目的 观察四君子汤是否通过线粒体凋亡信号通路发挥对脾气虚型大鼠视网膜脱离(RD)复位后感光细胞的保护作用.方法 成年SD大鼠52只随机分为对照组(A组)、RD自动复位组(B组)、脾气虚RD自动复位组(C组)、四君子汤组(D组).C、D组使用破气耗气加饥饱失常法制备脾气虚证动物模型,实验开始6周后B、C、D组使用视网膜下注射0.1％透明质酸钠的方法制备RD自动复位模型,D组随后灌服四君子汤(20g/kg)至实验结束.分别于实验开始后8、9周随机分批处死动物取材.记录大鼠进食量、体重及精神状态;比色法测定红细胞膜钠钾ATP酶(Na+-K+-ATPase)活性;JC-1荧光探针法检测视网膜组织线粒体膜电位(△ Ψm)水平;Western Blot检测各组视网膜组织B淋巴细胞瘤-2基因(Bcl-2)、Bcl-2相关X蛋白(Bax)及视网膜细胞核细胞凋亡诱导因子(AIF)表达量变化;免疫荧光法检测AIF、细胞色素C(CytC)在视网膜组织中的分布.结果 与A、B组比较,C、D组大鼠在实验开始后1周出现便溏、精神萎靡、毛色枯黄等脾气虚症状,6周红细胞膜Na+-K+-ATPase活性明显降低(P＜0.05),C组上述症状持续至实验结束,D组于9周时上述症状好转,红细胞膜Na+-K+-ATPase活性较C组升高(P＜0.05).与A组比较,B组8、9周视网膜组织△Ψ m降低(P＜0.01);与B组比较,C、D组8周时△ Ψm降低(P＜0.01);随着实验时间延长,至9周时D组△Ψm较C组显著升高(P＜0.05).与A组比较,8、9周时C组视网膜组织Bax升高(P＜0.05),D组则较C组显著降低(P＜0.05),同时9周时C组Bax水平亦高于B组(P＜0.01).8周时C组Bcl-2/Bax较A组降低(P＜0.05),9周时较A、B、D组降低(P＜0.01).8周时,与B组比较,C、D组细胞核AIF蛋白表达量升高(P＜0.01);至9周时,C组细胞核AIF蛋白表达量仍持续升高,且高于D组(P＜0.05).免疫荧光结果显示B、C、D组AIF及CytC较A组着色弥散,其中B组AIF特异性表达于少量外核层细胞核;C组AIF及CytC在外核层特异性着色显著;D组AIF及CytC在外核层部分细胞着色.结论 四君子汤能稳定脾气虚RD自动复位模型大鼠视网膜线粒体内膜及外膜的通透性,抑制线粒体源凋亡信号通路,减少脾气虚RD复位后感光细胞凋亡的发生,发挥神经保护作用.

中心性浆液性脉络膜视网膜病变(CSCR)是第四位最常见可能导致视力损害的获得性视网膜疾病,近年被认为是脉络膜肥厚谱系疾病之一.脉络膜新生血管(CNV)的发生发展是导致CSCR患者长期随访视力下降的主要原因之一,也是其重要并发症.关注CSCR患者伴发CNV的危险因素及相关影像学特征,及时给予诊断并制定相应的治疗策略是非常重要的.利用包括眼底自发荧光照相、荧光素眼底血管造影(FFA及ICGA)、SS-OCT及OCTA多模影像学检查有助于眼科医生更快地发现这类疾病并作出正确诊断,尤其是OCTA的应用有利于临床发现更多的CSCR伴发CNV.光动力学疗法及抗VEGF治疗目前已应用于很多CNV相关疾病的治疗,但对于CSCR所继发的CNV尚无统一的治疗标准.本文就CSCR继发CNV的相关危险因素以及目前的影像学检查和治疗研究作一综述.

Objective:To explore the methods of diagnosis and differential diagnosis of ocular toxocariasis (OT).Methods:11 patients (11 eyes) who were diagnosed OT at Department of Ophthalmology Xi′an People′s Hospital (Xi′an Fourth Hospital) and had ever misdiagnosed by other hospital from November 2016 to February 2021 were collected. Among them, there were 7 males (7 eyes) and 4 females (4 eyes) with an average age was (21.4±13.8) years (ranged from 4 to 47 years). The patient′s medical history, clinical manifestations, diagnostic procedure, imaging results and intraocular fluid test results were recorded. Age and intraocular pressure were described by ±s. Occupation, place of residence, contact history of cats or dogs, main complaint, past medical history, visualacuity, eye manifestations, imaging examination results, intraocular fluid test results and differential diagnosis were described by the number of cases and percentage. The patients were followed up for 6 months to observe whether the clinical diagnosis was corrected.Results:All 11 cases were monocular. There were 6 cases (6 eyes) under 18 years, accounting for 54.55% (6 /11), and 5 cases (5 eyes) over 18 years, accounting for 45.45% (5/11). There were 11 cases (11 eyes) with vitreous opacity, accounting for 100.00% (11/11), 7 cases (7 eyes) with vitreous stratification, accounting for 63.64% (7/11), and 4 cases (4 eyes) with vitreous proliferation and traction retinal detachment, accounting for 36.36% (4/11). Ultrasound biomicroscopy (UBM) showed there were 4 cases (4 eyes) with anterior vitreous opacity, accounting for 36.36% (4/11), and 3 cases (3 eyes) with abnormal hyperecho, accounting for 27.27% (3 / 11), suggesting the formation of peripheral granuloma; 9 cases (9 eyes) with abnormal vitreous echo by B-mode ultrasound, accounting for 81.82% (9/11), including 5 cases (5 eyes) with specific strip and strip layered echo, accounting for 45.45% (5/11), 4 cases (4 eyes) with point and mass echo, accounting for 36.36% (4/11). There were 6 cases (6 eyes) with traction retinal detachment by B-mode ultrasound, accounting for 54.55% (6/11). Fundus fluorescein angiography showed there were 6 cases (6 eyes) with optic disc staining / fluorescein leakage and significant retinal vascular leakage, accounting for 54.55% (6/11), of which 3 cases (3 eyes) showed "fern like" leakage of retinal capillaries, accounting for 27.27% (3/11). Optical coherence tomography showed significant macular edema in 3 cases (3 eyes), accounting for 27.27% (3/11). During the first misdiagnosis, there were 4 cases (4 eyes) with non infective uveitis, 2 cases (2 eyes) with old retinal detachment, 2 cases (2 eyes) with persistent primitive vitreous hyperplasia, 1 case (1 eye) with retinoblastoma, 1 case (1 eye) with macular edema, 1 case (1 eye) of Coat′s disease with neovascular glaucoma, accounting for 36.36% (4/11), 18.18% (2/11), 18.18% (2/11), 9.09% (1/11), 9.09% (1/9), 9.09% (1/11), respectively. The immunoglobulin (Ig) g of Toxocara lumbricoides in intraocular fluid was much higher than that of 3 U, accounting for 63.64% (7/11). Of the OT types, there were typical 9 cases (9 eyes), accounting for 81.82% (9/11), including 2 cases (2 eyes) with posterior pole granuloma, accounting for 18.18% (2/11), 4 cases (4 eyes) with peripheral granuloma, accounting for 36.36% (4/11), and 3 cases (3 eyes) with endophthalmitis, accounting for 27.27% (3/11); there were atypical 2 cases (2 eyes), accounting for 18.18% (2/11). The patients were followed up for more than 6 months, and the clinical diagnosis was not corrected.Conclusions:OT is mostly monocular, which can be found in children and adults. The clinical manifestations of OT are complex and diverse, including posterior pole and (or) peripheral granuloma, endophthalmitis, vitreoretinal proliferation and other typical manifestations. B-mode ultrasound and UBM can assist in the diagnosis, which can also only show panuveitis or intermediate uveitis, accompanied by atypical changes such as macular edema and "fern like" leakage of retinal capillaries. The detection of Toxocara antibody in intraocular fluid is of great significance in the auxiliary diagnosis of OT.

Objective:To investigate the effect of edaravone, a free radical scavenger, on the regulation of retinal autophagy and the protection of photoreceptor cells at the early stage of experimental retinal detachment (RD) in rats.Methods:Fifty-one adult male Sprague-Dawley rats were used for RD model establishment, and another 24 rats were served as PBS injection group.The RD model was established via subretinal injection of 0.5% sodium hyaluronate into the right eye of the rats and the rats with successful modeling were randomly divided into RD model group and edaravone treatment group.The rats in the edaravone treatment group were given edaravone of 3 mg/kg intraperitoneally, twice a day after modeling, and the rats in the PBS injection group and RD model group were given equal volume of normal saline.Rats were sacrificed on the 1st day, 3rd day and 7th day following modeling.The T-superoxide dismutase (T-SOD) activity and malondialdehyde (MDA) content in the intraocular fluid was detected.The expression levels of superoxide dismutase 2 (SOD2), nuclear factor E2-related factor 2 (Nrf2), autophagy related gene 4 (Atg4), microtubule-associated protein 1 light chain 3B (LC3B) and other proteins in retinal tissue were identified by Western blot analysis.TUNEL staining was performed on paraffin sections of the whole eyeball to analyze the apoptosis of photoreceptor cells.The study protocol was approved by an Ethics Committee of Xi'an Fourth Hospital (No. 2016016). The use and care of animals complied with the Regulations on the Administration of Experimental Animals.Results:The RD area was more than 60% in rat eyes of RD model.There were significant differences in MDA content and T-SOD activity among different groups at various time points (MDA: Fgroup=385.513, P<0.01; Ftime=13.021, P<0.01.T-SOD: Fgroup=48.865, P<0.01; Ftime=7.700, P=0.003). Compared with the PBS injection group, the MDA concentration was significantly increased and the T-SOD activity was significantly decreased in the RD group and edaravone treatment group on the 1st, 3rd and 7th day after modeling (all at P<0.05). The MDA concentration was significantly reduced and the T-SOD activity was significantly elevated in the edaravone treatment group on the 1st, 3rd and 7th day after modeling in comparison with those of the RD group (all at P<0.05). Compared with the PBS injection group, the relative expression levels of SOD2 and Nrf2 proteins were significantly increased in the RD group and edaravone treatment group on the 1st, 3rd and 7th day after modeling (all at P<0.05), and Atg4 and LC3B-Ⅱ/LC3B-Ⅰ were significantly increased on the 1st, 3rd and 7th day after modeling (all at P<0.05). The expression level of SOD2 in the edaravone treatment group was significantly higher than that in the RD group on the 1st, 3rd and 7th day after modeling (all at P<0.05), and the expression level of Nrf2 was significantly increased in the edaravone treatment group on the 1st and 3rd day after modeling compared with that of the RD group (both at P<0.05), and the expression levels of Atg4 and LC3B-Ⅱ/LC3B-Ⅰ were significantly increased in the edaravone treatment group on the 3rd day after modeling in comparison with those of the RD group (both at P<0.05). No significant TUNEL positive cells were observed in PBS injection group at all time points, and TUNEL positive cells were observed on the 1st, 3rd and 7th day after modeling in the RD group, and the expression level of caspase-3 in the RD group was significantly increased in comparison with that of the PBS injection group ( P<0.05). The apoptosis of photoreceptor cells and the expression level of caspase-3 in edaravone treatment group were significantly decreased in comparison with those of the RD group on the 1st, 3rd and 7th day after modeling (all at P<0.05). Conclusions:The intraperitoneal injection of edaravone, twice a day, can significantly improve the antioxidant capacity of the retina after experimental RD in rats, regulate retinal autophagy and reduce the apoptosis of photoreceptor cells in early-stage RD.

目的 观察四君子汤对脾气虚型大鼠视网膜脱离(RD)自动复位后感光细胞凋亡的影响.方法 成年SD大鼠40只随机分为对照组(A组)、RD自动复位组(B组)、脾气虚RD自动复位组(C组)、四君子汤组(D组).C、D组使用破气耗气加饥饱失常法制备脾气虚证动物模型;于实验开始后6周B、C、D组使用视网膜下注射0.1％透明质酸钠的手术方法制备RD自动复位模型;并分别于术后2、3周分批处死动物取材.记录大鼠进食量、体重及大鼠精神状态;测定大鼠血清D-木糖值、眼内液超氧化物歧化酶(T-SOD)、丙二醛(MDA)水平;眼球石蜡切片HE染色、原位末端标记(TUNEL)染色;Western Blot分析视网膜Caspase-3、SOD2、缺氧诱导因子-1α(HIF-1α)蛋白表达量变化.结果 与A、B组比较,C、D组于术前体重及进食量、血清D-木糖值明显降低(P＜0.05),C组上述症状持续至实验结束,D组于灌服四君子汤后症状改善,术后3周,与A组比较,血清D-木糖值差异无统计学意义(P＞0.05);与C组比较,D组进食量在术后3周显著增加(P＜0.05).与B组比较,术后2、3周C组眼内液T-SOD活性、视网膜组织SOD2、HIF-1α显著降低,视网膜组织Caspase-3、感光细胞凋亡指数显著上升(P＜0.05);术后3周MDA水平显著升高(P＜0.05);与C组比较,D组术后2、3周眼内液T-SOD活性、视网膜SOD2、HIF-1α显著增高(P＜0.05),Caspase-3显著降低(P＜0.05);术后3周MDA水平、感光细胞凋亡指数显著降低(P＜0.05).结论 脾气虚证通过加重RD复位后眼内氧化应激损伤加重视网膜感光细胞凋亡的发生,使用益气健脾经方四君子汤能有效提高眼内抗氧化能力,减少脾气虚证大鼠RD复位后感光细胞凋亡,发挥神经保护作用.

球周皮细胞瘤(Glomangiopericytoma,GPC)是一种间叶源性肿瘤,主要来源于鼻腔或鼻窦.既往称为鼻腔鼻窦血管外皮细胞瘤,占鼻腔鼻窦肿瘤不到0.5% [1].

Objective:To observe the application of ultra wide angle FFA (UWFA) in the study of the correlation between diabetic macular edema (DME) and retinal ischemia.Methods:One hundred and forty-five patients (220 eyes) with diabetic retinopathy (DR) diagnosed by fundus and FFA in Shaanxi Eye Hospital from January to August in 2018 were enrolled in the study. There were 132 eyes from 85 males and 88 eyes from 60 females. The average age was 54.87±10.89 years old, 171 eyes were non proliferative DR (mild 27 eyes, moderate 32 eyes, severe 112 eyes), 49 eyes were proliferative DR. There were 141 eyes with retinal ischemia. None of them received retinal laser photocoagulation, intravitreal injection of drugs and other eye surgery. UK Optomap200Tx imaging system was used for UWFA examination. According to whether the central macular retina of 2 disc diameter area was involved, the eyes were divided into DME group (183 eyes) and non DME group (37 eyes). According to different appearance of fluorescein leakage in macular zone, DME group was further divided into focal leakage (FL) group, diffuse leakage (DL) group and diffuse cystic leakage (DCL) group, with 94, 73 and 16 eyes, respectively. The incidence of retinal ischemia, retinal neovascularization (RNV) and/or NVD were compared between DME group and non DME group, and the difference of retinal ischemia index (IIS) of three macular edema subgroups was further compared. The differences of retinal ischemia, RNV and/or NVD between DME group and non DME group were compared by chi square test or Fisher exact probability method. The different retinal IIS of three macular edema subgroups was compared by one-way ANOVA.Results:Among 183 eyes in DME group, 132 eyes (72.13%, 132/183) were accompanied with retinal ischemia, and 9 eyes (24.32%, 9/37) were accompanied with retinal ischemia in non DME group. There was significant difference in the incidence of retinal ischemia between the two groups ( χ2= 30.56, P <0.05). In FL group, DL group and DCL group, there were 51 (54.26%, 51/94), 70 (95.89%, 70/73) and 11 (68.75%, 11/16) eyes with retinal ischemia, and 11 (11.70%, 11/94), 30 (41.10%, 30/73) and 4 (25.00%, 4/16) eyes with NVD and/or RNV, respectively, The retinal ischemia indexes of these three groups were 0.051 6±0.096 1, 0.219 2±0.216 6, 0.124 4±0.146 0. There were statistically significant differences in the incidences of retinal ischemia ( χ2=35.53), NVD and/or RNV ( χ2=18.50) and retinal ischemia indexes ( F=22.80) among the three groups ( P=0.000 0,<0.050 0, < 0.000 1). Conclusions:UWFA can dynamically evaluate the retinal ischemia in DME patients, and the enlargement of ischemic area. The formation of RNV are more likely to form DL macular edema.

1 临床资料 患者,男,61岁,2019年11月25日因“间歇性鼻塞3年,加重呈持续性6个月”入住大连医科大学附属第一院三部耳鼻咽喉科.3年前患者无明显诱因出现间歇性鼻塞,无明显流涕及头痛,无鼻出血,当时在我科门诊诊断为“鼻中隔偏曲,慢性鼻炎”给予对症处理后症状有所改善.近6个月症状逐渐加重,持续性鼻塞,伴嗅觉减退,无明显流涕及头痛,无鼻出血.按照以往对症处理后无缓解,遂来耳鼻咽喉科门诊,行鼻内镜检查后以“鼻中隔偏曲,慢性鼻炎”收入院治疗.病来体重无明显下降.

AIM: To observe the clinical therapeutic efficiency of 1g/L sodium hyaluronate eye drops on ocular surface disorders in patients with proliferative diabetic retinopathy(PDR)after 20G pars plana vitrectomy(PPV). METHODS: Randomized single blind case control study was used. Patients with type 2 diabetes who were admitted to the department of ophthalmology, Xi'an No.4 Hospital for PDR and underwent 20G PPV surgery by the same surgeon were randomly divided into PDR control group(Group A)and sodium hyaluronate treatment group(Group B). Group B received continuous 1g/L sodium hyaluronate eye drops from 1d to 2mo after surgery. Before and 1wk, 1, 3mo after surgery, OSDI, SⅠt, BUT, fluorescein cornea staining(FL)and the tear film and corneal epithelial cell layer under corneal laser scanning confocal microscopy of the two groups were compared. RESULTS:A total of 90 cases and 90 eyes were studied. In preoperative time, the two groups showed obvious dry eye syndrome, and compared with the control subjects, there were no significant difference existed between the two groups(P>0.05). In group A, ocular surface injury was further aggravated after surgery and failed to recover with time extension during the observation period.Some indexes of Group B improved at different observation time after surgery compared with those before surgery, and there were significant differences between group A and Group B after surgery(P<0.05). CONCLUSION: Applying 1g/L sodium hyaluronate eye drops could relief the uncomfortable feeling of ocular surface in patients with PDR after 20G vitrectomy and accelerate the recovery of ocular surface disorders.

腺样体肥大是儿童耳鼻咽喉科常见疾病,腺样体切除术是其主要治疗方式.通过鼻内镜直视下手术,可以完整、清晰的暴露术野,切除肥大的腺样体组织,以及邻近的咽鼓管扁桃体和咽隐窝扁桃体组织,极大的降低了腺样体切除术后并发症与复发的发生率.本文就腺样体肥大手术治疗的新进展进行综述.

目的:分析1例中耳后鼓室腺瘤病例的临床症状及体征、听力学特点、颞骨CT特点及病理特点对明确诊断的意义,经手术治疗后患者有无肿瘤局部复发及听力改善情况.方法:回顾性分析2017年在大连大学附属中山医院接受手术治疗并行病理检查的1例中耳后鼓室腺瘤患者的完整病例资料,包括临床变现与体征、听力学检查、颞骨CT检查结果、病理结果及术后15d、1月及1年随访过程中患者有无肿瘤的局部复发及听力改善情况.结果:该患者入院时左耳进行性听力下降,左耳骨膜松弛部可见圆形肿物、表面光滑、凸向外耳道,左耳感音神经性聋,颞骨CT左侧室内见斑片状稍高密度影,形态不整,大小约0.8cm×1.6cm,听小骨未见明显异常,双侧乳突气化良好,乳突腔内未见明显异常密度影,乳突腔骨壁骨质未见明显异常,均无明显特异性来确诊中耳后鼓室腺瘤,病理为左后鼓室腺瘤(伴神经内分泌分化特征),免疫组织化学结果CK(+)、CgA(+)、Sgn(+)、CD56(-)、Ki-67index 1％可明确中耳后鼓室腺瘤诊断,术后随访过程中患者无肿瘤局部复发、左耳听力无明显改善.结论:中耳后鼓室腺瘤病例的临床症状及体征、听力学特点、颞骨CT特点无明显特异性来明确诊断,病理及免疫组化结果可明确中耳后鼓室腺瘤诊断,其有神经内分泌分化特征,们该患者术后无肿瘤局部复发、患耳听力无明显改善.

目的 探讨玻璃体切除术(PPV)联合雷珠单抗玻璃体注射治疗增殖性糖尿病视网膜病变(PDR)的临床疗效.方法 选择2014年1月至2017年12月西安市第四医院眼科收治的68例PDR患者为研究对象,按照随机数表法分为观察组和对照组,每组34例,观察组给予PPV联合雷珠单抗玻璃体注射治疗,对照组单纯给予PPV治疗,比较两组患者术后视力改善情况、手术时间、眼内压、黄斑中心凹视网膜和并发症情况.结果 观察组患者的术后视力改善率为70.6%,明显高于对照组的41.2%,差异具有统计学意义(P<0.05);观察组患者手术时间为(55.7±11.6) min,明显短于对照组的(92.4±13.5) min,黄斑中心凹视网膜厚度为(289.3±20.1) μm,明显低于对照组(331.5±22.4) μm,差异均有统计学意义(P<0.05);观察组和对照组患者术后眼压[(17.4±3.3) mmHg vs (18.7±3.5) mmHg]比较差异无统计学意义(P>0.05);并发症主要为无菌性眼炎、术后再出血、术后感染和再增殖,观察组患者术后并发症的发生率为17.6% (6/34),明显低于对照组的55.9% (19/34),差异有统计学意义(P<0.05).结论 PPV联合雷珠单抗玻璃体注射治疗PDR可以有效改善患者视力,减少术后并发症发生率,临床疗效显著,值得推广应用.