纤维蛋白黏合胶黏合泪道治疗中老年性干眼症的临床疗效

目的探讨纤维蛋白黏合胶对中老年性干眼的治疗效果。方法选择中老年性干眼症患者60例(60只眼),随机分为:A组术眼泪道注入生理盐水; B组术眼泪道注入等量纤维蛋白黏合胶,两组均常规给予羟糖甘眼液点眼,3次/d,1滴/次。在术前、术后1 w、2 w及4 w评价患者眼表症状指数(OSDI)、行泪膜相关检查和测定泪液中各蛋白含量。结果术前两组OSDI、泪膜破裂时间(BUT)、泪河高度、角膜荧光素染色(FL)、基础泪液分泌实验(SIT)、泪液各蛋白含量差异无统计学意义(P0. 05);术后1 w及2 w时两组SIT、泪河高度、FL差异有统计学意义(P0. 05),但OSDI、BUT、泪液蛋白含量、溶菌酶及分泌型免疫球蛋白(sI g) A差异无统计学意义(P0. 05);至术后1个月,两组OSDI、泪膜四项差异有统计学意义(P0. 05),两组泪液蛋白含量较术前有所提高,但其差异无统计学意义(P0. 05)。治疗2个月后,B组与A组相比,其角膜上皮基底细胞密度明显增加,炎性细胞的密度明显减小,差异有统计学意义(P0. 05)。结论纤维蛋白黏合胶黏合泪道治疗中老年性干眼,可改善患者的症状,改善泪膜稳定性和提高泪液蛋白含量,提高患者的视觉质量。     

槲寄生水煎液治疗更年期女性干眼症的临床疗效

目的探讨槲寄生水煎液治疗更年期女性干眼症的临床效果。方法 60例(60眼)女性干眼症患者(45~55岁)被随机分为两组:实验组30例口服槲寄生水煎液和对照组30例口服安慰剂维生素C片。两组均加用羟糖甘滴眼液滴眼治疗;分别在治疗前和治疗后1 w,1、2个月各时间点检测并评定患者干眼眼表疾病指数(OSDI)、泪膜4项、泪液蛋白,观察治疗前后角膜共聚焦显微镜下情况。结果治疗前,两组患者各检测指标之间差异无统计学意义(P>0.05);治疗1 w、1、2个月后,试验组患者OSDI、泪膜破裂时间(BUT)、泪液分泌实验(SIT)、泪河高度及角膜灾光素染色(FL)均有显著变化(均P<0.05);泪液蛋白(TP),乳铁蛋白(LF),溶菌酶(LZM),分泌型免疫球蛋白(sIgA)均有不同程度改变,但差异无统计学意义(均P>0.05);对照组治疗1 w、1个月后,OSDI均有变化(均P<0.05);至治疗后第2个月时患者的OSDI、BUT、SIT、泪河高度及FL均无明显变化(均P>0.05)。经过治疗2个月后,试验组上皮朗格汉细胞和炎症细胞密度分别为(8±4)cells/mm~2和(52±22)cells/mm~2,而对照组上皮朗格汉细胞和炎症细胞密度分别为(51±24)cells/mm~2和(251±66)cells/mm~2,两组比较差异均有统计学意义(均P<0.05)。结论槲寄生水煎液可有效减轻更年期女性干眼症的症状和体征,具有一定的临床意义。     

真性糖尿病性白内障患者超声乳化术后角膜神经和泪液蛋白的特点

目的探讨真性糖尿病性白内障(TDC)患者超声乳化术后眼表症状、角膜神经和泪液蛋白的特点。方法 TDC患者56例(右眼),随机分为两组,A组采用上方透明角膜切口,B组采用颞侧透明角膜切口,均行超声乳化白内障吸除联合人工晶状体(IOL)植入术,分别于术前、术后1周、2周、1个月及3个月行眼表症状评分、泪液蛋白测定、角膜知觉计检查和共聚焦显微镜检查。结果术前两组干眼各眼表症状评分、泪液蛋白、乳铁蛋白、溶菌酶、神经纤维密度及角膜敏感度比较,差异均无统计学意义(P0.05);术后2周,两组干涩感、异物感、畏光、疼痛、眼红和流泪症状比较,差异均有统计学意义(P0.05);术后3个月,两组各症状和泪液总蛋白量、乳铁蛋白、溶菌酶及神经纤维密度比较,差异均无统计学意义(P0.05),但角膜敏感度、角膜切口连接型神经比较,差异有统计学意义(P0.05)。角膜切口中形态异常的神经纤维在B组中出现的几率高于A组(P0.05)。结论对于TDC,上方切口行超声乳化联合IOL植入术可以改善角膜知觉,减轻角膜切口神经损伤,提高患者的视觉质量。     

桑色素水煎液治疗绝经期女性干眼症的效果

目的探究桑色素水煎液在绝经期女性干眼症中的治疗作用。方法该研究为前瞻随机对照研究。48例(48眼)女性干眼症患者(45～55岁)被随机平均分为两组(各24例):A组作为对照组给予服用维生素C片(安慰剂),B组给予口服桑色素水煎液。两组都添加应用羟糖甘滴眼液点眼;两组均于治疗前和治疗后1 w、1个月、2个月检查并评价判定患者眼表疾病指数(OSDI)、泪液蛋白(TP)及泪膜4项,并观察治疗前后角膜共焦显微镜下情况。结果治疗前,两组各个指标检查结果差异均无统计学意义;A组治疗后1 w、1个月、2个月OSDI均较治疗前显著降低(P<0.05);B组治疗后2个月OSDI、泪膜破裂时间(BUT)、泪液分泌实验(SIT)、泪河高度、角膜荧光素染色(FL)较A组显著改善(P<0.05)。结论桑色素水煎液在治疗绝经期女性干眼症中发挥作用,使临床表现消退,有相当的临床意义。     

聚乙烯醇滴眼液在翼状胬肉术中应用对术后早期干眼的作用

目的观察在翼状胬肉术中应用聚乙烯醇滴眼液对患者术后早期干眼的作用。方法采用前瞻性研究,选择住院手术的翼状胬肉患者68例(68眼),随机分为试验组35例(35眼)和对照组33例(33眼)。两组患者术前和术后用药及处理完全相同,在手术中保持角膜湿润,试验组使用聚乙烯醇滴眼,对照组使用浸水棉片。两组患者分别于术前1 d及术后1 d、10 d、30 d进行眼表疾病指数(OSDI)问卷调查、自觉症状评价、角膜荧光素染色(FL)、泪膜破裂时间(BUT)、泪液分泌试验(SIT)评估检查,并进行统计学分析。结果两组OSDI评分、自觉症状评分在术后不同时间点比较差异均无统计学意义(P>0.05)。两组BUT在术后1 d、10 d比较差异均有显著性差异(P<0.05)。两组FL评分在术后1 d比较差异有显著性差异(P<0.05)。两组SIT差异均无统计学意义(P>0.05)。两组术后30 d SIT均未恢复至术前水平。结论翼状胬肉切除术中应用聚乙烯醇滴眼液可以保护角膜,改善眼表环境,减轻干眼症状,促进眼表功能和泪膜的恢复。     

应用Keratograph眼表综合分析仪分析老年人干眼症状与体征的相关性

目的应用新型眼表综合分析仪对老年人进行干眼相关检查,结合眼表疾病指数(OSDI)问卷评分,探讨体征与老年人干眼症状的相关性。方法选取在干眼门诊就诊的老年患者,利用Keratograph 5M进行非侵入性干眼相关检查(包括非侵入性泪膜破裂时间、泪河高度、脂质层评级、睑板腺评分、眼红分析),并进行OSDI问卷评分,将干眼检查结果与OSDI评分进行相关性分析。结果患者OSDI问卷评分(24.24±12.08)分,平均泪河高度(0.17±0.05)mm,首次非侵入性泪膜破裂时间(6.14±3.39)s,平均非侵入性泪膜破裂时间为(8.04±3.63)s,脂质层评级(1.56±0.64)级,睑板腺评分(2.19±1.47)分,眼红分析评分(1.38±0.57)分。OSDI问卷评分与泪河高度、眼红分析无相关性(P=0.679;P=0.143),与非侵入性泪膜破裂时间、脂质层评级呈显著负相关(均P0.01),与睑板腺评分呈显著正相关(P0.01)。无干眼及轻、中、重度干眼组间非侵入性泪膜破裂时间、脂质层评级、睑板腺评分的差异有统计学意义(均P0.01);4个组间泪河高度、眼红分析差异无统计学意义(P=0.499;P=0.384)。重测信度(ICC值)在0.855～0.890。结论 Keratograph 5M可以客观、准确、高效地获得老年人眼表状况相关参数,在老年人干眼检测中具有一定的优势和临床应用价值。老年人干眼症状与体征存在一定的相关性。     

两种术式治疗老年结膜松弛症的对比

目的对比研究新月形结膜切除术和双极电凝切除术的疗效和并发症,寻找一种更适合结膜松弛症的手术方式。方法 60例患者(60只眼)按随机数字表法分为2组,即A组(新月形结膜切除术组)和B组(双极电凝组)。比较两组患者术后的国际眼表面疾病指数(OSDI)、泪河、泪膜破裂时间(BUT)、并发症和手术时间。结果两组患者术后2 w时,OSDI评分B组少于A组(P<0.05),4、8 w时无基本差别(P>0.05);在术后松弛结膜的残留方面,两组也无统计学差异(P>0.05);在泪河恢复和BUT方面,两组患者2⁸ w,泪河正常的比例呈逐渐增高趋势,但两组在2、4、8 w时相比均无统计学意义(P>0.05);在术后并发症方面,二者在2、4 w时也无差异(P>0.05),只有在第8周时有统计学意义(P<0.05);在手术时间方面,B组明显低于A组(P<0.01)。结论两种术式在治疗效果、并发症方面相差无几,而双极电凝术手术时间明显缩短,且具有手术时间短、简单、不需进手术室等优点,但其明显的缺点是术后短时间内眼部刺激症状严重。     

聚乙二醇滴眼液联合小牛血去蛋白提取物眼用凝胶治疗翼状胬肉术后干眼的临床疗效

目的观察聚乙二醇滴眼液联合小牛血去蛋白提取物眼用凝胶治疗翼状胬肉术后干眼的临床疗效。方法选择翼状胬肉术后有干眼症状的患者64例(86只眼),随机分为治疗组和对照组,每组32例(43只眼),治疗组给予聚乙二醇滴眼液和小牛血去蛋白提取物眼用凝胶联合治疗,对照组单用聚乙二醇滴眼液,分别在用药前及用药后15、30 d同一时间点检测并评定患者干眼的主观症状、角膜荧光素染色(FL)、泪膜破裂时间(BUT)及基础泪液分泌试验(SIT)。结果治疗前治疗组与对照组干眼的主观症状、FL、BUT、SIT差异无统计学意义(P0.05);治疗后15、30 d,治疗组主观症状、FL、BUT、SIT与对照组比较差异显著(P0.01)。结论聚乙二醇滴眼液联合小牛血去蛋白提取物眼用凝胶治疗翼状胬肉术后干眼疗效优于单用聚乙二醇滴眼液效果显著。     

睑板腺热脉动系统对老年睑板腺功能障碍的疗效及对IL-6、IL-1β的影响

目的 探讨睑板腺热脉动系统治疗老年睑板腺功能障碍(MGD)患者临床疗效及对眼部症状、睑板腺分泌功能和泪液白细胞介素(IL)-6、IL-1β变化的影响。方法 选取老年MGD患者100例(200眼),随机分为两组各50例。对照组采取MGD常规治疗(睑缘清洁、眼部热敷及眼睑按摩,早晚各1次,共3个月),观察组采取睑板腺热脉动系统治疗(12 min,共1次),比较两组临床疗效[包括泪膜破裂时间(BUT)、泪液分泌试验(SIT)、角膜荧光素染色(FL)、泪膜脂质层厚度(LLT)]、眼部症状[干眼症状评估问卷(SPEED)评分]、睑板腺分泌功能[睑板腺分泌物性状(MGYSS)评分]、泪液IL-6与IL-1β表达水平及不良反应,分析SPEED评分、MGYSS评分与泪液IL-6、IL-1β的相关性。结果 观察组总有效率显著高于对照组(P<0.05)。治疗后3个月,观察组BUT、SIT、LLT显著高于对照组(P<0.05),FL及SPEED评分、MGYSS评分显著低于对照组(P<0.05,P<0.001)。治疗后3个月,观察组泪液IL-6、IL-1β水平显著低于对照组(P<...     

桑色素滴眼液预防去势雄兔干眼症

目的研究桑色素滴眼液对雄兔去势所致干眼症的预防作用。方法在36只雄性新西兰白兔中(36眼,均为右眼),选取24只制作去势雄兔干眼症模型,随机分为实验(A)组、对照(B)组各12眼,A组使用桑色素滴眼液滴眼,B组使用磷酸盐缓冲液(PBS)滴眼。连续滴眼6 w,4次/d。另12只雄兔只切开阴囊去除睾丸造模后不滴眼液,作为模型组。分别于干预前和干预后2 w、4 w及6 w进行Schirmer I试验(SIT)检查、角膜荧光素染色(FL),并进行泪液总蛋白含量、淀粉酶活性、乳铁蛋白、溶菌酶含量检测及角膜共聚焦显微镜扫描。结果干预前A、B两组SIT、FL评分、泪液总蛋白量、乳铁蛋白、溶菌酶及淀粉酶活性差异均无统计学意义(P0.05);干预2 w、4 w及6 w后,模型组和B组SIT、FL评分泪液蛋白检测和角膜上皮基底膜下神经分布较干预前明显恶化(P0.05);A组SIT、FL评分、泪液蛋白检测和角膜上皮基底膜下神经分布均有不同程度显著改善(P0.05);在每个干预的时间点上,A、B两组的SIT、FL评分、泪液总蛋白量、乳铁蛋白、溶菌酶及淀粉酶活性均存在显著差异(P0.05)。干预6 w后,A组上皮基底细胞和炎症细胞密度分别为(3 121±224)个/mm~2和(43±16)个/mm~2,而B组上皮基底细胞和炎症细胞密度分别为(4 321±216)个/mm~2和(265±102)个/mm~2,模型组上皮基底细胞和炎症细胞密度分别为(4 522±255)个/mm~2和(281±113)个/mm~2。与模型组和B组比较,A组上皮基底细胞和炎症细胞密度差异有统计学意义(P0.05)。结论预防性使用桑色素滴眼液能够有效改善雄激素水平降低所致兔干眼症。     

Therapeutic alternatives for the Mallory-Weiss tear

Opinion statement The Mallory-Weiss tear (MWT) is a frequent cause of upper gastrointestinal bleeding. It has been diagnosed more frequently since endoscopy was introduced. Once the diagnosis has been made, several treatment options are available. The treatment modality chosen depends on the type and location of the lesion, the patient’s comorbid conditions, the availability of the different therapeutic modalities, and the experience of the endoscopist with each of these different modalities. In general, if the MWT is not actively bleeding at the time of endoscopy, no further treatment is needed owing to a low risk of rebleeding, unless a visible vessel is present. In the presence of a visible vessel or an actively bleeding vessel, then we recommend the use of any of the endoscopic treatment modalities discussed later in this article depending on the patient’s condition and clinical scenario. Our review of the literature suggests that multipolar electric coagulation (MPEC) is the treatment modality with better evidence-based support for safety and bleeding control. MPEC has been associated only with very few complications. It should be avoided when esophageal varices are suspected because it may precipitate and aggravate bleeding. In such instances, either polidocanol injection or endoscopic band ligation of the tear is recommended, which is emerging as a safe and effective treatment modality even in patients without varices. In addition, epinephrine injection is an effective first-line modality. However, it should be avoided in patients with history of coronary artery disease owing to the potential for systemic absorption. Endoscopic hemoclipping (EH) is another useful treatment option and is emerging as a first-line modality. However, it is not widely available in all endoscopy emergency units. If it is available, it is a great alternative. Finally, if bleeding continues or recurs despite endoscopic therapy, the patient should be referred for surgical treatment. However, if the patient is not a surgical candidate, then radiologic hemostasis with selective vasopressin or Gelfoam embolization represents a viable treatment alternative that may be used depending on availability of a specialized interventional radiologist.     

泪膜稳定性检测方法的研究概况

干眼是指由于泪液的量或质的异常引起的泪膜不稳定和眼表面损害而致眼部不适的一类疾病。泪膜不稳定是引起干眼的一个重要原因。检测泪膜稳定性的传统方法是侵犯性泪膜破裂时间,具有一定的局限性。泪膜检测的新技术如泪膜镜、泪膜干涉成像仪、角膜活体共焦显微镜及角膜地形图摄像系统具有较小的侵犯性及较好的稳定性、重复性。该文对泪膜稳定性的几种检测方法的临床应用作一综述,以便更好地为干眼症的诊断、治疗提供可靠依据。     

The spectrum of the Mallory-Weiss tear.

A Mallory-Weiss tear is a mucosal laceration occurrring at or near the esophagogastric junction and is most often associated with vomiting. This is a common cause of upper gastrointestinal bleeding; in our series, 14% of patients presenting to the hospital because of upper gastrointestinal bleeding had Mallory-Weiss tears. Massive hemorrhage is not characteristic and 37% of the patients required no blood transufsions. A classical history of nonbloody emesis followed by hematemesis was found in only 29% of patients. The most common story was the appearance of blood with the first vomiting. In 35% of our patients with Mallory-Weiss tear, an additional potential bleeding site was identified, and, in approximately half of these patients, it was actually bleeding. Most Mallory-Weiss tears stop bleeding spontaneously and supportive treatment is all that is required. If bleeding continues, infusion of vasoactive substances into the celiac artery or into the left gastric artery often obviates the need for operation.     

Mallory-Weiss tear during gastric endoscopic submucosal dissection

A 78-year-old woman was referred to our department for treatment of an early gastric cancer. Esophagogastroduodenoscopy (EGD) demonstrated a flat elevated lesion and a polypoid lesion on the greater curvature of the antrum. Histological analysis of, endoscopic biopsy samples taken from these lesions revealed an adenocarcinoma and a hyperplastic polyp, respectively. ESD was conducted for removal of the lesions. Carbon dioxide (CO2) in- stead of room air was used for insufflation, and the patient was adequately sedated without struggling or vomiting during the treatment. No significant bleeding from the lesion was observed during ESD, but fresh blood was identified endoscopically. Surprisingly, a Mallory- Weiss tear with active bleeding was detected on the lesser curvature of the gastric corpus. A total of eight hemoclips were applied for hemostasis. Both lesions were completely removed en bloc, and no bleeding or perforation developed after ESD. Histologically, the first lesion was apapillary carcinoma limited to the mucosal layer and without lymphovascular invasion or involvement of the surgical margins, while the second lesion was a benign hyperplastic polyp.