青光眼患者血流变、Aβ、β-EP、Hcy及眼部血流动力学指标的变化观察

目的：观察分析青光眼患者血流变、Aβ、β-EP、Hcy及眼部血流动力学指标的变化情况。 方法：选取2011-11/2013-10本院收治的60例青光眼患者为观察组,并以60例健康人员为对照组,然后将两组的血流变、Aβ、β-EP、Hcy及眼部血流动力学指标进行检测与比较,同时对不同Richardson分期者的检测水平进行比较。 结果：观察组的血流变、同型半胱氨酸（ Hcy ）、β淀粉样蛋白（ Aβ）、β内啡肽（β-EP ）及血管阻力指数（ RI ）均显著地高于对照组,PSV及EDV则均明显地低于对照组,且其中Richardson分期较高者的波动大于 Richardson 分期较低者,P均〈0.05,上述比较指标均有显著性差异。 结论：青光眼患者血流变、Aβ、β-EP、Hcy及眼部血流动力学指标的变化较大,并且分期较高者的血供较差及血清相关指标较高。     

转化生长因子β在眼部纤维增生性疾病中的研究新进展

纤维化可破坏正常眼组织的透明结构,造成不可逆性视力丧失。眼部纤维增生性疾病的共同特征是细胞通过上皮间质转化为肌成纤维细胞。转化生长因子β(TGFβ)是纤维化过程中重要的细胞因子,通过调节纤维母细胞的表型使肌成纤维细胞转分化和细胞外基质(ECM)堆积。该因子在很多眼部纤维增生性疾病中发挥作用,本文就TGFβ与眼部纤维增生性疾病的研究新进展作一综述,以供眼科医生在临床工作中参考。     

蠕形螨相关眼部疾病的研究现状

蠕形螨是一类小型永久性寄生螨,在眼部主要寄居于毛囊、睑板腺及皮脂腺,可引起异物感、眼痒、眼干等眼部症状。近年来越来越多文献报道蠕形螨可引起多种眼部疾病,如睑缘炎、睑板腺功能障碍、霰粒肿、结膜炎、角膜炎、翼状胬肉等,甚至与眼睑基底细胞癌的发生也存在相关性。蠕形螨作为一种致病因素得到越来越多眼科医师的关注。现对蠕形螨相关眼部疾病的研究现状作一综述,旨在提高眼科医师对蠕形螨相关性眼部疾病的认识和重视。     

慢性眼部移植物抗宿主病相关干眼的研究与治疗现状

异基因造血干细胞移植(allo-HSCT)是治疗多种血液系统恶性肿瘤的主要方法,但术后的慢性移植物抗宿主病(cGVHD)是一种常见的并发症,其中眼部移植物抗宿主病(oGVHD)是最常见的一种,主要累及泪腺、睑板腺、角膜和结膜,典型症状为以纤维化为特征的干眼综合征。oGVHD相关干眼导致患者生活质量显著下降,已引起广泛关注。oGVHD的治疗除了应用全身免疫抑制剂和眼润滑剂外,通常联合局部使用糖皮质激素和环孢素。对于中重度oGVHD较新的治疗措施还包括使用自体血清滴眼液和角巩膜接触镜。本文主要就oGVHD及其相关干眼的治疗现状进行综述,以期为临床诊疗提供思路。     

TGF-β对小梁网作用机理及其靶向阻断的研究现状

转化生长因子-β(transformin ggrowth factor-β,TGF-β)是一组以多肽形式存在的细胞因子,属于一个结构相关的调节蛋白超家族,由全身多种细胞分泌。在肝脏、肾脏和皮肤,已证实TGF-β是独立的与纤维化相关的危险因子。青光眼是全球第2大致盲眼病,经过多年的研究,学者们仍执着于对其发病机制的探索。本文即就TGF-β与眼部相关疾病,尤其是与青光眼发病机制的关系及其靶向阻断研究现状作一综述。     

大鼠穿透性角膜移植术后TGF-β1及IL-1β的表达变化

目的 探讨转化生长因子β1(transforming growth factor β1,TGF-β1)对大鼠穿透性角膜移植术后免疫排斥反应的影响,角膜植片中TGF-β1和白细胞介素1β(interleukin-1β,IL-1β)的分布及含量的变化.方法 供体雌性Wistar大鼠20只,受体健康雌性SD大鼠60只,建立大鼠穿透性角膜移植模型,分为实验组、实验对照组及空白对照组3组,每组SD大鼠各20只,均选右眼手术,分别于术后1周、2周、3周、4周4个时间点,用HE染色及免疫组化法检测角膜植片中TGF-β1及IL-1β的含量变化.结果 实验组1-4周TGF-β1的表达较实验对照组和空白对照组均明显增高(13.88±1.74,5.12±0.31,5.24±0.54;15 84±2.56,5.86±0.64,6.96±0.55;18.46±2.36,6.67±1.73,8.26±0.98;17.06±2.02,4.61±0.23,7.22±0.39;P均<0.01);实验组术后2-4周3个时间点IL-1β的表达较实验对照组和空白对照组均有明显降低(7.74±0.73,18.55±1.84,15.76±0.44;5.94±0.64,16.00±0.76,12.44±0.55;5.24±0.35,11.06±0.09,10.49±0.56,P均<0.01).结论 TGF-β1能通过显著下调植片中IL-1β的表达,从而发挥免疫抑制作用.     

大鼠角膜碱、酸、热烧伤后房水中TGF-β2的变化研究

目的:通过检测角膜烧伤后前房水中TGF-β2含量的变化,探讨在眼部内环境下TGF-β2与角膜烧伤之间的关系,为角膜烧伤治疗提供依据。方法:制备Wistar大鼠角膜碱、酸、热中度烧伤动物模型,分别于伤后4,8h;1,3,5,7,14,28,49d处死。采集房水:用20g/LBSA包被的毛细管于角膜缘处刺入角膜,吸取房水至20g/LBSA包被的离心管中,-70℃保存。标准品和样品进行酸激活处理。使用ELISA方法检测角膜烧伤后前房水中TGF-β2的水平。结果:大鼠角膜碱烧伤后4hTGF-β2的水平呈现一过性升高,然后下降,3d时TGF-β2含量再次升高,7d时达高峰,持续至7wk时降至正常。大鼠角膜酸烧伤后4hTGF-β2的水平呈现一过性升高,然后下降,低于正常对照组,两者差异显著。7d时房水中TGF-β2升至正常,然后一直保持低平状态。49d时我们检测房水中TGF-β2水平仍低于正常。大鼠角膜热烧伤后4hTGF-β2的水平呈现一过性升高,1d时降至最低,3d时开始增长,直到7d时我们检测仍高于正常,然后缓慢下降。结论:角膜烧伤后前房水中TGF-β2的含量发生变化,致伤原因不同,其变化方式不同。角膜碱烧伤和热烧伤后于7d时出现TGF-β2高峰,说明此时角膜处于免疫功能抑制状态,这对于维持角膜前房的免疫赦免状态非常重要,证明此时机体发挥了自我保护功能,避免产生过度的病理反应。角膜酸烧伤后TGF-β2水平始终低平,其原因尚有待于进一步研究。     

Ocular abnormalities in multi-transfused beta-thalassemia patients

Aims:The aim of this study was to assess ocular changes in thalassemia patients who have received multiple transfusions and chelate binding therapy in order to avoid iron accumulation.Results:All the thalassemic patients were asymptomatic, but abnormal ocular findings (dry eye (33.3%), cataract (10.2%), retinal pigment epithelium degeneration (16.7%), color vision deficiency (3.7%), and visual field defects (33.7%)) were seen in 68.5% of thalassemic group. The prevalence of ocular abnormalities in normal group was 19.4%, which was significantly lower than that in thalassemia patients (P = 0.000). No significant correlation was found between ocular abnormalities and mean serum ferritin level (P = 0.627) and mean hemoglobin concentration (P = 0.143). Correlation of number of blood transfusion with the presence of ocular abnormalities was found to be statistically significant (P = 0.005).Conclusions:As life expectancy for beta-thalassemia patients extends, regular ophthalmological evaluation to detect early changes in their ocular system is recommended.     

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。     

不同切口白内障联合青光眼手术对眼表的影响

目的：探讨单切口和双切口白内障超声乳化联合小梁切除术治疗闭角型青光眼合并年龄相关性白内障术后眼表的影响。

方法：随机抽取在我院行单切口和双切口白内障超声乳化吸除、人工晶状体植入联合小梁切除术患者各26例26眼,对临床资料进行回顾性分析。比较两组病例术前1d和术后1wk,1、3mo时的泪膜破裂时间(break up time,BUT),泪液分泌试验Ⅰ(SchirmerⅠ time,SⅠt),角膜荧光素染色程度(corneal fluorescein staining,FL)等,并对结果进行统计学分析。

结果：所有入选的病例均在局部麻醉下行手术治疗,术后随访3mo。两组患者术后1wk,1mo的BUT,FL,SⅠt指标数值与术前相比均有明显差异(P<0.01),术后3mo基本恢复术前水平。术后1wk,1mo双切口组BUT,SⅠt均明显短于单切口组(P<0.05); FL双切口组术后1wk明显高于单切口组(P<0.05),而术后1mo两组差异无统计学意义(P>0.05)。术后3mo,两组患者的BUT,FL,SⅠt相比差异均无统计学意义(P>0.05)。

结论：单切口和双切口的白内障超声乳化联合显微小梁切除术术后均对术眼眼表有影响,双切口组影响更大,且相关指标异常的高峰期出现在术后1mo之内。     

兔急性高眼压状态后眼组织自由基及过氧化氢酶的变化

目的：观察急性高眼压状态后眼组织中自由基及过氧化氢酸活性变化。方法：用前房灌注生理盐水法制成急性高眼压模型后,按不同时间用电子自旋共振法测定小梁组织、视网膜组织中自由基的g值及量,同时测定视网膜、房水及血浆中过氧化氢酶的活性。结果：高眼压后0.5h直至第3天视网膜及小梁组织中均测到氧自由基并呈升高趋势。视网膜、房水中过氧化氢酶活性降低,血液中过氧化氢酶活性无改变。结论：急性高眼压状态视网膜、小梁组织中存在自由基损伤。提示急性闭角型青光眼发作手,应使用自由基清除剂,以保护眼组织。     

抗青光眼药物对青光眼患者泪液胰岛素水平的影响及其与眼表改变的关系

目的 分析抗青光眼药物对青光眼患者泪液胰岛素水平的影响及其与眼表改变评分之间的关系.方法 选择我院青光眼患者27例(30眼)为青光眼组,所有患者均局部使用抗青光眼药物降眼压治疗≥3个月.另选择无角膜接触镜配戴史的健康志愿者30人(30眼)为对照组.2组均行基础泪液分泌试验、泪膜破裂时间、角膜荧光素染色检查及眼表改变评分,放射免疫分析法测定2组基础泪液中胰岛素的含量.结果 对照组基础泪液胰岛素含量为13.40 ～ 193.40(70.66±38.16)μIU·mL-1,青光眼组为1.90 ～137.90(31.49±25.90) μIU·mL-1,差异有显著统计学意义(t=-4.65,P＜0.01).未诊断为干眼者泪液胰岛素含量为20.30 ～193.40(70.56±37.63) μIU·mL-1,诊断为干眼者为1.90 ～68.60(23.79±13.90) μIU·mL-1,差异有显著统计学意义(t =6.74,P＜0.01).对照组眼表改变评分为1～3(1.73 ±0.58)分,青光眼组为1～12(3.57±2.06)分,差异有显著统计学意义(t=-4.67,P＜0.01).泪液胰岛素含量和眼表改变评分之间呈负相关关系(r=-0.78,P＜0.01).结论 局部药物治疗可引起干眼,从而影响眼表基础泪液胰岛素的含量;泪液胰岛素含量和眼表改变评分呈负相关关系.     

Cicatricial changes in ocular pemphigus

Purpose

To describe the clinical characteristics of ocular involvement in patients with pemphigus at an ophthalmological referral center.

Methods

A retrospective review was conducted on patients with the immunopathological diagnosis of pemphigus examined between 1 January 2000 and 1 April 2010. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), ocular symptoms, and ocular surface inflammatory and scarring changes were assessed.

Results

A total of 15 patients were identified, with a mean age of 68.27±14.35 years, and 80% (n=12) were female. Extraocular involvement was reported in one patient. All of the eyes showed cicatricial changes in the conjunctiva. In all, 6 eyes (20%) were classified as stage I; 12 eyes (40%) as stage II; 10 eyes (33%) as stage III; and 2 eyes (7%) as stage IV. A statistically significant association was found between BCVA and the severity of ocular involvement. The mean BCVA logMAR was 1.66 (20/914), with a range from logMAR 0 (20/20) to logMAR 4 (NLP). Other ocular diseases were found in 8 (53.3%), systemic diseases in 10 (66.7%), and the use of pemphigus-inducing drugs in 10 patients (66.7%).

Conclusions

The present report represents the largest series of ocular involvement in pemphigus confirmed by immunopathology. The clinical manifestations varied from conjunctival hyperemia to corneal scarring and perforation. There was a strong association between scarring changes and low BCVA. Ocular and systemic diseases as well as the use of pemphigus-inducing drugs may predispose to ocular cicatricial changes observed in this series.     

Lacidipine, thiamine pyrophosphate and their combination on the ocular ischemic syndrome induced by bilateral common carotid artery ligation

AIM: To investigate the effect of lacidipine, thiamine pyrophosphate (TPP) and the combination of lacidipine and TPP against oxidative and inflammatory eye damage induced by bilateral common carotid artery ligation in rats. METHODS: Male albino Wistar rats were categorized as those who underwent sham surgery (SG), right and left common carotid cross-clamping and unclamping procedure (CCU), lacidipine+CCU (LCCU), TPP+CCU (TCCU), and combination of lacidipine and TPP (LTC)+CCU (LTCCU). One hour before anesthesia, the LCCU (n=6) received lacidipine (4 mg/kg, orally) and the TCCU (n=6) received TPP (20 mg/kg, intraperitoneally). The SG (n=6) and CCU (n=6) received the same volume of distilled water from the same route. After anesthesia (60 mg/kg ketamine, intraperitoneally), the necks of the rats were opened in the midline. Ischemia was created for 10min by placing clips on the right and left common carotid arteries. Rats in the SG only underwent subcutaneous incision. After 10min, the clips were removed and reperfusion was achieved for six days. Then, the animals were euthanized (120 mg/kg ketamine, intraperitoneally) and the levels of oxidant, antioxidant and proinflammatory cytokines in the eye tissues were determined. The retinal tissue of the eye was also examined histopathologically. RESULTS: Lacidipine, TPP, and LTC significantly prevent the increase in malondialdehyde, tumor necrosis factor-alpha, interleukin-1β (IL-1β), and IL-6 levels, decrease in total glutathione levels, superoxide dismutase and catalase activities and histopathological retinal damage in eye tissue induced by bilateral common carotid artery ligation in rats. The impact of these drugs on protection is determined to be LTC>lacidipine>TPP. CONCLUSION: As a result of the study, it is concluded that LTC may be more effective than lacidipine and TPP alone in treating ocular ischemic syndrome.     

高眼压对眼屈光影响的研究进展

高眼压(OH)可致多种眼组织结构及功能损害,其中对眼屈光的影响,临床早有认识。OH对眼屈光的影响,与屈光间质透明性和形态结构,以及眼轴改变有关。因眼压(IOP)升高快慢、程度等不同,眼屈光变化有可逆和不可逆不同特征。眼屈光呈不可逆变化者,也常伴视觉传输损伤,并对后者病情评估有一定参考价值。IOP变化致眼轴改变,与巩膜重塑和脉络膜血流灌注变化有关,对近视发生发展和白内障术后屈光误差有一定影响。本文就OH所致屈光间质和眼轴改变的表现,以及对眼屈光影响的特征等研究进展进行总结,以期加深OH对眼屈光影响的认识,并为预防不可逆性眼屈光改变,指导视觉传输损伤的病情评估和轴性近视发生发展的防控等提供参考。     

兔眼挫伤后的病理改变

目的探讨兔眼挫伤的病理学改变。方法用不同重量的重物正面击打正常兔眼,观察伤后不同时间兔眼病理组织学改变。结果眼挫伤后,兔眼损伤发生早,范围广,不同组织均有改变,且与外力强度呈正相关。挫伤对兔外眼与眼球的损伤程度并不一致,而且眼前段与眼后段的损伤程度也不成正比。伤后3天眼部病理改变已趋稳定。本组兔无眼球破裂。结论挫伤后,兔眼损伤遵循重力致伤的一般规律;运用流体动力学原理,有利于发现隐匿的损伤区域;应该充分认识对外伤眼全面检视的重要性,避免遗漏。     

实验性眼球挫伤眼血液动力学改变及其治疗

目的 探讨钝挫伤性眼血液动力学变化并评价药物对改善脉络膜络血供的疗效。方法 以自由落体击伤,损伤能量为３．３Ｊ,造成灰兔单眼轻度钝挫伤模型。伤后分别用生理盐水,复方樟柳碱,妥拉苏林治疗,１次／１日连续１周。用眼血流图检测双眼伤前,伤后即刻,１,３７天ＲＯＧ波幅值,结果 伤后即刻各组伤眼ＲＯＧ波幅值均降低,与伤前比较Ｐ〈０．０１。