危及晶状体的穿透性深层角膜异物取出

目的:探讨危及晶状体的穿透性深层角膜异物取出方法。方法:本次观察中共有患者12例12眼,其中植物性11眼,金属性1眼,均为位于瞳孔区的穿透性深层角膜异物。患者术前30min予全身镇静药,缩瞳剂充分缩瞳,以15°角膜穿刺刀作前房穿刺,确保无房水外漏,粘弹剂自穿刺口注入前房并加深其深度,以无齿镊挟持异物将其顶退出角膜表面,另手以有齿镊接应将异物拔除,或将异物拨向虹膜面并将其拽入前房,经角膜切口取出。结果:12眼异物均顺利取出,1眼多发性异物因初始取出经验不足导致术后轻度并发性白内障,8眼有角膜渗漏(其中3眼行角膜缝合),经加压包扎后恢复。结论:对于危及晶状体的穿透性深层角膜异物,术前应设计一个有针对性的周详应对方案,在外路取出存在危险的情况下,内路取出法不失为一个理想的方法。     

角膜深层异物及前房异物82例临床分析

目的 探讨角膜深层异物及前房异物的临床特点及治疗.方法 对82例角膜深层异物及前房异物的致伤原因、异物性质、异物位置、临床表现、并发症和疗效进行回顾分析.结果 82例患者中男女比例约为9:1,年龄为20～45岁者占78.05﹪,职业以农民、工人为多,分别为46.34﹪和43.90﹪.所有患者均手术取出异物,术后视力上升者42例(51.22﹪),视力稳定者29例(35.37﹪),视力减退者11例(13.41﹪).15例眼盲者有6例是爆炸伤患者(40﹪).就诊时间越早,视力恢复越好(χ2=10.69,P=0.001 4).结论 爆炸伤致角膜深层异物及前房异物者致盲率较高,其治疗的关键是及早就诊,早期治疗,手术取出异物,防治感染和处理好并发症.     

缝针支托法在深层角膜异物取出术的应用

目的 探讨缝针支托法取出深层角膜异物的效果和手术操作技巧。方法 显微镜下采用缝针支托法取出深层角膜异物28例28眼。结果 28例28眼均一次性取出深层角膜异物，无一例切穿角膜致异物落入前房。随访1～3个月，术后视力提高16例16眼，占57．1％，保持视力不变者12例12眼，占42．9％，无一例视力下降，术后视力恢复与异物种类、大小、位置、深度、存留时间长短、有无合并症等有关。结论 缝针支托法取出深层角膜异物操作简单、安全、有效，实用性强，并发症少，值得眼科医生应用。     

穿透角膜深层的栗刺异物的临床分析

目的 探讨部分穿透角膜深层及突入前房的栗刺异物的手术方法及疗效。方法 对1989～2002年收治的穿透角膜深层及突入前房的栗刺病例进行回顾分析。根据栗刺的深浅、部位采取相应的手术治疗。结果 本组238例穿透角膜深层及突入前房的栗刺异物(除1例眼内炎外)均一次全部取出。68例感染性并发症经治疗后除1例行眼内容物剜出术、3例眼内炎致眼球萎缩外均治愈。48例外伤性白内障中有31例需手术，经栗刺取出联合外伤性白内障摘除人工晶体植入术后视力恢复良好。结论 及时就诊、采用恰当的手术方式及药物治疗本病一般预后良好。     

角膜深层栗刺伤异物摘出临床分析

目的 探讨角膜深层栗刺异物伤异物摘出方法及临床效果.方法 对60例（60眼）角膜深层栗刺异物伤进行分析.根据栗刺异物的具体表现分别在裂隙灯显微镜下或手术显微镜下采取镊取法、针剔法、板层角膜瓣法,以及手术显微镜下的经前房顶推法进行异物摘出术.结果 60例角膜深层异物全部摘出且无手术并发症发生.50例（83.3％）视力较初诊时提高,基本维持不变者10例（16.7％）,未见下降者.结论 查清全部异物情况,选择合适的手术方式摘出异物,是角膜深层栗刺异物伤治疗的关键.     

自制钩镊式角膜异物针

角膜异物的取出需选择适用的器械,常用器械有尖头平镊子、线状刀、截囊刀或中等深层的角膜异物,上述器械可能得心应手。但对于深层异物特别是一端将进入前房者,往往不易取出。原因是镊类头钝,不能绕过异物背后夹持,反而易将异物推向深层甚至前房,刀、钩类虽能拨动异物,因无法夹持不易剔出。作者据此自制一种钩镊式角膜异物针,将“钩”与“镊”的功能集于一体,大大缩短了手术时间,避免了因反复操作造成的角膜损伤,现介绍如下。一、材料与制作取16号针头一枚,截去针管留取长度20mm,将其顶端重新磨成斜针尖,     

手术显微镜下取深层角膜异物

深层角膜异物临床上不少见，取出有一定难度。现将我们在手术显微镜下取出15例报告如下。一般资料：深层角膜异物15例，全部男性，年龄17－52岁，平均30±3．7岁，均为门诊病例。磁性异物10例，非磁性异物5例，其中玻璃异物2例。13例为朋击伤异物，2例为打碎眼镜时碎玻璃片进入角膜深层。除2例异物尖部已部分进入前房外，余均为角膜层间异物，末端均在角膜间质层内。（末端仍露出角膜表面，因取出较易，我们未列人本组深层角膜异物内）。异物一般均小于1．0×1．0×1．0mm3，但也有长径大于1．0mm的，系斜嵌在角膜深层或已部分突入前房者。…     

板栗刺致眼外伤186例临床分析

目的总结186例（188眼）板栗刺致眼异物伤的治疗经验及疗效观察。方法表麻后在显微镜下用一次性注射针头剔除角膜异物和局麻后切开结膜或角膜缘取出结膜下、巩膜异物或前房异物（板栗刺），术后进行预防感染治疗。结果186例（188眼）眼球板栗刺1次取出者占87．77％，分2次取出者占12．23％，剔除后视力无影响者168例（170眼）占90．43％。结论板栗刺致眼异物伤应及时诊治，取出方法得当，术后预防感染，预后良好。     

前房铺垫针在角膜深层栗刺异物摘出术中的应用

目的评价作者设计的前房铺垫针在剥取角膜深层异物中的作用。方法采用自制简易前房铺垫针,自角膜缘穿刺进入前房,直达角膜深层异物处,顶住异物,然后从角膜面剥取。结果166例（166眼）中全部眼痊愈。结论简易前房铺垫针,有利于顺利摘出角膜深层栗剌异物,减少并发症。     

器械不进入前房取出前房异物

作者采取器械不进入前房取出前房异物,效果满意,报告如下: 手术方法:术前准备,麻醉同眼内手术。在前房异物所在象限的球结膜上作以角膜缘为基底的结膜瓣,角膜缘切口长2至5mm,切口超过3mm者作一条予置缝线,用虹膜镊或手术刀背轻压切口后唇,让虹膜缓慢脱出切口,在虹膜连同异物脱出切口外时摘除异物。还纳虹膜于前房内,结扎予置缝线,缝合结膜瓣。结膜下注射氟美松5mg,庆大霉素10000u,涂抗生素眼膏包扎。     

经巩膜隧道切口眼前段异物取出术

目的:探讨经巩膜隧道切口眼前段异物取出术的效果。方法:眼前段异物8例8眼经3∶00或9∶00角膜缘辅助切口,前房注入粘弹剂,游离异物至瞳孔区后经12∶00巩膜隧道切口以玻璃体异物钳取出异物。2例同时行超声乳化人工晶状体植入。结果:8例8眼经巩膜隧道切口1次顺利取出异物,无1例发生医源性损伤或手术并发症。术后视力提高6眼,不变2眼。结论:经12∶00巩膜隧道切口联合角膜缘辅助切口可有效取出任何钟点位眼前段异物,较常规角巩缘切口手术方法以更小切口,更小损伤取出异物。     

Removal of full-thickness vertical corneal stromal wooden foreign bodies: An innovative ab-interno technique

A 28-year-old male presented with three full-thickness stromal wooden foreign bodies vertically oriented in the left cornea. An innovative intracameral approach was used. Paracentesis was done and healon was injected into the anterior chamber. Iris repositor was introduced into the anterior chamber and the area of foreign bodies was pushed up to compress the stroma. The wooden foreign body projected above the corneal surface and were picked up one by one using McPherson forceps. One of the foreign bodies has penetrated through the Descemet‘s membrane resulting a corneal perforation. A corneal perforation was confirmed by observing egress of the irrigating solution, injected into the anterior chamber through the paracentesis opening. The corneal perforation was sealed with corneal glue. He achieved 6/9 BCVA (OS) at 8 weeks and maintained it during18 months follow-up.     

穿透性角膜移植术中减少角膜内皮损伤的技术

探讨穿透性角膜移植术中减少角膜内皮损伤的方法。方法在２４例穿透性角膜移植手术中,采用多种保护角膜内皮的方法包括：剪取供体植片时前房注入１％透明质酸钠;内皮侧冲切植片;６针预置缝合后前房注入１％ＳＨ及ＢＳＳ以完全形成前房。     

The effect of scleral buckling surgery on corneal astigmatism, corneal thickness, and anterior chamber depth

PURPOSE: To evaluate the effect of scleral buckling surgery on corneal topography, corneal thickness, and anterior chamber depth. METHODS: Thirty-two eyes of 32 patients who underwent encircling buckling surgery for rhegmatogenous retinal detachment were included in the study. Fellow eyes comprised the control group. Orbscan II topography system was used to determine the changes in corneal topography, corneal thickness, and anterior chamber depth before surgery and 1 week, 1 month, and 3 months after surgery. Statistical analyses used in the study were independent t test, paired t test, one way analysis of variance, and correlation analyses. RESULTS: Postoperatively, mean central corneal astigmatism at 1 week, 1 month, and 3 months was 4.3 +/- 2.0 diopters (D), 3.3 +/- 1.6 D, and 3.1 +/- 1.0 D, respectively. The change between 1 week and 3 months was statistically significant. Central cornea was thickened at the first postoperative week. The thickness gradually decreased to the preoperative levels at 3 months. Anterior chamber depth decreased, and the anterior chamber remained shallow after the surgery. The comparison between preoperative (2.94 +/- 0.6 mm) and postoperative anterior chamber depth was statistically significant at 1 week (2.57 +/- 0.7 mm), 1 month (2.83 +/- 0.7 mm), and 3 months (2.73 +/- 0.6 mm). CONCLUSIONS: Corneal changes after scleral buckling surgery were mild to moderate and the cornea almost resumed its preoperative parameters in 3 months' time. However, the anterior chamber remained shallow during 3 months of follow-up.     

白内障人工晶状体植入术前后角膜厚度和前房深度及前房角的改变

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术前后,术眼前房深度和角膜厚度及前房角结构的改变。方法:对20例20眼老年性白内障患者行超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1wk使用超声生物显微镜量化测量前房深度、角膜厚度和前房角宽度。结果:全部患者术后1wk角膜厚度明显增加,前房深度明显增大;500μm处前房角开放距离(AOD500)及ACA角度均与术前值比较明显增加,且均P<0.01。结论:超声乳化白内障吸除折叠式人工晶状体植入术可以使角膜厚度显著增加;可显著增加老年性白内障患者的前房深度及房角宽度。     

Confocal microscopy imaging of the cornea in patients with silicone oil in the anterior chamber after vitreoretinal surgery

Objective Evaluation of corneal morphology by confocal microscopy after vitreoretinal surgery complicated by passage of silicone oil into the anterior chamber. Design Case series (case control study). Methods Eight patients (eight eyes) who had undergone vitreoretinal surgery and had silicone oil in the anterior chamber but no clinically evident corneal abnormalities made up the patient group. The control group consisted of eight patients (eight eyes) who had undergone vitreoretinal surgery with application of silicone oil tamponade but who had no silicone oil clinically observable in the anterior chamber. In vivo examination of the cornea using a ConfoScan 3 (Nidek Technologies) confocal microscope equipped with the standard 40× immersion lens was performed. Central, upper, and lower parts of the cornea were assessed separately. High-magnification evaluation of the status of corneal layers and endothelial cell density in upper parts of the cornea directly in contact with silicone oil in the anterior chamber and in parts of the cornea not in direct contact with silicone oil was carried out. Results Alterations in corneal morphology, especially in endothelium and posterior and medium stroma, were observed. In all cases, changes were more advanced in the upper part of the cornea. Endothelial cell density was significantly decreased in upper parts of the cornea. Conclusions In patients with silicone oil in the anterior chamber, confocal microscopy imaging reveals early morphological alterations of the cornea before their clinical manifestation. The authors have no financial or other interest in any products used or described in this study. No financial support was received. Presented in part at the annual meeting of the Deutsche Ophthalmologische Gesellschaft (DOG), Berlin, 2004     

双手微小切口白内障超声乳化术治疗硅油填充眼并发性白内障

目的:探讨双手微小切口白内障超声乳化吸除术在治疗硅油填充眼并发性白内障的临床疗效及安全性。方法:选取2007-10/2008-11收治的病例完整的硅油填充眼并发性白内障患者的31例(31眼),随机分成两组,分别采用两种不同的手术方式。A组16例(16眼)行双手微小切口白内障超声乳化吸除术,B组15例(15眼)行常规的超声乳化吸除术,分别于术前、术后1wk;1,3mo行视力、角膜地形图检查。结果:所有术眼在手术过程中前房稳定,未见切口热灼伤,术后2眼角膜轻度水肿,均在术后1wk内缓解。两组术后均随访3mo以上,未发现有视网膜脱离复发。术后1wkA组最佳矫正视力高于B组,两组间比较,有显著性差异(P<0.05);术后角膜地形图曲率和散光simk值手术前后比较,B组术后1wk角膜地形图散光与术前相比有显著性差异(P<0.05)。结论:双手微小切口白内障超声乳化吸除术在治疗硅油填充眼并发性白内障时安全有效,临床上值得推广。     

前节相干光断层扫描技术在角膜外伤中的应用研究

目的评估前节相干光断层扫描技术（AS-OCT）在角膜外伤诊疗中的应用价值。方法回顾性分析85例（91只眼）各类角膜外伤：穿通伤56只眼,钝挫伤18只眼,角膜异物10只眼,化学伤7只眼。所有患者在诊疗过程中除常规裂隙灯显微镜等检查外,均以AS-OCT观察了角膜形态结构,部分患者进行了角膜厚度测量。结果所有病例均获得清晰AS-OCT角膜图像,8只眼角膜穿通伤病例清创缝合术后患眼发现严重角膜伤口内口对合不佳,3只眼LASIK术后眼球钝挫伤发现角膜层间积液,对于透明/半透明角膜异物病例,AS-OCT可显示异物在角膜内具体位置。但对于金属异物,在AS-OCT检查所获图像中异物后的部分呈现为无反射区,故而无法判断异物深度。AS-OCT可清晰显示急性期角膜化学伤患者角膜水肿情况并可进行厚度测量。1只眼因陈旧性化学伤导致的角膜白斑,裂隙灯显微镜下无法窥见眼内结构,AS-OCT显示前房、虹膜结构基本正常。结论 AS-OCT可清晰显示外伤后角膜的形态结构,对于角膜外伤的诊断和疗效评估具有很好的应用价值。