NPTS联合透明质酸钠生物胶治疗开角型青光眼

目的:回顾总结非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用治疗开角型青光眼的疗效。方法:对20例24眼开角型青光眼施行非穿透性小梁切除手术,术中巩膜床植入透明质酸生物胶及应用丝裂霉素,术后随访12～36mo,观察眼压、视力、前房角、滤过泡等情况。结果:术后1,2,3a时眼压分别为16.32±5.25,17.28±5.70,18.26±5.20mmHg,与术前眼压35.52±7.6mmHg相比明显下降(P<0.01)。术后视力达到或高于术前水平22眼,视力下降2眼。术中、术后均未出现浅前房及前房炎症反应。24眼均有功能型滤过泡。结论:非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用能安全、有效地治疗开角型青光眼。     

非穿透性小梁手术治疗原发性开角型青光眼的临床观察

目的探讨非穿透性小梁手术（NPTS）联合透明质酸钠生物胶植入的临床疗效。方法对32例（38眼）原发性开角型青光眼实施非穿透性小梁手术联合透明质酸钠生物胶植入术。观察术后视力、眼压、滤过泡、前房反应、前房深浅及并发症。术后随访（14．6±2．3）月。结果术前平均眼压（29．2±8．01）mmHg。术后1周平均眼压（15．01±4．65）mmHg,手术前后眼压差异有统计学意义。术后30眼前房无任何反应,2眼有I度浅前房伴少许前房积血,均术后2～3d自行恢复,6眼轻度房水闪光,术后2～3d消失。所有患眼术后均形成显著弥散滤过泡。术后1周及6月视力基本稳定。结论非穿透性小梁手术联合透明质酸钠生物胶植入治疗开角型青光眼疗效肯定,并发症少,为开角型青光眼提供了一种更安全的治疗方法。     

微穿透性小梁切除术联合交联透明质酸钠生物胶植入治疗开角型青光眼的中远期疗效

目的:研究微穿透性小梁切除术联合交联透明质酸钠生物胶植入术治疗开角型青光眼的中远期疗效及其并发症。方法:对24例36眼开角型青光眼患者行微穿透性小梁切除术联合交联透明质酸钠生物胶植入术,观察术前和术后视力、眼压、视野、滤过泡,并进行统计学分析。结果:随访6～24(15.93±2.35)mo。术前及术后24mo时眼压分别为37.89±6.80mmHg和18.28±1.75mmHg(P=0.000)。术前及术后使用的抗青光眼药物分别为2.83±0.51种和0.56±0.92种(P<0.05)。早中期视野缺损视野指数较术前有改善(P<0.05),晚期视野缺损没有改善。术后24mo82%形成功能性滤过泡,末次随访时手术完全成功率81%(29/36),质量成功率94%(34/36)。手术前后视力比较无统计学差异。无严重并发症发生。结论:微穿透性小梁切除术联合交联透明质酸钠生物胶植入是治疗开角型青光眼安全有效的方法,中远期疗效稳定可靠。     

非穿透性小梁手术联合透明质酸钠生物胶植入术治疗开角型青光眼

目的:探讨非穿透性小梁手术(nonperforatingtra-becularsurgery,NPTS)联合透明质酸钠生物胶植入术的临床疗效。方法:对34例(48眼)开角型青光眼的患者实施NPTS联合透明质酸钠生物胶植入术。术后观察视力、眼压、滤过泡、前房反应、前房形成情况及并发症。结果:术后随访3～22(平均8.2±4.1)mo。术前平均眼压(34.18±13.30)mmHg(1mmHg=0.133kPa),术后(7.71±2.69)mmHg;差异有显著性t=14.710,P<0.001。术前平均用药(2.77±0.77)种,术后(0.71±1.05)种,差异有显著性t=4.616,P<0.001。随访期间眼压≤21mmHg者46眼(96%),其中27眼(59%)不用抗青光眼药物,19眼(41%)加用抗青光眼药物。术后24眼无任何反应;10眼前房有轻度闪辉,术后2～5d消失;8眼有少量前房积血,积血均于2～4d消失。6眼出现低眼压性黄斑水肿(22%),均于术后随着眼压的回升而消失。术后均无浅前房、睫状体或脉络膜脱离等并发症发生。所有患者术后均形成显著弥散滤过泡。其中42眼I型滤过泡,6眼II型滤过泡。术后6mo复查32眼I型滤过泡,11眼II型滤过泡,1眼III型滤过泡。结论:NPTS联合透明质酸钠生物胶植入术,可有效降低眼压,并减少抗青光眼药物的应用,术后并发症少,术后远期疗效尚可,为一种治疗开角型青光眼的有效方法。     

非穿透性小梁手术联合生物胶植入术

目的探讨非穿透性小梁手术联合透明质酸钠生物凝胶植入术的临床效果。方法对16例(30眼)开角型青光眼行非穿透性小梁手术联合透明质酸钠生物凝胶植入手术,术后观察视力、视野、眼压、房角、滤过泡形态。结果术后视力、视野较术前无变化或略有提高,术后平均眼压为(13.97±4.81)mmHg(1 mmHg=0.133kPa),较术前平均降低18 mmHg,差异有统计学意义(P<0.01),功能性滤过泡为96.67%,术后前房角镜下可见下梁网后有一减压室存在。结论非穿透性小梁手术联合生物凝胶植入手术具有术后眼压控制好,并发症少等优点。     

非穿透性小梁手术联合羊膜移植治疗开角型青光眼

目的 :探讨非穿透性小梁手术 (NPTS)联合羊膜移植治疗开角型青光眼的机制及疗效评价。寻找透明质酸钠凝胶植入材料替代物。方法 :对 18例 2 5只开角型青光眼患者行非穿透性小梁手术联合羊膜移植 ,术后观察视力、眼压、滤过泡及眼内反应 ,随访时间最短 30天 ,最长 4 2 0天。结果 :术前 2 5只眼平均眼压为 (38 2± 14 4 )mmHg ,2 5只眼术后 3只眼眼压高于 2 1mmHg ,经降眼压药物治疗后 2只眼仍高达 2 8mmHg以上 ,余眼压均控制在 7～ 2 0mmHg之内 ,术后 2个月手术成功率为 88% ,条件成功率为 92 % ,术后 3个月手术成功率为 82 % ,条件成功率为 88%。术后视力均有显著提高 ,滤过泡扁平弥漫 ,轻微充血。术中、术后未出现浅前房、前房出血、玻璃体脱出、脉络膜脱离等并发症。结论 :非穿透性小梁手术联合羊膜移植能安全、有效地降低眼压 ,为非穿透性小梁手术提供了有效安全植入材料。可广泛用于开角型青光眼的治疗     

非穿透性小梁手术治疗青少年开角型青光眼

目的探讨非穿透性小梁手术（NPTS）联合透明质酸钠生物胶（SK胶）植入治疗青少年开角型青光眼的临床疗效。方法对12例（22眼）青少年开角型青光眼采用非穿透性小梁手术联合SK胶植入,术中应用抗代谢药物。术后观察视力、眼压、滤过泡、眼底杯/盘、视野及手术并发症。随访36～44个月,并在末次随访时行超声生物显微镜（UBM）检查。结果手术1周及随访末次平均眼压分别为（10.27±1.38）mmHg,（16.18±7.69）mmHg,与术前平均眼压（29.38±12.56）mmHg相比,差异均有统计学意义（分别为t=6.65,P〈0.01和t=2.71,P〈0.01）。术后22眼均形成显著弥散滤过泡,末次随访时10眼（45.50%）可见扁平稍弥散滤过泡,12眼（54.50%）手术区瘢痕形成,未见滤过泡;视力提高2行及以上者5眼,不变者17眼,无视力下降。眼底杯/盘减小者6眼,不变者16眼;视野改善者6眼,不变者16眼,无视野损害进行性加重。结论非穿透性小梁手术联合透明质酸钠生物胶植入治疗青少年开角型青光眼疗效确切,并发症少,可作为青少年开角型青光眼的首选术式。     

非穿透性小梁手术联合透明质酸钠生物胶植入术的临床疗效观察

目的观察非穿透性小梁手术(nonperforating trabecular surgery,NPTS)联合透明质酸钠生物胶植入术的临床疗效.方法对20例(28只眼)中、晚期开角型青光眼患者行NPTS联合透明质酸钠生物胶植入术.术后观察眼压、眼内反应和滤过泡,并做前房角镜及超声生物显微镜检查.结果术后随访4.5～18.0个月,平均(9.2±3.4)个月.术前平均眼压(28.1±10.2) mm Hg(1 mm Hg=0.133 kPa),术后(17.5±4.1) mm Hg;差异有非常显著性(t=5.776,P<0.001).术前平均用药(2.04±0.74)种,术后(0.71±0.71)种,差异有非常显著性(t=8.103,P<0.001).随访期间眼压≤21 mm Hg者27只眼(96.4%),其中12只眼(42.8%)不用抗青光眼药物,15只眼(53.6%)加用抗青光眼药物.眼压下降≥10 mm Hg者13只眼(46.4%),其中不加药者6只眼.术后14只眼无任何眼内反应;10只眼有轻微房水闪光,2～6 d消失;4只眼有少量前房积血,3～7 d消失.术后28只眼均形成显著弥散滤过泡;随访期间,19只眼有功能性滤过泡;9只眼于术后1.5～3.0个月功能性滤过泡消失.5只眼于术中发现小梁网处有小穿孔,但无虹膜膨出,术后经前房角镜检查可见3只眼有小穿孔;另4只眼术中未见小穿孔,但前房角镜下观察有小裂隙,1～8个月时,用超声生物显微镜检查可见生物胶未降解.结论 NPTS联合透明质酸钠生物胶植入术可有效降低眼压,并减少抗青光眼药物的应用,术后并发症少,为一种具有良好应用前景的抗青光眼新手术.     

单纯性非穿透小梁手术临床疗效观察

治疗开角型青光眼的传统方法是小梁切除术,此种滤过性手术的并发症较多.如前房炎性反应、浅前房、脉络膜脱离、低眼压、眼内炎等[1].近几年开展非穿透性小梁手术(NPIS)联合透明质酸生物胶植入术对开角型青光眼治疗,完全可能取代小梁切除术.但生物胶价格较高.本文对不能承受此费用患者进行了单纯性NPIS10例12眼,现将初步结果报告如下.     

非穿透性滤过手术治疗开角型青光眼的临床观察

目的 观察非穿透性滤过手术治疗开角型青光眼的临床疗效。方法 对开角型青光眼24例(32只眼)采用非穿透性滤过手术，术后观察病人前房反应、眼压及结膜滤枕情况。随诊时间3～18个月。结果 手术顺利．术后前房反应轻，5只眼发生前房出血，1只眼出现羊脂状角膜后沉淀，32只眼中9只眼形成滤过手术典型的滤过泡。23只眼手术滤过区结膜疏松，滤枕弥散，术后降压幅度较术前降低44．5％。结论 应用非穿透性滤过手术治疗开角型青光眼降压效果明显，术后并发症轻、少，可作为开角型青光眼患者的手术选择。     

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.