Experimental study of the damage characteristics of rocks containing non-penetrating cracks under cyclic loading

The damage evolution process of non-penetrating cracks often causes some unexpected engineering disasters.Gypsum specimens containing non-penetrating crack(s)are used to study the damage evolution and characteristics under cyclic loading.The results show that under cyclic loading,the relationship between the number of non-penetrating crack(s)and the characteristic parameters(cyclic number,peak stress,peak strain,failure stress,and failure strain)of the pre-cracked specimens can be represented by a decreasing linear function.The damage evolution equation is fitted by calibrating the accumulative plastic strain for each cycle,and the damage constitutive equation is proposed by the concept of effective stress.Additionally,non-penetrating cracks are more likely to cause uneven stress distribution,damage accumulation,and local failure of specimen.The local failure can change the stress distribution and relieve the inhibition of non-penetrating crack extension and eventually cause a dramatic destruction of the specimen.Therefore,the evolution process caused by non-penetrating cracks can be regarded as one of the important reasons for inducing rockburst.These results are expected to improve the understanding of the process of spalling formation and rockburst and can be used to analyze the stability of rocks or rock structures.

Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of Open Angle Glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED （1966 to 2009）, Embase （1980 to 2009） and CMB-disk （1979 to 2009） for the randomized clinical trials （RCT） concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration＇s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure （IOP） between non-penetrating trabecular surgery and trabeculectomy （Z=6.05 P0.00001）. There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures （Z=4.92, P0.00001）. Difference in the success rate was also found between the two surgeries （Z=3.82, P=0.0001）. It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

Bulging Distortion of Austenitic Stainless Steel Sheet on the Partially Penetrated Side of Non-Penetration Lap Laser Welding Joint

Non-penetration laser welding of lap joints in austenitic stainless steel sheets is commonly preferred in fields where the surface quality is of utmost importance.However,the application of non-penetration welded austenitic stainless steel parts is limited owing to the micro bulging distortion that occurs on the back surface of the partial penetration side.In this paper,non-penetration lap laser welding experiments,were conducted on galvanized and SUS304 austenitic stainless steel plates using a fiber laser,to investigate the mechanism of bulging distortion.A comparative experiment of DC01 galvanized steel-Q235 carbon steel lap laser welding was carried out,and the deflection and distortion profile of partially penetrated side of the sheets were measured using a noncontact laser interferometer.In addition,the cold-rolled SUS304 was subjected to heat holding at different temperatures and water quenching after bending to characterize its microstructure under tensile and compressive stress.The results show that,during the heating stage of the thermal cycle of laser lap welding,the partial penetration side of the SUS304 steel sheet generates compressive stress,which extrudes the material in the heat-affected zone to the outside of the back of the SUS304 steel sheet,thereby forming a bulge.The findings of these experiments can be of great value for controlling the distortion of the partial penetrated side of austenitic stainless steel sheet during laser non-penetration lap welding.

IOP-lowering effects for the application of human umbilical vein in non-penetrating deep sclerostomy in rabbits

AIM: To estimate the effects of human umbilical vein (HUV) implanted under the sclera of glaucoma model on intraocular pressure (IOP) lowering and to investigate its related mechanisms METHODS: A total of 20 human umbilical veins (HUV) were collected from healthy fetus umbilical core. After the establishment of glaucoma model in rabbits, human freeze-dried umbilical vein was implanted under the sclera during NPDS, while for control group, sclerostomy was performed without implant. The formation of the filtration bleb and TOP were detected every 24 hours before surgery and on day 3, 7, 10 and 14 after surgery. Handheld pen-type Tono-pen II tonometer was used to measure TOP after topical anesthesia treatment. Each measurement has three duplicates. The incision recovery, filtration, conjunctiva congestion and anterior chamber inflammation were observed everyday after surgery. RESULTS: IOP was decreased dramatically with less inflammation than traditional sclerostomies with the application of HUV. The significant differences of IOP between the NPDS with and without HUV implant groups were shown up from 10 days after surgery. The average TOP in NPDS without HUV implant was 14.25mmHg, while for NPDS with HUV implant group, it was 12.30mmHg. This structure of filtration bleb, which allowed the aqueous humor to leave the eye, was formed for any type of surgery. However, 1-2 weeks later, filtration bleb was still Existed in the group of sclerostomy with HUV implant and more stable than that of the surgery without HUV implant. Histological observations were performed on day 3, 7 and 14 after surgery. For the eyes under sclerostomy with HUV implant, HUV lumina was shown up on 3 days after surgery with few fibroblast cells near the sclera. On 7 days after surgery, HUV lumina was stably maintained but with obvious fibroblast cells and inflammatory cell. On 14 days after surgery, HUV lumina was still clearly observed but with scarring formation, which suggests that the IOP lowering effects might result from an effective drainage structure formation. CONCLUSION: HUV might be an alternative material to make the drainage pathway for non-penetrating deep sclerostomy.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery:a Meta-analysis

AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma.Primary outcomes included postoperative intraocular pressure(IOP)and the number of postoperative antiglaucoma medications.Secondary outcomes were the prevalence of complications,incidence of needling or goniopuncture,and surgical success rate.RESULTS:In total,380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included.Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group[weighted mean difference(WMD)=-1.12,95%confidence interval(CI):-2.11 to-0.12,P=0.03;WMD=-0.31,95%CI:-0.53 to-0.09,P=0.006].Moreover,Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone,while no significant difference existed for surgical success.CONCLUSION:Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications.Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy,fewer complications,and postoperative procedures.

Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China:a 325 eyes analysis

AIM:To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C(MMC)in Southwest Chinese patients.METHODS:A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)>5 and≤21 mm Hg and 20%reduction of IOP compared to preoperative,without IOP-lowering medications.A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications.The primary outcomes were IOP,the number of IOP-lowering medications,and cumulative success rate.The secondary outcomes included best corrected visual acuity(BCVA),mean deviation(MD)of visual field,major complications,and risk factors for surgical failure.RESULTS:A total of 325 eyes of 261 glaucomatous patients had been included in our study.Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg(P<0.0001)and 3.0±0.9 to 0.9±1.0(P<0.0001),respectively,at the last visit.The cumulative complete success rate and qualified success rate were 77.8%and 92.0%at 1-year follow-up,and 47.2%and 77.7%at 3-year follow up.There were no significant differences in surgical outcomes between primary angle-closure glaucoma(PACG)and primary open angle glaucoma(POAG).In PACG patients,the success rates of trabeculectomy were comparable with those of phacotrabeculectomy.Hypertension(HR=1.904,P=0.011),encapsulated bleb(HR=2.756,P<0.001),and more preoperative topical medications(HR=2.475,P=0.008)were risk factors for surgical failure.CONCLUSION:The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0%at 1-year,and 77.7%at 3-year follow up.Hypertension,encapsulated bleb,and more preoperative topical medications are associated with surgical failure.

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy

AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

个性化复合式小梁切除术和术后强化管理在青光眼中的临床应用

目的探索在临床上采用个性化复合式小梁切除术治疗青光眼及术后强化管理的有效性和安全性。方法回顾性病例研究。收集2020年1月至2022年10月在铜陵市人民医院眼科住院的青光眼患者63例(66只眼),均实施个性化复合式小梁切除术,术后给予强化管理,观察及对比术前术后视力、眼压、前房、滤过泡情况及并发症情况。结果术后随访至少3个月,术后1周、1个月、3个月视力与术前比较均有提升,差异均具有统计学意义(均P<0.05),术后1 d、1周、1个月、3个月眼压均较术前降低,差异均有统计学意义(均P<0.05),66只眼有55只眼视力提高,占83.33%,59只眼保持功能性滤过泡,眼压控制良好,占89.39%,有10只眼浅前房,占15.15%,术后均无严重并发症。结论青光眼患者采用个性化复合式小梁切除术及术后强化管理,效果确切,并发症少,可操作性强,成本低,推荐地市级及基层医院临床广泛开展。

缝线引导下穿透性Schlemm管成形术联合超声乳化术治疗原发性开角型青光眼

目的:比较分析小梁切除术联合超声乳化人工晶状体植入术与缝线引导下穿透性Schlemm管成形术联合超声乳化人工晶状体植入术治疗原发性开角型青光眼(POAG)患者的临床效果。方法:回顾性病例对照研究。收集2021-06/2022-06在我院住院手术治疗的晚期POAG合并白内障患者53例53眼,其中26眼行小梁切除术联合超声乳化人工晶状体植入(A组),27眼行缝线引导下穿透性Schlemm管成形术联合超声乳化人工晶状体植入(B组)。比较两组患者手术前后最佳矫正视力(BCVA)、眼压、使用降眼压药水数量。记录术中及术后并发症、手术成功率。结果:两组患者术后1 wk, 1、3、6 mo眼压均低于术前(均P<0.017)。两组前房出血并发症比较有差异(P<0.05),浅前房和脉络膜脱离比较无差异(均P>0.05)。术后6 mo两组患者BCVA(LogMAR)比较无差异(A组:1.29±1.19,B组:0.78±1.01,P=0.098),抗青光眼药物数量比较无差异[A组:0 (0, 2.75)种,B组:0 (0, 1)种,P=0.209]。术后6 mo两组患者手术成功率比较无差异(Z=0.448,P=0.654)。结论:缝线引导下穿透性Schlemm管成形术治疗晚期原发性开角型青光眼安全有效,手术成功率与小梁切除术相当。

青光眼小梁切除术后早期滤过泡功能不良行滤过泡剥离治疗患者的焦虑、抑郁及睡眠障碍状况

目的探讨青光眼小梁切除术后早期滤过泡功能不良行滤过泡剥离治疗患者的焦虑、抑郁及睡眠障碍状况。方法选取行青光眼复合式小梁切除术后6个月复查恢复正常患者(A组)、早期滤过泡功能不良行滤过泡剥离治疗患者(B组)及查体健康成年人(C组)各30例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和匹兹堡睡眠质量指数量表(PSQI)进行焦虑、抑郁及睡眠障碍评分,比较三组SAS、SDS、PSQI评分以及焦虑、抑郁及睡眠障碍阳性率差异,采用Spearman相关分析早期滤过泡功能不良行滤过泡剥离治疗患者SAS、SDS、PSQI评分的相关性。结果三组性别、年龄、文化程度、婚姻状况比较差异无统计学意义(P均>0.05),组间均衡可比。三组SAS、SDS、PSQI评分差异有统计学意义(P均<0.05)。B组与C组比较,SAS、SDS、PSQI评分差异有统计学意义(P均<0.05);A组与C组比较,PSQI评分差异有统计学意义(P<0.05)。分别以SAS评分≥45分、SDS评分≥50分、PSQI评分>7分作为焦虑、抑郁和睡眠障碍阳性判定标准。三组抑郁和睡眠障碍阳性率比较差异有统计学意义(P均<0.05);B组与C组相比,焦虑、抑郁和睡眠障碍阳性率差异均有统计学意义(P均<0.05);B组与A组、A组与C组相比,睡眠障碍阳性率差异有统计学意义(P均<0.05)。青光眼术后早期滤过泡功能不良行滤过泡剥离治疗患者PSQI评分与SAS评分、SDS评分呈正相关(r分别为0.511、0.296,P均<0.05);SAS评分与SDS评分呈正相关(r=0.355,P<0.05)。结论青光眼小梁切除术后早期滤过泡功能不良行滤过泡剥离治疗患者术后6个月内焦虑、抑郁及睡眠障碍发生率较高,应给予必要的心理干预。

负载曲安奈德水凝胶缓释片在兔眼微创小梁切除术中的抗瘢痕作用

目的:研究负载曲安奈德(TA)的水凝胶缓释片在兔眼“单步隧道法”新型微创小梁切除术(SIGS)中的抗瘢痕作用及其安全性。方法:选择健康新西兰大耳白兔48只,随机分为四组(每组12只),小梁切除术组(Trab组)、SIGS组、在SIGS术中结膜瓣下植入聚乙烯醇水凝胶(PVAH)薄片(PVAH组)、在SIGS术中结膜瓣下植入负载TA的水凝胶缓释片(TA/PVAH组)。分别于术后1、2、3、4 wk观察并记录各组眼压、滤过泡形态、前房反应及其它并发症情况,并处死动物,取右眼术区组织行病理组织石蜡切片,并行Masson染色、苦味酸-天狼星玫瑰红染色及α-平滑肌肌动蛋白(α-SMA)、纤维细胞生长因子-2(FGF2)免疫组化染色。观察局部组织炎性细胞浸润情况、成纤维细胞增殖及Ⅰ型、Ⅲ型胶原纤维合成情况,计算并比较各组α-SMA、FGF2抗体免疫组化染色的平均阳性面积比。结果:术后2 wk TA/PVAH组均保持了弥散隆起的功能性滤过泡,而Trab组、SIGS组和PVAH组均有术眼出现扁平滤过泡。术后4wk, PVAH组、TA/PVAH组分别有1眼(33%)、2眼(67%)存在功能性滤过泡,其余滤过泡均扁平。Masson染色显示:术后4 wk PVAH组和TA/PVAH组水凝胶均未降解,相对于Trab组和SIGS组,滤过道更为明显,有较少胶原纤维增生。天狼星红染色显示:术后4 wk,与Trab组、SIGS组和PVAH组相比,TA/PVAH组的Ⅰ型胶原和Ⅲ型胶原的表达更少。免疫组化染色显示:术后1 wk, TA/PVAH组α-SMA表达较Trab组和SIGS组均明显降低(P<0.01);术后2 wk Trab组和SIGS组α-SMA表达最高,而PHAP组和TA/PVAH组结膜组织中α-SMA表达较前两组均显著降低(P<0.01)。与Trab组相比,PVAH组、TA/PVAH组术后1、2、3、4 wk FGF2表达均明显升高(P<0.05);与SIGS组相比,TA/PVAH组术后4 wk FGF2表达明显升高(P<0.05)。结论:兔眼SIGS术中联合结膜瓣下填充负载TA的水凝胶缓释片能有效抑制手术区滤过道瘢痕化,可能是TA抗瘢痕作用与水凝胶支架作用的共同结果。

使用AS-OCT评价小梁切除术后滤过泡形态指标的临床意义

目的探讨眼前节相干光层析成像光术(AS⁃OCT)测量青光眼小梁切除术后滤过泡形态指标与眼压及手术结果的关系。方法前瞻性病例研究。对小梁切除术后患者于术后1年进行6次随访,使用AS⁃OCT辅助获得常见滤过泡形态学指标。分析所有指标的变化趋势,以及与眼压及手术结果的关系。结果术后1年眼压和形态学数据分布中,术后2周眼压显著低于术后3、6、12个月(P<0.00238)。术后2周微囊泡变分布广泛的患者最多,无微囊泡的患者最少。在术后1年内扁平⁃轻度隆起的滤过泡占比逐渐增加,“宽”滤过泡的占比逐渐下降。结膜下囊泡多的患者术后6个月后逐渐减少。术后2周时包囊范围、血管化、微囊泡变范围皆为眼压的影响因素(P<0.05);术后2周的AS⁃OCT下形态分类是远期手术结果的影响因素(P<0.001)。结论AS⁃OCT用于检测滤过泡准确有效。术后2周滤过泡形态为弥散型更易获得远期成功,包囊型更易获得手术失败。

吡非尼酮浸泡生物羊膜对兔青光眼模型滤过术后瘢痕形成的作用

目的:探讨吡非尼酮(PFD)浸泡生物羊膜在兔青光眼模型中的应用,评价其对兔青光眼模型的抗瘢痕效果及毒副作用。方法:健康新西兰白兔72只右眼采用前房注射复方卡波姆溶液的方法建立青光眼模型后随机分为0.5%PFD+生物羊膜组、单纯生物羊膜组、丝裂霉素C(MMC)组和空白对照组,每组18只,均行小梁切除术,其中0.5%PFD+生物羊膜组在巩膜瓣下放置0.5%PFD溶液浸泡的生物羊膜,单纯生物羊膜组在巩膜瓣下放置生理盐水浸泡的复水生物羊膜,MMC组在巩膜瓣下放置浸有MMC的棉片3 min后立即采用生理盐水冲洗,空白对照组制作巩膜瓣后不放入任何植入物。评估眼压、滤过泡及毒副作用和并发症情况,并采用苏木精-伊红(HE)、Masson染色及免疫组织化学染色法观察滤过区组织病理变化。结果:小梁切除术后14、21、28 d各组眼压比较,0.5%PFD+生物羊膜组<MMC组<单纯生物羊膜组<空白对照组(均P<0.05)。小梁切除术后28 d,0.5%PFD+生物羊膜组抗炎性增生及抑制胶原纤维增生效果最优,滤过泡存活率最高,且前房炎症反应轻。结论:吡非尼酮浸泡生物羊膜对兔青光眼模型有较明显的抗瘢痕作用,且毒副作用少,安全性好。

青光眼患者小梁切除术后泪液炎症因子与术后并发症的相关性分析

目的 探讨泪液炎症因子在早期评估青光眼患者小梁切除术后并发症发生的应用价值。方法 纳入在张家港市中医医院眼科接受小梁切除术的闭角型青光眼患者150例(共150眼)。收集所有患者临床资料,术前采集患者泪液,检测泪液中的炎症因子(G-CSF、GM-CSF、IFN-γ、MCP-1、TNF-α、IL-12、IL-13、IL-15、IL-1β、IL-4、IL-7、IL-10、IL-17、IL-5)水平。根据术后并发症发生情况将患者分为并发症组和对照组,对比2组患者临床资料,采用Logistic回归分析青光眼患者小梁切除术后发生并发症的相关因素;通过Logistic回归建立泪液炎症因子预测模型,绘制受试者工作特征(ROC)曲线分析该模型在早期评估青光眼患者小梁切除术后并发症发生的价值。结果 150例青光眼患者小梁切除术后有35例(23.33%)发生并发症,其中浅前房24例,睫状体或脉络膜脱离5例,虹膜睫状体炎3例,前房积血2例,视网膜脱离1例。并发症组患者IFN-γ、GM-CSF和IL-5水平低于对照组(P<0.05);2组患者其余炎症因子比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,IFN-γ升高(OR=0.999)、GM-CSF升高(OR=0.988)和IL-5升高(OR=0.996)是青光眼患者小梁切除术后并发症发生的独立保护因素(P<0.05);ROC曲线分析显示,该模型在早期评估青光眼患者小梁切除术后并发症发生的敏感度为94.29%,特异度为83.84%,AUC为0.906,高于IFN-γ(AUC=0.642)、GM-CSF(AUC=0.721)和IL-5(AUC=0.666)单独预测。结论 术前分析青光眼患者的泪液炎症因子能够早期评估术后并发症的发生情况,特别是IFN-γ、GM-CSF和IL-5水平联合检测对于预测术后并发症的发生具有重要意义。

手术风险自查护理在青光眼小梁切除术患者中的临床效果

目的探究手术风险自查护理在青光眼小梁切除术患者中的临床效果。方法选取济南市第二人民医院2022年11月至2023年2月期间收治的126例青光眼小梁切除术患者作为本次护理研究对象。依据护理方法的不同将其分为对照组(常规护理)和观察组(常规护理联合手术风险自查护理),各63例。对照组男38例,女25例,年龄(66.48±3.44)岁;核硬度分级:Ⅱ级36例、Ⅲ级27例。观察组男36例,女27例,年龄(66.51±3.58)岁;核硬度分级:Ⅱ级33例、Ⅲ级30例。对两组患者手术相关指标、心境状态、并发症等情况进行对比分析,统计学方法采用t检验和χ^(2)检验。结果观察组患者术中收缩压、术中舒张压、心率、手术时间、平均住院时间等手术相关指标情况均优于对照组[(119.56±9.38)mmHg(1 mmHg=0.133 kPa)比(126.36±12.41)mmHg、(70.57±5.44)mmHg比(68.39±3.34)mmHg、(74.53±13.38)次/min比(80.39±9.44)次/min、(48.61±8.49)min比(54.47±11.35)min、(2.44±0.33)d比(3.32±1.45)d],差异均有统计学意义(t=3.47、2.71、2.84、3.28、4.70,均P<0.05)。观察组患者抑郁、紧张、愤怒、慌乱、疲乏评分均低于对照组[(11.57±2.49)分比(13.33±4.43)分、(12.61±3.42)分比(14.36±5.28)分、(13.55±5.27)分比(15.38±4.40)分、(11.66±2.29)分比(13.37±3.35)分、(8.54±3.53)分比(10.41±1.42)分],精力和与自我有关的情绪评分均高于对照组[(18.56±4.27)分比(16.39±3.55)分、(15.58±3.22)分比(13.44±2.45)分],差异均有统计学意义(t=2.75、2.21、2.12、3.35、3.90、3.10、4.20,均P<0.05)。观察组患者并发症发生率低于对照组[1.59%(1/63)比11.11%(7/63)],差异有统计学意义(χ^(2)=4.81,P<0.05)。结论手术风险自查护理有助于改善青光眼小梁切除术患者手术相关指标,缓解患者术中恐慌与抗拒感,降低并发症发生率。

超声乳化白内障吸除术配合房角分离术治疗原发性急性闭角型青光眼合并白内障的临床效果和安全性分析

目的评定超声乳化白内障吸除术配合房角分离术治疗原发性急性闭角型青光眼合并白内障患者的效果及安全性。方法选取100例原发性急性闭角型青光眼合并白内障患者为研究对象,随机分为试验组和对照组,每组50例。试验组施以超声乳化白内障吸除术配合房角分离术治疗,对照组施以超声乳化白内障吸除术配合小梁切除术治疗。比较两组治疗效果,术前、术后3个月最佳矫正视力、眼压、前房深度、前房角宽度与并发症发生情况。结果试验组总有效率(98.00%)较对照组(86.00%)更高,差异具有统计学意义(P<0.05);术前,试验组最佳矫正视力为(0.23±0.08)、眼压为(43.60±3.45)mm Hg(1 mm Hg=0.133 kPa)、前房深度为(2.35±0.27)mm、前房角宽度为(13.52±2.63)°,对照组分别为(0.24±0.10)、(43.52±4.17)mm Hg、(2.46±0.35)mm、(13.44±3.07)°;术后3个月,试验组最佳矫正视力为(0.47±0.03)、眼压为(15.26±1.75)mm Hg、前房深度为(3.30±0.14)mm、前房角宽度为(30.21±1.27)°,对照组分别为(0.38±0.04)、(18.38±2.07)mm Hg、(3.02±0.25)mm、(26.35±1.14)°。两组术后3个月最佳矫正视力、前房深度、前房角宽度均高于术前,眼压水平均低于术前,且试验组术后3个月最佳矫正视力、前房深度、前房角宽度更高,眼压水平更低,差异具有统计学意义(P<0.05);试验组并发症发生率(6.00%)较对照组(20.00%)更低,差异具有统计学意义(P<0.05)。结论原发性急性闭角型青光眼合并白内障患者施以超声乳化白内障吸除术配合小梁切除术方案与配合房角分离术方案均能取得一定效果,其中超声乳化白内障吸除术配合房角分离术方案的应用能获取优质的效果,更好改善最佳矫正视力、眼压、前房深度、前房角宽度等指标水平,减少并发症发生的几率,意义重大。

急性闭角型青光眼治疗中减压性视网膜病变分类及防治

目的探讨急性闭角型青光眼(AACG)治疗过程中减压性视网膜病变(ODR)的发病特点及预防措施。方法回顾性病例研究。分析2019年11月至2021年11月山西爱尔眼科医院收治的AACG患者发生ODR的特点,比较分析不同治疗方案对ODR发生的影响,采用超广角激光扫描检眼镜(UWFSLO)和常规眼底照相观察和收集AACG治疗中发生ODR的形态特点。结果42例(48只眼)AACG治疗中发现15只眼ODR,占31.25%;ODR可分为视网膜静脉阻塞样型、微血管瘤样型、视盘血管炎样型和混合型4种形态。视盘血管炎型与混合型比较ODR发生率有显著性差异(χ2=4.26,P<0.05)。术前未输注甘露醇组8/23只眼发生ODR(34.78%),输注甘露醇组5/13只眼发生ODR(38.46%),输注甘露醇+地塞米松注射液组2/12只眼发生ODR(16.67%),三组ODR发生率比较有显著性差异(χ2=22.56,P<0.05)。结论AACG高眼压下行小梁切除术易发生ODR,UWFSLO有助于提高ODR检出率;ODR可分为视网膜静脉阻塞样型、微血管瘤样型、视盘血管炎样型和混合型4型;术前静脉输注甘露醇注射液+地塞米松注射液可减少ODR发生。

玻璃体腔与结膜下注射抗血管内皮生长因子联合小梁切除治疗新生血管性青光眼的效果比较

目的探究在新生血管性青光眼(NVG)患者治疗中应用玻璃体腔和结膜下注射抗血管内皮生长因子(VEGF)并小梁切除联合治疗的疗效对比差异。方法随机选取我院2021年1月至2022年6月期间,明确诊断为NVG的住院患者为研究主体,总计纳入患者26例,患眼30只。基于随机数字表法均衡原则分组,命名为A组(患者13例,患眼15只)和B组(患者13例,患眼15只)。A组患者行玻璃体腔注射抗VEGF药,然后行小梁切除术,B组患者行结膜下注射抗VEGF药后行小梁切除术,对比组间视力恢复效果、术后不同时点眼压水平、患眼新生血管面积和并发症发生情况。结果组间患者视力恢复效果对比无差异(P>0.05);在术后第7天,第21天、半年以及术后1年两组患者眼压水平均呈下降变化趋势(均P<0.05),但比较术前及术后各时间点,两组患者眼压水平对比差异无统计学意义(P>0.05);两组治疗前及术后1~6 d内每日比较,两组新生血管面积无差异(P>0.05),术后两组患者的新生血管面积呈逐渐减小趋势,且与术前相比更小(均P<0.05);和A组比较,B组患者术后并发症发生率更低(P<0.05)。结论玻璃体腔与结膜下注射抗VEGF均可有效治疗NVG,均可以达到降低眼压、促进视力恢复,缩小新生血管面积的作用,但是以结膜下注射方式的安全性更高。