Intraocular pressure after small incision cataract surgery: temporal sclerocorneal versus clear corneal incision

PURPOSE: To compare intraocular pressure (IOP) after phacoemulsification and foldable intraocular lens (IOL) implantation using a temporal sclerocorneal or clear corneal incision. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: One hundred patients (100 eyes) with cataract having phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision. Intraocular pressure was measured preoperatively and 6 hours, 1, 2, and 3 days, and 5 months postoperatively. Statistical significance was determined by nonparametric group comparisons using 2-sample random Wilcoxon tests. RESULTS: Six hours postoperatively, the median IOP increase was significantly higher in the sclerocorneal tunnel group (57%) than in the clear corneal incision group (18%) (P <.001). No significant between-group difference in IOP was found at 1, 2, or 3 days or 5 months. At 5 months, IOP was 0.6 mm Hg lower than preoperatively in the sclerocorneal tunnel group and 1.5 mm Hg lower in the clear corneal group. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, the immediate postoperative IOP increase was higher in eyes having a sclerocorneal incision than in those having a clear corneal tunnel incision. These results could be important in eyes with decreased outflow facility or preexisting optic nerve damage.     

Inzisionale Astigmatismusbeeinflussung bei der Implantation von phaken 6-mm-Irisklauenintraokularlinsen

BACKGROUND: The implantation of a phakic 6-mm-iris-claw intraocular lens requires a 6.1-6.2 mm incision. This induces a variable amount of corneal astigmatism depending on the location and the type of the incision used. The aim of the current study is to investigate the surgically induced astigmatism (SIA) of different incision types and locations. This should help to achieve nearly spherical postoperative refraction. PATIENTS AND METHOD: 28 eyes of 16 patients with a 1-year follow-up after an implantation of a 6-mm-non-foldable iris-claw phakic IOL were studied. 5 different incision techniques were used. These were a superior corneal incision alone (8 eyes) or in combination with a 60 degrees limbal relaxing incision (LRI) at the same axis (8 eyes), a superior sclerocorneal tunnel incision (6 eyes) and the two-incisional approach either with a sclerocorneal (4 eyes) or a pure corneal (2 eyes) main temporal incision. The SIA was calculated for each incision used. RESULTS: The superior corneal incision had a mean SIA of 1.2 D cyl. This SIA was enhanced by an opposite LRI by another 1 D cyl. The sclerocorneal tunnel induced 0.75 D cyl, while the two-incisional techniques delivered nearly astigmatismus neutral results. CONCLUSION: A proper selection of an appropriate incision site and type allows to correct the preexisting astigmatism or to keep a spherical refraction after an implantation of a 6-mm-rigid phakic iris-claw IOL.     

Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification

OBJECTIVE: To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: One hundred eyes of 100 patients were examined at a German University eye hospital. INTERVENTION: One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. MAIN OUTCOME MEASURES: Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photometry. Statistical inference was mainly based on nonparametric group comparisons by use of two sample Wilcoxon tests. RESULTS: Mean anterior chamber flare in the group with sclerocorneal tunnel increased from 7.5 photon counts/ms preoperatively to 19.6 at 6 hours postoperatively and decreased to 11.1 (day 1), 11.7 (day 2), 11.6 (day 3), and 9.2 (5 months) during the postoperative course. The mean flare in the clear corneal tunnel incision group increased from 7.7 preoperatively to 12.9 at 6 hours postoperatively and then decreased to 9.2 (day 1), 9.8 (day 2), 9.1 (day 3), and 9.2 (5 months). Individual postoperative flare changes were significantly lower in the clear corneal tunnel group at the day of surgery (P<0.0001), as well as at day 1 (P = 0.0011), day 2 (P = 0.0079), and day 3 (P = 0.0020). After 5 months, no statistically significant difference was found. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, postoperative alteration in the blood-aqueous barrier was statistically significantly lower with the clear corneal tunnel incision group compared with the sclerocorneal incision group, in the first 3 days postoperatively.     

Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

Aims:

To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery.

Materials and Methods:

This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes). The outcome measures were surgically induced astigmatism (SIA) and uncorrected visual acuity (UCVA) 1 and 3 months, post-operatively.

Results:

At 1 month, the mean SIA was 0.81 diopter (D) for the temporal incisions and 0.92 D for nasal incisions (P = 0.139). At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309). The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively.

Conclusion:

After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less) would be favorable for astigmatism-neutral cataract surgery.     

3.2 mm透明角膜切口超声乳化术治疗放射状角膜切开术后白内障的效果及安全性

目的  评估3.2 mm透明角膜切口超声乳化术治疗放射状角膜切开术（radial keratotomy,RK）后白内障的效果与安全性。设计  回顾性病例系列。研究对象  既往有RK手术史的白内障患者8例13眼,其中RK角膜瘢痕为8刀者2例4眼,12刀者3例4眼,16刀者3例5眼。方法  由同一手术医师进行3.2 mm透明角膜切口超声乳化人工晶状体植入术。8刀RK组中,角膜主切口位于相邻两条放射状角膜瘢痕之间,未与瘢痕接触;12刀RK组中,主切口跨越1条角膜瘢痕;16刀RK组中,主切口跨越2条角膜瘢痕。于术后1天,1周,1、3、6个月,1、2、3年进行随访,观察角膜RK瘢痕情况、并发症处理及术后视力恢复情况。主要指标 有无RK瘢痕裂开、术后最佳矫正视力、角膜散光、角膜内皮细胞密度。结果  8刀RK组和12刀RK组术中均未发生角膜RK瘢痕裂开,术毕切口密闭良好;16刀RK组中,2眼发生术中角膜瘢痕裂开,1眼采用前房注气封闭切口,另1眼采用主切口下注入黏弹剂,侧切口前房注气封闭切口。随访过程中,所有13眼术后角膜切口密闭良好,均未出现新发角膜瘢痕裂开。最后1次复查时,最佳矫正视力为（0.67±0.18）较术前（0.29±0.20）提高（t=-6.077,P=0.000）,角膜散光（1.69±1.23 D）较术前（1.28±0.78 D）无明显变化（t=-0.758,P=0.470）,角膜内皮细胞密度（1716.95±906.79/mm2）较术前（2383.97±833.39/mm2）降低（t=2.995,P=0.012）。结论  8刀、12刀RK术后白内障患者行超声乳化手术时采用3.2 mm透明角膜切口是安全的,16刀者术中易发生角膜瘢痕裂开,对此应采用更小的角膜切口或采用传统的角巩膜隧道切口。     

角膜地形图引导下不同部位角膜切口白内障超声乳化术后角膜散光分析

目的比较角膜地形图引导下不同部位透明角膜切口白内障超声乳化术后散光情况。方法选择行透明角膜切口超声乳化白内障吸除联合人工晶状体植入术的年龄相关性白内障患者198例（231例）为研究对象,分成A、B、C 3组,A组选择在上方11点位透明角膜切口,B组选择在颞侧透明角膜切口,C组选择在角膜最大曲率子午线上透明角膜切口,分别于术前,术后1周、1个月及3个月随访,行视力及角膜地形图检查,记录并比较3组术后视力及角膜散光的变化情况。结果术后3个月时C组裸眼视力≥1.0者多于A组和B组（P〈0.05）;C组患者术后3个月与术前相比,散光度明显减小（P〈0.05）;C组分别与A组、B组相比,术后1周、1个月及3个月时的散光度均明显减小（P〈0.05）;术后3个月平均手术源性角膜散光度（SIA）,C组最小。结论角膜地形图引导下位于角膜最大曲率子午线上透明角膜切口有助于减小术前及术后散光,术后获得较好的裸眼视力。     

两种巩膜隧道切口超声乳化白内障吸除手术的疗效比较

目的 研究新型“L”形不缝合巩膜隧道切口超声乳化白内障吸附人工晶状体植入术的临床疗效。方法 将68例（68只眼）老年性白内障患者分为两组,分别行“L”形巩膜隧道切口（34只眼）和3．2mm巩膜隧道切口（34只眼）超声乳化白内障吸除术,并分别植入光学部直径6mm的聚甲基丙烯酸甲酯硬性及丙烯酸酯聚合物折叠式人工晶状体。随访视力、角膜曲率和角膜地形图的改变。结果 术后1d至3个月两组视力、手术性角膜散光度数及轴向变化比较,差异均无显著意义（P＞0．05）;两组术后角膜地形图与术前比较无明显改变。结论“L”形巩膜隧道切口超声乳化白内障吸除术与3．2mm巩膜隧道切口手术的疗效基本相同,而且操作简便、安全、手术费用低廉,值得临床推广使用。     

角膜地形图引导下白内障手术切口对角膜散光的矫正

目的:比较不同位置和形态的手术切口对白内障摘除术后角膜散光及裸眼视力的影响。方法:选取术前角膜散光值>1.00D的白内障患者43例52眼,将患者随机分成两组,A组患者采用超声乳化白内障吸除联合人工晶状体植入术,手术切口为位于上方10∶30～11∶30的透明角膜隧道切口。B组患者采用手法碎核白内障摘除联合人工晶状体植入术,其中角膜散光值为1.00～2.00D的患者,切口为位于角膜最大屈光度径线的直线形巩膜隧道切口,长度为6.0～7.0mm,角膜散光值>2.00D的患者,在上述直线形切口对侧角膜缘处,另作一弧形板层松解切口。分别于术后2wk,3mo随访患者,检查裸眼视力及行角膜地形图检查。结果:B组患者术后2wk,3mo裸眼视力好于A组。B组患者术后角膜散光度在术后2wk,3mo时均小于A组。结论:位于角膜最大屈光度径线的6.0～7.0mm直线形巩膜隧道切口,及此切口联合作对侧弧形板层松解切口均能有效矫正白内障术前存在的角膜散光,能够使患者获得更好的术后裸眼视力。     

Corneal shape changes after temporal and superolateral 3.0 mm clear corneal incisions.

PURPOSE: To compare the corneal topographic changes after temporal and superolateral 3.0 mm clear corneal incisions (CCIs) and implantation of foldable silicone intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University of Vienna, Austria, and a private clinic, Winterthur, Switzerland. METHODS: This prospective study comprised 54 eyes of 54 patients scheduled for cataract surgery. After a 0.3 mm deep precut, a temporal 3.0 mm CCI was made in 26 eyes and a superolateral (at 10:30) 3.0 mm CCI in 28 eyes. Corneal topography was recorded preoperatively and 1 week and 1 and 3 months postoperatively using the TMS-1 computer-assisted videokeratoscope (Computed Anatomy, Inc.). Surgically induced corneal shape changes were evaluated by batch-by-batch analyses of the paired differences between the records. The significance of topographic changes was calculated by the paired Wilcoxon test; group comparisons were made using the Wilcoxon group comparison test. RESULTS: Both groups had incision-related corneal flattening at 1 week and 1 and 3 months postoperatively. The extent of this flattening at 1 week and 1 and 3 months postoperatively was up to 1.0, 0.9, and 0.7 diopter (D), respectively, in the temporal group and up to 1.2 D at each observation time in the superolateral group. There was statistically significantly more incision-related corneal flattening in the superolateral incision group than in the temporal incision group; the difference was up to 0.3 D after 1 month and 0.5 D after 3 months. CONCLUSION: The superolateral incision induced statistically significantly more incision-related corneal flattening than the temporal incision.     

不同透明角膜切口导致的角膜屈光力动态变化对比

目的:探讨白内障超声乳化术中,颞侧和上方2.8mm透明角膜切口引起的角膜屈光变化。方法:收集老年性白内障患者60例60眼,分成A组32例32眼(颞侧角膜切口组),B组28例28眼(上方角膜切口组)。检查术前、术后1d;1wk;1mo和3mo的视力、手术源性散光和角膜地形图。结果:A,B两组术前散光分别为0.67±0.31D,0.70±0.35D。术后1d;1wk;1,3mo,A组的散光分别为0.85±0.41D,0.75±0.38D,0.70±0.35D,0.68±0.33D;B组分别为1.18±0.46D,0.98±0.39D,0.80±0.31D,0.73±0.33D。术后各阶段散光均高于术前。A组的散光小于B组(P<0.05)。术后第1d各组散光最大,以后逐渐减小。术后1d;1wk;1,3mo,A组的手术源性散光(surgicallyin-ducedastigmatism,SIA)分别为0.65±0.30D,0.50±0.28D,0.43±0.21D,0.40±0.18D;B组分别为0.85±0.38D,0.71±0.35D,0.62±0.25D,0.49±0.20D。术后1d,A组SIA较B组小(P<0.05);各组SIA均随时间推移而减小,但A组SIA始终小于B组(P<0.05)。结论:颞侧切口操作方便,术后的角膜散光状态和手术性散光均小于上方切口。     

The effect of incisions for cataract on corneal curvature

PURPOSE: To determine the magnitude and duration of change on the horizontal and vertical meridians of the cornea after five different incisions for cataract. DESIGN: Retrospective comparative interventional study of five commonly used incisions for cataract surgery: extracapsular cataract extraction (ECCE), 6-mm superior scleral tunnel (6Sup), 3-mm superior scleral tunnel (3Sup), 3-mm temporal scleral tunnel (3Temp), and 3-mm temporal corneal incision (3Cor). PARTICIPANTS: A total of 662 cases with preoperative regular astigmatism, measured with keratometry. METHODS: The mean net change on each meridian was computed at 1 day, 1 week, 2 weeks, 1 month, 1.5 months, 2 months, 4 months, 6 months, and 12 months and at succeeding 6-month intervals after surgery. Best-fit parameters were calculated for the observed changes in the horizontal and vertical keratometry values after each incision. To determine when the cornea stabilized, average change on the horizontal and vertical meridians was compared with an estimate of the accuracy of keratometry measurement. MAIN OUTCOME MEASURES: The pattern of change on the horizontal and vertical meridians and time for the cornea to stabilize after each incision. RESULTS: The initial and final net changes after a superior incision decrease with length. A sigmoid equation describes the course of the changes on the horizontal and vertical meridians after the superior incisions. The changes after the temporal incisions depend linearly on time after surgery. Considering the uncertainty of keratometry, the corneal meridians stabilized 4.5 months after ECCE, 1.2 months after 6Sup, and 0.3 months after 3Sup. No significant change was detected on the horizontal and vertical meridians after 3Temp and 3Cor. CONCLUSIONS: The magnitude and the duration of keratometric change on the horizontal and vertical meridians of the cornea depend on the length and location of the incision. Within the limits of measurement error, no significant change in corneal curvature was detected after either small temporal incision.     

Effect of temporal and nasal unsutured limbal tunnel incisions on induced astigmatism after phacoemulsification

PURPOSE: To compare the surgically induced corneal astigmatism after unsutured temporal and nasal unsutured limbal tunnel incisions. SETTING: Departments of Ophthalmology, Marienhospital, Aachen, and Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. METHODS: In a prospective clinical study, 42 eyes of 21 patients with a mean age of 75.1 years had phacoemulsification and implantation of a foldable hydrophobic acrylic intraocular lens using a 3.6 to 3.8 mm unsutured limbal tunnel incision. The right eye always received a temporal incision and the left eye, a nasal incision. Computerized videokeratography was performed preoperatively and 2 weeks and 6 months postoperatively. Surgically induced astigmatism was calculated by vector analysis using the Holladay-Cravy-Koch formula. The 2 groups were compared using a paired Wilcoxon test. RESULTS: The mean surgically induced corneal astigmatism in the temporal incision group was 0.62 diopters (D) +/- 0.48 (SD) 2 weeks postoperatively and 0.47 +/- 0.32 D at 6 months and in the nasal incision group, 1.55 +/- 0.84 D and 1.05 +/- 0.57 D, respectively. The difference between the groups was statistically significant (P <.05). CONCLUSIONS: There was a highly statistically significant difference in surgically induced corneal astigmatism after temporal and nasal unsutured limbal tunnel incisions. The degree of induced astigmatism and the difference between the temporal and the nasal incisions decreased over time. A nasal tunnel incision is not appropriate for astigmatism-neutral surgery.     

两种不同长度角膜缘切口对白内障超声乳化术后角膜前后表面散光影响的对比

背景 白内障超声乳化术中切口的不同会引起不同的角膜手术源性散光已经被众多研究所证实,影响因素包括切口的长度、位置和形态等,但关于2.2 mm、3.0mm角膜缘切口白内障超声乳化手术引起的手术源性散光,尤其是引起的角膜后表面散光变化的研究国内外鲜有报道. 目的 对比经2.2 mm、3.0mm角膜缘切口的白内障超声乳化摘出联合人工晶状体(IOL)植入术后引起的角膜前表面、角膜后表面手术源性散光( SIA)值、总的SIA值及其变化.方法 将白内障患者47例71眼分成2.2mm切口组和3.0 mm切口组2个组,分别在角膜曲率最大子午线轴位做2.2 mm、3.0 mm角膜缘切口,行白内障超声乳化摘出联合IOL植入术.术前及术后1d、1周、1个月、3个月应用Pentacam系统测量角膜前表面、角膜后表面曲率及中央角膜厚度.根据角膜前表面平坦轴和陡轴方向的曲率半径及角膜前表面所在的空气和角膜本身的屈光指数计算角膜前表面散光值,以同样的方法计算角膜后表面的散光值,根据所得的角膜前表面、角膜后表面散光值,应用矢量法得出角膜总散光.使用Jaffe/Clayman分析法分别计算2个组患者不同时间点角膜前表面、角膜后表面SIA值和总SIA值,比较术后上述各时间点2个组间及2个组内SIA值的差别.结果 术后1d、1周、1个月及3个月2.2mm切口组白内障超声乳化摘出联合IOL植入术后平均角膜前表面、角膜后表面SIA值及总SIA值均低于3.0mm切口组,不同时间点组间的总体比较差异无统计学意义(前表面:P=0.290;后表面:P=0.740;总SIA:P=0.434).2个组术后3个月平均角膜前表面、角膜后表面散光值均明显低于术后1d和术后1周的散光值,差异均有统计学意义(2.2 mm切口组:P=0.020、0.036;3.0 mm切口组:P=0.006、0.023).术后1d时2.2mm切口组和3.0mm切口组术后角膜后表面散光值分别为(0.70±0.43)D和(0.75±0.54)D,而术后1周、1个月和3个月散光值均逐渐减少,与术后1d比较差异均有统计学意义(2.2mm切口组:均P=0.001;3.0 mm切口组:P=O.028、0.044、0.032).2个组术后1周、1个月、3个月的角膜总SIA值均明显低于术后1d值,差异均有统计学意义(2.2mm切口组:P=0.015、0.002、0.002;3.0mm切口组:P=O.049、0.007、0.016).结论 2.2mm和3.0 mm角膜缘切口超声乳化白内障摘出联合IOL植入术相比,前者SIA值相对较小但差异无统计学意义.对两组各个时间点的比较发现,角膜总的SIA值和后表面SIA值变化趋势基本一致,但与角膜前表面SIA值变化趋势不完全一致.     

选择性切口对有晶状体眼后房型人工晶状体术后散光控制的临床研究

探讨选择性手术切口对有晶状体眼后房型人工晶状体（ ICL）术后散光控制的作用。方法高度近视102例（195只眼）,随机分成选择性切口97只眼（A组）和颞侧角膜切口组98只眼（B组）,通过术前、术后1周、1、3个月分别行角膜地形图检查,观察患者术后散光的变化。结果 A组术前平均角膜散光为（1．26±0.35）D,B组术前平均角膜散光为（1．28±0．38）D,两组差异无统计学意义。术后1周、1、3个月,A组平均散光分别为（0．93±0．29）D、（0．85±0．16）D、（0．80±0．13）D,B组平均散光分别为（1．32±0．33）D、（1．27±0．18）D、（1.25±0．20）D,两组差异有统计学意义。结论选择性手术切口能在一定程度上控制ICL术后散光。     

Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery

PURPOSE: To evaluate astigmatism outcomes after congenital cataract surgery with intraocular lens implantation using clear corneal or scleral tunnel incisions. METHODS: We retrospectively reviewed the medical records of 46 children (67 eyes), aged 2 months to 12 years, who had undergone nontraumatic cataract extraction and intraocular lens implantation between 1996 and 2001, using a scleral tunnel incision (group 1), or a clear corneal incision (group 2). Refractive astigmatism was measured at 1 week, 3 months, and 5 months after surgery. Paired t-test was used to compare those variables, and Spearman's correlation was used to determine their relation to patient's age. RESULTS: Mean+/-SD astigmatism at 1 week postoperatively was 3.1+/-2.8 Diopter (D) and 2.1+/-1.7 D in groups 1 and 2, respectively. It significantly reduced to 1.1+/-1.2 D and 0.9+/-1.0 D, respectively, in the two groups at 5 months postoperatively (P<0.007). In both groups patients' age was significantly correlated with 1-week postoperative astigmatism (group 1: r=0.64; P=0.001; group 2: r=-0.58; P=0.003), and with the change in cylinder magnitude between 1 week and 3 months postoperatively (group 1: r=-0.67; P=0.001; group 2: r=0.50; P=0.013). CONCLUSION: Children who underwent congenital cataract surgery using clear corneal or scleral tunnel incisions showed high postoperative astigmatism at 1 week postoperatively, which spontaneously reduced during 5 months follow-up. Therefore, suture removal is not necessary in those cases.     

非球面和球面人工晶状体植入术后视功能观察

目的 分析白内障患者术前角膜散光情况评估经不同位置透明角膜切口行超声乳化术后的角膜散光变化情况.方法 218例(295只眼)白内障患者分为三组,第一组选择颞侧切口,第二组选择颞上方切口,第三组选择上方切口,三组患者通过透明角膜切口行白内障超声乳化及折叠式后房型人工晶体植入术.术前及术后一周、一月、三月分别检测患者角膜散光情况,并通过Holladay-Cravy-Koch方法 计算术源性散光.结果 术前角膜散光0.5至1.5D的占60.68%,大于等于1.5D的占11.86%,顺归散光占29.49%,逆归散光占51.19%,其余为斜轴散光.术后三次随访颞侧切口组的术源性散光最低,上方切口组的术源性散光最高,具有统计学差异(P<0.05).另外,在上方切口组中发现患者术后角膜散光有向逆归散光转变的趋势.结论 白内障患者术前大多存在小于1.5D的角膜散光.在白内障术后早期阶段,颞侧透明角膜切口引起的术源性散光较小,而上方透明角膜切口不仅可引起较显著的术源性散光,并且术后角膜散光有向逆归散光转变的趋势.

Abstract：

Objective To analyze the corneal astigmatism before cataract surgery and evaluate the astigmatism changes after cataract surgery performed using clear corneal incisions with different locations.Methods: This randomized prospective clinical study comprised 295 eyes of 218 patients having phacoemulsification and implantation of foldable intraocular lens through a corneal tunnel incision. Patients were randomly divided into three groups depending on the different locations of the incision: temporal, superotemporal and superior. Corneal topography was performed preoperatively and 1 week, 1 month, and 3 months postoperatively. Surgically induced changes were calculated by vector analyses using the Holladay-Cravy-Koch method. Results: Preoperatively, in 60.68% of eyes, corneal astigmatism was between 0.5 and 1.5 diopters (D) and in 11.86%, it was 1.5 D or higher. Meanwhile, about 29.49 percent of eyes had with-the-rule (WTR) astigmatism, while 51.19% had against-the-rule (ATR) astigmatism, and the others had oblique astigmatism. At three follow-up visits postoperatively, the mean magnitude of surgically-induced astigmatism (SIA) was lowest in the temporal incision group and highest in the superior incision group. In addition, an ATR shift was found in the superior incision group. Conclusions: Corneal astigmatism less than 1.5 D was present in most cataract surgery candidates. Cataract surgery using temporal clear corneal incision induced significantly less SIA in the early postoperative period. Superior incision may lead to an ATR astigmatism shift.     

小切口非超声乳化白内障术切口缝合与否的疗效比较

目的：探讨小切口非超声乳化白内障手术中巩膜切口缝合两针与不缝合的疗效差异。

方法：对420例477眼白内障患者行小切口非超声乳化联合后房型人工晶状体植入术,一字形巩膜隧道切口大小为6～7mm,植入直径5.5mm硬性人工晶状体,切口对称缝合两针者205例230眼(A组),不缝合者215例247眼(B组),术后2d; 3mo观察术眼视力和角膜散光。

结果：术后2d,A、B二组裸眼视力或球镜矫正视力≥0.5者分别为193眼(83.9%)和190眼(76.9%),术后3mo,A、B二组裸眼视力或球镜矫正视力≥0.5者分别为205眼(89.1%)和198眼(80.2%),两组病例不同时期视力差异均有统计学意义(P<0.05); 术后2d; 3mo,A组的平均角膜散光分别为1.53±0.59,1.05±0.43D,B组平均角膜散光分别为1.85±0.97,1.31±0.65D,两组病例术后不同时间平均角膜散光度差异均有统计学意义(P<0.01); A组病例术后无出现切口渗漏、浅前房、虹膜膨出的并发症,B组病例术后有3眼(1.21%)出现切口轻度渗漏、前房稍浅,4眼(1.62%)术后第1d出现上方虹膜膨出并嵌顿于巩膜切口。

结论：小切口非超声乳化白内障手术巩膜切口缝合两针者较不缝合者术后视力好,角膜散光小,手术更安全。     

角膜地形图引导下白内障手术切口构建的变异对角膜散光影响

目的 观察根据角膜地形图选择白内障手术切口位置及其构建变异,以进一步降低术前角膜散光.方法 对白内障患者123例(126只服),术前常规作角膜地形图检查.病人随机分成5组,A组、B组、E组为小切口手法组,A组和B组分别于上方和根据角膜地形图在强子午线方向行反眉形巩膜隧道切口;E组根据角膜地形图在强子午线方向行水平巩膜隧道切口;C组和D组为超声乳化组,分别于上方和根据角膜地形图在强子午线方向行透明角膜隧道切口;观察术后1d及7d后视力、角膜地形图等情况.结果 ①视力:术后7d,发现B组与E组患者差异有统计学意义,余各组间差异无统计学意义,组间裸眼视力≥1.0者差异亦无统计学意义.②术后散光轴向变化:A～D组变化不明显,E有12例散光轴向发生改变.③角膜散光:A组、B组散光变化较小,B组和E组术后7d较术前减少,差异有统计学意义;C组、D组术后1d角膜散光较大,7d后渐回复,但C组仍高于术前水平;A组与B组、C组与D组及A组与C组比较术后差异均无统计学意义;B组与D组术后1d差异有统计学意义,术后7d差异无统计学意义;B组与E组比较,术后1d差异无统计学意义,术后7d差异有统计学意义.结论 通过观察角膜地形图来选择白内障手术切口位置及其构建,可降低手术源性角膜散光或术前存在的角膜散光,明显改善术后早期视力.对进一步提高白内障术后的视觉质量具有临床指导意义.     

用3．5mm切口的白内障超声乳化术降低术前散光

目的：评价3．5mm上方巩膜隧道切口和颞侧透明角膜切口的白内障术后角膜散光，手术所致散光和裸眼视力。方法：根据术前角膜散光轴位选切口的白内障超声乳化摘出联合软性人工晶状体植入术共89眼，A组：47眼散光为顺规性，切口选在上方巩膜。B组：42眼散光为逆规性，切口选在颞侧透明角膜，术前，术后3天－1年，分别测量角膜散光，查裸眼视力，用Cravy法计算手术所致散光。结果：术前，术后3天，1，3，6，12月的平均散光，在A组分别为1．17D，1．10D，1．01D，0．88D，0．85D和0．82D，在B组分别为1．22D，1．03D，1．04D，1．01D，0．95D和1．00D。术后12月内，手术所散江，在A组为－0．22D－0．39D，在B组为＋0．57D－＋0．26D。术后3天裸眼视力≥0．5者，在A组和B组分别占85．1％和81．0％，结论：在这研究中，两种切口均能降低术前散光，术后眼视力恢复更理想。     

Preliminary clinical results of posterior lamellar keratoplasty through a sclerocorneal pocket incision

PURPOSE: To report the preliminary results of a surgical technique for transplantation of posterior corneal tissue through a sclerocorneal pocket incision for corneal endothelial disorders. DESIGN: Retrospective, noncomparative, interventional cases series. PARTICIPANTS AND INTERVENTION: In seven sighted human eyes, a deep stromal pocket was created across the cornea through a 9.0-mm superior scleral incision. A 7.0- or 7.5-mm diameter, posterior lamellar disc was excised and replaced by a 'same size' donor posterior disc, without suture fixation. The scleral incision was sutured. MAIN OUTCOME MEASURES: Intra- and postoperative complications, best spectacle-corrected visual acuity, keratometry, topography, biomicroscopy, pachymetry, and endothelial cell density were evaluated. RESULTS: Six to 12 months after surgery, all transplants were clear and in position. Best spectacle-corrected visual acuity was limited by preexisting maculopathies in two eyes and varied from 20/80 to 20/20. Postoperative astigmatism averaged 1. 54 diopters (D; standard deviation [SD] +/- 0.81 D), pachymetry averaged 0.49 mm (SD +/- 0.09 mm), and postoperative endothelial cell density averaged 2520 cells/mm(2) (SD +/- 340 cells/mm(2)). In one eye, a microperforation occurred during stromal pocket dissection so that the procedure was converted into a penetrating keratoplasty. CONCLUSIONS: Posterior lamellar keratoplasty through a sclerocorneal pocket incision is a feasible surgical approach to manage corneal endothelial disorders.