急性原发性房角关闭对侧眼激光周边虹膜切除术后接触性房角关闭的研究

目的了解急性原发性房角关闭（APAC）对侧眼激光周边虹膜切除术（LPI）后接触性房角关闭的发生率和眼部解剖特征。方法前瞻性研究。选择54例APAC对侧眼没有虹膜前黏连（PAS）的患者作为研究对象,平均年龄（67．1±7．2）岁（54—83岁）。采用超声生物显微镜（UBM）在暗环境下观察LPI后是否发生接触性房角关闭．并比较发生接触性房角关闭与不发生接触性房角关闭患眼的眼压、房角及各项UBM参数,包括房角开放距离。（AOD跏）、房角隐窝面积,。（ARA750）、小梁虹膜夹角（T—I角）、小梁睫状体距离（TCPD）、周边虹膜厚度（IT1）、虹膜悬韧带距离（IZD）、虹膜根部附着位置、中央前房深度（ACD）。对两组数据采用独立样本t检验及两样本秩和检验进行分析。结果LPI后暗环境下UBM检查至少一个象限发生接触性房角关闭的有20例,占37％。反映房角开放程度的指标（AOD500、ARA750、T-I角）和反映睫状体位置的指标（TCPD）：接触性房角关闭（＋）组小于（-）组（t=11．741、11．089、12．175、4．349,P均〈0．01）;反映虹膜形态和位置的指标IT1：接触性房角关闭（＋）组大于（-）组（t=-3．300,P=0．002）;IZD、虹膜根部附着位置及ACD比较,两组差异无统计学意义（t=-1．880,P=0．066;Z=-1．423,P=0．155;t=0．072,P=0．942）。结论APAC对侧眼LPI后在暗环境下仍有一定比例发生接触性房角关闭,房角窄、睫状体前位、周边虹膜厚是LPI后发生接触性房角关闭的解剖学特点,提示LPI后具有这些解剖特点的APAC患者有可能进展为慢性房角关闭。     

Small incision surgical iridotomy and iridectomy

Purpose To describe a minimally invasive method to create a full-thickness surgical iridectomy. Design An interventional case series. Methods Surgical iridectomies were performed through a 1-mm clear corneal incision. The anterior chamber was prepared with acetylcholine chloride 10 mg/ml and sodium hyaluronate 1%. A 25-gauge aspiration-cutter “probe” was introduced through the corneal incision such that the aspiration portal was occluded by the iris stroma. Then aspiration (600 mm/Hg) cutting (300 cpm) was used to create a surgical iridotomy in 2 cases. Then the probe was removed. Results Full-thickness iridotomies were created. None of the patients were noted to have a secondary increase in intraocular pressure, hyphema, infection, cataract or vision loss. The clear-corneal wounds were self-sealing. Conclusions Small incision surgical iridectomy can be minimally invasive and effective. Use of a 25-gauge aspiration-cutting probe allowed for small incision surgery, rapid rehabilitation and no significant complications. Supported by The EyeCare Foundation, Research to Prevent Blindness, and The New York Eye and Ear Infirmary Research Fund, New York City, New York, USA     

E.J. Curran,M.D., D. Ophth.

An historical vignette recounting the life of E.J. Curran, M.D., from his beginnings in Australia to his medical education at some of the most prestigious institutions of that era. His significant contributions as chairman of the University of Kansas Department of Ophthalmology are discussed. He became a national figure in ophthalmology when he elucidated the pathophysiology behind pupillary block glaucoma and the reason peripheral iridotomy would permanently relieve this condition.     

三联手术治疗伴虹膜新生血管的晚期青光眼临床疗效

目的评价三联手术治疗伴虹膜新生血管的晚期青光眼手术特点、手术时机及效果。方法36例（41眼）晚期青光眼合并虹膜新生血管采用虹膜热凝＋虹膜切开＋小梁切除术,观察视力、眼压、滤过泡、前房、虹膜新生血管、手术并发症和手术成功率。结果36例（41眼）手术成功40眼（97．56％）,术前有视力者术后视力均有提高,术后39眼虹膜血管新生消退,术后前房积血发生率7．31％,2—5d内吸收,无严重并发症发生。结论晚期青光眼合并虹膜新生血管实施局部虹膜热凝＋虹膜切开＋小梁切除术是一种安全有效的方法,晚期青光眼合并新生血管应积极采用手术治疗,以避免视功能的进一步损害。     

氪离子与Q-开关Nd∶YAG激光联合应用行虹膜切开术

目的　探讨治疗原发性闭角型青光眼的理想术式。方法　对 4 1例 (48眼 )原发性闭角型青光眼病例 ,采用氪离子激光与Q 开关Nd∶YAG激光联合应用的方法 ,行激光周边虹膜切开术。先用氪离子激光在虹膜面作分层击射 ,然后用Q 开关Nd∶YAG激光在此基础上作穿透性击射。结果　虹膜透切成功率为 10 0 0 % ,一次透切成功率为 97 9%。术后随访 1年 ,无一例发生击孔完全闭塞及青光眼发作。结论　联合激光虹膜切开术是预防和治疗原发性闭角型青光眼临床前期的有效术式 ,疗效确切 ,是适宜于亚洲人虹膜特点的较为理想的术式     

一种新型青光眼激光滤过术--自控式脉冲CO2激光手术系统

目的 为解决现有激光巩膜切除术存在的不足,寻求一种新的治疗青光眼的有效方法。方法 在提出经外路激光巩膜切除术的研究工作中,研制出由脉冲ＣＯ２激光器、指示激光器、ＣＣＤ摄像头、图像采集卡、激光器与微机的接口电路、微机和软件等几部分组成的自控式脉冲ＣＯ２激光手术系统,应用该系统对３０只日本大耳白兔眼进行了动物实验。结果 动物实验表明,研制出的自控式脉冲ＣＯ２激光手术系统。行巩膜切除联合虹膜切除具有明显的优越性。 结论 该自控式脉冲ＣＯ２激光手术系统可成为临床治疗青光眼的有效手段之一。     

脉冲染料激光虹膜切除术49例报告

为探讨脉冲染料激光虹膜切除术的效果，使用脉冲染料激光对４９例６６眼进行虹膜切除术。其中急性闭角型青光眼５８眼、慢性闭角型青光眼２眼、继发性青光眼３眼与虹膜后粘连３眼。结果：虹膜切除成功率１００％，其中一次治疗成功率９４％。并发症主要为暂时性眼压升高、前房出血及前葡萄膜炎，经药物治疗，效果良好。结果表明脉冲染料激光为一种安全、有效的治疗方法