新农合政策下上海奉贤东部地区白内障复明手术现状分析

目的:分析上海奉贤东部地区白内障复明手术现状及手术覆盖率,探讨其影响复明手术的相关因素及发展趋势。在"新农合"(新型农村合作医疗)政策下提高白内障手术率及质量,加速白内障防盲工作的进展。方法:收集回顾2008-01/2010-08间55岁以上白内障复明手术患者资料,以我国目前白内障流行病学调查的标准及世界卫生组织(WHO)盲与低视力的诊断标准对手术结果进行评估,统计性别、年龄构成、手术效果、医疗保障构成及术后低视力的原因,分析新农合政策下,对白内障复明手术的影响。结果:白内障手术患者994例1260眼中,女649例806眼,男345例454眼,女性患者多于男性患者,年龄55～99(平均74.75±7.92)岁。5个年龄组中70～79岁年龄组515例,最多,占51.81%。术后矫正视力≥0.05白内障患者1242眼,脱盲率为98.57%;术后矫正视力≥0.3白内障患者1179眼,脱残率为93.57%;人工晶状体植入1241眼,晶状体植入率98.49%;1260眼手术后,共39眼出现手术后并发症,占总手术眼的3.10%。在白内障手术患者的保障构成方面,农保561例,占手术人数56.44%,镇保135例,占手术人数13.58%,两项合计占复明手术人数的70.02%。结论:白内障仍是高龄者的致盲眼病,女性手术率高于男性;在新型农村合作医疗制度下,上海奉贤东部地区老年白内障手术率较高,白内障术后脱盲率、脱残率及晶状体植入率亦较高。老年人防盲和改善低视力工作的关键是白内障眼疾的早期诊断和治疗,防治白内障仍是防盲治盲工作的重点。     

复明九号车仙桃基地白内障复明手术临床观察

目的:回顾分析湖北省复明九号车仙桃基地为期25d,免费为贫困白内障患者施行白内障复明手术的临床疗效。方法:为经过严格筛查适合手术复明的贫困白内障患者,施行白内障超声乳化吸除术(或小切口非超声乳化白内障摘除术)及人工晶状体植入术。结果:本组270眼术后视力:1.2者2眼,1.0者25眼,0.8者21眼,0.6者48眼,0.5者33眼,0.4者33眼。共162眼,占60.00%。低视力:二级低视力0.3者46眼,0.2者33眼,一级低视力0.1者4眼,0.09～0.05者2眼。共85眼,占31.48%。盲:二级盲0.04～0.02者15眼,一级盲:指数8眼。共23眼,占8.52%。脱盲率91.48%。脱残率77.03%。结论:只有精心的术前筛查,规范的把握适应证和娴熟的手术技能,全程严格控制感染,才能保证手术车上短期大量手术的质量。而脱盲率和脱残率的高低,则主要由患者群自身综合因素决定。     

安阳县40岁以上农民白内障筛查及治疗

目的了解安阳县≥40岁自觉视力障碍的农民盲与低视力的患病率及致盲原因。方法安阳县各行政村中,≥40岁自觉视力障碍的农民为筛查对象。采用WHO盲与低视力标准和白内障诊断标准。由眼科医生作眼部检查。对所有视力<0.3的患眼进行主要病因诊断,确诊所有白内障患者,并筛选出需手术治疗者。结果共检查853例,盲目患者23例,患病率2.70%,低视力患者99例,患病率4.27%,致盲的主要眼病依次为白内障、角膜病、青光眼、视网膜病等。共筛查出533例白内障,行白内障手术治疗301人次,脱残率98%,脱盲率99.34%。结论白内障仍是盲和低视力的首要病因,防盲治盲的重点仍是白内障复明手术。     

农村老年性白内障术后低视力原因分析

目的评价分析老年性白内障术后视力恢复不良的原因.方法对1 154眼老年性白内障摘除及人工晶状体植入术后1～3个月随访检查视力及眼前、后段情况,分析其脱盲率、脱残率和未脱残原因.结果本组病例,脱盲率(矫正视力≥0.05)为96.62%,脱残率(矫正视力≥0.3)88.56%.未脱残(矫正视力＜0.3)共132眼,其中因合并眼部其它病变(高度近视黄斑病变、糖尿病视网膜病变、视神经萎缩等)99眼占75%;因手术操作有关所致并发症(后囊破裂,玻璃体脱出、葡萄膜炎、人工晶状体移位等)32眼占25%.结论老年性白内障术后低视力的主要原因是同时合并眼部其它病变,其次是手术严重并发症.不断提高白内障手术的技术水平减少并发症是提高脱残率的重要措施,但是对老年性白内障合并视神经、视网膜多种病变者,术后视力恢复不良应有充分估计,尽管术后可能影响脱残率,但仍应积极手术,尽可能提高患者视力.     

高龄患者白内障术后低视力的临床分析

目的 分析80岁以上高龄白内障患者,行白内障摘除术后非手术原因造成的术后低视力的原因.方法 回顾性分析129例(138只眼)高龄白内障患者的相关临床资料.术前综合因素评估,严格掌握手术适应证和手术禁忌证,12例(14只眼)患者因术前发现无法耐受手术及手术后视力无法提高而放弃手术.术中采取心电监护和持续低流量吸氧,对117例(124只眼)高龄白内障患者施行超声乳化或小切口白内障摘除联合人工晶状体植入术.术后随访4～12(平均7.2月).结果 术后1周最佳矫正视力＜0.05者3例(4只眼2.6%),0.05至＜0.3者23例(27只眼,19.6%),≥0.3者91例(93只眼,77.8%).术前与术后1周最佳矫正视力差异有统计学意义(P＜0.05).手术脱残率为72.3%,脱盲率为92.1%.术后矫正视力低于0.3的26例中,2例黄斑囊样水肿,1例外伤性白内障术后发生视网膜脱离并发症,其余23只眼均有不同程度的眼底病变存在.结论 随着显微手术技术的不断发展,白内障手术并发症已明显减少.白内障术后低视力的原因主要为患者自身眼底病变.     

西藏白内障手术后低视力原因的初步探讨

目的 分析西藏白内障手术后低视力的原因,探讨提高西藏白内障手术效果的方法。方法对82例（82眼）白内障手术后者进行小孔视力、非接触眼压、裂隙灯显微镜、直接检眼镜、B超及散瞳后的90D前置镜眼底检查,分析白内障术后低视力的原因。结果82眼中术后达到脱残标准（矫正视力≥0．3）的36眼,脱残率43．90％;脱盲（矫正视力≥0．05）64眼,脱盲率78．05％。白内障术后低视力的原因按发生率依次为黄斑变性15眼,屈光不正6眼,后发障5眼,无晶状体眼4眼,角膜变性3眼,瞳孔膜闭3眼,青光眼2眼,视网膜脱离2眼,人工晶状体偏位2眼,其他4眼。结论通过白内障手术后眼部紫外线的防护、术后及时的随诊和正规的应用有效的药物、尽可能减少可避免的手术并发症以及防治后发障、提高手术技术等办法可以提高西藏白内障的手术效果。     

白内障超声乳化吸除人工晶状体植入术后盲与低视力研究

目的 探讨白内障超声乳化吸除人工晶状体植入术后盲与低视力的原因,进一步提高白内障手术疗效及降低医疗纠纷的风险.方法 手术3个月后复查时检测视力和矫正视力,并进行详细、全面地眼科检杳,分析总结96例96只眼白内障术后盲与低视力的原因,结果白内障术后盲12例12只眼,一级低视力38例38只眼,二级低视力46例46只眼,导致盲与低视力的原因主要原因,为术前存在的影响视力恢复的眼部疾患,其中术前已经发现72例72只眼,术后才发现8例8只眼,与手术中并发症有关5例5只眼,后发性白内障9例9只眼,其他2例2只眼.结论 随着超声乳化手术技术的提高,术后视力恢复主要取决于玻璃体、视网膜视神经病变,对术前存在这些病变的白内障患者进行复明手术仍有意义,但术前告知病情、与患者良好沟通对降低术后纠纷风险十分重要.     

超声乳化治疗特殊类型白内障技术分析

目的：探讨超声乳化术治疗特殊类型白内障的安全性和有效性。

方法：回顾性分析临床资料,研究超声乳化吸出(联合)人工晶状体植入术治疗青光眼术后白内障、小瞳孔白内障、葡萄膜炎并发白内障和外伤后并发白内障等特殊类型白内障的技术要领。

结果：进行治疗的73例84眼特殊类型白内障患者中,单纯行超声乳化术27例28眼,植入后房型人工晶状体52眼,植入前房型人工晶状体4眼; 术后1mo平均眼压12.72±2.63mmHg,脱盲率99%,脱残率96%; 并发症发生率4%。

结论：特殊类型白内障手术难度大,超声乳化术切口小,可保留晶状体后囊膜和植入人工晶状体,是摘除特殊类型白内障的理想术式。     

西藏朗县(无眼科县)眼病初步调查和白内障手术报告

目的:探讨西藏无眼科医疗服务县朗县眼病患病情况和初次开展白内障手术情况。方法:在包括眼科医生在内的援藏医疗队工作中,记录统计就诊眼病情况和盲与低视力原因,开展白内障等眼科手术。结果:22个工作日内共有首诊患者300余例,依次为白内障、眼睑及结、角膜疾病、屈光不正、鼻泪管阻塞(慢性泪囊炎)和视网膜变性等。盲或低视力的原因依次为白内障、角膜混浊、眼球萎缩、视网膜变性、视神经萎缩和屈光不正等。62眼盲眼中,26眼(41.9%)为白内障所致。完成手术42台,白内障囊外摘除术或加人工晶状体植入27例(29眼),脱盲率93.1%,脱残率69.0%,白内障手术率2000。结论:西藏无眼科和眼科医生县眼病患病情况严重,白内障是致盲的主要原因。派遣医疗队进行1～2mo的眼科医疗工作,开展白内障手术,可在一定程度上减少盲和低视力患者,缓解无眼科县缺医少药的紧张情况。     

白内障超声乳化吸除人工晶状体植入术后患者低视力的影响因素

目的探讨白内障超声乳化吸除人工晶状体植入术后影响患者低视力的相关因素。方法将所在医院符合本次研究各项标准的白内障患者251例(260只眼)的临床资料纳入研究,患者白内障均采用超声乳化吸出术;分析手术并发症、术前致盲疾病发生情况;分析手术并发症、术前致盲疾病、性别、年龄、白内障类型、晶状体核硬度对手术影响,用SPSS18.0统计学进行单因素分析和多因素非条件Logistic归回分析,找出影响白内障超声乳化吸除及人工晶状体植入术后低视力发病独立危险因素。结果单因素分析结果:不同年龄段组术后低视力发生率有显著差异,其中>80岁组为50.00%,70~80岁为33.33%;有术前致盲疾病的患者术后低视力发生率为72.73%,较无术前致盲疾病组低视力发生率(9.25%)高;有手术并发症组手术低视力发生率为66.66%,较无手术并发症组(11.59%)高;晶状体核硬度>Ⅲ级组较≤Ⅲ组低视力发生率高。P均<0.05。多因素回归分析结果:年龄、晶状体核硬度、手术并发症、术前致盲疾病是术后低视力发生独立危险因素。结论术前评估患者有无致盲疾病及晶状体核硬度等能评估术后低视力发生危险程度。应提高术者操作技能,积极预防手术相关并发症,加强高龄患者低视力预防及护理。     

上海市普陀区白内障复明手术效果分析

目的 分析上海市普陀区白内障手术复明情况,探讨其影响复明的因素及发展趋势.方法 对上海市普陀区进行的白内障手术的手术方式、术后视力及影响手术效果的主要病因等情况进行调查,将结果进行统计学分析.结果 4年来共行白内障手术3361例（3939眼）.随着晶状体超声乳化人工晶状体植人手术率的提高,术后脱残率也逐年提高.从2001年12月的66.12%到2004年12月的81.38%,术后视力≥1.0的比率也从5.10%增加到7.36%.白内障手术后疗效差的比率为4.42%～5.32%.影响复明的原因除术中的并发症外,主要是术前合并的眼底疾病.结论 晶状体超声乳化吸出联合人工晶状体植入术是目前首选的治疗方法.它能提高手术质量,减少术后并发症.     

Traditional couching is not an effective alternative procedure for cataract surgery in Mali

INTRODUCTION: In Mali, more cataract patients receive sight-restoring surgery using a traditional "couching" procedure (the lens inside the vitreous body) than by modern cataract surgery. In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, we conducted a population-based survey in a rural district of Mali in 1996. METHOD: A total of 99,800 persons from 160 villages were eligible to be included in the sample. All individuals operated for cataract by a modern procedure were checked for visual acuity and questioned regarding their clinical history, the cost of the surgery and their satisfaction with the surgery immediately following the operation and presently. Each patient was paired with one person operated by a traditional cataract surgical procedure. RESULTS: From a total population of 99,800 we found 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and we paired these with 82 individuals operated by the traditional method and by a local healer. In both groups, males were predominant (74.4% in the modern group and 61.3% in the traditional) and the median age was 65 and 68 years, respectively. Men with a higher social status (defined as administrative or religious authority) were slightly more common among those operated by ICCE (18.9%) than among those operated by the traditional healer (4.4%). Nearly half (47.6%) of the patients operated by couching did not know that a modern alternative existed. The mean cost to the patient of the two procedures was similar; with traditional couching costing on average US$ 42.10 and modern surgery (including transport and drugs) costing US$ 52.40. The traditional healer was often paid partially in kind and the price paid varied according to the patient's ability to pay. The clinical results differed greatly between the two methods. After aphakic correction of eyes operated by ICCE, 5.3% had good vision (33/18), 76.8% had low vision (33/60 and &lt;3/18) and 17.9% were still blind (&lt;3/60). Of eyes operated by traditional couching, none had good vision, 29.1% had low vision and 70.9% were blind. The level of satisfaction was high (89.7%) among persons operated in an ophthalmic center by the modern method, and relatively low (22.6%) among persons operated traditionally. DISCUSSION: In Mali, two types of providers offer two different interventions to treat cataract-blind persons. This study suggests that the couching method used by traditional healers is relatively expensive and ineffective. It is also potentially dangerous although this study did not address this question specifically. It is important that health policy makers and medical authorities do what they can to prevent traditional healers from performing the couching procedure, as well as informing the population about the existence of a more-effective and safer alternative. However, while more effective and safer, the results obtained by ICCE are not excellent either. Further, it is important to improve the quality of ophthalmic services in order to provide cataract patients with the best, most accessible and least expensive services possible.     

白内障术后早期低视力原因分析

目的探讨白内障术后早期低视力的主要原因及处理方法。方法回顾性分析我院2008年6月至2011年8月444例(444眼)白内障术后144眼早期(一周内)视力低于0.3者的临床资料,探讨分析影响术后低视力的原因。结果本组术后视力低于0.3的144眼中,术前原有眼病32眼占22.22%,术中并发症35眼占24.31%,术后并发症77眼占53.47%。结论术前原有眼病和手术并发症是造成白内障术后低视力的主要原因。预防原发眼病,减少手术并发症是降低白内障术后低视力的主要措施。     

Comparison of intracapsular and extracapsular cataract surgery. Histopathologic study of eyes obtained postmortem

We examined 201 consecutive aphakic and pseudophakic eyes postmortem. Of these, 146 eyes had undergone intracapsular cataract extraction (ICCE) and 55 eyes had undergone extracapsular cataract extraction (ECCE), either with the posterior capsule preserved intact (ECCE-CI, 30 eyes) or having had a surgical discission performed (ECCE-D, 25 eyes). Wound-related complications were most numerous in the ICCE group, and this probably reflects the relatively recent development of microsurgical techniques. Posterior vitreous detachment was present in 84% of eyes following ICCE, in 76% of eyes following ECCE-D, and in 40% of eyes following ECCE-CI (P less than 0.001). Peripheral retinal holes were found in 8.2% of ICCE eyes, 8.0% after ECCE-D, and 3.3% of eyes after ECCE-CI. Five (3.4%) of ICCE eyes had associated retinal detachments, while no ECCE eyes had detachments. Macular edema, macular holes, and epiretinal membranes occurred in 2.1%, 1.4%, 12.3% of ICCE eyes; 4.0%, 0.0%, and 8.0% of ECCE-D eyes; and 0.0%, 6.7%, and 6.7% of ECCE-CI eyes, respectively.     

白内障术后盲及低视力的原因和防治方法

目的分析白内障手术后盲及低视力的原因和防治方法。方法收集资料完整的年龄≥20岁白内障超声乳化吸出术连续病例915例（991眼）,术后随访3个月,对盲及低视力的原因和防治方法进行回顾性分析。结果术后1d、1周、1个月和3个月时盲及低视力者依次为170例（183眼）、129例（138眼）、113例（121眼）和105例（113眼）。白内障术后早期（1周内）导致盲及低视力的主要原因是手术并发症,依次为角膜水肿、一过性高眼压、后囊破裂。术后中远期（1—3个月）导致盲及低视力的主要原因是术前原有的眼病,其中眼底病占79．64％,依次为糖尿病性视网膜病变、高度近视、青光眼视神经萎缩等。结论减少手术并发症和术前及术后治疗术前原有的眼病,是防治白内障术后盲及低视力的主要方法。     

白内障的两种手术方法效果比较

目的 探讨和分析白内障囊外摘除(ECCE)和超声乳化吸除术(PHACO)的白内障复明手术的手术效果.方法 2000年3月至2008年12月对408例(408只眼)行白内障手术.其中ECCE组92例(92只眼),PHACO组316例(316只眼).比较两组手术效果和手术并发症,将结果进行统计学分析.结果 ECCE组脱盲率为88.04%(81只眼),脱残率为56.52%(52只眼);PHACO组脱盲率为93.35%(295只眼),脱残率为76.27%(241只眼).两组比较差异有统计学意义(X~2=6.31,P<0.05)结论白内障超声乳化吸除联合人工晶状体植入术后可获得良好的复明效果.     

青光眼术后硬核白内障改良小切口囊外摘出术

目的:观察青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术的临床疗效。方法:对65例(69眼)小梁切除术后硬核(Ⅳ/Ⅴ)白内障,行颞侧或颞上方小切口白内障囊外摘出人工晶状体植入术,术后随访6~24mo,观察术后视力、眼压和并发症。结果:本组65例(69眼)术后视力有不同程度提高,其中视力≥0.5者50眼(72%),术后平均眼压为(15.22±3.92)mmHg(1mmHg=0.133kPa),手术并发症为术后早期角膜水肿及葡萄膜炎性反应。结论:青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术操作简单,术后眼压控制好,并发症少,视力恢复快,是治疗青光眼术后硬核白内障的有效方法。     

针拨术后小切口白内障摘除人工晶状体睫状沟悬吊术

目的:探讨在针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术的有效性和安全性。方法:对20例(21眼)针拨白内障术后患者进行白内障取出人工晶状体睫状沟悬吊固定术。随访3～12mo,观察术后视力、眼压、术中术后并发症及术后人工晶状体的位置。结果:术后第1d裸眼视力:0.4～0.5者7眼,0.6～0.8者14眼。术后7d进行显然验光,平均为(-0.87±0.43)D,与手术前设计保留(-0.50～-1.00)D接近。术后3mo平均度数为(-0.68±0.33)D。手术后7d眼压平均为17.11±3.13mmHg,术后3mo平均眼压为14.17±2.03mmHg。手术中入、出针时,发生少量出血2眼;术后角膜切口周围轻度水肿5眼,3～5d基本消退。结膜下出血4例,5～7d后自行吸收。随访观察3～12mo,21眼手术后人工晶状体位置均保持良好的居中性。未发现角膜内皮功能失代偿、青光眼、视网膜脱离等情况。结论:针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术是安全、有效的。     

Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma in Sturge-Weber syndrome

AIM: To investigate the prevalence and risk factors of age-related cataract (ARC), ARC surgery procedures, and postoperative vision results among adults over 50 years old in the Binhu District of Wuxi City, China. METHODS: Thirty basic sampling units were analyzed via a cluster random sampling method. Detailed medical histories were collected and eye examinations were performed. Cataract prevalence and surgical procedures were quantified. RESULTS: Among the 6150 participants, 1421 cataract cases were diagnosed and prevalence was 23.1%. The prevalence of cortical, nuclear, and posterior subcapsular cataracts increased with age (P<0.001). Cataract prevalence was significantly higher among elderly, female, or illiterate individuals and people with hypertension, diabetes, and a history of smoking and drinking (all P<0.05). As participant age increased and education level decreased, the frequency of cataract blindness surgeries gradually decreased, but without statistical significance within groups (P>0.05). The odds ratio of cataract patients who had or did not have cataract surgery was 3.15 (87/28) and the frequency of cataract blindness surgery was 75.7% (87/115). Poor visual outcomes was in 107 eyes (40.7%) after cataract surgery. Poor vision was mostly caused by uncorrected reflective errors (30.9%) and ocular comorbidities (41.1%). The prevalence of cataract surgery complications was 5.7% (15/263). Surgical complications and posterior capsular opacification were avoidable factors facilitating poor vision. CONCLUSION: ARC, especially in females and illiterate individuals, presents a public health problem in this district. Poor visual outcomes after cataract surgery are frequent. High-quality cataract surgeries and treatment of ocular comorbidities are vital.     

儿童先天性白内障摘除和人工晶体植入

目的 评价儿童白内障摘除联合人工晶体植入术后的临床疗效。方法 对64例（104只眼）1．5-14岁儿童先天性白内障患儿行白内障囊外摘除联合局限性前段玻璃体切除和人工晶体垂袋内植入术。对术后平均随访22个月的并发症、视力变化等进行分析。结果 术后脱盲率为86．4％．脱残率为62．7％。41．8％的眼获得了双眼视，30．6％的患儿有立体视。3只眼发生后发性白内障．5只眼有一定程度的人工晶体夹持。结论 白内障摘除联合前段玻璃体切除和人工晶体植入治疗儿童白内障，术中和术后并发症少，绝大多数患儿术后视力能够显著提高并建立了良好的视功能。影响术后视功能的因素应进一步研究。