针拨联合球结膜下注射丝裂霉素C治疗功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(mitomycin C,MMC)球结膜下注射治疗青光眼患者小梁切除术后早期功能不良滤过泡的疗效.方法 对47例(50眼)小梁切除术后2～8周滤过泡功能不良青光眼患者行针拨联合MMC 0.2 mL(0.04 mg)结膜下注射,术后所有患者随访3～6个月,观察患者眼压、滤过泡形态和并发症.结果 小梁切除术后2～8周,低平、限局、肥厚、充血型滤过泡32眼、包囊型囊样滤过泡18眼.针拨联合MMC结膜下注射治疗后3～6个月,46眼的滤过泡转为功能性的,轻度膨隆弥散型31眼,多腔或薄壁型15眼,限局肥厚型或无滤过泡4眼.治疗前患眼的平均眼压为(28.5±6.5)mmHg(1 kPa=7.5 mmHg),随访3～6个月平均眼压为(16.3±2.9)mmHg,与注射前比较二者差异有统计学意义(P<0.05).46眼没有用抗青光眼药物或用一种抗青光眼药物眼压控制在21 mmHg以下,成功率占92%.治疗后视物模糊10眼,结膜下出血6眼,角膜上皮点状脱落2眼,无低眼压、伤口渗漏和前房变浅等并发症.结论 针拨联合MMC结膜下注射治疗小梁切除术后早期功能不良滤过泡是安全、有效、简单的方法.     

针拨联合球结膜下注射丝裂霉素C治疗新生血管性青光眼小梁切除术后功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(MMC)球结膜下注射治疗新生血管青光眼小梁切除术后功能不良滤过泡的疗效.方法 对25例(25只眼)因新生青光眼行小梁切除术后滤过泡功能不良者,进行针拨联合MMC0.2 ml(0.04 mg)球结膜下注射,观察视力、眼压、滤过泡和副作用,并随访6～12个月.结果 小梁切除术后低平眼局肥厚充血型18只眼、包囊型囊样7只眼.针拨联合MMC结膜下注射治疗后6～12个月,轻度膨隆弥散型11只眼,多腔或薄壁型8只眼,眼局肥厚型或无滤过泡6只眼.治疗前患眼的眼压为(32.5±5.5)mmHg,随访结束时具有功能滤过泡眼的眼压为(18.2±3.4)mmHg.与针拨前比较两者差异有统计学意义(P<0.05).19只眼眼压下降有效,成功率占75%.治疗后结膜下出血3只眼,前房出血5只眼,无低眼压、伤口渗漏和脉络膜渗漏及浅前房等并发症.结论 针拨联合MMC结膜下注射治疗新生血管性青光跟小梁切除术后功能不良滤过泡是安全、有效、简单的方法.     

丝裂霉素C结膜下注射联合针拨治疗功能不良滤过泡

目的：探讨丝裂霉素C（ mitomycin C,MMC）结膜下注射联合针拨治疗青光眼小梁切除术后功能不良滤过泡的疗效。方法：对36例39眼因青光眼行小梁切除术后2～12 wk滤过泡功能不良者进行MMC 0．1mL（0．2mg／mL）结膜下注射联合针拨治疗,平均治疗1．31±0．58次,观察眼压、滤过泡和并发症．并随访3 mo。
　　结果：治疗后3mo时平均眼压为15．8±6．6mmHg,显著低于治疗前平均眼压27．4±5．7 mmHg;成功滤过泡32眼,成功率为82．1％。结膜下出血7眼,浅前房低眼压1眼,无伤口渗漏和脉络膜渗漏等并发症。
　　结论：MMC结膜下注射联合针拨治疗小梁切除术后功能不良滤过泡是安全、简单、有效的方法。     

难治性青光眼早期功能不良滤过泡处理的临床观察

目的：观察难治性青光眼小梁切除术后早期功能不良滤过泡的处理方法、治疗效果,探讨有效、安全的早期功能不良滤过泡处理方法。

方法：收集我院2006-01/2012-01诊断为难治性青光眼且行小梁切除术后出现早期功能不良滤过泡(或倾向)者20例20眼于小梁切除术后3～8d进行治疗,治疗方法包括：眼球按摩、断(或拆除)巩膜缝线后再行眼球按摩、钝针头针拨分离滤过泡或联合结膜下注射5-氟尿嘧啶(5-FU)。所有患者术中曾用过抗代谢药丝裂霉素C(MMC, 0.3g/L)。随访6mo。

结果：经眼球按摩后有9眼获得功能滤过泡,联合钝针头针拨分离滤过泡治疗后有5眼为功能滤过泡,4眼经联合5-FU结膜下注射后为功能滤过泡,其综合成功率达90%。治疗前平均眼压24.61±5.4mmHg(1mmHg=0.133kPa),随访6mo结束时平均眼压为15.20±4.8mmHg,治疗前后眼压差异有显著统计学意义(P<0.01)。操作中和操作后未见任何并发症。

结论：难治性青光眼病情复杂,小梁切除术后极易出现早期功能不良滤过泡(或倾向),我们提倡尽早处理,综合眼球按摩、断(或拆除)巩膜缝线、钝针头针拨分离滤过泡或联合结膜下注射5-FU更安全有效,可很大程度上挽救早期濒临失败的滤过泡,提高手术成功率。     

针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡

目的:观察利用针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡的效果。方法:对抗青光眼小梁手术后3~22wk失败滤过泡34例(35眼)用针拨联合丝裂霉素C滤过泡旁注射,并随访6mo以上,观察滤过泡重新形成和眼压下降情况。结果:成功29例(29眼),手术前平均眼压为23.74±6.2mmHg,手术后眼压平均为13±4.3mmHg。其中3例(3眼)重复针拨、注射。随访期结束后统计针拨前后眼压具有显著性差异,Kaplan-Meier生存分析2a滤过泡成功率82.9%±6.4%。针拨术中有4眼前房出血,2眼低眼压,未见丝裂霉素的其它毒性反应。结论:针拨联合丝裂霉素C结膜下注射可以重新建立功能性滤过泡,有效地控制眼压,减少青光眼患者再次手术的痛苦。它是挽救抗青光眼术后失败滤过泡的一种良好的方法,具有毒性小、安全可重复的特点。     

丝裂霉素C联合针刺分离治疗无功能滤过泡的疗效

目的 对青光眼滤过术后功能不良滤过泡行丝裂霉素C(mitomycin C,MMC)球结膜下注射联合针刺分离术,观察其疗效.方法 对25例(27眼)青光眼术后滤过功能不良患者行MMC球结膜下注射联合针刺分离术,观察眼压、滤过泡及不良反应.结果 术后随访6～48个月,平均(23.0±9.7)个月.术后3个月眼压均有下降(P<0.01),其中16眼达到成功标准,成功率59.3%,7眼为部分成功,占25.9%,4眼失败,占14.8%.结论 球结膜下注射MMC联合针刺分离术对青光眼小梁切除术后功能不良滤过泡是一种安全、有效及相对简便的处理方法 .(中国眼耳鼻喉科杂志,2009,9:150-152)     

MMC与青光眼小梁切除术后并发症的关系

目的观察青光眼滤过术中应用丝裂霉素C(MMC)的效果。方法对36例42眼青光眼患者行小梁切除术,术中应用0.4g·L-1MMC,时间为4min,观察术后并发症的发生、滤过泡的形成以及术后1月、3月、6月的眼压变化情况。结果(1)并发症:术后早期出现低眼压性浅前房(眼压≤5mmHg)4眼,薄壁滤过泡5眼,滤过泡渗漏2眼;角膜上皮点状或弥漫缺损3眼,均在3~7d内自行恢复;术后前房有少量出血者2例,3d内自行吸收。(2)滤过泡:Ⅰ、Ⅱ型滤过泡36眼;Ⅲ型滤过泡4眼;Ⅳ型滤过泡2眼。(3)眼压:术后1月42眼、术后3月38眼、术后6月34眼眼压均在10~20mmHg(1kPa=7.5mmHg)。需用一种降眼压滴眼液可控制在20mmHg以下有6眼,眼压控制不良再手术有2眼。结论青光眼小梁切除术后由于MMC应用不当而发生的并发症及其他不良后果仍不容忽视。     

非穿透小梁切除联合羊膜移植并MMC湿敷治疗开角型青光眼

目的：探讨非穿透小梁切除联合羊膜移植并丝裂霉素C(MMC)湿敷治疗开角型青光眼的疗效。 方法：对原发性开角型青光眼30例42眼行非穿透小梁切除联合羊膜移植并MMC湿敷。 结果：术后平均随访18mo,术前眼压35.76±6.34mmHg,术后13.82±4.22mmHg。视力有12眼较术前提高,26眼无变化,4眼术后视力下降。视野有34眼视野较术前扩大,8眼视野无变化。弥散扁平滤过泡38眼,限局性隆起滤过泡3眼,瘢痕机化泡消失1眼。全部病例无浅前房发生。 结论：非穿透小梁切除联合羊膜移植并MMC湿敷是一种安全、有效、经济的治疗开角型青光眼的滤过手术。     

针刺分离术联合丝裂霉素C球结膜下注射治疗包裹性囊状滤过泡

目的 通过针刺分离术联合滤过泡旁注射丝裂霉素C(MMC)治疗小梁切除术后包裹性囊状滤过泡.方法 21例小梁切除术后并发包裹性囊状滤过泡的患者行针刺分离术后,滤过泡旁注射MMC,随访观察眼压和滤过泡形态.结果 治疗前平均眼压为29.77±3.76 mmHg,治疗后为18.95±5.49 mmHg,P＜0.01.治疗后Ⅰ型滤过泡5眼;Ⅱ型滤过泡12眼;Ⅲ型滤过泡4眼.结论 用此法治疗小梁切除术后包裹性囊状滤过泡有显著效果.     

非穿透性小梁手术中应用丝裂霉素C32例

目的:观察非穿透性小梁手术联合应用丝裂霉素C(mitomycin,MMC)的临床疗效及超声生物显微镜表现。方法:开角型青光眼患者32例(44眼)行非穿透性小梁手术联合应用MMC。术后观察视力、眼压、滤过泡,并做超声生物显微镜检查。结果:术后随访6～18mo。术前平均眼压(34.64±8.37)mmHg(1mmHg=0.133kPa),术后(13.63±3.64)mmHg。随访期间眼压≤21mmHg者44眼,其中4眼(9%)加用1种抗青光眼药物,40眼(91%)不用抗青光眼药物。其中2眼在术后的2wk后即出现结膜下组织的瘢痕化而进行了第2次手术,手术后1眼眼压<21mmHg,另1眼经用5g/L噻吗心安后眼压<21mmHg。术后35眼无任何眼内反应;4眼有轻微房水闪光,2d内消失;5眼有少量前房积血,4～7d消失,其中1眼为术后1d打喷嚏后出现。术后44眼均形成显著弥散的滤过泡;最后1次随访时,有39眼有功能性滤过泡;5眼于术后的1～3mo时功能性滤过泡消失。在术后3mo和6mo时用UBM检查除4眼巩膜湖为一狭长缝隙外,40眼均为明显的巩膜湖,巩膜湖最大长度为1.56～3.2mm;滤过泡处的结膜下组织可见明显的低于其它部分的弱回声区,有的可见到比较明显的结膜下空腔。结论:非穿透性小梁手术联合应用MMC可有效降低眼压,术后并发症少,为一种经济有效的抗青光眼手术。     

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.