TIMP-2基因转染豚鼠巩膜成纤维细胞基质金属蛋白酶2及其抑制剂表达

目的观察转染基质金属蛋白酶2抑制剂(tissue inhibitor of matrix metalloproteinase2,TIMP-2)基因的豚鼠巩膜成纤维细胞不同时间增生能力及基质金属蛋白酶2(matrix metalloproteinase2,MMP-2)和TIMP-2的表达,探讨基因治疗近视的可行性。方法随机选取三色健康豚鼠,组织块法体外培养原代巩膜成纤维细胞,免疫组织化学法进行波形蛋白的鉴定,取第3～6代细胞进行实验。分子克隆构建携带TIMP-2基因的真核表达载体,转染豚鼠巩膜成纤维细胞,MTT法观察转染后12h、24h、48h、3d、5d、7d细胞增生能力。提取总RNA,二步法逆转录-聚合酶链反应检测MMP-2mRNA及TIMP-2mRNA的表达水平。结果豚鼠巩膜成纤维细胞原代、传代培养生长良好,波形蛋白鉴定阳性。转染3d、5d、7d TIMP-2基因转染组成纤维细胞的增生速度分别为0.6724±0.0092、0.7963±0.0060、0.8462±0.0064,明显快于正常对照组成纤维细胞(0.5810±0.0120、0.6525±0.0072、0.7129±0.0132),差异均具有显著统计学意义(均为P<0.01)。转染48h MMP-2mRNA表达即开始减少,转染3d时表达明显减少,达到最低,除转染12h与24h之间外,转染组与正常对照组、各转染不同时间组间MMP-2mRNA表达差异均有统计学意义(均为P<0.05)。TIMP-2mRNA表达在转染48h时即开始增加,除12h与24h外,转染组与正常对照组、各转染不同时间组间TIMP-2mRNA表达差异均有统计学意义(均为P<0.05)。结论转染TIMP-2基因对豚鼠巩膜成纤维细胞有促增生作用,TIMP-2基因转染豚鼠巩膜成纤维细胞抑制MMP-2mRNA的表达,可在一定程度上阻止近视发展中巩膜组织的丢失与重塑。     

经巩膜睫状体光凝术致巩膜组织损伤临床观察

目的探讨经巩膜睫状体光凝术对人体巩膜组织造成的损伤。方法对2004年1月至2008年12月在北京同仁眼科中心行睫状体光凝术的822例(830眼)患者进行回顾性研究。结果共4例5眼术后并发巩膜穿孔,发病率为6.02‰,1眼为真性小眼球、原发性闭角型青光眼,4眼为继发性青光眼,其中1眼为视网膜脱离术后硅油存留;发病时间为光凝术后3d～4个月。2例(2眼)为二次光凝术后,1例(1眼)为二次玻璃体切割术后及一次光凝术后,1例(2眼)为一次小梁切除术后及一次光凝术后。巩膜穿孔部位均位于进行光凝的巩膜范围内,均为角膜缘后2mm左右。5眼均行异体巩膜移植术治疗,术后巩膜无渗漏,眼压稳定。结论经巩膜睫状体光凝可以导致巩膜溶解及穿孔。应严格掌握睫状体光凝的适应证,尽可能采用最低有效能量,避免在同一点上过多重复光凝,从而减少对巩膜的损伤。一旦发生巩膜穿孔及时行异体巩膜移植术,可以取得较好的治疗效果。     

Biomechanical considerations: evaluating scleral reinforcement materials for pathological myopia

Objective: Scleral biomechanical weakness and thinness are known to be one of the main factors in the pathogenesis of progressive myopia. Posterior scleral reinforcement surgery remains the rational treatment for pathological myopia. We tested the biomechanical properties of 3 types of scleral reinforcement materials (artificial pericardium, human sclera, and all-dermal matrix) in an attempt to select the ideal material for the reinforcement of pathologic sclera.Design: Experimental study.Participants: Forty-five adult Japanese white rabbits.Methods: Animals were equally divided into 3 groups. For each group, 1 type of material was surgically implanted at the back of the globe. We harvested samples after 10 months of implantation, tested the elasticity modulus for both reinforced sclera and unreinforced control sclera, and assessed data by t test methods. Statistically significant differences were considered when p < 0.05.Results: Rabbit sclera reinforced by artificial pericardium or human sclera showed significant increases in the elasticity modulus compared with control eyes. However, the rabbit sclera reinforced by all-dermal matrix showed no significant difference in the elasticity modulus compared with normal controls.Conclusions: The analysis of biomechanical considerations in scleral reinforcement materials presented here is a very helpful method to choose the best materials for treatment of myopia. Of all materials tested, the artificial pericardium and human foreign-body sclera provided the best biomechanical characteristics.     

前巩膜片技术预防多孔材料义眼座植入的暴露

目的探讨在眼球摘除后多孔材料义眼座前部增加一巩膜片植入眼眶后预防暴露的有效性。方法美国Ore-gon州OHSU医学院Casey Eye Institute眼科研究所眼面部整形外科从2000年1月至2009年1月,John D Ng医生的162例（170眼）眼球摘除合并眼眶内植入有孔材料,使用前巩膜片技术（在多孔义眼座的前部缝合一7.5 mm×7.5 mm的巩膜片,并将四条直肌缝在巩膜片上）。根据病例资料,眼疾诊断,手术操作技术,先前眼科手术史,植入物的大小,随访时间,植入后并发症等,观察统计义眼暴露率及并发症。结果植入暴露发生7例,7眼（4.12%,7/170）。其中一例发生在早期（〈6个月）,6例发生在晚期（〉6个月）。这7例中1例给于抗生素及结膜切除手术,暴露得到修复;另外6例结膜撕裂较大未能得到修复,遂取出义眼座植入一新的前部缝有巩膜片的义眼座。这7例经过1a以上的随访,未出现再次暴露。结论巩膜片在移植物的前表面可以作为一种屏障,在预防暴露方面具有一定的有效性。     

联合或不联合板层角膜移植的结膜瓣移植治疗巩膜坏死

目的 介绍结膜瓣移植治疗眼部烧伤和眼科手术后巩膜缺血坏死的手术方法,观察其临床疗效.方法 回顾性病例研究.2007年1月至2012年3月,共13例眼部烧伤和眼科手术后巩膜缺血坏死、溶解的患者在山东省眼科医院接受了结膜瓣移植,其中碱烧伤4例,热烧伤6例,翼状胬肉切除手术后巩膜坏死3例.对所有患者行带蒂结膜瓣转位或游离结膜瓣移植术治疗,其中4例行单纯结膜瓣移植,2例联合部分板层角膜移植(LK)术,6例联合羊膜移植(AMT)术,1例联合LK和AMT术.随诊3～24个月,对手术后巩膜坏死和结膜瓣存活等情况进行观察.结果 移植的结膜瓣1周内血运差、色苍白,1周后逐渐出现充血表现,2周拆除结膜瓣缝线后充血症状逐渐减轻.13例患者结膜瓣均愈合良好,巩膜坏死控制.至最后一次随访,2例角膜透明,3例角膜植片透明,l例角膜斑翳,7例角膜血管化.结论 结膜瓣移植(或联合LK和AMT)治疗眼部烧伤和眼科手术后巩膜坏死在临床上安全有效,能够较好地解决巩膜穿孔的风险,为后续治疗提供一个相对稳定的眼部环境.     

高度近视白内障超声乳化摘除及负低度数后房型人工晶状体植入术疗效观察

目的:研究超声乳化联合植入负低度数后房型人工晶状体治疗高度近视眼合并白内障的临床效果。方法:对试验组80例100眼高度近视并发白内障实行巩膜隧道切口超声乳化吸除,同时通过5.5mm切口植入PMMA硬性人工晶状体。其中男45例56眼,女35例44眼,年龄44～76(平均61)岁;眼轴长为27.00～35.42(平均30.55)mm。取同期来我院治疗的94例100眼正常眼轴老年性白内障患者作为对照组。观察术中、术后并发症及手术效果。术后随访3～12mo。结果:试验组术后3mo矫正视力≥0.5者为51眼(51.0%),0.1～者43眼(43.0%),<0.1者6眼(6.0%)。术中并发症:后囊膜破裂2眼;晶状体脱位2眼。术后并发症:角膜水肿9眼;视网膜脱离1眼;后发性白内障2眼。对照组术中并发症:晶状体脱位1眼。术后并发症:角膜水肿4眼;后发性白内障2眼。结论:巩膜隧道切口超声乳化联合硬质后房型人工晶状体植入术治疗高度近视并发白内障,具有视力恢复快、屈光状态稳定等优点,是安全有效的方法。     

小梁切除改良术式治疗青光眼的远期疗效观察

目的:探讨小梁切除术中改良巩膜瓣的制作方法,观察术后远期疗效。方法:对50例85眼不同类型的青光眼行小梁切除(观察组),术中制作隧道式4mm×6mm巩膜瓣,巩膜瓣的后缘与巩膜床间作三针跨度为4mm的闭合式缝合,对照组50例82眼行常规小梁切除术。结果:术后平均随访8～30mo。视力:观察组有7眼较术前提高,5眼视力下降,其余视力无明显变化,差异无统计学意义。眼压:观察组术后末次随访平均眼压与术前平均眼压比较,差异有统计学意义(P<0.05)。视盘参数:观察组视乳头盘沿面积(RA,m2)、盘沿体积(RV,mm3)、平均神经纤维层厚度(mRNFL,mm)与术前比较有改善,差异有统计学意义(P<0.05)。视野:观察组5眼视野较术前扩大,3眼视野缩小,其余视野无明显变化。与对照组比较:观察组眼压控制率和功能性滤过泡形成率均高于对照组(P<0.05)。并发症发生率低于对照组(P<0.05)。结论:改良式小梁切除术,术后远期眼压控制效果明显,并发症少,可改善视功能,是一种安全有效的手术方法。     

Use of a novel haemostatic agent: ankaferd blood stopper in conjunctival incisions

Background: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, ankaferd blood stopper, in a rat conjunctival incision model. Methods: Twenty Wistar albino rats were divided into two equal groups (A, B). Limbal incisions of 90–120° were performed in both eyes of all rats. In group A, bleeding at the site of incision was controlled by the administration of ankaferd blood stopper to the right eyes and balanced salt solution to the left eyes. In group B, bleeding was controlled by the application of ankaferd blood stopper to the right eyes and cautery to the left eyes. Time to haemostasis was recorded. After a 4‐week period, conjunctival vascularity and postoperative adhesion between Tenon's capsule and sclera were assessed. Additionally, eyes were enucleated and evaluated histopathologically. Results: In group A, the mean bleeding times were 15.2 and 66.7 s for right and left eyes, respectively (P = 0.002). In group B, the mean bleeding times were 17.6 and 17.5 s for right and left eyes, respectively (P = 0.939). Cautery was found to cause significantly more adhesion (P = 0.04). Histopathological examination of the conjunctiva and scleral revealed no statistically significant difference between the samples. Conclusions: Given the ease of use and lack of histopathological side‐effects in the conjunctival incision model, ankaferd blood stopper is promising for use in ophthalmic surgery. Ankaferd blood stopper is a potent haemostatic agent. Its use in ophthalmic surgery should be investigated further in a larger cohort of patients and tested in clinical and experimental models.     

异体巩膜移植治疗眼睑恶性肿瘤术后睑板缺损的临床观察

目的：探讨异体巩膜移植在眼睑恶性肿瘤切除术后睑板缺损重建手术中的临床效果。

方法：对24例24眼眼睑恶性肿瘤术后睑板缺损长度大于1/2睑板的患者实施眼睑重建, 利用异体巩膜替代睑板,异体巩膜材料取自眼库。

结果：术后3～12mo随访,眼睑重建术后形态良好,未出现明显的异体巩膜溶解或排斥反应; 巩膜脉络膜面均被结膜细胞移行覆盖,异体巩膜与皮肤粘连紧密,缺损区修复完整。4眼出现睑缘轻、中度内翻后行眼睑内翻矫正。2眼出现不同程度睑球粘连,行睑球粘连分离手术。

结论：异体巩膜具有材质稳定性好、组织相容性佳、取材保存方便、手术操作简单易行等优点。术后眼睑功能良好、外观满意,是理想的睑板替代材料。     

虹膜根部离断的闭合式缝线修复技法和观察

目的虹膜根部离断是闭合性顿性眼外伤中较常见并发症。复位修复的方法是缝线法最有效。缝线法中有角巩膜缘切开法和闭合式缝线法两种。作者采用闭合式缝线法取得较好效果。方法虹膜根部离断病例中,多有前房出血,色素膜炎症等多种并发症,经治疗好转后,择期（术后3～7d）手术更好。在虹膜根部离断相对应的角巩膜缘作巩膜瓣下缝线固定术,根据离断范围长短,确定缝针数目（1-4针）,结扎线头埋在巩膜瓣下,结膜瓣复位复盖。结论本院治疗虹膜根部离断病例32例,完全修复。术后瞳孔居中圆形26例,瞳孔居中略呈椭圆形者4例,瞳孔偏位者2例,房角后退眼压增高2例。术后矫正视力0．5-1．0,21例（65．6％）;0．3～0．4,6例;0．1～0．20,2例（6．2％）,0．1以下者1例（3．1％）。视力差者有眼压增高,房角后退,玻璃体积血等多种病变。结论顿性闭合性眼外伤致虹膜根部离断,合理治疗后,择期作巩膜瓣下缝线固定术,效果良好,此法可推广。闭合式缝合法可减少对眼球的刺激,术后视力恢复快,瞳孔居中,园形或近园形较满意。但眼伤势过重,致玻璃体出血,房角后退,网膜病变,视神经外伤者,则视力恢复差。