目的:探讨经鼻内窥镜下手术治疗管内段视神经损伤的围手术期护理。方法:对收治的11例视神经损伤住院患者的资料及围手术期护理过程进行分析总结。结果:行视神经减压术的11例患者中1例失访,7例有效,其中4例视力有较明显的提高。结论:经鼻内镜视神经减压术损伤小,并发症少,手术时间短,疗效满意,其中围手术期的护理是提高手术疗效的一个重要环节。
ObjectiveTo observe the protective effect of human umbilical cord blood stem cells (hUCBSC) transplantation on retinal ganglion cells (RGC) after optic nerve injury. Method48 adult Sprague-Dawley rats were randomly divided into group A and B, therefore 24 rats in each group. Calibrated optic nerve crush injury model was induced in the left eyes, the right eyes served as a control. Medicine was injected at seventh day after optic nerve injury. PBS was injected into the eyes of Group A rats by peribulbar injection. The hUCBSCs were injected into the eyes of Group B rats by peribulbar injection. Seven days before sacrifice, 5% fluorogold was injected into superior colliculi bilaterally. At 7, 14, 21, 28 days after labeled, retinal flat mounts were observed under fluorescence microscope and optical microscope to investigate the morphological and RGC changes in density during retinal degeneration. ResultsThe RGC number showed a tendency to decline gradually along with increases of the time in two groups, but the trend of decrease of Group B was evidently slower than that of Group A. The RGC number of the injury eye were less than the control eye in Group A and B (t=3.24, 3.15; P < 0.05). At 7, 14, 21, 28 days after labeled, the RGC number (t=4.78, 4.70, 3.98, 3.27; P < 0.05) and labeled RGC rate (t=4.39, 4.21, 4.36, 5.07; P < 0.05) in group B were more than those in group A. After optic nerve injury, there was karyopycnosis on ganglion cell layer of retina, thinning on each layer of retina, derangement of cell and decrease in RGC. There was different degree of the above change in different time after optic nerve injury. There were the swelling, the hemorrhage, derangement of spongiocyte and the denaturation like vacuole in the spot of optic nerve injury. Moreover, they were aggravating with increases of the time after optic nerve injury. There was no pathological changes in normal eyes. ConclusionThe hUCBSC can increase the survival rate of the RGC and can rescue and(or) restore the injujed RGC after transplanted into body of optic nerve crush rat model by peribulbar injection.
ObjectiveTo observe the early ultrastructural changes of the optic nerves after the brain impact injury.MethodsEighteen 15-week-old Wistar rats were used in the air-pressure brain impact injury examination. All of the rats underwent the procedures of right-parietal-bone fenestration after abdominal cavity anesthesia with 1% sodium pentolbarbital (45 mg/kg), and then they were divided randomly into 3 groups, i.e., mild injury group (8 rats) underwent with 7 kg of air pressure in distance of 11 cm; severe injury group (8 rats) with 7 kg of airpressure in distance of 8 cm; and control group (2 rats) underwent with the parietalbone fenestration but without impact injury.The ultrastructural changes of the optic nerves were observed 1, 6, 24, and 72 hours after the injury by electron microscopy.ResultsThe difference of ultrastructural changes of optic nerve was not obvious in wild injury group and the control group, and the lanthanum nitrate was only found in the blood vessels in optic nerve. The lanthanum nitrate entered the nerve stroma 1 hour after severe and increased as time goes on. Simultaneously, displayed dilatation of endoplasmic reticulum, cavitation and tumefaction of mitochondrion, vacuolation of nerve stroma, and vacuolation of some axis-cylinder were seen in the glial cells.ConclusionThe brain impact injury may cause ultrastructural changes of the optic nerve and increase of permeability of blood vessels. (Chin J Ocul Fundus Dis, 2005,21:41-43)
Objective To investigate the mRNA expression of ciliary neurotrophic factor on the retina during injury and repair of optic nerves in rats. Methods Thirty-five healthy SD rats were randomly divided into 3 groups: 5 in the control group, 15 in the simply transected optic nerve group and 15 in the optic nerve-sciatic nerve anastomosis group. The simply transected and optic nerve-sciatic nerve anastomosed models were set up, and the retinal tissues of all of the rats were taken out after 3, 7 and 14 days, respectively; and the mRNA expression of CNTF in the 3 groups were observed by semiquantitative reversal transcription-polymerase chain reaction method. Results A minimum expression of CNTF mRNA was found in the retinae of the control group, and the increased rates of expression were found in the retinae of the simple transection of optic nerve group with the increase rate of 100%, 594%, and 485% on the 3rd, 7th, and 14th day respectively after the operation, while in optic nerve-sciatic nerve anastomosis group, the increase rates were found to be 258%, 752% and 515% on the 3rd, 7th, and 14th day respectively after the operation. Conclusion Retinal neurons can respond to axonal reaction of retinal ganglion cells by up-regulate endogenous CNTF after the injury of the optic nerves, which may provide a theoretic base for the application of the exogenous CNTF. (Chin J Ocul Fundus Dis，2004，20：355-357)
Objective To evaluate the relevant factors affecting prognosis of traumatic optic neuropathy. Methods Sixty-nine patients with traumatic optic neuropathy were enrolled. Multiple variable analysis was done to filter the risk factors to prognosis in traumatic optic neuropathy. Results At 3 months or more of followup,no light perception was found in 32 cases (46.4%); visual acuity were increased by≥1 lines in 33 cases (47.8%). The outcome of visual acuity was poorer in patients with the following conditions:no light perception after trauma （P=0.0031）, loss of consciousness （P=0.0262）, no pretreated common-dosage corticosteroids （P=0.0184）, and absence of VEP （P=0.0001）. Conclusion The initial visual acuity of no light perception, loss of consciousness, and no pretreated common-dosage corticosteroids were the risk factors to prognosis in traumatic optic neuropathy,and result of VEP was an effective prognosis indicator in traumatic optic neuropathy. (Chin J Ocul Fundus Dis, 2002, 18: 98-100)
Ojective To evaluate the therapeutic efficacy of surgical and nonsurgical treatment and the clinical factors affecting the efficacy in traumatic optic neuropathy. Methods To analyse retr ospectively the efficacy of recovery of visual acuity in 40 cases of traumatic optic neuropathy after treatment with transnasal endoscopic sphenoethmoidal optic canal decompression (28 cases) and drug therapy (12 cases). Results No significant difference existed between the therapeutic efficacy of surgery and that of drug therapy in patients with the visual acuity of LP～ 0.02. In surgery group,the therapeutic efficacy of the patients with visual acuity of LP～0.02 was better than that of the patients with no LP.The therapeu tic efficacy of patients with duration shorter than seven days before sutgery is better than that of patients with duration longer than seven days. Conclusions The patients with serious traumatic comperssive optic neuropathy should not be treated with decompressive surgery and should not delay to at most seven days after injury.With or without the visual acuity of light perception of the affected eye surgery is usually an important factor affecting the therapeutic efficacy. (Chin J Ocul Fundus Dis, 2001,17:204-206)
Objective To observe the content of thromboxane (TXA2 ) and prostacyclin (PGI2) in optic nerves after forehead impact injury.Methods The right forehead zones of 32 rabbits were struck by biology impact machine. Tweenty-four rabbits that had afferent papillary defect after injury were chosen, and randomly divided into four groups: 1 day, 2, 4, and 7 days group. Right eyes were in the experimental group and left eyes were in the control group. Flash visual evoked potentials were examined before and after the traumatic injury. The rabbits ′eyes were removed, the optic nerves were pathologically examined, and the content of TXB2 and 6-Keto-PGF1αwhich were the products of TXA2 and PGI2 were assayed 1, 2, 4, and 7 days after traumatic injury respectively.Results Histopath ological examination revealed the findings of injuries of optic nerves of all the 24 rabbits. The latency of wave P1 was significantly delayed after traum atic injury (Plt;0.01), and amplitude of wave P1 was significantly decreased after traumatic injury (Plt;0.01). The content of TXB2 ［(172.35±26.52) pg/mg ］and 6-Keto-PGF1α［(161.78±24.83) pg/mg］were significantly higher in the injured optic nerves than in the uninjured ones 1 day after the traumatic injury (Plt;0.01). The rate of TXB2 /6-Keto-PGF1α (1.077±0.18) was significantly increased compared to the control group (Plt;0.05), and lasted to the 7th day.Conclusions The content of TXA2 and PGI2 significantly increases and the ratio of them is lopsided after forehead impact injury in rabbits. (Chin J Ocul Fundus Dis，2003，19：49-51)
Objective To investigate the expression of matrix metallo proteinase (MMP)-2 and MMP-9 in rats′optical nerves after extrusion wound. Methods We set up the model of rats with extrusion wound of the optical nerves, detected activity changes of MMP-2 and MMP-9 in the optical nerves by gelatin zymography, identified the attribute by Western blotting, and verified the expression of mRNA of MMP-2 and MMP-9 by reverse transcriptase-polymerase chain reaction (RT-PCR ). Results MMP-2 existed in normal optial nerves and optical nerves with extrusion wound, while MMP-9 was only detected in the latter. The expression of MMP-9 was the highest 1 day after the extrusion wound, while that of MMP-2 was the highest 7 days after the extrusion wound. Conclusions MMP-2 and MMP-9 may participate in the pathological recovery process of optical nerves after extrusion wound. The glial cells in the optical nerves may be one of the sources of MMP-2 and MMP-9. (Chin J Ocul Fundus Dis，2003，19：269-332)