选择性激光小梁成形术治疗原发性开角型青光眼的临床观察

目的:评价选择性激光小梁成形术(selective laser trabecu-loplasty,SLT)治疗原发性开角型青光眼的疗效和安全性及对不同条件原发性开角型青光眼治疗效果的差异。方法:原发性开角型青光眼46例46眼,分为A组(曾行小梁切除手术)21眼,B组(单纯药物治疗)14眼,C组(诊断未经治疗)11眼,经SLT治疗,随诊6mo,观察眼压、视力、视野等改变。结果:总体平均眼压在术后1d;1wk;1,3和6mo分别为(16.9±3.2),(18.7±3.3),(18.9±3.3),(19.8±3.2),(20.0±3.4)mmHg,均比术前眼压下降,具有显著性统计学差异,同一时间3组间比较无差异,术后反应均为一过性,1～3d内消失。结论:SLT治疗不同条件的原发性开角型青光眼均安全有效,长期疗效及重复治疗有待进一步观察。     

Nd:YAG激光房角穿刺治疗非穿透性小梁手术后高眼压

目的观察评估Nd:YAG激光行房角穿刺治疗非穿透性小梁手术后眼压控制不理想的原发性开角型青光眼患者的临床疗效。方法选取非穿透性小梁手术后眼压控制不理想(不用降眼压药物眼压>21mmHg,1kPa=7.5mmHg)的原发性开角型青光眼患者35例(38眼)为研究对象,硝酸毛果芸香碱缩瞳后,在激光房角镜下原手术部位行Nd:YAG激光房角穿刺,观察激光前及激光后1h、1d、1周、1个月、3个月、6个月、12个月、18个月、2a时的眼压、滤过泡、房角及前房反应情况。结果激光前及激光后1h、1d、1周、1个月、3个月、6个月、12个月、18个月、2a的眼压分别为(25.0±3.4)mmHg、(12.5±3.4)mm-Hg、(12.0±3.2)mmHg、(13.1±3.0)mmHg、(14.0±3.1)mmHg、(14.1±2.7)mmHg、(14.3±2.9)mmHg、(15.3±2.6)mmHg、(16.2±2.8)mmHg、(16.0±3.0)mmHg,激光后各时间点眼压均较激光前下降,差异均有统计学意义(均为P<0.01)。其中10眼激光后眼压、滤过泡无明显改善,28眼滤过泡形成或原滤过泡面积、隆起度增大;激光后发生浅前房2眼(5.3%),虹膜周边前粘连2眼(5.3%),无前房出血、脉络膜脱离等并发症发生。结论 Nd:YAG激光房角穿刺能够安全有效地改善非穿透性小梁手术后小梁网-狄氏膜的房水低滤过状态,是非穿透性小梁手术后高眼压治疗的有效方法。     

选择性激光小梁成形术治疗青光眼的临床观察

目的评价选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)的疗效和安全性。方法选择局部用药眼压不能控制的原发性开角型青光眼20例(37眼),正常眼压性青光眼6例(10眼)。观察应用选择性激光小梁成形术后6个月眼压的变化。结果术后眼压平均降低幅度为4.86±2.14mmHg(24.04±10.21%),两组患眼的眼压在激光治疗后均有显著下降:开角型青光眼组术后6个月的眼压较术前平均下降5.44±2.32mmHg(24.90±11.09%);正常眼压性青光眼组平均下降2.71±1.12mmHg(19.06±7.19%)。术后暂时的眼压升高、前房炎症反应为常见的并发症。结论选择性激光小梁成形术具有降眼压效果明显、安全、实用、损伤小、可重复等特点,是治疗青光眼的一种较安全有效的方法。     

选择性激光小梁成形术治疗原发性开角型青光眼观察

目的 观察选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的有效性和安全性.方法 原发性开角型青光眼患者23例36只眼,原发性开角型青光眼小梁切除术后高眼压患者6例6只眼,眼压(25.15±8.23)mmHg,倍频Q-开关532nmNd:YAG激光,单脉冲,脉冲时间3ns,光斑直径400um.应用房角镜鼻侧或颞侧房角180°范围内进行治疗,能量0.60～1.50mJ,点数(50±5)点.测量术后第1h眼压,术后1d,1周,2周,3周,1月,3月,6月,1年随访,对比术前术后眼压、最佳矫正视力、视野及杯盘比变化.结果 患者术前眼压(25.15±8.23)mmHg,术后1h为(18.14±5.36)mmHg,1d为(14.52±3.63)月mmHg,1周为(18.12±2.38)mmHg,1月为(17.96±3.35)mmHg,3月为(18.05±2.58)mmHg,6月为(17.48±2.12)mmHg,1年为(17.89±3.13)mmHg;术前患者杯盘比为0.65±0.30,术后1年为0.63±0.20;术前视力0.60±0.30,术后1年视力0.61±0.32;视野术前术后无变化.结论 选择性激光小梁成形术可以有效地降低原发性开角型青光眼及原发性开角型青光眼小梁切除术后高眼压患者的眼内压.

Abstract：

Objective To evaluate the efficiency and safety of selective laser trabeculoplasty (SLT) on primary open angle glaucoma (POAG). Methods A total of 36 eyes of 23 patients with POAG, 6 eyes of 6POAG patients with high intraocular pressure (IOP) after SLT therapy, IOP (25.15± 8.23) mmHg, and they were treated with a frequency-doubled, Q-switched Nd:YAG laser (532nm). A total of approximately 50± 5nonoverlaping spots were placed over 180° of the gonioscope nasal or temporal side at the energy levels ranging from 0.60-1.50m J/pulses. Every patient was asked for follow-up at 1h, 1d, 1w, 2w, 3w, 1m, 3m, 6m and 1yafter treatment. IOP, visual acuity, C/D and visual field were examined each time. Results The pretreatment IOP was (25.15± 8.23) mmHg. At the end of first 1h, 1d, 1w, 1m, 6m, 1y of the follow-up, the IOP was (18.14± 5.36)mmHg, (14.52± 3.63)mmHg, (17.96± 3.35)mmHg, (18.05± 2.58)mmHg, (17.48± 2.12)mmHg, (17.89± 3.13) mmHg respectively. The pretreatment cup/disc ratio was 0.65± 0.30, at the end of 1y of the follow-up, the C/D ratio was 0.63± 0.20; the pretreatment visual acuity was 0.60± 0.30, at the end of 1y of the follow-up, the visual was 0.61± 0.32, without significant difference in visual field. Conclusions SLT is a kind of effective method to treat POAG and special patients with high intraocular pressure after SLT therapy.     

选择性激光小梁成形术对部分特殊类型高眼压患者的降压效果

目的:探讨选择性激光小梁成形术(selective laser trabecu-loplasty,SLT)对部分特殊类型眼压升高患者的降眼压效果。这些患者不适宜或者不接受抗青光眼手术治疗。方法:临床观察10例高眼压患者,其中硅油取出后无晶状体高眼压1例,青光眼术后3例(其中1例在阿塞拜疆行二次抗青光眼手术),未确诊青光眼的高眼压症3例,硅油充填术后1例,绝对期青光眼2例(其中开角1例,闭角1例),根据眼压范围行Nd:YAG激光SLT治疗(选择上方或下方180°范围内治疗,原发性闭角型青光眼行激光周边虹膜成形术和激光周边虹膜切除术后眼压>21mmHg的再行选择性激光小梁成形术)。结果:SLT10眼术前平均眼压28.9±5.4mmHg(眼压22～40mmHg);术后1d;1wk;1,6mo眼压分别为21.6±6.5mmHg,24.3±6.01mmHg,22.2±63mmHg,21.4±5.2mmHg。SLT术后6mo不用药物眼压≤21mmHg有6眼;部分患者需要重复治疗,全部患者加用1种降眼压药物眼压≤21mmHg,未出现明显的前房炎症反应,少部分患者在治疗时有轻微的疼痛及不适感。结论:SLT对于不适宜抗青光眼手术治疗的一些特殊类型的高眼压患者,是安全有效、费用低廉的可供选择的降眼压方法。     

选择性激光小梁成形术治疗原发性青光眼的疗效

目的 评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)和原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)的疗效及安全性.方法 收集我院眼科2007年1月至2008年1月就诊的原发性青光眼患者34例61眼,其中POAG组患者18例34眼,CPACG组患者16例27眼,2组均应用SLT治疗.观察患者术后1 h、1 d、1周、1个月、3个月、6个月的眼压以及术后6个月视力、视野、房角及角膜内皮细胞数等变化.结果 2组患者眼压在激光治疗后均有显著下降,POAG组患者术前平均眼压为(25.2±2.2)mmHg(1 kPa=7.5 mmHg),术后1 h、1 d、1周、1个月、3个月、6个月眼压分别为(28.9±1.3)mmHg、(17.0±1.9)mmHg、(19.9±1.7)mmHg、(20.1±1.8)mmHg、(18.2±2.1)mmHg、(18.0±2.1)mmHg.CPACG组患者术前平均眼压为(24.9±2.1)mmHg,术后对应时间点眼压分别为(29.3±1.6)mmHg、(16.9±2.0)mmHg、(20.3±1.8)mmHg、(19.3±1.9)mmHg、(20.1±2.0)mmHg、(18.9±2.2)mmHg.2组术后1 d、1周、1个月、3个月、6个月的眼压与术前相比明显下降,差异均有统计学意义(P均<0.05).术后1 d眼压下降最明显,术后一过性眼压升高为最常见的并发症.术后6个月2组患者随访视力、前房角、视野、角膜内皮细胞计数与术前比较均无明显变化.结论 SLT可以安全有效地降低POAG和房角大部分开放的CPACG患者的眼压.     

选择性激光小梁成形术治疗原发性开角型青光眼的一年疗效观察

目的研究选择性激光小梁成形术(SLT)治疗原发性开角型青光眼的安全性和有效性。设计回顾性病例系列。研究对象47例62眼早期原发性开角性青光眼患者。方法所有患者应用Q开关、倍频532 nm、Nd:YAG激光器(Selecta Duet型)行SLT治疗,范围下方房角180度,50个点,单脉冲能量0．5～1．4mJ。激光手术前后抗青光眼药物保持不变。随访12个月。主要指标眼压与并发症。结果在62眼中有72．5%眼压控制。SLT术前平均眼压(24．3±3．7)mmHg,手术后12个月的平均眼压(19．1±3．9)mmHg,眼压的下降差异有统计学意义(P＜0．001)。所有病例在手术后1小时均出现轻度前房炎症反应,3天后消失。结论SLT治疗早期原发性开角型青光眼随访一年是安全有效的。(眼科,2007,16:37-39)     

选择性激光小梁成形术治疗原发性开角型青光眼

目的:选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open angle glaucoma,POAG)观察。方法:原发性开角型青光眼80例160眼,蓝黄视野检查未见明显损害或轻度损害,眼压>30mmHg者20例40眼,眼压<30mmHg者60例120眼。使用倍频Q开关,波长532nm,Nd∶YAG激光,照射180°~360°小梁网,光斑400nm,脉宽3μs,能量设置0.3~1.0mJ。光斑点数50~80点,术后1d;1wk;1,3,6mo测眼压。结果:对于眼压在>30mmHg的POAG患者眼压控制不理想。眼压<30mmHg的POAG患者效果明显。结论:SLT的降眼压效果,虽然针对性较强,适宜患者人群窄,但给POAG的治疗提供了新思路和新希望。     

激光小梁成形术前后对原发性开角型青光眼患者昼夜眼压变化影响

目的 评价选择性激光小梁成形术(Selective laser Trabeculoplasty SLT)对原发性开角型青光眼(primary open-angle glaucoma,POAG)昼夜眼压的影响.方法 POAG患者40例76只眼.倍频Q-开关532nm Nd YAG激光,3ns单脉冲,光斑直径400μm,激光击射下方180°范围小梁组织,能量0.53～0.89mJ,点数60～100点.气动眼压计测量术前及术后12周昼夜眼压,两组数值比较采用配对t检验.结果 术前平均眼压(21.6±2.87)mmHg(1mmHg=0.133KPa),术后平均眼压(18.7±1.36)mmHg,两组比较P＜0.05(t=7.69);手术前后6am点术眼眼压降低最明显,为6.9 mmHg.术前眼压高峰出现在6am,波谷最低在10pm,昼夜眼压波动6.4 mmHg;术后眼压高峰移至12时,最低在22时,昼夜眼压波动3.2 mmHg.结论 SLT治疗原发性开角型青光眼安全、可靠,可有效降低POAG患者的平均眼内压,降低昼夜眼压波动.     

选择性激光小梁成形术治疗残余原发性闭角型青光眼的临床评价

背景 选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的安全性和有效性已得到人们广泛的认同,但迄今为止SLT治疗闭角型青光眼的研究较少,其效果和安全性尚待临床观察证实.目的 评价SLT治疗残余原发性闭角型青光眼(PACG)的疗效及安全性.方法 采用病例观察性研究设计.共纳入经激光周边虹膜成形术和/或激光虹膜周边切除术治疗后前房角开放但眼压不能降至正常的闭角型青光眼患者23例33眼,术前平均眼压(24.78±4.48)mmHg,日平均用药指数(1.62±0.66)分.所有眼的前房角能看到小梁网的范围约180°.用Q开关倍频Nd:YAG激光机在患眼开放的前房角照射小梁网,在180°范围内照射70 ～80点.术后继续使用术前的降眼压药物,术后随访9个月,定期复查眼压、视力、眼前节炎症反应和房水流畅系数测定值,并用前房角镜检查房角的开放情况.结果 本组术眼术后1d,1周,1、3、6、9个月的平均眼压分别为(18.78±4.87)、(18.83±3.95)、(19.78±4.48)、(19.63±3.68)、(19.11±3.36)、(21.17±3.14)mmHg,与术前眼压值(24.78±4.48)mmHg比较,术后1～9个月明显下降,差异均有统计学意义(P＜0.05).各时间点患眼日平均用药指数分别为(1.63±0.85)、(1.23±1.01)、(1.25±0.98)、(1.21±1.02)、(1.22±0.86)、(1.69±0.53)分,术后1周,1、3、6个月与术前值的(1.62±0.66)分比较,差异均有统计学意义(P=0.020、0.026、0.020、0.031).术后即刻可见睫状体充血和前房闪辉,1周后自然消退.16眼术前和术后3个月的平均房水流畅系数(C值)分别为0.11±0.09和0.23±0.15,差异有统计学意义(P=0.002).结论 SLT能够安全有效地降低部分闭角型青光患者的眼压,但其前提是必须有1/2周的虹膜小梁角是开放的.     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.