高度近视并发后巩膜葡萄肿研究进展

高度近视并发的眼底病变是不可逆的致盲眼病之一。在高度近视眼底的一系列并发病中,后巩膜葡萄肿(posterior seleral staphyloma,PSS)是最基础的病变之一。本文通过对国内外文献的整理就高度近视后巩膜葡萄肿的发生机制、检查方法、分类及治疗展开综述,为临床上后巩膜葡萄肿的防控提供更好的认识。     

异体巩膜移植联合自体结膜瓣覆盖术治疗无菌性巩膜融解的研究

目的评价异体巩膜移植联合结膜瓣覆盖术治疗眼科手术后无菌性巩膜融解的临床效果。方法对因眼部手术后发生无菌性巩膜融解10例（10只眼）的临床资料进行回顾性分析。进行巩膜坏死组织涂片,微生物培养,及血清学检查。采用异体巩膜移植联合自体结膜瓣覆盖术,术后局部滴眼。结果术前10只眼巩膜坏死组织的细菌及真菌培养均未见微生物生长,仅1只眼类风湿因子异常高表达,8只眼患有干眼。实施异体巩膜联合自体结膜瓣移植术后,8只眼术后32～50d巩膜坏死区愈合,2只眼于术后40d及48d后发生巩膜植片融解。结论全身胶原血管性疾病及手术刺激等所致的免疫反应可能是眼部手术后产生无菌性巩膜融解的主要原因;异体巩膜移植联合自体结膜瓣移植可控制及修复巩膜融解,有效保留眼球的完整性。     

Intrascleral Drug Delivery to the Eye Using Hollow Microneedles

Purpose  This study tested the hypothesis that hollow microneedles can infuse solutions containing soluble molecules, nanoparticles, and microparticles into sclera in a minimally invasive manner. Methods  Individual hollow microneedles were inserted into, but not across, human cadaver sclera and aqueous solutions containing sulforhodamine or fluorescently tagged nanoparticles or microparticles were infused into sclera at constant pressure. The infused volume of fluid was measured and imaged histologically as a function of scleral thickness, infusion pressure, needle retraction depth and the presence of spreading enzymes (hyaluronidase and collagenase). Results  Individual hollow microneedles were able to insert into sclera. Fluid infusion was extremely slow after microneedle insertion into the sclera without retraction, but partial retraction of the microneedle over a distance of 200–300 μm enabled infusion of 10–35 μl of fluid into the tissue. Scleral thickness and infusion pressure had insignificant effects on fluid delivery. Nanoparticle suspensions were also delivered into sclera, but microparticles were delivered only in the presence of hyaluronidase and collagenase spreading enzymes, which suggested the role of scleral glycosaminoglycans and collagen fibers as rate-limiting barriers. Conclusion  This study shows that hollow microneedles can infuse solutions into the sclera for minimally invasive delivery of soluble molecules, nanoparticles and microparticles.     

眼睑肿瘤切除后眼睑重建的远期疗效观察

目的探讨眼睑肿瘤切除后异体巩膜移植术修补眼睑缺损的远期疗效。方法选取眼睑恶性肿瘤患者19例,患者首先切除眼睑恶性肿瘤,然后异体巩膜移植修补眼睑缺损,进行眼睑重建治疗,记录并分析患者手术后的临床疗效。结果眼睑重建手术后进行随访,平均随访时间为35．3个月。治愈12例,好转7例,眼睑肿瘤均未复发。结论组织学控制性切除眼睑恶性肿瘤疗效确切,异体巩膜移植重建眼睑对于眼睑的形态和功能的恢复有良好的作用,值得临床推广应用。     

Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants

AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite(HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A(n=11), with donor sclera caps in group B(n=12), and without any wrapping material in group C(n=9). Follow-ups were set at 1, 2 wk, 1, 3, 6, and 12 mo after surgery.RESULTS: Altogether 32 cases finished the followup and were enrolled in this study. Three cases(27.27%) in group A, 4 cases(33.33%) in group B, and 4 cases(44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6 mo after placement of the orbital implant. The case of exposure of donor sclerawrapped implant was noted at the 12 mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment.CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.     

Quality of life in adult intermittent exotropia and the risk factors

AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT patients.METHODS: Total y 109 cases of normal eye(control group), 77 cases of IXT(IXT group) and 115 cases of strabismus control group(except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient’s quality of life scale(CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were analyzed.RESULTS: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT patients.CONCLUSION: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.     

隐匿性巩膜破裂伤的临床分析(附10例临床报告)

目的 探讨隐匿巩膜破裂伤的诊断要点及手术方式。方法 回顾分析了10例隐匿性巩膜破裂伤临床资料。结果 手术后视力提高3例，保持眼球形态6例。结论 眼挫伤后低眼压或形态改变要排除巩膜破裂。影像检查有参考价值。疑有后部巩膜破裂时应及早进行手术探查，是避免漏诊或误诊的关键。     

软化眼球顶压巩膜法检查锯齿缘断离裂孔

锯齿缘断离容易误、漏诊，寻找锯齿缘断离裂孔是诊断的最可靠依据。笔者采用软化眼球顶压巩膜法检查眼底很易找到锯齿缘断离裂孔，取得十分满意效果。本组对３类不同情况的锯齿缘断离４０例（４８眼），分别用此方法与锯齿缘断离常规检查法寻找锯齿缘断离裂孔。对比结果表明：二者有显著差异（Ｐ＜０．０５）。此法简便易行，值得推广。     

巩膜外加压术后视网膜下液厚度与脉络膜厚度的变化

目的：观察黄斑区孔源性视网膜脱离巩膜外加压术后视网膜下液厚度与脉络膜厚度的变化。

方法：回顾性非随机临床研究。共23例23眼黄斑区孔源性视网膜脱离患者成功采用巩膜外加压术联合冷冻,排除复发性视网膜脱离和增殖性视网膜前膜患者。采用OCT检测黄斑中心凹下视网膜下液厚度、中心凹下脉络膜厚度。对比观察分析患眼术前,术后1wk,1,3,6、12mo平均最佳矫正视力(BCVA,LogMAR)、黄斑中心凹下视网膜下液厚度、中心凹下脉络膜厚度的变化情况,分析视网膜下液厚度与脉络膜厚度的变化。

结果：术后1wk所有患者均有视网膜下液。术后黄斑中心凹下视网膜下液厚度逐渐下降。术后1wk,中心凹下脉络膜厚度增加,随后中心凹下脉络膜厚度逐渐下降。术后1wk BCVA为0.60±0.35,与术前BCVA比较,差异有统计学意义(t=6.35,P<0.01)。

结论：视网膜下液随时间逐渐吸收,脉络膜厚度早期增厚后期逐渐下降。视网膜脱离巩膜外加压术治疗累及黄斑区孔源性视网膜脱离,早期提高患者的视力。