青光眼显微小梁切除应用体会

本世纪七十年代以来,眼科显微技术已成为引人瞩目的进展,由于新型手术显微镜不断革新和完善,促进了眼科显微技术的发展,从而使得绝大分内眼手术得以在显微镜下顺利施行。本文通过72例(80眼)青光眼显微小梁切     

追求卓越——访贵阳市妇幼保健院眼科朱建华主任

本刊编辑:贵州只有你们一家儿童医院,大家都说你们小儿眼科做得很好,你们科室在贵州有那些工作是领先的?朱主任:在医院领导的关怀和大力支持下,贵阳市妇幼保健院眼科从仅做眼保健门诊的小科室发展到现在为贵州省斜弱视防治中心,是在贵州省具有一定影响力的综合性科室.眼科共有18人,其中正高1人,副高4人,研究生2人.以小儿眼科为主,承担了贵阳市幼儿园的眼保健筛查以及斜弱视的防治工作,我们引进视感知觉学习方法治疗斜弱视,该方法基于神经可塑性和知觉迁移性理论,使用知觉学习的方法,对斜弱视患者的知觉眼位、多维空间立体视、双眼视平衡、注视稳定性等双眼视功能进行检查和诊断,再针对缺损的功能位点进行个性化治疗,取得了较好的疗效.把压贴三棱镜用于斜视手术前,对斜视术后眼位稳定和立体视的建立有很大帮助,还可用于那些不能手术或不愿手术的斜视患者.眼科有专门的儿童眼保健筛查小组,长期循环地对贵阳市的幼儿园进行免费筛查,为小儿眼病早发现早治疗起到积极作用.我们还针对贵阳小儿泪道阻塞较多的情况,配备了两台泪道激光治疗机,为泪道疾病的患儿提供了方便.     

40例斜视的显微手术的初步报告

Ｔｒｏｕｔｍａｎ于 1 96 3年发明了眼科可变焦距显微镜后 ,三十多年来显微技术不仅在眼科的白内障手术、玻璃体切割术等方面应用 ,而且在眼科的其它领域也得到应用 ,自Ｖｅｒｏｎｎｅａｕ-Ｔｒｏｕｔｍａｎ于 1 972年开始在斜视手术中使用显微镜以来[1 ] ,相继有多篇关于斜视手术使用显微技术的报告发表[2～ 6] 。我院自 1 993年开始在斜视手术中应用显微技术 ,现报告 40例手术情况如下 :临床资料全部病例系住院手术患者 ,男 2 1例 ,女1 9例 ,共 40例。患者年龄 4～ 49岁 ,共同性斜视 1 3例 ,麻痹性斜视 8例 ,Ａ—Ｖ综合征1 9例。各病例的…     

《中国斜视与小儿眼科杂志》十年回顾

在各主管部门领导的关怀指导下 ,经全国眼科同道的共同努力 ,《中国斜视与小儿眼科杂志》于 1 993年创刊 ,至今已走过了 1 0年历程。一、《中国斜视与小儿眼科杂志》在斜视与小儿眼病专业发展中诞生随着现代眼科学及多个边缘学科的发展 ,一些严重影响儿童视觉发育的常见小儿眼病 ,如弱视、斜视等引起了专家们的关注。小儿眼科是一个与多学科相关的领域 ,如与妇产科、儿科、神经科及基础学科等密切相关 ,有很多未知的领域急待探索研究。 2 0世纪中期 ,我国眼科前辈就引进了有关理论技术 ,积极开展了儿童眼病的临床及研究。 1 984年以刘家琦教…     

《斜视弱视与小儿眼科》征订通知

由孟祥成、孟令勇主编 ,张方华主审的《斜视弱视与小儿眼科》已于 2 0 0 1年 3月由黑龙江人民出版社出版 ,现已开始征订。本书是主编者在原版《斜视弱视学》、《儿童视力不良与斜视》、《小儿临床眼病》的基础上 ,吸收国内外新观点、新技术 ,总结这些年来临床经验 ,最新编著的一本系统性很强的专著。本书内容系统、简明、实用 ,包括斜视弱视的诊断、检查、治疗和手术及小儿眼科综合征和遗传疾病等。全书上卷共 16章(解剖、视觉生理、检查法、眼的屈光、斜视与弱视的诊断及治疗 ) ;下卷共 15章 (小儿眼内眼外疾病、小儿眼肿瘤、遗传病及小儿…     

《斜视弱视与小儿眼科》征订通知

由孟祥成、孟令勇主编 ,张方华主审的《斜视弱视与小儿眼科》已于 2 0 0 1年 3月由黑龙江人民出版社出版 ,现已开始征订。本书是在原版《斜视弱视学》、《儿童视力不良与斜视》、《小儿临床眼病》的基础上 ,吸收国内外新观点、新技术 ,总结这些年来临床经验 ,最新编著的一本系统性很强的专著。本书内容系统、简明、实用 ,包括斜视弱视的诊断、检查、治疗和手术及小儿眼科综合征和遗传疾病等。全书上卷共16章 (解剖、视觉生理、检查法、眼的屈光、斜视与弱视的诊断及治疗 ) ;下卷共 15章 (小儿眼内眼外疾病、小儿眼肿瘤、遗传病及小儿综合征…     

重视斜视手术治疗中的常见问题

斜视是儿童多发眼病之一,患病率为1％～2％。近年来在全国斜视与小儿眼科学组和各地眼科医师的努力下,斜视专业学术水平有了飞速发展。针对共同性斜视的病因,进行了大量的临床和基础研究,发现了解剖学异常和特殊的神经肌肉结构(puueys),建立了斜视的数字化模型用于评价眼外肌功能和设计手术等。在有关斜视患者手术前、后双眼视觉功能改变的研究中,发现了双眼视觉损害     

手术显微镜下斜视矫正手术的临床疗效

目的 探讨手术显微镜下斜视矫正手术的可行性和并发症的发生情况.方法 128例斜视随机分为两组,手术显微镜下斜视矫正手术70例为试验组,肉眼直视下传统斜视矫正手术58例为对照组.术后随访时间6 ～12个月,平均(8.20±2.41)月,观察患者眼位矫正情况及结膜切口瘢痕、肌肉缝线反应、结膜下囊肿、术后感染、眼前段缺血综合征等并发症发生情况.结果 试验组眼位矫正有效率97.14％,对照组眼位矫正有效率96.55％,两组眼位矫正效果对比,差异无统计学意义(x2=0.04,P＞0.05).试验组并发症发生率1.43％,对照组并发症发生率10.34％,两组差异有统计学意义(x2=4.88,P＜0.05).结论 手术显微镜下斜视矫正手术是可行的,具有与传统斜视矫正手术相同的效果,显微斜视矫正手术具有术后反应轻、并发症少等明显优势.     

异丙酚在小儿斜视手术中的应用

异丙酚在小儿斜视手术中的应用温州医学院育英儿童医院麻醉科李琼英连庆泉小儿在眼科手术时常不能合作，多需在全麻下进行，眼科手术的麻醉会影响手术效果。故对麻醉有较高要求。术中要保持手术野平静，避免眼心反射，防止因麻醉对眼内压的影响，病人尤其麻醉后需保持安静...     

显微技术应用于斜视矫正术的疗效分析

目的探讨显微手术技术应用于斜视矫正术的优点。方法对37例斜视患者在显微镜下进行斜视矫正术,其中5例复杂性斜视行睫状前血管分离。平均随访6个月,对术中、术后并发症及手术效果进行临床分析。结果所有患者均在第一眼位获得理想眼位,术中、术后并发症明显减少,5例复杂性斜视成功分离并保留睫状前血管,减少手术次数。结论在手术显微镜下行斜视矫正术更安全,手术并发症少。     

眼科显微手术技能培训模式探讨

目的：探索一种眼科专科医师显微手术技能培训模式,使年轻的眼科医生了解并掌握眼科显微手术的基本特征、基本知识和基本技能, 以适应眼科临床工作的需要。 方法：对尚未熟练掌握眼科显微手术的本院眼科医生、进修医生和实习研究生进行眼科显微手术基础理论和操作技能培训,并建立起严格的培训制度。 结果：培训者46名基本显微手术操作比较准确和熟练,能在带教老师指导下应用手术显微镜完成翼状胬肉切除、白内障囊外摘出+人工晶状体植入术、青光眼小梁切除等手术操作。 结论：利用眼科显微手术培训平台进行显微手术技能培训,并将理论与实践相结合的这种培训模式,能达到掌握眼科显微手术操作的目的。     

我国斜视与小儿眼科近五年研究进展

在新世纪的又一个5年中,伴随着我国国力的进一步增强和国际交流的日益频繁,我国斜视与小儿眼科领域广大同道扎实工作、辛勤劳动、积极参与国际学术交流和竞争,取得了丰硕的成绩.无论是斜视与小儿眼科的临床研究,还是相关基础研究方面,一批新的科研成果开始得到国际认同,一批德才兼备的青年学术人才在此过程中得到锻炼与培养.我国斜视与小儿眼科的国际地位不断提升.     

Perspective on strabismus, 2006

During the last half of the 20th century, the field of strabismus did not undergo as many major advances as other areas of ophthalmology. In recent years, an increase in basic science research has fostered important advances in our understanding and treatment of disorders of binocular vision. This article identifies 4 important questions that need to be addressed by the pediatric ophthalmology and adult strabismus community: (1) What terms should be used to describe muscle dysfunction? (2) By what mechanism does strabismus surgery work? (3) What is the role of orbital imaging in the management of strabismus? (4) What is the role of refractive surgery in the treatment of patients with amblyopia and strabismus?     

丙泊酚复合小剂量氯胺酮用于小儿眼科手术的临床研究

目的：探讨丙泊酚复合小剂量氯胺酮在小儿眼科手术中的应用价值。方法选取66例ASA I~II级择期实施小儿眼科手术的病人,随机分成研究组（33例）和对照组（33例）,研究组运用丙泊酚复合小剂量氯胺酮进行麻醉,对照组采用氯胺酮进行麻醉。比较两组患者各个时间点的心率、平均动脉压、眼内压。药物停止以后分别记录两组患者的完全清醒时间以及评估术后恶心、呕吐等方面的情况。结果对照组患者在气管插管时、手术开始时、术中第15 min及手术结束时的心率、平均动脉压与麻醉前相比均有增快和升高（P＜0.05）。两组患者的相应各时点参数相比较均有极显著性差异（P＜0.05）;对照组患者气管插管时、手术开始时的眼内压跟麻醉前相比均有升高（P＜0.05）,两组相应时点的眼内压相比较均有显著差异（P＜0.05）。研究组的恶性呕吐发生率明显低于对照组（P＜O.05）,清醒时间也明显短于对照组（P＜;0.05）。结论丙泊酚复合小剂量氯胺酮用于小儿眼科手术的应用价值比较高,围术期的血流动力学稳定性好,术后恶心呕吐发生率低。     

A Preliminary Report of 40 Cases of Strabismus Microsurgery

Objective:To improve the qaulity of strabismus surgery and to find out the role of microsurgery in the field of strabismus.Methods:We performed separation and preservation of anterior ciliary vessels(ACV),adjustable sutures,routine rectus recession,and oblique muscle surgeries under microscope in 13 cases of comitant strabismus,19 cases of A-V syndrome and 8 cases of paralytic strabismus.Results:Surgeries were performed in a very clear field under microscope.We successfully did vascular microdissection and ACV preservation.Also with the use of microscope,various kinds of strabismus microsurgery videos were recorded.Conclusions:Microscopic technique can be used to enhance the quality and accuracy of strabismus surgery and to reduce surgical damage,postoperative inflammatory reaction and sear formation.All kinds of strabismus surgery,especially,oblique muscles and complex paralytic operations can be performed under microscope,.     

Early American Strabismus Surgery: 1840–1845

Abstract

The discovery of effective surgical therapy for strabismus was one of the outstanding triumphs of the first half of 19th-century ophthalmology, just prior to the invention of the ophthalmoscope in 1850. Although priority for the development of strabismus surgery belongs to Johann Friedrich Dieffenbach of Germany, who first reported his surgical results in 1839, 4 cases of tenotomy of the medial rectus muscle had been performed in the United States by William Gibson in 1818 but never published. By 1840, the reports of surgery in Europe had rapidly spread to America where surgeons immediately began using these procedures. The first American surgeon to perform eye muscle surgery and publish his results was John Dix of Boston, and other surgeons were soon reporting their cases as well. We discuss 8 American pioneers in this field during the time (1840–1845) of the first burst of enthusiasm for this surgery. Although these surgeons were active in performing a large number of cases and carefully reporting their experiences and results, they did not make any major advances in the field.     

History of corneal transplantation in Australia

Corneal transplantation is a triumph of modern ophthalmology. The possibility of corneal transplantation was first raised in 1797 but a century passed before Zirm achieved the first successful penetrating graft in 1905. Gibson reported the first corneal graft in Australia from Brisbane in 1940 and English established the first eye bank there a few years later. Corneal transplantation evolved steadily over the twentieth century. In the second half of the century, developments in microsurgery, including surgical materials such as monofilament nylon and strong topical steroid drops, accounted for improvements in outcomes. In 2013, approximately 1500 corneal transplants were done in Australia. Eye banking has evolved to cope with the rising demands for donor corneas. Australian corneal surgeons collaborated to establish and support the Australian Corneal Graft Registry in 1985. It follows the outcomes of their surgery and has become an important international resource for surgeons seeking further improvement with the procedure.     

角膜病变合并白内障手术疗法的研究进展

角膜病变合并白内障是角膜病医师经常遇到的问题.穿透性角膜移植联合白内障摘出及人工晶状体植入的三联手术,可以避免角膜植片遭受二期白内障手术的损伤,并能快速恢复视力,成为角膜病变合并白内障的主流手术方式.由于角膜移植术后角膜曲率不稳定且角膜形态不规则;导致三联手术后的屈光状态难以预测;而角膜缝线完全拆除后二期行白内障摘出及人工晶状体植入,则可以精确测算人工晶状体的度数以减少术后的屈光误差.因此,也有许多临床医师倾向于先行穿透性角膜移植术,二期行白内障手术.2种手术方式在手术安全性及术后效果等方面各具优势,其选择仍存在争议.近年来,随着眼科显微手术技术的提高及手术器械的发展,对角膜病变合并白内障的手术治疗策略有了新认识,本文就其研究进展作一综述.     

散光型人工晶状体的研究进展

随着现代眼科显微手术技术的日趋完善和提高,尤其是微切口白内障摘除手术的推广及在飞秒激光辅助下的白内障摘除手术的兴起,白内障摘除联合人工晶状体( intraocular lens,IOL)植入术逐渐从复明手术走向了屈光手术时代,人们对术后的视觉体验也有了更高的追求。然而手术前后存在的角膜散光一直是影响术后视觉效果的主要因素。近年来, IOL的设计及材料的发展,为散光型人工晶状体( Toric IOL)的临床应用提供了必备的基础条件。 Toric IOL的特点主要是有效地矫正了白内障患者术后的角膜散光,从而提高了患者术后的视觉功能。本文就Toric IOL的设计、分类、临床应用进行分析,并对目前所存在的问题与展望进行讨论。     

Learning curves for strabismus surgery in two ophthalmologists

Purpose:

To identify the average turning point by comparing the learning curves of two surgeons learning to perform strabismus surgery.

Materials and Methods:

Patients who underwent procedures to correct exotropia between January 2010 and December 2014 followed for at least 3 months were retrospectively assessed. The first 70 patients on whom each of two ophthalmologists (A and B) performed surgery to treat strabismus were divided into 7 cohorts comprising 10 patients each based on the chronological order of the surgery. Factors, including patient age, preoperative angle of deviation, operative time, and success or failure of the operation, were compared between the two surgeons. Learning curves were calculated based on changes in operative time and operation success rate. Operation success was determined by measuring the angle of deviation at a distance of 5 m 3 months after the operation.

Results:

A turning point was observed after 40 cases for Surgeon A and 50 cases for Surgeon B based on the operative time learning curve. No turning point was observed in the operation success rate learning curve based on the absence of a specific trend. Success rate by cohort was not significantly different between the two surgeons (P > 0.05). Surgeon B had a significantly longer mean operative time than Surgeon A (P = 0.045).

Conclusions:

Approximately 50 cases are required for an ophthalmologist to reach a turning point in strabismus surgery. This outcome can be used as a guideline when training surgeons to perform strabismus surgery.