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.     

提高眼科临床进修教育质量的对策探讨

通过对中山大学中山眼科中心50多年培养、管理进修生的经验总结，并结合管理现状和进修生的一般情况进行分析探讨，认为医院学科建设平台、健全管理制度、加强岗前培训、个体化培养、评价和激励机制等是提高眼科临床进修教育质量的重要途径。     

毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响

目的：探讨抗青光眼药物毛果芸香碱和布林佐胺滴眼液及各自的防腐剂三氯叔丁醇和氯化苯甲烃胺（BAC）对兔眼表组织的影响。方法:选取新西兰大白兔15只，分为正常对照组（3只）、毛果芸香碱组（A组，6只）和布林佐胺组（B组，6只）。用药组右眼使用青光眼药物毛果芸香碱或布林佐胺滴眼液，左眼使用对应的防腐剂三氯叔丁醇或BAC，连续用药30 d。取球结膜组织行苏木素－伊红（HE）染色计数结膜上皮层炎症细胞数；角膜行扫描电镜检测并进行上皮损害分级评分。结果:与正常对照组比较，布林佐胺滴眼液（P<0.01）和防腐剂BAC（P<0.01）导致球结膜上皮层炎症细胞浸润增多；毛果芸香碱滴眼液（P>0.05）和三氯叔丁醇（P>0.05）引起的球结膜炎症细胞增多不明显。布林佐胺滴眼液导致球结膜炎症细胞增加的程度较毛果芸香碱滴眼液严重（P<0.01）。青光眼药物和防腐剂均可导致兔角膜上皮超微结构的损伤，表现为角膜上皮细胞六边形结构变为不规则、边界不清、细胞膜皱缩、细胞间距增宽、上皮细胞表面的微绒毛丢失、细胞空洞和暗细胞增加。布林佐胺滴眼液和BAC引起的角膜损害较毛果芸香碱滴眼液（P<0.01）和三氯叔丁醇明显（P<0.05）。各组左右两眼的球结膜炎症细胞数和角膜损害评分均无显著差异。结论:布林佐胺滴眼液和防腐剂BAC使用1个月后可导致兔球结膜炎症细胞增加和角膜上皮细胞损伤，毛果芸香碱滴眼液和三氯叔丁醇主要引起角膜上皮超微结构的变化；防腐剂是引起眼表损伤的主要原因。布林佐胺滴眼液对兔眼表的损伤较毛果芸香碱滴眼液严重。     

3种眼科镜检溶液临床效果比较

对3种供眼科三面镜等检查用的滴眼溶液进行临床效果对比观察,各组观察107只眼,l次成功率分别为2％羟丙基甲基纤维素104只眼,占97.2％,5％聚乙烯醇滴眼溶液5l只眼,占47.7％;0.25％氯霉素滴眼溶液12只眼,占11.2％,此结果表明2％羟丙基甲基纤维索滴眼溶液优于其它二种滴眼溶液,而且它安全、无刺激、配制方便,因而认为2％羟丙基甲基纤维素是眼科三面镜等检查用的首选滴眼溶液.     

正常人各方位视网膜神经纤维层厚度值的测量

【目的】应用光学相干断层成像术(OCT)测量我国正常人视网膜神经纤维层(RNFL)各钟点范围厚度值和平均值;分析RNFL各钟点范围厚度值之间的差异及其与年龄、性别、眼别之间的关系。【方法】用OCT对104例(183眼)正常人进行以视乳头为中心的环行扫描,扫描直径3.46mm,记录平均和各个钟点范围的RNFL厚度值并分析其与年龄、性别和眼别的关系。【结果】正常人以1030～、1130～、1230～、130～、230～、330～、430～、530～、630～、730～、830～、930～12个钟点范围测量的RNFL厚度(μm)分别为144±14、141±16、135±12、104±17、78±15、90±18、130±16、147±17、145±13、92±16、80±11、103±10,而全周平均RNFL厚度值则为（116±5）μm。颞上(1030～1230)、颞下(530～730)和平均RNFL厚度均与年龄呈负相关(P值为0.005～0.000)。不同性别各钟点范围及平均RNFL厚度均数的比较,差异无显著性(P值为0.356～0.781)。正常人左、右眼各钟点范围及平均RNFL厚度之间差异亦无显著性(P值为0.155～0.612)。【结论】正常人各钟点范围RNFL厚度以颞上(1030～1230)和颞下(530～730)最厚,鼻侧(230～)和颞侧(830～)最薄;RNFL厚度随年龄的增加而变薄;各钟点范围RNFL厚度值与性别和眼别无关。     

周边虹膜切除术对原发性闭角型青光眼眼前段结构的影响

[目的]利用眼前段光学相干断层扫描仪(AS-OCT)观察原发性急性闭角型青光眼(APACG)和原发性慢性闭角型青光眼(CPACG)手术周边虹膜切除(SPI)前后眼前段结构的改变.[方法]连续性收集周边虹膜粘连＜6个钟点的、性别年龄匹配的APACG发作期患者37例(37眼)及CPACG患者25例(25眼),于SPI术前及术后1月行AS-OCT检查.比较术前及术后的中央前房深度(ACD)、房角开放距离(AOD)、小梁网虹膜间面积(TISA)、房角隐窝面积(ARA)、前房宽度(ACW)、前房容积(ACV)和晶状体矢高(CLR)的差异.[结果]与术前相比,APACG眼术后较术前AOD(0.096±0.063 vs 0.052±0.065,mm)、TISA(0.054±0.024 vs 0.030±0.029,mm2)、ARA(0.095±0.042 vs 0.059±0.057,mm2)和ACV(90±17 vs 73±17,mm3)增加(P＜ 0.001-0.032),而ACD、ACW及CLR无明显变化(P=0.102 ～ 0.609);CPACG眼术后较术前ARA (0.078±0.036 vs 0.065±0.024,mm2)及ACV(91±22 vs 83±22,mm3)明显增加(P=0.042和＜0.001),而AOD、TISA、ACD、ACW和CLR无明显变化(P=0.102-0.774).[结论]周边虹膜切除术可使APACG的房角开放和前房容积增加,使CPACG的前房容积增加,但不能改变APACG和CPACG眼的中央前房深度和晶状体的相对位置和CPACG眼的房角参数.     

复合式小梁切除术治疗抗青光眼术后眼压不降30例

目的探讨复合式小梁切除术治疗抗青光眼术后眼压不降的疗效。方法对30例抗青光眼术后眼压不降患者施行复合式小梁切除术。术后检查视力、眼压、滤过泡情况和前房深度。随访观察时间为2~33(11.80±7.40)个月。结果以眼压下降至6~21mmHg(用或不用降眼压药物)为标准,手术成功率为90%(27/30),术后视力提高、保持不变的有80%(24/30)。结论复合式小梁切除术是抗青光眼术后眼压不降再手术的一种有效治疗方法。     

3期特发性黄斑裂孔自发闭合一例

患者男,68岁.因左眼视力下降伴视物变形、变小2个月于2009年12月8日来我院就诊.无眼外伤史,全身检查无异常.     

激光偏振光扫描仪测量正常和近视眼视网膜神经纤维层厚度及影响因素研究

目的 评价激光偏振光扫描仪(GDxVCC)测量正常人及近视眼视网膜神经纤维层(RN-FL)厚度并分析其与年龄、性别、眼别、屈光度间的相关关系.方法 用GDxVCC测量正常人(正视眼)161例240只眼和近视眼99例167只眼的RNFL厚度.分析正常人性别间、眼别间RNFL厚度的差异.用相关及回归方法分析RNFL与年龄及屈光度之间的相关关系.结果 240只正视眼的RNFL厚度全周平均值(57.31±5.31)μm、上方平均值(69.97 ±7.32)μm、下方平均值(68.67±7.56)μm.男性与女性间平均厚度差异无统计学意义(P=0.062～0.934);左右眼间平均厚度差异无统计学意义(P=0.577～0.689).RNFL平均厚度与年龄呈负相关(r=-0.239,P=0.007),回归方程为RNFLT=-0.073×年龄+60.284.近视患者的RNFL厚度全周平均值(59.62±5.69)μm、上方平均值(71.88 ±7.97)μm、下方平均值(71.80±8.39)μm.RNFL平均厚度与近视度绝对值呈负相关(r=-0.341,P=0.008),同归方程为RNFLT=-0.758×屈光度绝对值+63.038.结论 激光偏振光扫描仪可以精确测量RNFL厚度.正常人RNFL厚度性别间、眼别间差异无统汁学意义.随着年龄的增长,RNFL厚度逐渐变薄.随着近视屈光度的增加,RNFL厚度逐渐变薄.     

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.