小切口圈垫式劈核白内障囊外摘除人工晶状体植入术的手术效果

目的：探讨小切口圈垫式劈核白内障囊外摘除人工晶状体植入术的手术效果。

方法：对75例80眼白内障应用圈垫器和劈核刀进行劈核取出,植入后房型人工晶状体,观察术后视力、散光度、及术中、术后并发症。随访3～12mo。

结果：术后第1d视力0.3～0.5者37眼,≥0.6者21眼,术后1mo 0.3～0.5者43眼,≥0.6者26眼。角膜散光在术后1wk为1.75±0.55D,与术前0.85±0.29D相比有显著差异(P<0.05),术后1mo 0.92±0.48D和3mo 0.89±0.35D与术前比较无显著差异(P>0.05)。4眼术中后囊破裂,1眼人工晶状体植入囊袋内,3眼人工晶状体植入睫状沟内。术后角膜内皮波纹状水肿2眼,术后3d左右消退; 斑块状水肿2眼,术后2wk内消退。一过性高眼压2眼。

结论：小切口圈垫式劈核白内障囊外摘除人工晶状体植入术治疗白内障术后效果好,手术成本低,操作简便,并发症小,值得临床推广应用。     

小切口白内障摘除联合小梁切除术治疗开角型青光眼合并白内障

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术治疗合并白内障的开角型青光眼的疗效。方法:回顾分析2011-01/2013-01在我院住院行小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术的34例34眼合并白内障的开角型青光眼的疗效,观察术后矫正视力、眼压、滤过泡及并发症等。结果:术后随访6~24mo。术后最佳矫正视力0.1~<0.3者4眼(12%),0.3~1.0者30眼(88%),术后6mo眼压14.7±0.8mmHg。术后1wk内34眼呈功能性滤过泡,6wk后28眼呈功能滤过泡,4眼滤过泡不明显,2眼滤过泡包裹并需加用1种局部降眼压药。术后并发症主要为角膜水肿12眼(35%),前房纤维素性渗出5眼(15%),浅前房6眼(18%),后发性白内障6眼(18%)。结论:小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术可有效治疗合并白内障的开角型青光眼。     

小切口无缝线白内障囊外摘除联合后房型人工晶状体植入术

目的　探讨小切口无缝线白内障囊外摘除联合后房型人工晶状体植入术的临床效果。方法　对 44例 (4 6只眼 )老年性及外伤性白内障施行小切口囊外摘除联合后房型人工晶状体植入术。结果　术后 1周矫正视力>0 .5者占 72 .4% ,3月后达 95 .7% ;术后 1周散光为 1.86± 0 .83D,术后 3月散光为 0 .89± 0 .6 1D,分别小于大切口 (10～ 12 m m) ECCE对照组 (P <0 .0 1)。结论　小切口无缝线白内障囊外摘除联合后房型人工晶状体植入术具有实用价值。     

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。     

反眉状及梯形两种巩膜小切口白内障囊外摘除联合IOL植入术的疗效对比

目的:观察反眉状及梯形两种巩膜小切口白内障囊外摘除联合人工晶状体植入术的临床疗效。方法:年龄相关性白内障患者89例113眼随机分为A组(43例56眼)和B组(46例57眼),分别采用反眉状及梯形两种无缝线巩膜小切口白内障囊外摘除联合人工晶状体植入术,术后1wk;1mo及3mo检查BCVA、角膜散光、眼压、人工晶状体位置以及并发症情况。结果:两组术后BCVA均较术前显著提高,差异有统计学意义(P<0.05),但术后角膜散光与术前比较差异无统计学意义;两组术后1wk;1mo及3moBCVA和角膜散光在组内和组间比较差异均无统计学意义。两组术后均未发生眼压异常升高、大泡性角膜病变和化脓性眼内炎等并发症。结论:反眉状及梯形两种无缝线巩膜小切口白内障囊外摘除联合人工晶状体植入术均具有术后视力恢复快、散光小、安全简便、不需要昂贵设备等优点,适合在基层医院推广应用。     

白内障隧道式小切口摘出并人工晶状体植入44例

目的:评价隧道式小切口白内障摘出人工晶状体植入术的疗效。方法:对44例53眼白内障行隧道式小切口白内障摘出人工晶状体植入术,术后1,2wk,1,3mo随访视力、角膜曲率及角膜散光。选角膜缘大切口白内障摘出40例51眼做对照。结果:小切口组术后1wk视力≥0.5者40眼占75%,≥0.8者27眼占53%,与对照组相比,P <0.01。小切口组角膜曲率变化小,稳定快,术后各期角膜散光明显小于大切口组。结论:隧道式小切口白内障摘出人工晶状体植入术术后反应轻,并发症少,散光小,视力恢复快而稳定,值得推广应用。     

青光眼滤过术后小切口白内障囊外摘除术的临床观察

目的　探讨青光眼滤过手术后进行小切口白内障囊外摘除后房型人工晶状体植入术的手术技巧及疗效。方法　对青光眼小梁切除术后白内障患者 138例 (14 2只眼 )采用颞侧隧道式切口及后房型人工晶状体植入手术 ,术后随访 1～ 12个月 ,平均 7月。结果　白内障术后患者视力均有不同程度提高 ,术后视力≥ 0 .2者占 73.2 % ,眼压平均 (12 .2 3± 3.96 ) mm Hg(1mm Hg=0 .133k Pa)。功能性滤过泡未见明显瘢痕化。结论　熟练掌握小切口白内障囊外摘出手术技巧 ,对青光眼滤过手术后白内障患者进行颞侧隧道式切口白内障囊外摘除术 ,可有效地提高术后视力 ,同时可保持良好的滤过功能     

小切口非超声乳化人工晶状体植入治疗老年性白内障40例临床观察

目的:探讨非超声乳化小切口囊外白内障摘出人工晶状体植入术治疗老年性白内障的临床效果。方法:对40例40眼老年性白内障患者采用巩膜隧道式小切口白内障囊外摘除术,同时植入后房型人工晶状体。观察术后视力恢复、散光情况及并发症。结果:术后随访1～36mo,裸眼或矫正视力<0.5者1例(2.5%),0.6～1.0者18例(45.0%),1.2～1.5者21例(52.5%)。术前、术后1mo和3mo平均散光分别为(0.90±0.81),(0.95±0.65)D和(0.93±0.60)D,术后1mo和3mo与术前比较都无显著差异(P>0.05)。主要并发症有角膜水肿、前房炎症反应。无娩核困难、后囊膜破裂、玻璃体脱出、人工晶状体植入失败和虹膜损伤等并发症。结论:小切口非超声乳化囊外白内障摘出人工晶状体植入术设备简单,操作易于掌握,切口小、创伤小、术后视力恢复良好、角膜散光小、并发症少。效果好、安全可靠、经济实惠,适于基层医院开展。     

白内障超声乳化手术846例分析

目的:免费开展白内障超声乳化摘除加人工晶状体植入的治疗。观察施行手术的治疗效果和并发症。方法:施行透明角膜切口,白内障超声乳化摘除联合人工晶状体植入术。观察术中术后并发症及效果。结果:术后1wk裸眼或矫正视力0.5～1.5者1205眼(93.41%);平均散光为1.15±0.53D。且1mo后基本恢复术前状态。并发症发生率为11.94%,且较轻,多能康复。结论:透明角膜隧道小切口白内障超声乳化摘除术,方法可行。术后视力恢复快,角膜散光少,术中、术后并发症少。     

青光眼白内障联合手术预置小梁切口的疗效

目的：探讨小切口白内障囊外摘出和后房型人工晶状体囊袋内植入联合预置小梁切口小梁切除术治疗青光眼合并白内障的临床疗效。 方法：对21例青光眼合并白内障患者实施白内障囊外摘出和后房型人工晶状体囊袋内植入联合预置小梁切口小梁切除术,观察术后患者视力、眼压及并发症情况。 结果：所有患者术后眼压均降至正常范围内。术后视力均有不同程度的提高。术后1眼发生早期人工晶状体前膜,2眼暂时性角膜水肿。 结论：预置小梁切口和小切口白内障摘除及后房型人工晶状体植入联合小梁切除是安全、有效、经济的治疗方法,值得推广。     

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.

---

     

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.