玻璃體手術治瘵化膿性眼内炎

目的觀察玻璃體切割手術聯合眼内灌注抗生素治瘵化膿性眼内炎的臨床瘵效,方法同顧性分析68例68眼化膿性眼内炎行玻璃體切割手術聯合灌注抗生素治瘵效果,分析對比眼内炎的治瘵方法及術中注意事項.結果68例68眼眼内炎癥全部控制,61眼眼球保存并且視力有不同程度的提高,視力在0.05以上者占48.5%,7眼眼球萎縮.結論玻璃體切割聯合眼内灌注抗生素是治瘵化膿性眼内炎最理想的方法,及時手術,術中精心操作是取得良好瘵效的關鍵.     

閉合式玻璃體切除術在眼内异物取出術中的应用

目的回顧性分析閉合式玻璃體切除術治療眼内异物的臨床療效.方法對22例(22眼)眼外傷合并眼内异物患者施行玻璃體切除術、晶體切除術、眼内异物取出、視綱膜脱離復位及鞏膜外環扎等聯合術.結果所有病例眼内异物均一次性取出,術後視力多數有不同程度的提高(0.05以上者共14例),視力提高者15例,不變者4例,下降者3例.結論應用閉合式玻璃體切除術取出眼内异物手術效果好,有利于及時處理并發癥和恢復有用視力.     

復合性眼内异物傷的聯合手術

目的探討復合性眼内异物傷的各種聯合手術方法,統計其結果.方法對眼内异物傷伴有角膜瘢痕、外傷性白内障、玻璃體渾濁、PVR、牽引性視網膜裂孔、視網膜脱離或和眼内炎等,分别進行异物摘出與晶狀體切除、玻璃體切除、視綱膜復位、人工晶狀體植入、角膜移植等三聯、四聯或五聯手術.術後隨訪觀察,統計效果.結果復合性磁性及非磁性眼内异物傷45例(45眼)其中36例(80%)術後視力達0.5～1.0.術後視力達0.05者42例(93.33%).結論合并晶狀體、玻璃體、視綱膜或/及角膜外傷的復合性眼内异物傷,進行聯合手術是安全的,效果良好,視力恢復尚滿意.關鍵詞眼内异物傷聯合手術     

无晶體眼難治性青光眼的聯合治疗

目的 探討無晶體眼難治性青光眼小梁切除聯合玻璃體抽吸及絲裂霉素應用的療效。方法 對14例無晶體眼難治性青光眼行小梁切除聯合玻璃體抽吸及術中應用0.4mg/ml絲裂霉素結膜瓣下及鞏膜瓣下濕敷。結果 14例中10例術后視力保持不變,1例術后視力下降。10例眼壓控制在2.74Kpa以下(1Kpa=7.5mmHg),3例術后需應用藥物治療,1例眼壓失控>31.52mmHg。結論 無晶體眼難治性青光眼行小梁切除聯合玻璃體抽吸及應用絲裂霉素治療,能提高手術成功率,且能较好的保存患者的殘余視功能。     

晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂的臨床觀察

目的改善穿通性眼外傷伴晶狀體后囊破裂患者的預后.方法對14例眼球穿通傷伴晶狀體后囊破裂的患者縫合角鞏膜后行晶體玻璃體切割.結果對14例患者隨訪6～24個月,平均11.5個月.術后隨訪最終矯正視力範圍0.06～1.0,其中≥0.4者8眼.結論晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂患者,具有能夠恢復有用視力,并發症少的理想效果     

闭合式玻璃體切割术摘除脱入玻璃體腔的晶状體

目的 评價通过闭合式玻璃體切割術治療晶體脱入玻璃體的療效。方法 对6例晶體全脱位或晶體核墜入玻璃體行闭合式玻璃體切割術切除或借用導光(?)維頭挤壓碎核切除進行效果分析。结果 5例顺利取出晶體或晶體核,無術中術后并發症,1例發生驅逐性出血。结论 对于晶體全脱位墜入玻璃體和超聲乳化晶體核脱入玻璃體腔者可采用闭合式玻璃體切割術進行处理。     

Nd:YAG激光清除人工晶體前纖維膜及殘留物

目的評價NdYAG激光治療白内障術後人工晶體前膜及殘留物的臨床療效.方法回顧性總結NdYAG激光治療白内障術後人工晶體前膜及殘留物共21例21眼;激光參數單次脉衝能量0.8～3.5mJ,擊發次數11～13次.結果所有患者一次治療均使瞳孔區透明,但有2例復發;術後視力提高率100%;術前視力平均0.22±0.17,術後平均0.42±0.12,激光治療前後視力差别非常顯著(P＜0.01).主要并發癥虹膜出血、人工晶體損傷和眼壓升高,各有2例,各占9.5%.結論NdYAG激光清除白内障囊外摘除術後人工晶體前膜及殘留物安全、有效.     

影響外傷性化膿性眼内炎療效的相關因素分析

目的外傷性化膿性眼内炎是病原菌随致傷物直接進入眼内,使眼内組織在短晴間内造成嚴重損傷,了解哪些因素對該病的預後起决定性作用,爲臨床醫師治瘵提供指導.方法1999年1月～2001年3月間眼球穿孔傷後臨床診斷爲化膿性眼内炎48例,回顧性分析傷口大小、异物存留、晶狀體損傷和病原菌檢查及外傷後手術時間對該病預後的影響.結果傷口大小、异物存留是否、晶狀體損傷對其預後無統計學差异,54%的病例發現病原菌,其中G+球菌占39%,G-杆菌占50%,真菌感染占11%,G-杆菌感染的眼内炎預後差,進對診斷爲眼内炎的患者越早行手術治瘵效果越明顯.結論眼球傷口大小、异物存留、晶體損傷對外傷性化膿性眼内炎預後無明顯影響,而感染病原菌的種類、發病距手術時時間的長短影響該病的預後.     

松馳性視網膜周邊切開術臨床應用

目的探討更有效治療伴有嚴重增殖性玻璃體視網膜病變(PVR)的難治性視網膜脱離的方法.方法采用玻璃體切除術聯合松弛性周邊視網膜切開與切除,并運用氟碳液展平視網膜和硅油填充.結果出院時19例中18例視網膜復位.視力有不同程度提高,最佳爲0.1.術后三個月以上隨訪者有17例,其中5例爲取硅油后,這5例中1例視網膜全部脱離,1例局部牽拉性視網膜脱離.其余3例視網膜平復視力提高,最佳視力爲0.15.復位率爲60%.結論松弛性周邊視網膜切開與切除術是治療難治性視網膜脱離有效的方法.     

小切口透明晶體吸出及人工晶體植入術治療超高度近視

目的評價超高度近視小切口透明晶體吸出及人工晶體植入術的療效.方法對15例(27眼)超高度近視,眼軸長26.54～33.05mm.屈光度-11.0D～-26.0D.通過3.2mm及5.5小切口植入折叠及硬性人工晶體.結果術后1個月裸眼視力≥0.5者占51.9%;≥1.0者占29.6%.結論小切口透明晶體吸出及人工晶體植入術,具有術后視力恢復快,屈光狀態穩定,術后并發症少等優點.     

去上皮瓣Epi-LASIK矫治高度近视

目的:探讨去上皮瓣机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)矫治高度近视的临床疗效。方法:对86例169眼高度近视患者施行去上皮瓣Epi-LASIK,术后随访6mo。观察术后刺激症状、角膜上皮愈合时间、视力、屈光度、角膜上皮下雾状混浊程度(haze)。结果:所有患者术后均未主诉明显疼痛,仅表现有轻中度的异物感、畏光、流泪。角膜上皮愈合时间3～4d。术后6mo,全部86例169眼术后等效球镜均在±1.00D以内,未见最佳矫正视力下降,23眼(13.6%)最佳矫正视力提高1行以上。术后1mo,142眼(84.0%)角膜haze为0级,27眼(16.0%)角膜haze为0.5级;术后3mo,2例4眼不明原因出现3级haze;术后6mo,所有患者角膜haze均为0级。结论:去上皮瓣Epi-LASIK治疗高度近视安全、有效,具有良好的可预测性和稳定性。个别患者在术后发生不明原因的迟发性haze有待于进一步研究。     

Cystoid and diabetic macular edema treated with nepafenac 0.1%.

Cystoid macular edema (CME), a common complication following cataract surgery, is routinely medically treated with topical nonsteroidal anti-inflammatory drugs (NSAIDs), alone or in combination with steroids. In this paper, we describe 6 patients with CME and 1 patient with diabetic macular edema (DME), all of whom were treated with nepafenac 0.1%, a novel prodrug NSAID. Three (3) patients with acute CME following cataract surgery were treated for 3-4 weeks with nepafenac 0.1%, with or without concomitant steroids. Both retinal thickness and visual acuity improved in all 3 cases. The 3 patients with chronic CME, each of whom had been previously treated with steroids with or without concomitant NSAID therapy, were started on nepafenac 0.1% three times daily. Retinal thickness and visual acuity improved in each case, except for 1 patient with 20/25 pretreatment visual acuity. The mean improvement in visual acuity of all 6 CME patients was 2.5 lines and the mean decrease in retinal thickness was 282.8 microm. The patient with DME also showed improvement in retinal thickness and visual acuity after 6 months of treatment with nepafenac. These clinical data strongly suggest that nepafenac 0.1% is a promising drug for the treatment of posterior segment inflammation, including CME, and warrants further investigation.     

青光眼术后经颞侧行小切口白内障手术

目的:探讨表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术效果。方法:对32例40眼青光眼小梁切除术后的白内障患者用倍诺喜表面麻醉联合球结膜下注射20g/L利多卡因麻醉,行改良小切口白内障囊外摘出联合后房型人工晶状体植入术,分析手术的麻醉效果及手术后的治疗效果。结果:全部患眼均能达到理想的麻醉镇痛效果,顺利完成手术,术后视力<0.1者5眼(12.5%),视力0.1～0.4者9眼(22.5%),术后视力≥0.5者26眼(65.0%),所有患眼术后视力与术前比较均有提高。结论:表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术,是治疗青光眼小梁切除术后白内障有效的手术方式,手术操作简便,不需要昂贵的手术设备,适用于基层医院开展。     

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.     

Visual outcome of surgery for epiretinal membranes with macular pseudoholes

OBJECTIVE: To evaluate the effect of macular pseudohole on visual results after epiretinal membrane (ERM) surgery. DESIGN: Retrospective case-control study. PARTICIPANTS: The postoperative results for 50 eyes with ERMs combined with pseudohole were compared with the results for a paired series of idiopathic ERMs without pseudohole operated on during the same period. INTERVENTION: All patients underwent standard three-port pars plana vitrectomy, including core vitrectomy, and removal of the membrane. MAIN OUTCOME MEASURES: Anatomic and functional evaluations were performed before and after surgery. Main outcome measures were postoperative visual acuity and the persistence or disappearance of the pseudohole. RESULTS: For the patients with pseudohole, median preoperative visual acuity was 20/63 (range, 20/32-20/860) and median postoperative visual acuity was 20/40 (range, 20/20-20/860). Vision improved by 2 or more lines in 31 (62%) of 50 eyes. Forty eyes (80%) reached visual acuity of 20/50 or more. Pseudohole persisted in 22 eyes (44%) 3 months after surgery and in 15 eyes (30%) at 6 months. There was no difference in visual acuity, whether or not the pseudohole persisted. For the patients without pseudohole, median preoperative visual acuity was 20/63 (range, 20/32-20/860). Median postoperative visual acuity was 20/40 (range, 20/20-20/860). Vision improved by 2 or more lines in 37 eyes (74%). In 36 eyes (72%), it was 20/50 or more. Neither preoperative nor postoperative visual acuity differed significantly in the groups with and without pseudohole. CONCLUSION: After surgery for idiopathic ERMs combined with pseudohole, visual outcome is good, and pseudohole has no adverse prognostic value. Pseudohole disappears inconstantly after surgery, but its persistence does not preclude good postoperative visual recovery.     

青光眼合并白内障联合手术的疗效观察

目的观察晶状体超声乳化人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床效果。方法青光眼合并白内障37例（42眼）应用联合手术治疗,随访3—24个月,观察术后视力、眼压、滤过泡及并发症情况。结果术后3个月视力均有不同程度的提高;0．3及以上者占83．33％。术后3个月眼压有41眼（97．62％）控制在9～16mmHg。术后6个月功能性滤过泡36眼（85．71％）。术后并发症有：葡萄膜反应、角膜水肿、暂时性眼压升高等,经治疗后缓解。结论青光眼合并白内障联合手术,既能控制眼压,又能改善视力,避免了分期手术给患者造成的痛苦,减少了术中术后并发症的发生。     

影响高度近视白内障患者疗效的相关因素分析

目的:分析白内障摘除手术治疗高度近视白内障患者疗效的影响因素.方法:回顾性研究.纳入高度近视合并白内障患者行白内障摘除术86例118眼,所有患者均完成术后6mo随访调查且临床资料完整,记录所有患者术后6mo最佳矫正视力(best correct visual acuity,BCVA),以0.3为分界将患者分为低视力组(视力<0.3)与视力正常组(视力≥0.3),回顾性分析两组患者临床资料,对年龄、性别、病程、BCVA、角膜屈光度、眼轴长度、角膜散光、巩膜、眼底病变程度、术后并发症、玻璃体脱离、黄斑病变等因素进行统计,采用单因素及多元Logistic回归分析法筛选影响白内障摘除手术治疗高度近视白内障患者疗效的相关因素.结果:所有患者中低视力34眼(29%),视力正常84眼(71%);低视力组眼轴长度、角膜散光度、合并黄斑病变所占比例、合并后巩膜葡萄肿所占比例、晶状体核硬度分级、眼底病变程度与视力正常组对比差异有统计学意义(P<0.05);眼轴长度(OR:1.567,95%CI:1.129~2.224)、黄斑病变(OR:8.054,95%CI:1.741~37.541)、晶状体核硬度分级(OR:3.642,95%CI:2.512~18.787)、眼底病变程度(OR:7.964,95%CI:1.254~28.415)均与高度近视白内障疗效相关(P<0.05);随访6mo,晶状体后囊膜混浊5眼,无继发性青光眼、人工晶状体移位、角膜失代偿及视网膜脱离并发症发生.结论:眼轴长度、黄斑病变、晶状体核硬度分级、眼底病变程度均为影响白内障摘除手术治疗高度近视白内障患者术后视力恢复的独立危险因素,为促进患者术后视力恢复,必须积极控制危险因素,重视术中精细操作.     

滤过术后选择性隧道切口晶状体超声乳化人工晶状体植入

目的评价青光眼滤过术后晶状体超声乳化白内障摘出人工晶状体植入术的效果。方法对33例（51眼）青光眼滤过术后的白内障，采用选择性切口行晶状体超声乳化白内障摘出人工晶状体植入。随诊3—18月，观察术后滤过泡、眼压、视力及并发症等情况。结果51眼术前视力手动-0．6，术后视力均较术前明显提高。其中，0．05-0．2者2眼（3．92％），0．3-0．4者7眼（13．73％），0．5-0．8者12眼（23．53％），1．0-1．2者30眼（58．82％）。13眼滤过泡无影响，眼压均在正常范围。24眼有不同程度的角膜水肿、炎症反应，用药后恢复，无角膜失代偿。结论青光眼滤过术后白内障，采用选择性隧道切口行晶状体超声乳化白内障摘出人工晶状体植入术，可以避开滤过泡，保护原有滤过功能，术后反应轻，视功能恢复好，手术安全可靠。     

Expulsive hemorrhage in perforating keratoplasty--incidence and risk factors]

BACKGROUND: Expulsive hemorrhage is a severe complication of intraocular surgery. In a retrospective study we looked up surgical records of all penetrating keratoplasties (PK) performed in our department between 1989 and 1998. In all patients suffering from expulsive or preexpulsive choroidal hemorrhage we intended to find out possible risk factors and to report on the final outcome of these eyes. PATIENTS AND METHODS: Between January 1989 and November 1998 a total of 2421 PKs were performed. Nine preexpulsive and three expulsive hemorrhages occurred. The group of patients with preexpulsive hemorrhage consists of four females and five males (mean age 57 +/- 6.5 years). Three patients (one female, 2 males; mean age 67 +/- 8.5 years) suffered from expulsive hemorrhage. RESULTS: Incidence of expulsive hemorrhage was 0.1% (preexpulsive hemorrhage 0.4%). All twelve operations were performed under general anesthesia. Risk factors for preexpulsive hemorrhage were: previous ocular surgery (three patients), ocular trauma (2 patients) and internal diseases (five patients): arterial hypertension, coronary heart disease, diabetes. Preoperative visual acuity was light perception to 4/20, visual acuity at the last postoperative examination after a mean follow-up of 41.0 +/- 22.6 months ranged from light perception to 12/20. Risk-factors for expulsive hemorrhage were: previous ocular surgery (two patients), primary open angle glaucoma (two patients), coronary heart disease (one patient) und asthma bronchiale (one patient). One of the patients awoke from general anesthesia during the "open-sky" situation. Preoperative visual acuity was light perception to 2/400, visual acuity at the last postoperative examination (mean follow-up 14.0 +/- 1.0 months) was light perception in all eyes. CONCLUSION: The incidence of an expulsive hemorrhage was 0.1% in 2412 Pks. Risk factors are ocular and internal predispositions which can hardly be controlled, although arterial blood pressure was not significantly elevated during opening of the globe.     

Outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion

OBJECTIVE: To investigate outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion (BRVO). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The medical records of all patients who underwent vitreoretinal surgery for complications of BRVO at Bascom Palmer Eye Institute between January 1, 1991 and December 31, 1998 were reviewed. Thirty-six eyes from 36 consecutive patients were identified. MAIN OUTCOME MEASURES: Visual acuity outcomes include preservation of preoperative visual acuity and visual acuity greater than or equal to 20/40, 20/200 and 5/200. When preoperative retinal detachment was present, the anatomic outcome assessed was complete retinal attachment. Postoperative event rates of retinal detachment, vitreous hemorrhage, epiretinal membrane (ERM), and cataract were tabulated. All outcomes were assessed at 6 months. RESULTS: Surgical indications included nonclearing vitreous hemorrhage (17 patients), traction retinal detachment involving the macula (15), and ERM (4). Mean follow-up was 19 months. Preoperatively, best-corrected vision was greater than or equal to 20/200 in 19/36 (53%) eyes. Six months postoperatively, best-corrected vision was greater than or equal to 20/40 in 12/36 (33%) eyes, greater than or equal to 20/200 in 27/36 (75%) eyes, and greater than or equal to 5/200 in 31/36 (86%) eyes. Postoperative complications included retinal detachment (2/36; 6% eyes), ERM (3; 8%), vitreous hemorrhage (2; 6%), suprachoroidal hemorrhage (1; 3%), central retinal vein occlusion (1; 3%), and central retinal artery occlusion (1; 3%). Clinical features associated with better visual outcome include better preoperative visual acuity (P: = 0.05), absence of preoperative afferent pupillary defect (P: = 0.01), and absence of preoperative macular edema (P: = 0.08). CONCLUSIONS: Following surgery, retinal attachment and improved visual acuity were achieved in the majority of patients. Pre-existing pathology and postoperative complications may limit final vision in eyes with BRVO.