Modified viscocanalostomy in the Chinese population with open angle glaucoma: a 10-year follow-up results

AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.

Analogs of microgravity: the function of Schlemm's canal, intraocular pressure and autonomic nervous during the head-down tilt test in healthy subjects

AIM:To evaluate the ocular outcomes and to elucidate possible mechanisms underlying intraocular pressure(IOP)change following the head-down tilt(HDT)test.METHODS:The study included 21 participants at the Department of Ophthalmology of Tongji Hospital.Subjects received the test of I-care tonometry,enhanced depth imaging optical coherence tomography and heart rate variability(HRV)analysis before and after 15 min HDT test.The lumen area of Schlemm’s canal(SCAR),IOP,HRV were calculated.RESULTS:IOP increased significantly after 20°head down position from 14.0±3.0 to 17.0±3.3 mm Hg(P<0.001).SCAR decreased from 13449.0±5454.9μm^(2) at sitting condition to 9576.6±4130.9μm^(2) post 15 min HDT test.High frequency(HF)indices increased significantly from 1462±865 Hz at baseline to 2128±824 Hz.Heart rate(HR)decreased significantly from 76±11.48 to 70±11.52 bpm after the HDT.The linear regression analysis showed that the difference of HF and SCAR significantly correlated with each other during the HDT(R^(2)=20%,P=0.04).CONCLUSION:These outcomes perform the first evidence of the activation of autonomic nervous system of HDT may cause the collapse of Schlemm’s canal lumen,which in turn leading to the increased IOP.

Changes in Schlemm’s canal,trabecular meshwork,and relevant parameters in the early stage after SMILE of myopia patients

AIM:To observe the changes in Schlemm’s canal(SC),trabecular meshwork(TM),and anterior chamber relevant parameters after small incision lenticule extraction(SMILE) of myopia patients.METHODS:A total of 58 eyes from 30 patients who underwent SMILE were divided into a low and moderate myopia group(group A,32 eyes) and a high myopia group(group B,26 eyes).The diameter and area of the SC,the width and thickness of TM obtained by CIRRUS HD-OCT5000,and the related anterior chamber parameters obtained by Pentacam anterior segment analysis system,accommodation amplitude(AMP) were observed pre-and postoperatively.The preoperative intraocular pressure(IOP) and postoperative correction of intraocular pressure(IOPcc) were measured.RESULTS:The diameter and area of the SC in the two groups were significantly increased postoperatively(all P<0.01).The TM width of the patients in the two groups were increased at 1mo after surgery(both P<0.01),but the TM thickness did not change(P>0.05).The corneal curvature,central anterior chamber depth,and anterior chamber volume decreased after SMILE surgery(all P<0.01).There was a weak negative correlation between the SC area change and AMP change in group A(r=-0.362,P<0.01).The postoperative IOP decreased after correction by Shah formula(P<0.05).CONCLUSION:SC and TM in myopia patients change in the early postoperative stage of SMILE and the IOP is decline.

Exostoses of the external auditory canal

Ear canal exostoses are bilateral, usually symmetric multiple bony growths occurring in the medial portion of the external auditory canal. Also known as surfer's ear, exostosis is thought to be a reactive process from repeated stimulation by cold water and is much more common than external auditory osteoma. Exostoses are usually asymptomatic and discovered on routine otoscopy. Indications for surgical treatment are recurrent otitis externa, hearing loss, otalgia and other conditions in which access medial to the exostoses is required. Surgery is not risk-free and postoperative complications are the most important factor for negative impact on the patient's health-related quality of life. Thisreview offers an overview of the recent advances in the understanding of this condition, with a special focus on the etiology and physiopathology of this condition, the different surgical procedures and their outcomes, the risk factors for recurrence and the results of preventive measures. Finally, this review suggests the need for the otological surgeon to acquire a great deal of experience before undertaking surgical treatment of exostoses as it is a challenging operation and, besides expertise, demands great patience and extreme care in order to achieve good results.

CSF Rhinorrhoea with Encephalocele through Sternberg’s Canal: Our Experience

Spontaneous cerebrospinal fluid rhinorrhoea with encephalocele restricted to the sphenoid sinus is rare clinical finding. As of today, only 17 cases encephalocele protruding through the Sternberg’s canal and extending into the lateral recess of sphenoid sinus, have been described in literature. Patients presenting with this special clinical entity usually do not have any history of trauma, tumour or iatrogenic injury. Thus the lesions are considered to originate from a congenital bony defect in the lateral wall of the sphenoid sinus, first described by Sternberg in 1888 as the lateral craniopharyngeal canal (Sternberg’s canal). In our experience each patient of spontaneous CSF rhinorrhea should have suspicion of intrasphenoid encephalocele though cribriform plate is a common site. Endoscopic tranasnasal approach is one of the best modalities for such cases.

Shaping ability of thermomechanically treated files in simulated S-shaped root canals

Aim: the aim of this study was to investigate the shaping ability of thermomechanically treated files manufactured by twisting(Twisted files)and compare it to conventional rotary system (K3, Sybron Endo, Orange, CA) in S-shaped canals, including formation of ledges, zipping, elbow, outer widening, danger zone, perforation and file deformation. Materials & Methods: Forty S-Shaped canals in resin blocks were randomly divided into 2 groups of 20 each. Pre-instrumentation images of the canals were taken via a digital camera and superimposed on images taken after preparation with TF and K3 systems to apical size of 25/06 and 30/06. Canal aberrations were measured from the superimposed image at five levels using AutoCAD system. Fisher exact test and Mann Whitney test were used for analysis of the data. Results: the incidence of zipping, elbow and apical transportation was significantly lower in the TF group (P = 0.04). Generally the incidence of aberration increased when the apical size increased to 30/0.06 regardless of the file system. Significant file deformation was evident in the TF after single use (P ? 0.001). Conclusion: Under the conditions of this study, TF manufactured by new technique performed better than K3 systems when used up to size 25/06 in simulated S-shaped canals. Clinical significance: The flexibility of thermomechanically treated files is beneficial in canals with multiple curvatures;however, attention should be paid to the instrument taper and final apical size of the preparation.

Agricultural Changes in Xinjiang in the Sixth Year of Guangxu s Reign from the Perspective of the Monument for Building Qarqi Canal

The Monument for Building Qarqi Canal was inscribed in the sixth year of Guangxu s reign in the Qing Dynasty(1880).This inscription made a detailed record of the event when the Qing army expelled the invading army of Mohammad Yaqub Beg,whenever the Qing army regained a place,it immediately started recruiting exiled people,restoring agriculture,building water conservancy and did other rehabilitation works.The army of the Qing Dynasty successively established rehabilitation bureaus in various parts of southern Xinjiang to be responsible for the rehabilitation works.These once again set off a climax in the development of water conservancy in multi-ethnic areas in Xinjiang,and laid the foundation for the rapid development of agricultural development and water conservancy in Xinjiang during the Guangxu s reign in the Qing Dynasty.

Resolving the“Matteo Ricci Puzzle”:Top-Level Design of the Grand Canal of China Based on the Ternary Leadership Theory

Guided by the ternary leadership theory from the perspective of social psychology,this paper explores the impacts of authoritarian,benevolent,and moral leadership on the top design of the Grand Canal of China in terms of its water management practice,while providing reference for resolving the“Matteo Ricci Puzzle”.The research findings are threefold:first,authoritarian as it is,the central government of China formulates relevant laws and regulations to provide legal system insurance for the construction of the Grand Canal Cultural Belt,thus providing the blueprint for constructing the“bright cultural belt,green ecological belt and colorful tourism belt of the Grand Canal”.Second,led by the Central Government,sticking to benevolent and moral leadership,China advocates scientific water management concepts and methods,and gives long-term and comprehensive care to the well-being of the people along the banks of the Grand Canal.Finally,the top-level design of the Grand Canal of China is based on the ternary leadership theory rooted in social psychology and has formulated a set of properly-scheduled,reasonably-coordinated,and flexibly-operated management system for the fundamental interests of the people and long-term goals of the country.

Dorello管区的解剖学特点及其临床意义

目的为颅底外科提供Dorello管区的解剖学资料。方法50例头颅标本进行血管灌注红、蓝乳胶或硅橡胶，对Dorello管区的构成、毗邻关系、内容物等进行观察和测量。对岩斜段展神经进行苏木精．伊红染色，研究该段展神经硬脑膜鞘的构成。结果Dorello管由Gruber韧带、颞骨岩部尖端、上斜坡外缘构成，管内走行脑膜背侧动脉、展神经及其硬脑膜鞘。展神经硬脑膜鞘由硬脑膜和蛛网膜构成。Gruber韧带可以分为6型：Y-型，蝴蝶型，三角型，镰型，爪型和复干（条索状）型。展神经存在多种变异，复干型展神经出现率为16％，双侧都为复干型展神经的出现率为5％。展神经在Dorello管区出现转折，按转折的程度分为：重型（〈120°）占60％（60侧），中型（12°-150°）占36％（36侧），轻型（150°-180°）占4％（4侧）。结论Dorello管区结构复杂，展神经变异多，对Dorello管区的研究有助于在手术中减少神经、血管的损伤，同时阐明展神经损伤的机理。

Dorello管区的显微解剖研究

目的:为Dorello管区显微神经外科手术及影像学诊断提供解剖学依据。方法:在5-20倍手术显微镜下,对30例成人头颅Dorello管区进行观测;并应用生物塑化技术制作Dorello管区横、矢状及冠状薄层塑化切片。结果:Dorello管位于岩斜静脉腔内,Dorello管直径为(1.93±0.62)mm,长(5.09±1.50)mm;Gruber韧带长度为(10.97±1.85)mm,宽为(3.72±1.03)mm。Dorello管区生物塑化薄层切片可清楚显示Dorello管的解剖结构。结论:本文结果可指导与Dorello管相关的颅底外科手术,以免损伤重要神经和血管。Dorello管区塑化薄片与显微解剖所见有良好对应关系,并可直接与MRI图像进行对照,为Dorello管区影像诊断提供解剖学依据。

ProTaper锉预备S形模拟根管的成形效果观察

目的:观察手用ProTaper各号锉在预备S形树脂模拟根管中对根管形态的影响。方法:选用15个S形树脂模拟根管,分别用手用ProTaper的各号锉按说明书进行预备,采集并储存S1,S2,F1,F2和F3预备完后的根管图像,将其依次分为S1组,S2组,F1组,F2组和F3组。从根管壁光滑度,根尖止点形成情况,纵沟或横沟,流畅度以及锥度5个方面综合比较手用ProTaper各号锉对根管形态的影响。结果:各号锉的预备对冠部管壁的光滑度无影响,冠部管壁光滑。随着各号器械的预备,根部管壁光滑度降低、根尖止点的形成质量下降,纵沟的发生率增加,流畅度和锥度逐渐不理想。结论:手用ProTaper预备S形树脂模拟根管,根管形态在F1预备前后发生显著改变,且随着F2、F3的预备,根管形态不理想现象加重。

S形根管经往复运动单支锉系统预备后的形态对冲洗效果的影响

目的:比较S形根管经Reciproc和Mtwo两种机用镍钛器械预备后的形态对根管冲洗效果的影响。方法:40个S形树脂模拟根管,随机分为2组(n=20),分别使用Reciproc和Mtwo完成根管预备;使用30G侧方开口冲洗针头结合注射器,定速定量将蓝黑色墨汁注入预备后根管内,记录针头与根尖孔距离和气锁长度;使用25#/0.04锥度牙胶尖扰动方法排除气锁,记录气锁去除时间;抽取生理盐水对完全充盈后根管内的墨汁进行冲洗,记录冲洗后死水区长度。结果:Reciproc组针头与根尖孔距离为(4.276±0.221)mm,显著长于Mtwo组的(3.459±0.205)mm(P<0.05);Reciproc组气锁长度为(4.472±0.230)mm,显著长于Mtwo组的(3.668±0.217)mm(P<0.05)。Reciproc组气锁去除时间显著短于Mtwo组[(10.13±1.79)s对比(15.29±2.15)s,P<0.05]。Reciproc组冲洗后死水区长度亦显著小于Mtwo组[(1.351±0.142)mm对比(2.245±0.206)mm,P<0.05]。结论:Reciproc与Mtwo对S形根管预备后,根管形态上的差异影响根管冲洗的效果,Reciproc预备后的冲洗效果优于Mtwo。

ProTaper锉预备S形弯曲模拟根管形态变化的连续观察

目的:观察手用ProTaper各号锉在预备S形树脂模拟根管中,不良根管形态在根管预备各阶段的产生情况。方法:选用15个S形树脂模拟根管,分别用手用ProTaper的各号锉按使用说明书进行预备,采集并储存S1,S2,F1,F2和F3预备完后的根管图像,将其依次分为S1、S2、F1、F2和F3组。将同一根管在各组的图像分别与其未预备的根管图像进行重叠,观察各组根管不良形态(包括危险区,台阶,肘形,根尖拉开,侧穿,未预备区域)产生的例数和种类。采用SPSS12.0软件包对结果进行四格表Fisher确切概率法检验。结果:未预备区域的面积在预备过程中逐渐减小,但直到预备完成,未预备区域仍然存在。危险区、肘形和根尖拉开的发生率在修形锉预备初(F1组)分别为15/15、11/15、4/15,显著高于在成形锉预备末(S2组)(分别为2/15、0/15、0/15)(P<0.001);直到F2组开始有台阶的产生,F3组台阶的出现显著增高;各组均未观察到侧穿的发生。结论:手用ProTaper锉预备S形树脂模拟根管,根管不良形态主要始于修形锉预备后;未预备区域的始终存在,提示在根管预备过程中使用大量冲洗液冲洗和在预备后的根管内封药是十分必要的。

大锥度镍钛锉单独及与标准锥度联合使用在S形模拟根管中成形能力的比较

目的:比较大锥度镍钛根管预备器械(手用ProTaper)单独使用以及与标准锥度(2%锥度)镍钛K锉联合使用在S形模拟根管中的成形效果。方法:选择20个S形树脂模拟根管均分为2组,分别用2种方法进行预备(P法:手用ProTaper预备;PN法:手用ProTaper的SX、S1、S2及25#、30#2%锥度镍钛K锉联合预备),用体视显微镜采集各根管预备前后的根管图像并储存。通过image-pro-plus5.0软件根据Cunningham等法测量S形根管预备前后第一弯曲度并记录第二弯曲的保留情况。使用Photoshop 9.0软件进行图片处理和重叠,观察并记录2组预备后的根管中出现不良根管形态的类型和数量。结果:2种方法预备S形根管,P法预备根管拉直程度显著高于PN法,第二弯曲保留率显著低于PN法预备;各类型不良根管形态的数量在2组之间有显著差异,PN法预备发生不良根管形态的类型和数量少于P法预备。结论:对于S形根管,联合大锥度(手用ProTaper)与小锥度(2%锥度K锉)镍钛根管预备器械进行预备,其成形效果优于单独使用大锥度镍钛根管器械(手用Pro-Taper)。

原发性开角型青光Schlemm管和集液管的病理形态学研究

目的研究原发性开角型青光眼(primary open-angle glaucoma,POAG)中集液管和Schlemm管的组织病理学特征,以探讨影响房水外流的阻力因素。方法选取经临床确诊的POAG病人20例(30眼)和经筛选的正常尸眼30只,采用透射电镜技术对房角组织进行超微结构形态学分析。结果实验组30眼中有27眼的集液管在Schlemm管外壁开口处存在电子致密物沉积,呈指纹状。电子致密物的数目与杯盘比(C/D)有正的直线相关关系(r=0.66,P<0.001);与年龄、术前眼压及视野缺损程度均无直线相关关系(r=0.03,P>0.50;r=-0.24,0.20<P<0.50;r=0.30,0.10<P<0.20)。在对照组30个标本的集液管在Schlemm管外壁开口处中均未观察到任何电子致密物等导致狭窄的因素。结论Schlemm管外壁尤其是集液管在Schlemm管外壁开口处的病变可能是形成POAG房水外流阻力的重要因素。

机用镍钛通畅锉用于S形根管成形能力的体外研究

目的:比较R-Pilot(RP)、One G(OG)、ProGlider(Pr)、PathFile(Pa)、HyFlex EDM Glidepath File(EDM)以及手动不锈钢K锉(K锉)在S形树脂模拟根管制备通畅通道的成形能力。方法:48个S形树脂模拟根管,随机分为6组(n=8),分别使用6种器械制备通畅通道,记录制备时间;扫描仪获取制备前后根管图像,使用Photoshop和ImageJ软件进行图像重叠,并从根尖止点开始,每隔1 mm测量根管内、外侧壁树脂去除量;外弯量减去内弯量,表示中心定位能力。单因素方差分析进行统计学检验,显著水平为0.05。结果:制备时间方面,RP与OG最短,显著小于其他各组(P<0.05)。树脂去除量方面,根方弯曲段(距根尖0~3 mm),RP、OG、Pr、Pa均显著小于EDM和K锉(P<0.05);冠方弯曲段(距根尖4~6 mm),RP、OG、K锉均显著小于EDM(P<0.05),显著多于Pr和Pa(P<0.05)。中心定位能力方面,根方弯曲段,RP、OG显著优于其他组(P<0.05);冠方弯曲段,Pr、Pa组最佳(P<0.05),RP、OG、K锉次之(P<0.05)。结论:S形根管制备通畅通道宜选用.03~.04锥度镍钛通畅锉,制备时间短、顺应性好、形成中上段开敞。

不同根管冲洗针头对S形弯曲根管冲洗效果的影响

目的:比较临床常用的2种冲洗针头对S形弯曲根管冲洗效果的影响。方法:采用80个树脂模拟弯曲S形根管,随机分成两组:IrriFlex组(A组)和NaviTip FX组(B组),分别预备至25^(#)0.06锥度和30^(#)0.04锥度各40个。根据根管冲洗针头、冲洗位置和预备形态分为A1组(IrriFlex,最大冲洗深度,25^(#)0.06锥度)、B1组(NaviTip FX,最大冲洗深度,25^(#)0.06锥度)、A2组(IrriFlex,最大冲洗深度,30^(#)0.04锥度)、B2组(NaviTip FX,最大冲洗深度,30^(#)0.04锥度)、A3组(IrriFlex,距根尖孔4 mm,25^(#)0.06锥度)、B3组(NaviTip FX,距根尖孔4 mm,25^(#)0.06锥度)、A4组(IrriFlex,距根尖孔4 mm,30^(#)0.04锥度)、B4组(NaviTip FX,距根尖孔4 mm,30^(#)0.04锥度),每组10个样本。先将1 mL亚甲蓝染色剂匀速注入树脂根管内,每根管使用3 mL 3%NaClO溶液匀速冲洗。在针头进入根管但尚未注射亚甲蓝时和注射亚甲蓝并冲洗完成后,使用牙科显微镜分别拍照,测量针头到根尖孔的距离及根尖部残留亚甲蓝的长度。采用SPSS 25.0软件对数据进行统计学分析。结果:在最大冲洗深度进行冲洗时,IrriFlex组均较NaviTip FX组深入距离根尖孔更近的位置(P<0.001),根尖部残余亚甲蓝的长度均显著减短(P<0.001);IrriFlex组中,两种终末预备号数对冲洗效果无显著影响(P>0.05),而NaviTip FX组中,25^(#)0.06锥度较30^(#)0.04锥度残余亚甲蓝的长度稍短(P<0.05)。当距根尖孔4 mm进行冲洗时,IrriFlex组与NaviTip FX组残留亚甲蓝长度无显著差异(P>0.05),25^(#)0.06锥度亚组较30^(#)0.04锥度亚组残余亚甲蓝的长度稍短(P<0.05)。结论:S形弯曲根管中,IrriFlex较NaviTip FX更有利于深入根管内进行冲洗。在选择使用NaviTip FX时,可考虑适当加大根管锥度以达到更好的冲洗效果。

Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼

目的探讨Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼的可行性和疗效评价。方法对23例(23眼)因眼外伤房角后退继发开角型青光眼患者施行Schlemm管引流联合复合式小梁切除术,术后观察眼压、矫正视力、前房情况、术后并发症和滤过泡的形态等。术后随访6～24个月,平均(14.46±9.16)月。结果术后1 d、1周、1月、3月、6月、12月平均眼压分别为(8.7±3.19)mmHg、(9.14±4.62)mmHg、(13.62±3.10)mmHg、(13.77±4.11)mmHg、(14.55±6.02)mmHg、(15.98±5.12)mmHg。与术前平均眼压(31.73±8.66)mmHg比较差异均具有统计学意义(P均<0.05)。最末次随访平均眼压(16.41±4.25)mmHg,与术前平均眼压比较,差异具有统计学意义(t=13.547,P=0.000)。术后21眼眼压控制在正常范围,手术成功率91.30%。15眼(65.22%)形成功能性滤过泡,6只眼(26.09%)为非功能滤过泡,但眼压正常范围内。术后并发症主要是早期前房出血。结论Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼安全有效,并发症少,具有良好临床应用前景。

上颌第二前磨牙S形根管治疗2例

根管形态的变异会增加根管治疗难度,其中S形双弯曲根管一直是根管治疗中的难点,现报道2例上颌第二前磨牙S形根管的根管治疗。

两种根管镍钛锉对L形和S形根管成形能力的研究

目的评价两种机用镍钛锉对弯曲根管的预备成形能力。方法20个L形树脂根管,随机分为2组,每组10个,分别使用#25,0.04锥度的M3铂金版、S3预备根管,术前术后拍摄数码照片,绘制根管外形线及中心线,分析根管预备前、后工作长度和弯曲角度变化值及根管中心线偏移量。另20个S形树脂根管,分组方法和实验方法同L形根管。结果L形根管,2组工作长度和弯曲角度变化值无统计学差异。中心线偏移量:根尖段及距根尖3mm,两组之间无统计学差异;根管弯曲段,S3组小于M3组(P<0.05);根管直段,S3组大于M3组(P<0.05)。S形根管,S3组工作长度及冠方和根方弯曲角度变化值小于M3组(P<0.05)。中心线偏移量:根尖至冠方弯曲,S3组小于M3组(P<0.05);根管直段,两组之间无统计学差异。M3组有根管预备并发症。结论在L形根管,M3和S3均有较好的预备成形能力;在S形根管,S3在根尖及根管弯曲部分的预备成形能力优于M3。