人工晶体植入术后继发青光眼的临床分析

报告14例后房型人工晶体植入术后继发青光眼患者，男性8例，女性6例。均为单眼发病，其中10例发生在术后1个月以内，另4例发生在1～3年以后。其中开角型8例，闭用型6例。7例经抗青光眼药物治疗可控制眼压，4例用激光治疗，另3例需行抗青光眼手术。治疗前矫正视力达0．5以上者为28％，治疗后矫止视力达0．5以上增加至50％。所有病例均眼压控制良好、视力不良原因为青光眼世视神经萎缩，提示早期发现的重要性。     

联合抗青光眼手术治疗不易控制眼压青光眼的研究

采用板层下巩膜床双咬切、睫状体剥离合并睛状体上腔植入硅橡胶条的抗青光眼联合手术治疗不易控制眼压的青光眼46例52眼，其中继发性青光眼27眼，原发闭角青光眼10眼，原发开角青光眼6眼，先天、青少年型青光眼7眼，虹膜角膜内皮综合征2眼。手术总有效率达94％。本术式具有小梁切除、睫状体剥离、睫状体扁平部引流的功能。作者认为用硅橡胶条作植入物，比异体或自体组织作植入物更为理想。     

胆管残余结石的内镜治疗(附306例分析)

目的：探讨内镜治疗肝内外胆管残余结石的效果。方法：对1994年1月～2004年1月间306例胆道残余结石的治疗效果进行回顾性分析，采用十二指肠镜127例，胆道镜116例，经皮经肝胆道镜(PTCS)63例。结果：306例．1中有286例成功(93．46％)。十二指肠镜治疗127例成功125例；胆道镜经T管窦道治疗116例，成功109例；PTCS治疗肝内结石63例，成功52例。结论：内镜治疗肝内外胆道结石效果显著，可使绝大多数患者避免再次手术。     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

Moorfields回归分析及多变量区别分析诊断开角型青光眼

目的研究Moorfields回归分析(MRA)及多变量区别分析(MDA)的2个指标FSM和RB诊断开角型青光眼的能力,及MRA在视盘整体和视盘分区间的差异。方法对23例正常人(26眼)、26例可疑开角型青光眼患者(32眼)和21例开角型青光眼患者(21眼)进行HRT-Ⅱ和OCTOPUS视野计G2-TOP程序两项检查。结果视盘整体MRA、FSM、RB与视野缺损指数间相关系数分别为0.537、-0.565、-0.716(P<0.01),且3个组间差异均有统计学意义(P<0.01),随着视盘面积增大,MRA、FSM和RB特异性均下降。可疑组中视盘分区MRA与视野检查一致率均高于整体,一致率最高分区为颞下(78.13%)。各分区中MRA敏感性、特异性最高的分区为颞上和颞下。结论MRA和MDA检测开角型青光眼能力较强,且与视野检查间存在较好的相关性,但应用于大视盘分析时须谨慎下结论。     

Limbus-based versus Fornix-based conjunctival flap in filtering surgery

Summary A randomized prospective study was performed to compare the results of filtering surgery using a Limbusbased versus a Fornix-based conjunctival flap. The wound closure of the Fornix-based flap was performed using a running 10/0 nylon suture at the limbus. No statistical significant difference of IOP regulation was found between the two groups. There was a tendency of reduced occurrence of shallow anterior chamber and of less vascularized filtering blebs in the Fornix-based technique.     

复合小梁切除术治疗青光眼效果观察

目的观察复合小梁切除术治疗青光眼的疗效。方法用青光眼复合小梁切除术54例（54眼），观察术后眼压、滤过泡及前房形成情况，随访3～24个月。结果54眼分别于术后3～15d拆除可调整缝线，术后发生浅前房3眼，发生率5．56％，眼压在18mmHg以下者52眼，控制率96．30％。结论复合小梁切除术既可避免术后早期滤过过强、眼压过低引起的并发症，又可安全的改善滤过，减少滤过区瘢痕形成，提高手术成功率。     

青光眼术后早期眼内出血的原因分析

目的分析青光眼术后早期眼内出血的原因，以预防眼内出血的发生。方法对261例（共493只眼）手术治疗的青光眼病人进行回顾性分析。结果术后早期发生眼内出血者17例，共17眼（前房出血6例，眼底出血11例），年龄均在68岁以上。其中闭角型青光眼术前持续性高眼压14眼，新生血管性青光眼3眼；伴糖尿病者6例，伴高血压者5例。结论青光眼术后早期发生眼内出血的主要原因是术前顽固性高眼压。其次与高龄和是否伴有糖尿病、高血压有一定关系。     

Long-term effects of glaucoma therapy with 4% pilocarpine gel on corneal clarity and endothelial cell density

Corneal thickness measurements and endothelial cell counts were carried out in 34 patients undergoing treatment for glaucoma with 4% pilocarpine gel between 18 to 78 months after initiation of therapy. The corneal thickness and endothelial cell population were found to be within normal limits in all cases except two, one patient with increased corneal thickness who had recently undergone cataract and glaucoma filtering surgery and another patient with decreased cell count who had an old endothelial scar sustained prior to pilocarpine gel therapy. There was a very close correlation for both of these parameters noticed in patients treated with pilocarpine gel and in age-matched control group of patients with glaucoma. The present study has shown that there are no adverse corneal effects with pilocarpine gel therapy.     

青光眼病人视野改变与行走速度的相关性研究

目的探讨青光眼病人的视野改变是否影响其行走速度。方法测量 71例青光眼病人的视野和走完一段规定路程所需时间 ,并与相同视力、年龄和性别的正常人进行对比。结果青光眼病人走完规定路程所需时间比正常人多 15 % ;早期青光眼组视野较正常组下降 (P <0 .0 5 ) ,而在行走时间上差异无显著性意义 (P >0 .0 5 ) ;中晚期青光眼组视野较正常组显著下降、行走时间明显增加 (均P <0 .0 1) ,且视野下降程度与所需时间呈显著正相关 (r =0 .78,P <0 .0 1)。结论中晚期青光眼病人的视野缺损可导致行走速度减慢 ,提示对该类病人就诊时要耐心、细致地加以引导 ,在日常生活中给予理解、关怀