Toric人工晶状体植入术后的远期临床疗效

目的评价AcrysofToric人工晶状体矫正白内障伴角膜散光患者的远期临床效果及其在囊袋内的旋转稳定性。方法回顾性非随机临床研究。选取在浙江大学医学院附属第一医院眼科已行白内障超声乳化吸除联合AcrysofToric人工晶状体植入术的白内障患者21例（23眼）,年龄53-84岁,均为术后24个月以上。观察术前术后的裸眼视力（UCVA）、最佳矫正视力（BCVA）,术前角膜散光、总散光,术后角膜散光、残留散光,人工晶状体轴位等。术前术后比较采用配对t检验。结果术后最后一次随访时,患眼的UCVA（10gMAR）为0．16±0．13,BCVA（10gMAR）为0．06±0．09。术前总散光（-2．98±1．22）D,术后残留散光（-0．57±0．78）D,两者比较差异有统计学意义（t=6．371,P〈0．05）。术前预留散光（-0．53±0．70）D,与术后残留散光比较差异无统计学意义。术前角膜散光（2．23＋1．17）D,术后角膜散光（1．89＋1．22）D,两者比较差异无统计学意义。AcrysofToric人工晶状体轴位偏离既定轴位度数平均为（2．84±2．66）°,1只术眼（4％）的人工晶状体轴位偏离7。,余术眼（96％）的人工晶状体轴位偏离均≤5°。结论白内障超声乳化术后植入AcrysofToric人工晶状体具有良好的远期临床效果和旋转稳定性,是一种安全、有效、预测性好的治疗伴角膜规则散光白内障的方法．     

Prospective evaluation of intraocular lens calculation after myopic refractive surgery

PURPOSE: To evaluate outcome after refractive surgery in cataract patients for whom intraocular lens (IOL) selection was based on the use of a myopic regression formula. METHODS: This prospective case series included 20 eyes of 14 patients who had previous uncomplicated myopic refractive surgery, followed by uncomplicated cataract extraction with IOL implantation. Calculation of IOL was based on flattest keratometry readings, spherical equivalent refraction before refractive surgery, and an adjustment factor derived from the regression formula: -(0.47x + 0.85). Following cataract extraction, refractive error was compared against refractive aim. The power of IOL obtained by the regression formula (IOL(RF)) was compared to those obtained using the clinical history method at the spectacle plane (IOL(HisKs)) and the Double-K formula (LOL(DoubleK)). The results acquired with each technique were compared with those achieved using an IOL back-calculated for emmetropia (IOL(exact)). RESULTS: Using the regression formula, IOL calculations produced postoperative cataract extraction refractions within 1.00 diopter (D) (range: -1.00 to 0.78 D) of the intended outcome. Mean spherical equivalent refraction after cataract extraction was -0.31 +/- 0.56 D. Twelve of 20 eyes had sufficient data to evaluate the statistical relationships among the three formulas compared with IOL(exact). Paired t test results revealed IOL(RF) (P = .0932) and IOL(HisKs) (P = .9955) were not statistically different from IOL(exact) whereas IOL(DoubleK) was statistically different from IOL(exact) (P = .0008). CONCLUSIONS: The myopic regression formula is recommended for postoperative myopic LASIK IOL selection to provide a simple, accurate, and consistent method of predicting IOL calculation that is not statistically different from IOL(exact).     

Monochromatic aberrations in eyes with different intraocular lens optic designs

PURPOSE: To study the wavefront aberration profile of eyes with three different types of intraocular lenses (IOLs)--the Tecnis Z9000 (modified prolate surface design) (Pfizer, New York, NY), the Acrysof MA60BM (unequal biconvex optic) (Alcon, Ft Worth, Tex), and the Sensar Optiedge AR40e (equibiconvex optic) (AMO, Santa Ana, Calif)--in eyes following cataract surgery. METHODS: This study was conducted in two parts. The first part was a randomized open study of 32 eyes of 16 patients who underwent bilateral phacoemulsification with a foldable IOL in the capsular bag. A Tecnis Z9000 IOL was implanted in one eye and an Acrysof MA60BM IOL in the fellow eye. The ALLEGRETTO WAVE Analyzer (Wavelight Laser Technologies AG, Erlangen, Germany) was used to measure ocular aberrations 2 weeks after surgery. A paired t test was used to compare each Zernike term from Z3(-3) to Z6(6) between fellow eyes (pupil diameter = 6 mm). In the second part of the study, the wavefront aberrations of 16 eyes that underwent an identical surgical procedure as in the first part of the study but had a Sensar Optiedge AR40e IOL implanted were studied and compared with eyes with the Tecnis Z9000 and Acrysof MA60BM IOLs. RESULTS: The mean spherical aberration (Z4(0)) was statistically significantly lower in eyes with a Tecnis Z9000 IOL (Z4(0) = 0.07 +/- 0.12 microm) compared with eyes with an Acrysof MA60BM IOL (Z4(0) = 0.29 +/- 0.20 microm, P < .001) and with eyes with a Sensar Optiedge AR40e IOL (Z4(0) = 0.20 +/- 0.09 microm, P = .002). No statistically significant differences were noted in any of the Zernike terms between eyes with Acrysof MA60BM and Sensar Optiedge AR40e IOLs, or in the root-mean-square (RMS) of total higher order aberrations among the three IOL groups. CONCLUSIONS: The implantation of a Tecnis Z9000 IOL produces a significant reduction in spherical aberration of the eye. No significant differences were noted in the wavefront profile between eyes with Acrysof MA60BM and Sensar Optiedge AR40e IOLs. No significant differences were found in the RMS of total higher order aberrations among the three IOL groups.     

Refraktion, Vorderkammertiefe, Dezentrierung und Tilt nach Implantation monofokaler und multifokaler Silikonlinsen

BACKGROUND: We prospectively investigated changes in refraction, anterior chamber depth, decentration and tilt after implantation of multifocal (MIOL) and monofocal (MONO) intraocular lenses (IOL). PATIENTS AND METHODS: We examined 103 cataractous eyes from 103 patients receiving either a three-piece monofocal or multifocal silicone IOL. Anterior chamber depth (ACD), amount of IOL decentration, and degree of IOL tilt were quantified using retroillumination and Scheimpflug photographs. Examinations, including subjective refraction, were performed preoperatively, one week and 6 months postoperatively. RESULTS: All eyes were within 2 dpt (spherical equivalent) from the target refraction, and 93% of eyes with a MIOL were within 1 dpt. No significant refractive shift or ACD change occurred during the postoperative course. Median tilt in the MIOL group at 6 months was 1.1 degrees (0-2.6) and that in the MONO group 1.0 degree (0-2.5). There was no statistically significant change in intraindividual IOL decentration or tilt. CONCLUSION: Three-piece silicone MIOLs and MONOs with polymethylmethacrylate haptics implanted in the capsular bag after circular capsulorhexis provide good centration and very little tilt without statistically significant change up to 6 months after surgery. Postoperative refractive shift is of minor concern for 6 months after surgery.     

Identification of microRNA-mRNA regulatory networks and pathways related to retinoblastoma across human and mouse

AIM: To explore the mRNA and pathways related to retinoblastoma (RB) genesis and development. METHODS: Microarray datasets GSE29683 (human) and GSE29685 (mouse) were downloaded from NCBI GEO database. Homologous genes between the two species were identified using WGCNA, followed by protein-protein interaction (PPI) network construction and gene enrichment analysis. Disease-related miRNAs and pathways were retrieved from miR2Disease database and Comparative Toxicogenomics Database (CTD), respectively. RESULTS: A total of 352 homologous genes were identified. Two pathways including “cell cycle” and “pathway in cancer” in CTD and enrichment analysis were identified and seven miRNAs (including hsa-miR-373, hsa-miR-34a, hsa-miR-129, hsa-miR-494, hsa-miR-503, hsa-let-7 and hsa-miR-518c) were associated with RB. miRNAs modulate “cell cycle” and “pathway in cancer” pathways via regulating 13 genes (including CCND1, CDC25C, E2F2, CDKN2D and TGFB2). CONCLUSION: These results suggest that these miRNAs play crucial roles in RB genesis through “cell cycle” and “pathway in cancer” pathways by regulating their targets including CCND1, CDC25C, E2F2 and CDKN2D.     

Refraction and anterior chamber depth change after vitrectomy for pseudophakia

PURPOSE: To evaluate the association between the vitreous and the refractive error in pseudophakia. METHODS: Vitrectomy was performed in 67 eyes of 61 patients who underwent cataract surgery. Vitrectomy was needed for epiretinal membrane in 30 eyes, macular edema in 22 eyes, macular hole in 3 eyes, lamelar macular hole in 2 eyes, vitreous opacity in 6 eyes, and vitreous hemorrhage in 4 eyes. Refraction was measured before the operation, and 1 month, 3 months, 6 months, and 12 months after operation. Anterior chamber depth was measured in 10 eyes before the operation, and 1 month, 3 months, and 6 months after operation. We evaluated the refractive error after vitrectomy in 49 eyes that had predicted refraction. RESULTS: The mean value of refractive change was -0.3 D 1 month postoperatively, and then gradually became positive. The variation of refraction (6-month postoperative refraction minus preoperative refraction) was negatively correlated with preoperative refraction (p = 0.0052, R2 = 0.146). If preoperative refraction was more myopic than -1.5 D, then refraction became positive. If preoperative refraction was not more myopic than -1.5 D, then refraction became negative. CONCLUSION: About 15% of postoperative refractive error may be associated with the vitreous, but further investigation is required.     

Refractive lens exchange with an array multifocal intraocular lens

PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL). METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO). RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 +/- 3.25 D (-1.75 to -15.50 D), and group B (n=26; hyperopia, average preoperative spherical equivalent refraction +3.04 +/- 1.04 D). Follow-up was 6 months in all eyes. Postoperatively, all eyes of both groups were within +/-1.00 D of target refraction. No eye in group A and three eyes in group B sustained a loss of one line of BSCVA. Forty-seven eyes (94%) remained unchanged or gained one or more lines of their preoperative BSCVA. In all eyes, postoperative UCVA was 20/40 or better. When compared to preoperative, uncorrected near visual acuity improved (statistically significant). All patients achieved uncorrected binocular visual acuity of 20/30 and J4 or better. Patient satisfaction was extremely high; no intra- or postoperative complications were reported. CONCLUSION: Six-month results of implantation of the AMO Array multifocal IOL for refractive lens exchange demonstrated safety, efficacy, and predictability in correcting high ametropia and significant improvement of uncorrected near and distance visual acuity.     

非球面人工晶状体术后视功能评估

目的 评估植入人工晶状体前表面非球面修饰的TecnisZ9003(AMO)术后视功能是否优于传统的球面人工晶状体(Acrosof Natural,Alcon).方法 随机选择8例白内障手术患者,1只眼植入Z9003 IOL,另眼植入Acrysof Natural SN6OATIOL.术后1周和1月,行对比敏感度检查、眩光检查和像差仪检查,分别评价术后视功能.结果 两组间平均术前和术后球镜、柱镜度及最佳矫正视力无统计学意义.对比敏感度(明亮光下)术后1周没有明显不同,术后1月植入TecnisZ9003 IOL眼在所有空间分辨率下均优于对侧眼,尤其在3,6cpd下差异有统计学意义.眩光检查两组间没有差别.像差仪检查显示术后1周、1月植入TecnisZ9003IOL眼的球差明显小于对侧眼.结论 临床结果证实白内障术后的球差可以通过植入非球面修饰的人工晶状体所消除.这样可以明显提高对比敏感度和功能视力.     

小切口白内障囊外摘出联合人工晶状体植入术后眼前节变化分析

目的探讨小切口白内障囊外摘出联合人工晶状体植入术后患者眼前节的变化。方法对104例(104眼)老年性白内障患者施行小切口囊外摘出联合人工晶状体植入术,对手术前后患者的眼压、前房深度、角膜屈光力(K值)、前房角进行对比观察。结果术后1个月时眼压为(12.96±1.87)mmHg(1kPa=7.5mmHg),较术前(13.61±1.56)mmHg有所下降,但差异无统计学意义(t=0.396,P>0.05)。术前前房深度为(2.98±0.39)mm,术后为(4.16±0.56)mm,差异有显著统计学意义(t=5.431,P<0.01)。术后K值较术前有所增加,但差异无统计学意义(t=0.461,P>0.05)。术后前房角镜检查均可见小梁功能区,术前、术后前房角情况分类比较,差异有显著统计学意义(χ2=42.16,P<0.01)。结论小切口白内障手术有效地改善了患者前房角宽度及前房深度。     

应用PENTACAM三维眼前段分析仪对人工晶状体在眼内稳定性的研究

目的:采用PENTACAM三维眼前段分析仪研究3种类型人工晶状体在眼内的倾斜度数、偏心值以及前房深度的变化情况,评价其在眼内的稳定性。方法:采用临床随机前瞻性研究,对109例(117只眼)老年性白内障患者行超声乳化白内障吸除术,随机植入一片式AcrysofSA60AT、三片式TecnisZ9001或SensarAR40e人工晶状体,采用PENTACAM三维眼前段分析仪测量三组术后1d、1、3、6及12个月人工晶状体的偏心量、倾斜度及前房深度值。结果:分别比较各组在不同时期的平均偏心量与平均倾斜度,差异均无统计学意义(P>0.05)。在术后1d、1、3、6及12个月,分别比较3组的平均偏心量与平均倾斜度,差异均无统计学意义(P>0.05)。一片式AcrysofSA60AT组在不同时期的前房深度变化不大,差异无统计学意义(P>0.05);而三片式TecnisZ9001及SensarAR40e组术后第1天的前房深度大于术后其它时期,也大于一片式AcrysofSA60AT组术后不同时期的值,差异有统计学意义(P<0.05)。结论:PENTACAM三维眼前段分析仪可动态客观地评价人工晶状体在眼内的稳定性;适当的连续环形撕囊和准确的囊袋内固定能很好地维持折叠式人工晶状体在眼内的稳定性,且AcrysofSA60AT一片式软性襻人工晶状体的囊袋稳定性略优于三片式硬性襻人工晶状体。     

Corneal topography and postoperative refraction after cataract phacoemulsification following radial keratotomy

We present one case in which phacoemulsification was performed seven years after radial keratotomy (RK). A 55-year-old military police officer had undergone successful bilateral RK for the correction of myopia seven years before he developed a cataract in his left eye. Pre-RK keratometric and refractive data and post-RK myopia reduction were not available. We relied upon corneal topography to measure corneal refractive power. We took the Effective Refractive Power (EffRP) index from EyeSys Holladay's Diagnostic Summary and used SRK-T formula for IOL calculation. A-scan axial length readings were consistent and reliable (AL = 26.0 mm). Aiming at postoperative emmetropia, we implanted a +20D PC IOL (A cost. = 118) was implanted. The lens was expected (SRK-T formula) to give a -1.35D postoperative refraction. After uneventful cataract surgery, corneal topography showed significant corneal instability with central corneal flattening in the first postoperative weeks, mild central corneal steepening at week 6, and return to preoperative corneal curvature at week 23. One year after cataract extraction, the patient's spherical equivalent is +1.12D, showing a prediction error of about 2.5 diopters.     

Comparison of clinical results between heparin surface modified hydrophilic acrylic and hydrophobic acrylic intraocular lens

PURPOSE. To compare the clinical results of heparin surface modified (HSM) hydrophilic acrylic intraocular lens (IOL) with those of hydrophobic acrylic IOL. METHODS. One hundred patients with cataract were randomized to receive one of acrylic foldable IOLs after phacoemulsification: HSM hydrophilic acrylic IOL (n=50) BioVue3(R) (BioVue, OII, Ontario, CA, USA) and hydrophobic acrylic IOL (n=50) Sensar(R) (AR40e, AMO, Santa Ana, CA, USA). Bestcorrected visual acuity and refractive error were measured at 1 week, 2 months, 6 months and 12 months after surgery in both IOL groups. To assess posterior capsular opacification (PCO), digital retroillumination image of posterior capsule was analyzed at 12 months using POCOman software. RESULTS. Best-corrected visual acuity (log MAR) was 0.032+/-0.082 in BioVue3(R) group and 0.034+/-0.077 in Sensar(R) group at 12 months. There was no statistically significant difference between the two groups (p=0.554). Refractive error was -0.247+/-0.821 diopter in BioVue3(R) group and -0.264+/-0.808 diopter in Sensar(R) group at 12 months. There was no statistically significant difference of refractive error between the two groups (p=0.909). At 12 months, BioVue3(R) IOL group had a lower percentage area and severity of PCO than Sensar(R) group. However, it was not statistically significant (p=0.349, p=0.288). No Nd:YAG capsulotomy was performed in BioVue3(R) group while it was required in two eyes (4.0%) in Sensar(R) group. CONCLUSIONS. There was no statistically significant difference of postoperative visual acuity, refractive error and degree of PCO between HSM hydrophilic acrylic IOL and hydrophobic acrylic IOL.     

Refraction and Anterior Chamber Depth Change After Vitrectomy for Pseudophakia

Purpose: To evaluate the association between the vitreous and the refractive error in pseudophakia.Methods: Vitrectomy was performed in 67 eyes of 61 patients who underwent cataract surgery. Vitrectomy was needed for epiretinal membrane in 30 eyes, macular edema in 22 eyes, macular hole in 3 eyes, lamelar macular hole in 2 eyes, macular hole in 3 eyes, lamelar macular hole in 2 eyes, vitreous opacity in 6 eyes, and vitreous hemorrhage in 4 eyes. Refraction was measured before the operation, and 1 month, 3 months, 6 months, and 12 months after operation. Anterior chamber depth was measured in 10 eyes before the operation, and 1 month, 3 months, and 6 months after operation. We evaluated the refractive error after vitrectomy in 49 eyes that had predicted refraction.Results: The mean value of refractive change was -0.3 D 1 month postoperatively, and then gradually became positive. The variation of refraction (6-month postoperative refraction minus preoperative refraction) was negatively correlated with preoperative refraction (P =.0052, R(2) = 0.146). If preoperative refraction was more myopic than -1.5 D, then refraction became positive. If preoperative refraction was not more myopic than -1.5 D, then refraction became negative.Conclusion: About 15% of postoperative refractive error may be associated with the vitreous, but further investigation is required.     

Acrysof Toric人工晶状体植入矫正低度角膜 散光的效果

目的：探讨合并低度角膜散光的白内障手术中Acrysof Toric人工晶状体（IOL）植入的临床疗效。方法： 前瞻性系列病例研究。选择2016年1-12月于温州医科大学附属眼视光医院行白内障微切口超声乳 化吸除联合IOL植入的年龄相关性白内障合并低度角膜散光（≤1.0 D）患者56例（65眼），根据患者 意向分为2组：散光组（Toric组，n=33眼）植入散光型人工晶状体（Acrysof IQ Toric IOL，SN6AT2 & SN6AT3）；对照组（IQ组，n=32眼）植入非散光型人工晶状体（Acrysof IQ IOL，SN60WF）。观察2组 手术前后的裸眼远视力（LogMAR）、最佳矫正远视力（LogMAR），术前角膜散光，术后残余散光， 术后等效球镜度和IOL轴位等，并对术后残余散光进行矢量分析。随访3个月。采用独立样本t检验 及秩和检验对数据进行统计学分析。结果：术前Toric组最佳矫正远视力中位数为0.39，IQ组为0.30。 术后3个月Toric组裸眼远视力中位数为0.09，优于IQ组的0.15，二者差异有统计学意义（Z=-2.802， P=0.005）。术后3个月Toric组残留散光值中位数为0.50 D，小于IQ组的1.00 D，二者差异有统计学意 义（Z=-3.636，P<0.001）。矢量分析显示，Toric组术后3个月残留散光的矢量J0比IQ组的减小0.11 D （t=1.456，P=0.151），J45减小0.11 D（t=1.998，P=0.050）。结论：与普通非球面IOL相比，散光型Toric IOL（SN6AT2 & SN6AT3）植入能够更加有效地矫正低度角膜散光（≤1.0 D），提高白内障患者术后视力。     

Paediatric pseudophakia: analysis of intraocular lens power and myopic shift

BACKGROUND: At the Alberta Children's Hospital, the authors have been performing paediatric cataract extraction with intraocular lens (IOL) implant for over 10 years. The authors examined the amount of myopic shift that occurs in various age groups and cataract types, in order to evaluate the success of predicting the appropriate power of IOL to implant. METHODS: This study is a retrospective review children undergoing small incision posterior chamber foldable IOL implantation between age 1 month and 18 years, from 1995 to 2005. 163 eyes of 126 patients underwent surgery. All patients were followed for a minimum of 6 months postoperatively. The children were divided into four groups at time of surgery: Group A: 1-24 months, Group B: 25-48 months, Group C: 49-84 months, Group D: 85 months-18 years. RESULTS: The mean target refraction for the groups were: Group A: +6.37 D, Group B: +4.66 D, Group C: +1.95 D, and Group D: +0.97 D. Children under 4 years experienced the most myopic shift and the largest mean rate of refractive change per year. Mean change Group A: -5.43 D, Group B: -4.16 D, Group C: -1.58 D, Group D: -0.71 D. Eighty-nine per cent of patients with unilateral cataracts had a postoperative refraction within 3.00 D of the fellow eye at last follow-up visit (mean=3.16 years). CONCLUSIONS: The rate of myopic shift is high in children under age 4 years at time of surgery, shifting as much as -12.00 D. The mean postoperative target refraction should probably be increased from previous literature recommendations. The patient's age at time of cataract surgery and the refractive power of fellow eye are all factors to consider when deciding what power IOL to surgically implant in a paediatric patient.     

Accuracy of preoperative biometry in vitrectomy combined with cataract surgery for patients with epiretinal membranes and macular holes: results of a prospective controlled clinical trial

PURPOSE: To evaluate how adding vitrectomy to cataract surgery affects the accuracy of preoperative biometry and postoperative refractive outcomes. SETTING: Department of Ophthalmology, Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic, Vienna, Austria. METHODS: This study comprised 40 patients with vitreoretinal pathology and coexisting significant cataract (study group) and 40 patients with significant cataract only (control group). The main outcome measure was intraocular lens (IOL) power prediction error. Secondary outcome measures were spherical equivalent, anterior chamber depth, axial length, keratometry values, and intraocular pressure. A multivariate regression analysis was performed. RESULTS: There was a significant difference in prediction error between the study group and control group (P< .05). The addition of vitrectomy was associated with induced myopia of approximately -0.4 diopter, more so in patients who had epiretinal membrane removal than in patients with macular hole surgery (P= .04). There was no significant difference in prediction error between the 3 IOLs used (P= .2). CONCLUSION: The myopic shift was strongly dependent on the diagnosis and the need for intraocular tamponade, indicating that a slightly hyperopic IOL should be used in patients having combined surgery.     

Myopic shift from the predicted refraction after sulcus fixation of PMMA posterior chamber intraocular lenses

BACKGROUND: To evaluate the refractive results of sulcus-fixated polymethylmethacrylate (PMMA) posterior chamber intraocular lenses (PC IOLs) after cataract surgery with and without posterior capsule complications. METHODS: The charts of patients who had undergone cataract surgery were reviewed, and eyes that had received sulcus-fixated PMMA PC IOLs were included in the study. Postoperative refraction, predicted postoperative refraction for in-the-bag IOL with the same diopter, intraoperative posterior capsular complications and vitrectomy, axial eye length, incision type (corneal or scleral), and surgery type were recorded and analyzed. The difference between actual postoperative refraction and predicted refraction for the in-the-bag lens was calculated for each patient. RESULTS: Of 143 patients (84 men and 59 women), 162 eyes with a sulcus-fixated posterior chamber intraocular lens were investigated. Mean age was 63.7 +/- 12.1 years. A mean myopic shift of -1.02 +/- 0.96 D from the predicted in-the-bag refraction was found. There were no significant differences between eyes with or without vitreous loss-vitrectomy (p = 0.8), eyes with scleral or corneal incisions (p = 0.11), and eyes having phacoemulsification or extracapsular cataract extraction (p = 0.93). In terms of axial length, there were no significant differences between long, normal, or short eyes (p = 0.85). INTERPRETATION: Sulcus fixation of a PMMA IOL originally planned for in-the-bag fixation caused approximately -1.00 D myopic shift in this study. We recommend that when sulcus fixation is necessary PMMA IOL power should be approximately 1.25 to 1.50 D less than the power for in-the-bag fixation. Axial length, incision type, vitreous loss and use of vitrectomy, and type of the surgery do not appear to alter the postoperative refraction significantly in eyes with sulcus fixation.     

Toric人工晶状体矫正散光的短期临床疗效

目的观察术前伴有较大角膜散光的白内障患者植入Toric人工晶状体（Acrysof SN60TT）后的屈光效果及囊袋内旋转稳定性。设计前瞻性病例系列。研究对象25例（30眼）角膜散光均大于1D的老年性及发育性白内障患者。方法术前通过生物测量及软件计算确定人工晶状体型号及放置轴位,并进行手术切口及目标人工晶状体轴位两步标记,行超声乳化白内障吸除手术,术中将人工晶状体准确放置于目标位置。术后随访3个月。主要指标裸眼视力、最佳矫正视力、总合散光、角膜散光、人工晶状体柱镜轴位。结果术后裸眼视力1个月为0．73±0．18,3个月为0．79±0．17。最佳矫正视力1个月为0．93±0．13,3个月为0．98±0．09。总合散光术后1个月为（0．68±0．53）D,3个月为（0．47±0．39）D。术后3个月角膜散光为（1．58±0．84）D,与术前（2．02±0．90）D相比明显下降（Jp=0．00）。手术源性散光为（O．62±0．32）D。术后3个月人工晶状体矫正散光（1．27＋0．69）D,与预计人工晶状体矫正散光（1．36±0．44）D相比,差异无统计学意义（P=0．31）。术后3个月人工晶状体旋转（4．0±3．2）°,旋转5。以内占76．7％。结论Toric人工晶状体在本文短期随访期间能有效地矫正散光,在囊袋内稳定,具有良好的旋转稳定性。（眼科,2009,18：84-87）     

影响年龄相关性白内障术后屈光误差的术前眼球生物学参数特征分析

目的 研究年龄相关性白内障术后屈光误差的分布特征以及影响屈光误差的术前眼球生物学参数特征。方法 回顾性研究。分析北京大学人民医院眼科就诊的年龄相关性白内障患者197例（197眼）的临床资料,采用Pentacam眼前节分析仪测量术前的前房深度（ACD）、前房容积、角膜横径（白到白距离,WTW）以及角膜球面像差,计算WTW与ACD比值（WTW/ACD）。采用IOLMaster测量术前角膜K值和眼轴,利用SRK-T公式计算预留屈光度。以术后3个月的主觉验光结果作为术后屈光度,减去术前预留屈光度,即为屈光误差（RE,<-0.50 D或>+0.50 D;-0.50~+0.50 D不认为存在屈光误差）。采用单因素回归和多元线性回归探索上述参数与屈光误差之间的关系。将存在屈光误差的患者分成近视误差组（<-0.50 D）和远视误差组（>+0.50 D）,采用独立样本t检验比较2组间各个参数的差异。结果 总共116例患者存在屈光误差,术后平均屈光误差为（-0.50±0.92）D;其中发生近视误差者88例（44.7%）,平均屈光误差为（-1.31±0.60）D;远视误差者28例（14.2%）,平均屈光误差为（+0.86±0.29）D。回归分析结果表明术前 WTW（β＝0.473,F=12.49,P<0.01）和术前ACD（β＝0.286,F=4.57,P<0.05）影响术后屈光误差;WTW/ACD比值对术后屈光误差的影响接近显著性水平（β＝－0.121,F=3.59,P=0.06）。多元线性回归分析最终仅WTW进入回归方程（F＝12.49,P<0.01）。近视误差组WTW/ACD为4.91±1.20,远视误差组为4.48±0.65,2组间差异有统计学意义（t=2.42,P<0.05）。结论 患者术前ACD、WTW可以影响年龄相关性白内障患者术后屈光误差,WTW/ACD反映前房形态,对于预测患者术后的屈光误差有一定临床意义。