激光虹膜周边切除与虹膜周边成形治疗早期闭角型青光眼的临床观察

目的观察激光虹膜周边切除术和激光虹膜周边成形术对早期原发性闭角型青光眼的疗效。方法30名（50眼）早期闭角型青光眼的患者，按照UBM检查分组：虹膜膨隆型眼做Q开关Nd：YAG激光虹膜周边切除术（A组，18人，31眼）；虹膜高褶型眼做倍频Nd：YAG激光虹膜周边成形术（B组，12人，19眼）；激光术后1月停用降眼压眼液，前房角开放度无明显增加，并且眼压≥21mmHg者，改做激光虹膜周边切除术或激光虹膜周边成形术（C组，8人，10眼）。结果术后3个月30名患者的平均眼压和平均用药指数从术前的（21．8±3．1）mmHg和2．6±1．4降到（17．8±1．6）mmHg和1．0±0．90。A、B、C三组术后小梁虹膜夹角分别增加了10°、9°、11°，房角开放距离（AOD500）分别增加了0．17mm，0．19mm，0．22mm，差异均有非常显著意义（p〈0．01）。A、B、C三组术后瞳孔增大者分别为16％、53％、50％，视力下降者分别为13％、32％、30％。3组间比较，术后视力的变化差异无显著性（P〉0．05），术后瞳孔的变化差异有显著性（P〈0．05）。结论激光虹膜周边成形术对根部虹膜高褶的青光眼疗效较好。激光虹膜周边切除术对虹膜膨隆型青光眼疗效较好。对1种激光疗法效果不佳者可联合2种激光治疗。     

超声生物显微镜指导青光眼激光手术

目的 了解利用超声生物显微镜(UBM)为早期闭角型青光眼选择激光手术的术式和评价疗效的意义.方法 62例98眼早期原发性闭角型青光眼,按照UBM的检查结果分为两组:A组虹膜膨隆型,32例53眼,行Q开关Nd:YAG激光周边虹膜切除术;B组虹膜高褶型,30例45眼,行倍频Nd:YAG激光虹膜成形术.结果 激光术后3个月,62例98眼的平均眼压从术前的(22.20±3.40)mmHg降到(17.50±1.80)mmHg(1 mmHg=0.133 kPa);平均用药指数从术前的(2.50±1.50)分降到(1.10±0.80)分;A组和B组小梁虹膜夹角较术前分别增加了7°和9°;房角开放距离(AOD500),分别增加130 μm和155μm;晶状体虹膜角分别减少了9°和6°,虹膜悬韧带距离分别减少了24μm和13μm.差异均有统计学意义(P<0.01).结论 利用UBM为早期闭角型青光眼选择激光手术的术式和评价其疗效是准确可靠的.     

半导体激光360°虹膜周边成形术联合YAG虹膜周边切开术治疗闭角型青光眼

目的探讨半导体、YAG激光360°虹膜周边成形术联合虹膜周边切除术对闭角型青光眼的疗效。方法对96例151眼闭角型青光眼行半导体激光360°虹膜周边成形术联合YAG虹膜周边切开术。结果激光孔通畅100%,其中治愈115眼,好转34眼,其中3眼需两种以上眼药控制,2眼需行手术治疗。房角开放,周边前房加深,术前术后比较,有显著差异性(P<0.01)。不良反应有术后暂时性眼压升高,术中虹膜出血,角膜灼伤,前部色素炎性反应等。结论联合激光360°虹膜周边成形术及虹膜周边切除术,操作简单。效果确切,并发症少,是治疗闭角型青光眼的理想术式。     

周边虹膜切除与YAG激光虹膜切除术治疗早期闭角型青光眼的临床比较

目的 探讨周边虹膜切除术与YAG激光虹膜切除术对早期闭角型青光眼的疗效差异.方法 一组采用周边虹膜切除术,90例97只眼;另一组采用YAG激光周边虹膜切除术作对照组,167例193只眼,随访观察1个月至5年.结果 周边虹膜切除术组术后发现有3例残留虹膜色素层,激光组术后激光孔1例闭合,经再次激光扩大后,激光孔可见,未再闭合.另虹切组术后眼压控制超过20mmHg者4例,激光组术后眼压控制超过20mmHg的7例.结论 周边虹膜切除术与YAG激光虹膜切除术均能有效地治疗早期闭角型青光眼.介于激光痛苦小,费用低的特点,继发性瞳孔闭锁性青光眼以及绝大多数早期闭角型青光眼者,选择YAG激光优于周边虹膜切除术.但对于虹膜肥厚、色素较多者,周边虹膜切除术优于YAG激光虹膜切除术.对于虹膜高褶型青光眼,两种手术无显著差异.     

超声生物显微镜对早期闭角型青光眼激光虹膜周边切除术后疗效观察

目的：应用超声生物显微镜（UBM）对早期闭角型青光眼激光虹膜周边切除术后疗效观察。方法：应用UBM对28例41眼早期闭角型青光眼激光虹膜周边切除术前后的观察。对激光虹膜周边切除术后房角增宽不明显的方法。应用UBM对28例41眼早期闭角型青光眼激光虹膜周边切除术前后的观察。对激光虹膜周边切除术后房角增宽不明显的患者,局部点0.5%pilocapine后再次复查UBM。结果：83%的急性闭角型青光眼激光虹膜周边切除后,可以达到治愈的目的。50%的慢性闭角型青光眼激光虹膜周边切除术后,仍不能完全治愈,局部点0.5%的pilocapine可减少房角粘连的机会。结论：对闭角型青光眼激光虹膜周边切除术后的房角再评价十分重要。     

联合激光手术治疗中晚期闭角型青光眼

目的：评价联合激光手术治疗中，晚期闭角型青光眼的临床效果及应用价值。方法：采用随机对照临床研究方法，将52例（78眼）中，晚期慢性闭角型青光眼患者分为两组。联合激光手术组（氩激光周边虹膜成形术联合氩激光加Nd:YAG激光周边虹膜切除术）32例（46眼），小梁切除术组20例（32眼），其中8例为同一患者左右眼对照。结果：两组比较，联合激光手术组，术后早期眼压控制率为95．65％（P＜0．05），术后视力提高迅速而且稳定（P＜0．05），术后并发症轻而少（P＜0．05），术后无需加用抗青光眼药物治疗的患者明显增多（P＜0．05），结论：联合激光手术安全有效，可作为中，晚期闭角型青光眼一种可行的治疗方法。     

激光周边虹膜成形并切除术治疗闭角型青光眼

目的 分析激光周边虹膜成形联合激光虹膜根部切除治疗闭角型青光眼的方法及疗效。方法 2003年1月～2004年1月间应用氩激光周边虹膜成形联合Nd：YAG和氩激光周边虹膜切除术21例21眼，缩瞳后氩激光在周边虹膜360。度范围共击射约30点，再于鼻上方或颢上方击射周边虹膜，范围约0．5～1mm，然后用Nd：YAG激光击穿虹膜。结果 术前术后平均视力无明显变化，术后1周眼压7～20mmHg，平均眼压14mmHg，暗室试验全部阴性。所有患者均可见周边切除孔沟通前后房，前房角均有不同程度加宽。结论 激光周边虹膜成形联合虹膜根部切除既可解除前房阻滞又可加深前房角，是治疗闭角型青光眼的良好方法。     

联合倍频及Nd：YAG激光周边虹膜切开术

目的 观察联合应用倍频Nd:YAG和Nd:YAG激光对闭角型青光眼进行周边虹膜切开术的效果。方法 对82例（102眼）闭角型青光眼患,用倍频Nd:YAG激光对虹膜作一“蜂巢”状创口,用Nd:YAG激光切透虹膜。结果 联合激光1次虹膜切开成功101眼（99.02%)。术后3月眼压有所下降,并发症有虹膜切口出血2眼;切开孔1月后再闭锁1眼;角膜内皮损伤5眼;术眼均有不同程度虹膜炎,抗炎治疗可吸收,结论 联合激光周边虹膜切开术治疗闭角型青光眼效果确切,并发症发生率低。     

激光周边虹膜切除及成形术治疗青光眼的体会

目的观察氩激光联合YAG激光行周边虹膜切除及周边虹膜成形术治疗急性闭角型青光眼的疗效及其并发症。方法本组共105例(169眼),包括急性闭角型青光眼临床前期91眼,先兆期32眼、间歇期46眼。均先用氩激光行360°周边虹膜成形术,然后在拟行周边切孔处用氩激光分层击射虹膜,最后用YAG激光穿透击射。随访12个月,观察其疗效及并发症。结果术后1～6小时眼压一过性升高,1天后眼压正常,周切孔均开放无闭塞,前房角开放;3眼周切孔处晶状体局限性浑浊。结论氩激光联合YAG激光行虹膜周边切除+虹膜周边成形术是治疗闭角型青光眼预防急性发作的有效而且安全的手术。     

多种激光联合应用治疗慢性闭角型青光眼

目的探讨氪(Kr)/Nd:YAG激光/SLT(Selectlasertrabecularplasty,SLT)联合应用治疗慢性闭角型青光眼的临床疗效。方法对11例14眼有适应症的患者,先以Kr/Nd:YAG激光联合应用进行周切虹膜切除术,1周后氪激光周边虹膜成形术联合SLT。比较手术前后眼压变化。结果全部病例1次透切虹膜,经氪激光周边虹膜成形术后,房角加宽,SLT治疗后9眼眼压改善到<20mmHg,1眼眼压在2mo时回升到36mmHg,转为手术治疗。4眼可停用局部降眼压药,眼压维持正常。结论对部分有适应症的慢性闭角型青光眼是一种安全有效的治疗方法。     

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.     

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.     

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.     

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。