Phacoemulsification in eyes with corneal opacities after deep anterior lamellar keratoplasty

To evaluate the maneuverability and efficacy of phacoemulsification and intraocular lens (IOL) implantation in eyes with corneal opacities after deep anterior lamellar keratoplasty (DALK), twelve eyes of 12 patients with mild to moderate corneal opacities after DALK and coexisting cataracts were analyzed retrospectively. Phacoemulsification and IOL implantation assisted with anterior capsule staining, as well as non-invasive optical fiber illumination, were performed on all eyes. No intraoperative or postoperative complications were noted. Mean corrected distance visual acuity (logMAR) improved from 1.24±0.17 to 0.73±0.22. Post-phaco intraocular pressure was maintained between 13 to 20 mm Hg in all cases throughout the follow-up period. Mean endothelial cell density decreased from 2258.42±205.94 to 1906.25±174.23 cells/mm2. Phacoemulsification and IOL implantation are safe and valid in eyes with mild to moderate corneal opacities after DALK and coexisting cataracts when assisted with anterior capsule staining and non-invasive optical fiber illumination.     

Safety & efficacy of single subconjunctival triamcinolone 5 mg depot vs topical loteprednol post cataract surgery: less drop cataract surgery

AIM: To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide (SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. METHODS: A total of 400 patients were randomized into 2 groups; Group A (200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine (0.5%) with ofloxacin (0.3%) combination for 3wk. Group B (200 patients) received tapering topical loteprednol etabonate (0.5%) along with ofloxacin (0.3%) and ketorolac tromethamine (0.5%) for 3wk. Outcomes evaluated were intraocular pressure (IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12wk. RESULTS: Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A (P=0.82) and Group B (P=0.61) and postoperative IOP values in between both groups (P=0.14) at 1wk. Incidence of cells/flare postoperative was statistically not significant (P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. CONCLUSION: SCTA appears to be an effective alternative to prolong postoperative topical steroid use.     

Alpha角对多焦点人工晶状体植入术后视觉质量影响

研究不同Alpha角对多焦点人工晶状体（MIOL）植入术后视觉质量的影响,指导功能性IOL的应用。方法：前瞻性临床研究。选取2016年12至2018年10月就诊于潍坊眼科医院行白内障超声乳化吸除联合MIOL植入术患者56例（74眼）,根据Alpha角大小（角膜上视轴与光轴的距离α）分为3组： A组12眼（0 mm<α≤0.2 mm）,B组38眼（0.2 mm<α≤0.4 mm）,C组24眼（α>0.4 mm）。术后随访3个月,记录裸眼远、中、近视力以及调制传递函数、眩光、光晕等情况。数据采用卡方检验、方差分析进行统计。结果：B组和C组光晕和眩光发生率高于A组,差异有统计学意义（χ2 =38.372,P=0.01）; 3组间术后3个月远、中、近视力比较差异无统计学意义（均P>0.05）;3组间MTF值在0～30 c/d范围差异无统计学意义（P>0.05）;夜间远视、重影、混合焦点、星芒的发生率差异均无统计学意义（均 P>0.05）。结论：当Alpha角大于0.4 mm时,植入MIOL会增加眩光和光晕的发生,所以Alpha角>0.4 需谨慎考虑使用MIOL。     

超声乳化联合IOL植入术围手术期瞳孔直径和反应的变化

探究晶状体超声乳化联合人工晶状体（IOL）植入术围手术期瞳孔直径、反应的变化。方法：前瞻性临床研究。收集于2016年1-9月上海交通大学医学院附属第九人民医院眼科行超声乳化联合IOL植入术的连续白内障和高度近视透明晶状体置换患者。采用动态瞳孔测量仪（Metro-vision MONCV3）测量术前、术后1周、术后1个月在4种光照度下（0、1、10和100 cd/m2 ）的瞳孔直径,并检测瞳孔反应（如瞳孔初始直径、收缩幅度、收缩潜伏期、收缩持续时间、收缩速度、扩张潜伏期、扩张持续时间和扩张速度等）。采用重复测量方差分析、Pearson相关分析及Spearman相关分析对数据进行分析。结果：共纳入患者53例（53眼）。在4种光照度下,术前瞳孔直径随年龄增加而下降（r0=-0.467,P0<0.001;r1=-0.383,P1=0.005;r10=-0.374,P10=0.006;r100=-0.312,P100=0.023）。 4种光照强度下瞳孔直径手术前后总体差异有统计学意义（F0=206.9,P0<0.001;F1=106.8,P1<0.001; F10=41.7,P10<0.001;F100=36.7,P100<0.001）,与术前相比,4种光照强度下瞳孔直径术后1周、1个月均下降（均P<0.001）。手术前后瞳孔反应的初始直径、收缩幅度、收缩和扩张速度总体差异有统计学意义（F初始直径=99.5,P初始直径<0.001;F收缩幅度=36.2,P收缩幅度<0.001;F收缩速度=51.9,P收缩速度<0.001;F扩张速度=23.8,P扩张速度<0.001）,与术前相比,术后1周、1个月初始直径、收缩幅度、收缩和扩张速度均下降（均P<0.001）。结论：超声乳化联合IOL植入术后1个月内可引起瞳孔缩小,瞳孔反应的收缩、扩张速度变慢,为IOL设计中确定有效光学区范围提供依据。     

Central retinal thickness changes and visual outcomes following uncomplicated small-incision phacoemulsification cataract surgery in diabetic without retinopathy patients and nondiabetic patients

ObjectiveTo compare the visual outcomes and central retinal thickness (CRT) 1 week, 2 weeks, and 4 weeks after surgery in diabetic patients without retinopathy and nondiabetic patients. The relationships between glycated hemoglobin (HbA1c) and visual outcomes and changes in CRT were also evaluated.MethodsPatients who underwent uncomplicated phacoemulsification cataract surgery were enrolled from May 2009 to December 2010, excluding those with preoperative retinal diseases. CRT and best-corrected visual acuity were obtained preoperatively and at 1 week, 2 weeks, and 4 weeks.ResultsThere were 101 eyes in the nondiabetic group and 58 eyes in the diabetic without retinopathy group. There was no difference in preoperative CRT between the two groups. A significant increase in thickness was observed at postoperative Week 4 (p < 0.001) in both groups. However, there were no significant differences in CRT and best-corrected visual acuity before surgery and in all postoperative periods between the groups. In the diabetic without retinopathy group, CRT and visual outcomes were not statistically related to HbA1c level at any time point.ConclusionThere were no significant differences in improvements in postphacoemulsification CRT and visual outcomes between the groups. In the diabetic without retinopathy group, the visual outcomes and CRT were not related to the level of HbA1c. Therefore, as long as there is no diabetic retinopathy, the early postoperative visual recovery and central retinal thickness may not be different from patients without diabetes mellitus.     

Pharmacological approaches to restoring lens transparency: Real world applications

Cataract is the most common cause of blindness and a major cause of visual impairment worldwide. As the world’s population ages, cataract-induced visual impairment is of increasing prevalence, and treatment is limited to those with access to surgical care. While cataracts are mainly a disease of the elderly, infantile cataracts lead to lifelong visual impairment if untreated. Even in those with surgical treatment early in life, visual prognosis is often guarded. Consequently, there is an increasing impetus for alternative therapeutic modalities. Makley and Zhao utilize two different experimental approaches to identify novel pharmacological substances able to improve lens transparency by reducing aggregation of crystalline proteins. These data support an alternative to surgical correction that may be applied to adult patients without access to surgical care as well as address the unique challenges of infantile cataracts.     

白内障超声乳化手术并发症原因分析及防治

目的:探讨白内障超声乳化联合人工晶体植入术中及术后并发症的原因以及应对施.方法:本文对我科2016年1月~12月420例(456眼)白内障行超声乳化联合人工晶体植入手术患者的临床资料进行回顾性研究,并对出现并发症的47眼进行分类、分析其发生原因及提出相关防治方法.结果:出现术中晶状体后囊膜破裂10眼(2.19%),晶状体碎核入玻璃体腔2眼(0.44%),术后角膜内皮水肿28眼(6.14%),短暂性高眼压15眼(3.29%),对症处理后均明显改善.结论:晶状体后囊膜破裂、角膜水肿和短暂性高眼压是白内障超声乳化联合人工晶体植入手术的主要并发症,我们在临床上对于超乳手术患者并发症的预防和治疗应给予高度的重视.     

囊袋收缩综合征的手术治疗

目的探讨白内障超声乳化术后囊袋收缩综合征的手术治疗效果。方法对12例（12只眼）白内障超声乳化术后并发囊袋收缩综合征进行囊袋松解术，观察术后视力及并发症情况。结果12只眼术后视力均有提高，10只眼视力〉10．4，2只眼视力0．1～0．3，无明显并发症发生。结论囊袋松解术是治疗重度囊袋收缩综合征的有效方法。     

Viscoless Manual Small Incision Cataract Surgery with Trabeculectomy

Purpose: To compare the efficacy of combined manual small incision cataract and glaucoma surgery with anterior chamber maintainer (ACM) alone versus that with intraoperative viscoelastics. Methods: Hospital electronic medical records of patients who underwent small incision cataract and trabeculectomy and intraocular lens implantation without Mitomycin-C from 2014 to 2016 were identified from the hospital operation theater database for this retrospective, hospital-based comparative study. All MSICS surgeries were performed by a single surgeon under peribulbar block. Data retrieved from all patients undergoing surgery with viscoelastic (group 2) or under AC maintainer without viscoelastic (group 1) included preoperative visual acuity, preoperative treated intraocular pressure, number of anti-glaucoma medications before surgery, total surgical time, intraoperative complications, postoperative best-corrected visual acuity and IOP at one week and one month, need for additional procedures, and corneal clarity. Differences in surgical time and postoperative course in both groups were compared. Results: Of 268 manual combined cataract and glaucoma surgeries done from 2014–2016, we identified 147 eyes of 130 age-matched patients, which included 51 PACG, 50 POAG, 12 NTG, and 24 PXG eyes with a mean age of 66 ±11.2 years and 64± 10.8 years in group 2 (n=74) and group 1 (n=73), respectively; p=0.9. The surgical time was significantly lower in group 1 (16±4.8 minutes compared to 44±14.6 minutes for group 2; p<0.001) with transient edema seen <1 week after surgery in 24 eyes of group 2 and seven eyes of group 1; p=0.02. The postoperative IOP at all postoperative visits dropped to >50% in both groups with 11 eyes (PXG n=6, PACG n=5) requiring medications for rise in intraocular pressure at a median time of 1.2 months (r=0.2–3 months). The final visual acuity improved >4 snellen lines in all cases with two patients with advanced damage having 1 line improvement in Snellen acuity at final follow-up. Conclusion: The ACM can help completely avoid the use of viscoelastic during surgery, which can be an effective technique for MSICS with trabeculectomy in low resource stings. Training for such procedures should be incorporated into residency training programs.