严重角巩膜裂伤的前房内麻醉

目的 探索利多卡因前房内麻醉在角巩膜严重裂伤手术中的镇痛效果。方法 采用国产不含防腐剂2%利多卡因稀释为0.5%浓度直接从伤口注入前房内进行麻醉。结果 20例全部取得良好镇痛效果。能顺利完成清创修补手术。结论 0.5%利多卡因作前房内麻醉在角巩膜裂伤手术中镇痛效果确切。可减少因常规麻醉带来的并发症，且方法简单，实用，安全可行。     

隐匿性巩膜裂伤40例治疗观察

目地探讨隐匿性巩膜裂伤的手术方法,并观察治疗效果。方法对40例(40只眼)隐匿性巩膜裂伤采用显微镜下巩膜修补及透热或冷凝术,术后随访3-18月。结果 40例中37例保全眼球,视力在0．05以上 18只眼(45％)。结论隐匿性巩膜裂伤应尽早行伤口修补。     

幼儿白内障手术表麻球后联合氯胺酮麻醉探讨

目的 探讨幼儿白内障手术采用表面麻醉，球后麻醉联合氯胺酮麻醉的方法和效果。方法 对6月～4岁幼儿白内障手术32例52眼采用0．5％爱尔卡因滴眼液表麻，联合氯胺酮肌肉注射麻醉，待患儿入睡后进行球后麻醉。手术方式为白内障针吸术和白内障超声乳化术，术中观察心率、呼吸、血压、氧饱和量及麻醉效果。结果 32例中的10例手术在15分钟内完成。另22例手术时间超过15分钟(多为双眼手术)者，追加氯胺酮静脉麻醉者1次16例，2次6例，32例52眼麻醉效果满意，均顺利完成手术。结论 幼儿白内障手术表面麻醉，球后麻醉联合氯胺酮麻醉效果满意，由于减少氯胺酮用量，对幼儿更加安全。     

84例闭角型青光眼高眼压下手术临床观察

目的探讨采取综合措施对84例闭角型青光眼在高眼压状态下进行手术的效果。方法（1）眼压3．86～4．6kPa者采用球后麻醉或球周麻醉，间断加压控摩10分钟．术中角巩膜切口时先作小切口，缓慢放出房水，待眼压降低后按拟定手术方式完成手术。（2）眼压＞4．6～6．62kPa者采用人工冬眠加上述方式。（3）眼压＞6．62kPa者用人工冬眠加球周麻醉及按摩加压和后巩膜穿刺术降低眼压完成手术。结果眼压控制满意，术后视力较术前提高，并发症与一般青光眼手术无明显差异。结论高眼压状态下采取综合措施进行手术安全、简便、可靠。     

翻转原位板层巩膜瓣修补角巩膜缘全层组织缺损一例

角巩膜裂伤在眼外伤中占很大比例，而有组织缺损的角巩膜裂伤并不多见，且伤口很难处理。2006年4月，我们收治1例利用翻转原位板层巩膜瓣修补邻近角巩膜缘组织缺损的患者，取得较好疗效。[第一段]     

62例斜视手术眼心反射观察

报道了心电监护下６２例斜视手术中的心电图所见。其中４０例为氮胺酮全麻，术前肌注阿托品，眼心反射阳性率为２２．６％。局麻２２例，用２％利多卡因局麻，加０．５％地卡因表面麻醉，眼心反射阳性率为８３．７％。全麻眼心反射严重程度明显低于局麻。说明斜视手术时，使用阿托品和氯胺酮作为术前和麻醉用药可以预防或减轻术中严重的眼心反射。     

角巩膜裂伤显微缝合的体会

我科1981年7月至1988年12月,显微缝合角巩膜裂伤63例,手术效果较好,现报告如下: 临床资料 本组63例中,男40,女23,其中角膜穿孔伤43例,巩膜裂伤13例,角巩膜联合伤7     

儿童角巩膜穿通伤合并外伤性白内障手术治疗53例分析

目的：探讨儿童角巩膜穿通伤合并白内障手术治疗效果。方法回顾性分析53例（53眼）儿童角巩膜穿通伤合并白内障手术治疗情况。采用显微镜下角、巩膜穿通伤缝合联合白内障超声乳化或囊外摘除及Ⅰ期后房型人工晶体植入、后囊切开前段玻璃体切除手术治疗,术后随访6~12月。结果视力恢复至0.8者26例（49.06%）,0.7~0.3者25例（47.17%）,0.3者2例（3.87%）;术前、术后视力差异有显著性,P〈0.001。行Ⅰ后囊切开前段玻璃体切除手术可明显降低视轴区后囊混浊发生率。结论儿童角巩膜穿通伤合并白内障行角、巩膜穿通伤缝合联合白内障超声乳化或囊外摘除及Ⅰ期后房型人工晶体植入、后囊切开前段玻璃体切除手术治疗可使患儿获得良好视功能,避免二次手术。     

非穿透性小梁手术联合羊膜移植的临床观察

目的：观察非穿透性小梁手术联合羊膜移植的效果。方法：对20例23眼开角型青光眼行此手术。手术方法是在浅层巩膜瓣下切除深层巩膜瓣及Schlemm管外壁，并向前进入透明角膜约2mm，仅留后弹力层，此时可见房水渗出，将羊膜移植于深层巩膜瓣下。术后随访观察，包括视力、眼压及裂隙灯等检查。结果： 手术成功率为81％。其中12眼术后眼压缓慢下降，4例术后加用降眼压药物后眼压控制。均未见术中术后浅前房或炎症反应等并发症。结论：非穿透性小梁手术中羊膜移植术是一种安全有效的、新的抗青光眼手术。     

青眼光白内障联合手术不同术式的探讨

目的探讨研究青光眼并白内障联合手术中不同术式的适应证及手术效果。方法对本院2000年1月～2005年11月收治46例青光眼并白内障患者，施行联合手术。对此进行手术适应证分析及疗效分析。结果巩膜小梁切除加白内障超生乳化（超乳），疗效好且并发症少。小梁切除加囊外摘除，并发症比前者多，疗效次之。囊外摘除加虹膜根切，疗效好。巩膜非穿透性小粱切除加超乳，只适合开角型青光眼并白内障患者。结论巩膜小梁切除加超乳术为联合手术中最好的方法，有局限性。小梁切除加囊外摘除术适应证广，并发症较多，但能克服。囊外摘除加虹膜根切术组织损伤小，手术时间短，有局限性。巩膜加非穿透性小梁切除加超乳术只适合开角型青光眼并白内障患者。     

利多卡因联合布比卡因表面麻醉进行晶状体超声乳化术的观察

目的观察利多卡因联合布比卡因表面麻醉进行晶状体超声乳化人工晶状体植入术的情况，同时与奥布卡因表面麻醉剂比较，分析他们的相似性。方法我们分别运用利多卡因联合布比卡因麻醉剂，以及奥布卡因麻醉剂在表面麻醉下进行晶状体超声乳化术各100眼，比较二者的安全性、有效性。并观察两组患者术中情绪、眼位固定情况、眼球不自主运动、痛觉、以及麻醉持续时间。结果利多卡因联合布比卡因麻醉剂表面麻醉进行晶状体超声乳化术具有良好的麻醉作用。结论在进行晶状体超声乳化术中，应用利多卡因联合布比卡因麻醉剂作表面麻醉剂，具有良好的麻醉作用和安全性，与奥布卡因麻醉剂作用相似，而且经济。     

Comparison of 4 topical anesthetic agents for effect and corneal toxicity in rabbits.

PURPOSE: To compare the onset time, duration of action, corneal toxicity, and corneal epithelial healing time of 4 topical anesthetic agents in rabbits. SETTING: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. METHOD: Fifty-six rabbits were treated with 4 topical anesthetics (bupivacaine, lidocaine, procaine, and benzocaine) at different concentrations and different pH of solutions. Corneal sensation, corneal toxicity, and corneal epithelial healing time were measured. RESULTS: The onset time of all 4 anesthetic agents was within 1 minute; however, bupivacaine and lidocaine produced significantly longer action than procaine or benzocaine (P < .05). Buffered bupivacaine and lidocaine had a significantly longer anesthetic effect than that of the nonbuffered solutions (P < .05). No significant effect on corneal epithelial healing time or corneal toxicity was observed. CONCLUSION: Topical bupivacaine and lidocaine had a longer anesthetic effect, particularly in buffered solutions. No significant corneal toxicity was observed.     

pH-adjusted periocular anaesthesia for primary vitreoretinal surgery

PURPOSE: To evaluate the efficacy of pH-adjusted bupivacaine in conjunction with medial orbital periconal block (periocular anaesthesia). METHODS: Sixty consecutive patients undergoing primary vitreoretinal surgery were enrolled prospectively. RESULTS: Adequate anaesthesia and akinesia with no intraoperative supplementation was achieved in 53 eyes (88.3%). Factors influencing intraoperative supplementation were combined vitrectomy with scleral buckling (p = 0.005) and duration of surgery of more than 2 hours (p = 0.001). No ocular or systemic complication resulted. CONCLUSION: pH-adjusted periocular anaesthesia is safe and effective in patients undergoing primary vitreoretinal surgery.     

Comparison of preservative-free bupivacaine vs. lidocaine for intracameral anesthesia: a randomized clinical trial and in vitro analysis

PURPOSE: To determine whether intracameral bupivacaine hydrochloride 0.5% is as effective as lidocaine hydrochloride 1.0% in controlling discomfort of patients during phacoemulsification and posterior chamber intraocular lens implantation. In rabbits, corneal endothelial cell function, ultrastructure, and viability were evaluated after in vitro perfusion of bupivacaine 0.5%. METHODS: In a double-masked, controlled trial, 48 eyes of 48 patients with uncomplicated age-related cataract were randomly assigned to receive bupivacaine 0.5% or lidocaine 1.0% intracamerally before phacoemulsification with a posterior chamber intraocular lens. Outcome measures such as pain, visual acuity, amount of sedation, length of surgery, pupil size, intraocular pressure, corneal clarity, and anterior chamber reaction were compared. In laboratory studies, paired rabbit corneas were evaluated by endothelial cell perfusion with either bupivacaine 0.5%, bupivacaine 0.5% and glutathione bicarbonate Ringer solution in a 1:1 ratio or bupivacaine 0.5% buffered to a pH of 7.0. The paired control corneas were perfused with glutathione bicarbonate Ringer solution and rates of corneal swelling were determined. Cell ultrastructure and viability were also evaluated. RESULTS: In the randomized trial, there was no significant difference in the pain patients had during surgery or in the early or late postoperative period. No statistically significant difference was seen between the two groups in terms of pupil size, intraocular pressure, corneal edema, anterior chamber reaction, or visual acuity immediately after the operation or on postoperative day 1. Paired rabbit corneas perfused with bupivacaine 0.5% and bupivacaine 0.5% buffered to a pH of 7.0 swelled significantly (P<.001, P = .009, respectively), and had corneal endothelial cell damage. Dilution of the bupivacaine 1:1 with glutathione bicarbonate Ringer solution prevented corneal edema and damage to the corneal endothelium. Endothelial cell viability was also decreased after perfusion of bupivacaine 0.5% (P<.001). CONCLUSIONS: Clinically, bupivacaine 0.5% is as effective as lidocaine 1.0% for anesthesia during phacoemulsification and posterior chamber intraocular lens implantation. However, in vitro perfusion of bupivacaine 0.5% damaged the corneal endothelium of rabbits except when the drug was diluted 1:1 with glutathione bicarbonate Ringer solution. Surgeons who use 0.2 to 0.5 ml of intracameral bupivacaine 0.5% should be aware of its potential to cause endothelial cell damage because of its lipid solubility. The bupivacaine 0.5% should be diluted at least 1:1 with balanced salt solution before intracameral injection, followed immediately by phacoemulsification. The surgeon should ensure that the bupivacaine 0.5% is nonpreserved and packaged in single-use vials or flip-top containers.     

Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis

Purpose:To describe a new technique of intracorneal scleral patch (ICSP) supported cyanoacrylate tissue adhesive (CTA) application in corneal perforations, greater than 3.0 mm secondary to rheumatoid arthritis (RA).Methods:This Prospective, non-randomized, non-comparative, interventional series included 14 eyes (14 patients). All patients had corneal perforations sized 3.5 to 4.5 mm due to RA, which were treated with ICSP supported CTA application. A partial thickness scleral patch 1.0 mm larger than diameter of corneal perforation was prepared. A lamellar corneal pocket 0.5 mm all around the corneal perforation was created. The partial thickness scleral patch was placed in the corneal perforation site and the edge was fitted into the lamellar intracorneal pocket. A minimum quantity of CTA was applied on the scleral patch to seal the perforation.Results:The corneal perforations healed in 14 eyes (100%) in a mean 7.71 ± 1.14 (range, 6–9) weeks. One eye (7.14%) had inadvertent extrusion of ICSP due to premature removal of CTA but, Seidel''s test was negative, and the corneal epithelial defect healed with BCL alone. One eye each (7.14%) developed steroid induced cataract and glaucoma. None of eyes developed infective keratitis, re-opening of corneal perforation (necessitating repeat procedure) or enlargement of corneal perforation requiring penetrating keratoplasty (PKP).Conclusion:ICSP supported CTA application is a successful alternative option to emergency PKP in treating corneal perforations sized 3.5 to 4.5 mm with associated RA.     

The effects of bupivacaine and lidocaine on the corneal endothelium when applied into the anterior chamber at the concentrations supplied commercially

PURPOSE: To investigate the direct toxic effects of bupivacaine HCl 0.5% and lidocaine HCl 2%, two commonly used injectable local anesthetic agents, on the corneal endothelium when applied intracamerally. METHODS: Two groups were formed, each consisting of 12 pigmented rabbits, and 0.2 ml of the anesthetic agent were injected intracamerally into the right eyes. The central corneal thicknesses and corneal clarities were evaluated preoperatively and at 3, 6, 9, 12 h and 1, 3, 7 days postoperatively. While the central corneal thicknesses were evaluated by ultrasonic pachymetry, the corneal opacification scored between 0 and 3 was assessed by biomicroscopic examination and photographs. RESULTS: Both bupivacaine and lidocaine caused corneal thickening in the 3- to 12-hour measurements. In addition, there was significant corneal opacification in both groups in the 3-hour and 3-day measurements. The corneal thickening and corneal opacification determined during 3- and 6-hour measurements in the eyes which received intracameral bupivacaine were significantly higher than those determined in the lidocaine-injected group. In both groups, the corneal thickness and corneal clarity scores returned to the preoperative values on the 1st and 7th days, respectively. CONCLUSIONS: When applied into the anterior chamber at the concentrations supplied commercially, both bupivacaine and lidocaine cause statistically significant corneal thickening and clinically significant corneal opacification. It should be noted that the injection of these agents into the anterior chamber during the operation at the concentrations supplied commercially may be a potential risk factor for endothelial injury.     

Retrobulbar anesthesia for cataract surgery: comparison of bupivacaine and bupivacaine/lidocaine combinations

Three groups of 15 patients each were randomly assigned to receive a retrobulbar anesthetic block with 0.5% bupivacaine, 0.5% bupivacaine/2% lidocaine or 0.5% bupivacaine/2% lidocaine/1:100 000 epinephrine for unilateral cataract surgery. Hyaluronidase was added to each of the preparations, which were used in double-blind fashion. Lid and globe akinesia and corneal anesthesia were graded after 4 minutes of ocular massage and 36 minutes later (at the end of the procedure) to assess the rapidity of onset and the duration of action of the anesthetics. Overall, bupivacaine/lidocaine/epinephrine was the most effective in producing akinesia of the lids and globe. Bupivacaine alone was more effective than bupivacaine/lidocaine without epinephrine in producing akinesia, although it was slower in producing anesthesia. There was no difference between the groups in the frequency of pain or of the need for analgesia 6 hours postoperatively.     

Peribulbar anaesthesia using a combination of lidocaine,bupivocaine and clonidine in vitreoretinal surgery

PURPOSE: The efficacy and safety of peribulbar anaesthesia was assessed using a combination of lidocaine, bupivacaine and clonidine during eye surgery. METHODS: We prospectively studied 100 vitreo-retinal surgical procedures performed by several surgeons. The exclusion criteria included age below 30 years and, axial length of the orbit above 28 mm. Peribulbar was performed using Hamilton's technique. A mixed anaesthetic solution of equal quantity of lidocaine 2% and bupivacaine 0.5% with clonidine (1 mg/kg) was injected. Patients received a mean volume of 14.5 ml +/- 3.5 of the mixture. Akinesia and analgesia were assessed 15 minutes later by the surgeon. Whenever required, supplemental lidocaine 2% (3 ml) by sub-Tenon infiltration was added by the surgeon. Supplemental injections were given only to patients who failed to develop analgesia. RESULTS: The mean age of patients (male 52%, female 48%) was 66 years +/- 10 (mean +/- SD, range 44-90). The 100 surgical procedures were made up of vitrectomy +/- gas +/- silicone oil (22/100), vitrectomy and lensectomy (6/100), vitrectomy and epiretinal membrane +/- laser coagulation +/- gas +/- silicone oil (35/100), scleral buckling or encircling +/- gas (36/100), and cryosurgery +/- gas (1/100). Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub-Tenon infiltration in 99%. Akinesia was complete in 84%, mild in 12% and absent in 4% of cases. The sub-Tenon injection was performed in 15% of cases. Three patients (3%) were agitated during surgery. No neurologic or cardiac complication was seen. In one patient, the systolic blood pressure decreased from 170 to 110 mmHg, 30 minutes after the institution of the peribulbar block. CONCLUSION: Our results show that peribulbar anaesthesia in the proposed mixture offers excellent analgesia in 85% of patients, and in 99% of the patients when supplemented by a subtenon injection. The current mixture of lidocaine, bupivacaine and clonidine is an excellent alternative to the previously used mixture etidocaine, bupivacaine and hyaluronidase for vitreoretinal surgery. However, a randomized controlled clinical trial is needed to prove the efficacy and safety of these results.     

联合或不联合板层角膜移植的结膜瓣移植治疗巩膜坏死

目的 介绍结膜瓣移植治疗眼部烧伤和眼科手术后巩膜缺血坏死的手术方法,观察其临床疗效.方法 回顾性病例研究.2007年1月至2012年3月,共13例眼部烧伤和眼科手术后巩膜缺血坏死、溶解的患者在山东省眼科医院接受了结膜瓣移植,其中碱烧伤4例,热烧伤6例,翼状胬肉切除手术后巩膜坏死3例.对所有患者行带蒂结膜瓣转位或游离结膜瓣移植术治疗,其中4例行单纯结膜瓣移植,2例联合部分板层角膜移植(LK)术,6例联合羊膜移植(AMT)术,1例联合LK和AMT术.随诊3～24个月,对手术后巩膜坏死和结膜瓣存活等情况进行观察.结果 移植的结膜瓣1周内血运差、色苍白,1周后逐渐出现充血表现,2周拆除结膜瓣缝线后充血症状逐渐减轻.13例患者结膜瓣均愈合良好,巩膜坏死控制.至最后一次随访,2例角膜透明,3例角膜植片透明,l例角膜斑翳,7例角膜血管化.结论 结膜瓣移植(或联合LK和AMT)治疗眼部烧伤和眼科手术后巩膜坏死在临床上安全有效,能够较好地解决巩膜穿孔的风险,为后续治疗提供一个相对稳定的眼部环境.     

Pulse-induced intraocular pressure variation and retrobulbar anaesthesia with and without adrenaline.

The intraocular pressure (IOP) and pulse-induced IOP variation (IOPV) were registered before and five min after retrobulbar anaesthesia (RBA) in 34 operations. The every second operation the anaesthetic (bupivacaine or lidocaine) was supplemented with adrenaline (epinephrine). Both IOP and IOPV were significantly lowered compared with the unanaesthetised fellow eye. The change in IOP was 16,8% with adrenaline and 15.1% without it. IOPV decreased 50.6% with adrenaline and 36.2% without adrenaline. It is concluded that RBA reduces the intraocular blood supply and this is probably one reason for the IOP lowering influence of RBA. Although to a smaller degree, this vascular effect is also achieved without adrenaline.