A simple new technique for the induction of residual posterior vitreous cortex removal and membrane peeling

AIM:To describe a quick,cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane(ILM)flap during vitrectomy.METHODS:The surgical technique and a retrospective interventional single-center series of cases were described.A hook was made on the tip of a conventional syringe needle(outer diameter,0.6 mm;23 gauge)by bending the needle against a plate.We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy.The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated.RESULTS:The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment,proliferative diabetic retinopathy,and pathological myopia.It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane.There were no serious complications associated with using the hook in delicate ophthalmological procedures.CONCLUSION:The hook,made by bending a conventional needle,is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.

Membrane Formation on the Surface of Implanted Posterior Chamber Intraocular Lenses

Purpose:To study the prevention and treatment of the membrane formation on the lens surface after extracapsular cataract extraction(ECCE)with posterior chamber intraocular lens(PCIOL)implantation.Methods:We reviewed the records of 312 cataractous patients that had undergone ECCEwith PCIOLimplantation between1989and1993,Postoperatively all pa-tients were examined under slit-lamp microscopy.The membrane formation on the surface of PCIOLin pupilar area was divided into four grades.Two mem-branes of surgical removal were observed under a transmission electrom mi-croscopy.One PCIOLof surgical removal was observed under a scanning electron microscopy.Results;Of312 patients,21 had the membrane formation on the surface of the PCIOL postoperatively.The incidence of the membrane formation was6.7%.Comparisone with cases of senile cataract showed the incidence to be significantly the highest among;1.patients who had traumatic cataract(P<0.05);2.pa-tients with complicated cataract(P<0.05).Interoperatively residual lens corten and rupture of posterior capsule,interval time betwwen the first and second eye operations less than 1month are the main factors of menbrane formation.The ultrastructure in membrane and cytology on the lens surface showed that the membrane on the surface of PCIOLs is usually composed of acellular protein film and cellular elements,including macrophages.fibroblast-like cells,epithelioid cells,giant cells,fibroblasts and collagen fibrils,etc.Conclusions:The cellular response on the surface of an implanted PCIOLis a chonic foreign-body inflammatory reaction and the membrane of the surfaceof implanted PCIOL is a reactive membrane of the foreign-body.Eye Science1995;11:131-135.

Accuracy of Transvaginal Ultrasound in Prediction of Latency Period in Women with Preterm Premature Rupture of Membranes

Background: Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. Aim of the Work: To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. Subjects and Methods: A Prospective cohort study on 205 women with PPROM was held at Ain Shams University Maternity Hospital, a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. Results: A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0°, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0°, sensitivity was 93.0%, specificity was 71.6%. Conclusion: The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predicts the latency period in women with PPROM, and Anterior uterocervical angle (AUCA) ≥ 106.0° had the highest diagnostic value in predicting latency period within two days.

A Case Report of Posterior Reversible Encephalopathy Syndrome with Rapidly Progressive Glomerulonephritis Combined with Membranous Nephropathy

Rapidly progressive glomerulonephritis is a group of clinical syndromes,in which renal function of patient progressively deteriorates with pathological manifestation of extensive glomerular crescent formation.Among which,anti-glomerular basement membrane antibody glomerulonephritis is the rarest but the most aggressive subtype.This paper discusses a case of rapidly progressive glomerulonephritis combined with membranous nephropathy.There were posterior reversible encephalopathy syndromes during diagnosis and treatment.Diagnosis was confirmed in time by laboratory examination and renal pathology.Condition of the patient was alleviated through close work between all departments.This allowed us to further understand the case characteristics of rapidly progressive glomerulonephritis combined with membranous nephropathy,importance of effective prevention,and significance of various complications during treatment,so as to alleviate pain and improve prognosis in patient.

无托槽隐形矫治器内收前牙时后牙移动趋势及牙周膜应力分布

目的 :利用三维数字化技术对无托槽隐形矫治器内收前牙时后牙移动趋势及牙周膜应力分布进行分析。方法 :选择广西壮族自治区人民医院2017年6月—2022年6月收治的88例患者CBCT数据,将其输入Mimics 20.0软件中,对其各部位进行初步抽取,使用STL文件进行存储。通过Geomagic Studio 2014软件进行修补和优化,在优化基础上,构建无托槽隐形矫治器和牙周膜模型。利用Ansys Workbench19.0 FEM软件对6个FEM模型进行模拟仿真与观测,分析当前牙整体回收时,不同组别患者支抗牙的初始移动趋势与牙周膜范式等效应力分布。采用SPSS 21.0软件包对数据进行统计学分析。结果:所有患者支抗牙均发生不同程度牙根部颊向移动等倾向,其中,第二前磨牙位置移动在近中咬合方向上表现最为明显;而水平矩形附件组与垂直矩形附件组成相对关系,牙周膜最大范式等效应力大范围分布于牙颈部,接着是根尖区,以NA组支抗牙的范式等效应力值最大。附件垂直矩形组中,所有患者牙周膜最大范式等效应力值显著小于水平矩形组。结论:正畸牙附件设计对前牙回收时的位置移动具有较强抑制作用,在一定程度上提升了牙三维方向移动的精确性。无托槽隐形矫治器应用初期,患者牙周膜受到的范式等效应力较大。

骨间前动脉背侧穿支的显微解剖

目的观察骨间前动脉背侧穿支的数量、起始处管径、供养范围及其与骨间后动脉分支的吻合情况。方法新鲜成人前臂标本13侧,红色乳胶灌注动脉并凝固后,解冻标本进行解剖。取10侧前臂标本,去除前臂皮肤、前臂屈肌后,显露骨间前动脉及其背侧穿支,测量并记录骨间前动脉背侧穿支的数量、起始处管径。沿桡侧腕屈肌和指伸肌的间隙向深层解剖,观测骨间前动脉背侧穿支的数量及其对前臂背侧伸肌的供养范围。取13侧前臂标本,解剖后在前臂背侧浅层伸肌的肌间隙、深层伸肌的肌间隙以及深浅两层伸肌之间的肌间隙中,观察骨间前动脉背侧穿支与骨间后动脉的分支吻合情况。结果10侧标本合计有骨间前动脉背侧穿支94支,每侧标本骨间前动脉背侧穿支数量7~12(9.4±1.5)支,起始处管径0.21~1.56(0.70±0.34)mm。骨间前动脉背侧穿支穿过骨间膜后主要供养前臂背侧深层伸肌,在前臂远端三分之一还发出肌支供养指伸肌、小指伸肌。13侧标本中,骨间前动脉背侧穿支与骨间后动脉分支之间单支吻合7侧、双支吻合5侧、无吻合1侧。结论骨间前动脉背侧穿支数量较多且起始处管径较粗大,主要供养前臂背侧深层伸肌、指伸肌、小指伸肌。骨间前动脉背侧穿支与骨间后动脉分支之间有单支吻合、双支吻合以及无吻合3种情况。

白内障超声乳化术中前囊膜抛光预防患者后囊膜混浊的运用价值评估

目的分析应用前囊膜抛光对白内障超声乳化术后后囊膜混浊进行预防的作用。方法随机选取2021年1月—2023年8月漳州市第三医院收治的190例白内障超声乳化术患者为研究对象,按照术中有无实施前囊膜抛光治疗将患者分为两组,研究组100例患者(100眼)术中进行前囊膜抛光治疗,对照组90例患者(90眼)经过常规后囊膜抛光处理后,将人工晶状体置入,并没有进行前囊膜抛光处理。比较两组对视力分布情况、后囊膜混浊发生情况。结果术后,研究组的视力分布情况均明显优于对照组,差异有统计学意义(P均<0.05)。术后6、12个月,研究组后囊膜混浊发生率分别为10.0%、15.0%,对照组分别为22.22%、27.78%,两组比较,差异有统计学意义(χ^(2)=5.322、4.653,P均<0.05)。结论白内障患者在接受白内障超声乳化术治疗时,术后开展前囊膜抛光治疗不但显著改善患者视力,而且能有效预防术后囊膜混浊。

Inflammatory choroidal neovascularization after tubercular posterior scleritis

A 45-year-old female presented with typical features of posterior scleritis in her left eye with visual acuity of 20/252. After treatment with oral steroids and immunosuppressive drugs, at 2 months follow-up, posterior scleritis resolved and visual acuity improved to 20/50. Five months later she presented with vision loss(20/160) associated with active choroidal neovascular membrane(CNVM) close to scar. Significant choroidal thinning(subfoveal choroidal thickness =137 microns), compared to fellow eye(subfoveal choroidal thickness =247 microns) was noted. Two doses of intravitreal bevacizumab(IVB) were given at 1 month interval. At 9 months follow-up, her visual acuity was maintained at 20/160 with scarred CNVM. In conclusion, IVB is safe and efficacious in treatment of inflammatory CNVM secondary to posterior scleritis. Choroidal changes after posterior scleritis could be contributory factor for formation of CNVM.

健康体检筛查黄斑及后极部视网膜前膜结果分析

目的在健康体检中用彩色免散瞳眼底照相机筛查黄斑及后极部视网膜前膜,研究其发病情况及相关影响因素,为预防和治疗提供基础依据。方法选取2021年参加北京理工大学校医院健康体检人群的眼底阅片诊断进行统计分析,研究黄斑及后极部视网膜前膜的发病情况并比较该体检群体中黄斑及后极部视网膜前膜患者和无相关疾病者的临床特点,用EXCEL软件和SPSS 26软件进行统计分析。结果本研究680例体检者共检出黄斑及后极部视网膜前膜65例,检出率为9.56%,男性36例,检出率10.65%,女性29例,检出率8.48%,男女检出率差异无统计学意义(P>0.05)。其中黄斑前膜检出46例,检出率为6.76%,男性25例,检出率7.40%,女性21例,检出率6.14%。≥70岁组黄斑及后极部视网膜前膜检出率为13.65%,显著高于<70岁组的5.54%,差异具有高度统计学意义(P<0.001)。黄斑及后极部视网膜前膜患者中高脂血症34例,患病率为52.31%,高于无相关疾病者的39.35%,差异具有统计学意义(P<0.05)。结论健康体检黄斑及后极部视网膜前膜检出率较高,呈现随年龄增长不断升高的趋势。另外高脂血症患者出现黄斑及后极部前膜的概率较常人高,对有高危因素者需要高度关注,发挥体检的作用进行早期干预。

后部多形性角膜营养不良49例共聚焦显微镜影像学观察

目的:探讨49例后部多形性角膜营养不良(PPCD)患者在共聚焦显微镜(IVCM)下的影像学特征。方法:回顾性病例研究。收集我院2013-01/2021-01诊断为PPCD患者49例86眼,包括男32例,女17例,平均年龄42.5±22.9岁。所有患者均进行IVCM检查,分析角膜内皮细胞密度及不同类型病变的镜下特点。结果:所有患者病灶区内皮细胞数量均较外周细胞数量低。IVCM下病变呈1型囊泡型的有44眼(51%),表现为角膜内皮层的圆形或不规则弹坑样病灶,单个或多个出现;2型条带型16眼(19%),表现为边缘弧形凸起,部分可见似赘疣样影像散在或条索状分布;3型弥漫型26眼(30%),表现为内皮细胞大面积缺失,大部分区域内皮成像不清,呈匍匐样、条索样延展的凸起,成像较清晰处部分同条带型病灶。观察病例中有2例患者随访4~5a,IVCM下病灶均较前有变化,包括中央角膜内皮数量的减少和上皮层铁质沉着等。结论:IVCM能够显示PPCD患者各期内皮细胞和Descemet膜水平的特征性显微结构改变,通过观察其影像学特点可以为疾病提供有效的诊断价值。

基于膜解剖间隙的经阴道双侧骶棘韧带固定在基层医院的实践

目的探讨基于膜解剖间隙的经阴道双侧骶棘韧带固定在基层医院开展的安全性、可行性及临床疗效分析。方法回顾性分析在重庆市巫溪县人民医院妇科完成的基于膜解剖间隙的改良骶棘韧带加前后壁修补手术共17例,统计患者围术期情况及术后随访情况。结果17例患者均安全完成手术并获得良好的效果,手术时间(73.63±11.80)min,术中出血(92.94±43.89)mL,住院时间(8.29±1.64)d,无术中术后严重并发症,术后未出现新的盆底功能问题。术后尿路症状好转45.46%,排便好转100.00%。无主观症状复发。结论基于膜解剖间隙的经阴道双侧骶棘韧带固定术,相对而言简单易学,不需要特殊手术器械,手术效果良好,可能适合基层医院学习开展。但本研究仅是单中心的小样本病历回顾,进一步的证据仍需多中心更多样本的积累及更长时间的随访。

游离龈移植及单纯应用可吸收膜诱导角化龈生成在种植体周围角化龈缺失中的应用对比

目的:探讨游离龈移植(Free gingival grafts,FGG)及单纯应用可吸收膜诱导角化龈生成在种植体周围角化龈缺失中的应用效果。方法:选取2018年5月-2021年1月笔者医院收治的10例预行后牙种植术的种植体周围角化龈缺失患者,于种植二期术前对患者行可吸收膜诱导再生术,术后4周测量种植位点仅生成部分角化龈,再行FGG,并将其以不同术式结果分为可吸收膜诱导术组和FGG组。比较两组疼痛程度、角化龈厚度和宽度、改良菌斑指数(Modified plaque index,mPI)、改良出血指数(Modif ied bleeding index,mBI)、探诊深度(Probing depth,PD)水平及患者满意度。结果:术后3d、7 d,两组视觉模拟量表(Visual analog scale,VAS)评分均逐渐降低,且同时间段FGG组VAS评分均低于可吸收膜诱导术组(P<0.05);术后8周,FGG组角化龈厚度和宽度均高于可吸收膜诱导术组,FGG组mPI、mBI、PD水平均低于可吸收膜诱导术组(P<0.05);术后6个月,两组PD水平均低于术后8周,可吸收膜诱导术组mBI水平低于术后8周,且FGG组均高于可吸收膜诱导术组(P<0.05);FGG组软组织美学评分高于可吸收膜诱导术组(P<0.05)。结论:FGG及单纯应用可吸收膜诱导角化龈生成均能增量种植体周围角化龈缺失患者角化龈,且FGG对患者疼痛程度更低,角化龈增量效果更显著,能更有利于维持患者口腔卫生和软组织水平,患者满意度更高。

寰枕后膜推拿松解术对寰枕后间隙的影响

目的观察寰枕后膜推拿松解术对寰枕后间隙的影响。方法观察30例寰枕后膜挛缩症的患者使用寰枕后膜推拿松解术治疗对寰枕后间隙的影响情况。结果治疗组30例患者,在寰枕后间隙间距改善率上明显高于对照组。结论寰枕后膜推拿松解术可通过松解挛缩的寰枕后膜从而使寰枕后间隙间距恢复,降低局部内压,以缓解临床症状。

OCT在无症状的不完全玻璃体后脱离诊断中的价值

目的:探讨OCT对无症状的不完全玻璃体后脱离的检出率。方法:对经检查明确诊断1眼玻璃体后脱离病例49例98眼,及正常体检自愿者93例186眼,采用Zeiss公司生产的CirrusHD-OCT进行双眼检查。结果:在1眼完全玻璃体后脱离的49例患者中,另1眼发生不同程度的玻璃体不完全后脱离24眼,发生率为48.9%,正常体检自愿者93例186眼,发生玻璃体不完全后脱离63眼,发生率为33.9%,所有玻璃体不完全后脱离者均无眼前黑影等症状。结论:OCT对玻璃体不完全后脱离的检出具有非常好的特异性和敏感性,可作为玻璃体后脱离的必需检查手段。

Nd:YAG激光松解切开术治疗晶状体后囊膜皱褶

目的:探讨Nd:YAG激光松解切开术治疗晶状体后囊膜皱褶的效果。方法:术前爱尔卡因表面麻醉下置CGP角膜接触镜,借助瞄准光,准确聚焦于皱褶上,发射Nd:YAG激光,单脉冲松解皱褶能量为0.4～1.0mJ,每次治疗总量为20～30(平均24.00±0.0625)mJ。结果:后囊膜皱褶激光松解切开术后矫正视力1.0者31眼(58%),0.6～0.8者17眼(32%),0.4～0.5者5眼(9%)。裂隙灯下观察未发生人工晶状体损伤,无玻璃体疝、黄斑囊样水肿或视网膜脱离等并发症。结论:用Nd:YAG激光松解切开术治疗晶状体后囊膜皱褶,可增进视力,疗效良好。

胎儿角膜内皮超微结构的观察

本文取18例水囊引产不同胎龄的胎儿角膜中心部、常规制成超薄切片。在透射电镜下观察角膜内皮超微结构的年龄变化。结果表明:8个月以后的胎儿角膜内皮细胞为单层扁平上皮,细胞核大呈扁椭圆形。胞浆较少。胞质内细胞器比角膜上皮多。可见许多线粒体、高尔基复合体,粗面内质网、糖元颗粒、吞饮小泡等。相邻细胞以胞突镶嵌。本文证实8个月胎儿角膜内皮细胞超微结构基本与成人相同,为角膜移植构料的选择提供参考。

玻璃体切割联合内界膜剥除术治疗顽固性糖尿病黄斑水肿

目的:观察玻璃体切割术(PPV)联合内界膜(ILM)剥除术治疗顽固性糖尿病黄斑水肿的临床疗效。方法:回顾性分析顽固性糖尿病黄斑水肿并行PPV联合ILM剥除术患者56例56眼,根据有无后极部玻璃体后脱离分为A组(无玻璃体后脱离,35例35眼)和B组(有玻璃体后脱离,21例21眼)。对比分析手术前及手术后1、3、6mo时患眼最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)变化情况。结果:A组手术后1、3、6mo平均CMT和BCVA与手术前比较均有差异(P<0.05)。B组手术后1、3、6mo平均BCVA与手术前比较均无差异(P>0.05);手术后1mo平均CMT与手术前比较有差异(P<0.05),术后3、6mo平均CMT与手术前比较均无差异(P>0.05)。术后1、3、6mo,两组CMT、BCVA比较均有差异(P<0.05)。结论:PPV联合ILM剥除术能有效治疗无玻璃体后脱离的顽固性糖尿病黄斑水肿,提高患者视力;但当患者玻璃体已经后脱离且没有牵拉时,PPV联合ILM剥除术治疗效果不佳。

基质金属蛋白酶-9在后交通动脉瘤瘤周蛛网膜中的表达及临床意义

目的初步探讨基质金属蛋白-9（MMP-9）在后交通动脉瘤瘤周蛛网膜中的表达及意义。方法选取南方医科大学南方医院2010年11月~2011年11月手术切除的颅内动脉瘤标本12例作为颅内动脉瘤组,并选取同期行海绵状血管瘤手术或颞叶癫痫手术患者后交通动脉起始部附近蛛网膜组织6例作为对照组。标本行常规HE染色,并采用Envision法行免疫组化染色,比较组间MMP-9的阳性表达情况。结果 HE染色提示动脉瘤瘤周的蛛网膜存在一定的组织破坏,表现为蛛网膜结构松散,与血管壁之间的连接程度下降,局部存在脱离现象。动脉瘤组瘤周蛛网膜中MMP-9阳性表达均高于照组,具有统计学意义（P〈0.05）。动脉瘤组内蛛网膜中MMP-9的阳性表达强度较血管壁弱,具有统计学意义（P〈0.05）;动脉瘤组内不同年龄、Hunt-Hess分级的MMP-9表达情况无显著性差异。结论动脉瘤瘤周蛛网膜中MMP-9表达明显增加预示着细胞外基质的溶解,破坏蛛网膜对血管壁的保护作用,可能与后交通动脉瘤的形成有重要关系。

两种硅油取出联合人工晶状体Ⅱ期植入术疗效比较

目的:比较经睫状体平坦部三切口硅油取出联合人工晶状体囊袋内或睫状沟植入术与既往二切口硅油取出联合人工晶状体睫状沟缝合术治疗玻璃体切割术后硅油填充无晶状体眼的疗效及并发症。方法:回顾性分析2004-01/2006-12及2007-01/2009-12于中国医科大学附属第一医院眼科分别行上述两种硅油取出联合人工晶状体Ⅱ期植入术共计698例713眼,其中二切口组305例314眼,三切口组393例399眼,比较两组视力提高、术中及围手术期并发症、术后1a内玻璃体再出血、视网膜脱离复发、视网膜前膜发生率。结果:二切口组术后视力提高2行及以上98眼(31.2%),术后发生角膜内皮失代偿6眼(1.9%),术后发生低眼压13眼(4.1%),高眼压者11眼(3.5%),人工晶状体严重偏位者17眼(5.4%),术后1a内玻璃体再出血37眼(11.8%),视网膜脱离复发24眼(7.6%),视网膜前膜者45眼(14.3%);三切口组术后视力提高2行及以上者217眼(54.4%),术后角膜内皮失代偿及术后高眼压者均为0,术后低眼压5眼(1.3%),人工晶状体严重偏位者6眼(1.6%),术后1a内玻璃体再出血9眼(2.3%),视网膜脱离复发7眼(1.8%),视网膜前膜者3眼(0.8%),两组比较有统计学意义(P<0.05)。结论:与既往二切口硅油取出联合人工晶状体睫状沟缝合术比较,经睫状体平坦部三切口硅油取出联合人工晶状体囊袋内或睫状沟植入术疗效更好,并发症少,适宜广泛应用。

急慢性肾衰竭合并可逆性后部白质脑病综合征(附二例病例报告)

目的探讨急慢性肾衰竭合并可逆性后部脑白质综合征(RPLS)的原因、临床表现和病理特点。方法回顾分析两例女性肾衰竭合并RPLS的临床资料并复习文献。结果两例患者均出现意识障碍和高血压;病例1合并Goodpasture综合征,以癫痫为首发症状,病例2以头痛、视物障碍为首发症状。头颅CT检查显示多发低密度。颅MRI检查显示T2加权像、FLAIR像高信号,T1加权像等信号,弥散加权像为等信号和部分高信号。经降血压和停用细胞毒性药物治疗4 d和7 d后患者神经系统症状和体征完全恢复正常。结论肾衰竭可引起RPLS。神经影像学检查对诊断RPLS具有重要地位。