准分子激光上皮下角膜磨镶术后并发症的治疗

目的:分析准分子激光上皮下角膜磨镶术(LASEK)治疗近视的并发症,探讨其发生原因及预防措施。方法:近视患者25例46眼行LASEK后,随诊6mo,分析其并发症。结果:术后角膜上皮愈合延迟4眼(8.7%);丝状角膜炎1眼(2.2%);角膜感染2眼(4.3%);角膜雾状混浊(haze)18眼(39.1%),平均0.81±0.48级;术后激素性高眼压8眼(17.4%)。术后6mo屈光回退>-1.00DS者5眼(10.9%);散光度增加>1.00DC者5眼(10.9%),矫正视力较术前下降1行者7眼(15.2%)。结论:LASEK治疗高度近视安全、有效,但存在一定的并发症,尤其是术后早期的角膜上皮愈合延迟和晚期的严重角膜雾状混浊必须引起重视。术后随访的完善、合理的用药、有效护理措施有助于减少术后并发症的发生和提高手术的预测性和准确性。     

LASEK与PRK矫正近视及近视散光的疗效比较

目的 比较LASEK与PRK手术矫正不同程度近视及近视散光的有效性、安全性及稳定性。方法 70名患者(140眼)，分为中低度近视组39人(78眼)、高度近视组31人(62眼)。患者一眼行LASEK手术，对侧眼行PRK手术，术后观察术眼疼痛情况、上皮愈合时问、角膜上皮下雾状混浊(haze)、术后裸眼视力6个月。结果LASEK与PRK术后上皮愈合时间及术眼疼痛指数无明显差异；中低度近视组两种手术后裸眼视力无显著差异；高度近视组裸眼视力及角膜haze程度差异显著。结论 LASEK矫正不同程度近视均能取得较好的临床效果，术后裸眼视力及视力稳定程度优于PRK，特别表现在高度近视组。     

准分子激光上皮下角膜磨镶术治疗异常眼并发症的分析

目的分析准分子激光上皮下角膜磨镶术（LASEK）治疗异常近视眼产生的并发症,并探讨其发生原因及预防措施。方法异常眼（眼球小,睑裂小、眼窝深、角膜薄）312例（611眼）,均为中高度近视（-5．00D--13．00D）,行LASEK后随访1年,观察其上皮愈合、haze、视力变化等并发症。结果术中角膜上皮瓣不完整72眼占11．7％;术后角膜上皮愈合延迟21眼占3．4％;角膜感染1眼占0．15％;术后6月haze0．5级56眼（9．1％）,1级14眼（2．3％）;2级2眼（0．3％）;术后皮质类固醇性高眼压7眼占1．1％。术后1年屈光回退〉1．00D者51眼,占8．3％;散光度增加〉1．00D者19眼,占3．1％;矫正视力较术前下降1行者9眼,占1．4％。结论LASEK治疗异常近视眼是安全有效的,但易出现一定的并发症,手术技巧的提高、手术器械的改良、术后病人的配合以及合理的用药都有助于减少手术并发症的发生。     

准分子激光角膜上皮瓣下磨镶术后角膜上皮愈合延迟三例

准分子激光角膜上皮瓣下磨镶术(excimer laser epithelial keratomileusis，LASEK)是目前治疗近视手术的新术式，它既减轻了准分子激光角膜切削术后术眼严重疼痛症状，也降低了角膜上皮下雾状混浊(haze)的发生率，同时也无准分子激光原位角膜磨镶术(excimer laser insitu keratomileusis，LASIK)角膜瓣及层间相关的并发症，尤其适于角膜薄、近视度数高、瞳孔大等不适于行LASIK的患者。但是，随着该手术在临床的广泛开展，其并发症也逐渐受到眼科界的重视。我院自2002年12月至2004年1月开展并施行LASEK手术178例(347只眼)，术后出现严重角膜上皮愈合延迟3例(5只眼)。     

去上皮瓣Epi-LASIK矫治高度近视

目的:探讨去上皮瓣机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)矫治高度近视的临床疗效。方法:对86例169眼高度近视患者施行去上皮瓣Epi-LASIK,术后随访6mo。观察术后刺激症状、角膜上皮愈合时间、视力、屈光度、角膜上皮下雾状混浊程度(haze)。结果:所有患者术后均未主诉明显疼痛,仅表现有轻中度的异物感、畏光、流泪。角膜上皮愈合时间3～4d。术后6mo,全部86例169眼术后等效球镜均在±1.00D以内,未见最佳矫正视力下降,23眼(13.6%)最佳矫正视力提高1行以上。术后1mo,142眼(84.0%)角膜haze为0级,27眼(16.0%)角膜haze为0.5级;术后3mo,2例4眼不明原因出现3级haze;术后6mo,所有患者角膜haze均为0级。结论:去上皮瓣Epi-LASIK治疗高度近视安全、有效,具有良好的可预测性和稳定性。个别患者在术后发生不明原因的迟发性haze有待于进一步研究。     

高度近视眼LASEK治疗并发症53例

目的:探讨准分子激光上皮瓣下角膜磨镶术(laserepithelialkeratomileusis,LASEK)手术并发症的类型、产生原因及处理方法。方法:应用LASEK治疗等效球镜为-7.25～14.50D的高度近视眼53例(106眼),对术中和术后产生的并发症进行相关原因分析。结果:LASEK术中并发症主要有上皮瓣剥离困难、破碎、游离、皱褶、局限性缺损等,术后并发症主要有角膜上皮下雾状混浊(Haze)、最佳矫正视力下降、屈光度回退、眩光、上皮瓣溶解等。结论:严格掌握LASEK的手术适应证,熟练掌握手术技巧和正确处理角膜上皮瓣的各种并发症是保证LASEK成功的关键。     

准分子激光上皮瓣下角膜磨镶术矫治超高度近视的临床研究

目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)矫治超高度近视的疗效与安全性。方法应用德国Zeiss MEL 80准分子激光器对-10.00以上的超高度近视22例(40眼)施行LASEK术,术前平均裸眼视力0.02±0.02 (0.01～0.05),平均等效球镜(-12.75±2.30)D。随访6个月,观察术后症状、裸眼视力和最佳矫正视力、显然屈光度、眼压、角膜愈合程度和并发症。结果LASEK术后角膜上皮愈合时间1～4d。6个月裸眼视力≥0.5者占95%,裸眼视力≥1.0者占27.5%。平均裸眼视力0.70±0.20,平均等效球镜(-1.25±1.78)D。haze发生14眼(35.0%),haze 0.5级10眼(25.0%),haze 1.0级4眼(10.0%)。5例出现眩光。结论LASEK术可以安全有效地进行超高度近视的矫治,可作为超高度近视治疗的一种较好选择。     

Epi—LASIK与LASEK术矫治中高度近视

目的 探讨和评估微型角膜刀准分子激光角膜上皮瓣下磨镶术(epipolislaserin situ keratomileusis,Epi-LASIK)与准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)治疗中高度近视的安全性和有效性.方法 Epi-LASIK组31例(59眼)和同期LASEK39例(75眼),Epi-K微型角膜上皮刀(平推型)进行EpiLASIK术(Moria Epi刀须负压45 s才达到规定指标).LASEK采用20%乙醇浸润20～30 s,临床观察两者术后症状、视力、角膜上皮瓣愈合特点及视觉质量等.结果 Epi-LASIK组术后6个月裸眼视力达术前矫正视力占92.35%,LASEK组术后6个月裸眼视力达术前矫正视力占93.83%.主要并发症有术后部分少许角膜上皮下雾状混浊(Haze)形成及继发高眼压.两组术后对比敏感度提高,出现眩光差异无显著性意义.结论 EpiLASIK及LASEK术均可安全,有效的矫治中高度近视.两者的长期疗效有待观察.(中国眼耳鼻喉科杂志,2006,6365～367)     

准分子激光角膜上皮瓣下磨镶术治疗近视效果观察

目的探讨准分子激光角膜上皮瓣下磨镶术(LASEK)治疗近视的疗效。方法对49例(91眼)角膜厚度不适合LASIK手术的近视者行LASEK手术,观察术后视力、屈光度及并发症情况。结果84眼(92.31%)术后视力达到或超过术前最佳矫正视力。术后屈光度有向近视回退的趋势,术后仍有角膜雾状浑浊(haze)等并发症的出现,且haze的发生表现出屈光度及性别差异。结论LASEK适合角膜薄的近视者,有较好的手术效果,但要重视其并发症,超高度近视慎行LASEK。     

LASEK治疗中、高度近视临床观察

目的 评价准分子激光角膜上皮瓣下磨镶术(LASEK)治疗中、高度近视的临床效果.方法 应用美国VISXstarS4准分子激光仪行LASEK手术治疗中、高度近视患者256例460眼,平均术前等值球镜为-7.21±3.56 D(-5.00～-11.00 D),平均角膜厚度522 μm(462～530 μm),观察术中及术后上皮瓣厚度、术后裸眼视力、术后症状、屈光度和角膜混浊程度,平均随访时间为12个月.结果 术后6个月8例出现上皮下混浊1级,其中,8例出现不同程度的屈光回退;术后屈光度及裸眼视力均在6个月内趋于稳定;角膜上皮瓣的厚薄与是否戴接触镜有关,与戴接触镜时间长短有关,配戴10年以上接触镜者角膜上皮明显变薄.结论 LASEK治疗中高度近视疗效确切、安全.高度近视手术后haze发病率低,无明显屈光回退发生.     

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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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.