手术治疗糖尿病性白内障60眼临床分析

目的:分析小切口白内障囊外摘出人工晶状体植入术和超声乳化白内障吸除人工晶状体植入术治疗糖尿病性白内障的疗效及并发症。方法:选择2006-01/2010-01确诊为糖尿病性白内障患者52例60眼,Ⅱ～Ⅲ级核47眼,采用超声乳化白内障吸除后房型人工晶状体植入术;Ⅳ～Ⅴ级核13眼,采用小切口白内障囊外摘出后房型人工晶状体植入术。结果:糖尿病患者52例60眼白内障术后视力均有不同程度的提高,其中50眼(83%)术后1wk裸眼视力≥0.4。术中术后主要并发症经处理对术后视力无影响。结论:对糖尿病性白内障患者采取恰当的术式,施行小切口白内障囊外摘出人工晶状体植入术或超声乳化白内障吸除人工晶状体植入术疗效肯定。     

改良隧道切口非超声乳化白内障摘除联合折叠晶状体植入术临床应用观察

目的:观察改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术的临床效果和特点。方法:118例白内障患者的118只眼,随机分为2组:超声乳化白内障吸除联合折叠人工晶状体植入术手术组58只眼与改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术组60只眼。对比观察两种术式并发症及术后视力。结果:改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术与超声乳化白内障吸除术联合折叠人工晶状体植入术在白内障手术中的并发症、近远期术后视力比较,差异均无统计学意义,而改良隧道切口非超声乳化白内障摘除术的手术成本低于超声乳化白内障吸除术,且学习曲线短。结论:改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术适合在基层医院的白内障治疗中推广。眼科学报2007;23:247-251.     

角巩膜隧道切口超声乳化白内障吸除 折叠式人工晶状体植入术临床观察

目的 探讨角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入术的临床疗效。方法 对86例（107只眼）老年性白内障患者,采用角膜上方膜缘后0.5mm做长约4mm角巩膜隧道切口的方法,行超声乳化白内障吸除术,同时植入丙烯酸酯类三片式折叠式人工晶状体。结果 术后1d、1周、1个月和3个月裸眼或矫正视力≥0.5者分别为62.6%、76.6%、92.5%和88.8%。结论 角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入术兼有巩膜隧道小切口和透明角膜小切口手术的优点,术后疗效满意。     

糖尿病患者白内障超声乳化吸除人工晶状体植入术的疗效观察

目的探讨糖尿病患者白内障超声乳化吸除人工晶状体植入术的临床疗效。方法对29例（35只眼）糖尿病白内障患者行白内障行超声乳化吸除人工晶状体植入术，对术前准备、手术技巧、并发症进行总结分析，术后随访3～12个月，平均6个月。结果术后复查时视力：0．2—0．4者5只眼，0．5～0．8者21只眼，≥1．0者9只眼；术后并发症：早期Tyndall征（＋＋）5只眼，前房纤维素性渗出2只眼，人工晶状体表面色素沉着3只眼，角膜线样混浊6只眼，晚期后发障4只眼。结论糖尿病患者白内障超声乳化吸除联合人工晶状体植入术，具有视力恢复好，术后反应小等效果。     

抗青光眼滤过术后患者白内障超声乳化吸除及人工晶状体植入术

目的：探讨抗青光眼滤过术后白内障患者进行白内障超声乳化吸除及人工晶状体植入术的手术切口选择和临床效果。方法：32例（41只眼）青光眼滤过术后的白内障患者,采用上方透明角膜隧道切口和避开滤过泡的巩膜隧道切口行白内障超声乳化吸除,植入折叠式人工晶状体24只眼,硬性人工晶状体17只眼。结果：全部白内障术后病例视力有不同程度的提高,视力≥0．5者达75．6％。采用透明角膜隧道切口和巩膜隧道切口术后患者的眼压和滤过泡改变无差异性,术后随访平均5个月,平均眼压较术前增加1．59mmHg(1mmHg=0.133kPa),差异无显著性。结论：对抗青光眼滤过术后白内障患者,采用透明角膜和巩膜隧道切口行白内障超声乳化吸除及人工晶状体植入术,可提高视力,同时可保持原有的滤过功能。     

表面麻醉下透明角膜切口超声乳化白内障摘除术临床观察

目的观察表面麻醉下经透明角膜切口行超声乳化白内障吸除联合折叠式人工晶状体植入术效果。方法各种类型白内障364例(364只眼)在表面麻醉下透明角膜10～12点钟作切口2．8～3．2mm,在3点或9点角膜缘作0．3～0．6 mm辅助切口,超声乳化吸除皮质及核,植入ACRYSOF折叠式人工晶状体。术后观察视力、切口、前房、人工晶状体位置、眼底。结果术后随访1天、7天、1个月和3个月,矫正视力≥0．8者分别为259只眼 (71．20％)、275只眼(75．43％)、279只眼(76．52％)、285只眼(78．34％)。结论表面麻醉下透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入术具有手术时间短、视力恢复快、并发症少等优点。     

超声乳化白内障吸除治疗葡萄膜炎并发白内障

目的观察超声乳化白内障吸除人工晶状体植入术治疗葡萄膜炎并发白内障的临床效果。方法对25例（29只眼）葡萄膜炎并发白内障行超声乳化白内障患者吸除人工晶状体植入术，同时用非切开方式对粘连性小瞳孔进行扩张。结果白内障术后患者视力均得到提高，术后6个月最佳矫正视力≥0．5者24只眼占82.8％，术后恢复生理性小圆瞳孔25只眼占86．2％。结论对葡萄膜炎并发白内障施行超声乳化白内障吸除人工晶状体植入术可提高视力，恢复生理性圆瞳孔。     

高度近视并发性白内障超声乳化吸除及人工晶状体植入的临床观察

目的观察高度近视并发性白内障超声乳化晶状体吸除联合人工晶状体植入的临床疗效及视力预后情况。方法对432例450眼高度近视并发性白内障患者行巩膜隧道切口超声乳化吸除术,通过5.5 mm切口植入人工晶状体。术后观察3~24个月,平均12.5个月。结果术后第3个月矫正视力0.1~0.5者201眼,>0.5者178眼。术后平均屈光度为(-2.49±2.11)D。发生术中、术后并发症,如后囊膜破裂、悬韧带断裂、玻璃体溢出、角膜水肿和后发障等共81眼。结论高度近视并发性白内障超声乳化晶状体吸除联合人工晶状体植入术具有手术后视力恢复快、手术安全和并发症少等优点,对高度近视并发性白内障是一种安全、有效的增视手术,有些患者还获得了意外的好视力。     

3 mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后的屈光状态分析

目的 观察3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后患者的屈光状态及其变化规律，确定最佳配镜时间。方法 老年性白内障患者34例（41只眼）行3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后第1周、第2周、第3周、第4周、第3个月和第6个月行视力及显然验光检查。记录患者的视力、球镜、柱镜和散光轴，分别对结果行多因素方差分析。结果 术后第1周、第2周、第3周、第4周、第3个月和第6个月的裸眼及矫正视力。球镜、柱镜度数及其散光轴的变化差异均无显著性（P〉0．05）。结论 3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后1周屈光状态趋于稳定，即可配镜。     

糖尿病患者白内障非超乳小切口摘出术临床分析

目的探讨糖尿病患者白内障非超声乳化小切口摘出联合人工晶状体植入术的效果。方法96例（109眼）糖尿病患者,血糖稳定且无全身并发症,行白内障非超声乳化小切口摘出联合人工晶状体植入术,观察术中、术后并发症及术后视力情况。结果随访3—18个月,术后视力1〉0．5者86眼（78．90％）,0．1～0．4者19眼（17．43％）,〈0．1者4眼（3．67％）。结论糖尿病患者白内障实施非超声乳化小切口摘出并人工晶状体植入术是安全有效的,适合在基层医院眼科及“复明工程”活动中推广应用。     

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.