视网膜脱离再手术患者心理特点及对策

视网膜脱离（retinal detachment,RD）治疗以于术为主,有效率可达90％,然而有约10％的病人由于原裂孔未闭、出现新裂孔及增殖性玻璃体视网膜病变等原因需再次手术。此类病人面临再次手术时,可能产生较第一次手术更为复杂的心理反应,因此,正确、全面的心理干预更显重要。2006年10月～2008年3月我科收治RD再手术患者146例,其心理特点及采取的对策总结如下：     

青光眼视盘损伤可能性估测法与视野缺损相关性研究

目的　研究视盘损伤可能性估测法(diskdamagelikelihoodscale ,DDLS)与原发性开角型青光眼(primaryopen an gleglaucoma,POAG)视野损害的相关性。设计　回顾性研究。研究对象　6 0例(10 7只眼)POAG患者。方法　POAG患者经静态视野检查,在裂隙灯显微镜下经 6 0D非球面凸透镜测量其视盘垂直径,按DDLS分期。采用HPA视野分期系统及以视野平均缺损值(meandefect,MD)作为视野分期标准。经Pearson及Spearman相关系数分析。主要指标　视盘垂直径,盘沿最窄处宽度/视盘垂直径比值,MD ,视神经损伤分期与视野分期。结果　DDLS与MD的dB值之间存在着非常显著的正相关(Pearsonr =0 6 33,P <0 0 0 1) ;与两种不同视野分期标准间亦存在非常显著的正相关,Spearmanr值分别为0 5 93和0 6 4 3(P <0 0 0 1)。在中等大小视盘组(视盘直径1 5～2 0mm)和大视盘组(视盘直径>2 0mm) ,DDLS分期与MD(dB值)存在非常显著的正相关:Pearsonr值为0 779和0 6 0 5 (P <0 0 0 1)。结论　DDLS与青光眼性视野缺损程度有非常显著的相关性。     

动态轮廓眼压计与Goldmann压平眼压计及非接触眼压计测量眼压的对比研究

目的探讨动态轮廓眼压计(DCT)与Goldmann压平眼压计(GAT)及非接触眼压计(NCT)测量眼压的准确性,并比较三种眼压计测量结果与中央角膜厚度(CCT)的相关性。设计前瞻性、比较性病例系列。研究对象连续选取90例(90眼)10~76岁正常人。方法采用KONAN非接触式角膜内皮镜测量CCT后,对所有入选者单眼以随机顺序采用Pascal型DCT、GAT及Topcon型NCT测量眼压。测量结果两两比较,并将眼压值与CCT进行直线回归分析。主要指标眼压值,Pearson相关系数。结果 90例正常人DCT眼压平均值(17.33±2.71 mm Hg)明显高于GAT(14.27±2.81 mm Hg)(P=0.000)及NCT(14.67±2.93 mm Hg)(P=0.000),平均差异分别为(3.06±2.01)mm Hg和(2.67±2.20)mm Hg;GAT与NCT之间平均差异为(-0.39±2.29)mm Hg(P=0.105)。DCT与GAT眼压值之间相关系数r=0.736(P=0.000);与NCT眼压值之间相关系数r=0.699(P=0.000)。GAT、NCT眼压值与CCT均明显相关(r=0.370,P=0.000;r=0.508,P=0.000);DCT眼压值与CCT无明显相关性(r=0.051,P=0.639)。DCT和GAT的差值与年龄无明显相关性(r=0.064,P=0.052)。结论 DCT测量的眼压值虽高于GAT及NCT,但不受CCT的影响,可能较GAT和NCT测量的眼压值更接近真实值。     

谈青光眼患者的健康教育

青光眼是威胁人类健康的重要眼病,是导致视功能减退和致盲的主要原因之一。在我国,青光眼的发病率约为0.21～1.64％,是当前我国第三或第四位致盲眼病,而且,青光眼所造成的视功能损伤是不可逆性的,后果极为严重,对个人、家庭和社会都将造成难以估计的痛苦和损失。但是,青光眼只要能早期发现、合理治疗,绝大多数患者均可保持视功能,这样就能减少青光眼患者的痛苦,减轻家庭和社会的负担。因而,加强医院健康教育,提高青光眼患者的自我保健意识具有非常重要的社会意义。     

1例糖皮质激素性青光眼术后前房积血的护理

糖皮质激素性青光眼(glucocorticoid induced glaucom a,G IG)是糖皮质激素诱导的一种开角型青光眼,通常与眼局部表面滴用糖皮质激素制剂有关,也可见于全身应用糖皮质激素药物者,近年来有逐步增多的趋势。本院于2005年1月收治了1例双眼激素性青光眼的患者,术后双眼均出现了前房积血的并发症,经过积极的治疗和精心的护理,痊愈出院,现将本例患者在治疗中的护理体会总结如下。1临床资料患者,男,26岁,学生。因双眼自行滴用“的确当”眼药水两年余,视物模糊2月于2005年1月10日步行入院,诊断为双眼激素性青光眼,全身体查未见异常,眼部检查:右眼视力0.02,最佳矫正视力为0.8;左眼视力为0.05,最佳矫正视力为0.7。眼压:右眼32m m H g,左眼22m m H g。房角:双眼均为宽角。眼底:右C/D=1.0,左C/D=0.9。经过药物治疗眼压控制不理想,G D X视神经纤维明显缺损,视野检查有晚期青光眼改变,故采取手术治疗。1月12日在局麻下行右眼复合式小梁切除 前房成形术,术后1天,患者诉右眼视物不清,专科检查:右眼手动/30cm,角膜透明,上方滤过泡I型,前房内有积血,占前房2/...     

眼内硅油充填术患者睡眠状况调查与相关因素分析

目的:通过眼内硅油充填术患者手术前后睡眠状况的调查,了解患者的睡眠状况及影响睡眠的相关因素。方法:用自编眼内硅油充填术前、术后影响睡眠因素调查表分别对40例术前患者及40例术后患者进行问卷调查。结果:术前、术后患者睡眠时间有明显差异,术后俯卧位、术眼疼痛、头痛、对术后并发症的忧虑等因素影响患者睡眠。结论:重视眼内硅油充填术后患者的睡眠状况并采取护理干预,可以减轻患者痛苦提高睡眠质量。     

11例闭角型青光眼并高度近视眼的临床分析

目的:探讨闭角型青光眼中高度近视的发病机制和诊疗方法.方法:回顾性分析了692例闭角型青光眼病例的临床资料,对11例闭角型青光眼并高度近视眼患者行手术治疗.结果:692例闭角型青光眼中高度近视眼患者11例,其中3例为Weill-Marchesani 综合征,1例虹膜高褶综合征,2例虹膜睫状体囊肿,余5例为瞳孔阻滞.11例患者19只眼接受晶体手术或滤过性手术后均成功控制眼压.结论:高度近视眼患者在一些特定情况下可发生房角关闭甚至闭角型青光眼,其发病机制主要是瞳孔阻滞.     

重组人白细胞介素-2玻璃体注射慢性高眼压大鼠神经节细胞层神经元的凋亡

BACKGROUND: The majority of studies addressing neuroprotection have focused on drugs, proteins and cytokines. A recent study reports that recombinant human interleukin-2 (rhIL-2) achieves good therapeutic effects, but the underlying mechanisms remain poorly understood. OBJECTIVE: To observe the neuroprotection of recombinant human interleukin-2 (rhIL-2) by intravitreous injection on the retinal ganglion cells (RGCs) following chronic elevated IOP model in Wistar rats. DESIGN, TIME AND SETTING: A randomized, controlled, animal experiment was performed at the Center Laboratory, Second Xiangya Hospital, Central South University, China, from July 2008 to March 2009. MATERIALS: LY294006 and AG490 were provided by Invitrogen, USA. Rabbit anti-AKT1 polyclonal antibody and rabbit anti-STAT3 polyclonal antibody were purchased from American Basic Gene Associate Bioscience, USA. METHODS: Chronic elevated IOP model of Wistar rats were established by cauterizing the limbal episcleral veins to block the reflux of aqueous humor by 532nm viridis-lite diode laser in right eyes. Intravitreous injection of 2µl PBS, rhIL-2 or rhIL-2 LY294002, AG490 mixed liquor for eyes were administered 1 week after chronic elevated IOP model established. Ocular tissue was immunostained to investigate ED-1 expressions. Rats were sacrificed after intravitreous injection 3 days, 14 days, 21 days to identify RGC, and the 3% fluorogold was used to the epithalamus 7 days before sacrifice. Western blot analysis Akt1 and STAT3 protein in the retina after intravitreous injection 3h,12h, 96h. MAIN OUTCOME MEASURES: ED-1 expression of activated microglia/macrophages was determined by immunofluorescence. The RGCs levels were detected using fluorogold staining. The efficacy of the intraocular rhIL-2 and rhIL-2, LY294002, AG490 mixed liquor injections in inhibiting PI3K/Akt、Jak/Stat3 signal transductions were confirmed by Western blot analysis. RESULTS: Numerous ED-1 positive macrophages were seen in the vitreous and along the inner retinal surface in rhIL-2 treatment group. The number of RGCs was much higher than that in control groups and PBS group (P<0.01). The numbers of RGCs in rhIL-2 and LY294002, AG490 mixed liquor group was as much lower than that in rhIL-2 group (P<0.01). Western blotting analysis showed very little Akt1 and STAT3 protein in the retina after 3h intravitreous injections of rhIL-2 in rats, started to increase rapidly at 12 reperfusion,96h decreased slightly. LY294002 and AG490 prevented the Akt1 and STAT3 protein expression in the retina. CONCLUTION: rhIL-2 has neuroprotective effection after intravitreous injection. It can decrease or avoid RGCs layer damage in chronic glaucoma model of rats. Intravitreal injection of rhIL-2 activates macrophages, which derived factors might enhance the RGCs survival. After intravitreal injection of rhIL-2 PI3K/Akt、Jak/Stat3 signal transductions may play an important role following a chronic elevated IOP model, and LY294002, AG490 can block this effect.     

全面认识"红眼病"

“红眼病”又叫“暴发火眼”,即急性流行性结膜炎。它是由肺炎双球菌、葡萄球菌、链球菌和科-韦氏杆菌或病毒(肠道病毒、腺病毒)等病原引起的急性传染性眼病。该病通常包括急性卡他性结膜炎(细菌感染)、流行性出血性结膜炎(病毒感染)、流行性角结膜炎