目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty, EK)手术的护理配合。方法：对19例(19只眼)飞秒激光辅助的EK手术进行术前访视，充分的术前准备，各种仪器调试及器械的准 备，术中熟悉手术过程，指导患者配合手术并密切配合医生，做好患者术中、术后的体位管理，仪器及器械的处理。结果：19例手术均顺利完成，术中无意外发生，患者积极配合，术后视力89.5%(17/19)明显提高，眼部刺激症状消失，植片角膜内皮细胞数丢失不多。结论：飞秒激光辅助EK作为一种全新的手术技术，完善的术前准备，密切的手术配合，特殊体位护理是保证手术成功的关键。
Objective: To investigate nursing and cooperation of femtosecond laser-assisted endothelial keratoplasty (EK). Methods: Preoperative visit and adequate preoperative preparation were proceeded in 19 patients (19 eyes) underwent femtosecond laser-assisted EK, instrument commissioning and equipment preparation were performed before the surgery. We mastered the surgical procedures, guided patients for cooperating the operation, and cooperated closely with surgeon during operation. Management of intraoperative and postoperative body position were accomplished, instruments and equipment were well processed aff er operation. Results: All of the 19 cases were successfully completed without intraoperative accident, all of the patients cooperated actively. Postoperative visual acuities in 89.5% (17/19) of the patients were improved significantly, ocular irritation symptoms were disappeared, and corneal endothelial cells of the grafts were decreased slightly. Conclusion: Femtosecond laserassisted EK is a brand new surgical technology, perfect preoperative preparation, intimate operative cooperation, and management of special body position are essential for a successful operation.
目的：观察和分析儿童眼科门诊就诊的屈光不正 3～7 岁患儿，有早产史和足月产史的患儿的屈光不正的特点和差异。
方法：屈光不正 179 例（358 眼），分为 2 组：早产史者 51 人，足月产者 128 人。1％阿托品眼膏散瞳进行视网膜带状光剪影验光。
结果：足月儿的屈光不正患儿中，以远视多见，占 157／256 眼（61.3％），对比有早产儿屈光不正的远视发病 25／102（24.5％），差异有统计学意义（P < 0.05）。有早产儿屈光不正中，以散光发病为主，占 81／102 眼（79.4％），尤以高度散光、混合散光多见，相对与足月儿，其散光发病，高度散光发病和混合散光发病眼数的差异均有显著性（P < 0.05）。
结论：散光，尤其是高度散光、复杂的混合散光是有早产儿童视力低下的重要原因。临床上散光与弱视的形成关系密切相关，因此不能忽略早产儿童视力发育，最早可提前到 2 岁即可进行屈光筛查。
Purpose: To observe the abnormal refractive state and clinical characteristics in preterm and full-term children of the Department of Pediatric Ophthalmology.
Methods: The ocular refraction status of 358 eyes in 51 preterm and 128 full-term children were checked by retinoscopy in dilated pupil after being used atropine eye drops.
Results: There were 157 eyes with hyperopia accounting for 61.3% in preterm children, and 25 eyes with hyperopia accounting for 24.5% in full-term children. The main type of refractive errors in preterm children is astigmatism, especially in high astigmatism and mixed astigmatism. The morbidity of astigmatism, hyper astigmatism, and mixed astigmatism in preterm children is higher than that in full-term children.
Conclusion: Astigmatism, especially high astigmatism and complex mixed astigmatism, are important reasons for low vision in preterm children. Clinically, there is a close relationship between astigmatism and amblyopia. Therefore, the visual development of preterm children should not be ignored, and refractive screening could be brought forward to two years old.
Two patients aged of 30 and 22 (female in cases 1, and male in case 2) both complained of unilateral blurring of vision and scotoma within a week of being diagnosed with dengue fever. No other abnormal findings were found in their anterior segment. Retinal examination revealed blurring of the optic disc margin and several white spots in the posterior in both cases. Optical coherence tomography (OCT) imagery revealed that the white spots were only located in the retinal outer layers. Macular cystic foveolitis were also found in case 1 and diff used macular edema in case 2. In case 1, visual and retinal recovery were seen to resolve spontaneously. In case 2, patient had complete visual recovery two months after onset of the disease after being treated with steroids but central scotomata has continued to persist.
Two patients aged of 30 and 22 (female in cases 1, and male in case 2) both complained of unilateral blurring of vision and scotoma within a week of being diagnosed with dengue fever. No other abnormal findings were found in their anterior segment. Retinal examination revealed blurring of the optic disc margin and several white spots in the posterior in both cases. Optical coherence tomography (OCT) imagery revealed that the white spots were only located in the retinal outer layers. Macular cystic foveolitis were also found in case 1 and diff used macular edema in case 2. In case 1, visual and retinal recovery were seen to resolve spontaneously. In case 2, patient had complete visual recovery two months after onset of the disease after being treated with steroids but central scotomata has continued to persist.
目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。
目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。
目的：观察羊膜移植手术对于减少碱烧伤后角膜新生血管的疗效。
方法：回顾性病例对照研究。2006－2010 年期间该院收治的 Ⅲ 度角膜碱烧伤的患者 19 例 23 眼，其中行羊膜移植术（治疗组）11 例 13 眼，未行羊膜移植术（对照组）8 例 10 眼。该两组的年龄和手术外的处理基本匹配。伤后 3 d 治疗组行羊膜移植术。分别在伤后 14、60 d 测量各组角膜新生血管面积。应用 SPSS 12.0 统计学软件将此两组的面积进行配对 t 检验，以 P < 0.05 作为差异有统计学意义。
结果：在烧伤后 14 d 治疗组新生血管面积（62.133 ± 8.571）mm2，明显低于对照组（89.561 ± 9.741）mm2，治疗组较对照组减低 30.6%，两组差异具有统计学意义（P < 0.05）。烧伤后 60 d 治疗组新生血管面积（112.019 ± 17.362）mm2，明显低于对照组（129.481 ± 13.534）mm2，治疗组较对照组减低 13.5%，两组差异具有统计学意义（P < 0.05）。
结论：羊膜移植术能明显抑制碱烧伤所致角膜新生血管的生长。
Purpose: To study the curative effect of amnion membrane transplantation on decreasing corneal neovascularization (CNV) induced by alkali burn.
Methods: It was a non-randomized retrospective case-control study. Among 19 cases (23 eyes) of third-degree alkali burns from 2006 to 2010, 11 cases (13 eyes) were performed with amnion membrane transplantation operation, and others were not. Amnion membrane transplantation was performed at the 3rd day after burn in the treatment group. Ages and treatments beyond surgery of double groups were matched. Areas of CNV in double groups were measured at the 14th day and 60th day after burn.
Results: Area of CNV in the treatment group was (62.133 ± 8.571) mm2 at the 14th day after burn, and was 30.6% lower than that in the control group. Area of CNV in the treatment group was (112.019 ± 17.362) mm2 at the 60th day after burn, and was 13.5% lower than that in the control group. There was statistical significance (P < 0.05).
Conclusion: Amnion membrane transplantation operation can inhibit the growth of corneal neovascularization induced by alkali burn.
目的：制作兔糖皮质激素性青光眼动物模型，观察小梁细胞超微结构的改变，探讨激素性青光眼房水排出阻力增加的机制。
方法：40 只新西兰大白兔，随机分为 4 组，正常对照组（10 只）、单独滴地塞米松组（10 只）、单独注射曲安奈得组（10 只）和联合用药组（10 只）。实验前连续 3 天于每日 8、10 和 12 am 用 Schitoz's 眼压计测量眼压后取平均值，最后取得兔基础眼压值。实验正式开始后，正常对照组用无菌生理盐水滴兔双眼，每日 3 次；单独滴地塞米松组用 0.5％地塞米松磷酸钠溶液滴兔双眼，每日 3 次，持续 8 周；单独注射曲安奈得组每周球结膜下注射曲安奈得 1 次（3 mg），持续 8 周；联合用药组用 0.5％地塞米松磷酸钠溶液滴兔双眼，每日 3 次，持续 8 周，每周球结膜下注射曲安奈得 1 次（3 mg）。用药开始后，第 4 天开始每 7 日用 Schitoz's 眼压计监测一日 4 组眼压（分别于 8、10 和 12 am 测一次眼压后取平均值），将眼内压 ≥ 21.975 mmHg（1 mmHg = 0.133 kPa）并持续 1 周者纳入诱发成功模型。8 周后取四组兔双眼标本，做成电镜超薄切片用于电镜研究。
结果：1. 兔基础眼压为（18.082 ± 2.398）mmHg（n＝80），联合用药组兔 2～3 周眼压开始升高，第 3 周时升高到（24.065 ± 1.245）mmHg，P ＜ 0.05，具有统计学意义，随后眼压逐渐升高，第 6 周达到峰值，眼压升高到（30.214 ± 0.766）mmHg，第 8 周兔眼压为（29.144 ± 0.685）mmHg，P ＜ 0.05。联合用药组兔 20 只眼 16 只眼压升高，眼压升高率为 80％。正常对照组兔眼压（18.254 ± 3.465）mmHg无升高。其余两组兔眼压虽有所升高，但升高不稳定，持续时间小于 1 周，未达到高眼压模型标准。2. 联合用药组兔小梁细胞核异形性增大，细胞间质微丝微管结构增多，胞浆空泡变性，粗面内质网扩张，以及细胞间无定形物质增多。
结论：1. 联合用药组成功地建立了兔糖皮质激素性高眼压模型，其余 3 组未能成功建立兔糖皮质激素性高眼压模型。2. 电镜下观察到的细胞骨架所发生一系列改变，是糖皮质激素诱导眼压升高的重要环节。
Purpose: Steroid-induced glaucoma in rabbit ocular was established to observe the ultrastructural changes in trabecular meshwork, and to preliminarily study the mechanisms of increased resistance of aqueous outflow in steroid-induced glaucoma.
Methods: Forty New Zealand white rabbits were randomly divided into four groups, namely, control group (n = 10), drops drug group (n = 10), injecting drug group (n = 10), and drug combination group (n = 10). For three consecutive days before the experiment, using the Schitoz's tonometer to measure intraocular pressure (IOP) at 8 am, 10 am, and 12 am each day, for the average value, finally obtained these rabbits' basis IOP. The drug combination group of rabbit eyes were treated with dexamethasone sodium phosphate solution (0.5%) for 8 weeks, three times a day, and injected triamcinolone acetonide (3 mg) weekly. While the control group of rabbit eyes were treated with sterile saline in the same period of experiment. After 4 days, the IOP of rabbit was measured by Schitoz's tonometer weekly (got the IOP at 8 am, 10 am, and 12 am each day, then taken after the average value). The rabbit with IOP more than 21.97 mmHg and continued for one week was regarded as a successful animal model as corticosteroid. After 8 weeks, the eyes of control group and corticosteroid rabbits were made for transmission electron microscopy (TEM) specimen to study the ultrastructure of trabecular meshwork cell.
Results: 1. The rabbit-based IOP was (18.082 ± 2.398) mmHg (n = 80) in the drug combination group. The IOP of rabbit was up to (24.056 ± 1.245) mmHg after three weeks, which was significantly higher than that of (18.254 ± 3.465) mmHg in the control group, the difference was significant (P < 0.05). After six weeks, which reached the peak, up to (30.214 ± 0.766) mmHg, in the eighth week, up to (29.144 ± 0.685) mmHg. The IOP of 16 rabbit eyes from 20 rabbit eyes in the experimental group increased. The positive rate was 80%. 2. After treatment with dexamethasone, the abnormality of nucleus of the trabecular meshwork cell increased, microfilament and microtubules among interstitial cells also increased, cytoplasmic vacuolation, rough endoplasmic reticulum expansion, as well as an increase in intercellular amorphous material.
Conclusion: 1. Successfully established the model which was glucocorticoid-induced high intraocular pressure in rabbits. 2. Under the transmission electron microscopy observation, a series of changes in the cytoskeleton is an important part of glucocorticoid-induced elevation of IOP.
目的：探讨数字化裂隙灯显微镜作为一种定量分析的工具应用于一维尺寸测量的可靠性。
方法：3 位观察者采用单盲法，分别在 4 倍、10 倍、16 倍、25 倍、40 倍和 4 倍、10 倍、16 倍的物镜放大率下，对游标卡尺上模拟人眼的瞳孔和角膜直径的 4.00 mm 和 10.00 mm 间距，使用国产数字化裂隙灯显微镜进行图像采集和重复测量，对测量结果的正确度和精密度进行比较。
结果：3 位测量者（A、B、C）对 4.00 mm 尺寸的图像进行测量，所测结果均数位于 3.98～4.06 之间。对 10.00 mm 的图像进行测量，所测结果均数位于 10.00～10.04 之间。4.00 mm 测量结果显示，除测量者 A 4 倍、测量者 B 25 倍、测量者 C 16 倍和 25 倍外，测量值与真实值的差异具有统计学意义。10.00 mm 测量结果显示，除测量者 A 10 倍外，测量值与真实值的差异具有统计学意义。比较同一测量者对同一尺寸在不同放大倍率的测量结果，除测量者 A 对 10.00 mm 尺寸的测量无统计学差异外，其余测量结果之间在不同放大倍率下对相同尺寸测量的结果均具有统计学差异。不同测量者对相同物镜放大倍率下的同一尺寸比较，除在 4 倍放大率下对 4.00 mm 测量的结果无统计学差异外，其余测量结果之间的差异均具有统计学意义。所有测量结果的变异系数均低于 5%；随放大倍率的增加，变异系数有降低的趋势。
结论：数字化裂隙灯显微镜作为一种一维尺寸测量工具，具有良好的精密度，在利用其做定量分析前进行测量的可靠性分析有助于减少系统误差对测量结果分析的干扰。
Purpose: To study the reliability in one dimensional size measurement with digital slit lamp microscope as a tool for quantitative analysis.
Methods: Three single-blinded observers acquired and repeatedly measured the images of 4.00 mm and 10.00 mm size on the vernier caliper, which simulated the human eye pupil and cornea diameter, with home-made digital slit lamp microscope, respectively, in the objective magnification of 4 times, 10 times, 16 times, 25 times, 40 times and 4 times, 10 times, 16 times. The correctness and precision of measurement were compared.
Results: Measurements were conducted on the 4.00 mm image size by three investigators and all averages were located between 3.98 to 4.06, and for the 10.00 mm image size, between 10.00 to 10.04. Measurement results of 4.00 mm showed that, except for A4, B25, C16 and C25, the difference of the measured value and the true value was statistically significant. The measurement results of 10.00 mm showed that, except for A10, the difference of the measured value and the true value was statistically significant. Comparison of the same size, the same investigators at different magnification measurements, except for investigator A's measurements of 10.00 mm dimensions, had no significant difference; the others were all statistically significant. Compared the measurements of the same size with different magnification, except for measurements of 4.00 mm in 4-fold magnification, which had no significant difference among the investigators, the remaining different results were statistically significant. The coefficient of variation of all measurement results was less than 5%; as magnification increased, the coefficient of variation decreased.
Conclusion: The measurement of digital slit lamp microscope in one-dimensional size, with good reliability, should be used for analysis reliability before being used in quantitative analysis.
