目的 探讨玻璃体切除术联合玻璃体腔注射曲安奈德治疗特发性黄斑前膜患者疗效观察。方法 选取我院2018年1月—2020年1月特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)患者38例。随机分为治疗组(18例,18眼)与对照组(20例,20眼)。治疗组在术中予以玻璃体切除联合黄斑前膜剥除及内界膜剥除术,并注入曲安奈德(triamcinolone acetonide,TA),对照组术中单纯行玻璃体切除联合黄斑前膜剥除及内界膜剥除术。比较两组患者手术前及手术后1月、3月、6月的最佳矫正视力(BCVA)及黄斑中心凹厚度数值(CMT)及房水白细胞介素-6(IL-6)的变化情况。结果 术中所有患者成功剥除黄斑前膜,术后所有患者均未出现玻璃体积血、视网膜脉络膜脱离及眼压增高等并发症。两组患者中,所有患者手术后BCVA均较手术前有所提高,且治疗组优于对照组,差异有统计学意义(P＜0.05)。手术后治疗组CMT下降幅度优于对照组,差异有统计学意义(P＜0.05)。手术后治疗组房水中IL-6水平明显低于对照组,差异有统计学意义(P＜0.05)。结论 玻璃体切割及内界膜剥除术联合玻璃体腔内注射TA治疗IMEM,有助于提高患者术后视力,降低患者黄斑中心凹厚度,减轻患者黄斑水肿程度,减少房水中白细胞介素-6的表达。

目的 观察同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法 选择2014年7月—2016年11月在我院就诊的68例(72只眼)患有老年性白内障合并糖尿病性黄斑水肿患者,分为2组,治疗组(32例,34只眼)行同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗;对照组(36例,38只眼)单纯行白内障超声乳化摘除;观察指标包括术前、术后最佳矫正视力、眼压及黄斑中心凹视网膜厚度,观察时间为术前、术后1周、1月、3月、6月、12月。结果 术后两组最佳矫正视力与术前相比差异有统计学意义(P<0.01);术前及术后1周2组最佳矫正视力无差异,术后1月、3月、6月、12月治疗组最佳矫正视力均优于对照组;术前2组患者黄斑中心凹视网膜厚度相比无明显差异,术后各个时间点治疗组黄斑中心凹视网膜厚度均低于对照组,二者相比差异有差异性(P均<0.001);两组患者术前及术后眼压无差异(P<0.05)。结论 对老年性白内障合并糖尿病性黄斑水肿患者,术中联合玻璃体腔注射雷珠单抗,可减轻术后黄斑水肿,改善患者术后中、远期视力。

Objective To assess the safety and efficiency of combination of micro incision phacoemulsification (PHACO) surgery and intravitreal ranibizumab injection in patients with cataract and diabetic macular edema. Methods The selected 68 patients (72 eyes) with age-related cataract and diabetic macular edema were randomly divided into two groups: the PHACO and intravitreal Ranibizumab injection (treatment group, 32 cases, 34 eyes), and only PHACO (control group, 36 cases, 38 eyes) in our hospital from July 2014 to November 2016. Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. The time points included preoperative day, 1 week, 1 month, 3 months, 6 months and 12months after surgery. Results Postoperative BCVA during the follow-up period was higher than the initial BCVA in both groups (P<0.01). There was no statistically significant difference between both groups in BCVA at pre-operation and 1 week after surgery. In the treatment group, the postoperative BCVA was significantly higher than the control group at 1 month, 3 months, 6 months and 12months after operation. The mean CMT in the treatment group was lower than the control group in all the follow-up time. There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (P>0.05). Conclusion Additional intravitreal ranibizumab injection after PHACO surgery reduced macular edema and preserved this improvement in the mid-and-long term of BCVA.

       目的   针对目前常规使用的玻璃体腔注射针头容易引起注射后小鼠眼内出血和损伤晶状体的缺陷，本研究采用直径仅0.08 mm的玻璃毛细管作为实验用小鼠眼内注射针头进行玻璃体腔注射，并评估其安全性和可行性。方法  选取12只6-8周的C57BL/6J雄性小鼠，左眼注射磷酸盐缓冲液为实验组，右眼不做特殊处理为对照组。6只小鼠玻璃体腔注射后立即腹腔注射伊文思蓝，检测视网膜血管渗漏情况；另外6只小鼠玻璃体腔注射后24 h处死，视网膜铺片免疫荧光染色小胶质细胞特异性抗体抗离子钙接头蛋白1，分析小胶质细胞的形态变化。结果  实验组和对照组血管与周围荧光强度比值分别为（4.45±0.30）和（4.51±0.24），小胶质细胞数量分别为（131.00±5.38）个/mm2 和（133.00±5.99）个/mm2 ，小胶质细胞胞体面积分别为34.02（27.82，40.54）μm2 和34.70（26.09，40.54）μm2 ，小胶质细胞分支长度分别为198.80（171.30，258.80）μm和223.30（178.20，278.30）μm，两组相比差异均无统计学意义（均P＞0.05）。结论   经改良的玻璃毛细管直径更细，损伤更小，可以替代传统的注射针头，可作为实验用小鼠眼内注射针头进行玻璃体腔注射。

       Objective  To assess the safety and feasibility of employing an enhanced glass capillary，with a diameter of 0.08 mm，as an intraocular needle for intravitreal injections in experimental mice eyes．Methods  Twelve male C57BL/6J mice，aged 6-8 weeks，were utilized in this investigation．Phosphate buffered saline（PBS）was administered via intravitreal injection into the left eye of each mouse（experimental group），while the right eye received no special treatment（control group）．Six mice received an intraperitoneal injection of Evans blue immediately following intravitreal injection to detect retinal vessel leakage．The remaining six mice were euthanized 24 hours after intravitreal injection，and the retinas were subjected to immunofluorescence staining using a microglia-specific antibody to analyze morphological changes in microglia．Results  In both the experimental and control groups，the ratio of vascular to peripheral fluorescence intensity was（4.45±0.30）and（4.51±0.24），respectively．The number of microglia was（131.00±5.38）/mm2  and（133.00±5.99）/mm2 ，the cell body area of microglia was 34.02（27.82，40.54）μm2  and 34.70（26.09，40.54）μm2 ，and the branch length of microglia was 198.80（171.30，258.80）μm and 223.30（178.20，278.30）μm，respectively．There were no statistically differences observed in any of the above indicators between the two groups（all P＞0.05）．Conclusions  The use of this glass capillary，characterized by a narrower diameter，reduces tissue damage，demonstrates its potential to replace traditional injection needles for performing intravitreal injections in experimental mice．