两种手术方法治疗慢性泪囊炎的疗效对比

目的：比较鼻腔泪囊吻合术（ EDCR）及鼻内镜下鼻腔泪囊造孔术（ IEDCR）联合泪道置管的疗效,探讨治疗泪囊炎的最佳手术方法。
　　方法：随机将门诊确诊的慢性泪囊炎患者37例37眼分为两组,分别采用上述两种手术方法治疗,术后随访6～12mo观察手术疗效。
　　结果：IEDCR组17眼,有效16眼,好转1眼,总有效率为94％;EDCR组20眼,有效18例,好转2眼,总有效率为90％。 EDCR组与IEDCR组之间有效率无显著性差异（ P＞0．05）。 IEDCR组术后反应轻,面部无瘢痕,恢复较快。EDCR组术后反应重,面部留有瘢痕,恢复较慢。
　　结论：EDCR和IEDCR均是治疗慢性泪囊炎的可靠方法,但IEDCR微创术后反应及疗效好,值得推广应用。     

泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术的疗效对比

目的:比较鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术治疗慢性泪囊炎的疗效。方法:回顾性分析2008-03/2011-03来我院136例136眼慢性泪囊炎患者手术治疗的效果,其中行鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术66例,行改良鼻腔泪囊吻合术70例,均为单侧慢性泪囊炎。结果:鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术治愈60例,好转5例,无效1例,治愈率达90.9%,有效率达98.5%;改良鼻腔泪囊吻合术治愈64例,好转4例,无效2例,治愈率达91.4%,有效率达97.1%。采用χ2检验,两组比较差异无统计学意义(P>0.05)。结论:鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术治疗慢性泪囊炎的疗效接近,但鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术无需面部皮肤切口,创伤小,出血少,值得推广。     

鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎的疗效及体会

目的:探讨经鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎的疗效。方法:慢性泪囊炎患者30例32眼,行鼻内镜下鼻腔泪囊造孔术,术后进行泪道冲洗、鼻内镜检查随访1～3a。结果:治愈26眼(81%),好转4眼(13%),无效2眼(6%),总有效率94%。结论:鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎,具有组织损伤小,操作简单快捷,面部不留瘢痕,并发症少,是治疗慢性泪囊炎的理想方式。     

泪囊鼻腔吻合术治疗116例慢性泪囊炎临床分析

目的:探讨和分析泪囊鼻腔吻合术治疗慢性泪囊炎的临床疗效。方法:回顾分析116例124眼慢性泪囊炎行泪囊鼻腔吻合术的资料,术后随访1～1.5a,观察手术疗效。结果:治愈103例108眼,占87.1%,好转12例12眼,占9.7%,失败4例共4眼,占3.2%。总有效率为96.8%。结论:泪囊鼻腔吻合术是治疗慢性泪囊炎的首选有效术式,掌握一定的手术技巧、精细操作和术后密切随访、定期泪道冲洗是手术成功的关键。     

泪囊鼻腔吻合术后失败激光治疗的对比研究

目的探讨在泪囊鼻腔吻合术后失败的患者行泪道激光成形术的临床效果及安全性。方法回顾分析189例(189眼)门诊行泪道激光成形术患者。其中慢性泪囊炎行泪囊鼻腔吻合术后失败鼻泪道阻塞者31例为A组,158例未经手术治疗的鼻泪管阻塞患者为B组。对比分析两组手术成功率,术后平均随访时间为28.2±4.3月。结果A组手术成功率为20例(64.52%),B组手术成功率为125例(79.11%)。A组与B组按α=0.05的标准检验,无明显统计学差异。结论泪囊鼻腔吻合术后失败的患者行泪道激光成形术临床效果良好,建议将泪道激光成形术作为鼻泪管阻塞患者首选治疗方法。     

留置泪道引流管对鼻内镜下泪囊鼻腔吻合术疗效的影响

目的 观察留置泪道引流管对慢性泪囊炎患者鼻内镜下泪囊鼻腔吻合术(EDCR)疗效的影响.方法 选取慢性泪囊炎患者98例(98只眼),所有患者均接受EDCR手术,以术中植入泪道引流管为依据,按照随机数字表法将患者随机分为泪道引流管非植入组与泪道引流管植入组,术后均随访6个月,观察并比较两组患者的手术成功率、吻合口愈合情况及...     

泪小点引流联合泪道激光置管治疗急性泪囊炎并发脓肿

目的：：观察泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术治疗急性泪囊炎并发泪囊脓肿的疗效。方法：对2011-12/2014-12在本院眼科就诊的28例急性泪囊炎并发脓肿患者行泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术,置管6 mo后拔管后再随访6mo,观察流泪、流脓、脓肿消退、泪道通畅等情况及有无并发症发生。结果：各种急性泪囊炎并发脓肿患者在带管6 mo内,脓肿均消退,溢泪消失或改善,泪道冲洗畅。拔管后随访6mo,治愈13眼,好转7眼,总有效率为71%,无效8眼(29%)。结论：泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术是一种有效的急性泪囊炎并发泪囊脓肿的治疗方法,但复发率高,可再次手术。     

激光泪道成形术联合泪道内注入典必舒眼膏治疗小儿泪囊炎

目的　探讨激光泪道成形术联合泪道内注入药物治疗小儿泪囊炎的临床疗效。方法　采用Nd :YAG泪道激光泪道成形术联合泪道内分别注入典必舒眼膏和生理盐水 ,共治疗慢性泪囊炎患者1 0 2例 1 1 2只眼。随访观察 3～ 6月。结果　典必舒组 6月冲洗通畅率为 98 2 1 % ,生理盐水组保持通畅者为 3 1眼 ,占 5 5 3 6% ,两组疗效差异有显著性 (χ2 =2 8 85 ,P <0 0 1 )。结论　采用Nd :YAG泪道激光泪道成形术联合泪道内注入典必舒眼膏 ,是成功率较高的治疗小儿泪囊炎的方法之一。     

碘化油造影在慢性泪囊炎治疗中的应用

目的:分析碘化油造影在慢性泪囊炎手术治疗中的应用。方法:对52例58眼慢性泪囊炎患者进行碘化油泪囊造影,观察泪囊显影形态,并根据造影结果选择治疗方法。泪囊大小在5.0mm×3.0mm×3.0mm以上,则选择鼻腔泪囊吻合术,低于以上数值则选择YAG激光泪道成形术。结果:58眼慢性泪囊炎造影发现鼻泪管阻塞53眼(91%),鼻泪管不完全阻塞(狭窄)5眼(9%);53眼完全阻塞中,阻塞部位在鼻泪管上端(开口处)45眼(85%),阻塞部位在鼻泪管中段4眼(8%),阻塞部位在鼻泪管下段4眼(8%)。58眼慢性泪囊炎的造影形态和大小:囊样扩张32眼(55%),不规则结节样12眼(21%),条索样5眼(9%),分叶样5眼(9%),节段样扩张4眼(7%)。46眼采取鼻腔泪囊吻合术,治愈44眼,治愈率96%,12眼采取YAG激光泪道成形术治愈10眼,治愈率83%。结论:碘化油泪囊造影可以对慢性泪囊炎治疗方法的选择给出指导,应该成为慢性泪囊炎手术治疗前的一项常规检查。     

内镜下经鼻泪囊鼻腔吻合联合泪道引流支架植入术治疗慢性泪囊炎

目的 探讨内镜下经鼻泪囊鼻腔吻合联合泪道引流支架植入术治疗慢性泪囊炎临床疗效.方法 回顾性病例研究.84例(86眼)慢性及复发性泪囊炎患者,行鼻内窥镜下经鼻泪囊鼻腔吻合联合泪道引流支架植入术.结果 术后随访3～12个月,治愈70眼(81.40％),好转10眼(11.63％),无效6眼(6.98％),总有效率为93.02％(80/86).结论 鼻内镜下泪囊鼻腔吻合联合泪道引流支架植入术应用于治疗慢性泪囊炎治愈率高,面部无瘢痕,术中放置合适的扩张管支撑可有效防止造孔口闭锁和扩张泪道作用,提高了手术成功率.     

联合激光周边虹膜切除术治疗原发性闭角型青光眼

目的：探讨联合激光周边虹膜切除术治疗原发性闭角型青光眼的临床疗效。

方法：收集2015-08/2017-10在我院就诊的原发性闭角型青光眼患者82例82眼,随机分为单纯激光组(33例,采用Nd：YAG激光周边虹膜切除术)和联合激光组(49例,采用532半导体激光联合Nd：YAG激光周边虹膜切除术)。记录两组患者眼压、激光能量、虹膜出血情况。

结果：单纯激光组患者术后眼压升高较联合激光组明显,术后1h,1d,1wk两组患者眼压差异明显(均P<0.01); 术后1mo两组患者眼压基本恢复至术前水平。单纯激光组患者术中1次透切成功率明显低于联合激光组(73% vs 100%,P<0.05),且术中使用Nd：YAG激光总能量明显高于联合激光组(40.16±13.43mJ vs 23.23±6.70mJ,P<0.05)。两组患者术中虹膜出血率无明显差异(33% vs 26%, P>0.05)。

结论：532半导体激光联合Nd：YAG激光行周边虹膜切除术1次透切率高,尤其对于无虹膜隐窝的患者,可明显降低激光操作难度,减少激光能量,减轻前房炎症反应。     

后发性白内障Nd:YAG激光治疗的分析

目的：观察Nd：YAG激光对各类白内障术后的后发性白内障的疗效、治疗参数和并发症。

方法：对360例382眼各类白内障术后的后发性白内障Nd：YAG激光治疗。观察术后视力及并发症。分1级膜、2级膜和3级膜三组统计激光参数以及分老年性、先天性、并发性和外伤性白内障术后后发性白内障四组统计激光参数进行对照分析。

结果：治疗前后最佳矫正视力比较有显著性差异(P<0.05)。老年性组与外伤性组使用的平均激光总能量和平均激光脉冲数比较均有显著性差异(P<0.05)。并发症包括激光治疗后7眼眼压升高(1.8%),人工晶状体损伤26眼(7.7%)。

结论：Nd：YAG激光是治疗后发性白内障安全有效的方法。外伤性白内障术后发生后囊膜混浊的病例多为3级膜,Nd：YAG激光治疗时使用单次能量,总脉冲数和激光总能量均大。针对患者的情况选择好激光治疗参数,及时处理术后并发症,能提高治疗的有效性和安全性。     

Ultra Q:YAG与传统Nd:YAG激光玻璃体消融术治疗飞蚊症的疗效比较

目的：通过观察Ultra Q：YAG玻璃体消融术治疗飞蚊症的长期效果,评价Ultra Q：YAG较传统Nd：YAG激光的治疗优势。

方法：回顾性分析2018-05/2020-01于我院确诊为玻璃体混浊并接受激光玻璃体消融术治疗的112例130眼患者的临床资料。所有患者均接受了激光玻璃体消融术治疗,根据不同治疗方法分为A、B两组,A组(60例70眼)接受Ultra Q：YAG玻璃体消融术治疗; B组(52例60眼)接受传统Nd：YAG激光治疗。根据患者玻璃体混浊的形态将A、B组各分为两亚组：其中A1组45例52眼和B1组30例38眼,玻璃体混浊形态多为Weiss环、絮状、致密膜状; A2组15例18眼和B2组22例22眼,玻璃体混浊形态多为细点状、丝状、网状。比较治疗前后的BCVA,治疗次数差异及主觉症状改善情况。

结果：BCVA：治疗前A1组和A2组、B1组和B2组、A组和B组均无差异(P>0.05); A组和B组在治疗后2wk,1mo时均有差异(P<0.001),A1组和A2组在治疗后1、6、12mo均有差异(P=0.019、0.042、<0.001)。A组患者治疗后的主觉症状改善程度优于B组(P=0.006)。A1组治疗后的主觉症状改善程度优于A2组(P<0.001)。Ultra Q：YAG比传统Nd：YAG激光所需的激光治疗次数少(P<0.001)。同一种激光方法,不同玻璃体混浊形态,治疗次数无差异(P>0.05)。

结论：Ultra Q：YAG较传统Nd：YAG激光进行玻璃体消融治疗飞蚊症,更易于操作、更安全、具有更好的主觉症状改善,尤其是对于伴有Weiss环、絮状、致密膜状混浊物的患者。     

后发性白内障Nd:YAG激光后囊切开尺寸对眼部生物学参数及屈光状态的影响

目的：评估不同切口尺寸的Nd：YAG激光后囊切开术对后发性白内障(posterior capsule opacification,PCO)患者最佳矫正视力(BCVA)、眼压(IOP)等眼部生物学参数及屈光状态的影响。

方法：选取2017-06/2017-12于上海市东方医院眼科行Nd：YAG激光后囊切开术治疗的PCO患者41例41眼的临床资料进行回顾性分析,根据后囊切开尺寸将患者分成2组,囊膜切口≤3.5mm为组1(20例20眼),囊膜切口>3.5mm为组2(21例21眼)。分别于术前,术后1wk,1、3mo行BCVA、屈光度、IOP、ACD、黄斑厚度(MT)等检查。

结果：术后1wk,1、3mo,两组患者BCVA均较术前显著改善,差异均有统计学意义(P<0.001),但两组之间差异均无统计学意义(P>0.05)。手术前后,两组患者屈光度(SE)比较,差异无统计学意义(P>0.05)。术后1wk,组2患者IOP高于组1,差异有统计学意义(t=-2.609,P=0.013)。术后1wk,两组患者ACD均较术前明显变浅,差异均有统计学意义(P<0.01),但术后1、3mo两组患者ACD差异均无统计学意义(P>0.05)。术后1wk,两组患者MT均较术前轻度增加,但差异无统计学意义(P>0.05),且术后1wk,1、3mo两组患者MT差异均无统计学意义(P>0.05)。

结论：后囊切开尺寸对Nd：YAG激光后囊切开术后IOP影响显著,对BCVA、ACD、SE、MT无明显影响。     

A randomized controlled trial of peeling and aspiration of Elschnig pearls and neodymium:yttrium-aluminium-garnet laser capsulotomy

AIM:To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification (PCO).METHODS:A prospective, randomized, double blind, study was done at Rotary Eye Hospital, Maranda, Palampur, India, Santosh Medical College Hospital, Ghaziabad, India and Laser Eye Clinic, Noida India. Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction (ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity (CDVA), intra-operative and post-operative complications were compared.RESULTS:A total of 634 patients participated in the study, and 314 (49.5%) patients were randomized to surgical peeling and aspiration group and 320 (50.5%) to the Nd:YAG laser group. The mean pre-procedural logMAR CDVA in peeling and neodymium:yttrium-aluminium-garnet (Nd:YAG) laser group was 0.80±0.25 and 0.86±0.22, respectively. The mean final CDVA in peeling group (0.22±0.23) was comparable to Nd:YAG group (0.24±0.28; t test, P=0.240). There was a significant improvement in vision after both the procedures (P<0.001). A slightly higher percentage of patients in Nd:YAG laser group (283/88.3%) than in peeling group (262/83.4%) had a CDVA of 0.5 (20/63) or better at 9mo (P<0.001). On the contrary, patients having CDVA worse than 1.00 (20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group (25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001 % risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group, thick PCO had a stronger impact on complications (Fischer test probability, Pr<0.0001) than thin PCO and total laser energy (Fischer test probability, Pr<0.002), respectively; similarly, in peeling group, thick PCO and preoperative vision had a stronger effect on complications than thin PCO, respectively (Fischer test probability, Pr<0.001).The rate of complications like uveitis (P=0.527) and cystoid macular edema (P=0.068), did not differ significantly between both the groups. However, intraocular pressure spikes (P=0.046) and retinal detachment (P<0.001) were significantly higher in Nd:YAG laser group as compared to peeling group. Retinal detachment was more common in patients having degenerative myopia (7/87.5%, P<0.001). Recurrence of pearls was the most common cause of reduction of vision in the peeling group (24/7.6%, P<0.001).CONCLUSION:There is no alternative to Nd:YAG laser capsulotomy for fibrous subtype of PCO. For pearl form of PCO, both techniques are comparable with regard to visual outcomes. Nd:YAG laser capsulotomy has a higher incidence of IOP spikes and retinal detachment whereas recurrence of pearls may occur after successful peeling and aspiration. When posterior capsulotomy is needed in patients with retinal degenerations, retinopathies and pre-existing retinal breaks, the clinician should be cautious about increased risks of possible complications of Nd:YAG laser capsulotomy.     

两种术式治疗慢性泪囊炎的疗效对比

目的：分析比较鼻泪管支架植入术和鼻内窥镜下鼻腔泪囊吻合术治疗慢性泪囊炎的疗效。

方法：将80例80眼慢性泪囊炎随机分为两组。A 组(鼻泪管支架植入术)40例; B 组(鼻内窥镜下鼻腔泪囊吻合术)40例。术后对其疗效进行追踪观察,检查泪道通畅情况。

结果：术后随诊1a。术后6mo; 1a,A组有效率分别为90%,85%; B组有效率分别为97.5%,100%。术后6mo,A,B组两间比较差异无统计学意义(P>0.05)。术后1a,A,B两组间比较差异有统计学意义(P<0.05)。

结论：鼻内窥镜下鼻腔泪囊吻合术较鼻泪管支架植入术治疗慢性泪囊炎的疗效更可靠。     

七叶皂苷钠联合激光光凝治疗糖尿病性黄斑水肿的疗效观察

目的：探讨七叶皂苷钠联合激光光凝治疗糖尿病黄斑水肿的疗效及安全性。

方法：通过随机数字表的方法将113例162眼糖尿病黄斑水肿患者分为观察组(55例80眼)和对照组(58例82眼),观察组给予七叶皂苷钠联合激光光凝治疗,对照组单纯应用激光光凝治疗,同时运用光学相干断层扫描检测和荧光素血管造影检查所有患者不同时间的黄斑水肿厚度和眼底情况,同时检测不同治疗时间双眼视力,治疗同时监测患者的不良反应,评价其安全性。

结果：治疗前观察组和对照组眼压、BCVA、CMT、黄斑区发生荧光渗漏的比例两组比较无统计学差异(P>0.05)。两组治疗前后眼压差异均无统计学差异(P>0.05),组间比较无统计学差异(P>0.05)。观察组治疗后1、2、3、4mo BCVA、CMT、黄斑区发生荧光渗漏的比例均优于治疗前(P<0.05),观察组术后各时间点间3 项指标两两比较差异均有统计学意义(均为P<0.05)。对照组治疗后1、2、3、4mo,BCVA、CMT、黄斑区发生荧光渗漏的比例均优于治疗前(P<0.05),但对照组治疗后各个时间点BCVA两两比较差异均无统计学意义(P>0.05),对照组治疗后各时间点间CMT及黄斑区发生荧光渗漏的比例两两比较差异均有统计学意义(均为P<0.05)。三项治疗除治疗后1mo BVCA观察组与对照组无统计学差异之外(P>0.05),其他指标均观察组优于同期对照组(均为P<0.05)。观察期间观察组有 8例9眼(14. 5%)患者发生胃部不适、恶心等不良反应,但未有严重的药物不良反应或后遗症,观察组有4例5眼,对照组有5例5眼因为玻璃体积血需行其他治疗而退出治疗,两组比较无统计学意义(P>0.05)。

结论：七叶皂苷钠片联合激光光凝治疗糖尿病黄斑水肿是一种疗效好且安全的方法。     

Revision of failed dacryocystorhinostomies using the transcanalicular approach. Results of 118 procedures

PURPOSE: To assess the efficacy of transcanalicular dacryocystorhinostomy for the revision of other procedures. The results are analyzed following the use of two different types of laser: the Neodymium: YAG (Nd: YAG) laser and the Holmium: YAG (Ho: YAG) laser. To study the efficacy of using two antimetabolite drugs in this context: mytomycin-C (MMC) and 5-fluoro-uracile (5-FU). METHODS: One hundred and fourteen patients were operated on. Of these, 88 had already undergone one procedure, 25 two procedures, and 5 three procedures. The Nd: YAG laser was used in 78 procedures, the Ho: YAG in 30 procedures, and both lasers in 10 procedures. Twenty patients were treated with an application of MMC and 25 patients with an application of 5-FU. RESULTS: The results are based on 106 procedures. The total success rate was 49.06% after one revision and 58.49% after two or three revisions. There is no statistically significant difference between the Nd: YAG and Ho: YAG lasers. The use of antimetabolites did not improve the success rate. CONCLUSION: Transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and it has a low rate of morbidity given that it causes very little surgical traumatism. The revision of other dacryocystorhinostomy methods using the transcanalicular approach is theoretically a positive indication because it does not dissect scarring tissues and because the osteotomy has already been performed. However, the success rate is lower than for the external and endonasal approaches. The success rate is not modified by the use of antimetabolites or by the type of laser.     

早期Nd:YAG激光后囊切开预防青壮年白内障术后后囊混浊

目的：寻找预防青壮年白内障术后后囊混浊的简单方法。

方法：在行白内障超声乳化吸出联合人工晶状体植入后1mo行Nd：YAG激光后囊切开。

结果：观察组21眼经3a随访,3眼出现后囊混浊。对照组20眼,3a时12眼发生后囊混浊,与观察组比较,Z=-3.04,P=0.002,两组差异有统计学意义。

结论：Nd：YAG激光预防性后囊切开,可有效地防止青壮年白内障术后后囊混浊的发生。     

532nm激光联合复方樟柳碱治疗视网膜分支静脉阻塞的疗效

目的：探讨倍频Nd：YAG 532nm激光联合复方樟柳碱治疗视网膜分支静脉阻塞(branch retinal vein occlusion, BRVO)的疗效。

方法：选择130例130眼BRVO患者随机分为对照组和治疗组。对照组单纯应用532nm激光进行视网膜激光光凝治疗; 治疗组在应用532nm激光进行视网膜激光光凝同时,加用复方樟柳碱局部封闭治疗。观察治疗3mo后两组患者视力变化情况,眼底荧光血管造影(fundus fluorescein angiography, FFA)检查视网膜循环情况。

结果：联合复方樟柳碱治疗组与单纯激光治疗对照组相比,视力提高显著,差异有统计学意义(P=0.02<0.05)。直接检眼镜及FFA检查视网膜出血吸收、黄斑水肿减轻程度、毛细血管无灌注区消失、无新生血管形成等,治疗组均较对照组明显好转。

结论：倍频Nd：YAG 532nm激光联合复方樟柳碱治疗BRVO 3mo后,视力及FFA检查明显优于单纯532nm激光治疗。