简介:目的探讨耳源性颅内并发症的临床特点及诊治措施。方法回顾分析2003-2010年我科收治的21例耳源性颅内并发症患者的临床资料,病例包括脑脓肿9例、脑膜炎5例、静脉窦血栓性静脉炎4例、硬膜外脓肿3例,继发于胆脂瘤型中耳炎14例、骨疡型中耳炎3例、隐蔽性中耳炎2例、Modini畸形2例。21例均行耳部及头颅cT平扫检查,其中6例未发现颅内病变,经行磁共振成像(MRI)检查后确诊。分别行单纯乳突根治术8例、乳突根治术+脑脓肿穿刺引流6例、乳突根治术+颅钻孔脑脓肿引流1例、乳突根治术+脑脓肿切除术1例、乳突根治术+静脉窦切开脓肿清除及血栓取出2例、外淋巴漏修补术2例。结果随访1-2年,1例死亡,其余20例治愈,其中19例干耳,1例术腔仍有少量分泌物。全部患者颅内并发症无复发。结论胆脂瘤型和骨疡型中耳炎仍是耳源性颅内并发症的最常见病因,应提倡对这两种危险性中耳炎早期进行手术治疗。临床高度怀疑颅内并发症,CT平扫阴性病例,需行MRI检查。乳突切除进路的显微微创手术有效,无需开颅。
简介:目的:探讨不同手术方式对无晶状体眼硅油充填术后早期并发症的影响。方法:回顾性分析在我院进行玻璃体视网膜手术的120例患者的临床资料,根据术中是否行巩膜扣带术及巩膜扣带术先后的不同,随机分为3组,每组40眼。A组:单纯硅油充填组;B组:术前预置环扎带+硅油充填组;C组:硅油充填后再进行外加压组,术后2wk内对各组硅油并发症进行观察。结果:术后A,B,C组高眼压的发病率分别为17.5%,12.5%.52.5%,硅油溢入前房的发病率分别7.5%,10.0%。30.0%。C组与其他两组比较差异有显著性意义(P〈0.05)。D组与E组进行比较差异有显著统计学意义,X^2=7.505,P〈0.01。结论:硅油充填术后早期并发症与手术方式密切相关,适当改进手术技巧,能降低硅油充填术后并发症的发生率。
简介:目的:在高度轴性近视眼与正常眼轴眼之间作对比分析,观察眼轴长度与白内障超声乳化加人工晶状体(intraocularlens,IOL)植入手术风险的相关性。方法:回顾性分析2012-02/2013-02在我院行白内障超声乳化加IOL植入术的连续病例843例1042眼。正常眼轴组(21~24mm)853眼,高度轴性近视组(≥26mm)189眼。对比分析两组的眼内并发症,包括玻璃体脱失,后囊膜破裂,晶状体核掉入玻璃体腔和IOL位置异常。结果:年龄在两个组中都是眼内并发症的风险因素,年龄的增长与眼内并发症的发生呈正相关,眼轴长度与眼内并发症的发生呈正相关,尤其对于后囊膜破裂和玻璃体脱失两个并发症。结论:此项研究结果提示,年龄和眼轴长度是白内障超声乳化手术并发症发生的两个风险因素,了解这些风险并提前做好准备可能会降低并发症的发生。
简介:目的对眼科住院医师实施白内障囊外摘除术及人工晶体植入术中,手术并发症的预防及处理能力培训探讨。方法开展防盲治盲工作中,住院医师共施行215例(235只眼)的白内障囊外摘除术及人工晶体植入手术,对发生并发症进行回顾性分析。结果术后发生的手术并发症:后囊破裂15只眼(6.4%),虹膜脱出5只眼(2.1%),虹膜根部离断3只眼(1.3%),角膜水肿45只眼(19.1%),瞳孔上移10只眼(4.3%),前房皮质残留2只眼(0.9%),后囊瞳孔区皮质残留2只眼(0.9%),继发性瞳孔阻滞性青光眼1只眼(0.4%),黄斑囊样水肿1只眼(0.4%)。结论后囊膜破裂和角膜水肿是本组白内障囊外摘除术及人工晶体植入手术主要并发症,住院医师手术者应规范掌握手术要点是预防并发症发生的关键,对出现的手术并发症应积极妥善处理是减少并发症有效措施。
简介:AIM:Toreportthelong-termvision-threateningcomplicationsinpatientswhounderwentphakicintraocularlens(pIOLs)implantationforhighmyopia.METHODS:Thisstudywasdesignedfromaconsecutiveseriesofphakicintraocularlenscomplicationandcorrectivesurgeries.Sixteeneyesof13patientshadimplantationofphakicintraocularlensforcorrectionhighmyopiaanddevelopedseriouscomplicationshavebeenincludedinthisstudy.Themeanageofpatientswas38.6±6.35y(range32-50y)andthemeantimeofhistoryofpIOLimplantationforhighmyopiawas6±2y(range2-10y).Beforecorrectivesurgery,bestspectaclecorrectivevisualacuity(BSCVA)rangedfromperceptionto20/200intheeyesinwhichseverecomplicationsoccurred.RESULTS:Cornealdecompensationoccurredin12eyesof9highmyopicpatientsafteranteriorchamberpIOLimplantation.Rhegmatogenousretinaldetachment(RRD)occurredin4eyesof4highmyopicpatientsfollowinganteriorchamberandposteriorchamberpIOLimplantation.Patientswithcornealdecompensation,hadcombinedproceduresconsistingofpIOLremovalandpenetratingkeratoplasty(PKP).RemovalsofpIOL,phacoemulsificationandparsplanavitrectomy(PPV)withsiliconeoiltamponadewereperformedinpatientswithRRD.Aftercorrectivesurgeries,allpatientsbutone(P+,patient2,righteye)achievedmoderateBSCVArangedfrom20/200to20/50atthelastvisit.CONCLUSION:PhakicIOLsmaybeeffectiveforthecorrectionofhighmyopia.AlthoughtheseIOLsmayhaveseverecomplicationsanditaffectssafetyandefficacyofthissurgery.Asseenhere,cornealdecompensationandrhegmatogenousretinaldetachmentarepossiblepostoperativevision-threateningcomplicationsofphakicIOLs.Patientsmustbecarefullyexaminedbeforeandaftersurgeryforpossibleendothelialcelllossandvitreoretinalproblems.
简介:目的探讨用改良圈匙娩核并注重粘弹剂应用对防止小切口非超声乳化白内障囊外摘出人工晶体植入术并发症的作用。方法用改良圈匙娩核并注重粘弹剂应用对355例白内障行小切口非超声乳化白内障人工晶体植入术。结果术后三天矫正视力≥0.5者291眼达82%,脱残339眼(95.5%)脱盲315眼(98.9%)。术后角膜水肿39眼,占10.98%均在3~6天后恢复透明。后囊破裂7眼,占1.97%,前房出血4眼,占1.13%。瞳孔轻度变形10眼,占2.8%,暂时性高眼压4眼,占1.13%。结论在行小切口白内障囊外摘出人工晶体植入时,应用改良后的圈匙娩核并注重粘弹剂应用,就会明显减少并发症,达到良好的效果。
简介:AIM:Toassesstheawarenessofeyecomplicationsandtheprevalenceofretinopathy,inthefirstvisittoeyeclinic,amongtype2diabeticpatientsattendingatertiarymedicalcentreinKualaLumpur,Malaysia.METHODS:Aninvestigator-administeredquestionnairewasgivento137patientswithdiabetesundergoingfirsttimeeyescreeningintheeyeclinic.Thiswasfollowedbyadetailedfundusexaminationbyaseniorophthalmologisttoassessforpresenceofretinopathy.RESULTS:Almost86%ofrespondentswereawareofdiabeticeyecomplications,especiallyinpatientswhohadachievedtertiaryeducationallevel(96.3%).Themajorityofthepatients(78.8%)werereferredbytheirphysiciansandonly20.4%cameontheirowninitiative.Manyofthepatients(43.8%)didnotknowhowfrequenttheyshouldgoforaneyecheck-upand72.3%didnotknowwhattreatmentswereavailable.Lackofunderstandingondiabeticeyediseases(68.6%)wasthemainbarrierformostpatientsfornotcomingforeyescreeningearlier.Despiteahighlevelofawareness,only21.9%hadrecordedHbA1clevelof<6.5%while31.4%wereundertheerroneousassumptionofhavingagoodbloodsugarcontrol.Atotalof29.2%haddiabeticretinopathyintheirfirstvisiteyetesting.CONCLUSION:Inthepresentstudy,29.2%oftype2diabeticpatientshadretinopathyintheirfirsttimeeyetesting.Althoughtheawarenessofdiabeticeyecomplicationswashighamongfirsttimeeyescreeningpatients,theappropriateeyecare-seekingbehaviorwascomparativelylessandshouldberectifiedtopreventtheriseofthissightthreateningeyedisease.
简介:结膜松弛症是年龄相关性老年性常见眼病,随着人口老龄化加快,患者日趋增多。下睑缘张力高、睑板腺功能障碍及结膜淋巴流动阻塞可能是结膜松弛症诱发因子之一。自身免疫性甲状腺疾病患者结膜松弛症发病率高。结膜松弛症患者球结膜杯状细胞减少,并有形态及超微结构异常表现。结膜松弛症泪液分泌减少,泪膜稳定性下降,泪液中黏蛋白减少,出现调节凋亡相关蛋白质和防御素。细胞凋亡和炎症可能是结膜松弛症发病的原因。结膜松弛症发病机制认为是泪液中IL-1β,IL-6,肿瘤坏死因子-α等炎性因子增加,使结膜成纤维细胞中MMP-1,3,9过度表达,使得MMPs与TIMPs之间失去平衡,可能使胶原纤维融解,弹力纤维变性减少,导致球结膜基质和Tenon囊的过度降解,引起眼表泪液异常的病理循环,而发生结膜松弛症。纤维蛋白胶应用于结膜松弛症手术中,电凝治疗结膜松弛症及开展上方结膜松弛症手术治疗。