偏心和倾斜对不同类型功能性IOL视觉质量的影响

在屈光性白内障手术时代, IOL由传统的球面设计发展为非球面, 散光矫正型、老视矫正型等各种功能性IOL可满足白内障患者的不同视觉需求, 但对偏心和倾斜的容忍度降低。零球差IOL具有良好的位移耐受性, 偏心和倾斜对非球面IOL视觉质量的影响与其球差矫正能力和屈光度大小有关, IOL负球差值越大、屈光度数越高, 其受影响则越大。偏心和倾斜是Toric IOL度数计算误差的来源之一, 会降低其散光矫正能力, 甚至引起新的散光, 产生不可预测的视觉功能结果。由于老视矫正型IOL更为复杂的光学设计、视近与视远光学区域的划分, 使得偏心和倾斜对其光学性能影响更大, 更易产生视觉干扰。(国际眼科纵览, 2022, 46:512-516)     

双眼多焦点人工晶状体ReSTOR植入术后视功能观察

目的 通过比较植入单、多焦人工晶状体(IOL)术后双眼视功能情况,以了解国人植入多焦点IOL的有效性及安全性.方法 选择年龄相关性白内障患者43例,按患者意愿植入多焦点或单焦点IOL.单焦点人工晶状体(MoIOL)组:双眼植入AcrysofNatural25例50只眼.多焦点人工晶状体(MIOL)组:双眼植入AcrysofReSTOR 18例36只眼.观察两组组患者术后双眼裸眼远视力(UCDVA)、裸眼近视力(UCNVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、远矫正下的近视力(DCNVA),中间距离视力(40、60、80cm),对比敏感度(CS),视觉症状.结果 MIOL组UCNVA、DCNVA、中间距离视力均优于单焦点人工晶状体MoIOL组,差异有统计学意义(P＜0.05).两组之间,CS无明显差异.MIOL组术后视觉症状较轻,脱镜率80%,患者满意度高.结论 双眼植入MIOL能提供更好的近、中距离视力,视觉症状轻,更好地提高白内障患者术后生活质量.     

老视矫正方法的研究进展

目的老视矫正方法的日趋多样化。配戴框架凸透镜是矫正老视最常见的方式,包括传统的单光（单焦）眼镜及近年出现的双光（双焦）、渐变多焦眼镜及衍射镜片。屈光手术矫正老视可分为角膜屈光性手术、眼内晶状体摘除联合可调节型人工晶状体（IOL）植入手术和巩膜屈光性手术。角膜屈光性手术包括激光角膜手术、角膜层闻植入物手术及传导性角膜成形术。鼎状体摘除联合可调节IOL植入术的IOL可分为单焦和多焦调节型两种,有引起眩光或光晕等视觉症状的情况,疗效需进一步观察。巩膜手术视觉完整性并不理想,且可能出现严重并发症,仍需临床观察。同时monovision（MV）被越来越多的引入到老视矫正手术中并且取得了较好效果。老视矫正方法的多样化为不同的需求者提供更多的选择。     

区域折射型多焦点与非球面单焦点IOL植入术后视力及视觉质量分析

目的：对比区域折射型多焦点人工晶状体(IOL)和非球面单焦点IOL植入术后患者的全程视力及视觉质量。

方法：前瞻性选取2017-01/2019-08于我院眼科接受白内障超声乳化吸除联合IOL植入术的年龄相关性白内障患者82例96眼,根据术中植入的IOL类型分为观察组(46例53眼,植入Oculentis MF30区域折射型多焦点IOL)和对照组(36例43眼,植入ADAPT AO非球面单焦点IOL)。比较两组患者术后3mo的全程视力和视觉质量。

结果：术后3mo,与对照组相比,观察组近、中视力显著改善,对比敏感度显著提高,调制传递函数截止频率、斯特列尔比、客观调节幅度以及模拟视力显著增加,VF-12-CN评分显著降低(38.16±4.05分 vs 45.72±4.69分),脱镜率评分(11.38±1.04分 vs 9.23±0.87分)和手术满意度评分(3.57±0.36分 vs 3.32±0.31分)显著升高(P<0.05)。年龄>65岁、文盲、好眼裸眼远视力≥0.1(LogMAR)、植入非球面单焦点IOL是导致白内障患者生活质量下降的影响因素。

结论：与非球面单焦点IOL相比,区域折射型多焦点IOL术后短期可提供良好的全程视力,对比敏感度、视觉质量、生活质量、脱镜率以及满意度均显著提高。     

自然视觉,全程清晰--2020至2021年白内障诊疗征文大赛通知

随着科学技术的发展和人口年龄结构的变化,白内障患者对术后视觉质量的需求日趋提高。手术后全程可以无需配戴框架眼镜.已成为众多白内障患者术后的首要需求。基于这种需求,植入老视矫正型多焦点人工晶状体解决白内障患者的老视问题目前已成为一种趋势。     

多焦点IOL植入联合角膜松解切口矫正白内障合并角膜散光的分析

目的:比较多焦点IOL植入联合角膜切口矫正散光与单焦点IOL植入术治疗白内障合并低度散光患者的视觉质量差异。方法:选取老年性白内障合并低度散光患者80例100眼,按随机原则分为对照组及干预组,各40例50眼。干预组行最陡角膜散光轴向上做一对透明角膜松解切口,同时按常规行透明角膜切口白内障超声乳化+多焦点IOL植入术;而对照组仅行透明角膜切口白内障超声乳化+单焦点IOL植入术。分别于术后1d;1wk;1,3mo观察两组术眼的角膜散光情况及裸眼远视力(uncorrected distance visual acuity,UCDVA),裸眼近视力(uncorrected near visual acuity,UCNVA);3mo时最佳矫正远视力(best corrected distance visual acuity,BCDVA)、最佳矫正近视力(best corrected near visual acuity,BCNVA)及最佳矫正远视力下最佳矫正近视力(distant corrected near visual acuity,DCNVA)并进行统计分析。结果:术后UCDVA和UCNVA干预组均高于对照组,而各时期角膜散光干预组均低于对照组。两组患者术后3d均有明显改善。术后1wk;1,3mo,UCDVA和UCNVA及3mo时BCDVA,BCNVA无显著差异。结论:多焦点IOL植入联合透明角膜松解切口可有效矫正白内障术前散光,提高全程视力,从而扩大多焦点IOL适用人群。     

散光矫正型多焦点与单焦点人工晶状体植入术的效果对比

目的：比较并分析散光矫正型多焦点IOL与单焦点IOL植入术后早中期的临床效果差异。
　　方法：老年性白内障患者行超声乳化IOL植入术34例40眼,其中A组植入散光矫正型多焦点IOL者18例20眼;B组植入散光矫正型单焦点IOL者16例20眼,观察两组患者术后1 mo和6 mo的裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、总眼球散光及术后6 mo时暗光下对比敏感度。
　　结果：两组患者的裸眼远视力、最佳矫正远视力及最佳矫正近视力差异均无统计学意义(P>0.05)。裸眼近视力差异具有统计学意义(P<0.05)。术后总眼球散光1mo时A组为0.65±0.25D,B组为0.52±0.27D,两组比较差异无统计学意义(P>0.05);6mo时A组为0.54±0.23D,B组为0.45±0.20D,两组比较差异亦无统计学意义( P>0.05)。6mo时暗光下对比敏感度及眩光对比敏感度两组比较在高频率差异具有统计学意义(P>0.05)。
　　结论：散光矫正型多焦点人工晶状体使具有较大角膜散光的白内障患者术后早期获得良好的、稳定的裸眼远、近视力,并且获得良好的视觉质量。     

人工晶状体在婴儿白内障手术中应用现状与趋势

婴儿白内障手术仍然是目前眼科临床治疗的难题。由于人工晶状体(IOL)矫正无晶状体眼符合眼部生理要求且利于弱视的治疗,IOL植入术在婴儿白内障手术中的应用越来越多,植入年龄也越来越小。随着眼科显微技术和IOL设计的进一步发展,婴儿IOL植入的手术并发症也不断减少。从历史发展趋势看,白内障摘除同期IOL植入可能成为未来婴儿白内障手术的首选方式;但当前同期植入IOL的并发症不可忽视,所以应重视IOL在婴儿白内障手术中的临床应用研究。     

IOL在婴幼儿白内障手术中的应用

目前,国内外已将白内障摘除和人工晶状体(intraocularlens, IOL)植入作为治疗儿童白内障的首要选择。但是,儿童眼特别是婴幼儿眼的IOL植入一直是眼科界关注的问题。适时的白内障摘除术后IOL植入对于屈光矫正、视功能建立、预防弱视和双眼视功能重建都有极大的作用。然而,有关婴幼儿白内障摘除术后IOL植入问题,在儿童白内障治疗方案上始终存在争议,争议的焦点主要集中在IOL植入的时机问题上。理论上讲,儿童白内障的手术治疗原则是越早越好,目的是去形觉剥夺因素,打开视觉通路,及时植入IOL,促进视觉发育。但如何找到既“早”又安全的IOL植入时间点无疑对患儿视功能的康复是大有益处的,本文就国内外儿童白内障摘除术后IOL植入问题进行综述。     

三焦点与单焦点人工晶状体植入术后1年视觉质量比较

目的:比较三焦点与单焦点人工晶状体(IOL)植入术后1年视觉质量。方法:采用队列研究设计,纳入2017年5月至2018年6月在南京大学医学院附属鼓楼医院行超声乳化白内障摘出联合IOL植入术的年龄相关性白内障患者41例41眼,根据患者意愿将其分为三焦点IOL组20例20眼和单焦点IOL组21例21眼,分别植入AT LIS...     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.