Sodium hyaluronate in cataract surgery. II. Report on the use of Healon in extracapsular cataract surgery using phacoemulsification

Healon has been used in a prospective study as a surgical device for extracapsular cataract extraction using Kelman's phacoemulsification technique. The study comprised 38 patients divided into two groups. Healon and balanced salt solution (BSS) were randomly applied and the patients were age-matched. The emulsification was done in the anterior chamber. Healon is shown to have a protective effect on the cornea as judged by corneal thickness measurements and by endothelial cell counts. Healon facilitated the procedure in several ways. In this study no attempt was made to remove Healon from anterior chamber at the end of surgery. It cannot be excluded that Healon may occasionally cause increased intraocular pressure. With regard to postoperative inflammatory reaction and wound healing, no side effects have been observed after use of Healon.     

白内障手术两种不同长度透明角膜切口对比

目的探讨3.2 mm和5.5 mm透明角膜不缝合自闭式切口白内障手术术后散光情况,并对其手术效果进行对比.方法老年性白内障60例（63眼）,随机分为两组,分别采用3.2 mm和5.5 mm透明角膜切口.除切口大小、人工晶状体类型及人工晶状体植入方法不同外,其余手术方法均相同.术前及术后定期观察视力、角膜散光及角膜内皮细胞计数情况,并进行统计学比较.结果3.2 mm切口组术后散光明显小于5.5 mm切口组（P＜0.05）且术后视力优于5.5 mm组（P＜0.05）,两组间比较统计学差异有显著性意义,但是随着时间推移,两组间统计学差异进行性减小.两组角膜内皮细胞丧失程度未见统计学差异（P＞0.05）.结论3.2mm透明角膜切口白内障超声乳化术术后视力恢复快,手术源性散光小,手术效果优于5.5mm组.     

角膜地形图引导下白内障手术切口对角膜散光的矫正

目的:比较不同位置和形态的手术切口对白内障摘除术后角膜散光及裸眼视力的影响。方法:选取术前角膜散光值>1.00D的白内障患者43例52眼,将患者随机分成两组,A组患者采用超声乳化白内障吸除联合人工晶状体植入术,手术切口为位于上方10∶30～11∶30的透明角膜隧道切口。B组患者采用手法碎核白内障摘除联合人工晶状体植入术,其中角膜散光值为1.00～2.00D的患者,切口为位于角膜最大屈光度径线的直线形巩膜隧道切口,长度为6.0～7.0mm,角膜散光值>2.00D的患者,在上述直线形切口对侧角膜缘处,另作一弧形板层松解切口。分别于术后2wk,3mo随访患者,检查裸眼视力及行角膜地形图检查。结果:B组患者术后2wk,3mo裸眼视力好于A组。B组患者术后角膜散光度在术后2wk,3mo时均小于A组。结论:位于角膜最大屈光度径线的6.0～7.0mm直线形巩膜隧道切口,及此切口联合作对侧弧形板层松解切口均能有效矫正白内障术前存在的角膜散光,能够使患者获得更好的术后裸眼视力。     

Astigmatism following cataract surgery: comparison of a scleral and a corneal incision in a mixed group of patients with and without glaucoma

We retrospectively analysed the course of postoperative corneal astigmatism and corrected visual acuity after extracapsular cataract extraction and posterior chamber lens implantation with either a corneal or a scierai incision in 170 eyes of 155 patients with and without glaucoma. A continuous 10/0 nylon shoelace suture was used for wound closure in two groups. In a third group, corneal wound closure was performed with a shorter shoelace suture in combination with two vicryl wing sutures at 11 and 1 o'clock.Although early postoperative mean astigmatism in eyes operated through a corneal incision was high (range 2.92–6.67 diopters at 1 month postoperatively) and significantly different when compared to eyes operated through a scierai incision (1.96 diopters), final mean astigmatism did not differ significantly between those two groups. Moreover, in 27% of eyes operated through a corneal incision, mean astigmatism at 2 months postoperatively was not significantly different from the scierai group and suture removal was not necessary. There was no statistically significant difference in corrected visual acuity over the entire study period between groups.Since safety and functional results of the corneal incision were not different from the scierai incision, we prefer a corneal incision in cataract surgery because of its surgical advantages, especially in patients with cataract and coexisting glaucoma.     

白内障切口对角膜散光的影响

目的:研究不同方位3.2mm切口超声乳化白内障术对角膜散光25度以内患者的影响。方法:收集Orbscan检测出角膜散光在25度以内白内障患者共40例,随机分成A,B两组。在Orbscan引导下,A组20例20眼行3.2mm角膜散光轴向切口,B组20例20眼在90度轴上行3.2mm透明角膜切口,并由同一位手术医师行超声乳化白内障吸除人工晶状体植入术。观察患者术前及术后Orbscan检测的角膜Simk值及PolarK的变化。结果:各组内术前与术后各个时间点PolarK比较,差异有显著统计学意义;两组之间术后各个时间点PolarK比较,差异无统计学意义,两种切口术后3mo都会增加角膜PolarK0.3D左右。结论:对于角膜散光25度以内白内障患者,3.2mm透明角膜切口可能引起角膜PolarK0.3D左右散光。     

青光眼术后透明角膜切口晶状体超声乳化术

目的探讨青光眼术后经透明角膜切口的晶状体超声乳化吸出手术的疗效。方法对22例(22眼)青光眼术后白内障行透明角膜切口晶状体超声乳化吸出人工晶状体植入术，术后随访3．6月，观察视力、滤过泡、眼压和并发症的情况。结果22例术后视力有不同程度提高。22例滤过泡均无影响，术后眼压在正常范围。22例均有不同程度角膜水肿，用药后恢复。无角膜内皮失代偿。结论青光眼术后白内障经透明角膜切口行超声乳化吸出人工晶状体植入术效果较好。     

应用角膜地形图设计个性化白内障手术方案

目的：探讨如何在角膜地形图的指导下,设计个性化白内障手术方案,实现利用手术性散光矫正术前角膜散光,提高术后视觉质量,降低治疗费用的目的。

方法：将202例226眼白内障患者分成随机治疗组和个性化治疗组,在随机治疗组再按手术切口的类型和位置的不同分成8组,观察术前、术后角膜散光,通过矢量分析法计算出不同手术切口的手术性散光值。个性化治疗组的手术设计以随机治疗组的各手术性散光值为参考,并以术前角膜散光与手术性散光最接近的原则选择手术切口类型,切口位置在最陡子午线上,并观察个性化治疗组术后角膜散光。

结果：个性化治疗组术后角膜散光低于随机治疗组中3.0mm透明角膜隧道切口组,差异有统计学意义,与3.0mm巩膜隧道组无统计学差异,利用个性化手术方案55.8%患者可采用费用较为低廉的白内障囊外摘除加硬性人工晶状体植入术,可以降低人均治疗费用。

结论：应用角膜地形图设计个性化白内障手术方案可以矫正术前角膜散光,提高视觉质量,降低治疗费用。     

白内障手术同时矫正散光的方法研究进展

目前,散光矫正已成为屈光性白内障手术的重要内容,白内障手术同时矫正散光的方法主要包括:利用角膜切口、松解性角膜切开、植入散光型人工晶状体和飞秒激光白内障手术.散光矫正效果受多种因素影响,这些方法各有其适应证及优缺点.术后残余散光将会不断减小,白内障术后获得更为完美的屈光状态必将成为现实.本文就以上内容对白内障手术同时矫正术前散光方面的研究进展作一综述.     

改良小切口手法碎核在白内障摘除术中的临床应用

目的探讨改良小切口白内障手法碎核摘除术的手术技术和临床应用效果。方法前瞻性病例研究116例(116只眼)随机分为两组:手法碎核58例(58只眼)1-3级核老年性白内障行3.2mm带球结膜的角巩膜缘隧道式切口的晶状体手法碎核摘除术,采用宽3.0mm的晶体碎核垫板作为垫板,以晶体定位钩作为劈核器进行劈核、分核、转核等方法。超声乳化组58例(58只眼),1-3级核老年性白内障行3.2mm透明角膜切口,常规超声乳化吸出术,采用劈核技术。观察比较两组术中、术后并发症,术后视力、角膜水肿情况、角膜内皮平均丢失率及术后角膜散光情况等变化。结果两组术中均无晶状体后囊破裂、晶体悬韧带断裂或虹膜损伤等并发症。手法碎核术后视力24小时视力:0.1-0.5者32只眼,占55%,0.5-0.8者26只占45%。超声乳化术后24小时视力:0.1-0.5者36只眼,占62%,0.5-0.8者22只眼占38%。两组术后1d,3d,一周,一个月,三个月视力,角膜内皮细胞平均丢失率,角膜散光变化值,两组数据比较差异均无统计学意义(P>0.05)。结论对于晶状体核硬一到三级核的白内障行3.2mm带球结膜的角巩膜隧道式切口,手法碎核摘除白内障术中可控性好,手术安全简单,其手术效果与切口同样大小的超声乳化手术效果相当,且术后患者只有轻度异物感,视力恢复快,术后感染率低。为手法小切口白内障手术提供一种更为安全有效俭省的手术方法。     

青光眼术后白内障超声乳化术的临床观察

目的探讨抗青光眼术后白内障超声乳化术的手术技巧,并评价手术效果。方法对22例24眼抗青光眼术后白内障行颞侧透明角膜切口超声乳化人工晶体植入术,术后随访3~6个月,观察视力、眼压和并发症的情况。结果21眼术后视力有不同程度提高,术后眼压在正常范围内,手术并发症主要是后囊破裂、晶体悬韧带部分离断和虹膜损伤。结论青光眼术后白内障经透明角膜切口行超声乳化效果良好,应强调角膜内皮细胞的保护和防止术后高眼压。     

切口位置对小切口非超声乳化术后角膜散光影响的观察

目的:比较小切口非超声乳化术不同位置的切口对角膜散光的影响。方法:将80例80眼白内障患者随机分两组各40眼,A组:顺规散光者切口选在上方,逆规散光者切口选在颞侧;B组:切口全部选在上方。均采用距角膜缘2mm反眉形6.0mm的巩膜隧道切口,不缝合。观察术前及术后3mo的视力、角膜散光。结果:A组术前和术后3mo的散光位为1.15±0.53D,0.89±0.50D,B组为1.13±0.57D,1.64±0.68D。A组视力≥0.5者34眼(85%),B组:24眼(60%),A,B组差异有统计学意义。结论:白内障手术切口选在角膜曲率最大的子午线上,可矫正术前已有散光并获得更好的术后视力。     

New applications of femtosecond laser in cataract surgery

 The high prevalence of blindness associated with cataract is an urgent public health issue. Femtosecond (FS) laser offers several advantages over conventional laser, such as high penetration, short pulse-duration and micro-precision. Since 2009, several types of FS laser systems have been applied to cataract surgery, offering novel approaches to the three steps of clear corneal incision (CCI) construction, anterior capsulotomy and lens fragmentation. Superior accuracy, predictability, reproducibility and safety have been achieved with use of this innovative technology. StillHowever, certain problems remain unresolved. More studies are needed to clarify the optimal utilization of FS in cataract surgery. The purpose of this review is to outline the features, applications, benefits and risks of FS in cataract surgery, and to discuss current scientific evidence and relevant commercial issues.     

白内障手术切口的差异对眼表的影响

目的:比较小切口手法碎核白内障摘除术与超声乳化白内障摘除术两种不同手术切口对角膜知觉以及泪液分泌功能的影响。方法:随机抽取行小切口手法碎核白内障摘除术和超声乳化白内障摘除术的年龄相关性白内障患者各30例30眼,分别于术前,术后1d;1wk;1,3mo行角膜知觉测量和泪液分泌试验,用日本HANDAYA角膜知觉计分别测量角膜中央、上方、下方、鼻侧、颞侧的角膜知觉阈值(以测定器的尼龙丝长度表示),用天津晶明泪液分泌试纸测量术前,术后1d;1wk;1,3mo患者的泪液分泌量。结果:术后1d两组患者各点角膜知觉显著下降,小切口手法碎核组角膜知觉以颞侧和中央下降最为明显,减退值分别为26%,24%;其次是上方、鼻侧和下方,分别减少:19%,14%,14%。术后3mo上方、下方、鼻侧的角膜知觉基本恢复到术前水平。超声乳化组上方角膜知觉下降最为明显,减少47%。术后1wk;1mo各点角膜知觉均有所恢复,术后3mo除了下方外,各点角膜知觉均未恢复到术前水平。两组患者术后1d泪液分泌量均增加,术后1wk泪液分泌逐渐减少,术后3mo泪液分泌量略低于术前水平。结论:与超声乳化白内障摘除术相比,小切口手法碎核白内障摘除术对患者角膜知觉影响较小,术后角膜知觉恢复较快;两种手术方法均对患者泪液分泌功能产生影响,但术后恢复较快。     

角巩膜缘切口与角膜切口超声乳化术治疗年龄相关性白内障的疗效比较

目的：分析角巩膜缘切口与角膜切口超声乳化术对年龄相关性白内障患者术后康复的影响。

方法：选择2015-01/2017-01在我院行超声乳化术的年龄相关性白内障患者98例132眼，按手术切口位置分为角巩膜缘切口组(A组，52例74眼)与角膜切口组(B组，46例58眼)，手术前后不同时间测定两组裸眼视力、BCVA、角膜散光度的变化，统计两组上皮修复时间、切口修复时间，记录治疗前后不同时间患者BUT、泪液分泌量及角膜染色评分的变化，统计两组术后并发症发生率。

结果：两组组内、组间不同时间裸眼视力、BCVA、角膜散光度、手术源性角膜散光度、BUT、泪液分泌量、角膜染色评分均有差异(P<0.05)，A组术后不同时间裸眼视力、BCVA优于B组，角膜散光度与手术源性角膜散光度低于B组，BUT长于B组，泪液分泌量高于B组，角膜染色评分低于B组(均P<0.05)； A组术后上皮修复时间、切口修复时间均短于B组(P<0.05)； 两组术后并发症发生率无差异(P>0.05)。

结论：角巩膜缘切口下超声乳化手术可改善年龄相关性白内障患者术后视力，降低角膜散光度，减少对泪膜功能的影响，促进患者术后康复。     

小切口白内障手术切口类型对患者角膜形态的影响

目的:探讨小切口手法碎核术不同切口类型对白内障患者角膜地形图的影响,为其临床治疗方案优选提供参考.方法:选取白内障患者71例94眼,随机分为A组和B组,分别以直线形和反眉弓形切口进行手术,将A组和B组进一步随机分为三组,控制切口至角膜缘距离分别为1.5 mm,2.0mm,2.5mm;对比各组手术前后的视力水平和角膜地形图指标ACP,CYL,SAI和SRI.结果:切口形态和切口至角膜缘距离对患者的术后视力和角膜地形图均有影响(P＜0.05),各检测时间术后视力和角膜地形图不全等(P＜0.05),且时间和组别之间不存在交互作用(P＞0.05).各组患者术后1wk的视力优于术前,术后3mo优于术后1wk,差异有统计学意义(P＜0.05);同时,术后1wk的ACP,CYL,SAI和SRI水平高于术前(P＜0.05),术后3 mo时逐渐降低,与术前水平无统计学差异(P＞0.05).术前,各组视力和角膜地形图无统计学差异(P＞0.05).术后1wk,2.0mm B组和2.5mm B组的视力水平明显高于其他各组(P＜0.05),且两组之间无统计学差异(P＞0.05);2.0mm B组和2.5mm B组的ACP,CYL,SAI和SRI水平明显低于其他各组,且2.5mmB组低于2.0mm B组(P＜0.05).术后3mo,各组视力、SAI及SRI水平均无统计学差异(P＞0.05);但2.0mm B组和2.5mm B组患者的ACP和CYL依然明显高于其他组(P＜0.05),且两组之间无统计学差异(P＞0.05).结论:小切口手法碎核术采用反眉弓形切口,并适当拉长切口至角膜缘的距离,可降低对白内障患者角膜地形图的影响,控制术后散光.     

不同黏弹剂在硬核白内障超声乳化术中对角膜内皮的保护

目的：探讨双重黏弹剂DisCoVisc和单纯Healon在白内障超声乳化摘除及折叠人工晶状体植入术中对角膜内皮的保护作用。 方法：将60例60眼单纯性硬核（≥Ⅳ级核）白内障分两组,每组30例30眼。第一组操作中应用双重DisCoVisc作为观察组;第二组操作中应用单纯Healon作为对照组。观察术后1d角膜水肿情况,术前及术后1mo角膜内皮细胞计数。 结果：观察组和对照组术后角膜水肿差异有统计学意义(P<0.01),术前、术后1mo角膜内皮丢失率无统计学意义(P>0.05)。 结论：硬核白内障超声乳化术中应用双重黏弹剂DisCoVisc较单纯Healon可以更有效保护角膜内皮细胞,减少术后角膜水肿,提高手术的安全性。     

低倍镜补偿景深超声乳化手术和小切口白内障手术对比观察

目的：观察低倍镜补偿景深下超声乳化白内障摘除术和小切口白内障囊外摘除术的临床疗效。方法：回顾性分析869例1258眼白内障患者手术治疗的情况,其中采用超声乳化白内障摘除手术者共计247例432眼;采用小切口白内障摘除术者共计622例826眼,对患者的术后视力、角膜内皮计数、角膜水肿情况及并发症进行统计学分析。
　　结果：两组患者术后1wk,1mo 视力恢复情况和术后1d 角膜水肿情况无统计学差异(P >0.05);角膜内皮计数损失,小切口白内障摘除手术组较超声乳化白内障摘除组略好(P<0.05)。
　　结论：基层医院手术显微镜景深不够清晰的情况下,仍可采用低倍镜补偿景深开展小切口白内障囊外摘除术和超声乳化白内障摘除术。     

个性化复合式切口在基层扶贫白内障手术中的临床应用

目的: 探讨根据角膜散光轴位选择复合性手术切口以降低术前角膜散光度在基层扶贫白内障手术中的作用。方法: 根据角膜曲率计选择角膜散光度数≥1.50D的白内障患者100例100眼,以角膜最大屈光力径线方向为中心做巩膜隧道主切口并在主切口的对侧做辅助切口,行白内障小切口囊外摘除联合人工晶状体植入术。分别测量术前、术后3d;1,3,6,12mo的角膜散光及裸视视力。结果: 术前、术后3d;1,3,6,12mo的平均角膜散光分别为+2.08±0.666,-1.06±0.75,+0.67±0.71,+1.11±0.77,+1.20±0.88,+1.30±0.68D;术前、术后3d;1,3,6,12mo的裸眼视力分别为0.30±0.19,0.55±0.25,0.69±0.21,0.66±0.18,0.65±0.20,0.60±0.22。结论: 个性化复合式手术切口这一技术适合在基层大批量扶贫白内障手术中广泛应用,具有疗效确切、操作简单、手术时间短、费用低廉等优点。     

不同超声乳化术切口对白内障患者术后角膜散光的影响

目的：比较不同超声乳化术切口对白内障患者术后角膜散光的影响。 方法：选取我院收治的白内障患者,将患者随机分为对照组（与角膜缘相反弧形巩膜隧道切口组）和观察组（角膜上方或颞上方透明角膜切口组）。比较分析两组患者术后1 wk;1,3 mo不同时间角膜散光度的变化情况及视力的变化情况。 结果：与对照组患者相比,观察组患者术后1 wk;1,3 mo平均角膜散光度及手术源性角膜散光度均明显降低,裸眼视力及矫正视力均明显提高,差异具有统计学意义（P〈0.05）。与对照组患者相比,观察组患者手术所用时间明显缩短,差异具有统计学意义（P〈0.05）。 结论：角膜中心远处的小切口超声乳化术,能够减少患者术后散光度,促进患者术后视力提高,为进一步加强患者的临床治疗效果提供了保障。     

Endothelial cell density and corneal pachometry after no-stitch,small-incision cataract surgery

In a prospective study we used the change of central and peripheral (12 o'clock-position) corneal thickness (CT) after no-stitch small incision cataract surgery as a parameter of tissue traumatisation (33 eyes) and compared the values to a series of cases (32 eyes) with conventional 3.5 mm scleral step incision. In both groups the peripheral measurements showed a higher increase in corneal thickness than the central. After 1 month all eyes regained their central preoperative thickness. Increase in corneal thickness (ACTc, ACTp) after the different postoperative periods were correlated. The values of the central cornea showed no significant difference between the two groups. 1, 7 and 30 days after surgery the increase of peripheral CT was significantly higher in the no-stitch group. This fact was underlined by the clinical aspect at the slit lamp and is due to the anatomical and surgical characteristic of this procedure. One month postoperatively there was no increased endothelial cell loss in the no-stitch group (3%). No-stitch cataract surgery surgery provides a lot of intra- and postoperative advantages. The problem of increased swelling of the peripheral corneal entry seems to be a secondary one as corneal thickness decreases with time. Concerning the prospective endothelial cell loss it is mandatory to study the long term results.