能恢复一定视功能,仍有极大的治疗价值.     

增生型糖尿病视网膜病变玻璃体切除手术后再出血病因及治疗

目的 分析增生型糖尿病视网膜病变(PDR)玻璃体切割手术后再出血病因，观察再治疗效果。 方法 回顾分析302例PDR患者315只患眼接受玻璃体切割手术治疗后32只眼再出血并再次治疗后随访3~48个月（平均随访时间12个月）的临床资料。 结果 PDR玻璃体切割手术后再出血发生率为10%，再出血发生时间为手术后1～210 d，平均时间为51 d。再出血的主要原因中，28%为巩膜切口纤维血管向内生长，19%为视盘表面残存新生血管膜或血管残端处理不当，22%为视网膜激光光凝不足，9%为视网膜表面新生血管膜剥除不彻底，6%为视网膜静脉阻塞，16%为外力作用。通过冷凝巩膜切口处纤维血管、剥离视盘和视网膜表面残存新生血管膜并电凝视盘表面血管残端、补充视网膜激光光凝、 包扎双眼等治疗，再出血眼视力提高者占91%，视力下降者占9%。再次手术后并发症主要包括再次出血、虹膜后粘连、晶状体混浊加重、角膜上皮愈合延迟等。 结论 PDR玻璃体切割手术治疗后再出血的主要原因是巩膜切口纤维血管向内生长、视盘表面和（或）视网膜表面新生血管膜剥除不彻底、血管残端处理不当、视网膜激光光凝不足和外力作用。处理好巩膜切口、彻底剥离视盘和视网膜表面新生血管膜、电凝血管残端以及足够的视网膜激光光凝是预防和治疗PDR玻璃体切割手术后再出血的有效方法。(中华眼底病杂志,2007,23:238-240)      

玻璃体手术和眼内光凝治疗伴玻璃体积血和新生血管膜的视网膜静脉阻塞

目的评估玻璃体手术和眼内光凝治疗伴玻璃体积血、新生血管膜或牵拉性视网膜脱离的视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＲＶＯ）的疗效。方法复习连续的３７例ＲＶＯ患者经玻璃体手术和眼内光凝治疗的３８只眼临床资料。视网膜分支静脉阻塞（ｂｒａｎｃｈｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＢＲＶＯ）１９例２０只眼，视网膜中央静脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＣＲＶＯ）１８例１８只眼。结果手术中确认２７只眼有新生血管膜，２３只眼有牵拉性视网膜脱离。手术后３４只眼视力改善，占８９．５％，其中２２只眼有０．１以上的视力。４只眼视力未变。ＣＲＶＯ组病史较长，手术后视力改善较少。结论玻璃体手术和眼内光凝能改善多数伴有玻璃体积血、新生血管膜和牵拉性视网膜脱离的ＲＶＯ眼预后。     

老年性黄斑变性玻璃体积血的玻璃体手术治疗

目的探讨老年性黄斑变性(AM D)伴玻璃体积血的诊断,观察单纯玻璃体切割治疗玻璃体积血对AM D的治疗效果。方法回顾分析10例渗出型AM D并发大量玻璃体积血住院行玻璃体切割手术治疗患者的临床资料。患者平均年龄63岁。3例患者患眼或对侧眼曾有黄斑玻璃疣或黄斑出血。9例患者视力为光感或手动。结果10例患者B型超声检查除玻璃体内光点外,后极眼底前都见到一条光带,光带下有点状高回声;4例患者同时在下方探查到有高回声的局限性视网膜隆起。手术中发现视网膜及视网膜色素上皮下大片出血,范围占1/2至4/5眼底,出血量大时可隆起。5例患者黄斑区见到黄色扁平、拟为新生血管膜的病变。手术仅作玻璃体切割。手术后随访时视网膜下出血吸收,原拟为新生血管膜的病变成为黄白色瘢痕。视力数指~0.3。无一例再发出血。结论渗出型AM D并发玻璃体积血患者B型超声显示后极或下方的视网膜脱离光带伴高回声光点为其特征性改变,单纯玻璃体手术可提高患眼视力。新生血管膜在大量出血后形成瘢痕,病情转向稳定。     

视网膜分支静脉阻塞早期氩激光光凝疗效的探讨

本文探讨了视网膜分支静脉阻塞早期氩激光光凝的疗效。５５例早期患者５８只眼依光凝时机早晚分早期光凝组及晚期对照组，观察６个月－２年，结果表明早期光凝可以促进ＢＲＶＯ视网膜出血的吸收，缩短病程；降低视网膜新生血管及新生血管引起的玻璃体出血的发生率；本组在改善黄斑视功能、降低黄斑水肿的发生率方面与晚期光凝组相比差异无显著性，原因有待探讨。作者认为应该对有视网膜大量出血、大面积缺血缺氧的ＢＲＶＯ，对严重威     

玻璃体切除治疗老年性黄斑变性玻璃体积血的临床分析

且的：探讨老年性黄斑病变相关性玻璃体积血患者的临床特点、手术治疗效果及手术时机。方法：对31例老年性黄斑病变玻璃体积血患者，采用玻切治疗。并根据患者情况采取黄斑部剥膜3例、视网膜切开1例。结果：术后患者视力均有不同程度的提高；病程在12个月以上者，黄斑区形成黄斑前膜和固定皱折，术后视力提高较少，均低于0.01；视网膜切开行黄斑下积血冲洗1例术后并发新生血管青光眼；27例发生完全玻璃体后脱离并且玻璃体腔为降解的血块。手术无并发症发生。结论：玻璃体切除术对老年性黄斑变性玻璃体积血有一定疗效，但手术最好在出血后半年内进行；视网膜切开冲洗易出现并发症，效果不好；对老年性黄斑病变玻璃体积血的手术因玻璃体后脱离及血块的降解使得手术操作较容易，不易出现并发症。     

糖尿病性视网膜病变的二极管激光治疗

目的探讨二极管激光治疗糖尿病性视网膜病变的疗效及优越性。方法应用英国keeler公司产二极管激光机治疗均并发不同程度白内障、玻璃体混浊的糖尿病性视网膜病变患者10例16只眼。结果随访1～10个月，视力均无下降，微血管瘤消失，出血、渗出有所吸收，新生血管膜有所退行，占93．8％；1例1只眼，新生血管膜无变化，占6．2％。结论二极管激光穿透力强，在治疗并发白内障及玻璃体混浊的糖尿病性视网膜病变方面，具有满意而确切的疗效。     

Therapeutic interference with EphrinB2 signalling inhibits oxygen‐induced angioproliferative retinopathy

Acta Ophthalmol. 2011: 89: 82–90

Abstract.

Purpose: To investigate whether EphrinB2 (EfnB2) or EphB4 influence retinal angiogenesis under physiological or pathological conditions. Methods: Using the mouse model of oxygen‐induced proliferative retinopathy (OIR), the expression of EfnB2, EphB4, vascular endothelial growth factor (VEGF), VEGFR1 and VEGFR2 was quantified by quantitative polymerase chain reaction (qPCR) and localized in EfnB2‐ and EphB4‐lacZ mice. Angioproliferative retinopathy was manipulated by intravitreal injection of dimeric EfnB2 and monomeric or dimeric EphB4. Results: Dimeric EphB4 (EphB4‐Fc) and EfnB2 (EfnB2‐Fc) enhanced hypoxia‐induced angioproliferative retinopathy but not physiological angiogenesis. Monomeric EphB4 (sEphB4) reduced angiogenesis. The messenger RNA (mRNA) level of EfnB2 increased significantly in the hyperoxic phase (P7–P12), while EphB4, VEGF, VEGFR1 and VEGFR2 showed a significant – up to fivefold – increased expression at P14, the start of morphologically visible vasoproliferation caused by relative hypoxia. Conclusion: The ephrin/Eph system is involved in angioproliferative retinopathy. Stimulation of EphB4 and EfnB2 signalling using EfnB2‐Fc and EphB4‐Fc, respectively, enhanced hypoxia‐induced angiogenesis. In contrast, sEphB4 inhibited hypoxia‐induced angiogenesis. Therefore, angiogenesis is enhanced by signalling through both EphB4 (forward) and EfnB2 (reverse). The distinction in the expression kinetics of EphB4 and EfnB2 indicates that they govern two different signalling pathways and are regulated in diverse ways. sEphB4 might be a useful drug for antiangiogenic therapy.     

Leber遗传性视神经病变基因治疗中ND4基因腺相关病毒的构建及检测

目的构建人ND4基因腺相关病毒,为Leber遗传性视神经病变(leber hereditary optic neuropathy,LHON)的基因治疗做准备。方法人工合成人的正常ND4基因,构建rAAV2/2-ND4重组腺相关病毒,进行纯化与浓缩后,用特异扩增ND4基因的引物进行PCR鉴定,用地高辛标记的H1探针点杂交方法检测病毒液中rAAV2/2-ND4的物理滴度。结果构建的rAAV2/2-ND4重组腺相关病毒能够特异地扩增出ND4目的基因条带,基因组测定物理滴度为400×109vg·mL-1,证明该重组腺病毒携带目的基因。结论本实验成功地构建了人ND4基因腺相关病毒,作为一种先进的载体系统,为今后Leber遗传性视神经病变患者的基因治疗奠定了基础。     

可溶性fms-样酪氨酸激酶受体-1不同基因片段对视网膜新生血管的抑制作用

目的 观察可溶性fms-样酪氨酸激酶受体-1(sFlt-1)不同基因片段对小鼠视网膜新生血管(RNV)的抑制作用.方法 构建携带sFlt-1(2～3)、(2～4)免疫球蛋白样区域编码基因的重组慢病毒sFlt-1(2～3)和sFlt-1(2～4).鼠龄7 d的C57/6J小鼠96只,数字表法随机分为4组,每组24只.1组为正常对照组;2组为模型对照组;3组为sFlt-1(2～3)组;4组为sFlt-1(2～4)组.2、3、4组置于(75±2)%氧浓度环境,出生后12 d再置于正常空气下饲养,并分别玻璃体腔注射空病毒、慢病毒sFlt-1(2～3)和sFlt-1(2～4)各1μl.出生后17 d,荧光素灌注造影行视网膜铺片,观察视网膜血管改变;视网膜切片行苏木精-伊红染色,计数小鼠RNV细胞核数;蛋白质免疫印迹法(Western blot)检测视网膜血管内皮生长因子(VEGF)和VEGF受体-2含激酶插入区受体/胎肝激酶-1(KDR/Flk-1)的蛋白表达.结果 出生后17 d,与2组比较,3、4组视网膜荧光渗漏面积、RNV、突破内界膜(ILM)的血管内皮细胞核数均明显减少(P<0.01);VEGF蛋白表达无明显变化(P>0.05),KDR/F1k-1蛋白表达明显下降(P<0.01).结论 sFlt-1(2～3)和sFlt-1(2～4)基因片段能明显抑制氧诱导小鼠RNV的形成,sFlt-1(2～3)效果更为显著.     

Topical administration of leukotriene antagonists in immunogenic keratitis.

Antagonists of leukotriene D4 (LTD4), 3-[7-(2-n-propyl-3-hydroxy-4-acetyl- phenoxy)-propoxy-2-methyl-3,4-dihydro-4-8-n-propyl-2H-1-benzopyran- 2-yl]-propionic acid (SC-39070) and 7-[3-(4-acetyl-3-hydroxy-2-propylphenoxy)-2-hydroxy- propoxy]-4-methyl- 2-oxo-2H-1-benzopyran-3-acetic acid (FPL-60319) were locally administered to eyes of rabbits with immunogenic keratitis. The period of circular leukocyte infiltration (Wessely's ring) in the cornea was markedly decreased. Edema and neovascularization of the cornea were not influenced.     

Lymphocyte subsets and interleukin-2 (IL-2) production of peripheral blood lymphocytes in patients with Vogt-Koyanagi-Harada disease

The lymphocyte subsets and the interleukin-2 (IL-2) production of peripheral blood lymphocytes (PBL) in patients with Vogt-Koyanagi-Harada Disease (V.K.H.) were studied. In PBL, increased percentages of CD4+ T cells and decreased percentages of CD8+ T cells, which lead to high CD4/CD8 ratio were observed. In the CD4+ T cells the percentage of CD4+ 2H4+ T cells and CD4+ DR+ T cells increased. PBL from 3 out of 9 cases with V.K.H. produced high amount of IL-2 in vitro after stimulation with PHA, indicating IL-2 might be related to the pathogenesis of V.K.H. The differences of the phenotypes of PBL and IL-2 production in vitro between the patients in the acute and prolonged stages were not demonstrated. These results suggest that CD4+ T cells, especially CD4+ 2H4+ T cells may play an important role in the pathological feature of V.K.H.     

Expression of P2Y1, P2Y2, P2Y4, and P2Y6 receptor subtypes in the rat retina

PURPOSE: To elucidate the expression pattern of different types of metabotropic P2Y receptors in the adult rat retina. METHODS: Qualitative RT-PCR was used to investigate the expression profile of different P2Y receptor subtypes (P2Y1, P2Y2, P2Y4, and P2Y6), and in situ hybridization studies were performed to show their cellular localization within the retina. Immunohistochemical staining was used to detect the corresponding P2Y proteins (P2Y1, P2Y2, and P2Y4) and their cellular localization. Southern blot analysis and sequencing verified the identity of the P2Y PCR products. RESULTS: RT-PCR revealed the presence of P2Y1, -2, -4, and -6 mRNA in the neural retina and the retinal pigment epithelium (RPE) and choroid. In situ hybridization showed labeling in the retinal ganglion cell layer for all four P2Y receptor subtypes, although the intensity varied. In addition, staining for P2Y1, -4, and -6 mRNA was shown in the inner nuclear layer, but was absent for the P2Y2 receptor subtype. Immunohistochemistry showed intense staining for P2Y1, -2, and -4 in the ganglion cell layer and the outer plexiform layer. There was also a specific subtype staining in the inner plexiform layer (P2Y2, -4), the inner (P2Y1, -4) and outer (P2Y1) nuclear layers and the inner segments of the photoreceptors (P2Y1, -2). discussion. The data suggest that extracellular nucleotides may play complex roles as autocrine-paracrine mediators and may have neuromodulatory effects in the retina through metabotropic P2Y receptors.     

考布他汀A4隐形/靶向脂质体抑制脉络膜新生血管的研究

目的观察考布他汀A4（CA4）隐形/靶向脂质体对激光诱导的棕色挪威（BN）大鼠脉络膜新生血管（CNV）的抑制作用。方法成年BN大鼠20只,647 nm氪红激光光凝视网膜至Bruch膜破裂诱导CNV,脂质体药物的制备采用薄膜分散-超声法。动物模型随机分为考布他汀A4磷酸盐（CA4P）组、连接精氨酸-甘氨酸-天冬氨酸三肽（RGD）靶头的CA4靶向脂质体（RGD-SSL-CA4）组、连接RGD靶头的空白靶向脂质体（RGD-SSL）组、不连接RGD靶头的CA4隐形脂质体（SSL-CA4）组和生理盐水（NS）组,于激光光凝后3 d和10 d经大鼠尾静脉给药。光凝后1周和2周进行荧光素眼底血管造影（FFA）检查,观察激光斑处荧光素渗漏情况。激光光凝后2周行FITC-Dextran灌注后处死大鼠制作脉络膜铺片,计算CNV面积。结果 RGD-SSL-CA4组视网膜光凝斑处的荧光素渗漏明显较其他组轻。RGD-SSL-CA4组CNV面积为（25 360±14 050）μm2,NS组为（46 500±17 230）μm2,RGD-SSL-CA4组较NS组明显缩小,差异有统计学意义（P〈0.05）;CA4P组为（38 290±19 290）μm2,RGD-SSL组为（44 150±16 410）μm2,SSL-CA4组为（39 690±17 850）μm2,与NS组比较差异均无统计学意义（P〉0.05）。结论 RGD-SSL-CA4具有长循环、靶向的双重优势,可显著抑制激光诱导的CNV。     

Immunopathology of ocular onchocerciasis 3. Th-2 helper T cells in the conjunctiva

Ocular onchocerciasis is the second most common infectious cause of blindness in the world. Th-2 helper T (Th-2) cells are thought to play a critical role in immediate hypersensitivity against allergens and extra-cellular parasitic infections. Th-2 cells secrete a high amount of IL-4, regulate IgE production, and recruit eosinophils and mast cells. Conjunctival biopsies from ten African patients with ocular onchocerciasis were evaluated for the presence of II-2, IL-4, mast cells and major basic protein (MBP), a marker for eosinophils. IL-4 mRNA was detected in seven of ten conjunctival specimens using in situ hybridization, yet IL-4 was detected in only one specimen using immunohistochemical staining. In contrast, IL-2 mRNA was detected in three of ten conjunctival specimens and IL-2 was detected in two specimens. There were greater numbers of mast cells and the presence of MBP in specimens with IL-4 mRNA. Furthermore, the three biopsies containing both IL-2 and IL-4 mRNA had greater numbers of CD4+cell infiltration and the patient with IL-4 protein in his conjunctiva also had the highest IgE in his aqueous humor. These findings suggest that Th-2 cells and their lymphokines are important for the localized host responsiveness to ocular onchocerciasis.     

Immunopathology of ocular onchocerciasis 3. Th-2 helper T cells in the conjunctiva

Ocular onchocerciasis is the second most common infectious cause of blindness in the world. Th-2 helper T (Th-2) cells are thought to play a critical role in immediate hypersensitivity against allergens and extra-cellular parasitic infections. Th-2 cells secrete a high amount of IL-4, regulate IgE production, and recruit eosinophils and mast cells. Conjunctival biopsies from ten African patients with ocular onchocerciasis were evaluated for the presence of II-2, IL-4, mast cells and major basic protein (MBP), a marker for eosinophils. IL-4 mRNA was detected in seven of ten conjunctival specimens using in situ hybridization, yet IL-4 was detected in only one specimen using immunohistochemical staining. In contrast, IL-2 mRNA was detected in three of ten conjunctival specimens and IL-2 was detected in two specimens. There were greater numbers of mast cells and the presence of MBP in specimens with IL-4 mRNA. Furthermore, the three biopsies containing both IL-2 and IL-4 mRNA had greater numbers of CD4+cell infiltration and the patient with IL-4 protein in his conjunctiva also had the highest IgE in his aqueous humor. These findings suggest that Th-2 cells and their lymphokines are important for the localized host responsiveness to ocular onchocerciasis.     

An ErbB2-Muc4 complex in rat ocular surface epithelia

PURPOSE: To show the presence and localization of type 1 growth factor receptors (ErbB2, ErbB3 and ErbB4) in rat corneal and conjunctival epithelia and investigate the association of ErbB2 with its intramembrane ligand Muc4. METHODS: Methacarn-fixed, paraffin-embedded sections of corneas and eyelids from female adult rats were immunocytochemically stained using antibodies against the ErbB receptors and Muc4. Sequential immunoprecipitation and immunoblot analyses were performed on epithelial lysates to investigate the presence of a complex of Muc4 and ErbB2 in corneal and conjunctival epithelia. RESULTS: Immunocytochemical staining demonstrated the presence of ErbB2, ErbB3 and ErbB4 growth factor receptors throughout the rat corneal and conjunctival epithelia. Co-immunoprecipitation of the epithelial lysates demonstrated that Muc4 and ErbB2 are present as a complex. CONCLUSIONS: The three type 1 growth factor receptors (ErbB2, ErbB3 and ErbB4) are present in the rat corneal and conjunctival epithelia, and ErbB2 is at least partly associated with Muc4. This demonstration of the presence and localization of these three type 1 growth factor receptors may help in understanding how these receptors contribute to ocular epithelial behavior and functions.