人工晶体眼视网膜脱离

目的：搪塞人工晶体眼视网膜脱离的特点及其手术治疗。方法：应用玻璃体手枚或常规视网膜复位手术治疗１５例人工晶体眼视网膜脱离。结果：术前发现视网膜裂孔７例、术崇高 膜裂孔６例。术后随访５－２４个月,平均１０．８个月,视网膜复位１１例,占７３．３％。未复位２例,视网膜脱离复发２例。结论：人工晶体眼视网膜脱离术前检查困难,但选择手术方法可以使大多数患者得到有效的治疗。     

矢量分析法评价眼内散光对飞秒激光LASIK治疗散光的影响

目的 应用矢量分析法评价眼内散光(ocular residual astigmatism,ORA)对飞秒激光LASIK治疗散光的影响.方法 收集2016年1月至4月在我院行飞秒激光LASIK的患者182例.应用矢量分析法计算ORA,ORA大于等于散光的为高眼内散光组(high ocular residual astigmatism group,HORAG),反之则为低眼内散光组(low ocular residual astigmatism group,LORAG).术后随访6个月,比较两组裸眼视力以及散光矫正率和误差率.结果 术前所有患者ORA为(0.61±0.27)D,其中超过0.75D者58例(31.9％);HORAG患者的ORA大于LORAG患者,两组差异有统计学意义(P＜0.05).术后6个月HORAG患者裸眼视力为1.06 ±0.15,LORAG患者裸眼视力为1.08 ±0.15,两组差异无统计学意义(t=0.97、P=0.35);HORAG误差率(58.11±63.23)％大于LORAG(26.12±35.37)％,两组差异有统计学意义(t=3.43、P＜0.05);HORAG矫正率(146.45±86.63)％较LORAG(122.56±36.31)％大,两组差异有统计学意义(t=2.81、P＜0.05).结论 ORA较大时增加飞秒激光LASIK治疗散光的误差率,影响散光矫正率,进行屈光手术前应进行散光来源分析.     

Keratoconic rigid lens residual astigmatism: treatment and management

Occasionally, residual astigmatism may degrade visual acuity with a rigid lens keratoconic fit. Three cases are presented concerning anterior toric and/or panofocal keratoconic designs. The advantages and disadvantages of this therapeutic modality are discussed and demonstrated.     

PRK矫正二次RK术后残留近视及散光

目的观察准分子激光屈光性角膜切削术治疗二次放射状角膜切开术后残留近视及散光的疗效.方法对我院自1996年3月至1 998年7月间用准分子激光屈光性角膜切削术治疗的二次放射状角膜切开术后残留近视及散光病人29例41眼进行观察,依术前病人屈光度分为两组,第一组＜-3.00D,17例25眼,第二组≥-3.00D,12例16眼.随访时间1年以上.结果术后1年第一组裸跟视力为0.90±0.1 6,第二组为0.87±0.12.第一组最佳矫正视力为1.02±0.1 6,第二组为0.96±0.17.第一组球镜屈光度下降2.29±0.451),第二组下降4.37±1.66D.病人散光度下降2.11±0.73D.结论准发子激光屈光性角膜切削术治疗放射状角膜切开术后残留近视及散光的预测性好,疗效确定,安全可靠.     

Pseudophakic endophthalmitis

We performed a retrospective study on 45 patients admitted to the Rotterdam Eye Hospital and the Ophthalmic Department of the Academic Medical Center in Amsterdam with pseudophakic endophthalmitis. Vitreous loss during cataract extraction was associated with a significantly increased risk of postoperative endophthalmitis when compared with uncomplicated cataract extraction (p < 0.0001). The incidence of pseudophakic endophthalmitis in diabetic patients was not significantly higher as compared to non-diabetic patients. Vitrectomy in the treatment of postoperative endophthalmitis did not improve the final visual acuity, probably because of selection bias. Methiciliin and cephazolin, used intravitreally against gram-positive organisms, failed to provide a good coverage for endophthalmitis due to Staphylococcus epidermidis.     

Toric IOL矫正角膜散光的疗效和残余散光的矢量分析

目的：观察Toric人工晶状体(Toric IOL)植入术矫正角膜散光的临床疗效，并对残余散光和角膜散光进行矢量分析。

方法：回顾性病例观察研究。选取2018-09/2019-10于我院行白内障超声乳化摘除联合Toric IOL植入术的白内障患者63例77眼。术后1wk，1、3mo观察裸眼远视力(UCDVA)、最佳矫正远视力(BCDVA)、主觉验光的残余散光，散瞳后采用OPD-scanⅢ测量Toric IOL轴位，计算IOL轴位偏差度(LAD)。

结果：术后1wk，1、3mo，本组患者UCDVA(LogMAR)分别为0.22(0.15，0.40)、0.30(0.15，0.40)、0.30(0.15，0.40)，均较术前UCDVA\〖0.82(0.60，1.22)\〗、BCDVA\〖0.52(0.30，0.70)\〗明显改善(P<0.008)； 残余散光分别为0.75(0.50，1.00)、0.75(0.38，1.00)、0.50(0.25，1.00)D，均较术前角膜散光\〖2.19(1.73，2.69)D\〗明显下降(P<0.008)。术后3mo，UCDVA(LogMAR)≤0.301的患者占比69%，残余散光≤0.75D的患者占比73%。术后1wk，1、3mo，本组患者LAD中位数分别为2.0°、2.0°、3.0°，LAD≤5°的患者占比分别为81%、82%、77%，最大LAD值为11°。散光矢量分析显示，本组患者术前角膜散光为2.31±0.80D，质心值为1.44D@177°±1.99D； 预测术后残余散光为0.14±0.17D，质心值为0.02D@58°±0.22D； 术后3mo残余散光为0.69±0.53D，质心值为0.05D@142°±0.88D。

结论：Toric IOL可以有效矫正白内障患者角膜散光且具有良好的旋转稳定性。散光矢量分析可直观显示预测术后散光与实际残余散光的差异，有利于分析优化角膜散光的测量、IOL度数计算、手术设计、术后观察等环节。     

Pseudophakic keratoplasty

The author reports on 12 unselected consecutive penetrating keratoplasties performed for pseudophakic bullous keratopathy, in which the intraocular lens was retained. The visual results achieved were significantly better than those in aphakic eyes.     

Ocular residual astigmatism's effect on high myopic astigmatism LASIK surgery

Purpose

To analyze the effect of ocular residual astigmatism (ORA) on the effectiveness of LASIK for treating high myopic astigmatism.

Methods

This is an observational, cross-sectional study. We studied 116 consecutive myopic eyes with −3 diopters (D) or more of astigmatism that underwent LASIK surgery. The magnitude of uncorrected residual refractive astigmatism 3 months postoperatively was measured.

Results

The mean preoperative cylinder was −4.0±0.83 D (range, −7.5 to −3 D) and the mean preoperative ORA was 0.82±0.5 D. The mean residual refractive cylinder 3 months postoperatively was −0.78±0.83 D (range, −3 to 0 D). No correlation was found between ORA and the refractive cylinder 3 months postoperatively (P=0.6).

Conclusion

In eyes with high myopic astigmatism undergoing LASIK, ORA was not correlated with the residual postoperative cylinder.     

Laser in situ keratomileusis retreatment for residual myopia and astigmatism

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) retreatment on eyes with residual myopia with or without astigmatism. METHODS: LASIK retreatment was performed on 35 eyes of 23 patients for correction of residual myopia, with or without astigmatism, with a mean manifest spherical equivalent refraction of -2.17+/-0.82 D (range, -1.00 to -3.87 D) and mean refractive astigmatism of -0.55+/-0.61 D (range, 0 to -1.75 D). Retreatment was performed 3 to 18 months after primary LASIK (mean, 5.1+/-2.6 mo). The corneal flap of the previous LASIK was lifted and laser ablation was performed using the Chiron-Technolas Keracor 116 excimer laser. Follow-up was 12 months for all eyes. RESULTS: At 1 year after retreatment, manifest spherical equivalent refraction was reduced to a mean -0.23+/-0.28 D (range, 0 to -0.87 D), and refractive astigmatism was reduced to a mean -0.16+/-0.25 D (range, 0 to -0.75 D). Thirty-two eyes (91.5%) had a manifest spherical equivalent refraction within +/-0.50 D of emmetropia, and 33 eyes (94.3%) had 0 to 0.50 D of refractive astigmatism. Uncorrected visual acuity was 20/20 or better in 11 eyes (31.4%). Spectacle-corrected visual acuity was not reduced in any eye after retreatment. There were no significant complications. CONCLUSION: LASIK retreatment was effective for correction of residual myopia or astigmatism after primary LASIK. Refractive results were predictable with good stability after 3 months. Lifting the flap during LASIK retreatment was relatively easy to perform and did not result in visual morbidity in eyes treated from 3 up to 18 months after primary LASIK.     

Arcuate keratotomy to correct residual astigmatism after stromal herpetic keratitis

CLINICAL CASE: A woman with a history of recurrent herpes simplex keratitis in the left eye developed endothelial and stromal keratitis after cataract extraction. Because of the resultant corneal distortion a high regular astigmatism appeared. An arcuate keratotomy was performed to improve her visual acuity. DISCUSSION: Corneal astigmatism can appear after herpetic keratitis. An arcuate keratotomy was effective in this case to decrease astigmatism and improve her vision. Keratitis reactivation is possible so antiviral prophylaxis is advisable. Our good results show that arcuate keratotomy can be a useful technique for these patients.     

Evaluating internal and ocular residual astigmatism in Chinese myopic children

Purpose

To investigate the nature of internal astigmatism (IA) and ocular residual astigmatism (ORA) in Chinese myopic children and to identify factors that may influence IA and ORA.

Methods

A total of 206 eyes of 206 myopic children (97 boys and 109 girls; 10.95 ± 2.2 years) were enrolled in this cross sectional study. Total ocular astigmatism (TOA), anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA) and total corneal astigmatism (TCA) were measured directly using either a Hartmann–Shack wavefront sensor or a Pentacam. IA and ORA were calculated by Fourier vector analyses (the definitions of IA and ORA are: IA = TOA ? ACA ? PCA, ORA = TOA ? ACA). Spearman or Pearson correlation was adopted to detect multiple factors that may influence IA and ORA, which were then predicted by linear regressions. Modified compensation factors were applied to evaluate the inter-relationship between corneal astigmatism and ORA.

Results

While the mean values of IA and ORA were ?0.52 DC × 94.8° and ?0.63 DC × 93.0°, respectively, the percentage of ORA power over 1.00 D was as high as 28.64%. Full or under-compensation of ACA by ORA predominated in the enrolled subjects. The mean ORA J₀ and J₄₅ were ?0.311 ± 0.236 and ?0.032 ± 0.156 D, respectively, negatively correlated with the corresponding ACA components (J₀: r = ?0.276, J₄₅: r = ?0.616, p < 0.001). While age was not correlated with either IA or ORA (p > 0.1), the power of IA or ORA was correlated inversely with the axial length (IA: r = ?0.193, p = 0.005; ORA: r = ?0.169, p = 0.015) and positively with the spherical equivalent refraction (IA r = 0.195, p = 0.005; ORA r = 0.213, p = 0.002) and power of corneal astigmatism (IA-ACA: r = 0.302, IA-TCA: r = 0.368, ORA-ACA: r = 0.334, ORA-TCA: r = 0.293). Girls had larger IA powers than boys (0.741 ± 0.345 D vs 0.651 ± 0.340, p = 0.036).

Conclusions

Full or under-compensation of ACA by ORA is common in Chinese myopic children, and the compensation efficiency may decrease with age. Among Chinese children with myopia, a larger ORA is more prevalent with less myopia and greater corneal astigmatism.

     

Pseudophakic glaucoma

Summary Pseudophakia by itself does not cause ocular hypertension. Pseudophakic glaucoma should be defined as glaucoma that would not be present in an eye if it were not pseudophakic. Ocular hypertension was noted in 15 (9%) of 166 pseudophakic eyes. Only 5 eyes (3%) had ocular hypertension requiring treatment. Three of these eyes (1.8%) had permanent ocular hypertension resulting in chronic pseudophakic glaucoma. This study shows that pseudophakic glaucoma is no more frequent than aphakic glaucoma. Secondary glaucoma in pseudophakic eyes is not always related to the presence of the lens.Pupillary block glaucoma and UGH syndrome are directly related to the lens. Secondary glaucoma by ghost cells and by pigment-dispersion are also in some cases directly related to the lens.     

Toric人工晶状体术后残余散光及手术源性散光（SIA）的临床观察

目的　观察Acrysof Toric人工晶状体（intraocular lens,IOL）植入术后的残余散光及手术源性散光（surgically induced astigmatism,SIA）。方法　回顾分析2016年2月至2017年6月行白内障超声乳化吸出联合Acrysof Toric IOL植入的患者52例（62眼）,于术前及术后1个月观察患者的裸眼视力、最佳矫正视力、综合验光、角膜曲率等,并计算出个体SIA、平均数SIA和centroid SIA。结果　术后目标残余散光为0.02~0.32（0.17±0.15）D,术后实际残余散光为0~1.50（0.49±0.37）D,差异有统计学意义 （P＜0.05）。术前角膜散光值为0.93~3.70（1.94±0.75）D,术后角膜散光值为0.68~3.80（1.95±0.80）D。术后个体SIA为0.08~1.39（0.44±0.25）D,平均数SIA为0.44 D,centroid SIA为0.12 D@126°。结论　利用Barrett Toric公式及centroid SIA计算Toric IOL度数精确及稳定,但术后仍残留一定度数残余散光,SIA仍需进一步优化。     

Pseudophakic retinal detachment

A total of 93 cases of pseudophakic retinal detachment are reported. The present study showed that vitreous loss had occurred during cataract surgery in 28% of eyes, indicating that anterior segment complications are an important contributory factor to aphakic retinal detachment in these cases. There was impairment of the retinal view in 46% of eyes, and in 22.5% no retinal breaks could be identified. The main factor responsible for poor visibility was inadequate pupillary dilatation, which was found particularly in association with the use of iris-supported lenses. Detachment of the macula was unexpectedly found to occur in as many as 88% of cases. Reattachment of the retina either by conventional detachment procedures or by pars plana vitrectomy was achieved in 76.3% of eyes. Complications directly attributable to the presence of an intraocular lens (such as dislocation or haemorrhage) are described. Failure of surgery was more likely to occur in eyes exhibiting a poor fundal view, in which the detection of retinal breaks was difficult. The best results were achieved in eyes in which posterior-chamber lenses had been implanted. Offprint requests to: A. Chiguell