白内障超声乳化吸除术中高灌注压下眼内血流的变化

目的 探讨高灌注压下白内障超声乳化吸除术时搏动性眼血流的变化及相关影响因素。设计  前瞻性非比较性病例系列。研究对象 白内障超声乳化吸除术患者23例。方法 应用搏动性眼血流分析仪分别在手术前、手术中动态测量眼内搏动性眼血流参数,包括搏动性眼血流量（POBF）、脉搏周期内平均眼压等,心电监护仪记录心率及血压。术前基线观察点为手术开始置开睑器后,术中超声乳化阶段及皮质抽吸阶段各测量1次。分析年龄、眼压、心率和血压与POBF的相关性。主要指标 搏动性眼血流量,眼压。结果 患者术前基线、超声乳化阶段、皮质抽吸阶段测得的搏动性眼血流量分别为（16.43±6.52）、（12.36±9.60）、（8.24±6.55）μl/秒。与术前基线相比,术中超声乳化及皮质抽吸时的搏动性眼血流量均有不同程度下降。在皮质抽吸时搏动性眼血流量较超声乳化时进一步下降,与基线值相比差异均有统计学意义（P均<0.001）。患者术前基线、超声乳化阶段、皮质抽吸阶段的平均眼压分别为（21.10±4.10）、 （59.64±13.83）、 （39.72±10.04）mm Hg。与术前基线眼压相比,术中两个观察点的眼压明显升高,且均有统计学意义（P均<0.05）。患者年龄和眼压与POBF呈负相关（b=-0.068,P<0.001和b=-0.012,P<0.001）,心率和收缩压与POBF呈正相关（b=0.005,P=0.046;b=0.007,P<0.001）。结论 白内障超声乳化手术在高灌注压的持续作用下,眼压明显升高,搏动性眼血流持续下降,提示持续高灌注压下的白内障超声乳化手术可造成眼内的血供减少。（眼科, 2013, 22:82-85）     

超声乳化人工晶状体植入术后眼压的观察

目的探讨晶状体超声乳化人工晶状体植入术后早期的眼压变化及术中、术后用药对术后早期的眼压变化影响。方法本组病例均为我院行晶状体超声乳化白内障吸出人工晶状体植入术的住院患者,60例,分4组进行研究。对4组病例于术前、术后2h、4h6、h、8h、10h、12h1、4h2、4h及36h进行眼压测量,并进行组间对比。结果晶状体超声乳化白内障吸出人工晶状体植入术后早期眼压有不同程度升高,术中用缩瞳剂可使术后眼压下降,但仍明显高于术前;术后用醋氮酰胺也可使眼压下降。但在用缩瞳剂后,醋氮酰胺降眼压作用被缩瞳剂的作用所掩盖。术后早期(2小时后)眼压升高,于12小时达高峰,以后眼压逐渐下降,24~36小时已降至术前水平。结论晶状体超声乳化的白内障吸出人工晶状体植入术时术中应使用小量缩瞳剂,术后口服醋氮酰胺,这样可以有效的控制术后眼压。     

小切口无缝线超声乳化和后房型人工晶状体植入术

目的探讨小切口（5．5mm）、无缝线超声乳化（Phaco）和后房型人工晶状体（PC－IOL）植入术的临床疗效及其安全性。方法120例（168只眼）老年性白内障施行上述手术，随机选择常规切口白内障案外摘出（ECCF）及PC－IOL术作为对照。结果视力≥0．5在Phaco术后1wk为84．53％，1a后为84．88％，均较大切口ECCE手术对照组为高（P＜0．05）。2组角膜内皮损失率各为6．93％和12．35％（P＜0．01）。未见任何严重手术并发症发生。结论小切口无缝线Phaco和PC－IOL植入术是当代安全有效的白内障摘出手术，手术并发症少，术后视力恢复较快。     

青光眼滤过术后白内障超声乳化摘出术疗效观察

目的 探讨超声乳化术对抗青光眼术后发生白内障的治疗效果。方法 对97例抗青光眼术后发生白内障病例避开原有滤过区选择颞侧切口行超声乳化人工晶状体植入术。对术后视力、眼压、并发症进行分析。结果 97例术后随访3个月，视力1．0以上25例（26％），0．3以下9例（9％）；随访期内无1例眼压升高，原有滤过泡无塌陷。11例（11％）术后5日内出现不同程度的角膜水肿。结论 避开滤过区手术能使抗青光眼术后发生白内障的患眼控制眼压和获得较好视力。     

A four‐year prospective study on intraocular pressure in relation to phacoemulsification cataract surgery

Aim of study: To follow up prospectively the intraocular pressure (IOP) of healthy eyes with senile cataract undergoing phacoemulsification surgery over a duration of 4 years. Patients and methods: Thirty‐five patients entering first eye cataract surgery had IOP measured by applanation tonometry pre‐operatively and on day 1, at 1 month, 6 months, 1 year, 2 years and 4 years after surgery at 9 a.m. and again at 2 p.m. in the Department of Ophthalmology, Oulu University Hospital. Thirty‐four patients attended the 1‐year checkup, and the 2‐ and 4‐year results are available for 31. Results: The pre‐operative IOP was 16.0 (SD 4.3, range 6–25) mmHg in the morning and 16.4 (SD 4.0, range 8–25.5) mmHg in the afternoon. On the first postoperative day, the IOP was 2.1 ± 5.6 mmHg higher than before surgery (p = 0.029). At 1 month, the IOP morning measurement had decreased 2.8 ± 3.6 mmHg, and in the afternoon, the decrease was 3.0 ± 2.7 mmHg from the pre‐operative level. At 6 months, the decrease was 3.3 ± 2.7 mmHg in the morning and 3.6 ± 2.7 mmHg in the afternoon, at 1 year, 3.2 ± 3.0 mmHg and 3.5 ± 3.2 mmHg, at 2 years, 3.2 ± 2.4 mmHg and 3.1 ± 2.8 mmHg, and at the 4‐year postoperative checkup, 3.6 ± 3.4 mmHg and 3.6 ± 2.7 mmHg, respectively (p = 0.000 for all time‐points). Conclusions: IOP decreases by about 3 mmHg (16–23% from the pre‐operative IOP level) after phacoemulsification and remains at this reduced level with no trend towards an increase during 4 years.     

超声乳化白内障吸除术对不伴青光眼剥脱综合征患者眼压的影响

目的:评价白内障超声乳化吸除术对不伴青光眼的剥脱综合征(exfoliation syndrome,XFS)患者眼压(IOP)的影响。方法:接受白内障超声乳化吸除术的不伴青光眼的剥脱综合征患者36例(38眼),不伴有剥脱综合征的白内障患者76例(76眼)。透明角膜切口白内障超声乳化吸除联合折叠人工晶状体植入,术后随访6~12mo,观察术后眼压的变化。结果:XFS组与Non-XFS组术前眼压分别为16.79±2.78mmHg,15.67±2.98mmHg(P>0.05)。XFS组术后1d;1wk;1,6,12mo眼压分别为16.32±3.26,13.59±3.55,13.24±2.38,14.53±2.27,15.10±2.09mmHg。Non-XFS组术后1d;1wk;1,6,12mo眼压分别为16.15±3.12,14.48±2.48,14.35±2.18,15.05±2.17,15.21±2.42mmHg。与手术前相比,术后1wk;1,6moXFS组患者眼压的下降程度较非XFS组的患者大(P<0.05)。术后12个mo,XFS组患者眼压仍较术前低,对照组患者眼压逐渐回到术前水平。结论:不伴青光眼的XFS患者超声乳化白内障吸出术后眼压较手术前明显下降,其下降程度大于非XFS患者。     

白内障超声乳化术后当日眼压升高临床观察

目的　对白内障超声乳化术后当日眼压升高进行临床观察与分析。方法　无术中并发症的晶状体超声乳化术2 0 0眼 ,分为 2 %甲基纤维素及医用透明质酸钠两组 ,对术前眼压 ,术后 4～ 8h及 2 4h眼压进行观察与分析。结果　术后当日眼压升高发生率平均为 3 5 .5 6% ,甲基纤维素组为 46 0 0 % ,医用透明质酸钠组为 2 5 0 0 % ,差别有统计学意义 (P <0 .0 1)。术后 4～ 8h为眼压升高峰值期。结论　晶状体超声乳化术后当日可发生眼压升高。对复杂病例术中应尽量选用高质量黏弹剂并于术后密切观察眼压变化。     

晶状体超声乳化人工晶状体植入术的临床观察

目的探讨白内障施行晶状体超声乳化人工晶状体植入术的特点、手术技巧、并发症及防治措施。方法对65眼白内障施行无缝线5.5mm切口超声乳化人工晶状体植入术。结果术后第1天裸眼视力≥0.5者38眼(58.46%),术后1周视力≥0.5者47眼(72.31%);术后1月视力≥0.5者53眼(81.54%)。术中术后主要并发症有后囊破裂3例(5眼,7.69%);角膜内皮水肿9例(11眼,16.92%)。结论采用无需缝合的反眉状隧道式切口行晶状体超声乳化人工晶状体植入术可获较佳视力,而手术成功的关键在手术者的手术方法和操作技巧。     

爆破式超声乳化在硬核白内障摘出术中的应用

目的 研究爆破式超声乳化术在硬核人障中的应用。方法 对７４例７４眼按硬度为Ⅳ～Ⅴ级的老年性成熟期或过熟期白内障施行爆破式超声乳化术,术中结合自制晶状体碎核钩进行手法劈核。结果 术后第１天、１ｗｋ及３ｍｏ裸眼视力达０．８及以上者分别为７５．６８７％、７９．７３％及８３．８７％,手术前后角散光改变无统计学意义（Ｐ〉０．０５）。角膜水肿５眼,晶状体后囊破裂５眼,少量晶状体物质沉入玻璃体内２眼。结论 该方法适合于硬核人障的超声乳化。     

前房放液治疗白内障超声乳化吸出术后早期高眼压

目的探讨前房放液治疗白内障超声乳化吸出及人工晶状体植入术后早期高眼压合并角膜上皮水肿的可行性。方法白内障超声乳化吸出及人工晶状体植入术1572眼中31眼术后早期高眼压合并角膜上皮水肿,平均眼压46mmHg(1kPa=7.5mmHg),前房放液在裂隙灯显微镜下进行,镊子轻压上方切口后缘,缓慢放出少量房水,即可见角膜上皮水肿明显减轻或消失。结果29眼1次放液后眼压未再升高,角膜上皮水肿消失,其余2眼为后囊膜破裂患者,1眼术后第1d、2d2次放液后眼压恢复正常,1眼术后第1d、2d2次放液联合降眼压药物治疗,于术后5d眼压恢复正常。结论前房放液是治疗白内障术后早期高眼压合并角膜上皮水肿的理想方法。     

改良式前房放液在白内障超声乳化术后早期高眼压中的应用

目的:探讨改良式前房放液法在白内障超声乳化吸出术后早期高眼压的应用价值。方法:对我院3170眼白内障超声乳化吸出术患者中14眼出现术后早期高眼压的患者经过一次性注射器针头轻压角膜侧切口放出部分房水,降低眼压,减轻角膜水肿。结果:经过上述处理后14眼眼压下降为(11.4±5.1)mmHg,角膜透明;视力大于或等于0.7者8眼,0.3～0.5者5眼,0.2者1眼;未出现与改良式前房放液相关并发症。结论:改良式前房放液治疗白内障超声乳化术后早期高眼压简单易行、安全有效,值得推广。     

角膜移植术后白内障应用扭动模式超声乳化吸出术治疗分析

目的观察扭动模式超声乳化白内障吸出术（PKP）治疗角膜移植术后硬核白内障的安全性和效果。方法回顾性分析2009年3月至2009年10月在我院眼科住院行白内障超声乳化吸除术的PKP患者28例（32只眼）临床资料。患者PKP术后11个月至8年,平均3.6年;根据晶状体核硬度分级,分别将28例（32只眼）并发Ⅲ级以上硬核白内障患者随机分为A、B两组,其中男12例（14只眼）,女16例（18只眼）。A组16只眼行常规超声乳化白内障吸出术,B组16只眼行扭动模式超声乳化白内障吸出术。观察术中前房稳定性、能量释放及时间,并比较术后第1天、3天、1周、2周角膜水肿及内皮细胞的变化及手术前后视力情况。结果术中B组前房稳定性优于A组（P〈0.05）;术中能量使用及超声时间明显少于A组,术后第1天、第7天B组角膜水肿情况明显轻于A组（P〈0.05）;术后第1天、第7天B组视力恢复明显优于A组（P〈0.05）。结论扭动模式超声乳化白内障吸出术是一种安全、高效、疗效好的手术方式,尤其对于硬核白内障的处理,优于传统超声乳化白内障吸出术。     

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Purpose

To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL.

Methods

In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra- and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.

Results

At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92–0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28, 95% CI 0.48–38.18). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect post-operative vision.

Conclusion

In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low- and middle-income countries.     

超声乳化术在青光眼白内障三联手术中的应用

目的 评价超声乳化术在青光眼白内障三联手术中的临床疗效。方法 随机选择1999年4月-2001年4月间资料完整的青光眼合并白内障患者行超声乳化白内障摘出后房型人工晶状体植入联合小梁切除术（PHACO组）36眼及白内障囊外摘出后房型人工晶状体植入联合小梁切除术（ECCE组）40眼，随访分析6-17个月。结果 PHACO组术后暂时性高眼压发生率低且术后眼压控制良好，无需加用抗青光眼药物的患者明显多于ECCE组，术后3天及3个月裸眼视力恢复≥0.5者，PHACO组优于ECCE组。术后前房出血，纤维素性渗出，人工晶状体表面色素沉积及黄斑囊样水肿等并发症的发生率，PHACO组明显低于ECCE组。结论 超声乳化白内障摘出后房型人工晶状体植入联合小梁切除术安全，有效。     

The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension

We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IOP values of the 1^st week, 1^st month, 3^rd month, 6^th month, and 1^st year was statistically significant, but that of the 2^nd year was not significant. The increase in ACD and ICA values of the 1^st week, 1^st month, 3^rd month, 6^th month, and 1^st year was statistically significant, but that of the 2^nd year was not significant. The increase in CCT values of 1^st week and 1^st month was statistically significant, but those of 3^rd month, 6^th month, 1^st year, and 2^nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.     

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。     

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.     

白内障超声乳化术与人工晶状体植入术546例

目的 对超声乳化联合人工晶状体植入手术治疗白内障的临床结果进行分析研究。方法 在表面麻醉下对５４６例６７２眼不同类型的白内障患者施行不同切口的超声乳化摘出术,并植入人工晶状体。结果 术后３ｈ及１ｄ裸眼或球镜矫正视力≥０．５者分别占８３．０％、８８．９％;术后１ｗｋ及１ｍｏ视力≥１．０者分别占２７．２％、２８．５％。术前无散光而术后出现散光３５例,但均在＋１．０Ｄ以下,且不同类型的白内障患者术后视力在排除合并症干扰后并无显著差异（Ｐ〉０．０５）。结论 超声乳化加人工晶状体植入术可广泛应用于临床所见的各种类型的白内障。     

Effect of latanoprost/timolol and dorzolamide/tiomolol on intraocular pressure after phacoemulsification surgery

AIM: To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery. METHODS: This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours. RESULTS: The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05). CONCLUSION: When compared with placebo, the use of preoperative fixed combination of latanoprost/ timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes.     

微爆破模式在超声乳化手术中的临床应用

目的探讨微爆破模式超声乳化术结合高负压的使用对角膜内皮细胞的影响。设计前瞻性病例系列。研究对象98例(120眼)老年性白内障患者。方法用爱尔康公司Legacy20000珠峰系统超声乳化仪,将患者分为三组,分别采用爆破、脉冲和连续3种不同超声能量模式行超声乳化白内障吸除术。主要指标患者术前视力、晶状体核硬度以及角膜内皮细胞情况。术中实际超声能量,有效超声时间。术后1天角膜水肿情况,术后1个月最佳矫正视力及角膜内皮情况。结果爆破组术中超声能量及有效超声时间的使用均低于脉冲组和连续组,差异有显著性意义(P<0.001);术后角膜水肿及角膜内皮损失率均低于脉冲组和连续组,差异有显著性意义(P<0.05)。结论应用微爆破模式结合高负压进行白内障超声乳化术,可以有效地减少超声能量的使用,减少角膜内皮的损伤,是一种先进高效的手术技术。(眼科,2006,15:201-205)