高三尖杉酯碱用于青光眼滤过术的临床随机对照研究

目的研究高三尖杉酯碱（ｈｏｍｏｈａｒｉｎｇｔｏｎｉｎｅ）在青光眼滤过术中的抗增殖作用。方法采用随机对照的临床验证方法,施行同一标准的小梁切除术,将７８例（８８只眼）难治性青光眼分为用药组４２例（４６只眼）和对照组３６例（４２只眼）。用药组术中应用高三尖杉酯碱０４ｍｇ,术后再分次结膜下注射高三尖杉酯碱０６２±０２０ｍｇ（范围０５３～０７５ｍｇ）;对照组未用高三尖杉酯碱。术后随访观察１８～４８个月（平均３６个月）。采用寿命表分析法统计。结果手术成功率：用药组为８４５％,对照组为５０９％（Ｐ＜０．０５）。功能性滤过泡的累计百分率：用药组为８４２％,对照组为５２９％（Ｐ＜０．０５）。并发症：用药组的角膜上皮缺损和结膜伤口渗漏发生率分别为２３９％和６５％,对照组为７１％和２４％（Ｐ＜０．０５）。用药组的角膜内皮细胞数在用药前后差异无显著性（Ｐ＞０．０５）。结论高三尖杉酯碱是安全有效的抗增殖药物,可明显提高青光眼滤过术的成功率,至少可在术后３年内将眼压维持在正常水平。     

青光眼滤过术后白内障超声乳化吸出术26例

1临床资料我科2001-04/2003-01所收治的26例(28眼)青光眼滤过术后的白内障超声乳化吸出术患者术前眼压均在正常范围,男9例,女17例;右眼17眼,左眼11眼;年龄50～78(66.5±8.7)岁。青光眼术后3mo～5a;术前视力:HM/10cm～0.25;术前患者伴有虹膜后粘连者8眼(28%)、高度近视者2眼(7%)     

青光眼滤过术后异常滤过泡的治疗

目的 探讨青光眼滤过术后异常滤过泡的特点及处理方法。方法 观察62例具有异常滤过泡的滤泡形态及眼压情况，分别给予指压按摩、针刺断线、针刺分离、手术修复及药物治疗等治疗措施。结果 59例异常滤过泡经治疗后转化为功能性滤过泡，眼压得到有效控制。结论 术后细致观察青光眼滤过泡的形态，对异常滤过泡及时正确处理，可使部分非功能性滤过泡转化为功能性滤过泡，提高了青光眼的手术成功率。     

青光眼滤过术后滤过泡失效的处理

滤过性手术是治疗青光眼的主要方法，术后球结膜下形成有功能的滤过泡是治疗成功的关键。但有些患眼并没有成功能的滤过泡，或虽形成有功能的滤过泡但在术后一段时期又发生滤过泡失效，同时滤过泡本身发生病变又会带来许多并发症。这是临床工作经常遇到，又必须处理的问题，因此，本就失败滤过泡和滤过泡相关并发症的处理作了综述。     

青光眼滤过术后影响滤过泡形成原因的临床分析

目的 探讨青光眼滤过术后影响滤过泡形成的因素.方法 对2006年以来在我院行滤过手术并坚持随访1年以上的139名患者172眼的滤过泡形成情况进行统计分析.结果 本组患者术后1 a,Ⅰ型滤泡共61眼,占35.5%,Ⅱ型滤泡共89眼,占51.7%,Ⅲ型滤泡共15眼,占8.7%,Ⅳ型滤泡7眼,占4.1%.术后1 a,眼压8～16 mmHg者123眼,占71.5%,16～21 mmHg者36眼,占20.9%,大于21 mmHg者13眼,占7.6%;10眼大于正常值者中10眼通过按摩加药物的方法可以控制眼压在正常范围内;另外3眼通过2次手术将眼压控制在正常值以内.结论 青光眼滤过术后滤过泡形成主要与抗代谢药物的使用、手术技巧以及术后处理等因素有关.     

青光眼滤过术后滤过不良的早期处理

青光眼滤过术后滤过道瘢痕形成,是导致滤过功能下降的主要原因,尽管有手术方式的改进和术中抗瘢痕药物的应用等,但术后仍出现滤过不良。为采取补救措施,我科对滤过不良、眼压升高的患者,采用滤过区球结膜下针刺分离联合5-氟尿嘧啶(5-Fu)结膜下注射及眼球按摩,取得较好效果...     

青光眼滤过术后滤泡并发症及其处理

目的 探讨青光眼滤过术后滤泡并发症及其处理效果。方法 回顾性分析我院青光眼滤过术后滤泡并发症情况，随访时间从2000年2月到2002年4月，观察记录并分析并发症发生情况和预后效果。结果 55例(68眼)青光眼患者，小梁切除术后发生滤过泡疤痕11例，滤过泡渗漏2例，滤过泡感染1例，包裹性囊状滤过泡1眼，巨大薄壁滤过泡1眼。其中7例早期疤痕性滤过泡患者经处理后有5例眼压得以控制，4例晚期疤痕性滤过泡患者仅1例加用抗青光眼药物后眼压可维持于正常水平；滤泡渗漏和滤泡感染患者经处理完全治愈；包裹性囊状滤过泡及巨大薄壁滤过泡也得到控制。结论 青光眼滤过手术后会出现各种滤过泡并发症，早期及时正确处理成功率高，可避免造成严重后果。     

青光眼滤过术后浅前房的临床探讨

目的 讨论青光眼滤过术后浅前房形成的常见原因及处理方法。方法 回顾性总结北京同仁医院青光眼组1998年10月～1999年10月期间连续收治的352例青光眼住院患者行青光眼滤过性手术后发生浅前房的原因、类型及处理方法。结果 共行青光眼滤过性手术495只眼，其中117只眼发生浅前房，发生率为23．64％。小梁切除术为19．2％(15／78)，小梁切除术 MMC为32％(93／291)，青光眼联合白内障的三联手术为7．1％(9／26)。浅前房发生在术后1～7天，其中滤过过畅36只眼(30．77％)、睫状体脉络膜脱离34只眼(29．06％)、结膜瓣渗漏27只眼(23．08％)、恶性青光眼15只眼(12．8％)、恶性青光眼合并睫状体脉络膜脱离3只眼(2．56％)、脉络膜上腔出血2只眼(1．71％)。需要手术治疗的35只眼，其余82只眼仅通过保守治疗均能恢复前房。结论 青光眼滤过术后浅前房发生率较高，其常见原因是房水滤过过畅、结膜瓣渗漏及睫状体脉络膜脱离。以小梁切除术 MMC的发生率最高，MMC不但能阻止滤过泡的纤维化，而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈。     

青光眼滤过术后浅前房的临床分析

作者对1985年至1996年4月所行的各种抗青光眼滤过手术169例236眼，就青光眼滤过术后浅前房进行1顾性临床分析。一般资料：本组1＠例236眼，男76例，女叨例，年龄41岁至m岁，年龄在45岁以下者16例明眼，46岁至59岁的65例83眼，cd岁以上幻例135眼。急性闭角型117例（49眼），慢性闭角型35例56眼，开角型13例26眼，继发性4例5眼。小梁切除术l叨眼，巩膜咬切术26眼，虹膜嵌顿术18眼。方法：所有患眼术前均经3－7天局部或全身降眼压药物治疗，术前平均眼压3．mll．刃M七（比比一7．5删讪培。术后每天常现裂隙灯检查，直接眼底镜查眼底，再测眼压…     

t—PA治疗眼内出血的初步临床观察

目的 探讨组织型纤溶酶原激活剂的对眼内出血的治疗作用及并发症。方法 常规方法治疗无效的眼内出血者１４例,４例前房出血行前房注射。９例玻璃体出血行玻璃体注射。１例暴发性脉络膜上腔出血后脉络膜上腔注射。结果 追踪１－６月,平均２月,出血溶解１３例,视力提高１２例。     

Promotion of glaucoma filter bleb with tissue plasminogen activator after sclerectomy under a clot

Since 1987 we have performed, with good results, glaucoma filtering surgery in which the limbo-scleral fistula was closed by an autogenic full blood clot (sclerectomy under a clot). In 8 patients with advanced stages of glaucoma simplex, 1–3 days after sclerectomy under a clot with rise IOP, 25g of tissue plasminogen activator (tPA) was injected subconjunctivally. Two weeks after surgery normalization of IOP below 15 mmHg and normal outflow facility in all tPA treated eyes were obtained. No increase in early postoperative complications, such as hemorrhage or corneal haze, was attributable to tPA use. In early period after sclerectomy under a clot, when blockage of outflow appears, the use of tPA can cause the re-creation of filtering tract.     

The use of recombinant tissue plasminogen activator for intracameral fibrinolysis following cataract surgery

In a prospective study performed between June 1992 and March 1994 19 eyes of 19 patients with dense fibrinous pupillary membranes following cataract surgery were treated with intracameral injections of 25g recombinant tissue plasminogen activator (r-tPA). Injections were performed between the second and twenty-third postoperative day (mean 5.6±6.9 days). Complete fibrinolysis within one to 4 hours (mean: 3.3±0.89 hours) was observed in 18 (94.7%) eyes. In one (5.3%) eye fibrinolysis was incomplete despite a second injection. In 2 (10.5%) eyes recurrence of a distinct fibrinous membrane was noted which then cleared spontaneously with topical treatment. A small hyphema developed in 2 (10.5%) eyes and intraocular pressure exceeded 25 mm Hg in 2 (10.5%) eyes. No increase of keratopathy nor any toxic intraocular side effect of 25g intracameral r-tPA was observed throughout the study. The intracameral injection of r-tPA clinically proved to safely accelerate the resorption of dense fibrinous membranes following cataract surgery and thus enhance visual recovery minimizing subsequent complications and systemic or subconjunctival anti-inflammatory treatment.     

Recombinant tissue plasminogen activator for treatment of fibrinous membranes after cataract surgery

AIM: To investigate the efficacy of recombinant tissue plasminogen activator (TPA) for treatment of fibrinous membranes following cataract surgery. · METHODS: 25μg of TPA was injected into the anterior chamber of 15 pseudophakic eyes with moderate to severe fibrinous membranes that developed after cataract surgery. Simultaneously, topical corticosteroid and cycloplegic therapy was continued. Routine follow-up included slit-lamp examination and intraocular pressure measurement. · RESULTS: Injection of the solution of tissue plasminogen activator into anterior chamber of 15 eyes resulted in complete dissolution of the fibrinous membranes in 9 (60.0%) eyes after 2 hours, and 11 (73.3%) eyes within 1 day. In 3 eyes, within a few days after injection, fibrinous membrane recurred. Increased anterior chamber reaction (P =0.54) and corneal edema (P =0.083) were seen after 24 hours. No evidence of toxicity was observed as measured by slit-lamp biomicroscopy and intraocular pressure. Finally, expectable stable result was obtained in all of the eyes. · CONCLUSION: Safety and high efficacy of TPA in the treatment of fibrinous membranes after cataract surgery are confirmed.     

重组组织型纤维蛋白酶原激活剂治疗白内障手术后的纤维蛋白膜

目的：研究重组组织型纤维蛋白酶原激活剂（tPA）对于治疗白内障手术后的纤维蛋白膜的作用。 方法：选取白内障人工晶状体植入术后中度至重度纤维蛋白膜15例,行25μgtPA前房注射。同时给与持续的局部激素和睫状肌麻痹剂治疗,以及常规的裂隙灯检查和眼压监测。 结果：在前房注射tPA的15眼中,其中9眼（60.0%）在2h后纤维蛋白膜完全溶解,11眼（73.3%）在1d内完全溶解。3眼内注射tPA几天后纤维蛋白膜复发。注射tPA24h后可观察到前房反应（P=0.54）和角膜水肿（P=0.083）增加。裂隙灯和眼压检查未发现明显的毒副作用。实验得到预期的稳定结果。 结论：前房注射tPA用于治疗白内障手术后出现的纤维蛋白膜具有安全有效的作用。由于病例数量较少,需要进一步观察。     

Treatment of experimental suprachoroidal hemorrhage with intravenous tissue plasminogen activator

Suprachoroidal hemorrhages were created in 15 albino rabbit eyes by injecting 0.1 cc of autologous blood into the suprachoroidal space. One day later, 10 of these eyes were treated with intravenous tissue plasminogen activator (TPA). Doses of 1 mg per kg were given to each rabbit over 2 to 3 hours by intravenous infusion. Five eyes served as control. The rate of clearance of hemorrhage was compared in the two groups. Average day of clearance was 14 days for the treated group, and 20.2 for the untreated control group. In this study, TPA given intravenously appears to accelerate the clearance of suprachoroidal hemorrhage.Supported in part by Public Health Service Grant EYO2377, from the National Eye Institute, National Institutes of Health, Bethesda, Md.     

Management of subconjunctival haematoma by tissue plasminogen activator

A patient with subconjunctival haematoma related to enterovirus 70 who was treated with tissue plasminogen activator (tPA) is reported. A 46-year-old man developed a severe subconjunctival haematoma and discharge in the left eye. Investigations, including coagulation tests, showed no abnormalities apart from a high-serum antibody titre for enterovirus 70. The polymerase chain reaction demonstrated enterovirus 70 DNA in resected conjunctival tissue, leading to a diagnosis of acute haemorrhagic conjunctivitis. The left eye was treated with a single subconjunctival injection of tPA (16 000 IU) and the subconjunctival haematoma resolved completely after 3 days. Severe subconjunctival haematoma can occur in patients with acute haemorrhagic conjunctivitis due to enterovirus 70. Subconjunctival injection of tPA may be useful for the treatment of severe subconjunctival haematoma.     

玻璃体腔组织纤溶酶原激活剂治疗玻璃体黄斑粘连

目的：评估仅玻璃体腔注射组织纤溶酶原激活剂(TPA)对玻璃体黄斑牵引以及玻璃体腔注射TPA和贝伐单抗对视网膜血管疾病的改善作用。

方法：前瞻性研究。对24例24眼患者进行干预性系统研究。其中5眼玻璃体黄斑牵引综合征(VMT),19眼视网膜血管疾病包括：糖尿病黄斑水肿(DME)眼,糖尿病性玻璃体出血(VH)眼,视网膜中央静脉阻塞(CRVO)和新生血管年龄相关性黄斑变性眼(AMD)。在注射前及注射1mo后分别进行视力,B超和OCT检查。3眼VMT接受玻璃体腔单次注射TPA50 μg,2眼接受100 μg 注射。19例视网膜血管疾病患者接受玻璃体腔组织纤溶酶原激活剂(50 μg)和贝伐单抗(1.25 mg)联合治疗。

结果：纳入病例中男性10眼视网膜血管疾病和VMT患者平均年龄分别为56.8y 和60.4y。纳入病例中男性10眼(41.7%),女性14眼(58.3%)。22眼(91.7%)晶状体眼,2眼(8.3%)人工晶状体眼。VMT和视网膜血管疾病的玻璃体后部脱离(PVD)分别为0(0/5)和57.8%(11/19)(P=0.04)。在改善最佳矫正视力(BCVA)和降低黄斑中心凹厚度(CMT)方面,与无PVD眼相比,有PVD眼改善更多。

结论：在VMT患者中,单独玻璃体腔内注射TPA不能成功诱导玻璃体后部完全脱离。玻璃体腔联合注射TPA和贝伐单抗可引起视网膜血管疾病患者玻璃体后部脱离,提高最佳矫正视力以及降低黄斑中心凹厚度。     

Intravitreal tissue plasminogen activator for treatment of vitreomacular adhesion

AIM: To evaluate the role of a single intravitreal injection of tissue plasminogen activator alone (TPA) for treatment of vitreomacular traction and the effect of combined intravitreal TPA and bevacizumab on retinal vascular diseases. METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome (VMT) and 19 eyes with retinal vascular diseases including diabetic macular edema (DME), diabetic vitreous hemorrhage (VH), central retinal vein occlusion (CRVO) and neovascular age related macular degeneration (AMD). Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. Totally 19 eyes with retinal vascular diseases received combined intravitreal TPA (50 μg) and Bevacizumab (1.25 mg). RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56.8y and 60.4y, respectively. Ten patients (41.7%) were male and 14 patients (58.3%) were female. 22 eyes (91.7%) were phakic and 2 eyes (8.3%) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 0% (0 of 5) and 57.8% (11 of 19) for VMT and retinal vascular diseases, respectively (P=0.04). Improvement of best corrected visual acuity (BCVA) and decrement of central macular thickness (CMT) were significantly greater in PVD positive eyes compared with PVD negative eyes. CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and Bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.     

The use of tissue plasminogen activator in postvitrectomy cases

The study concerns 17 eyes which, following vitrectomy, were given an injection of 25 g of tissue plasminogen activator (tPA). Of these 17 cases, ten showed a severe fibrin formation in the anterior chamber, 3 cases showed vitreous hemorrhage (one of them with hyphema), 2 had fibrin formation and cellular proliferation, while in one case tPA was injected at the end of the vitrectomy because of perisilicone proliferation and in one case because of fibrin depositions on the intraocular lens.The tPA was injected into the anterior chamber (10 eyes) or into the vitreous cavity (7 eyes). The follow-up period ranged from 4 to 15 months (mean period 91/2 months). Fibrinolysis was noted in the 10 cases with fibrin formation in the anterior chamber. Fibrin dissolution was achieved within 3–4 hours. None of these cases presented a recurrence throughout the follow-up period. Positive results were observed also in the case with perisilicone proliferation. On the contrary in 3 cases with postvitrectomy hemorrhage the hemorrhage persisted unchanged. Also in 2 cases with fibrin formation and cellular proliferation on the anterior and posterior surface of the iris the tPA injection proved ineffective. Both cases developed traction retinal detachment (TRD) due to anterior proliferative vitreoretinopathy (PVR). In the case with fibrin depositions on the intraocular lens the situation remained unchanged. Any complications observed in our case proved to be mild and transitory.