球结膜下浸润麻醉行青光眼小梁切除术临床观察

目的 评估和比较结膜下麻醉和球后麻醉行青光眼小梁切除术的可靠性和安全性。方法 对103例（120只眼）青光眼患者采用结膜下麻醉实施小梁切除术,与98例（109只眼）青光眼患者采用球后麻醉实施小梁切除术进行比较。对照分析两组麻醉方法的并发症、患者术中的配合程度及手术的安全性。结果 结膜下麻醉组115只眼（95．83%）、球后麻醉组中107只眼（98．16％）麻醉效果佳,球后麻醉组中有4只眼球后出血,1只眼光感消失,而球结膜下麻醉组无严重并发症出现。结论 球结膜下麻醉对于青光眼小梁切除是一种安全有效、并发症少的麻醉方法,值得推广。     

表面麻醉在成人小梁切除术中的应用

目的探讨采用0．4％倍诺喜滴眼液表面麻醉行小梁切除术的可靠性、安全性和有效性。方法82例93眼成人青光眼患者用0．4％倍诺喜表面麻醉行小梁切除术，对术中患者配合及疼痛反映情况进行评价。结果82例93眼成人青光眼患者行小梁切除术，单纯表面麻醉，效果良好顺利完成手术者81眼，占87．1％；因缝上直肌时疼痛明显用2％利多卡因0．5ml追加上直肌浸润麻醉后顺利完成手术者10眼，占10．7％；疼痛明显，精神紧张不能配合手术2眼，改做球后麻醉，占2．2％。结论表面麻醉下小梁切除术可靠、安全，无麻醉并发症，值得临床推广应用。     

表麻联合球结膜下浸润麻醉行隧道式小切口白内障手术的体会

目的 探讨表麻联合球结膜下浸润麻醉下白内障手术的效果。方法 40例(40只眼)白内障患者在表麻 球结膜下浸润麻醉下施行巩膜隧道式小切口白内障摘除联合后房型人工晶状体植入。结果 术后患者无明显的不适．并能很好的配合医生完成手术。结论 表麻联合球结膜下浸润麻醉可避免球后和球周麻醉带来的并发症．并能使手术在一个较好的麻醉效果下完成。     

眼前节麻醉下白内障手术

目的阐述眼前节麻醉的方法和评估眼前节麻醉下行白内障手术的可靠性、有效性和安全性。方法眼前节麻醉的方法为0．4％盐酸奥布卡因表面麻醉联合近角膜缘球结膜下2％利多卡因0．4ml注射。对552眼白内障患者经眼前节麻醉进行白内障手术，随机抽取同期552眼采用球后麻醉行白内障手术的患者作为对照组，比较两组患者麻醉镇痛效果和麻醉存在的并发症。结果球后麻醉组2眼术中黑朦，5眼球后出血，1眼中枢抑制，12眼后囊膜破裂，9眼术中有疼痛感；眼前节麻醉有5眼后囊破裂，41眼术中有可忍受的酸痛。2组患者均能较好地进行手术，眼前节麻醉中所有患者均能较好地配合手术，术中眼位可以很好地随医生的要求改变。结论眼前节麻醉是一种白内障可靠、安全且并发症较少麻醉方法。     

表面麻醉联合球结膜浸润麻醉下小梁切除术51例效果观察

目的 探讨表面麻醉联合球结膜浸润麻醉下行小梁切除术的可行性。方法 对51例(71只眼)表面麻醉联合球结膜浸润麻醉下行小梁咬切术,观察麻醉效果及其术后并发症。结果 麻醉效果：Ⅰ级占76．1％,11级占21．1％,Ⅰ级占2．8％。未发现严重并发症。结论 表面麻醉联合球结膜浸润麻醉对于青光眼小梁切除术是一种安全有效,简便易行的麻醉方法,值得推广。     

结膜下浸润麻醉与球后阻滞麻醉在抗青光眼小梁切除术中的比较

目的比较结膜下浸润麻醉与球后阻滞麻醉对小梁切除术的影响。方法选取30～70岁无手术禁忌证的各种类型青光眼患者200例（240眼），A组用球后阻滞麻醉完成小梁切除术100例（118眼）。B组用结膜下浸润麻醉完成小梁切除术100例（122眼）。结果A组患者在麻醉时发生4例球后出血，B组患者没有发生麻醉并发症，两种麻醉方法对小梁切除术在麻醉效果、手术时间、术后眼压及视力等方面的比较差异无统计学意义（P〉0．05），在麻醉并发症方面的比较差异有统计学意义（P〈0．05）。结论结膜下浸润麻醉操作简单，安全性高，不会发生麻醉并发症，它是一种值得推广的麻醉方法。     

表麻加结膜下浸润麻醉在抗青光眼手术中的临床应用

目的 探讨表麻加结膜下浸润麻醉进行青光眼手术的可行性，分析其安全性。方法 对49例63眼青光眼手术用倍诺喜(0．4％盐酸奥布卡因)眼液表面麻醉和2％利多卡因结膜下浸润麻醉。结果 用于青光眼手术，均顺利完成手术。不但镇痛效果好，节约手术时间，避免球后麻醉的并发症，缩短手术时间，而且减少对晚期青光眼手术的风险。结论 表麻加结膜下浸润麻醉对青光眼手术是一种安全、有效及简便易行的麻醉选择，尤其是对于晚期青光眼值得推广使用。     

小梁切除联合超声乳化IOL植入术中三种麻醉方法的比较

目的:探讨表面麻醉,表面麻醉联合球结膜下麻醉及球后麻醉在小梁切除联合超声乳化人工晶状体(IOL)植入术中的可行性并对其效果进行评价。方法:对90例120眼按入院时间先后分成3组,分别用表面麻醉,表面麻醉结合球结膜下麻醉及球后麻醉行小梁切除联合超声乳化人工晶状体植入术,观察麻醉效果及术中、术后的局部及全身并发症。结果:表面麻醉组有3眼因麻醉不足术中追加结膜下麻醉,有11眼因麻醉不足疼痛不能耐受手术。表面麻醉联合球结膜下麻醉全部30眼麻醉效果理想,均顺利完成手术,且无因麻醉量不足或过量及麻醉手法等问题引起的术中或术后的并发症,球后麻醉30眼有1眼出现一过性黑矇,3眼出现球后出血,1眼术后眼睑青紫,经术中及术后对患者的处理及解释病情,均无大碍,也顺利完成手术。结论:三种麻醉方法中以表面麻醉联合球结膜下麻醉在小梁切除联合超声乳化人工晶状体植入术中最安全且有效,为青光眼白内障联合手术的首选麻醉方式。     

结膜下麻醉行小梁切除术治疗中晚期青光眼

目的分析球结膜下麻醉行小梁切除术治疗中晚期青光眼的优点。方法采用上方球结膜下、上直肌附着点处浸润麻醉行小梁切除术76例（89眼）。结果术中麻醉效果肯定，眼压稳定，基本无痛苦，手术均能顺利完成。术后无视功能丧失。结论术前、术中有效控制眼压、细心操作，上方球结膜下麻醉行小梁切除术治疗中晚期青光眼，避免小梁切除术常规球后或球周麻醉过程中较多潜在危险的并发症和毒副作用，是一种安全、有效的麻醉方法。     

改良式球周麻醉下行青光眼小梁切除术

目的评价改良式球周麻醉下行青光眼小梁切除术治疗青光眼的安全性和有效性。方法对418例596眼各类型青光眼采用改良式球周麻醉,行常规青光眼小梁切除术,观察麻醉效果及其并发症。结果408例患者(574眼)麻醉满意,患者能配合顺利完成手术,术中、术后未出现严重并发症。术后矫正视力提高2行以上333眼,视力不变220眼,视力下降43眼。术后眼压在9~15mmHg(1kPa=7.5mmHg)者489眼,16~21mmHg者88眼,21~25mmHg者19眼。结论改良式球周麻醉行青光眼小梁切除术安全性高,麻醉效果好,麻醉并发症少,是一种值得推广的麻醉方法。     

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.