蓝光滤过型非球面人工晶状体植入术后高阶像差及MTF值临床对比观察

目的 对比观察白内障超声乳化联合植入蓝光滤过型非球面人工晶状体(intraocular lens,IOL)术后3个月的高阶像差及MTF值.方法 单纯年龄相关性白内障92例,依照患者意愿植入PY-60AD,AcrysofIQ,YA-60BB分为Ⅰ组Ⅱ组Ⅲ组,进行白内障超声乳化联合人工晶状体植入术.术后三个月利用波前像差仪i-Trace比较3mm,4mm,5mm,6mm瞳孔直径下各组球差(Z40),慧差(coma),总高阶像差(HOAs)的均方根 (the root meansquare,RMS)及3mm,5mm瞳孔直径下调制解调函数(modulation transferfunction,MTF).结果 ①波前像差检查,在各瞳孔直径下,两组非球面IOLZ40＜球面IOL,且差异具有统计学意义(P＜0.05).两组非球面IOL之间Z40差异无统计学意义(P＞0.05).②各瞳孔直径下三组IOL间coma差异无统计学意义(P＞0.05).③在各瞳孔直径下,两组非球面IOL高阶像差均方根(RMSh)＜球面IOL,但瞳孔直径在＜5mm下,差异无统计学意义(P＞0.05);瞳孔直径5mm下,差异有统计学意义(P＜0.05).在各瞳孔直径下,两组非球面IOL之间RMSh差异无统计学意义(P＞0.05).④3mm瞳孔直径下,去除低阶像差的MTF值每周5,10,15,20,25,30度(cyclesperdegree,cpd)六个空间频率下,两组非球面IOLMTF值＞球面IOL,三组间差异无统计学意义(P＞0.05).5mm瞳孔直径下,去除低阶像差的MTF值在5,10,15,20,25,30cpd六个空间频率下两组非球面IOL＞球面IOL,除30cpd外差异均有统计学意义(P＜0.05);两组非球面IOL间MTF值Ⅱ组＞Ⅰ组,差异无统计学意义(P＞0.05).结论 蓝光滤过型非球面人工晶状体在3mm瞳孔直径下可以明显降低球差,在5mm瞳孔直径下可以明显降低总高阶像差,从而使患者获得更好的视觉质量.且HOYAPY-60AD为预装式具有使用方便,减少人工晶状体装载过程中污染机会等优点,适于临床广泛应用.     

PEDF对视神经夹伤模型大鼠视网膜组织中NO和Caspase-3表达的影响

目的:分析色素上皮衍生因子(pigment epithelium-deriverd factor,PEDF)对视神经夹伤模型大鼠视网膜组织一氧化氮(nitrogen monoxide,NO)、天冬氨酸特异性半胱氨酸蛋白酶3(cysteine-containing aspartate-specific proteases-3,Caspase-3)表达的影响.方法:选择60只SD大鼠随机分为空白对照组、模型组、PEDF组各20只,除空白对照组外,均建立视神经夹伤大鼠模型,均取左侧眼球为标本,造模成功后,模型组玻璃体腔内注射平衡盐溶液5μL,PEDF组玻璃体内注射5μL PEDF(浓度0.2μg/μL).2wk后取视网膜组织,行HE染色后光镜下观察视网膜形态的变化,采用比色法测定NO含量的变化,采用逆转录-聚合酶链式反应(RT-PCR)法、蛋白印迹法(Western-blot)检测Caspase-3 mRNA和蛋白表达情况.结果:HE染色发现,空白对照组视网膜组织排列整齐且清晰,视网膜神经节细胞(retinal ganglion cells,RGCs)呈单层细胞排列,细胞为卵圆形,大小均匀,分布均匀,细胞核清晰,排列紧密,边界清晰;模型组视网膜组织结构稀疏,RGCs呈空泡样变化,整体细胞数量减少,残留RGCs细胞核见固缩,染色不均.PEDF组视网膜组织残留神经节细胞轻微水肿,但RGCs细胞层排列尚且紧密,且受损程度明显轻于模型组;模型组、PEDF组Caspase-3 mRNA和蛋白水平高于空白对照组,差异有统计学意义(P<0.05);PDEF组Caspase-3 mRNA和蛋白水平低于模型组,差异有统计学意义(P<0.05).模型组、PEDF组NO含量高于空白对照组,差异有统计学意义(P<0.05);PEDF组NO含量低于模型组,差异有统计学意义(P<0.05).结论:采用PEDF干预可下调视神经损伤大鼠Caspase-3、NO的表达,减轻RGCs细胞损伤.     

PEDF对大鼠视神经急性损伤后神经节细胞的保护作用

目的:观察色素上皮衍生因子(pigment epithelium derived factor,PEDF)对大鼠视神经急性损伤后视网膜神经节细胞(retinal ganglion cells,RGCs)的保护作用.方法:选取健康雌性SD大鼠60只随机分为:空白组、模型组和实验组,每组各20只.采用视神经夹伤方法,建立大鼠视神经急性损伤模型.模型组制作视神经损伤模型成功后即刻向玻璃体腔注射平衡盐溶液5μL,之后的1、2wk分别向玻璃体腔注射平衡盐溶液5μL;而实验组在视神经损伤模型制作成功后即刻向玻璃体腔注射PEDF 5μL,同样在1、2wk时分别向玻璃体腔注射PEDF 5μL.通过HE 染色,光镜下观察视网膜形态学变化并且对视网膜神经节细胞进行计数.通过免疫组织化学半定量的方法对Bcl-2和Bax的表达进行检测,观察PEDF对受损视神经的影响.结果:HE染色观察,实验组神经节细胞从细胞形态上要好于模型组,且RGCs数量较模型组多.实验组的Bcl-2和Bax的蛋白表达与空白组、模型组比较,差异有统计学意义(P<0.05),实验组较模型组Bcl-2蛋白表达增加,Bax蛋白表达下降.结论:PEDF可通过上调视网膜Bcl-2蛋白的表达、减弱Bax蛋白表达,以减弱或抑制视神经损伤后RGCs的细胞凋亡,减轻视神经损伤.     

国产散瞳药在白内障超声乳化术前准备及术中散瞳效果的临床观察

目的:比较国产散瞳药卓比安与进口散瞳药美多丽在老年性白内障超声乳化联合人工晶状体植入术前及术中的散瞳效果。方法:患者200例术前1d随机分为两组,每组各100例:试验组为卓比安组和对照组美多丽组。点眼前测量两组双侧瞳孔大小并记录,共3次点药,每隔5min1次,点药结束后15,20,25min观察并记录瞳孔直径大小,及瞳孔开始回缩时间。卓比安组和美多丽组于术前1h点药3次,每次间隔5min,白内障超声乳化术中,观察并记录术前,注入黏弹剂后,超声乳化完成后瞳孔直径及有效超声乳化时间,并进行统计学比较。结果:卓比安组与美多丽组术前1d间隔5min3次点药,于点药结束后20min左右均能达到最大瞳孔直径,且两组最大瞳孔直径无统计学差异;卓比安组与美多丽组瞳孔开始回缩时间(h)分别为2.49±0.75h与2.85±0.74h,且两者有统计学差异。超声乳化过程中国产散瞳药卓比安与美多丽维持散瞳效果相同。结论:国产散瞳药卓比安组与进口散瞳药美多丽组相比术前与术中散瞳效果无统计学差异,但术前瞳孔维持最大直径时间(h)卓比安组要比美多丽时间短,且两者有统计学差异。     

2型糖尿病视网膜病变患者RBP4和尿mAlb/Cr比值检测的临床意义

目的探讨2型糖尿病视网膜病变(DR)患者血清视黄醇结合蛋白4(RBP4)和尿微量清蛋白(mAlb)/肌酐(Cr)比值的临床意义。方法选择2017年3月至2019年4月该院收治的2型糖尿病(T2DM)患者183例和在该院体检的健康体检者66例为研究对象,分为无DR(NDR)组、非增生性DR(NPDR)组、增生性DR(PDR)组和对照组四组。检查记录各组体质量指数(BMI)、腰臀比(WHR)、糖尿病病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、糖化血红蛋白(HbA1c)、RBP4、mAlb、Cr,计算mAlb/Cr比值,分析RBP4、mAlb/Cr比值与其他临床指标的相关性,分析DR的危险因素。结果DR患者BMI、WHR、SBP、DBP高于对照组(P<0.05),糖尿病病程越长,DR患者病情越严重。随着DR患者病情加重,FBG、2 hPG、TC、HbA1c、CRP、RBP4、mAlb/Cr比值逐渐升高(P<0.05),DR患者TG、LDL-C水平高于对照组,NPDR组、NDR组HDL-C水平低于对照组、NDR组(P<0.05)。血清RBP4、mAlb/Cr水平与糖尿病病程、FBG、2 hPG、HbA1c、LDL-C、CRP、TC等指标呈正相关(P<0.05)。糖尿病病程、HbA1c、CRP、RBP4、mAlb/Cr比值等是DR的独立危险因素(P<0.05)。结论DR患者血清RBP4和mAlb/Cr比值异常升高,且与病情严重程度密切相关,可能参与了DR的发病与进展过程。     

蓝光滤过型非球面人工晶状体植入术后高阶像差及MTF值临床对比观察

Objective To observe the value of RMSh and MTF 3 months after implantation of bluelight-blocking aspherical intraocular lens. Methods Patients were divided into three groups according to their selection among three kinds of implant IOL: GroupⅠ(PY-60AD), Group Ⅱ (Acrysof IQ),and Group Ⅲ (YA-60BB), Wavefront aberrations were measured across different pupil diameters (PD)(3mm,4mm,5mm,6mm) to record the values of the Z40, coma,total higher order aberration and modulation transfer function (MTF) under pupil diameters of 3mm,5mm three months after cataract phacoemusification and implantation of IOL. Results The values of Z40 in the two aspherical IOL groups were significantly lower than the spherical IOL group at all different pupil diameters (P＜0.05).There was no significant difference between two aspherical IOL groups about the value of Z40.There were no statistically significant differences about the values of coma among three groups (P ＞0.05). The values of RMSh in the two aspherical IOL groups were significantly lower than the spherical IOL group (P＜0.05) when the PD≥5mm, but had no significant difference when the PD＜5mm(P＞0.05).There was no significant difference between two aspherical IOL groups about the RMSh at all different pupil diameters (P＞0.1). At a 3mm pupil diameter,there were no statistically significant differences about the values of MTF at all spatial frequency (5,10,15,20,25,30cpd) among three groups (P＞0.05).At a 5mm pupil diameter,the values of MTF in the two aspherical IOL groups were significantly lower than the spherical IOL group at spatial of 5,10,15,20,25cpd (P＜0.05). There was no significant difference between two aspherical IOL groups about the values of MTF, but in the following order group Acrysof IQ＞group PY-60AD (P＞0.05). Conclusions PY-60AD and Acrysof IQ IOL can decrease the spherical aberration even when the pupil diameter at only 3mm and decrease the higher order aberration when the pupil diameter at or greater than 5mm. Thereby the patients who implanted with aspherical IOLs can acquire better visual quality.There is no significant difference when PY-60AD comparing to Acrysof IQ about the values of wavefront aberrations and MTF. And HOYA PY-60AD is a preloaded IOL that have many advantages fit for widely applied in clinical field.