选择性散光轴切口对白内障超声乳化术后角膜散光的影响

目的 探讨根据患者术前角膜散光不同,在不同部位选择性预设散光轴透明角膜切口行白内障超声乳化联合后房型折叠式人工晶状体植入术,对术后患者角膜散光的影响.方法 收集老年性白内障患者102例150只眼,分为选择性散光轴位的透明角膜切口(A组)、颞侧透明角膜切口(B组)和11点方位透明角膜切口(C组)3组,施行超声乳化联合折叠式人工晶状体植入术,比较术后视力及角膜散光的变化情况.结果 术后3月视力≥1.0,A组67%,B组56%,C组50%,差异有统计学意义(P＜0.01);A组术后3个月平均角膜散光低于B、C组(P＜0.05),较术前平均减少了0.32D(P＜0.05);且A组中19例术前角膜散光度≥1.00D的患者,术后3个月角膜散光度减少了0.71D(P＜0.05).术后3个月平均SLA,A组最小(P＜0.05).结论 选择在患者角膜屈光力最大轴向上行个体化的透明角膜切口,能减少患者术后角膜散光,有效控制白内障超声乳化手术源性角膜散光,进一步提高患者术后视力,尤其适用于术前角膜散光在≥1.00D的白内障患者.

Abstract：

Objective To investigate the surgically induced refractive change after phacoemulsification with selective maximum astigmatic axis clear incision. Methods Phacoemulsification was performed on 102 cases of 150 eyes with senile cataract through a clear corneal incision without suture. The changes of corneal astigmatism before and after operation in group A (incision at the maximum astigmatic axis) or B (incision at the temporal) and C (incision at the 11:00) were compared. Results Three months after the opera tion, the Best correction visual acuity more than 1.0, were 67% in group A, 56% in group B and 50% in group C (P ＜0.01). The mean postoperative astigmatism of group A decreased 0.32 D than the preoperative one (P ＜0.05) and was less than the postoperative one of group B or C. Postoperatively, the mean astigmatism of 19 patients who preoperative astigmatism more than 1.00D in group A decreased 0.71 D (P ＜0.05). Among the three groups, the mean postoperative surgically induced astigmatism (SIA) of group A was minimum (P ＜0.05).Conclusions The incision placed on the maximum astigmatic axis in phacoemulsification is worth to be recommended, because of the corneal astigmatism can be significantly reduced postoperatively, the SIA can be controlled effectively and patients can get a better visual acuity, especially to patients preoprative astigmatism more than 1.00D.     

采用不同的手术切口玻璃体切除术治疗复杂眼内异物

目的:探讨采用不同的手术切口玻璃体切除术在治疗复杂眼内异物的效果.方法:对28例复杂眼内异物患者均采用闭合式玻璃体切除术及直视下异物取出术.,根据其病情不同分别联合视网膜脱离复位术、晶体咬切术、注入过氟化碳液体、眼内光凝、C3F8气体或硅油填充、巩膜外冷凝术等.根据异物大小及形状不同,采用不同的部位及不同形状的手术切口.结果:本组28例复杂异物均一次性取出.4例异物最小径＞5mm 的病例从角巩缘切口取出,24例从睫状体平坦部取出(其中6例不规则的异物5 mm＞最小径＞3 mm 采用"L"形切口,18例异物最小径≤3 mm采用"-"形切口).28例患者术后有21例视力提高占75.0%,3例视力不变占10.7%,3例视力下降占10.7%.1例合并有严重眼内炎,术后控制不良行眼球摘除.结论:对于复杂眼内异物术中应根据异物的大小、形状采用不同的部位及形状的手术切口,采用玻璃体切除联合术大多能挽救眼球并恢复有用的视力.     

超声乳化术毕眼压对无缝线透明角膜切口闭合的影响

目的：探讨超声乳化术毕眼压与早期无缝线透明角膜切口闭合的相关性。方法将90例（94眼）住院行手术治疗的老年性白内障患者随机分为A组46例（49眼）和B组44例（45眼）。 A组设置术毕眼压15～20 mmHg,B组设置术毕眼压21～25 mmHg。术后3 d内,观察透明角膜切口、眼压、视力、中央角膜内皮细胞、角膜厚度的情况。结果术后3d内,两组视力、眼压、角膜内皮细胞无明显差异,透明角膜切口闭合有差异,角膜切口闭合程度B组明显优于A组。结论术毕适度高眼压能促进超声乳化术后透明角膜切口闭合,眼前段光学相干扫描仪能无创、可重复、高度灵敏的检测早期术后切口情况,指导手术操作,减少术后并发症的发生。     

改良DACE显微手术治疗球形孔源性视网膜脱离

目的 探讨改良的放液、玻璃体腔内注气、冷凝、加压（drain－air－cryotherapy－explants,DACE ）手术方法对隆起较高的球形孔源性视网膜脱离的临床疗效。方法 回顾2008年3月～2010年1月球形孔源性视网膜脱离患者27例27眼,在原DACE手术方法基础上进行改良,先预置硅胶垫压缝线,巩膜外放液后取消眼内注射空气,改为用消毒棉签在结膜筋膜下巩膜表面顶压维持眼压;将间接眼底镜下裂孔定位、冷凝改为显微镜直视下操作。结果 随访3月～2年,手术一次性视网膜复位26眼（96.30%）,矫正视力在0.3以上者18眼。结论 改良DACE是治疗球形孔源性视网膜脱离的有效手术方法。