RGP镜片矫正圆锥角膜的疗效评价

目的 评价硬性透气性隐形眼镜(RGP)对圆锥角膜眼的治疗效果.方法 30例(43眼)圆锥角膜患者配戴RGP,观察视力、配适状况及并发症.结果 配戴RGP后,19眼矫正视力≥1.0,平均视力增加4行,均好于框架球柱面联合镜.眩光及视物变形症状均明显改善.随访6～12个月,本组病例配适良好,除少数病例出现点状角膜上皮脱落经...     

穿透性角膜移植术治疗坏死性基质角膜炎的临床报告

目的：探讨穿透性角膜移植术(penetrating keratoplasty，PKP)治疗坏死性基质角膜炎(necrotizing strornal keratitis)的手术适应证及其临床效果。方法：按照Holland等的HSK新分类法，选择确诊坏死性基质角膜炎患者。予以局部及全身药物治疗。对病情不能控制，药物治疗无效的患者22例(23只眼)，其中角膜融解穿孔3眼，用新鲜角膜组织行穿透性角膜移植术，并随访观察术后疗效。结果：随访3月～3年，22例(23只眼)中，术后视力提高者18眼，其中矫正视力达到0.1～0.5者12眼，0.05～0.1者6眼。无改善者5眼。角膜植片透明17眼，半透明2眼，植片混浊4眼，植片透明率为74％。术后3眼植片发生排斥反应，3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作，植片完全混浊，行2次角膜移植术。结论：对药物保守治疗无效、角膜坏死穿孔或行将穿孔的坏死性基质角膜炎患者，及时用新鲜角膜组织行穿透性角膜移植术治疗，不仅能控制炎症，缩短病程，而且能保存眼球，恢复部分视力，因此具有重要临床应用价值。     

78眼圆锥角膜的临床观察

目的 回顾并分析78眼圆锥角膜的筛查、临床诊断和治疗方法.方法 对万余名门诊患者应用验光、角膜地形图、角膜厚度测量等方法进行各项检查.结合病史做出分期诊断.结果 共查出圆锥角膜患者39例78眼,其中4例8眼为准分子激光术后继发性角膜膨隆.所有病例均具有高散光、高曲率、矫正视力不良的特点,采用配戴框架镜、透气性硬性接触镜(rigid gas-permeable RGP)等可以改善视力;部分患者伴有哮喘、湿疹等全身疾病.结论 结合临床体征和角膜地形图特征,可以明确诊断,但早期诊断较为困难,配戴RGP镜片可以有效地提高裸眼视力和最佳矫正视力,改善视觉质量,病变严重者需行角膜移植术.     

氟康唑联合碘伏烧灼治疗角膜真菌病的临床观察

自1996年以来，我院应用氟康唑和碘伏烧灼治疗角膜真菌病15例，现报告如下。临床资料一、一般资料15例（15只眼）中，男8例，女7例。右眼7例，左眼8例。农民8例，学生1例，工人6例。年龄ZO～7O岁，平均年龄50．9岁。发病至就诊时间2～Zo天，平均8．2天。有明显外伤史者6例，角膜炎史2例，配戴亲水性角膜接触镜后患病1例，原因不明者6例。治疗前视力光感1例，手动5例，指数5例，002以上4例。角膜括片均找到霉菌，角膜荧光素染色均为阳性。二、治疗方法1％地卡因滴眼2次，用棉律蘸少许碘伏在溃疡表面反复涂擦4～5次，不累及健康角膜，然后用…     

持续配戴亲水性软性接触镜治疗丝状角膜炎

目的 探讨亲水性软性角膜接触镜治疗丝状角膜炎的疗效和安全性。方法 对28例(32眼)丝状角膜炎患者刮除丝状物后配戴软性角膜接触镜联合人工泪液治疗,随访6个月,观察治疗效果。结果 26例(92.9%)患者眼部刺激症状在3 d内完全缓解;治愈率90.6%,总有效率100.0%。结论 配戴亲水性软性角膜接触镜治疗丝状角膜炎临床疗效好,是一种安全实用的治疗方法。     

青少年近视患者长期配戴角膜塑形镜的有效性和安全性探讨

目的:探讨长期配戴角膜塑形镜对青少年近视患者矫正视力的影响及并发症发生情况。方法:选择2017年1月～5月来到某院就诊的55名(99只眼)青少年近视患者,均严格按照要求配戴角膜塑形镜以矫正近视,对配镜前、配镜6个月、12个月、18个月时分别观察患者裸眼视力、眼轴长度、屈光度变化进行检测分析,并对其配戴期间并发症的发生情况进行观察。结果:患者配戴角膜塑形镜18个月后其眼轴长度并无明显变化(P0.05),但其球镜屈光度同配镜前相比明显下降,裸眼视力明显上升,差异具有显著性(P0.05);55例近视青少年配戴期间共计出现角膜点染10眼(18.18%),角膜压痕6眼(6.06%),视觉异常5眼(5.05%),结膜炎2眼(2.02%),结膜充血4眼(4.04%),经对症治疗后其症状均恢复正常。结论:长期配戴角膜塑形镜可有效提高青少年近视患者裸眼视力、降低角膜屈光度,且不引起严重眼部不良反应,对控制青少年近视增长,改善近视患者生活质量具有十分积极的作用,建议在临床推广应用。     

透明质酸钠滴眼液对单纯疱疹病毒角膜炎上皮愈合的影响

目的 观察透明质酸钠眼液对上皮型单纯疱疹病毒角膜炎病程的影响.方法 26例上皮型单纯疱疹病毒角膜炎患者随机分为2组.在使用更昔洛韦眼膏基础上A组(14例)加滴0.1％爱丽眼液4次/d,B组(12例)加滴泰利必妥眼液4次/d.对比2组治疗后1周、2周时角膜上皮愈合情况以及矫正视力.结果 治疗后1周时,A组角膜上皮愈合情...     

三弧反转设计RGP镜片在角膜屈光术后屈光回退患者中的应用

目的 探讨角膜屈光术后屈光回退患者验配三弧反转设计RGP镜片的有效性、可行性和安全性。方法 对角膜屈光术后屈光回退患者12例20眼进行三弧反转设计RGP镜片的验配,通过角膜地形图分析设计个性化三弧反转RGP镜片,记录戴镜前的裸眼视力、框架镜最佳矫正视力和戴RGP的最佳矫正视力;在随访过程中,观察并记录RGP镜片配戴适应情况、视力矫正效果、视觉质量以及并发症。结果 20眼成功验配三弧反转设计RGP镜片,戴RGP前裸眼视力0.05～0.30者5只眼,0.30～0.80者15只眼;戴RGP前框架镜最佳矫正视力在0.20～0.50者5只眼,0.60～1.00者15只眼;戴RGP的最佳矫正视力在0.70～0.90者4只眼,1.0者16只眼,其中15只眼（75.00%）矫正视力较框架眼镜更好,12例（100.00%）矫正视力等同或优于框架镜。裂隙灯检查可见镜片与角膜形态吻合度更佳,活动度较普通球面设计RGP更小。全部患者主诉眩光、光晕等视觉症状在配戴RGP后得到改善,视觉质量良好,夜间视力及对比敏感度显著提高,平均随访20个月,未见角膜上皮染色等角膜接触镜相关的并发症。结论 角膜屈光术后屈光回退患...     

托吡卡胺滴眼液辅助角膜病治疗的临床疗效观察

目的：观察托吡卡胺滴眼液对角膜相关疾病(如角膜细菌感染、外来异物刺激、角膜接触镜配戴不当等)的辅助治疗作用。方法：确诊为角膜病的38例患者,立即给予托吡卡胺滴眼液滴眼2滴,压迫泪小点,待15分钟后观察起效情况,如瞳孔已散大,即停止使用,如瞳孔尚未散大,则连续滴眼,直到瞳孔散大为止。结果：38例临床使用托吡卡胺滴眼液者角膜刺激症状不明显,治疗效果快。结论：及时使用托吡卡胺滴眼液充分扩瞳,可减轻角膜刺激症状,感染尽快吸收,角膜迅速愈合。     

素高捷疗眼膏治疗丝状角膜炎疗效观察

丝状角膜炎是以多种原因引起的角膜表面出现大小不等的上皮性丝状物为特征的一种角膜病变。本文观察了应用素高捷疗眼膏治疗丝状角膜炎9例(12眼),其结果报告如下: 1 临床资料 1.1 一般资料:本组病例均为1995年6月～1997年2月在门诊治疗的丝状角膜炎患者共9例(12眼),其中男3例,女6例。年龄18～47岁,平均32.5岁。其中结膜角膜干燥症3例(6眼),流行性结角膜炎1例(1眼),角膜异物术后2例(2眼),戴角膜接触镜2例(2眼),原因不明的丝状角膜炎1例(1眼),均有反复发作史。 1.2 治疗方法:首次应用素高捷疗眼膏前,先在1％地卡因表面麻醉下,用消毒棉签蘸氯霉素眼药水后擦去丝状物,暴露其下方的角膜上皮创面,以利于素高捷疗眼膏的吸收。用素高捷疗眼膏滴入眼     

玻璃酸钠滴眼液对轻中度干眼病患者角膜表面规则性的影响

目的评价玻璃酸钠滴眼液对干眼病患者的角膜表面规则性的影响。方法应用DICON——CT200角膜地形图仪检测滴玻璃酸钠滴眼液前后33例（64眼）干眼病患者的角膜表面规则指数（surface regularity index,SRI）表面不对称指数（surface asymmetry index,SAI）及角膜预测视力（potential visual acuity,PVA）的变化进行观察。结果干眼病患者的SRI、SAI、PVA值及散光度分别为1.32±0.44、1.11±1.43、20/30.12±20/11.93及2.45±1.9;滴玻璃酸钠滴眼液后SRI、SAI、PVA值分别0.83±0.21、0.59±0.31、20/21.03±20/5.12及1.87±1.13。干眼病患者在滴玻璃酸钠滴眼液后SRI、SAI和散光度均明显降低,而PVA则明显升高。滴玻璃酸钠滴眼液前干眼病患者的角膜地形图43.8%为不规则形,应用玻璃酸钠滴眼液后不规则形降为29.7%。结论SRI和SAI可作为诊断干眼病的客观指标并可用于评价干眼病的严重程度及玻璃酸钠滴眼液的疗效。璃酸钠滴眼液可改善干眼病患者的角膜表面光滑度。     

Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis

Purpose: The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2?mg/mL) eye drops together with subconjunctival injections of 2?mg/mL of fluconazole.

Methods: The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2?mg/mL in dextrose 5% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2?mg/mL.

Results: Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75%). Three cases showed no improvement (25%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture.

Conclusion: The use of a combination of topical amphotericin B eye drops at a concentration of 0.2?mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2?mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.     

Safety and efficacy of autologous serum eye drop for treatment of dry eyes in graft-versus-host disease

Purpose: To evaluate the treatment of autologous serum eye drops (ASED) on dry eyes in patients with graft-versus-host disease (GVHD).

Methods: A retrospective chart review of 35 patients with a history of ocular GVHD following hematopoietic stem cell transplantation that used ASED to alleviate dry eye symptoms was performed. Patients were categorized into three different groups. If patients had available ophthalmic data before and after starting treatment was group 1 (n?=?14), had available ophthalmic data after starting treatment in group 2 (n?=?10) and had available ophthalmic data before treatment or did not have any data after starting treatment in group 3 (n?=?11). Data were collected on patient’s age, gender, primary diagnosis, visual acuity and fluorescein corneal staining were collected on individual eyes in order to evaluate the efficacy of the ASED on alleviating dry eye-related signs and symptoms.

Results: No adverse ocular effect from the ASED was found in our series (except one fungal keratitis). All patients reported either improvement (55%) or stability (45%) in their ocular symptoms upon the use of ASED. In patients with available data before and after starting treatment, the corneal staining score improved by a median of 1 (p?=?0.003) and the LogMAR visual acuity had a non-significant improvement.

Conclusion: In our study, ASED used by patients with ocular GVHD were both safe and effective. ASED should be considered in patients with GVHD who suffer from dry eyes.     

自制阿昔洛韦地塞米松混合滴眼液治疗61例病毒性角膜基质炎的疗效分析

目的：观察自制阿昔洛韦地塞米松混合滴眼液治疗难治性病毒性角膜基质炎的临床疗效。方法：回顾性分析2013年6月—2015年12月我院确诊和收治的61例难治性病毒性角膜基质炎患者的临床资料。对这些患者，给予自制阿昔洛韦地塞米松混合滴眼液并采用逐渐减量、长期使用的方式治疗，同时给予长期辅助口服抗病毒药治疗。定期随访患者的视力、角膜水肿及浑浊情况、眼压，并进行角膜内皮细胞镜、角膜荧光素染色和眼前节反应等指标检查。结果：治疗前患者的平均视力为（0.15±0.12），角膜中央直径2 mm范围内的平均角膜厚度为（652±116）μm，平均眼压为（17.8±2.5）mmHg。治疗3个月后，患者的眼部症状和体征均明显好转，平均视力为（0.58±0.35），角膜中央直径2 mm范围内的平均角膜厚度为（557±61）μm，平均眼压为（15.4±3.6）mmHg，平均角膜内皮细胞密度为（2453±559）个/mm2，临床总有效率为90.2%。结论：自制阿昔洛韦地塞米松混合滴眼液治疗难治性病毒性角膜基质炎的疗效确切。     

离心法制备胶原膜载释氟康唑治疗兔眼真菌性角膜炎的研究

目的 研究用离心法制得的角膜胶原膜载释氟康唑(普芬)眼液在兔眼真菌性角膜炎治疗中的应用.方法 从猪巩膜中提取、纯化胶原,采用离心法制备角膜胶原膜,在普芬眼液内浸泡用于治疗兔眼真菌性角膜炎.结果 胶原膜载释普芬眼液治疗组病灶愈合平均时间11 d,局部滴用普芬眼液组病灶愈合平均时间18 d,两组治愈率和有效率分别为78.94%、63.15%和92.10%、78.94%,差异有统计学意义(P<0.05).结论 应用离心法制得的胶原膜载释普芬眼液是治疗真菌性角膜炎给药途径的创新,具有广阔的发展前景.     

Efficacy of bromovinyldeoxyuridine in the treatment of herpes simplex virus and varicella-zoster virus eye infections

As has been established in rabbits, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) is superior to 5-iodo-2'-deoxyuridine (IDU) in the topical treatment of epithelial HSV-1 (herpes simplex virus type 1) keratitis, and superior to 5-trifluoromethyl-2'-deoxyuridine (TFT) in the topical treatment of deep stromal HSV-1 keratitis and HSV-1 uveitis. BVDU 0.1% eye drops have also proven efficacious in the treatment of patients with dendritic corneal ulcers, geographic corneal ulcers and stromal keratitis, and combined treatment of BVDU 0.1% eye drops with oral BVDU at 375 mg/day for 5 days led to a prompt healing of keratouveitis and skin lesions in patients with ophthalmic herpes zoster.     

玻璃体手术治疗增生性糖尿病视网膜病变39例

目的观察玻璃体手术治疗增生性糖尿病视网膜病变的疗效及并发症。方法回顾性分析39例（61眼）增生性糖尿病视网膜病变患者行玻璃体视网膜手术的临床资料。随访10-24个月,平均随访时间13．5个月。结果术后视力提高51眼（83．61％）,视力不变8眼（13．11％）,视力下降2眼（3．28％）。术前视力光感42眼,指数～0．0213眼,0．03～0．056眼。术后视力无光感1眼,光感2眼,指数～0．025眼,0．03～0．058眼,0．06～0．111眼,0．12～0．318眼,0．3以上16跟。并发症主要为术中出血和医源性视网膜裂孔。结论玻璃体手术治疗增生性糖尿病视网膜病变疗效佳,并发症少。     

碱性成纤维细胞生长因子滴眼液在单纯疱疹性角膜炎中的应用

目的 探讨碱性成纤维细胞生长因子滴眼液治疗单纯疱疹性角膜炎的临床疗效.方法 选取我院就诊的42例单纯疱疹性角膜炎患者,随机均分为对照组和实验组,对照组患者用更昔洛韦眼用凝胶联合无环鸟苷滴眼液进行治疗,实验组患者用更昔洛韦眼用凝胶联合碱性成纤维细胞生长因子滴眼液进行治疗.比较两组患者治疗痊愈率和总有效率、角膜溃疡改善情况及不良反应发生率的差异.结果 实验组患者痊愈率和总有效率分别为66.7％和90.5％,均显著高于对照组的28.6％和61.9％ （P＜0.05）;实验组角膜溃疡改善情况显著优于对照组（P＜ 0.05）;两组患者均无不良反应发生（P＞0.05）.结论 用更昔洛韦眼用凝胶联合碱性成纤维细胞生长因子滴眼液治疗单纯疱疹性角膜炎疗效确切,见效快,无不良反应.     

那他霉素联合氟康唑治疗外伤后真菌性角膜炎的疗效观察

目的探讨5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎的临床疗效及预后情况。方法选取2011年6月—2015年6月重庆市长寿区人民医院收治入院的外伤后真菌性角膜炎患者180例为研究对象,按随机数字表法将患者分为对照组和治疗组,每组各90例。对照组给予0.2%氟康唑滴眼液1~2滴/次,角膜病变轻度者1次/h,中度及重度者1次/0.5 h,同时给予氟康唑注射液1 m L结膜下注射,1次/d。治疗组在对照组的基础上加用5%那他霉素滴眼液交替点眼1~2滴/次,1次/1 h。两组均治疗2~3周。观察两组的临床疗效,同时比较治疗前后两组患者的角膜炎严重程度评分、视力以及随访90 d的预后情况。结果对照组、治疗组患者总有效率分别为73.3%、88.9%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后7、14 d,两组患者角膜炎严重程度评分显著降低,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的降低程度优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后两组总体视力均明显改善,同组治疗前后差异具有统计学意义(P0.05);且治疗组总体视力改善情况优于对照组,两组比较差异有统计学意义(P0.05)。随访90 d,对照组、治疗组预后中等以上比率分别为85.5%、96.7%,两组预后中等以上比率比较差异具有统计学意义(P0.05)。结论 5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎具有较好的疗效,能够显著降低角膜炎严重程度评分,明显改善患者视力和预后水平,值得临床运用和推广。     

Visual recovery using small dilating eye drops.

It is well established that reduced size dilating eye drops of 1% tropicamide and 10% phenylephrine (micro drops) are effective for clinical purposes. Excellent pupil dilatation (mydriasis) is achieved and pupil constriction does not occur in response to light. In this study, the effect of micro drops of 1% tropicamide on distance and near visual recovery was compared with standard drops in a group of 20 healthy volunteers. For each person studied, one eye was selected at random to be tested first with the standard drop size, and then after a minimum of one week, the same eye was again tested using a drop of the same drug one fifth standard size. An iris photograph, Snellen visual acuity at 6 m, and reading visual acuity was obtained for each test procedure: before drop instillation and at 30 min, 1, 2 and 4 h after drug instillation. Use of the micro drops caused a small but statistically significant improvement in the rate of recovery of distance and near visual acuity. These findings, allied to the known beneficial effects of reduced systemic absorption using micro drops, lend further weight to the argument that mydriasis may be achieved more safely, with fewer side effects, and with earlier return of normal vision when reduced size drops are used. It is hoped that practical micro drop dispensers will be developed.