强化妥布霉素滴眼液在外因性细菌性眼内炎治疗中的应用

目的：探讨强化妥布霉素滴眼液治疗急性外因性细菌性眼内炎的方法和疗效.方法：54例随机分成两组,每组27例（27眼）.强化治疗组（A组）：13.4g/L妥布霉素滴眼液滴眼;对照组（B组）3g/L妥布霉素滴眼液滴眼.两组均进行前房冲洗加前房注射万古霉素,辅以全身加局部同种和相同剂量的抗生素及激素治疗.分别观察两组房水渗出全部吸收平均时间、角膜水肿完全消退平均时间、房水病原菌培养结果和术后1mo最佳矫正视力,统计学处理采用t检验.结果：两组病例眼内炎症均得到控制,大部分视力得到不同程度改善.强化治疗组房水纤维素性渗出吸收时间短于对照组,统计学分析有显著性差异.两组房水病原菌培养结果和术后1mo最佳矫正视力分布差异没有统计学意义.结论：对于急性外因性细菌性眼内炎,在及时前房冲洗、前房注药治疗或者联合玻璃体切割术之外,13.4g/L强化妥布霉素滴眼液频繁滴眼有利于眼内炎症控制,是有效而且安全的辅助治疗方法.     

妥布霉素滴眼液治疗绿脓杆菌性角膜溃疡的临床研究

目的　观察用 0 .3%妥布霉素滴眼液治疗绿脓杆菌性角膜溃疡的临床疗效。方法　采用回顾性分析方法 ,选择我院近 6年来绿脓杆菌性角膜溃疡的病例 97例 ,分三个治疗组 ,分别用妥布霉素、氧氟沙星、庆大霉素治疗 ,根据临床检查分析其药物敏感情况及治疗效果。结果　 97例细菌培养阳性的患者中 ,妥布霉素组药物敏感率为 88.6 % ,氧氟沙星组为 84 .3% ,两组统计学处理无显著差异 ,庆大霉素组敏感率为 6 6 .7% ,与妥布霉素组比较有显著差异 (P <0 .0 5 )。妥布霉素组治疗有效率 88.6 % ,氧氟沙星组为 81.3% ,两组统计学处理无显著差异 ,庆大霉素有效率为 6 0 .0 % ,与妥布霉素相比较有显著差异 (P <0 .0 5 )。结论　妥布霉素对绿脓杆菌有较高的敏感性 ,早期及时应用妥布霉素滴眼液治疗绿脓杆菌性角膜溃疡能得到较好疗效 ,故妥布霉素滴液可考虑为治疗绿脓杆菌性角膜溃疡的一线药物     

头孢唑啉钠与妥布霉素联合应用治疗细菌性角膜溃疡的临床观察

目的：观察头孢唑啉钠与妥布霉素联合应用对细菌性角膜溃疡的治疗效果。方法：将78例细菌性角膜溃疡的患者随机分为两组，治疗组采用5％头孢唑啉钠滴眼液与0.8％妥布霉素滴眼液交替点眼，对照组应用5％头孢唑啉钠滴眼液与0.8％庆大霉素滴眼液交替点眼，比较两组的治疗效果。结果：治疗组治愈率为95％，对照组治愈率为78.9％，经X^2检验，两组之间存在显著差异。结论：头孢唑啉钠与妥布霉素联合治疗细菌性角膜溃疡效果显著，值得临床推广。     

妥布霉素治疗异物伤后铜绿假单胞菌性角膜溃疡

本文介绍用妥布霉素成功抢救5例因异物伤而致铜绿假单胞菌性角膜溃疡的病例。报告如下：一般资料：本组病例男4例，女1例，异物的种类：3例为铁屑，2例为角膜接触镜。右眼4例，左眼1例。年龄27～36岁。视力：光感～0.2.角膜溃疡直径3mm－6mm。3例伴有前房积脓，5例经细菌学检查均为阳性。药敏试验：对妥布霉素高度敏感。方法：治疗用受市霉素针剂80mg/2ml，给予妥布霉素20mg球结膜下注射，每天一次，共3－6次，并自制0．5％的要布霉素眼滴液（妥布霉素50mg，生理盐水加至10ml），开始时每10分钟满眼一次，以后等溃疡表面分泌物减少，溃疡好…     

妥布霉素治疗绿脓杆菌性角膜溃疡四例

脓杆菌性角膜溃疡是一种严重危及视力的感染性眼病,其病情发展快,并发症多,若不及时治疗,常可造成严重的视力损害.我们应用妥布霉素结膜下注射并配合托百士滴眼液(膏)(0.3%妥布霉素)治疗4例严重绿脓杆菌性角膜溃疡,取得良好疗效,报告如下.     

角膜塑形术致黏质沙雷菌性角膜炎1例

患者,男,14岁,因“左眼反复异物感,胀痛,视物模糊4d,加重1d”于2020年3月30日至重庆爱尔儿童眼科医院就诊。患者双眼近视,配戴角膜塑形镜半年。眼部检查示：右眼裸眼视力（UCVA）0.2,左眼UCVA数指/30cm;双眼指测眼压正常。右眼裂隙灯显微镜检查未见明显异常。左眼裂隙灯显微镜下检查示：结膜混合充血（+++）,无水肿,角膜中央上皮片状缺损,大小约2mm×2mm,荧光素钠染色（+）,周围角膜浅基质层混浊（++）,水肿（++++）,角膜后弹力层皱褶（++）,内皮可见灰白色角膜后沉着物（+++）,前房轴深正常,前房闪辉（++++）,前房内见大量絮状漂浮物,下方积脓,液平高约1mm,虹膜纹理欠清,瞳孔圆,直径约3mm,对光反射迟钝,晶状体透明,眼底窥不清（患者欠配合）（见图1A—B）。患者手卫生检查示：双手指甲长,指甲内含大量污垢。患者配戴角膜塑形镜半年,期间仅在戴角膜塑形镜后的第1天到我院进行复查,此后半年患者均未遵医嘱返院复查。平素患者使用吸棒取戴角膜塑形镜,入院前1周,患者吸棒丢失,也未购买新的吸棒,而改用双手取戴。考虑诊断为：左眼细菌性角膜炎。入院后立即予以左眼0.5%左氧氟沙星滴眼液每10min滴用1次,强化妥布霉素滴眼液每10min滴用1次,妥布霉素眼膏每晚1次,全身给予注射用克林霉素0.6g静脉滴注抗感染治疗。同时左眼角膜病灶刮片取材,行细菌培养及药物敏感性试验检查。入院1d后,裂隙灯显微镜眼部检查示：左眼结膜混合充血（+++）,角膜中央上皮缺损较入院时变小,约1mm×1mm 大,角膜浅基质层混浊（++）,水肿（+++）,前房闪辉（+++）,前房积脓消失,其余眼部检查结果同入院时。青霉素皮试检查阴性,考虑抗感染治疗有效。治疗：左氧氟沙星滴眼液及强化妥布霉素滴眼液均减量为每1h滴用1次,同时加用氯替泼诺妥布霉素滴眼液点左眼每1h滴用1次,以减轻角膜基质层炎症,妥布霉素眼膏每晚滴用1次。克林霉素注射液更改为头孢他啶注射液1g静脉滴注,每8h滴用1次/h。随后每日多次行裂隙灯显微镜检查,密切观察病情变化。入院2d后,患者自诉左眼疼痛感逐渐减轻,裂隙灯显微镜眼部检查示：左眼结膜混合充血（++）,角膜中央上皮片状缺损减小为0.5mm×0.5mm,角膜浅基质层混浊（+）,水肿（++）,角膜后弹力层皱褶消失,内皮角膜后沉着物消失,前房闪辉（+++）。遂将氯替泼诺妥布霉素滴眼液减量为每日4 次,左氧氟沙星滴眼液及强化妥布霉素滴眼液减量为每2h滴用1次,其余用药不变。入院4d后,患者自述左眼视物较前清晰,无明显疼痛感,右眼UCVA0.2,左眼0.02。裂隙灯显微镜检查示：左眼结膜混合充血（+）,角膜上皮完整,中央角膜上皮粗糙,范围约4mm×4mm,角膜浅基质层混浊（+）,水肿（+）,前房闪辉（+）（见图1C—D）。细菌培养结果示：粘质沙雷菌、G-杆菌。药物敏感试验示：对庆大霉素、头孢他啶及左氧氟沙星等药物均敏感。治疗：予以左氧氟沙星滴眼液及强化妥布霉素滴眼液减量为每日4次,其余用药不变。入院1周后,患者诉左眼无明显不适。眼科检查示：左眼UCVA0.06,眼压18mmHg（1mmHg=0.133kPa）,裂隙灯显微镜检查示：左眼结膜混合充血（+）,角膜上皮完整,荧光素钠染色可见散在点状着染,角膜基质水肿（+）,后弹力层皱褶及前房闪辉均消失（见图1E—F）,予以出院。出院后继续予以氯替泼诺妥布霉素滴眼液每日4次,左氧氟沙星滴眼液及强化妥布霉素滴眼液每日4次,妥布霉素眼膏每晚1次治疗。出院后1周患者于门诊复查,左眼矫正视力恢复至1.0,左眼结膜无充血,角膜瞳孔区偏下方可见一直径约1mm类圆形云翳,其余角膜透明,基质无水肿,前房清亮。左眼角膜溃疡治愈。     

氟康唑滴眼治疗真菌性角膜溃疡的疗效观察

为观察氟康唑滴眼液治疗真菌性角膜溃疡的疗效，用０．２％氟康唑滴眼治疗２６例真菌性角膜溃疡，溃疡面积达６ｍｍ或小于６ｍｍ而有前房积脓者每半小时滴眼１次，溃疡面积小于６ｍｍ者每小时滴眼１次，视病情好转可减少点眼次数。抽１９９４年以前确诊真菌性角膜溃疡的住院病人１８例作为对照。结果：治疗组治愈率７３．０８％，总有效率达９２．３１％，两组间治愈率和总有效率经卡方检验Ｐ＜０．０１，有极显著差异。结论：０．２％氟康唑滴眼治疗真菌性角膜溃疡有较好疗效，无毒副作用，痛苦小，既经济又方便病人。     

妥布霉素滴眼液对家兔细菌性角膜炎体内外抗菌作用

目的:研究妥布霉素滴眼液的抗菌作用.方法:体外采用M-H肉汤稀释法,妥布霉素滴眼液对大肠埃希菌、金黄色葡萄球菌、绿脓杆菌、化脓性链球菌、肺炎克雷伯菌、肺炎链球菌进行体外抑菌、杀菌试验.体内用角膜环钻损伤兔眼角膜,感染大肠埃希菌、金黄色葡萄球菌、绿脓杆菌、化脓性链球菌造成角膜炎动物模型.然后用妥布霉素滴眼液滴眼4次/d,每眼0.1mL,连续给药7d.d8处死家兔.以观察角膜病理切片,临床症状评分统计学t检验处理及角膜分泌物细菌培养判断疗效.结果:体外试验表明妥布霉素滴眼液对上述6种细菌最低杀菌浓度(MBC)分别为0.19,0.39,0.78,46.88,93.75,187.50μg/mL.体内抗菌试验显示,家兔眼感染大肠埃希菌、金黄色葡萄球菌、绿脓杆菌、化脓性链球菌感染后,妥布霉素滴眼液在治疗3d评分结果与未治疗对照组比较均有显著差异,5d细菌培养转阴率大肠埃希菌、金黄色葡萄球菌、绿脓杆菌均为100%,化脓性链球菌83%.角膜病理结果显示除化脓性链球菌伤口愈合较慢,余3种菌伤口斑痕愈合良好.结论:妥布霉素滴眼液对大肠埃希菌、金黄色葡萄球菌、绿脓杆菌敏感性较强;所致家兔角膜炎治疗效果较好,化脓性链球菌、肺炎克雷伯菌、肺炎链球菌对其敏感性较弱.     

术前常用滴眼液对角膜内皮及角膜厚度的影响

目的 讨论白内障手术前常规使用的左氧氟沙星滴眼液、妥布霉素滴眼液及普拉洛芬滴眼液滴眼对角膜内皮细胞密度及角膜厚度的影响.方法 白内障手术前120例(120眼),随机分为6个组.术前分别以4次/d及1次/h两种频率滴用左氧氟沙星滴眼液、妥布霉素滴眼液及普拉洛芬滴眼液连续3d,检测用药前后角膜内皮细胞密度及角膜厚度.结果 3种滴眼液按照两种使用频率连用3d,用药前后角膜内皮细胞密度及中央角膜厚度自身对照比较差异均无统计学意义(t=- 1.595～1.608,P＞O.05).结论 左氧氟沙星、妥布霉素及普拉洛芬滴眼液对角膜内皮细胞密度及角膜厚度的并无明显影响.     

妥布霉素玻璃酸钠滴眼液在超声乳化白内障摘出术后的应用

目的评价妥布霉素玻璃酸钠滴眼液在超声乳化白内障摘出术后应用的临床有效性和安全性。方法随机、双盲筛选出白内障患者121例（121眼）施行超声乳化白内障摘出联合人工晶状体植入术，分为试验组和对照组，试验组术后滴用妥布霉素玻璃酸钠滴眼液，对照组术后滴用妥布霉素地塞米松滴眼液，分别于术后第1d、用药后第3、7、14d观察眼部症状和体征，并进行统计学分析。结果两组术后泪膜破裂时间、结膜充血、睫状充血、房水闪辉等比较，差异有统计学意义（P〈0．05）；角膜内皮细胞计数、视力、眼压等比较差异无统计学意义（P〉0．05）。结论对部分手术创伤小，反应轻的超声乳化白内障摘出术后的患者可以使用妥布霉素玻璃酸钠滴眼液。     

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.