高度近视眼白内障手术疗效观察

目的　分析高度近视眼白内障手术效果。方法　高度近视合并白内障病例共１９１ 例（２７９ 只眼）,行白内障术后３ｍｏ以上,随访视力、眼屈光度及并发症,计算测量误差及ＳＲＫ－ＩＩ公式误差。结果　术后矫正视力０ ．５ 者２００ 只眼,占７１．７ ％ ;矫正视力＜ ０．１ 者１３ 只眼,占４ ．７ ％ － 眼轴越长,近视性眼底病变越重。术后发生视网膜脱离２ 只眼（０ ．７％） 。眼轴长度测量误差值平均为０．５３ｍｍ ,ＳＲＫ－ＩＩ公式计算的平均绝对屈光误差值为１．１２Ｄ。结论　高度近视眼白内障手术效果较一般人群差,且眼轴越长效果越差。     

Distribution of Human Lens Crystallins and Their Sulphydryl Contents of Different Age in Two—dimension Electrophoresis

Purpose: To analyze water-soluble(WS) human lens proteins of fetus, adult and age-related cataract by two-dimensional IEF/SDSPAGE electrophoresis. Methods: DACM [ N- (7-Dimethylamino-4-methyl-3-coumarinyl) maleimide ] was used to determine the lens proteins sulphydryl (SH) content.Result: Protein SH contents in WS lens proteins have no significant difference among fetus, adult and age-related cataract lens. This is different from the relative published results obtained in lens proteins of animal cataract model using similar SH detecting methods.Conclusions: IEF/SDS-PAGE electrophoresis demonstrated that there were much more fragmentation of crystallins during lens development and cataractogenic process. It is suggested that this phenomenon is likely to be due to further conformational changes in the fragmented cyrstallins during aging and cataractogenic process. Eye Science 1999; 15:32-35.     

人工晶体眼的视网膜脱离

为分析人工晶体植入后的视网膜脱离的特殊性,对我院自９１年到９６年收治的人工晶体眼视网膜脱离４２例４４眼进行临床观察,并对其特殊性予以分析和讨论。结果：人工晶体眼视网膜脱离有发展快,裂孔难以寻找,增殖的后囊膜和人工晶体遮挡视路使检查很困难等特点,并易发展为复杂性视网膜脱离,治愈率为８０％。结论：在置入人工晶体时要尽量减少对手术眼的损伤,一旦发生视网膜脱离,要加大检查力度,尽早采取传统的视网膜脱离手术和现代玻璃体手术,以增加其疗效。     

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.     

外伤性白内障术前B超检查的临床意义

目的 探讨外伤性白内障术前采用Ｂ超检查后囊破损情况的临床意义。方法 外伤性白内障３０只眼,术前采用Ｂ超检查评估后囊情况,显微镜下白内障摘除术中直接观察后囊情况并记录。结果 １４只眼术前Ｂ超检查后囊完整,手术证实１２只眼后囊完整,２只眼后囊小破坏。１６只眼术前Ｂ超检查后囊破损,手术证实１４只眼后囊存在大小不等的破损,２只眼后囊完整。结论 外伤性白内障术前Ｂ超检查为非侵入性、无痛性检查方法,操作简便,     

儿童角膜穿通伤合并外伤性白内障人工晶体植入术临床分析

本文回顾分析２６ 例 （２６ 眼） ５～１４ 岁儿童角膜穿通伤合并外伤性白内障植入后房型人工晶体的临床结果。对麻醉、人工晶体植入、后囊纤维膜样混浊进行了分析讨论。提示 ８ 周岁以上儿童常能在眼局部麻醉下顺利地完成手术。认为对儿童角膜穿通伤合并外伤性白内障植入人工晶体, 应视眼部伤情及术中情况, 权衡利弊, 区别选择Ⅰ期或Ⅱ期植入。作者观察到, 这类联合手术的后囊纤维膜样改变, 在术后一至二周即在不同程度上有所表现。     

1CU可调节人工晶状体植入术后调节功能的临床观察

目的:观察分析1CU可调节人工晶状体植入术后近远期调节功能变化。方法:对2006/2008年在我院行白内障超声乳化联合1CU可调节人工晶状体植入术后的患者进行前瞻性随访研究2a,定期检测术眼裸眼远、近视力,最佳矫正远、近视力,分别用主觉近点法、离焦法检测术眼调节功能,并观察评价后囊膜混浊的发生。结果:1CU可调节人工晶状体植入术后1mo和6mo均可获得较好的裸眼远、近视力及最佳矫正远、近视力,其差异无统计学意义;术后1a远、近视力均下降,与6mo相比其差异有统计学意义(P<0.05)。近点法和离焦法检测的调节幅度在术后6mo和1a分别为(1.65±0.88)D,(1.78±0.67)D和(1.24±0.66)D,(1.15±0.62)D,其差异有统计学意义(P<0.05),术后2a为(0.92±0.44)D,(0.71±0.37)D,与术后1a相比差异有统计学意义(P<0.05)。发生后发性白内障的病例术后1a约占29%(10/34),术后2a约占47%(16/34)。结论:1CU可调节人工晶状体植入术后早期患者能够获得良好的远近视力及调节力,但随着后发性白内障的发生,术后1a以后远近视力及调节力均呈不同程度的下降,人工晶状体的特殊设计及晶状体材料可能与囊膜纤维化有较为密切的关系。     

术前配戴软性角膜接触镜对LASIK术后高阶像差的影响

目的探讨术前配戴软性角膜接触镜对波前引导和传统准分子激光原位角膜磨镶术(LASIK)术后高阶像差的影响。方法采用前瞻性随机双盲比较性研究,将拟行LASIK的青壮年近视患者48名(96眼),其中,术前配戴软性角膜接触镜者26名(52眼),随机分为波前引导组和传统组,分别检查术前、术后不同时间的视力、对比敏感度和高阶像差,并比较术前戴角膜接触镜组(contactlens,C组)与未戴组(non-contactlens,N组)术后高阶像差变化。结果无论是传统组还是波前引导组术后不同时间的裸眼视力(UCVA)、最佳矫正视力(BSCVA)、安全指数、有效指数和对比敏感度增加倍率等方面C组与N组均无显著差异(P>0.05)。传统组和波前引导组术后总高阶像差和各高阶像差RMS值(RMSh和RMS3～6值)均较术前增加,平均增加约1倍。传统组中术后RMSh和RMS3～6值增加倍率和下降比例C组与N组无显著差异,术后6个月时RMSh值增加倍率分别为1.28倍、1.17倍。引导组中术后RMSh、RMS3～5值增加倍率C组均明显高于N组(P<0.05),术后6个月时RMSh值增加倍率分别为1.58倍、0.77倍(P<0.05),N组术后不同时间RMSh、RMS3～5值下降比例均高于C组。术后6个月时,RMSh值下降比例C组与N组分别为9.1%和22.7%。结论术前配戴软性角膜接触镜影响波前引导LASIK对高阶像差的矫正,而对传统LASIK术后高阶像差影响不明显。术前配戴软性角膜接触镜者行波前引导LASIK应慎重。     

虹膜夹型有晶状体眼人工晶状体植入术对高度近视眼对比敏感度的影响

目的 研究虹膜夹型有晶状体眼人工晶状体（iris-claw phakic intraocular lens，ICPIOL）植人术后对比敏感度（contrastsensitivity，CS）的变化。方法 2005年5月至12月于温州医学院附属眼视光医院和中山大学中山眼科中心接受ICPIOL（Verisyse，美国AMO公司）植入术的高度近视眼患者12例（23只眼），分别在术前、术后1、3、6个月采用CS测试灯箱（CSV-1000型，美国Vector Vision公司）检查暗视状态下无／有眩光时的对比敏感度函数（contrast sensitivity function，CSF）。结果 术后1、3、6个月等效球镜度数分别为（-0．60±0．77）D，（-0．48±0．77）D，（-0．34±0．53）D，与术前（-15．53D±3．65D）差异均有显著统计学意义（P均〈0．001），最佳矫正视力（IogMAR）分别为0．064-0．12，0．02±0．09，-0．003±0．08，与术前（0．21±0．12）差异均有显著统计学意义（P均〈0．001）。术后各空间频率的CS与术前比较有增高趋势。术后3个月6、12、18周／度的CS在无眩光时和有眩光时均明显提高（P均〈0．01），开始接近正常范围。术后3、6个月在各空间频率上CS差异均无统计学意义（P均〉0．05）。结论 ICPIOL植入术矫治高度近视眼可以使CSF恢复到接近正常范围，显著改善视功能，是一种适用于高度乃至超高度近视眼的可供选择的屈光手术。     

硅油取出联合白内障超声乳化术的临床探讨

目的 评估通过透明角膜切口完成白内障超声乳化及折叠式人工晶体植入联合经瞳孔前路硅油取出改良术的安全性及有效性。方法 对57例硅油充填眼完成白内障超声乳化后经瞳孔前路硅油取出联合折叠式人工晶体植入。结果 术后未发生明显角膜并发症,89.4%的病人（51例）未发生视网膜再脱离,复发性视网膜脱离6例（11.6%）,再次手术后成功复位。41例患者的术后视力改善。结论 白内障超声乳化及折叠式人工晶体植入联合硅油奴出改良术安全有效,可以最大限度地减少手术损伤。