改良闭合式虹膜复位术的设计及应用

目的为治疗虹膜根部离断提供了一种简便易行、实用、有效的手术方式。方法对收治的28例虹膜根部离断患者，应用我们自行设计的在完全闭合状态下利用爱惜康10-0聚丙烯双直针经角膜缘一孔过双针的方式将虹膜根部固定在原位，并进行临床观察。结果8例患者经过该手术方法修复，虹膜均恢复原位，术后经2～16个月的临床观察，28例患者虹膜缝线无脱落现象，最佳视力1．2，最低视力0．6。无任何手术并发症发生。结论改良闭合式虹膜复位术方法简单、安全、并发症少，值得在临床上推广应用。     

闭合式单直针连续缝合法治疗虹膜根部离断

目的 观察外伤性虹膜根部离断患者经闭合式单寅针连续纳式缝合术治疗的手术方法、技巧和应用效果.方法 对19例(19只眼)虹膜根部离断患者采用闭合式单直针连续纳式缝合法进行修复.结果 所有病例均获良好修复,术后瞳孔完全恢复圆形14例,近圆形5例;消除了双瞳孔以及由此产生的影响视力的不良因素,视功能不同程度提高.结论 对外伤性虹膜根部离断患者采用闭合式单直针连续纳式缝合法进行修复,可有效地恢复瞳孔,提高视功能,是一种简便、安全、有效、微创的手术方式,值得临床上推广应用.     

闭合式微创虹膜根部离断缝合手术效果观察

目的 探讨虹膜根部离断手术缝合治疗的新方法,并评价其疗效。方法 前瞻性病例研究。将带双长针的10-0聚丙烯缝线的缝针略折成弧形,在靠近虹膜离断处的角膜旁中央区斜刺入前房,针尖挑起虹膜断缘,轻压针尾,使针尖连同虹膜断缘翘起并推向睫状沟,针尖穿过虹膜断缘,经睫状沟从角膜缘后约1.5 mm处巩膜面出针。第二针从第一针形成的角膜针孔进入前房,同样方法褥式缝合虹膜断缘后从角膜缘后1.5 mm处巩膜面出针并打结。如此反复可从同一针眼继续缝合离断的虹膜。4例虹膜根部离断的患者采取此方法进行虹膜根部修复手术,术后观察虹膜根部复位情况及瞳孔形态。结果 4例患者手术后虹膜根部离断得到完全修复,消除了双瞳孔征、瞳孔移位、复视等症状。结论 全闭合式微创虹膜根部离断缝合手术操作简单、创伤小,极大降低了发生手术并发症的机率,术后效果良好,值得推广应用。     

闭合式虹膜根部离断修复术的疗效分析

目的探讨虹膜根部离断修复手术治疗的新方法,并评价其手术疗效。方法在虹膜根部离断部位的周边角膜做0.5mm宽的隧道切口,以针心带线的4.5号针头经此切口进入前房,针尖穿过离断的虹膜根部后从相应部位的角巩缘穿出,引出针心内部分缝线,针尖退回前房后重复上述操作,如此反复行“锁边式”缝合,将相邻两针缝线在角巩缘处打结,虹膜根部离断即可修复。我们对31例虹膜根部离断患者按此方法行闭合式虹膜根部修复术的同时,对其合并症行Ⅰ期手术处理,观察其手术前后瞳孔形状、大小、居中性及视力的变化。结果31例患者虹膜根部离断完全修复,术后瞳孔形态、大小明显改善(X~2=12.68,P<0.05)。术后视力明显提高(!2=61,P<0.05),术后矫正视力≥0.2者24例(占77.42%),≥0.6者5例(占16.13%)。结论闭合式虹膜根部离断修复术操作简单、安全、方便、疗效满意,值得在临床推广应用。     

双直针直接缝合法治疗虹膜根部离断的临床观察

目的：观察双直针直接缝合法治疗虹膜根部离断的疗效。方法：14例虹膜根部离断患者，合并外伤性白内障10例，晶状体脱位6例，继发性青光眼4例，睫状体脱离1例。14例行双直针直接缝合法修复虹膜根部离断，同时联合晶状体玻璃体切割5例，白内障囊外摘除及人工晶状体植入2例，睫状体脱离复位1例，小梁切除术1例。通过角膜缘穿刺口，向前房注入粘弹剂，离断的虹膜被推回原位。10-0聚丙烯双直针分别自同一角膜缘穿刺口或玻璃体切割三切口，潜行于虹膜与晶状体之间或虹膜与角膜之间，在距虹膜根部0．5～1mm穿针，自角膜缘后1mm房角处穿出角膜缘并打结，可将线结埋藏于三角形巩膜瓣下或转入眼内或于球结膜下。打结松紧要适度，缝合的针数可根据虹膜离断的范围确定，以虹膜复位、瞳孔复圆为度。结果：14例离断的虹膜都得到较为满意的修复，基本恢复了虹膜的位置和瞳孔形态，使视力及外观明显改善。结论：双直针直接缝合复位法修复虹膜根部离断是一种微创、安全、简便、有效的手术方式，值得临床上推广应用。     

利用1mL针头连续褥式缝合虹膜根部离断的疗效分析

目的:观察以1mL注射器针头连续褥式缝合虹膜根部离断的临床效果。方法:在1mL注射器针头的辅助下,对37例外伤性虹膜根部离断的患者行连续褥式缝合,术后观察虹膜复位情况、瞳孔形状、视力、炎症反应等,探讨此方法的疗效和并发症。结果:虹膜根部离断全部复位,瞳孔复圆或近圆,复视消除,视力提高。无缝线脱落,迁延不愈的炎症等并发症,复位效果好。结论:利用1mL注射器针头连续褥式缝合虹膜根部离断是一种有效的术式,复位效果满意,并发症少,安全系数高,值得推广。     

一种新的手术方式治疗虹膜根部离断

眼球在遭受钝挫伤或爆炸伤时 ,薄弱的虹膜根部易发生离断。当虹膜根部离断超过 5ｍｍ时 ,易造成双瞳 ,导致视功能障碍。我院眼科自行设计的经角巩膜缘切口双直针直接缝合复位术 ,为治疗广泛性虹膜根部离断提供了一种简便、易行、实用、有效的手术方式。我们对 2例广泛性虹膜根部离断的病人进行此手术方式修复 ,取得良好效果 ,现报告如下。1　病例报告例 1,患者 ,男 ,43岁 ,因“右眼爆竹炸伤后视物不见 2 5天”收入院。眼科检查 :视力 :右眼手动 ;左眼 0 8。眼压 :右2 5 81ｍｍＨｇ ;左 17 30ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ)。右眼结膜…     

自制虹膜钩在虹膜根部离断修复术中的应用

目的:观察自制虹膜钩在虹膜根部离断修复术中的应用效果。方法:在黏弹剂维持前房的情况下,在虹膜根部离断的相应位置角膜缘后1mm行45°斜行切口,并根据虹膜根部离断的范围决定切口的大小和数量。在虹膜根部离断范围内进行逐段切开、逐段缝合,缝合点间距为30°。使用自制的虹膜钩勾取离断的虹膜组织,拉至角膜缘切口处,用10-0尼龙线经角膜切口前唇、缝合虹膜根部约0.5mm,然后再穿过角膜切口后唇出针,结扎缝线。虹膜钩应用1mL或2mL一次性注射器针头根据术中具体情况制作。结果:根部离断的虹膜组织得到良好修复,恢复了瞳孔形态,提高了视力。结论:应用自制的虹膜钩可以准确的勾取离断的虹膜组织,使修复手术更加简单、准确、易行,有效恢复瞳孔,提高视功能。     

虹膜根部离断解剖复位成形术的临床研究

目的:探讨虹膜根部离断后的解剖复位成形手术方法技巧及应用效果.方法:采用虹膜解剖复位成形术修复虹膜根部离断13例(13眼).结果:所有病例均获良好修复,外形改善,视功能不同程度地提高.结论:虹膜解剖复位成形术在处理虹膜根部离断时,操作简便,并发症少,是修复虹膜根部离断安全有效的手术方式.     

改良式虹膜根部离断缝合术

目的：研究大范围虹膜根部离断修复的手术方式，方法：对20例眼行改良的虹膜根部离断缝合术。结果：20例眼离断的虹膜均获得解剖及功能上的复位，且视力均获得不同程度的提高。结论：改良式虹膜根部离断缝合术是修复大范围虹膜根部离断的最佳手术方法。     

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.