HE和Giemsa染色在儿童细菌性和过敏性结膜炎诊断中的比较

目的：探讨苏木精-伊红染色法(HE)和吉姆萨(Giemsa)染色法在儿童细菌性和过敏性结膜炎中的诊断效果。

方法：选取2016-10/2019-10期间于我院眼科经结膜刮片检查诊断为结膜炎儿童患者422例作为研究对象，分别采用HE与Giemsa染色法进行结膜刮片染色，并根据染色结果诊断细菌性/过敏性结膜炎。观察两种染色结果对细菌性/过敏性结膜炎的阳性检出率及染色情况。

结果：HE染色诊断细菌性结膜炎阳性率(33.0%)和符合率(63.6%)显著低于Giemsa染色(90.7%和88.8%，均P<0.001)，而过敏性结膜炎阳性率无明显差异(90.8% vs 87.2%，P>0.05)。

结论：Giemsa染色法检查可准确诊断儿童细菌性结膜炎且方法简便，HE与Giemsa染色法均对过敏性结膜炎具有较好的诊断效果，可为提高临床诊断效率及早期治疗方案提供依据。     

氦氖激光联合药物治疗带状疱疹性角膜炎

目的：探讨氦氖激光在带状疱疹性角膜炎药物治疗中的作用。

方法：采用临床病例对照的方法,将单纯药物组患者设为对照组,增加氦氖激光组患者为实验组; 量化并比较患者眼部及全身情况的变化,进行统计分析。

结果：治疗后第10d,药物治疗过程中联合氦氖激光实验组皮肤水疱均结痂,且在第5d疼痛明显缓解(χ²=4.03,P<0.05); 实验组角膜炎明显好转(t =4.227,8.208; P<0.01)。实验组综合疗效优于单纯药物治疗组(χ²=4.49,P<0.05)。本研究过程中所有患者眼部及全身无严重并发症。

结论：氦氖激光可提高药物对带状疱疹病毒性角膜炎的治疗效率。     

极低出生体质量儿出生后体质量增长速率与阈值病变早产儿视网膜病变的相关性研究

目的：探讨极低出生体质量儿出生后体质量增长速率与阈值病变早产儿视网膜病变(TDROP)的相关性,评估其预测TDROP发生的价值。

方法：回顾性病例分析。收集2017-01/2018-12于厦门大学附属第一医院住院的早产儿386例,出生体质量<1 500g,分析其性别、出生体质量、胎龄、分娩方式、是否吸氧、Apgar评分、是否试管婴儿、是否双生、有无合并新生儿肺炎及出生后1～4wk的体质量增长速率等与TDROP的相关性。将入组患儿分为无ROP组298例和TDROP组88例。多因素Logistic回归分析TDROP的相关危险因素。ROC曲线确定临床诊断临界值,通过ROC曲线下面积(AUC)评估出生后2wk体质量增长速率对TDROP的预测价值。

结果：两组患儿出生体质量(t=2.264,P=0.024)、出生胎龄(t=3.158,P=0.002)、出生后2wk体质量增长速率(t=3.517,P<0.001)、是否吸氧(χ²=20.514,P<0.001)差异有统计学意义。多因素Logistic回归分析显示,出生体质量(β=0.699,P=0.016),出生胎龄(β=-0.631,P=0.039),出生后2wk体质量增长速率(β=-0.636,P=0.039),是否合并吸氧(β=-1.542,P<0.001)与TDROP显著相关,其OR(95%CI)分别为2.013(1.140～3.553)、0.532(0.292～0.970)、0.529(0.289～0.969)和0.214(0.113～0.404)。进一步分析出生后2wk体质量增长速率的ROC曲线,结果显示AUC为0.710,诊断临界值为4.14g/d,敏感性为70.8%,特异性为65.9%。

结论：出生体质量是TDROP发生的独立危险因素之一,而极低出生体质量儿出生2wk体质量增长速率与TDROP的发生有显著相关,对其发生具有一定的预测价值。     

玻璃体切割术联合内界膜剥离术治疗黄斑裂孔性视网膜脱落

目的：探究黄斑裂孔性视网膜脱落(macular hole retinal detachment,MHRD)患者应用玻璃体切割术(pars planavitrectomy,PPV)联合内界膜剥离术(internal limiting membrane peeling,ILMP)治疗的效果。

方法：选取我院在2013-12/2015-12期间收治的、符合纳入标准的MHRD患者78例83眼。根据患者是否应用PPV联合ILMP治疗,随机分为试验组(39例40眼)和对照组(39例43眼),对照组应用PPV治疗。观察两组治疗效果; 随访6mo后,比较两组患者视力改善情况以及手术前和手术后3、6mo的平均最佳矫正视力(best corrected visual acuity,BCVA); 并记录术后并发症发生情况。

结果：治疗效果：与对照组相比,试验组的视网膜复位率为92%(37/40),具有统计学差异(χ²=6.882,P=0.009); 视力改善情况：试验组的视力改善情况较对照组好,差异有统计学意义(χ²=14.216,P<0.001); 术后BCVA：试验组术后3、6mo的BCVA显著高于对照组,差异有统计学意义(t=7.119,P<0.001; t=10.573,P<0.001); 并发症：与对照组相比,试验组发生眼内压增高和视野缺损的情况较少,具有统计学差异(χ²=11.323,P=0.001; χ²=8.573, P=0.003); 晶状体混浊发生率无明显改变,但差异有统计学意义(χ²=1.835,P=0.176)。

结论：MHRD患者应用PPV联合ILMP术后恢复情况好,并发症发生率低,能更好地提高患者视网膜复位效果。     

ARMD与转铁蛋白受体基因单核苷酸多态性相关性研究

目的：探讨中国东北地区汉族人群中年龄相关性黄斑变性(ARMD)与转铁蛋白受体2(TFR2)基因单核苷酸多态性的相关性。

方法：选取200例ARMD患者(干性100例,湿性100例)和100名健康志愿者(对照组),采集所有研究对象的外周静脉血并以EDTA抗凝处理,提取基因组DNA,根据相关文献提供的引物序列,扩增TFR2基因多态性位点rs2075674,进行聚合酶链式反应(PCR)。比较各组间的基因型频率,并按照Hardy-Weinberg平衡原理确定样本的群体代表性。

结果：TFR2基因的多态性位点rs2075674 ARMD组与对照组比较有差异(χ²=6.494,P=0.011); 湿性ARMD组与对照组比较有差异(χ²=11.054,P=0.001),而干性ARMD组与对照组无差异(χ²=1.418,P=0.234)。

结论：中国东北地区汉族人群中TFR2基因多态性rs2075674与ARMD具有相关性,且与湿性ARMD相关性较大。     

长期应用前列腺素类似物滴眼液对青光眼患者结膜菌群的影响

目的：探讨长期应用前列腺素类似物滴眼液对青光眼患者结膜菌群的影响。

方法：选择2016-06/2017-06在我院就诊的应用拉坦前列素滴眼液治疗的69例113眼青光眼患者,所有患者分别于入组后、用药3mo,1a时检查结膜菌群及表皮葡萄球菌对抗生素敏感性。

结果：入组时、用药3mo,1a时检出细菌例数分别为63、66、67例(χ²=2.496,P=0.287)。患者入组时、用药3mo,1a时表皮葡萄球菌、链球菌属、金黄色葡萄球菌、人葡萄球菌、溶血葡萄球菌、莫拉菌属等检出率均无差异(P>0.05); 用药3mo时耐甲氧西林表皮葡萄球菌(MRSE)比率高于入组时(χ²=3.063,P=0.062),用药1a时MRSE比率高于入组时和用药3mo时(χ²=38.945、24.984,均P<0.001)。用药3mo时表皮葡萄球菌对左氧氟沙星、加替沙星、莫西沙星、头孢他啶、妥布霉素、头孢甲肟、红霉素的敏感性均低于入组时,但无差异(P>0.0167),对氯霉素敏感性低于入组时(P<0.0167); 用药1a时表皮葡萄球菌对左氧氟沙星、加替沙星、莫西沙星、头孢他啶、头孢甲肟、妥布霉素、氯霉素、红霉素敏感性低于入组时和用药3mo时(P<0.0167)。

结论：长期应用拉坦前列素滴眼液不会影响结膜菌群的检出率,但可增加MRSE的发生率,临床对需要长期应用拉坦前列素滴眼液的患者应综合考虑,防止耐药菌株产生,以防发生不可控制的感染。     

生物工程角膜移植术后排斥反应的临床及免疫病理观察:附5例报告

目的：对生物工程角膜移植术后发生免疫排斥反应患者进行激光共焦显微镜观察和免疫病理研究,初步探究生物工程角膜移植排斥反应的发生机制。

方法：回顾性病例研究。纳入2018-09/2020-12我院收治的感染性角膜炎行生物工程角膜移植术后发生免疫排斥患者5例5眼。裂隙灯检查角膜透明度、角膜新生血管; 激光共焦显微镜对角膜进行动态观察,记录免疫排斥反应后角膜上皮下朗格罕氏细胞和基质炎症细胞密度,并以对侧眼作为对照进行统计分析。行同种异体角膜移植时取下生物工程角膜,免疫组织化学染色后对CD4⁺细胞和CD8⁺细胞及炎症细胞的浸润和分布进行观察。

结果：激光共焦显微镜显示,术眼角膜上皮下可见大量活化郎格罕氏细胞,其活化比例与对侧眼比较有差异(χ²=38.29,P<0.001)。基质层大量炎症细胞,与对侧眼比较具有差异(t=32.5,P<0.05)。对生物工程角膜组织进行免疫组织化学染色和HE染色,角膜基质层均可见CD4⁺细胞和CD8⁺细胞,仅1眼角膜基质层可见大量嗜酸性粒细胞。

结论：生物工程角膜移植术后免疫排斥反应经免疫病理证实以T细胞介导的细胞免疫在发病机制中具有重要作用,对异种抗原的超敏反应可能参与其中。     

斜视性弱视伴偏中心注视眼的多焦视网膜电图表现

目的：探究斜视性弱视伴偏中心注视眼的多焦视网膜电图(mfERG)特征性变化。

方法：收集2018-01/2020-12在我院就诊的斜视性弱视伴偏中心注视患者20例作为研究组(4例为外斜视,16例为内斜视),同时收集屈光不正性弱视患者20例作为对照组。散瞳状态下检查mfERG,记录P1波的振幅密度和潜伏期。

结果：斜视组弱视眼多焦视网膜电图P1波振幅密度与対侧眼相比第一环(P=0.001),第二环(P<0.001),第三环(P=0.001),第四环(P=0.009),第五环(P=0.026)明显降低; 与对照组相比第一环(P=0.033),第二环(P=0.002),第三环(P<0.001),第四环(P=0.014)明显降低; 斜视组弱视眼潜伏期与対侧眼相比第一环(P=0.017)、第二环(P=0.001)有明显缩短,与对照组相比第二环(P=0.007)明显缩短。

结论：斜视性弱视伴偏中心注视眼的多焦视网膜电图P1波振幅密度越靠近黄斑中心凹下降越多,且与屈光不正性弱视眼相比下降更多。     

玻璃体腔注射康柏西普治疗湿性年龄相关性黄斑变性的早期mfERG变化

目的：利用多焦视网膜电图(mfERG)评价玻璃体腔注射康柏西普的湿性年龄相关性黄斑变性(age-related macular degeneration,ARMD)患者视网膜功能的早期变化。

方法：经眼底荧光血管造影确诊为湿性ARMD患者接受玻璃体腔注射康柏西普眼用注射液(0.05mL/0.5mg),记录注射前及注射后1mo的最佳矫正视力及mfERG各环N1、P1波潜伏期及P1波振幅密度。

结果：共20例20眼患者纳入研究,平均LogMAR视力从注射前0.80±0.48提高到注射后0.65±0.50(P<0.001),环1平均振幅密度从注射前39.59±16.60nV/deg²提高到注射后的53.81±20.41nV/deg²(P=0.006),振幅密度的改变与视力的改变呈正相关(r=-0.776,P<0.001)。

结论：对于湿性ARMD患者玻璃体腔注射康柏西普短期内能改善黄斑中心凹的功能。     

异硫氰酸荧光素染色在真菌性角膜炎中的应用

目的：寻找真菌性角膜炎组织切片快速、准确、方便操作的特殊染色方式。

方法：采用经真菌培养均为阳性的真菌性角膜炎患者的角膜标本38例,常规固定脱水透明浸蜡,进行4μm石蜡切片,脱蜡至水,选用异硫氰酸荧光素(FITC)荧光法和过碘酸雪夫氏染色法(PAS)进行染色对比。

结果：异硫氰酸荧光素法检测阳性率为97.4%(37/38),过碘酸雪夫氏染色法检测阳性率为86.8%(33/38)。结果比较有统计学差异(P<0.001)。

结论：异硫氰酸荧光素法镜检真菌性角膜炎优于过碘酸雪夫氏染色法镜检。     

HE和Giemsa染色在结膜刮片检测嗜酸粒细胞的染色比较

目的：通过HE和Giemsa对嗜酸粒细胞的染色效果比较，寻找最佳染色方法。方法：对春季结膜炎20例病人进行结膜刮片，并分别作HE和Giemsa染色，最后用光学普通显微镜观察。结果：在显微镜下，Giemsa染色的嗜酸粒细胞比HE染色的嗜酸粒细胞清晰。结论：实验表明，检测嗜酸粒细胞，采用Giemsa染色，可获得满意的染色效果。     

Rapid Diagnosis of Chlamydial Conjunctivitis in Laboratory

Purpose: To evaluate the techniques of rapid and accurate diagnosis of chlamydialconjunctivitis.Methods: Total 100 conjunctivitis patients (200 eyes) were studied. Twenty-two of100 cases were diagnosed as chlamydial conjunctivitis. The infected epithelia werescraped from tarsal conjunctiva of both eyes and stained separately with Giemsa (100cases) and immunofluorescence (anti-chlamydial antigen monoclonal antibody, 100cases).Result: In immunofluorescent staining, 38 cases were seen positive staining and 62were negative. In Giemsa staining, 29 were positive, and 71 were negative. In 22 caseswith clinical diagnosis of chlamydial conjunctivitis, 13 cases were confirmed, and 9were excluded by immunofluorescent staining. Technically, immunofluorescent andGiemsa stain takes 45 and 40 minutes, respectively.Conclusion: Comparing to Giemsa stain, 38 of 100 scraping specimens were positive(38% ) by immunofluorescent staining, 29 of 100 per cent were positive by Giemsastaining. Giemsa staining takes 5 minutes less     

Geographic distribution of corneal staining in symptomatic dry eye

PurposeTo describe the geographic distribution of corneal fluorescein staining across the five corneal zones, among non contact lens wearers who report symptoms of dry eye and determine which corneal zone most frequently exhibited the worst staining.MethodsPrior studies conducted at the Centre for Ocular Research & Education, Canada, were reviewed for inclusion in the analysis. Each study assessed dry eye symptoms using OSDI and also assessed corneal fluorescein staining in five corneal zones. For each subject, the corneal zones were ranked 1–5 according to their relative staining grade, Rank-1 representing the highest grade.ResultsData from 13 studies and 368 subjects were included. The total number of zones assigned Rank-1 (worst) staining was 449 (across 264 subjects). The inferior zone had the most Rank-1 counts of all zones at 193/43%, which involved 52.5% of all subjects. The nasal zone had 77/17% involving 20.9% of subjects, followed by the temporal (69/15.5%, 18.8% subjects) and superior zones (63/14%, 17.1% subjects). The central zone had the lowest count of Rank-1 designations, at only 47/10.5%, involving 12.8% of subjects. Bayesian analysis was used to generate distributions of the credible proportions of subjects likely to present with staining in a single peripheral zone, with or without central zone staining. It illustrated that staining in a peripheral zone without central staining was more credible. The worst single zone staining was most likely to present in the inferior zone (67.9%), followed by the nasal zone (11.3%), the superior zone (9.2%), and the temporal zone (5.6%).ConclusionIn the presence of dry eye symptoms, the inferior zone typically presents the most severe grade of corneal staining, more likely without central zone staining. This knowledge is valuable when developing a strategy to treat dry eye signs, as the inferior corneal zone has the highest grade of staining thus has the potential to exhibit the greatest reduction in staining post-treatment.     

染色剂辅助撕囊技术在白内障超声乳化术中的应用

目的 :探索对于一些缺乏眼底红光反射的白内障 ,采用染色剂蓝域辅助撕囊技术完成连续环行撕囊 (CCC)的超声乳化术手术效果。方法 :78例 (86只眼 )行白内障超声乳化术的患者 ,分成染色剂辅助撕囊组 (A组 ) 36例 (42只眼 ) ,和常规手法撕囊组 (B组 ) 4 2例 (44只眼 )结果 :(1)连续环行撕囊成功者 ,在A组为 97 4 6 % (41/4 2 ) ,在B组为 6 8 18% (30 /4 4 ) ;两组差异具极显著性意义 (P <0 0 1)。 (2 )A组中 ,2只眼出现前囊膜向赤道部撕裂 ,但未造成后囊破裂 ;B组中 ,8只眼发生后囊破裂及部分玻璃体脱出 ,需要行前段玻璃体切割术。结论 :染色剂辅助撕囊技术 ,对于一些缺乏眼底红光反射的白内障患者 ,可以明显提高连续环行撕囊的成功率 ,从而使这类患者的超声乳化术更加安全。     

Comparison of Hematoxylin-eosin Staining and Methyl Violet Staining for Displaying Ghost Cells

Purpose：To compare the merits and limitations of hematoxylin-eosin （HE） and methyl violet staining for displaying ghost cells from vitreous or aqueous humor.Methods：A specimen containing ghost cells was adjusted to five different concentrations：（12×104,10×104,8×104,6×104 and 4×104 cells/ml） and subjected to smearing and methyl violet and HE staining.The staining results were observed by light microscopy.Results：The ghost cells were readily observed at a cell density of ＞ 8×104 cells/ml with methyl violet staining,but only a few cells were occasionally seen at lower cell densities.In contrast,ghost cells were seen at all cell densities with HE staining.Conclusion：Methyl violet staining is more rapid and simpler for the identification of ghost cells,but its staining color more readily fades,the slides cannot be stored,and it is only effective at a cell density of ＞ 8 ×104 cells/ml.In contrast,HE staining is more time-consuming but it can display cell morphology and distinguish cell components more explicitly and slides can be permanently stored.HE staining has advantages over methyl violet staining in detecting the ghost cells when the concentration is ＜ 8×104 cells/ml.     

Benchmarking evaluation of five PHMB-based multi-purpose solutions and a silicone hydrogel contact lens

目的:针对搭配市售硅水凝胶隐形眼镜使用的5种中国产含聚六亚甲基双胍(polyhexamethylene biguanide,PHMB)多功能护理液,通过护理液相关角膜染色、眼部反应(角膜染色、眼部充血)、角膜浸润、眼部舒适度来评估和比较其临床表现.方法:前瞻性、开放、随机、平行对照临床试验.选取18岁以上受试者162名,并随机分为5组,分别使用5种中国产含PHMB多功能护理液:全能多功能护理液,海昌水感觉润护理液,保视宁护理液,卫康新视护理液及卫康2000多功能护理液(分别缩写为C,H,B,W,和W2).所有受试者都配戴月抛型硅水凝胶隐形眼镜(博士伦纯视)3mo,并每日使用指定的多功能护理液.在配戴前,配戴后2wk,1和3mo进行随访.统计每百人每月护理液相关角膜染色及角膜浸润事件.眼部反应分0-4级,最小梯度为0.5(0=无反应,4=严重反应);眼部舒适度通过数字量表评定(分1-10级,最小梯度为1,1=差,10=优).眼部舒适度和眼部反应采用线性混合模型进行分析.角膜浸润及护理液相关角膜点染通过Fisher确切概率法和logistic回归分析进行分析.结果:有36名(22%)受试者中途退出试验.每组护理液相关角膜染色发生率为:H组26.3%,B组20.8%,W组19.4%,W2组13.4%,C组12.8%,其中H组的发生率分别与W2组(P=0.012)、C组(P=0.005)的差异有统计学意义.不同组间眼部反应、角膜浸润及眼部舒适度的差异均无统计学意义(P> 0.05).存在护理液相关角膜染色的受试者在白天及结束时相比于不存在护理液相关角膜点染的受试者舒适度明显较低.结论:对于不同的护理液,护理液相关角膜染色发生率存在差异,但角膜浸润、眼部反应及眼部舒适度不存在差异.PHMB多功能护理液引发的角膜染色与眼部舒适度相关.     

Benchmarking evaluation of five PHMB-based multi-purpose solutions and a silicone hydrogel contact lens

AIM: To evaluate and compare the clinical performance of 5 kinds of polyhexamethylene biguanide (PHMB) based multi-purpose solutions (MPS) manufactured in China when used with a commercially available silicone hydrogel contact lens in terms of solution-induced corneal staining (SICS), ocular response (corneal staining and ocular hyperemia), corneal infiltrative event (CIEs) and ocular comfort. METHODS: This was a prospective, open label, randomized, parallel group clinical trial. Totally 162 participants (Pxs) who were at least 18y were enrolled and randomized into 5 groups of PHMB-based MPS made in China: Complete? MPS, Hydron? Aqua-shining moist, Baoshining?, Weicon? Fresh, Weicon? 2000 MPS (abbreviated as C, H, B, W, and W2). All participants wore balafilcon A contact lenses with monthly disposal (Bausch & Lomb Purevision?) in conjunction with the designated MPS on a daily wear for 3mo. Clinical visits were at baseline, 2wk, 1mo and 3mo. SICS and CIE were reported as first event incidence per 100 Px-months. Ocular response was graded on 0-4 scale in 0.5 steps (0=none, 4=severe) and ocular comfort was assessed via a numeric rating scale (1-10 in 1-point steps, 1=poor, 10=excellent). Ocular comfort and ocular response variables were analysed using linear mixed model. CIE and SICS were analysed using Fisher’s exact test and logistic regression. RESULTS: There were 36 (22%) Pxs who dropped out. SICS incidence for each MPS were: H (26.3%), B (20.8%), W (19.4%), W2 (13.4%), C (12.8%). The SICS rate of H was significantly different to W2 (P=0.012) and C (P=0.005). There were no significant differences in ocular response, CIE incidence and ocular comfort between different MPSs (P>0.05). Pxs with SICS had significantly lower comfort during the day and at the end of than those who did not have SICS. CONCLUSION: Differences in SICS incidence are found between MPSs but not for CIE incidence, ocular response or ocular comfort. SICS in PHMB-based MPS is found to be associated with ocular discomfort. More MPS/lens combinations should be studied in the future.     

Light and electron microscopic studies on human retinal blood vessels of patients with sclerosis and hypertension

Purpose To correlate the ophthalmoscopic and histological findings on human retinal blood vessels of patients with sclerosis and hypertension, respectively. Methods Ophthalmoscopy, light microscopy, and transmission and scanning electron microscopy with histochemical staining were performed on eyes obtained from patients with a malignant orbital tumor, with absolute glaucoma, or with hypertensive retinopathy. Results The retinal arteries in aged patients with ophthalmoscopic sclerotic blood vessels had walls in which the smooth muscle cells had been replaced by collagen fibers, proteoglycan filaments, and ruthenium red-positive materials. The venous blood columns were hidden by numerous swollen nerve fibers and extending Müller cell processes. In a patient with accelerated hypertensive retinopathy, some of the muscle cells in the arteriolar walls were edematous. Focal and generalized narrowing of the retinal arteries appeared to be caused by a true functional constriction of the smooth muscle cells in the walls. Conclusions The ophthalmoscopic signs, such as reflection of the retinal arterial blood column and crossing phenomena, were supported by sclerotic manifestations clearly visible upon histological examination. There were some organic changes in the retinal arteries in a patient with accelerated hypertensive retinopathy, but the ophthalmoscopic narrowings appeared to result from a functional constriction of the smooth muscle cells in these vessels.