高度近视眼白内障术中Ⅰ期后囊膜连续环形撕除术

目的 探讨I期后囊膜连续环形撕除术(Posterior continuous curvilinear capsulorhexis,PCCC)对高度近视眼白内障术后后发障的预防作用.方法 对203例(211只眼)高度近视眼白内障行白内障超声乳化及人工晶状体植入术,其中70只眼术中行连续环形撕除后囊(A组),植入普通聚甲基丙烯酸甲酯(PMMA)人工晶状体;非PCCC组138只眼进一步分为普通PMMA人工晶状体组(B组)73只眼,光学部边缘直角设计的折叠人工晶状体组(C组)68只眼.B组和C组单纯行白内障超声乳化及人工晶状体植入术,保留完整后囊膜.所有患眼术后随访2年以上,观察术后后发障、视网膜脱离等并发症情况. 结果 A组2只眼(2.86%)发生了后发障,B组为18只眼(24.66%),C组8只眼(11.76%),两两对比差异显著具有统计学意义(P＜0.05);A组和C组无视网膜脱离发生,B组仅1只眼发生视网膜脱离. 结论 I期后囊膜连续环形撕除术安全有效,明显减少了高度近视眼白内障术后后发障的发生.     

单步萃取RP-HPLC测定大鼠眼玻璃体腔醋酸地塞米松的浓度

目的:探讨单步萃取—反相高效液相色谱法(RP-HPLC)测定大鼠眼玻璃体腔醋酸地塞米松(DA)浓度的可行性。方法:取空白SD大鼠眼玻璃体50μL,分别加入不同浓度的DA标准液50μL和1.0mg/L醋酸泼尼松内标液5.0μL后混匀,经甲基叔丁醚单步提取后,甲醇溶解回收,以甲醇:水(V:V=65:35)为流动相,流速为1.0mL/min,35℃柱温下进行色谱分析,紫外检测波长为240nm。结果:大鼠眼玻璃体腔DA浓度在0.1～10.0mg/L范围内,其线性回归方程为Y=1.767X 0.078(r=0.9997)。该方法的平均回收率为102.3%(n=3),日内和日间精密度RSD均<10%(n=5),最低检测限为10.0μg/L。结论:该方法能简单、灵敏、准确地测定大鼠眼玻璃体腔DA的浓度。     

重硅油玻璃体替代物的应用观察

玻璃体替代物的研究发展,极大的改善了玻璃体视网膜疾病的治疗和预后,但是PVR的玻璃体视网膜手术后再手术的比例仍然很高并且最终视力很差。重硅油由于比重比水重用于治疗合并有PVR的复杂孔源性视网膜脱离时对眼底后极部及下方视网膜顶压效果较佳。所以近年来研究观察重硅油在玻璃体视网膜手术中的应用成为热点。本文就重硅油的临床应用及最新研究结果进行综述。     

肺泡蛋白沉积症的影像学表现4例报道并文献复习

目的 分析肺泡蛋白沉积症（PAP）的胸部平片、CT影像表现,旨在提高对本病的认识.方法 回顾性分析浙江省台州医院4例经病理证实的PAP患者的胸部影像资料,其中男3例,女1例,年龄29～61岁;4例患者均行螺旋CT、高分辨率CT（HRCT）检查,1例行胸部平片;其中3例肺泡灌洗,1例肺穿刺证实.结果 ①原发型3例,胸部平片表现为双肺弥漫性分布斑片状密度增高影,边界不清,两侧肋膈角锐利,心影未见增大.1例胸部CT示病变弥漫呈片状分布,边缘锐利,与周围正常肺组织界限清晰,并在其衬托下呈“地图样”分布,同时可显示磨玻璃影中的网格状影（铺路石征）.2例胸部CT示两肺弥漫分布磨玻璃影,肺尖及肺基底部均累及,部分胸膜下区未累及,边界不清,部分肺组织实变,见空气支气管征.②继发型l例,CT显现左下肺散在片状磨玻璃样高密度影,与周围正常组织分界清楚;右下肺大片状高密度影,内见支气管走形,周围见晕征.③1例原发型PAP纵隔内见肿大淋巴结影,短径未超过1.5 cm.4例均未见胸腔积液和心影增大.结论 弥漫、区域性磨玻璃样阴影,地图或铺路石样改变,胸膜下区未累及,临床与影像表现不符等征象是PAP具有特征性的表现;若有基础疾病合并上述影像表现,应考虑合并PAP可能.     

增生性玻璃体视网膜病变玻璃体中肝细胞生长因子的变化

目的：定量研究肝细胞生长因子（HGF）在增生性玻璃体视网膜病变（PVR）患者玻璃体中的水平。方法：采用双夹心酶联免疫吸附测定法检测正常对照组10只眼，PVR－A，B组7只眼PVR－C组13只眼，PVR－D组16只眼。结果：玻璃体内HGF的含量：正常对照组1．8－7．4μg.L^-1；PVR－A，B组3．8－12．8μg.L^-1，PVR－C组7．7－20．1μg.L^-1；PVR－D组10．3－24．6μg.L^-1，PVR各组玻璃体中HGF的含量比正常对照组显著升高（P＜0．01）；PVR－C，D组玻璃体中HGF的含量较PVR－A，B组的含量升高（P＜0．05orP＜0．01）；PVR－D组玻璃体中HGF的含量与PVR－C组比较含量升高（P＜0．05）。玻璃体中HGF的偏量随着PVR的发展而呈上行性升高，结论：PVR患者玻璃体中HGF含量升高，HGF可能参与了PVR的病理过程。     

玻璃体腔注射Ranibizumab联合25G+微创玻璃体视网膜术治疗严重PDR

目的:研究玻璃体腔注射ranibizumab辅助25G+微创玻璃体视网膜术(vitreous retinal surgery,VRS)治疗严重增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的疗效及安全性.方法:选取我院2015-03/2016-06确诊为严重PDR患者61例74眼,根据自愿原则,31例37眼在VRS前行玻璃体腔注射ranibizumab治疗,设为联合组,30例37眼行纯VRS,设为对照组.对比两组术后的玻璃体积血率、BCVA(LogMAR)、平均眼压、黄斑中心凹视网膜厚度及并发症.结果:联合组术后1wk玻璃体积血率为8%,显著低于对照组的27%,差异有统计学意义(x2=4.573,P=0.032);联合组术后>1~4wk玻璃体积血率为0,而对照组为16%,差异有统计学意义(P=0.033);联合组术后>1~3mo玻璃体积血率为0,低于对照组的8%,差异无统计学意义(P=0.238);术后3mo联合组的BCVA明显好于对照组,差异有统计学意义(t=2.320,P=0.023);术后3mo两组平均眼压差异无统计学意义(t=0.516,P=0.608);术后3mo联合组平均黄斑中心凹视网膜厚度为298.8±78.3μm,显著低于对照组的357.1±86.2μm,差异有统计学意义(t=3.045,P=0.003);联合组一过性高眼压率为14%,显著低于对照组的32%,差异有统计学(x2=10.385,P=0.001);联合组的视网膜前膜率、复发性牵拉性视网膜脱落率及新生血管性青光眼率均低于对照组,但差异无统计学意义(P>0.05).结论:玻璃体腔注射ranibizumab辅助VRS虽存在一定争议,但在合适的剂量、频率和时间下能取得显著的疗效,安全性也较高.     

Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results

STUDY OBJECTIVES: Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: Twenty patients who had been hospitalized with ZCSII-related conditions. MEASUREMENTS: The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)). RESULTS: HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up. CONCLUSIONS: The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.     

兔眼球后Tenon囊下灌注Bevacizumab的眼内通透性研究

目的：比较兔眼球后Tenon囊下灌注和玻璃体腔注射bevacizumab后玻璃体和血清中的浓度,并观察bevacizumab视网膜荧光显影,探讨bevacizumab球后Tenon囊下灌注的眼内通透性和眼外给药途径的可行性。

方法：实验用健康成年新西兰兔20只,随机分为A组和B组,A组均单眼接受单次玻璃体腔注射1.25mg bevacizumab(1.25mg/0.05mL),B组均单眼单次Tenon囊下灌注5mg bevacizumab(5mg/0.2mL)。1、3d后抽取玻璃体和血液,使用双抗体夹心Elisa检测玻璃体和血清中bevacizumab药物浓度,比较两组中玻璃体和血清内bevacizumab浓度差异,并通过激光共聚焦观察视网膜免疫荧光。

结果：给药1d后,A组和B组玻璃体腔内bevacizumab药物浓度分别为254.40±13.65、1.60±0.32μg/mL。A组和B组血清内bevacizumab药物浓度分别为0.55±0.15、0.63±0.05μg/mL,两组血清bevacizumab浓度比较差异无统计学意义(t=1.168,P=0.277)。给药3d后,A组和B组玻璃体腔内bevacizumab药物浓度分别为236.80±8.70、1.40±0.23μg/mL,A组和B组血清内bevacizumab药物浓度分别为0.66±0.17、0.64±0.14μg/mL,两组血清内bevacizumab浓度比较差异无统计学意义(t=0.207,P=0.841),两种给药方式视网膜各层荧光分布均能明显显现。

结论：给药1、3d后玻璃体腔注药组在玻璃体腔内bevacizumab药物浓度要明显高于Tenon囊下灌注组,玻璃体腔内注射是较为有效的给药途径,而球后Tenon囊下灌注也能使bevacizumab进入玻璃体腔而且达到完全抑制VEGF活动所需的浓度(>500ng/mL),并能至少持续3d以上,两种给药方法在血清中均能检测到较高浓度的bevacizumab,且两者浓度差异无统计学意义(P>0.05),两种给药方式视网膜各层荧光分布均能明显显现,提示两种给药方式药物均能作用于视网膜各层。     

Vitreous substitutes:challenges and directions

Thenatural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body .