玻璃体吸出和前房内注水或注气法治疗玻璃体疝继发青光眼二例

玻璃体疝继发青光眼是眼球挫伤晶体脱位后严重并发症之一,我科采用睫状体平坦部针吸玻璃体和前房内注射液体或灭菌空气治疗2例,报告如下。 例1、杜某,男,68岁,住院号91534。左眼被他人拳击伤后失明、眼胀痛伴头痛45天。曾在某医院治疗无效,1983年1月5日来我院诊治。检查:左眼视力光感消失,     

后段玻璃体切除术治疗严重的前房积血

目的探讨用后段玻璃体切除技术治疗严重的前房积血的手术疗效及安全性．方法对38例（38眼）严重的Ⅲ级以上的前房积血,经用药物保守治疗5d以上无明显疗效者,采用后段玻璃体切除器,经两侧透明角膜切口,行凝血块切除及抽吸手术治疗。结果38眼均一次性手术成功,术中有5眼出现前房自发性积血,经加大灌注压力后前房积血停止,3眼术后前房少许积血,5眼角膜内皮水肿。结论应用后段玻璃体切除技术治疗严重的前房积血,术后反应轻,视力恢复快,无严重并发症。     

出血性玻璃体混浊行玻璃体切除术后假性前房积脓分析

目的介绍一种发生于玻璃体切除术后的非感染性前房积脓现象，即假性前房积脓。方法收集我中心收治的需行玻璃体切除术的连续病例１２５０例，其中各种原因引起的玻璃体积血４１８例。术后发生假性前房积脓者７例，均为玻璃体积血者。主要治疗方法是前房冲洗及其自然吸收。结果假性前房积脓发生于术后３～５天，呈泥沙样沉积，局部抗生素及激素加强治疗无效。眼内穿刺行涂片、细菌和真菌培养未发现病原体。患者无疼痛等自觉症状及刺激征。随访时３例视力在０．０５以上。结论玻璃体积血行玻璃体切除术后可能出现假性前房积脓，须与眼内感染相鉴别。     

眼外伤玻璃体术后青光眼应用睫状体光凝联合前房穿刺治疗观察

目的 探讨经巩膜睫状体光凝联合前房穿刺术治疗眼外伤玻璃体切除术后难治性青光眼的效果.方法 回顾复杂性眼外伤玻璃体手术后难治性青光眼41例(41只眼),采用经巩膜睫状体光凝联合前房穿刺术治疗,术后随访3-12个月.结果 41只眼中,手术前眼压是(43.14±12.37)mmHg,术后最后一次随访眼压为(19.76±7.06)mmHg,手术后眼压明显下降,(t=6.5742,P＜0.001).5只眼视力略有提高,33只眼无变化,3只眼视力下降.术后1只眼眼球萎缩.结论 经巩膜睫状体光凝联合前房穿刺术是治疗眼外伤玻璃体手术后难治性青光眼一种安全有效的方法.

Abstract：

Objective To evaluate the clinical effects of transscleral diode laser cyclophotocoagulation and paracentesis of anterior chamber for traumatic refractory glaucoma following vitrectomy.Methods Forty-one cases (41 eyes) with traumatic refractory glaucoma following vitrectomy were received the transscleral diode laser cyclophotocoagulation and paracentesis of antenor chamber, the patients were followed three to twelve months. Results The intraocular pressure (IOP) were (43.14±12.37) mmHg before treatment. IOP were (19.76±7.06) mmHg in the last following-up. IOP was significantly decreased by this surgery (P <0.001). The visual acuity in following-up, 5 eyes was unproved, 33 stable and 3 eyes decreased. One eye was atrophiabulbi. Conclusions Transscleral diode laser cyclophotocoagulation and paracentesis of anterior chamber is a safe and effective treatment for traumatic refractory glaucoma following vitrectomy.     

急性发作期原发性闭角型青光眼的早期联合治疗体会

目的:探讨前房穿刺术联合激光周边虹膜切除术(LPI)治疗原发闭角型青光眼急性发作的疗效。方法:原发性闭角型青光眼急性发作期患者36例40眼分为联合治疗组及传统治疗对照组,联合治疗组行前房穿刺联合激光周边虹膜切除术,对照组按常规行药物治疗,根据眼压结果选择不同手术,并观察眼压、前房角开放范围、发作终止率及小梁切除术率。结果:发作终止率:联合治疗组为89%,传统治疗组为38%;小梁切除手术率联合组32%,对照组76%。结论:发作期行前房穿刺及LPI联合治疗取得了满意效果,它能迅速打开房角、降低眼内压,因此提高了大发作终止率,降低了小梁切除手术比率。     

前房穿刺术联合激光周边虹膜切除术治疗急性原发性闭角型青光眼

目的 评价前房穿刺术联合激光周边虹膜切除术(laser peripheral iridotomy,LPI)治疗急性原发性闭角型青光眼(primary angle-closure glaucoma,PACG)的效果.方法 回顾性分析北京同仁医院2007年11月至2009年5月就诊的急性PACG患者16例(16眼),就诊时眼压≥50 mmHg(1 kPa =7.5 mmHg),均及时行前房穿刺术,并于术后12h内行LPI.用压平眼压计测量并记录前房穿刺术前、术后30 min、2h,LPI术前、术后24 h、7d、1个月、6个月和1 a的眼压,同时记录患者术后角膜水肿及瞳孔情况.结果 16例PACG患者随诊1 a,前房穿刺术后眼压由术前(63.13±7.94) mmHg降至术后30 min(15.47±7.67)mmHg,LPI术前眼压为(15.56±6.93) mmHg,LPI术后24 h眼压为(18.81±7.24) mmHg,其中14例患者术后1 a眼压为(12.79±1.72) mmHg,另2例患者因高眼压控制不良再行小梁切除术.LPI术后患者角膜水肿明显减轻,LPI术前瞳孔明显缩小,为(1.94±1.09)mm,有利于LPI的进行.结论 作为一种可行治疗方法,前房穿刺术联合LPI可安全有效地降低急性PACG患者眼压.     

玻璃体切除术治疗老年黄斑变性所致玻璃体出血的临床观察

为了探讨老年黄斑变性引起的玻璃体出血的治疗方法，对该病患者１０例（１０只眼），经平坦部行玻璃体切除术，经随访１／２￣２８个月，视力提高者９例，下降者１例。术后视力与黄斑变性的程度，与是否有黄斑下出血有关。手术有利于尽快恢复视力、以便进一步检查眼底，为视网膜下的手术提供基础。     

玻璃体切除术治疗玻璃体积血临床效果分析

目的探讨玻璃体切除术治疗玻璃体积血的临床疗效。方法采用玻璃体切除术治疗的玻璃体积血58例（58眼）。分析玻璃体积血的病因，并观察玻璃体切除术后视力变化和并发症。结果本组主要病因为视网膜静脉阻塞和视网膜静脉周围炎；视力在0．01～0．05者术前为6眼（10．35％），术后1周为35眼（60．35％），随访2～4月的50例中为33眼（66．00％）。术中并发症有医源性裂孔和眼内出血；术后并发症有玻璃体再次积血，视网膜脱离，晶状体浑浊等。结论对药物治疗不能吸收的玻璃体积血施行玻璃体切除术后视力可显著提高，术中术后并发症少。     

25G微创玻璃体切除术治疗玻璃体积血的临床观察

目的：探讨25 G微创玻璃体切除术治疗玻璃体积血的临床疗效和安全性。方法：回顾性分析2012-01/2014-06经过视力、眼压、裂隙灯、眼底及B超等检查诊断为玻璃体积血患者200例208眼,所有患者采用25 G 微创玻璃体切除术。比较术前、术后1wk,1、3、6mo最佳矫正视力。观察眼压、前房炎症反应、眼底情况等临床资料。结果：术前视力光感16眼,手动82眼,指数49眼,0.01~0.09者38眼,0.1~0.2者23眼;术后6mo 视力手动1眼,指数2眼,0.01~0.09者31眼,0.1~0.2者29眼,0.2以上者145眼,术后所有患者视力稳定或不同程度提高,手术前后视力差异具有统计学意义( Z=-4.128, P=0.000)。术前平均眼压15.29±3.62mmHg,术后6mo平均眼压13.67±4.93mmHg。其中糖尿病性视网膜病变96眼(46.2％),视网膜分支静脉阻塞37眼(17.8％),视网膜中央静脉阻塞9眼(4.3％),视网膜静脉周围炎13眼(6.25％),息肉样脉络膜视网膜病13眼(6.25％),视网膜大动脉瘤5眼(2.4％),视网膜裂孔19眼(9.1％), Terson综合征16眼(7.7％)。术中联合白内障手术23眼(11.1％),术中玻璃体腔填充灌注液145眼(69.7％), C3F8气体21眼(10.1％),空气17眼(8.2％),硅油25眼(12.0％)。术后并发症：12眼(5.8％)出现术后早期一过性低眼压,8眼(3.8％)术后早期高眼压,19眼(9.1％)出现前房炎症反应,10眼(4.8％)术后早期玻璃体再出血,余所有患者在治疗过程中及治疗后随访均未见眼部或全身不良反应。结论：采用25 G微创玻璃体切除术治疗玻璃体积血是安全有效的,具有创伤小、时间短、恢复快。     

玻璃体切除术治疗玻璃体积血临床分析

玻璃体积血是多种眼病的常见并发症 ,严重影响视力。大量而长期的玻璃体积血对眼部组织造成破坏而致视功能损害。由于玻璃体切除术的开展 ,使这类疾病的预后有了明显改善。回顾 1996年 8月～ 1999年 9月共收治玻璃体大量积血且视力严重低下的患者 4 3例( 4 4眼 ) ,经玻璃体切除术治疗后 ,取得较好的疗效。现将临床资料分析如下。临床资料1 一般情况 :男 2 5例 ,女 18例。年龄 2 2～ 68岁 ,平均 ( 4 2 8± 12 6)岁。单眼 4 2例 ,双眼 1例 ,共 4 4眼 ;右眼18眼 ,左眼 2 6眼。病程 1月至 2 6月 ,平均 3 8月。术前患者均经过全身常规检查以及…     

复合式小梁切除术治疗青光眼的临床观察

目的:探讨复合式小梁切除术与经典小梁切除术治疗青光眼的效果.方法:我院于2004-01/2006-12采用复合式小梁切除术(小梁切除口减小 丝裂霉素 前房穿刺)治疗青光眼56例68眼,术后随访3mo～2a,对比2002年以来所作的经典小梁切除术70眼,观察中和手术后的前房、瞳孔、滤过泡、眼压的情况.结果:术后浅前房发生率:A组7.3%,B组为38.5%;术后瞳孔:A组基本无变形,无虹膜前后粘连.B组有8眼瞳孔变形,4眼虹膜后粘连;术后滤过泡:A组后期有1眼滤过泡壁薄破裂行修补后完好,2例无功能滤过泡.B组10眼无功能滤过泡;术后眼压:A组2眼眼压控制不佳,B组8眼眼压需药物控制或再次手术治疗.结论:复合式小梁切除术治疗青光眼安全性高,术后并发症少,疗效确切,是青光眼手术治疗的理想术式.     

重新开放房角在重症急性闭角型青光眼治疗中的临床意义

目的：探讨360°“最大程度”房角关闭的重症急性闭角型青光眼,通过“双穿刺”、联合超声乳化加房角分离手术,能否重新开放房角,开放的范围和眼压变化。

方法：回顾性系列病例研究。2008-11/2015-11收住我院病例完整的重症急性闭角型青光眼患者33眼,均为最大量药物治疗无效的患者。入院后行“双穿刺”手术短时间降低眼内压(术前和术后7d查房角),7～14d后行超声乳化联合房角分离手术治疗(术中检查房角),比较两次手术前后患者眼压、房角变化,观察手术并发症。随访时间为6～24mo。

结果：“双穿刺”术前眼压为53.4±10.7mmHg(1mmHg=0.133kPa),“双穿刺”手术后32眼眼压正常(其中2眼激光打孔后眼压正常),平均眼压为16.9±13.2mmHg。1眼眼压仍高。双穿刺术前、术后眼压比较差异有统计学意义(t=9.21,P<0.001)。超声乳化术后1wk眼压为16.7±4.8mmHg。双穿刺术后与超声乳化术后眼压比较差异无统计学意义(t=0.38, P>0.05)。1眼术后眼压异常,术后30d后正常。双穿刺术后房角的检查结果为：房角开放均值(131.8±111.3)°。术后7～14d 32眼行超声乳化联合房角分离术,1眼行超乳联合小梁切除手术,房角开放手术治疗有效率为32/33(97%)。术中房角开放均值(228.6±108.3)°,术后3mo房角开放均值(234.6±107.2)°。双穿刺术后与超声乳化术中房角开放度数比较差异有统计学意义(t=4.52,P<0.001),超声乳化术后3mo房角均值大于术中房角,差异无统计学意义(t=0.46, P>0.05)。没有严重并发症发生。

结论：“最大程度”房角关闭的重症急性闭角型青光眼,可以通过“双穿刺”联合晶状体摘除手术逐步开放房角、降低眼压。开放房角可以作为重症急性闭角型青光眼的选择。     

激光虹膜周切术治疗早期闭角型青光眼临床观察

目的：观察早期闭角型青光眼患者激光虹膜周边切除术（laser peripheral iridectomy,LPI）的近、远期临床疗效。方法：对急性闭角型青光眼临床前期21例21眼和慢性闭角型青光眼早期15例15眼患者行LPI,随访1a,观察中央前房深度,房角宽度及眼压等情况。结果：急性闭角型青光眼临床前期和慢性闭角型青光眼早期LPI术后中央前房深度加深,房角增宽,眼压下降,但随访1a后慢性闭角型青光眼早期患者中央前房深度有所变浅、眼压回升,其中3例需药物控制眼压,1例药物控制眼压失败需行滤过性减压手术。结论：LPI治疗急性闭角型青光眼临床前期效果满意,慢性闭角型青光眼早期患者应注意LPI适应证的选择,对所有LPI患者,应密切随诊,以防止视功能进一步损害。     

Ultra Q-YAG玻璃体消融术治疗飞蚊症的临床初步观察

目的：研究 Ultra Q-YAG 玻璃体消融术治疗不同年龄段临床有症状飞蚊症患者的疗效及安全性。
　　方法：回顾性队列研究。对2014-09/2015-05在北京爱尔英智眼科医院临床确诊为玻璃体混浊的患者263例340眼纳入研究,所有患者均行视力、眼压、裂隙灯、散瞳查眼底、B 超检查,并记录玻璃体混浊物的形态,排除眼底病变。根据患者年龄分为两组：A 组(<30岁)78例82眼,玻璃体混浊的形态多为细点、丝状、网状;B 组(>45岁)185例258眼,玻璃体混浊的形态多为 Weiss 环,半透明絮状或致密纤维膜状。均排除外伤与眼内病变所致混浊,30~45岁患者由于混浊因素不典型被剔除。所有患者均由同一有经验医师行 YAG 玻璃体消融术( Ellex Medical Lasers),对比分析治疗后1mo 飞蚊症状缓解情况。
　　结果：行问卷调查,根据患者问卷得分将术后症状改善程度分为基本无改善(1~2分)、部分改善(3~5分)、显著改善(6~10分)。1mo 后 A 组无改善9眼(11.0%),部分改善57眼(69.5%),显著改善16眼(19.5%);B 组无改善0眼,部分改善23眼(8.9%),显著改善235眼(91.1%);所有患者无1例并发症发生。
　　结论：YAG 玻璃体消融术治疗飞蚊症安全有效。对于年龄<30岁年龄组的飞蚊症患者,有改善但显著改善的几率不高。而对于年龄>45岁年龄组,因玻璃体后脱离导致的玻璃体混浊,患者效果更佳。     

Disposition of short-chain aliphatic alcohols in rabbit vitreous by ocular microdialysis

Anatomic and physiological barriers limit drug delivery to the posterior segment of the eye via topical or systemic administration. Intravitreal administration has proven to be a safe and effective means of treating various posterior segment diseases. Elimination of a compound from the vitreous chamber may depend on lipophilicity, diffusivity, and aqueous solubility. This information is critical for optimizing intravitreal dosing which in turn can aid in the design of drug delivery systems. The purpose of this study is to determine the vitreous disposition of an ascending homologous series of short chain aliphatic alcohols ranging from hydrophilic methanol to lipophilic 1-heptanol by microdialysis. Radiolabelled 14C-methanol, 14C-1-propanol, 14C-1-pentanol, and 14C-1-heptanol with log partition coefficient values ranging from -0.77 to 2.7 were studied. Microdialysis probes were implanted in both anterior and vitreous chamber of the rabbit eye to sample aqueous and vitreous humors simultaneously. Concentric probe was implanted in vitreous chamber about 3mm below the cornealscleral limbus. Linear probe was implanted in the anterior chamber using a 25-guage needle. Isotonic phosphate buffer saline (IPBS) (pH 7.4) was perfused through the probe with a flow rate of 2 microlml(-1). Alcohols (2.0 microg-130.72 microg) were injected into the vitreous body. In vitro recovery for the probes was calculated using respective alcohols in IPBS. Pharmacokinetic parameters were determined by non-compartmental analysis. Vitreal elimination half-lives of methanol, 1-propanol, 1-pentanol and 1-heptanol are 52.0+/-5.7, 58.5+/-5.8, 72.9+/-5.8 and 153.7+/-21.6 min, respectively. Dose normalized area under the aqueous concentration time curve values of methanol, 1-propanol and 1-pentanol are 33.8+/-13.4, 28.3+/-11.9 and 29.2+/-4.9 microgminml(-1)microg(-1)10(-2), respectively. Time taken to reach maximum concentration in the anterior chamber for methanol, 1-propanol and 1-pentanol is 120+/-42, 160+/-26, and 260+/-26 min, respectively. The maximum concentration of methanol, 1-propanol and 1-pentanol achieved in the anterior chamber is 18.6+/-10.3, 9.4+/-3.2, and 5.9+/-1.3 microgml(-1)10(-4) respectively. Detectable 1-heptanol levels were not observed in the anterior chamber with the intravitreal dose administered. The shorter vitreal elimination half-lives of the alcohols studied suggest retina as major route of elimination from the vitreous body. The elimination rate constants of alcohols from the vitreous appear to be progressively decreasing with ascending chain length and lipophilicity (methanol to 1-heptanol). Among the alcohols studied, methanol produced the highest concentration in the anterior chamber following vitreal administration.     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

超声乳化联合人工晶状体植入治疗急性闭角型青光眼

目的：探讨术前或术中辅助降压后超声乳化白内障吸除人工晶状体植入术治疗急性闭角型青光眼急性发作期的效果。

方法：收治87例92眼急性闭角型青光眼患者,入院时眼压均在45.0mmHg以上,术前通过全身及局部使用最大剂量降眼压药物处理,眼压能降至25.0mmHg以下者于降压后2～3d内行白内障超声乳化吸除人工晶状体植入手术(60眼),如眼压依然高于30.0mmHg且前房深度尚可者,术前先行前房穿刺降压并于降压后1～2d内行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(25眼),如药物降压后眼压仍高于35.0mmHg且前房较浅,则手术时行玻璃体腔穿刺抽取部分玻璃体腔液后再前房穿刺实现降眼压后行白内障超声乳化白内障摘除联合人工晶状体植入并前房角分离术(7眼)。对术前检查和术后6mo随访检查结果进行比较分析,包括眼压、视力、手术并发症及中央前房深度和前房角宽度等。

结果：随访6mo～2a,全部病例在随访期间眼压均可控制在20.0mmHg以下,其中有2眼在6mo时需20g/L卡替洛尔滴眼液点眼。术前视力均低于0.3,术后视力：<0.1者5眼,0.1～0.3者22眼,<0.3～0.5者50眼,>0.5者15眼。前房及房角：术后前房均明显加深,房角全部开放者8眼,开放大于270度者23眼,开放≥180度者56眼,开放<180度者5眼。术后并发症：60眼出现较明显的前房反应,其中有16眼出现前房纤维素性渗出。

结论：超声乳化白内障吸除人工晶状体植入术对于急性发作的急性闭角型青光眼有良好的疗效,能及时控制眼压并挽救患者的视功能。前房穿刺或玻璃体穿刺是术前眼压控制不良者有效降眼压手段,有利于提高手术的安全性。     

An evaluation of methylated collagen as a substitute for vitreous and aqueous humor

Purpose:To evaluate ocular tolerance of methylated collagen gel injected intravitreally and into the anterior chamber. Methods: Methylated collagen (type I/III) was tested in New Zealand white rabbits. Vitreous cavity: After pars plana vitrectomy, methylated collagen gel was injected intravitreally. The eyes were examined clinically; electroretinogram recordings were made before and after surgery. Vitreous samples were taken for immunological analysis for the presence of the injected collagen. The rabbits were sacrificed 6 months after surgery; the retina was evaluated by light microscopy. Anterior chamber: In another group of rabbits, methylated collagen gel (0.2 ml, 0.1 ml, or 0.05 ml) was injected into the anterior chamber after paracentesis. The eyes were examined with a slit lamp; intraocular pressure was measured postinjection. The rabbits were sacrificed after 4 months; the corneas were evaluated histologically. Results: Vitreous cavity: The fundus view was clear for 6 months after intravitreal injection. Scotopic and photopic electroretinograms were normal in 6/7 eyes; one eye experienced a mild decrease one month postoperatively. No abnormal changes were found in the retinal histology. Anterior chamber: Some corneas were hazy and edematous around the injection site for one week. The injected collagen appeared in bundles, patches, and little pieces in the anterior chamber with precipitates on the corneal endothelium, pupillary margin, and the anterior capsule of the lens. The collagen diminished gradually, without causing permanent opacity. Histologically, the corneal endothelium in the eye which received 0.2 ml collagen showed a mild distention of the mitochondriae and vesicle formation between endothelial cells under transmission electron microscope. Conclusion: Methylated collagen gel was tolerated by the eye after intravitreal injection. Localized temporary clinical and mild ultrastructural corneal changes were observed after anterior chamber injection.     

前房穿刺术在内眼手术中应用的临床观察

目的：探讨前房穿刺术在内眼手术中的实用性及其优越性。方法：在青光眼小梁切除术、虹膜嵌顿术、白内障摘除及人工晶状体植入术、瞳孔成形术、角膜穿通伤合并虹膜脱出修复术等337例内眼手术中应用前房穿刺术，观察术中及术后并发症的发生。结果：术后浅前房占6．3％，角膜内皮水肿占5．2％，虹膜炎占10．7％，瞳孔不圆占6．6％，后囊破裂者占8．3％，无其它并发症。结论：前房穿刺术应用在内眼手术中是预防术后浅前房的有效措施，也便于手术操作、减少术中及术后并发症、促进前房形成等优点，可挽救某些濒临失败的手术。