选择性透明角膜切口对白内障超声乳化术后角膜散光的影响

目的:探讨根据患者术前角膜散光差异,在不同部位选择性预设散光轴透明角膜切口行白内障超声乳化联合后房型折叠式人工晶状体植入术,对术后患者角膜散光的影响。方法:收集老年性白内障患者96例112眼,随机分为三组:A组颞侧透明角膜切口,34例39眼;B组11:00位透明角膜切口,26例31眼;C组角膜曲率引导下于角膜屈光力最大轴向上行个体化高选择性透明角膜切口,36例42眼。结果:术前、术后1wk,3组裸眼视力的差异无统计学意义(P>0.05);而术后1,3mo,C组裸眼视力显著优于A,B组(均P<0.05),而A组与B组间差异无统计学意义(P>0.05)。C组在术后1,3mo的角膜散光度显著小于A,B组(P<0.05)。结论:角膜曲率引导下行位于角膜屈光力最大轴方向切口,对白内障超声乳化术后角膜散光影响最小,并有利于患者术后视力较快恢复,有效控制术后术源性角膜散光,进一步提高患者术后视力。     

带状疱疹合并麻痹性不完全性肠梗阻案

患者,男,88岁,于2020年10月19日就诊.主诉:左下肢带状疱疹12 d.现病史:2020年10月8日出现左下肢皮肤灼痛,10月15日出现皮肤疱疹,次日于北京某医院皮肤科诊断为"带状疱疹、神经痛",予口服盐酸伐昔洛韦片抗病毒,维生素B1、甲钴胺片营养神经,普瑞巴林胶囊止痛;外用复方多粘菌素B软膏预防皮肤感染;吉法酯...     

玻璃体腔注射康柏西普联合小梁切除术及全视网膜光凝治疗新生血管性青光眼

目的：探究玻璃体腔注射康柏西普联合手术及全视网膜光凝治疗新生血管性青光眼(neovascular glaucoma,NVG)的临床疗效。

方法：本组探究对象选择2014-06/2016-06于我院治疗的新生血管性青光眼患者90例,对所有患者的病历资料进行回顾性分析,将采用小梁切除术及全视网膜光凝治疗的42例患者设为对照组,在此基础上术前5～7d加用玻璃体腔注射康柏西普的48例患者设为观察组。比较两组患者治疗前、治疗后1wk,1、3、6mo最佳矫正视力(转换成标准对数视力),各时期通过非接触式眼压计测量眼压,采用前房角镜检查虹膜及房角新生血管消退情况,结合眼压等判断综合疗效,记录术后并发症发生情况。

结果：两组治疗前后视力比较差异显著,组间比较观察组术后1mo显著高于对照组,差异有统计学意义(P<0.05),术后1wk,3、6mo无显著性差异(P>0.05); 两组治疗前后眼压比较差异显著,组间比较观察组术后1wk,1、3、6mo显著低于对照组,差异有统计学意义(P<0.05); 观察组综合治愈率为77%,显著高于对照组(64%),差异有统计学意义(P<0.05); 观察组前房出血、浅前房发生率显著低于对照组,差异有统计学意义(P<0.05); 低眼压黄斑性病变发生率无显著性差异(P>0.05); 观察组术后6mo新生血管复发率显著低于对照组,差异有统计学意义(P<0.05)。

结论：新生血管性青光眼在全视网膜光凝治疗术前5～7d加用玻璃体腔注射康柏西普能显著降低眼压,不同程度改善视力,综合治愈率更高。     

玻璃体腔注射UK联合TA治疗玻璃体积血的疗效观察

目的:观察玻璃体腔注射尿激酶(urokinase,UK)联合曲安奈德(triamcinoloneacetonide,TA)治疗玻璃体积血的疗效和安全性。方法:回顾性分析2009-04/2011-02就诊于我院眼科,确诊为玻璃体积血的患者52例52眼,年龄29～65(平均54.2)岁,给予玻璃体腔注射尿激酶1万U(0.1mL)+TA4mg(0.1mL),治疗前后检查视力、眼压和眼底改变。所有患者随访时间超过3mo,其中14例超过16mo。结果:治疗前患眼视力均为手动～0.02,治疗有效37例(71%),其中视网膜静脉阻塞引起出血28例,治疗有效26例。糖尿病性视网膜病变引起出血20例,治疗有效9例。视网膜静脉周围炎引起出血4例,治疗有效2例。效果最佳者视力由治疗前手动提高至1.0,为视网膜静脉阻塞引起玻璃体积血患者,15例治疗后视力无变化,无视力下降者。结论:玻璃体腔注射尿激酶联合TA治疗玻璃体积血,尤其是视网膜静脉阻塞引起的玻璃体积血安全有效,值得推广。     

显微镜下泪小管断裂吻合术的临床分析

目的 探讨创伤性泪小管断裂的手术治疗方法.方法 在显微镜下寻找泪小管断端并置入硬膜外麻醉导管于泪小管及鼻泪管,吻合断裂泪小管.结果 随访6个月-1年,84例患者一次治愈81例(96.4%).1例手术后第1天因麻醉导管置入位置异常,再次手术治愈,1例好转,1例未愈.80例置入麻醉导管到鼻泪管,4例置入于上下泪小管,其中2例用丝线作为支撑物.结论 在手术显微镜下应用硬膜外麻醉导管治疗创伤性泪小管断裂方便、快捷,成功率高.     

桐泽性葡萄膜炎1例

0引言 急性视网膜坏死是严重累及视网膜,损害视力能导致失明的眼科疾病.临床并不多见,本例同时合并高眼压更为少见.本文报道1例单眼急性视网膜坏死,就其发病原因、病情演变及并发症进行简要的分析总结.     

白内障超声乳化术中后囊破裂原因分析及其对视力的影响

目的:总结分析白内障超声乳化术中后囊破裂的原因及其对视力的影响,以便采取预防措施。方法:选择200例220眼年龄相关性白内障患者,常规实行白内障超声乳化联合人工晶状体植入术。结果:术中发生后囊破裂21眼(9.5%),其中发生于水分离时1眼(0.5%),超声乳化时15眼(6.8%),注吸皮质时3眼(1.3%),植入人工晶状体时2眼(0.9%)。结论:白内障超声乳化中后囊破裂与患者状况、术者的操作技术及经验密切相关,其发生直接影响术后患者的视力恢复,及时发现并妥善处理是提高手术效果的关键。     

超声乳化联合IOL植入治疗晶状体溶解性青光眼的临床研究

目的:研究超声乳化联合人工晶状体植入治疗晶状体溶解性青光眼的治疗效果。方法:对32例32眼过熟期白内障继发晶状体溶解性青光眼患者,采用超声乳化联合人工晶状体植入给予治疗,对视力及眼压情况进行观察和研究。结果:术后随访0.5a,眼压均控制到正常范围内,视力有不同程度提高。结论:通过临床观察证明单纯超声乳化联合人工晶状体植入治疗晶状体溶解性青光眼安全有效,且手术切口小,组织损伤小,术后反应较轻,可有效控制眼压,恢复视功能。     

针刺治疗慢性鼻窦炎及术后疼痛的网状Meta分析

BackgroundThe network meta-analysis system was used to evaluate the efficacy of various acupuncture and moxibustion techniques for chronic rhinosinusitis (CRS) and related postoperative pain.MethodsAn electronic search of PubMed, Embase, Web of Science, Cochrane Library, OVID(the Offshore Vessel Inspection Database), CNKI, Wanfang, VIP, and CBM databases was conducted to identify randomised controlled trials on acupuncture and moxibustion for CRS and related postoperative pain from database inception to February 2021.The study included randomised controlled trials (RCTs) published in China and other countries in languages limited to Chinese and English. Primary studies included treated individuals without limitations on age, gender, or nationality and diagnosed as CRS. The total effective rate, visual analogue scale (VAS) score, and symptom and sign score were the primary outcomes. Evidence quality and risk-of-bias were determined. Network meta-analysis was performed.ResultsNineteen articles were included, involving 11 types of intervention measures. The pairwise comparisons showed that both acupuncture therapy combined with drugs (ATD) and sphenopalatine ganglion acupuncture combined with drugs (SGAD) were superior to western medicine (WM) in improving the total effective rate, and ATD was superior to manual acupuncture therapy (MAT), WM, and placebo (PL). In reducing the VAS score, both ATD and SGAD were superior to WM. Point-through-point acupuncture combined with pricking blood therapy (PABT) was superior to MAT. In reducing symptom and sign score, ATD was superior to WM and PL. PABT was superior to MAT. The results of network meta-analysis showed that ATD was superior to MAT, Traditional Chinese medicine (TCM), and WM in improving the total effective rate. In reducing the symptom and sign score, ATD was superior to PL, WM, MAT, and sham acupuncture (SA). PL was superior to MAT, WM, and SA. and PABT was superior to MAT and SA, MAT was superior to WM. There was no significant difference between the intervention measures in reducing the VAS score. The surface under the cumulative ranking curve showed that ATD had the best effect in improving the total effective rate and reducing the VAS and symptom and sign score.ConclusionATD was the best method for improving the total effective rate and reducing the VAS and symptom and sign score in the treatment of CRS and related postoperative pain. However, considering the current study quantity and quality, multicentre and high-quality clinical studies with larger sample sizes are needed to verify our findings.Trial registrationInternational Prospective Register of Systematic Reviews(CRD42021246103).