复方士的宁点眼液治疗单疱性角膜炎临床疗效观察

本研究通过临床疗效观察对复方士的宁点眼液进行抗单纯疱疹性角膜炎的疗效比较研究，结果表明：复方士的宁点眼液具有较好的治疗单纯疱疹性角膜炎的作用，临床有效率及治愈率均达９０％以上，平均治愈日８．４４日，深浅层病例疗效均佳，该药易溶，性质稳定，无毒付作用及过敏反应，与其他抗病毒药无交叉耐药。     

近视与眼内压相关关系的研究

目的 :通过对近视眼与眼内压相关关系的分析 ,进一步探讨近视眼与原发性开角性青光眼的内在联系。方法 :随机选取非青光眼性近视眼病人 148例 (2 70眼 ) ,除给予常规的裸眼视力、矫正视力、裂隙灯显微镜、眼底、视野等检查外 ,还均给予非接触眼压计眼压测量、自动验光仪散瞳验光、A型超声波眼轴测量检查 ,并对上述病人的屈光状态、眼轴长度、眼内压的相关关系进行统计分析。结果 :近视患者的眼内压与患者性别、眼别、年龄、视力无关 ;近视眼病人眼内压与眼轴长度呈正相关 (r =0 .18,P<0 .0 1,Y^ =4.85 +0 .44X ) ;中、低度近视组眼压均值无显著性差异 (t =1.5 6,P >0 .0 5 ) ,高度近视组眼压均值 (16.6± 2 .42 )mmHg高于中度近视组 (15 .3 3± 2 .77)mmHg。两组差异显著 (t =2 .75 ,P <0 .0 1) ;随眼内压增高 ,眼轴长度≥ 2 6mm者所占百分比有逐渐增高趋势。结论 :在非青光眼性近视眼 ,其屈光状态、眼轴长度与眼内压存在一定内在联系 ,尤其是随着近视程度、眼轴长度和眼内压的增加 ,这种联系更为密切。因此对眼压值偏高的近视眼或高度近视眼要给予高度重视     

眼科相关性头痛

头痛通常是内科及神经科临床常见症状之一 ,但部分头痛与眼部疾病密切相关 ,或是由眼科疾病引起或是头痛时出现眼部症状。本文根据国际头痛学会头痛分类委员会提出的分类法对与眼科相关的头痛及其眼病作一较详尽的介绍。１功能性头痛是指眼部及全身均无器质性疾病的头痛。主要包括偏头痛、紧张型头痛和丛集性头痛 ,前以述及 ,此不赘述。但要强调的是临床上功能性头痛的诊断 ,要注意排除眼及全身相关性器质性疾病的存在 ,避免误诊或漏诊。２症状性头痛２ １视疲劳视疲劳又称眼疲劳 ,是以患者自觉眼的症状为基础 ,眼或全身器质性因素与精神（…     

儿童长期佩戴角膜塑形镜的角膜内皮状态评估

背景配戴角膜塑形镜可通过非手术方式治疗和延缓近视儿童屈光度的进展,但长期佩戴对角膜组织的影响值得研究。目的观察儿童长期佩戴角膜塑形镜对角膜内皮的影响。方法纳入2009年12月至2011年12月在同济大学附属第十人民医院眼科配戴角膜塑形镜的近视儿童76例150眼,近视儿童每日夜间佩戴角膜塑形镜8～10h,分别于配戴前,配戴后3、6、12、24个月用角膜内皮细胞显微镜测量戴镜者的角膜内皮细胞平均面积、角膜内皮细胞密度、角膜内皮细胞面积变异系数和角膜内皮六角形细胞密度,采用SPSS13．0统计学软件对儿童配戴角膜塑形镜前后的上述各指标变化进行重复测量单因素方差分析。结果近视儿童配戴前与配戴后各时间点间角膜内皮细胞平均面积、角膜内皮细胞密度的变化差异均无统计学意义（F=11．34、7．16,均P〉0．05）。配戴前与配戴后3、6、12、24个月近视儿童角膜内皮细胞面积变异系数的总体差异有统计学意义（F=12．70,P=0．02）,其中配戴后24个月近视儿童的角膜内皮细胞面积变异系数值为0．36~0．02,明显高于配戴前的0．28±0．05,差异有统计学意义（P〈0．05）。近视儿童配戴前及配戴后不同时间点间角膜内皮六角形细胞比例的总体差异有统计学意义（F=13．40,P=0．04）,其中配戴后12个月、24个月的角膜内皮六角形细胞比例分别为（62~12）％和（60~14）％,明显低于配戴前的（69~12）％,差异均有统计学意义（P〈0．05）。结论角膜塑形镜长期佩戴可使角膜内皮六角形细胞的比例下降及角膜细胞面积变异系数增加。     

伴有中枢性疾病的婴幼儿斜视临床特征

目的分析总结伴有中枢性疾病的婴幼儿斜视患者的一般临床特征和斜视类型。方法 回顾性系列病例研究。收集2010年1月至2011年3月就诊于上海交通大学医学院附属新华医院的患有中枢性疾病合并斜视患儿（23例）的临床资料,其中男12例（52%）,女11例（48%）。对患儿发病年龄、就诊时年龄、斜视类型、屈光状态、眼底及视力等情况进行描述性分析。结果 所有患儿均在生后6个月内发现斜视,患儿就诊时的年龄为6个月至8岁,平均（3.8±2.1）岁。外斜视18例（78%）,水平外斜视的度数为－30△～－120△,平均（－73.6±30.6）△。内斜视5例（22%）,其中部分调节性内斜视1例,非调节性内斜视4例;水平内斜视度数为+25△～+35△,平均（+29.0±4.2）△。合并A型斜视5例,合并V型斜视4例,合并DVD 4例,合并隐性眼球震颤1例。能够进行视力检查的7例患儿,无一例最佳矫正视力在0.8以上。术前能够配合同视机检查的12例患儿中无一例有同时视。患儿中脑瘫15例（65%）,脑积水3例（13%）,脑发育迟缓3例（13%）,癫痫1例（4%）,缺血缺氧性脑病1例（4%）。共有22例患儿行手术治疗,手术量的设计按照常规手术量计算,其中11例患儿（占50%）手术涉及3条直肌,且均为外斜视。随访3～15个月,平均（9.6±3.6）个月。术后正位20例;能够配合同视机检查12例患儿中,7例无同时视,3例有同时视,2例有融合视。结论 伴有中枢性疾病的婴幼儿斜视表现为共同性的先天性斜视,且以大角度的外斜视居多;中枢性疾病中以脑瘫居多。多数患儿伴有一定程度的弱视以及双眼视功能的破坏。     

基于临床类型制定上斜肌麻痹的个体化治疗方案

上斜肌麻痹是麻痹性斜视和垂直斜视的最常见类型和病因,也是眼性斜颈的代表性疾病,往往需要手术治疗。麻痹性斜视,尤其是垂直旋转肌麻痹,会破坏眼球运动系统的平衡。随着病程的延长,眼球运动系统会自发产生一系列代偿反应,从而建立新的运动平衡,逐渐向共同性扩散,这一系列代偿反应涉及到拮抗肌、配偶肌、协同肌等,使得垂直旋转斜视的临床表现多样,手术治疗方案也因型而异。现结合上斜肌麻痹的国际通用分型,拟就上斜肌麻痹的个性化手术治疗方案的选择、手术要点等进行解析探讨,以期与同道分享交流。     

不同睫状肌麻痹剂对儿童调节力及屈光状态的影响

Objective To find out the longest effective duration of Mydrin P and Romi eyedrop on cycloplegia,compare the residual accommodation after cycloplegia by Mydrin P eyedrop, 1% Atropine paste and Romi eyedrop, analyze their effect on ametropia. To provide some experimental basis for using cycloplegia adeptly in clinic. Methods Seventy-five children (147eyes) were checked, 4～16 years old with, mean age of 10.12 years old. There are no systemic diseases. The patients were divided into 3 groups: A, 1% Atropine group; B,Romi eyedrop group and C,Mydrin P group. Before and after administration of these eyedrops,ob-jective refraction was checked in hand-hold auto refractor; subjective refraction was checked in phoropter,and retinoscopy refraction was finished. Phoropter was used to check the accommodation response and the residual accommodation respectively by "pushup" method. Results (1)In Romi eyedrop group,the time of maxi-mum cycloplegia was 60 minutes,the patients can read in the next day; in Mydrin P group,the time was 30 minutes, can read next day. (2) Average residual accommodation at the maximum cycloplegia: A, 1% Atropine group (2.0440±0.95484D),B,Romi eyedrop group (2.2214±0.6952D),C,Mydrin P group (2.6656±0.9999D). The residual accommodation in Romi eyedrop and Atropine groups had no significant difference, In-dependent-samples t Test P 0.05.The residual accommodation in Mydrin P group was stronger than the other two groups,more significant in myopia eyes. (3) The residual accommodation of three groups had no relation-ship with age and refractive status. (4) The results were same in cycloplegic refraction with hand-hold auto re-fractor and phoropter of each group of A, 1% Atropine group,B,Romi eye, drop group and C,Mydrin P group (P 0.05). The difference was 0.33D in autorefraction and phoropter,autorefraction negative. Conelusions (1) The time of maximum cycloplegia effective of Romi eye-drop was 60 minutes, of Mydrin P was 30 min-utes. (2) The residual accommodation in Romi eyedrop and Atropine groups was almost same, the residual ac-commodation in Mydrin-P group was stronger than the other two groups,more significant in myopia eyes. (3)Residual accommodation. Three groups have no relationship with age and refiaction. (4) Romi eyedrop and,Mydrin-P eyedrop can be used in the cycloplegic refraction for children in myopia and hyperopia.     

反向型眼球后退综合征一例

患儿,男性,12岁.自幼右眼上睑下垂伴右眼向内偏斜.2008年1月以单眼反向型眼球后退综合征的收入院.视力:右眼0.8+/1.0,左眼0.8+/1.0.睑裂:右眼4mm×27mm,左眼9mm×27mm.提上睑肌肌力:右眼无肌力,左眼正常.Bell征:右眼(-),左眼(+).眼位:映光法(33cm):右眼+20°;三棱镜(马杆法):右眼+35△;同视机:自觉=他觉LEF+180°.     

原发性青光眼患者屈光状态的研究

目的:探讨原发性青光眼患者的屈光状态对其发病机制的影响.方法:对原发性青光眼患者50例(100眼),分别进行裸眼视力、矫正视力、主觉和他觉验光检查,以及眼轴的测量.结果:原发性青光眼患者50例(100眼)中,屈光不正患病率为71.00%.原发性开角型青光眼患者的近视率为76.09%,平均屈光度为-3.61D;原发性闭角型青光眼患者的远视率为50.00%,平均屈光度为 0.57D(P＜0.01).原发性开角型和闭角型青光眼平均眼轴长度为24.81 mm和22.30 mm(P＜0.01).结论:原发性青光眼的发病与患者的屈光状态存在一定内在联系,原发性开角型青光眼以近视性屈光不正为主,原发性闭角型青光眼以远视性屈光不正为主.     

透气硬性角膜接触镜在角膜屈光手术后的应用

目的 观察透气硬性角膜接触镜(Rigid Gas-permeableContactlenses,RGP)在角膜屈光手术后矫正视力、改善视觉症状的效果.方法 眼科视光门诊中做过近视性角膜屈光手术的患者7例1 1只眼,经常规检查后,予验配多种设计的RGP,记录戴镜前的裸眼视力、框架镜最佳矫正视力和戴RGP的最佳矫正视力.记录部分患者戴RGP前后的波前像差.随访过程中记录配戴情况及并发症.结果 该组患者需要三种设计的RGP镜片:圆锥角膜RGP、逆几何RGP和大直径非球面RGP.戴RGP前裸眼视力在0.03～0.4者7只眼,0.8～1.0者4只眼.戴RGP前的框架镜最佳矫正视力在0.2～0.5者5只眼,0.7～1.0者6只眼.戴RGP的最佳矫正视力在0.7～0.9者4只眼,1.0者7只眼.配戴RGP后的球差、彗差和三叶草差分别较配戴前降低88.7%、92.9%和18.9%.全部患者的视觉症状在配戴RGP后均改善.角膜上皮染色是最常见的并发症,主要是圆锥角膜的锥顶部上皮磨损染色.平均随访21.5月,全部患者能够坚持日间配戴.结论 角膜屈光手术后配戴特殊设计的RGP可以提高视力,改善视觉质量.未见严重地角膜接触镜相关的并发症.

Abstract：

Objective To evaluate the efficacy of specially designed rigid gas-permeable contact lenses (RGP) in visual correction and visual symptom control after corneal refractive surgery. Methods Eleven eyes of 7 cases after myopic corneal refractive surgery from optometry clinic were fitted with RGP in different designs after routine eye checks. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA) before RGP fitting and best contact lens corrected visual acuity (BCLCVA) after RGP fitting were recorded. Wave front aberrations of some patients before and after RGP fitting were measured. Fitting state and complications were recorded at follow-ups. Results Three kinds of lens design were applied: keratoconic design, reverse geometry design and aspheric design with larger diameter. BCLCVA was much higher than UCVA and BSCVA. Spherical aberration, coma and trefoil were reduced by 88.7%, 92.9% and 18.9% respectively after RGP fitting. Visual symptoms of all patients after RGP fitting were improved. The main complication was corneal staining of iatrogenic keratoconus. All patients can tolerate wearing RGP in the day time after an average follow-up of 21.5 months. Conclusions Specially designed RGP fitted after corneal refractive surgery can raise the best corrected visual acuity and improve the quality of vision. No serious complications related to RGPwearing are observed.