小瞳孔下行手法小切口白内障摘除术的临床观察

目的:探讨手法小切口白内障摘除术在小瞳孔白内障中的应用。方法:对30例38眼小瞳孔白内障行手法小切口白内障摘除联合人工晶状体植入术,术中采用不同手术技巧扩张瞳孔,顺利娩出晶状体核。结果:术后1wk裸眼视力>0.5者16眼(42%),0.5≥视力≥0.3者19眼(50%),视力<0.3者3眼(8%),无明显并发症。结论:小瞳孔下行手法小切口白内障摘除手术是一种安全可靠的方法。     

改良手法碎核在小切口白内障摘出术中的应用

目的 探讨定位钩碎核技术在手法小切口白内障手术中的安全性及手术效果.方法 采用定位钩碎核技术对212例(214眼)在表面麻醉下进行白内障囊外摘出及人工晶状体植入术并观察其疗效.结果 212例(214眼)全部成功完成定位钩碎核,术后第2天视力≥0.2者207眼,占96.7％;视力≥0.5者145眼,占67.8％;视力≥0.8者28眼,占13.1％.结论 采用定位钩碎核技术进行白内障囊外摘出术,缩小了手术切口,减少了术后散光,提高了视力.     

梯形小切口手法碎核人工晶状体植入术

目的 探讨梯形小切口及两种手法碎核方法在非超声乳化白内障摘出术中的应用。方法 用梯形小切口及穿刺碎核法和圈套碎核法施行白内障手术57例78眼。结果 术后裸眼视力≥0.5者占60.26%,矫正视力≥0.5者占97.44%,后囊破裂3例。结论 梯形小切口联合手法碎核技术治疗白内障,切口小、娩核容易、角膜损伤小,视力恢复快。     

手法碎核小切口高度近视眼白内障摘除术

目的:探索在基层医院应用手法碎核小切口摘除高度近视眼白内障联合人工晶状体植入手术的效果。方法:观察高度近视眼94眼白内障手法小切口摘除及人工晶状体植入术的安全性、并发症和术后视力结果。结果:术后随访12mo最佳矫正视力大于0.5者77眼(82%),低于0.5者17眼(18%),并发症包括后囊破裂8眼,角膜水肿19眼,黄斑囊性水肿3眼。结论:高度近视眼手法小切口白内障摘除及人工晶状体植入术是安全有效的。     

白色白内障小切口囊外摘除人工晶状体植入

目的:观察白色白内障用弓状切核刀劈核的小切口囊外摘除人工晶状体植入效果.方法:白色白内障32例(32眼),用改进后略呈弓状切核刀行劈核后的小切口囊外摘除并人工晶状体植入,对劈核效果、手术相关并发症和复明效果进行观察.结果:全部32例(32眼)均顺利完成劈核,无劈核相关的并发症.术后3mo,视力≥0.5者,矫正前27眼(84%),矫正后28眼(88%).结论:弓状刀劈核能减少一些并发症.不具备超声乳化时,此术式也能获得较满意的复明效果.     

手法娩核在硬核超声乳化手术中应用的研究

目的探讨硬核白内障超声乳化人工晶状体植入手术的技巧和效果。方法对Ⅳ级和Ⅴ级硬核白内障39例(39眼)施行超声乳化联合手法娩核手术,观察术中术后并发症、术后视力及角膜水肿等并进行分析。结果超声乳化时间为0.3～0.8min,平均0.5min。切口无热损伤,无严重并发症发生。全部39例均顺利一期囊袋内人工晶状体植入。术后1周视力≥0.5者29眼占74.36%,术后1月视力≥0.5者34眼占87.18%,其中视力≥1.0者8眼占20.51%。视力≤0.1的3眼(7.69%)中2眼为老年性黄斑变性,1眼为糖尿病性视网膜病变。结论超声乳化联合手法娩核技术可以降低超声能量,具有损伤小、术中术后并发症少、手术时间短、术后反应轻和视力恢复快等优点,是硬核白内障的可供选择的较好的手术方式。     

截囊针旋转晶状体核在手法小切口白内障摘除术的应用

目的探讨截囊针旋转晶状体核在手法小切口白内障囊外摘除术的安全性及效果。方法在96例（108眼）白内障患者施行手法小切口白内障摘除人工晶状体植入术,用截囊针完成晶状体核旋转到前房。观察术后视力、术中及术后的并发症。结果 108眼用截囊针将晶状体核顺利旋转至前房。术后视力0.5以上者82眼,0.3-0.5者16眼,0.1-0.25者6眼,0.1以下者4眼。术中后囊破裂6眼。术后角膜水肿12眼,无严重并发症。结论截囊针旋转晶状体核的方法简便、安全、可靠。     

小切口手法劈核白内障囊外摘除联合人工晶状体植入术

目的:探讨小切口手法劈核白内障囊外摘除联合人工晶状体植入术的疗效、手术技巧、相关并发症及处理方法。方法:回顾分析173例199眼采用小切口手法劈核白内障囊外摘除联合人工晶状体植入术,随访观察1a。结果:裸眼视力≥0.5的眼数术后1d;1wk;1mo;1a分别为70眼(35.2%)、93眼(46.7%)、134眼(67.3%)、158眼(79.4%),矫正视力≥0.6的眼数术后1d;1wk;1mo;1a分别为78眼(39.2%)、101眼(50.8%)、145眼(72.9%)、164眼(82.4%)。结论:小切口手法劈核白内障囊外摘除联合人工晶状体植入术作为防盲手术,具有疗效确切、安全、经济的特点,并发症少,值得临床应用与推广。     

小切口白内障囊外摘除人工晶状体植入

目的　探讨小切口非手法切核白内障囊外摘除人工晶状体植入的手术方法、疗效及手术并发症。方法　对 3 8只眼老年性白内障患者行小切口白内障囊外摘除人工晶状体植入 ,手术结果与同期 5 0只眼 10～ 12 mm大切口手术相比较。结果　小切口组术后 1周矫正视力≥ 0 .5者占 78.9% ,1月矫正视力≥ 0 .5者占 86.8%。术后1周角膜散光为 1.67± 1.0 3 D,术后 1月角膜散光 0 .75± 0 .86D,均小于大切口组 ( P <0 .0 5 )。小切口手术主要并发症为角膜水肿。结论　小切口白内障囊外摘除手术能显著减少术后角膜散光 ,迅速恢复视力。适用于中等硬度核的白内障     

定位钩劈核技术在白内障小切口手术中的应用观察

目的:评价定位钩劈核技术在白内障小切口手术中的应用效果。方法:做5.5～6.0mm一字形巩膜隧道切口,采用定位钩劈核技术对219例219眼老年性白内障进行囊外摘除术并Ⅰ期植入PMMA人工晶状体。结果:219例全部成功完成定位钩劈核,术后3d裸眼视力≥0.5者182眼(83.1%),≥1.0者37眼(16.9%),手术并发症主要有角膜水肿和前部色素膜炎,经常规治疗3d后痊愈。结论:结果提示定位钩劈核技术简便易行,可有效解决核大切口小的矛盾,减少术后角膜散光,早期获得良好的视力。     

小切口非超声乳化白内障摘除术两种娩核法的疗效比较

目的：通过对小切口非超声乳化白内障摘除术中黏弹剂娩核法与晶状体圈匙娩核法的疗效比较,探讨更适合在基层医院中推广应用的手术方法。方法：抽取白内障患者146例166眼随机分为两组,对照组78例84眼,晶状体圈匙娩核; 试验组68例82眼,黏弹剂娩核。对比观察两种手术术后视力恢复情况及术中术后的并发症情况。结果：小切口非超声乳化白内障摘除术黏弹剂娩核法与晶状体圈匙娩核法相比,两者术后后囊膜破裂的发生率相比差异有统计学意义（P〈0.05）。术后视力,散光度及术后并发症比较差异无统计学意义（P〉0.05）。 结论： 同晶状体圈匙娩核法治疗白内障相比较,黏弹剂娩核法能有效保护晶状体后囊膜,可在小切口白内障手术中进行推广。     

小切口非超声乳化白内障手术四种娩核方式的对比观察

目的探讨小切口非超声乳化白内障手术中4种不同娩核方式的特点及疗效。方法选白内障患者200例（200只眼）,随机分为4组,接受小切口非超声乳化白内障摘除联合人工晶状体植入术,分别通过黏弹剂娩核法、前房维持器娩核法、晶状体圈匙娩核法及前房内劈核法完成娩核过程,观察记录娩核时间、术后角膜水肿程度及术后视力。结果娩核时间（s）：黏弹剂组：11±2,维持器组：17±2,圈匙组：24±3,劈核组：63±5,经方差分析及最小显著性差异法（least-significant difference,LSD）检验,各组间均有统计学差异（P=0.00）;术后第1天角膜内皮水肿（≥2级）眼数（只）黏弹粘组：7（15%）,维持器组：10（20%）,圈匙组：19（40%）,劈核组：38（75%）,经检验,劈核组与黏弹粘组、维持器组以及圈匙组均存在统计学差异（Z=-7.477,-6.882,-4.294;P=0.00）,黏弹剂组与圈匙组存在统计学差异（Z=-3.281;P=0.001）。术后第1天视力≥0.3的眼数（只）：黏弹剂组：45（90%）,维持器组：43（85%）,圈匙组：33（65%）,劈核组：13（25%）,经检验,黏弹剂组优于圈匙组和劈核组（P=0.00）,维持器组和圈匙组均优于劈核组（P=0.00）。结论在临床应用中,4种娩核方式各有特点。其中,黏弹剂娩核法、前房维持器娩核法因其操作简便,损伤小,术后视力恢复良好,值得临床推广。     

小切口非超声乳化白内障摘除术中水压法与圈套器法娩核的疗效比较

目的:对比白内障小切口非超声乳化晶状体摘除手术中水压法娩核与圈套器法娩核两种方法的疗效及并发症。方法:白内障患者226例253眼随机分为水压法娩核与圈套器法娩核两组,观察两组不同方法治疗患者手术时间、术中术后并发症、术前与术后角膜内皮计数及黄斑区视网膜厚度变化的情况。结果:术中娩核平均时间:水压法娩核组5±0.79s,圈套器法娩核组4±1.23s;术中并发症:水压法娩核组少于圈套器法娩核组;术前与术后角膜内皮计数的差值两组相比有统计学差异;两组之间术后散光的差异无统计学意义;术前与术后黄斑区视网膜厚度差异两组相比无统计学差异。结论:同圈套器法娩核治疗白内障相比较,水压法娩核疗效好、简单易行、且能够减少并发症。     

小切口非超声乳化白内障手术水法娩核与圈套器娩核方法的对比

目的:对比小切口非超声乳化白内障摘除手术中水法娩核及圈套器法娩核两种方法.方法:326例老年性白内障成熟期患者随机分成水法娩核及圈套器法娩核两组,观察对比两种娩核方法晶体核娩出操作时间、术中并发症及术后角膜水肿情况.结果:娩核操作时间:水法娩核组平均时间20s,圈套器组平均时间90s,水法娩核组手术并发症较少.术后角膜水肿情况:水法娩核组:0级97眼,1～4级82眼;圈套器组:0级39眼2～4级108眼.两组结果有明显差异(x2=24.28,p＜0.01).结论:水法娩核具有操作快速简便、组织损伤轻、术中并发症少、角膜水肿发生率低等优点,适用于基层医院开展大规模的白内障扫盲手术.     

Accommodative intraocular lenses: short-term visual results of two different lens types

PURPOSE: To compare the ability of two types of accommodative intraocular lenses (IOLs) to provide uncorrected near and distance visual acuity (VA) after cataract surgery. METHODS: A total of 108 eyes of 75 patients underwent cataract surgery by phacoemulsification and IOL implantation either bilaterally or monocularly with one of two types of accommodative IOLs: the AT-45 lens (69 eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after cataract surgery. Near VA was measured through the distance correction to obtain the true near vision effect of the accommodating IOL. RESULTS: Uncorrected distance VA of 20/30 or better was achieved by 84.6% of the bilaterally implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL patients 1 year following surgery. Uncorrected near VA of J1 or better was achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the patients with the bilateral AT-45 implant. For J3 or better near acuity, the values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45% of the eyes were emmetropic at 1 year. CONCLUSIONS: Both accommodative IOLs provided good near and distance vision postoperatively. The 1-CU IOL appears clinically to provide slightly better uncorrected distance and distance-corrected near VA than the AT-45 lens.     

Challenges in the management of paediatric cataract in a developing country

AIM: To review the management of cataract in children in a tertiary hospital in a developing country, and to highlight the challenges therein. METHODS: The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital, Enugu from 2005 to 2008 were reviewed retrospectively. Information was obtained on bio-data, pre- and post-operative visual acuity (VA), biometry, and type of surgery, use of intraocular lens (IOL) and presence of co-morbidity. SPSS was used for data entry and analysis. RESULTS: The hospital records of 21 children (26 eyes) were analyzed. There were 12 males (57.1%) and 9 females (42.9%). Pre-operative VA could not be assessed in 11 eyes (42.3%), 14 eyes (53.9%) had VA <3/60 and 1 eye (3.8%) had VA 6/60. Biometry was done in only 5 eyes (19.2%). All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy; 12 eyes (46.2%) had posterior chamber intraocular lens (PC-IOL) implant while 13 eyes (50.0%) had no IOL. After 12 weeks of follow up, vision assessment was available in only 15 eyes. With best correction, VA of 6/18 or better was achieved in only 5 eyes (33.3%). CONCLUSION: Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries. If these challenges are not addressed, cataract will remain a major cause of childhood blindness and low vision in Africa for many years. There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer. Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.     

晶状体前囊膜在青光眼白内障联合术中的应用

目的 探讨晶状体前囊膜在青光眼白内障联合手术中的应用效果.方法 对47例56只眼青光眼合并白内障患者行白内障超声乳化吸出、后房折叠式人工晶状体植入及小梁切除术,术中植入自体晶状体前囊膜,术后随访1~3年,观察术前和术后视力、眼压及术后滤过泡的变化.结果 术后视力较术前显著提高(P＜0.05);术后一周眼压平均(10.6±2.4)mmHg,随访1~3年平均(15.3±2.1)mmHg,较术前用药前后眼压相比均明显下降(P＜0.05);Ⅰ型滤过泡21只眼(37.5%),Ⅱ型滤过泡35只眼(62.5%);术中术后无严重并发症发生.结论 晶状体前囊膜应用于青光眼白内障联合术中能有效防止滤过泡瘢痕化、控制眼压和稳定视力,方法安全有效.     

Visual outcome and success of amblyopia treatment in unilateral small posterior lens opacities and lenticonus initially treated nonsurgically.

PURPOSE: We sought to assess the success of amblyopia treatment in patients with small posterior lens opacities as well as the factors associated with a good visual outcome. METHODS: This was a retrospective study of patients with posterior lens opacities that initially were thought to be too small in size to warrant cataract surgery. The following variables were examined: cataract type, location, diameter, persistent hyaloid vessel, anisometropia, strabismus, and age of detection. Success of treatment of amblyopia was defined as improvement by at least 0.3 logMAR units. Good visual outcome was defined as 20/40 or better. Amblyopia was treated by glasses, patching, and/or atropine. Patients who failed with conservative treatment or had an increase in cataract size underwent surgery. RESULTS: Forty-eight (91%) of 53 eyes were amblyopic. Thirty amblyopic eyes had pre- and post-treatment Snellen acuities. Twenty (67%) had their visual acuity (VA) improved by 0.3 logMAR units or greater. None of the measured variables were associated with successful amblyopia treatment. Twenty-five (49%) of 51 patients had a final VA of 20/40 or better. The only variable associated with good visual outcome was cataract type: 18 of 25 (72%) posterior subcapsular cataract and 6 of 23 (32%) posterior lenticonus eyes achieved VA of 20/40 or better (P = 0.008). Six patients who went on to have cataract surgery experienced a larger improvement in BCVA (4.50 logMar units +/- 2.52 lines) compared with patients treated without cataract surgery (2.36 logMar units +/- 3.11 lines). DISCUSSION: Amblyopia treatment was successful in most cases. A small group of patients who underwent cataract surgery experienced a greater VA improvement; however, it was not statistically significant. Further studies are needed to determine which patients would benefit from cataract surgery.     

人工晶状体植入术后影响视力的因素

目的 探讨白内障囊外摘出人工晶状体植入术后影响视力的因素。方法 ９２例１２０肯术后３月至２年进行随访观察。结果矫正视力１．０及以上者５２眼（４３．３３％）,０．５及以上者１１０眼（９１．６７％）。影响视力的因素有术前测定所需人工晶状体度数欠精确、手术所致的角膜散光、角膜内皮失代偿、前段葡萄膜炎、后发性白内障。结论 术前精确测定所需人工晶状体屈光度,术中操作减少并发症及选择角膜缘小切口,对提高术后视     

超声乳化人工晶状体植入术后影响视力临床分析

目的 探讨白内障超声乳化人工晶状体植入术后影响视力的因素。方法 对94例118眼进行术后1月至1年随访观察。结果 矫正视力1．0以上者38眼（32％）。0．5以上96眼（81％）,主要影响视力的因素;角膜水肿及失代偿、后发性白内障、前段葡萄膜炎及脉络膜脱离。结论 超声乳化是一种较好的手术方法、术中操作损伤小、减少了并发症,对提高视力有极其重要的作用。