提上睑肌折叠术联合眼睑皮肤松弛矫正术治疗老年性上睑下垂

目的 探讨提上睑肌折叠术联合眼睑皮肤松弛矫正术治疗老年性上睑下垂的临床效果.方法 对21例42眼患者分别实施提上睑肌折叠术联合眼睑皮肤松弛矫正术,术中分离提上睑肌和节制韧带,并除去多余的皮肤及眶脂肪.结果 所有患者除1例失访外,均改善上睑下垂症状和达到了美容目的 ,无暴露性角膜炎等手术并发症.结论 提上睑肌折叠术联合眼睑皮肤松弛矫正术是一种理想的改善老年性上睑下垂患者视功能和容貌的手术方法.     

提上睑肌-Müller肌延长术治疗中、重度上睑退缩

目的评价提上睑肌-Muller延长术治疗中、重度上睑退缩的效果。方法采用重睑切口,打开眶隔, 暴露提上睑肌前表面。测量睑板上缘处提上睑肌的宽度,将其分成三部分,中央部分占1／2,两侧各占1／4。中央部分的高度以退缩量而定,即保留2mm矫正上睑退缩1mm,沿划线处剪断提上睑肌,将两端的肌肉缝于提上睑肌中央部分上端,术中嘱患者坐位以观察上睑的位置和轮廓,必要时需调整,皮肤以重睑成形方式缝合。结果 16例 (20只眼)行提上睑肌-Muller肌延长术,随访6-24个月,平均10．2个月。其17只眼在原位注视时上睑位于角膜缘下1-2mmm,2只眼过矫,1只眼欠矫。大部分病例在术后1个月内上睑位置多较低,而于术后3个月时上睑基本恢复至满意位置。全部病例手术效果满意。结论提上睑肌-Muller肌延长术可获得了良好的功能和美容双重效果,应为目前治疗中、重度上睑退缩的良好方法。     

超常量提上睑肌缩短及额肌瓣悬吊治疗重度先天性上睑下垂效果比较

目的：比较提上睑肌缩短术与额肌瓣悬吊术治疗重度先天性上睑下垂的疗效与并发症。

方法：对40例58眼重度先天性上睑下垂患者进行手术治疗,其中,20例28眼行额肌腱膜瓣悬吊术,20例30眼行改良的提上睑肌缩短术,术后随访6mo,观察两种手术方式治疗重度先天性上睑下垂的治疗效果及术后并发症的发生情况。

结果：术后随访6mo,提上睑肌缩短术组及额肌瓣悬吊术组治疗重度先天性上睑下垂的正矫率分别为：83%、82%,差异无统计学意义(P>0.05),但术后并发症的发生,如倒睫、闭合不全、暴露性角膜炎、结膜脱垂等,提上睑肌缩短术组少于额肌瓣悬吊术组,且有更好的外观。提上睑肌缩短术后6mo复诊时,眼睑闭合不全15眼,暴露性角膜炎共1眼,结膜脱垂2眼; 额肌瓣悬吊术后6mo随诊,眼睑闭合不全23眼,暴露性角膜炎2眼,上睑倒睫3眼。

结论：提上睑肌缩短术及额肌瓣悬吊术均能有效矫正重度先天性上睑下垂,但前者并发症少,术后外观好。     

提上睑肌缩短术在治疗中重度先天性上睑下垂中的应用

目的：观察应用提上睑肌缩短术治疗中重度先天性上睑下垂的效果。方法：对39例(56眼)中重度先天性上睑下垂患采用经皮肤-睑结膜入路提上睑肌缩短术。并对术后效果进行随访观察。结果：本组39例(56眼)随访2～18mo，除2眼矫正不足外，余均获得良好效果。上睑缘弧度及双重睑形成良好，术后仅部分病例早期有轻度睑裂闭合不全，无暴露性角膜炎等并发症发生。结论：提上睑肌缩短术可适用于中重度先天性上睑下垂患，在矫正畸形和改善外观方面均能达到良好的效果。     

义眼台术后上睑下垂的手术矫治

目的 探讨上睑提肌缩短联合眶上横韧带加强术治疗义眼台术后上睑下垂的效果。方法 依据上睑下垂的程度和肌力，确定上睑提肌缩短量；将上睑提肌缩短与眶上横韧带一并缝合固定在睑板中央偏下处。结果 本组13例，平均随访6月以上。术后睑裂高低与对侧眼基本一致，睑裂对称，重睑弧度自然。结论 上睑提肌缩短联合眶上横韧带加强术治疗义眼台术后上睑下垂，是一种有效的手术方法。     

改良提上睑肌缩短术矫治中重度先天性上睑下垂

目的 探讨治疗中、重度先天性上睑下垂简便的手术方法。方法 对35例(38只眼)中、重度先天性上睑下垂思者施行改良式提上睑肌缩短术。手术要点：自上横韧带上分离缩短提上睑肌矫正上睑下垂。结果 治愈36只眼，占94．2％，随访6月-2年，效果满意。结论 该术式手术方法简便，效果肯定，在改善功能和美学方面与传统提上睑肌缩短术无差别。     

提上睑肌折叠术矫正先天性上睑下垂在临床中的应用

目的 探讨采用提上睑肌折叠术治疗先天性上睑下垂的效果及可行性.方法 对30例(40眼)中(3mm)重度下垂(≥4mm)的先天性上睑下垂行提上睑肌折叠术.结果 本组30例(40眼),随访2个月-1年,除2只眼发生轻度回退外,无未矫正病例,无穹窿部结膜脱垂,无暴露性角膜炎等并发症出现.结论 提上睑肌折叠术治疗先天性上睑下垂是一种可靠有效的手术方法.     

提上睑肌腱膜折叠术治疗轻中度上睑下垂临床观察

目的探讨提上睑肌折叠术治疗轻中度上睑下垂的疗效。设计回顾性病例系列。研究对象30例（43眼）提上睑肌肌力达8mm以上的轻、中度上睑下垂患者。方法采用经皮肤人路的提上睑肌折叠术,无需分离提上睑肌,观察手术前后上睑睑缘位置的变化。主要指标第一眼位上睑睑缘位置。结果术后随访6个月～2年,平均13．1个月。30例（43眼）患者第一眼位上睑睑缘位于正常位置,3例（3眼）欠矫,1例（1眼）过矫,术后效果满意。结论提上睑肌腱膜折叠术适合于轻中度上睑下垂患者。（眼科．2070．79．716—77R）     

额肌瓣直接悬吊术的临床疗效观察

提上睑肌功能大部分或完全丧失的先天性和部分后天性上睑下垂患者 ,行提上睑肌缩短或间接额肌提吊等手术 ,不能达到较好的矫正效果 [1 ]。我们对 40例 46眼患者行额肌瓣直接悬吊术 ,现报告如下。1　资料与方法1.1　临床资料　 40例 46眼先天性上睑下垂患者 ,其中男2 8例 ,女 12例 ;年龄 4～ 2 1岁 ,平均 10 .2 5岁 ;6例 6眼为提上睑肌缩短术失败后患者。所有患者眼球运动无异常 ,上直肌功能正常 ,重度上睑下垂 32例 36眼 ,中度上睑下垂 8例10眼。提上睑肌肌力测定 2～ 3mm者 2 4例 2 6眼 ,0～ 1mm者 16例 2 0眼 ,额肌肌力测定均超过 7m m。…     

先天性上睑下垂经眶隔后隧道额肌瓣悬吊术

目的 观察经眶隔后隧道额肌瓣悬吊术治疗先天性上睑下垂的临床效果.方法 先天性上睑下垂170例,随机分为观察组和对照组,观察组采用经眶隔后隧道额肌瓣悬吊术治疗,对照组采用上睑提肌缩短徙前矫正术治疗.术后观察6个月,统计对比两组治疗效果及满意度.结果 观察组患者矫正满意度为92.05％,对照组者为71.95％,差异具有统计学意义（x2=13.29,P＜0.05）;观察组有效率为96.59％,对照组者为86.59％,差异具有统计学意义（x2=9.28,P＜0.05）.结论 经眶隔后隧道额肌瓣悬吊术治疗先天性上睑下垂效果明显.有较高的临床价值.     

LASEK--new laser refractive surgical technique. Personal experience

PURPOSE: The purpose of this study was to evaluate the clinical results of refractive error correction LASEK. MATERIAL AND METHODS: 115 eyes were analyzed after LASEK. The eyes were divided into 4 groups (myopia, myopic astigmatism, hyperopia, hyperopic astigmatism). The follow-up has taken 3 months. The effectiveness of this method was evaluated on the basis of the best visual acuity without correction after LASEK procedure, compared to the best visual acuity with correction before LASEK. The course of the healing process, the state of cornea and subjective symptoms were also evaluated. RESULTS: After 2 weeks in whole group the mean UCVA was in the same range of values compared with the BCVA before the operation. There were no postoperative complications observed. CONCLUSION: On the basis of our own observations we can say that LASEK is an effective and safe method for correction of refractive errors.     

Simple regression formula for intraocular lens power adjustment in eyes requiring cataract surgery after excimer laser photoablation

PURPOSE: To develop a simple and accurate method for determining appropriate intraocular lens (IOL) power in cataract patients who had prior excimer laser photoablation for myopia or hyperopia, because laser vision corrective surgery interferes with traditional keratometry and corneal topography, rendering IOL power calculations inaccurate. SETTING: Private Practice in Century City (Los Angeles), California, and free-standing outpatient surgery centers with institutional review boards. METHODS: Based on the empiric experience of the senior author, an IOL power correction factor that was proportional to the prior laser photoablation was determined and applied to the IOL power calculated by the IOLMaster (Zeiss). It was necessary to add to the predicted IOL power in eyes with prior myopic laser ablation, whereas eyes having prior hyperopic laser vision correction required a reduction in the IOL power. The correction factor was applied to 30 eyes that required cataract surgery at some time after laser refractive surgery; 23 eyes had prior treatment for myopia, and the remaining 7 eyes had prior hyperopic laser ablation. A regression formula was generated from the IOL power correction factor that was used in the 30 eyes. RESULTS: Using the correction factor for 30 eyes, the mean deviation from the desired postcataract refractive outcome was -0.15 diopter (D) +/- 0.29 (SD); 28 of 30 eyes were within +/-0.5 D of the intended goal; the remaining 2 eyes were both -0.75 D from the desired optical result of cataract surgery. Fourteen of the 30 eyes were emmetropic. CONCLUSIONS: A simple IOL power corrective adjustment regression formula allowed accurate determination of IOL power after laser refractive photoablation surgery. The weakness of the current method is that knowledge of the amount of prior laser vision correction is necessary.     

改良式额肌腱膜瓣悬吊术矫正儿童重度先天性上睑下垂

目的：探讨改良式额肌腱膜瓣悬吊术矫治儿童重度上睑下垂的长期临床疗效。

方法：回顾性分析2009-01/2011-12在我科收治的儿童重度上睑下垂患者83例114眼,采用改良式扇形额肌腱膜瓣悬吊术进行矫治,分析术后上睑下垂矫正效果和上睑缘弧度、重睑形成及倒睫、结膜脱垂等并发症发生情况。随访观察5a。

结果：术后第5a,矫正满意和基本矫正者共有84眼(73.7%),部分矫正30眼(26.3%),手术效果满意。术后并发症包括倒睫4眼(3.5%),其中3例3眼上睑内侧1/3灰线处缝牵引缝线牵引1wk后消失,1例1眼行二次手术; 结膜脱垂2眼(1.8%),应用皮质类固醇激素眼药水点眼,加压包扎1wk后结膜脱垂均消失; 术后无1例发生暴露性角膜炎、眼睑外翻、睑球分离、眼睑成角畸形、血肿形成、感染等并发症。术后上睑回退和外侧重睑皱襞消失是长期随访最常见的问题。

结论：改良式额肌腱膜瓣悬吊术矫治儿童重度上睑下垂长期疗效满意,效果持久稳定,安全可靠。     

Use of polymyxin as an endotoxin blocker in the prevention of diffuse lamellar keratitis in an animal model

PURPOSE: To determine whether bacterial endotoxin, lipopolysaccharide (LPS), could induce diffuse lamellar keratitis (DLK) in an animal model and whether DLK could be prevented by endotoxin blockers such as polymyxin. METHODS: Laser in situ keratomileusis (LASIK) flaps were created in rabbit eyes. The stromal bed was treated with 20 microg of Burkholderia cepacia LPS or balanced salt solution (BSS). Development of DLK, histological degree of inflammation, and presence of LPS detected by anti-LPS antibody were evaluated after 48 hours. In a second experiment, all eyes received LPS and were randomly assigned to receive either polymyxin in the form of two drops of Polytrim (Allergan, Irvine, Calif) on the stromal bed or two drops of BSS. RESULTS: In the animal model study, LPS was significantly associated with the development of DLK (P<.05, n=30). Infiltration with polymorphonuclear cells and presence of DLK were found in LPS treated eyes but not in controls. In the second experiment, 4 (27%) of 15 eyes that received polymyxin in addition to LPS developed DLK compared to 18 (95%) of 19 eyes that received only LPS (P<.05, n=34). There was a trend towards higher flap displacement in polymyxin treated eyes but this was not significant (P=.07). CONCLUSIONS: Diffuse lamellar keratitis in a rabbit model can be caused by bacterial endotoxin (LPS). Endotoxin blockers, such as polymyxin, are effective in decreasing the incidence of endotoxin-induced DLK in a rabbit model.     

One year results of European Multicenter Study of intrastromal corneal ring segments. Part 2: complications, visual symptoms, and patient satisfaction

PURPOSE: To assess intraoperative and postoperative complications, visual symptoms, and patient satisfaction after implantation of intrastromal corneal ring segments (ICRS, KeraVision, Inc.) for the correction of myopia and to demonstrate the reversibility and adjustability of refractive corrections with this method. SETTING: Twelve European investigational sites. METHODS: Patients with myopia of -1.0 to -6.0 diopters (D) were assigned to receive 1 of 5 ICRS thicknesses (0.25, 0.30, 0.35, 0.40, or 0.45 mm). Complications and visual symptoms were noted, and patient satisfaction was assessed at each postoperative visit (1 and 7 days and 1, 2, 3, 6, and 12 months). Refractive data were assessed after removal or exchange of the ICRS. RESULTS: Of 163 eyes of 110 patients enrolled, 159 eyes of 107 patients were implanted with an ICRS (52 patients had bilateral implantation). Intraoperative complications occurred in 2% of eyes (4/163 eyes in 3 patients) that were withdrawn from the study: 3 eyes had anterior surface perforations and 1 had a posterior microperforation into the anterior chamber. Most patients had no visual symptoms at 12 months; symptoms usually occurred rarely or sometimes and were mild in severity. At 12 months, good or excellent patient satisfaction was reported for 94% of eyes. Twelve ICRSs (8%) were removed, mainly because of undercorrection and induced astigmatism, and 2 were exchanged. All eyes were within +/-1.00 D of the preoperative manifest refraction spherical equivalent. CONCLUSIONS: The ICRS was safe for correction of low to moderate myopia. Severe postoperative visual symptoms were rare, and patient satisfaction was high. The refractive correction was largely reversible.     

Correction of myopia with LASIK--two year observation

PURPOSE: The purpose of this study was to evaluate the clinical results of correction of moderate and high myopia as well as myopic astigmatism with LASIK. MATERIAL AND METHODS: 112 randomly selected eyes (79 patients) were analyzed after LASIK. In this group there were 55 women and 24 men aged 17 to 50 (mean 34.9). The eyes were divided into two groups (the first: between -8.0 D to -14.75 D; the second: between -15.0 D to -23.0 D). The follow-up time was 24 months. The effectiveness of this method was evaluated on the basis of the best visual acuity without correction after LASIK procedure compared to the best visual acuity with correction before LASIK. The course of the healing process, the state of cornea and subjective symptoms were also evaluated. RESULTS: One week after the operation (after LASIK) a statistically significant decrease of mean visual acuity was observed. In group I after 2 weeks the mean visual acuity was in the same range of values compared with the visual acuity before the operation. In the next period no statistically significant were observed differences. In group II after 2, 4, and 12 weeks the mean visual acuity was equalized in comparison with the mean visual acuity before correction. After 6, 12 and 24 months statistically significant improvement of visual acuity was observed. CONCLUSION: On the basis of our own observations we can say that LASIK is an effective and safe method of myopia and myopic astigmatism correction.     

Confocal microscopy and histopathological examination of diffuse lamellar keratitis in an experimental animal model

PURPOSE: To investigate the cell populations and structural alterations of the cornea in an experimental model of diffuse lamellar keratitis (DLK) using confocal microscopy and histopathology. METHODS: A corneal flap was cut in 22 eyes of 11 New Zealand rabbits and the stromal interface was exposed to balanced salt solution (BSS, BSS group) and Pseudomonas aeruginosa lipopolysaccharide (LPS) endotoxin (5 mg/mL) (LPS 5 mg/mL group) and (3.5 mg/mL) (LPS 3.5 mg/mL group). Postoperatively, eyes were examined with a slit-lamp microscope (DLK grading) and confocal microscopy. Animals were sacrificed on day 3 (BSS group and LPS 5 mg/mL group) and day 4 (LPS 3.5 mg/mL group). Corneoscleral buttons were excised and processed for histopathologic examination. RESULTS: Seven eyes were excluded. Slit-lamp microscopy revealed no cellular infiltration in the BSS group (five eyes). In the LPS groups, all eyes developed DLK, with iritis only observed in grade III eyes. In the LPS 5 mg/mL group, four eyes had DLK grade III, with iritis in three eyes. In the LPS 3.5 mg/mL group, three eyes had grade II and three eyes had grade III with iritis. On confocal microscopy, the BSS group had no cellular infiltration. Dense accumulation of inflammatory cells at the interface was noted in both LPS groups. Histopathology in the BSS group had a normal appearance. In the LPS groups, an inflammatory infiltrate was present at the interface that consisted of three cell populations--eosinophils, neutrophils, and lymphocytes. CONCLUSIONS: Lipopolysaccharide endotoxin induced DLK in all exposed eyes, with iritis in a considerable proportion of eyes. The infiltrate consisted of three cell populations. Confocal microscopy showed the infiltrate in all affected eyes. Histopathological and confocal microscopic findings correlated well with the clinical appearance.     

Technical improvements in photorefractive keratectomy for correction of high myopia

PURPOSE: To evaluate the effects of hardware and software improvements in photorefractive keratectomy (PRK) for the treatment of highly myopic eyes. METHODS: A retrospective study was carried out in 554 patients (582 eyes) with myopia between -7.00 and -17.00 D (mean -11.20 +/- 3.60 D) who had undergone PRK using the Aesculap Meditec laser. Group 1 with a 5-mm-diameter single ablation zone; Group 2 with a 5-mm-diameter single zone surrounded by a 2-mm tapered transitional zone; Group 3 and Group 4, same as Group 2 but with the laser upgraded with a smoke aspiration control system (Group 3), and with a computer-controlled fluence (Group 4). RESULTS: In Group 1 at 2 years after PRK (50 eyes), 10 eyes (20%) were within +/-1.00 D of attempted correction and 13 eyes (26%) were within +/-2.00 D. In Group 2 at 2 years (118 eyes), 42 eyes (36%) were within +/-1.00 D of attempted correction and 65 eyes (55%) were within +/-2.00 D. In Group 3 at 2 years (43 eyes), 18 eyes (42%) were within +/-1.00 D of attempted correction and 28 eyes (65%) were within +/-2.00 D. In Group 4 at 2 years (47 eyes), 25 eyes (53%) were within +/-1.00 D of attempted correction and 29 eyes (62%) were within +/-2.00 D. CONCLUSIONS: Software and hardware improvements facilitated PRK correction of high myopia with reasonable predictability, especially if a tapered transition zone was used. At 12 and 24-month follow-up, only the use of a tapered transition zone was associated with a statistically significant improvement in predictability.     

Deep lamellar keratoplasty by deep parenchyma detachment from the corneal limbs

AIM: To improve the deep lamellar keratoplasty technique. METHOD: For the easy and reliable perfomance of deep lamellar keratoplasty (DLKP), detachment of Descemet's membrane through the corneal limber flap was improved. To expose Descemet's membrane, the parenchyma was detached by hydrodelamination through a sclerocorneal flap made in the corneal limbs. The parenchyma was removed after the pseudochamber between it and Descemet's membrane was maintained with viscoelastic material. The corneal graft was placed with a running suture. 22 eyes were treated. RESULTS: Complete exposure of Descemet's membrane was obtained in 20 of the 22 eyes (91%). The membrane was perforated in five of the 22 eyes (23%) during surgery, and two of the 22 eyes (9%) were converted to penetrating keratoplasty. These two eyes developed keratoconus after acute corneal hydrops. CONCLUSION: Compared with the conventional procedure, this new method provides easy, reliable exposure of Descemet's membrane.     

Artisan phakic intraocular lens for myopia:short-term results of a prospective,multicenter study

PURPOSE: To evaluate the safety and efficiency of the Artisan iris-supported phakic intraocular lens (Ophtec BV, Groningen, Netherlands) for the correction of high myopia. STUDY DESIGN: Nonrandomized, prospective, multicenter trial conducted under a United States Food and Drug Administration (FDA) Investigational Device Exemption. PARTICIPANTS: One hundred fifty-five eyes of 155 patients with myopia from -5.5 to -22.5 diopters (D) underwent implantation of an Artisan lens, as part of a phase I, II, or III FDA trial. METHODS: Eyes were examined at 1 day (154 eyes), 2 weeks (142 eyes), 2 months (130 eyes), and 6 months (84 eyes). Intraocular pressure and presence of flare and cell on slit-lamp biomicroscopy were recorded at each visit. MAIN OUTCOME MEASURES: Achieved correction, stability of spherical equivalent refraction, change in astigmatism, postoperative uncorrected vision, change in best spectacle-corrected acuity, and change in endothelial cell count. RESULTS: Mean spherical equivalent manifest refraction stabilized on postoperative day 1. Mean difference between attempted and achieved correction at 2 months was -0.32 +/- 0.95 D (mean +/- standard deviation; range, -4.42 to +2.2 D). At 6 months, 85% of eyes saw 20/40 or better uncorrected, and 90% of eyes were within 1 D of the attempted correction. Refractive astigmatism increased in 4.8% of eyes and decreased in 17% of eyes at 6 months. At 2 months, six eyes (4.8%) lost two or more lines of best spectacle-corrected visual acuity; by 6 months, no eyes lost two or more lines of best-corrected visual acuity. Endothelial cell count was unchanged at 6 months compared with the preoperative count. Nonprogressive lens opacities developed in four eyes as a result of surgical trauma. Chronic inflammation was not detected in any eye by slit-lamp biomicroscopy, nor did any eye develop angle closure or glaucoma. CONCLUSIONS: Short-term results suggest that the Artisan lens is an accurate and safe method for the correction of high myopia. Surgical skill is important in avoiding lens opacities. Longer-term data are needed to assess the impact of the lens on the endothelium, the crystalline lens, and the iris.