硅胶环管支撑泪小管断裂吻合术

目的 观察硅胶环管作为支撑物在泪小管断裂吻合术中的效果。方法 采用表面麻醉和阻滞麻醉,在手术显微镜下寻找泪小管鼻侧断端,用硅胶管环作为支撑物对10例泪小管断裂患者行泪小管断端吻合术。结果 随访3－6月,10例下泪小管断裂均获治愈。并且在硅管留置期间无异物感,无外观影响。结论 硅胶环管是一种理想的泪小管断裂吻合术中支撑物。     

硬膜外导管支撑下泪小管断端吻合手术38例

目的：探讨以硬膜外导管为断端支撑物行下泪小管吻合术的疗效。 方法：在表面麻醉和局部麻醉下对38例38眼下泪小管断裂患者行显微镜下寻找鼻侧断端,置入硬膜外导管后作下泪小管断端吻合术并留管3mo。 结果：在38 例患者中成功34例,其余4 例因术中未找到泪小管鼻侧断端而失败。 结论：以硬膜外导管作为断端支撑物行下泪小管吻合术,关键是寻找断端,该方法简便,手术成功率高。     

鼻内窥镜在泪小管断裂吻合术中的应用体会

目的探讨鼻内窥镜在泪小管断裂吻合术中的方法及效果.方法采用表面麻醉和阻滞麻醉,先在手术显微镜下寻找泪小管鼻侧断端,然后在鼻内窥镜下逆行插入自制硅胶管作为支撑物对15例(15眼)泪小管断裂吻合.结果随访6月以上,15例下泪小管断裂伤均治愈.结论鼻内窥镜下泪道插管术使泪小管吻合术的疗效更确切.     

羊膜移植在泪小管重建术中的临床应用

目的观察比较显微镜下泪小管断端吻合联合羊膜植入术与常规显微镜下泪小管断端吻合术治疗泪小管断裂的效果.方法 60例泪小管断裂吻合术中,32例采用泪小管断端吻合联合羊膜植入术(研究组),28例采用常规显微镜下泪小管断端吻合术(对照组).结果术后随访观察18个月,置管期内1个月治愈率比较:研究组87.50%(28/32),对照组57.14%(16/28)(P<0.01);拔管后l a治愈率比较:研究组为90.63%(29/32),对照组为69.86%(19/28)(P<0.05),研究组优于对照组.结论泪小管断端吻合联合羊膜植入术能提高泪小管术后的早期修复和最终治愈率,为泪小管手术提供了一个新的治疗途径.     

泪小管断裂吻合术临床分析

目的 探讨泪小管断裂吻合术的方法及效果。方法 应用神经阻滞麻醉,在手术显微镜下寻找鼻侧断端,以硬膜外导管为支撑物,缝合泪小管断端。结果 32例（32眼）中31眼术后泪道冲洗均通畅,其中1眼轻度溢泪,另外1眼未行吻合术。结论 新鲜泪小管断裂用神经阻滞代替局部浸润麻醉,并借助手术显微镜在直视下吻合泪小管成功率较高。     

手术显微镜下泪小管断裂吻合术43例

目的手术显微镜下寻找下泪小管鼻侧断端的位置,提高泪小管断裂吻合术的成功率。方法在手术显微镜直视下寻找到泪小管鼻侧断端,以硬膜外麻醉导管作为泪小管内支撑物,吻合泪小管断端。结果43例（43眼）均一次吻合成功。结论该方法大大提高了手术成功率,是一种方便、安全和易行的方法。     

外伤性泪小管断裂经上下泪小管置管吻合术

外伤性下睑撕裂伤常伴下泪小管断裂,这是临床上常见的眼外伤。将断裂的泪小管进行吻合,可以解除伤后的溢泪症状。泪小管断裂吻合术成功的关键是要找到泪小管近泪囊的断端(鼻侧断端),吻合下泪小管并在其中置管支撑,保证管腔再通。临床上寻找泪小管鼻侧断端的方法很多,如从上泪点注入消毒牛奶、维丁胶性钙或亚甲蓝等方法,支撑管通常是从下泪小管经断端、泪囊、鼻泪管进行。或在手术显微镜下直视寻找泪小管的断端。但这些方法在实践操作中都各有利弊。我院从1995～1999年自行设计经上、下泪小管置管行外伤性下泪小管断裂吻合术21例(21眼),取得较满意的效果,现介绍如下:     

泪小管断裂吻合术55例临床分析

目的 探讨寻找泪小管断端远端的方法，以顺利吻合泪小管。方法 利用手术显微镜直视下根据裂伤的位置寻找断端远端，然后插入硬膜外麻醉用导管吻合泪小管。结果 术后2～3个月拔管，随访1年，治愈45例，占81．8％；好转5例，占9．1％；未愈5例，占9．1％。结论 在手术显微镜下寻找泪小管断端远端成功率较高，联合植入硬膜外麻醉用导管，不失为泪小管断裂吻合术的一种可取方法。     

上泪点注水寻找断端吻合泪小管断裂

目的探讨下泪小管断裂吻合术的手术方法及术后效果。方法下泪小管断裂37例（37眼）。在手术显微镜下采用上泪点注水法寻找泪小管断端,以硬膜外导管为支撑物的方法吻合下泪小管断裂。保留插管2个月。结果手术中所有患者都能找到泪小管断端,35例拔管后泪道通畅,眼睑无畸形。2例手术失败。结论在手术显微镜下采用上泪小管注水明显优于其他泪小管断端的查找方法。     

泪小管断裂吻合术18例治疗体会

目的 对18例泪小管断裂吻合术治疗观察，对其手术失败原因进行探讨。方法 做筛前、眶下神经阻滞麻醉，在显微镜下找到泪小管鼻侧断端，用硬麻管圆头由下泪点插入泪小管颞侧断端穿出，再插入鼻侧断端向泪囊推进，将两则断端靠拢缝合。缝合，硬麻管上端缝合固定，2－3月拔除支撑物。结果 14例在显微镜下行泪小管管断裂吻合术成功，4例吻合失败，成功率77％。结论 伤后就诊时间长短及寻找到鼻侧泪小管断端、支撑物壁光滑，是手术成功的关键。     

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.