重组牛碱性成纤维细胞生长因子对LASIK术后角膜神经营养性上皮病变与角膜知觉恢复的疗效观察

目的 评价重组牛碱性成纤维细胞生长因子(r-bFGF)对准分子激光原位角膜磨镶术(LASIK)后神经营养性角膜上皮病变(LINE)和角膜知觉恢复的疗效.方法 前瞻性临床随机对照研究.对2007年5月至2008年7月在解放军总医院眼科行双眼LASIK手术患者,术前同意按要求随访的手术病例进行观察,共连续观察1154例,收集术后出现LINE患者,收集满60例结束.所有病例按不平衡指数最小的分配原则随机分为3组,每组20例,并开始治疗.A组采用r-bFGF滴眼液滴眼,4次/d;B组采用r-bFGF眼用凝胶滴眼,4次/d;C组用0.1%玻璃酸钠滴眼液滴眼,4次/d作为对照.观察用药后LINE消失时间以及术后角膜知觉恢复情况.手术前及术后各时间点比较以及各组之间比较采用方差分析方法.结果 (1)LINE发生率为5.2%,临床双眼角膜上皮点状糜烂较对称性出现,术后LINE出现时间:r-bFGF滴眼液组(28.57±37.48)d,r-bFGF眼用凝胶组(30.82±35.08)d,玻璃酸钠组(16.84±23.70)d,3组之间的比较采用方差分析,差异无统计学意义(F=1.456,P=0.238);LINE平均消失时间:r-bFGF滴眼液组(7.19±8.23)d,r-bFGF眼用凝胶组(2.86±1.73)d,玻璃酸钠组(7.00±6.40)d,3组比较,差异无统计学意义(F=4.521,P=0.130).(2)术前角膜知觉,r-bFGF滴眼液组(52.5±8.2)mm,r-bFGF眼用凝胶组(53.0±5.5)mm,玻璃酸钠滴眼液组(51.8±8.1)mm,3组比较,差异无统计学意义(F=0.036,P=0.849).术后3 d角膜知觉均有显著性的下降,分别为(18.8±9.5)mm,(17.4±9.9)mm和(13.4±4.6)mm,仅为术前水平的25.9%～35.8%,但各组间差异无统计学意义(F=0.542,P=0.463).随着给药时间延长各组角膜知觉均在逐渐恢复.在术后6个月时,r-bFGF滴眼液组角膜知觉为(48.4±10.0)mm,凝胶组为(49.8±9.9)mm,而玻璃酸钠组为(39.4±11.0)mm,3组角膜知觉分别为术前水平的92.1%,94.0%及76.1%,显示r-bFGF药物治疗的两组角膜知觉恢复比玻璃酸钠组恢复更快.统计学上r-bFGF眼用凝胶组与术前比较,差异无统计学意义(F=0.55,P=0.064).但在术后12个月时,玻璃酸钠组才接近术前正常水平.其他两组角膜知觉平均值均完全达到术前正常水平.结论 r-bFGF有助于LASIK术后角膜神经营养性上皮病变的修复,加速LASIK术后角膜知觉的恢复.

Abstract：

Objectiye To observe the effects of recombinant bovine basic fibroblast growth factor (r-bFGF) on the LASIK-induced neurotrophic epitheliopathy (LINE) and the recovery of corneal sensation after LASIK. Methods Prospective clinical study. LINE was found in 60 patients out of 1154 cases of LASIK (5.2% ). The 60 cases were randomly divided into three groups, each group including 20 cases.Group A was treated with r-bFGF eye drops (fusion protein), four times a day. Group B was treated with r-bFGF eye-gel, four times a day. Group C was treated with 0.1% sodium hyaluronate eye drops as a control. The treatment started since LINE was diagnosed. The typical clinical finding of LINE was punctate corneal erosion, which could be evaluated by slit-lamp examination and fluorescein staining. Masked CochetBonnet esthesiometry was performed in the central cornea one week preoperatively and 1, 3, 6 and 12 months postoperatively. Results ( 1 ) The average times of corneal erosion occurrence were ( 28.57 ±37.48 ) d, ( 30.82 ± 35.08 ) d and ( 16.84 ± 23.70 ) d in group A, group B and group C respectively. No significant differences were observed among the three groups ( F = 1.456,P -0.238), and the average times of corneal erosion disappearance were (7.19 ± 8.23 ) d, (2.86 ± 1.73 ) d and ( 7.00 ± 6.40 ) d in group A, group B and group C, respectively. The punctate corneal erosion cured significantly faster in r-bFGF eyegel treated group (P1 =0.007,P2 =0.014). (2)The loss of corneal sensation was greatest at 1 week after LASIK in all the three groups and improved at all subsequent examination time points. The corneal sensation gradually recovered through 12 months observation, but the r-bFGF eye-gel treated group showed faster recovery in comparison with the other two groups, had no statistic different at 6 month comparied with preoperation values( F = 0.55, P = 0.064). Conclusion The r-bFGF eye-gel is effective for both punctate corneal erosion (especially for severe LINE) and recovery of corneal sensation following LASIK surgery.     

超薄瓣LASIK与LASEK治疗角膜相对较薄高度近视比较分析

目的 比较超薄角膜瓣LASIK和LASEK在治疗角膜相对较薄的高度近视时的患者自觉症状、满意度、疗效、预测性、安全性等.方法 随机选择角膜相对较薄的高度近视患者分为两组.使用超薄角膜瓣LASIK治疗的患者设为A组:25人(50只眼);球镜度-6.00～-10.0D,平均-7.18D;柱镜度0～-2.00D,平均-0.84D.使用LASEK治疗的患者设为B组:25人(50只眼);球镜度-6.00～-10.00D,平均-7.15D;柱镜度0～-2.00D,平均-0.96D.两组各指标分别于治疗后1周、1、3、6、12个月检查并记录裸眼视力、矫正视力、等效球镜度、并发症等情况并进行比较.结果 A组平均角膜瓣厚度为(96.76±5.54)μm;术后反应较轻,疼痛及其他不适症状较轻,患者满意度较高;激素眼液使用时间短;裸眼视力恢复较快.B组术后反应较重,疼痛及其他不适症状较重;激素眼液使用时间长;裸眼视力恢复较慢;且术后6个月后发生屈光回退的眼数较多.两组均未见影响视力的严重并发症,LASEK组并发症主要为屈光回退和haze.结论 MoriaM2型90刀头适合临床LASIK超薄角膜瓣制作,超薄瓣LASIK的安全性和有效性方面与LASEK相同,而治疗后的稳定性及患者满意度优于LASEK.更大样本和更长时间的临床研究有待于继续进行.

Abstract：

Objective To compare the subjective symptom,curative effect,efficacy and safety of the ultra-thin flap LASIK and LASEK for the treatment of high mypia with relative thin cornea.Methods 100 eyes of 50 cases with high mypia with relative thin cornea were divided into two groups.50 eyes of 25 cases received ultra-thin flap LASIK were included in group A.50 eyes of 25 cases received LASEK were included in group B.The mean preoperative spherical equivalent was -7.18D(range from -6.00～-10.0D)and -7.15D (range from -6.00～-10.0D)respectively.The subject symptom,degree of satisfaction,uncorrected visual acuity,best corrected visual acuity,spherical equivalent and complications were observed and compared during after surgery.Results The average flap thickness was(96.76± 5.54)μ m.Postoperative visual acuity of group A recovered faster with less steroid use than of group B.The degree of satisfaction of guoup A is bettet than group B.There were no threatening complications for vision in both group.The main complications were haze and regression in group B.Postoperative reaction was mild in group A patients,who showed a quick recovery in UCVA.Conclusion Moria-M2-90-mikrokeratome is fit for LASIK with ultra-thincorneal flaps.LASIK with ultra-thin corneal flaps for high myopia with relative thin cornea is safe,effective and comfortable.LASIK with ultra-thin corneal flaps may be better than LASEK.It needs further clinical study with larger scale and longer follow-up.     

小牛血去蛋白提取物对LASEK与LASIK术后角膜神经修复作用的研究

目的 探讨准分子激光角膜上皮瓣下磨镶术(LASEK)与准分子激光原位角膜磨镶术(LASIK)术后早期应用小牛血去蛋白提取物对角膜神经修复的作用.方法 采用前瞻性随机对照双盲的方法.2009年1至2月在复旦大学附属眼耳鼻喉科医院视光学中心行LASEK患者25例(49只眼)和LASIK患者23例(44只眼),采用随机数字表法分别随机分为2组:LASEK术后小牛血去蛋白提取物眼用凝胶治疗组16例(32只眼)和未用药对照组9例(17只眼);LASIK术后小牛血去蛋白提取物眼用凝胶治疗组13例(24只眼)和未用药对照组10例(20只眼).所有患者均接受常规准分子激光术前检查和常规操作.术后给予治疗组小牛血去蛋白提取物眼用凝胶每日3次涂眼治疗,连续使用3个月.分别在术前、术后1、3、6个月及1年时采用共焦显微镜检查角膜上皮下神经,并测量角膜中央知觉,泪膜破裂时间(BUT).采用独立样本t检验、配对t检验和非参数检验对数据进行统计学分析.结果 LASEK和LASIK术后1年,共聚焦显微镜观察小牛血去蛋白提取物眼用凝胶治疗组和对照组间角膜神经修复的差异均无统计学意义(均为Z=0.0000,P=1.00),但LASEK治疗组在术后3个月即观察到神经交通支形成.LASEK和LASIK术后1年,角膜上皮下神经的形态仍未恢复到术前水平.LASEK术后1个月,LASIK术后1和3个月小牛血去蛋白提取物眼用凝胶治疗组和对照组角膜中央知觉分别为(4.95±0.84)μm、(3.29±1.40) μm、(4.31±1.61) μm和(3.62±1.38) μm、(2.35±1.51)μm、(3.18±1.62) μm,差异有统计学意义(t=4.23,P<0.01;t=2.10,P<0.05;t=2.31,P<0.05).术后6个月,LASEK治疗组、对照组和LASIK治疗组角膜中央知觉分别为(5.81±0.35) μm、(5.79±0.36)μm及(5.25±0.91)μm,与术前相比差异均无统计学意义(t=-1.26,P>0.05;t=-0.70,P>0.05;t=-1.87,P>0.05).LASEK和LASIK术后1年时,治疗组BUT分别为(8.13±2.18) μm和(7.71±2.14) μm,对照组BUT分别为(8.76±1.64)μm和(7.45±2.37)μm,差异均无统计学意义(t=-0.90,P>0.05;t=0.30,P>0.05).结论 LASEK和LASIK术后早期应用小牛血去蛋白提取物能在一定程度上促进术后角膜神经的修复.(中华眼科杂志,2011,47:539-545)

Abstract：

Objective To evaluate the effects of protein-free calf blood extract for recovery of corneal nerve after LASEK and LSEIK. Methods A prospective, randomized, control and double-blind study was carried out from January through February 2009 at Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University. Forty-nine eyes of 25 patients who underwent LASEK were randomly divided into two groups. One group with 16 patients (32 eyes) was treated by protein-free calf blood extract eye gel which was defined as drug treated group and the other group with 9 patients (17 eyes) was not treated by protein-free calf blood extract eye gel which was defined as no drug treated group. Forty-four eyes of 23 patients who underwent LASIK were also randomly divided into two groups. One group with 13 patients (24 eyes) was treated by protein-free calf blood extract eye gel which was defined as drug treated group and the other group with 10 patients (20 eyes) was not treated by protein-free calf blood extract eye gel which was defined as no drug treated group. Protein-free calf blood extract eye gel was delivered in both drug treated groups 3 times per day for three months after surgery. Laser scanning confocal microscopic examinations were performed on 48 eyes in vivo. Central corneal sensitivity and tear break-up time (BUT) were tested on 93 eyes preoperatively and 1,3,6 months, and 1 year after surgery. The obtained dates in the study were analyzed using independent samples t-test, paired t-test and Mann-Whitney Test. Results The morphology oserved by confocal microscope of sub-basal nerve fibers was not different between drug treated group and no drug treated group until the last follow up after LASIK or LASEK(Z=0.0000,P=1.00)and(Z=0.0000,P=1.00). Nerve fibers with interconnections were observed in drug treated group at 3 months after LASEK. The morphology of sub-basal nerve fibers had not recovered completely until 1 year after surgery. The central corneal sensitivity was better in drug treated group than in no drug treated group at 1 month after LASEK [(4.95±0.84)μm,(3.62±1.38) μm;t=4.23,P<0.01] and at 1 and 3 months after LASIK [(3.29±1.40)μm,(2.35±1.51)μm;t=2.10,P<0.05],[(4.31±1.61) μm,(3.18±1.62) μm; t=2.31,P<0.05]. At 6 months postoperatively, the central corneal sensitivity of both drug treated group and no drug treated group which underwent LASEK was not significantly different from pre-operation[(5.81±0.35) μm;t=-1.26,P>0.05],[(5.79±0.36)μm;t=-0.70,P>0.05]. At 6 months postoperatively, the central corneal sensitivity of drug treated group which underwent LASIK was not significantly different from pre-operation[(5.25±0.91)μm;t=-1.87, P>0.05]. No significant difference was seen in BUT between drug treated group and no drug treated group after LASEK or LASIK until 1 year after surgery[(8.13±2.18) μm,(8.76±1.64)μm;t=-0.90,P>0.05],[(7.71±2.14) μm,(7.45±2.37)μm;t=0.30,P>0.05]. Conclusion Protein-free calf blood extract could significantly promote the recovery of corneal nerve in the early period after LASEK and LASIK.     

准分子激光角膜屈光手术后散射的变化及其相关因素分析

目的 探讨眼内散射在机械法准分子激光上皮瓣下角膜磨镶术(Epi-LASIK)及准分子激光原位角膜磨镶术(LASIK)手术后的变化及相关因素分析.方法 病例系列研究.对87例(87只眼)近视及近视散光患者行Epi-LASIK(45只眼)或LASIK(42只眼),使用C-quant散射仪分别在手术前、手术后1、4、10个月测量散射光计量值.应用单因素方差分析及Pearson相关进行数据分析.结果 Epi-LASIK组及LASIK组手术前、手术后1、4、10个月眼内散射光计量值分别为(0.91±0.17)、(1.03±0.15)、(1.11±0.13)、(1.01±0.16)及(0.96±0.14)、(1.05±0.12)、(1.10±0.12)、(0.98±0.15),组间比较差异有统计学意义(F=12.29,8.11;P＜0.05);与手术前相比两组各时间段的变化量分别为(0.12±0.18)、(0.19±0.20)、(0.08±0.16)及(0.09 ±0.13)、(0.15±0.17)、(-0.01±0.17).Epi-LASIK组手术后4个月眼内散射光计量值与手术前屈光度、剩余基质床与中央最薄角膜厚度之比(RBT/CCT)、切削比有明显相关性(r=-0.344,-0.361,0.361;P＜0.05),LASIK组无明显相关性(r=0.186,0.162,-0.206;P＞0.05).Epi-LASIK组手术后1～4个月发生2级、1级、0.5级haze分别有1、2、4只眼,其4个月时眼内散射光计量值变化量分别为0.52,(0.37,0.42),(0.06,0.09,0.07,0.17).发生2级haze眼在haze消退后散射值变化量由4个月时的0.52降至10个月时的0.11.结论 Epi-LASIK及LASIK术后早期眼内散射光计量值较术前均增高,随时间延长有下降趋势.角膜伤口愈合反应可能是Epi-LASIK术后早期散射增加的主要因素,而LASIK 术后早期增加的主要原因可能是界面相关因素.Epi-LASIK术后轻度以上haze眼散射明显增加.

Abstract：

Objective To investigate the changes and relevant factors of forward scatter after Epipolis laser in situ keratomileusis (Epi-LASIK)and laser in situ keratomileusis (LASIK). Methods It was a prospective clinical comparative study. 45 patients (45 eyes) were scheduled for Epi-LASIK and 42patients (42 eyes) for LASIK. Straylight examinations were performed using the C-Quant straylight meter before and 1,4, 10 months after surgery. The data was analyzed for statistical significance by one-way ANOVA and the correlation was tested by Pearson' s test by using SPSS 13. 0 software. Results The straylight values were(0. 91 ±0. 17) , (1. 03 ±0. 15) ,(1. 11 ±0. 13) , ( 1. 01 ±0. 16) of Epi-LASIK group and (0.96±0. 14) ,(1. 05 ±0. 12) ,(1. 10 ±0. 12) ,(0. 98 ±0. 15) of LASIK group preoperatively and 1,4,10 months postoperatively respectively,which there were significant increase postoperatively in both groups (F = 12.29,8.11;P＜0.05). Compared with preoperative values, the changes in straylight values at 1, 4and 10 months postoperatively were (0. 12 ±0. 18) , (0. 19 ±0. 20) , (0. 08 ±0. 16) of Epi-LASIK group and (0.09 ± 0. 13 ) , ( 0. 15 ± 0. 17 ) , ( -0. 01 ± 0. 17 ) of LASIK group. In Epi-LASIK group, the preoperative refractive error, RBT/CCT, and ablation ratio have significant relevance with straylight values at 4 months postoperatively ( r = - 0. 344, - 0. 361 , 0. 361; P ＜ 0. 05 ) , no such correlation was found in LASIK group (r = 0. 186,0. 162,-0.206;P＞0. 05). For corneal haze which was found from 1 to4months after Epi-LASIK, grade 2, 1, 0. 5 appeared in 1, 2, 4 eyes respectively and the changes of straylight values were 0.52, (0.37, 0.42), (0.06, 0.09, 0.07, 0.17) at 4 months postoperatively. 10 months postoperatively, the increases of straylight values for the eye with grade 2 haze declined from 0. 52 to 0. 11after the haze disappeared. Conclusion Straylight values increase significantly at early time after EpiLASIK and LASIK, but decrease partially as time going. Corneal wound healing response may be the reasons induced the increases of light scatter after Epi-LASIK. For LASIK, flap interface factors may be the reasons.Corneal haze especially above mild grade, can affect the straylight obviously.     

角膜屈光手术后人工晶状体度数计算的初步研究

Objective To evaluate the results of cataract surgery in myopia patients after laser in situ keratomileusis(LASIK)and to compare the predictability of various methods of intraccular lens(IOL)power calculation.Method Seventeen cases (24 eyes)who had LASIK for myopia were divided into two group by with or without history of corneal power data.Corneal power was obtained by autokeratometry,corneal topography.Pentacam and IOLMaster.The IOL power was calculated with the clinical history method,Feiz-Mannis formula,Feiz-Mannis method and other methods.Postoperative final refraction and the deviation of the final spherical equivalent (SEQ) from the refractive target were measured 3 month after the surgery.Two sample t-test.linear correlation and regression analysis,paired t-test and Bland-Altman method of agreement were used to analyze these data.Results In the group with history data,the mean corneal power was(43.28±1.21)D and the mean SEQ was(-15.33±4.36)D before the LASIK surgery.In the group without history data,the mean SEQ was(-10.11±3.12)D.Before cataract surgery,the mean corneal power was(36.96±2.07)D and(36.85±1.40)D in these two groups.The mean arithmetic refractive prediction error after cataract surgery was(-0.66±1.27)D and(-0.47 ± 0.82)D in these two groups, respectively. Data calculated by using Hamed-Wang-Koch method, Masket Formula, Koch/Maloney method, Shammar method and Pentacam ERK method were lower than the emmetropic IOL power. Data calculated by using Feiz-Mannis Formula, Latkany Method, Savini method, Armberri Double K method were overestimated. The mean arithmetic errors of clinic history method, Corneal Passby Method and Haigis-L Formula were not significantly different from the predict refraction (P=0. 364, 0. 318 and 0. 069;t=0. 956,-1. 057 and -1. 911, respectively). There was strong correlation between the value calculated by using Feiz-Mannis Method or Haigis-L Formula and the true power (r = 0. 921,0. 915; P = 0. 000 and 0. 000,respectively). But none of the values calculated by these method could fully agree with the true value.Conclusions IOL power should be calculated accurately to avoid undercorrection. We recommend the combination of clinical history method, Feiz-Mannis Method, Corneal Passby Method and Haigis-L Formula for the calculation of IOL power.     

角膜屈光手术后人工晶状体度数计算的初步研究

Objective To evaluate the results of cataract surgery in myopia patients after laser in situ keratomileusis(LASIK)and to compare the predictability of various methods of intraccular lens(IOL)power calculation.Method Seventeen cases (24 eyes)who had LASIK for myopia were divided into two group by with or without history of corneal power data.Corneal power was obtained by autokeratometry,corneal topography.Pentacam and IOLMaster.The IOL power was calculated with the clinical history method,Feiz-Mannis formula,Feiz-Mannis method and other methods.Postoperative final refraction and the deviation of the final spherical equivalent (SEQ) from the refractive target were measured 3 month after the surgery.Two sample t-test.linear correlation and regression analysis,paired t-test and Bland-Altman method of agreement were used to analyze these data.Results In the group with history data,the mean corneal power was(43.28±1.21)D and the mean SEQ was(-15.33±4.36)D before the LASIK surgery.In the group without history data,the mean SEQ was(-10.11±3.12)D.Before cataract surgery,the mean corneal power was(36.96±2.07)D and(36.85±1.40)D in these two groups.The mean arithmetic refractive prediction error after cataract surgery was(-0.66±1.27)D and(-0.47 ± 0.82)D in these two groups, respectively. Data calculated by using Hamed-Wang-Koch method, Masket Formula, Koch/Maloney method, Shammar method and Pentacam ERK method were lower than the emmetropic IOL power. Data calculated by using Feiz-Mannis Formula, Latkany Method, Savini method, Armberri Double K method were overestimated. The mean arithmetic errors of clinic history method, Corneal Passby Method and Haigis-L Formula were not significantly different from the predict refraction (P=0. 364, 0. 318 and 0. 069;t=0. 956,-1. 057 and -1. 911, respectively). There was strong correlation between the value calculated by using Feiz-Mannis Method or Haigis-L Formula and the true power (r = 0. 921,0. 915; P = 0. 000 and 0. 000,respectively). But none of the values calculated by these method could fully agree with the true value.Conclusions IOL power should be calculated accurately to avoid undercorrection. We recommend the combination of clinical history method, Feiz-Mannis Method, Corneal Passby Method and Haigis-L Formula for the calculation of IOL power.     

皮质类固醇与非甾体抗炎药物对兔眼LASIK术后角膜微定结构的影响

目的 观察兔LASIK后应用皮质类固醇或非甾体类药物的角膜超微病理学改变.方法 对36只兔建立有眼LASIK模型,并随机分3组:A组为0.1%氟米龙滴眼液干预组;B组为普拉洛芬滴眼液干预组;C组为对照组.术后3天、1月、3月于3组分别取4只兔处死后取角膜组织处理,行光镜及透射电镜检查.结果 光镜:术后早期,C组上皮细胞的增生较A、B组明显,前基质胶原纤维排列较后两组紊乱;透射电镜:B组术后早期上皮表层细胞出现凋亡、脱落.指状突起结构显著减少,上皮细胞内胞质疏松,线粒体水肿.A组上皮内出现类似改变,但较轻微.结论 皮质类固醇及非甾体类药物均可抑制LASIK 术后兔角膜上皮细胞、前基质胶原纤维的增殖;前者作用略强且角膜上皮毒性较轻.

Abstract：

Objective To observe the ultrastructural pathological alterations of cornea after LASIK by local using corticosteroid and NSAIDs in rabbits.Methods LASIK was performed in right eye of 36 rabbits,and were randomly divided into group A (0.1%FML);group B (NASIDs).Both groups were dropped 4 times a day and subtracted gradually 1 time every week.Other rabbits were dropped nothing (group C).Four rabbits of every group were sacrificed and acquired cornea to perform light microscope and electron microscope at 3 days,1 month,and 3 months after LASIK respectively.Results Light microscope:at early stage after LASIK the proliferation of epithelial of group C was more evident than group A and B,the arrange of collagen fiber was more disorder;Electron microscope:the epithelial surface of group B appeared apoptosis and unhealthy.The finger protrude structure decreased obviously.Cytoplasm of epithelial cells was lost.The expression of group A was weaker than group B.Conclusions Corticosteroid can inhibit the proliferation of corneal epithelial and anterior stroma collagen fiber after LASIK.The function of NSAIDs is weaker.Corticosteroid has the lighter epithelial toxicity to cornea than NSAIDs after LASIK.     

Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus

AIM:To evaluate the incidence of increased intraocular pressure(IOP)and glaucomatous changes in systemic lupus erythematosus(SLE)patients in comparison with systemic steroids and immunosuppressive treatment.METHODS:Sixty-two women with SLE were divided into two groups:treated(n=47,94 eyes)and not treated(n=15,30 eyes)with systemic glucocorticosteroids(GC;GC-free).Twenty-one individuals in GC group were treated with immunosuppressive agents(immunomodulating and biologic).The visual acuity and IOP with ocular pulsatile amplitude(OPA)measurements,as well as scanning laser polarimetry(GDx)with nerve fiber index(NFI)measurement,spectral domain optical coherence tomography(SD-OCT)of the optic disk with retinal nerve fiber layer(RNFL)analysis and the macular region with ganglion cell analysis(GCA)were performed.RESULTS:Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment(17.63±4.38 mm Hg,P=0.043).Contrary,no dif ferences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected(P=0.563).Similarly,mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg(P=0.671).According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness,RNFL symmetry,cupping volume and the C/D ratio were observed.Similarly,no statistical differences for the mean and minimal ganglion cell layer(GCL)thickness measured in macular SD-OCT or NFI in GDx were detected.CONCLUSION:Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension.No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.     

Clinical effectiveness and safety of domestic 125I plaque irradiation for experimental choroidal melanoma北大核心CSCD

Background: Choroidal melanoma (CM) is the most common primary intraocular tumor, and brachytherapy is one of the most common therapeutic modality in the treatment of the tumor. However, this irradiation approach has not been evaluated in China. Objective: The present study was to analyze the effectiveness and safety of domestic I plaque irradiation in the treatment of CM. Methods: Forty New Zealand albino rabbits were randomized into 5 groups with 8 rabbits 8 eyes (right eyes) in each group. CM models were established in 16 of 40 New Zealand albino rabbits by implanting the rat B16F10 melanoma cell fragments into the suprachoroidal space of right eyes. After 3 weeks, domestic 1 plaque was fixed at the location of CM in the irradiation group 1, and 8 rabbits with CM served as model control group. The clinical effectiveness of 125I plaque for CM was evaluated based on the fundus examination with indirect ophthalmoscopy, B scan ultrasonography, fundus photographs and color Doppler imaging. Regarding the safety study, domestic I plaque was fixed on the normal right eyes of normal rabbits, while the plaques without I seeds were used as the sham group. No intervene was performed in the rabbits of blank group. The number of CD4+, CD8+ T cells in peripheral blood was detected by flow cytometry before plaques implanted and on 3,7,15 and 30 days after the plaque was removed. The animals were sacrificed and the eyes were obtained for histology examination. The use of the experimental animals complied with Statement of ARVO. Results: After implantation of B16F10 melanoma cell fragments, CM grew steadily and rapidly with the similar size between irradiation group 1 and model control group (P=0.550). One week after administration of the treatment, tumor size was (0.31 ± 0.07) cm in irradiation group 1 and (0.85 ± 0.18) cm in the model control group, with the significant difference between them(P=0.001). Two week after application of 125I plaque, the size of tumor was smaller than that before irradiation (P=0.007). Histologically, the tumors were mostly limited beneath the pigment epithelial layer with less neovascularization, fibrosis in the tumor was found in some area in the irradiation group when compared with model control group. No significant differences were found in the proportions of CD4+, CD8+ T cells and CD4+/CD8+ at different time points in the irradiation groups of normal eyes and sham group (Fgroup=0.770, 8.110, 2.230; P=0.380, 0.060, 0.140; Ftime=0.770, 3.220, 4.230; P=0.550, 0.170, 0.004). Chronic inflammatory cells infiltration cornea, subconjunctival epithelial and sclera surface, but sclera had no necrosis and organization. Conclusions: These results suggest that domestic I plaque irradiation is effective for the treatment of CM, and has limited side effects on normal rabbits.     

Effects of travoprost on actin cytoskeleton and β-catenin in the human trabecular meshwork cells treated with Dexamethasone

Objective To investigate the effect of travoprost on changes of actin cytoskeletal and β-catenin protein in the cultured human trabecular meshwork (HTM) cells treated with dexamethasone (DEX). Methods It was a control experiment study. The HTM cells were cultured in vitro and divided into control group, DEX (1 × 10-6mol/L) group, travoprost (1 × 10-6mol/L) group, and DEX (1 ×10-6mol/L) plus travoprost (1 × 10-6mol/L) group. F-actin in the HTM cells was detected by FITC-phallodin and observed under a fluorescence microscope. The expression of β-catenin was determined by immunofluorescence and western-blot. Statistical analysis was performed using SPSS13.0 software. The difference of β-catenin expression among groups was analyzed through variance analysis and, further by q test. Results The cultured HTM cells were identified by immunohistochemistry. A reorganization of actin cytoskeletal and a formation of cross linked actin networks (CLANs) were seen in the HTM cells treated with DEX, which were partially reversed by the treatment with DEX plus travoprost. An increase of the expression of β-catenin was discovered in the HTM cells treated with DEX, which was also partially reversed by the treatment with DEX plus travoprost. The amount of β-catenin protein in untreated control group, DEX group, DEX plus travoprost group and travoprost group were 0. 84 ± 0. 03,1.65 ± 0. 05, 1.21 ± 0. 05, and 0. 65 ±0. 04, respectively. Expression of β-catenin was significantly ( F = 143.07, P ＜ 0. 05 ) different when compared untreated control group with DEX group ( q = 15. 32 ,P ＜0. 05 ), untreated control group with DEX plus travoprost group (q = 11.40,P＜0. 05), DEX group with DEX plus travoprost group (q =9. 38,P ＜ 0. 05 ), DEX group with travoprost group ( q = 16. 55, P ＜ 0. 05 ), and DEX plus travoprost group with travoprost group (q = 14. 31 ,P ＜ 0. 05 ). No difference was found in untreated control group and travoprost group(q = 2. 84, P ＞ 0. 05 ). Conclusions Our results suggest that reversion of the changes of actin organization and β-catenin by travoparost in the HTM cells treated with DEX may partially elucidate the mechanism of action of increasing outflow by which travoprost reduces intraocular pressure.     

Additive effect of latanoprost, a prostaglandin F2 alpha analogue, and timolol in patients with elevated intraocular pressure.

A randomised observer masked clinical study was conducted to assess the additive effect of latanoprost (13,14-dihydro-17-phenyl-18,19,20-trinorprostaglandin F2 alpha-isopropylester) to timolol maleate in patients with elevated intraocular pressure (IOP). Patients were randomly assigned to two treatment groups. One group (n = 10) received timolol, the other group (n = 9) received latanoprost twice daily for 1 week. After 1 week all patients received both timolol and latanoprost. Eyes treated with timolol (mean diurnal IOP (SD) day 0, 24.2 (2.8) mm Hg) and latanoprost (mean diurnal IOP day 0, 28.5 (5.6) mm Hg) showed an IOP reduction of 5.9 (2.3) mm Hg (24%) and 8.9 (2.5) mm Hg (31%), respectively after the first week. Adding latanoprost to the eyes treated with timolol as well as timolol to the eyes receiving latanoprost gave a further reduction of 2.6 (1.1) mm Hg (13%) and 2.6 (2.2) mm Hg (14%), respectively. Only mild transient hyperaemia was observed in patients receiving latanoprost. The results indicate that latanoprost and timolol can be combined successfully and that complete or almost complete additivity is reached even at pressure levels below 20 mm Hg.     

Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles

PURPOSE: To investigate the influence of uneventful phacoemulsification on anterior chamber depth (ACD), iridocorneal angle (ICA) width, and intraocular pressure (IOP) in nonglaucomatous eyes with open ICA preoperatively. SETTING: Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. METHODS: Fifty-three eyes of 49 patients were evaluated for 6 months postoperatively. The nonparametric Wilcoxon signed rank test was used to compare preoperative and postoperative IOP, ACD, and ICA width. Univariate and multivariate regression analyses were used to evaluate the relationships between IOP, ACD, and ICA width and between preoperative patient characteristics. RESULTS: The mean preoperative IOP of 15.1 mm Hg +/- 2.8 (SD) dropped postoperatively to 13.4 +/- 3.4 mm Hg at 1 day, 13.3 +/- 2.6 mm Hg at 1 week, 13.2 +/- 3.1 mm Hg at 1 month, 13.3 +/- 2.7 mm Hg at 3 months, and 14.1 +/- 2.5 mm Hg at 6 months (P<.05). The mean preoperative ICA grade of 2.97 +/- 0.72 increased to 3.55 +/- 0.48 at 1 week and 3.68 +/- 0.45 at 1 month (P<.05). The mean preoperative ACD of 3.06 +/- 0.49 mm increased to 3.57 +/- 0.47 mm at 4 weeks, 3.69 +/- 0.32 mm at 1 month, and 3.70 +/- 0.36 mm at 3 months (P<.05). The IOP decrease was not correlated with the changes in ICA width or ACD. Multiple regression analysis showed preoperative IOP was the single predictor of the postoperative IOP drop (P<.001). CONCLUSIONS: In nonglaucomatous eyes with an open ICA preoperatively, uneventful phacoemulsification reduced IOP, increased ACD, and widened the ICA. The changes were statistically significant over 6 months.     

准分子激光原位角膜磨镶术术后早期应用卡替洛尔滴眼液对屈光状态的影响

目的 评估准分子激光原位角膜磨镶术（LASIK）术后早期应用盐酸卡替洛尔滴眼液对屈光状态及眼压的影响。 设计 前瞻性比较性病例系列。研究对象 2009年11月-2011年9月北京同仁医院行LASIK手术的近视患者32例（32眼）。 方法 试验组15眼LASIK术后第1周开始使用2%盐酸卡替洛尔滴眼液每日2次,低中度近视患者持续1个月,高度近视患者持续1.5个月。对照组17眼术后不使用2%盐酸卡替洛尔滴眼液。术前、术后1、3、6个月进行显然验光、Oculyzer眼前节测量系统、眼压等检查。主要指标 等效球镜度、角膜后表面高度、眼压。结果 试验组术后1、3、6个月时等效球镜度分别为（-0.150±0.742）、（-0.170±0.595）和（-0.525±0.618）D;对照组分别为（-0.258±0.581）、（-0.290±0.657）和（-0.459±0.591）D（P均＞0.05）。试验组术后1、3、6个月时角膜后表面高度分别为（7.47±2.326）、（6.60±3.158）和（5.86±2.610）μm;对照组分别为（6.59±3.355）、（7.35±3.622）和（7.33±2.992）μm（P均＞0.05）。试验组术后1、3、6个月眼压分别为（7.80±0.941）、（8.07±1.534）、（8.70±1.337） mm Hg;对照组分别为（9.35±2.827）、（9.59±2.717）、（8.73±1.580）mm Hg。术后1个月时试验组和对照组眼压有统计学差异（P=0.045）,余时间点均无统计学差异。结论 LASIK术后早期应用盐酸卡替洛尔滴眼液通过降低眼压可能对屈光状态具有稳定作用。（眼科,2013,22：49-52）     

LASIK术后质量分数0.5％氯替泼诺滴眼液应用的随机对照研究

背景 近视性准分子激光角膜原位磨镶术(LASIK)后需局部使用糖皮质激素滴眼液已成为共识,具有良好抗炎效果且不良反应小的糖皮质激素滴眼液有利于术后角膜上皮的快速修复.目的 评估质量分数0.5％氯替泼诺滴眼液在LASIK术后的临床应用效果.方法 采用前瞻性随机对照研究设计.本研究经中山大学中山眼科中心伦理委员会批准,所有患者纳入前均充分了解本研究的内容并签署知情同意书.112例224眼纳入研究,其中共97例194眼完成随访.双眼接受近视性LASIK的患者以随机数字表法分为0.5％氯替泼诺滴眼液点眼组(试验组)54例108眼和对照组43例86眼,两组患者年龄及术前等效球镜度差异均无统计学意义(P＞0.05).两组的基础治疗方法一致.试验组从术后第1天开始局部点用0.5％氯替泼诺滴眼液,每日4次,共1周,对照组以同样的方法点用妥布霉素地塞米松滴眼液.分别于术后1d、1周、1个月对2个组患者的主观症状进行评分,并行裸眼视力、最佳矫正视力(BCVA)、眼压、中央角膜厚度、角膜荧光素染色检查,同时观查术眼的术中和术后并发症情况,以评价0.5％氯替泼诺滴眼液点眼的安全性.结果 在随访过程中,未观察到与药物相关的全身和眼部严重并发症.术后1d、1周和1个月,试验组和对照组主观症状评分(包括眼痛、异物感、视物模糊评分)比较,差异均无统计学意义(P＞0.05).术后1周,试验组和对照组校正后的实际眼压分别为(16.27±3.31)mmHg和(17.49±4.48)mmHg,差异有统计学意义(t=-2.113,P=0.036);术后1个月,试验组和对照组校正后的实际眼压分别为(15.01±3.22)mmHg和(15.30±4.17)mmHg,差异无统计学意义(t=-0.532,P=0.595).术后1d,试验组发生轻度弥漫性层间角膜炎(DLK)者7眼,对照组为5眼,差异无统计学意义(x2 =0.153,P=0.926),术后1周和1个月两组中均未发现DLK.术后1d、1周和1个月两组间的角膜荧光素染色评分差异均无统计学意义(Z=-0.566,P=0.571;Z=-0.689,P=0.491;Z=-1.628,P=0.103).结论 0.5％氯替泼诺滴眼液用于LASIK术后可以有效控制术后炎症反应和DLK,并且减少了传统糖皮质激素升高眼压的风险.     

高度近视LASIK与LASEK术后角膜地形图的变化

目的分析高度近视LASIK与LASEK术后角膜地形图的变化,评价LASEK治疗高度近视的效果。方法选取接受准分子激光高度近视矫正术的连续性病例68例（125眼）。术前等效球镜值为-6．00D～-12．00D,平均（-8．91±2．12）D。按手术方式分为两组：LASEK组和LASIK组。比较术前、术后1个月、3个月和6个月患者角膜地形图的变化。结果两组术前角膜地形冈均以不对称领结型为主,LASEK组为55．6％,LASIK组为54．7％,两组差异无统计学意义（P〉0．05）;术后6月,两组均以平滑型为主,LASEK组为79．2％,LASIK组为83．0％,两组均无偏中心切削或中央岛型,两组差异无统计学意义（P〉0．05）。随着时间的推移,两组中的半环型均向平滑型转变。术后1个月、3个月、6个月与术前相比,两组模拟角膜镜度数（simk）的等效值、Simk差值明显减小,角膜不规则指数（CIM）明显增高,角膜形态因子（SF）向负值改变,其差异有统计学意义（P〈0．05）。术后1个月,LASEK组CIM值、Simk差值、SF绝对值均高于LASIK组,两组差异有统计学意义（P〈0．05）。术后3个月和6个月LASEK组CIM值低于LASIK组,两组差异有统计学意义（P〈0．05）,而Simk差值、Simk等效值及SF绝对值与LASIK组相比,差异无统计学意义（P〉0．05）。结论LASEK治疗高度、超高度近视术后角膜地形网形态较LASIK平整、规则。远期效果有待进一步观察。     

马来酸噻吗洛尔滴眼液对高度近视眼LASIK术后近视回退的影响

目的探讨马来酸噻吗洛尔滴眼液在防治高度近视眼准分子激光原位角膜磨镶术(1aser in situ keratomileusis,LASIK)后屈光回退中的作用。方法选取接受LASIK治疗的高度近视眼患者术后第1天主觉验光等效球镜屈光度在0～-0.75D患者78例(78眼),随机分为研究组39例(39眼)和对照组39例(39眼)。对照组术后常规应用抗生素滴眼液滴眼10d和皮质类固醇滴眼液滴眼1个月。研究组术后除常规用药外,术后第1天增加使用马来酸噻吗洛尔滴眼液每天2次滴眼1个月。术前、术后10d、1个月、3个月进行眼压和主觉验光检查,OrbscanⅡ测量角膜后表面前移量(Diff差值)。结果研究组术后10d、1个月、3个月眼压分别为(9.61±2.90)mmHg(1kPa=7.5mmHg)、(9.97±2.50)mmHg、(10.61±2.90)mmHg,与对照组比较[(11.69±2.60)mmHg、(11.99±3.07)mmHg、(10.92±2.65)mmHg],术后10d、1个月差异均有统计学意义(均为P<0.05),术后3个月差异无统计学意义(P>0.05)。研究组术后10d、1个月和3个月角膜后表面Diff差值分别是(9.56±6.66)μm、(10.72±6.70)μm和(14.11±4.66)μm,对照组分别为(19.57±7.76)μm、(20.24±7.37)μm和(20.10±6.98)μm,两组比较差异有显著统计学意义(F=34.236,P=0.000);两组术后同时间点Diff差值比较,差异均有统计学意义(均为P<0.05)。研究组术后10d、1个月和3个月时等效球镜屈光度分别为(-0.46±0.28)D、(-0.61±0.34)D和(-0.75±0.21)D,对照组分别为(-0.67±0.23)D、(-0.93±0.23)D和(-1.05±0.29)D,两组术后同时间点比较差异均有统计学意义(均为P<0.05)。结论高度近视眼LASIK术后早期应用马来酸噻吗洛尔滴眼液能阻滞角膜后表面前移,降低近视屈光度,是预防高度近视眼LASIK术后屈光回退的一种有效方法。     

盐酸卡替洛尔眼液预防超高度近视LASIK术后屈光回退的临床观察

探讨盐酸卡替洛尔滴眼液在预防超高度近视准分子激光原位角膜磨镶术（LASIK）术后早期屈光回退中的作用。 方法：超高度近视患者行LASIK治疗者68例136眼,随机分成试验组和对照组,所有患者术后第1d开始用1g/L氟米龙、1g/L玻璃酸钠和1g/L普拉洛芬滴眼液3次/d,1wk后试验组停用1g/L氟米龙滴眼液并且加用20g/L盐酸卡替洛尔滴眼液,术后1mo试验组和对照组患者均停用1g/L玻璃酸钠以外的其他滴眼液,术后随访6mo观察两术式的治疗效果。 结果：术后3,6mo试验组患者裸眼视力≥1.0者、屈光度和对照组比较差异有显著性（P＜0.05);术后1wk;1,3,6mo试验组眼压按时间点经重复测量方差分析比较两组差异有显著性（P＜0.02);术后1mo试验组和对照组患者前房深度比较差异有显著性（P＜0.05);术后3,6mo试验组患者角膜屈光力、角膜后表面Diff值和对照组比较差异有显著性（P＜0.05)。 结论：对于超高度近视患者,LASIK术后早期应用盐酸卡替洛尔滴眼液能预防屈光回退,使患者获得更持久的效果,但远期效果需进一步观察。     

LASIK手术前后IOLMaster、OrbscanⅡ及超声法测量角膜曲率、前房深度及眼轴长度的比较

背景角膜曲率、前房深度、眼轴长度的精确测量对人工晶状体（IOL）度数的计算至关重要,不同方法的测量结果可能对IOL度数的计算结果产生误差。目的比较光学相干生物测量仪（IOLMaster）、OrbscanⅡ眼前节分析仪（OrbscanⅡ）以及A型超声法测量近视患者准分子激光角膜原位磨镶术（LASIK）手术前后角膜曲率（K）、前房深度以及眼轴长度的结果。方法收集近视患者65例130眼,对LASIK手术前及手术后1个月随访到的28例56眼分别行IOLMaster、OrbscanⅡ以及A型超声法眼部生物测量,并对其结果进行比较。结果LASIK手术前,IOLMaster和OrbscanⅡ测量角膜K值分别为（43．32±1．52）D和（42．99±1．45）D,二者相差（0．33±O．03）D,差异有统计学意义（t=10．380,P=0．000）。手术后K值分别为（39．02±2．14）D和（38．91±2．04）D,二者相差（0．12±0．33）D,差异有统计学意义（t=2．715,P=0．009）。Bland—Ahman分析显示,2种方法测量K值的一致性较差。手术前IOLMaster、OrbscanⅡ和A型超声法测得前房深度分别为（3．72＋0．22）、（3．69±0．22）、（3．75±0．27）mm,差异无统计学意义（P=0．100）。A型超声法测量眼轴长度为（25．22±O．99）mm,IOLMaster测得长度为（25．59±1．01）mm,二者相差（-0．37±0．30）mm,差异有统计学意义（t=-14．098,P=0．000）,Pearson相关性分析显示二者呈正相关（r=0．954,P=0．000）。手术前后IOLMaster测量眼轴长度分别为（25．54±1．05）mm和（25．48±1．01）mm,二者相差（0．052±0．412）mm,差异无统计学意义（t=0．946,P=0．348）。结论IOLMaster测量角膜曲率与OrbscanⅡ测量结果差别较大,临床上二者不可替代。IOLMaster与OrbscanⅡ测量前房深度结果一致性较好,临床上可替代使用。与A型超声法比较,IOLMaster测得的眼轴长度较长,临床应用要引起注意。     

Unoprostone as adjunctive therapy to timolol: a double masked randomised study versus brimonidine and dorzolamide

AIMS: To compare the safety and efficacy of unoprostone, brimonidine, and dorzolamide as adjunctive therapy to timolol in patients with primary open angle glaucoma or ocular hypertension. METHODS: This was a randomised, double masked, parallel group, multicentre (14) study. After using timolol maleate 0.5% monotherapy twice a day for 2 weeks, patients (n = 146) with an early morning intraocular pressure (IOP) between 22 and 28 mm Hg, inclusively, received unoprostone isopropyl 0.15% (n = 50), brimonidine tartrate 0.2% (n = 48), or dorzolamide hydrochloride 2.0% (n = 48) twice daily as adjunctive therapy to timolol maleate 0.5% for another 12 weeks. Safety was based on comprehensive ophthalmic examinations, adverse events, and vital signs. Efficacy was based on mean change from baseline in the 8 hour diurnal IOP at week 12. Baseline was defined as values obtained after 2 weeks of timolol monotherapy. RESULTS: Each drug was safe and well tolerated. Burning/stinging was the most common treatment emergent adverse event. No clinically relevant changes from baseline were observed for any ophthalmic examination or vital signs. At week 12, each adjunctive therapy produced statistically significant (p<0.001) reductions from timolol treated baseline in the mean 8 hour diurnal IOP (-2.7 mm Hg, unoprostone; -2.8 mm Hg, brimonidine; -3.1 mm Hg, dorzolamide). The extent of IOP reduction did not differ significantly between unoprostone and either brimonidine (p = 0.154) or dorzolamide (p = 0.101). CONCLUSION: Unoprostone was safe and well tolerated and provided a clinically and statistically significant additional reduction in IOP when added to stable monotherapy with timolol. Furthermore, unoprostone was not significantly different from brimonidine and dorzolamide as adjunctive therapy to timolol.     

Reduction in intraocular pressure after laser in situ keratomileusis

PURPOSE: To investigate whether intraocular pressure (IOP) measured on the nasal side is affected after laser in situ keratomileusis (LASIK). SETTING: The Glaucoma Service, Dr. Hong's Eye Clinic, Seoul, Korea. METHODS: In 83 patients, IOP was prospectively measured with the Goldmann tonometer at the central (Tcenter) and nasal (Tnasal) areas of the cornea before and after LASIK. The Tcenter and Tnasal IOP between baseline and 1, 3, and 6 months postoperatively was compared. The correlation between ablation depth, amount of treatment, refractive change, and change in central corneal thickness and Tcenter change was evaluated. RESULTS: Six months after LASIK, Tcenter IOP decreased 3.9 mm Hg (25.2%) and Tnasal IOP decreased 2.0 mm Hg (12.7%) (P < .001, P = .02, respectively). The Tnasal measurement was 1.8 mm Hg higher than the Tcenter measurement (P < .001). Significant correlation between each corneal parameter and the Tcenter reduction at 1 month did not continue to 6 months (P > .05). CONCLUSION: At each follow-up, Tnasal IOP was statistically lower than at baseline, although the reduction was not as great as that of Tcenter IOP. A 2 to 3 mm Hg drop in Tnasal up to 6 months after LASIK should be expected. An alternative would be to measure IOP with the Tono-Pen on the nasal side to fit the tip to the relatively unchanged nasal side of the cornea.