优碘联合石碳酸烧灼治疗真菌性角膜溃疡的临床观察

目的：观察用优碘联合石碳酸治疗真菌性角膜溃疡的临床疗效。

方法：将临床确诊为真菌性角膜溃疡110眼随机分为两组,每组55眼。观察组：先用优碘滴眼后用石碳酸烧灼角膜溃疡再用氟康唑眼膏及重组牛碱性成纤维细胞生长因子眼胶包眼。对照组：用碘酊烧灼角膜溃疡再用氟康唑眼膏及重组牛碱性成纤维细胞生长因子眼胶包眼。观察碘酊和优碘联合石碳酸治疗真菌性角膜溃疡的临床可行性,并进行对比研究。

结果：观察组55眼用优碘联合石碳酸烧灼角膜溃疡创面所有溃疡愈合,病程缩短,效果优于对照组(P <0.05)。

结论：优碘滴眼联合石碳酸烧灼在治疗真菌性角膜溃疡中可以明显提高治愈率,是一种有效、安全的治疗方法。     

超声乳化吸除联合IOL植入术治疗不同房角关闭范围的闭角型青光眼的效果

目的：探讨不同房角关闭范围的闭角型青光眼采用超声乳化吸除联合后房型人工晶状体植入进行治疗的疗效,为闭角型青光眼的治疗提供依据。方法：闭角型青光眼患者47例54眼进行研究,所有患者均进行超声乳化吸除联合后房型人工晶状体植入术治疗。按照房角关闭粘连程度分为3组,房角关闭粘连≤1／2周者为A组（13眼）;1／2＜房角关闭粘连≤3／4者为B组（18眼）;房角关闭粘连＞3／4者为C组（23眼）,观察三组患者术后2 wk的房角和眼压情况,并观察术后3 mo内的并发症情况。结果：三组患者治疗后2wk的眼压均较治疗前相比显著降低,且B、C两组眼压降低幅度显著优于A组,差异有统计学意义（P＜0．05）;三组患者术后周边虹膜前粘连范围明显减少,其中 A 组患者房角重新开放13眼,开放率达100％,B组房角开放14眼,开放率达78％,C组房角开放16眼,开放率为70％,三组间相比差异有统计学意义（ P＜0．05）;治疗后仅有C组3眼再次发生青光眼,发生率为13％,与其他两组相比差异有统计学意义（ P＜0．05）;A组患者术后无并发症发生;B组有3眼角膜水肿、2眼房角关闭粘连＞3／4;C组5眼房角关闭粘连＞3／4,1眼有前房消失,3眼角膜水肿,1眼脉络膜上腔出血,三组患者术后并发症发生率组间相比差异具有统计学意义（P＜0．05）,且B、C两组再次出现房角关闭粘连率显著高于A组,差异有统计学意义（P＜0．05）。结论：对于轻中度房角关闭粘连的闭角型青光眼患者采用超声乳化吸除联合后房型人工晶状体植入术治疗效果显著,术后房角达到开放,但对于重度房角粘连患者其术后并发症较多,尤其是可能出现青光眼的复发。     

比较全氟丙烷气体和消毒空气泡在眼外伤前房重建术中的作用

目的:比较全氟丙烷气体和消毒空气泡在眼外伤前房重建术中的作用。方法:回顾性分析53例(53眼)角膜穿孔伤伴虹膜脱出的病例,角膜裂伤缝合后,28例前房注入消毒空气泡,25例前房注入C3F8气体,比较两者术后视力,气泡消失时间,前房形成情况,术后并发症等。结果:两组术后视力、并发症比较差别无统计学意义。前房注入消毒空气泡组气泡消失时间1.2±0.5d,注入C3F8组气泡消失时间14.0±7.1d,两组比较差别有显著统计学意义。两组术后并发症均为前房再出血、眼压升高、角膜水肿等。结论:前房注入C3F8气体术后视力、并发症与前房注入消毒空气泡基本相同,但其在前房内存留时间明显延长,可以良好地维持前房,是复杂性眼外伤眼前段重建的有效治疗方法。     

合并浅前房的年龄相关性白内障患者超声乳化术后疗效分析

目的:探讨合并浅前房的年龄相关性白内障患者超声乳化术后的疗效.方法:选取我院2015-06/2016-10收治的年龄相关性白内障合并浅前房患者38例38眼,根据中央前房深度:轻度浅前房 (2~2.5mm)23眼,高危浅前房(<2.0mm)15眼.收集同时期正常前房的年龄相关性白内障患者38例38眼作为对照组.两组均由同一位眼科医师行白内障超声乳化术,术后随访3mo,观察手术前后视力、眼压、前房深度、角膜内皮细胞密度及术后并发症情况.结果:术前两组患者视力、眼压、角膜内皮细胞密度比较均无统计学意义(P>0.05).术后两组患者视力均比术前提高,差异有统计学意义(P<0.05),术后不同时间两组患者眼压比术前降低,差异有统计学意义(P<0.05),两组患者前房深度较术前增加,差异有统计学意义(P<0.05),角膜内皮细胞密度较术前减少,差异有统计学意义(P<0.05).术后不同时间两组间眼压、角膜内皮细胞密度、前房深度比较均无统计学意义(P>0.05).术中浅前房组发生后囊膜破裂1眼、悬韧带断裂1眼.正常前房组无后囊膜破裂,悬韧带断裂发生.术后浅前房组发生角膜水肿10眼,角膜水肿的发生率为26%.正常前房组角膜水肿3眼,角膜水肿的发生率为8%.两组患者的并发症发生率比较有统计学意义(P<0.05).结论:对于合并浅前房的年龄相关性白内障患者应及时进行超声乳化手术.术前准确评估,术中仔细操作,可使患者术后视力提高,前房深度加深,超声乳化术治疗合并浅前房的年龄相关性白内障患者安全、有效.     

基于单中心FS-LASIK术中前房气泡的临床观察

目的：探讨飞秒激光制瓣LASIK（FS-LASIK）术中前房气泡的发生率、危险因素、发生机制及对手 术效果和角膜内皮细胞的影响、处理方法和预防措施。方法：回顾性系列病例研究。选择2012年 2月至2017年11月在中国人民解放军第三二二医院眼科屈光中心自愿接受FS-LASIK且术前常规检 查确认为符合手术适应证的患者1 379例（2 749眼）,将发生前房气泡患者的气泡眼作为观察组,将 患者对侧未发生前房气泡的眼作为对照组。统计分析术中发生前房气泡患者的裸眼视力（UCVA）、 最佳矫正视力（BCVA）、角膜曲率、角膜厚度、前房深度、等效球镜度（SE）、角膜直径、角膜内皮细 胞密度、角膜内皮细胞面积的变异系数、六边形角膜内皮细胞比率、眼压等手术前后相关参数。采 用定量数据重复测量方差分析、t检验对数据进行分析。结果：1 379例（2 749眼）患者中25例（27眼） 发生前房气泡,发生率0.98%。术中观察发现气泡均由房角移动至瞳孔区,鼻侧12眼（44%）、颞侧 9眼（33%）、下方4眼（15%）、上方2眼（7%）。Ⅰ级前房气泡16眼（59%）、Ⅱ级10眼（37%）、Ⅲ级 1眼（4%）,Ⅲ级气泡影响自动识别跟踪,需在手动跟踪模式下完成准分子激光切削。术中观察还发现 在进行准分子激光角膜基质切削时气泡在前房内发生了较高频率的振动。观察组（23眼）与对照组 （23眼）比较,角膜直径、曲率、厚度及前房深度、眼压、术前SE、术后SE、术前BCVA、术后UCVA 组间差异均无统计学意义（P>0.05）,但发生前房气泡的患者（25例）角膜直径[（11.11±0.31）mm] 与未发生前房气泡的患者（1 354例）角膜直径[（11.51±0.33）mm]比较差异有统计学意义（t=-3.28, P=0.003）。角膜内皮细胞密度组间差异有统计学意义（F分组=2.486,P分组=0.022）,组内各时间点比 较差异无统计学意义（F时间=1.342,P时间=0.260）。六角形角膜内皮细胞组间差异无统计学意义（F分组 =0.469,P分组=0.497）,组内各时间点比较差异有统计学意义（F时间=5.966,P时间=0.004）。角膜内皮细 胞面积变异系数组间差异无统计学意义（F分组=0.106,P分组=0.746）,组内各时间点差异有统计学意义 （F时间=21.248,P时间<0.001）。结论：前房气泡的产生可能受到术者个人因素、患者种族差异、设备类型、 角膜直径、角膜瓣直径、小梁网位置、pocket深度等多种因素的影响。气泡可能经小梁网逆行进入 前房,致角膜内皮细胞损害。降低前房气泡发生率,可有效提高术后视觉质量。     

Randomized clinical trial of surodex steroid drug delivery system for cataract surgery: Anterior versus posterior placement of two surodex in the eye

OBJECTIVE: To evaluate safety and antiinflammatory efficacy of placing two Surodex (Oculex Pharmaceuticals, Inc., Sunnyvale, CA) in the eye after cataract surgery in comparison with steroid eyedrops and to compare anterior versus posterior chamber placement. DESIGN: Randomized, masked, controlled trial. PARTICIPANTS: One hundred four eyes of 104 Asian patients undergoing extracapsular cataract extraction with intraocular lens implantation were examined. Of these, 33 eyes of 33 patients served as control eyes (group A). INTERVENTION: Two Surodex pellets were inserted in the anterior chamber (AC) of 35 eyes (group B), and two Surodex pellets were inserted in the ciliary sulcus of 36 eyes (group C) at the conclusion of surgery. Control eyes received neither Surodex nor a placebo implant, but were prescribed conventional 0.1% dexamethasone eyedrops four times daily for 4 weeks. MAIN OUTCOME MEASURES: Anterior chamber flare and cells were graded clinically at the slit lamp. Anterior chamber flare was assessed objectively with the Kowa FC500 Laser Flare Meter (Kowa Co. Ltd, Tokyo, Japan). Intraocular pressure and corneal endothelial specular microscopy with morphometric cell analysis were performed for up to 1 year after surgery. RESULTS: Lower flare meter readings occurred in both Surodex groups at all postoperative visits, as compared with the dexamethasone eyedrop group, with statistical significance at days 4 (P = 0.001), 8 (P = 0.001), and 15 (P = 0.02). No difference in flare occurred between AC and ciliary sulcus placement. Clinical slit-lamp assessment of anterior chamber flare and cells showed no difference between Surodex-treated eyes and dexamethasone-treated eyes. Nine of 33 eyes (27.3%) in group A required steroid augmentation, as opposed to 4 of 71 eyes (5.6%) in groups B and C. Inflammatory symptoms were reduced in the Surodex-treated eyes, with statistical significance for ocular discomfort (P = 0.001), photophobia (P = 0.04), and lacrimation (P = 0.01). No complications occurred with Surodex-treated eyes, and no significant difference in endothelial cell loss was noted between Surodex-treated eyes and dexamethasone-treated eyes up to 1 year after surgery. CONCLUSIONS: Intraocular placement of two Surodex is a safe and effective treatment method to reduce intraocular inflammation after cataract surgery and clearly is superior to eyedrops in reducing inflammatory symptoms and aqueous flare as measured with the laser flare meter. No difference in efficacy between AC placement and ciliary sulcus placement of Surodex was detected in this study.     

白内障患者术前术中细菌培养及药物干预研究

目的：研究年龄相关性白内障患者睑缘(睫毛根部睑板腺开口处)和结膜囊应用不同抗生素滴眼液滴眼及不同结膜囊冲洗液冲洗结膜囊后的灭菌效果。

方法：选取2015-01/11在我院拟行白内障超声乳化手术的年龄相关性白内障患者216例216眼随机分成A(72眼)、B(72眼)、C(72眼)三组,术前分别采用3g/L妥布霉素滴眼液、5g/L左氧氟沙星滴眼液及上述两种滴眼液点眼; 再随机分为莫西沙星组(110眼)和聚维酮碘组(106眼),分别于术野常规消毒后手术正式开始前使用1.6g/L莫西沙星和5g/L聚维酮碘冲洗结膜囊。分别于入院未用药前、手术未消毒前及结膜囊冲洗后采集术眼睑缘和结膜囊标本,术毕采集结膜囊标本并抽取前房水进行常规细菌培养及药敏试验。

结果：白内障患者术前睑缘、结膜囊细菌培养阳性率分别为86.6%、25.0%。A、B、C组患者应用不同抗生素滴眼液点眼前后睑缘细菌培养阳性率分别为86.1%和36.1%、84.7%和31.9%、88.9%和30.6%; 结膜囊细菌培养阳性率分别为25.0%和11.1%、26.4%和11.1%、23.6%和8.3%。采用莫西沙星和聚维酮碘组进行结膜囊冲洗前后睑缘细菌培养的阳性率分别为33.6%和10.9%、32.1%和10.4%; 结膜囊细菌培养的阳性率分别为10.0%和0、10.4%和0。

结论：白内障术前联合使用3g/L妥布霉素和5g/L左氧氟沙星滴眼液点眼清洁睑缘和结膜囊效果更佳,5g/L聚维酮碘和1.6g/L莫西沙星均可作为白内障术前结膜囊冲洗液使用。     

晶状体超声乳化联合房角分离术治疗原发性闭角型青光眼合并白内障患者的临床疗效及安全性

目的　探讨晶状体超声乳化联合房角分离术治疗原发性闭角型青光眼（PACG）合并白内障患者的临床疗效及安全性。方法　回顾性分析2016年1月至2018年12月海南爱尔新希望眼科医院收治的70例（70眼）PACG合并白内障患者的临床资料。将32例（32眼）行晶状体超声乳化联合房角分离术治疗的患者纳入观察组,另38例（38眼）行晶状体超声乳化联合小梁切除术治疗的患者纳入对照组。对比分析两组患者术前及术后12个月术眼前房深度、前房角度、眼压及散光度,比较两组患者视力改善及并发症发生情况。结果　两组患者年龄、性别构成,术前散光度、眼压、白内障核硬度分级及裸眼视力比较,差异均无统计学意义（均为P>0.05）。术后12个月两组患者术眼前房深度、前房角度、散光度均大于术前,眼压均低于术前,差异均有统计学意义（均为P<0.05）。术后12个月观察组和对照组患者术眼前房深度及眼压比较,差异均无统计学意义（均为P>0.05）;术后12个月,观察组患者术眼前房角度明显大于对照组,而散光度明显小于对照组,差异均有统计学意义（均为P<0.001）。术后12个月,观察组视力提高27眼、视力不变4眼、视力下降1眼,对照组分别为29眼、6眼、3眼;观察组视力提高率为84.38%,对照组为76.32%,两组视力提高率差异无统计学意义（χ²=0.291,P=0.589）。术后12个月内,观察组出现角膜水肿2眼、前房渗出1眼,对照组出现角膜水肿4眼、前房渗出1眼、前房积血3眼、浅前房2眼、黄斑水肿1眼,观察组并发症发生率（9.38%）明显低于对照组（28.95%）,差异有统计学意义（χ²=4.159,P=0.042）。结论　晶状体超声乳化联合房角分离术治疗PACG合并白内障可有效控制患者眼压,改善视力,且临床较为安全。     

Fungal keratitis in an intertropical area: diagnosis and treatment problems. Advantage of local use of polyvidone iodine

Fungal infection is rarely investigated in keratitis. The authors report five cases of fungal keratitis observed at the le Dantec University Teaching Hospital of Dakar, Senegal, involving two males and three females. Diagnosis was made by examination of smears and cultures of corneal scrapings revealing Candida albicans isolated in four patients and Acremonium strictium in another after 2 or 12 weeks of treatment with antibiotics, antivirals, or steroids. Povidone iodine 2.3% concentrated eye drop was used alone or with an azole for 4 a mean of weeks. All patients presented corneal scars. Fungal keratitis must be considered in presence of torpid corneal ulcer and corneal scraping must be systematically done. Topical povidone iodine alone or associated with azole may be an alternative fungal keratitis treatment in intertropical areas.     

那他霉素联合活力碘治疗真菌性角膜溃疡临床观察

目的：观察那他霉素联合5g/L活力碘治疗真菌性角膜溃疡的临床疗效。方法：对38例38眼真菌性角膜溃疡采用那他霉素联合5g/L活力碘及相关抗真菌药物（斯皮仁诺等）治疗,并进行回顾性分析。结果：经过那他霉素联合5g/L活力碘及斯皮仁诺（伊曲康唑）等药物的治疗,治愈30眼,好转7眼,1眼因角膜穿孔致真菌性眼内炎而丧失眼球。治愈率为79%,有效率97%。结论：那他霉素联合5g/L活力碘及斯皮仁诺（伊曲康唑）等药物治疗真菌性角膜溃疡是安全有效,简便实用的。     

ZB5M anterior chamber and Fyodorov's posterior chamber phakic intraocular lenses: long-term follow-up

PURPOSE: To compare the long-term complications of two outdated phakic intraocular lenses (PIOL) implanted in eyes with high myopia to aid development of better PIOL designs. METHODS: Sixty-two eyes of 37 patients implanted with the ZB5M anterior chamber PIOL (anterior chamber group) and 22 eyes of 14 patients implanted with Fyodorov's posterior chamber PIOL (posterior chamber group) were examined. Complications were compared after a mean follow-up of 71.15 +/- 32.17 months (range: 24 to 145 months) in the anterior chamber group and 84.14 +/- 26.43 months (range: 24 to 132 months) in the posterior chamber group (P = .07). RESULTS: At last follow-up, pupil ovalization was present in 32 (51.6%) eyes in the anterior chamber group and 1 (4.5%) eye in the posterior chamber group (P < .001), and cataract in 5 (8.1%) eyes in the anterior chamber group and 7 (31.8%) eyes in the posterior chamber group (P = .007). Phakic intraocular lens decentration, glaucoma, retinal detachment, corneal decomposition, and monocular diplopia were additional complications encountered in both groups, with no statistically significant difference. CONCLUSIONS: Proper understanding of these outdated PIOLs may be helpful in developing better PIOL designs.     

糖尿病患者白内障术中前房注射曲安奈德的有效性和安全性

目的：观察糖尿病患者白内障术中前房内注射曲安奈德（ TA）的安全性和有效性。
　　方法：连续收集我院300例300眼择期行超声乳化白内障手术的2型糖尿病患者。根据术中及术后抗炎方式的不同,将患者随机分成3组：A组：术后滴用妥布霉素地塞米松滴眼液＋普拉洛芬滴眼液1 mo;B组：术中前房注射1 mg TA,术后滴用左氧氟沙星滴眼液1mo;C组：术中前房注射
　　2 mg TA,术后滴用左氧氟沙星滴眼液1 mo。术后不同时点观察和比较三组的视力、眼压、角膜内皮细胞密度、前房炎症反应和黄斑中央厚度的变化情况。
　　结果：所有手术均顺利进行。 B,C 组患者术后1d;1wk;1mo的最佳矫正视力均优于A组（P＜0．05）,术后1d;1wk的前房炎症反应较A组患者轻（P＜0．05）;C组术后1d眼压平均值高于A组,差异具有统计学意义（P＜0．05）;B和C组术后各时点的最佳矫正视力,前房炎症反应和平均眼压值均无明显差异（P＞0．05）。 B和C组术前术后黄斑中央厚度无显著变化,A组术后3wk;1mo的黄斑中心凹厚度较术前增加,差异显著（ P＜0．05）。三组各时间点角膜内皮细胞密度均无统计学差异。
　　结论：2型糖尿病患者白内障超声乳化术中前房注射TA可有效控制炎症并减轻黄斑水肿,加速视力恢复,具有良好的安全性和有效性。我们推荐的白内障超声乳化术中前房内注射TA的剂量为1 mg。     

聚维酮碘二次消毒对结膜囊细菌的杀灭作用

目的 探讨聚维酮碘二次消毒对结膜囊细菌的清除效果.方法 采取比较性研究,选择在我院行白内障超声乳化手术的259例（259只眼）患者,随机分为4组.各组分别在以下时间点采集结膜囊标本做细菌培养和药物敏感性试验：A组：未使用任何药物之前的基准培养;B组：使用左氧氟沙星滴眼液（商品名：可乐必妥）1 d后;C组：术前手术区皮肤及结膜囊第1次聚维酮碘消毒后;D组：0.05%聚维酮碘消毒液（0.5%聚维酮碘原液10倍稀释）再次冲洗结膜囊后.采用卡方检验进行各组间培养阳性率的比较.结果 A、B、C、D四组的结膜囊培养阳性率分别是 96%、28.6%、3.77%、0%.应用SPSS数据分析软件对数据两两比较结果差异均有统计学意义（P＜0.05 ）.结论 术前抗生素预防用药以及在术前常规消毒后再进行二次结膜囊冲洗消毒有助于结膜囊细菌的彻底清除.     

Repetitive instillation of 0.1% cyclosporin A eye drops induces miosis and anterior chamber inflammation-like reactions in monkey eyes

PURPOSE: Miosis and anterior chamber inflammation-like reactions were recognized after six instillations of 0.1% cyclosporin A eye drops every 30 minutes into rabbit conjunctival sacs. In order to consider species specificity, 0.1% cyclosporin A eye drops were applied by the same method in monkeys. METHODS: Eye drops were applied in five monkeys (monkey A, B, C, D, E); in one eye as control and in nine eyes with 0.1% cyclosporin A. We investigated the changes of pupil diameter, intraocular pressure, and anterior chamber flare before and after applying the eye drops. We also examined the effect on ocular tissue histopathologically. RESULTS: Miosis was recognized in six eyes, but no significant intraocular pressure change was observed in any eyes. In both eyes of monkey A anterior chamber flare increased significantly, and flare increased slightly in both eyes of monkeys B, C, and D. On the other hand, there was no change in either eye of monkey E, including the control eye. Localized necrosis of nonpigmented ciliary epithelium was recognized at the beginning of the ciliary process in both eyes of monkey A. Mild cystoid degeneration of nonpigmented ciliary epithelium was seen at the beginning of the ciliary process in the right eye of monkey C, and in the left eye of monkey D. CONCLUSION: No species specificity can be recognized in monkeys from the fact that there is the selective destruction of nonpigmented epithelium at the beginning of the ciliary process after repeated instillation of 0.1% cyclosporin A eye drops, although there was a difference in miosis and anterior chamber inflammation-like reaction in individual monkeys.     

Study on Collagen Viscoelastic Substance as an Auxiliary Agent in Anterior Segment Surgery. Ocular Irritation Study by Replace ment of the Aqueous Humor in Rabbits

Purpose: Collagen solution was assessed as a possible visoelastic substance in anterior segment surgery, in terms of the depth of the anterior chamber and ocular irritation.Methods: The depth of the anterior chamber of enucleated rabbit eyes was evaluated 5 minutes after injection of collagen solution. For ocular irritation test, the aqueous humor of rabbits was replaced with collagen using sodium hyaluronate (HEALON((R))) and phosphate buffer (PB) as controls. Follow-up clinical examinations with hand-slit-lamp-microscopy, tonometry, pachymetry, and specular microscopy were performed for 7 days or 28 days, and then aqueous humor, corneal endothelium, and eye tissues were evaluated by gel electrophoresis, scanning electron microscopy, and light microscopy, respectively.Results: 2.5% to 3% collagen solution was found to be optimal for maintaining the depth of the anterior chamber. No significant differences in clinical findings such as anterior chamber and corneal thickness or in biochemical and histological findings were observed among collagen-, hyaluronate- and PB-treated groups, except for intraocular pressure which was increased in the hyaluronate-treated group, but not in the collagen-treated group.Conclusion: Collagen specifically prepared for this study seems to be an excellent auxiliary agent for anterior segment surgery, providing an appropriate anterior chamber with little ocular irritation. (Jpn Ophthalmol Soc 104:458-65, 2000)     

三种手术方式治疗闭角型青光眼临床前期及先兆期的疗效观察

目的:探讨超声乳化晶状体摘除并人工晶状体植入术治疗急性闭角型青光眼临床前期、先兆期的疗效。方法:选择原发性闭角型青光眼临床前期或先兆期患者66例66眼,随机分为3组,A组行激光周边虹膜造孔术,B组行单纯超声乳化,C组行超声乳化联合虹膜周边切除术(各22眼)。并比较观察3组术后眼压、中央前房深度、视力、房角Scheie分级等的变化。平均随访11.72±0.96mo。结果:术后最终随访时发现:A,B,C组患者的前房角(Scheie分级法)均显著增宽(P<0.05),3组间的房角Scheie分级无显著性差异;A组中央前房深度无明显变化,B、C组中央前房深度较术前均显著加深(P<0.05),A组的中央前房深度明显低于B、C组(P<0.05),B、C组间的中央前房深度无显著性差异;3组平均眼压无明显变化,三组间的平均眼压无明显差异(P<0.05);A组暗室激发试验的阳性率无显著变化,B,C组暗室激发试验的阳性率均显著小于术前。A,B,C3组暗室激发试验的阳性率无显著差异;A组患者最佳矫正视力无明显提高,B,C组患者最佳矫正视力较术前均显著提高(P<0.05)。结论:在加深中央前房深度、降低术后暗室激发试验的阳性(潜在的可能)及提高术后视力的效果方面,超声乳化晶状体摘除并人工晶状体植入术优于激光周边虹膜造孔术;超声乳化晶状体摘除并人工晶状体植入术中不需要进一步做周边虹膜切除术。     

Study on collagen viscoelastic substance as an auxiliary agent in anterior segment surgery--ocular irritation study by replacement of the aqueous humor in rabbits

PURPOSE: Collagen solution was assessed as a possible viscoelastic substance in anterior segment surgery, in terms of the depth of the anterior chamber and ocular irritation. METHODS: The depth of the anterior chamber of enucleated rabbit eyes was evaluated 5 minutes after injection of collagen solution. For ocular irritation test, the aqueous humor of rabbits was replaced with collagen using sodium hyaluronate (HEALON) and phosphate buffer (PB) as controls. Follow-up clinical examinations with hand-slit-lamp-microscopy, tonometry, pachymetry, and specular microscopy were performed for 7 days or 28 days, and then aqueous humor, corneal endothelium, and eye tissues were evaluated by gel electrophoresis, scanning electron microscopy, and light microscopy, respectively. RESULTS: 2.5% to 3% collagen solution was found to be optimal for maintaining the depth of the anterior chamber. No significant differences in clinical findings such as anterior chamber and corneal thickness or in biochemical and histological findings were observed among collagen-, hyaluronate- and PB-treated groups, except for intraocular pressure which was increased in the hyaluronate-treated group, but not in the collagen-treated group. CONCLUSION: Collagen specifically prepared for this study seems to be an excellent auxiliary agent for anterior segment surgery, providing an appropriate anterior chamber with little ocular irritation.     

10 g?

目的　评估聚维酮碘对大鼠眼表结构和泪膜稳定性的影响。方法　30只SD大鼠左眼使用生理盐水滴眼为A组,右眼使用10 g?L^-1聚维酮碘滴眼为B组,均为每天2次,分别在干预前和干预后2 d、4 d、6 d、8 d、10 d、12 d、14 d用裂隙灯观察角膜形态,并计算泪膜破裂时间（BUT）、泪液分泌量、角膜荧光素染色评分和炎症指数以评估干眼的临床指标改变,使用共聚焦显微镜观察两组角膜组织结构,干预后14 d完成临床指标记录后,取眼球组织行病理学检查,HE染色观察角膜各层结构,PAS染色观察结膜杯状细胞情况,PMN/ED1双重免疫组织化学染色观察中性粒细胞/巨噬细胞在角膜组织层间的浸润情况。结果　裂隙灯检查结果显示,干预后14 d B组大鼠角膜上皮粗糙,荧光素染色阳性,呈点片状着染。干预后6 d、8 d、10 d、12 d、14 d,与A组相比,B组BUT均明显缩短、泪液分泌量均明显下降,角膜荧光素染色评分及炎症指数均明显升高,差异均有统计学意义（均为P<0.05）。角膜共聚焦显微镜检查结果显示,B组角膜上皮层及基质层可见炎症细胞浸润。HE染色结果显示,B组角膜上皮细胞层数增多,上皮厚度增加,基底细胞呈现“空泡样”结构。PAS染色结果显示,B组结膜PAS染色阳性细胞数量显著降低,结膜上皮增厚,细胞层次增加。PMN/ED1双重免疫组织化学染色结果显示,B组角膜上皮层及基质层可见炎症细胞聚集。结论　10 g?L^-1聚维酮碘局部滴眼可引起实验大鼠眼表结构损伤和泪膜稳定性下降,聚维酮碘的眼表毒性有必要引起临床医师的高度重视。     

Bacterial culture after three sterilization methods for cataract surgery

Purpose

To compare bacterial cultures from three sterilization methods immediately before and after cataract surgery.

Design

A prospective randomized open-label group-comparison study.

Methods

We investigated 75 eyes in 73 consecutive patients undergoing cataract surgery. After swabbing the eyelid and surrounding area, patients were randomly assigned to one of 3 eye-washing methods: patients administered one drop of 5 % povidone–iodine (Group A); patients whose conjunctival sac was washed with 0.02 % chlorhexidine while everting the eyelid (Group B); or 0.02 % chlorhexidine as above but without eyelid eversion (Group C). In each group, specimens were collected from the conjunctival sac immediately before and after eye washing and again at completion of surgery, along with aqueous humor. The post-surgical condition of the corneal epithelium and the severity of anterior chamber inflammation were assessed by use of a slit-lamp microscope.

Results

In Groups A and C, the percentage of eyes with conjunctival bacteria decreased significantly from immediately before to immediately after washing (Group A, p = 0.008; Group C, p = 0.016), but there was no significant decrease in Group B (p = 0.125). Slit-lamp microscopy showed that inflammation of the anterior chamber 1 day after surgery was significantly milder in Group C than in Group B (p = 0.032).

Conclusion

Eye-washing methods without eyelid eversion are more effective in reducing conjunctival bacteria before surgery and anterior chamber inflammation after surgery than those with eyelid eversion.     

Postoperative endophthalmitis associated with sutured versus unsutured clear corneal cataract incisions

AIM: To compare the incidence of postoperative endophthalmitis in clear corneal cataract surgeries performed with and without suture closure, antibiotics and povidone iodine. SETTING: Ambulatory surgery facility. METHODS: In a retrospective, consecutive case-series study, we reviewed the incidence of endophthalmitis in 815 consecutive eyes that underwent cataract surgery by a single surgeon over a 5-year period (379 unsutured and 436 sutured, 294 without and 521 with antibiotic drops in the immediate postoperative period, and 247 without and 568 with povidone iodine before patching). RESULTS: There were five cases of culture-positive postoperative endophthalmitis in the unsutured group and none in the sutured group (p = 0.022). Although patients in these two groups received routine preoperative antibiotic and povidone-iodine drops, those in whom antibiotic eye drops were not initiated until the day after surgery (p = 0.006) and those who did not receive 5% povidone-iodine drops immediately after wound closure (p = 0.031), had a higher incidence of endophthalmitis. CONCLUSION: Results suggest that by suturing the corneal incisions, by initiating antibiotic eye drops within the first 24 h of surgery and by instilling povidone-iodine drops after closure, the incidence of endophthalmitis after cataract surgery could possibly be reduced.