第六讲 社区老年健康 第二章 常见老年病

第二十七节 老年性白内障 眼球内晶体囊受损或晶体蛋白质改变导致晶体混浊称为白内障。白内障是我国致盲的首要原因。国内现有白内障病人500多万,其中大部分为老年性白内障,其患病率随年龄增长而升高,70岁以上老年人白内障发病率可达80％。     

老年性白内障患者手术前后眼球结构的超声检测

老年性白内障患者手术前后眼球结构的超声检测１０６医院（山东济南２５００２２）杨艳峰济南军区总医院王焕旭张康兰蒋华于立波老年性白内障囊外摘除同期植入人工晶体（ＥＣＣＥ＋ＩＯＬ）可使患者恢复视觉功能，但功能恢复程度与术前预测有关。由于白内障的晶体混浊特性...     

老年性白内障血清、晶体及房水中微量元素的测定

为研究老年性白内障的病因，对不同时期老年性白内障病人的血清、晶体和房水，应用三电极直流等离子体原子发射光电直读光谱仪测定所含微量元素。     

白内障形成机制研究

通过对老年性白内障、外伤性白内障、先天性白内障(共14例)及正常晶体(20例)的SOD测定,表明晶体内自由基产生增加,抗氧化能力障碍是白内障形成的重要原因之一。同时,对晶体内自由基的发生及致病机理进行了探讨,提示在白内障形成初期,给予抗氧化制剂在可能阻止或延缓白内障形成。     

用晶体混浊分类系统Ⅲ探讨复方水蛭滴眼液防治老年性白内障的临床研究

目的 :用晶体混浊分类系统Ⅲ (lensopacitiesclassificationsystemⅢ ,LOCSⅢ )探讨复方水蛭 (shuizhi,SZ)滴眼液对老年性白内障的防治作用。方法 :采用以民间验方为基础、以SZ为主要成分、富含锌和维生素C的复方SZ滴眼液 ,并以进口抗白内障药物吡诺克辛钠滴眼液 (吡诺克辛 )为对照组 ,应用LOCSⅢ晶体混浊分类系统观察和比较两种滴眼液对老年性白内障的防治作用。结果 :复方SZ滴眼液组视力提高率 (76 % )、晶体混浊减低率 (5 9% )、有效率 (6 6 % )均明显优于吡诺克辛滴眼液对照组(2 .0 %、0 %和 2 .0 % )。且无明显的不良反应。结论 :复方SZ滴眼液是一种安全、有效的抗白内障药物 ,疗效优于进口抗白内障药物吡诺克辛滴眼液。     

皮质类固醇联合扩瞳治疗人工晶体前膜

人工晶体前膜是白内障囊外摘除联合后房型人工晶体植入术后较为常见的并发症。若治疗不及时,往往影响病人的术后视力,甚至使一部分病人须再次手术或激光切开前膜才能恢复视力。本文回顾了我科近年来施行的后房型人工晶体前膜形成,应用皮质类固醇联合扩瞳治疗取得良效,现报告如下。 1 资料和方法 1.1 1993年4月～1996年7月间共施行后房型人工晶体植入术51例,其中老年性白内障48例57眼,外伤性白内障2例2眼,并发性白内障1例1眼。出现明显的人工晶体前膜者6例(老年性白内障5例,外伤性白内障1例),其中1例老年性白内障     

缝线固定人工晶体的临床分析

应用缝线固定法植入人工晶体10只眼,其中老年性白内障、外伤性白内障术中晶体后囊破裂≥6mm7只眼,外伤性白内障术后无晶体后囊3只眼。随访观察3个月～24个月,矫正视力≥4.5。有9只眼,未发生严重并发症。对手术的方法进行了讨论。     

糖尿病合并白内障与单纯老年性白内障应用白内障超声乳化摘除及人工晶体植入的效果

目的研究糖尿病合并白内障与单纯老年性白内障应用白内障超声乳化摘除及人工晶体植入治疗的临床效果。方法运用小切口隧道式超声乳化与囊袋内人工晶体植入法对2017年3月至2018年1月收治患有糖尿病合并白内障患者(A组47例52眼)与单纯老年性白内障患者(B组47例52眼)展开治疗,对比两组患者的治疗情况。结果对比两组患者的术后并发症,A组经治疗后总并发症发生率为48.08%,B组经治疗后并发症发生率为50.00%,差异不明显P> 0.05。结论糖尿病合并白内障与单纯老年性白内障应用白内障超声乳化摘除及人工晶体植入治疗的效果佳,具有临床推广价值。     

人工晶体植入术联合超声乳化治疗老年性白内障的效果观察

目的对老年性白内障治疗中人工晶体植入术联合超声乳化的效果进行探讨。方法选择我院2016年7月至2017年6月收治的老年性白内障患者120例,依据随机数字表法分为实验组和常规组,每组各60例。对照组接受小切口白内障摘除联合人工晶体植入,实验组超声乳化联合人工晶体植入,统计并对比两组术后1 d、30 d视力和并发症发生情况。结果术后1 d、30 d实验组视力水平显著高于常规组(P<0.05)。实验组并发症发生率显著低于常规组(P<0.05)。结论在老年性白内障治疗中应用超声乳化联合人工晶体植入,能够使患者视力水平得到显著改善,减少术后并发症。     

探讨超声乳化联合人工晶体植入术治疗老年性白内障的临床效果

目的观察并分析超声乳化联合人工晶体植入术治疗老年性白内障的临床效果。方法以本院2014年5月至2016年4月间接诊的老年性白内障病患作为目标对象,将符合此次研究纳入标准及排除标准的80例患者作为此次研究对象,将80例病患依据信封法分为2组,并将小切口非超声乳化囊外摘除术联合人工晶体植入术治疗的40例作为对照组,将超声乳化联合人工晶体植入术治疗的40例作为观察组。结果观察组治疗6个月后视力正常或近正常概率约为90.0%明显高于对照组(P<0.05)。另对比两组患者并发症发生概率、生治质量评分等指标,观察组也均具有明显优异性(P<0.05)。结论采用超声乳化联合人工晶体植入术治疗老年性白内障所得治疗效果更为显著,帮助患者尽快恢复视力,降低并发症发生概率,促进患者康复,提高患者生活质量,故值得推广。     

老年性白内障晶体的超微结构改变

目的和方法,彩和透射电镜观察老年白内障晶体组织超微结构变化,结果：老年性白内障晶体囊可见双层膜结构,晶体上皮细胞间隙增大,细胞间指标状突起养活,线粒体突泡性变,结论：老年性白内障晶体囊膜及前囊下上皮细胞层通透性增加。     

Involvement of DNase II-like acid DNase in the cataract formation of the UPL rat and the Shumiya cataract rat

The loss of organelles and DNA is important to ensure transparency of the lenses, and DNase II-like acid DNase (also called DNase IIbeta, DLAD) is related to the loss of organelles and DNA in the lenses. We investigated the relation between the degradation of DNA and DLAD mRNA expression in the lenses of two hereditary cataract rats, the UPL rat (UPLR) and the Shumiya cataract rat (SCR), during cataract development. Undigested DNA was detected in the lens cortexes of normal UPLRs and SCRs, and undigested DNA was degraded in the lens nuclei of normal UPLRs and SCRs. DLAD does not affect common cataract formation, since DLAD mRNA expression levels in the lenses of cataractous SCRs were not changed with an increase in age, and undigested DNA was degraded in the lens nuclei of cataractous SCRs. On the other hand, an accumulation of undigested DNA was found in the lens nuclei of cataractous UPLRs at 46 and 53 d of age with opaque lenses, and the decrease in DLAD mRNA expression levels occurred prior to the accumulation of undigested DNA in the lens nuclei. It is possible that UPLRs are a good model for cataract caused by a decrease of DNA degradation in the lenses.     

Regional and subcellular distribution of ascorbate free radical reductase activity in the human lens.

This paper reports that the human lens is endowed with a characteristic regional and subcellular distribution of ascorbate free radical (AFR) reductase (EC 1.6.5.4) activity, and it is associated with the soluble fraction of the lens protein. AFR reductase activity in either immature senile cataractous or transparent lens was higher in the cortex, where the level of insoluble protein is lower, than in the nucleus. The high reductase activity and low insoluble protein content of the cortex were comparable between the assayed cataractous and transparent lenses. In the nucleus, in contrast, the reductase activity tended to decrease with an increase in the level of insoluble protein and with the development of nuclear coloration (sclerosis). As for the subcellular distribution of AFR reductase activity, 70-90% of the enzyme activity in the lens was located in the cytosol fraction. Based on the above results, it was proposed that cytosolic free radicals may be involved in oxidation, coloration and aggregation of lens protein in senile cataractogenesis and in lens aging.     

Studies on protein and taurine in normal, senile and diabetic cataractous human lenses

An attempt has been made to explore the possible role of Taurine in cataractogenesis. Normal lenses were obtained from eye bank donors and cataractous lenses from patients who had undergone surgery for cataract extraction. Lenses were weighed and homogenised. Extraction, isolation and estimation of protein and taurine were carried out. It has been found that the lens wet weight increased progressively with the stage of maturation of cataract, i.e., from mature to hypermature which was significant and also with increase in age. Diabetic cataract group also showed an increase similar to that of senile cataract. Taurine and total protein decreases with different stages of maturation of cataract but not with age. It may be suggested that in the process of development of human senile cataract, there is (a) alteration in the structural integrity and permeability of lens membrane to protein and amino acids including taurine, (b) changes in the lens function including possible inhibition of proteins and amino acids (taurine) synthesis and transport across the cell membrane.     

Reduced glutathione levels in senile cataractous lens epithelial cells.

A sensitive assay, utilizing high performance liquid chromatography and sulfhydryl (SH) fluorescence labeling, was used for the quantitative determination of reduced glutathione (GSH) and cysteine (CySH) in senile cataractous lens epithelial cells. The capsule-epithelia (CE), obtained following cataract surgery, were soaked in 0.3 ml saline at room temperature for 1 hour. Detached epithelial cells and the capsule with attached residual cells were assayed for GSH and CySH. Regression analysis of the relation between epithelial protein content and capsule wet weight was performed to evaluate the amount of contamination of the CE samples with lens cortex. GSH levels in the cataractous lens epithelial cells were 23.0 +/- 11.2 (Mean +/- S.D.) nmol/mg protein (n = 15); CySH levels were 0.51 +/- 0.50 nmol/mg protein (n = 12). No differences in GSH levels were observed between immature and mature cataracts. Thus, GSH levels in the lens epithelial cells did not appear to decrease with the progression of the senile cataracts.     

Crystallin proteins in lenses of hereditary cataractous rat, ICR/f

ICR/f mutation in rat, an inherited disorder, is characterized by the development of cataracts. In this study, we analyzed and compared the crystallins in normal and cataractous rat lenses using gel filtration and two-dimensional gel electrophoresis, and determined the transglutaminase activities and Ca2+ content in the mutant and normal lenses. The Ca2+ content about 10-fold and the activity of transglutaminase was about 1.8-fold higher in the cataractous lenses than in the normal lenses. Analysis of the cataractous lens proteins showed a remarkable decrease in gamma-, betaB1-, betaA3-, and betaA4-crystallin content, accompanied with some increase in alpha-crystallin (or its aggregate). Higher molecular weight proteins were also observed in the cataractous lenses, with molecular masses which correspond to those of cross-linked dimers (43 to 55 kDa) of beta-crystallins. We consider that the mutation accelerates the aggregation of the crystallins, which is associated with their cross-linking by transglutaminase.     

Delay of cataract development in the Shumiya cataract rat by the administration of drinking water containing high concentration of magnesium ion

We discovered that the cataract development in the Shumiya cataract rat (SCR) can be prevented by the administration of deep-sea drinking water (DDW). A standard diet based on the American Institute of Nutrition guidelines (AIN-76) and DDW containing a high mineral concentration such as low, medium and high Mg(2+) content (50, 200 and 1000 mg of Mg(2+)/l, respectively) were used in this study. SCRs were freely fed with combinations of the standard diet and purified water or DDW during 5-15 weeks of age. The opacities of SCR lenses were documented by anterior eye segment analysis system EAS-1000. The onset of opacification of cataractous SCR lenses administered a combination of standard diet and purified water started at 11 weeks of age, and mature cataracts had formed at 13 weeks of age. However, the supplementation of Mg(2+) by administration with medium DDW showed the greatest effect of delay of cataract onset in SCR. In addition, even cataractous SCR lenses at 14 weeks of age showed differences in opacity level. The opacification and Ca(2+) of the lenses in cataractous SCR administered medium DDW were lower than those administered purified water. In conclusion, the present study demonstrates that administration of DDW potently delays cataract development in SCR, and this may be caused by inhibiting the increase in Ca(2+) levels in the lens.     

过氧化物与老年性白内障

目的:为探讨老年性白内障晶体的脂质过氧化物水平,我们对正常透明晶体和老年性白内障混浊晶体的水溶性荧光物质(WSFS)进行了对比测定。方法:应用荧光光谱法,对40例老年性白内障患者施行囊内冷冻摘除术后晶体和9例透明晶体的WSFS进行了测定。结果:老年性白内障晶体WSFS的相对荧光强度均值为549.147±179.42单位;与透明晶体的相对荧光强度均值(345.165±92.93单位)相比,具有非常显著性差异(P<0.01)。结论:WSFS是脂质过氧化物的代谢产物,其在老年性白内障晶体的异常增高,提示氧化损伤与老年性白内障的发生密切相关。     

Phosphoproteome analysis of hereditary cataractous rat lens alpha-crystallin

We reported previously that C-terminal truncated alpha-crystallins were found in lenses of hereditary cataractous rat ICR/f. In this study, we examined the phosphorylation of the crystalline lens proteins, alphaB-crystallin and alphaA-crystallin, in cataractous and normal rats of different ages and have found an increase in the phosphorylation of serine residues of truncated alpha-crystallin in cataractous lens. Phosphorylation and C-terminal truncation of alpha-crystallins could, both, reduce their chaperone-like activity and lead to cataract formation.     

The Role of Vitamin C,Vitamin E,and Selenium on Cadmium-Induced Renal Toxicity of Rats

The aim of this study was to determine whether vitamin C, vitamin E, and selenium have protective effects against cadmium-induced renal toxicity of rats. Vitamin C (250 mg/kg/day), vitamin E (250 mg/kg/day), and sodium selenate (0.25 mg/kg/day) were given to rats orally for 8 days. Cadmium (2 mg/kg/day CdCl₂) was given to rats intraperitoneally. Vitamin C, vitamin E, and selenium (in the same dose and time) were given 1 h prior to the administration of cadmium every day. The tissue and blood samples were taken from the rats for histological evaluation and biochemical analyses on the Day 9. Lipid peroxidation (LPO) and glutathione (GSH) determination were made in kidney tissue. In addition, urea and creatinine levels were determined in serum. The damage to the kidney tissue was moderate in the rats given cadmium. In this group, the distinctive changes in the proximal tubules were observed. Degenerative changes in kidney tissue were also observed in rats given vitamin C, vitamin E, selenium, and cadmium. LPO levels significantly increased and GSH levels decreased in kidney tissues following cadmium administration. Serum urea and creatinine levels were also increased in rats given cadmium. The administration of vitamin C, vitamin E, and selenium caused a significant decrease in LPO levels and an increase in GSH levels in the kidney of rats given cadmium. Serum urea and creatinine levels were decreased in rats given both the antioxidant and cadmium. It is concluded that vitamin C, vitamin E, and selenium showed some protective effect on the rat kidney.