大鼠青光眼滤过手术模型的制作

目的 制作大鼠青光眼滤过手术模型,对以往建立的动物模型进行补充,以更好地开展青光眼滤过手术的相关研究. 方法 SD大鼠10只,制作以角膜缘为基底的结膜瓣,通过全巩膜隧道穿人前房25号硅胶管,末端埋于结膜下,连续缝合结膜瓣.同样方法做另外3只大鼠,分别于术后2、5、11 d取眼球做组织学检查,观察术后滤过泡形成情况.结果通过大鼠前房引流管植入术,可以在结膜下形成良好的滤过泡,经过7～11 d逐渐瘢痕化.结论大鼠引流管植入术是一个可靠的青光眼滤过手术动物模型,可用于滤过手术后伤口愈合、瘢痕化过程及滤过手术其他方面的相关研究.     

环孢霉素A应用于青光眼滤过术

目的　观察环孢霉素A(cyclosporinA ,CsA)在青光眼滤过术中的疗效 ,评价其临床应用价值。方法　采取随机对照临床试验方法 ,将 5 2例 6 4眼原发性开角型青光眼患者随机分为 2组 ,每组 32眼。 1组患者术中 1次性应用 2 0g·L-1CsA溶液浸润巩膜瓣下及结膜瓣内表面 ;另 1组行单纯小梁切除术 ,术后随访 6～ 15个月。结果　 (1)术后第 12个月末 ,CsA组功能性滤过泡累积维持 74 .8%± 16 .6 % ,高于对照组的 5 4 .9%± 18.9% (u =4 .4 6 4 ,P <0 .0 5 )。 2组术后滤过泡均以Ⅱ型滤过泡为主 ,但CsA组Ⅲ型滤过泡发生率16 .7%明显低于对照组的 38.7% (χ2 =6 .4 6 0 ,P <0 .0 5 ) ;(2 )CsA组术后完全和条件成功率分别为 76 .7% (2 3/30 )和96 .7% (2 9/30 ) ,高于对照组的 5 1.6 % (16 /31)和 71.0 % (2 3/31) (χ2 =4 .15 0 ,5 .5 91,P <0 .0 5 ,0 .0 5 ) ;术后第 1周 ,2组眼压无明显差异 (t =1.2 73,P >0 .0 5 ) ;而术后第 2周、1、3、6、12月CsA组眼压均显著低于对照组 (t =2 .0 2 9,2 .0 97,2 .2 85 ,2 .6 5 1,3.82 4 ,P <0 .0 5 ,0 .0 5 ,0 .0 5 ,0 .0 5 ,0 .0 1) ;第 1、3、6月 ,CsA组眼压 10～ 15mmHg(1kPa =7.5mmHg)的控制率明显高于对照组 (χ2 =4 .6 80 ,4 .15 0 ,7.878,P <0 .0 5 ,0 .0 5 ,0 .0 1) ;     

Ten year prospective follow-up of a glaucoma operation

The results of a longterm prospective follow-up study after the Double Flap Scheie filtering operation are presented. Fifty-two eyes of 47 patients with primary open angle glaucoma (POAG) were operated; after ten years 29 eyes of 24 patients could be examined. Twenty patients (43%) had died, in three follow-up was imcomplete.The two and four year results have been published earlier. In the 29 eyes the mean intraocular pressure (IOP) without medical therapy rose from 15.8 mm Hg at five years to 16.3 mm Hg at ten years (not significant). Additional medical or surgical treatment was necessary in 35% of the eyes. Diurnal variation and outflow facility remained stable. During the ten years 13 eyes showed some deterioration of visual fields. Nearly all clinically important deterioration occurred within five years after the operation.Cataract progression was noticed in 45% (13 of 29); four times a lens extraction was performed (13%).Complete succes of the operation, as judged by stable visual fields and IOP levels at or under 21 mm Hg without additional medical or surgical therapy was reached in 13 of 20 eyes (45%). Based on IOP alone the succes rate was 62% without and 93% with additional treatment.     

5-fluorouracil and glaucoma filtering surgery. II. A pilot study

5-Fluorouracil (5-FU) was injected subconjunctivally after glaucoma filtering surgery in a pilot study of eyes with poor surgical prognoses. Twenty-seven (79%) of the 34 aphakic eyes with glaucoma achieved an intraocular pressure (IOP) of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 91 -468 days). Nine (69%) of 13 eyes with neovascular glaucoma achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 120-379 days). Eight (89%) of nine phakic eyes with glaucoma following unsuccessful filtering procedures achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 134-394 days). Visual acuities remained within one line of their preoperative levels or improved in 32 (94%) of the 34 aphakic eyes with glaucoma, eight (62%) of the 13 eyes with neovascular glaucoma, and six (67%) of the nine phakic eyes with glaucoma following unsuccessful filtering procedures. Postoperative corneal epithelial defects occurred in 45% of the cases. Conjunctival wound and conjunctival needle tract leaks were observed in 41% of the cases, but only one eye required wound revision. No other serious side effects that we attributed to 5-FU were observed. It seems that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control following filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this.     

玻璃体切割合并滤过术治疗新生血管性青光眼

目的探讨玻璃体切割合并滤过术治疗新生血管性青光眼的疗效。方法对我院收治的13眼新生血管性青光眼施行了睫状体平坦部三切口闭合式玻璃体切割合并滤过术，其中新生血管性青光眼继发于增生性糖尿病视网膜病变9眼，继发于视网膜中央静脉阻塞4眼。术前视力为LP～0.1，术前眼压在药物控制下为21～70mmHg（1kPa=7．5mmHg），所有患者术后随访6个月。观察术后眼压和视力变化。结果随访期内，12眼眼压≤21mmHg（有／无抗青光眼药液滴眼），10眼视力保持稳定或有增进。结论玻璃体切割合并滤过术可有效地治疗新生血管性青光眼，并在较长时期内维持视觉功能。     

正常眼压性青光眼诊断中存在的问题

患者具有典型的青光眼视盘损害、视野缺损、前房角开放、眼压正常，并排除眼部或全身性疾病引起的视神经病变，即可诊断为正常眼压性青光眼。准确的眼压测量、两次以上24小时眼压曲线描记以及对眼部和全身可能原发疾病的排除在诊断过程中至关重要。     

5—氟尿嘧啶与丝裂霉素C在青光眼滤过术中的合理应用

目的 探讨青光眼滤过手术抗代谢药物丝裂霉素C（MCC）与5－氟尿嘧啶（5－Fu）的合理应用。方法 对108只需手术的青光眼随机分成3组。5－Fu组术后球结下注射5－Fu6－8次,MMC组术中一次性给予质量浓度为0.2mg/ml的MMC,对照组则不用任何药物,观察各组术后的疗效及并发症。结果 随访3－34个月（平均28．2月）,5－Fu和MMC组手术成功率明显高于对照组,P＜0．05。术后并发症5－Fu组角膜上皮点状损害18只眼（45％）,MMC组低眼压2例（6．7％）,与对照组比有显著差异（P＜0．05）。结论 5－Fu与MMC能提高青光眼手术的成功率,但有一定的毒副作用。临床上应根据病人的年龄、病情及青光眼类型选择用药。     

青光眼滤过性手术后脉络膜脱离的临床观察

目的:探讨抗青光眼滤过性手术后出现脉络膜脱离的相关因素及治疗措施,总结临床特点。方法:对457眼青光眼滤过性手术后发生脉络膜脱离的42眼患者进行回顾性分析和总结。结果:脉络膜脱离发生时间为术后3~7(平均4.51±1.14)d,患者的平均年龄为65.30±3.50岁。通过皮质类固醇类药物、散瞳、高渗剂等治疗,42眼脉络膜脱离全部恢复。治疗所需时间平均为16.50±2.75d。结论:脉络膜脱离是青光眼滤过性手术后的一个常见并发症,与术前眼压控制不好、术后眼压过低、患者年龄偏大及高血压、糖尿病有关。     

青光眼滤过术后创伤愈合的生物学调控

青光眼在全球是仅次于白内障导致视力丧失的主要病因,滤过手术联合应用抗代谢药物降低眼压是控制病情发展的主要手段。但抗代谢药物(MMC,5-FU)产生的毒副作用,使其应用受到限制。近年来众多研究开始转向低副作用、靶向性强、作用强度及作用时间可控的生物学调控,包括靶向细胞因子的各种单克隆抗体、靶向细胞外基质的基质金属蛋白酶、基因调控等,部分制剂已用于临床,显示了良好的应用前景,这无疑是针对青光眼滤过术区创伤愈合调控的理想研究方向。     

兔眼小梁切除术中巩膜瓣下植入陈旧生物羊膜的病理变化

目的:评价青光眼滤过手术中应用陈旧生物羊膜抗纤维增殖作用。方法:采取随机对照动物实验研究方法,选日本大耳兔30只,共60眼,采用随机数字表法将其分为两组。两组中右眼(30眼)均行小梁切除术,术中巩膜瓣层间植入陈旧生物羊膜,组A左眼(15眼)行小梁切除术联合应用干扰素α-2b,组B左眼(15眼)仅行单纯小梁切除术。并于术后3,7,14,30,60d分别处死两组中各3只动物,摘除眼球作病理切片,观察羊膜降解时间、成纤维细胞和炎症细胞计数。结果:羊膜组早期即可见大量成纤维细胞增殖,成纤维细胞处于功能活跃状态。羊膜组炎性细胞数目、成纤维细胞数目,术后3,7,14d均高于其它两组。羊膜大致在14～21d内降解。结论:兔眼小梁切除术中应用陈旧的生物羊膜诱发了兔眼的免疫排斥反应。     

A modified model of glaucoma filtering surgery in Sprague-Dawley rats

Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague–Dawley rats by performing a sclerostomy using a 26-G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS.     

Scleral free auto-implant plug with mitomycin as limitation of trepanosclerectomy flow in glaucoma filtering surgery

The purpose of this study is to evaluate the effect of trephination with free scleral auto-implant plug exposed to Mitomycin-C out of the eye, in surgical treatment of primary open-angle glaucoma (POAG), in comparison with efficacy of trabeculectomy with MMC (32 eyes with POAG of patients, younger than 55 years — group 1). Trephination with scleral auto-implant plug with MMC was done on 35 eyes of patients, younger than 55 years, with POAG (group 2). The postoperative follow-up was 28.52 ± 8.78 months. Surgical procedure: A limbal 1.0 mm diameter trephination is made beneath the limbus-based conjunctival flap, a small iridectomy is performed. From the external layers of the trephine button one third of the corneoscleral thickness, in the form of a thin disc, is excised. The scleral disc, a free auto-implant, is dipped into liquid containing MMC with concentration 0.2 mg/ml for 5 minutes, outside the eye. Afterwards the scleral disc soaked with MMC is carefully irrigated with 150 ml of BSS and placed in the external part of the trephine fistula in primary position and stabilized with two interrupted 10-0 nylon sutures. The operation is ended as a typical trabeculectomy. The final success rate in terms of IOP (IOP < 14 mmHg) was 100%, without or with antiglaucoma medication, in both groups, but the number of postoperative complications was significantly lower in group 2. Trephination with free scleral auto-implant plug soaked with MMC may represent a viable alternative to trabeculectomy with MMC; the scleral plug may be taken out of the eye and exposed to antimetabolite outside the eye to minimize toxicity.     

青光眼术后滤过泡功能障碍及其治疗的临床探讨

目的探讨青光眼滤过术后滤过泡功能障碍及其治疗。方法对2002年1月至2003年12月我院青光眼滤过手术67例（89眼）进行回顾性分析。结果术后滤过泡功能障碍14例14眼，其中渗漏性滤过泡1眼，滤过泡瘢痕4眼，包裹性滤过泡9眼。此14眼经及时进行药物治疗、眼球按摩及球结膜粘连分离等治疗均使眼压控制在正常水平。结论青光眼术后滤过泡功能障碍及时正确治疗，可提高手术成功率，避免严重并发症。     

青光眼滤过术后浅前房的前房重建手术

目的探讨青光眼滤过术后浅前房的前房重建手术时机及手术方法。方法34例（36眼）浅前房（包括无前房）者中23眼行脉络膜上腔放液联合前房注气；8眼行玻璃体水囊抽液联合前房注气；2眼行玻璃体水囊抽液联合白内障囊外摘出及后房型人工晶状体植入；3眼行前房角分离、前房形成、小梁切除联合囊外摘出或人工晶状体植入。结果36眼中33眼在浅前房发生2周内手术，2月、4月、9月手术各1眼。其中30眼一次手术成功；3眼脉络膜上腔放液联合前房注气者经原角膜穿刺口进行了二次注气成功；2眼行玻璃体水囊抽液联合前房注气后前房仍不能形成改行其它手术方式成功；1眼前房角分离、前房形成、小粱切除联合囊外摘出术者手术失败。结论青光眼滤过术后Ⅱ度浅前房保守治疗最长不要超过2周，无效时须考虑前房重建手术；Ⅲ度浅前房一旦发生应立即手术。根据浅前房原凶要选择不同的手术或进行多手术联合。     

青光眼滤过术中改良式可调节缝线缝合方法效果观察

目的：探讨青光眼滤过手术中改良式可调节缝线缝合方法的效果观察。方法：回顾性研究2013-01/2014-12我院病房收治的原发性青光眼行改良式小梁切除手术患者46例49眼的临床资料。结果：患者46例49眼均采用改良式可调节缝线的缝合方法,其滤过泡形成满意,眼压控制良好,缝线期间眼部无明显异物感,拆除缝线时简单、便捷。结论：此种可调节缝线缝合方法是青光眼滤过手术可调节缝线缝合方法中非常适宜、有效、简便的方法之一。     

青光眼滤过术后环孢素A缓释系统抗增殖的实验研究

目的:研究青光眼滤过术后环孢素A缓释系统防止滤过道瘢痕化的作用。方法:新西兰大白兔12只行小梁咬切术,左眼设为实验组,术中植入环孢素A缓释系统(CsA DDS);右眼设为空白对照组,术中植入空白缓释系统,术后观察眼压、滤泡、房闪,定期抽取房水,检测房水中药物浓度。术后7,14,28d分批处死兔子行组织病理学检查。结果:CsA DDS在兔眼表现出良好的局部耐受性;术后3d实验眼滤过泡均值与对照眼无显著性差异,术后7,15,28d实验眼均值高于对照眼,差异有显著性(P<0.05);术后3,7,15,21,28d的5个时间点实验组与对照组眼压差异有显著性(P<0.05);房水中药物浓度随时间推移呈缓慢下降趋势;HE染色观察到约有25%的实验眼切片出现咬切口区堵塞,对照眼所有切片均出现堵塞。结论:CsADDS防止抗青光眼术后滤过道瘢痕化是一种安全、有效的给药方式。     

青光眼滤过术后联合结膜下注射5-Fu剂量、时机及频率的研究

目的:探讨青光眼滤过术后联合不同的结膜下注射5-Fu方案对手术成功率的影响。方法:2001-01/2007-08间收治的青光眼滤过联合术后结膜下注射5-Fu患者176例,记录各例具体的5-Fu使用方案,并对手术成功率及并发症进行比较。结果:较高剂量的5-Fu并不能产生更高的手术成功率(P=0.320);术后第1d即使用5-Fu的患者手术成功率最高(P=0.015);5-Fu于术后1mo内平均注射次数为5.4次可收到较好的效果。结论:5-Fu作为青光眼滤过术辅助用药,正确、合理的使用能显著提高手术成功率。     

青光眼术后滤过泡渗漏的手术治疗

目的探讨青光眼术后滤过泡渗漏的手术治疗效果。方法23例(25眼)滤过泡渗漏患者,根据滤过泡渗漏的临床特点,9例(10眼)采取自体结膜瓣掩盖术,14例(15眼)施行异体巩膜移植术。术后随访6个月~4a。结果23例(25眼)术后平均眼压由术前(3.96±1.58)mmHg(1kPa=7.5mmHg)提高至(12.23±5.13)mmHg,其中2眼眼压于术后2个月后≥27mmHg,1眼加用降眼压药物后,眼压控制在正常范围;另1眼行滤过性手术后出现前房再次消失,最后失明。大部分患者视力有不同程度的提高。结论手术治疗是青光眼术后滤过泡渗漏最有效的治疗方法。     

Morphological and functional differences between normal‐tension and high‐tension glaucoma

Purpose: To compare visual field (VF) and nerve fibre loss in patients with normal‐tension (NTG) and high‐tension glaucoma (HTG) at an equal level of glaucomatous structural damage of the optic nerve head (ONH). Methods: In a retrospective, pair‐matched, comparative study, 126 eyes with NTG and 126 eyes with HTG were matched according to the same glaucomatous ONH damage based on rim volume, rim area and disc size measured by the Heidelberg Retina Tomograph (HRT III). Visual field by Humphrey perimetry and nerve fibre layer thickness measured by scanning laser polarimetry (GdxVCC) were compared between both groups. Results: Based on the HRT, NTG and HTG displayed comparable structural damage of the ONH without a statistically significant difference between both groups (mean, NTG/HTG: disc area 2.32/2.32 mm², p =0.342; rim area 1.03/1.00 mm², p = 0.279; rim volume 0.2/0.19 mm³; p = 0.274). Eyes with NTG had significantly less VF damage than eyes with HTG (mean, NTG/HTG: mean deviation (MD) ?3.69/?9.77 dB, p = 0.0001; pattern standard deviation (PSD) 4.80/7.17 dB, p = 0.0001). The nerve fibre layer of NTG patients was thicker than that of HTG patients (mean, NTG/HTG: GDx total: 46.9/44.0 μm, p = 0.073; GDx superior: 57.2/49.9 μm, p = 0.0001; GDx inferior: 54.9/49.7 μm, p = 0.001). Conclusions: At an equal level of glaucomatous structural damage of the ONH indicated by cupping, rim area and rim volume, NTG patients seem to have a less affected visual field and a better preserved nerve fibre layer than HTG patients.