陕西省农村盲的患病率和白内障手术

目的调查陕西省农村≥50岁老年人群中白内障盲的患病率和白内障手术覆盖率及其术后效果。方法2003年7～12月,采用整体随机分层抽样法在陕西省洋县、靖边县和富平县调查8500人,其中≥50岁人群2213人,所有受检人员均进行标准问卷调查及详细的眼科检查。视力检查使用LogMAR视力表分别对每只眼进行测量,晶状体混浊使用LOCSIII进行评价。结果≥50岁人群双眼盲和双眼低视力的患病率为2.1%,3.2%,其中女性患病率均高于男性(P<0.05)。由白内障造成的视力损伤患病率为6.9%,其中50岁人群中白内障造成的视力损伤患病率为2.4%,70岁人群则上升到17.9%,随着年龄的增加,患病率明显上升(P<0.01)。该人群中双眼视力<0.1的白内障手术负荷量为2.3%,手术覆盖率为37.0%,白内障盲的社会负担率为3.1%。在25只白内障手术眼中,实施ICCE手术眼10只,ECCE手术眼15只,无PHACO手术眼。其中ICCE术后矫正视力>0.3的占40.0%,ECCE术后矫正视力>0.3占53.3%。结论陕西省农村老年人群中由白内障造成的视力损伤还是一个比较严重的问题。该人群中白内障手术覆盖率还比较低,白内障术后效果没有达到病人的预期目标。     

陕西省农村50岁以上人群白内障和盲的患病率调查

目的:调查陕西省农村50岁以上老年人群中白内障的患病率,并评价由白内障造成视力损伤的情况.方法:2003-07/12,采用整体随机分层抽样法在陕西省洋县、靖边县和富平县调查8 500人,其中≥50岁人群2 213人.所有受检人员均进行标准问卷调查及详细的眼科检查.视力检查使用LogMAR视力表分别对每只眼进行测量,晶状体混浊使用国内标准在裂隙灯下进行评价.结果:1 775人接受了检查,应答率为80.2%,50岁以上人群白障患病率为37.2%,男性白内障患病率为28.6%,女性白障患病率为44.3%,男性患病率低于女性(P＜0.01),50岁人群白内障患病率为17.9%,70岁以上人群则上升到82.4%,白内障的患病率随着年龄增长而明显上升(P＜0.01).其中皮质性白内障患病率为34.5%,核性白内障为9.2%,后囊下白内障为6.7%.在1 775名受检者中,20人在检查前实施了白内障手术.该人群中双眼盲和双眼低视力的患病率分别为2.1%和3.2%,由白内障造成的双眼盲、单眼盲、双眼低视力、单眼低视力分别占56.8%,68.8%,38.6%,73.8%.结论:调查结果表明白内障在陕西省农村还是一个比较严重的公众健康问题.白内障手术在农村地区实施的情况还很低.白内障是造成视力损伤的最主要原因.     

广西合浦县白内障致盲及低视力的调查

目的调查广西合浦县白内障致盲及低视力的患病率及白内障手术负荷量。方法 2006年对广西合浦县4个乡镇8个自然小区人群进行检查。双眼视力〈0.05者为白内障盲人,〈0.3者为白内障低视力患者,〈0.1者为白内障手术对象。结果调查人群3270人,实检人数2800人,受检率为85.6%。白内障致盲率为1.89%,低视力患病率为2.71%,白内障手术负荷量为2.18%。结论广西合浦县白内障致盲率及低视力患病率较高,白内障手术复明是目前防盲治盲的首要任务。     

广东省梅县盲和低视力流行病学调查

目的 调查梅县盲及低视力的流行病学情况。方法 采用分层随机抽样原因,以世界卫生组织盲目分级为标准,对全县按2.01%抽样比例抽取11327例进行盲和低视力的流行病学调查。结果 双眼盲及低视力患病率分别为0.47%（男性0.30%,女性0.63%）和0.89%（男性0.66%,女性1.12%）;双眼盲率：县城0.29%、附城郊区0.34%、山区0.56%。单眼盲、双眼低视力和单眼低视力的患病率分别为0.72%、0.89%和0.59%。≥50岁盲及低视力患者的患病率明显增高。结论 致盲和致低视力的眼病均以白内障居首位,其次为青光眼、屈光不正、弱视及翼状胬肉等。     

广州市萝岗区盲与低视力流行病学调查

目的 调查广州市萝岗区年龄≥50岁人群盲与低视力的患病率及主要致病原因.方法 采用整群抽样方法 ,按世界卫生组织盲与低视力分类标准,对广州市萝岗区50岁及以上人群进行问卷调查,视力检测初筛后对针孔镜下视力低于0.3者,由眼科医师做视功能、眼前后节形态检查及主要致盲原闪诊断.结果 共录入人数4532人,实际受检4126人,受检率91.04%.其中双眼肓患病率为1.91%,单眼盲患病率5.96%,双眼低视力患病率8.41%.随着年龄增加,盲与低视力患病率明显升高.70岁年龄组双眼肓是50岁年龄组的25.5倍,差异具有统计学意义(P<0.01).在盲与低视力人群中致病原因的前几位依次是白内障(47.9%),眼底病(20.4%),屈光不正(9.52%),角膜病(7.59%).另外,脑垂体瘤致盲占0.74%.结论 广州市萝岗区≥50岁老年人群盲与低视力的首要原因为白内障,故降低自内障的患病率是该地区防旨治盲的关键,另外眼底病在该地区也是重点防治的疾病.     

四川省米易县攀莲镇眼病筛查及扫盲情况调查与分析

目的：通过本次筛查了解四川省米易县攀莲镇眼病分布的现状,为今后的防盲治盲工作提供可靠数据。

方法：对2013年米易县攀莲镇地区60岁以上、视力低于0.3的老年人共227例,集中行常规体格检查及眼科检查。对术前各个指标合格,排除其他眼病所致白内障且晶状体核达Ⅳ级者42例42眼,行单眼“白内障囊外摘除联合人工晶状体植入术”,观察术后第1d视力及眼科情况。

结果：2013年米易县攀莲镇低视力老年人群中,白内障患病率为81.06%,其中老年性白内障患病率为69.60%,并发性白内障患病率8.81%,代谢性白内障患病率为3.52%,其他引发低视力眼病患病率15.06%。选取42例42眼行手术治疗,术后脱盲率达100%。

结论：应在继续加强老年性白内障宣传的同时,加强可引发白内障其他眼病及内科疾病的防治知识,提高门诊诊断率,改进白内障手术方式,从而更好地开展好米易县乡镇的防盲治盲工作。     

沙湾县45岁及以上人群盲与低视力流行病学调查与治疗

目的调查新疆沙湾县≥45岁人群中盲与低视力患病率及致盲原因。方法采用分层整群随机抽样法,抽取8个基本抽样单位内的1322例≥45岁的患者作为调查对象。采用WHO盲与低视力标准由眼科医生作外眼、前房、晶状体、眼底等检查,对所有视力<03的患眼进行主要眼病原因诊断。结果1322列中受检1208例,总受检率9134%,盲目患病率为141%。低视力患病率为339%,致盲的主要眼病依次为白内障(4634%)、角膜病(1707%)、青光眼(976%)、玻璃体视网膜病(1463%)等。结论白内障仍占致盲和低视力病因的首位,今后防盲治盲的重点应是白内障的手术复明。     

安徽省两地人群盲和低视力及眼病的流行病学抽样调查（一）

目的方法结果结论对安徽省两地人群盲和低视力及眼病的流行病学情况进行抽样调查。选择阜阳市颍州区和宣城市绩溪县,采用随机整体抽样方法,对所属居民进行眼部及其他情况的调查。两地的受检人数和受检率分别为3336人（91.40%）和3602人（92.10%）,达到抽样调查要求;两地双眼盲、单眼盲、双眼低视力和单眼低视力的患病率分别为1.05%和0.69%、1.71%和1.25%、1.02%和0.97%、0.87%和0.89%;两地盲和低视力的主要原因分别为：白内障、弱视、青光眼和白内障、眼球萎缩/缺如、青光眼;两地主要眼病都为：屈光不正、白内障、翼状胬肉和沙眼;两地的白内障手术率分别为600和278。据不完全资料估计我省盲和低视力的患病率远高于全国平均水平,盲和低视力的高发人群为50岁以上老年人,女性,孤寡,文盲,低收入者,白内障仍是最主要致盲原因,屈光不正/弱视已日益成为影响人民特别是青少年视力的最主要因素,广泛宣传正确用眼方式,推广青少年正确验光配镜方法,提高相关人员验光配镜水平对于有效降低弱视致残率至关重要。     

天津蓟县桑梓村40岁及以上人群白内障患病率调查

目的　调查天津蓟县桑梓村 40岁以上白内障患病率、白内障致盲率及白内障手术负荷量。方法　 2 0 0 3年 1～ 3月 ,对天津蓟县桑梓村 40岁以上人群进行白内障的检查 ,白内障患者定义为至少 1只眼晶状体混浊并致视力 <0 7者 ,其中双眼视力 <0 0 5者为白内障盲人 ,双眼视力 <0 1者为白内障手术对象。结果　≥ 40岁人群共 1987人 ,1776人接受了检查 ,受检率为 89 3 8%。白内障患病率为 16 5 5 % ,白内障致盲率为 0 84% ,白内障手术负荷量为 2 0 3 %。结论　目前农村白内障致盲率仍较高 ,高质量增加白内障复明手术是防盲治盲的首要任务。     

上海奉贤东部地区65岁以上人群白内障患病率及手术现状分析

目的：分析上海奉贤东部地区65岁以上人群白内障患病率及手术现状。

方法：采用整体随机分层抽样方法。2015-01/12期间在奉贤东区四团镇、奉城镇对>65岁人群3 050名进行调查,采用统一眼科检查和问卷调查,其中眼科检查主要包括眼部裂隙灯显微镜检查和LogMAR视力表,了解接受白内障手术情况。

结果：受检者3 050名中,发现白内障1 244例,患病率为40.79%; 不同年龄的受检者患病率不同,随着年龄的增长,患病率不断升高。年龄组患病率差异有统计学意义(χ²=558.6,P<0.001); 男性和女性的患病率分别是31.06%和49.94%,差异具有统计学意义(χ²=112.4,P<0.001); 文盲(52.04%)与非文盲(38.76%)相比,差异有统计学意义(χ²=28.78,P<0.001)。接受白内障手术的患者为765例,手术覆盖率为61.25%; 年龄、性别差异不具有统计学意义,文化程度方面：非文盲盲人手术覆盖率明显远高于文盲的,差异具有统计学意义(χ²=39.72,P<0.001)。术后矫正视力≥0.3为脱残,术后矫正视力≥0.05为脱盲,脱残率为71.50%,脱盲率为95.29%,765只手术眼中,术后共29眼出现并发症,占总手术眼的3.79%。

结论：白内障是老年人常见的主要致盲眼病,上海奉贤东部地区老年人白内障患病率较高,虽近几年开展白内障复明工程以来,手术覆盖率有了一定提高,防治白内障仍然是防盲致盲工作的首要任务。     

Population-based assessment of the outcome of cataract surgery in an urban population in southern India

PURPOSE: To assess the outcome of cataract surgery in an urban population in southern India. METHODS: As part of a population-based cross-sectional epidemiologic study, the Andhra Pradesh Eye Disease Study, 2,522 people of all ages, including 1,399 individuals 30 years of age or older, from 24 clusters representative of the population of Hyderabad in southern India underwent a detailed interview and ocular evaluation including logarithm of minimal angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, dilation, cataract grading, aphakia/pseudophakia status, and stereoscopic fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were performed when indicated by standardized criteria. Very poor outcome in an eye that had undergone cataract surgery was defined as presenting distance visual acuity worse than 20/200, and poor outcome was defined as visual acuity worse than 20/60 to 20/200. RESULTS: In subjects 50 years of age or older, after adjustment for age and sex distribution, the rate of having had cataract surgery in one or both eyes was 14.6% (95% confidence interval [CI], 11.4% to 17.8%). Of 131 eyes (91 subjects) that had undergone cataract surgery, 28 (21.4%; 95% CI, 14.4% to 28.4%) had very poor outcome and another 40 (30.5%; 95% CI, 22.6% to 38.4%) had poor outcome. The very poor outcome in 20 (71.4%) of 28 eyes and poor outcome in 23 (57.5%) of 40 eyes could be attributed to surgery-related causes or inadequate refractive correction. With multivariate analysis, very poor outcome as a result of surgery-related causes or inadequate refractive correction was more likely to be associated with intracapsular cataract extraction than with extracapsular cataract extraction (odds ratio, 9.34; 95% CI, 2.49 to 35.06) in subjects belonging to the lowest socioeconomic status (odds ratio, 4.92; 95% CI, 1.16 to 20.93) and with date of surgery 3 or fewer years before the survey than with more than 3 years (odds ratio, 4.52; 95% CI, 1.33 to 15.39). Also, very poor or poor outcome as a result of surgery-related causes or inadequate refractive correction was associated with women (odds ratio, 2.55; 95% CI, 1.06 to 6.16). CONCLUSIONS: The very high rate of very poor and poor visual outcome, predominantly as a result of surgery-related causes and inadequate refractive correction, in this urban population of India suggests that more attention is needed to improve the visual outcome of cataract surgery. In order to deal with cataract-related visual impairment in India, as much emphasis on surgical quality, refractive correction, and follow-up care is necessary as on the number of surgeries.     

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review

Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.     

Cataract surgical reach: Falling short to catch white cataracts!

Purpose:The aim of this study was to know proportion of white cataracts from among patients coming for cataract surgery, and to find causes delaying uptake of cataract surgery.Methods:A hospital-based, prospective study enrolled patients of senile cataract between April 2018 and March 2019. The proportion of white cataract was calculated and underlying causes delaying uptake of cataract surgery studied.Results:White cataracts constituted 13.5% of total 3634 senile cataract patients, with gender disparity disfavoring women. Bilateral white cataract was presentation in 39 (8%) patients and lens-related glaucoma in 24 (5%) patients. Pseudophakia in the other eye was single most common cause of delay.Conclusion:A large proportion of white cataracts suggest that penetration of cataract surgical services in not reaching to the most eligible individual.     

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。     

Congenital Anterior Polar Cataract: A Review of 63 Cases

Sixty-three patients with congenital anterior polar cataracts seen over a period of 15 years at The Children's Hospital, Boston, were reviewed to determine their clinical course and visual outcome. Over one-third of the patients were found to have strabismus, refractive anisometropia, or some form of amblyopia. Seven other patients had additional ocular pathology which affected their visual prognosis. One patient manifested progressive lens opacification that eventually warranted cataract surgery. These findings suggest a less benign prognosis for congenital anterior polar cataracts than has generally been described. In our series early ophthalmological examination did not always allow us to forecast later visual disability. We therefore recommend regular follow-up of all children with anterior polar cataracts until a secure assessment of vision can be made.     

发展中国家白内障手术的现状

随着人口的老龄化白内障的发病率也在升高,白内障已经成为发展中国家最常见的致盲眼病,在发展中国家中,盲和视觉损伤已经成为严重的公共卫生、社会和经济问题。虽然白内障手术是最具有成本效益的干预方式,但在发展中国家提供白内障手术服务仍存在很多问题和挑战,在过去10a中一些国家在治疗白内障时采用手法小切口白内障摘除术这种手术方式并取得了较好的效果。另外,制定不同的可持续发展的防盲模式在这些发展中国家也是一个挑战。本文就近年发展中国家的白内障手术情况做一综述。     

Phacoemulsification in posterior polar cataract: does size of lens opacity affect surgical outcome?

Background: To study the effect of size of the posterior polar opacity on surgical and visual outcome of phacoemulsification in posterior polar cataract. Setting: Post Graduate Institute of Medical Education and Research, Chandigarh, India. Methods: Consecutive patients with posterior polar cataract who underwent phacoemulsification were analysed for intraoperative complications and postoperative outcome. The continuous curvilinear capsulorhexis size was kept approximately 5.5 mm, and hydrodelineation was done instead of hydrodissection. Results: There were 58 eyes of 51 patients who underwent phacoemulsification for posterior polar cataract. The mean follow‐up time was 15.4 months (range 12–40 months). Twenty‐three eyes had size of polar opacities 4 mm or more in diameter whereas 35 eyes had less than 4 mm. Posterior capsule rupture occurred in nine eyes (15.51%). In eyes with polar opacities 4 mm or more, seven (30.43%) had posterior capsule rupture whereas in eyes with less than 4 mm size, only two (5.71%) had posterior capsule rupture. Capsular bag placement of intraocular lens (IOL) was achieved in 50 eyes and sulcus‐sulcus in eight eyes. Three‐piece hydrophobic acrylic IOL was implanted in 47 eyes and all polymethylmethacrylate IOL in 11 eyes. Postoperatively best‐corrected visual acuity of 6/12 or better was achieved in 55 eyes (94.8%) and three eyes achieved 6/24 or less. Conclusion: Phacoemulsification in eyes with larger size of polar opacity has significant risk of posterior capsule rupture.     

Perinatal cataract of the rat I. Development, influence of temperature, ultrastructure

The transparency of the lens was studied in rats from 4 days before birth to 24 days after birth both in situ and after isolating the lens. It was observed that in the isolated lens, left at room temperature of 21–22°C, a cataract developed from 3 days before birth to 23 days after birth. In situ the presence of the cataract was detected from 1 day before birth to 11 days after birth. After producing a cataract in lenses in situ by lowering eye temperature, it was possible to demonstrate that in each developmental stage, there was a minimal temperature necessary to maintain the transparency of the lens. The simultaneous study of the body and ocular temperature of developing rats showed that at day 11 the ocular temperature was similar to the minimal temperature necessary to maintain the transparency of the lens. This could explain why after day 11 there is no cataract in situ in spite of the fact that it can still be induced in the lens by lowering the temperature. In mice on the contrary, it was not possible to observe cataracts in situ although they could be produced by lowering eye temperature. The explanation for this finding is that the ocular temperature in this species is at all ages above the minimum temperature needed for the maintenance of a transparent lens. The opacity of the lens produced by lowering the temperature has different morphological configurations depending on the developmental stage studied. The ultrastructural analysis indicated that in the opaque areas the homogeneous structure of the fibers characteristic of transparent zones is altered by the presence of electron opaque areas which vary in size, shape and density. These electron dense regions seem to correspond to the precipitation of granular cytoplasmic components of lens fibers and have also been observed in other forms of cataracts. These electron opaque areas are not observed when the lens is fixed at the minimum temperature needed for the maintenance of lens transparency.     

白内障术后感染性眼内炎治疗11例

目的探讨白内障术后感染性眼内炎相关因素及治疗方法。方法对我院1999年11月至2005年10月11例11眼白内障术后感染性眼内炎进行回顾性分析。结果7眼细菌培养阳性，培养细菌包括：表皮葡萄球菌2眼，粪肠球菌1眼，催产克雷白菌1眼，腐生葡萄球菌1眼，异型枸橼酸杆菌1眼，醋酸不动杆菌1眼。行后部玻璃体切割术者5眼，其中眼球摘除1眼；单纯前房冲洗加注药2眼；前房冲洗注药联合玻璃体腔注药4眼。结论前房和玻璃体注药，后部玻璃体切割术是治疗的有效方法。