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65例眼內炎臨床分析

胃穿透性潰瘍侵蝕胰腺及脾臟血管： 1例報道及文獻復習

目的總結胃穿透性潰瘍侵蝕胰腺及脾臟血管患者的診治經驗，為臨床診治提供一定的參考。方法回顧四川大學華西醫院收治的1例胃穿透性潰瘍侵蝕胰腺及脾臟血管患者的病程發展、診治過程及臨床結局，并結合在中英文數據庫中檢索到的相關病例進行討論，對本病臨床特征、治療措施、臨床結局等進行總結。結果本例患者行近端胃切除術、脾切除術及胰腺修補術，術后檢查及隨訪結果提示患者痊愈。共檢索到27篇相關病例的文獻報道，包括本例患者在內共30例患者，其中男21例、女9例，發病年齡為（56.7±13.2）歲，臨床癥狀以上腹部疼痛為主（66.7%），潰瘍好發于胃小彎（26.7%）及胃后壁（23.3%），穿透性潰瘍最大直徑為（4.2±2.4）cm，易受侵犯部位包括胰腺（40.0%）、脾臟血管（33.3%）、肝臟（33.3%），治療方案以胃部分切除術為主（27.2%），受潰瘍侵蝕組織器官多采取局部修補手術治療（68.2%）。結論胃穿透性潰瘍為消化性潰瘍少見并發癥，患者應行消化內鏡及腹部CT評估潰瘍進展情況。若已經發生潰瘍穿透，則應積極開展手術治療并及時處理病灶，避免穿透進一步侵蝕周圍器官及重要血管。

Relaxing retinotomy for the treatment of perforating traction retinal detachment

Objective To explore the therapeutic value and effects of relaxing retinotomy for perforating traction retinal detachment(PTRD). Method A retrospective survey was done in 21 patinets (21 eyes) with PTRD who underwent vitrectomy combined with relaxing retinotomy in our hospital from 1998 to 2001.Results The retinae were completely reattached in all 21 cases. The visual acuity of 12 patients (57%) was counting finger, and the best visual acuity was 0.05. Among the 18 patients who were followed up for 6 to 25 months, 14(77.8%) remained retinal reattachment. Conclusions Relaxing retinotomy is effective for anatomic reattachment of PTRD, especially to the patients with retinal incarceration and severe proliferative vitreoretinopathy. (Chin J Ocul Fundus Dis，2003，19：5-7)

視神經挫裂傷一例

外傷眼玻璃體切割手術中驅逐性脈絡膜上腔出血的臨床觀察

眼球穿孔傷人工晶狀體手術后視網膜脫離

復雜性眼球穿通傷行玻璃體切除聯合穿透性角膜移植術

目的：分析探討玻璃體切除聯合穿透性角膜移植術對復雜性眼球穿通傷的治療價值。 方法；對18例復雜性眼球穿通傷致角膜瘢痕性混濁同時伴有玻璃體、視網膜病變患者的18只眼，應用臨時人工角膜I期完成經睫狀體平坦部的閉合式玻璃體切除、視網膜復位、穿透性角膜移植等聯合手術。 結果：術后隨訪6個月一2年，14例角膜植片透明，16例視網膜復位。15例患者矯正視力為指數／1m以上，10只眼脫盲，6只眼脫殘。 結論：應用現代顯微手術設備和技巧，對嚴重眼前后節復雜性眼外傷患者，行玻璃體切除聯合穿透性角膜移植術，可以使多數傷眼眼球保存和復明。 （中華眼底病雜志，1997，13：102-103）

The opportunity and key techniques of vitrectomy for opening eyeball injury

The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.

Non-penetrating Trabecular Surgery versus Trabeculectomy for Open Aangle Glaucoma: A Systematic Review

Objectives　To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods　We searched the Cochrane Central Register of Controlled Trials (issue 2, 2007), MEDLINE (1966 to May 2008), EMbase (1980 to May 2008), and CMB-disk (1979 to May 2008). We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used for statistical analysis. Results　Three RCTs involving 127 participants (144 eyes) with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure (WMD2.78, 95%CI 1.41 to 4.15), improved the operation success rate (RR 0.53, 95%CI 0.37 to 0.77), and reduced the use of postoperative antiglaucoma medication (WMD 0.96, 95%CI 0.84 to 1.08). Non-penetrating trabecular surgery reduced the incidence of postoperative complications (RR 17.00, 95%CI 8.36 to 26.00). Conclusion　 Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.

Observation of prognosis of traumatic retinal detachment combined with choroidal damage treated by vitreous surgeries

Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)