患者,男,41岁,因左眼视物不清2年伴耳鸣1个月余,于2021年4月19日至南京中医药大学附属南京中医院眼科就诊,眼科检查:左眼视力0.08,矫正视力0.8;双眼眼压均为18 mmHg(1 mmHg=0.133 kPa);左眼瞳孔正圆,瞳孔直径约5 mm,直接对光反射迟钝;右眼瞳孔正圆,瞳孔直径约3 mm,直接对光反射灵敏,余眼前节及眼底未见明显异常;双眼视野检查示可见生理盲点,全视野范围内各部位光敏感度正常.

目的:观察系统性红斑狼疮(systemic lupus erythematosus,SLE)患者角膜神经纤维的表现,探讨SLE患者干眼和神经纤维病变的关系.方法:应用HRT3-CM角膜共聚焦显微镜检查比较30例(52只眼)SLE患者和33例(49只眼)健康对照者的角膜神经纤维密度(corneal nerve fiber density,CNFD)、角膜神经纤维分支密度(corneal nerve branch density,CNBD)、角膜神经纤维长度(corneal nerve fiber length,CNFL)和角膜神经纤维迂曲度(corneal nerve fiber tortuosity,CNFT),分析SLE患者干眼临床综合评分与系统性红斑狼疮疾病活动度(SLEDAI)评分的相关性.结果:SLE无干眼组、SLE干眼组、健康无干眼组和健康干眼组CNBD的差异有统计学意义(P＜0.05),SLE干眼组的CNBD明显小于健康干眼组和健康无干眼组,差异有统计学意义(P＜ 0.05);CNFL、CNFD、CNFT的差异在4组间均无统计学意义(P均＞0.05);SLE干眼组的SLEDAI评分与干眼临床综合评分的Pearson相关分析呈正相关(r=0.51,P=0.004),SLE干眼组的病程与干眼临床综合评分无相关性(r=0.34,P=0.069);SLE干眼组的角膜神经纤维参数与干眼临床综合评分均无相关性(P均＞ 0.05).结论:SLE发生干眼时,角膜神经结构异常可能为干眼的内在原因之一,角膜共聚焦显微镜可用于检查SLE角膜神经的病变情况;SLE病情严重程度与干眼严重程度呈正相关.

目的 探讨飞秒激光辅助深板层角膜移植(DALK)术后联合他克莫司治疗感染性角膜炎的疗效.方法 选择我院眼科2015年3月至2018年3月确诊的64例感染性角膜炎患者,按照手术方式分为2组,每组32例.2组患者在术前均给予抗感染药物规范治疗2周.观察组患者行飞秒激光辅助深板层角膜移植术,对照组患者行穿透性角膜移植术,术后2组患者均使用他克莫司滴眼液治疗.观察比较2组患者治疗有效率、最佳矫正视力、免疫排异反应、角膜表面曲率以及不良反应.结果 观察组患者治疗有效率(90.63％)高于对照组(65.63％),差异有统计学意义(P=0.016).通过对患者术后1个月、3个月、6个月的矫正视力对比观察,结果显示观察组患者均优于对照组;治疗后7d、14d观察组出现免疫排异反应的患者显著少于对照组;术后7d、1个月、3个月观察组患者眼压明显低于对照组,以上差异均具有统计学意义(P<0.05).术后6个月,2组患者眼压趋于稳定;治疗前后,2组患者的不同时点角膜表面曲率之间无显著差异.2组患者均未出现明显的不良反应.结论 飞秒激光辅助DALK术联合他克莫司可显著改善感染性角膜炎患者术后视力和球内压力,治疗效果显著,安全性较高.

目的：观察准分子激光角膜上皮瓣下磨镶术(LASEK)治疗成人近视的临床效果.方法：LASEK 治疗135例(258眼)中高度近视,屈光度－2．00D~－14．25D,随访3~6月,观察症状、视力、屈光状态、角膜并发症等情况.结果：术后刺激症状与 PRK 类似,无严重 haze 出现.视力：术后第3月,裸眼视力≥0．8者242眼,占93．8％,裸眼视力≥1．0者219眼,占84．7％；术后第6月裸眼视力≥0．8者227眼,占87．8％,裸眼视力≥1．0者205眼,占79．6％.结论 LASEK治疗成人近视安全性高,术后视觉效果好,拓宽了准分子激光应用的适应症.

Objective:To observe the curative effects of compound anisodine(CA) combined with high pressure oxygen(HPO) on anterior ischemic optic neuropathy(AION).Methods:42 monocular patients with AION were randomly divided into trial group and control group,two groups were received routine therapy,at the same time,trial group 23 patients were treated by CA superficial temporal subcutaneous injection and hyperbaric oxydrenation(HBO),control group 19 patients were treated by CA subcutaneous injection only.After 30 days treatment,visual acuity,visual field and fundus condition were examined to evaluate the effects of the therapy.Results: The total effective rate of the two groups was respectively 82.61% and 63.15%.There were significant difference in therapeatic effect between the two groups(P0.01).Conclusions: compound anisodine(CA) combined with high pressure oxygen(HPO) shows a relatively good therapeutic effect for anterior ischemic optic neuropathy.

Objective:To evaluate the effect and safety of TriamcinoloneAcetonide(TA) vitreousinjectiononretinalveinocclusionsecondary macula edema. Methods: Forty-two cases( 42 eyes) with retinal vein occlusion secondary macula edema were diagnosed with indirective ophthalmoscope, fluorescence fundus angiography ( FFA) and optical coherence tomography( OCT) ,and of which received TA 0. 1ml( 4mg) vitreous injection. The visual acuity,intraocular pressure,fundus,FFA,and OCT on macula were examined before-and after-operation,and with 6 months follow-up. Results: Twenty-five eyes with central retinal vein occlusion( 17 eyes with ischemic central retinal vein occlusion and 8 eyes with un-ischemic) ,17 eyes with branch retinal vein occlusion( 11 eyes with ischemic central retinal vein occlusion and 6 eyes with un-ischemic) . By the end of follow-up,visual acuity increased in 30 eyes,no changed 7 eyes,and decreased 5 eyes. The pattern of OCT recovered in 16 eyes ,improved in 23 eyes,no improved in 3 eyes. Intraocula pressure increased temporary was fund in 11 cases. In 1 case,TA granule attached to post-capsula and disappeared after 1 month. Conclution: TA vitreous injection is safe and effective for retinal vein occlusion secondary macula edema.

目的探讨中老年干眼症患者的发病特点和临床特证,分析其误诊的原因。方法对156例(312眼)中老年干眼症患者进行回顾性分析,以干眼症的三项检查结果为诊断标准。结果 156例患者中曾经误诊为其他眼病者103例。结论中老年干眼病发病率高,女性多见。眼科医生应掌握中老年患者干眼症的临床特点,重视症状、病史的询问以及传统的三项检查,避免误诊误治。

为探讨角膜塑形镜对治疗近视的有效性及安全性,观察74例145眼近视患者在佩戴角膜塑形镜前后屈光度、视力、角膜厚度、角膜内皮细胞以及裂隙灯下角结膜的改变并进行比较,随访9～20个月,平均16.32个月。结果显示:佩戴角膜塑形镜一周后裸眼远视力明显提高(P<0.05),屈光度明显下降(P<0.05),而眼压、角膜厚度及角膜内皮细胞等指标在佩镜前后无显著性改变。观察期间未见严重角结膜并发症。试验结果表明,角膜塑形镜治疗近视,有效、安全,无严重并发症。

Objective:To evaluate postoperative corneal swelling as a predictor of corneal endothelial cell loss after phacoemulsification cataract surgery.Methods:This study included 428 eyes which were performed routine phacoemulsification surgery.Ultrasonic pachymetry and endothelial photography of the central of the cornea and Orbscan II slit-scan tomography were performed preoperatively,on the the first day after surgery and three months after surgery.SPSS 13.0 was used for statistical calculations.Independent-Samples t test and repeated measures were used to test differences and a backward stepwise multiple regression analysis were performed to indentify the variables independently contributing to the corneal endothelial cell loss.Results:The ratio of endothelia cell loss 3 months after phacoemulsification cataract surgery was 18.34 ± 11.63% from 1.56% to 59.30% in this study.It was closely related to phaco time,nuclear hardness and corneal pachymetry chang to first day after surgery.Conclusion:In this study,the degree of permanent corneal endothelial damage had significant correlation with the degree of early postoperative corneal swelling.Measuring the difference in phachymetry at postoperative first day is a useful way to assess the effects on the corneal endothelium exerted by the phacoemulsification procedure.

目的:研究糖尿病患者白内障超声乳化术后早期的角膜水肿和角膜内皮细胞丢失情况。方法:本研究包括了白内障超声乳化术后糖尿病患者78例(116眼),非糖尿病患者69例(116眼),所有患者术前采用OrbscanⅡ和Tomey Al-3000型A超仪测量角膜中央厚度,Topcon Sp2000p型非接触角膜内皮计进行角膜中央部位的角膜内皮细胞计数;术后1d所有患者测量角膜中央厚度,87眼角膜透明进行中央角膜内皮细胞计数;术后1个月和术后3个月所有患者进行角膜中央厚度的测量和角膜中央内皮细胞的计数。结果:OrbscanⅡ和A超法测量都表明两组患者的术前角膜厚度差异无显著性(P>0.05);术后第1天差异有显著性(P<0.05);术后1个月两组之间差异有显著性(P<0.01),非糖尿病组的角膜厚度已经和术前相近,和术前相比差异无显著性(P>0.05);术后3个月两组角膜厚度差异有显著性(P<0.01),糖尿病组和术前相比较差异有显著性(P<0.01),而非糖尿病组和术前相比较差异无显著性(P>0.05)。角膜内皮细胞计数的变化:术前糖尿病组和非糖尿病组差异无显著性(P>0.05);术后1d角膜透明的糖尿病组(34眼)和非糖尿病组(54眼)差异无显著性(P>0.05);术后1个月和术后3个月两组之间均差异存在显著性(P<0.01)。结论:糖尿病患者眼在白内障手术后表现出更重的内皮细胞损害及术后角膜水肿的恢复延迟,术后第1天的角膜厚度的测量可以作为对术后糖尿病患者角膜内皮细胞丢失情况的评估的有效的方法。

目的探讨儿童白内障术中3种不同后囊处理方法对后发性白内障的预防作用.方法 42例(51眼)白内障儿童,年龄2～14岁,在白内障联合人工晶状体植入术中,分别采用3种不同后囊处理方法:Ⅰ组行大面积后囊抛光,保留完整后囊;Ⅱ组行后囊连续环形撕囊;Ⅲ组行连续环形撕囊联合前段玻璃体切割术.随访2个月～3a,对术后视力、后囊混浊情况及并发症进行分析.结果 3级以上后囊混浊Ⅰ组为71%,Ⅱ组为24%,Ⅲ组为0%.各组均无视网膜脱离、黄斑水肿等并发症出现.结论儿童白内障摘出联合人工晶状体植入术中I期后囊环形撕囊,一定程度上减少后囊混浊的发生;后囊环形撕囊联合前部玻璃体切割术可有效地预防儿童后发性白内障的发生,其远期效果及并发症有待进一步观察和研究.

Objective: To study the proliferation, migration and metaplasm of residual rabbit lens epithelial cells (LECs) after extracapsular cataract extraction (ECCE) based on the rabbit capsular bag model in vitro. Methods: Sham cataract surgery, including anterior capsulorhexis, nucleus hydroexpression and aspiration of lens fibers, was performed on 20 rabbit lens. The capsular bags were isolated and pinned to sterile non-toxic silicone rings on petri dishes. The capsular bags were incubated with Eagle's minimum essential medium (DMEM) supplemented with 10% fetal calf serum (FCS) and monitored for 3 weeks by phase-contrast microscopy, after which light microscopy was performed on them. Results: After a latent period of 2-3 d, outgrowth was observed across the posterior capsule. Growth proceeded rapidly so that the posterior capsule was totally covered by a confluent monolayer of cell at 6-8 day. Capsular wrinkles became increasingly apparent as time progressed, causing a marked rise in light scatter. An increase in capsular tension also came. Conclusion: This model exhibits many of the in vito characteristics of the lens capsule after extracapsular surgery and may prove useful in further elucidating the cellular mechanisms of posterior capsule opacification and developing strategies for inhibiting cell growth with this system.

Objective: To study the proliferation, migration and metaplasm of residual rabbit lens epithelial cells(LECs) after ex-tracapsular cataract extraction(ECCE) based on the rabbit capsular bag model in vitro. Methods: Sham cataract surgery, including anterior capsulorhexis, nucleus hydroexpression and aspiration of lens fibers, was performed on 20 rabbit lens. The capsular bags were isolated and pinned to sterile non-toxic silicone rings on petri dishes. The capsular bags were incubated with Eagle' s minimum essential medium (DMEM) supplemented with 10% fetal serum (FCS) and monitored for 3 weeks by phase-contrast microscopy , after which they were underwent for light microscopy. Results: After a latent period of 2-3 days, outgrowth was observed across the posterior capsule. Growth proceeded rapidly so that the posterior capsule was totally covered by a confluent monolayer of cell atfter 6-8 days. Capsular wrinkles became increasingly apparent as time progressed, causing a marked rise in light scatter. An increase in capsular tension also came. Conclusion: This model exhibits many of the in vito characteristics of the lens capsule after extracapsular surgery and may prove useful in elucidating the cellular mechanisms of posterior capsule opacification and developing strategies for inhibiting cell growth with this system.