外伤性视神经病变内镜手术的临床分析

目的探讨内镜经鼻视神经减压术治疗外伤性视神经病变的意义及疗效。方法分析27例（27眼）内镜经鼻视神经减压术的治疗效果，随访6个月至1年。结果11眼视力有不同程度的提高，总有效率40．7％，无光感者4眼获视力改善（4／18，22．2％），术前有残余视力者7眼有效（7／9，77．8％），其中皮质类固醇激素治疗无效而采取手术者4眼有效（4／15，26．7％），未经激素治疗即手术者7眼有效（7／12，58．3％）。结论内镜经鼻视神经减压术进路简捷，损伤小，疗效确切，对伤后时间较长，大剂量皮质类固醇激素治疗无效，视力损伤严重的患者，手术仍有挽救视力的可能。     

中西医结合治疗视神经炎67例体会

目的观察中西医结合治疗视神经炎的疗效。方法应用中西结合治疗视神经炎。结果视神经炎67例（74眼），治愈43眼，显效20眼，有效8眼，无效3眼，总有效率95．94％。结论中西医结合治疗视神经炎疗效显著。     

中药辨证针刺配合西药治疗视神经萎缩66例

目的 观察滋补肝肾类药物内服配合针刺及西药治疗视神经萎缩的临床疗效及影响疗效的因素.方法 以药物,针刺睛明、承泣、上明为主,配合穴位注射西医治疗,治疗视神经萎缩66例(95眼).结果 66例中显效24例35眼(36.8％),有效34例48眼(50.5％),无效8例12眼(12.6％),总有效率87.3％.结论 该法治疗视神经萎缩疗效肯定,能促进已萎缩的视神经提高视功能.     

中西医结合治疗视神经萎缩疗效观察

目的观察中西医结合治疗视神经萎缩的疗效。方法对视神经萎缩76例(84只眼)患者辨证为肝郁不舒、心脾两虚、肝肾亏损、脾贤阳虚四型,用中药、针灸和西药中西医结合治疗,观察治疗前后视力、视野变化。结果76例84只眼中,显效19只眼,有效43只眼,总有效率73.8%。结论中西医结合治疗视神经萎缩有一定疗效。     

217例视神经萎缩的病史调查与分析

视神经萎缩是一种致盲严重的眼病,此病是其它疾病遗留的或并发的一种后遗症,因此有多种病因引起,非常复杂。为了有效的减少视神经萎缩的发生,现将1994～1999年所接诊的视神经萎缩、视力在0.1以下者的病史调查与分析报告如下。1 临床资料 217例视神经萎缩患者,共计242只眼。单眼患者192例,左眼99例,右眼93例,双眼患者25例。年龄最小患者只有3个月,最大者87岁。其中女性患者111例,共计120只眼。男性患者106例,共计122只眼。视力无光感者103例,共121只眼。有光感但不能辨指数者60例,共66只眼。视力眼前指数,但不足0.1者54例,共55只眼。有视神经萎缩但视力在0.1以上者     

单唾液酸四己糖神经节苷脂联合甲钴胺治疗视神经挫伤的疗效观察

目的:观察单唾液酸四己糖神经节苷脂联合甲钴胺治疗视神经挫伤的临床疗效。方法:将42例(50眼)视神经挫伤患者随机分成治疗组和对照组各21例(25眼)。对照组给予激素以及改善循环治疗。治疗组在对照组治疗的基础上给予单唾液酸四己神经节苷脂80mg日一次静脉滴注,甲钴胺0.5mg日一次肌肉注射,治疗2周,较重病例治疗4~8周。随访6个月~1年,比较各组患者治疗后视力和视野、VEP恢复情况。结果:治疗组总有效率为82.35%,对照组总有效率为47.05%,2组比较差异有统计学意义(P0.005)。结论:单唾液酸四己糖神经节苷脂联合甲钴胺治疗视神经挫伤有显著疗效,可促进视功能的恢复,提高视力。     

建立小鼠视神经损伤模型的实验研究

[目的]探索建立稳定的小鼠视神经损伤模型实验方法.[方法]选用成年C57BL/6小鼠60只,手术进行左眼视神经钳夹损伤,右眼设为正常对照眼,随机分为5个组,每组12只,分别在损伤后1d、3 d、5 d、7 d、14 d5个时间点摘除眼球.取眼球和视神经行冰冻切片,HE染色,观察组织形态并对神经胶质细胞计数.[结果]光镜下观察损伤部位形成损伤区域,损伤区域组织染色浅,未损伤眼视神经纤维排列整齐,胶质细胞与神经纤维走向一致,呈极性排列.损伤眼视神经纤维排列紊乱,胶质细胞杂乱无序.损伤后视神经胶质细胞计数减少,少于未损伤侧视神经,两者具有统计学差异.[结论]成功建立小鼠神经损伤模型,视神经损伤后形态学有显著改变.     

化学因素对眼的影响

化学活性气体、粉尘、硫化物、重金属、有机溶剂、染料、酸是职业性眼病的常见原因。 文献报道粉尘、瓦斯、酸、树脂、硫化物能引起睑炎、角膜和结膜疾患。苯中毒:早期是眼调节作用的神经肌肉受损;重症中毒,视网膜血管受损,眼底出血,球后神经炎,视神经纤维受损、视敏度降低;慢性中毒,瞳孔缩小,瞳孔反射性反应降低。苯胺中毒:畏光,瞳孔扩     

烫染发引起眼部并发症的临床观察

目的探讨烫染发引起的眼部并发症的原因及处理方法。方法门诊30例（60眼），均为女性，年龄18—67岁，烫染发引起不同程度眼部并发症和临床表现及处理方法和预防措施。结果本组30例（60眼）烫染发经及时处理均取得较好的效果。结论烫染发时尽量保护眼部周围，不慎损伤眼部应争分夺秒救治，最大限度减少损伤。     

给青光眼患者选眼药

青光眼是眼球内压力升高，造成视觉神经细胞缺血性损伤所致。造成眼压升高的原因是循环于眼前房中的房水淤积所引起。房水的生成和排除在正常情况下维持着一种平衡状态，如果房水生成过多或排除受阻，就会滞留在眼球内，使眼压升高。过大的压力强加在眼后部视网膜的血管上，影响血液流通，致使视神经出现病理性变化，损伤视力，造成失明。     

Clinical, pathological and photochemical studies of laser injury of the retina

Nineteen cases of acute accidental laser injury of the human retina and two groups of laser workers with chronic retinal damage were reviewed. Most acute cases had macular injury and vision impairment; the chronic cases usually suffered from nonspecific eye complaints. Pathological and photochemical studies of laser injury to rabbit retina were also made following exposure to a 0.49-W Ar laser. The retinal pigment epithelial cells and photoreceptors were mildly damaged in the laser spot center, but the Bruch's membrane was still intact. Malondialdehyde (MDA), the main degradation product of lipid peroxidation of the retina, was assessed with fluorescence spectrophotometry. The level of MDA in the injured retina was significantly higher than that in control eyes, suggesting that thermal levels of Ar laser exposure can yield evidence of photochemical light damage mechanisms.     

控制暴露人体实验——眼结膜受损色斑检查方法的研究(续三)

「目的」多方面的评价建筑装饰材料和室内产品的健康影响,特别是对粘膜细胞的客观伤害作用,拟引进“眼结腊受损色斑实验”。「方法」采用“小型环境气候舱排出气”＋“眼局部暴露装置”的方法。本质人造板是被评价的建筑材料。甲醛是评价的化学指标。眼睛为本研究的靶器官。以１％虎红溶液作为染色液,分别测定暴露前后眼结膜受损斑面积。「结果」暴露前、后眼结膜受损斑面积差异有极显著意义。「结论」眼结同色斑检查可成为今后进     

Neuropathy in non-freezing cold injury (trench foot).

Non-freezing cold injury (trench foot) is characterized, in severe cases, by peripheral nerve damage and tissue necrosis. Controversy exists regarding the susceptibility of nerve fibre populations to injury as well as the mechanism of injury. Clinical and histological studies (n = 2) were conducted in a 40-year-old man with severe non-freezing cold injury in both feet. Clinical sensory tests, including two-point discrimination and pressure, vibration and thermal thresholds, indicated damage to large and small diameter nerves. On immunohistochemical assessment, terminal cutaneous nerve fibres within the plantar skin stained much less than in a normal control whereas staining to von Willebrand factor pointed to increased vascularity in all areas. The results indicate that all nerve populations (myelinated and unmyelinated) were damaged, possibly in a cycle of ischaemia and reperfusion.     

喉返神经显露在甲状腺手术中避免神经损伤的作用

目的分析并评价显露喉返神经在甲状腺手术中防止神经损伤的意义。方法将我院从2005年5月至2011年10月期间收治的甲状腺疾病病人856例分成观察组(显露喉返神经)与对照组(未显露喉返神经),并对比分析两组术后喉返神经损伤状况。结果术后两组均未见双侧喉返神经损伤发生。全部患者的喉返神经损伤率为2.10%(18/856),观察组喉返神经损伤率为1.31%(6/459),对照组喉返神经损伤率为3.02%(12/397)。观察组喉返神经损伤率低于对照组,两组比较差异显著(χ2=5.81,P<0.05),具有统计学意义。8个月后观察组6例喉返神经损伤病人声带活动全部恢复至正常;对照组5例恢复至正常,7例为永久性损伤。观察组在术后8个月时喉返神经损伤病人恢复程度优于对照组,两组比较差异显著(χ~2=15.02,P<0.001),具有统计学意义。结论术中喉返神经显露可以有效降低术中喉返神经的损伤率,该方法安全可靠且效果理想,值得临床广泛推广。     

视诱发电位在眼外伤视神经挫伤中的应用

目的通过检测视诱发电位（VEP）,探讨其在眼外伤视神经挫伤中的应用价值。方法对49例眼外伤视神经挫伤患者行棋盘格翻转刺激VEP检查,并与健侧眼或正常对照组相比较。结果49例（55眼）患中者P100波幅降低40例（45眼）,P100潜伏期延长11例（14眼）,P100潜伏期延长并波幅降低3例（5眼）,视神经挫伤眼P100波幅较健侧眼、对照组差异有统计学意义,而P100潜伏期与健侧眼比较差异无统计学意义,与对照组比较差异有统计学意义。结论VEP对眼外伤后视神经损伤检出有较高敏感性,能客观、定量评定视功能,对早期诊断、预后评价有重要价值。     

8497例伤害住院患者损伤部位及预后统计分析

[目的]探讨兰州市伤害住院患者损伤部位一般分布状况,为伤害防治提供依据。[方法]采用整群抽样方法,抽取兰州市2002～2008年间2所省级综合医院8497例伤害住院患者的病历资料,对不同损伤部位进行统计分析。[结果]颅脑损伤比例最高(30.61%),其次为下肢部(21.34%),上肢部(10.38%)。除65岁～以上老年组以下肢损伤(48.31%)所占比例最高外,其余各年龄组均以颅脑损伤所占比例最高。交通事故和意外跌落主要损伤部位为颅脑部和下肢部,暴力事件为颅脑和颈胸部,自然环境为眼部和上肢。[结论]头部和四肢仍是伤害损伤的主要部位,应加强安全防护意识,开展教育干预,降低伤害损伤的危害程度。     

慢性正己烷中毒后周围神经损害迁延不愈2例报道

目的 报道并讨论2例慢性正己烷中毒后周围神经损害迁延不愈的病例,提高对中毒后周围神经损害的认识水平。 方法 收集病例资料,分析其特点,查阅相关文献。 结果 2例病例周围神经损害迁延不愈,且以自主神经和感觉神经损害为主,要考虑发生或合并了少见的周围神经疾病,如自主神经和感觉神经节病变。 结论 对于正己烷中毒后周围神经损害迁延不愈的病例,应考虑合并其他周围神经疾病的可能;正己烷中毒是否会导致自主神经和感觉神经节病变,值得关注。     

手指抠挖致视神经撕脱伤临床分析

目的报告家庭暴力事件中由手指抠挖所致的视神经撕脱伤(ONA),眼球脱出,视力严重受损或丧失。方法回顾我院1997年11月-2006年3月收治3例视神经撕脱伤视功能严重受损病例。分析外伤原因、就诊时的症状和体征、诊断和治疗、以及结果。结果本组病例均为女性,平均年龄35岁。受伤均为双方发生纠纷时丈夫施虐所致。就诊时视力有1例为光感,2例无光感,1例眼球丢失。所有病例都有ONA。3例均因要求美容而接受了眼球摘除术。结论手指抠挖致ONA临床罕见,预后差,对家庭和社会造成严重危害,应为全社会共同关注。     

Characteristics and causes of penetrating eye injuries reported to the National Eye Trauma System Registry, 1985-91.

Ocular trauma is one of the most important preventable causes of visual impairment. The National Eye Trauma System was developed to provide optimal clinical care for severe ocular injuries, to foster research on eye injury, and to increase awareness of ocular trauma as a public health problem. From 1985 through 1991, the National Eye Trauma System Registry collected data on 2,939 cases of penetrating eye injury reported by ophthalmologists at 48 collaborating eye trauma centers in 28 States and Washington, DC. Eighty-three percent of the cases involved men; the median age of the patients was 27 years, ranging from 1 to 92 years of age. Seventy-seven percent of the injuries were unintentional, 22 percent were the result of assault, and 1 percent were self-inflicted. In 62 percent of the cases studied, the injured person''s initial best corrected visual acuity in the injured eye was the ability to perceive hand motion, or worse. The settings in which the injuries occurred included the home (28 percent), the worksite (21 percent), at recreation (11 percent), and in transportation (8 percent). At the time of the injury, 1.5 percent of the injured persons were wearing safety glasses and 2.9 percent were wearing nonsafety glasses. There was evidence of definite or possible alcohol use by at least 24 percent of the injured persons and illicit drug use by 8 percent. The most frequent types of tissue damage included corneal or scleral laceration, traumatic cataract, intraocular foreign body, vitreous hemorrhage, and prolapse of intraocular tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of ocular protection filters in field situations

A computer program has been developed to simulate eye movement during pursuit tracking to test the effectiveness of filters protecting the eyesight of individuals exposed to laser radiation. Two types of retinal damage are considered: macular lesions and retinal injury causing vitreous or subretinal hemorrhage. The retinal damage caused by optical radiation in the visible and near infrared of the spectrum differs from almost all other types of hazards in their proabilistic nature. That is, a small movement of the laser beam or change of eye position decreases or increases the probability of injury by several orders of magnitude. A laser beam combines the problem of a small source with extreme directionality with the probabilistic nature of this hazard location in space, and we now add the probabilistic nature of the action of the protective filter, i.e., a dependence upon angle of incidence. From this combination, an even more probabilistic picture of injury or disablement emerges. When it is necessary to plan the probabilities during military operations of mission fulfillment or injury with regard to various types of lasers in the battlefield ++environment, the problem must be analyzed very carefully. Our solution of the problem indicates the type of injuries to be expected and their dependence upon the various parameters of the angle of incidence of the lasers on the protective filters in the viewing system.