Moria M2"90"微型角膜刀联合准分子激光角膜切削术治疗近视的临床观察

目的 探讨Moria M2"90"微型角膜刀联合准分子激光角膜切削术治疗近视的预测性、稳定性及安全性.方法 使用Moria M2微型角膜刀,90μm深度一次性切割头和德国ALLEGRETTOWAVETM Eye-Q准分子激光机对98例195眼近视病人施行矫治手术.按屈光度分为两组,Ⅰ组89眼(-6～-12.875)D,Ⅱ组106眼(-1.25～-5.875)D,术后随访3m以上.结果 术中制瓣良好,出现薄角膜瓣1例,未出现瓣碎裂、游离瓣等严重并发症.术后1d181眼(92.82%)裸眼视力达到术前最佳矫正视力.术后3m裸眼视力大于或等于最佳矫正视力的I组为84眼(97.67%),Ⅱ组为97眼(91.51%).195眼中共5眼(2.56%)出现-1.25D～-2.75D的回退.术后3m角膜地形图曲率(38.37±1.88)D和散光(-0.82±0.69)D均显著低于术前(P＜0.05);术后平均高阶像差均方根为(0.24±0.08)较术前增大.结论 Moria M2"90"微型角膜刀联合准分子激光角膜切削术治疗近视是安全和有效的.     

AcrySof IQ非球面人工晶状体植入后视觉质量观察

目的 对比研究AcrySof IQ非球面人工晶状体和AcrySof Natural人工晶状体在年龄相关性白内障患者手术后的视觉质量.方法 前瞻性随机对照研究.选取年龄相关性白内障患者,按照双肓原则分为两组:IQ组和Natural组,分别植入AcrySof IQ和AcrySof Natural人工晶状体,其中IQ组:124只眼;Natural组:136只眼.术后观察两组患者的最佳矫正远视力、对比敏感度(CS)值、波阵面像差.采用统计软件SPSS 11.0进行数据分析,两组间术后视力采用重复测量方差分析,CS、波阵面像差采用具有一个重复测量两因素设计定量资料方差分析.结果术后1周、1个月、3个月采用CGT-1000 CS眩光测试仪检查发现两组间的CS值在中、高空间频率段均有差异(F值范围5.05～26.47,P＜0.05),低频空间两组间差异随时间推移逐渐明显.两组的波阵面像差检查显示4.0 mm和6.0 mm瞳孔时,两组的总均方根值有差异(F值范围6.373～10.679,P＜0.05).两组的C7、C8的均方根值差异尤统计学意义(F值范围0.144～2.493,P＞0.05).两组C12的均方根值差异有统计学意义(F值范围7.005～12.24,P＜0.05).结论与AcrySof Natural人工晶状体相比较,AcrySof IQ可以有效地提高CS,减少白内障术后全眼像差和高阶像差,改善患者术后视觉质最.(中华眼科杂志,2009,45:239-242)     

白内障超声乳化术中扭动模式与传统爆破模式的临床研究

目的 比较并探讨扭动模式与传统爆破模式对白内障超声乳化术后的影响.方法 前瞻性随机对照研究.对2008年1月至2009年1月在上海交通大学医学院附属第九人民医院按照手术日登记将接受白内障超声乳化手术的患者随机分为2组,扭动模式组94例,传统爆破模式组94例,分别使用扭动模式和爆破模式进行超声乳化手术.术中记录超声时间(Ultrasound Time,UST),累计分散能量(Cumulative Dissipated Energy,CDE)和手术并发症.患者术后1周、1月、3月接受复诊和随访.术后检查项目包括最佳矫正视力和角膜内皮计数.结果 根据Emery白内障核分级:扭动组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的超声时间分别是(31.06±14.29)s、(35.72±19.74)s、(74.11±41.50)s;爆破组Ⅰ+Ⅰ、Ⅲ、Ⅳ级以上核的超声时间分别是(47.3±17.58)s、(53.34±19.51)s、(84.54 4-15.45)s,两者之间差异有统计学意义(F值分别为3.845、5.643、7.814,P＜0.05).扭动组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的CDE值分别是11.2 4±5.33、12.42±5.49、18.19±1.31;爆破组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的CDE值分别12.65±5.71、15.64±9.35、42.5±3.01,两者间差异有统计学意义(F值分别为8.800、9.386、9.388,P＜0.05).手术3月的最佳矫正视力扭动组0.72±0.21,爆破组0.70±0.18,两者间无明显差异(P＞0.05).术后1周、1月、3月的角膜内皮细胞计数,扭动组分别为(2149±199)、(2222±177)、(2313±161)个/mm2,爆破组分别为(2055±218)、(2084±175)、(2259±179)个,mm2,各组间差异有统计学意义(F值分别为6.297、6.272、5.957,P＜0.05).结论 白内障超声乳化手术中采用扭动模式可以有效减少能量和缩短时间,减轻患者角膜内皮的损伤,是一种安全有效地手术模式.

Abstract：

Objective To compare the intraoperative and postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System. Methods Randomized comparative study. A total of 188 eyes were assigned to phacoemulisification by torsional mode or conventional ultrasound mode according to the appointed day. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complication. Patients were seen 7, 30, and 90 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in endothelial cell count. Results The US group had 94 eyes and torsional group 94 eyes. All patients completed the follow-up visits.In the eyes with nucleus density grades ofⅠ+Ⅱ、Ⅲ、Ⅳ and above,the mean UST was 31.06+14.29 s,35.72+19.74 s,74.11±41.50 s,respectively in the US group and 47.3±17.58 s,53.34±19.51 s,84.54±15.45 s respectively in the torsional group(P＜0.05);the mean CDE was 11.2±5.33,12.42±5.49,18.19±1.31 respectively in the US group and 12.65±5.71,15.64±9.35,42.5±3.01 respectively in the torsional group(P＜0.05).Postoperative 90 days,the mean BCVA were 0.72±0.21 in torsional group and 0.70+0.18 in US group(P＞0.05).At 7 days,30 daysand 90 days,the mean central corneal endothelial cell count was 2149±199,2222±177,2313±161respectively in the US group and 2055±218,2084±175,2259±179 respectively in the torsional group (P＜0.05).Conclusions The torsional mode can provide more effective lens removal with a lower level of phacoemulsification time and energy.