同种异体巩膜瓣移植治疗前巩膜葡萄肿

目的探讨异体巩膜瓣移植治疗病理性前巩膜葡萄肿的临床疗效。方法对玻璃体切除术后的前巩膜葡萄肿3例（3眼）和前巩膜葡萄肿穿孔伴化脓性眼内炎1例（1眼）施行同种异体巩膜瓣移植,随访5～24个月。观察视力、巩膜植片、视网膜、眼压及其并发症等。结果3例玻璃体切除后的前巩膜葡萄肿,巩膜移植术后视力均同术前;巩膜植片表面可见血管网,植片无溶解,视网膜均在位,眼压控制在正常范围。1例前巩膜葡萄肿穿孔伴化脓性眼内炎,巩膜移植术后视力由术后光感／光定位不准恢复至0．05,玻璃体腔硅油填充,视网膜在位。巩膜植片周围被纤维组织包裹,略呈弧形隆起,并有新生血管长人,形成加厚的“新巩膜”。结论同种异体巩膜瓣移植治疗病理性前巩膜葡萄肿,能修补菲薄或穿孔的巩膜,且无排斥反应;能有效维持眼压,尽可能挽救患者的视力。     

异体巩膜移植联合自体结膜瓣覆盖术治疗无菌性巩膜融解的研究

目的评价异体巩膜移植联合结膜瓣覆盖术治疗眼科手术后无菌性巩膜融解的临床效果。方法对因眼部手术后发生无菌性巩膜融解10例（10只眼）的临床资料进行回顾性分析。进行巩膜坏死组织涂片,微生物培养,及血清学检查。采用异体巩膜移植联合自体结膜瓣覆盖术,术后局部滴眼。结果术前10只眼巩膜坏死组织的细菌及真菌培养均未见微生物生长,仅1只眼类风湿因子异常高表达,8只眼患有干眼。实施异体巩膜联合自体结膜瓣移植术后,8只眼术后32～50d巩膜坏死区愈合,2只眼于术后40d及48d后发生巩膜植片融解。结论全身胶原血管性疾病及手术刺激等所致的免疫反应可能是眼部手术后产生无菌性巩膜融解的主要原因;异体巩膜移植联合自体结膜瓣移植可控制及修复巩膜融解,有效保留眼球的完整性。     

异体巩膜移植治疗丝裂霉素所致的低眼压

目的观察青光眼滤过术联合应用丝裂霉素后致低眼压的患者行异体巩膜移植术的疗效。方法应用异体板层巩膜对７例（８只眼）青光眼滤过术联合应用丝裂霉素后低眼压的患者行巩膜移植术。结果术后随访３～１９个月（平均７．７５±５．３７个月），５例（５只眼）术后视力提高，７例（８只眼）术后眼压恢复正常。结论异体巩膜移植术对青光眼滤过术后低眼压有治疗作用。     

局部切除合并部分异体板层角巩膜移植治疗角膜皮样瘤

目的 观察局部切除合并异体板层角巩膜移植治疗角膜皮样瘤的临床效果。方法 对107例110眼角膜皮样瘤用比瘤体大0．5mm的环钻划界，行病灶处角巩膜组织板层切除，于供体眼球相应部位钻取形状和厚度相似的板层角巩膜植片，植片比植床直径大0．25mm，角膜侧行连续缝合，巩膜侧行间断缝合。结果 随访6个月～5年，所有植片愈合良好，7眼出现植片下新生血管及植片轻度水肿，抗排斥治疗后血管萎缩、消退。术后正常眼表结构恢复快，视力及角膜散光较术前改善（P〈0．05）。2例复发，无层间植入等并发症。结论 局部彻底切除合并相应部位的异体板层角巩膜移植是治疗角膜皮样瘤的较理想的方法。     

陈旧性视网膜脱离的手术治疗

目的评价巩膜外环扎、加压联合放液、冷凝术治疗陈旧性视网膜脱离的效果。设计回顾性、非对照研究。研究对象13例（13眼）陈旧性视网膜脱离患者。方法对13例（13眼）陈旧性视网膜脱离采用巩膜外环扎、加压、放液、冷凝等联合手术方法治疗，分析术后视网膜复位，视力、眼压及术后并发症等情况。主要指标视力、眼压、视网膜复位状况。结果13例（13眼）术后均达到解剖复位，6例患者视力较术前提高，7例患者视力无明显变化，但自觉症状较术前改善。术后眼压维持在正常范围，术后随访至1年，未见并发症发生。结论采用巩膜外环扎、加压、放液、冷凝联合手术方法治疗某些陈旧性视网膜脱离，能取得较好的疗效。     

异体巩膜用于结膜囊成形的实验研究

目的 探讨异体巩膜在结膜囊成形中的应用。方法 18只新西兰大白兔随机分为6组,每组3只,每只兔行右眼球摘除 义眼胎植入 异体巩膜植入全结膜囊成形术。左眼局部球结膜切除,异体巩膜植入替代术。结果 结膜上皮可沿植片上生长,且移植片逐渐溶解吸收,被新生的结缔组织所取代,形成一个新的结膜囊。结论 异体巩膜能够作为支持物起支架作用,结膜组织附于其上生长并愈合形成新的结膜囊。     

异体巩膜用于结膜囊成形的实验研究

目的 探讨异体巩膜在结膜囊成形中的应用。方法 18只新西兰大白兔随机分为6组，每组3只，每只兔行右眼球除＋义眼胎植入＋异体巩膜植入全结膜囊成形术。左眼局部球结膜切除，异体巩膜植入替代术。结果 结膜上皮可沿植片上生长，且移植片逐渐溶解吸收，被新生的结缔组织所取代，形成一个新的结膜囊。结论 异体巩膜能够作为支持物起支架作用，结膜组织附于其上生长并愈合形成新的结膜囊。     

巩膜切口位置调整下玻璃体切除术治疗眼弓蛔虫病的效果

目的 观察巩膜切口位置调整后玻璃体切除术治疗眼弓蛔虫的临床效果。设计 回顾性病例系列。研究对象 2012年3月至2018年3月北京同仁医院眼科因眼弓蛔虫病行巩膜切口位置调整下玻璃体切除术、随诊≥5个月的患者139例（139眼）。方法 回顾性分析患者病历资料,描述其一般情况,术前行UBM检查,根据术前UBM检查结果或双目间接检眼镜检查结果进行巩膜切口位置调整。描述手术前后视力及局部解剖变化和手术并发症。术后最佳矫正视力较术前提高≥2行者定为视力改善,下降≥2行为视力下降,提高或下降≤1行定为视力稳定。主要指标 手术前后视力和局部解剖变化及手术并发症。结果 139眼眼弓蛔虫患者64眼（46.0%）联合晶状体切除术。平均随访（29±9）个月。末次随访时视力较术前改善者70.2%（85/121）,视力稳定者22.3%（27/121）,视力下降者7.5%（9/121）;69.1%（96/139）的患者术前合并牵拉性视网膜脱离,其中65眼术后视网膜脱离复位或改善;术后1周内22.3%低眼压（31/139）和1个月后13.7％高眼压（19/139）。 结论 巩膜切口位置调整下玻璃体切除术有助于改善眼弓蛔虫病患者视功能和眼局部解剖预后;术前UBM检查可明确周边玻璃体视网膜病变的位置和范围而引导巩膜切口位置调整。     

两种实验性兔巩膜加固术的比较研究

目的 为临床开展后巩膜加固术选择稳定、有效的手术方式,对常见的两种手术方法(单条带固定和改良式)行动物实验研究.方法 对10只新西兰兔按眼别分为两组,每只兔右眼行改良后巩膜加固术(插片组);左眼行单条带后巩膜加固术(固定组).以同种异体巩膜为植入材料,同时观察比较不同植片面(视网膜面和结膜面)与受体巩膜生长融合的情况,分别于术后3、6、12周取标本,行肉眼观察及病理组织检查.结果 10例行固定法的兔眼标本其植片与受体巩膜均贴附紧密.10例行插片法的兔眼标本只有1眼的植片与受体巩膜贴附较好,其余9眼均有不同程度的松动、溶解吸收,而其中2眼的植片几乎完全溶解吸收,肉眼不可分辨.病理组织切片结果:插片组植片结构6周后玻璃样性严重,巩膜纤维破坏明显重于固定组.结论 固定法有利于植片与受体巩膜的生长融合,不同的植片面对融合无明显的影响.     

后巩膜加固术联合超声乳化人工晶状体植入术治疗视网膜色素变性合并白内障

目的探讨后巩膜加固术联合超声乳化人工晶状体植入术治疗视网膜色素变性(retinitispigmentosa,RP)合并白内障的临床疗效。方法 对RP合并白内障患者16例(30眼)进行回顾性分析,所有患者先行后巩膜加固术,再行白内障超声乳化人工晶状体植入术,术后1周、1个月、3个月、6个月分别复查视力,定期复查视野、视网膜电图。结果 患者术后视力提高≥2行者24眼,<2行者4眼,无提高者2眼;术前、术后1周、1个月、3个月、6个月视力差异有统计学意义(P<0.05或0.01)。术后第1天角膜内皮轻微水肿3眼,前房Tyndall征阳性5眼,经皮质类固醇类激素滴眼液局部滴眼后,均于2～7d内消退。术前、术后眼压均正常,无一过性高眼压,未发生人工晶状体移位、角膜内皮失代偿、视网膜脱离等严重并发症。与术前比较,所有患眼术后视野范围扩大或光敏感度提高。视网膜电图与术前无明显差异。结论 后巩膜加固术联合超声乳化人工晶状体植入术是治疗RP合并白内障的一种安全、有效的方法。     

Structural and functional outcome of scleral patch graft

PURPOSE: To evaluate the visual and structural outcomes of scleral patch grafting in cases of scleral defect. METHODS: The study was a retrospective interventional case series. Medical records of all patients who underwent scleral patch grafting at a tertiary care centre between 1997 and 2003 for scleral defects were reviewed. After removal of all the devitalized tissue, alcohol-preserved full-thickness sclera was tailored to fit the defect and sutured in place. The graft was covered with a conjunctival flap or amniotic membrane. Structural integrity and visual outcome were assessed as the main outcome measures. RESULTS: A total of 13 eyes of 13 patients required scleral patch grafting for scleral defects of varying aetiologies, the most common being necrotizing scleritis following pterygium surgery (40%). The patients were followed up for 6-60 months, an average period of 24.3 months. Tectonic success was achieved in 10 eyes (76.9%). Three complications were noted: endophthalmitis, graft necrosis, and graft dehiscence with uveal prolapse. However, no regrafts were needed. Epithelialization and vascularization were seen in the remaining eyes after an average duration of 3-4 weeks. Visual acuity remained stable in the majority (9/13, 60%), improved in one and deteriorated in three eyes. CONCLUSIONS: Scleral grafting with overlying conjunctival or amniotic membrane graft is an effective and simple measure for preserving globe integrity both structurally and functionally.     

晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂的臨床觀察

目的改善穿通性眼外傷伴晶狀體后囊破裂患者的預后.方法對14例眼球穿通傷伴晶狀體后囊破裂的患者縫合角鞏膜后行晶體玻璃體切割.結果對14例患者隨訪6～24個月,平均11.5個月.術后隨訪最終矯正視力範圍0.06～1.0,其中≥0.4者8眼.結論晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂患者,具有能夠恢復有用視力,并發症少的理想效果     

Surgically induced scleral staphyloma

Background: To report the clinical features of surgically induced scleral staphyloma and investigate the management. Methods: Retrospective uncontrolled study. Results: A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed. The first patient was a 3-year-old young girl underwent corneal dermoid resection. The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C (MMC). The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery. All patients performed allogeneic sclera patch graft. In the at least half a year follow-up, the best corrected visual acuity (BCVA) of all the four patients were no worse than that of preoperative. Ocular symptoms disappeared, including eye pain, foreign body sensation, and so on. Unfortunately, the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month. Conclusions: Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid, pterygium, and cataract surgery. Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma. However sclera rejection and dissolution should be considered postoperatively.     

Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery

PURPOSE: To describe the technique and review the indications and success of tectonic corneal lamellar grafting for the management of severe scleral melts after pterygium surgery. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty cases of severe scleral necrosis after pterygium surgery (1993-1999). INTERVENTION: Tectonic corneal lamellar grafting. Surgery involved (1) removal of all devitalized or infected scleral tissue surrounding the melt; (2) use of lamellar or full-thickness donor corneal tissue, fashioned to fit the scleral defect exactly or a 0.25-mm diameter larger; and (3) placement of a pedicled or free conjunctival flap over the corneal lamellar graft. MAIN OUTCOME MEASURES: Eradication of progressive scleral necrosis, preservation of globe integrity, eradication of infection, and preoperative and postoperative visual acuity. RESULTS: Sixteen (80%) of 20 cases developed severe scleral necrosis that required tectonic surgery after bare sclera pterygium excision with mitomycin C or beta-irradiation. Surgery was also therapeutic to eradicate progressive infection in 6 cases of infective scleritis that did not respond to maximal medical treatment. Scleral melting presented 1 month to 20 years after initial pterygium surgery in healthy, immune-competent adults. Therapeutic and tectonic success was achieved in 19 cases (95%); in 1 case, recurrence of fusarium fungal infection led to severe graft necrosis and intraocular spread. Among the cases of infectious scleritis, three eyes required repeat lamellar grafting to successfully eradicate infection. CONCLUSIONS: Tectonic and therapeutic lamellar keratoplasty, combined with aggressive antibiotic therapy, preserved globe integrity and eradicated infection in cases of severe scleral melting after pterygium surgery.     

Homologous scleral graft for corneal perforation in a child

PURPOSE: To show the emergency use of preserved homologous sclera for the repair of a perforated cornea in a young child. METHODS: Our case was a 3.5-year-old boy who presented with an acute corneal ulcer and endophthalmitis, which was complicated by a developing corneal melting and perforation of 2.5-mm diameter during pars plana vitrectomy. Because no donor cornea was available, a full-thickness preserved donor sclera was used to close the corneal defect. RESULTS: During the next 8 months, scar tissue formed underneath the scleral graft. The graft was removed, revealing mild opacification at the site of corneal perforation. Three years after surgery, best-corrected visual acuity was 20/60. CONCLUSIONS: In the absence of a corneal button for grafting, preserved homologous sclera may be used for closing a corneal defect.     

Hypotony caused by scleral buckle erosion in Marfan syndrome

PURPOSE: To describe hypotony caused by erosion of the conjunctiva and sclera by a silicone scleral buckle. METHODS: Interventional case report. A 33-year-old man with Marfan syndrome presented with hypotony maculopathy and a collapsed globe 17 months after repair of retinal detachment with a silicone sponge and silicone encircling band. RESULTS: Examination in the operating room revealed extrusion of the buckle through the conjunctiva and full-thickness scleral erosion. The silicone buckle was removed, and the scleral defect was closed with interrupted 8-0 nylon sutures. Postoperative glaucoma was treated with cyclophotocoagulation. Eight months after scleral repair, visual acuity was RE: 20/40, intraocular pressure was 10 mm Hg, and the retina was attached. CONCLUSION: Full-thickness scleral erosion secondary to a silicone exoplant causing hypotony is a rare long-term complication in patients with thin sclera.     

玻璃体手术联合后巩膜清创缝合术治疗眼球贯通伤的临床观察

目的探讨玻璃体手术联合后巩膜清创缝合术治疗眼球贯通伤的疗效。方法对8例(8眼)眼球贯通伤患者行玻璃体手术联合后巩膜清创缝合术,6例先行一期前部角膜、巩膜伤口清创缝合,再行二期玻璃体手术;2例一期同时行前、后巩膜伤口清创缝合+玻璃体手术。随访4～12个月,观察患者视力、眼压、眼底等情况。结果 8例眼球贯通伤中术前视网膜脱离3例,术后视网膜均得到了解剖复位。术后视力均有提高,最高达0.6。术后眼压均在10～20mmHg(1kPa=7.5mmHg),平均14.4mmHg。术后无一例眼球萎缩、眼球摘除患者。结论玻璃体手术联合后巩膜清创缝合术治疗眼球贯通伤安全、有效。     

前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体的临床观察

目的评价无后囊无晶状体眼行前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体的临床疗效。方法选用AMOZ900折叠人工晶状体,对无后囊或后囊破损严重不足以支撑人工晶状体者36例（36眼）行前部玻璃体切除联合人工晶状体缝线固定术,观察其术中、术后并发症及术后视力、角膜曲率、眼压的情况。结果术中无明显并发症,术后眼压升高2眼,玻璃体少量积血1眼,黄斑水肿2眼,无其他严重并发症。术后第1天的裸眼视力0．3以上者占41．67％,术后1周、1个月、3个月裸眼视力0．3以上者分为47．22％,80．56％和86．11％。结论前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体植入术是治疗无后囊支撑眼的较好选择。     

颞侧巩膜小切口手法白内障摘出术治疗青光眼术后白内障

目的评价青光眼小梁切除术后白内障经颞侧巩膜小切口白内障摘出术手术方法和临床效果。方法采用颞侧巩膜隧道切口，对42例（47眼）青光眼术后白内障施行小切口白内障摘出及人工晶状体植入术，术后观察视力、眼压、角膜曲率、滤泡等情况。结果随访3～18个月，47眼视力较术前均有提高，眼压与术前基本相同，滤泡形态无改变，术后角膜曲率的变化（0．75～1．25D）在术后3个月恢复至术前状态。未见明显并发症。结论经颞侧巩膜手法小切口白内障摘出术是治疗青光跟术后白内障的有效方法。