经穹窿结膜手术治疗结膜下眶脂肪脱垂

眶脂肪脱垂的原因不明,和遗传及肥胖有一定关系.近年来,随着肥胖人群的比例的增加,其发病率也呈上升趋势.眶脂肪脱垂对眼部损害不大,只影响美容,所以要求治疗者甚多.我们新近开展了经穹窿结膜进路手术方法治疗脱垂眶脂肪,手术痛苦轻,是一种简单有效的治疗方法.     

5-氟尿嘧啶局部注射治疗结膜下眶脂肪脱垂

我科在治疗一例青光眼合并双眼结膜下眶脂肪脱垂患者的过程中，偶然发现结膜下注射5-氟尿嘧对结膜下眼眶脂肪脱垂有效，报道如下： 患者男69岁因左眼胀，视物模糊，于2006年11月8日来诊检查，眼压：右眼13mmHg；左眼61mmHg；右眼视力为0．6，左眼视力0．1，双眼颞上方穹隆部结膜下突出黄色肿物，平视时肿物突出于睑裂之外，右眼周边视野呈向心性缩小，     

表面麻醉下结膜下麻醉行小切口白内障手术

表面麻醉联合球结膜下麻醉作为内眼手术麻醉方法的一大进展,已逐渐被接受并广泛应用[1-6],我院2009年1月至2010年3月于白内障手术中应用此技术行非超乳小切口白内障摘出术取得了良好效果.现报告如下:     

表面麻醉联合结膜下麻醉在抗青光眼术中的应用

目的：探讨表面麻醉和结膜下麻醉进行青光眼手术的可行性，分析其镇痛效果和安全性。方法：对83例146眼青光眼手术用0．5％爱尔凯因眼液表面麻醉和2％利多卡因结膜下浸润麻醉，总结分析其麻醉效果。结果：用于青光眼手术，镇痛效果良好，能避免球后麻醉的并发症，简化了麻醉和手术步骤，缩短了手术时间。结论：表面麻醉加结膜下麻醉对常规抗青光跟手术是一种有效、安全、简便易行的麻醉选择，值得推广应用。     

结膜下麻醉行抗青光眼手术

我们在临床上对 5 6例单纯球结膜下麻醉手术病例进行观察 ,现报告如下。1　资料与方法1.1　一般资料　观察 5 6例患者 ,其中男 2 1例 ,女 35例 ,年龄35～ 81岁 ,急性闭角型青光眼 4 6例 ,慢性闭角型青光眼 9例 ,继发性青光眼 1例 ,均行小梁切除术加虹膜根切术。1.2　手术方法     

原发性结膜下脂肪疝临床分析

结膜下脂肪疝是指眶内脂肪经过薄弱的眼球筋膜、肌间膜而疝出于颞侧球结膜下。临床上将之分为原发性和继发性两种。原发性结膜下脂肪疝是指无明确原发全身或眼部疾病、原因尚不明确的结膜下脂肪疝出。继发性是指多种引起眶压升高的眼部疾病所致的眶脂疝出于球结膜下。如眶内肿瘤、甲状腺相关眼病、眼部外伤等。本病于1987年由Jorden首次报告并命名。1资料与方法1.1一般资料本文7例原发性结膜下脂肪疝患者中,男性5例,女性2例,年龄65～75岁,均为双眼。病程4～6年,2例因流泪,2例因异物感就诊,另外3例因黄色肿物暴露于睑裂部,影响美观而就诊。1…     

表面麻醉球结膜下麻醉行小切口白内障摘出术

传统白内障手术常规麻醉方法为球后及球周麻醉，应用一个多世纪以来，被公认是安全而有效的麻醉方法。但近年来对其并发症的报道越来越多。随着白内障显微手术的不断成熟和完善，对于麻醉方法的选择也在不断更新。为观察和评价表面麻醉联合球结膜下麻醉在小切口白内障手术中应用的可行性、安全性和有效性，我们1998年2月-21304年12月对119例（128眼）小切口白内障囊外摘出及人工晶状体植入术采用表面麻醉联合球结膜下麻醉进行了观察，麻醉效果良好。现报告如下：     

表面麻醉加球结膜下麻醉在白内障手术应用

目的探讨球结膜下麻醉行白内障手术治疗的可行性并对其效果进行评价。方法对512例（578眼）白内障在表面麻醉联合球结膜下麻醉情况下，分别行晶状体超声乳化人工晶状体植入术338例（386眼）及小切口白内障囊外摘出，人工晶状体植入术174例（192眼）。观察麻醉效果及术中术后并发症。结果578眼麻醉成功率100．00％，术中未出现常规麻醉可能出现的局部及全身并发症。结论表面麻醉联合球结膜下麻醉行白内障手术麻醉效果好，安全性高，适应证范围广。     

表面麻醉联合球结膜下麻醉在防盲白内障手术中应用

目的 探讨表面麻醉联合球结膜下麻醉行白内障手术治疗的可行性并对其效果进行评价.方法 对157例(157眼)白内障在表面麻醉联合球结膜下麻醉情况下行小切口白内障囊外摘出加人工晶状体植入术.观察麻醉效果及术中术后并发症.结果 157眼麻醉成功率100%,术中末出现常规麻醉可能出现的局部及全身并发症.结论 表面麻醉联合球结膜下麻醉行白内障手术,麻醉效果较满意、安全性高.     

表面麻醉联合结膜下麻醉在抗青光眼术中的应用

目的探讨表面麻醉联合结膜下麻醉对抗青光眼手术的可行性并分析其镇痛效果及优点。方法对52例88眼抗青光眼手术应用表面麻醉联合结膜下麻醉。结果本组全部患眼均能达到理想的麻醉镇痛效果，顺利完成手术，同时避免了球后阻滞麻醉的一些潜在危险和并发症。结论表面麻醉联合结膜下麻醉对抗青光眼手术是一种有效、安全、简便易行的麻醉选择。     

表面麻醉联合结膜下麻醉在小梁切除手术中的应用

目的:探讨表面麻醉联合球结膜下麻醉方法行青光眼小梁切除术的可行性并对其效果进行评价。方法:对82例118眼青光眼患者用4g/L倍诺喜表面麻醉结合球结膜下麻醉行青光眼小梁切除术,观察麻醉效果及术中术后并发症。结果:全部患眼均能达到理想的麻醉镇痛效果,顺利完成手术,术中未出现常规麻醉可能出现的局部及全身并发症。结论:表面麻醉联合球结膜下麻醉行青光眼小梁切除术是一种安全、可靠、有效、简便易行的麻醉选择,值得推广应用。     

Efficacy of transconjunctival excision of orbital fat prolapse: a long‐term follow‐up study

Purpose: To describe the long‐term efficacy of transconjunctival excision of subconjunctival orbital fat prolapse. Methods: Retrospective study of consecutive cases of orbital fat prolapse treated with transconjunctival resection between December 2002 and December 2011. Results: Thirty‐two eyes of 23 patients (19 males and four females) were included. The lesion was unilateral in 14 and bilateral in nine cases. It was located superotemporally in a majority of cases. Excision was performed by opening the conjunctiva and excising the prolapsing orbital fat. The conjunctival wound was closed with 1–2 interrupted sutures. With an average follow‐up of 29 months (range 4–108), a recurrence was seen in three cases. The average time to recurrence was 46 months (range 40–52 months). Conclusion: Transconjunctival excision is a simple, safe and effective primary surgical procedure to treat subconjunctival fat prolapse. In our series, the recurrence rate was 9%, but no additional surgery was required. As the average time to recurrence was longer than our average follow‐up, more patients may develop a recurrence in future.     

Manual small-incision cataract surgery under topical anesthesia

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon’s perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient’s comfort and surgeon’s perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45± 0.96 and average patient cooperation score based on surgeon assessment was 3.42 ± 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.     

结膜下麻醉行小梁切除术治疗中晚期青光眼

目的分析球结膜下麻醉行小梁切除术治疗中晚期青光眼的优点。方法采用上方球结膜下、上直肌附着点处浸润麻醉行小梁切除术76例（89眼）。结果术中麻醉效果肯定，眼压稳定，基本无痛苦，手术均能顺利完成。术后无视功能丧失。结论术前、术中有效控制眼压、细心操作，上方球结膜下麻醉行小梁切除术治疗中晚期青光眼，避免小梁切除术常规球后或球周麻醉过程中较多潜在危险的并发症和毒副作用，是一种安全、有效的麻醉方法。     

A surgical technique with connective tissue repair for the management of subconjunctival orbital fat prolapse

Abstract Subconjunctival orbital fat prolapse is an uncommon benign entity. In addition to insufficient information concerning the mechanisms of the prolapse, detailed surgical methods that can be followed are uncommon in the literature. We prospectively studied six consecutive eyes in four males who were to undergo our novel surgical sequence, attempting to avoid postoperative complications by reconstructing intermuscular septa on the basis of the assumption that the spontaneous prolapsed fat at the superior temporal quadrant stemmed from intraconal fat. Intraoperative findings were in agreement with our hypothesis that the anterior part of the herniated fat is covered by both the intermuscular septum and Tenon's capsule. All the surgeries were uneventful and cosmetic improvement without postoperative complications was obtained. Our early results indicated the safety and efficacy of this newly developed technique for spontaneous orbital fat prolapse.     

表面麻醉行青光眼小梁切除术临床观察

目的总结表面麻醉下小梁切除术的体会。方法对19～89岁各种类型青光眼209例（376眼）在表面麻醉下行小梁切除术。结果376眼中356眼能顺利配合手术,20例因眼球转动不能配合需加滴1～2次。结论选择适当的病例表面麻醉施行小梁切除术是安全可行的。     

盐酸奥布卡因表面麻醉剂在斜视矫正术中的应用

目的:探讨盐酸奥布卡因滴眼液表面麻醉下行斜视矫正术的临床麻醉效果。方法:对118例斜视患者术前滴盐酸奥布卡因滴眼液5次,常规行斜视矫正术。结果:Ⅰ级麻醉效果83例(70.3%),Ⅱ级麻醉效果34例(28.8%),因眼胃反射终止手术1例。结论:盐酸奥布卡因表面麻醉下行斜视矫正术安全、有效、并发症少,简单易行。     

表麻下单侧孔钝头泪道探针治疗新生儿泪囊炎

目的:探讨表面麻醉下单侧孔钝头泪道探针治疗新生儿泪囊炎的疗效。方法:对年龄满4月龄～5岁泪囊炎患儿75例86眼经泪囊按摩治疗1mo无效且行常规加压泪道冲洗不通畅者,在表面麻醉下用单侧孔钝头泪道探针行泪道探通术,术后隔日行泪道冲洗最少3次。结果:一次探通痊愈84眼,第二次探通后痊愈2眼。全部病例无感染、假道或泪点撕裂等并发症,经过3mo随诊观察,86眼痊愈患儿无1例复发。结论:表面麻醉下单侧孔钝头泪道探针治疗新生儿泪囊炎安全有效。     

表面麻醉下联合手术治疗晚期青光眼并发白内障

目的 观察表面麻醉方式下行小梁切除术联合白内障超声乳化及折叠式人工晶状体植入术治疗晚期青光眼合并 白内障患者或全身情况差的青光眼患者的临床疗效。方法对35例43眼晚期青光眼合并白内障患者或合并全身病的青光眼患者,在表面麻醉下行小梁切除联合白内障超声乳化折叠式人工晶状体植入术,观察患者手术前后的眼压、视野、视力及并发症情况。结果 术后3d、1、6周、3个月平均眼压较术前明显降低,术后平均眼压18mmHg(1kPa 7.5mmHg);视力由术前0.19±0.11提高到术后3个月0.67±0.16;术后视野无缩窄。结论 表面麻醉下行小梁切除术联合白内障超声乳化术对青光眼合并白内障患者均有较好的临床疗效,对视野影响小,尤其适合全身情况差或青光眼晚期患者。