目的:探究针药联合治疗视神经脊髓炎(NMO)所致视神经萎缩的临床疗效.方法:收集2016年3月～2019年12月就诊于本院眼科或者神经眼科门诊的以视神经炎(ON)为主要临床表现的NMO所致视神经萎缩患者21例(24眼),以患者自身治疗前后为对比,纳入后接受针刺和中药治疗8周,分别于治疗前和治疗后4周、8周进行最佳矫正视力和动态视野检测,评价针药联合对患者视功能的影响.结果:24眼治疗4周后有8只眼视力提高≥2行,总有效率91.67％,治疗8周后有12眼视力提高≥2行,总有效率100.00％;治疗4周,患者动态视野平均缺损度(MD)及平均敏感度(MS)较前改善,但与治疗前相比,差异无统计学意义(MD:t=1.579,P=0.121;MS:t=?1.500,P=0.140);治疗8周后患者MD显著下降(t=2.65,P<0.05),MS明显提高(t=?2.58,P<0.05),差异均有统计学意义.结论:针药联合可显著提高以ON为主要表现的NMO所致视神经萎缩患者的视功能,明显提高患者最佳矫正视力和动态视野敏感度,降低患者视野缺损.

Objective:To discuss the influence of QiShenYiQi Gutta Pills(QGP)on expression of vascular endothelial growth factor(VEGF),pigment epithelium derived factor(PEDF)and mRNA expression of VEGF and PEDF in rats with diabetic retinopathy.Methods:The diabetic rat model was established by one-time injection of streptozotozin(STZ,65mg/kg).All SD rats(n=82)were randomly divided into the normal group,model group, control group and QGP group.After 10 months,the expression of VEGF and PEDF was detected by immunohistochemistry method,VEGFmRNA and PEDFmRNA were examined by reverse transcription-polymerase chain reaction(RT-PCR).Results:The expression of VEGF and VEGFmRNA in model group was higher than that in the normal group(P<0.01).The expression of PEDF and PEDFmRNA in model group was lower than the normal group(P<0.01).The expression of VEGF and VEGFmRNA in QGP group was lower than that in the model group(P<0.01).The expression of PEDF and PEDFmRNA in QGP group was higher than the model group(P <0.01).Conclusion:QGP can delay the development of diabetic retinopathy in rats through decreasing the expression of retinal VEGF and VEGFmRNA,and increasing the expression of retinal PEDF and PEDFmRNA.

OBJECTIVE To discuss the influence of Qishen Yiqi Gutta Pills(QGP)on the expression of advanced glycation end products(AGEs)and mRNA expression of receptor of AGEs(RAGE)in rats with diabetic retinopathy.METHODS The diabetic rat model was established by one-time injection of streptozotocin(STZ,65mg/kg).All SD rats(n=70)were randomly divided into the normal group,model group,control group and QGP group.After 10 months,the expression of AGEs was detected by using immunohistochemistry method and RAGE mRNA was examined by using reverse transcription-polymerase chain reaction(RT-PCR).RESULTS The expression of AGEs and RAGEmRNA in model group was higher than that in the normal group(P0.01).The expression of AGEs and RAGEmRNA in QGP group was lower than that in the model group(P0.01).CONCLUSIONS QGP could delay the development of diabetic retinopathy in rats through decreasing the expression of retinal AGEs and RAGEmRNA.

何谓高度近视眼 近视眼指来自无限远的平行光,在视网膜前形成焦点,在视网膜上不能清晰成像;其远视力降低,但近视力正常.-3.00D以下称轻度近视,-3.00D～-6.00D为中度近视,高于-6.00D为高度近视.高度近视者眼底多有病理性改变,又称为病理性近视.

OBJECTIVE To investigate the effect of Qishen Yiqi Pills on expression of glutamate-aspartate transporters(GLAST) and glutamine synthetase(GS) in diabetic rat's retina and observe the protection mechanism of Qishen Yiqi Pills on retinal nerve cells.METHODS Diabetic rats were induced by streptozotocin.Rats in diabetes prevention group were with Qishen Yiqi Pills once each day.LSAB method detected the expression of GLAST and GS in the retina.Image plus Pro6.0 analytical system was used to calculate the IOD value.RESULTS The expression of GLAST and GS in diabetic rat's retina decreased obviously compared with normal group;Compared with diabetes control group,GLAST and GS expression in the treatment group increased.CONCLUSIONS Qishen Yiqi Pills could promote the expression of GLAST and GS and reduce the high concentrations of the role of glutamate excitotoxicity.

<正>北京中西医结合学会第四届眼科专业委员会换届会议及学术交流会于2011年3月5日在北京新闻大厦举行。本次会议由北京中西医结合学会眼科专业委员会举办,首都医科大学附属北京同仁医院承办。会议由委员会副主任委员马东丽教授主持。首先一致通过了由刘刚副秘书长宣布的第四届眼科专业委员会委员候选人员组成名单,名誉主任委员和主任委员分别由中国中医科学院眼科医院庄曾渊研究员和中日友好医院金明教授继续担任;眼科医

Objective To assess the expression of GFAP,GLAST,GS and NT-3 in Müller cells and the apoptosis of retinal nerve cells in rats with diabetes mellitus(DM) and to discuss the mechanisms of retinal nerve cell injury in DM rats.Design Experimental study.Paticipants 82 Sprague-Dawley(SD) rats.Methods Diabetic model in rats was induced by streptozotocin method.The rats are randomly divided into 2 groups: model group and normal group.The expression of GFAPmRNA in retina was measured by RT-PCR.LSAB method was used to measured the expression level of GFAP,GLAST,GS,NT-3 in retinal Müller cells.Apoptosis of retinal nerve cells was measured by TUNEL assay and apoptosis cells were counted.Immunological histochemistry assay was used for quantitative analysis.Main Outcome Measures The expression of GFAP,CLAST,GS,and NT-3;the number of apoptotic cells in inner nuclear layer and RGC layer.Results Compared with normal group(1.00±0.02),the positive expression of GFAP in the retina of diabetic rats(5.22±1.34) was increased significantly(P=0.000).The positive apoptotic retinal cells were only expressed in RGCs and inner nuclear layer.The numbers of apoptotic cells in RGCs and inner nuclear layer of diabetic rats(36.00±6.02 and 11.48±2.08) were significantly higher than that of normal group(16.33±2.34 and 5.34±0.52)(all P=0.000).Compared with normal group(0.29±0.08),the expression of GFAPmRNA in the retina of diabetic rats(7.00±0.37) was enhanced significantly(P=0.000).The number of apoptotic RGCs and cells in inner nuclear layer was correlated positively with the positive expression level of GFAP(r=0.88,0.85,P=0.021,0.028),and was negatively correlated with the expression of GLAST,GS and NT-3(r=-0.74~-0.93,-0.71~-0.90;all P<0.05).Conclusion The number of apoptosis of retinal nerve cell is closely related to the active proliferation of glial reactive state in retinal Müller cells and the deficiency of neurotrophic factors.The excitotoxicity of high concentrations of glutamate and the deficiency of neurotrophic factors are important mechanism of retinal nerve cell injury in diabetes.

Objective:To study the therapeutic effect of Yiqi Huoxue therapy on vascular endothelial growth factor(VEGF) in retina of diabetic rats.Methods:The diabetic rat model was set up by a single intraperitoneal injection of streptozotocin(65mg/kg).Fifty rats were randomly divided into normal group,model group and Yiqi Huoxue medicine group,the normal group and model group were given normal saline by intragastric administration,and Yiqi Huoxue medicine group was given extractum of Qisheng Yiqi Dripping Pills(0.2g·kg-1·d-1) by intragastric administration.All rats were killed after 300days.The serum VEGF levels were measured.Immunological histochemistry assay was used to observe the expression of VEGF of eyeball slice for quantitative analysis.SPSS was used for statistical analysis.Results:Ten months later,the levels of VEGF in serum of model group were higher than those in control group,the levels of VEGF in serum of Yiqi Huoxue medicine group were lower than those in model group(P0.05).The model group rats displayed high expression of VEGF.Compared with the model group,the expression of VEGF in Yiqi Huoxue medicine group decreased evidently(P0.01).Conclusion:Yiqi Huoxue medicine can reduce damage of diabetic retinopathy and this effect may be achieved by restraining the expression of VEGF.

Objective To discuss the influence of Qishenyiqi Gutta Pills (QGP)on expression of intercellular adhesion molecule-1 (ICAM-1) in rats with diabetic retinopathy.Methods The diabetic rat model was established by one-time injection of streptozotozin (STZ,65 mg/kg).All SD rats (n=50) were randomly divided into the control group,model group and QGP group.The extractum of QGP (0.2 g/(kg·d)) was administrated intragastrically.After 10 months,the rats were killed and the eyeballs were collected for the observation of retinal vascular digest preparations.The expression of ICAM-1 was detected by using immunohistochemistry method,and ICAM-1-mRNA was examined by using reverse transcription-polymerase chain reaction (RT-PCR).The blood samples were collected from rats for detecting the serum content of ICAM-1.Results The serum content of ICAM-1 was higher in the model group than that in the control group,and was lower in the QGP group than that in the model group,but had no statistical significance (P>0.05).The expressions of retinal capillary ICAM-1 and retinal ICAM-1-mRNA were higher significantly in the model group than those in the control group,and was lower significantly in the QGP group than those in the model group with a significant difference (P<0.01).Conclusion QGP can delay the occurrence and development of diabetic retinopathy in rats through decreasing the expressions of retinal ICAM-1 and ICAM-1-mRNA.

Objective:To observe the apoptosis of the retinal ganglion cells(RGCs)and the expression level of vascular endothelial growth factor(VEGF)in diabetic rats and discuss ginseng on RGCs apoptosis and VEGF expression and the relationship between them.Methods:Diabetic rats were induced by streptozotocin and randomly divided into diabetes control(DC)group and diabetes prevention(DP)group.Rats in DP group were given with Ginseng once each day.Apoptosis of RGCs was measured by TUNEL assay and apoptosis RGCs were counted.LSAB method detected the expression of VEGF in the retina.Image analysis detected by immunohistochemistry color intensity and quantitative analysis.Results:Compared with normal control(NC)group,diabetes mellitus rats were significantly increased the number of apoptotic RGCs(P<0.01).Compared with DC,DP significantly reduced the number of apoptotic RGCs(P<0.05).Compared with NC,DM rats increased the expression of retinal VEGF.Compared with DP,VEGF expression in the treatment group decreased.Conclusion:Ginseng can inhibit VEGF expression and reduce the apoptosis of RGCs in diabetic rats.The number of apoptotic RGCs was positively correlated with VEGF expression.

Objective:To observe the pathologic changes of the retinal ganglion cells(RGCs)and capillary in rats with diabetes mellitus for seven months.Methods:Diabetic rats were induced by streptozotocin.After seven months we removed the eyes under anesthesia and made retinal slides and digest preparations.The RGCs and capillary were observed by light and electron microscopy.Results:In light microscopy the retinal tissues were indistinct disturbance and capillaries were enlarged.There were some early symptoms of diabetic retinopathy(DR),such as extensive pericyte loss,endothelial cell proliferation,pericyte ghost,acellular capillary and apoptosis of endothelial cell.Retinal nerve fiber layer was edematous,nuclear shrinkage and mitochondrion condensed.In electron microscopy endothelial cell of capillary and mitochondrial was edematous obviously,the basement membranes were thickened.RGCs were vacuolated,chromatin of nucleus aggregated marginally decreased and densification.Some of RGCs were necrosis,nucleus were dissolved,mitochondria was edematous,the rough endoplasmic reticula decreased obviously.Conclusion:In the early stage of DR in rats,accompanying the retinal capillary,the RGCs were damaged.

目的观察复方丹参滴丸治疗早期糖尿病视网膜病变的疗效.方法收集20例Ⅰ～Ⅲ期糖尿病视网膜病变的患者,其中治疗组10例,对照组10例,治疗组口服复方丹参滴丸,15粒/次,3次/日;对照组口服多贝斯,500mg/次,3次/日,用药时间90天.通过眼底检查及荧光素眼底血管造影、视力及视野观察评价疗效;同时检测血尿便常规及心电图、肝肾功能、空腹血糖等安全性指标.结果治疗组和对照组眼底视网膜微血管瘤数较治疗前明显减少(P<0.05),视野灰度值(mean defect,MD)较治疗前明显降低(P<0.05),两组对比差异无显著性(P>0.05).结论复方丹参滴丸能改善早期糖尿病视网膜病变视网膜的缺血缺氧状态,促进视网膜微血管瘤的吸收,改善视野.

OBJECTIVE To observe the effects of compound danshendripping pills in treating early diabetic retinopathy.METHODS Twenty patients with early diabetic retinopathy were observed and treated for 90 days.There were ten cases in treated group with compound danshen dripping pills and ten cases in control group treated with calcium dobesilate.Therapeutic effect of compound danshen dripping pills was evaluated by fundus findings,fundus fluorescein angiography,visual acuity and visual field.Some of system examinations were also observed.RESULTS The number of microaneurysm decreased obviously in both groups than before treatment, which showed significant difference.Mean defect(MD) of visual field decreased obviously than before in two groups,but there was no significant difference between the two groups.CONCLUSION Compound danshen dripping pills can improve the ischemic of retina and the visual field in early diabetic retinopathy.It also can reduce the number of microaneurysm.

糖尿病性视网膜病变(Diabetic Retinopathy, DR)是糖尿病最为常见和严重的微血管并发症之一,是主要的致盲原因之一.研究发现,DR发生率随糖尿病病程发展有所不同,发病5年后视网膜病变发生率约为25%,10年后增至60%,15年后可高达75%～80%,其中危害最大的增殖性视网膜病变(PDR)占25%[1].DR目前尚无理想疗法,药物治疗仅为辅助治疗,至今尚无一种药物能有效控制DR的发展.根本的治疗在于早期控制血糖和全身相关因素如血压、血脂、肾功能、饮食控制等.中医药治疗仍在探索之中.现将近15年来中医治疗进展综述如下.

Objective:To explore the relationship between the classification of diabetic macular edema(DME)and stages of the diabetic retinopathy(DR)and visual loss.Methods:The clinical data of fundus fluorescein angiography(FFA)and other related information of 425 patients (850 eyes)with DR were analyzed retrospectively.DR were classified according to national standard of the diagnosis and classification of DR,and DME were classified according to the standard made by the Early Treatment Diabetic Retinopathy Study Research Group of the United States.The occurrence of DME in DR in each stage and the relationships between DME and vision were analyzed.Results:In 425 patients,387 eyes had DME(45.5%),including 67 eyes(17.3%)with focal DME,176 eyes(45.5%)with diffuse DME,115 eyes(29.7%)with cystoid edema and 29 eyes(7.5%)with ischemic maculopathy.The occurrence of DME was 1.03% in I-stage DR,11.11% in Ⅱ-stage DR,36.64% in Ⅲ-stage DR,45.47% in Ⅳ-stage DR and 5.7% in V-stage DR.The visual loss of DME: 13.69% in0.1,28.68% in 0.1～0.3,33.85% in 0.4～0.6,16% in 0.7～0.9 and 7.7% in≥1.0. Conclusion:DME is the main cause of visual impairment of DR.Along with the development of retinopathy,the incidence of DME increases,and the severity of DME aggravateds,but the development of DME and its classification do not have definite correspondence or unification with the classification of DR,hence the typing of DME in another individual classification in DR,of course,is necessary.

强直性脊柱炎(ankylosing spondylitis, AS)是一种病因尚不完全清楚的主要累及轴骨骼的特发性慢性炎症性疾病.约25%患者发生葡萄膜炎,且多为急性前葡萄膜炎(AAU),有96%患者HLA-B27抗原阳性.近2年在我科临床收治的急性葡萄膜炎患者中,有2例患者为强直性脊柱炎合并葡萄膜炎,且HLA-B27抗原阳性,报告如下.

目的:观察红参胶囊对中老年高血压性视网膜病变和血压的影响.方法:患者口服红参胶囊,停服降压药和其他相关治疗.定时测量患者血压,观察眼底变化.结果:用药6周后患者血压有下降;视网膜小动脉痉挛缓解,渗出吸收,视盘水肿逐渐消退.结论:红参胶囊对中老年高血压性视网膜病变有防治作用,对血压有调节作用.