病理性近视后巩膜葡萄肿的研究进展

我国近视眼患者超过3亿,其中高度近视患者已超过一千万,高度近视中很大一部分为病理性近视(pathological myopia,PM),其并发的眼底病变已成为眼底病中不可逆致盲的首位眼病.在病理性近视眼底一系列退行性病变中,后巩膜葡萄肿(posterior staphyloma,PS)是最基础的病变之一,其发病原因仍无定论,可能是眼轴不断延长、巩膜中胶原的合成及分解紊乱造成胶原蛋白减少共同造成巩膜变薄而不能抵抗眼压的结果.目前病理性近视后巩膜葡萄肿的唯一治疗手段为后巩膜加固术.对于无临床症状或者因PS而产生的并发症需要定期观察,手术时机仍需要大量的临床研究进行评估.     

超高度近视并发白内障患者术后视力与后巩膜葡萄肿相关性分析

目的 探讨后巩膜葡萄肿对超高度近视并发白内障超声乳化术后视力的影响.方法 对129例(153只眼)超高度近视合并白内障患者实施小切口超声乳化吸除联合人工晶状体植入术,术后随访3个月.观测后巩膜葡萄肿与术前测量的眼轴及术后视力的关系.结果 后巩膜葡萄肿组与非后巩膜葡萄肿组相比眼轴长度有所增加,但对术后视力的影响差异无统计学意义(P>0.05).结论 超高度近视并发白内障患者中,术后视力与是否伴发后巩膜葡萄肿无明显相关性.

Abstract：

Objective To evaluate the relationships between the postoperative visual acuity and posterior staphyloma in cataract with extreme myopia.Methods One hundred and twenty-nine cases (153eyes)with extreme myopia received small incision phacoemulsification and followed up for 3 months.The relationship between posterior staphyloma and the postoperative visual acuity as well as axial length were analyzed.Results The axial length in posterior staphyloma group were increased,but there were no statistical difference in postoperative visual acuity when compared with none posterior staphyloma group (P >0.05).Conclusions The postoperative visual acuity of extremely myopic eye with cataract after phacoemulsification has no significant correlation with posterior staphyloma.     

后巩膜葡萄肿深度与高度近视合并白内障患者术后屈光误差的关系

目的　研究后巩膜葡萄肿深度与高度近视合并白内障患者术后屈光误差的关系。方法　选取在我院行白内障超声乳化摘出联合人工晶状体植入术的高度近视合并白内障伴后巩膜葡萄肿的患者共56例（70眼）。术前B超测量后巩膜葡萄肿深度。术后2个月时测量患者屈光状态,计算平均绝对屈光误差值（mean absolute refractive error,MAE）,并将后巩膜葡萄肿深度与MAE进行Pearson相关分析。结果　预期屈光度为（-2.91±0.85）D,术后实际屈光度为（-2.63±1.15）D,MAE为（-0.74±0.56）D,实际屈光度与预期屈光度差异有统计学意义（t=-2.723,P=0.008）。本组患者后巩膜葡萄肿深度为0~6.27（2.13±1.45）mm,其中64眼能测出后巩膜葡萄肿深度;6眼无法测量其后巩膜葡萄肿深度。后巩膜葡萄肿深度与眼轴长度呈正相关关系（r=0.776,P=0.00）;后巩膜葡萄肿深度与MAE呈正相关关系（r=0.522,P=0.00）;MAE与眼轴长度呈正相关关系（r=0.540,P=0.00）。结论　随着高度近视后巩膜葡萄肿深度增加,术后屈光误差增大。     

后部眼球壁膨突的超声鉴别诊断

目的 探讨后部球壁膨突的声像学表现及声像图对先天性脉络膜缺损和高度近视后巩膜葡萄肿的诊断价值。方法 回顾性分析163例先天性脉络膜缺损和高度近视后巩膜葡萄肿的声像学表现。结果 先天性脉络膜缺损声像图表现为自视盘上缘或下缘向下的局限性球壁向后膨突；膨突后缘陡峭，前缘平滑，与极周边球壁无明显界限；后巩膜葡萄肿声像图上均表现为后方球壁向后一致性膨突，膨突球壁呈渐进性移行，无具体边界，表现为锥形、楔形和矩形等不同形状。长期合并视网膜脱离时，先天性脉络膜缺损的球壁膨突仍然存在，而高度近视的后巩膜葡萄肿消失。结论 声像学检查可为先天性脉络膜缺损和高度近视后巩膜葡萄肿的诊断和鉴别诊断提供依据。     

高度近视眼轴的初步研究

本文观测了高度近视５６例１１２眼的前房深度、眼轴长度、后巩膜形态、屈光状态、眼内压及巩膜壁硬度，并与正常对照组６２眼比较。高度近视的眼轴明显延长，主要是眼球后部扩张。这种变化在发生后巩膜葡萄肿的病例更为显著。高度近视组巩膜壁硬度下降，眼内压无明显改变，提示眼球壁抗力降低似为眼轴延长的重要因素。     

巩膜加固术治疗高度近视的研究进展

由眼轴不断加长引起的病理性近视（高度近视）及其并发症是导致视力损害及致盲的主要原因之一。因其病因尚不完全明了，目前仍无较理想的治疗方法。放射状角膜切开术（ＲＫ）、准分子激光角膜成形手术虽可解决部分屈光问题，但不能阻止本病进展。巩膜加固术，旨在加固后葡萄肿的变薄区巩膜，阻止后葡萄肿进展，达到稳定近视度数；阻止黄斑及后极部视网膜变性发生和发展的作用，从而挽救部分进展迅速的高度近视患的视力。本拟从实     

高度近视黄斑劈裂研究进展

黄斑区视网膜劈裂是高度近视后巩膜葡萄肿常见并发症之一,光学相干断层成像(optical coherence tomography OCT)技术能直观的显示其特征。近年来随着OCT技术的广泛应用,高度近视黄斑劈裂的研究也备受关注,本文主要就其发生机制和目前治疗方法进展作一综述。     

高度近视伴后巩膜葡萄肿超声乳化术后视觉质量分析

目的：评价高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合人工晶状体(intraocular lens,IOL)植入术后的视觉质量,并分析其原因。 方法：本研究根据患者术前屈光状态以及有无后巩膜葡萄肿分为三组：A组为高度近视伴有后巩膜葡萄肿的白内障患者;B组为高度近视无后巩膜葡萄肿的白内障患者;C组为正视眼的白内障患者。于手术后3d观察A、B、C三组裸眼远视力(uncorrected distance visual acuity,UCDVA)和最佳矫正远视力(best-corrected distance visual acuity,BCDVA),术后6mo观察A组视力与眼轴的关系、A、B、C三组UCDVA和BCDVA、对比敏感度、眼底检查及患者术后满意度调查。 结果：在本实验收集的472例患者（545眼）中,A组患者74例（91眼）;B、C组各199例（227眼）。术后3d及6mo,B、C组的UCDVA及BCDVA均优于A组,差异有统计学意义（均P<0.05）;术后3d,C组的裸眼远视力及最佳矫正远视力优于B组,差异有统计学意义（P<0.05）;术后6mo患者UCDVA及BCDVA在B、C两组间的差异无统计学意义。 A组和B组在4种状态5种空间频率下的对比敏感度的差异均有统计学意义（均P<0.05）,C组的对比敏感度高于A、B组,B组的对比敏感度要高于A组,差异有统计学意义（均P<0.05）。经统计学检验,高度近视伴后巩膜葡萄肿白内障患者超声乳化术后视力与眼轴长短之间呈负相关性。 A、B组患者术后视觉质量满意度高于C组,差异有统计学意义（均P<0.05）,但A、B组间患者术后质量满意度无明显差异。 结论：高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合IOL植入术后的视觉质量较高度近视不伴有后巩膜葡萄肿的白内障及正视眼的白内障患者差,这与高度近视眼底病变有直接关系。     

同种异体巩膜瓣移植治疗前巩膜葡萄肿

目的探讨异体巩膜瓣移植治疗病理性前巩膜葡萄肿的临床疗效。方法对玻璃体切除术后的前巩膜葡萄肿3例（3眼）和前巩膜葡萄肿穿孔伴化脓性眼内炎1例（1眼）施行同种异体巩膜瓣移植,随访5～24个月。观察视力、巩膜植片、视网膜、眼压及其并发症等。结果3例玻璃体切除后的前巩膜葡萄肿,巩膜移植术后视力均同术前;巩膜植片表面可见血管网,植片无溶解,视网膜均在位,眼压控制在正常范围。1例前巩膜葡萄肿穿孔伴化脓性眼内炎,巩膜移植术后视力由术后光感／光定位不准恢复至0．05,玻璃体腔硅油填充,视网膜在位。巩膜植片周围被纤维组织包裹,略呈弧形隆起,并有新生血管长人,形成加厚的“新巩膜”。结论同种异体巩膜瓣移植治疗病理性前巩膜葡萄肿,能修补菲薄或穿孔的巩膜,且无排斥反应;能有效维持眼压,尽可能挽救患者的视力。     

高度近视黄斑劈裂研究进展

黄斑劈裂（MF）是高度近视后巩膜葡萄肿的最常见并发症之一。本文主要对高度近视MF的发生机制、病理改变、合并病变、自然病程及手术治疗进行综述。     

丝裂霉素C用于不同屈光度LASEK术中的对比研究

目的探讨丝裂霉素C（MMC）对不同屈光度准分子激光上皮瓣下角膜磨镶术（LASEK）后角膜上皮下雾状浑浊（haze）与屈光回退的影响。方法将接受LASEK手术者先根据屈光度分为低、中、高度组,再将各组分为LASEK组和LASEK联合MMC组。低、中、高度LASEK联合MMC组在激光切削完毕后用浸有0.02%MMC的绵片覆于角膜切削区,时间分别为20～25s、40～50s、60～80s。术后早期观察眼部刺激症状及角膜上皮愈合情况;1、3、6、12个月复查视力、角膜haze及角膜地形图。结果 （1）术后疼痛反应、角膜上皮愈合时间低、中、高度的LASEK组与LASEK联合MMC组无显著性差异（P〉0.05）;（2）术后1、3、6、12个月,haze发生率低度近视LASEK组与LASEK联合MMC无显著性差异,中、高度近视LASEK联合MMC组haze发生率低于LASEK组（P〈0.05）;（3）低、中、高度近视LASEK联合MMC组角膜曲率术后1a与1个月相比,差别无统计学意义（P〉0.05）,高度近视LASEK组角膜曲率术后1a与1个月相比差异有统计学意义（P〈0.05）;（4）术后1a低、中近视LASEK联合MMC组与LASEK组达最佳矫正视力者差异无统计学意义（P〉0.05）,但高度近视LASEK联合MMC组达最佳矫正视力的眼数多于LASEK组（P〈0.05）。结论 LASEK术中MMC敷贴合适时间可以降低术后haze及屈光回退的发生率,高度近视组尤为显著;术前屈光度越高,所需MMC敷贴时间越长。     

高度近视遗传学和基因定位研究进展

高度近视在人群中患病率较高(约1%),是致盲的重要原因之一。高度近视有家族性并有明显的遗传倾向。我们就近年来有关高度近视的遗传因素、遗传模式、候选基因的筛查、相关基因定位等分子遗传学研究工作方法和进展加以综述。     

高度近视并发性白内障术后屈光误差影响因素的研究进展

高度近视是我国乃至全世界主要致盲性疾病之一,而高度近视并发性白内障更是一种高致盲风险的复杂性白内障,目前手术是唯一的治疗手段,由于高度近视可导致眼内一系列复杂改变,相比正常眼轴眼而言,术后更易产生屈光误差以及屈光漂移,本文就术前生物学测量准确性、人工晶状体计算公式的选择、有效人工晶状体位置变化等几部分对高度近视并发性白内障术后屈光误差的影响因素作一综述。     

青光眼睫状体炎综合征的临床特征分析

目的分析青光眼睫状体炎综合征（PSS）的临床特点。方法连续选取PSS患者66例（69只眼）,记录及追踪其性别、首次发病年龄、既往史、临床体征（眼压、KP、虹膜情况、C/D等）、首次诊断、治疗方案等临床资料并进行分析。结果 66例（69只眼）患者中,男性38例（41只眼）,女性28例（28只眼）;平均发病年龄（37.89±12.69）岁;发病时平均眼压（35.71±12.42）mmHg;平均KP数为（4.93±4.27）个;虹膜异色者9例,占13.64%;6例发病眼与对侧眼C/D差≥0.2,占9.09%;首诊误诊9例,误诊率为13.64%;具有内分泌或免疫性疾病史病例共19例,占28.79%;合并近视性屈光不正者21例。结论 PSS并非全部为良性经过,有待进一步分型;误诊误治时有发生,临床上需加以重视;具有内分泌或免疫性疾病史者可能为易感人群;PSS的发生与机体状态的关系有待明确,PSS发生机制有待研究。     

豚鼠实验性近视诱导方法及形成过程

近视,尤其是高度近视,是当今全球眼病危害的重要原因之一,多年来研究人员建立了多种动物模型、进行了各种动物实验以探究近视发生发展的机制.豚鼠是近年来最常采用的一种近视模型动物,其在各方面都具有明显的优点,是有价值继续应用于各种近视实验并进行深入研究的实验动物.本文就豚鼠近视模型诱导方法及形成过程作一综述.     

小切口超声乳化及大直径折叠式人工晶体植入治疗高度近视眼白内障临床观察

目的评价小切口超声乳化及大直径折叠式人工晶体植入对于治疗高度近视性白内障的安全性和疗效。方法表麻醉下对40例68只眼高度近视白内障患者施行透明角膜3.2mm切口超声乳化吸除,植入大直径后房型折叠式人工晶体。察术中的安全性及术后疗效。结果术中无一例发生后囊膜破裂、前房出血以及爆发性脉络膜上腔出血。术后1天裸眼或正视力≥0.5者,占54.41%;术后1周为70.59%;1个月为82.35%;视力≥1.0者,术后1天为8.82%、术后1周为25%、1个为41.18%。结论小切口超声乳化及大直径折叠式人工晶体植入治疗高度近视白内障,具有视力恢复快、无严重并发症等点,但是对手术技巧要求较高。术后视力提高与高度近视眼底病变有关。     

A metabolic analysis of high myopia and senile macular degeneration

Abnormal zinc and copper metabolism have been described in several retinal disorders affecting the retinal pigment epithelium. An infrequent presentation of senile macular degeneration in high myopia is well known. We examined the blood for zinc and copper and the urine for copper of three groups of patients, one consisting of high myopia, another with high myopia and primary retinal detachment and the other a group of patients with senile macular degeneration. When comparing the above groups of patients, we found statistically elevated values of serum zinc (p = less than 0.005) in the group of patients with senile macular degeneration. The significance of these findings, and a correlation with the pathogeneses of high myopia and senile macular degeneration is discussed.     

Community-based study of the association of high myopia in children with ocular and systemic disease.

PURPOSE: High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. METHODS: Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. RESULTS: High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. CONCLUSIONS: There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia > or =5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.     

Family aggregation of high myopia: estimation of the sibling recurrence risk ratio

PURPOSE: To estimate the sibling recurrence risk (KS) and the sibling recurrence risk ratio (lambda(S)) for high myopia in a cohort in the United Kingdom. METHOD: The recurrence risks for myopia and high myopia were estimated in the siblings of 296 randomly selected high myopes ascertained from an optometric practice population. A model using an age of onset of spectacle wear for myopia of 9.1 +/- 0.7 years or younger was developed as a surrogate for high myopia. The influence of parental myopia on the sibling recurrence risk for high myopia was also evaluated. RESULTS: KS was estimated (95% confidence limits) to be 10.0% (5.9, 14.8) and lambdaS to be 4.9 (2.8, 7.6). High myopes without myopic parents were surprisingly common ( approximately 40%) and were less likely to have highly myopic siblings (KS approximately 6%) than those with at least one myopic parent (KS approximately 14%). CONCLUSIONS: The sibling recurrence risk ratio reported herein (lambdaS approximately 4.9) implies that the high penetrance autosomal dominant loci for high myopia identified to date account for only a minority of cases of high myopia in the United Kingdom. Furthermore, high-penetrance autosomal dominant inheritance or even high-penetrance recessive inheritance, per se, cannot account for most cases of high myopia. Instead, it may be necessary to consider high myopia as a "complex disease" resulting from the influence of either alleles of reduced penetrance ("susceptibility genes"), environmental factors, or both.     

高糖饮食与近视相关信号通路关系的研究

随着近视发病率的升高,近视已成为影响我国社会健康的主要问题之一。近视是环境或遗传因素造成异常的视觉信息作用于视网膜,经视网膜色素上皮层-脉络膜信号转导,最终作用于巩膜,引发巩膜重塑而形成的。其中饮食因素很少受到关注,但已有文献报道高糖是近视的危险因素之一,长期高糖摄入导致血糖和胰岛素升高,胰高血糖素降低,以及诱发的慢性高胰岛素血症介导的胰岛素样生长因子-1、胰岛素样生长因子结合蛋白-3表达变化等均可影响近视的进程。本文就高糖饮食与近视相关信号通路的关系进行综述,探讨影响近视进程的潜在分子机制。