玻璃体切割术联合巩膜扣带治疗复杂性视网膜脱离

目的:探讨玻璃体切割术联合巩膜扣带治疗复杂性视网膜脱离的疗效。方法:采用玻璃体切割术联合巩膜扣带治疗复杂性视网膜脱离27例,分别为脉络膜脱离型视网膜脱离、病理性近视性视网膜脱离、玻璃体积血并视网膜脱离、增生性玻璃体视网膜病变、玻璃体切割术后视网膜脱离复发、硅油眼视网膜脱离复发。结果:一次手术复位24例,复位率89%。主要并发症有高眼压。结论:玻璃体切割术联合巩膜扣带是治疗复杂视网膜脱离的有效方法。     

玻璃体切割加巩膜扣带术治疗视网膜脱离

目的：探讨玻璃体切割术中、术后巩膜扣带术的应用范围。方法：在玻璃体切割术中发现视网膜裂孔不能与脉络膜紧贴的患，或术后视网膜裂孔封闭不理想并伴有局限性视网膜脱离，按常规行巩膜扣带术。结果：87眼中，玻璃体切割术中行巩膜扣带术36眼，术后行扣带术42眼，玻璃体切割术中及术后各行1次扣带术6眼，术后行2次扣带术3眼，其中视网膜复位79眼，失败的8眼中，有6例行第2次玻璃体切割术，视网膜复位5眼。结论：巩膜扣带术适合于视网膜增厚及视网膜前后膜增殖不严重、裂孔小、视网膜脱离范围不大的患。     

单纯巩膜扣带术治疗硅油填充眼视网膜脱离

目的　探讨单纯巩膜扣带术治疗硅油填充眼复发性视网膜脱离的临床疗效。方法　选取我院行玻璃体切割联合眼内硅油填充术后复发性视网膜脱离 2 1例 2 1眼 ,采用单纯巩膜扣带术 ,术中放出少许硅油调整至正常眼压。结果2 0眼视网膜复位 ,1眼 2月后视网膜脱离复发 ,行硅油取出、膜剥离再次硅油填充术后视网膜复位。 2 1例最终视力较术前提高 ,随访 3～ 2 4个月 ,视网膜复位好。结论　单纯巩膜扣带术治疗硅油填充眼视网膜脱离中的部分病例具有一定价值 ,特别是对未合并广泛前部和 (或 )后部增生性视网膜病变的下方象限或周边部裂孔引起的视网膜脱离有较好的治疗效果 ,不一定需再行玻璃体切割术     

充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离

目的 观察充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离的疗效.方法 回顾分析我科经充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离13例(13眼)孔源性视网膜脱离或合并增生性玻璃体视网膜病变(PVR),其中PVR A级3眼,B级6眼,C1级3眼,C2级1眼;黄斑部脱离4眼.眼轴长度21.45-28.47 mm.前次手术采用单纯巩膜外加压8眼,环扎联合加压3眼,环扎联合加压、注气2眼.患眼于本次术中玻璃体腔内注入纯全氟丙烷(C3F8)气体0.5-1.0ml,术后严密观察,保持适当体位,确保气泡封闭裂孔.结果 手术后随访2-13月,12眼视网膜完全复位.1眼因PVR进展视网膜下液增多,视网膜未复位,后行玻璃体手术.手术后9眼视力提高,3眼视力不变,1眼视力下降.结论 巩膜扣带术后残留视网膜脱离可以通过充气性视网膜固定术获得视网膜解剖复位,视力改善.     

视网膜切开术与玻璃体切除联合巩膜扣带术对开放性眼球伤预后的影响

目的比较视网膜切开术与玻璃体切除联合巩膜扣带术对开放性眼球伤预后的影响。方法临床病例对照研究。对2009年3月至2013年7月在西安市第四医院眼科住院的开放性眼外伤患者,根据眼部损伤严重性及伤口长度、玻璃体视网膜嵌顿位置、是否合并视网膜脱离,将11例玻璃体切割联合巩膜扣带术患者（巩膜扣带组）和11例玻璃体切割联合视网膜切开患者（视网膜切开组）进行配对;比较两组患者视网膜复位率、并发症发生率及矫正视力。结果巩膜扣带组视网膜复位率81．82％（9/11）,视网膜切开组视网膜复位率63．64％（7/11）,差异无统计学意义（P=0．632）。巩膜扣带组6只眼（54．54％）、视网膜切开组4只眼（36．36％）术后视力提高,差异无统计学意义（P=0．361）。术后眼内炎症反应发生率,视网膜切开组为45．45％（5／11）,巩膜扣带组无;术后出血发生率,巩膜扣带组为9．09％（1／11）,视网膜切开组为36．36％（4/11）。结论在开放性眼外伤中,玻璃体视网膜手术联合巩膜扣带术比视网膜切开术,术后出血更少,炎症反应更轻和更好的视网膜复位率。     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者94例96眼,术中直视下定位、冷凝视网膜裂孔。91眼行巩膜表面节段性外加压,其中37眼联合环扎术,另5眼单纯行环扎术。67眼进行了视网膜下液引流术,19眼在手术结束时行玻璃体腔气体充填。结果:90眼单次手术视网膜解剖复位,首次手术复位率94%,4眼再次手术后复位,手术最终解剖复位率98%。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

巩膜扣带术在玻璃体切除术后视网膜未复位患者中的应用

目的 探讨应用巩膜扣带术治疗玻璃体切除术后视网膜未复位患者的手术疗效.设计回顾性病例系列.研究对象2004～2010年北京同二医院43例43眼玻璃体切除术后视网膜未复位患者.方法 所有患者采用间接检眼镜直视下冷冻裂孔、巩膜环扎或外垫压、外放液方法治疗.对硅油填充眼,先行巩膜扣带术,术后1～4周后再行硅油取出.主要指标术后视网膜复位情况、视力、眼压和并发症等.结果 43眼中,12眼为单纯行玻璃体切除或联合玻璃体腔注气术后视网膜脱离,经一次巩膜扣带术,11眼复位,1眼失败后再次行玻璃体切除硅油填充术 24眼为硅油填充眼,其中22眼行巩膜扣带术后视网膜完全复位,1～4周后行硅油取出,2眼视网膜未复位,取油时联合视网膜切开,硅油再填充,最终1眼完全复位,1眼广泛视网膜增殖,增生性玻璃体视网膜病变（PVR）形成,光感消失,眼球萎缩 7眼为硅油取出术后视网膜再脱离眼,行巩膜扣带手术后6眼视网膜完全复位,1眼再次硅油填充.随访3～72个月,经一次巩膜扣带术后视网膜复位39眼（90.7%）,最终42眼（97.7%）视网膜复位.结论 对于玻璃体切除手术失败且裂孔位于周边部的视网膜脱离患者,采用巩膜扣带术式能有效地使视网膜再复位.     

巩膜扣带术联合激光光凝术治疗视网膜脱离的效果观察

目的 观察巩膜扣带术联合激光光凝术治疗非复杂性孔源性视网膜脱离的疗效。方法 回顾性分析2003年1月-2005年9月我院行巩膜扣带术联合激光光凝术治疗的非复杂性孔源性视网膜脱离27例（28眼）。术后随访3-6月,观察视网膜复位情况,视力及并发症。结果 视网膜复位27眼（96.43%）,视力提高25眼,视力无改变2眼,下降1眼。结论 巩膜扣带术联合激光光凝术治疗非复杂性孔源性视网膜脱离效果满意。     

巩膜扣带术治疗陈旧性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性视网膜脱离的效果。方法:选取38例38眼陈旧性视网膜脱离患者,术中直视下定位、冷凝视网膜裂孔。针对不同病例36眼于裂孔处缝合硅海绵(其中19眼加缝硅胶环扎带),另2眼单纯行环扎术。26眼进行了视网膜下液引流术,7眼在手术前、后联合了激光光凝术。结果:其中33眼单次手术视网膜解剖复位,首次手术复位率87%,2眼再次手术后复位,手术最终解剖复位率92%。术中及术后无严重并发症发生。结论:通过个体化设计手术方案,巩膜扣带术治疗伴有视网膜下增生的陈旧性视网膜脱离可获得较高的手术治愈率。     

4期早产儿视网膜病变巩膜扣带手术与玻璃体视网膜手术治疗疗效评价

目的 评价巩膜扣带手术与玻璃体视网膜手术治疗4期早产儿视网膜病变（ROP）的疗效。 方法回顾性分析接受巩膜扣带手术与玻璃体视网膜手术治疗的39例4期ROP患儿50只眼的临床资料。其中,4a期20只眼,4b期30只眼。患儿年龄2~18个月,平均年龄（6.0±3.4）个月;胎龄26~33周,平均胎龄（30.0±1.6）周;出生体重800~1900 g,平均体重（1404.5±237.6）g。行巩膜扣带手术19只眼,玻璃体视网膜手术31只眼。手术治疗后随访时间6~84个月,平均随访时间（26.0±21.7）个月。观察视网膜复位及屈光情况。 结果 行巩膜扣带手术的19只患眼视网膜全部复位,复位率占接受巩膜扣带手术患眼的100.0%。行玻璃体视网膜手术的31只眼中,27只视网膜复位,占接受玻璃体视网膜手术患眼的87。1%;4只眼手术后视网膜脱离继续进展,占接受玻璃体视网膜手术患眼的12.9%。行巩膜扣带手术的19只患眼中,5只眼随访期间拆除扣带加压物,占26.3%。行玻璃体视网膜手术的患眼屈光度为-1.25~11.00 D,平均屈光度为（-4.46±2.49） D;行巩膜扣带手术患眼屈光度为-1.25~9.25 D,平均(-3.21±1.96) D。两种手术患眼手术后屈光度比较,差 异无统计学意义（F=2.76,P=0.103）。结论玻璃体视网膜手术及外加压手术对4期ROP患儿的视网膜复位均有良好效果。     

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.