目的:探讨垂体腺瘤对眼视功能损害的临床表现。方法:对 126 例( 252 只眼)垂体腺瘤患者进行视力、视野、荧光眼底血管造影(Fundus fuorescein angiography, FFA)、图形视诱发电位(Pattem visual evoked potential, PVEP)及眼底检査。结果:视力下降 186 只眼,占73.8%。眼底原发性视神经萎缩 130 只眼,占51.6%。视野缺损 156 只眼,占69.6%。PVEP异常 160 只眼,占88.9%。26.2%的患者以眼部异常为首诊症状,其中16.7%曾被诊断为眼科疾病。结论:垂体腺瘤可引起视功能的损害,充分认识垂体腺瘤在眼部的临床特点,有助于早期诊断及时治疗。
Purpose : To investigate the clinical manifestation of damage of visual function causedby pituitary adenoma.Methods: Visual acuity, visual field, fundus fluorescein angiography (FFA), pattemvisual evoked potential (PVEP) and examination fundus were performed in 126 cases(252 eyes)of pituitary tumor.Results :There was 73.8% (186 eyes) of patients with decreased visual acuity, 51.6%(130 eyes) with primary optic atrophy, 69.6 %(156 eyes) with the defects of visualfield and 88.9%(160 eyes) with abnormal PVEP. Abnormal ophalmological manifestationwas the first diagnostic symptom in 26.2%, and 16.7% was misdiagnosed as eye diseases.Conclusions: Pituitary tumor could cause defection of visual function. lt is helpful toearly diagnosis and timely treatment by fully understanding clinical features in the eyewith pituitary tumor.
前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。
前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。
青光眼是一组以病理性眼压升高为主要危险因素的，以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术，其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成，并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛，早期主要用于各类难治性青光眼患者，特别是晚期及绝对期患者，研究者发现其除降眼压外，还能够显著缓解该类患者的局部疼痛。近年来，UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中，也表现出了良好的降眼压效果，同时显示出较少的并发症和较轻的术后反应，并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异，且为达最佳治疗效果，其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法，测算精度并不适用于国人，然而精准度更高的模型法，其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量，但术后用药策略的调整仍可能导致眼压波动。综上，针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等，仍有待开展相关临床研究，以期为其临床应用提供更加可靠的依据。
青光眼是一组以病理性眼压升高为主要危险因素的，以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术，其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成，并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛，早期主要用于各类难治性青光眼患者，特别是晚期及绝对期患者，研究者发现其除降眼压外，还能够显著缓解该类患者的局部疼痛。近年来，UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中，也表现出了良好的降眼压效果，同时显示出较少的并发症和较轻的术后反应，并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异，且为达最佳治疗效果，其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法，测算精度并不适用于国人，然而精准度更高的模型法，其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量，但术后用药策略的调整仍可能导致眼压波动。综上，针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等，仍有待开展相关临床研究，以期为其临床应用提供更加可靠的依据。
目 的: 比 较 不 同 能 量 氪 离 子 黄 绿 光 联 合 Nd ∶YAG 激 光 行 周 边 虹 膜 切 开 术 的 临 床 疗 效 和 对 眼压、血- 房 水 屏 障 的 影 响。方 法: 使 用 激 光 蛋 白 细 胞 仪 及 压 平 式 眼 压 计 对 31 例(62 只 眼) 接 受 高 能 量 组 700 mW, 低 能量 组 400 mW的 氪 离 子 联 合 Nd: YAG 激 光 行 周 边 虹 膜 切 除 术 前、术 后 的 房 水 蛋 白 浓 度、前 房细 胞 数 和 眼 压 进 行 比 较。术 后 随 访 1 个 月。结 果: 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅 无 闭 合, 无 角 膜 损 伤 及 晶 体 混 浊。 术 前 和 术 后1 h、3 d、7 d 及 1 个月的平均 Goldmann 眼压值在高能量组分别为 ( 15.68±2.41) 、(27.13±3.48) 、(20.97±5.27) 、(16.35±1.14) 、(15.06±2.02) , 在 低 能 量 组 分 别 为( 15.35±1.78) 、(22.77±3.26) 、(16.26±2.41) 、(15.68±2.06) 、( 15.06±1.36) 。术 前 和 术 后 3 d、7 d 及 1 个 月 的 平 均 房 水 闪 光 值在 高 能 量 组 分 别 为( 4.65±1.50) 、(10.41±2.47) 、(7.31±2.31) 、(6.15±2.16) , 在 低 能 量 组 分 别 为(4.45±1.19) 、(6.47±1.11) 、(4.81±0.55) 、(4.98±1.48) pc/ms; 前 房 细 胞 数 平 均 值 在 高 能 量 组 分别 为( 0.47±0.42) 、( 36.22±9.16) 、(18.54±3.60) 、( 6.29±0.98) , 在 低 能 量 组 分 别 为(0.58±0.52) 、(24.73±6.09) 、(10.61±1.70) 、(2.96±1.35) 。高 能 量 组 术 后 1 h 及 第 3 天 眼 压 的 升 高 幅 度 较 低能 量 组 高, 术 后 各 点 的 房 水 闪 光 值 和 前 房 细 胞 数 升 高 幅 度 均 较 低 能 量 组 明 显, 术 后 1 个 月 两组 前 房 细 胞 数 及 高 能 量 组 房 水 闪 光 值 仍 未 能 降 至 术 前 水 平, 差 异 有 显 著 性 意 义( P < 0.05) 。结 论: 低 能 量 与 高 能 量 氪 黄 绿 激 光 联 合 Nd ∶YAG 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅, 临 床效 果 相 同; 低 能 量 组 术 后 一 过 性 眼 压 升 高 恢 复 至 正 常 较 快, 前 房 蛋 白 较 快 恢 复 正 常。提 示 在 进行 激 光 周 边 虹 膜 切 开 术 时 应 尽 可 能 用 低 能 量。两 组 术 后 1 个 月 前 房 仍 有 细 胞, 应 继 续 随 访。
Purpose: To compare the influence of krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy (LPI) on the intraocular pressure, blood-aqueous barrier and inflammatory of anterior chamber as well as the therapeutic effect.Methods: Using a laser flare cell meter and Goldmann tonometer, the level of aqueous protein, the number of cells in the anterior chamber and intraocular pressure of 31 patients (62 eyes) who underwent krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy were examined and recorded preoperatively and postoperatively.Results: The mean preoperative and 1-hour, 3-day, 7-day, 1-month postoperative intraocular pressure ( IOP) of the high power-density group were (15.68±2.41) , (27.13 ±3.48) , (20.97 ±5.27) , (16.35 ±1.14) and (15.06 ±2.02) mmHg, while those of the low were (15.35±1.78) , (22.77±3.26) , (16.26±2.41) , (15.68±2.06) and (15.06±1.36) mmHg. The mean preoperative and 3-day, 7-day, 1-month postoperative flare intensity of the high power-density group were (4.65±1.50) , (10.41±2.47) , (7.31±2.31) and (6.15±2.16) pc /ms, while those of the low were (4.45±1.19) , (6.47±1.11) , (4.81±0.55) and (4.98±1.48) pc/ms. The number of aqueous cells of the high was (0.47±0.42) , (36.22±9.16) , ( 18.54±3.60) and (6.29±0.98) , while that of the low was (0.58±0.52) , (24.73±6.09) , (10.61±1.70) and (2.96±1.35) . The mean 1-hour and 3-day postoperative IOP of the high was higher than that of the low. Both the mean flare intensity and the mean number of aqueous cells of the high power-density group were higher than those of the low. The differences were of statistical significance (P <0.05) . The mean flare intensity of the high power-density group in the 1-month postoperative follow-up was still higher than the baseline. The mean number of aqueous cells of both the high and the low power-density groups in the 1- month postoperative follow-up was still higher than the baseline. During 1-month follow-up, no obvious visual damage, diffuse corneal endothelial burns or corneal decompensation, lens injury and closure of the peripheral iris incision were observed.Conclusion: When krypton laser combined with Nd: YAG laser peripheral iridotomy is under consideration, relatively low power-density krypton laser is recommended because it can achieve the similar therapeutic effects as high power-density krypton laser but leads to less complications and a briefer recovery. More follow-ups are needed after LPI, because the number of aqueous cells in 1-month follow-up was still abnormal.
玻璃体淀粉样变性是一种罕见的眼病, 可独立发病, 也可以表现为系统性淀粉样变性的眼部受累, 常有家族史。报道 1 例遗传性玻璃体淀粉样变性患者, 中年发病, 双眼先后受累,有明确的家族史。双眼均行玻璃体切除术。术后病理检查结果显示: 玻璃体呈刚果红染色阳性, 电镜下发现纤维丝状物。对患者外周血进行 DNA 抽提, PCR 扩增, 克隆、筛选及测序等一系列基因检测, 发现转甲蛋白(Transthyretin, TTR) 存在着基因突变, 突变点 Gly83Arg, 这可能是玻璃体淀粉样变性发病的一个新的突变位点。
Vitreous amyloidosis is a rare condition that mainly occurs in Familial Amyloidotic Polyneuropathy (FAP). In some cases, it may be the only symptom without systemic disorders. One case of familial vitreous amyloidosis was reported here, with white, wispy opacities in vitreous cavity in both eyes. Pars plana vitrectomy and histopathological examination of the vitreous specimens were performed. The vitreous specimens showed typical microscopic features of amyloidosis with Congo red stain and non-branching fibrils on a transmission electron microscope. Transthyretin (TTR) gene was amplified with DNA isolated from the peripheral blood cells. Bi-directional sequencing of exon 3 showed a single base-pair substitution, which results in an amino acid substitution at position83, glycine to arginine (TTR Arg-83) . TTR Arg-83 may be a new pathologic mutation in vitreous amyloidosis.
目的: 研究 TGF-β1 短期眼部应用对兔角膜碱烧伤后整合素 β1 表达和角膜上皮愈合的影响,探求其对角膜碱烧伤的治疗作用。方法: 制备大耳白家兔角膜碱烧伤模型, 一组给予 TGF-β1 (浓度为 200 ng /ml) 局部滴眼, 每日 3 次, 连续 7 日; 另一组给予 PBS 溶液代替, 处理相同。于角膜碱烧伤后每日观察角膜上皮愈合面积, 并于烧伤后 6 h、1 d、3 d、7 d 和 14 d 5 个时间点应用免疫组化方法检测 TGF-β1 实验组与 PBS 组角膜整合素 β1 表达情况。结果: 烧伤后 4 d、10 d、11 d、12 d 和 14 d 实验组和对照组上皮愈合率比较, 差异有统计学意义(P < 0.05) , 两组随着上皮修复过程的进行, 整合素 β1 的表达均逐渐增加, 烧伤后 7 d、14 d两个时间点实验组和对照组整合素 β1 平均灰度值比较, 差异有显著性(P < 0.05) 。结论: TGF-β1 在活体实验中能促进整合素 β1 的表达, 而后者的增加可以促进角膜上皮细胞向损伤区域的移行和粘附, 从而减少碱烧伤愈合过程中上皮再次脱落现象, 有利于创伤愈合。
Purpose: To observe the effect of TGF-β1 applied topically to the alkali-injured rabbit eye on corneal epithelial wound healing and expression of integrin β1 and its therapeutic action on corneal alkali burns.
Methods: Alkali burn was produced in 60 corneas from 30 rabbits. Two groups were randomly divided. One group was treated with TGF-β1 solution (200 ng /ml) topically 3 times one day within the first 7 days, the other group was treated with phosphate-buffered saline (PBS) solution. The injured eyes were photographed after the fluorescence staining with a digital camera and the pictures were analyzed with computer-aided picture analysis system to calculate the rate of corneal epithelial healing. The expression of integrin β1 was investigated in the point 6 h, 1 d, 3 d, 7 d, 14 d after the injury by means of immunohistochemical analysis.
Results: On the 4th, 10th, 11st, 12nd and 14th days after the burning, the rate of corneal epithelial healing of TGF-β1 groups was markedly higher than that of the PBS group (P < 0.05) . The expression of integrin β1 in the cornea epithelial cells gradually increased during the wound healing. On the 7th and 14th days after the burning, the expression of integrin β1 in the cornea epithelial cells of TGF-β1 group was remarkably higher than that of the PBS group(P < 0.05) .Conclusions: TGF-β1 could up-regulate integrin β1 in vivo corneal alkali burn model, which could stimulate the cornea epithelial cells to migrate and adhere to the cornea stroma, that can reduce the cases of the epithelial cells_detachment from the cornea stroma and sustain the corneal reepithelization.
目的: 探讨 ETDRS 对数视力表对儿童视力检查的可重复性及其影响的相关因素。方法: 在流行病学调查的过程中, 随机使用 ETDRS 对数视力表, 为 250 位裸眼视力低于 0.5 和 98 位视力正常儿童进行裸眼视力重复检查。
结果: 两次视力测量之间差异的均数为0.004log±0.07; Kappa 分析结果具有很好的一致性(k = 0.71) ; 性别与视力检查一致性无明显相关(P = 0.845) ; 年龄与视力检查一致性有显著相关性(P = 0.019) , 年龄越小视力检查一致性越差; 屈光不正与视力检查一致性也有显著相关性(P = 0.000) , 近视度数在- 1.00D～- 5.00D 之间的儿童视力检查一致性相对差, 而正视眼的视力检查一致性较好。结论: 结果提示 ETDRS 对数视力表适合儿童视力检查, 建议推广使用。
Purpose: To evaluate repeatability of the ETDRS log MAR visual acuity measurementin children and the relative influence factors.Methods: The children (n = 348) with visual acuity less than 0.5 ( equal to 0.3 logunit) in either eye,or one tenth in children with normal visual acuity were chosen todo repeatable uncorrected VA measurement with Bland-Altman analysis and Kappa analysis using ETDRS acuity chart.Results: The mean difference of visual acuity was 0.004log±0.07. There was a significant repeatability (k = 0.71) between two visual acuity examination. There were significant consistent results both on male and female patients (P = 0.845) . A significant relationship was found between age and VA repeatability(P = 0.019) . The VA repeatability could also be influenced by refractive error (P = 0.000) . The acuity measurement in children with emmetropia (k = 0.82) had a higher repeatability than in the children with myopia (k = 0.66) .Conclusions: The ETDRS visual acuity chart can provide a repeatable measure of visual acuity in children. It is recommended for clinic examination of children.
目的:探讨碱性成纤维细胞生长因子(Basic fibroblast growthfacfor, bFCF)，表皮细胞生长因子(Epidermal growth factor, EGF)和神经细胞生长因子(Nerve growth factor, NGF)对体外培养的人角膜内皮细胞的生长调控作用。方法:将相同数量的人角膜内皮细胞接种于96孔板。加人浓度分别为0 ng/ml、1 ng/ml、3 ng/ml、10 ng/ml、30 ng/ml、100 ng/ml的 EGF、bFGF 和 NGF 进行培养。5 天后 MTT法用检测增殖情况。
结果:在0 ng/ml、1 ng/ml、3 ng/ml、10 ng/ml、30 ng/ml、100 ng/ml 浓度下 bFGF 组的平均 OD 值分别为： 0.224±0.045、0.239±0.040、0.262±0.0342、0.278±0.0319、0.281±0.0324、0.260±0.0310 EGF组的平均 0D 值分别为: 0.228±0.0304、0.245±0.0418、0.267±0.0454、0.275±0.0347、0.271±0.0449、0.250±0.0253。NGF 组的平均 OD 值分别为：0.216±0.0187、0.228±0.0226、0.231±0.0225、0.242±0.0279、0.245±0.0294、0.247±0.0349。
结论:bFGF在 30 ng/ml范围内对内皮细胞生长有促进作用,并具有剂量依赖性。高于100 ng/ml时促生长作用降低。EGF在10 ng/ml范围内对内皮细胞生长有促进作用，并具有剂量依赖性。高于30 ng/ml 时促生长作用降低。NGF本次实验剂量范围内对角膜内皮细胞生长无明显作用。
Purpose: To investigate effect of bFGF, EGF and NGF on growth of cultured humancorneal endothelial cells.
Methods: Cultured human corneal endothelial cells were seeded into individual wellsof 96-well tissue culture plate with the same culture media containing separately bFCF, EGF or NGF with a serial of concentrations of 0 ng/ml、1 ng/ml 、3 ng/ml、10 ng/ml 、30 ng/ml and 100 ng/ml and then cultured for 5 days. Then MTT method wasused to detect the growth of the cells.
Results: The averaged OD values of the cell wells containing bFCF with a serial of concentrations of 0 ng/ml、1 ng/ml、3 ng/ml、10 ng/ml、30 ng/ml and 100 ng/ml were 0.224±0.045, 0.239±0.040, 0.262±0.0342, 0.278±0.0319, 0.281±0.0324, 0.260±0.0310. The averaged OD values of EGF group and NGF group were separately 0.228±0.0304，0.245±0.0418, 0.267±0.0454, 0.275±0.0347, 0.271±0.0449, 0.250±0.0253 and 0.216±0.0187, 0.228±0.0226, 0.231±0.0225, 0.242±0.0279, 0.245±0.0294，0.247±0.0349.
Conclusion: bGFC can promote the growth of human corneal endothelial cells in adose dependent manner while with concentration lower than 30 ng/ml. bFGF withconcentration that is higher than 100ng/ml will weaken this effect. EGF can alsopromote proliferation of human corneal endothelial cells demonstrating a linear dosedependent effect when its concentration is lower than 10 ng/ml and this effect decreasedwhen its concentration was higher than 30 ng/ml, NGF showed no effect on the growthof human cornea endothelial cells in this study.
