Role of pilocarpine use following laser peripheral iridotomy in eyes with refractory acute angle closure glaucoma: A case report and literature review

Rationale:Angle closure glaucoma (ACG) is one of the most emergent types of glaucoma in clinical practice. Laser peripheral iridotomy (LPI) could minimize pupillary block and prevent ACG from an acute attack. However, recurrent increase in intraocular pressure (IOP) may still occur despite successful LPI. The aim of this study is to highlight the importance of postLPI pilocarpine use and larger LPI size as well as to share some experiences of cataract surgery in patients with ACG.Patient concerns:A 63-year-old female was referred to our hospital for headache, and poor control of IOP in the right eye for 3 hours.Diagnoses:The patient was diagnosed ACG in the right eye. Recurrence of ACG in the right eye and new-onset and recurrent ACG in the left eye were noted during follow-up, despite successful LPI. The diagnosis was confirmed through slit lamp and gonioscope examination.Interventions:The LPI size was enlarged and pilocarpine use was maintained at 2% (1 drop 4 times a day) in both the eyes. Finally, cataract surgery was performed in both the eyes.Outcomes:No recurrence of ACG was noted during postLPI pilocarpine use in both the eyes. The postoperative IOP was stable for >6 months after cataract surgery without any surgical intervention or antiglaucoma medication use. No discomfort or major complication was observed.Conclusion:This report highlights the importance of postLPI pilocarpine use and larger LPI size in patients with refractory ACG.     

Intraocular lens power calculation after radical keratotomy and photorefractive keratectomy: A case report

Rationale:To report a rare case of calculating the IOL power in a cataract patient who underwent both radial keratotomy (RK) and photorefractive keratectomy (PRK).Patient concerns:A 48-year-old woman underwent bilateral RK at age 22 and bilateral PRK at age 46. She developed bilateral corneal haze and corneal endothelial inflammation and received steroids therapy for long time after PRK. Then she was referred to our hospital due to decreased vision in the both eyes.Diagnoses:The patient was diagnosed with binocular complicated cataract, corneal haze, high myopia and post corneal refractive surgery (RK and PRK).Interventions:The patient underwent bilateral phacoemulsification. The IOL power was calculated using SRK/T formula for RK and Haigis-L formula for PRK, respectively. We finally selected the Haigis-L formula and the intraocular lens (SN60WF) was implanted within the capsular bag.Outcomes:After the surgery, both eyes showed myopia drift, and the right eye continuously fluctuated in refractive results. However, by nearly 1 year later, refractive results in both eyes had stabilized, and no other complications had occurred.Lessons:IOL power in patients who undergo both RK and PRK can be reliably calculated using the Shammas-PL, Average of multiple formulas, or Barret True-K No History formulas. Haigis-L formula is not suitable. Such patients require at least three months after surgery to attain refractive stability in both eyes.     

Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report

Rationale:Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.Patient concerns:A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.Diagnoses:Based on the patient''s symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.Interventions:FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.Outcomes:IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.Conclusions:We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.     

叔丁醇治疗SD大鼠硒性白内障的疗效观察

目的:探讨叔丁醇外用滴眼液对SD大鼠硒性白内障模型(模拟老年性白内障)的治疗作用. 方法:建立SD大鼠硒性白内障模型,并将实验大鼠右眼作为药物干预组,左眼作为对照组;用自行配制的叔丁醇外用滴眼液(浓度分别为25、50、75 mmol/L)按时滴眼(1滴/次,3~5次/d);每日进行肉眼观察,并于用药后第5日及第10日用裂隙灯显微镜观察大鼠双眼晶状体核性病变,每日用游标卡尺(最小刻度值0.02 mm)测量大鼠双眼晶状体核性斑块最大直径的改变.另选未建模的SD大鼠,用100 mmol/L的叔丁醇滴眼液滴眼(1滴/次,3~5次/d),观察药物有无毒性及其他不良反应. 结果:硒性白内障大鼠用药眼晶状体核性混浊斑块直径小于对照眼(P<0.01);用药眼核性混浊斑块混浊程度低于对照眼;叔丁醇滴眼液毒性低,刺激性小. 结论:叔丁醇滴眼液对SD大鼠硒性白内障有一定的治疗作用.     

食管癌P16表达与患者预后的关系

目的 探讨P16蛋白的表达与食管癌恶性潜能和进展密切相关.方法 检测56例食管癌患者癌组织P16的表达,并进行随访.结果 P16蛋白表达阳性率越低,食管癌术后生存率也越代,反之也然.结论 P16蛋白表达率能较好地反映食管癌预后,P16表达缺失或下调是食管癌恶性潜能和进展晚期的一种特异表现.P16蛋白表达与食管癌患者预后有一定的关系.     

亚低温防治颅脑损伤患者术后脑血管痉挛的效果观察

目的 观察亚低温防治颅脑损伤患者术后脑血管痉挛(CVS)的效果及对预后的影响.方法 将98例颅脑损伤患者按数字表法随机分为对照组和观察组,每组49例.对照组给予常温常规治疗,观察组患者给予亚低温治疗;观察比较两组患者术后1、3、5、7d大脑中动脉平均血流速度(VMCA)水平;比较两组患者CVS发生率、CVS严重程度及术后3个月预后情况.结果 术后1d两组患者VMCA水平比较差异无统计学意义(P＞0.05);术后3、5、7d观察组较对照组VMCA水平均明显降低(P＜0.05).观察组CVS严重程度明显轻于对照组,CVS发生率明显低于对照组(P＜0.05);术后3个月观察组较对照组术后良好率明显提高(P＜0.05).结论 亚低温应用于颅脑损伤患者治疗中,可降低CVS发生率,减轻CVS严重程度,并改善预后.     

肾上腺素对糖尿病性白内障患者角膜内皮细胞的影响

目的：观察不同浓度肾上腺素对糖尿病并发白内障患者行超声乳化白内障吸除术后角膜内皮细胞的影响,探讨术中应用肾上腺素的合理浓度。方法选取2013年1至6月糖尿病性白内障患者90例（90眼）,随机分为3组,每组30眼,分别于灌注液中加入0．1 ml、0．2 ml及0．5 ml肾上腺素,均行白内障超声乳化吸除联合人工晶体植入手术,于术前及术后1周采用非接触型角膜内皮显微镜行角膜内皮细胞密度及六角形细胞比例检查。结果3组术前角膜内皮细胞密度及六角形细胞比例比较,差异无统计学意义（ P ＞0．05）。3组术后1周角膜内皮细胞密度分别为（2494±177;286）/mm 2,（2428±177;353）/mm 2,（2380±177;375）/mm 2,六角形细胞比例分别为（49±177;13）/mm 2,（45±177;13）/mm 2,（43±177;14）/mm 2。3组术后角膜内皮细胞密度及六角形细胞比例均较术前减少,其差异均有统计学意义（ P＜0．05）。术后3组间比较,随加入肾上腺素浓度增加,角膜内皮细胞密度及六角形细胞比例逐渐下降,但差异无统计学意义（ P ＞0．05）。结论糖尿病性白内障患者角膜内皮细胞对手术损伤及肾上腺素毒性损害的耐受性降低,在有效维持术中瞳孔散大状态的同时,选用浓度较低的肾上腺素,以减少对角膜内皮细胞的损害。     

佳贝和欧可芬滴眼液在白内障手术中应用的研究

目的：评价佳贝和欧可芬滴眼液在白内障术中维持瞳孔散大及术后抗炎作用疗效。胡机分组（佳贝组、欧可芬组和对照组）研究８６名白内障患者术前应用两种药物后,白内障术中瞳孔大小的改变以及对卡米可林（氨甲酰胆碱,Ｃａｒｂａｃｏｌ）缩瞳作用的影响;以地塞米松滴眼液为对照,研究应用两种滴眼液对术后角膜后ＫＰ和房水混浊度的影响,以及对术眼眼压的影响。结果：与对照组相比,佳贝和欧可芬都能有效抑制术中的瞳孔缩小（Ｐ〈０     

榄香烯对晶状体上皮细胞增殖的抑制作用

目的：研究榄香烯（Ele）对重组人表皮生长因子（rhEGF）诱导的晶状体上皮细胞（LEC）增殖的抑制作用及剂量．效应和时间．效应关系，探寻防治后发性白内障的有效方法。方法：四甲基偶氮唑蓝法（MTT）测定不同浓度Ele对增殖状态的牛LEC活性的抑制作用，同时观察时间．效应关系；流式细胞术（FCM）检测不同浓度的Ele对增殖状态的牛LEC增殖细胞核抗原（PCNA）蛋白表达的抑制作用，同时观察时间．效应关系。结果：低、中、高不同浓度的Ele作用24h后，其增殖抑制率随浓度增加而增高，呈明显的剂量．效应关系；中浓度的Ele作用6、12、24、48、72h后，其增殖抑制率随作用时间延长而增高，呈明显的时间．效应关系。Ele对LEC内PCNA蛋白表达有明显的下调作用，低、中、高不同浓度的Ele作用24h后，其PCNA表达率随浓度增加而降低，呈明显的剂量．效应关系；中浓度的Ele作用6、12、24、48、72h后，其PCNA表达率随作用时间延长而降低，呈明显的时间．效应关系。结论：Ele能有效抑制IhEGF诱导的LEC增殖，对防治后发性白内障具有广阔的前景。     

超声乳化针头影响白内障超声乳化吸出术效率和安全性的研究进展

白内障超声乳化吸出术以其手术切口小、时间短和术后散光小、视力恢复良好等诸多优点受到白内障手术医师的青睐,但是超声能量在碎核的同时对眼内组织可造成一定的损伤.超声乳化针头全堵时超声能量使用效率最高,而全堵解除后产生前房涌动易损伤角膜内皮和晶状体后囊膜,核块脱落可延长手术时间.超声乳化针头的物理特性在一定程度上影响着超声能量和抽吸作用,其良好设计和轻微改进可以明显提高手术的效率和安全性.现就超声乳化针头对白内障超声乳化吸出术效率和安全性的影响做一简要综述.