轴型皮瓣移植在眼部成形术中的应用

目的：研究颜面大片疤痕形成，全眼睑缺损整形修复的方法。方法：应用前臂轴型皮瓣和颞浅动脉岛状皮瓣移植修复全眼睑缺损，眉毛、睫毛缺如及结膜囊成形术。结果：两例典型病例均获得满意的矫治，安装了义眼，改善了外观。结论：轴型皮瓣矫正颜面大片疤痕畸形和全眼睑缺损是一种很好的方法。     

颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损

目的探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性。方法根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例（18眼）。术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果。结果16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意。1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死。1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活。6例患者因皮瓣肿胀,行Ⅱ期修整术。结论颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣。     

颞浅动脉岛状皮瓣修复重度感染性义眼座暴露

目的探讨颞浅动脉岛状皮瓣一次性修复感染性义眼座大面积暴露的方法和效果。方法新疆职业病医院眼科6例（6眼）义眼座暴露直径〉10mm或合并感染的回顾性分析。结果经过局部贯穿并冲洗控制感染,取同侧颞浅动脉岛状皮瓣,植入义眼一次性修复大面积结膜囊缺损,6例全部成活,皮瓣血供稳定,耐磨性良好,与结膜囊内组织愈合平整。安装义眼各象限活动自如。术后2例出现毛发过长,需修剪,未见其它术后并发症,随访1～5年,手术效果良好。结论局部有效抗炎结合颞浅动脉岛状皮瓣,一次性修复严重义眼座暴露合并感染,是可行有效的手术方式。     

羊膜移植联合动脉岛状皮瓣治疗眼部严重热烧伤的临床观察

严重眼部热烧伤的治疗一直是眼科的棘手问题，尤其在伴有上、下眼睑皮肤、睑板及睑缘完全破坏时，睑板及睑缘的缺损及溃疡面使角结膜损伤更加难以修复，甚至加重，羊膜、角膜等移植物亦难以成活，极易造成眼球穿孔，最终丧失视力。以往一直没有良好的治疗办法，我们应用羊膜移植联合动脉岛状皮瓣治疗此类病人，取得一定疗效。     

颞浅动脉岛状皮瓣修复眼睑及眶周缺损的临床应用

随着对颞浅血管解剖学研究的进展,以颞浅动脉为基础的顺流岛状皮瓣及以颞浅动脉为基础的反流轴型岛状皮瓣应用日益广泛,本文查阅了近年来国内外相关的文献和综述,旨在探讨和总结颞浅动脉顺行和逆行岛状皮瓣在修复眼睑及眶周缺损中的临床应用。     

内联多孔羟基磷灰石在眼部整形术中的应用

目的　探讨羟基磷灰石在眼部整形中的作用。方法　用国产及进口内联多孔羟基磷灰石包埋入眼眶塌陷处、自体或异体巩膜壳内,置入眼肌锥内。Ⅱ期手术时需将眼外肌缝于相应的异体巩膜壳上,制成可转动的义眼座。保留原眼球外形及眼外肌的生理功能,术后安装义眼片。结果　患者外形矫正满意,义眼活动自如,改善了眼部外观。随访２～１５ｍ ｏ,未见严重并发症、后遗症,术后效果良好。结论　羟基磷灰石是目前眼部整形术中首选、效果最好的材料之一。     

异体阔筋膜浅低温长期保存方法及在眼部整形中的应用

我们自 1995年开始探索用浅低温长期保存异体阔筋膜〔1、2〕的方法 ,并用保存的异体阔盘膜作为移植材料应用于眼科的整形手术。我们对其中资料较为完整的住院患者共计 69例 115眼 ,进行了治疗观察和术后随访 1— 4年 ,并与我院 1991至于 1994年间采用自体阔筋膜的 2 1例 36眼进行临床比较 ,获得较满意效果。兹将结果报告如下。材料与方法1.材料 :来源于无感染疾病及恶性肿瘤的新鲜尸体的阔筋膜 (死后 4— 6小时之内 )。在尸腿外侧中部进行充分皮肤消毒后 ,作一约 15厘米长的切口 ,钝性分离皮下脂肪组织 ,充分暴露银白色的筋膜 (为阔筋膜张肌…     

岛状皮瓣在耳廓肿块切除后修复中的应用

我科采用耳后双蒂的岛状皮瓣修复耳廓前方肿块切除术后局部皮肤缺损效果满意,报告如下。 1资料与方法 1．1资料2005年9月至2009年2月我科收治耳廓前方肿块患者8例,其中男性6例,女性2例;年龄45～72岁;病程3个月至8年。肿块位于耳甲腔3例,三角窝2例,耳甲腔及外耳道口、三角窝均累及1例,三角窝、舟状窝累及1例,耳甲腔及三角窝累及1例。     

平原居民在高海拔地区工作眼部动脉血流动力学的变化

目的:探讨平原居民赴高原地区工作的眼血流动力学的变化。方法:对2017年8月15日至8月18日于日喀则人民医院超声科对从上海抵达日喀则1个月内的26名汉族男性进行双眼超声灰阶以及彩色多普勒超声血流探测,测定眼部动脉的血流动力学指标,并在1年后再次于同一地点测定。同时随机选取日喀则当地的藏族男性居民26名作为对照组。结果...     

风筝皮瓣及旋转皮瓣在修复眉眼前层缺损中的应用

目的：探讨风筝皮瓣及旋转皮瓣在眼外伤或良性肿物切除术后造成眉眼前层缺损的疗效,评价其预后、修复效果以及美学评分改变。方法：收集2018年5月至2020年5月34例眉/眼外伤或因良性肿物行手术切除患者,其眉眼前层缺损最大直径不超过眼长度1/2,根据创面缺损位置、范围,设计沿皮纹方向的缺损邻接部位局部风筝皮瓣及旋转皮瓣,推进滑行局部转移皮瓣向缺损区移位一期修复缺损。随访6个月观察术后皮瓣愈合情况、缺损的修复效果、并发症、患者满意度,比较手术前后美学评分。结果：所有皮瓣全部成活,切口均为I期甲级愈合,局部皮瓣的皮肤色泽、厚薄、毛发情况、质地以及眉毛走行分布与未手术侧基本一致,皮瓣创周器官组织形态无明显改变,皮瓣上眉毛生长良好,手术切口隐蔽在肌肤纹路处、瘢痕增生不鲜明,所有患者无需再次手术。缺损部无臃肿,双侧连续性以及对称性良好,无眉眼变形、倒睫、睑内外翻、上睑下垂等出现,眉/眼组织形态美观、功能良好。患者对手术效果比较满意。患者术后1 d及1、3、6个月的美学评分分别为(73.50±7.79)、(76.97±6.84)、(82.21±6.11)和(87.06±6.07)分,均高于术前的(50...     

Fasciocutaneous Flap,Secondary Axial Pattern Flap,and Microvascular Free Flap in Socket Reconstruction

Three techniques are described to rebuild a missing or recurrently contracted socket, the selection of which is based on the anatomy of the periorbital tissue and vascular supply. When the superficial temporal vessels are present, the ipsilateral fasciocutaneous postauricular flap is used. When the vessels are present but the postauricular flap has been used, a secondary axial pattern flap is used. When the superficial temporal vessels are absent or not suitable, the dorsalis pedis vascularized free flap is used.     

Supratrochlear Artery Island Paramedian Forehead Flap for Reconstructing the Exenterated Patient

Orbital exenteration may be needed for surgical extirpation of advanced squamous or basal carcinoma of the eye or ocular adnexa. Many surgeons prefer to allow the exenterated socket granulate by secondary intention. This leads to morbidity and can be very disturbing for the patient. Moreover, it delays the delivery of adjunctive radiation often required in these individuals. We suggest a 1-stage operation that can be undertaken at the time of exenteration or as a delayed procedure to reconstruct the orbit and ensure rapid wound healing and patient rehabilitation. There is minimal donor site morbidity. A total of 5 exenterated orbits have been reconstructed by a new technique utilizing islanded median forehead flap based upon ipsilateral supratrochlear vessels. The donor site could be closed primarily in all patients. The healing was uneventful; the median hospital stay was 3 days. Although there is inevitable scarring of the forehead, this improves considerably over a period of time and does not appear to cause undue aesthetic concerns among our patients. Thus an islandised ipsilateral paramedian forehead flap based upon supratrochlear vessels is another option to close an exenteration defect.     

复方樟柳碱治疗青少年急性视神经炎的疗效观察

目的:观察应用复方樟柳碱注射液、激素冲击及补充能量综合治疗青少年急性视神经炎的疗效.方法:将65例82眼青少年急性视神经炎患者随机分为两组,治疗组33例41眼,对照组32例41眼;治疗组在与对照组同样的全身用药的同时,于患眼颞浅动脉旁注射复方樟柳碱注射液,1次/d,2mL/次,于14,30,60d观察两组患者治疗前后病程时间、视力、视觉诱发电位及眼底荧光血管造影的变化.结果:于14,30,60d观察两组患者治疗后的疗效,治疗组均比对照组的有效率高,两组比较差异有统计学意义(P<0.05).结论:加用复方樟柳碱颞浅动脉旁注射较传统激素冲击及补充能量综合治疗青少年急性视神经炎,可以缩短病程,减小激素用量,提高患者视力.     

复方樟柳碱颞浅动脉旁注射治疗视神经炎37例

目的 观察复方樟柳碱治疗早期视神经炎的疗效.方法 将81例(93眼)视神经炙患者随机分为2组,治疗组37例41眼,对照组44例52眼;治疗组在与对照组同样的全身用药的同时,于患眼颞浅动脉旁注射复方樟柳碱注射液,每天1次,每次2 mL,1个月后观察2组患者治疗前后视力、视野、视觉诱发电位及眼底荧光血管造影的变化.结果 治疗组治愈37眼,有效率100.0%,对照组治愈33眼,有效率86.5%,二者比较差异有统计学意义(χ2=4.17>3.84,P<0.05).2组间视力变化、视野改变、视觉诱发电位及眼底荧光血管造影检查差异均有统计学意义(P均<0.05).结论 复方樟柳碱颞浅动脉旁注射治疗早期视神经炎,可有效改善视神经及其附近血液循环,增加血流量,改善血供,促进组织缺血、缺氧状况在较短时间内恢复,从而提高患者的视功能.     

Trabeculectomy Using a Fornix-Based Conjunctival Flap and Tightly Sutured Scleral Flap

Trabeculectomy is classically and almost universally performed with a limbal-based conjunctival flap. This method has definite theoretic and practical disadvantages compared with a fornix-based conjunctival flap, including (1) poorer visualization and exposure of the area for surgical treatment; (2) a greater chance of button-holing the conjunctival flap; (3) a more anteriorly placed conjunctival bleb; and (4) a higher risk of a thin flap overhanging the cornea. The practical advantages of a fornix-based flap, the surgical results, and the surgical techniques are discussed. Because of its advantages, this method is preferred to the use of a limbus-based conjunctival flap.     

小梁切除术后结膜瓣渗漏

观察了５０眼穹窿部为基底结膜瓣小梁切除术后滤泡的形成及房水渗漏。术后３０眼曾有渗漏，７天内愈合。讨论了结膜瓣渗漏与愈合的关系。     

Rotational Flap Repair of Full Thickness Eyelid Defects without a Posterior Lamellar Graft or Flap

Background: To determine the safety and effectiveness of full thickness eyelid reconstructions using a semicircular rotational flap without reconstructing the posterior lamella.

Methods: The charts of all patients undergoing semicircular flap closure of full thickness eyelid defects by one surgeon (JDP) at the Cole Eye Institute between March 2000 and October 2012 were reviewed. Charts were reviewed for patient demographic information, as well as for the size of the defect, the type of flap used, length of follow-up and complications.

Results: Fifty eyelids of 50 patients underwent a semicircular flap repair without posterior lamellar reconstruction during the study period, and 41 charts were available for review. Average patient age was 74 years (range, 40–92 years). Average follow-up was 9.8 months (range, 1–84 months). Average defect size was 19.1?mm (range, 14–30?mm, SD 4.6). Complications included pyogenic granuloma (10 patients, 24.4%), exposure keratopathy (7 patients, 17.1%) lagophthalmos (5 patients, 12.2%), ectropion (6 patients, 14.6%), lateral canthal dystopia (2 cases, 4.9%), eyelid notch (2 cases, 4.9%) and trichiasis (4 cases, 9.8%). Two patients underwent subsequent tarsorrhaphy and one patient underwent ectropion repair. There were no cases of wound dehiscence, diplopia or fornix inadequacy, and the recruited aspect of the eyelid healed well in each case. No case required reconstruction of the eyelid margin or fornix.

Conclusions: Semicircular flap repair of full thickness eyelid defects without flap or graft repair of the posterior lamella results in an adequate fornix and a low rate of secondary surgery.     

Axial Lengths in Children with Recessive Cornea Plana

Introduction: While flat keratometry contributes to the hyperopia and associated refractive accommodative esotropia that is part of recessive cornea plana, whether or not axial lengths are abnormally short in the disease is unclear. In this study we assess this possibility.

Methods: Prospective (2010–2012) axial length measurement (IOLmaster; Carl Zeiss, Oberkochen, Germany) of affected right eyes and comparison to right eyes with refractive accommodative esotropia only. Keratometry and refraction were also performed.

Results: For eight affected right eyes (age 10–12 years; seven families) axial length ranged from 21.46–24.80?mm (mean 23.34). Best corrected visual acuity ranged from 20/25 to 20/50, keratometry from 25.33–39.80 diopters (D) [mean 31.80], and refraction from +2.00 to +14.00 D (mean +7.22). For 50 control right eyes (age 4–12 years), axial length ranged from 19.87–23.66?mm (mean 21.6). Best-corrected visual acuity was 20/25 or better, keratometry ranged from 39.81–46.25 D (mean 42.42), and refraction from +2.25 to +8.00 D (mean 4.71). Axial lengths were longer in the affected group (2-tailed unpaired t-test p value 0.000005) despite greater hyperopia (2-tailed unpaired t-test p value 0.001).

Conclusions: Despite greater hyperopia, axial lengths were longer in eyes with recessive cornea plana, evidence that axial lengths are not shortened by the disease. Keratometry in children with cornea plana was below the range of controls and was the major factor underlying the phenotype's hyperopia.