玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物

目的：探讨玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物的疗效。方法：应用玻璃体切割术、眼内异物取出术、外伤性白内障摘除术、眼内光凝、眼内充填术,部分病例结合巩膜外加压术等玻璃体视网膜手术治疗复杂眼球穿通伤伴眼内异物41只眼。结果：41只眼异物均一次手术取出,术后视力高于术前者36只眼（87．80％）,等于术前者4只眼（9．76％）,下降者1只眼（2．44％）。3个月至3年随访期间,无一便发生复发性视网膜脱离。结论：复杂眼于穿通伤伴眼内异物常导致眼内多种组织的严重损伤。玻璃体切割、异物取出等联合手术是准确、安全、有效的治疗方法,可挽救患者一定视功能。     

眼内巨大异物摘出术17例临床分析

目的讨论眼内巨大异物的定义、手术方式的选择以及提高治愈率，方法（１）经Ｘ线定位，常规经巩膜取出法；（２）间接检限镜直规定位法；（３）显微镜直视下自睫状体平坦部夹取法；（４）经前房取出法。结果１７例（１８只眼）均为一次手术摘出异物。联合玻璃体切除显微镜直视下摘出异物１３只眼，占７２．２％（二期行眼内容剜出人造骨植人术１只眼）；经巩膜摘出异物５只眼。术后视力提高６只眼，不变９只眼，下降３只眼。结论异物摘出联合玻璃体切除手术损伤小、准确、安全，可减少手术开发症，提高治愈率，是值得推广的手术方式。     

眼后段眼内异物行玻璃体手术摘出的临床观察

目的观察眼后段眼内异物行玻璃体手术摘出的临床效果。方法本组156例（156眼）。其中非磁性异物128眼,伴玻璃体积血浑浊96眼,外伤性白内障81眼,视网膜脱离69眼,异物被纤维包裹33眼,伴眼内炎5眼,视网膜下异物2眼。手术均采用经睫状体平坦部标准三通道切口。伴有晶状体浑浊者,先行晶状体摘出,再行玻璃体手术摘出眼内异物;伴有视网膜脱离者,在玻璃体手术摘出眼内异物后再行视网膜复位、眼内光凝术或气体或硅油填充。行I期或Ⅱ期人工晶状体植入或睫状沟缝合固定术。本组3眼因异物较大,而采用角膜缘隧道切口摘出。术后观察3—6个月。结果本组156眼均经玻璃体手术成功摘出眼内异物,伴视网膜脱离的69眼均复位,伴眼内炎的5眼均得以有效控制。术后视力与术前相比均有不同程度提高。结论玻璃体手术可以去除屈光间质浑浊,同时摘出眼内异物、治疗视网膜脱离及其他并发症。     

玻璃体切除联合眼内异物摘出术的临床分析

目的 探讨玻璃体切除联合眼内异物摘出的手术时机和手术方法。方法 对经睫状体平坦部玻璃体切除联合眼内异物摘出术30例（30眼）进行回顾性分析。结果 本组30例（30眼）眼内异物均一次手术摘出，其中27例采用经睫状体平坦部玻璃体切除取出异物；1例锯齿缘附近磁性大异物，经玻璃体切割后，从巩膜切口用磁铁将异物吸出；1例锯齿缘巨大非磁性异物，行晶体摘除后经角膜缘切口取出。本组病例术后视力改善19眼（63．3％），无变化6眼（20％），视力下降5眼（16．7％）。早期视力下降的原因与术后角膜水肿，视网膜出血，玻璃体混浊、玻璃体腔内填充物等因素有关。术后有3例（3眼，1％）发生视网膜脱离，其中1例行巩膜扣带术＋玻璃体切除＋晶体切除＋冷凝＋注气术后治愈，1例放弃治疗；1例因眼球萎缩行眼球摘出。结论 对穿通伤口小且已自行闭合者、穿通伤口已缝合但角膜透明不影响观察者和有化脓性眼内炎征象者均应尽早手术。对于＜35岁晶体已混浊者，建议采取玻璃体切割切除晶体和眼内异物摘出同时进行，术中应尽量保留晶体前囊膜，以利于人工晶体植入。对位于周边部的非磁性异物，虹膜后粘连瞳孔无法扩大者建议术中切除晶体，以扩大视野有利于异物的寻找取出和病变玻璃体的切除。对巩膜裂伤伴球内异物存留的患者，建议玻璃体切除的同时行巩膜扣带术以降低视网膜脱离的风险。     

玻璃体切除和人工晶体植入联合与分期手术的探讨

对７１例累及前后段复杂眼外伤患者采取玻璃体切除、晶体切除或囊外摘出、眼内异物取出、视网膜裂孔封闭的联合手术，同期或分期植入人工晶体。其中同期植入４６只眼，分期植入２５只眼。术后视力１．０以上１３只眼（１８．３％），０．３以上４４只眼（６２％），０．０５～０．２者１４只眼（１９．７％）。对联合与分期手术的选择、手术方式、合并症的处理等进行了探讨。     

玻璃体切除术在眼内异物摘出中的应用

目的评价玻璃体切除术治疗眼内异物伤的效果及影响因素。方法对行玻璃体切除联合眼内异物摘出的５１７例（５３３只眼）住院患者进行回顾性研究。结果眼内异物摘出率为９７．６％，术后有用视力（本组为０．０５～０．４）由术前的１２．５％增至２３．２％，良好视力（本组为≥０．５）由７．２％增至１７．０％（Ｐ＜０．００５）。当异物位于前段、玻璃体、视网膜时，术后有用视力增加率分别为４４．４％、２５．１％、１０．７％，良好视力增加率分别为２６．３％、１２．７％、２．７％。结论通过玻璃体切除术有利于摘出眼内异物和提高术后视力，解决异物存留的并发症     

玻璃体切除术治疗眼内异物并发感染性眼内炎

目的：探讨眼内异物并发感染性眼内炎的治疗手段和预后。方法：回顾分析26例(26只眼)经玻璃体切除术治疗眼内异物合并眼内炎的临床资料。结果：26只眼的眼内异物全部摘出。25只眼的眼内炎症得到控制。随访2～21个月，平均7．6个月。视力0．02～0．09者3只眼(11．5％)，≥0．1者8只眼(30．8％)。结论：玻璃体切除术是治疗眼内异物并发眼内炎的有效手段，手术预后与多种因素有关。同时应注意眼内异物伤的预防和术后并发症的治疗。     

睫状体平坦部附近磁性异物的摘出

目的观察分析睫状体平坦部及其附近磁性异物的摘出。方法回顾性分析位于睫状体平坦部附近的磁性异物20例（20眼）。结果CT扫描及X线定位确诊20例眼内磁性异物位于睫状体平坦部及其附近,其中19例进行经巩膜的异物摘出术,1例因伴有玻璃体浑浊而进行玻璃体切除眼内异物摘出联合手术。一次异物摘出成功率为100％。术后视力较术前提高者占90．00％。结论对睫状体平坦部及其附近磁性异物,传统经巩膜的异物摘出手术是一种简单、安全、有效和经济的治疗方案。     

玻璃体切割联合玻璃体注药治疗眼内炎

对２８例２８眼化脓性眼内炎经平坦部行玻璃体切割联合玻璃体注药、眼内异物摘出,配合全身及局部应用抗生素、皮质类固醇药物或抗真菌药物治疗患者,回顾性分析了玻璃体切割联合玻璃体注药治疗化脓性眼内炎的临床应用价值。结果：随访６～１２月２８例２８眼眼内感染全部控制,２６眼视力有不同程度的提高,２眼眼球萎缩,无１眼眼球摘除。结论：玻璃体切割联合玻璃体注药是治疗化脓性眼内炎最有效方法。     

玻璃体切割联合玻璃体注药治疗眼内炎

目的 回顾性分析玻璃体切割联合玻璃体注药治疗化脓性眼内炎的临床应用价值。方法 对２８例２８眼化脓性眼内炎经平坦部行玻璃体切割联合玻璃体注药、眼内异物摘出,配合全身及局部应用抗生素、玻质类固醇药物或抗真菌药物治疗。结果 随访６～１２ｍｏ,２８例２８眼内感染全部控制,２６眼视力有没程度的提高,２眼眼球萎缩,无１眼眼球摘出。结论 玻璃体切割联合玻璃体注药是治疗化脓性眼内炎最有效方法。     

药源性干眼症

药源性干眼症是近年来逐渐被认识的一类药源性眼病,引起此病的药物有十余类上百种,其中常见的有抗胆碱能受体药、抗组胺药、抗抑郁症类药、抗精神病类药、激素类药、抗青光眼类药等。主要机制是药物影响副交感或交感神经系统,支配腺体分泌的通路受到阻断;或药物局部使用引起泪膜不稳定及眼表面异常。防治此类干眼症主要采用停药或换药,对因治疗以及对症处理。     

卡波姆眼用凝胶联合聚乙二醇滴眼液治疗干眼症的疗效

目的:探讨卡波姆眼用凝胶联合聚乙二醇滴眼液治疗干眼症的临床疗效.方法:干眼症患者120例240眼随机分为观察组(60例120眼)和对照组(60例120眼),两组患者均给予聚乙二醇滴眼液,观察组在此基础上使用卡波姆眼用凝胶,疗程为1mo.对两组患者白细胞介素-1β(interleukin-1β,IL-1β)水平和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、眼部症状评分[眼表疾病指数(ocular surface disease index,OSDI)、泪膜破裂时间(break-up time,BUT)、基础泪液分泌试验Ⅰ(SchirmerⅠtest,SⅠt)、角膜荧光素染色(corneal fluorescein staining,FL)]、疗效和不良反应进行比较.结果:治疗后两组患者泪液中IL-1β 和TNF-α 水平、OSDI和FL较治疗前均明显降低,BUT和SⅠt较治疗前均明显升高,差异均具有统计学意义(P<0.05),且观察组泪液中IL-1β水平、TNF-α 水平、OSDI、BUT、SⅠt、FL改善程度均优于对照组(P<0.05).对照组总有效率明显低于观察组,差异具有统计学意义(x2=5.065,P=0.024).两组患者中无1例出现眼部不适症状和药物不耐受.结论:卡波姆眼用凝胶联合聚乙二醇滴眼液治疗干眼症疗效明显,优于单用聚乙二醇滴眼液,且不增加患者的不良反应.     

The development of the angle of the anterior chamber in vertebrate eyes

The development of the angle of the anterior chamber of the eye in chick embryos (avian eye), in new born rats (rodents), in calf fetuses (ungulates) and in humans (primates) has been studied. The main determinant in the configuration of the angle is the two-layered structure of the mesoderm of the ciliary body: the external muscular layer inserted into the spur and growing with the same growth rate as that of the corneoscleral mesoderm and the internal fibrovascular layer giving rise to the ciliary processes and growing with the same growth rate as that of the neural ciliary and iris epithelium. First the neural epithelium grows faster than the corneoscleral mesoderm and the ciliary processes appear anteriorly positioned and later the corneoscleral mesoderm grows faster than the neuroepithelium and the ciliary processes appear posteriorly positioned.The eyes of premature and low birth weight babies present the different stages of normal embryological development of the angle. The angle in eyes of various embryopathies and developmental diseases presents aspects similar to those of the premature and low birth weight babies. The etiopathogenic mechanism in cause is the same in both groups: arrest of development.During the first post-natal years, the corneoscleral mesodermgrows at a greater rate than the inner neuro-epithelium and the region of the most active growth is located at the ora serrata. That is why, during this period, the ora serrata recedes, giving rise to the formation of retinal teeth, the angle despens and makes a recess and the Lange fold disappears.Abbreviations C Cornea - E External layer of the ciliary body mesoderm - I Internal layer of the ciliary body mesoderm - C.P. Ciliary processes - En Endothelium - Si Sinus von Szily - S Sclera - S.S. Scleral spur - Tr Corneoscleral trabeculum - U.M. Fetal uveal meshwork - Ir Iris - C.B. Ciliary body - La.F. Lange fold - R Retina - L Longitudinal ciliary muscle - Sc Schlemm's canal - Ci Circular ciliary muscle - A Apex of the angle - Cr Crampton's muscle - P.L. Pectinate ligament - M.P. Membrana pupillaris - Ca Caoukkart - C.E. Ciliary epithelium - V Vacuoles in lens - Ep Lens epithelium This paper was delivered as the IXth Hearst Lecture on April 4, 1974, at the Annual Meeting of the Frederick C. Cordes Eye Society, University of California, San Francisco, California, USA.From the Mitrani Foundation Eye Pathology Laboratory, the Chaim Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Israel.     

贝复舒（重组bFGF）滴眼液治疗干眼症的临床研究

目的：评价贝复舒滴眼液治疗干眼症的临床效果。方法：32例（64只眼）干眼症患者,双眼自身对照,随机分为贝复舒组和对照组。贝复舒组采用贝复舒滴眼液滴眼,每日4次;对照组不用药或双眼点用珍珠明目液。连续用药一周后复诊。分别检查记录用药前后Schirmer-1试验、泪液膜破裂时间（BUT）及荧光素染色结果,并询问干眼症程度。结果：治疗后两组BUT、角膜荧光素染色程度分级结果及临床症状有明显差异（P＜0．05）;Schirmer-1试验结果无显著差异（P＞0．05）。结论：贝复舒滴眼液对干眼症有明显的治疗作用。     

秦皮滴眼液联合环孢素A滴眼液治疗干眼症的疗效

目的:观察秦皮滴眼液联合环孢素A滴眼液治疗干眼症的疗效。方法:将200例400眼干眼症患者随机分为试验组和对照组,每组各100例200眼。试验组:秦皮滴眼液与0.5g/L环孢素A滴眼液间隔30min,每次1滴点双眼(1mL≈15滴),各4次/d。对照组仅用0.5g/L环孢素A滴眼液每次1滴点双眼,4次/d。两组均以4wk为一疗程,两组治疗前后均进行基础泪液分泌试验、泪膜破裂时间(BUT)检查,并对结果进行统计分析。结果:两组用药前Schirmer试验、BUT无统计学差异(P>0.05);治疗后两组Schirmer试验、BUT均较治疗前改善,且差异均有显著统计学意义(P<0.01);试验组治疗后,Schirmer试验、BUT的改善情况均优于对照组,其差异有显著统计学意义(P<0.01)。结论:秦皮滴眼液联合环孢素A滴眼液治疗干眼症较环孢素A滴眼液单药使用有更好的治疗效果。     

The length-tension diagrams of human oblique muscles in trochlear palsy and strabismus sursoadductorius

We determined the relation between length and tension in detached oblique muscles of 16 strabismus patients that underwent surgery, before and during contraction evoked by intravenous administration of succinylcholine. We frequently found a nonlinear relation between length and tension, unlike our previous findings in recti. In superior oblique palsies, the superior oblique was found, before injection of succinylcholine, to be stiff after elongation, and did not contract after injection of succinylcholine, while the ipsilateral inferior oblique contract after injection of succinylcholine, but with a higher spring constant than did usual. In 3 cases the superior oblique contracted vividly after administration of succinylcholine despite the presence of excyclotropia, stereopsis, torticollis (2 cases) and a hypertropia that increased in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt. The finding of a vividly contracting superior oblique is incompatible with the diagnosis of a complete superior oblique palsy. We conclude that some of the cases diagnosed as congenital superior oblique palsy, having a hypertropia increasing in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt, are in fact cases of unilateral strabismus sursoadductorius (upshoot in adduction), a non-paretic motility disorder.This work was supported by a fellowship of the Royal Netherlands Academy of Arts and Sciences (Dr Simonsz).     

施图伦滴眼液治疗干眼引起的视疲劳

目的观察施图伦滴眼液对于干眼（dnyeye）所致视疲劳的治疗效果。方法应用施图伦滴眼液滴眼治疗干眼所致视疲劳25例（50眼）。每日用药3-4次,连续4周。以视疲劳的10项自觉症状为观察指标,比较治疗前后的变化,同时观察药物的不良反应。结果25例中,施图伦滴眼液能明显降低视疲劳10项症状的总评分（P〈0．01）,除恶心、呕吐及眩晕症状外,其它各指标在治疗后均有改善。治疗后患者视力及屈光度无明显变化（P〉0．05）,安全性评价为1级（安全）。结论施图伦能有效缓解干眼引起的视疲劳,使用安全。     

A statistical model of the aberration structure of normal, well-corrected eyes

A statistical model of the wavefront aberration function of the normal, well-corrected eye was constructed based on normative data from 200 eyes which show that, apart from spherical aberration, the higher-order aberrations of the human eye tend to be randomly distributed about a mean value of zero. The vector of Zernike aberration coefficients describing the aberration function for any individual eye was modelled as a multivariate, Gaussian, random variable with known mean, variance and covariance. The model was verified by analysing the statistical properties of 1000 virtual eyes generated by the model. Potential applications of the model include computer simulation of individual variation in aberration structure, retinal image quality, visual performance, benefit of novel designs of ophthalmic lenses, or outcome of refractive surgery.     

Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis

ABSTRACT

Purpose

To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US).     

共同性外斜视主眼与斜眼眼外肌组织学比较

目的探讨共同性外斜视主视眼与主斜眼眼外肌组织学上有无差异。方法对26例共同性外斜视手术患者的眼外肌进行了主视眼与主斜眼的组织学观察比较。结果主视眼与主斜眼的内直肌组织学检验无差别,主视眼的外直肌在肌肉萎缩、纤维组织增生方面较斜眼明显,而在排列紊乱、胶原变性、脂肪组织增生诸方面两组间无差别。结论共同性外斜视主视眼与主斜眼眼外肌均发生了肌源性病变。