锯齿缘离断与外伤关系的分析

在2100例视网膜脱离手术眼中有78眼(70人)为锯齿缘离断,发病率为3.71％。8例为双眼。其中67.1％有挫伤。单侧锯齿缘离断有挫伤史者46例(74.2％)、双侧有挫伤史者1例(12.5％)。锯齿缘离断范围大于90°的占大多数(85.7％)。由直接挫伤所致的锯齿缘离断多在鼻上方,常并发玻璃体基础部脱离。在颞下方的锯齿缘离断,外伤性者占30.2％,自发性者占69.8％。手术宜用巩膜缩短加阔肌膜填充垫压,如并发ⅢA或ⅢB膜形成则宜环扎加压。复位率为93.4％。文中讨论了手术中的并发症。     

视网膜脱离合并视网膜囊肿18例临床分析

报告18例（19只眼）视网膜脱离合并视网膜囊肿。视网膜囊肿多继发于陈旧性视网膜脱离，位于周边部。由视网膜囊样变性引起，在囊肿周围常存在小的锯齿缘离断和裂孔。只要手术封闭裂孔，视网膜复位，囊肿可逐渐消失，预后良好。 （中华眼底病杂志，1995，11：90-91）     

外伤性锯齿缘离断48例行激光光凝临床疗效分析

目的 分析外伤性锯齿缘离断行激光光凝的治疗效果.方法 回顾性分析48例(眼)锯齿缘离断,大部分伴视网膜浅脱离患者,行局限性视网膜激光光凝术.结果 48例(眼)中除2眼发现限局性视网膜脱离,又行巩膜外垫压复位术,术后复位,其余46例(眼)均未发现视网膜脱离,随诊观察3～6个月,治疗有效率达95.83%.结论 通过本组病例观察可见,激光光凝治疗外伤性锯齿缘离断是安全、简便、有效,对单纯锯齿缘离断可预防视网膜脱离的发生,且对伴有限局性视网膜脱离患者有治疗作用.     

挫伤性视网膜脱离疗效相关因素分析

目的 分析影响挫伤性视网膜脱离疗效的有关因素。方法 回顾了９６例视网膜破裂的部位,外伤到网脱的间隔时间,手术复 率及视力。结果 在视网膜破裂的病例中,１７例巨大裂孔及锯齿缘离断,其中１２例位于颞下象限,５３眼不规则裂孔。伤后１周内诊断出破裂性视网膜脱离８例,伤后１周－６周内３９例。     

眼球钝挫伤致视网膜脱离的临床观察

目的观察眼球钝挫伤所致视网膜脱离的临床特点及手术预后。方法对本院1999年1月～2002年1月收治的36例36只眼钝挫伤所致视网膜脱离患者的临床资料进行了回顾性分析。结果本组病例巨大裂孔(≥90°)3只眼(8.3％)，其中2只眼裂孔位于颞侧偏上方，1只眼仅有鼻下方视网膜相连；锯齿缘离断4只眼(11.1％)；黄斑裂孔4只眼(11．1％)；未发现裂孔的增生性玻璃体视网膜病变(PVR)视网膜脱离3只眼(8.3％)；其他部位的裂孔(<90°)22只眼(61．2％)，其中颞侧近周边部裂孔9只眼(25.O％)，鼻侧近周边部裂孔5只眼(14.O％)，近后极部裂孔8只眼(22.2％)。36只眼均有不同程度的 PVR，PVRC1以下14只眼(38.8％)，PVRC1或以上22只眼(61.2％)，其中c1～c3 11只眼(30.6％)， D1～D2 27只眼(19.5％)，D3者4只眼(11．1％)。从外伤到视网膜脱离的间隔时间最短为1 d，最长为22个月，以1～8周为常见(69.4％)。32只眼(88.8％)，手术后视网膜完全复位；手术前后视力经统计学处理，差异有显著性的意义(χ2=27.174，P相似文献   

巩膜外路手术联合术后眼底激光治疗孔源性视网膜脱离

目的讨论巩膜外路手术联合术后眼底激光治疗单纯孔缘性视网膜脱离的临床疗效。方法对591例592眼单纯性视网膜脱离病人行巩膜外路手术，包括：巩膜外加压、放液或不放液，部分病人联合环扎或玻璃体腔注C，R气体，术后氩激光或532激光治疗视网膜裂孔。结果视力提高414眼，不变166眼，下降12眼。视网膜复位情况：完全复位561眼（成功率95％），部分复位24眼，未复位7眼。接受一次手术558眼，接受二次手术（包括玻璃体手术）29眼，接受三次手术1眼，7例7眼病人自动放弃。视网膜复位不良手术失败的原因依次为：玻璃体出血、脉络膜脱离型网脱、马蹄形视网膜裂孔伴牵引、黄斑裂孔、锯齿缘离断，以上均与PVR关系密切。结论选择适当病例，巩膜外路手术联合术后激光治疗孔源性视网膜脱离是一种安全、可行、简便、易操作、效果良好的方法。     

超声生物显微镜下观察锯齿缘截离

目的运用超声生物显微镜观察存在于锯齿缘的截离,以期为诊断周边部视网膜裂孔提供一条新的途径。方法对14例(14眼)临床检查未发现明确的视网膜裂孔的视网膜脱离患者,通过超声生物显微镜(ultrasound biomi-croscopy,UBM)检查锯齿缘截离的存在情况。结果经过UBM检查的14例患者均提示存在锯齿缘截离,其中2例未在本院手术而失访。其余12例中有11例通过手术证实锯齿缘截离的存在,并且证实了UBM下裂孔定位的准确性,1例术中未发现锯齿缘截离的存在。在UBM检查中发现周边部视网膜存在囊变的有7眼(7/12),裂孔往往位于囊变发生的部位;裂孔类型为Ⅰ型6眼,裂孔类型为Ⅱ型的5眼。裂孔的类型与裂孔存在的部位无关。结论运用UBM,我们能够较为方便地观察玻璃体基底部和周边部视网膜,并且不受屈光间质的影响,它为周边部视网膜裂孔诊断提供了一种新的方法。     

眼球穿孔伤牵拉性网脱37例临床分析

３７例眼球穿孔伤牵拉性网脱病人中３２例为球内异物，５例为锐器伤。视网膜复位２９例，部分复位３例，失败５例。２４眼有视网膜裂孔，其形态有锯齿缘离断、马蹄孔、圆孔、视网膜裂孔伤４种。手术采用常规网脱手术或玻璃体手术。对玻璃体丢失较多而形成的扇形膜强调手术彻底清除增殖膜及其周围玻璃体，对有视网膜嵌顿的病例同时行松解性视网膜切开术。     

青少年视网膜脱离21例

2001／2004我科收治20岁以下青少年视网膜脱离病例21例,全部为单眼发病,男18例(86％),有眼部钝挫伤史9例(43％),外伤时间：3mo～6a。眼球穿通伤后继发视网膜脱离病例不作为此次统计对象。高度近视眼5例(24％),低至中度近视8例(38％),正视眼8例(38％)。视网膜脱离1个象限2例(10％),2个象限13例(61％),3个象限2例(10％),全脱离4例(19％)。除4例未查见裂孔外,其余17例均为周边部及锯齿缘部裂孔。萎缩型裂孔8例(38％),牵引型裂孔3例(14％),锯齿缘截离6例(29％)。单个裂孔14例(67％),2个以上裂孔3例(14％),未发现裂孔4例(19％)。     

玻璃体切除合并注气治疗巨大锯齿缘离断的视网膜脱离

对于超过180°的巨大锯齿缘离断的视网膜脱离,过去的手术方法是不满意的,成功率很低(11%至25%)。关键在于不能使脱离的视网膜皱折展开,原因如下:①裂孔太大,即使脱离的视网膜可以活动,一部分复位时,另一部分又发生皱折;②玻璃体积聚在脱离的视网膜后面;③玻     

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.