白内障合并翼状胬肉两种手术方案的选择

目的 探讨老年性白内障合并翼状胬肉两种手术方案的临床效果.方法 回顾性分析我院107例翼状胬肉未遮盖瞳孔区的老年性白内障,按其接受手术方案分为两组,A组行超声乳化吸出+人工晶状体植入联合翼状胬肉切除术,B组先行翼状胬肉切除术,术后2～4d再行超声乳化吸出+人工晶状体植入术,观察手术前后裸眼视力,最佳矫正视力,角膜散光及术后屈光度并加以比较.结果 与联合手术相比,分次手术术后残余屈光不正度数更低,术后裸眼视力更好.结论 老年性白内障合并翼状胬肉先行翼状胬肉手术,再行超声乳化吸出白内障能取得更好效果.     

高度近视白内障人工晶状体植入术的临床观察

目的　观察超声晶状体乳化吸出联合折叠式人工晶状体植入术治疗白内障合并高度近视的临床效果。方法　对70例 (12 5眼 )白内障合并高度近视行超声乳化吸出低度数或负度数丙烯酸酯折叠式人工晶状体植入术 ,观察术中术后并发症、术后视力和屈光状态。术后随访时间≥ 3月。结果　术中和术后并发症有后囊破裂 3眼 ,角膜水肿 12眼。术后 3月最佳矫正视力 <0 1者 4眼 ,0 1～ 0 4者 2 5眼 ,0 5～ 0 9者 86眼 ,1 0～ 1 5者 10眼。 4眼 (3 2 % )晶状体后囊浑浊 ,无视网膜脱离者。结论　超声乳化吸出低度数或负度数丙烯酸酯折叠式人工晶状体植入术治疗白内障合并高度近视 ,是安全有效的。     

小切口超声乳化吸出术联合低及负度数人工晶状体植入术治疗轴性高度近视白内障

目的　探讨小切口超声乳化吸出术联合低、负度数人工晶状体植入术治疗轴性高度近视白内障的临床效果。方法　对86例111眼轴性高度近视患者进行超声乳化吸出术联合低、负度数人工晶状体植入术。观察患者术后视力、屈光度数和手术并发症。随访1 a。结果　术后3 个月,85 眼最佳矫正视力≥0.5;屈光度数为-0 26~-3.50 D,平均(-1.32±0.65)D,无过矫现象发生。术中发生后囊破裂1 眼;术后角膜水肿14眼,3~7 d消退;后囊混浊9眼;术后6个月内无视网膜脱离者。结论　小切口超声乳化吸出术联合低、负度数人工晶状体植入术提高了轴性高度近视患者的视力,有效的预防了视网膜脱离,获得了预期的屈光状态。     

小切口非超声乳化白内障手术联合人工晶状体植入术后屈光状态的分析

目的分析小切口非超声乳化白内障手术联合人工晶状体植入术术后屈光状态。方法老年性白内障52例（68眼）。术前应用手动角膜曲率计及眼科A/B超测量角膜曲率及眼轴长度,计算所需人工晶状体度数,全部行小切口白内障囊外摘出联合PMMA人工晶状体植入术,术后观察视力、角膜曲率、散光及实际屈光度。结果所有手术均顺利完成,术后3月,裸眼视力0.5～0.8者51眼（75.00%）,裸眼视力〉0.8者13眼（19.12%）;最佳矫正视力〈0.5者4眼（5.88%）（检查发现此4眼为老年性黄斑变性）。角膜曲率平均K值44.22±1.45,角膜散光（0.98±0.76）D,与术前比较,差别均无统计学意义（P〉0.05）;术后屈光度等值球镜（0.10±0.95）D,与术前预测目标屈光度差别有高度统计学意义（P〈0.02）。结论现代小切口非超声乳化白内障摘出术对角膜散光影响较小,手术安全,并发症少。但术后实际屈光度与术前预测值存在差别,应在工作中进一步探索准确计算所需人工晶状体度数的手段。     

负度数人工晶状体植入术治疗白内障合并超高度近视

目的 观察超声乳化白内障吸出负度数人工晶状体植入术治疗白内障合并超高度近视的临床效果.方法 对66例97眼白内障合并超高度近视眼患者施行超声乳化白内障吸出联合负度数人工晶状体植入术,观察术后视力、屈光状态、眼前段情况和并发症.术后随访3～12个月.结果 97眼均成功植入人工晶状体,视力都有不同程度的提高,术后3个月时矫正视力＜0.1者9眼,0.1～0.4者52眼,＞0.4者36眼;大部分患者残留低度的近视屈光状态;后囊膜混浊18眼;部分人工晶状体与后囊膜之间存在间隙,且后囊膜出现皱褶;无视网膜脱离和黄斑囊样水肿的发生.结论 超声乳化白内障吸出联合植入负度数人工晶状体治疗白内障合并超高度近视眼,具有良好的有效性和安全性,同时预测性好,并发症少.     

白内障超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障

目的　评价高度近视合并白内障行超声乳化摘出及后房折叠型人工晶状体植入术的疗效。方法　对４６例（７７眼）高度近视合并白内障患者施行透明角膜切口超声乳化吸出术,通过３．２ｍｍ切口植入后房折叠型人工晶状体。于术后１周、１个月、３个月、６个月随访复查,比较手术前后最佳矫正视力、球镜度数、柱镜度数、角膜曲率、角膜内皮细胞计数和眼轴长度的变化。结果　手术均顺利完成,人工晶状体１００％囊袋内植入。术后１周、１个月、３个月、６个月最佳矫正视力≥０．５者分别有５９眼、６０眼、６５眼和６５眼。术后６个月患者球镜度数、柱镜度数、角膜曲率、眼轴长度、角膜内皮细胞计数分别为（ －１．０４±０．５９）Ｄ、（－０．２３±１．１４）Ｄ、（４３．７２±１．１６）Ｄ、（２８．４６±１．７７）ｍｍ、（２０４１±８２５）个·ｍｍ－２。与术前相比,球镜度数、角膜内皮细胞计数两项差异具有统计学意义（均为Ｐ＜０．０５）。结论　超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障效果良好,术后视力恢复快、屈光状态稳定。     

透明角膜3mm切口白内障超声乳化术后的屈光状态研究

目的:观察3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后患者的屈光状态及其变化规律,确定最佳配镜时间。方法:老年性白内障患者68例(79眼)行3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术,术后行EAS-1000检查,除外人工晶状体存在偏位情况。然后1,2,3,4wk;3,6mo行视力及显然验光检查,记录患者的视力、球镜、柱镜和散光轴,分别对结果行多因素方差分析。结果:术后1,2,3,4wk;3,6mo的裸眼及矫正视力,球镜、柱镜度数及其散光轴的变化差异均无显著性(P>0.05)。结论:3mm透明角膜切口白内障超声乳化吸除及折叠式人工晶状体植入术后1wk屈光状态趋于稳定,即可配镜。     

重视白内障合并角膜散光的精准手术矫正问题

临床上白内障合并角膜散光患者较为常见,而以往白内障超声乳化术中散光并未得到精准矫正,严重影响术眼术后的屈光功能和视觉质量.术前精确测量角膜散光的大小和轴向是白内障屈光手术术中确定角膜切开位置或植入Toric人工晶状体(IOL)的关键.联合应用IOLMaster计算IOL球镜度数、利用Pentacam测定全角膜曲率、采用VERION导航系统可提供精准的术前检查数据和良好的术后效果,使得白内障术中可以通过改进手术切口、弧形角膜切开和植入适宜的Toric IOL来矫正角膜散光.飞秒激光弧形角膜切开联合白内障超声乳化可有效、安全和精准地矫正中低度角膜散光,改善视功能.为提高白内障屈光手术的准确性,我们应进一步研究建立角膜生物力学数字化模型、改良手术量计算方案,以增进飞秒激光角膜切开矫正角膜散光的可预测性和精准性.     

白内障超声乳化术3.2mm透明角膜切口术源性散光的分析

目的:计算并比较不同位置3.2mm透明角膜切口白内障超声乳化吸出联合人工晶状体植入术的手术源性散光(surgery induced astigmatism,SIA)的度数,分析切口对角膜曲率的影响。方法:将88例100眼随机分为A,B两组,A组做颞侧(9∶00或者3∶00方位)透明角膜3.2mm斜形切口,B组做上方12∶00方位透明角膜斜形切口,行白内障超声乳化吸出联合折叠人工晶状体植入术,测量术前和术后3mo的角膜曲率,用矢量分析法计算SIA度数,比较两组SIA度数的差异,同时分别比较切口所在子午线、与切口垂直子午线术前和术后角膜曲率的变化。结果:两组平均SIA度数比较,差异无显著性(P=0.483),切口所在子午线术前和术后角膜曲率比较,差异有显著性(P=0.006),而与切口垂直子午线的术前和术后角膜曲率比较差异无显著性(P=0.084)。结论:3.2mm透明角膜切口SIA的度数与切口位置无明显关系,切口对所在子午线角膜曲率有松解作用,对与切口垂直子午线角膜曲率无明显影响,矢量公式法计算所得的SIA值在散光型人工晶状体植入术中提供了重要的参考价值。     

准分子激光屈光性角膜手术后白内障人工晶状体植入术

目的探讨准分子激光屈光性角膜手术后白内障吸出术中、植入人工晶状体的屈光度计算方法。方法对4例（4眼）准分子激光屈光性角膜手术后的白内障行超声乳化吸出及人工晶状体植入术，术前采用OrbscanⅡ角膜地形图及角膜曲率计测量角膜的K值，分别应用第二代经验公式（SRKⅡ）计算所需人工晶状体的屈光度。术后验光记录术眼屈光状况，与术前结果对比，评价所选择的人工晶状体屈光度的准确性。结果OrbscanⅡ角膜地形图和角膜曲率计分别测量的角膜K值，以及所计算的人工晶状体的屈光度，均有明显的差别。尽管按预留近视状态，选用角膜地形图测量的K值计算人工晶状体的屈光度，术后仍然欠矫，平均产生远视＋1．57D，较术前预留度数仍相差约＋3．44D。结论采用OrbscanⅡ角膜地形图的K值来计算人工晶状体屈光度误差小，在预留的屈光度数基础上加3．50D来选择人工晶状体是较为精确和安全的。     

Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results

AIM: To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases. METHODS: Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y. RESULTS: The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE) was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered values remained stable also at the end line evaluation. CONCLUSION: The excimer laser treatment of residual refractive errors after cataract surgery with IOL implantation in abnormal eyes resulted in satisfactory and stable visual outcome with good safety and efficacy.     

角膜屈光术后人工晶状体度数计算的临床观察

目的：探讨角膜近视屈光术后白内障患者的人工晶状体度数的计算方法,观察初步的临床效果。方法：回顾性分析2013－03／2015－06于我院行白内障手术同时伴有角膜近视屈光手术史的患者14例23眼。根据患者既往角膜手术方式分为 LASIK （ laser in situ keratomileusis）组9例15眼,RK（ radial keratotomy）组5例8眼。将每例患者的角膜地形图中央2．5 mm最低点曲率值,带入SRK－T公式,按照预留－1．00～－1．50 D选择人工晶状体度数,完成常规的白内障超声乳化联合人工晶状体植入术。术后随访3mo,观察术后视力、矫正视力和屈光状态。计算出术后人工晶状体计算公式的预测屈光误差,分别与www．iolcalc．org网站上的Shammas公式和Barrett True K公式进行比较,观察其应用效果,采用独立样本t检验进行统计分析。结果：LASIK组和RK组相比,两组患者术后3 mo的裸眼视力（LogMAR）分别是0．15±0．11、0．21±0．16,术后屈光度分别是－0．43±1．04、－1．52±1．01D,SRK－T公式预测屈光误差分别是－0．71±0．80、0．43±0．99,LASIK组均优于RK组且两组间差异均有统计学意义（ P＜0．05）。将本研究方法分别与Shammas公式和Barrett True K公式相比,观察各种公式的预测屈光误差,本研究方法的屈光误差最小,但是差异无统计学意义（P＞0．05）。结论：应用研究方法的术后屈光状态均为轻度近视,适用于因近视行角膜屈光手术的白内障患者进行人工晶状体度数的选择,此方法对于LASIK手术史患者的人工晶状体度数预测性更佳。     

Intraocular lens power calculation after refractive surgery

PURPOSE: To analyze the results of phacoemulsification cataract surgery in eyes that had had refractive surgery and to compare the predictability of various methods of intraocular lens (IOL) power calculation. SETTING: Instituto de la Visión, Buenos Aires, Argentina. METHODS: The study involved 7 cases that had phacoemulsification after radial keratotomy or laser in situ keratomileusis. The spherical equivalent (SE) and visual acuity were evaluated preoperatively and postoperatively to assess the changes before cataract development. The IOL power calculated with conventional keratometry (CK), adjusted keratometry, the clinical history method (CHM), corneal topography (CT), and the contact lens method (CLM) was compared with the final refractive and keratometric results measured with the BackCalcs (Holladay(R) IOL Consultant Program, Holladay Consulting, Inc.) to assess the accuracy and predictability of each method. RESULTS: The mean SE was -4.82 diopters (D) +/- 5.13 (SD) before phacoemulsification and +0.19 +/- 1.01 D after phacoemulsification, and the mean best corrected visual acuity was 0.39 +/- 0.07 (20/50) and 0.80 +/- 0.06 (20/25), respectively. CONCLUSIONS: Post-phacoemulsification refraction in cases with previous refractive surgery appeared to be predictable when the appropriate calculation method was applied. When all the data were available, the CHM provided the best results. Adjusted keratometry and CT seemed to be more accurate than CK and the CLM.     

Excimer laser surgery for correction of ametropia after cataract surgery

PURPOSE: To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation. SETTING: Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA. METHODS: In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation. RESULTS: Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was -3.76 diopters (D) +/- 2.50 (SD) (range -6.50 to +0.75 D), spherical refraction ranged from -9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was -0.88 +/- 1.43 D (range -2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved. CONCLUSIONS: In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.     

Acrysof Toric IOL 植入矫正白内障患者角膜散光的早期临床效果研究

目的评价白内障患者超声乳化术中植入 Acrysof Toric IOL 矫正术前规则角膜散光的早期临床效果、有效性、安全性和预测性.方法本研究收集2010年8月至2011年10月期间于南京爱尔眼科医院就诊,行白内障超声乳化术并植入 Acrysof Toric IOL 的白内障患者27例(34只眼).主要观察指标:术前术后的裸眼视力,最佳矫正视力,角膜散光,术后残留散光,IOL 轴位等.随访3个月.结果患者术后3个月裸眼视力(0.68±0.12)较术前(0.11±0.17)有明显提高,且差异具有统计学意义.术后3个月散光(0.45±0.20) D 较术前散光(2.13±0畅35) D 减少,且差异具有统计学意义.与预测残余散光(0.23±0.14) D 比较,差异无统计学意义.术后3个月Toric IOL 轴位旋转为5.0°±1.6°,其中32只眼(94%)小于8°.无1例发生术中或术后并发症.结论年龄相关性白内障伴术前规则角膜散光患者,超声乳化术中植入 Acrysof Toric IOL 是一种有效、安全、可预测的矫正的方法.     

角膜屈光手术后人工晶状体屈光度计算方法的选择

目的：探讨角膜屈光手术后白内障患者进行超声乳化联合人工晶状体( intraocular lens,IOL)植入手术的临床效果,对不同IOL屈光度准确性进行比较。
　　方法：对我院收治的120例160眼接受白内障手术并曾行角膜屈光手术的治疗近视患者相关资料进行分析,采用病史法对可获得角膜屈光手术前的角膜曲率数据K值进行计算,采用矫正角膜曲率数值法以及角膜地形图法对患者治疗前后资料记录不完整者K值,将K值代入公式,通过比较白内障术后实际屈光状态和预期屈光状态(-0.50D),比较三种计算方法IOL屈光度准确性。
　　结果：白内障患者手术前平均最佳矫正视力为0.25±0.05,术后最佳矫正视力提高0.80±0.05;白内障患者手术前平均等效球镜值( spherical equivalent,SE)为-1.98±1.75,患者手术后SE为+0.85±3.38(P<0.05);48眼临床病史调查法( CHM)计算K值;73例采用校正角膜曲率数值法( AKM)计算K值;39例采用角膜地形图法( CTM)计算K值。
　　结论：对具有角膜屈光手术史患者根据患者临床症状、病史等选择合适的方法,能够准确地计算患者IOL,对于资料完整者采用CHM提供角膜K值;对于资料不完整者采用AKM和CHM计算K值。     

手法碎核小切口高度近视眼白内障摘除术

目的:探索在基层医院应用手法碎核小切口摘除高度近视眼白内障联合人工晶状体植入手术的效果。方法:观察高度近视眼94眼白内障手法小切口摘除及人工晶状体植入术的安全性、并发症和术后视力结果。结果:术后随访12mo最佳矫正视力大于0.5者77眼(82%),低于0.5者17眼(18%),并发症包括后囊破裂8眼,角膜水肿19眼,黄斑囊性水肿3眼。结论:高度近视眼手法小切口白内障摘除及人工晶状体植入术是安全有效的。     

独眼白内障手术28例临床分析

目的:探讨独眼白内障患者的手术可行性。方法:对28例独眼白内障患者行白内障摘除及人工晶状体植入手术,其中白内障超声乳化吸出并后房型人工晶状体植入术17例,白内障囊外摘出并后房型人工晶状体植入术11例。结果:术后视力均有提高,<0.1者(0.04)1例(4%),0.1～0.25者7例(25%),0.3～0.5者16例(57%),0.6～1.0者4例(14%)。脱残率71%,脱盲率96%。结论:只要对独眼白内障患者做好充分的术前评估,制定完善的手术方案,态度认真稳妥,手术安全可行,效果满意。     

后曲率实测法计算准分子激光角膜原位磨镶术后角膜屈光力的准确性

目的 探讨后曲率实测法计算准分子激光原位角膜磨镶术(LASIK)后角膜屈光力的准确性.方法 多种测量角膜屈光力方法的比较性研究.回顾性分析按后曲率实测法计算人工晶状体度数的LASIK术后人工晶状体植入眼8例(11只眼,10只为超声乳化白内障吸除及人工晶状体植入术,1只为人工晶状体置换术),计算术后稳定屈光状态与目标屈光度的差异,并据此推导实际角膜屈光力.分析其他角膜曲率法(自动曲率计、角膜地形图、球镜当量法、前曲率法、Pentacam提供的EKR曲率)计算人工晶状体度数可能造成的届光偏差.对LASIK术后6个月随访眼23例行详细屈光检查,根据术前角膜屈光力及手术前后眼屈光度改变推导术后理论角膜屈光力.分析后曲率实测法计算所得角膜屈光力与理论角膜屈光力的差异,并与其他角膜曲率法作比较.结果 采用后曲率实测法计算的人工晶状体植入眼术后平均裸眼视力0.8±0.2,与目标屈光度绝对偏差平均为(0.36±0.36)D(-0.63～+0.85 D),绝对偏差≤0.25 D、≤0.50 D、≤1.00 D的眼比例数分别为55%、73%和91%.其屈光偏差显著低于自动曲率计[(2.50±1.08)D]、角膜地形图[(1.90±0.88)D]、球镜当量法[(2.09±1.62)D](P<0.01)及前曲率法[(1.45±1.10)D](P<0.05)的预期结果;与EKR曲率法比较差异无统计学意义,但其偏差范围(-1.13～0.85 D)小于后者(-1.10～1.80 D).23例单纯LASIK术后眼的角膜屈光力测算同样显示后曲率实测法计算所得角膜屈光力与理论角膜屈光力偏离程度最小,绝对偏差为(0.67±0.45)D.结论 后曲率实测法计算LASIK术后角膜屈光力,可行性准确性俱佳.