程丑夫教授运用黄连温胆汤经验举隅

黄连温胆汤以《备急千金要方》中的温胆汤为基础方加黄连,其主要功效是清热燥湿,理气化痰,和胃利胆,为临床治疗痰热证的经典方.程丑夫教授认为痰热病邪致病广泛,痰火扰心,心神不安则见心烦失眠;痰热中阻,清阳不升,则见眩晕耳鸣;情志不遂,痰热郁积,则见郁病;痰热中阻脾胃,升降逆乱则见胃痛.众疾病虽病名和临床表现不同,但其病理机制总归为痰热内扰.本文旨在通过验案举隅总结探讨程教授运用黄连温胆汤的临床经验.     

视网膜疾病和青光眼血液流变学改变及其治疗（二）

三、青光眼血液流变学改变就青光眼损害的原因而言,部分患者可能是以机械性损害为主,另一些则因缺血、血供不足为其主要的损害因素。目前广泛认可的是视盘血供障碍及视网膜神经纤维层的血循环异常,如果合并有异常眼压,则导致青光眼视神经损害,强调了血液灌注的重要性。从80年代开始,不少学者从事青光眼血液流变学研究,大多数研究均表明青光眼血液流变学可发生异常改变。这些异常改变包括全血粘度增高,红细胞压积升高,红细胞变形性下降,血小板粘附率升高,Klaver等(1985)对低压性青光眼和高压性青光眼进     

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.     

光学相干断层扫描仪在我国眼科临床的应用(一)

光学相干断层扫描仪(optical coherence tomography，OCT)是20世纪90年代初发展起来的新的影像学检查方法，90年代中应用于眼科临床。OCT的工作原理类似超声波，但其用光波代替声波。OCT利用低相干光对生物组织进行横截面扫描，并将所获取的信息转化为数字，经计算机处理，再以图     

光学相干断层扫描仪在我国眼科临床的应用(二)

1 OCT在视网膜前膜诊断及术后随访中的应用。OCT由于其独特的横截面成像技术，可以清楚地观察视网膜前膜各层的病理改变，并进行精确的测量。用OCT对特发性黄斑视网膜前膜进行检查可以观察到主要有4种图像特征：①视网膜前膜伴黄斑水肿，中心凹凹陷变浅或消失，神经上皮层下方为一暗区，视网膜内层见光带增强的前膜；②增生性视网膜前膜，黄斑中心凹厚度明显增加，神经上皮间或神经上皮下也可有暗区(水肿)，视网膜内层见光带增强增宽的前膜，亦可见前膜呈团块状向玻璃体腔凸起；③视网膜前膜伴假性黄斑裂孔形成，黄斑中心凹厚度增加或正常，中心凹呈陡峭状改变，周围视网膜厚度增加，可见光带增强的前膜；④视网膜前膜伴板层黄斑裂孔形成，中心凹神经上皮层部分缺失，中心凹周围的视网膜内层可见光带增强的前膜。利用OCT可以测量视网膜前膜黄斑中心凹视网膜厚度，并与视力进行相关分析，结果表明黄斑中心凹视网膜越厚，视力越差。     

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.     

先天性视网膜劈裂症的光学相干断层扫描图像特征

目的 探讨先天性视网膜劈裂症的光学相干断层扫描(optical coherence tomography,OCT)图像特征及临床诊断价值。 方法 对临床拟诊或诊断为先天性视网膜劈裂症患者8例15只眼行OCT、直接检眼镜、眼底彩色照相检查,其中3例6只眼行视网膜电图(electroretinogram,ERG)及荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查。 结果 先天性视网膜劈裂症的OCT图像表现为典型的黄斑区囊样改变,伴斜形或垂直的桥状组织相连;后极部视网膜神经上皮层之间分离,其间有桥状组织相连;纱膜样改变的OCT图像为内层神经上皮增厚,与外层神经上皮分离。 结论 OCT能在活体直观、清晰地显示先天性视网膜劈裂症中的视网膜神经上皮层组织结构的改变,为先天性视网膜劈裂症的临床诊断提供了一种有效的新的检测手段。 (中华眼底病杂志, 1999, 15: 209-211)     

川芎嗪对原发性开角型青光眼患者的治疗作用

目的 探讨中药川芎嗪对原发性开角型青光眼的血液流变学、眼底荧光血管造影以及视功能的影响。方法 采有自身对照的方法对眼压已控制的原发性开角型青光眼患者１１例（１９）眼进行川芎嗪治疗前后血液流变学测定、眼底蓉光血管造影、Ｈrmphrey视野检查以及图形视诱发电位（ＰＶＥＰ）检测。结果 用磷酸川芎嗪治疗后患者血液流变学各指标明显下降（Ｐ＜０．０５～０．００１）;眼底荧光血管造影臂－脉络膜循环时间从隧的１４．６     

急性闭角型青光眼合并前房积血一例

患者女,53岁.因双眼反复胀痛2年,右眼红痛1周于2008年1月24日收入院.患者于2年前发现双眼房角窄Ⅳ(开).因患者不愿行预防性手术而长期滴用匹罗卡品滴眼液.     

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.