眼外肌睫状前血管的解剖

眼前节的血液供应主要来自睫状前动脉和睫状后长动脉两组血管。传统的斜视矫正手术中,在离断眼直肌时同时损伤睫状前动脉,影响了眼前节的正常血供。若能在手术中保留睫状前动脉大部分血供,将有效减少术后眼前节血供锐减造成的组织损伤。既往在多条直肌的离断手术     

视网膜中央动脉和睫状后动脉的应用解剖

目的：为视神经鞘减压术和视神经周围区手术提供视网膜中央动脉和睫状后动脉的解剖学资料。方法：采用显微解剖学技术对60例成人视网膜中央动脉和睫状后动脉进行观察。结果：（1）视网膜中央动脉多发自眼动脉角（21．7％）,内侧睫状后动脉（20．0％）,眼动脉第一段（19．3）。（2）视网膜中央动脉发起后在视神经下方弯曲前行,其起始部在眶内视神经后1／3段与眼外直肌之间者占85．0％。（3）入鞘点在视神经的正下方者68．3％,内下方者占21．7％,外下方者占10．0％。结论：视网膜中央动脉及睫状后动脉的起点、走行变化较大,视神经鞘减压术和视神经周围区手术时应保护好这些动脉,以免引起视神经等结构缺血。     

彩色多普勒对高度近视眼的微循环血液动力学研究

目的 :研究高度近视眼的微循环血液动力学变化。方法 :应用彩色多普勒对 3 8只高度近视眼和 40只正常眼的眼动脉、睫状后短动脉、视网膜中央动脉的收缩期最大流速、阻力指数结果进行对比分析。结果 :高度近视眼组和正常组的血流参数比较 ,睫状后短动脉和视网膜中央动脉的收缩期最大流速和阻力指数均低于正常组有显著差异 ( P<0 .0 1)。眼动脉血流参数无明显差异 ( P>0 .0 5 )。结论 :高度近视眼的睫状后短动脉、视网膜中央动脉的血流参数均明显降低 ,彩色多普勒有可能应用于眼的微循环的血液动力学的病理改变形成机制的研究。     

睫状前动脉的巨微解剖及其临床意义

对30只成人和6只新生儿眼球的睫状前动脉的数目、起点外径、长度、行径及侧支吻合进行观测.上、下、内睫状前动脉多为二支,各占76.7%;73.3%;83.3%.外睫状前动脉多为一支(76.6%).上、下、内、外睫状前动脉的长度分别为5.58土0.44mm;4.79士0.72mm;4.43土0. 76mm;8.00土1.07mm.起点外径分别为0.20mm;士0.04mm;0.I8士0.02mm;0.21土0.03mm.在巩膜表面和虹膜大环处睫状前动脉的侧支之间以及侧支与睫状后长动脉之间相互吻合,这些吻合在眼前节侧支循环方面起一定作用.文中对眼直肌手术时如何减少或避免睫状前动脉损伤等问题做了探讨.     

睫状神经营养因子促进大鼠坐骨神经运动轴突再生

睫状神经营养因子(Ciliary Neurotrophic Factor,CNTF)作为神经营养因子家族一员,在神经系统发育和神经损伤修复过程中具有重要作用.但在周围神经再生时,睫状神经营养因子的作用如何,尤其是其对运动轴突、感觉轴突的作用,目前未见研究报道.本实验采用160～200克雄性SD大鼠,一侧作手术侧,另一侧不手术作正常对照侧.睫状神经营养因子组6只,生理盐水组5只.暴露股后部坐骨神经,切除约2mm长的坐骨神经,用硅管(内径1mm,外径2mm)套接神经断端,断端间距约5mm.睫状神经营养因子组术时将重组人睫状神经营养因子(25μg)溶液注入硅管中.生理盐水组所给液体为生理盐水.术后分别皮下注射睫状神经营养因子(350μg/kg/天)和生理盐水.术后4周,多点注射30%辣根过氧化物酶于两侧腓总神经中.动物再存活48小时,灌注固定,取脊髓L_(3～6)节     

颜面部美容注射引发眼部并发症解剖分析

目的分析颜面部美容注射后引发视网膜中央动脉阻塞或眼动脉阻塞的颜面部血管吻合解剖学特点。方法回顾性分析2010年6月至2015年6月3例因额面部美容后出现视力急剧下降,经眼底检查、荧光素视网膜血管造影检查确诊为视网膜中央动脉阻塞的患者,分析注射部位血管分布及眶周血管吻合特点。结果 3例患眼均无光感并伴有眼痛或(及)眼球转动痛,视网膜血管造影均表现为完全性中央动脉阻塞;面部美容注射压在开始注射2 s后就大大超过眼动脉收缩压(P0.05);鼻背动脉与内眦动脉多有吻合,内眦动脉常与后睫状长动脉的鼻侧分支吻合。填充物进入上述血管后可经吻合动脉分支进入眼动脉,使得填充物阻塞与眼动脉、视网膜中央动脉、睫状后短动脉及其分支内。结论颜面部美容注射时,注射物可能会进入眶周围动脉,逆行流入眼动脉,造成眼动脉阻塞,或经眼动脉流入视网膜中央动脉、睫状动脉,从而造成严重的眼部并发症。     

眼直肌滑车结构与功能的研究进展

眼球外肌麻痹导致的斜视及A-V型斜视常采用眼直肌止点移位术来矫治。这种手术与眼直肌止点后退、徙前术相比,前者是改变眼直肌对眼球的施力方向。后者则主要改变眼直肌对眼球的施力大小。由于眼直肌止点移位术的矫治效果具有一定程度的不确定性,影响了其在临床的推广应用。近期的研究结果显示,止点移位后的眼直肌的走行路径并非直线,而呈现     

视网膜中央动脉对视神经血供关系的研究

采用碳素墨水动脉灌注和苯浸渍透明研究了３０例视网膜中央动脉的起点，经过和分支分布情况。视网膜中央动脉可发自眼动脉，亦可与内侧睫状后短动脉或与外侧睫状后短动脉共干发自眼动脉。按视网膜中央动脉的经过可分为眶内段、鞘内段和神经内段。观察了各段的分支及其与其它动脉分支之间的吻合情况。讨论了视网膜中央动脉对视神经血供关系的生理意义，为眼科临床提供了形态学基础。     

猫的翼腭节和眼之间的神经通路

<正> 作者通过解剖硫胆碱染色的眶标本,确定了3条连结猫的翼腭节和眼之间的不同的神经通络。1)从近侧半来的神经参予神经丛和在上颔动脉的奇异网的节细胞。颈内动脉神经的分支亦供应此丛。由丛发出的微小神经通到视神经,再到眼与通过网的鼻睫神经和从网发出的睫状动     

Orbscan Ⅱ眼前节分析系统和Pentacam眼前节分析系统测量屈光手术前后角膜屈光力的差异

背景：OrbscanⅡ眼前节分析系统和Pentacam眼前节分析系统均能对角膜前后表面屈光力进行测量,但两者结果的一致性、精确性尚无定论。 目的：利用2种不同眼前节分析系统对屈光手术前后的角膜前后表面屈光力进行测量,分析2种仪器的可靠性,及角膜屈光手术对角膜后表面形态的影响。 方法：纳入2010-02/04在广东省人民医院屈光手术中心连续就诊的近视患者69例患者(136眼),行准分子激光原位角膜磨镶33例65眼和准分子激光上皮下角膜磨镶36例71眼,比较Orbscan Ⅱ眼前节分析系统和Pentacam眼前节分析系统检测不同手术方法的角膜前后表面3 mm平均轴向屈光力和的测量值。 结果与结论：屈光手术前后,2种仪器前后表面屈光力测量值的差异有显著性意义。后表面屈光力的OrbscanⅡ眼前节分析系统测量值在术后均变小,而Pentacam眼前节分析系统测量值无显著改变。OrbscanⅡ眼前节分析系统测量的后表面屈光力变化值与残余基质层厚度存在线性相关。提示2种仪器的测量结果不能相互替代使用。后表面屈光力,在屈光手术前Pentacam眼前节分析系统测量值较小,但在屈光手术后则相反,Pentacam眼前节分析系统并未发现OrbscanⅡ眼前节分析系统测量出的术后后表面前突。     

眼外肌手术135例的临床疗效观察

目的：探讨眼外肌手术量的设计。方法：收集本科室2003年3月-2009年3月进行眼外肌的手术病员,分析其手术并总结手术量的设计。结果：内直肌截除或后徙1mm约矫正1．5°斜视角,外直肌后徙或截除1mm约矫正1°斜视角,截除并后徙1mm约矫正3°斜视角,下直肌后徙在第一眼位为每毫米1．5°,向下注视眼位为每毫米2．5°,垂直肌后徙或缩短1mm最多矫正1．5°,一般后徙量不超过6mm,直肌截除量,内直肌7-8mm,外直肌10mm,上下直肌各6mm。结论：从临床经验中总结眼外肌手术量的设计,为今后的眼外肌手术提供参考,但眼外肌手术不能一概公式化,具体还应结合患者的实际情况和要求来设计。     

Pulley与经典眼外肌相关结缔组织解剖结构关系的研究

目的　观察Pulley与经典眼外肌相关结缔组织解剖结构的关系 ,为临床眼外肌手术寻找定位眼外肌Pulley的解剖标志。方法　采用保留骨性眶缘的整体眶壁磨除法观察 6例 12侧人眼眶眼外肌Pulley的位置及与经典眼外肌相关结缔组织解剖结构关系。结果　直肌表面可见增厚的纤维环 (Pulley) ,Pulley位于Tenon s囊后部 ,4条直肌穿过Tenon s囊处 ;节制韧带将Pulley隔附着到骨性眶缘 ;直肌Pulley表面可见眼外肌眶层形成的白色止点线。结论　Pulley表面眼外肌眶层的白色止点线可作为临床定位Pulley的解剖标志。     

Registered eye position: short- and long-term effects of botulinum toxin injected into eye muscle

Botulinum toxin is sometimes injected into human eye muscles as an alternative to surgery in the correction of strabismus. Within minutes of botulinum injections into ungulate eye muscles, proprioceptive discharge from muscle spindles decreases dramatically. It is only over 7–48 h, however, that surgically treated strabismus patients usually show an altered proprioceptive signal about eye position, presumably from the palisade endings attached to the global multiply innervated fibers. How quickly will botulinum toxin alter proprioceptive registration of eye position in humans? First, to examine the short-term effects, we measured open-loop pointing responses (which requires knowledge of eye position) in six strabismus patients preinjection and then over a 45 min postinjection period, and in six normal controls over the same time period. Second, to examine the long-term effects, 13 strabismus patients were tested preinjection and then daily over the next 3 weeks, and three normal controls over the same time period. We compared their open-loop pointing responses with the injected eye fixating the target to the photographically determined position of the occluded other eye (a measure of where the patient would point if eye position were determined by efference, not proprioception). There were three groups of patients: esotropes with no previous injection, exotropes with no previous injection, and exotropes with previous injection. First, all patients showed significant correction of their tropias. Second, over the short-term, there was no difference in pointing responses found between the patients and the controls (t(18) = –1.427, P = 0.1706). Third, over the long-term, however, the difference between the pointing responses and eye position information was compared among the four groups across four posttests and a significant difference found (F _3,12 = 58.988, P < 0.00001). Only in patients with no previous injections was there altered proprioceptive feedback about eye position. Also, injections into the medial rectus induced a significantly greater proprioceptive response than those injected into the lateral rectus. In humans, botulinum toxin alters proprioception from eye muscles only over the long-term. We suggest that the toxin temporarily affects proprioceptive feedback from palisade endings.     

Transient increase of higher-order aberrations after lateral rectus recession in children

The changes of higher-order aberrations (HOAs) after bilateral lateral rectus muscle recession were evaluated. Forty eyes of 20 children were enrolled and their wavefront information was assessed until postoperative 3 months. Even though the root mean square (RMS) of total aberration was not changed, the RMS of HOA was transiently increased at postoperative 1 week and returned to baseline level after 1 month. Among individual Zernike coefficient, secondary astigmatism, quadrafoil, secondary coma, secondary trefoil, and pentafoil showed similar tendency with the RMS of HOA. However, coma, trefoil, and spherical aberration were not changed. Regarding recession amount, it did not correlate with any Zernike coefficient. In summary, our data imply that the HOAs are transiently increased after lateral rectus recession surgery. These results are in collusion with previous reports that strabismus surgery induced transient corneal astigmatism.     

Immediate and long-term effects on visual acuity of surgically induced strabismus in kittens

Summary In order to isolate some of the factors responsible for strabismic amblyopia as well as to ascertain the time course of its development, frequent measurements were made of the visual acuity of the two eyes of kittens following imposition of surgically induced strabismus. Following behavioural training on a jumping stand, strabismus was induced in all but one animal by simple section of either the lateral (esotropia) or medial (exotropia) rectus muscle of one eye. The one exception was a kitten on which esotropia was induced by another common but more radical surgical procedure that involved removal of the body of both the lateral rectus and superior oblique muscles of one eye. There was a surprising difference between the immediate consequences for vision of section of the lateral and medial rectus muscles that were reflected by equally large differences in the magnitude of the amblyopia that developed eventually in the two situations. Following section of the lateral rectus muscle, there was an immediate reduction in the visual acuity of the operated eye of as much as 2 octaves after which vision returned to normal levels over 4 to 8 days. The acuity of the two eyes remained comparable for a few days after which the vision of the operated eye began to decline once more, signalling the onset of amblyopia some 10 to 12 days following imposition of strabismus. In contrast to the severity of these effects, the effects observed following section of the medial rectus were both mild and transitory. Furthermore, whereas all kittens that were rendered esotropic early developed amblyopia, none of the kittens that were made exotropic at the same age did so. Together, these results suggest that factors associated with the immediate consequences of the surgical procedure employed to produce a misalignment of the visual axes may contribute to the severity of the effects of surgically induced strabismus.This research was supported by a grant (MA7732) to D.E.M. from the Medical Research Council of Canada. We wish to thank Keith Grasse for his assistance with the measurements of eye alignment under paralysis, and Cindy Trask and Heather Dzioba for their assistance with the behavioural testing     

膝骨关节炎患者膝关节置换后下肢肌的表面肌电图变化

背景：膝骨关节炎患者膝关节置换后下肢肌功能恢复一直存在着争议。 目的：评价膝骨关节炎患者膝关节置换手术后下肢肌肉功能。 方法：应用TELEMYO 2400R G2表面肌电图遥测仪对25例双膝骨关节炎单膝关节置换后患者在平常自然步态下进行双下肢股直肌、胫前肌、股二头肌和腓肠肌内侧的表面肌电信号测试。在肌电图测试前,对患者双膝关节功能进行美国特种外科医院膝关节评分。 结果与结论：患者置换后美国特种外科医院膝关节评置换侧平均分91.44,其优良率达100%;未置换侧平均分54.52。置换侧在疼痛、关节功能方面有明显改善;膝关节置换后置换侧股直肌、胫前肌、股二头肌的肌电振幅、肌电积分、平均频率、中位频率的(平均值、最小值、最大值)与未置换侧相比差异无显著性意义(P > 0.05);置换侧腓肠肌内侧肌电振幅值及肌电积分值显著大于未置换侧(P < 0.05);置换侧腓肠肌内侧平均频率、中位频率与未置换侧相比差异无显著性意义(P > 0.05)。提示膝关节置换后置换侧的下肢肌没有恢复到正常的功能活动水平,因此膝关节置换后康复要特别重视患者的肌肉锻炼。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

An anomalous muscle linking superior and inferior rectus muscles in the orbit

Dissections of the bilateral orbits in a 45-year-old female cadaver, who had no ocular movement disorders in her lifetime, revealed anomalous muscles linking the superior and inferior rectus muscles. The muscles, situated between the optic nerve and the lateral rectus muscle, originated from the annulus of Zinn and branched off two heads; one inserted into the medial inferior side of the superior rectus muscle and the other inserted into the central superior side of the inferior rectus muscle. Each insertion was located on a distal site of the myoneural junction of each rectus muscle. Histological investigations showed that the muscles had a striated muscle structure. No definite nerve insertion was observed in the muscles. Although this type of anomalous muscle has been reported in a few Caucasian cases, the present study is the first report in an Asian person. Anomalous orbital structures, which are a rare cause of strabismus, are important in the differential diagnosis of intra-orbital space-occupying lesions, rather than the differential diagnosis of strabismus.     

应用超声生物显微镜观察小梁切除术后的房角改变

目的 应用超声生物显微镜（UBM）观察原发性闭角型青光眼（PACG）小梁切除术后的房角改变。方法：PACG患者30人（30只眼），行巩膜板层下小梁切除术，分别于术前和术后使用UBM观察房角形态并测量。结果：术前2只眼存在睫状体脱离。ACD、AOD500,TIA、TCPD、ID1术前术后比较差异均无显著性（P〉0．05）。结论：UBM有利于发现青光眼手术前后的睫状体脱离。小梁切除术对PACG的房角结构无改善。     

Inaccuracy of Intraocular Lens Power Prediction for Cataract Surgery in Angle-Closure Glaucoma

Purpose

To assess the accuracy of intraocular lens (IOL) power predictions for cataract surgery in eyes with primary angle-closure glaucoma (ACG). Because of shifting of the capsular bag apparatus and shortening of the axial length, preoperative calculation of IOL power may be inaccurate for eyes with ACG.

Materials and Methods

This retrospective comparative case series comprised of 42 eyes from 42 patients with primary ACG and 45 eyes from 45 subjects with normal open-angles undergoing uneventful cataract surgery. Anterior segment biometry including anterior chamber depth, lens thickness, and axial length were compared. Using the SRK-II formula, the powers of the implanted IOL and the actual postoperative spherical equivalent (SE) refractive errors were compared between the two groups. Also, the absolute values of differences between predicted and residual SE refractive errors were also analyzed for each group.

Results

In ACG patients, anterior chamber depth and axial length were shorter and the lens was thicker than normal controls (all p < 0.001). Even though residual SE refractive error was not significantly different (p = 0.290), the absolute value of the difference between predicted and residual SE refractive error was 0.64 ± 0.50 diopters in AGC patients and 0.39 ± 0.36 diopters in control subjects (p = 0.012). The number of eyes that resulted in inaccurate IOL power predictions of more than 0.5 diopters were 21 (50.00%) in the ACG group, but only 12 (26.67%) in the control group (p = 0.043).

Conclusion

IOL power predictions for cataract surgery in ACG patients can be inaccurate, and it may be associated with their unique anterior segment anatomy.