白内障超声乳化术后当日眼压升高临床观察

目的　对白内障超声乳化术后当日眼压升高进行临床观察与分析。方法　无术中并发症的晶状体超声乳化术2 0 0眼 ,分为 2 %甲基纤维素及医用透明质酸钠两组 ,对术前眼压 ,术后 4～ 8h及 2 4h眼压进行观察与分析。结果　术后当日眼压升高发生率平均为 3 5 .5 6% ,甲基纤维素组为 46 0 0 % ,医用透明质酸钠组为 2 5 0 0 % ,差别有统计学意义 (P <0 .0 1)。术后 4～ 8h为眼压升高峰值期。结论　晶状体超声乳化术后当日可发生眼压升高。对复杂病例术中应尽量选用高质量黏弹剂并于术后密切观察眼压变化。     

壳多糖在白内障人工晶状体植入术中的应用

比较壳多糖与透明质酸钠作为粘弹剂在白内障人工晶状体手术中的作用。方法对１４０例白内障随机分组,分别彩和ＥＣＣＥ＋ＩＯＬ或超声乳化吸出ＩＯＬ两种手术方法。７０眼术中用壳多糖作为粘弹剂使用,７０眼用透明质酸钠作为对照。结果术后矫正视力,角膜内皮,前房反应以及眼压变化,壳多糖组与透明质酸钠组均无显著差异。     

透明质酸钠与硫酸软骨素制剂在白内障摘除人工晶状体植入术中的应用对比观察

目的对比观察透明质酸钠与硫酸软骨素两种制剂在白内障摘除人工晶状体植入术中的应用效果。方法选择透明质酸钠与硫酸软骨素二种黏弹剂应用于反眉小切口白内障碎核摘除联合人工晶状体植入术,对术中及术后的效果进行观察。对比二者的特性和差异,以便在术中更有效的应用,使手术过程和术后效果更加完美。结果通过120例(100只眼)的对比观察,表明在对眼内组织驱动、假可塑性作用玻璃酸钠(爱维)优于硫酸软骨素制剂(V iscoat),而后者对角膜内皮粘附作用好于前者,如果二者在手术中有机结合使用,效果会更加完美、理想。     

白内障超声乳化吸出人工晶状体植入术后24小时眼压变化的临床分析

目的分析白内障超声乳化吸出人工晶状体植入术后24h眼压变化。方法选取125例（140只眼）进行白内障超声乳化吸出植入折叠式人工晶状体术患者,术中无并发症,在术前、术后4～8h、术后24h测眼压进行观察和分析。结果术后4～8h为眼压升高峰值期,眼压升高发生率为32.14%,眼压≥24mmHg为10.71%,最高值可达到40mmHg,术后24h后眼压逐渐下降。结论术后眼压的变化与粘弹剂的应用、核硬度及超声能量等因素有关。要重视白内障超声乳化术后早期眼压的监测,特别是术后4～8h的眼压测量。术中应该注意选择优质的粘弹剂或者合理的结合使用,并早期进行眼压观察。     

不同大小透明角膜切口超声乳化术后早期稳定性的对比研究

目的 通过眼前段光学相干断层扫描仪(anterior segment optical coherence tomography,OCT),观察分别经2.2 mm、3.0 mm透明角膜切口白内障超声乳化吸除手术后24 h的切口形态,探讨切口的稳定性。方法 选择年龄相关性白内障患者120例(120眼)进行超声乳化白内障吸除术,晶状体核硬度<Ⅳ级82例(82眼),≥Ⅳ级38例(38眼),随机选择2.2 mm、3.0 mm透明角膜手术切口。术后24 h应用眼前段OCT对切口处角膜进行观察,用非接触眼压仪测量眼压。结果 术前晶状体核硬度<Ⅳ级术眼眼压为(15.21±1.38)mmHg(1 kPa=7.5 mmHg),术后24 h眼压为(15.45±1.43)mmHg,术前、术后眼压差异无统计学意义(t=-0.32,P>0.05);核硬度≥Ⅳ级术眼眼压为(16.00±2.01)mmHg,术后24 h眼压为(16.21±1.75)mmHg,术前、术后眼压差异无统计学意义(t=-0.51,P>0.05)。眼前段OCT观察显示,在晶状体核硬度<Ⅳ级的患者术眼中,2.2 mm及3.0 mm两种透明角膜切口术后24 h切口处的外切口哆开、内切口哆开及后弹力层脱离等切口并发症的发生率差异均无统计学意义(均为P>0.05);在晶状体核硬度≥Ⅳ级的患者术眼中,2.2 mm组术后24 h切口处的外切口哆开、内切口哆开及后弹力层脱离等切口并发症的发生率均高于3.0 mm组(均为P<0.05)。结论 晶状体核硬度≥Ⅳ级的白内障患者,3.0 mm透明角膜切口白内障超声乳化手术后24 h切口的愈合程度高于.2 mm切口     

超声乳化人工晶状体植入术后眼压变化的观察

目的观察白内障超声乳化联合人工晶状体植入术对眼压的影响.方法182例218眼行无缝线小切口超声乳化联合人工晶状体植入术,测量术前及术后1周、3周、2月、3月的眼压,进行分析比较.结果术后1周、3周、2月、3月平均眼压分别为(14.7±0.22)mmHg、(14.2±0.23)mmHg、(13.6±0.20)mmHg、(13.8±0.20)mmHg,均与术前(16.0±0.21)mmHg差异有显著性.术前为青光眼者术后1周眼压较术前升高(1.4±2.17)mmHg(P＜0.01),与术前有显著差异.病人年龄、性别、眼别、手术切口、人工晶状体及粘弹剂类型、超乳时间对术后眼压影响差异无显著性.结论无缝线小切口白内障超声乳化联合人工晶状体植入术在眼压方面具有安全性.     

小切口非超声乳化白内障摘出术后早期高眼压

目的:针对小切口非超声乳化白内障摘出术后早期高眼压进行临床观察与分析,检测其发生率,探讨其发生机制,以指导临床工作。方法:对2011-01/06在我院行小切口非超声乳化白内障摘出术的116例116眼进行回顾性分析。结果:患者116眼中有35眼(30.2%)术后早期出现眼压升高。眼压升高峰值期在术后6～24h,最高56mmHg(1mmHg=0.133kPa),高眼压的88.6%也发生在术后>6～24h内,此时间段眼压升高发生率明显高于其他时段(P<0.05)。高眼压的62.9%为轻度升高(<30mmHg)。结论:小切口非超声乳化白内障摘出术后早期高眼压发生率较高,但大多为轻度增高。残留的黏弹剂或晶状体残余皮质堆积在房角上阻塞小梁网、术中或术后的眼内出血致变性的红细胞-血影细胞及吞噬了血红蛋白的巨噬细胞或其他物质如色素颗粒阻塞了小梁网,房水流出受阻为眼压升高最常见的原因。     

不同切口超声乳化白内障吸除联合小梁切除术的疗效比较

目的比较白内障摘除联合小梁切除术一切口术式和二切口术式的临床疗效.方法按不同术式将45例(47只眼)拟行超声乳化白内障吸除人工晶状体植入联合小梁切除术(联合手术)患者分为一切口组29只眼和二切口组18只眼,所有病例的晶状体核硬度均不超过Ⅲ级,分析比较两组患者的术后眼压控制及并发症情况.随访13～30个月,平均18.9个月.结果术后平均眼压一切口组为(16.81±4.56)mmHg(1mmHg＝0.133kPa),较术前降低(15.32±6.67)mmHg;二切口组为(17.63±4.60)mmHg,较术前降低(16.42±6.98)mmHg.两组术后平均眼压下降差异无显著性(t＝1.44.P》0.05).结论联合手术的一切口术式和二切口术式均具有较好的降眼压作用;对于软性晶状体核白内障合并青光眼患者,两种术式的降低眼压作用基本相同.     

不同黏弹剂对白内障超乳摘除及折叠IOL植入术后患者角膜内皮的影响

目的：分析双重黏弹剂DisCoVisc和透明质酸钠两种黏弹剂对白内障超声乳化摘除及折叠人工晶状体(IOL)植入术患者术后角膜内皮的影响。

方法：选取2017-06/2019-12在荆门市爱尔眼科医院就诊的白内障患者247例285眼,按随机数字表法分DisCoVisc组(123例141眼)与透明质酸钠组(124例144眼)。两组均接受超声乳化摘除及折叠IOL植入术,DisCoVisc组术中使用DisCoVisc作为黏弹剂,透明质酸钠组术中使用1.7%透明质酸钠作为黏弹剂; 比较两组术中超声乳化时间(UST)、累计释放能量(CDE)、植入IOL后抽吸黏弹剂的时间; 术后1d,1wk,1、3mo时角膜水肿情况,术前、术后3mo时的角膜内皮细胞密度(ECD)及ECD损失率,角膜内皮细胞面积变异系数(CV)、角膜六角形内皮细胞比率(6A); 术前,术后1d,1wk,1mo时的眼压、裸眼视力≥0.5的患者比例及中央角膜厚度(CCT)值。

结果：两组UST、CDE、黏弹剂抽吸时间均无差异(P>0.05); 两组术后1d时角膜水肿率无差异(P>0.05),术后1wk时角膜水肿均消失; 术后3mo时DisCoVisc组ECD损失率显著低于透明质酸钠组(P<0.05); 两组术前,术后1d,1wk,1mo时的眼压水平、裸眼视力≥0.5比例、CCT值均无差异(P>0.05)。

结论：Emery-Little晶状体核硬度分级Ⅱ～Ⅲ级患者超声乳化摘除联合折叠IOL植入术中使用DisCoVisc作为黏弹剂对角膜内皮的保护作用更好。     

超声乳化白内障吸除术后前房内脂质样异物一例

患者男52岁因右眼老年性白内障在我院行超声乳化白内障吸除联合折叠人工晶状体植入术。在颞上方清亮角膜切口，注入和透明质酸钠针（爱维），2点钟辅助侧切口，前囊膜连续环形撕囊术，囊袋内拦截劈裂超声乳化晶状体核，自动注吸系统吸除残留皮质，囊袋内注入透明质酸钠针，植入后房型折叠人工晶状体。置换粘弹剂，结膜囊涂典必殊眼膏，术后常规处理。术后第1d检查：右眼视力0．8，角膜清亮，伤口对合好，前房深，Kp（-），12点前房角内可见一油滴状脂质样灰白色异物，约lmm×1．5mm×2mm，呈游离状，瞳孔小圆，     

Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents

AIM: To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%-sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery. METHODS: This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Ocucoat or Viscoat during cataract surgery of the first eye. The second eye was operated later and received the other viscoelastic agent. Cataract surgery was performed with a temporal 3.2 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively as well as 6 hours, 20-24 hours, and 1 week postoperatively. RESULTS: At 6 hours after surgery the mean IOP increased by 4.6 (SD 5.1) mm Hg in the Ocucoat group (p<0.001) and by 8.6 (8.1) mm Hg in the Viscoat group (p<0.001). The increase was significantly higher in the Viscoat group than in the Ocucoat group (p=0.004). Intraocular pressure spikes of 30 mm Hg or more occurred in two eyes in the Ocucoat and in nine eyes in the Viscoat group (p=0.023); 20-24 hours and 1 week postoperatively the mean IOP was not statistically different. CONCLUSION: These findings indicate that Viscoat causes a significantly higher IOP increase and significantly more IOP spikes than Ocucoat in the early period after small incision cataract surgery.     

Intraocular pressure after small incision cataract surgery with Healon5 and Viscoat

PURPOSE: To evaluate the effect of Healon5 (sodium hyaluronate) and Viscoat (sodium chondroitin sulfate-sodium hyaluronate) on intraocular pressure (IOP) after bilateral small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 70 eyes of 35 consecutive patients with age-related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Healon5 or Viscoat during cataract surgery in the first eye. The second eye received the other viscoelastic substance. Cataract surgery was performed in an identical fashion in both eyes, with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively. RESULTS: At 6 hours after surgery, the mean IOP increased by 5.2 mm Hg +/- 5.3 (SD) in the Healon5 group (P < .0001) and by 10.1 +/- 8.7 mm Hg in the Viscoat group (P < .0001). The increase was significantly higher in the Viscoat group than in the Healon5 group (P = .0016). Intraocular pressure spikes of 30 mm Hg or more occurred in 2 eyes in the Healon5 group and in 10 eyes in the Viscoat group (P = .0112). Twenty to 24 hours and 1 week postoperatively, the mean IOP in the 2 groups was not statistically different. CONCLUSIONS: Viscoat caused a significantly higher IOP increase and significantly more IOP spikes than Healon5 in the early period after small incision cataract surgery.     

Intraindividual comparison of the effects of a fixed dorzolamide-timolol combination and latanoprost on intraocular pressure after small incision cataract surgery

To compare the effect of a fixed dorzolamide-timolol combination with that of latanoprost on intraocular pressure (IOP) after small incision cataract surgery.Department of Ophthalmology, University of Vienna, Vienna, Austria.This prospective randomized study comprised 60 eyes of 30 patients scheduled for small incision cataract surgery in both eyes. The patients were randomly assigned to receive 1 drop of a fixed dorzolamide-timolol combination or latanoprost immediately after cataract surgery in the first eye. The second eye received the other antiglaucomatous agent. Cataract surgery was performed under sodium hyaluronate 1% with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively.Six hours after surgery, the mean IOP decreased by -0.8 mm Hg +/- 3.2 (SD) (P =.184) in the dorzolamide-timolol group and increased by 3.6 mm Hg +/- 3.5 (P <.001) in the latanoprost group. Twenty to 24 hours after surgery, the mean IOP decreased by -2.8 +/- 2.4 mm Hg (P <.001) in the dorzolamide-timolol group and increased by 0.6 +/- 3.5 mm Hg (P =.353) in the latanoprost group. The differences between groups were significant at 6 hours (P <.001) and 20 to 24 hours (P <.001).The fixed dorzolamide-timolol combination was more effective than latanoprost in reducing IOP after small incision cataract surgery. Only the fixed dorzolamide-timolol combination prevented a postoperative IOP increase and occasional IOP spikes of 30 mm Hg or higher.     

The effect of brimonidine on postoperative hypertonia after an extracapsular cataract extraction

PURPOSE: We conducted a prospective study to determine the effect of topical administration of brimonidine tartrate 0.2% on postoperative intraocular pressure (IOP) spikes during the first 24 hours after an extracapsular cataract extraction. MATERIAL AND METHODS: In a placebo-controlled study, we randomized 40 consecutive normotensive eyes undergoing extracapsular cataract surgery into two treatment modalities. Twenty eyes (group A) received placebo and 20 eyes (group B) were given brimonidine tartate 0.2% drops twice the day before and twice on the day of the operation. IOP was measured at baseline (prior to surgery) and then 4, 6, 12 and 24 hours postoperatively. RESULTS: Mean postoperative IOP was higher in the placebo group than in the brimonidine group at every time point studied. In both groups, peak elevation of mean IOP was recorded 6 hours after surgery. At that time, mean IOP was significantly higher in the placebo group (36.2+/-4.0 mmHg) than in the brimonidine group (24.7+/-3.8 mmHg) (p<0.001). A gradual reduction in IOP followed, yet with significantly higher values than those found preoperatively, even 12 hours after surgery (p<0.001). It was only the brimonidine group that achieved a near-to-normal mean IOP 24 hours after surgery (p>0.05). Four of the placebo group patients compared to 1 of the brimonidine group patients had an IOP higher than 40 mmHg 6 hours after surgery and therefore received additional therapy. CONCLUSION: Prophylactic treatment with brimonidine tartrate 0.2% drops twice a day for 2 days is effective in reducing IOP spikes throughout the first 24 hours after an extracapsular cataract extraction.     

白内障手术后0.1%溴芬酸钠水合物滴眼液的应用研究

目的：探讨0.1%溴芬酸钠水合物滴眼液联合妥布霉素地塞米松眼液应用于控制白内障手术的疗效和安全性。

方法：行白内障超声乳化联合人工晶状体植入术的老年性白内障患者100例120眼,将患者随机分为两组：0.1%溴芬酸钠水合物滴眼液和妥布霉素地塞米松滴眼液联合用药组(试验组)、术后单独滴用妥布霉素地塞米松滴眼液组(对照组)。手术方法采用巩膜隧道切口超声乳化白内障摘除联合人工晶状体植入术。术后第1、7、14d观察症状和体征并进行评分; 并观察眼压变化及黄斑水肿发生情况。

结果：患者100例120眼完成研究,两组患者症状和体征综合评分术后1d无统计学差异(P>0.05),而术后7、14d内有统计学差异(P<0.05),试验组比对照组值低。术前眼压试验组(14.657±2.605mmHg)和对照组(14.415±2.761mmHg)比较,差异无统计学意义(P>0.05)。试验组眼压：在术后1、7、14d眼压均低于对照组,差异有统计学意义(P<0.05)。黄斑水肿发生率：对照组术后1、7、14d黄斑水肿发生率分别为1.7%、1.7%和3.3%,明显高于试验组的 0、0和1.7%,两组比较差异具有统计学意义(P<0.05)。

结论：应用0.1%溴芬酸钠水合物滴眼液和妥布霉素地塞米松滴眼液对白内障超声乳化摘除联合人工晶状体植入术后炎症的治疗效果较佳,是安全有效的,且不易发生高眼压等严重并发症; 同时可显著降低术后黄斑水肿发生率,预防白内障术后黄斑水肿的发生,具有安全可靠性,值得临床推广应用。     

Effect of a fixed dorzolamide-timolol combination on intraocular pressure after small-incision cataract surgery with Viscoat

PURPOSE: To evaluate the effect of a fixed dorzolamide-timolol combination (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat). SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 76 eyes of 38 patients scheduled for small-incision cataract surgery in both eyes. Patients were randomized to receive 1 drop of the fixed dorzolamide-timolol combination in 1 eye or no treatment (control) immediately after cataract surgery. The fellow eye received the other assigned treatment. Cataract surgery was performed with Viscoat in an identical fashion in both eyes. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 mm Hg +/- 5.6 [SD] versus 8.4 +/- 6.1 mm Hg; P =.003). Two eyes in the dorzolamide-timolol group and 9 in the control group had IOP spikes of 30 mm Hg or higher (P =.022). Twenty to 24 hours after surgery, the mean IOP change was -2.6 +/- 3.3 mm Hg in the dorzolamide-timolol group and 1.5 +/- 3.2 mm Hg in the control group (P<.001). CONCLUSIONS: The fixed dorzolamide-timolol combination was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery. However, it did not prevent Viscoat-induced IOP spikes of 30 mm Hg or higher.     

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery

PURPOSE: To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement. CONCLUSIONS: In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.     

白内障超声乳化人工晶状体植入术后高眼压危险因素分析

目的:探讨白内障超声乳化工晶状体植入术后高眼压的相关危险因素、发生的原因及防治。方法:对我院2006-01/2012-10完成的白内障超声乳化工晶状体植入术1258例1318眼临床资料进行回顾分析。结果:术后发生高眼压共54眼,发生率为4.10%。术后眼压升高的幅度为22～60mmHg,大多数患者出现高眼压的时间为术后2～24h。54眼中先天性白内障1眼,外伤性白内障2眼,合并糖尿病15眼,合并高血压病12眼,陈旧性色素膜炎2眼,玻璃体切割术后1眼,合并高度近视11眼,未合并全身疾病的白内障10眼。裂隙灯观察高眼压患者可见部分皮质残留以及黏弹剂残留或晶状体后囊膜破裂玻璃体溢入前房或严重的炎症反应。结论:黏弹剂残留和炎症反应是引起术后高眼压的主要原因,合并有糖尿病、高度近视、陈旧性色素膜炎、眼外伤等疾病的白内障患者更容易出现术后高眼压。