先天性白内障术后视觉重建(续)

<正>IATS报告了婴儿期单侧白内障的视觉结果,在4.5岁时,接触镜组和人工晶体组视力没有显著差异,两组中约50%治疗眼的视力低于或等于20/200^[6]。若白内障手术后无明显并发症,可在术后1周配戴角膜接触镜。接触镜度数取决于患者年龄,≤1岁者过矫2.0D;1～2岁过矫1.0D～1.5 D;3岁及以上:双焦点接触镜,下加+3.0D^[7]。     

依地酸二钠预防后发性白内障的实验研究

目的 探讨应用依地酸二钠(EDTA)清除晶状体上皮细胞,预防后发性白内障的可行性.方法 白内障摘除术中连续环形撕囊后取得人晶状体前囊膜30例,随机分为五组,分别用平衡盐溶液(对照组、A组),5mmol/L、10 mmol/L、15 mmol/L、30 mmol/L的EDTA溶液(B、C、D、E组)进行处理,观察晶状体上皮细胞的清除情况.结果 A组未见明显细胞脱落;B组晶状体上皮细胞仅有少部分脱落;C组和D组晶状体上皮细胞大部分脱落;E组晶状体上皮细胞完全脱落.结论 合适浓度的EDTA可以作为白内障手术中清除晶状体上皮细胞的有效方法,为防治后发性白内障提供理论依据.     

密蒙花总黄酮对去势雄鼠干眼症模型角膜和泪腺组织中TNF-α,IL-1β表达的影响

目的:探讨密蒙花总黄酮对去势雄鼠干眼症动物模型角膜及泪腺组织炎症因子表达的影响与组织损伤的关系。方法:选取150只健康1月龄Wistar雄性大鼠随机分为5组(正常组、假手术组、手术对照组、雄激素治疗组、密蒙花总黄酮治疗组,分别用A,B,C,D,E组表示),每组30只。将C,D,E三组实验鼠切除双侧睾丸及附睾;B组只切开阴囊,不切除睾丸,作为假手术对照组,A组不作处理。自造模后1wk,待伤口基本愈合开始用药。A,B,C组以生理盐水灌胃,1次/d;D组用丙酸睾酮注射液大腿肌肉注射,3d1次;E组以密蒙花提取物生理盐水混悬液灌胃,1次/d。各组实验动物分别于用药1,3,5mo后随机取10只,行SchirmerⅠ试验、泪膜破裂时间(break-up time,BUT)及角膜荧光素染色检查并处死各组动物,取双眼泪腺、角膜组织采用免疫组织化学方法观察各组角膜和泪腺组织中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),白细胞介素1β(interleukin 1β,IL-1β)蛋白的表达。结果:A与B组泪腺、角膜上皮细胞中TNF-α,IL-1β阳性表达均不明显;C组泪腺、角膜上皮细胞中TNF-α,IL-1β阳性表达的细胞数明显高于D,E组(P<0.05);D,E各组间差异不显著(P>0.05)。结论:去势雄鼠干眼症角膜和泪腺组织局部炎症反应可能是角膜损伤和泪腺分泌功能丧失的原因之一,TNF-α,IL-1β表达增加与其炎症反应有关。密蒙花总黄酮能够下调去势雄鼠角膜和泪腺局部TNF-α,IL-1β蛋白的表达,可能是其治疗干眼症的关键机制之一。     

血清维生素D水平与2型糖尿病视网膜病变程度的相关性研究

维生素D是一种脂溶性维生素,调节钙磷代谢,在骨骼代谢,骨质形成方面起重要作用。研究发现,维生素D除传统钙磷调节作用外,还参与炎性反应、免疫、糖脂代谢等病理、生理过程,维生素D通过受体发挥作用,是一种具有激素样作用机理的类激素样物质。近年来越来越多的研究表明维生素D可以预防和治疗糖尿病^[1-3],但也有一些研究并不支持这一观点^[4-5]。本研究探讨了维生素D与2型糖尿病视网膜病变     

菊花总黄酮对去势导致干眼症雄兔泪腺细胞Fas、FasL表达的影响

目的：观察菊花总黄酮对去势所致干眼症白兔泪腺凋亡相关基因蛋白Fas、FasL表达的影响,探讨菊花总黄酮治疗干眼症的作用机制。
　　方法：将150只雄性日本大耳白兔随机分为正常组( A组)、假手术组(B组)、模型组(C组)、雄激素对照治疗组(D组)和菊花总黄酮治疗组(E组)。 C组、D组、E组行双侧去势术建立白兔干眼症模型。 E组白兔用菊花总黄酮灌胃治疗,D组用雄激素肌肉注射,A组、B组、C组用生理盐水灌胃。分别于治疗后1,3,5mo每组处死10只,取材用与相关指标检测。全部白兔行 SchirmerⅠ试验,并检测泪膜破裂时间,处死后取泪腺组织,采用免疫组织化学法检测泪腺组织中凋亡相关基因蛋白Fas、FasL的表达,并计数凋亡细胞数量。
　　结果：E组SchirmerⅠ试验测量所得滤纸湿长明显高于C组(P<0.01),泪膜破裂时间明显长于C组(P<0.01)。 E组治疗1,3,5 mo后,泪腺导管及腺泡上皮细胞中Fas阳性表达的细胞数均明显低于C组,FasL阳性表达的细胞数均明显高于C组,细胞凋亡数量均明显低于C组(P<0.01)。结论：菊花总黄酮中主要成分为黄酮类物质,可显著抑制雄激素水平降低后白兔干眼症的发生,抑制泪腺细胞凋亡,维持泪腺基础分泌量和泪膜的稳定性。     

糖尿病视网膜病变患者玻璃体样本中白细胞介素-8和肿瘤坏死因子-α水平

目的:测量糖尿病性视网膜病变(DR)行玻璃体切除术(PPV)患者玻璃体样品中白细胞介素-8(IL-8),肿瘤坏死因子-α(TNF-α)的水平,与对照组比较结果并探讨其对DR的影响。方法:将伊斯坦布尔Bilim大学眼科系的57例(57眼)DR患者和22例黄斑裂孔未伴有增生性玻璃体视网膜病变患者分为研究组和对照组。对所有79例患者行3切口,20G PPV。PPV手术眼内灌注前,用Vitrector抽吸0.5mL玻璃体样品并稀释。样品转至冷藏室,存放在-70℃。IL-8和TNF-α的测量结果用酶联免疫吸附法以pg/mL为单位计算。结果:DR患者玻璃体样本中IL-8水平[82.7891±74.08700(0.08-307.09)pg/mL]明显高于对照组患者[2.9805±3.77546(0.08-18.53)pg/mL](P<0.001)。同样,DR患者TNF-α水平[18.0007±13.90015(2.32-51.11)pg/mL]也显着高于对照组[1.7005±1.26949(0.1-5.17)pg/mL](P<0.001)。结论:在视网膜新生血管形成中起重要作用的TNF-α和作为炎症和血管生成介体的IL-8水平在DR患者玻璃体样本中明显高。     

中国恩施土家族苗族自治州高度近视患者SCO2基因新突变

目的：探讨SCO2(OMIM 604272)基因在恩施土家族苗族自治州高度近视患者中的致病性变异。方法：共招募384例高度近视患者，其中至少一眼球镜度数≤-6.00 D，且眼轴长度≥26.00 mm。应用苯酚-氯仿法从5 mL外周静脉血中提取DNA。通过Sanger测序以鉴定SCO2第2外显子的致病性变异。运用计算机预测软件对检测到的变异进行评估。来自同一地区的288名健康人群作为正常对照。结果：共检测出7个突变位点，分别为4个同义突变(c.201C&#x003E;T/p.=，c.576C&#x003E;T/p=，c.633A&#x003E;C/p.=，c.780T&#x003E;C/p.=.)，2个错义突变(c.187A&#x003E;G/p.Ile63Val，c.59G&#x003E;C/p.Arg20Pro)和1个无义突变(c.544C&#x003E;T/p.Gln182*)。通过PolyPhen2、SIFT和Provean软件预测，两个错义突变没有致病性。新的无义突变(c.544C&#x003E;T/p.Gln182*)在1000G中未被发现，在288个正常对照中也未被发现。Variant Taster预测该无义突变位点是保守的。结论：新发现的无义突变可能是我们研究的高度近视患者的致病原因。SCO2与高度近视相关，而这批高度近视人群中SCO2基因突变的发生率低至1/384； 该无义突变可能是中国恩施土家族苗族自治州高度近视的一种罕见变异。     

间歇性外斜视手术对调节反应及调节微波动的影响

目的：研究间歇性外斜视患者的调节反应及调节微波动在手术前后的变化。方法：前瞻性临床研究。选取2017年6-8月在温州医科大学附属眼视光医院就诊的29例8～20岁间歇性外斜视手术患者,术前及术后1个月分别用Grand Seiko WAM-5500在双眼注视及单眼注视状态下测量持续注视33 cm处视标时的调节反应及调节微波动。数据采用配对t检验进行分析。结果：术前间歇性外斜视患者在双眼注视时的近距调节反应[主导眼： （2.23±0.44）D;非主导眼： （2.44±0.51）D]显著大于单眼注视状态[（2.03±0.40）D; （2.11±0.40）D]（t=2.481,P=0.019;t=2.786,P=0.009）。术后双眼注视时的调节反应[（2.00±0.37）D; （2.11±0.50）D]较术前显著减小（t=2.628,P=0.014;t=3.120,P=0.004）。术后双眼注视时的调节微波动[（0.16±0.08）D; （0.16±0.07）D]也较术前[（0.22±0.14）D; （0.22±0.12）D]显著减小（t=2.306,P=0.029;t=2.242,P=0.033）。结论：间歇性外斜视患者在斜视手术后调节功能得到改善,调节微波动变平稳,视觉功能得到提高。     

试题与答案

1.黄斑发育完全的时间约是:A.出生后4个月;B.胚胎第6个月;C.1岁;D.3岁;E.2岁。2."Smooth vergence"指的是:A.用遮盖试验+阶梯三棱镜法测量隐斜度;B.用von Graefe法测量隐斜度;C.用Risley棱镜测量聚散度;D.用阶梯三棱镜测量聚散度;E.以上都不是。3.不通过眶下裂的组织结构有:     

密蒙花总黄酮对去势导致干眼症雄鼠泪腺Bax mRNA、BcL-2 mRNA表达的影响

目的观察密蒙花总黄酮对雄激素水平下降所致干眼症雄鼠的泪腺上皮细胞中Bax mRNA、Bcl-2mRNA表达的影响。方法将健康1月龄、体质量150～180gWistar雄性大鼠150只随机分为A1、B1、C1、D1、E1、A3、B3、C3、D3、E3、A5、B5、C5、D5、E5共15组,每组10只。采用去势的方法建立雄激素水平下降所致干眼症动物模型,分别观察各组SchimerI试验、泪膜破裂时间及角膜荧光素染色情况,以确定干眼症模型是否建立成功。其中,A代表正常组;B代表假手术组;C代表模型对照组;D代表雄激素对照治疗组(造模成功后,丙酸睾酮1mg.kg-1大腿肌肉注射,每3d1次);E代表密蒙花总黄酮治疗组(造模成功后,密蒙花总黄酮0.045g.kg-1灌胃,每3d1次);1代表饲养1个月;3代表饲养5个月;5代表饲养7个月。用RT-PCR法对各组泪腺组织中Bax mRNA、Bcl-2mRNA的表达进行检测,并比较。结果SchimerI试验、泪膜破裂时间及角膜荧光素染色结果显示,大鼠均在造模3个月后形成干眼症。D3组、D5组泪腺组织中的BaxmRNA相对含量较C3组、C5组降低,差异均有统计学意义(均为P<...     

成人后极性白内障的临床特点和手术技巧

目的评价成人后极性白内障的临床特点、手术技巧和疗效。方法回顾性分析连续病例20例30眼,总结术前术中后囊情况、手术技巧、术中并发症以及术后视力恢复情况。结果术中后囊完整透明14眼(占46.7%),病理性后囊16眼(占53.3%),其中术前后囊破裂2眼(占6.7%),中央后囊缺损1眼(占3.3%),点状混浊但保持完整8眼(占全部病例的26.7%),后极偏鼻下混浊伴原始玻璃体动脉残留但保持后囊完整1眼(占3.3%),术中后囊破裂4眼(占13.3%)。2眼在轻柔水分层时出现破裂,2眼在试图清除后囊点状混浊时破裂。26眼囊袋内植入人工晶状体,4眼睫状沟植入。术后矫正视力:0.1~0.3者7例7眼(占23.3%),0.4~0.8者2例3眼(占10%),1.0~1.2者11例20眼(占66.7%)。结论后极性白内障很可能具有后囊先天异常、后囊破裂或缺损,可能术前已经存在或术中发生,充分的术前散瞳检查、轻柔的水分层、不作后囊抛光是避免术中并发症和提高手术预后的关键。大部分患者视力均明显提高,单眼患者视力恢复较差。     

Calibration error on the measurement of back vertex power for contact lenses with method using focimeter with manual focusing.

PURPOSE: The International Standard ISO 9337-1, which sets forth the method for measuring back vertex power of contact lenses with manually focusing focimeters, specifies that test lenses conforming to ISO 9342 may be used to calibrate focimeters on its spectacle lens support, and correction values obtained in this way can be used directly in measuring contact lenses on its contact lens support. This study was conducted because of concern that the method mentioned in ISO 9337-1 is not good enough for the calibration of focimeters used to measure contact lenses. METHODS: To test the validity of this method, a research group from China National Institute of Metrology (NIM) studied it theoretically and carried out a series of comparison experiments, respectively, with the conventional test lenses conforming to ISO 9342 and test lenses made at NIM (with an expanded uncertainty of 0.025 D). RESULTS: The results show that the measurement error between the two calibration methods will exceed 0.50 D if the specification described in ISO 9337-1 is adopted. This error also exceeds allowable tolerances for focimeters and for contact lenses themselves. Experiments and theoretical calculations done by the NIM group show that these errors mainly come from spherical aberration. Vertex error induced by the lens support is not negligible. CONCLUSION: When focimeters are calibrated to find correction values with the method specified in ISO 9337-1, measurement error will not be eliminated if these correction values are used in measuring contact lenses, and the resulting deviation is too large to be ignored. Therefore, special test lenses should be used to calibrate focimeters to find correction values when these focimeters are used to measure back vertex power of contact lenses because contact lenses are a special product being used to correct human vision.     

FLAMMABILITY TESTING OF MATERIALS CURRENTLY USED IN AUSTRALIA FOR INDUSTRIAL AND COSMETIC EYEWEAR*

Until recently, standards concerned with flammability testing of eyewear materials have been vague and inadequate. The International Standards Organization (ISO) In 1968 produced a draft for Non-optical Aspects of Eye Protectors. This includes a comprehensive test for flammability testing of frame and lens materials which has subsequently been incorporated into current Australian Standard specifications for Industrial Eye Protectors. This study was conducted to investigate flammability characteristics of materials currently used in the manufacture of frame and lens materials for industrial and cosmetic eyewear in Australia. Procedures were carried out according to ISO recommendations. Results and implications of the tests are discussed. The conclusion is reached that materials currently used in Australia for protective and cosmetic eyewear — with the exception of cellulose nitrate, which is rarely used — comply with ISO and hence Australian flammability standards.     

Imaging quality of intraocular lenses

PURPOSE: To compare the imaging quality of several commercially available intraocular lenses (IOLs) using the modulation transfer function (MTF) method according to the requirements of the International Standard European Industrial Norm/International Organization for Standardization 11979. SETTING: Universitat für Technik der Informationsverarbeitung, Universit?t Karlsruhe, Karlsruhe and Universit?ts Augenklinik, Ulm, Ulm, Germany. METHODS: Two refractive powers (+13 diopter [D] and +26 D) of each IOL type were tested. The imaging quality of all tested IOLs was measured before the injection test and in 5-minute intervals after the injection for 40 minutes. The measurement data were analyzed according to 2 quality criteria, Strehl ratio and the ISO condition. For analysis of the type of optical design, SEM images of the central cross section were taken of each IOL. Basic terms in optics such as MTF, resolution, and optical aberration are introduced, and their relevance for ophthalmology is discussed in detail. This paper represents an extensive study comparing the imaging quality of various IOLs including the comparison of measurements before and after injection through a cartridge as used for state-of-the-art implantation techniques. All measurements were performed using an MTF measurement system using a 546 nm optimized laser source and an effective aperture of 3.0 mm on the IOL according to ISO standard. An ISO standard eye model using an artificial cornea (spherical design) and a watery solution to simulate in vivo conditions was used. RESULTS: All IOLs apart from 1 +26 D lens complied with ISO standard requirements. However, the imaging quality varied up to 49% depending on the optical design and the manufacturing quality. CONCLUSION: When the methods and materials recommended by the manufacturer for IOL injection through a cartridge were used, no long-term effect on the imaging quality of the IOLs was observed. However, the basic imaging quality of different designs and different manufacturers varied significantly (up to 50% at +26 D) IOLs and should be considered when choosing an IOL.     

Efficacy of contact lens multipurpose solutions against serratia marcescens.

PURPOSE: To compare the susceptibilities of clinical isolates of Serratia marcescens and the standard ISO ATCC 13880 strain to five contact lens multipurpose disinfection solutions (MPDSs). METHODS: Five commercially available MPDSs, containing either a polymeric biguanide or polyquaternium, were tested using ISO/CD 14729 stand-alone test for contact lens care products against four ocular isolates of S. marcescens and the strain ATCC 13880. An average log reduction in bacterial numbers at the manufacturer's minimum recommended disinfection time was determined and compared with the criteria for stand-alone disinfection products for each MPDS against each bacterial strain. RESULTS: All the MPDSs tested met the stand-alone criteria of 3-log reduction of viable bacteria against the ATCC strain of S. marcescens. However, there was more variability in their ability to meet disinfection criteria when tested against the clinical isolates. Two of the clinical isolates were significantly more resistant to disinfection than was the recommended ISO strain (p < or = 0.034). Two of the polyquaternium-1-based disinfection solutions (solutions D and E, p < or = 0.005) were less effective overall than the other MPDSs against S. marcescens. CONCLUSIONS: The importance of strain selection for the testing of MPDSs is indicated, and the use of a single laboratory strain may be insufficient to provide assurance that the disinfection solution will be effective against clinical isolates. Furthermore, clinical isolates of S. marcescens may show increased resistance to disinfection with polyquaternium.     

Pre-school visual acuity tests

A number of visual acuity tests are available for both the literate and the preliterate child. This paper compares the results obtained with five different visual acuity tests; Illiterate E, Landolt C, Bailey-Hall Cereal test, Lighthouse Flash Cards and Stycar Five Letter test, for 43 children between the ages of three and five years. The linear Illiterate E test appears to be the test of choice; it will detect amblyopia, and the results are not significantly different from those obtained for the single optotype tests. No significant differences were found between the results for the different single optotype tests used in this study. The Landolt C test results are significantly different from those for the other tests and we do not recommend this test for young children.     

Vision test program for ophthalmologists on Apple II, IIe and IIc computers

A microcomputer program for the Apple II family of computers on a monochrome and a color screen is described. The program draws most of the tests used by ophthalmologists, and is offered as an alternative to a projector system. One advantage of the electronic generation of drawings is that true random orientation of Pflueger's E is possible. Tests are included for visual acuity (Pflueger's E, Landolt rings, numbers and children's drawings). Colored tests include a duochrome test, simple color vision tests, a fixation help with a musical background, a cobalt blue test and a Worth figure. In the astigmatic dial a mobile pointer helps to determine the axis. New tests can be programmed by the user and exchanged on disks among collageues.     

Preschool visual acuity tests: A comparison between two prototype charts and two visual acuity charts in current use

The lack of standardised visual acuity charts with established norms for preschool children has resulted in a diverse variety of visual acuity tests in use for the paediatric patient. All available tests appear to have some limitations, including inadequate norms, long test times, poor reliability, and frequently use test parameters and stimuli which are different from those used with adults. This study compares results for four visual acuity test charts. A Bailey-Lovie Illiterate E chart and an abbreviated Sheridan-Gardiner test were compared with two prototype acuity charts; a modified Bailey-Lovie letter chart and an Arrow chart. A novel symbol such as an arrow constructed as a Snellen optotype incorporated into a chart on the Bailey-Lovie principle, was the test of choice. This test was interesting to preschool children and results showed significant correlation with those obtained using charts based on adult standards.     

Refraction and visual acuity measurements: what are their measurement uncertainties?

The details of refractive and visual acuity measurement have been examined using the International Standards Organization (ISO) guidelines for the estimates of uncertainty. It is clear that there is a number of sources of uncertainty in quoted values. Some of these can be analysed statistically, using the ISO guidelines and can be used to estimate an uncertainty in the final recorded values. These should be regarded as minimum uncertainties because there are other factors involved such as unwanted accommodation, which will affect the final outcome. The analysis shows that the standard uncertainty (± one standard deviation) is about 0.3 D in refractive error measurement and about 0.04 in LogMAR acuity. The normally quoted expanded uncertainty, which provides a 95 per cent confidence level, would then be 0.6 D in refractive measurement and 0.08 in LogMAR acuity.     

A comparison of stereopsis testing between red/green targets and polarized targets in children with normal binocular vision.

BACKGROUND: Measurement of stereopsis is important in assessing a patient's binocular status. Several measurement methods are available, most commonly using polarized targets. Recently, less expensive red/green targets have become available. In this study, we compare polarized versus red/green methods, using random dot and contour targets. METHODS: Sixty children with no strabismus, amblyopia, or high refractive error and normal ocular health were recruited. Stereopsis measurements were taken using the red/green and polarized versions of the Random Dot Letter "E"/RDE Test, Random Dot Butterfly/Stereo Butterfly Test, Stereo Circles/Wirt Circles, Stereo Numbers, and Stereo Animals tests. Observed agreement was used to assess agreement between results. Wilcoxon signed-rank tests were used to compare an individual's response with both targets. RESULTS: There was greater than 95% agreement using any of the Random Dot-based tests and the Stereo Animals tests. However, agreement was less than 60% with the Stereo Numbers test and less than 35% with the Stereo Circles/Wirt Circles test. CONCLUSION: The red/green versions of the Random Dot-based tests and the Stereo Animals test appear to be a cost-effective alternative to their polarized equivalents. Our data, however, show that the red/green versions tend to underestimate the level of stereopsis when using the Stereo Numbers and Stereo Circles/Wirt Circles tests compared to their polarized equivalents.