干涉条纹视力计预测白内障术后视力的准确性分析

目的 研究干涉条纹视力计预测白内障患者术后视力的准确性及各种影响因素。方法 69只白内障眼在手术前用Heine视网膜视力计进行干涉条纹视力的检查。干涉条纹视力与术后最佳矫正视力进行比较,得出预测准确率、假阳性率和假阴性率。分析了白内障浑浊程度、自内障合并其他病变、术前最佳矫正视力、预测视力大小等因素对Heine视网膜视力计预测准确性的影响。结果 Heine视网膜视力计对白内障患者预测准确率为45．3％,假阳性率3．1％,假阴性率51．6％。预测视力比术后最佳矫正视力平均低3．75行对数视力表视力,预测视力与术后最佳矫正视力相关性较差（相关系数r=0．411）。白内障术前最佳矫正视力≥4．0组预测准确率为60．7％,最佳矫正视力〈4．0组为33．3％,差异有显著性意义（P=0．029）。预测视力≥4．7组预测准确率89．5％,而预测视力〈4．7组预测准确率为26．7％,差异有显著性意义（P〈0．001）。结论 Heine视网膜视力计不能准确预测白内障患者的术后视力,它往往较大程度地低估术后视力。Heine视网膜视力计预测准确性受白内障浑浊程度和术前最佳矫正视力的影响。     

手持式视网膜视力计在屈光间质混浊患眼中视功能的预测评价

目的将手持式视网膜视力计大量应用于临床屈光间质混浊的手术病例，以评估它的临床应用价值。方法将收集的病例234例（308眼）分为三组，术前2天、术后2周进行视网膜视力和最佳矫正视力的测量，分别比较各组中两组数据的符合情况。结果具有Ⅰ、Ⅱ、Ⅲ级晶状体核硬度、Odrich评分1和2分及玻璃体混浊分级Ⅱ级患者两组资料差异无统计学意义，其余均有统计学意义。结论只要屈光间质存有一点能容干涉条纹通过的间隙，视网膜视力计就能发挥它的预测作用。     

视网膜视力计检查在预测白内障术后视力的价值

目的:评价视网膜视力计(retinometer)在预测白内障手术后视力的价值。方法:随机选择各类白内障患者93例106眼,术前采用LAMBDA100视网膜视力计检测患者的预测视力,与术后3mo矫正视力相比较。结果:106眼中12眼(11.3%)术前预测视力与术后视力一致,69眼(65.1%)术后视力好于预测视力(假阴性),25眼(23.6%)术后视力低于预测(假阳性)。结论:视网膜视力计对判断非致密非成熟期白内障的术后视力具有较高的准确性,不同的眼病存在假阴性和假阳性情况,可为术中植入不同类型的人工晶状体提供依据。     

两种干涉条纹视力计对白内障患者术后视力预测的对照研究

目的通过国产干涉条纹视力计与Heine干涉条纹视力计在预测白内障患者术后视力中的应用对比,探讨国产干涉条纹视力计预测白内障患者术后视力的准确性、实用性、可行性。方法将71例(92眼)白内障患者平均分成2组,术后的视功能情况分别用国产干涉条纹视力计与Heine干涉条纹视力计2种方法进行预测,结果与患眼术后最佳矫正视力进行相关性分析对比。结果国产干涉条纹视力计预测的准确率为81.0%(预测视力与术后视力相差2行以内者认为准确),平均预测视力(4.695)与平均术后最佳矫正视力(4.771)比相差不到1行。Heine干涉条纹视力计预测的准确率为43·9%,平均预测视力(4.481)与平均术后最佳矫正视力(4.771)比相差约3行。结论比起Heine干涉条纹视力计,国产干涉条纹视力计检查更能合理的反映视觉功能,对白内障术后视力具有较好的预测性。     

单眼先天性白内障手术的效果

目的 观察单眼先天性白内障儿童行白内障摘出人工晶状体植入术的效果并探讨其影响因素.方法 2～ 12岁单眼先天性白内障摘出联合Ⅰ期人工晶状体植入术61例(61眼).术后随访12 ～56个月,平均(42.7±10.5)月,记录术前情况及术后最佳矫正视力(BCVA)、双眼视功能、并发症及弱视治疗情况.结果 随访期末18例(29.5％)BCVA≥0.5;11例(18.0％)取得良好立体视(＜100″),其中10例BCVA≥0.5.术后视力恢复较好(≥0.5)与较差(＜0.5)者,其晶状体浑浊程度、是否合并斜视及有无做弱视治疗方面的差异有统计学意义(P＜0.05);术后立体视在BCVA、晶状体浑浊程度、是否合并斜视及有无做弱视治疗方面的差异有统计学意义(P＜0.05).结论 患儿术后视力和立体视的恢复与晶状体浑浊程度、眼部并发症、弱视治疗等多种因素有关;双眼视功能的恢复与术后BCVA关系密切.     

超声乳化及人工晶状体植入治疗高度近视白内障

目的:探讨超声乳化人工晶状体植入术治疗高度近视白内障患者的术后疗效。方法:对45例52眼高度近视白内障患者行超声乳化人工晶状体植入术。结果:术后视力43眼(83%)较术前有不同程度的提高,术后视力<0.1者7眼(13%),0.1~0.4者33眼(63%),>0.4者12眼(23%);9眼(17%)术后视力与术前矫正视力比较无明显变化。结论:超声乳化人工晶状体植入术治疗高度近视白内障,同时矫正屈光不正,是安全有效的。     

高度近视白内障人工晶状体植入术的临床观察

目的　观察超声晶状体乳化吸出联合折叠式人工晶状体植入术治疗白内障合并高度近视的临床效果。方法　对70例 (12 5眼 )白内障合并高度近视行超声乳化吸出低度数或负度数丙烯酸酯折叠式人工晶状体植入术 ,观察术中术后并发症、术后视力和屈光状态。术后随访时间≥ 3月。结果　术中和术后并发症有后囊破裂 3眼 ,角膜水肿 12眼。术后 3月最佳矫正视力 <0 1者 4眼 ,0 1～ 0 4者 2 5眼 ,0 5～ 0 9者 86眼 ,1 0～ 1 5者 10眼。 4眼 (3 2 % )晶状体后囊浑浊 ,无视网膜脱离者。结论　超声乳化吸出低度数或负度数丙烯酸酯折叠式人工晶状体植入术治疗白内障合并高度近视 ,是安全有效的。     

同轴1.8mm微切口超声乳化术在超高度近视白内障的应用

目的：观察同轴1.8mm微切口超声乳化术联合负度数人工晶状体植入在治疗白内障合并超高度近视的临床疗效。 方法：选取我院因白内障合并超高度近视行超声乳化吸除术和负度数人工晶状体植入的患者71例98眼进行回顾性研究,记录术前眼轴长度、术前视力、术前最佳矫正视力（BCVA）。观察手术并发症和术后眼部情况。术后随访3～6mo,并记录术后裸眼视力（UCVA）,最佳矫正视力。 结果：术前平均眼轴长度为29.33±1.95mm。术前裸眼视力均<0.05。术后裸眼视力≥0.3共60眼(61％);最佳矫正视力≥0.5为48眼(49%);术中1眼出现晶状体后囊膜破裂;术后20例患者出现双眼干扰症状;后发性白内障6眼,5眼行激光晶状体后囊膜切开术;无视网膜和脉络膜脱离者,术后无眼压升高者。 结论：同轴1.8mm微切口超声乳化吸除术联合负度数人工晶状体植入术是治疗白内障合并超高度近视安全、有效的方法     

高度近视白内障晶状体超声乳化人工晶状体植入术的临床观察

目的 观察晶状体超声乳化吸出联合折叠式人工晶状体植入术治疗白内障合并高度近视的临床效果.方法 对27例(47眼)白内障合并高度近视行晶状体超声乳化吸出,低度数丙烯酸酯折叠式人工晶状体植入术,观察术中、术后并发症,术后视力及屈光状态,术后随访>6月.结果 术中有后囊破裂1眼(2.13%),角膜水肿7眼(14.89%),葡萄膜炎症1眼(2.13%).术后1月-3月矫正视力<0.1者1眼(2.13%),0.1-0.4者12眼(25.53%),0.5-0.8者30眼(63.83%),1.0-1.5者4眼(8.51%).晶状体后囊浑浊6眼(12.77%).观察2年无视网膜脱离者.结论 晶状体超声.乳化吸出,低度数丙烯酸酯折叠式人工晶状体植入治疗白内障合并高度近视安全并且效果良好.     

高度近视眼黄斑劈裂患者白内障超声乳化术临床分析

目的观察高度近视眼黄斑劈裂合并白内障患者行白内障超声乳化吸出及人工晶状体植入术的临床疗效。方法术前行黄斑相干光断层扫描（OCT）检查筛选出高度近视并发黄斑劈裂25只眼施行白内障超声乳化摘出及人工晶状体植入术,随访3～9个月,记录术中、术后并发症,并观察患者术后视力及屈光状态变化。结果术后3个月后矫正视力≥0.8者7只眼（28%）,矫正视力0.5～0.7者4只眼（16%）,矫正视力0.3～0.4者5只眼（20%）,矫正视力0.1～0.2者6只眼（24%）,矫正视力〈0.1者3只眼（12%）。随访期内视力稳定。术后3个月患者平均屈光度为（-1.54±0.87）D。术后无黄斑水肿、出血及视网膜脱离,术后5只眼后囊混浊行激光后囊膜切除术,患者主观满意度96%。结论高度近视并发黄斑劈裂行白内障超声乳化术及人工晶状体植入术,能够有效提高患者视力,提高患者生存质量,手术安全,疗效可靠。     

Comparative Study of Hyperacuity and Retinometer Tests for the Evaluation of Vision in Patients with Advanced Cataract

Objective: To investigates the clinical application value of hyperacuity test for evaluating vision through dense cataracts.Methods: Ten normal subjects (20 years) were tested both with Bailey-Lovie type chart and three points vernier acuity test (one of the hyperacuity test) ; and retinometer test were performed preoperatively and postoperatively in 30 patients (31 eyes) with senile cataract. These patients' lens opacity was classified with LOGS III system.Results: The correlation of vernier acuity and visual acuity of normal subjects is significant. The result of difference compression of pre-surgical and post-surgical vernier acuity of 30 cataract patients is not significant. The correlation of retinometer findings with post-surgical visual acuity shows not statistically significant. Our result shows that there is good correlation between vernier acuity and post-surgical visual acuity.Conclusion: It appears that hyperacuity is a good test for foveal function behind dense cataract and other ocular opa     

高度轴性近视白内障潜视力预测的准确性分析

目的:分析LAMBDA100视网膜计在预测高度轴性近视白内障超声乳化术后视力准确性及影响因素.方法:应用LAMBDA100视网膜计测定91例91眼高度轴性近视白内障患者的患眼视网膜视力,与术后2wk最佳矫正视力进行比较.预测视力与术后视力相差2行对数视力表以内为符合.结果:患者91例91眼预测的总符合率为62%,假阳性率2%,假阴性率36%.晶状体混浊度影响预测准确性,混浊愈重,准确度愈低.眼轴≥32mm预测准确度明显低于眼轴<32mm预测准确度,两组比较有统计学差异(P<0.05).术前最佳矫正视力≥4.0组预测准确率为75%,最佳矫正视力<4.0组为49%,两组比较有统计学差异(P<0.05).结论:对合并非成熟性白内障的高度近视患者,LAMBDA 100可以作为预测术后视力的辅助工具,眼轴、术前视力和白内障程度会影响预测的准确度.     

视网膜计在白内障术前视力预测中的应用

目的　探讨视网膜计在白内障术前视力预测中的意义和应用价值。方法　随机选择各类白内障患者４８ 例（４８ 只眼） ,术前采用ＬＡＭＢＤＡ １００ 视网膜计检测患眼的预测视力,并与术后３ ｍｏ 时的矫正视力作比较。结果　预测视力与术后视力之间呈良好的正直线相关（ ｒ ＝ ０ ．８０２ , Ｐ＜ ０ ．００５） ,结果完全一致８ 只眼（１６７ ％ ） ,假阳性１０ 只眼（２０８ ％ ） ,假阴性３０ 例（６２５ ％ ） 。结论　ＬＡＭＢＤＡ１００ 视网膜计能较准确地反映术前视网膜黄斑区的结构和功能状态,是一种较为理想的视力预测检查方法,但应注意减少假阳性或假阴性结果的产生,文中专门进行了讨论     

48例白内障术后视力预测研究

目的 研究探讨视网膜计在白内障术后视力预测中的意义和临床应用价值。方法 随机选择各类型白内障患者４８例（４８只眼）,采用ＥＣＣＥ／ＩＯＬ手术方法,术前用ＬＡＭＢＤＡ１００视网膜计检测术眼的预测视力,并与术后三个月时的矫正视力作比较分析。结果预测视力作比较分析。结果 预测视力与术后视力之间呈良好的正直线相关（ｒ＝０．８０２,Ｐ〈０．００５）,结果完全一致８只眼（１６．７％）,假阳性结果１０只眼（２     

干涉条纹视力测定在高度近视者白内障术前检查的应用

目的评价激光干涉条纹视力(IVA)检测在预测高度近视者白内障术后潜在视力的可靠性及应用价值。设计前瞻性病例系列。研究对象49例(71眼)高度近视白内障患者(眼轴长度≥26.00 mm)。方法所有患者术前进行IVA检测,按LOCSII标准依晶状体核硬度将患者分为,甲组(60眼):晶状体核I～III级,乙组(10眼):晶状体核IV级,丙组(1眼):晶状体核V级;根据术前IVA值分为,A组(51眼):IVA≥0.4,B组(20眼):IVA<0.4。检测结果与患者术后1个月最佳矫正视力(BCVA)进行相关分析及检验,评价IVA检测在预测高度近视者白内障术后潜在视力的应用价值。主要指标IVA值、晶状体混浊程度及术后最佳矫正视力。结果 IVA预测高度近视者白内障术后视力相符率达71.8%;晶状体核硬度IV级及以下者(n=70)术前IVA值与术后BCVA呈显著相关性(r=0.677,P=0.000);IVA≥0.4者与术后BCVA的差异显著低于IVA<0.4者与术后BCVA的差异(χ2=9.906,P=0.002)。结论 IVA能比较准确地反映高度近视白内障患者潜在视功能,特别是对于晶状体核硬度IV级及以下、术前IVA≥0.4者。     

非对称性巩膜隧道切口人工晶状体植入术分析

目的探讨在非对称性巩膜隧道切口下植入人工晶状体的效果。方法上方角膜缘后2mm为中心点作反“J”形巩膜隧道切口,圈出晶状体核后,植入后房型或前房型人工晶状体。结果本组10例(11只眼),外伤性白内障8只眼,先天性白内障3只眼,术后第1天平均视力0.1,术后第7天0.57,术后1个月0.6。术后并发症:角膜上皮轻度水肿7只眼,内皮线状混浊5只眼,无1例前房积血和角膜失代偿。结论非对称性巩膜隧道切口适用于外伤性白内障、先天性白内障摘除后小切口下植入较大光学直径的人工晶状体。     

Development of a new evaluation system for visual function

Visual deterioration is caused principally by media opacity, by retinal damage, or by disorders of the higher visual system posterior to the optic nerve. In this article, we focused on media and retinal disorders and clinically evaluated a newly developed system for visual function. The decrease in visual function in cataract is subjectively well evaluated by contrast sensitivity, but is difficult to evaluate objectively. Recently, a wavefront sensor has been developed and ocular higher-order aberration (HOA) can now be measured objectively. We studied the relationship between age and HOA by wavefront sensor and found that HOA, especially spherical aberration in the lens, increased abruptly at the presbyopic age. We also found that the against-the-rule astigmatism in the lens increased at this age. Next, we investigated monocular diplopia which was presumably caused by HOA. Nine eyes with monocular triplopia and with mild nuclear cataract showed significant increase of trefoil aberration and negative spherical aberration (p<0.001). The simulated retinal Landolt's image from these two aberrations showed a triple configuration. Thus we confirmed that triplopia is caused by the combination of trefoil aberration and negative spherical aberration in early nuclear cataract. Next, we investigated whether Area under Log Contrast Sensitivity Function (AULCSF) can be predicted by HOA and light scattering. Backward light scattering (BLS) was evaluated by Schei mpflug image and the forward light scattering (FLS) by a spot size of the Hartmann image compensated for the effect of HOA. HOA was evaluated by root mean square (RMS) value from Hartmann image in a 4 mm pupil. Multiple linear regression revealed that AULCSF could be predicted from BLS, FLS, and HOA, in which each parameter contributed to the prediction significantly (p<0.01). By using this predicted value of AULCSF, the improvement of vision after cataract surgery can be predicted in cataract complicated by retinal disease. It has been reported that by fundus camera equipped with adaptive optics (AO), which is an application of wavefront analysis, photoreceptors could be visualized 2-dimensionally. We developed a compact AO fundus camera and demonstrated that cones were separately analyzed at retinal loci 1 degree temporal to the fovea centralis when the ocular aberration was reduced to less than 0.1 microm RMS in a 6 mm pupil. We are going to use this apparatus for eyes with retinal disease. The functional evaluation of residual retinal ganglion cells (RGCs) in the retina with damage to the photoreceptors is critically important for selecting candidates for artificial retina or regenerative therapy. Transcorneal electrical stimulation (TES) of the retina via contact lens electrodes evokes phosphene and indirect pupillary reflex. The threshold current for evoking phosphene in severely degenerated retinas with visual acuity worse than counting fingers showed a wide distribution, which suggested that TES was useful to evaluate residual RGCs functionally. TES also showed a neuroprotective effect. We suggest that the activation of glial cells by TES up-regulates the production of IGF-1, which eventually protects RGCs. The peripheral retina is important for walking even though the spatial resolution is not high. We developed an apparatus to measure stereopsis in the peripheral retina using a wide screen, and evaluated the peripheral stereopsis of 12 patients after macular translocation surgery and squint surgery. All three patients who showed peripheral stereopsis had only a small amount of squint angle. This method may be useful to evaluate stereopsis in patients with a central scotoma.     

新型辅助技术在角膜病相关性白内障手术中的应用价值

角膜病相关性白内障,即在角膜病的基础上又发生了晶状体混浊,严重损害视觉质量。为使部分患者免于角膜移植术,恢复部分视功能。全面准确评估角膜混浊对视功能的影响对判定单纯行白内障手术具有重要意义。受限于角膜混浊遮挡,白内障手术操作具有高难度及挑战性。故开发使用新型辅助技术,如囊膜染色技术、辅助照明技术、瞳孔扩张技术、飞秒激光辅助技术等,可规避角膜混浊带来的可视性受限、通光量下降等问题,助力白内障手术顺利进行。本文就角膜病相关性白内障手术辅助技术的有关进展进行综述,望能指导临床应用。     

The Opacity Lens Meter 701: clinical experiences

The quantitative influence of cataracts on visual fields was studied in 11 patients before and after cataract extraction with intraocular lens implantation. Lens opacity, measured with the Opacity Lens Meter 701, correlated closely with the visual field changes. Measurement of stray light backscattered from the cataractous lens permits quantitative prediction of the influence of cataract on the visual field.     

Assessment of contrast sensitivity. Part II: The relationship between objective lens opacity and laser interferometric contrast sensitivity in the cataract patient

The laser interferometer can effectively bypass the optics of the eye and measure retinal function in patients with immature cataracts. However, it is not known how much laser interferometric measurements are impaired by cataract density. In this study we compared objective lens opacity using the IntraOptics opacity lensmeter with contrast sensitivity (CS) measured by a Randwal He-Ne laser interferometer. Comparison of lens opacity with CS in the cataract population revealed an inverse linear relationship between objective lens opacity and retinal contrast sensitivity. Separation by cataract type showed correlation coefficients as high as -0.91 for nuclear sclerotic predominant cataracts and as low as no significant correlation for posterior subcapsular predominant cataracts. Comparisons of before and after implantation surgery contrast sensitivities (as measured by the laser interferometer) with preoperative lens opacities (as measured by the IntraOptics opacity lensmeter) quantified the extent to which laser interferometric measurements underestimated potential retinal function. We found that for all cataracts, other than posterior subcapsular predominant cataracts, potential contrast sensitivity (in decibels) was underestimated by about 0.2 to 0.3 times the opacity measured by this technique.