眼挫伤早期继发性青光眼血-房水屏障功能的动态观察

【目的】 探讨眼挫伤早期继发性青光眼患者药物治疗后血-房水屏障(BAB)功能的动态变化及其与眼压的关系? 【方法】 收集受伤时间在7 d内的闭合性眼挫伤患者61例61眼,分为高眼压组(39例39眼)和正常眼压组(22例22眼)?所有患者均予糖皮质激素和非甾体类药物治疗,眼压升高者予降眼压药物治疗?在治疗后不同时间点行激光蛋白细胞检测仪检测,对比高眼压组和正常眼压组不同时间点房水闪辉值与细胞数,分析房水闪辉值?细胞数与眼压的相关关系? 【结果】 挫伤患者眼压与房水闪辉值和房水细胞数呈正相关,相关系数分别为r = 0.529和0.590(P < 0.001)? 高眼压组初诊时房水闪辉(pc/ms)?每0.5 mm3房水细胞数,均显著高于正常眼压组(78 ± 60 vs 20 ± 16,205 ± 88 vs 50 ± 16,P < 0.001)?高眼压组初诊时眼压为(39 ± 10)mmHg,治疗后末次眼压为(19 ± 11)mmHg,较治疗前显著下降(P < 0.001);眼压恢复至正常范围者31例(79.5%),仍高于21 mmHg者8例(20.5%)?两组患者LFCM值随治疗时间延长呈下降趋势;正常眼压组治疗后约30 d房水闪辉值(5 ± 2)pc/ms和0.5 mm3细胞数(1 ± 1)恢复至正常范围;而高眼压组治疗后120 d房水闪辉值(9 ± 1)pc/ms和0.5 mm3细胞数(5 ± 3)仍高于正常人(P < 0.001)?【结论】 眼挫伤早期继发青光眼患者的血-房水屏障功能的损害较正常眼压者严重,且与损伤早期眼压升高密切相关?抗青光眼药物治疗眼压控制的有效率为79.5%?合理应用糖皮质激素和非甾体抗炎药可以促进BAB功能恢复?     

3期特发性黄斑裂孔自发闭合一例

患者男,68岁.因左眼视力下降伴视物变形、变小2个月于2009年12月8日来我院就诊.无眼外伤史,全身检查无异常.     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

长期使用青光眼药物对眼表的影响

目的 探讨长期使用青光眼药物对患者眼表的影响.方法 收集局部使用青光眼药物3个月以上的患者65例108只眼,分为单种药物使用组(A组)和多种药物使用组(B组);另收集正常对照组(c组)25例25只眼.对所有观察对象进行泪膜破裂时间测定(BUT)、基础泪液分泌试验(ST)、角膜上皮荧光素染色、结膜上皮虎红染色以及结膜印迹细胞(IC)检查.结果 正常对照组BUT(12.25±5.40)s,ST(11.65±4.66)mm,A组BUT(6.97±4.87)8 9ST(7.19±5.36)mm,明显低于正常对照组(BUT P=0.000;STP=0.001). B组BUT(4.81±2.45)s,显著短于正常对照组(P=0.000)和A组(P=0.008);ST(5.20±2.97)mm,显著少于正常对照组(P=0.000)和A组(P=0.026).A组和B组的角膜荧光素染色评分和结膜虎红染色评分显著高于正常对照组.与正常对照组相比,A组和B组IC评分2-3级所占比例明显增高,结膜上皮表现出鳞状上皮化趋势.结论 长期使用青光眼药物会导致患者泪膜稳定性下降、泪液分泌减少,角膜上皮荧光素染色增多,结膜上皮杯状细胞减少、上皮细胞呈鳞状上皮化等泪膜、角膜和结膜的损伤.     

青光眼睫状体炎综合征超声生物显微镜图像特征

[目的]研究青光眼睫状体炎综合征患者超声生物显微镜(UBM)图像特征,从而对其发病机制作初步的探讨.[方法]收集22例青光眼睫状体炎综合征患者,在炎症活动期作双眼UBM检查,检查内容包括前房、房角、后房、睫状体、玻璃体基底部,并将检查结果与临床表现相联系.[结果]22例患者发病时眼压[平均(40.6±13.3)mmHg],24～62 mmHg,裂隙灯显微镜检查均可见角膜背羊脂状沉着物,4眼(18.2%)有房水混浊.除1例对侧眼UBM表现正常外,21例双眼UBM图像均显示为轻重不等的前部及中间葡萄膜炎的表现,而眼压升高眼炎症渗出往往较对侧眼多,房水混浊和睫状体水肿多见于眼压升高眼.[结论]UBM可以显示青光眼睫状体炎综合征中睫状体炎症的情况,大部分单眼眼压升高者对侧眼也有睫状体炎改变,表明青光眼-睫状体炎综合征可能是双眼前部和中间葡萄膜炎性疾病,炎症较重眼可以引起小梁网炎症或房水分泌增多从而导致眼压升高.     

糖尿病视网膜病变黄斑区视网膜厚度与 多焦视网膜电图变化的关系

目的了解糖尿病视网膜病变(diabetic retinopathy,DR)患者黄斑区视网膜厚度以及相对应的视网膜功能改变。方法对38例患者60只DRⅢ～Ⅳ期患眼进行光学相干断层扫描(optical coherence tomography,OCT)及多焦视网膜电图(multifocal electroret inography, mERG)的检查。数据应用SPSS统计软件进行处理,并作线性相关分析。结果黄斑中央5°区域N₁、P₁和N₂波反应密度绝对值与黄斑中心凹神经上皮层厚度呈显著的负相关(γ＝-0.252～-0.266,P<0.05);黄斑中央10°区域N₂波反应密度绝对值与黄斑中心凹神经上皮层厚度呈显著的负相关(γ＝-0.332,P=0.01)。黄斑中央5°和10°区域N₁波 潜伏期与黄斑中心凹视网膜厚度无显著的相关关系,而黄斑中央5°区域P₁和N₂波潜伏期与黄斑中心凹视网膜色素上皮厚度有显著的负相关(γ＝-0.271～-0.322,P<0.05)。结论DR患者黄斑区神经上皮厚度的改变影响黄斑区局部视网膜的功能状态,主要表现为黄斑中央5°和10°区域mERG各波反应密度的降低。(中华眼底病杂志,2001,17:257-259)     

综合教学方法应用于临床医学专业留学生眼科学见习教学初探

临床医学专业留学生与国内学生之间存在较多差异,传统的教学方法并不适合临床医学专业留学生的临床学科教学.在临床医学专业留学生的眼科学见习教学中,根据他们的具体情况和眼科学本身的特点,综合运用兴趣激发教学方法、情景教学方法、以问题为基础学习教学方法和集中教学与分散教学结合教学方法,营造活泼的教学氛围,提高留学生在教学过程中主动参与和积极思考的意识,取得了良好的教学效果.     

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.     

原发性开角型青光眼眼底荧光血管造影与血液粘度及其它因素的关系

探讨原发性开角型青光眼眼底荧光血管造影与血液粘度及其它因素的关系。方法将１２２只原发性开角型青光眼的眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）的臂－脉络膜充盈时间〔ａｒｍ－ｃｈｏｒｏｉｄｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＣＴ）、臂－视网膜动脉充盈时间（ａｒｍ－ｒｅｔｉｎａｌａｒｔｅｒｙｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＡＴ）和视网膜动－静脉充盈时间（ｒｅｔｉｎａｌａｒｔｅｒｙ－ｖｅｎｏｕｓｆｉｌｌｉｎｇｔｉｍｅ，Ａ－ＶＴ）与高、中和低切变率下全血表观粘度、血浆粘度及红细胞压积进行逐步回归分析，将７０只眼ＦＦＡ的Ａ－ＡＴ、Ａ－ＶＴ与收缩压、舒张压、年龄和低切变率下全血表现粘度进行逐步回归分析。结果低切变率下全血表观粘度可明显影响Ａ－ＣＴ和Ａ－ＡＴ，而红细胞压积可明显影响Ａ－ＶＴ。低切变率下全血表现粘度和年龄均可影响Ａ－ＡＴ和Ａ－ＶＴ，尤以低切变率下全血表观粘度影响为大。结论血液粘度可明显影响原发性开角型青光眼ＦＦＡ各循环时间。     

睫状体恶性髓上皮瘤一例

睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤,易因其伪装特性而被漏诊和误诊.本文报道了1例3岁9个月的男性患儿,眼部表现似晶状体破裂,经部分肿物切除活检,病理诊断为睫状体恶性髓上皮瘤.