眼内淋巴瘤(intraocular lymphoma，IOL)比较罕见。按起源位置分为两种类型，主要类型为原发性眼内淋巴瘤(primary intraocular lymphoma，PIOL)，也称为原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma，PCNSL)；另外一种类型为继发性眼内淋巴瘤(secondary intraocular lymphoma，SIOL)，为中枢神经系统以外的淋巴瘤转移至眼内。按肿瘤类型主要分为三类，主要类型为眼内弥漫大B细胞淋巴瘤，属于高级别淋巴瘤，预后较差；其次为少见的主要侵犯脉络膜的黏膜相关淋巴组织结外边缘区B细胞淋巴瘤，属于低级别淋巴瘤，预后较好；第三种类型为极少见的眼内NK/T细胞淋巴瘤，属于高级别淋巴瘤，预后极差。该病的诊断对眼科医生和病理医生都极具挑战性。实验室检测方法主要包括病理学、免疫细胞化学、流式细胞术、细胞因子及基因重排等，但眼内病理活检仍然是该病诊断的金标准。该病的治疗主要为眼内局部化疗、放射治疗及系统性化疗。IOL早期常因误诊而耽误治疗，目前该病明确诊断时多在患者出现症状后4~40个月，多数病例早期被误诊为葡萄膜炎而失去治疗的最佳时机，导致预后较差。因此应充分认识IOL的早期表现，早期诊断、早期治疗，从而大大提高疗效。
Intraocular lymphomas (IOL) are rare malignant neoplasms including primary intraocular lymphoma (PIOL) and secondary intraocular lymphoma (SIOL). The former is also known as primary central nervous system lymphoma(PCNSL). The latter is a kind of lymphoma metastasizing to the eye from outside the central nervous system. IOL can further be divided into three different types. The most common type is vitreoretinal high-grade diffuse large B-cell lymphoma with poor prognosis. The less common type is primary choroidal extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue, which is low-grade B-cell lymphoma with better prognosis.The rare type is NK/T cell lymphomas with very poor prognosis. The diagnosis of this disease is challenging for both ophthalmologists and pathologists. Laboratory testing methods mainly include cytology/pathology,immunocytochemistry, flow cytometry, cytokine analysis and gene rearrangement detection. The detection of malignant lymphoid cells cytologically/pathologically is still the gold standard for diagnosing IOL. The treatment involves local chemotherapy, radiotherapy and systemic chemotherapy. Most intraocular lymphomas at early stage are misdiagnosed as uveitis and proper treatment is often delayed with poor diagnosis due to the lost of best time for treatment. So far, the delay between the diagnosis and the onset of ocular symptoms ranges from 4 to 40 months. Therefore, we should fully understand the early manifestations of intraocular lymphoma and early diagnose and timely treat the disease in order to improve prognosis.
目的：探索用细胞块制备试剂盒对眼内玻璃体液微量细胞制备细胞块的成功率，苏木素-伊红(hematoxylin-eosin，HE)染色效果及技术要点。方法：收集中山大学中山眼科中心临床病理科2020年9月至2021年1月由临床送检的25例玻璃体液(含玻璃体切割液)，应用细胞块制备试剂盒制备细胞块后，常规固定、脱水、包埋、切片，随后进行HE染色，观察染色效果。结果：25例玻璃体细胞蜡块制作成功率达到100%，制片后HE染色效果好，背景干净，细胞形态清晰，核质对比分明。结论：应用细胞块制备试剂盒能将眼内玻璃体液微量细胞制成蜡块，极大提高了标本的利用率，为后续的病理研究提供丰富的材料。
Objective: To explore the effect and technical key points of the cell block preparation kit for collecting a few cells in ocular vitreous humor. Methods: A total of 25 cases of vitreous humor (including vitrectomy fluid) were collected from Zhongshan Ophthalmic Center, Sun Yat-sen University from September 2020 to January 2021.Cell block preparation kit was used to prepare cell blocks, which were routinely fixed, dehydrated, embedded,sectioned, and then hematoxylin-eosin (HE) stained. Results: The success rate of 25 cases of vitreous cell paraffinblocks reached 100%, and the morphology of the cells was clear with clean background and shape contrast of nucleus and plasma in HE staining. Conclusion: The cell block preparation kit can make the cells of intraocular vitreous humor into paraffin blocks, which greatly improves the utilization rate of specimens and is conducive to providing abundant materials for pathological studies.
目的：评估硅油填充术后眼压对角膜内皮细胞的影响及变化特点。方法：选取2019年1月1日至9月30日在佛山市第二人民医院眼科中心行玻璃体切除联合硅油注射的患者共131名，分为高眼压组(n=80)和正常眼压组(n=51)。高眼压组术后任意一次测眼压>21 mmHg，正常眼压组术后眼压均≤21 mmHg。比较填充硅油前与取硅油时的角膜内皮细胞参数测量值。结果：高眼压组的平均眼压为20.79 mmHg，正常眼压组的平均眼压为14.70 mmHg(P<0.001)。取硅油时，两组角膜内皮细胞密度(corneal endothelial cell density，ECD)均明显减少，平均内皮细胞面积均明显增大(P<0.05)，高眼压组内皮细胞大小变异系数(coefficient of variation of endothelial cell size，CV)明显变大(P<0.05)。高眼压组ECD丢失率(6.3%)高于正常眼压组(3.5%)；其中，高眼压组中术后1~6周内的眼压升高(7.1%)、眼压≥40 mmHg(7.3%)对角膜内皮细胞影响最大。ECD丢失与眼压变化有显著相关性(r=0.176，P=0.044)。结论：硅油填充后高眼压是角膜内皮细胞丢失的重要危险因素。
Objective: To evaluate the effect of intraocular pressure (IOP) on corneal endothelial cells after silicone oil tamponade. Methods: Patients (n=131) received vitrectomy with silicone oil injection in Ophthalmology Center in Second People’s Hospital of Foshan City from January 1st to September 30th 2019 were divided into the high IOP group (n=80) and normal IOP group (n=51). IOP was >21 mmHg at any time in the high IOP group and was ≤21mmHg in the normal IOP group after surgery. The values of corneal endothelial cells before filling with silicone oil and before removing silicone oil were compared.Results: The average IOP was 20.79 mmHg in the high IOP group, and 14.70 mmHg in the normal IOP group (P<0.001). The number of endothelial cells (ECD) was reduced, but the average endothelial cell area was increased (P<0.05) in both groups. The coefficient of variation of endothelial cell size in high IOP group was increased (P<0.05). ECD loss rate was 6.3% in the high IOP group and 3.5% in normal IOP group. Increased IOP within 1–6 weeks after surgery (7.1%) and IOP ≥40 mmHg (7.3%) had the greatest impact on ECD. ECD loss was correlated with IOP (r=0.176, P=0.044). Conclusion: High intraocular pressure after silicone oil filling is an important risk factor for the loss of corneal endothelial cells.Keywords intraocular pressure; corneal endothelium; silicone oil; vitrect
随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。
With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.
青光眼是世界范围内致盲和引起视力损害的主要眼病，也是不可逆性致盲性眼病之一。眼压是青光眼发生发展的重要危险因素，但除眼压外，血压在青光眼进展引起的影响也不可忽视。眼灌注压是血压和眼压的差值，可调节视神经的血液供应。眼压、血压、灌注压在青光眼发生发展中有一定相关性。本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血压监测在青光眼中的应用进行文献索引，分析青光眼24h眼压和血压同步监测的意义。
Glaucoma is a major eye disease causing blindness and visual damage worldwide, and it is also one of the irreversible eye diseases causing blindness. Intraocular pressure (IOP) is an important risk factor for the development of glaucoma, and the influence of blood pressure (BP) on the progression of glaucoma also cannot be ignored. Eye perfusion pressure is the difference between blood pressure and intraocular pressure, regulating the blood supply to the optic nerves. IOP, BP and perfusion pressure are related to the occurrence and the progression of glaucoma. Literature review was performed related to the effects of IOP and BP on glaucoma, and the application of 24-hour IOP and BP monitoring in glaucoma, aiming to analyze the significance of simultaneous monitoring of IOP and BP for 24 hours.
白内障作为一种常见的眼科疾病，是全球第一位致盲眼病，目前尚无药物能够治疗，手术是唯一有效的办法。随着现代眼科手术技术的发展以及人工晶状体(intraocular lens，IOL)设计和功能的更新升级，人们对视觉质量的要求越来越高，白内障超声乳化联合IOL植入术已经从单纯的复明手术转变为个性化的屈光手术。为满足不同需求的患者术后获得较好的视觉质量，IOL经历了从单焦点到多焦点、球面到非球面的发展，还有散光型IOL和各类功能性IOL的临床应用，也为患者提供了更多的选择。充分了解不同类型IOL的优势和特点，根据患者自身眼部情况、日常用眼习惯以及需求，个性化地选择IOL植入对视觉质量的恢复和满意度起着至关重要的作用。因此本文将针对不同类型的IOL，从设计与分类、术后临床效果及适应人群进行综述，为IOL的选择提供指导建议。
As a common eye disease, cataract is the first-leading cause of blindness in the world. Currently, there is no drug to treat it, and surgery is the only effective way. With the development of modern ophthalmic surgical technology and the updating and upgrading of the design and function of intraocular lens (IOL), people have higher and higher requirements for visual quality. Cataract phacoemulsification combined with IOL implantation has transformed from a simple vision restoration to personalized refractive surgery. In order to meet the needs of patients with different needs to obtain better visual quality after surgery, IOL has experienced the development from monofocal to multifocal, spherical to aspherical, as well as the clinical application of astigmatic IOL and various functional IOLs, which also provides more choices for patients. Fully understanding the advantages and characteristics of different types of IOLs, according to the patient’s own eye conditions, daily eye habits and needs, individualized selection of IOL implantation plays a crucial role in the recovery and satisfaction of visual quality. Therefore, this article will review different types of IOLs from the aspects of design and classification, postoperative clinical effects and adaptation to the population, and provide guidance for the selection of IOLs.
目的：分析高度近视有晶状体眼后房型人工晶状体植入术后孔源性视网膜脱离的临床特征及预后。方法：回顾分析2012年4月至2021年6月中山眼科中心收治的9例(9只眼)行后房型人工晶状体植入术后孔源性视网膜脱离患者的临床特征、手术方式及疗效，随访(4.96±4.78)个月。结果：患者年龄(30.44±20.11)岁，屈光手术至发病时间(32.10±17.80)个月。4例(44.4%)马蹄形裂孔，1例(11.1%)萎缩性裂孔，4例(44.4%)巨大裂孔；9眼裂孔均位于赤道部前，除2眼(22.2%)为单个巨大裂孔，1眼(11.1%)单个马蹄孔，余6眼(66.7%)均有视网膜周边变性区存在；视网膜脱离范围(3.0±1.12)个象限，8例累及黄斑；增殖性玻璃体视网膜病变C级以上4眼。视网膜初始复位率为77.8%，最终视网膜复位率100%。末次随访最佳矫正视力优于术前(P<0.05)。随访期间，2例硅油填充眼发生并发性白内障，4眼发生术后早期高眼压。结论：有晶状体眼后房型人工晶状体植入术前存在的视网膜变性或术后玻璃体牵引的存在可能是孔源性视网膜脱离发生的危险因素。
Objective: To analyze the clinical presentation, surgical management, and outcomes of rhegmatogenous retinal detachment (RRD) in patients with high-myopia corrected by posterior chamber phakic (PCP) intraocular lens (IOL) implantation. Methods: Nine eyes of 9 patients in whom RRD developed after PCPIOL implantation from April 2012 to June 2021 in Zhongshan Ophthalmic Center were retrospectively studied. Mean follow-up after retinal detachment surgery was (4.96±4.78)months. Results: Mean patient age was (30.44±20.11) years old. RRD occurred (32.10±17.80) months after PCPIOL implantation. Four (44.4%) breaks were horseshoe tear, 1 (11.1%) was atrophic hole and 4 participants (44.4%) had a giant retinal tear. Nine cases had causative breaks located anterior to the equator while peripheral retina lattice degeneration was found in 6 eyes. RRD extended from 1 to 4 quadrants (3.0±1.12 quadrants) and 8 cases were macula-off retinal detachments. Four eyes’ proliferative vitreoretinopathy were more severe than level C. Initial reattachment rate was 77.80%. Final retinal reattachment was 100%. Final follow-up BCVA was significantly better than baseline (P<0.05). Furthermore, concurrent cataract occurred in 2 eyes in which silicone oil was used as tamponade. Ocular hypertension was detected in 4 eyes after surgery. Conclusion: The existed lattice degeneration and postoperative vitreous traction may be risk factors for RRD after PCPIOL implantation.
目的：探讨全身麻醉诱导期应用不同种类的非去极化肌松药罗库溴铵、顺式阿曲库铵和米库氯铵对眼压升高的青光眼患者眼内压的影响。方法：将术侧眼眼压>21mmHg青光眼手术患者随机分配到罗库溴铵组、顺式阿曲库铵组和米库氯铵组。靶控输注丙泊酚至患者脑电双频指数(bispectral index，BIS)低于55后，根据组别分别静注0.6mg/kg罗库溴铵、0.1mg/kg顺式阿曲库铵及0.2mg/kg米库氯铵，待4个成串刺激(train of four stimulation，TOF)比值降至0后置入可弯曲喉罩，随后行机械通气并给予芬太尼1.5~2.0μg/kg，2%~3%七氟烷吸入维持麻醉。分别于麻醉诱导前(T0)、镇静后(T1)、肌松后(T2)及喉罩置入后(T3)测量三组青光眼患者术侧眼眼压并记录上述时间点血流动力学参数。结果：罗库溴铵组、顺式阿曲库铵组、米库氯铵组患者的眼压在T1、T2、T3时间点均较T0显著下降，差异有统计学意义(均P<0.001)；三组患者T2时间点眼压与T1相比差异均无统计学意义(P=0.337，P=0.520，P=0.062)；三组患者给予肌松药前后的眼压差值(T2–T1)分别为(0.68±4.39)、(0.36±3.72)和(1.27±3.91)mmHg，组间比较差异无统计学意义(P=0.353)。结论：非去极化肌松药罗库溴铵、顺式阿曲库铵及米库氯铵对眼压升高的青光眼患者的眼压无明显影响，且3种肌松药之间未见显著差异。
Objective: To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia. Methods: Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group, cis-atracurium group and mivacurium group. After target controlled infusion of propofol until the bispectral index (BIS) lower than 55, 0.6 mg/kg rocuronium, 0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups. The flexible laryngeal mask was placed after the train-of-four stimulation (TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately. General anesthesia was maintained by 1.5–2.0 μg/kg fentanyl and 2%– 3% sevoflurane. Intraocular pressure and hemodynamic parameters were measured before anesthesia induction (T0), after sedation (T1), after muscle relaxation (T2), and after laryngeal mask insertion (T3). Results: The intraocular pressure of patients in rocuronium group, cis-atracurium group and mivacurium group at T1, T2, T3 were lower than baseline (T0), and the difference was statistically significant (P<0.001); There was no significant difference in intraocular pressure at T2 compared with T1 in rocuronium group, cis-atracurium group and mivacurium group (P=0.337, P=0.520 and P=0.062 respectively); The difference of intraocular pressure between T2 and T1 in rocuronium group, cis-atracurium group and mivacurium group were (0.68±4.39), (0.36±3.72) and (1.27±3.91) mmHg respectively and there was no significant difference among the groups (P=0.353). Conclusion: The non-depolarizing muscle relaxants rocuronium, cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure, and there is no significant difference among the three muscle relaxants.
目的：观察后房型有晶体眼人工晶体(implantable collamer lens，ICL)V4c植入术后2年的有效性、安全性和稳定性，评估ICL V4c矫正屈光不正的中远期临床疗效。方法：回顾性病例研究。收集在河北省沧州市中心医院眼一科行ICL V4c手术治疗的屈光不正患者，观察并记录术前至术后2年的裸眼视力、最佳矫正视力、屈光状态、对比敏感度、高阶像差、眼压、人工晶体拱高、角膜内皮细胞计数、不良反应、主观视觉质量等临床资料，进行统计学分析。结果：完成随访的96例术眼，术后2年的平均裸眼视力(LogMAR)为0.021±0.065，平均最佳矫正视力(LogMAR)为0.002±0.041，优于术前最佳矫正视力，有效性指数为1.05，安全性指数为1.09，等效球镜数值稳定，对比敏感度提升，高阶像差有所增加，但主观视觉质量良好，眼压基本稳定，内皮细胞丢失率为1.6%，平均拱高为(549.6±50.0) μm，随访期间未发现眼内感染、继发性青光眼、晶状体混浊、黄斑水肿、视网膜脱离等并发症。结论：ICL V4c植入术矫正屈光不正具有良好的中远期临床效果。
Abstract Objective: To assess the medium-long term efficacy, safety and stability of a newly developed posterior chamber phakic intraocular lens (model V4c Visian Implantable Collamer Lens) to correct refractive errors. Methods: Retrospective case series. This study evaluated eyes that had implantation of ICL V4c to correct ametropia for at least two years. Uncorrected and corrected distance visual acuities, refraction, contrast sensitivity, high-order aberration, quality of life, intraocular pressure, endothelial cell density, pIOL vault, and adverse events were evaluated to assess the efficacy, safety and stability of V4c. Results: The study comprised 96 eyes of 50 patients. At 2 years postoperatively, the mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.021±0.065 logMAR and 0.002±0.041 logMAR, which were better than preoperative CDVA. The efficacy and safety indices were 1.05 and 1.09, respectively. The spherical equivalent was stable withimproved contrast sensitivity and increased high-order aberrations, but the subjective visual quality was well. The IOP remained stable over time. The mean vault was (549.6±50.0) μm and the mean endothelial cell loss was 1.6%. No eye developed intraocular infection, secondary glaucoma, lens opacity, macular edema or retinal detachment. Conclusion: The good medium-long term outcomes support the use of ICL V4c for the correction of myopia.
