角膜移植术后白内障应用扭动模式超声乳化吸出术治疗分析

目的观察扭动模式超声乳化白内障吸出术（PKP）治疗角膜移植术后硬核白内障的安全性和效果。方法回顾性分析2009年3月至2009年10月在我院眼科住院行白内障超声乳化吸除术的PKP患者28例（32只眼）临床资料。患者PKP术后11个月至8年,平均3.6年;根据晶状体核硬度分级,分别将28例（32只眼）并发Ⅲ级以上硬核白内障患者随机分为A、B两组,其中男12例（14只眼）,女16例（18只眼）。A组16只眼行常规超声乳化白内障吸出术,B组16只眼行扭动模式超声乳化白内障吸出术。观察术中前房稳定性、能量释放及时间,并比较术后第1天、3天、1周、2周角膜水肿及内皮细胞的变化及手术前后视力情况。结果术中B组前房稳定性优于A组（P〈0.05）;术中能量使用及超声时间明显少于A组,术后第1天、第7天B组角膜水肿情况明显轻于A组（P〈0.05）;术后第1天、第7天B组视力恢复明显优于A组（P〈0.05）。结论扭动模式超声乳化白内障吸出术是一种安全、高效、疗效好的手术方式,尤其对于硬核白内障的处理,优于传统超声乳化白内障吸出术。     

扭动超声乳化加囊膜染色在成熟期白内障摘除术的疗效观察

目的观察扭动超声乳化加囊膜染色在成熟期白内障摘出术中的应用。方法将80例（128眼）成熟期白内障患者随机分为A、B两组,其中A组40例（66眼）行扭动超声乳化白内障摘除术。B组40例（62眼）行传统超声乳化白内障摘除术,术中采用吲哚青绿行前囊染色后撕囊,术中观察前房稳定性,能量释放及时间,术后第1、3、7天观察角膜水肿、前房反应和视力情况。跟踪角膜内皮细胞变化。结果术中连续环形撕囊（CCC）成功率为96.8%,A组前房稳定性优于B组（〈0.05）;术中能量使用及超声时间明显少于B组,术后第1、3、7天时A组角膜水肿情况明显少于B组（〈0.05）;术后第1、3天A组视力恢复明显好于B组（〈0.05）。结论扭动超声乳化加囊膜染色在成熟期白内障摘除术应用是安全且高效、疗效好的手术方式,尤其对于成熟期中硬核白内障的处理,优于传统超声乳化白内障摘出术。     

超声乳化术与小切口非超声乳化术治疗白内障疗效比较

目的：比较超声乳化术与小切口非超声乳化术治疗老年性白内障的临床疗效。

方法：白内障患者355例393眼分成A、B两组,其中A组180例193眼施行小切口非超声乳化白内障手术,B组175例200眼施行超声乳化白内障手术。术后观察视力、角膜散光、角膜内皮细胞计数情况。

结果：术后1d,患者视力恢复情况超声乳化手术组明显优于小切口非超声乳化手术组,但术后7d和30d两组无显著差异。术后7d,小切口非超声乳化组角膜散光度明显高于超声乳化组,但术后30d无显著性差异。对核硬度在Ⅳ～Ⅴ级的患者,超声乳化术后角膜内皮细胞计数少于小切口非超声乳化组,统计学分析有显著差异。

结论：应针对老年性白内障患者核硬度的具体情况,选择合适的手术方式进行治疗。     

抗青光眼术后低密度角膜内皮细胞白内障患者行超声乳化并人工晶状体植入术的临床观察

目的评价超声乳化技术在抗青光眼术后低密度角膜内皮细胞的白内障患者中应用的可行性、手术技巧及临床效果。方法抗青光眼术后低密度角膜内皮细胞的白内障患者4例（4只眼）,术前角膜内皮细胞密度为348．1—1724．6个／mm^2,均接受超声乳化联合人工晶状体植入术,观察其术前角膜内皮细胞密度及术前、术后视力的改变。结果术后3只眼术后视力均有明显的提高。1只眼视力无明显改善。结论抗青光眼术后低密度角膜内皮细胞的白内障患者在一定程度上可行超声乳化联合人工晶状体植入术。     

低倍镜补偿景深超声乳化手术和小切口白内障手术对比观察

目的：观察低倍镜补偿景深下超声乳化白内障摘除术和小切口白内障囊外摘除术的临床疗效。方法：回顾性分析869例1258眼白内障患者手术治疗的情况,其中采用超声乳化白内障摘除手术者共计247例432眼;采用小切口白内障摘除术者共计622例826眼,对患者的术后视力、角膜内皮计数、角膜水肿情况及并发症进行统计学分析。
　　结果：两组患者术后1wk,1mo 视力恢复情况和术后1d 角膜水肿情况无统计学差异(P >0.05);角膜内皮计数损失,小切口白内障摘除手术组较超声乳化白内障摘除组略好(P<0.05)。
　　结论：基层医院手术显微镜景深不够清晰的情况下,仍可采用低倍镜补偿景深开展小切口白内障囊外摘除术和超声乳化白内障摘除术。     

微切口白内障超声乳化术的临床研究进展

白内障超声乳化摘除联合人工晶状体植入是目前治疗白内障最有效的方法.随着屈光性人工晶状体手术时代的到来,白内障手术已经从传统的复明手术向现代屈光性白内障手术转变.最大限度地缩小手术切口、尽可能地获得术后最佳视功能,已成为人们追求的目标.微切口白内障超声乳化术作为达成该目标的重要方法,正受到越来越多的关注.我们通过复习国内外文献,简要回顾了微切口超声乳化术的发展历史,着重阐述了微切口超声乳化术对角膜散光、角膜内皮细胞、术后视力的影响.     

白内障小切口手法摘除术与超声乳化吸出术临床疗效比较观察

目的比较小切口白内障摘除术与超声乳化吸出术对术后视力、角膜散光、手术并发症的影响。方法随机选择102例（102只眼）白内障分别行小切口手法非超声乳化摘除与超声乳化吸出术,观察两组术后临床疗效。结果术后3个月手法组及超声乳化组的散光分别为（1.58±0.89）D及（1.57±0.88）D,术后最好矫正视力大于0.3者分别为95.02%及95.89%,角膜水肿于术后半个月后均消退。结论术后3个月两种手术方式疗效相近,无超声乳化仪的基层医院可推广白内障小切口手法摘除术。     

Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review

PURPOSE: To determine the risk for rhegmatogenous retinal detachment (RRD) after phacoemulsification. SETTING: Private and public facility, Auckland, New Zealand. METHODS: A retrospective study of 1793 consecutive patients having cataract surgery by phacoemulsification was performed. Patients younger than 40 years were excluded, as were patients who had cataract surgery after ocular trauma. Patients having cataract surgery combined with other ocular procedures such as keratoplasty, glaucoma drainage surgery, or posterior segment surgery were similarly excluded. RESULTS: Rhegmatogenous retinal detachment occurred in 1.17% of the patients having cataract surgery. The risk was greater in patients younger than 50 years (5.17%) and less in those older than 70 years (0.64%). The median interval between cataract surgery and development of the retinal detachment was 39 months. The rate of retinal detachment was greater with complicated cataract surgery, but there was no increased risk for those eyes requiring neodymium:YAG laser capsulotomy. CONCLUSIONS: The overall risk for RRD after cataract surgery by phacoemulsification was small. However, in the younger patient, the risk for pseudophakic detachment was higher. In light of this finding, the requirement for cataract surgery in this group should be reassessed.     

Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience

PURPOSE: Phacoemulsification cataract surgery is one of the most important surgical procedures learned by ophthalmology residents during their residency training. We evaluated the visual outcomes and incidence of vitreous loss of phacoemulsification cataract surgeries performed by ophthalmology residents without prior planned extracapsular cataract extraction experience. DESIGN: Interventional case series. METHODS: A retrospective review was performed on 332 consecutive phacoemulsification cataract surgeries performed by third-year ophthalmology residents from July 1999 through June 2001. Data included are preoperative and postoperative best-corrected visual acuity, preexisting ocular comorbidities, and intraoperative and postoperative complications. RESULTS: Postoperative best-corrected visual acuity was 20/40 or better in 89% of eyes. After excluding the cases with preexisting ocular comorbidities, the percentage increased to 97.7%. Vitreous loss occurred in 4.8% of cases. CONCLUSIONS: Ophthalmology residents can learn to perform phacoemulsification cataract surgery safely and effectively without prior planned extracapsular cataract extraction experience.     

Phacoemulsification cataract surgery and unplanned anterior vitrectomy--is it bad news?

PURPOSE: The aim of this study was to determine the final visual outcome of patients who undergo complicated phacoemulsification cataract surgery in which the posterior capsule is compromised and vitrectomy was required. METHODS: Data were collected for patients operated on over an 18-month period from the 1st of January till the 24th of June 1999 at the Department of Ophthalmology, Leicester Royal Infirmary. All grades of surgeons were included and patients were identified from the theatre logbook. A standard proforma was completed and the data evaluated. RESULTS: A total of 2538 phacoemulsification cataract operations were performed over this duration. Of these, 2446 (96.4%) had uncomplicated phacoemulsification cataract surgery while 92 (3.6%) required anterior vitrectomy.In order to allow for a more accurate interpretation of the visual outcome, patients were divided into two groups, depending on whether or not there was pre-existing eye disease at initial listing.Sixty-five patients did not have pre-existing eye disease. From this, notes were available for 57 patients, whereby the best-corrected visual acuity (BCVA) was obtained postoperatively.Vision of 6/12 or better was used to define acceptable postoperative vision. This group consisted of 49 patients (86%): five had visual acuities of 6/12, 26 = 6/9, one = 6/7.5 and 17 = 6/6. There were eight (14%) patients with poor visual outcome, largely represented by patients with cystoid macular oedema (8.8%). The most frequent stage of vitreous loss was during primary phacoemulsification in 46 (50%). Irrigation and aspiration, which resulted in 21 (23%) instances, followed this.The rate of posterior capsule rupture and anterior vitrectomy during phacoemulsification cataract surgery is 2% when performed by consultants, 4% by specialist registrars and staff grades and 10% by senior house officers. CONCLUSION: This study looks at the final visual outcome of patients who underwent unplanned anterior vitrectomy during routine phacoemulsification cataract surgery, in a university teaching hospital in the United Kingdom. It includes all levels of surgeons with varying experience. The rate of vitreous loss in this study for phacoemulsification cataract surgery is 3.6%. Patients who undergo complicated phacoemulsification cataract surgery do comparatively well.     

超声乳化吸出先天性白内障

目的:观察超声乳化在先天性白内障的应用。方法:对32例49眼行先天性白内障超声乳化吸出及人工晶状体植入,术中应用隧道切口和连续环形撕囊技术,低能量超声乳化或I/A系统清除晶状体核和皮质,囊袋内植入折叠式人工晶状体。并与同期相同条件的病例行ECCE PMMA人工晶状体植入术41例59眼相对比,观察术后视力及并发症。结果:术后1a时2组病例脱残率和并发症发生率有显著差异(P<0.01),其中后发性白内障发生率,超声乳化组6%,对照组76%。结论:本组病例中超声乳化吸出先天性白内障,有良好的前房稳定性,彻底清除晶状体皮质,术后并发症少。     

Bimanual microincisional cataract surgery technique and clinical outcome

Bimanual microincisional cataract surgery has been introduced recently as a technique for cataract surgery and it is gaining interest of many cataract surgeons in the world. Over the last few years many changes were made in the phacoemulsification machines and the intraocular lenses design which allowed bimanual microincisional cataract surgery to be safer and more efficient. The purpose of this review is to introduce the technique of bimanual microincisional cataract surgery and to review all the prospective randomized studies comparing bimanual microincisional cataract surgery and standard phacoemulsification in term of safety and efficacy parameters.     

超声乳化术治疗青光眼术后瞳孔缘全粘连白内障

目的 探讨超声乳化吸出术治疗青光眼术后瞳孔缘全粘连白内障的疗效。方法 运用超声乳化术治疗青光眼术后瞳孔缘全粘连的白内障56例58眼。结果 术后随访3．6月，所有患眼视力均明显提高。结论 对于青光眼术后瞳孔缘全粘连的白内障，超声乳化吸出术是首选的有效方法。     

白内障伴血液系统疾病行超声乳化术临床分析

目的:评价超声乳化技术在伴有血液系统疾病的白内障患者手术的临床效果。方法:伴有血液系统疾病的白内障患者14例19眼,行白内障超声乳化联合人工晶状体植入手术,观察术前术后视力变化。结果:所有术眼视力均有不同程度的提高。最佳矫正视力≥0.3者15眼占79%,最佳矫正视力≥0.5者10眼占53%。结论:伴有血液系统疾病的白内障患者在一定程度上可以行白内障超声乳化合并人工晶状体植入术。     

Bimanual microincisional phacoemulsification: the future of cataract surgery?

PURPOSE OF REVIEW: Bimanual microincisional cataract surgery has recently become a procedure of interest among cataract surgeons, and a number of trials have shown its potential as a minimally invasive cataract surgery. The purpose of this review is to examine the studies that have been published to date and to evaluate the potential of bimanual phacoemulsification as a method of cataract extraction. RECENT FINDINGS: Recent studies have reinforced the safety of bimanual phacoemulsification. In particular, recently published studies have focused on evaluating various phacoemulsification technologies and their safety when used in bimanual phacoemulsification. Newly developed rollable hydrophilic acrylic ThinOptX lenses have been shown to be implantable in 2.2-mm incisions safely with good visual outcomes. SUMMARY: Bimanual phacoemulsification has been a potential technique for a number of years, but only recently have the technology, software, and technique advanced sufficiently to make bimanual phacoemulsification a feasible method of cataract extraction. Although the main disadvantage to bimanual phacoemulsification remains the lack of intraocular lenses that can fit through microincisions, necessitating the enlargement of corneal wounds for intraocular lens implantation, bimanual phacoemulsification has a number of advantages over traditional small-incision phacoemulsification. Theses advantages have been a source of interest for cataract surgeons and surgical companies who are now developing technologies that will permit the performance of truly microincisional cataract surgery.     

基层医院在临床路径下开展小切口非超声乳化白内障摘除手术的卫生经济学评价

目的:评价临床路径下开展小切口非超声乳化白内障摘除术的手术效果和患者的住院天数、住院费用等卫生经济学指标,制定一套适合基层医院开展白内障复明工程的管理体系和手术方法。方法:制定与实施老年性白内障的临床路径表,在临床路径下将96例老年性白内障患者随机分为两组,A组采用小切口非超声乳化白内障摘除术,B组采用超声乳化白内障吸除术,并观察比较两组患者术后第1d远视力、术中术后并发症、患者住院天数与住院总费用的不同。结果:A组与B组患者术后第1d远视力较术前均有明显提高(P<0.01),但两组术后远视力比较,差异无统计学意义;A组术后角膜水肿发生率低于B组,差异有统计学意义(P<0.05),其余各并发症发生情况差异无统计学意义;A组与B组住院日比较差异无统计学意义,但A组住院费用明显低于B组,差异有显著统计学意义(P<0.01)。结论:基层医院在临床路径下开展小切口非超声乳化白内障摘除术能提高医疗质量,降低医疗成本,减少医疗资源的消耗,让更多白内障盲患者受益。符合卫生经济学的根本宗旨,值得推广。     

Cataract surgery after needling revision of trabeculectomy blebs

PURPOSE: To assess the effect of cataract surgery on trabeculectomy blebs that have previously had successful needling revision. STUDY DESIGN: A retrospective controlled study. PATIENTS AND METHODS: A cohort of patients undergoing needling of a poorly functioning trabeculectomy bleb was collected. From this cohort a group having had a successful needling outcome who subsequently underwent uneventful phacoemulsification was identified. Each member of this phacoemulsification group was matched with 2 controls from the cohort who had also had success from needling but who had not undergone cataract surgery. Survival analysis was performed using the date of cataract surgery as the entry time for the phacoemulsification group. For controls the entry time was the date of needling adjusted by subtracting the time between needling and cataract surgery of the matched phacoemulsification group subject. In this way an identical period had elapsed between needling and entry time for both phacoemulsification group and controls. Survival depended on (a) intraocular pressure (IOP) < or =21 mm Hg and (b) IOP <80% of preneedling IOP, on the same or fewer glaucoma drops and without further glaucoma surgery. RESULTS: Forty-five patients were included. Intervals from trabeculectomy to needling, needling to phacoemulsification, and from phacoemulsification to final follow-up ranged from 1 to 320, 4 to 15, and 5 to 19 months, respectively. Mean survival for the phacoemulsification group was 34.4 weeks and 190.0 for controls [hazard ratio 8.1 (95% confidence interval: 2.8-23.9) (log rank P<0.0001)]. Survival at final follow-up was 4/15 and 25/30 for cases and controls, respectively (chi2 P=0.0002). CONCLUSIONS: Previously successful bleb needling can be significantly compromised by subsequent cataract surgery.     

扭动超声乳化白内障摘除术的疗效观察

目的:观察扭动超声乳化白内障摘出术治疗Ⅲ级以上硬核白内障的临床疗效。方法:将63例(78眼)III级以上硬核白内障单病种患者随机分为A、B两组,其中A组37眼行常规超声乳化白内障摘除术,B组41眼行扭动超声乳化白内障摘除术。术中观察前房稳定性,能量释放及时间,术后第1,7d观察角膜水肿,前房反应和视力情况。结果:术中B组前房稳定性优于A组(P<0.05);术中能量使用及超声时间明显少于A组,术后第1,7dB组角膜水肿情况明显少于A组(P<0.05);术后第1,7dB组视力恢复明显好于A组(P<0.05)。结论:扭动超声乳化白内障摘除术是一种安全、高效、疗效好的手术方式,尤其对于硬核白内障的处理,优于传统超声乳化白内障摘出术。     

Management of coincident glaucoma and cataract

Cataract and glaucoma are two very common conditions that frequently are coincident within the same patient. The surgical treatment of the patient with both cataract and glaucoma has changed considerably in the era of small-incision cataract surgery. Additionally, many surgeons are employing antimetabolites routinely in combined phacoemulsification and trabeculectomy. This article reviews the literature as it pertains to combined cataract and glaucoma surgery within the 1-year scanning period. This is not a comprehensive review in that many very important articles are excluded because they were published either before or after the scanning period. The important topics included within this article involve the use of mitomycin C in combined surgery, the comparison of combined phacoemulsification and combined standard extracapsular procedures, long-term results of combined cataract and glaucoma surgery, the survival of filtration blebs after cataract extraction in eyes that had previous trabeculectomy, new techniques of combined surgery including clear corneal cataract extraction combined with trabeculectomy, and the effect of phacoemulsification on intraocular pressure in patients with and without glaucoma.     

Anterior chamber flare after trabeculectomy and after phacoemulsification

AIMS: To evaluate and compare prospectively the anterior chamber inflammatory response after phacoemulsification cataract surgery and after trabeculectomy with peripheral iridectomy. METHODS: Anterior chamber inflammation was measured using the Kowa FM-500 laser flare meter in 131 patients undergoing trabeculectomy and 148 patients undergoing phacoemulsification cataract extraction with intraocular lens implantation. Flare was measured before surgery and on each postoperative visit up to 12 months. RESULTS: Before surgery there was no significant difference in flare readings between the two groups. Following trabeculectomy flare returned to baseline levels 4 weeks after surgery, while following phacoemulsification cataract extraction it remained significantly higher at week 6 (p<0.006) and month 3 (p<0.05). CONCLUSIONS: Anterior chamber inflammation is more prolonged after cataract surgery than after trabeculectomy. This may have implications for the timing of trabeculectomy in relation to cataract surgery.