糖尿病患者白内障囊外摘除并后房型人工晶体植入术的临床观察

为探讨糖尿病患者白内障囊外摘除并后房型人工晶体植入术的疗效及影响视力恢复的因素 ,对施行人工晶体植入术的 12 1例 (156只眼 )老年糖尿病患者进行了回顾分析。结果发现 156只眼术后矫正视力≥ 0 .5者为 73.2 8% ;无糖尿病视网膜病变组 10 8只眼、背景性糖尿病性视网膜病变组 4 2只眼和增殖性糖尿病视网膜病变组 6只眼术后矫正视力≥ 0 .5者分别为 90 .74 %、51.16 %和 0 % ,各组之间有显著性差异 (P <0 .0 0 1)。表明无糖尿病性视网膜病变者术后视力恢复良好 ,增殖性糖尿病性视网膜病变者最差。     

匹罗卡品家兔点眼对葡萄膜巩膜途径房水流出量的影响

为探讨匹罗卡品家兔点眼对葡萄膜巩膜途径房水流出色的影响，用1％匹罗卡品（Pilocarpine，PC）对家免单侧点眼。并用0.1mmol／L异硫氰酸荧光素牛血清白蛋白（Fluoreceinisothlocyanate－bovineserumalbumin，FITC－BSA）持续前房灌注30min。测定前、后葡萄膜等6种组织的FITC－BSA含量，计算每眼的葡萄膜巩膜层水流出量（Uveosderdoutflow，Fu）。分别比较点眼前后眼压和点眼后双眼的Fu。结果示：PC点眼后1h处理眼眼压为（0．70±0．08）kPa，下降率为25％（P＜0．01），对照眼眼压无显著变化（P＞0．05）；点眼后2h处理眼Fu值为（0．123±0．026）μl／min，对照眼Fu值为0．177±0．032）μl／min，双眼比较差异有显著性（P＜0．05）。说明1％PC单侧点眼可降低正常家兔眼压，PC可阻断家兔葡萄膜巩膜途径房水外流，兔眼的眼压下降主要为前路排出增加所致。     

莫索尼定点眼对家兔葡萄膜巩膜途径房水流量的影响

目的　测定莫索尼定 (Moxonidine ,MOX)局部应用后对家兔葡萄膜巩膜途径 (Uveoscle raloutflow ,Fu)房水流出量的影响 ,探讨MOX局部应用的房水动力学机制。方法　正常家兔2 0只 ,随机分为 2组 ,分别采用生理盐水及莫索尼定点眼 ,点眼前及点眼后 3 0min ,测量双眼眼压。点眼后 1 .5h用 0 .1mmol/L异硫氰酸荧光素牛血清白蛋白 (Fluorescein isothiocyanatebovinealbumi,FITC BSA)行前房灌注 ,测定Fu各组织的荧光强度 ,采用改良Suguro法计算各组Fu房水再现量。结果　MOX单侧点眼后 ,点眼侧兔眼Fu房水再现量为 (7.2 1± 0 .988)×1 0 - 1 μL·3 0min- 1 ,对侧眼Fu房水再现量为 (7.5 3± 0 .2 1 4)× 1 0 - 1 μL·3 0min- 1 ,与对照组相比具有显著性差异。结论　局部点用MOX可通过增加后路房水流量降低眼压     

外源性p27Kip1对兔眼滤过术后结膜瘢痕的抑制作用

目的观察外源性p27Kip1作用于兔眼滤过术后的效果,研究其对术后结膜瘢痕形成的抑制作用。方法根据GenBank人p27基因序列设计引物,制备腺病毒介导Ad-p27并验证其正确性。兔眼滤过术中结膜下注射Ad-p27、丝裂霉素C(MMC)和PBS,术后28d内测定眼压、观察眼前节的动态变化及并发症,依照Krofeld评分法进行滤过泡评分。结果 Ad-p27作用后28d内维持低眼压的状态,术后3d眼压下降达峰值7.68mmHg。Ad-p27降眼压程度与MMC相似,与PBS比较术后7d(P<0.05)、14d(P<0.01)、21d(P<0.01)和28d(P<0.05)眼压存在显著性差异。Ad-p27作用后14d内滤过泡弥漫性隆起,28d有囊性泡形成。Ad-p27组与PBS组比较,滤过泡评分在7d(P<0.01)、14d(P<0.01)和21d(P<0.05)有显著性差异。Ad-p27组术后21d前房恢复正常,而PBS组术后14d恢复正常。Ad-p27作用偶有前房渗出、前房出血等并发症。结论 Ad-p27通过抑制手术区瘢痕形成保持滤过道通畅,降低眼压。     

兔眼硅胶膜植入滤过术的实验研究

目的 建立兔眼硅胶膜植入引流术模型,通过眼压、滤过泡及光镜下形态学的观察,探讨硅胶膜植入引流术的可行性、安全性。方法 将40只家兔随机分为4组,每组10只。每只家兔随机选择一眼植入硅胶膜,对侧眼行滤过术作为对照,术后观察眼压和滤过泡,并行病理组织学检查。结果 硅胶膜植入眼眼压下降维持时间和滤过泡的持续时间均长于对照眼。光镜显示硅胶膜植入眼可见开放的滤过道和咬切口。植入眼与对照眼的成纤维细胞增殖活性及规律相似。结论 硅胶膜引流术是一种安全、有效、操作简单的引流性手术。     

人晶状体上皮细胞原代培养方法的改进

目的 建立一种简单有效的人晶状体上皮细胞体外培养的方法.方法 用组织块培养法,采用连续花瓣状撕囊法获得人白内障患者的晶状体前囊膜,使用含有表皮生长因子的培养液进行培养,对培养的细胞进行形态学观察及鉴定;在倒置相差显微镜下观察其生长规律,应用免疫荧光组织化学法进行鉴定.结果 体外培养的原代人晶状体上皮细胞在组织块贴壁24 h后从组织块边缘长出,具有上皮细胞的形态特点.αA-晶状体蛋白抗体阳性率几乎100％,鉴定为晶状体上皮细胞.结论 采用连续花瓣状撕囊法获得的组织块较易在体外培养出入晶状体上皮细胞,可用于白内障后囊膜混浊发病机制的进一步研究.     

Effects of systemic domestic recombinant human erythropoietin on HIF-1α expression in the retina in a rabbit model of acute high intraocular pressure

Objective To observe the expression of hypoxia inducible faetor-1α (HIF-1α) in the retina of rabbits with acute high intraocular pressure and to investigate the mechanism of systemic domestic recombinant human erythropoietin (rhEPO) protecting the retina from ischemia-reperfusion injury. Methods First, control group and model group were established in rabbit eyes. The acute high intraocular pressure model was established by saline perfusion into anterior chamber, and then hypodermic injection of domestic rhEPO was made. HIF-1α protein in the retina was observed by immunohistochemical staining method on days 1, 3, 7 and 14 after retinal ischemla-reperfusion, respectively. Results No cells with HIF-la positive expression were observed in the retina of the control group. Ceils with HIF-1α positive expression in the model group outnumbered those in the control group (P < 0. 01). The resemblance pattern occurred in EPO group but its degree was slightly greater than that in the model group from day 3 after ischemia-reperfusion (P<0.05). Conclusion Domestic rhEPO can down-regulate the expression of HIF-1α in the retina with acute high intraocular pressure, which may be one of the mechanisms that rhEPO protects the retina from ischemia-reperfusion injury.     

水下囊袋内人工晶体植入术治疗外伤性白内障

以眼内平衡盐（ＢＳＳ）代替价格昂贵的粘调剂Ｈｅａｌｏｎ，进行水下囊袋内人工晶体植入术治疗外伤性白内障１２例（１２眼），针对外伤性白内障的复杂性，对手术要点、手术时机的选择、降压措施进行了讨论。强调术前充分散瞳、充分降低眼压，手术操作轻巧是保证手术成功的关键。     

PRK术后家兔角膜透射电镜、扫描电镜的实验研究

应用 SVS APEX PLUS型准分子激光治疗系统对 6只家兔双眼进行 PRK术 ,设定右眼- 4.0 0 D,左眼 - 8.0 0 D。分别于术后 3天、30天、1 0 0天两组随机选取 1只家兔 ,使其猝死摘除双眼球 ,取其角膜。每只角膜分为两半 ,一半角膜电镜下观察其超微结构 (1 /4行 SEM,1 /4行TEM)。透射电镜观察手术后 1 0 0天 ,角膜上皮细胞基本恢复正常。扫描电镜观察则上皮细胞界限分明 ,上皮明亮细胞较多 ,但微绒毛、微皱褶相对减少。提示 PRK术后 1 0 0天角膜组织结构基本正常 ,但仍有组织薄弱处和特殊性改变。其角膜上皮微绒毛、微皱褶相对减少 ,可能是临床上PRK术后部分患者近期角膜干燥的原因之一     

AN EXPERIMENTAL STUDY ON UVEOSCLERAL OUTFLOW WITH FITC-BSA AS A TRACER IN RABBIT EYE

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A HISTOPATHOLOGIC IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL STUDY OF RABBIT CORNEA AFTER EXCIMER LASER PHOTOREFRACTIVE KERATECTOMY

In excimer laser photorefractive keratectomy(PRK), the central part of the Bowman's mem-brane and superficial stroma is ablated after re-moval of the corneal epithelium. Clinical studiesshowed that the results of PRK for myopia of up to--6 diopters are satisfactory[' 'J. However, deeperresearch is needed, especially the healing processfollowing PRK,which is different from the woundhealing mechanism after conventional occularsurgery['.'J. Corneal haze and myopic regression arethe 2 main co…     

土贝母皂甙对家兔单纯疱疹病毒性角膜炎的作用

目的评价土贝母皂甙(tubei moside,Tu)治疗家兔单纯疱疹病毒性角膜炎(herpes si mplex keratitis,HSK)的效果。方法在地鼠肾细胞BHK-21上进行单纯疱疹病毒I型(HSV-1型)SM44毒株复苏,制作兔HSK模型。家兔分为0.2g/L Tu、无环鸟苷(ACV)和生理盐水(NS)3组,采用裂隙灯显微镜、扫描电镜和透射电镜观察眼部病变的变化。结果0.2g/L Tu、无环鸟苷和生理盐水组第6~8天角膜病变分值分别为3.13~3.5、1.75~1.88和3.83~3.88,第14天时为2.07、1.13和2.77,3组间比较,均有显著性差异(P<0.01)。0.2g/L Tu可以显著缩小角膜病变面积,促进角膜上皮细胞的修复,其作用优于生理盐水组,但不及ACV组。结论Tu点眼剂治疗实验性HSK有一定的疗效,但尚不及ACV。     

EFFECT OF FUNDUS PIGMENT ON RESPONSE OF RABBIT RETINA TO TRANSPUPILLARY THERMOTHERAPY

Objective To study the effect of fundus pigment on the response of the retina to transpupillary thermotherapy (TTT). Methods The retina were irradiated with 810 nm diode laser in 16 eyes of 8 pigmented rabbits and 12 eyes of 6 albino rabbits. The spot size was 1.2 mm; the duration was 60 s; and powers were 50, 80, 150 and 300 mW for pigmented rabbits and 800, 1 200 and 1 500mW for albino rabbits. All of the eyes were followed up with ophthalmolscope. The fundus was photographed and examined histologically with optic microscope immediately and 1 month after TTT respectively. Results The changes of the fundus and the histological examination were not significant immediately and 1 month after TTT in 50 mW group of pigmented rabbit and 800 mW of albino rabbit. Grey spot on the retina was observed on the fundus in 80 mW group of pigmented rabbit and 1 200 mW of albino rabbit immediately after TTT. The structure of the retina remained intact and subretinal fluid was observed histologically. Grey spot was still visible on the fundus, though the fluid was absorbed after 1 month. As the power of diode laser was increased to 150 mW for pigmented rabbits and 1500 mW for albino rabbit, fundus white spots were observed and the outer retina was destroyed while photoreceptors existed immediately after TTT. Pigmentation was found in white lesions and the fibrous proliferation was found in choroid 1 month after TTT. Prominent white spot was seen on the fundus immediately after laser irradiation of 300 mW in pigmented rabbits and the structure of the retina was obscured. One month after TTT, dense pigmentation appeared at laser lesions. The retina was thinner. There was prominent fibrous proliferation in the choroid. Conclusion The fundus pigment seems to play an important role in the response of the retina to TTT. The reaction of the retina is in proportion to the intensity of laser.     

前列腺素F2α和E2降低眼压及与房水cAMP含量变化关系的初探

目的 探讨小剂量前列腺素F２α和E２（PGF２α、PGE２)对正常兔眼压的作用及与环磷酸腺苷(cAMP)的房水动力学介导作用的相关性。方法 采用随机盲法对照研究,30只兔60只眼随机分成三组,每组分别点用PGF２α10μg或PGE２ １０μg或等量生理盐水。每组选10眼,用药后不同时间测量眼压。另外10眼滴药后2h抽取房水检测cAMP含量变化。结果 PGF２α治疗组用药后0..5h、PGE２组用药后1h眼压开始下降,持续至用药后5h,其中2h时眼压下降幅度最大,平均分别为0..50kPa和0..45kPa。用药2h后PGE２组房水中cAMP含量由用药前(17..50±3..80)pmol/ml增高至(37..21±4.34)pmol/ml,而PGF２α组房水cAMP含量变化不明显。结论 小剂量PGF２α及PGE２可以降低正常兔眼内压。PGE２降眼压机理与房水中第二信使cAMP的动力学介导作用相关,而PGF２α可能另有一套不同的第二信使系统。     

糖尿病性白内障超声乳化术后泪膜稳定性的动态变化

目的观察糖尿病性白内障术后泪膜稳定性的变化规律,了解糖尿病患者术后泪膜功能的改变及其影响因素。方法设计自身配对研究。选2型糖尿病性白内障患者(随机检查48例48只眼),无糖尿病者设为对照组(随机检查80例90只眼)。采取透明角膜切口超声乳化白内障吸除及折叠式后房型人工晶体植入术,术前、术后1 d、7 d、1月、3月依次行Schirmer试验(Sit)、泪膜破裂时间(BUT)、角膜荧光素染色并对其泪膜稳定性的变化进行分析。结果术前两组SIt、BUT有明显差异(P<0.001),其中糖尿病组的患者泪膜稳定性较差。与术前相比,术后1 d两组BUT均明显缩短,Schirmer-I值明显增加,角膜荧光素染色为(+);与对照组相比,糖尿病组下降明显(BUT:P<0.05;Schirmer-1P<0.001)。两组Schirmer-I值术后7d恢复至术前水平,两组恢复有显著性差异(P<0.001)。对照组BUT术后1个月恢复至术前水平(P>0.001),糖尿病组BUT术后3个月恢复至术前水平(P<0.05),两组恢复程度有明显差异(P<0.05)。术前两组的角膜荧光素染色为阴性~+,无显著性差异;术后1 d两组亦无显著性差异。与对照组相比,糖尿病组角膜荧光素染色术后1个月恢复至术前水平。结论糖尿病患者泪膜稳定性较差,术后其泪膜稳定性较对照组下降明显,恢复较慢,部分患者术后出现眼干涩、畏光、视力波动等。术前应常规检查SIt、BUT、角膜荧光素染色,有助于早期发现、及时治疗。     

FITC-BSA示踪法测定兔眼葡萄膜巩膜途径房水流出量

用异硫氰酸荧光素牛血清白蛋白（Fluorescein－isothiocvanatebovineserumalbumin，FITC－BSA）示踪法测定兔眼葡萄膜巩膜途径房水流出量。造健康白色家兔6只12眼，测量双眼眼压。用0．1mmol／LFITC－BSA持续前房灌注30min，灌注毕处死家兔，摘除双眼球，并将组织分离为前葡萄膜、后葡萄膜、前巩膜、后巩膜、视网膜和残余液体等6种组织。测定每种组织的荧光强度，计算每眼葡萄膜巩膜房水流出量（uveoscleraloutflow，Fu）为（0．178±0．029）μl／min。证明FITC－BSA示踪法是一种测定葡萄膜巩膜途径房水流出量的有效方法。     

青藤碱对家兔血管平滑肌细胞增殖的影响

目的　研究青藤碱对血管平滑肌细胞增殖作用及 DNA合成的影响。方法　采用内皮素刺激的离体家兔血管平滑肌细胞增殖模型 ,细胞计数 ,氚 -胸腺嘧啶核苷掺入方法。结果　青藤碱明显抑制血管平滑肌细胞增殖反应及 DNA合成 ,呈剂量依赖关系。结论　表明青藤碱具有抗血管平滑肌细胞增殖作用     

手术显微镜下前房内植管术治疗新生血管性青光眼

本文报道了16例新生血管性青光眼在手术显微镜下行前房内植管术的治疗效果。其中15例作了3～26个月的随访,14例取得了令人满意的疗效。表明这种方法具有组织损伤小,减压效果确切的优点,因此,值得推广。     

蝮蛇抗栓酶对胎儿晶状体上皮细胞体外生长的影响

目的研究蝮蛇抗栓酶(AF)对胎儿晶状体上皮细胞体外生长的影响。方法取中晚孕引产死胎眼球晶状体前囊膜,用改良方法进行胎儿晶状体上皮细胞培养,取生长状况良好的2、3代传代细胞,加入6种不同浓度(2×10-4、4×10-4、8×10-4、16×10-4、32×10-4、64×10-4u/mL)的蝮蛇抗栓酶溶液与胎儿晶状体上皮细胞持续接触48h,倒置显微镜下观察各组细胞形态的变化,四甲基偶氮唑盐法检测各孔细胞数量的吸光度(A)值。结果与对照组相比,AF组特别是高浓度AF组中,细胞失去正常多角形,胞质减少,细胞内颗粒增多,细胞间隙增宽,排列疏松散乱,甚至崩解不贴壁。随着浓度增加,各组A值逐渐减低,除2×10-4u/mLAF组外,其他各浓度组A值与对照组比较均有统计学差异(P<0.05),并且随着浓度增加,生长抑制率逐渐增加。结论AF浓度>4×10-4u/mL,能通过持续接触抑制体外培养的胎儿晶状体上皮细胞的生长,并且具有浓度依赖效应。     

直视下颈椎间盘切吸术的临床应用及其对颈椎稳定性的影响

采用经前路主要病变节段椎间盘切除植骨十次要阶段椎间盘切吸术；或在单开门椎管扩大成形术的同时，加作后路椎间盘切吸术，共治疗颈椎病４６例。其中脊髓型４４例，神经根型２例，优良率８４．７８％。并对椎间盘切吸术后颈椎生物力学稳定性进行了测试，证明该术式不影响颈椎稳定性。从而为颈椎病的手术治疗开辟了一条新的途径。