半導體激光光凝治療糖尿病性視網膜病變臨床分析

目的總結半導體激光光凝治療糖尿病性視網膜病變的體會.方法回顧性分析我院應用VIRIDIS532nm半導體激光泵浦的眼科黄绿激光治療糖尿病性視網膜病變116祗眼的臨床資料.結果激光光凝術後糖尿病性視網膜病變患者視力穩定或進步者達79.25%.結論根據糖尿病性視網膜病變的程度選擇合適的光凝術,確保高比例的視綱膜有效光斑是光凝術成功的關鍵.     

Nd:YAG激光清除人工晶體前纖維膜及殘留物

目的評價NdYAG激光治療白内障術後人工晶體前膜及殘留物的臨床療效.方法回顧性總結NdYAG激光治療白内障術後人工晶體前膜及殘留物共21例21眼;激光參數單次脉衝能量0.8～3.5mJ,擊發次數11～13次.結果所有患者一次治療均使瞳孔區透明,但有2例復發;術後視力提高率100%;術前視力平均0.22±0.17,術後平均0.42±0.12,激光治療前後視力差别非常顯著(P＜0.01).主要并發癥虹膜出血、人工晶體損傷和眼壓升高,各有2例,各占9.5%.結論NdYAG激光清除白内障囊外摘除術後人工晶體前膜及殘留物安全、有效.     

异體組織埋藏法治療視網膜色素變性療效觀察

目的觀察异體組織埋藏法治療視網膜色素變性的近期及中遠期療效.方法隨訪26例(52眼)接受异體組織埋藏法治療視網膜色素變性患者;術前、術後12周、術後6月和術後1年分别檢查視力、視野.結果術後近期(12周)患者視力顯著提高(X2=11.02,P<0.05),術後6月患者視力無繼績提高(X2=0.31,P>0.05),術後一年患者視力亦無繼續改善(X2=0.83,P>0.05);術後近期(12周)視野較術前明顯擴大(X2=7.90,P<0.05),術後6月視野舆術後12周視野相比無明顯改善(X2=1.14,P>0.05),術後一年視野和術後12周視野相比有進步,但無統計學意義(X2=0.42,P>0.05).結論异體組織埋藏法治療視網膜色素變性近期(12周)具有肯定療效;中遠期(6～12月)療效穩定.     

中西醫結合治療糖尿病性視網膜病變

目的比較西藥結合活血化瘀中藥與單純用西藥治療糖尿病性視綱膜病變的療效.方法對35例(55祗眼)糖尿病性視網膜病變患者作了觀察.6例(8祗眼)西藥治療,29例(47祗眼)采用西藥結合中藥治療.全部病例隨訪3年.觀察兩種治療後視力眼底的變化,結果西藥結合中藥治療組患者視力提高優于單純西藥組,眼底出血,黄斑水腫及滲出的吸收時間較單純西藥組縮短.結論我們用檢眼鏡觀察眼底的改變,中西醫結合治療糖尿病性視網膜病變效果優于單純西藥治療.     

糖尿病患者白内障摘除人工晶體植入術的臨床觀察

目的評價Ⅱ型糖尿病患者白内障摘除人工晶體植入術的療效.方法對17例21眼糖尿病患者行白内障摘囊外除後房型人工晶體植入術,以122例152眼非糖尿病患者同類手術為對照組,進行術後視力及并發癥的比較.結果糖尿病組術後視力較術前明顯提高(P＜0.05),與非糖尿病組無顯著性差异(P＞0.05),術後影響視力的主要原因是糖尿病性視網膜病變,手術前後血糖無顯著性差异(P＞0.05),未發生嚴重的眼部并發癥.結論糖尿病患者血糖控制穩定,實行ECCE+I0L治療白内障可改善視力,無全身及眼部并發癥,手術安全可靠.     

視網膜色素變性(RP)患者的EOG异常改變

目的探討RP患者眼電圖(EOG)的特徵以及EOG作為評估RP手術療效的客觀指標的可能性.方法采用MVT-3型視覺電生理儀的EOG采集和分析軟件,對正常對照組和RP患者組在術前與術後進行檢測.結果(1)105名RP患者的EOG曲綫大體可分為兩種類型,即彎曲型與平坦型.彎曲型EOG各項參數較接近正常組EOG,該組絕大部分患者的視野為斑駁狀;而平坦型EOG的一些主要參數(如Arden比和G比值等),明顯地低于正常組,該組患者的視野多為管狀視野或視野完全缺損.(2)在進行手術後半年以上復查EOG,則一些主要參數數值增加,有的患者(34.5%)的EOG由平坦型轉變為彎曲型.結倫RP患者的EOG具有為該病所特有的特徵,術後隨主觀癥狀的改善,EOG异常也恢復或部分恢復,這些都可作為該病診斷以及術後療效評估的客觀指標之一.     

閉合式玻璃體切除術在眼内异物取出術中的应用

目的回顧性分析閉合式玻璃體切除術治療眼内异物的臨床療效.方法對22例(22眼)眼外傷合并眼内异物患者施行玻璃體切除術、晶體切除術、眼内异物取出、視綱膜脱離復位及鞏膜外環扎等聯合術.結果所有病例眼内异物均一次性取出,術後視力多數有不同程度的提高(0.05以上者共14例),視力提高者15例,不變者4例,下降者3例.結論應用閉合式玻璃體切除術取出眼内异物手術效果好,有利于及時處理并發癥和恢復有用視力.     

隧道式小切口人工晶體植入聯合小梁切除手疗效观察

目的探討隧道式小切口白内障摘除後房型人工晶體植入聯合小梁切除術(三聯手術)治療白内障合并繼發青光眼患者的療效.方法應用隧道式小切口三聯手術對16例(18祗眼)白内障合并繼發青光眼患者進行手術治療.術後隨訪3～27個月.結果術前平均眼壓30.31mmHg,術後隨訪最終平均眼壓降至10.24mmHg,術後隨訪最終矯正視力範圍0.06～0.8,≥0.5者12衹眼(67%);術後2例2眼因纖維素性滲出切口粘連致使滤過手術失敗(11%);術後早期并發角膜水腫4眼(22%).結論隧道式小切口三聯手術治療白内障合并繼發青光眼,具有恢復有用視力,穩定眼壓.     

隧道式小切口人工晶體植入聯合小梁切除手术疗效观察

目的探討隧道式小切口白内障摘除後房型人工晶體植入聯合小梁切除術(三聯手術)治療白内障合并繼發青光眼患者的療效.方法應用隧道式小切口三聯手術對16例(18祗眼)白内障合并繼發青光眼患者進行手術治療.術後隨訪3～27個月.結果術前平均眼壓30.31mmHg,術後隨訪最終平均眼壓降至10.24mmHg,術後隨訪最終矯正視力範圍0.06～0.8,≥0.5者12衹眼(67%);術後2例2眼因纖維素性滲出切口粘連致使滤過手術失敗(11%);術後早期并發角膜水腫4眼(22%).結論隧道式小切口三聯手術治療白内障合并繼發青光眼,具有恢復有用視力,穩定眼壓.     

透明質酸酶治療青光眼濾過術後早期高眼壓的初步觀察

目的觀察透明質酸酶對青光眼術後早期高眼壓的療效.方法對11例(11祗眼)青光眼濾過術後早期高眼壓的病例,結膜下注射透明質酸酶750IU,隔天一次,一般2～3次.結果 11祗眼中10祗眼眼壓控制良好,1例加用適利達眼藥水眼壓正常,濾過泡形成彌散隆起,所有病例視野舆術前比較基本保持不變,視力基本不變或增减一行.結論透明質酸酶在治療青光眼濾過術後早期高眼壓方面有良好的療效,改善了青光眼濾過術的預後.透明質酸酶的應用至今未發現任何并發癥.     

视网膜色素变性眼肌深层巩膜移植术患者图形视觉诱发电位分析

目的探讨视网膜色素变性(RP)患者的P-VEP特征及对RP患者眼肌深层巩膜移植术进行治疗前、后P-VEP变化加以比较,为跟踪疗效提供客观依据。方法采用MVT-3型多功能和多导程视觉电生理仪,分别测定棋盘格翻转刺激全视野、中央6°视野,以及遮盖中央、刺激6°以外周边视野时的P-VEP。结果在202例RP患者中有110例(54.5%),用上述3种刺激方式均记录不到P-VEP。全视野刺激能诱发P100波的为92例(45.5%),刺激中央视野可记录到P-VEP的为83例(41.1%),而刺激周边视野能记录到P-VEP的仅为48例(23.8%)。全视野刺激记录到的P100波平均振幅,RP组明显低于正常组的相应值,有非常显著的统计学意义(P<0.001)。用上述3种刺激方式从RP患者记录到的P100波峰潜伏期,与正常组的相应值相比,都明显延长,且都有显著的统计学意义(P<0.01)。施行了眼肌深层巩膜移植术的RP患者中,有42例在术后3～22(平均10.9)月,来院进行了P-VEP复查,手术前刺激中央视野能记录到P-VEP的为20例(47.6%),术后复查时已增加到26例(61.9%)(配对χ2检验,χ2=4.17,P<0.05)。不仅人数增加,而且振幅也明显增大。结论眼肌深层巩膜移植术使患者视力有明显好转,P-VEP也有明显改善。因此P-VEP可以作为对RP患者进行疗效评估的客观指标之一。     

视网膜色素变性患者手术治疗45名

目的:评估视网膜色素变性患者的手术疗效。方法:对45名视网膜色素变性患者90眼进行手术治疗,术前和术后分别对这些患者进行了视锐度、自动视野计和三种视觉电生理指标(F-ERG、EOG和P-VEP)的检测。结果:术后3～22月,患者的视锐度得到了明显的改善,视野显著扩大,视野缺损减低。术前在90眼中有73眼(81.1%)的暗视F-ERG为熄灭型,在术后3～22月期间进行复查时,有些曾消失的F-ERG波复现,暗视F-ERG为熄灭型的眼下降至66(73.3%)只(P <0.05, t检验),一些原来残存的F-ERG波的波幅增加,峰潜伏期也缩短。EOG曲线变得更为弯曲,某些EOG的参数(如Arden比和G比值)也明显的增加(P <0.05, t检验)。用棋盘格翻转刺激中央6о视野时能够记录到P-VEP的患者数目,在45例中由术前的22例在术后增加到31例。这45例的残存P100波的平均振幅由术前的1.007μV增加到术后的2.236μV,有显著的统计学差异(P<0.005, t检验)。结论:手术治疗RP是有效和安全的,并能改善患者的视觉和阻止RP病程的发展。     

Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study

PURPOSE: To evaluate the efficacy of a safety enhanced photodynamic therapy (PDT) protocol with half-dose verteporfin for treating chronic central serous chorioretinopathy (CSC). METHODS: Forty-eight eyes of 48 patients with symptomatic chronic CSC underwent indocyanine green angiography guided PDT with half dose (3 mg/m) verteporfin. Outcome measures included logMAR best-corrected visual acuity (BCVA), central retinal thickness, and angiographic changes during the 12-month study period. RESULTS: The mean CSC duration was 8.2 months (range, 3-40 months). At 12 months after PDT, the mean logMAR BCVA improved from 0.31 to 0.15 (P < 0.001). The mean improvement was 1.6 lines and 45 (95.8%) eyes had stable or improved vision. Eyes without pigment epithelial detachment (PED) had significantly greater visual improvement compared with eyes with PED (P = 0.031). Patients with CSC of 6 months or less or younger than 45 years were more likely to gain vision by two or more lines after treatment (P = 0.007 and P = 0.018, respectively). Forty (83.3%) eyes had complete resolution of serous detachment at 3 months, with 43 (89.6%) eyes at 12 months. CONCLUSIONS: The safety enhanced PDT protocol appeared to be beneficial for patients with chronic CSC. Further controlled study is warranted to evaluate the safety and efficacy of this treatment option.     

儿童部分调节性内斜视手术时机的选择及疗效观察

目的：：分析儿童部分调节性内斜视手术时机的选择和疗效观察,为临床治疗提供参考。方法：选取我院儿童部分调节性内斜视手术患者52例为研究对象,依照手术时机不同分为A组10例、B组25例和C组17例,A组患者发病1a内手术治疗,B组患者发病1~3a手术治疗,C组患者发病3a以上手术治疗,分析手术治疗效果。结果：>6岁儿童术后获得立体感比例(83%)显著高于<3岁儿童(30%)(P<0.05);患者术后立体视觉与患者手术时机存在明显相关性, A组(80%)和B组患者有立体感比例(76%)显著高于C组(41%)(P<0.05);A组(90%)、B组治疗优良率(88%)显著高于C组(71%)(P<0.05)。结论：儿童部分调节性内斜视患者应待患儿6岁以后,尽早开展手术治疗,根据斜视度和裸眼视力情况决定手术量。     

眼眶骨折修复手术后残余复视的手术矫正

目的 探讨眼眶骨折修复手术后主要功能视野内消除复视的手术时机、方法和效果。方法 筛选眼眶骨折修复手术后,对残余复视进行手术矫正的40全（40眼）进行回顾性研究。分析不同患者复视的成因,手术时机及手术方法的选择。术后随访6个月对手术疗效进行评价。结果 40例术前存在Ⅲ级复视,行眼外肌手术。根据被动牵拉试验结果,选择直肌后徒悬吊、截除以及Jensen联结、眶骨膜固定等术式。术中25例角膜映光基本正位,主要功能视野内无复视,10例略过矫,5例欠矫。术后6月观察,27例主要功能视野无复视;7例正前方无复视,但下方视野残留复视;6例第一眼位残留复视,给予配戴压贴三棱镜后复视改善。结论 眼眶骨折修复术后消除主要功能视野复视的手术方法应根据术前和术中牵拉试验结果以及眼球运动检查来选择,合理的手术方式可有效地消除复视、改善眼球运动功能。     

Vision improvement in retinal degeneration patients by implantation of retina together with retinal pigment epithelium

PURPOSE: To demonstrate efficacy and safety of the implantation of neural retinal progenitor cell layers (sheets) with its retinal pigment epithelium (RPE) in retinitis pigmentosa (RP) and dry age-related macular degeneration (AMD) patients with 20/200 or worse vision in the surgery eye. DESIGN: Interventional nonrandomized clinical trial. METHODS: Ten patients (six RP, four AMD) received retinal implants in one eye and were followed in a phase II trial conducted in a clinical practice setting. Early Treatment Diabetic Retinopathy Study (EDTRS) was the primary outcome measure. All implant recipients and nine of 10 tissue donors were deoxyribonucleic acids typed. RESULTS: Seven patients (three RP, four AMD) showed improved EDTRS visual acuity (VA) scores. Three of these patients (one RP, two AMD) showed improvement in both eyes to the same extent. Vision in one RP patient remained the same, while vision in two RP patients decreased. One RP patient has maintained an improvement in vision from 20/800 to 20/200 ETDRS for more than five years; at the six-year examination, it was still maintained at 20/320 while the nonsurgery eye had deteriorated to hand motion vision. This patient also showed a 22.72% increase in light sensitivity at five years compared to microperimetry results at two years; the other patients showed no improved sensitivity. Although no match was found between donors and recipients, no rejection of the implanted tissue was observed clinically. CONCLUSIONS: Seven (70%) of 10 patients showed improved VA. This outcome provides clinical evidence of the safety and beneficial effect of retinal implants and corroborates results in animal models of retinal degeneration.     

Clinical experience with the surgical removal of subfoveal neovascular membranes. Short-term postoperative results.

BACKGROUND: Severe visual loss occurs in the presumed ocular histoplasmosis syndrome (POHS) and in age-related macular degeneration (ARMD) from subfoveal neovascularization. Although laser photocoagulation has recently been recommended for this complication in ARMD, treatment is inevitably associated with a loss of central vision. In an attempt to restore and/or preserve central vision, the authors undertook surgical removal of subfoveal neovascular membranes in these diseases. METHODS: Patients with POHS and ARMD with reduced Snellen visual acuity to 20/80 or less were selected if there was angiographic evidence of a neovascular membrane beneath the fovea. Modern vitreoretinal techniques were used to remove the subfoveal neovascular complex. RESULTS: The authors' first 15 patients with POHS and 19 patients with ARMD were followed for an average of 4 months postoperatively. Snellen visual acuity improved by 2 lines or more in 8 of 15 (53%) cases of POHS. Although similar improvements in Snellen visual acuity were not observed in cases of ARMD, 14 of 19 (74%) cases showed either slight improvement or stabilization of their vision postoperatively. Complications included recurrent neovascularization in 2 of 15 (13%) and 3 of 19 (16%) eyes with POHS and ARMD, respectively. No retinal detachment or preretinal proliferation was observed. CONCLUSIONS: These results suggest that subfoveal neovascularization can be successfully removed with preservation of foveal vision in POHS and stabilization in ARMD, at least for the short term. Visual improvement was observed in POHS even after 6 months of decreased vision. Finally, visual prognosis is most dependent on the integrity of the subfoveal RPE after removal of the membrane.     

Visual evoked potential in the management of pituitary tumor during pregnancy

We examined a pregnant woman with chiasmal syndrome in the late stage of pregnancy. Her vision was determined to be seriously threatened after 31 weeks' gestation. Study of the latency of preoperative visual evoked potentials (VEPs) in other patients with pituitary tumor showed that insofar as latency is not delayed, surgical decompression is expected to be followed by functional improvement of the optic pathway. We monitored optic nerve function by serially recorded VEPs, and labor was induced at 38 weeks because there had been no delayed response up to that time. After a decompressive operation, visual field and visual acuity recovered normally. Serially recorded VEPs can provide a useful monitor along with visual field and acuity tests in guiding therapy for a patient with threatened vision in late pregnancy and in determining whether or when to induce labor.     

准分子激光原位角膜磨镶术治疗近视

目的 全面评价准分子激光原位角膜磨镶术（laser in-situ keratom ileusis,LASIK）治疗近视的疗效。方法 对术前近视度为-2.00～-28.00D的患者429只眼行LASIK手术,观察12个月以上,按术前屈光度分为三组：-2.00～-8.00 D组179只眼,-8.25～-15.00 D组137只眼,-15.25～-28.00 D组113只眼,手术前后检查包括远、近视力、验光,裂隙灯和眼底检查,以及眼压、角膜知觉、对比敏感度、角膜内皮细胞照像、超声角膜测厚及角膜地形图等。手术参数包括：角膜瓣厚度130～160μm,最大切削直径5.8mm。手术后滴0.1%氟甲脱氧泼尼松龙眼液,持续1-2个月,结果 术后裸眼视力和屈光状态于1-3个月趋向稳定,角膜知觉在术后3个月时恢复术羊水平,而对比敏感度于术后3-6个月恢复正常,角膜内皮细胞密度无变化,术后12个月时,三组的屈光度在±1D以内者分别为88.8%、19.6%和70.8%,在±0.5D以内者分别为73.7%、65.0%和46.0%;裸眼视力达0.5或以上者分别为96.6%、81.8%和54.9＆,达1.0或者分别为84.4％、58.4％和15.0％。结论 LASIK手术对于高、中、低度近视均可取得良好的治疗效果,手术安全,但较PRK复杂,依赖于手术者的技术,目前尚无LASIK专用程序,需对PRK程序作一定修改。