半导体激光透巩膜睫状体光凝治疗难治性青光眼

目的 :评价利用半导体激光透巩膜睫状体光凝治疗难治性青光眼的效果。方法 :对 34例难治性青光眼患眼进行 810nm半导体激光的透巩膜睫状体光凝 ,能量为 15 0 0～ 2 2 5 0mW ,时间为 2秒 ,范围 180°～ 2 70° ,观察 3～ 6个月的治疗效果。结果 :治疗前眼压为 5 1mmHg± 3 7mmHg ( 2 4～ 5 9mmHg) ,经过第一次治疗后的眼压是 18mmHg± 2 1mmHg ( 12～ 35mmHg)(P <0 0 1) ,最后统计的眼压是 17± 1 6mmHg ( 13～ 31mmHg) (P <0 0 1)。并发症主要是前房的炎症反应 ,在 2W左右消失。结论 :透巩膜半导体激光睫状体光凝是治疗难治性青光眼的一种有效的方法 ,而且操作方便 ,患者痛苦小。     

经巩膜睫状体光凝治疗难治性青光眼的临床观察

目的:评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的效果。方法:回顾性分析55例56眼难治性青光眼的临床资料,均行睫状体光凝,术后随访观察并记录眼压、视力、眼部自觉症状以及并发症,随访时间3mo以上。结果:术前平均眼压53.5±18.7mmHg,末次随访平均眼压为19.4±9.6mmHg,术后眼压与术前眼压相比,差别具有统计学意义(P<0.01)。术后44眼视力无变化,2眼视力提高,10眼视力下降;眼痛均消失或缓解;并发症少,主要有葡萄膜炎、前房出血等。结论:睫状体光凝能有效降低难治性青光眼患者的眼压,且并发症少。     

810nm激光睫状体光凝治疗难治性青光眼的疗效

目的:探讨810nm激光经巩膜睫状体光凝治疗难治性青光眼的临床疗效。方法:对25例30眼难治性青光眼患者行810nm激光经巩膜睫状体光凝术,术后随访3mo,分析术后眼压、疼痛感、视力、并发症等情况。结果:术后随访期间全部患者眼痛症状均缓解。术前平均眼压为50.42±2.50mmHg,末次随访时平均眼压15.95±4.19mmHg,术后眼压与术前相比,差异有显著统计学意义(P<0.01)。光凝术后2眼(6.7%)视力提高,24眼(80.0%)视力无变化,4眼(13.3%)视力下降。术后前房渗出12眼(40.0%),前房积血3眼(10.0%),玻璃体积血1眼(3.3%),药物治疗后消失。结论:810nm激光经巩膜睫状体光凝术是治疗难治性青光眼的有效方法,能显著降低眼压,减少患者痛苦,并发症少。     

二极管激光经巩膜睫状体光凝术治疗穿透性角膜移植术后难治性青光眼的疗效观察

目的 :观察接触性二极管睫状体光凝术治疗穿透性角膜移植术后难治性青光眼的效果和对角膜植片的影响。方法 :使用IRIS OculightSLX二极管激光系统 ,光凝角巩膜缘外 1 2mm处 ,范围 180°～ 36 0° ,能量 1 7～ 2 6W ,2 0～ 4 0点 ,对 2 4例穿透性角膜移植术后难治性青光眼患者共 2 4只眼行 1～ 3次半导体二极管睫状体光凝术 ,随访时间≥ 9个月者被列入本研究。结果 :眼压 :治疗前在用抗青光眼药物的情况下眼压为 (32± 9 7)mmHg(2 7～ 5 9mmHg)。激光治疗后一周内眼压明显降低 ,随访 9～ 16个月 (平均 11 4个月 ) ,末次随访眼压为 (18± 5 8)mmHg(8～ 2 8mmHg) ,眼压平均降低 14mmHg。视力 :末次随访视力从 0 2到手动 ,手术后视力无改变者 16只眼 (6 6 7% ) ,下降者 6只眼 (2 5 % ) ,提高者 2只眼 (8 2 % )。角膜植片 :术前植片透明者 16只眼 ,半透明 2只眼 ,混浊 6只眼 ,术前植片透明眼在术后有 3只眼 (19% )发生排斥反应致植片混浊 ,排斥均发生在术后 3个月内 ,术前植片半透明的 2只眼在术后植片亦变混浊。结论 :接触性二极管睫状体光凝术简单易行 ,安全有效 ,可重复进行。对于多次行其它抗青光眼手术治疗 ,眼压不能控制的穿透性角膜移植术后难治性青光眼 ,是一个较好的选择。     

经巩膜睫状体光凝术治疗难治性青光眼初步观察

目的　探讨经巩膜睫状体光凝术治疗难治性青光眼的疗效、方法、术后并发症。方法　 2 4例难治性青光眼中新生血管性青光眼 9例 9只眼 (NVG) ,原发性闭角性青光眼 (绝对期 ) (PACG) 7例 7只眼 ,复杂眼外伤继发青光眼 5例 (5只眼 ) ,PPV手术后及慢性葡萄膜炎继发青光眼 3例 (3只眼 ) ,行经巩膜睫状体光凝术 ,其中 8例 (8只眼 )进行了 2次光凝。结果　 2 4例 (2 4只眼 )治疗前平均眼压 (40 .83± 3.79) m m Hg,光凝后 1周平均眼压 (2 1.76± 9.4 3) mm Hg,两者比较 ,差异有显著意义。 (t=11.0 84 ,P <0 .0 5 ) ,光凝治疗后 1月平均眼压 (2 5 .5 1± 9.8)0 m m Hg,(t=8.2 7,P <0 .0 5 )。术后视功能保持不变 2 3只眼 (96 % )。术后前房出血 2只眼 ,顽固性前房炎症反应1只眼 ,无眼球萎缩病例。结论　睫状体光凝术治疗难治性青光眼疗效可靠 ,但要掌握光凝方法 ,注意治疗并发症。     

睫状体光凝术对晚期青光眼的止痛效果观察

目的观察睫状体光凝术对晚期青光眼的止痛效果.方法34例36眼青光眼以半导体激光经巩膜的睫状体光凝术,于角膜缘后1.0～1.2 mm处3个象限做18～20个光凝点,能量为1500mW,每个光凝点的光凝时间为0.2秒,术后随访6月以上.结果术前平均眼压(53.92±16.33)mmHg(1 mmHg=0.133 KPa),术后第2周平均眼压(27.29±10.99)mmHg,经统计学处理两者差异具有非常显著意义,(t=8.117,P=0.001).术前轻度疼痛7眼,重度疼痛22眼,剧痛7眼;术后第2周无痛22眼,轻度疼痛12眼,重度疼痛2眼;术后1月有10眼仍有疼痛,测眼压在40.18 mmHg及以上,遂进行第二次光凝术,术后疼痛消失,眼压在40 mmHg以下.结论睫状体光凝术对控制晚期青光眼的眼压和减轻其疼痛效果良好.     

睫状体光凝与视网膜消融术治疗新生血管性青光眼

目的观察半导体激光经巩膜睫状体光凝联合视网膜消融术(全视网膜光凝或前部视网膜冷凝)治疗新生血管性青光眼的临床效果。方法12例12眼药物不能控制的新生血管性青光眼接受治疗。8眼睫状体光凝和全视网膜光凝，4眼同时行睫状体光凝和前部视网膜冷凝。术后随访6～19月，对比分析6月时的眼压、视力及虹膜新生血管改变。结果睫状体光凝前眼压36～67mmHg(1mmHg=0．133kPa)，平均45．52mmHg。末次治疗后6月，在不用抗青光眼药物的情况下，6眼(50％)眼压在9～17mmHg；局部滴用0．5％噻吗心胺滴眼液后4眼(33．33％)眼压低于21mmHg，2眼(16．67％)眼压高于21mmHg。视力下降者2眼，提高者2眼，不变者8眼。虹膜新生血管完全消失8眼，部分消失4眼。结论半导体激光经巩膜睫状体光凝联合视网膜消融术治疗新生血管性青光眼，既能及时降低眼压，又能减少视网膜缺血，拯救现有或潜在视力。     

半导体激光经巩膜睫状体光凝治疗难治性青光眼临床分析

目的　探讨半导体激光经巩膜睫状体光凝治疗难治性青光眼的有效性和安全性。方法　对 18例 (18只眼 )难治性青光眼施行半导体经巩膜睫状体光凝术 ,术后随访 3～ 6个月。激光能量 2 0 0 0 m W,时间 10 0 0～15 0 0 m s,击射范围 90°～ 36 0°,击射点 18～ 30点 ,点间距 2 m m。结果　手术降眼压有效率 6 6 .6 %,眼痛解除率94.4%,视力提高率 5 4.4%。结论　半导体激光经巩膜睫状体光凝治疗难治性青光眼是相对安全、简便有效的治疗手段。     

巩膜睫状体光凝术对难治性青光眼的中长期疗效

目的　评价经巩膜 810nm半导体激光睫状体光凝术对难治性青光眼的中长期疗效。方法　回顾性地分析了 65例 (65只眼 )经巩膜睫状体光凝的难治性晚期青光眼 ,时间从 1998年 10月至 2 0 0 0年 10月 ,随访 2 4m～ 46m (平均 3 4 1m± 5 8m ) ,观察指标包括包括眼压、视力、用药数量、眼痛情况和眼球萎缩发生率。结果　术前平均眼压 5 1 2mmHg± 14 3mmHg ;最后一次随访 ,平均眼压 16 1mmHg± 11 2mmHg ;最后眼压在 6mmHg～ 2 1mmHg之间者有 41眼 (63 1% ) ,经配对资料T检验 ,术前眼压与术后眼压相比 ,差异有显著性 ,P <0 0 1。术后 46只眼 (70 8% )视力保持不变 ;18只眼 (2 7 7% )视力下降 ;1只眼 (1 5 % )视力增加。抗青光眼用药种类从治疗前的平均3 1种降至治疗后平均 0 4种 (P <0 0 1)。术前有眼痛的患者中 93 3 %的眼痛症状显著缓解或消失。7只眼 (10 8% )发生眼球萎缩。结论　经中长期随访观察 ,810nm半导体激光经巩膜睫状体光凝术仍是治疗难治性青光眼的有效方法。     

半导体激光经巩膜睫状体光凝术治疗新生血管性青光眼的远期疗效

目的评价半导体激光经巩膜睫状体光凝术治疗新生血管性青光眼的远期疗效。方法回顾性分析71例（72眼）行半导体激光经巩膜睫状体光凝术的新生血管性青光眼,术前平均眼压为（56.2±12.0）mmHg（36～71mmHg,1kPa=7.5mmHg）,术后随访6个月～5a,观察眼部自觉症状、眼压、视力及并发症。结果最后1次随访的平均眼压为（17.3±5.9）mmHg（13～32mmHg）,降压成功率为94.4%.2眼发生眼球萎缩。视力提高7眼,视力无变化55眼,视力下降10眼。结论半导体激光经巩膜睫状体光凝术是一种简单、安全、有效的治疗新生血管性青光眼的方法。     

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.

---

     

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.