白内障术后继发后囊膜混浊激光治疗前后视功能的变化

目的:探讨白内障术后继发的后囊膜混浊(posterior capsule opacification,PCO)对患者视功能的影响及YAG激光治疗前后视功能的变化。方法:对57例(59眼)的患者于激光治疗前后进行视力检查,并主觉验光矫正视力;采用对比敏感度检测卡分别测试患眼和对侧眼的对比敏感度曲线;采用颜氏《立体视觉检查图》和Titmus立体视觉检查图检测患者的近距立体视锐度;采用王克长《色觉检查图》检测患者的色觉辨认功能。采用SPSS12.0统计软件进行统计分析比较。结果:激光治疗前患眼的平均视力为0.56±0.25,治疗后患眼平均视力为0.86±0.21。采取最小角度对数视力统计比较患眼治疗前LogMAR视力0.3103,较对侧眼LogMAR视力0.0707低下,差异有极显著性(t=7.63,P=0.000);治疗后患眼LogMAR视力0.0811较治疗前提高差异有显著性(t=7.076,P=0.000)。治疗前患眼各频区的对比敏感度值均较对侧眼显著低下,治疗后敏感度值明显提升较治疗前差异有非常显著性。治疗前44眼(75%)出现色觉异常,仅15眼(25%)辨色完全正常;治疗后31眼(53%)辨色完全正常,治疗前后的辨色能力差异有显著性。采用颜少明《立体视觉检查图》和Titmus立体视觉检查图检测显示,治疗前立体视缺失者分别为39例(68%)和19例(33%),具有正常立体视锐度者分别为3例(5%)和6例(11%);治疗后立体视缺失者降至11例(19%)和2例(4%),具有正常立体视锐度者达到22例(39%)和36例(63%),立体视的改善较之前差异有显著性。结论:白内障术后的后囊膜混浊不仅影响患眼的最佳矫正视力,还影响其对比敏感度值和色觉辨认,并可损伤患者的立体视功能。YAG激光后囊膜切开术是治疗PCO,恢复患者多项视功能的有效手段。     

人工晶状体后囊膜混浊激光治疗前后视功能的变化

目的探讨人工晶状体植入术后后囊膜混浊(PCO)对视功能的影响以及Nd:YAG激光治疗后的变化。设计前瞻性自身对照研究。研究对象接受超声乳化白内障摘除人工晶状体植入术57例(59眼)PCO患者。方法对57例(59眼) PCO患者行Nd:YAG激光治疗。于治疗前、后对患眼和对侧眼进行LogMAR视力、最佳矫正视力、对比敏感度、近距立体视锐度检查。主要指标 LogMAR视力、最佳矫正视力、对比敏感度、立体视锐度。结果激光治疗前患眼的平均LogMAR视力(0．22)及患眼各频区的对比敏感度值均较对侧眼显著低下;治疗后有明显提高(LogMAR视力0．00)。治疗后立体视阳性比率和达到中心立体视的比率,以及平均立体视锐度值均较治疗前有显著性改善。治疗后立体视锐度仍未达到正常者与最佳矫正视力低常、屈光参差及原有眼病有关。结论 PCO不仅影响患眼视力和对比敏感度,也影响立体视功能。Nd:YAG激光后囊膜切开术是治疗 PCO、恢复患者视力和重建正常立体视功能的有效手段。     

掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法

目的探讨对比敏感度和眩光敏感度检查在晶状体后囊膜混浊(posterior capsule opacification, PCO)患者视功能评价中的意义,为掺钕钇铝石榴石(neodymium-yttrium aluminum garnet,NdYAG)激光治疗晶状体PCO提供视功能评价方法.方法对67例(73只眼)超声乳化白内障吸除人工晶状体植入术后晶状体PCO患者行NdYAG激光晶状体后囊膜切开术,分别于手术前、后进行视力、对比敏感度和眩光敏感度检查,并加以分析.NdYAG激光晶状体后囊膜切开术采用环形切开向后翻转法,晶状体后囊膜瓣直径为5 mm,平均单次脉冲能量为(2.93±0.63) mJ,平均脉冲次数为(19.09±8.63)次,平均总能量为(57.47±36.05) mJ.术后平均随访时间(14±6)个月.结果术后视力、对比敏感度和眩光敏感度均较术前明显提高,差异有非常显著意义(P＜0.01).术前矫正视力≥0.8的16只眼手术前、后最佳矫正视力比较,差异无显著意义(P＞0.05);不同视角的对比敏感度和眩光敏感度比较,差异均有显著意义(P＜0.05).术前不同视力患者各频段的对比敏感度比较,差异均无显著意义(P＞0.05).术前不同视力患者低频段和中频段眩光敏感度间差异有显著意义(P＜0.05),高频段眩光敏感度间差异无显著意义(P＞0.05).术前晶状体后囊膜2级混浊者不同频段的平均对比敏感度和眩光敏感度与1级混浊者比较,差异均有显著意义(P＜0.05).NdYAG激光晶状体后囊膜切开术中人工晶状体出现激光损伤斑者5只眼(6.8%),术后无高眼压、黄斑囊样水肿、视网膜脱离和人工晶状体移位等并发症发生.结论对比敏感度和眩光敏感度检查可灵敏、全面反映晶状体PCO患者的视功能状态,可成为确定NdYAG激光晶状体后囊膜切开术手术时机和评价手术疗效的方法.     

中心性浆液性脉络膜视网膜病变患者诸项视功能检测及评估

目的分析探讨中心性浆液性脉络膜视网膜病变(简称中浆)患者病愈前后诸项视功能的受损特点和恢复情况。方法对25例中浆患者进行视力检测,并采用Amsler卡、色觉检查图、FACT对比敏感度测试卡和双眼影像不等检查图,分别检测患者的中心暗点和变形、辨色能力、对比敏感度和双眼同时视像差;并采用Titmus立体视检测卡、立体视觉检查图和同视机随机点立体画片检测患者的立体视功能,以远近6项指标均达到标准者则视为立体视功能正常。病变痊愈后重复上述检查。结果①患眼平均视力为4.80±0.17,对侧眼平均视力为5.08±0.08,两眼平均视力差异有极显著性(P<0.001)。痊愈后患眼平均视力为5.05±0.07,较病愈前差异有极显著性(P<0.001)。②Amsler卡检查24只患眼(占96.0%)有中心暗点和视物变形,病愈后4只眼(占16.0%)仍遗留轻度变形。③色觉检查14只患眼(占56.0%)辨色异常,其中以蓝紫色异常最明显;病愈后5只眼遗留(占20.0%)轻度蓝紫色弱。④患病期间双眼同时视像差平均为(2.80±1.87)%;病愈后平均像差为(0.42±0.48)%。⑤患病期间患眼各频段的对比敏感度值均较对侧眼下降,差异有极显著性(P<0.001)。病愈后患眼各频段敏感度值均达到正常范围,较患病时差异有极显著性,但仍较对侧眼低,在中高频区差异有显著性(P<0.05)。⑥Titmus立体图检测1例(占4.0%)患者无立体视,14例(占56.0%)立体视异常,10例(占40.0%)具有正常立体视。病愈后1例(占4.0%)患者立体视异常,余24例(占96.0%)为正常立体视。⑦采用立体视觉检查图和同视机随机点立体画片检测立体视功能,6项指标均正常者3例(占12.0%),余22例(占88.0%)患者均异常;病愈后20例(占80.0%)患者的6项立体视功能恢复正常,5例(占20.0%)仍异常。病愈前后的Amsler卡、辨色能力、同时视像差、对比敏感度以及立体视觉各项视功能等项检查结果差异均有显著性(P<0.01)。结论中浆患者视功能损害的表现是多方面的,其机制亦较复杂,有些功能在病愈后仍遗留轻度异常,因此仅凭视力检测不能确切反映患者视功能损害程度和恢复情况。     

白内障手术前后视功能及生存质量的改变

白内障即晶状体的混浊导致光线不同程度的散射增加,进而引起对比敏感度变差,视力下降,立体视等视功能的受损,从而患者主观感觉变差,日常生活能力受限;本文就引起视功能改变的相关因素,以及患者术前、术中及术后的视功能(视力、对比敏感度、立体视等)、主觉症状的改变(色觉、眩光、光晕等)做一综述。     

真性小眼球白内障患者的手术疗效观察

目的观察手术治疗真性小眼球白内障的疗效。方法对7例(12只眼)真性小眼球白内障患者施行超声乳化白内障吸除联合人工晶状体植入术,术后随访时间3~48个月。结果术后所有患眼最佳矫正视力均较术前显著提高,其中11只眼最佳矫正视力大于0.1,2只眼最佳矫正视力达0.3以上;无人工晶状体异位及夹持;手术并发症包括术后2只眼角膜内皮水肿,7只眼术后出现不同程度的后囊膜混浊,3只眼行YAG激光后囊膜切开术。无其它严重并发症发生。结论手术能够安全有效地提高真性小眼球合并白内障患者的视力。     

Bigbag人工晶状体在屈光晶体置换术中的临床应用

目的 评价三襻式Bigbag人工晶状体在高度近视屈光晶状体置换术中的临床效果.方法 对53例80只眼高度近视伴或不伴晶状体混浊,施行屈光晶状体置换术,其中单眼高度近视19例,双眼高度近视因近视力低于0.1,选择近视力及矫正视力较好的单眼进行手术的7例,双眼手术的27例,全部行超声乳化吸出植入低度数或负度数亲水性丙烯酸酯折叠Bigbag人工晶状体,观察术中和术后并发症.观察手术前后最佳远视力(VA),最佳矫正视力(BCVA),近视力(NVC),眼轴长度,屈光状态,术后随访6月～1年.结果 术后56只眼(占70％)裸眼视力≥0.3,46只眼(占57.5％)裸眼视力≥0.5,6只眼(占7.5％)裸眼视力≥0.8,≤0.3有24只眼(占30％),除2例(占3.7％)术前裸眼近视力≤0.1,术后视力无改善外,其余病人均较术前最佳矫正视力提高.术中因撕囊口偏小,植入人工品状体后囊破裂人工晶状体偏位1例,其余病例人工晶状体与后囊膜紧贴,后囊膜未见皱褶,人工晶状体固定良好.结论 通过详细术前检查,超声乳化吸出植入低度数或负度数Big bag人工晶状体,完成屈光晶状体置换手术安全有效,视觉质量好,不仅降低了后囊膜皱褶,后发性白内障,稳定囊袋,同时也减少了视网膜脱离的风险.     

非球面人工晶状体术后视功能评估

目的 评估植入人工晶状体前表面非球面修饰的TecnisZ9003(AMO)术后视功能是否优于传统的球面人工晶状体(Acrosof Natural,Alcon).方法 随机选择8例白内障手术患者,1只眼植入Z9003 IOL,另眼植入Acrysof Natural SN6OATIOL.术后1周和1月,行对比敏感度检查、眩光检查和像差仪检查,分别评价术后视功能.结果 两组间平均术前和术后球镜、柱镜度及最佳矫正视力无统计学意义.对比敏感度(明亮光下)术后1周没有明显不同,术后1月植入TecnisZ9003 IOL眼在所有空间分辨率下均优于对侧眼,尤其在3,6cpd下差异有统计学意义.眩光检查两组间没有差别.像差仪检查显示术后1周、1月植入TecnisZ9003IOL眼的球差明显小于对侧眼.结论 临床结果证实白内障术后的球差可以通过植入非球面修饰的人工晶状体所消除.这样可以明显提高对比敏感度和功能视力.     

Q开关Nd:YAG激光治疗后囊膜混浊

目的:探讨Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊的疗效及安全性。方法:回顾性分析行Q开关Nd:YAG激光后囊膜切开术后囊膜混浊患者165例(193眼),记录手术前后视力、眼压及并发症,并进行统计学分析。结果:①后囊膜一次性切开成功率为100%,所用激光脉冲数平均24±21.7次,激光总能量4~451mJ;②91.2%(176眼)视力较术前提高;③59.6%(115眼)出现一过性眼压升高;手术前后眼压变化与是否植入人工晶状体、所用激光脉冲数以及白内障手术与后囊膜切开术间隔时间有关;④19.3%(32眼)出现人工晶状体损伤。结论:Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊安全、有效,但应严格掌握适应证,并合理选择激光参数。     

经睫状体平坦部切口行晶状体后囊膜切开术治疗后发性白内障

目的探讨经睫状体平坦部切口行晶状体后囊膜切开术治疗后发性白内障的临床价值。方法对因白内障人工晶体植入术后的后发性白内障患者73例80眼行经睫状体平坦部切口的晶状体后囊膜切开术。结果术后视力均好于术前并达到或超过了白内障人工晶体植入术后后发性白内障发生之前的视力。术后的平均视力为0.72±0.36,80眼中有62眼(77.5%)的矫正视力达0.5以上,其中有25眼(31.25%)达1.0以上。结论经睫状体平坦部切口行晶状体后囊膜切开术是治疗后发性白内障的一种简便、安全、有效的方法,特别适用于广泛的基层医院。     

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.