Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).

Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery

Dear Editor,We read with interest the Meta-analysis conducted by Chen et al[1]on the clinical outcomes and complication rates between femtosecond laser-assisted cataract surgery(FLACS)and conventional phacoemulsification cataract surgery(CPCS).The authors reported no statistical difference between both methods for all measured complications except posterior capsular tear,with CPCS displaying a higher rate of posterior capsular tear.Since its inception in 2011[2].

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis

AIM:To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis(TGU).METHODS:Patients of cataract with TGU in the membranous(inactive) stage underwent cataract surgery with intraocular lens(IOL) implantation.Preoperative history and ophthalmic examination were conducted for all cases,whereas Schimphlug imaging and corneal topography were done for some patients.Postoperative follow up was done on the 1st,2nd,and 5th postoperative days after surgery.Then,it was done at least at one,three,and six months postoperatively.Intraoperative and postoperative complications and the methods of their management were reported.RESULTS:Twelve eyes of 12 male children were included in this study ranging from 8 to 16y.The mean best corrected Snellen visual acuity(BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively(P<0.001).Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea.Intraoperative difficulties and complications included the poor dilatability of the drown down pupil,strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema.All cases underwent primary hydrophobic IOL implantation.CONCLUSION:Surgery for this type of cataract is relatively safe and effective.It is associated with some specific difficulties and complications that should be considered during surgery and follow up.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary

AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Ocular complications of diabetes mellitus

Diabetes mellitus(DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and isbecoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world's most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases.

Expressions of TGF-β2, bFGF and ICAM-1 in lens epithelial cells of complicated cataract with silicone oil tamponade

AIM： To investigate the expression differences of transforming growth factor-β2（TGF-β2）, basic fibroblast growth factor（b FGF） and intercellular cell-adhesion molecule-1（ICAM-1） in lens epithelial cells（LECs） of complicated cataract with silicone oil tamponade and agerelated cataract. METHODS： Totally 150 eyes of 150 patients（aged 35 to 77y） were investigated, including 75 patients with complicated cataract after silicone oil tamponade and 75 patients with age-related cataract. The central piece of anterior capsules was collected during cataract surgery. TGF-β2, b FGF and ICAM-1 were detected in the 60 specimens of the two groups by immunohistochemistry. The expression levels of the three kinds of messenger ribonucleic acid（m RNA） were determined by real-time quantitative reverse transcriptionpolymerase chain reaction in the 90 specimens of the two groups.RESULTS： TGF-β2 was detected in the cytomembrane and cytoplasm of the LECs and b FGF was detected in the nucleus. ICAM-1 was positive in the cytomembrane of the LECs and the distribution of positive cells was uneven. The m RNA genes expression of the TGF-β2, b FGF and ICAM-1 was significant differences between the two groups and markedly increased in complicated cataract group（P〈0.05）.CONCLUSION： The up-regulated TGF-β2, b FGF and ICAM-1 maybe associate with the occurrence and development of complicated cataract with silicone oil tamponade.

Clinical Analysis of Cataract Surgery Complicated by Endophthalmitis

Purpose:.To assess the efficacy of vitrectomy combined with intravitreal injection in the treatment of endophthalmitis after phacoemulsification and IOL implantation. Methods:.Five patients.(5 eyes),.who had undergone conventional phacoemulsification combined with IOL implantation at another treatment facility,.presented with endophthalmitis. The subjects ranged in age from 41 to 79 years (65.8±0.5 years on average),.and three were male..All five cases received bacterial culture susceptibility testing..On the basis of the treatment of primary disease, 3 cases had anterior chamber irrigation,.and posterior vitrectomy followed by intravitreal injection of 1 mg vancomycin plus 2.25 mg ceftazidime. Results:.Four out of the five cases of endophthalmitis had a positive bacterial culture testing results.(two cases of staphylococcus epidermidis,.one case of enterococcus faecalis and one case of head-like staphylococcus),.and the remaining case had no bacterial growth..Four cases showed restored visual acuity,.clear vitreous cavity,.and no retinal detachment or other complications. Conclusion: Management of patients presenting with endophthalmitis subsequent to cataract surgery should include: prompt bacterial culture and drug sensitivity tests, and where appropriate, vitrectomy combined with intravitreal injection of vancomycin.

结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果

目的探讨结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果。方法选取2020年1月至2022年12月南昌大学第二附属医院收治的40例(80眼)白内障合并增殖型糖尿病视网膜病变患者作为研究对象,所有患者均为双眼病变,按照随机数字表法将其分为观察组(20例,40眼)与对照组(20例,40眼)。对照组采用常规玻璃体切割术与白内障超声乳化吸除术,观察组采用结膜无缝合玻璃体切割系统联合微切口白内障超声乳化吸除术。比较两组手术前,术后7 d,术后1、3个月视力水平、眼压水平及内皮细胞数目以及两组术后并发症发生情况。结果两组患者术后7 d,术后1、3个月视力水平高于手术前,差异有统计学意义(P<0.05);手术前、术后7 d、术后1个月,两组患者的视力水平比较,差异无统计学意义(P>0.05);术后3个月,观察组患者的视力水平高于对照组,差异有统计学意义(P<0.05)。术后7 d及术后1、3个月,两组患者的眼压水平低于手术前,差异有统计学意义(P<0.05);手术前,术后7 d,术后1、3个月,两组患者的眼压水平比较,差异无统计学意义(P>0.05)。术后7 d及术后1、3个月,两组患者的内皮细胞数目低于手术前,差异有统计学意义(P<0.05);术后1、3个月,两组患者的内皮细胞数目均高于术后7 d,差异有统计学意义(P<0.05);术后7 d及术后1、3个月,观察组患者的内皮细胞数高于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论结膜无缝合玻璃体切割系统联合微切口白内障超声乳化治疗白内障合并增殖型糖尿病视网膜病变效果显著,可改善患者视力水平,不增加患者术后眼压,且可减少术后内皮细胞的丢失,术后并发症发生率较低。

飞秒激光辅助下超声乳化术、普通白内障超声乳化术对年龄相关性白内障患者眼内压及最佳矫正视力、视盘区血流密度的影响

目的比较飞秒激光辅助下超声乳化术(FLACS)、普通白内障超声乳化术(CPCS)在年龄相关性白内障(ARC)患者中的效果。方法选取2021年7月至2023年7月南昌爱尔眼科医院收治的70例ARC患者作为研究对象,按随机数字表法分为对照组(35例)、观察组(35例)。对照组行CPCS,观察组行FLACS,两组术后均随访3个月。比较两组的手术相关指标、眼内压、黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)、视盘区血流密度、并发症等。结果观察组的超声乳化时间为(14.57±2.30)min,短于对照组的(22.49±3.58)min,观察组的超声乳化能量为(5.39±1.20)ml,低于对照组的(11.33±2.15)ml,观察组的并发症总发生率为5.71%(2/35),低于对照组的22.86%(8/35),差异有统计学意义(P<0.05)。重复测量方差分析结果显示,两组患者术前,术后1 d,术后1周,术后1、3个月BCVA的时间、组间比较,差异有统计学意义(P<0.05),交互作用比较,差异无统计学意义(P>0.05);两组患者术后1 d,术后1周,术后1、3个月的BCVA均高于本组术前,差异有统计学意义(P<0.05)。两组患者手术前后各时间点眼内压、CMT、视盘旁血流密度、视盘内血流密度的时间、组间、交互作用比较,差异无统计学意义(P>0.05)。结论FLACS具有更短的超声乳化时间,更少的乳化能量,其可提升视力,且不会加重对眼压、视盘区血流密度与CMT的影响,并发症较少。

小切口白内障手法碎核摘除术治疗硬核白内障的临床效果及对术后恢复的影响

目的:探讨小切口白内障手法碎核摘除术治疗硬核白内障的临床效果及对术后恢复的影响。方法:选取2022年1月—2023年2月丹阳市中医院收治的90例硬核白内障患者。按照患者的治疗方案分为对照组和观察组,各45例。对照组行囊外白内障摘除术治疗,观察组行小切口白内障手法碎核摘除术治疗。比较两组术后视力水平、角膜散光水平、眼压水平、角膜内皮细胞密度及并发症发生率。结果:术前,两组视力水平比较,差异无统计学意义(P>0.05);术后1个月、3个月,观察组视力水平高于对照组,差异有统计学意义(P<0.05)。术前,两组角膜散光水平比较,差异无统计学意义(P>0.05);术后1个月、3个月,观察组角膜散光水平低于对照组,差异有统计学意义(P<0.05)。术前、术后3个月,两组眼压水平比较,差异无统计学意义(P>0.05);术后1个月,观察组眼压水平低于对照组,差异有统计学意义(P<0.05)。术前、术后1个月,两组角膜内皮细胞密度比较,差异无统计学意义(P>0.05);术后3个月,观察组角膜内皮细胞密度高于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:小切口白内障手法碎核摘除术治疗硬核白内障取得满意治疗效果,患者术后视力、眼压、散光均取得更理想的恢复效果,并且并发症少,安全性更高。

精细化流程管理在白内障手术护理配合中的应用

目的 探究精细化流程管理在白内障手术护理配合中的应用价值。方法 选取2021年6月至2022年6月100例在福建省立医院就诊的白内障患者,采用随机数字表法把患者分成对照组50例(常规的护理管理模式)和观察组50例(常规护理管理+精细化流程管理模式),对比两组不良情绪、手术恐惧情况、并发症发生情况、满意度。结果 护理后观察组患者的抑郁评分(SDS)、焦虑评分(SAS)、手术恐惧情况评分(SFQ)以及并发症发生率均低于对照组(均P <0.05);观察组患者对护理工作的满意度高于对照组(P <0.05)。结论 精细化流程管理的应用可改善患者的情绪水平,减轻患者对手术的恐惧及减少术后并发症,提高患者对护理工作的满意度。

老年性白内障患者日间手术模式的构建与临床效果分析

目的探讨80岁及以上老年白内障患者日间手术模式的构建与应用效果。方法回顾性分析2021年1—7月中国科学技术大学附属第一医院(安徽省立医院)收治的80岁及以上182例老年白内障患者资料,这些患者由同一位高年资医生手术,将普通眼科病房住院91例患者作为对照组,日间眼科病房的91例患者作为观察组,比较2组对围术期相关知识的掌握程度、术后并发症发生率、住院费用,患者满意度。结果研究组患者对围术期相关知识的掌握程度及满意度均优于对照组,差异有统计学意义(P<0.05);2组术后并发症发生率比较,差异无统计学意义(P>0.05),且2组患者均无24 h非计划再手术。结论老年性白内障患者日间手术模式可有效降低平均住院日,减少住院费用,提高医患双方满意度,且不增加术后并发症。

内镜下睫状体光凝联合超声乳化人工晶状体植入术治疗闭角型青光眼合并白内障的临床研究

目的:分析内镜下睫状体光凝联合超声乳化人工晶状体植入术在闭角型青光眼(ACG)合并白内障患者中的治疗效果。方法:选取2021年3月—2023年3月泰安八十八医院收治的82例ACG合并白内障患者,按随机数表法分为两组,各41例。对照组行房角粘连分离术联合超声乳化人工晶状体植入术治疗,观察组行内镜下睫状体光凝术联合超声乳化人工晶状体植入术治疗,术后随访3个月。比较两组视力、眼压、中央前房深度、生活质量及并发症发生率。结果:术前,两组最佳矫正视力(BCVA)、眼压、中央前房深度与生活质量综合评定问卷(GQOLI-74)内各维度评分比较,差异无统计学意义(P>0.05);术后3个月,观察组BCVA、中央前房深度高于对照组,眼压低于对照组,GQOLI-74评分高于对照组,差异有统计学意义(P<0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:内镜下睫状体光凝联合超声乳化人工晶状体植入术能够改善ACG合并白内障患者视力,降低眼压,提升中央前方深度,改善生活质量,且无严重并发症。

信息-动机-行为模型引导的风险管理在白内障术后患者中的应用效果

目的 分析信息-动机-行为(IMB)模型引导的风险管理在白内障术后患者中的应用效果。方法 选择2021年1月至2023年3月安徽省马鞍山十七冶医院五官科收治的119例白内障患者,根据随机数字表法将其分为对照组(60例)和试验组(59例)。对照组术后接受常规干预,试验组术后接受IMB模型引导的风险管理,均干预1个月。比较两组干预前后的疾病知识掌握度、疼痛、焦虑、抑郁情况,干预期间的并发症发生情况及干预后的满意度。结果 干预后,两组疾病相关知识、健康知识、用药知识掌握度评分高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。干预后,两组视觉模拟评分法、焦虑自评量表、抑郁自评量表评分低于干预前,且试验组低于对照组,差异有统计学意义(P<0.05)。试验组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。试验组满意度情况优于对照组,差异有统计学意义(P<0.05)。结论 IMB模型引导的风险管理在白内障术后患者中的应用效果较好。

基于互动达标理论的思维导图健康宣教对白内障患者并发症与依从性的影响

目的分析基于互动达标理论的思维导图健康宣教对白内障患者并发症与依从性的影响。方法研究纳入2022年10月至2023年10月医院收治白内障患者90例为研究对象,数字抽签分组为观察组(n=45,实施基于互动达标理论的思维导图健康宣教)与对照组(n=45,实施常规健康宣教),连续护理患者4周,比较组间护理前后并发症及依从性,采用一般自我效能感量表(GSES)评估患者护理前后自我护理效能感。结果观察组并发症发生率为4.44%低于对照组的20.00%(χ^(2)=5.075,P<0.05);组间护理前依从性评分无统计学意义(P>0.05);护理后观察组依从性评分[(36.37±3.63)分]高于对照组(P<0.05);组间护理前GSES差异无统计学意义(P>0.05);护理后观察组GSES[(3.86±0.11)分]高于对照组(P<0.05)。结论基于互动达标理论的思维导图健康宣教能提升白内障患者护理依从性及自我护理效能感,降低并发症,综合性护理价值高。

个体化护理在白内障手术患者围术期的应用效果及对并发症的影响

目的探讨个体化护理在白内障手术患者围术期的应用效果及对并发症的影响。方法选择2022年6月至2023年6月于我院行手术治疗的白内障患者80例,随机分为两组。对照组实施常规护理,观察组在对照组基础上给予个体化护理。比较两组术后相关指标、并发症及生活质量。结果观察组术后视力水平高于对照组,住院时间短于对照组,住院费用低于对照组(P<0.05)。术后1个月,观察组生活质量评分高于对照组(P<0.05)。观察组术后并发症发生率为10.0%,明显低于对照组的27.5%(P<0.05)。结论个体化护理在白内障手术患者围术期的应用效果明显,有助于提高患者视力水平和生活质量,缩短住院时间,降低并发症发生率。

围术期护理在白内障手术患者中的应用效果

目的:分析围术期护理在白内障手术患者中的应用效果。方法:选取2019年3月—2021年3月阳光融和医院收治的124例白内障患者作为研究对象,采用随机数字表法分为两组,各62例。对照组实施常规手术护理,研究组实施围术期护理。比较两组负性情绪、疼痛程度、生活质量、并发症发生情况、护理满意度。结果:护理后,两组焦虑、抑郁、疼痛评分低于护理前,且研究组低于对照组,两组生活质量评分高于护理前,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组并发症总发生率低于对照组,护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论:围术期护理在白内障手术患者中的应用效显著,可改善患者负性情绪,减轻疼痛、提高术后生活质量,降低并发症发生率,患者护理满意度高。

标准化护理对白内障超声乳化手术患者康复效果的影响

目的:分析标准化护理对白内障超声乳化手术患者康复效果的影响。方法:选取兰州大学第二医院2021年1月—2023年1月间400例接受超声乳化手术的白内障患者作为观察对象,按照入院时间顺序分组,分为对照组(常规护理)和观察组(标准化护理),各200例,比较应用效果。结果:观察组并发症发生率低于对照组(P<0.05);观察组各维度视功能生存质量评分高于对照组(P<0.05);观察组生理应激反应指标优于对照组(P<0.05)。结论:针对接受白内障超声乳化手术的患者,采取标准化护理可提高术后康复效果,减轻应激反应,减少并发症,改善视功能生存质量。

2.2 mm角膜微切口白内障超声乳化术治疗老年白内障的临床效果

目的探究2.2 mm角膜微切口白内障超声乳化术治疗老年白内障的效果及对角膜内皮功能、并发症发生率的影响。方法以2020年3月至2022年3月期间收治的113例老年白内障患者为研究对象,均行白内障超声乳化术治疗,根据切口大小将患者分为2.2 mm组(55例)及常规组(58例)。比较两组手术相关指标及手术前后视力恢复情况,对患者手术前后角膜切口内外口处厚度、角膜内皮细胞功能、角膜生理指标及泪膜功能进行分析评估,并统计患者术后一过性高眼压、角膜水肿的并发症发生率。结果2.2 mm组术后7 d裸眼远视力、最佳矫正视力(BCVA)的LogMAR值及角膜散光值小于常规组,差异有统计学意义(P<0.05);2.2 mm组术后1 d、7 d切口外口处角膜厚度及术后1 d的切口内口处厚度小于常规组,差异有统计学意义(P<0.05);2.2 mm组术后7 d的角膜内皮细胞(CECs)密度及六角形细胞比例大于常规组,CECs变异系数小于常规组,差异有统计学意义(P<0.05);2.2 mm组术后7 d的角膜阻力因数(CRF)大于常规组,Goldmann相关眼压(IOPg)及角膜补偿眼压(IOPcc)高于常规组,差异有统计学意义(P<0.05);2.2 mm组术后7 d的泪膜破裂时间(BUT)长于常规组,基础泪液分泌试验(ST-Ⅱ)值小于常规组,差异有统计学意义(P<0.05);2.2 mm组并发症发生率为1.82%(一过性高眼压1例),常规组并发症发生率为3.39%(一过性高眼压1例、角膜水肿1例),两组并发症发生率对比差异无统计学意义(P>0.05)。结论2.2 mm角膜微切口白内障超声乳化术治疗老年白内障,可有效提高患者术后视力,促进角膜切口愈合,并能改善角膜内皮细胞功能及泪膜功能。