玻璃体切除术治疗合并视网膜脱离的重症眼外伤疗效分析

目的评价玻璃体手术救治合并视网膜脱离的重症眼外伤的疗效。方法对近3年来我院收治的39例(39只眼)合并有玻璃体出血、外伤性视网膜脱离的重症机械性眼外伤患者的病史资料和随访情况作回顾性研究分析报告。结果39只眼中最后随访时36只眼(36/39,92.3%)视网膜成功复位,其中32只眼(32/39,82.1%)首次手术后痊愈。15只眼巨大裂孔中14只眼(14/15,93.3%)视网膜成功复位。最后随访时34只眼(34/39,87.2%)视力有明显提高,手术前后视力比较,差异显著(χ2=29.632,P<0.01)。结论玻璃体视网膜手术救治合并视网膜脱离的重症眼外伤有良好的疗效,各期良好的手术处理均对最后视功能的恢复有重要作用。     

穿孔性眼外伤玻璃体手术的视力恢复和影响因素

目的 探讨穿孔性眼外伤显微玻璃体视网膜手术(Micro—vitreoretinal surgery，MVRS)后视力恢复和影响因素。方法 用MVRS联合眼内异物取出、视网膜切开、氟碳液、内光凝及内填充等治疗穿孔性眼外伤113例患者。结果 出院时≥数指(CF)视力88只眼(78％)，≥0．1视力16只眼(24％)。55例随访6～28个月≥CF视力50只眼(90％)，0．1～1．2视力27只眼(49％)。出院时视网膜复位111只眼(98％)，远期视网膜解剖复位率90．9％。在伤后14天之内手术，视力达优(视力≥0．1)。者占34．8％，但10处理无显著差别。IOL及保留晶体组、非视网膜切开组、无填充组及单纯玻璃体积血组视力达优者，分别占35．6％、25．2％、39．5％和41％。经X^2处理前二者无显著差别；后二者有显著差别。结论 MVRS术后视力恢复与手术并发症和外伤严重程度等因素有关，预防术后PVR发展和牵引性视网膜脱离(Traction retinal detachment，TRD)是提高术后视力恢复的关键。     

糖尿病性视网膜病变玻璃体切割术视力预后的多因素分析

目的 评价多种因素与糖尿病性视网膜病变玻璃体切割术后视力的关联情况.方法 对90例行玻璃体切割术的糖尿病性视网膜病变患者进行回顾性分析.分析术前矫正远视力、糖尿病病程、空腹血糖、尿蛋白、玻璃体积血时间、术中是否剥膜等因素与术后视力预后的关系.结果 统计学分析P<0.05的指标有:糖尿病性视网膜病变的分期、空腹血糖波动>3mmol/L、尿蛋白>100ug/L、既往是否行眼底激光光凝术、玻璃体积血时间、术前视力、手术次数、血压是否控制在150/85mmHg(1mmHg=0.133kPa)以下;统计学分析P>0.05的指标有:患者年龄、性别、是否应用胰岛素、是否注入惰性气体或硅油、术中是否剥膜,是否合并网脱.结论 糖尿病性视网膜病变严重,糖尿病病程长,空腹血糖控制不稳定,肾脏功能的损害,玻璃体长时间积血,术前低视力,多次手术,术中联合行白内障手术,合并有高血压病是影响术后视力的重要因素.     

25G微创玻璃体切除术治疗眼内异物的疗效及术后视力的影响因素分析

目的:探讨经25G微创玻璃体切除手术(PPV)治疗的眼内异物的临床特征及疗效,分析术后视力的影响因素。方法:收集西南医科大学附属医院眼科2016-01-01/2019-01-01以眼内异物并行25G微创玻璃体切除手术治疗的患者105例105眼,对患者眼内异物的临床特征、PPV的疗效和最佳矫正视力(BCVA)等情况进行回顾性研究并统计分析术后视力的影响因素。结果:患者105例中以中青年男性居多,多来自于乡镇。异物类型以金属常见,共计62眼(59.0%),主要由Ⅰ区进入眼内(78眼,74.3%)。术中异物取出率100%。术前BCVA≥0.1的患者17眼,BCVA<0.1者88眼;术后BCVA≥0.1患者43眼,BCVA<0.1患者62眼,术后BCVA较术前BCVA有提高(P<0.05)。经多因素Logistic回归分析,术前较差的BCVA、视网膜脱离和眼内炎是术后视力较差的独立危险因素。结论:25G微创玻璃体切除手术可以改善大多数眼内异物患者视力。术前较差的BCVA、合并视网膜脱离和眼内炎是术后视力较差的重要危险因素。     

增殖型糖尿病视网膜病变玻璃体切割术后视力不良的相关因素研究

目的 调查增殖型糖尿病视网膜病变玻璃体切割术后视力低于0.1的发生频率及相关因素.方法 回顾性分析95例120只眼增殖型糖尿病视网膜病变行玻璃体切割手术治疗患者的临床资料,在术后视力低于0.1和大于等于0.1两群间,对可能影响术后视力的相关因素进行比较.结果 37只眼(31%)术后视力低于0.1.根据单变量分析,术后视力不良与术前黄斑脱离、眼内填充物填充、术后高眼压及术前未进行全视网膜光凝治疗具有较高的相关性.根据多变量分析,术后视力不良与术前黄斑脱离及术后高眼压的关系更为密切.结论 增殖型糖尿病视网膜病变玻璃体切割术后视力低于0.1与术前黄斑脱离及术后高眼压密切相关.     

玻璃体切割治疗后段眼内异物伤视力预后及相关因素分析

目的 评价经玻璃体切除手术治疗后段眼内异物伤的临床疗效,以及术后视力预后的主要影响因素. 方法 于2008年9月至2011年6月,经玻璃体切除治疗后段眼内异物伤患者64例64眼,对术前最佳矫正视力 (BCVA)、异物大小、异物位置、外伤严重程度、手术时间、视网膜脱离(RD)与术后BCVA的关系进行分析.结果 经玻璃体切除术后BCVA≥0.1者50只眼(78.13％),≥0.5者18只眼(28.13％).玻璃体切除联合眼内异物取出手术后影响BCVA的因素为伤口长度、术前BCVA、手术时机、RD、眼内炎、tPVR、异物损伤区域.结论 后段眼内异物伤宜首选玻璃体切割手术.合并 RD、眼内炎和tPVR者应尽早行玻璃体切割手术治疗,但术后视力预后差.     

增殖型糖尿病视网膜病变玻璃体切割术后视力不良的相关因素研究

Objective To determine the incidence and predisposing factors for the poor visual acuity of less than 0.1 after vitrectomy in the treatment of proliferative diabetic retinopathy (PDR). Methods The clinical data of 95 cases (120 eyes) of PDR patients treated with vitrectomy were analyzed retrospectively. Compared the potential predisposing factors to the poor visual acuity between the two groups: one group with postoperative visual acuity of less than 0.1, the other group with postoperative visual acuity of 0.1 or more than 0.1. Results There were 37 (31%) eyes with postoperative visual acuity of less than 0.1. Univariate analysis revealed that there were association between the poor postoperative visual acuity and preoperative macular detachment、intraocular tamponade, postoperative high intraocular pressure, with no preoperative panretinal photocoagulation. Multivariate analysis revealed that there were great association between the poor postoperative visual acuity and preoperative macular detachment, postoperative high intraocular pressure. Conclusions The poor visual acuity of less than 0.1 after vitrectomy in the treatment of PDR has great association with preoperative macular detachment, postoperative high intraocular pressure.     

增殖型糖尿病视网膜病变玻璃体切割术后视力不良的相关因素研究

Objective To determine the incidence and predisposing factors for the poor visual acuity of less than 0.1 after vitrectomy in the treatment of proliferative diabetic retinopathy (PDR). Methods The clinical data of 95 cases (120 eyes) of PDR patients treated with vitrectomy were analyzed retrospectively. Compared the potential predisposing factors to the poor visual acuity between the two groups: one group with postoperative visual acuity of less than 0.1, the other group with postoperative visual acuity of 0.1 or more than 0.1. Results There were 37 (31%) eyes with postoperative visual acuity of less than 0.1. Univariate analysis revealed that there were association between the poor postoperative visual acuity and preoperative macular detachment、intraocular tamponade, postoperative high intraocular pressure, with no preoperative panretinal photocoagulation. Multivariate analysis revealed that there were great association between the poor postoperative visual acuity and preoperative macular detachment, postoperative high intraocular pressure. Conclusions The poor visual acuity of less than 0.1 after vitrectomy in the treatment of PDR has great association with preoperative macular detachment, postoperative high intraocular pressure.     

影响孔源性视网膜脱离术后视力的因素分析

目的:探讨孔源性视网膜脱离(rhegmatogenous retinalde-tachment,RRD)术后视力的恢复情况及其影响因素。方法:回顾性分析我院眼科2002-01/2007-10期间,以孔源性视网膜脱离为第一诊断并经手术治疗视网膜复位成功的病历资料,共99例102眼。其中采用巩膜外路手术81眼、玻璃体联合视网膜手术21眼。观察RRD患者的发病年龄、视网膜脱离范围、视网膜脱离时间、增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)程度、黄斑状态、屈光状态、裂孔位置、手术前后视力、术后裂孔封闭及视网膜复位情况,用卡方检验对不同年龄、视网膜脱离范围、视网膜脱离时间、PVR分级、黄斑状态及屈光状态的患者术后视力变化情况进行分析,根据结果选择差异有统计学意义的因素进行Spearman等级相关检验。结果:视网膜复位术后视力提高53眼(52.0%),视力不变33眼(32.3%),视力下降16眼(15.7%)。不同PVR分级、黄斑状态、视网膜脱离范围、视网膜脱离时间及年龄的术后视力恢复情况有显著差别(P<0.05),不同屈光状态的术后视力恢复情况无明显差别。对上述因素进行Spearman等级相关检验,发现上述术前因素与术后视力关联程度从大到小为:PVR分级(rs=-0.521,P=0.000)、黄斑是否脱离(rs=-0.446,P=0.000)、视网膜脱离时间(rs=-0.423,P=0.000)、视网膜脱离范围(rs=-0.411,P=0.000)、患者年龄(rs=-0.267,P=0.007)。结论:RRD患者的术后视力恢复与术前PVR分级、黄斑状态、视网膜脱离时间、视网膜脱离范围、年龄有关,其中术前PVR分级、黄斑状态、视网膜脱离时间对术后视力的恢复影响最为显著。     

玻璃体切除联合眼内异物摘出术术后视力的影响因素分析

目的:分析玻璃体切除联合眼内异物摘出手术术后视力影响的因素。方法:回顾性分析信阳市中心医院2013年2月至2019年2月眼外伤所致眼内异物者60例(60眼)的临床资料。所有患者行玻璃体切除联合眼内异物摘出手术,分析影响手术效果及术后视力的因素。结果:手术成功率为93.33%(56/60);术后视力<0.1的独立影响因素...     

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.     

小梁切除术后影响视力因素的临床分析

目的探讨青光眼患者小梁切除术术后影响视力的因素.方法回顾分析59例74只眼青光眼患者实施小梁切除术对视力的直接影响诸因素.并对视力较术前降低者展开讨论.结果术后视力改变程度59只眼(79.76%)不变和提高;15只眼(20.24%)降低.视力下降者年龄≤60岁者占26.7%,＞60岁者占73.3%.引起视力下降是综合因素,诸如瞳孔散大,晶状体混浊加重,晶状体前囊色素附丽,前房出血等.结论各类青光眼中慢性闭角型及老年伴有全身性疾病者手术后更具有发生视力下降的可能性,视力下降原因大多系多因素综合.     

Improved functional visual acuity after punctal occlusion in dry eye patients

PURPOSE: To report an increased functional visual acuity, which was recently reported as a simulation of visual function of daily acts of gazing, in dry eye patients after punctal occlusion. DESIGN: Prospective comparative interventional study. METHODS: We measured ordinary best-corrected visual acuity and functional visual acuity in eight eyes of eight dry eye patients after punctal occlusion, and compared the results with those of 22 eyes of 22 dry eye patients without punctal occlusion. RESULTS: Functional visual acuity in dry eye patients after punctal occlusion was 0.962 in decimal notation, which was significantly higher than that of patients without punctal occlusion, 0.283 (P <.0001). CONCLUSIONS: This study shows that punctal occlusion can improve the impaired functional visual acuity of dry eye patients.     

Influence of final corneal thickness in visual acuity after deep lamellar endothelial keratoplasty

PURPOSE: To determine if the final corneal thickness after deep lamellar endothelial keratoplasty (DLEK) is correlated in any way with visual performance. METHODS: One hundred fifty-five consecutive eyes without macular disease underwent DLEK surgery and had pachymetry recorded at 6 months postoperatively. The eyes were grouped according to visual acuity, and pachymetry was correlated between groups: group 1 (20/20, 20/25, or 20/30), n = 38; group 2 (20/40 or 20/50), n = 79; group 3 (20/60, 20/70, or 20/80), n = 30; group 4 (20/100 or worse), n = 8. RESULTS: The mean pachymetry, SD, and range of pachymetry for each group are as follows: group 1, 0.571 +/- 0.080 mm (range, 0.408-0.784 mm); group 2, 0.598 +/- 0.080 mm (range, 0.437-0.816 mm); group 3, 0.605 +/- 0.099 mm (range, 0.454-0.945 mm); group 4, 0.607 +/- 0.120 mm (range, 0.410-0.781 mm). There was no significant correlation between vision and corneal thickness (P = 0.312). There was no statistical difference in pachymetry among all 4 groups (P = 0.323). The influence of pachymetry in visual acuity is not relevant (r = 0.03). CONCLUSIONS: The variance in corneal thickness in DLEK does not seem to influence visual results.     

白内障超声乳化术后视网膜微循环变化特点及影响术后视力因素分析

目的:探讨白内障超声乳化术后视网膜微循环变化特点及影响术后视力因素。方法:回顾性分析。选取2022-01/12于我院行超声乳化术的白内障患者264例264眼为研究对象。根据患者术后3mo最佳矫正视力(BCVA)恢复情况分为BCVA≥0.3组198眼,BCVA<0.3组66眼。比较患者手术前后视网膜微循环指标变化。使用Logistic回归和LASSO回归模型筛选影响患者术后BCVA恢复的因素。构建患者术后BCVA的列线图预测模型并对模型进行验证。建立限制性立方样条Logistic回归模型分析舒张末期血流速度(EDV)、收缩期峰值流速(PSV)与BCVA恢复不佳风险关联强度的剂量-反应关系。结果:术后3mo所有患者EDV、PSV较术前明显改善,阻力指数(RI)水平较术前明显降低(均P<0.05)。术前EDV、PSV、房水细胞分级、眼底病变分级、高龄、Emery分级均是白内障患者超声乳化术后BCVA恢复不佳的影响因素(P<0.05)。采用Bootstrap法对列线图模型验证前后的AUC分别为0.869(95%CI:0.815-0.903)和0.866(95%CI:0.802...     

影响青少年近视矫正视力低下相关因素探讨

目的分析近视性屈光不正儿童矫正视力低于正常的原因,为提高患儿视觉质量提供依据。方法收集在我院初诊的近视患儿68例(130只眼),年龄6~11岁,矫正视力均低于1.0,测量调节灵敏度、正相对调节、负相对调节并记录,采用1%硫酸阿托品眼用凝胶散瞳验光,6个月一次,记录验光结果,随访1年。结果屈光度越大,眼对模糊像的敏感性越低,其中61.83%的患儿调节滞后,13.74%患者调节超前,24.43%患儿调节正常,通过正确戴镜、对症训练,79.39%患儿矫正视力达到1.0,20.61%患儿视力提高。结论近视儿童矫正视力低于正常不仅与屈光度高低有关而且与调节功能异常有关,尽早戴镜并视觉训练是必要的。     

Low-contrast visual acuity cards in pediatric ophthalmology

The usual high-contrast visual acuity chart is well known as the best indicator of central visual function. It has the limitation of only testing the high frequency, high-contrast sensitive cells in the visual system. Some conditions demonstrate a normal response on the standard visual acuity test, but abnormal results when testing visual fields or contrast-sensitivity function (CSF). A variety of diseases fall into this category (multiple sclerosis, diabetes mellitis, glaucoma, CNS tumors in the visual system, etc). The testing of CSF permits us not only to vary the size of the target (spatial frequency), but also to determine the contrast of the target first visible to the patient. Due to the time necessary to conduct the test and the important challenge of obtaining consistent subjective responses, contrast-sensitivity testing in children has been difficult. Recently, Regan has developed low-contrast visual acuity cards similar in format to those used in the Sheridan Gardiner test. Although they do not require literacy, correct responses can be immediately verified and the test can be carried out within a short period of time. These cards allow testing well within the child's limited attention span. In the future it may be possible to use this method of testing to detect CSF defects in amblyopia similar to those previously reported by Hess and others and to see how these defects are affected by standard treatment.Dedicated to Dr. G.K. von Noorden on the occasion of his 60th birthdayPresented at the II International IOC Symposium, Congenital Oculomotor Disorders, Barcelona, Spain, 5 October 1987     

儿童彩色视力表的研制及应用

目的:研制一种儿童彩色视力表,并探讨其应用效果。方法:视力表设计采用视角原理,用彩色图形视标,各行视标间增率以几何级数(10槡10),即1.2589增加。11个彩色图形,共8行,检查距离3m,视力记录为五分记录和小数记录。以标准对数视力表为对照,用新的儿童彩色视力表检查4~6岁儿童100眼。结果:儿童彩色视力表和E字对数视力表检查,两组视力检查结果差异无统计学意义(t=1.2671,P>0.05),两组视力数据存在正相关(r=0.924,P<0.01)。合作率100%,对视标的识别率90%以上。结论:儿童彩色视力表儿童容易接受,具有可靠性,适用于儿童视力的检查。     

Evaluation of factors affecting visual acuity after Descemet stripping automated endothelial keratoplasty

Purpose

To elucidate the factors affecting visual acuity after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods

We reviewed consecutive patients who underwent primary DSAEK for corneal endothelial dysfunction at Inouye Eye Hospital from January 2010 through January 2015 and who had a follow-up of at least 6 months. Fifty-four eyes of 49 patients (24 men and 25 women) were enrolled; the mean age was 72.5 ± 8.7 years. Medical charts were retrospectively examined for best spectacle-corrected visual acuity (BSCVA), intraocular pressure, keratometric value, keratometric cylinder, grade of preoperative corneal edema, preoperative graft thickness, and endothelial cell density (ECD) before and at 1, 3, 6, 12, and 24 months after surgery. A multiple regression analysis was used to evaluate the factors associated with BSCVA at 3, 6 months, and 1 year after surgery. Explanatory variables included age, sex, preoperative factors (BSCVA, degree of corneal edema, donor ECD, and graft thickness), and factors at each time point (keratometric value, keratometric cylinder, and intraocular pressure).

Results

The mean logarithms of the minimum angle of resolution (logMAR) BSCVA preoperatively and at 1, 3, 6, and 12 months after surgery were 1.03 ± 0.49, 0.42 ± 0.26, 0.29 ± 0.21, 0.24 ± 0.20, and 0.22 ± 0.20, respectively. Multiple regression analysis showed that preoperative BSCVA alone was significantly associated with BSCVA at 3, 6, and 12 months.

Conclusion

A better preoperative BSCVA was associated with a better BSCVA after DSAEK, which suggests that DSAEK should be considered earlier than stromal changes such as subepithelial fibrosis occurrence.