简介：<正>今天许多种类的内窥镜已应用于临床诊断。由于优良的光源和光导系统使得精确的观察成为现实。手术可以在电视屏幕下操作,并获得优质的屏幕影像和内窥镜手术像片资料。1959年HopkinsHH博士发明了棒状透镜,1960年StorzK.在此基础上添加了光导纤维,这些形成了现代内窥镜突破性进展。本文总结了与内窥镜发明者StorzK.的谈话内容。早期的内窥镜是JacksonC.医学博士设计的,在许多年内,这个设计没有进一步改进。培养一个内窥镜医师需要许多年时间在实验室用很讲究的方

简介：视野使用红色视标的视野检查可以发现显著的视野异常.简单的测试如正切暗点计屏也很有效.精确评估视野缺损需要视野计：人工（Goldmann）或者自动（Humphery）视野计可以给出详细的视野参数.但是结果受操作者的主观操作影响.

简介：青光眼青光眼是一组进行性的视神经病变，伴有视乳头特征性的结构改变和相应视野缺损的疾病。青光眼视神经病变的主要危险因素是眼压的升高。

简介：目的探讨一种规范化的的高度近视白内障超声乳化方式,总结手术注意点。方法选取高度近视白内障患者91例（91眼）均予以超声乳化联合人工晶体植入术治疗并总结。结果所有病例的术后裸眼视力均优于术前裸眼视力。术后第1天裸眼视力≥0.2共72眼（79.12%）,≥0.5共37只眼（40.66%）;术后3月裸眼视力≥0.2共85只眼（93.41%）,≥0.5共42只眼（46.15%）。最佳矫正视力≥0.2共89只眼（97.80%）,最佳矫正视力≥0.5共72只眼（79.12%）。术前散光度平均1.10D±0.78D,术后3月散光度平均1.25D±0.72D。术后散光度与术前散光度比较,差异无显著性（t=1.166,P=0.261）。无瞳孔严重变形、视网膜脱离、囊样黄斑水肿、瞳孔夹持、青光眼以及顽固性葡萄膜炎等并发症。结论低能量,高负压,低灌注,连续环形撕囊,双手劈核技术对于高度近视白内障患者更加安全有效。

简介：AIM:Toinvestigatethediffusioncharacteristicsofwaterofopticnerveandopticradiationinhealthyadultsanditsrelatedfactorsbydiffusiontensorimaging（DTI）at3T.METHODS:Atotalof107healthyvolunteersperformedheadconventionalMRIandbilateralopticnerveandopticradiationDTI.TheprimarydataofDTIwasprocessedbypost-processingsoftwareofDTIstudio2.3,obtainingfractionalanisotropyvalue,meandiffusivityvalue,principalenginevalue,orthogonalenginevaluebymeasuring,andanalyzedbytheSPSS13.0statisticalsoftware.RESULTS:Thebilateralopticnerveandopticradiationfiberspresentedgreencolorindirectionalencodedcolor（DEC）mapsandpresentedhighsignalinfractionalanisotropy（FA）maps.TheFAvalueoftheleftopticnervewas0.598±0.069andtherightwas0.593±0.065;themeandiffusivity（MD）valueoftheleftopticnervewas（1.324±0.349）×10-3mm2/sandtherightwas（1.312±0.350）x10-3mm2/s;theprincipalenginevalue(λ?)oftheleftopticnervewas（2.297±0.522）×10-4mm2/sandtherightwas（2.277±0.526）×10-3mm2/s;theorthogonalenginevalue（λ⊥）oftheleftopticnervewas（0.838±0.285）×10-3mm2/sandtherightwas（0.830±0.280）×10-3mm2/s;theFAvalueoftheleftopticradiationwas0.636±0.057andtherightwas0.628±0.056;themeandiffusivity（MD）valueoftheleftopticradiationwas（0.907±0.103）×10-3mm2/sandtherightwas（0.889±0.125）×10-3mm2/s;theprincipaleigenvalue(λⅡ)oftheleftopticradiationwas（1.655±0.210）×10-3mm2/sandtherightwas（1.614±0.171）×10-3mn2/s;theorthogonalenginvalue（λ⊥）oftheleftopticradiationwas（0.531±0.103）×10-3mm2/sandtherightwas（0.524±0.152）×10-3m

简介：AIM:Toevaluatetheefficacyofintralesionalradiofrequencyablationinthetreatmentofperiorbitalsyringomas.·METHODS:Wetriedtheintralesionalradiofrequencyablationfor64patientswithperiorbitalsyringomasfrom2007to2011.Theoperationwasperformedunder2.5loupemagnifications.Thehandpiecewasassembledwithaneedleelectrodeandconnectedtotheradiofrequencyablationapparatus.Theelectrodewastheninsertedintothetargetlesionsindermisanddeliveringinjurytothebaseofthesetumors.Resultswereassessedclinicallybycomparingpre-andpost-treatmentphotographsandpatientsatisfactionrates.·RESULTS:Clinicalimprovementincreasedwitheachsubsequenttreatmentsession.Thepercentofpatientswhoseclinicimprovementgradewere≥3aftereachsessionwasrespectively71.9%(Session1),83.3%(Session2),and100%(Session3).Thestatisticalresultsindicatedtheconcordanceoftheclinicalassessmentandthesatisfactionlevelofpatients(kappa=0.78ofthesession1;kappa=0.82ofthesession2).Themajorityofpatientshadgoodorexcellentcosmeticresults.Postoperatively,therewerenopermanentsideeffectsorrecurrences.·CONCLUSION:Asanewtechniqueofminimallyinvasion,theintralesionalradiofrequencyablationwasfoundtobeaneffective,inexpensive,highlypreciseandsafewayoftreatingperiorbitalsyringomas.

简介：AIM:Toevaluatetheaccuracyofsphericalequivalent(SE)estimatesofadouble-passsystemandtocompareitwithretinoscopy,subjectiverefractionandatablemountedautorefractor.METHODS:Non-cycloplegicrefractionwasperformedon125eyesof65healthyadults(age23.5±3.0years)fromOctober2010toJanuary2011usingretinoscopy,subjectiverefraction,autorefraction(AutokeratorefractometerTOPCONKR-8100,Japan)andadoublepasssystem(OpticalQualityAnalysisSystem,OQAS,VisiometricsS.L.,Spain).Nineconsecutivemeasurementswiththedouble-passsystemwereperformedonasubgroupof22eyestoassessrepeatability.ToevaluatethetruenessoftheOQASinstrument,theSElaboratorybiasbetweenthedoublepasssystemandtheothertechniqueswascalculated.RESULTS:TheSEmeancoefficientofrepeatabilityobtainedwas0.22D.SignificantcorrelationscouldbeestablishedbetweentheOQASandtheSEobtainedwithretinoscopy(r=0.956,P<0.001),subjectiverefraction(r=0.955,P<0.001)andautorefraction(r=0.957,P<0.001).ThedifferencesinSEbetweenthedouble-passsystemandtheothertechniquesweresignificant(P<0.001),butlackedclinicalrelevanceexceptforretinoscopy;Retinoscopygavemorehyperopicvaluesthanthedouble-passsystem-0.51±0.50Daswellasthesubjectiverefraction-0.23±0.50D;Moremyopicvalueswereachievedbymeansofautorefraction0.24±0.49D.CONCLUSION:Thedouble-passsystemprovidesaccurateandreliableestimatesoftheSEthatcanbeusedforclinicalstudies.Thistechniquecandeterminethecorrectfocuspositiontoassesstheocularopticalquality.However,ithasarelativelysmallmeasuringrangeincomparisonwithautorefractors(-8.00to+5.00D),andrequirespriorinformationontherefractivestateofthepatient.

简介：作为临床医生,面对患者视力无法提高时,常常会有挫败感。然而有很多方法可以帮助这样的低视力者。图片1显示的是人们由于远视力低下而可能面临的困难,以及帮助人们克服困难的设施。这些包括光学设备,非光学设备,环境改造的建议,以及康复和特殊的学习措施。在这篇文章中,我们会展示如何评估低视力者,并找出他们最迫切的需求。我们将概述可能的干预措施并给出指导方针。

简介：每年,在低收入和中等收入国家有数千名婴儿和儿童失去他们的视力和生命,因为一种叫视网膜母细胞瘤的可治愈的眼癌,通常是因为它没有被及时诊断和治疗。尽管视网膜母细胞瘤相对罕见,但对受其影响的儿童可能会造成破坏性的后果。如果治疗太晚,可能会导致失去眼睛,侵袭大脑并且导致死亡。

简介：目的：探讨儿童瞬目症BUT情况，为临床治疗提供依据。方法：215例患者均排除全身疾患，检查角膜、结膜、屈光不正等，着重检查BUT，详细了解患者病史，不良生活习惯等，治疗上停用含有防腐剂及激素类滴眼液，避免及纠正不良卫生及生活习惯，心理治疗，合理用眼，矫正屈光不正，给予不含防腐剂的滴眼液点眼，如3g／L艾丽滴眼液3次／d点眼，需用抗生素的给予可乐必妥滴眼液3～4次／d点眼，酌情给予抗病毒及维生素类药物。结果：215例患者BUT小于10s者197例（91．6％）326眼，其中5S以下123例224眼。本组215例病例中经过7～28d治疗，173例（80．5％）治愈，37例（17．2％）好转，5例（2．3％）无效，均未患眼部疾病，且不配合治疗，仍每天看电视或玩电脑游戏2h以上。经治疗BUT正常者192例（89．3％），好转19例（8．8％）无效者4例（1．9％）。随访1～6mo，复发31例，均为长期看电视、玩电脑、习惯揉眼者，BUT检查再次异常者，重复治疗后治愈或好转。结论：泪膜的保持并发挥其生理功能与瞬目动作休息相关，我们认为泪膜稳定性差是瞬目症的另一重要因素，BUT检查在诊治儿童瞬目症中起着关键的作用，它可以正确指导医生合理用药，使患者早日康复，而且简单易行，无痛苦，儿童易接受。我们建议BUT可作为儿童瞬目症的常规检查。

简介：目的对改良翼状胬肉手术方法进行安全性评估的研究。方法188例翼状胬肉患者随机分为实验组和对照组。实验组接受改良方法进行翼状胬肉手术。对照组按照《眼科手术图谱》传统翼状胬肉切除术方法进行手术。记录所有患者手术时间、术后角膜上皮修复时间。术后每周随访,记录术后1周、2周、3周、4周时结膜充血情况及结膜充血完全消退时间。随访3个月,记录发生角巩膜溃疡、结膜肉芽以及翼状胬肉复发的病例数。结果实验组有96人完成随访,对照组有92人完成随访。实验组患者角膜上皮修复时间为2.42±0.68天,对照组为4.27±1.05天,P〈0.05,差别有统计学意义;实验组结膜充血评分术后1周、2周、3周、4周时分别为3.31±0.47、2.76±0.74、1.89±0.860.94±0.70,对照组分别为3.84±0.37、3.58±0.67、2.93±0.71、1.85±0.78,两两比较P〈0.05,差别有统计学意义。结膜充血消退时间实验组为5.15±0.92周,对照组为7.20±1.08P〈0.05,差别有统计学意义。实验组未发生结膜肉芽,对照组为14例,P〈0.05,差别有统计学意义。实验组发生角巩膜溃疡4例、复发4例,对照组为7例、5例,P〉0.05,差别无统计学意义。结论改良的翼状胬肉手术方法在术后角膜上皮修复时间、术后结膜充血程度、结膜充血消退时间、结膜肉芽发生率上忧于传统手术方法,差别有统计学意义。在角膜溃疡发生率、翼状胬肉复发率上改良手术方法与传统手术差别无统计学意义。

简介：目的观察单纯性巩膜暴露术与自体角膜缘结膜瓣移植术对翼状胬肉的疗效。方法将73例（73眼）单侧原发性翼状胬肉患者分为A、B2组。A组进行单纯性巩膜暴露术，B组进行自体角膜缘结膜瓣移植术。比较2组术前翼状胬肉突入角膜缘长度，术后角结膜上皮愈合时间及术后3个月复发率。结果术前2组翼状胬肉突人角膜缘长度差异无统计学意义（P〉0．05）。术后B组比A组角结膜上皮愈合时间短，差异有统计学意义（P〈0．01）。A组术后3个月复发率比B组高，差异有统计学意义（P〈0．01）。结论自体角膜缘结膜瓣移植术治疗翼状胬肉比单纯性巩膜暴露术更有效。

简介：AIM:Toevaluatetheeffectofbrinzolamide-timololfixedcombinationonintraocularpressure(IOP)aftercataractsurgery.METHODS:Thestudyincluded92eyesof87patientswhounderwentcataractsurgeryandintraocularlensimplantation.Patientsscheduledforphacoemulsificationwereassignedto1of2groups.Thetreatmentgroupreceived1dropofbrinzolamide-timololfixedcombinationimmediatelyaftersurgery,andthecontrolgroupreceivednotreatment.TheIOPwasmeasuredpreoperativelyandat2hand24hpostoperatively.RESULTS:ThemeanIOPchangewaslowerinthetreatmentgroupthaninthecontrolgroupat2hpostoperatively.ThedifferencebetweenthemeanIOPvaluesofthetwogroupsat2hpostoperativelywasfoundtobestatisticallysignificant.Twenty-fourhoursafterthesurgery,themeanIOPchangewasstillhigherinthecontrolgroupwhencomparedtothetreatmentgroup.CONCLUSION:ThefixedcombinationbrinzolamidetimololcaneffectivelyreduceIOPaftercataractsurgery.

简介：AIM:ToinvestigatetheinterferingeffectofY-27632,aROCK-Iselectiveinhibitor,onthesignaltransductionpathwayoftransforminggrowthfactor-β1(TGF-β1)inocularTenoncapsulefibroblasts(OTFS)invitro.METHODS:AfterOTFSfrompassages4to6invitrowereinducedbyTGF-β1andthentreatedbyY-27632,thechangesoftheOTFScellcycleswereanalyzedviaflowcytometry,andtheproteinsexpressionoftheα-smoothmuscularactin(α-SMA),connectivetissuegrowthfactor(CTGF),collagenIwerecalculatedbyWesternblot.AfterOTFStreatedbythedifferentconcentrationsofY-27632,theexpressionlevelsoftheα-SMA,CTGFandcollagenImRNAwereassayedbyRT-PCR.RESULTS:Y-27632hadnomarkedlyeffectontheOTFScellcycles.AftertreatedbyTGF-β1,OTFSinG1periodsignificantlyincreased.ThecellcyclesdistributionbybothTGF-β1andY-27632hadnoremarkabledifferencefromthatincontrolgroup.Y-27632significantlyinhibitedtheproteinsexpressionsofbothα-SMAandCTGF,whiletosomeextentinhibitedthatofcollagenI.TGF-β1significantlypromotedtheproteinsexpressionsofα-SMA,CTGFandcollagenI.AfterOTFStreatedbybothTGF-β1andY-27632,ofα-SMA,theproteinexpressionwassimilarwiththatincontrolgroup(P=0.066>0.05),buttheproteinexpressionofCTGForcollagenI,respectively,wassignificantlydifferentfromthatincontrolgroup(P=0.000<0.01).Thedifferencesofexpressionsoftheα-SMA,CTGFandcollagenImRNAin30,150,750μmol/LY-27632groupwerestatisticallysignificant,comparedwiththoseincontrolgroup,respectively(α-SMA,P=0.002,0.000,0.000;CTGF,P=0.014,0.002,0.001;collagenI,P=0.003,0.002,0.000).CONCLUSION:BlockingtheRho/ROCKsignalingpathwaybyusingofY-27632couldinhibitthecellularproliferationandtheexpressionofbothCTGFandα-SMAwhateverOTFSinducedbyTGF-β1ornot.Y-27632suppressedtheexpressionofcollagenImRNAwithoutinduction.

简介：目的：研究带有Ⅲ级以上硬核的复杂性白内障，两种手术方式的治疗效果。方法：回顾性分析52眼带有Ⅲ级以上硬核的复杂性白内障患者，采取晶状体超声粉碎技术（A组）以及小切口白内障囊外摘除（B组）不同术式的治疗效果。结果：A组术后最佳矫正视力的提高优于B组，差异有统计学意义（P〈0．05）；两种手术方式对中央角膜厚度的影响，差异无统计学意义（P〉0．05）；A组手术中对角膜内皮的影响多于B组，差异有统计学意义（P〈0．05）；A组手术并发症的发生低于B组，差异有统计学意义（P〈0．05）。结论：对于治疗带有Ⅲ级以上硬核的复杂性白内障，超声粉碎晶状体技术可以考虑应用。

简介：目的探讨采用前后囊环形切除联合前段玻璃体切除术预防治疗儿童白内障术后后囊混浊的临床疗效.方法对23例36眼患儿行前后囊环形切除、白内障超声乳化吸出联合前段玻璃体切除术,随访1年以上,评价其手术疗效.结果术后全部病例周边囊均有不同程度混浊,视轴区均透明,未出现人工晶状体明显移位、视网膜脱离等严重并发症.结论一期行前后囊环形切除联合前段玻璃体切除术是处理和预防儿童白内障术后后囊混浊的有效方法,方法简便,疗效可靠,值得推广.

简介：目的分析白内障超声乳化加人工晶体植入联合小梁切除术中单切口术式和双切口术式对手术效果的影响.方法28例（31眼）青光眼合并白内障病例分为A、B两组.A组（单切口组）：15例（17眼）,巩膜隧道切口行白内障超乳＋IOL植入＋小梁切除术；B组（双切口组）：13例（14眼）,透明角膜切口行白内障超乳＋IOL植入,上方做传统小梁切除术.分析比较两组术后眼压、视力及并发症情况,随访3-6月.结果术后随访3-6月,两组视力均有提高.眼压：A组术前平均眼压33.21mmHg,术后16.24mmHg;B组：术前平均眼压34.25mmHg,术后15.74mmHg.术后眼压与术前相比,两组均有明显差异性；术后平均眼压两组之间无明显差异性.术后并发症无明显差异,功能性滤过泡数量两组之间无明显差异.结论超乳青光眼白内障联合手术,单切口和双切口术式均有良好的降低眼压、提高视力的作用,是治疗闭角型青光眼合并白内障安全、有效的方法.

简介：目的:对比全身麻醉与局部麻醉下进行儿童霰粒肿切除术的综合疗效。方法:回顾性病例对照研究。将2015-01/2016-12在我院接受霰粒肿切除手术的双眼霰粒肿患儿(4~10周岁),根据采用的麻醉方法分为两组:全身麻醉组(全麻组,67例134眼)和局部麻醉组(局麻组,72例144眼)。分析两组患者的疼痛及术后心理创伤,以及术后1mo眼表健康状况、术后1a内复发率和并发症等四个方面的差异。结果:全麻组和局麻组患儿均未出现麻醉相关并发症和意外。全麻组患儿术中不存在疼痛,术后3h的面部表情疼痛量表(FPS-R)值为4.94±1.23分,低于局麻组(7.00±1.14分),差异有统计学意义(P<0.001)。全麻组患儿有12例出现再次就医回避,局麻组为35例,差异有统计学意义(P<0.01)。全麻组的泪膜破裂时间、泪膜脂质层厚度和泪河高度均高于局麻组,差异有统计学意义(P<0.001);其睑脂性状评分也低于局麻组,差异有统计学意义(P<0.01)。全麻组患儿囊肿复发率为6.0%,低于局麻组的20.8%,差异有统计学意义(P<0.05)。全麻组患儿出现并发症发生率为4.5%,局麻组为15.3%,差异有统计学意义(P<0.05)。结论:全身麻醉下进行儿童霰粒肿手术具有术后疼痛轻、患儿依从性好的基本优点。与局部麻醉下手术相比,全身麻醉术中能够进行精细操作,术后眼表健康情况更好,并发症更少。

简介：AIM:ToidentifythegeneticdefectinaChinesefamilywithbilateralprogressivechildhoodposteriorcataract.METHODS:Atwo-generationfamilywasrecruitedinthisstudy.Familyhistoryandclinicaldatawererecorded.AllreportedcandidategenesassociatedwithcongenitalposteriorcataractwerescreenedbydirectDNAsequencing.·RESULTS:Allaffectedindividualspresentedposterioropacitiesinthelens.Directsequencingofthecandidategenesshowedaheterozygousc.2668C>TvariationinEPHA2gene,whichresultedinthereplacementofargininebycysteineatcodon890(p.R890C).Thismutationwasfoundintwoaffectedindividuals,butwasnotobservedin200normalcontrols.·CONCLUSION:Wereportanovelmutation(p.R890C)intheEPHA2receptortyrosinekinasegene.ThefindingexpandsthemutationspectrumofEPHA2inassociationwithposteriorcataract.

简介：Thedamageofhumancornealcellsencounterwiththeproblemofavailabilityofcornealcellsforreplacement.Limitationofthesourceofcornealcellshasbeenrealized.Anattemptofdevelopmentofcornealepithelial-likecellsfromthehumanskin-derivedprecursor(hSKPs)hasbeenmadeinthisstudy.Combinationofthreeessentialgrowthfactors:epidermalgrowthfactor(EGF),keratinocytegrowthfactor(KGF)andhepatocytegrowthfactor(HGF)coulddemonstratesuccessfullyinductionofhSKPstodifferentiationintocornealcells.Theinducedcellsexpressedtheappearanceofmarkersofcornealepithelialcellsasshownbythepresenceofkeratin3(K3)byantibodylabelandWesternblotassay.TheK3geneexpressionofinducedhSKPscellsasshownbyreversetranscription-polymerasechainreaction(RT-PCR)technologywasalsodemonstrated.ThepresenceofthesemarkersatbothgeneandproteinlevelscouldleadtoourconclusionthatthedirectionaltransdifferentiationofhSKPscellsintocornealepithelialcellswassuccessfullydoneunderthiscellinductionprotocol.Thefindingshowsanewlyavailablestemcellsourcecanbeobtainedfromeasilyavailableskin.Cellsfromautologoushumanskinmightbeusedforcornealdisordertreatmentinfutureclinicalapplication.