角膜移植手术是治疗角膜病变重要且有效的手段。但对眼表功能完全失代偿、多次角膜移植排斥等类型的患者,常规同种异体角膜移植手术成功率却非常低。对于这类患者,人工角膜植入术成为复明的新希望。随着人工角膜的设计和植入方式的不断改进,人工角膜的功效及优点已渐渐突显。目前,波士顿I型(领扣型)人工角膜在全球范围内应用最为广泛。现就波士顿I型人工角膜的基本特征、临床应用及未来发展等方面进行阐述。
The corneal transplantation is an effective option for visually impaired patients with keratopathy to restore vision function. However, the success rate of allograft keratoplasty is still very low for those patients with end-stage ocular surface or repeated corneal graft rejection. For those patients, artificial keratoplasty might be a promising alternative option. The efficacy and advantages of artificial keratoplasty have been gradually highlighted, after consistent improvement of the product design and implantation procedure. Nowadays, the Boston type I (collar button) corneal prosthesis is the most widely used product around the world. In this review, the history, indications, postoperative complications and future prospect of Boston type I corneal prosthesis will be summarized.
玻璃体替代物是玻璃体切割术后的必需品,用于填充玻璃体腔,恢复玻璃体的支撑视网膜、屈光和细胞屏障等功能。严重眼外伤及复杂视网膜脱离引起的视网膜/脉络膜脱离,如选用传统的玻璃体替代物(如硅油)填充,部分患者会出现硅油依赖眼或眼球萎缩,眼球难以保全。折叠式人工玻璃体球囊(foldable capsular vitreous body,FCVB)是我国独立研发的挽救眼球的人工玻璃体,属于国际首创,可以精细模拟自然玻璃体的结构,恢复玻璃体的部分功能。目前临床研究证实FCVB不仅可以有效避免硅油的并发症,还可以维持后房空间,缓慢恢复睫状体的功能,从而治疗硅油依赖眼,阻止眼球进一步萎缩。该文综述了FCVB的研究背景、结构特点、临床应用和拓展研究进展。
Vitreous substitutes are necessary after vitrectomy to fill the vitreous cavity and restore the vitreous to support retinal, refractive, and cellular barrier functions. Severe ocular trauma-induced retinal/choroidal detachment filled with traditional vitreous substitutes (e.g., silicone oil) can lead to silicone oil-dependent eyes and ocular atrophy in some patients, making it difficult to preserve the eye. Foldable capsular vitreous body (FCVB) is an artificial vitreous body independently developed in China to save the eye, which is the first of its kind in the world and can finely simulate the structure of natural vitreous body and restore some of the functions of vitreous body. It has been clinically proven that it can not only effectively avoid the complications of silicone oil, but also maintain the posterior chamber space and slowly restore the function of the ciliary body, thus treating silicone oil-dependent eyes and preventing further atrophy of the eye. This article reviews the research background, structural features, clinical applications and extended studies of FCVB.
目的:评价欧堡Daytona 200度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法:本研究为前瞻性病例研究,收集爱尔眼科医院要求行屈光手术的近视患者1 000例(2 000只眼),分别进行小瞳下欧堡Daytona 200度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查,记录检查结果并进行比较分析。结果:通过欧堡Daytona 200度超广角激光扫描检眼镜检查发现有周边视网膜病变共230例(310只眼),检出阳性率为15.50%;三面镜检查发现周边部视网膜病变共242例(322只眼),检出阳性率为16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性(Kappa值0.8~1.0)。结论:欧堡Daytona 200度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法,在屈光手术前筛查视网膜周边部病变,具有广阔的临床应用前景。
Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by three- mirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery.
目的:应用彩色多普勒超声造影检查测定不同类型原发性青光眼患者的视神经血液供应情况,探讨血流变化与青光眼的关系。方法:选取2012年1 2月至2014年3月在哈尔滨医科大学附属第二医院眼科经临床确诊的原发性闭角型青光眼(primary angle closure glaucoma,PACG)患者16例(20只眼)和原发性开角型青光眼(primary open angle glaucoma,POAG)患者8例(10只眼),分别设为PACG组和POAG组;同时,选取1 0例1 0只正常眼设为对照组。所有受试者分别行彩色多普勒及超声造影检查,观察眼动脉(ophthalmic artery,OA)、视网膜中央动脉(central retinal artery,CRA)、睫后短动脉(short posterior ciliary artery,SPCA)的血流动力学指标,包括收缩期最大血流速度(peak systolic velocity,PSV)、舒张末期血流峰值速度(diastolic peak velocity,EDV)、血流阻力指数(resistance index,RI)、造影剂到达时间(arrival time,AT)及消退时间(departure time,DT)等指标,并对结果进行统计学分析。结果:超声造影测定POAG组的眼动脉造影剂AT较正常对照组延长(P=0.035),PACG组及POAG组的眼动脉造影剂DT均较正常对照组延长(P=0.010);彩色多普勒测定PACG组及POAG组的OA和SPCA,以及POAG组的CRA的PSV、EDV均较正常对照组减低(P=0.003);同时,PACG组及POAG组的OA以及POAG组的CRA的RI较正常对照组增高(P<0.001)。结论:彩色多普勒及超声造影可以检测青光眼患者的眼部血供明显低于正常人群,为临床诊治青光眼及评价眼部疾病患者的眼部血供状态提供了一种新的技术手段。
Objective: This study used Doppler imaging and contrast-enhanced ultrasound to measure ocular haemodynamic of patients with primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG), to investigate the association between the blood flow changes and glaucoma. Methods: Doppler imaging and contrast-enhanced ultrasound were performed on 16 PACG patients (20 eyes, PACG group), 8 POAG patients(10 eyes, POAG group) who were diagnosed in the Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University from Dec. 2012 to Mar. 2014. The normal eyes from 10 persons were selected as control group. The flow velocity of ophthalmic artery, central retinal artery, and posterior ciliary artery were observed, including the peak systolic velocity, diastolic peak velocity, resistance index, and the arrival time and departure time of the ultrasound microbubbles (SonoVue). Results: Compared to control group, the arrival timeof the ultrasound microbubbles (SonoVue) of ophthalmic artery of patients with POAG increased (P=0.035),and the departure time of ophthalmic artery of patients with PACG and POAG increased (P=0.010). Both peak systolic velocity and diastolic peak velocity of the ophthalmic artery and short posterior ciliary artery of patients with PACG and POAG and the central retinal artery of patients with POAG decreased (P=0.003). Meanwhile, the resistance index of ophthalmic artery of patients with PACG and POAG and the central retinal artery of patients with POAG were higher than those in the control group (P<0.001). Conclusion: The flow velocity of ocular vascular was worse than that of normal group respectively. This study provides a new technology for the diagnosis of glaucoma and the evaluation of the flow velocity of ocular vascular.
干眼是以泪膜稳态丢失及伴随眼部不适症状为特征的最常见眼表疾病,泪膜不稳定、泪液高渗透性、眼表炎症及感觉神经异常为其主要病因。地夸磷索钠是一种P2Y2受体激动剂,能刺激黏蛋白及泪液分泌,其独特的作用机制为干眼的治疗开辟了新的方向,本文就地夸磷索钠近年的临床及基础研究进展作一综述。
Dry eye is one of the most common ocular surface diseases. It is characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play major etiological roles. Diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that promotes mucin and aqueous tear secretion. The unique pharmacological mechanism of diquafosol tetrasodium opens up a new direction for the medical therapies of dry eye. This article reviews the clinical therapeutic effect and research progress of diquafosol tetrasodium for the past few years.
白内障作为一种常见的眼科疾病,是全球第一位致盲眼病,目前尚无药物能够治疗,手术是唯一有效的办法。随着现代眼科手术技术的发展以及人工晶状体(intraocular lens,IOL)设计和功能的更新升级,人们对视觉质量的要求越来越高,白内障超声乳化联合IOL植入术已经从单纯的复明手术转变为个性化的屈光手术。为满足不同需求的患者术后获得较好的视觉质量,IOL经历了从单焦点到多焦点、球面到非球面的发展,还有散光型IOL和各类功能性IOL的临床应用,也为患者提供了更多的选择。充分了解不同类型IOL的优势和特点,根据患者自身眼部情况、日常用眼习惯以及需求,个性化地选择IOL植入对视觉质量的恢复和满意度起着至关重要的作用。因此本文将针对不同类型的IOL,从设计与分类、术后临床效果及适应人群进行综述,为IOL的选择提供指导建议。
As a common eye disease, cataract is the first-leading cause of blindness in the world. Currently, there is no drug to treat it, and surgery is the only effective way. With the development of modern ophthalmic surgical technology and the updating and upgrading of the design and function of intraocular lens (IOL), people have higher and higher requirements for visual quality. Cataract phacoemulsification combined with IOL implantation has transformed from a simple vision restoration to personalized refractive surgery. In order to meet the needs of patients with different needs to obtain better visual quality after surgery, IOL has experienced the development from monofocal to multifocal, spherical to aspherical, as well as the clinical application of astigmatic IOL and various functional IOLs, which also provides more choices for patients. Fully understanding the advantages and characteristics of different types of IOLs, according to the patient’s own eye conditions, daily eye habits and needs, individualized selection of IOL implantation plays a crucial role in the recovery and satisfaction of visual quality. Therefore, this article will review different types of IOLs from the aspects of design and classification, postoperative clinical effects and adaptation to the population, and provide guidance for the selection of IOLs.
目的:观察盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术中的临床应用效果,评价盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术麻醉中的有效性和安全性。方法:选择2020年11月至2021年7月在佛山市第二人民医院择期行眼睑肿物刮除术的70例患儿,随机分为A组和B组,每组35例。A组采用七氟烷联合丙泊酚复合麻醉,B组采用盐酸艾司氯胺酮联合丙泊酚复合麻醉。记录两组患儿诱导时间、手术时间、苏醒时间、复苏总时间;监测麻醉前、麻醉后5 min、手术开始前、手术结束后患儿血流动力学及呼吸频率变化;记录两组患儿苏醒后即刻、返回病房即刻的东安大略儿童医院疼痛评分量表(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)疼痛评分、躁动评分、恶心呕吐评分。结果:两组患儿麻醉诱导时间比较差异无统计学意义(P>0.05);两组患儿麻醉过程中血流动力学水平、呼吸频率差异无统计学意义(P>0.05);B组患儿苏醒时间、复苏总时间均明显低于A组(P<0.05);B组患儿苏醒后即刻及返回病房即刻CHEOPS疼痛评分、躁动评分、恶心呕吐评分均明显低于A组(P<0.05)。另外,B组患儿术后出现恶心呕吐概率低于A组(P<0.05)。结论:盐酸艾司氯胺酮联合丙泊酚应用于小儿眼睑肿物刮除术麻醉,能提供良好麻醉镇痛效果,降低躁动反应和恶心呕吐的发生
Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.