The Effect of Corneal Higher Order Aberrations on Postoperative Residual Astigmatism after Toric IOL Implantation

Background: To demonstrate the effect of preoperative higher order aberrations (HOAs) on postoperative residual astigmatism in toric intraocular lens (IOL) implantation.

Methods: A retrospective, controlled, comparative study that involved patients who underwent toric IOL implantation. Patients were divided into two groups according to the difference between the estimated residual astigmatism and actual postoperative astigmatism [difference ≤0.5 diopters (D), Group A; difference >0.5 D, Group B]. Corneal astigmatisms with axis, and various aberration values were compared between the two groups.

Results: Total RMS and HOA RMS values in Group B were significantly higher than those in Group A (p < .001, = 0.003). The vertical coma value, and its absolute value, in Group B were significantly higher than those in Group A (p < .001, = 0.002). The total RMS and absolute value of the vertical coma showed a positive linear correlation with the degree of residual postoperative astigmatism (R-square = 0.139, 0.131; p = .027, 0.036).

Conclusions: If the residual astigmatism after insertion of the toric IOL was greater than expected, corneal aberrations, shown by total RMS and HOA RMS values before surgery, especially of the vertical coma, tended to be high.     

两例 SMILE 术中特殊情况更改 SBK 手术的疗效观察

目的：通过对同一患者双眼不同手术方式的自身对比，了解飞秒扫描后改SBK手术的疗效差异，为不同患者屈光手术方式的选择提供临床指导依据。方法回顾分析2例右眼行飞秒激光小切口透镜取出术（ SMILE），左眼SMILE术中负压环脱失和激光扫描不良透镜分离困难而改行机械刀制瓣准分子激光手术（ SBK）的患者，比较术后视力、等效球镜（ SE）、对比敏感度（ CSF）、波前像差（ HAOS）以及泪膜破裂时间（ BUT）、泪液分泌功能试验（ Schimer I）和SPEED、OSDI干眼症状问卷调查分析差异。结果（1）术后个月，均能达到最佳矫正视力（BSCVA），等效球镜均在±0．75 D以内，双眼比较无显著性差异。（2）CSF的比较，左右眼无显著性差异，略低于正常水平。（3）术后3个月，BUT和Schimer检查中，双眼无显著性差异。（4）HAOS比较中，总像差RMS和高阶像差这两项， SMILE眼低于SBK眼；球差（S）的比较，SMILE眼高于SBK眼。（5）SPEED和OSDI问卷评分双眼无显著差异。结论 SMILE失败眼改SBK后视觉质量与SMILE眼无显著差异，其视觉质量、疗效不受影响。     

Particle engineering/different film approaches for earlier absorption of meloxicam

Meloxicam (Mel) is a non-steroidal potent anti-inflammatory drug with effective analgesic effect for various situations; e.g. postoperative pain. The early systemic exposure to Mel and hence the rapid onset of pharmacological action is limited by its poor water solubility; a situation which may be more pronounced during acute pain episode because of reduced gastric motility that affects disintegration and dissolution of solid dosage forms. To overcome delayed absorption of Mel, improvement in the dissolution behavior of Mel is essential. Firstly, Mel spherical crystalline agglomerates (SCA) were prepared. Secondly, selected Mel SCA were integrated into intraoral fast disintegrating (OF) and edible (EF) films, they possess larger surface area that leads to rapid disintegration and release of the drug into the oral cavity within seconds and hence a rapid onset of action could be achieved. Stability study of formulations resulting in faster and higher extent of dissolution and suitable mechanical properties (G3 and G12) revealed their physical and chemical stability after three months of storage under different conditions. Both G3 and G12 successfully offered rapid absorption rate and accordingly an earlier systemic exposure to Mel compared to Mobic tablets as revealed by significantly earlier T _max and higher AUC_0–0.5h and AUC_0–4h. T _max following G3 fast disintegrating film administration was comparable to that reported following Mel parenteral administration but avoiding patient inconvenience. Both films may be suitable alternative to conventional oral and intramuscular Mel especially when earlier onset of action is required (in acute conditions).     

调整Kappa角及光学切削直径对准分子激光原位角膜磨镶术后的影响

目的　评价调整光学切削直径及Kappa角后对准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）后效果的影响。方法　选取2017年1月至12月在我院行LASIK手术的高度近视患者313例（626眼），根据切削直径分成两组，试验组157例314眼，切削直径设定为6.0 mm，对照组156例312眼，切削直径设定为6.5 mm。试验组患者激光切削前修正Kappa角，对照组不做修正。患者术前进行裸眼视力、主视眼确定、验光、眼压、暗室下瞳孔直径、泪液分泌试验、裂隙灯、散瞳验光、眼底检查、pentacam测量角膜厚度、角膜地形图测量角膜前后表面及Kappa角等检查。术后1 d、1周、1个月随访，并检查裸眼视力、角膜厚度、波前像差及夜间视力、光晕、眩光等情况。比较两组患者角膜厚度变化、手术所用时间以及两组患者术后的高阶像差的差异。结果　试验组与对照组患者年龄分别为18～44（24.19±5.33）岁、18～42（25.08±4.91）岁，屈光度分别为（-7.47±1.04）D、（-7.61±1.12）D。两组年龄、屈光度比较差异均无统计学意义（均为P>0.05）。试验组与对照组患者术前Kappa角分别为，X轴:（210±40）μm、（200±30）μm，Y轴:（190±30）μm、（220±40）μm，差异无统计学意义（P=0.210）。两组手术前后的角膜厚度及术后角膜基质床的厚度差异均无统计学意义（均为P>0.05）。试验组与对照组的手术时间分别为（15.56±1.89）s和（20.83±3.03）s，差异有统计学意义（P=0.000）。试验组的总高阶像差和垂直慧差的变化均明显低于对照组（均为 P<0.01），但两组间的水平慧差差异无统计学意义（P>0.05），对照组的球差低于试验组（P<0.01）。结论　LASIK手术中科学合理地调整Kappa角可有助于提高患者术后的视觉质量。