白藜芦醇对紫外线诱导人晶状体上皮细胞氧化损伤的保护作用

目的:探讨白藜芦醇对紫外线诱导人晶状体上皮细胞氧化损伤的保护作用。方法:人晶状体上皮细胞系传代培养,紫外线诱导细胞发生凋亡,20μmol/L白藜芦醇预处理细胞后,观察各项指标改变:流式细胞仪检测细胞凋亡率,比色法检测凋亡相关因子caspase-3及caspase-9的表达,透射电镜观察超微结构变化。结果:流式细胞仪检测发现,白藜芦醇可以抑制紫外线照射诱导的细胞凋亡,阳性对照组中caspase-3及caspase-9含量显著高于同时段阴性对照组,差异有统计学意义(P<0.05);实验组中caspase-3及caspase-9含量均低于同时段阳性对照组,差异有统计学意义(P<0.05)。此外,伴随白藜芦醇作用时间的延长,透射电镜下人晶状体上皮细胞损伤的程度减轻。结论:白藜芦醇可以抑制紫外线诱导的晶状体上皮细胞的凋亡,对辐射性白内障具有预防作用,从而为寻求有效的防治白内障药物提供可靠的实验依据。     

Comparison of posterior capsule folds following intracapsular implantation of three types of intraocular lenses with different haptic design

AIM: To compare the incidence of posterior capsule folds among different types of intraocular lens (IOL) to determine risk factors of posterior capsule folds. METHODS: It was a retrospective study. We collected the cases in which the patients underwent phacoemulsification (PHACO) and IOL implantation and at least one of the three types of IOL was implanted, including 2-haptic 3-piece IOLs (HOYA PY60AD), 4-haptic 1-piece IOLs (Bausch&Lomb AO), 2-haptic 1-piece IOLs (AMO Tecnis ZCB00). The posterior capsule folds were measured using slit lamp microscope 2d after the surgery. Information of patient’s age, gender, length of ocular axis, intraocular pressure, types of IOL were recorded. Posterior capsule fold risk indicators were identified by using logistic regression analysis. RESULTS: One hundred eighty-seven patients (242 eyes) had been collected, including 80 eyes implanted with HOYA PY60AD IOLs, 81 eyes implanted with Bausch&Lomb AO IOLs, 81 eyes implanted with AMO Tecnis ZCB00 IOLs. The incidence of posterior capsule folds of patients implanted with HOYA PY60AD IOLs was significantly higher than those of patients implanted with AMO Tecnis ZCB00 IOLs. While the incidence of patients implanted with Bausch&Lomb AO IOLs was significantly lower than those of patients implanted with AMO Tecnis ZCB00 IOLs. Multi-factor logistics regression analysis demonstrated that independent risk factors were type of IOLs and length of ocular axis. Compared with AMO Tecnis ZCB00 IOLs, using HOYA PY60AD IOLs increased the risk of posterior capsule folds [P=0.020, OR (95%CI)=2.145 (1.129, 4.073)], while using Bausch&Lomb AO IOLs reduced the risk [P=0.001, OR (95%CI)=0.274 (0.127, 0.591)]. Shorter ocular axis might increase the risk of posterior capsule folds [P=0.012, OR (95%CI)=0.669 (0.489, 0.915)]. CONCLUSION: Haptic design should be an important consideration in IOL design. Compared with AMO Tecnis ZCB00 IOLs, using HOYA PY60AD IOLs is more likely to lead to posterior capsule folds formation, while using Bausch&Lomb AO IOLs is less likely to lead the formation. The posterior capsule folds are more engendered in eyes with shorter ocular axis.     

改良ABC设计的非球面IOL植入对白内障患者术后视觉质量的影响

目的:评估改良非球面平衡曲线(ABC)设计的非球面人工晶状体(IOL)植入术后的视觉质量,同时进行临床IOL选择的影响因素分析,指导患者的IOL选择方案。方法:前瞻性病例对照研究。选取拟行白内障超声乳化联合折叠式IOL植入术的单纯性白内障患者67例74眼,其中观察组植入改良设计IOL 23眼(HOYA Vivinex XY1组),对照组植入传统设计IOL 51眼(Tecnis ZCB00组27眼,IQ SN60WF组24眼),术后1wk, 1mo测量裸眼视力及最佳矫正视力、不同瞳孔直径下(3、4、5、6mm)全眼球差及彗差、不同瞳孔直径(3、4、5mm)下的调制传递函数(MTF)曲线、客观散射指数(OSI)、眼内散射光值Log(s)及对比敏感度。对所得的数据进行统计学分析。结果:三组术后1wk, 1mo裸眼视力及最佳矫正视力均较术前显著提高,组间均无差异(P>0.05)。术后全眼球差值比较,术后1wk, 5、6mm瞳孔直径下三组存在差异(P=0.045、0.037),术后1mo 6mm瞳孔直径下三组存在差异(P=0.042)。全眼彗差值比较,术后1wk, 1mo 5、6mm瞳孔直...     

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.     

可调节人工晶状体植入术后的视觉质量及拟调节力

目的:研究Tetraflex可调节人工晶状体(IOL)植入术后视力、调节幅度、对比敏感度及主观视觉功能的临床应用效果。方法:病例对照研究。选择2010-03/2012-12在我院接受白内障超声乳化摘除联合囊袋内IOL植入术的白内障患者48例72眼,其中23例35眼植入Tetraflex可调节IOL(Tetraflex组),25例37眼植入AcrySof SA60AT单焦点IOL(SA60AT组),对比研究两组患者术后1,3,6mo裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、最佳矫正远视力下近视力、拟调节力、脱镜率以及患者满意度情况,采用主观移近法测量调节力。采用SPSS13.0统计软件包进行统计学处理。结果:术后随访期间,两组患者的裸眼远视力、最佳矫正近视力和最佳矫正远视力差异无统计学意义(P>0.05);Tetraflex组患者的裸眼近视力和最佳矫正远视力下近视力与单焦组比较差异有统计学意义(P<0.05)。术后Tetraflex组拟调节力均高于SA60AT组(P<0.05),于术后6mo Tetraflex组拟调节力有所下降,与1,3mo比较差异均有统计学意义(P<0.05),两组间对比敏感度差异无统计学意义。脱镜率及和主观视功能满意度,Tetraflex可调节IOL组均明显优于单焦组,差异有统计学意义(P<0.05)。结论:可调节IOL可提供较好的远近视力,增加拟调节力,有效降低患者术后对老视镜的依赖,改善主观视功能。但其拟调节力仍需要进一步的研究。     

连续环形撕囊术抑制后囊膜混浊的实验研究

目的：搪塞连续环形撕囊术（ＣＣＣ）对白内障囊外摘除术后晶体后囊膜混浊的影响。方法：将２４只白色家兔随机平均分为三个时间组,每只家兔又按双眼术中前切开法的不同随机分为ＣＣＣ组和开罐式截囊组,术后不同时期观察后囊膜病理变化。结果：术后一月,Ａ组后囊膜纤维增殖明显减少,赤道 后囊膜间无显著粘连,早期即在可在后囊膜面查见纤维弱细胞增生。结论：ＣＣＣ可抑制白内障术后晶体后囊膜混浊的发生。     

糖性白内障大鼠晶状体水不溶性蛋白的改变

用D一半乳糖诱发了大鼠白内障,分析了其膜固有蛋白和尿素溶蛋白的改变。对正常大鼠晶状体纤维细胞膜蛋白电泳图谱的分析表明,其26KDa的主要膜固有蛋白(MIP26)约占膜固有蛋白总量的42.9％,22KDa的膜固有蛋白约占6.4％。糖性白内障大鼠晶状体纤维细胞膜固有蛋白以22KDa为主,约占30.5％,MIP26几乎消失。并在24KDa处有一深染区带。在白内障发病过程中18KDa的膜蛋白的相对含量无明显改变。这些结果提示在糖性白内障发病过程中MIP26发生了降解,产生了22KDa的降介产物。 以每克湿重计,白内障晶状体尿素溶蛋白降低约22.5％。但白内障晶状体尿素溶蛋白占总蛋白的比例升高。正常大鼠尿素溶蛋白电泳图谱主要显示四条区带,其近似分子量分别为22.5KDa、22.4KDa、20.6KDa和19.2KDa。白内障晶状体20.6KDa和19.2KDa的二条区带所占的比例明显减小。这个结果提示正常晶状体尿素溶蛋白主要含有α—和β—晶体蛋白,而且白内障晶状体尿素溶蛋白则主要含有β—晶体蛋白。     

α_1—抗胰蛋白酶异质体的测量新方法及其临床意义的探讨

本文对a_1-抗胰蛋白酶异质体的检测方法(小扁豆凝集素亲合交叉免疫电泳法)进行改进。改进后的方法操作流程短、成本低、结果清晰、操作简便、不需预测a_1-抗胰蛋白酶总浓度,适合于临床广泛应用。本文用该法对原发性肝癌、转移性肝癌,其它器官癌肿、肝硬化及正常人血清中的a_1-抗胰蛋白酶异质体进行分析,发现小扁豆凝集素结合型a_1-抗胰蛋白酶百分比(LCA-R-AAT％)原发性肝癌组明显高于其它各组,以LCA-R-AAT(％)>25％为阳性标准,则原发性肝癌诊断的敏感性、特异性、准确性分别为80.6％、86.2％和84.3％,与小扁豆凝集素结合型甲胎蛋白联合检测,可使原发性肝癌诊断的敏感性提高至100％(P<0.05),特异性和准确性分别为82.8％和89.9％(P均>0.05),表明LCA-R-AAT(％)的检测对原发性肝癌的诊断及鉴别诊断有一定的价值。