薄壁囊状滤过泡的结膜瓣加固术

目的　探讨改良转移结膜瓣对矫正青光眼小梁切除术后薄壁囊状滤过泡的临床效果。方法　剪开滤过泡周围的结膜（保留原滤过泡）,游离转移上方或颞侧球结膜-筋膜组织,加固覆盖于经局部冷冻的变性囊状泡表面,转移结膜瓣的前缘固定缝合于周边角膜的槽状浅沟内。转移结膜瓣不够松弛时,在穹窿部做一减张性球结膜-筋膜组织切开。结果　46例（52只眼）术后随访6个月至4年,平均眼压由术前（4.25±1.33）mmHg（1mmHg=0.133kPa）提高至术后（12.98±5.70）mmHg,差异有显著性（t=3.26,P<0.01）。51只眼仍保留滤过功能,20只眼的结膜渗漏和6只眼的黄斑水肿消失,术后视力较术前有明显改善（χ     

改良青光眼合并白内障的联合术式临床分析

目的探讨改良白内障超声乳化人工晶体植入联合隧道内小梁切除术、手法小切口白内障摘除人工晶体植入联合隧道内小梁切除术,治疗原发性闭角型青光眼合并白内障的两种术式效果。方法原发性闭角型青光眼合并白内障共62例,分为甲乙两组。甲组37例,采用手法小切口白内障摘除后房型人工晶体植入联合隧道内小梁切除术。乙组25例,采用白内障超声乳化后房型人工晶体植入联合隧道内小梁切除术。两种术式均不做巩膜瓣及虹膜周切孔。结果术后随访12个月,视力(0.3占72.95%,眼压62只眼(18.2±1.76mmHg。结论两种术式在术后眼压控制、视力改善、并发症方面均无明显差异。     

经角膜缘结膜切口小梁切除术

小梁切除术降眼压机理主要是外引流,故泸枕形成的好坏是手术成败的重要标志。结膜瓣的制备直接影响泸枕的形成。本文总结29例41眼经角膜缘切口小梁切除术,与对照组比较,具有损伤轻、愈合快、泸枕形成好、手术野清晰、简便、省时、效果可靠等优点。     

Measurement and analysis of visual acuity in multicenter randomized clinical trials in the United States: Findings from a survey

Purpose To describe visual acuity (VA) testing and scoring methods used in multicenter randomized clinical trials in ophthalmology in the United States (USA) sponsored by the National Eye Institute (NEI). Methods A survey was conducted among multicenter studies in the US that included one or more randomized clinical trials and were sponsored by the NEI, National Institutes of Health. To be included in the survey, a study had to have VA reported in one or more publications or patient eligibility based on VA, a majority of study subjects 13 years of age or older, and a patient population primarily or exclusively from the US. A standard survey form was completed for each study based on information presented in the study manual of procedures and publications. Findings were summarized and displayed with frequency distributions. Results The survey included 24 studies, each with enrollment initiated in the period 1972 to 1999.VA was one of the study eligibility criteria for 19 (79%) studies, and VA or change in VA was the primary outcome in 12 (50%) studies. ETDRS charts have been employed in 16 of 19 studies initiated after the charts were published in 1982. All studies but one specified in the documents reviewed that VA testing was performed at multiple VA test distances. For studies that used ETDRS charts, methods of converting VA scores obtained at different test distances to a common scale fell into two categories: 11 studies used a method similar in nature to that first reported in the Macular Photocoagulation Study, and 7 studies used a method similar in nature to that first reported in the Krypton-Argon Regression of Neovascularization Study. Conclusion The development of the ETDRS charts and a custom light box has led to more uniformity in VA test charts and chart illumination. However, details of VA measurement protocols vary widely from study to study. To assure comparable data across studies and ocular conditions, it would be useful to have a standard VA testing and scoring protocol with provisions for testing different levels of visual acuity that recommends a single method for converting scores from different test distances to a common scale and standard conversion of “off the chart”VA levels for calculation of means and changes in VA.     

小梁切除术后持续性浅前房的发生与眼解剖因素相关性分析

目的 探讨部分眼解剖因素与青光眼小梁切除术后并发持续性浅前房之间的关系.方法 术前A超测量拟接受小梁切除手术的原发性闭角型青光眼患者的中央前房深度(D)、晶状体厚度(L)和眼轴长度(A),并计算前房深度和轴长的积与晶状体厚度的比值(D×ML).根据Spaeth分类法和术后前房的形成时间,如患者Ⅲ度浅前房持续1d以上,Ⅱ度浅前房持续5～7d以上需手术介入者,归入浅前房组;其他患者术后前房在7d之内恢复正常者则归入正常组,统计分析两组上述参数的差异.结果 浅前房组的眼轴长度较正常组短(P<0.01),而中央前房深度较正常组深(P<0.05).晶状体厚度较正常组薄(P<0.01),参数D×A/L两组则差异无统计学意义(P>0.05).结论 在上述原发性闭角型青光眼的危险因素中,只有眼轴长度短与持续性浅前房的发生有关,提示术前进行眼轴长度的测量可部分预测小梁切除术后持续性浅前房的发生.     

人羊膜与丝裂霉素C用于青光眼小梁切除术的临床对比研究

目的 :探讨羊膜与丝裂霉素C (MMC)应用于小梁切除术的临床疗效。方法 :采用随机对照的方法 ,施行同一标准的小梁切除术 ,将 2 6例 (4 2眼 )闭角型青光眼患者分为羊膜组和MMC组各 2 1眼。前者施行小梁切除术联合巩膜瓣下羊膜植入术 ,后者在术中一次性应用MMC ,浓度为 0 2 5mg/ml ,共 5分钟。随访 6个月。结果 :手术成功率 :羊膜组的累积完全成功率和条件成功率分别为 86 2 3 %和 96 68% ,MMC组的累积完全成功率和条件成功率分别为 5 8 79%和 79 5 6% (P <0 0 1)。功能性滤过泡的累积存活率羊膜组为 86 2 6% ,MMC组为 5 1 3 3 % ,两组之间有显著性差异 (P <0 0 1)。术后视力 :MMC组术后视力下降者 10眼 (4 7 6% ) ,羊膜组则只有 2眼 (11 8% )。两组间差异有显著性 (P <0 0 5 )。并后并发症 :羊膜对眼部的副作用小 ,引起的并发症主要有术后浅前房 ;MMC引起的眼部并发症主要有薄壁滤过泡、术后浅前房、滤过泡渗漏、前房出血、持续性低眼压、低眼压性黄斑病变等。结论 :羊膜应用于小梁切除术可有效地防止滤过泡的瘢痕组织形成 ,并能有效长期保留功能性滤泡 ,且并发症较MMC少     

复合式小梁切除术的疗效观察

目的观察复合式小梁切除术治疗难治性青光眼及原发性青光眼的疗效.方法对1998年7月至2000年5月收治的难治性青光眼、晚期原发性开角型青光眼、前房极浅或疑有恶性青光眼倾向的原发性闭角型青光眼38例(38只眼)进行复合式小梁切除术.术后根据眼压水平、滤过泡形态及前房情况适时拆除巩膜瓣缝线.定期随访患者平均14±2.9个月.内容包括眼压、视力、滤过泡、前房、晶状体及眼底.结果 6只眼术后因眼压控制良好未作缝线拆除;32只眼分别于术后3～31天拆线,拆线时间平均12.1±7.9天,拆线后眼压平均下降10.1±5.4mmHg.患者术后一周平均眼压13.7±5.9mmHg,与术前平均眼压26.6±10.1mmHg相比,差异有非常显著性.术后12个月末时眼压≤21mmHg者32只眼(84.2%),其中28只眼眼压≤15mrnHg.12个月末时功能性滤过泡的累积存活率为80.1±5.4%.术后33只眼呈中度或深前房;4只眼术后第一天前房浅I度,经药物治疗前房逐渐加深;1只眼因伴发脉络膜脱离发生Ⅲ度浅前房.并发症有前房积血4只眼,脉络膜脱离1只眼,无血管的薄壁微囊样滤过泡1只眼,持续性低眼压2只眼,低眼压性黄斑病变1只眼.结论复合式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、提高手术成功率.     

原发性开角型青光眼早期小梁切除术治疗的临床观察

观察原发性开角型青光眼早期小梁切除术的远期效果。方法随访５年以上的ＰＯＡＧ早期手术治疗民药物治疗一年以上再手术的对照组，就眼压，视野改变进行比较分析。     

巩膜瓣下深层纵形小梁切除术的超声生物显微镜观察

目的通过超声生物显微镜(UBM)观察巩膜瓣下深层纵形小梁切除术后的房角情况并探讨其术式的降眼压机制。方法采用巩膜瓣下深层纵形小梁切除术对患各种不同类型青光眼的85名患者进行手术治疗,在术后检查以及其后的随访期间使用加拿大OTI Scan1000型超声生物显微镜观察其术眼并监测眼压,随访时间3~30个月,平均(7.9±6.2)个月。结果UBM观察术后均形成明显弥散性滤过泡,平均眼压(14.22±3.62)mmHg。随访过程中,54眼有功能性滤泡;16眼术后2~3个月功能性滤过泡消失。结论UBM检查能直观地了解巩膜瓣下深层纵形小梁切除术后的眼前段状态,并能对该手术的降眼压效果及术后远期疗效作出评估。     

青光眼小梁切除术后浅前房的分析

目的分析青光眼小梁切除术后浅前房的原因和处理方法。方法我院近5年来134例（150眼）青光眼患者，行小梁切除手术，术后观察浅前房的发生并给予相应处理。结果150眼中12眼发生浅前房，占8％。滤过道引流过畅，缝线松脱、房水渗漏，恶性青光眼是术后浅前房发生的主要原因。术后对并发症相应处理后，12眼发生浅前房均恢复正常。结论青光眼小梁切除术术前、术后有效地控制眼压，术中保持前房深度，注意伤口缝线的松紧，术后观察眼压及前房的变化，及时对症处理并发症能取得较好效果。