单切口和双切口联合手术对闭角型青光眼合并白内障患者视力、IOP及CCT的影响

目的:探讨单切口和双切口联合手术对闭角型青光眼合并白内障患者视力、眼压(IOP)及中央前房深度(CCT)的影响。方法:选择2013年6月至2016年6月我院收治的90例闭角型青光眼合并白内障患者,随机分为观察组和对照组,每组各45例。对照组采用单切口手术治疗,观察组采用双切口手术治疗。观察并比较两组患者治疗前后角膜内皮细胞密度、面积、最佳矫正视力、裸眼视力、IOP以及术后并发症的发生率。结果:与术前比较,两组患者术后角膜内皮细胞密度均升高,且观察组高于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后角膜内皮细胞面积均减小,且观察组小于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后最佳矫正视力、裸眼视力均升高,且观察组高于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后IOP均降低,且观察组低于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后CCT均升高,且观察组高于对照组,差异具有统计学意义(P0.05);观察组术后并发症总发生率低于对照组(P0.05)。结论:双切口手术治疗闭角型青光眼合并白内障的效果显著,能够有效改善患者视力、IOP及CCT水平,且安全性高,值得临床推广。     

Selection of suitable reference genes for quantitative real-time PCR in trabecular meshwork cells under oxidative stress

Oxidative stress-induced dysfunction in trabecular meshwork (TM) cells is considered a major alteration that can lead to glaucoma. Hydrogen peroxide (H₂O₂) is the most widely used agent for inducing oxidation in TM cells in vitro. Quantitative real-time PCR (qPCR) is an important method for studying alterations in gene expression, and suitable (i.e. invariant) reference genes must be defined to normalize expression levels. In this study, eight common reference genes, i.e. PRS18, ACTB, B2M, GAPDH, PPIA, HPRT1, YWHAZ, and TBP, were evaluated for use in studies of H₂O₂-induced dysfunction in TM cells. Three established algorithms, geNorm, NormFinder, and BestKeeper, were used to analyze the reference genes. ACTB expression was least affected by H₂O₂ treatment in TM cells, and the combination of PPIA and HPRT1 was the most suitable gene pair for normalization. GAPDH and TBP were the most unstable genes and accordingly should be avoided in experiments with TM cells. These results provide a foundation for analyses of the mechanisms underlying glaucoma, and emphasize the importance of selecting suitable reference genes for qPCR studies.     

Comparative analysis of the uptake and expression of plasmid vectors in human ciliary and retinal pigment epithelial cells in vitro.

The retinal pigment epithelium is uniquely suited to gene therapy that uses lipid-mediated DNA transfer due to its high phagocytic activity in situ. We compared the relative efficacy of phagocytosis on the uptake of labeled plasmid vectors by retinal pigment epithelial and ciliary epithelial cells in vitro. Relative levels of endocytosis were then compared with the efficiency of marker transgene expression in these cells. Human retinal pigment epithelial and ciliary epithelial cells from a single donor were isolated and expanded in vitro. Polyplex-mediated transfections were performed using a rhodamine-labeled expression vector for green fluorescent protein. Rhodamine-labeled endosomes were examined by fluorescence microscopy at different time points. Rhodamine labeling and green fluorescent protein expression were analyzed by flow cytometry 48 h after transfection. These gene transfer studies showed that expression of transgenes does occur in both human retinal pigment epithelial and ciliary epithelial cells in vitro. Endocytosis of labeled plasmid vectors occurs at a significantly higher number and density in retinal pigment epithelial cells than in ciliary epithelial cells (P < 0.04). However, the efficiency of marker transgene expression is similar in the two cell types. These studies demonstrate that the higher intrinsic phagocytic activity does not enhance the efficacy of transgene expression in retinal pigment epithelial cells in vitro. Both human retinal pigment epithelial and ciliary epithelial cells are competent recipients for lipid-mediated gene transfer, and transgene expression occurs at similar levels in both cell types.     

Increased sensitivity of the non-human primate eye to microwave radiation following ophthalmic drug pretreatment.

Previous studies in our laboratory have established that pulsed microwaves at 2.45 GHz and 10 mW/cm2 are associated with production of corneal endothelial lesions and with disruption of the blood-aqueous barrier in the non-human primate eye. In the study reported here we examined ocular damage in monkeys (M. mulatta and M. fascicularis) following topical treatment with one of two ophthalmic drugs (timolol maleate and pilocarpine) that preceded exposure to pulsed microwaves. Anesthetized monkeys were sham exposed or exposed to pulsed, 2.45 GHz microwaves (10 microseconds, 100 pps) at average power densities of 0.2, 1, 5, 10, or 15 mW/cm2 4 h a day for 3 consecutive days (respective SARs were 0.052, 0.26, 1.3, 2.6, and 3.9 W/kg). Immediately before microwave exposure, one or both eyes were treated topically with one drop of 0.5% timolol maleate or of 2% pilocarpine. Following administration of a drug, we observed a significant reduction in the power-density threshold (from 10 to 1 mW/cm2) for induction of corneal endothelial lesions and for increased vascular permeability of the iris. Diagnostic procedures (in vivo specular microscopy and fluorescein iris angiography) were performed following each exposure protocol. In addition, increased vascular permeability was confirmed with horseradish peroxidase tracer techniques. Although we did not measure intraocular temperatures in experimental animals, the results suggest that a mechanism other than significant heating of the eye is involved. Our data indicate that pulsed microwaves at an average SAR of 0.26 W/kg, if administered after pretreatment with ophthalmic drugs, can produce significant ocular effects in the anesthetized primate.     

Cytokine profile and cytoskeletal changes after herpes simplex virus type 1 infection in human trabecular meshwork cells

Uveitis caused by herpes simplex virus (HSV)-1 is characterized by increased intraocular pressure (IOP) in the presence of anterior chamber inflammation. Despite their clinical significance, the pathogenic changes associated with HSV-1 infection in trabecular meshwork (TM) cells, the key cell type regulating IOP, have not been completely elucidated. In this study, cytokine array analyses showed a significant stepwise increase in monocyte chemoattractant protein (MCP)-1 expression upon HSV-1 infection in TM cells (p < 0.05). HSV-1 infection led to downregulation of fibrogenic molecules (fibronectin, α-smooth muscle actin, connective tissue growth factor and TGF-β1). Notably, HSV-1 infection caused a significant increase in actin stress fibres, with a twofold increase in active RhoA, which was enhanced by treatment with TGF-β1 and inhibited by treatment with the Rho-kinase inhibitor, Y-27632. TM cells treated with MCP-1 exhibited a dose-dependent increase in actin stress fibres compared to untreated TM cells. Our study suggests that HSV-1 infection in TM cells increases cell contractile activity rather than fibrotic changes in the extracellular matrix (ECM) components. Taken together, these observations demonstrate the enhanced expression of MCP-1 and TM cell contractile activity upon HSV-1 infection and events with potential implications for the pathobiology of abrupt IOP elevation in HSV-1 anterior uveitis.     

Structure-based drug discovery of carbonic anhydrase inhibitors

Inhibition of the metalloenzyme carbonic anhydrase (CA; EC 4.2.1.1) has pharmacologic applications in the field of anti-glaucoma, anti-convulsant and anti-cancer agents. But recently, it has also emerged that these enzymes have the potential for designing anti-infective drugs (anti-fungal and anti-bacterial agents) with a novel mechanism of action. Sulphonamides and their isosteres (sulphamates/sulphamides) constitute the main class of CA inhibitors (CAIs), which bind to the metal ion from the enzyme active site. Recently, the dithiocarbamates (DTCs), possessing a similar mechanism of action, were reported as a new class of inhibitors. These types of CAIs will be discussed in detail in this review. Novel drug design strategies have been reported ultimately based on the tail approach for obtaining sulphonamides/DTCs, which exploit more external binding regions within the enzyme active site (in addition to coordination to the metal ion), leading thus to isoform-selective compounds. Most of the promising data have been obtained by combining x-ray crystallography of enzyme-inhibitor adducts with novel synthetic approaches for generating chemical diversity. Whereas sulphonamide – NO donating hybrid drugs were reported as effective anti-glaucoma agents, most of the interesting new inhibitors were designed for inhibiting specifically the tumour-associated isoforms CA IX and XII, validated targets for imaging and treatment of hypoxic tumours. Promising compounds that inhibit CAs from bacterial and fungal pathogens, of the DTC and carboxylate types, will be also reviewed.     

不同术式治疗新生血管性青光眼的疗效比较

目的：比较不同手术方法治疗新生血管性青光眼（neovascular glaucoma,NVG）的疗效。方法：对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析,其中行单纯睫状体冷凝术20例（A组）,改良小梁切除术15例（B组）,引流阀植入术联合全视网膜光凝术22例（c组）。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况,并随访3～6个月。结果：A组患者出院时的平均眼压为（28．13＋4．83）mmHg,B组为（19．24±5．48）mmHg,C组为（21．22±4．76）mmHg。随访期间,术后A组9例眼压正常,手术成功率45％;B组11例眼压正常,手术成功率73．3％;C组13例眼压正常,手术成功率57．1％。B组手术成功率最高,A组最低。结论：三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳,有视力眼不宜采用此种手术方式;改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式;引流阀植入术联合全视网膜光凝术费用较高。     

不同术式治疗新生血管性青光眼的疗效比较

目的:比较不同手术方法治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法:对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析,其中行单纯睫状体冷凝术20例(A组),改良小梁切除术15例(B组),引流阀植入术联合全视网膜光凝术22例(C组)。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况,并随访3~6个月。结果:A组患者出院时的平均眼压为(28.13±4.83)mmHg,B组为(19.24±5.48)mmHg,C组为(21.22±4.76)mmHg。随访期间,术后A组9例眼压正常,手术成功率45%;B组11例眼压正常,手术成功率73.3%;C组13例眼压正常,手术成功率57.1%。B组手术成功率最高,A组最低。结论:三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳,有视力眼不宜采用此种手术方式;改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式;引流阀植入术联合全视网膜光凝术费用较高。