试题与答案

1.在无额肌帮助下,提上睑肌肌力为: A.13 ～ 16mm;B.10 ～ 13 mm; C.7～10 mm;D.4～7 mm. 2.典型眼眶爆裂性骨折的最常见发生部位为: A.眶顶;B.眶外侧壁;C.眶缘; D.眶底和(或)眶内侧壁. 3.睑裂狭小综合征的四联征不包括以下哪一项? A.睑裂狭小;B.上睑下垂; C.正向型内眦赘皮;D.内眦间距增宽. 4.患者男性,25岁,因右眼拳击伤5h就诊.体格检查:右眼视力0.6,右眼睑肿胀,皮下积气、淤血明显,右侧颧面部感觉减退.无明显眼球凹陷,眼球上转受限,结膜下出血,角膜上皮擦伤,前房Tyn(+),瞳孔圆,光敏,晶状体透明,视盘界清、色淡红,视网膜平伏.该患者最需完善的进一步检查是: A.电生理(视觉诱发电位+视网膜电图); B.眼眶CT(横断位+冠状位); C.眼眶磁共振成像;D眼压.     

试题与答案

1.下列眼部组织发育来源不是中胚叶的是:A.血管;B.巩膜;C.睫状体上皮;D.脉络膜.2.下列关于角膜发育的说法不正确的是:A.胚胎6周末,前半中胚叶组织形成角膜基质层和内皮细胞层;B.胚胎6周末,角膜上皮层已形成;C.胚胎3个月,基质层前部细纤维形成前弹力层;D.胚胎2个月,内皮细胞分化形成后弹力层.     

A Case of Choroidal Tubercles

A14year鄄old鄄boywasadmittedtohospitalduetocough,feverwithchestpainforonemonth.Miliarytuberculosiswasdiagnosed,whichwasconfirmedbychestradiography,sputumspecim鄄enandsputumculture.Isoniazid,Rifampin,Py鄄razinamideandEthambutolwereincludedinthetherapy.Thepatientdidhavenosignofeyeprob鄄lem.JustincasetherewouldbesideeffectofEthambutol.Routineocularscreenwasrequested.Thepatientwasfirstseeninourdepartmentonthe10thApril,1997.Hisbestuncorrectedsightwas20/20bilaterally.Bothanteriorsegmentsandvitre…     

慢性扁桃体炎合并硬皮病及雷诺现象1例

患者,女,37岁.主诉为咽痛、吞咽困难10余日来我科就诊.检查:体温38.9℃,面部表情肌萎缩,皮下组织缺少,皮肤与肌肉组织粘连、变硬,双侧中指指尖黑色,呈坏死表现,双侧膝关节肿胀,压痛.双侧扁桃体Ⅱ度大,表面较多脓苔、易刮除,腭咽弓及腭舌弓急性充血,双侧下颌角淋巴结肿大、压痛.心脏听诊正常.验血常规:白细胞:16.5×109/L,抗"O"阳性,血沉加快.追问病史,该患者自幼咽痛、发热反复发作,年均发作5～8次,持续至今.10年前出现双侧膝关节肿胀,疼痛,行动受限.我院诊断:风湿性关节炎.给予对症治疗.4～5年前出现面部软组织萎缩,于外地诊断为"硬皮病",经治疗无效.一年前双手中指指尖疼痛,逐渐加重,指尖变黑,某医院诊断为"雷诺病",对症治疗无效.指端坏死范围逐渐增大.诊断:1.慢性扁桃体炎急性发作.2.风湿性关节炎.3.硬皮病及雷诺现象.急性炎症缓解后,行双侧扁桃体切除术.术后3个月复诊.关节肿胀疼痛症状明显减轻,指端坏死无加重,疼痛亦见明显减轻.验血常规及抗"O"、血沉等结果均正常.     

The Changes of Quality of Life in the Patients after Phacoemulsification with IntraocularLens Implantation

Cataractistheleadingcauseofworldwideblindness,whichcanresultintheimpairmentofvisionfunctionandthedecreaseofqualityoflife.Aftercataractextractionwithintraocularlensimplantation,thevisionfunctionandotherfunct鄄ionsrecover.Asaresult,thequalityoflifeimp鄄rove.Becauseofthesmallincision,visualacuitywillrecoverquicklyafterphacoemulsifecationwithintraocularlensimplantation.Afewreportshavebeenfoundabouttheearlychangesofquali鄄tyoflifeafterthiskindofprocedure.Thisprospe鄄ctivestudyinvestigatestheearlyp…     

视网膜色素变性的相干光断层成像

目的 通过相干光断层成像（optical coherence tomography,OCT）观察原发性视网膜色素变性（retinitis pigmentosa,RP）患者的视网膜黄斑区图像特征.方法 对临床诊断为原发性视网膜色素变性的25例50只眼进行相干光断层成像检查,观察形态特点并进行厚度测量.结果 原发性视网膜色素变性患者黄斑区的相干光断层图像,通常有6种表现：1.神经上皮层弥漫性增厚即水肿（厚度＞170μm）,13只眼（26%）.2.黄斑囊样水肿8只眼（16.7%）.3.神经上皮层萎缩薄变（＜120μm）,18只眼（36%）.4.视网膜色素上皮层和脉络膜毛细血管层萎缩薄变,见于所有患者.5.黄斑前膜4只眼（8%）.6.黄斑正常厚度.结论 相干光断层成像有助于较早地发现RP的各种黄斑病变,是很有用的检查方法.     

IJO/IES Event Photos

Prof.G.O.H.Naumann,President of ICO and Prof.Bruce Spivey,President-Elect of ICO met Prof.Xiu-Wen Hu(middle),Chief Editor of IJO/IES at WOC 2006 in Sao Paulo,Brazil.Prof.Bruce Spivey,President of ICO met Prof.Xiu-Wen Hu Chief Editor of IJO/IES at 2013 ICO WORLD Meeting in New Orleans USA.     

鼓膜修补术后致全聋1例

患者,女,41岁.主诉双耳听力下降30余年于2004年11月入院.患者自幼双耳流脓,伴听力下降,药物治疗无改善.20多年前曾在外院行"右耳乳突根治术",术后右耳听力完全丧失.1年前又在外院行"左耳鼓膜修补术",术后即发现左耳听力完全丧失.发病以来无眩晕、耳鸣和面瘫等症状.查体:左鼓膜紧张部中央性穿孔,鼓室少量分泌物.右耳道宽大,乳突腔引流通畅,未见异常分泌物.纯音测听检查示双耳全聋.ABR检查示双耳100dB均无反应.耳部轴位和冠状位放大CT示右侧乳突术腔周围软组织增厚,半规管和前庭缺失.左耳听骨外侧少许软组织密度影,内耳未见明显异常.内耳三维重建MRI示右侧半规管和前庭未显影,左侧内耳形态完好,未见明显异常.     

角膜丝状真菌感染病原学检查及药物敏感分析

Objective To analyze the distribution of cultured fungal specimens and the drug susceptibility of corneal fungal infection in vitro in Tianjin, China. Methods From January 2006 to June 2009, all of 170 corneal specimens of suspected fungal keratitis were collected in Tianjin Eye Hospital. The smear of microscopic was observed and cultured on the Sabouraud' s medium for 3～10 days. Drug susceptibilities test for positive samples were evaluated by microdilution method. Results In 170 specimens, the positive serapings smears were 98, positive rate 57.6%. Of 118 samples were positive, positive rate 69.4%. The Agreement rate of smear microscopic observation and fungal culture was 84.7%. Fusarium sp. (69.5%) was the most common pathogen, Aspergrium sp. was 24.6%. Fusarium sp. showed significantly higher susceptible to voriconazole (97.6%) and amphotericin B (84.2%), it was resistant to itraconazole and fluconazole. Aspergrium sp. was susceptible to voriconazole (96.6%), terbinafine (93.1%) and amphotericin B (86.2%), it resisted to itraconazole and fluconazole. Conclusions Fusarium sp. and Aspergrium sp. are the predominant pathogens of corneal mycotic diseases. Most of fungal isolates are susceptible to voriconazole, amphotericin B and terbinafine, whereas most isolates are resistant to itraconazole and fluconazole.     

近视发生发展影响因素的研究进展（续）

27. Fischer AJ , Miethke P , Morgan IG , et al . Cholinergic amacrine cells are not required for the progression and atropine-mediated suppression of form deprivation myopia. Brain Res ,1998,794 （ 1 ） ： 48. 28. Duncan G, Collison DJ. Role of the non-neuronal cholin- ergic system in the eye ： a review . Life Sci , 2003 , 72 （ 18-19 ） ：2013.     

婴幼儿白化病二例

病例1女,82天.因自出生后视力差就诊.患儿家长发现其注视不能,伴畏光,无眼红,未见明显分泌物.患儿为第1胎,足月顺产,出生体重3450g,出生后无明显窒息,无吸氧史.父母非近亲婚配,家族史不详.查体：发育良好,全身皮肤色淡,微呈粉红,毛发色黄白,心、肺、腹未及异常.患儿有物体追随视,固视差,畏光.     

Wegener肉芽肿病1例

患者男,47岁.因右眼发红疼痛,在他院诊断为"巩膜炎",久治无效.于2003年7月16日来我院就诊.检查视力右眼0.8、左眼1.0.右眼球颞上侧巩膜充血呈紫红色,无明显压痛,角膜透明,前房清晰,瞳孔圆形,直径3 mm,晶状体及玻璃体无混浊,眼底无异常.左眼正常.     

前囊膜收缩综合-Nd:YAG激光治疗1例

1病例报告 男,50岁.因双眼视力下降10a,左眼加重0.5a在我院就诊.查:右眼视力:0.2,左眼:0.05.双眼角膜明,前房清,晶状体核性混浊,右眼Ⅲ级,左眼Ⅳ级.眼底看不清.B超:无异常.眼电生理提示:双眼视诱发电位,视网膜电图均异常.于2006-12-20和2007-01-12分别行Phaco IOL植入术.植入博士伦亲水性丙烯酸酯人工晶状体-AKEROSADAPT四襻式人工晶状体.术后视力OD:0.6,OS:0.4.0.5a后,患者感双眼视力进行性下降复诊.视力:OD:0.1,OS:0.05.散瞳后视觉质量进一步下降.双眼前房(-),人工晶状体被挛缩的前囊膜紧紧包裹,近余中心2mm大小前囊袋口.四襻向前,向心卷曲,晶状体光学面向后凸起,后囊膜可见薄层增殖,混浊(图1).予Nd:YAG激光前囊膜放射状切开,人工晶状体光学面变平展,晶状体襻向外张开,视力提高至0.3(图2).     

Ophthalmic manifestations of Cryptococcus gattii species complex: a case series and review of the literature

AIM:To report 4 cases of Cryptococcus gattii(C.gattii)species complex infection with diverse ophthalmic manifestations,and to review the literature to examine pathobiology of disease,classical ophthalmic presentations and outcomes,and treatment modalities for this emerging pathogen.METHODS:Cases of C.gattii meningoencephalitis with ophthalmic manifestations were identified via chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series.Additionally,a MEDLINE literature review was conducted to identify all reported cases of C.gattii with ophthalmic manifestations from 1990-2020.Cases were reviewed and tabulated,together with our series of patients,in this report.RESULTS:Four cases of C.gattii with ophthalmic manifestations are presented;three from Australia and one from the USA.A literature review identified a total of 331 cases of C.gattii with visual sequelae.The majority of cases occurred in immunocompetent individuals.Blurred vision and diplopia were the most common presenting symptoms,with papilloedema the most common sign,reported in 10%-50%of cases.Visual loss was reported in 10%-53%of cases,as compared to rates of visual loss of 1%-9%in C.neoformans infection.Elevated intracranial pressure,cerebrospinal fluid(CSF)fungal burden,and abnormal neurological exam at presentation correlated with poor visual outcomes.The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures.CSF diversion procedures should be considered for refractory cases.Acetazolamide and mannitol are associated with high complication rates,and adjuvant corticosteroids have demonstrated higher mortality rates;these treatments should be avoided.CONCLUSION:Permanent visual loss represents a devastating yet potentially preventable sequelae of C.gattii infection.Intracranial hypertension needs to be recognised early and aggressively managed.Referral to an ophthalmologist/neuro-ophthalmologist in all cases of cryptococcal infection independent of visual symptoms at time of diagnosis is recommended.     

葡萄膜炎合并视网膜血管炎伴虹膜结晶一例

患者女,30岁.因左眼视物不清2个月于2010年7月26日来我院就诊.无眼红、眼痛、眼部异物感.既往身体健康,无眼部外伤及特殊药物使用史.2个月前足月顺产1名健康男婴.无阳性家族史.全身检查未见异常.跟部检查:视力:右眼0.8,左眼0.6.双跟矫正至1.0,近视力1.0.眼压:右眼19 mm Hg(1 mm Hg=0.133 kPa),左眼14 mm Hg.双眼外眼未见明显异常.裂隙灯显微镜及间接检眼镜检查显示,右服眼前节及眼底未见异常.     

家族性渗出性玻璃体视网膜病变伴假性外斜视一例

患者女性,33岁.自幼眼斜,未治疗.正常产,无吸氧史.家中兄长眼斜,未治疗.检查:视力:右0.2/Jrl,左0.1/Jrl.散瞳验光:右-5.00 DS,矫正视力0.6;左-5.00 DS,矫正视力0.4.眼压:右14 mmHg,左13 mmHg.眼位:双眼外斜15°注视,交替遮盖双眼不动(图1).双眼球运动正常.双眼角膜清,前房中深,瞳孔直径2 mm,对光反射正常.     

合并视网膜劈裂症的高度近视眼超声乳化白内障吸除术的临床观察

Objective To evaluate the changes of the retinal thickness in the highly myopic eyes with retinoschisis after phacoemulsification by optical coherence tomography (OCT) and to analyze their postoperative visual acuity. Methods It was a retrospective case series study. This study included 25 (35eyes) highly myopic patients with retinoschisis. One week, 1 and 3 months after phacoemulsification, the best corrected visual acuity (BCVA) was measured and OCT was performed to evaluate the central foveal thickness (CFT) as well as the maximum neurosensory thickness (MNT). These 35 eyes were divided into low and high accumulated energy complex parameter (AECP) groups, and ≤28.00 mm, ＞ 28. 00 and ≤ 30. 00 mm, ＞ 30. 00 mm groups according to the axial length respectively.Variance analysis of data obtained from repeated measurement, Wilcoxon rank sum test, linear correlation and one-way ANOVA were used to analyze the data. Results According to the location of schisis, the 35 eyes were classified as foveal schisis (20 eyes) and nonfoveal schisis (15 eyes). Among the 35 eyes,there were 30 eyes with outer retinoschisis and 5 with compound schisis. The mean BCVA (logMAR)preoperatively and 1 week, 1 and 3 months postoperatively was 0. 23 ± 0. 24, 0. 59 ± 0. 38,0. 57 ± 0. 38 and 0. 60 ±0. 36 respectively ( F = 31.15, P = 0. 000 ). CFT preoperatively and 1 week, 1 and 3 months postoperatively was (255.46 ± 197.57) μm, (256.80 ± 199.88) μm, (274.37 ±246.87) μm, and (268.60±238.41) μm (F=0.99,P=0.420); while MNT was (473.31 ±175.52) μm, (477.71 ±188.71 ) μm, (486. 60 ± 229. 17 ) μm and (482. 63 ± 208. 82) μm respectively ( F = 0. 26, P = 0. 857).BCVA in eyes with foveoschisis and in eyes with nonfoveal schisis was statistically significantly different at 1 week, 1 and 3 months postoperatively ( Z = - 0. 580, P = 0. 048; Z = - 2. 147, P = 0. 030 and Z =-2. 099,P =0. 034). BCVA (0. 43 ±0. 28) was inversely correlated with CFT (497.42 ±281.49) μm in the eyes with foveoschisis unaccompanied with a macular lamellar hole at 3 months postoperatively ( r =-0. 667, P =0. 018). There were no significant differences in the changes of the thickness of the retina between the groups with different AECP or among the groups with different axial lengths ( Z = - 0. 314-1. 290, P =0. 192-0. 741 and F =0. 15-0. 62, P =0. 545-0. 859). Conclusions Cataract surgery has no significant effect on thickness of the retina in the highly myopic eyes with retinoschisis. The patients with retinoschisis could achieve good visual recovery after phacoemulsification. Postoperative visual acuity is related to the location and degree of retinoschisis. Besides, patients with non-foveal schisis could obtain better visual acuity than those with foveoschisis. Further investigation on the development of retinoschisis and the complications after surgery is required.     

丙烯酸酯人工晶状体囊袋内稳定性和囊膜透明性观察

Objective To compare the amounts of intraocular lens (IOL) decentration and tilt, the anterior chamber depth (ACD) and the degree of posterior capsule opacification (PCO) using the Pentacam Scheimpflug System after cataract surgery between eyes with 1-piece acrylic IOL and 3-piece acrylic IOL Methods It was a perspective study. Fifty-one patients with bilateral senile cataract had implantation of a 1-piece SA60AT IOL in one eye and a 3-piece MA60BM IOL in the contralateral eye. The amount of IOL decentration, tilt, the ACD, and the degree of PCO was measured using the Pentacam Scheimpflug System 1 day and 1,6, 12 and 24 months postoperatively. Results There were no significant changes during the 24 m follow-up period in the decentration ( 0. 37 ± 0. 16, 0. 36 ± 0. 15, 0. 36 ± 0. 16, 0. 37 ± 0. 15,0. 38 ± 0. 16), tilt (3.59±0.91,3.64 ±0.92,3.61 ±0.90,3.63 ±0.90,3.70 ±0. 89)or PCO(22. 20 ±3.99,21.96 ±4. 00,22.40 ± 4. 03,22. 53 ± 4. 00,22. 95 ± 3. 87 ) in the 1 -piece SA60AT group ( F = 1. 938,0. 785,1. 814;P ＞ 0. 05 ) or in the 3-piece MA60BM group (0. 34 ± 0. 14,0. 33 ± 0. 14,0. 34 ± 0. 14,0.35±0.14,0.36 ±0.14),(3.55 ±0.90,3.57 ±0.92,3.63 ±0.88,3.61 ±0.88,3.65 ±0.89),(21.14 ±3.88,20. 98 ±3. 87,21.23 ±3. 83,21.59 ±3. 82,21.65 ±3. 87) (F = 1. 004,0. 525,1. 963;P ＞0. 05). There was no significant difference between the two groups in IOL decentration (t = 0. 802,0. 701,0.588,0. 898,0.631), tilt (t =0. 199,0.337,0.094,0. 121,0.248) or PCO(t = 1.214,1. 119,1.334,1. 082,1. 517)at any time points (P ＞ 0. 05 ). The ACD did not change after the surgery in the 1-piece group (3.90 ±0. 99,3.88 ± 1.07,3.91 ± 1.01,3.90 ± 1.02,3.92 ± 1.02) (F= 1. 333,P ＞0. 05) but was significantly deeper in the 3-piece group ( 4. 37 ± 1.02,3.90 ± 0. 98,3.95 ± 0. 99,3.93 ± 0. 96,3.97 ± 0. 99 ) ( F = 92. 757, P ＜ 0. 05 ) one day after the operation. The ACD was more shallow in the 1-piece SA60AT group than in the 3-piece MA60BM group at all time points. However, the difference was statistically significant only at 1 day after surgery ( t = 102. 944, P ＜ 0. 05 ). Conclusions The degrees of IOL decentration, tilt, ACD and PCO in eyes with a 1-piece acrylic IOL with flexible haptics implanted in the capsular bag were similar to those in eyes with a 3-piece acrylic IOL with rigid PMMA haptics. But the 1 -piece acrylic IOL provides a better stability than the 3-piece acrylic IOL in the early stage postoperatively.     

结核性全眼球炎并发眼球壁穿孔1例

患者男性,27岁.因右眼红、眼痛、视物不见1个月余入院.患者1个月前无明显诱因感右眼痛,视物模糊4 d在当地医院以右眼急性葡萄膜炎诊治(头孢拉定、地塞米松静滴)后病情加重.门诊以右眼全眼球炎收治.既往有结核病史.(根据患者诉已治愈).入院后查体:T 37.4℃慢性病容.双肺未闻及罗音.眼科检查:Vod无光感,Vos1.0.右眼睑肿胀.球结膜水肿明显.下方眼球壁见一蚕豆大小黄白色肿物,触痛剧烈,上下转动受限.角膜稍水肿,KP(-),房水闪光(+)虹膜纹理欠清,后粘连.下方隆起,瞳孔为黄色纤维紊物覆盖.晶状体隐约未见明显混浊,眼底窥不见.眼压Tn+3.左眼无异常.实验室检查:中性粒细胞89.1%,血红蛋白:99g/L,血沉:76 mm/h.尿、粪检查无异常.     

Effects of blocking activation of IGF-1-Stat3 signaling pathway in guinea pig sclera fibroblast by AG490 on expression of MMP-2 and Integrinβ1

Objective To explore the effect of Blocking activation of IGF-1-Stat3 signaling pathway in guinea pig sclera fibroblast (GSFs) by AG490 on expressions of MMP-2, Integrinβ1. Methods Cultured GSFs were divided into four groups: group A( control group: only DMEM without IGF-1 ), group B (only IGF-1 group), group C( IGF-1 + PBS group), group D( IGF-1 +25 μmol/L AG490 group). The expressions of Stat3, p-Stat3, MMP-2, Integrinβ1 protein induced by IGF-1 and inhibited by AG490 in GSFs were detected by Western blot. The levels of Stat3, MMP-2 and Integrinβ1mRNA were detected by RTPCR. Results Compared with Groups A and D, Stat3, p-Stat3, MMP-2 protein expression in groups B and C were expressed at higher level ( tpr = - 32. 324, - 26. 284, - 32. 876, - 26. 345, - 68. 668, - 58. 724,- 187.481, - 58. 842, - 110. 264, - 120. 256, - 121. 345, - 120. 286; tmRNA = - 31. 554, - 31. 178,- 31. 286, - 31.198, - 12. 076, - 14. 969, - 11. 896, - 14. 546, P ＜ 0. 05 ), but the expression levels were not obviously different between groups B and C (tp = -32.720, -32. 816, -68.668, -187.481,- 110. 264, - 121. 345; tmRNA = - 0. 692, - 0. 579, P ＞ 0. 05 ), which were similar to mRNA level. The Integrinβ1 protein and mRNA were expressed in groups A, B, C and D but no significant difference among them respectively (Fpr =0.214;FmRNA = 0.045,P ＞0.05). Conclusions Activation of Stat3 signaling pathway may be involved in up-modulating the expression of MMP-2 in GSFs, and not affect the Integrinβ1protein and mRNA changes. The results reveal that Stat3 signaling transduction pathway may play a critical role in sclera remodeling by means of modulating MMP-2 expression.