试题与答案

1.在无额肌帮助下,提上睑肌肌力为: A.13 ～ 16mm;B.10 ～ 13 mm; C.7～10 mm;D.4～7 mm. 2.典型眼眶爆裂性骨折的最常见发生部位为: A.眶顶;B.眶外侧壁;C.眶缘; D.眶底和(或)眶内侧壁. 3.睑裂狭小综合征的四联征不包括以下哪一项? A.睑裂狭小;B.上睑下垂; C.正向型内眦赘皮;D.内眦间距增宽. 4.患者男性,25岁,因右眼拳击伤5h就诊.体格检查:右眼视力0.6,右眼睑肿胀,皮下积气、淤血明显,右侧颧面部感觉减退.无明显眼球凹陷,眼球上转受限,结膜下出血,角膜上皮擦伤,前房Tyn(+),瞳孔圆,光敏,晶状体透明,视盘界清、色淡红,视网膜平伏.该患者最需完善的进一步检查是: A.电生理(视觉诱发电位+视网膜电图); B.眼眶CT(横断位+冠状位); C.眼眶磁共振成像;D眼压.     

慢性扁桃体炎合并硬皮病及雷诺现象1例

患者,女,37岁.主诉为咽痛、吞咽困难10余日来我科就诊.检查:体温38.9℃,面部表情肌萎缩,皮下组织缺少,皮肤与肌肉组织粘连、变硬,双侧中指指尖黑色,呈坏死表现,双侧膝关节肿胀,压痛.双侧扁桃体Ⅱ度大,表面较多脓苔、易刮除,腭咽弓及腭舌弓急性充血,双侧下颌角淋巴结肿大、压痛.心脏听诊正常.验血常规:白细胞:16.5×109/L,抗"O"阳性,血沉加快.追问病史,该患者自幼咽痛、发热反复发作,年均发作5～8次,持续至今.10年前出现双侧膝关节肿胀,疼痛,行动受限.我院诊断:风湿性关节炎.给予对症治疗.4～5年前出现面部软组织萎缩,于外地诊断为"硬皮病",经治疗无效.一年前双手中指指尖疼痛,逐渐加重,指尖变黑,某医院诊断为"雷诺病",对症治疗无效.指端坏死范围逐渐增大.诊断:1.慢性扁桃体炎急性发作.2.风湿性关节炎.3.硬皮病及雷诺现象.急性炎症缓解后,行双侧扁桃体切除术.术后3个月复诊.关节肿胀疼痛症状明显减轻,指端坏死无加重,疼痛亦见明显减轻.验血常规及抗"O"、血沉等结果均正常.     

A Case of Choroidal Tubercles

A14year鄄old鄄boywasadmittedtohospitalduetocough,feverwithchestpainforonemonth.Miliarytuberculosiswasdiagnosed,whichwasconfirmedbychestradiography,sputumspecim鄄enandsputumculture.Isoniazid,Rifampin,Py鄄razinamideandEthambutolwereincludedinthetherapy.Thepatientdidhavenosignofeyeprob鄄lem.JustincasetherewouldbesideeffectofEthambutol.Routineocularscreenwasrequested.Thepatientwasfirstseeninourdepartmentonthe10thApril,1997.Hisbestuncorrectedsightwas20/20bilaterally.Bothanteriorsegmentsandvitre…     

试题与答案

1.下列眼部组织发育来源不是中胚叶的是:A.血管;B.巩膜;C.睫状体上皮;D.脉络膜.2.下列关于角膜发育的说法不正确的是:A.胚胎6周末,前半中胚叶组织形成角膜基质层和内皮细胞层;B.胚胎6周末,角膜上皮层已形成;C.胚胎3个月,基质层前部细纤维形成前弹力层;D.胚胎2个月,内皮细胞分化形成后弹力层.     

近视发生发展影响因素的研究进展（续）

27. Fischer AJ , Miethke P , Morgan IG , et al . Cholinergic amacrine cells are not required for the progression and atropine-mediated suppression of form deprivation myopia. Brain Res ,1998,794 （ 1 ） ： 48. 28. Duncan G, Collison DJ. Role of the non-neuronal cholin- ergic system in the eye ： a review . Life Sci , 2003 , 72 （ 18-19 ） ：2013.     

The Changes of Quality of Life in the Patients after Phacoemulsification with IntraocularLens Implantation

Cataractistheleadingcauseofworldwideblindness,whichcanresultintheimpairmentofvisionfunctionandthedecreaseofqualityoflife.Aftercataractextractionwithintraocularlensimplantation,thevisionfunctionandotherfunct鄄ionsrecover.Asaresult,thequalityoflifeimp鄄rove.Becauseofthesmallincision,visualacuitywillrecoverquicklyafterphacoemulsifecationwithintraocularlensimplantation.Afewreportshavebeenfoundabouttheearlychangesofquali鄄tyoflifeafterthiskindofprocedure.Thisprospe鄄ctivestudyinvestigatestheearlyp…     

IJO/IES Event Photos

Prof.G.O.H.Naumann,President of ICO and Prof.Bruce Spivey,President-Elect of ICO met Prof.Xiu-Wen Hu(middle),Chief Editor of IJO/IES at WOC 2006 in Sao Paulo,Brazil.Prof.Bruce Spivey,President of ICO met Prof.Xiu-Wen Hu Chief Editor of IJO/IES at 2013 ICO WORLD Meeting in New Orleans USA.     

Effects of blocking activation of IGF-1-Stat3 signaling pathway in guinea pig sclera fibroblast by AG490 on expression of MMP-2 and Integrinβ1

Objective To explore the effect of Blocking activation of IGF-1-Stat3 signaling pathway in guinea pig sclera fibroblast (GSFs) by AG490 on expressions of MMP-2, Integrinβ1. Methods Cultured GSFs were divided into four groups: group A( control group: only DMEM without IGF-1 ), group B (only IGF-1 group), group C( IGF-1 + PBS group), group D( IGF-1 +25 μmol/L AG490 group). The expressions of Stat3, p-Stat3, MMP-2, Integrinβ1 protein induced by IGF-1 and inhibited by AG490 in GSFs were detected by Western blot. The levels of Stat3, MMP-2 and Integrinβ1mRNA were detected by RTPCR. Results Compared with Groups A and D, Stat3, p-Stat3, MMP-2 protein expression in groups B and C were expressed at higher level ( tpr = - 32. 324, - 26. 284, - 32. 876, - 26. 345, - 68. 668, - 58. 724,- 187.481, - 58. 842, - 110. 264, - 120. 256, - 121. 345, - 120. 286; tmRNA = - 31. 554, - 31. 178,- 31. 286, - 31.198, - 12. 076, - 14. 969, - 11. 896, - 14. 546, P ＜ 0. 05 ), but the expression levels were not obviously different between groups B and C (tp = -32.720, -32. 816, -68.668, -187.481,- 110. 264, - 121. 345; tmRNA = - 0. 692, - 0. 579, P ＞ 0. 05 ), which were similar to mRNA level. The Integrinβ1 protein and mRNA were expressed in groups A, B, C and D but no significant difference among them respectively (Fpr =0.214;FmRNA = 0.045,P ＞0.05). Conclusions Activation of Stat3 signaling pathway may be involved in up-modulating the expression of MMP-2 in GSFs, and not affect the Integrinβ1protein and mRNA changes. The results reveal that Stat3 signaling transduction pathway may play a critical role in sclera remodeling by means of modulating MMP-2 expression.     

视交叉出血1例

资料 患者女性,56岁,会计.发现双眼视物遮挡1个月来诊.患者晨起注意到双眼视物模糊,无头痛、眼痛及转眼痛.无肢体麻木、无力.既往有高血压,服药控制佳.神经眼科检查：神清、言语流利、合作.双眼最佳矫正视力为1.0.眼底双侧视盘边界清、色红,杯盘比（C/D）分别为右眼0.4,左眼0.3.视网膜及黄斑未见明显异常（图1）.双侧瞳孔等大、等圆,对光反射灵敏.眼睑无下垂,眼球各向运动正常.眼前节（-）,眼压正常.Humphrey视野检查：双眼颞侧偏盲（图2）.头颅磁共振成像（magnetic resonance imaging,MRI）：视交叉偏右侧T1加权高信号影,T2加权为混杂信号（图3）.诊断为：视交叉出血,海绵状血管瘤可能性大.患者发病后未经特殊治疗,自觉颞侧视野遮挡逐渐好转.因目前出血仅局限于视交叉内部,无外科手术指征,建议密切随访.     

视网膜色素变性的相干光断层成像

目的 通过相干光断层成像（optical coherence tomography,OCT）观察原发性视网膜色素变性（retinitis pigmentosa,RP）患者的视网膜黄斑区图像特征.方法 对临床诊断为原发性视网膜色素变性的25例50只眼进行相干光断层成像检查,观察形态特点并进行厚度测量.结果 原发性视网膜色素变性患者黄斑区的相干光断层图像,通常有6种表现：1.神经上皮层弥漫性增厚即水肿（厚度＞170μm）,13只眼（26%）.2.黄斑囊样水肿8只眼（16.7%）.3.神经上皮层萎缩薄变（＜120μm）,18只眼（36%）.4.视网膜色素上皮层和脉络膜毛细血管层萎缩薄变,见于所有患者.5.黄斑前膜4只眼（8%）.6.黄斑正常厚度.结论 相干光断层成像有助于较早地发现RP的各种黄斑病变,是很有用的检查方法.     

先天性白内障伴无虹膜一家系病例报告

先证者:男性,0岁.无近亲婚配史.自幼双眼视力差,近5年明显加重.2004年2月5日入院.查体,视力:Vd眼前手动,s眼前手动,均不能矫正.     

Quantitative Measurements of the Decentration Distance of Four Kinds of Intraocular Lens

Goodpostoperativevisioncanimprovethelifequalitiesofcataractpatientsgreatly[1]andtheintraocularlens(IOL)decentrationcanaffectvi鄄sualacuityandinduceglare.Todate,itisdiffi鄄culttomeasurethedecentrationdistance(DD)quantitatively.Thedecentrationconditionisusu鄄allyexaminedbynakedeyes.WeappliedthePhotoshopsoftwaretoanalyzethepositionsof4kindsofIOLsquantitatively.Theresultsarere鄄portedasfollows.PatientsandMethods1.Patients.After6monthsofcataractandIOLsurgery,thephotosofpseudophakiceyeswereta…     

鼓膜修补术后致全聋1例

患者,女,41岁.主诉双耳听力下降30余年于2004年11月入院.患者自幼双耳流脓,伴听力下降,药物治疗无改善.20多年前曾在外院行"右耳乳突根治术",术后右耳听力完全丧失.1年前又在外院行"左耳鼓膜修补术",术后即发现左耳听力完全丧失.发病以来无眩晕、耳鸣和面瘫等症状.查体:左鼓膜紧张部中央性穿孔,鼓室少量分泌物.右耳道宽大,乳突腔引流通畅,未见异常分泌物.纯音测听检查示双耳全聋.ABR检查示双耳100dB均无反应.耳部轴位和冠状位放大CT示右侧乳突术腔周围软组织增厚,半规管和前庭缺失.左耳听骨外侧少许软组织密度影,内耳未见明显异常.内耳三维重建MRI示右侧半规管和前庭未显影,左侧内耳形态完好,未见明显异常.     

糖皮质激素类药物临床应用指导原则

(一)眼表急性炎症和干眼急性细菌性结膜炎急性细菌性结膜炎是由各种致病细菌引起的结膜急性炎症.结膜充血,结膜囊出现脓性、黏液性或黏液脓性分泌物是急性细菌性结膜炎的典型体征.[治疗原则]1.针对病因治疗.合并角膜炎者按角膜炎处理.勿包扎患眼,可配戴有色眼镜减少刺激.2.若患眼分泌物较多,可用生理盐水等溶液冲洗结膜囊.早期使用广谱抗生素,确定致病菌后给予敏感抗生素.根据病情可联合用药.3.奈瑟菌性结膜炎应及时全身使用足量抗生素.青霉素为首选药物,如耐药可选择同类其他敏感抗生素.成人淋球菌性结膜炎若角膜被感染,应加大用药剂量.新生儿急性细菌性结膜炎可用静脉滴注或肌内注射方法给药.     

角膜丝状真菌感染病原学检查及药物敏感分析

Objective To analyze the distribution of cultured fungal specimens and the drug susceptibility of corneal fungal infection in vitro in Tianjin, China. Methods From January 2006 to June 2009, all of 170 corneal specimens of suspected fungal keratitis were collected in Tianjin Eye Hospital. The smear of microscopic was observed and cultured on the Sabouraud' s medium for 3～10 days. Drug susceptibilities test for positive samples were evaluated by microdilution method. Results In 170 specimens, the positive serapings smears were 98, positive rate 57.6%. Of 118 samples were positive, positive rate 69.4%. The Agreement rate of smear microscopic observation and fungal culture was 84.7%. Fusarium sp. (69.5%) was the most common pathogen, Aspergrium sp. was 24.6%. Fusarium sp. showed significantly higher susceptible to voriconazole (97.6%) and amphotericin B (84.2%), it was resistant to itraconazole and fluconazole. Aspergrium sp. was susceptible to voriconazole (96.6%), terbinafine (93.1%) and amphotericin B (86.2%), it resisted to itraconazole and fluconazole. Conclusions Fusarium sp. and Aspergrium sp. are the predominant pathogens of corneal mycotic diseases. Most of fungal isolates are susceptible to voriconazole, amphotericin B and terbinafine, whereas most isolates are resistant to itraconazole and fluconazole.     

家族性渗出性玻璃体视网膜病变伴假性外斜视一例

患者女性,33岁.自幼眼斜,未治疗.正常产,无吸氧史.家中兄长眼斜,未治疗.检查:视力:右0.2/Jrl,左0.1/Jrl.散瞳验光:右-5.00 DS,矫正视力0.6;左-5.00 DS,矫正视力0.4.眼压:右14 mmHg,左13 mmHg.眼位:双眼外斜15°注视,交替遮盖双眼不动(图1).双眼球运动正常.双眼角膜清,前房中深,瞳孔直径2 mm,对光反射正常.     

婴幼儿白化病二例

病例1女,82天.因自出生后视力差就诊.患儿家长发现其注视不能,伴畏光,无眼红,未见明显分泌物.患儿为第1胎,足月顺产,出生体重3450g,出生后无明显窒息,无吸氧史.父母非近亲婚配,家族史不详.查体：发育良好,全身皮肤色淡,微呈粉红,毛发色黄白,心、肺、腹未及异常.患儿有物体追随视,固视差,畏光.     

Wegener肉芽肿病1例

患者男,47岁.因右眼发红疼痛,在他院诊断为"巩膜炎",久治无效.于2003年7月16日来我院就诊.检查视力右眼0.8、左眼1.0.右眼球颞上侧巩膜充血呈紫红色,无明显压痛,角膜透明,前房清晰,瞳孔圆形,直径3 mm,晶状体及玻璃体无混浊,眼底无异常.左眼正常.     

前囊膜收缩综合-Nd:YAG激光治疗1例

1病例报告 男,50岁.因双眼视力下降10a,左眼加重0.5a在我院就诊.查:右眼视力:0.2,左眼:0.05.双眼角膜明,前房清,晶状体核性混浊,右眼Ⅲ级,左眼Ⅳ级.眼底看不清.B超:无异常.眼电生理提示:双眼视诱发电位,视网膜电图均异常.于2006-12-20和2007-01-12分别行Phaco IOL植入术.植入博士伦亲水性丙烯酸酯人工晶状体-AKEROSADAPT四襻式人工晶状体.术后视力OD:0.6,OS:0.4.0.5a后,患者感双眼视力进行性下降复诊.视力:OD:0.1,OS:0.05.散瞳后视觉质量进一步下降.双眼前房(-),人工晶状体被挛缩的前囊膜紧紧包裹,近余中心2mm大小前囊袋口.四襻向前,向心卷曲,晶状体光学面向后凸起,后囊膜可见薄层增殖,混浊(图1).予Nd:YAG激光前囊膜放射状切开,人工晶状体光学面变平展,晶状体襻向外张开,视力提高至0.3(图2).     

葡萄膜炎合并视网膜血管炎伴虹膜结晶一例

患者女,30岁.因左眼视物不清2个月于2010年7月26日来我院就诊.无眼红、眼痛、眼部异物感.既往身体健康,无眼部外伤及特殊药物使用史.2个月前足月顺产1名健康男婴.无阳性家族史.全身检查未见异常.跟部检查:视力:右眼0.8,左眼0.6.双跟矫正至1.0,近视力1.0.眼压:右眼19 mm Hg(1 mm Hg=0.133 kPa),左眼14 mm Hg.双眼外眼未见明显异常.裂隙灯显微镜及间接检眼镜检查显示,右服眼前节及眼底未见异常.