儿童白内障人工晶体植入术后双眼视功能恢复情况的研究

目的：评价儿童白内障人工晶体植入术后双眼视功能的恢复情况。方法：对60例14岁以下儿童白内障人工晶体植入术后视功能恢复情况进行回顾性研究。将病人分为单眼先天性白内障、单眼外伤性白内障和双眼先天性白内障三组,随访时间为术后半年至3年半,对每位患者进行了最好矫正视力、眼位及双眼视功能检查。结果：60例病人最好矫正视力达到0．5以上的有33例（55％）,具有融合功能的有28例（47％）,达到≤200秒弧度立体视觉的只有15例（25％）,在三组病人中,单眼外伤性白内障的术后视力及双眼视功能恢复情况明显好于单眼先天性白内障。结论：儿童白内障人工晶体植入术后可以获得较满意的视力效果,但双眼视功能的恢复情况往往不理想。对儿童先天性白内障在视觉尚未发育成熟之前尽早进行手术、儿童外伤性白内障在伤后早期进行人工晶体植入,将有利于儿童白内障术后双眼视功能的恢复。     

白内障现代囊外摘除后房型人工晶体植入术316眼临床分析

1992年6月至lop年12月共施行白内障现代囊外摘除术（ECCE）316眼，其中联合后房型人工晶体植入术（IOL）168眼。占同期手术53呢，取得满意效果，现报告如下。临床资料：白内障住院病例视力0．02－0．08。年龄最小9岁，最大85岁，男170眼占53．7％，女146眼占46．1％。其中老年性白内障246眼占77．8％，外伤性白内障24眼占7．5％，并发性白内障38眼占12％，包括青光眼合并白内障16眼。先天性白内障8眼占2．5％。单眼手术288例，双眼手术14例。同期植入IOL159眼，Ⅱ期植入IOL9眼。本组对246例老年性白内障术前全身检查发现全身疾病164例…     

双眼同时人工晶状体植入术的报告

目的：观察双眼同时进行白内障摘出及人工晶状体植入的手术效果和风险情况。方法：47例双眼财时进行现代白内障囊外摘出及人工晶状体植入术，术后观察视力1眼内炎症等情况，并与同期单眼同样手术进行对照。结果：同时手术的双眼与单眼同样手术的眼之间在手术视力并发症方面差异均无显著性意义（P＞0．05）。结论：双眼白内障时行囊外摘出及人工晶状体植入术在临床上是安全的，但不主张向患者推荐双眼同时手术。     

人工晶状体植入治疗角膜穿孔外伤性白内障的临床研究

目的评价角膜穿孔伤合并外伤性白内障患者行，一期人工晶状体植入的疗效。方法对30例角膜穿孔合并外伤性白内障患者施行角膜清创缝合，一期人工晶状体植入，并对手术方法，时机、并发症，术后视力，双眼视觉进行研究。结果随访3～30月，平均8月。视力≥0．5者20眼，≤0．2者2眼。20例具有不同程度的双眼视觉。结论一期人工晶状体植入可使单眼角膜穿孔伤合并外伤性白内障患者获得良好的视力及双眼视觉。     

外伤性白内障手术时机的探讨

目的探讨如何选择外伤性白内障的手术时机。方法对常州市眼耳鼻咽喉科医院2002—2006年收治的外伤性白内障352例（354眼）进行回顾性分析，根据患者年龄、病情判断手术时机的选择。结果术后视力0．05以上（349眼）占98．59％，0．25以上占86．44％，0．5以上占76．55％，1．0以上占16．95％。结论准确掌握外伤性白内障手术时机，积极处理术中、术后并发症，即使是较复杂的外伤性白内障术后也能获得较好的视力，并有助于恢复双眼单视功能。     

外伤性白内障人工晶状体植入术时机的选择

目的：探讨外伤性白内障手术时机的选择。方法：21例单眼外伤性白内障，一期植入后房型人工晶状体19眼，二期植入后房型人工晶状体2眼，手术距外伤时间6小时－3年。结果：术后矫正视力0．5以上者达63．2％，术后并发症中后囊浑浊4眼（19％），玻璃体浑浊3眼（14．3％），虹膜后粘连2眼（9．5％），人工晶状体偏位2眼（9．5％），结论：正确把握外伤性白内障的手术时机和术式选择，可减少术中术后的并发症，提高手术的成功率和手术质量。     

后房型人工晶体植入术治疗糖尿病患者白内障手术时机及疗效探讨

随着糖尿病治疗的进展，该病患者的寿命逐渐延长，其白内障的发病率逐年增多，因此糖尿病患者白内障的手术治疗时机，术后疗效是眼科医生关注和研究的问题．1990年-1996年我们共行白内障囊外摘除联合后房型人工晶体植入术679例，其中术前确诊有糖尿病者对例，68眼．现报告如下：临床资料1．一股资料：本组对例68眼，单眼46例，双眼11例男32例，42眼．女22例26眼．50岁以下7例7眼，50～59岁18例22眼，60～69岁29例36眼，70岁以上13例13眼．双眼者均先后手术．间隔时间10天～3年，2．术前全身情况：对例术前均由内分泌专科根据糖尿病诊断标准…     

角膜穿孔伤三联术的临床观察

目的：探讨单纯性角膜穿孔伤合并外伤性白内障同时进行清创缝合、外伤性白内障摘出加人工晶状体植入三联手术的效果。方法：对1997－2000年在我院因旁中央及近角膜缘的角膜穿孔伤合并外伤性白内障行三联手术的25例进行回顾性分析。结果：术后随访3月－3年，术后视力≥0．3者21例（80．4％），视力≥0．5者10例（40％），术后并发症主要有：角膜水肿、人工晶状体前后膜性渗出、后发性白内障及瞳孔粘连等。结论：同时行角膜清创缝合、外伤性白内障摘出和人工晶状体植入三联手术可达到迅速恢复视力、重建双眼单视功能和立体视觉，减少手术并发症、减轻患者的痛苦和经济负担的效果。     

高度近视并发性白内障人工晶体植入后视力康复的相关因素分析

目的：探讨高度近视白内障人工晶体植入术后视力康复的相关因素。方法：统计分析42例（66眼）高度近视白内障患者行ECCE＋IOL术（38眼）和PHACO＋IOL术（28眼）后视力康复与性别、年龄、眼轴、手术方式的关系。结果：术后最佳视力（含矫正）：≥0．3者50眼（78．5％）,≥0．5者22例。其中视力大于等于0．5的患者眼轴多＜30mm（21眼）。结论：高度近视并发性白内障人工晶体植入术后视力康复程度与患者眼底变性程度、眼轴、术中操作技巧正相关,与年龄、性别、术式选择关系不大;高度近视白内障手术能明显提高患者视力,但因其并发症相对多,应在推广及实施此类手术时引起重视。     

表面麻醉下白内障超声乳化术中的心电监护

目的：评价表面麻醉在白内障超声乳化人工晶状体植入术中的效果及对心血管系统的影响。方法：观察84例（87眼）表面麻醉下手术中的麻醉效果、心电监护及术后视力。结果：术组全部病例均在表面麻醉下完成手术，手术前后患者的血压、脉搏均无显著变化。术后视力第1天0．5者25眼（28．73％），1周≥0.5者56眼（63．36％），1月≥0.5者69眼（79．31％）。结论：表面麻醉可使白内障手术更加简便、安全、舒适，并更快恢复视力。老年白内障患者中心电监护对提高手术安全性十分重要。     

Factors associated with second eye cataract surgery

AIMS—To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery.
METHODS—An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups—those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period.
RESULTS—Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1.8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye.
CONCLUSIONS—Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye.

     

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。     

Cataract surgery by phacoemulsification in adults with retinopathy of prematurity

PURPOSE: To report the preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with retinopathy of prematurity. METHODS: Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and January 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) with retinopathy of prematurity were identified who had undergone phacoemulsification for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative follow-up. RESULTS: Cataract extraction by phacoemulsification was performed on 20 eyes. Follow-up ranged from 6 to 103 months (mean, 32 months). A posterior chamber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the intraocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and remained unchanged in two eyes. Postoperatively, visual acuity was worse than 5/200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegmatogenous retinal detachment 1 month after cataract surgery; the retina was successfully reattached. CONCLUSIONS: Although cataract extraction in eyes with regressed retinopathy of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeon should be aware of the special considerations in this population, alert to potential zonular weakness intraoperatively, and careful of increased postoperative risks, including retinal detachment.     

双切口白内障超声乳化人工晶状体植入联合小梁切除术疗效分析

目的探讨双切口白内障超声乳化人工晶状体植入联合小梁切除术的临床效果。方法双切口白内障超声乳化人工晶状体植入联合小梁切除术治疗青光眼合并白内障患者24例（32只眼）;患者术后随访6个月,观察视力、眼压及并发症情况。结果 32只眼中视力﹤0.1者1只眼（3.13%）,0.1～0.3者2只眼（6.25%）,0.3～0.8者25只眼（78.12%）,其中〉1.0者4只眼（12.5%）;术后眼压控制在正常范围内（〈21 mm Hg）者30只眼;2只眼术后术后出现浅前房伴低眼压（〈9 mm Hg）,经积极治疗后明显改善。结论双切口白内障超声乳化人工晶状体植入联合小梁切除术治疗青光眼白内障的联合手术操作简便、疗效佳,是一种理想的手术方式。     

Impact of differences between eyes on binocular measures of vision in patients with cataracts

PURPOSE: To assess the association of stereopsis with differences between eyes (better minus worse eye value) and the binocular value of visual acuity and contrast sensitivity, and to analyse binocular summation or inhibition phenomena owing to differences between eyes. METHODS: A cohort of 137 patients with bilateral cataracts (visual acuity of 0.3 LogMAR or worse in both eyes) was followed up through first- and second-eye cataract surgery. The patients were recruited from the ophthalmology departments of two teaching hospitals. Visual acuity, contrast sensitivity (monocular and binocular), and stereopsis were measured preoperatively, after first- and second-eye surgery. Multiple linear regression and local correlation analyses were used. RESULTS: Stereopsis was most strongly influenced by visual acuity in the postoperative period after first-eye surgery (standardized coefficients of 0.382 for difference between eyes and 0.356 for binocular visual acuity) and by contrast sensitivity in the postoperative period after second-eye surgery (standardized coefficients of 0.353 for the difference between eyes and -0.312 for binocular contrast sensitivity). After first-eye surgery, the correlation of the differences between eyes with stereopsis was stronger (between 0.4 and 0.5) when the differences were greater than 0.4 logMAR units for visual acuity. Slight binocular summation was found for contrast sensitivity. CONCLUSIONS: When assessing the indication for and outcomes of cataract surgery, analysis of visual function should include measures of both eyes, rather than measures of the operative eye only, as differences between eyes (better minus worse eye value) may play an important role in binocular measures such as stereopsis.     

After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL

PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (相似文献   

Outcomes of bilateral macular hole surgery

BACKGROUND AND OBJECTIVE: Characteristics and outcomes in patients undergoing macular hole surgery in both eyes are studied. MATERIALS AND METHODS: Demographic and clinical data were abstracted from patients' medical records for a retrospective study of 31 consecutive patients (62 eyes) who underwent macular hole surgery in both eyes between 1992-1998. Outcome measures included best corrected Snellen visual acuity and status of the macular hole 3 months after surgery. RESULTS: The duration of symptoms was 5.5 months at the time of surgery in the first eye and 9.8 months in the second operated eye (P= 0.063). The macular hole was closed after surgery in both eyes (17), only in the first eye (6), only in the second eye (6), and not closed in either eye (2) (P = 0.9) (46/62, 74% eyes overall). With reoperation 55/62 (89%) were closed. In eyes with a closed macular hole, the visual acuity improved 2 or more lines in 20 (88%) first eyes and 12 (52%) of the second eyes (P = 0.02). Cataract surgery was performed in 12 (41%) first eyes and 13 (45%) second eyes within 1 year of the initial macular hole surgery. The occurrence of cataract surgery in the second eye correlated with the first eye (P= 0.017). CONCLUSION: Macular hole surgery is usually successful in one or both eyes. Surgical results in the second eye do not appear to correlate with the results in the first eye.     

Cataract surgery in children with chronic uveitis

OBJECTIVE: To evaluate the visual outcome of cataract surgery in children's eyes with chronic uveitis and the feasibility of intraocular lens (IOL) implantation in these cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seventeen children (20 eyes) with chronic uveitis, dense cataract, and a preoperative visual acuity of 6/120 or less with follow-up of 5 years after the initial cataract surgery. METHODS: In 10 eyes of 10 children (five with juvenile rheumatoid arthritis [JRA] and five with non-JRA-associated uveitis) with uniocular or markedly unequal binocular disease, surgery was carried out through the limbus and a posterior chamber IOL was implanted. In seven children (10 eyes), three with JRA and four with non-JRA-associated disease, a pars plana approach was used, and contact lenses or glasses (for the bilateral cases) were prescribed. RESULTS: The postoperative course and immediate restored visual acuities were similar whether an IOL was implanted or not. One month after the surgery, visual acuity improved in all operated eyes. After monocular surgery, in the younger children, contact lenses were poorly tolerated and their use discontinued. These aphakic eyes remained with low vision, developing strabismus on longer follow-up. Children with JRA-associated uveitis were younger, demonstrated an active intraocular inflammation for an extended period after surgery, and tended to have secondary membranes develop, necessitating a second surgical intervention. Five years after the initial surgery, only two of nine eyes (22%) in the JRA group (one aphakic of a bilaterally affected child and one pseudophakic in a child undergoing cataract surgery in one eye) retained a visual acuity of 6/9 and 6/6, respectively. In the other seven eyes, the visual acuity was 6/60 in one pseudophakic eye and 6/240 or less in six eyes (three aphakic and three pseudophakic). In children with non-JRA-associated uveitis, 6 (four aphakic in two patients bilaterally affected and two pseudophakic) of 11 eyes (54.5%) retained a vision of 6/12 or better. CONCLUSIONS: Cataract surgery in children's eyes with uveitis may be beneficial. IOL implantation seems preferable to correction with contact lenses in young children needing surgery in one eye. In children with JRA-associated uveitis, the final visual results remain guarded because of irreversible amblyopia and a more complicated postoperative course. For these cases, a modified management approach and a better surgical technique are needed.     

Posterior chamber lens implantation concurrent with vitrectomy for proliferative diabetic retinopathy

Combined operation of cataract removal with posterior chamber intraocular lens implantation and pars plana vitrectomy were performed on 25 eyes in 22 patients with cataract concurrent with diabetic retinopathy. In 21 eyes, extracapsular cataract extraction followed by intraocular lens insertion, aiming at in-the-bag fixation, was performed, and in 4 eyes pars plana lensectomy with anterior capsule left and intraocular lens insertion between the iris and anterior capsule was carried out. Mean postoperative follow-up period was 14 months, ranging from 3 to 32 months. Visual acuity on the last examination was 0.5 or better in 2 eyes (8%), 0.1 or better in 12 eyes (48%), and worse than 0.05 in 9 eyes (36%). Major postoperative complications were fibrin reaction (20 eyes, 80%), pupillary deformation (19 eyes, 76%), pupil capture by intraocular lens (3 eyes, 12%), rhegmatogenous retinal detachment (1 eye, 4%), neovascular glaucoma (2 eyes, 8%), and recurrent vitreous hemorrhage (13 eyes, 52%). Intraocular pressure was well controlled in neovascular glaucoma cases. At the last examination ocular fundus was invisible due to vitreous hemorrhage in two eyes.     

Results of late surgery for presumed congenital cataracts.

We reviewed the results of cataract extraction and visual rehabilitation in 76 eyes of 47 infants and children with presumed congenital cataracts who were first seen after they were 10 months old. Eighteen patients underwent surgery for unilateral cataracts, including five patients with persistent hyperplastic vitreous, five with posterior lenticonus, one with a nuclear cataract, six with posterior subcapsular cataracts, and one with a lamellar cataract. Of these 18 patients, seven (39%) attained a visual acuity of 20/60 or better, one (6%) had a visual acuity of 20/100, and ten (60%) had a visual acuity of 20/200 or worse. Twenty-nine patients (62 eyes) underwent bilateral cataract extraction. The visual acuity could be measured in 22 patients (44 eyes). Visual acuity improved to 20/60 or better in 32 eyes (73%), was between 20/70 and 20/150 in 11 eyes (25%), and became worse than 20/200 in one eye (2%). Results were good in patients with persistent hyperplastic primary vitreous, posterior lenticonus, and bilateral cataracts.