两种单焦点人工晶状体经睫状体平坦部巩膜缝线固定术后视觉质量的比较

目的: 探究2种不同类型单焦点人工晶状体(IOL)经睫状体平坦部巩膜缝线固定术后视觉质量的差异。方法: 回顾性系列病例研究。选取2019年6月至2020年6月就诊于潍坊眼科医院因外伤导致无法囊袋内植入IOL的患者42例(42眼), 所有患者均接受二期经睫状体平坦部IOL巩膜缝线固定术, 其中植入Zeiss CT Lucia 601PY单焦点后房型IOL 25例(25眼)作为601PY组;植入AQBH单焦点后房型IOL 17例(17眼)作为AQ组。术后随访6～12个月, 观察2组患者手术前后的最佳矫正视力(BCVA)、调制传递函数截止频率(MTF cutoff)、客观散射指数(OSI)、等效球镜度(SE)等差异。数据采用Mann-WhitneyU秩和检验、独立样本t检验进行分析。结果: 601PY组、AQ组患者手术前、后BCVA差异均无统计学意义(Z=-1.39, P=0.164;Z=-0.36, P=0.721)。2组术后BCVA差异无统计学意义(Z=-1.24, P=0.215)。2组术后MTF cutoff、OSI值差异有统计学意义(t=2.15, P=0.043;t=-2.22,...     

多焦点与单焦点人工晶状体植入术后视觉质量的临床研究

目的:评价多焦点人工晶状体与单焦点人工晶状体植入术后患者的视觉质量。方法:前瞻性研究2018年11月至2019年10月在山西省眼科医院就诊的年龄相关性白内障62例(102只眼),患者随机分为两组：多焦点组,40例(66只眼),植入SN6AD1阶梯渐进性衍射非球面多焦点人工晶状体;单焦点组,22例(36只眼),植入SN6...     

儿童经巩膜后房型人工晶状体缝线固定术后感染性眼内炎的临床分析

目的 分析儿童经巩膜后房型人工晶状体缝线固定术后感染性眼内炎的临床表现。方法 回顾性病例研究。对2017年12月至2019年12月本院收治的10例(10只眼)经巩膜后房型人工晶状体缝线固定术后感染性眼内炎患儿的临床资料进行分析。观察其发病特征、治疗方法、治疗前后最佳矫正视力(BCVA)等情况。结果10例患儿中8例出现不同程度的巩膜缝线暴露情况,所有患儿均接受玻璃体内注射抗生素。感染严重的患者行玻璃体切除术,5例患儿接受单纯玻璃体切除术,2例玻璃体切除联合硅油填充及1例联合气体填充。术后随访12个月,8例患儿术后视力提高,1例视力无改善,1例患儿视力下降。患儿治疗后BCVA明显提高,差异有统计学意义(P <0.05)。结论 线结暴露是引起儿童经巩膜后房型人工晶状体缝线固定术后感染性眼内炎的重要原因,严格处理手术细节,开发改良手术方式,对于预防此类眼内炎的发生具有重要意义。     

两焦点与三焦点人工晶状体植入术后视觉质量的比较

目的:比较两焦点(AT LISA 809MP)和三焦点(AT LISA tri 839MP)IOL植入术后的视觉质量。方法:回顾性研究。共收集2018-03/2019-02行超声乳化吸除术联合多焦点IOL植入术的白内障患者28例49眼。两焦点组18例30眼,年龄40~85(平均67.08±10.80)岁。三焦点组10例19眼,年龄38~79(平均62.21±14.50)岁。所有患者均行视觉质量分析系统(OQAS)、离焦曲线等检查。结果:两焦点组近BCVA优于三焦点,三焦点组中UCVA和远BCVA均优于两焦点组(P<0.05)。三焦点组+1.5、-1.0、-1.5、-2.0、-2.5、-3.0D视力显著优于两焦点组。两组间OQAS视觉质量参数两焦点组OV 20%、OV 9%、SR均优于三焦点组(P<0.05)。结论:两焦点和三焦点IOL植入术后均可获得良好的裸眼远和近视力,视觉质量均较高,而三焦点IOL可获得更佳的中间视力。     

后房型人工晶体巩膜缝线固定术

报告一种后房型人工晶体（ＰＣＩＯＬｓ）睫状沟植入技术。７０眼（７０例）行穿透巩膜的ＰＣＩＯＬｓ缝线固定术,术后随访６￣３６个月（平均１８个月）。术前视力ＣＦ￣０．１。术后４３眼（６１．５％）视力增进至０．４￣０．６,７眼（１０％）至０．７￣１．０,很少有并发症发生。介绍了手术方法及术中注意事项,该手术的开展使ＰＣＩＯＬｓ。植入几可以应用于所有白内障摘除术眼。     

后房型人工晶体巩膜缝线固定术

本研究主要探索白内障囊内摘除术后或白内障囊外伴后囊破损者，采用巩膜缝线固定技术植入后房型人工晶体的临床效果及并发症。２３例（２３眼），１３眼为白内障囊内摘除无晶体眼，１０眼为白内障囊外摘除术后后囊破裂或外伤性白内障后囊不完整，用巩膜缝线固定晶体襻技术植入后房型人工晶体。本组病例随访３－１６个月（平均８．３个月），视力在４．７（０．５）以上者２１眼，５．０（１．０）以上者１３眼，未发现严重手术并发症     

四点式后房型人工晶状体巩膜缝线固定术的临床应用

目的:探讨四点式经巩膜缝线固定人工晶状体植入的临床应用及效果。方法:对20例20眼各种原因致后囊不完整的无晶状体眼及晶状体脱位患者行白内障手术联合四点式经巩膜缝线悬吊术植入四襻人工晶状体,其中一期植入15眼,二期植入5眼,随访2～6mo。结果:患者术眼术后裸眼视力和矫正视力均达到或超过术前矫正视力,其中0.2～者2眼(10%),0.5～者10眼(50%),≥1.0者7眼(35%),≤0.12者1眼(5%),术后患者人工晶状体位置均未发生偏移。结论:四点式经巩膜缝线固定的人工晶状体悬吊术是后囊不完整的无晶状体眼和晶状体脱位患者人工晶状体植入的一项有效措施,手术安全,术后并发症少,保证了最佳矫正视力。     

无巩膜瓣后房型人工晶状体缝线固定术的临床观察

目的评价无巩膜瓣后房型人工晶状体(IOL)双襻固定术的技巧及效果。方法对20例(20眼)因各种原因致晶状体后囊膜破裂较大或囊膜完全缺损而不能行囊袋内或前囊膜睫状沟IOL植入患者,用无巩膜瓣的"W"形巩膜层间缝合技术固定双襻后房型IOL,术后随访3～18个月,观察临床效果及术中、术后并发症。结果术后视力≥0.5者8眼(40%),0.3～0.5者8眼(40%),0.15～0.3者4眼(20%);术中、术后并发症:玻璃体出血1例,低眼压2例,IOL偏移2例。结论无巩膜瓣的"W"形巩膜层间缝合技术固定双襻后房型IOL操作简单,术中、术后并发症少,值得临床推广。     

无后囊不缝线后房型人工晶状体巩膜层间固定术

目的 研究无后囊支持的后房型人工晶状体不缝线巩膜层间固定的方法及应用价值。方法 ２３例无后囊支持患者,将人工晶状体两袢不缝线而固定于水平位置的巩膜层间,随访１０～３４月,平均１６．６月。结果 视力≥０．５者１９眼（８２．６％）。术后高眼压６眼,前房出血１眼,１周内消退,视网膜脱离１眼,人工晶状体位置均良好,固定切口无渗漏。结论 该术式简便经济,能减少并发症,人工晶状体位置稳定。     

后房型折叠人工晶状体缝线固定术

目的探讨后房型折叠人工晶状体缝线固定术的临床效果。方法选取自2011年5月至2013年3月期间26例（26只眼）患者,均采用巩膜隧道切口联合持续灌注,无巩膜瓣经巩膜睫状体平坦部缝线三点式固定后房型折叠式人工晶状体。结果26例（26只眼）手术均获成功,术中术后无明显并发症,术后随访3～10个月,视力恢复〉0．3者16例（61．5％）。结论此术式是一种安全有效、视力恢复满意的治疗方法,可获得好的临床效果。     

玻璃体切割术后IOL混浊病例的临床与实验研究

目的：探讨玻璃体切割术（PPV）后人工晶状体（IOL）混浊的病例特点及相关危险因素。方法：回顾性研究。连续纳入2007年2月至2022年2月在山东第一医科大学附属青岛眼科医院发现的全部PPV 术后出现IOL混浊的病例资料11例,选取其中2枚取出且保存良好的IOL进行体外光镜、扫描电镜、激光共聚焦显微镜检测以及能谱分析。结果：11例患者年龄为23~76（63.3±15.0）岁,发现IOL混浊与PPV间隔时间为24~180（82.2±45.7）个月。11例患者中8例有视网膜光凝史,5例有眼内硅油/气体注入手术史,1例有青光眼手术史。11例患者中糖尿病6例,高血压5例。患者所用IOL类型及临床处置情况分别为：9例（9/11）为亲水性丙烯酸酯,型号分别为860UV（1例,已取出）、Akreos AdaptAO（2例,已取出1例）和具有疏水涂层的亲水性L-312（6例,已取出4例）;另外2例（2/11）为疏水性丙烯酸酯MA60MA（未取出）。2枚混浊的IOL检测情况如下：第1枚是860UV型IOL,混浊部位主要集中于光学部前表面,光镜及扫描电镜下呈弥漫、凹凸不平蚯蚓状、地嵴状,襻部及周边未见明显沉积物;激光共聚焦显微镜显示混浊主要集中在前浅层,深度大约为IOL整体厚度的前6.9%;能谱分析显示,按元素组成比例高低排列为碳、氧、钙、磷、硅和镁元素。第2枚是Akreos Adapt AO型 IOL,混浊主要处于光学区中央,光镜及扫描电镜下呈粗糙、小圆形的砂粒,襻部也散在累及,呈较为致密的砂粒状;共聚焦显微镜显示混浊区域更深,大约为IOL整体厚度的前12.5%;能谱分析显示,按元素组成比例高低排列为碳、氧和硅元素。结论：PPV后不同类型丙烯酸酯IOL均有可能发生混浊,且IOL混浊的形态和表面沉积物各不相同。     

动态视力在白内障术后视觉获益评价中的应用

目的：评估白内障超声乳化联合人工晶状体（IOL）植入术后动态视力（DVA）获益。方法：前瞻性队列研究。2012 年5 月至2013 年8 月于北京大学第三医院行双眼白内障手术的年龄相关性白内障患者23例（46眼）为白内障组,健康中老年人26例（52眼）为对照组。术前及术后1个月,检查视标速度为15、30、60、90 dps的DVA,1.5、3、6、12、18 cpd的对比敏感度（CS）。计量资料比较采用t检验及秩和检验,Pearson相关分析DVA获益与CS获益的相关性。结果：术后,患者15、30、60、90 dps各速度DVA较术前提高,差异有统计学意义（Z=-4.110、-4.109、-4.110、-4.110,P < 0.001）。各速度DVA获益均高于静态视力（SVA）获益（t=-3.596、-5.304、-6.220、-6.170,P < 0.01）。SVA及DVA获益与低频CS获益相关（rSVA~1.5 cpd=0.780,rSVA~3 cpd=0.839,r15 dps~1.5 cpd=0.746,r15 dps~3 cpd=0.692,r30 dps~1.5 cpd=0.775,r30 dps~3 cpd=0.719,r60 dps~1.5 cpd=0.718,r60 dps~3 cpd=0.590,r90 dps~1.5 cpd=0.636,r90 dps~3 cpd=0.561;P < 0.01）;中速DVA获益与中频CS获益相关（r30 dps~12 cpd=0.537,r60 dps~12 cpd=0.554;P < 0.01）;高速DVA获益与中高频CS获益相关（r90 dps~12 cpd=0.562,r90 dps~18 cpd=0.542;P < 0.01）。结论：白内障手术可有效重建DVA,DVA获益与CS获益存在频率依赖的相关性。     

Clinical Outcomes after Combined Ahmed Glaucoma Valve Implantation and Penetrating Keratoplasty or Pars Plana Vitrectomy

Purpose

To evaluate whether a combination of penetrating keratoplasty (PKP) or pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation affords a level of success similar to that of AGV implantation alone.

Methods

Eighteen eyes underwent simultaneous PPV and AGV, 14 eyes with PKP and AGV and 30 eyes with AGV implantation alone were evaluated. Success was defined as attainment of an intraocular pressure (IOP) >5 and <22 mmHg, with or without use of anti-glaucoma medication. Kaplan-Meier survival analysis was performed to compare cumulative survival between the combined surgery groups and the AGV implantation-alone group. Cox proportional hazard regression analysis was conducted to identify factors predictive of success in each of the three groups.

Results

Mean (±standard deviation) preoperative IOP was 30.2 ± 10.2 mmHg in the PKP + AGV, 35.2 ± 9.8 mmHg in the PPV + AGV, and 36.2 ± 10.1 mmHg in the AGV implantation-alone group. The cumulative success rate at 18 months was 66.9%, 73.2%, and 70.8% in the three groups, respectively. Neither combined surgery group differed significantly in terms of cumulative success rate compared with the AGV implantation-alone group (p = 0.556, p = 0.487, respectively). The mean number of preoperative anti-glaucoma medications prescribed was significantly associated with success in the PKP + AGV implantation group (hazard ratio, 2.942; p = 0.024).

Conclusions

Either PKP or PPV performed in conjunction with AGV implantation afforded similar success rates compared to patients treated with AGV implantation alone. Therefore, in patients with refractory glaucoma who have underlying corneal or retinal pathology requiring treatment with PKP or PPV, AGV implantation can be performed simultaneously.     

SMILE术后不同瞳孔直径下视觉质量的比较

目的：:探讨近视患者飞秒激光小切口角膜基质透镜取出术（SMILE）后在4 mm和7 mm瞳孔直径下视觉质量变化及其影响因素。方法：:前瞻性临床研究。选取2019年2-5月在中南大学湘雅医院行SMILE的近视和近视散光患者46例,年龄18～36岁,均选择右眼数据用于统计。采用欧卡斯视觉质量分析系统测量术眼在4 mm和7 ...     

The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Purpose

To investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment.

Methods

We retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded.

Results

Postoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker.

Conclusions

In our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.     

A Comparative Study on Surgical Outcomes of Glued Intraocular Lens and Sutured Scleral Fixated Intraocular Lens Implantation

Purpose: To compare the surgical outcomes of glued intraocular lens (GIOL) and sutured scleral fixated intraocular lens (SFIOL) implantation. Methods: A retrospective, interventional case series of 60 patients (68 eyes) who underwent GIOL (28 eyes: 11 primary; 17 secondary) and SFIOL (40 eyes: 24 primary; 16 secondary) in a tertiary eye care institute was done. The main outcome measures were complications, time taken for surgery, postoperative refractive outcomes, and final best-corrected visual acuity (BCVA). Results: The mean final BCVA was 0.42 (20/40) (+/– SD 0.29) in the GIOL group and 0.57 (20/50) (+/– SD 0.48) in the SFIOL group (p=0.08). The time taken for primary GIOL (mean+/– SD: 66+/–19 minutes) was significantly lower than primary SFIOL (means+/–SD: 94+/–34 minutes) (p=0.006). The complications were comparable between the GIOL (25%) and SFIOL (15%) groups (p=0.30). The most common complication noted was transient vitreous hemorrhage (GIOL 17%, SFIOL 5%). The only sight-threatening complication seen was retinal detachment, with one eye in each group. The mean follow-up was 20 (GIOL) and 20.4 weeks (SFIOL). Conclusion: Both glued intraocular lens and sutured scleral fixated intraocular lens are safe and effective procedures in cases of insufficient capsular support. In view of the shorter surgical time with similar outcomes, primary GIOL can be considered as a preferred surgical option over primary SFIOL.     

三种人工晶状体植入术后静态视力和动态视力的评估及比较

目的：对三焦点、双焦点及连续视程人工晶状体植入术后的单眼视力和动态视力（DVA）进行评估及比较。方法：前瞻性临床研究。选取2020年1月至2021年1月于重庆医科大学附属第一医院眼科行白内障超声乳化摘除联合人工晶状体植入且资料完整的白内障患者65例（81眼）。根据所选择的IOL 类型分为3组：双焦点组33眼,植入Tecnis ZMB00 IOL;三焦点组20眼,植入AT Lisatri.839MP IOL;EDOF组28眼,植入Tecnis ZXR00 IOL。术后3个月分别检测每眼的裸眼静态视力（SVA）：包括裸眼远视力（UDVA）、裸眼中视力（UIVA）、裸眼近视力（UNVA）（LogMAR视力）。采用运动视标法检测裸眼DVA（检测速度分别为4、8、12、24fps）：包括裸眼动态远视力（UDDVA)、裸眼动态中视力（UIDVA）、裸眼动态近视力（UNVA）（LogMAR视力）,并进行评估比较。通过“手抓尺子试验”检测患者反应速度。数据采用卡方检验、方差分析、Kruskal-WallisH检验进行统计分析。结果：3组的总体UDVA、UNVA差异均无统计学意义;3组的总体UIVA差异有统计学意义（H=23.13,P<0.001）,进一步两两比较发现EDOF组优于双焦点组（P<0.001）;三焦点组优于双焦点组（P=0.016）;EDOF 组与三焦点组差异无统计学意义。3组的总体UDDVA在4、8fps时差异均无统计学意义;而在12、24fps时总体差异均有统计学意义（H=10.96,P=0.004;H=11.52,P=0.003）,进一步比较发现双焦点组优于三焦点组（H=-16.21,P=0.003;H=-17.98,P=0.004）,EDOF组优于三焦点组（H=-12.67,P=0.030;H=-16.48,P=0.009）,双焦点组与EDOF组差异无统计学意义。3组的总体UIDVA在8fps 时差异无统计学意义,而在4、12、24fps时差异均有统计学意义（H=8.17~11.36,P<0.05）：4、12fps 时,EDOF组优于双焦点组（H=14.61,P=0.013;H=14.52,P=0.009）,与三焦点组差异无统计学意义;24fps时,EDOF组优于双焦点组、三焦点组（H=15.31,P=0.008;H=-16.60,P=0.027）。3组的总体UNDVA在4、8、12、24fps时差异均有统计学意义（H=11.25~17.61,P<0.05）,且EDOF组均分别优于双焦点组（H=12.71~17.87,P<0.05）和三焦点组（H=-23.04~-15.87,P<0.05）,双焦点组与三焦点组差异均无统计学意义（均P>0.05）。结论：在SVA方面,三焦点IOL及EDOFIOL均可获得较好的UDVA、UIVA、UNVA,而双焦点IOL的UIVA较弱。在DVA方面,远距离、低速度时,3种IOL结果相当;但是近距离、高速度时,EDOFIOL的DVA较其余二者更佳。     

The Comparative Development of Movement Hyperacuity and Visual Acuity in Children

Oscillatory movement displacement thresholds (OMDT) have been suggested as a test of neural integrity of the visual system, detecting deficit even in the presence of normal resolution. Both OMDT and visual resolution were measured in 153 normal children between the ages of 2.2 and 13 yr (mean = 6.2 ± 2.8 yr). OMDT were obtained using a computer-generated vertical bar stimulus oscillating at 4 Hz. Visual acuity was determined using a Polymetric Vision Assessment technique (PVA) where a single letter optotype is presented at increasing viewing distance to determine threshold.OMDT is a hyperacuity at all ages, exhibiting improving thresholds up to around 8 yr of age when results are typical of adults. PVA thresholds improve less markedly over the range measured, appearing mature by 6–7 yr. Correlation between OMDT hyperacuity and visual acuity is poor, illustrating the complexity of the relationship between hyperacuity and resolution functions. Copyright © 1996 Elsevier Science Ltd