实验性眼球内铜异物的炎症反应及ERG改变

将四种不同大小、不同含铜量的铜片置入兔眼玻璃体中央,用裂隙灯、眼底镜观察术后反应,暗适应视网膜电流图(ERG)检查视功能改变。结果:大的铜异物在眼内很快发生强烈的化学性炎症反应,ERG2周内呈熄灭型,小的铜异物则炎症反应轻微,4个月观察期无明显变化。纯铜与铜合金所致损害无明显差别。提示眼球内铜异物对眼的损害程度主要取决于异物的大小,对临床治疗有重要参考价值。     

视网膜对铁的敏感性与抗坏血酸分布的相关性研究

目的 观察大鼠和家兔视网膜组织中抗坏血酸的分布形式与铁异物对2种不同动物的视网膜损伤形态,验证大鼠视网膜光感受器细胞对铁异物的敏感性是否与视网膜中抗坏血酸的分布有关。 方法 将5 mg铁异物分别置入32只健康雄性Sprague-Dawley (SD ) 大鼠、15 mg铁异物分别置入9只健康雄性新西兰白色家兔玻璃体腔后，苏木精-伊红（hematoxylin-eosin, HE）染色观察2种不同种动物视网膜的受损情况。凋亡原位染色（TdT-mediated dUTP-biotin nick-end labeling, TUNEL）方法观察家兔视网膜神经元的细胞凋亡。Chinoy 法染色观察抗坏血酸在2种不同的正常动物视网膜组织中的分布形式。 结果 SD大鼠铁异物置入术后，HE染色的切片仅见光感受器细胞层的破坏。新西兰白色家兔铁异物置入术后3 d，HE 染色见全层视网膜神经元细胞受损，在神经节细胞层、内颗粒层以及外颗粒层均观察到TUNEL阳性细胞核。正常SD大鼠抗坏血酸阳性染色仅见于外颗粒层；新西兰家兔视网膜全层抗坏血酸染色阳性。 结论 视网膜对铁异物毒性的敏感性与视网膜组织中的抗坏血酸分布形式有关。 （中华眼底病杂志，2003，19：269-332）     

眼内铜性异物

本文报导了纯铜及铜合金眼内异物的动物实验观察。作者用纯铜(99.8%)和铜合金1106(含铜量近60%)异物,灭菌后在无菌条件下由睫状体平部切口植入于家兔玻璃体内。异物的平均表面面积和重量为1.35平方毫米和1.4毫克。以后分别于不同时期进行观察及组织病理学检查。结果如下:(一)纯铜异物:其中16只眼异物置于玻璃体的周边部,全都于24小时内出现初期炎症反应,并于6天内形成     

用地塞米松抑制眼球内铜异物炎症

1888年 Leber 氏报告玻璃体内植入铜片可引起无菌性化脓性改变,作者曾做兔眼试验,在眼球内壁嵌入纯铜,24小时即开始炎症反应,六天内异物被包围;如果植入60%的合金铜,10眼中的7眼在24小时内开始发炎,一周内被包围,另3眼则发炎较晚,经1～3周才被包围。     

眼内铜质沉着症—临床病程研究

在非磁性球内异物中,临床上经常遇到的是纯铜或合金铜,对留存在眼球内的铜异物的毒性反应,有许多不同的意见。Duke-Elder 认为比较纯的铜可以产生脓性眼内炎,Beckerman 谓因眼内含有纯铜异物而产生之早期铜质沉着症,临床上并没有眼内炎症状。Duke-Elder 还说如果异物含铜量是少于85%的合金铜时,眼的反应很轻,但有典型的铜质沉着症特征。然而文献上有许多报导,铜片在玻璃体内留存了很久,有者仅有极微小损伤,有者则自动吸收了。     

一种新型可吸收性巩膜外加压弹性体的研究

目的 寻找具有可吸收性及良好物理特性的人工合成材料作为视网膜脱离巩膜外加压术填充物。方法 用灰兔做视网膜脱离模型，以可吸收性化学合成材料磷酸酯-碳酸酯共聚物弹性体作为填充物，行巩膜外加压术，术后用B超测巩膜嵴高度，相应时间取眼球做病理检查，观察视网膜复位情况及组织相容性。测量其降解率。结果 视网膜平伏，巩膜嵴高度在术后3个月内变化不大。术后第3个月时共聚物吸收8．2％，组织学观察无明显炎症反应。结论 磷酸酯-碳酸酯共聚物弹性体作为巩膜外填充物均使用安全、结果可靠。     

涤纶(Teflon)巩膜填充治疗视网膜脱离的临床及实验研究

本院自1979年开始应用医用涤纶布(Teflon)做巩膜层间及巩膜外填压治疗视网膜脱离,迄今已施术100例,效果良好。为了研究涤纶在巩膜内的组织反应及其对邻近的脉络膜、视网膜的影响,我们进行动物实验,并用硅胶海绵做对比。现将动物实验结果及临床疗效进行分析报告如下:     

后极部巩膜内铁异物对视网膜及视神经影响的实验研究

背景铁质异物嵌在眼球壁在临床上时有发生,目前认为应尽快手术以免造成眼铁质沉着症。动物实验证实小的球壁铁质异物短期内对视网膜和视神经并不产生严重影响,因此是否必须手术取出仍是值得探讨的问题。目的评估兔眼后极部巩膜内植入铁异物对视网膜及视神经的影响。方法选取健康成年日本大耳白兔12只,采用随机数字表法分为无锈铁片组和有锈铁片组。以右眼为对照眼,左眼为实验眼。制备2．0mm×1．0mm×0．2mm有锈或无锈中碳铁片,经眶路植入兔左眼后极部巩膜板层内。分别于术前1周及术后1周、2周、1个月、3个月裂隙灯下观察并记录角膜、前房、晶状体、玻璃体及眼底的大体改变,并进行闪光视网膜电图（F—ERG）和闪光视觉诱发电位（F—VEP）检查,观察视网膜、视神经的功能变化。3个月实验结束时处死实验兔,观察植入铁片的位置,摘除眼球,行苏木精-伊红染色,光学显微镜下对视网膜、视神经进行组织病理学检查。结果暗适应下F—ERG最大混合反应a波振幅不同时间点之间比较差异无统计学意义（F=1．885,P=0．129）,不同处理组之间差异亦无统计学意义（F=1．188,P=0．340）;各组不同时间点的F—ERG最大混合反应b波振幅差异无统计学意义（F时间=2．73,P=0．064;F分组=1．114,P=0．367）。F—VEPN,波隐含时（F时间=1．605,P=0．263;F分组=1．556,P=0．314）、P1波隐含时（F时间=2．329,P=0．092;F分组=2．186,P=0．103）不同时间点及不同处理组之间的比较差异均无统计学意义。实验各指标不同时间及不同干预因素间均无交互作用（P〉0．05）。术后1周、2周、1个月、3个月均未观察到兔眼铁质沉着症改变。实验结束时可见巩膜内铁异物被组织包裹、位置稳定,光学显微镜下兔眼视网膜、视神经均未见明显的细胞学改变。结论兔眼后极部巩膜内细小铁异物无论氧化与否,短期内均不会对视网膜及视神经造成严重的功能性或病理性损害。     

用可伸出的导管针处理视网膜下异物

虽然近年玻璃体显微手术发展很快,但手术处理后极部视网膜内和视网膜下异物仍有困难,往往需要做视网膜切开才能取出。本文报告2例用可伸出的导管针取出视网膜下非磁性异物而不用做后极部视网膜切开。例1,15岁男孩被弹子枪击伤左眼,造成巩膜穿孔伤。CT报告异物在眼球后壁。巩膜穿孔伤修复后9天,视力0.015,有早期白内障和轻度玻璃体出血,后极部隐约可见异物,超声显示下方视     

聚乳酸作为视网膜脱离手术可吸收性填充材料的实验研究

目的研制可吸收性化学合成材料聚乳酸（ｐｏｌｙｌａｃｔｉｃａｃｉｄ，ＰＬＡ）作为视网膜脱离手术填充物，以避免非吸收性合成材料引起的手术并发症。方法健康灰兔作视网膜脱离模型，应用可吸收化学合成材料聚乳酸作为填充物，行巩膜外加压术，术后定期以Ｂ超检测巩膜嵴高度，相应时间取眼球作病理检查。观察聚乳酸在体内降解速度。结果巩膜嵴高度术后３个月内无明显变化，术后７个月下降３０％。术后１个月填充物吸收５．６％，４个月为１６．９％。组织学观察填充物未引起明显炎症反应，相邻巩膜、视网膜结构正常，无明显手术并发症。术后２周填充物为纤维膜包绕。结论聚乳酸是一种理想的巩膜外填充材料，不仅填压效果可靠，而且安全，无脱出和继发感染危险。     

Comparative studies in chronic ocular chalcosis

Seven eyes containing a copper foreign body for a period from 8 months to 2.5 years were studied histopathologically. Foreign bodies, containing 99% copper, were in all eyes, encapsulated and located in the anterior vitreous. Characteristic features were: formation of foreign body granuloma, especially in later stages, marked fibroblastic proliferation in the vitreous with traction retinal detachment, choroidal effusion with fibrosis and foci of chronic nongranulomatous inflammation in cyclitic membranes, iris, ciliary body and sclera. Copper could be identified by rubeanic acid and rhodanine stainings in the fibrous capsule around foreign body in all eyes, in the lens capsule in one eye and in macrophages in the vitreous and retina in 2 eyes. In eyes with intravitreal haemorrhage macrophages contained also haemosiderin.     

Transscleral ocular siderosis.

Intraocular migration of iron from iron foreign bodies in an extraocular or intrascleral location was studied in rabbits. Focal changes occurred in the choroid and retina beneath the foreign bodies. Significant amounts of iron diffused through the sclera into the globes. This iron was typically deposited in the epithelium of the ciliary processes and in the tissues at the choroid-scleral junction in the posterior pole.     

眼外肌涡静脉定位眼内金属异物摘出

目的　探讨巩膜表面径线定位新方法，提高眼内异物摘出手术效果。方法　根据眼外肌、涡静脉在巩膜表面不同时钟方位及功能，对51例51眼眼内及眼球壁异物患者，运用眼外肌、涡静脉巩膜表面径线定位切口摘出异物，并与角膜缘标记法对比。结果　一次性切口摘出异物成功率、并发症发生率、脱盲率均有较大差异（P＜0.05)。结论　眼外肌、涡静脉解剖学径线定位法，简单易行，创伤小，眼球前后段径线位均较准确可靠，优于角膜缘标记法。 ［眼科新进展2001；21(1)∶33-34］     

眼后段异物摘出方法--间接检眼镜下摘出法

目的：探讨眼后段异物摘出方法。方法：对间接检眼镜直视下确诊的玻璃体内或无粘连的视网膜表面磁性异物，试行睫状体平坦部切口，间接检眼镜监视下脉冲电磁铁球外磁吸摘出方法。对间接检眼镜直视下确认的后极以外眼球壁或视网膜表面粘连异物，采用间接检眼镜监视下、改良对应异物的眼球壁切口摘出方法。结果：本组20例（21眼）玻璃体内或视网膜表面无粘连磁性异物，6例后极以外眼球壁或视网膜表面粘连异物均一次顺利摘出，无一发生手术意外或手术并发症。结论：对部分屈光间质不太浑浊的眼后段异物，在间接检眼镜直视下进行异物定位、定性及在其监视下进行异物摘出，具有极大的优越性，值得临床推广试用。     

Biocompatibility and retinal support of a foldable capsular vitreous body injected with saline or silicone oil implanted in rabbit eyes

Introduction: The aim of this study was to evaluate over a 180‐day period the biocompatibility and retinal support of a foldable capsular vitreous body injected with either saline or silicone oil implanted in rabbit eyes. Methods: A standard three‐port pars plana vitrectomy was performed, and foldable capsular vitreous bodies were implanted into the vitreous cavity of rabbit eyes (n = 18). Silicone oil tamponade was used as the control group (n = 5). Of the foldable capsular vitreous body‐implanted eyes, either saline (n = 9) or silicone oil (n = 9) was injected into the foldable capsular vitreous body to support the retina. The treated eyes were examined using a slit lamp with a non‐contact slit‐lamp lens, a tonopen, a non‐contact specular microscope and a B‐scan ultrasound during the 180‐day implantation period. A histological examination was performed at 90 and 180 days. Results: During the 180‐day implantation period, no significant corneal keratopathy or intraocular inflammation was noted, and the intraocular pressure (IOP) and corneal endothelial numbers remained steady among the three groups. B‐scan ultrasonography showed a smoothly increased echogenicity in front of the retina in group of foldable capsular vitreous bodies injected with saline. Gross examination showed that the foldable capsular vitreous bodies injected with saline or silicone oil smoothly supported the retina. The saline or silicone oil inside the foldable capsular vitreous body was homogeneous, transparent and filled the foldable capsular vitreous body. Histological examination showed no obvious abnormality of the cornea, ciliary body or retina in the foldable capsular vitreous body‐implanted eyes. Conclusions: These results suggest that foldable capsular vitreous bodies injected with either saline or silicone oil showed good biocompatibility and retinal support in rabbit eyes over a 180‐day implantation time.     

铁锈症眼玻璃体视网膜手术疗效分析

目的观察铁锈症眼玻璃体视网膜手术治疗的疗效。方法回顾分析玻璃体视网膜手术治疗眼后段磁性异物诱发眼铁锈症22例22只眼的临床资料。男性21例,女性1例;年龄6～54岁,平均年龄40岁。异物存留于眼内1个月～20年。手术前最佳矫正视力（BCVA）＜0.01者15只眼,0.01～0.15者5只眼,0.1～0.2者2只眼。玻璃体腔异物18只眼,眼球壁异物4只眼。并发白内障18只眼。合并视网膜脱离3只眼。12只眼联合环扎、硅油填充,7只眼联合环扎、C3F8填充。18只眼联合白内障摘除术。2只眼联合小梁切除术。结果 22只眼内异物均手术一次成功摘除。手术后视力增加20只眼,占90.9%,不变2只眼,占9.1%。BCVA＜0.1者7只眼,0.1～0.4者8只眼,0.5～1.0者7只眼。手术中并发症,视网膜裂孔并发局限性视网膜脱离2只眼;扩大巩膜切口,玻璃体腔积血2只眼。手术后并发症,并发白内障4只眼;黄斑下异物取出手术后3个月,硅油取出时再次发生视网膜脱离1只眼,再次硅油填充视网膜复位;C3F8填充后7 d继发视网膜脱离1只眼,再次硅油填充,手术后视网膜复位。随访结束时22只眼视网膜均在位。结论铁锈症眼玻璃体视网膜手术治疗安全、有效,可避免铁离子进一步释放,改善患者视功能。     

Studies on the use of desferrioxamine in experimental ocular siderosis produced by extrabulbar administration of iron

The objective of these studies was to find out whether iron administered extrabulbarly can penetrate inside the eyeball and whether this process can be checked by transconjunctival injections of desferrioxamine. Histological examination revealed that 12 months after the placing of iron in the orbit, an accumulation of the metal can be observed in the sclera, choroid, and retina of untreated animals. In the group of animals treated with desferrioxamine, iron did not penetrate into the eyeball, and only in some animals could its presence be found in superficial layers of the sclera. The possibility is discussed of using the drug for the treatment of conditions resulting from the presence of foreign bodies in the orbit.     

哌仑西平脂质体在家兔眼内的药代动力学研究

目的研究哌仑西平脂质体结膜囊内应用后在家兔眼部的药代动力学。方法48只家兔随机分为磷酸盐缓冲液组和脂质体组，分别于给药后0．5、1、2、4、6、8、10、12h取材，采用高压液相色谱技术进行测定，3P97软件拟合药代动力学参数，统计学分析采用t检验和单因素方差分析。结果脂质体组各组织中哌仑西平的质量浓度和质量分数较磷酸缓冲液组高，用药2h后各时间点各组织间相比均有显著统计学差异（P〈0．01），它们在各组织中的变化均呈一室开放模型。同一种组织中除脉络膜的消除半衰期外，其余组织各药代动力学参数间（Cmax、t1/2、MRT、AUC）差异有统计学意义（P〈0．05）。巩膜中哌仑西平的质量分数高于脉络膜和视网膜（P〈0．05）。结论哌仑西平脂质体眼部应用有缓释效应，生物利用度高，其很可能是以非角膜途径吸收为主进入眼内的。     

玻璃体腔内超声乳化治疗晶状体后脱位的疗效观察

目的 评价玻璃体腔内超声乳化治疗晶状体后脱位的疗效.方法 选取2007年11月至2009年11月,18例(18只眼)因眼伤或白内障摘除术中后囊破裂晶状体核脱位于玻璃体腔的患者,应用标准睫状体扁平部闭合式三切口,先行全玻璃体切除术,再采用去硅胶袖套的超声乳化头乳化摘除脱位的晶状体,并根据病情行眼内异物取出术、视网膜激光光凝术等.术后观察视力、眼压、视网膜、巩膜伤口等恢复情况.结果 在没有使用全氟化碳(重水)的情况下,所有晶状体均成功摘除,没有发生严重的并发症.13只眼术后视力不同程度提高,其余5例保持不变;术前合并继发性青光眼的6例患者,术后眼压控制良好;术前合并球内异物的3例均成功取出异物;视网膜、巩膜无明显医源性损伤.结论 玻璃体腔内超声乳化联合玻璃体切割治疗晶状体后脱位疗效好,具有方便、快捷、不需应用重水的特点.超声乳化头可以代替超声粉碎头用于晶状体脱位于玻璃体腔的治疗.     

Transcleral contact krypton-laser photocoagulation of the retina in rabbits.

Transcleral contact retinal krypton laser photocoagulation of the retina was studied in rabbit eyes. The laser application was performed under indirect ophthalmoscope visual control with indentation of the sclera by the laser probe. Retinal lesions were produced with powers ranging from 0.2 to 0.3 W and application times between 1 and 2 sec. The lesions were studied histologically 2, 5, 10, 12, 20, 30 and 70 days after treatment. Histopathological examination of the lesions showed damage of mainly the outer retinal layers in light lesions, and to all layers of the retina in the more intense lesions. No scleral damage was observed in the light lesions, whereas transient oedema of the inner sclera was seen in the intense lesions. Studies with enucleated rabbit eyes showed that indentation of the sclera by the laser probe substantially decreased the power needed to produce a retinal lesion. It is concluded, that when used with scleral indentation, transscleral krypton laser photocoagulation of the retina can be performed with minimal damage to the sclera.