翼状胬肉中增殖细胞核抗原的免疫组化研究

目的　观察翼状胬肉的增殖状况及用药后的变化。方法　将５４ 例翼状胬肉术前患者随机分为３ 组：Ⅰ组１８ 例为未用药组,Ⅱ组１６ 例术前局部应用氟美松,Ⅲ组２０ 例术前局部应用高三尖杉酯碱加氟美松。采用免疫组化方法对手术切除的翼状胬肉标本进行增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇ ｃｅｌｌｎｕｃｌｅａｒ ａｎｔｉｇｅｎ ,ＰＣＮＡ） 检测。结果　未用药组（ Ⅰ组）ＰＣＮＡ 阳性率为（１１５３ ±３６２）％ ,氟美松组（ Ⅱ组） 为（１０２８ ±４１８）％ （ Ｐ＞ ００５） ,高三尖杉酯碱加氟美松组（ Ⅲ组） 为（５５９±３８２） ％ （ Ｐ＜ ００１） 。＜ ６０ 岁的进行型患者ＰＣＮＡ阳性率高于≥６０ 岁的静止型患者。结论　翼状胬肉组织中存在细胞增殖及ＰＣＮＡ表达,术前应用高三尖杉酯碱加氟美松可抑制ＰＣＮＡ 表达及术后翼状胬肉的复发,而术前应用氟美松对ＰＣＮＡ的表达则无影响     

自体角膜缘与结膜移植治疗复发性翼状胬肉

目的比较自体角膜缘与结膜移植治疗复发性翼状胬肉的疗效。方法复发性翼状胬肉病人９４例（１１５眼）随机分为Ａ,Ｂ两组,Ａ组４７例（５６眼）,Ｂ组４７例（５９眼）。手术显微镜下切除胬肉后Ａ组行自体角膜缘移植术,Ｂ组行自体球结膜移植术。观察术后植片生长、角膜创面修复、角膜新生血管及胬肉复发率。结果术后植片成活时间３～５天（平均３．７５天）;术后角膜创面修复时间Ａ组较Ｂ组快（Ｐ＜０．０５）。角膜新生血管Ａ组较Ｂ组少。术后１２个月胬肉复发率Ａ组（３．８％）较Ｂ组（２５．９％）低（Ｐ＜０．０１）。结论治疗复发性翼状胬肉自体角膜缘移植较结膜移植疗效好。     

局部应用地塞米松对翼状胬肉组织中趋化因子受体CCR3表达的影响及意义

目的　探讨术前局部应用地塞米松对趋化因子受体ＣＣＲ３在翼状胬肉中表达的影响和意义。方法　选取３０例翼状胬肉患者,分为用药组和对照组,术前２周分别局部滴用３ｇ?Ｌ－１妥布霉素地塞米松眼液或３ｇ?Ｌ－１妥布霉素眼液,取手术切除的翼状胬肉组织;ＲＴ-ＰＣＲ及Ｗｅｓｔｅｒｎｂｌｏｔ法检测趋化因子受体ＣＣＲ３ｍＲＮＡ水平及蛋白水平的表达,进一步采用免疫组织化学法检测其蛋白水平的表达。结果　翼状胬肉组织中ＣＣＲ３在ｍＲ-ＮＡ和蛋白水平均存在表达,但用药组ＣＣＲ３ｍＲＮＡ表达明显低于对照组,差异有统计学意义（ｔ＝－５７１３,Ｐ＝０．０１３）,用药组ＣＣＲ３的蛋白表达也明显低于对照组（ｔ＝－３．９１５,Ｐ＝０００１）。免疫组织化学染色显示ＣＣＲ３表达主要分布在结膜上皮细胞及部分血管内皮细胞上。结论　趋化因子受体ＣＣＲ３可能参与翼状胬肉的发生发展。地塞米松引起的ＣＣＲ３表达改变是影响翼状胬肉预后、减少术后复发的可能机制之一。     

结膜下注射丝裂霉素C的抗瘢痕化效果和安全性研究

目的　研究结膜下注射丝裂霉素Ｃ（ｍｉｔｏｍｙｃｉｎＣ,ＭＭＣ）对兔眼瘢痕化模型的抗瘢痕化效果及对兔眼局部组织的毒副作用,探讨其作为青光眼滤过性手术后抗瘢痕形成辅助用药的可行性及有效性。方法　取１８只健康成年新西兰大白兔,随机分为３组,分别为Ａ组、Ｂ组和Ｃ组,每组１２眼,建立实验性瘢痕化模型。Ａ组术后３ｄ结膜下注射０．４ｇ?Ｌ－１的ＭＭＣ０．３ｍＬ,Ｂ组术中巩膜瓣下放置浸泡０．４ｇ?Ｌ－１ＭＭＣ的棉片５ｍｉｎ,Ｃ组术后３ｄ结膜下注射生理盐水（ｎｏｒｍａｌｓａｌｉｎｅ,ＮＳ）０．３ｍＬ。应用结膜印迹细胞学检查观察结膜损伤情况。分别于术后７ｄ、１４ｄ、２８ｄ分批处死实验兔,摘出眼球,应用免疫组织化学染色检查观察成纤维细胞增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｏｎｃｅｌｌｎｕｃｌｅａｒａｎｔｉｇｅｎ,ＰＣＮＡ）的表达情况,应用光镜观察手术部位的病理改变。结果　术后３组均未出现结膜伤口渗漏,Ａ组、Ｂ组角膜上皮点状缺损于术后１周消失,Ｃ组无角膜上皮点状缺损。结膜印迹细胞学检查显示Ａ组和Ｂ组结膜印迹细胞分级均为２～３级,Ｃ组为２级。术后７ｄ、１４ｄ、２８ｄ光镜下,Ｃ组手术区球结膜下炎性细胞、纤维细胞、新生毛细血管增多,纤维组织增生较Ａ组和Ｂ组显著。免疫组织化学染色结果显示,术后７ｄ,Ａ组、Ｂ组、Ｃ组每高倍视野ＰＣＮＡ阳性细胞计数分别为（１２．８３±２．０８）个、（１４．３７±３．７６）个、（２８．１２±６．７４）个;术后１４ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１３．８１±１．５３）个、（１６．２８±３．７８）个、（２５．６７±４．４５）个;术后２８ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１１．９６±１．４５）个、（１３．０７±２．０４）个、（１７．６９±３．１１）个;相应时间点,Ａ组、Ｂ组ＰＣＮＡ阳性细胞计数均较Ｃ组少（均为Ｐ＝０．０００）,但Ａ组与Ｂ组间差异均无统计学意义（均为Ｐ＞０．０５）。结论　结膜下注射ＭＭＣ能有效抑制手术后术区的瘢痕化,与术中常规应用ＭＭＣ相比,其对结膜的损伤程度无明显差异,对其进一步研究有望为青光眼滤过手术后抗瘢痕化提供一种使用方便、安全、有效的局部用药方式。     

冀状胬肉中增殖细胞核抗原的免疫组化研究

目的 观察冀状胬内的增殖善及用药后的变化。方法 将５４例冀状胬肉术前患者随机分为３组：Ⅰ组１８例为未用药组，Ⅱ组１６主前局部应用氟美松，Ⅲ组２０例术前局部应用高三尖杉酯碱加氟美松。采用免疫组化方法对手术切除的冀状胬肉标本进行增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇ ｃｅｌｌ ｎｕｃｌｅａｒ ａｎｔｉｎｅｎ，ＰＣＮＡ）检测。结果 未用药组（Ⅰ组）ＰＣＮＡ阳性率为（１１．５３±３．６２）％，氟美松组     

丝裂霉素C对眼内压的影响

目的探讨丝裂霉素Ｃ（ＭＭＣ）对眼内压的影响。方法显微镜下对２９只眼翼状胬肉患者行胬肉切除和球结膜转位移植术,并术中用０．０２５％ＭＭＣ浸泡胬肉切除后巩膜裸露区３分钟,术后应用０．０１％ＭＭＣ点眼,每日３次,共一周,将其与另２６只眼患者术中不用ＭＭＣ的眼压进行监测及比较。结果所有患者在随访期间均无严重并发症,且两组间眼压经统计学处理无显著性差异（Ｐ＞０．０５）。结论０．０２５％ＭＭＣ局部应用对眼内压无明显影响。     

高三尖杉酯碱用于青光眼滤过术的临床随机对照研究

目的研究高三尖杉酯碱（ｈｏｍｏｈａｒｉｎｇｔｏｎｉｎｅ）在青光眼滤过术中的抗增殖作用。方法采用随机对照的临床验证方法,施行同一标准的小梁切除术,将７８例（８８只眼）难治性青光眼分为用药组４２例（４６只眼）和对照组３６例（４２只眼）。用药组术中应用高三尖杉酯碱０４ｍｇ,术后再分次结膜下注射高三尖杉酯碱０６２±０２０ｍｇ（范围０５３～０７５ｍｇ）;对照组未用高三尖杉酯碱。术后随访观察１８～４８个月（平均３６个月）。采用寿命表分析法统计。结果手术成功率：用药组为８４５％,对照组为５０９％（Ｐ＜０．０５）。功能性滤过泡的累计百分率：用药组为８４２％,对照组为５２９％（Ｐ＜０．０５）。并发症：用药组的角膜上皮缺损和结膜伤口渗漏发生率分别为２３９％和６５％,对照组为７１％和２４％（Ｐ＜０．０５）。用药组的角膜内皮细胞数在用药前后差异无显著性（Ｐ＞０．０５）。结论高三尖杉酯碱是安全有效的抗增殖药物,可明显提高青光眼滤过术的成功率,至少可在术后３年内将眼压维持在正常水平。     

低浓度丝裂霉素C在翼状胬肉术后的应用

〕目的：评估低浓度丝裂霉素Ｃ在预防翼状胬肉术后复发的疗效及安全性。方法：对照组采用暴露巩膜的单纯胬肉切除术；治疗组为单纯胬肉切除术，术后加用０．０２％（０．２ｍｇ／ｍｌ）丝裂霉素Ｃ滴眼，每日２次，连续５天。随访期为１２～１８月，平均１４．２±１．２月。结果：对照组３１眼中８眼复发（２５．８％），治疗组中２８眼中２眼复发（７．１％），两者差异显著（Ｐ＜０．０１）。无重大并发症出现。结论：低浓度（０．０２％）丝裂霉素Ｃ在翼状胬肉术后应用是一种安全而有效的方法。     

超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效观察

目的　对比观察超声乳化白内障吸出人工晶状体植入术联合及不联合房角分离术治疗闭角型青光眼合并年龄相关性白内障的疗效。方法　选取８９例（９８眼）闭角型青光眼合并年龄相关性白内障患眼分为两组,Ａ组４９眼采用超声乳化白内障吸出人工晶状体植入术联合房角分离术治疗,Ｂ组４９眼行超声乳化白内障吸出人工晶状体植入术,对比观察两组患者手术前后的眼压、中央前房深度、房角结构等。结果　Ａ组术后１ａ眼压为（１４．３４±３．６４）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,比术前眼压（３４．６５±６．５３）ｍｍＨｇ明显降低,差异有统计学意义（ｔ＝１９．２８,Ｐ＜０．０５）。Ｂ组术后１ａ眼压为（１６．２６±４．９１）ｍｍＨｇ,比术前（３５．１５±６．２７）ｍｍＨｇ亦明显降低,差异有统计学意义（ｔ＝１６．５５,Ｐ＜０．０５）。术后１ａ两组间眼压对比差异有统计学意义（ｔ＝２．１９,Ｐ＜０．０５）。Ａ组绝对成功３０眼（６１．２２％）,相对成功９眼（１８．３７％）,总成功率７９．５９％。Ｂ组绝对成功２７眼（５５．１０％）,相对成功７眼（１４．２９％）,总成功率６９．３９％。两组间的总成功率差异无统计学意义（Ｚ＝０．８８６,Ｐ＞０．０５）。Ａ组术后１个月中央前房深度（３．２４±０．３８）ｍｍ较术前（２．０４±０．３１）ｍｍ加深,差异有统计学意义（ｔ＝３．１４１,Ｐ＜０．０５）。Ｂ组术后１个月中央前房深度（３．０５±０．３６）ｍｍ较术前（２．０１±０．２９）ｍｍ亦加深,差异有统计学意义（ｔ＝３．０７８,Ｐ＜０．０５）。术后１个月两组比较差异无统计学意义（ｔ＝０．１７５,Ｐ＞０．０５）。术后１个月行房角检查:Ａ组４０眼前房角全部开放,９眼残留小于４５°的锥状或堤坝状粘连。Ｂ组１０眼３个象限残留房角粘连,１９眼２个象限残留房角粘连,２０眼有小于１个象限的房角粘连。两组视力改善率及术后并发症发生率差异均无统计学意义（均为Ｐ＞０．０５）。结论　超声乳化白内障吸出人工晶状体植入术联合房角分离术是治疗闭角型青光眼合并白内障的安全、有效的方法,对眼压、中央前房深度和房角结构都有明显改善。     

翼状胬肉切除术后局部滴0．02％丝裂霉素C液的疗效

翼状胬肉切除术后局部滴０．０２％丝裂霉素Ｃ液的疗效［英］／ＲａｃｈｍｉｅｌＲ…∥ＢｒＪＯｐｈｔｈａｌｍｏｌ．－１９９５，７９（３）．－２３３～２３６翼状胬肉切除术后的复发率很高，约达２５％～４５％。最近有用丝裂霉素Ｃ在翼状胬肉术后局部滴眼可减少此病复...     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.