羊膜匀浆治疗实验性孔源性视网膜脱离

目的 观察和探讨羊膜匀浆在封闭视网膜裂孔中的作用及其机制。方法 40只新西兰白兔随机分为A、B、 C、D 4组，其中A、C为治疗组，B、D为对照组，每组各10只兔。每只兔随机取1只眼进行实验。经扁平部玻璃体切割，视网膜造孔，人为造成视网膜脱离，气液交换。治疗组裂孔表面滴加0.1 ml羊膜匀浆，而对照组滴加0.1 ml磷酸盐缓冲液(PBS)；术毕视网膜复位，20% SF6眼内填充。A、B组于手术后14 d处死动物，C、D组于手术后28 d处死动物，进行光学显微镜、电子显微镜和免疫组织化学染色检查。结果 手术后14 d，A组视网膜复位6只眼，占60%，B组视网膜复位2只眼，占20%（P=0.021）。手术后28 d，C组视网膜复位8只眼，占80%， D组视网膜复位3只眼，占30%(P=0.046)。各组之间视网膜复位的比例比较，差异有统计学意义(P＜0.05)。治疗组手术后出现轻度前节炎症反应，经局部应用糖皮质激素后炎症于3～5 d消退。光学显微镜检查结果显示，治疗组应用羊膜后在视网膜裂孔边缘有多层成纤维细胞样细胞增生，与其下脉络膜和视网膜色素上皮细胞发生粘连。对照组视网膜裂孔边缘细胞增生明显减少，视网膜不能和脉络膜形成粘连。电子显微镜检查与光学显微镜检查结果一致。成纤维细胞样细胞免疫组织化学染色显示胶质纤维酸性蛋白 （GFAP）阳性，提示裂孔边缘增生细胞主要是视网膜胶质细胞。结论 羊膜匀浆有助于封闭视网膜裂孔，通过刺激裂孔边缘视网膜胶质细胞增生，促进视网膜脱离复位。     

姜黄素防治兔眼增生性玻璃体视网膜病变的实验研究

背景先前的系列研究表明,姜黄素可以诱导体外培养的兔视网膜色素上皮（RPE）细胞凋亡,抑制其RPE细胞的增生,且在玻璃体内应用后不良反应较小,具有防治增生性玻璃体视网膜病变（PVR）的潜在价值。目的探讨姜黄素玻璃体内注射对RPE细胞诱导的兔眼PVR模型的防治效果。方法新西兰白兔20只40只眼,所有兔眼玻璃体注射前先抽取0．2ml玻璃体液,然后在兔眼玻璃体内注射0．1ml（2×10^6）同种RPE细胞,每只兔随机选取1只眼立即注入1mg／L的姜黄素0．1ml作为姜黄素组（20只眼）,对侧眼注入等量的含质量分数0．5‰DMSO的生理盐水作为对照组（20只眼）。注药后1、3、7、14、21、28d裂隙灯显微镜下观察角膜、房水、晶状体的透明度及眼前节炎症反应情况;使用间接检眼镜、眼底彩色照相和B型超声检查玻璃体视网膜情况。以视网膜脱离发生眼数作为检测指标,评价姜黄素对PVR的防治效果。结果玻璃体注药后1d、3d所有兔眼发生眼前节炎症反应,玻璃体轻中度混浊,但未见增生条带及视网膜脱离。玻璃体注药后7d,所有兔眼前节炎症反应基本消退,对照组14只眼（75％）玻璃体出现增生条带,姜黄素组2只眼（10％）玻璃体内出现增生条带,差异有统计学意义（P〈0．01）,但2组均未见视网膜脱离。注药后14d,对照组11只眼（55％）出现视网膜脱离,姜黄素组2只眼（10％）出现视网膜脱离,差异有统计学意义（P〈0．01）;注药后21d,对照组16只眼（80％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离;注药后28d,对照组19只眼（95％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离,差异有统计学意义（P〈0．01）。结论姜黄素玻璃体腔内注射可以有效预防RPE细胞诱导的兔眼实验性PVR的发生发展。     

实验性视网膜脱离的病理改变及细胞增生

目的:探讨实验性视网膜脱离的病理变化和细胞增生。方法:成年白化病兔32眼在间接检眼镜直视下,先抽取玻璃体液0.5mL软化眼球,用50nm玻璃微管在下方6:00赤道部部位刺入视网膜造成裂孔并注射生理盐水0.5mL于视网膜下间隙。术后0.5,1,3,6,24h;3,7d和14d摘除眼球作组织学观察并以免疫组织化学的方法检测视网膜下细胞增生。结果:32只兔眼术后均发生视网膜脱离,视网膜脱离范围3:00～9:00(髓腺下方视网膜均脱离)。自发性复位的时间在3～14d,组织学切片显示,3d可见视网膜色素上皮细胞积聚团,7dRPE细胞增生肥大呈巨噬细胞样改变,14dRPE多层化改变,并见巨噬细胞样RPE来源于单层的RPE,游离RPE层后,吸附于脱离的光感受器细胞外节;3d增生细胞核抗原即表达阳性,增生细胞表达角蛋白阳性。结论:在此模型中,RPE细胞表现出细胞增生,巨噬细胞样细胞也来源于RPE。     

玻璃体切除术治疗人工晶状体眼视网膜脱离

目的探讨以玻璃体切除术治疗人工晶状体眼视网膜脱离的临床效果。方法对50例（50眼）人工晶状体眼视网膜脱离施用玻璃体切除术。其中16眼行硅油填充术，34眼行C3F8眼内填充。术后随访6～24月。结果术后视网膜最终完全复位49眼（98．00％）。15眼（30．00％）术中新发现裂孔。术后视力均有不同程度的提高。结论玻璃体切除术治疗人工晶状体眼视网膜脱离具有术野清晰、易于寻找隐匿性裂孔、提高视网膜复位率及复发率低的优点。     

视网膜脱离术后复杂性裂孔的光凝治疗

目的 探讨激光进一步应用于视网膜脱离术后一些复杂裂孔的光凝治疗。方法 对４３例４３眼视网膜脱离术后特殊复杂性裂孔行光凝治疗。结果 ３４眼（７９．１％）裂孔封闭,脱离视网膜复位。结论 在视网膜脱离的治疗中,进一步地应用激光光凝,能提高视网膜脱离复位手术的成功率。     

晚期急性视网膜坏死综合征的手术效果观察

目的评价急性视网膜坏死综合征视网膜脱离行玻璃体切除、硅油填充联合视网膜光凝术的手术效果。方法对10例（10眼）急性视网膜坏死综合征视网膜脱离进行经睫状体平坦部玻璃体切除和增生膜剥离术，术中氩激光光凝视网膜裂孔和残留的正常视网膜边缘，并行硅油填充术，3眼因晶状体浑浊同时行晶状体切除术，术后5～6个月取出硅油，硅油取出之前3周行赤道部的氩激光光凝，观察硅油取出后视网膜复位及视力状况。结果术后短期内（〈1月）视网膜全复位，随访14～26月，8眼视网膜复位良好，复位率80．00％（8／10），2眼因视网膜表面增生膜形成，视网膜再次脱离。术后视力：光感者1眼，手动者1眼，数指者3眼，0．05～0．1者3眼，0．12者2眼。结论现代玻璃体切除、硅油填充联合视网膜光凝术提高了急性视网膜坏死视网膜脱离的视网膜复位率，但因视网膜坏死结构破坏以致视力恢复较差。     

直视下巩膜环扎加压术治疗孔源性视网膜脱离的疗效观察

目的探讨直视下孔源性视网膜脱离复位手术的临床效果。方法孔源性视网膜脱离16例（16眼）由同一术者进行外路手术,术前三面镜下,间接检眼镜下仔细严格定位裂孔,术中肉眼下大致定位,全部行环扎并裂孔变性区外垫压,根据裂孔大小冷凝或非冷凝,尽可能安全放液,根据眼压,裂孔形态,部位选择注入气体填充物,定期观察术后视力、眼内反应和视网膜复位情况。结果16例视网膜脱离手术患者,术后随访半年,视网膜完全复位14眼（87．5％）,视力较术前提高12只眼（75％）,不变3只眼（18．75％）,不完全复位少量视网膜下液吸收缓慢1眼,再次脱离行玻璃体切割手术视网膜复位1眼（6．25％）。最好矫正视力0．1以上10只眼（62．5％）。结论手术前的仔细检查定位裂孔,环扎术避免遗漏裂孔及变性区均为直视下外路治疗孔源性视网膜脱离提供安全有效的保证,为眼科医师提供新的视网膜脱离手术方式的选择,且手术时间较短,操作相对简单,疗效有明确的保证。     

首选玻璃体切除术治疗简单孔源性视网膜脱离的临床观察

目的回顾总结首选玻璃体切割术治疗简单裂孔源性视网膜脱离的临床疗效。方法选择26例（26只眼）简单裂孔源性视网膜脱离，裂孔均位于上方，增生性玻璃体视网膜病变（PVR）C1级或以下。均采用标准闭合式玻璃体切割术，巩膜外冷凝裂孔，眼内注入C3F8填充，均无外加压。随访2—16个月，平均9个月，记录视网膜复位情况、末次最佳矫正视力及并发症。结果全部病例均一次复位成功（复位率100％），末次最佳矫正视力均有不同程度的提高，在0．2～0．3者9只眼（34．6％），0．3～1．0者17只眼（65．4％），视网膜裂孔冷凝不足8只眼（30．8％），补充激光光凝，1只眼（3．8％）术后1个月出现后囊下型白内障，12只眼（46．2％）一过性高眼压，经局部使用降眼压药物，1周后眼压正常，未出现其它并发症。结论在经济条件允许时，对于上方裂孔的简单孔源性视网膜脱离．可采用玻璃体切割术作为首选方式。     

视网膜脱离的预防性激光疗效分析

目的探讨多波长氪激光预防性治疗视网膜脱离的方法和疗效。方法采用多波长氪激光对153例（162眼）视网膜变性、裂孔、脱离及各种复杂的视网膜脱离术后患者行视网膜光凝术。结果周边视网膜变性、裂孔62眼,成功率100．00％;伴有局限性视网膜脱离的周边裂孔组13眼,成功率76．92％,3眼行局部外垫压术后再行激光治疗;黄斑裂孔组12眼,成功率83．33％,2眼因玻璃体牵拉发生视网膜脱离行玻璃体切除术;孔源性视网膜脱离环扎或局部外垫压术后,及各种复杂视网膜脱离玻璃体切除术后75眼,成功率96．00％,1眼行玻璃体切除术中行激光治疗成功,1眼再次手术调整外加压块,1眼为硅油填充眼行光凝术后视网膜脱离区扩大行玻璃体腔硅油补充术。结论多波长氪激光用于视网膜脱离的预防和补充治疗,可根据病情选用不同的治疗波长,同时掌握好光凝的适应症,控制光能量和范围,就可获得较好疗效。     

硅油取出前视网膜脱离病因分析

目的；报告硅油取出前视网膜脱离发生率，并分析发生此视网膜脱离的有关病因。方法：选择增生性玻璃体视网膜病变（PVR）和增生型糖尿病视网膜病变患者行玻璃体切割联合硅油填充手术。结果：16眼中，有10眼在硅油取出前视网膜复位，6眼视网膜脱离，视网膜脱离发生率为37．5％，视力增进4眼（25％），不变8眼（50％），下降4眼（25％）。术后并发症为晶状体混浊加重（5眼，31％），继发性青光眼（2眼，13％），虹膜新生血管（1眼，6％），低眼压（2眼，13％），PVR加重（2眼，13％）。结论：硅油取出前视网膜脱离发生主要原因为原裂孔未封闭，新裂孔形成，视网膜表面增殖膜形成等。     

神经生长因子对视网膜脱离视细胞保护作用的实验研究

目的 探讨神经生长因子(NGF)对视网膜脱离(RD)视细胞损伤的保护作用。方法 选用健康青紫蓝兔36只随机分为正常对照组、NGF治疗组和生理盐水(NS)模型组，实验组右眼RD模型制作后，NGF治疗组每天结膜下注射NGF0．1mL(1mg／mL)2次；NS模型组每天结膜下注射NS0．1mL，2次；实验动物于3d、14d后处死，取眼球壁做光镜、电镜检查。结果 光镜、电镜检查NGF治疗组内外节损害较轻、视细胞数较多、外核层较厚、视网膜结构和层次排列较好。NGF治疗组视网膜外核层凋亡细胞计数少于NS模型组。视网膜脱离后14d外核层厚度NGF治疗组厚于NS模型组；NGF治疗组视网膜外核层细胞计数多于NS模型组。结论 结膜下注射NGF对视网膜脱离后视细胞损伤有一定的保护作用。     

抗代谢药物8-氯腺苷抑制兔实验性视网膜新生血管的研究

目的探讨抗代谢药物8-氯腺苷(8-Cl-A)眼局部应用对兔实验性视网膜新生血管的抑制作用。设计实验研究。研究对象纯种青紫兰家兔40只。方法采用视网膜静脉直接光凝法建立兔视网膜静脉阻塞(RVO)模型。分别设立对照组及8-Cl-A给药组,每组各20只(20眼)。于造模后次日治疗组每日球后注射8-Cl-A 9mg(计10日),对照组注射等体积生理盐水,采用荧光素眼底血管造影观察注射后2周内2组兔视网膜新生血管的发生率,并进行统计学分析。主要指标视网膜新生血管发生率及程度。结果RVO对照组20眼中,17跟发生视网膜新生血管:8-Cl-A治疗组20眼中3眼发生光凝点远端的视网膜新生血管(P= 0.000),且发生的程度及范围小于对照组,同时未见视网膜静脉侧支循环的建立。结论8-Cl-A可有效抑制兔实验性视网膜新生血管的发生。在视网膜血管增生性病变治疗中可能具有潜在的临床应用价值。     

Management of rhegmatogenous retinal detachment without detectable breaks

Purpose: To evaluate the causes of failure to find retinal breaks, the anatomical and functional outcomes of patients with rhegmatogenous retinal detachment (RD) without detectable breaks (Group I), to compare the results with detectable breaks (Group II). Methods: Forty‐five out of 258 eyes that had RD without detectable breaks were analysed retrospectively. Results: The causes of failure to find retinal breaks were aphakia/pseudophakia in 22 eyes, small pupil without any eye disease in four eyes, corneal opacity in two eyes, cataract in two eyes, vitreous haze in two eyes, choroidal detachment in one eye, and unknown cause in 12 eyes. After a single scleral buckling procedure, anatomical re‐attachment of the retina successfully occurred in 62.2% of group I and 78.9% of group II patients. After repeated surgery, final anatomical success rates were 87.2% and 90.2%, respectively. The best corrected visual acuity was 6/60 or better in 53.9% in Group I and 52.5% in Group II. Conclusion: The main cause of failure to find the retinal break was aphakia or pseudophakia. Although the rates of retinal reattachment in eyes without detectable breaks in primary buckling surgery was lower than detectable breaks and reoperations were required more frequently, final success rates were satisfactory and similar in both groups.     

Safety of intravitreal quinupristin/dalfopristin in an animal model

AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.     

Intraocular Use of Hydrogel Tissue Adhesive in Rabbit Eyes

Purpose

To evaluate the safety and efficacy of newly developed hydrogel glue to treat rhegmatogenous retinal detachments in in vitro and in vivo studies.

Methods

In the in vitro study, the solid hydrogel glue was soaked in a balanced salt solution (BSS). The pH was measured periodically, and the dissolution time was recorded. In the in vivo study in six albino rabbits, 0.1?ml of hydrogel glue was injected into the right vitreous cavity, and 0.1?ml BSS was injected into the left vitreous, as the control. Clinical, electroretinography (ERG) and histological examinations were performed. Retinal detachment with a retinal hole was created in 12 albino rabbits after vitrectomy. After fluid–air exchange, the hydrogel glue was applied to the hole in nine rabbits; three other rabbits were used as controls. Clinical and histological examinations were performed.

Results

The pH ranged from 6.65 to 8.14. The glue remained solid in BSS for 7 weeks. The glue injection did not induce inflammation. There was no significant difference between the study and control eyes in the ERG amplitude or the implicit times of the a and b waves. No significant histological abnormality was detected. The retina was reattached with glue in three of nine eyes. The histological examination showed glue under the retina.

Conclusions

Hydrogel glue, which seemed to be minimally toxic to the eye, can be used to patch retinal breaks. However, methods to mix a small amount of each solution completely and a more effective intraocular delivery system for the glue are needed.?Jpn J Ophthalmol 2007;51:89–95 © Japanese Ophthalmological Society 2007

     

曲安奈德溶媒视网膜毒性的形态学研究

目的探讨两种商用曲安奈德(TA)溶媒的视网膜毒性及其与剂量的关系。方法用梯度离心法从两种TA注射液提取高纯度溶媒A、溶媒B。36只新西兰白兔右眼玻璃体内分别注入0.1mL和0.2mL溶媒A、溶媒B及平衡盐溶液。术前、术后定时行眼前节、检眼镜检查及眼底照相;荧光素眼底血管造影(FFA)观察血管病变;光镜、透射电镜观察视网膜结构。结果眼底和FFA检查显示溶媒B引起视网膜血管损害和有髓神经纤维水肿。两种溶媒均引起视网膜结构及光感受器超微结构损害,且随剂量增加而加重;溶媒B引起的损害较溶媒A更显著。结论两种溶媒可引起无色素兔眼不同程度的视网膜损害,并随剂量增加而加重。     

透明质酸酶诱导玻璃体后脱离的实验研究

目的 研究透明质酸酶诱导玻璃体后脱离的安全性和有效性。方法 选取成年健康纯种新西兰白兔15只，随机分为A、B、C3组。随机选取每只兔的一眼为实验眼，另一眼为对照眼。A组玻璃体腔注入透明质酸酶5IU／0．1mL，B组透明质酸酶10IU／0．1mL，C组透明质酸酶20IU／0．1mL，对照组眼内注入0．1mL BSS。结果 A组术后所有眼均未见玻璃体后脱离；B、C组于术后第5周出现玻璃体后脱离，并且无出血、渗出或视网膜脱离等并发症发生。结论 浓度为10IU／0．1mL和20IU／0．1mL的透明质酸酶玻璃体腔注射后第5周可形成玻璃体后脱离，并且安全有效。     

The Natural History of Asymptomatic Retinal Breaks

A long-term prospective follow-up of 359 asymptomatic retinal breaks, involving 231 eyes of 196 patients, was carried out for from one to 18 years, without treatment. This group was drawn from a consecutive series of phakic eyes of patients who had not had retinal detachment. Fifty of the breaks were fractional tears with attached flaps. No case of clinical retinal detachment occurred. Eighteen separate small subclinical retinal detachments occurred, involving 17 eyes, but only three of these enlarged slightly. No case in the series was treated. The absence of clinical retinal detachment in this series argues strongly for the relative safety of asymptomatic retinal breaks in phakic, nonfellow eyes, even if they are tears with attached flap in superior locations. Prophylactic treatment is not justified for this type of break in this type of eye.     

Evaluation of potential retinal toxicity of adalimumab (Humira)

Purpose  The purpose of this study is to evaluate the retinal toxicity of two doses of adalimumab (Humira), a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF), when injected intravitreally in rabbits. Methods  Sixteen male pigmented rabbits (divided into two groups, eight animals per group) were used for this study. Two concentrations of adalimumab were tested: 0.5 mg/0.1 ml and 5 mg/0.1 ml. Each concentration was injected intravitreally randomly in one eye (study group) of each rabbit (group I received 0.5 mg/0.1 ml and group II received 5.0 mg/0.1 ml), while in the other eye (control group) 0.1 ml of sterile balanced saline solution (BSS) was injected. Slit-lamp and funduscopic examinations were performed every second day for 2 weeks for signs of infection, inflammation and toxicity. A baseline electroretinogram (ERG) was performed before the experiment and at the last follow-up day (day 14). ERG examination followed ISCEV standards. At the last follow-up day, the animals were sacrificed and the enucleated eyes were prepared for histological evaluation of retinal toxicity. Results  No differences in ERG responses at photopic and scotopic conditions were observed in eyes injected with either concentration of adalimumab or BSS. Furthermore, histologic examination of the retina in the enucleated eyes (in all groups) did not demonstrate any evidence of drug toxicity. Conclusions  Intravitreal adalimumab did not appear toxic to the retina in this experimental model at concentrations of 0.5 and 5 mg. If found safe in additional studies, intravitreally injected adalimumab could be evaluated for efficacy in the treatment of inflammatory eye conditions.