改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

原发性虹膜睫状体囊肿的超声生物显微镜检测

目的　探讨超声生物显微镜 (UBM)在原发性虹膜睫状体囊肿诊断中的应用价值。方法　用UBM对1 1 6 5例 (2 1 2 7只眼 ) ,无眼外伤、手术史的患者进行眼前段检查。结果　 1 1 6 5例 (2 1 2 7只眼 )中发现原发性虹膜睫状体囊肿 6 0例 (77只眼 ) ,检出率占被检眼数的 3 6 2 %。其中单发性囊肿 37例 (4 8只眼 )占 6 2 34% ,多发性囊肿2 3例 (2 9只眼 )占 37 6 6 %。囊肿水平直径最大 4 2 3mm ;最小 0 33mm ;平均 (1 1 5± 0 6 7)mm。囊肿垂直直径最大1 86mm ;最小 0 1 7mm ;平均 (0 6 5± 0 2 9)mm。 77只眼共检出囊肿 1 1 2个 ,其中位于颞侧 5 1个 ,占 4 5 5 4 % ;下方 4 5个 ,占 4 0 1 8% ;鼻侧 1 0个 ,占 8 93% ;上方 6个 ,占 5 36 %。结论　UBM能客观地检测出原发性虹膜睫状体囊肿 ,提供囊肿的大小、位置及数量信息。原发性虹膜睫状体囊肿好发于颞侧及下方     

晶状体在原发性闭角型青光眼发病机制和治疗中的作用

原发性闭角型青光眼(PACG)的发病机制包括传统的瞳孔阻滞、非瞳孔阻滞、多种机制共存等类型。实际上,随着年龄增长晶状体阻滞因素在PACG发病中起着十分重要的作用。对PACG抗青光眼术后及晶状体摘除术后眼前段结构变化的研究发现,超声乳化白内障吸出联合人工晶状体植入术可有效地同时解决房角关闭的多个机制。临床医师在选择手术方式时,除考虑患者自身条件外,还应考虑术者对手术的娴熟程度、手术仪器和器械等条件是否适合开展此手术,以使患者得到最佳的眼压控制和良好的视觉质量。     

光动力疗法治疗有无伴发黄斑囊样水肿脉络膜新生血管的疗效观察

目的 观察光动力疗法（PDT）治疗渗出型老年性黄斑变性（AMD）脉络膜新生血管（CNV）有无伴发黄斑囊样水肿（CME）的临床疗效。方法 回顾分析经临床确诊为渗出型AMD并接受PDT治疗的的44例患者54只眼的临床资料。其中,CNV伴黄斑CME者16例21只眼,不伴CME者28例33只眼。所有患者治疗前及治疗后每3个月采用糖尿病早期治疗研究（ETDRS）视力表检查视力、光相干断层扫描（OCT）检测黄斑水肿和黄斑中心小凹处层间厚度（BFT）。治疗后随访3~18个月,平均随访8.3个月。结果 末次随访时,伴CME组ETDRS字母数为（29.429±17.907）个,与治疗前相比,差异无统计学意义（t=-0.389,P=0.701）;OCT检查显示BFT为（316.429±77.161) μm,与治疗前相比,差异有统计学意义（t=2.246,P=0.019）。不伴CME组ETDRS字母数为（48.121±17.911）个,OCT检查显示BFT为(244.667±37.619) μm,与治疗前相比,差异均有统计学意义（t=-3.424,6.880;P=0.002,0.000）。两组间治疗前后ETDRS视力提高字母数和BFT提高值差异均有统计学意义（t=-2.194,2.212;P=0.033,0.031）。结论 PDT治疗渗出型AMD CNV不伴CME患者的临床疗效优于CNV伴CME者。     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.     

原发性慢性闭角型青光眼视网膜神经纤维层损害及相关因素研究

目的 观察原发性慢性闭角型青光眼患者(chronic primary angle closure glaucoma,CACG)活体视网膜神经纤维层(retinal nerve fiberlayer thickness,RNFL)损害;分析CACG不同房角粘连程度间RNFL差异及平均RNFL厚度和视野平均缺损(mean visual fielddefects,MD)的相关性.方法 对CACG患者36例(64只眼)和正常人82名(82只眼)用光学相干断层扫描仪(optical coherence tomography,OCT)测量RNFL厚度,比较两者间的差异;比较CACG中无房角粘连、房角粘连范嗣＜1/2和≥1/2圆周眼的RNFL损害的差异;对CACG平均RNFL与相应视野的MD值进行Pearson直线相关分析.结果 CACG平均RNFL(80.61±23.96)μm与正常人(103.7±9.92)μm比较有统计学差异(P＜0.05);CACG平均RNFL厚度在无房角粘连眼(98.46±12.34)μm、粘连范围＜1/2(93.93±14.78)μm和粘连≥1,2圆周眼(69.78±23.82)μm的RNFL的差异有统计学意义(P＜0.05).CACG平均RNFL厚度与视野缺损(MD值)呈正相关(r=0.652,P＜0.001).结论 CACG的RNFL较正常人明显减少;随着CACG病程的发展,平均RNFL厚度减少,视野平均缺损增加.     

中心性浆液性脉络膜视网膜病变频域光相干断层扫描与时域光相干断层扫描图像比较

Objective To compare difference of the cross-sectional pathological imaging and quantitative measurement of central serous chorioretinopathy (CSC) between time-and fourier-domain optical coherence tomography (OCT). Methods Consecutive 26 patients (26 eyes) with unilaterial CSC were subsumed. Bilateral eyes of all the patients underwent time-and fourier-domain OCT. Horizontal and vertical line scanning and radial six-line scanning protocols were used for time-domain OCT examination; horizontal and vertical high resolution five-line scanning and macular cube scanning protocols were used for fourier-domain OCT examination. The characteristics of OCT images, retinal segmentation and the quantitative measurement were compared between these two methods. Results Fourier-domain OCT could yield the three-dimensional images of surface of inner limiting membrane (ILM) and RPE. The band of external limiting membrane (ELM) of normal subjects and CSC patients, and the inner segment and outer segment (IS/OS) of normal subjects could be clearly shown by fourier-domain OCT. However, the band of IS/OS disappeared in 65.4 % of the CSC patients. The outer boundary of retina was defined in front of the retinal pigmental epithelia (RPE) by fourier-domain OCT. The foveal thickness of normal subjects and CSC patients was (180. 50 ±12.69) and (158. 41 ± 34.20) μm, respevtively. The height of detachment of neuralepithelial layer was (245.84± 154.61) μm measured by fourier-domain OCT. The band of IS/OS of normalsubjects could be clearly shown by time-domain OCT. However, the band of IS/OS disappeared in 73.4%of the CSC patients, which showed no difference with fourier-domain OCT (Z=-0. 108, P=0. 914). Theouter boundary of retina was defined in front of the IS/OS band by OCT. The foveal thickness of normal subjects was (141.16±12.75) μm, which was thinner than that measured by fourier-domain OCT (t= 20. 671,P= 0. 000). The foveal thickness and the height of detachment of neural epithelial layer was (146.40± 36.28) μm and (240. 32±156. 82) μm measured by time-domain OCT, respectively, which showed no significant difference with which measured by fourier-domain OCT (t value was from 0. 026 to 1. 517, P value was from 0. 144 to 0. 980). Conclusions Fourier-domain OCT yields better visualization of intraretinal layers and more accurate definition of outer boundary of retina than time-domain OCT. Thus the measurements by fourier-domain OCT were more accurate. Moreover, three-dimensional images of CSC shown by fourier-domain OCT enable the comprehensive observation of pathological morphology and location.     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

目的 观察外伤性黄斑裂孔的光相干断层扫描（OCT）形态特征及其临床意义。方法 对采用国际标准视力表、裂隙灯显微镜、直接或间接检眼镜、三面镜检查确诊的74例闭合性眼外伤致黄斑裂孔患者74只眼进行光相干断层扫描（OCT）检查。利用OCT分析软件对外伤性黄斑裂孔进行定量测量,并根据OCT图像特征对外伤性黄斑裂孔进行分型。OCT检查完毕用Topcon眼底照相机进行眼底50°彩色照相。回顾分析患者黄斑裂孔与平均视力、病程、孔缘神经上皮层厚度、裂孔底径、孔径之间的相互关系。结果 74只眼的OCT图像特征可分为5种类型。其中,黄斑裂孔伴神经上皮层对称性水肿27只眼,占36.5%;黄斑裂孔伴神经上皮层不对称性水肿12只眼,占16.2%;单纯性黄斑裂孔14只眼占18.9%;黄斑裂孔伴神经上皮层局限性脱离17只眼,占23.0%;黄斑裂孔伴神经上皮层变薄4只眼,占5.4%。不同类型的黄斑裂孔之间视力比较,差异无统计学意义（F=1.574, P=0.191）;其视力与孔缘平均神经上皮层厚度呈正相关 （r＝0.342,P＝0.003）,与致伤时间、年龄、裂孔直径无明显相关关系（r＝-0.022～-0.134,P＝0.863～0.261）。黄 斑裂孔伴神经上皮层局限脱离者,病程较其它各型黄斑裂孔者病程短;病程90 d及以上的患者中,黄斑裂孔伴神经上皮层对称性水肿最多。各型黄斑裂孔的孔缘神经上皮层厚度之间比较,差异有统计学意义（F=13.921, P=0.000）。结论 外伤性黄斑裂孔可根据OCT形态特征分为5种类型,不同类型的外伤性黄斑裂孔临床特征存在差异。     

干扰素α-2b用于早期滤过泡失败的再治疗

为探讨青光眼滤过性手术后早期滤过泡失败的再治疗及应用干扰素α－２ｂ（ＩＦＮα－２ｂ）的疗效，我们采取前瞻性研究方法，应用ＩＦＮα－２ｂ对２１例２６只眼早期滤过泡失败的病例进行滤过泡针刺分离和球结膜下注射，其中早期滤过泡疤痕化或疤痕倾向１９只眼，包裹性囊状泡７只眼。所有患眼接受小梁切除术时，术中曾应用过抗代谢药ＭＭＣ（０．２ｍｇ／ｍｌ－０．３ｍｇ／ｍｌ）。术后发生滤过泡失败的时间平均２２．０±８．７天。结果：随访时间最长１３个月，最短６个月，平均９．４±１．９个月。治疗前平均眼压２３．２１±６．５ｍｍＨｇ，治疗后平均眼压１６．１０±５．１８ｍｍＨｇ，治疗前后眼压差异有显著性（Ｐ＜０．００１）。治疗后有１８只眼形成功能性滤过泡，治疗的完全成功率为６９．２％，条件成功率９２．３％。结论：应用ＩＦＮα－２ｂ对早期滤过泡失败病例进行针刺分离和注射治疗可获良好的疗效，可挽救一部分濒临失败的滤过泡，而且操作简单、安全、并发症少，具有比５－Ｆｕ更理想的优点。本文强调早期发现和早期治疗是治疗成功的关键。并提出利用ＵＢＭ技术监测滤过泡失败再治疗的效果是值得探讨的方法