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。     

人眼玻璃体内CXC配体16与2型糖尿病视网膜病变的关系

目的　探讨人眼玻璃体内ＣＸＣ配体１６（ＣＸＣｌｉｇａｎｄ１６,ＣＸＣＬ１６）与２型糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＤＲ）的关系。方法　选取２０１３年１月至２０１４年２月在安阳市眼科医院行玻璃体切割术的患者６０例６０眼为研究对象,根据疾病情况分为３组,对照组为无糖尿病的特发性黄斑前膜患者,ＮＤＲ组为合并２型糖尿病但无ＤＲ的特发性黄斑前膜患者,ＤＲ组为２型糖尿病合并ＤＲ及玻璃体积血或牵拉性视网膜脱离患者,每组各２０例２０眼。所有患者均于玻璃体切割术中收集中央及周边皮质玻璃体,经酶联免疫吸附检测试剂盒定量测定各组不同部位玻璃体内ＣＸＣＬ１６的含量并进行对比。结果　对照组、ＮＤＲ组、ＤＲ组患者中央玻璃体内ＣＸＣＬ１６浓度分别为（２．５０±０．２３）μｇ?Ｌ－１、（４．１７±０.２６）μｇ?Ｌ－１和（４.２２±０．３５）μｇ?Ｌ－１,周边皮质玻璃体内的ＣＸＣＬ１６浓度分别为（４．４３±０．２１）μｇ?Ｌ－１、（６．３５±０．２４）μｇ?Ｌ－１和（６．７３±０．３４）μｇ?Ｌ－１,３组中央与周边皮质玻璃体中的ＣＸＣＬ１６浓度比较差异均有统计学意义（均为Ｐ＜０．０５）。ＮＤＲ组、ＤＲ组中央及周边皮质玻璃体内ＣＸＣＬ１６的浓度均高于对照组（均为Ｐ＜０．０５）,ＮＤＲ组周边皮质玻璃体ＣＸＣＬ１６浓度低于ＤＲ组（Ｐ＜０．０５）。结论　ＣＸＣＬ１６可能与ＤＲ的发生有关,并有可能参与了ＤＲ的进展。     

视网膜电图对玻璃体出血机化和玻璃体手术的意义

报告118例(133眼)由各种疾病引起的玻璃体出血机化患者的视网膜电图(ERG)检查结果,其中31例作了玻璃体手术,结果表明,ERG检查对玻璃体出血机化的患者,能客观地反映其网膜功能,并对玻璃体手术的预后有指导作用。术前ERG检查,a、b波下降越严重,视功能损害显著,术后视力的预后越差,同时证实,玻璃体机化膜是影响a、b波波幅和时间的一个因素。     

右美托咪定和咪达唑仑在老年人玻璃体手术中应用的对比研究

目的比较右美托咪定和咪达唑仑在老年人玻璃体手术中的不同作用。方法选择择期拟行玻璃体手术老年人患者40例,随机分为右美托咪定组(20例)和咪达唑仑组(20例)。两组患者球周阻滞麻醉后右美托咪定组给予右美托咪定,咪达唑仑组给予咪达唑仑。对比观察2组患者平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、Ramsay镇静评分、视觉模拟法(visual analogues cale,VAS)疼痛评分。结果两组患者术中不同时间MAP、HR与麻醉前比较,右美托咪定组各时间点均显著降低(均为P<0.05),咪达唑仑组各时间点均显著增高(均为P<0.05);右美托咪定组术中MAP、HR比咪达唑仑组显著降低,差异均有统计学意义(均为P<0.05)。两组患者术中不同时间的Ramsay镇静评分与麻醉前比较,均明显增高(均为P<0.05),两组之间差异无统计学意义(P>0.05)。两组不同时间的VAS疼痛评分与麻醉前比较,均有明显增高(均为P<0.05),两组之间差异无统计学意义(P>0.05)。右美托咪定组术中没有一例患者辅助使用芬太尼,无躁动、烦躁不安;咪达唑仑组有14例患者由于术中疼痛使用芬太尼,有3例出现呼吸抑制,需要暂时辅助人工通气可使脉搏氧饱和度维持在正常范围,有6例患者出现躁动。结论右美托咪定用于老年人玻璃体手术是安全、有效的,值得临床推广应用。     

Appearance of age‐related macular degeneration in vitrectomized and nonvitrectomized eyes: an intraindividual case study

Purpose: This study analyses the consequences of vitreoretinal traction on the macula and in particular the impact of a vitrectomy on the development of the age‐related macular degeneration (ARMD). Methods: In this retrospective case study, 42 eyes of 21 subjects were examined. The vitreous of one eye must have been removed by vitrectomy at least 8 years ago. At that point in time, the patients had to be at least 50 years old, with a healthy vitreous body of the other eye and a healthy macula in both eyes. Both eyes were examined using an optical coherence tomography (OCT) scan, B‐scan ultrasound, a binocular slit‐lamp funduscopy and a fluorescence angiography (FAG) to evaluate the potential development stage of an ARMD and the vitreous status. Results: In the follow‐up examination, the patients had an average age of 73.6 years. In 0 of 21 vitrectomized eyes (0%), there were signs for an early ARMD. In 5 of 21 nonvitrectomized eyes (23.8%), we found ARMD‐like changes in the angiography and slit‐lamp examinations. Of these 21 eyes, five eyes presented persistent attachment of the posterior vitreous cortex to the macula, while 16 eyes showed complete posterior vitreous detachment. All five eyes (100%) with premonitory signs of an ARMD showed persistent attachment of the posterior vitreous to the macula. Conclusion: We demonstrated a positive relationship between a persistent attachment of the posterior vitreous cortex to the macula and early signs of ARMD. Although the precise mechanism of this relationship remains unclear, the role of chronic low‐grade inflammation, chronic oxidative and mechanical stress and an increase in VEGF is discussed. Persistent vitreous attachment is likely to be another risk factor for ARMD.     

Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion

Purpose: To compare cytokines in undiluted vitreous of treatment‐naïve patients with macular oedema without vitreomacular traction secondary to branch (BRVO), central (CRVO) and hemi‐central (H‐CRVO) retinal vein occlusion. Methods: Ninety‐four patients (median age 72 years, 42 men) underwent an intravitreal combination therapy, including a single‐site 23‐gauge core vitrectomy and the application of bevacizumab and dexamethasone due to vision‐decreasing macular oedema. Among these were 43 patients with BRVO, 35 with CRVO and 16 patients with hemi‐CRVO, which were distributed in a fresh or old retinal vein occlusion type (seven or more months after onset). Undiluted vitreous samples were analysed for interleukin 6 (IL‐6), monocyte chemoattractant protein‐1 (MCP‐1) and vascular endothelial growth factor (VEGF‐A) with cytometric BEAD assay. Vitreous samples from patients with idiopathic epiretinal membrane served as controls (n = 14). Results: The mean cytokine values were highest in the CRVO group with IL‐6 = 64.7 pg/ml (SD ± 115.8), MCP‐1 = 1015.8 pg/ml (±970.1) and VEGF‐A = 278.4 pg/ml (±512.8), followed by the H‐CRVO group with IL‐6 = 59.9 pg/ml (SD ± 97.5), MCP‐1 = 938.8 pg/ml (±561.1) and VEGF‐A = 211.5 pg/ml (±232.4). The BRVO group had IL‐6 = 23.2 pg/ml (SD ± 48.8), MCP‐1 = 602.6 pg/ml (±490.3) and VEGF‐A = 161.8 pg/ml (±314.4). The values of MCP‐1 and VEGF‐A were significantly different for CRVO or H‐CRVO versus BRVO. All values were significantly higher than in the control samples, which had 6.2 ± 3.4 pg/ml (IL‐6), 253 ± 74 pg/ml (MCP‐1) and 7 ± 4.9 pg/ml (VEGF‐A). Within the old RVO type, only MCP‐1 was significantly different for CRVO or H‐CRVO versus BRVO. Conclusions: Both inflammatory markers and VEGF‐A were higher in CRVO and H‐CRVO than in BRVO undiluted vitreous samples. It seems that monocyte recruitment to the vessel wall, which might underlie the importance of eosinophils in tissue remodelling after RVO, is of special interest owing to the significant difference in MCP‐1 in the older RVO types.     

小梁切除联合玻璃体抽液术治疗术中恶性青光眼倾向疗效观察

观察小梁切除术联合玻璃体抽液术治疗术中有恶性青光眼倾向患者的疗效。 方法：青光眼患者19例 20眼术中从角膜穿刺口注水恢复前房检查巩膜瓣渗漏情况时,表现为前房浅眼压高的患者,予以玻璃体穿刺抽液、前房注黏弹剂的方法治疗。 结果：患者19例术后无1例浅前房,出院眼压为5~22.5（平均10.4）mmHg,视力较术前提高者5例6眼,下降者9例9眼,3例3眼有玻璃体出血。 结论：小梁切除术中出现恶性青光眼倾向患者常为伴有睫状体前位晶状体前移的闭角型青光眼,术中联合玻璃体抽液术,可有效预防术后恶性青光眼的发生。     

盐酸万古霉素综合方案治疗眼内炎

目的：探讨盐酸万古霉素综合方案治疗眼内炎的临床疗效和并发症。 方法：收集我院2009-07/2011-08眼内炎住院患者27例27眼,采用盐酸万古霉素综合治疗方案进行治疗。所有患者取玻璃体做细菌培养和药敏试验。采用玻璃体腔内注射盐酸万古霉素,全身使用盐酸万古霉素联合左旋氧氟沙星。炎症无明显好转者,2~4d后行玻璃体切割术,术中使用含盐酸万古霉素的灌注液。术后观察视力、眼压、前房和玻璃体混浊情况。对术后最佳矫正视力和眼压进行统计学分析。 结果：患者27例眼内炎均治愈,视力均有提高。细菌培养检出率56%。革兰氏阳性菌占67%,对盐酸万古霉素敏感。革兰氏阴性菌对氧氟沙星较敏感。8例患者经过静脉滴注及玻璃体腔内注药后眼内炎症控制,19例行玻璃体切割手术。术后最佳矫正视力提高。临床症状体征好转。 结论：早期细菌培养对眼内炎的治疗有重要意义。盐酸万古霉素综合治疗方案能有效治疗眼内炎。     

Proteomic analysis of ophthalmic disease

Proteomics, a highly sophisticated way to study the protein profile of various biological tissues or fluids, has hitherto had a relatively limited role ophthalmic science. Of the few proteomic studies that have been performed, liquid chromatography, electrophoresis gel separation and mass spectrometry have been utilized to investigate the proteome of several different eye structures and fluids from both humans and animal models. Ophthalmic proteomic studies have so far attempted to identify proteins unique to the eye, to investigate protein changes due to the onset of various diseases and to identify proteins that could act as markers of disease. Proteomics has the potential to improve the way in which eye disease is diagnosed and potentially even treated by identifying novel pathogenic pathways that may be susceptible to therapeutic manipulation. The aim of this review is to give an overview the current and potential application of proteomic science to ophthalmic research.     

Detection of iso‐α‐acids to confirm beer consumption in postmortem specimens

Iso‐α‐acids (IAAs) can be used as markers for the consumption of beer. Postmortem specimens from a range of coronial cases were analyzed for IAAs in order to determine the prevalence of beer consumption and any correlation to blood alcohol concentrations (BAC). A total of 130 cases were included in this study including those where beer was mentioned in the case circumstances, cases where beer was not mentioned specifically but alcohol was detected, and cases where neither beer was mentioned nor a positive BAC was present. Available blood, serum, vitreous humour and urine specimens were analyzed. Of the 50 cases where beer was mentioned, 86% had one or more IAAs detected. In cases that only had a positive BAC (n = 60), 57% of these cases also showed the presence of these beer markers. IAAs were detected in specimens obtained from traumatized, burnt, and decomposed cases with a mention of beer consumption or where BAC was positive in blood. No IAAs were detected in cases where BAC was negative. There was little or no correlation between blood IAA concentrations and BAC. This study demonstrates the possible detection of IAAs as a marker for beer consumption. Copyright © 2014 John Wiley & Sons, Ltd.