针拨联合球结膜下注射丝裂霉素C治疗功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(mitomycin C,MMC)球结膜下注射治疗青光眼患者小梁切除术后早期功能不良滤过泡的疗效.方法 对47例(50眼)小梁切除术后2～8周滤过泡功能不良青光眼患者行针拨联合MMC 0.2 mL(0.04 mg)结膜下注射,术后所有患者随访3～6个月,观察患者眼压、滤过泡形态和并发症.结果 小梁切除术后2～8周,低平、限局、肥厚、充血型滤过泡32眼、包囊型囊样滤过泡18眼.针拨联合MMC结膜下注射治疗后3～6个月,46眼的滤过泡转为功能性的,轻度膨隆弥散型31眼,多腔或薄壁型15眼,限局肥厚型或无滤过泡4眼.治疗前患眼的平均眼压为(28.5±6.5)mmHg(1 kPa=7.5 mmHg),随访3～6个月平均眼压为(16.3±2.9)mmHg,与注射前比较二者差异有统计学意义(P<0.05).46眼没有用抗青光眼药物或用一种抗青光眼药物眼压控制在21 mmHg以下,成功率占92%.治疗后视物模糊10眼,结膜下出血6眼,角膜上皮点状脱落2眼,无低眼压、伤口渗漏和前房变浅等并发症.结论 针拨联合MMC结膜下注射治疗小梁切除术后早期功能不良滤过泡是安全、有效、简单的方法.     

针拨联合球结膜下注射丝裂霉素C治疗新生血管性青光眼小梁切除术后功能不良滤过泡

目的 探讨针拨联合丝裂霉素C(MMC)球结膜下注射治疗新生血管青光眼小梁切除术后功能不良滤过泡的疗效.方法 对25例(25只眼)因新生青光眼行小梁切除术后滤过泡功能不良者,进行针拨联合MMC0.2 ml(0.04 mg)球结膜下注射,观察视力、眼压、滤过泡和副作用,并随访6～12个月.结果 小梁切除术后低平眼局肥厚充血型18只眼、包囊型囊样7只眼.针拨联合MMC结膜下注射治疗后6～12个月,轻度膨隆弥散型11只眼,多腔或薄壁型8只眼,眼局肥厚型或无滤过泡6只眼.治疗前患眼的眼压为(32.5±5.5)mmHg,随访结束时具有功能滤过泡眼的眼压为(18.2±3.4)mmHg.与针拨前比较两者差异有统计学意义(P<0.05).19只眼眼压下降有效,成功率占75%.治疗后结膜下出血3只眼,前房出血5只眼,无低眼压、伤口渗漏和脉络膜渗漏及浅前房等并发症.结论 针拨联合MMC结膜下注射治疗新生血管性青光跟小梁切除术后功能不良滤过泡是安全、有效、简单的方法.     

丝裂霉素C结膜下注射联合针拨治疗功能不良滤过泡

目的：探讨丝裂霉素C（ mitomycin C,MMC）结膜下注射联合针拨治疗青光眼小梁切除术后功能不良滤过泡的疗效。方法：对36例39眼因青光眼行小梁切除术后2～12 wk滤过泡功能不良者进行MMC 0．1mL（0．2mg／mL）结膜下注射联合针拨治疗,平均治疗1．31±0．58次,观察眼压、滤过泡和并发症．并随访3 mo。
　　结果：治疗后3mo时平均眼压为15．8±6．6mmHg,显著低于治疗前平均眼压27．4±5．7 mmHg;成功滤过泡32眼,成功率为82．1％。结膜下出血7眼,浅前房低眼压1眼,无伤口渗漏和脉络膜渗漏等并发症。
　　结论：MMC结膜下注射联合针拨治疗小梁切除术后功能不良滤过泡是安全、简单、有效的方法。     

小梁切除术中丝裂霉素与调节缝线的联合应用

目的探讨丝裂霉素(MMC)与调节缝线在小梁切除术中的作用.方法随机选择49眼小梁切除术中联合应用MMC与调节缝线;随机对照42眼单纯小梁切除术,分析比较两组术后眼压、滤过泡及前房深浅.结果本组病例术后第一天浅前房发生率联合组8.2%,明显低于对照组23.8%(P＜0.05);一年后随访60眼(联合组34眼,对照组26眼),联合组弥散性滤过泡88.2%较对照组65.4%多(P＜0.05).不用任何抗青光眼药物眼压＜21 mmHg手术成功标准,联合组一年后手术成功率94.1%较对照组73.1%高(P＜0.01).结论MMC联合调节缝线在青光眼小梁切除术的合理应用,可提高手术成功率,减少术后并发症.     

难治性青光眼的复合式小梁切除术

目的:探讨难治性青光眼的复合式小梁切除术的临床疗效。方法:回顾性分析2003-08/2008-06我院收治的难治性青光眼共59例59眼,应用常规小梁切除术联合丝裂霉素C(MMC)24例(对照组),应用复合式小梁切除术(常规小梁切除术联合MMC和巩膜可调节缝线)35例(观察组)。分析比较两组术后前房形成、眼压、滤过泡及并发症等情况,结果均经统计学处理。结果:59眼手术顺利,未引发爆发性脉络膜出血等严重并发症,术后追踪12mo。术后第1d浅前房发生率观察组为6%,明显低于对照组29%(P<0.05)。术后随访12mo时,观察组30眼眼压控制在6～21mmHg(86%),对照组15眼眼压控制在6～21mmHg(62%),两组间比较差异有统计学意义(P<0.05),观察组功能性滤过泡占86%,较对照组功能性滤过泡62%为多(P<0.05)。结论:难治性青光眼的复合式小梁切除术可有效降低眼压,且并发症少,是治疗难治性青光眼安全、有效的手术方法之一。     

复合式小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼

目的 观察复合式小梁切除术联合巩膜瓣F羊膜植入治疗难治性青光眼的临床疗效.方法 对32例(40眼)行复合式小梁切除术联合巩膜瓣下羊膜植入,观察术后滤过泡的形成以及眼压变化和并发症的发生.随访3～24个月.结果 滤过泡:Ⅰ、Ⅱ型滤过泡34眼,Ⅲ、Ⅳ型滤过泡6眼;眼压:术后3个月平均眼压(13.2±2.7)mmHg,术后12个月平均眼压(15.6±3.1)mmHg.,结论复合式小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼能有效提高手术成功率.     

小梁切除术中应用羊膜与丝裂霉素C的比较

目的 比较丝裂霉素C（Mitomycin C,MMC）与羊膜在青光眼小梁切除术中应用的抗滤过通道瘢痕化的作用.方法 原发性闭角型青光眼38例（68眼）随机分为羊膜组和MMC组各34眼.羊膜组在小梁切除术中联合巩膜瓣下生物羊膜植入;MMC组在小梁切除术中巩膜瓣下一次性应用MMC,浓度为0.3 mg/ml,时间3 min.术后随访10个月.结果 手术成功率：羊膜组的总成功率（包括条件成功率和完全成功率）为94.02％,完全成功率为82.09％;MMC组则分别为81.05％和62.03％,两组之间差异无统计学意义（x2=2.403,P=0.238;x2 =2.101P =0.210）.术后并发症：羊膜组的主要并发症有术后浅前房（6眼）、白内障（2眼）、前房积血（2眼）及薄壁滤过泡（2眼）;MMC组的主要并发症有术后浅前房（8眼）、白内障（7眼）、前房积血（9眼）、薄壁滤过泡（9眼）、持续性低眼压（9眼）、滤过泡渗漏（6眼）及低眼压性黄斑病变（6眼）.结论 羊膜应用于小梁切除术中能长期保留功能性滤泡,且并发症较应用MMC者少.     

青光眼小梁切除术中应用羊膜与丝裂霉素C的对比研究

目的　评价羊膜在青光眼小梁切除术中的作用 ,寻找抗滤过泡瘢痕化的有效方法。方法　采用随机对照的方法 ,施行标准的小梁切除术 ,将 3 0例 ( 5 0只眼 )闭角型青光眼患者分为羊膜组和丝裂霉素 ( MMC)组各 2 5只眼 ,前者施行小梁切除术联合巩膜瓣下羊膜植入术 ,后者在术中一次性应用 MMC,浓度 0 .2～ 0 .4mg/ ml,时间3 m in,随访 6个月。结果　手术成功率 :羊膜组累积完全成功率和条件成功率分别为 84%和 96% ,MMC组的累积完全成功率和条件成功率分别为 60 %和 80 % ( P <0 .0 1)。功能滤过泡的累积存活率羊膜组为 88% ,MMC组为60 % ,两组之间有显著性差异 ( P <0 .0 1)。术后视力 :MMC组术后视力下降者 12只眼 ( 48% ) ,羊膜组则只有 4只眼 ( 16% ) ,两组间差异有显著性 ( P <0 .0 5 )。术后并发症 :羊膜组眼部的副作用小 ,引起的并发症主要有术后浅前房 ;MMC引起的眼部并发症有薄壁滤过泡、滤过泡渗漏、术后浅前房、前房出血、持续性低眼压、低眼压性黄斑病变、白内障等。结论　羊膜应用于小梁切除术可有效地防止滤过泡的瘢痕组织形成 ,并能有效长期保留功能性滤泡 ,且并发症较 MMC少     

小梁切除术联合丝裂霉毒C治疗青光眼的临床疗效

目的:探讨小梁切除联合丝裂霉素C(mitomycin C,MMC)治疗青光眼的临床疗效。方法:原发性青光眼患者57例95眼随机分为两组,为小梁切除术联合MMC(T+MMC)组(31例54眼)和小梁切除术(T)组(26例41眼),术后随访4~6mo,观察其前房、滤过泡、眼压及并发症。结果:T+MMC组术后1d平均眼压为11.24±3.73mmH g,较术前眼压明显降低(P<0.01),与T组比较差异无统计学意义(P>0.05)。而末次随访平均眼压为16.15±3.62mmH g,与T组(18.79±5.27mmH g)比较具有统计学差异(P<0.05)。T+MMC组和T组功能性滤过泡形成率分别为94.44%和80.48%,组间差异具有显著统计学意义(P<0.01)。两组偶发前房出血、角膜水肿,均治愈。结论:采用小梁切除术联合MMC治疗青光眼,术后眼压控制及滤过泡形态维持均良好,并发症少。     

外伤性房角退缩性青光眼小梁切除联合丝裂霉素治疗

目的观察小梁切除术术中联合应用丝裂霉素C（Mitomycin C，MMC）治疗外伤性房角退缩性青光眼的效果。方法小梁切除术联合术中心用MMC治疗外伤性房角退缩性青光眼22例（22眼）。术后对眼压、视力和并发症进行了分析。以Kaplan—Meier寿命表判断成功率。结果成功标准为：不用或用局部抗青光眼药物，眼压在6～21mmHg之间；不需要再进行抗青光眼手术；并且未发生严重的并发症。6月累积成功率为86．36％（n=22），12月为78．57％（n=14），18月为66．67％（n=6）。术后视力与术的相间或稍有提高17例（77．27％），视力下降5例（22．73％）。并发症包括浅前房6眼、溥壁滤过泡3眼、低眼压1眼和白内障1眼。结论小梁切除术联合MMC是治疗外伤性房角退缩性青光眼一种有效的方法。术后大部分病人眼压被控制，保存了有用的视力。     

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.