虹膜角膜内皮综合征12例的临床观察和分析

目的：分析虹膜角膜内皮综合征( iridocorneal endothelial syndrome,ICE综合征)的临床特点及发病机制,探讨其治疗及预后。
　　方法：选择2007-06/2015-02在第三军医大学附属西南医院住院治疗的12例12眼ICE综合征患者,其中原发性进行性虹膜萎缩7眼,Chandler综合征3眼,Congan-Reese综合征2眼。对所有患者的临床资料进行回顾性分析及随访。
　　结果：所有患者中,8眼行一次或多次滤过手术,4眼仅行青光眼阀门植入术。术后随访时间为15mo ~5a,平均30mo。12眼患者中,4眼抗青光眼术后眼压升高的时间为3~16(平均10)mo,远期观察眼压控制不佳。
　　结论：ICE综合征是一组临床上比较少见的严重眼病,其基本病变为角膜内皮层存在的ICE细胞过度增生导致房角粘连、虹膜萎缩及继发性青光眼等,目前青光眼滤过手术及青光眼阀门植入术只能在术后早期控制眼压,但远期效果不佳。     

人例虹膜角膜内皮综合征的临床观察与分析

目的：探讨虹膜角膜内皮（ＩＣＥ）综合征的发病机制。方法：对８例（１０只眼）ＩＣＥ综合征患者的临床表现，分型及治疗效果进行分析和数据统计。并介绍目前国内外一些新的研究进展。结果：８例ＩＣＥ综合征患者临床表现为三型：原发笥进行性虹膜萎缩７只眼，Ｃｈａｎｄｌｅｒ氏综合征１只眼，Ｃｏｇａｎ－Ｒｅｅｓｅ综合征２只眼。１０只眼均继发闭角型青光眼，２只眼并发大泡性角膜病变。９只眼行一次和多次滤过手术，人只眼行角     

虹膜角膜内皮综合征继发青光眼的临床治疗

目的:探讨虹膜角膜内皮综合征继发青光眼的临床治疗方法及效果。方法:对2005-08/2009-08连续收治的10例12眼ICE综合征继发青光眼患者随访3~40mo,观察其手术方法及术后眼压、视力情况。结果:所有患眼均行复合式小梁切除术,成功8眼,失败眼中3眼行Ahmed青光眼阀植入术成功,1眼行睫状体光凝术。结论:复合式小梁切除术和Ahmed青光眼阀植入术是治疗虹膜角膜内皮综合征继发青光眼的有效手术方法。     

青光眼术后晶状体超声乳化术的探讨

目的探讨抗青光眼术后白内障行晶状体超声乳化吸出术的手术技巧，并评价手术效果。方法对26例（32眼）青光眼术后的白内障行颞侧透明角膜切口晶状体超声乳化吸出折叠人工晶状体植入术，术后随访4-21月，观察视力、滤过泡、眼压和并发症的情况。结果有30眼（93．75％）视力有不同程度的提高；2眼术后视力无提高者系青光眼性视神经萎缩者。术后矫正视力低于0．05者3眼（9．38％），0．05～0．25者8眼（24．99％），0．3～1．0者21眼（65．63％）。所有病例术后滤过泡均无影响，术后眼压在正常范围。并发症主要为角膜水肿和虹膜炎症反应。结论青光眼术后白内障采用颞侧透明角膜切口行晶状体超声乳化吸出折叠人工晶状体植入术效果良好，并发症少，可提高视力并保持滤过泡的功能。     

穿透性角膜移植治疗人工晶状体植入术后大泡性角膜病变的临床观察

目的 评价穿透性角膜移植术治疗人工晶状体植入术后大泡性角膜病变临床疗效,探讨术中对原人工晶状体的处理。方法 对12例(12只眼)人工晶状体植入术后大泡性角膜病变施行穿透性角膜移植术或穿透性角膜移植术联合手术,观察术后角膜植片及视力变化。结果 随访6～16个月,平均11．2个月,术后临床症状明显缓解或消失,植片保持透明,视力较术前均有提高,其中矫正视力0．02以上11例(0．2以上4例);术后继发性青光眼1例,内皮型排斥反应1例。结论 穿透性角膜移植术是治疗人工晶状体植入术后大泡性角膜病变的一种理想手术方式,不仅能消除刺激症状且能增进视力。术中如何处理人工晶状体应视眼部具体情况。     

角膜层间烧灼联合错位神经根切断及羊膜覆盖术治疗大泡性角膜病变

目的 观察角膜层间烧灼联合错位角膜神经根切断及羊膜覆盖术治疗大泡性角膜病变的临床疗效。方法 选取有明显眼痛且视功能差的大泡性角膜病变患者28人（28只眼）,其中白内障摘除联合人工晶体植入术后16只眼,单纯白内障摘除术后2只眼,白内障针拨术后1只眼,青光眼白内障联合术后3只眼,青光眼滤过术后2只眼,闭角型青光眼绝对期1只眼,眼外伤2只眼,玻璃体切割术后1只眼。对28只眼均行角膜板层切开,层间烧灼,错位角膜神经根切断及羊膜覆盖术。术后随诊观察6～ 32个月,平均18月。结果 术后28只眼中25只眼(89.3％)术后疼痛感消失,3只眼(10.7％)疼痛明显缓解。术后1月8只眼(28.6％)视力提高,20只眼(71.4％)视力同术前。羊膜于术后5 ～45天脱落或溶解,平均28.8天。 术后26只眼(92.9％)角膜上皮在1月内愈合,角膜大泡完全消失,2只眼(7.1％)角膜大泡范围明显缩小。28只眼角膜基质水肿均减轻。随访6～ 32个月均未发现症状复发,角膜大泡复发或其他并发症出现,患者原有残存视力保留或提高。结论 角膜层间烧灼联合角膜错位神经根切断及羊膜覆盖术是缓解视功能差的大泡性角膜病变患者疼痛症状的有效的手术方法。     

青光眼滤过术后角膜缘切口手术治疗白内障的临床观察

目的探讨青光眼滤过术后白内障手术治疗的方式及疗效。方法对88例（112只眼）青光眼滤过术后白内障患者施以滤过泡前角膜缘切口手术资料进行分析,观察术中术后并发症及视力情况。结果术后随访观察1～3个月,术后裸眼视力〉0.5者39只眼（35%）,0.25～0.5者63只眼（56%）,≤0.2者10只眼（8.9%）。结论青光眼滤过术后经滤过泡前角膜缘切口行白内障手术安全有效。     

板层角膜移植联合睫状体冷凝术治疗青光眼性大泡性角膜病变

目的探讨板层角膜移植联合睫状体冷凝术治疗青光眼性大泡性角膜病变的临床效果。方法对１０例（１０只眼）青光眼性大泡性角膜病变的病人，施行板层角膜移植联合睫状体冷凝术。冷凝的范围在角膜下方１８０°，距角膜缘３～６ｍｍ之间，冷凝５～６个点，温度控制在－７０℃左右，冷凝时间为３０ｓ～１ｍｉｎ。结果１０例病人术后眼部刺激症状缓解，９例眼压稳定在正常范围。结论板层角膜移植联合睫状体冷凝术是治疗青光眼性大泡性角膜病变的有效方法，适用于眼压高没有条件接受穿透角膜移植的大泡性角膜病变病人     

穿透性角膜移植治疗人工晶体植入术后大泡性角膜病变的临床观察

目的探讨穿透性角膜移植术治疗人工晶体植入术后大泡性角膜病变临床疗效。方法对21例（21眼）人工晶体植入术后大泡性角膜病变施行穿透性角膜移植术或穿透角膜移植联合手术，观察术后视力及植片情况。结果随访6～18个月，平均11．6个月，术后临床症状明显缓解或消失，视力较术前均有提高，其中矫正视力0．02以上17例（0．2以上7例）；术后继发性青光眼2例，内皮型排斥反应1例。结论穿透性角膜移植术是治疗人工晶体植入术后大泡性角膜病变的一种理想手术方式，不但缓解症状且能不同程度提高视力。     

穿透性角膜移植术后早期青光眼发生的原因及处理

穿透性角膜移植术 (penetrating keratoplasty,PKP)是使角膜盲患者复明的主要方法 ,但术后早期继发青光眼较为常见 ,治疗难度也较大 ,如处理不当会导致手术失败。故认清术后早期继发青光眼的原因 ,正确预防和处理该并发症具有十分重要的临床意义。1　资料与方法1.1　一般资料　对我院 1996年 6月～ 2 0 0 1年 6月行 PKP手术的 2 15例 2 2 0眼的临床资料进行回顾性分析 ,其中 2 6例 2 6眼术后 1个月内继发青光眼 ;男 17例 17眼 ,女 9例 9眼 ;年龄 8～ 70岁 ,平均 45 .6岁。术前诊断 :角膜白斑 17例 ,无晶状体眼的大泡性角膜病变 5例 ,角膜…     

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.