中西医结合治疗外伤眼病

中西医结合治疗外伤眼病哈尔滨电缆厂职工医院（１５００２０）刘玉兰哈尔滨市眼科医院赵桂芝近几年来，我们采用中西医结合的方法对５０例外伤引起的眼病进行了临床治疗和疗效观察，由于效果显著，此种治疗方法已成为我们临床的常规治疗，现将５０例５０只眼的治疗情况介...     

水牛角在血证眼病中应用举偶

水牛角在血证眼病中应用举偶浙江省海宁市中医院眼科（３１４４００）周腾芳犀角是中医眼科临床要药，对各种热性眼病有明显疗效，但因价格昂贵且药源紧张，临床使用受到限制。我科近年应用水牛角代替犀角作为主药，并辅以生地、丹皮、玄参、竹叶、赤芍等治疗热性血证眼病...     

综合疗法治疗眼轮匝肌痉挛疗效观察

目的:研究综合疗法治疗眼轮匝肌痉挛的治疗方法及疗效.方法:原发外眼病的治疗、心理治疗、针灸治疗(新明Ⅱ穴、鱼腰透阳白、承泣透四白穴,重者加印堂,1次/d)全身及局部药物治疗.综合治疗眼轮匝肌痉挛.结果:采取上述综合疗法,治疗眼轮匝肌痉挛124例247眼.针灸6次(1wk),症状消失者96例192眼,占77 4%;24例48眼针灸12次(2wk),总治愈率96.8%;4例8眼症状缓解,0.5mo后眼轮匝肌痉挛症状再现,再次治疗1wk,症状无明显改善.无效3.2%.结论:综合疗法及个体化治疗眼轮匝肌痉挛,是目前治疗眼轮匝肌痉挛安全、有效的方法.     

Graves眼病治疗途径的现况及展望

摘要Graves眼病又叫甲状腺相关眼病，浸润性突眼，是自身免疫性甲状腺病的眼部表现，尤其是与Graves甲亢有关，发病率占甲亢的5％～10％，男性多于女性。对该病的治疗尽管已经取得一些进展，但是仍然十分棘手，尚不能取得完全的功能和外观的改善。严重Graves眼病的治疗更是一个临床难题，因此人们不断研究新的治疗方法，希望攻克Graves眼病这一课题。本文对甲状腺相关眼病的治疗途径和个体化治疗的现状做简要综述，并展望Graves眼病治疗的发展趋势。     

熏蒸法治疗眼病疗效观察

熏蒸法治疗眼病疗效观察上海市中医医院眼科（２０００７１）李洁，刘崇晏中药蒸洗法治疗眼病由来已久，此法不同于单纯的热敷法，因此用中药不论是香散闻名的麝香、冰片、藿香、乳香、薄荷等药，还是普通中药，如人参、当归、川芎等，以鼻闻之均有气味散发。如果煎以热汤...     

超声波雾化治疗角膜病的临床观察

角膜病是眼科常见病，也是致盲眼病之一。角膜自身无血管，营养供应条件不及其他器官，易发生感染。虽然治疗方法多，但疗效不理想。我科至2003年以来采用超声雾化法熏蒸眼部起到较好疗效，现报告如下。[第一段]     

玻璃体腔注射抗VEGF药物治疗早产儿视网膜病变的研究进展

早产儿视网膜病变(ROP)是发生于早产儿的一种未成熟视网膜血管增殖性眼病，是一种严重的儿童致盲性眼病。视网膜激光光凝术是治疗ROP的经典方法，然而激光治疗是破坏性的，尤其是在ROP Ⅰ区病变的情况下，视网膜激光光凝治疗会引起严重的并发症。研究表明，血管内皮细胞生长因子(VEGF)在ROP发生及发展过程中具有关键作用，而玻璃体腔注射抗VEGF药物不仅能有效控制ROP，并且为视网膜继续发育争取了机会。本文就玻璃体腔内注射抗VEGF药物治疗ROP的治疗指征、药物筛选、注射部位、给药剂量、疗效观察以及并发症对其进行综述。     

高度近视儿童弱视25例临床观察

弱视是儿童常见的眼病，屈光不正是造成弱视的重要原因之一。早期诊断、早期治疗对提高临床疗效具有重要意义。我院对25例高度近视造成的弱视儿童进行治疗，取得一定效果，现总结报告如下。     

活血化瘀治疗挫伤性出血性眼病

活血化瘀治疗挫伤性出血性眼病福建福州市中西医结合医院眼科（３５０００７）刘新挫伤性眼部出血是眼外伤常见的疾病。近年来，我们对１７例挫伤性出血性眼病在止血治疗的同时，应用中药活血化瘀治疗疗效较好，现报告如下。临床资料１一般资料：资料选自１９９４年以来笔...     

中药外洗湿敷法治疗儿童溃疡性睑缘炎

中药外洗湿敷法治疗儿童溃疡性睑缘炎河北省献县人民医院（０６２２５０）白国际，崔景岐溃疡性睑缘炎是儿童易患的一种常见外眼病，病多反复，顽固难愈，我们自１９８３年开始采用中药外洗湿敷法治疗１１３例，疗效满意，现报告如下：临床资料：本组１１３例，男性４９例...     

电针对负透镜诱导型近视豚鼠视网膜M1受体表达的影响

目的　探讨电针对负透镜诱导型近视豚鼠视网膜中毒蕈碱样乙酰胆碱Ｍ１受体表达的影响。方法　４８只３周龄豚鼠随机分为４组:正常对照组、近视模型组、近视电针组与近视假穴组,后３组豚鼠右眼配戴－１０．００Ｄ透镜片,建立透镜诱导型近视豚鼠动物模型,近视电针组戴镜同时给予针刺豚鼠的合谷穴和太阳穴,近视假穴组针刺臀部无穴位处。于造模前及造模后４周测量各组眼轴长度和屈光度,同时取视网膜组织,利用ＲＴ-ＰＣＲ的方法检测各组豚鼠视网膜中Ｍ１受体ｍＲＮＡ的相对表达量,ＥＬＩＳＡ法检测Ｍ１受体的蛋白含量。结果　造模４周后,近视模型组右眼屈光度为（－３．４０±０．５５）Ｄ,明显低于正常对照组右眼的（１．２０±０．２４）Ｄ和自身对照眼左眼的屈光度（１．２５±０．３２）Ｄ（均为Ｐ＜０．０５）;近视模型组右眼眼轴长度为（８．７４±０．３８）ｍｍ,明显大于正常对照组的右眼眼轴长度（８．２３±０．２１）ｍｍ,也大于自身对照眼左眼的眼轴长度（８．１６±０．４３）ｍｍ（均为Ｐ＜０．０５）;近视模型组、近视电针组和近视假穴组右眼的眼轴长度和屈光度比较差异均无统计学意义（均为Ｐ＞０．０５）。正常对照组、近视模型组、近视电针组、近视假穴组视网膜中Ｍ１受体的ｍＲＮＡ相对表达量分别为５９．１７±４．０２、７４．５０±４．６４、６４．８３±６．０５和７４．６７±３．９３,Ｍ１受体蛋白含量分别为（９８４．６７±４４．６９）ｎｇ·Ｌ－１、（１１７２．００±４１．９１）ｎｇ·Ｌ－１、（１０２７．００±４１．０８）ｎｇ·Ｌ－１和（１１５３．５０±５６．４０）ｎｇ·Ｌ－１,统计学分析显示正常对照组与近视电针组相比差异无统计学意义（Ｐ＞０．０５）,两组分别与近视模型组和近视假穴组相比差异均有统计学意义（均为Ｐ＜０．０５）。结论　负透镜诱导型近视豚鼠视网膜中Ｍ１受体表达增高,针刺合谷穴和太阳穴可以减少其视网膜中Ｍ１受体表达,这可能是针刺改善近视患者远视力的机制之一。     

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy

PURPOSE: To evaluate the long-term intraocular pressure (IOP) control of eyes that developed an encapsulated bleb (EB) following trabeculectomy. METHODS: Between 1994 and 1995, 25 eyes developed EBs and were randomized to medical treatment or needling without adjunct antimetabolites. Among the 25 patients who developed an EB, 21 were followed for at least 6 months. A control group of 21 consecutive eyes, which underwent trabeculectomy during the same period and that did not develop EBs was retrospectively selected. Success was defined as IOP <21 mmHg with or without medications. Kaplan-Meier survival analysis was performed to compare the groups. RESULTS: Among the 21 eyes that developed EBs, 12 (57%) had undergone transconjunctival needling and nine (43%) had received medical treatment. Mean follow-ups were 30.0 +/- 14.0 months, 33.3 +/- 18.5 months, and 37.4 +/- 2.6 months for the needling, medical treatment, and control groups, respectively (P = 0.19). Kaplan-Meier survival curves demonstrated that the control group showed a significantly lower chance of failure than both the needling and the medical treatment groups (P < 0.0001). CONCLUSION: Encapsulated blebs may be associated with an increased risk for surgical failure.     

Reported effects of non‐traditional treatments and complementary and alternative medicine by retinitis pigmentosa patients

Background: Benefits of complementary and alternative medicine (CAM)‐related interventions have been demonstrated for patients with chronic, systemic diseases in which stress, anxiety and disability are prevalent. Subjects with retinitis pigmentosa (RP) commonly indicate that they have ‘good’ and ‘bad’ vision days, stating that stress causes a decrease in vision and that vision improves when the stress is alleviated. We assessed CAM use by RP patients and its perceived effectiveness. Methods: We enquired about nine CAM areas: meditation, mind‐body therapies, yoga, movement therapies, energy therapies, acupuncture, massage therapy, spirituality/religion and herbal therapies/aromatherapy. Ninety‐six RP patients with any level of vision completed an anonymous internet survey. Results: Ninety‐five per cent of respondents tried at least one of the nine CAM areas. Seventy‐five per cent have used nutritional supplements, including lutein (47 per cent), bilberry (32), vitamin A palmitate (36) and docosahexaenoic acid (23 per cent). Some tried meditation (47) and yoga (31 per cent). Stress and anxiety levels were reported as improved in 93, 92 and 87 per cent of those who used yoga, meditation and mind‐body therapies, respectively. Many of those who tried mind‐body therapies (40) or acupuncture (50 per cent), used it with a desire to fight RP. Vision was subjectively affected in 65 per cent of acupuncture users and from 20 to 35 per cent of the users of the other CAM areas. Those who indicated that their vision was affected by at least one type of CAM (35 per cent) were statistically significantly more likely to require magnification to read (that is, they had lost more vision and RP had progressed), than those who did not believe vision was impacted (59 versus 84 per cent). Conclusions: RP patients are using CAM and are experiencing some impact on vision and physical/emotional well‐being. Clinicians and researchers should be aware of its use. Clinical trials with CAM interventions are necessary to attempt to validate these findings.     

Restoring the function of the failed bleb

Failure of the filtering bleb after trabeculectomy with a gonioscopically patent drainage cleft is likely to be due to: encapsulation of the bleb; flattening of the bleb; or cystoid bleb. Encapsulated blebs and flattened blebs are usually associated with a high intraocular pressure (IOP) while cystoid blebs are not, but corneal ulceration due to the prominent cystoid bleb may make revision of the bleb necessary. If the IOP is raised it is best to proceed quickly to needling of the bleb using 5-fluorouracil. Sixteen patients underwent needling of the bleb, eight with encapsulated, six flattened and two cystoid blebs. Chronic open-angle glaucoma (10 cases) was the commonest glaucoma. Twelve patients obtained satisfactory control of IOP with mean pre-needling IOP for encapsulated blebs of 32 mmHg (4.27 kPa), flattened blebs 36 mmHg (4.8 kPa) and cystoid blebs 16 mmHg (2.13 kPa), while post-needling IOP for encapsulated blebs was 12 mmHg (1.6 kPa), flattened blebs 13 mmHg (1.73 kPa) and cystoid blebs 12 mmHg (1.6 kPa). Mean follow-up for encapsulated blebs was 15, flattened blebs 11 and for cystoid blebs nine months. Mean time between trabeculectomy and needling was: for encapsulated blebs 16 days; flattened blebs 24 days; and cystoid blebs 19 months.     

Restoring the function of the failed bleb

Failure of the filtering bleb after trabeculectomy with a gonioscopically patent drainage cleft is likely to be due to: encapsulation of the bleb; flattening of the bleb; or cystoid bleb. Encapsulated blebs and flattened blebs are usually associated with a high intraocular pressure (IOP) while cystoid blebs are not, but corneal ulceration due to the prominent cystoid bleb may make revision of the bleb necessary. If the IOP is raised it is best to proceed quickly to needling of the bleb using 5-fluorouracil. Sixteen patients underwent needling of the bleb, eight with encapsulated, six flattened and two cystoid blebs. Chronic open-angle glaucoma (10 cases) was the commonest glaucoma. Twelve patients obtained satisfactory control of IOP with mean pre-needling IOP for encapsulated blebs of 32 mmHg (4.27 kPa), flattened blebs 36 mmHg (4.8 kPa) and cystoid blebs 16mmHg (2.13 kPa), while post-needling IOP for encapsulated blebs was 12 mmHg (1.6kPa), flattened blebs 13 mmHg (1.73 kPa) and cystoid blebs 12 mmHg (1.6 kPa). Mean follow-up for encapsulated blebs was 15, flattened blebs 11 and for cystoid blebs nine months. Mean time between trabeculectomy and needling was: for encapsulated blebs 16 days; flattened blebs 24 days; and cystoid blebs 19 months.     

Cataract surgery after needling revision of trabeculectomy blebs

PURPOSE: To assess the effect of cataract surgery on trabeculectomy blebs that have previously had successful needling revision. STUDY DESIGN: A retrospective controlled study. PATIENTS AND METHODS: A cohort of patients undergoing needling of a poorly functioning trabeculectomy bleb was collected. From this cohort a group having had a successful needling outcome who subsequently underwent uneventful phacoemulsification was identified. Each member of this phacoemulsification group was matched with 2 controls from the cohort who had also had success from needling but who had not undergone cataract surgery. Survival analysis was performed using the date of cataract surgery as the entry time for the phacoemulsification group. For controls the entry time was the date of needling adjusted by subtracting the time between needling and cataract surgery of the matched phacoemulsification group subject. In this way an identical period had elapsed between needling and entry time for both phacoemulsification group and controls. Survival depended on (a) intraocular pressure (IOP) < or =21 mm Hg and (b) IOP <80% of preneedling IOP, on the same or fewer glaucoma drops and without further glaucoma surgery. RESULTS: Forty-five patients were included. Intervals from trabeculectomy to needling, needling to phacoemulsification, and from phacoemulsification to final follow-up ranged from 1 to 320, 4 to 15, and 5 to 19 months, respectively. Mean survival for the phacoemulsification group was 34.4 weeks and 190.0 for controls [hazard ratio 8.1 (95% confidence interval: 2.8-23.9) (log rank P<0.0001)]. Survival at final follow-up was 4/15 and 25/30 for cases and controls, respectively (chi2 P=0.0002). CONCLUSIONS: Previously successful bleb needling can be significantly compromised by subsequent cataract surgery.     

Sub-Tenon’s anaesthesia for modern eye surgery—clinicians’ perspective, 30 years after re-introduction

Sub-Tenon’s block (STB) is a good technique of local anaesthesia for many types of eye surgery. It has a relatively good risk profile, in that sight- and life-threatening complications appear to be extremely rare. STB has gained popularity in the last three decades, with refinements including different types of blunt metal cannula, plastic cannulae and ‘incisionless’ approaches. Usage of STB varies significantly across the globe. This narrative review documents the historical evolution of STB techniques, anatomical and physiological considerations, its utility and suitability, complications, explores the current practice and possible future applications.Subject terms: Surgery, Eye diseases, Education     

A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.     

Risk factors for failure of 5-fluorouracil needling revision for failed conjunctival filtration blebs

PURPOSE: To investigate the risk factors for failure of 5-fluorouracil (5-FU) needling revision, a useful procedure for restoring a failed filtration bleb. DESIGN: Interventional case series.METHODS: Retrospectively conducted study. SETTING: Institutional. STUDY POPULATION: Sixty-four eyes of 64 consecutive glaucoma patients that underwent 5-FU needling revisions for failed filtering bleb following either trabeculectomy or phaco-trabeculectomy with or without adjunctive mitomycin C (MMC). OBSERVATION PROCEDURES: Goldmann applanation tonometry, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: Successful outcome of the initial 5-FU needling revision, arbitrarily defined as target intraocular pressure (IOP) control with not more than two topical glaucoma medications and no additional 5-FU needling or other surgical procedures, was analyzed by Kaplan-Meier survival analysis, and risk factors for failure of the initial 5-FU needling revision were analyzed by Cox proportional hazards regression analysis. RESULTS: The cumulative success rate of the initial 5-FU needling revision was 45% at 1 year, 33% at 2 years, and 28% at 4 years. Failure of the initial 5-FU revision correlated significantly with preneedling IOP > 30 mm Hg (P =.0003), lack of MMC use during the previous filtration surgery (P =.013), and IOP >10 mm Hg immediately following needling revision (P =.0012) according to Cox's proportional hazards regression analysis.CONCLUSIONS: Pre-needling IOP > 30 mm Hg, lack of MMC use during the previous filtration surgery, and IOP > 10 mm Hg immediately after needling were found to be significant risk factors for failure of the initial 5-FU needling procedure. Therefore, it is important to monitor IOP closely following needling revision in those patients with such risk factors. They are more likely to require additional therapeutic interventions, including repeat needling revisions.     

Optic nerve head circulation after intraocular pressure reduction achieved by trabeculectomy

OBJECTIVE: To study the effects of trabeculectomy and needling revision of poorly functioning blebs on the optic nerve head (ONH) circulation in patients with primary open-angle glaucoma (POAG). DESIGN: Prospective, nonrandomized, self-controlled trial. PARTICIPANTS: Nineteen POAG patients (age range, 52 +/- 12 years; mean +/- standard deviation) undergoing trabeculectomy and six POAG patients (age range, 62 +/- 14 years) undergoing needling revision of the bleb. METHODS: Using the laser speckle method, the normalized blur (NB) value, a quantitative index of blood velocity, was determined every 0.125 seconds and averaged more than three cardiac pulses in the optic nerve head (NB(ONH)). MAIN OUTCOME MEASURES: The NB(ONH) and intraocular pressure (IOP) in both eyes, and blood pressure (BP) and pulse rate (PR) were measured before and 2 days and 1, 4, and 8 weeks after trabeculectomy, and also before and 10 and 40 min after needling procedures. RESULTS: Intraocular pressure in the operated eye was significantly decreased after trabeculectomy or needling procedures, and the ocular perfusion pressure was significantly increased by a maximum of 38%. The IOP in the unoperated eye, BP, and PR did not significantly change. The NB(ONH) did not significantly change in either the operated or unoperated eye. CONCLUSIONS: Trabeculectomy and needling procedures induced little change in the ONH circulation.