超声乳化联合小切口硬核白内障摘除的临床观察

目的 探讨贫困地区超声乳化联合小切口硬核白内障摘除联合PMMA人工晶状体植入手术的疗效。方法 对336例(336只眼)Ⅳ级以上核白内障行超声乳化联合小切口晶状体摘除联合PMMA人工晶状体植入术。结果 术后1天、3天视力在0．5以上分别为240只眼(71．4％)、265只眼(78．8％)。术中主要并发症为后囊破裂。术后主要并发症为角膜水肿、眼压升高。结论 超声乳化联合小切口晶状体摘除治疗Ⅳ级以上核白内障切口小，术后反应轻，散光小，并且视力恢复快，费用低。手术技巧的提高可避免或减少术中术后并发症。     

抗青光眼滤过术后超声乳化白内障摘除术

目的：探讨抗青光眼滤过手术后进行表明角膜缘切口超声乳化白内障摘除手术的可行性。方法：对抗青光眼小梁切除术后白内障患者32例（32只眼）、采用颞侧透明角膜隧道切口进行超声乳化白内障摘除及囊袋内人工晶状体植入手术,同时对的小瞳孔进行扩张或采用括约肌切开。结果：白内障术后患者视力不同程度提高,视力≥0．5者占68．75％;眼压正常。结论：对抗青光眼滤过术后白内障患者进行颞侧透明角膜隧道切口超声乳化白内障摘除术,可提高视力,同时可维持原滤过功能。     

白内障超声乳化硬性人工晶状体植入术210眼

目的:探讨表麻下颞侧透明角膜切口、超声乳化白内障摘除及硬性人工晶状体植入术的疗效。方法:表面麻醉下,经颞侧透明角膜做切口,对210眼老年性白内障超声乳化摘除,植入PMMA一体式硬性人工晶状体,观察术后视力、角膜散光、人工晶状体位置等术后并发症。结果:术后不同时间视力恢复情况:≥0.51d140眼(66.7%),1wk167眼(79.5%),1mo183眼(87.1%),3mo195眼(92.8%)。术前角膜散光(0.75±0.58)D,术后角膜散光1wk,1,3mo,分别为(0.85±0.75)D,(0.82±0.56)D,(0.77±0.54)D;术前角膜散光与术后1wk,1,3mo均无显著差异(P>0.05)。角膜不同程度水肿37眼(17.6%),角膜上皮散在浅点状脱落3眼(1.4%)。结论:超声乳化白内障摘除及硬性人工晶状体植入术是一种经济有效的术式。     

两种手术方式在青光眼术后硬核白内障摘除术中的对比研究

目的观察透明角膜切口超声乳化与超声劈核后手法娩核治疗青光眼术后硬核白内障的初步临床疗效,并探讨其手术技巧。方法对青光眼术后硬核白内障患者32例（40只眼）随机分组,观察组20只眼采用透明角膜切口超声劈核后手法娩核,对照组20只眼采用超声乳化碎核,两组均联合后房型人工晶状体植入。对比两组术后视力、眼压及角膜内皮细胞数量变化等。结果两组术后视力、眼压无显著性差异,观察组术后角膜内皮减少数量低于对照组。结论透明角膜切口超声劈核后手法娩核治疗青光眼术后硬核白内障更具有安全性和有效性。     

硬核白内障小切口水平手法劈核与超声乳化手术临床疗效观察

目的:评价白内障小切口水平手法劈核与超声乳化摘除手术的手术方法和疗效。方法:回顾2007-11/2009-08间210例249眼行小切口水平手法劈核白内障手术,199例227眼行超声乳化白内障手术,均联合人工晶状体植入术,比较两组术后视力、散光、术中术后并发症差异。结果:术后1mo小切口非超乳和超乳的视力≥0.5分别为205眼(82.3%)和191眼(84.1%),术后3mo散光分别是(0.95±0.51)D和(0.89±0.78)D,两组差异均无统计学意义。角膜反应术后1mo全部消退。无术后感染或角膜失代偿等严重并发症。结论:小切口非超声乳化白内障摘除人工晶状体植入术与白内障超声乳化摘除人工晶状体植入术两种手术方式疗效相近,同样具有安全、视力恢复快、术后散光小的优点。     

抗青光眼术后白内障手术方式的探讨

目的 观察三种不同切口摘除青光眼术后白内障的视力及眼压的变化。方法 对我院1990-2001年的抗青光眼术后白内障手术108例110眼进行分类观察，其中颞侧角巩膜大切口囊外摘除人工晶状体植入术62例62眼，上方透明角膜大切口囊外摘除人工晶状体植入10例10眼，颞侧透明角膜超声乳化及人工晶状体植入术36例38眼。分别检查视力和眼压并进行比较。术后观察3-24月。结果 三种手术方式术后视力和眼压分别为：术后矫正视力0.1以上者，角巩膜缘组61.29%，透明角膜组50.0%，超声乳化组86.84%。术后眼压正常者，角巩膜缘组88.7%，透明角膜组100%，超声乳化组100%。结论 术中避开滤过泡选择颞侧透明角膜切口超声乳化及人工晶状体植入术。术后以应轻、并发症少，恢复快，眼压稳定。     

小梁切除手术史对白内障超声乳化摘除手术的影响

目的 探讨闭角型青光眼既往小梁切除手术史对白内障超声乳化摘除联合人工晶状体植入手术早期眼压和视力的影响。方法 对闭角型青光眼28只眼(其中既往有小粱切除手术史者16只眼，无小梁切除手术史者12只眼)行透明角膜缘切口白内障超声乳化摘除及人工晶状体植入术，对其术前及术后视力，术前及术后1、2、3及6天眼压进行比较分析。结果 既往有／无小梁切除手术史两组之间手术前后眼压、视力及视力提高幅度均无显著性差异。结论 既往小梁切除手术史对透明角膜缘切口白内障超声乳化摘除联合人工晶状体植入手术对术后早期眼压和视力无显著影响。     

硬核白内障小切口非超声乳化摘除人工晶状体植入术

目的：探讨硬核白内障小切口非超声乳化摘除人工晶状体植入术的疗效及并发症。方法：68例（68只眼）硬核白内障通过6mm小切口用劈核器碎核摘除联合人工晶状体植入（称非超声乳组）；随机抽取32只眼白内障超声乳化摘除人工晶状体植入（简称超乳组）作为对照组。结果：术后一周视力≥0．5，非超乳组50只眼（78．09％）；超乳组26只眼（81．25％），两组差异无显著性（P＞0．05），两组均采用巩膜隧道切口术后散光均较小。非超乳组主要并发症为：可逆性角膜内皮混浊，后囊膜破裂。结论：硬核白内障用劈核器碎核摘除人工晶状体植入术创伤小，技术难度小，费用低，并发症少，视力恢复好。     

小切口手法碎核人工晶状体植入术治疗硬核白内障

目的探讨小切口手法碎核对硬核白内障摘出人工晶状体植入临床效果。方法作角膜缘后反眉弓5.5mm巩膜隧道切口,采用晶状体硬核手法碎核技术对70例（70眼）白内障摘出,并植入折叠式或PMMA人工晶状体。结果 69眼成功完成手法碎核,劈核器对力不均造成晶状体2眼翻转致后囊破裂。术后1周裸眼或球镜矫正视力≥0.5者占92.86%,术后1周平均散光为（1.23±0.75）D。结论反眉弓巩膜隧道小切口手法碎核人工晶状体植入术不需特殊设备,简便易行,其效果可与超声乳化术媲美,可有效地减少术后角膜散光,早期获得良好的视力,降低手术费用。     

反向与常规结合方式白内障超声乳化摘除人工晶状体植入术临床观察

目的探讨反向与常规结合方式白内障超声乳化摘除人工晶状体植入术临床效果。方法采用反向与常规结合方式施白内障超声乳化摘除人工晶状体植入术1006例（1167只眼）。晶状体核硬度Ⅱ-Ⅲ级核915只眼,Ⅳ级核241只眼,Ⅴ级核11只眼。预置超声能量30%～50%,超声乳化负压100～350mmHg,在陡经线上做上方、颞上方或鼻上方透明角膜缘切口或巩膜隧道切口,使用斜面为45°超声乳化针头,根据核硬度不同分别采用刻槽式分而治之法或拦截劈裂法。超声乳化过程中超声乳化针头斜面朝下,雕刻沟槽分割晶状体核成四块或拦截劈裂晶状体核成多块后,超声乳化针头斜面改为朝上,将超声乳化针头自断面插入核实质形成全堵状,依次乳化吸除。抽吸净晶状体皮质,囊袋内植入人工晶状体。979只眼植入折叠人工晶状体,188只眼植入一片式硬人工晶状体。术后1、3、7、30d检查术眼。结果术中累积超声能量1.08±0.24。术后第1天视力≥0.6者999只眼,术后第3天视力≥0.6者1097只眼,术后7天视力≥0.6者1112只眼,术后第30天本组病例平均矫正视力0.8。术后第1天角膜水肿24只眼,发生率2.05%,术后第3天角膜水肿4只眼,发生率0.03%,术后第7天角膜水肿全部消退。术中晶状体后囊破裂13只眼,发生率为1.11%,无晶状体核脱入玻璃体内,无眼内出血及眼内炎等严重并发症发生。结论反向与常规结合方式白内障超声乳化摘除人工晶状体植入术,术中适时调整超声乳化针头斜面的方向,减少无效超声能量的逸散,提高超声能量使用的效率与安全性,既避免或减少角膜内皮损伤又降低了晶状体后囊破裂的发生率。     

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.