AkreosAdapt折叠式人工晶体植入的临床体会

目的：探讨Akreos Adapt折叠式人工晶体植人的临床疗效。方法：对62例（68眼）白内障患者行超声乳化术植人Akreos Adapt折叠式人工晶体作为观察组，以植入两襻亲水性丙烯酸酯折叠式人工晶体（oii）71例（80眼）作为对照组。术后观察视力、角膜曲率和角膜内皮细胞密度变化，术后3个月观察人工晶体的位置和晶状体后囊膜的混浊情况，对两组结果进行统计学分析。结果：术后早期矫正视力、手术性散光度数、晶状体后囊膜混浊的发生率、人工晶体位置，观察组均优于对照组，两组比较差异有统计学意义（P〈0．05）。术后3个月矫正视力、角膜内皮细胞的丢失率、手术性散光度数，两组比较差异无统计学意义（P〉0．05）。结论：Akreos Adapt折叠式人工晶体植人方便，居中性好，安全性高，视力恢复快，并发症少，是较为理想的人工晶体。     

人工晶体植入术患者超声检查的价值

目的探讨白内障超声乳化吸出联合人工晶体植入术做眼部超声检查的临床意义。方法对68例白内障患者人工晶体植入术超声检查的情况进行分析。结果术前做超声检查者50例均成功植入人工晶体,其中15例患者视力中等,其余患者视力良好;18例人工晶体植入术前未做超声检查者,有12例术后视力良好、中等;有6例合并不同球内病变者,术后无视力、视力低下或光感。结论超声检查可查清眼球内部及眼底病变情况,对白内障术前眼后段状态可提供重要的参考,对手术操作和选择手术方式有指导意义。     

Management of nucleus and IOL drop

Background: Thirty six cases of lenticular nucleus drop following phacoemulsification and 43 cases of posterior dislocation of intraocular lens (IOL) inclusive of two paediatric cases were managed by a modified vitrectomy procedure without using perfluorocarbon liquid (PFCL).     

糖尿病患者白内障超声乳化吸出联合人工晶体植入术50例疗效观察

目的:观察糖尿病(DM)患者行白内障超声乳化吸出联合人工晶体植入术的临床效果.方法:50例(55眼)糖尿病白内障患者接受白内障超声乳化吸出联合人工晶体植入术,选择随机抽取同期年龄施行白内障超声乳化吸出联合人工晶体植入手术的非糖尿病患者50例(55眼)为对照组,比较两组术后视力及并发症情况.结果:两组术后并发症、术后视力比较差异无统计学意义.结论:糖尿病白内障患者在术前空腹血糖控制良好的情况下行超声乳化吸除联合人工晶体植入术能获得较满意的疗效.     

六种人工晶状体计算公式预测三焦点人工晶状体屈光度准确性的比较

目的：评估Barrett Universal II计算公式预测三焦点人工晶状体（IOL,AT Lisa tri.839MP）屈光度的准确性,并与其他5种IOL计算公式（Haigis、HofferQ、SRK/T、SRKII和Holladay1）进行对比。方法：前瞻性临床研究。选择2016年12月至2018年8月于武汉爱尔眼科医院行飞秒激光辅助超声乳化白内障吸除联合三焦点IOL植入术的患者。术前使用Lenstar LS 900进行光学生物测量,并通过该仪器内置的其中6种IOL计算公式预测术后屈光度,IOL优化常数取自ULIB网站。随访至术后3个月行主觉验光,比较各IOL计算公式平均绝对屈光误差（MAE）的差异,并对各公式绝对屈光误差中值 （MedAE）、绝对屈光误差最大值（MaxAE）以及术后屈光误差在±0.5 D、±1.0 D和±2.0 D范围内患眼的百分比进行评估比较。数据采用Kruskal-Wallis H检验进行分析。结果：本研究最终纳入患者 55例（78眼）。根据各公式MAE值由小到大排序,依次为Barrett universal II（0.332 D）、SRK/T（0.420 D）、 Haigis（0.480 D）、Holladay1（0.607 D）,HofferQ（0.626 D）以及SRKII（0.822 D）。各公式MAE差异具有统计学意义（P<0.001）。Barrett Universal II公式中MaxAE小于其他IOL计算公式。术后屈光误差在 ±0.5 D、±1.0 D以及±2.0 D范围内患眼所占百分比,Barrett Universal II公式最高,分别为73%、94.8% 以及100%。结论：Barrett Universal II、SRK/T、Haigis公式能更准确地预测患者术后实际屈光结果。因此,对于植入三焦点IOL的患者我们推荐使用Barrett Universal II、SRK/T或者Haigis公式。     

Comparison of postoperative optical quality according to the degree of decentering of V4c implantable collamer lens

AIM: To evaluate the clinical outcomes of V4c implantable collamer lens (Hole ICL) implantation with regard to the optical quality assessed according to different degrees of decentering. METHODS: This included 49 eyes that received conventional ICL and 94 eyes that received Hole ICL. The eyes that received Hole ICL were divided into three groups according to the degree of decentering: group 1, central hole within 1 hole diameter (HD) from the pupil center; group 2, central hole within 1 HD to 2 HD; and group 3, central hole within 2 HD to 3 HD. Visual acuity (VA), intraocular pressure (IOP), and spherical equivalent (SE) values were assessed at 1wk, 1 and 3mo after surgery. The ocular modulation transfer function, Strehl ratio, objective scattering index, and higher order aberrations (HOAs) were measured for 4-mm pupils at 3mo after surgery. RESULTS: There were no significant differences in VA, IOP, and SE among the conventional and Hole ICL groups. With regard to HOAs, values for coma and spherical aberrations showed no differences. The total HOA and trefoil values were significantly higher in group 2 than in group 1 (P=0.02, 0.03, respectively). There were no significant differences among groups with regard to other optical quality parameter at 3mo after surgery. CONCLUSION: Our results suggest that Hole ICL implantation provides satisfactory visual quality that is equivalent to that provided by conventional ICL, regardless of the presence of central hole and degree of decentering.     

有晶状体眼后房型人工晶状体植入治疗屈光不正的研究进展

屈光不正(refractive errors)是常见的眼科疾病,可以通过配镜、激光屈光手术等方法为患者进行矫正,但是这些方法对高度屈光不正、圆锥角膜等疾病的治疗有一定的局限性。有晶状体眼后房型人工晶状体(ICL)植入术是矫正屈光不正的主要方式之一,目前主要应用于矫正高度近视和散光,为探讨ICL植入术矫正低、中、高度近视及远视等的安全性和有效性,本文将会对ICL植入术矫正屈光不正的研究进展进行综述。     

玻璃体切除术中白内障的不同处理方式及远期疗效观察

目的:通过观察玻璃体切除手术中白内障的不同处理方式及远期疗效,寻找玻璃体切除手术中最适宜的白内障的手术方式。方法:选取2006-06/2009-08于我院行玻璃体视网膜手术联合晶状体摘除手术的糖尿病视网膜病变患者50例50眼。采用标准三通道玻璃体切除手术方式。对术前晶状体混浊影响术中玻璃体手术操作或术中晶状体混浊加重无法进行玻璃体手术的患眼同时行晶状体手术。患者随机分为两组,晶状体超声乳化组(A组)和晶状体超声粉碎组(B组),各25例25眼。晶状体手术完成后,建立标准的巩膜三通道切口,进行前后段的玻璃体切除术,完全切除周边前段玻璃体和玻璃体后皮质。部分病例同时行剥膜,部分患者同时行硅油填充术。手术结束后,根据视网膜情况决定是否囊袋内或睫状沟内植入折叠人工晶状体。观察术后1,3,6mo的视力、前房反应程度、虹膜表面新生血管情况、囊膜混浊情况和人工晶状体的位置。术后均按常规局部应用抗生素、激素眼药水和短效散瞳剂,检测眼压和进行裂隙灯散瞳检查。结果:两组手术经过顺利,术中晶状体囊膜完整。两组同时行硅油充填15眼。A组术后囊袋内植入AcrysofNatural人工晶状体15例15眼。B组术后睫状沟内植入AcrysofNatural人工晶状体18例18眼。术后最佳矫正视力:随诊3～22mo,乳化组手术后视力为光感3眼,眼前手动者10眼,0.1～0.3者12眼,粉碎组手术后视力为光感者4眼,眼前手动者10眼,0.1～0.3者11眼,差别无显著性(P>0.05);乳化组术后1,3,6mo后囊膜混浊逐渐增加,以后囊周边部及前囊膜为主,术后3～6mo,取硅油时后囊膜混浊不妨碍手术前后对眼底的检查,粉碎组术后2～4wk晶状体前囊膜混浊逐渐加重,术后3～6mo取硅油时14例均有严重的囊膜混浊,16例同时进行前囊膜切开术,差别有显著性(P<0.05);人工晶状体偏移程度:乳化组有4眼发生轻度偏移,粉碎组有10眼发生轻、中度偏移,差别有显著性(P<0.05)。结论:本组观察表明,玻璃体切除手术中,对混浊的晶状体采取超声乳化手术方式的远期疗效优于晶状体超声粉碎术。由于现有人工晶状体的设计多适用于囊袋内植入,符合生理解剖结构,其后表面的方边设计有利于减少后发性白内障的发生。囊袋内的稳定植入,有利于减少术后的炎症反应。     

The triple procedure: in the bag placement versus ciliary sulcus placement of the intraocular lens

AIMS: To evaluate the influence of intraocular lens (IOL) placement on triple procedure clinical results and to investigate whether it is appropriate to use phacoemulsification in patients with large lens nucleus. METHODS: 40 consecutive penetrating keratoplasties combined with cataract extraction performed in a single institution were studied. Whenever possible a capsulorhexis was performed and the IOL was placed into the capsular bag. Phacoemulsification was used when the nucleus was too large to pass through the capsulorhexis. RESULTS: Out of 25 patients with an intact capsulorhexis phacoemulsification was used in 13 (52.0%) whereas the entire nucleus passed through the capsulorhexis in the remaining 12 patients (48%). The average 12 month visual acuity was 0.46 (SD 0.21) in patients with in the bag IOL (n = 23) and 0.29 (0.08) in patients with ciliary sulcus IOL (n = 13) (p = 0.04). Elevated intraocular pressure occurred in 26.1% (6/23) of patients with in the bag IOL and 61.5% (8/13) of patients with ciliary sulcus IOL (p = 0.08). The average postoperative graft thickness at 18 months was 552 (27) microns in the former group and 650 (29) microns in the latter group (p = 0.04). No significant difference in graft survival, postoperative endothelial cell density, astigmatism, and videokeratoscopic measurements was found between both groups. CONCLUSION: In the bag placement of the intraocular lens during the triple procedure results in better outcome of transplantation than ciliary sulcus placement of the IOL. Phacoemulsification allows removal of large nuclei through a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.     

脱位晶状体摘出联合后房型人工晶状体缝线固定术

目的　探讨晶状体脱位手术摘出联合Ⅰ期后房型人工晶状体缝线固定的临床疗效。方法　对１５眼脱位晶状体,其中Ｍａｒｆａｎ 综合征２ 眼、钝挫性晶状体脱位７ 眼、确诊为单纯性晶状体脱位３ 眼、白内障囊外摘出术中晶状体脱入玻璃体内３ 眼进行晶状体摘出联合后房型人工晶状体缝线固定术。结果　术后视力在０．１ 以上者１３ 眼（８６．７％ ）,０．５ 以上者９眼（６０％ ）;主要手术并发症：前房少量出血、高眼压、虹膜炎性反应、玻璃体腔内出血,术后１～２ｗ ｋ 均得到控制。结论　此术式是一种安全有效、视力恢复满意的治疗方法,可获得好的临床效果。