颞侧角膜缘切口高负压吸引手法劈核白内障超声乳化术临床观察

目的　讨论颞侧角膜缘直线形切口、高负压吸引手法劈核白内障超声乳化摘除硬性PMMA人工晶状体植入的手术效果和优点。方法　对96例(10 5只眼)白内障在颞侧角膜缘处作一3.2 m m×2 .0 mm大小的隧道切口,行高负压吸引手法劈核超声乳化术,扩大切口至5 .5 mm,植入PMMA硬性人工晶状体,记录手术平均超声能量和时间。随访6～12个月,观察术后视力和并发症。结果　平均累积能量复合参数(AECP)与晶状体核硬度和角膜水肿成正相关。术后1周、1、6个月的视力≥0 .5者分别为76只眼(72 .4 % )、92只眼(87.6 % )和93只眼(88.6 % )。只有1只眼术中发生后囊破裂。术后1～7天角膜轻中度水肿2 2只眼,并迅速吸收。后囊混浊11只眼。结论　角膜缘切口、高负压吸引手法劈核白内障超声乳化摘除PMMA人工晶状体植入术具有手术时间短、视力恢复好、并发症少、经济等优点。     

小切口白内障手术中普通器械劈核法的应用

目的 探讨应用普通晶状体圈匙和虹膜恢复器劈核在硬核白内障小切口非超声乳化人工晶状体植入术中的临床效果。方法于上方角膜缘后2mm处作直线形巩膜隧道切口，长约5．5mm，剖至透明角膜内约1mm，不作侧切口。开罐式截囊或连续环形撕囊，水分离后使晶状体核浮至前房，以晶状体圈匙进入核下方并向上托住核，虹膜恢复器进入前房至核的上方向下用力切割，双手配合将核劈为两半，分别托出。结果97例97眼术后第1天视力≥0．5者62眼(63．9％)，术后1周82眼(84．5％)，术后第1天角膜水肿25眼(25．7％)，3～5天内水肿完全消失。随访6～12月无并发症。结论此法不需特殊器械，操作方便，安全有效，便于推广。     

自闭小切口非超声乳化白内障人工晶状体手术

目的　观察无缝线自闭小切口应用于非超声乳化白内障囊外摘出人工晶状体植入术的可靠性、快捷和安全性。方法　对2 86例(3 17眼)施行自闭小切口非超声乳化白内障囊外摘出人工晶状体植入术。根据角膜曲率检查结果决定手术切口部位(上方、颞上方或颞侧)。做以穹隆为基底球结膜瓣,做切口中心距角膜缘1mm的直线形或反眉形巩膜半层切口,长5 .5～6. 0mm ,根据核硬度适当扩大切口,板层分离作角巩膜隧道,进入透明角膜1 5mm ,用角膜刀入前房形成活瓣式内切口,内切口大于外切口,3 :0 0或9:0 0时钟方位做透明角膜辅助切口,术毕切口水密自闭不缝合。结果　术后3天视力≥0 . 5者2 76眼(占87%) ,术后1周视力0 . 5～1 .0者3 0 1眼(占95 %)。随访3～12月,视力稳定。结论　自闭切口免缝线,手术快捷、安全。术后并发症少、散光轻、视力恢复快而稳定。     

改良型劈核器在小切口非超声乳化白内障手术中的应用

目的探讨应用改良型晶状体圈匙和劈核刀在硬核白内障小切口非超声乳化人工晶状体植入术中的临床效果。方法对58例(58眼)Ⅲ级以上的硬核白内障采用改良型劈核器进行小切口非超声乳化人工晶状体植入术。在显微镜下,于上方角膜缘后2mm处做反眉弓形巩膜隧道切口,长约5.5mm,板层分离至透明角膜内约1mm,进入前房。开罐式截囊或连续环形撕囊,水分离后把晶状体核旋拨至前房,以晶状体圈匙进入核下方并向上托住核,劈核刀进入前房至核的上方向下用力切割,双手配合将核劈为两半,分别托出。术后随访3个月,分别进行劈核效果、术后视力、角膜散光和术中术后并发症的观察和分析。结果本组所有患者晶状体核一次性劈开率为100%。58例患者术后第1天裸眼视力≥4.7者42眼(占72.4%),术后第1周≥4.7者50眼(占86.2%)。术中发生破囊2例,均非劈核所致。术后第1天角膜水肿12眼(占20.7%),3～5d内水肿完全消失。一过性眼压升高者有4眼(占6.8%),术后第1天角膜轻度雾状水肿,眼压在35mmHg以下,给予降眼压治疗3d后未见眼压再度升高。术后1周平均角膜散光度为(0.89±0.85)D,与术前相比差异无统计学意义(P>0.05)。随...     

普通器械劈核在小切口白内障手术中的应用

目的探讨采用普通晶状体圈匙和虹膜恢复器劈核,在硬核白内障小切口囊外摘除人工晶状体植入术中的临床效果。方法于上方角膜缘后1.52.0mm处作水平直线形巩膜切口,长6.0-6.5mm,分离至透明角膜缘内1.0mm,不作侧切口,开罐式或连续环行撕囊,充分水分离后使晶状体核浮至前房,以晶状体圈匙进入核下方并向上托住核,虹膜恢复器进入前房至核的上方向下用力切割,双手配合将核劈为两半,分次托出。结果134例（144眼）术后第1天裸眼视力≥0.5者89眼（61.81%）,术后1周的视力≥0.5者120眼（83.33%）。结论此方法不需特殊器械,操作相对简便,术后视力恢复快,手术费用低,适合于基层医院应用。     

青光眼术后颞侧巩膜小切口手法白内障摘出术

目的评价青光眼小梁切除术后经颞侧巩膜隧道小切口非超声乳化手法娩核囊外摘出术治疗白内障的手术方法和临床效果。方法对38例42眼施行手术。常规球后麻醉。于颞侧角膜缘后2.0 mm行直线形或反眉形巩膜板层切开,长为5.5 mm,作隧道切口至透明角膜内1 mm。注入黏弹剂,行连续环行撕囊或开罐式截囊,直径6 mm,水分离后以旋转法将晶状体核旋入前房,以晶状体圈匙将核托出。以注吸针头吸净晶状体皮质。囊袋内植入人工晶状体。术中缩瞳。术后随访至少3月,观察视力、眼压、滤过泡等。结果本组38例42眼术后第3天视力≥0.5者29眼(69.04%),术后眼压均在正常范围内,对原滤过泡无影响,未见严重并发症。结论青光眼术后特别是上方小梁切除术后的白内障患者,经颞侧巩膜隧道式小切口进行手法娩核白内障手术切实可行,效果良好,值得向基层医院推荐。     

注射器针头囊袋内吸附劈核法在白内障手术中的应用

目的探讨在小切口非超声乳化白内障摘出联合人工晶状体植入术中,利用注射器针头实施囊袋内吸附劈核法的可行性及疗效。方法对365例(458眼)晶状体核硬度为Ⅱ-Ⅳ级的老年性白内障患者,实施小切口非超声乳化白内障摘出术,其中235例297眼采用晶状体圈匙前房内劈核法,即为前房内劈核组,130例161眼采用普通注射器针头囊袋内劈核法,即为囊袋内劈核组。术后随访1～7d,观察并比较两组患者术后视力恢复及术中、术后并发症情况。结果术后第1天,前房内劈核组视力为0.40±0.13,其中≥0.3者233眼(78.5%),囊袋内劈核组为0.42±0.13,其中≥0.3者132眼(82.0%);术后第7天复诊的307眼中,前房内劈核组188眼,视力为0.61±0.14,其中≥0.5者157眼(83.5%),囊袋内劈核组119眼,视力为0.62±0.15,其中≥0.5者101眼(84.9%),两组不同时间点视力相比差异均无统计学意义(均为P>0.05)。术中发生后囊膜破裂者前房内劈核组4眼,囊袋内劈核组3眼,两组劈核成功率差异无统计学意义(P>0.05)。术后瞳孔非正圆及角膜水肿者,前房内劈核组分别为12眼、78眼,囊袋内劈核组分别为9眼、31眼。结论利用注射器针头实施囊袋内吸核和劈核方法具有操作简单、手术成功率高、术后恢复好、手术成本低等优点,易于在基层医院推广实施。     

小切口囊袋内手法碎核白内障摘除人工晶状体植入术的探讨

目的　探讨非超声乳化小切口囊袋内手法碎核白内障摘除人工晶状体植入技术。方法　用百赖皓式碎核刀对 12 0例 (12 0只眼 )白内障行小切口手法碎核 ,囊袋内植入人工晶状体。结果　 12 0例中无一例后囊破裂 ,全部囊袋内植入人工晶状体。术后第一天视力 111例均≥ 0 .3,轻度角膜水肿 9例 (发生在 ～ 级核的病人 ) ,术后第 3天出院时水肿均消失 ,视力≥ 0 .3。虹膜根部断离 3例。结论　非超声乳化小切口囊袋内手法碎核白内障摘除人工晶状体植入技术是一种可靠的手术方法 ,且术后反应小 ,并发症少     

手法小切口白内障向超声乳化手术转化前的技术改进

目的探讨手法小切口白内障如何安全向超声乳化手术过渡。方法改进手法小切口白内障手术方法对186例软核白内障实施手术,麻醉:表面麻醉加上方球结膜下浸润麻醉。切口:双切口,右上方10点方位角膜缘后1mm巩膜横行长4mm左右主切口,左上方2点方位角膜缘内1mm处作透明角膜2mm辅助穿刺口。前囊膜处理:均采用连续环形撕囊法。人工晶体植入:折叠人工晶体推注囊袋内植入。对其疗效进行评价分析总结。结果 159眼在连续环形撕囊囊袋内植入人工晶体(撕囊成功85.5%);撕囊失败27眼(14.5%),18眼在截囊、撕囊及剪囊情况下囊袋内植入人工晶体,4眼人工晶体植入睫状沟内;2眼悬韧带断裂1/4周(1.07%),行囊袋内植入人工晶体;2眼后囊破口较小睫状沟植入人工晶体;1眼后囊破裂口较大未植晶体,后囊膜破裂3眼(1.6%)。术中虹膜损伤4眼(2.1%),后弹力层脱离1眼(0.54%),皮质残留6眼(3.2%),角膜水肿、内皮混浊16眼(10.7%),术后高眼压14眼(7.5%),术后虹膜反应6眼(3.2%)。术后3天矫正视力:视力≥0.6者158眼(84.9%);0.3-0.5者19眼(10.2%);0.1-0.2者9眼(4.8%);结论改进手法小切口白内障手术方法对软核白内障进行手术,效果良好,能锻炼基层医院医生由手法小切口白内障手术向超声乳化手术过渡的基本技能,为开展超声乳化手术打下良好基础。     

表面麻醉下透明角膜切口超声乳化白内障摘除术临床观察

目的观察表面麻醉下经透明角膜切口行超声乳化白内障吸除联合折叠式人工晶状体植入术效果。方法各种类型白内障364例(364只眼)在表面麻醉下透明角膜10～12点钟作切口2．8～3．2mm,在3点或9点角膜缘作0．3～0．6 mm辅助切口,超声乳化吸除皮质及核,植入ACRYSOF折叠式人工晶状体。术后观察视力、切口、前房、人工晶状体位置、眼底。结果术后随访1天、7天、1个月和3个月,矫正视力≥0．8者分别为259只眼 (71．20％)、275只眼(75．43％)、279只眼(76．52％)、285只眼(78．34％)。结论表面麻醉下透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入术具有手术时间短、视力恢复快、并发症少等优点。     

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.