准分子激光治疗性角膜切削术治疗角膜浅层病变的临床研究

目的探讨准分子激光治疗性角膜切削术(phototherapeutickeratectomy,PTK)的最佳适应证、治疗参数及评价其有效性。方法对角膜浅层病变30眼,包括角膜营养不良12眼,感染后角膜瘢痕7眼,钱币状角膜炎6眼,外伤性角膜瘢痕3眼和角膜带状变性2眼行PTK治疗,于术后1周、1、3、6月分别检查裸眼视力(UCVA)、最佳矫正视力(BCVA)和屈光状态等并回顾分析其疗效。结果术后6个月BCVA与术前比较提高21眼,不变4眼,下降5眼。术后6个月平均远视移动+1.52D,Haze0.5级5眼、1级2眼和0级23眼,原发病无1例复发。结论PTK治疗角膜浅层病变,简单、安全、有效,视不同疾病选择去除和非去除上皮PTK或PTK+PRK。适应证是角膜病变不超过前1/3角膜深度,以角膜营养不良和带状变性的疗效为佳。     

交替性内斜视手术治疗临床效果分析

目的:研究交替性内斜视的手术量.方法:对72例交替性内斜视采用相同检查方法,一组给同等量内直肌后徙术,另一组给不同量内直肌后徙术.结果:在术后1～6年的随访中,同等量后徙组保持正位(±10△),术后成功率为89%,非同等量后徙组手术成功率为80%.术后三级功能的建立,同等量后徙术显著优于非同等量后徙术.结论:交替性内斜视手术采用同等量内直肌后徙术,不但手术成功率高,而且有利于手术后双眼三级功能的建立.     

人工晶体植入术后后发性白内障手法后囊切开术

1993年10月至1998年12月我们采用手法后囊切开治疗53例人工晶体植入术后发生的后发性白内障,疗效良好.现报告如下.     

角膜缘干细胞移植术治疗翼状胬肉的疗效观察(附100例报告)

目的评估角膜缘干细胞移植术治疗翼状胬肉的疗效.方法对100眼行翼状胬肉切除联合角膜缘干细胞移植术,术后随访半年以上,与既往行翼状胬肉切除联合带蒂球结膜转移术的100眼对照.结果实验组治愈85例,好转10例,复发5例.对照组治愈70例,好转22例,复发8例,2组差异有显著性( P<0.05).结论角膜缘干细胞移植可提高手术疗效.     

下斜肌前移位术治疗先天性上斜肌麻痹原在位垂直性斜视的疗效观察

目的观察下斜肌前移位术治疗先天性上斜肌麻痹原在位垂直性斜视的疗效.方法对39例单侧先天性上斜肌麻痹原在位垂直性斜视≥15△的患者行下斜肌前移位术.手术前后采用三棱镜加交替遮盖法测定斜视度.根据原在位垂直性斜视程度将下斜肌断端移位至下直肌颞侧止端水平后1mm(15△～19△),止端水平(20△～24△),止端水平前1mm(≥25△)处.结果原在位垂直斜视度术前平均为21.0△,术后平均为5.4△,平均矫正15.6△.结论下斜肌前移位术是治疗＞15△的先天性上斜肌麻痹原在位垂直性斜视的首选术式.     

Lasik术后非接触眼压计测量值的变化

目的:探讨Lasik术后眼压测量值的变化及其规律.方法:分析72眼Lasik手术前、后非接触眼压的测量值及相关手术参数.结果:术后1周时眼压测量值较术前下降0.796±0.26kPa,下降值与切削深度呈正相关(r=0.3164,P<0.01),与预矫屈光度无显著相关性(r=0.2232,P>0.05),术后眼压下降比(眼压下降值/术前眼压)与切削比(切削深度/术前中央角膜厚度)呈正相关(r=0.3478,P<0.01).切削比与眼压下降比回归方程为:眼压下降比=0.1581+0.1329×切削比.结论:判断Lasik术后眼压测量值下降的最佳参数是切削比,其次为切削深度.     

外直肌后徙调整缝线术治疗儿童间歇性外斜视的探讨

间歇性外斜视是介于外隐斜与恒定性外斜之间的斜视,若延误治疗时机常变为恒定性外斜视,从而丧失双眼单视功能,对间歇性外斜视倾向于手术治疗,由于斜视度不稳定,通常的手术方法易产生术后眼位矫正不足。自1995年以来,我们对43例间歇性外斜视患儿行外直肌后徙调整缝线术,随访观察效果较好,现报告如下。 1 资料与方法 1.1 临床资料 1995年6月以来我们采用外直肌后徙调整缝线术治疗儿童间歇性外斜视43例,其中男28例,女15例。5～14岁,平均9岁。斜视度20△～96△,平均65.3△,随访2～10个月,平均6.1个月。     

加速型角膜胶原交联术治疗真菌性角膜炎的临床研究

目的 评价角膜胶原交联术(CXL)治疗真菌性角膜炎的安全性和临床效果。 方法 对2017年1月-2019年12月期间济南市第二人民医院眼表疾病科确诊为“真菌性角膜炎”的患者92例(92眼),进行CXL治疗(观察组);同时回顾性分析2016年1月~2017年2月本院真菌性角膜炎单纯应用药物治疗的患者47例(47眼)的临床资料(对照组)。入组标准:病变深度<角膜厚度2/3;浅层的角膜溃疡,病变未累及的正常角膜厚度>400 μm;病变直径在3~6 mm范围、病变位置均偏离或少量影响瞳孔区;共聚焦显微镜可见真菌菌丝,真菌培养结果为镰刀菌。对两组治疗效果进行对比分析。 结果 观察组在术后2周开始,最佳矫正视力有显著改善,治疗效果优于对照组,差异有统计学意义(P<0.001);术后3个月最佳矫正视力较术前有显著提高,效果优于对照组,差异有统计学意义(P<0.001);观察组治疗2周后所有患眼的病变范围均保持稳定或缩小,术后3个月时,全部患眼病变区域均形成云翳,检查上皮愈合良好;观察组术后2周和术后1个月的真菌检出阳性率明显低于对照组,两组差异有统计学意义(P<0.001);随访期间,观察组所有患者均无真菌性疾病复发,且无并发症出现。 结论 针对范围较小、偏中心的真菌性角膜炎,CXL可以显著缩短病程,提高视力,是一种安全有效的治疗方法。     

挫伤性晶体半脱位继发青光眼的手术治疗

目的观察5例挫伤性晶体脱位继发青光眼手术治疗的效果.方法2例行晶体摘除加前玻切,3例行闭合式扁平部三切口玻切.结果术后矫正视力最好为0.6,最差仅1例视力不能矫正.结论挫伤性晶体半脱位继发青光眼药物治疗眼压不能控制时,应采用手术治疗,但要慎重选择.     

深低温长期保存角膜穿透性移植治疗感染性角膜病的临床观察

目的:观察深低温长期保存角膜穿透性移植治疗感染性角膜病的临床效果.方法:应用深低温保存1～60月的健康人尸角膜为真菌性角膜炎10例、10眼和病毒性角膜炎4例、4眼行穿透性角膜移植术.结果:随诊1～19月,13例角膜植片透明(92.85%),1例半透明,无1例原发病复发,视力均有提高.结论:深低温长期保存的角膜是治疗急性致盲性角膜病的重要储备材料,有重要的临床应用价值.     

A model of canine tracheal stenosis induced by radiofrequency cauterization

Objective

The current methods of management of tracheal stenosis have disadvantages and are controversial, therefore ideal experimental animal models for the further studies are required. The aim of this study was to establish a new model of canine tracheal stenosis by radiofrequency cauterization.

Methods

The tracheal cartilage ring was injured by radiofrequency at the level of the sixth tracheal ring in 12 mongrel dogs. A fibrolaryngoscope was used to guide the procedure. The animals were observed after operation and examined after euthanasia. Endoscopic and histological examinations were undertaken to evaluate the progress of stenosis. The degree of stenosis was calculated using the formula: degree of stenosis = (initial lumen area − final lumen area)/initial lumen area × 100%.

Results

Tracheal stenosis had developed in all dogs by the 21st day post operation. Costal retraction was observed in all dogs after the 18th day post operation. At the end of the study, gross and endoscopic examinations showed that stenosis had been induced to a satisfactory degree and without any complications. The median of the degree of stenosis was 92%, with a range of 84-94%. Histological examination showed that cartilage was damaged and that granulation tissue and collagen fibres had formed.

Conclusions

The model of canine tracheal stenosis induced by radiofrequency cauterization is a relatively simple, reliable, and reproducible animal model. This model may be useful in the development of new methods of treatment for tracheal stenosis.     

Endoscopic cauterization of fourth branchial cleft sinus tracts

OBJECTIVE: To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses. DESIGN: Retrospective chart review with follow-up questionnaire. SETTING: Tertiary care children's hospital. PATIENTS: Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002. MAIN OUTCOME MEASURE: Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts. RESULTS: Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for follow-up, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery. CONCLUSIONS: Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.     

Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis

OBJECTIVES: The authors present a retrospective study concerning cauterization by endoscopic approach of the sphenopalatine artery in the treatment of severe posterior epistaxis. The purpose is to evaluate the effectiveness of these therapeutics, their complications, to determine their indications and their contributions to the therapeutic arsenal of the treatment of severe epistaxis. PATIENTS AND METHOD: This study concerns 10 patients, which have been operated in the department of ORL head and neck surgery of Strasbourg and treated over a 23-month period (from January 2001 to November 2002), for clinically labelled posterior origin epistaxis. A preliminary treatment, by anterior and posterior tamponage, using a Brighton Epistaxis Balloon was carried out (n = 8); the use of an associated ligature of the ethmoidal arteries was sometimes necessary during operative time (n = 4). RESULTS: Hemorrhagic control with absence of recurrence was the rule (n = 9). A complementary interventional radiology embolization due to failure was necessary in one case. The average duration of post-surgical hospitalization was of 2.1 days. No post-surgical complications were noted. CONCLUSION: Cauterization by endonasal approach of the sphenopalatine artery in severe posterior epistaxis is a reliable intervention. Its role is clearly defined in our department, after failure of traditional treatments by packing methods.     

Direct cauterization of the nasal septal artery for epistaxis

Emergency management of epistaxis may include the use of local pressure and vasoconstrictors, chemical or electric cautery, hemostatic agents, nasal packing, embolization, and surgical arterial ligation. There is no definitive protocol for the management of epistaxis, although various protocols have been proposed in the literature. As approaches to surgical ligation of the arterial supply of the nasal cavity have evolved from external carotid ligation to minimally invasive approaches, surgical management of epistaxis has become more effective than embolization and may be less risky. In the surgical management of epistaxis, arterial ligation immediately proximal to the bleeding site is preferred. We propose a simple variation of the endoscopic sphenopalatine artery ligation that may be used to manage epistaxis arising from the nasal septum and floor.     

Fistula of the fourth branchial pouch: apropos of a case treated by endoscopic cauterization]

Fistula of the fourth branchial pouch is a rare congenital cervical malformation. It typically affects child and occurs in the left side of the neck. Surgical removal of the entire fistulous tract through an external cervical approach is the treatment traditionally performed. We report a case of a right 4th branchial pouch in an adult managed through an endoscopic approach. Endoscopic cauterization of 4th branchial pouch may be considered as an attractive alternative procedure for the management of this congenital anomaly.     

Bilateral transnasal cauterization of the vidian nerve in vasomotor rhinitis.

A brief report of twenty cases of bilateral cauterization of the Vidian Nerve Canals in intractable non-atopic chronic Vasomotor Rhinitis by a Trans-Nasal approach not previously described is given. The authors find this approach to be a much safer and simpler procedure than either the Trans-Septal or the Trans-Antral routes. The advantages of this approach to the Vidian Nerve Canal over the Trans-Septal and Trans-Antral routes are discussed.