兔眼内窥镜下睫状体光凝联合白内障超声乳化手术对房水成分的影响

目的　观察眼内窥镜下睫状体光凝术（ｅｎｄｏｓｃｏｐｉｃｃｙｃｌｏｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ,ＥＣＰ）联合白内障超声乳化及人工晶状体植入术（ｐｈａｃｏｅｍｕｌｓｉｆｉｃａｔｉｏｎａｎｄｉｎｔｒａｏｃｕｌａｒｌｅｎｓ,Ｐｈａｃｏ＋ＩＯＬ）后不同范围睫状体光凝对前房蛋白质浓度、ＴＮＦ-α含量、ＩＬ-１β含量改变的影响,并分析对前房炎症反应的影响。方法　将２４只（４８眼）成功建立慢性青光眼模型的灰兔随机分成Ａ组、Ｂ组、Ｃ组、Ｄ组,其中Ａ组、Ｂ组、Ｃ组分别给予１８０°、２７０°、３６０°三种不同范围睫状体光凝的ＥＣＰ＋Ｐｈａｃｏ＋ＩＯＬ手术,Ｄ组给予小梁切除（ｔｒａｂｅｃｕｌｅｃｔｏｍｙ,ＴＲＡＢ）＋Ｐｈａｃｏ＋ＩＯＬ手术,分别对术前、术后房水蛋白质浓度、ＴＮＦ-α、ＩＬ-１β含量检测;观察术后炎症反应;术中、术后并发症的发生情况。结果　Ａ组、Ｂ组、Ｃ组、Ｄ组术后１ｄ、７ｄ、１４ｄ房水中蛋白质浓度、ＴＮＦ-α含量、ＩＬ-１β含量升高,３０ｄ基本恢复至术前水平;术前及术后１ｄ、７ｄ、１４ｄ、３０ｄ房水中蛋白质浓度、ＴＮＦ-α含量、ＩＬ-１β含量:不同组间含量随时间变化趋势相同,差异均无统计学意义（Ｐ＝０．１５３、０５９３、０．２０３）;相同时间点不同组间含量差异均无统计学意义（均为Ｐ＞００５）。４组术后蛋白质浓度与前房炎症反应均呈正相关（均为Ｐ＜０．０５）。结论　ＥＣＰ＋Ｐｈａｃｏ＋ＩＯＬ与ＴＲＡＢ＋Ｐｈａｃｏ＋ＩＯＬ两种不同联合手术方式术后早期均引起蛋白质浓度、ＴＮＦ-α和ＩＬ-１β含量升高,３０ｄ基本恢复正常;而在同一时间点不同的手术方式对蛋白质浓度、ＴＮＦ-α和ＩＬ-１β含量影响不大。     

23G前段玻璃体切割术在浅前房低角膜内皮细胞密度白内障手术中的应用

目的　探讨２３Ｇ前段玻璃体切割联合白内障超声乳化手术治疗浅前房低角膜内皮细胞密度（ｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｄｅｎｓｉｔｙ, ＥＣＤ）白内障的疗效及安全性。方法　根据患者自愿原则,将２０１２年１月至２０１５年１２月在郑州大学第二附属医院接受手术治疗的３０例（３４眼）ＥＣＤ＜１０００ｍｍ－２的浅前房白内障患者分为联合手术组和Ｐｈａｃｏ组。联合手术组１６例（１９眼）,行２３Ｇ前段玻璃体切割联合白内障超声乳化术;Ｐｈａｃｏ组１４例（１５眼）,行单纯白内障超声乳化术。术后１ｄ、１周及３个月检查两组患者最佳矫正视力、角膜水肿程度,同时记录术前及术后３个月ＥＣＤ,观察角膜水肿消退时间、术中及术后并发症。结果　术后１ｄ,联合手术组最佳矫正视力较术前显著增高,差异有统计学意义（Ｐ＜０．０５）。术后１周及３个月,两组最佳矫正视力均较术前显著增高,差异均有统计学意义（均为Ｐ＜０．０５）。术后１ｄ及１周,联合手术组最佳矫正视力均优于Ｐｈａｃｏ组,差异均有统计学意义（均为Ｐ＜０．０５）。术后１ｄ,联合手术组以１级角膜水肿为主,Ｐｈａｃｏ组以２级角膜水肿为主,两组角膜水肿程度差异有统计学意义（Ｐ＜０．０５）。联合手术组角膜水肿平均消退时间为１．０ｄ,小于Ｐｈａｃｏ组的４．０ｄ,差异有统计学意义（Ｐ＜０．０５）。术后３个月,联合手术组角膜内皮细胞丢失率为（７．８６±０．７６）％,低于Ｐｈａｃｏ组的（１３．３９±０．４７）％,差异有统计学意义（Ｐ＜０．０５）。结论　２３Ｇ前段玻璃体切割联合白内障超声乳化术安全性好,角膜内皮细胞损伤小,术后角膜水肿轻,早期视力恢复快,适用于浅前房低ＥＣＤ白内障患者。     

飞秒激光小切口透镜切除术与飞秒LASIK术后角膜后表面高度变化

目的　应用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析系统探讨飞秒激光辅助的准分子激光原位角膜磨镶术（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒｉｎｓｉｔｕｋｅｒ-ａｔｏｍｉｌｅｕｓｉｓ,Ｆｓ-ＬＡＳＩＫ）和飞秒激光小切口透镜切除术（ｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ,ＳＭＩＬＥ）术后角膜后表面高度的变化。方法　前瞻性随机对照研究。选择２０１４年５月至１１月于我院行激光角膜屈光手术的近视患者（等效球镜度数≤ －６．００Ｄ）６０例（１１９眼）,随机分成Ａ、Ｂ两组,每组３０例（Ａ组５９眼,Ｂ组６０眼）。Ａ组施行ＳＭＩＬＥ,Ｂ组施行Ｆｓ-ＬＡＳＩＫ,观察术后视力、屈光度等的变化。采用Ｏｒｂｓｃａｎ-Ⅱ眼前节分析仪,分别于术前、术后１个月对术眼进行眼前节图像采集,记录角膜后表面Ｄｉｆｆ值变化并进行对比。结果　术后１个月两组患者裸眼视力均比术前提高,但两组间相比差异无统计学意义（Ｐ＞０．０５）。术前最佳矫正视力与术后１个月相比差异均无统计学意义（均为Ｐ＞０．０５）,术后最佳矫正视力两组间相比差异亦无统计学意义（Ｐ＞０．０５）。术前及术后１个月Ａ、Ｂ两组屈光度相比差异均无统计学意义（均为Ｐ＞０．０５）。两组后表面Ｄｉｆｆ值均较术前显著增加,其中Ａ组术前、术后分别为（０．０２７±０．００１）ｍｍ和（０．０５９±０．００１）ｍｍ（Ｐ＜０．０５）;Ｂ组术前、术后分别为（０．０２９±０．００１）ｍｍ和（０．０５４±０．００２）ｍｍ（Ｐ＜０．０５）,但Ａ、Ｂ两组术后角膜后表面Ｄｉｆｆ值增加量相比差异无统计学意义（Ｐ＞０．０５）。结论　ＳＭＩＬＥ和Ｆｓ-ＬＡＳＩＫ矫正近视均安全有效,术后１个月角膜后表面高度均部分前移,其远期变化有待进一步探索。     

同轴微切口白内障超声乳化术后泪膜及角膜规则性的研究

目的　比较１．８ｍｍ和３．０ｍｍ两种白内障手术切口术后泪膜及角膜规则性的变化。方法　选取２０１４年１１月至２０１５年１０月行白内障超声乳化吸出术的年龄相关性白内障患者４８例（６２眼）,根据患者对人工晶状体的选择分为:Ａ组２４例（３０眼）行１．８ｍｍ透明角膜微切口白内障超声乳化术,Ｂ组２４例（３２眼）行３．０ｍｍ透明角膜切口白内障超声乳化术。比较术前及术后１ｄ、７ｄ、１个月、３个月的泪膜破裂时间（ｂｒｅａｋ-ｕｐｔｉｍｅ,ＢＵＴ）、基础泪液分泌（ＳｃｈｉｒｍｅｒⅠ ｔｅｓｔ,ＳⅠｔ）、角膜荧光素染色评分（ｃｏｒｎｅａｆｌｕｏｒｅｓｃｅｉｎｓｔａｉｎｉｎｇ,ＦＬＳ）、干眼主观症状评分、角膜表面规则性指数（ｓｕｒｆａｃｅｒｅｇｕｌａｒｉｔｙｉｎｄｅｘ,ＳＲＩ）及角膜表面非对称性指数（ｓｕｒｆａｃｅａｓｙｍｍｅｔｒｙｉｎｄｅｘ,ＳＡＩ）。结果　术后１ｄ、７ｄＢ组ＢＵＴ均短于Ａ组（均为Ｐ＜０．０５）。术后１ｄＢ组ＳⅠｔ低于Ａ组（Ｐ＜０．０５）。术后１ｄ、７ｄ、１个月Ｂ组ＦＬＳ均高于Ａ组（均为Ｐ＜０．０５）。术后１ｄ、７ｄＢ组干眼主观症状评分均高于Ａ组（均为Ｐ＜０．０５）。术后１ｄ、７ｄ、１个月Ｂ组ＳＡＩ、ＳＲＩ均高于Ａ组（均为Ｐ＜０．０５）。Ａ组ＢＵＴ、ＦＬＳ、干眼主观症状评分、ＳＡＩ于术后１个月恢复至术前状态,ＳⅠｔ和ＳＲＩ于术后７ｄ恢复至术前状态;Ｂ组各项结果均于术后３个月恢复至术前状态。结论　１．８ｍｍ切口较３．０ｍｍ切口白内障超声乳化术后干眼症状更轻,泪膜功能及角膜规则性恢复更快。     

2.0mm小切口飞秒激光角膜基质透镜取出术与飞秒激光辅助的LASIK矫正近视的疗效比较

目的　比较２．０ｍｍ微切口飞秒激光角膜基质透镜取出术（２．０ｍｍｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ,２．０ｍｍＳＭＩＬＥ）与飞秒激光辅助的ＬＡＳＩＫ（ｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓｗｉｔｈｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒ,ＦＳ-ＬＡＳＩＫ）矫正近视的疗效。方法　研究纳入行２．０ｍｍＳＭＩＬＥ的近视患者４８例（９６眼）,同期行ＦＳ-ＬＡＳＫ者５０例（１００眼）,记录并比较两组术前及术后１ｄ、１周、１个月、３个月及６个月的裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＵＣＶＡ）、最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、屈光度、生活质量量表（ｑｕａｌｉｔｙｏｆｌｉｆｅ,ＱＯＬ）得分及手术满意度量表评分。结果　在术后１周以后ＳＭＩＬＥ组视力高于ＦＳ-ＬＡＳＩＫ组,且状态较ＦＳ-ＬＡＳＩＫ组更为稳定。术后１个月、３个月、６个月ＳＭＩＬＥ组ＵＣＶＡ≥术前ＢＣＶＡ的比例高于ＦＳ-ＬＡＳＩＫ组,差异均有统计学意义（均为Ｐ＜０．０５）。术后早期（术后１周）ＳＭＩＬＥ组存在１例过矫,而ＦＳ-ＬＡＳＩＫ组存在１例欠矫,但在术后１个月、３个月、６个月两组手术患者均在±１．００Ｄ范围内。术后平均角膜前表面形态变异指数及垂直不对称指数在各时间点均为ＦＳ-ＬＡＳＩＫ组大于ＳＭＩＬＥ组,差异均有统计学意义（均为Ｐ＜０．０５）。两组术前及术后６个月ＱＯＬ得分组间比较,差异均无统计学意义（均为Ｐ＞０．０５）,术后６个月ＱＯＬ得分均较术前有所增加,且差异均有统计学意义（ＳＭＩＬＥ:ｔ＝－１３．８５,Ｐ＝０．００;ＦＳ-ＬＡＳＩＫ:ｔ＝－１３．２１,Ｐ＝０．００）,而两组术后６个月ＱＯＬ得分比较,差异无统计学意义（Ｐ＞０．０５）。两组均有较高的再次手术选择率及手术推荐率,并且未发生严重的并发症。结论　２．０ｍｍＳＭＩＬＥ与ＦＳ-ＬＡＳＩＫ均具有良好的有效性、稳定性以及可预测性,术后都可获得良好的视力及良好的生活质量,前者更好地保持了角膜前表面的形态。     

应用EDI-SDOCT观察全视网膜光凝对糖尿病视网膜病变黄斑区脉络膜厚度的影响

目的　应用深层成像谱域光学相干断层扫描（ｅｎｈａｎｃｅｄｄｅｐｔｈｉｍａｇｉｎｇｓｐｅｃｔｒａｌ-ｄｏｍａｉｎｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＥＤＩ-ＳＤＯＣＴ）观察全视网膜光凝（ｐａｎｒｅｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）对非增生性糖尿病视网膜病变（ｎｏｎ-ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａ-ｔｈｙ,ＮＰＤＲ）患眼黄斑区脉络膜厚度的影响。方法　对３５例（５９眼）ＮＰＤＲ患者行ＰＲＰ术,以４２例（５９眼）正常眼作为对照组。应用ＥＤＩ-ＳＤＯＣＴ分别在ＰＲＰ术前和术后１周测量对照组和光凝组黄斑区各点位脉络膜厚度,比较术后１周较术前的变化,各点标记为:中心凹下脉络膜厚度（ｓｕｂｆｏｖｅａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＳＦＣＴ）,各扫描线上距离中心凹７５０μｍ、１５００μｍ处的鼻侧脉络膜厚度（ｎａｓａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＮＣＴ）、颞侧脉络膜厚度（ｔｅｍｐｏｒａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＴＣＴ）、上方脉络膜厚度（ｓｕｐｅｒｉｏｒｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＳＣＴ）、下方脉络膜厚度（ｉｎｆｅｒｉｏｒｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＩＣＴ）、平均黄斑区脉络膜厚度（ａｖｅｒａｇｅｍａｃｕｌａｒｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＡＭＣＴ）。结果　光凝组术前、术后１周的ＳＦＣＴ、ＮＣＴ７５０、ＴＣＴ７５０、ＳＣＴ７５０、ＩＣＴ７５０、ＮＣＴ１５００、ＴＣＴ１５００、ＳＣＴ１５００、ＩＣＴ１５００、ＡＭＣＴ均明显低于对照组（均为Ｐ＜０．０５）;术后１周ＳＦＣＴ和ＡＭＣＴ明显高于术前（均为Ｐ＜０．０５）;除ＴＣＴ７５０和ＴＣＴ１５００术后与术前无明显差异外（均为Ｐ＞０．０５）,余各点位术后均明显高于术前（均为Ｐ＜０．０５）。其中１０眼术后各值低于术前,２眼可观察到术后脉络膜血管孔径较术前增加。结论　ＮＰＤＲ会导致黄斑区脉络膜变薄,ＰＲＰ术短期内能够明显增加黄斑区脉络膜厚度,同时一定程度上增加脉络膜的血管孔径。ＥＤＩ-ＳＤＯＣＴ是用于评价ＮＰＤＲ患者疗效和预后的有效无创检测手段。     

婴儿先天性白内障摘出术后早期中央角膜厚度变化与眼压的相关性研究

目的　测量并观察生后１２个月以内行先天性白内障摘出术患儿术后术眼中央角膜厚度（ｃｅｎｔｒａｌｃｏｒｎｅａｌｔｈｉｃｋｎｅｓｓ,ＣＣＴ）及眼压（ｉｎｔｒａｌｏｃｕｌａｒｐｒｅｓｓｕｒｅ,ＩＯＰ）的变化。方法　选取２６例（４９眼）生后１２个月内行白内障摘出术的先天性白内障患儿为观察组,按行手术时月龄分为三组:１组:月龄≤３个月,２组:３个月＜月龄≤６个月;３组:６个月＜月龄≤１２个月。分别在术前、术后１个月、３个月、６个月时测量术眼ＣＣＴ与ＩＯＰ。另选取与各观察组最后一次随访时的患儿年龄与性别相匹配的相对正常眼婴幼儿作为对照组。结果　观察组术后１个月、３个月、６个月的ＣＣＴ为（５７８．３９±４７．７９）μｍ、（５８１．３４±５１．５４）μｍ、（５８８．２９±４９．９０）μｍ,均显著大于术前（５６３．５６±３７．１４）μｍ及对照组（５３４．９６±４０．３４）μｍ（均为Ｐ＜０．０５）。观察组术前、术后１个月、３个月、６个月ＩＯＰ测量值间差异无统计学意义（Ｐ＞０．０５）,观察组术后６个月ＩＯＰ测量值大于对照组（Ｐ＜０．０５）。观察组术后６个月ＣＣＴ与ＩＯＰ线性相关（ｒ＝０．５３８,Ｐ＝０．００４）。结论　婴儿先天性白内障摘出术后早期的ＣＣＴ显著大于正常同龄婴儿,且与ＩＯＰ线性相关。     

不同材料及球差人工晶状体眼散射比较分析

目的　比较负球差疏水性丙烯酸酯人工晶状体眼和零球差亲水性丙烯酸酯人工晶状体眼术后１个月术眼散射情况。方法　收集我院行超声乳化吸出联合人工晶状体植入术患者６０眼,其中３０眼植入负球差疏水性丙烯酸酯人工晶状体,定义为ＴｅｃｎｉｓＺＡ９００３组;另外３０眼植入零球差亲水性丙烯酸酯人工晶状体,定义为ＳｏｆＴｅｃＨＤ组。术后１个月使用欧卡斯测量各组客观散射指数（ｏｂｊｅｃｔｉｖｅｓｃａｔｔｅｒｉｎｇｉｎｄｅｘ,ＯＳＩ）、调制传递函数截止空间频率（ｍｏｄｕｌａｔｉｏｎｔｒａｎｓｆｅｒｆｕｎｃｔｉｏｎｃｕｔｏｆｆ,ＭＴＦｃｕｔｏｆｆ）、斯特尔比值（ｓｔｒｅｈｌｒａｔｉｏ,ＳＲ）。使用Ｐｅｎｔａｃａｍ测量各组角膜总高阶像差、球差、水平彗差、垂直彗差,将ＯＳＩ与其进行相关分析。结果　ＴｅｃｎｉｓＺＡ９００３组ＯＳＩ值为２．０２０±０．６９３,ＭＴＦｃｕｔｏｆｆ值为２１．１８８±５．９６５,ＳＲ值为０．１１６±０．０３９;ＳｏｆＴｅｃＨＤ组ＯＳＩ值为１．６８３±０．６２４,ＭＴＦｃｕｔｏｆｆ值为２２．７９７±７．２０５,ＳＲ值为０．１３１±０．０３２,组间比较差异均无统计学意义（Ｐ＝０．０５３、０．３５０、０．１３１）。两组ＯＳＩ与其角膜总高阶像差、球差、水平彗差、垂直彗差均没有相关性（均为Ｐ＞０．０５）。结论　ＴｅｃｎｉｓＺＡ９００３人工晶状体和ＳｏｆＴｅｃＨＤ人工晶状体术后１个月全眼ＯＳＩ没有差异,且与自身角膜像差没有相关性。     

LASIK术后白内障患者应用不同公式计算的人工晶状体植入后效果分析

目的　评估ＬＡＳＩＫ术后白内障患者应用ＳＲＫ-Ｔ公式、ＨＯＦＦＥＲ-Ｑ修正公式和Ｈａｉｇｉｓ-Ｌ修正公式进行白内障超声乳化＋人工晶状体（ｉｎｔｒａｏｃｕｌａｒｌｅｎｓ,ＩＯＬ）植入术后的临床效果。方法　收集从２０１１年１月至２０１５年２月行白内障超声乳化＋ＩＯＬ植入术且既往有ＬＡＳＩＫ术史的患者１３例（２１眼）。根据不同ＩＯＬ计算公式分为３组,分别为ＳＲＫ-Ｔ公式（６眼）、ＨＯＦＦＥＲ-Ｑ修正公式（５眼）和Ｈａｉｇｉｓ-Ｌ修正公式（１０眼）。所有患者在白内障术前术后均进行常规检查,均由同一手术医师进行透明角膜切口超声乳化＋ＩＯＬ植入术。术后随访６个月,使用配对ｔ检验比较手术前后裸眼视力、最佳矫正视力、等效球镜、眼压、角膜内皮细胞密度的变化,对不同公式计算的术后等效球镜和术后等效球镜与目标屈光度之间的差值进行方差分析。结果　术后等效球镜和术后等效球镜与目标屈光度之间的差值,在±０．２５Ｄ内分别为５眼（２３．８１％）和１眼（４．７６％）,在±０．５Ｄ内均为６眼（２８．５７％）,在±１．０Ｄ分别为１０眼（４７．６２％）、１１眼（５２．３８％）。与术前相比,术后６个月时裸眼视力、最佳矫正视力明显提高（均为Ｐ＜０．００１）,等效球镜偏差度数显著减小（Ｐ＜０．００１）。应用ＳＲＫ-Ｔ公式、ＨＯＦＦＥＲ-Ｑ修正公式和Ｈａｉｇｉｓ-Ｌ修正公式后,术后等效球镜误差在±１．０Ｄ内的分别为６７％、８０％、３０％;而术后等效球镜与目标屈光度之间的差值,误差在±１．０Ｄ内的分别为５０％、６０％、５０％。术后等效球镜和术后等效球镜与目标屈光度之间差值采用Ｈａｉｇｉｓ-Ｌ修正公式和ＨＯＦＦＥＲ-Ｑ修正公式组间差异有统计学意义（Ｐ＜０．００１、Ｐ＝０．００１）、Ｈａｉｇｉｓ-Ｌ修正公式和ＳＲＫ-Ｔ公式组间差异有统计学意义（Ｐ＜０．００１、Ｐ＜０．００１）。结论　ＬＡＳＩＫ术后白内障患者在进行白内障超声乳化＋ＩＯＬ植入术后,ＨＯＦＦＥＲ-Ｑ修正公式计算的ＩＯＬ度数误差相对较小。     

Cirrus HD-OCT测量近视患者角膜厚度的应用研究

目的　对比分析ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量中央角膜厚度的差异性及相关性,并探索ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚与眼轴长度的关系。方法　回顾性研究２０１５年１月至４月拟在我院行角膜激光矫正近视手术的患者４２例（８４眼）,按眼轴长度分为三组,Ａ组（３２眼）:眼轴长度２４～２６ｍｍ组;Ｂ组（３１眼）:眼轴长度＞２６～２８ｍｍ组;Ｃ组（２１眼）:眼轴长度＞２８ｍｍ组。利用ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超分别测量患者的中央角膜厚度,用配对ｔ检验来比较两种方法测厚的差异性,用Ｐｅａｒｓｏｎ分析两种方法测厚的相关性,用两独立样本ｔ检验比较不同眼轴组角膜厚度的差异性。结果　Ａ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５３９．９１±３０．７４）μｍ和（５４０．２２±３０．７９）μｍ,测量结果差异无统计学意义（ｔ＝０．２３０,Ｐ＞０．０５）。Ｂ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５４３．９４±３１．７５）μｍ和（５４４．３６±３３．５８）μｍ,测量结果差异无统计学意义（ｔ＝０．３０４,Ｐ＞０．０５）。Ｃ组ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量患者的中央角膜厚度分别为（５４８．１９±２５．８１）μｍ和（５４５．４３±２６．７０）μｍ,测量结果差异也无统计学意义（ｔ＝１．７６６,Ｐ＞０．０５）。ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超测量结果具有显著正相关性（ｒ＝０．９７,Ｐ＜０．０５）。三组间ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚的差异性比较,Ａ组与Ｂ组测量值差异无统计学意义（ｔ＝０．５０４,Ｐ＞０．０５）、Ａ组与Ｃ组测量值差异无统计学意义（ｔ＝０．９９９,Ｐ＞０．０５）、Ｂ组与Ｃ组测量值差异无统计学意义（ｔ＝０．４９９,Ｐ＞０．０５）。ＣｉｒｒｕｓＨＤ-ＯＣＴ测量角膜厚度与眼轴长度无相关性。结论　ＣｉｒｒｕｓＨＤ-ＯＣＴ测量中央角膜厚度结果可靠,且ＣｉｒｒｕｓＨＤ-ＯＣＴ和Ａ超的测量结果显著的正相关。ＣｉｒｒｕｓＨＤ-ＯＣＴ角膜测厚与眼轴长度无关。     

Corneal biomechanical properties changes after coaxial 2.2-mm microincision and standard 3.0-mm phacoemulsification

AIM: To compare the changes in corneal biomechanics measured by ocular response analyzer (ORA) after 2.2-mm microincision cataract surgery and 3.0-mm standard coaxial phacoemulsification. METHODS: The prospective nonrandomized study comprised eyes with cataract that had 2.2-mm coaxial microincision or 3.0-mm standard incision phacoemulsification. The corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg) were measured by ORA preoperatively and at 1d, 1-, 2-, 3- and 4-week postoperatively. Results were analyzed and compared between groups. RESULTS: In both groups, CH decreased in the immediate postoperative period (P<0.05), returned to the preoperative level at one week (P=0.249) in the 2.2-mm group, and at two weeks in the 3.0-mm group (P=0.264); there was no significant change in CRF values. In 2.2-mm group, mean IOPcc and IOPg increased at 1d postoperatively (both P<0.05), and returned to preoperative level at one week (P=0.491 and P=0.923, respectively). In 3.0-mm group, mean IOPcc and IOPg increased at 1d and 1wk postoperatively (P=0.005 and P=0.029, respectively), and returned to preoperative level at 2wk (P=0.347 and P=0.887, respectively). CONCLUSION: Significant differences between preoperative and postoperative corneal biomechanical values were found for CH, IOPcc and IOPg. But the recovery time courses were different between the two groups. The 2.2-mm coaxial microincision cataract surgery group seemed recovery faster compared to the 3.0-mm standard coaxial phacoemulsification group.     

青年女性生理周期期间角膜生物力学性能和眼压的节律性变化

目的探讨中国青年女性生理周期期间角膜生物力学性能和眼压的节律性变化以及两者之间的关系。方法前瞻性研究。41例健康青年女性分别在月经周期初期、排卵期和月经周期末期用眼反应分析仪（ORA）对角膜补偿眼压（IOPcc）、可重复模拟Goldmman眼压（IOPg）、角膜滞后量（CH）和角膜阻力因子（CRF）进行测量。采用Pentacam对CCT进行测量。采用重复测量方差分析法分析测量参数在不同时间点的变化以及Pearson相关进行相关性分析。结果在女性生理周期的不同阶段,CCT、CH和CRF存在波动,但差异无统计学意义,在月经周期末期IOPcc和IOPg均较初期显著下降（P<0.01）。△IOPg与△CRF呈低度正相关（r=0.356,P<0.05）,与△CH呈低度负相关（r=-0.336,P<0.05）,△IOPcc则与△CH呈中度负相关（r=-0.702,P<0.01）,与△CRF不相关（r=-0.069,P>0.05）。△CRF、△CH、△IOPg和△IOPcc均与△CCT无明显相关性（│r│均<0.3,P均>0.05）。结论在女性生理周期期间,角膜生物力学性能无明显变化但眼压在月经周期末期发生了显著下降。IOPg的变化与CH、CRF低度相关,而IOPcc则与CH中度相关,与CRF不相关。角膜生物力学性能可能是眼压的影响因素之一。     

Corneal Biomechanical Characteristics in Patıents with Behçet Disease

Aim: To examine corneal biomechanical properties, intraocular pressure, and central corneal thickness in uveitic eyes with Behçet disease (BD) and to compare them with healthy controls. Methods: This study included 40 eyes of 34 patients with ocular BD and 20 eyes of 20 healthy controls. Eyes with ocular BD were subdivided into active and inactive groups. Ocular response analyzer (ORA) measurements were performed on the 20 eyes of 16 patients with active BD (group 1), 20 eyes of 18 patients with inactive BD (group 2), and 20 eyes of 20 healthy volunteers who served as the control group (group 3). Corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (Goldmann correlated [IOPg], and corneal compensated [IOPcc]) and central corneal thickness (CCT) values were recorded. Results: Mean age of patients in groups 1, 2, and 3 was 33.81?±?9.36, 32.38?±?9.08, and 31.05?±?5.85 years, respectively (p?=?0.76). Mean CH, CRF, IOPg, IOPcc, and CCT values in groups 1, 2, and 3 were [8.51?±?1.88, 9.72?±?2.11, 19.87?±?2.92, 16.13?±?3.29, and 592.50?±?39.95], [8.46?±?1.82, 8.45?±?1.98, 15.89?±?2.68, 15.35?±?2.91, and 528.35?±?19.18], and [8.47?±?1.48, 8.43?±?1.58, 15.59?±?2.74, 15.42?±?3.19, and 526.30?±?18.21], respectively [(p₁?=?0.040, 0.904, <0.001, 0.495 and <0.001 for CRF, CH, IOPg, IOPcc and CCT in group 1, respectively), (p₂?=?0.989, 0.904, 0.659, 0.989, and 0.989 for CRF, CH, IOPg, IOPcc and CCT in group 2, respectively), (p₃?=?0.989, 0.904, 0.660, 0.989, and 0.989 for CRF, CH, IOPg, IOPcc and CCT in group 3, respectively)]. Conclusion: CRF, IOPg, and CCT values altered in active BD group when compared with inactive BD and control group (p?相似文献   

Are There Any Changes in Corneal Biomechanics and Central Corneal Thickness in Fuchs’ Uveitis?

Purpose: To compare corneal biomechanics, intraocular pressure (IOP) and central corneal thickness (CCT) of 38 patients with unilateral Fuchs’ uveitis (FU) with 42 healthy controls.

Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively) and CCT were measured.

Results: The mean CH, CRF, and IOPg of the involved FU eyes were significantly lower (9.5?±?1.6, 9.0?±?1.9 and 13.1?±?4.3?mmHg) than contralateral eyes (10.1?±?1.7, 9.9?±?1.7 and 14.6?±?3.4?mmHg), and controls (10.5?±?1.5, 10.3?±?1.5 and 14.8?±?2.5?mmHg), respectively. There was no significant difference for mean IOPcc between involved FU or contralateral eyes and controls (14.8?±?4.1, 15.5?±?3.4 and 15.0?±?2.7?mmHg). The CCT values correlated with CH and CRF in the involved and contralateral eyes.

Conclusions: Involved FU eyes had lower CH, CRF, and IOPg than contralateral eyes and controls, with no difference regarding IOPcc.     

Internal limiting membrane dragging and peeling: a modified technique for macular holes closure surgery

AIM: To introduce a modified technique of internal limiting membrane (ILM) centripetal dragging and peeling to treat idiopathic macular hole (IMH) and to observe the ILM-retina adhesive forces. METHODS: Twenty-six consecutive patients with stage 3 to 4 IMH and followed up at least six months were enrolled. All patients underwent complete par plana vitrectomy, ILM dragging and peeling, fluid and gas exchange, 15% C3F8 tamponade and 2-week prone position. The best corrected visual acuity, macular hole evaluation by optical coherence tomography, and complications were evaluated. RESULTS: The mean diameter of IMH was 524±148 μm (range: 201-683 μm), with 21 cases (80.8%) greater than 400 μm. ILM dragging and peeling were successfully performed in all cases. Most of the ILM-retina adhesive forces are severe (42.3%, 11/26), followed by mild (38.5%, 10/26), and moderate (19.2%, 5/26). The mean follow-up duration was 21.2±6.1mo. The IMH was closed in 25 (96.3%) eyes. Visual acuity (logMAR) improved significantly from 1.2±0.6 preoperatively to 0.7±0.5 postoperatively (P<0.001). CONCLUSION: Preexisting ILM-retina adhesive force is found in IMH patients. With assistance of this force, this modified technique may help to release the IMH edges and improve the closure rate of large IMH.     

LASIK术后角膜生物力学变化与眼压测量值的相关性

目的 观察LASIK术后角膜生物力学参数和眼压测量值的变化及角膜生物力学变化与眼压的相关性。设计 前瞻性病例系列。研究对象 哈尔滨医科大学附属第一医院2014年1-12月LASIK手术患者81例（162眼）。方法 应用非接触眼压计（non-contact tonometer,NCT）分别在术前及术后3个月测量眼压。同时应用眼反应分析仪（ocular response analyzer,ORA）测量角膜滞后量（corneal hysteresis,CH）、角膜阻力因子（corneal resistance factor, CRF）、模拟Goldmann 眼压（Goldmann intraocular pressure,IOPg）和角膜补偿眼压（corneal-compensated intraocular pressure,IOPcc）。比较手术前后各参数的变化并分析术后角膜生物力学参数变化与眼压测量值的相关性。 主要指标 手术前后NCT、IOPcc、IOPg、CH、CRF。 结果 LASIK术后3个月CH、CRF、IOPcc、IOPg、NCT测量值与术前比较均显著降低,术后IOPcc与IOPg和NCT之间比较差异均有统计学意义（P<0.05）;△CH、△CRF与△IOPcc、△IOPcc- IOPg和△IOPcc-△NCT均成负相关,△CH、△CRF与△IOPg和△NCT均成正相关（P<0.05）;CH和CRF的减少量与眼压测量值下降具有相关性（P<0.05）。结论 LASIK术后角膜生物力学参数和眼压测量值均较术前显著降低,眼压测量值下降与CH和CRF的减少量具有相关性,说明眼压下降的程度可能受角膜生物力学特性的影响。     

1.8mm同轴微切口超声乳化白内障吸出术对角膜内皮细胞的损伤及修复研究

目的　探讨同轴微切口超声乳化白内障吸出术对角膜内皮细胞的损伤及其修复特点。方法　选取２０１１年１月至２０１３年１２月我院收治的１００例（１００眼）年龄相关性白内障患者为研究对象,根据手术方式不同分为常规切口组和微切口组,分别行常规３．０ｍｍ切口白内障超声乳化术和１．８ｍｍ同轴微切口超声乳化白内障手术,使用角膜内皮显微镜于术前、术后１ｄ、１周、１个月、３个月检查角膜内皮细胞密度和形态,对两组结果进行观察比较。结果　两组术前角膜内皮细胞密度组间比较差异无统计学意义（Ｐ＞０．０５）;两组术后不同时间角膜内皮细胞密度均低于术前,差异均有统计学意义（均为Ｐ＜０.０５）;两组术后不同时间点组间比较,差异均无统计学意义（均为Ｐ＞０．０５）。两组术前六角形细胞比例组间比较,差异无统计学意义（Ｐ＞０.０５）;两组术后不同时间六角形细胞比例均低于术前,差异均有统计学意义（均为Ｐ＜０．０５）;两组术后不同时间点组间比较,差异均无统计学意义（均为Ｐ＞０．０５）。两组术前角膜内皮细胞变异系数组间比较,差异无统计学意义（Ｐ＞０.０５）;两组术后不同时间角膜内皮细胞变异系数均高于术前,差异均有统计学意义（均为Ｐ＜０．０５）;两组术后不同时间点组间比较,差异均无统计学意义（均为Ｐ＞０．０５）。两组术后１ｄ、１周中央角膜厚度增加明显,均高于术前,差异均有统计学意义（均为Ｐ＜０.０５）,术后１个月、３个月逐渐恢复至术前水平,与术后１ｄ、１周比较,差异均有统计学意义（均为Ｐ＜０．０５）;两组术前及术后不同时间点中央角膜厚度组间比较差异均无统计学意义（均为Ｐ＞０．０５）。结论　同轴微切口白内障超声乳化手术进一步缩小了手术切口,术后恢复更快,是一种安全有效的手术方式。     

Effect of biometric characteristics on biomechanical properties of the cornea in cataract patient

AIM: To determine the impact of biometric characteristics on the biomechanical properties of the human cornea using the ocular response analyzer (ORA) and standard comprehensive ophthalmic examinations before and after standard phacoemulsification. METHODS: This study comprised 54 eyes with cataract with significant lens opacification in stages I or II that underwent phacoemulsification (2.8 mm incision). Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured by ORA preoperatively and at 1mo postoperatively. Biometric characteristics were derived from corneal topography [TMS-5, anterior equivalent (EQTMS) and cylindric (CYLTMS) power], corneal tomography [Casia, anterior and posterior equivalent (EQaCASIC, EQpCASIA) and cylindric (CYLaCASIA, CYLpCASIA) power], keratometry [IOLMaster, anterior equivalent (EQIOL) and cylindric (CYLIOL) power] and autorefractor [anterior equivalent (EQAR)]. Results from ORA were analyzed and correlated with those from all other examinations taken at the same time point. RESULTS: Preoperatively, CH correlated with EQpCASIA and CYLpCASIA only (P=0.001, P=0.002). Postoperatively, IOPg and IOPcc correlated with all equivalent powers (EQTMS, EQIOL, EQAR, EQaCASIA and EQpCASIA) (P=0.001, P=0.007, P=0.001, P=0.015, P=0.03 for IOPg and P<0.001, P=0.003, P<0.001, P=0.009, P=0.014 for IOPcc). CH correlated postoperatively with EQaCASIA and EQpCASIC only (P=0.021, P=0.022). CONCLUSION: Biometric characteristics may significantly affect biomechanical properties of the cornea in terms of CH, IOPcc and IOPg before, but even more after cataract surgery.     

Changes in corneal biomechanics and intraocular pressure following Femto-LASIK using Goldman applanation tonometry and ocular response analyzer

AIM:To compare intraocular pressure(IOP)measurements before and after laser in situ keratomileusis(LASIK)with a femtosecond laser for flap creation using ocular response analyzer(ORA)and Goldmann applanation tonometry,and to identify factors that may influence the preoperative and postoperative IOP.METHODS:A prospective study conducted on myopic patients who underwent LASIK using a femtosecond laser for flap fashioning.Enrolled patients were evaluated preoperatively,6 wk and 3 mo postoperatively for manifest refraction(MR),keratometric(K)readings and central corneal thickness(CCT)using a scheimpflug-based topography.Corneal resistance factor(CRF),corneal hysteresis(CH),Goldmann correlated IOP(IOPg)and corneal compensated IOP(IOPcc)were measured using ORA besides IOP assessment by Goldman applanation tonometry(GAT).RESULTS:There was a statistically significant decrease in measures of IOPg by 3.35±0.83 mm Hg,followed by GAT which decreased by 2.2±0.44 mm Hg,and the least affected by operation was IOPcc which decreased only by 0.87±0.1 mm Hg after 6 wk.After 3 mo follow up there was a statistically significant decrease in IOPcc which decreased only by 0.76±0.4 mm Hg,followed by IOP GAT by 1.6±0.5 mm Hg,and the most affected by operation was IOPg which decreased by 2.3±0.3 mm Hg.Correspondingly,there was a statistically significant decrease in CH and CRF after 6 wk and 3 mo.At 3 mo,the preoperative MR and preoperative GAT were prominent significant predictors of the postoperative GAT changes.The prediction equation was subsumed.CONCLUSION:IOP measurements and corneal biomechanical factors reduce significantly after LASIK with a femtosecond laser for flap creation.The IOPcc values are less influenced by changes in corneal properties than IOPg and GAT,indicating that IOPcc may provide the most reliable measurement of IOP after this procedure.     

同轴微小切口超声乳化吸出术在闭角型青光眼滤过术后白内障中的应用

目的　比较同轴微小切口与标准切口超声乳化吸出术在原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ,ＰＡＣＧ）滤过术后白内障摘出术中的安全性与有效性。方法　连续收集抗ＰＡＣＧ滤过术后白内障患者７２例（９０眼）,随机分为两组:试验组３７例（４９眼）行２．０ｍｍ同轴微小切口超声乳化术,对照组３５例（４１眼）行３．０ｍｍ标准透明角膜切口超声乳化术,观察两组术中有效超声乳化时间、超声能量及术中前房稳定性,于术后１ｄ、７ｄ观察角膜水肿、视力情况,同时于术前、术后７ｄ观察两组患者角膜内皮细胞计数、角膜散光。结果　试验组和对照组患者术中超声乳化时间分别为（６．４３±１．０３）ｓ、（６．５４±１．２５）ｓ,超声能量分别为（１６．５２±２．３５）％、（１５．９４±３．５３）％,两组间超声乳化时间和超声能量比较,差异均无统计学意义（均为Ｐ＞００５）。两组术后角膜水肿均以１级为主,术后１ｄ、７ｄ两组角膜水肿程度比较,差异均有统计学意义（均为Ｐ＜０．０５）。术后１ｄ、７ｄ试验组最佳矫正视力均好于对照组,差异均有统计学意义（均为Ｐ＜０．０５）。试验组术前角膜散光为（０．５２±０．２８）Ｄ,术后７ｄ为（０．５６±０．３２）Ｄ,差异无统计学意义（Ｐ＞０．０５）;对照组术前角膜散光为（０．４９±０．３１）Ｄ,术后７ｄ为（０．７２±０．４３）Ｄ,差异有统计学意义（Ｐ＜０．０５）;两组术后７ｄ角膜散光比较,差异有统计学意义（Ｐ＜０．０５）。两组术后７ｄ角膜内皮细胞计数均低于术前（均为Ｐ＜０．０１）;术后７ｄ试验组角膜内皮细胞计数高于对照组,差异有显著统计学意义（Ｐ＜０．０１）。结论　同轴微小切口超声乳化术具有术中前房稳定性好,术后角膜内皮细胞丢失率低,促进视力迅速恢复,安全可靠等优点。