白内障手术服务快速评估法在白内障干预工作中的应用及意义

白内障手术服务快速评估法(RACSS)是WHO推出的用于评估一个国家或地区白内障盲情的一种简单方法。建议国内各级防盲机构在评估中国的每年白内障手术量时采用白内障手术覆盖率指标。为了提高评估效率,我们建议筛查人群为≥60岁者。为了了解每年的手术趋势,在其白内障手术服务调查记录表中加入“哪年做的白内障手术”的内容。     

静态抽吸法在白内障手术中的应用

后囊膜破裂是白内障手术中最常见也是最严重的并发症。尤其是在白内障超声乳化手术中如处理不当会出现晶状体核坠入玻璃体等严重情况 ,这样不仅会影响术后视力的恢复 ,而且会使手术失败。我们采用静态抽吸法处理后囊膜破裂时的晶状体皮质和核碎块 ,取得满意的临床效果 ,现将结果报告如下。1　材料和方法1.1　材料　近三年我们采用静态抽吸法处理了白内障手术中后囊膜破裂的 31例病例。其中白内障超声乳化手术中发生者 18例 18眼 ,白内障囊外手术中发生者 13例 13眼。发生于清除皮质时者 2 1例 ,发生于乳化晶状体核者 8例 ,另外3例由于术前外…     

北京市城乡限定人群白内障手术负荷量及术后视力评价

目的：探讨北京限定区域城市及农村人群白内障患病率、低视力及手术负荷量，分析白内障手术覆盖率及术后视力情况。方法：晶状体图像资料完整的40岁以上受试者4364人(农村1909人，城市2455人)，所有受试者均进行问卷调查及眼部检查。眼部检查包括裸眼及矫正视力、电脑验光、眼压、散瞳后裂隙灯检查，数码照相采集晶状体图象及眼底照相。白内障手术负荷量入选标准：(1)符合白内障诊断；(2)除外角膜病、青光眼、眼底病、严重沙眼性角膜混浊等影响视力的疾病；(3)标准一：单眼矫正视力≤0.3；标准二：双眼矫正视力≤0.3。结果：本次调查白内障患病率为16.3％，其中双眼矫正视力≤0.3者14例，手术负荷量为0.32％(农村0.52％，城市0.16％)；单眼矫正视力≤0.3者67例，手术负荷量为1.54％(农村1.89％，城市1.26％)。对白内障手术需求女性大于男性，随年龄增加，需求上升，农村高龄女性需求最大。已行白内障手术者共55例(72只眼)，总的白内障手术覆盖率为7.03％，其中农村为4.71％，城市为9.03％，女性6.69％，男性为7.33％，农村女性的手术覆盖率最低，为3.77％。白内障手术后矫正视力≤0.3者占18.06％。术后视力不佳的原因为后发性白内障、眼底病变及其它手术并发症等。结论：白内障手术需求农村高于城市，农村高龄女性需求最大；白内障手术后总体视力提高欠佳；白内障手术需求远远超过现有的手术能力。     

洛阳市白内障手术患者晶状体核硬度的变迁

目的调查近4年来洛阳市白内障手术患者中硬核白内障者比率变化。方法对2006年1月至2009年6月期间接受手术治疗的2640例（2640只眼）老年性白内障患者,根据LOCSⅢ（Lens Opacities ClassificationSystem III）白内障核硬度分级标准,统计每例晶状体核硬度,对比分析4年来核硬度分布的变化趋势。结果 2006年间患者546例,年龄57~89岁,平均（70.6±7.6）岁,Ⅴ级核96例（17.6%）;2007年间患者628例,年龄51~92岁,平均（70.0±7.6）岁,Ⅴ级核87例（13.9%）;2008年间患者892例,年龄57~85岁,平均（69.0±6.6）岁,Ⅴ级核90例（10.1%）;2009年间患者574例,年龄54~90岁,平均（68.5±6.4）岁,Ⅴ级核48例（8.4%）。各年份硬核（Ⅴ级核）白内障患者比例呈现逐渐减少趋势,结果具统计学意义（P=0.000）。结论随着我国卫生事业的发展,政府倡导的大规模白内障复明行动,白内障手术率逐渐增加,硬核白内障患者在减少,对于我们以后的白内障防治工作具有指导意义。     

重视白内障患者的术前准备与评估

白内障手术并非简单的手术，术前准备和评估均十分重要，如手术适应证的选择，术前采取预防并发症的措施以及对人工晶状体进行个体化选择等。只有在充分准备与评估的基础上，术前对患者进行详细的解释，才更利于获得手术成功。     

高频透热双截囊法在白内障手术中的应用

目的：探讨高频透热截除后囊预防后发障的方法。方法：在常规的白内障手术的同时进行，即在白内障手术娩出晶状体核抽吸干净皮质后，注入粘弹剂，用高频透热截囊头在后囊正中作－2mm环形截后再植入人工晶状体完成手术。结果：术后近期远期均获得良好视力，无一发生后发障，结论：双截囊法是避免后发障发生的一种操作简单，安全可靠，切实有效的方法。     

双钩法预劈核在白内障超声乳化手术中的应用

目的 探讨双钩法预劈核技术在白内障超声乳化手术中的应用效果。设计 前瞻性比较性病例系列。研究对象 2013年3-5月在沈阳何氏眼科医院治疗的老年性白内障患者80例（80眼）。方法 按随机数字表法将患儿分为两组,分别采用双钩法预劈核及常规拦截劈核法（对照组）进行手术。比较两组术中所用的有效超声时间,术后1、3、7、30天的最佳矫正视力,角膜水肿程度（评分）及手术并发症情况。主要指标 有效超声时间,术后最佳矫正视力、角膜水肿程度及并发症。结果 与对照组（19.32 s ±6.12 s）相比,双钩法预劈核组（13.56 s ±5.21 s）的有效超声时间更短（P=0.000）。术后3天,预劈核组视力（<0.5者1眼、0.5~0.8者19眼、>0.8者18眼）也较对照组（<0.5者9眼、0.5~0.8者21眼、>0.8者12眼）好（P=0.023）;术后1个月,预劈核组视力（<0.5者0眼、0.5~0.8者9眼、>0.8者29眼）与对照组（<0.5者1眼、0.5~0.8者10眼、>0.8者31眼）无差异（P=0.879）。术后3天预劈核组角膜水肿程度评分（0分18眼、1分11眼、2分8眼、3分1眼）较对照组（0分12眼、1分10眼、2分11眼、3分9眼）低（P=0.047）;术后1个月预劈核组角膜水肿程度评分（0分37眼、1分1眼、2分0眼、3分0眼）较对照组（0分38眼、1分4眼、2分0眼、3分0眼）无差异（P=0.653）。双钩法预劈核组术中未见明显并发症发生,对照组发生1例后囊膜破裂。结论 在白内障超声乳化手术中与常规拦截劈核法相比,双钩法预劈核技术有效超声时间短,术后早期即获得较好的视力,无严重并发症发生。（眼科,2014, 23： 86-90）     

广东省斗门县白内障手术的生存质量评价

目的：评价广东省斗门县年龄≥50岁人群中白内障术后患者的主观视功能（visual function,VF）和生存质量（quality of life,QOL）。方法：整群抽样法确定样本人群,其中白内障术后患者组成手术组,视功能损害者（1只眼视力＜0．1者）和部分正常对照者（双眼视力均＜＞0．3者）组成非手术组,由4位工作人员按照标准化方式完成VF和QOL问卷调查工作。结果：在5342例受检查中,手术组109例白内障术后患者中99例,非手术组626例视功能损害者中535例、3227例正常对照者中119例完成问卷调查工作。随着视力自正常下降至严重盲,非手术组VF和QOL分数的中位数分别自92下降至2和自100下降至19;手术组VF和QOL分数的中位数分别自80下降至8和自90下降至31。手术组视力与VF和QOL分数的关系与非手术组相似。VF和QOL的总分数手术组分别为40和56,非手术组分别为56和72。通过多因素回归分析校正视力、年龄、性别和教育程度后,非手术组和手术组的QOL分数差异有显著意义（P＝0．015）,VF分数差异无显著意义（P＝0．199）。结论：VF和QOL与视力显著相关。在本研究人群中,白内障术后患者的主观VF和QOL无明显提高,临床应进一步重视白内障术后患者的随访工作和社会心理康复。     

Rapid assessment of visual impairment due to cataract and cataract surgical services in urban Argentina

AIM: To present results of a rapid assessment on visual impairment due to cataract and on cataract surgical services in the Northwestern districts of Buenos Aires, Argentina. These results will enable health managers to plan effective interventions in this area in line with VISION 2020. METHODS: One hundred fifteen clusters of 40 persons of 50 years and older in each cluster (4600 eligible persons) were selected by systematic sampling from the Northwestern districts of Buenos Aires, Argentina. This area consists of 10 districts with a total population of 2,716,573 (2001 census), from whom 4302 persons were examined (coverage 93.5%). The visual acuity was measured with a tumbling E-chart and the lens status with distant direct ophthalmoscopy. RESULTS: Cataract is the major cause of bilateral blindness (54.2%). The age and sex adjusted prevalence of bilateral cataract blindness (presenting VA < 20/400) in people of 50 years and older was 0.5% (95% CI: 0.4-0.8%), an estimated number of 2,985 persons. The cataract surgical coverage at this level was 70% for males and 78% for females. The prevalence of bilateral cataract and VA < 20/200 in persons of 50 years and older was 0.8% (95% CI: 0.6-1.1), an estimated 4,705 persons. In this last group, the surgical coverage was 66% (persons) and 57% (eyes). Of all operated eyes, 10% could not see 20/200. 'Cannot afford' (32%), 'unaware of cataract' (21%) and 'contraindication for surgery' (18%) were mentioned most as reason why surgery had not been done. CONCLUSION: The cataract problem is getting under control in this area. Coverage indicators are fairly high, and the outcome data better than in other studies. The cataract surgical rate could be raised further by awareness campaigns and by making cataract surgery more affordable.     

Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh

AIMS: To estimate the magnitude and causes of blindness in people aged > or =50 years in Satkhira district, Bangladesh, and to assess the availability of cataract surgical services. METHODS: 106 clusters of 50 people aged > or =50 years were selected by probability-proportionate to size sampling. Households were selected by compact segment sampling. Eligible participants had their visual acuity measured. Those with visual acuity <6/18 were examined by an ophthalmologist. A needs assessment of surgical services was conducted by interviewing service providers. RESULTS: 4868 people were examined (response rate 91.9%). The prevalence of bilateral blindness was 2.9% (95% confidence interval (CI) 2.4% to 3.5%), that of severe visual impairment was 1.6% (95% CI 1.2% to 2.0%) and that of visual impairment was 8.4% (95% CI 7.5% to 9.3%). 79% of bilateral blindness was due to cataract. The cataract surgical coverage was moderate; 61% of people with bilateral cataract blindness (visual acuity <3/60) had undergone surgery. 20% of the 213 eyes that had undergone cataract surgery had a best-corrected poor outcome (visual acuity <6/60). The cataract surgical rate (CSR) in Satkhira was 547 cataract surgeries per million people per year. CONCLUSIONS: Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved.     

'Fast-track' cataract services and diagnostic and treatment centre: impact on surgical training

AIMS: To evaluate the impact of 'Action on Cataracts' and the development of Diagnostic and Treatment Centre (DTC) on cataract surgery training in the Central Manchester and Manchester Children's University Hospital's Trust. METHODS: We compared all cataract extractions undertaken from April to September 2005 with the same 6-month time period over the preceding 5 years. Surgery was performed on one of four types of lists: Manchester Royal Eye Hospital standard lists (MREH), Cataract Services list, Waiting List Initiative list (WLI), and Diagnostic and Treatment Centre list (DTC). Surgeons were identified by their specific codes and divided into grades. RESULTS: The total number of cataract operations undertaken on the standard MREH lists has declined significantly over the years (P<0.001 chi(2) test for trend). The number of cataract operations performed by both Specialist Registrars (SpRs) and Senior House Officers (SHOs) demonstrated a statistically significant decline over the years (P<0.001 for both cases, chi(2) test for trend), with the SHOs number dropping dramatically over the last 2 years. When comparing the number of operations performed by junior SpRs and senior SpRs, shift in the balance can be seen towards the senior surgeons. The proportion of operations performed by junior SpRs declined from 50% in 2000 to 28.2% in 2005. CONCLUSION: Recent changes in cataract care provision have had a significant impact on training. Our results document for the first time that both higher and basic surgical trainees were affected. Future care of our patients could be comprised owing to lack of training.     

单通道玻璃体切除在外伤性白内障术中应用

目的探讨晶状体前、后囊均破裂的外伤性白内障,经睫状体平坦部的单通道的前部玻璃体和晶状体切除术的效果。方法角巩膜穿透伤伴外伤性白内障26例(26眼)。术前视力:光感14眼,手动5眼,数指7眼。均在一期外伤清创缝合后进行二期玻璃体切除联合手术。玻切通道位于颞上方角膜缘后3.5～4mm处睫状体平坦部,另一切口为12点位角膜缘后2mm处的巩膜角膜隧道切口,切口宽2.8mm于透明角膜内2mm处进入前房。经巩膜切口插入玻切头,经隧道切口插入注水针头,进行前段玻璃体及晶体切除术,经角巩隧道植入折叠式人工晶状体。结果术后3个月视力0.2者5眼,0.3者4眼,0.5者8眼,0.8者6眼,1.0者3眼。术后5眼出现一过性高眼压,经对症处理后缓解,3例病人因虹膜损伤出现虹膜夹持。结论此手术方法简捷、手术效果佳、术中损伤小、视力恢复快,而且并发症少。     

Sex inequalities in cataract blindness burden and surgical services in south India

AIM: To determine sex inequalities in cataract blindness and surgical services in south India. METHODS: Details of lens status and cataract surgery were recorded for subjects aged 50 years and older identified through cluster sampling as part of population based cross sectional assessments of cataract blindness and surgical outcomes in three districts of south India. RESULTS: Females were less likely to be operated on for cataract (adjusted OR 0.71, 95% CI: 0.57 to 0.87) although the cataract blindness burden was higher for females (p<0.001). Literacy of the subject was a major predictor for being operated on for cataract. Achieving equal surgical coverage between sexes will have resulted in an additional 25.3% reduction of cataract blindness. CONCLUSIONS: Eye care programmes in this population need to be sensitised to the substantial reduction in blindness possible by achieving equal surgical coverage between sexes.     

儿童先天性白内障不同术式的后发障发生率

目的探讨减少儿童白内障术后后发障的手术方法。方法15岁以下的先天性白内障117例(158眼)。分为3组:A组进行超声乳化吸出术及后囊抛光术,共79眼;B组进行超声乳化及后囊连续环形撕囊术,共32眼;C组进行超声乳化、后囊连续环形撕囊及前部玻璃体切除术,共47眼。≥3岁者一期囊袋内植入人工晶状体。观察术后后发障的发生情况。结果A组有71眼在术后25天～3年期间出现后发障,占89.87%,平均出现时间为11月。B组有24眼在术后45天～2年半期间出现后发障,占75.00%,平均出现时间为1年5月。C组有6眼在术后50天～2年期间出现后发障,占12.77%,平均出现时间为1年3月。结论3岁以下婴幼儿进行白内障吸出、后囊环形撕囊术并行前部玻璃体切除术,二期植入人工晶状体。3～15岁的患儿进行白内障吸出、后囊环形撕囊术并行前部玻璃体切除术,〗并囊袋内植入人工晶状体可有效预防后发障的发生。