锯齿缘断离36例分析

锯齿缘断离３６例分析北京铁路总医院眼科徐景美锯齿缘断离是一种特殊类型的视网膜脱离，多发生在青少年，大多数有外伤史，因本病病变部位隐蔽，发展缓慢，未波及黄斑区患者无自觉症状。我院自１９８５年１月至１９９３年１２月收治视网膜脱离病人１９０例，其中锯齿缘断...     

锯齿缘断离46例临床分析

本文报告了１０年中住院的锯齿缘断离子４６例（４８眼），占同期孔源性视网膜脱离的１３．１８％，锯齿缘断离较多发生在年青人，且多位下颞下象限，本组４８眼均行手术治疗，成功率８７．５０％，对此病的特点，影响手术成功的因素及发病原因进行了讨论。     

锯齿缘断离术式探讨

报道４２例锯齿缘断离视网膜脱离的临床特点，讨论了四种术式的作用原理和复位率，指出巩膜外加压术效果最好，复位率为９５％，建议作为治疗该病的首选术式。     

视网膜锯齿缘断离53例

锯齿缘断离是一种特殊类型的视网膜脱离，多发生在青壮年。因本病的病变部位隐蔽，病情发展缓慢，未累及后极部时常无自觉症状，故常在发病较久后才初次就诊。我院自１９８０年以来收治锯齿缘断离病人５３例，报告如下。１临床资料１．１一般资料本组共５３例，其中男３１例，女２２例，年龄１５～６０ａ，右眼２３例，左眼３０例。有外伤史者１３例。屈光状态：一３．００Ｄ以内者８服，一３．００Ｄ～一６．００Ｄ者２３眼，大于一６．００Ｄ者７眼，余无屈光不正。１．２眼底表现（ｌ）锯齿缘断离的部位：颞上１３眼，颞下３１眼，鼻上５…     

锯齿缘断离误诊与漏诊的分析

锯齿缘断离是一种特殊类型的孔源性视网膜脱离，容易误诊，漏诊，报道的２０例（２４眼）锯齿缘断离中，被误诊或漏诊为中心性浆液性脉络膜视网膜病变８眼，继发性视网膜脱离７眼，外伤性脉络膜视网膜病变５眼，弱视４眼，分析了误诊，漏诊的原因并论述了鉴别诊断的要点。     

青年性前部视网膜劈裂锯齿缘断离及视网膜脱离

目的：探讨青年性前部视网膜劈裂锯齿缘断离及视网膜脱离的临床特点、治疗及其预后。方法：对青年性前部视网膜劈裂锯齿缘断离合并视网膜脱离患者10例20只眼进行常规检眼镜眼底及Goldmann三面镜联合巩膜压陷检查，根据不同情况进行激光光凝，或巩膜冷凝外加压手术治疗，并随访1～5年。结果：共lO例，年龄17～32岁，8例为双眼患病，病变位于颞下，双侧对称。11眼同时患有前部视网膜劈裂、锯齿缘断离及视网膜脱离，3眼患有前部视网膜劈裂及锯齿缘断离，1眼仅有前部视网膜劈裂，3眼仅有锯齿缘断离其中2眼合并视网膜脱离。13眼合并视网膜脱离者采用巩膜冷凝外加压术，全部一次治愈，5眼行激光封闭锯齿缘断离及劈裂区。随访期间未见视网膜脱离，视力均有不同程度提高。结论：青年性前部视网膜劈裂锯齿缘断离及视网膜脱离有典型的临床特点，尽早发现、适宜治疗，预后良好。     

锯齿缘断离术式选择与疗效的关系

报告５０例（５３眼）锯齿缘断离视网膜脱离的临床特点与术式，正确地选择术式视网膜复位率达１００％，其中１次复位率为９０．５７％，讨论了４种术式的适应症，作用原理和复位率。认为正确选择术式与疗效有密切关系。     

锯齿缘断离术式选择与疗效的关系

报道５０例（５３眼）锯齿缘断离视网膜脱离的临床特点与术式。正确地选择术式视网膜复位率达１００％，其中１次复位率为９０．５７％，讨论了４种式的适应症，作用原理和复位率。认为正确选择术式与疗效有效密切关系。     

人眼玻璃体基底-视网膜界面超微结构与锯齿缘解离

目的通过对人眼玻璃体基底-视网膜界面超微结构的研究,认识基底部玻璃体与视网膜的连接方式及特点,探讨锯齿缘解离的发病机制。方法对4例锯齿缘解离患者术中所获标本及10例眼库眼球标本行透射电子显微镜观察,研究玻璃体基底-视网膜界面的超微结构及连接特点。结果锯齿缘解离患者标本及眼库眼球标本均显示玻璃体基底与其下的神经视网膜及视网膜色素上皮紧密粘连。电镜下显示:与其他部位相比,玻璃体纤维明显粗大密集,呈束状、发辫状、编织状排列,视网膜内界膜缺损或消失,玻璃体纤维插入其下,或穿入细胞层的"隐窝",与视网膜神经胶质细胞(Mller细胞)甚至视网膜色素上皮细胞形成错综复杂的紧密连接。同时,在玻璃体基底-视网膜界面还存在有"类半桥粒"样结构的紧密连接方式。结论玻璃体基底-视网膜界面处复杂的紧密连接方式是导致锯齿缘解离发生的解剖学基础。     

广视野系统联合手术显微镜直视下冷凝锯齿缘断离性视网膜脱离

目的 探讨应用广视野系统联合手术显微镜直视下冷凝治疗锯齿缘断离性视网膜脱离的价值.方法 对锯齿缘断离性视网膜脱离24例(24眼)借助广视野系统进行玻璃体切除联合手术显微镜直视下巩膜外冷凝视网膜裂孔,对手术疗效、冷凝手术时间、手术并发症等进行随访和评价.结果 术后随访6 ～38个月,一次手术治愈率91.7％ (22/24),另2眼二次手术获得解剖复位,盲目率从术前75％ (18/24)下降到术后6个月的33％ (8/24);手术冷凝时间(5.0±1.2)min;无严重并发症发生.结论 广视野观察系统联合手术显微镜直视下冷凝治疗锯齿缘断离性视网膜脱离具有手术方式简化,冷凝时间缩短,术后视力恢复良好,一次手术治愈率高及并发症少.     

Biomechanics of the sclera and effects on intraocular pressure

Accumulating evidence indicates that glaucoma is a multifactorial neurodegenerative disease characterized by the loss of retinal ganglion cells (RGC), resulting in gradual and progressive permanent loss of vision. Reducing intraocular pressure (IOP) remains the only proven method for preventing and delaying the progression of glaucomatous visual impairment. However, the specific role of IOP in optic nerve injury remains controversial, and little is known about the biomechanical mechanism by which elevated IOP leads to the loss of RGC. Published studies suggest that the biomechanical properties of the sclera and scleral lamina cribrosa determine the biomechanical changes of optic nerve head, and play an important role in the pathologic process of loss of RGC and optic nerve damage. This review focuses on the current understanding of biomechanics of sclera in glaucoma and provides an overview of the possible interactions between the sclera and IOP. Treatments and interventions aimed at the sclera are also discussed.     

形觉剥夺下雏鸡视网膜、脉络膜和巩膜中全反视黄酸含量的变化

目的:雏鸡形觉剥夺性近视眼及形觉剥夺性近视恢复眼中视网膜、脉络膜和巩膜中视黄酸含量的作用.方法:选用新孵出的普通肉食家鸡75只,采用半透明薄膜眼罩遮盖的方法对左眼进行形觉剥夺,分为形觉剥夺组,遮盖时间为14d;形觉剥夺恢复组,遮盖11d后,去遮盖3d.两组的右眼作为对照眼.暗室内处死小鸡后,立即摘出眼球.冰台上用角膜钻取直径为8mm的后极部眼组织块,手术显微镜下快速分离出视网膜、脉络膜及巩膜纤维层和软骨层组织.将每3个标本作为一个样品.取空白样品,加入全反视黄酸标准溶液,按样品处理方法操作后,绘制标准曲线,根据标准品的色谱分析,分别确定出各组织中视黄酸的出峰位置,根据计算机的色谱工作站计算出样品的含量.结果:正常眼视网膜、脉络膜、巩膜中均有RA存在,其中脉络膜中RA含量最高,其次为巩膜及视网膜,其中巩膜纤维层的含量高于软骨层中的含量(P＜0.05).形觉剥夺14d后,视黄酸含量在视网膜中明显增高(P＜0.01,n=10);在脉络膜中明显下降(P＜0.01);在巩膜软骨层及纤维层中RA均明显下降(P＜0.01),其中,纤维层中下降得更为明显.除去形觉剥夺3d后,视黄酸含量在视网膜中明显下降(P＜0.01);在脉络膜中明显升高(P＜0.01),为剥夺眼视黄酸水平的7倍;在巩膜软骨层和纤维层中明显升高(P＜0.01),且纤维层中的含量高于软骨层中的含量(P＜0.05).结论:形觉剥夺及去形觉剥夺时,小鸡视网膜、脉络膜、巩膜纤维层及软骨层中视黄酸含量均发生了明显的变化,后极部巩膜纤维层中视黄酸含量变化比软骨层更为明显.     

外伤后重度眼球萎缩羟基磷灰石义眼座植入术

目的 探讨外伤后重度眼球萎缩患者羟基磷灰石义眼座植入的一种新方法。方法 对12例自体巩膜腔仅能包裹义眼座l／4～l／2的重度眼球萎缩患者，采用沿自体巩膜缘交叉褥式缝合，形成网式捆绑义眼座植入肌锥内，自体巩膜呈帽状覆盖义眼座，眼外肌较常规位置靠前缝合。结果 12例中除l例先天性小眼球患儿结膜裂开5mm，2月自愈外，其余11例均无并发症，义眼安装满意。结论 “网式捆绑法”羟基磷灰石义眼座植入术解决了因患者重度眼球萎缩，自体巩膜无法牢固包裹义眼座，又无异体巩膜时的眼眶美容难题。     

眼球壁异物X线、B超和CT定位诊断的评价

目的 分析X线、B超和CT对眼球壁异物定位的准确性,探讨较可靠的球壁异物定位方案。方法 对1993年6月～2000年12月间入院治疗的236例眼球壁异物进行临床回顾分析。以异物的术中定位为“金标准”分析B超、X线和CT对眼球壁异物的诊断阳性率,以及X线、CT对异物的空间定位准确性。并分析辅助检查准确性与异物大小、位置的关系。结果 X线、B超和CT判断异物与球壁关系的准确性依次为:CT>B超>X线;对异物是否穿出球壁的判断以CT最为灵敏,而B超的误诊率最低。结论 推荐X线作为眼球异物诊断的筛选方法,当定位片提示异物位于眼球壁附近时,应首选CT做进一步的确认;CT联合B超诊断眼球壁异物是目前最佳的诊断方法组合。     

恒河猴与人眼球结构及生物学参数差异的研究进展

恒河猴属于非人灵长类动物中的一种,因其形态解剖、生理机能与人类相似,已作为实验动物广泛运用于医学领域。为了进一步了解人眼和恒河猴眼球的正常形态、结构以及彼此之间的解剖学差异,笔者通过查阅大量文献,分别从角膜、晶状体、视网膜、巩膜结构、屈光参数以及眼压等6 个方面,阐述恒河猴眼与人眼的异同点,为以恒河猴为实验动物模型进行人类视觉系统疾病的研究提供参考依据。     

Finite element modeling of the human sclera: influence on optic nerve head biomechanics and connections with glaucoma

Scleral thickness, especially near the optic nerve head (ONH), is a potential factor of interest in the development of glaucomatous optic neuropathy. Large differences in the dimensions of the sclera, the principal load-bearing tissue of the eye, have been observed between individuals. This study aimed to characterize the effects of these differences on ONH biomechanics. Eleven enucleated human globes (7 normal and 4 ostensibly glaucomatous) were imaged using high-field microMRI and segmented to produce 3-D individual-specific corneoscleral shells. An identical, idealized ONH geometry was inserted into each shell. Finite element modeling predicted the effects of pressurizing the eyes to an IOP of 30 mmHg, with the results used to characterize the effect of inter-individual differences in scleral dimensions on the biomechanics of the ONH. Measurements of the individual-specific corneoscleral shells were used to construct a 2-D axisymmetric idealized model of the corneoscleral shell and ONH. A sensitivity analysis based on this model quantified the relative importance of different geometrical characteristics of the scleral shell on the biomechanics of the ONH. Significant variations were observed in various measures of strain in the idealized lamina cribrosa (LC) across the seven normal corneoscleral shells, implying large differences in individual biomechanics due to scleral anatomy variations alone. The sensitivity analysis revealed that scleral thickness adjacent to the ONH was responsible for the vast majority of variation. Remarkably, varying peripapilary scleral thickness over the physiologically measured range changed the peak (95th percentile) first principal strain in the LC and radial displacement of the ONH canal by an amount that was equivalent to a change in IOP of 15 mmHg. Inter-individual variations in scleral thickness, particularly peripapillary scleral thickness, can result in vastly different biomechanical responses to IOP. These differences may be significant for understanding the interactions between IOP and scleral biomechanics in the pathogenesis of glaucomatous optic neuropathy. The relationship between scleral thickness and material properties needs to be studied in human eyes.     

Combined hamartoma of the retina and retinal pigment epithelium associated with neurofibromatosis type-1

Background: Retinal tumors are occasionally seen in patients with neurofibromatosis type-1 (NF-1). These are usually astrocytic hamartomas or angiomas. Combined hamartoma of the retina and retinal pigment epithelium are tumors also described in NF-1, but this association has not been definitively established yet. Method: We report on a child with NF-1, who presented a combined hamartoma of the retina and retinal pigment epithelium in both eyes. Results: The diagnosis of bilateral combined hamartoma of the retina and retinal pigment epithelium in our patient was performed on the basis of the ophthalmoscopic appearance of the lesions. NF-1 was diagnosed following the current international clinical criterion, supplemented by neuroimaging findings. Conclusion: Despite the extreme rarity of this association, we believe that it is not coincidental, as the presence of a hamartomatous retinal lesion in a patient with a systemic hamartomatous neuroectodermic disease would be, at least, rational. Thus, NF-1 must be excluded in patients with combined hamartoma of the retina and retinal pigment epithelium.     

Gyrate atrophy of the choroid and retina. Early findings

Examination of two sisters ages 2 years 10 months and 6 years four months with gyrate atrophy of the choroid and retina provided an opportunity for detailed clinical investigation. Although the chorioretinal lesions were confined to the peripheral retina in the older case and were quite minimal in the younger case, there was electroretinographic evidence of marked involvement of the cone and rod systems. These cases offer an opportunity to assess an arginine restricted diet in preventing the progress of the disease.