湿性年龄相关性黄斑变性患者白内障术后视力评估

目的:分析术前合并有年龄相关黄斑变性(wet age-related macular degeneration,wAMD)的白内障患者行超声乳化联合人工晶状体植入手术后视力的恢复情况.方法:收集2013-06/2016-01于西安交通大学第一附属医院眼科就诊行白内障超声乳化联合人工晶状体植入术患者的资料,筛选出术前合并wAMD且处于稳定期的患者48例61眼进行回顾性分析,对其手术前后视力的差异进行统计分析.结果:选取的61眼患者中49眼术后视力有提高,11眼术后视力无提高,1眼术后视力下降.手术前后视力进行秩合检验比较发现,术后视力明显优于术前视力,手术前后视力差异有统计学意义.未发现术后视力的改善情况与患者年龄的相关性.结论:对于术前合并wAMD的白内障患者,进行白内障超声乳化联合人工晶状体植入手术可以较为有效地改善患者视力.     

视网膜振荡电位在糖尿病患者白内障术后视力预测中的应用

对视网膜振荡电位(OPs)的定义、发展史、起源、记录条件及与视网膜循环障碍的关系进行综述，对于存在糠尿病视网膜病变的患者，OPs幅值的改变在视网膜病变不明显之前就可出现。OPs在糖尿病性视网膜病变各个阶段有着不同的表现。所以，对于糖尿病患者白内障，如果在人工晶状体植入术前做视网膜电图振荡电位检查，可了解患者是否存在糖尿病视网膜病变及病变程度，对估测术后视力、确定手术适应征、术后治疗方法、减少医疗纠纷的发生都有积极意义。     

年龄相关性白内障术后视觉质量影响因素的研究新进展

随着白内障超声乳化手术的发展,以及功能性人工晶状体的应用,白内障手术已进入屈光手术时代。绝大多数患者手术后均可获得较好的可预测视力效果,但与此同时,白内障患者对术后视觉质量的要求也H益提高,他们不仅仅是要看得见,还要看的好,看得舒服。这就要求眼科医生把更多的注意力放在提高患者的视觉质量上面。因此,文中将影响年龄相关性白内障术后视觉质量的因素做一综述。     

糖尿病眼底病变患者白内障术后黄斑水肿和视力情况

目的：探讨糖尿病(DM)眼底病变患者白内障术后视力及黄斑水肿情况。

方法：选取2016-01/2017-09于我院治疗的白内障伴糖尿病眼底病变患者97例97眼,其中观察A组43例43眼(DM病程<5a),观察B组54例54眼(DM病程≥5a),同时选取单纯白内障患者60例60眼作为对照组,观察三组患者治疗前后最佳矫正视力(BCVA)、黄斑区视网膜厚度(中心凹区、内环区、外环区)、视网膜平均光敏感度(MS)等情况。

结果：术后1mo,对照组和观察A组患者BCVA优于观察B组(0.24±0.09),差异均有统计学意义(P<0.05); 观察B组患者黄斑区中心凹区、内环区和外环区厚度分别为283.30±17.06、335.51±20.26、297.28±20.22μm,均高于观察A组和对照组,差异均有统计学意义(P<0.05); 观察B组患者MS(11.54±1.89dB)明显低于观察A组和对照组,差异均有统计学意义(P<0.05)。术后3mo,对照组总渗漏率明显低于观察A组和B组,观察B组总渗漏率(55.6%)明显高于观察A组,差异均有统计学意义(P<0.0167)。

结论：相比于单纯白内障患者,合并糖尿病眼底病变的患者术后视网膜厚度明显增加,易发生黄斑水肿,同时影响术后视力恢复,其中DM病程较长者尤其明显。     

年龄相关性白内障并发浅前房患者手术治疗后的屈光状况分析

目的:研究年龄相关性白内障并发浅前房患者手术治疗后的屈光状况.方法:选择2012-01/2014-12在我院接受治疗的年龄相关性白内障患者80例106眼.将前房深度(anterior chamber depth,ACD)在2.20 ～2.90mm之间的患者归为对照组,ACD＜2.20mm者为浅前房组.比较两组患者的术前眼部资料、术后屈光度数误差和术后ACD变化.结果:两组患者的眼轴长度、角膜曲率比较,差异无统计学意义(P＞0.05).ACD和眼压、晶状体混浊值比较差异有统计学意义(P＜0.05).两组患者术后屈光度数误差、ACD变化比较,差异有统计学意义(P＜0.05);两组患者术后1 mo和3mo屈光度数误差、ACD变化比较,差异无统计学意义(P＞0.05).结论:年龄相关性白内障并发浅前房患者的眼压、晶状体混浊值较高,术后屈光度数误差和ACD变化较大.     

白内障术后视力相关因素的分析

对白内障术后３个月裸眼视力≥０．８者４６６例,包括术后第一天裸眼视力≥０．８者１９９例进行统计分析,发现在同等条件下,３．５ｍｍ小切口ＰＨＡＣＯ术优于６ｍｍ切口ＰＨＡＣＯ术,更优于ＥＣＣＥ术;术前视力与术后裸眼视力正相关,患者年龄与术后视力负相关。     

糖尿病患者白内障术后后囊膜混浊的临床研究

目的:研究糖尿病患者白内障术后后囊膜混浊(PCO)的发生情况及其危险因素。方法:收集2016-04/08于我院行白内障超声乳化联合人工晶状体植入术的白内障患者182例203眼,根据术前是否合并糖尿病分为糖尿病组(DM组,98眼)和非糖尿病组(非DM组,105眼),DM组患者按照白内障术后30mo是否发生PCO分为PCO组(26眼)和非PCO组(72眼)。比较DM组和非DM组术后PCO的发生及分级情况,分析术前糖尿病病程、糖化血红蛋白(HbA1c)水平、是否存在糖尿病视网膜病变(DR)等因素对DM组患者白内障术后PCO发生影响。结果:术后12、18、24、30mo,DM组患者PCO发生率分别为10.2%、14.3%、22.4%、26.5%,非DM组患者分别为2.8%、4.8%、10.5%、14.3%,两组患者PCO程度均逐渐加重,且DM组患者各时间点PCO程度均重于非DM组,(均P<0.05)。PCO组和非PCO组患者术前糖尿病病程、存在DR情况均有差异(P<0.05),术前HbA1c水平无差异(P>0.05)。结论:糖尿病患者白内障术后PCO的发生率高于非糖尿病患者,且混浊程度较重,糖尿病患者术前糖尿病病程、存在DR是影响PCO发生的危险因素。     

Posterior capsule opacification after cataract surgery in remote Australian Aboriginal patients

Purpose: The aim of this retrospective study was to determine the rate of visually significant posterior capsular opacification formation after cataract surgery for Australian Aborigines living in rural or remote areas in the ‘Top End’ of the Northern Territory, Australia, and then to assess these patients’ outcomes after capsulotomy. Methods: Aboriginal patients living in remote areas of the Top End of the Northern Territory who underwent cataract surgery between 1994 and 1999 were identified from records at the three major hospitals in the region. The presence of posterior capsular opacification (PCO) was determined by clinical examination. The primary endpoint for this study was the presence of axial opacification of the posterior capsule and the need for subsequent Nd:YAG posterior capsulotomy to improve sight. Linear regression analysis of the time from surgery to follow up and the number of eyes requiring Nd:YAG capsulotomy was performed. Operated eyes were grouped according to the interval between surgery and follow up (Group 1: follow up within 1 year of surgery, n= 25; Group 2: follow up 1?3 years after surgery, n= 42; Group 3: follow up 3?5 years after surgery, n= 51). Results: One hundred and eighteen operated eyes were examined. Eyes in Group 3 were found to have the highest incidence of visually significant PCO (27.5%). There were more eyes requiring capsulotomy after 3 years than after 1 year following surgery. Linear regression analysis revealed an odds ratio of 1.4 (P = 0.07). All nine eyes in the 1?3 year group that had developed visually significant PCO had undergone extra‐capsular cataract extraction. Conclusions: For the remote Aboriginal patient who has undergone cataract surgery, there is a relatively minor chance of developing PCO within the first postoperative year regardless of the type of surgery undertaken. This study illustrates that the longer the time after surgery the greater the chance of developing visually significant PCO. For the remote Aboriginal patient there is a high chance (approximately 28%) of developing visually significant PCO within 5 years after cataract surgery. These figures are lower than those reported from other parts of Australia.     

糖尿病患者人工晶状体植入后后囊混浊及眼底改变

目的 观察糖尿病患者白内障囊外摘除及人工晶状体植入术后后囊混浊及眼底改变。方法 对108例(117眼)糖尿病患者的白内障采用6-7mm角巩膜切口行ECCE及后房型IOL植入术,术后5月观察视力、晶状体后囊及眼底改变。结果108例糖尿病患者平均糖尿病病程7.9年,白内障平均病程2.5年。117眼白内障术后5月内观察:后囊混浊18眼(15.4％)。术后视力≥0.5者76眼(65.0％),36眼为0.05～0.4(30.8％),5眼<0.05(4.3％)。眼底检查发现108眼患糖尿病性视网膜病变,其中Ⅲ期58眼、Ⅳ-Ⅴ期24眼、Ⅵ期2眼,黄斑水肿10眼。结论 术后后囊混浊发生率为15.4％,糖尿病性视网膜病变发生率92.3％,而糖尿病病程5年以上者眼底病变发生率高达94.4％(102眼),其中Ⅲ期及以上者达78.7％(Ⅲ期53.7％、Ⅳ-Ⅴ期22.2％、Ⅵ期1.9％),黄斑水肿9.2％,后囊混浊及眼底改变均影响术后视力,但后者是最主要的原因。     

Using the real-life vision test to assess the functional vision of age-related cataract patients

Purpose

(1) To describe and validate a newly developed, timed performance-based measures of functional vision—the real-life vision test (RLVT). (2) To determine how RLVT relates to clinical measures and self-report assessment of visual function and the complex interactions among visual impairment, psychosocial status, and demographic factors.

Methods

A total of 64 patients with age-related cataract and 45 age-matched controls were evaluated by four types of measurements: (1) demographic, medical, cognitive, and depressive evaluation and the reaction time (RT) testing; (2) clinical measures (visual acuity, contrast sensitivity, stereopsis, and the color perception); (3) the 25-item National Eye Institute''s Visual Functioning Questionnaire; and (4) the RLVT. Spearman''s coefficients, partial correlation, and multiple regression analysis were conducted to determine the relationship among RLVT, clinical measures, and self-report assessment of visual function while controlling for confounders.

Results

Control subjects performed RLVT significantly better than the cataract patients. RLVT correlated well with both clinical and self-report assessments of visual function. All subscales of RLVT remained highly associated with most of the clinical measures, even after adjusting for age, years of education, depression, cognitive status, and the RT. Distance, intermediate and near visual acuity, and binocular contrast sensitivity were significant predictors of the RLVT performances.

Conclusions

Given the strong relationship among RLVT, clinical measures, and the self-report assessments, our results highlight the potential usefulness of RLVT for assessing the functional vision of cataract patients. RLVT may provide information not obtainable from clinical measures or surveys and therefore it is essential to be incorporated into future ophthalmological practice.     

2型糖尿病白内障术后后囊混浊的临床研究

目的比较合并2型糖尿病的老年性白内障患者与单纯老年性白内障患者行超声乳化白内障摘出人工晶状体植入术后后囊膜混浊情况。方法2001年3月～2003年3月我院行超声乳化白内障摘出人工晶状体植入术162例245眼，A组为合并2型糖尿病的老年性白内障患者80例120眼，B组为单纯性老年性白内障患者82例125眼。随访3～36个月，比较2组PCO发生率及YAG激光后囊切开百分率、囊膜混浊程度。结果A组、B组后囊膜混浊百分率分别为50．00％、26．04％；YAG激光后囊切开百分率分别为20．00％、6．04％，2种百分率差异均有显著性（P〈0．01）。2组后囊膜混浊程度分级后行秩和检验，差异有显著性（P〈0.01）。结论2型糖尿病是影响白内障术后后囊膜混浊的重要因素之一。     

年龄相关性白内障术后泪膜稳定性变化早期临床研究

目的：评价白内障术后不同时间泪膜稳定性的变化,探讨泪膜稳定性的变化与手术方式之间的关系。方法：设计自身配对研究。选择2003／2004期间在我院住院的年龄相关性白内障患者（随机检查110例120眼）。透明角膜切口超声乳化白内障及折叠式后房型人工晶状体植入组：80例（90眼）;白内障囊外摘除联合后房型人工晶状体植入组：30例（30眼）。所有患者分别于术前、术后1,7d;1,3mo依次行SIt、BUT、角结膜荧光素染色并对其泪膜稳定性的变化进行分析。结果：术前两组SIt、BUT测定及角膜荧光染色无明显差异（P〉0．05）;与术前相比,两组术后1-2d,BUT测定明显缩短（P〈0．001）,差异有显著意义,其中囊外组较超声乳化BUT下降明显（P〈0．05）,SIt明显增加（P〈0．001）,差异有显著意义;两组增加的程度无显著意义（P〉0．05）;术后7d,两组SIt测定恢复到术前水平,差异无显著意义;两组恢复程度亦无明显差异SIt（P〉0．05）;术后1moBUT测定基本恢复到术前水平,差异无显著意义;两组恢复的程度亦无显著意义（P〉0．05）。术后1d超声乳化组角膜荧光素染色为（＋）,伤口处角膜水肿,囊外组角膜荧光素染色为（＋～＋＋）。术后1mo,角结膜荧光素染色及伤口处角膜水肿基本恢复到术前水平。结论：年龄相关性白内障两种手术方式均影响泪膜稳定性,手术切口越大,影响泪膜稳定性越明显;但两种手术方式术后泪膜稳定性恢复程度却无显著性差异。     

预防儿童后发性白内障3种不同术式的临床探讨

目的 探讨儿童白内障术中3种不同后囊处理方法对后发性白内障的预防作用。方法 42例(51眼)白内障儿童，年龄2～14岁，在白内障联合人工晶状体植入术中，分别采用3种不同后囊处理方法：Ⅰ组行大面积后囊抛光，保留完整后囊；Ⅱ组行后囊连续环形撕囊；Ⅲ组行连续环形撕囊联合前段玻璃体切割术。随访2个月～3a，对术后视力、后囊混浊情况及并发症进行分析。结果 3级以上后囊混浊Ⅰ组为71％，Ⅱ组为24％，Ⅲ组为0％．各组均无视网膜脱离、黄斑水肿等并发症出现。结论 儿童白内障摘出联合人工晶状体植入术中Ⅰ期后囊环形撕囊，一定程度上减少后囊混浊的发生：后囊环形撕囊联合前部玻璃体切割术可有效地预防儿童后发性白内障的发生，其远期效果及并发症有待进一步观察和研究。     

囊袋张力环对高度近视患者白内障术后疗效影响的荟萃分析

目的 基于荟萃分析评价术中联合植入囊袋张力环(CTR)对高度近视患者白内障手术疗效的影响。方法 全面检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普等7个数据库,检索时间范围为1990年1月1日至2022年3月20日,收集CTR在高度近视患者白内障手术中应用的随机对照试验和非随机对照试验。2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评价,采用Review Manager 5.4进行荟萃分析。结果 最终纳入8篇文献,共涉及1292例(1630眼)患者。荟萃分析结果显示,在改善患者最佳矫正视力(BCVA)方面,术后1个月、3个月、6个月CTR联合人工晶状体(IOL)植入组患者的BCVA均显著优于IOL植入组(均为P<0.05);在IOL倾斜角、偏心量方面,术后6个月时CTR联合IOL植入组患者较IOL植入组均显著降低(均为P<0.05);晶状体前囊口面积方面,术后3个月时CTR联合IOL植入组患者大于IOL植入组(P=0.048);术后PCO发生率方面,CTR联合IOL植入组患...     

年龄相关性黄斑变性合并白内障手术治疗的研究进展

年龄相关性黄斑变性(age-related macular degeneration, AMD)与白内障是世界范围内最常见的导致低视力的疾病.目前对于合并AMD的白内障患者是否应该实施手术和手术的时机问题尚存争议.本综述的目的在于评估白内障手术对于AMD发生和发展的影响,分析其影响因素,探讨合并AMD的白内障手术时机和联合抗VEGF等治疗,还包括人工晶状体的研究进展和应用,以期选择综合治疗措施,避免和减缓白内障手术后黄斑变性的发生和发展,以保证患者获得良好的视力转归.