准分子激光双面式原位与上皮瓣下角膜磨镶术治疗高度近视评价

目的 比较准分子激光双面式切削原位角膜磨镶术(Both-sideLasik,BSL)和准分子激光角膜上皮瓣下磨镶术(LASEK)治疗薄角膜高度近视的临床效果,两种手术方法的优缺点.方法 应用BSL和LASEK治疗近视度>-8.00D,角膜厚度471～546μm的患者.BSL组45例51只眼,近视球镜度数为-8.25～-13.25D,平均-9.71D.LASEK组39例67只眼,近视球镜度数-8.25～-12.75D,平均-926D.分别于术后10d、1、3、6、12个月检查裸眼视力,矫正视力,屈光度和角膜雾样混浊(Haze)等,并进行比较.结果 BSL组术后反应轻,裸眼视力恢复快,术后10d、1、3、6、12个月裸眼视力达到术前最佳矫正视力的比例,BSL组分别为为72.55%、80.39%、84.31%1.31%、78.43%和68.63%,LASEK组分别为47.76%、65.67%、71.64%、70.15%和61.19%,未出现矫正视力下降2行及以上者.两组屈光度均由手术早期的过矫逐渐转变为后期的欠矫,LASEK组发生Haze的比例明显高于BSL组,差异有统计学意义(P<0.05),但多为0.5～1级Haze,术中、术后无严重并发症.结论 准分子激光双面式切削原位角膜磨镶术治疗薄角膜高度近视安全、有效,与LASEK相比,其角膜雾样混浊发生率更低,且程度轻,视力恢复更快.     

角膜地形图在筛查圆锥角膜中的应用

目的探讨角膜地形图在筛查圆锥角膜中的应用,为早期诊断圆锥角膜提供可靠依据。方法采用计算机辅助系统角膜地形图对17～55岁5813例欲接受角膜屈光手术的患者进行常规检查。检查内容(1)角膜中央屈光力;(2)角膜中心下方3mm处屈光力与角膜中心上方3mm处屈光力的差值(IS);(3)同一个体双眼角膜中心屈光力差值。结果筛查出进展期圆锥角膜患者4例(4眼),亚临床期圆锥角膜患者9例(11眼),可疑圆锥角膜患者12例(24眼)。结论角膜地形图检测是诊断圆锥角膜敏感而可靠的方法,对角膜屈光手术这一特定人群进行圆锥角膜的严格筛选,可以避免对亚临床期圆锥角膜患者实施角膜屈光手术,从而提高手术的预测性。     

囊袋张力环在高度近视合并白内障中的应用进展

近年来,高度近视合并白内障的发病率逐渐升高,高度近视眼特殊的解剖构造及病变性质,使得此类患者治疗难度及各类并发症远高于普通白内障手术。随着设计和材料的不断进步,囊袋张力环(CTR)的适应证逐渐扩展,尤其对于高度近视患者而言,可以维持人工晶状体位置的稳定,辅助悬韧带松弛部位,抑制术后残留的晶状体上皮细胞的迁移和增生,改善患者视觉质量以及降低视网膜脱离的发生率。本文就CTR的历史发展背景、临床使用情况以及在高度近视合并白内障中的应用效果等进行综述。     

混合性散光弱视基本治愈前后双眼视功能比较

目的观察混合性散光弱视基本治愈前后双眼视功能状况。方法对56例混合性散光弱视患者于治疗前和基本治愈后检测立体视锐度(包括黄斑中心凹立体视锐度、黄斑立体视锐度、周边立体视锐度)、三级视功能(包括1级同时视、2级融合范围和3级立体视)。结果基本治愈前后:立体视锐度各项指标比较差异均有统计学意义(P<0.01);1级同时视无明显差异(P>0.05),2级融合功能及3级立体视均有明显改善(P<0.05)。结论混合性散光弱视影响融合和立体视觉的发育,随着视力的提高,双眼视功能有显著改善。     

视屏终端的使用对人泪膜及眼表的影响及非侵入性眼表综合分析仪的应用价值

背景 目前,视屏终端已广泛用于人们的工作和生活中,其对眼表健康的影响受到关注,而临床上对眼表的健康评估和干眼的早期诊断尚有一定的困难.以往对眼表的检查以侵入性方法为主,影响检查结果的客观性.近年来,非侵入性眼表综合分析仪已用于临床,其在对视屏终端使用者眼表健康状况的评估方面的研究尚少. 目的 使用Keratograph 5M非侵入性眼表综合分析仪观察青年人长时间注视视屏终端对泪膜及眼表的影响.方法 采用前瞻性干预性研究方法,于2015年3月1日至11月10日在南昌大学附属眼科医院纳入健康志愿者81人,其中男39人,女42人;年龄18～ 30岁,均取右眼为受试眼.受试者在自然光线和屈光矫正状态下观看和操作计算机上的同一个视频,距离计算机显示屏约30 cm,使用Keratograph 5M非侵入性眼表综合分析仪分别测定受试者计算机操作前后右眼非侵入性泪膜破裂时间(NITBUT)、泪河高度、结膜充血评分、角膜缘充血评分、睑板腺和泪膜脂质层等,比较计算机操作前后各项检查指标的差异和出现眼表异常的眼数.结果 受试者持续操作计算机3h后出现视物疲劳、干涩感、眼胀痛、视物模糊和结膜充血的眼数明显多于试验前,差异均有统计学意义(均P＜0.01).受试眼计算机操作后首次NITBUT、平均NITBUT分别为(6.086±3.701)s和(9.103±4.680)s,明显低于试验前的(11.445±4.964)s和(14.626±4.467)s;操作后受试眼泪河高度为(0.190±0.032) mm,明显低于受试前的(0.212±0.040) mm;操作后结膜充血评分和角膜缘充血评分分别为0.869±0.311和0.572±0.276,均分别高于受试前的0.780±0.306和0.509±0.266,差异均有统计学意义(均P＜0.01),而试验前后眼压变化及不同级别角膜荧光素染色眼数分布、不同形态睑板腺眼数分布及不同形态的脂质层眼数分布均无改变.结论 长时间注视视屏终端影响泪膜及眼表健康,Keratograph 5M非侵入性眼表综合分析仪是临床上客观评估泪膜及眼表情况的有用手段.     

江西近视手术人群角膜前表面非球性参数调查分析

Objective To assess the distribution features of Q-value of corneal anterior surface in Jiangxi myopia population for laser refractive surgery and to investigate the relationship between Q-value and other related parameters, such as spherical equivalent (SE), corneal curvature, cornea astigmatism, wavefront data and age. Methods The K&Q calculator of Orbsean- Ⅱ anterior segment system was used to obtain the Q-value of 6 mm optical zone in 411 cases (822 eyes) .There were 188 male subjects (376 eyes) and 223 female subjects (446 eyes). Accnrding to SE, subjects were divided into three groups including low myopia, moderate myopia and high myopia. According to different age, subjects were divided into three groups including group Ⅰ (age from 17 to 25), group Ⅱ (age from 26 to 34) and group Ⅲ (age from 35 to 44). Statistical analysis was used to comprehend the distribution characters of Q-value and its relations with SE, corneal curvature, cornea astigmatism, wavefront data and age. Results The Q-value of 822 eyes (411 cases) distributed as positive normal distribution, the average of Q- value was -0.148± 0.120 (range from -0.73 to 0.56) and -0.130± 0.128for male subjects and -0.163± 0.110 for female ones with statistically significant difference in Q-value in different genders (t=4.069, P <0.01). A significant difference was observed in Q-value among 17-25 years, 26-34 years and 35-44 years groups (F =4.567, P <0.05) as well as between 26-34 years group and 35-44 years group (P =0.004). However, there was no significant difference found between different myopic groups (F =1.434, P >0.05). The Q-value shown significantly negative relationship with C12, the Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8. But the Q-value was not related with SE, RMSg, C7, cornea thickness, ocular pressure and age. Conclusions In Jiangxi myopia population for refractive surgery corneal curvature of majority population become flatter from center to periphery (Q<0), minority become steeper from center to periphery (Q>0). The Q-value of corneal anterior surface is independent from myopic SE. The Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8, C12 is the most important related factor of Q-value. The Q-value is significantly greater in males than in females. A significant difference is observed in Q-value between 26-34 years and 35-44 years group.     

江西近视手术人群角膜前表面非球性参数调查分析

Objective To assess the distribution features of Q-value of corneal anterior surface in Jiangxi myopia population for laser refractive surgery and to investigate the relationship between Q-value and other related parameters, such as spherical equivalent (SE), corneal curvature, cornea astigmatism, wavefront data and age. Methods The K&Q calculator of Orbsean- Ⅱ anterior segment system was used to obtain the Q-value of 6 mm optical zone in 411 cases (822 eyes) .There were 188 male subjects (376 eyes) and 223 female subjects (446 eyes). Accnrding to SE, subjects were divided into three groups including low myopia, moderate myopia and high myopia. According to different age, subjects were divided into three groups including group Ⅰ (age from 17 to 25), group Ⅱ (age from 26 to 34) and group Ⅲ (age from 35 to 44). Statistical analysis was used to comprehend the distribution characters of Q-value and its relations with SE, corneal curvature, cornea astigmatism, wavefront data and age. Results The Q-value of 822 eyes (411 cases) distributed as positive normal distribution, the average of Q- value was -0.148± 0.120 (range from -0.73 to 0.56) and -0.130± 0.128for male subjects and -0.163± 0.110 for female ones with statistically significant difference in Q-value in different genders (t=4.069, P <0.01). A significant difference was observed in Q-value among 17-25 years, 26-34 years and 35-44 years groups (F =4.567, P <0.05) as well as between 26-34 years group and 35-44 years group (P =0.004). However, there was no significant difference found between different myopic groups (F =1.434, P >0.05). The Q-value shown significantly negative relationship with C12, the Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8. But the Q-value was not related with SE, RMSg, C7, cornea thickness, ocular pressure and age. Conclusions In Jiangxi myopia population for refractive surgery corneal curvature of majority population become flatter from center to periphery (Q<0), minority become steeper from center to periphery (Q>0). The Q-value of corneal anterior surface is independent from myopic SE. The Q-value show poor relationship with cornea curvature, cornea astigmatism, RMSh and C8, C12 is the most important related factor of Q-value. The Q-value is significantly greater in males than in females. A significant difference is observed in Q-value between 26-34 years and 35-44 years group.     

白内障术后囊袋阻滞综合征临床分析*

目的:探讨白内障术后囊袋阻滞综合征(capsular block syndrome,CBS)的临床病因。方法:采用前瞻性分析法,观察我院2010年7月~2011年9月施行白内障超声乳化联合人工晶体植入术的患者。A组为小撕囊口组,241例(250眼),前囊连续环形撕囊口直径4.0~5.0 mm。B组为常规撕囊口组,311例(326眼),前囊连续环形撕囊口直径5.5~6.0 mm。结果:B组未发生术后CBS病例,A组共发生17例(17眼)术后CBS,11例诊断为术后早期CBS,6例为术后晚期CBS,17例均植入了折叠型软性人工晶体。结论:前囊撕囊口直径过小是发生术后CBS的主要原因,术中黏弹剂残留和植入软性人工晶体是术后CBS的另两个易发因素。     

白内障复明手术2873例疗效分析

目的评价2873例白内障复明手术的效果。方法对经我院严格筛查适合复明手术的白内障患者2873例（3256只眼）,实施免费小切口或超声乳化白内障摘除联合人工晶体植入术,并对效果与并发症进行分析。结果手术后追踪复查资料完整者2645例（2963只眼）,术后1个月视力≥0.05者2905只眼,复明率98.04%;视力≥0.3者2217只眼,脱残率74.82%;植入人工晶体者2919只眼,植入率98.52%。术后并发症：角膜水肿463只眼（15.63%）;后囊膜破裂103只眼（3.48%）;虹膜损伤42只眼（1.42%）;迟发性葡萄膜炎21只眼（0.71%）;术后高眼压117只眼（3.95%）;后发性白内障38只眼（1.28%）。未发生大泡性角膜炎、暴发性脉络膜上腔出血、感染性眼内炎等严重并发症。结论我院白内障复明手术总体临床疗效显著,小切口和超声乳化白内障摘除手术均是有效的复明手段。超声乳化白内障摘除联合折叠型人工晶体植入术,效果更佳。