视网膜电图明视负波反应在开角型青光眼中的临床应用价值

目的评价视网膜电图(electroretinogram,ERG)的明视负波反应(photopic negative response,PhNR)在开角型青光眼患者中的临床应用价值。方法应用美国ESPION视觉电生理仪及一次性使用的DTL微纤维电极测量67例(67眼)正常人(年龄为21~76岁)、41例(62眼)开角型青光眼患者(年龄为21~77岁)的PhNR。全视野刺激器由LED光源发光,选用蓝色背景光(亮度为10 cd/m2),刺激光为红色光(刺激光强度分别为1 cd.s/m2、5 cd.s/m2和7 cd.s/m2)。采用Humphrey C30-2程序检查患者的视野,根据视野检查结果将青光眼患者分为早期组12例(21眼),进展期组13例(17眼)和晚期组16例(24眼)。在记录视网膜电图时,患者的眼压控制在正常范围内。检查患者的眼底并测量视盘的杯盘比。结果正常人的明视ERG都有伴随b波的缓慢的负向电位,即PhNR,其振幅随年龄的增大而降低。青光眼患者的a波及b波的振幅和潜伏期与年龄匹配的正常值对照差异无显著性,但是PhNR振幅较正常值明显降低,甚至在视野敏感度轻度缺失的早期组患者就出现PhNR的振幅下降,并且随视野敏感度缺失的增加,进展期和晚期组患者PhNR的振幅下降更加明显。在全部青光眼患者中,PhNR的振幅与视野的平均偏差(mean deviation,MD)、模式标准差(pattern stan-dard deviation,PSD)和垂直方向的杯盘比(C/D)存在明显的相关性(P<0.01)。结论开角型青光眼患者的PhNR的振幅比正常对照组低,PhNR振幅降低与青光眼病情的严重程度相关,早期青光眼患者的PhNR振幅就出现下降,并随视野敏感度缺失的增加下降更加明显。PhNR振幅降低对青光眼有较高的敏感性和特异性。PhNR可以作为开角型青光眼的早期检测及其青光眼损伤进展的一个视功能评价指标。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

大鼠视网膜色素上皮细胞系载脂蛋白基因表达与脂质合成和分泌

目的:检测大鼠视网膜色素上皮细胞系(RPE-J)是否表达载脂蛋白的基因及其是否具有合成和分泌中性脂质的功能。方法:将RPE-J细胞培养于组织培养板及Transwell上,用RT-PCR检测载脂蛋白mRNA的表达。将荧光标记颗粒加入细胞中培养以检测细胞吞噬功能。细胞中加入光感受器细胞外节,培养不同时间点后提取脂质,用薄层层析法和酶学荧光法分析细胞中脂质含量及变化。用放射性标记的OleicAcid([3H]-oleate)检测细胞新合成和分泌中性脂质的功能。结果:RPE-J细胞有载脂蛋白A-I,A-II,B,E,C-I,C-II,C-III,以及微粒体甘油三酯酸转移蛋白基因的表达。RPE-J细胞具有吞噬功能。吞噬光感受器细胞外节后,RPE-J细胞中甘油三酯含量增加5.8倍,磷脂含量增加2.6倍,非酯化胆固醇增加1.5倍,酯化胆固醇增加0.3倍。RPE-J细胞和培养基内可以检测到新合成的放射标记的中性脂质。细胞内脂质含量随时间延长而增加;培养基中只有磷脂随时间延长而增多。结论:RPE-J细胞有多种载脂蛋白及微粒体甘油三酯酸转移蛋白的基因表达。吞噬光感受器细胞外节后,RPE-J细胞中脂质增加。培养基中加入长链脂肪酸后,RPE-J细胞可以新合成和分泌中性脂质。     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

视网膜中央动脉阻塞的光相干断层扫描 病理形态学改变

目的观察视网膜中央动脉阻塞（CRAO）的光相干断层扫描（OCT）病理形态学改变特征。方法通过检眼镜、荧光素眼底血管造影(FFA)检查确诊的CRAO患者53例（53只眼）进行OCT检查，所有患者发病2周内。OCT检查采用水平或垂直线性扫描，扫描部位为黄斑区、后极部视网膜、视盘及出血、渗出等相应病灶部位。结果CRAO的OCT活体病理改变的图像特征包括黄斑区及后极部全层视网膜厚度增加、反射增强，光感受器暗区增宽（水肿）；黄斑中心凹水肿或囊样水肿；后极部视网膜出血及棉絮斑可有不同的OCT表现；视盘边缘隆起，呈水肿改变；其中4例患者伴有睫状视网膜动脉，在睫状视网视膜动脉供应区视网膜结构正常。结论OCT可以无创伤地在活体上观察CRAO的视网膜组织病理改变，特别适用于不允许进行FFA检查的高龄或合并全身病的CRAO患者，其独特的OCT图像病理改变可以为临床即时诊断提供客观依据。(中华眼底病杂志,2005,21:74-78)     

肿瘤患者营养知识健康教育临床技术路径

肿瘤患者营养不良发生率高、后果严重,直接导致不良临床结局,如并发症发生率增加、抗肿瘤治疗的反应下降、住院时间延长、生活质量降低、死亡率增加等。因此,临床营养治疗对于肿瘤患者具有重要意义。肿瘤患者营养支持治疗指南指出,无证据表明营养支持会促进肿瘤生长。相反,通过营养支持可以增强患者免疫功能,使患者在抗肿瘤治疗中获益。为了维持和改善患者营养状况,提高治疗性和耐受性,对患者进行营养健康教育十分重要。营养知识教育路径是护士为所有肿瘤患者在抗肿瘤治疗期间制定的健康教育工作计划,其能指导护士有预见性的、主动性的工作,减少患者的并发症,降低医疗费用,提高患者满意度。     

光学相干断层成像仪的临床应用

光学相干断层成像仪（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａ－ｐｈｙＯＣＴ）是近年发展的一种用光对生物组织进行高分辨横截面成像的新的影像学检查方法〔１〕。ＯＣＴ利用干涉仪、近红外光、低相干光在眼内获得接近１０μｍ高分辨率的图像,是一种非接触性、...     

青光眼视乳头地形图积分诊断模式研究

目的:对正常人与原发性开角型青光眼(primary open angle glaucoma,POAG)视乳头地形图参数进行比较,建立POAG视乳头地形图积分诊断模式并进行诊断。方法:对116例(116只眼)正常、63例(99只眼)连续性POAG患者和42例(75只眼)早期POAG患者进行海德堡视网膜断层扫描(Heidelberg Retina Tomograph,HRT)检查,进行视乳头地形图参数的比较:根据青光眼和正常人视乳头地形图参数分布的50％、95％和99％分布范围,分别记积分-4、-3、-2、-1、1、2、3、4分,以积分总和为变量进行诊断分析,以95％的特异性分别作出正常人和青光眼的肯定诊断,对不能作出肯定诊断的患者视为可疑青光眼。结果:正常人与青光眼患者视乳头地形图各参数具有显著性差异;运用积分诊断法,对连续病例POAG与正常资料进行判断的漏诊率为6.1％,误诊率为5.2％,确诊率为57.6％,疑诊率为36.4％;对早期青光眼与正常人资料进行的漏诊率为10.7％,误诊率为5.2％,确诊率为36％,疑诊率为53.3％。结论:正常人与青光眼患者的视乳头地形图参数具有明显差异,运用积分法可将受检人群分...     

非穿透小梁手术与小梁切除术远期疗效比较

目的 比较非穿透小梁手术和改良小梁切除术治疗原发性开角青光眼(POAG)的远期效果及并发症.设计回顾性队列研究.研究对象非穿透小梁手术患者69例,改良小梁切除手术患者53例.方法 对2000年1月-2001年12月间因POAG在中山眼科中心行非穿透小梁手术或改良小梁切除术(小梁切除术联合可拆除缝线、丝裂霉素C)的广东省内患者,于2004年7-10月以电话或信件方式通知复诊;复诊时详细记录病史、历次复诊和处理情况、当前用药种类,并进行视力、眼压、眼底检查,运用Kaplan-Meier生存分析法比较两种术式的成功率.主要指标眼压、手术成功率及并发症情况.结果 83例126眼POAG患者复查,其中非穿透小梁手术57例84眼,改良小梁切除术26例42眼.非穿透小梁手术组、改良小梁切除术组平均年龄分别为(43.7±21.2)岁、(39.6±19.5)岁.平均随访时间42.3±7.9月.非穿透小梁手术组、改良小梁切除术组术前眼压分别为(24.7±8.9)mmHg、(28.9±11.2).mmHg;术前用药种数分别为(1.89±1.1)种、(2.4±0.63)种;术后终点眼压分别为(16.7±6.7)mmHg、(12.2±4.8)mmHg(P=0.000);术后用药种数分别为(0.68±0.9)种、(0.17±0.4)种(P=0.001);完全成功率分别为52.38%、76.2%(P=0.032).在非穿透小梁手术组中,透明质酸钠凝胶植人物组、生物胶原植人物组完全成功率分别为66.7%、34.6%.结论 非穿透小梁手术治疗POAG的远期成功率低于改良式小梁切除术.术中植入人工支撑材料可提高非穿透小梁手术的远期成功率,且透明质酸钠凝胶植入材料比胶原效果好.(眼科,2008,17:278-282)