F6H8前房内存留对眼内压影响的实验研究

目的:通过动物实验观察硅油清洗剂全氟己基正辛烷 (F6H8)存留于前房对眼内压的影响 ,探讨F6H8的安全性。方法 :新西兰白兔 15只 ,实验组 12只 ,对照组 3只 ,行前房穿刺术 ,注入F6H8(实验组 )或BSS (对照组 ) 0 15ml,术前后定期行裂隙灯检查、眼内压测量 ,并对小梁网组织行组织学检查。结果 :实验组眼压值比对照组升高明显。实验组内术后眼内压呈持续缓慢升高。组织学检查见术后 8周小梁网内皮细胞水肿变性 ,前房角有大量炎症细胞浸润。透射电镜下见小梁网细胞空泡样变性 ,巨噬细胞浸润。结论 :F6H8存留于前房 ,引起眼内压持续缓慢升高 ,8周时出现小梁网内皮细胞组织学结构改变。故临床上应尽量避免硅油清洗剂F6H8进入前房 ,已进入前房的F6H8要尽快取出     

视网膜光凝术联合雷珠单抗治疗新生血管青光眼的临床研究

目的：探讨视网膜激光光凝术联合雷珠单抗(ranibizumab)治疗新生血管青光眼(neovascular glaucoma, NVG)对视功能的改善及不良反应,为临床治疗提供依据。

方法：选择本院2012-01/2014-06 NVG患者100例129眼,随机分为观察组和对照组,对照组50例67眼,应用视网膜激光光凝术治疗; 观察组50例62眼,应用视网膜激光光凝术联合雷珠单抗进行治疗。评估治疗后虹膜新生血管消退情况、视力恢复、眼压及眼底状况,评估患者不良反应。并应用光学相干断层扫描(OCT)检测视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度及视野缺损值。

结果：观察组患者虹膜新生血管消失率为95.2%(59/62),高于对照组83.6%(56/67); 观察组视力4.3～4.7为62.9%(39/62),高于对照组49.3%(33/67),观察组视力≤4.3为25.8%(16/62),低于对照组43.3%(29/67)(P<0.05); 观察组治疗后视网膜静脉循环时间和眼压分别为8.20±0.41s和18.50±0.48mmHg,低于对照组9.42±0.30s和23.94±0.52mmHg(P<0.05); 观察组虹膜新生血管消退时间6.19±0.27d,低于对照组8.37±0.31d(P<0.05); 观察组治疗后RNFL厚度为91.12±2.05μm,高于对照组治疗后85.06±2.19μm,观察组治疗后视野缺损值为13.44±0.59dB,低于对照组治疗后15.92±0.56dB(P<0.05)。两组患者不良反应结果比较,差异无统计学意义(P>0.05)。

结论：视网膜激光光凝术联合雷珠单抗治疗NVG具有较好的临床疗效,能够显著改善患者视力及视网膜结构和功能,具有较高的安全性。     

准分子激光原位角膜磨镶术治疗视觉敏感期后远视性屈光参差性弱视

目的评价准分子激光原位角膜磨镶术（laser in situ kemtomileusis，LASIK）治疗视觉敏感期后远视性屈光参差性弱视1年后的作用和安全性。方法对25例（25眼）年龄为12—16岁的远视性屈光参差性弱视患儿行角膜中央最薄处厚度和中央2．5mm外四个方位厚度检测、1％阿托品散瞳验光、角膜直径测量、wavefront或OPD—scan波前像差仪进行坐位时的虹膜识别后行LASIK治疗。弱视眼屈光度远视1．50—7．50DS，散光为1．00-5．00DC，激光仪使用visxstarS4或NidekEC5000 CX—Ⅱ激光仪，两种激光均具有眼球主动追踪和虹膜识别技术。术后辅助弱视训练，随访12个月以上。结果弱视眼远视切削均值达（3．75±1．20）D，最高限度为6，75DS，术中术后无角膜瓣相关并发症发生。术后第12个月随访时，术眼残余屈光度均值（1.09±1．13）D（P〈0．01），最佳矫正视力由0．24±0．17提高至0．67±0．37（P〈0．01），无最佳矫正视力下降或丢失。结论视觉敏感期后的弱视仍具有可塑性，术后1年的随防表明LASIK治疗远视性屈光参差性弱视安全、有效。     

Impact of Ocular Residual Astigmatism on Visual Outcomes of Myopic Astigmatism Correction after Small Incision Lenticule Extraction

Objective: To calculate ocular residual astigmatism (ORA) by vector analysis and to evaluate the impact of ocular residual astigmatism on refractive and visual outcomes after correction of myopic astigmatism by small incision lenticule extraction (SMILE). Methods: In this prospective case-series study, 115 eyes with myopic astigmatism were treated with SMILE from Jauary 2019 to August 2019 atRefractive Center of Ophthalmology Department, Shengjing Hospital, China Medical University. ORA was calculated by vector analysis and patients were divided into two groups according to the magnitude of ORA: high ORA group (ORA≥1.00 D) with 42 eyes and low ORA group (ORA<1.00 D) with 73 eyes. The follow-up period was 3 months after the operation. Uncorrected visual acuity (UCVA) and pythagorean length were measured and compared after the operation. The following measurements were compared: refractive outcomes, total higher order aberrations (tHOAs), vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, and vertical quadrafoil. Contrast sensitivity was compared between the high and low ORA groups under either 85 cd/m2 or 3 cd/m2 illumination from 1.5 c/d to 18 c/d. The data were analyzed by an independent-samples t test and Mann-Whitney U test to compare the differences between the two groups. Results: Three months postoperatively, refractive outcomes showed that postoperative residual astigmatism in the high ORA group was significantly higher than in the low ORA group (t=3.293, P=0.001). Vector analysis showed that the error vector (EV), absolute error of angle (absolute EA) and index of success (SI) were higher in the high ORA group (t=-3.235, P=0.001; t=-2.326, P=0.020; t=-2.587, P=0.010). After SMILE，all cases had achieved a desirable visual acuity: high ORA group: -0.15±0.05, low ORA group: -0.15±0.05. There were no statistically significant differences in visual acuity, pythagorean length, tHOAs, vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, or vertical quadrafoil between the two groups. An obvious difference was found in contrast sensitivity, which showed a higher contrast sensitivity at a spatial frequency of 18 c/d with 85 cd/m2 in the low ORA group than in the high ORA group (t=-2.877, P=0.005), but this tendency was not present at 3 cd/m2 . Conclusions: Ocular residual astigmatism impacts the precision of SMILE in correcting myopic astigmatism. This leads to a tendency of more residual astigmatism in refractive outcomes, and reduces contrast sensitivity at high spatial frequencies. However, it does not affect the outcome of obtaining good visual quality in both visual acuity and higher order aberrations.     

准分子激光原位角膜磨镶术术中一眼激光切削延迟时双眼波阵面像差的分析

目的利用波阵面像差检测仪探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)中角膜瓣制作与激光扫描切削在时间上有延迟时对手术效果的影响。方法30例(60眼)近视患者自愿接受LASIK手术。手术方式基本同常规LASIK术,不同点为:用角膜刀先后制作左、右眼带蒂上方角膜瓣,再分别对右、左眼角膜基质层行激光切削。于术前、术后第1周、第1个月、第3个月进行双眼波阵面像差的检测和分析。结果术前双眼波阵面像差均方根值(root means squares,RMS)检测各组值比较差异无显著性(P>0.05)。术后第1周在中小瞳孔直径下,右、左眼RMS2和RMSg比较差异有显著性(P<0.05)。术后第1个月仅在小瞳孔直径下,右、左眼RMS2比较差异有显著性(P<0.05)。RMS1、RMS3-6、RMSg及RMSh各组值比较差异均无显著性(P>0.05)。术后第3个月双眼RMS各组值比较差异均无显著性(P>0.05)。术后各时期双眼裸眼视力、最佳矫正视力、平均屈光度比较差异均无显著性(P>0.05)。结论该手术方式步骤衔接紧密,省出有效时间消毒显微角膜板层刀和相关器械,对术后稳定效果无影响,适宜于对大批患者集中进行手术,易于推广应用。     

国人Stargardt病患者ABCA4基因突变分析与表型特征

目的通过对眼底黄色斑点症患者ABCA4基因突变分析,分析国人Stargardt病(STGDI)患者中ABCA4基因突变特点及其表型特征。设计回顾性病例系列。研究对象北京同仁医院可疑Stargardt病患者119例,其中17例家族史明确,102例为散发。方法利用PCR扩增DNA直接测序方法检测患者ABCA4基因50个编码外显子及外显子与内含子交界区,并记录患者的表型特征。主要指标ABCA4基因测序结果、家族史、眼底像、相干光断层扫描(OCT)、眼底自发荧光(AF)、视网膜电图(ERG)、视力。结果 119例STGDI患者中110例(92.4%)检测到2个及以上ABCA4基因致病突变,9例(7.6%)检测到1个致病突变。本研究共检出136种突变,其中新发现突变16种。基因突变中55.1%(75/136)为错义突变,15.4%(21/136)为缺失或插入,17.6%(24/136)为剪接位点突变,11.8%(16/136)为无义突变。最常见突变为无义突变p.Y808X,其等位基因频率最高为17次(7.1%)。STGDI患者平均发病年龄(12.85±9.01)岁,平均最佳矫正视力(0.11±0.12)。结论本研究结果拓展了ABCA4基因突变谱。中国人STGDI患者发病年龄早、视力损伤重,且ABCA4基因特点与其他种族明显不同。     

小干扰RNA沉默 HIF-1α对缺氧状态下脉络膜黑色素瘤细胞中MMP-2 表达的影响

目的：以小干扰RNA沉默人眼脉络膜黑色素瘤细胞中的低氧诱导因子-1(hypoxia inducible factor-1,HIF-1)基因,在缺氧状态下观察其对人眼脉络膜黑色素瘤(human uveal melanoma cell,OCM-1)细胞中基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)基因表达的影响。

方法：将脉络膜黑色素瘤细胞分为正常组与缺氧组,其中将缺氧组再分成单纯缺氧组、干扰组、脂质体对照组、阳性对照组和阴性对照组; 对正常组细胞用含有浓度为10%的胎牛血清和1%的双抗(青-链霉素混合液)的DMEM高糖培养基进行培养。在缺氧组人眼OCM-1细胞的培养瓶中加入100μmol/L CoCl₂以构建肿瘤细胞内部的缺氧微环境。干扰组转染HIF-1α siRNA,阴性对照组转染无义siRNA,阳性对照组转染β-actin siRNA,脂质体对照组转染空脂质体。RT-PCR检测细胞中HIF-1α和MMP-2 mRNA的表达,行Western-blot检测HIF-1α和MMP-2蛋白的表达。

结果：与正常组相比,单纯缺氧组HIF-1α蛋白的表达增高(P<0.05),而其mRNA表达量无明显变化(P>0.05); MMP-2 mRNA及蛋白的表达升高(P<0.05)。缺氧培养的各组之间相比,阳性对照组β-actin mRNA表达下降(P<0.05),证实转染成功; 干扰组HIF-1αmRNA和MMP-2 mRNA和蛋白表达均下降(P<0.05),阴性对照组、脂质体对照组各检测因素均无明显差别(P>0.05)。

结论：缺氧条件下可以提高人眼脉络膜黑色素瘤细胞中HIF-1α蛋白的表达,而且HIF-1α蛋白的表达水平可以影响MMP-2的转录与翻译,从而可能进一步影响人眼脉络膜瘤细胞的外周浸润和远处转移能力。     

Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome

The objective of this study is to identify maternal, perinatal, and fetal risk factors for clavicular fracture in a single institution. We performed a prospective study of all deliveries during a 14-month period to identify confirmed cases of neonatal clavicular fracture. The control group consisted of the deliveries immediately preceding and following the index cases. Fifty-three cases of clavicular fracture were identified among the 4789 deliveries from October 1995 through November 1996 for an incidence of 1.11%. Three neonates in the clavicular fracture group were delivered through cesarean section. Neonates with fracture were significantly heavier at birth than those without (3564 vs. 3283 g, p <0.001), and had a lower mean head-to-abdominal circumference ratio (0.93 vs. 1.08, p <0.001), history of giving birth to a macrosomia (21 vs. 4%, p <0.05). The anterior shoulder was the predominant site of fracture (30/53). Fracture was detected mostly during the first 3 days of neonatal life (46/53). The outcome was benign, with complete recovery in all cases and no associated neurological sequelae. Neonatal clavicular fracture tended to be associated with neonatal somatometric characteristics and difficult deliveries. Considering the benign nature of this birth trauma, more invasive intrapartum management to lower its incidence is not advised.     

调控人羊膜上皮细胞AQP8表达的cAMP-PKA信号转导通路研究

目的:研究调控人羊膜上皮细胞AQP8表达的cAMP-PKA信号转导通路。方法:用RNA转录抑制剂ACT-D、蛋白合成抑制剂Cycloheximide(CHX)及蛋白激酶A抑制剂H-89处理被8-Br-cAMP诱导的WISH细胞。采用Western blot技术定量WISH细胞AQP8蛋白表达水平,逆转录聚合酶链反应(RT-PCR)技术检测WISH细胞AQP8 mRNA的表达。结果:8-Br-cAMP处理组WISH细胞AQP8 mRNA和蛋白表达水平分别为0.083±0.007和0.144±0.008,与对照组的0.026±0.003;0.027±0.004比较,差异有统计学意义(P0.05)。ACT-D处理组WISH细胞AQP8 mRNA的表达水平为0.021±0.004,低于对照组的0.026±0.003,差异有统计学意义(P0.05)。ACT-D+8-Br-cAMP处理组WISH细胞的AQP8 mRNA表达水平为0.031±0.006,明显低于8-Br-cAMP处理组,但高于ACT-D处理组,差异均有统计学意义(P0.05)。H-89处理组WISH细胞AQP8 mR-NA和蛋白表达水平均低于对照组,差异有统计学意义(P0.05)。H-89+8-Br-cAMP处理组WISH细胞AQP8 mRNA和蛋白表达水平均明显低于8-Br-cAMP处理组,但高于H-89处理组,差异均有统计学意义(P0.05)。CHX处理组WISH细胞AQP8 mRNA和蛋白的表达水平均低于对照组,差异有统计学意义(P0.05)。CHX+8-Br-cAMP处理组WISH细胞AQP8 mRNA和蛋白表达水平均明显低于8-Br-cAMP处理组,但高于CHX处理组,差异均有统计学意义(P0.05)。结论:ACT-D、CHX和H-89抑制cAMP诱导的人羊膜上皮细胞AQP8 mRNA和蛋白表达增加的效应,cAMP可能是通过PKA信号转导途径在基因转录、蛋白合成等多个水平调控人羊膜上皮细胞AQP8表达。