目的：探讨上睑提肌缩短术和额肌肌瓣悬吊术后眼表改变和恢复的差异。

方法：对2007 年1 月至2007 年4 月在中山眼科中心住院的42例(62只眼)先天性上睑下垂患者，按手术方式和术后是否加用局部用药进行随机分组，观测各组术后2 d、5 d、7 d和2周患者泪液的分泌、泪膜破裂时间、结膜充血、角膜荧光染色、睑板腺功能、瞬目次数、上睑睫毛角度和眼睑闭合情况，并分析其观察结果的差异是否有统计学意义。

结果：3名患者(7.1 ％)因需要加用其它促角膜上皮生长的药物而退出本研究，其中1例(2.3 ％)因倒睫刺激角膜上皮水肿缺损需行手术调整，其余所有患者眼表检测项目的结果均显示不同程度地受到了手术影响，但是随着术后炎症的逐渐消退，这些受影响的眼表异常均会逐渐恢复正常。泪膜破裂时间、瞬目次数、眼睑闭合情况的影响在两种术式之间的差异有统计学意义，而在术后是否局部用药之间没有统计学差异；角膜荧光素染色在是否加用局部用药组之间有统计学差异，而不同术式之间没有统计学差异；泪液分泌量、结膜充血、睑板腺功能、睫毛角度则在所有组别之间均没有统计学差异。

结论：两种上睑下垂的矫正术均会引起患者眼表的改变，额肌肌瓣悬吊术对泪膜破裂时间、瞬目次数、眼睑闭合情况影响的程度较大，而局部用药只能改善角膜荧光素染色异常、对其它眼表因素影响不大。上睑睫毛角度异常是引起角膜损害最危险的因素。

Objective : To investigate the difference of ocular surface change and restoration after ex-ternal levator advancement and frontalis suspension.

Methods : Forty-two patients (62 eyes) with congenital ptosis hospitalized in ZhongshanOphthalmic Center from Jaruary to April in 2007 were randomly divided into four groups according to different surgery types and with or without post surgery ophthalmic medica-tion. Sehirmer test, tear film break-up time , conjunctiva congestion , cornea fluorescentpigmentation , tarsal gland function , winking frequency, angle of eyelash and eyelid clo-sure were all observed and statistically analyzed in all groups 2 days , 5 days , 7 days and 2 weeks after surgery.

Results : Except 3 patients needed advanced ophthalmic medicine, one of whom waswith corneal ulceration and needed another surgery, all the others were observed withocular surface items altered in varied degrees and gradually returned to normality as theinflammation caused by surgery recovered. Break-up time , winking frequency and eyelid closure were statistically diferent between the two types of surgery but not betweengroups with and without post surgery ophthalmic medication. Cornea fluorescent pigmen-tation was statistically different between groups with and without post surgery ophthalmicmedication but not between the two types of surgery. The other items did not have statis-tical difference in all groups.

Conclusion : The two types of surgery for ptosis correction could alter the ocular surface ,but frontalis suspension affect tear film break-up time , winking frequency and eyelid clo-sure much more than levator advancement. Ophthalmic medication after the surgerycould only ameliorate cornea fluorescent pigmentation but was not necessarily to restora-tion of normal ocular surface. Abnormality of eyelash angle was the most dangerous fac-tor to the corea injury.

目的: 测量单眼挫伤患者瞳孔对光反射的改变, 分析瞳孔对光反射与眼挫伤后其他视功能评价方法的相关性。

方法: 使用红外线自动瞳孔仪分别检测 26 例单眼挫伤患者双眼瞳孔对光反射, 并行视力、视野、图形视觉诱发电位等视功能检查。检查的瞳孔对光反射参数包括瞳孔面积, 对光反应潜伏期、反应幅度。

结果: 眼挫伤患者健眼直接、间接反应幅度比与双眼视力差具有显著相关性(r =- 0.648) ; 瞳孔对光反应幅度差、反应幅度比均与视野平均偏差具有显著相关性(r =0.5 和 r =- 0.535) ; 瞳孔对光反应幅度比与双眼视觉诱发电位振幅比具有显著相关性; 多重线性回归分析显示瞳孔对光反应幅度和 VEP 振幅结合可提高预测视力预后的可能性。

结论: 在瞳孔对光反射各参数中, 瞳孔对光反应幅度在反映眼挫伤后视功能改变方面优于其它参数, 眼挫伤患者瞳孔对光反应幅度与视力、视野、VEP 波幅具有中度相关性, 其与 VEP 联合应用可提高眼挫伤后准确预测视功能的可能性。

Subjects and objective: To measure the quantitative pupil light reflex after unilateral ocular contusion, analyze the correlation of pupil light reflex and other tests of visual function.

Methods: The pupil light reflex in 26 patients who suffered unilateral ocular contusion was tested by infrared video pupillography, psychophysical and electrophysiological tests including visual acuity, visual field, and visual evoked potentials were also tested. Pupil area, the latency and amplitude of pupil light reflex were recorded.

Results: The correlation of the ratio of pupil light reflex amplitude and the differences of visual acuity between 2 eyes in 26 contusion patients was statistically significant. The correlation coefficient r was - 0.648. There were significant correlation between amplitude of pupil light reflex and median defect of visual field. The correlation coefficients r were 0.5 and 0.535. The significant correlations were found in the ratio of amplitudes between pupil light reflex and visual evoked potentials. Multiple linear regression analysis showed combining pupil light reflex amplitude and visual evoked potential amplitude could elevate the possibility of predicting visual acuity.

Conclusion: Pupil light reflex amplitude measurement is superior to other pupil measurements for reflection of the changes of visual function after ocular contusion. The correlations of pupil light reflex amplitude and visual acuity, visual field, visual evoked potential are significant in the ocular contusion patient. Pupil light reflex combined with visual evoked potential could elevate the possibility of predicting visual function precisely after ocular contusion.

目的：通过球结膜下注射基质金属蛋白酶(metalloproteinase,MMP)-1、3构建结膜松弛症的动物模型。方法：20只新西兰大白兔随机分为4组：对照组无干预措施；伪造模组球结膜下注射生理盐水；MMP-1组球结膜下注射MMP-1；MMP-3组球结膜下注射MMP-3。8周后观察眼前节照相和眼前节光学相干检查、泪液蕨类试验及结膜组织光镜检查结果。结果：对照组和伪造模组未见结膜皱褶形成，泪液羊齿状结晶样结构完整，光镜下未见胶原和弹力纤维破坏；MMP-1组可见结膜皱褶形成，泪液羊齿状结晶样结构破坏，光镜下见胶原和弹力纤维破坏；MMP-3组未见结膜皱褶形成，泪液羊齿状结晶样结构部分破坏，光镜下见胶原和弹力纤维部分破坏。结论：球结膜下注射MMP-1可构建结膜松弛症1~2级的动物模型。

Objective:To establish an animal model of conjunctivochalasis by subconjunctival injection of matrix metalloproteinase 1 and 3. Methods:New Zealand white rabbits were randomly divided into four groups, the control group had no intervention measures; Pseudo model group was injected susbconjunctival with normal saline; MMP-1 group was injected subconjunctival with matrix metalloproteinase 1; MMP-3 group was injected subconjunctival with matrix metalloproteinase 3. Afer 8 weeks, the results of anterior segment photography and optical coherence test, tear fern test and conjunctival tissue light microscopy were observed. Results:No conjunctival folds were observed in the control group and Pseudo model group, the lacrimal fern-shaped crystalline structures were intact, and no destruction of collagen and elastic fbers was found under the light microscope. In MMP-1 group, conjunctival folds were formed, lacrimal ferns crystalline structures were damaged, and collagen and elastic fbers were damaged under light microscope. No conjunctival folds were found in MMP-3 group, and the lacrimal ferns crystalline structure was partially destroyed, while the collagen and elastic fibers were partially destroyed under light microscope. Conclusion:Subconjunctival injection of matrix metalloproteinase-1 can construct the animal model of conjunctivochalasis of 1-2 grades.