Clinicopathological analysis of 719 pediatric and adolescents’ ocular tumors and tumor-like lesions: a retrospective study from 2000 to 2018 in China

AIM: To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique. METHODS: A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occured, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule. RESULTS: After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occured in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule. CONCLUSION: The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.     

Clinical outcomes after intrastromal corneal ring segments reoperation in keratoconus patients

AIM:To evaluate the clinical outcomes after Ferrara intrastromal corneal ring segments (ICRS) reoperation in patients with keratoconus.RESULTS: The mean follow-up time after the reoperation was 30.5±9.7 months. The mean UCVA improved from 20/300 to 20/80 (P=0.005); the mean BCVA improved from 20/160 to 20/50 (P=0.0002), the mean keratometry reduced from 49.33±4.19D to 46.16±3.90D (P=0.0001), the mean pachymetry at the thinnest point increased from 450±42.9mm to 469±40.8mm (P=0.0001). The asphericity increased from -0.84±0.74 to -0.35±0.81 (P=0.15) and the spherical equivalent reduced from -4.64±4.87D to -3.04±3.45D (P=0.137). The changes in the asphericity and spherical equivalent were not statistically significant.CONCLUSION: Ferrara ICRS implantation showed to be a reversible and readjustable surgical procedure for keratoconus treatment. Good outcomes can be obtained even after removal, addition, reposition or exchange of ICRS.     

PRK治疗高度近视的临床分析

目的探讨准分子激光角膜切削术对高度近视的疗效及其并发症。方法采用UV200型准分子激光机,对183例（330眼）—6．00D以上近视患者施行准分子激光角膜切削术,对随诊1a以上的患者进行观察。术前等值球面镜屈光度为—6．00～—26．00D（—10．27±—3．87D）,按屈光度分为3组：A组—600～—10．00D,199眼;B组—10．00～—15．00D,87眼;C组＞—15．00D,44眼。结果术后1a时裸眼视力＞0．5者276眼,占83．64％,M1．0者144眼,占43．64％;术后类固醇高眼压37眼,占11．21％;23眼（6．97％）的患眼有严重的角膜混浊,发生视网膜脱离3眼,眼底出血2眼。角膜曲率和中央角膜厚度在术后各时期无明显变化。结论PRK手术对高度近视是有效的．安全的。部分患者可获得良好的裸眼视力,大部分患者可明显减轻眼镜度数。     

角膜基质环植入术的研究进展

角膜基质环(intrastromal corneal ring，ICR)植入术，是一种矫正低、中度近视的角膜屈光手术。它与PRK，LASIK不同，不需切削角膜中央光学区组织，手术后患者不会出现任何异物感。而且具有可预测性、安全性、稳定性及可逆性和可调换性的优点。     

Evaluation of anterior and posterior surfaces of the cornea using a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments

AIM: To evaluate corneal parameters measured with a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments (ICRS). METHODS: Fifty eyes of 40 keratoconus patients had Ferrara ICRS implantation from November 2010 to April 2014. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, keratometry, asphericity, elevation, pachymetry, root mean square (RMS), spherical aberration and coma were studied. All patients were evaluated using a dual Scheimpflug system. RESULTS: The mean follow-up time after the procedure was 12.7mo. The mean UCVA improved from 0.82 to 0.31 (P<0.001); the mean BCVA improved from 0.42 to 0.05 (P<0.0001), the mean spherical refraction changed from -3.06±3.80 D to -0.80±2.5 D (P<0.0001) and the mean refraction astigmatism reduced from -4.51±2.08 D to -2.26±1.18 D (P<0.0001). The changes from preoperative to postoperative, in parameters of the anterior and posterior surface of the cornea, were statistically significant except the elevation posterior at the apex of the cornea and posterior asphericity. CONCLUSION: The implantation of Ferrara ICRS induces changes in both anterior and posterior surfaces of the cornea.     

准分子激光屈光性角膜切削术对角膜内皮细胞的影响

目的 探讨分析准分子激光屈光性角膜切削术（ＰＲＫ）治疗近视后对角膜内皮细胞的影响。方法 对１０１只眼ＰＲＫ术后者,用接触型镜面反光角人皮显微镜（Ｋｏｎａｎ ＳＰ－３５００型,日本）检测不同部位角膜内皮细胞,并统计分析其在不同度数范围内的平均细胞密度、细胞面积的变异系数和六角形细胞的百分率。结果 平均细胞密度在Ｃ组上降１０％,Ａ,Ｂ组的下降无统计学意义。细胞面积的变异系数及六角形细胞百分率均下降１０     

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy(t-PRK) with adjuvant mitomycin C(MMC) versus femtosecond laser assisted keratomileusis(Femto-LASIK) in correction of high myopia.METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction(SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12 mo postoperatively.RESULTS: The preoperative mean SER was-8.86±1.81 and-9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively(P=0.99) which improved to-0.65±0.43 D and-0.69±0.50 D at 12 mo follow up. Mean SER remained stable during the 12 mo of follow-up, with no statistically significant difference between the two groups(P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze(one reversible haze grade 2, while the other had dense irreversible haze grade 4).CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.     

PRK联合术中丝裂霉素矫正高度近视的临床研究

目的:探讨准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)联合术中使用0.2g/L丝裂霉素(MMC)矫治高度近视的安全性、有效性、稳定性。方法:对109例201眼高度近视的患者行PRK术,激光切削后使用0.2g/LMMC20s,观察术后角膜上皮愈合时间、观察术后1,3,6,12mo时裸眼视力、矫正远视力、屈光状态、haze形成情况及并发症情况、角膜内皮细胞计数等。结果:角膜上皮愈合时间为3.68±0.35d。术后裸眼视力均有明显提高,术后12mo裸眼视力达到1.0以上的者189眼(94%),等效球镜在±0.5D以内者153眼(76%)。术后矫正远视力下降1行者7眼(3%),无1例矫正远视力下降2行或2行以上。术后3mo与术后12mo相比,屈光度变化≤0.5D者占96%。手术前后角膜内皮细胞计数、变异系数比较均无显著性差异(P1=0.71;P2=0.83)。术后12mo,0～0.5级haze者189眼(94%),1级haze者12眼(6%);未见2级以上haze。术后未见丝裂霉素毒性反应及并发症。结论:准分子激光屈光性角膜切削术联合术中使用0.2g/LMMC20s矫治高度近视安全、有效。     

激光去除角膜上皮的屈光性角膜切削术的临床观察

目的:探讨治疗性准分子激光角膜切削术去除角膜上皮进行准分子激光角膜切削进行屈光矫治随访1a的临床效果.方法:前瞻性分析2012-07/2014-07随访资料完整的16例30眼近视及近视散光的连续性病例,术中使用治疗性准分子激光角膜切削术去除角膜上皮,再进行屈光性准分子激光角膜切削完成屈光矫治.随访记录术后1、3、6、12mo的视裸眼视力(UCVA)、角膜haze及残余等效球镜度(MRSE).结果:术后各时期UCVA ≥0.5者与术前BCVA差异无统计学意义(P＞0.05).术后各时期UCVA≥1.0者较术前BCVA差异经卡方检验两两比较差异亦无统计学意义(P＞0.006).术后不同时期角膜haze值差异有统计学意义(F=16.751,P=0.000).术后1mo角膜haze值为0.71±0.25,随时间推移角膜haze逐渐减轻,无2级以上haze出现.术后lmo MRSE为0.9±0.87D,较术后3mo (0.5±0.65D)差异有统计学意义(t=2.017,P=0.048),而MRSE在术后3、6mo (0.5±0.65、0.5 ±0.45D)及12mo(0.25±0.4D)差异无统计学意义(F=2.389,P=0.098).结论:本组研究获得较好的临床视力结果,术后1 mo有轻度远视漂移及较明显的角膜haze,对于其远期屈光稳定性及视觉质量等仍需大样本及分组的临床研究.     

Clinical outcomes after implantation of a new intrastromal corneal ring with 140-degree of arc in patients with corneal ectasia

AIM: To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment (ICRS) with 140-degrees of arc in eyes with corneal ectasia. METHODS: We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015. Outcome measures included preoperative and postoperative corrected distance visual acuity (CDVA), keratometry simulated (K) reading, tomographic astigmatism and asphericity. All patients were evaluated using the Pentacam Scheimpflug system. RESULTS: The study evaluated 58 eyes. The mean follow-up was 16.81±10.8mo. The CDVA (logMAR) improved from 0.5±0.20 (20/60) to 0.3±0.21 (20/40) (P<0.01). The average K reduced from 49.87±7.01 to 47.34±4.90 D (P<0.01). The asphericity changed from -0.60±0.86 to -0.23±0.67 D (P<0.01). The mean preoperative tomographic astigmatism decreased from -8.0±3.45 to -4.53±2.52 D (P<0.01). CONCLUSION: The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.     

Complications of intrastromal corneal ring segment implantation using a femtosecond laser for channel creation: a survey of 850 eyes with keratoconus

Acta Ophthalmol. 2011: 89: 54–57

Abstract.

Purpose: To report complications after the implantation of intrastromal corneal ring segments (Keraring; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a femtosecond laser (IntraLase; Advanced Medical Optics, Santa Ana, California, USA) for channel creation. Methods: Retrospective chart review of 531 patients (850 eyes) who underwent Keraring insertion using a femtosecond laser for channel creation. Intraoperative and postoperative complications were recorded. Results: Intraoperatively, there were 22 (2.7%) cases of incomplete channel formation. The rest of the intraoperative complications were galvo lag error (system malfunction) [five eyes (0.6%)], endothelial perforation [five eyes (0.6%)] and incorrect entry of the channel [two eyes (0.2%)]. Postoperatively, there were 11 (1.3%) cases of segment migration, two (0.2%) cases of corneal melting and one (0.1%) case of mild infection. The overall complication rate was 5.7% (49 cases out of 850 eyes). Conclusion: In this study, intracorneal ring segment implantation using a femtosecond laser for channel creation was related to a number of complications. The most common complications were incomplete channel creation (intraoperatively) and segment migration (postoperatively).     

全激光TransPRK术治疗高度近视的临床观察

目的：全激光TransPRK术治疗高度近视的安全性及疗效的分析。

方法：选择2012-12/2013-12在我院行全激光TransPRK手术的高度近视患者68例136眼,随访1a,观察眼部刺激症状、视力、眼压、haze和屈光度等情况进行分析。

结果：术后无不适感54例108眼,14例28眼患者出现眼干涩、磨疼、异物感。两组患者术后3、6mo,1a裸眼视力比较差异均有统计学意义(t=2.04,P=0.047)。术后3mo时裸眼视力最佳,术后6mo视力稳定。术后1a裸眼视力均达到0.8以上,与术前最佳矫正视力比较无明显下降。haze发病率低,多数在0～1级。通过对夜间视力、干眼、视疲劳等进行调查问答。满意度达85%。

结论：TransPRK术因术中全激光,术后反应轻、视力恢复快、干眼、haze发病率低,在治疗高度近视方面,其安全性高,疗效满意,是治疗高度近视较为理想的表层手术方式之一。     

TransPRK与LASEK术治疗高度近视的临床疗效

目的：对比观察TransPRK与LASEK术治疗高度近视的临床疗效。

方法：选择行激光矫正的高度近视患者120例240眼。随机分TransPRK术组60例120眼,LASEK术组60例120眼。观察术后1wk眼部刺激症状、术后2wk视力、术后3mo haze的发病率、术后1a屈光度等。

结果：两种方法均取得良好的手术效果。术后第1d TransPRK组无刺激症状者：86眼(71.7%),视物清楚,睁眼来医院复查。LASEK组术后81眼(67.5%)无刺激症状; 术后2wk视力与术前矫正视力比较,TransPRK组109眼(90.8%),LASEK组87眼(72.5%); 术后3mo haze的发病率,TransPRK组0级113眼,LASEK组0级109眼。

结论：TransPRK组刺激症状明显轻于LASEK组,TransPRK组比LASEK组术后视力恢复快; TransPRK组比LASEK组术后haze的发病率低,以上均有统计学差异(P<0.01); 术后两组1、3、6、12mo两组视力、屈光状态、视觉质量均无统计学意义(P>0.05)。两种手术方式矫正高度近视疗效无明显差异,均具有较好的安全性、有效性及可预测性。     

Clinical effectiveness of intrastromal corneal ring segments among keratoconus patients

AIM: To evaluate the clinical effectiveness of intrastromal corneal ring segments (ICRS) among the patients suffering from keratoconus. METHODS: A retrospective and non-comparative interventional design had been utilized on the basis of postoperative follow-up among 56 keratoconus patients. Visual acuity was significantly assessed during complete ophthalmic examination of the patients. The femtosecond laser had been used to create the corneal tunnels in 15 eyes; whereas, the corneal tunnels were created in 72 eyes mechanically. RESULTS: The ranges and standard deviations had been used to obtain results. It had been revealed through ophthalmic assessment that the mean preoperative uncorrected visual acuity observed was 1.38±0.37 logarithm of Minimal Angle of Resolution. Moreover, a significant improvement was observed postoperatively in visual acuity by 0.58±0.32 during the 4th month. The improvement was also witnessed in the 16th month by 0.48±0.30. CONCLUSION: The implantation of ICRS is an efficient and effective surgical intervention for the treatment of keratoconus. Thus, identified intervention seems to be associated with appropriate visual outcomes and safety after the development of femtosecond as well as mechanical tunnels.     

高度近视行Trans-PRK术中联合MMC对术后haze的影响

目的：评价经上皮准分子激光角膜切削术(Trans-PRK)联合0.02%丝裂霉素C(MMC)治疗高度近视预防角膜上皮下雾状混浊(haze)的临床效果。

方法：回顾性病例分析。收集我院2016-01/2017-12行Trans-PRK手术治疗的高度近视患者89例142眼,其中94眼联合使用0.02% MMC设为MMC组,MMC的使用时间为30～45s; 48眼未使用MMC设为对照组。两组患者术后均规律使用类固醇激素滴眼液治疗4mo,随访6mo。采用树模型分析探讨不同相关因素与haze发生的相关性。

结果：按照Fantes分级进行haze评估。MMC组术后haze发生率为8.5%(8/94),对照组为33.3%(16/48)(P=0.001)。树模型结果显示,切削光区直径和切削深度是haze发生的主要相关因素(P<0.01)。当切削光区直径≤5.6mm时发生haze的可能性越大,当切削光区直径>5.6mm时,最大切削深度成为haze发生的主要影响因素。

结论：对于薄角膜及角膜形态异常的高度近视患者,在选择Trans-PRK治疗时应考虑切削光区直径及切削深度,同时应联合使用0.02% MMC,可以安全有效地减少haze发生。     

Prognostic factors of visual quality after transepithelial photorefractive keratectomy in patients with low-to-moderate myopia

Purpose:The aim of this study was to evaluate visual quality after high-frequency transepithelial photorefractive keratectomy (t-PRK) by assessing the relationship between the operational parameters and the first-year postoperative corneal higher-order aberrations (HOAs).Methods:This was a retrospective study of low-to-moderate myopic eyes treated with t-PRK. The files of 46 low-to-moderate myopic patients (90 eyes; myopia up to −5D) were included in the study. Eyes having a cylindrical refractive error more than 2D and the patients not having completed a 1-year follow-up were excluded from the study. Factors including age, preoperative mean spherical equivalent (MSE), mean keratometry (Km), central corneal thickness (CCT), scotopic pupil, optical zone (OZ), transition zone (TZ), ablation zone (AZ), central ablation depth (CAD), and static cyclotorsion correction (SCC) were analyzed for association with the first-year postoperative corneal HOAs.Results:Corneal HOAs were found to be increased postoperatively with a 6-mm pupil (P < 0.05). The increased spherical aberration had a positive correlation with patient age, preoperative MSE, Km, TZ, and CAD, whereas it had a negative relationship with OZ and AZ (P < 0.05). The corneal coma had a significantly positive correlation with preoperative MSE and a significantly negative relationship with OZ (P < .05).Conclusion:Postoperatively induced corneal HOAs may affect patients'' scotopic vision (night time driving, cinema) when the pupils get larger. The relationship between patient age, preoperative MSE, Km, CAD, TZ, OZ, AZ, and postoperative corneal HOAs underlines the need to consider the effects of these parameters on the final vision quality.     

PRK和LASIK偏中心切削分析

目的　分析准分子激光屈光性角膜切削术 (photorefractivekeratectomy ,PRK)和准分子激光原位角膜磨镶术 (laserinsitukeratomileusis ,LASIK)治疗近视偏中心切削及其与临床效果的关系。方法　对术前屈光度为 -3 0 0D～ -10 0 0D ,平均 (-6 0 8± 1 2 1)D76例 (15 0眼 )行PRK ,75例 (15 0眼 )行LASIK ,分为PRK和LASIK组。术后 1、3、6、12月行角膜地形图检查。结果　两组偏中心距离大部分≤ 0 5 0mm ,偏中心方位大多位于鼻上象限 ,差异无显著意义 (P >0 0 5 )。偏中心距离 >0 5 0mm时 ,裸眼视力较术前最佳矫正视力下降≥ 2行所占比例明显高于偏中心距离≤ 0 5 0mm者 (P <0 0 0 1)。结论　偏中心切削与PRK和LASIK的手术方式无关。偏中心距离≤ 0 5 0mm ,对视力的影响不大 ,偏中心距离 >0 5 0mm时 ,术后裸眼视力较差。     

像差引导的准分子激光联合角膜胶原交联治疗早期圆锥角膜的临床观察

目的：观察像差引导的经上皮准分子激光屈光性角膜切削术（WG-TransPRK）联合快速角膜胶原交 联术（A-CXL）治疗早期圆锥角膜的临床疗效和安全性。方法：回顾性系列病例研究。收集在武汉爱 尔眼科医院汉口医院行WG-TransPRK同期联合A-CXL的早期圆锥角膜患者7例（12眼）,并于术前, 术后1周、1个月、3个月、6个月、1年分别行裸眼视力（UCVA,LogMAR）、最佳矫正视力（BCVA, LogMAR）、屈光度、角膜地形图、共焦显微镜和角膜像差检查。数据采用配对t检验分析。结果： 术后1年,UCVA从0.77±0.25改善到0.34±0.26（P=0.001）,BCVA从0.18±0.21改善到0.05±0.09 （P=0.034）;角膜前表面平坦曲率（K1）、角膜前表面陡峭曲率（K2）、角膜前表面最大角膜曲率（Kmax） 分别从（43.85±1.72）D、（46.64±2.36）D、（48.88±3.62）D降至（40.63±2.13）D（t=9.48,P=0.001）、 （42.27±1.89）D（t=8.29,P=0.001）、（45.43±1.54）D（t=3.02,P=0.014）,差异均有统计学意义（均 P<0.05）。共聚焦显微镜观察上皮下神经纤维密度降低（P=0.001）;浅、中层基质细胞密度降低（均 P<0.05）,深基质及内皮细胞密度变化差异无统计学意义。4 mm直径分析区域角膜总像差与角膜球 差降低,差异均有统计学意义（均P<0.05）。结论：WG-TransPRK联合A-CXL能安全有效治疗早期圆 锥角膜,提升患者视力。     

Corneal refractive surgery: past to present

There have been many historical corneal refractive techniques and procedures developed over the years. From early techniques of radial keratotomy to modern excimer laser techniques, the field of refractive surgery is one of the most rapidly developing in ophthalmology. This review details the historical aspects of the many early techniques up to current techniques used on millions of eyes around the world.     

准分子激光角膜切削术治疗高度、超高度近视眼术后角膜上皮下混浊的远期观察

目的:探讨准分子激光角膜切削术(PRK)治疗高度、超高度近视眼术后角膜上皮下雾状混浊(Haze)的发生情况及影响因素。方法:应用日本NIDEKEC-5000型准分子激光仪治疗高度、超高度近视眼143例(245眼),I组:-6.25～-10.00D,167眼;Ⅱ组-10.25～-24.00D,78眼。观察术后不同时期Haze的发生情况,随访7a以上。结果:术后3mo,0.5,1,4,7a,Haze的发生率,I组分别为74.8%,44.3%,24.5%,11.9%,7.8%;Ⅱ组为80.7%,52.1%,33.3%,24.3%,19.2%。7a时I组屈光度-0.57±1.84D,Ⅱ组-5.02±4.26D。有3级Haze7眼,I组2眼,为RK术后者;Ⅱ组5眼,4眼为年龄>40岁者。≥3级Haze者多出现在Ⅱ组,3～6mo达到高峰,持续时间达1a以上。结论:Haze为高度、超高度近视眼PRK术后的主要并发症。预矫屈光度越高,切削越深,则混浊程度越重;部分患者Haze逐渐减轻,角膜组织创伤修复时间长,部分重度Haze日后可能成为永久性瘢痕。