应用冠状切口治疗颧弓、颧骨骨折38例临床分析

目的　对于我科应用冠状切口治疗 38例颧弓、颧骨骨折行综合临床分析。方法　收集经冠状切口治疗的颧弓、颧骨骨折患者 38例 ,对其临床资料进行分析研究。结果　依治疗后功能恢复情况、面部畸形整复效果及并发症消失程度分级 ,38例中效果优级 2 6例 ,占 6 8.4% ,良级 1 2例 ,占 31 .6 %。结论　应用冠状切口行手术治疗较其它术式可获更为理想的治疗效果。     

c-Jun expression after axotomy of corneal trigeminal ganglion neurons is dependent on the site of injury

The proto-oncogene c-Jun has been implicated in the control of neuronal responses to injury and in axonal growth during regenerative processes. We have investigated the expression of c-Jun during normal terminal remodelling in trigeminal ganglion neurons innervating the cornea and after acute injury of epithelial nerve terminals or parent axons. Remodelling and rearrangement, or damage limited to corneal epithelium endings, was not a trigger for activation of c-Jun expression. However, injury of parent axons in the stroma or in the orbital ciliary nerves induced c-Jun expression in 50% of the population of corneal neurons, which included all of the large myelinated and 20% of the small neuropeptide-containing corneal neurons. This suggests that c-Jun expression in trigeminal ganglion neurons is not associated with normal remodelling or regeneration of peripheral nerve terminals, and that it takes place only when parent axons are injured. A substantial number of damaged neurons do not express c-Jun, indicating that in primary sensory neurons, injury and regeneration may not always be coupled to the expression of this proto-oncogene.     

Confocal microscopy in cornea guttata and Fuchs'' endothelial dystrophy

AIMS: To report the appearances of cornea guttata and Fuchs' endothelial dystrophy from white light confocal microscopy. METHODS: Seven eyes of four consecutive patients with cornea guttata were prospectively examined. Of the seven eyes, three also had corneal oedema (Fuchs' dystrophy). In vivo white light tandem scanning confocal microscopy was performed in all eyes. Results were compared with non-contact specular microscopy. RESULTS: Specular microscopy was precluded by corneal oedema in one eye. In the remaining six eyes, it demonstrated typical changes including pleomorphism, polymegathism, and the presence of guttae appearing as dark bodies, some with a central bright reflex. In all seven eyes, confocal microscopy revealed the presence of round hyporeflective images with an occasional central highlight at the level of the endothelium. Changes in cell morphology and size were readily appreciated. CONCLUSION: By comparison with specular microscopy, the hyporeflective images with an occasional central highlight seen on confocal microscopy are consistent with the presence of guttae. Confocal microscopy may confirm the diagnosis of cornea guttata and Fuchs' endothelial dystrophy by demonstrating the presence of guttae. This technique is especially valuable in cases of corneal oedema, where specular microscopy may fail to visualise the endothelium. However, specular microscopy should remain the method of choice to evaluate the endothelium, principally because it is easier to use.     

Macular edema induced by phacoemulsification

Purpose: To characterise the association between lens phacoemulsification and the development of macular edema. Methods: We studied 15 patients who underwent lens phacoemulsification in our clinic between January and April 1998 performed by the same surgeon. Ultrasound power and cumulative time was noted. Follow-up was performed at 1 day, 1 week, 1, 3 and 6 months after operation. On each visit corneal thickness, best corrected visual acuity, biomicroscopy and fluorescein angiography were performed. Patients with systemic diseases and/or retinal diseases were not included. Results: Visual acuity was inversely related to the amount of energy delivered during phacoemulsification. In patients who had received more than 1 Joule of energy, fluorescein angiography revealed a higher incidence of blood retinal barrier breakdown. Corneal thickness was not correlated with the ultrasound energy used. Conclusions: Excessive use of power during phacoemulsification may hamper the postoperative evolution of cataract surgery. This revised version was published online in July 2006 with corrections to the Cover Date.     

严重晶状体不全脱位的小切口囊袋内吸出术

目的评价自闭性小切口囊袋内吸出术治疗严重晶状体不全脱位的疗效。方法对１４例１８眼悬韧带离断大于１８０°的严重晶状体不全脱位者,根据晶状体核硬度的不同,分别采用自闭性小切口手动囊袋内吸出术和超声乳化囊袋内吸出术。结果术后随访３月～２年,２例４眼因弱视矫正视力０１～０３,３例５眼０５～０７,８例外伤眼术中植入人工晶状体,７例裸眼视力０５～１０,另１眼因青光眼视神经损害视力００３。无术中及术后并发症。结论此手术方法具有切口小,对角膜、虹膜及玻璃体扰动小,便于联合其它手术,术中、术后并发症少,视力恢复好等优点,是一种安全、有效的手术方法。     

高龄老年白内障透明角膜切口超声乳化术临床探讨

目的 探讨避免高龄老年白内障手术风险的办法。方法 对高龄老年白内障３６眼采用透明角膜切口和机械碎核协助进行超声乳化手术。结果 术中血压平稳,眼心反射不明显,安全手术。术后１月视力〉０．５占８６．１１％。结论采用透明角膜切口避免球后麻醉和压迫眼球并缩短术程,能减少风险;机械碎核可降低超声能量,减少角膜并发症,提高疗效。     

锥兰联合茜素红活细胞染色法观察角膜中央碱烧伤内皮细胞愈合过程

目的:研究角膜碱烧伤内皮细胞的愈合过程。方法:锥兰联合茜素红内皮细胞染色法对角膜中央碱烧伤内皮细胞形态学变化进行观察。结果:伤后20分钟内皮细胞已破坏。72小时,损伤区的周边内皮细胞变形向创面内迁移。第7天后缺损区大部分范围均可见梭形细胞覆盖。结论:兔碱烧伤损伤区内皮细胞的修复由邻近内皮细胞变形,增殖和移行长入创面内完成,修复的内皮细胞具有纤维细胞特征。眼科学报1999;15:218-220。     

The deleterious effects of exogenous bicarbonate on the rabbit cornea undergoing prolonged refrigerated storage

The functional integrity of stored corneas is investigated, using the criterion of final minimum thickness achieved by the corneas when incubated under standardized conditions. This criterion indicates that rabbit corneas stored in low bicarbonate media function better in vitro than those stored in high bicarbonate media. Reasons are advanced which might explain the phenomenon. It is proposed that a relatively low concentration of bicarbonate in McCarey-Kaufman medium (1974) is a major factor in the success of their procedure.     

Observations on the human cornea in vitro

Human corneas seem to have a vegetative physiology similar to the rabbits. The swelling-hydration characteristics of the stromas are similar and there is a pump in the endothelium which continuously pumps fluid out of the stroma. An electrical potential is found across the endothelium which is stimulated and stabilised in the presence of 0·5 mm reduced glutathione. Both fluid flow across the endothelium and trans-endothelial electrical potential are reversibly abolished in the absence of exogenous bicarbonate and CO₂ which suggests that the two phenomena are manifestations of a common underlying mechanism.Difficulties in using the specular microscope on human cornea in vitro are illustrated. It is suggested that results from such experiments usually cannot be interpreted.     

小切口白内障手术中后囊膜破裂一期人工晶体植入术临床疗效分析

目的评价小切口白内障摘除术术中后囊膜破裂的原因及处理方法.方法回顾分析1 05 6例小切口白内障手术联合人工晶体植入术,其中术中51例后囊膜破裂,玻璃体溢出,行前段玻璃体切割术联合一期后房型人工晶体植入术.结果本组患者手术中后囊膜破裂发生率为4.8%,全部行一期后房型人工晶体植入术,其中5例囊袋内固定植入,42例睫状沟固定植入和4例DGR人工晶体双襻缝线固定法植入.术后矫正视力大于或等于0.3者46例(90.2%);矫正视力大于或等于0.05,低于0.3者4例(7.8%);矫正视力低于0.05者1例(2.0%).结论前段玻璃体切割术为小切口白内障摘除术中后囊膜破裂一期人工晶体植入提供了安全有效的保证.