眼球萎缩安装超薄义眼的临床观察

眼球萎缩安装超薄义眼的临床观察哈尔滨医科大学附属第二医院展玉璟，王巾，贡晓萍，汪宝麟哈尔滨医科大学附属第一医院崔浩我科义眼室从１９８０至１９９３年，先后为６００例眼球萎缩的病人，配制超薄义眼，使病人在外观上与健眼极为相似，取得了满意的效果。６００例眼...     

741例义眼临床应用情况小结

1984年一1996年我院装配义眼741例，其中普通义眼511例（60％）、活动义服105（19％）、薄壳义眼125例（21％）。年龄最大73岁。最小6月。男440例，女302例。随访时间最长12年，最短2月。配戴活动义眼和薄壳义眼效果比较理想。其优点为装配义眼后双眼饱满度相仿，义眼活动度＞25°。普通义眼是在摘除眼球时未植入眼台，术后按健眼形态装配之义服。活动义服是在摘除眼球的同时植入一个合适眼台，术后装配活动度较好的义服。薄壳义眼是因外伤等原因致眼球萎缩，在眼球搭较长时间无炎症反应者配上一个薄壳层的义眼。本文重点介绍装配各类义服后…     

以萎缩眼球为依托义眼装配

以萎缩眼球为依托义眼装配李宏科李占林＊张文强（解放军第１５医院眼科，新疆乌苏８３３０００）对于眼球萎缩要求义眼装配者，一般需行眼球摘除之后装配义眼。作者近３ａ采用不摘除眼球直接义眼装配或结膜囊包埋萎缩眼球后义眼装配。用本方法装配义眼后无眼球摘除后的眼...     

改良结膜瓣掩盖术在眼球萎缩安装义眼时的应用

目的评价改良的结膜瓣掩盖术在轻中度眼球萎缩安装义眼时应用的效果。方法轻中度眼球萎缩11例行角膜浅板层切除、异体巩膜包盖及全结膜瓣掩盖术，术后3周安装定制的个性化义眼。随访半年，观察其效果。结果双侧睑裂高度、眼睑饱满度及眼球活动度均十分相似，容貌显著改善，外观满意。结论改良的结膜瓣掩盖术联合个性化义眼安装用于轻中度眼球萎缩，可获得良好的美容效果。     

术源性全角膜结膜化保留眼球安装义眼

目的探讨眼球萎缩安装义眼的新手术治疗方法。方法对21例（21只眼）眼球萎缩而角膜刺激反应健存的患者施行角膜缘干细胞电凝烧灼及机械刮除破坏角膜上皮细胞,联合球筋膜结膜全角膜覆盖术,术后1—3个月配戴定制玻璃义眼片。结果21例患者术后随访3个月至4年,配戴义眼后均无刺激症状,查体见结膜及筋膜完全生长覆盖角膜,无结膜瓣裂开或退缩,上下穹隆深度正常,义眼固定于结膜囊内,位置无倾斜,下缘不易脱出,在各方向均有良好的活动度,术眼睑裂高度及饱满度与健眼基本一致,静态和动态情况下都达到满意效果。结论术源性角膜结膜化保留患者眼球,安装义眼片手术方式操作简便,创伤小,术后反应轻。     

异体巩膜移植对眼球萎缩的美容效果

目的评价异体巩膜移植并结膜瓣遮盖术对轻、中度眼球萎缩的美容效果。方法对10例（10眼）单侧轻到中度眼球萎缩进行异体巩膜移植加结膜瓣遮盖术，术后配戴超薄义眼片。观察手术前后患眼的睑裂高度及眼球交出度变化并与健眼对比。结果患眼手术后睑裂高度及眼球突出度明显改善（P〈0．001，P〈0．01），二项指标与健侧相比无明届差异（P〉0.3P〉0．4）。结论异体巩膜移植加结膜瓣遮盖术后配戴义眼片是一种改善轻到中度眼球萎缩容貌的有效方法。     

外伤后重度眼球萎缩羟基磷灰石义眼座植入术

目的 探讨外伤后重度眼球萎缩患者羟基磷灰石义眼座植入的一种新方法。方法 对12例自体巩膜腔仅能包裹义眼座l／4～l／2的重度眼球萎缩患者，采用沿自体巩膜缘交叉褥式缝合，形成网式捆绑义眼座植入肌锥内，自体巩膜呈帽状覆盖义眼座，眼外肌较常规位置靠前缝合。结果 12例中除l例先天性小眼球患儿结膜裂开5mm，2月自愈外，其余11例均无并发症，义眼安装满意。结论 “网式捆绑法”羟基磷灰石义眼座植入术解决了因患者重度眼球萎缩，自体巩膜无法牢固包裹义眼座，又无异体巩膜时的眼眶美容难题。     

眼外伤后眼球萎缩的矫治

严重的眼外伤往往造成视力丧失,最后致使眼球变形萎缩。为了达到美容目的,我们自1979年以来对9例这种外伤后萎缩的眼球作为“活动眼座”安装合适义眼,取得了较满意效果,现报告如下。     

保留萎缩眼球定制个性化义眼

目的:探讨保留萎缩眼球定制个性化义眼的方法及效果。方法:轻中度眼球萎缩19例行患眼角膜浅板层切除联合全结膜瓣遮盖术,术后2wk定制个性化义眼,随访4～10mo,观察其临床效果。结果:患者配戴个性化义眼后,双侧睑裂高度、眼睑饱满度、眼球突出度接近,虹膜、巩膜颜色和结膜充血程度相似。患者对个性化义眼外形、颜色、活动性、固位性、舒适性评价总满意率(满意和基本满意)分别为84%,90%,79%,100%,95%。个性化义眼水平活动度20°～35°,垂直活动度15°～20°。结论:轻中度萎缩眼球行角膜浅板层切除联合全结膜瓣遮盖术,术后定制个性化义眼可获得良好的仿真效果。     

薄型义眼的制作与临床应用初步报告

眼球受伤或疾病所致的眼球萎缩变形为眼科临床所常见。治疗常用摘除眼球、装植义眼的方法来解决。但患者常不能接受这种手术所带来的痛苦。为了解除这类患者痛苦,作者旨在改善美容,不影响健眼的前提下,用不摘除萎缩眼、装植一种自行制作的薄型义眼的方法应用于临床,并经32例6—36个月的随访观察,收到了满意的美容效果。报告如下:     

软性义眼的研制与临床应用

目的 为不摘除眼球配戴义眼而研制软性义眼。方法 采用水凝胶（聚甲基丙烯酸β－羟乙酯／ＨＥＭＡ）材料,用模具法分层幅照聚合成型。软性义眼规格有大中小分厚薄２种。结果 临床应用,眼球萎缩留有角膜等２０例。角巩膜葡萄肿,无光感行玻璃体除,视神经离断术２例。２月后配戴软笥义眼,配戴服运动自如。结论 作者设想尽可能的保留其自身的,天然的带有各知眼肌的活体眼座,为不摘除眼球,直接配戴软性义眼创造条件。     

水凝胶软性义眼100例临床应用

目的 观察我们研制的水凝胶软性义眼的临床应用效果。方法 采用水凝胶（聚甲基丙烯酸β－羟乙酯／ＨＥＭＡ）为材料的软性义眼,经临床应用１００例,用于眼球萎缩４８例,植入义眼座１８例,硬性义眼对照组１０例,植入羟基磷灰石义眼座２０例,行眼球萎缩手术４例。结果 配戴后患者感到基本满意。较硬性义眼对照组配戴舒适、无下垂感。对植入羟基磷灰石义眼座者可直按吸附在义眼的表面上,达到同步运动,不需作栓钉植入术。结论     

Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants

PURPOSE: To compare artificial eye amplitudes in patients who randomly received either a hydroxyapatite or an acrylic, scleral-covered spherical implant after enucleation. DESIGN: Randomized, controlled trial. PARTICIPANTS: Thirty-four consecutive patients who underwent enucleation because of an intraocular melanoma and 21 healthy control participants from the hospital staff. METHODS: Eligible patients randomly received a hydroxyapatite or an acrylic, scleral-covered spherical orbital implant. Fourteen patients were fitted with a hydroxyapatite implant, and 16 were fitted with an acrylic implant. We measured horizontal and vertical saccadic amplitudes of both the artificial eye and the healthy eye. Measurements were performed with the magnetic search coils technique. Saccadic amplitudes of the artificial eye were compared with the healthy eye of the patient. The amplitudes of the healthy eyes were compared with saccadic amplitudes of control participants. The interval from surgery to measurements was at least 3 months in all patients. Saccadic gain (artificial eye and eye amplitude divided by target amplitude) and saccadic symmetry (artificial eye amplitude divided by healthy eye amplitude) were calculated. MAIN OUTCOME MEASURES: Saccadic gain and saccadic symmetry. RESULTS: The gain in the healthy eyes of the patients was comparable with the gain of the control eyes. Saccadic symmetry was 1.0 in control participants. In patients, it was 0.334 in horizontal saccades and 0.577 in vertical saccades. However, saccadic symmetry did not differ significantly between the acrylic group and the hydroxyapatite group (P: > 0.1 for any saccadic direction). Equivalence was detectable with a power more than 90% for horizontal saccades and more than 80% for vertical saccades. Curvilinearity was rejected for both patient groups and for all saccadic directions (P: > 0.5). CONCLUSIONS: When no motility peg is placed, acrylic and hydroxyapatite spherical implants yield comparable saccadic amplitudes of the artificial eye. Artificial eye amplitudes were markedly more restricted horizontally than vertically. In all saccadic directions, the relation between target amplitude and artificial eye amplitude was linear.     

干眼症患者对比敏感度的临床研究

目的 探讨干眼症患者对比敏感度(contrast sensitivity,CS)的变化.方法 试验组为视力正常的干眼症患者40例(80只眼),模拟分别为:85cd/m2无眩光(85cd/m2without glare,85wog)、85cd/m2有眩光(85cd/m2with glare,85wg)两种昼的环境,在不同空间频区进行CS测定.与试验组年龄匹配的门诊患者30例(60只眼)为正常对照组.双眼视力均≥0.8.结果 干眼患者CS值在各空间频区都有下降,尤其在低空间频率CS值下降更明显,差异极显著有统计学意义(P＜0.001);在应用聚乙烯醇滴眼液(无防腐剂人工泪液)后30minCS值明显上升,用药前后CS值改变有统计学意义(P＜0.001).结论 干眼患者在视力检查正常的前提下,视觉对比敏感度下降,应用人工泪液后视功能有明显改善.     

诊断性玻璃体切割判断眼外伤无光感眼视力预后

目的：通过对眼外伤后无光感眼行诊断性玻璃体切割术,判断伤情,决定具体的手术方式。 方法：对8例8眼眼外伤视力无光感的患者行2期玻璃体切割术。 结果：术后无光感5眼,1眼FC,1眼HM,1眼0.05。术中改术式为眼内容剜除+羟基磷灰石义眼台植入2眼,1眼4mo后眼球摘除,3眼硅油眼。 结论：诊断性玻璃体切割可估计眼外伤伤情、决定术式。     

羟基磷灰石义眼台植入术临床应用

目的探讨眼球摘除或眼内容剜除羟基磷灰石义眼台植入术临床应用。方法眼内容剜除,后巩膜开窗,羟基磷灰石义眼台植入巩膜腔或肌锥内,分层紧密缝合巩膜、筋膜及结膜。结果2例2眼义眼台轻度外露,观察随访半年无发展,后行羊膜移植后愈合,其余21例21眼均无结膜裂开及义眼台外露,取得了满意的效果。结论眼内容剜除后一期植入义眼台于巩膜腔或肌锥内,术中充分降低巩膜、筋膜及结膜的张力,并紧密分层缝合是降低和预防结膜裂开,义眼台外露、脱出的关键。     

A test eye for wavefront eye refractors

PURPOSE: A multi-site study was conducted to test feasibility of a modified automatic refractor style test eye as a test device for wavefront refractors of various types and to determine whether a) they could be measured and b) when measurements could be made, to see if they were similar. This study did not attempt to assess which instrument most accurately measures the aberrations of the test eye or human eye. METHODS: Three automatic refractor style test eyes were modified for use as test devices for wavefront refractors. One had a simple spherical front surface, and two had additional aberrations added. The test eyes and holder were circulated to 11 test sites where attempts were made to measure them with eight different wave-front refractor systems. RESULTS: Eight (100%) of the eight wavefront refractor systems tested successfully measured the test eyes. The systems did not give similar results for the same test eye. In some cases, coma was reported where none was present. Differences in reported defocus values reflect different approaches for compensating for the dispersion of the eye. A corneal topography system could measure and recognize the aberrations of the test eyes as well as the wavefront refractor systems tested. Interferometry, on the other hand, did not prove to be a successful method to assess the surface of the test eyes. CONCLUSIONS: The test eye design may be used as a test device for wavefront refractor systems. This type of test eye can detect systematic differences between various wavefront refractors and can serve as a useful calibration and comparison tool.     

转换注视眼治疗分离垂直性偏斜的疗效观察

目的 探讨转换注视眼方法治疗单眼分离垂直性偏斜(DVD)或双眼不对称性DVD患者上斜视的效果。方法 收集弱视眼矫正视力≥0．5的儿童DVD患者23例(9例为单眼,14例为双眼),采用戴镜后遮盖和光学方法使原注视眼视力低于现注视眼视力2或3行(国际标准视力表),以达到转换注视眼的目的。观察治疗前、后患者的视力、眼位及视网膜对应情况。结果 采用转换注视眼方法治疗后,原注视眼视力无明显下降,现注视眼视力提高2行者10例;19例患者眼位达到外观美容效果,4例双眼上斜视度数相差不明显(≤10^△)患者原注视眼出现上飘现象;3例近距离注视具有正常视网膜对应、远距离注视表现为高位眼抑制的患者恢复正常视网膜对应。结论 转换注视眼方法可有效矫正DVD患者的上斜视症状,尤其对于单眼DVD和双眼不对称性DVD一侧眼为上斜视、对侧眼为隐性上斜视者效果较好。本方法适用于不愿接受手术治疗、且合并轻中度弱视和屈光不正的儿童DVD患者。     

少年儿童泪小管断裂的手术

目的分析少年儿童泪小管断裂吻合术的特点，探讨采用缝合固定于鼻前庭的人工泪管植入的效果。方法全麻或局部麻醉联合基础麻醉支持下，对16例（16眼）少年儿童（3～15岁）泪小管断裂者行泪小管吻合，术中采用硬膜外麻醉导管将带线硅胶人工泪管引导入泪道作为泪道支撑物，人工泪管两端分别通过上、下泪点植人鼻泪道并固定于鼻前庭。结果术后随诊观察3个月～3年。15例术后泪道冲洗通畅，1例出现轻度溢泪，泪道冲洗不通，成功率93—7％。16例人工泪管均在位，均在预期时间拔管。结论少年儿童泪小管断裂吻合术，采用带线硅胶制人工泪管作为泪道支撑物，固定于鼻前庭，能较好保持少年儿童人工泪管位置，手术成功率高。     

Fellow eye of patients with retinal detachment associated with macular hole and bilateral high myopia

PURPOSE: To estimate the risk of retinal detachment in the fellow eye of patients with bilateral high myopia who had retinal detachment associated with macular hole (MH-RD) in one eye. METHODS: The present study examined retrospectively 56 patients with bilateral high myopia who had MH-RD. To determine the incidence of involvement of the fellow eye, patients who completed a follow up of 12 months or longer were eligible for the current study. RESULTS: Of 56 patients with MH-RD due to high myopia, 54 had unilateral detachment at presentation and two had bilateral detachment. Of the 54 highly myopic fellow eyes without retinal detachment at presentation, 37 eyes underwent 12 or more months of documented follow up. Mean follow up after initial surgery to the primary eye was 6.5 +/- 4.9 years. During follow up, a macular hole without retinal detachment was noted in one (2.7%) of these 37 eyes. Three other eyes (8.1%) had MH-RD at 1, 2 and 7 years, respectively, after the initial surgery to the primary eye. At the final visit, 12 eyes (32%) had visual acuity of > or =6/9, whereas 12 eyes (32%) had visual acuity of < or =6/60. CONCLUSIONS: When patients with bilateral high myopia have MH-RD in one eye, they would be expected to be at increased risk of retinal detachment in the fellow eye.