重硅油填充术后眼屈光状态的初步研究

目的 研究重硅油填充对眼屈光状态的影响.方法 采用Gullstrand-Emsley模型眼计算重硅油填充眼的屈光状态,在无晶状体眼模型上设计3种后囊膜状态,计算不同状态对屈光的影响.对21例重硅油填充眼视网膜复位患者进行检影,研究重硅油填充眼屈光状态理论和实际差异.结果 重硅油填充可导致有晶状体眼屈光度增加+6.33 D.对于无晶状体眼,后囊膜前凸时镜片屈光度增加+11.30 D,后囊膜为平面时镜片屈光度增加+14.70 D,后囊膜后凸时镜片屈光度增加+19.10 D.重硅油可导致人工晶状体眼屈光度增加约+7.28 D.有晶状体眼、无晶状体眼、人工晶状体眼重硅油填充后实际屈光度增加约(+6.25±3.27)D、(+7.94±3.83)D、(+4.40±1.34)D.结论 重硅油填充使眼球屈光状态向远视方向变化,实际测量值均低于理论计算值,无晶状体重硅油填充眼屈光状态与后囊膜形态密切相关.     

眼内硅油对屈光状态影响的理论推导与临床观察

目的　研究眼内硅油对屈光状态的影响。方法　 ( 1)理论推导 :在 5种模型眼上推导硅油填充后屈光变化。在无晶状体模型眼上设计 4种硅油状态 ,计算其对屈光的影响。 ( 2 )临床观察 :3 4只硅油填充眼 ,测定硅油取出前后的镜片屈光度。结果　 ( 1)理论推导 :不同折射率的硅油可导致不同有晶状体模型眼镜片屈光度增加 6 0 7～ 8 3 9D。对于无晶状体眼 ,房水 /硅油界面为平面时 ,眼屈光无变化 ;硅油形成与玻璃体腔相同的球体、屈光指数为 1 40 5时 ,镜片屈光度改变 -5 47;硅油量过大或不足时 ,眼屈光度随硅油量不同而改变。 ( 2 )临床观察 :硅油导致有晶状体眼屈光改变6 90 5D± 1 40 3D ;无晶状体眼无巩膜环扎者屈光改变 -6 5 8D± -3 3 8D ,巩膜环扎眼屈光改变 -9 10D± -4 42D。结论　 ( 1)硅油导致无晶状体眼近视化 ,有晶状体眼远视化。 ( 2 )Helmholtz模型眼是研究硅油对有晶状体眼屈光影响的最佳理论模型。 ( 3 )眼内硅油对无晶状体眼屈光状态的影响与硅油填充量密切相关。     

硅油填充眼在不同时机行人工晶状体植入的屈光误差比较

目的:比较玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术后屈光误差。方法:回顾性分析选取2009-01/2011-12玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术51例51眼,其中A组17例行玻璃体切割硅油填充联合白内障超声乳化并人工晶状体植入术,术后3～6mo行硅油取出;B组13例行玻璃体切割术后硅油取出联合白内障超声乳化并人工晶状体植入术,C组21例硅油取出术后择期行白内障超声乳化并人工晶状体植入术,比较术后3mo时屈光误差情况。结果:三组平均绝对屈光误差值分别为(0.873±0.256)D,(0.828±0.134)D,(0.473±0.121)D,A组和B组之间差异无统计学意义(P>0.05),C组和A组及B组之间差异有统计学意义(P<0.05)。结论:A超眼轴测量计算人工晶状体度数,玻璃体切割硅油填充眼在取油后择期行白内障超声乳化并人工晶状体植入术屈光误差小。     

硅油填充术后眼屈光状态的分析

目的 :初步观察玻璃体切割硅油填充术后眼的屈光状态。方法 :对 17例已行玻璃体切割硅油填充手术后视网膜基本复位的患者进行检影 ,对比患者术前术后不同的屈光状态并进行分析。结果 :17例术后患者的屈光度均比术前增加 9.15± 1.96D(平均值 )、矫正视力也均有提高。结论 :术后患者的屈光度偏向正是由于晶体后表面被硅油融合后其屈光度的表现     

硅油对眼屈光状态的影响及相关因素分析

目的评估有晶状体或无晶状体囊膜是否保留的不同状态下硅油填充对眼屈光状态的影响,进一步探讨可能影响硅油填充眼屈光度改变的相关因素。方法将行玻璃体硅油填充并拟行硅油取出的69眼依据晶状体的情况分为有晶状体眼组（n=34）、无晶状体囊膜保留完整组（n=22）和无晶状体无囊膜组（n=13）。硅油取出前后行屈光度、视力、眼压、B型超声和超声生物显微镜（UBM）检查。采用多元回归法分析硅油取出前后术眼的屈光度差值与患者年龄、性别、眼别、术前屈光度、硅油填充时间和眼压的相关性。结果有晶状体组、无晶状体囊膜（前或后）保留完整组及无晶状体无囊膜组硅油取出后屈光度的改变量分别为（-9.23±2.82）、（＋1.09±2.50）、（＋5.47±2.97）D,3组间屈光差值的差异有统计学意义（F=160.89,P=0.000）。在有晶状体组中,硅油取出术后屈光度的改变量与年龄（r=-0.140,P=1.000）、性别（r=-0.164,P=0.982）、眼别（r=-0.008,P=0.981）、硅油填充时间（r=-289,P=0.997）和眼压（r=-0.038,P=1.000）间均无明显相关,但与硅油填充前屈光度呈负相关（r=-0.558,P=0.000）。B型超声检查显示,坐位时硅油泡完全与后极部视网膜贴伏。UBM检查显示,在有晶状体眼及无晶状体眼中囊膜后均有玻璃体残留。结论在晶状体、囊膜的不同状态下硅油取出术后的屈光度改变量各不相同。在有晶状体眼中,屈光度改变与硅油填充前术眼的屈光度有关。囊膜后玻璃体残留、囊膜的自身状态影响了硅油泡前表面的形态,导致个体差异性的产生。     

硅油填充术后眼的屈光变化

目的 研究视网膜脱离复位手术硅油填充后各种注视状态下的眼球屈光变化。 方法 采用Gullstrand模型眼参数进行以下分析：（1）非调节状态下正常眼球与硅油填充后眼球的屈光状态;（2）调节状态下正常眼球与硅油填充后眼球的屈光状态;（3）无晶状体眼玻璃体腔填 充后的屈光状态;（4）正常眼球与填充硅油后视网膜像放大率变化;（5）硅油填充后的白内障人工晶状体植入术人工晶状体度数的变化。 结果 （1）与正常眼球屈光相比,硅油填充后,眼球趋向远视,总屈光度变化为+9.19 D;无晶状体眼硅油填充后更趋远视化;（2）硅油填充后如将眼屈光矫正至正视,调节幅度减少1.42 D;（3）硅油填充后常规人工晶状体度数计算公式不再适用,可以通过计算推知合适的晶状体度数。 结论 视网膜脱离复位术并硅油填充后眼球屈光发生了高度远视趋向变化,调节幅度明显下降,常规人工晶状体的有效度数计算在硅油填充后将不再适用。（中华眼底病杂志,2000,16：139-212）     

硅油填充状态下测算人工晶状体屈光度数准确性分析

目的 探讨一种利用数学矫正公式来准确测算硅油填充状态下人工晶状体屈光度数的方法 .方法 选取2005年1月至2006年10月在我院施行硅油取出联合白内障超声乳化吸出及人工晶状体植入术的患者共25例25眼,分成A、B 2组.A组13眼, 为对照组,采用玻璃体切割硅油填充术前提前测定的晶状体度数作为参考值;B组12眼,为公式组,采用矫正公式来进行计算.A、B 2组术前预期术后屈光度均为-1.5 D.分析A、B 2组术后屈光度分布情况,并和预期值之间进行比较.结果 对照组和公式组术后屈光度与预期值(-1.5 D)差值之间进行比较,P=0.035＜0.05,差异均有统计学意义.从差值的均数来看,公式组要优于对照组.结论 硅油填充眼预设晶状体度数时,数学矫正公式不失为一种准确、有效的办法,值得推广,但有一定的适用范围.     

硅油填充眼A超眼轴测算及人工晶状体度数计算

目的:评价声速调整法测量硅油眼眼轴、测算人工晶状体度数的准确性。方法:对2003/2008年于我院治疗的24例硅油填充术后并发性白内障患者,采取坐位眼轴测量并改变硅油眼中超声波的传播速度来修正眼轴长度,再将计算所得眼轴长度代入SRKII公式计算拟植入的人工晶状体度数。行硅油取出术联合白内障摘除+人工晶状体植入术。术后3mo测量眼轴及屈光状态。对手术前后眼轴长度进行对比,将术后屈光状态与术前预期值比较。结果:硅油取出术前平均眼轴长度为25.25±0.65mm,术后平均眼轴长度为24.80±0.67mm,取油前后眼轴长度均值差异无统计学意义。手术后屈光度与术前预期值差值平均为1.50±0.40D,差异无统计学意义。结论:通过坐位测量并调整超声波在硅油中的传导速度,可准确测量硅油填充眼眼轴,较传统方法测算人工晶状体度数准确率更高。     

玻切联合硅油填充术后并发性白内障的手术治疗

探讨白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障的疗效。 方法：回顾分析2007-11/2011-11玻璃体切割联合硅油填充术后白内障患者102例102眼,距离玻璃体手术时间3~9（平均6.1）mo,采用玻璃体腔灌注,先行白内障超声乳化手术,前房注入黏弹剂,行硅油置换,然后人工晶状体植入,环形后囊切开,观察术中、术后并发症,术后视力等。 结果：术后 4wk,102例102眼中,97眼视力不同程度提高,5眼术后视力无改善;后囊破裂2例,无晶状体核坠入玻璃体,无脉络膜脱离。 结论：玻璃体切割联合硅油填充术后行白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障,可有效减少术中、术后并发症,同时避免二次手术所带来的风险。     

硅油眼的硅油取出联合白内障超声乳化术的疗效观察

目的观察玻璃体切除术后硅油填充眼患者硅油取出联合超声乳化人工晶状体植入术的术后视力、屈光度变化和术中及术后并发症情况。方法收集17例(17眼)玻璃体切除术后硅油填充眼的白内障患者,行硅油取出联合超声乳化人工晶状体植入术,观察术前及术后最佳矫正视力(BCVA)、眼压,术中及术后并发症情况,并对术后实际屈光度和术前目标屈光度进行比较。结果随访时间为3～14.5个月,平均(4.00±2.81)个月。6眼术后BCVA为0.05～0.1,6眼为0.12～0.3,4眼为0.4～0.7,1眼>0.8。术后眼压为(13.61±3.67)mm Hg(1mm Hg=0.133kPa),与术前(16.31±6.95)mm Hg相比,差异无统计学意义(Z=1.1043,P=0.2933)。术后实际测得屈光度为(-1.09±3.91)D,与术前目标屈光度(-1.46±1.29)D相比,差异无统计学意义(Z=3.7504,P=0.0527)。术中1眼出现灌注偏离综合征,9眼行中央部后囊膜切除,所有患者术中未出现晶状体坠入玻璃体腔等并发症。术后早期5眼出现轻度角膜水肿,1眼行掺钕钇铝石榴石(Nd:YAG)激光后囊膜切开,2眼发生视网膜再次脱离。结论玻璃体切除硅油填充患者行硅油取出联合超声乳化人工晶状体植入术可有效提高视力,术后实际屈光度与术前目标屈光度较为一致,手术并发症少,手术方法安全、有效。     

Axial length, vitreoretinal pathology, and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM: To evaluate the postoperative refractive prediction error (PE) and determine the factors that affect the refractive outcomes of combined pars plana vitrectomy (PPV) or silicone oil removal (SOR) with cataract surgery. METHODS: The study is a retrospective, case-series study. Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled. Eligible individuals were separated into four groups according to their preoperative diagnoses: silicone oil-filled eyes after PPV (group 1), epiretinal membrane (group 2), macular hole (group 3), and primary retinal detachment (RD; group 4). The variables affecting postoperative refractive outcomes were analyzed, including age, gender, preoperative best-corrected visual acuity (BCVA), axial length (AL), keratometry average, anterior chamber depth (ACD), intraocular tamponade, and vitreoretinal pathology. The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within ±0.50 diopter (D) and ±1.00 D. RESULTS: For all patients, the mean PE was -0.04±1.17 D, and 50.17% of patients (eyes) had a PE within ±0.50 D. There was a significant difference in refractive outcomes among the four groups (P=0.028), with RD (group 4) showing the least favorable refractive outcome. In multivariate regression analysis, only AL, vitreoretinal pathology, and ACD were strongly associated with PE (all P<0.01). Univariate analysis revealed that longer eyes (AL>26 mm) and a deeper ACD were correlated with hyperopic PE, and shorter eyes (AL<26 mm) and a shallower ACD were correlated with myopic PE. CONCLUSION: RD patients have the least favorable refractive outcome. AL, vitreoretinal pathology, and ACD are strongly associated with PE in the combined surgery. These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.     

Association between retinopathy, nephropathy, and periodontitis in type 2 diabetic patients: a Meta-analysis

AIM:To verify the association between retinopathy,nephropathy,and periodontitis in type 2 diabetic(T2 D)patients.METHODS:Several electronic databases were available for our comprehensive search including China National Knowledge Infrastructure(CNKI),Chinese VIP Information(VIP),Wanfang,Web of Science,ScienceDirect and PubMed and were queried for relevant citations(updated to Mar.2019).RevMan was utilized to perform Meta analysis and publication bias detection.After evaluation of the methodological quality of included studies,a fixed or random effect model was utilized to analyze data from included studies.RESULTS:A total of eight articles were finally included in this Meta analysis.In all 3987 subjects,there were 1207 T2 D patients accompanying with microvascular complications and 1734 patients with periodontitis as well.The Meta forest plot presented little heterogeneity of the eight studies(P<0.00001,I²=89%).The total effect demonstrated periodontitis was associated with overall microvascular complications(OR:1.96,95%CI:1.67-2.30,Z=8.25,P<0.00001).Subgroup investigations among the studies in Asian(OR:2.33,95%CI:1.91-2.85)and North American(OR:1.42,95%CI:1.08-1.86)populations confirmed the existed association between retinopathy,nephropathy,and periodontitis.While the strength of such associations between periodontitis and diabetic microvascular complications were more obvious in the Asians than North Americans.All the results indicated that periodontitis was associated with diabetic retinopathy(OR:3.77,95%CI:2.71-5.24),diabetic nephropathy(OR:1.55,95%CI:1.24-1.94)in T2 D patients.CONCLUSION:The periodontitis is associated with diabetic retinopathy,diabetic nephropathy among T2 D patients and further large sample size clinical trials are in need to confirm the findings.     

25G玻璃体切割术后空气与硅油填充治疗孔源性视网膜脱离的疗效比较

目的:比较25G玻璃体切割术(PPV)联合空气或硅油填充治疗孔源性视网膜脱离(RRD)的疗效。方法:前瞻性随机对照研究。收集2018-01/12经我院确诊的RRD患者146例146眼,根据25G PPV术后眼内填充物分为空气组(60例60眼)和硅油组(86例86眼)。术后随访6~12mo,分析两组患者最佳矫正视力(BCVA)、眼压、视网膜解剖复位率及并发症情况。结果:术后1mo,空气组患者BCVA为0.45±0.5,硅油组为0.78±0.65,两组患者BCVA均较术前明显改善,且空气组患者BCVA明显优于硅油组(均P<0.05)。术后3mo,空气组患者视网膜解剖复位率(93.3%)低于硅油组(97.7%),但无差异;术后6mo,两组患者视网膜解剖复位率均为100.0%。本研究纳入患者术中主要并发症是医源性裂孔(6.8%),术后主要并发症是高眼压,术后早期(7d内)硅油眼高眼压比例明显高于空气组(P<0.001),但随访期间两组患者均未出现感染性眼内炎、脉络膜出血等严重并发症。结论:对于简单新鲜的RRD患者,25G PPV术后空气和硅油填充视网膜解剖复位率无差别,术后早期空气填充眼视力优于硅油填充眼,术后高眼压发生率更低。     

Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To report the results of rhegmatogenous retinal detachment (RRD) repair after pars plana vitrectomy (PPV) without operative use of heavy liquid, and utilizing air tamponade in selected cases. METHODS: RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5d. RESULTS: Totally 36 eyes of 36 patients (24 males, 66.7%) aged 53.8±10.9y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes (29, 80.6%) had retinal detachment involving more than one quadrant. Twenty-two (61.1%) eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4% (34/36). Six (16.7%) eyes had intraocular pressure higher than 25 mm Hg. The visual acuity (logMAR) improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively (P<0.001). CONCLUSION: The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.     

Accuracy of segmented measurement of axial length in ultra-high myopia filled with silicone oil using immersion B-scan ultrasonography

AIM: To evaluate the accuracy of segmented measurement of axial length (AL) in high myopia filled with silicone oil by immersion B-scan ultrasonography (immersion B-scan). METHODS: From June 2016 to June 2020, a total of 67 ultra-high myopia inpatients (67 eyes) who underwent silicone oil removal combined with cataract extraction and intraocular lens (IOL) implantation were retrospectively enrolled. The preoperative axial length (AL) of 31 patients with severe cataract were segmented measured using immersion B-scan (B-scan group) and another 36 patients with mild or moderate cataract were measured using IOLMaster 500 (IOLMaster group). The post-operative ALs in two groups were both measured using IOLMaster 500. The IOL power was calculated with Haigis formula. The differences in ALs between pre- and post-surgery, as well as the postoperative refractive spherical equivalent, absolute refractive error, the prediction deviation of postoperative refraction and best corrected visual acuity (BCVA) were compared. RESULTS: The pre- and post-operative ALs were 30.46±1.63 mm (range 28.09-33.51 mm) and 30.42±1.70 mm (range 28.03-33.90 mm) in B-scan group (t=0.644, P=0.542) and 30.51±1.21 mm (range 28.03-33.90 mm) and 30.43±1.27mm (range 28.54-33.50 mm) in IOLMaster group (t=1.843, P=0.074), respectively. Three months after surgery, BCVA were 0.45±0.13 (range 0.3-0.9) and 0.44±0.20 (range 0.2-1.0) in B-scan and IOLMaster group respectively (t=0.086, P=0.932). There was no significant difference of the postoperative spherical equivalent (-3.11±0.65 D vs -3.21±0.51 D, t=0.671, P=0.505) and the absolute refractive error (0.589±0.340 vs 0.470±0.245 D, t=1.615, P=0.112) between two groups. In B-scan group, absolute refractive error within ±0.50 D was found in 18 eyes (58.1%), within ±1.00 D in 26 eyes (83.9%), and within ±1.50 D in 31 eyes (100%). In IOLMaster group, absolute refractive error within ±0.50 D was found in 23 eyes (63.9%), within ±1.00 D in 34 eyes (94.4%), and within ±1.50 D in 36 eyes (Z=0.757, P=0.449). CONCLUSION: The segmented measurement of ALs by immersion B-scan shows comparable measurement accuracy with that of IOLMaster 500 in ultra-high myopia patients with severe cataract secondary to silicone oil filling and can obtain an ideal postoperative refractive state.     

Biometry and refractive outcome of eyes filled with silicone oil by standardized echography and partial coherence interferometry

Background We evaluated the validity of calculations for refractive outcome in cataract surgery in silicone oil-filled eyes. The retrosilicone space (RSS) was included in these calculations. Methods In a prospective study the axial length (AL) of silicone oil-filled eyes was measured. with standardized A-scan echography (SAE) and partial coherence interferometry (PCI). Meldrum’s formula was used to transform the velocity of ultrasound within the vitreous cavity. To investigate whether refractive outcome can be calculated accurately, we assessed the difference between precalculated and final refractive outcome. Furthermore, we determined the advantages and disadvantages of SAE and PCI. A minor aim was to assess whether theAL of the two eyes differed significantly. Results In 85% of 117 eyes the difference between precalculated and postsurgical refraction was smaller than 1 diopter spherical and statistically not significant (p>0.2). The mean AL was 24.1 mm (range 20.0–31.4 mm). The difference in outcome between the two methods was without statistical significance: the AL difference was 0.4 (±2.6) mm on measurement with SAE and 0.04 (±0.46) mm with PCI. PCI has the advantage that it can be performed more easily, without contact, while echography is advantageous in the presence of advanced cataracts. In supine position an oil-free fluid space behind the silicone oil was detected with echography. The mean dimension of this space was 1.9 (±0.67) mm and it was taken into consideration for IOL calculation. The mean AL difference between the two eyes was 0.4 mm, but the difference was greater than 1 mm in 26% of the patients. Conclusion The AL of eyes filled with silicone oil can be measured reliably with SAE and PCI. In supine position the RSS has to be considered to obtain more accurate IOL calculations. There was no private or public financial support for this study. The authors have no proprietary or financial interest in any product mentioned in this article.