先天性白内障6例术后远期随访

先天性白内障是儿童弱视和失明的主要原因.手术后的视力恢复与手术时机及术后处理密切相关,手术成功的主要问题是弱视的治疗.本文报告6例术后远期随访情况.临床资料:6例中双眼4例,单眼2例.手术时年龄自1岁到4岁4例,5岁1例,14岁1例.患眼晶体均完全混浊.术式全部采用截囊加冲吸术.术后戴镜者3例,开始戴镜时间为术后1～5年.术后随访时间为3～16年.随访视力(矫正视力):3例双眼者0.1～0.3,另1例14岁才发病者矫正视力达0.7.但单眼白内障术后视力均较差;1眼为0.01,另1眼0.02.     

儿童白内障术后人工晶状体远期混浊1例

患儿女性,6岁.4年前因"双眼先天性白内障"在某三甲医院眼科行"双眼白内障针吸+后囊膜切开+前段玻璃体切除+人工晶状体植入术".患儿当时植入的人工晶状体是美国博士伦公司生产的折叠式亲水性丙烯酸酯人工晶状体,型号为Akreos ADAPT-AO.半年前出现双眼视物模糊,就诊于陆军军医大学大坪医院眼科.     

白内障术后后部缺血性视神经病变一例

患者男74岁因右眼突然视力下降5m于2005年10月来我院就诊。患者5m前于外院行右眼白内障超声乳化＋人工晶状体植入术后视力下降,术前右眼视力0.3,眼底正常,眼压正常,手术过程顺利,未出现任何并发症。术后第1d,右眼视力突然下降至无光感，不伴眼痛头痛，前房轻度炎症反应，人工晶体位正。双眼眼匝均为12mmHg。     

智能语音随访系统在先天性白内障患儿术后随访中的应用与分析

目的:探索智能语音随访系统在医疗场景中的新型应用服务模式并分析其在新冠肺炎疫情期间的应用效果,以此评估该系统应用于互联网医院开展医疗咨询服务的实际效能.方法:本研究应用智能语音随访系统针对先天性白内障患儿术后的常见问题进行回访.首先,针对随访目的,设计出完善的结构化随访内容与步骤.其次,部署智能外呼系统自动拨打用户电话...     

外伤性白内障术中植入多焦点人工晶状体的初步观察

目的 初步观察外伤性白内障植入多焦点人工晶状体(muhifocal intraocular lens,MIOL)的安全有效性.方法 收集我院2007年10月至2008年4月外伤性白内障患者中病情允许并积极要求植入MIOL的患者5例5眼,行外伤性白内障摘出联合MIOL植入术,观察术后视力、拟调节力及患者视物舒适度.结果 所有患者术后未发生严重并发症;所有患者术后3个月时术眼远视力改善明显,视力也达到较好状态;所有患者读书看报不需配戴近用镜,有2例患者诉有眩光、光晕现象,但不影响生活;所有患者自觉夜间双眼视物良好.结论 对于外伤性白内障患者若条件允许,可考虑行MIOL植入术,尤其是对角膜、瞳孔和晶状体囊袋条件较好的患者.     

先天性大角膜并发白内障手术治疗一例

先天性大角膜是一种少见的双侧性眼前部较正常增大的发育异常性疾病。我们于2005年1月至12月成功地为一例先天性大角膜患者实施了双眼白内障超声乳化吸除及人工晶状体（IOL）植入术，效果满意并获得一些经验。     

白内障术后1年半发生恶性青光眼伴慢性闭角性青光眼1例

患者女性,74岁。因＂双眼视力下降1年多＂于2014年11月19入日院。既往＂高血压10年,糖尿病7年,血压血糖控制可＂。入院视力OD 0.05,OS 0.04。双眼角膜透明,前房中深,晶状体混浊（右眼C3N3P3,左眼C3N3P4）,眼底不清。眼轴OD 22.45 mm,OS 22.44 mm。     

双眼白内障术后单眼人工晶状体混浊一例

人工晶状体混浊是白内障术后较为少见的并发症,患者多于手术后数月或数年因不明原因视力下降或视朦就诊。本文报道一例73岁女性患者,在同一时期双眼先后植入同一型号亲水性丙烯酸酯人工晶状体,术后6年右眼人工晶状体完全混浊,而左眼人工晶状体仍为完全透明状态。两眼的临床眼部体征、眼前节光学相干断层成像(optic coherence tomography,OCT)、超声生物显微镜检查(ultrasound biomicroscopy,UBM)等检查结果均有明显差异,人工晶状体混浊眼通过手术治疗后视力恢复满意。文章详细记录了该例患者术前的相关资料、手术治疗以及手术取出人工晶状体的检查结果,并进行了分析讨论,供专家同行参阅,为该类患者的诊疗提供参考。     

老年性白内障1000例术后视力总结

0引言白内障是全世界致盲和视力损害的首要原因,随着社会人口老龄化的进展,晶状体混浊导致视力丧失的人数也在逐年增多,至2025年,全世界将有4000万人因白内障而失明。我院2006-10/2008-11为老年性白内障患者行免费复明手术1235例1260眼,现就1000例手术患者术     

白内障针拨术后20年继发晶状体溶解性青光眼一例

我们经手术治疗1例白内障针拨术后20年继发品状体溶解性青光眼患者，报告如下。     

多焦点人工晶状体植入术后视觉质量和阅读能力的研究

目的:研究多焦点人工晶状体(IOL)植入术后白内障患者的视觉质量及阅读能力。方法:前瞻性临床研究。选择2018年6月至2019年10月于重庆医科大学附属第一医院眼科就诊并行双眼白内障手术的患者共75例(150眼),依据患者选择的IOL进行分组,双眼植入Tecnis ZCB00 IOL 25例(50眼)作为单焦组,双眼植入Tecnis ZMB00 IOL 25例(50眼)作为双焦组,双眼植入AT Lisa tri.839MP IOL 25例(50眼)作为三焦组,对比3组患者术后3个月时的祼眼远视力(UDVA)、祼眼中视力(UIVA)、祼眼近视力(UNVA) (LogMAR)及阅读能力。使用NEI-RQL-42量表中文版评价3组患者术后视觉质量的差异。数据采用卡方检验、方差分析、Kruskal-Wallis检验、Mann-Whitney U检验进行统计分析。 结果:共75例(150眼)患者纳入研究。3组间UDVA差异无统计学意义( H=3.187, P=0.203)。三焦组UIVA(0.2±0.1)优于双焦组(0.3±0.2) ( Z=-2.041, P=0.041)和单焦组(0.3±0.3) ( Z=-2.142, P=0.032)。三焦组UNVA(0.3±0.2)和双焦组UNVA(0.3±0.2)优于单焦组(0.4±0.2) ( t=2.332, P=0.017;t=3.014, P=0.036)。3组阅读视力( F=0.421, P=0.658)、阅读速度( F=1.754, P=0.182)、阅读错误率( H=6.347, P=0.052)差异均无统计学意义。三焦组近视力维度得分(92±14)和双焦组近视力维度得分(100±11)均高于单焦组(50±42) ( U=-3.139, P=0.005;U=-3.726, P=0.001);三焦组中视力维度得分(100±12)高于双焦组(75±25)和单焦组(25±75) ( U=-2.758, P=0.017;U=-3.145, P=0.002)。三焦组脱镜率维度得分(100±25)和双焦组脱镜率维度得分(100±40)高于单焦组(30±100) ( U=-3.004, P=0.008;U=-3.766, P=0.001)。 结论:多焦点IOL植入患者可获得与单焦点IOL植入患者配戴老花镜时相同的近距离视觉质量;AT Lisa tri.839MP IOL与Tecnis ZMB00 IOL可提供相同的远近视力及近距离阅读能力,但前者中距离视觉质量更佳。     

压贴镜在婴幼儿无晶体眼的应用

目的评价压贴镜联合弱视训练在婴幼儿先天性白内障术后无晶体眼的疗效。方法连续收集44例(87眼),年龄为4～30个月婴幼儿分为2组。治疗组23例(45眼)为先天性白内障,均在全麻下行白内障注吸及后囊膜连续环形撕囊术,术毕在全麻状态下,由视光师检影验光,术后一周配压贴球镜,联合红光闪烁弱视治疗,随访6～18月。对照组为正常婴幼儿21例(42眼),视觉发育正常。2组治疗或观察前后均采用优先注视法检查视力。结果1.术后随访时视力明显高于出院时视力(P<0.05),但低于正常对照组视力(P<0.05)。2.术中检影屈光度为 14DS～ 20DS,其中 16DS～ 17DS者26眼占57.718%。3.连续性后囊膜环形撕囊,可以保持视轴区透明,观察期内未见明显后发障。结论婴幼儿先天性白内障术中全麻状态下检影验光,用压贴球镜矫正屈光不正,验光准确,镜片轻便,婴幼儿易接受,值得推广。术后及时弱视训练,可促进视觉发育。     

Long-Term Outcomes of Primary Intraocular Lens Implantation for Unilateral Congenital Cataract

Purpose: In congenital cataracts, the need for early intervention is well established to prevent visual deprivation and amblyopia. We evaluated patients with unilateral amblyogenic congenital who had undergone simultaneous cataract removal and intraocular lens implantation. Methods: We retrospectively reviewed all patients operated on between 1990 and 2010 at the Pediatric Eye Department of the University Federico II of Naples (Italy). Minimum follow-up for inclusion was 48 months. Results: 52 patients (28 females, 24 males, mean age at surgery 9.0?±?4.5 months, range 2–21 months) were included in this retrospective review. Mean follow-up was 100.7?±?57.0 months (range, 48–270 months). At last visit, mean BCVA in the operated eyes was 0.65?±?0.4 (range, 0.04–1.3) LogMAR and 40 patients (76.9%) had strabismus. In patients undergoing surgery at an age >12 months, BCVA was significantly lower (0.92?±?0.4 LogMAR versus 0.60?±?0.4 LogMAR, p?=?0.01), although development of myopic shift was less frequent (61.5% versus 43.5%, p?=?0.03). BCVA at last visit was higher in patients with a first stable pseudophakic SE between +1D and +3D (p?=?0.02). Conclusions: Worse final BCVA, despite less frequent development of myopic shift, was observed when surgery was performed after 12 months of age. A hyperopic correction in first stable pseudophakic SE seems advisable.     

Stereopsis after Implantation of Intraocular Lens in Patients under 40 Years Old with Unilateral Cataract

 PURPOSE:To investigate the stereopsis after single focus intraocular lens (SIOL) implantation in patients aged <40 years with unilateral cataract. METHODS:In total, 36 patients (36 eyes) were divided into emmetropia and myopia groups. Twenty seven subjects with good uncorrected distance visual acuity (UCDVA) after surgery were enrolled in the emmetropia group. The myopia group consisted of 9 subjects whose one eye had mild myopia postoperatively and the other was emmetropic or myopic. Visual acuity, distance and near stereoacuity were measured post-operatively. RESULTS:In the emmetropia group, uncorrected near visual acuity (UCNVA) did not differ significantly between eyes (t=1.87, P>0.05). The LogMAR UCNVA of the operated and fellow eyes were (0.71±0.12) and (-0.05±0.07, t = 28.4, P<0.001) respectively. Distance stereoacuity was 60"; the near stereoacuity with uncorrected visual acuity and BCNVA in the operated eyes were 200" and 30" respectively (Z=－4.121, P<0.001). In the myopia group, the BCDVA did not differ significantly between the operated and fellow eyes (t =-0.636, P>0.05). The UCNVA of the operated eyes (0.18±0.12) was significantly better compared with that of the fellow eyes (-0.04±0.10, t = 4.2252, P<0.001). The distance stereoacuity with uncorrected visual acuity and BCDVA in the operated eyes were 200" and 60" respectively (Z =-2.371, P<0.05). The near stereoacuity with uncorrected visual acuity was 50". CONCLUSION:For patients with unilateral cataract aged <40 years, stereopsis is closely associated with refractive status after IOL implantation. Near stereoacuity in emmetropic eyes can be improved with refraction, and that in mildly myopic eyes can be enhanced by leaving myopia uncorrected.     

A Case of Delayed-Onset Propionibacterium acnes Endophthalmitis after Cataract Surgery with Implantation of a Preloaded Intraocular Lens

Purpose

To report a case of delayed-onset endophthalmitis after implantation of a preloaded intraocular lens (IOL) and examine the surgically removed IOL by scanning electron microscopy (SEM).

Case

A 77-year-old female underwent uneventful phacoemulsification and aspiration with preloaded silicone IOL implantation. Since intraocular inflammation unexpectedly worsened 1 month after the surgery, she was referred to our hospital. Her visual acuity was hand motion in the left eye. Hypopyon and fibrin formation were observed in the anterior chamber. A diagnosis of postoperative delayed-onset endophthalmitis was made, and vitrectomy with anterior chamber wash-out was performed. As intraocular inflammation remained unchanged postoperatively, an additional surgery with IOL removal was performed. We cultivated the surgically removed samples of aqueous humor and vitreous fluid under both aerobic and anaerobic conditions, performed 16S rDNA clone library analysis of these clinical samples, and examined the removed IOL by SEM.

Result

Inflammation subsided after the re-operation. Although cultures of aqueous and vitreous samples were negative, DNA of Propionibacterium acnes was detected in the aqueous humor. The SEM images showed that the rod bacteria and biofilm-like material formed on the tip of the IOL haptic.

Conclusion

Delayed-onset endophthalmitis may occur after uneventful implantation of a preloaded IOL. The SEM findings suggested that the tip of the preloaded IOL haptic might scratch bacteria which adhered to the tip of the injector nozzle when the IOL was inserted into the anterior chamber. In some cases with delayed-onset endophthalmitis, IOL removal is needed to eliminate the bacteria which adhere to the tip of the IOL haptic.Key Words: Endophthalmitis, Preloaded intraocular lens, Propionibacterium acnes, Scanning electron microscopy     

晶状体切除联合巩膜缝线固定人工晶状体植入术治疗先天性晶状体半脱位的长期效果

目的：分析先天性晶状体半脱位患眼经晶状体切除+前段玻璃体切割+经巩膜缝线固定人工晶状体（IOL）植入术后长期治疗效果。方法：回顾性系列病例研究。观察2005年1月至2014年6月期间于复旦大学附属眼耳鼻喉科医院收治的先天性晶状体半脱位患者53例（77眼）,所有患眼均接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术。对术后最终随访时最佳矫正视力（BCVA）、眼压及术眼出现的主要并发症进行系统性的临床观察。数据采用配对t检验或独立样本t检验进行比较。结果：77 例接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术的先天性晶状体半脱位患眼,术后随访时间为（38±26）个月,最短12个月,最长130个月。术前BCVA（LogMAR）为0.84±0.55,术后为0.26±0.43,术后视力较术前明显改善（t=8.55,P < 0.001）。术中及术后早期并发症包括：1眼（1.3%）术中视网膜脱离,2眼（2.6%）术后早期前房积血,2眼（2.6%）术后早期切口玻璃体嵌顿。术后远期并发症包括：6 眼（7.8%）视网膜脱离,发生于术后（22±12）个月,1 眼（1％）IOL移位或脱位,发生于术后5 年。术后不良主诉包括：32 例（60.4%）术后随访时主诉干眼症状,6例（11.3%）主诉眩光现象。结论：晶状体切除前段玻璃体切割+经巩膜缝线固定IOL植入术可以显著提高先天性晶状体半脱位患者视力。远期随访中,视网膜脱离及IOL脱位是尤其需要警惕的术后并发症。     

RETRACTED: Long-term Follow-up of Eye Growth after Bilateral Intraocular Lens Implantation in Children with Congenital Cataracts

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