Molteno植入物治疗无晶体性青光眼

Ｍｏｌｔｅｎｏ植入物治疗无晶体性青光眼亢晓丽徐丽＊张劲松石树敏中国医大第一医院眼科（１１０００１）我们采用Ｍｏｌｔｅｎｏ植入物治疗１例因外伤后晶体脱位将晶体摘出术后无晶体性青光眼患者，取得良好效果，介绍如下。患者徐某男４６岁右眼被铁钉崩伤１周，眼红、...     

应用超声生物显微镜观察小梁切除术后的房角改变

目的 应用超声生物显微镜（UBM）观察原发性闭角型青光眼（PACG）小梁切除术后的房角改变。方法：PACG患者30人（30只眼），行巩膜板层下小梁切除术，分别于术前和术后使用UBM观察房角形态并测量。结果：术前2只眼存在睫状体脱离。ACD、AOD500,TIA、TCPD、ID1术前术后比较差异均无显著性（P〉0．05）。结论：UBM有利于发现青光眼手术前后的睫状体脱离。小梁切除术对PACG的房角结构无改善。     

早治疗：让弱视孩子不再“视”弱

目前,我国斜视发病率为儿童总人数的1％,弱视发病率占儿童总人数的3％,共有一千余万弱视患者。这是一个非常惊人的数字。专家呼吁,要特别重视斜视和弱视的早期发现和治疗。     

青光眼固视状态与视功能关系的研究

以往关于弱视存在的偏心固视现象,人们早有认识,近年,对偏心固视现象的认识正逐渐被深化,我国夏德昭等曾指出临床许多疾患如黄斑部疾患、视神经病等,在病变累及黄斑中心凹,致使其功能丧失时,视网膜的固视部位将由中心凹转移至中心凹以外视力最好、距中心凹最近,又是与病变相交界的健康或比较健康的视网膜部位。     

临床孤立综合征引发儿童视觉、听觉障碍 1 例报告

目的了解临床孤立综合征(CIS)的临床特征。方法回顾分析1例CIS导致视力、听力损害患儿的临床资料。结果患儿,男,5岁7个月,以视力不佳就诊,体检无异常。右眼视力0.15,左眼0.15。视觉诱发电位示右眼P100波峰延迟,振幅降低;左眼P100波峰延迟,振幅降低。脑干听觉诱发电位,DPOAE右耳各频率均未通过,左耳4 KHz、8 KHz通过,其余各频率均未通过;TEOAE双耳均未通过。脑电图、智力测验(WPPSI)均无异常。头部和眼眶的MRI检查提示脱髓鞘病变。符合"一次局灶或多灶性临床中枢神经系统事件,推测与炎症性脱髓鞘有关"的CIS诊断标准。结论 CIS可引起视觉和听觉障碍。     

儿童孤立性脉络膜血管瘤1例

孤立性脉络膜血管瘤生长缓慢，常因瘤体或其渗液波及黄斑区引起视力减退时就诊，临床上对早期病例漏误诊率较高。我院小儿眼科门诊于2004年2月19日遇到1例孤立性脉络膜血管瘤患者，曾在多家医院误诊为远视、弱视，现报告如下：     

球面透气性硬性角膜接触镜矫正高度角膜散光

目的评价球面透气性硬性角膜接触镜（rigid gas permeable contact lens，RGP）矫正高度角膜散光（≥3．00 D）时的有效性、稳定性和患者耐受性。方法选择高度角膜散光患者41例55眼，经角膜曲率检查、电脑验光、检影验光、综合验光仪验光，确认为总散光与角膜散光基本一致者，进行试戴片配适评估、戴片验光，给予配戴球面RGP。定期回访，记录矫正视力、镜片配适及配戴情况。结果RGP最佳矫正视力：30眼（占54.5％）高于框架镜，22眼（占40.0％）等于框架镜，3眼（占5．5％）低于框架镜。患者均获得稳定配适。随访1—65个月（平均40．5个月），3例（4眼）患者因不能适应镜片的异物感而停戴。其余38例（51眼）仍坚持配戴，并对该矫正方法满意。结论应用球面RGP矫正高度角膜散光，可获得良好配适和满意的视力矫正效果。多数患者能够坚持长期配戴。     

婴儿眼球震颤综合征的治疗进展

婴儿眼球震颤综合征(infantile nystagmus syndrome,INS)是一种在生后早期出现的病理性眼球震颤,以双眼非自主性共轭眼球运动为临床特征,会破坏双眼视力及视功能,同时是引起弱视、斜视以及斜颈的原因之一.目前尚无治愈INS的方法,但治疗方法有许多进展,如视光学治疗采用框架眼镜、角膜接触镜、三棱镜、低视力助视器及激光,药物治疗采用碳酸酐酶抑制剂、肉毒素眼外肌注射等,生物反馈治疗采用听觉反馈等,以及新的手术方法.     

单眼上斜肌麻痹伴同侧上直肌亢进或挛缩综合征手术治疗

目的观察下斜肌减弱联合同侧上直肌后徙手术治疗单眼上斜肌麻痹伴同侧上直肌亢进或挛缩综合征的临床疗效和安全性。方法2013年5月至2016年2月在沈阳市第四人民医院眼科,临床确诊为单眼上斜肌麻痹伴同侧上直肌亢进或挛缩综合征患者12例,所有患者第一眼位垂直斜视度≥15△,麻痹眼侧歪头试验阳性,向麻痹眼方向注视时垂直斜视度比第一眼位〉5△,上方所有注视眼位均上斜,对侧眼上斜肌功能过强。所有患者均为初次手术治疗,手术将下斜肌后徙于下直肌颞侧止端后3mm,上直肌后徙3-5mm,合并水平斜视者同时予以矫正。结果术前患者均有代偿头位,中度9例,重度3例;术后所有患者代偿头位均有改善,头位消失者6例,轻度倾斜者4例,中度倾斜者2例;术前第一眼位垂直斜视度（24．8±5．2）△,术后（6．0±2．8）△;术后歪头试验10例阴性,2例轻阳性;术后术眼有轻度上转受限,无双眼复视。结论下斜肌减弱联合同侧上直肌后徙手术是治疗单眼上斜肌麻痹伴同侧上直肌亢进或挛缩综合征可选择的手术方式,可以有效改善代偿头位和垂直斜视,未引起明显上转受限。     

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.