晶状体溶解性青光眼手术20例临床分析

目的探讨晶状体溶解性青光眼的诊断治疗。方法分析20例晶状体溶解性青光眼的临床表现、诊断、治疗、手术方法及疗效。结果晶状体溶解性青光眼正确诊断、积极治疗、及时手术，仍可获得一定视力。结论晶状体溶解性青光眼有其特殊性，临床医生需提高对其认识，及时正确诊断治疗，最大程度恢复患眼视力。     

Retinochoroiditis associated with congenital toxoplasmosis in children: IgG antibody profiles demonstrating the synthesis of local antibodies

PURPOSE: Retinochoroiditis is generally diagnosed after the first year of life and the association with congenital toxoplasmosis presents a diagnostic dilemma. The detection of local intraocular specific antibodies could be useful for diagnosis. METHODS: We studied six patients (mean age 7 +/- 5 years) with retinochoroiditis which appeared after the first year of life. Aqueous and serum were analysed by immunoblotting for anti T. gondii IgG to diagnose toxoplasmosis. RESULTS: All serum samples were positive only for anti T. gondii IgG. The retinochoroiditis was active in three patients and inactive in the others. Immunoblot analysis of serum and aqueous from the patients with active lesions showed IgG versus the specific antigen of T. gondii. In the patients with inactive lesions the pattern was the same in the two compartments. In active forms, aqueous and serum Western blot patterns differed in proteins lower than 16kDa and higher than 116kDa: in aqueous the findings were typically positive for 30kDa. CONCLUSIONS: Aqueous humour analysis by the Western blot technique may be useful in the diagnosis of congenital toxoplasmosis. In the present small series, we nevertheless detected different patterns for inactive and active retinochoroiditis, confirming the diagnosis in the latter. Aqueous humour paracentesis may be indicated in a child with active retinochoroiditis with unusual clinical features, appearing after the first year of life, and with no clinical or serological evidence of congenital infection.     

Congenital ectopia lentis and secondary buphthalmos likely occurring as an autosomal recessive trait.

A family from Turkey with congenital ectopia lentis, likely occurring as an autosomal recessive trait, is presented. No systemic disorders such as homocysteinuria, Marfan's or Weill-Marchesani's syndromes were found in any of the patients. However, all patients except one were less than 2 years old when first examined so that lens luxation must have happened very early in life. Besides almost total lack of zonular threads the patients presented anomalies of ocular dimensions with increased corneal diameters and axial lengths, and in several cases glaucomatous distension of the optic discs could also be found. A possible explanation for these buphthalmic changes and their relation to lens luxation taking place very early in life is proposed. The importance of early diagnosis and treatment is discussed.     

诊断性玻璃体手术临床应用及其微创化前景

诊断性玻璃体手术是对一些病因不明、治疗无效的眼内炎性疾病或恶性肿瘤等进行玻璃体手术,从而获得玻璃体和视网膜或脉络膜标本,再运用现代分子生物学技术和实验室技术进行明确诊断的一种手段.诊断性玻璃体手术可以明显提高临床医师对原因不明和传统方法治疗无效的非典型葡萄膜炎,可疑感染的眼内炎,进行性视网膜、脉络膜及色素上皮病变,伪装综合征及疑为恶性肿瘤的眼内出血的诊断率,可用于治疗慢性葡萄膜炎的并发症.诊断性玻璃体手术的微创化发展使手术更方便、更快捷、更安全.     

先天性白内障患儿术后中央角膜厚度变化及其对眼压测量的影响

先天性白内障术后易发生青光眼、高眼压征、虹膜粘连、囊膜机化等并发症,其中青光眼对患者视神经产生不可逆损伤,尤其需要引起临床医生的关注。但是,先天性白内障患者视野、视神经损伤等方面难以获得可靠数据为诊断提供依据,因此眼压精确测量对青光眼诊断尤为重要。先天性白内障术后常伴有角膜厚度改变,会影响眼压测量的准确性。本文就先天性白内障术后中央角膜厚度(CCT)、眼内压(IOP)的变化及变化的原因作一综述。     

Diagnosis and treatment of intraocular tumors in the child]

PURPOSE: To remind of the absolute necessity for early diagnosis in the presence of ocular signs in children giving rise to possible intraocular tumours. METHOD: Based on our own experience of intraocular tumours in children, together with findings from the literature, diagnostic criteria and methods of treatment are presented. RESULTS: Retinoblastoma is the predominant cause of intraocular tumours in children, representing over 80% of cases under the age of 15 years. Other diseases may give rise to the same initial signs, usually leukocoria, sometimes strabismus, more rarely other atypical signs. Elements taken into account for diagnosis include age, sex, laterality, heredity, size of the globe, clinical aspect of the tumours, presence of calcifications and vitreous seeding. Full fundus examination under general anaesthetic is usually necessary. Biological examination, ultrasonography, computerized tomography and MRI enable an accurate diagnosis to be made in the majority of doubtful cases. The management of retinoblastoma is adapted for each individual case from the wide range of treatments available. Enucleation, radioactive applicators (...), brachytherapy (...), cryo- and photocoagulation represent classical measures. Primary chemotherapy, combined with other treatments such as thermotherapy, has become the treatment of choice in those cases where external beam radiotherapy has been used up to now, or in some instances before enucleation. Enucleation is usually carried out for medullo-epitheliomas, but brachytherapy may offer an alternative. CONCLUSION: Any unexplained ocular sign in children should be considered as a possible retinoblastoma, making an accurate and certain diagnosis imperative. Early treatment may save not only the life but also the vision of patients carrying this highly malignant lesion.     

应当以眼科急症来处理外伤性视神经病变

近年来外伤性视神经病变(TON)有增多的趋势.TON视功能损伤严重,预后较差.TON的早期诊断和早期治疗能获得较高的视力改善率.TON治疗成功的关键是抓住时机,以眼科急症来尽早处理TON病例,进行快速准确的临床诊断;尽快完成必要的辅助检查,包括计算机断层扫描(CT)和视觉电生理检查,以便判断是否有手术指征;尽早给予合理治疗.(中华眼科杂志,2008,44:673-675)     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

与眼眶疾病相关的复视问题及治疗对策

复视是眼眶疾病中较为常见的临床表现,严重影响患者的生活质量.眼眶骨折、甲状腺相关眼病和眼外肌病变是常见的眼眶疾病,复视为共同特征.本文介绍了眼眶骨折造成复视的机制、检查方法及手术适应证和手术时机.甲状腺相关眼病可累及眼外肌,炎症活动期和静止期均可发生复视,但治疗方案有所不同.眼外肌病变包括特发性炎症、寄生虫囊肿及多种良、恶性肿瘤,经手术明确病理诊断后给予针对性治疗,可有效改善复视.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

关注干眼的诊断问题

干眼是一类涉及眼表多部位的多病因疾病,严重影响患者的生活质量.正确地诊断干眼是进行合适治疗的必要条件.笔者通过分析干眼定义的变化,综合目前临床诊断干眼的各种手段及其优缺点,提出用于准确判断患者是否存在干眼的有效方法,从而避免治疗的盲目性.     

The 10-diopter base-down fixation test for amblyopia: comparison of techniques

Two techniques for performing the 10-diopter base-down fixation test were used in 44 patients, and the fixation-pattern responses were compared to determine whether they showed any significant differences. The two techniques elicited the same responses in most cases. A comparison of fixation pattern and visual acuity showed that for most of the patients with equal visual acuity or documented amblyopia an accurate diagnosis could be made with the 10-D base-down fixation test. However, for most of the patients with borderline amblyopia the test either overdiagnosed or underdiagnosed the visual status.     

Tumors metastatic to the orbit: a changing picture

Clinical characteristics of tumors metastatic to the orbit are related to primary tumor biology, and vary substantially among the various primary types. Common known primary sites include breast, lung, prostate, and melanoma. Tumor presentations can be classified into four generalized syndromes of mass, infiltrative, inflammatory, and functional effects. We found the infiltrative syndrome of presentation to be more common than for other types of orbital neoplasm. Accurate diagnosis often depends on recognition of the types of clinical syndromes and on the use of diagnostic modalities such as computed tomography, magnetic resonance imaging, fine needle aspiration biopsy, and open biopsy. Special histologic techniques are often useful in determining the origin of these often poorly differentiated tumors, and can provide a basis for specific hormonal therapy. Ophthalmologists play a vital role in the diagnosis of metastatic cancer; the orbital tumor was the presenting sign of systemic cancer in 42% of the cases reviewed. Although the overall prognosis for patients with metastatic cancer is quite poor, specific therapy is available for a growing number of cancers. Timely intervention based on accurate diagnosis can dramatically improve the duration and quality of life with selected tumors.