关注眼内散射光对人工晶状体眼视觉质量的影响

随着人们生活水平的提高,白内障患者对术后视功能的期望越来越高,不仅要有良好的视力,而且要求满意的视觉质量。人工晶状体（IOL）眼散射光的大小成为评价患者术后视觉质量的重要参数,患者术后一系列异常闪光感现象的出现均与其相关。IOL植入术后,引起IOL眼散射光增大的因素主要包括IOL的材质、IOL边缘设计、手术操作及后发性白内障（PCO）和瞳孔直径的影响。围绕关注眼内散射光对IOL眼视觉质量的影响,从而提高手术质量和患者的视觉质量这一主题,从眼内散射的作用机制、影响因素等方面进行阐述。     

影响白内障术后人工晶状体稳定性的相关因素分析

白内障术后人工晶状体(intraocular lens,IOL)的稳定性包括偏心、倾斜、旋转及手术前后前房深度的变化,其稳定性是影响术后视觉质量重要因素.对影响白内障术后IOL稳定性的相关因素进行分析有助于术者改进手术方式,提高手术质量,使患者获得更好的视觉效果.IOL的稳定性受多种因素的影响:患者内眼情况、术中撕囊的大小和对称性、IOL放置的位置、IOL的材料和设计等.因此,为了使患者看到更光明的世界,白内障手术的方式一直经历着不同的演变,IOL的材料也进行着不断地创新.     

白内障术后囊膜与人工晶状体贴附过程及其对术后视觉质量的影响

囊膜与人工晶状体(IOL)的贴附是白内障术后普遍存在的现象。目前,国内外关于术后囊膜与IOL贴附的研究日益增多,本文将从白内障手术后囊膜与IOL贴附过程、贴附形态,影响贴附的相关因素以及囊膜与IOL贴附对视觉质量的影响这四方面做一综述。     

景深延长型人工晶状体对散光包容性的研究进展

自1949年Harold Ridley植入了第一枚人工晶状体以来,到景深延长型人工晶状体(EDOF IOL)在临床的广泛应用,人工晶状体(IOL)一直在不断更新与发展,旨在为患者提供良好的术后视觉质量。而残余散光是影响白内障患者术后视觉质量的重要因素之一,35%-40%白内障患者散光达到1.00 D,19%-22%白内障患者散光达到1.50 D。因此,了解EDOF IOL对散光的包容性,从而为患者选择合适的IOL显得十分重要。文章总结了不同类型EDOF IOL对散光的包容性及优缺点,期望在为不同残余散光的患者选择EDOF IOL时提供参考。     

术后囊袋弯曲形成在屈光性白内障手术中的意义

屈光性白内障手术时代,术后后囊膜混浊（PCO）以及人工晶状体（IOL）位置异常已成为影响患者视觉质量的重要因素。笔者将从囊袋弯曲角度阐述白内障术后后发性白内障和IOL在囊袋内的稳定性。囊袋弯曲是术后囊袋和IOL锐利边缘贴合形成的屏障结构。完全黏附型囊袋弯曲不仅可以有效减少晶状体上皮细胞的迁移,而且提高IOL稳定性（包括轴向位移、偏心、倾斜及旋转等）。现立足于囊袋弯曲的形成演变过程以及不同分型,阐述了其预防PCO和维持IOL稳定性的机制,为提高白内障患者术后视觉质量提供思路及可行措施。     

后房型人工晶状体的位置对视觉质量的影响

人工晶状体(intraocular lens,IOL)在眼内常有不同程度的倾斜、偏心或旋转,是影响白内障患者术后视觉质量的重要因素。以往常用视力来评价视觉质量,近年来引入像差、调制传递函数(modulation transfer function,MTF)、主观视觉评价等新指标,表明IOL偏斜将引起视力下降、像差增加、MTF下降、屈光不正等。因此,更好地评价IOL偏斜对视觉质量的影响,将对IOL选择、定位和白内障个体化治疗具有指导意义。     

人工晶状体的偏心和倾斜

在屈光性白内障摘除手术中,理想的人工晶状体（IOL）位置是居于囊袋内且中心与视轴重叠。但由于患者眼部解剖结构、IOL特性和手术操作等因素,IOL可能发生偏心和倾斜,影响术后视力和视觉质量。准确测量晶状体和IOL偏心和倾斜状态有助于术前指导IOL选择,术后评价IOL在眼内的稳定性,并探讨IOL偏心和倾斜与视觉质量的关系。...     

高度近视白内障患者人工晶状体计算公式的研究进展

高度近视合并白内障患者数量日益增长,复明性白内障手术逐渐向屈光性白内障手术转变,良好的术后视力是高度近视白内障患者术后的目标。由于眼轴长度测量误差、术后有效晶状体位置变化和人工晶状体(IOL)计算公式选择不当等因素,高度近视白内障术后屈光预测准确性欠佳,严重影响患者视觉质量和满意度。随着IOL计算公式的不断发展,SRK...     

白内障人工晶状体植入术后人工晶状体混浊1例

<正>白内障是世界范围内致盲的主要原因,超声乳化白内障摘除联合人工晶状体植入术已成为眼科领域最常见的手术之一。人工晶状体(intraocular lens,IOL)混浊作为术后并发症之一发生率较低,但若严重混浊影响视觉质量,需要行IOL置换术。目前IOL混浊的机制不清,现将2021年3月在北京同仁医院白内障中心就诊并治疗的白内障术后IOL混浊病例1例报告如下。患者男性,63岁。因“右眼白内障术后5年,视物模糊4年”至我院白内障中心门诊就诊。     

重视散光矫正型人工晶状体的规范应用

在屈光性白内障摘除手术时代, 角膜散光是影响白内障摘除手术后视觉质量的重要因素。散光矫正型人工晶状体(Toric IOL)具有矫正散光度数范围广、手术预测性好、对眼表损伤轻和远期效果稳定的优势, 可显著提高白内障患者术后视觉质量和满意度。然而, Toric IOL的临床应用仍存在诸多问题, 主要包括对矫正散光的重视程度、角膜生物测量的准确性、全角膜散光概念的普及、手术操作细节的把控以及术后残余散光的管理等。本文将围绕这些问题展开讨论, 以期进一步规范Toric IOL的临床应用, 助力提高我国屈光性白内障摘除手术的整体水平。     

有晶状体眼后房型人工晶状体植入术后视觉质量及并发症的研究进展

角膜屈光手术和有晶状体眼后房型人工晶状体(ICL)植入术是目前的主流屈光手术方式。众多研究证明ICL植入术能有效提高患者的术后视力,因此受到越来越多屈光医生和患者的青睐。良好的术后视力及视觉质量是提高患者满意度的关键因素。为了评估患者术后的主观及客观视觉质量、预防并发症的发生,本文对ICL植入术后的视觉质量及术后并发症进行综述。     

Refractive lens exchange with the array multifocal intraocular lens

PURPOSE: To study the safety and efficacy of refractive lens exchange as a refractive surgery modality in the presbyopic population. SETTING: Oregon Eye Institute, Eugene, Oregon, USA. METHODS: This retrospective review of patient charts included patient selection, preoperative evaluation, management of astigmatism, surgical technique, postoperative visual outcome, and complications. The study included 68 eyes comprising 32 bilateral and 4 unilateral refractive lens exchanges. RESULTS: All patients having bilateral refractive lens exchange achieved an uncorrected binocular visual acuity of 20/40 and J5 or better 1 to 3 months postoperatively. More than 90% achieved an uncorrected binocular visual acuity of 20/30 and J4 and nearly 60%, of 20/25 and J3. CONCLUSION: Refractive lens exchange was a safe and effective refractive surgery modality in presbyopic patients.     

Refractive lens exchange for correction of high myopia

PURPOSE: To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia. METHODS: We made a prospective study of the results of refractive lens exchange in 72 eyes that had undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded. RESULTS: In 72.2% of the eyes best-corrected visual acuity (BCVA) was > or = 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was > or = 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA > or = 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%) and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up. CONCLUSIONS: Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.     

有晶状体眼悬浮型后房型人工晶状体植入治疗高度近视

目的观察和探讨悬浮型后房型有晶状体眼人工晶状体（PC-PRL）植入术治疗高度近视的效果及安全性。方法回顾性病例研究。38例（68眼）高度近视患者（近视度为-11.25～-20.00 D）植入PC-PRL。术前及术后1周、1个月、3个月、6个月对患者的视力、眼压、角膜内皮细胞计数、前房深度及PC-PRL位置进行观察。采用重复测量方差分析比较PIOL术后不同时间段的等效球镜的差异。结果术后6个月时,所有患者UCVA均≥4.7,达到或高于术前BCVA（F=6.813,P<0.01）;术后7例（10眼）早期眼压升高,经降眼压治疗后眼压正常;术后前房深度较术前有所下降（F=32.952,P＜0.01）,小梁虹膜水平/垂直夹角、房角开放距离、拱高均无明显变化（P＞0.05）,未见虹膜膨隆,房角阻滞;术后PIOL位置稳定,与晶状体距离稳定。结论PC-PRL植入术治疗高度近视效果确切,预测性好,手术安全。     

A retrospective analysis of five intra-ocular lenses and the predictive value of six different intra-ocular lens power calculation formulas

PURPOSE: To evaluate the refractive and visual outcome after implantation of five different lenses and to evaluate the accuracy of six different intra-ocular lens (IOL) power formulas. SETTING: Department of Ophthalmology, University Medical Centre Rotterdam, The Netherlands. METHODS: In total, 288 eyes had cataract surgery with implantation of a polymethylmethacrylate lens (Centra55B) or a foldable silicone lens (AMO SI40, Staar AA, Silens 5, Pliolens). The pre- and postoperative refraction and visual outcome were analysed for all lenses under study. Six different IOL power formulas have been used to compare the accuracy of the predictive refractive outcome. RESULTS: The Staar Plate Haptic lens was found to have the best uncorrected visual acuity (UCVA) compared to the Centra55B, AMO SI40 and the Pliolens. Based on the A constant given by the company, the Pliolens revealed a significant overcorrection and the Staar Plate Haptic lens an undercorrection. The achieved postoperative refraction minus the intended postoperative refraction caused significant myopia with the Pliolens and hyperopia with the Staar Plate Haptic lens. The SRK-T and the Holladay formulas give the best predictive lens calculations in relation to the axial length. CONCLUSION: The A constant of all lenses has to be adjusted for our institute. Especially the AMO SI40, the Staar AA lens and the Silens 5 showed a remarkable difference compared to the A constant given by the company. All foldable lenses were comparable in their visual outcome. The significantly better UCVA of the Staar Plate Haptic lens can be explained by the emmetropic outcome of the postoperative refraction.     

Survey of intraocular lens material and design.

Modern cataract surgery is constantly evolving and improving in terms of lens material and design. Researchers and physicians strive to obtain better refractive correction with smaller wound size and minimizing host cell response to limit the proliferation of lens epithelial cells leading to opacification of the lens capsule. Intraocular lens material varies in water content, refractive index, and tensile strength. Intraocular lens design has undergone revisions to prohibit lens epithelial cell migration and reflection of internal and external light. The evolution of intraocular lens and extracapsular cataract surgery has lead to faster postoperative recovery and better visual outcomes.     

手法小切口联合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:探讨手法小切口联合负度数人工晶状体植入术治疗白内障合并超高度近视眼的临床疗效。方法:对因白内障合并超高度近视眼行小切口联合负度数人工晶状体植入术的75例98眼患者进行回顾性研究,记录术前眼轴长度和术后视力、屈光度数及其与预期屈光度数的偏差值(屈光度数偏差值),观察手术并发症和术后眼部情况。术后随访6～12mo。结果:术前平均眼轴长度为32.05±1.78mm。术后最佳矫正视力≥0.2者66眼(67.3%);≥0.5者43眼(43.9%),术后屈光度数偏差值<±1.00D者48眼(49.0%);<±2.00D者78眼(79.6%)。术中后囊膜破裂3眼。术中出现后弹力层部分脱离1例。术后角膜不同程度水肿21眼。术后6mo有13眼出现后囊混浊,经Nd:YAG激光切开后视力恢复。未见发现视网膜脱离、继发性青光眼、黄斑囊样水肿、人工晶状体移位等并发症。术后2眼出现双眼干扰症状,经过3mo后行另一眼人工晶状体植入术,术后症状消除。结论:手法小切口白内障摘除负度数人工晶状体植入术是治疗白内障合并超高度近视眼安全、有效的方法。     

Effectiveness of cultured human keratinocyte onlays on epithelial healing and clinical outcome after photorefractive keratectomy

PURPOSE: To evaluate epithelial healing time, postoperative pain, corneal haze, and visual and refractive outcomes following the application of cultured sheets of human allogeneic epidermal keratinocyte (CEAK) onlays on the photorefractive keratectomy (PRK) -ablated corneal surface as dressing material. METHODS: In total, 204 eyes from 103 patients with myopia or myopic astigmatism were prospectively evaluated for 6 months after PRK. The ablated cornea was dressed in three different ways. Specifically, CEAK onlays were placed in 80 eyes (CEAK group), CEAK with amniotic membrane (AM) strips in 63 eyes (CEAK with AM group), and therapeutic contact lenses only in 61 eyes (control group). All eyes were covered with bandage contact lens after the operation. Contact lens removal time, intensity of postoperative pain score on postoperative day 2, corneal haze, Snellen visual acuity, and remaining refractive errors were measured. RESULTS: The mean contact lens removal time was shorter in the CEAK with AM group (1.84 +/- 0.72 days) compared to the control (2.77 +/- 1.59 days) and CEAK only (2.24 +/- 0.79 days) groups (P < .001). However, no significant differences were evident among the groups in terms of immediate postoperative pain, Snellen visual acuity, remaining refractive errors, and corneal haze at 6 months postoperative. CONCLUSIONS: The CEAK onlay with AM facilitates epithelial healing, and is thus a good candidate dressing material to decrease the epithelial healing time after PRK. However, this onlay method did not affect the intensity of postoperative pain or final visual outcomes after surgery.     

穿透性角膜移植联合白内障摘出及人工晶状体植入术疗效观察

目的　评价同时行穿透性角膜移植、白内障囊外摘出联合人工晶状体植入术（简称三联手术）患者的手术效果,探讨三联手术术后角膜屈光力与术前晶状体度数的选择。方法　回顾性分析2016年4月至10月在北京佑安医院行三联手术的15例患者资料,观察患者术后1 a的最佳矫正视力（best corrected visual acuity,BCVA）、眼压、角膜屈光度、眼轴长度、并发症及角膜内皮细胞数以及植片存活情况。结果　所有患者术后1 a角膜植片均保持透明,角膜内皮细胞数为（1974.20±472.82）个·mm^-2。术后BCVA为(0.80±0.27）LogMAR,与术前（2.63±0.62）LogMAR相比,有显著性提高（t=13.042,P<0.001）。术后眼压为（14.53±3.04）mmHg（1 kPa=7.5 mmHg）,与术前眼压（15.27±2.37）mmHg相比,差异无统计学意义（t=0.685,P=0.505）。术后眼轴长度为（23.62±2.12）mm,与术前（23.69±2.01）mm相比,差异无统计学意义（t=-0.138,P=0.893）。术后角膜屈光度为（42.56±5.48）D,与术前对侧眼（45.01±1.66）D相比,差异无统计学意义（t=1.202,P=0.260）。术前目标屈光度为（0.58±0.25）D,术后等效球镜度为（0.40±4.65）D。结论　三联手术对于治疗伴有白内障的角膜疾病是一种安全有效的手术方式,术前选择预留偏正视的晶状体度数可能获得满意的术后视力,但术后不可预知的角膜曲率改变仍会对屈光状态造成影响。     

Grundlagen des refraktiven Linsenaustausches

Removal of the crystalline lens and its replacement by an intraocular lens (IOL) is known as refractive lens exchange (RLE). RLE is performed to correct high ametropia or aniseikonia. Crystalline lens removal always leads to a complete loss of accommodation; therefore, RLE should mainly be used for patients with beginning or existing presbyopia. RLE patients usually have a good best-corrected visual acuity, which is the default value for the postoperative uncorrected visual acuity. To reach this goal, microincisional and astigmatism-neutral implantation techniques as well as special IOL optic designs are available. These optic designs offer each patient individualized best visual performance. In spite of the high requirements for postoperative optical quality, RLE can lead to an effective, safe, predictable, and stable outcome with a low risk of complications.