晶状体超声乳化治疗闭角型青光眼

目的 探讨晶状体超声乳化白内障摘出治疗闭角型青光眼合并白内障的临床疗效.方法 本组临床观察对象为闭角型青光眼29例(37眼).均有不同程度的晶状体浑浊.行巩膜隧道切口晶状体超声乳化白内障摘出折叠式人工晶状体植入术.随访1-21个月(平均13.9月).结果 术后平均眼压(11.25±2.50)mmHg,比术前用药后平均眼压(19.50±10.26)mmHg明显降低,差异有统计学意义(P＜0.05),中央前房深度由术前的(1.47±0.32)mm增加到术后(2.35±0.34)mm,两者比较差异有统计学意义(P＜0.05).术后视力均有不同程度提高.结论 闭角型青光眼并白内障行晶状体超声乳化联合后房型折叠式人工晶状体植入术,在一定程度上可得到有效的治疗.     

超声乳化联合IOL植入术治疗原发性闭角型青光眼合并白内障

目的:探讨超声乳化联合人工晶状体(IOL)植入术治疗原发性闭角型青光眼合并白内障的临床疗效及应用价值.方法:将我院行手术治疗原发性闭角型青光眼合并自内障患者98例130眼采用随机数字法分为观察组和对照组,每组各65眼,对照组行周边虹膜切除手术,观察组采用超声乳化联合IOL植入手术治疗,记录两组患者手术情况和治疗效果.结果:观察组手术后7d眼压14.111.97mmHg,术后lmo眼压14.01 ±1.65mmHg,术后3mo眼压14.16±1.45mmHg;对照组手术后7d眼压17.46±2.31 mmHg,术后1mo眼压17.15±2.27mmHg,术后3mo眼压17.03±2.18mmHg,经统计学分析差异有统计学意义(P＜0.05).观察组治疗后视力0.73±0.11,前房深度4.58±0.85mm;对照组治疗后视力0.60±0.07,前房深度4.01 ±0.51mm,组间对比差异有统计学意义(P＜0.05).观察组手术并发症发生率为4.6％,对照组手术并发症发生率15.4％,组间对比差异有统计学意义(P＜0.05).观察组术后视野缺损值为-19.78±4.65dB,对照组术后视野缺损值为-16.13±3.03dB,组间对比差异有统计学意义(P＜0.05).结论:超声乳化联合IOL植人手术治疗原发性闭角型青光眼合并白内障临床疗效可靠,术后并发症少,安全有效.     

白内障超声乳化联合房角分离术治疗原发性慢性闭角型青光眼

目的:探讨超声乳化白内障吸除及人工晶状体植入术联合房角分离术治疗原发性慢性闭角型青光眼的疗效。方法:采用白内障超声乳化及人工晶状体植入联合房角分离术治疗合并白内障的原发性慢性闭角型青光眼32例32眼,比较手术前后的眼压、视力、前房深度、房角形态,观察术后并发症等情况。结果:术后随访6mo～2a;所有病例术后最佳矫正视力均提高;术后眼压明显降低,术前平均眼压15.2±8.1mmHg,术后11.2±5.0mmHg,差异有显著统计学意义(t=3.126,P<0.01);术后中央前房深度显著加深,术前平均中央前房深度2.22±0.39mm,术后3.36±0.43mm,差异有显著统计学意义(t=-14.371,P<0.01);术后房角粘连范围有减少,无严重并发症出现。结论:白内障超声乳化房角分离术能有效的治疗并发白内障的原发性慢性闭角型青光眼。     

超声乳化白内障吸出和IOL植入术治疗激光周边虹膜切除术后急性闭角型青光眼(英文)

目的:观察超声乳化白内障吸出术联合人工晶状体(IOL)植入治疗激光周边虹膜切除术后闭角型青光眼的治疗效果。方法:激光周边虹膜切除术后闭角型青光眼并白内障患者39例(39眼),被分为两组,Ⅰ组须用抗青光眼药控制眼压,Ⅱ组不须用抗青光眼药控制眼压,患者均行超声乳化白内障吸出和折叠式人工晶状体植入术,术后随访3mo。结果:两组术后最佳矫正视力均较术前显著提高(P<0.05)。术后3moⅠ组眼压为15.72±3.02mmHg,Ⅱ组为16.30±3.81mmHg,两组眼压均比术前明显下降,有显著性差别(P<0.05)。Ⅰ组中央前房深度由术前1.64±0.45mm加深至术后3mo的3.21±0.41mm,Ⅱ组中央前房深度由术前1.92±0.52mm加深至术后3mo的3.18±0.39mm,两组术后中央前房深度均比术前明显加深,有显著性差异(P<0.05),前房角明显增宽。结论:超声乳化白内障吸出和人工晶状体(IOL)植入术不仅能提高激光周边虹膜切除术后青光眼视力,而且可彻底解除闭角型青光眼的瞳孔阻滞。     

无灌注玻切联合晶状体超声乳化及小梁切除治疗有晶状体眼的恶性青光眼

目的：探讨利用23 G微创无灌注玻璃体切割联合白内障超声乳化并小梁切除术治疗有晶状体眼的恶性青光眼的疗效,分析前后节复合手术治疗恶性青光眼的诊疗思路。
　　方法：有晶状体眼恶性青光眼患者21例21眼采用23 G玻切头进行前节玻璃体切割及玻璃体前界膜切开,玻切操作迅速且无需灌注及縫合,超声乳化人工晶状体植入联合小梁切除需进行晶状体后囊膜环形撕囊。术后观察视力、眼压、前房变化及术后并发症。
　　结果：术后3mo眼压从术前57.18±6.18mmHg降至16.15±2.43mmHg,两者差异有显著统计学意义(P<0.001);术前房角深度为0.88±0.25mm,术后增至2.44±0.37mm,术后前房深度较术前显著加深(P<0.001);术后视力较术前明显提高,无严重并发症发生。
　　结论：23 G微创无灌注前段玻璃体切割联合白内障超声乳化并小梁切除的复合手术方法,可以有效治疗有晶状体眼的恶性青光眼发作,恢复部分功能性视力。根据恶性青光眼发病机制及临床体征,进行早诊断、早发现、早治疗,前后节三联手术能有效控制并且能长时间维持稳定的眼内压。     

超声乳化联合房角分离术治疗原发性闭角型青光眼

目的 观察超声乳化白内障吸除人工晶状体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼的疗效.方法 回顾性分析合并有白内障的闭角型青光眼患者35例(37眼),其中前房角关闭范围≤180°者16眼,＞180°者21眼,均行角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入联合房角分离术,对其手术前后的视力、眼压、视野、中央前房深度、房角状态进行对照观察.结果 随访3～24个月.术后视力除2眼有视神经萎缩外,余均有不同程度提高,末次随访平均眼压(14.31±4.13)mm Hg(1 mm Hg=0.133 kPa),较术前用药后平均眼压(26.42±3.22)mm Hg明显降低,差异有统计学意义(t=5.86,P＜0.01),中央前房深度由术前的(2.0±0.3)mm,增加到术后的(3.2±0.4)mm,房角状态与术前相比有3眼大部分开放,余房角均开放.结论 对于合并有白内障的闭角型青光眼的治疗,行超声乳化白内障吸除折叠式人工晶状体植入联合房角分离术能有效降低眼压,开放房角,加深前房,提高视力,手术并发症少.     

晶状体超声乳化治疗短眼轴白内障的临床研究

目的 观察短眼轴白内障行超声乳化人工晶状体植入术后眼压和前房深度的变化,探讨手术难点和疗效.方法 前瞻性病例对照研究.对51例(77眼)眼轴18.6 ～ 22mm,平均(21.65±0.57) mm的白内障行晶状体超声乳化人工晶状体植入术,对比观察手术前后视力、眼压、中央前房深度的变化,探讨手术难点和并发症.随访时间:3个月～2年.统计学处理采用配对资料t检验.结果 术后眼压(13.49 ±2.31) mm Hg较术前(15.26 ±3.44) mm Hg明显下降,P＜0.001;术后前房深度(4.07 ±0.22) mm较术前(2.80±0.34) mm明显加深,P＜0.001.术后视力均提高,除眼底病变和弱视者外,63眼视力≥0.5(81.82％).后囊破裂2眼,核坠入玻璃体1眼,悬韧带断裂1眼,均经正确处理后获较好视力.长期观察全部病例无青光眼发生.结论 短眼轴白内障行晶状体超声乳化折叠人工晶状体植入术后前房加深、眼压下降.因前房浅,手术有一定难度,采取正确措施后是安全有效的.此类患者宜尽早手术.     

白内障超声乳化联合房角粘连分离术治疗闭角型青光眼合并白内障

目的:观察白内障超声乳化人工晶状体植入联合房角粘连分离术治疗闭角型青光眼的疗效以及术后房角形态的改变。方法:白内障超声乳化联合房角分离术治疗闭角型青光眼48例(54眼),对手术前后的视力、眼压、视野、中央前房深度、房角形态进行对照观察。结果:术后随访3～6mo,54眼中48眼视力较前有明显提高。54眼前房深度均加深,术前前房深度(1.612±0.354)mm,术后前房深度(3.296±0.243)mm。54眼术后眼压明显降低,术前眼压(22.42±3.53)mmHg,术后眼压(13.52±3.24)mmHg。房角镜检查术后1mo和3mo随访房角均开放,未发现房角再粘连。48例术后6mo复查视野无缩小。结论:白内障超声乳化房角分离术可有效治疗闭角型青光眼合并白内障的患者。     

超声乳化治疗合并白内障的闭角型青光眼

目的 探讨超声乳化吸出人工晶状体植入术治疗合并白内障的闭角型青光眼的效果.方法 对26例(29眼)急慢性闭角型青光眼合并白内障行晶状体超声乳化吸出人工晶状体植入术.观察手术前后眼压、前房角、前房深度及视力变化.随访6个月～2年.结果 术后眼压(13.32±4.32) mm Hg(1 mm Hg=0.133 kPa),比术前药物控制眼压(25.12 ±8.52) mm Hg明显降低,二者差异有统计学意义(P＜0.05);中央前房深度增加,由术前的(1.73±0.36) mm增加到术后的(3.30±0.35) mm,两者差异有统计学意义(P＜0.05);前房角有所加宽,视力均有不同程度提高.结论 超声乳化吸出人工晶状体植入术,可作为合并有白内障的闭角型青光眼可供选择的手段之一.     

闭角型青光眼合并白内障两种术式的临床比较

目的探讨不同手术方法治疗慢性闭角型青光眼合并白内障的临床效果.方法 54例67眼慢性闭角型青光眼合并白内障患者,随机分为2组,观察组39眼和对照组 28眼.观察组行白内障超声乳化吸出人工晶状体植入联合小梁切除术,对照组行单纯白内障超声乳化吸出人工晶状体植入术,术后随访6～12月. 结果术后2组早期视力差异无显著性.6月后因眼压较高引起视力下降者,观察组3眼,对照组8眼,2组差异显著( P＜ 0.05);眼压控制在正常范围者(<20.55 mmHg,1 kPa=7.5 mmHg)观察组32眼,对照组 20眼.对照组有5眼眼压在30 mmHg以上,需手术治疗.2组间有显著性差异(P＜0. 05).术后2组并发症的发生无显著差异(P＞0.05). 结论慢性闭角型青光眼合并白内障,术前房角粘连≥3/4象限、眼压不易控制者,应选择青光眼白内障联合术,效果更加确切.     

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.