改良超声乳化联合小梁切除术的临床应用

目的探讨改良超声乳化联合小梁切除术治疗青光眼合并白内障的可行性及临床效果。方法对21例(21眼)青光眼合并白内障患者施行改良白内障超声乳化联合巩膜隧道切口内的小梁切除术,术后随访观察视力、眼压、滤过泡、人工晶状体位置等情况。结果术后平均随访1年,18眼术后视力均有不同程度提高。指数者2眼,<0.1者1眼,0.1～0.3者5眼,0.3以上者13眼,术后眼压均在正常范围,平均眼压为(12.32±4.06)mmHg(1mmHg=0.133kPa)。结论改良白内障超声乳化及人工晶状体植入联合巩膜隧道内小梁切除术,可达到降眼压和提高视力的双重效果,是青光眼合并白内障较好的手术方法之一。     

青光眼术后硬核白内障改良小切口囊外摘出术

目的:观察青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术的临床疗效。方法:对65例(69眼)小梁切除术后硬核(Ⅳ/Ⅴ)白内障,行颞侧或颞上方小切口白内障囊外摘出人工晶状体植入术,术后随访6~24mo,观察术后视力、眼压和并发症。结果:本组65例(69眼)术后视力有不同程度提高,其中视力≥0.5者50眼(72%),术后平均眼压为(15.22±3.92)mmHg(1mmHg=0.133kPa),手术并发症为术后早期角膜水肿及葡萄膜炎性反应。结论:青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术操作简单,术后眼压控制好,并发症少,视力恢复快,是治疗青光眼术后硬核白内障的有效方法。     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

球结膜下浸润麻醉行青光眼小梁切除术临床观察

目的 评估和比较结膜下麻醉和球后麻醉行青光眼小梁切除术的可靠性和安全性。方法 对103例（120只眼）青光眼患者采用结膜下麻醉实施小梁切除术,与98例（109只眼）青光眼患者采用球后麻醉实施小梁切除术进行比较。对照分析两组麻醉方法的并发症、患者术中的配合程度及手术的安全性。结果 结膜下麻醉组115只眼（95．83%）、球后麻醉组中107只眼（98．16％）麻醉效果佳,球后麻醉组中有4只眼球后出血,1只眼光感消失,而球结膜下麻醉组无严重并发症出现。结论 球结膜下麻醉对于青光眼小梁切除是一种安全有效、并发症少的麻醉方法,值得推广。     

急性闭角型青光眼持续高眼压下的手术治疗

目的探讨急性闭角型青光眼发作期持续高眼压状态下手术的特点及效果。方法对应用大剂量降眼压药物2~3天后眼压仍持续在40mmHg以上的60例65眼施行小梁切除术。术中先间断地缓慢放出房水,减低眼压后进行小梁切除术。术后随访6个月。结果65眼术前视力均在0.05以下。术后1周视力≥0.05者64眼,视力≥0.3者31眼;眼压≤21mmHg者52眼。术中术后无玻璃体脱出、脉络膜脱离、脉络膜下大出血或睫状环阻塞性青光眼等并发症发生。结论急性闭角型青光眼持续高眼压时,小梁切除术术中多次间断缓慢放出房水对持续高眼压状态下的治疗是安全有效的。     

高眼压下急性闭角型青光眼小梁切除术的临床观察

目的探讨急性闭角型青光眼发作期持续高眼压状态下行小梁切除术的可行性及效果。方法对应用大剂量降眼压药物2~3 d后眼压仍持续在40 mmHg以上的40例(65眼)行小梁切除术;术中均在切除小梁组织前在巩膜瓣根部中央角膜缘处用剃须刀刺开一小切口,缓慢放出房水,眼压降低后再常规完成手术。结果本组术中及术后均未出现暴发性脉络膜上腔出血、恶性青光眼等严重并发症,术后1周视力≥0.1者64眼;视力≥0.3者39眼;眼压≤21 mmHg者52眼;术后3眼出现脉络膜脱离,7眼前房形成延缓,经治疗后逐渐恢复。本组病例手术后大多数保留了较好的视力。结论药物不能控制眼压的急性闭角型青光眼,及时行前房穿刺加小梁切除术手术治疗十分必要,可以避免视功能的进一步损害。     

复合式小梁切除术治疗非穿透小梁切除术后眼压失控

目的：探讨复合式小梁切除术治疗原发性开角型青光眼行非穿透小梁切除术后眼压失控（眼压升高）的长期疗效与安全性。方法：回顾分析了2006-03/2011-07非穿透小梁切除术治疗原发性开角型青光眼术后眼压失控（眼压升高）再次行小梁切除术的连续随访患者13例25眼。青光眼术后再次眼压异常升高,均属于难治性青光眼,我们采取复合式小梁切除术,对于仅存中心视岛及管状视野患眼,手术在表面麻醉联合球筋膜浸润麻醉下实施。主要检查指标：手术前后眼压、视力、角膜水肿情况、滤过泡特征、前房深浅及其它并发症。结果：随访3mo～5a,非接触眼压测定术前眼压28～52mmHg,术后眼压11.7～18mmHg,术后3mo,眼压为145mmHg,眼压以≤21mmHg为成功标准。术后3mo,视力提高3眼（12%）,视力不变17眼（68%）,视力下降5眼（20%）;术后21眼角膜均变清亮;功能性滤过泡22眼（80%）,有3眼为非功能性滤过泡,眼压再次高于21mmHg,二次进行复合式小梁切除术后眼压控制在21mmHg以下;术后有15眼（60%）出现前房轴深在1.5～2CT间,均自行恢复;术中、术后有10眼（40%）出现不同程度的前房出血,经对症治疗后均已吸收;术后有5例5眼（20%）出现房水闪辉,经散瞳及典必殊滴眼液进行眼局部频点后房水闪辉完全消失,未发生眼内炎等并发症。结论：小梁切除术目前仍是可挽救有视力眼的青光眼最经典、最有效的方法;复合式小梁切除术是原经典手术方式的进一步发展;青光眼术后眼压再次异常升高均属于难治性青光眼,原发性开角型青光眼行非穿透小梁切除术后眼压失控应用复合式小梁切除术再次治疗,证实安全有效,长期疗效满意,是弥补非穿透小梁切除术眼压失控（升高）后有效的治疗措施,并且可以一眼多次手术;有效地保护仅存的视力,维持了一定的视功能;晚期原发性开角型青光眼不适合非透性小梁手术。     

白内障超声乳化联合改良小梁切除术治疗青光眼合并白内障

目的　评价白内障超声乳化联合改良小梁切除术治疗青光眼合并白内障的临床疗效。方法　对 6 5例 6 5眼青光眼合并白内障患者 ,采用超声乳化联合改良小梁切除术进行治疗 :30眼经透明角膜切口行超声乳化术并植入折叠型硅胶人工晶状体 ,另 35眼经巩膜隧道切口行超声乳化术 ,植入聚甲基丙烯酸甲酯人工晶状体 ,观察术中术后并发症及视力变化。结果　术后所有患者视力均有不同程度地提高 ;术后 3月眼压 11.4 4～ 19.5 0mmHg( 1kPa =7.5mmHg) ,平均 ( 14 .2 1± 2 .13)mmHg ;术中并发症 :前房出血 ;术后并发症 :早期角膜水肿 ,前房炎性反应 ,晚期后发性白内障。结论　白内障超声乳化联合改良小梁切除术术后患者视力恢复快 ,眼压控制良好 ,手术并发症轻微 ,是一种治疗青光眼合并白内障的理想方法     

持续高眼压状态下小梁切除术的安全性及疗效

目的 研究闭角型青光眼持续高眼压状态下小梁切除术的安全性和临床效果.方法 对41例41眼眼压控制不良的闭角型青光眼患者进行了小梁切除术,观察视力、眼压、并发症和手术效果.结果 所有病例手术均顺利,均未出现暴发性脉络膜出血、眼内出血、恶性青光眼等术中、术后并发症,术后视力提高27眼,占65.85%,视力不变11眼,占26.83%,视力下降3眼,占7.32%.不用任何降眼压药物眼压控制<21 mmHg(1 kPa=7.5 mmHg)者27眼,占65.85%,需局部用药方可控制者12眼,占29.27%.结论 对持续性高眼压状态下的闭角型青光眼患者应尽早采取手术治疗,小梁切除术是安全有效的治疗措施,可避免视功能进一步损害.     

筋膜下麻醉小梁切除术

目的:探讨筋膜下麻醉行小梁切除术的有效性及安全性。方法:在连续58例(60眼)青光眼小梁切除术中分别应用表面麻醉、球后麻醉、筋膜下麻醉各20眼,观察麻醉效果、并发症情况。结果:表面麻醉组患者术中在上直肌牵引缝线、巩膜电凝、周边虹膜切除、结膜缝合时有不同程度痛感,筋膜下麻醉、球后麻醉组患者术中无明显痛感,筋膜下麻醉组1眼、球后麻醉组2眼术中出现一过性黑矇,球后麻醉组术中出现球后出血1眼,术后短暂性上睑下垂2眼。结论:小梁切除术采用筋膜下麻醉具有麻醉效果好、并发症少的优点,是理想麻醉方法。     

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.