悬吊式人工晶状体睫状沟固定术临床观察

目的探讨悬吊式人工晶状体睫状沟固定术的临床应用价值。方法回顾性分析21例(21眼)晶状体后囊缺如或不完整,悬韧带断离眼选择悬吊式人工晶状体睫状沟固定术治疗情况,对手术方式、特点、效果、并发症和防治措施等进行了分析。结果术后矫正视力:一期植入0.1~0.2者2眼,0.3~0.8者10眼,≥1.0者1眼;二期植入0.1~0.2者2眼,0.3~0.8者5眼,≥1.0者1眼。术后3月平均手术源性散光度数为(0.68±0.63)D。结论悬吊式人工晶状体睫状沟固定术为非常规无支持人工晶状体植入眼屈光矫正的一种较好的替代手术方式。     

微小切口推注式人工晶状体睫状沟悬吊术临床应用

目的:探讨微小切口推注式折叠人工晶状体睫状沟悬吊术的有效性和安全性。方法:选择因晶状体后囊破裂或悬韧带断裂不能正常植入后房型人工晶状体的患者52例52眼,利用推注器系统,通过3.2mm的透明角膜小切口,把襻预扎了聚丙烯缝线的折叠人工晶状体植入后房并缝合固定于睫状沟,观察术后视力、角膜散光度及并发症。结果:所有患者术后裸眼视力均提高,其中1.0以上8眼,0.6～0.8为18眼,0.4～0.6为16眼,0.4以下10眼。术后1wk;1,3mo视力在0.5以上者分别为33眼(63%)、39眼(75%)、41眼(79%)。术前及术后1wk;1,3mo的平均角膜散光度分别为1.86±1.65D,2.09±1.28D,1.92±1.34D和1.77±1.16D,术后各时期与术前的角膜散光度差别均无统计学意义(P>0.05)。术中、术后没有出现严重并发症。结论:微小切口推注式折叠人工晶状体睫状沟悬吊术为治疗晶状体、玻璃体切除术后,无晶状体囊支持的患者,提供了一个更安全可靠的人工晶状体植入方法。     

针拨术后小切口白内障摘除人工晶状体睫状沟悬吊术

目的:探讨在针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术的有效性和安全性。方法:对20例(21眼)针拨白内障术后患者进行白内障取出人工晶状体睫状沟悬吊固定术。随访3～12mo,观察术后视力、眼压、术中术后并发症及术后人工晶状体的位置。结果:术后第1d裸眼视力:0.4～0.5者7眼,0.6～0.8者14眼。术后7d进行显然验光,平均为(-0.87±0.43)D,与手术前设计保留(-0.50～-1.00)D接近。术后3mo平均度数为(-0.68±0.33)D。手术后7d眼压平均为17.11±3.13mmHg,术后3mo平均眼压为14.17±2.03mmHg。手术中入、出针时,发生少量出血2眼;术后角膜切口周围轻度水肿5眼,3～5d基本消退。结膜下出血4例,5～7d后自行吸收。随访观察3～12mo,21眼手术后人工晶状体位置均保持良好的居中性。未发现角膜内皮功能失代偿、青光眼、视网膜脱离等情况。结论:针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术是安全、有效的。     

小切口折叠人工晶状体睫状沟悬吊术

目的探讨小切口折叠人工晶状体睫状沟悬吊术的临床疗效。方法因晶状体后囊破裂、悬韧带断裂、晶状体完全脱位及玻璃体切除术中切除晶状体而不能正常植入后房型人工晶状体者12例（12眼）。通过3．2mm的角膜切口,将折叠人工晶状体缝合固定于睫状沟。结果术后裸眼视力均提高。术后3个月检查,平均新增散光为（0．50±0．25）D,人工晶状体无倾斜或偏位,术中术后没有出现出血、视网膜脱离、脉络膜脱离等严重并发症。结论小切口折叠人工晶状体睫状沟悬吊术手术效果可靠,术中术后并发症较少。     

透明晶状体屈光手术的疗效观察

目的 :评价透明晶状体屈光手术的有效性、预测性和安全性。方法 :对屈光不正患者 5 8例 87眼行透明晶状体超声乳化摘除联合折叠式人工晶状体植入。患者年龄 2 5～ 73岁 ,平均 5 4 .32岁。将病例分为 3组 ,A组为高度近视共 6 1眼 ,眼轴长度 (2 9.5 7± 2 .10 )mm ,等效球镜度数 (- 11.93± 4 .6 4 )D ,植入人工晶状体屈光度 ( 9.0± 3.82 )D ;B组为远视共 17眼 ,眼轴长度 (2 2 .39± 0 .96 )mm ,等效球镜度数 ( 2 .2 9± 1.0 5 )D ,植入人工晶状体屈光度 ( 2 2 .70± 2 .0 8)D ;C组为屈光参差共 9眼 ,眼轴长度 (2 8.4 8± 1.77)mm ,屈光参差度数 (- 11.2 5± 5 .38)D ,植入人工晶状体屈光度 ( 10 .6 2±3.6 2 )D。随访 3～ 36个月。结果 :术后最佳矫正视力 87眼均达到或超过术前最佳矫正视力 ;术后裸眼视力达到或超过术前最佳矫正视力者在A、B、C组分别占 86 .89%、94 .12 %和88.89% ;术后裸眼视力 0 .5以上者分别为 5 4 .10 %、4 1.18%和 5 5 .5 6 % ;术中未发生后囊破裂。随访中 12眼发生后囊混浊 ,未发现视网膜脱离、黄斑囊样水肿等并发症。结论 :透明晶状体屈光手术与目前的角膜屈光手术相比 ,可能更适宜于中年以上不愿戴镜和戴镜不能矫治的屈光不正患者 ,但其远期疗效尚需长期随访     

严重先天性晶状体不全脱位超声乳化人工晶状体植入术15例

目的：探讨严重先天性晶状体不全脱位超声乳化后房型人工晶状体睫状沟固定术后的效果。方法：严重先天性晶状体不全脱位15例20眼,脱位范围1／2—3／4,做近角巩缘巩膜隧道切口,偏中心连续环行撕囊,在脱位侧尽量靠晶状体周边部,但应适当保留悬韧带附着处的囊袋,充分水分离、乳化、注吸出晶状体核及皮质,植入折叠6mm人工晶状体,睫状沟固定,襻的方向与脱位方向垂直。出现后发性白内障术后2mo行YAG激光。结果：术后视力不同程度提高,0．1～0．24眼(20％1,0．3～0．510眼(50％),≥0．66眼(30％);玻璃体脱出1眼(5％),渗出膜3眼(15％),后发性白内障6眼(30％)、行YAG激光后囊切开术。结论：超声乳化后房型人工晶状体植入(睫状沟固定)是治疗严重先天性晶状体不全脱位的有效方法,手术简化、损伤小、反应轻、人工晶状体居中、经济。     

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。     

儿童人工晶状体睫状沟缝线固定术的临床观察

目的:探讨对儿童施行人工晶状体睫状沟缝线固定术的临床应用。方法:对32例(35眼)无法行后房型人工晶状体植入的白内障患者行晶状体、玻璃体切除,同期或二期行人工晶状体睫状沟固定术。结果:所有病例术中无严重并发症发生。随诊1～12mo术后视力>0.8者5眼(14%),0.3～0.7者19眼(54%),0.1～0.2者7眼(20%),<0.1者4眼(12%)。结论:人工晶状体睫状沟固定术为无后囊支持的儿童患眼提供了安全有效的手术方法。     

囊袋内白内障摘出及人工晶状体植入术的临床分析

探讨囊袋内白内障摘出及人工晶状体植入术的手术方式，术后并发症及优点，方法６０例白内障行开信封式前囊截开，囊袋内白内障摘出及人工晶状体植入术。结果７８眼中７６眼人工晶状体固定在囊袋内，２眼因后囊破裂，行睫状沟固定人工晶状体植入。     

虹膜缝线固定后房型折叠人工晶状体的手术探讨

目的 探讨采用虹膜缝线固定术植入折叠人工晶状体的手术方法及效果.方法 无晶状体眼、晶状体脱位或后囊破裂无法行睫状沟或囊袋内植入人工晶状体者13例(14眼),植入三件式折叠人工晶状体,将晶状体两襻置于虹膜后,光学面置于虹膜表面,10 -0聚丙烯缝线缝合人工晶体袢于虹膜中周部.双襻相同方法缝线固定,再将人工晶状体光学面放入后房.结果 随访3 ～12个月,术后最佳矫正视力0.6～1.0者8眼(53.8％),0.3 ～0.5者5眼(38.5％),＜0.2者1眼(7.7％).UBM提示人工晶状体正位无偏斜,随访中无出血、人工晶状体襻滑脱、慢性葡萄膜炎或继发性青光眼等并发症出现.结论 折叠人工晶状体虹膜缝线固定术操作简单、创伤小、并发症少,是无法行睫状沟或囊袋内植入情况下人工晶状体者又一有效方法.     

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.