复合式小梁切除术治疗急性闭角型青光眼54例体会

目的探讨急性闭角型青光眼持续高眼压状态下行复合式小梁切除术的疗效及安全性。方法对54例（54眼）经药物治疗后眼压仍〉40mmHg的急性闭角型青光眼患者行复合式小梁切除术,术后应用抗生素眼水及皮质类固醇眼水点眼,常规阿托品散瞳。术后7—14d根据眼压、前房形成情况及滤过泡功能拆除可调整缝线。随访视力及眼压控制情况。结果术后1—2d内前房形成25眼,3—5d前房形成20眼,1周后6眼浅前房者形成稳定前房。51眼形成功能型滤过泡,无严重并发症发生。随访3—18个月,眼压〈21mmHg52例,需二次手术治疗2例,视力均有所提高。结论对应用药物治疗不能有效控制眼压的急性闭角型青光眼患者行复合式小梁切除术安全有效,可避免视功能进一步受损。     

复合小梁切除术治疗原发性青光眼疗效观察

目的观察复合小梁切除术治疗原发性青光眼的临床疗效。方法将原发性青光眼患者68例（88眼）随机分为A组40眼和B组48眼。A组行单纯小梁切除术,B组行复合小梁切除术。比较两组术后浅前房发生率、滤过泡情况、眼压和手术成功率。结果 B组术后浅前房发生率为6.3%,显著低于A组的30.0%（P〈0.05）;术后6、12个月两组眼压比较,P〈0.05;B组手术成功率为87.5%,高于A组的62.5%（P〈0.05）。结论复合小梁切除术治疗原发性青光眼疗效好。     

改良小梁切除术治疗青光眼92例临床观察

目的 观察改良小梁切除术治疗青光眼的临床疗效.方法 将186例青光眼患者随机分为观察组92例(156眼)和对照组94例(160眼),对照组行传统小梁切除术;观察组行改良小梁切除术,手术要点为术中加固巩膜瓣缝合、应用丝裂霉素及可松解缝线.术后随访3个月～1 a,观察两组眼压、前房形成、滤过泡形态及并发症发生情况.结果 术后第1天浅前房发生率观察组和对照组分别为4%、20%(P＜0.05);术后1 a观察组和对照组功能性滤过泡分别占89%、66%,眼压控制在21 mmHg以下者分别为95%、67%,P均＜0.05.结论 改良小梁切除术可减少巩膜瓣瘢痕、主动调节房水过量、促进功能性滤过泡形成,并减少并发症发生,利于提高手术成功率.     

5%肝素滴眼预防青光眼小梁切除术后并发症疗效观察

小梁切除术是治疗青光眼常用的手术方式,但术后2a手术失败率达15％-30%。2002年12月-2005年12月,我们采用5％肝素滴眼预防青光眼小梁切除术后并发症（早期低眼压、浅前房,后期滤过泡瘢痕化）,效果满意。现报告如下。     

小梁切除术治疗青光眼术中应用生物羊膜“三明治”式植入的疗效及安全性

目的小梁切除术治疗青光眼过程中应用生物羊膜"三明治"式植入对滤过泡及眼压的影响。方法该院2006年1月至2011年1月在小梁切除术中巩膜瓣下及结膜瓣下"三明治"式植入生物羊膜治疗青光眼患者26例(30只眼),术后随访12～48个月,观察术后眼压、视力、视野、滤过泡、术后并发症等情况。结果患者术后最终随访完全成功27眼(90%),条件成功1眼(3.3%),手术失败2眼(6.7%),手术总成功率为93.3%。在不用任何降眼压药物下眼压值为〔(16.75±2.10)mmHg〕,与术前眼压〔(44.32±5.2)mmHg〕相比,差异有显著统计学意义(t=43.25,P<0.05)。保持功能性滤过泡28眼;术后视力提高2行以上者21眼(70%),并发症主要包括浅前房(3眼)和低眼压(1眼)。未出现排斥反应及其他严重的并发症。结论生物羊膜"三明治"式植入应用在小梁切除术治疗青光眼能有效控制滤过道的瘢痕化,使之保持通畅,术后眼压降至正常,提高手术成功率,是一种效果良好的、安全的改良手术方法。     

NPTS联合透明质酸钠生物胶植入术治疗POAG 31例临床观察

目的观察非穿透性小梁手术（NPTS）联合透明质酸钠生物胶植入术治疗原发性开角型青光眼（POAG）的临床疗效。方法对31例（36眼）POAG患者实施非穿透性小梁手术联合透明质酸钠生物胶植入术。结果术前眼压为（29.2±8.01）mmHg,术后1周为（15.01±4.65）mmHg,手术前后相比,P〈0.05。术后28眼前房无任何反应,2眼有Ⅰ度浅前房伴少许前房积血,均于2～3 d后自行恢复,6眼前房有轻度闪辉,术后2～3 d消失。所有患者术后均形成显著弥散滤过泡。术后1周～6个月视力基本稳定。结论NPTS联合透明质酸钠生物胶植入治疗POAG疗效肯定,并发症少。     

改良青光眼小梁切除滤过术及其临床应用

目的对青光眼小梁切除滤过术进行改良,以降低青光眼小梁切除滤过术后房水引流不畅及斑痕形成发生率。方法利用自体巩膜条作为引流物,在常规小梁切除术后的巩膜瓣后,再做一板层巩膜条,植入巩膜瓣下．引流房水。结果治疗38例（50只眼）,术后早期前房形成良好,眼压正常;随访2年,1只眼滤过泡消失（手术失败）,49只眼维持功能滤过泡,眼压正常。结论自体巩膜作为引流物能长期保持滤过功能及防止并发症。     

复合式小梁切除术治疗糖尿病并发新生血管性青光眼效果分析

目的研究分析对糖尿病并发新生血管性青光眼患者实施复合式小梁切除术治疗的临床效果。方法抽取该院2017年6月—2018年12月接收的糖尿病并发新生血管性青光眼患者50例为研究对象,依据治疗术式差异将其分为对照和观察组,其中对照组采纳传统小梁切除术治疗,观察组实施复合式小梁切除术治疗;对比分析两种治疗模式下两组患者治疗前后不同时段内眼压水平、血清VEGF、房水VEGF水平以及并发症发生率。结果观察组眼压术后1 d(25.58±3.88)mmHg,术后1周(24.66±3.45)mmHg,术后1个月(20.68±2.88)mmHg,术后3个月(25.44±2.22)mmHg,观察组术后各时段眼压水平明显较对照组好(P0.05)。观察组血清VEGF(72.47±9.22),房水VEGF(190.14±12.33)pg/mL,观察组血清VEGF水平、房水VEGF水平下降程度明显较对照组低(P0.05)。观察组并发症发生率为8.0%,对照组32.0%;观察组低(P0.05)。结论对糖尿病并发新生血管性青光眼患者实施复合式小梁切除术治疗疗效显著,可以推广并借鉴。     

小梁切除术联合应用丝裂霉素C治疗青光眼疗效观察

目的观察小梁切除术联合应用丝裂霉素C治疗青光眼的效果。方法将54例青光眼患者随机分为两组,观察组行小梁切除术联合丝裂霉素C治疗,对照组仅行小梁切除术治疗。结果观察组术后1、6个月眼压均低于对照组（P〈0．01）。术后6个月观察组眼压控制率为93．8％、浅前房发生率为9．4％、功能性滤过泡发生率为90．6％;对照组分别为66．7％、33．3％、70．4％,两组相比,P均〈0．b5。结论小梁切除术联合应用丝裂霉索C治疗青光眼安全有效。     

复合式小梁切除术治疗糖尿病并发新生血管性青光眼疗效研究

目的探讨复合式小梁切除术治疗糖尿病并发新生血管性青光眼的临床疗效。方法收集2012年2月—2014年6月收治的糖尿病并发新生血管性青光眼患者172例(182眼),随机分为两组各86例,两组均给予糖尿病治疗,观察组采用复合式小梁切除术,对照组采用传统小梁切除术,比较两组术后视力、眼压恢复及并发症情况。结果观察组视力提高率为94.2%,对照组视力提高率为70.9%,两组比较有统计学差异(P0.05);观察组术后眼压为(15.19±2.21)mm Hg,对照组术后眼压为(18.62±2.35)mm Hg,观察组明显优于对照组(P0.05);观察组并发症发生率为3.5%,对照组并发症发生率为11.6%,两组比较差异有统计学意义(P0.05)。结论复合式小梁切除术在治疗糖尿病并发新生血管性青光眼上具有显著的临床效果,对改善患者生活质量有重大意义,值得应用。     

老年性白内障膨胀期继发性青光眼的治疗方法

目的 探讨老年性白内障膨胀期继发性青光眼的治疗方法. 方法 对16例16眼老年性白内障膨胀期继发性青光眼患者在应用常规降眼压药物治疗后不能有效降低眼压(用药后眼压仍＞ 40 mmHg)时,采用1ml注射器做前房穿刺放液,待眼压稳定2d后再行白内障联合抗青光眼手术治疗. 结果 所有患者经前房穿刺放液后眼压迅速降低,眼痛、头痛缓解,视力有不同程度的提高,手术前眼压控制在10～18 mmHg.行白内障联合抗青光眼手术后患者矫正视力均≥0.12. 结论 毫针穿刺放液可以缩短降眼压时间,为及早行白内障联合抗青光眼手术创造条件.对白内障膨胀期继发性青光眼患者行联合手术的远期疗效较好.     

Interface Fluid Syndrome Induced by Uncontrolled Intraocular Pressure Without Triggering Factors After LASIK in a Glaucoma Patient: A Case Report

This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK).Case report and review of the literature.A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable.In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.     

腹主动脉瘤支架置入术后处理

目的探讨腹主动脉瘤支架植入术后的处理方法,提高治疗效果,减少并发症的发生。方法收集我院自2011年4月至2014年2月收治的腹主动脉瘤患者38例,分为对照组和观察组,各19例。均采用支架置入术,术后对照组给予常规的护理治疗方式,观察组在常规护理治疗的基础上给予科学的康复干预处理。1个月后观察比较两组的疗效。结果对照组14例患者术后康复良好,康复率73.7%,4例患者出现较重并发症,1例患者病情加重死亡;观察组18例患者康复良好,康复率94.7%,1例出现较重并发症,无死亡病例。结论观察组患者康复率94.7%明显高于对照组康复率73.7%,并发症少于对照组,得出腹主动脉瘤支架置入术后,给予科学的康复干预处理,可以有效的提高患者康复率,减短康复时间,并发症少,值得临床推广和应用。     

白内障伴浅前房患者行超声乳化术的手术技巧及安全性探讨

目的探讨白内障伴浅前房患者行超声乳化术的手术技巧及安全性。方法选择2018-01~2019-01于北海市第二人民医院眼科接受超声乳化术治疗的白内障伴浅前房患者46例(46眼)。比较患者术前、术后的视力、眼压、中央前房深度(CACD)、房角开放距离(AOD)、角膜内皮细胞密度,分析术后并发症发生情况。结果患者术前平均视力为(0.28±0.16),术后上升至(0.62±0.22),差异有统计学意义(t=8.688,P=0.000)。与术前比较,患者术后眼压降低,CACD增加,差异有统计学意义(P<0.05)。在治疗后,术眼“3点”、“6点”、“9点”和“12点”方位的AOD500均较术前显著增加(P<0.05)。术中发生虹膜损伤3例(6.52%),悬韧带部分断裂1例(2.17%),仍安全顺利植入人工晶体。术后发生角膜水肿16例(34.78%),术后1个月均恢复。未发生后囊破裂和角膜失代偿等较严重并发症。结论超声乳化手术能有效改善白内障伴浅前房患者眼前节拥挤情况,具有较好的疗效和安全性。术前评估以及准备、手术中技巧的合理应用是保证手术成功的关键。     

分析糖尿病合并白内障患者行两种不同手术方式的临床效果

目的分析对比糖尿病合并白内障患者行两种不同方式白内障手术的临床效果。方法选取2018年10月—2020年11月该院收治糖尿病合并白内障患者70例,根据治疗方法不同分为对照组(小切口白内障摘除联合人工晶体植入术)和观察组(超声乳化吸除联合人工晶体植入术),各35例,观察两组患者的临床血糖指标水平、并发症情况以及者裸眼视力。结果观察组患者HbA1c、FPG、2 hPG等血糖指标与对照组,差异无统计学意义(P>0.05);观察组患者角膜水肿、后囊破裂、前房炎性渗出、黄斑水肿以及低血糖等并发症发生率与对照组差异无统计学意义(P>0.05);观察组患者术后裸眼视力提高优于对照组,差异有统计学意义(P<0.05)。结论对糖尿病合并白内障患者实施超声乳化吸除联合人工晶体植入术是安全有效的,能使患者得到更好的术后视力,跟小切口白内障摘除联合人工晶体植入术相比更有其优势。     

Secondary glaucoma with anterior chamber cholesterolosis: Case series

Rationale:The presence of cholesterol crystals in the anterior chamber is extremely rare, and secondary glaucoma with cholesterol crystals in the anterior chamber, reported in the literature, is even rarer. This paper reports 3 cases of secondary glaucoma with cholesterol crystals in the anterior chamber.Patient concerns:Three patients were admitted to the hospital because of ocular distension and blindness. Ocular examination on admission indicated high intraocular pressure, and crystalline gold substances were observed in the anterior chamber.Diagnosis:Based on clinical manifestations and an aqueous fluid smear, absolute glaucoma and anterior chamber cholesterol crystals were diagnosed.Interventions:In the first case, transscleral ciliary photocoagulation was performed; in the last 2 cases, trabeculectomy combined with extracapsular cataract extraction was performed.Outcomes:The follow-up period was 11 to 15 months. Intraocular pressure was stable in 2 patients treated with surgery, and no cholesterol crystals were observed in the anterior chamber. The intraocular pressure increased in 1 patient treated with laser, and a small amount of cholesterol crystals was still observed in the anterior chamber.Lessons:Anterior chamber cholesterol crystallization is extremely rare and cannot be treated if it does not cause other lesions. However, glaucoma occurred in all 3 cases in this study, and intraocular pressure increased in 1 case after laser treatment and remained stable in 2 cases after surgical treatment. Therefore, the treatment plan for anterior chamber cholesterol crystallization in glaucoma requires further discussion.     

前路和后路手术方式治疗老年脊髓型颈椎病的疗效比较

目的探讨老年脊髓型颈椎病（cervical spondylotic myelopathy,CSM）不同入路手术的疗效,以期提高老年CSM的临床效果。方法选择接受手术治疗的160例老年CSM患者,根据手术入路的方式分为前路组（n=80）与后路组（n=80）。前路组患者接受颈椎前路减压植骨融合术;后路组患者接受颈椎后路单开门椎管成形术。观察并比较2组患者的手术时间、术中及术后并发症、脊髓神经功能优良率及手术前后日本骨科学会评分（JOA）的变化。结果前路组平均手术时间比后路组明显缩短（P〈0.05）;前路组平均术中出血量显著少于后路组（P〈0.01）。2组脊髓神经功能优良率差异无统计学意义（P〉0.05）;2组术后JOA评分均较术前明显改善,差异有统计学意义（P〈0.05）,术后前路组JOA评分改善优于后路组（P〈0.05）。结论颈椎前路减压植骨融合术和颈椎后路单开门椎管成形术治疗CSM均具有较好的疗效;合理选择好手术适应证可提高老年CSM患者的临床疗效及减少并发症的发生。     

Tentative surgical repair of leaking filtering bleb with amniotic membrane transplantation--a case report

To repair a traumatic leaking cystic bleb in a 50-year-old male patient who had received multiple glaucoma filtering surgeries with the application of mitomycin-C, an amniotic membrane covered over the leaking bleb and sutured it to the adjacent conjunctiva with 10-0 nylon was done. The anterior chamber gradually formed after the amniotic membrane transplantation (AMT) and intraocular pressure returned to the level before trauma. Three weeks after the operation, the amniotic membrane was removed. No more leakage from the bleb was observed during four months follow-up. However, another bleb revision surgery was performed later to repair recurrent bleb leakage. Although conjunctival advancement or free conjunctival autograft have been reported to repair leaking bleb successfully, the simple primary method of using AMT is still encouraged in repair of a ruptured bleb with tentative maintenance of adequate filtration.     

雷珠单抗对糖尿病增殖性视网膜病变患者玻璃体切割术的影响

目的 观察玻璃体腔内注射雷珠单抗对增殖性糖尿病视网膜病变（PDR）患者玻璃体切割术实施及预后的影响. 方法 选择PDR患者40例（45眼）,随机分为：试验组20例（22眼）玻璃体腔内注射雷珠单抗0.5 mg,行玻璃体切割术;对照组20例（23眼）直接行玻璃体切割术.分析两组术中、术后临床指标的差异. 结果 试验组平均手术持续时间、术中电凝止血频率及医源裂孔发生率均低于对照组[时间：（96±12）vs（133±15） min,P＜0.001;止血百分率：3（13.6％）vs9（39.1％）,P=0.038;裂空发生率：1（4.54％） vs 4（17.4％）,P=0.034].试验组术后1个月内前房和玻璃体腔积血率均较对照组降低[前房：1（4.54％）vs2（8.70％）,P=0.025;玻璃体腔：1（4.54％）vs3（13.0％）,P=0.048].两组术后视力均较术前提高,组间比较差异有统计学意义（P=0.020）. 结论 PDR患者在玻璃体切割术前注射雷珠单抗可缩短手术时间,减少术中出血及医源性裂孔的发生,减少术中术后并发症,获得更好的术后视力.