Molteno implants in children

We report our experience with Molteno implants in 27 eyes of 20 children with glaucoma. Associated ocular findings included Sturge Weber syndrome (one patient), aniridia and retinoschisis (one patient), aphakia (seven patients, eight eyes), rubella syndrome (two patients), Peters anomaly (one patient), and Treacher Collins syndrome (one patient). Fifteen eyes received a single-plate implant, and 12 eyes received a double-plate implant in two stages. The patients' ages ranged from 2 months to 13 years (mean 47 +/- 55 months). The average number of previous glaucoma procedures was four per eye (range two to 10). The follow-up period ranged from 6 to 36 months (mean 20 +/- 9 months). The mean intraocular pressure before surgery was 34 +/- 4 mm Hg. The mean postoperative intraocular pressure was 19 +/- 11 mm Hg at 1 month and 19 +/- 6 mm Hg at 1 year (p < 0.001 at both times). After surgery nine eyes (33.3%) required no medication for control of intraocular pressure. Additional surgery was required in 12 eyes (44.4%). We believe the Molteno implant is a useful approach for children with glaucoma who fail to respond to standard medical and surgical treatments.     

A retinal vessel boundary tracking method based on Bayesian theory and multi-scale line detection

A retinal vessel tracking method based on Bayesian theory and multi-scale line detection is proposed in this paper. The optic disk is located by a PCA method and the initial points of tracking are identified. In each step, candidate points for vessel edges are selected on a semi-ellipse. Three types of vessel structure are considered in the tracking: normal vessel, branching, and crossing. To determine the new pair of edge points, the characteristics of the vessel intensity profiles along both the cross section and the longitudinal direction are considered in the tracking. A Gaussian model is assumed in the cross section and multi-scale line detection is employed in the longitudinal direction. The advantage of the proposed method is that two dimensional vessel information is employed, which makes it work better than methods using one dimensional information only. Our method is tested on the REVIEW database and a comparison study is performed. Experimental results show that the proposed method is precise and robust in tracking vessel edges.     

农村失能老年人情绪社交孤独感与家庭功能的相关性研究

目的 探讨农村失能老年人情绪社交孤独感状况，并分析家庭功能对失能老年人孤独感的影响。方法 采用便利抽样的方法，抽取329名开封市农村失能老年人为调查对象，采用一般资料调查表、情绪社交孤独感量表（ESLI）、家庭关怀度指数问卷（APGAR）进行调查。结果 农村失能老年人情绪社交孤独感总分为（30.72±15.24）分，家庭功能总分为（5.85±1.73）分。家庭功能良好组有129人（占39.2%），家庭功能良好组失能老年人情绪社交孤独感得分低于家庭功能障碍组（均P＜0.01）。失能老年人孤独感总分及各维度得分与家庭功能呈负相关，相关系数为 - 0.180～ - 0.909（均P＜0.01）。分层回归分析显示，老年人失能程度、与照顾者关系、家庭功能是失能老年人情绪社交孤独感的重要影响因素，家庭功能可独立解释失能老年人孤独感37.5%的变异量。 结论 农村失能老年人情绪社交孤独感较重，孤独感与家庭功能呈负相关。协助失能老年人建立良好的家庭功能有助于改善其孤独感。     

Periocular reconstruction

The periocular area is a complex region with free margins and cosmetic landmarks that are easily distorted during surgical reconstruction. Repair of surgical defects should maintain both periorbital function and aesthetics. In this article we discuss the basic methods of closure (side-to-side closure, flaps, grafts and second intent healing) as they apply to the periocular area and suggest an algorhythmic approach to reconstruction by aesthetic subunit. Pertinent regional anatomy and perioperative management are also reviewed.     

Ocular and periocular injuries from orbital fractures

BACKGROUND: Orbital fractures are associated with ocular and periocular injuries. The role of the ophthalmologist in the evaluation and management of facial trauma, including orbital fractures, has not been clearly defined. The purpose of this study is to identify and characterize ocular and periocular injuries associated with orbital fractures to define the role of the ophthalmologist in the management of facial trauma. STUDY DESIGN: Retrospective case review. RESULTS: Three hundred sixty-five patients with orbital fractures who were evaluated by an ophthalmologist as part of their initial trauma evaluation were studied. The majority of the patients with orbital fractures (74%) did not have associated ocular or periocular injuries. Twenty-three of 104 (22%) ocular injuries in 23 of 95 (24%) patients required immediate intervention by an ophthalmologist. CONCLUSIONS: Facial trauma and orbital fractures are associated with significant ocular and periocular injuries, the minority of which require immediate evaluation and treatment by an ophthalmologist. These results differ from those previously reported.     

Deep topical fornix nerve block versus peribulbar block in one-step adjustable-suture horizontal strabismus surgery

Background. We compared the efficacy of deep topical fornixnerve block anaesthesia (DTFNBA), which does not paralyse theextraocular muscles, with peribulbar block in patients undergoingone-step adjustable-suture horizontal strabismus surgery. Patientswith a vertical, oblique squint were excluded from the study. Methods. We studied 100 patients, allocated randomly to twogroups. Group 1 (n=50) received peribulbar block with 5 mlof 1:1 mixture of 0.5% plain bupivacaine and 2% lignocaine supplementedwith hyaluronidase 300 i.u. ml^–1. Group 2 (n=50)received DTFNBA with placement of a sponge soaked in 0.5% bupivacainedeep into the conjunctival fornices for 15 min. No sedationwas given to either group. Analgesia was assessed by directquestioning of patients during the procedure. A three-pointscoring system was used (no pain =0, discomfort =1, pain =2).If the pain score was 1, the patient was asked to look in theopposite direction to decrease the tension on the periostealattachment of the muscle to relieve discomfort. If the painscore was 2 at any stage of the operation, general anaesthesiawas given. Results. In Group 2, significantly more patients (15) experienceddiscomfort than in Group 1 (no patients) (P<0.05), but generalanaesthesia was not needed. Conclusions. DTFNBA is a useful technique for intraoperativeadjustable-suture strabismus surgery. It does not alter muscletone, thus allowing the surgeon to adjust the muscle suturesintraoperatively, and reducing the incidence of under- or over-correctionof the squint in the immediate postoperative period. Br J Anaesth 2002; 88: 129–32     

多焦视网膜电图及彩色多普勒在糖尿病视网膜病变早期诊断中的应用比较

目的 比较多焦视网膜电图（mfERG）与彩色多普勒在糖尿病视网膜病变（DR）早期诊断中的应用.方法 采用横断面研究,运用mfERLG检测正常对照组22例（22眼）、糖尿病无DR组52例（52眼）及DR单纯期组32例（32眼）.在上述患者中运用彩色多普勒测量视网膜中央动脉（CRA）的血流.采用单因素方差分析方法以及S-N-K法进行统计学分析.结果 糖尿病患者中,无DR组mfERG环1至环3中P1波反应密度低于正常对照组（P＜0.05）;CRA的血流则无异常变化（P＞0.05）.在DR单纯期组,mfERG除上述指标异常以外,Pt波潜伏期也出现延长（P＜0.05）.CRA的流速比正常对照组及无DR组降低（P＜0.05）.结论 在DR的临床早期诊断中,mfERG比彩色多普勒检测CRA血流的方法更敏感.     

Periodic alternating nystagmus in two children with a similar, unusual phenotype

The report describes two unrelated male children, aged 6 and 8 years, respectively, with congenital periodic alternating nystagmus, congenital strabismus, microcephaly with cortical and cerebellar hypoplasia, mental retardation, low stature, and bat ears. Karyotypes were normal. Neuropediatric and ophthalmologic examinations, radiologic imaging of the brain, and laboratory analyses were performed to exclude other causes of periodic alternating nystagmus, such as ataxia-telangiectasia, acquired disease of the caudal brainstem or the cerebellum, albinism, or loss of vision resulting from cataract or vitreous hemorrhage. The similar morphologic and clinical features of both patients raise the possibility that they have an identical syndrome.     

高密度多孔聚乙烯材料行眶缘凹陷充填再造术

目的 探讨采用Medpor高密度多孔聚乙烯生物材料行眶缘凹陷充填再造术的效果和安全性。方法 对行Medpor高密度多孔聚乙烯生物材料眶缘凹陷充填再造术16例患者的预后进行追踪随访。结果 用Medpor行眶缘凹陷充填再造术16例,均获满意效果。随访1～4年,平均2．4年,未见植入物脱出、移位及吸收等并发症。结论 Medpor是一种良好的骨替代材料,明显优于自体组织及其他人工材料。(中华眼科杂志,2004,40：377-379)     

Shortterm and longterm visual and astigmatic results of an opposing 10-0 nylon double running suture technique for penetrating keratoplasty

BACKGROUND: In ophthalmic surgery, corneal transplantation (penetrating keratoplasty) may be employed when the clarity of the cornea has been significantly compromised by conditions such as scarring, edema, and variable corneal thickness. Irregularities in corneal curvature can occur postoperatively. This astigmatism is of concern, because it can impair visual acuity despite an otherwise good surgical result. Different suturing techniques have been developed to minimize astigmatism. The purpose of this study was to evaluate an opposing 10-0 nylon double running suture technique for penetrating keratoplasty. STUDY DESIGN: A retrospective study was undertaken of 91 records of patients who underwent penetrating keratoplasty performed by one surgeon (RNG). This represents 54.8% of 166 consecutive cases. Every eye with an opposing double running suture and a 1- to 3-month postsuture removal followup was selected and evaluated for best corrected visual acuity and astigmatism, excluding eyes that developed graft failure or corneal ulcer or that had lack of adequate followup. The cases were divided into five groups by preoperative diagnosis: pseudophakic bullous keratopathy (n = 43), aphakic bullous keratopathy (n = 5), keratoconus (n = 17), Fuchs dystrophy (n = 12), and miscellaneous (n = 14). The mean standard followup period was 13.7 months after penetrating keratoplasty. Thirty percent of the eyes had an extensive followup, with a mean of 33 months after penetrating keratoplasty. RESULTS: Eighty-two percent of the patients had a significant improvement of their visual acuity postoperatively, defined by a five-line improvement of best corrected visual acuity or a best corrected visual acuity of 20/40 or better. The mean astigmatic keratometric reading was 3.98 diopters, with a manifest refraction cylinder of 3.42 diopters at the 1- to 3-month postsuture removal visit. This study also shows that there is no statistically significant change in keratometric astigmatism or manifest refraction cylinder from the 1- to 3-month postsuture removal measurements to the more extensive followup of 18 to 66 months after penetrating keratoplasty (p > 0.10). CONCLUSIONS: This suture technique allows for excellent longterm stability of the wound with visual and astigmatic results that are comparable to those of previous studies. The use of the opposing double running suture is a viable alternative to some of the other widely used techniques and may be considered more stable and secure.