PRK切削中心偏离的临床观察

为研究准分子激光屈光性角膜切削术（ＰｈｏｔｏｒｅｆｒａｃｔｉｖｅＫｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）切削中心偏离对角膜散光与欠矫的影响。对ＰＲＫ术后２１０眼行角膜地形图检查后发现，ＰＲＫ切削偏心小于０５０ｍｍ者为３７２％，０５０～１００ｍｍ者为５３３％，１０ｍｍ以上者为９５％，切削偏心平均为０７６ｍｍ，欠矫平均为１４１Ｄ，散光无明显改变。切削偏心能直接导致欠矫的发生，但对角膜散光无明显影响，减小偏心可以避免欠矫的发生。     

准分子激光屈光性角膜切削术后的再治疗

目的 评价准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅ ｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）术后因屈光回退,欠矫出现的残留近视及严重角膜上皮下雾状混沌（ｈａｚｅ）而再次手术治疗的疗效及安全性。方法 采用准分子激光仪对－１．００～－１６．５０Ｄ的近视眼及近视散光患者进行治疗。ＰＲＫ术后３５例（５１只眼）患者出现残留近视及严重ｈａｚｅ。结合ＰＲＫ手术及准分子激光治疗性角膜切削术（ｐｈｏｔｏｐ     

准分子激光屈光性角膜切削术（PRK）的副作用

准分子激光屈光性角膜切削术（ＰＲＫ）的副作用上海医科大学金山医院眼科周晓东，李军，许涛，张颂东综述汪芳润审校屈光性角膜成形术，其中如准分子激光屈光性角膜切削术（ｅｘｃｉｍｅｒｌａｓｅｒｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）近年...     

准分子激光角膜切削深度与术后角膜上皮下雾状混浊的关系

目的研究准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后角膜上皮下雾状混浊（ｈａｚｅ）与角膜切削深度之间的关系。方法选择治疗条件基本相同，对双眼同时接受ＰＲＫ治疗的３１例（６２只眼）近视性屈光参差（平均４．９７Ｄ）患者进行前瞻性自身对照研究，将高近视度数眼（－１４．１０±４．１７Ｄ）作为治疗组，低近视度数眼（－９．１３±３．５３Ｄ）作为对照组，术后随访６～１２个月，平均１０个月。结果术后两组的角膜上皮下雾状混浊程度经统计学分析差异有显著性（Ｐ＜０．０５）。结论准分子激光角膜切削术治疗近视，矫正度数越高，角膜切削越深，术后发生角膜上皮下雾状混浊的危险性则越大。     

准分子激光屈光性角膜切削术后并发症3例报告

准分子激光屈光性角膜切削术后并发症３例报告解放军第３７１医院眼科（河南新乡市４５３０００）郑晓龙准分子激光屈光性角膜切削术（ＰｈｏｔｏｒｅｆｒａｃｔｉｖｅＫｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）治疗近视安全、可靠、精确度高，但术后可出现角膜混浊、角膜上皮糜烂...     

影响准分子激光屈光性角膜切削术后眼压的因素

目的分析影响准分子激光屈光性角膜切削术（ｅｘｃｉｍｅｒｌａｓｅｒｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）术后眼压的因素。方法采用非接触式眼压计（ｎｏｎｃｏｎｔａｃｔｔｏｎｏｍｅｔｒｙ,ＮＣＴ）测量眼压,对ＰＲＫ前、后随访半年以上８６例（１５０只眼）患者眼压差与角膜切削厚度、术前术后角膜曲率差之间进行多元回归分析。结果术前眼压明显高于ＰＲＫ术后１周、３及６个月的眼压,差异有非常显著性（ｔ检验,Ｐ＜０．０１）,与术后１个月时眼压比差异无显著性（Ｐ＞０．０５）。术后１个月时的眼压高于术后其他时间眼压（Ｐ＜０．０１）。ＰＲＫ后眼压降低与角膜厚度减少及角膜前表面曲率的降低有关（ｒ＝０．３６１,Ｐ＜０．０１;ｒ＝０．１８８,Ｐ＜０．０５）,建立二元回归方程如下：Ｙ＝－０．０５９－０．０３８Ｘ１＋０．００９Ｘ２。Ｙ：术前术后眼压差（ｋＰａ）,Ｘ１：术前术后角膜曲率差（Ｄ）,Ｘ２：角膜切削厚度（μｍ）。结论ＰＲＫ后ＮＣＴ测量眼压低于术前,术后眼压与氟甲脱氧泼尼松龙（ｆｌｕｏｒｏｍｅｔｈｏｌｏｎｅ）的用药次数和时间、角膜切削厚度、角膜曲率有关。     

放射状角膜切开术后残余近视眼的准分子激光角膜切削术

目的探讨准分子激光角膜切削术（ＰＲＫ）矫治放射状角膜切开术（ＲＫ）后残余近视眼的安全性与有效性。方法应用ＣＨＩＲＯＮ公司ＴｅｃｈｏｌａｓＫｅｒａｃｏｒｌ１６型准分子激光机对１６例（２１只眼）ＲＫ后残余近视眼施ＰＲＫ，应用计算机辅助的角膜地形图对手术的有效性与安全性作客观评估。结果１６例（２１只眼）经ＰＲＫ后，裸眼视力提高４～１０行（平均７．５行）；等效球镜的屈光度下降２．５０～６．００Ｄ（平均４．７５Ｄ）；所有术眼的角膜地形图提示角膜中央呈规则圆形变扁区，角膜中央３ｍｍ直径的屈光力平均下降４．２５Ｄ。随访期内（１ａ）所有术眼无明显并发症。结论ＰＲＫ是矫治ＲＫ后残余近视眼安全有效的方法     

准分子激光角膜切削中心的角膜地形图分析

目的探讨准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）的切削中心对视功能的影响。方法采用Ｅｙｅｓｙｓ角膜形态分析系统对随访６个月以上的９８例（１５８只眼）ＰＲＫ前、后１０天的角膜地形图进行分析，确定激光切削中心相对入射瞳孔中心的方向、距离；比较单区和多区域激光切削的偏中心差异。结果切削区中心相对入射瞳孔中心：０～０．５ｍｍ者１００只眼（６３．３％），０．５～１．０ｍｍ者５５只眼（３４．８％），＞１．０ｍｍ者３只眼（１．９％），平均０．４５ｍｍ。多区域切削３８只眼及单区域切削１２０只眼，其偏心量分别为０．５５ｍｍ和０．４４ｍｍ。差异有显著性（ｔ检验，Ｐ＜０．０５）。偏中心切削致术后最好矫正视力下降１～２行者４只眼，其偏心量＞０．５ｍｍ。结论严重的偏心切削将影响术后视功能恢复，术中眼球跟踪系统（ｐａｓｓｉｖｅｅｙｅ－ｔｒａｃｋｉｎｇ，ＰＥＴ）的应用有利于切削中心的确定，减少偏心量。     

准分子激光角膜切削术治疗低、中度近视术后五年疗效分析

目的评价准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｏｍｙ,ＰＲＫ）治疗低、中度近视的远期疗效。方法对１４８只眼屈光度为－１５０～－６００ＤＰＲＫ术后５年以上患者的视力、屈光度及角膜曲率进行随访观察。结果ＰＲＫ术后５年未矫正视力≥１０者１３６只眼（９１９％）,０８者４只眼（２７％）,≥０６者８只眼（５４％）。术后等值球镜（－０１２±０２２）Ｄ,角膜曲率Ｋ值术前（４３８１±１１０）Ｄ,术后（４１３６±１３０）Ｄ两者间比差异有显著性（Ｐ＜００１）。结论ＰＲＫ治疗低、中度近视的远期疗效可靠。     

准分子激光角膜切削术后屈光回退伴角膜雾浊再次手术疗效

近视眼准分子激光角膜切削术（ｐｈｏｔｏｒｅ－ｆｒａｃｔｌｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后，部分病例存在远期屈光回退、角膜雾浊（Ｈａｚｅ）影响疗效。我院ＰＲＫ中心于１９９６年８月～１９９７年２月对６例８眼ＰＲＫ术后屈光回退伴角膜Ｈａｚｅ病例行再次ＰＲＫ治疗，效果满意，总结报道如下。１材料与方法１．１临床资料８眼病例为我院ＰＲＫ中心治疗后随访１１．２±１．４ｍｏ出现屈光回退伴角膜Ｈａｚｅ的近视眼患者，男６眼，女２眼，年龄２４．０±４．０６ａ（１９～４０ａ）。首次ＰＲＫ术前平均等值球镜屈光度为一…     

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.