高度近视白内障并低视力超声乳化术后视力分析

目的 :观察高度近视白内障并低视力患者行白内障超声乳化 +人工晶状体植入手术后视力变化。方法 :高度近视白内障并低视力患者 2 5例 40只眼 ,术前常规眼部检查 ,散瞳详细检查眼底并记录 ,使用检影验光和综合验光仪精确验光 ,汉字阅读视力表检查最佳近视力 ,手术后 6个月至 2年后进行随访 ,再次精确验光和近视力检查 ,并调查近阅读情况。结果 :(1)远视力 :2 5例 40只眼矫正远视力明显优于术前 ,5例 10只眼矫正视力≥ 0 3 ,等效球镜度为 -1 75～ -3 75D ,2 0例 3 0只眼 <0 3 ,等效球镜度为 -1 75～ -4 0 0D ;(2 )近视力 :手术后测最佳近视力明显下降 ,3 0只低视力眼最佳近视力三号字 /2 5cm ,最差不能看清初号字 ;(3 )近阅读情况调查 :3 0只低视力眼均反映近视力下降 ,出现近阅读困难 ,不能阅读书报 ;在 5例10只眼矫正视力≥ 0 3中也表现近视力下降 ,4例出现近阅读困难。 (4)解决方法 :2 0例 3 0只低视力眼患者近阅读时配戴正高屈光度数眼镜 ,移近目标至足够近距离进行阅读 ,度数 + 4 50～ + 13 0 0D ,平均 + 7 82D ,除 1只眼因黄斑功能差配戴近阅读镜近视力为四号字 / 10cm ,其余均能够完成近阅读。在 4例 8只眼矫正视力≥ 0 3中同样验配近阅读眼镜 ,屈光度 + 3 0 0～+ 6 2 5D ,完成近阅读。结     

白内障超声乳化手术后黄斑区光学相干断层扫描

目的:观察白内障超声乳化吸除联合人工晶状体植入术后黄斑中心凹厚度的改变。方法:对行白内障超声乳化吸除联合人工晶状体植入术,且术前、术中无并发症患者56例56眼,行术前及术后1,3mo黄斑区OCT检查,观察术眼黄斑中心凹厚度变化及视力变化。结果:56眼黄斑中心凹视网膜平均厚度术前为241.3±9.9μm,术后1mo为(260.7±16.8)μm,术后3mo为(245.6±17.6)μm,术后1mo与术前比较,差异有显著性意义(P=0.000),术后3mo与术前比较,差异无显著性意义(P=0.137)。术后1mo,2眼出现黄斑囊样水肿,术后3mo,1眼黄斑囊样水肿消退,另1眼黄斑囊样水肿较前略降低,其余眼未出现黄斑囊样水肿。结论:白内障超声乳化吸除联合人工晶状体植入术后1mo黄斑中心凹厚度明显增加,术后3mo大部分黄斑水肿消退。     

激光乳化白内障术后黄斑区视网膜厚度的变化

目的观察掺钕钇铝石榴石（Nd：YAG）激光乳化白内障手术后黄斑区视网膜厚度的变化。方法在Nd：YAG激光乳化白内障手术前和术后1周，用光学相干断层成像术（OCT）测量64眼黄斑区视网膜神经上皮的厚度，用激光闪辉细胞仪测量房水的闪光值。结果在手术后1周，本组64眼中10眼黄斑厚度增加15μm以上，黄斑厚度异常组的房水闪光值高于黄斑厚度正常组。结论Nd：YAG激光乳化白内障手术后黄斑水肿和术后炎症反应有关。降低手术后前房的炎症反应，可能有助于减轻术后黄斑水肿的发生。     

白内障超声乳化术后黄斑区光学相干断层扫描观察

目的 应用光学相干断层扫描(optical coherence tomography,OCT)观察白内障超声乳化术后黄斑区视网膜的变化.方法 回顾性分析2011年9月至2012年6月间行白内障超声乳化吸除联合人工晶状体植入术,且术中无并发症的单纯老年性白内障患者102例(138眼)的临床资料.术前、术后1周及1个月对所有术眼行视力和黄斑区OCT检查,观察术眼黄斑中心视网膜的变化.采用SPSS13.0软件对检查结果进行统计分析.结果 138眼术前最佳矫正视力0.07～0.40,OCT检查显示黄斑中心视网膜形态结构均无明显异常,黄斑中心厚度(central fovea thickness,CF、)为(239.72±12.31) μm;138眼成功施行超声乳化术,术后视力均有不同程度提高,眼部无明显炎症反应,眼底镜下未见黄斑区异常;术后1周和1个月OCT检查均未发现黄斑囊样水肿,CFT分别为(248.33±10.87) μm和(241.29±9.68) μm,较术前均略有增加,差异均无统计学意义(均为P＞0.05).结论 单纯老年性白内障患者成功施行超声乳化吸除联合人工晶状体植入术后短期内平均CFT较术前有所增加,术后OCT检查未发现黄斑囊样水肿.     

高度近视合并白内障超声乳化术后患者视力预后相关因素分析

目的 探讨影响超声乳化术治疗高度近视合并白内障患者视力预后的相关因素。方法 回顾性临床病例研究。2021年1月至2022年12月在凤台县人民医院眼科接受超声乳化术治疗的高度近视合并白内障患者78例(78只眼)纳入研究。以术后1个月最佳矫正视力(BCVA)分为视力预后不佳组和视力预后良好组,对比两组患者术前眼部特征及相关生物参数并进行统计学分析。结果 视力预后不佳和视力预后良好两组患者术后1个月BCVA较术前均显著提高,差异具有统计学差异(Z=-4.715,-5.908,P<0.01)。单因素分析显示,两组患者在高度近视病程、眼轴长度、角膜曲率、角膜散光以及是否合并玻璃体后脱离和后巩膜葡萄肿上差异具有统计学意义(均P<0.05)。多因素Logistic回归分析显示,眼轴长度和角膜曲率是影响高度近视合并白内障患者超声乳化术后视力预后的独立影响因素(P<0.05)。结论 超声乳化术治疗高度近视合并白内障可有效提高患者视力,术后视力与高度近视病程、眼轴长度、角膜曲率、角膜散光以及是否合并玻璃体后脱离和后巩膜葡萄肿相关,其中,眼轴长度和角膜曲率是影响视力预后的独立影响因素。     

OCT在白内障超声乳化术后黄斑微小病变早期诊断中的应用

目的探讨应用光学相干断层成像术（optical coherence tomography,OCT）早期诊断白内障超声乳化术后低视力眼黄斑微小病变的作用。方法对行白内障超声乳化术后3d，最佳矫正视力低于0．3，排除眼前节和光学通路等并发症、眼底镜检查怀疑黄斑病变的患者31例31眼行黄斑OCT检查，对所得结果进行分析。结果黄斑OCT检查：16眼为黄斑水肿，其中并发视网膜前膜形成者7眼；13眼为黄斑板层裂孔；2眼为黄斑区视网膜劈裂。结论在影响白内障超声乳化术后视功能恢复的各种因素中，以视网膜特别是黄斑区视网膜微小病变为主，OCT作为一种新型的高分辨率的视网膜断层成像技术，对于白内障术后造成低视力的黄斑微小病变的早期诊断、病情追踪和治疗效果观察均具有指导作用。[眼科新进展2005；25（5）：434—435]     

高度近视眼白内障超声乳化术临床分析

目的:浅析高度近视眼白内障超声乳化吸出术及后房型人工晶状体植入术后的疗效和并发症。方法:对83例96眼高度近视眼白内障行角膜缘隧道切口白内障超声乳化吸出术及后房型人工晶状体植入术。眼轴长度为26.32～32.46(平均28.58)mm,其中<28mm的31眼,28～30mm的42眼,>30mm的23眼。植入PMMA后房型人工晶状体,观察术后视力及术中术后并发症。结果:眼轴长度<28mm的31眼中≥0.5者30眼(97%);眼轴长度28～30mm的42眼中≥0.5者36眼(86%);>30mm的23眼中≥0.5者13眼(57%)。后囊膜破裂2眼,其中1眼后囊膜破孔较大,行前部玻璃体切除后,睫状沟植入人工晶状体,但术后2mo发生视网膜脱离。其它并发症为角膜水肿、黄斑囊样水肿以及后囊膜混浊等。结论:高度近视眼白内障超声乳化吸出及后房型人工晶状体植入术能明显提高患者视力,但眼轴长度>30mm者术后视力恢复欠佳。     

基于OCTA的白内障超声乳化术后黄斑区视网膜厚度和血管密度分析

目的利用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)评估白内障超声乳化术后黄斑区视网膜厚度和血管密度的改变。方法纳入47例(57眼)白内障患者,分别在白内障超声乳化术前及术后1周、1个月和3个月使用OCTA检查患眼黄斑中心凹、黄斑中心凹旁、黄斑中心凹周边视网膜厚度和黄斑区视网膜浅层、深层的微血管密度以及黄斑中心凹无血管区(foveal avascular zone,FAZ)面积的变化。结果与术前相比,术后1个月和3个月黄斑中心凹、黄斑中心凹旁和黄斑中心凹周边视网膜全层厚度均显著增加(均为P<0.05),主要表现在内层视网膜的增加上。术后1周、1个月、3个月,黄斑中心凹旁及黄斑中心凹周边视网膜浅层血管密度与术前相比差异均无统计学意义(均为P>0.05),仅术后1个月视网膜深层黄斑中心凹周边血管密度显著高于术前(P<0.05)。术后1个月和3个月黄斑FAZ面积分别为(0.42±0.23)mm²和(0.34±0.17)mm²,显著低于术前的(0.73±0.9...     

超声乳化白内障术后黄斑区光学相干断层扫描观察

目的:应用三维光学相干断层扫描仪观察白内障术后黄斑区结构的影像学特征。方法:回顾性分析我院2009-11/2010-02行超声乳化白内障手术且术中无并发症的32例46眼单纯老年性白内障患者,记录术后视力、眼前段和眼底情况,术后1mo行三维光学相干断层扫描(Topcon3D OCT-1000)检测。结果:白内障患者46眼均成功施行超声乳化吸除术,术后视力均有不同程度提高;术后1mo从三维OCT中未发现明显黄斑区结构的改变且检测到黄斑中心凹视网膜平均厚度(CMT)为(217.34±36.15)μm,较正常同年龄人群组黄斑中心凹视网膜平均厚度CMT为(195.87±40.87)μm略增加,但两者经统计学处理未见明显差异(P=0.284);少数视力和视功能恢复略差的患者其OCT中表现为光感受器内外节连接(IS/OS)层的连续性及视网膜色素上皮(RPE)的完整性欠佳。结论:无全身及眼部其他疾病的老年性白内障患者,术后1mo黄斑区结构基本与正常人群相同,部分患者出现视网膜后极部IS/OS和RPE连续性和完整性的轻度变化,因而使术后患者视力尤其是视功能质量的提高受到影响。     

高度近视白内障晶状体超声乳化术效果分析

目的:分析晶状体超声乳化人工晶状体植入术治疗高度近视者白内障的效果。方法:回顾性分析牡丹江医学院附属红旗医院2017年1月至2020年6月高度近视者进行超声乳化人工晶状体植入术74例(96眼)的临床资料。随访3个月,观察术后视力及并发症。结果:术后1 d,裸眼视力0.05～0.25者24眼(25.0%,24/96),0...     

扭动式超声乳化术对黄斑中心凹厚度及角膜的影响

目的：观察扭动式超声乳化对白内障术后黄斑中心凹视网膜厚度及角膜的影响。 方法：采用常规式超声乳化和扭动式超声乳化进行白内障手术,选取术中无并发症发生的单纯性老年性白内障52例52眼,随机分入观察组（扭动式超声组,26眼）和对照组（常规超声组,26眼）,于术后1,4,12 wk行光学相干断层成像术（OCT）测量黄斑中心凹视网膜厚度,术后1d裂隙灯观察角膜水肿情况。 结果：观察组和对照组黄斑中心厚度在术后1,4,12 wk时均较相应组术前值增加（P〈0.05）;两组间在术后1wk时黄斑厚度增加差异明显（P〈0.05）,4,12wk时两组间无明显差异（P〉0.05）。术后观察组对角膜水肿的影响较小（P〈0.05）。 结论：扭动式超声乳化手术相对常规超声来说对眼角膜及黄斑中心凹视网膜的影响都较小,能有效地减轻术后反应。     

生物以及手术参数对白内障超声乳化术后黄斑中心凹厚度的影响

目的评估白内障超声乳化术中的生物以及手术参数对术后黄斑中心凹厚度的影响。方法选取85例(100眼)行白内障超声乳化术联合人工晶状体植入术患者,记录患者的年龄、晶状体核分级、眼轴长度、超声时间、切口累积消散能量(cumulative dissipated energy,CDE)。术前以及术后1个月行光学相干断层扫描测量黄斑中心凹厚度,记录患者术前、术后视力。分析黄斑中心凹厚度与各指标的相关性。结果患者术后裸眼视力、最佳矫正视力(best corrected visual acuity,BCVA)较术前均有明显的提高(P<0.001)。术前黄斑中心凹平均厚度为(154.43±17.43)μm,术后1个月黄斑中心凹平均厚度(182.28±30.78)μm,平均增加(22.85±25.57)μm,差别有统计学意义(P<0.001)。1眼术后2周发生黄斑囊样水肿。黄斑中心凹厚度增加量与核硬度、超声时间、CDE以及眼轴长度呈正相关(分别为P<0.001、P=0.006、P=0.031、P=0.047),但与患者年龄无明显相关性(P=0.386)。术后黄斑中心凹的增加量与BCVA的负对数(LogMAR)呈正相关(r=0.884,P<0.001)。结论白内障超声乳化术后,患者黄斑中心凹厚度有所增加,其与视力的下降有一定的相关性。术后黄斑中心凹厚度增加的因素是多方面的,例如:核硬度、超声时间、CDE和眼轴长度。     

合并视网膜劈裂症的高度近视眼超声乳化白内障吸除术的临床观察

Objective To evaluate the changes of the retinal thickness in the highly myopic eyes with retinoschisis after phacoemulsification by optical coherence tomography (OCT) and to analyze their postoperative visual acuity. Methods It was a retrospective case series study. This study included 25 (35eyes) highly myopic patients with retinoschisis. One week, 1 and 3 months after phacoemulsification, the best corrected visual acuity (BCVA) was measured and OCT was performed to evaluate the central foveal thickness (CFT) as well as the maximum neurosensory thickness (MNT). These 35 eyes were divided into low and high accumulated energy complex parameter (AECP) groups, and ≤28.00 mm, ＞ 28. 00 and ≤ 30. 00 mm, ＞ 30. 00 mm groups according to the axial length respectively.Variance analysis of data obtained from repeated measurement, Wilcoxon rank sum test, linear correlation and one-way ANOVA were used to analyze the data. Results According to the location of schisis, the 35 eyes were classified as foveal schisis (20 eyes) and nonfoveal schisis (15 eyes). Among the 35 eyes,there were 30 eyes with outer retinoschisis and 5 with compound schisis. The mean BCVA (logMAR)preoperatively and 1 week, 1 and 3 months postoperatively was 0. 23 ± 0. 24, 0. 59 ± 0. 38,0. 57 ± 0. 38 and 0. 60 ±0. 36 respectively ( F = 31.15, P = 0. 000 ). CFT preoperatively and 1 week, 1 and 3 months postoperatively was (255.46 ± 197.57) μm, (256.80 ± 199.88) μm, (274.37 ±246.87) μm, and (268.60±238.41) μm (F=0.99,P=0.420); while MNT was (473.31 ±175.52) μm, (477.71 ±188.71 ) μm, (486. 60 ± 229. 17 ) μm and (482. 63 ± 208. 82) μm respectively ( F = 0. 26, P = 0. 857).BCVA in eyes with foveoschisis and in eyes with nonfoveal schisis was statistically significantly different at 1 week, 1 and 3 months postoperatively ( Z = - 0. 580, P = 0. 048; Z = - 2. 147, P = 0. 030 and Z =-2. 099,P =0. 034). BCVA (0. 43 ±0. 28) was inversely correlated with CFT (497.42 ±281.49) μm in the eyes with foveoschisis unaccompanied with a macular lamellar hole at 3 months postoperatively ( r =-0. 667, P =0. 018). There were no significant differences in the changes of the thickness of the retina between the groups with different AECP or among the groups with different axial lengths ( Z = - 0. 314-1. 290, P =0. 192-0. 741 and F =0. 15-0. 62, P =0. 545-0. 859). Conclusions Cataract surgery has no significant effect on thickness of the retina in the highly myopic eyes with retinoschisis. The patients with retinoschisis could achieve good visual recovery after phacoemulsification. Postoperative visual acuity is related to the location and degree of retinoschisis. Besides, patients with non-foveal schisis could obtain better visual acuity than those with foveoschisis. Further investigation on the development of retinoschisis and the complications after surgery is required.     

合并视网膜劈裂症的高度近视眼超声乳化白内障吸除术的临床观察

Objective To evaluate the changes of the retinal thickness in the highly myopic eyes with retinoschisis after phacoemulsification by optical coherence tomography (OCT) and to analyze their postoperative visual acuity. Methods It was a retrospective case series study. This study included 25 (35eyes) highly myopic patients with retinoschisis. One week, 1 and 3 months after phacoemulsification, the best corrected visual acuity (BCVA) was measured and OCT was performed to evaluate the central foveal thickness (CFT) as well as the maximum neurosensory thickness (MNT). These 35 eyes were divided into low and high accumulated energy complex parameter (AECP) groups, and ≤28.00 mm, ＞ 28. 00 and ≤ 30. 00 mm, ＞ 30. 00 mm groups according to the axial length respectively.Variance analysis of data obtained from repeated measurement, Wilcoxon rank sum test, linear correlation and one-way ANOVA were used to analyze the data. Results According to the location of schisis, the 35 eyes were classified as foveal schisis (20 eyes) and nonfoveal schisis (15 eyes). Among the 35 eyes,there were 30 eyes with outer retinoschisis and 5 with compound schisis. The mean BCVA (logMAR)preoperatively and 1 week, 1 and 3 months postoperatively was 0. 23 ± 0. 24, 0. 59 ± 0. 38,0. 57 ± 0. 38 and 0. 60 ±0. 36 respectively ( F = 31.15, P = 0. 000 ). CFT preoperatively and 1 week, 1 and 3 months postoperatively was (255.46 ± 197.57) μm, (256.80 ± 199.88) μm, (274.37 ±246.87) μm, and (268.60±238.41) μm (F=0.99,P=0.420); while MNT was (473.31 ±175.52) μm, (477.71 ±188.71 ) μm, (486. 60 ± 229. 17 ) μm and (482. 63 ± 208. 82) μm respectively ( F = 0. 26, P = 0. 857).BCVA in eyes with foveoschisis and in eyes with nonfoveal schisis was statistically significantly different at 1 week, 1 and 3 months postoperatively ( Z = - 0. 580, P = 0. 048; Z = - 2. 147, P = 0. 030 and Z =-2. 099,P =0. 034). BCVA (0. 43 ±0. 28) was inversely correlated with CFT (497.42 ±281.49) μm in the eyes with foveoschisis unaccompanied with a macular lamellar hole at 3 months postoperatively ( r =-0. 667, P =0. 018). There were no significant differences in the changes of the thickness of the retina between the groups with different AECP or among the groups with different axial lengths ( Z = - 0. 314-1. 290, P =0. 192-0. 741 and F =0. 15-0. 62, P =0. 545-0. 859). Conclusions Cataract surgery has no significant effect on thickness of the retina in the highly myopic eyes with retinoschisis. The patients with retinoschisis could achieve good visual recovery after phacoemulsification. Postoperative visual acuity is related to the location and degree of retinoschisis. Besides, patients with non-foveal schisis could obtain better visual acuity than those with foveoschisis. Further investigation on the development of retinoschisis and the complications after surgery is required.     

老年性白内障行超声乳化吸除术前OCT检查的临床价值

目的:探讨光学相干断层扫描(optical coherence tomography,OCT)在老年性白内障行超声乳化吸除术前检查中的临床意义。方法:选择尚可看见眼底,直接及间接眼底镜检查正常或仅表现为黄斑中心凹反光消失的老年性白内障患者400例400眼,包括糖尿病史者100例,高度近视者60例,术前除了进行全面详细的眼科常规检查外,进行黄斑区OCT检查。计算眼底镜检查的漏诊率及白内障并发黄斑病变一般危险因素的相对危险度。结果:术前OCT检查发现黄斑病变28例,包括黄斑水肿12例,老年性黄斑变性10例,玻璃体黄斑牵拉2例,黄斑区出血1例,黄斑裂孔2例,黄斑萎缩1例。糖尿病、高度近视、年龄>60岁的相对危险度及95%可信区间分别为:4(1.837,8.087),2.27(1.050,4.9),2.5(1.14,5.53)。结论:OCT在老年性白内障行超声乳化吸除术前检查中对合并的黄斑病变检查灵敏度高,尤其是对于年龄>60岁、高度近视和糖尿病史患者,可作为术前常规检查。     

超声乳化术治疗高度近视白内障的临床观察

目的探讨晶状体超声乳化联合人工晶状体植入术治疗高度近视白内障的临床效果。方法对55例(86眼)高度近视白内障患者采用晶状体囊袋内超声乳化技术行白内障吸出,并植入后房型人工晶状体,手术后随访4个月～2a,观察视力和屈光度变化,并对相关并发症进行分析。结果 83眼(96.5%)的术后最佳矫正视力明显优于术前。术后3个月矫正视力>0.40、>0.03～0.40和≤0.30的患者眼数和构成比,在眼轴≤30mm组,分别为24眼(40.0%)、26眼(43.3%)和10眼(16.7%);在眼轴>30mm组,分别为6眼(23.1%)、13眼(50.0%)和7眼(26.9%)。术中并发症包括环形撕囊不佳者5眼(5.8%)、后囊膜破裂者2眼(2.3%)和悬韧带断裂者2眼(2.3%);术后并发症有一过性角膜水肿16眼(18.6%)、暂时性眼压升高5眼(5.8%)、房水混浊明显15眼(17.4%),以及晶状体后囊膜混浊2眼(2.3%)、孔源性视网膜脱离1眼(1.2%)。结论超声乳化联合人工晶状体植入术既治疗了白内障,同时又矫正了高度近视,术后视功能恢复良好,是高度近视合并白内障患者安全有效的治疗方法。     

合并视网膜劈裂症的高度近视眼超声乳化白内障吸除术的临床观察

目的 应用相干光断层扫描术(OCT)观察合并视网膜劈裂症的高度近视眼白内障患者超声乳化白内障吸除术前后的视网膜厚度变化及其对视力的影响.方法 回顾性系列病例研究.对25例(35只眼)合并视网膜劈裂症的高度近视眼白内障患者行超声乳化白内障吸除联合人工晶状体植入术,术后1周、1个月及3个月记录最佳矫正视力(BCVA)并行OCT检查,测量黄斑中心凹视网膜厚度(CFT)以及劈裂最显著处视网膜神经上皮层厚度(MNT).根据术中累积能量复合参数(AECP)大小将35只眼分为高、低AECP组;根据患者眼轴长度将35只眼分为≤28.00 mm组、＞28.00且≤30.00 mm组以及＞30.00 mm组.采用重复测量资料的方差分析、Wilcoxon秩和检验、直线相关分析以及单因素方差分析对数据进行统计分析.结果 35只视网膜劈裂眼术后1周、1个月、3个月的BCVA分别为(0.59±0.38)、(0.57±0.38)及(0.60±0.36),较术前有所提高(F=31.15,P=0.000).术后1周、1个月、3个月的CFT分别为(256.80±199.98)μm、(274.37±246.87)μm及(268.60±238.41)μm,与术前相比,差异均无统计学意义(F=0.99,P=0.420);术后1周、1个月、3个月的MNT分别为(477.71±188.71)μm、(486.60±229.77)μm以及(482.63±208.82)μm,分别与术前相比,差异均无统计学意义(F=0.26,P=0.857).术后3个时间点非中心凹劈裂眼BCVA好于中心凹劈裂眼(Z=-0.580,P=0.048;Z=-2.147,P=0.030;Z=-2.099,P=0.034).不伴有黄斑板层裂孔的中心凹劈裂眼术后3个月BCVA与其CFT呈负相关(r=-0.667,P=0.018).术后3个时间点内,高、低AECP组以及不同眼轴长度组之间术前术后视网膜厚度变化的差异均无统计学意义(Z=-0.314～1.290,P=0.192～0.741;F=0.15～0.62,P=0.545～0.859).结论 合并视网膜劈裂症的高度近视眼白内障患者行超声乳化白内障吸除联合人工晶状体植入术,手术对劈裂的视网膜无明显影响,术后能够获得良好的复明效果,其术后视力的恢复与劈裂发生的部位有关.

Abstract：

Objective To evaluate the changes of the retinal thickness in the highly myopic eyes with retinoschisis after phacoemulsification by optical coherence tomography (OCT) and to analyze their postoperative visual acuity. Methods It was a retrospective case series study. This study included 25 (35eyes) highly myopic patients with retinoschisis. One week, 1 and 3 months after phacoemulsification, the best corrected visual acuity (BCVA) was measured and OCT was performed to evaluate the central foveal thickness (CFT) as well as the maximum neurosensory thickness (MNT). These 35 eyes were divided into low and high accumulated energy complex parameter (AECP) groups, and ≤28.00 mm, ＞ 28. 00 and ≤ 30. 00 mm, ＞ 30. 00 mm groups according to the axial length respectively.Variance analysis of data obtained from repeated measurement, Wilcoxon rank sum test, linear correlation and one-way ANOVA were used to analyze the data. Results According to the location of schisis, the 35 eyes were classified as foveal schisis (20 eyes) and nonfoveal schisis (15 eyes). Among the 35 eyes,there were 30 eyes with outer retinoschisis and 5 with compound schisis. The mean BCVA (logMAR)preoperatively and 1 week, 1 and 3 months postoperatively was 0. 23 ± 0. 24, 0. 59 ± 0. 38,0. 57 ± 0. 38 and 0. 60 ±0. 36 respectively ( F = 31.15, P = 0. 000 ). CFT preoperatively and 1 week, 1 and 3 months postoperatively was (255.46 ± 197.57) μm, (256.80 ± 199.88) μm, (274.37 ±246.87) μm, and (268.60±238.41) μm (F=0.99,P=0.420); while MNT was (473.31 ±175.52) μm, (477.71 ±188.71 ) μm, (486. 60 ± 229. 17 ) μm and (482. 63 ± 208. 82) μm respectively ( F = 0. 26, P = 0. 857).BCVA in eyes with foveoschisis and in eyes with nonfoveal schisis was statistically significantly different at 1 week, 1 and 3 months postoperatively ( Z = - 0. 580, P = 0. 048; Z = - 2. 147, P = 0. 030 and Z =-2. 099,P =0. 034). BCVA (0. 43 ±0. 28) was inversely correlated with CFT (497.42 ±281.49) μm in the eyes with foveoschisis unaccompanied with a macular lamellar hole at 3 months postoperatively ( r =-0. 667, P =0. 018). There were no significant differences in the changes of the thickness of the retina between the groups with different AECP or among the groups with different axial lengths ( Z = - 0. 314-1. 290, P =0. 192-0. 741 and F =0. 15-0. 62, P =0. 545-0. 859). Conclusions Cataract surgery has no significant effect on thickness of the retina in the highly myopic eyes with retinoschisis. The patients with retinoschisis could achieve good visual recovery after phacoemulsification. Postoperative visual acuity is related to the location and degree of retinoschisis. Besides, patients with non-foveal schisis could obtain better visual acuity than those with foveoschisis. Further investigation on the development of retinoschisis and the complications after surgery is required.     

闭角型青光眼超声乳化人工晶状体植入前后的眼前节结构变化

【摘要】目的 观察原发性闭角型青光眼患者白内障超声乳化吸除加人工晶状体植入手术前后的前房结构的变化。方法 对18例(34只眼) 原发性闭角型青光眼合并白内障患者实施白内障超声乳化加人工晶体植入术,手术前后进行眼前段相干光断层扫描（slit lamp optical coherence tomography）,观察前房结构的变化。同时监测手术前后眼压,观察手术对闭角型青光眼的治疗作用。结果:前段OCT扫描显示,手术后角膜前后曲率、K值(7.53±0.81 mm /44.46±4.64 dpt)与术前(7.60±1.19 mm /43.90±6.93 dpt)无明显差异(p>0.05),前房深度、前房体积、500微米房角开放距离(3.06±0.25 mm/138.25±16.33 mm³/0.62±0.35 mm)与术前（2.29±0.22 mm/94.50±27.28 mm³/0.25±0.12 mm）相比均有非常显著的差异(p<0.01),500微米小梁网虹膜间隙面积(0.26±0.15 mm²）与术前(0.14±0.05 mm²)相比有显著差异(p<0.05)。手术后眼压在脱离药物治疗的情况下稳定于正常范围,术后视力均好于术前。结论:前段OCT提供了对眼前节快速、非接触的检查方法。白内障超声乳化术对房角未全部粘连的闭角型青光眼有较好的治疗作用。     

Changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography

AIM: To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA). METHODS: Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery. RESULTS: In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001). CONCLUSION: Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.