眼用胶封闭滤过术后结膜瓣破口临床观察

眼用胶封闭滤过术后结膜瓣破口临床观察河北峰峰矿务局第二医院眼科张孟祥抗青光眼术后，由结膜瓣破损或切口愈合不良等原因，以致房水渗漏过强，造成持续性课前房或无前房形成，是滤过术后常见并发症之一，一旦发现应尽早治疗。以往常需局部加压包扎防止渗漏或手术修复缝...     

结膜瓣掩盖术治疗难治性角膜溃疡

目的观察结膜瓣掩盖术治疗难治性角膜溃疡的临床和效果。方法46例（47眼）行病灶清创和结膜瓣掩盖术治疗,术后针对原发病进一步行药物治疗。结果45眼一次手术治愈角膜溃疡,2眼术后结膜瓣后退,再次行结膜瓣掩盖加1／3睑裂缝合术。45眼（78．72％）角膜溃疡清创和结膜瓣掩盖成功,8眼（17．02％）角膜溃疡大部分愈合。结论结膜瓣掩盖术对于药物治疗无效的难治性角膜溃疡是有效的治疗方法。为后期角膜移植创造了有利条件。     

复合式小梁切除术中采用角巩膜缘后界1mm结膜切口的疗效观察

目的：观察改良的角巩膜缘后界1mm结膜切口在复合式小梁切除术的临床疗效。

方法：回顾性分析原发性青光眼171例220眼,根据结膜瓣切口不同及缝合方法不同,分为三组,A组采用传统的角巩缘切口33例44眼,B组采用角巩缘后界1mm结膜切口76例94眼,C组采用B组结膜切口基础上连续缝合结膜瓣62例82眼,随访1a。观察术后眼压、滤过泡、前房深度、结膜切口有无渗漏,并进行组间比较三组的临床效果。

结果：术后切口漏水、浅前房发生A组>B组>C组,具有统计学意义(P<0.05),手术成功率94.5%,术后眼压控制和滤过泡形态无明显区别。

结论：角巩膜缘后界1mm结膜切口制作结膜瓣,同时采用结膜切口连续缝合,愈合快,发生结膜切口漏水明显减少,显著能提高复合式小梁切除术的成功率。     

角膜全结膜瓣遮盖术式探讨

报告眼球萎缩及先天性小眼球１０例１０只眼行角膜上皮去除全结膜瓣遮盖术，９例９只根均获满意结果，结膜瓣一期愈合，上窝饮满，义眼活动好，１例术后４天结膜瓣裂开，７天 至角膜缘。产吩眼球萎缩及先天性小眼球患者可保留眼球，行角膜全结膜瓣遮盖术，安装义眼，改善外观。本文讨论了角膜全结膜瓣盖手术的关键步骤，手术的适应证，禁忌证及相关手术的比较。     

荷包状改良结膜瓣遮盖术治疗难治性角膜溃疡

目的：观察采用荷包状改良结膜瓣遮盖术治疗难治性角膜溃疡的临床疗效。 方法：对36例36眼药物治疗无效的难治性角膜溃疡患者进行病灶清除+荷包状改良结膜瓣遮盖术治疗,术后针对病因行进一步药物治疗。随访3～6mo。 结果：1次手术治愈35眼。1眼术后结膜瓣中央部位松解未能紧贴角膜,再次同法行结膜瓣遮盖术并联合羊膜移植,最终角膜溃疡愈合。36眼全部治愈。 结论：对于药物难治性角膜溃疡,荷包状改良结膜瓣遮盖术能有效抑制炎症反应,更好的保存眼球。     

结膜瓣遮盖术治疗真菌性角膜溃疡

目的 探讨结膜瓣遮盖术治疗真菌性角膜溃疡的效果.方法 16例（16眼）药物不能控制的真菌性角膜溃疡施行结膜瓣遮盖术治疗.术后观察角膜溃疡愈合情况,视力等改变.随访3月～3年.结果 16眼均一次治愈,表现为角膜溃疡愈合,前房积脓吸收,视力稳定或提高.结论 结膜瓣遮盖术是一种简单、有效的治疗真菌性角膜溃疡的方法.     

用颊黏膜重建复杂性渗漏滤过泡

滤过泡渗漏发生率约2．5％～10％，辅助应用丝裂霉素C者更易发生。术后早期渗漏与切口愈合较差或缝合技术不佳有关，手术2个月以后发生的晚期渗漏常需手术修复治疗。手术修复滤过泡渗漏常用局部结膜（前移或带蒂结膜瓣）重建滤过泡，有时可用游离自体结膜移植或羊膜移植治疗。     

两种结膜瓣式小梁切除术的比较

目的：比较两种结膜瓣式小梁切除术的临床效果。

方法：将我院132例148眼行青光眼小梁切除术的原发性青光眼的患者分为以角膜缘为基底的结膜瓣(A组)64例72眼和以穹隆部为基底的结膜瓣(B组)68例76眼两组,术后随访6～12mo,观察眼压、滤过泡、前房深度及术中术后并发症。

结果：两种术式在术后成功率及术后降眼压效果上无明显的统计学差异。以穹隆部为基底的结膜瓣(B组)能得到更理想的滤过泡。以角膜缘为基底的结膜瓣(A组)表现出更多的并发症,如晚期滤过泡渗漏、低眼压等。

结论：以穹隆部为基底的结膜瓣(B组)优于以角膜缘为基底的结膜瓣(A组)。     

复合式小梁切除术两种不同结膜切口的比较

目的:探讨角巩缘结膜切口和角巩缘后界1mm结膜切口施行复合式小梁切除术的临床疗效。方法:原发性青光眼43例(51眼),随机分为2组,分别采用角巩缘切口和角巩缘后界1mm切口做结膜瓣,观察术后眼压、滤过泡、前房深度,结膜切口有无渗漏,并进行统计学比较。结果:角巩缘后界1mm结膜切口术后切口漏水、浅前房明显少于角巩缘切口,术后眼压控制和滤过泡形态无明显区别。结论:角巩缘后界1mm结膜切口术后结膜漏水发生少,切口愈合快。     

改进结膜瓣缝合预防小梁切除术后结膜瓣渗漏的发生

0引言小梁切除术是使房水经滤过道聚集于结膜下形成滤过泡,而后经结膜淋巴管吸收。因此结膜瓣渗漏可引起低眼压、浅前房、黄斑水肿、滤过泡感染和眼内炎等并发症发生。我科2000-03/2007-03改进结膜瓣缝合预防小梁切除术后结膜瓣渗漏的发生,取得了良好的效果,现报道如下。1临床资料我科于2000-03/2007-03共收治青光眼128例144眼。其中男50例58眼,女78例86眼。年龄37~80(平均62.5)岁。急性闭角型青光眼82例88眼,慢性闭角型青光眼30例36眼,开角型青光眼16例20眼。按就诊次序随机分成两组:A,B组。术前眼压均降至21mmHg(1mmHg=0.133kPa)以下。所     

青光眼小梁切除术后低眼压浅前房的临床分析

目的分析青光眼小梁切除术后低眼压浅前房的原因和处理。方法回顾性总结2006年1月至2010年4月在我院住院的行小梁切除术闭角型青光眼患者94例110眼发生低眼压浅前房的常见原因和处理探讨。结果 94例110眼小梁切除术后发生浅前房21眼,发生率为19.09%,眼压8mmHg至测不出,时间术后1-5天。其中滤过过畅9眼,42.86%,结膜瓣渗漏6眼,28.57%,脉络膜脱离6眼,28.57%。通过保守治疗19眼,手术治疗2眼。结论闭角型青光眼行小梁切除术,术后浅前房的发生率高,常见原因滤过过畅,脉络膜脱离和结膜瓣渗漏。大部分患者通过保守治疗治愈。     

两种瓣式小梁切除术后辅助眼球按摩对形成功能性滤过泡的影响

目的:比较穹隆部为基底的球结膜瓣和角膜缘为基底的球结膜瓣在青光眼复合式小梁切除术后辅助眼球按摩治疗对形成功能性滤过泡的影响。方法:将51例61眼原发青光眼并接受复合小梁切除术患者随机分成两组:A组26例31眼以角膜缘为基底的球结膜瓣;B组25例30眼以穹隆部为基底的球结膜瓣。术后观察两组患者眼压、滤泡、前房深度,并根据情况适时辅助眼球按摩治疗。全部患者术后观察6mo。结果:两种结膜瓣的复合式小梁切除术均有显著降眼压效果(P<0.01);功能性滤过泡的形成率也无统计学差异(P>0.05);术后早期眼球按摩促进滤泡形成中出现被动性滤泡渗漏B组多于A组。结论:两种结膜瓣的复合小梁切除术治疗青光眼都有相同良好的效果。眼球按摩可促进形成功能性滤过泡。角膜缘为基底球结膜瓣的复合小梁切除术后眼球按摩治疗不易出现被动性滤泡渗漏。     

青光眼复合式小梁切除术后浅前房原因及治疗

目的分析青光眼复合式小梁切除术后浅前房发生的原因和治疗效果。方法回顾性分析我院青光眼复合式小梁切除术后浅前房37例（38眼）的原因及治疗效果。结果青光眼复合式小梁切除术683眼中术后发生浅前房38眼（5．56％）。分析其原因主要为滤过过强18眼,结膜瓣渗漏3眼,脉络膜脱离11眼,睫状环阻塞性青光眼5眼,其他原因1眼。治疗采用的药物：睫状肌麻痹剂、高渗剂、皮质类固醇等和／或手术,包括：结膜瓣修补术,玻璃体抽液联合前房注气术等,32眼经过药物治疗前房形成,6眼药物治疗无效通过手术治疗后前房形成。结论38眼复合式小梁切除术后浅前房84．22％的术后浅前房可以通过药物形成前房,只有15．78％需要手术治疗。     

薄壁囊状滤过泡的结膜瓣加固术

目的　探讨改良转移结膜瓣对矫正青光眼小梁切除术后薄壁囊状滤过泡的临床效果。方法　剪开滤过泡周围的结膜（保留原滤过泡）,游离转移上方或颞侧球结膜-筋膜组织,加固覆盖于经局部冷冻的变性囊状泡表面,转移结膜瓣的前缘固定缝合于周边角膜的槽状浅沟内。转移结膜瓣不够松弛时,在穹窿部做一减张性球结膜-筋膜组织切开。结果　46例（52只眼）术后随访6个月至4年,平均眼压由术前（4.25±1.33）mmHg（1mmHg=0.133kPa）提高至术后（12.98±5.70）mmHg,差异有显著性（t=3.26,P<0.01）。51只眼仍保留滤过功能,20只眼的结膜渗漏和6只眼的黄斑水肿消失,术后视力较术前有明显改善（χ     

Novel tissue adhesives to secure laser in situ keratomileusis flaps

PURPOSE: To evaluate 2 novel biodendrimer tissue adhesives in sealing and securing laser in situ keratomileusis (LASIK) flaps. SETTING: Duke University Eye Center, Durham, North Carolina, USA. METHODS: Laser in situ keratomileusis flaps were created in 10 human eye-bank eyes using the Hansatome microkeratome system (Bausch & Lomb). These eyes were divided into 2 groups. Flaps in the first group (n=4) were secured with a laser-activated biodendrimer adhesive along the flap edge. In the second group (n=6), the flaps were secured with a self-gelling dendritic adhesive. Dry Merocel sponges (Medtronic Solan) were used to test the strength of flap adherence in both groups. Further testing was performed in the second group. The hinges of these flaps were cut with a scalpel blade and fluorescein dye was injected under the flap to observe potential dye leakage along the flap edge. RESULTS: Laser in situ keratomileusis flaps sealed with both adhesives were secure with no flap dislocation. There was no leakage of fluorescein dye observed in the second group. Both adhesives were easy to apply, clear when dry, and had a soft rubbery consistency. CONCLUSIONS: Two novel biodendrimer adhesives successfully sealed and secured LASIK flaps. These adhesives may prove to be an effective alternative for treating LASIK flap complications such as epithelial ingrowth or flap dislocation.     

Two-site phacotrabeculectomy with intraoperative mitomycin-C: fornix- versus limbus-based conjunctival opening in fellow eyes

To prospectively compare the influence of fornix-based and limbus-based conjunctival flaps on the final outcome and complications of 2-site phacotrabeculectomy with mitomycin-C in fellow eyes of patients with bilateral open-angle glaucoma (OAG).Glaucoma Unit, Department of Ophthalmology, University of Crete, Crete, Greece.Twenty-two patients with bilateral primary OAG and 8 patients with bilateral exfoliative glaucoma had 2-site phacotrabeculectomy in both eyes. Eyes were randomly assigned to the fornix-based flap or limbus-based flap group by the use of random tables.The intraocular pressure (IOP) decreased significantly in both groups (P <.01); however, there was no statistically significant difference between the groups in the amount of IOP decrease or the number of postoperative antiglaucoma medications after a 1-year follow-up. Faster improvement in visual acuity was observed in the fornix-based group during the first week. The mean time of surgery was 3.5 minutes less in the fornix-based group. An increased incidence of fibrin exudation, pupillary membrane formation, and capsule opacification was found in eyes with exfoliative glaucoma. The early bleb leakage was 3 times more frequent in the fornix-based group.The type of conjunctival flap in a 2-site phacotrabeculectomy did not seem to influence the final outcome. The main advantage of the fornix-based conjunctival flap is the shorter surgical time and the relatively faster improvement in vision postoperatively. The main disadvantage is more frequent early bleb leakage.     

保留眼球的眶周侵袭性恶性肿瘤切除及修复

目的　总结保留眼球及个体化皮瓣修复用于治疗眶周侵袭性恶性肿瘤的手术治疗效果及预后。方法　回顾性分析2007年3月至2016年3月我院收治的14例（14眼）眼睑及眼眶侵袭性恶性肿瘤,手术完整切除肿瘤,残留结膜或皮瓣覆盖眼球,个体化皮瓣修复缺损,对该手术治疗方法的效果进行分析。结果　14眼中眼睑基底细胞癌3眼,鳞状细胞癌4眼,皮脂腺癌6眼,横纹肌肉瘤1眼。14例恶性肿瘤均完整摘除,1例治疗20个月后死亡,1例复发性横纹肌肉瘤放弃继续治疗,1例术后放疗后无光感,皮肤溃疡角膜暴露,其余患者随访2~5 a均无复发,创面愈合良好,皮瓣下眼球运动良好,光感存在。结论　眶周侵袭性恶性肿瘤较为罕见,肿瘤扩大性切除后可以采取保留眼球的手术方式,并根据缺损范围选择合适的皮瓣修复,可以减少创伤,简化手术操作,保留一定外观。血管吻合皮瓣修复应慎重应用于该类侵袭性肿瘤患者中。     

青光眼常规小梁切除术结膜瓣大小对手术效果的影响

目的:探讨青光眼常规小梁切除术中结膜瓣大小对降压效果及术后并发症的影响。方法:对10例已确诊双眼慢性闭角型青光眼的患者行常规小梁切除术+虹膜周切术,均做以穹窿为基底的结膜瓣,术中不用抗代谢药物。1眼做底边长10mm,高6mm等边三角形结膜瓣,另1眼做边长10mm,高6mm矩形结膜瓣(实际面积相当于前眼的两倍),其余手术步骤一致。于术后2d开始,每日测量眼压(非接触式眼压计),裂隙灯检查前房至术后7d拆线。分别于术后0.5,1,3mo复查。结果:患者10例扩大结膜瓣眼于术后全部发生浅前房,对侧无1例发生。其中1级浅前房5例,2级浅前房4例,3级浅前房1例。染色:2级浅前房中1例结膜瓣伤口漏。3级浅前房患眼下方结膜囊见滤过泡隆起。无1例发生睫状体脉络膜脱离。眼压测量:手术眼眼压均位于4～8mmHg,双眼相差<2mmHg。1,2级浅前房眼行滤枕加压、绷带包扎,3级浅前房眼行美多丽每日散瞳、滤枕加压、绷带包扎,均未口服及静脉使用降眼压药物。术后7d拆线时,术眼前房均正常,1例双眼眼压为14mmHg,9例眼压<10mmHg,双眼相差<2mmHg,双眼滤过泡大小一致。术后0.5,1,3mo复查双眼滤过泡无差别,眼压无差别。结论:扩大的结膜瓣并不能更有效的降低眼压,增大有效滤过泡的容积,反而会在术后早期增加滤过过强,眼压低,滤过泡大而弥散的并发症。