先天性鼻泪管阻塞治疗探讨

目的 探讨先天性鼻泪管阻塞的不同治疗方法和治疗时机.方法 回顾分析了735例837只眼在复旦大学附属儿科医院诊断为先天性鼻泪管阻塞的患儿,平均首诊年龄4.5月.根据首诊年龄和症状分别采用保守治疗、加压泪道冲洗法和泪道探通法,经随访3～16月,平均6.4月.以溢泪症状完全消失作为治愈指标.结果 保守治疗的有效率为14.7%;加压泪道冲洗法的有效率为25.4%;泪道探通法的有效率为97.2%;15只眼未愈.早期探通(<6月龄组)1次成功率为87.7%;后期探通(>7月龄组)1次成功率为56.6%.结论 泪道探通法治疗先天性鼻泪管阻寒安全有效,最佳干预时机为4～6月龄.     

婴幼儿先天性鼻泪管阻塞的综合治疗

目的探讨应用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术综合治疗婴幼儿先天性鼻泪管阻塞的临床应用价值及治疗效果.方法回顾自2000年11月～2005年5月在我院眼科门诊治疗的382例(419眼)婴幼儿先天性鼻泪管阻塞的病历资料,首诊年龄3d～6y.根据患者年龄和症状分别采用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术的综合治疗进行处理,并随访6个月以上.以无泪溢,眼无分泌物,泪道冲洗通畅或极少返流为治愈标准.结果综合治疗治愈率97.1%,其中5.5%为抗生素眼液滴眼加泪囊区按摩法治愈,11.2%为泪道加压冲洗法治愈,80.4%鼻泪管探通术治愈.2.9%的病例未愈,2.3%病例发生并发症.结论综合治疗婴幼儿先天性鼻泪管阻塞是行之有效且风险较小的一种治疗方法.(中国眼耳鼻喉科杂志,2006,6:97～98)     

先天性鼻泪管阻塞的综合治疗

目的　先天性鼻泪管阻塞是婴幼儿常见的眼病 ,其处理历来存在争议。本文的研究目的是探讨应用滴抗菌素眼液加泪囊挤压按摩、泪道加压冲洗及鼻泪管探通术的综合治疗方法对先天性鼻泪管阻塞患儿的临床应用价值及其治疗效果。方法我们回顾性分析了 4 83例 54 7眼 ,从 1997年 1月～ 2 0 0 0年 12月在中山眼科中心小儿眼科门诊治疗的先天性鼻泪管阻塞的病例资料 ,首诊平均年龄为 11.8个月。根据患者的年龄和症状 ,分别采用滴抗菌素眼液加泪囊挤压按摩 ,泪道加压冲洗及鼻泪管探通的综合治疗方法进行处理 ,并观察随访 3个月以上 ,症状消失作为治愈的指标。结果　综合治疗方法对先天性鼻泪管阻塞总的治愈率为 97.3 % .其中 6.1%病例用滴抗菌素眼液加泪囊挤压按摩法治愈 ;8.2 %病例用泪道加压冲洗法治愈 ;83 %的病例用鼻泪管探通术治愈。共有 15例患儿在治疗中发生并发症。结论　综合治疗方法对先天性鼻泪管阻塞患儿是安全有效的处理方法。     

先天性鼻泪管阻塞的治疗

目的探讨先天性鼻泪管阻塞的治疗效果。方法选取在本院接受治疗并有随诊记录的先天性鼻泪管阻塞的患儿共97例(117眼)。根据年龄大小的不同而分别采取泪囊按摩、加压冲洗及泪道探通三种治疗方法并行疗效统计。结果年龄1∽3个月患儿42例(52眼),选用泪囊挤压按摩法,31眼治愈,占59.62%。4月~1岁患儿34例(41眼),选用加压冲洗法,一次治愈36眼,占87.80%。1~2岁患儿21例(24眼),选用泪道探通法,一次治愈18眼,占75.00%。结论根据年龄大小,选择性采取泪囊挤压按摩、加压冲洗及泪道探通更为合理而有效治疗先天性鼻泪管阻塞。     

先天性鼻泪管阻塞不同年龄采用不同方法的治疗效果

目的探讨先天性鼻泪管阻塞根据不同年龄采用不同方法治疗效果。方法选取在本院接受治疗并有随诊记录的先天性鼻泪管阻塞的患儿97例（117眼）。根据年龄大小的不同而分别采取泪囊按摩、加压冲洗及泪道探通3种治疗方法并行疗效统计。结果年龄1～3个月患儿42例（52眼）,选用泪囊挤压按摩法,31眼治愈,占59．62％。4个月～1岁患儿34例（41眼）,选用加压冲洗法,一次治愈36眼,占87．80％。1～2岁患儿21例（24眼）,选用泪道探通法,一次治愈18眼,占75．00％。结论根据年龄大小,选择性采取泪囊挤压按摩、加压冲洗及泪道探通更为合理而有效治疗先天性鼻泪管阻塞。     

先天性鼻泪管阻塞泪道探通最佳时机的探讨

目的评估先天性鼻泪管阻塞最佳手术探通时机。方法随机选择眼科门诊2009年1月至2010年9月1057例(1232只眼)先天性鼻泪管阻塞病例。根据年龄分为A组(<1个月),B组(1～3个月),C组(3～6个月),D组(≥6个月)4组进行观察,所有患儿均在局麻下采用泪道冲洗探通针一次性完成泪道探通手术,手术前后使用生理盐水行泪道冲洗1～2 d,术后予妥布霉素滴眼液滴眼,对于术后泪道不通患儿手术1周复行泪道再次探通,2次探通失败者手术后1个月后再行泪道探通术。治愈标准为无溢泪,无分泌物,泪道冲洗通畅。术后仍然流泪,伴分泌物,泪道冲洗不畅为无效。结果 A组、B组、C组、D组1次治愈率分别为100%、93.3%、82.6%、66.7%,4组比较,患儿年龄越小,手术探通治愈率越高,差异有统计学意义(P<0.01)。结论先天性鼻泪管阻塞,年龄越小手术治愈率越高,出生后3个月内为最佳探通治疗时机。     

先天性泪囊炎的治疗方法及治疗时机

目的探讨先天性泪囊炎的治疗方法和时机选择。方法回顾分析了305例（330只眼）诊断为先天性泪囊炎患儿,分别采用泪囊按摩法、泪道加压冲洗和泪道探通术,以溢泪症状完全消失为治愈指标。结果泪囊按摩法治疗330只眼,治愈45只眼,治愈率13．6％;泪道加压冲洗法治疗285只眼,治愈61只眼,治愈率21．4％;泪道探通术治疗224只眼,治愈217只眼,治愈率96．9％。结论集探通及冲洗为一体的泪道探通术是治疗先天性泪囊炎的最有效方法,最佳治疗时机为3～6个月龄。     

2769例先天性泪道阻塞的临床分析

目的探讨治疗先天性泪道阻塞的有效措施及临床特点。方法收集先天性泪道阻塞的患儿2769例,采用局部按摩、加压冲洗保守方法治疗,治疗无效或家长要求手术者行泪道探通术,观察各治疗方法的治愈率。结果经按摩、冲洗或探通共治愈3498只眼,总治愈率达98.48%,其中保守治疗治愈率达32.92%,探通手术的治愈率可达97.77%。结论先天性鼻泪管阻塞的患儿,早期进行保守治疗十分必要,可大大提高自愈率,而泪道探通术是简单易行、治愈率高的方法。     

探针式泪道冲洗针治疗婴幼儿先天性鼻泪管阻塞

目的观察探针式泪道冲洗针治疗婴幼儿先天性鼻泪管阻塞的临床疗效。方法对83例（86眼）先天性鼻泪管阻塞的婴幼儿用探针式泪道冲洗针冲洗探通治疗进行观察分析。结果83例（86眼）先天性鼻泪管阻塞，全部探通治愈，其中1次探通治愈78眼（90．70％），2次探通治愈6眼（6．98％），3次探通治愈2眼（2．32％）。无1例出现假道或下泪点撕裂，无并发急性泪囊炎。结论厢探针式泪道冲洗针冲洗探通治疗先天性鼻泪管阻塞是有效的方法。     

先天性泪囊炎探通时机的选择

目的探讨先天性泪囊炎探通的时机.方法共计1 031例1 066眼,年龄最小15 d,最大8岁.按摩、冲洗、加压冲洗无效者行泪道探通术,观察治疗效果,选择探通的时机.结果泪道冲洗、加压泪道冲洗治愈295例310眼(28.61%).泪道探通一次治愈608例625眼(58.97%),泪道探通二次治愈107例110眼(10.38%),泪道探通三次治愈5例5眼(0.48%),共720例740眼(69.84%).总治愈率98.44%,好转15例15眼(1.45%),失败1例1眼(0.09%).结论经按摩、冲洗及加压冲洗泪道效果不好的患者,应及时行泪道探通术.在泪道探通技术熟练的情况下,出生1个月后可行泪道探道术.     

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.