术中调整巩膜瓣缝线预防小梁切除术后浅前房的探讨

目的探讨术中调整巩膜瓣缝线预防小梁切除术后浅前房的效果。方法将60例（74只眼）原发性青光眼随机分成A、B组,每组均为37只眼。A组术中调整巩膜瓣缝线;B组术中不调整巩膜瓣缝线。观察两组术后浅前房形成情况。结果A组浅前房发生率为5．40％;B组浅前房发生率为48．64％。两组间浅前房发生率对比差异显著有统计学意义。结论在小梁切除术中调整巩膜瓣缝线能有效地降低术后浅前房的发生率。     

可拆除巩膜瓣缝线的小梁切除术疗效观察

目的观察应用可拆除巩膜瓣缝线的小梁切除术治疗闭角型青光眼的临床疗效。方法64例(87只眼)闭角型青光眼在小梁切除术中应用可拆除巩膜缝线,术后观察前房、滤过泡形成情况,测量眼压、视力。结果术后Ⅰ度浅前房4只眼,Ⅱ度浅前房1只眼,其发生率是5.75%;术后随访3～16个月,眼压的控制率是97. 70%。结论术后加用可拆除巩膜缝线的小梁切除术可降低术后前浅房的发生,可提高手术疗效。     

可拆式巩膜瓣缝线小梁切除术

为了解可拆式巩膜瓣缝线是否能有效地减少小梁切除术后并发症。以６５例原发性慢性闭角型青光眼（１０５眼）为对象。前６个月，３４例病人（４８眼）接受标准小梁切除术；后６个月，３１例病人（５７眼）接受可拆式巩膜瓣缝线小梁切除术。术后一天、七天、一月及一年，检查比较两组滤过泡、前房深度、眼压、视力和眼底情况。结果：在可拆式巩膜瓣缝线小梁切除术组，术后早期Ⅱ—Ⅲ度浅前房和视力下降的发生率分别为３．５１％和１０．５３％；而在标准小梁切除术组，为１６．６７％和２９．１７％（Ｐ＜０．０１）。而且，术后前房轴深减少值与术后一天眼压成直线负相关关系。结论：小梁切除术后超滤过是前房形成迟缓和低眼压性黄斑病变的主要原因。可拆式巩膜瓣缝线小梁切除术能有效控制术后滤过水平，从而减少因超滤过所引起的术后并发症。     

巩膜瓣可调整缝线在小梁切除术中的应用分析

目的观察巩膜瓣可调整缝线在小梁切除术中的应用效果。方法对60例(80只眼)青光眼患者做常规的三角形巩膜瓣与小梁切除术,在巩膜瓣两侧做可调整缝线,术后观察眼压、前房深度、结膜滤过泡。当手术后前房形成稳定或眼压回升大于10 mm Hg时,拆除巩膜瓣可调整缝线。结果术后第1天全部前房形成良好,术后巩膜瓣可调整缝线2周内拆除,平均7 d,可调整缝线拆除后,结膜滤过泡明显增大。结论巩膜瓣可调整缝线能促进小梁切除术后早期前房的形成,有效预防术后浅前房发生,术后2周内拆线对眼压具有调节作用,提高青光眼小梁切除术的安全性。     

两种巩膜瓣可调整缝线在小梁切除术中的应用

目的评价两种巩膜瓣可调整缝线在青光眼小梁切除术中应用的临床效果。方法对原发性青光眼首次接受小梁切除术136例（142眼）进行随机分组，术毕采用巩膜瓣可调整缝线。67例（70眼）采用Kolker法作为A组，69例（72眼）采用Shin法作为B组。比较两组术后自觉症状、前房深度、滤过泡形态、眼压情况。结果术后术眼有酸、磨、溢泪等自觉症状的A组30眼，B组2眼，两组比较差异有统计学意义；术后浅前房A组3眼（4．29％），B组4眼（5．56％），两组比较差异无统计学意义；随访6个月，滤过泡形态A组Ⅰ型7眼，Ⅱ型59眼，Ⅲ型3眼，Ⅳ型1眼，功能型滤过泡66眼（94．29％）；B组Ⅰ型15眼，Ⅱ型51眼，Ⅱ型1眼，Ⅳ型5眼，功能型滤过泡66眼（91．67％）。功能型滤过泡两组比较差异无统计学意义，但Ⅳ型滤过泡A组与B组差异有统计学意义；眼压情况两组差异无统计学意义。结论两种巩膜瓣可调整缝线均能提高青光眼小梁切除术成功率，但Kolker法自觉症状明显，Shin法滤过泡易局限，必要时可两种缝线联合应用。     

可松解缝线小梁切除术预防浅前房发生的效果

目的：观察可松解缝线小梁切除术预防浅前房发生的效果。方法：112眼原发性闭角型青光眼分为2组，观察组（A组）48眼行可松解缝线的小梁切除术，对照组（B组）64眼行常规小梁切除术。两组主要临床参数相似（P＞0．05）。观察两组术后前房形成、眼压及滤过泡等情况。结果：术后第1天A组发生浅I级前房2眼，B组发生浅I级前房16眼，浅Ⅱ级9眼，浅Ⅲ级1眼。两组差异具有显著性（P＜0．05），A组末次随访眼压控制在21mmHg(1mmHg=0.133kPa）以下者42眼，控制率为87．5％；B组末次随访眼压控制55眼，控制率为85．94％；术后功能性滤过泡A组为85．42％，B组为87．50％，两组差异无显著性（P＞0．05）。结论：可松解缝线小梁切除术后早期可有效地控制滤过水平量而减少低眼压性浅前房的发生，提高青光眼手术的成功率。     

巩膜瓣可拆缝线及角膜侧切口在小梁切除术中的应用

目的观察巩膜瓣可拆缝线及角膜侧切口对小梁切除术后低眼压、浅前房的影响。方法青光眼95例(145眼)在常规小梁切除术中联合应用巩膜瓣可拆缝线及角膜侧切口,术中全部病例人工形成前房,观察术后前房形成情况、滤过泡形态及眼压水平,根据眼压高低、滤过泡形态及前房深浅决定拆除可拆缝线时间,并将浅前房发生率与行单纯小梁切除术的144例(179眼)作对比。结果小梁切除联合巩膜瓣可拆缝线及角膜侧切口术后12眼发生浅前房,浅前房发生率为8.2％;单纯小梁切除术后,浅前房发生率为18.4％。二者相比有显著差异(P<0.01)。结论小梁切除联合巩膜瓣可拆缝线及角膜侧切口可主动调节房水滤过量,促进功能性滤过泡形成,减少小梁切除术后低压性浅前房的发生。     

完全可拆除调节缝线在小梁切除术中临床应用

目的 探讨完全可拆除巩膜瓣调节缝线在小梁切除术中的临床应用效果.方法 对拟行小梁切除术的青光眼63例（80眼）随机分为两组：观察组（A组）29例（40眼）行完全可拆除巩膜瓣调节缝线的小梁切除术;对照组（B组）34例（40眼）行常规小梁切除术.术后观察前房情况、滤过泡形态、眼压、视力及并发症.随访3～6个月.结果 A组：未拆除调节缝线前无浅前房发生,拆除后发生浅前房7眼（17.5％）,B组浅前房9眼（22.5％）,两组差异无统计学意义（χ2 =2.83,P＞20.05）.功能性滤过泡形成：A组33眼（82.5％）,B组28眼（70.0％）,差异具有统计学意义（χ2=7.65,P＜0.05）.眼压：术后3个月、6个月,A组眼压控制较好,两组眼压下降比较差异具有统计学意义（t=2.536,2.489,P＜0.05）.术后视力：早期A组视力恢复较好,组间差异具有统计学意义（x2=8.94,P＜0.05）.术后两组主要并发症为脉络膜脱离,B组3眼（7.5％）发生角膜缘切口漏.结论 完全可拆除巩膜瓣调节缝线应用于小梁切除术,降低了术后早期并发症,提高了中远期手术疗效.     

小梁切除术中无暴露线结的巩膜瓣可拆除缝线法临床观察

目的对小梁切除术中应用无暴露线结的巩膜瓣可拆除缝线法与传统的小梁切除术的术后并发症、疗效进行分析。方法７１例（８０眼）首次行小梁切除术患者分为２组，可拆除缝线组３５例（４０眼），术中应用双臂一体无暴露线结的巩膜瓣可拆除缝线；对照组３６例（４０眼）行传统的小梁切除术。结果术后浅前房发生率，可拆除缝线组７．５％（３眼），对照组２７．５％（１１眼）（Ｐ＜０．０５）。随访至术后６个月，２组手术成功率分别为：８７．５％和８５％（Ｐ＞０．０５），但可拆除缝线组术后眼压比对照组更低（Ｐ＜０．０５）。结论该技术能在小梁切除术后早期灵活地控制滤过量，明显减少了术后因滤过强所致的浅前房，可将术后眼压控制在较低水平     

难治性青光眼小梁切除术术中调整巩膜瓣缝线的效果

目的探讨小梁切除术术中调整巩膜瓣缝线联合应用丝裂霉素C（MMC）治疗难治性青光眼的效果。方法对58例（58眼）难治性青光眼采取小梁切除术，术中调整巩膜瓣缝线并应用MMC。观察术后视力、滤过泡、角膜、前房、晶状体、眼底、眼压等。随访6～18月。结果术后有50眼（86．21％）的眼压≤21mmHg；3眼（5．17％）加用眼局部降眼压药物治疗，眼压〈30mmHg；5眼（8．62％）的眼压无改善。结论在小梁切除术术中调整巩膜瓣缝线联合应用MMC是治疗难治性青光眼的有效方法之一。     

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.