Dermatography as a treatment after periocular surgery

Dermatography is the application of tattooing techniques in medicine. In the past, several techniques have been tried but none of these led to reproducible results. Over the last 17 years, dermatography has been developed into a technique that is both generally applicable and reproducible. It is a suitable treatment modality for disturbing skin discolorations and scars. With dermatography these can be permanently camouflaged. In this paper, the use of dermatography as a treatment after periocular interventions is discussed.     

Two differing presentations of periocular dermatitis as a side effect of dupilumab for atopic dermatitis

Dupilumab is a monoclonal antibody used to treat atopic dermatitis. Worsening of atopic dermatitis and conjunctivitis following dupilumab use are reported adverse effects; however, there is little reported on the nature and mechanism of these complications. Here, we describe two patients with chronic atopic dermatitis who developed new or severely worsened periocular dermatitis, believed to be a side effect of dupilumab injections, and resolution after its discontinuation. We explore the possibility of dupilumab-induced suppression of Th2 mediated inflammation and upregulation of Th1 and IFNγ mediated inflammation as a possible mechanism.     

抗青光眼手术后滤过泡并发症的治疗

目的：探讨青光眼滤过泡并发症的治疗方法。方法：对45例45眼青光眼滤过性手术后的早、晚期滤过泡并发症。分别给予眼球按摩、断线、针刺分离与药物注入等治疗。结果45例早、晚期青光眼滤过泡并发症,有44例治愈（97．77％）,结论：根据青光眼滤过泡并发症的不同时期采取不同的治疗方法,可有效提高青光眼手术的成功率。     

上睑下垂矫正术后发生角膜溃疡的特殊原因及处理

目的探讨上睑下垂术后角膜溃疡发生的特殊原因及处理措施。方法回顾性分析深圳市眼科医院2012年1月至2013年12月进行的上睑下垂矫正术89例（110眼）,其中5例（6眼）发生了角膜溃疡,分析其原因及治疗效果。结果5例（6眼）发生角膜溃疡,3例是因为术后下睑倒睫加重而引起,1例与心因性疾病有关,1例是因为脑膜瘤术后,角膜营养不良引起。进行了睑裂缝合、营养角膜、对症治疗等处理,患者角膜均恢复透明,上睑下垂手术效果满意。结论上睑下垂患者虽然在术前、术后均采取措施避免角膜溃疡的发生因素,但还是有少数患者术后发生角膜溃疡,其原因并不常见。术前完善检查,术后出现溃疡后积极处理,是可以避免或治愈角膜溃疡的。     

斜视术后并发复视555例临床分析

目的 探讨斜视矫正术后复视的发生情况.方法 回顾性系列病例研究.回顾分析1999年1月至2009年12月西安市中心医院眼科收治的5900例斜视矫正手术病例,对斜视术后并发复视的发生率、手术年龄、斜视类型进行分析,并总结手术原则和方案设计思路.结果 手术方案设计：①儿童内斜、外斜手术做到角膜映光正位,保留少量内隐斜;②成人内斜视手术做到角膜映光正位,保留少量内隐斜,不要过矫;③成人外斜视手术做到角膜映光正位,保留少量外隐斜,不要过矫;④获得性麻痹性斜视手术量宁欠勿过;⑤垂直斜视均做到少量欠矫为宜;⑥成人超过40°以上的大角度外斜视,术后保留5°外斜视,外观较满意;⑦一条肌肉不要承担过大的手术量,以避免引起眼球运动受限,造成非共同性斜视,向肌肉运动方向出现复视.术后常规用同视机进行双眼单视功能训练.5900例斜视手术病例中,术后仅有555例（9.41%）患者诉复视,其中短暂性复视患者552例（9.36%）,复视症状分别于术后3 d、1周或1个月完全消失;持续性复视患者有3例（0.05%）,术后复视症状持续半年或两年半不等.共同性外斜视术后复视的发生率较高,达12.58%（433/3443）,占总发生率的78.02%.年龄对复视的发生率影响不大.结论 斜视术后复视不可避免,一般以短暂性复视为主,只要手术设计合理,术后经 同视机训练后均能消失,持续性复视的发生率极低.     

Thermal cautery as a treatment for conjunctival inclusion cyst after strabismus surgery.

Conjunctival cysts may be congenital or acquired. A common cause of acquired conjunctival inclusion cysts is the implantation of conjunctival epithelium after surgery or trauma. These cysts often form at the site of muscle reattachment after strabismus surgery. They may disappear spontaneously, but persistent cases often require surgical excision. We report a new technique using cauterization under slit-lamp visualization to treat conjunctival inclusion cysts that can form after strabismus surgery. This procedure is fast, effective, and well tolerated by patients.     

Efficacy of diclofenac versus dexamethasone for treatment after strabismus surgery

OBJECTIVE: To compare the efficacy of topical diclofenac sodium 0.1% versus dexamethasone 0.1% on the conjunctival healing process and on intraocular pressure (IOP) after strabismus surgery. DESIGN: A randomized clinical trial. PARTICIPANTS: Forty consecutive pediatric patients who underwent strabismus surgery. INTERVENTION: The patients were assigned before surgery to receive topical diclofenac 0.1% (study group, 20 patients) or dexamethasone 0.1% (control group, 20 patients) from immediately after surgery to up to 4 weeks after surgery (both combined with chloramphenicol 0.2%, polymyxin B sulfate 2500 U). MAIN OUTCOME MEASURES: Between-group comparison of five parameters: patient discomfort, conjunctival chemosis, inflammation, gap, and intraocular pressure (IOP) at 1, 2, and 4 weeks after surgery. RESULTS: At postoperative week 2, the diclofenac-treated group showed significantly less patient discomfort and less conjunctival inflammation, edema, and gap than the dexamethasone group (P: = 0.003, P: = 0.04, P: = 0.02, P: = 0. 001, respectively). At week 4, the study patients continued to show less discomfort and conjunctival gap (P: = 0.02). The dexamethasone group showed a significant change in IOP between the preoperative and the fourth postoperative week (P: = 0.001 in the right eye, P: = 0.0005 in the left eye) and an increased prevalence of higher IOP during the fourth postoperative week (P: = 0.01 in the right eye, P: = 0.02 in the left eye). Thirty-eight percent of the dexamethasone group showed an increase in IOP to more than 21 mmHg during the four postoperative weeks. No increase in IOP was noted in the diclofenac group. CONCLUSIONS: Topical diclofenac is superior to dexamethasone for each of the five postoperative parameters examined. Its maximal effect occurred at 2 weeks after surgery, without an increase in IOP or in local subconjunctival hemorrhage.     

多层螺旋CT面神经管曲面重建应用于中耳手术中的解剖学研究

目的探讨多层螺旋CT（muhislice spiral CT,MSCT）面神经管曲面重建（curved planar reformation,CPR）在中耳乳突手术中的应用。方法成人尸头标本20具,行颞骨MSCT超薄层高分辨率扫描,在3个垂直平面上分别进行面神经管CPR重建,在重建图像上测量面神经管与各外科解剖标志结构间的距离,并与标本测量结果进行对照。结果（1）外半规管与面神经管关系在横断面重建CPR像上显示最好,壶腹部与面神经管间距离最短,为（1．74±0．29）mm,外半规管后缘与面神经管锥曲处间距离最大,为（2．47±0．51）mm。（2）砧骨短脚窝形态在矢状面重建CPR像上显示最佳,与面神经管锥曲最短距离为（2．88±0．41）mm。（3）乙状窦沟在冠状面重建CPR像上显示最好,与面神经管最短距离为（8．97±2．72）mm。CPR像上各测量值与解剖标本测量值差异均无统计学意义（P〉0．05）。结论MSCT面神经管CPR重建可用于测量面神经管与外科标志性结构间的距离,为术中面神经的保护发挥重要作用。（中国眼耳鼻喉科杂志,2009,9：89-91）     

Dermatitis neglecta as a complication after cataract surgery

Dermatitis neglecta, a condition of the skin secondary to a primary underlying disease, is an important diagnosis to be kept in mind as the clinical presentation may mimic a severe disease, but the treatment basically includes patient counseling and personal hygiene.     

安徽省贫困白内障患者复明术后视力效果评估

目的了解安徽省2013-2014年度贫困白内障患者复明术后中远期恢复情况。方法横断面调查研究。采用整体随机抽样方法抽取8个受检点（舒城县、庐江县、潜山县、池州市贵池区、郎溪县、太和县、毫州市谯城区、灵璧县）调查1 140例（1 557眼）白内障术后患者,所有受检人员均接受详细眼科检查,包括视力、裂隙灯显微镜、直接检眼镜、眼压和验光等。结果共718例（985眼）完成检查,受检率为83.0%。术后最佳矫正视力（BCVA）≥0.05者940眼（95.4%）,≥0.3者826眼（83.8%）,≥0.5者670眼（68.0%）。979眼（99.4%）植入人工晶状体（IOL）;963眼（97.8%）角膜透明,904眼（91.8%）瞳孔正圆无移位,953眼（96.8%）IOL居中正位,623眼（63.2%）后囊透明,眼压为（14.3±4.9）mmHg。284眼（28.8%）伴屈光不正。主诉最多者为流泪[313眼（31.8%）]。BCVA低于0.05的眼中,原因依次为年龄相关性黄斑变性、高度近视性视网膜病变、后发性白内障、角膜斑翳和视神经萎缩等;在BCVA低于0.3的眼中,主要原因依次为年龄相关性黄斑变性、后发性白内障、高度近视性视网膜病变、角膜斑翳和糖尿病视网膜病变等。结论安徽省80%以上的免费白内障手术患者达到康复视力,约30%的患者伴有屈光不正和后发性白内障,术后低视力和盲的患者主要由术前原有的眼底病变导致。     

可降解聚合微球持续释放5-氟脲嘧啶作为滤过手术的辅助治疗

目的:研究 5 Fu高分子微球对实验性质滤过术后瘢痕形成的疗效及毒性。方法 :对 40只兔行巩膜后唇咬切术 ,实验组术中结膜下注射 1ml 5 Fu微球 ,对照组术中结膜下注射 2 5 % 5 Fu注射液 10mg。结果 :术后实验组和对照组眼内压和滤过泡的存留有显著性差异。 5 Fu微球药物浓度变化范围 2 6 47～ 9 872ug/ml,持续 14天 ,可降低它的毒性 ,组织学显示两组纤维增生有显著差异。结论 :PTL EO PLA聚合微球通过释放 5 Fu ,防止瘢痕增殖引起的滤过不畅 ,降低 5 Fu的毒性 ,提高兔眼滤过术的成功率 ,有临床应用价值     

晶状体脱位继发青光眼的联合手术治疗分析

目的评价晶状体摘除联合玻璃体切除、小梁切除术、人工晶状体植入术治疗晶状体脱位继发青光眼的临床疗效。方法18例(18只眼)晶状体脱位继发性青光眼患者分别行晶状体摘除术联合前部或全部玻璃体切除术、单纯小梁切除术、Ⅰ期或Ⅱ期联合手术,术后随访眼压、视力及并发症情况。结果18例均成功摘除脱位晶状体并植入人工晶状体;16例(88.9%)眼压控制良好,12例(66.7%)矫正视力提高。结论联合手术是治疗晶状体脱位继发性青光眼的有效手段,能有效控制眼压,提高视力。应根据病情需要选择适当的手术方式尽早恢复患者的视功能。     

青光眼术后彩色多谱勒眼底血流动力学检测分析

目的了解青光眼术后正常眼压和高眼压情况下眼底血流动力学变化,为临床治疗提供依据。方法应用彩色超声多谱勒检测高眼压组青光眼23只眼、眼压正常青光眼组25只眼和正常对照组23只眼,将每组数据间进行比较。结果与对照组比较,高眼压组视网膜中央动脉(CRA)舒张末期峰值速度(EDV)明显降低、阻力指数(RI)明显增高(P<0.01);眼压正常组青光眼的EDV明显下降,RI显著增高(P<0.05)。结论青光眼眼底血液循环障碍是造成视功能损害的原因之一,即使术后眼压正常情况下此危害也存在。     

青光眼术中房水逆流的原因分析及处理

目的探讨青光眼手术中出现房水逆流的处理方法并分析其发生原因。方法对我院青光眼术中出现高眼压、浅前房的7例（7眼）青光眼考虑为房水逆流,行玻璃体腔积液抽吸术后完成手术。结果术后1个月内观察视力、眼压、前房、眼底、B超等。视力较术前提高者4例,维持不变者1例,下降者2例。未见浅前房。眼压控制5例,2例辅助滴一种降眼压药物眼压控制。玻璃体少量积血1例。结论青光眼手术中出现高眼压、浅前房,考虑为房水逆流时,玻璃体腔积液抽吸术是积极有效的应急措施。     

Laser in situ keratomileusis as treatment for anisometropia after scleral buckling surgery

Scleral buckling is an excellent procedure for retinal reattachment but can induce disabling refractive errors. Laser in situ keratomileusis (LASIK) has been proven effective for the reduction of refractive errors induced by ophthalmic surgery. We describe the case of a 53-year-old man who developed symptomatic anisometropia after placement of a scleral buckle for repair of a rhegmatogenous retinal detachment (RD). After the scleral buckling procedure, he retained excellent best corrected visual acuity but could not tolerate spectacle or contact lens correction. Thirty-four months after the scleral buckling procedure, LASIK was performed to correct myopic astigmatism with excellent refractive and functional results. This case demonstrates that LASIK may be safe and effective for the correction of refractive errors induced by RD repair.     

特发性黄斑裂孔患者手术前后中心视野的改变

目的 分析特发性黄斑裂孔患者手术前后的中心视野改变情况.方法 对2005～2006年在中山大学中山眼科中心接受玻璃体手术联合0.25%ICG辅助内界膜剥离治疗的特发性黄斑裂孔患者共19例(19只眼),用Octopns101全自动视野计M2程序观察手术前及手术后2个月、6个月、1年时患者中心10度视野平均缺损(MD)及中心4度平均敏感度(MS)的改变情况.结果 特发性黄斑裂孔手术后共有16例裂孔闭合(84.21%).经多元方差分析16例裂孔闭合的病人手术前及术后2月、6月、1年10度中心视野MD及4度中心视野MS四次测量结果之间的改变情况,趋势图显示术后2个月视野较术前差,随时间延长逐渐有所恢复.结论 特发性黄斑裂孔患者术后2个月时中心视野较术前变差,随时间延长逐渐接近术前水平.     

儿童垂直斜视术后角膜散光的分析

目的 探讨儿童垂直斜视矫正术后角膜散光状态的变化以及其与时间的关系.方法 对垂直斜视36例（58眼）采用术前术后阿托品散瞳验光及角膜地形图检查,术后不同时期的散光度进行比较分析,寻找规律.结果 Ⅰ组（上直肌后徙加下斜肌减弱）和Ⅱ组（上直肌后徙加下直肌缩短合并下斜肌部分切除）术后均有不同程度的角膜散光度改变,Ⅱ组较Ⅰ组明显,与术前相比差异均有统计学意义.结论 不同手术方式术后角膜散光度的恢复时间不同,垂直肌后徙加缩短恢复较慢,甚至术后8周有部分患儿仍不能完全恢复,因此配镜矫正时间应根据角膜散光的恢复情况而定.     

严重开放性眼球外伤的玻璃体视网膜手术

目的 探讨玻璃体视网膜手术治疗严重开放性眼球外伤的临床效果.方法 9例（9眼）严重开放性眼球外伤,均有巩膜裂伤.均进行I期急诊眼球伤口缝合术.9～14 d行Ⅱ期三通道闭合式玻璃体视网膜联合手术.结果 8例术后视力有不同程度的提高.1例因后期眼球萎缩行眼球摘除联合义眼台植入手术.2例出现术后低眼压（5～9 mmHg）（1 mmHg=0.133 kPa）,均有不同程度的眼球萎缩,但视力均为光感.结论 玻璃体视网膜手术能够有效挽救伤眼和恢复有用视力,手术时机的选择和熟练的手术技巧尤为重要.     

特发性视神经炎患者治疗后色觉损害

目的 观察特发性视神经炎(ION)患者治疗后色觉损害情况.方法 临床确诊的ION患者26例44只眼纳入本研究.所有患者均经糖皮质激素类药物大剂量冲击治疗,治疗后视力恢复至1.0以上,神经系统MRI及血液检查等无异常.另选取24名健康体检者作为正常对照组.ION患者治疗后8～10周,平均(9.64±1.39)周后进行色觉检查.采用Farnsworth Munsell-100型色觉测试仪检测ION患者患眼的总错误得分及红、绿、蓝各色彩的错误得分,原值及取平方根后进行统计学分析;并与对照组色觉检测结果进行比较.结果 ION组总错误得分及总错误得分平方根与对照组相比,差异均有统计学意义(t=3.079,3.133;P=0.0033,0.0026).红、绿、蓝3种色彩错误得分在原值水平比较分析时,两组差异无统计学意义(t=1.91,1.15,1.62;P=0.061,0.26,0.11),但将原值平方根后显示2组红色觉得分差异有统计学意义(t=2.21,P=0.031).结论 ION患者经治疗后虽然视力恢复,但其色觉损害仍然存在,其中红色觉在视力恢复后最早出现明显损害.