非穿透性小梁切除术联合丝裂霉素C治疗青光眼的疗效观察

青光眼是一组以视神经萎缩和视野缺损为共同特征的疾病.以往青光眼滤过手术失败的主要原因是球结膜下成纤维细胞过度增殖,致滤过泡下瘢痕形成,阻断滤过作用.主要并发症为滤过泡囊肿,术后浅前房、脉络膜驱逐性大出血,脉络膜脱离及眼内炎等.     

非穿透性小梁切除加羊膜移植治疗开角型青光眼

目的探讨非穿透性小梁切除术术中加羊膜移植治疗开角型青光眼的机理及疗效.方法为10例、12眼开角型青光眼行非穿透性小梁切除术联合术中巩膜瓣下植入羊膜,术后观察视力、眼压、滤过泡、眼内反应及并发症,随访3～5个月.结果术后炎症反应轻,眼压控制良好,术后眼压为14～19mmHg,术后并发症少.结论非穿透性小梁切除术能安全、有效地降低眼压,是治疗开角性青光眼有效的手术方法.     

可拆除缝线小梁切除术治疗青光眼的临床观察

目的探讨可拆除缝线小梁切除术治疗青光眼的效果.方法将65例、68眼青光眼患者随机分为2组,实验组35眼行可拆除缝线小梁切除术,对照组33眼行常规小梁切除术.结果实验组的眼压控制率、功能性滤过泡的比例均高于对照组(P＜0.05),浅前房、脉络膜脱离等并发症明显减少.结论可拆除缝线小梁切除术疗效良好,手术并发症少,是理想的抗青光眼手术.     

非穿透小梁手术联合羊膜植入临床观察

目的探讨非穿透小梁手术联合羊膜植入治疗开角型青光眼的机理及临床效果.方法对20例24眼开角型青光眼患者行非穿透性小梁手术,术中植入羊膜,并对术后视力、眼压、滤过泡情况、羊膜植片及手术并发症进行观察.结果 20例、24眼术后眼压均控制在21mmHg以下,视力提高12眼,不变12眼,所有病例均形成功能性滤过泡,术后炎症反应轻,并发症少.结论非穿透小梁手术联合羊膜植入是一种安全有效的抗青光眼手术.     

小梁切除术中应用丝裂霉素C与术后应用肝素的对比研究

目的：探讨丝裂霉素C和肝素用于小梁切除术的临床疗效。方法：采用随机对照的方法,将青光眼患者90例（150眼）分为丝裂霉素组和肝素点眼组,各75眼,行标准小梁切除术。丝裂霉素组在术中一次性应用丝裂霉素C,浓度为0.2～0.4mg/ml,　2～4min;肝素组术后用5％肝素滴眼液点眼。随访观察6个月。结果：两组的完全成功率和条件成功率均高于标准小梁切除术,两组之间的成功率差异无统计学意义（P>0.05）。结论：在小梁切除术中应用丝裂霉素C,或术后应用肝素,均能提高手术成功率,长期保留功能性滤过泡。     

开角型青光眼非穿透性小梁切除术的临床观察

非穿透性小梁切除术(non-penetrating trabecularsurgery,NP TS)是治疗开角型青光眼的主要术式之一,疗效可靠,降压效果确切,并发症少.2000年11 月至2002年2月我们对29例、36眼原发性开角型青光眼行非穿透性小梁切除术,疗效满意, 现报道如下.     

小梁切除联合巩膜层间反折小梁组织垫入术治疗青光眼临床分析

目的 探索小梁切除联合巩膜层间反折小梁组织垫入在预防和减少滤过道阻塞中的作用。方法 收集青光眼患者36例(36眼),即在常规小梁切除术的基础上将小梁巩膜条一端切断,一端部分保留并反折合于深层巩膜上,术后随访6～24个月。结果 术后眼压控制在21 mmHg以下者33例33眼,平均为(15.86±3.01)mmHg,明显低于术前平均水平(29.62±5.49)mmHg(t=7.398, P<0.001)。手术成功率为94.45%。结论 小梁切除联合巩膜层间反折小梁组织垫入术能有效控制眼压,减少滤过道瘢痕阻塞,手术简便易行,安全有效。     

青光眼引流阀植入治疗不同类型难治性青光眼

目的 观察青光眼引流阀植入治疗不同类型难治性青光眼的临床疗效.方法 回顾分析23例(23眼)行青光眼引流阀植入术的难治性青光眼患者资料,根据青光眼类型及治疗方法分为两组:A组14例(14眼),为新生血管性青光眼,行青光眼引流阅植入术联合视网膜激光光凝;B组9例(9眼),为其他类型难治性青光眼,行青光眼引流阀植入术,术中联合应用丝裂霉素C.记录眼压、视力、并发症,测算手术成功率.结果 与术前比较,两组术后平均眼压均明显降低(P＜0.05);术后6个月A组视力提高8眼(57.14％),B组提高6眼(66.67％);所有患者均未发生严重并发症;A组手术成功率为85.71％ (12/23),B组为88.89％( 8/9).结论 青光眼引流阀植入治疗不同类型难治性青光眼可有效控制眼压,提高手术成功率.     

复合小梁切除术治疗前葡萄膜炎继发青光眼

目的 观察应用玻璃酸钠的复合小梁切除术治疗前葡萄膜炎继发青光眼的临床疗效.方法 观察组共37例(37眼)前葡萄膜炎继发青光眼,经药物治疗眼压仍不能控制而行复合小梁切除术,术中向巩膜瓣下及前房内注入玻璃酸钠0.2mL;以同期行复合小梁切除术的29例(29眼)前葡萄膜炎继发青光眼作为对照,术中于巩膜瓣下及前房内注入0.2mL平衡盐溶液.术后监测并记录视力、眼压、前房深度、前房角及滤过泡情况,随访9～15个月.结果 与对照组比较,观察组手术成功率及功能性滤过泡比率较高,滤过瘘口开放较好,术后早期浅前房发生率较低,差异有统计学意义(P＜0.05).两组间视力改善差异无显著性(P＞0.05).结论 对前葡萄膜炎继发青光眼行复合小梁手术,应用玻璃酸钠能减少滤过道黏连,明显提高手术质量及成功率.     

平行隧道式小切口非乳化联合小梁切除治疗白内障合并青光眼

目前,隧道式小切口非乳化白内障摘除联合小梁切除及后房型IOL植入术治疗白内障合并青光眼已在临床上普遍应用[1,2].我们用此手术方法治疗白内障合并青光眼38例、38眼,术后恢复了有用视力,有效降低了眼压,疗效满意.现报告如下. 1 资料与方法 1.1 临床资料 1999年2月至2001年5月我院为白内障合并青光眼38例、38眼行联合手术,随访4～24个月.男20例、20眼,女18例、18眼,37～71岁,平均61岁.白内障合并原发性闭角型青光眼17例、17眼,白内障继发青光眼15例、15眼,白内障合并开角型青光眼4眼,外伤性白内障青光眼2眼,术前视力为光感至0.3;眼压为28～60mmHg,平均33.18±4.63 mmHg,患者均为一期植入后房型IOL,晶体为Stroze公司产的一体式晶体.     

四种手术方法治疗翼状胬肉168眼

目的 探讨单纯翼状胬肉切除术、翼状胬肉切除联合丝裂霉素C、翼状胬肉切除联合带角膜缘的结膜瓣移植术、翼状胬肉切除联合羊膜移植术四种方法治疗胬肉的手术效果。方法 分析翼状胬肉患者158例(168眼)接受不同手术方式的手术效果。其中,A组（41眼）接受单纯翼状胬肉切除术,B组（42眼）接受单纯胬肉切除联合丝裂霉素C术,C组（44眼）接受翼状胬肉切除联合带角膜缘的结膜瓣移植术,D组（41眼）接受翼状胬肉切除联合羊膜移植术。术后随访 6～12个月。结果 A组复发率 17.1% ,B组复发率为9.5％,C组复发率4.5%,D组复发率为4.9% 。A组的复发率和其它三组比较差异有统计学意义 (P﹤0．05);B、C组、B、D组、C、D组复发率的比较差异无统计学意义(P﹥0．05)。C组的并发症较其他三组的并发症少。 结论 翼状胬肉切除联合带角膜缘的结膜瓣移植术是目前值得推广的手术方式,具有经济实用、复发率低、角膜上皮愈合快、并发症少等优点。     

Evaluation of folded amniotic membrane and injectable amniotic membrane pieces as soft tissue filler materials

Objective

The search for safe and effective tissue fillers has been an ongoing effort for many years. Obtaining biological materials from patients can require additional incisions and brings surgical and cosmetic risks as a major disadvantage. The aim of this experimental study was, therefore, to evaluate the efficacy of folded amniotic membrane as a soft tissue filler and to assess its volume, and to investigate the possible usage of injectable amniotic membrane for augmentation.

小梁切除联合睫状体冷冻术与单纯睫状体冷冻术治疗绝对期新生血管性青光眼的效果比较

目的 比较小梁切除联合睫状体冷冻术与单纯睫状体冷冻术对绝对期新生血管性青光眼的治疗效果。方法 回顾性分析绝对期新生血管性青光眼32眼,随机分成两组,分别行单纯睫状体冷冻术或小梁切除联合睫状体冷冻术。观察术后眼压、前房反应及疼痛程度。结果 术后短期内行单纯睫状体冷冻术组平均眼压明显高于联合组,疼痛程度亦较重,但是前房反应较轻。远期效果两组在眼压、前房反应、疼痛程度等观察指标上无明显差异。结论 小梁切除联合睫状体冷冻术治疗绝对期新生血管性青光眼,术后降压效果明显,疼痛程度轻,疗效较单纯睫状体冷冻术好。     

角膜缘干细胞移植与羊膜移植治疗翼状胬肉的Meta分析

目的 以循证医学证据评价角膜缘干细胞移植和羊膜移植治疗翼状胬肉的临床疗效。方法 通过计算机检索Pubmed数据库、EMBASE、万方数据库、中国期刊全文数据库和维普数据库,并结合文献追溯的方法,收集关于角膜缘干细胞移植和羊膜移植治疗翼状胬肉临床疗效的随机前瞻性对照试验(RCT),并按 Cochrane协作网推荐的方法对符合纳入标准的35个研究,共3126只眼进行Meta分析,发表偏倚用漏斗图评估。结果 Meta分析结果显示,与羊膜移植组相比,角膜缘干细胞移植组能降低术后翼状胬肉复发率(P＜0.00001)、术后并发症的发生率(P=0.01),缩短术后角膜创面上皮愈合时间(P＜0.00001)。结论 与羊膜移植术相比,角膜缘干细胞移植术能有效预防翼状胬肉复发、术后睑球粘连,缩短角膜创面上皮愈合时间。     

Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone

ObjectiveChronic tympanic membrane perforation (TMP) in a clinical setting may attract surgical intervention. With the advent of modern biomaterials, new options are available for myringoplasty but safety and efficacy need evaluation in a chronic TMP animal model. The aim of this study was to evaluate the efficacy of ventilation tube (VT) insertion in conjunction with topical application of mitomycin C/dexamethasone (M/D) for the creation of chronic TMP in rats.MethodsThirty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were divided into three experimental groups: spontaneous healing (myringotomy control), VT insertion for 2 weeks and VT insertion for 2 weeks in conjunction with topical application of M/D (VT-M/D). All TMs were regularly assessed by otoscopy for 10 weeks and then animals were sacrificed for histological evaluation.ResultsIn the VT-M/D group, seven out of ten (70%) perforations were patent at 10 weeks (mean patency, 57.9 days; P < 0.01). The VT group had two out of ten (20%) perforations patent at 10 weeks (mean patency, 26.5 days; P < 0.01), while all TMPs from the myringotomy control group were closed by day 9 (mean patency, 7.2 days). Histologically, the TMPs patent at week 10 had a stratified squamous epithelialized rim, keratinocyte layer thickening around the perforation edge as well as increased collagen deposition and macrophage infiltration.ConclusionChronic TMP in a rat model was successfully created by VT insertion and the efficacy was increased in combination with topical application of M/D.     

Chronic model of tympanic perforation in rats with mitomycin C and dexamethasone

A rat model of chronic tympanic membrane perforation was developed to be used in the search of new materials for the sealing of these perforations. A longitudinal study was carried out in rats subjected to incisional myringotomy followed by the application of mitomycin C alone or with dexamethasone. Rats were checked at days 3, 7, 10, 14 and weekly thereafter until perforation closure, for up to 6 months. The addition of dexamethasone is a key component in order to obtain a chronic opening. Myringotomies treated with saline had a mean healing time of 8.5 days. At 8 weeks, between 62.5% and 77.7% of tympanic membranes treated with mitomycin C and dexamethasone remained perforated and at 6 months this number fell to 21.4%. This technique is able to maintain most tympanic membrane perforations patent for at least 8 weeks. This rat model is adequate for its use in preclinical or translational research.