松弛性视网膜切开术治疗复杂性视网膜脱离

探讨松弛性视网膜切开联合眼内激光和硅油或C3F8气体填充治疗复杂性视网膜脱离的效果及并发症。方法 :对 5 8例复杂性视网膜脱离患者行松弛性视网膜切开术 ,联合眼内激光和硅油或C3F8气体填充进行治疗。观察术后视网膜解剖复位、视功能及术后眼压变化情况。结果 :随访 6月 ,5 8例患者中有 42例视网膜仍在位 ,38例视力获得改善 ,5例眼压≤ 5mmHg。结论 :松弛性视网膜切开术是治疗复杂性视网膜脱离的有效方法。部分患者会出现术后眼压降低 ,因此应严格掌握手术适应症。     

Vitreon眼内短期填充的并发症分析

目的：评价过氟氢菲（Perfluoroperhydrophenanthrene,PFPh.又名Vitreon）液体作为眼内短期填充物在复杂性玻璃体视网膜手术中应用的临床疗效、并发症。方法：分析6例（6只眼）复杂性视网膜脱离的患者，行经睫状体平坦部玻璃体切除、Virteon眼内填充，裂孔周边部的激光光凝等手术治疗。Vitreon眼内填充4周后行取出术后，随访6个月以上的临床资料。结果：手术中，所有患眼视网膜均解剖复位成功。术后4周取出Vitreon，所有患眼视网膜均保持解剖复位。术后患者视力均有不同程度的提高。Vitreon眼内填充期间，产生的并发症包括Vitreon进前房（2例）、晶状体后囊下沉着物形成（3例）、高眼压（2例）、葡萄膜炎（2例）等。其中1例高眼压患者的病理结果显示Vitreon能引起房水结晶样改变和小梁网变性。取出Vitreon后，以上部分并发症可获得好转或消除。结论：Vitreon眼内短期填充能提高复杂性玻璃体视网膜手术中视网膜复位的成功率，但填充4周会产生一定的并发症。其临床应用应慎重考虑其适应证。     

人工晶体及无晶体眼巨大裂孔性视网膜脱离

目的探讨人工晶体及无晶体眼巨大裂孔性视网膜脱离的手术治疗。方法7例采用玻璃体切除术,术中使有过氟萘烷展平视网膜,眼内激光及眼外冷凝封闭视网膜裂孔,惰性气体或硅油与过氟萘烷交换。结果7例手术后出院时视网膜均复位。C3F8气体填充2例中1例于气体吸收后局部视网膜脱离,二次16?F8填充,视网膜复位。硅油填充5例于术后10m-18m取出眼内硅油3例,其中1例视网膜再脱离,二次注入硅油。7例术后视力不同程度提高。结论玻璃体切除术及术中使用过氟萘烷、眼内激光、眼外冷凝封闭视网膜裂孔是治疗人工晶体眼及无晶体眼巨大裂孔性视网膜脱离的有效方法。     

玻璃体切除联合眼内填充治疗复杂性视网膜脱离158例

目的:探讨一期玻璃体切除联合眼内填充术治疗复杂性眼视网膜脱离的临床疗效。方法:158例(158眼)复杂性视网膜脱离施行玻璃体切除联合眼内填充手术治疗。其中,35例行C3F8充填,123例行硅油充填,术后随访2～12mo。结果:视网膜完全复位128眼(81.0%),部分复位23眼(14.5%),未复位7眼(4.5%)。其中,硅油填充123例,103例解剖复位,复位率为83.7%。C3F8填充35例,25例解剖复位,复位率71.4%。术后视力均有不同程度的提高。结论:玻璃体切除术联合眼内填充治疗复杂性视网膜脱离有良好的疗效,解除视网膜牵引及合理选择充填物,及时处理并发症是手术成功的关键。     

重硅油眼内填充治疗复杂视网膜脱离的临床观察

目的探讨重硅油玻璃体腔填充治疗复杂性视网膜脱离的术后效果。方法对4例视网膜下方裂孔或/和发生严重增殖性玻璃体视网膜病变的复杂性视网膜脱离患者进行了玻璃体腔填充重硅油视网膜复位术,术后对眼压及眼底情况随访观察。结果3例术后眼压长时间增高,药物控制效果差,2例视网膜复位,2例再手术时取出重硅油填充标准硅油。结论重硅油玻璃体腔填充后引起高眼压,眼内耐受性较差。     

中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。     

硅油填充术后视网膜再脱离临床分析

目的:探讨玻璃体切除联合硅油填充治疗复杂性视网膜脱离术后 ,硅油填充期间发生视网膜再脱离的原因及处理方法。方法 :回顾总结分析 2 8眼硅油填充期间发生视网膜再脱离的原因 ,对不同眼底表现分别采取巩膜外顶压联合眼外激光封孔 ,硅油取出、剥膜、再次眼内填充 ,硅油下视网膜剪开等术式 ,观察治疗效果。结果 :2 8眼有 2 5眼解剖复位 ,3眼复位后再脱离 ,成功率为 89 3%。其中一次手术成功率 78 6 %。结论 :术后增殖膜形成牵引是硅油填充期间视网膜再脱离的主要原因 ,对不同类型的视网膜再脱离 ,应采取不同治疗措施     

曲安奈德辅助玻璃体切除取出眼内异物的疗效观察

目的观察和分析曲安奈德辅助玻璃体切除取出眼内异物的临床疗效。方法选择伴有视网膜损伤且行玻璃体手术的眼内异物伤患者23例(23只眼),玻璃体切除手术中辅助应用曲安奈德染色玻璃体。结合高负压人工玻璃体后脱离法,尽可能切除全玻璃体,同时处理损伤的视网膜,必要时眼内填充C3F8或硅油。结果所有患者异物均一次性取出,15例成功实施玻璃体后脱离,术后视网膜脱离3例。结论玻璃体切除治疗眼内异物伤,术中辅助应用曲安奈德染色,有利于充分切除玻璃体,降低术后视网膜脱离的发生率。     

全氟己基正辛烷对视网膜的毒性作用

目的 观察全氟己基正辛烷（F6H8）对兔视网膜组织结构的影响。方法 新西兰白兔15只，玻璃体切割术后玻璃体腔内注入F6H8（实验组12只）或平衡盐溶液（balanced salt solution,BSS)(对照组3只）2ml，手术前后定期裂隙灯、间接检眼镜检查，手术后并行组织学和透射电镜检查。结果 F6H8在玻璃体腔内形成单个透明泡，未见视网膜脱离及白内障。实验组兔眼组织学检查，手术后4周开始下方视网膜出现外丛状层水肿，继而变薄，部分内、外核层细胞变性，电镜下见细胞空泡变性。结论 F6H8玻璃体腔内填充对视网膜有一定的毒性作用，目前尚不宜用作眼内长期填充物。     

儿童复杂性视网膜脱离的手术治疗

目的　探讨儿童复杂性视网膜脱离病因、特点及手术方法和疗效。方法　对采用玻璃体切割联合眼内填充术治疗的儿童复杂性视网膜脱离患者 71例 (74眼 )进行临床分析。结果　 9眼膨胀气体填充 ,术后近期 5眼 (5 5 6% )视网膜复位 ;66眼硅油填充 ,近期 5 5眼 (83 3 % )视网膜复位。随访 2～ 3 0月 ,其中 5 1眼随访时间超过 6个月 ,最终视网膜完全复位 3 4眼 (66 7% ) ,视力在 0 0 5以上者 2 8眼 (5 4 9% )。结论　玻璃体切割联合眼内填充术是治疗儿童复杂性视网膜脱离的有效方法之一 ,儿童复杂性视网膜脱离的手术成功率比成年人低 ,手术失败的主要原因是PVR复发     

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.