巩膜瓣大小对小梁切除术后功能性滤过泡形成的影响

目的 探讨青光眼小梁切除术两种不同大小巩膜瓣术后功能性滤过泡成功率.方法 比较339例(339只眼)原发性青光眼中2 mmx2 mm的小巩膜瓣149只眼,4 mmx4 mm的大巩膜瓣190只眼,小梁切除术后功能性滤过泡形成情况.结果 小巩膜瓣手术组术后1周滤过泡成功率为82.55％,3个月时为55.36％.大巩膜瓣手术组术后1周滤过泡成功率为67.89％,3个月时为77.05％.两组比较差异有统计学意义.结论 较大巩膜瓣青光眼小梁切除术后远期功能性滤过泡形成好于短小巩膜瓣且更安全,故应尽量采用较大巩膜瓣术式.     

复合式小梁切除术治疗青光眼的并发症及疗效观察

目的:探讨复合式小梁切除术对青光眼患者术后浅前房发生率、手术成功率及功能性滤过泡形成率的影响.方法:选取我院2013-05/2015-05收治的青光眼患者58例64眼,依据随机数字表法将这些患者分为复合式小梁切除术组(复合式组,28例32眼)和传统小梁切除术组(传统组,30例32眼)两组,对两组患者的术后浅前房发生率、手术成功率及功能性滤过泡形成率、并发症发生率进行统计分析.结果:复合式组患者的术后浅前房发生率6％(2/32)显著低于传统组22％(7/32),差异有统计学意义(P＜0.05).复合式组术后眼压显著低于传统组,差异有统计学意义(P＜0.05).复合式组手术成功率88％(28/32)显著高于传统组44％(14/32),差异有统计学意义(P＜0.05).复合式组功能性滤过泡形成率91％(29/32)显著高于传统组69％(22/32),差异有统计学意义(P＜0.05).复合式组术后并发症发生率9％(3/32)显著低于传统组25％(8/32),差异有统计学意义(P＜0.05).结论:复合式小梁切除术较传统小梁切除术更能有效降低青光眼患者的术后浅前房发生率,提高患者的手术成功率及功能性滤过泡形成率,并降低患者的并发症发生率,安全有效.     

小梁切除术不同结膜瓣滤过泡的形成分析

目的:探讨小梁切除术两种不同结膜瓣术后功能性滤过泡形成情况.方法:比较372例(372只眼)原发性青光眼不同结膜瓣小梁切除术术后功能性滤过泡形成情况,其中以角巩缘为基底的结膜瓣165只眼,以穹窿部为基底的结膜瓣207只眼.结果:术后1周对所有患者进行了观察.3个月时只有127只眼进行了随访.以角巩缘为基底的结膜瓣手术组术后1周滤过泡成功率为83.03%.3个月时为78.69%.以穹窿部为基底的结膜瓣手术组术后1周滤过泡成功率为55.07%,3个月时为53.03%.两组比较有明显差别.结论:本组研究发现.传统的以角巩缘为基底的结膜瓣术后滤过泡成功率高于以穹窿部为基底的结膜瓣,其术后降压效果相应亦较好.     

原发性闭角型青光眼小梁切除早期滤过泡形态与24h眼压关系

目的 观察原发性闭角型青光眼小梁切除术后1个月时结膜滤过泡形态与术后24h眼压(IOP)的关系.方法 对46例施行小梁切除术的原发性闭角型青光眼患者进行随访观察.采用IBAGS滤过泡分级系统(Indiana Bleb Grading Scale,IBAGS)对术后1个月的滤过泡进行记录,应用Goldmann压平眼压计进行眼压测量.采用线性回归分析方法检验滤过泡与24 h眼压的关系,采用t检验的方法对有无微囊结构滤过泡的24 h眼压进行比较.结果 线性回归分析显示滤过泡高度(H)每增加1分术后24 h眼压波动值将降低0.60 mm Hg(95％可信区间为-1.183～-0.024),滤过泡范围(E)每增加1分术后24 h眼压波动值将降低0.66 mm Hg(95％可信区间为-1.193～-0.122),滤过泡面积(即大小H+E)每增加1分术后24 h眼压波动值将降低0.43 mm Hg(95％可信区间为-0.756～-0.109),术后具有微囊结构的滤过泡其眼压波动范围较无微囊结构者平均降低1.02 mm Hg(95％可信区间为-1.876～-0.156).具有微囊特征滤过泡的患者上午10点的IOP、24h IOP平均值、波动值、24 h IOP 最大值及最小值均较无微囊者为理想(P值分别为0.0058、0.0039、0.0019、0.0014、0.0211.),差异有统计学意义.所有患者中仅有一例发生滤过泡渗漏.结论 滤过泡形态与术后24 h眼压具有一定的相关性.滤过泡的高度,范围及面积对术后24 h眼压的影响最明显.同时具有微囊结构滤过泡的病例术后24 h眼压控制良好.     

促进功能性滤过泡形成相关因素的探讨

目的 探讨促进功能性滤过泡形成的相关因素。方法 回顾性分析122例(157只眼)青光眼行改良式的小梁切除术及术后处理和随访观察情况。结果 术后失败滤过泡28例,经积极处理,75％转为功能滤过泡。随访6～36个月,手术成功率91％。结论 改良式小梁切除术、眼球按摩、加压包扎、滤过泡针刺分离术、结膜前移直接缝合、合理用药等,有助于形成功能性滤过泡,提高手术成功率。     

针拨联合球结膜下注射丝裂霉素C治疗功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(mitomycin C,MMC)球结膜下注射治疗青光眼患者小梁切除术后早期功能不良滤过泡的疗效.方法 对47例(50眼)小梁切除术后2～8周滤过泡功能不良青光眼患者行针拨联合MMC 0.2 mL(0.04 mg)结膜下注射,术后所有患者随访3～6个月,观察患者眼压、滤过泡形态和并发症.结果 小梁切除术后2～8周,低平、限局、肥厚、充血型滤过泡32眼、包囊型囊样滤过泡18眼.针拨联合MMC结膜下注射治疗后3～6个月,46眼的滤过泡转为功能性的,轻度膨隆弥散型31眼,多腔或薄壁型15眼,限局肥厚型或无滤过泡4眼.治疗前患眼的平均眼压为(28.5±6.5)mmHg(1 kPa=7.5 mmHg),随访3～6个月平均眼压为(16.3±2.9)mmHg,与注射前比较二者差异有统计学意义(P<0.05).46眼没有用抗青光眼药物或用一种抗青光眼药物眼压控制在21 mmHg以下,成功率占92%.治疗后视物模糊10眼,结膜下出血6眼,角膜上皮点状脱落2眼,无低眼压、伤口渗漏和前房变浅等并发症.结论 针拨联合MMC结膜下注射治疗小梁切除术后早期功能不良滤过泡是安全、有效、简单的方法.     

不同方法治疗无功能性滤过泡的远期疗效比较

目的　观察 2种方法治疗小梁切除术后无功能性滤过泡的远期疗效。方法　选择小梁切除术后无功能性滤过泡患者 10 5例 ,随机选择 5 5例 (A组 )在显微镜下作以穹隆为基底的结膜瓣 ,去除包裹、纤维性囊壁组织 ,用含 0 .4 g·L-1MMC的棉片在结膜下放置 5min ;5 0例 (B组 )在显微镜下用 5号针头潜行分离滤过泡后 ,在滤过泡旁 3mm结膜下注射MMC 0 .1mL。随访 2a后 ,观察眼压、滤过泡及并发症情况。结果　A组中成功 4 3例 ,有效 6例 ,无效 6例 ,总有效率为 89.0 9% ;I型滤过泡 32例 ,II型滤过泡 17例 ,III型滤过泡 6例。B组中成功 2 9例 ,有效 6例 ,无效 15例 ,总有效率为 70 .0 0 % ;I型滤过泡 19例 ,II型滤过泡 16例 ,III型滤过泡 15例。经统计学处理 ,2组之间成功率 (χ2 =4 .95 ,P <0 .0 5 )、总有效率 (χ2 =5 .97,P <0 .0 5 )的差别均有统计学意义。结论　无功能性滤过泡采用切除增生的纤维性囊壁的手术优于针分离术     

小梁切除术后早期功能不良滤过泡治疗

目的 观察青光眼小梁切除术后早期功能不良滤过泡的处理效果.方法 对36例(36眼)小梁切除术后3～8d内功能不良滤过泡行眼球按摩和钝针头针拨分离治疗,所有患者术中曾用过0.3ms/mL的抗代谢药丝裂霉素c(mitomycin-C,MMC).随访6个月.结果 经治疗后32眼为功能滤过泡,4眼为非功能滤过泡.治疗前平均眼压23.21±6.50mm Hg(1mm Hg=0.133kPa),治疗后即刻为11.60±5.40mm Hg,随访结束时平均眼压16.10±4.18mm Hg,治疗前后眼压差异有统计学意义(P＜0.001).术中和术后无严重并发症.结论 对早期功能不良滤过泡采用眼球按摩和钝针头针拨分离治疗,获得良好效果,可挽救濒临失败的滤过泡,此法操作简单、安全,并发症少.早期发现和早期治疗是成功的关键.     

小梁切除联合羊膜移植术治疗青光眼

目的 探讨小梁切除联合羊膜移植术治疗青光眼的临床疗效.方法 选择行滤过手术的58例(74眼)青光眼患者,随机分为小梁切除联合羊膜移植术组(实验组)26例(36眼)和单纯小梁切除术组(对照组)32例(38眼).分析比较两组术后的前房、眼压及滤过泡情况.结果 术后第1天的浅前房发生率实验组(2.8%)明显低于对照组(21.1%);术后1年时实验组的功能性滤过泡(88.9%)较对照组(60.5%)多,实验组手术成功率(94.4%)较对照组(71.1%)高,差异均有统计学意义(P＜0.05).结论 小梁切除联合羊膜移植术可有效地控制眼压,并能有效地促进青光眼功能性滤过泡的形成而减少术后浅前房的发生.     

小梁切除术不同结膜瓣滤过泡的形成分析

目的：探讨小梁切除术两种不同结膜瓣术后功能性滤过泡形成情况。方法：比较372例（372只眼）原发性青光眼不同结膜瓣小梁切除术术后功能性滤过泡形成情况，其中以角巩缘为基底的结膜瓣165只眼，以穹窿部为基底的结膜瓣207只眼。结果：术后1周对所有患者进行了观察，3个月时只有127只跟进行了随访。以角巩缘为基底的结膜瓣手术组术后1周滤过泡成功率为83．03％，3个月时为78．69％。以穹窿部为基底的结膜瓣手术组术后1周滤过泡成功率为55．07％，3个月时为53．03％。两组比较有明显差别。结论：本组研究发现，传统的以角巩缘为基底的结膜瓣术后滤过泡成功率高于以穹窿部为基底的结膜瓣，其术后降压效果相应亦较好。     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

Refractive error in children in a rural population in India

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. METHODS: Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in seven clusters. RESULTS: A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. CONCLUSIONS: Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.     

Vitrectomy in traumatic cataracts and in the complications of surgery in congenital cataract in children

Vitrectomies were carried out in 35 children with traumatic cataracts and complications of surgery for cataracts, caused by injury to the posterior lenticular capsule and incorporation of its fragments to the vitreous. Complete removal of lenticular rudiments rapidly eliminated phacogenic iridocyclitis and improved visual acuity. Improvement of visual functions was attained in 66.6% cases; in 33.4% cases visual acuity did not change. Hemorrhages to the vitreous cavity occurred in 4 cases with pronounced iridocyclitis; therefore, a corneal approach is preferable for cases with pronounced iridocyclitis.     

Refractive error in children in an urban population in New Delhi

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in an urban population in New Delhi, India. METHODS: Random selection of geographically defined clusters was used to identify a sample of children 5 to 15 years of age. From December 2000 through March 2001, children in 22 selected clusters were enumerated through a door-to-door survey and examined at a local facility. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in four of the clusters. RESULTS: A total of 7008 children from 3426 households were enumerated, and 6447 (92.0%) examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 6.4%, 4.9%, and 0.81%, respectively. Refractive error was the cause in 81.7% of eyes with vision impairment, amblyopia in 4.4%, retinal disorders in 4.7%, other causes in 3.3%, and unexplained causes in the remaining 5.9%. There was an age-related shift in refractive error from hyperopia in young children (15.6% in 5-year-olds) toward myopia in older children (10.8% in 15-year-olds). Overall, hyperopia was present in 7.7% of children and myopia in 7.4%. Hyperopia was associated with female gender. Myopia was more common in children of fathers with higher levels of education. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a major public health problem in urban school-aged children in India. Cost-effective strategies are needed to eliminate this easily treated cause of vision impairment.