149例老年性白内障超声乳化联合人工晶体植入术临床分析

目的 进一步提高老年性白内障患者的手术治疗效果。方法 对149例行白内障超声乳化联合人工晶体植入术的老年白内障患者的临床资料进行分析。结果 术后6个月-1a裸眼视力均不同程度提高,术后主要并发症为角膜水肿、反应性葡萄膜炎、暂时性高眼压,无严重并发症。结论 超声乳化联合人工晶体植入术治疗老年白内障效果确切;术中规范操作可减少术后并发症的发生。     

超声乳化白内障吸除术治疗急性闭角型青光眼临床观察

对于闭角型青光眼是单独做白内障手术,还是单独做青光眼手术或是进行白内障与青光眼联合手术,各家观点不一[1]。随着微创超声乳化白内障吸除术的成熟,采用超声乳化白内障吸除术联合后房型人工晶体植入术治疗急性闭角型青光眼合并白内障,取得较好的疗效,现报道如下。1资料与方法     

冷超声乳化白内障吸除手术应用于硬核白内障的疗效

<正>目前治疗老年性白内障最有效的方法是白内障超声乳化吸除及人工晶体植入术,但是此方法在治疗硬核白内障时容易引起术中破后囊、切口灼伤、角膜水肿、术后角膜失代偿等严重并发症〔1³〕,影响了白内障手术的效果及安全。我院采用冷超乳技术(又称双手微切口超声乳化技术)治疗硬核白内障,取得良好临床效果。本文通过对部分在我院行白内障冷超声乳化摘除术患者的临床资料进行分析,旨在进一步评价该方法的安     

超高度近视老年性白内障超声乳化术后视觉质量分析

超声乳化白内障吸除人工晶体手术用于治疗老年性白内障患者,对于合并超高度近视的老年性白内障患者,手术可以带来双重疗效.超高度近视为屈光度≥-10.0D或眼轴≥27.0 mm的近视,是引起低视力的主要原因之一[1],超高度近视老年性白内障患者因患眼具有眼轴长、玻璃体液化、后巩膜葡萄肿、白内障发展迅速、晶体核较硬等特点,在手术难度和人工晶体的选择上都与普通老年性白内障不同,行超声乳化白内障吸除人工晶体植入术后,视力恢复、预留屈光度及视觉质量等多方面更是与普通老年性白内障有差别,本研究探讨超高度近视老年性白内障患者超声乳化术后临床疗效及视觉质量.     

分析糖尿病合并白内障患者行两种不同手术方式的临床效果

目的分析对比糖尿病合并白内障患者行两种不同方式白内障手术的临床效果。方法选取2018年10月—2020年11月该院收治糖尿病合并白内障患者70例,根据治疗方法不同分为对照组(小切口白内障摘除联合人工晶体植入术)和观察组(超声乳化吸除联合人工晶体植入术),各35例,观察两组患者的临床血糖指标水平、并发症情况以及者裸眼视力。结果观察组患者HbA1c、FPG、2 hPG等血糖指标与对照组,差异无统计学意义(P>0.05);观察组患者角膜水肿、后囊破裂、前房炎性渗出、黄斑水肿以及低血糖等并发症发生率与对照组差异无统计学意义(P>0.05);观察组患者术后裸眼视力提高优于对照组,差异有统计学意义(P<0.05)。结论对糖尿病合并白内障患者实施超声乳化吸除联合人工晶体植入术是安全有效的,能使患者得到更好的术后视力,跟小切口白内障摘除联合人工晶体植入术相比更有其优势。     

经透明角膜切口白内障超声乳化吸除联合折叠式人工晶状体植入术疗效观察

目的 观察经透明角膜切口白内障超声乳化吸除联合折叠式人工晶状体植入术治疗白内障的临床效果.方法 采用上方3.0 mm透明角膜切口,对289例(325眼)白内障患者行超声乳化吸除联合折叠式人工晶状体植入术.术后观察手术反应、角膜散光、视力恢复情况和并发症情况.结果 术后1d裸眼视力≥0.5者255眼(78.46％);术后1周裸眼或矫正视力≥0.5者306眼(94.15％);术后1个月为315眼(96.92％);术后3个月为315眼(96.92％).术后1d与术后1周视力相比,P＜0.05.术前与术后3个月平均角膜散光分别为(0.83±0.42)D和(0.91±0.52)D,二者差异无统计学意义(P＞0.05).术后后囊膜破裂3眼,角膜水肿21眼,前房闪光22眼,一过性高眼压5眼,后囊中度混浊3眼.结论 采用透明角膜切口行超声乳化吸除联合折叠式人工晶状体植入术治疗白内障术后视力恢复快、角膜散光小、并发症少,疗效较好.     

老年2型糖尿病性白内障的术后疗效评价

目的　探讨白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗老年 2型糖尿病性白内障的疗效。方法　选择老年 2型糖尿病性白内障患者 52例 (59眼 )。 31例 (36眼 )为 ～ 级核 ,采用现代白内障囊外摘除 -后房型人工晶体植入术。 2 1例 (2 3眼 )为 ～ 级核 ,采用超声乳化白内障吸除后房型人工晶体植入术。结果　术后疗效评价采用术前和术后平均裸眼视力等级资料配对秩和检验。结果术后裸眼视力≥ 0 .5者占 54.2 % ,≥ 0 .3者占 94.8%。术前和术后裸眼视力有非常显著差异 (Z=4.70 7,P<0 .0 0 0 1 )。结论　白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗老年 2型糖尿病性白内障疗效肯定 ,94.8%患眼视力改善≥ 0 .3。     

年龄相关性白内障超声乳化吸除术联合人工晶体植入术的临床观察

随着人口老龄化的加快和生活水平的提高,我国年龄相关性白内障患者呈逐年递增趋势.手术治疗是目前白内障复明的公认的有效治疗方法.我院近年来对年龄相关性白内障患者进行白内障超声乳化吸除术联合人工晶体植入术,取得了良好的临床效果.     

小切口非超声乳化与超声乳化治疗老年性白内障疗效比较

目的 比较小切口非超声乳化与超声乳化治疗老年性白内障疗效.方法 对近期152例170眼老年性白内障患者,年龄61～78(平均68)岁,分别行该两种手术,并进行回顾性总结分析.结果 小切口非超声乳化白内障摘除术及人工晶体植入术与超声乳化白内障摘除术及人工晶体植入术1 w后的术后视力水平、散光程度、角膜中央厚度以及角膜内皮水肿程度相比无显著差异.结论 小切口非超声乳化与超声乳化治疗老年性白内障疗效相似.     

治疗糖尿病代谢性白内障合并屈光不正的安全性分析

目的分析糖尿病代谢性白内障合并屈光不正治疗的安全性水平。方法选择该院于2018年1月—2019年5月收治的132例糖尿病代谢性白内障合并屈光不正患者为研究对象,随机分成对照组、观察组,给予两组常规小切口囊外切除联合人工晶体植入术治疗、超声乳化吸除联合人工晶体植入术治疗。结果观察组疗效与对照组比较差异无统计学意义(P0.05);观察组并发症发生率低于对照组(P0.05);观察组手术切口及手术时间均优于对照组(P0.05)。结论糖尿病代谢性白内障并屈光不正治疗中,超声乳化吸除联合人工晶体植入术的效果可靠,安全性高。     

白内障伴浅前房患者行超声乳化术的手术技巧及安全性探讨

目的探讨白内障伴浅前房患者行超声乳化术的手术技巧及安全性。方法选择2018-01~2019-01于北海市第二人民医院眼科接受超声乳化术治疗的白内障伴浅前房患者46例(46眼)。比较患者术前、术后的视力、眼压、中央前房深度(CACD)、房角开放距离(AOD)、角膜内皮细胞密度,分析术后并发症发生情况。结果患者术前平均视力为(0.28±0.16),术后上升至(0.62±0.22),差异有统计学意义(t=8.688,P=0.000)。与术前比较,患者术后眼压降低,CACD增加,差异有统计学意义(P<0.05)。在治疗后,术眼“3点”、“6点”、“9点”和“12点”方位的AOD500均较术前显著增加(P<0.05)。术中发生虹膜损伤3例(6.52%),悬韧带部分断裂1例(2.17%),仍安全顺利植入人工晶体。术后发生角膜水肿16例(34.78%),术后1个月均恢复。未发生后囊破裂和角膜失代偿等较严重并发症。结论超声乳化手术能有效改善白内障伴浅前房患者眼前节拥挤情况,具有较好的疗效和安全性。术前评估以及准备、手术中技巧的合理应用是保证手术成功的关键。     

Ophthalmological aspects in patients with Werner's syndrome

In ten of 18 eyes from nine patients with Werner's syndrome, cataract surgery was complicated by wound dehiscence and its consequences: peripheral anterior synechiae (4), secondary epiretinal gliosis (4), cystoid macular edema (3) in the framework of Hruby-Irvine-Gass syndrome, unplanned filtering bleb (2), and post-operative anterior ischemic optic neuropathy (1). Additionally, corneal endothelial decompensation occurred in eight eyes. In view of the fibroblasts' reduced growth potential, we suggest small surgical incisions, extracapsular cataract surgery using phacoemulsification, intraocular irrigation solutions protecting corneal endothelium, nonabsorbable single knot sutures not removed before 1 year after surgery, and no local or systemic use of cortisone.     

85岁以上老年白内障患者的围手术期处理

目的探讨围手术期对≥85岁老年白内障患者进行综合因素处理的临床效果。方法对168例，208眼≥85岁老年白内障患者进行全面的术前检查、耐心的心理疏导和认真的术前准备后行小切口手法碎核白内障摘除联合人工晶状体植入术，观察术后视力，角膜内皮细胞等情况。结果术后1周，矫正视力〈0．05者11只眼（5．29％），0．05-0．1者10只眼（4．81％），0．1～0．4者72只眼（34．61％），≥0．5者115只眼（55．29％）。术后角膜内皮细胞平均丢失率为9．03％。结论对≥85岁老年白内障患者围手术期进行综合因素处理，可降低手术风险，提高手术效果。     

老年性白内障膨胀期继发性青光眼的治疗方法

目的 探讨老年性白内障膨胀期继发性青光眼的治疗方法. 方法 对16例16眼老年性白内障膨胀期继发性青光眼患者在应用常规降眼压药物治疗后不能有效降低眼压(用药后眼压仍＞ 40 mmHg)时,采用1ml注射器做前房穿刺放液,待眼压稳定2d后再行白内障联合抗青光眼手术治疗. 结果 所有患者经前房穿刺放液后眼压迅速降低,眼痛、头痛缓解,视力有不同程度的提高,手术前眼压控制在10～18 mmHg.行白内障联合抗青光眼手术后患者矫正视力均≥0.12. 结论 毫针穿刺放液可以缩短降眼压时间,为及早行白内障联合抗青光眼手术创造条件.对白内障膨胀期继发性青光眼患者行联合手术的远期疗效较好.     

Atypical Regressive Corneal Endothelial Cysts in Long-Term Confocal Follow-Up: A Case Report

Corneal endothelium is formed of 1 layer of mitochondria-rich cubic cells whose main role is to maintain corneal transparency. Corneal endothelial disorders represent group of both inherited and noninherited and may affect proper vision.A 36-year-old male patient with suspicion of corneal endothelial dystrophy underwent visual acuity, intraocular pressure, the basic slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, CA), and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III, Heidelberg, Germany). During the 3-year observation the patient reported symptoms mainly in the right eye. Slit-lamp examination revealed endothelial changes, much more pronounced in the right eye. Examination by the AS-OCT Visante showed hyperreflective dots within the right corneal endothelium. In order to assess endothelial cell morphology, analysis using corneal confocal microscopy in vivo was performed. Scans revealed presence of single endothelial deposits and severe cell changes of different morphology in both eyes. In the right eye, less pronounced changes of the polymorphic structure—polygonal guttas in different stages, linear and branched loss with “nuclear-like” formations and accompanying sediments. In the left eye, severe homomorphous polygonal “guttas-like” changes with “nuclear-like” formations were observed. Endothelial cysts’ features were dynamically changing during follow-up time with different effects on the patient''s clinical state.Corneal confocal microscopy allows accurate imaging of the endothelial cells and their detailed characteristics. Structural changes within the endothelial cells are not always proportional to visual acuity and slit-lamp image. The presented case is an example of an unusual corneal endothelial syndrome with probably nondystrophic background due to observed dynamic state with regressive tendency.     

The development of cataract in children as a late side-effect of bone marrow transplantation

Children with hematological malignancies (n = 33), severe aplastic anemia (SAA, n = 7) and other non-malignant diseases (n = 4) were followed for cataract development after bone marrow transplantation (BMT). The children with hematological malignancies were subjected to total body irradiation (TBI), 10 Gy, in one session with no shielding of the eyes as part of their conditioning regimen before BMT. The children with SAA or other non-malignant diseases received either no irradiation before BMT or a reduced dose, 8 Gy, with shielding of their eyes. After 3 years all patients who had undergone BMT for hematological malignancies had developed lens opacification. No patients in the other groups, without leukemia, showed any sign of cataract development. There was no relationship between steroid treatment for graft-versus-host disease and cataract development. No relation to age of onset of treatment or to the sex of the patient and cataract formation was seen. It seems evident from the present study that TBI given in one session was the main cause of cataract development after BMT.     

The predictive value of a strongly positive stress test in patients with minimal symptoms

The ability of a strongly positive stress test to predict left main coronary artery disease in people with suspected coronary artery disease but with minimal or no angina was investigated in 40 such patients. Nine had a history of myocardial infarction but no angina. Thirty-one had mild angina or a history of mild angina. The stress electrocardiograms were analyzed according to criteria known to be associated with left main coronary artery disease in moderately or severely symptomatic patients; (1) early S-T segment changes (stage I or II of exercise), (2) 2 mm or more S-T segment depression, (3) downsloping S-T segments, (4) associated exercise-induced hypotension, (5) prolonged S-T segment changes after the test (≥8 minutes) and (6) anterior and inferior S-T segment depression. The prevalence of left main coronary artery disease was 35 percent and that of any severe coronary artery disease 75 percent. The criterion of anterior and inferior electrocardiographic changes with exercise was most predictive of left main coronary artery disease (P < 0.01 by χ²). Exercise electrocardiography is useful in the prediction of left main or other severe coronary artery disease even when performed in patients who have minimal angina or in those who are asymptomatic after myocardial infarction.     

Significance of treadmill stress testing in transmural myocardial infarction: Correlation with coronary angiography

To assess the usefulness of stress testing in predicting multivesselcoronary disease and left ventricular dysfunction, 83 male patientswith a myocardial infarction one to 84 months previously werestudied. In inferior infarction (45 patients), the ST segment depressionhad a sensitivity of 91% and a specificity of 77% to detectmultivessel disease. Patients with multivessel disease had significantlylower exercise capacity and maximal heart rates. ST segmentelevation showed a poor correlation with the number of affectedvessels. In anterior infarction (38 patients), both ST segment depressionand elevation were of little value to detect multivessel disease.However, the predictive value of an exercise test without STsegment changes to exclude multivessel disease was 89%; on theother hand, patients without ST segment changes had significantlyhigher ejection fractions, exercise capacity, maximal heartrates and rate-pressure products than patients with ST segmentchanges. Patients with ST segment elevation had significantly lower ejectionfractions in both groups. The sensitivity of ST segment elevationto detect severe segmental left ventricular dysfunction was84% for anterior infarction and 54% for inferior infarction.Specificity was 84 and 85%, respectively. We conclude that: (1) exercise-induced ST segment depression is useful to predictthe extent of coronary artery disease in inferior infarction,but it is of limited value in anterior infarction, (2) exercise-induced ST segment elevation correlates well withthe presence of severe left ventricular dysfunction in bothanterior and inferior infarction, and (3) an exercise test of considerable intensity without ST segmentchanges makes the existence of multivessel coronary diseaseand/or severe left ventricular dysfunction very improbable.