Ⅱ期义眼座植入联合羊膜移植治疗眼窝内陷结膜囊狭窄

目的探讨Ⅱ期义眼座植入联合保存羊膜移植治疗眼球摘除和眼内容物剜除术后眼窝内陷伴结膜囊狭窄的手术方法及临床效果。方法对2001年4月至2004年4月收治32例眼内容物剜除术后(A组)和24例眼球摘除术后(B组)眼窝内陷结膜囊狭窄患者共56例行Ⅱ期义眼座植入联合保存羊膜移植手术。观察术后眼窝内陷矫正、结膜囊成形情况,义眼座活动度、有无眼座外露、感染,义眼配戴情况。随访10-18月。结果术后所有患者眼窝内陷明显好转,结膜囊成形良好,穹窿深浅正常,义眼配戴后无脱落,义眼活动度水平方向>5mm,垂直方向>3mm,A组30例(93.75%),B组10例(41.67%)两组比较,差异有显著性(P<0.05)。配戴义眼片3月后复诊B组2例(8.33%)出现义眼座外露。论结Ⅱ期义眼座植入联合保存羊膜移植是目前治疗眼球摘除术后出现眼窝内陷、结膜囊狭窄的理想方法。     

改良唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术

目的 探讨同期唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术的手术方法及临床效果。方法 对16例眼球摘除术后结膜囊缩窄患者行改良唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术，观察术后眼窝内陷矫正、结膜囊成形及移植唇粘膜愈合情况，义眼座有无外露、感染及活动度。结果 移植唇粘膜全部成活，眼窝内陷基本矫正，眼座无外露，患者满意。结论 改良有唇粘膜移植结膜囊成形联合Ⅱ期羟基磷灰石义眼座植入术是治疗眼球摘除术后眼窝内陷、结膜囊缩窄的理想方法。     

Ⅱ期眼窝凹陷及结膜囊狭窄的联合整复手术

目的 探讨眼球摘除或眼内容物剜出术后眼窝内陷伴结膜囊狭窄的同期整复手术方法及临床疗效。方法 对2007年8月至2010年5月收治35例患者施行Ⅱ期义眼座植入联合结膜囊成形术,其中7例结膜囊轻度缺损采用下、上穹窿结膜划开;23例结膜囊中度缺损采用异体巩膜;5例结膜囊重度缺损采用自体唇粘膜移植。所有病例结膜囊内眼模支撑,轻、中度组行睑缘临时缝合,术后1月拆线,自体唇黏膜移植组行部分睑缘粘连术,术后3个月分开眼睑,试装义眼。观察术后眼窝内陷矫正、结膜囊成形情况。随访3～6月。结果 术后所有患者眼窝内陷明显改善,结膜囊成形良好,穹窿深浅可,均可配戴适合的义眼,活动度可。结论 Ⅱ期义眼座植入联合结膜囊成形术是治疗眼球摘除或眼内容物剜出术后眼窝内陷伴结膜囊狭窄的理想手术。     

义眼座植入联合羊膜移植结膜囊重建术疗效观察

目的 观察义眼座植入联合羊膜移植结膜囊重建术的疗效.方法 对30例（30眼）眼窝凹陷合并Ⅰ、Ⅱ度结膜囊狭窄行义眼座植入联合羊膜移植结膜囊重建术.术后上下睑缘褥式缝合,3月后拆除眼睑缝线,定制义眼.结果 术后12眼Ⅰ度结膜囊狭窄全部治愈;18眼Ⅱ度结膜囊狭窄中15眼治愈,3眼好转.30眼均无义眼座暴露或感染等并发症,术后义眼座的活动度和外观较好.结论 眼窝凹陷合并Ⅰ、Ⅱ度结膜囊狭窄采用义眼座植入同期行羊膜移植术较安全有效.     

利用羊膜移植部分结膜囊成形术临床报告

目的 评价保存人羊膜移植治疗结膜囊狭窄的效果.方法 伴有结膜囊狭窄的眼球摘除术后综合征24例24眼,结膜缺损1.5 mm× 2.0 mm～1.8 mm×2.5 mm,在羟基磷灰石眼座Ⅱ期植入的同期,用保存人羊膜移植行结膜囊成形术.结果 24眼在术后22～30天移植的羊膜被结膜覆盖.结论 保存人羊膜移植治疗结膜囊狭窄取材方便,疗效显著,操作简单.     

羟基磷灰石义眼台Ⅱ期植入矫正重度眼窝内陷

目的探讨羟基磷灰石义眼台Ⅱ期植入术矫正眼窝重度内陷效果。方法对26例（26眼）眼球摘除或眼内容摘除术后半年至38年采用羟基磷灰石义眼台Ⅱ期眶内植入。结果眼窝重度内陷矫正术后外观良好。义眼活动度好,双眼相似,真假难辨。术后随访3～5年无排斥反应发生,未发现义眼台移位、脱出或眶内感染者。结论Ⅱ期眶内植入义眼台矫正眼窝重度内陷要根据眶内容积大小和结膜囊腔大小选择术式和合适的义眼台,并需要用异体巩膜固定在4条直肌附着处覆盖于义眼台表面,可以增加义眼活动度,并可防止义眼台排出。     

结膜囊狭窄98例治疗体会

目的 探讨眼球摘除术后眼窝凹陷及结膜囊狭窄患者的手术治疗方案及疗效.方法 收集1994年10月至2006年10月间行眼球摘除术后伴有眼窝凹陷和结膜囊狭窄的患者98例,先行羟基磷灰石(hydroxyapatite,HA)眼座二期植入,术后6个月再行全结膜囊成形术或部分结膜囊成形术.结果 术后随访6个月至2年,术后效果较好者61例(62.2%),表现为结膜囊深浅正常,义眼佩戴顺利,眼窝凹陷得到矫正.效果一般者32例(32.7%),结膜囊深度略浅,义眼能佩戴不滑脱,眼窝凹陷矫正.效果较差者5例(5.1%),表现为残留上眶区凹陷,结膜囊较小,不能佩戴义眼.结论 采取HA义眼座植入,待义眼座完全血管化并与机体融为一体,二期再行结膜囊成形术,因植床血供好,移植的黏膜或皮片易存活,是理想的治疗方法.     

口腔黏膜移植治疗义眼座植入术后重度结膜囊狭窄的疗效分析

目的:探讨口腔黏膜移植在HA眼座植入术后重度结膜囊狭窄成形术中的临床效果。方法:眼球严重损害同时伴重度结膜囊狭窄33例33眼者,先行羟基磷灰石义眼座植入,6mo后再行口腔黏膜移植全结膜囊成形术。结果:口唇黏膜31例移植成功,结膜囊成形良好,未见并发症,1例上睑下垂,1例结膜囊再狭窄。结论:对眼球严重损害伴重度结膜囊狭窄患者,可在羟基磷灰石义眼座植入后,以口腔黏膜Ⅱ期行结膜囊成形术,效果良好。     

异体巩膜移植治疗结膜囊狭窄17例临床观察

目的 观察异体巩膜移植治疗结膜囊狭窄的临床效果.方法 对17例眼球摘除术后无法安装义眼的结膜囊狭窄患者行异体巩膜移植结膜囊成形术.结果 术后随诊6月至2年,10例手术术后能安装成品义眼,2例结膜囊水平径偏短的患者能配戴定制义眼片,对合并有眼窝凹陷的5例患者均二期行羟基磷灰石义眼台植入并配置合适的义眼片.结论 异体巩膜用于结膜囊成形术是一种使用安全、方便、制备保存容易的生物材料.     

义眼座植入联合皮片移植术治疗眼窝凹陷Ⅲ度结膜囊狭窄

目的:为观察义眼座植入同时联合皮片移植术矫正眼窝凹陷并Ⅲ度结膜囊狭窄的疗效。方法:对32例(32眼)Ⅲ度结膜囊狭窄行义眼座植入同时联合皮片移植结膜囊成形术。结果:术后32眼Ⅲ度结膜囊狭窄全部治愈,均无义眼座暴露、感染、皮片坏死、伤口裂开等并发症,术后义眼座的活动度和外观较好,配戴义眼后患者满意,眼窝凹陷全部矫正。结论:眼窝凹陷合并Ⅲ度结膜囊狭窄采用义眼座植入同时联合皮片移植安全有效。     

超声乳化联合前房角分离治疗伴白内障的青光眼

目的：：观察晶状体超声乳化联合前房角分离术对伴有白内障的慢性闭角型青光眼患者的治疗效果。方法：无并发症伴有白内障的慢性闭角型青光眼50例50眼,施行晶状体超声乳化吸出人工晶状体植入联合前房角分离术。术后随访3mo,记录并比较术前及术后最佳矫正视力、眼压、前房深度及前房角。各指标均采用均数±标准差(x±s)表示,术前及术后3mo的最佳矫正视力、眼压、前房深度及前房角的情况进行比较。结果：术后3 mo的最佳矫正视力较术前明显提高,差异有统计学意义( t=8.76, P=0.001);术后3 mo 的眼压为15.63±3.11mmHg,较术前(45.12±5.30mmHg)明显下降,差异有统计学意义(t=6.27,P=0.000);术后3mo的前房深度为3.57±0.02mm,较术前(1.43±0.25mm)明显加深,差异有统计学意义(t=8.16,P=0.001);术前、术后前房角情况的比较,差异有统计学意义(Z=-4.432,P=0.000;Z=-2.432,P=0.016;Z=-4.379,P=0.000;Z=-4.538, P=0.000)。结论：晶状体超声乳化吸出人工晶状体植入联合前房角分离术治疗伴有白内障的慢性闭角型青光眼,能够有效控制眼压,提高视力,是一种安全、有效的手术方法。     

环喷托酯在屈光参差儿童散瞳验光中的应用

目的比较分析1%盐酸环喷托酯与1%阿托品对3~12岁屈光参差儿童散瞳验光效果。设计回顾性病例系列。研究对象2010年10月~2011年2月在北京同仁医院眼科斜弱视门诊就诊的3~12岁屈光参差儿童40例(80眼)。方法对以上40例患儿按年龄分成3组,即3~6岁组,7~9岁组和10~12岁组。全部患儿均首先用1%盐酸环喷托酯进行散瞳验光,待其瞳孔完全恢复正常(1周后)再行1%阿托品散瞳验光,比较两种方法的验光结果。主要指标屈光值(球镜度数、柱镜度数及轴向)。结果用1%盐酸环喷托酯散瞳验光结果(球镜:+1.18 D±4.90 D,柱镜:+1.47 D±1.16 D,散光轴向:80.50°±38.62°)与用1%阿托品散瞳验光结果(球镜:+1.20 D±4.91 D,柱镜:+1.47 D±1.15 D,散光轴向:80.06°±38.48°)比较,差异均无统计学意义(P均>0.05)。在80眼中,球镜值相同或相差≤0.50 D者77眼,符合率为96.25%;柱镜值在69眼中,结果相同或相差≤0.50 D者65眼,符合率为94.20%;散光轴向在69眼中,结果相同或相差≤5°者67眼,符合率为97.10%。三个年龄组间的球镜、柱镜和散光轴向符合率差异均无统计学意义(P均>0.05)。结论 1%盐酸环喷托酯可以替代1%阿托品用于3~12岁屈光参差儿童散瞳验光,其结果可以作为配镜的依据。     

滤过试验结合可拆缝线在小梁切除术中的应用

目的　探讨小梁切除术术中做滤过试验结合可拆缝线的应用对预测和控制术后滤过量及预防浅前房的疗效。方法　对 92例 ( 113眼 )原发性青光眼 ,在小梁切除术术中根据滤过试验结果来决定固定缝线和可拆缝线缝合的位置和数量。术后 1～ 7天 ,抽出可拆缝线。回顾性总结术中缝合种类、数量及术后前房深度、眼压、滤过泡、视野。结果　术中 40眼 ( 3 5 40 % )采用一针固定缝线和一至二针可拆缝线 ,5 1眼 ( 45 14 % )采用二针固定缝线和一至二针可拆缝线。术后无一例持续性浅前房。术后第 7天眼压平均 13 5± 3 3 0mmHg。追踪观察 6～ 2 4个月 ,形成功能性滤过泡 89眼( 78 76% ) ,眼压控制 <2 1mmHg 91眼 ( 80 5 3 % ) ,视野不变 98眼 ( 86 73 % )。结论　小梁切除术术中根据滤过试验的结果 ,通过对固定缝线和可拆缝线缝合的位置和数量的选择能有效预测和控制术后滤过量并预防术后浅前房     

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.     

合并成型性渗出的急性前葡萄膜炎与HLA-B27的相关性研究

目的 探讨急性渗出性前葡萄膜炎与HLA-B27的相关性。方法 对53例前房内出现成型性渗出的急性前葡萄膜炎（AAUPE）患者及61例前房内无成型性渗出的急性前葡萄膜炎（AAU）患者进行HLA-B27的检测,并结合临床表现加以分析。结果 成型性渗出的AAUPE患者的HLA-B27阳性率为100％,而无成型性渗出的AAU患者的HLA-B27阳性率仅为50.8％。二者有显著差异性（P<0.01）。两组HLA-B27阳性的病人强直性脊柱炎发生率分别为50.0％和42.9％。结论 结果进一步证实了HLA-B27与成型性渗出密切相关的论点。提示检测AAU患者HLA-B27的阳性率,发现成型性渗出裂隙灯检查似与血清法检测同样准确。     

小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的：观察小梁切除联合超声乳化白内障吸除术在原发性闭角型青光眼(包括急性闭角型青光眼与慢性闭角型青光眼)合并白内障患者中的临床治疗效果及对并发症的影响。

方法：选取2014-01/2016-07在我院诊治的青光眼合并白内障患者60例60眼,采用随机数字方法分为对照组(30例30眼)和观察组(30例30眼)。对照组采用小梁切除术治疗,观察组采用小梁切除联合超声乳化白内障吸除治疗,比较两组临床效果及并发症发生率情况。

结果：观察组术后视力与对照组相比差异无统计学意义(P>0.05); 观察组术后眼压水平低于对照组,差异有统计学意义(P<0.05); 观察组术后前房深度大于对照组,差异有统计学意义(P<0.05); 观察组术后并发症发生率为7%,显著低于对照组的23%,差异有统计学意义(P<0.05)。

结论：原发性闭角型青光眼合并白内障患者在小梁切除术基础上联合超声乳化白内障吸除术治疗效果理想,并发症发生率相对较低。     

Levodopa-carbidopa with occlusion in older children with amblyopia

PURPOSE: To study the role of levodopa-carbidopa in supplementing occlusion therapy in older children with strabismic or anisometropic amblyopia. Methods: A clinical study was performed on 40 amblyopic children (19 strabismic and 21 anisometropic), 6 to 18 years old (mean age, 10.9 years). They received an average dose of 1.86 mg/kg/day (1.33-2.36 mg/kg/day) of levodopa and carbidopa (4:1 ratio) or a placebo in 3 divided doses over a 4-week period, combined with full-time occlusion. The occlusion was continued for the study duration of 3 months. Early Treatment Diabetic Retinopathy Study visual acuity charts and Cambridge low-contrast gratings for contrast sensitivity (CS) were used to assess visual functions. Tolerance and compliance with occlusion and capsule consumption were assessed. RESULTS: Visual acuity of the nonamblyopic eye did not deteriorate during the study in either group. CS decreased by 22 units in the levodopa group and increased in the placebo group by 53 units at the first month. The CS in the levodopa group recovered later by the third month of follow-up. Both the levodopa and the placebo groups showed significant improvement in visual function in the amblyopic eye (P <.001). Overall changes in logarithm of minimum angle of resolution values and CS in the amblyopic eyes were similar in both groups (P >.05). Strabismic and anisometropic amblyopes did not behave differently. Drug tolerance, occlusion compliance, and capsule ingestion compliance were similar between the groups, with no significant side effects. CONCLUSIONS: Clinically, levodopa supplementation does not offer any advantage over occlusion alone. Moreover, the risk of occlusion amblyopia could increase with the use of drugs like levodopa that might affect the plasticity of the visual cortex.     

Phacotrabeculectomy with mitomycin C in patients with uveitis

PURPOSE: To evaluate the safety and efficacy of combined phacoemulsification, intraocular lens implantation, and trabeculectomy with mitomycin C for the management of uveitic complications. DESIGN: Retrospective case-control study. METHODS: We conducted a retrospective review of the records of 23 consecutive eyes with chronic noninfectious uveitis (uveitic group) and 43 nonuveitic eyes (control group) that had received primary phacotrabeculectomy. Mitomycin C was used in all the uveitic eyes. Considering the high preoperative intraocular pressure (IOP) of the uveitic group, nonuveitic eyes that had a preoperative IOP of >or=20 mm Hg or that had been given two or more medications were included in the control group. All patients were followed for at least one year. The main outcome measures were postoperative vision, IOP control, complications, and acute uveitis relapse rates. RESULTS: Visual outcome of the uveitic group was similar to the control group. In the uveitic group, the success rate of IOP control (91.3% at one year, 84.8% at two years) was favorable but was significantly lower than in the control group (P = .0423). Complications were comparable between the groups. Primary surgical failure in the uveitic group was associated with the postoperative acute uveitis attack. In the uveitic group, the acute uveitis attack rate showed no change after surgery (P = .283). CONCLUSION: With adequate inflammation suppression, phacotrabeculectomy with mitomycin C is an effective and safe therapeutic option for the management of secondary cataract and glaucoma in uveitic eyes. A lower surgical success rate of the uveitic group might be attributable to the postoperative inflammation recurrence.     

Epikeratoplasty with nonlyophilized tissue in children with aphakia

We studied 75 epikeratoplasty procedures using nonlyophilized tissue performed by eight ophthalmic surgeons in 70 eyes (47 patients) to correct for aphakia in children less than 8 years of age (mean age, 3.4 +/- 2.1 years). Of the 47 patients in the study, 24 were girls and 23 were boys; 23 patients had bilateral surgery. Seven of the epigrafts required removal; two were not replaced, and five underwent successful repeat epikeratoplasty. Overall, the success rate (that is, the percentage of epigrafts that remained optically and functionally clear throughout the course of this study) for the epikeratoplasty procedure was 89% (62 of 70 eyes) for initial surgery and 96% (67 of 70 eyes) for repeat surgery. The average spherical equivalent was +14.4 +/- 3.7 diopters preoperatively and +0.3 +/- 2.9 diopters one year after the operation. One year after the final surgical procedure, 42 of 56 eyes (75%) were within 3 diopters of emmetropia. In the 29 verbal patients, best-corrected visual acuity was 20/100 or better in 25 (86.2%) one year after the operation.