氯丙嗪球后注射联合角膜层间灼烙治疗绝对期青光眼

目的:探讨氯丙嗪球后注射联合角膜层间灼烙治疗绝对期青光眼的临床效果,以解除绝对期青光眼疼痛问题。方法:对29例(30眼)绝对期青光眼采用球后注射氯丙嗪,对伴发大泡性角膜病变者加用角膜层间灼烙术。结果:29例中14例仅采用球后注射氯丙嗪一种方法就达到止疼目的,15例(16眼)伴发大泡性角膜病变者,因球后注射未完全解除疼痛而加用角膜层间灼烙术后疼痛消失。结论:球后注射氯丙嗪治疗绝对期青光眼引起的疼痛是简单有效的方法,对合并大泡性角膜病变者,于第1次注射氯丙嗪后即需加用角膜层间灼烙术。     

角膜层间分离灼烙术治疗大泡性角膜病变

目的探讨施行角膜层间分离灼烙术治疗大泡性角膜病变的临床效果.方法对14例大泡性角膜病变患者施行8～9mm深达1/2角膜的层间分离及灼烙.结果所治病例角膜愈合良好,无不良反应,眼痛、异物感症状消失,视力有不同程度改善,随访6～24个月,临床疗效稳定.结论角膜层间分离灼烙术为不具备穿透性角膜移植的大泡性角膜病变提供了一种简便、安全、不需特殊材料、较为理想的手术方法.     

大泡性角膜病变18例手术治疗效果回顾性分析

目的:评价羊膜移植几种手术方法治疗大泡性角膜病变的临床效果。方法:对18例大泡性角膜病变患者,分别采取角膜层间烧烙术、新鲜羊膜移植术、角膜灼烙联合羊膜嵌入移植手术。结果:18例大泡性角膜病变患者,术后1～5d疼痛消失,7～12d角膜上皮修复,7～21d后羊膜植片常规溶解。角膜层间烧烙术1眼、新鲜羊膜移植术3眼术后1～2mo再次出现角膜大泡及角膜刺激症状而再次手术。角膜灼烙联合羊膜嵌入移植术,术后当天疼痛消失,14d角膜上皮光滑,角膜大泡消失。随访6～18mo无1例复发,部分患者视力有不同程度的提高。结论:角膜灼烙联合羊膜嵌入移植对大泡性角膜病变具有明显的治疗效果。     

维生素C结膜下注射治疗丝状角膜病变

目的 探讨维生素C治疗丝状角膜病变的疗效。方法 31例（33眼丝状角膜病变,予结膜下注射维生素C0.5ml(125mg）／次,隔日1次,分析其疗效。结果 治疗3－12日后合部治愈。结论 丝状角膜病变与角膜上皮基底膜胶原组织变性有关,而维生素C对胶原纤维的生成有一定作用。可促进病变角膜的愈合而治疗丝状角膜病变。     

PRK及LASIK术后丝状角膜病变的观察

丝状角膜病变(filamentary koratopathy)又称丝状角膜炎，是角膜上皮病变的一种。准分子激光角膜屈光术是当前矫治近视的有效方法，近年来在国内已广泛开展，许多屈光不正患者接受了这种激光治疗。我院眼科对1256例近视患者施行了准分子激光角膜切削术(PRK)及准分子激光角膜原位磨镶术(LASIK)。术后有69例发生丝状角膜病变，我们采用润舒滴眼液滴眼治疗，取得了良好的治疗效果。现报告如下：     

角膜浅层基质穿刺术治疗丝状角膜病变

丝状角膜病变(FilamentaryKoratopathy)是临床上常见的角膜上皮病变。患者常伴有异物感、流泪、畏光、眼睑痉挛以及瞬目反射增多等症状。本病容易复发,传统的治疗方法如局部擦除、加压绷带包扎、配戴软角膜接触镜及局部滴乙酰半胱氨酸等,效果均不理想。我们于1993年以来采用角膜浅层基质穿刺术(anteriorsteromalpuncture,ASP)治疗丝状角膜病变效果满意,报告如下。资料与方法1.对象:本文40例(47眼),其中男性22例,女性18例。年龄29～72岁。40例中原发性(原因不明)丝状角膜病变7例7眼,伴内眼手术后持续纱布绷带包扎15例16眼,伴干眼症13例16眼…     

角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变

目的：：观察角膜层间灼烙联合羊膜移植治疗疼痛性大泡性角膜病变的手术疗效。方法：选取疼痛性大泡性角膜病( PBK )患者156例156眼(均为单眼),行角膜层间灼烙联合羊膜移植术,术后随访2~3mo,观察患者术眼疼痛症状、角膜上皮水泡、异物感、术后并发症等指标。结果：疼痛症状全部消失,角膜上皮不再出现水泡130例(83.3%);患者剧烈眼疼消失,但偶有异物感等不适,角膜上皮偶有小水泡24例(15.4%);术后2wk内角膜基质发生溶解,再行结膜瓣覆盖后治愈2例(1.3%)。结论：角膜层间灼烙联合羊膜移植术能解除98.7%的PBK患者的痛苦且手术操作简单,值得提倡。     

丝状角膜炎角膜丝状物构成分析

背景丝状角膜炎患者临床症状较重，易复发，病因复杂，治疗十分棘手。目前，其发病机制仍不明确，对丝状物构成方面的研究较少，结果不一。目的应用影像学检查结合组织病理学方法检测丝状角膜炎患者丝状物的组成结构，分析角膜丝状物的形成机制。方法收集山东省眼科医院2008年1月至2011年1月收治的丝状角膜炎患者82例88眼，详细记录患者的病史等临床资料，并根据病因进行分类。采用高清光学相干断层扫描（HD-OCT）检查角膜丝状物附着处的角膜结构，激光扫描共焦显微镜（LSCM）检查角膜丝状物的组成结构，然后取丝状物铺片行Giemsa染色及Masson三色染色，分析丝状物的成分。结果穿透角膜移植术后发生丝状角膜炎者40例；白内障手术、准分子激光角膜切削术（PRK）等术后发生者18例；眼部功能失调，如干眼、神经营养不良性角膜病者14例；急性结膜炎患者10例。HD—OCT显示丝状物病变可累及前弹力层。LSCM检查显示，丝状物由上皮细胞、炎性细胞、黏液、高反光螺旋状条索形核心构成，核心中含有上皮细胞、炎性细胞及纤维状组织。Giemsa染色结果显示，角膜丝状物含有角膜上皮细胞、炎性细胞和黏液，丝状物中央有螺旋状深蓝染的条状核心，核心中含有炎性细胞、上皮细胞、纤维状细胞。Masson三色染色表明，条状核心呈红色纤维组织，周围黏液为蓝色。结论角膜炎丝状物的主要成分有条状核心、炎性细胞、上皮细胞和黏液，病变较深，可达前弹力层。     

爱丽滴眼液治疗角膜病的临床评价

干眼症、点状角膜炎、丝状角膜炎、角膜上皮剥脱等角膜上皮损伤的病例,常表现眼干、异物感及眼不适等各种症状,影响患者的视功能及生活质量.因此,改善患者的痛苦是治疗上述病变的主要目标.作者将爱丽应用于上述各种病变的患者,以评价其治疗效果.一、病例选择:在我院门诊就诊的患者20例,男5例、女15例.年龄17～79岁.其中干眼症 16例、干燥综合征2例、戴隐形眼镜后点状角膜炎1例、PRK术后干眼症1例.二、治疗方法:0.1%爱丽每天滴眼6次,每次1滴,连续用药2周后进行药物疗效评价.用药前、用药后1周和2周共观察3次,每次均检查并记录自觉症状、角膜上皮萤光素染色及泪膜破裂时间.     

药物源性角膜病变临床特征和治疗回顾分析

背景 近年来药物源性角膜病变患者日益增多.临床特征不典型,诊断困难,常与原发病混淆,容易误诊,病情迁延不愈,严重影响视力,总结药物源性角膜病变的临床特征及规范治疗方法是亟需解决的问题. 目的 探讨药物源性角膜病变临床特征及治疗转归.方法 采用回顾性系列病例观察分析方法.收集2008年5月至2012年10月就诊于山东省眼科医院的药物源性角膜病变患者31例36眼,详细记录其既往眼病史、用药史、用药持续时间及给药途径,检查患眼治疗前及治疗后2周和1个月的最佳矫正视力（BCVA）、基础泪液分泌试验Ⅰ（SⅠt）、泪膜破裂时间（BUT）;裂隙灯显微镜下观察患眼睑板腺情况、角膜病变的位置及角膜荧光素钠染色情况.治疗均首先停用原有药物,给予促进角膜修复药物及少量抗炎药物的方案,合并睑板腺功能障碍者行热敷及睑板腺按摩,S Ⅰ t＜5 mm/5 min和BUT＜5s者行泪小点栓塞治疗.采用SPSS 17.0统计学软件进行分析,对治疗前及治疗后1周患眼BCVA的差异行配对t检验;对手术前后3个时间点患眼的BUT和SⅠt结果的差异行重复测量单因素方差分析;对患眼角膜修复天数与SⅠt的关系行Pearson积矩直线相关分析. 结果 导致角膜病变的主要原因为不合理用药,其中抗病毒药物不合理应用者23例,抗生素药物16例,糖皮质激素药物10例,抗过敏药物1例,降眼压药物1例.不合理给药途径包括局部频繁点眼25例及连续球结膜下注射6例.患眼治疗后1个月的BCVA为0.69 ±0.28,明显优于治疗前的0.32±0.26,差异有统计学意义（t=11.02,P＜0.01）.药物源性角膜病变主要表现为角膜上皮弥漫性细点状粗糙,严重者合并角膜上皮缺损,甚至角膜溃疡,角膜伴有不同程度的水肿,局部出现后弹力层皱褶,部分可见角膜丝状物附着,病变区主要位于角膜中央及下方.药物源性角膜病变的治疗主要是停用原有药物,给予促进角膜修复的药物及抗炎治疗,同时治疗干眼症及睑板腺功能障碍等眼表问题.治疗周期为1～8周,角膜修复期间与SⅠt结果呈负相关（r=-0.835,P＜0.01）.结论 局部用药导致的角膜病变会影响角膜全层,临床医师应了解药物导致的眼部损害.药物源性角膜病变的早期诊断主要依靠病史及临床特征,采取综合的治疗措施是治疗的关键.     

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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Current Thoughts on the Aetiology of Ocular Changes during Contact Lens Wear

ABSTRACT: Contact lenses are known to produce changes to the ocular tissues, and this review attempts to give a comprehensive assemblage of the knowledge on the aetiology of such changes. To achieve this result, the changes are categorized by structure and function, and discussed according to the temporal nature of occurrence where appropriate. Although assessment of the importance of a particular tissue change is difficult, this overview enables some degree of judgement to be made on the aetiology of the major side-effects of contact lens wear. This gives a basis on which to modify aspects of contact lens wear to ultimately increase the success rate.     

The detection of motion in chromatic stimuli: first-order and second-order spatial structure

This study provides evidence for the existence of a low-level chromatic motion mechanism and further elucidates the conditions under which its operation becomes measurable in an experimental stimulus. Observers discriminated the direction of motion of amplitude modulated (AM) gratings that were defined by luminance or chromatic variation and masked with spatiotemporally broadband luminance or chromatic noise. The size and retinal location of the stimuli were varied and the effects of broadband noise and grating masks were both compared with the cohort of stimuli. Some significant disparities in the published literature were well explained by the results. In conclusion, evidence for a chromatically sensitive motion mechanism that evades the, detrimental effects of a luminance mask was found only at the fovea and only when the stimulus was small and centrally placed.     

Local chemotherapeutic agents for the treatment of ocular malignancies

We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive.