白内障围手术期结膜囊菌群分布及药敏试验

目的 分析白内障围手术期结膜囊菌群的分布及药敏试验结果。方法 选取264例白内障患者,分别在患者入院后、手术消毒前、手术消毒后、手术结束后四个时间点取样,进行细菌培养及药敏试验,比较不同时期的细菌培养结果和药敏结果。结果 入院后结膜囊细菌培养阳性率明显高于手术消毒前、手术消毒后及手术结束后;入院后结膜囊细菌培养以表皮葡萄球菌为主;革兰氏阳性球菌对头孢西丁、加替沙星、左氧氟沙星等敏感性较高。结论 表皮葡萄球菌是结膜囊最常见的细菌,术前应常规应用抗生素点眼,聚维酮碘冲洗结膜囊等来预防术后感染性眼内炎。     

Sustained eosinophil cationic protein release into tears after a single high-dose conjunctival allergen challenge

Background The appearance of eosinophils is a hallmark sign of the allergic late-phase response (LPR). Eosinophil cationic protein (ECP), a readily measurable product released from activated eosinophils, has so far not been evaluated in the ocular LPR. Objective Two sets of trials were performed in order to investigate changes of local and systemic eosinophil activity and their possible link with symptoms and hyper-reactivity in the allergic LPR in the eye. Methods In the first experiment, ECP was analysed in tears and serum and the clinical reaction was evaluated during a 72-h time–course after a single, high-dose allergen challenge out of season in one eye of 15 pollen-sensitized volunteers. In a second experiment, the hypothesis of an increased clinical response to an allergen challenge in an eye that had been provoked with allergen 48h previously was tested in nine sensitized individuals. Results In the first experiment, symptoms at 10 min and 2, 4, 6, 8 and 24 h significantly exceeded base line scores of the challenged eyes. Tear ECP was significantly elevated in challenged eyes compared to contralateral eyes at 6, 8 and 24 h. In addition, symptoms and ECP release correlated significantly at the 24-h evaluation. Serum ECP remained unchanged throughout the study period. In the second experiment, conjunctival hyperreactivity 48h after an allergen challenge was not confirmed. Conclusion ECP secretion occurs in the experimental ocular LPR and is in part associated with the magnitude of the clinical reaction, which suggests a truly pathogenic role of the activated eosinophil in pollen-induced allergic conjunctivitis.     

Pterygium excision with free conjunctival autograft (FCG) versus postoperative strontium 90 (90Sr) beta-irradiation. A prospective study

In a prospective study the results of a pterygium excision in 54 patients (57 eyes) who underwent a superficial free conjunctival autograft (FCG) were compared to those of patients who were treated with postoperative90Sr-irradiation. In 51 cases the minimum follow-up was six months, the maximum follow-up seven years. We divided the study up into a randomized part and an open part. In the randomized part, surgery of a primary pterygium was performed in 25 eyes, of which 16 were treated with a FCG and compared with 9 eyes with primary pterygium surgery and postoperative90Sr beta-irradiation. In the same period 16eyes were treated because of a recurrent pterygium: 8 with FCG and 8 with90Sr-irradiation. In the open part of the study16 eyes with primary pterygium were successively treated with FCG alone. The results showed in the randomized, as well as in the open study on primary surgery with a minimum follow-up of six month, one recurrence in each of the FCG-groups (2 out of 31 eyes =6.4%), and no recurrences in the 90Sr-group(0%). In the randomized group of patients treated for a recurrent pterygium one recurrence developed in the FCG group (1 out of 8 eyes =12.5%) and one in the 90Sr-group (1 out of 7 =14.6%). Analysis of other clinical parameters showed that postoperative treatment with corticosteroids, nonsteroidal anti-inflammatory drugs, and artificial tears was necessary for a longer period in the FCG group than in the90Sr-group. This revised version was published online in August 2006 with corrections to the Cover Date.     

Clinical and therapeutical considerations on a case of conjunctival melanoma

The authors report a case of limbal conjunctival melanoma treated in a conservative manner. The choice of such a therapy was based not only on clinical examinations and review of literature, but also and mainly on the intraoperative histological examination that showed no involvement of the conjunctival deeper layers.     

心包膜移植在结膜囊成形术中的应用

目的：探讨保存人心包膜移植治疗结膜囊狭窄的临床效果及安全性。方法：对眼球摘除术后伴有结膜囊狭窄综合征的26例26眼，利用心包膜移植行部分结膜囊成形术，术后随访观察3～12个月，平均8个月。结果：24眼（92．31％）在术后30～60天移植的心包膜被结膜覆盖，感染1例（3．85％），结膜囊狭窄1例（3．85％）。结论：保存心包膜移植治疗结膜囊狭窄取材方便，疗效显著，操作简单。     

Immunopathology of ocular sarcoidosis

Summary Sarcoidosis is a multisystem disease characterized by enhanced immune responses at sites of involvement. To elucidate the immunopathogenesis of ophthalmic lesions, cell infiltrates in biopsies from conjunctiva and other tissues involved (lungs, lymph nodes, skin) were studied in 26 patients with active sarcoidosis in order to define the surface phenotype and the distribution of cells in granulomatous lesions. Biopsy specimens were also stained for detection of immunoglobulins, complement and fibrinogen deposits. The data demonstrate a lymphocytes/macrophages interaction in the central core of granulomatous areas as the crucial event that initiates the maintains the state of inflammation: at all sites of disease activity is present a compartmentalization of T-cells expressing a helper-related phenotype which account for the great majority of infiltrating cells both in the early lesions (aggregate of macrophages surrounded by lymphocytic infiltrate) and in well-organized sarcoid granulomata. The presence of plasma cells and immunoglobulin deposits may represent an epiphenomenon in line with the helper infiltration, suggesting a local hyper-reactivity of the B-cells immune system. This study suggests some immunopathogenetic mechanisms leading to the formation and growth of conjunctival sarcoid granulomata.     

Clinical History, Skin Prick Test and RAST in the Diagnosis of Birch and Timothy Pollinosis

The diagnostic efficacy of clinical history (CH), skin prick test (SPT) and RAST was estimated in relation to nasal and conjunctival provocation tests (NPT, CPT) in 69 patients with seasonal rhinoconjunctivitis. The extracts used were freeze-dried, and biologically standardized birch and timothy allergen preparations matched to the extracts on Phadebas RAST discs. Based on single determinations the sensitivity, specificity and predictive values were calculated. There were highly significant (P less than 0.001) correlations between all parameters: NPT, CPT, CH, SPT and RAST. For birch the combination of SPT and RAST made the PTs superfluous as both sensitivity and specificity then reached 100%. With timothy the sensitivity was 97% and with the addition of CH 100%. However, the specificity was only 79% through combining CH, SPT and RAST. The present study using the same standardized allergen preparation in all tests showed a good correlation between indirect test results and provocation tests.     

Protective effect of different doses of terfenadine on the conjunctival provocation test

The protective effect of terfenadine on inOammatory processes following the early phase of conjunctival provocation tests by specific allergen was assessed in 24 patients suffering from seasonal allergic rhinoconjunctivitis, in a single-blind, randomized, placebo-controlled, parallel-group study. Patients were randomly assigned to four treatment groups, each being given terfenadine 60, 120, 180 mg daily, or placebo, respectively, for 7 days, out of the pollen season. Clinical severity (burning, itching, lacrimation and hyperemia), and number of inflammatory cells obtained by conjunctival scraping (neutrophils, eosinophils, lymphocytes, and monocytes) were evaluated before and after treatment. Pre-treatment with terfenadine resulted in a significantly higher allergen threshold dose than placebo (p<0.01), regardless of drug dose. Patients given terfenadine experienced a significant reduction (p<0.03) in conjunctival symptom severity, as compared with placebo, following conjunctival challenge. Accordingly, the number of inflammatory cells in terfenadine-treated patients was significantly lower (p<0.01) than in the placebo-treated after the conjunctival provocation test. The results of this study suggest that terfenadine has a significant protective effect on the early-phase cellular and clinical events of conjunctival reaction induced by allergen challenge in atopic patients.     

Do skin prick and conjunctival provocation tests predict symptom severity in seasonal allergic rhinoconjunctivitis?

BACKGROUND: In the investigation of seasonal allergic rhinoconjunctivitis (SAR), quantitative skin and conjunctival allergen challenge tests are used to measure individual allergen sensitivity. These tests are reproducible and relate well to prevalence but their relationship to symptom severity is less well established. OBJECTIVE: We wished to determine if quantitative skin prick tests (QSPT) and conjunctival provocation tests (CPTs) using a single grass pollen allergen extract are reproducible and predict symptom severity in SAR. METHODS: We retrospectively analysed data from 91 participants in a previously published randomized placebo controlled study of low dosage allergen immunotherapy who were randomized to receive placebo treatment. We examined the relationship between pre-seasonal QSPT, CPT and SAR symptoms. RESULTS: We found a high level of reproducibility when repeated measures were compared for both the QSPT (P < 0.001) and the CPT (P < 0.001) and moderate correlation (0.49) between the standard skin prick test (SPT) and the QSPT (P < 0.001). We found weak negative correlation (-0.27) between the QSPT and the CPT (P < 0.001). We found no correlation between seasonal symptom, use of rescue medication or quality of life (QOL) scores and pre-seasonal QSPT or CPT. Conclusion In the assessment of seasonal rhinoconjunctivitis, quantitative skin and conjunctival allergen challenge tests are strongly reproducible, although there is no correlation between these tests and seasonal symptom, use of rescue medication or QOL scores.     

Conjunctival oxygen tension is influenced by plasma and blood volume, and flow through the external carotid artery

An investigation of the feasibility and validity of measurement of the conjunctival oxygen tension as a monitor of peripheral circulation, blood and extracellular fluid volume and cerebral circulation was carried out in 7 healthy volunteers and 5 unconscious critical care patients with proven total cerebral infarction. The healthy volunteers were subjected to changes in hydration achieved by the administration of furosemide and subsequent rehydration by administration of normal saline. Conjunctival oxygen tension was found to be a sensitive indicator of changes in the degree of hydration presumably by its ability to detect changes in peripheral circulation depending upon circulating blood and extracellular fluid volume. A drawback is that other stimuli of the sympatho-adrenergic system such as temperature and pain, interfere with measurement in the conscious volunteer. In patients with presumed total brain infarction the conjunctival PO₂ cannot be used as a reliable monitor of cerebral blood flow because of varying perfusion of the palpebral conjunctiva from the external carotid artery in the occasional patient.