小切口非超声乳化囊袋内手法劈核术在硬核性白内障中的应用

目的探讨囊袋内手法劈核术在硬核性白内障手术中的临床效果。方法采用小切口非超声乳化囊袋内的手法劈核术,治疗硬核性白内障117例(159眼),分别于术后1周、1个月、3个月、6个月观察患者术后视力、散光、角膜内皮细胞丢失率、并发症等情况。结果术后1周最佳矫正视力≥0.5者占54.1%,术后散光度数为(2.00±0.75)D,角膜内皮细胞密度为(3327±231)mm-2,角膜内皮细胞丢失率为3.00%;术后1个月最佳矫正视力≥0.5者占86.2%,术后散光度数为(1.50±0.75)D,角膜内皮细胞密度为(3271±253)mm-2,角膜内皮细胞丢失率为4.64%;术后3个月最佳矫正视力≥0.5者占91.2%,术后散光度数为(1.25±0.50)D,角膜内皮细胞密度为(3267±239)mm-2,角膜内皮细胞丢失率为4.75%;术后6个月最佳矫正视力≥0.5者占92.5%,术后散光度数为(1.00±0.50)D,角膜内皮细胞密度为(3257±242)mm-2,角膜内皮细胞丢失率为5.04%,无严重并发症发生。术后视力,散光度差异均有统计学意义(均为P<0.05),角膜内皮细胞丢失率差异均无统计学意义(均为P>0.05)。结论对Ⅳ-Ⅴ级硬核性白内障应用囊袋内手法劈核术,不仅具有小切口的优点,而且角膜相关并发症少,操作更安全,术后视力恢复快。     

圈垫式劈核技术在白内障摘除术中的应用

目的　探讨圈垫式劈核技术在白内障摘除术中的应用和临床效果。方法　利用自行设计的圈垫器 ,采用圈垫式劈核技术对 6 4例 (73只眼 )老年性白内障患者行白内障摘除及折叠式人工晶状体植入术。结果　术中晶状体后囊膜破裂 2只眼 ;全部术眼术后炎性反应轻微 ,瞳孔圆。术后 1周矫正视力≥ 0 5者 5 8只眼 (79 5 % ) ;术后 3个月矫正视力≥ 0 5者 6 5只眼 (89 0 % ) ,≥ 1 0者 5 3只眼 (72 6 % )。角膜内皮细胞损失率角膜上方为 14 1% ,角膜中央为 12 2 % ,手术前、后角膜内皮细胞密度比较 ,差异均有非常显著意义 (P <0 0 0 1)。结论　在白内障摘除术中应用圈垫式劈核技术 ,不仅使手术步骤简化 ,操作安全、简便 ,而且具有小切口手术的优点     

白内障超声乳化术中快速劈核法临床报告

目的 观察白内障超声乳化术中快速劈核法的临床效果及应用。方法 对327例(354只眼)患者施行3．2mm透明角膜切口快速劈核法作白内障超声乳化及折叠式人工晶状体植入术。结果 术后1周裸眼视力≥0．5者319只眼(90．1％),术后1月裸眼视力≥0．5者335只眼(94．6％)。结论 此手术方法超声时间短、超声能量少,值得在眼科手术医生中普遍使用。     

小切口双针劈核法白内障囊外摘出术疗效观察

目的观察小切口双针劈核法白内障囊外摘出术的临床效果。方法对52例（56眼）老年性白内障利用一次性注射针头,双针呈180°劈开晶状体核,小切口囊外摘出,植入后房人工晶状体。结果术后1d裸眼视力≥0．5者22眼（39．29％）,术后1周裸眼视力1〉0．5者41眼（73．21％）。术后角膜水肿9眼（16．07％）;前房积血4眼（7．14％）,房水浑浊5眼（8．93％）,均经治疗后恢复。结论在小切口白内障囊外摘出术中,应用双针劈核法摘出晶状体核,安全、经济、并发症少。     

劈核刀的研制及在硬核白内障摘出术中的应用

目的 探讨自行研制的劈核刀在硬核白内障小切口非超声乳化人工晶状体植入术中的临床应用效果。方法 对27例(27眼)硬核白内障(Ⅲ—Ⅴ级核)用自行研制的劈核刀进行手术。结果 术后第1天视力：≥0．3者15眼(55．56％)，术后1周视力≥0．3者22 眼．(81．48％)。角膜散光与传统的囊外摘出术相比明显减少。结论 自研制的劈核刀在小切口非超声乳化人工晶状体植入术中的操作方便，手术效果满意，设备费用低。     

手法小切口白内障手术硬核碎核技术98例临床分析

目的探讨手法小切口白内障手术硬核碎核技术的临床效果。方法在上方角膜缘后做5．5～6．5mm反弧形隧道切口，采用手法劈核技术对98例101眼进行白内障囊外摘出术，并植入人工晶状体。结果术后第1天视力达0．5以上者占72．26％，达0．8以上者占21．78％；术后1周视力达0．5以上者占87．13％，达0．8以上者占42．57％。结论手法小切口白内障硬核碎核手术，所需器械简单，简便易行，术后并发症少，是一种适合基层治疗白内障的手术方式。     

手法小切口白内障手术水平劈核法的设计与效果观察

目的 探讨手法小切口白内障手术中硬核的水平劈核法的方法及效果。方法Ⅳ级和Ⅴ级硬核老年性白内障286例（286眼）,应用作者设计的水平劈核法进行手术,即在连续环形撕囊和水分离水分层后,核的前后注入黏弹剂,使核上方向前翘起达70°-80°,核的上半进入前房,下半仍在囊袋内,用细而硬的打结镊,先张开由切口两端进入前房夹持核,然后稍用力将核劈成两半,分别娩出。观察术中术后并发症及术后视力。结果286眼均顺利完成手术并植入IOL。术中后囊破裂3眼占1．05％,破口小,玻璃体均未脱至前房;后弹力层脱离2眼占0．70％,均为小范围脱离,用灌注液的水流使其复位;术后角膜水肿浑浊5例占1．75％,3～5d消退;术后虹膜炎2例,占0．69％,经治疗7—10d痊愈。术后1d裸眼视力0．1—0．25者9眼,占3．15％;0．3～0．5者31眼占10．84％;0．6～0．8者168眼占58．74％;1．0以上者78眼占27．27％。其中视力≥0．6者占86．01％。术后3个月裸眼视力0．1～0．5者占9．09％,视力≥0．6者占90．91％。结论水平劈核法简单易行,不需特殊器械,术中前房维持较好,眼内组织损伤小,并发症少,术后视力恢复较好。     

拦截劈核技术在硬核白内障超声乳化中的应用

目的 探讨改良拦截劈核技术在硬核白内障超声乳化手术中的应用。方法 采用改良拦截劈核乳化技术，施行白内障超声乳化手术165例（186眼），其中Ⅲ级核99眼，Ⅵ级核87眼。结果 术后第1天视力≥0．5者占85．5％，≥1．0者占21．2％，角膜轻中度水肿29眼占15．6％，后囊破裂7眼占3．8％。结论 采用改良拦截劈核技术，使分割硬的晶体核变得容易，减少了能量的使用，缩短了乳化时间，安全、易操作，值得推广应用。     

透明角膜小切口折叠人工晶体植入术

目的评价透明角膜小切口折叠人工晶体植入术的效果。方法经３．５ｍｍ小切口完成４１例４５眼。分别观察视力、角膜地形图及角膜内皮细胞丢失率。结果术后ｄ１，裸眼视力≥０．５占８２．３５％，≥１．０占５０％；术后１个月时≥０．５占１００％，≥１．０占７５．３２％。角膜地形图显示角膜切口附近较为平坦，但术后１月时可恢复至术前状态。角膜内皮丢失率术后１周为９．３７％±４．１２。结论透明角膜小切口折叠人工晶体植入术反应轻，散光小，视力恢复快。     

囊袋内劈核术在非超声乳化小切口白内障囊外摘出术中的应用

目的探讨囊袋内劈核术在非超声乳化小切口白内障囊外摘出术中的有效性、安全性和手术操作技巧。方法应用卜氏劈核刀及劈核钩做囊袋内劈核行小切口非超声乳化白内障摘除及人工晶状体植入术。结果在77例（90眼）中，1次劈开75眼（83．3％），2次劈开14眼（15．6％）；后囊膜破裂2眼（2．2％）。核瓣全部顺利娩出，角膜透明。术后第1天裸眼视力〉10．5者56眼（62．2％），术后3个月裸眼视力≥0．5者62眼（68．9％）。结论囊袋内劈核术是一种安全有效的劈核方法，适合在基层医院做非超声乳化小切口白内障囊外摘出术。（中国眼耳鼻喉科杂志，2008，8：40-41）     

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.

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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.