睫状环阻塞性青光眼的联合治疗

目的探讨睫状环阻塞性青光眼的治疗方式及其疗效。方法对22例（22眼）睫状环阻塞性青光眼的发病情况、治疗方案及疗效进行回顾性分析。结果3眼药物治疗有效，晶状体超声乳化＋人工晶状体植入术6眼，玻璃体水囊抽吸术6眼，玻璃体水囊抽吸＋前房角分离＋晶状体超声乳化＋人工晶状体植入7眼。11眼行ND：YAG后囊切开。22眼前房均形成。眼压稳定。结论睫状环阻塞性青光眼是多种因素并存的难治性青光眼，经过早期、及时、准确的药物及手术治疗可取得良好的效果。     

Improving the function of the visual system in children with aphakia

Systematic reeducation by pleoptic-orthoptic exercises was performed in children with posttraumatic and congenital aphakia for the improvement of the visual acuity, normal retinal fixation and binocular vision. The treatment comprised 244 children aged 1-16 years who were formerly given a correcting contact lens on the aphakic eye. In the result of rehabilitation a visual acuity of over 5/16 was attained in 79.5 per cent of cases, a normal retinal fixation in 73.77 per cent and the binocular vision in 46.31 p.c. Better results were obtained after treatment of a posttraumatic cataract, poorer results after extraction of a congenital cataract.     

Second malignant neoplasms in children with retinoblastoma: the St. Jude Children's Research Hospital experience

A retrospective review of 172 children with primary diagnosis of retinoblastoma (rb) was completed at St. Jude Children's Research Hospital to evaluate the incidence of second malignant neoplasm (smn) development. Sixty-five patients presented with bilateral rb and 107 with unilateral rb. During follow-up, which ranged from 6 to 340 months (median = 170 months), 6 children (3.5%) developed smn. All patients who developed smn presented with bilateral disease (n = 5) or asynchronous bilateral disease (n = 1); two patients had a family history of rb. All had received irradiation. Four patients developed osteogenic sarcoma within this irradiated volume, one developed a basal cell carcinoma in the temporal region (within the irradiation field), and one was diagnosed with a lower extremity Ewing's sarcoma. Time to development of smn ranged from 125 to 194 months post-irradiation. Initial irradiation total dose ranged between 32 and 45±76 Gy. Three patients were treated with anterior field irradiation and three received lens-sparing techniques (anterior/lateral n = 2, lateral n = 1). At last follow-up, 4/6 patients had died of smn. The crude incidence is 3.5% with an estimation of risk using the density method of 24% at 20 years for smn development. The specifics of the treatment associated with these second malignancies and the possible reasons for the reported incidence of smn will be discussed.     

Orbital neoplasms in children

The incidence, diagnosis and clinical picture of the orbital tumors in children are discussed on the basis of 49 personal cases. Discovered was the preponderance of primary non-malignant tumors. The most frequently encountered tumors were angiomas (27 p.c.), dermatomas (19 p.c.) lymphomas (8 p.c.) and among the malignant tumors--rhabdomyosarcoma (6 p.c.).     

Study of visual field and vigabatrin treatment in children

INTRODUCTION: Concentric visual field defects have been described in association with vigabatrin, a GABA mimetic antiepileptic agent. Few cases have been reported in children. METHODS: A systematic ophthalmological examination was performed in 14 children treated with vigabatrin for seizures. A manual kinetic perimetry test (Goldmann) was done in 11 cases. The ERG was recorded in the 3 cases where perimetry could not be done. RESULTS: All children were asymptomatic. The mean age was 9.6 years. The mean duration of vigabatrin treatment was 41 months. The visual field was abnormal when central and peripheral fields were constricted. A visual field defect was discovered in 6 cases: 4 were severe, 2 were mild. When vigabatrin treatment was stopped, 1 case became worse, 1 case was slightly better, and 1 case remained stationary. A disturbed ERG was found in 3 children (depressed b-wave, raised a/b ratio). CONCLUSION: The visual field defects discovered in children treated with vigabatrin are similar to those described in adults. The incidence and progression of visual field constriction in children with and after vigabatrin treatment are not yet well known. Children treated with vigabatrin should therefore have systematic and regular ophthalmological perimetry, and ERG examinations.     

Primary malignant neoplasms of the lacrimal gland.

The clinical characteristics and outcome of 50 primary malignant neoplasms of the lacrimal gland are reviewed: 38 (76%) adenoid cystic carcinomas, six (12%) carcinomas arising in pleomorphic adenoma, and six (12%) adenocarcinomas or other types of carcinoma. Most patients presented with a short history and pain, though pain tended to occur less often and later with adenocarcinoma than with adenoid cystic carcinoma. Pain was unrelated to the duration of symptoms, invasion of bone, loss of trigeminal nerve function, or the frequency and time of tumour recurrence. The estimated disease-free survival for patients with adenoid cystic carcinoma was significantly (p less than 0.01) reduced where half or more of the biopsy specimen showed basaloid differentiation. Eleven patients underwent extended cranio-orbital resection, and the others received a combination of total dacryoadenectomy adenectomy and/or radiotherapy. Survival after adenoid cystic carcinomas appears to be significantly (p less than 0.05) greater when tumour resection is combined with radiotherapy than after radiotherapy alone. At present, however, the rate of disease-free survival after treatment of adenoid cystic carcinoma appears unaltered by cranio-orbital resection, though these latter patients form a relatively greater proportion of those surviving for more than 10 years. Further long-term follow-up is needed to see if this technique does influence survival.     

眼睑恶性肿瘤发病的分子机制

眼睑恶性肿瘤是眼科常见病,其中眼睑基底细胞癌、鳞状细胞癌及眼睑皮脂腺癌最多见,并称眼睑3大恶性肿瘤。随着分子生物学技术的发展,研究发现多种因素参与眼睑恶性肿瘤发病过程,与其发病有关的癌基因、抑癌基因、细胞凋亡相关基因、细胞增殖相关因子、粘附因子、基底膜蛋白、端粒酶等,这些基因和蛋白的变异与眼睑恶性肿瘤的发生发展、分化程度、浸润转移、预后等密切相关。     

Dynamic topography of visual evoked potential in children: a study of the development of the visual system

To study the development of the visual system, the dynamic topography of the visual evoked potential (VDT) was investigated in 30 normal children aged from two weeks to four years. Twenty-three of the 30 children (77%) showed reliable VDT. The results showed three steps in the development of the visual system in these young children. The first step was seen during the first 4 months after birth, and it was represented by a shortening of duration and an increasing of amplitude in N70 in the occipital region. The second step was seen between 9 months and 2 years of age, and it was represented by a shortening of duration and an increasing of amplitude in P100 and P150 over a widespread area in the occipito-parieto-temporal region. The third step was not clearly seen until 3 years of age, and was represented by the appearance of P200, the so called "vertex potential", around the occipitoparietal region. These three steps in the development of the visual system seemed to be closely related to the time-course of the development in the myelination and maturation of the neuron synapses in the visual pathway and visual cortex. With the aid of VDT, it was possible to clarify that the visual system in children develops step by step from a low level to a high level of the visual function.     

多媒体视觉训练系统治疗儿童弱视疗效观察

目的:探讨多媒体视觉训练系统治疗儿童弱视的效果。方法:采用"多媒体视觉训练系统"治疗4～14岁儿童弱视患者38例68眼,治疗时间1疗程(3mo),对弱视的类型、程度、注视性质、治疗年龄与疗效的关系进行观察。结果:治疗1疗程后有效51眼,总有效率75%,其中基本治愈15眼(22%),进步36眼(53%),无效17眼(25%)。屈光不正性弱视、轻度弱视、中心注视性弱视和年龄4～6岁的弱视治疗有效率最高。结论:多媒体视觉训练系统将弱视训练与电脑游戏相结合,使弱视训练较传统方法有较强的趣味性和娱乐性,提高了弱视儿童的治疗积极性和顺应性,其治疗效果与传统的治疗方法相同。     

Congenital developmental anomalies of the visual system in children in our 13-year observations

Cases of congenital anomalies of the visual system in children hospitalized in the period 1974-1986 were analyzed. Together 305 cases were analyzed. The most frequently seen congenital anomaly was an unilateral or bilateral cataract (107 cases), further glaucoma (50 cases) and pathological changes caused by Toxoplasma Gondii (33 cases). Among principal causes of these anomalies the author ++ is citing the rubella and toxoplasmosis.     

联合个体化训练治疗大龄儿童屈光参差性弱视

目的探讨联合个体化训练治疗大龄儿童屈光参差性弱视的临床疗效。方法对45例9～14岁弱视患儿散瞳验光足矫配镜,每日遮盖健眼2～4h,周六和周日各遮6～10h。用DV-100视觉诱发电位分析系统检测患儿最佳的空间频率,以此为标准,制取相应的自律空间频率刺激和三级功能训练光盘进行训练,每眼10min/d。当矫正视力低于0.6时,用自律空间频率刺激光盘训练以提高视力。当矫正视力提到0.6时,用三级功能训练光盘训练以提高并巩固视力,直至视力提高到1.0。结果随访1年,视力提高到0.9及以上者33例,视力提高2行或2行以上者7例,无效5例。结论通过联合个体化训练既可增进视力,巩固疗效,又可促使双眼视功能的建立。     

Organic changes of the visual system rendering difficult the attainment of binocular vision in children

The authoress analyses 36 cases of children with organic changes of the visual system who revealed secondary squint. She tries to give evidence that the presence of structural changes makes difficult the treatment of squint and very often the organic changes are superimposed by functional changes.