Tono-Pen眼压计对兔眼不同部位眼压测量值的相关性研究

目的 研究兔眼球不同部位眼压测量值的相关性规律。方法 采用Tono—pen眼压计在全身麻醉下测量40只新西兰白兔角膜中央、旁中央区、角膜缘及巩膜部位眼压值，同时采用Schioetz眼压计测量角膜中央眼压值。采用SPSS软件分析不同部位眼压测量值间的相关性。结果 兔角膜中央区、旁中央区、角膜缘及角膜缘后4mm巩膜部位眼压值分别为（19．44±2．33）mmHg、（19．44±1．95）mmHg、（21．66±4．26）mmHg和（21．83±4．84）mmHg，Schioetz眼压计测量角膜中央眼压值为（19．27±3．14）mmHg。角膜旁中央区与角膜中央区眼压值有相关性．检验有统计学意义（r=0．615，P=0．007），而角膜缘、角膜缘后4mm巩膜与角膜中央区眼压值相关系数r及P值分别为0．537／0．021．0．215／0．391。结论 采用Tono-Pen眼压计测量兔眼角膜旁中央区或角膜缘眼压可以反映眼压实际值．     

不同术式治疗翼状胬肉术后角膜修复情况的对比

目的：比较不同手术方法治疗原发性翼状胬肉术后角膜修复情况及术后不适症状的差异。方法：选取原发性翼状胬肉患者47例60眼分为两组, A组24例30眼,B组23例30眼。 A组应用2．5mm巩膜隧道刀锐性切除角膜上翼状胬肉头部,B组应用有齿镊钝性分离撕除角膜上翼状胬肉头部。分别在术后1、3d,1wk,1 mo观察角膜上皮修复情况及不适症状。结果：术后1、3d,B组的角膜修复优于A组。术后1d睁眼疼痛、畏光流泪、异物感A组较B组严重,差异具有统计学意义（ P＝0．005、0．015、0．012）;术后3 d睁眼疼痛、畏光流泪、异物感A组较B组严重,差异具有统计学意义（P＝0.019、0．018、0．015）;术后1wk,1mo不适症状两组无统计学差异（ P＞0．05）。结论：与锐性分离相比较,翼状胬肉手术最好选用钝性分离胬肉头部与角膜粘连。     

翼状胬肉手术中带状角膜缘组织移植及丝裂霉素C应用的意义

目的 探讨翼状胬肉手术中带状角结膜缘组织移植及联合丝裂霉素c应用的意义.方法 252例（368眼）翼状胬肉切除术,术中巩膜创面放置0.4 mg/mL的丝裂霉素C棉片3 min,林格液冲洗3 min（400 mL）,取颞上方宽约3 mm,比创面略长的带状角结膜缘组织移植于巩膜创面近角膜缘处,随访6个月～3年.结果 252例（368眼）翼状胬肉中治愈245例（360眼）,复发7例（8眼）,治愈率97.83%.结论 翼状胬肉手术中带状结膜角膜缘组织移植及丝裂霉素C应用,可降低复发率,减少并发症.     

透明角膜及巩膜梯形隧道切口白内障超声乳化吸除硬性人工晶体植入术的临床研究

目的 探讨在表麻下一种新的透明角膜及巩膜梯形隧道切口白内障超声乳化吸除植入硬性人工晶体的手术技巧，评价其疗效。方法 对510例病人，在表麻下，先做3．0mm透明角膜隧道切口行白内障超声乳化吸除，然后使用3．0mm穿刺刀，在透明角膜切口的两端，向巩膜方向扩大切口。其扩大的外切口是以视轴为中心的放射状切口，与透明角膜的外切口相连接形成一个无底边的等腰梯形。梯形的顶边长为3．0mm，两腰各长2．0mm，底边的距离为3．5-4．0mm。扩大的内切口仍在透明角膜内，与原有的内切口连接呈弧形（与角膜同弧）。隧道内部的形状是一个非平面（三个平面）立体的，酷似一个展翅的蝴蝶形状。植入5．5mmPMMA硬质人工晶体。动态观察术前及术后1d、1w、1m、3m裸眼视力、角膜散光和角膜地形图变化。结果 510例手术均在表麻下完成，病人无明显疼痛，均配合良好。切口闭合良好，前房深度正常。术后第1d裸眼视力≥0．5者483例，占94．7％；术后1周裸眼视力≥0．5者477例，占93．5％；术后1m裸眼视力≥0．5者486例，占95．3％；术后3m裸眼视力≥0．5者484例，占94．9％。将术前散光度分别与术后各时期的散光度比较，差异均无统计学意义（X2检验P值均〉0．05）。术前及术后1d、1w、lm、3m角膜表面规则指数（surfaceregularity．index．SRI）分别为：0．63±0．32，0．73±0．44，0．71±0．42，0．68±0．37，0．64±0．39；角膜表面不规则指数（surfaceasymmetryindexSAI）分别为：0．57±0．39，0．69±0．48，0．66±0．50，0．62±0．47，0．60±0．45；术后1w各项值逐渐下降，在1m-3m渐趋平稳；术后与术前比较无统计学意义（P〉0．05）。结论 在表面麻醉下，采用透明角膜及巩膜梯形隧道切口的超声乳化白内障摘除，硬质人工晶体植入术。具有操作简单，手术时间短；在选择切口的位置时，有较大的选择空间；不增加角膜散光，切口闭合良好；术后视力恢复快且稳定；手术成本低；适合我国国情，有利于规模化手术。     

角膜缘上皮联合羊膜移植治疗眼表疾病的研究

目的：探讨角膜缘上皮联合羊膜移植治疗眼表疾病的效果。方法：复发性翼状胬肉，睑球粘连，陈旧性碱烧伤，角膜缘外伤，角巩膜在面积皮样肿，采用甘油保存的人羊膜联合自体或异体角膜缘移植进行治疗。结果：复发性翼状胬肉6例6眼，术后随访4月－2年，上皮愈合稳定，角膜光滑，透明，无复发。视力提高或保持不变。陈旧性碱烧伤3例4眼，随访3，8，12月，表面保持安静，周边部有少许的新生血管；一眼手术失败，出现血管生长，基质溶解，角巩膜大范围皮样肿1眼，术后角膜半透明，外观正常，视力除1例失败外，均有不同程度的提高，从术前光感－0．05提高至0．02－0．8，结论；保存的人羊膜无抗原性，具有抗炎，抑制新生血管，阻止结膜源组织再侵入的作用。联合角膜缘移植是一种有效的治疗眼表疾病的手段。     

自体结膜角巩膜缘移植治疗原发性翼状胬肉(英文)

目的:评价自体结膜角巩膜缘移植术治疗原发性翼状胬肉的有效性。方法:原发性翼状胬肉患者15例(15眼),接受自体结膜角巩膜缘移植术。切除翼状胬肉后,植片的角膜缘部分与翼状胬肉切除处的角膜缘对位缝合,植片的上皮面向上。纤维血管组织在原翼状胬肉区遮盖角膜1mm以上定为复发。结果:随访平均8mo,所有的患者既无一例复发也无并发症发生。结论:单纯翼状胬肉切除联合自体结膜角巩膜缘移植是一种治疗原发性翼状胬肉安全有效的手术方法。     

自体角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉

目的 观察自体角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉及合并睑球粘连等并发症的疗效。方法 对25例(27只眼)复发性翼状胬肉,其中,5例(6只眼)并发睑球粘连,1例(1只眼)合并上皮囊肿,施行复发性翼状胬肉切除、睑球粘连分离、囊肿切除联合自体角膜缘干细胞移植及羊膜移植术,术后随访(18.76±8.05)月,观察眼表上皮修复、炎症反应、新生血管、视力等。结果 角膜上皮愈合时间为(3.03±0.46)天,无睑球粘连及上皮囊肿再发,翼状胬肉复发7.41％(2／27),视力提高74.07％(20／27),症状改善88.89％(24／27)。结论自体角膜缘干细胞移植联合羊膜移植能够有效重建眼表,修复角膜缘缺损,改善角膜缘基质微环境,促进上皮修复,是治疗角膜缘干细胞功能衰竭、减少复发性翼状胬肉再发的良好方法。     

翼状胬肉撕离联合角膜缘干细胞移植的研究

目的探讨翼状胬肉头部撕离联合角膜缘干细胞移植术治疗翼状胬肉的临床效果。方法撕离术组：53例（53眼）在手术显微镜下用有齿镊撕离胬肉头部。切除术组：32例（32眼）用单纯刀具切除头部。两组均联合角膜缘干细胞移植。术后随访观察6—24月。结果撕离术组与切除术组的角膜创面愈合平均时间分别为3天和5天，复发率分别为5．66％和25．00％。差异有统计学意义（x^2=0．920，P〈0.005）。结论胬肉头部撕离术联合角膜缘干细胞移植术角膜创面愈合时间短，胬肉复发率低。     

闭角型青光眼超声乳化人工品状体植入前后的眼前节结构变化

目的观察原发性闭角型青光眼患者白内障超声乳化吸出联合人工晶状体植入手术前后的前房结构的变化。方法对18例（34眼）原发性闭角型青光眼合并白内障患者实施白内障超声乳化联合人工晶状体植入术，手术前后行眼前段相干光学断层扫描（optical coherence tomography，OCT），观察前房结构的变化。同时监测手术前后眼压，观察手术对闭角型青光眼的治疗作用。结果前段OCT扫描显示，手术后角膜前后曲率半径（7．53±0．81）mm、角膜陡峭度K值（44．46±4、64）dpt与术前（7．60±1．19）mm、（43．90±6．93）dpt相比差异均无统计学意义（P〉0．05）；前房深度、前房体积、500μm房角开放距离[（3．06±0．25）mm、（138．25±16．33）mm^3、（0．62±0．35）mm]与术前[（2．29±0．22）mm、（94．50±27．28）mm^3、（0．25±0、12）mm]相比，差异均有显著统计学意义（P〈0．01）；500μm小梁网虹膜间隙面积（0.26±0.15）mm^2与术前（0．14±0.05）mm^2相比，差异有统计学意义（P〈0.05）。术后眼压在脱离药物治疗的情况下稳定于正常范围，术后视力均好于术前。结论前段OCT提供了对眼前节快速、非接触的检查方法。白内障超声乳化术对房角未全部粘连的闭角型青光眼有较好的治疗作用。     

翼状胬肉切除术中丝裂霉素C的应用

报告三种翼状胬肉手术治疗方法的术后复发率和并发症。纳入年龄大于>18岁的原发性翼状胬肉、头部侵入角膜大于2mm的患者,排除复发性胬肉及干燥综合征、眼类天疱疮者。术中应用MMC组(50眼),即单纯胬肉切除术中应用0.02%MMC,持续5分钟;术后用MMC组(53眼),即单纯胬肉切除术后0.02%MMC液滴眼,每日2次,持续5天;胬肉切除加自体角膜缘干细胞移植组(52眼),手术步骤:表面麻醉后,2%利多卡因胬肉体部结膜下注射;距角膜缘1mm处,剪开结膜和结膜下组织,离断胬肉体和头部;剥离切除胬肉头部;分离剪除离断体部结膜下组织和Tenons囊,暴露巩膜,不需缝合游…     

Effect of pterygium surgery on corneal topography: a prospective study

OBJECTIVE: To evaluate the effect of pterygium surgery on the corneal topography and visual acuity and to correlate the results with patients' features. METHODS: A prospective, nonrandomized, self-controlled trial. Computerized videokeratography was performed in 54 patients (55 eyes) with primary pterygium before and after pterygium excision using bare sclera technique combined with intraoperative mitomycin C. The following topographic parameters were noted: corneal astigmatism at the central 3 mm; total mean refractive power of the whole cornea; surface regularity index (SRI); and surface asymmetry index (SAI). Best corrected visual acuity of the operated eyes was also examined. Differences between pre- and postoperative values were evaluated statistically with paired two-tailed t test and two-tailed Pearson correlation. RESULTS: The respective values (mean +/- SD) before and after treatment of the study parameters were as follows: simulated keratometric astigmatism at 3 mm, 3.12 +/- 2.43 and 2.51 +/- 2.50 (P = 0.05); mean SRI, 0.99 +/- 0.65 and 0.90 +/- 0.65 (NS); mean SAI, 1.37 +/- 1.69 and 1.23 +/- 1.49 (NS). Best corrected visual acuity was 20/40 preoperatively and 20/25 postoperatively (P < 0.01). Both pre- and postoperative astigmatism correlated with pterygium size. CONCLUSIONS: Pterygium surgery significantly reduces refractive astigmatism and improves SRI, SAI, and best corrected visual acuity.     

带环形巩膜瓣及角膜缘的全角膜板层移植术治疗蚕蚀性角膜溃疡

目的观察带环形巩膜瓣及角膜缘的全角膜板层移植术治疗蚕蚀性角膜溃疡的临床效果.方法取带宽6mm球结膜和4mm板层巩膜的全角膜板层植片,治疗4例(4只眼)蚕蚀性角膜溃疡.结果 4例蚕蚀性角膜溃疡患者均Ⅰ期愈合,视力提高;随访1～3年,视力为0.2～0.6,无明显基质型排斥反应,也无复发;角膜表面稳定,无上皮糜烂现象,无假性翼状胬肉发生;层间新生血管部分萎缩,2例表层出现不同程度的新生血管.结论带环形巩膜瓣及角膜缘的全角膜板层移植术是治疗蚕蚀性角膜溃疡的有效手段.     

不同术式治疗翼状胬肉的疗效分析

目的:比较巩膜暴露法、带球结膜瓣的角膜缘干细胞移植术、带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙的手术方式治疗翼状胬肉的临床疗效。方法:翼状胬肉患者130例138眼,分为三组:A组(45例,48眼):采用巩膜暴露法行翼状胬肉切除术;B组(42例,45眼):带球结膜瓣的角膜缘干细胞移植术;C组(43例,45眼):翼状胬肉切除联合带球结膜瓣的角膜缘干细胞移植术及封闭球结膜与Tenon囊之间间隙。术后随访12mo。结果:三组复发率分别为27.1%,8.9%,4.4%。A组与其余两组比较存在显著差异(P<0.05),B组与C组存在差异,但无统计学意义。肉芽肿形成:A组3眼,B组2眼,C组未见。C组泪阜的形态及位置明显优于A组及B组。结论:带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙能显著降低翼状胬肉术后复发率,减轻炎症反应,预防肉芽肿的形成,有助于恢复泪阜的正常形态及位置,是目前治疗翼状胬肉的较理想手术方式。     

手术显微镜下翼状胬肉切除联合丝裂霉素C应用98例疗效观察

目的:手术显微镜下翼状胬肉切除联合丝裂霉素C应用疗效观察。方法:采用在手术显微镜下操作:局部麻醉后用角膜剪在角膜缘外1mm处轻轻剪开浅层结膜,分离结膜与胬肉组织,剪除胬肉及肥厚增生的结膜下组织,在手术显微镜下把残留在角膜和巩膜上的胬肉组织彻底清除,并用0.2g/L丝裂霉素溶液棉片置于术区巩膜表面3min,间断缝合把结膜瓣固定在浅层巩膜上,暴露角膜缘后巩膜3～4mm,术后滴用复方硫酸新霉素眼药水,4次/d,连用2wk。结果:所有病例门诊随访,时间3～48mo,手术后角膜刺激症状持续天数减少,术后视力有提高者40眼(39.2%),复发4眼(3.9%)。结论:手术显微镜下行翼状胬肉切除,辅助应用0.2g/L丝裂霉素,复发率低,反应轻。     

纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的临床效果

目的:探讨应用纤维蛋白胶在胬肉切除联合自体角膜缘干细胞移植术中的效果。方法:对48例60眼行胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组(纤维蛋白胶组)22例30眼和对照组(缝线组)26例30眼。实验组及对照组给予常规20g/L利多卡因浸润麻醉后进行胬肉切除联合自体角膜缘干细胞移植术;试验组采用黏合剂将植片与植床进行粘贴(黏合剂为凝血酶溶液及含有因子Ⅷ和抑肽酶的纤维蛋白溶液),对照组采用10-0缝线缝合植片与植床。术后随访6mo,主要观察手术时间,植床与植片的匹配程度及术中与术后患者的疼痛评分。结果:试验组手术时间相对较短,差异有统计学意义(P<0.01),试验组植床与植片匹配度与对照组无明显差异(P<0.05),术后1wk内患者生活质量试验组优于对照组。结论:纤维蛋白胶黏合剂完全能满足胬肉切除联合自体角膜缘干细胞移植术的要求,且能清晰地切除病变组织并使植床与植片很好匹配,缩短了手术时间,减少了患者的痛苦。     

翼状胬肉大小与角膜散光的关系

目的:探讨翼状胬肉大小与角膜散光的关系。方法:选取64例70眼翼状胬肉患者纳入研究,测量裸眼视力、角膜曲率及胬肉侵入角膜缘长度,分析胬肉长度与角膜散光的相关度,对比翼状胬肉切除+角膜缘干细胞移植术手术前后裸眼视力。结果:术前69眼有不同程度的角膜散光,与胬肉侵入角膜长度相关,以循规性散光为主。术后1mo,其角膜散光明显下降,裸眼视力提高。结论:翼状胬肉可引起角膜循规性散光,散光程度与胬肉侵入角膜长度关系密切,手术可以使角膜散光改善、视力提高。     

Pyogenic granuloma following eye muscle surgery]

BACKGROUND: A pyogenic granuloma developing after eye muscle surgery is a rare complication. It can impair aestethical results and ocular motility. PATIENT AND METHODS: A 7-year-old girl presented in our department with recurrence of a conjunctival granuloma following a bimedial retroequatorial myopexia an excision of conjunctival suture granuloma in the left eye. Clinically, a nodular painless and reddish mass was found at the nasal limbus in the interpalpebral zone. Other results of ocular examinations were limitation of adduction and elevation, mild amblyopia (visual acuity 0.8) due to microstrabismus of 1 degree. After surgical excision following the initial biopsy, the histopathologic study established the diagnosis of pyogenic granuloma. After recessing residual conjunctiva and Tenon's fascia in 10 mm distance from the limbus the conjunctiva was fixed to the sclera. The sclera between the limbus and the conjunctiva was left uncovered. Reepithelialisation of the bare sclera occurred after few days. RESULTS: No further symptoms were observed during a follow-up time of 1 year. CONCLUSIONS: The rapid growth and appearance as well as the clinical examination may imitate another tumor necessitating surgical excision and histopathological study. Bare sclera-technique is a suitable method for plastic reconstruction.     

翼状胬肉逆行切除加羊膜移植的临床疗效

目的 :观察分析翼状胬肉逆行切除加羊膜移植防止胬肉复发的临床疗效。方法 :在角巩缘位置连同表层结膜剪断胬肉颈部。逆行将胬肉头部自角膜上分离 ,向泪阜方向及上下方向钝性分离结膜及其下增生变性组织 ,钝性分离增生组织与巩膜 ,接近半月皱襞处离断胬肉根部。最后移植羊膜于巩膜裸露区。结果 :6 0例翼状胬肉患者的角膜上皮 1～2天内全部愈合 ,随访 6～ 16个月 ,3例复发。结论 :翼状胬肉逆行切除加羊膜移植可较大程度地降低胬肉术后复发率 ,有其独到优点     

Long-term results after bare sclera pterygium resection with excimer smoothing and local application of mitomycin C

PURPOSE: To evaluate the long-term results and complications after bare sclera pterygium excision with local application of mitomycin C and consecutive smoothing of the wound area with an excimer laser (PTK). METHODS: This was an observational case series of 133 eyes of 101 patients who underwent pterygium surgery using the bare sclera technique. Thirty-one of these treated eyes (23%) were recurrences with a mean of 3 previous operations. After pterygium surgery, phototherapeutic keratectomy with an ArF:excimer laser was performed in the area of the excision. Additionally, all patients were treated with mitomycin C 0.02% twice daily for 4 days. Median follow-up was 53 months (minimum, 36). RESULTS: In the group with primary pterygia, 3 recurrences occurred after 6, 12, and 28 months (recurrence rate, 2.9%). In the group with previous pterygium operations, 2 recurrences (recurrence rate, 6.4%) were recorded. Uncorrected visual acuity of all treated patients improved from 0.61 preoperatively to 0.79 postoperatively (P < 0.0001), best corrected visual acuity increased from 0.82 to 0.91 (P = 0.0001) [LogMAR]. Mean astigmatism was significantly reduced from 1.54 D preoperatively to 0.61 D postoperatively (P < 0.0001). In 7 eyes, discrete granulomas developed postoperatively (5.3%); in 3 cases (2.3%), dellen formation occurred that persisted for a maximum of 4 months. No further complications were recorded during the follow-up. CONCLUSIONS: Pterygium excision using the bare sclera technique, phototherapeutic keratectomy, and local application of mitomycin C 0.02% eyedrops is a safe method with good functional results and a low recurrence rate.     

The cut-and-paste method for primary pterygium surgery: long-term follow-up

OBJECTIVE: To evaluate the recurrence rate, reoperation rate and side-effects of a novel technique for pterygium surgery. DESIGN: Retrospective study. PARTICIPANTS: The study included 461 eyes of 381 patients operated for primary nasal pterygium by the same surgeon between 1994 and 2003 and followed for 23 +/- 20 months (range 6-112 months). METHODS: Autologous conjunctival grafts harvested at the superotemporal limbus were used to cover the sclera after pterygium excision. Using a retrospective chart review, the outcome after attaching the transplant to the sclera with a fibrin tissue adhesive (n = 325) was compared to the outcome after graft attachment using absorbable sutures (n = 136). MAIN OUTCOME MEASURES: Recurrence rate, reoperation rate and complications. Results: The recurrence rate was 5.3% in the glue group and 13.5% in the suture group (p = 0.01). The reoperation rates were 1.2% and 3.3%, respectively (p = 0.31). Complications, such as transient transplant oedema and persistent corneal epithelial defects, occurred equally in both groups. CONCLUSION: Using a fibrin tissue adhesive instead of sutures when attaching the conjunctival transplant in primary pterygium surgery results in a significantly lower recurrence rate.