Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology

PurposeTo review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.MethodsA literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.ResultsThe agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.ConclusionsThe current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.     

西藏地区藏族白内障患者两种手术方式的对比

目的：：比较分析西藏高原地区白内障患者行小切口非超声乳化与超声乳化两种不同手术方式的术后视力、术中及术后并发症情况。方法：收集2014-10/2015-01西藏自治区藏医院眼科收治的白内障患者413例413眼,随机分成白内障超声乳化吸除联合人工晶状体植入术(超乳组)200例200眼,小切口非超声乳化白内障摘除联合人工晶状体植入术(小切口组)213例213眼。分别比较两组术后1、5 d裸眼视力、术中及术后并发症情况。结果：术后1、5d两组患者裸眼视力≥0.5分别为小切口组150眼(70.4%),196眼(92.0%),超声乳化组156眼(78.0%),185眼(92.5%);与小切口组相比,超乳组术后1d与术前视力差值有统计学意义(P<0.05);小切口组和超乳组术后5d与术后1d裸眼视力差值比较差别无统计学意义(P=0.33)。核硬度Ⅰ级白内障患者,术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异( P>0.05);核硬度Ⅱ级白内障患者,术后超乳组视力≥0.5患眼数明显多于小切口组(P<0.01);核硬度Ⅲ级白内障患者,术后超乳组视力≥0.5患眼数明显多于小切口组( P<0.01);核硬度Ⅳ级白内障患者,术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异(P>0.05);核硬度Ⅴ级白内障患者,术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异(P>0.05)。小切口组与超乳组患者角膜水肿者比较无统计学差异(P>0.05)。小切口组与超乳组患者虹膜反应比较无统计学差异(P>0.05)。结论：本研究表明老年性白内障仍是西藏地区白内障患病的主要病因之一,目前手术治疗白内障仍是最有效的治疗方式。超声乳化组核硬Ⅱ、Ⅲ级的白内障患者术后1d 视力提高较小切口非超声乳化白内障摘除术组显著,而核硬度Ⅰ、Ⅳ、Ⅴ级无统计学差别。两组在术后5d视力、角膜水肿、虹膜反应等并发症无明显差异,因此,在没有条件进行超声乳化手术的情况下,小切口非超声乳化手术同样可以达到相似的治疗效果。     

角膜形态学评价的方式及其在LASIK中作用

准分子激光手术安全性问题随着准分子激光原位角膜磨镶术（LASIK）的发展受到越来越多的重视,所以在选择手术适应证方面应该慎重。在术前筛查患者时,角膜形态学检查是各种术前检查最具临床意义的检查之一。角膜形态学检查历经几代检查仪器的更新进步,形态学变化也得以应用于LASIK术后观察角膜愈合情况、监测各种并发症的发生等。其中OrbscanII及Pentacam系统为目前最具优势且被广泛应用的角膜形态学检查,在LASIK术前术后具有极其重要的临床意义。     

糖尿病视网膜病变相关基因多态性的研究进展

糖尿病视网膜病变是目前国际上最主要的致盲性眼病之一,患病率日渐升高.其发生和发展与血糖水平、糖尿病病程、环境及遗传等多种因素有关.近些年来,随着基因多态性与糖尿病视网膜病变关系的研究不断深入和进展,已经筛选出了可能与之相关的数十 种基因,其中几种基因多态性已经被证实为糖尿病视网膜病变发生的独立危险因素.现将与糖尿病视网膜病变密切相关的基因多态性研究进展作一综述.     

LASIK术后角膜后表面的改变及其稳定性的影响因素

目的研究准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后角膜后表面(包括中央和周边区)改变,探索影响其稳定性的因素,为获得理想的术后效果提供新的术前筛选标准。方法本研究入选患者共59例(117眼),屈光不正的等效球镜范围为-2.75～-11.75D,术中和术后无并发症,于术前和术后3个月分别行Pentacam检查。测量角膜后表面各参数的改变,包括中央6mm区角膜后表面最适球面;周边6mm、7mm、8mm、9mm、10mm环区平均角膜后表面曲率半径。结果术后3个月中央6mm区角膜后表面最适球面曲率半径为6.4087±0.3778mm,与术前(6.3037±0.2479)mm相比显著增加(P<0.001),周边6mm和7mm环区平均角膜后表面曲率半径减小,术前为(6.3450±0.2680)mm、(6.4374±0.2563)mm,术后为(6.3190±0.2473)mm、(6.4170±0.2514)mm,差异均有统计学意义(均为P<0.05)。利用(角膜瓣厚度+切削厚度)/术前角膜最薄点厚度分组,百分比>45%组术后3个月中央6mm区角膜后表面BFS曲率半径较术前显著增加(P<0.001),而周边6mm环区平均曲率半径明显减小(P=0.017);百分比<45%组各参数都无明显改变。结论 LASIK术后,中央6mm区角膜后表面变平,周边6mm和7mm环区变凸。"(角膜瓣厚度+切削厚度)/术前角膜最薄点厚度"百分比小于45%者角膜后表面稳定性较好,该百分比可能作为提高术后可预测性的新指标。     

孔源性视网膜脱离巩膜扣带术后持续性视网膜下液的研究进展

孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)巩膜扣带术(scleral buckle,SB)后部分患者会出现视网膜下积液延迟吸收的情况,黄斑区受累者可能对视功能的影响更显著。本文就近年来RRD术后持续性视网膜下液(persistent subretinal fluid,PSF)的流行病学、检查方法、致病因素及发病机制、治疗及预防等方面的研究进展进行综述。