翼状胬肉组织中ATP结合盒转运蛋白B5的表达变化及意义

背景 角膜缘干细胞(LSCs)缺乏可引起多种眼表疾病,如翼状胬肉等.ATP结合盒转运蛋白B5(ABCB5)是新发现的特异性LSCs标志物,研究ABCB5在翼状胬肉组织中的表达变化对于翼状胬肉的防治具有重要的临床意义. 目的 研究ABCB5在翼状胬肉组织中的表达变化,探讨其在翼状胬肉发生和发展中的作用.方法 收集2015年1-11月在解放军474医院行原发性翼状胬肉切除术的手术标本37例,同期收集年龄匹配的行斜视矫正术和视网膜脱离复位术患者的正常结膜组织22例.采用免疫组织化学法检测ABCB5在翼状胬肉组织标本中的表达和定位,分别采用Western blot和实时荧光定量PCR法检测翼状胬肉标本中ABCB5蛋白及其mRNA的相对表达量,并与正常结膜标本进行比较. 结果 ABCB5蛋白表达于所有22例正常结膜复层扁平细胞的细胞质和细胞核中,以基底层细胞中表达更为明显,呈现明显极性.在37例翼状胬肉标本中,可见ABCB5阳性表达者34例,占91.89％,ABCB5表达阴性者3例,占8.11％.正常结膜组和翼状胬肉组ABCB5蛋白相对表达量分别为0.90±0.31和0.59±0.41,ABCB5 mRNA表达量分别为1.01±0.26和0.65±0.32,翼状胬肉组ABCB5蛋白和mRNA的相对表达量均明显低于正常结膜组,差异均有统计学意义(t=-0.266,P=0.011;t=-4.560,P=0.000). 结论 LSCs标志物ABCB5的表达下调提示LSCs的减少和缺失与翼状胬肉的发生和发展有关,提示ABCB5检测可能作为翼状胬肉发生和发展、术后复发及疗效评估的观察指标之一,也可能成为翼状胬肉的治疗靶点.     

无巩膜瓣经巩膜缝线固定后房折叠型人工晶状体植入术的临床研究

目的　探讨无巩膜瓣经巩膜缝线固定后房折叠型人工晶状体植入术的手术方法及效果。方法　对２２例（２２眼）行无巩膜瓣经巩膜固定后房折叠型人工晶状体植入术,记录术前和术后的裸眼视力及最佳矫正视力并随访超过１２个月,探讨该手术方法的技巧,观察手术效果及术后并发症。结果　２２眼术前最佳矫正视力为０．５８±０２４,术后视力均有提高。术后１周裸眼视力０．５２±０．２７,与术前最佳矫正视力相比,差异无统计学意义（ｔ＝０．７４２,Ｐ＞００５）。术后１个月最佳矫正视力０．６１±０２３,与术后１周相比,差异无统计学意义（ｔ＝０．８１４,Ｐ＞０．０５）。术后１眼出现眼压升高,１ｄ后降至正常;１眼出现角膜水肿, ３ｄ内逐渐消退。未见人工晶状体移位、脱位及倾斜,无缝线脱落及暴露,无虹膜粘连、黄斑水肿等并发症发生。结论　无巩膜瓣经巩膜固定后房型人工晶状体植入术具有视力恢复良好、术后并发症发生率低等优势,对于无后囊或后囊支撑力不足的无晶状体眼的屈光矫正是安全有效的。     

牵牛花综合征误诊一例

患儿,女,7岁,汉族。自幼左眼视力不好,内斜,4岁时在当地医院曾行内斜矫正术,弱视训练3年,效果不佳。检查诊断:左眼视乳头炎,药物治疗1个月无效,于2000年3月转我院治疗。门诊检查:视力右10, 20ＤＳ→10,左002, 175ＤＳ()-25ＤＣ×180°→005。眼位左内斜10°～15°,运动良,眼球水平眼震,双眼屈光间质清亮。眼底:右正常。左视盘扩大约为对侧3倍,边缘淡红色欠清,中央有一个深凹陷,凹陷内有白色不透明组织呈分叶状,周围约有27支放射状排列走行直的血管,部分至视网膜。视网膜无出血及渗出,黄斑中心反射弱。房角宽。非接触眼压:右眼13ｍｍＨｇ,左…     

绷带镜在翼状胬肉切除联合结膜瓣移植术后的应用

目的:探讨绷带镜在翼状胬肉切除联合结膜瓣移植术后应用的临床效果.方法:前瞻、随机、对照性病例研究.收集2015-01/2016-01在我院诊断为原发性翼状胬肉拟接受翼状胬肉切除联合结膜瓣移植术患者共110例110眼,奇数者为绷带镜组(在翼状胬肉切除联合结膜瓣移植术后给予配戴绷带镜),偶数组为对照组(仅行翼状胬肉切除联合结膜瓣移植术).术后1、3、7d时采用VAS视觉模拟量表法评估术后疼痛程度,并观察术后患者角膜刺激症状;术后3d采用角膜荧光染色法检测角膜上皮修复情况;随访患者至术后1a,统计翼状胬肉复发情况.结果:术后1d绷带镜组疼痛评分(4.13±2.06分)较对照组(5.80±1.93分)明显减轻(t=4.391,P<0.001);术后3d绷带镜组疼痛评分(2.09±1.36分)较对照组(3.65±1.65分)明显减轻(t=5.422,P<0.001);术后7d绷带镜组和对照组疼痛评分无统计学差异(t=1.295,P=0.198).术后1d和3d时,绷带镜组刺激症状均较对照组减轻(P<0.05),而术后7d时绷带镜组与对照组比较无统计学差异(P=0.052).术后3d时角膜荧光染色面积,绷带镜组(0.33±0.37mm2)较对照组(2.73±2.21mm2)明显减小(t=7.921,P<0.001).术后1a翼状胬肉复发率,绷带镜组与对照组比较无统计学差异(P=1.000).结论:翼状胬肉切除联合结膜瓣移植术后配戴角膜绷带镜可以有效减轻患者术后疼痛和刺激症状,加速角膜上皮愈合,明显提高患者术后舒适度.     

Pentacam与前节OCT测量有晶状体眼后房型人工晶状体植入术后拱高的比较

目的对有晶状体眼后房型人工晶状体（PPC-ICL）植入术后患者应用三维眼前节全景分析仪（Pentacam）与前节光学相干断层扫描仪（AS-OCT）测量拱高及其他眼前节参数,分析2种仪器的差异性和一致性。方法横断面研究。连续选取50例（100眼）PPC-ICL植入术术后复查患者,分别应用Pentacam和前节OCT测量眼前节参数。采用配对样本t检验及Bland-Altman图法对二者差异性和一致性进行统计学分析。结果Pentacam测得拱高值为（353.8±124.0）µm,前节OCT测得拱高值为（536.2±150.8）µm,两者差异有统计学意义（t=27.92,P＜0.05）,两者呈高度正相关性（r=0.905,P＜0.05）,Pentacam测得拱高比前节OCT测得拱高低（182.4±65.3）µm,其差值95%一致性区间为54.3～310.5 µm。结论Pentacam与前节OCT均能为我们提供拱高值,Pentacam测量值显著低于前节OCT测量值,在临床工作中应该综合分析。     

Bevacizumab对大鼠角膜新生血管的抑制作用

目的 观察bevacizumab对角膜新生血管的抑制作用.方法 选取鼠龄6～8周、体质量(180±10)g的雄性Wistar大鼠40只,建立碱烧伤角膜新生血管模型;将大鼠随杌分为3个不同剂量药物治疗组(实验组)和1个对照组,每组10只(20眼),大鼠角膜碱烧伤后分别给予结膜下注射不同剂量(0.5 mg、1.0 mg、2.0 mg)的bevacizumab,对照组注入生理盐水;然后进行角膜新生血管的各项数据观察,观察期为16 d,主要观察项目包括各组角膜新生血管的生长情况;计算角膜新生血管的生长面积;碱烧伤后第7天和第16天后采集角膜,标本行组织病理学检测和免疫组织化学检测,第16天,计算平均OD值;评价药物对角膜新生血管的抑制效果.结果 碱烧伤后第7天、第14天,实验组与对照组新生血管面积比较差异均有统计学意义(均为P＜0.05);组织病理学检测发现各实验组炎性细胞浸润、新生血管形成均明显轻于对照组.对照组血管内皮生长因子(vascular endothelial growth factor,VEGF)染色明显增强,实验组的表达明显减弱.碱烧伤后第16天,实验组与对照组比较,VEGF染色阳性细胞数和VEGF平均OD值差异均有统计学意义(均为P＜0.05).碱烧伤后第7天、第16天大鼠角膜CD34的免疫组织化学检测结果及新生血管密度计数方面,实验组和对照组比较差异均有统计学意义(均为P＜0.05).结论 结膜下注射一定浓度的bevacizumab对大鼠角膜碱烧伤后的新生血管生长有抑制作用.     

地塞米松在复合式小梁切除术中应用的临床研究

目的评价地塞米松联合丝裂霉素在青光眼滤过术中的临床效果。方法 A组：小梁切除术应用0.5 mL的0.4 mg/mL丝裂霉素加0.5 mL（2.5 mg）地塞米松;B组：小梁切除术应用0.5 mL的0.4 mg/mL丝裂霉素＋0.5 mL生理盐水。观察两组术后眼压、视力、结膜充血、滤过泡及并发症等。每组80只眼、男性、年龄40-60岁、原发性闭角型青光眼、随访12个月。结果术后A组眼压控制显著优于B组,但差异无统计学意义（P〉0.05）,视力改善无明显差别（P〉0.05）,功能性滤过泡成功率高,结膜充血反应较轻,术后应用抗瘢痕增生药量减少。结论青光眼滤过术中应用地塞米松可减轻术后眼部充血及炎症反应,在临床实用中,取得良好的效果。     

鼠神经生长因子对早期糖尿病大鼠玻璃体中感光细胞间维生素A类结合蛋白含量的影响

Objective To observe the effect of intravitreal injection of mouse nerve growth factor (NGF)on interphotoreceptor retinoid-binding protein(IRBP)in the vitreous of diabetic rats at early stages.Methods Ninety-six male Sprague Dawley(SD)rats were divided into control group(group A,24 rats)and experimental group(72 rats).The rats in experimental group were induced with streptozotocin injection for diabetic retinopathy model,and then randomly divided into positive control group(group B),normal saline group(group C)and NGF group(group D),24 rats in each group.The rats in the group A and B were not intervened.The rats were received intravitreal injection with 4μl normal saline(group C)or 4 μl(0.5 μg/μ1)NGF(group D).At 2,4,6 and 8 weeks after injection,IRBP levels were detected bv enzvmelinked immunosorbent assay(ELISA);hematoxylin-eosin(HE)staining and light microscope were used to observe the morphological changes of the retina;transmission electron microscope was used to observe the retinal uhrastructure.Results At 2 weeks after injection,there was no significant difference in IRBP expression between group A,B,C and D(F=2.833,P=0.052).At 4,6,8 weeks after injection,the differences of IRBP expression between group A,B,C and D were significant(F=22.252,108.459,105.726;P=0.000).At different time points after injection,there was no significant difference in IRBP expression of group A(F=1.462,P=0.241),but there were significant differences in IRBP expression of group B.C and D(F=150.98,63.519,64.604;P=0.000).Light microscope found that the retinal structure was clear in group A and in group B,C,D at 2,4 weeks after injection;the retinal thickness were thinner in group B,C,D at 8 weeks after injection.Transmission electron microscope displayed that the structure of rod outer segments was clear in group A and in group B,C,D at 2 weeks after injection;partly unclear structure of rod outer segments and slightly enlarged gap were observed in group B,C,D at 4,8Weeks after injection.Conclusion Intravitreal injection with NGF can stabilize the IRBP expression in the vitreous of diabetic rats at early stages effectively.     

白内障术后糖尿病性视网膜病变多波长激光治疗

Objective To investigate the effect and opportunity of multiwavelength laser Photocoagulation on diabetic retinopathy after cataract extraction combined with intraocular lens implantation. Methods Retrospective analysis. Forty-seven eyes (35cases) with diabetic retinopathy after cataract extraction combined with intraocular lens implantation staged by examination results of retinophotoscopy, FFA and OCT two weeks later. All patients received multiwavelength laser Photocoagulation relied on diseased region and stage in third week, including local Photocoagulation, grid pattern Photocoagulation and panretinal Photocoagulation. Results All patients completed 3-12 months of follow-up. In all eyes, visual acuity improved in 11 eyes, remained stable in 32 eyes, decreased in 6 eyes, accounting for 23.40%, 63.83%, 12.77%, respectively. FFA showed that macular edema subsided completely in 23 eyes, subsided partly 16 eyes, remained stable or even worsen 8 eyes, accounting for 48.94%, 34.04%, 17.02%, respectively. OCT showed the mean forveal thickness were (390.3± 102.5)μ m before Photocoagulation and (287.67± 82.81)μ m, (208.47± 56.72)μ m, (168.38±42.560)μ m after Photocoagulation 1 month, 3 and 6 months, respectively, the difference was significant (P＜0.05). Retinal capillary leakage subsided extensively or neovascular atrophied completely 20 eyes, invalid 4 eyes by FFA. Conclusions To examine patients by retinophotoscopy, FFA and OCT in time after cataract extraction combined with inuaocular lens implantation and then receive multiwavelength laser Photocoagulation rely on diseased region and stage, such can control further development of diabetic retinopathy and conserve vision function effectively.