后固定术对上直肌转位治疗外展神经 全麻痹疗效的影响

目的：探讨后固定术在上直肌转位（SRT）治疗外展神经全麻痹中对外展受限的改善效果及并发症情 况。方法：回顾性研究。选择徐州市第一人民医院2014年3月至2019年1月行上直肌转位术治疗外 展神经全麻痹患者21例,其中SRT联合后固定术者作为A-SRT组（10例）,为外展不能过中线的严重 病例。单纯行SRT术者作为SRT组（11例）。比较2组间手术前后水平、垂直、旋转斜视变化,外展 受限的改善和出现内转受限等情况。随访时间为10～12个月。数据采用Wilcoxon秩和检验、MannWhitney检验分析。结果：SRT组手术前后内斜视度差值为28.0°（25.0°～30.0°）,A-SRT组为40.0° （36.0°～45.0°）,组间手术前后差值的差异有统计学意义（Z=-2.940,P<0.001）。SRT组手术前后眼球 外展受限差值为1.0（1.0～1.0）,A-SRT组为2.0（1.0～2.0）,组间差值的差异有统计学意义（Z=-3.272, P=0.001）。组间手术前后内转受限加重变化差值、垂直斜视度变化差值的差异均无统计学意义（Z= -1.855,P=0.064;Z=-1.505,P=0.132）。SRT组双马氏杆主观旋转检查眼球发生内旋变化为0.0° （0.0°～ 2.0°）,A-SRT组为3.0°（0.0°～4.25°）,2组间变化差异有统计学意义（Z=-2.228,P=0.026）,但2组患 者均无旋转、垂直复视发生,也无其他并发症。结论：后固定术在SRT治疗外展神经全麻痹时,有 引起轻度的眼球内旋及内转受限可能,但可增强外展受限改善程度,原在位内斜矫正好,患者无明 显的主观垂直、旋转复视,故此术式安全、有效。     

Von Pflugk (Dresden): Contribution to the Technique of Strabismus Operations,Suturing Anteriorly and Posteriorly

Up to 25% of the eyes affected with Duane's syndrome show upshoot and/or downshoot in attempted adduction. This is thought to be caused by the tight horizontal muscles both contracting in attempted adduction (leash or bridle effect) due to abnormal firing of the lateral rectus muscle through which the globe slips beneath the muscle. Surgical procedures successful in correcting the very disturbing cosmesis of gaze are posterior fixation, recession of the horizontal rectus muscles or splitting of lateral recti muscles insertion. The authors report on a 27-year-old male with Duane's syndrome type III with extreme upshoot in adduction. After recession of both horizontal muscles the upshoot on attempted adduction was no longer present postoperatively. At one year follow-up a very discrete upshoot in attempted adduction could be documented. The resolving of the upshoot postoperatively could be explained by the bridle mechanism alone. The low grade upshoot in attempted adduction at one year follow-up could have been caused by new adhesions of the check ligaments and Tenon's capsule at the level of the lateral rectus muscle resulting from surgery itself. The possibility of an anomalous cyclovertical innervation playing a role in the vertical anomalous movements as Duane originally hypothetized cannot be excluded.     

Unilateral Scleral Fixation of Posterior Chamber Intraocular Lenses in Pediatric Complicated Traumatic Cataracts

Purpose

The purpose of this study was to evaluate the visual outcomes and complications of unilateral scleral fixation of posterior chamber intraocular lenses (SF-PCIOLs) in pediatric complicated traumatic cataracts without capsular support.

Methods

This study involved five eyes of five children who underwent unilateral SF-PCIOL. All patients had a unilateral complicated traumatic cataract associated with anterior or posterior segment injury. Visual acuity (VA), IOL position, and postoperative complications were assessed during follow-up.

Results

The mean age of patients at the time of SF-PCIOL was 90 months (range, 66-115). The mean duration of follow-up time after surgery was 22 months (range, 5-55). In all patients, the best-corrected VA was either improved or was stable at last follow-up following SF-PCIOL implantation. There were no serious complications.

Conclusions

Unilateral scleral fixation of PCIOL can be a safe and effective procedure for pediatric, unilateral, complicated traumatic cataracts without capsular support in selected cases.     

分离性垂直斜视上直肌解剖位置的异常

目的观察分离性直斜视中上直肌和水平直肌肌肉止端的位置,探讨分离性直斜视的发病机理。方法回顾手术治疗的125例垂直分离性斜视病例,对手术中测量的上直肌肌肉止端距角膜缘距离进行统计,对同时伴有内外斜视的病例内外直肌附着点位置也分别进行统计。结果上直肌止端距角膜缘最近5.5mm,最远8.0mm,平均为6.77mm。DVD与伴有内外斜视的DVD上直肌帐端距离无明显差别,(P>0.05)。DVD垂直斜视角≤20~Δ与>20~Δ时止端位置无明显统计学差别,(P>0.05)。结论DVD病例中存在上直肌止端位置更靠近角膜缘的变异,提示DVD的病因中可能有解剖因素的异常。     

Non—trans—scleral Suture Fixation of Posterior Chamber Intraocular Lenses in the Absence of Posterior Capsular Support

Purpose: To develop a new technique for fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsule support.Materials and Methods: We performed non-trans-scleral fixation of intraocular lenses on 24 cases (24 eyes) without posterior capsule support. Two scleral flaps with limbal incisions and two peripheral iridectomies were made at 1 o' clock and 7 o' clock positions respectively. A suture-leading needle was used to lead the prolene suture from the limbal incision and iridectomy on one side through the iridectomy and limbal incision on the other side. Intraocular lens (IOL) was then fixed in the ciliary sulcus. Results: After a mean follow-up of 6. 6 months (range from 3 to 14 months), corrected visual acuity of 16 cases (16 eyes,66. 7% ) got 0.5 or better. Postoperative complications included discoria (4 eyes) , surface membrane formation ( 1 eye ), choroidal detachment (1 eye) and tilt of IOL (1 eyes),but all were not severe. Conclusion: In some situations such as low int     

The Effect of Fixation Disparity on the Size of Panum ‘s Fusional Area

ABSTRACT Factors affecting the size of Panum's fusional area are reviewed. One of these factors, prolonged fixation disparity, is investigated. The results show that this does not appear to significantly alter the size of Panum's area within the limitations of the tests used in detecting subjects with prolonged fixation disparity.     

改良Yokoyama术治疗高度近视固定性内下斜视

目的探讨改良Yokoyama术治疗高度近视限制性内下斜视的效果。方法回顾性病例研究。分析2011-2014年江苏省中医院6例（8眼）高度近视固定性内下斜视的手术效果。术前CT检查眼外肌位置及组织变化。术前、术后9个诊断眼位检查眼运动功能。术前、术中行被动牵拉试验以评估肌肉的限制程度和功能。以改良Yokoyama+内直肌后徙术对患眼的眼位进行矫正。结果CT显示患眼眼外肌出现移位。术前被动牵拉患眼内直肌出现挛缩,患眼外上转严重受限。术后观察半年,患眼第一眼位正位,外、上转明显改善,无一例出现眼前节缺血并发症。结论改良Yokoyama术术后患者眼位及眼球运动均恢复良好,是矫正高度近视固定性内下斜视较好的一种手术方法。     

Temporary Visual Loss Due to Posterior Reversible Encephalopathy Syndrome in the Case of an End-Stage Renal Disease Patient

Posterior reversible encephalopathy syndrome is a clinical phenomenon associated with headache, altered mental status, seizures, and visual disturbances along with radiographic acute cerebral oedema. Several conditions are correlated with posterior reversible encephalopathy syndrome, with acute hypertension, eclampsia, and cytotoxic agents being the most common. This report presents a case of posterior reversible encephalopathy syndrome in a 45-year-old male with multiple underlying conditions, including hypertension, diabetes, and end-stage renal disease. Sudden onset of bilateral visual loss with mild systemic feature of dizziness was noted on presentation. Radiologic findings showed characteristic findings of posterior reversible encephalopathy syndrome. Following prompt control of hypertension and haemodialysis, resolution of symptoms was noted.     

后部眼球筋膜下曲安奈德注射治疗视盘血管炎

目的:评估后部眼球筋膜下注射曲安奈德治疗视盘血管炎的效果。方法:回顾性分析郑州市第七人民医院2016年5月至2019年5月60例(60眼)视盘血管炎的临床资料。患者均采用自行改制6号泪道冲洗针头进行后部眼球筋膜下注射曲安奈德40 mg/0.5 ml,同时辅以静脉滴注复方血栓通及能量合剂,颞浅动脉旁皮下注射复方樟柳碱注射液,口服甲钴胺、胞二磷胆碱及复合维生素B。随访观察6~18个月。结果:60例均治愈,视力有不同程度提高,部分患者黄斑中心凹形态恢复,水肿减轻。结论:后部眼球筋膜下注射曲安奈德治疗视盘血管炎安全有效,操作简单,费用低廉。     

先天性单眼上斜肌麻痹不同手术方式疗效观察

目的:探讨不同手术方式治疗先天性单眼上斜肌麻痹的疗效以及术后双眼视觉功能的恢复重建情况。方法:回顾性病例研究。选择2016-05/2019-05郑州市第二人民医院斜视与小儿眼科收治的82例先天性上斜肌麻痹患儿作为研究对象,根据患者第一眼位垂直斜视度、患眼下斜肌功能亢进程度、单眼及双眼运动情况等术前检查结果,设计相应的手术方式。包括下斜肌断腱术(3例)、下斜肌部分切除术(63例)、下斜肌徙后术(6例)、健眼下直肌徒后术(4例)、下斜肌减弱+对侧/同侧直肌术(5例)、上斜肌折叠术(1例)。结果:和手术前比较,手术后同时知觉、融合功能、远立体视、近立体视、矫正视力、代偿头位均得到明显改善(P<0.05);有无代偿头位患儿手术后立体视无差异(P>0.05)。结论:根据先天性单眼上斜肌麻痹病情严重程度选择不同的手术方式,在改善患儿视力、代偿头位方面具有积极意义,有助于重建双眼视觉功能。     

先天性脑神经异常支配眼病的分子遗传学与神经科学研究进展

先天性脑神经异常支配眼病(CCDDs)为一组先天性、非进行性一条或多条脑神经发育异常或缺失,从而导致的原发或继发脑神经异常支配眼外肌的斜视综合征,可散发或家族遗传,可伴有全身系统异常。近年来随着神经病理学、神经影像学、遗传学的研究进展,不仅明确了CCDDs的病因是神经源性的眼球运动障碍,也发现了CCDDs的致病基因,包括SALL4、HOXA1、KIF21A、PHOX2A、TUBB3及HOXB1等。针对基因突变影响大脑神经发育从而进一步导致先天性脑神经支配异常性病变发生这一问题,文章回顾了近年国内外相关文献,就已知的CCDDs的分子遗传学和神经科学研究进展作一综述,以期为CCDDs的临床和基础研究提供参考。     

眼睑痉挛型Meige综合征的治疗进展

Meige综合征是一种节段性的颅颈部肌张力障碍性的锥体外系疾病,属于成人多动症的一种。发病原因不明,常见于中老年女性,多与抑郁、外伤、药物、手术等危险因素相关,眼睑痉挛是Meige综合征最早也是最常见的临床症状,尽管有自发缓解的可能,但亦有致盲风险,临床上多因对此病认识不足而延误治疗影响预后,随着其发病率的增长,尤其以眼睑痉挛就诊于眼科的人数增长,全面认识Meige综合征有利于提高眼科医师诊治本病的能力以及指导临床合理用药。本文就眼睑痉挛型Meige综合征的治疗进展予以综述,总结了药物、手术和中医疗法的利弊,以期提高眼科医师对此类疾病的诊治水平。     

Morphology of the Trabecular Meshwork and Schlemm's Canal in Posner-Schlossman Syndrome

PurposeThe purpose of this study was to investigate trabecular meshwork (TM) and Schlemm''s canal (SC) morphology in Posner-Schlossman syndrome (PSS).MethodsForty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography.ResultsTM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm² vs. 5445.69 ± 1368.89 µm², P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm² vs. 5476.40 ± 1390.15 µm², P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05).ConclusionsTM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.     

Positioning of the posterior intraocular lens in the longer term following cataract surgery in eyes with and without pseudoexfoliation syndrome

Purpose: To assess long‐term positioning of posterior chamber intraocular lenses within the capsular bag in eyes with pseudoexfoliation syndrome. Methods: The study includes 44 patients with pseudoexfoliation syndrome and 85 age‐matched controls, who underwent cataract surgery in 2001 and 2002 at the Eye Department, Oslo University Hospital. In 2008, all patients were re‐examined. A comparison of the extent of possible decentration in eyes with and without pseudoexfoliation syndrome was made by evaluating Scheimpflug images (Pentacam) of the anterior segment. Results: It was found that, 6–7 years following cataract surgery, posterior chamber intraocular lenses were positioned lower in eyes with pseudoexfoliation syndrome than in control eyes. The difference was statistically significant (p = 0.01). Downward shift was associated with presence of glaucoma only in eyes with pseudoexfoliation syndrome (p = 0.01). No patients had visual disturbances related to displacement of the intraocular lens. Three of the patients with pseudoexfoliation syndrome (6.8%) had observable pseudophacodonesis by slit‐lamp examination, compared to one in the control group (1.2%). The study demonstrated that Pentacam is an appropriate instrument to measure decentration of intraocular lenses. Conclusion: The study suggests that, 6–7 years after cataract surgery, the intraocular lenses within the capsular bag are more prone to decentration in pseudoexfoliation syndrome eyes, compared to controls.     

The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

White‐on‐white standard automated perimetry (SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure‐function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure‐function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management.     

Cat scratch disease bacilli in the conjunctiva of patients with Parinaud's oculoglandular syndrome

Unilateral conjunctivitis with regional lymphadenitis has been designated Parinaud's oculoglandular syndrome (POGS). The cause has been attributed to various infectious agents, especially leptothrix and the unidentified agent of cat scratch disease (CSD). In 1983-84 the cause of CSD in lymph node and skin was established as small pleomorphic gram-negative bacilli. We now report identical bacteria in the conjunctival lesions of 9 of 24 patients with POGS. This confirms the belief that the CSD bacillus is a major cause of POGS.     

Subconjunctival dendrimer-drug therapy for the treatment of dry eye in a rabbit model of induced autoimmune dacryoadenitis

Purpose

To investigate the efficacy of a single subconjunctival injection of dendrimer-dexamethasone conjugate in a rabbit model of induced autoimmune dacryoadenitis (AID).

The Use of Slow-Release Artificial Tears in the Long-Term Management of Keratitis Sicca

Fifty-eight patients with keratitis sicca were enrolled in a long-term study to test the effectiveness of slow-release artificial tears (SRAT). The average follow up period was 39 weeks, with a range of 9 to 136 weeks. Forty-six (79%) are still being followed. Almost all of these patients have had marked relief from their symptoms and a significant decrease in corneal abnormalities. The high rate of success in this patient population was probably due in large part to patient selection, that is, patients were quite symptomatic and had been symptomatic for an average of three years prior to entering this study. For patients with fairly severe keratitis sicca for whom artificial tears alone are insufficient, SRAT offers an important and practical means of markedly decreasing symptoms and improving vision with only minor side effects.