结膜瓣覆盖联合药物治疗真菌性角膜溃疡

目的　探讨药物治疗联合桥式结膜瓣覆盖治疗真菌性角膜溃疡的疗效。方法　药物采用氟康唑静滴 ,伊曲康唑口服 ,那他霉素混悬液滴眼 ;手术采用病灶切除结膜瓣覆盖植床。结果　 31例中 30例治愈 ,保住了眼球 ,1例失败。结论　药物治疗联合桥式结膜瓣覆盖是治疗真菌性角膜溃疡的有效方法。     

结膜瓣遮盖治疗真菌性角膜溃疡的临床疗效观察

目的探讨结膜瓣覆盖治疗真菌性角膜溃疡的疗效。方法对18例（18只眼）真菌性角膜溃疡患者采用病灶切除结膜瓣覆盖植床并于术后使用抗真菌药物治疗,术后随访5～11月。结果18例中17例治愈,保住了眼球,1例失败。结论对药物治疗效果欠佳的真菌性角膜溃疡患者,结膜辩覆盖法治疗是一种安全、有效的手术方式。     

志贺氏菌激发的粘膜免疫与粘膜保护

将家兔分为三组,分别经口服、滴眼或皮下接种活福氏2a 志贺氏菌。用 BA-ELISA 技术测定血、唾液、泪和粪中 IgG、IgM 和 IgA 类特异抗体。结果表明:滴眼组兔血 IgG 抗体迅速上升,口服组兔血以 IgM 抗体增加幅度较大,并出现较早。两组动物的唾液、泪和粪中 IgG 和 IgA 抗体上升幅度大。粪抗体以口服组出现最早。皮下组血 IgM 增加明显,下降迅速。其他体液中,三类抗体都未见增加。各组动物于免疫后约90天,经眼攻击。局部免疫的两组动物呈现有保护作用,皮下组则无。以上结果证实了机体内共同粘膜免疫系统的存在,并提示唾液、泪和粪产生的对志贺氏菌的免疫应答可能反映动物肠道的免疫状态,评价口服疫苗和研究免疫机理。     

美宝湿润烧伤膏治疗眼烧伤临床体会

目的：观察湿润烧伤膏(MEBO)在治疗眼结膜及角膜烧伤的临床疗效。方法：对174例204只眼结膜角膜烧伤应用湿润烧伤膏治疗，常规首次应用表面麻醉方法后，用生理盐水氯霉素眼药水冲洗眼角膜及结膜烧伤及充血部位后，再用5-10ml无菌空针管“去针头”将美宝湿润烧伤膏吸入，每3小时将湿润烧伤膏压入眼睑结膜与球结膜之间一次，连续应用治疗。结果：治疗总有效率为100％，随访均为6个月以上，未发现视力障碍。结论：应用美宝湿润烧伤膏治疗眼结膜角膜烧伤，临床效果良好，操作简便，便于临床推广应用。     

微创结膜切口治疗孔源性视网膜脱离的临床优势分析

目的探求微创结膜切口行巩膜外垫压术治疗孔源性视网膜脱离的临床优势。方法选取我科2012年1月~2013年12月孔源性视网膜脱离患者164例164眼,按照随机数字表法分为实验组82例82眼和对照组82例82眼。实验组采用微创结膜切口行巩膜外垫压术,即在裂孔所在象限距角膜缘10 mm的位置,根据裂孔大小做平行或垂直角膜缘的结膜切口;对照组采用常规角膜缘结膜切口行巩膜外垫压术。随访观察两组术后眼底视网膜复位率、视功能恢复效果、视力提高程度、术后并发症的发生率,随访时间为6~24（10.5±2.0）个月。结果两组的平均住院时间、术中并发症发生率及平均住院时间相比较,实验组均较对照组明显下降（ P〈0.05）;两组术后的眼底视网膜复位率、视功能恢复情况及视力提高情况比较,实验组较对照组明显提高（P〈0.05）;并且实验组较对照组术后并发症明显减少（P〈0.05）。结论微创结膜切口行巩膜外垫压术治疗孔源性视网膜脱离效果较佳。     

Neck injury and conjunctival petechiae in a woman who underwent cardiopulmonary resuscitation and subsequently died from meningococcal sepsis

Cardiopulmonary resuscitation (CPR) can create a range of unusual lesions and injuries, which may complicate forensic evaluation. Although potentially sinister findings, neck injury and conjunctival petechiae may also be seen in patients who have undergone CPR. We report a case of an individual with subcutaneous bruising and hemorrhage in the deep structures of the neck and florid conjunctival petechiae at autopsy that can be explained by cardiopulmonary resuscitation and meningococcal sepsis.     

两种取材方法体外培养结膜细胞的实验比较

目的比较离体人结膜上皮细胞组织块培养法与刮片培养法的差异。方法选择原发性翼状胬肉患者10例,术中在相邻结膜部位,分别予以切取组织块和结膜刮片。组织块进行贴壁法培养,刮片离心后进行细胞培养,观察两种不同方法结膜上皮细胞生长情况,并进行结膜细胞鉴定。结果组织块培养法,细胞1～3 d贴壁,细胞呈多角形或纺锤形,胞体梭长;细胞5～7 d铺满瓶底,排列紧密,呈椭圆形或圆锥形。刮片培养法,获得细胞较少,一般1～3 d贴壁,贴壁效率较低,死亡率较高,细胞形态同组织块培养法。两种方法培养细胞荧光染色TRITC标记CK和FITC标记PCNA皆阳性。结论组织块培养法和刮片培养法都能培养出活性较高的结膜上皮细胞,但是组织块培养法培养效率更高,结果稳定性好。     

Technique of ruthenium-106 application in the treatment of conjunctival melanoma

In 1966 Lommatzsch has introduced the ruthenium-106 radiation therapy in the treatment of the choroidal melanoma. He reported on good results with a less rate of ocular side effects in compare to the different forms of conventional radiation therapy modalities. It seemed useful to utilize the advantages of ruthenium-106 therapy also for the treatment of the conjunctival melanoma. The technique of the ruthenium-106 irradiation of conjunctival melanoma is described and the first clinical results are reported.     

长跑运动对老年人球结膜微循环影响的初步探讨

本文对70名老年长跑队员进行球结膜微循环观察,井以77名非长跑运动健康老年人作对照。观察结果均采用田牛氏加权积分法计分评定。结果表明,老年长跑运动组的形态积分、流态积分、周围状态积分与总积分值均显著低于非长跑运动对照组。老年长跑运动组球结膜微循环主要指标的异常发生率明显少于非长跑运动对照组。长跑运动依跑龄时问长短,反映球结膜微循环的加权积分值不同,跑龄越长,加权积分值越低。提示:长跑运动对改善老年人微循环障碍有明显的效应,长期坚持长跑运动,对维持老年人全身微循环始终保持良好状态有重要作用。     

超脉冲CO2激光在眼袋整复术中的临床应用分析

目的将超脉冲CO2激光应用于眼袋整复术以提高临床疗效。方法用超脉冲CO2激光对240例不同类型的眼袋患者采取经结膜入路单独或结合经皮肤入路进行眼袋整复术。结膜入路:用激光在结膜面切开,去除眶脂;结膜入路结合皮肤入路:经结膜去除眶脂后,按常规皮肤径路,切开皮肤皮下,剪除多余皮肤和眼轮匝肌,缝合伤口。结果超脉冲CO2激光眼袋整复术术后效果满意。结论眼袋整复术中用超脉冲CO2激光切除眶脂具有显著的优越性,可以减少并发症。     

萎缩眼球做活动眼座安装薄型义眼的临床观察

目的探索利用萎缩眼球做活动眼座安装薄型义眼,改善患者容貌的临床效果。方法对40例眼球轻中度萎缩患者施行眼球筋膜及结膜全角膜覆盖术,部分患者加异体巩膜包裹术,术后1个月配戴定做薄型义眼。结果40例40眼经过治疗并配戴薄型义眼,均达到满意的美容效果。结论保留萎缩眼球,行眼球筋膜及结膜全角膜覆盖术,部分患者加异体巩膜包裹,术后安装薄型义眼,能明显改善患者容貌。     

High-resolution conjunctival contrast-enhanced MRI dacryocystography

We assessed high-resolution MRI of the lacrimal system with conjunctival contrast enhancement in patients with suspected stenosis. We studied 18 patients with epiphora affecting 22 eyes, using a surface coil, before and after conjunctival and intravenous Gd-DTPA. Stenosis or obstruction of the ducts was found in 18 of 22 cases: at canalicular level in 3 cases, at the sac in 7 cases, and in the nasolacrimal duct in 8 cases. Periductal pathology following surgery to the maxillary sinus or dacryocystorhinostomy was seen in three cases. In conjunction with the findings on syringing and/or conventional dacryocystography, the narrowing was classified as stenosis or obstruction. Received: 21 January 1998 Accepted: 30 June 1998     

Petechial hemorrhages and unexpected infant death

The significance of petechial hemorrhages in cases of unexpected infant death remains uncertain. While intrathoracic petechiae occur in the majority of cases of sudden infant death syndrome (SIDS), their relationship to terminal mechanisms has been debated. Facial, conjunctival and external upper chest petechiae are not a feature of SIDS and raise the possibility of underlying illness such as sepsis, or of forceful coughing or vomiting. Alternatively the presence of cutaneous or conjunctival petchiae may suggest trauma or asphyxia due to chest or neck compression. Given the possibility of alternative mechanisms of death it is preferable to designate the cause and manner of death as 'undetermined', rather than 'SIDS', when petechiae are found in unusual locations.     

MRI patterns in orbital malignant lymphoma and atypical lymphocytic infiltrates

OBJECTIVE: To evaluate the potential of MRI in differentiating between malignant lymphomas and atypical lymphocytic infiltrates in the orbit. MATERIALS AND METHODS: MRI, clinical and histopathological findings in 30 patients presenting with orbital lymphoproliferative diseases (malignant lymphoma and atypical lymphocytic infiltrates) were evaluated. RESULTS: MRI detected 28 out of 30 (93%) orbital lymphoid tumors. Seven out of eight (87.5%) atypical lymphocytic infiltrates and 21/22 (95.4%) of malignant lymphomas were detected. One conjunctival malignant lymphoma and one conjunctival atypical lymphocytic infiltrate were missed. Only malignant lymphoma lesions were hyperintense compared to the extraocular muscles on precontrast and postcontrast T1-weighted images. The lacrimal duct was involved only with malignant lymphoma. Bilateral disease was more likely to be malignant lymphoma. Intraconal lesions were more likely to be associated with lesions elsewhere. No malignant lymphoma involved the extraconal fat. Only intraconal atypical lymphocytic infiltrates had indistinct margins. CONCLUSION: In the orbit, MRI features alone may not allow clear-cut differentiation of malignant lymphomas from atypical lymphocytic infiltrates. However, certain imaging features increase the likelihood of distinguishing them. MRI may miss conjunctival disease. Both orbits should be imaged when orbital lymphoid disease is a probability. The presence of intraconal disease should prompt a search for lesions elsewhere. The use of a head coil instead of a superficial coil may be advantageous by eliminating coil shine effect and allowing evaluation of both orbits. Comparison of lesion signal to extraocular muscle signal appears to be a better alternative than cerebral gray matter or periorbital fat in differentiating malignant lymphoma from atypical lymphocytic infiltrates. Since imaging findings overlap, histopathological diagnosis is necessary in all cases.     

Bilateral orbital emphysema and pneumocephalus as a result of accidental compressed air exposure

Orbital emphysema is a rare condition in the absence of trauma or sinus disease. A 22-year-old man suffering from left orbital trauma due to sudden exposure to compressed air tube was admitted with severe pain in the left eye, swelling, and mild periorbital ecchymosis. Physical examination revealed a large conjunctival laceration in the left orbit. Multislice computed tomographic scanning of the head and orbits showed extensive radiolucencies consistent with the air in both orbits, more prominent in the left. There was also subcutaneous air in the left periorbital soft tissue extending through fronto-temporal and zygomatic areas. Air was also demonstrated adjacent to the left optic canal and within the subarachnoid space intracranially. There was no evidence of any orbital, paranasal sinus, or cranial fracture. Visual acuity was minimally decreased bilaterally. The conjunctiva was sutured under local anesthesia. After 3 weeks of follow-up, the patient completely recovered without visual loss. Bilateral orbital emphysema with pneumocephalus can occur from a high-pressure compressed air injury after unilateral conjunctival trauma without any evidence of fracture.     

颈内动脉—海绵窦瘘的眼部表现及其治疗

10例外伤性颈内动脉-海绵窦瘘的男性患者,年龄18-55岁,均为单眼发病,同时伴有颅底骨折,分析其致伤原因,眼部表现特征、CT及脑血管造影所见及治疗方法选择等,结果表明,10例患者中9例（90%）治愈,瘘口闭合,眼球突出、眶区杂音、眼睑及结膜肿胀消失;1例好转者眼球突出、眼睑及结膜肿胀也较术前减轻。其中一次栓塞治愈4例,二次栓塞治愈4例,三次栓塞治愈1例,治愈的9例中随访6个月-10年,无一例复发,2例发生并发症,分别为暴露性角膜炎和球囊误入颈内动脉,经对症处理均未发生严重后果。结果提示,搏动性眼球突出,眶区闻及与脉搏一致的血砭性杂音,球结膜血管高度扩张,为颈内动脉-海绵窦瘘的眼部特征性表现;球囊或弹簧圈栓塞是治疗颈内动脉-海绵窦瘘的有效方法。     

微弹簧圈栓塞难治性外伤性颈动脉海绵窦瘘的疗效观察

目的 探讨和研究微弹簧圈血管内栓塞难治性外伤性颈动脉海绵窦瘘的疗效.方法 回顾13例用微弹簧圈栓塞治疗的难治性外伤性颈动脉海绵窦瘘患者.所有患者均有持续性颅内血管杂音、搏动性突眼及球结膜充血水肿.均采用微弹簧圈栓塞治疗,其中经动脉入路9例,经眼上静脉入路4例.结果 12例术后造影瘘El消失且颈内动脉通畅.1例填人5枚微...     

Fistula of the posterior communicating artery and cavernous sinus.

A 24-year-old man was admitted with conjunctival hyperemia of the left eye and progressive chemosis and proptosis 1 month after a head injury. An angiogram showed an arterial-cavernous sinus fistula of the posterior communicating artery, which was treated with minicoils. The atypical configuration, transvenous embolization, and unusual nature of the communication suggested that communication developed through a newly generated vessel in granulation tissue.     

流感疫情的快速实验室诊断与分析

目的 通过实验室病原学检查,结合流行病学史及临床症状,初步确定某部集体发热疫情的致病病原体.方法 采集患者的血液、结膜分泌物及鼻、咽拭子等标本,分别通过间接免疫荧光法、酶联免疫吸附试验(ELISA)、反转录巢氏聚合酶链反应(RT-PCR)实验、病毒分离培养和细菌培养等实验室诊断方法,筛查致病病原体.结果 所有鼻、咽拭子、结膜分泌物及血细菌培养未见致病菌生长.3例最后退热患者咽拭子的病毒分离培养结果为阴性.20种呼吸道病原体免疫荧光IgM抗体筛查结果显示,流感A型阳性率为68.4%(39/57),其余病原体抗体阳性率的升高无统计学意义.ELISA流感病毒总IgM抗体阳性率70.2%(40/57)、流感病毒A型IgM抗体阳性率64.9%(37/57)、B型为35.1%(20/57).所有鼻、咽拭子及结膜分泌物RT-PCR扩增结果未见特异扩增带.结论 初步诊断此次群体发热由流感病毒感染引起.该疫情的实验室快速诊断为今后疫情的早期诊治及医院实验室开展传染病防治工作积累了经验.     

Ophthalmic Artery Embolization as Pretreatment of Orbital Exenteration for Conjunctival Squamous Cell Carcinoma

The aim of this study is to describe the effect of transarterial embolization from the ophthalmic artery as a pretreatment for orbital exenteration. A 75-year-old Chinese man with a 7-year history of gradual increase of the left eye swelling showed a massive conjunctival tumor growing outwardly from the interpalpebral fissure and had no light perception in the left eye. Magnetic resonance imaging showed orbital invasion of the tumor around the left eyeglobe. The initial surgery for the planned orbital exenteration was discontinued after skin incision around the orbital margin due to massive hemorrhage. The patient underwent transarterial embolization with gelatin sponge (Spongel) of the feeding arteries from the left ophthalmic artery and, the next day, had orbital exenteration with well-controllable bleeding and reconstruction with free vascularized anterolateral thigh cutaneous flap transfer. Pathologically, well-differentiated squamous cell carcinoma proliferated in exophytic, papillary, and nested fashions, arising from the bulbar conjunctiva. Tumor cells were also found in the conjunctival stroma around the vessels. The sclera at the equator had a perforated site with tumor cell invasion, but no intraocular invasion was found. Hematoxylin-positive gelatin sponges were found inside the orbital vessels and large choroidal vessels. In conclusion, transarterial embolization of feeding arteries arising from the ophthalmic artery is a useful pretreatment to control bleeding at orbital exenteration for malignancy.