A comparison of rust-ring removal methods in a rabbit model: small-gauge hypodermic needle versus electric drill

Corneal rust rings are common findings after removal of a metallic foreign body. These rings should be removed to prevent inflammation and scarring. We compared the corneal damage in rabbit eyes caused by rust-ring removal using two different methods: a small-gauge hypodermic needle and a hand-held electric ophthalmic drill. No significant difference was found in the amount of corneal scarring as graded by a masked observer. However, there was a trend toward deeper stromal damage in the drill-treated subjects (207 +/- 73 microns) than in the needle-treated subjects (172 +/- 61 microns). In light of this finding, we suggest caution in removing central rust rings with an electric drill since an avoidable, permanent scar may result.     

Complicated removal of corneal foreign bodies 18 months after laser in situ keratomileusis

We present a 39-year-old young engineer who developed flap complications after removal of corneal foreign bodies 18 months after successful laser in situ keratomileusis. The right eye had a flap scar and debris in the interface, and the left eye had a central rust ring and debris in the interface. Attempted removal of the flap in the left eye lifted off a large area around the rust ring, and the ring was left in place. One week after treatment with topical antibiotics, the eye was white and the rust ring had begun to disappear. The ring was successfully removed without complications the following week.     

自制角膜微型磨钻与传统注射针头在角膜铁屑异物取出术中的效果比较

目的 评价自制角膜微型磨钻与传统注射针头在角膜铁屑异物取出术中的效果。设计 回顾性比较性病例系列。研究对象 铁屑异物侵入角膜基质层内的Ⅱ度角膜铁屑异物患者3475例3621眼,采用随机数字表法将患者分为甲、乙两组,甲组1730例1758眼,乙组1745例1863眼。方法 甲组采用传统注射针头剔除角膜异物,乙组采用自制角膜微型磨钻清除角膜异物。主要指标 手术时间、需二次手术率、角膜锈环清除时间、角膜愈合时间、术后并发症。结果 甲、乙两组手术时间分别为（3.2±0.7）分、（1.1±0.2）分,需二次手术率分别为50.11%、0.81%,角膜锈环清除时间分别为（3.6±0.6）天、（1.1±0.3）天,角膜愈合时间分别为（6.8±1.1）天、 （3.3±0.8）天,术后并发症发生率分别为7.0%、1.23%。两组以上各指标比较差异均有统计学意义（P均＜0.05)。结论 自制角膜微型磨钻较传统注射针头在角膜铁屑异物处理方面有较大的优势,在临床使用中安全有效。（眼科, 2014, 23： 332-334）     

玻璃酸钠和重组牛bFGF滴眼液在角膜铁锈异物取出术后的疗效

目的:观察比较玻璃酸钠滴眼液和重组牛碱性成纤维细胞生长因子滴眼液联合应用对角膜铁锈异物取出术后角膜创面上皮修复的临床效果。方法:选择角膜铁锈异物患者98例98眼,随机分成联合治疗组49例49眼和对照组49例49眼。联合治疗组于角膜异物取出术后滴玻璃酸钠滴眼液+重组牛碱性成纤维细胞生长因子滴眼液+盐酸左氧氟沙星滴眼液;对照组滴重组牛碱性成纤维细胞生长因子滴眼液+盐酸左氧氟沙星滴眼液。每周3次观察角膜荧光素染色、角膜创面上皮修复及患眼局部症状等指标,观察2wk。结果:联合治疗组的总有效率96%高于对照组的88%(P<0.05)。结论:玻璃酸钠滴眼液和重组牛碱性成纤维细胞生长因子滴眼液联合应用能明显促进角膜损伤后上皮修复速度,疗效确切,安全可靠。     

取出角膜金属异物和锈环的改良方法

目的：比较用两种方法取出角膜金属异物和锈环的效果。方法：将40例门诊角膜金属异物患者分为两组。第1组(20例)采用注射针头配合镊子取出异物和锈环;第2组(20例)采用注射针头取出异物和锈环。将两组间操作时间长短、患者疼痛程度、角膜上皮损伤修复时间和取出锈环的完整性进行比较。结果：第1组患者的角膜锈环经过一至两次尝试后完整取出;而在第2组中,锈环往往破碎成数块之后才能全部取出。第1组患者的平均手术时间较第2组短1.9 min (37.3%)(P<0.001)。第1组患者术中和术后1d的疼痛评分也明显低于第2组。第1组患者80%的眼术后1 d角膜上皮细胞已修复,荧光染色呈阴性;而在第2组,同期只有55%的眼角膜荧光染色呈阴性。结论：第1组取出角膜金属异物和锈环所采用的方法较第2组的传统方法更容易操作且疗效更好。     

The effect of Solcoseryl eye gel in combination with neomycin and bacitracin on the healing of corneal lesions after foreign body removal

The effect of Solcoseryl on the healing rate of corneal lesions after foreign body removal was assessed in a double-blind study. Solcoseryl is a protein-free hemodialysate which is widely used to stimulate tissue repair processes. The healing rate was determined by means of photodocumentation which was complete in 82 out of 92 cases. The Solcoseryl group showed in significantly faster healing rate and a lower tendency to development of corneal opacities than the control group. No side-effects were observed which could be attributed to either of the drugs used in the study.     

Efficicacy of eye patching for corneal healing after removal of corneal foreign body

Standard treatment of corneal epithelial loss includes an eye patch with antibiotic ointment. We compared the efficacy of eye patching with no eye patching on corneal epithelial healing of 84 patients after foreign body removal. Since no significant difference between two groups for corneal healing was found, antibiotic treatment alone may be sufficient for treatment of corneal epithelial loss after foreign body removal. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacture or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Corneal honey bee sting: endoilluminator-assisted removal of retained stinger

To report the clinical findings and a novel method of removal of bee sting using an endoillumination light source the following methods were used: clinical presentation, slit-lamp photographs, serial endothelial images and surgical management of a case of retained bee sting in the cornea. The bee sting was surgically removed by forceps under focal illumination with an endoillumination light source. Topical steroids and cycloplegics were given postoperatively to control the inflammation. The patient had complete visual recovery and partial resolution of endothelial changes after 1 year of treatment. The clinical picture of a corneal honey bee sting resembles keratouveitis. Focal corneal infiltrate and associated low-grade uveitis tend to persist if treated with topical steroids only. Early recognition and prompt removal of the stinger may help in the early resolution of anterior segment inflammation and prevent irreversible damage to endothelial cells.     

Cortical removal simplified by J-cannula irrigation.

Subincisional cortical removal is one of the more specific obstacles impeding the performance of uneventful cataract extraction. In this technique, staged use of a J-cannula irrigates the cortex remaining after phacoemulsification, particularly in the subincisional space. This is followed by standard automated aspiration. The irrigation procedure is independent of a small pupil or capsulorhexis and typically allows for complete cortical cleanup in less than 1 minute. The details of the procedure, used in more than 3000 cases, are reported.     

A convenient rabbit model of ocular epithelium damage induced by osmotic dehydration.

Dry eye is an ocular disease clinically associated with corneal epithelium damage and arises acutely or chronically from dehydration of the ocular surface. We provide herein a novel in vivo model of corneal epithelium damage, in which the corneal surface was entirely covered with a sugar powder to provoke the rapid removal of corneal surface liquid. In this animal model, such corneal damage as can be fluorometrically detected was observed immediately after 20-minute hyperosmotic treatment, reached a maximum 6 hours later, and then gradually declined to complete recovery at Hour 126. Recovery of the damaged corneas produced by hyperosmotic stress was significantly accelerated by treatment with 0.1% sodium hyaluronate, a dry eye remedy in Japan. Thinning or partial erosion of the epithelial cell layers was histopathologically demonstrated in and around the sugar powder-applied area but the posterior stromal cell layer remained intact, indicating that the present rabbit in vivo model may be used to conveniently screen therapeutics against acute ocular diseases with corneal epithelium damage. In addition, microscopic observations of TUNEL-stained thin-sections of the damaged corneas indicated that apoptotic cell death, but not any inflammatory reactions, may be at least partially responsible for the hyperosmolarity-induced destruction of the corneal epithelium.     

Corneal steepening with final suture removal after penetrating keratoplasty

We reviewed 53 patients after they underwent penetrating keratoplasty, comparing the change in average corneal curvature before and after final suture removal 15-18 months postsurgery. In 29 eyes with keratoconus, there was a significant increase in average curvature of 3.48 diopters +/- 3.76 (p less than 0.0005). In 24 eyes with other diagnoses, there was also a significant increase in the average curvature of 3.26 diopters +/- 3.98, (p less than 0.0005). The difference between these groups was not significant. The amount of steepening correlated negatively (-.6494) with the average corneal curvature before suture removal (p less than 0.005). We found no change in the average astigmatism after suture removal; however, large changes in astigmatism occurred unpredictably with some patients. This study shows that corneal curvature after penetrating keratoplasty steepens after suture removal, particularly in flat corneas, and astigmatism may shift unpredictably.     

缝针支托法在深层角膜异物取出术的应用

目的 探讨缝针支托法取出深层角膜异物的效果和手术操作技巧。方法 显微镜下采用缝针支托法取出深层角膜异物28例28眼。结果 28例28眼均一次性取出深层角膜异物，无一例切穿角膜致异物落入前房。随访1～3个月，术后视力提高16例16眼，占57．1％，保持视力不变者12例12眼，占42．9％，无一例视力下降，术后视力恢复与异物种类、大小、位置、深度、存留时间长短、有无合并症等有关。结论 缝针支托法取出深层角膜异物操作简单、安全、有效，实用性强，并发症少，值得眼科医生应用。     

绷带型角膜接触镜在角膜深层异物取出术后的应用

目的:观察绷带型角膜接触镜在角膜深层异物取出术后的临床疗效.方法:对角膜深层异物取出术后患者46例46眼,随机分成戴镜组和对照组各23例23眼,两组均实施角膜深层异物取出术,比较两组患者术后1、3、7d的眼部疼痛程度及术后7d角膜上皮愈合情况.结果:术后1、3、7d两组患者眼部疼痛程度评分:戴镜组分别为0.44±0.26、0.26±0.14、0.12±0.08分,对照组分别为1.26±0.44、1.02±0.38、0.68±0.26分,两组同一时段的眼部疼痛程度差异有统计学意义(P<0.05);术后7d两组患者角膜上皮缺损情况:戴镜组角膜上皮完全修复21眼(91%),对照组上皮完全修复14眼(61%),差异有统计学意义(P<0.05).结论:配戴绷带型角膜接触镜能有效缓解角膜深层异物取出术后患者的眼部刺激症状,能加速术后角膜创面的修复.     

Acute corneal decompensation after silicone oil removal

Purpose: To assess acute corneal decompensation after silicone oil removal in some aphakic eyes with clear corneas whose anterior chambers were completely filled with silicone oil for a considerable period of time. Methods: Eight eyes of 8 patients who underwent vitrectomy and intraocular silicone oil injection were studied. All the eyes were aphakic and anterior chambers were completely filled with silicone oil. In all eyes, corneas were clear and no corneal finding indicating keratopathy was detected by slit-lamp microscopy before silicone oil removal. The mean silicone oil removal time was 4 months (range 2–7 months). A specular microscope was used for the evaluation of corneal endothelial changes and corneal pachometry was performed to observe corneal changes before and after the silicone oil removal in 5 eyes besides slit-lamp microscopy. The follow up period after silicone oil removal was 2–12 months (mean 6 months).Results: In all eyes severe corneal stromal edema and clouding was detected in the first day following silicone oil removal. Increased corneal thickness was seen in all eyes. Decreased (at or below critical levels) corneal cell density was detected by specular microscopy before and after silicone oil removal. No significant improvement was observed during the follow up period. Conclusion: Eyes whose anterior chambers completely filled with silicone oil could be evaluated as clear corneas by slit lamp microscopy despite severe endothelial damage. We recommend that eyes with silicone oil in the anterior chambers should be monitored by a combination of slit-lamp microscopic examination and specular microscopy to determine the relative corneal endothelial tolerance to the silicone oil and endothelial damage. Early removal of the silicone oil can be considered when the retinal adhesion allows.     

Corneal topography for selective suture removal after penetrating keratoplasty

Twenty-nine suture removals from 20 eyes (21 patients) on which penetrating keratoplasty had been performed were analyzed in a nonrandomized consecutive study to evaluate the role of computer-assisted corneal topography in selective suture removal to reduce astigmatism. Topographic guidance for suture removal resulted in a net decrease in refractive and keratometric astigmatism in 21 of the 29 cases. The net reduction in astigmatism averaged 1.4, 0.9, and 1.0 diopters when measured by refraction, keratometry, and topography, respectively. The preliminary choice of sutures to be removed on the basis of refraction, keratometry, and inspection was changed in 20 of the 29 cases when information added by the topographic map was considered. Although many variables of suture removal remain unpredictable, computer-assisted corneal topography is a powerful means of describing corneal power after penetrating keratoplasty and is useful as a guide in selective suture removal for reduction of astigmatism.     

The effect of suture removal on postkeratoplasty astigmatism

I followed up for a minimum of six months 439 eyes that had undergone corneal transplantation using a suturing technique consisting of eight interrupted 10-0 and a single, continuous, 16-bite 11-0 nylon suture. All sutures were removed from 188 eyes an average of 20 months after surgery. After suture removal, 64 corneas had an increase of astigmatism greater than 0.5 diopter, 79 eyes showed a decrease in astigmatism greater than 0.5 diopter, and 42 corneas had no change in astigmatism. The mean astigmatism before suture removal was 3.7 diopters, and the mean astigmatism after suture removal was 3.5 diopters. There was no apparent difference in postkeratoplasty astigmatism with donor corneal diameters 0.25 to 0.75 mm greater in diameter than the recipient diameters, or with different host diseases. The longer the sutures were left in place after surgery, the smaller the quantitative change in astigmatism after suture removal. The complications of this technique were no different from other currently used suture techniques.     

Change in refraction and topography after penetrating keratoplasty suture removal

PURPOSE: To study the refractive and topographic modifications induced by penetrating keratoplasty suture removal. METHODS: We prospectively studied 80 corneas from 80 patients who had undergone penetrating keratoplasty. All of the eyes were examined before and after all sutures were removed, respectively at 10.9 5.1 months and 21.5 9.6 months after keratoplasty. Subjective refraction, best spectacle-corrected visual acuity (LogMAR units), keratometry, and corneal topography using the EyeSys 2000((R)) device (axial tangential and refractive power) were recorded. Topographies were classified according to the pattern (Bogan classification) and the asphericity shape (prolate and oblate). RESULTS: Best spectacle-corrected visual acuity (Log MAR units) increased significantly after suture removal (1.1 1.9 lines, plt; 0.001). Suture removal decreased the subjective cylinder (5.01 D 2.06 with suture, 4.11 2.08 without suture; p=0.009). The change in subjective cylinder correlated with the change in topographic pattern(s)=0.67 p<0.001). Conversely to the "bow tie" patterns, the other topographic patterns were more frequent after suture removal. The change in visual acuity was essentially explained by the change in subjective cylinder(s)=0.40 p=0.002). The average central corneal power decreased significantly after suture removal by 0.83 to 1.81 D (p<0.001), whereas the subjective spherical equivalent increased (hyperopization) (-4.07D 3.73 with suture, -3.48 3.40 without suture; p=0.02). The change in central corneal power significantly correlated with the change in subjective spherical equivalent (r(s)()>0.30 plt; 0.001). The corneal power of the mid-periphery did not significantly change after suture removal. Suture removal significantly modified the asphericity shape distribution. (majority of prolate shape with suture, majority of oblate shape without suture, p<0.001). CONCLUSION: Keratoplasty sutures induce a central bulge in the corneal graft. Suture removal induces a decrease in the subjective cylinder and it increases the subjective spherical equivalent (hyperopization) through a decrease in the central corneal power. Suture removal modifies the corneal topographic pattern and shape. Visual acuity improvement after suture removal is mainly explained by the decrease in subjective astigmatism.     

硅油取出术后视力丧失原因分析

目的 探讨硅油取出术后患者视力丧失的原因。 方法 对行硅油取出术后最终视力丧失的15例患者的15只眼临床及随访资料进行分析,随访时间4～20个月。 结果 15只眼中,视网膜再脱离11只眼,其中5只眼由于各种原因不再手术而失明;6只眼为再次手术失败,视网膜再脱离而失明。因继发性青光眼和角膜混浊而丧失视力者各2只眼。 结论 取出硅油后最终丧失视力的原因最常见为视网膜再脱离,其次为继发性青光眼及角膜混浊。 (中华眼底病杂志, 1999, 15: 230-231)     

DR硅油填充后并发白内障行超声乳化联合硅油取出

目的：探讨糖尿病视网膜病变硅油填充后并发白内障的超声乳化及人工晶状体（IOL）植入联合硅油取出术的临床疗效。 方法：糖尿病视网膜病变患者22例22眼硅油填充后并发白内障行超声乳化及IOL植入联合硅油取出术,均通过角膜透明切口植入软性IOL。 结果：患者19眼视力均在白内障超声乳化手术后视力较术前提高,其中0.1以上者13例,3例同术前视力;手术中后囊膜保持完整,均顺利植入软性可折叠IOL;5例术后不同程度发生角膜水肿,均在术后3~7d内消退。22例硅油均顺利取出。3例术后1mo内发现玻璃体腔积血,其中2例约4wk内玻璃体腔积血自行吸收,1例再行玻璃体手术去除积血联合眼内光凝。22例术后均未发现视网膜再脱离。 结论：糖尿病视网膜病变硅油填充眼并发性白内障的超声乳化IOL植入术联合硅油取出手术效果满意,可减少患者多次手术的痛苦。     

小切口改良翼状胬肉手术的优势

目的：研究小切口改良翼状胬肉手术较传统手术方式的优势。

方法：将40例原发翼状胬肉病例按手术方式分为2组(每组20例)：第一组为小切口组,手术先在翼状胬肉体部切一小口,经其分离结膜与结膜下的变性筋膜组织; 而第二组则先用刀片将翼状胬肉头部从角膜分离,然后再分离结膜与结膜下的变性筋膜组织。第一组分离翼状胬肉头部时采用类似角膜瓣成型的方法,用镊子钝性分离而不是用刀片。分别观察两组的手术时间、疼痛程度和创面愈合,进行比较。

结果：第一组平均手术时间较第二组缩短了7.72min(48.9%,P<0.001)。手术后1,2d第一组的疼痛程度和创面愈合均好于第二组(P<0.001)。另外,第一组的手术可由一名医生完成,而第二组则由两名医生完成。

结论：小切口翼状胬肉手术较传统手术方式更容易操作,效果更好。