3D手术视频系统在PDR合并牵拉性视网膜脱离手术中的应用

目的：评价3D手术视频系统在增生性糖尿病视网膜病变(PDR)合并牵拉性视网膜脱离(TRD)玻璃体切除术中的应用效果。

方法：回顾性分析2018-08/2019-03于我院行25G微创玻璃体切除术的PDR合并局部TRD(无牵拉性视网膜裂孔)患者32例38眼的临床资料,根据术中采用的观察系统进行分组,试验组16例19眼采用3D手术视频系统手术,对照组16例19眼采用传统显微镜手术。记录两组患者手术时间、术中医源性视网膜裂孔和硅油注入情况。术后至少随访6mo,观察最佳矫正视力及术后并发症发生情况。

结果：试验组术中发生医源性视网膜裂孔1眼,硅油注入1眼; 术后视网膜均完全复位; 术后1d玻璃体出血4眼,2～4wk后自行吸收; 术后2wk内发生高眼压6眼,药物治疗均能控制; 术后6wk后玻璃体再出血2眼; 术后6mo最佳矫正视力0.3以上者15眼。对照组术中发生医源性视网膜裂孔4眼,硅油注入5眼; 术后视网膜均完全复位; 术后1d玻璃体出血6眼,2～4wk后自行吸收; 术后2wk内发生高眼压5眼,药物治疗均能控制; 术后6wk后玻璃体再出血3眼; 术后6mo最佳矫正视力0.3以上者14眼。所有患者手术均顺利完成,均无眼内炎等严重并发症发生,但试验组手术时间明显短于对照组(37.3±4.8min vs 41.2±5.1min,P=0.020)。

结论：3D手术视频系统在PDR合并TRD玻璃体切除术中的应用能够缩短手术时间,提高手术效率。     

3D 平视技术在玻璃体切割联合白内障手术中的应用

目的：比较3D平视技术与显微镜目镜下行玻璃体切割联合白内障手术的疗效和安全性。方法：回顾 性系列病例研究。收集2018年9月至2021年6月于徐州市第一人民医院眼科行玻璃体切割联合白内 障手术的患者48例（48眼）的临床资料。根据手术时观察系统不同分为3D平视技术组和显微镜目镜 组,每组24例（24眼）。比较2组患者术眼手术持续时间及术中并发症等情况。术后随访3个月,评 估术眼手术前后最佳矫正视力（BCVA）、术后解剖复位率和术后并发症发生率情况。数据采用t检验、 卡方检验及Fisher确切概率法进行分析。结果：显微镜目镜组、3D平视技术组的手术时间依次为 （64.4±19.8）min和（63.1±18.5）min,差异无统计学意义（t=-0.27,P=0.089）。术后1、3个月,显微 镜目镜组和3D平视技术组术眼BCVA均较术前明显提高,且术后3个月BCVA均优于术后1个月,差 异均有统计学意义（P<0.05）。术后1、3个月复查时,同一时间点2组BCVA比较差异均无统计学意义。 2组术中出血率、后囊膜破裂率、气体注入率和硅油注入率及术后出现角膜水肿、前房反应、高眼压 及低眼压率差异均无统计学意义。随访3个月时显微镜目镜组和3D平视技术组均未出现术后并发症。 结论：3D平视技术下的玻璃体切割联合白内障手术可以达到与显微镜目镜下同样的治疗效果,且安 全性好,可在临床上进行推广。     

Initial experience with three-dimensional heads-up display system for cataract surgery – A comparative study

Purpose:To compare the complication rates, surgical time and learning curve using the 3-D Heads up display system in comparison with the conventional microscope for routine cataract surgery.Methods:Consecutive consenting adults with uncomplicated cataract were offered phacoemulsification using the 3-D Heads up display system (ARTEVO 800 Carl Zeiss Meditec) or the conventional microscope (Zeiss Lumera 700) by two experienced surgeons. Surgical time, measured from start of corneal incision to removal of microscope from the surgical field and complication rates were compared between the groups.Results:Of the 343 eyes enrolled, 100 (29%) underwent surgery using the 3-D Heads up display system. The surgical time for 3-D Heads up display system was significantly higher in the 3-D group (8.4 ± 2.1 vs. 6.5 ± 1.8 minutes, P < 0.001). There were no group differences in surgical complications (2% in 3-D vs. 2.5% in conventional microscope, P = 0.28). Comparing across 4 quartiles within the 3-D group, the mean surgical time was slightly higher during the 1^st quartile (n = 25, 9.1 ± 1.9 minutes) compared to the last quartile (n = 25, 8.2 ± 1.9 minutes) (p = 0.17). Complications in the 3-D group occurred only in the initial 50% of cases. Seven (7%) cases in the 3-D group were converted to conventional binocular microscope of which 3 each were due to difficulty in depth perception and low illumination while one was due to intraoperative pupillary constriction.Conclusion:Phacoemulsification with the 3-D Heads up display system takes longer time but offers excellent visualization, ergonomics and safety compared to conventional microscopes. Experienced surgeons should be able to adapt easily after their first 50 surgeries.     

眼科麻醉的现状分析与发展思路

目的：通过分析本单位和国内眼科麻醉发展的概况及其目前存在问题,探讨未来眼科麻醉在技术、药物与监测等方面的发展思路.方法：回顾早期及目前眼科麻醉应用技术和药物、并以调查方式分析局麻患者主要存在的问题.结果：眼科麻醉已取得了一定的进展,但麻醉技术、药物与监测等仍存在不足,大部分局麻手术患者可有不同程度的紧张焦虑及不适.结论：通过列举国内外文献资料方法探讨眼科麻醉发展的思路,指出应在传统麻醉的基础上不断完善现有的技术,并解决非全麻患者对安全、舒适的镇静镇痛的需求,形成现代眼科麻醉的规范化方法,建立专科麻醉分支.     

Analysis of real-world visual ergonomics at the visual display unit

Introduction

In this interventional study, the ergonomic workplace set-up and the impact of character size on subjectively estimated working productivity and computer vision syndrome (CVS) were evaluated in the field.

Methods

The number of displays and their size, resolution, surface structure, position in the room and relation to the eye were evaluated for 152 units. CVS was assessed using the CVS-Questionnaire. Habitually used character size for an uppercase E was recorded and compared to the ISO 9241–303:2011, national standards (e.g., ANSI/HFES 100–2007) and national guidelines (e.g., German DGUV Information 215–410). In case of failure to comply with these standards, character size was increased to 22 angular minutes to reach the recommended ranges. Reasons for returning to former or smaller character sizes were recorded, and subjectively perceived changes in productivity were estimated by the participants using a visual analogue scale before and 2 weeks after the intervention using a questionnaire.

Results

The average visual display unit consisted of two non-glare (matt) 24″ widescreen monitors that were located approximately 73 cm (primary) and 76 cm (secondary) from the eyes. The mean (SD) habitually set character size was 14.29 angular minutes (3.53) and therefore both statistically and clinically significantly too small compared with ISO 9241–303:2011 (p < 0.001). Increasing the character size to 22 angular minutes produced a 26% reduction in subjectively rated productivity (p < 0.001). No significant correlation between character size and symptoms of CVS was demonstrated.

Conclusions

In the workplaces investigated, recommendations for character size were not adhered to. This resulted in a reduction in productivity and was not compatible with some of the work requirements, for example, obtaining a broad overview of a spreadsheet.     

飞秒激光在眼外科中的应用新进展

飞秒激光由于光致分解作用使组织电离,在组织内进行精确切削,对切削区以外的组织影响较小,具有极高的安全性。近年来逐渐应用于眼外科领域,是一种全新的方法。我们就飞秒激光的作用原理及在眼科手术领域的应用进行综述。     

新型冠状病毒肺炎疫情期间眼科手术安全性及防控对策

目的:探讨新型冠状病毒肺炎疫情期间开展眼科手术的安全性,并提出相关防控对策。方法:收集2020年1月25日至2020年2月28日新型冠状病毒肺炎疫情期间,在天津医科大学总医院眼科接受手术治疗者11例(12眼)的资料。其中眼球破裂,角膜穿孔伤,角膜穿孔伤合并外伤性白内障,眼内异物各1例(1眼),泪小管断裂2例(2眼),孔源性视网膜脱离4例(4眼),青光眼1例(2眼)。所有患者进行体温监测和流行病学调查。按照国家疫情防控要求和医院的应急管理流程,制订了眼科诊疗流程,所有患者均严格按照此流程进行管理,围手术期严格监测体温、呼吸道等全身情况。结果:11名患者就诊前行体温监测、流行病学调查、临床及影像学检查均正常,并请感染科专家会诊排除新型冠状病毒肺炎。所有患者均为眼外伤和急性眼病,包括急诊手术6眼,限期手术6眼,严格遵照眼科诊疗流程进行手术治疗,术后恢复良好,均未出现严重手术并发症。住院及随访期间患者、家属及医护人员均未发生新型冠状病毒肺炎。结论:新型冠状病毒肺炎疫情期间严格筛查患者,严格按照疫情期间防控工作流程要求,眼科手术是安全可行的。     

眼整形外科存在的问题及对策

眼整形外科是眼科和整形外科学科交叉产生的一门新兴专业,包括眼部美容、眼部整形和眼眶外科三部分。本文主要对三部分的关键问题进行述评:眼部美容(包括眼睑美容手术、药物注射美容和激光美容)的现状和发展;眼睑恶性肿瘤、眼睑缺损、眼睑痉挛及眼窝凹陷等眼部整形手术中存在的问题和解决措施;眼眶外科中甲状腺相关眼眶病、眼眶骨折和眼眶畸形等方面亟待解决的问题及对策,并对我国眼整形外科发展中存在的问题逐一提出解决策略。(眼科,2007,16:365-367)     

OCT联合眼部B超对白内障术前眼底检查价值评估

目的：探讨光学相干断层扫描(OCT)联合眼部B超对白内障患者术前眼底检查的临床价值。

方法：通过常规检眼镜、眼部B超及OCT对176例278眼白内障患者术前进行眼底病检查,计算三种检查方法对眼底病的阳性检出率,并利用McNemar检验对数据进行配对分析,比较不同检查方法对眼底病诊断的价值。

结果：常规检眼镜检出眼底病32眼(眼底病阳性率为11.5%),眼部B超检出眼底病18眼(6.5%),其中晶状体严重混浊患者有6眼(2.2%),OCT检出眼底病51眼(18.3%),OCT联合眼部B超眼底病阳性病例为57眼(20.5%)。OCT检出眼底病阳性率与B超、常规检眼镜及OCT联合眼部B超检出的眼底病阳性率在α=0.05水平均具有显著性差异。

结论：三种检查方法比较OCT的价值较大,对黄斑区病变检查灵敏度高,但在患者晶状体严重混浊时,OCT无法获取眼底黄斑区视网膜结构,而眼部B超很好弥补OCT眼底检查的“盲区”,两者联合使用,对眼底病的准确诊断以及术后视力恢复预测价值最大。     

瑞芬太尼联合丙泊酚静脉麻醉在小儿眼科手术中的应用

目的观察小儿眼科手术瑞芬太尼(rem ifentan il)联合丙泊酚(propofol)静脉麻醉的麻醉效果。方法小儿眼科手术40例,ASA(美国麻醉医师协会)Ⅰ级,随机分为瑞芬太尼组(Ⅰ组,试验组)和芬太尼(fentanyl)组(Ⅱ组,对照组),每组各20例。分别采用瑞芬太尼联合丙泊酚及芬太尼联合丙泊酚静脉麻醉。观察并记录麻醉诱导前、插管前、插管后即刻、手术开始时、手术开始后30 m in及拔管时6个时间点血液动力学的变化,记录术后呼吸恢复时间,清醒拔管时间,苏醒期躁动及恶心呕吐等不良反应。结果与麻醉诱导前比较,Ⅱ组插管后即刻及拔管时收缩压(SBP)、舒张压(DBP)均升高(P<0.05);与Ⅱ组比较,Ⅰ组插管后即刻及拔管时SBP、DBP、HR均平稳(P<0.05)。术毕呼吸恢复时间及清醒拔管时间Ⅰ组较Ⅱ组短(P<0.05)。结论瑞芬太尼联合丙泊酚静脉麻醉用于小儿眼科手术,术中血液动力学较平稳,术后苏醒迅速,苏醒质量良好,是一种安全可行的静脉麻醉方法。     

下方角巩膜缘牵引缝线在眼科手术中的应用

目的:探讨下方角巩膜缘牵引缝线在眼科手术中的应用价值和操作技巧。方法:应用下方角巩膜缘牵引缝线方法固定眼球,暴露手术野协助完成眼科手术163例181眼,包括小切口白内障囊外摘出术联合人工晶状体植入术86例98眼,青光眼小梁切除术48例54眼,青光眼白内障联合手术10例10眼,结膜瓣遮盖手术8例8眼,玻璃体腔注气术3例3眼,外伤性睫状体脱离缝合复位手术2例2眼,经睫状体平坦部三通道玻璃体切除手术6例6眼。用直尺测量12∶00位角巩膜缘至上睑缘的距离(mm)。结果:应用下方角巩膜缘牵引缝线协助完成眼科手术163例181眼,操作效果满意者160例178眼,占98.3%。不满意者3例3眼,占1.7%,暴露不满意者为青光眼伴小睑裂患者行外眦开大术后达到满意效果,无1例发生并发症。测量12∶00位角巩膜缘至上睑缘的距离为9.5±3.5mm。结论:下方角巩膜缘牵引缝线在固定眼球和暴露手术野方面能够顺利协助完成眼科手术,具有操作简单,安全性高,实用性强的特点,效果满意,可以代替上直肌牵引缝线,值得临床眼科医生在手术操作中应用。     

抗栓治疗患者眼科围手术期的处理

大多数需要眼科手术的老年患者同时定期应用抗血小板和抗凝药物。抗栓治疗可引起球后出血、脉络膜上腔出血等出血性并发症,甚至导致失明,然而中断患者的抗血栓药物可能诱发血栓形成,造成严重不良后果。但目前并没有针对应用抗血小板和抗凝药物眼科患者围手术期管理的指南。患者回顾了传统和新型抗栓药物在白内障、玻璃体视网膜、青光眼及眼眶手术前后的使用,对眼科手术围手术期各类抗血小板和抗凝药物的继续使用、中断和恢复用药提出建议,以减少出现出血性或血栓性并发症的风险。     

The effect of latency on surgical performance and usability in a three-dimensional heads-up display visualization system for vitreoretinal surgery

Graefe's Archive for Clinical and Experimental Ophthalmology - Although latency has been cited as a disadvantage of the three-dimensional heads-up display (3D HUD) visualization system for...     

抗青光眼滴眼液每日治疗费用的比较

目的比较我国各种抗青光眼滴眼液的每日费用。设计调查研究。研究对象我国市场上主要的抗青光眼滴眼液 15种。方法选取我国市场上主要的抗青光眼滴眼液16种,每种滴眼液5瓶,分别由5名研究者记录单瓶滴数,计算平均单瓶滴数、单滴药物容量、单瓶滴眼液双眼使用天数和每日费用。主要指标每种滴跟液单瓶双眼使用天数及每日费用。结果抗青光眼滴眼液的单滴药物容量为0．027ml(卢美根)-0．053ml(诚瑞和0．5％真瑞);单瓶价格从5．7元(马来酸噻吗洛尔)到338元(适利达)不等;单瓶滴眼液双眼使用天数从12天(真瑞)到52天(卢美根)。抗青光眼滴眼液双眼同时应用时的每日费用为:适利达 7．51元、苏为坦6.30元、卢美根3．84元、阿法根3．36元、迪立见2．97元、派立明2．83元、2％真瑞2．34元、贝他根2．11元、贝特舒 2．0元、0．5％真瑞1．49元、2％护明1．29元、1％和2％美开朗1．21元、1％护明0．85元、诚瑞0．63元、马来酸噻吗洛尔0．23元。结论我国市场上的抗青光眼滴眼液治疗费用高低悬殊。本研究结果的数据可能对我国青光眼药物治疗费用的预算和选择有参考价值。     

Video recording of ophthalmic surgery—ethical and legal considerations

Video documenting is increasingly used in ophthalmic training and research, with many ophthalmologists routinely recording their surgical cases. Although this modality represents an excellent means of improving technique and advancing knowledge, there are major ethical and legal considerations with its use. Informed consent to record is required in most situations. Patients should be advised of any risk of identification and the purpose of the recording. Systems should be in place to deal with issues such as data storage, withdrawal of consent, and patients requesting copies of their recording. Privacy and security of neither patients nor health care professionals should be compromised. Ownership and distribution of video recordings, the potential for their use in medical litigation, the ethics and legality of editing and the impact on surgeon performance are other factors to consider. Although video recording of ophthalmic surgery is useful and technically simple to accomplish, patient safety and welfare must always remain paramount.     

眼手术相关性干眼发病机制的研究进展

随着各类眼科手术的快速发展和广泛开展,术后视觉质量受到了更多的关注。干眼(dry eye)是眼科手术后的常见并发症,常引起眼部不适、视物模糊等症状以及其他干眼体征。眼手术相关性干眼是干眼的一个常见类型,通常由于手术损伤角结膜组织及神经、破坏泪膜稳定性、术后炎症反应以及围术期局部用药等多种因素导致。本文就眼手术相关性干眼的危险因素、不同眼科手术导致干眼的发病机制以及对此类干眼的预防等进行综述,以期眼科医生在临床中能够减少眼手术相关性干眼的发生及发展,提高眼科手术后的视觉质量及生活质量。     

喉罩和气管导管在小儿眼科手术中对眼压影响的比较

目的：探讨喉罩（LMA）麻醉与气管插管麻醉应用于小儿眼科手术的安全性以及对眼压波动的影响。方法：小儿眼科手术患者90例,按照入院随机数字表随机分为喉罩组（L组）和气管导管组（T组）,每组45例。观察记录两组麻醉诱导前（T0）、建立气道即刻（T1）、建立气道后3min（T2）、拔管后即刻（T3）、拔管后3min（T4）的SBP,DBP,HR及眼内压（IOP）的变化,并记录两组患者拔管时间、术中术后相关并发症发生情况。结果：T组T1,T2,T3,T4时SBP,HR均高于T0及L组（P〈0.05）。L组T1,T2,T3,T4时SBP,HR较T0时略有升高,但无统计学意义（P〉0.05）。T组T1,T2,T3,T4时IOP较T0,L组明显增高（P〈0.05）,L组T1,T3时IOP略有升高,但各时点IOP差异无统计学意义。T组拔管时间较L组明显延长且较多术后并发症（P〈0.05）。结论：与气管导管相比,喉罩通气在诱导及麻醉过程中血流动力学稳定,气道损伤少、眼内压波动幅度小,围手术期并发症少,术后恢复快,适用于小儿眼科手术。