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1.
PURPOSE: To report the ultrasound biomicroscopic appearance of the anterior chamber angle before and after successful goniosynechialysis. METHODS: Interventional case report. Ultrasound biomicroscopy using a 50-MHz transducer was performed in the supine position preoperatively and postoperatively in a 76-year-old woman with angle-closure glaucoma. RESULTS: Ultrasound biomicroscopy of the anterior chamber angle demonstrated restoration of an open anterior chamber angle after goniosynechialysis. CONCLUSION: High-resolution imaging of the anterior segment to evaluate preoperative and postoperative anatomy may be useful in eyes undergoing goniosynechialysis.  相似文献   

2.
Outflow facility studies in the perfused bovine aqueous outflow pathways   总被引:1,自引:0,他引:1  
We have recently developed a technique for constant pressure perfusion of the aqueous outflow pathway of the eye. Our preliminary studies, conducted in the calf eye, show surprisingly that the manipulations necessary for preparing the outflow pathways and attached corneoscleral shell for perfusion do not greatly disrupt normal aqueous outflow physiology and anatomy according to the following criteria: 1. facility of outflow is similar before and during outflow pathway perfusion 2. as in the intact eye, facility of outflow decreases with increased IOP 3. removal of outflow resistance tissue greatly increases facility of outflow 4. morphology of outflow tissues remains normal Use of the perfused outflow pathway model may enable the creation of valuable in vitro preparations which may provide much needed information about the pathogenesis of primary open-angle glaucoma.  相似文献   

3.
We have recently developed a tissue model of the human aqueous outflow pathway involving placement of the eviscerated anterior corneoscleral shell, [with lens and uveal tissue removed but trabecular meshwork (TM) attached] onto a specialized perfusion apparatus. The TM and associated outflow tissues are perfused with culture medium at a physiologically-relevant perfusion pressure in a 5% CO2 environment at 37 degrees C. Under these conditions, the perfused outflow tissues are similar for several days, to the human and/or subhuman primate outflow system in vivo with regard to morphology as well as several functional parameters. Measured facility of outflow (0.271 +/- 0.018 microliters min-1 mmHg-1, n = 79) is similar to facility values obtained by tonography in living human beings. Moreover, outflow facility decreases in a linear fashion with increased perfusion pressure by 1.4% mmHg-1. Finally the removal of the TM results in a 41% decrease in measured outflow resistance. The ability to study viable human outflow tissue for at least several days and the opportunity to establish a model which serves as an alternative to animal testing, point to the potential importance of this technique in investigating the biology of the aqueous outflow system.  相似文献   

4.
We performed laser gonioplasty following goniosynechialysis on 12 eyes that exhibited a very narrow angle. In these cases, angle closure had recurred postoperatively, although gonioscopy carried out at the time of goniosynechialysis revealed opening of the trabecular meshwork. The use of laser gonioplasty following goniosynechialysis was most effective in flattening the configuration of the iris and opening the iridocorneal angle. The induced alteration of the structure of the iris remained unchanged in all cases throughout the follow-up period, and intraocular pressure remained below 20 mmHg in 9 of the 12 eyes. It thus appears that a combination of goniosynechialysis and laser gonioplasty may be effective in the management of refractory angle-closure glaucoma in the presence of an extremely narrow angle.  相似文献   

5.
何峰英 《国际眼科杂志》2018,18(9):1687-1691

目的:通过前节OCT检测超声乳化联合房角分离术后1wk内睫状体脉络膜上腔积液(supraciliochoroidal fluid,SCF)的发生情况。

方法:选取2016-01/2017-06于我院行超声乳化吸除联合房角分离术的PACG合并白内障患者40例40眼,通过前节OCT评估术后SCF发生情况,将术后1wk内发生SCF的患者纳入发生SCF组(10例10眼),未发生SCF的患者纳入未发生SCF组(30例30眼)。分析两组患者眼压、中央前房深度、黄斑中心凹厚度(central macular thickness,CMT)、最佳矫正视力(best corrected visual acuity,BCVA)情况。

结果:所有患眼术前均未发现SCF,术后1wk内10眼(25%)发生SCF,分别发生于术后1d(2眼)、术后3d(7眼)、术后1wk(1眼)。SCF累及范围分别为4个象限7眼、2个象限2眼、1个象限1眼。SCF的严重程度分别为Ⅰ级8眼、Ⅱ级2眼。术后4wk,9眼SCF消失; 术后8wk,全部消失。发生SCF组患者术后1wk内最低眼压(8.9±0.9mmHg)低于未发生SCF组(12.5±2.6mmHg),差异有统计学意义(P<0.001)。SCF发生时患者的平均眼压为10.0±1.2mmHg,SCF消失时的眼压增加至14.3±1.5mmHg,差异有统计学意义(P<0.001)。Spearman相关分析显示,术后8wk,BCVA与CMT呈正相关(rs=0.838,P<0.001)。

结论:超声乳化联合房角分离术后超早期(术后1wk内)可采用前节OCT检查SCF的发生情况,具有较高的临床价值。  相似文献   


6.
王俊勇  邵毅  周方兴  孙慧 《国际眼科杂志》2014,14(10):1818-1821
Citation:Wang JY, Shao Y, Zhou FX, et al. Clinical observation of phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy. Guoji Yanke Zazhi( Int Eye Sci)2014;14(10):1818-1821
  目的:观察白内障超声乳化联合房角分离术治疗小梁切除术后绝对期青光眼的效果。
  方法:对16例16眼绝对期青光眼施行白内障超声乳化联合房角分离术,随访6~12mo,观察眼压、前房深度、术前术后用药种类(数量)、术前与术后1 mo焦虑和抑郁状态、眼表症状等情况。
  结果:行白内障超声乳化联合房角分离术后,眼压明显下降。术前眼压平均值35.00±15.43mmHg,术后第1d眼压平均值为12.00±6.69 mmHg;术后6 mo 为15.00±4.26 mmHg;术后12 mo为15.3±5.2 mmHg。术后眼压与术前比较差异有统计学意义(t=6.22,P<0.05)。术前前房深度为1.45±0.19mm,术后增加至3.37±0.13mm,差异有统计学意义(t=6.65,P<0.05)。术后仅2例患者需用2种降眼压药物,2例患者需1种降眼压药物。术后12 mo 16例患者的焦虑和抑郁状态均有所改善;16例患者眼胀、眼痛等主观不适症状均减轻;所有患者眼球都得以保留,且无严重并发症。
  结论:超声乳化联合房角分离治疗小梁切除术后绝对期青光眼是安全、有效的手术选择。  相似文献   

7.
Outflow changes in normal eyes after closed-angle glaucoma.   总被引:2,自引:2,他引:0       下载免费PDF全文
Twenty-four patients with spontaneous acute closed-angle glaucoma in one eye were selected for study. All 24 eyes had a peripheral iridectomy, were normotensive, and had no gonioscopically visible peripheral anterior synechiae. Of the 24 contralateral eyes 14 gave a positive response to provocative tests and had peripheral iridectomy. The remaining 10 eyes did not give positive responses to the tests and were on no treatment. The 24 pairs of eyes were provoked with pilocarpine and phenylephrine. Tonography was performed at the start of the test, 1 1/2 hours later, and at its termination. At the start of the test the 24 eyes that had had spontaneous closed-angle glaucoma showed a higher pressure and lower outflow facility than the 24 contralateral eyes. This difference disappeared as the test progressed. It is concluded that apparently normal eyes--after an acute attack--do none the less show a significant degree of damage to the outflow system. Ten pairs of eyes from 10 normal persons were provoked in a similar fashion and at no point did a significant difference appear between right and left eyes.  相似文献   

8.
9.
10.
Surgical goniosynechialysis for angle-closure glaucoma   总被引:3,自引:0,他引:3  
Fifteen patients with synechial angle-closure glaucoma uncontrolled by medical and laser therapy were treated with surgical goniosynechialysis. Five patients were treated with goniosynechialysis alone, and ten were treated with goniosynechialysis in combination with other surgical procedures. The procedure was successful, in terms of reducing synechiae, in 14 eyes (93%). The extent of angle closure was reduced from 340 degrees +/- 45 degrees (mean +/- standard deviation) preoperatively to 80 degrees +/- 70 degrees postoperatively; the mean reduction was 260 degrees +/- 95 degrees (P less than 0.0001) for the group overall and 280 degrees +/- 80 degrees (P less than 0.0007) for the subgroup treated with goniosynechialysis alone. The mean preoperative intraocular pressure (IOP) was 40 +/- 4 mmHg. The mean postoperative IOP was 14 +/- 4 mmHg. The mean reduction in IOP was 26 +/- 15 mmHg (P less than 0.0001) for the group overall and 27 +/- 18 mmHg (P less than 0.015) for the subgroup treated with goniosynechialysis alone. Glaucoma medications were reduced from a mean of 2.6 +/- 1.0 preoperatively to 1.1 +/- 1.2 postoperatively for the group overall and to 1.4 +/- 1.5 for the subgroup treated with goniosynechialysis alone. Complications consisted of two eyes with intraoperative bleeding. One of these required intraoperative conversion to surgical trabeculectomy. The other was associated with a transient postoperative IOP elevation to 40 mmHg. Surgical goniosynechialysis may be an effective means of reducing synechiae and lowering IOP, either alone or in conjunction with other surgical procedures, in patients with angle closures of less than 6 months' duration.  相似文献   

11.
Surgical results and complications of goniosynechialysis   总被引:6,自引:0,他引:6  
Goniosynechialysis (GSL) was performed in 70 eyes with primary angle-closure glaucoma in which the intraocular pressure (IOP) could not be controlled with laser or surgical iridectomy. Following GSL, the IOP was maintained at below 20 mmHg, with and without eye drops, in 34 (87%) of 39 aphakic eyes and in 13 (42%) of 31 phakic eyes. In 8 of 10 eyes, all of which were phakic and the first GSL procedure was not effective, IOP could be controlled by a second GSL procedure combined with lens extraction. Life-table analysis showed a significant difference between the probable success rate, after 5 years, between the phakic and aphakic groups. Postoperative tonographic C values showed improvement in outflow facility. However, frequently encountered complications were exudation of fibrin and minor hemorrhage. Our results suggest that a combination of GSL and extraction of the lens may be necessary to control refractory angle-closure glaucoma.  相似文献   

12.
Five patients reporting asthenopia secondary to accommodative deficiencies underwent automated accommodative facility training. A matched-subjects, crossover design was used to control for placebo effects. All patients receiving automated accommodative training showed a marked increase in accommodative amplitude along with a concurrent reduction of asthenopia. Decreases of blur and increases of reading time were the most frequently reported changes by patients. This experiment shows the effectiveness of automated accommodative training in reducing asthenopia and improving accommodative facility.  相似文献   

13.
胡郑君  胡红梅  李婷 《国际眼科杂志》2015,15(12):2099-2101
目的:探讨白内障超声乳化联合房角分离术与单纯白内障超声乳化治疗周边虹膜切除术后合并白内障的临床疗效。

方法:周边虹膜切除术后合并白内障患者69例85眼,随机分抽签法分为两组,观察组38例45眼,行白内障超声乳化联合人工晶状体植入联合房角分离术,对照组31例40眼行白内障超声乳化联合人工晶状体植入术,术后随访12mo,比较两组手术前后眼压、视力、中央前房深度及房角的变化。

结果:术后1wk,观察组与对照组平均眼压分别为10.36±2.85、12.09±3.75mmHg,均较术前降低,与术前比较差异有统计学意义(P<0.01),组间比较差异有统计学意义(t=2.41,P<0.05)。观察组与对照组平均视力分别为0.52±0.22、0.55±0.20,较术前均明显提高,与术前比较差异有统计学意义(P<0.01),组间比较差异无统计学意义(t=0.65,P>0.05)。观察组与对照组中央前房平均深度分别为3.57±0.32、3.44±0.35mm,均较术前明显增加,与术前相比较差异有统计学意义(P<0.01),组间比较差异无统计学意义(t=1.79,P>0.05)。术后2mo,观察组房角粘连范围<90°共42眼(93.33%),高于对照组的31眼(77.50%),两者相比较差异有统计学意义(P<0.05)。

结论:白内障超声乳化联合房角分离术治疗周边虹膜切除术后合并白内障,可以有效开放粘连的房角,控制眼压并提高视力,是一种安全有效的治疗方法。  相似文献   


14.
15.
目的 评价晶状体超声乳化联合房角分离术治疗小梁切除术后复发的原发性闭角型青光眼(PACG)合并白内障患者的临床疗效.方法 回顾性临床研究.选取2017年1月至2020年6月我院收治的小梁切除术后复发的PACG合并白内障患者27例(29眼),患者入院后均行晶状体超声乳化联合后房型人工晶状体植入及房角分离术.采用国际标准视...  相似文献   

16.
白内障超乳联合房角分离术治疗闭角型青光眼   总被引:3,自引:3,他引:3  
目的 观察晶状体超声乳化吸出联合房角分离术治疗合并有白内障的闭角型青光眼的效果。方法 回顾分析2 0 0 1年 1月~ 2 0 0 4年 4月 ,2 4例 2 7眼合并晶状体浑浊的急性及慢性闭角型青光眼合并白内障行透明角膜切口晶状体超声乳化吸出、后房型折叠式人工晶状体植入术联合房角分离术。观察手术前、后视力和眼压。UBM及前房角镜观察手术前后的前房角粘连范围和前房深度的变化。随访 2月至 3年 ,平均 2 4月。结果 术后随访 2 5眼 (92 5 9% )最佳矫正视力比术前明显提高 ,最终眼压较术前明显降低。中央前房深度较术前增加。 2 0眼 (74 0 7% )术后前房角全开放。结论 超声乳化吸出、后房人工晶状体植入联合房角分离术能使此类患者降低眼压、加深前房、开放房角和提高视力。  相似文献   

17.
目的:观察白内障超声乳化吸除并人工晶状体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼术前术后房角的改变。方法:回顾性分析合并有白内障的闭角型青光眼患者35例(37眼),其中前房角关闭范围≤180°者16眼,>180°者21眼,均在表面麻醉下行角巩膜隧道切口行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术,对其手术前后的房角状态,眼压,中央前房深度,视力进行对照观察。结果:随访3~24mo术后房角状态与术前比有3眼大部分开放,余房角均开放,随访期内未见房角关闭及粘连范围扩大,末次随访平均眼压(14.3±4.1)mmHg,较术前用药后平均眼压(26.4±3.2)mmHg明显降低,差异具有统计学意义(t=5.86,P<0.01),中央前房深度由术前的(2.0±0.3)mm,增加到术后的(3.2±0.4)mm,视力除2眼有视神经萎缩外,余均有不同程度提高。结论:对于合并有白内障的闭角型青光眼的治疗,行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术治疗能有效地降低眼压,开放房角,加深前房,提高视力,与滤过性手术相比,手术并发症少,是有效且安全的手术方法。  相似文献   

18.
19.
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。  相似文献   

20.
A study in cats has shown that intracameral injection of calcitonin gene-related peptide (CGRP) increases the outflow facility by four- to fivefold concomitant with a decrease in intra-ocular pressure (IOP). Since there are great differences in the anatomy of the aqueous outflow routes between cats and primates, we have examined the effects of CGRP in the cynomolgus monkey. The possible influence of the sensory neuropeptides cholecystokinin (CCK), galanin and substance P on the outflow facility and IOP were also investigated. Determinations were performed using a two-level constant-pressure procedure. At 40-60 min after intracameral injection of 3 micrograms CGRP the outflow facility was increased from 0.68 +/- 0.11 to 1.03 +/- 0.15 microliters min-1 mmHg-1 in the CGRP-treated eyes, and from 0.71 +/- 0.12 to 0.79 +/- 0.10 microliter min-1 mmHg-1 in the control eyes. The mean difference in increase was 0.27 +/- 0.06 microliter min-1 mmHg-1 (P less than 0.01, n = 7). During the experiments there was a small rise in the IOP. CGRP at a dose of 3 micrograms caused a small rise in aqueous humor protein concentration. An attempt to release endogenous CGRP with capsaicin did not result in an increased outflow facility. Three micrograms each of CCK, galanin and substance P had no significant effect on either the outflow facility or the IOP. A miosis was observed in the experiments with CCK in agreement with previous findings. CCK seems thus to cause contraction of the pupillary sphincter but does not influence the ciliary muscle sufficiently to cause a facility effect in the monkey eye.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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