扶贫白内障超声乳化手术1 800例疗效分析

目的:评价1800例扶贫白内障超声乳化手术的效果。方法:对2010-06/2012-11期间经我院筛查适合手术的白内障患者1800例1800眼,实施免费白内障超声乳化及人工晶状体植入术,并主要对年龄相关性白内障的术后效果与并发症进行分析。结果:手术患者中年龄相关性白内障为1326眼(73.67%);年龄相关性白内障手术后第1d脱盲率达98.72%,脱残率达89.52%。术中并发症:后囊膜破裂32眼(2.41%);平衡液逆流7眼(0.53%);悬韧带完全断裂1眼(0.075%),部分断裂5眼(0.38%)。术后并发症:角膜水肿103眼(7.77%),轻度角膜水肿79眼(5.96%),中重度角膜水肿24眼(1.81%);反应性葡萄膜炎6眼(0.45%);一过性高眼压9眼(0.68%);人工晶状体夹持3眼(0.23%);黄斑水肿6眼(0.45%)。未发生大泡性角膜炎、暴发性脉络膜上腔出血、感染性眼内炎等严重并发症。结论:白内障超声乳化术在患有年龄相关性白内障的手术患者中疗效显著,超声乳化术手术时间短,创伤小,术后视力恢复快,并发症少,在白内障复明手术中优势明显。     

角巩膜缘切口在超声乳化白内障手术转型中的应用

目的:探讨角巩膜缘切口在小切口向超声乳化白内障手术转型中的应用.方法:选取我院在2012-02/2013-02接受手术的200例200眼白内障患者,行角巩膜缘切口超声乳化手术,术中如遇不安全因素即改为SICS+IOL术,手术均顺利完成.结果:顺利实施超声乳化白内障手术者共172眼(86％),28眼(14％)改为角巩膜缘切口SICS+IOL术,术后视力≥0.5者176眼(88％),0.1～0.4者22眼(11％),0.1以下者2眼(1％).术后均无严重并发症.结论:在小切口转型超声乳化白内障手术初期时,运用角巩膜缘切口能提高手术的可操作性和安全性,是具有小切口白内障手术经验眼科医生很好的选择方式.     

硅油填充眼的白内障超声乳化联合人工晶状体植入术

目的:探讨玻璃体视网膜手术联合硅油眼内填充术后并发性白内障行白内障超声乳化人工晶状体植入的临床效果、临床特点及特殊手术方法。方法:回顾性分析了我科2005-01/2008-06视网膜脱离硅油注入术后并发白内障病例共47例47眼。硅油注入术后6～35(平均16.2)mo。采用超声乳化白内障摘除+人工晶状体植入术。结果:经过随访,视力提高41眼(87%);视力达到视网膜脱离术后白内障发生前的最佳视力的有32眼(68%)。最高矫正视力0.4;脱盲率为62%。结论:白内障超声乳化手术是提高硅油注入术后并发白内障患者视力的较好方法。     

深圳地区近3a白内障手术趋势探讨

目的:分析深圳地区近3a白内障手术趋势。方法:通过统计出入院相关资料,回顾近3a(2007-01/2009-12)在我院住院治疗的白内障患者,对白内障类型及手术方式进行统计分析。结果:我院2007-01/2009-12住院治疗白内障患者10058例,其中男4284例(42.59%),女5774例(57.41%),男女比例约为1:1.35;年龄3月龄～99岁,平均67.03±15.37岁;2007年共2803例(27.87%),年龄4月龄～99岁,平均66.06±16.76岁,2008年共3265例(32.46%),年龄3月龄～96岁,平均66.16±15.61岁,2009年共3990例(39.67%),年龄5月龄～99岁,平均67.82±14.94岁;白内障类型:老年性白内障9000例(89.48%),并发性白内障565例(5.62%),外伤性白内障265例(2.63%),先天性白内障178例(1.77%),代谢性白内障14例(0.14%),无晶状体眼36例(0.36%);手术方式:白内障超声乳化摘除联合折叠型后房型人工晶状体植入术9499例(94.44%),白内障囊外摘除联合人工晶状体植入术220例(2.19%),白内障囊外摘除术100例(1.00%),二期人工晶状体植入术228例(2.27%),未行手术11例(0.1%)。结论:深圳地区近3a来白内障住院患者数量逐年递增,老年性白内障是最主要的白内障类型,超声乳化白内障摘除联合折叠型人工晶状体植入术是治疗白内障稳定、占优势地位的手术方式。     

婴幼儿先天性白内障手术后视力和继发青光眼的临床分析

目的：探讨婴幼儿先天性白内障手术后视力和继发青光眼的相关分析。

方法：回顾性系列病例研究。观察我院2006-05/2018-01期间收治的婴幼儿先天性白内障患儿48例86眼，均行白内障吸除、后囊膜及前段玻璃体切除手术及人工晶状体(IOL)植入术。术后随访最长13a。对最佳矫正视力(BCVA，LogMAR)，继发性青光眼进行临床观察。数据采用独立样本t检验、Fisher确切概率法分析、Logistic多元回归分析进行统计学分析。

结果：继发青光眼13眼(15%)，BCVA 0.63±0.20； 无继发青光眼73眼(85%)，BCVA 0.44±0.27； 两组BCVA比较有差异(t=2.417，P<0.05)。白内障摘除手术年龄≤3、>3～12、>12月龄，继发青光眼概率分别29%(6/21)、18%(6/34)、3%(1/31)； Fisher分析，手术年龄≤3月龄继发青光眼概率要高于手术年龄>12月龄的(P<0.05)。继发青光眼组眼轴长度(AL)长于未继发青光眼组(t=-2.92，P=0.004)； 继发青光眼组屈光度小于未继发青光眼组(t=4.00，P=0.0001)。Logistic多元回归分析显示：白内障手术年龄≤12月龄是术后继发青光眼的危险因素，发生率是手术年龄>12月龄的8.372倍(OR=8.372，95%CI：1.033～67.864，P=0.047)。

结论：婴幼儿先天性白内障术后可获得一定视力并有一定继发性青光眼发生率，青光眼对术后视力有极大影响。白内障手术年龄≤12月龄是术后继发青光眼的危险因素，尤其3月龄前手术的青光眼发生率远高于12月龄以后。继发青光眼患儿AL更长，屈光度更小，有着更明显的近视漂移。     

睫状体平坦部硅油取出术联合超声乳化白内障摘除术短期效果观察

目的:观察硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出手术的治疗效果。方法:对2005-01/2007-01我院收治的24例24眼玻璃体切除术后硅油填充眼患者,实施白内障超声乳化联合睫状体平坦部硅油取出术,观察术后视力、并发症等。结果:术中发生视网膜脱离3例3眼(12%)。术后3mo最佳矫正视力>0.3者1眼(4%);0.12～0.3者16眼(67%);≤0.1者7眼(29%);植入人工晶状体21眼(88%);未植入人工晶状体3眼(12%)。结论:硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出术是安全有效的手术方式。     

尼日利亚翼状胬肉治疗状况的回顾性分析

目的:总结尼日利亚翼状胬肉的治疗现状。方法:选择1999-01/2002-12的4a期间的翼状胬肉手术患者,所有病例都来自于尼日利亚Enugu市的尼日利亚大学教学医院和Ebrans临床中心。收集这些患者的生理数据、临床表现、手术方法和术后并发症等资料,应用6.1版EPI-INFO方法进行数据处理。共选择3种不同的手术方法:60眼单纯施行巩膜暴露术,42眼施行联合5-氟尿嘧啶(5-FU)的巩膜暴露术,22眼施行联合丝裂霉素C的巩膜暴露术。结果:72例(124眼)施行翼状胬肉切除术的患者,术后至少随访1a,包括男41例(56.9%),女31例(43.1%),男女比例为1∶0.8。术后复发率最高的在病变第III期(55.6%),最低在病变第I期(22.2%)。3种手术方法比较,复发率分别为65.0%、52%和13.6%。结论:在像尼日利亚这样的发展中国家,联合丝裂霉素的早期手术切除术,是一种安全性强、治疗费用低、方法简单且创伤小的治疗翼状胬肉的有效手段,值得推广。     

超声乳化白内障吸除术中后囊膜破裂的处理体会

目的:为探讨超声乳化白内障手术并发症。方法:对2008-01/2011-01开展超声乳化白内障手术500眼进行回顾性临床分析。结果:年龄相关性白内障共500例500眼,全部采用超声乳化白内障手术,手术发生后囊膜破裂45眼(9.0%),其中前250眼后囊膜破裂33眼(6.6%),后250眼后囊膜破裂12眼(2.4%)。结论:超声乳化白内障手术中后囊膜破裂可根据术中不同情况,采用不同的手术处理,选择不同人工晶状体植入方式可以达到很好的处理效果。     

中国中部城市郊区影响实施免费白内障手术的原因分析

目的:分析中国中部城市郊区影响实施免费白内障手术的原因。方法:2008/2009年,在中国中部一个城市郊区的白内障复明活动中,我们对所有筛查出的影响视力的白内障患者进行问卷调查,询问为何接受(或不接受)免费白内障手术等问题。将答案记录进行分析。结果:在筛查出的892名患者中,起初只有387人(43.39%)接受免费白内障手术,最终490人(54.93%)接受手术。患者不接受白内障手术的主要原因包括:193人(21.64%)害怕手术,希望有其他治疗方式;148人(16.59%)认为现有视力够用;担心手术效果不如付费手术好(147,16.48%;17人(1.91%)有其他原因。结论:中国中部城市郊区影响实施免费白内障手术的原因主要包括:患者医学知识匮乏,周围白内障患者手术效果和指定手术医院对免费白内障手术运作形式。     

西藏朗县(无眼科县)眼病初步调查和白内障手术报告

目的:探讨西藏无眼科医疗服务县朗县眼病患病情况和初次开展白内障手术情况。方法:在包括眼科医生在内的援藏医疗队工作中,记录统计就诊眼病情况和盲与低视力原因,开展白内障等眼科手术。结果:22个工作日内共有首诊患者300余例,依次为白内障、眼睑及结、角膜疾病、屈光不正、鼻泪管阻塞(慢性泪囊炎)和视网膜变性等。盲或低视力的原因依次为白内障、角膜混浊、眼球萎缩、视网膜变性、视神经萎缩和屈光不正等。62眼盲眼中,26眼(41.9%)为白内障所致。完成手术42台,白内障囊外摘除术或加人工晶状体植入27例(29眼),脱盲率93.1%,脱残率69.0%,白内障手术率2000。结论:西藏无眼科和眼科医生县眼病患病情况严重,白内障是致盲的主要原因。派遣医疗队进行1～2mo的眼科医疗工作,开展白内障手术,可在一定程度上减少盲和低视力患者,缓解无眼科县缺医少药的紧张情况。     

Challenges in the management of paediatric cataract in a developing country

AIM: To review the management of cataract in children in a tertiary hospital in a developing country, and to highlight the challenges therein. METHODS: The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital, Enugu from 2005 to 2008 were reviewed retrospectively. Information was obtained on bio-data, pre- and post-operative visual acuity (VA), biometry, and type of surgery, use of intraocular lens (IOL) and presence of co-morbidity. SPSS was used for data entry and analysis. RESULTS: The hospital records of 21 children (26 eyes) were analyzed. There were 12 males (57.1%) and 9 females (42.9%). Pre-operative VA could not be assessed in 11 eyes (42.3%), 14 eyes (53.9%) had VA <3/60 and 1 eye (3.8%) had VA 6/60. Biometry was done in only 5 eyes (19.2%). All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy; 12 eyes (46.2%) had posterior chamber intraocular lens (PC-IOL) implant while 13 eyes (50.0%) had no IOL. After 12 weeks of follow up, vision assessment was available in only 15 eyes. With best correction, VA of 6/18 or better was achieved in only 5 eyes (33.3%). CONCLUSION: Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries. If these challenges are not addressed, cataract will remain a major cause of childhood blindness and low vision in Africa for many years. There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer. Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.     

2007年云南省医疗机构眼科现状调查

目的了解截至2007年云南省的眼科医疗现状和服务能力。设计横断面问卷调查。研究对象云南省内165家医疗机构。方法采用卫生部统一设计的眼科机构现状调查表,于2007年10-12月对云南省内医疗机构的眼科现状进行问卷调查。收集整理并分析问卷结果。主要指标医护人员数量、年手术量、门诊量、可独立完成白内障手术的医生数量。结果参与调查的的165家医疗机构共有眼科医生735名,能独立完成白内障手术者392名,眼科护理人员771人。全省16个地州市中,昭通地区每百万人口拥有的眼科医生资源仅为7人,而昆明市为32人。2006年所有医疗机构共完成眼科各类手术58346例,包括白内障23833例。尚未开展白内障手术的医疗机构有27家。各级医疗机构仅29家（17．6％）拥有较好的眼科设备,6家（3．6％）没有任何眼科设备。结论云南省不同等级和不同地区之问的医疗机构眼科水平差异很大,人力资源分布不均,工作效率较低,需要进一步进行资源整合和优化利用,以满足群众对眼科医疗服务的需求。（跟科,2010,19：142—144）     

Preoperative visual acuity of people undergoing cataract surgery in rural and urban Nepal

Background: Preoperative presenting visual acuity (PPVA) is not a commonly reported indicator for the delivery of cataract services. This study aimed to evaluate the PPVA of patients undergoing cataract surgery in rural and urban areas of Nepal. Design: A prospective, non‐interventional study conducted from October 2007 to March 2008 in a tertiary hospital and outreach clinics of Nepal. Participants: A total of 3023 consecutive subjects from urban and rural settings (1323 from the tertiary hospital and1700 from outreach clinics) with cataract were included. Methods: Visual acuity was tested with a Snellen E‐chart at 6 m by ophthalmic assistants. All Outreach Microsurgical Eye Clinic patients were examined by either ophthalmologists or senior ophthalmic assistants. Patients at the Tertiary Eye Care Centre were examined only by ophthalmologists. Main Outcome Measures: Preoperative presenting visual acuity of patients undergoing cataract surgery was measured in both the settings. Results: The sex ratio was 0.96 (male/female). Based on PPVA, 11.5% of patients operated were blind (PPVA < 3/60 in the better eye). The proportion of blind people operated was similar in rural (11.4%) to urban (11.6%) areas. The proportion of blind eyes operated was higher in rural (50.7%) compared to urban (38.9%) areas. Conclusion: Despite a comparatively high volume of cataract surgery carried out in Nepal every year, only about one in eight patients operated for cataract in the sample population was blind. PPVA is an important indicator for the progress towards eliminating cataract blindness.     

Outcomes of high volume cataract surgeries in a developing country

AIM: To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. METHODS: In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. RESULTS: Best corrected visual acuity of >or=6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16-18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon. CONCLUSION: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.     

Outcomes and Barriers to Uptake of Cataract Surgery in Rural Northern China: The Heilongjiang Eye Study

Purpose: To report visual outcomes and barriers to uptake of cataract surgery among subjects of all ages in Mingshui County, Heilongjiang Province, China.

Methods: Cluster sampling was used to select a cross-sectional sample of people living in the Heilongjiang Province. Each subject underwent a participant interview, presenting and best-corrected vision measurements and an ocular examination. Visual outcomes and barriers to uptake of cataract surgery were assessed among subjects undergoing cataract surgery. Individuals who needed cataract surgery were interviewed regarding barriers.

Results: Of 11,787 subjects, 10,384 eligible participants underwent visual acuity (VA) testing and a basic eye examination (88.1% response rate). The cross-sectional sub-sample of 21 participants receiving cataract surgery had a median age of 63 years. Six eyes undergoing surgery at the county hospital with conventional intracapsular and extracapsular cataract extraction without an intraocular lens implant were aphakic, and 15 eyes (71.4%) undergoing surgery at tertiary care hospitals were pseudophakic. Seven eyes (33.3%) had corrected VA?≥?20/60, and nine eyes (42.9%) had presenting VA?≥?20/60. Approximately 28.6% (6/21) had poor outcomes. The principal causes of presenting blindness after cataract surgery were refractive error/uncorrected aphakia and posterior capsular opacification. Cost was the most common barrier (73.9%) to uptake of cataract surgery.

Conclusions: Cataract surgical outcomes in northern China were poor. The principal barrier to uptake of cataract surgery was cost. These findings call for the establishment of cataract surgical services that are of high quality, affordable, and sensitive to high-risk groups.     

Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery

The number of people coming for cataract surgery in Madagascar remains low and most ophthalmologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding (<6/60) cataract were identified by cataract case finders in the community, interviewed, and given a referral card for surgery at the hospital. We then monitored uptake of surgery at the hospital. Overall, 142 people were identified, interviewed and referred. Among the referrals, 35 (24.6%) presented at the hospital for surgery. The most important factors associated with acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services.     

The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital

PURPOSE: To determine the incidence of vitreous loss in patients undergoing cataract surgery and the visual outcome in a tertiary teaching hospital. METHODS: Hospital records of 2095 consecutive patients undergoing cataract surgery between July 1999 and June 2000 were reviewed in this non-concurrent cohort study. Incidence and visual outcome of vitreous loss managed using standard vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, Blumenthal technique and phacoemulsification) as well as at different levels of surgical training. The outcome was compared with matched cases without vitreous loss (controls). RESULTS: Vitreous loss occurred in 160 of 2095 eyes (7.63%; CI -7 to 9.3): 8.3% for ECCE, 8.1% for the Blumenthal technique and 5% with phacoemulsification. Vision > or = 6/18 was achieved in 85% of cases and 95% of controls. For experienced surgeons, 95% of the cases and controls had vision > or = 6/18. 5.8% of cases and 0.7% of controls had vision < 6/60. One patient in each group was blind following cataract surgery; both had operable cataracts in the fellow eye. CONCLUSIONS: The vitreous loss rate in this tertiary teaching hospital is relatively high. This complication, managed with standard surgical techniques, is compatible with good visual outcome. In eyes with vitreous loss, the final visual acuity achieved by experienced surgeons was similar to that in uncomplicated cases.     

视网膜母细胞瘤-发展中国家治疗中的挑战

目的:回顾发展中国家在治疗视网膜母细胞瘤中的挑战。方法:回顾1998-01/2002-12,埃努古的尼日利亚大学教学医院和Ebrans临床中心的视网膜母细胞瘤患者的临床及组织病理学资料。结果:总共34例通过组织学被确诊为视网膜母细胞瘤患者。男25例(74%),女9例(26%),男女比例为1∶0.4。平均年龄2.9±1.5岁(5mo～7岁)。6例(18%)患者为双眼发病,28例(82%)为单眼。所予以的治疗为眼内容物剜除术或眼球摘除术联合化疗。结论:在发展中国家,由于患者未及时就诊、贫穷、医疗资源匮乏等因素,视网膜母细胞瘤的治疗现状很差。改善其在发展中国家的治疗,应包括健康教育、早期诊断及提供现代化治疗设施。     

Profile of patients presenting for cataract surgery in the UK: national data collection

AIMS/METHODS: A national data collection exercise was carried out in more than 100 hospital eye service units within the UK to provide clinical and administrative information on patients undergoing cataract surgery. This included patient clinical data such as visual acuity at the time of wait listing and at the time of admission for surgery, presence of other eye disorders, other serious medical disorders, and data on waiting time and type of admission. RESULTS: The profiles of the 18 454 patients aged 50 years or older are reported. Findings of particular note were as follows. At the time of wait listing for cataract surgery 31% had visual acuity of 6/12 or better, 54% had visual acuity between 6/18 and 6/60, and 15% had less than 6/60 vision. Considering those who had visual acuity of 6/12 or better at the time of wait listing, by the time of admission for surgery, the vision deteriorated to 6/18-6/60 in 33% and in a further 3% the vision deteriorated to below 6/60. In patients with moderately poor visual acuity (<6/12-6/60) at the time of wait listing, 13% had less than 6/60 vision by the time of admission for surgery. CONCLUSION: This type of data collection and reporting exercise provides new material that can be used in the planning and provision of cataract surgery services in the UK.