飞秒激光辅助的穿透性角膜移植联合手法碎核白内障摘除人工晶状体植入术

目的：探讨同时行飞秒激光辅助的穿透性角膜移植术（ PKP）及小切口手法碎核白内障摘除联合人工晶状体植入术治疗同时患有白内障及角膜病患者的适应证、手术技巧及术后疗效。方法应用飞秒激光辅助的PKP联合小切口手法碎核白内障摘除人工晶状体植入术治疗同时患有白内障及角膜病的患者6例（6只眼）,观察其术后裸眼视力、最佳矫正视力、眼压、植片、人工晶状体情况及前房反应。随访9个月。结果治疗后6例术后裸眼视力均比术前有不同程度的提高,术后9个月裸眼视力≥0．3者4例,0．2者2例;5例最佳矫正视力≥0．5,1例最佳矫正视力为0．4。术后7～14 d,5例角膜植片全透明,1例角膜植片轻度水肿。至术后9个月,6例角膜植片全透明;6例术后眼压均正常,人工晶状体位置正,位于囊袋内。结论飞秒激光辅助的PKP联合小切口手法碎核白内障摘除人工晶状体植入术对眼球损伤更小、手术效果更确切、治疗病程更短,可以一次性解决眼前段的屈光间质混浊。与传统分期手术相比减少了术后并发症,使患者快速恢复术后视力,安全性较高。     

穿透性角膜移植联合小梁切除术的临床观察

采用穿透性角膜移植联合小梁切除术治疗角膜溃疡穿孔、角膜瘘或术前合并青光眼的角膜病变３０例，其中联合白内障囊外摘除８例，联合人工晶体取出１例。术后视力提高２５例（８３．３％），２８眼眼压控制在小于２０ｍｍＨｇ（有效率９３．３％），２９眼角膜移植片保持透明（９６．７％）。穿透性角膜移植联合小梁切除术是治疗角膜溃疡穿孔、角膜瘘或术前合并青光眼的角膜病变的有效措施，可以减少术后并发症，增加角膜植片透明率，有效地改善视功能。     

穿透性角膜移植治疗人工晶体植入术后大泡性角膜病变的临床观察

目的探讨穿透性角膜移植术治疗人工晶体植入术后大泡性角膜病变临床疗效。方法对21例（21眼）人工晶体植入术后大泡性角膜病变施行穿透性角膜移植术或穿透角膜移植联合手术，观察术后视力及植片情况。结果随访6～18个月，平均11．6个月，术后临床症状明显缓解或消失，视力较术前均有提高，其中矫正视力0．02以上17例（0．2以上7例）；术后继发性青光眼2例，内皮型排斥反应1例。结论穿透性角膜移植术是治疗人工晶体植入术后大泡性角膜病变的一种理想手术方式，不但缓解症状且能不同程度提高视力。     

穿透性角膜移植术治疗内眼术后大泡性角膜病变

目的：评价穿透性角膜移植术治疗内眼术后大泡性角膜病变的临床疗效。方法：我们对因内眼术后发生大泡性角膜病变的11例病人进行回顾性研究，其中9例行穿透性角膜移植术，1例行穿透性角膜移植术联合白内障囊外摘除、后房型人工晶体植入术，1例行带环形板层巩膜瓣的全角膜移植术。观察术后视力及植片情况。结果：随访4～36个月，平均16．6个月，眼部刺激症状均缓解，术后视力提高10眼，视力无改变1眼；术后9例角膜植片透明，2例再次行穿透性角膜移植术联合小梁切除术。结论：穿透性角膜移植术是治疗大泡性角膜病变的有效方法，不但缓解症状且能不同程度提高视力。     

基层开展小切口手法碎核白内障手术临床效果

目的探讨小切口手法碎核技术在基层医院的应用和临床效果。方法对345例（380眼）白内障行小切口手法碎核白内障摘出联合人工晶状体植入术。结果术后视力≥0．5者337眼（88．68％），术中保持了囊袋完整性的375眼（98．68％）。结论小切口手法碎核进行白内障囊外摘出术，适合在基层医院开展。     

3.5 mm角膜缘隧道切口囊袋内手法碎核人工晶体植入术

目的　探讨 3 5mm角膜缘隧道切口囊袋内手法碎核白内障摘除人工晶体植入术的临床效果。方法　在上方角膜缘做 3 5mm隧道切口 ,采用晶状体囊袋内手法碎核技术对 12 8只眼行白内障摘除 ,并植入折叠式或PMMA人工晶体。结果　 12 8只眼中 ,12 0只眼成功完成囊袋内碎核 ,未成功者与浅前房、小瞳孔及水分离不充分有关。术后 1天裸眼或球镜矫正视力≥ 0 6者占 79 7% ,术后 1周平均散光为 ( 0 95± 0 74)D ,仅比术前增加 0 0 8D (P >0 0 5 ) ,明显低于 12mm切口囊外摘除组 (P <0 0 1)。结论　本结果提示 3 5mm角膜缘隧道小切口囊袋内手法碎核白内障摘除和人工晶体植入技术 ,可有效减少术后角膜散光并早期获得良好视力 ,降低手术费用。     

穿透性角膜移植联合梁切除术的临床观察

２穿透性角膜移植联合小梁切除术治疗溃疡穿孔、角膜瘘或术前合并青光眼的角膜病变３０例。其中联合白内障囊外摘除８例，联合人工晶体取出１例。术后视力提高２５例（８３．３％），２８眼眼压控制在小于２０ｍｍＨｇ（有效率９３．３％），２９眼角膜移植片保持透明（９６．７％），穿透性角膜移植联合小梁切除术是治疗角膜溃疡穿孔、有膜瘘或术前合并青光眼的角膜病主煌有效措施。可以减少术后并发症，中角膜植片透明率，有效地改     

小切口手法碎核人工晶状体植入术治疗硬核白内障

目的探讨小切口手法碎核对硬核白内障摘出人工晶状体植入临床效果。方法作角膜缘后反眉弓5.5mm巩膜隧道切口,采用晶状体硬核手法碎核技术对70例（70眼）白内障摘出,并植入折叠式或PMMA人工晶状体。结果 69眼成功完成手法碎核,劈核器对力不均造成晶状体2眼翻转致后囊破裂。术后1周裸眼或球镜矫正视力≥0.5者占92.86%,术后1周平均散光为（1.23±0.75）D。结论反眉弓巩膜隧道小切口手法碎核人工晶状体植入术不需特殊设备,简便易行,其效果可与超声乳化术媲美,可有效地减少术后角膜散光,早期获得良好的视力,降低手术费用。     

穿透性角膜移植术治疗假晶体大泡性角膜病变的临床观察

目的：评价穿透性角膜移植术治疗假晶体大泡性角膜病变的临床疗效，探讨术中对原人工晶体的处理。方法：假晶体大泡性角膜病变１４例（１４只眼）。原人工晶体类型为后房型人工晶体１２例，弹性开放襻前房型人工晶体２例。手术方法为穿透性角膜移植术１２例，穿透性角膜移植联合人工晶体取出术２例。结果：术后临床症状均完全消失，所有植片均透明，矫正视力０．０２以上１２例（０．１以上４例）。随诊３￣２２个月，１３例植片透明     

白内障囊外摘除人工晶体囊袋内植入与穿透性角膜移植联合手术(摘要)

我院自1987年以来先后施行白内障囊外摘除人工晶体囊袋内植入与穿透性角膜移植联合手术3例,取得满意效果。手术方法:角膜材料为外伤死亡后3～6小时内的成人新鲜角膜,人工晶体为成都蜀光生物医学工程技术研究所生产的GN5 15透明硅凝胶后房型人工晶体。术前准备及消毒同白内障摘除人工晶体植入术,术式采用穿透性角膜移植术,在切除病变角膜后行开罐式截除晶状体前囊膜,挽除晶体核,开放式注吸皮质,保留完整后囊膜及囊袋,将人工晶体直接植入囊袋内,做2～3处虹膜根部切除。将新鲜角膜片放入植孔,间断或连续缝合固定移植片,其它处置同穿透性角膜移植及人工晶体移植术。结     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Ethics and optometry: concepts and applications

Ethics refers both to the study of behaviour, and moral principals. The related concepts of justice and law are also relevant to optometry. A profession typically claims specialist knowledge and ethical behaviour – putting the interests of clients above its own. However, professional codes fail as ethical directives, and their goals are questioned. Beginning with broad principles, institutional ethics and issues of general health care provision are considered, and applications to optometry are made. Ethical theory can guide us in interacting with our patients, utilising resources and ordering priorities. The conservative approach to consumerism and advertising is defended on the basis of protecting public and professional interests. Ethical behaviour can be fostered, and this process should begin in undergraduate education.     

Nutritional antioxidants and age-related cataract and maculopathy

Loss of vision is the second greatest, next to death, fear among the elderly. Age-related cataract (ARC) and maculopathy (ARM) are two major causes of blindness worldwide. There are several important reasons to study relationships between risk for ARC/ARM and nutrition: (1) because it is likely that the same nutritional practices that are associated with prolonged eye function will also be associated with delayed age-related compromises to other organs, and perhaps, aging in general, (2) surgical resources are insufficient to provide economic and safe surgeries for cataract and do not provide a cure for ARM, and (3) there will be considerable financial savings and improvements in quality of life if health rather than old age is extended, particularly given the rapidly growing elderly segment of our population. It is clear that oxidative stress is associated with compromises to the lens and retina. Recent literature indicates that antioxidants may ameliorate the risk for ARC and ARM. Given the association between oxidative damage and age-related eye debilities, it is not surprising that over 70 studies have attempted to relate antioxidant intake to risk for ARC and ARM. This article will review epidemiological literature about ARC and ARM with emphasis on roles for vitamins C and E and carotenoids. Since glycation and glycoxidation are major molecular insults which involve an oxidative stress component, we also review new literature that relates dietary carbohydrate intake to risk for ARC and ARM. To evaluate dietary effects as a whole, several studies have tried to relate dietary patterns to risk for ARC. We will also give some attention to this emerging research. While data from the observational studies generally support a protective role for antioxidants in foods or supplements, results from intervention trials are less encouraging with respect to limiting risk for ARC/ARM prevalence or progress through antioxidant supplementations, or maintaining higher levels of antioxidants either in diet or blood. Without more information it is difficult to parse these results. It would be worthwhile to determine why the various types of studies are not yielding similar results. However, there are many common insults and mechanistic compromises that are associated with aging, and proper nutrition early in life may address some of these compromises and provide for extended youthful function later in life. Indeed, proper nutrition, possibly including use of antioxidant supplements for the nutritionally impoverished, along with healthy life styles may provide the least costly and most practical means to delay ARC and ARM. Further studies should be devoted to identifying the most effective strategy to prevent or delay the development and progress of ARC/ARM. The efforts should include identifying the right nutrient(s), defining useful levels of the nutrient(s), and determining the age when the supplementation should begin.     

Exogenous attention and color perception: performance and appearance of saturation and hue

Exogenous covert attention is an automatic, transient form of attention that can be triggered by sudden changes in the periphery. Here we test for the effects of attention on color perception. We used the methodology developed by Carrasco, Ling, and Read [Carrasco, M., Ling, S., & Read, S. (2004). Attention alters appearance. Nature Neuroscience, 7 (3) 308-313] to explore the effects of exogenous attention on appearance of saturation (Experiment 1) and of hue (Experiment 2). We also tested orientation discrimination performance for single stimuli defined by saturation or hue (Experiment 3). The results indicate that attention increases apparent saturation, but does not change apparent hue, notwithstanding the fact that it improves orientation discrimination for both saturation and hue stimuli.     

血糖和血脂异常代谢与糖尿病性眼肌麻痹患者的关联分析

目的探究糖代谢和脂代谢异常与糖尿病性眼肌麻痹患者的关联性。方法选取2012年2月至2016年2月在首都医科大学附属北京同仁医院神经内科住院的39例糖尿病性眼肌麻痹患者为观察组,40例于本院体检中心进行健康检查的人群为对照组。对比两组研究对象糖代谢(Hb A1c、FPG、2h PBG)及脂代谢(TG、TC、HDL-C、LDL-C)水平;分析观察组患者脂代谢指标中TG、TC与糖代谢指标Hb A1c的相关性。结果观察组糖代谢的Hb A1c、FPG及2h PBG水平显著高于对照组;观察组脂代谢的TG、TC及LDL-C水平显著高于对照组,指标HDL-C水平低于对照组;观察组血糖血脂的关联性分析得出TG及TC与Hb A1c呈正相关,均处于平行上升趋势。结论糖尿病患者高血糖和血脂代谢异常是引发颅神经病变的因素,导致患者眼肌麻痹并发症的出现,治疗和改善糖尿病患者血糖及血脂代谢异常,可以更好的预防糖尿病患者眼肌麻痹的发生。