硬核白内障超声乳化吸出术中扭动模式与爆破模式的效果比较

目的研究扭动模式和爆破模式在硬核白内障超声乳化吸出术中的对比效果。方法Ⅳ级硬核（Emery分级）老年性白内障超声乳化吸出术51例（65眼）,随机分为扭动模式组和爆破模式组。记录两组术中累积释放能量（CDE）、平均超声时间（UST）、术后1d、7d角膜水肿程度、术后1d、7d、30d最佳矫正视力（BCVA）及术后3个月角膜内皮细胞丢失情况。结果扭动模式组较爆破模式组术中CDE少（P〈0．05）,但两组间UST比较差异无统计学意义（P〉0．05）。术后1d扭动模式组角膜水肿程度较轻,差异有统计学意义（X^2=8．620,P〈0．05）,但术后7d两组角膜水肿程度差异无统计学意义（X^2=0．955,P〉0．05）。术后1d扭动模式组BCVA优于爆破组,差异有统计学意义（X^2=4．975,P〈0．05）,但术后7及30天两组BCVA差异无统计学意义（P〉0．05）。术后3个月角膜内皮细胞计数丢失数,扭动模式组较爆破模式组低,两组差异有统计学意义（t=4．317,P〈0．05）。结论在硬核白内障超声乳化吸出术,扭动模式较爆破模式对眼内组织损伤更小,更高效和安全,有助于更快恢复视力。     

白内障超声乳化术两种护理模式的对比观察

目的晶状体超声乳化术是一种安全、快捷、有效的白内障复明技术，为了让这一手术在临床上获得很好的复明效果，根据我国白内障病人的特点和现阶段我国的基本国情，我院采用一种介于传统住院手术和门诊手术之间并取二者之所长的模式——超声乳化家庭病床护理模式。通过120例白内障手术两种护理模式的对比观察，认为白内障超声乳化患者家庭病床具有方便安全的优点，效果满意。     

微小切口晶状体超声乳化吸出术应用价值

目的探讨双手微小切口晶状体超声乳化吸出术的应用值。方法对行双手微小切口晶状体超声乳化吸出术A组。观察术中乳化时间、术后视力、手术性角膜散光及角膜内皮数量。并与常规超声乳化手术组(B组)进行统计学分析比较。结果A组术中平均超声乳化时间为(1.0±0.53)min;B组术中平均超声乳化时间为(0.75±0.56)min,差异无统计学意义(P>0.05)。在术后1天:A组裸眼视力≥0.5者占90.36%;B组裸眼视力≥0.5者占80.90%。术后1天A组平均手术性角膜散光:(0.15±0.56)D,术前、后角膜散光变化差异无统计学意义(P>0.05):B组为:(1.20±0.96)0,手术前、后角膜散光变化差异有统计学意义(P<0.05)。A组术后角膜内皮计数:平均(2198±210)个/mm2;B组术后角膜内皮计数平均(1800±240)个/mm2。结论双手微小切口冷超声乳化吸出术具有良好的临床应用价值。     

晶状体超声乳化吸出术后视网膜脱离

我科自 1997年开展超声乳化白内障摘出联合人工晶状体植入术以来 ,2例患者术后发生视网膜脱离。报告如下 :例 1:男 ,5 8岁 ,因右眼视力下降 ,下方黑影遮挡 7天 ,于 2 0 0 1年 1月 3日来我科就诊 ,既往双眼近视 6 0 0ＤＳ ,半年前在他院作右眼超声乳化白内障摘出联合人工晶状体植入术 ,术中后囊完整 ,人工晶状体植入囊袋内 ,术后视力 0 6,全身检查无异常 ,眼部检查 ,右眼视力 0 0 6,人工晶状体位置正 ,双襻在囊袋内 ,前囊开口 6ｍｍ直径 ,周边前囊浑浊 ,玻璃体浑浊 ,视网膜颞上方 ,颞侧8:0 0～ 12 :0 0方位灰白色隆起 ,波及黄斑区 ,11:3 0…     

糖尿病患者白内障超声乳化吸出联合人工晶状体植入

目的　观察糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术的临床效果。方法　对884 例1 079 眼患有糖尿病的白内障术后患者的视力及并发症进行分析,并选取同时期、同一手术医师施行的非糖尿病白内障患者做对照。手术采用巩膜隧道切口超声乳化及囊袋内人工晶状体植入法。术前空腹血糖控制在8.5 mmol·L-1以下。结果　糖尿病患者术后3 d矫正视力与非糖尿病患者相比无明显差异(P>0 05),<0.5者454眼,均为眼底出血、渗出累及黄斑及黄斑囊样水肿、增殖性视网膜病变所致。糖尿病患者术前瞳孔不能充分散大或术中瞳孔缩小、瞳孔缘损伤和术后角膜水肿、黄斑水肿的病例明显多于非糖尿病患者。结论　糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术,可明显改善视力,超声乳化吸出术治疗糖尿病患者白内障是安全有效的,并为糖尿病视网膜病变的荧光血管造影和激光治疗提供了条件。眼底出血、渗出累及黄斑、黄斑囊样水肿、增殖性糖尿病视网膜病变是影响术后视力的主要因素。     

超声乳化吸出治疗晶状体半脱位白内障

目的探讨超声乳化白内障吸出联合人工晶状体植入术在晶状体半脱位白内障手术中的应用。方法对15例（15眼）行超声乳化白内障吸出联合人工晶状体植入术。结果术后视力0．4～0．8者9眼,0．1～0．3者5眼,0．08以下者1眼。结论超声乳化白内障吸出联合人工状体植入术,是晶状体半脱位白内障的有效的手术方法。     

角膜移植术后的晶状体超声乳化吸出术

目的探讨穿透性角膜移植术后超声乳化吸出术的疗效。方法对23例(23眼)角膜移植术后白内障患者施行超声乳化吸出联合人工晶状体植入术。患者年龄18~67岁,平均(41.5±11.3)岁。观察术后视力、眼压、角膜水肿情况、角膜内皮细胞计数及并发症。结果所有患者手术顺利。随访3~18月,术后最佳矫正视力>0.5者8眼(34.78%),角膜内皮细胞平均损失率4.92%,眼压均正常。后囊浑浊1眼(4.35%)。术后2月1眼发生角膜排斥反应,经药物抗排斥治疗移植片恢复透明。结论对穿透性角膜移植术后患者施行晶状体超声乳化吸出术是安全有效的。     

白内障超声乳化术中扭动模式与传统爆破模式的临床研究

目的 比较并探讨扭动模式与传统爆破模式对白内障超声乳化术后的影响.方法 前瞻性随机对照研究.对2008年1月至2009年1月在上海交通大学医学院附属第九人民医院按照手术日登记将接受白内障超声乳化手术的患者随机分为2组,扭动模式组94例,传统爆破模式组94例,分别使用扭动模式和爆破模式进行超声乳化手术.术中记录超声时间(Ultrasound Time,UST),累计分散能量(Cumulative Dissipated Energy,CDE)和手术并发症.患者术后1周、1月、3月接受复诊和随访.术后检查项目包括最佳矫正视力和角膜内皮计数.结果 根据Emery白内障核分级:扭动组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的超声时间分别是(31.06±14.29)s、(35.72±19.74)s、(74.11±41.50)s;爆破组Ⅰ+Ⅰ、Ⅲ、Ⅳ级以上核的超声时间分别是(47.3±17.58)s、(53.34±19.51)s、(84.54 4-15.45)s,两者之间差异有统计学意义(F值分别为3.845、5.643、7.814,P＜0.05).扭动组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的CDE值分别是11.2 4±5.33、12.42±5.49、18.19±1.31;爆破组Ⅰ+Ⅱ、Ⅲ、Ⅳ级以上核的CDE值分别12.65±5.71、15.64±9.35、42.5±3.01,两者间差异有统计学意义(F值分别为8.800、9.386、9.388,P＜0.05).手术3月的最佳矫正视力扭动组0.72±0.21,爆破组0.70±0.18,两者间无明显差异(P＞0.05).术后1周、1月、3月的角膜内皮细胞计数,扭动组分别为(2149±199)、(2222±177)、(2313±161)个/mm2,爆破组分别为(2055±218)、(2084±175)、(2259±179)个,mm2,各组间差异有统计学意义(F值分别为6.297、6.272、5.957,P＜0.05).结论 白内障超声乳化手术中采用扭动模式可以有效减少能量和缩短时间,减轻患者角膜内皮的损伤,是一种安全有效地手术模式.

Abstract：

Objective To compare the intraoperative and postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System. Methods Randomized comparative study. A total of 188 eyes were assigned to phacoemulisification by torsional mode or conventional ultrasound mode according to the appointed day. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complication. Patients were seen 7, 30, and 90 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in endothelial cell count. Results The US group had 94 eyes and torsional group 94 eyes. All patients completed the follow-up visits.In the eyes with nucleus density grades ofⅠ+Ⅱ、Ⅲ、Ⅳ and above,the mean UST was 31.06+14.29 s,35.72+19.74 s,74.11±41.50 s,respectively in the US group and 47.3±17.58 s,53.34±19.51 s,84.54±15.45 s respectively in the torsional group(P＜0.05);the mean CDE was 11.2±5.33,12.42±5.49,18.19±1.31 respectively in the US group and 12.65±5.71,15.64±9.35,42.5±3.01 respectively in the torsional group(P＜0.05).Postoperative 90 days,the mean BCVA were 0.72±0.21 in torsional group and 0.70+0.18 in US group(P＞0.05).At 7 days,30 daysand 90 days,the mean central corneal endothelial cell count was 2149±199,2222±177,2313±161respectively in the US group and 2055±218,2084±175,2259±179 respectively in the torsional group (P＜0.05).Conclusions The torsional mode can provide more effective lens removal with a lower level of phacoemulsification time and energy.     

外伤性晶状体不全脱位白内障超声乳化吸出术

目的 探讨超声乳化吸出术治疗外伤性晶状体不全脱位白内障的手术技巧。方法 采用旋转切削超声乳化技术对22例(22眼)进行超声乳化吸出联合人工晶状体植人手术，其中10例需联合前段玻璃体切除术。结果 术后随访3～36月，平均15．1月，最佳球镜矫正视力：≥1．0者5眼；0．4～0．8者14眼；0．1～0．3者3眼。继发青光眼2例。结论 运用旋转切削超声乳化技术治疗外伤性晶状体不全脱位白内障，安全且并发症少。     

超高度轴性近视白内障的晶状体超声乳化吸出术

目的观察超声乳化吸出及人工晶状体植入术治疗超高度轴性近视白内障的效果。方法对105例（105眼）超高度近视白内障行品状体超声乳化吸出术，植入低度数人工品状体，随访3月。结果术中无并发症发生。术后8眼晶状体后囊轻度浑浊，无视网膜脱离者。结论超声乳化白内障吸出术对于超高度轴性近视白内障是一种较好的手术方式，尤其同时植入负、低度数后房型人工晶状体既可为增加眼内组织的稳定性。防止发生视网膜脱离，又可同时进行屈光矫正。     

晶状体超声乳化吸出联合小梁切除术治疗白内障合并青光眼

目的 评价晶状体超声乳化吸出联合小梁切除术治疗白内障合并青光眼的手术效果.方法 对38例(43眼)白内障合并青光眼采用经上方巩膜隧道切口行三联手术,术后随访6个月.结果 术后最佳矫正视力:≥0.5者35眼(81.40%),0.2-0.4者5眼(11.63%),≤0.1者3眼(6.98%).术后眼压≤15 mmHg者14眼(32.56%),16～21 mmHg者24眼(55.81%),≥22 mmHg 者5眼(11.63%).结论 品状体超声乳化白内障摘出联合小梁切除术是治疗白内障合并青光眼的理想术式.     

Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study

PURPOSE: To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). SETTING: Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. METHODS: In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. RESULTS: The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P<.001); the mean CDE was 1.25 +/- 0.5, 4.18 +/- 1.2, 8.59 +/- 6.5, and 16.51 +/- 9.6, respectively, in the US group and 0.94 +/- 0.3, 3.13 +/- 2.7, 7.47 +/- 12.6, and 14.08 +/- 8.3, respectively, in the torsional group (P<.001). At 1 day and 7 days, the mean BCVA was 0.23 +/- 0.12 logMAR and 0.00 +/- 0.10 logMAR, respectively, in the US group and 0.18 +/- 0.11 logMAR and -0.08 +/- 0.05 logMAR, respectively, in the torsional group (P<.001). At 30 days, the mean BCVA was -0.10 +/- 0.07 logMAR and -0.12 +/- 0.06 logMAR in the US group and the torsional group, respectively (P>.01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P<.001). At 30 days, the mean CCT was 531 +/- 30 microm in the US group and 529 +/- 39 microm in the torsional group (P>.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). CONCLUSION: The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.     

Consent to cataract surgery performed by residents

BACKGROUND: Surgical teaching seems to be in conflict with the contract between surgeon and patient. We carried out a study to determine the prevalence of consistent disclosure to patients that a resident will perform part or all of their cataract surgery procedure. A second objective was to investigate the effect of such disclosure on patients' willingness to undergo the procedure. METHODS: We sent a survey to all 20 ophthalmologists working in our university-affiliated hospitals, inquiring about their practice of disclosure to patients regarding residents' involvement in surgery. Staff physicians were also asked to record their patients' consent to an operation performed partly or entirely by a trainee while under supervision. RESULTS: Of the 20 surveys sent, only 5 (25%) were returned. Those who declined to participate in the study mentioned several reasons, including that such disclosure might increase a patient's anxiety level, that they might lose potential patients as patients might be reluctant to have trainees perform their surgery, and lack of time to talk to patients about these issues. Of the five ophthalmologists who completed the survey, four were part-time affiliated staff and one was a geographic full-time physician working in our institution. Four of the five ophthalmologists said that they do not consistently disclose residents' involvement to their patients. Of the 49 patients enrolled, only 8 (16%) agreed to undergo the procedure after being informed that a trainee would be actively involved. INTERPRETATION: It is crucial to inform patients that residents may be involved in their surgery in order to avoid possible litigation. However, our results suggest that such disclosure may have a negative effect on surgical education because it could limit the number of cases available to trainees.     

Bilateral cataract surgery: A controlled clinical trial

Purpose  To evaluate the efficacy and safety of simultaneous bilateral cataract surgery with respect to patient satisfaction, outcomes, and complication rates. Methods  We conducted a prospective study of consecutive patients who had simultaneous bilateral cataract surgery on the same day or separate bilateral cataract surgery with an interval of 2 days between operations. The changes in refraction, visual acuity, degree of anisometropia, and complication rates were compared between the simultaneous bilateral cataract surgery and separate bilateral cataract surgery groups. Patient satisfaction was assessed with a questionnaire. Results  Ninety-four patients who had simultaneous bilateral cataract surgery and 100 patients who had separate bilateral cataract surgery were enrolled in this study. The preoperative best-corrected visual acuity (logMAR) was 0.31 ± 0.17 in the simultaneous bilateral cataract surgery group and 0.29 ± 0.16 in the separate bilateral cataract surgery group, and it improved postoperatively to 0.11 ± 0.12 in the simultaneous bilateral cataract surgery group and to 0.10 ± 0.11 in the separate bilateral cataract surgery group. There was no significant difference between the two groups (P = 0.061). In addition, 96.8% of eyes in the simultaneous bilateral cataract surgery group and 97.0% of eyes in the separate bilateral cataract surgery group were within 1.0 diopters of the mean absolute error, and there were no sight-threatening intraoperative or postoperative complications in the two groups. Conclusions  Simultaneous bilateral cataract surgery may be an effective and safe bilateral cataract surgery option with a high degree of patient satisfaction.     

双眼白内障手术患者对两次手术痛觉感知的比较研究

目的比较双眼先后接受表面麻醉下白内障手术的患者对第1次手术和第2次手术的痛觉感知。 方法收集2016年10月至2017年10月于湖南中医药大学第一附属医院先后做双眼白内障手术的73例患者的病例资料进行研究。其中,男性32例,女性41例,平均年龄(64±8)岁。全部患者双眼连续行白内障手术,所有手术均经透明角膜切口行超声乳化白内障吸除联合人工晶状体植入术,且手术全程在有麻醉监护的表面麻醉下进行。每一只眼的白内障手术,患者都必须完成2个简短的量表,即用视觉模拟评分对术后疼痛程度进行两次评分(极差为0～10分)。疼痛的程度和双眼疼痛的差别是主要的评价标准。白内障手术评分、程度分级、麻醉剂量和手术持续时间等资料采用K－S法进行正态检验,当数据符合正态分布时,组间比较采用t检验,否则采用威尔科克森(Wilcoxon)符号秩检验,性别和病史等分类资料采用例数和百分比描述,比较采用卡方检验。 结果全部患者中有41例患者(56%)对第2只眼白内障手术的疼痛程度有更高的视觉模拟评分。第1只眼手术和第2只眼手术的即刻疼痛程度评分中值分别为0(极差为0～6分)和1(极差为0～9分),其差异有统计学意义(z＝3.48,P<0.05)。但术后第1天,第1只眼手术和第2只眼手术的疼痛程度评分比较,中值均为0(极差为0～9分),差异无统计学意义(z＝0.78,P>0.05)。所有病例中,有41例对第2只眼手术的疼痛程度评分更高,与另外32例相比,两组疼痛回忆的差异有统计学意义(χ²＝31.01,P<0.05)。 结论虽然在有麻醉监护的表面麻醉下行白内障手术,患者的疼痛已经很轻,但是对比第1只眼的手术,第2只眼手术的痛觉感知还是明显增加。这可能与术前的焦虑程度紧密相关,也可能与术中静脉镇静药物的遗忘作用有关。本研究的数据有助于解释一系列常见的术后临床观察结果,并应用于白内障围手术期管理研究。     

Adverse medical events associated with cataract surgery performed under topical anaesthesia

Background: Cataract surgery in Australia is increasingly performed in an elderly population with multiple medical comorbidities. The purpose of this study was to investigate the frequency and type of adverse medical events associated with cataract surgery performed under topical anaesthesia with light sedation. Methods: Retrospective analysis was undertaken for 631 consecutive cases of clear corneal phaco‐emulsification and implant surgery performed under assisted topical anaesthesia, by a single surgeon (TR) in a private ophthalmic day surgery unit. In the 238 patients who underwent bilateral surgery, data from the first procedure for each patient were analysed, unless the second procedure was associated with greater morbidity. Results: A total of 393 procedures were included in the study. The mean age was 73 ± 11 years with 75% of patients having at least one significant medical comorbidity. The most common comorbidities were hypertension (51%), gastro‐oesophageal reflux (19%), angina and myocardial infarction (14%), diabetes (13%) and asthma (9%). Significant intraoperative adverse medical events requiring intervention occurred in four cases (1%): bradycardia occurred in three cases and hypotension in one case. None of these adverse events resulted in death or hospitalization. There were no postoperative adverse events, hospitalizations or deaths within 7 days. Minor changes in heart rate, blood pressure and oximetry not requiring intervention were observed in 35 cases (9%). Conclusion: This retrospective analysis shows that cataract surgery performed under assisted topical anaesthesia is safe with a low rate of systemic complications despite being performed in an elderly population.     

Nurse anaesthetic care during cataract surgery: a comparative quality assurance study

BACKGROUND: We studied whether a new model of nurse-provision of conscious sedation for cataract surgery maintained patient satisfaction and safety. METHODS: We prospectively and non-randomly studied 106 patients who had outpatient cataract surgery on a day when an anaesthetist was present at the UBC, Vancouver Hospital Eye Care Centre, and 105 patients with no anaesthetist, but instead a surgical suite nurse trained to give conscious sedation was present. Questionnaires determined patient perception of well-being, pain, and anxiety before surgery, before discharge, at 48 hours and at 6 weeks postoperative. Hospital records and a surgeon questionnaire were used to determine complications. Ophthalmology records were used to determine visual acuity (preoperative and at 6 weeks). RESULTS: No anaesthetic complications were reported in either group and there were no significant differences in surgical complications. Patient responses to assessments of discomfort, well-being, and anxiety, preoperatively and postoperatively, were very similar on the nurse days and anaesthetist days. INTERPRETATION: Conscious sedation of cataract surgery patients can be safely and effectively provided by a trained nurse for selected patients. This nursing role is likely replicable in similar operating room settings.