视网膜脱离围手术期的护理

视网膜脱离是视网膜的神经上皮层和它本身的色素上皮层分离。它是一种常见的严重性、致盲性眼底疾病,手术是唯一有效的治疗方法[1]。特别是原发性视网膜脱离应争取早日手术治疗。2003年1月~2005年1月,我院采用巩膜外冷凝外加压环扎术治疗视网膜脱离58例,效果满意。现将护理体会总结如下。1临床资料本组58例患者中,男38例,女20例,年龄最小12岁,最大68岁。全部患者均行冷凝外加压环扎术。术后全部患者视网膜均达到解剖复位,且无感染发生。2护理2·1术前护理(1)术前心理护理。患者因视网膜脱离而视力减退,心理负担很重,既希望尽快手术,又对手术…     

基于网络药理学和GEO数据研究五苓散治疗视网膜脱离的分子机制

目的 探讨五苓散治疗视网膜脱离(RD)的潜在分子机制。方法 寻找五苓散治疗RD的特异性靶点并构建分析网络,进行基因本体分析和通路富集分析。对五苓散和RD作用靶点进行分子对接,并使用GEO数据对作用靶点进行验证。结果 构建的分析网络包含5种药物成分(51种入血活性成分和1 023个靶点)和1种疾病(RD靶点85个)。根据GEO数据,14个交集靶点中的PFN1、RAC1、ERBB2和MTOR与对照组相比表达具有显著差异,分子对接显示MTOR与药物结合能力最强。结论 本研究初步验证了五苓散可能通过调节MTOR、PI3K-Akt和HIF-1等相关通路参与RD的治疗,为进一步研究提供了理论基础。     

兔眼孔源性视网膜脱离手术复位后视功能以及超微结构的变化

目的对比研究兔眼视网膜脱离后选择不同时期手术复位视功能的变化情况,为临床手术时机的选择及预测术后视功能的恢复情况提供理论与实验依据。方法利用家兔制备孔源性视网膜脱离模型,成模后1 d、7 d1、4 d时经手术达解剖复位,采用多焦视网膜电流图检测复位后视网膜的功能,数据处理应用SPSS软件。制备组织病理学切片。结果多焦视网膜电流图显示1 d、7 d、14 d的RRD手术复位后P1波平均象限反应密度(QAP1,nV/deg2),P1波幅值(AP1,μV),N1波幅值(AN1,μV),P1波潜伏期(TP1,ms),N1波潜伏期(TN1,ms)各项数值差异有显著性(P<0.05)。光镜电镜显示视网膜脱离复位后组织病理学改变。结论视网膜脱离手术复位后视网膜细胞功能的恢复与脱离时间有明显的负相关性;多焦视网膜电流图对于局部视网膜功能的评价有重要意义;组织病理学研究提供了解释视功能变化的重要依据。     

正常和急性高眼压兔眼视网膜的ACP组织化学研究

用光镜定量酶组织化学和电镜细胞化学方法,观察了兔眼视网膜酸性磷酸酶(acid phos-phatase,ACP)分布及急性高眼压对 ACP 分布及溶酶体的影响。ACP 活性强度在视网膜各层的顺序为(F 检验 P<0.05):由高到低依次①色素上皮层,②外网状层,③内网状层,④外核层和内核层,⑤杆锥体层和神经节细胞及神经纤维层,该结果与以往半定量判定有较大差异。高眼压后15天、30天组色素上皮层 ACP 活性增强,7天组杆锥体层 ACP 活性增强(P<0.01)。电镜下见高眼压后色素上皮层溶酶体数量增多,溶酶体外 ACP 活性增强,外段膜盘内溶酶体外 ACP 活性明显增强。提示 ACP(及其他溶酶体酶)可能在急性高眼压后的视网膜损伤过程中起重要作用。     

慢性高眼压下兔视网膜组织蛋白质组变化的初步研究

应用蛋白质组学技术对兔青光眼慢性高眼压视网膜组织的蛋白进行初步分析。左眼前房注入0.2mL复方卡波姆溶液制作成慢性高眼压模型,右眼为对照眼。28d后分离各组视网膜组织,用双向电泳分离试验组和对照组的蛋白,然后分析电泳图谱,对比、分析其表达蛋白质点的差异,寻找兔视网膜中与慢性高眼压相关的蛋白质。结果表明,慢性高眼压诱导视网膜组织3种蛋白质出现明显差异表达。质谱鉴定出3个蛋白质,分别为热休克蛋白70(heat shock 70 kD protein,HSP70),丙酮酸激酶(Pyruvate kinase)和烯醇酶(enolase)。通过双向电泳,发现兔视网膜蛋白质表达与对照眼相比有质和量的变化,这些变化涉及与神经节细胞(retinal ganglion cells,RGCs)糖酵解及应激反应有关的几组蛋白质,提示上述蛋白质组改变可能参与了慢性青光眼神经节细胞凋亡的过程。     

小鼠慢性高眼压模型下视网膜神经节细胞的损伤

目的:通过巩膜外静脉烧烙术建立慢性高眼压模型,研究小鼠慢性高眼压状态下视网膜神经节细胞的凋亡情况.方法:取C57BL/6J小鼠30只.3只作为空白对照组,其余27只右眼为实验眼,左眼为对照眼.术前用iCare眼压计测量眼压,按巩膜外静脉烧烙法建立慢性高眼压模型,术后用iCare眼压计每日监测眼压.分剐取空白对照组6眼,术后1w、4 w造模成功的小鼠各8只16眼眼球,石蜡切片行Tunel法,荧光显微镜下采集图像.小鼠眼压的组间比较采用t检验.结果:给予巩膜外静脉烧烙术后1d、1w、4w小鼠慢性高眼压眼眼压(11.15±0.98、10.65±0.95、10.35±1.05)与对照眼(6.40±0.95、6.35±1.05、6.50±1.15)相比,差异有统计学意义(t=10.77～18.08,P＜0.001).Tunel法结果显示,正常小鼠空白对照组未见明显凋亡的视网膜神经节细胞.慢性高眼压组术后1w、4w可见Tunel阳性表达.而对照组术后1w及4w均未见Tunel阳性表达.结论:巩膜外静脉烧灼法能诱导出持续的肯定的小鼠慢性高眼压模型,慢性高眼压状态下小鼠视网膜神经节细胞发生凋亡,细胞凋亡是小鼠慢性高眼压状态下视网膜神经节细胞损伤的主要方式.     

猫外层视网膜和脉络膜的年龄相关变化

取老年猫(12龄,2.5~3 kg)和青年猫(1~3龄,2~2.5 kg)各4只的视网膜,经4%多聚甲醛处理后用H.E染色以显示视网膜和脉络膜的结构。光学显微镜下观察感光细胞层、玻璃膜(Bruch’s membrane)结构的变化,计数色素上皮层(retinal pigment epithelium,RPE)细胞数、脉络膜毛细血管数,测量玻璃膜、脉络膜厚度,脉络膜毛细血管之间的距离。结果显示,与青年猫比较,老年猫视网膜感光细胞层结构杂乱;色素上皮细胞数显著下降;玻璃膜厚度无显著变化,出现较多碎片;脉络膜厚度明显变薄,脉络膜毛细血管数显著减小,脉络膜毛细血管之间的距离显著增大。推测老年猫脉络膜的退化可能是导致玻璃膜、色素上皮层的退化,进而导致感光细胞的功能衰退的重要原因。     

532 nm波段连续激光对视网膜和脉络膜生物学作用的观察

目的：探讨532nm波段激光不同光剂量参数对眼底组织的损伤特点及损伤阈值。方法：以新西兰兔为实验对象,532nm连续激光照射眼底,眼底光斑直径1．5mm～2．5mm,功率密度从500mW／cm^2：～2400mW／cm^2,照射时间100s～300s,每组参数10个光斑。在照射后1h和24h进行眼底观察和荧光眼底造影,计算三种照射时间情况下视网膜的损伤阈值。结果：在照射后第1h,功率密度为902mW／crn2,照射时间300s开始出现视网膜灰色改变,病灶范围接近照光面积,在24h后颜色微加重。随着照光剂量的增加,在功率密度达1479mW／cm2,照射时间300s,照射后1h出现视网膜灰白色改变,在24h后出现脉络膜出血;而且随着照光剂量的增加,病灶范围扩大越明显。出血量越多。随着照光剂量的减少,当功率密度1003mW／cm^2,照射时间200s时,在照光后1h眼底没有改变,24h出现视网膜灰白色改变,面积接近照光面积;光剂量降低到1002mW／cm^2,照射时间100s时,在24h才出现视网膜灰白色改变,变化的视网膜范围小于照光面积。统计学计算在照射时间为300s、200s和100s,照光后1h视网膜损伤阈值分别为911．15628mW／cm^2,1167．64770mW／cm^2,1513．89832mW／cm^2,24h视网膜损伤阈值分别为827．09664mW／cm^2。1003．73143mW／cm^2,1154．17863mW／cm^2。结论：在光线照射后24h之内,视网膜损伤是一个逐渐增强的过程。从视网膜没有明显可见改变到视网膜出现灰白色可见损伤,变化范围从小于照光面积到接近照光面积,甚至超过照光面积,并出现脉络膜出血,出血面积随着照光剂量的增加而范围变大。相同能量密度的光剂量对视网膜损伤轻重取决于激光的功率密度。     

间接眼底镜下外路手术治疗孔源性视网膜脱离对患者视力与黄斑水肿的影响

摘要 目的：探讨间接眼底镜下外路手术治疗孔源性视网膜脱离对患者视力与黄斑水肿的影响。方法：选择2018年8月到2021年9月在本院诊治的孔源性视网膜脱离患者84例作为研究对象,根据1:1随机数字表法把患者分为眼底镜组与对照组各42例,对照组采用巩膜扣带术治疗,眼底镜组给予间接眼底镜下外路手术治疗,测定患者视力与黄斑水肿情况。结果：两组术后3个月的最佳矫正视力好于术前1 d,眼底镜组好于对照组（P<0.05）。眼底镜组术后3个月的总有效率为97.6 %,高于对照组的76.2 %（P<0.05）。眼底镜组术后3个月的眼内出血、视网膜坏死、眼内炎、高眼压等并发症发生率为4.8 %,低于对照组的23.8 %（P<0.05）。两组术后3个月的视网膜下液高度低于术前1 d,眼底镜组低于对照组（P<0.05）。眼底镜组术后3个月的自理等生活质量评分较对照组高（P<0.05）。结论：间接眼底镜下外路手术治疗孔源性视网膜脱离能改善黄斑水肿提高,促进恢复患者的视力,提高总体治疗效果,减少并发症,有利于患者视网膜下液高度降低,从而提高生活质量。     

The Short-Term Effects of Exercise on Intraocular Pressure,Choroidal Thickness and Axial Length

Purpose

To explore ocular changes in healthy people after exercise.

Methods

Twenty five volunteers underwent exercise for 15 minutes on a treadmill. Measurements of choroidal thickness, intraocular pressure (IOP), ocular biometry, and blood pressure were taken before and after exercise. Enhanced Depth Imaging optical coherence tomography (EDI-OCT) was used to measure choroidal thickness at the fovea. Intraocular pressure (IOP) was measured by Goldmann applanation tonometry. Ocular biometric measures were collected using A scan ultrasound. Blood pressure was measured concurrently with the acquisition of the scans.

Results

Twenty five volunteers (25 eyes) with a mean age of 25.44±3.25 years were measured. There was a significant increase in systolic and diastolic pressure after exercise (P<0.05). The IOP showed a significant decrease after exercise (P<0.05). However there was no significant difference in the mean choroidal thickness, ocular axial length, anterior chamber depth, lens thickness, or vitreous length before and after exercise measurements (P>0.05).

Conclusion

There was a significant decrease in IOP from exercise without a change in choroidal thickness and ocular biometric measures. IOP and choroidal thickness were not correlated, suggesting that the IOP decrease from exercise is not due to changes in choridal thickness.     

Five-Year Change in Intraocular Pressure Associated with Changes in Arterial Blood Pressure and Body Mass Index. The Beijing Eye Study

Purpose

To examine a potential association between longitudinal changes in intraocular pressure (IOP), arterial blood pressure and body mass index (BMI) in a population-based setting.

Methods

The longitudinal population-based Beijing Eye Study included 2355 subjects with an age of 45+ years who were examined in 2006 and in 2011. The participants underwent a detailed ophthalmic examination including tonometry and measurement of arterial blood pressure and BMI.

Results

Data on IOP, arterial blood pressure and BMI measured in 2006 and in 2011 were available for 2257 (95.8%) subjects with a mean age of 59.5±9.7 years. The mean change in IOP was −1.25±2.26 mm Hg, mean change in mean blood pressure −7.4±12.1 mmHg, and mean change in BMI was 0.01±2.04 kg/m². In multivariate analysis, the 5-year change in IOP was significantly associated with a higher change in mean blood pressure (P<0.001; standardized regression coefficient Beta:0.11; regression coefficient B:0.02; 95% confidence interval (CI):0.01,0.03) after adjusting for younger age (P<0.001;Beta:−0.18;B:−0.04;95% CI:−0.05,−0.03), shorter body stature (P = 0.002;Beta:−0.06;B:−0.06;95% CI:−0.03,−0.01), thicker central corneal thickness (P<0.001;Beta:0.19;B:0.02;95% CI:0.01,0.02), deeper anterior chamber depth (P = 0.01;Beta:0.05;B:0.33;95% CI:0.07,0.60), and lower intraocular pressure at baseline (P<0.001;Beta:−0.56;B:−0.42;95% CI:−0.45,−0.39). If the analysis included only longitudinal parameters, the change in IOP was significantly associated with a higher change in mean arterial blood pressure (P<0.001;Beta:0.10;B:0.02;95% CI:0.01,0.03) and a higher change in body mass index (P<0.04;Beta:0.04;B:0.04;95% CI:0.01,0.09).

Conclusions

In the 5-year follow-up of our population-based sample, a change in IOP was associated with a corresponding change in arterial blood pressure and with a corresponding change in body mass index. These longitudinal data support the notion of a physiological relationship between arterial blood pressure, intraocular pressure and body mass index. These findings may be of interest for the discussion of the pathogenesis of glaucomatous optic neuropathy.     

The Effect of Ageing on Ocular Blood Flow,Oxygen Tension and Retinal Function during and after Intraocular Pressure Elevation

Purpose

To investigate the effect of ageing on the recovery of ocular blood flow, intravitreal oxygen tension and retinal function during and after intraocular pressure (IOP) elevation.

Methods

Long Evans rats (3- and 14-month-old) underwent acute stepwise IOP elevation from 10 to 120 mmHg (5 mmHg steps each 3 minutes). IOP was then returned to baseline and recovery was monitored for 2 hours. Photopic electroretinograms (ERG) were recorded at each IOP step during stress and at each minute during recovery. Ocular blood flow and vitreal oxygen tension (pO₂) were assayed continuously and simultaneously using a combined laser Doppler flow meter (LDF) and an oxygen sensitive fibre-optic probe, respectively. The combined sensor was placed in the vitreous chamber, proximal to the retina. Data were binned into 3 minute intervals during stress and 1 min intervals during recovery. Recovery data was described using a bi-logistic function.

Results

Rats of both ages showed similar susceptibility to IOP elevation, with pO₂ showing a closer relationship to ERG than LDF. During recovery, both ages showed a distinctive two-phased recovery for all three measures with the exception of the LDF in 3-month-old rats, which showed only 1 phase. In all animals, LDF recovered fastest (<1 minute), followed by pO₂ (<10 minute) and ERG (>1 hour). 14-month-old rats showed surprisingly faster and greater LDF recovery compared to the younger group, with similar levels of pO₂ recovery. However, the ERG in these middle-aged animals did not fully recover after two hours, despite showing no difference in susceptibility to IOP during stress compared to the young group.

Conclusions

Young and middle-aged eyes showed similar susceptibility to IOP elevation in terms of pO₂, LDF and ERG. Despite this lack of difference during stress, older eyes did not completely recover function, suggesting a more subtle age-related susceptibility to IOP.     

Normative Values of Retinal Oxygen Saturation in Rhesus Monkeys: The Beijing Intracranial and Intraocular Pressure (iCOP) Study

Objective

To study the normal values of the retinal oxygen saturation in Rhesus monkeys and to evaluated repeatability and reproducibility of retinal oxygen saturation measurements.

Methods

Eighteen adult Rhesus macaque monkeys were included in this experimental study. An Oxymap T1 retinal oximeter (Oxymap, Reykjavik, Iceland) was used to perform oximetry on all subjects. Global arterial (SaO₂) and venous oxygen saturation (SvO₂), arteriovenous difference in SO₂ were measured. In the first examination, each eye was imaged three times. At the following two examinations, each eye was imaged once. All examinations were finished in one month. P values were calculated to evaluate the difference between the measurements during three visits by performing an ANOVA. Intra-visit and inter-visit intraclass correlation coefficient (ICC) was determined.

Results

At baseline, the average SaO₂ and SvO₂ were 89.48 ± 2.64% and 54.85 ± 2.18%, respectively. The global A-V difference was 34.63 ± 1.91%. The difference between the three visits was not significant (p>0.05). The highest A-V difference in SO₂ and lowest saturations were found in the inferotemporal quadrant. Intra-session and inter-visit repeatability were both high. For all oxygen saturation parameters, the ICC values of the intra-session repeatability ranged between 0.92 and 0.96. As found previously, a relatively high ICC value for inter-visit repeatability also was found for all oxygen saturation measurements, ranging between 0.86 and 0.94, with the lowest values in the infero-nasal quadrant.

Conclusions

Our study is the first to describe retinal SO₂ in healthy Rhesus monkeys. In normal monkey eyes, the reproducibility and repeatability of retinal oximetry oxygen saturation measurements were high in the retinal arterioles and venules. Our results support that Oxymap T1 retinal oximetry is a suitable and reliable technique in monkey studies.     

Comparison of Retinal Nerve Fiber Layer Thickness In Vivo and Axonal Transport after Chronic Intraocular Pressure Elevation in Young versus Older Rats

Purpose

To compare in young and old rats longitudinal measurements of retinal nerve fiber layer thickness (RNFLT) and axonal transport 3-weeks after chronic IOP elevation.

Method

IOP was elevated unilaterally in 2- and 9.5-month-old Brown-Norway rats by intracameral injections of magnetic microbeads. RNFLT was measured by spectral domain optical coherence tomography. Anterograde axonal transport was assessed from confocal scanning laser ophthalmolscopy of superior colliculi (SC) after bilateral intravitreal injections of cholera toxin-B-488. Optic nerve sections were graded for damage.

Results

Mean IOP was elevated in both groups (young 37, old 38 mmHg, p = 0.95). RNFL in young rats exhibited 10% thickening at 1-week (50.9±8.1 µm, p<0.05) vs. baseline (46.4±2.4 µm), then 7% thinning at 2-weeks (43.0±7.2 µm, p>0.05) and 3-weeks (43.5±4.4 µm, p>0.05), representing 20% loss of dynamic range. RNFLT in old rats showed no significant change at 1-week (44.9±4.1 µm) vs. baseline (49.2±5.3 µm), but progression to 22% thinning at 2-weeks (38.0±3.7 µm, p<0.01) and 3-weeks (40.0±6.6 µm, p<0.05), representing 59% loss of dynamic range. Relative SC fluorescence intensity was reduced in both groups (p<0.001), representing 77–80% loss of dynamic range and a severe transport deficit. Optic nerves showed 75–95% damage (p<0.001). There was greater RNFL thinning in old rats (p<0.05), despite equivalent IOP insult, transport deficit and nerve damage between age groups (all p>0.05).

Conclusion

Chronic IOP elevation resulted in severely disrupted axonal transport and optic nerve axon damage in all rats, associated with mild RNFL loss in young rats but a moderate RNFL loss in old rats despite the similar IOP insult. Hence, the glaucomatous injury response within the RNFL depends on age.     

食管癌患者手术前后免疫功能改变对外周血细胞凋亡的影响

为探讨食管癌手术前后患者外周血细胞的凋亡情况。利用流式细胞仪对70例食管癌手术前及其手术后10天~14天患者外周血细胞的DNA和CD4,CD8和CD16/56含量进行了分析。结果显示:手术前后患者外周血细胞的凋亡有差异(P<0.05),但血细胞的DNA合成期细胞比率(S-phage fraction,SPE)、细胞增长指数无明显的差异(P>0.05)。两组的CD4/CD8比值或CD16/56比例有明显差异(P<0.001)。实验数据表明:手术前患者的细胞凋亡增加可能有利于平衡肿瘤细胞的恶性增殖;而外周血细胞的CD8、NK(自然杀伤细胞,natural killer cells)增高,可能有助于这种平衡作用。但手术后患者肿瘤负荷减轻,免疫功能恢复常态,细胞凋亡率相应降低。     

两种可摘局部义齿戴用前后语音效果的对比研究

目的：对上颌肯氏I类牙列缺损可摘局部义齿戴用前后的临床语音适应效果做出客观评价。方法：对30例上颌肯氏I类牙列缺失患者在义齿初戴前、初戴时、初戴后的1、2、4、8用语音变化规律进行分析。结果：辅音／j／：在塑料组,在初戴后2．4、8周与初戴时F2有统计学差异（P〈0．05）;在初戴时与初戴前相比F2也有统计学差异（P〈0．05）。初戴后1周也有统计学差异（P〈O．05）;两组同一时间内比较,/j/的F2在初戴时有统计学差异（P〈0．01）。／sh／音：在初戴时与初戴后2、8周F1有统计学差异（P〈0．05）。/z／音：在塑料、铸造两组中,F1、F2在初戴前、后2、4、8周均有统计学差异（P〈0．05）。结论：可摘局部义齿基托厚度主要影响的发音部位是硬腭前部,在临床上,减少硬腭区基托厚度,对临床修复有较好的指导意义。