裂孔源性视网膜脱离手术中不放液的选择与疗效分析

目的：探讨视网膜裂孔冷凝、巩膜环扎、外加压、手术中不放液治疗裂孔源性视网膜脱离（ＲＲＤ）的手术适应证及疗效。方法：对７８例（８０眼）ＲＲＤ采用视网膜裂孔冷凝、巩膜环扎、外加压、术中不放液的手术方法,并对治疗结果进行分析。结果：８０眼ＲＲＤ一次手术成功率为９３．８％,视网膜下液（ＳＲＦ）在术后１～２ｄ吸收为５１．３％,３～７ｄ吸收为３５％,术后视力明显提高。结论：ＲＲＤ术中不放液为手术步骤的重要改进。因其可保持眼内液体及眼压相对稳定,手术成功率高,并发症少,适应证可适当放宽。     

视网膜下液生长因子含量与增生性玻璃体视网膜病变关系

目的 探讨生长因子与增生性玻璃体视网膜病变形成和发展的关系。方法 选４１例孔源性视网膜脱离伴ＰＶＲ患者,采用放射免疫方法测其ＴＮＦ,ＦＧＦ,ＴＧＦ－β,ＥＧＦ的含量。结果 ＰＶＲ患者视网膜下液中ＴＮＦ,ＥＧＦ,ＦＧＦ浓度明显高于对照组（Ｐ〈０．０５）。ＴＮＦ,ＥＧＦ,ＦＧＦ浓度Ｃ组高于Ｂ组,Ｂ组高于Ａ组,差异有显著性（Ｐ〈０．０５）。视网膜下液中ＴＮＦ,ＥＧＦ浓度各组高于血浆中ＴＮＦ,ＥＧＦ浓度,     

视网膜下液促使视网膜色素上皮细胞膜上蛋白激酶C变化的机制分析

目的：研究视网膜下液（SRF）能否引起体外培养的视网膜色素上皮（RPE）细胞浆内蛋白激酶C（PKC）的激活和转位，探讨SRF与RPE细胞中PKC信号系统变化的关系。方法：实验对象为体外培养的RPE细胞；不同的刺激因素分别在不同的时间刺激RPE细胞，通过细胞裂解和离心获取细胞浆和细胞膜蛋白粗提液，用同位素^32P标记和液体闪烁计数法检测细胞浆和细胞膜PKC活性水平。结果：SRF和佛波酯（PMA）都可以激活RPE细胞浆中的PKC（c-PKC），并使其由胞浆向胞膜转位，但胞膜上PKC（m-PKC）活性峰值水平和出现的时间不同。结论：SRF可引起RPE细胞膜上PKC的活性发生变化，变化的幅度与增殖性玻璃体视网膜病变（PVR）的分级呈正相关。     

Multimodality imaging in macular telangiectasia 2: A clue to its pathogenesis

Macular telangiectasia type 2 also known as idiopathic perifoveal telangiectasia and juxtafoveolar retinal telangiectasis type 2A is an acquired bilateral neurodegenerative macular disease that manifests itself during the fifth or sixth decades of life. It is characterized by minimal dilatation of the parafoveal capillaries with graying of the retinal area involved, a lack of lipid exudation, right-angled retinal venules, refractile deposits in the superficial retina, hyperplasia of the retinal pigment epithelium, foveal atrophy, and subretinal neovascularization (SRNV). Our understanding of the disease has paralleled advances in multimodality imaging of the fundus. Optical coherence tomography (OCT) images typically demonstrate the presence of intraretinal hyporeflective spaces that are usually not related to retinal thickening or fluorescein leakage. The typical fluorescein angiographic (FA) finding is a deep intraretinal hyperfluorescent staining in the temporal parafoveal area. With time, the staining may involve the whole parafoveal area but does not extend to the center of the fovea. Long-term prognosis for central vision is poor, because of the development of SRNV or macular atrophy. Its pathogenesis remains unclear but multimodality imaging with FA, spectral domain OCT, adaptive optics, confocal blue reflectance and short wave fundus autofluorescence implicate Müller cells and macular pigment. Currently, there is no known treatment for this condition.     

Assessing the risk of epidemic dropsy from black salve use

Epidemic dropsy is a potentially life‐threatening condition resulting from the ingestion of argemone oil derived from the seeds of Argemone mexicana Linn. Exposure to argemone oil is usually inadvertent, arising from mustard cooking oil adulteration. Sanguinarine, an alkaloid present in argemone oil, has been postulated as a causative agent with the severity of epidemic dropsy correlating with plasma sanguinarine levels. Cases of epidemic dropsy have also been reported following the topical application of argemone containing massage oil. Black salve, a topical skin cancer therapy also contains sanguinarine, but at significantly higher concentrations than that reported for contaminated massage oil. Although not reported to date, a theoretical risk therefore exists of black salve inducing epidemic dropsy. This literature review explores the presentation and pathophysiology of epidemic dropsy and assesses the risk of it being induced by black salve.     

绿脓杆菌制剂治疗恶性体腔积液的观察及护理

目的探讨绿脓杆菌制剂治疗恶性体腔积液的护理要点。方法对34例恶性体腔积液患者注射绿脓杆菌制剂全程观察治疗过程并给予相应的护理及心理和饮食指导。结果本组34例恶性体腔积液患者局部应用绿脓杆菌制剂总有效率88.2%,其中恶性胸水有效率89.3%,恶性腹水有效率75%,心包积液有效率100%。结论患者通过严密的病情观察,强化环节护理、心理护理及饮食护理,及时观察、处理毒副反应,才能保证治疗的顺利进行。     

中西医结合治疗肝硬化腹水临床研究

目的:观察利水疏肝化瘀方治疗肝硬化腹水疗效.方法:将56例肝硬化腹水病人随机分为两组,均予西药治疗,治疗组加用丹参注射液及利水疏肝化瘀方治疗.结果:治疗组有效率高于对照组.结论:利水疏肝化瘀方对腹水消退及改善肝功能有利.     

340例白内障术后角膜内皮水肿治疗体会

目的:探讨白内障术后角膜内皮水肿治疗方法。方法:对已经确诊治疗的340例白内障患者的临床资料进行回顾性分析.结果:340例白内障术后角膜内皮水肿经积极治疗后水肿均消退。结论:采用超声乳化术治疗白内障,术后出现角膜内皮水肿术后积极治疗视力提高,安全有效。     

Functional implications of short‐term retinal detachment in porcine eyes: study by multifocal electroretinography

Purpose: The aim of the study was to determine the type and magnitude of detectable changes in pig multifocal electroretinography (mfERG) induced by the vitreoretinal surgical procedures necessary to gain access to the subretinal space. Methods: Twenty pigs underwent posterior segment surgery. Six animals had a vitrectomy (V), six had in addition a retinal bleb detachment (V + B); five had in addition a retinal diathermia on the bleb (V + B + D) and three received a retinotomy in the diathermized retinal area (V + B + D + R). mfERG evaluation was performed at baseline and 1 and 6 weeks postoperatively. Selected eyes were enucleated for histological evaluation. Results: The retinal detachments blebs all reattached spontaneously. All four surgical sequences resulted in slight, non‐significant changes in the mfERG peaks. A trend towards an amplitude reduction of the mfERG peaks N1, P1 and N2 were observed within the first postoperative week. After 6 weeks, all amplitudes had normalized. Of the implicit times only that of peak N1 (after retinal diathermia) was prolonged significantly at 1 week (P = 0.037). However, it returned to the preoperative level after 6 weeks. Histologically, the retinal detachment bleb was characterized by transient double layering of the retinal pigment epithelium (RPE) and loss photoreceptor outer segments. Conclusion: Access to the subretinal space in pigs can be gained without permanent detectable changes in the mfERG. A short‐term retinal detachment was found to cause only reversible electrophysiological and histological changes in the outer retina, which suggests that this procedure is tolerated well in the porcine retina. The size of the known destructive lesion (retinotomy) was too small to be detected, given the spatial resolution of the mfERG method applied. In the future, the presented protocol can be used to assess the functional outcome of surgery and transplantation in the subretinal space in pigs.     

Hemorrhagic Characteristics Associated with the Prognosis of Polypoidal Choroidal Vasculopathy with Subretinal Hemorrhage

Objective: To investigate the hemorrhagic characteristics associated with the treatment prognosis of polypoidal choroidal vasculopathy (PCV) with subretinal hemorrhage. Methods: This was a prospective study. Patients who were included had been diagnosed with naïve PCV from January 2015 to December 2017 in the Eye Hospital, Wenzhou Medical University, and were followed up for at least 3 months after the treatment. The logarithm of the minimum angle of resolution (logMAR) visual acuity during the follow-up after treatment were compared with baseline in different groups: A hemorrhage area of >4 disc area (DA) or less, whether or not there was foveal involvement, and the location of the center of the subretinal hemorrhage based on the Early Treatment Diabetic Retinopathy Study (ETDRS) ring. Data were recorded and analyzed by mixed linear models. Results: One hundred twenty-two patients (124 eyes) were enrolled, including 84 males and 38 females. The mean age was 64.9±9.8 years. Subretinal hemorrhage was presentin 69 eyes (55.6%) at baseline. Among them, a larger hemorrhage area (>4 DA) in 34 eyes (49.3%) showed poorer visual improvement during the follow-up period than a smaller hemorrhage area (≤4 DA) in 35 eyes (50.7%). The fovea was involved in 59 eyes (85.5%) and showed poorer visual improvement during the follow-up than 10 eyes without foveal involvement (F=3.92, P=0.01). Among the 59 eyes with foveal involvement, 25 eyes (42.4%) with the center of the hemorrhage located within ETDRS ring 1 showed poorer visual improvement than eyes with the central hemorrhage ring at 2 or beyond (F=2.23, P=0.05). Conclusion: Large area, foveal involvement, and proximity to the fovea are risk factors for the poor prognosis of PCV with subretinal hemorrhage.