基层医院初期开展白内障超声乳化术的体会

目的 回顾分析基层医院如何顺利开展白内障超声乳化手术.方法 对白内障行超声乳化联合人工晶状体植入手术47例(49眼)进行总结分析.结果 术后视力:49眼术后1d裸眼视力≥0.3者34眼(69.39％),术后7d裸眼视力≥0.5者41眼(83.67％).术中术后并发症主要为后囊破裂,悬韧带断裂,虹膜脱色素,角膜水肿等,人工晶状体植入囊袋内41眼,植入睫状沟8眼.结论 基层医院只要设备齐全,医生培训到位,就能逐步地开展白内障超声乳化吸出及人工晶状体植入手术.     

超乳术中后囊破裂行Ⅰ期后房人工晶状体植入

目的：探讨基层医院开展白内障超声乳化术中后囊破裂行Ⅰ期后房人工 晶状体的可行性和疗效。方法：在297眼白内障患者行超声乳化术，其中19例在术中发现后囊破裂，15眼合并玻璃体脱出而行前段玻璃体切除，均植入后房人工晶状体。结果：在19眼中，7眼囊袋内植入人工晶状体，12眼睫状沟植入。平均随访6月，裸眼视力≥0．3有19眼，≥0．5有14眼，≥1．0有5眼。8眼出现前房玻璃体渗出。结论：在超乳术中，若出现后囊破裂，只要处理得当，完全可以植入后房型人工晶状体，术后视力恢复较好。     

超声乳化术后囊破裂时人工晶状体植入的方法

目的探讨晶状体超声乳化吸出术中后囊破裂的处理及人工晶状体植入的方法。方法表面麻醉下晶状体超声乳化术中发生后囊破裂,术中及时发现破孔,充分利用黏弹剂,并联合前段玻璃体切除术。3 0例(30眼)全部植入后房人工晶状体。结果人工晶状体的两个襻植入囊袋内者10眼,一襻植入囊袋内另一襻在睫状沟内或两个襻都在睫状沟内共16眼,人工晶状体两个襻缝线固定于巩膜瓣下4眼。术后4周随访,视力>0.5者20眼,占66.67%;0.3~0.5者6眼,占20.00%;0.05~0.2者共4眼,占13.33%。结论晶状体超声乳化术中如果发生后囊破裂,只要及时发现,妥善处理,仍可以安全地植入后房人工晶状体,术后视力恢复较好。     

超声乳化术中后囊膜破裂的后房型人工晶体植入术

目的：对超声乳化术中后囊膜破裂的后房型人工晶体植入术进行分析，总结出一套较好的处理方法。方法：对我院过去3年中，术中发生后囊膜破裂后，经过妥善处理后成功植入后房型人工晶体的20例病例进行分析发现。术中能及时发现破孔，并充分利用粘障剂的作用，加上前段玻璃体切割器的作用，20例病例全部100%植入了后房型人工晶体。结果：二襻植入囊袋内人工晶状体5眼，一襻植入囊袋内另一襻在睫状沟内或二襻在睫状沟内者12眼，人工晶体2襻缝线固定于巩膜上者3眼，术后随访6个月。视力≥0.5者18眼，占90%，0.3者1眼，占5%，0.2者1眼，占5%。结论：在白内障超声乳化术中，如果发生后囊膜破裂，只要及时早期发现，并妥善处理。仍然能安全植入后房型人工晶体。且术后视力较好，随访无远期并发症。     

后囊膜破裂行后房型人工晶状体一期植入

后囊膜破裂是白内障摘出术中严重并发症之一 ,本文选择 1998年 6月～ 1999年 12月后囊膜破裂而行后房型人工晶状体一期植入者进行临床分析 ,现报告如下。1　资料和方法1.1　临床资料　本文 46 0眼中超声乳化摘出术 32 6眼 ,现代囊外摘出术 134眼 ;后囊破裂 31眼 (包括超声乳化术 2 2眼 ,现代囊外 6眼 ,外伤 3眼 ) ,其中囊袋内植入 12眼 ,前囊膜支撑睫状沟植入 16眼 ,缝线固定术 3眼。1.2　手术方法1.2 .1　囊袋内植入术　后囊膜破孔≤ 5 mm者 ,若破孔位于中央 ,则襻植入水平位 ,否则 ,襻应保持在与破孔子午线方向垂直的位置。1.2 .2　前囊膜…     

后囊破裂的外伤性白内障超声乳化人工晶状体植入的临床观察

目的 探讨后囊破裂的外伤性白内障的手术时机和技巧。方法 对２８例（２８眼）后囊破裂的外伤性白内障施行巩膜隧道切口白内障超声乳化Ⅰ期后房人工晶状体植入。结果 术中玻璃体脱出前房４眼。术后矫正视力〈０．１者３眼,０．１－０．４者９眼≥０．５者１６眼。人工晶状体植入囊袋内１７眼,植入睫状沟内１１眼。术后４眼出现瞳孔区纤维蛋白渗出,１眼人工晶状体脱位。结论 后囊破裂的外伤国性白内障可行超声乳化Ⅰ期后房人工     

白内障超声乳化术中后囊破裂的预防和处理

目的 讨论白内障超声乳化术中后囊破裂的原因、预防及处理方法。方法 对889眼白内障采用弹性技术、分离处置技术或拦截劈裂技术施行超声乳化并人工晶状体植入术,对发生术中后囊破裂的原因、预防及处理进行了分析和总结。结果 发生术中后囊破裂32眼,其中发生于水分离时2眼、超声乳化时23眼、注吸皮质时6眼、人工晶状体植入时1眼。人工晶状体囊袋内植入12眼、睫状沟植入17眼、巩膜缝线固定3眼。术后半月视力＞0．8者9眼,0．5－0．8者18眼,＜0．5者5眼。结论 后囊破裂可发生在术中的不同阶段,而大部分是可以预防的。一旦发生后囊破裂,经及时妥善处理后仍可获得近期较满意的效果。     

白内障超声乳化术中后囊破裂后的人工晶体植入

目的 对白内障直声乳化摘出及人工晶状体植入术中后囊膜破裂后处理进行分析。方法 在２２８例老年性白内障、并发性白内障、先天性白内障者施行不同切口的超声乳化吸除，通过３．２ｍｍ切口植入折叠式人工晶状体，通过５．５ｍｍ切口植入ＰＭＭＡ人工晶体状。在术中后囊膜破裂１６眼（６．５８％），并发玻璃体外溢６只眼（２．６３％）。结果 术中人工晶状体植入的情况：人工晶体状体两袢均植入在囊代内者有９眼，其中人工晶状体     

白内障超声乳化术中后囊破裂的分析及处理

目的探讨白内障超声乳化人工晶状体植入术中后囊破裂的原因和处理方法。方法365例(365只眼)白内障实施超声乳化人工晶状体植入术,对其中发生后囊破裂的情况、处理的方法、并发症进行分析。结果后囊破裂者26只眼,发生于水分离时2只眼、超声乳化时21只眼、注吸皮质时3只眼。人工晶状体囊袋内植入7只眼、睫状沟植入14只眼、巩膜缝线固定5只眼。术后3个月视力0.6以上者19只眼,0.3以上者5只眼,未见严重并发症。结论超声乳化技术娴熟和及时发现并妥善处理后囊破裂是提高手术效果的关键。     

高度近视白内障超声乳化及人工晶状体植入术

目的　分析高度近视白内障超声乳化吸出及后房人工晶状体植入术的疗效。方法　对 5 0例 ( 5 8眼 )高度近视白内障行巩膜隧道切口晶状体超声乳化吸出及后房人工晶状体植入。眼轴长 2 7～ 3 3 5 6mm ,平均 2 9 3 5mm。其中眼轴长≤ 3 0mm者 40眼 ,眼轴长 >3 0mm者 18眼。植入折叠式人工晶状体 ,观察术中术后并发症及术后视力。结果　眼轴长≤ 3 0mm的40眼中术后视力≥ 0 4者 3 5眼 ( 87 5 %) ;眼轴长 >3 0mm的 18眼中术后视力≥ 0 4者 9眼 ( 5 0 0 %)。术中后囊破裂 1例 ,行前部玻璃体切除及人工晶状体睫状沟植入术。结论　高度近视白内障超声乳化及人工晶状体植入能改善视力 ,但眼轴长 >3 0mm者术后视力恢复较差     

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.