泪小管栓子治疗干眼的临床观察

干眼(Dryeye)是由于泪液生成不足或泪液蒸发过强并致泪膜不稳定引起眼表病变而产生眼部一系列不适症状.泪液生成不足型干眼病是由于泪液生成功能紊乱或泪液由泪腺排人结膜囊受阻所致.通过阻止泪液的排泄而增加眼表泪液从而减轻干眼症状.本文以不可吸收性泪小管栓子栓塞干眼患者泪小管后,观察干眼症状的减轻,客观检查进行比较,以及并发症的发生情况来观察泪小管栓子治疗干眼的应用前景.     

干眼症的病因与治疗研究进展

干眼症是一种临床常见的慢性眼表疾病,是指由于泪液质和量的异常或泪液流体动力学异常引起的泪膜不稳定和眼表损害,从而导致眼部不适症状的一类疾病.近年来,随着干眼发病率的增加,干眼越来越受到人们的重视.此文就干眼的病因和治疗的研究进展进行综述.     

术前应用人工泪液联合rbFGF对白内障合并干眼患者术后眼表功能及泪液中炎症因子水平的影响

目的：探究术前应用人工泪液联合重组牛碱性成纤维细胞生长因子(rbFGF)对白内障合并干眼患者术后眼表功能和泪液中炎症因子水平的影响。

方法：选取2019-02/2020-02我院收治的白内障合并干眼患者118例118眼作为研究对象,随机分为对照组和观察组,各59例59眼,对照组术前采用人工泪液治疗,观察组术前采用人工泪液联合rbFGF治疗。比较两组患者治疗前后临床症状评分、眼表功能指标\〖眼表疾病指数(OSDI)问卷评分、泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt)和角膜荧光染色评分(FL)\〗、泪液中炎症因子\〖白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)\〗及氧化应激指标\〖丙二醛(MDA)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)\〗水平,并采用随机行走模型评价两组患者眼表功能及泪液中炎症因子水平。

结果：治疗前,两组患者临床症状评分、OSDI、BUT、SⅠt、FL、IL-6、TNF-α、MDA、SOD、LPO、TAC水平均无差异(P>0.05); 治疗后30d,两组患者临床症状评分、OSDI、FL、TNF-α、IL-6、MDA、LPO水平明显降低,BUT、SⅠt、SOD、TAC水平明显增加,且观察组患者治疗后的临床症状评分、眼表功能、炎症因子及氧化应激指标改善情况明显优于对照组(P<0.05)。

结论：术前采用人工泪液联合rbFGF进行干预可明显改善白内障合并干眼患者术后眼表功能,降低泪液中炎症因子水平,改善干眼症状,为临床上白内障合并干眼的治疗提供参考。     

P2Y2受体激动剂用于干眼治疗的研究进展

干眼属常见的眼表疾病,是指由于泪液的量和（或）质的异常引起的泪膜不稳定和眼表面的损害,从而导致眼部不适症状的一类疾病。目前我国干眼的治疗包括病因治疗、人工泪液替代治疗、抗炎治疗、免疫抑制剂治疗、手术治疗以及中医治疗等。Ｐ２Ｙ２受体激动剂是一种治疗干眼的新型药物,它能够通过激动位于眼表的Ｐ２Ｙ２受体,促使结膜上皮细胞泪液的分泌以及结膜杯状细胞对黏蛋白的分泌,从而增强泪膜稳定性,改善干眼症状。３０ｇ·Ｌ－１地夸磷索四钠滴眼液是目前唯一上市的Ｐ２Ｙ２受体激动剂。本文就近年来地夸磷索四钠用于干眼治疗的临床疗效、安全性以及相关研究进展作一综述。     

鱼腥草滴眼液联合人工泪液治疗干眼的临床观察

目的:研究鱼腥草滴眼液联合人工泪液治疗干眼的效果。方法:干眼患者130例244眼随机分为对照组和试验组,以人工泪液和生理盐水滴眼为对照,鱼腥草滴眼液联合和人工泪液治疗为试验组,患者自觉症状、泪膜破裂时间(breaking up time,BUT)、泪液分泌时间(schirmerⅠtest,SⅠt)的变化,并采用结膜印迹细胞学检查(conjunctival impression cytology,CIC)观察眼表结构的改善情况。结果:两组治疗后患者自觉症状均有不同程度改善,对照组BUT较治疗前虽有延长(P<0.05),但SⅠt和CIC评分无明显好转;试验组治疗后BUT,SⅠt及CIC评分较治疗前均有明显改善,且改善程度优于对照组(P<0.01)。结论:鱼腥草滴眼液联合人工泪液治疗干眼依从性好,疗效高。     

原发性翼状胬肉与干眼关系的临床观察

目的:探讨原发性翼状胬肉与干眼的关系。方法:选择2011-08/2012-08住院行手术治疗的原发性单眼翼状胬肉患者50例,行回顾性分析,以胬肉眼为观察组,对侧眼为对照组,比较两组患者的眼部症状评分、泪液分泌试验(SchirmerⅠtest,SⅠt)、泪膜破裂时间(tear break-uptime,BUT)、眼表荧光素染色(fluorescent,FL)干眼评分。结果:观察组与对照组的SⅠt比较无统计学差异(P>0.05),但观察组BUT明显低于对照组(P<0.05),眼部症状、FL干眼症评分相比,观察组明显高于对照组(P<0.05)。结论:原发性翼状胬肉患者胬肉眼可同时患有干眼,可伴有明显的眼部干涩、视力下降、异物感等干眼症状,眼表泪膜的稳定性下降,并伴有眼表上皮的损害,翼状胬肉与干眼可同时共存,关系密切,但二者之间是否存在因果关系尚不明确。     

干眼的研究现状

干眼是一种临床常见的慢性眼表疾病,是指由于泪液质和量的异常或泪液流体动力学异常引起的泪膜不稳定和眼表损害,从而导致眼部不适症状的一类疾病。不适感觉包括眼干涩、眼红、眼痒、异物感等。近年来,随着干眼发病率的增加,干眼越来越受到人们的重视。就干眼的临床症状、流行病学研究、病因、发病机制、分类和诊断等方面进行综述。     

干眼的流行病学研究进展

干眼是一种临床常见的慢性眼表疾病,是指由于泪液质和量的异常或泪液流体动力学异常引起的泪膜不稳定和眼表损害,从而导致眼部不适症状的一类疾病。不适感觉包括眼干涩、眼红、眼痒、异物感等。近年来,随着干眼发病率的增加,干眼越来越受到人们的重视。我们就干眼的诊断、分类和病因流行病学研究等方面进行综述。     

1g/L花青素护眼贴治疗轻中度干眼疗效

目的：探讨1g/L花青素护眼贴应用于轻中度干眼的临床疗效。

方法：本研究为前瞻性、多中心设计。收集2016-10/2017-04长沙、重庆、武汉等8家爱尔眼科医院轻、中度干眼患者共320例640眼,以随机数字表法分为护眼贴组(160例)和人工泪液组(160例)。护眼贴组夜间睡眠时使用1g/L花青素护眼贴6h以上; 人工泪液组滴用聚乙烯醇滴眼液4次/d。于治疗前1d及治疗后14d对症状及体征进行评价,症状评价采用眼表疾病指数(ocular surface disease index,OSDI)评分,体征观察包括泪液分泌试验(Schirmer I test,SⅠt)以及采用Oculus眼表综合分析仪测量非侵入式首次泪膜破裂时间(first noninvasive tear break-up time,NITBUTf)和非侵入式平均泪膜破裂时间(average noninvasive tear break-up time,NITBUTav)。

结果：两组患者治疗后的OSDI评分、NITBUTf、NITBUTav较治疗前有明显改善,差异有统计学意义(P<0.05),SⅠt治疗前后差异无统计学意义(P>0.05)。两组间治疗后OSDI评分、NITBUTf、NITBUTav、SⅠt比较差异无统计学意义(P>0.05)。

结论：对于轻、中度干眼,1g/L花青素护眼贴与人工泪液具有类似的疗效,能有效改善干眼症状、提高泪膜稳定性。     

诺沛凝胶联合中药治疗更年期干眼的临床评估

目的 探讨应用诺沛凝胶联合中药治疗更年期干眼的个性化方案.方法 采用前瞻性研究方法,将研究对象60例更年期女性(120只眼),随机分为诺沛凝胶治疗组和诺沛联合中药(干眼Ⅰ号)治疗组各30例,分别观察两组患者用药一个月后的临床效果.结果 一个月随访用药后两组患者泪液分泌量、BUT和荧光素染色都有显著性差异(P<0.05),联合用药组效果明显优于人工泪液组.结论 联合人工泪液诺沛凝胶和干眼Ⅰ号治疗干眼,通过中西医结合标本兼治的原则,是一种针对更年期女性干眼病因的个性化治疗方案,不仅改善了干眼患者临床症状,同时也延长了泪膜破裂时间.     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

p53 expression in pterygium in two climatic regions in Turkey

Purpose:

To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey.

Materials and Methods:

Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson''s chi-square test was used to compare the p53 immunoreactivity.

Results:

The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group (P<0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 (P= 0.060).

Conclusion:

The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore

Purpose: To report the trends in etiology of patients with anterior uveitis (AU) in Singapore over 6 years.

Methods: A retrospective review of the clinical records of all new patients who presented with anterior uveitis to the uveitis subspecialty clinic from 2005 to 2010 at Tan Tock Seng Hospital, Singapore.

Results: There were 552 new cases of AU. This comprised 59.5% of a total of 928 new patients diagnosed with uveitis from 2005 to 2010. The mean age was 48.0?±?17.2 years. There was a male predominance (62.5%), with a male:female ratio of 1.7:1. The majority were of Chinese ethnicity (69%), followed by Malays (13.2%). Most cases were unilateral (79.5%) and idiopathic (50.4%). Common etiological causes included Fuchs heterochromic iridocyclitis (FHI) (5.6%), ankylosing spondylitis (AS)-related AU (5.1%), herpes simplex virus (HSV) (4.7%), and herpes zoster virus (HZV) (4.5%). There were increasing trends in AS-related AU from 3.2% in 2008 to 6.5% in 2010, and psoriasis-associated AU from 1.7% in 2005 to 4.0% in 2008. There were decreasing trends in the incidence of FHI from 10.6% in 2006 to 4.7% in 2009. No change in incidence of viral etiologies was noted, but cytomegalovirus-related immune-recovery uveitis (IRU) comprised 7.4%. IRU showed an increasing trend from 1.7% in 2005 to 11.9% in 2007, then decreased to 3.3% in 2010. Using the Pearson chi-square test, there was no statistically significant association between ethnicities (Chinese, Malay, Indian) comparing infectious and noninfectious cases (p?=?0.788), idiopathic and nonidiopathic cases (p?=?0.170), or between the various etiologies of uveitis (p?=?0.168).

Conclusions: AU was the predominant form of uveitis seen at our centers. Infectious etiologies (18.5%) are the most common among nonidiopathic cases, with herpes viruses (9.2%) being most prevalent. Despite increased use of polymerase chain reaction (PCR) in the detection of microbial and viral DNA, there was no overall increase in detection of infectious causes for uveitis. The changes in CMV-related immune recovery uveitis from 2005 to 2010 could reflect a change in HIV management in Singapore.     

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews. Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49 D and the median refractive cylinder was ‐0.50 D (range zero to ‐4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.     

内毒素诱导的大鼠葡萄膜炎的巨噬细胞中Toll样受体4的表达

目的 探讨在内毒素诱导的Wistar大鼠葡萄膜炎中Toll样受体4(TLR4)阳性细胞与虹膜组织中巨噬细胞的动态变化和分布.方法 实验研究.Wistar大鼠50只,用随机数字法随机分为5组,每组10只,分别为正常对照(0 h)组、6 h组、12 h组、24 h组及48 h组.除0 h组外其余各组均足垫部注射霍乱弧菌内毒素200μg,注射后于裂隙灯显微镜下观察双眼前节炎症反应变化.按实验分组于0、6、12、24、48 h处死大鼠.取虹膜一睫状体及脉络膜组织.通过葡萄膜铺片免疫组织化学方法检测TLR4和巨噬细胞的标记CD163的表达.人工计数虹膜中TLR4~+与CD163~+的细胞并计算细胞密度,计算圆形和多形性的CD163~+细胞占所有CD163~+细胞的百分比.进一步采用免疫荧光双标记检测TLR4和CD163共表达的情况.通过单因素方差分析分别对大鼠虹膜内阳性细胞密度以及圆形、多形性CD163~+细胞的百分比进行统计学检验.结果 正常大鼠虹膜睫状体组织不表达TLR4.6 h组有2只大鼠虹膜内可见少量TLR4~+细胞,12～48 h组所有大鼠虹膜内TLR4~+细胞明显增多(F=167.2,P＜0.001),虹膜内TLR4~+细胞密度分别为(506.1±39.5)个/mm~2(12 h组)、(492.3±54.5)个/mm~2(24 h组)及(663.8±150.2)个/mm~2 (48 h组).在注射LPS后12～48 h期间TLR4~+细胞形态无明显变化.0～48 h组大鼠虹膜内均有CD163~+细胞,0 h组圆形和多形性CD163~+细胞百分比为13%,12～48 h组其百分比约为80%,且圆形细胞主要位于虹膜基质层.免疫荧光双标记可见TLR4和CD163的共表达,TLR4位于细胞膜,CD163位于细胞质.5组大鼠脉络膜内均未见TLR4表达.结论 内毒素诱导的大鼠葡萄膜炎中虹膜内TLR4表达增高,部分虹膜固有巨噬细胞表达TLR4.TLR4可能在葡萄膜炎的发生发展中起一定作用.     

弱视眼底光学相干断层扫描的研究进展

弱视是由于视觉发育关键期内各种异常的视觉经验导致单眼或双眼最佳矫正远视力低于正常同龄儿童,而眼部无明显器质性病变。目前普遍观点认为,弱视的发病机理主要源于视皮层。近年来,光学相干断层扫描（OCT）作为一种先进的活体成像技术,促进了对视网膜形态结构的大量研究,同时也被应用到弱视的研究领域。陆续有不同的研究人员利用OCT发现弱视患者眼底视网膜、脉络膜等眼部结构存在改变。笔者将对弱视眼底OCT的研究进展做一综述。