白内障超声乳化摘除联合不同术式治疗先天性白内障

目的观察白内障超声乳化摘除联合后囊膜连续环形撕囊及前段玻璃体切除术治疗先天性白内障的疗效。方法对59例(90只眼)3个月至25岁先天性白内障患者施行白内障超声乳化摘除(超过2岁者植入人工晶状体),其中34例(53只眼)联合后囊膜连续环形撕囊(Ⅰ组),25例(37只眼)联合后囊膜连续环形撕囊及前段玻璃体切除术(Ⅱ组)。随访6~48月,观察并比较两组视力及后囊膜混浊情况。结果手术后可进行视力检查的40例(60只眼)中,最佳矫正视力≥0.3者71.67%,Ⅰ组和Ⅱ组比较差异有显著性(P<0.05),Ⅱ组优于Ⅰ组。后囊膜混浊发生率两组间比较,Ⅰ组为18.87%,Ⅱ组为2.70%,Ⅱ组明显低于Ⅰ组。结论白内障超声乳化摘除联合后囊膜连续环形撕囊及前段玻璃体切除术治疗先天性白内障优于仅联合后囊膜连续环形撕囊术,可获透明视区,有效预防后发障的形成,同时植入人工晶状体者术后视力均有提高。     

儿童白内障摘除及人工晶体植入术

目的探讨儿童白内障摘除联合前段玻璃体切割及人工晶体植入的临床疗效.方法41例(59只眼)儿童先天性白内障及外伤性白内障施行现代囊外摘除联合前段玻璃体切割,对3岁以上儿童38例(53只眼)同期成功植入后房型人工晶体.结果3岁以上儿童术后裸眼视力≥0.3者先天性白内障25只眼(69.4%),外伤性白内障14只眼(82.4%).术后,先天性白内障1只眼发生后囊混浊;外伤性白内障3只眼轻度瞳孔上移,1只眼轻度晶体偏位.影响术后视力提高的主要原因是先天性白内障的重度弱视和外伤性白内障的角膜瘢痕.结论儿童白内障后囊膜切开联合前段玻璃体切割是防止术后并发障的有效方法.     

前段玻璃体切割在复杂眼外伤手术中的应用

目的探讨前段玻璃体切割术在复杂性眼前段、后段外伤手术中的效果。方法选择我院资料完整的眼外伤住院病例86例(86眼),均行前部玻璃体切割术。其中开放性眼球外伤53眼、钝挫伤性晶状体脱位19眼、外伤性白内障合并前后囊膜破裂伴玻璃体脱入前房14眼,均采用前段玻璃体切割器切除前房破碎的晶状体及脱出的玻璃体,或超声乳化联合前段玻璃体切割术。其中12眼合并后段病变行玻璃体视网膜手术联合C3F8气体或硅油填充术。术后随诊6~48个月(平均15个月)。结果 76眼较术前视力提高;57眼植入人工晶状体,其中54眼位置居中。开放性眼外伤53眼眼球破裂经Ⅰ期缝合、前段玻璃体切割处理,其中28眼Ⅱ期植入人工晶状体,矫正视力0.15~0.50;13眼未植入人工晶状体,矫正视力0.02~0.10;12眼经玻璃体视网膜手术处理后,视网膜复位,保留了眼球。晶状体脱位19眼、外伤性白内障合并后囊膜破裂伴玻璃体脱出14眼,术后矫正视力<0.1者2眼,0.1~0.3者7眼,0.3~0.5者10眼,0.5以上者14眼。结论前段玻璃体切割手术在处理复杂眼外伤有较好的效果,为人工晶状体植入或玻璃体视网膜手术创造条件。     

前段玻璃体切割联合后囊膜切开治疗先天性白内障的疗效分析

目的探讨先天性白内障手术中,前段玻璃体切割联合后囊膜切开的疗效。方法选取2005年3月-2008年5月我院收治的先天性白内障患儿46例（59只眼）,行超声乳化白内障吸出,后囊膜中央切开及前段玻璃体切割术。〉3岁的患儿均一期植入人工晶体,〈3岁的患儿采用二期植入人工晶体。术后随访二年以上。结果 59只眼中有4只眼（6.8%）在术后3月至2年出现后发性白内障。术后3个月复查最佳矫正视力：〈0.1者3只眼;0.1-0.3者10只眼;0.4-0.5者26只眼;0.6-0.8者13只眼;7只眼因年龄偏小不能配合检查。结论后囊膜切开联合前段玻璃体切割在先天性白内障手术中能有效预防后发性白内障的发生。     

儿童白内障后囊撕囊联合前玻璃体切除预防后囊浑浊

目的探讨后囊撕囊联合前段玻璃体切除术对小儿白内障术后后发障的预防。方法对58例（62眼）儿童白内障采用超声乳化后行后囊撕囊联合前段玻璃体切除,再行人工晶状体植入,术后随访2a以上。结果术后矫正视力〉0.3者59眼（95.16%）。随访显示56眼（90.32%）视轴区透明。结论后囊撕囊联合前玻璃体切除可预防儿童白内障术后后囊浑浊的发生。     

先天性白内障手术中后囊撕囊联合人工晶状体后囊嵌顿术的应用

目的探讨先天性白内障手术中后囊撕囊联合人工晶状体后囊嵌顿术的应用效果。方法对32例(36只眼)先天性白内障,手术中采用后囊连续环形撕囊联合人工晶状体光学区后囊口嵌顿术,术后随访24个月以上。结果 36只眼均将人工晶状体攀植入囊袋,光学区嵌顿于后囊口。术后矫正视力较术前均有提高,其中最佳矫正视力≥0.3者33只眼(91.7%),≥0.5者22只眼(61.1%)。后囊中央部混浊0级者27只眼(75.0%),1级者4只眼(11.1%),2级者3只眼(8.3%),3级者2只眼(5.6%),未出现4级混浊的病例。无眼底并发症。结论先天性白内障术中,行后囊环形撕囊联合人工晶状体光学区后囊嵌顿术,能有效阻止中央部后囊混浊的发生,有助于视功能的恢复。     

固定孔型囊袋张力环在大范围晶状体脱位白内障手术中的应用

目的 探讨固定孔型囊袋张力环在晶状体大范围脱位白内障手术中的应用价值.方法 对13例(14眼)白内障并伴有＞ 180°晶状体脱位患者行白内障手术,其中3例(3眼)玻璃体脱出前房者先行前部玻璃体切除后环形撕囊;8例(8眼)应用虹膜拉钩固定脱位处前囊.行晶状体超声乳化吸出或囊外摘出术,将囊袋张力环(CTR)固定孔穿过聚丙烯缝线固定于脱位侧巩膜上,抽吸晶状体皮质后植入折叠式人工晶状体.5例(6眼)同时行瞳孔成形术.结果 术后随访3 ～ 12个月,最佳矫正视力＜0.3者1眼(7.1％),0.3 ～0.5者4眼(28.6％),0.6～1.0者9眼(64.3％).术后散光明显减轻,与术前比较差异有统计学意义.UBM提示所有的人工晶状体均正位无偏斜.结论 对于晶状体大范围脱位者应用固定孔型囊袋张力环有利于囊袋完整及人工晶状体植入,防止人工晶状体偏位,获得良好的视力恢复.     

先天性白内障手术中双撕囊联合前段玻璃体切除术的应用

目的 探讨先天性白内障手术中双撕囊联合前段玻璃体切除术应用的效果.方法 对42例(44眼)儿童先天性白内障,行前后囊双撕囊、前段玻璃体切除联合人工晶状体植入术(A组);同期进行的36例(38眼)儿童先天性白内障,行前后囊双撕囊联合人工晶状体植入术作为对照组(B组);随访6～24月.结果 术后矫正视力≥0.5者,A组30眼(68.18%),B组13眼(34.21%);0.2-0.4者,A组12眼(27.27%),B组17眼(44.74%);≤0.1者,A组2眼(4.55%),B组8眼(21.05%);两组比较差异有统计学意义(x2=5.16,P＜0.05).后囊浑浊≥3级者,A组2眼(4.55%),B组8眼(21.05%);两组比较差异有统计学意义(x2=5.62,P＜0.05).均未出现眼底并发症.结论 先天性白内障术中行双撕囊联合前段玻璃体切除术,能够完全有效地止视轴区后囊的浑浊,有助于视功能的恢复.     

儿童白内障摘除人工晶状体植入疗效观察

目的:评价儿童白内障摘除人工晶状体植入疗效,探讨并发症防治措施。方法:对78例93眼儿童行白内障摘除时作后囊截囊或撕囊前玻璃体切除、联合人工晶状体植入术,术后随访时间平均为24mo。结果:术后矫正视力普遍提高,除2例合并黄斑病变、1例单眼先天性白内障、1例双眼先天性白内障外,视力>0.05占94.3%,>0.2占75.0%,>0.5占44.3%。结论:儿童白内障摘除人工晶状体植入1期行后囊撕囊联合前玻璃体切除,绝大多数儿童视力显著提高,并建立良好的视功能。     

折叠式人工晶状体治疗儿童白内障的初步报告

目的　评价小切口白内障吸除及折叠式人工晶状体囊袋内植入术中采用撕除后囊、切除前段玻璃体技术治疗儿童白内障的临床效果。方法　对 2 8例 (37只眼 )儿童白内障患者行小切口白内障吸除、前后联合撕囊、前段玻璃体皮质切除及折叠式人工晶状体囊袋内植入术 ,其中先天性白内障 2 7只眼 ,外伤性白内障 10只眼。术后随访 3～ 15个月 ,平均 10个月。观察记录并发症发生情况、视力及角膜曲率的变化。结果　先天性白内障患者术后矫正视力均≥ 0 1,16只眼 (5 9 3% )矫正视力≥ 0 5 ;外伤性白内障患者术后矫正视力均≥ 0 3,8只眼 (80 % )矫正视力≥ 0 5。术后 1周 ,1个月和 3个月的手术源性角膜散光度数分别为 (1 18± 0 6 5 )、(0 6 7± 0 5 9)及 (0 6 0± 0 39)D。术后 1个月时 ,手术源性角膜散光度数趋于稳定。随诊中有 5只眼 (13 5 % )出现晶状体后囊膜切开区混浊 ,无其他并发症。结论　小切口白内障吸除及折叠式人工晶状体囊袋内植入术中撕除后囊、切除前段玻璃体治疗儿童白内障具有术后角膜散光小 ,视力恢复快 ,炎性反应轻 ,手术并发症少的优点     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.