复合式小梁切除术治疗人工晶状体植入术后继发青光眼的临床观察

目的 探讨复合式小梁切除术治疗经透明角膜切口人工晶状体植入术后继发青光眼的疗效及意义.方法 31例(32只眼)经透明角膜切口人工晶状体植入术后继发青光眼行常规复合式小梁切除术.术后观察视力、眼压、滤过泡、浅前房及其它并发症.结果 手术12月后:视力增进2/32只眼(6.2%),不变28/32只眼(87.6%),下降2/32只眼(6.2%).功能性滤过泡24/32只眼(75.0%).眼压≤21mmHg(1kPa=7.5mmHg)者26/32只眼(81.2%),术后早期并发症有浅前房5只眼(15.5%),前房出血3只眼(9.3%)低眼压性黄斑病变2只眼(6.2%),脉络膜脱离1只眼(3.1%).结论 复合式小梁切除术是治疗经透明角膜切口人工晶状体植人术后继发青光眼的有效方法,此类青光眼不应归属于难治性青光眼.     

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma

PURPOSE: This retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. METHODS: Data were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. RESULTS: Need for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. CONCLUSIONS: This study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.     

Aspirin and recurrent hyphema after blunt ocular trauma

Recurrent hyphema after traumatic blunt injury to the eye is associated with a more serious prognosis than that occurring from the initial trauma, resulting in a higher risk of glaucoma, corneal staining, surgical intervention, poor visual acuity, and enucleation. Risk factors associated with the development of recurrent bleeding are not well defined, but recent evidence suggests a high association with concurrent aspirin ingestion. Of 25 consecutive patients with hyphemas (20 males and five females, ranging in age from 2 to 53 years), 12 took aspirin after the initial trauma and seven had recurrent hyphemas. Platelet aggregation determinations in these seven patients showed defects associated with aspirin. Only one of 13 patients without aspirin intake had recurrent bleeding.     

眼外伤合并前房积血55例的治疗

目的：探讨眼外伤合并前房积血的治疗。

方法：根据55例眼外伤合并前房积血患者的临床表现、治疗效果及随访观察进行分析,对临床疗效进行回顾性分析总结。

结果：治疗后前房积血吸收41例,占75%,未完全吸收,视力较入院前提高但低于0.8者10例,占18%,出现角膜血染者2例,占4%,继发青光眼2例,占4%。

结论：眼外伤合并前房积血,根据出血量的多少和受伤程度、症状采取差异化的治疗方法,恰当选择手术适应证,能取得良好疗效,挽救视力。     

Ex-press青光眼引流器植入术治疗难治性青光眼的疗效及并发症

目的：探讨Ex-press青光眼引流器植入术治疗难治性青光眼的临床疗效及并发症。
　　方法：随机选取本院2013-02/2014-08收治行 Ex-press青光眼引流器植入术治疗的难治性青光眼53例56眼,男39例41眼,女14例15眼,平均年龄52.63±10.58岁;新生血管性青光眼25例26眼,滤过手术失败后青光眼16例18眼,玻璃体切除术后继发青光眼6例6眼以及复杂眼外伤后青光眼6例6眼。观察术后1、12 lo视力、眼压、前房深度、角膜内皮细胞密度及并发症等情况,并与术前进行分析比较。
　　结果：术后12lo,完全成功率为62%(35眼),部分成功率为14%(8眼),总成功率为77%。其中新生血管性青光眼有效率为85%,滤过手术失败后青光眼有效率为56%,复杂眼外伤后青光眼100%,玻璃体切除术后青光眼83%。术后1 lo视力较术前提高者28眼(50%),视力不变18眼(32%),视力降低10眼(18%)。术后12lo视力较术前提高者19眼(34%),视力不变18眼(32%),视力降低19眼(34%)。术前平均眼压29.58±8.66llHg,术后1lo平均眼压12.75±5.66llHg,与术前比较差异有统计学意义(P<0.05),其中56例患眼眼压均表现为降低(100%)。术后12lo 眼压为9.8~28.4(平均15.42±4.09)llHg,与术前比较差异有统计学意义(P<0.05),其中眼压较术前增高者2眼,眼压不变0眼,眼压降低54眼(96%)。术后1、12lo 内皮细胞计数分别为1958.22±168.30、1793.99±201.55个/ll2,与术前的2113.47±80.56个/ll2比较,差异有统计学意义(P<0.01)。术后总并发症发生率为29%,其中术后早期发生浅前房低眼压4眼,暂时性高眼压3眼,引流管阻塞5眼,前房出血3眼。后期并发症有局部隆起的包裹的囊状泡1眼。
　　结论：Ex-press青光眼引流器植入术治疗难治性青光眼,虽然存在一定的术后并发症,但仍可取得较好的临床疗效,是目前治疗难治性青光眼的有效方法。     

眼外伤所致继发性青光眼的临床分析

目的分析眼外伤所致继发性青光眼临床疗效。方法对62例（62眼）眼外伤所致继发性青光眼的临床表现、病因及治疗方法进行分类与分析。结果根据病因及临床表现将眼外伤所致继发性青光眼归纳为以下几类：前房积血型、房角损伤型、晶状体源型和粘连增生型。药物治疗或联合前房冲洗29例（46．77％）,其他手术治疗（包括滤过手术、玻璃体切除和联合手术等）33例（53．22％）。治疗后眼压正常者眼压（6～21mmHg）53例（85．48％）,眼压〉21mmHg者7例（11．29％）,眼压〈6mmHg者1例（1．61％）。视力下降或丧失者4例。余58例视力均与人院视力相同或提高。术后低眼压1例,术后眼内出血1例。结论眼外伤所致继发性青光眼是由多种发病机制形成的,临床表现较为复杂。预后也较差,临床治疗要区别对待。     

挫伤性前房积血的临床分析

目的:探讨外伤性前房积血的治疗及预后。方法:对78例78眼挫伤性前房积血及其并发症及同时存在的其他眼外伤治疗经过进行回顾性分析。结果:外伤性前房积血致伤物呈多样性,常见的并发症有继发性青光眼、角膜血染、外伤性白内障等。积极治疗可避免严重的视力损害。结论:单纯前房积血经积极治疗视力恢复较好,有严重的并发症以及同时有其他眼外伤是导致视功能低下的重要原因。加强防护,根据病情及时手术,减少和预防并发症,以恢复视功能。     

眼外伤所致继发性青光眼的临床分析

目的探讨眼外伤所致的继发性青光眼的病因与治疗方法。方法眼外伤所致继发性青光眼50例（50眼）,对其致伤原因、临床表现、治疗方法进行临床观察及分析。结果眼外伤所致继发性青光眼由眼挫伤、前房积血、晶状体源性、炎症性粘连等所引起。单纯药物（全身和滴眼）治疗35例（35眼）,联合手术治疗（前房冲洗、白内障摘除、小粱切除等）15例（15眼）。治疗后眼压恢复正常者47例（47眼）;眼压高于21mmHg（1mmHg=0．133kPa）者3例（3眼）,但较治疗前眼压有所下降。结论眼外伤所致继发性青光眼病因复杂,多为钝挫伤及眼内积血引起,需针对病因积极对症处理,预防并发症的发生,保存视功能。     

眼外伤相关性青光眼的临床分析

目的分析外伤性青光眼的发病原因及相应的治疗方法。方法选取2008年7月至2012年12月在我院确诊的眼外伤继发的青光眼病例,根据发病原因不同,采取药物及手术治疗,记录视力提高及眼压下降的情况。结果根据受伤后引起青光眼的临床原因分类,其中眼内积血55例,前房角挫伤31例,晶状体损伤源性6例,眼内炎症/外伤性虹膜睫状体炎3例。根据受伤原因及眼压下降情况分别予药物及手术治疗,随访6个月至2年,85例(89.5%)患眼眼压控制在正常范围,80例(84.2%)视力提高有不同程度的提高。结论选取合适的治疗方法,能有效的提高患者的视力及降低眼压,最大程度的维持患者的视功能。     

Eye injuries in outpatient clinic of Department of Ophthalmology Medical University Gdansk in 1992-1993 and 2002-2003 years

The aim of this study was the statistical and epidemiological analysis of patients with eye injuries. We analyzed all patients attending the emergency department of Department of Ophthalmology Medical University in Gdansk over the period of 1992-1993 and 2002-2003 years. We determined the visual function (visual acuity- distance and near Snellen acuity test, intraocular pressure measurement, biomicroscopy, ophthalmoscopy, X- ray examination and US -examination) in two groups of subjects. The 6427 patients were subjected in the first period (37% with eye injuries). In the second period we examined 10512 patients (44% with eye injuries). A total of visits have been examined in the first period: 24.1% of patients were between 19-25 and 48% between 26-50 years. In the second group of patients 35.7% of patients were between 19-25 and 30.3% were between 26-50 years. In the both periods we observed mainly corneal injuries. Corneal foreign body and corneal abrasion were the most common etiology among close eye injuries in both groups. A total of visits have been examined: 7.78% with the first group and 8.95% was with burns. There were 1.89% in the first and 5.75% in the second period of severe eye injury such as penetrating ocular trauma, orbital fracture and intraocular foreign body. The main causative activity of ocular injuries in both groups was work (5.80% group I and 23.80% group II), assault (36.20% group I and 47.75% group II) and traffic accidents (4.84% group I and 12.05% group II). Results of our work indicated that ocular trauma is a common cause of improvement of visual acuity and a common cause of visit to the Emergency Department of Department of Ophthalmology.     

手术治疗挫伤性前房积血所致继发性青光眼的疗效及安全性分析

目的：探讨手术治疗挫伤性前房积血所致继发性青光眼的疗效及安全性分析。方法：选取2014－11／2015－11我院收治的挫伤性前房积血继发性青光眼患者70例70眼，所有患者均行手术治疗，对比患者手术前后的视力、前房深度、平均眼压及术后并发症情况。结果：与治疗前相比，挫伤性前房积血所致继发性青光眼患者治疗后视力明显改善，差异有统计学意义（t＝42.471，P＜0．001）。与治疗前相比，挫伤性前房积血所致继发性青光眼患者治疗后前房深度较深，平均眼压较低，差异有统计学意义（ t＝9．726、26．041， P＜0．001）。2例继发性青光眼患者手术治疗后出现前房积血，经治疗后症状缓解，未出现角膜血染、眼球肿胀疼痛等并发症。结论：手术治疗挫伤性前房积血所致继发性青光眼患者的疗效佳，安全性高，能提高患者的视力、加深前房角深度以及降低眼压。     

外伤性白内障摘除人工晶體植入临床观察

本文报告外伤性白内障摘除人工晶體植入術78例78眼。外伤至手術时间为5天到7年。Ⅰ期后房型人工晶體植入76眼,其中聯合小梁切除1眼,聯合玻璃體前段切除1眼;Ⅱ期后房型人工晶體植入2眼。術后随访3個月至3年,視力在0.4以上者54眼,占70％。術后常見并發症为角膜水腫、前房滲出物、前房出血,后期为后囊混濁。对手術时期的選择,并發症及其处理進行了讨论。     

外伤性白内障人工晶状体植入手术时机及方法的探讨

目的探讨外伤性白内障的手术时机的选择。方法对我院2008年7月～2011年8月收治的52例52眼外伤性白内障,根据其年龄、晶状体外伤性质、其他部位外伤情况及炎症反应程度,选择时机进行白内障摘出联合人工晶状体植入术。伴有角膜裂伤者,先缝合伤口,视情况进行一期或者二期白内障手术;晶状体囊破口较小及挫伤性白内障,待皮质浑浊较充分后进行手术;外伤后炎症反应较重者,先控制炎症,于(1-2)周内手术;晶状体皮质膨胀突出于前房接触角膜及引起严重炎症反应或继发青光眼者,则立即进行手术。采用白内障吸出、囊外摘出或玻璃体晶状体切除联合后房人工晶状体一期植入手术方法。52眼中,一期人工晶状体植入35眼,二期植入17眼,均为后房人工晶状体。结果术后视力0.05以上者占96.15%,0.3以上者占67.31%,0.5以上者占36.54%,1.0以上者占3.85%。结论正确掌握白内障的手术时机,及时处理术中术后并发症,复杂的外伤性白内障术后仍能获得较好的视力,并能促进恢复双眼单视功能。     

Traumatic dislocation of an implantable phakic contact lens

Ocular trauma can range from trivial to significant, with varying implications on the visual acuity and prognosis. A 32-year-old woman presented with complaints of blurring of vision following blunt ocular trauma with a previous history of having undergone implantable phakic contact lens (IPCL V2.0) implantation 2 years back. The corrected distance visual acuity (CDVA) was 20/20 in the right eye and 20/30 in the left eye. Slit-lamp examination revealed a prolapse of inferonasal IPCL footplate into the anterior chamber with pupillary entrapment. No corneal endothelial touch was noted. Immediate repositioning of the IPCL was performed and the patient regained a CDVA of 20/20 in the left eye, postoperatively. Traumatic dislocation of IPCL is a rare occurrence, which can be successfully managed by prompt surgery, thus avoiding further complications like corneal endothelial decompensation.     

Late results of the treatment of eye burns]

An analysis of patients treated in the Ophthalmic Department in Bydgoszcz for eye burns in the 10 years period from 1980 till 1990. Taken into account were the causes of burns, the treatment installed in the early period and in cases of late complications. All the patients were asked to call in for a control examination in order to compare the condition of the eyes at the date of discharge and in the long-lasting time. Among 118 eyes in 91 the visual acuity amounted 0.5-1.0, in the remaining 25 it was only hand movements--0.4. The main causes of low visual acuity were: corneal leucoma, secondary glaucoma, complicated cataract. The eye was enucleated in 2 patients because a painful ocular atrophy developed in the course of the pathological process. These were the cases of thermal burns combined with a mechanical injury. The obtained results were evaluated as sufficiently favourable and comparable to the data of other authors.     

Bottle-cork injury to the eye: a review of 13 cases

PURPOSE: To analyze the anatomic and functional consequences of wine-cork injury to the eye in relation to the patient's age and the type of cork and wine. METHODS: We retrospectively studied 13 patients, six women and seven men, presenting to our department with bottle-cork injury to the eye between January 1999 and June 2001. RESULTS: All patients presented with closed-globe injury according to Kuhn et al's classification. All the cases were injured by bottle corks from sparkling wine: white in ten cases and red in three. Mean visual acuity at admission was 20/100 (range, hand motion to 20/20). The most frequent early injury was anterior chamber hyphema (84.6%), followed by corneal injury (62.2%), ocular hypertension (46.1%), lens subluxation (30.8%), traumatic cataract (23.1%), and post-traumatic retinal edema (23.1%). Mean final visual acuity was 20/25; the follow-up ranged from 3 to 29 months, averaging 16.1 months. Late complications were as follows: pupil motility anomalies (38.5%), traumatic cataract (30.8%), iridodialysis (15.4%), traumatic optic neuropathy (7.7%), post-traumatic glaucoma (7.7%), and traumatic maculopathy (15.4%). Surgical treatment was necessary in two cases (15.4%). CONCLUSIONS: Bottle-cork eye injuries account for 10.8% of post-traumatic hospital admissions to our department. Most of them are due to sparkling white wine served at room temperature. There is no correlation between ocular injury and the eye-bottle distance or the type of cork.     

角膜移植治疗角膜及眼表疾病98例临床分析

目的分析穿透性角膜移植及板层角膜移植治疗角膜疾病及眼表疾病的临床特点。方法回顾性研究穿透性角膜移植、板层角膜移植及板层角膜移植联合羊膜移植手术共98例（101眼）,观察术后视力、排斥反应、继发青光眼及原发病复发。随访6～24月,平均12．8月。结果穿透性角膜移植术79例（82眼）巾,62例（78．48％）术后视力较术前有提高,排斥反应11例（12眼）,原发病复发3例（3眼）,继发青光眼10例（10眼）。板层角膜移植术后视力无明显变化,排斥反应1例（1眼）,未见原发病复发及继发青光眼。结论角膜移植是治疗严重角膜疾病及眼表疾病有效手术方式,积极预防及治疗术后并发症可以提高角膜移植成功率。     

陕西商洛地区栗刺所致眼外伤256例临床分析

目的 探讨栗刺所致眼外伤的临床特点和治疗方法.方法 回顾分析栗刺所致眼外伤256例（256眼）.位置各异、深浅不一、数目不等的角膜、结膜、巩膜异物伤及穿孔伤为其基本特点,部分病例合并有角膜感染、前房积血、晶状体破裂、继发性青光眼、玻璃体积血、睫状体脱离、全葡萄膜炎和感染性眼内炎等.在明确诊断后,分步骤在裂隙灯显微镜或手术显微镜摘出栗刺异物,并对相关并发症采用药物治疗或手术治疗.结果 256例中,单纯异物伤198例在异物剔除后给予抗炎营养角膜等对症治疗,视力恢复到术前视力,或视力下降在两行以内;25例角膜细菌感染预后较好,3例真菌感染预后较差;9例前房积血和7例玻璃体积血经药物治疗恢复良好;13例晶状体刺伤、破裂中5例晶状体浑浊不明显,仍在随访观察,其余8例中有5例继发青光眼,分别于受伤后6d～3个月行超声乳化＋人工晶状体植入术,术后眼压控制,视力恢复至0.4 ～1.0;2例睫状体脱离的原因均为栗刺经巩膜刺伤睫状冠部或平坦部引发的出血性脱离,药物治疗2个月后恢复.1例全葡萄膜炎药物治疗后视力由眼前指数恢复到1.0.2例感染性眼内炎视力恢复较差,分别为眼前手动和0.04.结论 栗刺相关性眼外伤为陕西商洛地区常见的眼外伤,推测其年发病率超过1/10000.多发于中年男性,男女比例约9∶1.主要表现为角膜异物伤,严重病例还合并角膜感染、前房积血、晶状体刺伤破裂、继发性青光眼甚至眼内炎等.在受伤后及时就诊,积极进行药物联合手术治疗,对改善预后至关重要.加强防护意识,作业时戴草帽或防护眼镜为有效的预防措施.     

眼外伤后继发性青光眼87例临床分析

目的：分析眼外伤后继发性青光眼的主要病因及治疗方法。方法：回顾性分析我院2008-06/2010-06收治的87例87眼眼外伤后继发性青光眼患者的临床资料和治疗方法。结果：眼外伤后继发性青光眼可由多种原因引起,主要原因包括眼内出血40眼（46%）、晶状体源性27眼（31%）、前房角挫伤14眼（16%）、眼内炎症6眼（7%）,根据不同的眼外伤原因制定不同的治疗方案,经药物和手术治疗后随访3～12mo,79眼眼压控制在正常水平,控制率为91%;视力提高91%。结论：眼外伤后继发性青光眼的发病原因及机制比较复杂,应根据不同的病因及时治疗,控制眼压,提高视力。     

四川乐山市人民医院738例住院眼外伤分析

目的 分析5年间住院眼外伤患者的相关因素。方法 回顾性统计5年间住院眼外伤患者资料。分别逐年比较分析眼外伤所占比例、性别、年龄、眼别、外伤后就诊时间、外伤类型、致伤物、并发症、治疗前后视力等情况。结果 5年来住院眼外伤738例（764只眼）占眼科住院总人数的6．45％,眼外伤所占比例逐年降低。男女之比为4．31：1,左右眼比例相近,受伤年龄段主要为41～60岁,其次为19～40岁。外伤后就诊时间在1d以内者占62．74％。主要致伤物为钝器,其次为锐器及爆炸物。主要外伤类型：眼挫伤占38．64％,角巩膜穿孔伤占17．17％,角膜穿孔伤占11．87％。以前房积血、晶状体脱位、继发性青光眼、外伤性白内障和玻璃体积血为主要并发症。治疗前盲目占68．97％,治疗后盲目占45．15％。眼球摘除61眼,占7．98％。结论 建议加强眼外伤预防知识宣传,做好预防工作,及时有效救治,提高眼外伤一期和二期诊治水平,以降低致盲率。