假性剥脱性青光眼和非假性剥脱性青光眼中白内障超声乳化联合应用丝裂霉素C的小梁切除术的疗效观察

Background: This study was conducted to evaluate the rate of intraoperative and postoperative complications and the outcome of combined phacoemulsification (phaco) with posterior chamber (PC) intraocular lens (IOL) and trabeculectomy in patients with pseudoexfoliation (PXF) versus non-pseudoexfoliation (non-PXF) glaucoma. Methods: One hundred and four eyes of 88 patients with combined phaco, PC IOL and trabeculectomy with mitomycin C (MMC) were included in the study. MMC 0.02%was applied for 1 min in all cases. Main outcome measures were rate of intraoperative and postoperative complications, intraocular pressure (IOP) and visual acuity (VA). Success rates were determined via Kaplan-Meier survival analysis. Surgical success for both groups was defined as IOP being less than 21 mmHg with no treatment or less than 16 with one topical pressure-reducing agent allowed. Results: The PXF group included 55 (52.9%) eyes and the non-PXF group 49 (47.1%) eyes. Transition to extracapsular cataract extraction (ECCE) occurred in 12.7%of the PXF group, and in 6.1%of the non-PXF group (P=0.16). The occurrence of vitreous loss did not differ significantly between the groups. Patients of both groups had a significant IOP reduction after surgery (P=0.0001). At the end of postoperative follow-up, the success rate approached 83.6%in the PXF group and 83.7%in the non-PXF group. The most common postoperative complications were hyphema (14.5%) in the PXF group and fibrin (14.3%) in the non-PXF group. Conclusions: Although transition to ECCEwasmore frequent in the PXF than in the non-PXF group, there was no significant difference in the rate of complications between PXF and non-PXF eyes.

无植片Molteno管插入的疗效

Aims:To determine the long term outcome of Molteno implants inserted using a modified surgical technique that eliminates the need for a donor scleral graft.Methods:Retrospective case series involving a medical record analysis of 35 consecutive patients undergoing first Molteno implant surgery for refractory glaucoma.The main outcomes included life table analysis of intraocular pressure control following surgery and frequency of intraoperative and postoperative complications.Results:There were no complications related specifically to the modified method of tube placement.Medium term intraocular pressure control was similar to other series.Conclusions:This simpli-fiedmethod for the insertion of Molteno implants eliminates the need for a donor scleral graft while maintaining the implant’ s ability to control intraocular pressure.

比较个体双眼间有或无蓝光滤光片人工晶体植入术后的功能结果

Background:The new generation of intraocular lenses(IOL)with an additional blue light filter has a slight yellowish colour(compared to the IOLs with only a UV filter)due to its different light transmitting properties.This could have an effect on contrast sensitivity and subjective visual perception.Patients and Methods:In this intraindividual prospective comparative study including 14 cataract patients without further ocular pathology,a blue light filtering IOL(SN60AT,Alcon)was implanted in one eye and 1 month later a conventional single-piece IOL(SA60AT,Alcon)was fitted into the fellow eye.The visual acuity and the clinical findings were assessed at one day and four weeks post-operatively.Contrast sensitivity was tested under defined mesopic(6cd/m2)and high mesopic(18,8cd/m2)light conditions in the Ginsburg Box using the Functional Acuity Contrast Test(F.A.C.T.).Furthermore,subjective differences in the visual perception of both eyes were noted.Results:The contrast sensitivity testing 1 day and 1 month postoperatively,revealed no statistically significant differences(P > 0008)between both IOL types for all spatial frequencies(1,5/3/6/12/18 cpd)and light levels.13 patients(85%)reported no differences in the colour perception of both eyes,and none had visual disturbances.Conclusion:This intraindividual comparison revealed no relevant differences concerning mesopic contrast sensitivity and the subjective visual perception after implantation of one IOL with or without a blue light filter.

美容或医疗原因萎缩性上睑下垂矫正术前和术后对干眼症状客观检测和主观认知间的差别

Background:This study was designed to examine if patients undergoing the same operative procedure(blepharochalasis operation)have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons.Patients and Method:The study included 32 patients(25 women,7 men,mean age 57.8± 12.1 years),who underwent blepharochalasis operation between 1/2005 and 5/2005.In 17 patients(group 1)the operation was done for cosmetic reasons,in 15 patients we found a medical indication(group 2).We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre-or postoperative recognition of dry eye problems(all done by scales).Additionally we measured tear secretion by Schirmer’ s test and break-up time before and after operation.Results:The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation(p < 0.005),but objective data were nearly identically(BUT,Schirmer’ s test).Conclusion:When operated due to cosmetic reasons the stronger recognition of sicca problems(while objectively lacking)is may be caused by a stronger fixation on the lid disease itself.It seems necessary to document objective data for that reason.

视力正常的色素性视网膜炎患者异常眼底自发荧光的功能性特征和系列图像

Aim:To characterise and monitor abnormal fundus autofluorescence(AF)in patients with retinitis pigmentosa(RP)who have good visual acuity.Methods:21 patients with a clinical diagnosis of RP were examined.All had rod-cone dystrophy(ISCEV standard electroretinograms(ERGs)),visual acuity of 6/9 or better,and manifested a parafoveal ring of high density fundus AF.Repeat AF imaging was performed after periods of between 2 years and 5 years in 12 patients.Pattern ERG(PERG)and multifocal ERG(mfERG)were performed in 20 cases.Visual fields(VF),photopic and scotopic fine matrix mapping and small field PERGs were performed in representative cases.Results:The rings of high density AF varied in size between patients(from 4°-16° diameter).MfERGs showed relative preservation over the central macular area,correlating with the size of AF ring and with PERG and psychophysical data.Progressive constriction of the AF ring was demonstrated at follow up in three patients.Serial PERG,mfERG,and VFs,performed in one of these cases,showed evidence of deterioration concordant with ring constriction.Conclusions:High density rings of AF,seen in some patients with RP with good visual acuity,demarcate areas of preserved central photopic function.MfERGs correlate with the area encircled by high density AF and the PERG data.The size of the ring of AF can show progressive constriction accompanied by increasing macular dysfunction.

眼球转动对环面人工晶体轴向定位分析的影响:对环面人工晶体旋转稳定性的最佳评价法

Background:After the implantation of toric intraocular lenses(tIOLs)significant postoperative tIOL rotation angles were measured occasionally.We investigated the rotational stability of eyes during standardized photography and recommend two methods for an enhanced evaluation of tIOL rotation.Patients and Methods:1.The cyclororation of the eye was investigated using standard fundus photography.A sequence of two fundus photographic slides was taken in 550 phakic eyes of 275 consecutive patients with a time interval of at least 6 months.With characteristic markers on the fundus photograph,the axial orientation of the eyes was defined and the cyclorotation between the two slides of each eye was measured.2.Using bifocal photography(HRA II-Heidelberg Retina Angiograph),a sequence of anterior segment and fundus images was taken considering stable head position in 19 pairs of photographs of eyes with implanted tIOLs.The angle between reference fundus axis and tIOL axis was measured at both time stages(mean:after 3 months).The difference of the angle between bifocal-image samples was defined as the real tIOL rotation angle.3.Ten pairs of anterior segment photographs of eyes with a tIOL were investigated using the Axenfeld loop analysis.In each photograph,the angle between the axis connecting two Axenfeld loops and the tIOL axiswasmeasured.The difference of two angles of two photographs was defined as the rotational tIOL angle.Results:1.The mean absolute eye’ s rotation angle was 2.3± 1.7(range:0 to 11.5)in all 550 eyes.Only 9.1% of the eyes did not rotate.In 57.3% of the eyes a rotation of less than 3° and in 33.6% of more than or equal to 3 was detected.The eye’ s cyclorotation correlated(p < 0.04)with an age older than 39 years and higher astigmatism(> 1.5 D).Because of the significant amount of spontaneous globe rotation we developed the following enhanced methods to minimize measurement errors of tIOL rotation:2.Bifocal photography:Comparing the 19 HRA anterior segment images,the amount of mean tIOL rotation was 5.4± 4.8°(range:0-20.0°).Using the bifocal photography,the mean tIOL rotation was 1.9± 1.3°(range:0-5.0°).The overestimated rotation of the tIOL(only anterior segment tIOL comparison)correlated with higher amounts of the eye’ s cyclorotation(r=0.94;p=0.01)and higher corneal astigmatism(r=0.54;p=0.05).3.The simultaneous analysis of Axenfeld loops revealed significantly smaller amounts of tIOL rotation(2.3± 2.5° range:0-7.0°)in 10 pairs of anterior segment photographs in contrast to the single analysis of tIOL axis(5.5± 4.8° range:1-13.0° p=0.09).A reduction of up to 18.0° tIOL rotation measurement failure was possible in single cases by applying the bifocal photography or simultaneous Axenfeld loop analysis.Conclusions:Head inclination,head rotation,and incyclo-or excyclorotation of the eye may have a significant impact on the tIOL axis evaluation.Besides the bifocal photography the simultaneous Axenfeld loop analysis could be a promising alternative to the conventional axis evaluation of tIOLs.

中国的巨轮

长期以来,中国一直想主宰全球汽车工业,这将使中国成为未来个人交通的一支力量。北京林荫道上的车辆几乎没有证据表明中国有汽车工业。路虎揽胜的数量似乎超过了哈弗、长安和比亚迪的总和;有时你只能看到一系列的大众和丰田。

为何一吃拉面就会流鼻涕

弯曲小拇指的时候,为何无名指也会一起弯曲请试着把手的小拇指弯曲。你会发现,旁边的无名指也一起弯了。这是由于传送脑部发送指令的神经的作用。你一旦意识到要弯曲小拇指,大脑就会发出“弯曲小拇指”的指令传送到脊髓。脊髓内侧有“灰白质”的神经细胞聚集,指令通过从“灰白质”发出的神经,传递到能让手指活动的肌肉里。