眼球穿孔伤30例治疗体会

目的探讨眼球穿孔伤的显微手术治疗效果。方法30例（30眼）眼球穿孔伤均于手术显微镜下行急诊伤口探查修复术,并依伤情需要行二次手术治疗。结果30例手术治疗后均达到Ⅱ期甲级伤口愈合,27例保留了眼球,术后视力均有不同程度的提高;1例伤眼萎缩,健眼发生交感性眼炎;2例因严重的眼球破裂伤,视功能恢复无望,经患者同意行伤眼眼球摘除。结论眼球穿孔伤的预后取决于损伤程度、并发症及伤口及时正确处理。     

Surgical correction of progressive high myopic esotropia by Yamada's technique: report of two cases

"Progressive esotropia fixus" is a disease present in high myopic patients with a large angle esotropia associated with hypotropia with poor surgical results. This paper has the purpose to describe Yamada's surgical technique (hemitranspositions of the superior rectus and lateral rectus) applied to 2 patients with good surgical results.     

视网膜光凝和玻璃体手术治疗糖尿病视网膜病变的有效性

糖尿病视网膜病变( diabetic retinopathy,DR)是工作人群中首位的致盲性眼病.视网膜激光光凝术和玻璃体切割术是目前干预和治疗DR的经典模式.随着手术设备的不断更新和手术技术的日益成熟,手术治疗的有效性是眼科临床医师关注的重点和难题.本文就DR的视网膜激光光凝术和手术治疗有效性现状进行总结如下.     

Complications of surgery for subfoveal choroidal neovascularization

Advancing surgical techniques have made the surgical excision of subfoveal CNV possible in all cases. However, serious surgical complications lead to a limited visual outcome in many cases. The major complications that cause poor visual outcome are related to poor case selection and include injury to the RPE, with secondary atrophy of the choriocapillaris and damage to the neurosensory retina, and a high rate of persistent or recurrent CNV. Patients with POHS have localized disease of the RPE-Bruch's membrane complex and typically have CNV growing between the RPE and neurosensory retina (type 2 CNV). These patients have the best visual prognosis postoperatively because of the potential for maintaining native RPE beneath the fovea. Patients with AMD typically have CNV growing beneath the RPE (type I CNV). These patients are poor surgical candidates because the surgical excision of type I CNV is almost always associated with débridement of native subfoveal RPE and a poor visual outcome. Presently, all surgical studies have been retrospective and are characterized by limited follow-up. Therefore, whether surgical excision of subfoveal CNV is beneficial as compared to mere observation is uncertain. A large, randomized, prospective study currently is being performed. These Submacular Surgery Trials will attempt to determine whether these surgical procedures are more efficacious than observation and whether the benefits outweight the risks of surgery in these patients.     

囊袋张力环和虹膜拉钩在白内障手术中的应用进展

在白内障手术中合理应用手术辅助器械能够有效提高手术安全性,减少手术并发症,提高患者视觉质量。囊袋张力环及虹膜拉钩是白内障手术中最主要的手术辅助器械,近年来得到了广泛的应用。本文就其材料与设计的发展、单独或联合在白内障手术中的应用作一综述。     

黄斑裂孔性视网膜脱离手术治疗效果分析

目的 探讨不同手术方法治疗黄斑裂孔性视网膜脱离术后复发率及术后视功能的差异。方法 对黄斑裂孔性视网膜脱离22例22眼采用2种不同的手术方法治疗，一组采用单纯玻璃体腔内注气(C3F8)术，另一组采用巩膜外环扎或巩膜外垫压联合巩膜外冷凝、玻璃体切割并玻璃体腔内注气术。结果 单纯玻璃体腔内注气术较巩膜外环扎或巩膜外垫压联合巩膜外冷凝，联合玻璃体切割并玻璃体腔内注气术复发率高，二者术后视力恢复均不理以未见明显差异。结论 提高黄斑裂孔性视网膜脱离手术成功率，关键在于根据患者具体病情，选择适宜的手术方法，在达到视网膜解剖复位的同时，尽可能保护视功能。     

儿童部分调节性内斜视的手术量

目的探讨儿童部分调节性内斜视手术量及方法。方法对儿童部分调节性内斜视109例分成两组：治疗组6l例，以平均斜视角或偏向于裸眼斜视角制定矫正斜视手术量；对照组48例，以戴镜后斜视角制定矫正斜视手术量。两组术前术后均作了同样的相关检查。结果治疗组矫正良好者55例（90．16％），部分矫正6例（9．84％）。对照组矫正良好者25例（52．08％），部分矫正者23例（47．92％）。结论儿童部分调节性内斜视的手术量宜按照平均斜视角或偏向于裸眼斜视角制定。     

正确理解及应用白内障微小切口超声乳化技术

微切口白内障手术的优点在于其组织损伤更小,切口愈合更快;引起的手术源性角膜散光更小,对角膜的像差变化影响也变小。但随着手术切口逐渐减小,临床手术操作中会面临手术方式的微小改变,尤其是撕囊方式的改进、手术器械及超声乳化机器的更新、人工晶状体的选择、硬核白内障的处理等新问题。所以应该平衡手术切口与手术过程的安全性这一重要问题,依据病情及患者所采用的人工晶状体合理选择超声乳化方式。（眼科, 2012, 21： 79-81）     

Trabeculectomy with mitomycin C for treatment of neovascular glaucoma in diabetic patients

BACKGROUND: To assess the efficacy and to determine the risk factors of trabeculectomy with mitomycin C (MMC) in eyes with neovascular glaucoma (NVG) secondary to diabetic retinopathy. METHODS: Kaplan-Meier survival analysis of the surgical outcome was performed on 35 eyes with NVG. Age, extent of peripheral anterior synechia, surgical history (cataract, glaucoma, vitrectomy), and concurrent retinal cryotherapy were evaluated to determine factors influencing the surgical outcome. The main criterion for success was a postoperative intraocular pressure (IOP) of < or = 21 mm Hg. RESULTS: The cumulative probability of success was 67.0% at 1 year and 61.8% after 2 to 3 years. The surgical outcome was significantly better in patients without a previous vitrectomy (p = 0.03). Extensive preoperative peripheral anterior synechia was also a risk factor for surgical failure (p = 0.013). CONCLUSIONS: Trabeculectomy with MMC can effectively reduce the elevated IOP associated with NVG. The extent of peripheral anterior synechia and a history of vitrectomy are significant negative predictors of surgical outcome.     

The surgical treatment of congenital divided nevus of the eyelid: a case report and review of the literature

We describe a 16-year-old male patient with congenital divided nevus of the eyelids who underwent surgical management using musculocutaneous and tarsoconjunctival flap, and discuss the alternative surgical approaches in the light of the literature. Musculocutaneous flap in conjunction with a tarsoconjunctical flap can be considered as a suitable surgical approach in the management of divided nevus. The patient’s age, gender, the diameter of the lesion, and involvement degree of the entire tarsus, must be kept in mind before the surgery. If the surgical treatment method is tailored for the patient, a better cosmesis can be achieved.     

Current concepts in the identification and treatment of stage 2 macular holes

Over the past decade, a better understanding of the pathogenesis and evolution of idiopathic macular holes has developed. Theories implicating the role of the vitreous in hole formation have led to surgical interventions that have met with surprising success. Recent advances in identifying early lesions, coupled with variations in surgical results based on the hole's preoperative stage, have led some authors to suggest earlier intervention. This report reviews current concepts of macular hole development, focusing on the pathoanatomy, natural history, surgical approach, and surgical outcomes of stage 2 macular holes.     

Symptomatic cicatrizial occlusion of canaliculi after insertion of Herrick lacrimal plugs

PURPOSE: To report severe symptomatic complications following bilateral insertion of Herrick lacrimal plugs. DESIGN: Interventional case report. METHODS: Bilateral clinical, surgical, and histologic findings in a patient with surgical revision of canaliculi after plug insertion. RESULTS: A 55-year-old patient presented with recurrent inflammation, discharge, and epiphora 24 months after insertion of lacrimal plugs; surgical intervention and partial resection of the cicatrized canaliculi was necessary. Light microscopic histology revealed canaliculi destruction, reactive tissue embedding of the plugs, and dissociated plug material. CONCLUSIONS: The application of Herrick lacrimal plugs may not be reversible and may require invasive surgical intervention.     

Surgical drainage of chronic serous retinal detachment associated with uveitis

PURPOSE: To evaluate the anatomic and visual outcomes after surgical management of chronic serous retinal detachments (SRD) associated with uveitis. METHODS: Retrospective, interventional, case study of patients with uveitis with controlled ocular inflammation who underwent drainage of a chronic SRD at the Cole Eye Institute (1998-2006). Data collected included diagnosis, ophthalmic findings, medical management, surgical technique, complications, and anatomic and visual outcomes. RESULTS: Five patients with uveitis were identified who underwent surgical drainage of a SRD. Preoperative medical treatment included prednisone 1 mg/kg with various tapering regimens. The median time on oral corticosteroids preoperatively was 4 months (range 3-6 months). Four patients received further adjuvant treatment. Median time from SRD diagnosis to surgical drainage was 6 months (range 3-15 months). No patient had active intraocular inflammation preoperatively. Retinal reattachment was achieved in all patients after a median follow-up of 55 months (range 1-61 months). Four of five patients experienced improvement in visual acuity after surgical intervention. CONCLUSION: Select patients with uveitis with a SRD whose subretinal fluid fails to resorb after medical therapy and resolution of inflammation can achieve long-term retinal reattachment by surgical management.     

玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔

目的　探讨玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔的疗效。方法　回顾性分析2017年3月至2019年12月在我院行玻璃体切割术治疗的大孔径（最小直径＞400 μm）特发性黄斑裂孔患者68例,其中40例联合内界膜翻转填塞治疗（传统术式组）,28例联合玻璃酸钠凝胶辅助内界膜翻转填塞治疗（改良术式组）。比较两组患者术前及术后最佳矫正视力及裂孔闭合率。结果　传统术式组术后6个月视力（0.842±0.340）logMAR较术前（1.160±0.310）logMAR明显改善（P<0.05）,改良术式组术后6个月视力（0.825±0.288)logMAR较术前（1.204±0.334）logMAR也明显改善（P<0.05）,但两组患者术后视力改善程度差异无统计学意义（P>0.05）。改良术式组术后裂孔闭合率（100.00%）高于传统术式组（77.50%）,差异有统计学意义（P<0.05）,且随着裂孔直径的增大,传统术式组术后裂孔闭合率逐渐降低。超大孔径特发性黄斑裂孔（裂孔直径>700 μm）分组中,传统术式组和改良术式组患者术后裂孔闭合率分别为61.53%、100.00%,差异也有统计学意义（P<0.05）。结论　玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术是一种安全有效的手术方式,不仅在一定程度改善大孔径黄斑裂孔患者术后视力,还可大幅提高大孔径特发性黄斑裂孔闭合率,尤其是超大孔径黄斑裂孔的闭合率。     

Sodium hyaluronate in cataract surgery. I. Report on the use of Healon in two different types of intracapsular cataract surgery

Healon has been used in a prospective study as a surgical device for two cataract surgical methods. The study comprised 80 patients divided into two groups. In each group Healon and balanced salt solution (BSS) was randomly applied in two age-matched patient subgroups. The surgical procedures were intracapsular cataract extraction (ICCE) with corneoscleral incision and ICCE with corneal incision. Healon is shown to have a protective effect on the cornea as judged by corneal thickness measurements and by endothelial cell counts. Healon facilitated the surgical procedure in several ways. No side effects, either with regard to intraocular pressure or to postoperative inflammatory reaction have been observed.     

后囊膜混浊的相关因素分析

目的:探讨在白内障及人工晶状体植入后,后囊膜混浊的相关因素以及预防治疗的方法。方法:根据手术方法分为单纯白内障摘除组及白内障加人工晶状体植入组,后者又根据手术方法的不同及人工晶状体的类型进行比较分析。结果:单纯摘除组与人工晶状体植入组,人工晶状体植入中,不同的手术方法及不同的人工晶状体类型其后囊膜混浊发生的频率及程度均存在较大差异。结论:选择适宜的手术方法(完全封闭技术)、优良的人工晶状体材质(疏水性丙烯酸酯和肝素处理)、特殊的形态设计(锐利边缘)就能最大程度的减少或避免后囊膜混浊的发生。     

急性共同性内斜视矫正手术中可调节缝线的效果观察

目的观察术中置可调节缝线矫正急性共同性内斜视的效果。方法12例急性共同性内斜视进行手术治疗,术中置可调节缝线,术后同视机训练15d。结果术后复视情况：11例看远看近复视消失,均恢复双眼单视;1例欠矫8^△,1m以内复视消失,1m以外复视较前明显减轻。结论急性共同性内斜视全矫手术置可调节缝线效果良好。     

晶状体半脱位的诊断及治疗

目的探讨晶状体脱位的诊断及治疗方法。方法应用超声生物显微镜（UBM）及裂隙灯显微镜检查方法对晶状体半脱位进行早期诊断,回顾总结近10年来我院就诊的晶状体脱位45例,分别采用晶状体囊内摘出术,囊外摘出术及超声乳化术等手术方式,分析手术前后视力及并发症。结果应用UBM能对早期的晶状体脱位进行诊断,根据脱位程度,采取不同的手术方式,术后视力均有不同程度提高。术后视力与术式无明显关系,与术前并发症有关。晶状体囊内摘出术的术后并发症较其他术式多。结论应用UBM有助于晶状体脱位的早期诊断;不断提高手术技巧,完善手术设备,选择合适的手术适应证对晶状体脱位的治疗是非常重要的。     

Surgical outcome of 21 patients with congenital upper eyelid coloboma

AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.