严格掌握屈光性角膜手术的适应证

严格掌握屈光性角膜手术的适应证陈家祺角膜屈光力占眼全部屈光力的３／４，改变角膜的屈光力将极大地影响整个眼的屈光状态，因而通过角膜屈光手术矫正眼的屈光状态具有巨大的潜力。屈光性角膜手术是一个高度选择性手术，因此严格掌握手术适应证是眼科医生必须慎重考虑的...     

准分子激光术后角膜雾状混浊的研究状况

近年来，人们在努力寻求预防与治疗屈光不正尤其是患病率很高的近视眼的方法。角膜屈光力占眼全部屈光力的３／４，改变角膜的屈光力将极大地影响整个眼的屈光状态，因而通过角膜屈光手术矫正眼的屈光状态具有巨大的潜力。１９８３年Ｔｒｏｋｅｌ〔１〕等把一种新型的角膜...     

个性化角膜屈光手术的研究进展

角膜屈光手术目前正广泛开展，是矫正屈光不正最常见的手术方式。传统角膜屈光手术可能会出现医源性高阶像差，且对不规则角膜的矫正的能力不足，可能导致视觉质量下降、夜间主观症状增加。个性化角膜屈光手术能考虑到角膜形态、厚度与患者需求，为患者提供更好的术后视力及视觉质量。除了作为一期屈光不正的矫正手段外，个性化手术也能为术后角膜形态不规则、高阶像差及主观症状明显的患者提供增效治疗。现就个性化角膜屈光手术的设计原理、适应证、临床应用、并发症、手术效果及患者满意度等方面进行综述。     

疑难性角膜屈光手术分析

目的分析疑难性准分子激光角膜屈光手术的原因、分类、方案设计及治疗效果。设计回顾性病例系列。研究对象非常规疑难性准分子激光屈光性角膜手术患者47眼。方法分析患者进行屈光手术的原因、方案设计及治疗效果。除视力（裸眼、矫正、小孔视力）、屈光度（散瞳和显然验光）、主视眼、角膜厚度、角膜地形图、像差检查等常规术前检查外,还要依据患者情况进行相应的特殊检查,包括角膜多点厚度、角膜曲率时间变化、眩光仪、对比敏感度、眼肌功能、VEP等检查。手术前对患者进行个性化手术设计以及可能的预后评估。主要指标治疗前角膜厚度、视力、角膜地形图变化、屈光度、手术次数。结果疑难角膜屈光手术的界定：除最佳矫正视力小于0．8,还伴有角膜形态、结构异常或屈光参差、弱视等异常,或曾行屈光角膜手术但效果不佳,最佳矫正视力低于0．5,需再次进行角膜屈光手术的患者。疑难角膜屈光手术分类：（1）根据角膜屈光手术史分为手术原性屈光状态异常性、手术原性角膜结构异常性;（2）根据角膜情况分为角膜结构异常性、角膜曲率异常性;（3）根据双眼屈光状态差异分为高度近视伴弱视性、屈光参差性疑难角膜屈光手术。治疗方法：个性化设计手术,地形图引导手术,角膜屈光手术方式包括准分子激光角膜屈光手术（PRK）、上皮下准分子激光角膜磨镶术（Epi—LASIK）、准分子激光角膜表层磨镶术（LASEK）、准分子激光原位角膜磨镶术（LASIK）、治疗性角膜屈光手术（PTK）以及联合手术等。治疗效果：所有患者达到预期最佳矫正视力,其中超过预期矫正视力2行以上者为51．1％（24眼）,超过3行以上者为23．4％（11眼）。预期性：实际矫正度在预期矫正度±0．5D之间者45眼。患者对手术效果满意,随访2     

老视矫正的多样化研究进展

配戴框架凸透镜是矫正老视的主要方式，如单光眼镜、双光眼镜、渐变多焦镜及其他新兴衍射镜片。屈光性手术也为矫正老视提供了新的途径，可分为角膜屈光性手术、晶状体摘除联合可调节型人工晶状体（IOL）植人手术以及巩膜屈光性手术。角膜屈光性手术通过改变角膜的屈光力而改变眼球的屈光状态，包括激光角膜手术和角膜层间植人物手术两类。晶状体摘除联合人工晶状体植人术的关键在于可调节型人工晶状体的研发，现有的单焦调节型及多焦调节型人工晶状体优点是减少眩光或光晕，获得较好的夜间视觉，临床效果仍需进一步研究。巩膜屈光性手术通过增加晶状体赤道部与睫状肌的距离治疗老视，包括睫状体前巩膜切开术、激光老视逆转术和巩膜扩张术。老视矫正逐渐向多样化发展，为不同需求的老视者提供了更多的选择。     

角膜地形图角膜波前像差引导的切削治疗术后屈光回退

目的探讨运用以角膜地形图角膜波前像差引导的最优个性化角膜屈光矫正程序(OptimizedRefractiveKeratectomyORK)治疗各种角膜屈光性手术后,包括放射状角膜切开术(RadialKeratotomyRK)、准分子激光屈光性角膜切削术(PhotorefractioKeratectomyPRK)及准分子激光原位角膜磨镶术(LaserinsituKeratomileusisLASIK)后屈光过矫、欠矫或回退的疗效。方法运用角膜地形图角膜波前像差引导ORK程序及小光斑高速飞点激光扫描系统对38例(57只眼)多种角膜屈光手术后屈光回退、欠矫、过矫等患者行再次激光手术。术后随访6-18个月,观察视力及屈光状态。结果38例57眼手术顺利,全部术眼术后裸眼视力≥0.6,即57眼(100%);≥1.049眼(85.96%);57眼屈光度均少于±1.0D,无严重并发症。结论角膜地形图角膜波前像差引导(ORK)程序矫治RK、PRK、LASIK术后的屈光回退安全有效,但需深入研究和严格掌握适应症。     

角膜屈光手术后人工晶状体屈光度的计算和选择

目的 初步探讨角膜屈光手术后的白内障患者接受超声乳化联合人工晶状体（intraocular lens,IOL）植入手术的效果,并对三种计算IOL屈光度的不同方法的准确性进行比较。方法 回顾性调查自1999年7月至2004年6月间在我院接受白内障手术并且曾行角膜屈光手术（radial keratotomy,RK、photorefractive keratectomy,PRK或laser in situ keratomileusis,LASIK）治疗近视的9例患者（16眼）,对其中可获得角膜屈光手术前的角膜曲率数值（K值）及手术前、后稳定屈光状态的2眼使用临床病史调查法（clinical historymethod,CHM）计算出当前实际K值。另外14眼因屈光手术前后的相关资料记录不完整,故分别使用校正角膜曲率数值法（adjusted keratometrymethod,AKM）和角膜地形图法（corneal topography method,CTM）计算出当前实际K值,各7眼。所有K值均代入SRK/T公式测算出应植入IOL的屈光度,并通过比较白内障术后实际屈光状态和预期屈光状态（-0.50D）之间的差别来评价这三种方法计算IOL屈光度的准确性。结果 16眼术后视力均较术前明显提高。使用CHM计算角膜K值的2眼术后屈光状态和预期屈光状态差值均在±1.00D以内。使用AKM计算角膜K值的7眼中,4眼术后屈光状态和预期屈光状态差值在±1.00D以内,3眼术后屈光状态和预期屈光状态差值在±2.00D以内。使用CTM计算角膜K值的7眼中,3眼术后屈光状态和预期屈光状态差值在±1.00D以内,4眼术后屈光状态和预期屈光状态差值在±2.00D以内。结论 对曾行角膜屈光手术治疗近视的白内障患者可安全施行超声乳化手术,只要选用适当方法均可较为准确地计算出IOL屈光度。对于临床资料完整的患者来说,CHM是提供角膜K值的最佳方法;而对于那些相关资料不完整的患者,AKM和CTM是替代CHM计算角膜K值的有效方法。     

准分子激光角膜原位磨镶术治疗近视疗效观察

准分子激光角膜原位磨镶术(1aser in situ keratomileusis，LASK)是治疗近视的一种新型屈光性角膜手术，矫正屈光范围大，预测性好，术后屈光回退小，视力恢复快，是目前手术矫正近视的最佳方法之一。     

PRK治疗屈光性斜视的临床效果分析

目的：评价角膜屈光手术治疗屈光性斜视的临床效果。方法：对43例（77眼）近视及近视散光并伴有不同程度的斜视的病例进行PRK治疗，术后辅以遮盖疗法等非手术治疗训练，观察术前后斜视的变化。结果：术后在视力得到充分矫正的同时，斜视也得到了改善及消除。结论：角膜屈光手术治疗屈光性斜视是一种有效的方法。     

角膜屈光矫正手术后白内障手术

目的:探讨角膜屈光矫正手术后白内障手术的诊疗特点。方法:对2005/2008年间于我院就诊的4例角膜屈光矫正手术后白内障患者行白内障超声乳化吸出术+人工晶状体植入术。依据患者提供的角膜屈光手术资料,分别采用临床病史法或角膜后表面曲率法计算矫正角膜曲率及人工晶状体度数。术后随访观察角膜情况、手术并发症、裸眼视力、最佳矫正视力、术后屈光状态等。结果:术后最佳矫正视力较术前明显提高。术后稳定屈光度与手术前预留屈光状态比较误差范围为-1.00～+1.25D。结论:对角膜屈光手术后的白内障患者施行白内障超声乳化吸出术+人工晶状体植入术是可行的。然而只有了解这类患者病情特点,掌握手术前后诊疗方法,准确计算人工晶状体度数,才能达到满意的疗效。     

Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden.

PURPOSE: To evaluate dissatisfied patients and those with subjectively worse visual ability after cataract surgery and to analyze how these factors relate to poor visual acuity results (worse than 20/40). SETTING: Department of Ophthalmology, Norrlands University Hospital, Ume?, Sweden. METHODS: A prospective, population-based study of cataract surgery outcome was conducted. All patients (459 surgeries) who had cataract surgery during a 1 year period were studied using self-administered questionnaires and data from patient records. Outcome measures were (1) patient degree of satisfaction with the result, (2) subjective visual ability after surgery of visually demanding tasks such as reading, television viewing, orientation in unfamiliar surroundings, and distance estimation far and near, and (3) visual acuity results. RESULTS: After surgery, 37 of the 459 cases (8%) were dissatisfied. These patients had a significantly lower age-corrected visual acuity in the operated eye than the satisfied patients (P < .0001). Ten percent said 1 or more visual ability was worse after their cataract surgery. Logistic regression analysis revealed that the visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors. Poor visual acuity after surgery in the operated eye was found in 22%, mostly as a result of concurrent age-related maculopathy, diabetes, or glaucoma. Four percent had no improvement in visual acuity in the operated eye. CONCLUSIONS: Dissatisfaction seemed to rely mostly on visual acuity in the operated eye. Low visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors for subjectively worse visual ability after surgery. The degree of satisfaction after cataract surgery and changes in visual ability differed in important ways from visual acuity as a measure of visual function.     

The evaluation of macular thickness in patients with retinal detachment treated with conventional surgery--preliminary report

The aim of the study was to evaluate retinal thickness in macular area (before and after surgery), and its correlation with visual acuity in patients with retinal detachment treated conventional surgery. Twenty eyes of 20 patients, treated in our clinic and eyes of 20 healthy subjects without any ocular pathology were evaluated. Retinal thickness in macular area (obtained with retinal thickness analyzer RTA - TALIA Technology) and visual acuity achieved after surgery compared with ocular pathology before and after surgery were analyzed. The correlation between visual acuity changes after successful surgery and macular thickness was evaluated. Retinal thickening in macula in patients with detached retina (even if macula was attached), and immediately after successful surgery in comparison to control group was observed. In selected cases, withdrawal of subclinical macular edema correlated with improvement of visual acuity. RTA allows for quantitative evaluation of retinal thickness in macula and its correlation with visual rehabilitation in patients with retinal detachment treated conventional surgery. Therefore RTA can be a useful tool in monitoring and determining visual acuity improvement.     

Correlations between optical coherence tomography measurement of macular thickness and visual acuity after cataract extraction

PURPOSE: To investigate correlations between optical coherence tomography macular thickness measurements and visual acuity after cataract surgery. METHODS: Sixty-two patients underwent routine cataract surgery as part of a randomized clinical trial of oral Cox-2 inhibitor prophylaxis of cystoid macular oedema. Optical coherence tomography was used to quantify several parameters of macular thickness. Optical coherence tomography measurements were obtained before surgery, day one, week two and week six after surgery. These measurements were then correlated with logMAR best-corrected visual acuity. RESULTS: Optical coherence tomography macular thickness parameters increased after surgery by up to 20%. A significant correlation was identified between foveal minimum macular thickness and best-corrected visual acuity at day one and week six after surgery. Other macular parameters failed to show any significant correlation. At day one and week six, the 10 patients with greatest macular thickness had significantly lower visual acuity than the other patients. CONCLUSION: In this study routine cataract surgery caused an increase in macular thickness. Some significant positive correlations between macular thickness and best-corrected visual acuity were found, although not for all parameters or time points. There may be a threshold relationship between degree of foveal anatomic change and significant loss of visual acuity.     

Results of epiretinal membrane removal combined with PEA and IOL

We examined 558 eyes from 538 surgical cases of idiopathic epiretinal membrane with respect to the effectiveness of the triple surgery that involves concomitant intraocular lens surgery, the most appropriate timing for the evaluation of postoperative visual acuity, and the relationship between the pre- and postoperative visual acuity. From the viewpoint of the timing of the intraocular lens surgery, we classified our patients into 4 groups: (1) a phakic eye group; (2) a two-step surgery group; (3) a triple surgery group; and (4) an intraocular lens group. The visual acuity evaluation was performed in 22 eyes from the phakic eye group based on the patient's age being 45 years or younger, in all 326 eyes from the triple surgery group, and in all 86 eyes from the two-step surgery group. We excluded the intraocular lens group from the visual acuity evaluation. The timing of the visual acuity evaluation was one year after the surgery for the phakic eye and triple surgery groups, and one year after the intraocular lens surgery for the two-step surgery group. The postoperative visual acuity was correlated with the patient's age. When a patient was less than 55 years of age, the postoperative visual acuity correlated positively with age. In contrast, when a patient was 55 years of age or older, it correlated inversely with age. The postoperative visual acuity was significantly correlated with the preoperative visual acuity, and it was possible to predict the postoperative visual acuity based on a regression equation. The preoperative visual acuity necessary for a postoperative visual acuity of 20/20 or more was 20/20 for patients under 40 years old, 20/40 for 40-59 years, 20/32 for 60-79 years, and 20/20 for 80 years and older.     

Visual quality of life after macular hole surgery: outcome and predictive factors

BACKGROUND: In the present study we evaluated the functional success after macular hole surgery in correlation to visual quality of life and looked for predictive factors determining surgical success. METHODS: Fifty-nine patients that underwent pars plana vitrectomy for idiopathic macular hole were included. Follow-up visits were performed in regular intervals after surgery and included a clinical examination, optical coherence tomography (OCT) and measurement of visual acuity. To assess the visual quality of life patients filled out the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) before and three months and one year after surgery. RESULTS: Macular hole closure was achieved in 57 of 59 patients (97%). Mean visual acuity increased from 20/100 preoperatively to 20/34 one year after surgery (p = 0.02). Despite good visual acuity (20/27) in the fellow eye, visual quality of life (VFQ composite score) rose from 75.9 +/- 14.4 (SD) to 81.5 +/- 14.2 one year after surgery (p<0.001). Although there was no correlation between the increase in visual quality of life and visual acuity, the increase in VFQ-25 could be well predicted: low visual acuity and significant impairment on VFQ-25 testing preoperatively made patients most likely to benefit from macular hole surgery. A relatively high retinal thickness measurement at the hole border measured on OCT further increases the predictive value. CONCLUSION: Macular hole surgery is associated with an increase in visual quality of life despite good visual acuity of the fellow eye. Preoperative visual acuity, VFQ-25 value and partly OCT may help to predict the increase in patients' vision related quality of life after surgery.     

严重眼外伤的玻璃体切除手术

目的：总结玻璃体手术治疗严重眼外伤的疗效。方法：回顾性分析1999年6月－2000年10月行闭合式玻璃体切除手术的46例（47眼）严重眼外伤患者的资料。结果：术后视力提高33眼（70．2％），不变9眼（19．2％），下降5眼（10．6％），27眼（57．5％）术后和达到0．02以上，15眼（31．9％）视网膜解剖复位，5眼（10．6％）失败，结论：选择适当时机行玻璃体手术可使大多数严重眼外伤患者视力提高。     

LVC程序视野检查在白内障手术中的应用

目的　探讨中央低视力(lowvisioncenter ,LVC)程序视野检查在术前评估白内障低视力患者视功能的价值。方法　白内障低视力患者共30例30眼,其中合并青光眼、入院后行青白联合术者2 1例2 1眼;无青光眼史、单纯行白内障手术者9例9眼。术前1日及术后3月内行LVC程序视野检查。术前同时行视网膜潜视力测定。结果　所有患者在术后总的平均阈值敏感度(meansensi tivity,MS)均有显著提高(P <0. 0 1) ,而颞侧的MS值较鼻侧的MS值改善更为明显。术前视野已有绝对暗点形成的区域,术后仍存在。与视网膜潜视力测定相比,LVC程序视野检查的MS值与术后最佳矫正视力间存在更好的对应关系。结论　术前LVC程序视野检查对于白内障尤其是合并青光眼低视力患者有特殊价值,有助于术者判断该类患者术后的视力、视野的情况,可作为术前估计其潜在视功能的新方法之一     

大量集中白内障手术术后早期视力状况及相关因素分析

目的 统计观察大量集中白内障术后早期视力状况及其影响因素.方法 统计分析1500例大量集中白内障手术患者的术前术后资料,对可能影响术后早期视力以及术中后囊破裂的各个因素(性别、年龄、眼别、术前视力、眼压、角膜曲率、眼轴、晶状体核分级、术式、全身性疾病等)行Logistic回归分析.结果 术后早期视力与术前是否存在黄斑病变、年龄以及是否术中是否后囊破裂玻璃体脱出密切相关,后囊破裂的发生与高度近视(长眼轴)密切相关.结论 术后早期视力是评价大量集中白内障手术效果的重要指标,要高度重视术中后囊破裂玻璃体脱出对术后早期视力的影响.     

青光眼术后经颞侧行小切口白内障手术

目的:探讨表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术效果。方法:对32例40眼青光眼小梁切除术后的白内障患者用倍诺喜表面麻醉联合球结膜下注射20g/L利多卡因麻醉,行改良小切口白内障囊外摘出联合后房型人工晶状体植入术,分析手术的麻醉效果及手术后的治疗效果。结果:全部患眼均能达到理想的麻醉镇痛效果,顺利完成手术,术后视力<0.1者5眼(12.5%),视力0.1～0.4者9眼(22.5%),术后视力≥0.5者26眼(65.0%),所有患眼术后视力与术前比较均有提高。结论:表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术,是治疗青光眼小梁切除术后白内障有效的手术方式,手术操作简便,不需要昂贵的手术设备,适用于基层医院开展。     

Visual results after early surgical treatment of unilateral congenital cataracts

The authors reviewed the records of 25 consecutive patients who had been operated on for unilateral congenital cataracts at 1 year of age or younger and who had been followed for a period of 5 years or longer. Excluded were patients who demonstrated retinal and optic nerve anomalies. Five eyes achieved 20/40 or better Snellen visual acuity, 5 eyes achieved 20/50 to 20/100 visual acuity, and 15 eyes had 20/200 or less visual acuity. All patients with visual acuity of 20/40 or better had cataract surgery performed before 17 weeks of age, the critical period, and surgery was scattered within this time frame. For surgery performed between 17 weeks and 1 year of age, the best achieved visual acuity in children with surgically significant unilateral congenital cataracts was between 20/50 and 20/100. There was no correlation between the age at the time of surgery and the attainment of these visual levels in this patient subset.