顽固干眼症,祸首睑缘炎

60岁的张大爷最近心烦异常,眼睛干干的不舒服,用了不少眼药水,可始终不见好转。来眼科就诊之前,张大爷使用了一种较为黏稠的人工泪液类药水,他焦急地对医生说,"这个眼药水就像眼药膏,用了之后眼睛前面模模糊糊,更看不清。"     

纳豆激酶对视网膜中央静脉阻塞动物模型中闪光视网膜电图的影响

目的:评价纳豆激酶对兔视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)视网膜功能是否有改善作用?方法:采用氩激光直接光凝法建立兔CRVO模型成功后,纳豆激酶组(A组)连续3天玻璃体腔注射0.1 FU纳豆激酶提取液0.1 ml;林格氏液组(B组)同方法注射林格氏液0.1 ml;空白模型组(C组)未外加处理?检测3组光凝前?光凝后2周闪光视网膜电图(FERG)?结果:①激光可以建立兔CRVO模型,造模成功后FERG-a?FERG-b波潜伏期较造模前明显延长;②A组FERG-a?FERG-b波潜伏期较B?C组明显缩短(P < 0.05)?结论:激光致兔CRVO模型是成功的,纳豆激酶可部分改善视网膜功能?     

加替沙星和左氧氟沙星治疗细菌性结膜炎的疗效对比研究

Objective To evaluate the different efficacy and safety to the treatment of baeterial conjunctivitis between the fluoroquinolone antibiotics gatifloxacin and levofloxacin.Methods A multicentre,random,double-blind and control trial was performed in six centers including Eye Ear Nose and Throar Hospital of Fudan University,Henan Eye Institute,Eye Hospital Affiliated to Wenzhou Medieal College,the First Affiliated Hospital Of Nanjing Medical University,Xijing Hospital Affiliated to the Fourth Military Medical University,the Second Affiliated Hospital of Xi'an Jiaotong University between August 2006 and October 2007. The levofloxacin was set as the efficient control. Two hundred and thirty-five patients (235 eyes ) that diagnosed as bacterial conjunctivitis were randomly divided into two groups by the method of randomized blocks, the test group (gatifloxacin) had 118 eyes and the control (levofloxacin) group had 117eyes. The drug delivery into conjunctival sac was performed at a 7-day period ( two drops per time, eight times per day at the first two days and two drops per time, four times per day at the following 5 days). All participants were given the conjunetival sac germ culture and drug sensitive test before and after the study.The combination score of signs and symptoms and evaluation of safety were conducted at the pre-dilivery day,the (4 ± 1 ) and (7 ± 1 ) dilivery day. The statistic analysis was conducted by CMH X2 test, Pearson X2 test and Fisher's exact probabilities test. Results The efficacy of the two groups was 94. 0% ( 110/117 eyes)in gatifloxacin group and 93.8% ( 106/113 eyes) in levofloxacin group with no significant difference( X2 =0.052,P = 0.8201 ). There was also no difference in the bacteria clearance between the two groups [ gatifloxacin versus levofloxacin, 94.1% (80/85 eyes) versus 92. 5% (74/80 eyes) ,P =0. 3470]. The decrease of combination score of signs and symptoms at the (4 ± 1 ) delivery day was 4. 436 +2. 310 in the gatifloxacin group and 3. 814 ± 1. 962 in the levofloxacin group, the difference of which was significant ( F =7.280,P = 0. 0075 ) . This trend was also proved at the ( 7 ± 1 ) delivery day ( gatifloxacin versus levofloxacin, 7. 487 ± 2. 821 versus 6. 912 ± 2. 911, F = 4. 060, P = 0. 0452 ). The visual acuity and the tolerance after local application of the eye drops between the two groups had no diffenrence ( the visual acuity F = 1.04, P = 0. 3080; the tolarence after local admission X2 = 0. 1372, P = 0. 7111 ). According to the result of the germ culture, the major pathogenic bacteria were Gram-positive bacteria ( totally 20 kinds of Grampositive bacteria and 8 kinds of Gram-negetive bacteria). The MIC and drug resistence of gatifloxacin to the Gram-positive bacteria was lower than that of the levofloxaxin ( Staphylococcus Epidermidis, Staphylococcus Aureus, coagulase negative Staphylococcus, α-hemolytic Streptococcus). Conclusions The gatifloxacin eye drop has a good therapeutic effect to the bacterial conjunctivitis, It can effectively clear the pathogen with fast and strong effect. Moreover, it has a low MIC in vitro, advance a prospect in drug resistance, safety and ocular tolerance.     

金雀异黄素对培养的人RPE细胞诱导凋亡作用的研究

目的 研究金雀异黄素(genistein,Gen)对培养的人视网膜色素上皮(retinal pigment epithelium,RPE)细胞的诱导凋亡作用,探讨其作用机制.方法 0、25、50、100、200μmol·L-1 Gen分别作用RPE细胞24 h;MTT检测细胞活性;流式细胞仪检测细胞周期,定量分析凋亡;免疫印迹技术检测细胞外调节蛋白激酶(extracellular regulated proteinkinases,ERK)、p38MAPK的表达及活性.结果 不同浓度的Gen作用RPE细胞24 h后,细胞生长明显受到抑制,抑制率分别为6.44%、14.71%、28.97%、45.75%;细胞凋亡率明显增高,分别为16.87%、19.44%、23.14%、34.81%;细胞周期表现为S期和G2/M期阻滞,并伴随G0/G1期细胞减少;p-ERK1/2表达下调,p-p38表达下调.ERK1/2的激活与Gen诱导的细胞凋亡呈负相关,p38的激活与凋亡可能也存在一定的关系.结论 Gen可以抑制人RPE细胞的增殖,并诱导其凋亡,存在量效关系,且主要是通过ERK通路发挥生物学效应.     

改良穿刺放液在外路法视网膜脱离复位术中的应用

目的 探讨外路法视网膜脱离复位手术中改良穿刺放视网膜下液的临床有效性及安全性.设计回顾性病例系列.研究对象2006年1月至2009年9月收住南京医科大学第一附属医院眼科的329例孔源性视网膜脱离的患者.方法 手术显微镜下予巩膜环扎和（或）巩膜外加压术,术中均联合改良穿刺法放出视网膜下液,即穿刺点选在角巩膜缘后11 mm的直肌两侧,避开涡状静脉和视网膜裂孔,采用25 G 5/8-in针头（1ml BD针头,新加坡Becton Dickinson Medical（S）Pte Ltd.）垂直巩膜穿刺放出视网膜下液,穿刺深度不超过针头斜面.收集术前、术后及手术数据并进行分析.主要指标改良穿刺放液的成功率及并发症的发生率.结果 329例外路法视网膜脱离复位手术,327例（99.4%）引流出视网膜下液,2例未引流出视网膜下液.改良穿刺放液的并发症有视网膜下出血2例（0.6%）,出血范围小于2PD,穿刺点正对视网膜裂孔处1例（0.3%）,导致玻璃体自巩膜穿刺口脱出.结论 改良穿刺放液法是外路法视网膜脱离复位术中引流视网膜下液的一种安全、有效的方法.     

高糖刺激人视网膜色素上皮细胞诱导型一氧化氮合酶表达及与p38 MAPK信号通路关系

目的:观察高糖刺激体外培养的人视网膜色素上皮(human retinal pigment epithelium,RPE)细胞表达诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)的作用及其与p38信号通路(p38 mitogen activated protein kinase,p38 MAPK)的关系,从而进一步探讨糖尿病视网膜病变的发病机制.方法:培养人RPE细胞,分为对照组、高糖组、高糖 SB203580组和甘露醇组,采用四甲基氮唑蓝(MTT)比色法检测细胞活力,免疫荧光染色法观察RPE细胞中磷酸化p38 MAPK和iNOS的蛋白表达.结果:①MTT检测结果:高糖可以抑制RPE细胞增殖,加入特异性p38 MAPK抑制剂SB203580预处理后,抑制作用减弱;②免疫荧光法检测结果:与对照组相比,高糖组磷酸化p38 MAPK,iNOS蛋白表达明显增高;加入SB203580预处理后,iNOS表达被显著抑制.结论:高糖能够抑制RPE细胞增殖,通过活化p38 MAPK信号通路刺激RPE细胞iNOS的表达,在糖尿病视网膜病变的发生发展中起重要作用.     

巩膜扣带术治疗青年人陈旧性视网膜脱离的疗效分析

目的 观察巩膜扣带术治疗青年人陈旧性视网膜脱离的疗效。 设计 回顾性病例系列。研究对象 2007年1月至2011年3月间在南京医科大学第一附属医院眼科行巩膜扣带术治疗的陈旧性视网膜脱离患者60例（64眼）,年龄在15~30岁（20.6±4.3岁）。方法  对所有研究对象在手术后第1、2周、1、3月各随访一次,记录视力、眼压,用裂隙灯显微镜结合前置镜观察视网膜的复位情况,并于术后第3月时记录最佳矫正视力。术后3个月时最佳矫正视力较术前提高≥2行者认为视力提高。单次手术视网膜完全复位超过3个月以上者认为手术成功。主要指标 视网膜复位例数,术后最佳矫正视力。结果 64眼中单次手术成功者61眼,成功率达95.3%。单次巩膜扣带术后,67.2%（43/64眼）的患眼视力提高。结论 青年人陈旧性视网膜脱离行巩膜扣带术治疗的手术成功率较高,多数患者术后可获得有用视力。     

两种手术治疗翼状胬肉的临床观察

翼状胬肉是一种慢性炎症性病变,其患病率高达2%～5%,手术是治疗该病的主要措施,虽然手术方法较多,但术后复发是眼科医生面临的问题。我院自2009年3月至2012年3月对翼状胬肉82例（102只眼）分别用两种不同手术方法进行治疗,现报告如下。     

非穿透性小梁切除术治疗难治性青光眼

目的：非穿透性小梁切除术（NPT）治疗难治性青光眼的临床效果。方法：对残余青光眼、外伤性青光眼、无晶体眼继发性青光眼、新生血管性青光眼、色素性青光眼13例（14眼）采用单纯NTP、粘性小管切除术。结果：术后随访1－5个月,无1例下降,平均眼压由术前6.13kPa改善为术后1.57kPa。无任何严重并发症发生。结论：NPT治疗难治性青光眼降眼压效果好,术中、术后并发症少,是一种有前景的抗青光眼手术。     

TGF-β1诱导人Tenon囊成纤维细胞增殖及其机制

目的:观察TGF-β1是否促进人Tenon囊成纤维细胞(HTFs)增殖并且探讨其作用机制?方法:用TGF-β1(0?0.5?1.0?2.0?5.0?10.0 ng/ml)作用于体外培养的3~6代HTFs 24 h,CCK-8 法?EdU染色法检测其增殖;采用Western blot法检测HTFs中RhoE的表达及其下游细胞增殖相关蛋白cyclinD1和增殖细胞核抗原(PCNA)的表达,用慢病毒建立RhoE敲降细胞系?结果:TGF-β1可以剂量依赖性促进HTFs增殖,以5 ng/ml TGF-β1处理后有统计学差异,EdU掺入法检测发现,5 ng/ml TGF-β1组EdU标记率明显高于对照组?5 ng/ml TGF-β1组 HTFs中RhoE蛋白的表达平均灰度值明显低于对照组,细胞增殖相关蛋白cyclinD1?PCNA的表达平均灰度值高于对照组?细胞中RhoE沉默后,CCK-8法检测细胞活力较对照组上升,流式细胞术发现S期也升高,cyclinD1?PCNA灰度值也上升?结论:TGF-β1可以通过降低RhoE引起下游周期蛋白cyclinD1的表达升高,诱导人Tenon囊成纤维细胞增殖?