Comparison of ultrasound biomicroscopy and spectraldomain anterior segment optical coherence tomography in evaluation of anterior segment after laser peripheral iridotomy

AIM：To quantitatively assess narrow anterior chamber angle using spectral-domain anterior segment optical coherence tomography（SD-AS-OCT） and ultrasound biomicroscopy（UBM）,and to evaluate the correlations and consistency between SD-AS-OCT and UBM.· METHODS：Fifty-five eyes from 40 patients were examined.Patients were diagnosed with primary angleclosure glaucoma（PACG） remission（11 eyes from 8patients）,primary angle closure（PAC,20 eyes from 20patients） and PAC suspect（24 eyes from 12 patients）.Each eye was examined by SD-AS-OCT and UBM after laser peripheral iridotomy（LPI）.The measurements of SD-AS-OCT were angle open distance（AOD）,anterior chamber angle（ACA）,trabecular iris angle（TIA）,and trabecular iris space area（TISA）.UBM measurements were AOD and TIA.Correlations of AOD500 and TIA500 between UBM and AS-OCT were assessed.All parameters were analysed by SPSS 16.0 and MedCalc.· RESULTS：ACA,TIA and AOD measured by SD-ASOCT reached a maximum at the temporal quadrant and minimum at the nasal quadrant.Group parameters of AOD500 and AOD750 showed a linear positive correlation,and AOD750 had less variability.UBM outcomes of AOD500 and TIA500 were significantly smaller than those of SD-AS-OCT.The results of the two techniques were correlated at the superior,nasal and inferior quadrants.CONCLUSION：Both UBM and SD-AS-OCT are efficient tools for follow-up during the course of PACG.We recommended using parameters at 750 μm anterior to the sclera spur for the screening and follow-up of PACG and PAC.The two methods might be alternatives to each other.

Association of peripheral anterior synechia,intraocular pressure,and glaucomatous optic neuropathy in primary angle-closure diseases

AIM:To investigate the association of peripheral anterior synechiae(PAS)with intraocular pressure(IOP)and glaucomatous optic neuropathy(GON)in primary angle closure(PAC)and primary angle-closure glaucoma(PACG).METHODS:Totally 355 eyes(238 PAC and 117 PACG)of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial.All patients had undergone a comprehensive ophthalmic examination.The extent of PAS in clock hours as determined on gonioscopy was documented.The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation(GEE)models.RESULTS:The frequency of GON increased with the extent of PAS and a higher IOP.PAS were more extensive(8 vs 1 clock hour,P<0.001)and IOP higher(28.01 vs 18.00 mm Hg,P<0.001)in PACG compared to PAC.The prevalence of GON among the PAS quartiles were 10.2%(PAS<0.5 clock hours),16.9%(PAS≥0.5 and PAS<3 clock hours),29.6%(PAS≥3 and PAS<7 clock hours),and 74.4%(PAS≥7 clock hours),respectively.After adjusting for IOP,age,gender,spherical equivalent,average Shaffer score and number of medications,the odds ratio(OR)for GON was 4.4(95%CI:1.5-13.0;P=0.007)with PAS≥3 clock hours and 13.8(95%CI:4.3-43.6;P<0.001)with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours.The frequency of GON increased linearly with the extent of PAS.Extent of PAS was also associated with higher IOP.Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg(OR=18.0,95%CI:7.5-43.4;P<0.001).CONCLUSION:The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP,suggesting other factors related to PAS formation may be involved in the development of GON in PACG.

Effect of axial length and anterior chamber depth on the peripheral refraction profile

AIM:To evaluate the effect of axial length(AL)and anterior chamber depth(ACD)on peripheral refractive profile in myopic patients compared to emmetropic participants.METHODS:This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic.Central and peripheral refraction were measured at 10°,20°,and 30°eccentricities in nasal and temporal fields using an open-field autorefractor.The Lenstar LS900 was used to measure ACD and AL.The participants were divided into three groups of short(<22.5 mm),normal(22.5-24.5 mm),and long eye(>24.5 mm)according to AL and three groups of low ACD(<3.00 mm),normal ACD(3.00-3.60 mm),and high ACD(>3.60 mm)according to ACD.RESULTS:The mean age of the participants was 22.26±3.09 y(range 18-30 y).The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group.The results showed significant changes in the spherical equivalent,J0,and J45 astigmatism in all gazes with an increase in eccentricity(P<0.001).The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes.Moreover,the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group.CONCLUSION:Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.

The Relation of the Location of Haptics of Posterior Chamber Intraocular Lenses and Peripheral Anterior Synechia

Purpose:To investigate the occurrence,outcome and influencial factors of the pe-ripheral anterior synechia(PAS)following implantation of posterior chamber in-traocular lenses for finding a way to reduce thePAS.Subjects;40 eyes of 38senile cataract patients with normal chamber angle and in-traocular pressue(IOP)preoperatively were examined.Methods:Extracapsular cataract extraction was performed under microscope with insertion of a posterior chamber lens implant vaulted anteriorly by 10°.Go-nioscopy and slit-lamp examination and photography of the operated eyes were performed 3to 6months postoperatively.Results:PAS were found in 20(50%)of the 40eyes.Among the 20eyes with PAS the locations of 23haptics in17eyes corresponded with those of the PAS.PAS were seen more frequently with vertically sulcus-fixated haptics than with the horizontally capsular-fixated haptics.showing a significant difference(P<0.05).88%of the eyes withPAS had pupillary edformation,but their visual acuities and IOP were not affected.Conclusions:PAS is more likely to occur with vertically sulcus-fixated IOL.Rotat-ing the capsular-fixated haptics to the horizontal position may reduce the inci-dence of PAS.Gonioscopy should be a routine follow-up examination.

Progression rate to primary angle closure following laser peripheral iridotomy in primary angle-closure suspects: a randomised study

AIM:To report the progression rate(PR)to primary angle closure(PAC)following laser peripheral iridotomy(LPI)in PAC suspects(PACS).METHODS:Prospective,randomized controlled interventional clinical trial conducted at the Handan Eye Hospital,China.Totally 134 bilateral PACS,defined as non-visibility of the posterior trabecular meshwork for≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye.Gonioscopy and Goldmann applanation tonometry were performed prior to,on day 7 and 12 mo post LPI.RESULTS:Eighty of 134 patients(59.7%)could be followed up at one year.The mean intraocular pressure(IOP)in treated eyes was 15.9±2.6 mm Hg at baseline,15.4±3.0 mm Hg on day 7;16.5±2.9 mm Hg at one month,and 15.5±2.9 mm Hg at 12 mo;the IOP in untreated eyes was similar(P=0.834).One or more quadrants of the angle opened in 93.7%of the LPI treated eyes,but 67.0%(53/79)remained closed in two or more quadrants.The PR to PAC in untreated eyes was 3.75%and one developed acute angleclosure glaucoma(AACG);the PR to PAC in treated eyes was 2.5%and none had developed peripheral anterior synechia(PAS)or AACG.CONCLUSION:LPI can open some of the occludable angle in the majority of eyes with PACS,but 67%continue to have non-visibility of the trabecular meshwork for over 180 degrees.

Associations of lens thickness and axial length with outcomes of laser peripheral iridotomy

AIM:To investigate the association of axial length(AL),lens thickness(LT),and lens vault(LV)with postoperative anterior chamber angle metrics after laser peripheral iridotomy(LPI).METHODS:Prospective observational study of 69 patients(97 eyes)were diagnosed as primary angle-closure suspect(PACS),primary angle closure(PAC)or primary angle-closure glaucoma(PACG).AL,LT,anterior central chamber depth(ACD),angle opening distance(AOD),trabecular iris angle(TIA),and angle recess area(ARA)were measured before and 1 wk after LPI.The association between AL,LT,LV with ACD,AOD,TIA,ARA were analyzed by comparing the differences between preoperative and postoperative measurements for anterior segment biometric parameters.RESULTS:ACD,AOD,TIA,and ARA were significantly increased after LPI(all P<0.05).Greater LT was significantly associated with greater postoperative increases in ACD,AOD,TIA,and ARA(all P<0.05).AL was not significantly associated with changes of anterior segment biometric parameters.Greater LV was significantly associated with greater postoperative increases in ACD,AOD,and TIA(all P<0.05),but was not significantly associated with changes of ARA.CONCLUSION:Greater baseline LT and LV measurements are associated with greater increases in anterior segment biometric parameters after laser peripheral iridotomy.AL are not associated with the change of anterior segment biometric parameters.

Intraoperative single administration of neutrophil peptide 1 accelerates the early functional recovery of peripheral nerves after crush injury

Neutrophil peptide 1 belongs to a family of peptides involved in innate immunity. Continuous intramuscular injection of neutrophil peptide 1 can promote the regeneration of peripheral nerves, but clinical application in this manner is not convenient. To this end, the effects of a single intraoperative administration of neutrophil peptide 1 on peripheral nerve regeneration were experimentally observed. A rat model of sciatic nerve crush injury was established using the clamp method. After model establishment, a normal saline group and a neutrophil peptide 1 group were injected with a single dose of normal saline or 10 μg/mL neutrophil peptide 1, respectively. A sham group, without sciatic nerve crush was also prepared as a control. Sciatic nerve function tests, neuroelectrophysiological tests, and hematoxylin-eosin staining showed that the nerve conduction velocity, sciatic functional index, and tibialis anterior muscle fiber cross-sectional area were better in the neutrophil peptide 1 group than in the normal saline group at 4 weeks after surgery. At 4 and 8 weeks after surgery, there were no differences in the wet weight of the tibialis anterior muscle between the neutrophil peptide 1 and saline groups. Histological staining of the sciatic nerve showed no significant differences in the number of myelinated nerve fibers or the axon cross-sectional area between the neutrophil peptide 1 and normal saline groups. The above data confirmed that a single dose of neutrophil peptide 1 during surgery can promote the recovery of neurological function 4 weeks after sciatic nerve injury. All the experiments were approved by the Medical Ethics Committee of Peking University People's Hospital, China(approval No. 2015-50) on December 9, 2015.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in the Treatment of Patients with Primary Angle Closure Disease and Concomitant Cataract at Preah Ang Duong Hospital in Cambodia

Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.

NA-AION患者昼夜血压、外周血ACA变化与BCVA、GC-IPL厚度的相关性

目的分析非动脉炎性前部缺血性视神经病变(NA-AION)患者昼夜血压及外周血抗心凝脂抗体(ACA)变化与最佳矫正视力(BCVA)和视网膜神经节细胞-内丛状层(GC-IPL)厚度的相关性。方法选取沧州市人民医院2021年6月至2022年6月收治的96例NA-AION患者(共96眼)为NA-AION组,另择本院同期50岁以上无眼科疾病的40名体检者纳入对照组。对比两组性别、年龄、昼夜血压变化、外周血ACA、BCVA及GC-IPL厚度差异,并采用多因素Logistic回归分析NA-AION的危险因素;采用pearson相关性分析NA-AION患者昼夜血压、外周血ACA水平及BMI值与BCVA、GC-IPL厚度的相关性;采用spearman相关性分析NA-AION患者血压昼夜节律与BCVA、GC-IPL厚度的相关性。结果NA-AION组高血压、BMI≥25 kg/m^(2)、嗜酒、匹兹堡睡眠指数量表(PSQI)评分>7分、血压昼夜节律异常的比例均大于对照组,且白昼平均收缩压、夜间平均收缩压、舒张压及外周血ACA水平均高于对照组,差异均有统计学意义(P<0.05);多因素Logistis回归分析显示,高血压、BMI≥25 kg/m^(2)、嗜酒、PSQI评分>7分、血压昼夜节律异常、夜间平均收缩压及外周血ACA水平均是NA-AION的独立危险因素(P<0.05)。NA-AION组的BCVA(LogMAR视力)明显高于对照组,GC-IPL厚度明显低于对照组,差异均有统计学意义(P<0.05)。相关性分析显示,NA-AION患者夜间平均收缩压、舒张压及外周血ACA水平及BMI均与BCVA(LogMAR视力)呈正比(P<0.05),与GC-IPL厚度呈反比(P<0.05);血压昼夜节律与BCVA(LogMAR视力)呈反比(P<0.05),与GC-IPL厚度呈正比(P<0.05)。结论血压昼夜节律异常、外周血ACA表达异常及BMI值与NA-AION的发病相关。

雷珠单抗注射液辅助激光周边虹膜切开术治疗闭角型青光眼的临床研究

目的观察雷珠单抗注射液联合激光周边虹膜切开术(LPL)治疗闭角型青光眼的临床效果。方法本研究为前瞻性研究,选择河南科技大学第一附属医院2021年1月至2023年6月期间收治的112例闭角型青光眼患者为研究对象,基于随机、对照原则,采用计算机分组法将其列为常规组(56例)和联合组(56例),2组患者均实施LPL治疗,联合组采用雷珠单抗注射液辅助治疗,比较2组患者的前房参数,前方周边深度,眼内新生血管参数,眼压、视力恢复情况,及不良事件发生情况。结果在不同治疗方案下,联合组的中央前房深度(CACD)、前房角宽度(ACA)、前房容积(ACV)分别为(1.95±0.27)mm、(26±5)mm、(85±10)mm3,均高于常规组[(1.52±0.31)mm、(22±5)mm、(80±10)mm3];联合组的上方前房深度、下方前房深度、鼻侧前房深度分别为(1.15±0.25)mm、(1.36±0.27)mm、(1.13±0.33)mm,均高于常规组[(0.88±0.42)mm、(0.95±0.31)mm、(0.92±0.31)mm];联合组的肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、血管内皮生长因子(VEGF)分别为(30±5)ng/ml、(105±20)pg/ml、(85±10)pg/ml,均低于常规组[(33±5)ng/ml、(120±21)pg/ml、(90±10)pg/ml];联合组治疗1个月、3个月后眼压分别为(20±5)mmHg、(15±3)mmHg,均低于常规组[(23±5)mmHg、(18±4)mmHg];视力分别为(4.28±1.24)、(4.92±1.46),均高于常规组[(3.81±0.82)、(4.33±1.21)];联合组的不良事件发生率7.1%(4/56)低于常规组23.2%(13/56)(P<0.05)。结论雷珠单抗注射辅助LPL术可进一步改善闭角型青光眼患者的前房结构,对抑制眼内新生血管生成、促进眼压及视力恢复并降低不良事件发生风险均有积极意义。

重复外周磁刺激联合A型肉毒毒素肌注对痉挛型双瘫患儿下肢运动功能改善的作用

目的研究重复外周磁刺激联合A型肉毒毒素肌注治疗对痉挛型双瘫患儿下肢运动功能的近期和远期疗效。方法选择2023年1月—2023年6月徐州医科大学附属徐州儿童医院收治的痉挛型双瘫患儿60例,按照随机数字表法分为对照组(30例)和观察组(30例),对照组入组后进行A型肉毒毒素肌内注射和传统综合康复训练,观察组在对照组的基础上增加重复外周磁刺激胫前肌治疗;治疗期间观察组退出1例,最终对照组30例、观察组29例纳入研究。分别在治疗前、治疗3个月及6个月时采用踝关节主动背曲活动度、平衡功能测定(BBS)、粗大运动评估量表(GMFM-88)D、E区评分、小腿三头肌肌张力评估(MAS)评价2组患儿的踝关节主动背曲功能、平衡功能、粗大运动功能以及小腿三头肌的痉挛程度。结果治疗前,2组患儿的踝关节主动背曲活动度、BBS、GMFM-88 D、E区评分、MAS的评分比较差异无统计学意义(P>0.05);2组患儿治疗3个月及6个月时的上述指标均较治疗前改善,对照组和观察组比较差异有统计学意义(P<0.05)。结论重复外周磁刺激应用于A型肉毒毒素肌注后痉挛型双瘫患儿可进一步提高下肢运动功能。

Long-term intraocular pressure fluctuation of primary angle closure disease following laser peripheral iridotomy/iridoplasty

Background Many studies indicated that short-term and long-term intraocular pressure （IOP） fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy （LPI） with or without laser peripheral iridoplasty.Methods A total of 158 patients with primary angle closure suspect （PACS, n=21）, primary angle closure （PAC, n=81） and primary angle closure glaucoma （PACG, n=55） had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation （GEE） regression models was used to evaluate the association of long-term IOP fluctuation （maximum IOP minus minimum IOP） with gender, age, baseline IOP, baseline peripheral anterior synechia （PAS）,baseline vertical cup/disc ratio （VCDR）, baseline mean deviation （MD）, need for IOP-lowering medications.Results IOP fluctuation during follow-up in PACS, PAC and PACG groups were （4.83±2.90）, （5.67±3.35）, and （9.40±7.14）mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP （r=0.356, P 〈0.001）, PAS （r=0.374, P 〈0.001）.IOP fluctuation was higher in patients with higher baseline IOP （0.18 mmHg per unit increase, 95% CI： 0.05-0.31 mmHg）.Conclusions Long-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.

Change of retinal nerve fiber layer thickness in patients with nonarteritic inflammatory anterior ischemic optic neuropathy

In this study, 16 patients （19 eyes） with nonarteritic anterior ischemic optic neuropathy in the acute stage （within 4 weeks） and resolving stage （after 12 weeks） were diagnosed by a series of complete ophthalmic examinations, including fundus examination, optical coherence tomography and fluorescein fundus angiography, and visual field defects were measured with standard automated perimetry. The contralateral uninvolved eyes were used as controls. The retinal nerve fiber layer thickness was determined by optical coherence tomography which showed that the mean retinal nerve fiber layer thickness and the retinal nerve fiber layer thickness from temporal, superior, nasal and inferior quadrants were significantly higher for all measurements in the acute stage than the corresponding normal values. In comparison, the retinal nerve fiber layer thickness from each optic disc quadrant was found to be significantly lower when measured at the resolving stages, than in the control group. Statistical analysis on the correlation between optic disc nerve fiber layer thickness and visual defects demonstrated a positive correlation in the acute stage and a negative correlation in the resolving stage. Our experimental findings indicate that optical coherence tomography is a useful diagnostic method for nonarteritic anterior ischemic optic neuropathy and can be used to evaluate the effect of treatment.

Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

白内障术中房角镜指导下房角成形术治疗原发性闭角型青光眼合并白内障疗效评价

目的评估超声乳化白内障吸除术中房角镜指导下房角成形术(Phaco-GAAP)治疗原发性闭角型青光眼(PACG)合并白内障的疗效及安全性。方法采用系列病例观察研究方法,于2022年4月至2022年8月在首都医科大学附属北京同仁医院纳入PACG合并白内障患者22例25眼。所有患眼均接受Phaco-GAAP手术,术中先进行黏弹剂辅助下房角成形操作,再用房角镜观察并记录术眼360°房角周边前粘连(PAS)部位及范围,对未完全开放处的房角行二次房角成形操作,记录房角PAS范围。若2次房角成形后房角PAS范围依然>180°,则术中联合内窥镜下睫状体光凝术。分别于术后1 d、1周、1个月及3个月进行随访,主要效应指标包括眼压、房角PAS范围、降眼压药物使用数量和手术并发症,计算手术成功率。手术条件成功定义为术后联合药物应用眼压可控制到≤21 mmHg,完全成功定义为术后未使用降眼压药物眼压≤21 mmHg。术后1个月、3个月评估房角PAS范围。结果25眼术前、Phaco-GAAP术中第1次和第2次房角成形后房角PAS范围分别为[270(225,360)°]、[165(110,215)°]和[100(35,175)°],总体比较差异有统计学意义(χ^(2)=40.742,P<0.001),其中术中第1次房角成形后PAS范围小于术前,第2次房角成形后PAS范围小于第1次房角成形后,差异均有统计学意义(均P<0.001)。2次房角成形后房角PAS范围≥180°的比例由48%下降到24%。随访末期完成房角镜检查的13眼术前、术毕、术后1个月及术后3个月房角PAS范围分别为[240(195,305)°]、[60(25,182.5)°]、[170(120,275)°]和[180(140,280)°],总体比较差异有统计学意义(χ^(2)=23.631,P<0.001),术后1个月、3个月术眼PAS范围明显小于术前,但均大于术毕时房角PAS范围,差异均有统计学意义(P=0.004、0.004、0.011、0.003)。术眼手术前及术后1 d、1周、1个月和3个月眼压值分别为(40.19±17.23)、(15.80±7.98)、(13.89±5.09)、(12.80±3.79)和(13.24±2.78)mmHg(1 mmHg=0.133 kPa),总体比较差异有统计学意义(F=44.031,P<0.001),术后各时间点眼压均低于术前,差异均有统计学意义(均P<0.001)。术眼术毕与术前PAS范围呈正相关(r_(s)=0.409,P=0.042)。所有术眼及术后各时间点抗青光眼药物使用均少于术前。术后1个月手术完全成功率和条件成功率均为95.8%,术后3个月手术完全成功率和条件成功率分别为95.8%和100%。术中主要并发症为局限性前房角出血,发生率为68%,未见其他严重并发症。结论Phaco-GAAP术中可定量观察房角PAS范围并指导二次房角成形,是一种安全有效的治疗PACG合并白内障的手术方式。

超声引导下前锯肌平面阻滞在老年周围型肺癌手术中的应用观察

目的观察超声引导下前锯肌平面阻滞(SAPB)在老年周围型肺癌手术中的应用价值。方法将90例老年周围型肺癌患者随机分为观察组和对照组,每组45例。观察组在麻醉诱导后行超声引导下SAPB,对照组麻醉诱导后直接进行手术。采用视觉模拟评分法(VAS)比较患者的疼痛程度,简易精神状态检查量表(MMSE)评估患者的认知功能,同时比较两组患者的细胞免疫功能和不良反应。结果观察组患者术后2、4和12 h在静息和咳嗽时的VAS评分明显低于对照组,MMSE评分高于对照组(P<0.01)。术后24 h,两组的CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平均明显降低,观察组降低的幅度低于对照组(P<0.05或0.01)。观察组不良反应总发生率明显低于对照组(P<0.05)。结论超声引导下SAPB可减轻老年周围型肺癌手术患者的疼痛程度、术后认知功能障碍和细胞免疫功能损伤,同时可降低不良反应发生率。

激光周边虹膜切除术治疗原发性房角关闭的临床效果

目的探讨激光周边虹膜切除术在治疗原发性房角关闭中的疗效。方法前瞻性选取2020年1月至2021年12月于首都医科大学附属北京友谊医院眼科经激光周边虹膜切除术治疗21例42眼原发性房角关闭患者,其中6例伴眼压升高,均无视神经损伤。在局部麻醉下以YAG激光进行周边虹膜打孔,平均能量8 mJ。于术前,术后1 h、1 d、1周及1个月监测眼压、最佳矫正视力(BCVA)和前房深度的变化。结果术后1 d、1周和1个月眼压为(19.80±1.23)、(18.20±1.55)、(18.45±2.21)mmHg,较术前眼压[(25.80±7.45)mmHg]有明显降低,差异均有统计学意义(P<0.05)。观察患者治疗前和治疗后1 d、1周及1个月的BCVA比较,差异均无统计学意义(P>0.05)。术后1周和术后1个月前房深度为(2.26±0.09)、(2.28±0.08)、(2.27±0.11)mm,较术前[(2.12±0.12)mm]明显加深,差异均有统计学意义(P<0.05)。结论LPI在临床治疗原发性房角关闭患者中疗效确切,值得进行推广和应用。

晶状体超声乳化摘除联合人工晶体置入术治疗早期原发性闭角型青光眼患者的短期随访研究

目的探讨晶状体超声乳化摘除联合人工晶体(IOL)置入术在早期原发性闭角型青光眼(PACG)患者中的应用效果。方法选取2019年1月~2020年10月我院早期PACG患者66例,均为临床前驱期患者,根据治疗方案不同分为观察组(n=33例,43眼)、对照组(n=33例,41眼)。对照组予以虹膜周边切除术,观察组予以晶状体超声乳化摘除联合IOL置入术。比较两组疗效、并发症发生率、手术前后眼内压(IOP)、前房深度(ACD)、最佳矫正视力(BCVA)、角膜内皮细胞计数(CECC)。结果观察组治疗总有效率95.35%高于对照组78.05%(χ^(2)=5.520,P=0.019);术后两组IOP呈降低趋势,ACD呈增加趋势(P<0.05),术后1d、1个月观察组IOP低于对照组,ACD高于对照组(F组间=16.398、14.376;F时间=23.065、20.528;F组间×时间=16.398、16.119,P均<0.001);术后1个月观察组BCVA优于对照组(χ^(2)=4.750,P=0.029);两组术后1d CECC均降低,术后1个月逐渐回升,但术后1d、1个月观察组CECC高于对照组(F_(组间)=12.346;F_(时间)=17.274;F_(组间×时间)=13.557,P均<0.001);观察组并发症发生率6.98%低于对照组24.39%(χ^(2)=4.865,P=0.027)。结论晶状体超声乳化摘除联合IOL置入术治疗早期PACG效果显著,降低IOP,提高BCVA、ACD,减轻角膜内皮损伤,减少并发症。

虹膜周边前后节沟通术治疗恶性青光眼及具有恶性青光眼倾向的原发性闭角型青光眼

目的探讨虹膜周边前后节沟通术治疗原发性闭角型青光眼(具有恶性青光眼倾向)及恶性青光眼的临床效果。方法回顾性选取2020年2月至2022年2月榆林市中医医院眼科原发性闭角型青光眼(具有恶性青光眼倾向)及恶性青光眼患者100例(100眼),依据手术方法分为新型虹膜周边前后节沟通术组(新型手术组)、传统超声乳化吸出加人工晶状体植入加后囊切开加前部玻璃体切割术组(传统手术组)两组,各50例(50眼)。统计分析两组患者的眼压、最佳矫正视力、视野、视神经功能、中央前房深度、临床疗效、浅前房分度、泪膜功能、生活自理能力、睡眠情况、并发症发生情况及患者满意度。结果新型手术组患者的眼压、最佳矫正视力、图形视觉诱发电位(P-VEP)潜伏期为(13.15±2.54)mmHg、(0.61±0.10)logMAR、108.43±9.56,均明显低于传统手术组[(23.56±3.58)mmHg、(0.83±0.11)logMAR、119.60±9.25],平均光敏度、P-VEP振幅、中央前房深度为28.04±4.82、8.00±0.70、(3.33±0.36)mm,均明显高于传统手术组[24.24±4.26、4.95±0.60、(2.51±0.41)mm],差异均有统计学意义(P<0.05)。新型手术组患者的总有效率为92.00%,明显高于传统手术组(56.00%),差异有统计学意义(P<0.05)。新型手术组患者的浅前房分度发生率为20.00%,明显低于传统手术组(68.00%),差异有统计学意义(P<0.05)。新型手术组患者的视盘面积/视杯面积(C/D)、角膜荧光素染色(FSC)为0.34±0.03、(1.02±0.30)分,均明显低于传统手术组[0.39±0.03、(1.75±0.25)分],前房深度、泪膜破裂时间、Shirmer I试验(2.08±0.17)mm、(15.85±2.04)s、(14.62±2.47)mm,均明显高于传统手术组(1.80±0.16)mm、(12.32±2.12)s、(12.12±2.32)mm,差异均有统计学意义(P<0.05),但两组患者的眼轴长度之间的差异无统计学意义(P>0.05)。新型手术组患者的生活自理能力强比率为74.00%,明显高于传统手术组(44.00%),睡眠好比率为76.00%,明显高于传统手术组(46.00%),差异均有统计学意义(P<0.05)。新型手术组患者的并发症发生率为6.00%,明显低于传统手术组(22.00%),差异有统计学意义(P<0.05)。新型手术组患者的满意度为96.00%,明显高于传统手术组(82.00%),差异有统计学意义(P<0.05)。结论虹膜周边前后节沟通术治疗原发性闭角型青光眼(具有恶性青光眼倾向)及恶性青光眼的临床疗效优于统超声乳化吸出加人工晶状体植入加后囊切开加前部玻璃体切割术,且并发症少,患者满意度高。

骨间前神经旋前方肌支移位修复鱼际肌支、尺神经深支的解剖研究及临床应用

为了进一步证实骨间前神经移位术式的可行性，选用１０个新鲜前臂标本，对骨间前神经旋前方肌支、鱼际肌支及尺神经深支进行显微解剖，发现正中神经旋前方肌支直径为（１．５±０．４）ｍｍ，分别测量各肌支的有髓神经纤维数为（８６６±１４４）条；正中神经鱼际返支直径为（１．７±０．３）ｍｍ，有髓神经纤维数为（１１２０±９７）条；尺神经深支直径为（２．１±０．４）ｍｍ，有髓神经纤维数为（１３６８±１２０）条。用神经移植法可修复正中神经鱼际肌支，将尺神经深支向近端分离，可直接与旋前方肌支吻合。根据解剖特点，临床上应用正中神经旋前方肌支修复鱼际支１７例，修复尺神经深支３例。其中１７例随访２年～７年，１０例肌电图正常，肌力均有不同程度恢复，Ｍ２２例，Ｍ３５例，Ｍ４７例，Ｍ５３例。介绍了手术方法及注意事项。