白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂

目的:评价白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂的疗效.方法:回顾性分析.选取我院收治的非黄斑裂孔超高度近视性黄斑劈裂患者32例32眼,屈光度为-12.00~-20.00(平均-15.78±2.16)D.平均最佳矫正视力(LogMAR) 4.1±0.4.所有患者均行白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术,内界膜采用吲哚菁绿染色并顺利剥除,术毕进行气体填充.术后随访1~9(平均4.5)mo,观察术后视力及黄斑劈裂愈合效果.结果:共30例30眼(94%)患者劈裂腔消失,视力较术前提高,视物变形改善.手术前后最佳矫正视力比较,差异具有统计学意义(t=-7.91,P<0.05).结论:白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术是治疗非黄斑裂孔超高度近视性黄斑劈裂安全有效的手术方法,可有效保存视功能,不同程度提高患者的视力.     

Combined 23-gauge microincisonal vitrectomy surgery and phacoemulsification with AcrySof toric intraocular lens implantation: a comparative study

Aim

To compare AcrySof toric intraocular lens (IOL) and non-toric IOL in patients who had combined 23-gauge microincisional vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with pre-existing corneal astigmatism.

Methods

This is a prospective comparative study comprised of 30 patients (30 eyes) who had combined 23-gauge MIVS and phacoemulsification for vitreoretinal diseases and cataract with pre-existing regular corneal astigmatism greater than 1 diopters (D). In all, 15 eyes had AcrySof toric IOL (Alcon Laboratories) and 15 eyes had non-toric IOL (Akreos AO MI60; Bausch & Lomb) implantation. Main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, surgically induced astigmatism (SIA), and IOL misalignment during 6 months.

Results

The mean UCVA of the toric IOL group was better than the non-toric IOL group at postoperative months 1, 3, and 6 (P<0.001, respectively). The mean absolute residual refractive cylinder of the toric IOL group at postoperative week 1, and months 1, 3, and 6 was less than the non-toric IOL group (P=0.008, <0.001, <0.001, and <0.001, respectively). There was no difference in the mean SIA between the two groups (P>0.05, respectively). The mean toric IOL axis rotation was 3.52±2.75°, which was within 5° in 66.7% of the toric IOL group and within 10° in 100%.

Conclusions

Combined 23-gauge MIVS and phacoemulsification with AcrySof toric IOL implantation is an effective method of correcting vitreoretinal diseases and cataract and pre-existing corneal astigmatism, and the toric IOL showed good rotational stability, even in vitrectomized eyes for 6 months.     

影响眼前后节联合手术屈光误差的相关因素分析

白内障超声乳化吸除、IOL植入联合玻璃体切除术是一种既可矫正屈光亦可治疗眼底疾病的前后节联合手术,该术式具有术中更清晰的视野、术后早期视力提高及避免二次手术等多种优势,因此逐渐被用于治疗合并白内障的眼底病患者。与分期手术相比,前后节联合手术设备要求高、技术难度大、并发症更为多样,其中术后屈光误差(refractive error, RE)常常见诸报道。本文就近年来联合手术影响RE的相关因素、RE形成机制及控制措施进行综述,为手术适应证选择、并发症预防以及获得更满意的术后视功能提供参考。     

Efficacy of phacovitrectomy combined with internal limiting membrane peeling for macular diseases

 Purpose: To observe the efficacy of vitrectomy with internal limiting membrane (ILM) peeling combined with phacoemulsification with intraocular lens (IOL) implantation in the treatment of cataract with co-existing macular diseases.    Methods: A total of 28 cataract patients (28 eyes) with co-existing macular diseases were admitted to Aier Eye Hospital between May 2008 and May 2011. The clinical characteristics were analyzed in this study. Subjects included 6 men and 22 women, aged from 56 to 77 years (mean 64 years), with duration of disease ranging from 2 to 36 months (mean 9.3 months). All patients underwent phacoemulsification with implantation of a hydrophobic acrylic IOL into the capsular bag and pars plana vitrectomy with ILM peeling. Results: Postoperatively, patients underwent 3- to 18-months of follow-up (mean 7.2 months). Only one eye had macular hole failing to close. Normal macular structure was restored in the other 27 eyes. The presenting visual acuity and best corrected visual acuity (BCVA) did not differ significantly (t=-1.724, P=0.096), with the BCVA in 27 eyes (96.4%) improving by 2 lines or more. The improvement in minimum angle of resolution (MAR) was > 0.3 in 21 eyes, ≥ 0.1 in 6 eyes and < 0.1 in 1 eye. The mean spherical equivalent (SE) was -4.67±5.98D preoperatively and -0.38±0.69D postoperatively (t=4.157,P＜0.005). Conclusion: Combined phacovitrectomy surgery is a reliable and safe procedure in the treatment of cataract complicated by macular disease.      

Secondary Angle-Closure Glaucoma Due to Posterior Synechiae of Iris Following Combined Phacoemulsification and 23-Gauge Transconjunctival Vitrectomy

Purpose: To describe the clinical characteristics of eyes with secondary angle-closure glaucoma following combined phacovitrectomy. Methods: Retrospective case series. Results: Nine eyes developed angle-closure glaucoma due to iris posterior synechiae with an incidence rate of 1.82% (95% CI: 0.64 – 3%) among 493 eyes following phacovitrectomy. PDR with TRD was the most common surgical indication. Single piece IOL insertion and silicone oil were present in all cases. Fibrin in the anterior chamber was found in six eyes postoperatively. Mean degree of iris bombe was 310±79.37° at 3.55±1.87 weeks with a mean IOP of 32.56±5.89 mm of Hg. Systemic diabetes and grade of cataract were the only significant risk factors (r² =1; p= 0.016 and 0.049, respectively). Nd:YAG laser PI relieved the angle-closure attack in all cases. Conclusion: Systemic diabetes and advanced grade of cataract are significant risk factors for secondary angle-closure glaucoma following combined phacovitrectomy.     

Metabolomics and biomarkers in ocular matrix: beyond ocular diseases

AIM: To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract.METHODS: A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed.RESULTS: Mean logMAR BCVA improved and CFT decreased significantly (P<0.001) until 6mo after surgery. Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA (r=0.716, P<0.001 at 1mo, r=0.417, P=0.014 at 3mo, r=0.359, P=0.037 at 6mo, and r=0.369, P=0.032 at 12mo post-op respectively), but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA. There was a positive correlation between CFT and logMAR BCVA at 1mo (r=0.346, P=0.045), 6mo (r=0.347, P=0.045), and 12mo (r=0.342, P=0.048) post-operatively. The intra- and postoperative complications were relatively mild, and the incidences were generally low.CONCLUSION: For severe iERM patients with significant visual symptoms, combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT. Early surgery in selected patients may help preserving better visual function.     

Microincision cataract surgery combined with vitrectomy: a case series

Aim

The objective of this study was to present the results of combined phacovitrectomy using 1.8 mm microincision cataract surgery (MICS) with special emphasis on the anterior segment complications in this group.

Methods

Retrospective, single-centre case series involving consecutive patients undergoing phacovitrectomy in a single centre in the United Kingdom during a 6-month period.

Results

A total of 52 eyes underwent combined MICS and pars plana vitrectomy. Intraoperative complications included posterior capsule rupture (n=2), minor iris trauma during phacoemulsification (n=1), iatrogenic retinal tears (n=2), and entry site break (n=1). Postoperatively two cases had significant inflammation, one of which resulted in 360° posterior synaechiea, iris bombe, and raised intraocular pressure. Other complications included mild posterior synaechiae (n=2), posterior capsular opacification (n=3), cystoid macular oedema (n=1), and hyphaema (n=1), which spontaneously resolved. There were no cases of intraocular lens decentration. Two patients who underwent surgery for retinal detachment repair subsequently redetached. Among those having surgery for macular hole, non-closure was seen in one patient and one patient developed a retinal detachment.

Conclusion

In conclusion, sub-2 mm MICS is a safe and effective technique in dealing with vitreoretinal disorders necessitating cataract surgery at the same time.     

Intraocular Lens Power Estimation in Combined Phacoemulsification and Pars Plana Vitrectomy in Eyes with Epiretinal Membranes: A Case-Control Study

Purpose

To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone.

Materials and Methods

Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction.

Results

In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305±0.717 diopters (D) and -0.356±0.639 D, respectively, compared to 0.215±0.541 and 0.077±0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599).

Conclusion

Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.