手术治疗先天性眼球震颤合并斜视

目的 探讨先天性眼球震颤合并斜视的手术方法和效果.方法 回顾性分析先天性眼球震颤合并斜视手术24例.手术的设计根据中间带位置、代偿头位、斜视角度和主导眼的关系进行综合考虑,代偿头位矫正在主导眼上施行,斜视矫正在非主导眼上施行.结果 手术后随访3 ～12个月,平均（6.38±2.18）月.20例（83.33％）术后代偿头位消失,3例（12.50％）代偿头位明显改善,残留原方向15°以内头位扭转角,1例（4.17％）过矫.18例（75.00％）术后眼位达到正位,5例（20.83％）达到轻度欠矫或过矫,1例（4.17％）明显欠矫.所有病例原在位眼震减轻或消失,原在位双眼同时视视力均较术前提高2行或2行以上.术前术后双眼同时视视力及头位扭转角变化差异均有统计学意义（z=-5.83,-3.37,P ＜0.01）.结论 合并有斜视的先天性眼球震颤,手术既要矫正斜视又要解决代偿头位,合理的手术设计可以取得良好的治疗效果.     

先天性特发性眼球震颤合并水平斜视的手术治疗

目的:探讨先天性特发性眼球震颤合并水平斜视的手术治疗方法。方法:对27例合并水平斜视的先天性特发性眼球震颤患者,采用主导眼中间带移位术联合斜视眼斜视矫正术。结果:在27例患者中,所有患者主导眼第1眼位视力均提高2行以上,22例代偿头位消失,明显改善5例,术后25例患者眼位映光基本正位(±5°以内),2例患者眼位映光在±5°～±10°,部分患者双眼视功能较术前有所好转。结论:对合并水平斜视的先天性特发性眼球震颤行主导眼中间带移位术联合斜视眼斜视矫正术,不仅能改善原在位视力,矫正代偿头位和斜视,还有利于双眼视的建立。     

先天性眼球震颤手术疗效的临床观察

目的探讨先天性眼球震颤的治疗方法。方法总结26例先天性眼球震颤采用parks(部分调整)法手术,合并水平斜视者同时进行斜视矫正手术。结果26中代偿头位消失21例,明显改善5例,建立双眼单视功能19例。结论采用parks(部分调整)法治疗先天性眼球震颤不仅可以矫正代偿头位和斜视,还有利于双眼单视功能的建立。     

先天性特发眼球震颤合并斜视手术治疗的研究

目的 探讨先天性特发眼球震颤(CIN)合并斜视手术设计方案及手术疗效.设计回顾性病例系列.研究对象66例先天性眼球震颤合并斜视患者,其中合并共同性内斜视22例,内斜视V征5例,共同性外斜视5例,外斜视A征4例,间歇性外斜视3例,麻痹性斜视11例,眼球后退综合征2例,垂直分离性斜视3例,Helveston综合征1例.方法 手术方式设计综合考虑患者的双眼视的状态、注视眼、视力是否平衡、麻痹性斜视的代偿头位和眼球震颤中间带的代偿头位,在改善代偿头位的基础上矫正斜视.主要指标代偿头位扭转角,第一眼位的双眼视力.结果 手术后随访3～12个月,平均6个月.术后头位消失占70.8%,明显改善占29.2%;在第一眼位术后视功能获得改善的患者占89.3%.结论 合并有斜视的先天性特发眼球震颤的手术治疗既要解决斜视问题也要解决代偿头位.合理的手术设计是获得较好结果的前提.(眼科,2009,18:55-58)     

手术治疗伴有斜视的先天性冲动型眼球震颤

目的探讨先天性冲动型眼球震颤合并斜视的手术治疗方法及效果。方法回顾性分析行手术治疗的先天性冲动型眼球震颤伴有斜视11例,所有患者均根据中间带位置、代偿头位、斜视角度和注视眼的关系进行中间带的移位以及斜视的矫正。结果9例术后代偿头位完全改善,1例术后残留15°面转角,1例残留10°上斜视,所有患者原在位视力均提高两行以上。结论通过中间带移位及斜视度叠加矫正斜视,可以明显改善先天性冲动型眼球震颤的代偿头位及外观,并能提高第一眼位的双眼视力。     

先天性冲动型眼球震颤合并共转性斜视的手术治疗

目的 探讨先天性冲动型眼球震颤合并共转性斜视的手术治疗效果。方法 对我院1995～2001年收治的118例水平性共转性斜视，其中10例合并先天性冲动型眼球震颤患者的手术方式和疗效作回顾分析。设计手术时，先将眼球震颤和斜视的手术矫正量分开计算，然后将手术量相加。结果 10例中9例术后正位，1位患者残留外斜视。9例患者术后第一眼位眼震明显减轻，代偿头位消失或明显改善，第一眼位最佳矫正视力均提高，视力增进1～5行。结论 先天性眼球震颤合并共转性斜视，既考虑眼震情况、静止眼位、代偿头位方向及度数，又考虑斜视性质、度数，注视眼眼别，两者可一并手术。     

手术治疗先天性眼球震颤疗效观察

目的 观察手术治疗先天性眼球震颤疗效方法对我院24例有代偿头位的先天性眼球震颤病人根据中间带、头位扭转角、斜视的性质以及主导眼之间的关系设计手术. 结果 24例先天性眼球震颤患者通过手术治疗均获得良好的效果.结论 手术效果与处理好中间带、扭转角、斜视度及主导眼之间的关系有关.     

先天性特发性眼球震颤手术疗效观察

目的为探讨先天性特发性眼球震颤手术治疗设计方法与效果。方法28例患者采用改良parks5-6-7-8法加减的原则，对头位扭转角、合并水平斜视和垂直斜视一次矫正，而转角的手术量设计在注视眼上，而转角矫正后带来的斜视度变化与原斜视度叠加或抵消后，把矫正斜视的手术量设计在斜视眼上。结果28例患者术后观察324个月，原在位双眼视力均较术前提高2-4行，原在位眼颤明显减轻或消失，代偿头位基本消失者26例（92．8％），所有伴斜视的患者外观矫正效果满意，结论我们的体会足手术前明确注视眼，中间带位置，而转方向及角度，斜视性质及斜视度，以及它们之间的相互关系是正确设计手术前提。parks法适合矫正代偿头位15°的先天性特发性眼球震颤。     

先天性眼球震颤手术后远期疗效的随访观察

先天性眼球震颤,特别是合并有斜视时,临床处理较为困难.部分病例可以通过手术治疗改善临床症状,提高原在位视力.我院自1990～2001年问采用Parks法矫正先天性眼球震颤代偿头位,合并水平斜视者17例同时矫正,收到较为满意的效果.现报告结果如下:     

先天性水平性眼球震颤的Parks理想眼位矫正术的疗效观察

目的 探讨Parks理想眼位矫正术治疗先天性眼球震颤的手术设计和效果。方法 对19例先天性水平性眼球震颤均采用Parks理想眼位矫正法手术治疗，并追踪观察术后疗效。结果 绝大多数患者相对休止眼位移至正前方，头位改善，视力提高。结论 采用Parks理想眼位矫正术，适合于伴或不伴斜视的先天性水平性眼球震颤。     

超声乳化联合前房角分离治疗伴白内障的青光眼

目的：：观察晶状体超声乳化联合前房角分离术对伴有白内障的慢性闭角型青光眼患者的治疗效果。方法：无并发症伴有白内障的慢性闭角型青光眼50例50眼,施行晶状体超声乳化吸出人工晶状体植入联合前房角分离术。术后随访3mo,记录并比较术前及术后最佳矫正视力、眼压、前房深度及前房角。各指标均采用均数±标准差(x±s)表示,术前及术后3mo的最佳矫正视力、眼压、前房深度及前房角的情况进行比较。结果：术后3 mo的最佳矫正视力较术前明显提高,差异有统计学意义( t=8.76, P=0.001);术后3 mo 的眼压为15.63±3.11mmHg,较术前(45.12±5.30mmHg)明显下降,差异有统计学意义(t=6.27,P=0.000);术后3mo的前房深度为3.57±0.02mm,较术前(1.43±0.25mm)明显加深,差异有统计学意义(t=8.16,P=0.001);术前、术后前房角情况的比较,差异有统计学意义(Z=-4.432,P=0.000;Z=-2.432,P=0.016;Z=-4.379,P=0.000;Z=-4.538, P=0.000)。结论：晶状体超声乳化吸出人工晶状体植入联合前房角分离术治疗伴有白内障的慢性闭角型青光眼,能够有效控制眼压,提高视力,是一种安全、有效的手术方法。     

环喷托酯在屈光参差儿童散瞳验光中的应用

目的比较分析1%盐酸环喷托酯与1%阿托品对3~12岁屈光参差儿童散瞳验光效果。设计回顾性病例系列。研究对象2010年10月~2011年2月在北京同仁医院眼科斜弱视门诊就诊的3~12岁屈光参差儿童40例(80眼)。方法对以上40例患儿按年龄分成3组,即3~6岁组,7~9岁组和10~12岁组。全部患儿均首先用1%盐酸环喷托酯进行散瞳验光,待其瞳孔完全恢复正常(1周后)再行1%阿托品散瞳验光,比较两种方法的验光结果。主要指标屈光值(球镜度数、柱镜度数及轴向)。结果用1%盐酸环喷托酯散瞳验光结果(球镜:+1.18 D±4.90 D,柱镜:+1.47 D±1.16 D,散光轴向:80.50°±38.62°)与用1%阿托品散瞳验光结果(球镜:+1.20 D±4.91 D,柱镜:+1.47 D±1.15 D,散光轴向:80.06°±38.48°)比较,差异均无统计学意义(P均>0.05)。在80眼中,球镜值相同或相差≤0.50 D者77眼,符合率为96.25%;柱镜值在69眼中,结果相同或相差≤0.50 D者65眼,符合率为94.20%;散光轴向在69眼中,结果相同或相差≤5°者67眼,符合率为97.10%。三个年龄组间的球镜、柱镜和散光轴向符合率差异均无统计学意义(P均>0.05)。结论 1%盐酸环喷托酯可以替代1%阿托品用于3~12岁屈光参差儿童散瞳验光,其结果可以作为配镜的依据。     

滤过试验结合可拆缝线在小梁切除术中的应用

目的　探讨小梁切除术术中做滤过试验结合可拆缝线的应用对预测和控制术后滤过量及预防浅前房的疗效。方法　对 92例 ( 113眼 )原发性青光眼 ,在小梁切除术术中根据滤过试验结果来决定固定缝线和可拆缝线缝合的位置和数量。术后 1～ 7天 ,抽出可拆缝线。回顾性总结术中缝合种类、数量及术后前房深度、眼压、滤过泡、视野。结果　术中 40眼 ( 3 5 40 % )采用一针固定缝线和一至二针可拆缝线 ,5 1眼 ( 45 14 % )采用二针固定缝线和一至二针可拆缝线。术后无一例持续性浅前房。术后第 7天眼压平均 13 5± 3 3 0mmHg。追踪观察 6～ 2 4个月 ,形成功能性滤过泡 89眼( 78 76% ) ,眼压控制 <2 1mmHg 91眼 ( 80 5 3 % ) ,视野不变 98眼 ( 86 73 % )。结论　小梁切除术术中根据滤过试验的结果 ,通过对固定缝线和可拆缝线缝合的位置和数量的选择能有效预测和控制术后滤过量并预防术后浅前房     

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.     

合并成型性渗出的急性前葡萄膜炎与HLA-B27的相关性研究

目的 探讨急性渗出性前葡萄膜炎与HLA-B27的相关性。方法 对53例前房内出现成型性渗出的急性前葡萄膜炎（AAUPE）患者及61例前房内无成型性渗出的急性前葡萄膜炎（AAU）患者进行HLA-B27的检测,并结合临床表现加以分析。结果 成型性渗出的AAUPE患者的HLA-B27阳性率为100％,而无成型性渗出的AAU患者的HLA-B27阳性率仅为50.8％。二者有显著差异性（P<0.01）。两组HLA-B27阳性的病人强直性脊柱炎发生率分别为50.0％和42.9％。结论 结果进一步证实了HLA-B27与成型性渗出密切相关的论点。提示检测AAU患者HLA-B27的阳性率,发现成型性渗出裂隙灯检查似与血清法检测同样准确。     

小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的：观察小梁切除联合超声乳化白内障吸除术在原发性闭角型青光眼(包括急性闭角型青光眼与慢性闭角型青光眼)合并白内障患者中的临床治疗效果及对并发症的影响。

方法：选取2014-01/2016-07在我院诊治的青光眼合并白内障患者60例60眼,采用随机数字方法分为对照组(30例30眼)和观察组(30例30眼)。对照组采用小梁切除术治疗,观察组采用小梁切除联合超声乳化白内障吸除治疗,比较两组临床效果及并发症发生率情况。

结果：观察组术后视力与对照组相比差异无统计学意义(P>0.05); 观察组术后眼压水平低于对照组,差异有统计学意义(P<0.05); 观察组术后前房深度大于对照组,差异有统计学意义(P<0.05); 观察组术后并发症发生率为7%,显著低于对照组的23%,差异有统计学意义(P<0.05)。

结论：原发性闭角型青光眼合并白内障患者在小梁切除术基础上联合超声乳化白内障吸除术治疗效果理想,并发症发生率相对较低。     

Levodopa-carbidopa with occlusion in older children with amblyopia

PURPOSE: To study the role of levodopa-carbidopa in supplementing occlusion therapy in older children with strabismic or anisometropic amblyopia. Methods: A clinical study was performed on 40 amblyopic children (19 strabismic and 21 anisometropic), 6 to 18 years old (mean age, 10.9 years). They received an average dose of 1.86 mg/kg/day (1.33-2.36 mg/kg/day) of levodopa and carbidopa (4:1 ratio) or a placebo in 3 divided doses over a 4-week period, combined with full-time occlusion. The occlusion was continued for the study duration of 3 months. Early Treatment Diabetic Retinopathy Study visual acuity charts and Cambridge low-contrast gratings for contrast sensitivity (CS) were used to assess visual functions. Tolerance and compliance with occlusion and capsule consumption were assessed. RESULTS: Visual acuity of the nonamblyopic eye did not deteriorate during the study in either group. CS decreased by 22 units in the levodopa group and increased in the placebo group by 53 units at the first month. The CS in the levodopa group recovered later by the third month of follow-up. Both the levodopa and the placebo groups showed significant improvement in visual function in the amblyopic eye (P <.001). Overall changes in logarithm of minimum angle of resolution values and CS in the amblyopic eyes were similar in both groups (P >.05). Strabismic and anisometropic amblyopes did not behave differently. Drug tolerance, occlusion compliance, and capsule ingestion compliance were similar between the groups, with no significant side effects. CONCLUSIONS: Clinically, levodopa supplementation does not offer any advantage over occlusion alone. Moreover, the risk of occlusion amblyopia could increase with the use of drugs like levodopa that might affect the plasticity of the visual cortex.     

Phacotrabeculectomy with mitomycin C in patients with uveitis

PURPOSE: To evaluate the safety and efficacy of combined phacoemulsification, intraocular lens implantation, and trabeculectomy with mitomycin C for the management of uveitic complications. DESIGN: Retrospective case-control study. METHODS: We conducted a retrospective review of the records of 23 consecutive eyes with chronic noninfectious uveitis (uveitic group) and 43 nonuveitic eyes (control group) that had received primary phacotrabeculectomy. Mitomycin C was used in all the uveitic eyes. Considering the high preoperative intraocular pressure (IOP) of the uveitic group, nonuveitic eyes that had a preoperative IOP of >or=20 mm Hg or that had been given two or more medications were included in the control group. All patients were followed for at least one year. The main outcome measures were postoperative vision, IOP control, complications, and acute uveitis relapse rates. RESULTS: Visual outcome of the uveitic group was similar to the control group. In the uveitic group, the success rate of IOP control (91.3% at one year, 84.8% at two years) was favorable but was significantly lower than in the control group (P = .0423). Complications were comparable between the groups. Primary surgical failure in the uveitic group was associated with the postoperative acute uveitis attack. In the uveitic group, the acute uveitis attack rate showed no change after surgery (P = .283). CONCLUSION: With adequate inflammation suppression, phacotrabeculectomy with mitomycin C is an effective and safe therapeutic option for the management of secondary cataract and glaucoma in uveitic eyes. A lower surgical success rate of the uveitic group might be attributable to the postoperative inflammation recurrence.     

Epikeratoplasty with nonlyophilized tissue in children with aphakia

We studied 75 epikeratoplasty procedures using nonlyophilized tissue performed by eight ophthalmic surgeons in 70 eyes (47 patients) to correct for aphakia in children less than 8 years of age (mean age, 3.4 +/- 2.1 years). Of the 47 patients in the study, 24 were girls and 23 were boys; 23 patients had bilateral surgery. Seven of the epigrafts required removal; two were not replaced, and five underwent successful repeat epikeratoplasty. Overall, the success rate (that is, the percentage of epigrafts that remained optically and functionally clear throughout the course of this study) for the epikeratoplasty procedure was 89% (62 of 70 eyes) for initial surgery and 96% (67 of 70 eyes) for repeat surgery. The average spherical equivalent was +14.4 +/- 3.7 diopters preoperatively and +0.3 +/- 2.9 diopters one year after the operation. One year after the final surgical procedure, 42 of 56 eyes (75%) were within 3 diopters of emmetropia. In the 29 verbal patients, best-corrected visual acuity was 20/100 or better in 25 (86.2%) one year after the operation.