超声乳化人工晶状体植入术治疗高度近视合并白内障患者的疗效

目的：探讨超声乳化人工晶状体植入术治疗高度近视合并白内障患者的疗效。

方法：回顾性研究。收集2017-02/2019-01我院行超声乳化联合人工晶状体植入术的高度近视合并白内障患者42例42眼,并按1：1比例选取同期行超声乳化联合人工晶状体植入术的不合并高度近视的白内障患者42例42眼作为对照组。检查两组患者术前,术后1wk,1、3mo最佳矫正视力(BCVA); 记录术前和术后3mo眼压、黄斑中心凹视网膜厚度(CMT)、角膜曲率、角膜散光、前房深度、前房角、房角开放距离、角膜内皮细胞计数、六角细胞比例及手术并发症发生情况。

结果：两组患者术后1wk,1、3mo BCVA比较有差异(均P<0.001); 术前、术后3mo,高度近视合并白内障组CMT、前房深度、房角开放距离、前房角均高于对照组(P<0.001),两组手术前后眼压比较无差异(P>0.05); 术后3mo,高度近视合并白内障患者后表面鼻上角膜曲率较术前增大(P<0.001),对照组后表面中心、颞下角膜曲率较术前大(P<0.001),高度近视合并白内障患者后表面中心、后表面颞下角膜曲率低于对照组(均P<0.05); 两组患者术后3mo前表面、后表面角膜散光均上升(均P<0.001),后表面逆规散光较术前增多(P<0.05),但组间比较差异无统计学意义(P>0.05); 两组患者术后3mo角膜内皮细胞计数、六角细胞比例均较同组术前降低(P<0.05),高度近视合并白内障术后3mo角膜内皮细胞计数、六角细胞比例低于对照组(均P<0.05); 高度近视合并白内障并发症发生率高于对照组,但组间比较无差异(P>0.05)。

结论：高度近视合并白内障患者超声乳化联合人工晶状体植入术后视力可获益,但改善效果不及不合并高度近视的白内障患者,高度近视合并白内障患者术后CMT较不合并高度近视的白内障患者更高,后表面散光有所增加,术后前房形态改变更明显,角膜内皮细胞受损更重,但相对安全可靠。     

年龄相关性白内障合并浅前房患者超声乳化术后的屈光状态分析

目的：探讨年龄相关性白内障合并浅前房患者超声乳化术后屈光变化特点。

方法：回顾性研究。将2018-03/2019-06我院收治的96例112眼年龄相关性白内障患者按前房深度(ACD)分为浅前房组(ACD≤2.20mm,52例62眼)和对照组(ACD 2.21～2.90mm,44例50眼),均接受白内障超声乳化手术治疗,于术前,术后1d,3mo测定屈光度、ACD、前房容积(ACV)的变化,Pearson线性相关法分析年龄相关性白内障合并浅前房患者超声乳化术后屈光状态与前房参数的关系。

结果：浅前房组术后3mo屈光误差较对照组高(P<0.001); 浅前房组术前,术后1d,3mo较术前ACD、ACV变化值均高于对照组(P<0.001); 对照组术后1d,3mo屈光误差与术前ACD、术前ACV及术后不同时间ACD、ACV较术前变化值均无明显相关性(P>0.05); 浅前房组术后3mo屈光误差与术前ACD呈负相关(P<0.05),术后3mo 屈光误差与术后1d,3mo较术前ACD变化值均呈正相关(P<0.05),但与术后1d,3mo较术前ACV变化值无明显相关性(P>0.05)。

结论：年龄相关性白内障合并浅前房患者超声乳化手术后存在远视漂移现象,且远视漂移程度与术前ACD呈负相关,与术后ACD呈正相关,即术前ACD越浅,术后ACD增加越高,远视漂移程度越高。     

飞秒激光辅助白内障手术对黄斑形态的影响

目的：观察飞秒激光辅助白内障手术对黄斑形态的影响。

方法：回顾性分析。选取2019-06/2020-05行白内障手术患者79例79眼,分为研究组(行飞秒激光辅助超声乳化手术的白内障患者38例38眼)和对照组(行传统超声乳化手术的白内障患者41例41眼)。采用OCT的共焦激光成像技术,收集术前1d,术后1wk,1mo的黄斑小凹厚度和黄斑小凹区、内环区、外环区3个区域平均视网膜厚度,并将术前术后及组间进行比较。

结果：研究组和对照组在术后1wk,1mo时,黄斑小凹厚度、小凹区厚度、外环区厚度较术前均无差异(P>0.05); 两组手术前后不同时间内环区黄斑厚度有差异(P<0.001)。其中研究组术后1wk内环区黄斑厚度较术前轻度增加,但无差异(P=0.057),术后1mo较术前和术后1wk均明显增加(均P<0.001)。对照组术后1wk,1mo均较术前明显增加(均P<0.001),术后1mo较1wk仍轻度增加(P=0.017)。内环区组间比较：术后1wk内环区黄斑厚度对照组明显高于研究组(t=6.233,P<0.05); 术后1mo内环区黄斑厚度仍略高于研究组(t=7.055,P<0.05)。

结论：飞秒激光辅助白内障手术无明显增加黄斑损害的风险,相较于传统手术方式早期发生黄斑水肿的概率更低,是一种较为安全的手术选择。     

甘肃省和政县年龄相关性白内障患者术后生活质量分析

目的：评价甘肃省和政县年龄相关性白内障患者术后生活质量水平,并分析其影响因素。

方法：于2015-10/2016-02采取整群随机抽样的方法,将确诊为年龄相关性白内障并自愿接受小切口白内障摘除联合人工晶状体植入术的患者195例纳入本研究,分别于术前和术后6mo采用参考美国国立研究所开发的QOL问卷修订后制成的眼健康相关生活质量量表调查患者的生活质量情况。

结果：本研究最终回收有效问卷193份(99.0%)。将量表各维度总分的1/2作为此维度的正常生活质量水平,本组患者在身体运动功能、独立性/生活自理功能、社会角色和社会功能、精神心理健康维度得分均低于正常水平,且生活质量各维度得分均低于术前(均P<0.001)。视力损伤时间和双眼术后最佳矫正视力提高值对年龄相关性白内障患者术后生活质量影响显著。

结论：手术干预能够显著提高年龄相关性白内障患者的生活质量水平,视力损伤时间和双眼术后最佳矫正视力提高值是年龄相关性白内障患者术后生活质量的主要影响因素。     

高度近视患者白内障术后视力与椭圆体带完整性的相关性

目的：分析高度近视白内障患者超声乳化联合IOL植入术后视力预后的影响因素,初步探讨椭圆体带完整性与术后视力的相关性。

方法：回顾性病例研究。将临床确诊为高度近视合并白内障患者96例106眼纳入研究。术前检查后所有患者均行白内障超声乳化联合IOL植入术,对比分析术前及术后1wk,1、3、6mo患眼BCVA变化,比较不同BCVA分段手术前后患眼椭圆体带的完整性,同时分析影响患者术后视力的相关影响因素。

结果：术前和术后1wk,1、3、6mo患眼BCVA分别为0.80(0.50, 1.70)、0.51(0.28, 1.30)、0.50(0.09, 0.60)、0.30(0.22, 0.90)、0.30(0.22, 0.70),有差异(P<0.001); 术前和术后6mo不同BCVA分段患眼椭圆体带完整性,均有差异(P<0.001)。多元逐步回归分析显示,术后6mo时BCVA与术前BCVA和椭圆体带完整性具有相关性(P<0.05); 和性别、年龄、术前平均角膜曲率、眼轴无相关性(P>0.05)。

结论：高度近视白内障患者经超声乳化吸除联合IOL植入术后视力改善,术后视力与椭圆体带完整性和术前视力具有相关性。     

原发性房角关闭疾病合并白内障术后黄斑结构变化的研究

目的：探讨原发性房角关闭疾病(PACD)合并白内障术后黄斑结构的变化。

方法：回顾性分析我院收治的PACD合并白内障患者200例的临床资料,根据手术方式分为传统小梁切除手术组(A组,60例60眼)、白内障超声乳化联合人工晶状体植入手术组(B组,72例72眼)和小梁切除手术+白内障超声乳化联合人工晶状体植入手术组(C组,68例68眼),观察比较手术前后三组患者视力和术前及术后1wk,1、3mo眼压和黄斑厚度(中心凹区、旁中心区、中心凹周围区)的变化情况,同时比较三组患者术中及术后并发症发生情况。

结果：三组患者在术后3mo视力提高率和降低率比较,差异均有统计学意义(P<0.01),且C组视力提高率最高,A组视力提高率最低。三组患者术后1wk,1、3mo眼压均较术前显著降低(P<0.05),且术后1wk,1mo,B组患者眼压均显著高于A、C组(P<0.05)。三组患者手术前后中心凹区、旁中心区厚度比较,差异均有统计学意义(P<0.05),且A组和C组术后1wk,1、3mo黄斑中心凹区、旁中心凹区厚度均较术前显著增厚(P<0.05),B组术后1wk,1mo仅黄斑中心凹厚度较术前显著增厚(P<0.05); A、C组患者术后1wk,1、3mo黄斑中心凹区、旁中心区厚度均较B组显著增厚(P<0.05)。三组患者术后并发症发生率比较,差异有统计学意义(P<0.01),其中A组患者并发症发生率最高,B组最低。

结论：白内障超声乳化联合人工晶状体植入术能够解除房角关闭的瞳孔阻滞和晶状体因素,对PACD合并白内障患者术后黄斑结构影响较小,且能够改善视力,降低眼内压。     

超声乳化术中高灌注压对急性闭角型青光眼患者术后视功能的影响

目的：观察白内障超声乳化术中高灌注压对急性闭角型青光眼(acute angle-closure glaucoma,AACG)患者术后视功能的影响。

方法：选择2017-03/2018-10于我院住院并行白内障超声乳化摘除人工晶状体植入联合房角分离的AACG合并白内障的患者35例37眼,比较术前、术后3、 6mo最佳矫正视力(BCVA)、眼压、平均视敏度(MS)、平均缺损(MD)和丢失方差平方根(sLV)值的变化。

结果：与术前相比,患者术后3、6mo BCVA、 MS明显改善,MD和sLV明显下降,眼压显著降低(P<0.001),术后3、6mo组间比较无差异(P>0.05)。

结论： 白内障超声乳化术中高灌注压不会对AACG患者术后视功能造成损伤。     

基于SD-OCT建立新的前膜分级法评估IMEM对年龄相关性白内障患者术后视功能的影响

目的：在单纯白内障术前,根据频域光学相干断层扫描技术(SD-OCT)显示年龄相关性白内障合并特发性黄斑前膜(IMEM)的患眼黄斑中心凹内部精细结构的紊乱程度建立新的IMEM分级法,评估其用于预测年龄相关性白内障患者的视功能预后的价值。

方法：选取2017-10/2018-11在暨南大学附属深圳市眼科医院因年龄相关性白内障单纯行超声乳化白内障摘除联合人工晶状体植入术,术前眼底检查发现合并IMEM者64例80眼,根据SD-OCT显示的IMEM对黄斑中心凹内部精细结构的破坏程度将IMEM分为4级。对合并各级IMEM的患者术前、术后3mo的最佳矫正视力(BCVA,LogMAR)、平均视敏度(MS)、黄斑中心凹厚度(CMT)、黄斑前膜进展率进行对比分析。

结果：在SD-OCT图像上,随着合并的IMEM分级的增高,前膜越明显,患者的黄斑中心凹凹部丢失和内部结构紊乱越严重。白内障术前及术后3mo的患眼BCVA随着所合并的IMEM分级升高而增加(F=37.72、26.43,均P<0.001)。白内障术前及术后3mo的患眼MS随着所合并的IMEM分级升高而降低(F=43.77、28.96,均P<0.001)。术后3mo CMT的改变和黄斑前膜进展率并不一致,合并各级IMEM的患眼CMT与术前均无差异(P>0.05),但黄斑前膜进展率呈显著上升趋势(χ²_趋势=12.59,P<0.001)。

结论：借助于SD-OCT对年龄相关性白内障合并的IMEM进行新的精细分级,可以更精准地预测该类患者单纯行白内障手术术后的视功能恢复情况。     

高度近视并发白内障患者行飞秒激光辅助超声乳化术的视功能变化

目的：研究高度近视并发白内障患者行飞秒激光辅助超声乳化术的视功能变化。

方法：高度近视并发白内障患者97例97眼皆给予实施飞秒激光辅助白内障超声乳化联合人工晶状体植入术,于术前1d,术后1d,1wk,1、3、6、12mo检查最佳矫正视力、调节功能(负/正调节力、调节灵活度)、集合功能(集合近点、融合范围)、调节性集合与调节比率(AC/A值)、远距立体视锐度,进行统计学分析。

结果：术后各时间点最佳矫正视力均较术前提高(P<0.05),术后各时间点间均无差异(P>0.05)。调节功能：术前及术后各时间负相对调节、调节灵敏度均无差异(P>0.05); 术后1d,1wk,1mo正相对调节与术前均无差异(P>0.05),术后3、6、12mo与术前均有差异(P<0.05)。集合功能：术后1d,1wk集合近点均较术前有差异(P<0.05),术后6mo与术后12mo无差异(P>0.05),余各时间点间均有差异(P<0.05); 术后1d,1wk,1mo融合范围与术前均无差异(P>0.05),术后3、6、12mo与术前均有差异(P<0.05)。术后1d,1wk AC/A值较术前均有差异(P<0.05),术后6mo与术后12mo无差异(P>0.05),余各时间点间均有差异(P<0.05)。术后1d,1wk,1mo远距立体视锐度与术前均无差异(P>0.05),术后3、6、12mo与术前均有差异(P<0.05)。

结论：高度近视并发白内障患者行飞秒激光辅助超声乳化联合人工晶状体植入术,术后早期最佳矫正视力较术前明显提高,而视功能恢复相对缓慢。     

原发性闭角型青光眼合并白内障两种手术方式疗效研究

目的：比较单纯小梁切除术和青光眼白内障联合手术(青白联合手术)治疗原发性闭角型青光眼(primary angle-closure glaucoma ,PACG)合并白内障的效果。

方法：回顾性分析我院2010-01/2013-10间收治的PACG合并白内障患者80例90眼,分为观察组(青白联合手术组,45眼)和对照组(单纯小梁切除术组,45眼)。术后对所有患者随访6mo,观察术后眼压、视力以及术后并发症等情况。

结果：两组术后眼压比术前眼压均明显的降低,而观察组眼压降低更明显(P=0.003)。观察组患者术后视力明显上升,而对照组术后视力与术前上升不明显,两组对比差异有统计学意义(P=0.036)。对照组术后发生低眼压性浅前房、黄斑水肿、前房炎症的患眼均较观察组多,差异均有统计学意义(P=0.002,P=0.003,P=0.001)。

结论：对PACG合并白内障的患者行青白联合手术治疗能有效提高视力,控制眼压,且并发症少。     

LaserACE激光巩膜手术矫正老视

目的评价LaserACE激光巩膜手术矫正老视术后12个月的临床效果。方法回顾性病例研究。纳入老视患者8例（16眼）,进行LaserACE激光巩膜矫正手术。术后1、3、6、12个月复查,测量远中近距离视力、近附加、阅读速度、眼压（IOP）和等效球镜度（SE）,并通过Catquest-9SF问卷评估患者主观感受。采用重复测量方差分析和配对t检验对数据进行处理。结果术后均无明显并发症,无最佳矫正远视力丢失者。术后1、3、6、12个月双眼及单眼近距离视力较术前相比明显提高,差异有统计学意义（F=10.79、26.64,P<0.01）。手术前后各时间点双眼及单眼中距离视力差异有统计学意义（F=5.11、8.10,P<0.05）,但术后12个月双眼中距离视力与术前差异无统计学意义。手术前后双眼及单眼远视力差异无统计学意义。术后近附加较术前下降（F=69.79,P<0.01）;平均阅读速度较术前均有显著提高（F=11.27,P<0.01）。手术前后IOP、SE无显著改变。结论LaserACE激光巩膜气化手术是安全的,术后12个月内患者近、中距离视力提高,且远视力不受影响。     

Functional visual outcomes of cataract extraction in monocular versus binocular patients

PURPOSE: To determine the change in functional vision that occurs with cataract surgery in a group of monocular patients compared with a group of binocularly sighted control subjects. DESIGN: A retrospective case-control study. METHODS: Study subjects comprised 100 functionally monocular patients who underwent cataract surgery at the Jules Stein Eye Institute between 1996 and 2002. Control subjects were 100 binocularly sighted patients, matched to study subjects by age, sex, and timing of surgery. A single ophthalmologist performed all of the operations using an ultrasonic phacoemulsification technique. Best-corrected visual acuity (BCVA) was measured before and after surgery using a conventional visual acuity monitor. Self-reported visual function was assessed before and after surgery using the Visual Function 14 (VF-14) questionnaire. Paired t tests were used to report statistical significance. RESULTS: The monocular group had significantly worse mean BCVA than the binocular group before and after surgery, but the improvement experienced by the two groups was statistically indistinguishable (P =.913). Mean global VF-14 score was significantly worse for the monocular than the binocular group before and after surgery, but the monocular group experienced a significantly greater improvement (P =.00164) in VF-14 following surgery (20.4 points for the monocular group vs 10.1 points for the binocular group). CONCLUSIONS: Monocular patients report twice as much improvement in functional vision as binocular patients despite similar BCVA gains. This may be because monocular patients had cataract surgery on their better-seeing eye, whereas binocular patients typically had surgery on their poorer-seeing eye.     

国人白内障视功能相关生存质量简表的研制及其测量特性评价

目的 研制国人白内障视功能相关生存质量简表Catquest-9SF并评价其在中国白内障人群中的适用性、项目区分度及信、效度,为中国白内障人群的视功能相关生存质量评价提供科学、简便的工具,并初步分析白内障术前患者生存质量的影响因素。方法 横断面调查研究。对原Catquest-9SF量表进行翻译、回译和跨文化调试,选取在温州医科大学附属眼视光医院确诊的白内障住院患者150例行量表调查,其中50例患者由2名调查者先后进行调查。对数据进行内部一致性、评定者间信度、内容效度和结构效度等分析,评价量表的适用性、项目区分度及信、效度,并分析得分的相关因素。结果 国人白内障视功能相关生存质量简表Catquest-9SF简短易行,项目区分度好;总表的Cronbach′s α系数为0.90;评定者间信度的Bland-Altman 95%一致性界限为-2.1~2.0,Pearson相关性分析表明评定者间信度高度相关（r=0.988,P＜0.01）;量表水平内容效度指数为0.98;结构效度的探索性因子分析提取出1个公因子,解释方差百分比为55.89%,累积方差贡献率为55.89%。量表得分和视力（r=0.43,P＜0.01）及年龄（r=-0.22,P<0.01）的相关性显著,不同性别的患者得分差异有统计学意义（t=-2.30,P<0.05）,不同文化程度和第一眼/第二眼手术的患者得分差异无统计学意义。结论 国人Catquest-9SF量表在中国南方地区适用性好,且具有良好的信、效度,是评价中国南方地区白内障人群视功能相关生存质量简单而有效的可行工具。     

Decision-making in second-eye cataract surgery: can presence of Pulfrich phenomenon help?

PURPOSE: To determine whether testing for the Pulfrich phenomenon (PP) can be used as a tool to assess the need for and optimal timing of second-eye cataract surgery. METHODS: A total of 61 patients with logMAR 0 visual acuity (VA) after cataract surgery in one eye and logMAR 0.2-0.7 VA in the other eye were tested for PP using a computer-generated oscillating target at Baskent University Hospital. Only patients who had no ophthalmologic or systemic problem that could cause PP were included. In all, 15 normal patients with logMAR 0 VA in both eyes served as controls. The main outcome measures were presence and magnitude (measured by neutral density filters) of PP and presence of complaints related to binocular vision. RESULTS: Of the 61 patients, 36 (59%) and none of the controls were PP (+) (P<0.001). A total of 27 (75%) of the PP (+) patients had logMAR 0.7-0.4 VA, and nine (25%) had logMAR 0.3-0.2 VA (P=0.01). In all, 16 patients (all PP (+)) had developed binocular vision-related complaints since cataract surgery. The mean PP magnitude in these cases was significantly greater than the mean for the 20 patients without complaints (1.2+/-0.5 vs0.6+/-0.4 log units, respectively; P<0.001). There was no significant difference between the mean VA in the complaint (+) and complaint (-) subgroups (P=0.213). CONCLUSION: PP testing may detect binocular visual dysfunction after first-eye cataract surgery; thus, it could help assess the need for second-eye cataract surgery on this basis.     

Catquest questionnaire: re-validation in an Australian cataract population

Background:  The Catquest questionnaire was developed using traditional methodology to enable cataract surgery outcomes assessment in European countries. Recently, it has been validated using Rasch analysis in a Swedish population resulting in the Catquest-9SF. The aim of the present study was to assess the performance of the Catquest and the Catquest-9SF questionnaires using Rasch analysis in Australian cataract patients.
Methods:  A total of 217 cataract patients awaiting surgery at Flinders Medical Centre, Adelaide, South Australia self-administered the Catquest questionnaire. This is a 19-item instrument containing frequency, difficulty, symptoms and global rating items. Rasch analysis was undertaken to assess the unidimensionality (whether all the items are measuring a single underlying construct using principal components analysis or PCA), person separation (ability of the questionnaire to distinguish between strata of patient ability) and targeting of item difficulty to person ability.
Results:  Similar to the previous validation study, the original Catquest questionnaire required revision because of misfit and multidimensionality necessitating removal of the frequency items. The revised version was similar to the Catquest-9SF although an extra driving item was a valid optional inclusion. The Catquest-9SF performed well in the Australian cohort satisfying all criteria for valid measurement including unidimensionality. However, targeting of item difficulty to person ability was marginally worse compared with the Swedish cataract population indicating the Australian cataract patients present for surgery at lower levels of visual disability.
Conclusions:  The Catquest-9SF is a reliable and valid measure of visual disability in the Australian cataract population.     

白内障摘除手术单眼视设计度数对白内障患者预后视觉质量的影响

目的：探讨白内障摘除手术单眼视设计中不同的近附加度数对白内障患者预后视觉质量的影响。

方法：选取2016-02/2017-02在我院进行白内障摘除手术的白内障患者84例168眼进行前瞻性研究,根据单眼视设计中近附加度数的不同,将入选患者分为低近附加度数组(1.25～1.75D)和高近附加度数组(2.25～2.75D)每组各42例84眼。比较两组患者的术后6mo双眼裸眼近视力、中距离视力、远视力及立体视,以及治疗前后的视功能生存质量评分。

结果：低近附加度数组患者的双眼裸眼中、远视力分别为0.27±0.20、0.09±0.08,高近附加度数组患者的双眼裸眼中、远视力分别为0.29±0.25、0.10±0.07,两组相比差异均无统计学意义(P>0.05)。高近附加度数组患者的双眼裸眼近视力为0.03±0.06,显著优于低近附加度数组0.07±0.04,差异具有统计学意义(P<0.05)。治疗前两组患者视功能指数量表(VF-14)评分分别为27.93±4.52、28.24±4.91分,治疗后两组患者视功能指数量表(VF-14)评分分别为82.04±14.31、81.22±13.70分,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后VF-14评分均显著增加,差异具有统计学意义(P<0.05)。低近附加度数组患者正常立体视、周边立体视及黄斑立体视所占百分比分别为47.6%、31.0%、21.4%,高近附加度数组正常立体视、周边立体视及黄斑立体视所占百分比分别为42.9%、23.8%、33.3%,两组相比差异均无统计学意义(P>0.05)。

结论：白内障患者的两种近附加度数对提高单眼视设计白内障摘除手术后患者的裸眼视力、视功能生存质量及立体视均有相似的优越性。     

Correlation between visual function and visual ability in patients with uveitis

AIM: To investigate the correlation between tests of visual function and perceived visual ability recorded with a quality of life questionnaire for patients with uveitis. METHODS: 132 patients with various types of uveitis were studied. High (monocular and binocular) and low (binocular) contrast logMAR letter acuities were recorded using a Bailey-Lovie chart. Contrast sensitivity (binocular) was determined using a Pelli-Robson chart. Vision related quality of life was assessed using the Vision Specific Quality of Life (VQOL) questionnaire. RESULTS: VQOL declined with reduced performance on the following tests: binocular high contrast visual acuity (p = 0.0011), high contrast visual acuity of the better eye (p = 0.0012), contrast sensitivity (p = 0.005), binocular low contrast visual acuity (p = 0.0065), and high contrast visual acuity of the worse eye (p = 0.015). Stepwise multiple regression analysis revealed binocular high contrast visual acuity (p <0.01) to be the only visual function adequate to predict VQOL. The age of the patient was also significantly associated with perceived visual ability (p <0.001). CONCLUSIONS: Binocular high contrast visual acuity is a good measure of how uveitis patients perform in real life situations. Vision quality of life is worst in younger patients with poor binocular visual acuity.     

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery

PURPOSE: To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. METHODS: A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. RESULTS: In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. CONCLUSIONS: The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.     

The Pyhäjärvi Cataract Study II. Criteria for cataract surgery

Purpose: It is necessary to develop tools for patient selection to target cataract surgery to patients with the best expected outcomes. We used visual acuity, visual functioning 14 (VF‐14) test, the 15‐dimension health‐related quality‐of‐life questionnaire (15D) and the New Zealand priority criteria to evaluate the criteria for cataract surgery in a post hoc setting. Material and methods: Ninety‐three consecutive patients living in a defined rural area in Finland had cataract surgery as a part of the Pyhäjärvi Cataract Study in 2003. Success of cataract surgery was defined as improvement of visual acuity by at least 2 lines and/or improvement of visual function measured by questionnaires. Results: The patients with a visual acuity of 0.30 logMAR (0.5 Snellen decimal) or worse in the better eye and/or 0.52 logMAR (0.3 Snellen decimal) in the worse eye had successful surgery in 59–83% of cases depending on the definition of success. When subjective judgement was added, the success rates varied between 63% and 91%. Conclusion: Setting indication criteria, it seems sufficient to use two global questions in addition to visual acuity: one on the subjective view on disability, and one on a more neutral view on visual function, such as the 15D item on vision. The VF‐14 did not perform any better than the single item counterparts.     

高度近视白内障双眼术后视功能和生存质量早期变化

目的：比较高度近视白内障患者第1眼和第2眼手术前后早期视功能和生存质量的变化,为短期内第 2眼手术的意义提供一定的依据。方法：前瞻性临床研究。收集2019年6月至2020年6月于西安市人民医院（西安市第四医院）白内障中心手术的高度近视白内障患者48例（96眼）,患者眼轴长度≥27.0mm,近视屈光度<-6.0D。视力较差眼先手术,间隔2~4周行第2眼手术。观察术前、术后1周及术后3 个月的裸眼视力（UCVA）和最佳矫正视力（BCVA）;采用主观视功能（VF）和生存质量（QOL）问卷调查量表评估手术前后VF和QOL变化;采用双通道视觉质量分析系统（OQAS-II）比较术前和术后的客观散射指数值（OSI）以及调制传递函数截止频率（MTFcutoff）。采用独立样本t检验比较第1眼和第2眼各数据间的差异。结果：第1眼术后1周BCVA（LogMAR）为0.20±0.35,等效球镜度（SE）为（-2.42±0.84）D,第2眼BCVA（LogMAR）为0.57±0.29,SE为（-19.30±4.65）D;VF问卷调查显示第1眼术后1周患者主观视觉质量、周边视野、视觉适应及立体视功能均较术前明显提高（t=-16.16、-18.65、-9.79、-9.94,均P<0.001）;第2眼术后1周这4项功能均较第1眼术后1周进一步提高（t=-34.32、-14.87、-15.95、-21.36,均P<0.001）;双眼术后3个月与第2眼术后1周仅周边视野和立体视功能进一步提高（t=-2.27,P=0.030;t=2.37,P=0.020）。QOL问卷显示第1眼术后1周患者在自理能力、活动能力、社交能力及心理状况量表分值均较术前明显提高（t=-31.52、-21.79、-19.68、-14.16,均P<0.001）;第2眼术后1周心理状况量表分值较第1眼术后明显提高（t=-12.50,P<0.001）。OQAS-II检查显示第1眼和第2眼术后1周和3个月OSI均较其术前明显降低（t=17.15、-19.54、9.61、10.18,均P<0.001）,MTFcutoff均较术前提高（t=10.58、-11.65、-8.23、-9.15,均P<0.001）。结论：高度近视白内障患者第1眼手术可明显改善患者的生存质量,第2眼手术可进一步改善视功能并提升心理健康状况。