高度远视白内障患者人工晶状体屈光度数计算公式的选择

目的 比较Haigis、SRKⅡ、Hoffer Q、Hollady、SRK/T公式的准确性,以期为高度远视白内障患者植入的人工晶状体(IOL)屈光度数计算提供参考.方法 比较性研究.分析了24例(31只眼)行超声乳化白内障吸除联合后房型人工晶状体植入术的高度远视白内障患者,术前分别应用A超和IOL Master测量眼轴长度,计算人工晶状体度数,术后验光获得实测屈光度数.比较应用IOLMaster测量时Haigis、SRKⅡ、Hoffer Q、Hollady、SRK/T公式预测植入人工晶状体屈光度数的准确性,以及两种生物测量方法对各公式预测误差的影响.两种测量方法间的比较采用配对t检验.结果 (1)应用IOL Master测量时,Haigis公式的平均预测误差最小(0.37±0.14),随后依次为Hoffer Q、Hollday、SRK/T、SRK Ⅱ公式,分别为-0.70±0.12,-0.97±0.15,-1.25±0.14,-1.46±0.13.Haigis公式引起轻度的过矫,而其他公式则产生不同程度的欠矫.(2)A超的预测误差偏向正值,而IOL Master的预测误差却偏向负值.在A超测量眼轴时,Hoffer Q公式较为精确(-0.39±0.16),而在使用IOL Master时,Haigis更为精确(0.37±0.14).结论 高度远视白内障患者选择IOL屈光度数的计算公式,使用IOL Master测量时,建议选择Haigis公式,而采用A超测量时,选择Hoffer Q公式则能获得较为准确的IOL屈光度数.     

改良提上睑肌缩短术治疗重度先天性上睑下垂38例临床探讨

目的探讨改良提上睑肌缩短术治疗重度先天性上睑下垂的临床效果。方法对38例先天性上睑下垂患者进行改良提上睑肌缩短手术,观察术后疗效。结果正矫30眼（79%）,欠矫7眼（18%）,复发1眼（3%）、复发者为3岁患儿,无过矫病例。大部分患者均能在3个月内自然闭合眼睑,最迟者为1年。随访时间半年~1年,无一例发生暴露性角膜溃疡。结论改良提上睑肌缩短术治疗重度先天性上睑下垂安全、可靠,是一种实用的治疗手段。     

马方综合征晶状体半脱位不同手术方法的探讨

目的探讨马方综合征晶状体半脱位的不同手术治疗技巧及术后临床效果观察。方法根据术中观察的晶状体半脱位情况，分别采用以下四种手术方法：超声乳化晶状体吸除加改良带钩张力环（CTR）加折叠式后房型人工晶状体（PCIOL）植入术、超声乳化晶状体吸除加虹膜拉钩囊袋固定加折叠式PCIOL双襻睫状沟固定术，超声乳化晶状体吸除加折叠PCIOL双襻睫状沟固定术，以及晶状体囊内摘除加硬性PCIOL双襻睫状沟固定术。观察术后最佳矫正视力、CTR和IOL位置；术中和术后并发症。结果临床治疗20眼，术后视力均显著提高。术中的并发症主要为玻璃体脱出，多发生于囊内手术患者，行前部玻璃体切除后手术仍可顺利进行。UBM和后反光裂隙照相显示1双襻固定眼出现人工晶体稍倾斜，其余人工晶状体及CTR位置正常。10眼发生后囊膜混浊，IOL囊袋外植入的发生率达100％，其中1眼需行Nd：YAG激光后囊膜切开术。1眼发生瞳孔阻滞性青光眼，行激光周边虹膜切除术后眼压正常。无其他手术合并症的发生。结论改良带钩CTR和虹膜拉钩的应用实现半脱位晶状体原位超声乳化和IOL手术，前者还可维持术后囊袋的长期稳定性，是最佳的手术方式。根据患者和医生的具体情况选择最适宜的手术方式，是马方综合征晶状体半脱位患者术后视力获得良好恢复的关键。     

角膜和全眼高阶波前像差的特点及年龄相关性变化的研究

Objective To investigate age-related changes in corneal and ocular monochromatic high-er-order aberrations and elucidate the distribution of corneal primary spherical in Chinese. Methods Using Traeey-iTrace visual function analyzer (EyeSys corneal topography combined with a ray-tracing aberrometer),113 normal eyes of 59 Chinese,mean age of 33.81+20.50 years (range,5-73 years),were evaluated for corneal and ocular monochromatic total higher-order aberrations (HOAs), primary spherical aberration (Z40),total spherical (TS),total coma (TC),and total trefoil aberration (TT) in the central 6mm diameter. Correla-tion analysis was also performed to assess the association between age and both corneal and oeular higher-order aberrations. Results The mean Zemike coefficient of Z40 was (0.27±0.07) ?m (range,0.130～0.451). Al-though corneal Z40 increased slightly with age,the correlation was small and insignificant (r =0.172,p =0.069 ). However, ocular Z40 had a positive correlation with age (r =0.545,p =0.000 ). Analyzer showed positive correlations with age for both corneal (r=0.499,p =0.000) and ocular (r=0.427,p =0.000) HOAs. Positive correlations were also observed between age and both corneal (r=0.149,p =0.021 ) and ocular (r=0.253,p =0.007) TC. Corneal and ocular TT (r =0.344,p =0.000; r=0.185,p =0.050,respectively) were increased with age. No significant correlation was found between corneal TS and age (r =0.180,p =0.057 ), but TS of the whole eye in-creased with age (r =0.560,p =0.000). There was a positive correlation between corneal and ocular HOAs (r =0.327,p=0.000),TC (r=0.233 ,p=0.013),and TT (r=0.481 ,p=0.000) aberration. Conclusions These re-suits also suggest that the ocular HOAs,TC,and TT increase with age,mainly because of the increase in corneal HOAs,TC,and TT; and the ZAO aberration increases with age,mainly because of the increase in Z40 in the internal optics. Individual variability in corneal primary spherical aberration was observed in Chinese.Therefore, preoperative measurement of corneal Z40 is crucial to the selection of aspheric IOL.     

浅谈基层检验队伍现状及改善措施

文章透过当前基层检验科的队伍现状及存在的问题,通过典型调查的方法选取福建省山区九县市基层防疫站为调查对象。以此"折射"出基层防疫机构检验工作的共性问题,剖析其存在的原因,在此基础上提出一些建议,为促进检验队伍的建设提供理论参考。     

玻璃体手术治疗12例眼内炎临床分析

目的 观察眼内炎的临床表现及玻璃体手术治疗眼内炎疗效并探讨硅油填充的必要性.方法 12例眼内炎,其中10例采用玻璃体手术联合玻璃体腔注药,两例眼内容剜除.结果 术后除2例眼内容剜除以外,其余10只眼均保全眼球,视力较术前不同程度提高.结论 眼内炎如果得到及时诊断,把握玻璃体手术时机,可以保住眼球和挽救部分视力.对于外源性眼内炎,硅油填充不是必需的.     

中国东南沿海地区儿童眼外伤临床特点及预后分析

眼外伤已成为世界单眼盲的首要致病原因,而儿童眼外伤也成为全球儿童主要后天性致盲眼病之一,给患者家庭与社会造成沉重负担。既往流行病学研究发现,导致严重视力损害的儿童眼外伤发病率为2％～14％。各研究对于儿童眼外伤的性别构成比与致伤性质已有共识,但不同研究对于儿童眼外伤发病年龄高峰范围与致伤原因的研究结果差距较大,发病高峰值从小于5岁到大于14岁不等,致伤原因更是大相径庭[4培]。     

改良小切口非超声乳化在高度近视白内障手术中的运用

目的 探讨改良小切口非超声乳化手术在高度近视中应用的有效性和安全性.方法 高度近视56例（70眼）.手术中构建改良的辅助切口,并经辅助切口完成撕囊、水分离和分层、辅助劈核、皮质注吸等操作,前房密闭稳定.联合黏弹剂的运用,在低灌注和黏弹剂保护下彻底清除晶状体皮质.结果 眼轴＜30 mm的58眼中,术后1月矫正视力≥0.5者45眼（80.36%）;眼轴≥30.00 mm的12眼中,术后1月矫正视力≥0.3者7眼（58.33%）.手术后角膜曲率稳定.无后囊破裂,无悬韧带、虹膜、角膜损伤等术中术后并发症的发生.结论 改良小切口非超声乳化手术使高度近视眼的白内障摘出和人工晶状体植入更为安全和有效.     

角膜和全眼高阶波前像差的特点及年龄相关性变化的研究

Objective To investigate age-related changes in corneal and ocular monochromatic high-er-order aberrations and elucidate the distribution of corneal primary spherical in Chinese. Methods Using Traeey-iTrace visual function analyzer (EyeSys corneal topography combined with a ray-tracing aberrometer),113 normal eyes of 59 Chinese,mean age of 33.81+20.50 years (range,5-73 years),were evaluated for corneal and ocular monochromatic total higher-order aberrations (HOAs), primary spherical aberration (Z40),total spherical (TS),total coma (TC),and total trefoil aberration (TT) in the central 6mm diameter. Correla-tion analysis was also performed to assess the association between age and both corneal and oeular higher-order aberrations. Results The mean Zemike coefficient of Z40 was (0.27±0.07) ?m (range,0.130～0.451). Al-though corneal Z40 increased slightly with age,the correlation was small and insignificant (r =0.172,p =0.069 ). However, ocular Z40 had a positive correlation with age (r =0.545,p =0.000 ). Analyzer showed positive correlations with age for both corneal (r=0.499,p =0.000) and ocular (r=0.427,p =0.000) HOAs. Positive correlations were also observed between age and both corneal (r=0.149,p =0.021 ) and ocular (r=0.253,p =0.007) TC. Corneal and ocular TT (r =0.344,p =0.000; r=0.185,p =0.050,respectively) were increased with age. No significant correlation was found between corneal TS and age (r =0.180,p =0.057 ), but TS of the whole eye in-creased with age (r =0.560,p =0.000). There was a positive correlation between corneal and ocular HOAs (r =0.327,p=0.000),TC (r=0.233 ,p=0.013),and TT (r=0.481 ,p=0.000) aberration. Conclusions These re-suits also suggest that the ocular HOAs,TC,and TT increase with age,mainly because of the increase in corneal HOAs,TC,and TT; and the ZAO aberration increases with age,mainly because of the increase in Z40 in the internal optics. Individual variability in corneal primary spherical aberration was observed in Chinese.Therefore, preoperative measurement of corneal Z40 is crucial to the selection of aspheric IOL.     

护理本科新生老年护理职业认知与就业意愿相关性研究

目的了解护理本科新生老年护理职业认知水平及其与老年护理就业意愿的相关性,为老年护理专科人才培养提供参考。方法采用自制调查表和对老年人态度量表对某高等医学院校2014级240名护理本科新生进行调查。结果护生对老年人态度得分为133.68±20.16;对老年护理职业认知总分及工作认知、现状认知维度得分为27.71±5.19、14.53±2.83及13.18±2.47。40.8%的护生表示非常或比较愿意从事老年护理工作,65.0%首选公立性养老机构。对老年人态度、老年护理职业认知总分、老年护理工作认知、老年护理现状认知与老年护理就业意愿相关(r=-0.169~0.197,均P0.05)。结论护理新生老年护理职业认知水平及就业意愿偏低,就业意愿与其老年护理职业认知水平相关;应进行针对性教育以提高其认知水平和老年护理就业意愿。