应用超声生物显微镜对挫伤性近视发病机制的研究

目的应用超声生物显微镜（UBM）并结合普通超声波,初步探讨挫伤性近视的发病机制。方法对51例（66只眼）眼球钝挫伤患者,在急性期和恢复期分别用自动验光仪测量屈光度;A超测量晶状体厚度;UBM测量角膜厚度、前房轴深、小梁睫状突距离（TCPD）、A角、睫状突的高度（T值）;66例正常眼为对照进行分析。结果眼球受钝挫伤后均表现为近视;且急性期晶状体变厚、前房变浅、TCPD缩短、A角变小、T值增大（P〈0．05）;而角膜厚度变化不明显（P〉0．05）。对照组各参数比较无明显差异（P〉0．05）。结论挫伤性近视的发病有诸多因素。除睫状肌痉挛外,前房变浅、晶状体变凸是共同机制;而睫状体肿胀及位置的改变是原发因素;UBM具有重要的临床应用价值。     

Pathogenesis of transient high myopia after blunt eye trauma

OBJECTIVE: To determine the pathogenesis of transient high myopia after blunt eye trauma. DESIGN: Two observational case reports and literature review. METHODS: Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. MAIN OUTCOME MEASURES: Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. RESULTS: The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. CONCLUSIONS: Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.     

Bilateral myopia following blunt trauma to one eye

PURPOSE: To evaluate bilateral myopia following blunt trauma to one eye. CASE REPORT: Traumatic myopia is a rare transient situation which may be seen in the injured eye or both eyes after blunt ocular trauma. We examined one case with transient myopia in the left eye which had been exposed to a blunt ocular injury. Myopia was also observed in the right eye 12 hours after the trauma. The right eye and left eye had reverted to emmetropia respectively two and six weeks after trauma. DISCUSSION: The myopia may have been due to ciliary spasm arising from stimulation of the efferent autonomic system in the right eye and ciliary body edema in the left eye. CONCLUSIONS: To our knowledge, this is the first reported case developing bilateral transient myopia after the blunt trauma to only one eye.     

Blood-retinal barrier after blunt trauma to the eye

The competence of blood retinal barrier at the level of retinal pigment epithelium (RPE) and retinal capillaries was studied 30 min, 24 h, 3 days, and 7 days after experimental blunt eye injury in the pig, using horseradish peroxidase (HRP). Leakage of HRP into the outer retinal layers was observed in association with disrupted RPE in the first three days after injury. No HRP leakage was seen 7 days after the trauma and the retinal vessels remained competent throughout the study. It is suggested that extracellular edema occurs in the early stages of commotio retinae due to the disruption of blood retinal barrier at the level of the RPE. Present address: Estelle Doheny Eye Foundation, 1355 San Pablo Street, Los Angeles, California 90033, USA     

眼挫伤后一过性近视临床分析

目的探讨眼挫伤后一过性近视的发生机制。方法收集眼挫伤后一过性近视26例(26眼),并对其临床特征和发病机制进行分析。结果小瞳检影验光发现所有外伤眼均存在近视,其中96%的外伤眼表现为轻、中度近视。睫状麻痹剂散瞳后验光发现所有外伤眼的近视度数均显著减轻。经合适的凹透镜矫正后所有外伤眼视力均可达1.0。对症治疗后4周内所有外伤眼的视力均恢复至≥1.0。结论当眼挫伤眼部检查未见明显阳性体征,而又主诉视力下降时,应进行屈光检查,以确定有无眼挫伤后一过性近视的存在。外伤性一过性近视病程短,对药物治疗反应好,且预后佳。     

外伤性一过性近视的临床观察

目的：观察外伤性一过性近视的临床特点和预后。方法：对20例（25眼）外伤性一过性近视患者的临床资料进行回顾性分析。结果：小瞳检影验光发现所有外伤眼均存在近视，其中84％的外伤眼表现为轻、中度近视。睫状肌麻痹剂散瞳后验光发现所有外伤眼的近视度数均显著减轻。经合适的凹透镜矫正后所有外伤眼视力均可达1．0。对症治疗后4周内所有外伤眼的视力均恢复至≥1．0。结论：外伤性一过性近视病程短，对药物治疗反应好，且预后佳。     

睫状体挫伤的形态学研究

目的探讨严重眼球伤后睫状体各种损伤形态的特点。方法应用超声生物显微镜(ultrasoundbiomicroscopy,UBM)检查眼挫伤连续病例共196例(202)眼。结果109例(121眼,59.90%)有睫状体的损伤,包括:房角后退42例(42眼,20.79%);睫状体分离28例(30眼,14.85%);睫状体脉络膜脱离31例(31眼,15.35%);睫状体脉络膜上腔积血12例(12眼,5.94%);睫状体上皮脱离3例(3眼,1.49%);睫状体破裂3例(3眼,1.49%)。结论眼挫伤后睫状体的损伤多种多样,UBM检查能提供这些损伤的清楚图像,是正确地诊断这些损伤的无创伤性检查方法。     

外伤性近视的临床观察

目的:观察外伤性近视的临床特点和预后.方法:对30例外伤性近视患者的临床资料进行回顾性分析.结果:小瞳检影验光发现所有外伤眼均存在近视,表现为轻、中度近视.睫状肌麻痹剂敞瞳验光检查发现所有外伤眼的近视度数均有不同程度的减轻.用合适的凹透镜均可使外伤眼矫正视力达到1.0.经过治疗有29例外伤眼4wk内,1例外伤眼6wk,视力恢复至≥1.0.结论:外伤性近视:有钝挫伤史,病程短,经药物治疗后效果佳,恢复快,关键是要重视.     

A case report of transient myopia following blunt trauma

We present a case report on a young man complaining of transient myopia following a blunt trauma. Clinical and paraclinical (ultrasound) follow-up allowed us to discuss the different physiopathological mechanisms involved. We observed anterior lens displacement, increased lens thickness probably due to lens edema, choroidal detachment, and ciliary body edema. Progression was positive with full regression of the myopia. Ultrasound analysis also underlined an iridocorneal angle closure that could have led to angle-closure glaucoma (preventive peripheric iridotomy was discussed). The spontaneous progression showed spontaneous angle reopening on the main meridians.     

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma

PURPOSE: This retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. METHODS: Data were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. RESULTS: Need for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. CONCLUSIONS: This study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.     

右眼外伤后继发性青光眼

患者因右眼外伤后8年,视力下降5年,胀痛20d入院。体格检查发现右眼晶状体完全白色混浊,前囊膜下可见结晶样反光物质。眼部B超和眼眶CT发现右眼球壁异物。初步诊断为右眼继发性青光眼、右眼外伤性白内障。继发性青光眼的病因鉴别主要包括眼内铁锈沉着症和晶状体溶解性青光眼。患者入院后行右眼白内障超声乳化吸除术,术后随访,眼压控制良好。讨论体会:外伤后继发性青光眼,需分析具体原因,采取针对性治疗。     

干眼症的发病机制

眼表（角膜、结膜、副泪腺和睑板腺）、主泪腺和它们之间的神经连接组成的泪腺功能单位共同发挥对泪液分泌和泪膜形成的调控作用,维护眼表的健康,其中任一环节的损害均可导致泪膜完整性和正常功能的破坏.引起干眼症的起始病因很多,如果这些因素在未引起眼表改变时消失,则泪膜恢复正常;如这些因素不能消失,则引起眼表面的病理改变.虽然干眼症的临床表现类型不同,但其病理生理改变是相似的,炎症是干眼症发病机制中最关键的病理生理改变,而细胞凋亡、神经调节及性激素等也共同参与了干眼症的发病过程.     

Gene profiling in experimental models of eye growth: Clues to myopia pathogenesis

To understand the complex regulatory pathways that underlie the development of refractive errors, expression profiling has evaluated gene expression in ocular tissues of well-characterized experimental models that alter postnatal eye growth and induce refractive errors. Derived from a variety of platforms (e.g. differential display, spotted microarrays or Affymetrix GeneChips), gene expression patterns are now being identified in species that include chicken, mouse and primate. Reconciling available results is hindered by varied experimental designs and analytical/statistical features. Continued application of these methods offers promise to provide the much-needed mechanistic framework to develop therapies to normalize refractive development in children.     

Photodynamic therapy and indocyanine green guided feeder vessel photocoagulation of choroidal neovascularization secondary to choroid rupture after blunt trauma

Purpose: To describe photodynamic therapy (PDT) and additional indocyanine green (ICG) guided feeder vessel photocoagulation as a treatment of choroidal neovascularization (CNV) secondary to choroidal rupture in case of blunt head trauma. Design: Interventional case report. Methods: A 61-year-old woman developed subfoveal CNV originating from a choroid tear 8 years after blunt head trauma. Four sessions of PDT were applied and an additional two consecutive sessions of selective ICG-guided feeder vessel photocoagulation conducted. Results: Transient reduction of leakage and closure of feeder vessels could not prevent further growth of the CNV. Conclusions: PDT reduced leakage temporarily and additional ICG-guided feeder vessel photocoagulation closed treated feeder vessel and CNV. New feeder vessel formation and growth of CNV in case of traumatic choroid rupture could not be treated effectively by these two laser treatment modalities to prevent severe deterioration of visual acuity.     

Effects of blunt trauma of eye on retinal nerve fibre layer

AIM: To study the effects of blunt trauma of eye on visual acuity and retinal nerve fiber layer (RNFL). METHODS: A prospective observational study was done on the patients of a road traffic accident (RTA) having blunt trauma injury of the eye from august 2018 to July 2019 at the Department of Ophthalmology, Hind Institute of Medical Sciences, Barabanki. Patients between the age group of 20 to 65 years undergoing RTA with ocular complaints were included in this study. Colour vision, contrast sensitivity, and best-corrected visual acuity (BCVA) were recorded, RNFL analysis was done through OCT. RESULTS: A total of 108 patients were enrolled in this study and were grouped as 54 cases and 54 controls. The mean age was 43±2.3 years with 11 (20.37%) females and 43 (79.6%) males in the case group. At initial visit after RTA, the difference between color vision, contrast sensitivity and BCVA between right and left eyes of cases and controls were significant. After a follow up of 3mo only significant difference was noted in contrast sensitivity between cases and control groups. Change in color vision and BCVA after 3mo was insignificant. Similarly, an initial significant difference was noted in mean RNFL thickness between cases and control groups, but after follow up of 3mo mean RNFL thickness difference was significant only in superior and temporal quadrants. CONCLUSION: RTA or blunt trauma of eye can lead to persistent RNFL thinning and decreased visual function.