先天性白内障6例术后远期随访

先天性白内障是儿童弱视和失明的主要原因.手术后的视力恢复与手术时机及术后处理密切相关,手术成功的主要问题是弱视的治疗.本文报告6例术后远期随访情况.临床资料:6例中双眼4例,单眼2例.手术时年龄自1岁到4岁4例,5岁1例,14岁1例.患眼晶体均完全混浊.术式全部采用截囊加冲吸术.术后戴镜者3例,开始戴镜时间为术后1～5年.术后随访时间为3～16年.随访视力(矫正视力):3例双眼者0.1～0.3,另1例14岁才发病者矫正视力达0.7.但单眼白内障术后视力均较差;1眼为0.01,另1眼0.02.     

超声乳化联合折叠式人工晶体植入术治疗儿童白内障

目的评价超声乳化及折叠式人工晶体植入术治疗儿童白内障的临床效果.方法对15例(20眼)儿童白内障患儿行2.8mm切口超声乳化及折叠式人工晶体植入术,其中先天性白内障11眼,外伤性白内障7眼,低钙性白内障2眼.术后随访3月～26月,观察视力、并发症和角膜曲率的变化.结果先天性白内障术后矫正视力1眼0.05,5眼0.05～0.3,5眼矫正视力≥0.5,外伤性白内障2眼0.12,5眼≥0.6;低钙性白内障2眼≥1.0.术前、术后1月角膜曲率变化差异无显著性.随访中6眼行后囊切开.结论超声乳化联合折叠式人工晶体植入术治疗儿童白内障术后反应轻,并发症少,能最大限度减少手术源性散光.     

儿童单侧性白内障后房型人工晶体植入术

目的　探讨儿童后房型人工晶体植入时机、屈光度选择及疗效。方法　总结 79例 (先天性 2 6例 ,外伤性 53例 )儿童单侧性白内障后房型人工晶体植入术。结果　术后矫正视力 0 5以上者占 72 1 % ,后囊混浊发生率高 ( 93 6% )。结论　植入人工晶体最早年龄 3岁为宜 ,影响儿童术后视力恢复的重要因素是弱视和后囊混浊     

白内障术后远期疗效的临床观察

目的 观察和评价白内障术后远期疗效。方法 对107例128眼行白内障囊外摘出或超声乳化吸入联合人工晶状体植入术后3-8年的视力，远期并发症的临床表现进行观察和分析。结果 术后矫正视力≥0.05者125眼（脱盲率97.66%)；≥0.3者118眼（脱残率92.12%)；眼前段并发症（虹膜损伤，瞳孔变形，IOL夹持）43眼（33.87%)。后囊浑浊，轻度21眼（16.40%)，中重度20眼（15.63%)。结论 现代白内障摘出及人工晶状状体植入术远期疗效良好，提高手术质量是减少和避免各种并发症的最好方法。     

儿童白内障后房型人工晶体植入术

本文总结儿童白内障后房型人工晶体植入54例56眼。术后矫正视力≥0．5者占76．7％。外伤性白内障组占82．1％；无晶体限二期植入组占75％；先天性白内障组占60％。本文讨论了儿童人工晶体植入的特殊性及并发症的防治方法。     

儿童白内障一期连续环形撕后囊手术探讨

目的　探讨儿童白内障术后后囊膜混浊的处理方法及其安全性。方法　对２６ 例（２９ 眼）儿童白内障行巩膜隧道切口囊外摘除白内障联合人工晶体植入术后, 于后囊膜中心穿刺小洞, 向后囊膜与玻璃体前膜之间注入Ｈｅａｌｏｎ 使二者分离, 再以小洞为起点连续环形撕后囊膜, 成直径约３ｍ ｍ ～４ ｍ ｍ 的近圆形裂孔。结果　全部术眼视轴区均透明, １ 眼玻璃体进入前房, ２ 眼后囊膜不规则撕裂。结论　一期连续环形撕后囊术可防止儿童白内障摘除术后后囊膜混浊, 安全可靠     

后囊膜切开大小对先天性白内障术后远期预后的影响

目的评价不同后囊膜切开大小对先天性白内障摘除术后视力、视功能、视轴区混浊(VAO)的影响情况。方法前瞻性临床研究。对年龄<8岁的儿童白内障患者58例(107眼)行白内障摘除人工晶状体(IOL)植入术。记录患儿术前情况,包括视力、眼压、眼位、晶状体混浊程度、全身及眼部合并症、手术年龄。根据术中后囊膜切开直径的大小分成2组:A组为2~<4 mm,B组为4~<5.5 mm。术后定期随访。结果平均随访时间(61.3±12.3)个月,A组20例37眼(单眼3例),B组26例46眼(单眼6例),2组患者基线资料比较差异无统计学意义(P>0.05)。术后5年,A组最佳矫正视力(BCVA)为0.31±0.21,其中6眼BCVA≥0.5(16.2%),具有融合功能的6例,具有立体视功能的4例。19眼(51.4%)在术后7~24个月发生不同程度的VAO,其中6眼因严重的VAO再次手术切除,其余13眼给予YAG激光切开术。B组BCVA为0.48±0.26,其中24眼BCVA≥0.5(52.17%),具有融合功能的8例,具有立体视功能的8例。6眼(13.0%)发生不同程度VAO,其中2眼行YAG激光切开术治疗,且有2例随着术后双眼视功能的建立,眼球震颤减轻甚至消失。术后5年,A组平均眼轴长度较术前增长(2.30±2.06)mm,B组较前增长(2.13±1.53)mm,2组患者在BCVA、VAO发生方面差异有统计学意义(P=0.002,P<0.05;P值均<0.05),在眼轴增长长度、双眼融合功能及立体视功能方面差异无统计学意义(P=0.67,0.837,0.296;P值均>0.05)。结论儿童白内障摘除后房型IOL植入联合前部玻璃体切除术,术中后囊膜切开范围为4~<5.5 mm时不但可以安全植入IOL,便于术中前部玻璃体的有效切除,同时可以明显改善术后视觉质量并减少VAO的发生。     

双眼多焦点人工晶状体植入术后远期视功能的研究

目的探讨双眼植入多焦点人工晶状体（multifocal immocular lenses，MIOL）后的远期视功能的变化规律。方法对16例32眼植入MIOL的白内障患者和13例26眼双眼植入单焦点人工晶状体（mondoeal intraocular lens，SIOL）的白内障患者，在手术后〉6个月时进行视力、对比敏感度及焦点深度的检查，同时进行统计学分析。结果MIOL眼远期近视力和矫正远视度数下的近视力≥4．7的眼数为28眼，明显好于SIOL眼（4眼）；两组的对比敏感度值均位于正常值范围；MIOL眼的焦点深度为（4．93±1．10）D，明显大于SIOL眼[（3．62±1．13）D]。结论双眼植入MIOL在术后远期可以获得满意的非矫正近视力和矫正远视力下的近视力以及中间距离视力，对比敏感度恢复到正常值范围。     

影响白内障人工晶体术后远期视力因素分析

目的 分析总结影响现代晶体囊外 除联合人工晶体植入术术后远期视力的因素与手术操作的关系。方法 对７０眼行现代晶体囊外摘除联合人工晶体植入术口才进行术后一年后的随访,排除人为造成的术后近视,排除用于不镜矫正视力达１．０患者,共有４７例（５８眼）。结果 影响视力因素主要为散光５２眼,占８２．８％;后发障２１眼,占３０％;人工晶体表面膜３眼,占４．２％;视网膜病变３眼,占４．２％;角膜混浊２眼,占２．８     

儿童白内障一期后囊截开及后记主型人工晶体植入术的探讨

目的：探讨不同方法一期后囊截开对儿童白内障后房型人工晶体植入术后晶体后囊膜混浊的预防作用。方法：对２８例儿童先天性白内障和外伤性白内障分别采用一期后囊膜切开、部分切除或联合前部玻璃体切除及后房型人工晶体植入术。术后随访３个月以上。结果：出院时矫正视力≥０．５者达７１％，随访显示８０％术眼视轴区透明，眼底清晰可见。结论：一期切开或部分切除后囊在一定程度上预防儿童白内主后晶体后囊膜混浊的发生。对于穿通     

白内障术后人工晶状体混浊

白内障术后人工晶状体(intraocular lens,IOL)混浊是近来研究的热点之一.亲水性IOL混浊平均发生率不同文献统计差异较大,国内平均发病年龄小于国外.PMMA、硅凝胶和疏水性丙烯酸酯IOL混浊的发生率均较亲水性为低.女性发生率高于男性.糖尿病和青光眼是与IOL混浊关系最大的两种疾病.对比敏感度检查对早期诊断IOL混浊具有重要价值.IOL混浊易被误诊为其他疾病,尤其是后发障,应引起高度重视.IOL置换术是目前治疗IOL混浊的主要手段.手术时机需根据患者视力、年龄等情况具体掌握.置换术后效果明显,严重并发症发生率均较低.二次植入IOL优先选择非亲水性IOL.     

儿童白内障手术的研究进展

白内障手术是儿童内眼手术中最常见的手术,虽然近年来基本手术技术未见更多进展,但仍有许多研究着眼于争论性问题,如围手术期的局部麻醉、囊膜的处理、人工晶状体的类型和度数选择、人工晶状体缝合术、继发性青光眼的风险等.另外,多中心“婴儿无晶状体眼治疗研究”也有了早期的研究结果.     

Secondary glaucoma after pediatric cataract surgery

AIM:To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery.METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011.The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes.RESULTS: The mean follow-up periods of group 1 and 2 were (60.86±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8%) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycin C surgery. One patient underwent a second trabeculectomy + mitomycin C operation for both of his eyes.CONCLUSION: The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.     

Intraocular lens optic capture in pediatric cataract surgery

Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.     

儿童白内障手术治疗的临床观察

目的观察白内障摘出联合人工晶状体植入术治疗儿童白内障的临床疗效并探讨术后并发症的防御措施。方法对45例(60眼)儿童白内障,其中先天性白内障38眼,外伤性白内障22眼,分别采用不同术式联合不同类型的人工晶状体植入,术后随访12个月,对术后视力、术中及术后并发症等进行分析。结果术后脱盲率为91.3%,脱残率为81.0%.术中并发症为后囊破裂和玻璃体脱出,术后主要的并发症为后囊膜混浊、葡萄膜炎、人工晶状体夹持、弱视和斜视、继发青光眼。结论儿童先天性白内障及外伤性白内障行晶状体摘出联合人工晶状体植入,可以有效提高患眼的视功能,而术后的屈光矫正及弱视训练对于患儿视功能重建具有重要作用。     

儿童外伤性白内障手术后影响视力恢复的原因分析

目的 探讨儿童外伤性白内障人工晶状体（IOL）植入术的临床疗效及影响因素.方法 对本院2001年1月～2006年6月的136例3～14岁儿童外伤性白内障的临床资料进行分析.结果 手术脱盲率为92.2%,脱残率为78.9%.8～14岁的脱残率（90.3%）明显高于3～7岁者（68.7%）.应用超声乳化吸出术联合植入肝素处理的聚甲基丙烯酸甲酯（PMMA）硬性IOL,或植入疏水性丙烯酸酯（Actysof）折叠式IOL均可减少后囊浑浊的发生.术后主要并发症为葡萄膜炎、后囊浑浊、继发性青光眼、IOL瞳孔夹持及虹膜粘连.结论 儿童外伤性白内障IOL植入术后视力恢复受多种因素影响,如患儿术前视觉发育状态（与年龄相关）、受伤性质及程度、手术时间的选择、IOL的选择及术中术后并发症的处理等.     

Advances in cataract surgery

Cataract surgery is a technique described since recorded history, yet it has greatly evolved only in the latter half of the past century. The development of the intraocular lens and phacoemulsification as a technique for cataract removal could be considered as the two most significant strides that have been made in this surgical field. This review takes a comprehensive look at all aspects of cataract surgery, starting from patient selection through the process of consent, anaesthesia, biometry, lens power calculation, refractive targeting, phacoemulsification, choice of intraocular lens and management of complications, such as posterior capsular opacification, as well as future developments. As the most common ophthalmic surgery and with the expanding range of intraocular lens options, optometrists have an important and growing role in managing patients with cataract.     

白内障术后感染性眼内炎的临床观察

目的探讨白内障术后感染性眼内炎的感染途径和治疗措施。方法回顾性分析2005至2006年间入院的8例8眼白内障术后感染性眼内炎病例。结合既往病史和临床检查探讨其感染途径。6例行玻璃体切除联合人工晶体摘除,并结合玻璃体腔内药物注射。结果导致感染的途径主要为白内障手术切口。3例细菌培养结果为表皮葡萄球菌。7例随访期末视力有提高,最高达0.3。结论白内障围手术期规范细致的操作是预防术后感染性眼内炎的重要措施。玻璃体切除联合人工晶体摘除是值得采用的有效治疗步骤。     

白内障超声乳化术后混浊人工晶状体置换术

目的探讨白内障超声乳化术后人工晶状体(intraocular lens,IOL)混浊的原因与治疗方法 ,研究改良手术方式以减少手术并发症。方法收集2001年8月至2011年1月在我院因超声乳化白内障吸出联合Hydroview H60M IOL植入术后远期IOL发生混浊的患者14例,在表面麻醉下行IOL置换术,比较术前与术后最佳矫正视力。术中采用IOL剪碎法、旋转法等方式将IOL取出,重新植入STAAR公司疏水性KN-X IOL。将取出的IOL在显微镜下进行观察拍照,用钙特异性茜素红染色并进行病理检查,与未使用的Hydroview H60M IOL对比观察。结果所有病例均成功实施IOL置换术,术后视力为0.4~1.0,有10例IOL重新植入囊袋内,有4例置换的IOL植入睫状沟内。术中晶状体后囊膜破裂1例、晶状体襻残留1例、睫状体出血2例、黄斑囊样水肿2例。混浊IOL茜素红染色呈阳性反应,光学部表面有粗糙的着色颗粒,光学部内有细小颗粒所组成的云雾状或团状着色区。结论 IOL混浊与IOL材质、IOL表面钙离子富集有关,IOL置换术是改善IOL混浊患者视力的有效方法 ,术中使用改良技术可以减少手术期并发症的发生。     

The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis

AIM: To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS: Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS: Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION: This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.