Nd:YAG激光治疗糖尿病性白内障术后后发性白内障的临床研究

目的探讨Nd:YAG激光治疗糖尿病性白内障术后后发性白内障的临床疗效与术后并发症。方法对137例(137眼)单纯性年龄相关性白内障术后后发障(A组)和53例(53眼)糖尿病性白内障术后后发障患者(B组),在同等条件下进行Nd:YAG激光后囊膜切开术,比较二组术前、术后最佳矫正视力及术后并发症情况。结果随着后囊膜混浊级别的增高,A、B两组Nd:YAG激光后囊膜切开术后并发症均逐渐增加(P<0.05)。A、B两组组间比较,术前最佳矫正视力无明显差异(P>0.05),术后并发症出现的几率无明显差异(P>0.05),B组术后最佳矫正视力提高幅度较A组小(P<0.05),房水闪辉程度较A组重(P<0.05)。结论 Nd:YAG激光是治疗糖尿病性白内障术后后发障简单、安全、有效的方法,术后并发症与后囊膜混浊级别呈正相关。     

Nd:YAG激光带蒂开罐式后囊切开术治疗后发性白内障

目的 探讨YAG激光带蒂开罐式后囊切开术治疗后发性白内障的技术要点、疗效及安全性.方法 对85例(96只眼)明显影响视力的Ⅱ级膜和Ⅲ级膜性后发性白内障行Nd:YAG激光带蒂开罐式后囊切开术,根据后囊混浊程度选用不同能量.结果 截囊成功率99.3%,术后矫正视力均明显提高,由术前平均视力0.21改变为0.61,并发症有术后眼压升高19只眼,占19.8%,轻度人工晶状体损伤13只眼,占13.5%.结论 YAG激光带蒂开罐式后囊切开术治疗后囊明显增厚的后发性白内障是安全、有效的方法,能减少并发症的发生和防止复发.     

后发性白内障Nd:YAG激光治疗的分析

目的：观察Nd：YAG激光对各类白内障术后的后发性白内障的疗效、治疗参数和并发症。

方法：对360例382眼各类白内障术后的后发性白内障Nd：YAG激光治疗。观察术后视力及并发症。分1级膜、2级膜和3级膜三组统计激光参数以及分老年性、先天性、并发性和外伤性白内障术后后发性白内障四组统计激光参数进行对照分析。

结果：治疗前后最佳矫正视力比较有显著性差异(P<0.05)。老年性组与外伤性组使用的平均激光总能量和平均激光脉冲数比较均有显著性差异(P<0.05)。并发症包括激光治疗后7眼眼压升高(1.8%),人工晶状体损伤26眼(7.7%)。

结论：Nd：YAG激光是治疗后发性白内障安全有效的方法。外伤性白内障术后发生后囊膜混浊的病例多为3级膜,Nd：YAG激光治疗时使用单次能量,总脉冲数和激光总能量均大。针对患者的情况选择好激光治疗参数,及时处理术后并发症,能提高治疗的有效性和安全性。     

Nd：YAG激光治疗后发性白内障的临床观察

目的 探讨Nd:YAG激光治疗后发性白内障的时机、疗效和并发症.方法 对78例(103只眼)(I级膜76只眼,Ⅱ级膜18只眼,Ⅲ级膜9只眼)后发性白内障应用Nd:YAG激光行后囊膜切开术进行治疗,术后随访3个月.结果 103只眼后囊膜一次击穿,随访3个月未见复发.所有病例术后1周视力较术前有显著改善(P＜0.01),术后1周、1个月及3个月视力之间无显著性差异(P＞0.05).术后并发症主要有房水闪辉(为1～3级,术后一周随访基本吸收)、人工晶状体损伤9只眼(8.91%)和眼压升高12只眼(11.65%).结论 Nd:YAG激光治疗后发性白内障术后视力提高明显,并发症少.     

Nd:YAG激光治疗后发性白内障临床分析

目的:探讨Nd:YAG激光治疗后发性白内障的临床疗效。方法:应用Nd:YAG激光对147例(176眼)后发性白内障行后囊膜切开术,散瞳后于瞳孔区行十字形或圆形后囊切开。术后抗炎、散瞳、必要时控制眼压、随访。结果:后囊膜均切开,视力比治疗前增加的患者占94.9%,14眼术后眼压高在治疗后12～48h正常,36眼人工晶状体遗留局限性击射斑。结论:对于后发性白内障,Nd:YAG激光后囊膜切开可增加视力,且安全有效。     

Nd:YAG激光后囊膜切开术后黄斑区三维光学相干断层扫描观察

目的:应用三维光学相干断层扫描仪观察Nd:YAG激光后囊膜切开对黄斑区视网膜的影响。方法:对超声乳化白内障术后后发性白内障患者65例79眼,依据后囊膜混浊的不同程度,使用不同输出能量的Nd:YAG激光进行治疗。术后10min及术后7d采用三维光学相干断层扫描(Topcon,3D-OCT-1000)检测眼底变化,并记录视力和眼前段情况。结果:后发性白内障患者79眼均成功施行Nd:YAG激光后囊膜切开术,术后患者视力均有不同程度提高,前房无炎性反应,仅6眼人工晶状体光学面出现小凹痕迹。术后10min,7d时患眼黄斑中心凹视网膜平均厚度(CMT)分别为201.36±41.27μm与197.23±36.54μm,比正常同年龄人群组CMT(189.95±43.57μm)略有增加,但两者与正常同年龄人群组比较差异没有统计学意义(P>0.05)。少数患者OCT表现为视网膜光感受器内外节连接(IS/OS)层不完整及黄斑中心凹视网膜各层次欠清晰。结论:Nd:YAG激光是治疗不同程度的后发性白内障安全有效的方法。3D-OCT显示Nd:YAG术后10min,7d的视网膜厚度较同年龄正常人群相似,结构未出现明显异常改变。操作技巧娴熟且激光能量选择适当能减小其对黄斑区视网膜的影响。     

Q开关Nd：YAG激光治疗后发性白内障临床观察

目的　探讨 Q开关 Nd:YAG激光后囊膜切开术治疗后发性白内障的疗效及安全性。方法　回顾性分析行 Q开关 Nd:YAG激光后囊膜切开术后发性白内障患者 16 5例 193眼 ,记录手术前后视力、眼压及并发症 ,并进行统计学分析。结果　 (1)后囊膜一次性切开成功率为 10 0 % ,所用激光脉冲数平均 2 4± 2 1.7次 ,激光总能量平均 5 9.3± 6 6 .2 m J;(2 ) 91.2 % (176眼 )视力较术前提高 ;(3) 5 9.6 % (115眼 )出现一过性眼压升高 ;手术前后眼压变化与是否植入人工晶状体、所用激光脉冲数以及白内障手术与后囊膜切开术间隔时间有关 ;(4) 19.3% (32眼 )出现人工晶状体损伤。结论　 Q开关 Nd:YAG激光后囊膜切开术治疗后发性白内障安全、有效 ,但应严格掌握手术适应证 ,并合理选择激光参数。     

Nd：YAG激光在不同类型后发性白内障中的应用

目的：观察Nd：YAG激光对后发性白内障的治疗效果。方法：对652例830眼分别为Elschnig珍珠样小体性、皱褶性及纤维化性后发性患者行白内障YAG激光治疗,对Elschnig珍珠样小体性、皱褶性后发性白内障采用十字形切开法,对纤维化性后发性白内障视纤维化程度采用开罐式切开术或十字形切开法。根据不同的病变类型选择不同的激光参数,激光后分别于1wk;1mo和3～6mo进行随访眼压、视力及眼部情况。平均随访时间2．72mo。结果：Elschnig珍珠样小体性后发性白内障390眼,激光后眼压保持正常者385眼,视力有所提高者386眼（99．0％）;皱褶性后发性白内障320眼,激光后眼压保持正常者320眼,视力提高318眼（99．3％）;纤维化性后发性白内障120眼,激光后眼压保持正常者113眼,视力提高者118眼（98．3％）。结论：根据后囊膜混浊的程度和视力的情况灵活选择激光参数,确保高比例有效的脉冲能量,是YAG激光治疗后发性白内障的关键。     

碘剂对后发性白内障术后囊膜碎片吸收的疗效观察

目的评价激光治疗后发白内障同时应用口服碘剂-沃丽汀促进后囊膜碎片吸收的疗效。方法将自2004年1月至2005年3月将Nd∶YAG激光晶状体后囊膜切开术者96例116眼随机分为两组,其中43例52眼激光治疗后给予口服沃丽汀片剂,对照组53例64眼激光治疗后不给予沃丽汀口服。所有患者均在门诊治疗,给药后的7d、30d和60d分别复诊。治疗前后检查视力、矫正视力、眼压,裂隙灯显微镜检查眼前节及眼底检查。结果沃丽汀治疗组在术后2个月时,后囊膜碎片的混浊吸收程度（68.1%）明显优于对照组（51.2%）。结论研究显示,沃丽汀能加快后囊膜碎片在眼内的吸收。为白内障患者带来更好的术后视力。     

Nd∶YAG激光在不同类型后发性白内障中的应用

目的:观察Nd∶YAG激光对后发性白内障的治疗效果。方法:对652例830眼分别为Elschnig珍珠样小体性、皱褶性及纤维化性后发性患者行白内障YAG激光治疗,对Elschnig珍珠样小体性、皱褶性后发性白内障采用十字形切开法,对纤维化性后发性白内障视纤维化程度采用开罐式切开术或十字形切开法。根据不同的病变类型选择不同的激光参数,激光后分别于1wk;1mo和3～6mo进行随访眼压、视力及眼部情况。平均随访时间2.72mo。结果:Elschnig珍珠样小体性后发性白内障390眼,激光后眼压保持正常者385眼,视力有所提高者386眼(99.0%);皱褶性后发性白内障320眼,激光后眼压保持正常者320眼,视力提高318眼(99.3%);纤维化性后发性白内障120眼,激光后眼压保持正常者113眼,视力提高者118眼(98.3%)。结论:根据后囊膜混浊的程度和视力的情况灵活选择激光参数,确保高比例有效的脉冲能量,是YAG激光治疗后发性白内障的关键。     

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.

---

     

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.