反义肿瘤坏死因子α对小鼠眼内单疱病毒感染影响的实验研究

目的观察局部使用肿瘤坏死因子α反义寡核苷酸（TNF-α-ASON）对小鼠眼内单纯疱疹病毒（herpes simplex virus,HSV）-1感染的影响。方法将HSV-1注入小鼠前房建立动物模型。分别于建模前1d,建模后1d和4d结膜下注射TNF-α-ASON和PBS。8d和10d后观察两组小鼠眼部的炎症改变,测定病毒复制和眼内TNF-α含量。结果与对照组相比,8d时实验组葡萄膜炎发病率和眼内TNF-α含量显著降低（P〈0.01）,眼内HSV-1滴度无明显改变;10d时葡萄膜炎发病率和眼内HSV-1滴度都显著升高。结论局部使用TNF-α-ASON可以显著降低HSV-1感染小鼠眼内TNF-α含量,降低视网膜炎发病率。TNF-α在眼内具有抑制HSV-1复制的作用。     

生物羊膜移植与自体球结膜移植治疗复发性翼状胬肉的临床观察

目的观察生物羊膜移植与自体球结膜移植治疗翼状胬肉的术后临床观察，比较两种手术方法的疗效。方法随机将复发性翼状胬肉患者64例（70只眼）分为A、B两组-A组30例（34眼）采用翼状胬肉切除联合生物羊膜移植．B组34例（36眼）采用翼状胬肉切除及自体球结膜移植．观察术后角膜愈合情况、角膜缘新生血管及角结膜是否有翼状胬肉样组织．结果术后随访10-18个月，A组复发2眼（6%）；B组复发3眼（8%）．两组比较没有统计学意义（P〉0.05．）结论生物羊膜移植与自体球结膜移植治疗翼状胬肉，效果良好，复发率低，随诊观察二者无显著统计学差异。     

自身免疫性葡萄膜炎中免疫细胞的功能及变化的研究进展

葡萄膜炎是一种常见眼病，其发病机制多与自身免疫反应有关，可引起严重的视功能损害。在自身免疫性葡萄膜炎及实验性葡萄膜炎模型中均发现了1型辅助T(Th1)细胞、 Th17细胞参与疾病发生，且Th17细胞被发现与疾病的复发密切相关。调节性T细胞(Treg)参与炎症反应的消退，其功能及比例的失调是葡萄膜炎迁延不愈的重要原因。Th17细胞与Treg在一定条件下可以相互转化，通过调节Th17细胞/Treg平衡以缓解炎症也成为葡萄膜炎治疗的新途径。     

hUMSCs外分泌蛋白治疗实验性自身免疫性葡萄膜炎模型大鼠的机制初探

目的：探讨腹腔注射人脐带间充质干细胞外分泌蛋白（hUMSCs-S）治疗实验性自身免疫性葡萄膜炎（EAU）模型大鼠的可能性及其相关作用机制。方法：6～8周龄Lewis大鼠72只，用随机数字表分方法均分为3组，分别为正常对照（CTRL）组、EAU模型组及hUMSCs-S治疗组，每组24只。EAU组与hUMSCs-S组大鼠采用光感受器间维生素A结合蛋白（IRBP）联合弗氏完全佐剂建立EAU模型，hUMSCs-S组大鼠在建模的同时予以腹腔注射hUMSCs-S,EAU组及CTRL组大鼠均腹腔注射等量PBS。裂隙灯显微镜拍摄记录各组大鼠眼前段情况，根据Caspi评分标准评价眼前段炎症程度；于免疫后第7天（初发期）、14天（高峰期）、21天（恢复期）取眼球组织制成石蜡切片进行HE染色、免疫组化及免疫荧光染色，分别用于眼球组织病理学评分、前房浸润细胞情况评估，观察眼球组织中CD3+T细胞及紧密连接蛋白ZO-1的表达。无菌操作下采腹主动脉血，制备血清，行ELISA法检测各组大鼠血清中白细胞介素10(IL-10)和IL-17的浓度。结果：（1）通过裂隙灯显微镜观察和比较，EAU组大鼠出现明显眼前段炎症反应...     

口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对hs-CRP和ADA的影响

目的探讨口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对高敏C反应蛋白（hs-CRP）和腺苷脱氨酶（ADA）的影响。方法结核性胸膜炎患者135例,按照给药方法的不同分为观察组和对照组,观察组57例予以口服和胸腔注射糖皮质激素,对照组78例予以口服糖皮质激素。观察两组的疗效、症状和体征、胸膜的厚度、胸穿次数、胸腔积液中的hs-CRP和ADA水平。结果观察组的总有效率为87.72%,优于对照组的71.79%（P〈0.05）。观察组的胸水消失时间、发热消退时间、胸痛消退时间和盗汗消退时间均较对照组明显缩短,差异有统计学意义（P〈0.01）。观察组的胸穿〈3次的比例明显高于对照组（P〈0.01）,而胸膜增厚的比例明显低于对照组（P〈0.05）。两组治疗后胸水中hs-CRP和ADA水平均较治疗前明显降低,用药3d和用药后7d,观察组的胸水中hs-CRP和ADA水平较对照组降低更为明显,差异有统计学意义（P均〈0.05）。结论口服结合胸腔注射糖皮质激素治疗结核性胸膜炎具有较好的疗效,可显著降低胸腔局部的hs-CRP和ADA表达。     

中西医结合法治疗前葡萄膜炎的临床疗效观察

目的 探讨中西医结合治疗前葡萄膜炎的临床疗效.方法:选取我院2006年7月～2008年9月收治的60例前葡萄膜炎患者的临床资料,随机分为治疗组(30例,35只眼)和对照组(30例,36只眼),对照组患者采用西药治疗,治疗组患者在对照组治疗的基础上加用中药治疗,连续治疗2个月,比较两组患者的临床疗效.结果:治疗组患者显效22眼,有效9眼,无效4眼,总有效率88.57%,对照组患者显效18例,有效7例,无效11眼,总有效率69.44%,治疗组患者疗效优于对照组,两组患者比较差异有统计学意义(p＜0.05).结论:中西医联合治疗急性前葡萄膜炎,减少患者的并发症,减少复发,充分发挥中医治疗本病的优势,值得在临床推广.     

毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响

目的：探讨抗青光眼药物毛果芸香碱和布林佐胺滴眼液及各自的防腐剂三氯叔丁醇和氯化苯甲烃胺（BAC）对兔眼表组织的影响。方法:选取新西兰大白兔15只，分为正常对照组（3只）、毛果芸香碱组（A组，6只）和布林佐胺组（B组，6只）。用药组右眼使用青光眼药物毛果芸香碱或布林佐胺滴眼液，左眼使用对应的防腐剂三氯叔丁醇或BAC，连续用药30 d。取球结膜组织行苏木素－伊红（HE）染色计数结膜上皮层炎症细胞数；角膜行扫描电镜检测并进行上皮损害分级评分。结果:与正常对照组比较，布林佐胺滴眼液（P<0.01）和防腐剂BAC（P<0.01）导致球结膜上皮层炎症细胞浸润增多；毛果芸香碱滴眼液（P>0.05）和三氯叔丁醇（P>0.05）引起的球结膜炎症细胞增多不明显。布林佐胺滴眼液导致球结膜炎症细胞增加的程度较毛果芸香碱滴眼液严重（P<0.01）。青光眼药物和防腐剂均可导致兔角膜上皮超微结构的损伤，表现为角膜上皮细胞六边形结构变为不规则、边界不清、细胞膜皱缩、细胞间距增宽、上皮细胞表面的微绒毛丢失、细胞空洞和暗细胞增加。布林佐胺滴眼液和BAC引起的角膜损害较毛果芸香碱滴眼液（P<0.01）和三氯叔丁醇明显（P<0.05）。各组左右两眼的球结膜炎症细胞数和角膜损害评分均无显著差异。结论:布林佐胺滴眼液和防腐剂BAC使用1个月后可导致兔球结膜炎症细胞增加和角膜上皮细胞损伤，毛果芸香碱滴眼液和三氯叔丁醇主要引起角膜上皮超微结构的变化；防腐剂是引起眼表损伤的主要原因。布林佐胺滴眼液对兔眼表的损伤较毛果芸香碱滴眼液严重。     

532激光联合曲安奈德治疗糖尿病视网膜病变的临床观察

目的评价倍频532激光联合曲安奈德治疗伴有黄斑水肿的糖尿病视网膜病变的疗效。方法对52例87眼伴有弥漫性黄斑水肿的糖尿病视网膜病变患者采用532激光进行黄斑格栅样光凝联合全视网膜光凝，同时球后注射曲安奈德20mg，1～3次，间隔1周，分析患者视力、黄斑水肿及并发症情况。结果激光治疗后随访6～18个月，87眼中51（59％）眼视力稳定，视力提高者30（35％）眼，视力下降者6（7％）眼；眼底荧光血管造影检查，光凝后水肿完全消退者50（57％）眼，部分消退者32（37％）眼，不变者5（6％）眼，晶状体混浊加重者5眼，4只眼眼压升高。结论532倍频激光联合曲安奈德治疗糖尿病视网膜病变有助于黄斑水肿消退，提高视力。     

生物型硬脑膜补片在无眼球结膜囊成形术中的应用

目的 研究生物型硬脑膜补片用于无眼球结膜囊成形术中的可行性和临床效果.方法 对12例(12只眼)无眼球结膜囊狭窄患者,采用生物型硬脑膜补片进行结膜囊成形术,术后随访,观察植片植入后的转归及术后结膜囊成形的效果.结果 12只眼术后植入的补片无收缩、脱落、感染及坏死.术后6～12个月,所有植片均被结膜覆盖,术后结膜囊大小深度合适,配戴义眼后外观满意.结论 采用生物型硬脑膜补片修复无眼球结膜囊狭窄是一种安全有效的手术方法.     

小切口白内障囊外摘除人工晶状体植入术观察

目的观察小切口白内障囊外摘除人工晶状体植入术的临床效果：方法观察300例（396眼）小切口白内障囊外摘除人工晶体植入术的手术并发症及并发症的处理情况。结果术中并发症：后囊破裂16眼（4.04％），均一期植入后房型人工晶状体，无晶状体移位发生。术后并发症：角膜水肿56眼（14．14％），术后一周内药物治疗水肿消退。前房炎症反应26眼（6.57％），袁现为房水混浊、纤维素性渗出，药物治疗3-7天内消退，本组无角膜失代偿、视网膜脱离、人工晶状体脱位等严重并发症发生。结论小切口白内障囊外摘除术具有损伤小、恢复快、并发症少。适合基层医院开展等优点。     

Ocular changes in hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-originating zoonotic disease caused by Puumala and Dobrava viruses, which belong to the genus Hantavirus. The most prominent ocular change in HFRS is transient myopia, which lasts for up to one week and is due to a forward movement of the ocular anterior diaphragm and thickening of the lens. Other ophthalmic manifestations of HFRS are eyelid edema, conjunctival injection with or without hemorrhages, chemosis, anterior uveitis, retinal edema with or without hemorrhages, and photophobia. Acute glaucoma attacks, which are rare, could be explained by the increased intraocular pressure (IOP) due to edema and hemorrhage in the ciliary body, causing anterolateral rotation, relaxation of the zonules, and anterior movement of the lens. They are treated with mydriatic-cycloplegic and corticosteroid eye drops and with furosemide. However, there are also controversial reports on decreased IOP during the acute phase of HFRS. Despite the fact that ocular symptoms in HFRS are common generally they do not require any medical therapy and the recovery of the patients is complete.     

雷公藤甲素在LPS诱导的急性葡萄膜炎中的抗炎作用

目的:观察雷公藤甲素对细菌脂多糖(LPS)诱导的急性葡萄膜炎(LIU)的抗炎作用。方法:BALB/c小鼠24只,随机分为空白对照组、模型组和雷公藤甲素组,每组8只,雷公藤甲素组给予0.05%雷公藤甲素滴眼液,空白对照组和模型组均给予等体积的生理盐水。连续给药30 d后,除空白对照组外各组小鼠于玻璃体腔内注射125 mg/L的LPS建立LIU模型。分别在造模后12、24、48和72 h后,对各组小鼠眼前节进行裂隙灯检查,并对眼组织进行病理学观察,同时提取眼组织蛋白,ELISA法检测眼组织中细胞间黏附分子1(ICAM-1)、白细胞介素1β(IL-1β)和单核细胞趋化蛋白1(MCP-1)的水平。结果:造模24 h后,与模型组相比,雷公藤甲素组能明显减轻LIU引起的炎症反应并降低炎症临床评分,差异有统计学意义(P0.01)。组织病理学也表明雷公藤甲素对小鼠前房、玻璃体腔内的炎症细胞浸润以及视网膜水肿增厚有明显的抑制作用。同时,ELISA结果显示雷公藤甲素显著下调眼组织中ICAM-1、IL-1β和MCP-1的表达,差异有统计学意义(P0.05)。结论:雷公藤甲素可能通过下调炎症细胞因子表达,从而减轻葡萄膜炎的眼部组织损伤,为葡萄膜炎的治疗提供了新的免疫疗法。     

雷公藤总生物碱滴眼液对大鼠自身免疫性葡萄膜炎的作用

目的: 探讨雷公藤总生物碱滴眼液对大鼠葡萄膜炎的治疗作用。方法: 从昆明山海棠中提取生物碱,并制备3种浓度的雷公藤总生物碱滴眼液。将实验性葡萄膜炎Lewis大鼠80只随机分为A(生理盐水治疗组)、B(0.0125％雷公藤总生物碱滴眼液组)、C(0.025％雷公藤总生物碱滴眼液组)、D(0.05％雷公藤总生物碱滴眼液)和E(典必殊滴眼液组)5组,每组16只大鼠,并分别给予生理盐水、3种不同浓度雷公藤总生物碱滴眼液及典必殊滴眼液点眼。各组于免疫后第9 d开始每天使用滴眼液点眼,于免疫后3、6、9、12、15、18、21、24 d每组各处死 2只大鼠,取4只眼球(n=4)行常规组织切片及HE染色;根据病理切片的炎症反应程度分为5级并按炎症反应程度给予相应评分;将各组评分结果进行非参数检验统计分析。结果: 将各组大鼠炎症病理反应评分相比较,A组、B组和C组在各个时点均无显著差异;D组和E组自免疫后第15 d开始与前3组之间差异显著;D组和E组在各个时点的炎症反应均无显著差异。结论: 0.05％雷公藤总生物碱滴眼液可有效抑制Lewis大鼠实验性葡萄膜炎眼病理改变。     

多种药物联合治疗白内障术后干眼症的临床效果观察

目的 探讨多种药物联合治疗白内障术后干眼症的临床疗效。方法 选取2015年5月~2018年 9 月于我院行白内障手术术后干眼患者125例,随机分为A、B、C组三组,C组患者采用玻璃酸钠滴眼液治疗,A组在C组基础上加用贝复舒滴眼液治疗,B组在C组基础上加用普拉洛芬滴眼液治疗,比较各组患者治疗前后OSDI值、BUT、SIt值、FL的变化,比较各组患者治疗前后OSDI值、BUT、SIt值、FL的变化。结果 治疗后三组患者BUT,SIt值比较,差异有统计学意义（P＜0.05）;治疗后三组OSDI值,FL比较,差异无统计学意义（P＞0.05）;B组患者治疗的总有效率（95.24%）高于A组（93.02%）及C组（87.50%）,差异有统计学意义（P＜0.05）。结论 玻璃酸钠滴眼液联合普拉洛芬滴眼液、玻璃酸钠滴眼液联合贝复舒滴眼液及单纯使用玻璃酸钠滴眼液均可减轻白内障术后干眼症患者的症状,增加泪液分泌量,延长泪膜破裂时间,使角膜染色降低,但玻璃酸钠滴眼液联合普拉洛芬滴眼液的治疗方案更佳。     

Association of complement allotype C4B2 with anterior uveitis

We have studied allotypes of the fourth component of complement (C4) in 44 patients with inflammatory eye disease in order to define genetic susceptibility factors further. Twenty-six patients had uveitis (18 had anterior uveitis) and 18 patients had retinal vasculitis. There was an increased incidence of the C4B2 allotype in patients with anterior uveitis (p_c < 0.002), especially in HLA B27 positive males. In contrast, there was no increased incidence of specific allotypes in patients with posterior uveitis or retinal vasculitis. This genetic association may form part of a disease susceptibility supratype in patients with anterior uveitis.     

Evaluation of ocular hypersensitivity to dipivalyl epinephrine by component eye-drop testing

Dipivalyl epinephrine (dipivefrin) is a prodrug of epinephrine used for topical glaucoma therapy. Local side effects have been noted in approximately 20% of patients treated and include conjunctival hyperemia, foreign body sensation, and follicular conjunctivitis. We studied five patients with adverse local reactions to dipivefrin (Propine) eye drops. Propine contains the following: dipivefrin, 0.1%; mannitol, 1.89%; sodium metabisulfite, 0.075%; disodium edetate, 0.0127%; and benzalkonium chloride, 0.004%. Since the reactions could conceivably have been caused by an ingredient other than dipivefrin, we first patch tested the patients with the maximum recommended concentration of each ingredient. All patch tests were negative. Sterile ophthalmic solutions of each individual component at the concentrations used in the commercial product were then prepared. In a double-blinded study, the patients applied two drops of each preparation, twice daily for 1 week, with a 1-week, drug-free period between trials. Dipivefrin alone reproduced each patient's initial Propine-induced conjunctivitis; symptoms occurred unilaterally in one patient and bilaterally in the other four patients. This study indicates that testing with single component eye drops can identify the provocative component in ocular drug hypersensitivity and that these reactions can be unilateral.     

The Effect of Adalimumab in Korean Patients with Refractory Noninfectious Uveitis

We sought to analyze the efficacy of adalimumab in active noninfectious uveitis, and evaluate its efficacy and safety for the management of refractory noninfectious uveitis in Korean patients. A retrospective observational study was conducted. A total of 23 eyes of 14 Korean patients with noninfectious uveitis refractory to conventional treatment, including corticosteroid and immunosuppressive agents, were treated with adalimumab between December 2017 and February 2020. The primary outcomes were vitreous haziness grades, anterior chamber cell grades, and central macular thickness measured prior to injection and at 1, 3, 6, and 12 months after the first adalimumab injection. Among the 23 eyes, 14 eyes (60.9%) were diagnosed with panuveitis and 9 eyes (39.1%) with posterior uveitis [mean follow-up period: 22.3 months (7–27)]. The most common etiologic diagnoses requiring adalimumab injection were Behçet''s disease (9 eyes, 39.1%), followed by undifferentiated inflammation (6 eyes, 26.1%), Vogt-Koyanagi-Harada disease (3 eyes, 13.0%), psoriasis (2 eyes, 8.7%), serpiginous chorioretinopathy (2 eyes, 8.7%), and systemic lupus erythematosus (1 eye, 4.3%). At the 1-year follow-up after the first injection, anterior chamber cell grade decreased from 0.5±0.4 to 0.3±0.4, and vitreous haziness grade decreased from 1.1±1.1 to 0.3±0.5 (p<0.05). Central macular thickness improved from 347.2±98.1 µm to 264.3±61.1 µm (p<0.05). Adalimumab injection in patients with refractory noninfectious uveitis decreased the anterior chamber cell grade, vitreous haziness grade, and central macular thickness with no severe side effect. Overall, adalimumab injection may, therefore, be an effective and relatively safe treatment modality for noninfectious uveitis in Korean patients.     

Management of Immune-Mediated Uveitis

AbstractImmune-mediated uveitis is a collective term referring to a group of potentiallyblinding intraocular inflammations which may coexist with systemic inflammatorydiseases. T lymphocytes appear to play an important pathogenic role in uveitis, andthese cells are therefore the logical target of drug therapy. Corticosteroids actnonspecifically, but are highly effective in controlling the inflammation rapidly. Theyare administered locally when disease is confined to the anterior portion of the eye.However, posterior eye involvement often requires systemic corticosteroid therapy,carrying a high risk of serious adverse effects when used for extended periods. Inthis situation, steroid-sparing agents are used. Few relevant randomised, controlled clinical trials have been performed, and thechoice of systemic immunosuppressive regimen is usually guided by individualpatient characteristics, cost, drug availability and physician preference. Patientsshould actively participate in therapeutic decision-making. Our first choice for steroid-sparing medication is often methotrexate, anantimetabolite which carries a low risk of adverse reactions when appropriatelyprescribed and monitored, is relatively inexpensive, and has once-weekly ease ofuse. For more severe uveitis, we may combine the immunomodulating agentcyclosporin with methotrexate and a corticosteroid. Azathioprine andcyclophosphamide are other treatment options. Steroid-sparing drugs also havesignificant potential for causing adverse effects, albeit less frequently thancorticosteroids. Future therapies aim to reduce this problem by increasing thespecificity of the therapeutic action.     

Reduced structural proteins in the conjunctival epithelium in allergic eye disease

AIMS: Allergic eye disease affects up to 20% of the population with varying severity. The conjunctival epithelium plays a key role in allergic eye disease. The purpose of this study was to determine whether the conjunctival epithelium is abnormal in allergic eye disease. METHODS: Conjunctival biopsy samples were taken from patients with seasonal allergic conjunctivitis (SAC) 'in' and 'out of season' and nonatopic control subjects. Specimens were fixed in glycol methacrylate, 2 microm serial sections cut and Image-J used to assess the sites and areas of immuno-staining. RESULTS: E-cadherin, CD44, keratins K5/6, K8, K13, K14, K18 and pan-keratin immuno-staining were all significantly lower in patients 'out of season' compared with normal controls. No structural differences in the epithelium were observed between the two groups. The epithelium of patients 'in season' was thicker and immuno-staining of the above markers similar to controls. CONCLUSIONS: The expression of a wide spectrum of epithelial cell adhesion proteins and cytoskeletal elements is downregulated in the conjunctiva of SAC patients 'out of season' compared with normal controls. We suggest that this could have an important impact on the ability of the epithelium to protect itself against allergen penetration, potentially influencing the development and course of allergic eye disease and offering a novel area for therapeutic control.