电光性眼炎防治研究与临床形态观察

本文对７０只标准兔电光性眼炎的动物模型及３２例患者进行了“防治灵”的防治研究与临床形态观察，结果表明：１．可延长角膜上皮水肿期。２．缩短角膜上皮脱落时间。３．缩短眼疼、流泪、畏光症状。４．减少眼部充血及分泌物。５．预防作用。其临床形态在水肿期有轻、中、重三型，脱落期有１０种形态，修复期特点是具有反复性。     

大鼠泪液缺乏型干眼症眼表组织中IL- 6和TNF-α的表达

目的：探讨白介素6（interleukin- 6,IL- 6）和肿瘤坏死因子（tumor necrosis factor α ,TNF-α）在泪液缺乏型干眼症发病机制中的作用.方法：SD大鼠48只随机分成实验组和对照组两组,实验组通过摘除泪腺的方法制作干眼模型,对照组不做处理,分别于实验前1d及实验后1,2,4wk检测泪液的分泌、泪膜破裂时间及观察角膜荧光素染色,术后4wk将动物脊髓离断致死,用免疫组织化学方法检测结膜及角膜组织中IL- 6和TNF-α的表达.结果：实验组大鼠SchirmerⅠ滤纸湿长较正常组缩短（P〈0.01）,泪膜破裂时间较正常组缩短（P〈0.01）;IL- 6和TNF-α在两组均有表达,在实验组表达较强,对照组表达较弱,两者差异有统计学意义（P〈0.05）.结论：IL- 6和TNF-α在泪液缺乏型干眼的发病机制中起着重要的作用,泪液缺乏型干眼的发病机制与炎症有关.     

大鼠泪液缺乏型干眼症眼表组织中IL-6和TNF-α的表达

目的:探讨白介素6(interleukin-6,IL-6)和肿瘤坏死因子(tumor necrosis factorα,TNF-α)在泪液缺乏型干眼症发病机制中的作用。方法:SD大鼠48只随机分成实验组和对照组两组,实验组通过摘除泪腺的方法制作干眼模型,对照组不做处理,分别于实验前1d及实验后1,2,4wk检测泪液的分泌、泪膜破裂时间及观察角膜荧光素染色,术后4wk将动物脊髓离断致死,用免疫组织化学方法检测结膜及角膜组织中IL-6和TNF-α的表达。结果:实验组大鼠SchirmerⅠ滤纸湿长较正常组缩短(P<0.01),泪膜破裂时间较正常组缩短(P<0.01);IL-6和TNF-α在两组均有表达,在实验组表达较强,对照组表达较弱,两者差异有统计学意义(P<0.05)。结论:IL-6和TNF-α在泪液缺乏型干眼的发病机制中起着重要的作用,泪液缺乏型干眼的发病机制与炎症有关。     

牛磺酸对实验性半乳糖性白内障的防治作用

目的 观察牛磺酸对大鼠半乳糖性白内障的防治作用。方法 设置对照组,白内障组,预防组,结膜下注射组,腹腔注射组,点眼组。采用Ｄ－半乳糖诱发白内障,预防组诱发当开始腹腔注射１５％牛磺酸,其它３个给药组从实验第４天开始分别结膜下注射,腹腔注射,双眼点１５％牛磺酸。     

活体观察N-乙酰半胱氨酸防治白内障的实验研究

背景 亚硒酸钠诱导的白内障与年龄相关性白内障的形成机制具有一定的相似性,即氧化损伤,N-乙酰半胱氨酸(NAC)是一种有效的抗氧化剂,但其对白内障的预防和治疗作用研究尚少. 目的 观察NAC对亚硒酸钠诱导大鼠白内障的预防和治疗作用,为白内障的药物防治提供实验依据.方法 实验分为预防部分和治疗部分.选取SD大鼠60只,随机数字表法分为正常对照组1、正常对照组2、硒性白内障组、NAC白内障预防组、硒性白内障生理盐水组及NAC白内障治疗组,每组10只大鼠.采用3.46 mg/kg亚硒酸钠颈部皮下注射法制作硒性白内障模型,隔日1次,共3次.预防实验时在首次注射亚硒酸钠前30 min大鼠腹腔内注射2 mmol/L NAC,每日1次,共6次;治疗实验时,硒性白内障大鼠造模后1d腹腔内注射2 mmol/LNAC,每日1次,共1个月;硒性白内障生理盐水组以同样方法注射生理盐水.每周各组大鼠在裂隙灯下观察晶状体混浊程度并参考LOCSⅢ标准进行分级.各实验组大鼠最后一次注药后制备晶状体组织切片,光学显微镜下观察晶状体上皮细胞( LECs)的组织病理学改变,扫描电子显微镜下观察晶状体上皮超微结构的改变.采用免疫组织化学法观察亚硒酸钠对晶状体中caspase-3的影响;对各组大鼠晶状体组织中超氧化物歧化酶(SOD)、丙二醛(MDA)含量的变化进行生化测定.结果 实验后7d正常大鼠晶状体透明.硒性白内障组Ⅴ级晶状体混浊者有11只眼,NAC白内障预防组仅有Ⅱ级混浊8只眼和Ⅰ级混浊2只眼,差异有统计学意义(x2=40.000,P＜0.05).实验后30d,硒性白内障生理盐水组和NAC白内障治疗组Ⅳ～Ⅴ级晶状体混浊均为20只眼,差异无统计学意义(x2=0.153,P＞0.05).常规组织病理学检查表明,正常对照组LECs及晶状体纤维结构正常,硒性白内障组、硒性白内障生理盐水组和NAC白内障治疗组LECs与前囊部分分离,排列疏松紊乱,细胞膜破裂,细胞核呈椭圆形或长条形,晶状体纤维断裂,NAC白内障预防组晶状体结构破坏程度较轻.扫描电子显微镜下可见硒性白内障组、硒性白内障生理盐水组和NAC白内障治疗组晶状体前囊分层,外膜脱离,深层可见“变性球样小体”,纤维紊乱破碎,形成无结构的“水泥样”外观.硒性白内障组caspase-3和SOD的表达明显低于正常对照组,MDA的表达高于正常对照组,差异均有统计学意义(P＜0.05),而NAC白内障预防组caspase-3和SOD的表达明显高于硒性白内障组,差异均有统计学意义(P＜0.05).硒性白内障生理盐水组与NAC白内障治疗组caspase-3、SOD和MDA表达均明显低于正常对照组2,差异均有统计学意义(P＜0.05),而硒性白内障生理盐水组与NAC白内障治疗组比较,caspase-3、SOD和MDA表达的差异均无统计学意义(P＞0.05).结论 NAC可以提高晶状体组织中SOD的活性,减少MDA生成,降低caspase-3的活性,从而减轻晶状体的氧化损伤,对早期白内障的发生、发展有一定的延缓和预防作用,但对于已经形成的白内障无明显治疗作用.     

硫代磷酸甘露醇戊糖防治实验性脉络膜新生血管的初步研究

目的 探讨乙酰肝素酶抑制剂硫代磷酸甘露醇戊糖对实验性脉络膜新生血管(CNV)的干预作用及机制.方法 实验研究.29只雄性BN大鼠,双眼眼底采用氪激光光凝建立CNV模型(波长647 nm,功率360 mW,光斑直径50 μm,曝光时间0.05 s),随机分为空白对照组、生理盐水对照组、预防组和治疗组,另取3只作为正常对照组,预防组和治疗组分别在眼底光凝当天和1周CNV已形成时开始连续15 d腹腔注射硫代磷酸甘露醇戊糖(25 mg·kg-1·d-1),生理盐水对照组以生理盐水代替预防组硫代磷酸甘露醇戊糖,采用脉络膜巩膜铺片FITC-D标记CNV定量分析、眼底荧光血管造影检查和组织病理学方法综合评价硫代磷酸甘露醇戊糖干预CNV生长的效果;应用蛋白免疫杂交技术和免疫组织化学方法观察药物干预前后乙酰肝素酶蛋白的表达变化.采用单因素方差分析、Kruskal-Wallis秩和检验或均数资料t检验对数据进行统计学分析.结果 光凝后3周预防组和治疗组CNV面积较对照组分别减小了52.1%和53.8%;组织病理学结果也发现,治疗组CNV膜相对厚度较对照组减小了46%;对照组和预防组在1周都开始形成CNV,但预防组荧光素渗漏较对照组明显受抑制;3周时预防组已停药7 d,其荧光素渗漏并未增强,而治疗组已连续用药15 d,荧光素渗漏较2周则表现明显减弱;免疫印迹法结果显示,预防组和治疗组乙酰肝素酶蛋白相对表达水平均受到明显抑制;免疫组织化学结果发现,乙酰肝素酶主要在CNV膜向视网膜下进展的前沿和CNV膜内部血管管壁周围位置表达,治疗组激光斑内染色强度明显受到抑制.结论 硫代磷酸甘露醇戊糖不仅能够一定程度预防CNV的形成,还能使已经形成的CNV部分消退;其机制与抑制乙酰肝索酶表达有关.     

肌肽和吡诺克辛防治大鼠糖尿病性白内障的比较

目的:比较肌肽和吡诺克辛防治大鼠糖尿病性白内障的作用。方法:以链脲佐菌素对大鼠进行糖尿病性白内障造型。动物分为3组,分别为肌肽组、吡诺克辛组和空白组。肌肽组和吡诺克辛组只对右眼治疗,左眼不治疗。组内对左、右眼病变进行比较,组间对各组动物左右眼病变的差值进行比较。结果:治疗后5wk,肌肽组和对照组的右眼与左眼间无显著性差异(P>0.05),吡诺克辛组的治疗眼病变显著低于不治疗眼(P=0.012)。吡诺克辛组显著低于对照组(P=0.005)和肌肽组(P=0.005),肌肽组与对照组无显著性差异(P>0.05)。6wk时肌肽组和对照组的右眼与左眼间无显著性差异(P>0.05),吡诺克辛组治疗眼病变显著低于不治疗眼(P=0.023)。吡诺克辛组显著低于肌肽组(P=0.011),吡诺克辛和肌肽与对照组间无显著性差异(P>0.05)。结论:肌肽对防治大鼠糖尿病性白内障没有作用,而吡诺克辛有一定的作用。     

霉酚酸酯对大鼠角膜移植排斥反应的免疫抑制作用

目的 研究霉酚酸酯(MMF)对大鼠角膜移植排斥反应的防治作用.方法 建立大鼠穿透性角膜移植排斥反应的动物模型,观察MMF对大鼠角膜移植片存活的影响,并与阴性对照组和CsA治疗组相比较.结果 阴性对照组角膜植片平均存活时间为11.375±1.685天,CsA治疗组为18.625±1.598天,MMF治疗组为16.500±1.852天,CsA+MMF组为24.500±1.773天,均比阴性对照组显著延长.结论 MMF对大鼠穿透性角膜移植排斥反应具有抑制作用,显著地延长角膜植片的存活时间.     

免疫刺激剂CpGODN防治烟曲霉菌引起的变态反应性结膜炎的实验研究

背景研究证实免疫调节剂CpGODN对蛋白类过敏原引起的变态反应性结膜炎有防治作用,但其对真菌引发的变态反应性结膜炎是否有类似作用尚不清楚。目的研究局部应用CpGODN是否能够预防或减轻烟曲霉菌引发的变态反应性结膜炎。方法建立烟曲霉菌变态反应性结膜炎小鼠模型,用CpGODN或对照ODN（GpCODN）对其进行干预,PBS干预作为阴性对照。实验分为预防实验（模型动物在变态反应原再次激发前给药）和治疗实验（激发后给药）,对小鼠眼部临床症状进行评分。取小鼠结膜组织进行组织病理学检查,并计数标本中的炎性细胞。应用实时定量聚合酶链反应（real-timePCR）法动态观察小鼠结膜组织中TLR4mRNA的变化;将烟曲霉菌免疫原与眼部回流淋巴结和脾脏的细胞进行共培养,流式细胞分析培养细胞中调节性T淋巴细胞的比例和活化状态。结果预防实验中,结膜下注射CpGODN组与GpCODN对照组、PBS对照组比较,小鼠眼部过敏症状评分差异均无统计学意义（P〉0．05）;CpGODN组与GpCODN对照组、PBS对照组比较结膜组织中性粒细胞数降低,差异均有统计学意义（21．25±11．59vs30．75-4-_11．44,21．25±11．59vs69．00±9．90;t=5．140,t=3．210,P〈0．01）;TLR4mRNA表达上调。在治疗实验中,CpGODN组与GpCODN对照组、模型对照组比较,跟部过敏症状评分降低（t=4．000,t=2．750,P〈O．05）;中性粒细胞数显著减少（t=4．870,t=3．829,P〈0．01）。CpGODN治疗组小鼠眼部回流淋巴结CD4^＋CD25^＋细胞以及CD4^＋CD25^＋CD69’细胞所占的比例均显著高于GpCODN组和PBS对照组（P〈0．05）。结论CpGODN通过上调结膜TLR4的表达、活化Treg细胞来预防和治疗烟曲霉菌引起的变态反应性结膜炎,预先结膜下注射和点眼均可减轻小鼠眼部过敏症状和晚期结膜炎性细胞的聚集。     

维甲酸防治增殖性玻璃体现视网膜病变的实验研究

为探讨维甲酸对实施性增殖性玻璃体视网膜病变的防治作用及维甲酸对视网膜是否有毒性，本实验将２６只色兔随机分成４组，对照组Ａ组２０眼、Ｃ组６眼，玻璃体内注射ＰＢＳ，实验组Ｂ组２０眼、Ｄ组６眼，玻璃体内注射１５ｕｇ／ｍｌ维甲酸，Ａ组和Ｂ组玻璃体内同时注射２．５×１０＾５视网膜色素上皮细胞。以检眼镜观察增殖性玻璃体视网膜病变的级别；以光镜、电检检查来观察２８天时视网膜变化。结果表明：４周后，实验组与对照组     

大鼠眼内异物伤诱发交感性眼炎的实验研究

目的观察大鼠单侧眼外伤能否诱发交感性眼炎，为交感性眼炎的发病机制提供理论依据。方法将36只Wistar健康成年大鼠随机分为Ⅰ组眼内异物（砂粒）伤组、Ⅱ组异物（刀片）伤组、Ⅲ组正常对照组。正常对照组大鼠4只，不做任何处理。Ⅰ组、Ⅱ组中各16只大鼠右眼为异物植入眼，将不同异物经睫状体部位置入玻璃体腔，获得大鼠单眼异物伤型，通过额带放大镜观察双眼前段变化，并于2、4、6、8周摘除眼球，应用HE染色观察双眼球的组织病理学变化。结果Ⅰ组、Ⅱ组大鼠右眼眼前段主要表现为球结膜充血、水肿，创口处有异常分泌物，眼球萎缩随时间延长例数增加。组织病理学可见中性粒细胞、淋巴细胞浸润。左眼无眼前段变化及组织病理学变化。Ⅲ组未见病理性改变。所有外伤眼均未能诱发交感性眼炎。结论交感性眼炎的发病机制复杂，通过单纯模拟交感性眼炎的易发条件未能诱发出交感性眼炎。     

Cataract surgery in sympathetic ophthalmia

PURPOSE: To analyze the results of cataract surgery in patients with sympathetic ophthalmia. SETTING: Sankara Nethralaya, Medical Research Foundation, Chennai, India. METHODS: This study comprised 66 patients (132 eyes) with sympathetic ophthalmia seen at the uveitis referral clinic between January 1990 and July 2001; 42 eyes (31.8%) had cataract. Cataract surgery was performed in 17 sympathizing eyes and 1 exciting eye (17 patients). The records of these 18 eyes were retrospectively analyzed. Three eyes had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation, 6 eyes had ECCE without IOL implantation, and 9 eyes had phacoemulsification with IOL implantation. The mean follow-up was 28.7 months (range 3 to 60 months). RESULTS: The causes of sympathetic ophthalmia were penetrating trauma (n = 8 eyes), ocular surgery (n = 6), perforated corneal ulcer (n = 2), and cyclocryotherapy (n = 1). The most common cataract type, present in 7 eyes (38.8%), was mixed (posterior subcapsular and posterior polar). Visual acuity improved after surgery in 13 eyes (72.2%). The main factors impairing visual recovery were submacular scar and optic atrophy, which were sequelae of the sympathetic ophthalmia. Posterior capsule opacification was noted in 14 eyes (77.7%); it was visually significant in 6 eyes. There was no significant difference in postoperative inflammation or disease reactivation between the 3 types of surgery. CONCLUSIONS: Cataract extraction in cases of sympathetic ophthalmia can be safely and successfully performed with vigilant preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome, however, depends on the posterior segment complications of the disease.     

中学生群体发生电光性眼炎临床分析

目的探讨群体电光性眼炎的临床特征及救治措施。方法中学生325人（650眼）同日突发电光性眼炎，经先后滴1％的卡因及1％荧光素钠滴眼液后作眼部检查。根据临床表现，分轻重2型。轻型：209例（64．30％）418眼。重型：116例（35．61％）232眼。给患者滴促进角膜损伤修复和预防感染的眼液治疗。结果患者经药物治疗3天后，先后均痊愈。结论对群体突发电光性眼炎宜现场救治，以赢得时间。日常应加强卫生健康教育，严格管理紫外线灯的正确使用。     

川芎嗪离子导入治疗糖尿病视网膜病变疗效观察

目的:探讨眼部直流电控川芎嗪离子导入治疗糖尿病视网膜病变的疗效。方法:糖尿病视网膜病变患者45例(88眼),其中治疗组25例(48眼)应用电控川芎嗪离子导入和葛根素注射液静脉滴注。对照组20例(40眼)只用葛根素注射液静脉滴注。观察两组治疗前后视力和眼底的变化。结果:治疗组总有效率90%,对照组60%,治疗组的疗效明显优于对照组,两组疗效比较差异有显著性(P<0.01)。结论:眼部电控川芎嗪离子导入是治疗糖尿病视网膜病变的一种有效方法。     

Ophthalmia neonatorum in northern Norway. II. Microbiology with emphasis on Chlamydia trachomatis.

In a population of 1928 neonates in Northern Norway, ophthalmia neonatorum was diagnosed in 18.9%, including mild and self-limiting cases. Sixteen out of 269 (6.0%) cultured cases were positive for Chlamydia trachomatis. No gonococcal ophthalmia was seen. In neonates whose symptoms began in the maternity wards, the distribution of the isolated microorganisms (mainly Staphylococcus aureus) was different from those in whom symptoms began after discharge (mainly S. aureus, Staphylococcus species (coagulase-negative), Streptococcus viridans and C. trachomatis). Growth of C. trachomatis was significantly associated with the intensity of conjunctivitis (P less than 0.001). However, no sequelae could be demonstrated in the eyes at the age of 6 months. 60% of the neonates with chlamydial ophthalmia also suffered from rhinitis. 31.4% of the neonates received silver nitrate instillation, which had no significant influence on the frequency of chlamydial ophthalmia. General practitioners are often faced with chlamydial ophthalmia. In cases of ophthalmia neonatorum, a microbiological examination is recommended, as a guide to appropriate antibiotic treatment. The result of microbiological examination may also indicate other infections in mother and child. In areas with a readily available health service, including an adequate microbiological laboratory service, prophylaxis in the eyes does not seem to be necessary.     

Study of suppressive effect of intravenous fluconazole on endogenous Candida endophthalmitis in rabbits.

The effect of intravenous fluconazole on endogenous Candida endophthalmitis in rabbits was investigated. Preventive and therapeutic experiments were carried out. In the preventive series, rabbits were injected intravenously with 5 mg/kg of fluconazole at 30 minutes, 1 day and 2 days after intravenous inoculation with Candida albicans spores. The control group received no medication. No treated rabbits developed ocular lesions and no Candida spores were isolated from the treated eyes. On the other hand, all control rabbits developed bilateral chorioretinitis and C. albicans was isolated invariably from the control eyes. In the therapeutic series, intravenous fluconazole (5 mg/kg body weight) was administered from 3 to 6 days after inoculation. All rabbits developed chorioretinitis and Candida spores were isolated from all eyes. Therefore, the results of this study prove that intravenous fluconazole is more effective in preventive use than in therapeutic use against endogenous Candida endophthalmitis in rabbits.     

近视回归镜控制青少年近视发展的临床观察

目的:临床观察近视回归镜对青少年近视发展的防治作用。方法:随机选取52例在我院视光中心就诊的年龄在9~18岁近视患者配戴近视回归镜作为治疗组,观察裸眼视力变化,屈光度变化,眼轴长度及角膜曲率变化情况.并与52例年龄及屈光度相似的近视患者配戴框架眼镜作为对照组,观察时间12mo。结果:治疗组屈光度增加<0.50D者38例(76眼)有效率73.1%,对照组屈光度增加<0.50D者18例(36眼)有效率34.6%,两组间有显著差异(P<0.01);治疗组裸眼视力下降<2行者39例(78眼)有效率73.6%,对照组裸眼视力下降<2行者10例(20眼)有效率19.2%,两组间差异有显著性(P<0.05);眼轴长度及角膜曲率值变化治疗组与对照组之间无明显差别。结论:近视回归镜对青少年近视发展有延缓作用。     

Reversible retinal changes in the acute stage of sympathetic ophthalmia seen on spectral domain optical coherence tomography

To report the changes seen in the photoreceptor layer during the acute phase of sympathetic ophthalmia. Six consecutive patients diagnosed with sympathetic ophthalmia were enrolled in the study. All 6 patients had a fundus fluorescein angiogram and spectral domain optical coherence tomography (OCT) scan carried out at presentation. The outer retinal segment was demarcated on the raster line scan between the external limiting membrane (ELM) and the retinal pigment epithelium (RPE)–choriocapillaris complex. All patients received intravenous methylprednisolone followed by oral corticosteroids 1–1.5 mg/kg/day. The serial follow-up OCT scans taken 48 h after the initiation of treatment, and 1, 2 and 12 weeks later, were studied and compared. The retina inner to the ELM did not show any remarkable structural alteration in any of the eyes. The outer retinal segment demarcated by the ELM and the RPE–choriocapillaris complex showed serous retinal detachment in all the eyes and elongation of photoreceptors could be seen in four eyes. There was a disruption to the continuity of the two inner hyper-reflective bands in all the eyes. A repeat raster line scan performed 48 h after systemic corticosteroid therapy showed a reduction in the height of the serous retinal detachment with elongation of photoreceptors and the protrusion of their apical segments into the serous detachment in 4 eyes. The serous detachment showed a progressive reduction in height following intravenous methyprednisolone therapy in all the eyes over the following week with elongated photoreceptors in all six eyes. After two weeks, none of the eyes showed any residual detachment and this corresponded with the improvement in visual acuity in all the eyes. OCT raster line scans repeated at 4 weeks showed resolution of serous detachment with normal photoreceptor layer and restoration of a third hyper-reflective band (IS/OS junction) in all the eyes. The photoreceptor layer is involved during the acute phase of sympathetic ophthalmia as indicated by the in vivo morphological changes seen on spectral domain OCT. These changes are reversible following systemic corticosteroid therapy thus supporting the hypothesis that prompt and aggressive anti-inflammatory therapy is capable of reversing the photoreceptor changes.     

玻璃体手术后交感性眼炎的临床及病理学观察

目的观察玻璃体手术后交感性眼炎的临床特点及病理学改变。方法回顾性分析1998年1月至2004年12月期间13000例玻璃体手术后8例交感性眼炎患者的临床资料，并对其中3例摘除的诱发眼进行了病理学观察。结果交感性眼炎的发生率为0.06%。发生交感性眼炎的时间距最后一次玻璃体手术的时间为7~150 d，平均时间为(77.8±50.8) d。主要表现为交感眼视力下降、视物变形，眼红，眼痛。发病时交感眼视力为手动~0.5，诱发眼视力为无光感~0.04。双眼羊脂状角膜后沉着、前房闪辉及细胞、玻璃体混浊、视盘水肿充血、后极部视网膜水肿，2例交感眼有渗出性视网膜脱离。所有患者经口服泼尼松1.0~1.5 mg/kg治疗后交感眼和诱发眼视力均有不同程度恢复。3例患者因诱发眼视力丧失行眼球摘除手术。被摘除的诱发眼病理检查表现为葡萄膜弥漫性淋巴细胞浸润增厚，类上皮细胞结节形成，淋巴细胞浸润巩膜孔道，眼球萎缩。结论玻璃体手术后交感性眼炎发生率为0.06%；大多数发生在手术后3个月内；其临床表现及病理学检查符合交感性眼炎的特征。（中华眼底病杂志，2007，23：112-114）