青光眼是一种严重的不可逆性致盲眼病，是以视网膜神经纤维缺失、视神经结构及视功能相关改变为特征的多因子视神经病〔1〕。其视神经损害的发病机制尚未完全清楚。许多青光眼患者在眼压得到有效控制后依然出现进行性视功能损害。因此除眼压外，缺血性改变是青光眼发生发展的另一个重要因素。本文就青光眼视功能损害的血流动力学研究进行综述。

患者女,41岁.患者7天前出现发热症状,体温达40.2℃,当地医院给予药物静点(药名不详),3天前出现头痛、恶心,1天前突发右眼视力下降,于2012年12月2日来我院眼科就诊. 既往无外伤史、无传染病接触史.查体:有眼:视力:0.01,眼压:17 mmHg,前眼部未见异常,眼底:视乳头境界不清,隆起+2 D,视乳头颞上方可见视网膜血管下团块状黄白色孤立病灶,波及黄斑区,直径约5 PD～6 PD,境界清楚,病灶表面及整个眼底散在片状出血,中心Roth斑,病灶周围视网膜静脉扩张,可见白鞘.左眼:视力:0.4,眼压:18 mmHg,前眼部未见异常,眼底视乳头境界清,颜色正常,黄斑中心凹反射欠清,颞上方距视乳头5 PD处可见与右眼类似的视网膜血管下团块状黄白色孤立病灶,直径约4 PD,病灶表面及病灶周围视网膜散在片状出血,中心Roth斑,病灶周围视网膜静脉扩张,可见白鞘(图1).

目的观察长期单纯应用拉坦前列素滴眼液治疗老年慢性闭角型青光眼（CACG）的临床疗效及安全性。方法选取29例（55只眼）早、中期老年CACG患者,平均年龄为77.83±5.74岁,眼压﹥21mmHg（1mmHg=0.133kPa）且﹤36mmHg。给予拉坦前列素滴眼液滴眼,每天1次,共随访3年。于用药后1周、4周、6月、12月、24月及36月观察眼压、视野、视乳头杯盘比（C/D）、视网膜神经纤维层（RNFL）、眼部症状及体征。结果与基线眼压值（24.89±2.96mmHg）相比,用药后1周、4周、6月、12月、24月及36月平均眼压分别下降6.77±2.98、7.54±3.24、8.25±3.49、7.36±3.11、7.99±2.89及8.38±2.96mmHg,用药后各时间段眼压显著低于用药前,差异有显著性（P＜0.05）。视野及光学相干断层成像（OCT）动态观察虽有改变,但差异无统计学意义。55眼中4眼出现结膜充血,1眼出现虹膜色素沉着,继续治疗无不适。结论每日一次拉坦前列素滴眼液对老年CACG患者具有良好的长期平稳降低眼压作用,且不良反应少,安全性高。

目的探讨药物治疗对老年慢性闭角型青光眼(CACG)患者的疗效及其维持有效视功能的可行性。方法选取吉林大学第一医院2007年6月～2008年6月收治的33例(65只眼)CACG患者,均采用抗青光眼药物局部点眼,制定个体化的治疗方案,观察其用药前后眼压(IOP)值、视网膜神经纤维层(RNFL)厚度与视乳头杯盘(C/D)比值及视野的差异,并行统计学分析。随访期限为3年。结果 Paired-Sample t Test显示:用药前后,CACG患者眼压的差异具有统计学意义,而反映疾病进展程度的RNFL厚度、C/D比值及视野均不具有显著性差异(P<0.05)。结论对于老年慢性闭角型青光眼患者,局部给药可以明显降低眼压,且没有其他副作用;通过制定个体化治疗方案及规范化的随访,老年闭角型青光眼患者可以维持长久可用视力。

目的通过检测视网膜神经纤维层厚度(RNFL)及视盘结构参数,结合视野改变,探讨光学相关断层成像术(OCT)在青光眼早期诊断中的价值。方法采用OCT对正常人10眼、疑似青光眼患者34眼,慢性闭角型青光眼(CACG)早中期患者36眼进行视盘扫描及以视乳头中心为圆心、直径为3.4 mm的环形扫描,观察各组人群的OCT图像特征。分别比较各组受检者的各象限RNFL厚度、视乳头水平、垂直杯盘比及杯/盘面积比,平均RNFL厚度与视野指数进行直线回归和相关分析。结果OCT检测正常人、疑似青光眼和CACG早中期三组间各象限RNFL厚度、各视盘参数均有显著性差异(P<0.05)。平均RNFL厚度与视野平均缺损值(MD)呈强的且正的直线关系。结论OCT能够早期反映RNFL厚度及视盘的改变,与视野检查有较好的相关性,可以作为青光眼早期诊断的方法。

Objective To evaluate the effect of direct cyclopexy on traumatic ciliary body detachment. Methods 11 cases of traumatic ciliary body detachment were treated with direct cyclopexy under microscope. Results Postoperatively intraocular pressure recoverd to normal in 6 eyes within one day and in 1 eye within a week,in 3 eyes of increased intraocular pressure within a week by treatment,and in 1 eye after received the second surgery.The visual acuity was improved obviously in all eyes. Conclusion Direct cyclopexy is an effective method in the treatment of traumatic ciliary body detachment.

原发性青光眼是严重的不可逆转的致盲性眼病之一,早期诊断和干预是防止青光眼患者视功能严重丧失的关键措施.近年来,原发性青光眼在基础和临床研究中取得了重要进展,同时先进的仪器设备辅助检查进一步提高了青光眼的早期确诊率,同时有利于随访观察并可指导治疗.本文对与原发性青光眼的早期诊断相关的几点新概念及相关辅助检查进行综述.

目的 评价在应用角膜共焦显微镜检查指导下的老年坏死性角膜基质炎(NSK)治疗效果.方法 51例(54只眼) NSK患者在角膜共焦显微镜检查指导下,根据角膜细胞结构的病变特点,局部应用更昔洛韦眼凝胶、环孢素A滴眼液滴眼,溃疡好转后联合低浓度皮质类固醇滴眼液滴眼或单纯应用更昔洛韦眼凝胶联合低浓度皮质类固醇滴眼液治疗,随诊观察16～28个月.结果 老年NSK组(≥60岁)治愈率(84.62%,10 /13)与≤59岁组(80.48%,35/41)比较,无明显差异(P＞0.05),老年NSK组复发率(7.69%,1/13)与≤59岁组(4.88%,2/41)比较,差异亦无显著性(P＞0.05).结论 NSK患者治疗效果与年龄无关,在角膜共焦显微镜检查指导下选择合理用药是治疗关键.

Objective To evaluate the significance of the retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters measured by optical coherent tomography (OCT) in the early diagnosis of glaucoma, combined with visual field change. Methods Thirty-six eyes of glaucoma patients, 34 eyes of suspected glaucoma and 10 healthy eyes were included in this study. All patients performed ONH and RNFL thickness examination with OCT during the same visit. Comparisons were made with regard to each quadrant and average RNFL thickness. Comparison of Cup/Disc horizontal and vertical ratio and area ratio were made between each group. Analyze the correlation between the average RNFL thickness and visual field. Results There was significant difference of RNFL thickness and optic disc parameters in various quadrants and means among the three groups (P< 0.05). Normal and SACG group: RNFL thickness in superior, inferior and the average was significant difference. Normal and CACG group: Every quadrant and average RNFL thickness was significant differences. CACG and SACG Group: the superior, inferior, nasal and the average of RNFL thickness was significant difference. The average RNFL thickness and visual field mean defect (MD) showed a strong and positive linear relationship. Conclusions OCT can early reflect the changes of glaucoma in RNFL thickness and optic disc parameters, also can find the RNFL thickness damage before the of visual field changes, and have a better correlation with the vision. It can serve as a method of early diagnosis of glaucoma.

目的:对正常学龄前儿童立体视及不等像进行检测及临床评估,探讨屈光参差性弱视儿童立体视发育和双眼不等像的情况。方法:利用计算机随机点立体视及不等像检查软件对2所幼儿园100名视力正常的3～6岁儿童进行立体视及不等像检查,并与同视机随机点立体视检查图片的检查结果进行比较。对24名屈光参差性弱视儿童进行立体视及不等像的检测。结果:正常学龄前儿童随年龄的增长,立体视锐度逐渐增高,5岁基本达到成人水平;而不等像不随年龄的增长而变化。屈光参差性弱视儿童随着弱视程度的增高,立体视锐度降低,不等像增高;随着屈光参差度数增加,立体视锐度降低,不等像值增高。结论:计算机随机点立体视及不等像检查软件是一种可靠而实用的软件,不仅可用于临床检查和诊断,还可用于科学研究。

目的利用单纯疱疹病毒1型(HSV-1)糖蛋白B基因疫苗(pgB)免疫小鼠,观察pgB在小鼠体内的表达。方法利用pgB肌肉接种方法免疫小鼠,通过免疫组化法检测免疫后2、4、6wpgB在眼、三叉神经、脑表达HSV-1gB情况。结果免疫后第2、4、6w均可见视网膜、三叉神经节、脑组织中大部分细胞核呈棕黄色,免疫组化呈阳性。结论经肌肉免疫pgB能持续、稳定地在视网膜、三叉神经节、脑组织细胞中表达。

目的 利用构建成功的重组真核表达质粒pgB免疫小鼠,探讨单纯疱疹病毒I型(HSV-Ⅰ)gB基因作为基因疫苗的可能性.方法 用重组真核表达质粒pgB免疫小鼠,通过中和试验、ELISA方法检测pgB接种小鼠的免疫效果,并对免疫的小鼠进行病毒攻击.结果 实验小鼠产生了对HSV-1特异性的抗体(抗体滴度:ELISA法1∶273,中和试验法:1∶49),实验组中和效价显著高于载体对照组和阴性对照组(P＜0.01);对病毒的攻击并有免疫保护作用,实验组和空白对照组比较(P＜0.01).结论 证明pgB真核表达质粒,具有DNA疫苗作用,可在小鼠体内诱发保护性免疫反应,pgB有可能作为基因疫苗用于单纯疱疹病毒性角膜炎预防和治疗,为进一步构建单纯疱疹病毒糖蛋白联合疫苗并最终用于单疱病毒角膜炎奠定了理论基础.

患儿女 4岁 2个月前发现患儿右眼视力下降,加重1个月而就诊.在外院诊断为弱视,给予验光配镜及弱视训练.因患儿视力无提高,1周前就诊于我院眼科,诊断为双眼原发性视神经萎缩,知觉缺陷性眼球震颤,右眼知觉性外斜视.建议行头部核磁检查,结果提示为鞍上占位病变,于2007年4月23日收入脑外科.查体:生命体征平稳,神志清.眼科检查:右眼视力:光感,瞳孔直径约5 mm,对光反射迟钝.

单纯疱疹病毒1(HSV-1)是双链线性DNA包膜病毒,其DNA编码至少有11种特异型的糖蛋白,其中gB、gD、gH和gL是病毒复制、穿入、病毒胞间扩散和病毒囊膜与感染的细胞膜融合必须糖蛋白[1～5].gB是病毒囊膜的组成部分,是HSV-1感染晚期糖蛋白,在感染的细胞中,gB是跨膜蛋白,穿膜时是以二聚体和糖基化形式由胞外区穿向细胞膜,存在于感染细胞的胞膜上、内质网、高尔基复合体和核膜上.HSV-1 gB在疱疹病毒家族中是高度保守蛋白,各毒株间差异较小,且与所有的疱疹类病毒亚群有较大的同源性[6～9];gB是病毒复制必须的多功能蛋白,是宿主免疫反应的主要靶抗原,能诱导细胞免疫、体液免疫和细胞毒T淋巴细胞反应[10～14].鉴于gB蛋白的多种生物活性,近年来许多学者对gB的抗原和功能区进行大量研究.HSV-1 gB由UL27基因编码,全长2172bp,编码904氨基酸,由-30(有的是29)氨基酸序列组成的信号肽、-696氨基酸序列组成的在氨基端具有亲水性的胞外区、-69氨基酸序列组成的具有疏水性的跨膜区、-109氨基酸序列组成的羧基端具有极性胞内区[15].HSV-1 gB含有6个一致序列N-连接糖基化位点和10个半胱氨酸序列,在与gB同源序列中是高度保守序列,这些结构是整个分子内的重要结构[16]。

崔××,男,50岁,农民,以双眼渐进性视力下降1年为主诉于2006年6月25日来我院就诊.患者自诉年轻时视力非常好,18岁征乓时体检视力双眼均为1.2.近1年来自觉双眼视力渐下降明显,尤其在强光下视力更差,在弱光下稍好些.

Objective The article directed at the phenomena that at the clinic monocular vision of some Datients is normal,while binocular vision of those is declining,accents the different signification of binocular vision and monocular vision,and analyses reasons and mechanisms of binocular eyesight decline and binocular vision functions abnormity.Methods naked Distant vision and near vision of simple eye,those of oculus uterque,and corrected visual acuity,eyeball position,eye movement are examined.Preocluar and eyeground examining.Optometry using the phoropter.Synoptophore,prism and stereopsis checking.Results 15 patients of monocular vision is normal while binocular vision is weak,three are medium or high hypermetropia,six are intermittence exotropia,other six are mild anisopia.ARer the therapy on the grounds of different causes,binocular vision is elevated.Conclusion At the clinic the examination of binocular vision and binocular vision functions should be regarded besides general examination of monocular vision and be given corresponding rectification.

Objective To evaluate the safety of herpes simplex virusⅠ glycoprotein B DNA vaccine(pcDNA3-gB) in mice by examing the indexes of hematology,hematological biochemistry and pathological results of eight important organs of immunized mice.Methods Twenty-four mice were divided into four groups(n=6) randomly,including control group,100,300 and 500 mg·L-1 pcDNA3-gB groups,and 1 mL sodium chloride,100,300 and 500 mg·L-1 pcDNA3-gB were injected into mice through the quadriceps in various groups.At the 10th day after last immunity,the blood samples were collected and the indexes of hematology,hematology biochemistry and the pathological results of liver,kidney,heart,brain,spleen,cornea,retina and trigeminal ganglia were examined.Results The differences in RBC,HB,HCT,MCV,MCH,MCHC,PLT,RDW,WBC,ALT,AST,ALP,T-BIL,GLU,ALB,TP,Cr,BUN betwen control group and pcDNA3-gB groups were not significant as well as the pathological results of liver,heart,kidney,brain,spleen,cornea,retina and trigeminal ganglion(P0.05).Conclusion pcDNA3-gB with different doses have not significant effect on the indexes of hematology,hematological biochemistry and pathology in immunized mice.It is initially proved that pcDNA3-gB is safe.

典必殊是地塞米松与妥布霉素组成的糖皮质激素(Glucocorticoid,GC)类眼药水,每5毫升典必殊眼药水中即含有地塞米松5mg.眼局部、全身使用, 甚至气管吸入糖皮质激素都可能使眼内压增高, 导致高眼压症和/或激素性青光眼(Glucocorticoid-induced glaucoma GIG)的发生.

迅速发展起来的DNA疫苗由于具有多项优点受到人们的高度重视,但其诱导的特异性免疫应答效果却不尽人意,因而妨碍了它们的实际应用.如何增强和提高DNA疫苗的免疫效果是新一代DNA疫苗分子设计和研究的关键问题,其中之一就是应用分子佐剂来优化DNA疫苗.本文就近几年在单纯疱疹病毒基因疫苗加分子佐剂方面的研究进展作一综述。

Objective To detect the influence of herpes simplex virusⅠ-glycoprotein B DNA vaccine to the index of mice hematology.Methods Twenty-four mice were divided into four groups randomly.The four groups were control group、1 mg/ml、3 mg/ml、5 mg/ml DNA vaccine group.There were six mice in each group and a half of them were male,and others were female.To inject mice different dose of DNA vaccine every ten days,and give normal saline to control group.Totally injections were three times.After the last injection,we killed mice and collected blood to examine the index of their hematology.Results Compare to the control group,index of other groups were not found differences obviously in statistics(P0.05).Conclusion Because there were no obvious differences between each two groups,we consider the herpes simplex virusⅠ-glycoproteinB DNA vaccine has no influence to the index of mice hematology.