咪喹莫特联合中药治疗扁平疣临床疗效观察

目的观察咪喹莫特联合中药的内服外涂组合是否优于维A酸联合中药之组合治疗扁平疣。方法治疗组：患部外涂咪喹莫特每晚1次,每周5次（连续5天,停2天）。同时口服中药桑菊去疣方;对照组：外用药为维A酸乳膏,用法与口服药同治疗组。两组疗程均为8周,每2周复诊1次。结果治疗组痊愈率44．44％,总有效率87．04％;对照组痊愈率28．189／6,总有效率69．09％,两组均有统计学意义（P〈0．05）。治疗组起效时间明显快于对照组。治疗组、对照组两组不良反应没有统计学意义。结论咪喹莫特联合中药治疗扁平疣较维A酸乳膏联合中药治疗组起效快,且无不良反应,协同作用好,优势明显。     

玻璃体切除治疗Ⅲ区开放性眼外伤的效果

目的 评价玻璃体切除治疗Ⅲ区开放性眼外伤的效果.方法 本研究为前瞻性分析.2012年7月至2013年8月收治Ⅲ区开放性眼外伤36例（36只眼）,记录致伤原因、术前最佳矫正视力、外伤眼特征、手术时机、手术方式、手术效果,分析影响治疗效果的因素.结果 36例Ⅲ区开放性眼外伤巩膜全层裂伤达角膜缘后（以最远距离为准）5 ～20 mm,平均（9.0±3.7）mm.术后最佳矫正视力提高者21只眼（59.3％）.术前无光感的11只眼中术后无光感2只眼,光感3只眼,手动2只眼,眼内容摘除4只眼;术前视力光感的19只眼中术后光感3只眼,视力提高13只眼,眼内容摘除3只眼.视网膜脱离34只眼中视网膜复位26只眼,其中首次玻璃体切除硅油填充术后视网膜复位16只眼;联合巩膜外加压术复位10只眼（包括联合视网膜前膜剥除术8只眼,同时联合2次玻璃体切除和部分视网膜切除只2眼）.结论 Ⅲ区开放性眼外伤,经过玻璃体切除联合手术和相应的治疗,能够在一定程度上挽救眼球,并且恢复一定的视功能.     

Analysis of long-term outcomes for combined pars plana vitrectomy (PPV) and glaucoma tube shunt surgery in eyes with advanced glaucoma

Purpose

To analyze 12- and 24-month visual acuity, intraocular pressure, and complications associated with combined pars plana vitrectomy (PPV) and glaucoma tube shunt placement in eyes with glaucoma.

Patients and methods

A retrospective chart review was performed of patients with advanced glaucoma who underwent combined PPV and tube shunt surgery from 2006 to 2010. A minimum of 12 months of follow-up was required for their inclusion in the study. Visual acuity, intraocular pressure, complications, and number of glaucoma medications at 1 and 2 years postoperatively were analyzed.

Results

Twenty-eight eyes met the inclusion and exclusion criteria. Baseline visual acuity was 20/200 or worse in 14/28 eyes (50.0%) and 20/40 or better in 2/28 eyes (7.1%). Visual acuity remained 20/200 or worse in 50.0% (P=0.921) and 44.4% (P=0.973) of eyes after 1 and 2 years postoperatively, respectively. At baseline, the mean intraocular pressure was 30.4 mm Hg. There was significant improvement in mean IOP at 1 year (14.7 mm Hg, P=0.001) and at 2 years (15.2 mm Hg, P=0.001) postoperatively. Baseline number of glaucoma medications averaged 3.0±1.09 (SD), and improved to 1.8±1.28 (SD) at 1 year (P=0.0002) and to 1.4±1.33 at 2 years (P<0.0001) postoperatively.

Conclusion

In this retrospective interventional case series, surgical management of advanced glaucoma with a combination of PPV and glaucoma tube shunt resulted in significantly reduced IOP and glaucoma medications at 1 and 2 years postoperatively.     

严重眼外伤一期缝合联合玻璃体切割术的疗效观察

目的观察严重眼外伤一期缝合联合玻璃体切割术的疗效。方法总结2008年10月—2012年5月治疗的严重眼外伤（眼球穿通伤）患者46例（共46眼）资料,所有患者均选择一期缝合伤口联合玻璃体切割术,治疗后进行指标统计,以此评价严重眼外伤一期缝合联合玻璃体切割术的临床疗效,随访3个月一3年,观察视力变化,视网膜情况（视网膜脱离、视网膜增殖、萎缩）及眼球情况（萎缩、感染）。结果经治疗后,46只眼中,有30只眼（占65．3％）视力不同程度提高,眼内异物全部清除,视网膜复位率达到77．7％,眼球萎缩5只眼（占10．8％）。结论严重眼外伤一期缝合联合玻璃体切割术临床疗效满意。     

Ultrabiomicroscopic Findings in Acute Uveitic,Convalescent and Chronic Recurrent Stage of Vogt-Koyanagi-Harada Syndrome

ABSTRACT

Purpose

To describe the ultrabiomicroscopy (UBM) characteristics in patients with uveitic, convalescent, and recurrent Vogt-Koyanagi-Harada (VKH) disease.     

Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases

AIMS—To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet.
METHODS—The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis.
RESULTS—The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter 3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis.
CONCLUSION—The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (<3 mm) and initial visual acuity 20/200 were predictors of good visual outcome after primary magnetic extraction.

Keywords: intraocular foreign body; penetrating ocular injury; pars plana magnetic extraction     

联合手术治疗增殖性糖尿病视网膜病变的继发性新生血管性闭角型青光眼

目的：探讨联合手术治疗增殖性糖尿病视网膜病变的继发性新生血管性闭角型青光眼的临床疗效。
　　方法：前瞻性非随机临床研究。所有入选患者先行玻璃体腔注射ranibizulab 0.5lg(0.05lL),待虹膜和房角新生血管完全消退,再行白内障超声乳化吸除术+人工晶状体植入术+小梁切除术+经睫状体平坦部玻璃体切除术+眼内激光术。术后随访6lo,观察最好矫正视力( best corrected visual acuity,BCVA)、眼压( IOP)、虹膜新生血管( NV)及并发症的变化情况。
　　结果：入选患者19例19眼,随访6 lo所有患者术后视力均有提高。平均IOP显著降低,差异有统计学意义( P<0.01),从术前60.00±6.98 llHg 降至术后1 wk 9.68±2.11 llHg、术后1 lo 13.32±2.38 llHg、术后3 lo 16.37±3.42 llHg、术后6 lo 18.32±2.14 llHg。术后所有IOP 均控制<21llHg,其中3眼用1种降眼压药物,2眼用2种降眼压药物。所有眼3~8 d内NV消退,仅有1眼在术后36 d复发。无严重并发症发生。
　　结论：玻璃体腔注射ranibizulab辅助白内障超声乳化吸除术+人工晶状体植入术+小梁切除术+经睫状体平坦部玻璃体切除术+眼内激光联合手术可有效、安全地治疗增殖性糖尿病视网膜病变的继发性新生血管性闭角型青光眼。     

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIM: To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS: A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS: The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP(8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION: Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.