围手术期白内障患者278例SCL-90自评量表结果分析

目的：了解我科各型白内障患者围手术期的心理健康状况,为该特定人群特定时期的心理评估和心理干预工作提供依据。方法：应用症状自评量表（SCL-90）对在我科2008—06／2009—06确诊的278名各型白内障患者在围手术期进行无记名问卷调查。在术前和术后分别进行问卷调查,其结果与常模作比较;将患者分为两组,A组为年龄相关性白内障,B组为伴有青光眼,外伤或代谢性疾病的白内障患者,分别将这二组的结果进行比较。结果：各型白内障患者术前和术后的躯体化,抑郁,焦虑和恐惧因子的阳性得分高于常模,其差异具有统计学意义（P〈0．05）,尤其是躯体化因子（P〈0．01）。B组的焦虑,躯体化,抑郁和恐惧因子阳性得分高于A组,其差异具有统计学意义（P〈0．05）,其中焦虑因子的差异具有显著的统计学意义（P〈0．01）。结论：各型白内障患者在术前和术后都存在不同程度的躯体化表现和抑郁,焦虑,恐惧情绪,尤以躯体化明显;合并有外伤,青光眼或者代谢性疾病的白内障患者的上述表现比年龄相关性白内障更加显著,尤其是焦虑。     

原发性青光眼患者术前术后心理特征变化

目的:探讨原发性青光眼患者术前术后心理特征的变化。方法:原发性青光眼患者62例,其中原发性开角型青光眼患者8例,原发性闭角型青光眼患者54例,术前、术后2d及术后1mo,分别用汉米尔顿(Hamilton)焦虑量表(HAMA)(同时附自评量表STAI)、汉米尔顿抑郁量表(HRSD)(同时设抑郁自评量表SDS)、燥狂评定量表(MRS)进行测评。结果:术前与术后2d比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.576,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=1.788,P>0.05)、汉米尔顿抑郁量表(HRSD)中的迟缓因子(B4)得分结果(t=1.880,P>0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=1.727,P>0.05)无显著性差异,其余各项均有显著性差异(P<0.05);术前与术后1mo比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.972,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=0.382)无显著性差异,其余各项均有显著性差异(P<0.05),显示了青光眼患者术前与术后的心理特征有较明显的变化;术后2d与术后1mo组比较:汉米尔顿抑郁量表(HRSD)中的总分(B)(t=2.499,P<0.05)、汉米尔顿抑郁量表(HRSD)中的体重因子(B2)得分结果(t=2.257,P<0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=3.131,P<0.05)、燥狂评定量表(MRS)总分(C)(t=5.515,P<0.05)、抑郁自评量表SDS总分(E)(t=3.788,P<0.05)有显著性差异,其余各项均无显著性差异。结论:原发性青光眼患者术前、术后的心理特征会发生较大的变化,术后随病情好转,其情绪也将趋于稳定。     

原发性闭角型青光眼心理和行为特征调查

目的:研究闭角型青光眼患者的心理、个性和行为特征,探讨青光眼患者心理因素与疾病的关系。方法:运用SCL-90、艾森克个性问卷和A型行为问卷对100例青光眼患者和45例正常对照组进行测试比较。结果:SCL-90评分中,青光眼组的躯体化、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性等症状因子评分和SCL-90总分均明显高于对照组(P<0.05),而强迫因子得分两组间差异无显著性。A型行为问卷测评结果,青光眼组TH量表得分高于正常组,有明显差异,TH+CH和CH得分两组间无明显差异。青光眼组的精神病性(P)、神经质或情绪(N)得分明显高于对照组(P<0.05),而内外向、掩饰两项得分青光眼与对照组无显著性差异(P<0.05)。结论:社会心理因素与原发性青光眼有明确的联系,青光眼患者主要表现为A型性格,患者的精神性和神经质倾向人格特征与闭角型青光眼发病密切相关。     

原发性青光眼患者心理因素分析

目的探讨原发性青光眼患者的心理特征。方法41例原发性青光眼患者(其中POAG者12例,PACG者29例)和41例正常对照者分别用汉米尔顿焦虑量表(附自评量表STAI),汉米尔顿抑郁量表HRSD(附抑郁自评量表SDS)、躁狂评定量表MRS进行测评,记分项目包括:汉米尔焦虑量表总分A,包括2个因子,精神性焦虑(A1)、躯体性焦虑(A2);STAI表总分用D表示;HRSD表总分用B表示,包括5个因子,焦虑/躯体化(B1)、体重(B2)、认识障碍(B3)、迟缓(B4)、睡眠障碍(B5);SDS表总分用E表示;MRS表总分用C表示,病情程度用病情指数(C0)表示。结果评分并统计进行测评,所有受试者的各量表总分均在抑郁或焦虑症、燥狂状态的诊断分数以下,各量表包含的影响因子得分分析:对照组与原发性青光眼组比较:HRSD表中的体重因子(以体重减少0.5kg加1分记分)得分结果无显著性差异,t=0.47,P=0.643>0.05,青光眼患者体重不受疾病影响而变化,除此因子外,其余12项均有显著性差异(P<0.05),自评量表结果与调查者评分结果一致,显示出青光眼患者心理因素较对照组有明显不同;POAG和PACG比较:MRS表(C)分数有显著性差异,其中焦躁易激惹因子分突出(C0),POAG组因子分明显高于PACG组(P<0.05),其余11项无显著性差异(P>0.05);Logistic回归分析结果:HRSD表中的焦虑/躯体化因子B1、迟缓因子B4、以及SDS表得分结果进入回归方程,得到OR值分别为13.772,11.776,0·577。结论和正常人比较,青光眼患者群在心理评定量表中的多项因子有显著差异,青光眼患者的心理特征和正常人不同。     

白内障患者手术前后认知及心理状况比较研究

目的:探讨白内障小切口摘除人工晶状体植入术患者术前与术后疾病相关知识认知、心理状况的变化。方法:采用白内障小切口摘除人工晶状体植入术患者手术前后疾病相关知识认知量表及焦虑自评量表(SAS)对123例患者进行问卷调查,并对收集资料进行比较分析。结果:术前20.4%白内障患者知识掌握好,71.5%白内障患者知识掌握一般,8.1%白内障患者知识掌握差;而手术后知识掌握好的则有63.4%,33.3%知识掌握一般,3.3%知识掌握差,卡方检验,P<0.01,差异有显著性;手术前患者普遍存在焦虑,手术前焦虑评分分别为(39.23±6.12),高于常模水平(29.78±10.07)与术后焦虑评分(27.43±6.02),术前患者高于常模和术后焦虑评分,P<0.05,差异有显著性。结论:白内障小切口摘除人工晶状体植入术患者在术前普遍存在焦虑,故应积极开展健康知识教育,加强心理辅导教育。     

双切口超声乳化联合小梁切除术治疗青光眼合并白内障

目的：探究双切口白内障超声乳化联合小梁切除术治疗对青光眼合并白内障患者视力、眼压和并发症的影响。

方法：回顾性分析2016-04/2017-10我院行双切口(观察组)和单切口(对照组)白内障超声乳化联合小梁切除术的青光眼合并白内障患者各68例68眼的临床资料。记录两组患者术前和术后1mo视力、角膜内皮细胞情况(密度、面积),以及术后1mo内并发症发生情况(前房积血、角膜内皮水肿、前房纤维素性渗出、滤过泡瘢痕化)差异,并比较两组患者术前和术后1、6mo眼压、散光程度差异。

结果：术后1mo时,两组患者视力均较术前升高,差异有统计学意义(P<0.05); 但组间比较,差异无统计学意义(P>0.05)。术后1mo时,两组患者角膜内皮细胞面积均较术前升高,差异有统计学意义(P<0.05); 角膜内皮细胞密度则较术前降低,差异有统计学意义(P<0.05),且对照组变化幅度均大于观察组,差异有统计学意义(P<0.05)。观察组术后并发症总发生率明显低于对照组,差异有统计学意义(P<0.05)。两组患者术后眼压均较术前降低,差异有统计学意义(P<0.05),但术后1mo与术后6mo比较,差异无统计学意义(P>0.05); 且两组间比较,差异无统计学意义(P>0.05)。两组患者术后散光程度均较术前升高,差异有统计学意义(P<0.05),且术后1mo高于术后6mo(P<0.05),而对照组均高于观察组,差异有统计学意义(P<0.05)。

结论：双切口白内障超声乳化联合小梁切除术治疗青光眼合并白内障患者效果显著,虽然双切口术式与单切口术式在改善视力和眼压方面效果相似,但双切口术式对术区损伤更小,能降低术后角膜内皮损伤,并减轻患者术后散光程度,还可减少术后并发症,于促进患者病情转归有积极意义。     

不同房角分离术治疗原发性急性闭角型青光眼合并白内障的疗效

目的：探讨白内障超声乳化联合两种不同房角分离术治疗原发性急性闭角型青光眼合并白内障的临床疗效。

方法：原发性急性闭角型青光眼合并白内障的患者60例62眼随机分为两组,A组31眼行白内障超声乳化摘除术联合I/A头牵拉房角分离术,B组31眼行白内障超声乳化摘除联合黏弹剂钝性房角分离术,比较两组患者术前和术后3mo的最佳矫正视力、眼压、中央前房深度、房角开房范围和瞳孔大小。

结果：术后所有患者眼压明显低于术前眼压,差异具有统计学意义(P<0.05); 62眼视力较术前均有不同程度的改善; 前房深度和房角开放范围均较术前明显增加,差异具有统计学意义(P<0.05)。A组与B组相比,两组患者术后3mo视力、眼压控制和中央前房深度方面差异无统计学意义(P>0.05),A组在房角开放范围方面优于B组,差异有统计学意义(P<0.05)。术后3mo,A组患者中有8眼瞳孔缩小1mm以上,B组患者中有2眼瞳孔缩小1mm以上。

结论：白内障超声乳化摘除术联合两种不同的房角分离术均能有效治疗原发性急性闭角型青光眼合并白内障,其中I/A头牵拉房角分离术能更有效地增加房角开放范围。     

小切口白内障摘除联合房角分离术治疗ACG合并白内障

目的:观察小切口白内障摘除人工晶状体植入联合房角分离术治疗急性闭角型青光眼(acute angle closure glaucoma,ACG)合并白内障的患者临床疗效。方法:收集我院2010-07/2012-06的急性闭角型青光眼合并白内障患者48例48眼,均接受小切口白内障摘除人工晶状体植入联合房角分离术治疗,术后随访3mo。结果:术后最佳矫正视力较术前显著提高(P<0.001);术后3mo,平均眼压为15.6±3.4mmHg,较术前平均眼压(27.3±4.8mmHg)明显下降(P<0.05);术后中央前房深度由术前的1.67±0.46mm增加到3.19±0.38mm(P<0.05);房角较术前增宽,术前关闭的房角不同程度的开放。结论:小切口白内障摘除人工晶状体植入联合房角分离术是一种治疗急性闭角型青光眼合并白内障的有效方法。     

改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗青光眼合并白内障的临床观察

目的 探讨改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗青光眼合并白内障的的临床效果。方法 回顾性病例研究。选取我院2018年2月至2020年8月原发性青光眼合并白内障患者共65例(70只眼),其中原发性闭角型青光眼合并白内障患者33例(35只眼),原发性开角型青光眼合并白内障患者32例(35只眼)。两组均采用改良式“L型”巩膜瓣下超声乳化联合小梁切除术治疗,术后随访6个月,观察两组患者视力、眼压、滤过泡、中央前房深度及并发症等情况。结果 A、B两组术前视力差异无统计学意义(P>0.05),A组术后视力提高要优于B组(P<0.05);与术前视力相比,A组在术后1个月和6个月视力均有提高(P<0.05),而B组在术后1 d、1周、1个月和6个月视力提高,差异均有统计学意义(P<0.05)。末次随访,A组术后功能性滤过泡为31只眼(88.57%),B组术后功能性滤过泡为30只眼(85.71%),两组差异无统计学意义(P>0.05)。两组术后眼压及前房深度均低于术前(P<0.05)。A组手术成功率要优于B组(P<0.05),A组的手术并发症发生率高...     

超乳联合人工晶状体植入术治疗急性闭角型青光眼合并白内障

目的：分析透明角膜切口超声乳化白内障人工晶状体植入术治疗急性闭角型青光眼合并白内障患者的临床应用效果。

方法：选取2016-06/2018-01期间我院收治的急性闭角型青光眼合并白内障患者80例80眼纳入本组研究,按随机数字表法分为观察组和对照组。观察组患者采用超声乳化白内障吸除术治疗,对照组患者采用青光眼白内障联合术治疗,将两组患者治疗结果进行对比。

结果：两组患者术后视力、眼压和并发症发生率比较,观察组改善优于对照组,差异具有统计学意义(P<0.05)。

结论：超声乳化白内障吸除术治疗急性闭角型青光眼合并白内障的临床效果显著。     

白内障患者术前角膜内皮功能分析

目的 分析不同白内障患者术前角膜内皮结构,以指导制定合理的个性化手术方案.方法 前瞻性病例系列研究.白内障患者1910例（3423眼）,按合并疾病的不同分组：A组为年龄相关性白内障组,1511例 B组为合并青光眼组,22例 C组为合并2型糖尿病组,179例.再将A组按年龄段分为40～59岁组,60～79岁组,≥80岁组（高龄组）.所有患者术前检测角膜内皮细胞密度（CD）、细胞平均面积（AVE）、六棱细胞比例（HEXA）等.采用单因素方差分析进行整体比较,组内两两之间差异采用Tukev法.结果 与A组相比,B组CD较低、AVE较大,差异有统计学意义（P＜0.05）,HEX较少,但差异无统计学意义 C组CD较低、AVE较大、HEXA较少,但与A组相比,差异均无统计学意义.按年龄分组,≥80岁组白内障患者角膜内皮CD较低、AVE较大、HEXA较少,与40～59岁组、60～79岁组相比,差异有统计学意义（P＜0.05）.结论 青光眼可导致角膜内皮细胞密度下降,平均细胞面积增大 糖尿病对角膜内皮细胞形态没有明显影响.随年龄增长,年龄相关性白内障患者的角膜内皮细胞密度下降,平均细胞面积增大,六棱细胞比例减小.     

超声乳化人工晶状体植入联合房角分离术治疗年龄相关性白内障合并PACG

目的:探索超声乳化人工晶状体植入联合房角分离术治疗年龄相关性白内障合并原发性闭角型青光眼(primary angle-closure glaucoma,PACG)患者的疗效.方法:选取2014-01/2016-01于我院收治的年龄相关性白内障合并原发性闭角型青光眼患者80例80眼,患者平均眼压33.22±3.17mmHg,平均前房深度2.07±0.15 mm;房角镜检查动态下房角关闭≤1/2周.随机平均分为A、B两组进行研究,两组均行超声乳化联合人工晶状体植入术,其中A组联合房角分离术.术后随访2 mo对眼压以及前房深度、房角情况进行观察.结果:两组患者术后眼压及前房深度变化:A组平均眼压15.11±3.67mmHg,前房深度3.11±0.08mm;B组平均眼压17.24±1.67mmHg,前房深度2.76±0.15mm,两组之间比较差异有统计学意义(P<0.05).两组患者术后房角完全开放比较:A组术后房角全部开放的为28例(70%),B组术后房角全部开放的为18例(45%),两组比较差异有统计学意义(P<0.05).结论:超声乳化人工晶状体植入联合房角分离术治疗年龄相关性白内障合并原发性闭角型青光眼患者安全可靠,操作简单,不会增加手术风险.     

麻风病患者白内障经巩膜隧道切口囊外摘除术效果观察

目的 追踪观察麻风病患者白内障经巩膜隧道切口囊外摘除手术后的临床疗效.方法 同负责治疗麻风病患者的皮肤科医生一起,筛选出适合白内障手术的麻风病患者57例(57只眼),其中麻风病并发性白内障39只眼,麻风病老年性白内障18只眼,在局麻下行经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术.术后1年追踪其临床效果,并与同期的老年性白内障患者63例(63只眼)的手术效果相比较.结果 麻风病患者白内障手术术中分别出现虹膜裂伤、反应晶状体前囊膜破裂、玻璃体溢出等并发症,术后出现不同程度眼压升高、前房反应、角膜水肿、瞳孔上移等.经过一年随访,麻风病并发性白内障组术后最好的视力≥0.4者为38.5%,视力在0.1～0.3者为46.2%,<0.1者为15.4%,麻风病老年性白内障组术后最好的视力≥0.4者为72.2%,视力在0.1～0.3者为27.8%,<0.1者为0;麻风病白内障术后视力≤0.3的29例患者中,24例存在术前慢性葡萄膜炎,是术后低视力的首要原因.麻风病自内障患者出现术后慢性葡萄膜炎、术后瞳孔区膜状物形成、人工晶体移位、术后继发性青光眼等术后并发症.结论 经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术治疗麻风病并发性白内障手术安全、有效,患者视力获得提高.手术前后需要加强抗炎,控制葡萄膜炎.

Abstract：

Objective To evaluate the clinical effect of the scleral tunnel incision in extracapsluar cataract extraction(ECCE)in leprosy patients. Methods Fifty-seven eyes of 57 cataract blind leprosy patients screened by dermatologists underwent the scleral tunnel incision in ECCE, including 39 eyes of complicated cataract and 18 eyes of age-related cataract retrospectively. The clinical effects were evaluated at 1 year after surgery compared with the homochronous surgery outcome of 63 eyes of 63 age-related cataract patients. Results Vitreous loss and iris trauma et cetera occurred during ECCE in leprosy patients, and also elevated intraocular pressure et cetera occurred after ECCE. The best postoperative visual acuity(VA)was better than 0.4 in 38.5% patients in the complicated cataract and in 72.2% in the age-related cataract of leprosy patients. The better VA was from 0.1 to 0.3 in 46.2% and 27.8% in the two groups, respectively, and less than 0.1 in 15.4% and 0% in the two groups, respectively. Among the 29 cases whose best VA were poorer than 0.3 in the leprosy patients, 24 cases had preoperative chronic uveitis, which seemed to be the primary reason for the poor postoperative VA in leprosy patients. Chronic uveitis and secondary glaucoma etc were the postoperative complications of ECCE in leprosy patients. Conclusions Scleral tunnel incision in extracapsluar cataract extraction is safe and effective when performed in leprosy with complicated cataract. Chronic uveitis need to be controlled pre- and postoperation.     

麻风病患者白内障经巩膜隧道切口囊外摘除术效果观察

目的 追踪观察麻风病患者白内障经巩膜隧道切口囊外摘除手术后的临床疗效.方法 同负责治疗麻风病患者的皮肤科医生一起,筛选出适合白内障手术的麻风病患者57例(57只眼),其中麻风病并发性白内障39只眼,麻风病老年性白内障18只眼,在局麻下行经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术.术后1年追踪其临床效果,并与同期的老年性白内障患者63例(63只眼)的手术效果相比较.结果 麻风病患者白内障手术术中分别出现虹膜裂伤、反应晶状体前囊膜破裂、玻璃体溢出等并发症,术后出现不同程度眼压升高、前房反应、角膜水肿、瞳孔上移等.经过一年随访,麻风病并发性白内障组术后最好的视力≥0.4者为38.5%,视力在0.1～0.3者为46.2%,<0.1者为15.4%,麻风病老年性白内障组术后最好的视力≥0.4者为72.2%,视力在0.1～0.3者为27.8%,<0.1者为0;麻风病白内障术后视力≤0.3的29例患者中,24例存在术前慢性葡萄膜炎,是术后低视力的首要原因.麻风病自内障患者出现术后慢性葡萄膜炎、术后瞳孔区膜状物形成、人工晶体移位、术后继发性青光眼等术后并发症.结论 经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术治疗麻风病并发性白内障手术安全、有效,患者视力获得提高.手术前后需要加强抗炎,控制葡萄膜炎.     

糖尿病患者白内障与老年性白内障超声乳化术前后房水蛋白浓度变化的比较

目的　通过检测老年性白内障与糖尿病患者白内障超声乳化白内障吸除并人工晶体植入手术前后房水蛋白浓度的变化 ,评估该手术对眼血 -房水屏障的影响。方法　对 60例 (64眼 )老年性白内障患者及 5 2例 (5 6眼 )伴发糖尿病的白内障患者 (3 4眼非增殖型糖尿病性视网膜病变 ,2 2眼伴增殖型糖尿病性视网膜病变 ) ,应用激光闪光细胞检测仪 (Laserflarecellmeter ,LFCM )定量检测超声乳化白内障吸除并人工晶体植入术前、术后前房蛋白浓度。结果　术前 ,伴增殖型糖尿病性视网膜病变患者的前房蛋白浓度高于老年性白内障和非增殖型糖尿病性视网膜病变白内障患者 ,且差异有显著性 (P <0 0 5 ) ;而老年性白内障和非增殖型糖尿病性视网膜病变白内障患者间的房水蛋白浓度无明显差别。各组术后 1天、 7天及 3 0天的房水蛋白浓度均较术前高 ,并有显著性差别 (P <0 0 5 )。术后 90天时 ,老年性白内障和非增殖型糖尿病性视网膜病变白内障患者的房水蛋白浓度与术前无显著性差别 ;但伴增殖型糖尿病性视网膜病变患者的仍高于术前水平 ,且差异有显著性 (P <0 0 5 )。结论　对于老年性白内障患者与非增殖型糖尿病性视网膜病变的白内障患者 ,超声乳化吸除并折叠式人工晶体植入手术后眼血 -房水屏障功能均可在短期内恢复 ,而对     

Morphology of and visual performance with posterior subcapsular cataract

PURPOSE: To study the prevalence and clinical profile of etiologically diverse posterior subcapsular cataracts (PSCs) and their effect on visual performance. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective observational study comprised 160 eyes of 100 consecutive patients with PSC. Exclusion criteria included cortical opacities, cataract other than PSC, and a nondilating pupil. Lenticular changes such as gross appearance, density of opacity in the central 7.0 mm, and location and approximate area of cataract involvement were noted. The uncorrected distance and near acuities, best corrected visual acuity (BCVA), contrast sensitivity with BCVA, and history of glare were recorded. RESULTS: Sixty patients had bilateral PSC. The most prevalent cataracts were of unknown etiology (32.5%). The most common coexisting disease or factor was atopy (30.6%). Others were myopia, steroid use, diabetes, uveitis, retinitis pigmentosa (RP), glaucoma, and trauma. Most patients (47.0%) were 41 to 50 years old. The PSC was vacuolar in 45.0% of eyes, solid in 15.6%, and mixed in 39.4%. Vacuolar PSC was the most common type in the myopia, diabetes, RP, and trauma groups. Solid PSC was seen with myopia, diabetes, and glaucoma. Mixed PSC was the most common type in the steroid, atopy, uveitis, and idiopathic groups. Eighty-seven percent of patients had reduced visual acuity; 76%, glare; and 46%, decreased contrast sensitivity. More eyes with vacuolar PSC had decreased visual acuity and contrast sensitivity, followed by eyes with solid PSC and eyes with mixed PSC. CONCLUSIONS: Most PSCs were of unknown etiology; a significant number of eyes had more than 1 etiology. Vacuolar PSC was the most common type, with more eyes in this group having significantly reduced visual acuity and contrast sensitivity. Specific morphological patterns occurred with some conditions (eg, RP, myopia, diabetes).     

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.     

Australian prospective study of cataract surgery and age-related macular degeneration: rationale and methodology

BACKGROUND: Cataract surgery is the most frequently performed ophthalmic procedure worldwide. While benefits gained from cataract surgery outweigh surgical risks, there have been concerns that older persons may have an increased risk of developing age-related macular degeneration (AMD) after cataract surgery. OBJECTIVE: The Australian Prospective Study of Cataract Surgery and Age-Related Macular Degeneration Study aims to assess the risk of AMD in a large cohort of older patients following cataract surgery. The current report describes the study rationale, design and methodology. DESIGN: Longitudinal study. PARTICIPANTS: Approximately 2000 cataract surgical patients aged 65 years or older are being recruited from both public and private sources in western Sydney, Australia. METHODS: At study visits, participants are interviewed using standardized questionnaires to obtain information on demographic, medical, and ocular conditions and AMD risk factors, together with data on general health and vision-related quality of life. Eye examinations include visual acuity, intraocular pressure, keratometry and A-scan measurements, plus lens and retinal photography, following pupil dilatation. Retinal photographs taken before cataract surgery, and at 1, 6, 12, and 24 months after surgery are graded for early and late AMD lesions, using the Wisconsin age-related maculopathy grading system. The 1-month post-operative retinal photographs supplement the baseline macular assessment for cases in which cataract occludes a clear view of the macula pre-operatively. It is intended that study participants will be followed for up to five years post-operatively to clarify the question of whether aphakic or pseudophakic, compared to phakic eyes, have a greater risk of developing AMD.     

Surgical indications in coexisting cataracts and glaucoma

Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.