Ⅱ期人工晶状体植入术治疗玻璃体切除术后无晶状体眼的临床观察

目的:评价因复杂眼外伤或孔源性视网膜脱离行玻璃体手术后无晶状体眼Ⅱ期人工晶状体植入术的治疗效果、手术安全性。方法:采用巩膜隧道切口,根据晶状体囊膜保留程度选择不同眼内灌注、不同方法植入不同类型人工晶状体,对35例35眼玻璃体手术后无晶状体眼行Ⅱ期人工晶状体植入术。术后随访3～15(平均8)mo。结果:35例均完成Ⅱ期人工晶状体植入术,术后裸眼视力均有提高。裸眼视力≥0.3者22眼(62.8%),0.1～0.2者10眼(28.6%),≤0.1者3眼(8.6%)。主要并发症有驱逐性脉络膜上腔出血、玻璃体积血、低眼压、脉络膜脱离、人工晶状体偏斜、角膜水肿等。结论:巩膜隧道切口人工晶状体植入术治疗玻璃体手术后无晶状体眼能改善和提高患眼视力。术中采用稳定的眼内灌注、巩膜隧道切口、合适的人工晶状体植入,可降低手术并发症的发生。     

前段玻璃体切割在复杂眼外伤手术中的应用

目的探讨前段玻璃体切割术在复杂性眼前段、后段外伤手术中的效果。方法选择我院资料完整的眼外伤住院病例86例(86眼),均行前部玻璃体切割术。其中开放性眼球外伤53眼、钝挫伤性晶状体脱位19眼、外伤性白内障合并前后囊膜破裂伴玻璃体脱入前房14眼,均采用前段玻璃体切割器切除前房破碎的晶状体及脱出的玻璃体,或超声乳化联合前段玻璃体切割术。其中12眼合并后段病变行玻璃体视网膜手术联合C3F8气体或硅油填充术。术后随诊6~48个月(平均15个月)。结果 76眼较术前视力提高;57眼植入人工晶状体,其中54眼位置居中。开放性眼外伤53眼眼球破裂经Ⅰ期缝合、前段玻璃体切割处理,其中28眼Ⅱ期植入人工晶状体,矫正视力0.15~0.50;13眼未植入人工晶状体,矫正视力0.02~0.10;12眼经玻璃体视网膜手术处理后,视网膜复位,保留了眼球。晶状体脱位19眼、外伤性白内障合并后囊膜破裂伴玻璃体脱出14眼,术后矫正视力<0.1者2眼,0.1~0.3者7眼,0.3~0.5者10眼,0.5以上者14眼。结论前段玻璃体切割手术在处理复杂眼外伤有较好的效果,为人工晶状体植入或玻璃体视网膜手术创造条件。     

保留周边部前囊膜的玻璃体晶状体联合手术的临床观察

目的：探讨玻璃体切割联合晶状体切除保留周边部前囊膜治疗需行晶状体切除联合玻璃体切割术的眼外伤的临床疗效。

方法：诊断为眼外伤并需行晶状体切除联合玻璃体切割术的患者33例33眼,采用保留周边部前囊膜的晶状体切除术联合玻璃体切割术,术后Ⅱ期植入人工晶状体,随访6mo,观察视力、眼内压(IOP),人工晶状体位置,术中及术后并发症。

结果：所有患者视力均有不同程度提高,未发生明显的晶状体偏位和青光眼、视网膜脱离等并发症。

结论：玻璃体切割联合晶状体切除术保留周边部前囊膜治疗需行晶状体切除联合玻璃体切割术的眼外伤,减少了术中和术后并发症,视力恢复良好。     

玻璃体切除术中切除晶状体保留前囊膜同时植入人工晶状体的疗效观察

目的:探讨玻璃体切除联合晶状体切除保留前囊膜同时植入人工晶状体的临床疗效。方法:玻璃体视网膜病变同时伴有晶状体混浊46例46眼,术中采用经睫状体平坦部切口切除晶状体,保留前囊膜,并行玻璃体切除,Ⅰ期植入人工晶状体。结果:所有患者视力均有不同程度提高,部分患者复查时前囊膜出现不同程度混浊,行YAG激光切开。结论:玻璃体切除联合晶状体切除保留前囊膜Ⅰ期植入人工晶状体,保留了眼内正常解剖结构,减少了术中及术后并发症,视力恢复良好。     

外伤性晶状体脱位的联合手术治疗

目的：评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位或半脱位的临床疗效。方法：对1993年10月－2000年5月连续收治的外伤性晶状体脱位或半脱位36例作回顾性研究。所有患眼根据病情均采用不同的术式去除脱位晶状体,包括角巩缘切口圈套娩出、睫状体扁平部切口行晶状体切除或超声晶状体粉碎,同时切割玻璃体,并应用小梁切除、阀门管植入术、玻璃体视网膜手术联合治疗因晶状体脱位引起的并发症,17例I期植入前房或后房型人工晶状体。结果：所有患眼成功的去除晶状体,91．7％患眼视力有不同程度提高,52．3％患眼视力≥0．3,继发青光眼患者术后眼压获得控制,6例视网膜脱离全部复位。结论：各种手术方法联合应用治疗外伤性晶状体脱位及其所致并发症,视力增进效果明显。阀门管植入术是治疗严重眼外伤顽固性青光眼的有效手术方法。     

眼挫伤致晶状体后脱位的晶状体玻璃体切除术

目的探讨玻璃体切除联合晶状体切除术治疗眼挫伤致晶状体后脱位的临床疗效。方法对22眼外伤程度、手术方式及效果等资料进行回顾性分析。结果除晶状体后脱位以外,合并损伤主要包括不同程度前房角后退10眼,视网膜震荡伤8眼,玻璃体疝6眼,前房或玻璃体积血5眼,外伤性瞳孔散大4眼,虹膜根部断离3眼,视网膜脱离3眼,视网膜裂孔2眼,视网膜脉络膜裂伤1眼。22眼均施行玻璃体切除联合晶状体切除术,术中同时眼内激光封孔和C,F。气液交换5眼,小梁切除3眼,硅油注入1眼,虹膜根部断离修补1眼,一期植入前房型人工晶状体3眼。术前矫正视力≤0．15。术后随访1～27月,矫正视力≥0．2者13眼。结论术前充分评估眼外伤程度,有利于合理选择手术时机和手术方式;玻璃体切除联合晶状体切除术能有效摘出脱位晶状体,可同时进行裂孔封闭、视网膜复位、小梁切除、虹膜断离根部修补、人工晶状体植入等操作,最大程度修复创伤。     

严重眼外伤的玻璃体手术治疗

目的探讨玻璃体手术治疗严重眼外伤的效果。方法严重眼外伤35例(35眼),行玻璃体切除术和眼内异物摘出术,联合角巩膜缝合、晶状体切除、眼内激光光凝、巩膜外冷凝以及C3F8或硅油填充术,并根据年龄、眼部外伤情况及术前炎症反应,行人工晶状体Ⅰ期植入或Ⅱ期植入术。随访3～6月。结果术中16例眼内异物均成功摘出,视网膜脱离22眼,其中19眼复位。术后视力提高22眼,视力不变10眼,视力下降3眼。结论玻璃体切除术能有效治疗严重眼外伤,能最大限度挽救患者的视力和眼球。     

玻璃体视网膜手术中切除晶状体保留前囊膜的疗效观察

目的探讨玻璃体切割联合晶状体切除手术中于睫状体平坦部切口切除晶状体、保留前囊膜的远期治疗效果。方法37例(38眼)玻璃体视网膜病变同时伴有晶状体混浊病例,术中均采用经睫状体平坦部切口切除晶状体、保留晶状体前囊膜、吸除前囊下上皮细胞、同期或Ⅱ期植入人工晶体。结果35眼前囊膜瞳孔区保持光滑透明、视力接近预期矫正视力。结论玻璃体切割联合晶状体切除、保留前囊膜,简化手术操做,恢复视功能疗效良好。     

玻璃体切除术治疗复杂眼外伤的临床研究

目的 探讨玻璃体切除术在复杂眼外伤中的治疗效果和应用价值.方法 对36例(36只眼)复杂眼外伤的玻璃体手术进行回顾性分析.结果 36只眼中术后视力提高者32只眼,其中2只眼最佳矫正视力分别为0.4和0.8,0.12～0.3者26只眼,0.05～0.1者4只眼,视力不变者4只眼.9只眼眼内异物(合并化脓性眼内炎4只眼),异物取出率100%,眼内炎控制好;玻璃体积血16只眼,视网膜平伏,无再次出血;复杂视网膜脱离1只眼,视网膜复位;晶状体脱位合并继发性青光眼10只眼,眼压均控制正常,其中3只眼行Ⅰ期人工晶状体植入,7只眼行Ⅱ期人工晶状体植入.结论 玻璃体切除手术是目前最理想的治疗复杂眼外伤的有效方法,能挽救受伤眼并恢复一定的有用视力.     

晶状体脱位继发青光眼的联合手术治疗分析

目的评价晶状体摘除联合玻璃体切除、小梁切除术、人工晶状体植入术治疗晶状体脱位继发青光眼的临床疗效。方法18例(18只眼)晶状体脱位继发性青光眼患者分别行晶状体摘除术联合前部或全部玻璃体切除术、单纯小梁切除术、Ⅰ期或Ⅱ期联合手术,术后随访眼压、视力及并发症情况。结果18例均成功摘除脱位晶状体并植入人工晶状体;16例(88.9%)眼压控制良好,12例(66.7%)矫正视力提高。结论联合手术是治疗晶状体脱位继发性青光眼的有效手段,能有效控制眼压,提高视力。应根据病情需要选择适当的手术方式尽早恢复患者的视功能。     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

p53 expression in pterygium in two climatic regions in Turkey

Purpose:

To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey.

Materials and Methods:

Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson''s chi-square test was used to compare the p53 immunoreactivity.

Results:

The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group (P<0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 (P= 0.060).

Conclusion:

The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore

Purpose: To report the trends in etiology of patients with anterior uveitis (AU) in Singapore over 6 years.

Methods: A retrospective review of the clinical records of all new patients who presented with anterior uveitis to the uveitis subspecialty clinic from 2005 to 2010 at Tan Tock Seng Hospital, Singapore.

Results: There were 552 new cases of AU. This comprised 59.5% of a total of 928 new patients diagnosed with uveitis from 2005 to 2010. The mean age was 48.0?±?17.2 years. There was a male predominance (62.5%), with a male:female ratio of 1.7:1. The majority were of Chinese ethnicity (69%), followed by Malays (13.2%). Most cases were unilateral (79.5%) and idiopathic (50.4%). Common etiological causes included Fuchs heterochromic iridocyclitis (FHI) (5.6%), ankylosing spondylitis (AS)-related AU (5.1%), herpes simplex virus (HSV) (4.7%), and herpes zoster virus (HZV) (4.5%). There were increasing trends in AS-related AU from 3.2% in 2008 to 6.5% in 2010, and psoriasis-associated AU from 1.7% in 2005 to 4.0% in 2008. There were decreasing trends in the incidence of FHI from 10.6% in 2006 to 4.7% in 2009. No change in incidence of viral etiologies was noted, but cytomegalovirus-related immune-recovery uveitis (IRU) comprised 7.4%. IRU showed an increasing trend from 1.7% in 2005 to 11.9% in 2007, then decreased to 3.3% in 2010. Using the Pearson chi-square test, there was no statistically significant association between ethnicities (Chinese, Malay, Indian) comparing infectious and noninfectious cases (p?=?0.788), idiopathic and nonidiopathic cases (p?=?0.170), or between the various etiologies of uveitis (p?=?0.168).

Conclusions: AU was the predominant form of uveitis seen at our centers. Infectious etiologies (18.5%) are the most common among nonidiopathic cases, with herpes viruses (9.2%) being most prevalent. Despite increased use of polymerase chain reaction (PCR) in the detection of microbial and viral DNA, there was no overall increase in detection of infectious causes for uveitis. The changes in CMV-related immune recovery uveitis from 2005 to 2010 could reflect a change in HIV management in Singapore.     

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews. Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49 D and the median refractive cylinder was ‐0.50 D (range zero to ‐4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.     

内毒素诱导的大鼠葡萄膜炎的巨噬细胞中Toll样受体4的表达

目的 探讨在内毒素诱导的Wistar大鼠葡萄膜炎中Toll样受体4(TLR4)阳性细胞与虹膜组织中巨噬细胞的动态变化和分布.方法 实验研究.Wistar大鼠50只,用随机数字法随机分为5组,每组10只,分别为正常对照(0 h)组、6 h组、12 h组、24 h组及48 h组.除0 h组外其余各组均足垫部注射霍乱弧菌内毒素200μg,注射后于裂隙灯显微镜下观察双眼前节炎症反应变化.按实验分组于0、6、12、24、48 h处死大鼠.取虹膜一睫状体及脉络膜组织.通过葡萄膜铺片免疫组织化学方法检测TLR4和巨噬细胞的标记CD163的表达.人工计数虹膜中TLR4~+与CD163~+的细胞并计算细胞密度,计算圆形和多形性的CD163~+细胞占所有CD163~+细胞的百分比.进一步采用免疫荧光双标记检测TLR4和CD163共表达的情况.通过单因素方差分析分别对大鼠虹膜内阳性细胞密度以及圆形、多形性CD163~+细胞的百分比进行统计学检验.结果 正常大鼠虹膜睫状体组织不表达TLR4.6 h组有2只大鼠虹膜内可见少量TLR4~+细胞,12～48 h组所有大鼠虹膜内TLR4~+细胞明显增多(F=167.2,P＜0.001),虹膜内TLR4~+细胞密度分别为(506.1±39.5)个/mm~2(12 h组)、(492.3±54.5)个/mm~2(24 h组)及(663.8±150.2)个/mm~2 (48 h组).在注射LPS后12～48 h期间TLR4~+细胞形态无明显变化.0～48 h组大鼠虹膜内均有CD163~+细胞,0 h组圆形和多形性CD163~+细胞百分比为13%,12～48 h组其百分比约为80%,且圆形细胞主要位于虹膜基质层.免疫荧光双标记可见TLR4和CD163的共表达,TLR4位于细胞膜,CD163位于细胞质.5组大鼠脉络膜内均未见TLR4表达.结论 内毒素诱导的大鼠葡萄膜炎中虹膜内TLR4表达增高,部分虹膜固有巨噬细胞表达TLR4.TLR4可能在葡萄膜炎的发生发展中起一定作用.     

弱视眼底光学相干断层扫描的研究进展

弱视是由于视觉发育关键期内各种异常的视觉经验导致单眼或双眼最佳矫正远视力低于正常同龄儿童,而眼部无明显器质性病变。目前普遍观点认为,弱视的发病机理主要源于视皮层。近年来,光学相干断层扫描（OCT）作为一种先进的活体成像技术,促进了对视网膜形态结构的大量研究,同时也被应用到弱视的研究领域。陆续有不同的研究人员利用OCT发现弱视患者眼底视网膜、脉络膜等眼部结构存在改变。笔者将对弱视眼底OCT的研究进展做一综述。     

实验性糖尿病视网膜微血管病变的病理研究

目的：观察糖尿病视网膜病变（diabetic retinopathy,DR）的组织学改变。方法：应用光镜、免疫组织化学、电镜及组织化学电镜等技术,研究在不同时间点Spregue-Dawley(SD)大鼠视网膜毛细血管基底膜中的Ⅳ型胶原蛋白及层黏蛋白和视网膜毛细胞血管基底膜的厚度,以及其负电荷位点数目的变化。结果：随着糖尿病病程的发展,视网膜毛细血管基底膜下不断增厚伴有Ⅳ型胶原蛋白及层黏蛋白的增加,同时负电荷位点数目减少。结论：视网膜毛细血管基底膜增厚,Ⅳ型胶原蛋白及层黏蛋白的增加,负电荷位点数目减少可能是导致DR渗出性病变的病理基础。