典必殊眼膏注入泪小管治疗泪小管炎的临床体会

目的：探讨改善临床治疗泪小管炎疗效的新方法。方法：针对我科门诊就诊的泪小管炎病例,先用生理盐水尽量冲洗泪道分泌物和泪道内结石,然后用庆大霉素冲洗,再用典必殊眼膏泪小管内注入保留。结果：所有5例泪小管炎病例均病情恢复迅速,15天至1月内均获得治愈,随访半年以上无复发表现。结论：采用冲洗后再加入典必殊眼膏泪小管内注入的新方法疗效确切,且起效迅速,操作简单,为临床治疗慢性泪小管炎提供了一条新途径。     

先天性泪囊炎的治疗及护理

目的探讨先天性泪囊炎的治疗及护理措施。方法对386例(407眼)先天性泪囊炎患儿采用泪囊按摩、泪道冲洗、探通、再冲洗的治疗方法及护理措施。结果泪囊区按摩法一次治疗成功率1.47%,泪道冲洗+探通+再冲洗一次治疗成功率94.34%,二次治疗成功率2.70%,三次治疗成功率1.47%。结论先天性泪囊炎患儿采取泪道冲洗+探通+再冲洗并配合临床护理可显著提高治疗效果。     

亚甲蓝在泪小管断裂手术中的应用

目的：探讨泪小管断裂实施手术修复时，利用亚甲蓝的粘膜染色功能寻找泪小管断端，从而提高泪小管吻合成功率的临床治 疗效果。方法：将65例眼睑撕裂伤伴泪小管断裂患者随机分为两组。A 组使用亚甲蓝为染色剂，B 组使用Worst 的猪尾巴探针，术 中帮助寻找泪小管鼻侧断端，比较两组患者的临床治疗效果。结果：两组患者手术治愈率比较，差异无统计学意义（P>0.05）；A 组 手术时间比B组短，差异具有统计学意义（P<0.05）。结论：亚甲蓝的粘膜染色功能有助于术中顺利找到泪小管鼻侧断端，减少术 源性再损伤，缩短手术时间，提高手术成功率，操作简便，患者耐受性较好。     

慢性泪囊炎行泪囊鼻腔吻合术围手术期护理

目的总结慢性泪囊炎鼻腔吻合术围手术期护理效果。方法对31例慢性泪囊炎行泪囊鼻腔吻合术患者于术前给予心理护理、患者准备,术后严密病情观察、加强健康教育、泪道冲洗、出院指导等护理措施。结果 31例(31眼)患者均痊愈出院,无1例并发症发生。结论积极有效的围手术期护理措施是提高手术成功率,减少术后并发症,促进患者顺利康复的重要保证。     

不同泪道硅胶引流管留置时间对慢性泪囊炎患者视力、生活质量及复发率的影响

目的:探讨不同泪道硅胶引流管留置时间对慢性泪囊炎患者的生活质量、视力及复发率的影响。方法:回顾性选取2018年1月2019年12月期间于我院就诊的慢性泪囊炎患者91例(128眼),根据术后泪道硅胶引流管留置时间分为A、B两组,其中A组泪道硅胶引流管留置时间6周,44例(61眼),B组泪道硅胶引流管留置时间12周,47例(67眼)。对比两组疗效、视力、并发症发生率、主诉溢泪发生率、生活质量及复发率。结果:A组拔管当天的总有效率高于B组(P<0.05),两组拔管后3个月总有效率对比无明显差异(P>0.05)。拔管后6个月两组社会功能、躯体疼痛、精神健康、生理功能、精力、情感职能、生理职能、总体健康维度评分均较术前升高(P<0.05),但两组组间对比未见统计学差异(P>0.05)。两组患者术前、拔管后3个月视力组间及组内比较均未见统计学差异(P>0.05)。两组患者主诉溢泪发生率比较未见统计学差异(P>0.05)。A组并发症发生率、复发率低于B组(P<0.05)。结论:泪道硅胶引流管留置时间的长短对慢性泪囊炎患者疗效、视力、生活质量、主诉溢泪发生率无明显影响,但留置6周者并发症发生率、复发率低于留置12周者,提示临床应视患者具体情况尽量缩短泪道硅胶引流管留置时间。     

典必殊眼膏加艾灸治疗中老年睑板腺功能障碍的临床观察

目的:观察糖皮质激素典必殊联合中药艾灸在治疗睑板腺功能障碍性的临床疗效。方法:对本院门诊就诊的睑板腺功能障碍的患者72例144只眼,进行眼科一般常规检查后,再做泪液分泌实验和泪膜破裂时间测定等检查,确定为睑板腺功能障碍后分成两组,一组给予典必殊加艾灸治疗;另一组给予常规治疗(热敷、氧氟沙星滴眼液、普拉洛芬滴眼液点眼等),观察记录治疗效果,进行统计学处理。结果,4到5周后,实验组治疗效果明显高于对照组的效果。实验组总有效率94.4%,对照组总有效率86.1%%。结论:睑板腺功能障碍用典必殊眼膏加艾灸治疗疗效显著,长期疗效优于其它疗法,经临床观察且无局部和全身的不良反应。     

改良泪囊鼻腔吻合术治疗慢性泪囊炎的治疗体会

慢性泪囊炎为眼科常见眼病之一,长期流泪、流脓,给患者带来极大痛苦.临床上多继发于鼻泪管狭窄或阻塞后而导致的,其治疗原则是重新建立鼻内引流通道,解除阻塞,消除感染[1].传统术式经鼻外内眦部行泪囊鼻腔吻合的创伤大.我院采用改良泪囊鼻腔吻合术治疗慢性泪囊炎149例（192眼）,效果较好,现报告如下.     

同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的疗效对比研究

摘要 目的：探讨同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的临床疗效。方法：回顾性分析本院2017年1月至2019年10月期间收治的76例慢性泪囊炎合并慢性鼻-鼻窦炎患者的临床资料,根据手术方式分为A组和B组,各38例。A组行分期手术（鼻腔鼻窦病变处理控制鼻腔鼻窦炎症后再行鼻内镜下泪囊鼻腔造孔术）。B组行同期手术（处理鼻腔鼻窦病变后立即行鼻内镜下泪囊鼻腔造孔术）,比较两组围术期指标、临床疗效、术后并发症发生情况,采用慢性泪囊炎生活质量量表（DQOLS）评价患者术前和术后6个月时的生活质量。结果：B组总有效率为94.74 %（36/38）,A组总有效率为92.11 %（35/38）,两组总有效率比较无明显差异（P>0.05）;B组术后并发症总发生率为13.16 %（5/38）,与A组的10.53 %（4/38）比较无明显差异（P>0.05）。两组患者术后6个月时的DQOLS各维度评分和总分均较术前升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）。B组患者住院总费用少于A组,住院时间、手术时间均短于A组（P<0.05）,两组术中出血量比较无明显差异（P>0.05）。结论：同期手术与分期手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎患者具有相当的临床疗效和安全性,且对患者生活质量的改善程度亦无明显差异,但前者能够缩短手术时间、住院时间及减少住院费用。     

负压吸引联合冲洗法治疗慢性骨髓炎

目的探讨负压吸引联合冲洗法治疗慢性骨髓炎的临床疗效。方法分析总结我院2009年以来应用负压吸引加冲洗治疗的61例慢性骨髓炎患者的临床资料。结果全部病例均痊愈,经6个月~2年的随访无复发病例。结论负压吸引加冲洗治疗慢性骨髓炎的疗效显著,安全、可靠。     

慢性泪囊炎病原菌的初步调查

慢性泪囊炎病原菌的初步调查大连市二院眼科邵彦,李桂香,吴萍大连市二院护理组吕秀玉,单华慢性泪囊炎是一种比较常见的眼病。为了更好地指导其治疗工作,本文运用微生态学方法,对本病病原菌分布做了初步调查,并做了病原菌对四种常用眼药水敏感试验。１．材料与方法１...     

Blind canalicular marsupialization in complete punctal absence as part of a systematic approach for classification and treatment of lacrimal system obstructions

The procedure of choice for epiphora caused by bipunctal and canalicular obstruction is conjunctivodacryocystorhinostomy. Despite its high success rate, it may result in multiple complications, such as extrusion, migration, and secondary obstruction. The author describes a simple alternative procedure to conjunctivodacryocystorhinostomy for patients with epiphora caused by bipunctal and proximal canaliculus complete occlusion and a systematic approach to treat lacrimal system obstructions. Ten instances of bipunctal and proximal canaliculus absence in five consecutive patients, caused in four patients by ocular surface disorders (topical drug toxicity, herpetic keratoconjunctivitis, and trachoma), were treated by blunt dissection of the presumed lower punctal site under a surgical microscope. The punctal site was determined by several landmarks, the peaked medial lid margin, a dimple at that site, or an area of relative avascularity. The canaliculus was exposed and expanded to create a pocket. After the procedure, the lacrimal drainage system was found patent in nine of the 10 procedures. After one additional procedure, irrigation of the lacrimal drainage system revealed a nasolacrimal duct obstruction that was treated with dacryocystorhinostomy and silicone tube insertion. After these procedures, an objective resolution of the epiphora was noted in all patients. Epiphora resulting from lack of punctal and proximal canaliculus caused by ocular surface diseases may be treated with blind exposure and marsupialization of the proximal canaliculus instead of conjunctivodacryocystorhinostomy. If, in addition, the nasolacrimal duct is obstructed, a dacryocystorhinostomy may be performed. If this proposed procedure fails, the patient can still undergo conjunctivodacryocystorhinostomy or other procedures. The procedure may be part of a systematic approach to treat lacrimal drainage obstructions that is based on an association between the location and the cause of the obstruction.     

Development of a new lacrimal drainage conduit using POSS nanocomposite

Lacrimal surgery in cases of severely obstructed or missing canalicular ducts is highly challenging. In these cases, the placement of a bypass tube is currently the only option to restore the drainage of tears into the nose and reduce the symptomatic watery eye. Different approaches to achieve functional drainage have been tried using blood vessels or artificial implants. The implantation of the rigid Lester Jones tube is, since its introduction in the late 1960s, the gold standard. The functional success is satisfactory. However, complication rates are high and remain, even with many modifications of the original design, a major problem. These complications include mainly the displacement and blockage of the tube, requiring regular checkups, as well as irritation of the surrounding tissue including the nose and the eye. The objective of this study was to develop a new lacrimal duct conduit (LDC) to restore structural and functional integrity of the lacrimal drainage system. The conduit is constructed with a novel polymer, polyhedral oligomeric silsesquioxane-poly(carbonate-urea)urethane (POSS-PCU), that offers biocompatibility. We exploit nanotopography to evade the problems associated with current applications. A number of extrusion techniques were investigated for this purpose: ultrasonic atomization spraying, electrohydrodynamic atomization spraying/spinning, extrusion-coagulation, and high-pressure coagulation by autoclave and casting. Finally, the coagulation and cast technique were selected to construct an LDC superior to its predecessors, and its advantages highlighted.     

Severe focal sialadenitis and dacryoadenitis in NZM2328 mice induced by MCMV: a novel model for human Sjögren's syndrome

The genetic and environmental factors that control the development of Sj?gren's syndrome, an autoimmune disease mainly involving the salivary and lacrimal glands, are poorly understood. Viruses which infect the glands may act as a trigger for disease. The ability of sialotropic murine CMV (MCMV) to induce acute and chronic glandular disease was characterized in an autoimmune-prone mouse strain, NZM2328. MCMV levels were detectable in the salivary and lacrimal glands 14-28 days after i.p. infection and correlated with acute inflammation in the submandibular gland. After latency, virus was undetectable in the glands by PCR. At this stage, NZM2328 female mice developed severe chronic periductal inflammation in both submandibular and lacrimal glands in contrast to the much milder infiltrates found in female B6-lpr and male NZM2328. The focal infiltrates consisted of CD4+ and B220+ cells as opposed to diffuse CD4+, CD8+, and B220+ cells during acute infection. Salivary gland functional studies revealed a gender-specific progressive loss of secretory function between days 90 and 125 postinfection. Latent MCMV infection did not significantly affect the low incidence of autoantibodies to Ro/SSA and La/SSB Ags in NZM2328 mice. However, reactivities to other salivary and lacrimal gland proteins were readily detected. MCMV infection did not significantly alter the spontaneous onset of kidney disease in NZM2328. Thus, chronic inflammation induced by MCMV with decreased secretory function in NZM2328 mice resembles the disease manifestations of human Sj?gren's syndrome.     

Effects of total parenteral nutrition on rat bile canaliculi: a stereologic analysis

OBJECTIVE: To quantitate, in a stereologic manner, changes in bile canalicular morphology before and after choleretic infusion of total parenteral nutrition (TPN) and to determine whether TPN produces changes in localized regions within the hepatic lobule. STUDY DESIGN: Livers were obtained from sham-operated on normal adult male rats (control) and from rats that received intravenous TPN solution containing 20% glucose and 3.5% Molipron F. The tissues, obtained by a rigorous sampling procedure, were systematically subjected to stereologic analysis. Measurements were made on electron micrographs at two levels of magnification by point, intersection and profile counts, and then volume, surface area and length were estimated per unit parenchymal volume. RESULTS: The surface area of the canalicular wall per parenchymal volume increased significantly (from 5.33 x 10(-2) to 6.73 x 10(-2) microns 2/micron 3) after TPN treatment, as did the length of microvilli (from 0.241 to 0.267 microns/micron 3). However, the volume of bile canalicular lumina per parenchymal volume (0.306% and 0.320%), total length of bile canaliculi (1.05 x 10(-2) and 1.06 x 10(-2) microns/micron 3) and diameter of microvilli (8.73 x 10(-2) and 8.94 x 10(-2) microns) remained constant. CONCLUSION: These results indicate that changes in canalicular shape and microvillus hypertrophy may cause lowering efficiency of the bile flow rate.     

SD大鼠、Beagle犬和新西兰白兔主泪腺的解剖学特点及形态学观察

目的观察及比较SD大鼠、Beagle犬、新西兰白兔主泪腺的解剖学和形态学特点.方法 SD大鼠、Bea-gle犬和新西兰白兔的主泪腺剖取并用12%福尔马林固定,进行石蜡切片、HE染色和PAS染色,光学显微镜观察.结果SD大鼠的眶外泪腺和眶内泪腺均为管泡状的浆液性腺;Beagle犬的主泪腺属于管泡状混合性腺,腺组织被结缔组...     

NF-kB 和TGF-beta1在超声乳化术治疗的白内障患者结膜上皮细胞中的表 达及其意义

目的：探讨NF-kB 和TGF-beta1 在超声乳化术治疗的白内障患者结膜上皮细胞中的表达及其意义。方法：选取我院眼科收治 的白内障患者24 例,共24 眼,且均接受超声乳化白内障摘除术和后房型人工晶状体植入术治疗。在治疗前和治疗后15天、30 天,采用免疫组织化学法检测患者结膜上皮细胞中NF-kB 和TGF-beta1 的表达,并进行泪液分泌试验、荧光素染色、泪膜破裂时间 和泪河高度测量四项检查。结果：NF-资B 和TGF-茁1 呈现先增强后减弱的趋势,与术前相比,术后15 天患者NF-kB 和TGF-beta1 染 色程度显著增强,差异具有统计学意义,(P<0.05);与术后15 天比较,术后30 天NF-kB 和TGF-beta1 染色程度减弱,差异具有统计 学意义,(P<0.05);与术前相比,术后15 天泪膜破裂时间较术前明显缩短,荧光素染色明显增强;与术前相比,术后30 天四项检查 结果无差异,P＞0.05。结论：超声乳化手术可提高白内障患者结膜上皮细胞中NF-kB 和TGF-beta1的表达,与术后眼膜的炎症反应 有关。     

Oxidative Stress Induced Inflammation Initiates Functional Decline of Tear Production

Oxidative damage and inflammation are proposed to be involved in an age-related functional decline of exocrine glands. However, the molecular mechanism of how oxidative stress affects the secretory function of exocrine glands is unclear. We developed a novel mev-1 conditional transgenic mouse model (Tet-mev-1) using a modified tetracycline system (Tet-On/Off system). This mouse model demonstrated decreased tear production with morphological changes including leukocytic infiltration and fibrosis. We found that the mev-1 gene encodes Cyt-1, which is the cytochrome b₅₆₀ large subunit of succinate-ubiquinone oxidoreductase in complex II of mitochondria (homologous to succinate dehydrogenase C subunit (SDHC) in humans). The mev-1 gene induced excessive oxidative stress associated with ocular surface epithelial damage and a decrease in protein and aqueous secretory function. This new model provides evidence that mitochondrial oxidative damage in the lacrimal gland induces lacrimal dysfunction resulting in dry eye disease. Tear volume in Tet-mev-1 mice was lower than in wild type mice and histopathological analyses showed the hallmarks of lacrimal gland inflammation by intense mononuclear leukocytic infiltration and fibrosis in the lacrimal gland of Tet-mev-1 mice. These findings strongly suggest that oxidative stress can be a causative factor for the development of dry eye disease.     

Liver cell plasma membrane lipids and the origin of biliary phospholipid.

The liver cell plasma membranes of fed male Wistar rats were separated into a fraction rich in bile canaliculi and the remainder of the plasma membrane. Electron-microscopically, the bile canalicular fraction consisted almost exclusively of intact bile canaliculi with thier contiguous membranes. The remaining plasma membrane fraction consisted primarily of vesicles and sheets of membranes essentially free from the bile canaliculi. The bile canalicular membrane fraction contained relatively more total lipid, cholesterol, and phospholipid, and relatively less protein. Although the phospholipid composition of the two fractions was the same, the specific activity of the bile canalicular membrane phosholipids, up to 12 h following in vivo administration of [2-3H]glycerol, was always significantly greater than that of the remaining plasma membranes, and showed a biphasic response not found in the latter. The specific activity of the phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylcholine of the bile canalicular membranes rose to a peak within 40 min after administration of the label, fell sharply and then rose to a second peak after 120 min. The specific activity of the sphingomyelin and phosphatidylserine plus phosphatidylinositol of the bile canalicular membranes and of all the phospholipids of the remaining plasma membranes diphasic pattern but increased steadily to reach a maximum at 120 min. The specific activity of biliary phosphatidylcholine followed a pattern identical to that of the phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylcholine of the bile canalicular membrane fraction. These results show that the average rate of turnover of phospholipid in the bile canalicular membranes is considerably greater than that in the remaining plasma membrane and other cell membrane fractions; they indicate that the phospholipid of the bile canalicular membranes exists in two or more pools, turning over a different rates; and they support the concept that biliary phospholipid is derived from the bile canalicular membrane. The results also suggest that bile canalicular phospholipid may be derived from two different sources, in contrast to the remainong plasma membrane.