白内障手术后斜视复视的病因分析和防治

目的探讨白内障手术后斜视、复视的临床表现,发病原因及防治措施.方法对白内障手术联合人工晶状体植入术后发生斜视、复视的31例患者(31眼)进行常规的视力、眼前节、眼底的检查,并进行了屈光、眼肌运动、复视像的检查.结果 31例患者中大部分受累肌为垂直肌,以下直肌受累更为多见,6例合并上睑下垂.大部分患者在3个月左右恢复正常眼位,2例出现永久性复视,年龄越大恢复越慢.结论白内障手术联合人工晶状体植入术后部分患者合并眼肌运动障碍,并引起斜视、复视,其发病原因可能与麻醉药物引起的眼肌毒性反应有关.早期治疗大部分患者可恢复双眼视觉,手术治疗有一定的效果.     

白内障摘除人工晶体植入术后复视的临床探讨

目的 探讨白内障摘除人工晶体植入术后复视的发病原因、机制及临床转归。方法 对白内障摘除人工晶体入术后２４例复视患者行视力、眼前节、眼底等常规检查,并进行屈光、眼肌运动、复视像检查,用三棱镜及同视机检查眼位及融合功能,部分患者行眼肌牵拉试验。结果 双眼复视１９例中,斜视性复视１７例,中枢融合障碍复视２例;斜视性复视中,除３例为间歇性外斜视外,其余１４例均有不同程度的眼肌运动障碍;单眼复视５例中,４例     

人工晶体植入术后复视

目的:本文报道7例人工晶体植入术后复视病例,并初步探讨其原因及预防。方法:随访60例单侧白内障摘除及人工晶体植入术连续病例。复视病例,检查复视类型、眼位、眼球活动度、屈光状态、瞳孔及眼底,并散瞳检查人工晶体位置。结果:本文报告白内障摘除及人工晶体植入术后复视发生率为11.67％。术前存在斜视,双眼融合功能障碍,局麻药物对眼外肌的毒性作用,人工晶体中心偏移,黄斑部病变及晶体后囊不均匀混浊等与术后复视有关。结论:复视是白内障摘除及人工晶体植入术后一个重要的并发症。其治疗往往较困难,根据复视的可能原因,采取预防措施对减少术后复视有帮助。眼科学报1997;13:210—212。     

伴有知觉性外斜视白内障患者79例的疗效观察

目的：评价超声乳化白内障吸除联合人工晶状体植入术对伴有知觉性外斜视的白内障患者的疗效。方法：通过前瞻性研究观察伴有知觉性外斜视的白内障患者79例,行超声乳化白内障吸除联合人工晶状体植入术。于术前、术后1,3mo观察其视力、眼位、双眼视功能及复视情况。并对眼位改善情况、复视情况与引起知觉性斜视的原因做相关分析。结果：术后随访3mo,术后1mo最佳矫正视力≥0.3的有48例,其中≥0.5的有31例,≤0.02有8例。53例患者术后1～3mo外斜眼位均已自发纠正,且获得不同程度双眼视功能恢复。术后3mo,30例患者复视消失。单纯由白内障所致的知觉性斜视患者术后视力、眼位及复视均改善优于其他眼病所致的白内障患者。结论：对于伴有知觉性斜视的白内障患者作相应的治疗,斜视程度可以得到一定的改善。     

眼科手术后斜视和复视的临床分析

目的　探讨眼科手术后继发性斜视的发生机制和防治方法。方法　检查 79例不同眼科手术后发生继发性斜视患者的眼位、眼球运动、复视及预后情况 ,并进行牵拉试验。对部分患者行斜视矫正术 ,术中观察眼部受累组织的情况。结果　在全部患者中 ,视网膜脱离术后患者占 38 0 %(30 / 79) ,白内障摘除手术后患者占 31 7% (2 5 / 79) ,眼眶手术后患者占 13 9% (11/ 79) ,其他为青光眼、翼状胬肉及上睑下垂术后患者。视网膜脱离手术和白内障摘除手术后部分继发性斜视症状持续时间 >6个月的患者 ,受累肌纤维化并 (或 )与结膜、巩膜及外加压物广泛粘连 ,牵拉试验呈阳性 ;眼眶手术后患者眼球主要表现为牵制性运动障碍 ;翼状胬肉切除术后患者内直肌及其周围组织损伤明显 ;抗青光眼手术后患者继发性斜视症状于术后 2～ 14d自行缓解。结论　内眼和外眼手术均可导致继发性斜视的发生 ;斜视的发生机制主要包括眼肌损伤、限制及机械压迫 3个因素。眼科手术医师应高度重视 ,积极采取针对性预防和治疗措施。     

小切口白内障囊外摘除人工晶状体植入术治疗高度近视眼并发白内障的临床观察

目的探讨小切口白内障囊外摘除人工晶状体植入术治疗高度近视眼并发白内障的临床效果。方法 83例(109只眼)高度近视眼并发白内障患者采用小切口白内障囊外摘除人工晶状体植入术,观察术中、术后并发症及术后视力恢复情况。结果术后矫正视力>0.2者98只眼(89.9%),>0.5者76只眼(69.7%);术中后囊膜破裂8例,术后角膜水肿12只眼,一次性高眼压2只眼,后发障28只眼,术后发现黄斑变性3只眼。结论小切口白内障囊外摘除人工晶状体植入术治疗高度近视眼并发白内障,术中、术后并发症少,术后患眼视力恢复好,且对手术设备要求不高,适应于基层医院开展。     

单眼严重白内障伴外斜视患者临床疗效观察

目的：观察单眼严重白内障合并外斜视患者术后临床效果。 方法：回顾我院2010-03/2012-12单眼严重白内障合并外斜视行白内障摘除联合人工晶状体植入手术的患者资料45例。术前44例较差眼视力均〈0.05,1例2岁患儿无法配合视力检查。随诊观察术后6mo患者的最佳矫正视力、眼底、斜视度、双眼单视功能及复视情况。 结果：先天性白内障患者2例中有1例患儿2岁,无法配合视力及复视检查,眼底正常;另1例患儿术后无同时知觉,无复视。5例不明原因中青年单眼白内障患者中,有3例患者术后视力〉0.6,眼底正常,术后眼位正,有双眼单视;2例患者术后视力为指数,眼底有异常,术后斜视度与术前无变化,无同时知觉,无复视。38例老年性白内障患者中,有31例患者术后有双眼单视;3例患者术后斜视度与术前无差异,无同时知觉,无复视;3例患者术后斜视度与术前无差异,有复视,6mo内复视均自行消除;1例患者外斜10o,术后出现复视,且6mo内无改善,可用12？矫正,建议戴镜治疗。 结论：单眼严重视力障碍合并外斜视的成年患者多数术后可自行纠正眼位,获得一定的双眼单视功能。     

糖尿病白内障囊外摘除联合后房型人工晶状体植入术临床观察

目的观察糖尿病患者白内障手术摘除联合后房型人工晶状体植入术的临床疗效及并发症。方法对63例（63只眼）糖尿病白内障患者施行白内障囊外摘除联合人工晶状体植入术（ECCE＋IOL）,并以63例（63只眼）非糖尿病白内障患者施行相同术式白内障摘除联合后房型人工晶状体植入术作为对照。结果糖尿病患者术后并发症为：角膜内皮水肿19只眼（占30.1%）,前房纤维渗出10只眼（占15.8%）,瞳孔后粘连14只眼（占22.2%）,后囊混蚀26只眼（占41.2%）,色素弥散晶状体表面1只眼（占1.6%）。糖尿病患者明显高于非糖尿病患者。术后视力糖尿病与非糖尿病无明显差异,糖尿病患者术后矫正视力≥0.5%者为39只眼（占61.9%）,≥0.3者为52只眼（占82.5%）。结论糖尿病白内障患者术前应将血糖控制稳定在5.1～8.0 mmol/L之间,施行白内障囊外摘除联合后房型人工晶状体植入,疗效满意,并发症少。     

白内障术后垂直斜视的治疗观察

目的探讨白内障摘除人工晶体植入术后垂直斜视的原因、表现和治疗方法.方法对9例白内障摘除人工晶体植入术后出现垂直斜视的患者进行角膜映光、眼球运动、三棱镜加Maddox杆、同视机、Hess屏及牵拉试验检查.并采用神经营养,地塞米松肌腹旁注射及手术治疗.结果9例患者中3例表现为上直肌受累,6例为下直肌受累;其中左眼受累7例,右眼受累2例;上直肌受累表现为肌肉不全麻痹,下直肌受累3例表现为肌肉亢进,3例表现为肌肉不全麻痹.7例经非手术治疗治愈,2例经手术治疗治愈.结论白内障术后垂直斜视的病人多数经非手术治疗可治愈,地塞米松肌腹旁注射对这种病人有一定价值.     

两种不同术式治疗高度近视白内障的疗效对比

目的:评价两种不同手术方式治疗高度近视白内障疗效。方法:患者48例(65眼),其中30眼行囊外摘除,35眼行超声乳化摘除,术后均植入相应度数的人工晶状体。结果:术后视力较术前有明显提高,囊外摘除术后矫正视力与超声乳化术后矫正视力差异有显著性(︱t︱=2.867,P=0.006)。囊外摘除术后后囊膜轻度混浊4眼,局限性视网膜脱离2眼;超声乳化术后黄斑囊样水肿1眼,未见视网膜脱离。结论:晶状体摘除联合人工晶状体植入术作为治疗高度近视白内障的方法是有效的,超声乳化联合人工晶状体植入术与白内障囊外摘除联合人工晶状体植入术相比,安全性更高。     

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.