应用激光共焦显微镜诊断真菌性角膜炎的临床研究

目的:应用激光共焦显微镜观察真菌性角膜炎患者图像特点及菌丝和孢子检出率,探讨激光共焦显微镜检查在真菌性角膜炎临床诊断中的意义。方法:对41例41眼经门诊确诊为真菌性角膜炎的患者行角膜激光共焦显微镜检查,观察不同治疗期真菌性角膜炎患者活体角膜各层图像特点。结果:共焦显微镜下真菌性角膜炎患者图像有如下特点:(1)病变部位角膜各层形态结构破坏明显;角膜上皮至基质不同程度水肿;炎细胞浸润;神经结构破坏;基质层结构紊乱,透过度降低;(2)真菌菌丝是本病的特异性诊断依据,不同菌种感染在镜下菌丝有不同的影像学特点;(3)不同病变时期和治疗阶段,图像有很大差异,真菌菌丝的检出并不是诊断本病的唯一依据。结论:激光共焦显微镜检查具有无创、及时等优点,在临床诊断真菌性角膜炎中有重要参考意义,尤其是指导临床早期诊断、合理治疗及评价预后。     

真菌性角膜炎70例早期临床诊断分析

目的:分析70例真菌性角膜炎早期临床诊断结果,评价共焦激光显微镜在真菌性角膜炎早期临床诊断中的应用价值。方法:用共焦激光角膜显微镜对临床拟诊为真菌性角膜炎的70例患者进行检查,同时行涂片检查真菌菌丝及培养查真菌菌落,对三组结果进行比较。结果:在70例患者中,根据病史、临床表现确诊为真菌性角膜炎,其中共焦激光角膜显微镜的确诊率为94%(66/70),角膜刮片的确诊率为31%(22/70),培养查真菌菌落确诊率为20%(14/70)。激光共焦角膜显微镜检查检出率高于角膜组织刮片(χ2=29.615,P<0.01)及真菌培养(χ2=39.433,P<0.01)检查。结论:共焦激光角膜显微镜是一种无创、快速、有效的活体检查方法,在真菌性角膜炎的早期诊断、治疗和研究中将起重要作用。     

真菌性角膜溃疡刮片前后的共焦显微镜对照研究

目的 对活体真菌性角膜溃疡患者刮片前后的病灶,采用角膜激光共焦显微镜进行观察、比较并总结其特点.方法 取45例(45只眼)角膜溃疡刮片、培养确诊真菌性角膜溃疡的患者,在角膜刮片取材培养前后,采用激光角膜共焦显微镜进行检查,研究其图像特点,并进行对比.结果 在真菌性角膜溃疡刮片取材前,溃疡灶中的真菌菌丝在活体角膜激光共焦显微镜中结构完整、成像清晰.刮片取材后,溃疡灶中的真菌菌丝在活体角膜激光共焦显微镜中结构不完整、成像较模糊,菌丝有断裂.结论 角膜刮片取材会造成真菌性角膜溃疡灶中的真菌菌丝断裂,对真菌性角膜溃疡进行活体共焦显微镜的最佳检查时间应在角膜刮片取材前进行,以提高共焦显微镜对真菌性角膜溃疡的检出水平.     

激光共焦显微镜在真菌性角膜炎诊断中的应用

目的:探讨激光共焦显微镜HRT3-RCM在真菌性角膜炎诊断中的应用价值。方法:对临床拟诊真菌性角膜炎患者32例32眼行HRT3-RCM检查,同时进行角膜刮片细胞学检查。结果:在32例患者中,24例在角膜组织刮片中查到了菌丝,阳性率为75%;30例在激光共焦显微镜下观察到真菌菌丝,阳性率为94%。结论:HRT3-RCM是利用激光作为光源的新一代共焦显微镜,是一种快速、有效、无创的检查方法,可用于真菌性角膜炎的早期病原学诊断以及治疗观察。     

暗场显微镜联合角膜激光共焦显微镜在非典型真菌性角膜溃疡的应用研究

目的 对非典型的真菌性角膜溃疡患者(角膜刮片取材,涂片镜检不能确诊的真菌性角膜溃疡),采用暗场显微镜联合角膜激光共焦显微镜检查进行观察研究,并归纳总结其临床特点.方法 23例(23只眼)非典型的真菌性角膜溃疡患者,在角膜刮片取材培养前采用激光角膜共焦显微镜对溃疡灶进行活体检查,然后进行角膜刮片取材,涂片常规镜检和暗场显微镜检查,研究其图象特点,并进行对比研究.结果 非典型真菌性角膜溃疡灶中的真菌菌丝在活体角膜激光共焦显微镜中结构不完整、成像不清晰;在常规镜检下,成像不清甚至难以成像;但采用暗场显微镜检查能发现清晰的真菌菌丝.结论 暗场显微镜观察非典型真菌性角膜溃疡有着独特的优点,该方法联合常规涂片镜检及共焦显微镜检查能提高对非典型真菌性角膜溃疡的诊断水平.     

共焦激光角膜显微镜在真菌性角膜炎诊断中的应用

目的评价共焦激光角膜显微镜在临床诊断真菌性角膜炎中的应用价值。方法用共焦激光角膜显微镜对临床拟诊为真菌性角膜炎的26例患者进行检查,同时行涂片检查真菌菌丝,对两组结果进行比较。结果26例患者中,根据病史、临床表现24例确诊为真菌性角膜炎,其中共焦激光角膜显微镜的确诊率为95.83%(23/24),角膜刮片的确诊率为83.33%(20/24)。结论共焦激光角膜显微镜是一种快速、有效、无损伤的活体检查方法,在真菌性角膜炎的早期诊断、治疗和研究中将起重要作用。     

真菌性角膜炎临床转归与病理分析

目的探讨如何通过术前检查更合理地指导真菌性角膜炎手术治疗方式的选择,分析影响真菌性角膜炎预后的因素。方法回顾性分析真菌性角膜炎患者31例,观察分析临床特点、激光角膜共焦显微镜检查图像、治疗过程、病理检查结果、临床转归情况。将所有共焦深度、临床特点、病理检查资料采用SPSS17.0软件包完成统计学分析。结果共焦深度为(202.58±150.65)μm,病理深度(261.29±150.95)μm;水平生长22例,垂直生长9例。Kappa检验示共焦深度与病理深度的一致性较好(P=0.000);临床特点中,前房积脓与共焦深度存在线性回归关系(P<0.05);Logistic回归分析示前房积脓与病理形态存在回归关系(OR=4.047,P=0.016);前房积脓、共焦深度、病理形态3个指标与真菌性角膜溃疡预后有相关性(均为P<0.05)。结论临床医师可通过对真菌性角膜溃疡的临床、共焦显微镜检查来帮助推测真菌生长形态,进而判断预后以及是否可行板层角膜移植术。     

共焦显微镜在临床诊断真菌性角膜炎中的应用

目的 评价共焦显微镜在临床诊断真菌性角膜炎中的应用价值。方法 用共焦显微镜对52例临床拟诊为真菌性角膜炎的患者进行检查，同时行角膜病灶刮片培养，对两组结果进行比较。结果 综合病史、临床表现及治疗结果，有45例临床诊断为真菌性角膜炎，其中32例角膜刮片培养到真菌，阳性率为71．11％(32／45)；43例共焦显微镜检查观察到真菌菌丝和／或孢子，阳性率为95．56％(43／45)。结论 共焦显微镜可以在活体角膜上直接观察到真菌菌丝，是一种快速、有效和无损伤的检查方法，对真菌性角膜炎的早期诊断、治疗和研究等具有重要的临床价值。     

真菌性角膜炎病原学诊断

目的分析角膜涂片细胞学检查、真菌培养、角膜共焦显微镜在真菌性角膜炎诊断中的应用价值。方法对324临床诊为真菌性角膜炎患者进行涂片细胞学检查、真菌培养和角膜共焦显微镜检查,并对其检查的阳性率进行汇分析,以探讨病原学诊断在真菌性角膜炎诊断中的应用价值。结果324份标本中,细胞学检查阳性者168例(51.85%),真菌培养阳性者212例(65.43%),角膜共焦显微镜检查阳性者277例(85.63%)。结论角膜共焦显微镜检查在真菌性角膜炎诊断中有重要意义,是一种快速、有效、无损伤、可以直接在活体角膜上观察真菌菌丝的检查方法,较真菌培养和细胞学检查对真菌性角膜炎的早期诊断,治疗具有更重要的临床价值。     

角膜穿通伤术后缝线所致眼内炎四例

例1 男 26岁 22d前因左眼角膜穿通伤行角膜伤口缝合,术后早期伤口愈合良好.就诊时主诉左眼视力明显下降.检杏左眼视力眼前手动,中央角膜灰白溃疡,其间角膜缝线明显松动,溃疡表面白色坏死物附着,前房积脓2 mm,虹膜面脓性渗出覆盖,眼底无法窥入.B超提示,玻璃体混浊,角膜刮片发现真菌菌丝.诊断为左眼真菌性角膜溃疡,感染性眼内炎.     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.