小切口非超声乳化白内障摘除联合人工晶体植入术的疗效观察

目的 探讨对白内障病人实施小切口非超声乳化摘除联合人工晶体植入术的临床疗效.方法 对50例(55眼)白内障病人实施小切口非超声乳化白内障摘除联合人工晶体植入术,观察病人术前、术后视力变化.结果 在术后3日、1周及1个月时病人裸眼或矫正视力≥0.5者分别占70.91％(39/55)、81.82％ (45/55)、89.09％ (49/55).6例病人视力低于0.5为视网膜病变者.术后未见巩膜隧道切口渗漏现象,外切口在1周内覆盖结膜上皮,无悬韧带断裂与后囊破裂,瞳孔均呈现出圆形或近圆形.结论 该治疗方法具有创伤小、手术安全、疗效确切、视力恢复速度快,不良反应少.可作为治疗白内障的微创手术推广应用.     

白内障超声乳化及人工晶体植入术138例临床分析

目的 探讨小切口白内障超声乳化摘除及折叠式人工晶体植入术的手术方法和疗效.方法 表面麻醉[1]下行透明角膜切口,对138例(168眼)老年性、并发性、发育性和外伤性白内障行起声乳化摘除并植入折叠式人工晶体.结果 术后第一天裸视力0.4以上者157眼(93.45%);术后第一周矫正视力在1.0以上者152(90.48%);术后第一月矫正视力在1.0以上者156眼(93.48%).结论 透明角膜切口具有切口小、术程短、术后散光小、裸眼视力恢复快、并发症少,能在表面麻醉下安全操作,可门诊手术的优点[2].     

白内障超声乳化及人工晶体植入术138例临床分析

目的探讨小切口白内障超声乳化摘除及折叠式人工晶体植入术的手术方法和疗效。方法表面麻醉[1]下行透明角膜切口,对138例（168眼）老年性、并发性、发育性和外伤性白内障行超声乳化摘除并植入折叠式人工晶体。结果术后第一天裸视力0.4以上者157眼（93.45%）;术后第一周矫正视力在1.0以上者152（90.48%）;术后第一月矫正视力在1.0以上者156眼（93.48%）。结论透明角膜切口具有切口小、术程短、术后散光小、裸眼视力恢复快、并发症少,能在表面麻醉下安全操作,可门诊手术的优点[2]。     

基层医院开展非超声乳化白内障摘出及人工晶体植入术的体会

目的 探讨小切口非超声乳化白内障摘出及人工晶体植入的临床效果.方法 上方角膜缘后直切口,进入前房后连续环形撕囊或截囊,水分离核后,晶状体圈匙摘出晶状体核、囊袋内植入人工晶状体.结果 术后1周视力≥0.5者68眼(66.02%),术后1个月视力≥0.5者90眼(87.38%).结论 小切口非超声乳化白内障摘除术操作简便,不需要昂贵的设备,可取得良好的效果,适合基层医院应用.     

硬核年龄相关性白内障小切口非超声乳化和超声乳化手术临床疗效比较

目的：对比观察硬核年龄相关性白内障采用小切口非超声乳化手法劈核和超声乳化手术治疗的临床疗效。方法：分别实施小切口非超乳手法劈核手术210例和超声乳化手术161例,同期联合人工晶体植入术治疗硬核年龄相关性白内障共371例,比较术后视力、术后散光以及术中、术后并发症。结果：两组术后视力均较术前提高。术后1周和3个月,患者的并发症、术后视力和散光组间比较差异无统计学意义（P〉0．05）。角膜水肿在术后1周均消退。结论：小切口非超乳手法劈核术后并发症少,操作简单,较超声乳化方法更易掌握。与超声乳化相比,远期效果相同。     

超声乳化白内障吸出术后低视力研究

目的探讨超声乳化白内障手术后低视力的原因及对策.方法对412例(418眼)老年性白内障行超声乳化白内障摘除及人工晶体植入术,于术后1天、1周、1月及3月分别测裸眼视力,对低视力者进行病因分析.结果术后第1天低视力者112例(112眼)(26.8%),其原因主要为手术并发症,随着随诊时间的延长,低视力者人数逐渐减少,而且其原因主要为屈光不正和眼底病.结论人工晶体计算误差造成的屈光不正、手术源性散光及眼底病变是造成超声乳化白内障手术后低视力的主要原因,经过术式的改进及术前、术后的治疗可以得到一定的改善.     

小切口非超声乳化白内障摘除术后虹膜瞳孔变化的临床分析

目的探讨小切口非超声乳化的白内障摘除术后虹膜瞳孔变化的原因。方法回顾性总结了我院自2002年3月～2003年3月施行小切口非超声乳化白内障摘除人工晶体植入术后55例57眼虹膜瞳孔近期变化的情况。结果本组患者术后发生的虹膜及瞳孔变化的并发症占33％。结论小切口非超声乳化白内障摘除术后引起虹膜，瞳孔近期变化的原因主要有：术中瞳孔缩小，器械反复进入前房过多刺激损伤虹膜，术中后囊破裂玻璃体脱出，人工晶体襻未植入囊袋内，术后虹膜炎等。     

基层医院行小切口白内障摘除人工晶体植入80例分析

目的探讨在基层医院有限的条件下行小切口白内障摘除及人工晶体植入的可行性、有效性。方法对80例（80眼）白内障患者行球周麻醉小切口白内障摘除及人工晶体植入术。结果80倒手术经过顺利、术中术后并发症少、全部脱盲。术后1周视力：0．5以上者58眼（72．5％）,0．2-04者16眼（20．0％）,0．1者6眼（7．5％）。结论在基层医院比较简陋的条件下行小切口白内障摘除及人工晶体植入术,其经济、有效、安全,能减轻患者经济负担．适宜基层医院推广。     

超声乳化白内障吸出术后低视力研究

目的：探讨超声乳化白内障手术后低视力的原因及对策．方法：对412例(418眼)老年性白内障行超声乳化白内障摘除及人工晶体植入术，于术后1天、1周、1月及3月分别测裸眼视力，对低视力者进行病因分析．结果：术后第1天低视力者112例(112眼)(26．8％)，其原因主要为手术并发症，随着随诊时间的延长，低视力者人数逐渐减少，而且其原因主要为屈光不正和眼底病．结论：人工晶体计算误差造成的屈光不正、手术源性散光及眼底病变是造成超声乳化白内障手术后低视力的主要原因，经过术式的改进及术前、术后的治疗可以得到一定的改善．     

高龄患者白内障摘除人工晶状体植入的临床观察

目的 探讨高龄患者白内障摘除人工晶状体植入术的临床效果。方法 对56例（56眼）高龄白内障患者行白内障囊外摘除或超声乳化吸出术及人工晶状体植入术，术后观察视力，手术并发症及老人的身心改变。结果 术后视力≥0.3者42眼（75％），0．05-0.25者9眼（16％），总脱盲率（91．1％）。结论 在精心准备下，对高龄患者行白内障人工晶状体植入是可行的。     

The problems of cataract surgery and intraocular correction: Russian school achievements and modern trends

The development of the safest and, at the same time, efficient methods of cataract surgery, is not only a topical task of medical science and practice, but also, taking the demographic situation into account, a solution to a social problem. The article describes the main achievements of academician S. N. Fyodorov's school in the field of cataract surgery with intraocular lense (IOL) implantation. Special attention is paid to the key components of cataract extraction technique named "small incision surgery", which is based upon the use of ultrasmall surgical approaches with self-sealing ability and no need for suturing. The main advantages and disadvantages of various types of cataract lense fragmentation, including ultrasound emulsification, mechanic and hydraulic fragmentation, and laser destruction, are described. Topical issues concerning cataract extraction technique under the conditions of complicating ophthalmopathology including the weakness of ciliary zonule system, high-degree myopia, glaucoma, pseudoexfoliative syndrome, small pupil, past injuries and eye surgery, are outlined. The paper also reflects a new qualitative step in the development of intraocular aphakia correction technique under modern conditions. Basic requirements to design parameters and IOL materials are determined from the position of reestablishing the accommodative function and fine visual functions. Ways of IOL design improvement are described especially for their application in non-standard and complicated cases.     

Acute interventions with intraocular lenses implantation

Complications associated with the intraocular lenses (IOL) implantation can be classified into 3 groups: intraoperative, early and late complications. Some of the complications have to be treated at once, otherwise the condition may deteriorate and lead to the occurrence of various secondary complications. One of the intraoperative complications during the IOL implantation can be the impairment of the corneal endothelium which occurs due to the inadequate size of the incision. A part of the IOL loop can remain incarcerated in the corneo-scleral wound during surgery. A strong choroidal hemorrhage may occur, as well as the shallowing of the anterior chamber. Iridodialysis may appear as a consequence of the implant manipulation. IOL can also be subluxated or luxated anteriorly or below the sclera. All of these complications should be promptly attended to. Early postoperative complications that should be treated as soon as possible are the occurrence of the pupillary block, shallow anterior chamber, secondary glaucoma, choroidal detachment, corneal edema and postoperative iritis. Besides the corneal edema, late postoperative complications include the formation of secondary cataract, the occurrence of cystoid macular edema and retinal detachment. The treatment of some of these complications can be delayed for a certain period, while other require the immediate treatment and correction. In this work the author presents his results, the complications encountered in different stages of the IOL implantation, and the immediate interventions that were carried out.     

糖尿病合并白内障摘除人工晶体植入术的护理

目的探讨糖尿病患者行白内障囊外摘除和超声晶体乳化联合人工晶体植入术护理方法。方法对46例(51只眼)糖尿病患者行白内障囊外摘除术和人工晶体植入术,手术前后进行糖尿病知识教育,饮食、运动、药物治疗、血糖监测、并发症的预防等,使手术前后血糖稳定在6.0～8.9mmol/L以内。结果健康教育组血糖控制较好,视力维持较好,稍有提高。结论通过对糖尿病健康教育干预,普及糖尿病知识,提高病人的自我保健和护理能力,可以有效地控制血糖,防止糖尿病性视网膜病变的发生、发展,维持术后视力,可取得白内障摘除和人工晶体植入手术的良好治疗效果。     

多焦点人工晶体治疗老年性白内障的安全性和有效性：随机对照临床试验方案

BACKGROUND: Phacoemulsification with intraocular lens (IOL) implantation has become a well-established treatment for senile cataract. The ideal IOL is characterized by good biocompatibility and resolution, with no spherical aberration. The Acri.LISA 366D is a refractive/diffractive multifocal IOL that differs from traditional multifocal IOLs. Its unique optical design can improve the patient's vision and reduce incident ray scattering, glare and halo. OBJECTIVE: To perform a comparative analysis between the Acri.LISA 366D and the Tecnis Z9001 diffractive multifocal IOL, to determine if there are any differences in biocompatibility and improvement in visual function. METHODS: A prospective, single-center, randomized, double-blind, parallel-controlled study will be conducted at the Affiliated Hospital of Qinghai University in China. Forty cataract patients aged 50–80 years will be randomly assigned to either the Acri.LISA 366D or Tecnis Z9001 IOL (n=20 per group). This study protocol has been approved by the Medical Ethics Committee of Qinghai University Affiliated Hospital in China (approval No. QHY1107K) and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding trial procedure and treatment will be obtained from each patient or their guardians. This trial was registered at ClinicalTrials.gov (NCT02696496). RESULTS AND CONCLUSION: The primary outcome of the trial is to investigate the biocompatibility of the IOL after implantation. The secondary outcomes include visual acuity, refractive changes and the presence of any complications. Outcome measures will be evaluated at 1, 3, 6, 12 and 24 months after IOL implantation. It is anticipated that the data collected from this trial will provide evidence for IOL selection in senile cataract patients.     

The effect of the haptic portion of intraocular lens on the development of posterior capsular opacification in rabbit.

Using a white rabbit model, the effect of the haptic portion of the intraocular lens (IOL) and intracapsular ring on the development of posterior capsular opacification (PCO) after extracapsular cataract extraction (ECCE) with phacoemulsification was studied. Implantation of both the intracapsular ring and IOL developed less PCO than implantation of the IOL alone. ECCE followed by implantation of the intracapsular ring alone also developed less PCO than ECCE alone. Through this experimental work in a rabbit model, it could be conceived that the haptic portion of IOL and the intracapsular ring can prevent the development of PCO.     

Intraocular Lens Power Estimation in Combined Phacoemulsification and Pars Plana Vitrectomy in Eyes with Epiretinal Membranes: A Case-Control Study

Purpose

To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone.

Materials and Methods

Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction.

Results

In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305±0.717 diopters (D) and -0.356±0.639 D, respectively, compared to 0.215±0.541 and 0.077±0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599).

Conclusion

Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.     

Cataract surgery and uveitis

The authors deal with uveitis and cataract from two aspects. The occurrence of uveitis was analysed both before cataract surgery and postoperatively. The authors found in their material that uveitis occurred before cataract surgery in 1.8% and postoperative uveitis in 1.2% of cases. Special emphasis is put on the occurrence of postoperative complications in such eyes and the indications for the IOL implantation in uveitis patients.     

The evolution of cataract surgery,extra- and intraocular correction of aphakia

The evolution of cataract surgery during the recent 2 centuries, and especially in the last 50 years, witnessed essential changes--from reclination of the lens and a traditional extracapsular cataract extraction to cataract microsurgery including phacoemulsification. A lack of the lens in the eye, i.e. aphakia, is considered to be a serious complication. The optic extraocular correction of aphakia is implemented mainly by the use of spectacles and contact lenses, which are not deprived of essential shortcomings. H. Ridley was the first to implant, in 1949, a polymethylmethacrylate (PMMA) intraocular lens (IOL). After that, anterior-chamber and iris-clips lenses as well as extrapupillary lenses with fixation to Sulcus cyliaris, which had by some complications, were offered. Only in 1973, we offered, for the first time in the world practice, an intracapsular implantation and intercapsular fixation of IOLs of various models. The designed intraocular correction of aphakia was checked by time and it is used now in cataract microsurgery, including small-incisions as well as ultrasound and laser phacoemulsification. The use of the lens bag as a natural bed for the fixation and isolation of IOL from intraocular structures is a priority direction in the Russian research ophthalmology.