三种不同术式治疗复发性翼状胬肉的疗效观察

目的:评价羊膜移植、自体角膜缘干细胞移植、羊膜移植联合自体角膜缘干细胞移植3种不同术式治疗复发性翼状胬肉的效果。方法:将127例127眼复发性翼状胬肉患者随机分为A,B,C三组,采用不同手术方式。其中A组45例45眼行羊膜移植术;B组40例40眼行自体角膜缘干细胞移植术;C组42例42眼行羊膜移植联合自体角膜缘干细胞移植术。术后随访12～24mo,分析对比3种不同术式的手术复发率。结果:A组10眼复发,复发率为22.2%;B组9眼复发,复发率为22.5%;C组3眼复发,复发率为7.1%。A组与B组比较差异无统计学意义,C组与A,B组比较有显著性差异(P<0.05)。结论:羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉术后复发率最低,是治疗复发性翼状胬肉较为理想的手术方式,值得临床推广应用。     

二种手术方法治疗翼状胬肉疗效分析

目的 比较翼状胬肉切除联合生物羊膜移植与翼状胬肉切除联合自体角膜缘干细胞移植对原发性翼状胬肉的治疗效果.方法 翼状胬肉患者186例190眼.分为A、B二组,A组60眼翼状胬肉切除联合生物羊膜移植术;B组130眼翼状胬肉切除联合自体角膜缘干细胞移植术.术后随访6-24个月,观察翼状胬肉复发率.结果 A组60眼中9眼复发,复发率15.0％; B组 130眼中7眼复发,复发率5.38％,x2=4.922,P=0.03,差异有统计学意义.结论 在防止胬肉复发方面,角膜缘干细胞移植组优于生物羊膜移植组.     

自体角膜缘联合羊膜移植术与联合结膜移植术治疗复发性翼状胬肉比较

目的 比较自体角膜缘联合羊膜移植术和自体角膜缘联合结膜移植术治疗复发性翼状胬肉的疗效，探讨自体角膜缘联合羊膜移植术能否代替自体角膜缘联合结膜移植术治疗复发性翼状胬肉。方法 36例42眼复发性翼状胬肉患者随机分成A、B2组，A组18例22眼行自体角膜缘联合羊膜移植术；B组18例20眼行自体角膜缘联合结膜移植术。结果 A组20眼术后效果满意，2眼术后5个月复发，复发率9．09％；B组19眼术后效果满意，1眼术后3个月复发，复发率5．00％．2组术后复发率在统计学上无显著差异。结论 自体角膜缘联合羊膜移植术可代替自体角膜缘联合结膜移植术治疗复发性翼状胬肉。     

角膜缘干细胞联合羊膜移植治疗翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植与羊膜移植术治疗翼状胬肉的临床疗效。方法:将126例142眼翼状胬肉患者随机分成A,B组,A组64例72眼行翼状胬肉切除联合角膜缘干细胞移植术;B组62例70眼行翼状胬肉切除联合羊膜移植术,术后1wk;1mo及3mo,观察比较移植片生长、角膜创面修复、角膜新生血管及胬肉复发率。术后随访24mo。结果:A、B两组角结膜上皮愈合时间分别为(2.6±0.4)d和(3.2±0.7)d,两组比较差异有显著性差异(P<0.05);A组2例2眼翼状胬肉复发,治愈率为97.1%,复发率2.9%;B组9例12眼翼状胬肉复发,治愈率为81.8%,复发率18.2%;两组比较差异有统计学意义(P=0.003)。结论:自体角膜缘干细胞移植与羊膜移植术均可有效防止翼状胬肉的复发,具有方便、创伤小,修复快,术后患者自觉症状轻,复发率低等优点。     

自体角膜缘干细胞移植与联合羊膜移植治疗进展期翼状胬肉的临床分析

目的 比较自体角膜缘干细胞移植与联合羊膜移植,治疗进展期翼状胬肉的疗效.方法 126例(132眼)进展期翼状胬肉随机分A、B两组,A组63例(68眼),行自体角膜缘干细胞移植术;B组63例(64眼)行自体角膜缘干细胞联合羊膜移植术.结果 A组8例(8眼)复发,复发率11.76%,B组3例(3眼)复发,复发率4.69%,两组术后复发率差异有统计学意义(P为0.1336).结论 自体角膜缘干细胞联合羊膜移植术可有效治疗进展期翼状胬肉,降低复发率改善视功能.     

复发性翼状胬肉切除联合角膜缘干细胞移植术或羊膜移植术的疗效比较

目的:观察显微镜下复发性翼状胬肉患者自体角膜缘干细胞移植术与羊膜移植术后疗效比较。方法:将复发性翼状胬肉患者90例96眼随机分为A,B两组,A组40例42眼行胬肉切除联合自体角膜缘干细胞移植;B组50例54眼行胬肉切除联合羊膜移植,观察术后患者自觉症状,角膜愈合情况,角膜缘处结膜组织愈合情况,新生血管及2a内胬肉组织增生情况。结果:角膜缘干细胞移植组治愈39眼(93%),复发3眼(7%);羊膜移植组治愈48眼(89%),复发6眼(11%),两组比较差异无统计学意义(χ2=0.0456,P>0.05)。角膜创面平均愈合时间角膜缘干细胞移植组为(4.12±1.08)d,羊膜移植组(7.38±1.12)d,两组比较有显著性差异(t=4.307,P<0.05)。结论:角膜缘干细胞移植与羊膜移植均效果良好,复发率低,但角膜缘干细胞移植术具有角膜创面上皮愈合快,患者不适感随之消失较快的优点,值得临床推广。     

角膜缘干细胞移植与羊膜移植及单纯胬肉切除治疗复发性翼状胬肉的疗效比较

目的 比较自体角膜缘干细胞移植与新鲜羊膜移植及单纯胬肉切除治疗复发性翼状胬肉的疗效.方法 对复发性翼状胬肉166例(176只眼),随机分为A、B、C 3组,A组67例,72只眼,行复发性翼状胬肉切除联合自体角膜缘干细胞移植术.B组58例,59只眼,行复发性翼状胬肉切除联合新鲜羊膜移植术.C组43例,45只眼,行单纯胬肉切除.手术后随访6～60个月.比较3组患者的症状,创伤愈合情况,胬肉复发情况.结果 A组72只眼中年复发28只眼,复发率39%,B组59只眼中复发28只眼,复发率47.5%.C组45只眼中复发39例,复发率86.6%.结论 自体角膜缘干细胞移植与新鲜羊膜移植较单纯胬肉切除明显降低复发性翼状胬肉手术后复发率.而自体角膜缘干细胞移植比新鲜羊膜移植更有效降低复发性翼状胬肉的复发率.     

翼状胬肉不同手术方法疗效分析

目的 比较自体角膜缘干细胞移植，新鲜羊膜移植及单纯性翼状胬肉切除对原发性翼状胬肉的临床疗效。方法 137例（167眼）翼状胬肉患者随机分为A、B、C组，A组48例行单纯性翼状胬肉切除术；B组53眼行翼状胬肉切除联合新鲜羊膜移植术；C组66眼行翼状胬肉切除联合自体角膜缘干细胞移植术。术后随访6月～60月，比较各组患者术后翼状胬肉复发情况。结果 A组48眼中16眼复发，复发率33．33％；B组53眼中8眼复发，为15．09％；C组66眼中3眼笔发，复发率为4．55％；A组与B组比较（X^2=4．47，P〈0．05）；B组与C组比较（X^2=3．90，P〈0．05）差异具有显著性。结论 自体角膜缘于细胞移植可有效地降低翼状胬肉术后的复发率，是目前较理想的手术方法。     

翼状胬肉撕离联合不同角膜缘干细胞移植

目的比较翼状胬肉撕离联合自体游离结膜瓣角膜缘十细胞移植及带蒂结膜瓣角膜缘干细胞移植治疗翼状胬肉的临床疗效。方法91例（97眼）翼状胬肉随机分为A、B两组．A组45例（47眼）行翼状胬肉撕离联合白体游离结膜瓣角膜缘干细胞移植术;B组46例（50眼）行翼状胬肉撕离联合带蒂结膜瓣角膜缘干细胞移植术。术后随访6～30月,比较两组术后角膜缘干细胞植片存活及翼状胬肉复发情况。结果A组5眼移植片脱落,B组植片无脱落,（X2=5．31,P〈0．05）。A组6眼翼状胬肉复发,复发率为12．76％;B组巾1眼复发,复发率仅为2．00％;（X2=5．20,P〈0．05）。结论翼状胬肉撕离联合带蒂角膜缘干细胞移植术,植片存活率高,翼状胬肉复发率低。     

角膜缘干细胞移植及羊膜移植联合丝裂霉素C治疗复发性翼状胬肉

目的:研究角膜缘干细胞移植及羊膜移植联合丝裂霉素C治疗复发性翼状胬肉的临床效果。方法:收集复发性翼状胬肉47例54眼,随机分成A,B两组,均在显微镜下手术,A组行胬肉切除+羊膜移植术(24例28眼),B组行胬肉切除+角膜缘干细胞移植+羊膜移植联合丝裂霉素C(23例26眼),随访2a,观察术后复发情况。结果:A组治愈22眼,复发6眼,复发率21%,B组治愈25眼,复发1眼,复发率4%,采用SPSS统计字软件分析χ2=11.6452,P=0.0006,复发率有显著性差异,B组复发率明显低于A组。结论:角膜干细胞移植,羊膜移植联合丝裂霉素C治疗复发性翼状胬肉,术后复发率低,术后远期效果需进一步观察。     

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.