目的:研究增殖性糖尿病视网膜病变患者玻璃体基质细胞衍生因子(Strmalcell-derivedfactor-1, SDF-1)和血管内皮生长因子(Vascular endothelial growth factor, VECF)的浓度,及其相互作用关系。

方法:酶联免疫吸附法(Enzyme-linked immunosorbent assay, ELISA)检测玻璃体内 SDF-1 和 VEGF 的含量,每个标本重复3次。实验组为增性糖尿病视网膜病变(Proliferalive diabeticretinopathy, PDR)的住院患者30例,对照组为同期行玻璃体切除术的特发性黄斑裂孔患者12例。

结果: PDR 患者玻璃体 VECF 的平均浓度为(2865.87+387.85) pg/ml,明显高于特发性黄斑裂孔组[(142.42+21.03) pg/ml，P < 0.0001]。增殖性糖尿病视网膜病变患者玻璃体 SDF-1的含量平均为(298.40+24.57) pg/ml,对照组为(86.91+15.89) pg/ml,两组的差异具有统计学意义(P < 0.0001)。在30例PDR患者玻璃体内 VEGF 和 SDF-1 的含量表现为正相关(Peanson相关系数 r=0.62，P < 0.001)。

结论:增殖性糖尿病患者玻璃体 SDF-1 和 VECF 的含量均高于非糖尿病患者,提示 SDF-1 和 VEGF 共同参与了增殖性糖尿病视网膜病变患者病理性新生血管的形成过程。

Purpose: To investigate the levels of stromal cell-derived factor-1(SDF-1) andvascular endothelial growth factor (VEGF) in the vitreous of patients with proliferativediabetic retinopathy.
Methods: The levels of $DF-1 and VEGF in the vitreous of 30 eyes of 30 patients withproliferative diabetic retinopathy(PDR)and 12 eyes of 12 patients with idiopathicmacular hole (MH) were measured by enzyme-linked immunosorbent assay. Vitreousfluid samples were obtained by vitrectomy.
Resuls: The vitreous concentration of VEGF was signifcantly higher in eyes with PDR(2 865.87+387.85 pg/ml) than in eyes with idiopathic macular hole (142.42+21.03 Pgml, P< 0.000 1). The vitreous level of SDF-1 was also significantly higher in eyes withPDR (298.40+24.57 pg/ml ) than in eyes with idiopathic macular hole (86.91+15.89Pg/ml, P<0.000 1 ). The vitreous concentration of SDF-1 correlated significantly with that of VEGF in eyes with PDR( [correlation coefficient]r=0.62,P<0 .001)
Conclution: Vitreous levels of both SDF-1 and VEGF in patients with PDR aresignificantly higher than those of nondiabetic patients. SDF-1 may be correlated withVEGF in angiogenesis in PDR.

目的：观察 NIDEK EC5000 准分子激光治疗系统准分子激光原位角膜磨镶术(Laser in sitkeratomileusis, LASIK) 角膜切削深度的可预测性。
方法：采用 NIDEK EC5000 准分子激光系统对 79 例近视和(或)近视散光患者进行标准 LASIK 手术，术中使用超声角膜测厚仪分别测量制瓣后和激光切削后的剩余角膜床厚度，计算实际角膜切削深度，比较实际角膜切削深度同理论预测角膜切削深度的差异。
结果：LASIK 术中实际切削深度(92.32±29.86) μm，预测切削深度(74.16±25.95) μm，两者差值(18.16 ± 14.71) μm 有统计学意义(P < 0.001)。实际切削深度与预测切削深度具有较好的相关性，相关系数为0.87 (P < 0.001)，其直线回归方程为Y = 18.06 + 1.001X。按术前角膜 K 值、术前等效球镜绝对值及术前中央角膜厚度值分组的实际切削深度与预测切削深度的差值均有统计学意义。实际切削深度与术前等效球镜有关，与术前中央角膜厚度和 K 值无关。实际切削深度与预测切削深度差值同 K 值、等效球镜，术前中央角膜厚度均无关。
结论：NIDEK EC5000 准分子激光系统 LASIK 术中实际角膜切削深度比预测角膜切削深度高 (18.16±14.71) μm，在手术设计时要考虑实际切削与机器标示值存在偏差，应尽可能多的预留剩余角膜基质床厚度，以提高手术安全性。

Purpose: To assess the predictability of corneal ablation depth in LASIK using NIDEK EC5000 excimer laser.
Method: Standard LASlK surgery was performed in 79 myopic patients with or without astigmatism with the NDEK EC5000 excimer laser system. Ultrasonic cornealpachymetry was performed immediately after flap creation and after laser ablation during LASIK procedure, by which the actual corneal ablation depth was calculated.The values of actual and predicted ablation depth were compared.
Results: The actual ablation depth was (92.32+29.86) μm, the predicted ablationdepth was (74.16+25.95) μm. The differences between them (18.16+14.71) μm were statistically significance (P < 0.001 ). Linear regression suggested that the actual ablation depth correlated closely with the predicted ablation depth (r = 0.87 , P < 0.001 ). The regression model was Y = 18.06+1.001X. The differences remained statistically significant and were independent of the levels of preoperative corneal keratometry, absolute preoperative spherical equivalent and the preoperative central cornea thickness.
Conclusion: The actual ablation depth was about (18.16+14.71) μm thicker than thepredicted ablation depth in the NlDEK EC5000 excimer laser system. We may have totake into account this deviation in order to ensure sufficient thickness of residualstromal bed.

大部分眼科手术/操作具有创伤小、疼痛刺激轻等特点，因此，选择眼表面麻醉即可满足手术的镇痛的需要，促进了眼科日间手术的广泛开展。其中，盐酸奥布卡因滴眼液是常用的眼科表面麻醉剂，具有麻醉起效迅速、镇痛作用强、持续时间久(约13 min)等特点，已经广泛应用在眼内手术中，在使用过程中，盐酸奥布卡因滴眼液对瞳孔及血管无影响，保证了眼内手术的安全。盐酸奥布卡因滴眼液能提供良好的眼表环境，对角膜厚度及角膜上皮厚度影响轻微，从而满足屈光手术的需要。此外，盐酸奥布卡因滴眼液能提供良好的术后镇痛，减少术后镇痛药物的使用，降低斜视术后患儿的躁动发生率。不含防腐剂的表面麻醉剂不影响麻醉剂的起效时间及镇痛效果，对眼表的影响轻微，从而创造良好的手术操作环境，提高手术效果，降低并发症和手术风险，是眼科手术中较为理想的表面麻醉药物。文章就盐酸奥布卡因滴眼液的作用机制及麻醉效果、药代动力学、临床疗效、安全性等进行综述。

Most ophthalmic surgeries are characterized by small incisions and mild pain, therein, the choice of topical anesthesia can meet the needs of surgeries and accelerate ophthalmic surgeries to be conducted in day surgery model. 0.4% oxybuprocaine hydrochloride eye drops is one of commonly used topical anesthetics for ophthalmic surgery, which has the characteristics of rapid onset and sufficient analgesia with long duration (about 13 minutes). Oxybuprocaine hydrochloride eye drops has been widely and safely used in intraocular surgery without affecting the pupil and blood vessels. Meanwhile, oxybuprocaine hydrochloride eye drops has negligible effects on corneal thickness and corneal epithelial thickness to meet the needs of refractive surgery. In addition, oxybuprocaine hydrochloride eye drops can provide sufficient postoperative analgesia, reduce the use of postoperative analgesics and the incidence of emergence agitation in children after strabismus surgery. The preservative-free topical anesthetic would be one of ideal topical anesthetics as it can provide a good surgical condition and reduce complications and risks of post-operative infections without changing the onset time and analgesia effects. This article provides a review of the mechanism, analgesia, pharmacokinetics, clinical efficacy, and safety profiles of 0.4% oxybuprocaine hydrochloride eye drops.

角膜是基因治疗的理想靶器官。角膜碱烧伤、角膜新生血管、角膜移植术后排斥反应因其病理机制复杂，所牵涉的致病因素众多而治疗困难，疗效不佳。本文就基因治疗在上述疾病中的应用加以综述，以了解基因治疗应用于角膜病变的新进展 。

Cornea is an ideal target organ for gene therapy. Corneal alkali burn, cornealneovascularization and corneal graft rejection tend to be with poor treatment elicacydue to its complex pathogenesis. This article aims to update the recent progress of genetherapy on corneal diseases.

       髓上皮瘤是源自神经系统的一种少见的恶性肿瘤，多发生在中枢神经系统和睫状体，而源自视神经的恶性髓上皮瘤则很少见，国内尚未有病例报道。此病早期类似胶质瘤，易造成误诊。本文报道了 1 例 3 岁 10 个月的男性患儿，经部分肿物切除活检发现肿瘤具有典型恶性髓上皮瘤的病理特点， 部分瘤细胞向软骨细胞分化，并逐渐形成透明软骨岛，NSE 及 S-100 表达阳性，病理诊断为源自视神经的畸胎性恶性髓上皮瘤。

       Medulloepithelioma is a clinically uncommon tumor originated from nervous system, often occurred in central nerve system and ciliary body, and malignant medulloepithelioma of the optic nerve is far rarer. So far, there has been no case report in China. It may be clinically misdiagnosed because it resembles glioma at the early stage of the disease. We reported a boy with a tumor in his right eye at age of 3.8 years, which was shown by biopsy of the partial tumor that there were some obviously heteromorphous neoplastic cells, karyokinesis, and moreover, some neoplastic cells differentiatied into cartilage cells, gradually formed into hyaline cartilage islands and the expressions of NSE and S-100 were positive. Teratoid malignant medulloepithelioma of optic nerve was made pathologically.

目的: 报道原发性空泡蝶鞍综合征致双眼视乳头水肿病案 1 例。

方法: 回顾性研究1例原发性空泡蝶鞍综合征致双眼视乳头水肿患者的临床表现、眼底改变、CT 和 MRI 影像学检查的特征、治疗方法及疗效。

结果 : 原发性空泡蝶鞍综合征致双眼视乳头水肿除有典型视乳头水肿的临床表现外，蝶鞍 MRI 亦显示垂体窝呈液型信号、垂体上缘受压凹陷、垂体变薄等典型空泡蝶鞍影像学表现。手术治疗后患者视乳头水肿改善、视力提高。

结论: 蝶鞍 MRI 是诊断原发性空泡蝶鞍综合征的首选影像学检查方法。视力下降明显的患者及时行蝶鞍区手术，术后效果良好。

Purpose:To report a case of papilloedema caused by primary empty sella turcica syndrome.

Methods:Retrospectively review the clinical and physical features, magnetic resonance imaging records and therapies of a patient with papilloedema caused by primary empty sella turcica syndrome.

Results: Except for typical clinical manifestation of papilloedema , a characteristic magnetic resonance imaging (MRI) can be found in a case of papilloedema caused by primary empty sella turcica syndrome. These imaging features are that sella turcica expanded, the inside of sella turcica was filled with cerebrospinal fluid(CSF) signal, pituitary gland was pressed, flatted and near the basis of sella turcica. Papilloedema was relieved and acuity of vision improved after surgery.

Conclusions:MRI is the preferred imaging technique for patient with papilloedema caused by primary empty sella turcica syndrome. If acuity of vision apparentlydecreases,surgery is necessary, and therapeutic effect is excellent.

神经营养性角膜病变是一种与角膜神经退行性改变有关的疾病，角膜神经的知觉和营养功能受损，导致角膜上皮缺损、角膜溃疡甚至角膜穿孔。目前人工泪液、治疗性角膜绷带镜、泪点栓塞、羊膜移植，睑缘缝合等治疗措施仍是治疗神经营养性角膜病变的主要治疗方式，对于轻中度病变患者，具有较好的治疗效果，而对于重度病变患者，药物治疗及简单的手术干预治疗效果不佳，病情反复发作。由于重度神经营养性角膜病变患者的角膜神经完全消失，丧失角膜感觉，对未恢复角膜神经营养功能的角膜白斑或溃疡患者行角膜移植术，可能导致角膜移植术后上皮持续不愈合，因此恢复角膜神经营养功能是复明的重要保障手段。角膜神经移植术是重度神经营养性角膜病变患者恢复角膜神经营养功能，提高角膜知觉，改善角膜透明度的重要和有效的治疗方法。角膜神经移植术通过将具有正常功能的供体神经移植到麻痹眼角膜缘周围，使神经末梢重新长入角膜基质，恢复角膜知觉功能。随着角膜神经移植术的术式的不断改进，其良好的术后效果和优点已经渐渐突显。角膜神经移植术包括直接角膜神经移植和间接角膜神经移植，促使角膜神经重新生长，重建角膜神经的营养和知觉功能。角膜神经移植手术已有40年历史，1981年Samii等首次报告了角膜神经移植术，2009年Terzis等成功地实施了第1例直接角膜神经移植术，2014年Elbaz等进行了第1例以腓肠神经作为间置移植物的间接角膜神经移植。封面展示了神经营养性角膜病变患者未接受治疗前的和接受角膜神经移植术后的眼表角膜图像。由于角膜神经退行性改变，角膜失去神经支配，继而出现角膜上皮缺损，角膜缘新生血管形成，经角膜神经移植后，角膜上皮愈合，角膜透明度改善，同时角膜缘新生血管消退。

神经营养性角膜病变是一种与角膜神经退行性改变有关的疾病，角膜神经的知觉和营养功能受损，导致角膜上皮缺损、角膜溃疡甚至角膜穿孔。目前人工泪液、治疗性角膜绷带镜、泪点栓塞、羊膜移植，睑缘缝合等治疗措施仍是治疗神经营养性角膜病变的主要治疗方式，对于轻中度病变患者，具有较好的治疗效果，而对于重度病变患者，药物治疗及简单的手术干预治疗效果不佳，病情反复发作。由于重度神经营养性角膜病变患者的角膜神经完全消失，丧失角膜感觉，对未恢复角膜神经营养功能的角膜白斑或溃疡患者行角膜移植术，可能导致角膜移植术后上皮持续不愈合，因此恢复角膜神经营养功能是复明的重要保障手段。角膜神经移植术是重度神经营养性角膜病变患者恢复角膜神经营养功能，提高角膜知觉，改善角膜透明度的重要和有效的治疗方法。角膜神经移植术通过将具有正常功能的供体神经移植到麻痹眼角膜缘周围，使神经末梢重新长入角膜基质，恢复角膜知觉功能。随着角膜神经移植术的术式的不断改进，其良好的术后效果和优点已经渐渐突显。角膜神经移植术包括直接角膜神经移植和间接角膜神经移植，促使角膜神经重新生长，重建角膜神经的营养和知觉功能。角膜神经移植手术已有40年历史，1981年Samii等首次报告了角膜神经移植术，2009年Terzis等成功地实施了第1例直接角膜神经移植术，2014年Elbaz等进行了第1例以腓肠神经作为间置移植物的间接角膜神经移植。封面展示了神经营养性角膜病变患者未接受治疗前的和接受角膜神经移植术后的眼表角膜图像。由于角膜神经退行性改变，角膜失去神经支配，继而出现角膜上皮缺损，角膜缘新生血管形成，经角膜神经移植后，角膜上皮愈合，角膜透明度改善，同时角膜缘新生血管消退。

目的:通过观察对金黄色葡萄球菌性角膜溃疡的疗效,筛选克拉霉案眼用凝胶的合适浓度。

方法:角膜实质层接种法建立40只家兔右眼金黄色葡萄球菌性角膜溃疡模型,将模型随机分成5组,每组8只免(8只眼),各组分别给予空白基质、0.1%克拉素眼用凝胶、0.25%克拉霉素眼用凝胶、左氧氟沙星凝胶、0.25%克拉霉素眼用凝胶联合重组牛碱性成纤维细胞生长因子(Recombinant bovine basic fibroblast growth factor, Rb-bFGF)，每天4次，每次2滴，分别在第1、3、5、7、10、14 天观察角膜病变情况及溃疡面积大小。

结果:在相同的给药方法下，0.1%克拉霉素眼用凝胶、0.25%克拉素眼用凝胶、左氧沙星凝胶、0.25%克拉霉素眼用凝胶联合Rb-bFCF均能使金黄色葡萄球菌性角膜溃疡面积缩小角膜病变好转，与空白基质组相比有统计学差异(P < 0.05)：0.25%克拉素眼用凝胶组疗效明显优于0.1%克拉荐素眼用凝胶组(P < 0.05)。

结论:制备的 0.25%克拉霉素眼用凝胶对金黄色葡萄球菌性角膜溃疡疗效肯定，可以进一步开发应用于临床。

Purpose:To screen proper concentration of clarithromycin ophthalmic gel by observingthe efficacy of different concertrations of clarithromycin ophthalmic gel for treatingstaphylococcal corneal ulcers.
Methods:Corneal ulcer was induced in the right eye of 40 rabbits, 3.0 x 10°CFU/mlstaphylococcus aureus suspension was injected midstromally into the central cornel.These rabbits were divided randomly into $ groups ,each group received respectivelytopical blank matrix, clarithromycin ophthalmic gel 0.1%, clarithromycin ophthalmicgel 0.25%,levofloxacin ophthalmic gel, clarithromycin ophthalmic gel 0.25% andrecombinant bovine basic fibroblast growth factor (Rb-bFGF), 4 times every day, 2drops each time. The eyes were examined respectively with the slit lamp beforetreatment(day0), on day3, day5, day7, day 10, day 14 to observe theprogression of corneal ulceration. including the area of the corneal ulcer and mark of keratitis.

Resuls:Under the same way of giving medicine, experimental coreal ulcer studiesshowed a statistically significant decrease in all tratement groups on measurements ofthe area of the comeal ulcer and mark of keratitis(P<0.05), and clarithromycinophthalmic gel 0.25% had a better action than clarithromycin ophthalmic gel 0.1%against staphylococcus aureus corneal ulcer.
Conclusion:Clarithromycin ophthalmic gel 0,25% was proved to be an effective ocularmedication for the therapy of gram-positive bacterial corneal ulcer. 

目的: 观察老年性黄斑变性(Age-related macular degeneration, AMD) 和息肉状脉络膜视网膜病变(Polypoidal choroidal vasculopathy, PCV) 患者眼底陈旧性出血在吲哚青绿血管造影(Indocyanine green angiography, ICGA) 中的自发荧光表现。

方法: 对伴有眼底陈旧性出血的AMD和PCV患者共36例(36只眼)行ICGA检查。受试者在进行ICGA检查前, 均经过详细的眼底镜检查、眼底彩色照相及荧光素眼底血管造影(Fundus fluorescein angiography, FFA) 检查。

结果: 眼底陈旧性出血灶 ICGA 均表现出相应的自发荧光。陈旧性出血灶呈浅灰黄色, 其自发荧光的形态大小与眼底彩色图像所示的陈旧性出血灶相一致, 边界清晰; 造影后期陈旧性出血灶的自发荧光强度最强，与 AMD 的斑状及焦点状脉络膜新生血管 (Choroidal neovasculari-zation, CNV) 及 PCV 的息肉状脉络膜血管扩张灶的荧光表现不同。陈旧性眼底出血的自发荧光多与 CNV 或息肉状病灶重叠或位于其边缘(27只眼, 75%) 。

结论: ICGA 中陈旧性眼底出血所致的自发荧光易与 CNV 及息肉状病灶性强荧光相混淆, 将眼底彩色图像与 ICGA 图像对比分析及掌握其与CNV及息肉状血管扩张灶的不同荧光特性有助于鉴别诊断。

Objective: To investigate the autofluorescence of stale fundus haemorrhage in age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) with indocyanine green angiography (ICGA) .

Methods: The color photographs and ICGA were performed in 36 eyes of 36 cases of exudative AMD or PCV with stale fundus haemorrhage. All of the cases were examined by funduscopy and fundus fluorescein angiography (FFA) .

Results: Autofluorescence could be observed in all of the stale haemorrhage cases. Stale haemorrhage showed grayish color and the shapes and sizes of autofluoresence in ICGA were in accordance with those of the stale haemorrhage in the color photographs. The boundaries of autofluorescence were clear and the intensities were strong. The percentage of choroidal neovascularization (CNV) or PCV in or beside stale haemorrh-age was significantly higher than that outside the stale haemorrhage (27 eyes, 75%) . 

Conclusions: Autofluorescence of stale haemorrhage in ICGA can be mixed up with the high fluorescence of CNV and grapes-like polypoidal dilatation. It is helpful to compare the color photographs with ICGA and recognize the different ICGA characteristics in the assessment of ICGA results in these circumstances.

目的:研究形觉剥夺性和光学离焦性近视豚鼠视紫红质的表达变化,探讨视紫红质表达与实验性近视眼之间的关系。

方法:40只出生后1周的豚鼠随机分为形觉剥夺组和光学离焦组(n=20)，形觉剥夺组单眼戴半透明(半透明薄膜贴于平镜表面)平光硬性角膜接触镜片(Rigidgass-pemmeable contactlens, RCP)，光学离焦组单眼藏-4.0DRGP镜片，另一只眼为对照组。戴镜干预后1、2周各组分别测量屈光度、眼轴长度、玻璃体腔深度，并于上午10~12 点钟取材，实时荧光定量PCR观察视紫红质 mRNA 的变化 Westem-blot 观察视紫红质的变化，进行对比比较,统计分析。

结果:实验干预后1周，形觉剥夺组和光学离焦组与对照组相比各项指标无显著性差(除形觉剥夺组屈光度以外)。实验干预后2周，与对照组相比较，形觉剥夺组和光学离焦组明显发生近视、眼轴延长、玻璃体腔加深(t=22.20、18.32、19.65、15.78、6.18、11.20.P<0.01)：形觉剥夺组视紫红质及其 mRNA 表达均增加(t=17,489、14.31.P<0.05)光学离焦组视紫红质及其mRNA表达无明显变化。

结论:视紫红质的表达可能参与了形觉剥夺性近视眼的形成,而在光学离焦性近视眼中作用有限。

Purpose:To investigate the rhodopsin expression in form-deprived and defocus myopiain guinea pig and study the relationship between the rhodopsin expression andexperimental myopia.

Methods:Fourty guinea pigs were randomized into the form-deprived group and thedefocus group (n= 20 ). Guinea pigs in the form-deprived group wore a diffuser(rigidgass-permeable contact lens(RGP)on one eye since one week after birth. Those in defocus group wore a -4 D RGPon one eye. The contralateral eyes were left ascontrol. Refraction, axial length and depth of vitreous cavity were measured after 1and 2 weeks respectively. Retina were dissected at 10 ~ 12 o'clock in the moring.The level of rhodopsin and its mRNA were observed through Western-blot and real-time PCR respectively.

Result:There is no difference between form-deprived group, defocus group and controlgroups(except refraction in form-deprived group). One week later, there is nodifference between the form-deprived group, the defocus group and the control groups(except refraction in form-deprived group). Two weeks later, eyes in the form-deprivedgroup and the defocus group became myopic. Its axial length lengthened and depth ofvitreous cavity appeared deep. The form-deprived groups showed an increasedexpression of rhodopsin and its mRNA compared to the control groups. There is nodifference between the defocus group and the control groups.

Conclusion : Expression of rhodopsin might involve formation of form-deprived myopia,but has less influence on defocus myopia.