改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响

目的：探讨抗青光眼药物毛果芸香碱和布林佐胺滴眼液及各自的防腐剂三氯叔丁醇和氯化苯甲烃胺（BAC）对兔眼表组织的影响。方法:选取新西兰大白兔15只，分为正常对照组（3只）、毛果芸香碱组（A组，6只）和布林佐胺组（B组，6只）。用药组右眼使用青光眼药物毛果芸香碱或布林佐胺滴眼液，左眼使用对应的防腐剂三氯叔丁醇或BAC，连续用药30 d。取球结膜组织行苏木素－伊红（HE）染色计数结膜上皮层炎症细胞数；角膜行扫描电镜检测并进行上皮损害分级评分。结果:与正常对照组比较，布林佐胺滴眼液（P<0.01）和防腐剂BAC（P<0.01）导致球结膜上皮层炎症细胞浸润增多；毛果芸香碱滴眼液（P>0.05）和三氯叔丁醇（P>0.05）引起的球结膜炎症细胞增多不明显。布林佐胺滴眼液导致球结膜炎症细胞增加的程度较毛果芸香碱滴眼液严重（P<0.01）。青光眼药物和防腐剂均可导致兔角膜上皮超微结构的损伤，表现为角膜上皮细胞六边形结构变为不规则、边界不清、细胞膜皱缩、细胞间距增宽、上皮细胞表面的微绒毛丢失、细胞空洞和暗细胞增加。布林佐胺滴眼液和BAC引起的角膜损害较毛果芸香碱滴眼液（P<0.01）和三氯叔丁醇明显（P<0.05）。各组左右两眼的球结膜炎症细胞数和角膜损害评分均无显著差异。结论:布林佐胺滴眼液和防腐剂BAC使用1个月后可导致兔球结膜炎症细胞增加和角膜上皮细胞损伤，毛果芸香碱滴眼液和三氯叔丁醇主要引起角膜上皮超微结构的变化；防腐剂是引起眼表损伤的主要原因。布林佐胺滴眼液对兔眼表的损伤较毛果芸香碱滴眼液严重。     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

三种仪器测量中央角膜厚度的比较

 [目的]探讨光学相干断层扫描仪（OCT）、超声波角膜测厚仪及OrbscanⅡ角膜地形图/角膜测厚系统（OrbscanⅡ系统）测量中央角膜厚度（CCT）的差异及测量的可重复性.[方法]分别用OCT、超声波角膜测厚仪和OrbscanⅡ系统测量近视患者34例（68只眼）的CCT并对测量值进行比较,用相关分析方法分析不同仪器间测量值的相关性;随机选择15例（30只眼）用三种仪器依次重复测量中央角膜厚度3次,采用方差分析方法分析3种仪器重复测量值的方差.[结果]OCT、超声波角膜测厚仪、OrbscanⅡ系统测得的CCT平均值分别为（515±33）μm、（535±35）μm和（534±44）μm,OCT的测量值比超声波角膜测厚仪与OrbscanⅡ的测量值小,差异有统计学意义（P值分别为0.004和0.003）,超声波角膜测厚仪与OrbscanⅡ的测量值差异无统计学意义（P=0.900）.OCT测量的CCT值与超声波角膜测厚仪（r=0.980,P＜0.001）和OrbscanⅡ系统（r=0.963,P＜0.001）测量的CCT值呈正相关.OCT、超声波角膜测厚仪、OrbscanⅡ系统CCT重复测量值的方差分别为（3.75±3.05）、（6.53±3.02）和（5.26±2.98）.OCT的方差与超声波角膜厚度测量仪比较差异有统计学意义（P=0.001）,与OrbscanⅡ系统比较差异无统计学意义（P=0.083）.[结论]OCT测量的CCT值最小;OCT与超声波角膜测厚仪和ObscanⅡ系统对CCT测量值的相关性较好;OCT测量CCT的可重复性较好,可以作为中央角膜厚度测量的工具.     

双眼自发性晶状体悬韧带松弛致继发闭角型青光眼一例

双眼自发晶状体悬韧带松弛,导致前房波动,进行性近视加重,继发闭角型青光眼的病例在临床比较少见。本病例报道了1例25岁女性双眼自发晶状体悬韧带松弛不伴有晶状体脱位及形态异常,出现双眼前房波动,近视加重,最终继发双眼闭角型青光眼。经过局部抗炎、散瞳处理和"PHACO IOL(Phacoemulsification intraocular lens)植入 前段玻璃体切除术"将IOL置于睫状沟后,患者眼压得到控制、视力基本矫正至正常。眼科学报2007;23:243-246.     

泪膜改变对Goldmann眼压测量值的影响

目的:探讨泪膜改变对Goldmann压平眼压计测量值的影响.方法:将68例(136只眼)受检者随机分为2组,每组34例.随机选择一只眼作为实验眼.另一只眼作为对照眼.A组的实验眼采用右旋糖苷70滴眼液滴眼,B组的实验眼采用粘弹剂Viscoat滴眼.采用Goldmann眼压计测量2次眼压,比较滴眼前、后测量值的差异.结果:A组对照眼第1、2次的眼压测量值分别为(14.44±2.68)mmHg(1 mmHg=0.133 KPa)、(14.47±2.69)mmHg,两次眼压测量值的差异无统计学意义(t=-0.329,P=0.744).实验眼滴右旋糖苷70滴眼液前、后的眼压测量值分别为(14.41±2.63)mmHg、(12.94±2.59)mmHg.两次眼压测量值的差异有统计学意义(t=13.949,P=0.000).B组对照眼第1、2次的眼压测量值分别为(14.29±2.96)mmHg、(14.35±3.12)mmHg,两次眼压测量值的差异无统计学意义(t=-0.466,P=0.644).实验眼滴Viscoat前、后的眼压测量值分别为(14.53±3.13)mmHg、(11.18±3.07)mmHg,两次眼压测量值的差异有统计学意义(t=22.126,P=0.000).两组的实验眼滴眼后的眼压均呈一致性的下降.结论:泪膜的改变可以使Goldmann压平眼压计的测量值产生偏差.     

单眼原发性急性闭角型青光眼的临床分析

目的 研究单侧眼发病的原发性急性闭角型青光眼患者的临床特点。方法 对14例确诊为单侧眼发病的原发性急性闭角型青光眼患者双眼的视力、眼压、前房深度、房角形态、屈光状况及眼球轴长等多种参数进行分析和比较。结果 双眼前房深度：发病眼前房轴深，最浅眼为1．4mm，最深眼为2．04mm，平均为1．89mm；周边前房深度均小于1／4CT或完全消失。未发病眼前房轴深，最浅眼为2．45mm，最深眼为3．62mm，平均为2．73mm；周边前房深度均大于1／3CT。双眼房角状态：发病眼全部为窄Ⅳ房角，并且都存在不同程度的粘连闭合。未发病眼均为窄Ⅰ至宽房角，无粘连闭合。双眼屈光状态：发病眼14只全部为远视，远视度数为 200至 450度；未发病眼中正视3眼，近视11眼，其近视度数为-320至-850度。双眼眼球轴长：发病眼眼轴最短的为20．8mm，最长的为22．5mm，平均为21．3mm；未发病眼眼轴最短的为23．4mm，最长31mm，平均为27．1mm。结论 前房浅、房角窄是原发性急性闭角型青光眼发病的解剖基础。并非所有的原发性急性闭角型青光眼患者都一定双眼发病，一只眼发生原发性急性闭角型青光眼，另一只眼若不存在前房浅、房角窄这一发病的解剖基础，则不会发生同样性质的青光眼。     

年龄对正常人视乳头结构的影响

目的 用HRT-Ⅱ系统测量我国不同年龄正常成人视乳头结构参数,探讨年龄对视乳头结构的影响.方法 选取2004～2007年在中山眼科中心就诊的正常人156例(20～80岁),20～40岁55例,41～60岁53例,61岁以上48例;各年龄段男女比例1∶1.随机选取一眼进行HRT-Ⅱ检查,获得视乳头地形图总体和局部参数.用单因素方差分析、Pearson相关分析、回归分析探讨年龄对视乳头结构总体和局部参数的影响.结果 年龄与视乳头总体平均视网膜神经纤维层厚度(mRNFL)、视网膜神经纤维层截面面积(RNFLA)的相关性有显著统计学意义(P<0.01).年龄对最大视杯深度(MxCD)、视乳头轮廓线高度变化(HVC)、视杯形态测量(CSM)的影响差异有统计学意义(P<0.05).视杯形态测量(CSM)与年龄正相关(r=0.241;P=0.002),平均视网膜神经纤维层厚度(mRNFL)、视网膜神经纤维层截面面积(RNFLA)、最大视杯深度(MxCD)与年龄呈负相关关系(r=-0.40～-0.31,P<0.01).年龄对这些参数的影响在视乳头不同部位有所不同.结论 年龄、视盘面积大小对视乳头地形图参数有一定影响.随着年龄的增加视网膜神经纤维层有变薄的趋势.在青光眼患者筛查及追踪随访时,视乳头地形图参数分析应考虑到年龄对视乳头的影响.     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

复方血栓通胶囊在眼科临床中的应用

复方血栓通胶囊是中山大学中山医学院与广东众生制药厂联合研制而成的纯中药制剂。其主要成分为三七、丹参和黄芪，具有活血化瘀、益气养阴的药理作用。本文拟就复方血栓通胶囊在眼科方面的临床应用作一叙述。