泪道置管联合外路泪囊鼻腔吻合术治疗慢性泪囊炎合并上泪道狭窄

目的:探讨泪道置管联合外路泪囊鼻腔吻合术治疗慢性泪囊炎合并上泪道狭窄的临床疗效。方法:回顾性分析33例33眼慢性泪囊炎合并上泪道狭窄的患者资料,所有患者在进行外路泪囊鼻腔吻合术同时于上泪道留置硅胶泪道引流管,泪管留置时间为6mo。患者于术后1wk;1,3,6,9mo复查,观察术眼泪道通畅、溢泪、溢脓等情况。结果:术后1wk~6mo复查,冲洗泪道通畅率100%,均无溢泪;术后6mo取出泪道置管,取管后3mo复查,32例(97%)冲洗泪道通畅,无溢泪;1例(3%)冲洗阻力大,溢泪症状减轻。2例(6%)泪小点轻度撕裂,无其他并发症。结论:泪道置管联合外路泪囊鼻腔吻合术能够有效治疗慢性泪囊炎合并上泪道狭窄。     

改良鼻内窥镜下泪囊鼻腔造口术

目的 探讨改良鼻内窥镜下泪囊鼻腔造口术治疗慢性泪囊炎的临床效果。方法 采用泪囊鼻腔造口C形置管术治疗慢性泪囊炎42例(42眼)。对伴上泪道阻塞者用自制的头端略呈锥形泪道探针，按泪道探通方向突破阻塞部位11眼。结果 42眼术后全部治愈，拔管后溢泪、溢脓症状消失，泪道冲洗通畅。结论 改良鼻内窥镜下泪囊鼻腔造口术能较好地解决伴上泪道阻塞的慢性泪囊炎；C形置管使手术效果更为可靠。     

泪囊鼻腔吻合术联合泪道置管治疗慢性泪囊炎合并泪道狭窄

目的：探讨泪囊鼻腔吻合术联合泪道置管在慢性泪囊炎合并泪道狭窄病例的临床疗效。方法：对41例41眼慢性泪囊炎合并泪道狭窄的患者,在施行外路泪囊鼻腔手术中同时行泪道探通,留置新型泪道引流管3～6mo,在取管后3mo随访,观察术眼流泪、溢脓及泪道通畅情况。结果：术后3～6mo取管,冲洗泪道通畅率100%;取管后3mo复查,38例（93%,38/41）冲洗泪道通畅。冲洗不通3例（7%,3/41）。除8例（20%）下泪小点有轻微撕裂伤外,无其他并发症。结论：泪囊鼻腔吻合术联合泪道置管治疗慢性泪囊炎合并泪道狭窄,效果明显,所需手术设备简单、直视下操作、手术难度小,是一种适合基层医院使用的较好方法。     

泪道逆行置管失败后行鼻腔泪囊吻合联合义管置入术疗效观察

目的 观察鼻腔泪囊吻合术联合泪道义管置入,治疗慢性泪囊炎经泪道逆行置管失败后的效果.方法 21例(27只眼)慢性泪囊炎经泪道逆行置管失败后,施行改良式泪囊鼻腔吻合术联合泪道义管置入,即经改良式鼻腔泪囊吻合术中,利用含记忆合金丝的泪道探通导引针行义管U形置入.结果 术后随访半年以上,治愈25只眼(92.59%),好转1只眼(3.70%),无效1只眼(3.70%).结论 改良鼻腔泪囊吻合术联合泪道义管置入术具有操作简便,成功率高,是治疗慢性泪囊炎经逆行泪道置管失败后有效的方法.     

改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿

目的:探讨改良的外路泪囊鼻腔吻合术式联合泪道置管治疗泪囊黏液囊肿的临床疗效.方法:对23例(23眼)泪囊黏液囊肿行改良式泪囊鼻腔吻合术,并联合泪道置管,术后行泪道冲洗,并观察泪溢情况.结果:23例患者,1例术中改为泪囊摘除术,20例完成12个月的追踪观察治疗,1例术后6个月失访,1例12个月时失访.随访1个月,22例患者术后泪囊囊肿均消失,外观明显改善;随访12个月,20例患者中18例溢泪症状完全消失,所有患者泪道冲洗通畅,仅1例患者因泪溢症状对手术疗效不满意.结论:改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿,具有良好的临床效果,值得推广.     

泪囊鼻腔吻合术联合泪道置管在慢性泪囊炎合并泪管阻塞中的应用

目的:探讨泪囊鼻腔吻合术联合硬膜外麻醉导管泪道置管治疗慢性泪囊炎合并泪管阻塞的临床疗效。方法:采用泪囊鼻腔吻合术联合硬膜外麻醉导管经下泪小点、下泪小管、泪总管及吻合口、中鼻道的泪道置管方法治疗慢性泪囊炎合并泪管阻塞54例54眼。结果:拔管后行泪道冲洗全部通畅,总有效率100%,1a后总有效率96%。结论:泪囊鼻腔吻合术联合泪道置管治疗慢性泪囊炎合并泪管阻塞,手术操作简便,手术成功率高,容易掌握和推广。     

小泪囊慢性泪囊炎泪囊鼻腔吻合术疗效观察

目的观察泪囊鼻腔吻合术对小泪囊慢性泪囊炎的治疗效果。方法对术前经泪道冲洗和造影检查证实泪囊体积小的慢性泪囊炎患者47例53眼施行泪囊鼻腔吻合手术,观察术后疗效。结果47例53眼术后泪道畅通,治愈率100%。结论泪囊鼻腔吻合术是治疗小泪囊慢性泪囊炎的理想术式,小泪囊是泪囊鼻腔吻合术的适应症。     

改良外路泪囊鼻腔吻合术94例的临床疗效观察

目的：观察改良外路泪囊鼻腔吻合术疗效。 方法：回顾性分析我院2010-10/2013-12单侧慢性泪囊炎患者94例,行外路泪囊鼻腔吻合术,手术方法在传统术式上进行以下改良：（1）麻醉后填塞鼻腔,减轻疼痛和出血;（2）手术中不切断内眦韧带;（3）只缝合鼻黏膜上瓣;（4）置管;（5）皮肤分层美容缝合。术后随访3mo ~2a,观察疗效。 结果：患者94例94眼,术后93例93眼溢泪、溢脓症状完全消失,泪道冲洗通畅,有效率99%;无效1例1眼（1%）溢泪,泪道冲洗不通畅。 结论：改良外路泪囊鼻腔吻合术操作简单、治愈率高、远期疗效确切,是治疗慢性泪囊炎的有效手术方法。     

高频泪道浚通术联合泪道置管治疗泪囊鼻腔吻合术后早期复发

目的 观察高频泪道浚通术联合泪道置管治疗泪囊鼻腔吻合术后早期复发的疗效.方法 对21例泪囊鼻腔吻合术后6个月以内复发者行高频泪道浚通术联合泪道置管术,术后随访6～12月.结果 14例溢泪消失,占66.7％;5例流泪减轻,泪道冲洗基本通畅,占23.8％;2例无改善,占9.5％.结论 高频泪道浚通术联合泪道置管治疗泪囊鼻腔吻合术后早期复发,手术创伤小,成功率高,取得了良好的疗效,是治疗泪囊鼻腔吻合术后早期复发的一种有效的方法.     

鼻内镜下经鼻泪囊鼻腔吻合术治疗复发性泪囊炎的临床效果

目的评价鼻内镜下经鼻泪囊鼻腔吻合术治疗复发性泪囊炎的临床效果。方法回顾性病例系列研究。选取徐州医科大学附属徐州市立医院2018年1月至2022年6月住院行鼻内镜下经鼻泪囊鼻腔吻合术治疗的复发性泪囊炎31例(31眼)的临床资料, 其中泪道置管术后管留置复发者9例, 外路泪囊鼻腔吻合术后复发者12例, 鼻内镜下泪囊鼻腔吻合术后复发者10例。术后随访3个月至1年, 分析患者复发原因, 观察吻合口是否开放、泪道冲洗结果及术后症状改善情况。结果泪道置管术后复发者复发原因为泪囊黏膜增生肥厚导致泪囊腔变小, 影响泪液引流;泪囊鼻腔吻合术后复发者复发原因有:骨窗制作不适19例(86.36%)、吻合口与鼻腔粘连者4例(18.18%)、泪囊黏膜误与鼻窦黏膜吻合者1例(4.54%)。31例均行经鼻内镜下泪囊鼻腔吻合术, 29例吻合口开放, 冲洗泪道通畅, 溢泪、溢脓症状消失, 均治愈, 2例有轻微溢泪, 吻合口开放, 泪道冲洗通畅, 溢脓症状消失, 均好转, 治愈率93.55%, 有效率100.00%。结论鼻内镜下泪囊鼻腔吻合术治疗复发性泪囊炎损伤小, 疗效确切, 手术成功率高。     

滤过试验结合可拆缝线在小梁切除术中的应用

目的　探讨小梁切除术术中做滤过试验结合可拆缝线的应用对预测和控制术后滤过量及预防浅前房的疗效。方法　对 92例 ( 113眼 )原发性青光眼 ,在小梁切除术术中根据滤过试验结果来决定固定缝线和可拆缝线缝合的位置和数量。术后 1～ 7天 ,抽出可拆缝线。回顾性总结术中缝合种类、数量及术后前房深度、眼压、滤过泡、视野。结果　术中 40眼 ( 3 5 40 % )采用一针固定缝线和一至二针可拆缝线 ,5 1眼 ( 45 14 % )采用二针固定缝线和一至二针可拆缝线。术后无一例持续性浅前房。术后第 7天眼压平均 13 5± 3 3 0mmHg。追踪观察 6～ 2 4个月 ,形成功能性滤过泡 89眼( 78 76% ) ,眼压控制 <2 1mmHg 91眼 ( 80 5 3 % ) ,视野不变 98眼 ( 86 73 % )。结论　小梁切除术术中根据滤过试验的结果 ,通过对固定缝线和可拆缝线缝合的位置和数量的选择能有效预测和控制术后滤过量并预防术后浅前房     

超声乳化联合前房角分离治疗伴白内障的青光眼

目的：：观察晶状体超声乳化联合前房角分离术对伴有白内障的慢性闭角型青光眼患者的治疗效果。方法：无并发症伴有白内障的慢性闭角型青光眼50例50眼,施行晶状体超声乳化吸出人工晶状体植入联合前房角分离术。术后随访3mo,记录并比较术前及术后最佳矫正视力、眼压、前房深度及前房角。各指标均采用均数±标准差(x±s)表示,术前及术后3mo的最佳矫正视力、眼压、前房深度及前房角的情况进行比较。结果：术后3 mo的最佳矫正视力较术前明显提高,差异有统计学意义( t=8.76, P=0.001);术后3 mo 的眼压为15.63±3.11mmHg,较术前(45.12±5.30mmHg)明显下降,差异有统计学意义(t=6.27,P=0.000);术后3mo的前房深度为3.57±0.02mm,较术前(1.43±0.25mm)明显加深,差异有统计学意义(t=8.16,P=0.001);术前、术后前房角情况的比较,差异有统计学意义(Z=-4.432,P=0.000;Z=-2.432,P=0.016;Z=-4.379,P=0.000;Z=-4.538, P=0.000)。结论：晶状体超声乳化吸出人工晶状体植入联合前房角分离术治疗伴有白内障的慢性闭角型青光眼,能够有效控制眼压,提高视力,是一种安全、有效的手术方法。     

环喷托酯在屈光参差儿童散瞳验光中的应用

目的比较分析1%盐酸环喷托酯与1%阿托品对3~12岁屈光参差儿童散瞳验光效果。设计回顾性病例系列。研究对象2010年10月~2011年2月在北京同仁医院眼科斜弱视门诊就诊的3~12岁屈光参差儿童40例(80眼)。方法对以上40例患儿按年龄分成3组,即3~6岁组,7~9岁组和10~12岁组。全部患儿均首先用1%盐酸环喷托酯进行散瞳验光,待其瞳孔完全恢复正常(1周后)再行1%阿托品散瞳验光,比较两种方法的验光结果。主要指标屈光值(球镜度数、柱镜度数及轴向)。结果用1%盐酸环喷托酯散瞳验光结果(球镜:+1.18 D±4.90 D,柱镜:+1.47 D±1.16 D,散光轴向:80.50°±38.62°)与用1%阿托品散瞳验光结果(球镜:+1.20 D±4.91 D,柱镜:+1.47 D±1.15 D,散光轴向:80.06°±38.48°)比较,差异均无统计学意义(P均>0.05)。在80眼中,球镜值相同或相差≤0.50 D者77眼,符合率为96.25%;柱镜值在69眼中,结果相同或相差≤0.50 D者65眼,符合率为94.20%;散光轴向在69眼中,结果相同或相差≤5°者67眼,符合率为97.10%。三个年龄组间的球镜、柱镜和散光轴向符合率差异均无统计学意义(P均>0.05)。结论 1%盐酸环喷托酯可以替代1%阿托品用于3~12岁屈光参差儿童散瞳验光,其结果可以作为配镜的依据。     

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.     

Epikeratoplasty with nonlyophilized tissue in children with aphakia

We studied 75 epikeratoplasty procedures using nonlyophilized tissue performed by eight ophthalmic surgeons in 70 eyes (47 patients) to correct for aphakia in children less than 8 years of age (mean age, 3.4 +/- 2.1 years). Of the 47 patients in the study, 24 were girls and 23 were boys; 23 patients had bilateral surgery. Seven of the epigrafts required removal; two were not replaced, and five underwent successful repeat epikeratoplasty. Overall, the success rate (that is, the percentage of epigrafts that remained optically and functionally clear throughout the course of this study) for the epikeratoplasty procedure was 89% (62 of 70 eyes) for initial surgery and 96% (67 of 70 eyes) for repeat surgery. The average spherical equivalent was +14.4 +/- 3.7 diopters preoperatively and +0.3 +/- 2.9 diopters one year after the operation. One year after the final surgical procedure, 42 of 56 eyes (75%) were within 3 diopters of emmetropia. In the 29 verbal patients, best-corrected visual acuity was 20/100 or better in 25 (86.2%) one year after the operation.     

雷珠单抗联合玻璃体切割术治疗DR合并新生血管性青光眼

目的：探究雷珠单抗联合玻璃体切割术治疗DR合并新生血管性青光眼(NVG)的临床效果。

方法：选取2016-01/2018-02我院眼科收治的DR合并NVG患者198例,根据治疗方案不同分为观察组(103例)和对照组(95例),观察组采用术前注射雷珠单抗联合玻璃体切割术治疗,对照组单纯采用玻璃体切割术治疗,玻璃体切割术后10～15d Ⅱ期实施Ahmed房水引流阀植入。观察两组治疗后眼压、BCVA、VEGF等指标变化情况。

结果：观察组的玻璃体切割术的手术时间、新生血管出血次数、电凝次数均低于对照组(P<0.001)。观察组在玻璃体切割术后1wk和Ⅱ期Ahmed房水引流阀植入术后1mo BCVA、眼压均低于对照组(P<0.001)。观察组Ⅱ期Ahmed房水引流阀植入术前VEGF和术后1mo视网膜黄斑中心凹厚度均低于对照组(P<0.001)。观察组总并发发生率低于对照组(10.7% vs 28.4%,P<0.05)。

结论：雷珠单抗联合玻璃体切割术治疗DR合并NVG的疗效显著,且使Ⅱ期Ahmed房水引流阀植入手术难度下降,对患者视力、眼压水平恢复较好。     

合并成型性渗出的急性前葡萄膜炎与HLA-B27的相关性研究

目的 探讨急性渗出性前葡萄膜炎与HLA-B27的相关性。方法 对53例前房内出现成型性渗出的急性前葡萄膜炎（AAUPE）患者及61例前房内无成型性渗出的急性前葡萄膜炎（AAU）患者进行HLA-B27的检测,并结合临床表现加以分析。结果 成型性渗出的AAUPE患者的HLA-B27阳性率为100％,而无成型性渗出的AAU患者的HLA-B27阳性率仅为50.8％。二者有显著差异性（P<0.01）。两组HLA-B27阳性的病人强直性脊柱炎发生率分别为50.0％和42.9％。结论 结果进一步证实了HLA-B27与成型性渗出密切相关的论点。提示检测AAU患者HLA-B27的阳性率,发现成型性渗出裂隙灯检查似与血清法检测同样准确。     

Levodopa-carbidopa with occlusion in older children with amblyopia

PURPOSE: To study the role of levodopa-carbidopa in supplementing occlusion therapy in older children with strabismic or anisometropic amblyopia. Methods: A clinical study was performed on 40 amblyopic children (19 strabismic and 21 anisometropic), 6 to 18 years old (mean age, 10.9 years). They received an average dose of 1.86 mg/kg/day (1.33-2.36 mg/kg/day) of levodopa and carbidopa (4:1 ratio) or a placebo in 3 divided doses over a 4-week period, combined with full-time occlusion. The occlusion was continued for the study duration of 3 months. Early Treatment Diabetic Retinopathy Study visual acuity charts and Cambridge low-contrast gratings for contrast sensitivity (CS) were used to assess visual functions. Tolerance and compliance with occlusion and capsule consumption were assessed. RESULTS: Visual acuity of the nonamblyopic eye did not deteriorate during the study in either group. CS decreased by 22 units in the levodopa group and increased in the placebo group by 53 units at the first month. The CS in the levodopa group recovered later by the third month of follow-up. Both the levodopa and the placebo groups showed significant improvement in visual function in the amblyopic eye (P <.001). Overall changes in logarithm of minimum angle of resolution values and CS in the amblyopic eyes were similar in both groups (P >.05). Strabismic and anisometropic amblyopes did not behave differently. Drug tolerance, occlusion compliance, and capsule ingestion compliance were similar between the groups, with no significant side effects. CONCLUSIONS: Clinically, levodopa supplementation does not offer any advantage over occlusion alone. Moreover, the risk of occlusion amblyopia could increase with the use of drugs like levodopa that might affect the plasticity of the visual cortex.