纯甘油保存人羊膜治疗翼状胬肉的临床研究

目的观察纯甘油保存的人羊膜用于原发性及复发性翼状胬肉治疗的临床疗效,并与细胞培养液(DMEM)加二甲亚砜(DMSO)保存的人羊膜进行比较,探讨简便实用的羊膜保存方法。方法对82例(90眼)翼状胬肉患者行翼状胬肉切除术联合羊膜移植术,随机对61例(65眼)联合使用纯甘油保存的羊膜(甘油组),包括45例(48眼)初发性翼状胬肉及16例(17眼)复发性翼状胬肉。21例(25眼)联合用细胞培养液加二甲亚砜保存的羊膜(DMEM+DMSO组),包括15例(18眼)初发性翼状胬肉及6例(7眼)复发性翼状胬肉。术后定期随访观察。结果术后随访7～29月,平均(16.2±6.3)月。共8眼复发,其中甘油组6眼复发,包括初发性翼状胬肉3眼和复发性翼状胬肉3眼。DMEM+DMSO组2眼复发,均为初发性翼状胬肉。2组复发率经χ2检验(χ2=0.061,P>0.05)差异无显著性,2组初发性翼状胬肉复发率(χ2=0.215,P>0.05)及复发性翼状胬肉复发率(Fisher’stest,P=0.333)均无统计学差异。结论纯甘油羊膜移植治疗初发性翼状胬肉及复发性翼状胬肉均取得满意疗效。纯甘油保存羊膜是一种安全、简便、有效的羊膜保存方法。     

丝裂霉素抑制PRK后haze形成及屈光回退的研究

目的评价在高度近视的PRK手术中预防性使用丝裂霉素（MMC）抑制术后角膜上皮下混浊（haze）和屈光回退的效果，以寻求更佳的屈光手术方式。方法将不宜接受LASIK手术的高度近视患者（－6．0～－10．0D）按协议随机分为研究组40例（80眼）和对照组38例（76眼），研究组患者在PRK手术中使用0．02％丝裂霉素，对照组患者采用常规的PRK手术，术后两组用药方案一样，评价术后角膜上皮下混浊（haze）、角膜上皮修复、屈光状态、裸眼视力，矫正视力、角膜内皮细胞改变等情况。结果研究组未出现一眼2级或2级以上haze，无一眼出现术后最佳矫正视力下降，术后达到最佳矫正视力所需屈光改变小于－0．5D有70眼；对照组有26眼出现2级或2级以上haze，有14眼出现术后矫正视力下降，术后达到最佳矫正视力所需屈光改变小于－0．5D有37眼。研究组与对照组的差异有显著性。使用丝裂霉素未见明显毒副作用。结论PRK手术中预防性使用0．02％丝裂霉素，对术后减少角膜雾状混浊，防止屈光回退，改善裸眼视力和最佳矫正视力，是安全有效的。     

紫外线与翼状胬肉形成

翼状胬肉的病因复杂，相关学说众说纷纭。紫外线辐射的病因学说通过流行病学以及其组织病理学改变两个方面得到证实，但其促使翼状胬肉形成的具体机制尚不清楚。最近的研究成果推测：光毒性损伤，氧化应激损伤以及细胞因子异常表达在翼状胬肉的病理形成过程中起到一定的作用。     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.     

第15例——双眼疼痛并畏光流泪数日

病历摘要 患者女性,30岁.因双眼疼痛、畏光、流泪,右眼20余天,左眼5 d,于2008年4月23 日来华中科技大学同济医学院附属协和医院眼科就诊.患者既往无外伤史;4年前曾有眼红病史,但诊治情况不详;偶患鼻炎.患者20余天前,于野外活动后无明显诱因,突发右眼红肿、畏光、流泪、眼痛,分泌物稀少,伴有打喷嚏、流涕及咽部不适等表现,在外院诊断为急性结膜炎,行抗细菌联合抗病毒等治疗1周,症状一度好转后又加重;     

细胞周期依赖性激酶抑制剂及其在眼科的应用

哺乳动物细胞能否增殖主要取决于细胞内特异性细胞周期依赖性激酶 (cyclindependentkinase,CDK)的活性发挥 ,CDK的活性发挥依赖于其正调控亚基Cyclin的顺序性表达及其负调控亚基CDK抑制剂 (cyclin dependentkinasein hibitor,CKI)的浓度。因此CKI与眼科肿瘤及增殖性疾病有着密切关系。通过抑制或激活CKI活性也有着广阔的临床治疗前景。我们就CKI的结构功能 ,CKI与眼科肿瘤、白内障、角膜病、增生性玻璃体视网膜病变等的关系及治疗作用作一综述     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.     

激光治疗使用不同接触镜填充液对角膜的影响

为探讨视网膜光凝中使用不同接触镜填充液对角膜的影响。对46例(52眼)病人分3次进行氩激光全视网膜光凝治疗,采用自身对照法,每隔一周分别使用0.25％氯霉素滴眼液、2％羟甲基纤维素(HPMc)及医用透明质酸钠(SH)作为眼底激光角膜接触镜填充液各1次,在治疗前及治疗后均用角膜测厚仪测量病人中央角膜厚度。结果治疗后中央角膜平均增厚,氯霉素为(31.4±10.2)μm;2％HPMC为(10.6士4.3)μm;SH为(8.0±3.5)μm。氯霉素与另两种填充液比较,差异有显著性意义(均P<0.01);HPMC与SH比较,差异无显著性意义(P>0.05>。提示2％HPMC和SH作为眼底激光角膜接触镜的填充液,对角膜水肿影响明显小于0.25％氯霉素滴眼液,是可供选用的优良填充液。     

《Kanski临床眼科学》(第8版)出版

由张明昌、刘欣主译的《Kanski临床眼科学》(第8版)由人民卫生出版社于2019年6月出版发行。全书共分21章。包括眼睑、泪道系统、眼眶病、干眼、结膜、角膜病、角膜及屈光手术、表层巩膜和巩膜、晶状体疾病、青光眼、葡萄膜炎、眼肿瘤、视网膜血管病变、获得性黄斑疾病、遗传性眼底营养不良、视网膜脱离、玻璃体混浊、斜视、神经眼科学、全身药物治疗的眼部不良反应、外伤等。     

电离子手术治疗机治疗尖锐湿疣的疗效观察

目的：观察电离子手术治疗机治疗200例尖锐湿疣的疗效。方法：我们用广西南宁物理应用所研制的高频电离子手术治疗机对尖锐湿疣给予治疗。结果：经治疗的200例患者均取得了较满意的效果。结论：电离子手术治疗机治疗尖锐湿疣操作方便、灵活、费用低,值得推广。