泪液特异性IgA检测诊断单纯疱疹病毒性角膜炎的初步研究

目的 评估泪液单纯疱疹病毒(HSV)特异性IgA(HSV-IgA)在单纯疱疹病毒性角膜炎(HSK)的临床应用价值.方法 采用毛细管收集105例门诊确诊的HSK患者(77例上皮染色组及28例上皮完好组)和73例对照组患者的泪液,采用酶联免疫吸附试验(ELISA)法检测泪液中HSV-IgA抗体水平,并进行受试者工作特征曲线...     

泪液前列腺素E2水平与干眼严重程度的相关性

目的:探讨泪液中前列腺素E2(prostaglandin E2,PGE2)水平与干眼严重程度的关系.方法:选取干眼患者60例,并接受眼表疾病指数(Ocular Surface Disease Index,OSDI)问卷调查及眼科检查,包括泪膜破裂时间(tear film breakup time,BUT)、角膜荧光素染...     

单纯疱疹病毒性角膜炎患者双眼泪液功能改变

目的观察单纯疱疹病毒性角膜炎(herpes simplex keratitis,HSK)患者双眼泪液量及泪膜稳定性的改变,并通过共焦显微镜观察双眼角膜神经的变化。方法选取2007年1月至2010年1月间我院门诊就诊的HSK患者132例(132眼),对所有患者的双眼进行泪液分泌试验(Schirmer I test,SIt)、泪膜破裂时间(tear break-up time,BUT)及角膜知觉的检查。并通过共焦显微镜对患者角膜上皮下神经和基质神经进行观察。设立相应年龄段的正常人51例51眼为对照组。结果 HSK患者健眼的SIt为(8.80±7.34)mm,明显短于对照组的(17.30±4.13)mm(P=0.013),BUT为(9.60±4.94)s,明显短于对照组的(14.51±5.32)s(P=0.049)。基质型及内皮型HSK患者健眼SIt分别为(4.23±2.79)mm和(4.72±3.93)mm,BUT分别为(8.00±3.89)s和(7.50±4.51)s,均明显低于对照组(均为P<0.05),而上皮型HSK患者健眼SIt为(17.51±4.77)mm,BUT为(13.20±4.88)s,与对照组相比差异均无统计学意义(均为P>0.05)。HSK患者健眼的角膜知觉略低于对照组,但差异无统计学意义(P=0.899)。HSK患者患眼的BUT及角膜知觉均明显少于对照组(P=0.000、0.003),而SIt无明显差异(P=0.498)。HSK患者患眼由于角膜水肿及炎症等因素影响均未看到基质神经干及角膜上皮下神经丛;健眼基质中可见粗大神经干,但上皮下神经丛神经纤维数目较对照组有所减少(P=0.001),而且26.5%的HSK患者健眼神经纤维走行为横向,对照组仅为4.3%。结论 HSK患者患眼及健眼泪液功能均存在不同程度异常,可能与神经调控异常有关。HSK患者在治疗患眼的同时应密切观察健眼的变化,并可预防性应用人工泪液。     

糖皮质激素联合人工泪液治疗单纯疱疹病毒性角膜炎恢复期干眼症的效果

目的 探讨糖皮质激素联合人工泪液在病毒性角膜炎恢复期中治疗干眼症的效果。设计 回顾性病例系列。研究对象 2008年6月至2011年8月就诊于天津医科大学眼科中心的43例（52眼）病毒性角膜炎经常规治疗恢复期被确诊为干眼症的患者。方法 上述患者在停用抗病毒、抗生素眼药及各种人工泪液的基础上,用不含防腐剂的人工泪液（每日4次）联合糖皮质激素（每日3次）点眼,观察所有患者治疗前及治疗后7、14、21天泪膜破裂时间（BUT）、角膜荧光素染色（FL）、基础泪液分泌试验（SIT）的变化。主要指标 BUT、FL评分、SIT。结果 所有患者均完成治疗和随访。治疗后7、14、28天观察BUT、FL及SIT较治疗前均有不同程度改善,部分病例症状消失。从治疗前到治疗后28天,SIT从（6.40±2.31）mm增加到（14.58±2.81）mm（P=0.000）、FL评分由（7.52±2.78）分降低到（0.14±0.26）分（P=0.000）、BUT从（7.63±0.90）秒延长到（11.53±1.78）秒（P=0.000）。结论 对于病毒性角膜炎恢复期干眼患者,在停用抗病毒及抗生素药物的基础上联合应用糖皮质激素及不含防腐剂的人工泪液治疗,治愈率高,效果确切。（眼科,2013, 22: 101-104）     

單疱病毒性角膜炎泪液及角膜上皮的病毒檢測

目的 探讨如何检测单疱病毒性角膜炎患眼中泪液及角膜上皮病毒,为临床诊断提供依据和方法。方法 应用聚合酶链反应技术对60例按临床诊断标准诊断为单疱病毒性角膜炎(其中点状角膜病变24例,树枝地图状角膜病变29例,盘状角膜病变7例)患者的患眼泪液及角膜上皮进行检测。结果 通过聚合酶链反应检测60例患者中阳性46例占76.7％,阴性14例占23.3％。结论 对单疱病毒性角膜炎诊断不能袱根据其临床特徵来诊断;聚合酶链反应为临床提供实验诊断依据。     

泪液SigA和锌的相关关系与单疱病毒性角膜炎

应用I~(125)-放射免疫技术及原子吸收光谱法检测了单疱病毒性角膜炎(HSK)48例60眼泪液SIgA和微量元素锌的含量,并做了相关性探讨。结果显示:HSK 患者泪液SIgA 与锌含量(202.7±48.6mg/L 和15.6±5.8μmol/L)明显低于对照组(312.5±107.0mg/L 和29.2±11.5μmol/L)两组问差异显著,P<0.001,二者呈高度正相关性。提示泪液锌同眼表面免疫功能密切相关。建议在治疗HSK 时,除抗病毒及免疫调节用药外,还应及时补充锌剂。     

Tear lipocalin is the predominant phosphoprotein in human tear fluid

Proteins are very important components in tears. Their phosphorylation is an important posttranslational modification affecting biological activity. Using proteomic techniques, this study was designed to analyze phosphoproteins found in open eye basal tears from normal human subjects. Proteins in tear samples were separated in 1-dimensional (1D) and 2-dimensional (2D) gels and phosphoproteins were selectively stained with Pro-Q diamond dye before visualization of all proteins using Sypro Ruby. Potential phosphoproteins in 2D gels were identified by liquid chromatography-mass spectrometry (LC-MS/MS) after trypsin digestion and phosphopeptide enrichment using titanium dioxide (TiO₂) columns. The tryptic digests of the tear samples were also analyzed to identify phosphoproteins directly by LC-MS/MS after phosphopeptide enrichment. The major phosphoprotein stained by Pro-Q diamond in the gels and identified by LC-MS/MS from the spots was tear lipocalin. Tear lipocalin was separated into 3 different isoforms and one phosphorylation site (serine at position 24) was identified in one of the isoforms. Prolactin-induced protein, nucleobindin-2 and lipophilin C were also stained with Pro-Q diamond although no phosphorylated peptides from these proteins could be found using LC-MS/MS. Direct analysis of the tear tryptic digests by LC-MS/MS identified a further 12 potential phosphoproteins with tear lipocalin predominant. Four phosphorylation sites (position 24 (serine), 32 (serine), 34 (threonine) and 36 (tyrosine)) were identified for tear lipocalin using this method. These results indicate that tear lipocalin is the predominant phosphoprotein in normal human basal tears. Nucleobindin-2, prolactin-induced protein and lipophilin C also appear to be phosphorylated in basal tear samples.     

The Precorneal Tear Film as a Fluid Shell: The Effect of Blinking and Saccades on Tear Film Distribution and Dynamics

We conducted a series of experiments to elucidate the behavior of the human precorneal tear film (PCTF) during blinking and horizontal and vertical saccades. Methodology included video-interferometry with subsequent image cross-correlation (tear film lipid layer [TFLL]) and video-microscopy (mucoaqueous subphase [MAS]). We observed that the TFLL interference pattern deteriorates rapidly with successive blinks and degrades slowly with repeated horizontal saccades during blink suppression when dark arcs of thinning appear in the fluorescein-stained PCTF. Furthermore, after full downgaze and a return to the primary position, a transient horizontal bright band appears, deep to the spreading TFLL. It may be followed by local disturbances in the interference pattern. Two horizontal dark bands form in the stained PCTF after the return saccade. PCTF disruption may occur below the lower band during blink suppression. We concluded that shearing during horizontal saccades is insufficient to disturb the tear film structure greatly. The MAS and TFLL move together as a fluid shell. The dark arcs/bands are caused by meniscus-induced thinning, imprinted onto the PCTF at the lid margin. Their stability during blink suppression suggests that the MAS has gel-like properties. The horizontal bright bands are probably due to transient corneal indentation in downgaze. In downgaze, the disturbance of the TFLL and MAS below the dark bands is possibly due to shearing across the MAS in the return phase. This could cause desiccating stress in everyday activities, such as working at a computer.     

睑缘炎所致泪膜损害23例

目的探讨睑缘炎对泪膜的损害作用。方法对23例严重睑缘炎患者进行详细裂隙灯检查、泪膜破裂时间、泪液分泌试验测定及角膜上皮荧光素染色。观察经药物治疗后上述各项的改变。结果23例患者睑缘充血、不规则,睫毛根部及睑板腺开口处黄色分泌物及痂皮附着,泪膜破裂时间缩短,角膜弥漫着色,泪液分泌试验在正常范围。结论睑缘炎引起脂质分泌减少及成分异常,破坏泪膜稳定性,导致蒸发过强型干眼。     

Tear diluents in the treatment of keratoconjunctivitis sicca

To determine the optimum solution concentration for lowering elevated tear film osmolarity in keratoconjunctivitis sicca (KCS), tear osmolarity was measured in four KCS patients before and after instillation of either an isotonic saline solution or one of four hypotonic saline solutions (range, 75-225 mOsm/L). Average tear osmolarity one minute after instillation was significantly lower with the hypotonic solutions than with the isotonic saline (mean +/- SEM, 290 +/- 3 mOsm/L vs. 317 +/- 1 mOsm/L, P less than 0.0005). Solutions 150 mOsm/L or less were most effective in lowering osmolarity; the 75 mOsm/L solution was occasionally associated with irritation. In 16 KCS patients, we then compared the therapeutic efficacy of the 150 mOsm/L solution with that of an otherwise identical isotonic solution in a two-week, double-masked, crossover study. The 150 mOsm/L solution was superior for symptom relief by nearly 2:1 (P = 0.01).     

Tear ferning and other lacrimal tests in normal persons of different ages

Summary We investigated in normal persons of different ages ranging from 4 months to 85 years the frequency of different ferning types as well as the results of the Schirmer I test, break-up time and tear protein profile. With increasing age, ferning types of higher degree were significantly more frequent. Furthermore, a correlation was found between the ferning test and low Schirmer test values (p < 0.05) as well as break-up time (p < 0.1). No correlation exists between ferning the test and tear protein pattern. These results indicate that tear ferning is independent from single tear proteins but in correlation with secreted watery volume and plays some role in tear film stability. Furthermore, these normal values of ferning and protein pattern can be used as references for different ages.     

TL对脂质泪液不足型干眼症影响的初步研究

目的检测脂质泪液不足型干眼症患者的泪液lipocalin(tear lipocalin,TL)浓度水平,探讨其与临床症状严重程度的相关性。方法本组研究对象为50例脂质性泪液不足干眼症患者(lipid tear deficiency,LTD),50例水液性泪液不足干眼症患者(aqueous tear deficiency,ATD),50例正常控制组人群。所有的研究对象均收集右眼下方泪湖的泪液,微量吸管吸取3μl。泪液样本使用高效液相色谱法分析,并测定TL浓度。结果脂质泪液不足型干眼症患者泪液的平均TL浓度明显低于正常控制组,而水液不足型干眼症患者泪液的平均TL浓度与正常控制组的差别无统计学意义。LTD组TL的浓度与泪膜破裂时间呈正相关,与荧光染色分数呈负相关。且LTD组患者各个级别的TL浓度均有差别,且差别具有统计学意义。结论TL的不足可能与LTD患者病变严重程度相关。     

Sialic Acid in Human Tear Fluid Decreases in Dry Eye

Purpose To evaluate the association between tear mucin and dry eye, we compared tear fluid sialic acid concentration in dry eye patients with that in normal volunteers. We also compared the sialic acid concentration with the results of several different types of dry eye examinations.Methods Subjects comprised 16 age-matched, normal healthy controls and 45 dry eye patients. Dry eye examinations included fluorescein staining, rose bengal staining, Schirmer I test, cotton thread test, and fluorescein breakup time. Tear samples were collected with a micropipette after the instillation of 50µl saline. The sialic acid concentration was measured by high-performance liquid chromatography.Results The sialic acid concentration was significantly lower in the dry eye group (5.3 ± 4.3µg/ml) than in the control group (37.1 ± 28.3µg/ml) (P < 0.001). Also, the sialic acid concentration correlated significantly with the results of dry eye examinations (P < 0.0002).Conclusions The different sialic acid levels in the control and dry eyes may imply differences in the quantity or quality of glycoprotein in tears between these two groups. Thus, sialic acid, a component of mucin, may play a key role in the dry eye condition. Jpn J Ophthalmol 2004;48:519–523 © Japanese Ophthalmological Society 2004     

Tear film osmolarity in patients with thyroid ophthalmopathy

PURPOSE: To compare tear film osmolarity between patients with thyroid ophthalmopathy and normal healthy subjects. METHODS: The tear film osmolarity in 15 normal subjects (15 eyes) (control group) and 21 patients (21 eyes) with thyroid ophthalmopathy was evaluated. Tear film osmolarity in milliosmole (mOsm) was determined by using an auto-osmometer. The palpebral fissure width, degree of proptosis, and tear break-up time (BUT) were also determined. The results for the two groups were compared statistically. RESULTS: The mean palpebral fissure width was 9.13 +/- 0.74 mm in the healthy subjects and 13.33 +/- 1.55 mm in the thyroid ophthalmopathy patients. This difference was statistically significant (P = 0.0001). The mean proptosis was 15.33 +/- 1.39 Hertel units in the healthy subjects and 20.71 +/- 0.95 Hertel units in the patients. This difference was also statistically significant (P = 0.0001). The mean tear BUT was 6.35 +/- 1.56 s in the patients and 18.27 +/- 1.53 s in the healthy subjects, and this difference was also statistically significant (P = 0.0005). The mean tear film osmolarity was 290.80 +/- 13.58 mOsm in the healthy subjects and 340.38 +/- 18.74 mOsm in the patients. There was a statistically significant difference between the groups (P = 0.0001). CONCLUSIONS: The significantly higher tear film osmolarity in patients with thyroid ophthalmopathy was most likely due to the increased proptosis and lid fissure width. These conditions may lead to injury of the ocular surface.