葡萄膜炎小瞳孔后粘连白内障人工晶状体植入术

目的 探讨葡萄膜炎并发白内障虹膜后粘连小瞳孔状态下的手术技巧、合理用药及疗效。方法 借助粘弹剂分离虹膜后粘连,并采用非切开的瞳孔扩攻忝型术及膜闭切除术,对32例（36眼）伴有虹膜后粘连且瞳孔不能放大的葡萄膜炎并发性白内障,行囊外摘出联合人工晶状体植入手术。结果 36眼术后28眼（77.8%）瞳孔恢复原状,8眼（22.2%）瞳孔呈欠规则的类圆型,术后3月矫正视力≥0.5者30眼（83.3％）,0.1－0.4者6眼（16.7％）。结论 虹膜后粘连小瞳孔状态下葡萄膜炎并发白内障囊外摘出联合人工晶状体植入可获得良好的视力和术后圆瞳孔而无严重并发症。     

葡萄膜炎并发白内障人工晶状体植入术

目的 探讨葡萄膜炎所致并发白内障的人工晶状体植入术。方法 37例（40眼）葡萄膜炎后严重后粘连并发白内障采用切除瞳孔区机化前囊、瞳孔缘切开、充分水分离晶状体核,完成人工晶状体植入。并对手术技巧和术后处理进行探讨。结果 术后视力：0.1及以下者3眼（7.5%）,0.2－0.5者13眼（32.5%）,0.6-1.0者24眼（60％）;无严重并发症。结论 葡萄膜炎并发白内障人工晶状体植入术临床效果良好。     

葡萄膜炎并发白内障两种手术方法的探讨

目的 介绍2种小瞳孔下行葡萄膜炎并发性白摧障摘出和瞳孔成形的手术方法。方法 30例34只葡萄膜炎严重后粘连并发性白内障的眼接受了该2种手术，手术方法：91）剪除瞳孔区机化的前囊膜，瞳孔缘剪开，水分离核，囊袋内晶关於 本圈匙反转娩出晶状体体核。人工晶状体（IOL）植入；（2）上方虹膜根部切除，分离并剪开上方虹膜，超声乳化白内障摘出，IOL植入，最后缝合上方虹膜，人造圆形瞳孔。结果 术后34眼瞳孔均在3.0-3.5mm，并保持圆形，均无后囊膜破裂，无严重并发症发生，视力均比术前有不同程度的提高。结论 葡萄膜炎并发白内障。在采用所介绍的2种手术方法后能获得良好的视力和圆形瞳孔，而无严重并发症。     

葡萄膜炎并发白内障的超声乳化术疗效观察

目的：寻求一种对葡萄膜炎伴粘连性小瞳孔白内障的摘出更有效的方法。方法：对62例（68只眼）小瞳孔白内障患者施行超声乳化联合人工晶状体植入术，随访3－12个月。结果：术后68只眼瞳孔基本圆，94.1％的患者视力有不同程度的改善，随访3个月以上的61只眼中，52只眼视力＞0.5。术中后囊破裂4例，术后角膜水肿23例，瞳孔纤维渗出膜4例。结论：粘连性小瞳孔白内障采用超声乳化吸出术，能获得良好的视力和圆瞳孔，能减轻对虹膜的刺激、损伤，减少术中、术的并发症。     

角膜穿孔伤三联术的临床观察

目的：探讨单纯性角膜穿孔伤合并外伤性白内障同时进行清创缝合、外伤性白内障摘出加人工晶状体植入三联手术的效果。方法：对1997－2000年在我院因旁中央及近角膜缘的角膜穿孔伤合并外伤性白内障行三联手术的25例进行回顾性分析。结果：术后随访3月－3年，术后视力≥0．3者21例（80．4％），视力≥0．5者10例（40％），术后并发症主要有：角膜水肿、人工晶状体前后膜性渗出、后发性白内障及瞳孔粘连等。结论：同时行角膜清创缝合、外伤性白内障摘出和人工晶状体植入三联手术可达到迅速恢复视力、重建双眼单视功能和立体视觉，减少手术并发症、减轻患者的痛苦和经济负担的效果。     

小瞳孔下小切口白内障摘除及人工晶状体植入术

目的:探讨在小瞳孔状态下白内障手术的操作方法和技巧。方法:对42例46眼小瞳孔白内障患者,行巩膜隧道小切口,利用黏弹剂钝性分离虹膜后粘连或瞳孔缘放射状剪开的方法扩大瞳孔,白内障囊外摘出,植入后房型人工晶状体。结果:术后随访6~18mo,所有病例术后视力均有不同程度提高。最佳矫正视力0.04~0.1者8眼(17%),0.2~0.5者18眼(39%),0.6~1.0者20眼(44%),其中视力<0.1者均为眼后段病变所致,未出现严重并发症。结论:掌握好手术适应证和手术技巧,小瞳孔下小切口白内障摘除及人工晶状体植入手术同样能取得良好的临床效果。     

白内障小切口囊外摘出术与传统囊外摘出术效果的分析

目的分析白内障小切口非超声乳化囊外摘出术与传统囊外摘出术效果。方法回顾分析白内障复明行动中老年性白内障手术1437例（1675眼）。患者随机分成两组,分别采用小切口非超声乳化白内障囊外摘出与传统的囊外摘出术两种方法进行手术,术中都植入人工晶状体。其中,小切口组（A组）,716例（846眼）;传统囊外摘出组（B组）,721例（829眼）。对两组手术效果（术后视力及并发症）进行分析和比较。结果两组术后7d视力比较：A组,视力低于0．3者59眼（6．97％）,0．3～0．5者183眼（21．63％）,0．5以上者604眼（71．5％）;B组,视力低于0．3者128眼（15．44％）,0．3～0．5者583眼（70．32％）,0．5以上者118眼（14．23％）。并发症有角膜水肿、虹膜损伤、前房积血、后囊破裂、玻璃体脱出及瞳孔夹持。两组比较：A组发生并发症260眼（30．73％）,B组发生并发症388眼（46．8％）。两组术后视力及并发症差异有统计学意义（视力：x^2=30．26,P〈0．01;并发症：x^2=45．59,P〈0．01）。结论在大规模白内障复明行动中,应用小切口无缝线非超声乳化白内障囊外摘出术较传统的白内障囊外摘出术术后视力较好,手术并发症较小,且无需昂贵的设备及特殊器械,手术步骤简单．适宜基层医院开展。     

严重虹膜后粘连的并发性白内障摘出人工晶状体植入术

探讨减少严重虹膜后粘连的并发性白内障囊外摘出人工晶状体植入术后的并发症。方法对１４例伴有严重虹膜后粘连的并发性白内障，不强行分离虹膜后粘连，采用垂直径剪开瞳孔上下方虹膜达中段，线状截囊，囊袋内晶状体摘出及ＩＯＬ植入。结果术后随访６－２５个月，无严重并发症发生，术后视力０．５以上者达２９．４％。     

葡萄膜炎并发白内障的手术摘出

目的探讨葡萄膜炎并发白内障手术摘出的技巧和方法。方法采取角膜缘后小切口，常规虹膜根切，借助黏弹剂分离虹膜后粘连，囊外摘出白内障及植入人工晶状体。瞳孔过小者做瞳孔缘放射状剪开。结果在21例23眼手术中有2眼后囊破裂，2眼前房积血，其他均手术顺利，术后反应轻，视力提高达0．2～0．8。结论此手术方法操作简单，并发症少，术后恢复良好。     

小瞳孔下白内障超声乳化联合人工晶状体植入术的疗效观察

目的 探讨在小瞳孔下白内障超声乳化联合人工晶状体植入术的临床疗效.方法 采用超声乳化白内障摘出联合人工晶状体植入术治疗并发性小瞳孔白内障患者20例(32眼),对于虹膜粘连或非粘连、瞳孔不能散大者,前房内注入黏弹剂,双手持调位钩适当牵拉,扩大瞳孔.如果瞳孔缘有膜状纤维组织,可用囊膜剪环形剪除瞳孔域的机化纤维膜和部分瞳孔缘虹膜.对于瞳孔膜闭者,用截囊针沿瞳孔缘在机化膜上钩出小孔后,撕去或剪除机化膜.并用高负压(100～400 mmHg,1 kPa=7.5 mmHg)、低能量(20%～50%)、原位劈核法进行手术.结果 32眼术前裸眼视力或矫正视力均≤0.4,术后1周1≥0.5者20眼(62.5%),术后1个月、3个月≥0.5者均为27眼(84.4%).术后患眼瞳孔全部接近圆形或椭圆形,部分患者瞳孔直径较术前偏大;无人工晶状体明显偏位.结论 在小瞳孔下行白内障超声乳化联合人工晶状体植入术手术复杂,手术技巧、手术时机以及并发症的处理等是手术治疗成功的关键因素.     

Blindness and visual impairment in the Americas and the Caribbean

AIM: To summarise available data on the prevalence and causes of visual impairment and blindness in the Americas and the Caribbean. METHODS: The published literature was searched in Medline and LILACS using the following key words: blindness, visual impairment, prevalence. Articles were reviewed, and the references of the articles were also searched for relevant articles, which were also reviewed. RESULTS: Using the mortality in children under the age of 5 as an indicator, the overall prevalence of childhood blindness (in the under age 15 group) for the region was estimated at 0.45/1000, with the majority (67%) living in countries with mortality of children under age 5 above 30/1000 live births. Corneal opacities were more common in countries where the under 5 year mortality are above 30/1000 live births and retinopathy of prematurity (ROP) was an important cause in countries with intermediate death rates. For adults, overall blindness rates were not estimated because of the social, economic, and ethnic diversity in the region. The primary causes of visual loss in adults in the Americas were age related eye diseases, notably cataract and glaucoma in the African-American and Hispanic populations, and age related macular degeneration in the white population. Uncorrected refractive error was a significant cause of decreased vision across ages, ethnic groups, and countries. CONCLUSION: More data are needed on the magnitude and causes of visual loss for the Caribbean and Latin American countries. Rates of blindness and visual loss from available data within these countries are widely disparate. Prevention and control of avoidable blindness needs to be an ongoing focus in this region.     

甲状腺相关眼病患者及正常人眼眶成纤维细胞的培养和鉴定

目的:体外培养甲状腺相关眼病患者和正常人的眼眶成纤维细胞,并进行比较、观察及鉴定。方法:采用组织块培养法,体外培养甲状腺相关眼病患者和正常人的眼眶成纤维细胞,并进行细胞形态观察及免疫组织化学鉴定。结果:甲状腺相关眼病患者与正常对照的眼眶成纤维细胞形态区别不明显,Vimentin染色均呈阳性,而Desmin,S-100,CK均呈阴性。结论:甲状腺相关眼病患者与正常人的眼眶成纤维细胞体外培养的形态及免疫组织化学鉴定无明显差异。     

Diffusion of the human retina and quality of the optics of the eye on the fovea and the peripheral retina

The linespread profile after double passage through the eye has been measured previously. We show that one cannot separate the contributions of the optics of the eye and of the retina to image degradation with this last method. We present here a new method which allows just such a separation. We have measured the modulation transfer function of the optics of the eye in the visual axis and oblique axes, and a function which characterizes light scattering in different portions of the living retina.     

Relationship between vitrectomy and the morphology and function of the retina

Pathological processes in the vitreous will be reflected in the morphology and function of the retina, and these processes can originate from sources outside the vitreous. The purpose of vitreous surgery is to remove the qualitatively and/or morphologically diseased vitreous. Successful vitrectomy will be manifested by an improvement in the structure and/or function of the retina. We have evaluated the morphology of the vitreoretinal interface, and the function of the retina before and after vitreous surgery. Plasmin-assisted vitrectomy was used in some cases to remove the diseased vitreous more efficiently and less invasively. The effect of this procedure was assessed by examining the morphology and function of the retina. First, the relationship between the qualitative and structural abnormality of the vitreous in macular diseases was studied. In aphakic/pseudophakic eyes with cystoid macular edema, there was a depression of retinal function over the entire retina which may have been caused by chemical mediators released into the vitreous. These mediators may have been produced by inflammation in the anterior segment of the eye. In eyes with an idiopathic macular hole, optical coherence tomographic (OCT) images suggested that the progression of the macular hole might depend on a balance between foveal adhesion and the posterior vitreous. Second, the efficacy, surgical damage, and limitations of vitreous surgery were investigated. The recovery of macular function was assessed by focal macular electroretinograms (FMERGs) after vitrectomy for epiretinal membrane, choroidal neovascularization, and diabetic macular edema. The concurrent examination by optical coherence tomography (OCT) suggested that a decrease in retinal thickness contributed to the functional recovery. Macular functional recovery was delayed and limited after macular translocation, diabetic macular edema, and internal limiting membrane peeling. Third, we studied the effect of plasmin-assisted vitrectomy on the retina. The plasmin was used to remove the vitreous more completely and less invasively. In rabbits, ERG, OCT, and histological examinations demonstrated that the use of commercially-available plasmin at a concentration used on human patients resulted in temporary adverse effects on the retina. For human patients, we purified the plasmin from the patients' serum at the Nagoya University Hospital and the activity was about the same as in previous reports. The purified plasmin was approved by our hospital's institutional review board, and written informed consent was obtained from each patient. Patients with macular edema, idiopathic macular hole, and epiretinal membrane without posterior detachment underwent plasmin-assisted vitrectomy and were evaluated morphologically and electrophysiologically. The efficacy of the plasmin in separating the vitreo-retinal interface was demonstrated by an occasional spontaneous posterior vitreous detachment with or without core vitrectomy, and the presence of less vitreous cortex attached to the internal limiting membrane that was removed during vitrectomy. This was the first histological demonstration of the effectiveness of plasmin in the living eye. Full-field ERGs before and after surgery demonstrated clear evidence that no alteration of retinal functional had occurred, although we did detect a possible osmotic effect by an increase in OCT-determined retinal thickness by the high-molecular weight autologous plasmin. In future studies, the proper concentration and reaction time for each condition of the vitreous should be determined. In conclusion, the pathophysiology of the vitreous should reflect the retinal function. The recovery of the structure of the retina is important for the recovery of retinal function. This should always be the primary goal of surgeons who perform quality surgery.