实验性近视眼巩膜成纤维细胞力学特性的动态变化

目的 研究豚鼠镜片诱导型近视眼(LIM)前部及后极部巩膜成纤维细胞的力学特性的动态变化.方法 实验研究.取2周龄豚鼠30只,分为A、B、C 三组,每组10只,用离焦的方法制备凹透镜诱导近视(LIM)动物模型,对侧眼为f自身对照眼(SC眼),再随机选取5只(10眼)正常2周龄豚鼠不作任何干预,作为正常对照组(NC组),将A、B、C 三组分别造模6、15、30 d后,用组织块培养法培养每组豚鼠前部及后极部巩膜成纤维细胞,,并传2代.利用细胞微管吸吮的疗法测定各组巩膜成纤维细胞的平衡杨氏模量和细胞表观黏性.各组数据结果计算记录为均数±标准误((x)±s)和等级资料表示,对照组与实验组间差异分别行配对t检验,组间差异行完全随机单因素方差分析.结果 LIM各组间的细胞力学特性比较,及与SC组比较,发现无论是平衡杨氏模量还是细胞表观黏性,LIM组前部于诱导6 d[(0.2252±0.0836)kPa,μ=(1.3119±0.4862)kPa.s]、15 d[(0.2373±0.0903)kPa,( 1.3583±0.5652)kPa.s]时与SC组[(0.2220±0.0593)kPa,( 1.4122±0.4326)kPa]比较无明显变化,诱导30 d[ (0.3874±0.0965)kPa,( 2.6278±0.8063 )kPa.s]时与6、15 d及SC组比较均增高,其差异有统计学意义(P＜0.05);LIM组后极部于诱导6 d [(0.3432± 0.0786)kPa,( 1.9237±0.5203 )kPa.s]时与SC组[(0.2283±0.059 )kPa,μ=1.3248±0.3535)kPa.s]比较无明显变化,但诱导15 d [(0.4797±0.1241)kPa,(3.3221±0.7179)kPa.s]、30 d[(0.5663±0.1127)kPa,[4.6264±1.2205) kPa.s]时与6 d组、SC组比较均增高,其差异有统计学意义(P＜0.05).结论 LIM组前部及后极部巩膜成纤维细胞的平衡杨氏模量、黏弹性参数分别在诱导30 d和诱导15 d后有明显升高,即有“硬化”现象.     

巩膜外垫压联合视网膜激光光凝治疗硅油眼视网膜脱离的临床分析

目的研究巩膜外垫压手术联合视网膜激光光凝对硅油眼视网膜脱离的治疗效果。方法回顾性分析2009年1月一2012年1月,用巩膜外垫压联合视网膜光凝手术治疗36例硅油眼视网膜脱离的视网膜复位效果。结果全部患者均顺利完成巩膜外垫压手术及随后的视网膜激光光凝,行巩膜外放液5只眼,手术中未发生视网膜嵌顿、眼内出血和眼压显著升高等并发症;手术后1周视网膜复位21只眼（58．33％）,剩下15只眼1个月后复位7只眼（19．44％）,视网膜脱离总复位率为28只眼（77．77％）;未复位8只眼（22．23％）,改用玻璃体切割手术方式,视网膜成功复位;6个月后取出硅油,随访6个月视网膜无脱离或者脱离范围增加;手术后眼压≥30mmHg（11mmHg=0．133kPa）3只眼,≥20mmHg7只眼,对症治疗1周后眼压均恢复到正常范围。结论巩膜外垫压联合视网膜激光光凝治疗硅油眼视网膜脱离,手术简单,复位率高,可为硅油眼视网膜脱离首选手术方式,对于巩膜外垫压手术失败和复杂的硅油眼视网膜脱离,应当选择玻璃体切割手术方式。     

卵磷脂络合碘对视网膜脱离复位术后低视力患者视网膜功能和形态的影响

目的探讨卵磷脂络合碘对视网膜脱离（RD）术后视网膜功能和黄斑部视网膜形态的干预效果。方法采用前瞻随机对照研究的方法将50例（50眼）RD术后患者分为卵磷脂络合碘组和对照组；应用视网膜电图（ERG）和光学相干断层扫描（OCT）方法观察术后1、2、4、8周视网膜功能和形态的改变。结果对照组和用药组的年龄、视力和病程匹配。与术后第1周ERGb波比较，用药组第2周ERGb波即有显著的改变，而对照组延迟到第8周。OCT检查表明，用药组黄斑部视网膜厚度在术后第4周明显改善，而对照组为术后第8周。术后第8周用药组患者的最佳矫正视力与对照组的差异有统计学意义（P〈0．01）。结论卵磷脂络合碘可在一定程度上促进RD术后视功能的改变。     

Hardness evaluation of penile prostheses

AIM: This work investigates the hardness and buckling force of penile prostheses to further understand the rigidity of penile prostheses before and after implantation. METHODS: Evaluated herein are four prosthetic samples (three inflatable, one semi-rigid), five real prostheses (one inflatable, four semi-rigid), and one prosthesis after implantation. The hardness is measured with a Shore Durimeter by pressing the tester's indentor to the surface of the specimen. A volunteer with inflatable prosthesis implantation is evaluated with respect to penile hardness versus various numbers of pumping. The buckling force of the prosthesis is also determined by a push-pull gauge and a specially designed sampling table. RESULTS: Results in this study demonstrate that although the inflatable prosthesis could only be pumped to a certain amount of hardness, hardness and buckling force correlate well with each other. After reaching the hardness limit, prostheses can even be pumped a further few times. However, continuous pumping only puts more tension on the prosthetic material without increasing hardness and could induce mechanical failure of the prosthesis. Results also indicate that the buckling force decreases with increasing length of the semirigid prostheses, and increases when the prosthesis has a larger diameter. CONCLUSION: This mechanical measurement of rigidity in penile prostheses could provide more information to clinicians about the penile prosthesis before surgical implantation, and to patients about prosthesis usage after implantation.     

Massive Exudative Retinal and Choroidal Detachments Following Scleral Buckling Surgery

Three aphakic male patients underwent successful scleral buckling surgery for unilateral rhegmatogenous retinal detachment. Within a two-week postoperative period, each developed severe ocular pain with massive exudative retinal and choroidal detachments resembling recurrent rhegmatogenous or traction retinal detachment or implant infection. Systemic prednisone therapy resulted in prompt resolution of ocular pain and reabsorption of subretinal and suprachoroidal fluid. It is important to recognize this uncommon postoperative syndrome so that proper medical therapy may be initiated and unnecessary additional retinal or vitreous surgery can be avoided.     

The Effect of Vitreous and Retinal Surgery on Corneal Endothelial Cell Density

The effect of vitreoretinal surgery on corneal endothelial cell density was studied prospectively in 69 eyes by comparing preoperative endothelial cell densities to postoperative data. The mean cell loss in eyes of diabetic patients did not differ significantly from those of non-diabetics. The mean endothelial cell loss in 30 phakic eyes which underwent pars plana vitrectomy without lens removal was 1.3 ± 1.4%. In aphakic eyes, vitrectomy and scleral buckling led to a mean cell loss of 12.6 ± 2.3%. When vitrectomy was combined with lentectomy and scleral buckling, the mean cell loss was 8.5 ± 1.8%, but eyes undergoing fluid-gas exchange in addition to these procedures suffered a mean cell loss of 16.9 ± 1.9%. The presence of the lens protects the corneal endothelium during pars plana vitrectomy, while fluid-gas exchange in aphakic eyes appears to have a detrimental effect.     

不作凝固的视网膜脱离巩膜外垫压术

采用不作凝固的手术方法治疗裂孔性视网膜脱离10例,全部病例用硅胶海绵作巩膜外蛰压。其中一例放出视网膜下积液。除一例因缝线松脱,垫压物移位而失败外,其余一次治愈。随访平均20个月,未复发。本术式的优点是①简化手术步骤,缩短手术时间。②避免热凝引起的巩膜坏死,有利再手术。③术毕玻璃体、视网膜等组织反应轻,术后无明显视网膜、脉络膜萎缩,避免了永久性视机能障碍。④术后色素膜及外眼反应轻,病人痛苦小。此外,对本法适应证和作用机制作了初步讨论。     

玻璃体视网膜手术联合巩膜扣带术治疗复杂性视网膜脱离

使用玻璃体视网膜手术联合巩膜扣带术的方法，进行复杂性视网膜脱离的治疗，达到提高治愈成功率的目的。（１）进行常规的巩膜扣带术，（２）进行睫状体平部三切口的闭合式玻璃体切除手术，包括膜剥离、气体、硅油眼内填充等技术。随访１－１６月，２９眼中，２２眼达到解剖复位，成功率７５．８％；其中，１５眼行硅油眼内填充，１２眼视网膜复位，成功率８０％，闭合式玻璃体手术的开展，使复杂性视网膜脱离的治疗成为可能，其解剖     

Pulsatile Ocular Blood Flow: Changes Associated with Scleral Buckling Procedures

Purpose To determine the changes in the pulse amplitude (PA) and the pulsatile ocular blood flow (POBF) after scleral buckling (SB).Methods Retrospectively, we studied 24 patients (average age, 52 years) who had undergone SB to repair a retinal detachment in one eye. The patients were divided into two groups: those in whom SB had been performed less than 6 months earlier (n = 10), and those in whom the procedure had been performed more than 6 months previously (n = 14). In each group, the PA and the POBF were determined with a computerized tonometry system, and the values in the SB eyes were compared with those in the control fellow eyes.Results Within 6 months postoperatively, the mean PA in the SB eyes (0.66 ± 0.30mmHg) was significantly lower than that in the control eyes (1.43 ± 0.34mmHg; P < 0.05). The mean POBF in the SB eyes (349.5 ± 154.1µl/min) was also significantly lower than that in the control eyes (631.0 ± 226.6µl/min; P < 0.05). After more than 6 months postoperatively, there were no significant differences in the PA or the POBF between the SB eyes (1.08 ± 0.49mmHg and 612.4 ± 341.2µl/min, respectively) and the control eyes (1.50 ± 0.51mmHg and 589.5 ± 278.4µl/min, respectively).Conclusions These results indicate that the choroidal blood flow decreases after SB but returns to normal levels after 6 months. Jpn J Ophthalmol 2005;49:162–165 © Japanese Ophthalmological Society 2005     

Techniques of intraocular lens suspension in the absence of capsular/zonular support

Implantation of intraocular lenses has become the standard of care in the aphakic state. Ideally, the lens is placed in the capsular bag, which affords stable fixation at a position closest to the nodal point of the eye. However, there will always be instances where this will not be possible. Congenital weakness of the lens zonules in various conditions, trauma, and surgical complications of cataract surgery are just some examples. In this article, we review the methods that have been devised to allow intraocular lens implantation in the absence of capsular or zonular support. These include anterior chamber angle and iris-fixated lenses, as well as posterior chamber iris- and scleral-sutured lenses. The various lenses are described, and the techniques involved, advantages and disadvantages, complications, and results of each method are discussed. It is hoped that this article will provide a comprehensive overview of ways to deal with a problem that can still result in a very good visual outcome for the patient. This is particularly relevant given the many recent developments and refinements of methods in implanting intraocular lenses.