Er:YAG激光乳化与超声乳化白内障吸除术的临床对比分析

目的研究使用掺铒钇铝石榴石激光乳化系统对不同硬度核的白内障行激光乳化白内障吸除术的有效性。方法将150例白内障患者(167只眼)根据核硬度不同随机分为2组:A组(85只眼)行常规超声乳化白内障摘除术,B组(82只眼)行Er:YAG激光乳化白内障摘除术。术后评估手术时间、眼内压(IOP)、角膜厚度、角膜内皮丢失率和视力。结果Er:YAG激光乳化组中顺利完成手术78只眼,术中改术式为超声乳化1只眼。术后随访激光乳化组中Ⅰ级核、Ⅱ级核和Ⅲ级核患者视力与超声乳化组无显著差异,而Ⅳ级核患者视力明显低于超声乳化组(P<0.05)。Er:YAG激光乳化组中Ⅳ级核术后IOP平均增加为10.5%,远大于Ⅰ、Ⅱ和Ⅲ级核(P<0.05);超声乳化手术组眼内压IOP手术前后无明显改变。所有病例角膜内皮细胞均有减少,对于Ⅰ、Ⅱ级核,Er:YAG激光乳化组明显少于超声乳化组(P<0.05);而Er:YAG激光乳化组中Ⅳ级核患者角膜内皮细胞丢失率明显大于超声乳化组(P<0.05)。激光乳化组术后1年及3年晶状体后囊膜发生混浊的百分率分别为9.8%及14.7%,均明显小于超声乳化组的45.9%及49.4%(P<0.05)。结论使用MCL29铒钕钇铝石榴石激光白内障乳化仪行激光乳化白内障吸除术是治疗白内障安全、有效的方法;手术设备和操作技能尚待进一步完善和提高。     

小切口非超声乳化白内障摘除术与超声乳化吸除术的疗效观察

目的通过比较小切口非超声乳化白内障摘除术与超声乳化白内障吸除术，探讨更适合在基层医院以及医疗扶贫行动中推广应用的手术方法。方法抽取200例（200只眼）白内障患者，其中小切口非超声乳化手术118例（118只眼），超声乳化吸除术82例（82只眼）。对比观察两种手术术后视力恢复情况、术中术后的并发症，以及两种手术方法的手术成本。结果小切口非超声乳化白内障摘除术及超声乳化白内障吸除术在术后视力、术中术后并发症和患者满意度在远期均无显著差异，而手术成本小切口非超声乳化术明显低于超声乳化吸除术。结论小切口非超声乳化白内障摘除术更适合在基层医院以及医疗扶贫行动中推广应用。     

铒激光乳化与超声乳化白内障摘除术对角膜内皮影响的对比观察

目的：比较激光乳化白内障摘除术与超声乳化白内障摘除术对角膜内皮形态、密度及角膜厚度的影响。方法：对35例白内障病作地激光乳化及后房型人工晶体植入术。并与同期进行的39例超声乳化及后房型人工晶体人术眼的角膜内皮损失率、六边形细胞百分率及角膜厚度的变化相比较。结果：激光组术后1周、1个月及3个月角膜内皮损失率分别为7.56%、5.12%及5.26%,均明显小于超声组的12.31%、11.37%及12.04%;激光组六边形细胞百分率分别为52.49%、53.28%及53.01%,均明显大于超声组的45.30%、46.61%及45.92%;角膜厚度增加率激光组为10.26%、4.62%及2.45%,与超声组的12.69%、5.69%及2.92%相比无统计学差别。结论：激光乳化术较超声乳化术对角膜内皮损伤小,安全性更高。     

两种白内障手术方法在治疗老年性白内障中的应用观察

目的通过对比观察小切口非超声乳化白内障摘除术与超声乳化白内障吸除术,探讨适合在老年性白内障防盲治盲中推广的手术方式。方法抽取108例老年性白内障患者,随机分为二组:超声乳化白内障吸除术手术组56例与小切口非超声乳化白内障摘除术组52例。对比观察两种术式并发症、术后视力、手术成本。结果小切口非超声乳化白内障摘除术与超声乳化白内障吸除术在老性白内障手术中的并发症、远期术后视力比较,差异均无统计学意义,而小切口非超乳白内障摘除术的手术成本明显低于超声乳化白内障吸除术。结论小切口非超声乳化白内障摘除术适合在老年性白内障防盲治盲中普遍推广。     

激光白内障手术研究进展

激光白内障手术已经有近20年的发展史，体外和临床试验证明激光白内障手术安全、有效，具有较多的潜在优势，有良好的发展前景。目前已有多种Er:YAG激光和Nd:YAG激光白内障手术系统相继问世。但要超越超声乳化术，激光白内障手术在仪器性能和手术技巧上仍需进一步完善。本就其近几年来的进展做一综述。     

冷微超声乳化手术中器械护士的配合

目的 冷微切口超声乳化手术是国际尖端技术，培养器械护士上台配合很有必要，效果好。方法 阐述了对216例(219只眼)进行冷微切口超声乳化手术的方法及经过。结果 冷微超声乳化手术适合各种硬度的白内障乳化手术，显著提高了对硬核的乳化效率。使患者的视力在原来的基础上平均提高了0．6以上。结论 使用冷微超声乳化白内障摘除术使患者视力恢复更快，效果更显著，并发症少，从而减少器械与灌注液对眼内组织的损伤。器械护士上台配合还能大大的缩短手术时间，使手术顺利进行达到尽善尽美，提高了临床疗效和患者的满意度。     

巩膜隧道切口超声乳化白内间术后房角镜的观察

目的 通过超声乳化白内障摘除术后房角的观察,了解手术对其的损害。方法 对２０例采用隧道小切口白内障超声乳化摘除术及２０例白内障囊外摘除术的病例,通过房角镜观察前房角损害、虹膜周边前粘连、人工晶体襻不对称等的发生率。结果 超声乳化白内障摘除术与白内障囊外摘除术比较,前房角损害、虹膜周边前粘连、人工晶体襻不对称等明显减少。结论：白内障超声乳化摘除术对前房的损害明显小于白内障囊外摘除术。     

适合中国国情的非超乳小切口囊外白内障摘除术

目的通过比较非超乳小切口囊外白内障摘除术(ECCE)与超声乳化白内障吸除术，探讨更适合中国国情的手术方法。方法随机抽取100例白内障患者，其中非超乳小切口手术37例，超声乳化吸除术63例。对比观察两种手术的术中并发症、内皮细胞术中丢失率、术前及术后前房蛋白定量分析、术后患者满意度以及手术成本。结果非超乳小切口囊外白内障摘除术及超声乳化白内障吸除术在手术中并发症以及术后视力、角膜内皮丢失率、前房蛋白定量和患者满意度在远期均无显著差异，而手术成本小切口ECCE明显低于超声乳化吸除术。结论非超乳小切口ECCE手术更适合中国国情。     

巩膜隧道切口超声乳化白内障术后房角镜的观察

目的 :通过超声乳化白内障摘除术后房角的观察 ,了解手术对其的损害。方法 :对 2 0例采用隧道小切口白内障超声乳化摘除术及 2 0例白内障囊外摘除术的病例 ,通过房角镜观察前房角损害、虹膜周边前粘连、人工晶体襻不对称等的发生率。结果 :超声乳化白内障摘除术与白内障囊外摘除术比较 ,前房角损害、虹膜周边前粘连、人工晶体襻不对称等明显减少。结论 :白内障超声乳化摘除术对前房的损害明显小于白内障囊外摘除术。     

白内障超声乳化术对角膜影响的研究现状

白内障超声乳化摘除术已成为治疗白内障手术的最常用方法，随着手术技术的日臻完善，各种并发症已逐渐减少。由于术中超声探头数万次的震动所产生的能量，必将对角膜产生影响，因此，角膜并发症已成为白内障超声乳化摘除术后最主要的并发症。本文就其术后散光及对角膜内皮的影响进行文献综述。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.