白内障超声乳化吸除联合人工晶状体植入术后发生角膜水肿的影响因素

目的：分析影响白内障患者超声乳化吸除联合人工晶状体植入术后发生角膜水肿的危险因素。

方法：回顾性分析2018-03/2020-09在我院行超声乳化吸除联合人工晶状体植入术治疗的白内障患者623例957眼临床资料，术后前3d内观察到角膜水肿者82例82眼，未观察到角膜水肿者541例875眼。收集两组患者术前、术中、术后相关指标纳入Logistic回归模型筛选高危因素。

结果：Logistic回归分析结果显示，年龄(OR=1.162)、Emery晶状体核硬度分级(OR=1.301)、灌注时间(OR=1.172)均是导致超声乳化吸除联合人工晶状体植入术后发生角膜水肿的危险因素，而前房深度(OR=0.651)则是避免其发生的保护因素(P<0.05)。

结论：白内障患者超声乳化吸除联合人工晶状体植入术后发生角膜水肿涉及因素较为复杂，临床需对高危患者提高警惕，围术期采取相应防范措施，以促进患者术后视功能快速恢复。     

高度近视白内障患者手术前后眼生物测量参数相关性分析

目的：对高度近视白内障患者手术前后眼生物测量参数进行分析,为高度近视白内障的人工晶状体屈光度计算公式提供参考。

方法：选取2011-01/2017-05我院收治的152眼高度近视白内障患者,所有患眼眼轴≥26mm,测量白内障手术前眼轴长度、角膜曲率、前房深度、晶状体厚度,以及手术后3mo角膜曲率、前房深度。分析各参数之间相互关系,并对术后前房深度进行多元线性回归分析。

结果：术前眼轴长度与术前角膜曲率、晶状体厚度呈正相关(r=0.236、0.216,P<0.05)。术前眼轴长度与术前前房深度无相关关系(P>0.05)。术前前房深度与术前角膜曲率无相关关系(P>0.05)。术前前房深度与术前晶状体厚度呈负相关关系(r=-0.513,P<0.05)。术后前房深度与术前眼轴长度、术前前房深度、术前角膜曲率、术后角膜曲率呈正相关关系(r=0.374、0.364、0.333、0.356,P<0.05)。术后前房深度与术前晶状体厚度无相关关系(P>0.05)。术后前房深度的多元线性回归方程为：术后前房深度=-2.592+0.091×术前眼轴长度+0.078×术前角膜曲率+0.491×术前前房深度。

结论：通过测量术前眼轴长度、角膜曲率、前房深度,利用术后前房深度多元回归方程,可以计算出术后前房深度,从而为高度近视白内障患者术后人工晶状体屈光度计算公式提供参考。     

高血压合并糖尿病与白内障的相关性

目的：探讨年龄相关性白内障(ARC)与合并型高血压、糖尿病的关系。

方法：排除创伤、先天性异常,相关药物或白内障手术史,年龄相关性白内障定义为至少一只眼睛存在有晶状体混浊。从我科2011-01-01/2017-05-20收治的6 467例50岁及以上眼科患者中,4 316例出院确诊为白内障, 其中的3 343为ARC。同一时期入住我科的379例50岁及以上眼外伤患者,检查确认无白内障的临床证据者作为年龄匹配对照组纳入分析。我们使用非条件Logistic回归模型估计似然比(OR),同时获取年龄、性别、城乡差别和医疗保健的可及性。

结果：男性白内障患者中, 29.54%(n=1 275)同时患有高血压; ARC男性患者,30.12%(n=1 007)同时患有高血压。眼外伤患者中只有10.82%(n=41)患者合并高血压。研究合并糖尿病患病率：男性白内障患者中,16.64%(n=718)同时患有糖尿病; ARC男性患者中, 16.48%(n=551)同时患有糖尿病, 而同龄的眼外伤患者中只有4.22%(n=16),在女性患者中观察到类似的模式。多因素分析表明高血压与ARC的相关性相对微弱 \〖OR=1.83(95% CI=1.23,2.74)\〗,糖尿病与ARC的相关性较强\〖OR=3.38(95% CI=1.86,6.15)\〗,但合并型高血压和糖尿病与ARC有着极强的相关性,OR=18.20(4.38,75.59)。

结论：非合并型高血压或糖尿病与ARC轻微或中度相关。合并型高血压和糖尿病与ARC则高度相关。合并有高血压和糖尿病的患者应为白内障防治的重点人群。     

两种Nd:YAG激光后囊膜切开方式治疗后囊膜混浊的Meta分析

目的：系统评价两种Nd：YAG激光后囊膜切开方式治疗白内障术后后囊膜混浊的效果与安全性,为临床实践中后囊膜切开方式的选择提供可靠依据。

方法：计算机检索中文全文期刊数据库(CNKI)、万方数据库、维普数据库、PubMed、Medline、Cochrane Library搜集不同Nd：YAG激光后囊膜切开方式治疗后囊膜混浊的相关文章,检索时限定义为2000-01-01/2019-12-31,2位评价者独立进行文献检索、筛选、质量评价及数据提取,采用RevMan5.3软件进行Meta分析。以均值差(MD)与95%置信区间(CI)衡量计量资料的效应量,对术后最佳矫正视力(BCVA)、术后眼压、激光使用能量进行合并分析。以比值比(OR)衡量计数资料的效应量,对出现人工晶状体受损以及眼前黑影飘动的比例进行合并分析。

结果：共纳入7篇研究,包括行Nd：YAG激光圆形后囊膜切开和十字形后囊膜切开共计432眼。Meta分析结果显示：圆形后囊膜切开组和十字形后囊膜切开组患者术后BCVA无差异(MD=-0.01,95%CI：-0.03～0.01,P=0.32); 术后眼压无差异(MD=-0.60,95%CI：-1.31～0.11,P=0.10); 使用激光能量无差异(MD=18.82,95%CI：-11.88～49.51,P=0.23); 晶状体受损率无差异(OR=0.97,95%CI：0.50～1.87,P=0.93); 眼前黑影飘动发生率无差异(OR=2.88,95%CI：0.28～29.26, P=0.37)。

结论：在白内障术后发生后囊膜混浊的患者行Nd：YAG激光后囊膜切开治疗中,圆形后囊膜切开与十字形后囊膜切开在治疗效果与安全性方面均无明显差异。     

非甾体抗炎药的不同给药时机对超声乳化吸除术后CME影响的Meta分析

目的：系统评价白内障超声乳化吸除术前加用非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)对术后黄斑囊样水肿(cystoid macular edema,CME)的影响。

方法：计算机检索Cochrane Library、PubMed、BMC、中国期刊全文数据库(CNKI)、维普中文期刊数据库(VIP)。收集NSAIDs的不同给药时机(试验组予以NSAIDs术前及术后局部点眼治疗,对照组予以NSAIDs术后治疗)对白内障超声乳化吸除术后CME及黄斑中心凹厚度影响的临床随机对照试验文献。采用RevMan 5.2软件及Stata12.0软件进行Meta分析。

结果：共纳入6项研究。术前是否加用NSAIDs对白内障超声乳化吸除术后CME的发生在术后1wk差异无统计学意义(OR=1.58,95%CI：0.48～5.18,P>0.05)、术后1mo差异无统计学意义(OR=0.78,95%CI：0.30～2.00,P>0.05),术后3mo差异有统计学意义(OR=0.22,95%CI：0.11～0.43,P<0.01); 黄斑中心凹厚度在术后1wk差异无统计学意义(WMD=-7.20,95%CI：-15.17～0.77,P>0.05)、术后1mo差异无统计学意义(WMD=-3.98,95%CI：-14.05～6.08,P>0.05),术后3mo差异有统计学意义(WMD=-18.25,95%CI：-33.80～-2.70,P<0.05)。

结论：术前及术后联合应用NSAIDs治疗可以显著降低白内障超声乳化吸除术后CME的发生,降低术后黄斑中心凹的厚度,提示NSAIDs的术前术后联合应用较单独术后应用更具有优越性。     

YAG激光联合RS引流管置入治疗泪道阻塞疗效影响因素分析

目的：探讨YAG激光联合RS引流管治疗泪道阻塞的疗效及独立影响因素。

方法：回顾性分析2015-01/2018-01在我院行激光联合引流管置入治疗的250例泪道阻塞患者病例资料,总结术后疗效并采用Logistic回归分析影响疗效的独立因素。

结果：患者术后临床治疗总有效率为87.9%; 病程(OR=8.654,95% CI：3.740～20.023)、泪道冲洗频率(OR=3.480,95% CI：2.128～5.691)、泪道阻塞长度(OR=0.518,95% CI：0.238～1.131)、拔管时间(OR=0.386,95% CI：0.237～0.628)以及首次手术(OR=14.717,95% CI：10.798～20.059)是影响患者术后疗效独立影响因素。

结论：YAG激光联合RS引流管置入治疗泪道阻塞疗效显著,早期治疗、避免多次手术、术后适度冲洗泪道、控制拔管时间,均有利于提高疗效。     

白内障超声乳化手术中台盼蓝囊膜染色对角膜内皮细胞影响的Meta分析

目的：系统评价白内障超声乳化手术中台盼蓝囊膜染色对角膜内皮细胞的影响。

方法：采用Cochrane系统评价的方法,计算机检索中国知网、万方、维普、SinoMed、PubMed、SpringerLink、Clinicalkey、Medline、Cochrane图书馆、Web of Science、OVID、Embase数据库中关于白内障超声乳化手术中使用台盼蓝进行囊膜染色的随机对照试验(RCTs),检索时限均为建库至2019-04,采用Revman5.3、R 3.7对纳入文献进行Meta分析。

结果：共纳入8篇RCTs(378例)。结果显示0.02%、0.06%或0.1%浓度台盼蓝囊膜染色组(193例)与未染色或安慰剂染色组(185例)角膜内皮细胞丢失数均无差异\〖术后1mo内(WMD =-10.47,95%CI：-26.44～5.61,P=0.20); 术后1mo后(WMD =-60.72,95%CI：-170.92～49.49,P=0.28)\〗; 两组术后1mo角膜内皮六角形细胞丢失比例无差异(WMD =0.50,95%CI：-2.09～3.09,P=0.71); 中央角膜厚度(CCT)无差异(WMD =3.10,95%CI：-5.77～11.98,P=0.49); 角膜变异系数(CV)无差异(WMD =-1.00,95%CI：-2.86～0.86,P=0.29)。

结论：白内障超声乳化手术中应用0.02%、0.06%或0.1%浓度台盼蓝囊膜染色对角膜内皮细胞数量及功能无明显影响。     

前房内注入头孢呋辛预防白内障术后眼内炎的Meta分析

目的：通过检索收集国内外文献,运用Meta分析方法,比较前房内注入头孢呋辛与对照组无干预措施后白内障术后眼内炎的发病情况,评价前房内注入头孢呋辛对白内障术后眼内炎的预防作用。

方法：检索国内外数据库如Pubmed、The Cochrane Library、EMBASE、维普中文科技期刊数据库、中国知网、万方数据库经审稿人审核发表选取2006-01-01/2015-01-31的关于前房内注入头孢呋辛与对照组无干预措施对白内障术后眼内炎预防作用的文章,共纳入5篇文献,通过提取数据,观察采取与未采取该预防措施后白内障术后眼内炎的发病率,应用Review Manager 5.2软件,采用固定效应模型,统计比较OR值和95%CI,进行敏感性分析,排除异质性,得出结果。

结果：Meta分析比较前房内注入头孢呋辛与对照组,以白内障术后眼内炎的发病率作为指标,统计结果差异有明显的统计学意义(OR=0.11,95%CI=0.07～0.18,P<0.01),提示前房内注入头孢呋辛组与未注入头孢呋辛对照组的差异有统计学意义。

结论：前房内注入头孢呋辛可有效地降低白内障术后眼内炎的发生。     

超长眼轴白内障手术前后眼生物测量参数变化及相互关系

目的：研究超长眼轴白内障患者超声乳化手术前后眼生物测量参数变化及其相互关系。

方法：收集2013-09/2015-03在首都医科大学宣武医院眼科确诊为白内障,且行白内障超声乳化联合人工晶状体植入术患者44例61眼,其中超长眼轴组20例29眼,正常眼轴对照组24例32眼。术前应用光学相干生物测量仪(IOL Master)测量眼生物参数,术后3mo应用IOL Master及超声生物显微镜(UBM)测量眼生物参数,应用SPSS17.0统计软件进行统计学描述并分析其变化及相互关系。

结果：超长眼轴组术后前房深度与年龄、术前眼轴长度、术前角膜曲率无相关性(P>0.05)。术后前房深度与术前前房深度呈正相关(r=0.402,P=0.031)。超长眼轴组术后3mo相比术前,眼轴长度显著缩短,角膜曲率增加,前房深度较术前显著增加(P<0.05)。正常眼轴对照组术后前房深度与年龄、术前眼轴长度、术前前房深度无相关性(P>0.05),术后前房深度与术前角膜曲率呈正相关(r=0.538,P=0.001)。正常眼轴对照组术后3mo较术前,眼轴长度显著缩短,前房深度显著增加(P<0.05),角膜曲率无改变(P>0.05)。手术前后,超长眼轴组相比正常眼轴对照组角膜曲率变化更大(P<0.05); 眼轴长度变化百分率、前房深度变化百分率,两组差异无统计学意义(P>0.05)。

结论：超长眼轴白内障患者术后眼轴长度缩短,角膜曲率增加,在计算人工晶状体度数时应增加一定度数,以便获得更佳的术后视力。超长眼轴白内障患者的术后前房深度预测具有复杂性与个体差异的不可预知性,需要进一步研究。     

双氯芬酸与奈帕芬胺在白内障术后抗炎疗效比较

目的：比较白内障患者术前局部应用0.1%双氯芬酸与0.1%奈帕芬胺的疼痛度和抗炎疗效。

方法：该前瞻性随机临床试验于2017/06-08在Dr. Yap眼科医院进行。共56例患者诊断为老年性白内障并接受超声乳化术,未出现并发症。受试者按术前应用滴眼剂分为两组(双氯芬酸组和奈帕芬胺组)。炎症特征(第1,7和14d随访)如疼痛度、结膜充血、眼睑痉挛、房水闪辉和细胞水平为主要结果,而角膜内皮细胞密度和形态为次要观察结果。

结果：术后1d(分别为P=0.284, 效应量=0.29, 95% CI=-0.09～0.31; P=0.254, 效应量=0.31, 95% CI=-0.13～0.49)和7d(P=1.000 和 P=0.556, 效应量=0.18, 95% CI=-0.08～0.16),两组间结膜充血和眼睑痉挛水平无统计学差异。奈帕芬胺组疼痛指数(术中及术后1、4d)显著低于双氯芬酸组(分别为P=0.006, 效应量=0.77, 95% CI=0.24～1.34; P=0.045, 效应量=0.39, 95% CI=-0.10～0.62; P=0.014, 效应量=0.69, 95% CI=-0.06～0.50)。术后1d奈帕芬胺组房水闪辉和细胞水平较低(P=0.029, 效应量=0.59, 95% CI=0.02～0.36)。两组间角膜内皮密度降低无统计学差异,而术后7d奈帕芬胺组六角形细胞比例减少较多(P=0.042, 效应量=-0.55, 95% CI=-2.33 ～ -0.03)。

结论：与双氯芬酸组相比,奈帕芬胺组疼痛度和房水闪辉细胞值较低。     

Population-based assessment of the outcome of cataract surgery in an urban population in southern India

PURPOSE: To assess the outcome of cataract surgery in an urban population in southern India. METHODS: As part of a population-based cross-sectional epidemiologic study, the Andhra Pradesh Eye Disease Study, 2,522 people of all ages, including 1,399 individuals 30 years of age or older, from 24 clusters representative of the population of Hyderabad in southern India underwent a detailed interview and ocular evaluation including logarithm of minimal angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, dilation, cataract grading, aphakia/pseudophakia status, and stereoscopic fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were performed when indicated by standardized criteria. Very poor outcome in an eye that had undergone cataract surgery was defined as presenting distance visual acuity worse than 20/200, and poor outcome was defined as visual acuity worse than 20/60 to 20/200. RESULTS: In subjects 50 years of age or older, after adjustment for age and sex distribution, the rate of having had cataract surgery in one or both eyes was 14.6% (95% confidence interval [CI], 11.4% to 17.8%). Of 131 eyes (91 subjects) that had undergone cataract surgery, 28 (21.4%; 95% CI, 14.4% to 28.4%) had very poor outcome and another 40 (30.5%; 95% CI, 22.6% to 38.4%) had poor outcome. The very poor outcome in 20 (71.4%) of 28 eyes and poor outcome in 23 (57.5%) of 40 eyes could be attributed to surgery-related causes or inadequate refractive correction. With multivariate analysis, very poor outcome as a result of surgery-related causes or inadequate refractive correction was more likely to be associated with intracapsular cataract extraction than with extracapsular cataract extraction (odds ratio, 9.34; 95% CI, 2.49 to 35.06) in subjects belonging to the lowest socioeconomic status (odds ratio, 4.92; 95% CI, 1.16 to 20.93) and with date of surgery 3 or fewer years before the survey than with more than 3 years (odds ratio, 4.52; 95% CI, 1.33 to 15.39). Also, very poor or poor outcome as a result of surgery-related causes or inadequate refractive correction was associated with women (odds ratio, 2.55; 95% CI, 1.06 to 6.16). CONCLUSIONS: The very high rate of very poor and poor visual outcome, predominantly as a result of surgery-related causes and inadequate refractive correction, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery. In order to deal with cataract-related visual impairment in India, as much emphasis on surgical quality, refractive correction, and follow-up care is necessary as on the number of surgeries.     

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review

Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.     

Cataract surgical reach: Falling short to catch white cataracts!

Purpose:The aim of this study was to know proportion of white cataracts from among patients coming for cataract surgery, and to find causes delaying uptake of cataract surgery.Methods:A hospital-based, prospective study enrolled patients of senile cataract between April 2018 and March 2019. The proportion of white cataract was calculated and underlying causes delaying uptake of cataract surgery studied.Results:White cataracts constituted 13.5% of total 3634 senile cataract patients, with gender disparity disfavoring women. Bilateral white cataract was presentation in 39 (8%) patients and lens-related glaucoma in 24 (5%) patients. Pseudophakia in the other eye was single most common cause of delay.Conclusion:A large proportion of white cataracts suggest that penetration of cataract surgical services in not reaching to the most eligible individual.     

白内障手术服务快速评估法在白内障干预工作中的应用及意义

白内障手术服务快速评估法(RACSS)是WHO推出的用于评估一个国家或地区白内障盲情的一种简单方法。建议国内各级防盲机构在评估中国的每年白内障手术量时采用白内障手术覆盖率指标。为了提高评估效率,我们建议筛查人群为≥60岁者。为了了解每年的手术趋势,在其白内障手术服务调查记录表中加入“哪年做的白内障手术”的内容。     

Congenital Anterior Polar Cataract: A Review of 63 Cases

Sixty-three patients with congenital anterior polar cataracts seen over a period of 15 years at The Children's Hospital, Boston, were reviewed to determine their clinical course and visual outcome. Over one-third of the patients were found to have strabismus, refractive anisometropia, or some form of amblyopia. Seven other patients had additional ocular pathology which affected their visual prognosis. One patient manifested progressive lens opacification that eventually warranted cataract surgery. These findings suggest a less benign prognosis for congenital anterior polar cataracts than has generally been described. In our series early ophthalmological examination did not always allow us to forecast later visual disability. We therefore recommend regular follow-up of all children with anterior polar cataracts until a secure assessment of vision can be made.     

发展中国家白内障手术的现状

随着人口的老龄化白内障的发病率也在升高,白内障已经成为发展中国家最常见的致盲眼病,在发展中国家中,盲和视觉损伤已经成为严重的公共卫生、社会和经济问题。虽然白内障手术是最具有成本效益的干预方式,但在发展中国家提供白内障手术服务仍存在很多问题和挑战,在过去10a中一些国家在治疗白内障时采用手法小切口白内障摘除术这种手术方式并取得了较好的效果。另外,制定不同的可持续发展的防盲模式在这些发展中国家也是一个挑战。本文就近年发展中国家的白内障手术情况做一综述。     

Phacoemulsification in posterior polar cataract: does size of lens opacity affect surgical outcome?

Background: To study the effect of size of the posterior polar opacity on surgical and visual outcome of phacoemulsification in posterior polar cataract. Setting: Post Graduate Institute of Medical Education and Research, Chandigarh, India. Methods: Consecutive patients with posterior polar cataract who underwent phacoemulsification were analysed for intraoperative complications and postoperative outcome. The continuous curvilinear capsulorhexis size was kept approximately 5.5 mm, and hydrodelineation was done instead of hydrodissection. Results: There were 58 eyes of 51 patients who underwent phacoemulsification for posterior polar cataract. The mean follow‐up time was 15.4 months (range 12–40 months). Twenty‐three eyes had size of polar opacities 4 mm or more in diameter whereas 35 eyes had less than 4 mm. Posterior capsule rupture occurred in nine eyes (15.51%). In eyes with polar opacities 4 mm or more, seven (30.43%) had posterior capsule rupture whereas in eyes with less than 4 mm size, only two (5.71%) had posterior capsule rupture. Capsular bag placement of intraocular lens (IOL) was achieved in 50 eyes and sulcus‐sulcus in eight eyes. Three‐piece hydrophobic acrylic IOL was implanted in 47 eyes and all polymethylmethacrylate IOL in 11 eyes. Postoperatively best‐corrected visual acuity of 6/12 or better was achieved in 55 eyes (94.8%) and three eyes achieved 6/24 or less. Conclusion: Phacoemulsification in eyes with larger size of polar opacity has significant risk of posterior capsule rupture.     

白内障术后感染性眼内炎治疗11例

目的探讨白内障术后感染性眼内炎相关因素及治疗方法。方法对我院1999年11月至2005年10月11例11眼白内障术后感染性眼内炎进行回顾性分析。结果7眼细菌培养阳性，培养细菌包括：表皮葡萄球菌2眼，粪肠球菌1眼，催产克雷白菌1眼，腐生葡萄球菌1眼，异型枸橼酸杆菌1眼，醋酸不动杆菌1眼。行后部玻璃体切割术者5眼，其中眼球摘除1眼；单纯前房冲洗加注药2眼；前房冲洗注药联合玻璃体腔注药4眼。结论前房和玻璃体注药，后部玻璃体切割术是治疗的有效方法。