超声乳化术在高度近视并发白内障的应用

本文观察６２例（７２只眼）高度近视（眼轴长度≥２６．００ｍｍ）合并白内障患者接受超声乳化手术后３个月内的角膜散光和视力情况，发现术后１个月时角膜散光已基本稳定，为１．１２±０．６１Ｄ，散光≤１Ｄ的占７５％，但最终矫正视力达到０．５以上的只占６９％，高度近视合并视网膜病变是引起其白内障术后视力恢复差的主要原因。提示对高度近视合并白内障患者来讲，充分认识术前视网膜情况，及时抓住手术时机，熟练进行超声乳化手术还是能收到良好的术后效果。     

超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素

目的　分析超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素。方法　对６３例（８７眼）高度近视并发性白内障患者行超声乳化联合人工晶状体植入术,术后随访３个月,分别测量患者视力、最佳矫正视力及眼底检查,术后最佳矫正视力分为＜０．３和≥０．３两个等级,并用Ｌｏｇｉｓｔｉｃ回归分析年龄、近视病史时间、术前眼轴长度、术前角膜散光度、术前角膜屈光度、玻璃体后脱离、后巩膜葡萄肿及黄斑病变多种因素对术后视力恢复的影响。结果　术后２周视力:裸眼视力:＜０．３者４５眼（５１．７２％）,≥０．３者４２眼（４８．２８％）;最佳矫正视力:＜０．３者３２眼（３６．７８％）,≥０．３者５５眼（６３．２２％）。术后３个月视力:裸眼视力:＜０．３者３８眼（４３．６８％）,≥０．３者４９眼（５６．３２％）;最佳矫正视力:＜０．３者２３眼（２６．４４％）,≥０．３者６４眼（７３．５６％）。术后最佳矫正视力＜０．３和≥０．３组比较,眼轴长度、角膜散光度、黄斑病变差异均有统计学意义（均为＜０．０５）。黄斑病变（ＯＲ:８．０６,９５％ＣＩ:１．７５～３７．０７）、角膜散光度（ＯＲ:３．８７,９５％ＣＩ:１．２０～１２．４８）和眼轴长度（ＯＲ:１．５０,９５％ＣＩ:１．０９～２．０６）是术后矫正视力恢复的独立影响因素;有黄斑病变者术后矫正视力预后差;随着角膜散光度和眼轴长度的增加,术后矫正视力恢复差;其他因素尚不能认为是术后视力恢复的独立影响因素。结论　超声乳化术治疗高度近视并发性白内障是安全有效地,伴随黄斑病变、角膜散光度过大和眼轴过长是超声乳化术治疗高度近视并发性白内障术后低视力的独立影响因素,影响强度:黄斑病变＞角膜散光度过大＞眼轴过长。     

超声乳化白内障摘除和折叠人工晶体植入初步报告

目的：对３．２ｍｍ切口行白内障超声乳化同期植入折叠式人工晶体的手术结果行回顾性总结。方法：随机选择白内障２２例２８只眼行上述手术，对术后视力、屈光状态、角膜内皮细胞损失率等进行分析。结果：术后１周矫正视力在１．０以上者２３只眼（８２％），术后３个月矫正视力在１．０以上者２４只眼（８６％），术后角膜内皮细胞损失率１３％，角膜散光在术后１周、１月、３月与术前角膜散光相比，差别无显著性。结论：该手术的主要优点是患者在术后早期获得较好的裸眼视力及矫正视力，角膜散光轻微，同时减少了缝合所需要的时间及消除了缝线引起的不良反应。     

折叠式人工晶体眼内植入临床观察

目的对３．２ｍｍ切口行白内障超声乳化同期植入折叠式人工晶体的手术结果进行回顾性总结。方法随机选择白内障４２例（４９只眼）行上述手术，对术后视力、屈光状态、角膜内皮细胞损失率等进行分析。结果术后１周裸眼视力在１．０以上者３２只眼（６５．３１％），术后３个月裸眼视力１．０以上者４１只眼（８３．６７％），角膜内皮细胞损失率为１１．７２％，术后角膜散光较术前平均逆规化０．１０ＤＣ。结论手术切口小，操作轻，术后早期获得良好的裸眼视力，角膜散光轻微，减少了缝合所需时间及消除缝线的不良反应。     

非超声乳化小切口白内障摘除人工晶体植入术

本文报告５０例６０眼１９～７９岁各种白内障患者进行非超声乳化小切口白内障摘除人工晶体植入术。术中３２眼晶体核直径测量，平均为６．０９×７．０５ｍｍ。术后矫正视力９１．６％在０．５以上，１．０以上占８０％。术前平均角膜散光０．３９Ｄ（ＳＤ１．０８），术后平均１．７９Ｄ（ＳＤ２．１３），９５％术后散光在１．１２Ｄ以内。随访１个月，角膜散光为０．３０Ｄ（ＳＤ１．９７Ｄ）。术中、术后合并症少；与超声乳化术比较，该手术成本低，费用少，无需超声乳化仪操作即可获得满意的结果。     

小切口超声乳化白内障手术初步报告

报告３４只眼行超声乳化白内障手术的结果，术后１周矫正视力在１．０以上者２４只眼（７０．５９％），术后３个月矫正视力在１．０以上者２５只眼（７３．５３％）。术后散光表现为从循规性向逆规性转变。术后角膜内皮细胞损失率为１３．２８％。术后中术后无任何严重并发症发生。与常规白内障摘除术比较，其主要优点是手术切口小、术后反应轻微、术后视力恢复快而且好。     

玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变

目的探讨玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变的有效性和安全性。方法回顾性分析合并白内障的增生性糖尿病视网膜病变23例（26眼）。行玻璃体切除联合晶状体超声乳化及人工晶状体植入术的临床资料,观察术后视力改善程度及术中术后并发症。结果术后随访7—24个月,平均12．8个月。术后矫正视力较术前提高者20眼（76．92％）;视力不变者5眼（19．23％）;视力下降者1眼（3．85％）。术中未见严重并发症。术后主要并发症有角膜上皮水肿7眼（26．92％）,前房炎性反应6眼（23．08％）,玻璃体再积血3眼（11．54％）,复发性视网膜脱离2眼（7．69％）,后发性白内障8眼（30．77％）,术后虹膜后粘连4眼（15．38％）。术后15眼需补充眼内激光光凝。结论玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变,可使大多数患眼视力改善,并发症少,手术安全有效。     

晶状体乳化术中国产与进口折叠式人工晶状体效果对比研究

目的 比较晶状体乳化术植入国产与进口折叠式人工晶状体的效果。方法 ７９例８７眼老年性白内障超声乳化小切口（巩膜隧道或角膜隧道切口）折叠式人工晶状体植入。术后随访半年,观察手术效果。结果 术后第１天８３眼裸眼视力视力≥０．５（９３．１％）,术后１周８７眼≥０．５（１００％）,６１眼≥１．０（７０％）。术后随访半年以上６９眼≥１．０（７９．３％）。结论 白内障小切口超声乳化折叠式ＩＯＬ植入术具有视力恢     

白内障超声乳化吸除术的不同切口对角膜散光的影响

为探讨超声乳化白内障吸除术不同大小切口对术后视力和手术源性角膜散光的影响，对白内障超声乳化３２ｍｍ水平切口、６０ｍｍ反眉状切口的６９只眼对照白内障囊外摘除术１２ｍｍ切口的９６只眼，在术后１周至３个月进行视力和角膜散光的测定和评价。结果：超声乳化３２ｍｍ切口组和６０ｍｍ组术后１周至１个月的视力明显高于囊外摘除１２ｍｍ切口组（Ｐ＜００５），术后１周至３个月时超声乳化组角膜散光明显低于囊外摘除组（Ｐ＜００１）。结论：采用６ｍｍ反眉状巩膜隧道切口水平缝合一针，同样有效减少术后角膜散光并早期获得良好视力，术后１个月时的视力和角膜散光比较３２ｍｍ切口组无明显差异。     

超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼,V期33眼,Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％）,V期28眼（84．8％）,Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）;玻璃体积血,术中17眼（25．8％）,术后7眼（10．6％）;角膜上皮延期愈合9眼（13．6％）;角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。     

小切口白内障术后低视力原因分析

目的:分析小切口白内障摘除人工晶状体植入术后低视力的相关因素。方法:回顾性分析我院2011-07/2012-07间白内障患者291例291眼,对其行小切口白内障囊外摘除联合人工晶状体植入术,最佳矫正视力低于0.3者诊断为低视力,并分析其发生原因。结果:患者291例术后共发生低视力49眼,其中手术所致术后低视力17眼(34.7%),术前病变所致术后低视力32眼(65.3%),其中年龄相关性黄斑变性8眼、糖尿病视网膜病变14眼、高度近视6眼,其他4眼。结论:原有眼病是术后低视力的主要原因,术前仔细检查可以提高手术的可预测性。     

增生性糖尿病视网膜病变合并白内障的联合手术治疗

目的探讨玻璃体手术联合晶状体超声乳化治疗增生性糖尿病性视网膜病变（PDR）合并白内障的临床疗效。方法分析19例（20只限）增生性糖尿病性视网膜病变合并不同程度白内障患者行白内障超声乳化联合玻璃体手术同时进行人工晶状体囊袋内植入的临床资料，观察术后视力改善程度及术中术后并发症。结果随访2—16个月，所有术眼人工晶状体位置良好，手术后20只限中有16只限（80％）视力有不同程度的提高，其中视力提高二行以上13只限（65％）；视力较术前无改善4只限（20％）。术后视力恢复不佳的原因主要与不同程度的糖尿病黄斑病变、视网膜广泛缺血有关。术后并发症包括高眼压、虹膜后粘连、玻璃体腔再出血、视网膜再脱离、晶状体后囊混浊及新生血管性青光眼等。结论玻璃体手术联合白内障超声乳化人工晶状体植入术治疗增生性糖尿病性视网膜病变合并白内障是安全和有效的，可使大多数患者视力改善，且无明显并发症。     

晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变

目的分析晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变(PDR)的疗效。设计回顾性临床病例系列。研究对象123只合并不同程度白内障的PDR患眼。方法对123只合并不同程度白内障的PDR患眼实施晶状体超声乳化联合玻璃体手术治疗,同时I期植入人工晶状体(IOL),观察术后视力改善程度及术中术后并发症。主要指标术后视力改善程度、术后并发症发生率。结果123眼均实施晶状体超声乳化联合玻璃体手术,并同时一期植入IOL于囊袋内。随访时间3￣21月(平均10个月)。99眼(81%)术后均有不同程度的视力改善。其中93眼(76%)术后视力提高2行或以上。术后无明显角膜水肿和角膜内皮失代偿发生。1例I型糖尿病患者术后6个月发生新生血管性青光眼;1眼术后发生视网膜脱离,再次手术后复位;4眼因玻璃体腔出血再次手术。术后视力无明显改善或视力提高不足2行的病例均合并不同程度的糖尿病黄斑病变。结论晶状体超声乳化联合玻璃体手术是提高合并白内障的PDR患者视力的有效手段。糖尿病黄斑病变是影响术后视力提高的主要因素。(眼科,2006,15:198-201)     

Cystoid macular oedema following cataract extraction in patients with diabetes.

The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.     

白内障术后低视力原因分析

目的：探讨白内障术后低视力的主要原因。 方法：2009/2011年740眼白内障行白内障超声乳化摘除+IOL植入术,回顾性分析术后低视力48眼的临床资料。 结果：引起术后低视力的原因：糖尿病视网膜病变累及黄斑占22.9％(11／48),高度近视眼视网膜病变占20.8％(10／48),年龄性黄斑变性占18.8％（9/48),视神经萎缩占16.8%（8/48）,其它占20.8％(10／48)。 结论：白内障超声乳化摘除+IOL植入术后低视力主要原因是视网膜及视神经病变,但手术对有眼底疾病的白内障仍有重要临床意义。     

倍频YAG激光光凝治疗糖尿病视网膜病变

目的总结倍频YAG激光光凝治疗糖尿病视网膜病变临床疗效。方法对195例(347眼)增殖前期及增殖期糖尿病性视网膜病变病例行分次全视网膜光凝治疗。光凝后2、4、8、12周复查眼底、视力。1月后复查眼底荧光血管造影,部分病例复查时补充光凝治疗。结果本组病例347眼,有效308眼(88.8％);其中增殖前期244眼有效236眼(96.7％);增殖期103眼有效72眼(69.9％)。视力提高126眼(40.9％);视力不变166眼(53.9％);视力下降16眼(5.2％)。结论倍频YAG激光光凝是治疗糖尿病视网膜病变的有效方法,对糖尿病视网膜病变应及时进行光凝治疗,阻止病情发展,以保护视功能。     

老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

糖尿病患者白内障不同术式效果分析

目的 比较白内障超声乳化吸出术与现代囊外摘出术两种不同术式治疗糖尿病患者白内障的优缺点。方法 采用回顾性的分析方法，对我院1998-2001年66例76眼糖尿病患者白内障，行超声乳化吸出人工晶状体植入36例42眼及现代囊外摘出人工晶状体植入30例34眼，对术前血糖、术后视力、角膜散光及术中术后并发症进行统计学对比分析。结果 全部患者包括术前空腹血糖高于正常者均安全完成手术，超乳组的空腹血糖水平高于囊外组。术后裸眼视力≥O．5者超乳组占76．2％，优于囊外组的26．5％。角膜散光超乳组低于囊外组。超乳组术后并发症低于囊外组。结论 超乳组有较高的血糖耐受水平，把握好手术时机，采用小切口超声乳化吸出术，多数糖尿病患者可获得满意效果。     

The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes

AIM: To assess clinical, visual, computerised corneal topographic, and subjective satisfaction with visual acuity, in a cohort of subjects 2 years after phacoemulsification surgery in a public hospital in New Zealand. METHODS: Prospective study of a representative sample of 97 subjects (20%) randomly selected from 480 subjects in the original Auckland Cataract Study (ACS) cohort. The clinical assessment protocol was identical to the ACS and included an extensive questionnaire to enable direct comparisons to be made between the two groups. RESULTS: The study population was predominantly female (66%) with a mean age of 76.3 (SD 9.9) years. New systemic and ocular disease affected 18.4% and 10.3% of subjects respectively, and 10.3% required referral to either a general practitioner (2.1%) or ophthalmologist (8.2%). Mean best spectacle corrected visual acuity (BSCVA) was 0.2 (0.2) logMAR units (6/9 Snellen equivalent), with mean spherical equivalent -0.37 (1.01) dioptres (D) and astigmatism -1.07 (0.70) D 2 years postoperatively, compared to mean BSCVA 0.1 (0.2) logMAR units (6/7.5 Snellen equivalent), spherical equivalent -0.59 (1.07) D, and astigmatism -1.14 (0.77) D 4 weeks after surgery. 94.9% of subjects retained a BSCVA of 6/12 or better, irrespective of pre-existing ocular disease. The overall posterior capsule opacification (PCO) rate was 20.4% and this was visually insignificant in all but 3.1% of eyes that had already undergone Nd:YAG posterior capsulotomy. Orbscan II elevation technology demonstrated corneal stability 2 years after uncomplicated phacoemulsification. Although corneal astigmatism was eliminated in approximately half of the subjects 1 month postoperatively, astigmatism showed a tendency to regress towards the preoperative level with local corneal thickening at the site of incision 2 years after cataract surgery. Of fellow eyes, 61.2% had undergone cataract surgery. Overall, 75.3% of subjects were moderately to very satisfied with their current level of visual acuity. CONCLUSION: Two years after cataract surgery subjects are generally satisfied with their current level of vision and distance BSCVA is 6/12 or better in the majority of eyes. Although only a minority of eyes develop sufficient PCO to require capsulotomy 10.3% of eyes develop new vision threatening ocular pathology.     

Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema

BACKGROUND: Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients--especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME) in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery. METHODS: Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retinopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the non-operated fellow eyes. RESULTS: Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 71%. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (31%), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA. CONCLUSION: Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.