视网膜切开与切除术在复杂性视网膜脱离手术中的应用

目的探讨视网膜切开与切除术在复杂性视网膜脱离手术中的临床应用。方法对１９９７年９月至１９９８年１２月间行视网膜切开与切除的２４例复杂性视网膜脱离患者作回顾性分析。其中巨大裂孔性网脱１５例,外伤牵引性视网膜脱离２例,增殖性血管性视网膜病变２例,复发性视网膜脱离３例,前部ＰＶＲ２例。手术联合玻璃体切除联合巩膜扣带技术,三通道睫状体平部晶体／玻璃体切除、膜剥离、过氟化碳液体使用、眼内激光、硅油－过氟化碳液体交换填充硅油或气体－过氟化碳液体交换填充Ｃ２Ｆ６气体。其中采用视网膜切开１０例,视网膜切除１０例,视网膜切开联合切除４例。结果２４例患者近期（出院时）观察视网膜解剖复位２２例,有效率为９１．７％,１９例视力不同程度的改善。１５例巨大裂孔僵硬边缘切除或裂孔两边松驰性视网膜切开,解剖复位１４例,视力改善。术后随访１９例,时间为３～１４月（平均６月）,视网膜复位１８例,占９４．７％,视力≥０．０５者９例,占５０％,眼球萎缩及低眼压１例。结论视网膜切开与切除术提高了复杂性视网膜脱离手术的成功率。     

硅油下视网膜复位术疗效探讨

目的 总结硅油填充术后视网膜再脱离行硅油正视网膜复位术的疗效,探讨该手术的适应证及手术技巧。方法 对１７例（１７只眼）硅油填充术后视网膜再脱离者,在保留硅油的条件下,做睫状体扁平部３切口,在导光纤维的导引下行剥膜、断膜、视网膜切开、内放液、内激光光凝、视网膜下全氟化碳液体取出、补充硅油等使视网膜得位。结果 １７只眼中,术后视网膜重位１４只眼,成功率为８２．４％。术中硅油误入前房１只眼,误入脉络膜上     

HSV-1感染对人视网膜色素上皮细胞生长的影响

目的:建立单纯疱疹病毒1型(Herpes simplex virus,HSV-1)感染人视网膜色素上皮细胞(Retinal pigmentepith elial,RPE)的体外模型,观察HSV-1感染对体外培养RPE细胞生长的影响。方法:以感染复数(MOI)为5的HSV-1(F株)感染体外培养的RPE细胞。用相差显微镜观察RPE细胞的形态变化;用MTT法、流式细胞术观察HSV-1感染对RPE细胞增殖、凋亡和细胞周期的影响;用PCR和免疫荧光法验证HSV-1感染RPE细胞是否成功。结果:成功在体外建立了HSV-1感染RPE的细胞模型。HSV-1感染RPE细胞8h后出现病变,细胞形态开始变得细长和皱缩;感染24h后细胞病变更加明显,细胞间间隙增加,甚至可见多核巨细胞;感染48h后所有细胞均变圆,细胞开始出现脱落甚至死亡。MTT法显示HSV-1感染RPE后24h和48h能抑制细胞生长(P<0.01),细胞的抑制率分别为(16.37±3.28)%和(47.91±6.39)%;流式细胞仪检测发现HSV-1感染可影响RPE细胞的细胞周期,但对细胞凋亡无明显影响。结论:HSV-1能感染体外培养的RPE细胞,抑制RPE细胞的增殖,并影响RPE细胞的细胞周期。眼科学报2007;23:212-218.     

人眼缺血型视网膜中央静脉阻塞组织病理学观察

目的 观察视网膜中央静脉阻塞（CRVO）的病理改变，为临床寻找有效的防治方法提供客观的依据。 方法 对11例11只眼缺血型CRVO标本进行组织病理学分析，重点观察视盘和视神经处视网膜中央静脉（CRV）和中央动脉（CRA）的改变。 结果 11只眼CRV在通过筛板区时管腔均变狭窄。其中，5只眼在筛板区和筛板后区CRV内可见机化血栓存在，6只眼在筛板区及其后区CRV内存在血栓机化再通管道，CRV管壁内皮增生，管腔狭窄。11只眼CRA均有明显的动脉硬化改变，管壁增厚，管腔变细；2只眼CRA在筛板区管壁内膜增生，管腔严重狭窄；筛板水平CRA无血栓形成。 结论 在缺血型CRVO发生中，CRV在筛板水平有血栓形成；血栓机化再通的时间及程度，可能决定了CRVO的转归与预后。CRV在巩膜管狭小间隙内受压迫是CRVO的发病机制。 (中华眼底病杂志，2007，23：163-165)     

在玻璃体切割术中保留前囊膜的临床观察

目的评价玻璃体手术中保留前囊膜的临床效果。方法选取2002年4月～2006年4月在我院行保留前囊膜的玻璃体晶状体联合切割手术治疗视网膜脱离患者36例,其中裂孔源性视网膜脱离患者17例,糖尿病性视网膜病变（VI期）患者19例。术中眼内注气者21例,硅油填充者15例。术后追踪观察至少3个月,根据其术前、术后的视力及并发症对手术效果做出评价。结果随访期间均发生不同程度前囊膜混浊、但不影响术后眼底的观察。所有患者术后视力均高于术前或与术前相等。其中16例患者二期植入后房型人工晶体。36例患者中1例发生视网膜脱离复发,1例硅油滴进入前房,未发生角膜失代偿、青光眼等并发症。结论完整保留前囊膜可以避免复杂性视网膜脱离患者术中和术后由于眼内注气或硅油填充而产生的并发症,并有利于PCIOL的植入,可以保留虹膜的正常形态,是一种理想的手术方式。     

高度近视眼LASIK前后视网膜神经纤维层厚度的HRT测量

目的 探讨准分子激光原位角膜磨镶术(LASIK)对高度近视眼视网膜神经纤维层厚度的影响.方法 用海德堡视网膜断层扫描仪(HRT)黄斑水肿分析软件(MEM)对施行准分子激光原位角膜磨镶术8例(16只眼),近视度数为-6.75～-11.25 D(-9.75±1.75 D)的高度近视眼患者的黄斑视网膜信号宽度进行测量.检测时间为术前、术后第1、3和7 d.检测部位为黄斑中央及距离黄斑中心凹500 μm的视网膜神经纤维层.结果 准分子激光原位角膜磨镶术术前、术后第1、3和7 d视网膜信号宽度差异有显著意义(P＜0.05).结论 准分子激光原位角膜磨镶术对高度近视视网膜神经纤维层的厚度有影响.     

Long-term neuroretinal full-thickness transplants in a large animal model of severe retinitis pigmentosa

Background The purpose of this study was to explore neuroretinal transplantation in a large animal model of severe retinitis pigmentosa and to establish graft development, long-term survival, graft-host integration, and effects on the host retina. Methods Rhodopsin transgenic pigs, aged 6 months, received in one eye a fetal full-thickness neuroretinal sheet in the subretinal space by means of vitrectomy and retinotomy. Six months postoperatively, eyes were studied in the light microscope and with immunohistochemical markers. Full-field electroretinography (ERG) was performed at 4 and 6 months. Results Laminated grafts with well-organized photoreceptors, rod bipolar cells, and Müller cells were found in five of six eyes. Neuronal connections between graft and host retina were not seen. In the five eyes containing a graft, the number of surviving rods in the host retina was significantly higher compared with unoperated eyes. The ERG did not reveal any significant difference in b-wave amplitude between operated and control eyes, but the cone-derived response in operated eyes increased significantly from 4 to 6 months while the rod response in control eyes decreased significantly. Conclusions Fetal full-thickness neuroretina can be transplanted safely to an eye with severe retinal degeneration. In their major part, the transplants develop a normal laminated morphology and survive for at least 6 months. Graft and host retinal neurons do not form connections. Retinal function in the host is reduced initially by the surgical trauma, but the presence of a well-laminated graft counteracts this effect and rescues rods from degeneration. Supported by The Foundation Fighting Blindness (grant# C-NC02-798-0078), The Faculty of Medicine, University of Lund, The Swedish Research Council, The Princess Margaretas Foundation for Blind Children, The 2nd ONCE International Award for New Technologies for the Blind.     

Recombinant α2(IV)NC1 domain of type IV collagen is an effective regulator of retinal capillary endothelial cell proliferation and inhibits pre-retinal neovascularisation

Background A recombinant form of the α2(IV)NC1 domain of type IV collagen has been shown to have potent anti-angiogenic activity although this peptide has not been studied in the context of proliferative retinopathies. In the current investigation we examined the potential for α2(IV)NC1 to regulate retinal microvascular endothelial cell function using a range of in vitro and in vivo assay systems. Materials and methods α2(IV)NC1 at concentrations between 0.1 and 1 μg/ml was added to retinal microvascular endothelial cells (RMECs) followed by assessment of cell attachment, proliferation and survival. This agent was also tested within a novel in vitro three-dimensional retinal angiogenesis assay and the number of angiogenic sprouts quantified. α2(IV)NC1 was also delivered intra-vitreally to mice with oxygen-induced proliferative retinopathy (OIR) and neovascularisation evaluated in comparison with vehicle-treated controls. Results RMECs treated with α2(IV)NC1 (0.1, 0.5 and 1 μg/ml) showed delayed attachment at 3 h post-seeding, although this deficit had been restored at the 6-h time point. BrdU assay of DNA replication revealed that confluent RMECs treated with α2(IV)NC1 showed no measurable response in comparison with vehicle-treated controls. By contrast, proliferation of sub-confluent RMECs was significantly reduced by α2(IV)NC1 at 0.5 μg/ml (P<0.01). α2(IV)NC1 also induced apoptosis in RMECs and inhibited angiogenesis of pre-existing retinal vascular networks in vitro (P<0.001). Intra-vitreal injection of α2(IV)NC1 in the OIR model significantly inhibited pre-retinal neovascularisation compared with vehicle-treated controls (P<0.001). Conclusion α2(IV)NC1 inhibits angiogenesis in the retinal microvasculature. This recombinant protein has potential for the treatment of neovascularisation in proliferative retinopathies. BioStratum Inc. did not sponsor this research in any way. None of the authors are paid consultants with this company.     

Effects of subretinal implant materials on the viability,apoptosis and barrier function of cultured RPE cells

Background Subretinal microphotodiode array (MPDA) is a type of visual prosthesis used for the implantation in the subretinal space of patients with progressive photoreceptor cell loss. The present study aimed to evaluate the effect of materials for MPDA on the viability, apoptosis and barrier function of cultured pig retinal pigment epithelium (RPE) cells.Methods Primary culture of pig RPE cells was performed and 24 pig eyes were used to start RPE culture. The third passage of the cultures was plated on different materials for MPDA and MPDAs. The tetrazolium dye-reduction assay (MTT) was used to determine RPE cell viability. Flow cytometry was measured to indicate the apoptosis rates of RPE cells on different materials. RPE cells were also cultured on microporous filters, and the transepithelial resistance and permeability of the experimental molecule were measured to determine the barrier function.Results The data from all the methods indicated no significant difference between the materials groups and the control group, and the materials tested showed good biocompatibility.Conclusions The materials for MPDA used in the present study had no direct toxicity to the RPE cells and did not release harmful soluble factors that affected the barrier function of RPE in vitro.This research is supported by National Basic Research Program of China under the project: 2005CB724307