青光眼引流阀植入治疗不同类型难治性青光眼

目的 观察青光眼引流阀植入治疗不同类型难治性青光眼的临床疗效.方法 回顾分析23例(23眼)行青光眼引流阀植入术的难治性青光眼患者资料,根据青光眼类型及治疗方法分为两组:A组14例(14眼),为新生血管性青光眼,行青光眼引流阅植入术联合视网膜激光光凝;B组9例(9眼),为其他类型难治性青光眼,行青光眼引流阀植入术,术中联合应用丝裂霉素C.记录眼压、视力、并发症,测算手术成功率.结果 与术前比较,两组术后平均眼压均明显降低(P＜0.05);术后6个月A组视力提高8眼(57.14％),B组提高6眼(66.67％);所有患者均未发生严重并发症;A组手术成功率为85.71％ (12/23),B组为88.89％( 8/9).结论 青光眼引流阀植入治疗不同类型难治性青光眼可有效控制眼压,提高手术成功率.     

HRT-Ⅱ在原发性慢性闭角型青光眼诊断中的应用

目的 探讨海德堡视网膜断层扫描仪(HRT-Ⅱ)在原发性慢性闭角型青光眼((CPACG)诊断中的意义.方法 对30例(60眼)CPACG患者进行HRT-Ⅱ检测及视野检查,统计分析HRT-Ⅱ检测敏感性、病变分区特点及视盘参数与视野平均缺损的相关性.结果 ①60眼中视野异常53眼,HRT-Ⅱ检测异常54眼;视野异常和HRT-Ⅱ异常对应为98.15%;单眼视野组8例中有对侧2眼视野检测正常而HRT-Ⅱ检测异常,对侧5眼视野检测正常而HRT-Ⅱ检测也正常,对侧1眼HRT-Ⅱ检测正常而视野检测异常.颞下象限盘沿面积异常率最高;②盘沿面积、杯/盘面积比、盘沿容积、视杯形态测量与视野平均缺损呈直线相关.结论 HRT-Ⅱ检查敏感性良好,与视野检查有良好的对应关系,可以用于CPACG患者视神经损害的监测及早期诊断.     

HRT-II在原发性慢性闭角型青光眼诊断中的应用

目的探讨海德堡视网膜断层扫描仪（HRT-II）在原发性慢性闭角型青光眼（CPACG）诊断中的意义。方法对30例（60眼）CPACG患者进行HRT-II检测及视野检查,统计分析HRT-II检测敏感性、病变分区特点及视盘参数与视野平均缺损的相关性。结果① 60眼中视野异常53眼,HRT-II检测异常54眼;视野异常和HRT-II异常对应为98.15%;单眼视野组8例中有对侧2眼视野检测正常而HRT-II检测异常,对侧5眼视野检测正常而HRT-II检测也正常,对侧1眼HRT-II检测正常而视野检测异常。颞下象限盘沿面积异常率最高;②盘沿面积、杯/盘面积比 、盘沿容积、视杯形态测量 与视野平均缺损呈直线相关。结论HRT-II检查敏感性良好,与视野检查有良好的对应关系,可以用于CPACG患者视神经损害的监测及早期诊断。     

近视眼合并青光眼临床特点

目的:分析近视眼合并青光眼的临床特点.方法:分析观察近视合并青光眼43例、86眼.结果:(1)43例患者不同的屈光度发病率不同;(2)高度近视青光眼发病率高于低度者,本组病例＞-6D 34例,占79.07%;＜-5.75D 9 例,占20.93%;(3)眼压升高是近视合并青光眼的主要特征;(4)视盘形态不规则较显著;(5)视网膜神经纤维层检查发现早期青光眼结构改变的敏感性很高.结论:近视、青光眼两病并存致病程缓慢而隐蔽,症状不典型,体征较特殊,易漏诊、误诊;通过系统检查,是可以发现和确诊的.     

闭角型青光眼

现将近年来对闭角型青光眼的研究成果,常用的房角检查技术,发病的解剖学基础,以及常见的闭角青光眼类型的诊断处理中的有关问题作一综述.     

新生血管性青光眼病因分析

新生血管性青光眼(NVG)是以虹膜出现新生血管,眼压升高为特征的继发性青光眼,近年其发生率有增加的趋势.由于治疗困难,预后差,已引起了学者们的重视.我们对70例、77眼新生血管性青光眼进行了病因分析,以冀发现其发生发展规律,为治疗和预防提供理论依据.     

Ahmed青光眼引流阀植入术治疗难治性青光眼

目的 观察Ahmed青光眼引流阀植入术治疗难治性青光眼的疗效。方法 回顾分析行Ahmed青光眼引流阀植入术的难治性青光眼22例,随访10～26个月,分析术后视力、眼压变化及并发症。结果 术后视力提高和不变者占81.8%,眼压由术前的(40.4±12.0)mmHg降至术后的(17.1±7.3)mmHg,手术成功率为86.4%。手术早期的并发症主要为浅前房、低眼压、前房出血,中远期并发症为引流阀周围包裹瘢痕增生。结论 Ahmed青光眼引流阀植入术治疗难治性青光眼安全、有效。     

XEN微支架在青光眼手术中的应用进展

青光眼的治疗主要是降低眼压,将眼压控制在不使视神经损害进一步发展的水平。传统抗青光眼手术治疗存在降压效果不稳定、降压时间有限且并发症发生率较高等局限性,这就促成了新型微创青光眼手术方式的出现,如XEN微支架植入术,这一新技术的有效性及安全性在许多临床研究中得以证实,同时也获得了越来越多的关注。为使更多的眼科医生了解XEN微支架植入术,论文通过分析整理近年来与XEN微支架植入术相关的文献并加以概括总结,探讨XEN微支架植入术在青光眼手术中的应用与研究进展。     

青光眼滤过性术后浅前房的原因及处理

目的探讨小梁切除术后低眼压性浅前房发生的原因、预防及治疗.方法回顾分析小梁切除术76眼的临床资料.结果76眼中发生浅前房32眼,发生率为42.10%.术中应用丝裂霉素C的45眼中29眼发生浅前房,发生率为64.44%.浅前房原因中房水滤过过强22眼,占68.75%.25眼用保守治疗,7眼用手术治疗均恢复前房,患者预后良好.结论低眼压性浅前房是青光眼小梁切除术后早期的主要并发症,术中应用丝裂霉素C所致的房水滤过过强是最常见的原因,多数病例通过非手术方法可恢复前房,必要时手术治疗.     

正常人及闭角型青光眼患者小梁细胞凋亡流式细胞学研究

目的研究正常人及闭角型青光眼患者小梁细胞凋亡发生率及与眼压升高的关系.方法采用Apo2.7分子探针,使用流式细胞仪检测22例正常人及27例闭角型青光眼小梁细胞凋亡发生率.结果正常人小梁细胞Apo2.7分子检出率为(2.01±0.68)%.闭角型青光眼发作期检出率为(5.25±0.89)%,两者差异有高度显著性(P＜0.01),正常人小梁细胞Apo2.7因子检出率与年龄增长无相关性(r=0.29).闲角型青光眼小梁细胞Apo2.7因子检出率与眼压升高呈显著性正相关(r=0.77).结论正常人小梁细胞存在细胞凋亡发生,与年龄增长无相关,闭角型青光眼小梁细胞凋亡明显增加,与眼压升高呈正相关.     

Dynamic and static subjective visual vertical with aging

Objective: Our vestibular function is gradually deteriorating during aging, although, its behavioral consequences are not easily recognized due to a substitution process by other sensory modalities as visual or proprioceptive inputs. Methods: To reveal such a hidden substitution process by visual signals, the measurement of the static as well as the dynamic subjective visual vertical (SVV) was performed among 63 healthy subjects of different age. Results: The static SVV was found to be stable among all subjects, whereas the shift of the dynamic SVV during rotation of a background scene gradually increased with age. Conclusion: This result indicates that the substitution process identified as a function of age in a perceptual test may have its counterpart in postural stabilizing reflex.     

The development of the text reception threshold test: a visual analogue of the speech reception threshold test.

PURPOSE: In this study, the authors aimed to develop a visual analogue of the widely used Speech Reception Threshold (SRT; R. Plomp & A. M. Mimpen, 1979b) test. The Text Reception Threshold (TRT) test, in which visually presented sentences are masked by a bar pattern, enables the quantification of modality-aspecific variance in speech-in-noise comprehension to obtain more insight into interindividual differences in this ability. METHOD: Using an adaptive procedure similar to the SRT test, the TRT test determines the percentage of unmasked text needed to read 50% of sentences correctly. SRTs in stationary noise (SRT(STAT)), modulated noise (SRT(MOD)), and TRTs were determined for 34 participants with normal hearing, aged 19 to 78 years. RESULTS: The results indicate that about 30% of the variance in SRT(STAT) and SRT(MOD) is shared with variance in TRT, which reflects the shared involvement of a modality-aspecific cognitive or linguistic ability in forming meaningful wholes of fragments of sentences. CONCLUSION: The TRT test, a visual analogue of the SRT test, has been developed to measure the variance in speech-in-noise comprehension associated with modality-aspecific cognitive skills. In future research, normative data of the TRT test should be developed. It would also be interesting to measure TRTs of individuals experiencing difficulties understanding speech.     

Compensatory changes in static and dynamic subjective visual vertical in patients following vestibular schwanoma surgery

OBJECTIVE: Among patients with vestibular schwanoma (VS), vestibular function is nonhomogeneous, both before and after surgical removal of the VS. This paper reports investigations of neural changes, especially changes in the contribution of visual input to vestibular system integration, after VS surgery. METHODS: We examined 33 patients who underwent VS surgery via a middle fossa approach. Static and dynamic subjective visual vertical (SVV) was measured once after surgery and compared to those measured in control subjects. SVVs were assessed using a paradigm requiring the subject to manually adjust an image of a bar to the perceived vertical alignment. SVVs were measured when the background was stationary or rotating. RESULTS: In almost all patients, static SVV deviated toward the operated side. In VS subjects, the mean static SVV was 1.8+/-2.2 degrees; the amount of deviation in the dynamic SVV toward the operated side (11.7+/-8.3 degrees ) was significantly larger than that to the intact side (8.8+/-5.5 degrees ). In VS subjects, static SVV was correlated with dynamic SVV only in cases of bar adjustments toward the operated side (R=0.67, P<0.001), but not in cases of adjustments toward the intact, unoperated side. The axis of rotation was defined as the mean value of dynamic SVV for adjustments toward either side. There was only a weak correlation between the static SVV and the axis of rotation (R=0.31; P<0.05) in the control subjects. On the other hand, a more robust correlation between static SVV and axis of rotation was found (R=0.67, P<0.001) in VS subjects. There was no correlation between the static SVV and the deviation of dynamic SVV from static SVV for CCW and CW in control subjects. In contrast, there were significant correlations between static SVV and deviation of dynamic SVV from static SVV for adjustments made toward both operated (r=0.48, P<0.001) and intact sides (r=038, P<0.05). CONCLUSION: It is assumed that the amount of deviation in static SVV reflects the individual level of compensation. In addition, increased visual dependency evoked a symmetrical bias of the dynamic SVV from the measures at initial SVV assessment (i.e. static SVV or the center of tilt). As a result, we conclude that the contribution of visual inputs had changed after surgery, while at the same time, each patient used their static SVV as their reference point for orientation.     

Longitudinal threshold changes in older men with audiometric notches

Age-related hearing loss (presbycusis) is a multifactorial process that results chiefly from the accumulating effects of noise damage and aging on the cochlea. Noise damage is typically evidenced clinically by a discrete elevation (notch) of the auditory thresholds in the 3-6 kHz region of the audiogram whereas aging affects the highest frequencies first. To determine whether the presence of such high-frequency notches influences auditory aging, we examined the 15 year change in audiometric thresholds in 203 men from the Framingham Heart Study cohort. The mean age at the first hearing test was 64 years (range 58-80). Occupational and recreational noise exposure over the 15 years was assumed to be minimal due to the age of the subjects. The presence or absence of a notch was determined using a piecewise linear/parabolic curve fitting strategy. A discrete elevation of the pure-tone thresholds of 15-34 dB in the 3-6 kHz region was deemed a small notch (N1), and elevations of 35 dB or greater were deemed large notches (N2). Absence of a notch (N0) was encoded those ears with <15 dB elevation in the 3-6 kHz region. The presence and absence of notches correlated with the subjects' history of noise exposure. The 15 year pattern of change in age-adjusted pure-tone thresholds varied significantly by notch category. There was less change over time in the notch frequencies (3-6 kHz) and significantly greater change in the adjacent frequency of 2 kHz in the N2 group as compared to the N0 and N1 groups. The adjacent frequency of 8 kHz showed a significant, but smaller, change in the N1 group as compared to the N0 and N2 groups. The change at 2 kHz was independent of the starting hearing level at E15, whereas the changes at 4-8 kHz were influenced by the hearing level at E15. These data suggest that the noise-damaged ear does not 'age' at the same rate as the non-noise damaged ear. The finding of increased loss at 2 kHz suggests that the effects of noise damage may continue long after the noise exposure has stopped. The mechanism for this finding is unknown but presumably results from prior noise-induced damage to the cochlea.     

干扰本体感觉和视觉对正常人及单侧前庭功能低下患者的静态姿势的影响

目的观察干扰视觉或本体感觉对正常人和单侧前庭功能低下（unilateral vestibular hypofunction,UVH）患者的静态姿势描记的影响,并探讨正常人和UVH患者维持静态姿势平衡时的策略有无区别。方法60例健康志愿者和28例UVH患者进行如下静态姿势描记试验：（1）睁眼站立于坚硬平板上的直立试验（T1）;（2）闭眼站立于坚硬平板直立试验（T2）;（3）睁眼站立于海绵上直立试验（T3）。每种条件下各站立30s,分别记录足底压力中心的平均晃动速度（Swayvelocity,SV）作为姿势稳定性的参数。结果（1）正常组和UVH患者组当视觉或本体觉受到干扰时,SV较正常站立时均增加,差异具有非常显著性意义（P值均〈0.01）;（2）正常组在本体觉受到干扰时的SV比在视觉受到干扰时的SV大,差异具有非常显著性意义（P〈0.001）;UVH患者组的视觉受到干扰和本体觉受到干扰时,SV比较差异无显著性意义（P=0.051）;（3）睁眼站立于坚硬平板时,正常组和UVH患者组的SV比较,差异无显著性意义（P=0.257）;本体觉受到干扰时,两组的SV比较,差异也无显著性意义（P=0.232）;视觉受到干扰时,UVH患者组比正常组的SV大,且差异有显著性意义（P〈0.05）。结论干扰视觉或本体觉对正常人和UVH患者的静态姿势稳定性的影响大小并不完全一致,正常人更依赖本体觉,而UVH患者则更依赖视觉,这可能提示正常人和UVH患者维持静态姿势平衡的策略有所差异。     

Movements of the ossicular chain during changes in static pressure

The effects of static pressure on the movements of the ossicles have been a neglected aspect of reconstruction of the ossicular chain. The pattern and the magnitude of the movement of the intact ossicular chain during changes in static pressure described. Displacement of the handle of the malleus was also measured in three points after removing of the incus. Experiments were carried out on 7 fresh human temporal bones. Digital photographs were taken during incremental changes of static pressure from -500 to +500 daPa. Digital videos were recorded to analyse the pattern of the movement. Minimal displacement of the handle of the malleus for negative pressure was 108 microm for -100 daPa and 200 microm for -500 daPa. Maximal displacement for negative pressure was 209 microm for -100 daPa and 439 microm for -500 daPa. Minimal displacement for positive pressure was 82 microm for 100 daPa and 150 microm for 500 daPa. Maximal displacement for positive pressure was 126 microm for 100 daPa and 237 microm for 500 daPa. Malleus displacements were greater for negative pressure changes than positive pressure (p<0.01). When 500 daPa was applied medial displacement of the middle of the handle of the malleus was smaller for 30 microm and the displacement of the region of lateral process of the malleus was smaller for 94 microm than the displacement of the umbo of the drum. The lateral to medial movement of the malleus during changes in static pressure is converted into a predominantly superior to inferior movement of the incus.     

Masked threshold changes associated with angular separation of noise and signal sources

Threshold changes associated with separating a signal source and a masking white noise source from 0 degree to 90 degrees were determined for 0.5, 1 and 8 kHz pure tones and click trains. No changes occurred for the 0.5 and 1 kHz pure tones. Masked thresholds of 8 kHz pure tones and click trains decreased linearly by 9 and 13 dB respectively as angular separation was moved from 0 degree to 90 degrees. Changes in click train stimuli masked thresholds did not change significantly when the ear directed toward the masking source was occluded (11 dB drop at 90 degrees). The absence of changes at low frequencies and the similarity in magnitude of the changes in signals containing high frequency components with the responses to the monaural click trains, suggests that the threshold changes can be attributed to a head shadow effect. The casting of a sound shadow effectively lowers the noise level on the shielded side. These findings question the importance of cross-correlation techniques when detecting signals in noise.     

A behavioral measure of the cochlear changes underlying temporary threshold shifts

It is well documented that exposure to recreational noise may result in a temporary threshold shift (TTS) due to cochlear dysfunction. A forward-masking paradigm was used to estimate the relative contribution of inner hair cell (IHC) and outer hair cell (OHC) dysfunction to TTS. Eighteen normal-hearing adults completed a test battery before, immediately after, and one week after attending a loud music venue. Personal dosimeters recorded mean equivalent exposure levels of 99.0?dB?A. Shortly after exposure, there was an average TTS of 10.8?dB at 4?kHz, and an average reduction in the estimated gain provided by the OHCs of 11.5?dB. Gain reduction correlated significantly with TTS. The results suggest that OHC dysfunction can account almost entirely for the raised thresholds. For the test battery conducted a week after exposure, all measures showed recovery to pre-exposure values.