改良额肌筋膜瓣悬吊术矫治重度上睑下垂临床观察

目的探讨改良式额肌筋膜瓣悬吊术治疗重度上睑下垂的手术方法,并对手术效果进行评价。方法重度上睑下垂患者28例38只眼行改良式额肌筋膜瓣悬吊术治疗。手术方式:无眉下辅助切口,术中利用眼睑拉钩,手术视野充分暴露,形成的额肌瓣蒂部宽大。术后随访6个月～1年,观察疗效。结果28例38只眼除1例2眼因Bell现象阴性基本矫正外,27例36只眼均获良好矫正。所有病例术后3～6个月内均有不同程度的睑裂闭合不全,但均未引起暴露性角膜炎或其他并发症。结论改良式额肌筋膜瓣悬吊术术式设计有理论基础,操作简便,并发症少,矫治重度上睑下垂疗效可靠。     

兔视网膜多波长激光光凝术后OCT图像与组织病理学图像的比较

目的 探讨不同波长激光光凝术后视网膜、脉络膜结构的光学相干断层成像(optical coherence tomography,OCT)与组织病理学变化的相关性.方法 有色兔36只,左眼为空白对照组,右眼为实验组,实验组随机分3组,分别用绿光、黄光、红光激光光凝视网膜后极部,激光反应斑Ⅲ级,光斑直径300μm,光斑间距300μm,曝光时间200 ms.于光凝后lh、7d、14 d、28 d分别对光凝区行OCT和组织病理学检查.结果 组织病理学检查:3种激光光凝后1h,视网膜、脉络膜组织不同程度受到破坏:绿光光凝斑处主要表现为脉络膜毛细血管轻度扩张,视网膜色素上皮(retinal pigment epithelium,RPE)层线性结构消失,光感受器细胞层结构紊乱,外核层见核固缩;黄光光凝斑处主要表现为脉络膜毛细血管扩张明显,RPE层色素大量缺失,光感受器细胞层内、外节结构紊乱,内、外核层见核固缩;红光光凝斑处主要表现为脉络膜血管大部分扩张,内、外核层细胞缺失.随后,3种激光激光斑处RPE细胞、Müller细胞及成纤维细胞增生修复光凝区.OCT图像:3种激光光凝后1h,脉络膜组织的反射均显示不清,视网膜失去了其正常组织结构的划分,视网膜神经上皮层(retinal neuroepithelial layer,RNL)全层增厚、高反射;绿光、黄光、红光光斑处RNL厚度分别为(265.81±5.39) μm、(227.90±6.11) μm、(193.76±8.76) μm,与光凝前的(149.43±6.80)μm相比,差异均有统计学意义(均为P＜0.01);绿光光凝斑处见RPE层光带基本消失,黄光光凝斑处见RPE层光带连续性大部分中断,红光光凝斑处RPE层光带只见连续性部分中断.随后,3种激光斑处RNL全层向光凝斑中心牵拉凹陷,视网膜内RPE反射不断增多,遮挡脉络膜组织反射.结论 激光光凝后光凝斑OCT图像变化与组织病理学结构的变化具有一致性,可作为激光光凝后活体观察视网膜及脉络膜组织结构变化的影像学工具之一.不同波长的激光作用于眼底的组织学深度不同.     

青蒿琥酯预防牛血吸虫病的现场研究

根据吴玲娟等报道 [1] 用青蒿琥酯预防血吸虫病的动物试验和现场预防人体血吸虫病研究的启发 ,我们用青蒿琥酯预防牛血吸虫病。 1 999年夏对江西省永修县吴城镇猪屎湖洲上放牧的牛进行青蒿琥酯预防牛血吸虫病的现场研究。现将结果报告如下。1　疫区概况吴城镇位于永修县东部 ,鄱阳湖西岸 ,赣江与修河交汇处 ,境内河、沟纵横 ,镇周围草洲冬陆夏水 ,是典型的湖沼洲岛型疫区 ,经过 40余年的防治 ,疫情已有下降。据现场调查 ,截止 1 999年试验区的 2个行政村居民感染率为 1 2 .1 % ;牛感染率 7.1 % ;感染螺密度 0 .0 0 1 9只 /框 (每框 0 .1 m2 …     

眼视光学硕士研究生临床眼科学Seminar教学法应用初探

努力提高眼科学的临床能力与素质是当今眼视光学硕士研究生培养的核心内容之一。作为一种西方教学范式，“seminar”教学法在学生能力、素质与创造性培养方面备受推崇。温州医学院眼视光学院创新性地将此试应用于眼视光学硕士生临床眼科学教育，在培养高质量的复合型眼视光学高级专门人才领域进行了有益探索。     

丙烯酸酯人工晶状体囊袋内稳定性和囊膜透明性观察

Objective To compare the amounts of intraocular lens (IOL) decentration and tilt, the anterior chamber depth (ACD) and the degree of posterior capsule opacification (PCO) using the Pentacam Scheimpflug System after cataract surgery between eyes with 1-piece acrylic IOL and 3-piece acrylic IOL Methods It was a perspective study. Fifty-one patients with bilateral senile cataract had implantation of a 1-piece SA60AT IOL in one eye and a 3-piece MA60BM IOL in the contralateral eye. The amount of IOL decentration, tilt, the ACD, and the degree of PCO was measured using the Pentacam Scheimpflug System 1 day and 1,6, 12 and 24 months postoperatively. Results There were no significant changes during the 24 m follow-up period in the decentration ( 0. 37 ± 0. 16, 0. 36 ± 0. 15, 0. 36 ± 0. 16, 0. 37 ± 0. 15,0. 38 ± 0. 16), tilt (3.59±0.91,3.64 ±0.92,3.61 ±0.90,3.63 ±0.90,3.70 ±0. 89)or PCO(22. 20 ±3.99,21.96 ±4. 00,22.40 ± 4. 03,22. 53 ± 4. 00,22. 95 ± 3. 87 ) in the 1 -piece SA60AT group ( F = 1. 938,0. 785,1. 814;P ＞ 0. 05 ) or in the 3-piece MA60BM group (0. 34 ± 0. 14,0. 33 ± 0. 14,0. 34 ± 0. 14,0.35±0.14,0.36 ±0.14),(3.55 ±0.90,3.57 ±0.92,3.63 ±0.88,3.61 ±0.88,3.65 ±0.89),(21.14 ±3.88,20. 98 ±3. 87,21.23 ±3. 83,21.59 ±3. 82,21.65 ±3. 87) (F = 1. 004,0. 525,1. 963;P ＞0. 05). There was no significant difference between the two groups in IOL decentration (t = 0. 802,0. 701,0.588,0. 898,0.631), tilt (t =0. 199,0.337,0.094,0. 121,0.248) or PCO(t = 1.214,1. 119,1.334,1. 082,1. 517)at any time points (P ＞ 0. 05 ). The ACD did not change after the surgery in the 1-piece group (3.90 ±0. 99,3.88 ± 1.07,3.91 ± 1.01,3.90 ± 1.02,3.92 ± 1.02) (F= 1. 333,P ＞0. 05) but was significantly deeper in the 3-piece group ( 4. 37 ± 1.02,3.90 ± 0. 98,3.95 ± 0. 99,3.93 ± 0. 96,3.97 ± 0. 99 ) ( F = 92. 757, P ＜ 0. 05 ) one day after the operation. The ACD was more shallow in the 1-piece SA60AT group than in the 3-piece MA60BM group at all time points. However, the difference was statistically significant only at 1 day after surgery ( t = 102. 944, P ＜ 0. 05 ). Conclusions The degrees of IOL decentration, tilt, ACD and PCO in eyes with a 1-piece acrylic IOL with flexible haptics implanted in the capsular bag were similar to those in eyes with a 3-piece acrylic IOL with rigid PMMA haptics. But the 1 -piece acrylic IOL provides a better stability than the 3-piece acrylic IOL in the early stage postoperatively.     

SPARC与白内障

1　ＳＰＡＲＣ的生物学特性ＳＰＡＲＣ (ｓｅｃｒｅｔｅｄｐｒｏｔｅｉｎ ,ａｃｉｄｉｃａｎｄｒｉｃｈｉｎｃｙｓ ｔｅｉｎｅ ,富含半胱氨酸的酸性分泌蛋白 )是由细胞分泌到细胞外基质中的糖蛋白 ,分子量为 4 0～ 4 3ＫＤ。最初 (Ｔｅｒｍｉｎｅ ,1981)发现ＳＰＡＲＣ是一种能     

丙烯酸酯人工晶状体囊袋内稳定性和囊膜透明性观察

Objective To compare the amounts of intraocular lens (IOL) decentration and tilt, the anterior chamber depth (ACD) and the degree of posterior capsule opacification (PCO) using the Pentacam Scheimpflug System after cataract surgery between eyes with 1-piece acrylic IOL and 3-piece acrylic IOL Methods It was a perspective study. Fifty-one patients with bilateral senile cataract had implantation of a 1-piece SA60AT IOL in one eye and a 3-piece MA60BM IOL in the contralateral eye. The amount of IOL decentration, tilt, the ACD, and the degree of PCO was measured using the Pentacam Scheimpflug System 1 day and 1,6, 12 and 24 months postoperatively. Results There were no significant changes during the 24 m follow-up period in the decentration ( 0. 37 ± 0. 16, 0. 36 ± 0. 15, 0. 36 ± 0. 16, 0. 37 ± 0. 15,0. 38 ± 0. 16), tilt (3.59±0.91,3.64 ±0.92,3.61 ±0.90,3.63 ±0.90,3.70 ±0. 89)or PCO(22. 20 ±3.99,21.96 ±4. 00,22.40 ± 4. 03,22. 53 ± 4. 00,22. 95 ± 3. 87 ) in the 1 -piece SA60AT group ( F = 1. 938,0. 785,1. 814;P ＞ 0. 05 ) or in the 3-piece MA60BM group (0. 34 ± 0. 14,0. 33 ± 0. 14,0. 34 ± 0. 14,0.35±0.14,0.36 ±0.14),(3.55 ±0.90,3.57 ±0.92,3.63 ±0.88,3.61 ±0.88,3.65 ±0.89),(21.14 ±3.88,20. 98 ±3. 87,21.23 ±3. 83,21.59 ±3. 82,21.65 ±3. 87) (F = 1. 004,0. 525,1. 963;P ＞0. 05). There was no significant difference between the two groups in IOL decentration (t = 0. 802,0. 701,0.588,0. 898,0.631), tilt (t =0. 199,0.337,0.094,0. 121,0.248) or PCO(t = 1.214,1. 119,1.334,1. 082,1. 517)at any time points (P ＞ 0. 05 ). The ACD did not change after the surgery in the 1-piece group (3.90 ±0. 99,3.88 ± 1.07,3.91 ± 1.01,3.90 ± 1.02,3.92 ± 1.02) (F= 1. 333,P ＞0. 05) but was significantly deeper in the 3-piece group ( 4. 37 ± 1.02,3.90 ± 0. 98,3.95 ± 0. 99,3.93 ± 0. 96,3.97 ± 0. 99 ) ( F = 92. 757, P ＜ 0. 05 ) one day after the operation. The ACD was more shallow in the 1-piece SA60AT group than in the 3-piece MA60BM group at all time points. However, the difference was statistically significant only at 1 day after surgery ( t = 102. 944, P ＜ 0. 05 ). Conclusions The degrees of IOL decentration, tilt, ACD and PCO in eyes with a 1-piece acrylic IOL with flexible haptics implanted in the capsular bag were similar to those in eyes with a 3-piece acrylic IOL with rigid PMMA haptics. But the 1 -piece acrylic IOL provides a better stability than the 3-piece acrylic IOL in the early stage postoperatively.     

经腹腔缝闭疝内口治疗小儿斜疝56例体会

我院自1993年1月到1997年1月，共收治56例小儿先天性斜疝患儿，全部采用小切口经腹腔闭锁疝囊内口治愈，并随访半年至4年，无1例复发，现报告如下。临床资料1一般资料：56例患儿中，男51例，女5例，男女之比为10．2：1．右侧48例，左侧5例，双侧3例．不完全性疝56例，完全性疝3例．2手术方法：在而内口上方1．（k处，沿皮肤横纹切开皮肤、皮下组织L5cm－2．（hi，切开腹外斜肌腹膜，分离腹内斜肌及腹横肌，提起腹膜并切开．取头低足高位，同时沿腹壁内侧面向下寻找见羹内D，回纳见内容物，提起血囊内D，远离庙内日离断而囊，敞开班囊远端…     

综合省血方法降低心脏手术用血量

目的:探讨采用综合省血方法降低心脏手术围术期用血量的可行性和方法。方法:将104例接受心脏单瓣膜手术的患者随机分为两组:研究组(n=52)和对照组(n=52)。对研究组的患者采取综合措施,通过麻醉、体外循环、手术、术后处理等方面的措施以减少其围术期的输血率;对对照组的患者则不采取这些措施。结果:研究组36例未输血,输血率30.8%,平均用血量302.9 mL;对照组19例未输血,输血率63.5%,平均用血量538.9 mL;两组患者输血率的差异有统计学意义(P<0.05)。结论:应用综合省血方法和严格的输血标准,能有效降低心脏手术围术期的输血率,并减少手术用血量。