普南扑灵滴眼剂合并地塞米松对白内障术后炎症的疗效

目的评估普南扑灵滴眼剂在减轻白内障术后炎症反应中的疗效及其副作用。方法100例(122眼)白内障患者采用囊外摘除术加人工晶状体植入,术后随机分为治疗组和对照组,治疗组50例(58眼),选用0.1%普南扑灵滴眼剂点眼加0.025%地塞米松滴眼剂点眼,对照组50例(64眼),选用0.025%地塞米松滴眼剂点眼。观察指标为眼部畏光、异物感、流泪、疼痛等症状及充血、前房闪辉、角膜炎症、前房浮游体、KP及虹膜后黏连等体征,以各项指标的综合评分评价其疗效。结果治疗组在术后第3天、第7天、第14天综合评分优于对照组,差异有显著性(P<0.05);第21天差异无显著性(P>0.05)。结论普南扑灵联合地塞米松滴眼剂点眼能显著地减轻白内障术后的炎症反应。     

肝素表面处理人工晶状体在并发性白内障手术中应用疗效观察

目的探讨肝素表面处理人工晶状体在并发性白内障患者手术中应用的疗效。方法106例(152只眼)并发性白内障患者中随机抽取98只眼为研究组(A),植入HQ-201HEP型肝素表面处理人工晶状体;54只眼为对照组(B),植入MA-60MB型人工晶状体。比较术后视力、眼压、前房闪辉、房水细胞、虹膜后粘连、后囊膜混浊等结果。结果研究组(A)中98只眼有前房闪辉30只眼(30.6%),房水细胞阳性26只眼(26.5%),虹膜后粘连17只眼(17.3%),后囊膜混浊2只眼(2.04%),高眼压2只眼(2.04%)。而对照组(B)54只眼有前房闪辉42只眼(77.8%),房水细胞阳性43只眼(79.6%),虹膜后粘连24只眼(44.4%),后囊膜混浊7只眼(12.7%),高眼压6只眼(11.1%)。结论临床研究发现肝素表面处理人工晶状体在减轻眼内炎症反应、异物反应、细胞在人工晶状体表面沉着(前房闪辉、房水细胞、虹膜后粘连、后囊膜混浊)等方面优于对照组,尤其对于有葡萄膜炎病史、青光眼术后、局部和全身应用类固醇激素者尤为适合,可减轻高眼压和前房出血的发生。     

不同术式治疗黄斑裂孔视网膜脱离的临床观察

目的　评价不同手术方式治疗黄斑裂孔视网膜脱离 (retinal detachment,RD)的疗效。方法　回顾性分析 1997年 6月～ 2 0 0 0年 3月经不同术式治疗的黄斑裂孔性 RD连续病例 192例患者 196只眼 ,其中采用单纯注气术 10 2只眼 ,注气术联合巩膜扣带术 (scleral bucking surgery,SBS) 5 2只眼 ,玻璃体视网膜手术 (vitreoretinalsurgery,VRS)联合 SBS18只眼。随访 2～ 6 1个月 ,平均 7.6± 10 .5个月。结果　复位 16 4只眼 (83.6 7% ) ,好转 16只眼 (8.16 % ) ,16只眼 (8.16 % )失败 ,总有效率 91.84 % ,其中单纯注气术组有效率 93.13% ,注气联合 SBS组94 .2 3% ,VRS组 83.33% ,VRS联合 SBS组 88.89%。最终治愈的 180只眼中视力提高者 92只眼 (5 1.11% ) ,其中单纯注气术组 4 4 .12 % ,注气联合 SBS组 5 3.85 % ,VRS组 5 0 .0 0 % ,VRS联合 SBS组 5 0 .0 0 %。有严重增生性玻璃体视网膜病变 (proliferative vitreoretinopathy,PVR)、黄斑“白孔”、玻璃体牵引及术前有 RD复位手术失败史则显著影响手术效果。结论　按其适应证选择不同术式治疗的黄斑裂孔 RD,均能达到较好的解剖及功能复位。手术成功的关键是术前根据玻璃体视网膜情况 ,正确设计手术方案     

激素和非甾体类抗炎药在白内障术后联合使用的临床研究

目的　比较超声乳化白内障吸除术后单纯典必殊眼水 (地塞米松加妥布霉素 )和典必殊减量使用加普南扑灵眼水 (普拉洛芬 )的术后炎症反应 ,以探讨激素和非甾体类抗炎药联合使用在白内障术后应用的价值。方法　采用随机对照的方法 ,将术中无并发症的 12 0只眼分为两组 ,每组 60眼。试验组 :典必殊眼水和普南扑灵合用一周 ,以后普南扑灵单独使用三周。对照组 :典必殊眼水使用四周。分别于术后不同时间观察随访症状、体征、房水闪辉和细胞 ,并测量眼压。结果　两组的术后症状和体征综合得分无显著性差异 (P >0 0 5 ) ;房水闪辉除术后 14天无显著性差异外 (P >0 0 5 ) ,其余均有显著性差异 (P <0 0 5 ) ,试验组比对照组闪辉值低 ;房水细胞在术后 3 0天有统计学差异 (P <0 0 5 ) ,此前 ,两组的前房细胞未见统计学差异 (P >0 0 5 ) ;在术后两周和一月时 ,对照组的眼压比术前有所增加 ,而试验组则轻微降低 ,且有显著性差异 (P <0 0 5 )。结论　无并发症的超声乳化吸除术术后应用激素加非甾体类抗炎药比单纯激素抗炎作用相当甚至更好 ,避免了长期使用激素眼水引起的眼压增高等副作用 ,术后应用非甾体类抗炎药联合激素是一种较好的用药方式     

普南扑灵滴眼剂用于白内障超声乳化手术的临床研究

目的　探讨普南扑灵滴眼剂不同用药方式对白内障超声乳化手术后炎症反应的抑制作用。方法　年龄相关性白内障患者10 0例(112只眼)随机分为试验1组(2 5例2 8只眼)、试验2组(2 5例2 8只眼)、试验3组(2 5例2 8只眼)和对照组(2 5例2 8只眼)。试验1组单纯用普南扑灵滴眼剂,试验2组术前1天及术后使用普南扑灵滴眼剂,试验3组使用普南扑灵滴眼剂+科恒滴眼剂,对照组单纯使用科恒滴眼剂。观察用药后异物感、睫状充血、角膜反应、房水闪光等指标。结果　除了术后3天,试验3组的房水闪光减少大于试验1组(P <0 .0 5 ) ;术后7天,对照组房水闪光好于试验1组(P <0 .0 5 ) ,其余的症状和体征在术后各时间内均无差别。各组综合得分在术后同一时间内差别没有统计学意义。结论　普南扑灵滴眼剂与科恒滴眼剂一样对白内障超声乳化手术后炎症反应的控制有效、安全。     

不同术式治疗增殖性糖尿病视网膜病变的疗效分析

目的评价玻璃体切除联合超声乳化人工晶状体植入术(联合手术)和单纯玻璃体切除术治疗增殖性糖尿病视网膜病变的临床效果。方法回顾性分析了33例(41眼)行联合手术与36例(42眼)行单纯玻璃体切除治疗的增殖性糖尿病视网膜患者,手术前后的眼部病情、视力及手术并发症等临床资料。平均随访时间分别为20月和21月。结果2组患者手术后视力较均术前提高,但2组之间差异无统计学意义;联合手术组术前虹膜新生血管在术后1～2月内完全消退(5眼),单纯玻璃体切除组只有1眼完全消退(P<0.05);联合手术组有9眼术后前房内纤维素渗出膜形成,单纯玻璃体切除组只有1眼,差异有统计学意义(P<0.05);联合手术组有7眼术后形成虹膜后粘连,单纯玻璃体切除组只有1眼(P<0.05);联合手术组有4眼术后再行玻璃体切除术,占9.8%,单纯玻璃体切除有8眼占19%(P>0.05)。结论联合手术治疗增殖性糖尿病视网膜病变是安全有效的,早期恢复患者的视力,避免再次手术,但联合手术后前房炎性反应、虹膜后粘连的发生率较高。     

联合手术治疗增生性糖尿病视网膜病变的研究

目的 评价玻璃体切除联合晶状体切除或超声乳化吸出人工晶状体植入术(联合手术)和单纯玻璃体切除术治疗伴有轻度白内障的增生性糖尿病视网膜病变的临床效果.方法 回顾性分析了32例(40眼)联合手术与28例(33眼)单纯玻璃体切除术治疗的增生性糖尿病视网膜病变的临床资料,包括手术前后的眼部状况、视力及手术并发症等.结果 两组手术后视力较术前提高者,联合手术组占77.50％,单纯玻切组占66.67％,两组之间差异有统计学意义(x2=4.74,P＜0.05).联合手术组术前5眼虹膜新生血管在术后1～2个月内5眼均完全消退,单纯玻璃体切除组7眼中仅有1眼完全消退.联合手术组有9眼术后前房内纤维素渗出膜形成,单纯玻璃体切除组只有1眼.联合手术组有7眼术后形成虹膜后粘连,单纯玻璃体切除组只有1眼.结论 联合手术治疗增生性糖尿病视网膜病变是安全有效的,可较早恢复视力,避免再次行白内障手术,但联合手术后前房炎性反应、虹膜后粘连的发生率较高.     

普拉洛芬滴眼液治疗眼前节激光术后炎症反应的观察

目的:评估普拉洛芬滴眼液在减轻眼前节激光术后,即激光虹膜周边切除术(LPI)和激光后囊切开术后炎症反应中的疗效。方法:选取60例60眼闭角型青光眼患者行LPI,60例60眼行激光后囊切开术,术后随机分为试验组和对照组,试验组包括行LPI患者30例30眼,行激光后囊切开术患者30例30眼,选用普拉洛芬滴眼液点眼。对照组包括行LPI患者30例30眼,行激光后囊切开术患者30例30眼,选用典必殊滴眼液点眼。观察指标为眼部疼痛、畏光、异物感、流泪等症状及充血、角膜上皮完整性、前房闪辉、前房浮游体等体征,以各项指标的综合评分评价其疗效。结果:试验组在术后1,3,7d综合评分与对照组比较,差异无显著性(P>0.05)。结论:普拉洛芬滴眼液应用于眼前节激光术后安全有效,可降低激素性高眼压的风险。     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。     

晶状体摘除对糖尿病视网膜病变玻璃体视网膜手术效果的影响

目的 探讨晶状体摘除对糖尿病视网膜病变(diabetic retinopathy,DR)玻璃体视网膜手术(vitreoretinal surgery,VRS)效果的影响.方法 回顾性分析2001年2月至2007年8月行VRS的68例(80只眼),比较摘除晶状体眼同人工晶状体眼与保留晶状体眼的手术效果,随访5～63个月,平均(12.24±9.13)月.结果 术后87.27%的保留晶状体眼及68%的摘除晶状体眼视力提高或不变(x2=4.191,P=0.062);再次VRS率在保留晶状体组为12.7%,摘除晶状体组20%(x2=0.713.P=0.502);解剖复位率在保留和摘除晶状体眼分别为92.73%和96%(x2=0.314,P=1.000);保留晶状体组和摘除晶状体组各2只眼发生虹膜红变(x2=689,P=0.585),差异均无统计学意义.术后摘除晶状体组前房纤维素性渗出和黄斑水肿的发生率较保留晶状体组增加,差异有统计学意义(P<0.05).结论 晶状体摘除并不增加DR再次VRS率和虹膜红变的发生率,但术后前房纤维素性渗出和黄斑水肿的发生率增加.     

Cataract surgery after retinal surgery

Many patients require surgery for cataract after retinal surgery. When evaluating patients preoperatively, the surgeon should pay careful attention to the assessment of visual function and potential acuity, and to the slit lamp examination of the lens, posterior capsule, anterior cortical vitreous, and zonules. The surgeon's technique must account for increased nuclear sclerosis, intraoperative miosis, a characteristically longer axial length, and fluctuations in anterior chamber depth from movement of the iris-lens diaphragm. Posterior capsule plaques are not unusual. Posterior capsule opacification is the most frequent late complication. Visual outcomes are usually good except when limited by pre-existing macular pathology. Vision-threatening complications of cataract surgery are unusual.     

角膜屈光矫正手术后白内障手术

目的:探讨角膜屈光矫正手术后白内障手术的诊疗特点。方法:对2005/2008年间于我院就诊的4例角膜屈光矫正手术后白内障患者行白内障超声乳化吸出术+人工晶状体植入术。依据患者提供的角膜屈光手术资料,分别采用临床病史法或角膜后表面曲率法计算矫正角膜曲率及人工晶状体度数。术后随访观察角膜情况、手术并发症、裸眼视力、最佳矫正视力、术后屈光状态等。结果:术后最佳矫正视力较术前明显提高。术后稳定屈光度与手术前预留屈光状态比较误差范围为-1.00～+1.25D。结论:对角膜屈光手术后的白内障患者施行白内障超声乳化吸出术+人工晶状体植入术是可行的。然而只有了解这类患者病情特点,掌握手术前后诊疗方法,准确计算人工晶状体度数,才能达到满意的疗效。     

Cataract surgery combined with retinal detachment surgery

Cataract surgery can be associated with vitrectomy, with good anatomical results. But one can face problems during or after surgery. This combined procedure is made possible in cases with retinal detachment and difficult fundus examination because of cataract. Otherwise, cataract surgery can be performed, and retinal surgery can be made a few days later.     

Prognostic factors for strabismus surgery after cataract surgery

PURPOSE: To evaluate the clinical features of strabismus that present after cataract surgery and determine the motor and sensory results after surgical correction of the strabismus. SETTING: Department of Ophthalmology, the Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. METHODS: Thirty-one patients who had strabismus surgery after cataract surgery between January 1996 and June 2004 were included in the study. The clinical features of strabismus and the factors contributing to successful strabismus surgery results were retrospectively analyzed. Sensory functional tests were performed postoperatively. RESULTS: Fifteen patients (48.4%) had exotropia. The types of cataract included traumatic (35.5%), congenital (32.3%), and senile (25.8%). Prolonged deviation was the statistically significant factor contributing to final alignment (P = .023). Fourteen of 31 patients had stereoacuity measurement; all achieved a stereoacuity of 3000 seconds of arc. Five of the 14 patients (35.7%) had better than 200 seconds of arc. CONCLUSIONS: The anatomical results and sensory function of the patients were generally good. When appropriate, surgical intervention to treat strabismus after cataract surgery should be offered, and this is important for restoration of fusion.     

Cataract surgery in patients with prior refractive surgery

As the number and types of keratorefractive procedures increase and as the baby boomer population moves into the "cataractous decades," the number of patients requiring cataract surgery following refractive surgery grows larger each year. While technological advances in surgical instrumentation and intraocular lens (IOL) design allow us to perform cleaner, faster, and more reliable cataract extractions, the ultimate postoperative refraction depends primarily on calculations performed before surgery. Third-generation IOL formulas ( Haigis, Hoffer Q, Holladay 2, or SRK/T) provide outstanding accuracy when used for eyes with physiologic, prolate corneas. In addition, most instruments used today for measuring corneal curvature and power were designed before the era of refractive surgery. These formulas and instruments make assumptions about the anatomy and refractive properties of the cornea that are no longer valid following most keratorefractive procedures. These breakdowns in IOL calculation often result in a "refractive surprise" after cataract surgery, which may require subsequent surgical correction. This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting "refractive surprises" postoperatively.