可调整巩膜缝线在小梁切除术中的临床观察

目的　探讨可调整巩膜缝线对小梁切除术的效果及防止并发症的意义。方法　用 1 0 - 0尼龙线缝合巩膜瓣两角各 1针 ,两侧做 1对可调整巩膜瓣缝线 ,外露端距角膜缘 6mm于球结膜穿出 ,单道活结。结果　前房深度 :术后第 1d未见浅前房发生 ,第 4d拆除可调整缝线 ,前房出现浅Ⅰ级 ,经处理前房恢复正常 ,1 4d拆线 ,无浅前房发生。眼压 <2 73kPa 30眼 ,>2 73kPa 3眼。结论　采用可调整缝线在小梁手术中可主动调节滤过功能 ,控制眼压 ,防止浅前房发生 ,并能减少因眼压性浅前房引起一系列并发症 ,提高手术成功率。     

巩膜潜池式小梁切除术

目的探讨巩膜潜池式小梁切除术的疗效。方法手术显微镜下作以穹隆部为底的结膜瓣和5mm×5mm、1/3巩膜厚度的浅层巩膜瓣。再作边长各3mm的等边三角形,厚1/3的中层巩膜切除。作小梁切除。虹膜根切。巩膜瓣固定。球结膜瓣缝合。术毕枣核形棉球加压包扎。结果76例(92眼)近期眼压均≤21mmHg。远期随访35例(38眼),眼压≤21mmHg36眼,>21mmHg2眼。结论巩膜潜池式小梁切除术降眼压效果确切,并发症少。     

绝对期青光眼巩膜条带嵌置联合睫状体贫血术

目的探讨深层巩膜条带嵌置联合睫状体贫血术治疗绝对期青光眼的效果。方法采用深层巩膜条带嵌置以增强房永引流动能,环扎部分眼肌动脉减少睫状体血液供应以减少房水生成的方法,治疗绝对期青光眼34例35眼。结果通过对患者半年至10年的随访观察,降压效果稳定,达到了预期目的。结论此联合手术治疗绝对期青光眼有较好的临床效果,不失为对绝对期青光眼患者姑息治疗的方法之一。     

巩膜羊膜覆盖防治羟基磷灰石义眼台暴露

目的探讨羊膜加前部巩膜覆盖防治羟基磷灰石Ⅱ期义眼台植入暴露的临床效果。方法采用羊膜联合异体巩膜为加固物对7例(7眼)行Ⅱ期羟基磷灰石义眼台植入,随访12~20月。结果7例均获得了较好的疗效,未见其他并发症。结论在行羟基磷灰石义眼台Ⅱ期植入时采用羊膜联合前部异体巩膜覆盖加固有利于结膜创口的愈合,预防创口裂开,减少义眼台暴露。     

Biomechanical considerations: evaluating scleral reinforcement materials for pathological myopia

Objective: Scleral biomechanical weakness and thinness are known to be one of the main factors in the pathogenesis of progressive myopia. Posterior scleral reinforcement surgery remains the rational treatment for pathological myopia. We tested the biomechanical properties of 3 types of scleral reinforcement materials (artificial pericardium, human sclera, and all-dermal matrix) in an attempt to select the ideal material for the reinforcement of pathologic sclera.Design: Experimental study.Participants: Forty-five adult Japanese white rabbits.Methods: Animals were equally divided into 3 groups. For each group, 1 type of material was surgically implanted at the back of the globe. We harvested samples after 10 months of implantation, tested the elasticity modulus for both reinforced sclera and unreinforced control sclera, and assessed data by t test methods. Statistically significant differences were considered when p < 0.05.Results: Rabbit sclera reinforced by artificial pericardium or human sclera showed significant increases in the elasticity modulus compared with control eyes. However, the rabbit sclera reinforced by all-dermal matrix showed no significant difference in the elasticity modulus compared with normal controls.Conclusions: The analysis of biomechanical considerations in scleral reinforcement materials presented here is a very helpful method to choose the best materials for treatment of myopia. Of all materials tested, the artificial pericardium and human foreign-body sclera provided the best biomechanical characteristics.     

前巩膜片技术预防多孔材料义眼座植入的暴露

目的探讨在眼球摘除后多孔材料义眼座前部增加一巩膜片植入眼眶后预防暴露的有效性。方法美国Ore-gon州OHSU医学院Casey Eye Institute眼科研究所眼面部整形外科从2000年1月至2009年1月,John D Ng医生的162例（170眼）眼球摘除合并眼眶内植入有孔材料,使用前巩膜片技术（在多孔义眼座的前部缝合一7.5 mm×7.5 mm的巩膜片,并将四条直肌缝在巩膜片上）。根据病例资料,眼疾诊断,手术操作技术,先前眼科手术史,植入物的大小,随访时间,植入后并发症等,观察统计义眼暴露率及并发症。结果植入暴露发生7例,7眼（4.12%,7/170）。其中一例发生在早期（〈6个月）,6例发生在晚期（〉6个月）。这7例中1例给于抗生素及结膜切除手术,暴露得到修复;另外6例结膜撕裂较大未能得到修复,遂取出义眼座植入一新的前部缝有巩膜片的义眼座。这7例经过1a以上的随访,未出现再次暴露。结论巩膜片在移植物的前表面可以作为一种屏障,在预防暴露方面具有一定的有效性。     

隐匿性巩膜破裂伤临床分析

目的　探讨隐匿性巩膜破裂伤的临床表现和手术方法。方法　总结 1986年 5月～ 2 0 0 1年 12月因隐匿性巩膜破裂而行手术治疗的 3 2例 3 2眼。分析其致伤原因、临床表现、手术方法及结果。结果　术后视力≥ 0 .0 5者 19眼 ,视力 <0 .0 5者 5眼 ,眼球萎缩 4眼 ,眼球摘除 4眼。结论　隐匿性巩膜破裂伤主要由眼挫伤引起 ,应及时根据临床表现进行手术探查 ,缝合伤口 ,预防并发症发生。     

异体巩膜矫正甲状腺相关眼病上睑退缩并内翻

目的 评估异体巩膜移植延长上睑提肌矫正甲状腺相关眼病上睑退缩并内翻的疗效.方法 对17例（21眼）上睑退缩并内翻的静止期甲状腺相关眼病患者行异体巩膜移植延长上睑提肌矫正上睑退缩并内翻,观察其临床效果.结果 术后所有患者睑裂宽度均较术前缩小,差异有统计学意义（t=2.94,P=0.028）,患者自觉症状不同程度减轻或消失,随访6个月和1年无上睑退缩或内翻复发.结论 异体巩膜移植延长上睑提肌能有效矫正甲状腺相关眼病上睑退缩并内翻.     

Diffusion of macromolecules through sclera

Purpose: To quantify the in vitro permeability coefficient over different topographical locations of porcine sclera to macromolecules with different molecular weight. Methods: Fresh equatorial and posterior superotemporal porcine sclera was mounted in a two‐chamber diffusion apparatus, and its permeability to fluorescein isothiocyanate (FITC)‐conjugated dextrans ranging in molecular weight from 40 kDa to 150 kDa was determined by fluorescence spectrophotometry. The sclera was processed as frozen sections and viewed with a fluorescence microscope. The thickness of the area and the thickness that macromolecules enriched in the surface of sclera were measured. Results: The permeability coefficient (Pc) of porcine sclera to macromolecules was significantly higher (40 kDa, p = 0.028; 70 kDa, p = 0.033; 150 kDa, p = 0.007) in equatorial region than posterior, which could be attributed to the significant difference of thickness (p < 0.001, Kruskal–Wallis) between them. Moreover, linear regression indicated a significant negative relationship (40 kDa, p < 0.001; 70 kDa, p = 0.015; 150 kDa, p < 0.001) between scleral permeability coefficient and thickness. Also, Pc declined significantly with increasing molecular weight (MW, p < 0.001, Kruskal–Wallis). The area that the macromolecules enriched in the scleral surface was thicker for those with larger MW (p < 0.001, Kruskal–Wallis). The maximum MW and size for equatorial and posterior superotemporal scleral tissue were 185.01 KDa and 180.42 KDa, 9.92 nm and 9.67 nm, respectively. Conclusions: The permeability coefficient of porcine sclera has a significant negative relationship with scleral thickness and MW of macromolecules. Larger macromolecules are more likely to accumulate in scleral surface. The difference between topographical locations may have pharmacokinetic implications when considering transscleral diffusion of macromolecules.     

鸡形觉剥夺性近视眼后极部巩膜胰岛素样生长因子-1/胰岛素样生长因子-2 mRNA表达的动态变化

目的观察鸡形觉剥夺性近视眼后极部巩膜胰岛素样生长因子(insulinlikegrowthfactor,IGF)IGF1/IGFmRNA表达水平的变化,探讨IGF1/IGF2在实验性近视眼发病中的作用。方法取孵化1d的白色来亨鸡36只,右眼为遮盖眼,左眼为自身对照眼。测量实验前以及单眼遮盖后第7天、第14天、第21天时实验眼和对照眼的屈光度和眼轴长度,并检测不同遮盖时间时鸡眼后极部巩膜IGF1/IGF2mRNA的表达水平。结果随着遮盖时间的延长,IGFmRNA在试验眼和对照眼后极部巩膜的表达水平均升高,但两者之间差异无显著性(P>0.05);实验眼后极部巩膜的IGF2mRNA表达水平在遮盖7d后即明显高于对照眼(P<0.001),随着遮盖时间的延长,实验眼后极部巩膜IGF2mRNA表达水平明显升高,而对照眼则逐渐下降,两者的差值明显增大。结论形觉剥夺可能通过上调鸡眼后极部巩膜IGF2mRNA表达水平,影响巩膜的发育和重塑,从而导致近视的形成。