内窥镜下手术在眼科的应用

近年来，内窥镜下手术在眼科的应用有了很大进展，并且逐渐展现出其创伤小、并发症少、直视下操作、安全有效的优点。眼内窥镜联合激光可应用于青光眼前房角手术、青光眼睫状体光凝术、周边部视网膜玻璃体手术等等；另外泪道内窥镜在泪器疾病中的应用、鼻内窥镜在鼻眼相关手术中的应用也有很大的发展。眼内窥镜的应用开创了眼科微创手术时代。本文就眼用内窥镜的基本工作原理、应用现状和发展前景进行综述。     

内窥镜在眼科的应用现状及展望

内窥镜是一种安全有效的新型手术器械,近年来已应用于眼科领域。其在泪道等外眼疾病的诊治渐趋成熟,并逐渐显示出于睫状体部或屈光间质不清的内眼手术中不可替代的应用价值,使用指征逐渐拓宽。本文复习近年有关文献,就眼用内窥镜发展历史、基本原理和构造、临床应用现状以及发展前景作一综述     

内窥镜在眼科的应用现状及展望

内窥镜是一种安全有效的新型手术器械，近年来已应用于眼科领域。其在泪道等外眼疾病的诊治渐趋成熟，并逐渐显示出睫状体部或屈光间质不清的内眼手术中不同替代的应用价值，使用指征逐渐拓宽。本文复习近年有关文献，就眼用内窥镜发展历史、基本原理和构造、临床应用现状以及发展前景作一综述。     

内窥镜在眼科手术中的应用

近年来,眼科内窥镜技术及相关治疗方法已经逐步丰富完善,内窥镜在泪道手术、青光眼手术、晶状体手术、眼后段手术、眼眶手术及眼整形美容手术中逐渐推广应用,开创了眼科微创手术的新时代。其创伤小、并发症少、直视下操作、安全有效的优点得到了广大眼科医生认同。本文就眼用内窥镜的发展过程、内窥镜在眼科手术中的应用现状和发展前景进行综述。     

重视微创技术治疗泪道阻塞性疾病

泪道阻塞性疾病是眼科常见病.泪道微创治疗技术近年来在发达国家有替代传统疗法的趋势,国内少数医院眼科已开展了微创技术诊治泪道疾病.新一代磷酸钛氧钾(KTP)激光技术与泪道置管术联合使用,扩大了泪道置管术的适应证.具有记忆功能的专用置管工具改进了逆行置管系统.鼻腔内窥镜下鼻腔泪囊吻合手术拓展了医治空间,清晰的鼻腔内窥镜树立了泪道内窥镜质量追求标准.泪道微创技术的健康发展有利于促进泪道疾病的早期诊治,扩大微创手术适应证.规范地应用基本检查方法,恰当选择影像学检查项目,术前确立有阻塞部位、性质、程度、原因等内容的完整诊断.我国泪道阻塞性疾病的诊治常规也亟待建立.(眼科,2008,17:79-81)     

泪道阻塞性疾病治疗方法新进展

泪道阻塞疾病为眼科常见病,传统治疗多采用鼻腔泪囊吻合术及泪道探通术。近年来随着新材料新技术的发展,新型泪道支架和泪道内窥镜得以越来越多的应用于泪道阻塞疾病的治疗。传统的鼻腔泪囊吻合术在经过多年的实践和改进后,效果稳定可靠;由于鼻内窥镜技术的发展,鼻腔泪囊吻合术也得以在内镜下治疗;泪道探通术简单易行,受器械及场地影响较小,结合激光置管等辅助治疗疗效肯定,新型材料支架的应用也为泪道探通术提供了新的发展前景;国外发达国家近年已开始将经泪小点泪道内窥镜用于对泪道阻塞性疾病的检查和治疗,使手术医师有了更多的选择。泪道内窥镜技术在阻塞性泪道疾病方面具有良好的应用前景。     

鼻内窥镜下逆行泪道支架植入术治疗鼻泪管阻塞的疗效观察

目的探讨鼻内窥镜下逆行泪道支架植入术的临床疗效。方法回顾性系列病例研究。2007年12月至2010年6月在安徽省安庆市第二人民医院眼科就诊鼻泪管阻塞患者共93例（101眼），在鼻内窥镜协助下，将泪道支架逆行植入鼻泪管，使阻塞泪道通畅，手术植入成功率及术后疗效采用百分比表示。结果100眼一次植入成功，1眼因泪道探通时造成假道，于1周后再次植入成功。本组病例植入成功率为100％。术后随访6个月～2年，其中显效83眼（82％），好转14眼（14％），无效4眼（4％）。结论鼻内窥镜协助下植入泪道支架可缩短术程，显著提高手术成功率和疾病的远期治愈率。     

新型眼内窥镜及其在泪道手术中的应用

目的探讨新型眼内窥镜对泪道手术中的应用价值。方法用国产自聚焦透镜制成新型眼内窥镜。外径1．2mm、视场角45°、物距1～10mm,放大率25倍,具有同步光源。对131例泪道病人,2例正常人进行检查。观察正常及手术前后泪道粘膜的情况。结果新型眼内窥镜能清晰观察泪小管、泪囊、鼻泪管粘膜及手术后伤口的形态。结论新型眼内窥镜可用于泪道内窥镜检查。     

鼻内窥镜下泪道浚通联合硅胶管植入治疗泪道阻塞的临床观察

目的:观察鼻内窥镜下泪道浚通联合硅胶管逆行植入和丝裂霉素C(MMC)应用治疗泪道阻塞的手术疗效。方法:鼻内窥镜下利用泪道浚通联合类Y形硅胶管规范泪道逆行植入和MMC应用,留置Y形管3mo,跟踪观察并统计其中106例106眼的治疗结果。结果:鼻内窥镜下泪道浚通后MMC应用,置留、拔管操作特别简单容易,创伤甚微。全部治疗在门诊完成,期间患者正常生活、工作、学习。3a以上随访治疗结果:有效以上率96.2%(102眼);显效以上率92.5%(98眼);治愈率84.9%(90眼);无效3.8%(4眼)。结论:鼻内窥镜下泪道浚通联合硅胶管逆行植入和MMC应用技术是治疗泪道阻塞的首选与补充方法,损伤小,成功率高,并发症少,手术费用低。     

泪道激光与内窥镜下泪道钻通联合置管术治疗慢性泪囊炎的疗效比较

目的 观察并比较泪道激光联合置管术与内窥镜下泪道钻通联合置管术治疗慢性泪囊炎的临床疗效.设计比较性病例系列.研究对象选择2008年3月至2009年3月在宁波市眼科医院诊治的慢性泪囊炎患者90例(108眼).方法 48例(58眼)慢性泪囊炎患者行泪道激光联合环形置管术,42例(50眼)慢性泪囊炎患者行内窥镜下泪道钻通联合...     

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.