不同的目标屈光度设计SMILE术后早期临床效果

目的在SMILE手术中设计不同目标屈光度手术方案,观察术后的疗效和可预测性,以期为临床合理设计手术方案提供依据。方法回顾性病例研究。接受SMILE手术的近视病例共104例（207眼）．人选患者的等效球镜度小于-8．25D,散光度小于-3．25D。根据手术后的目标屈光度分为3组：0D组目标屈光度为0．00D（82眼）,术前等效球镜度为（-6．26±1．47）D;＋0．25D组目标屈光度为＋0．25D（81眼）,术前等效球镜度为（-5．62±1．43）D;＋0．50D组目标屈光度为＋0．50D（44眼）,术前等效球镜度为（-4．31±2．75）D。术后1d、7d、1个月和3个月分别检查UCVA、BCVA、屈光状态及残余散光。应用方差分析检验术后不同时间点各组内屈光状态的稳定性和各组间视力的差异。结果①在术后1d、7d、1个月和3个月3组间视力比较差异均无统计学意义（F=2．67、0．82、0．62、0．25,P〉0．05）。②0D组、＋0．25D组和＋0．50D组组内在不同时间点间的等效球镜度差异无统计学意义（F=1．88、1．03、2．18,P〉0．05）。结论SMILE术后随时间推移屈光状态的变化较小,屈光状态和视力的稳定性好,在手术设计时个性化地行0．50D内过矫的设计调整是安全可行的。     

视知觉学习疗法治疗近视性弱视儿童屈光动态观察

目的:了解基于视知觉学习疗法(视频终端治疗)的近视性弱视儿童近视屈光增长规律及其影响因素。方法:选择行视知觉学习治疗的近视性弱视儿童54例(98只眼),前瞻性收集患者治疗前、后的近视屈光度动态变化资料,并按弱视程度、近视程度和疗效等特征进行分层分析。结果:近视性弱视儿童视知觉治疗后的球镜和等效球镜高于治疗前(P<0.05);治疗后等效球镜值年增长变化为1.00D以内占76.53%。轻、中、重度弱视的球镜和等效球镜动态变化差异均有统计学意义(P<0.05)。轻、中、重度近视的弱视眼镜、柱镜和等效球镜动态变化差异均无统计学意义(P>0.05)。不同疗效的弱视眼屈光度动态变化差异无统计学意义(P>0.05)。结论:近视性弱视儿童治疗后屈光度的增长主要来自球镜,散光变化不大;弱视程度是近视屈光度增长的影响因素,但近视程度和疗效对近视增长无影响。     

Clinical Characteristics of Glaucomatous Subjects Treated with Refractive Corneal Ablation Surgery

Purpose

To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS).

Methods

Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group.

Results

With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 µm, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003).

Conclusions

Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.     

传统综合治疗近视性弱视儿童屈光动态变化研究

目的探讨传统综合治疗前后近视性弱视儿童的近视屈光动态变化。方法选择2007—2009年在广西视光中心弱视门诊行传统综合治疗的近视性弱视患者45例（82只眼）,前瞻性收集患者治疗前后的近视屈光度,并对治疗前后屈光动态按患者弱视程度、近视程度和疗效等特征进行分层分析。结果（1）治疗后的球镜、柱镜和等效球镜高于治疗前（P〈0．05）;球镜、等效球镜的年均变化为（0．49±1．09）D／年和（0．54±1．09）D／年;等效球镜年均增长在1．00D以内（占91．5％）。（2）轻、中、重度弱视的球镜、柱镜和等效球镜动态变化差异均有统计学意义（P〈0．05）。（3）轻、中、高度近视程度的弱视眼球镜、柱镜和等效球镜动态变化差异均无统计学意义（P〉0．05）。（4）不同疗效的弱视眼屈光度动态变化差异无统计学意义（P〉0．05）。结论传统综合治疗对近视性弱视患者近视屈光度增长影响甚微,重度弱视程度的患者屈光动态变化低于轻、中度弱视患者。     

高度近视眼角膜中央厚度、眼压、眼轴及角膜曲率的相关性

目的探讨高度及超高度近视眼中央角膜厚度（CCT）、眼压（IOP）、眼轴（AL）及角膜曲率（CC）之间的关系,以为其临床矫治提供指导。方法横断面研究。测量128例（252眼）高度近视（≥6.00 D）患者的CCT、IOP、AL、CC等数据,依据等效球镜度（SE）分为3组,分析SE、CCT、IOP、AL、CC相互之间的相关性。组间比较采用方差分析,2个变量之间的相关性分析采用Pearson相关分析。结果3组间CCT比较差异有统计学意义（F=256.9,P＜0.05）,SE越高,CCT越薄,两者呈负相关（r=-0.024,P＜0.05）。SE与AL呈正相关关系（r=0.895,P＜0.01）。随SE增加,IOP有下降趋势,但两者之间不相关（r=-0.216,P＞0.05）。而CC随SE增加而变小,两者呈负相关关系（r=-0.231,P＜0.01）。随AL延长,IOP有下降趋势,但两者之间不相关（r=0.312,P>0.05）。平均CC随着AL的增大而逐渐变小,二者呈负相关关系（r=-0.291,P＜0.05）。随CCT增厚,IOP逐渐增大,CCT与IOP之间存在正相关关系（r=0.511,P＜0.01）。CCT与CC间不相关（r=-0.142,P＞0.05）。结论高度及超高度近视眼SE与AL正相关、与CCT负相关,与IOP无相关关系;AL与CC呈负相关而与IOP无相关关系;CCT与IOP呈正相关,与CC无相关关系。     

Intravitreal bevacizumab for pediatric exudative retinal diseases

Purpose

To detect if intravitreal bevacizumab can reduce retinal exudation, improve visual and anatomical outcomes, and facilitate the treatment in various pediatric exudative retinal diseases.

Patients and methods

Prospective, non-randomized, case series of nine eyes of pediatric exudative retinal diseases less than 18 years old which included six eyes with juvenile diabetic retinopathy, two eyes in children with Coats’ disease, and one eye with myopic choroidal neovascular membrane (CNV). All eyes received only intravitreal bevacizumab injection 1.25 mg/0.05 ml as the primary treatment. The need for adjuvant ablative procedures, including laser photocoagulation or cryotherapy, were performed and recorded. The need for supplementary intravitreal bevacizumab injection was recorded. The changes in pre- and post-operative best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded. Serial optical coherent tomography (OCT) and fundus flourescein angiography (FFA) were performed to follow treatment efficacy.

Results

The study included 19 eyes of 11 patients with age equal to or less than eighteen years with exudative retinal diseases including type I DM (n = sixteen eyes), Coats’ disease (n = 2 eyes), and due to myopic CNV (n = 1 eye). Mean pre-injection log MAR for all was 0.605 ± 0.174 and mean post-injection for all log MAR was 0.284 ± 0.247. While Mean pre-injection log MAR for DR and myopic CNV patients was 0.576 + 0.152 SD and mean post-injection log MAR for DR and myopic CNV patients was 0.229 + 0.189 at one year. Serial OCT measurements showed that mean CMT for all eyes was 355.8 ± 35.3 μm SD at baseline, which was decreased to 222.42 + 26.2 μm SD. The two eyes of Coats’ disease needed another two supplementary intravitreal bevacizumab injections. No ocular or systemic complications related to bevacizumab were noted during the entire course of follow-up.

Conclusion

Intravitreal bevacizumab appears to be a well-tolerated treatment for pediatric age group with various exudative retinal diseases. It has the potential as an adjuvant therapy for ablative procedures to improve final visual and anatomical outcome.     

视知觉学习治疗近视性弱视屈光度的观察及护理

目的 探讨视知觉学习治疗近视性弱视过程中患儿屈光度的变化及护理特点.方法 选择2007至2009年行视知觉学习治疗的近视性弱视患儿54例(98眼),收集治疗前后球镜、柱镜和等效球镜,并对不同程度弱视眼屈光变化进行比较.结果 视知觉学习治疗过程中近视性弱视患儿球镜年均增长0.52D,散光年增长0.03D;等效球镜年均增长在0.50D以内占57.14%;轻、中、重度弱视患儿的球镜和等效球镜变化有差异,但柱镜变化比较无显著差异.结论 视知觉学习治疗近视性弱视对患儿的屈光度增长影响甚微,但在治疗过程中仍需密切关注患儿近视屈光度变化.     

A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation

Purpose:To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques.Methods:In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared.Results:The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2).Conclusion:Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.     

近视眼眼球形态结构的改变及其对眼内压的影响

了解近视眼的成因对近视眼的治疗具有重要意义。近视眼可导致眼球形态结构的改变,包括眼轴、角膜厚度、眼前房、晶状体及玻璃体均有不同程度的改变,眼轴延长可直接导致屈光度的近视化。近视眼的平均眼压较正常人眼压增高,影响眼压的主要因素为眼轴长度、屈光度及角膜厚度。近视眼、眼轴延长、眼压增高三者关系密切,现就近视眼眼球形态的改变及其对眼压的影响进行综述。     

儿童IOL术后近视度变化的研究

为了探讨儿童白内障注吸术 +IOL术后近视度的变化 ,对 2 1例 (2 4只眼 )行白内障注吸术 +IOL的儿童进行回顾性分析 .按年龄分组 ,比较随访初次与末次的屈光度 .结果 :平均近视度变化 3～ 5岁组为 -0 89± 0 40D ;6～ 10岁组为 - 0 97± 0 18D ,两组之间无显著性差异 (t =0 2 1,P >0 0 5 ) ;91 6 7%的眼近视度 <1 5 0D ,83 33%的眼视力≥ 0 5 .结果表明大多数 3～ 10岁儿童施行IOL术时 ,欠矫 1 0 0D ,可望获得正视 .