雌激素抑制白内障形成的作用

流行病学研究表明初潮晚、绝经早可增加白内障发病率,内源性雌激素及激素替代治疗(hormone replacement therapy,HRT)可抑制白内障的形成.但雌激素抑制白内障发生的分子机制尚不清楚.雌激素可能通过抗氧化损伤、维持细胞膜正常功能、转化生长因子β(transforming growth factor-β,TGF-β)介导途径、雌激素受体(estrogen receptor,ER)途径发挥作用,对各途径及其相互关系的研究,有助于阐明雌激素的作用机制,为有效防治白内障提供新思路.

转化生长因子β1在非增殖型糖尿病视网膜病变中的变化

目的:探讨非增殖型糖尿病视网膜病变患者血清转化生长因子(TGF-β1)和病变程度之间的关系,为糖尿病视网膜病变的早期干预寻找新的方法.方法:对经眼底血管荧光造影证实的非增殖型糖尿病视网膜病变患者(DR组)、无糖尿病视网膜病变的糖尿病患者(DM组)和健康对照组(C组)进行血清TGF-β1的测定,结果分别进行差异性比较.再按Ⅰ、Ⅱ、Ⅲ期病变将视网膜病变患者分成DR1、DR2、DR3三个亚组,再进行差异性比较.结果:血清TGF-β1水平DM组与C组差异无显著性.DR组分别高于DM和C组,差异显著.DR1分别比DR2、DR3低,差异均显著.DR2、DR3两组差异无显著性.结论:非增殖型糖尿病视网膜病变患者血清TGF-β1是升高的,并能部分反映病变的严重程度.对其血清中TGF-β1的测定可以在某种程度上提示干预的时间.

一例脉络膜黑色素瘤的眼科影像学改变

目的:报道1例脉络膜黑色素瘤的眼科影像学改变.方法:回顾性分析1例经病理确诊脉络膜黑色素瘤患者的荧光素眼底血管造影(fundus fluoreseein angiography,FA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)、B超、光相干断层扫描(optical coherence tomography,OCT)等特征.结果:FA检查显示造影早期左眼后极大片遮蔽荧光和散在点状高荧光,造影晚期可见病灶处呈融合加强的点片状高荧光,没有发现明显的异常粗大血管和典型的"双循环征".ICGA检查显示早期病灶区呈弱荧光和脉络膜毛细血管点状高荧光,晚期病灶区呈点片状强荧光,没有发现明显的"发夹样"或"鸡冠样"等异常血管荧光征象.光相干断层扫描(0CT)检查见视网膜全层及脉络膜毛细血管层向玻璃体腔内隆起,B超检查显示左眼玻璃体后段见起自眼球后极部中强回声光团.结论:脉络膜黑色素瘤FA和ICGA可出现不同的表现形式,因此对于眼底造影特征不典型的患者,要结合其他检查共同分析,并密切随诊.

Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods: Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy (≤ C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy.Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in31 eyes (86%) during the primary surgery and in three eyes after a second surgery(94% total). The best-corrected visual acuity was ＜0.1 in 6 eyes (16.7%), 0.1～0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy.Conclusions: This microsurgical procedure to correct RD is simple, convenient,reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.

双侧人工晶状体眼立体视的临床观察

目的:观察老年性白内障患者双眼人工晶状体植入术后近立体视的恢复.方法:分为双眼人工晶状体组及正常老年人组,检影验光后测量远矫正下和近矫正下的近视力并应用Randot stereotests图分别检查两种矫正下的近立体视锐度.结果:远矫正下两组的双眼近视力分别是0.51±0.15和0.52±0.17(LogMar),立体视锐度分别是(101±59)弧秒和(112±55)弧秒.近矫正下两组的双眼近视力分别是0.09±0.10和0.11±0.11,近立体视锐度分别是(33±11)弧秒和(34±10)弧秒,两组间两种矫正下的近视力和近立体视锐度均无差异(P＞0.05),两组内近矫正下的近视力和近立体视锐度均明显优于远矫正下(P＜0.01).结论:老年性白内障患者双眼人工晶状体植入术后近立体视锐度可以恢复到正常同龄人水平.

Purpose:To study the characteristics of PEDF in cataractous aqueous humor and its expression in human lens epithelium.Methods:The PEDF concentration in the aqueous humor was measured by enzyme linked immunosorbent assay in senile (130cases) and congenital (18cases) cataract patients who underwent cataract phacoemulsification extraction surgery. Anterior lens capsular specimens were obtained from these patients to count lens epithelial cells(LEC) density. The Lens Opacities Classification System Ⅲ was used to classify the senile cataracts as cortical, nuclear, posterior subcapsular and mixed types of opacity, and quantitative analysis of the nuclear opacities was performed by Pentacam Scheimpflug imaging system. Anterior lens capsular specimens from another senile(10cases) and congenital (10cases) cataract were collected for immunofluorescence with polyclonal antibodies specific to human pigment epithelium-derived factor(PEDF).Results:The mean aqueous level of PEDF was(178. 9±87. 5)ng/ml, and there was negative linear correlation of PEDF level and age (r=0. 811, P ＜ 0. 001) . In senile cases, the aqueous PEDF concentration decreased with increasing nuclear opacities(r=0. 447, P ＜ 0.01 ), and the mean PEDF level in nuclear cataract was significantly lower than that in posterior subcapsular opacity (P ＜ 0.01 ) . PEDF immunostaining was detected in LEC of all capsular specimens.Conclusion :The PEDF level in human aqueous humor is related to age, types of cataracts and lens opacity. PEDF also express in human LEC. The study results suggest PEDF may regulate and/or protect LEC by paracrine and autocrine, and lack of PEDF may play a role in cataractogenesis.

交流电电击小鼠眼损伤的电镜实验观察

目的:采用透射电镜观察电击死后小鼠眼损伤的超微形态学改变特点.方法:以9例实验小白鼠电击致死(220V,50Hz电流正极接头部,负极接右下肢),取眼球经戊二醛固定后,双眼按中轴线切开一分为二,取其中一半进行电子显微镜观察.结果:9例电击组小白鼠电击死后,眼组织中角膜、晶体、视网膜等均发生了不同程度的电镜形态学改变;5例非电击实验组小白鼠形态学改变不明显.结论:电击实验组小白鼠的眼睛组织在电镜下观察具有一定形态学改变特点,该改变特点对治疗眼部电击损伤有着一定的参考价值.

离体猪眼睫状体上皮电参数测量

目的:测量离体猪眼跨睫状体上皮(ciliary epithelium,CE)电参数,为人眼睫状体研究提供依据.方法:应用改良的Ussing-chamber连续灌注系统对离体的猪眼睫状体上皮电参数:电阻(resistance,R)、电位差(potential difference,PD)及短路电流(short-circuit current,SCC)进行测量,并观察哇巴因(ouabain)对电参数的影响.结果:猪眼跨睫状体上皮房水侧PD为:(-0.6±0.1)mV,且始终保持负性.SCC及R分别为:(-10.9±1.2)μA/cm2及(54.6±1.6)Ωcm2.0.1mM ouabain应用于房水侧PD及SCC表现为先超极化再去极化,即先是刺激作用,然后是抑制作用.结论:猪眼跨睫状体上皮房水侧PD为负性;Na+,K+-ATP酶存在于猪眼色素上皮(pigmented epithelium,PE)和非色素上皮(non-pigmented epithelium,NPE)细胞上,且对维持其睫状体上皮房水侧电极性为负性起重要的作用.

人翼状胬肉细胞的分离和培养

目的:探索人翼状胬肉细胞的体外分离和培养方法.方法:取原发翼状胬肉50例,无菌条件下将胬肉组织剪成1×1 mm2的组织块,37℃环境中0.025%Ⅱ型胶原酶消化20 min,0.05%胰蛋白酶消化10 min,1500 rpm离心10 min,将收集到的细胞用内皮细胞条件培养基制成悬液后进行接种培养,经机械刮除和密度梯度离心法进行纯化,采用CD31、CD34、Ⅷ因子免疫组化和透射电镜方法进行鉴定,设阴性和空白对照.结果:经原代培养后可得到人翼状胬肉成纤维细胞和内皮细胞样细胞,胞浆内分别含有VIM和CD31、CD34及W-P小体.结论:本实验培养获得了人翼状胬肉成纤维细胞和内皮细胞样细胞,方法简便,可操作性强,为进一步研究翼状胬肉的发病机制奠定了坚实的基础.

Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM).Methods: UBM echograms of the anterior segment were taken preoperatively and 62to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue.Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm,0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed.Conclusion: Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.

视网膜电图和多焦视网膜电图视杆细胞ON和OFF反应记录研究

目的:研究全视野视网膜电图(electroretinogram,ERG)和多焦视网膜电图(multifocal eletroretinogram,mf-ERG)视杆细胞ON和OFF反应记录条件并分析其波形特征.方法:2例正常人放瞳、暗适应30 min后,分别采用矩形刺激(rectangle stimulus)、锯齿状的rapid on和rapid off刺激模式记录反应波形,并改变刺激强度和频率观察波形变化.采用模拟矩形刺激、锯齿状的rapid on和rapid off刺激模式记录mf-ERG波形.结果:ERG采用矩形和rapid-on刺激模式可记录到大的正向波,随刺激频率增加,振幅减小,潜伏时变化不明显.采用rapid-off刺激模式记录到小的负向波,潜伏时80ms左右,在负向波下降支近波谷处可见小的正向波.随刺激频率增加,负向波潜伏时延长,而小正向波振幅逐渐减小.当刺激频率大于3 Hz时,上述反应均出现类似振荡电位波形.mf-ERG采用模拟矩形和模拟rapid-on刺激模式可记录到大的正向波,其波形特征与ERG矩形刺激模式的波形类似;采用模拟rapid-off刺激模式仍可记录大的正向波,但其后出现较大陡峭的负向波.结论:采用锯齿状的rapid-on和rapid-off刺激模式可以记录到视杆细胞ON和OFF反应,视杆细胞OFF反应的负向波下降支近波峰处存在小的正向波,采用模拟的rapid-on刺激模式记录到mf-ERG视杆细胞ON反应.建议记录ERG视杆细胞ON和OFF反应采用0.5～1Hz刺激频率和低强度刺激光.将来可利用这些刺激模式研究视网膜疾病,具有一定的临床价值.

增强型绿色荧光蛋白基因在人胚胎视网膜前体细胞中的表达

目的:研究增强型绿色荧光蛋白基因(enhanced green fluorescent protein,EGFP)转染人胚胎视网膜前体细胞的转染效率及瞬时表达情况,建立人胚胎视网膜前体细胞的示踪方法,为视网膜前体细胞移植提供示踪依据.方法:在大肠杆菌中扩增pEGFP-N1质粒,通过磷酸钙介导法转染人胚胎视网膜前体细胞,应用流式细胞仪检测其转染效率,荧光显微镜和激光共聚焦显微镜观察其瞬时表达情况.结果:pEGFP-N1在基因转染24 h细胞转染率为28.98%,48 h为32.45%,72 h为30.40%,对照未转染细胞24 h、48 h分别为2.50%和2.04%;体外观察培养细胞转染24 h已有绿荧光表达,48～72 h细胞荧光强度强,96 h荧光强度减弱.结论:pEGFP-N1质粒能有效转染人胚胎视网膜前体细胞,其转染效率可达到30%,是人胚胎视网膜前体细胞较为理想的瞬时表达载体和细胞示踪报告分子.