Conductive keratoplasty: an approach for the correction of residual hyperopia in post-lasik pseudophakia

Although there are many formulae for the calculation of intraocular lens power in the eyes with previous kerato-refractive surgeries, unexpected refractive bias still exists. Hyperopic bias is particularly disliked because it affects both uncorrected distance and near visual acuity. Surgical treatment of the residual hyperopia for the eyes with both laser in situ keratomileusis and cataract surgery remains to be a big problem. Conductive keratoplasty has been shown to be an effective, safe and predictable method for low and moderate hyperopia in the pseudophakic eyes or in the eyes with kerato-refractive surgeries. However, the efficacy and safety of conductive keratoplasty in the correction of residual hyperopia after both corneal and lens refractive surgeries has not been reported. Herein, we reported the surgical correction with conductive keratoplasty for cases of residual hyperopia with/without astigmatism after previous laser in situ keratomileusis for high myopia and following phacoemulsification combined with posterior intraocular lens implantation for complicated cataract.

Stereopsis, Aniseikonia, and Associated Symptoms in Patients with Bilateral Pseudophakia with and without Anisometropia: A Comparative Study

Objectives: The study aimed to compare stereopsis, aniseikonia, and associated symptoms in bilateral pseudophakia with and without anisometropia. Methods: Patients with senile cataracts, previously scheduled for phacoemulsification with an IOL implant in both eyes were included in this cross-sectional study. Patients were divided into two groups: control group (n = 69) with an interocular post-surgical refraction difference in Spherical Equivalent (SE) ?;Stereotest. Ten symptoms related to aniseikonia were evaluated with a questionnaire. Statistical evaluation of data included models of univariate, multivariate, and regression analyses. Results: Cataract surgery-induced aniseikonia was 0.64% ± 1.41% in control group and 0.62% ± 1.76% in anisometropia group with an insignificant difference (p = 0.766). Measured stereoacuity was 1.95 ± 0.17 log10 seconds of arc in the control group and 2.12 ± 0.22 log10 seconds of arc in the anisometropia group with a significant difference (p Conclusions: The study showed that stereopsis, aniseikonia, and associated symptoms did not stand for a substantial problem for visual comfort of bilateral pseu- dophakia with anisometropia less than 3D.

玻璃体切割术治疗人工晶状体眼视网膜脱离的结果分析

目的 探寻人工晶状体眼裂孔性视网膜脱离（pseudophakic retinal detachment，PRD）玻璃体切割术后视网膜再脱离和视力差的原因。方法 106例PRD患者均选择玻璃体切割作为首选手术，其中术前27例未发现裂孔，26例曾行Nd：YAG激光后囊膜切开术。术后随访6～94．8月，平均20．8月。结果 术后视网膜首次复位77例，29例视网膜再脱离的原因主要是视网膜新裂孔出现和增生性玻璃体视网膜病变。术后视力〉0．3者63例，≤0．3者43例。视力≤0．3的主要原因是术后黄斑功能异常（13例）、黄斑前膜（8例）、黄斑水肿（3例）和视神经萎缩（3例）。结论 PRD玻璃体切割术后视网膜再脱离的原因主要是新裂孔出现和增生性玻璃体视网膜病变，而视力差的主要原因是术后黄斑功能并常、黄斑前膜、黄斑水肿和视神经萎缩。

光学质量分析系统对不同材质和屈光指数的IOL植入眼视觉质量的评估

背景白内障超声乳化摘出术联合IOL植入术可降低由晶状体混浊引起的光线散射，但很多IOL植入后的患者主诉眩光或视物模糊。IOL的材质会影响IOL的屈光指数（RI）及光学区设计，从而影响IOL植入眼的散射光值。目的使用光学质量分析系统（OQAS）对不同材质和RI的IOL植入眼视觉质量进行评估。方法对2014年3—10月在天津市眼科医院因年龄相关白内障行白内障超声乳化摘出联合IOL植入术的65例95眼病历资料进行回顾性分析，术眼中植入疏水性丙烯酸酯IOL（AR40e组）者32眼，植入疏水性丙烯酸酯IOL（SA60AT组）者30眼，植入亲水性丙烯酸酯IOL（620H组）者33眼。分析的视觉质量指标包括IOL植入眼的裸眼远视力（UCDVA，LogMAR）、客观散射指数（OSI）、调制传递函数截止频率（MTFcutoff）、斯特尔比率（SR）、Profilewidth分别在50％和10％的点扩散函数（PSF）和对比度为100％、20％和9％的视力，对3种不同类型IOL植入眼的视觉质量检测结果进行比较。结果AR40e组、SA60AT组和620H组术眼术后1个月裸眼远视力（UCDVA）均≥0．3，且3个组间最佳矫正远视力（BCDVA，LogMAR）总体比较差异无统计学意义（F=1．362，P=0．246）。AR40e组、SA60AT组和62014组术眼OSI分别为1．72±1．11、1．89±1．07和2．13±1．13，组间总体比较差异有统计学意义（F=3．638，P=0．045），AR40e组术眼OSI值均明显低于SA60AT组和620H组，差异均有统计学意义（均P〈0．05）。各组间术眼MTFcutoff的总体比较差异无统计学意义（F=2．401，P=0．192）。AR40e组SR值明显高于SA60AT组和620H组，而50％PSF和10％PSF均明显低于SA60AT组和620H组，差异均有统计学意义（均P〈0．05），3个组间术眼9％VA的总体比较差异有统计学意义（F：3．866，P=0．038），其中AR40e组术眼9％VA明显好于SA60AT组和620H组，差异均有统计学意义（均P〈0．05）。AR40e组、SA60AT组和620H组术眼OSI与BCDVA间均呈明显负相关（r=-0．275，P=0．041；r=-0．287，P=0．042；r=-0．233，P=0．037）。结论OQAS可客观评估白内障患者术后的视觉质量，IOL材质和RI的不同对于IOL植入眼视觉质量有较大影响，在低对比度的环境下影响更明显。疏水性且RI较低的IOL植入眼视觉质量更好。

儿童后发障激光后囊切开与人工晶体损伤

目的探讨Nd:YAG激光治疗儿童人工晶体植入术后后囊混浊时避免或降低人工晶体损伤的技巧。方法对140例(152只眼)儿童人工晶体术后后囊混浊应用激光治疗的情况进行回顾性研究。结果术后3．3％病例出现轻度人工晶体损伤。其治疗单脉冲能量均控制在0．4～1．0 mJ,每次治疗总能量均在20～30 mJ,平均25 mJ。结论对于儿童人工晶体植入术后后囊混浊的患儿待眼内炎症稳定应尽早行激光治疗,低能量即可完成且无损伤。治疗时应尽量争取患儿最大限度的配合,激光照射时避开视轴中心,单脉冲能量控制在1 mJ以内,即可避免人工晶体中、重度损伤。

Monovision法白内障术后屈光矫正

目的 研究以Monovision法植入普通单焦点人工晶状体（IOL）进行白内障术后无调节状态矫正的疗效.方法 47例行双眼白内障超声乳化手术患者在术前调查视觉需求,检查最佳远、近矫正视力,主眼检测,分为两组.Monovision组39例植入单焦点折叠式IOL,其中主眼正视化矫正,非主眼保留-0.75～-2.50 D的近视矫正.对照组8例植入单焦点折叠式IOL,双眼均做常规正视化矫正.术后对视力、视觉质量满意度进行随访.结果 术后屈光度与术前预测预留度数具有较高的一致性,高度近视患者目标屈光度误差为-（0.46±0.39）D,略差于正常眼轴者的-（0.33±0.25）D,但差异无统计学意义（P＞0.05）.Monovision组中,87.2%者双眼同时视裸眼远视力达到20/20～20/30,与对照组（7/8例）的差异无统计学意义（x^2=0.79,P＞0.05）.Monovision组裸眼近视力均达到或优于J4,达到J1～J3者占77.2%;对照组则均为J4;两组间差异有统计学意义（x^2=17.0,P＜0.05）.所有患者生活质量得到提高,能够从事更多的个人自理和社会活动.两组术后主观满意度的差异无统计学意义（x^2=0.06,P＞0.05）.结论 Monovision法应用于白内障术后屈光矫正,能够满足一定程度的远、近视力日常需求,减少术后眼镜的依赖率.

Distance vision after bilateral implantation of AcrySof toric intraocular lenses:a randomized,controlled,prospective trial

·AIM:To evaluate the distance vision of Chinese patients with cataracts and corneal astigmatism after implantation of bilateral AcrySof toric intraocular lens (IOL) versus bilateral AcrySof spherical IOL.·METHODS:This study randomized 60 patients into equal groups to receive toric IOL or spherical IOL.IOL powers targeting emmetropia were selected for 93% of toric IOL patients and for 90% of spherical IOL patients.Assessments included monocular and binocular distance vision,with and without best correction.Patients also completed surveys about their distance vision.·RESULTS:Preoperatively,the two study groups were similar in age,in distance visual acuity,and in the magnitude of corneal astigmatism.At 6 months postoperative,binocular uncorrected distance vision was 0.06?à0.14 logMAR in the AcrySof toric IOL group,significantly better than the 0.14?à0.11 logMAR in the spherical IOL group (P<0.05).For eyes with emmetropia as a target,the equivalent of 20/20 uncorrected vision was more likely (P<0.001) in the toric IOL group (36% of eyes) than in the spherical IOL group (4% of eyes).No patients in the emmetropia/toric IOL group used distance glasses,as compared to 52% of patients in the emmetropia/spherical IOL group.All patients were satisfied or highly satisfied.Quality of distance vision was rated higher by toric IOL patients than by spherical IOL patients (P<0.05).·CONCLUSION:Bilateral AcrySof toric IOL is superior to bilateral spherical IOL in providing uncorrected distance vision to cataract patients with corneal astigmatism.·

Comparison of pseudophakic retinal straylight in spherical/aspherical and hydrophobic/hydrophilic intraocular lens

AIM: To study the potential reasons of increased straylight in pseudophakic eyes. METHODS: Cross -sectional study. Seventy patients diagnosed as bilateral age-related cataract and implanted with Tecnis ZA9003, Sensar AR40e, SA6OAT, XLSTABI ZO or Akeros AO intraocular lens (IOL) were enrolled in this research. Straylight was measured by a C -Quant straylight meter three to four weeks postoperatively. Five different modalities of IOL, including spherical/aspherical optics and hydrophobic/hydrophilic material were tested in this study. Normal as well as dilated pupils were used. The main outcome variable for straylight measurement was the logarithmic straylight parameter, log(s). RESULTS: The straylight parameter increased significantly after pupil dilation (P<0.05). Straylight of aspherical IOL was significantly higher after pupil dilation (P<0.06) compared to spherical IOL. In normal pupil, straylight of hydrophobic IOL was significant higher when compared with hydrophilic IOL (P<0.05). CONCLUSION: Straylight and visual acuity stand for the different aspects of visual function. Several factors including pupil diameter, optic material, aspherical design of IOL influence intraocular light scattering in pseudophakic eyes. Further investigation was needed to study the impact of optic material and optic surface design on pseudophakic straylight.

Pseudophakic Malignant Glaucoma Treatment Assisted with Anterior Segment Optical Coherence Tomography: A Case Report

PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.

儿童人工晶状体植入术后的眼球发育和屈光状态变化

目的观察儿童期人工晶状体植入术后术眼屈光状态、眼轴长度及角膜屈光力的变化,为合理选择儿童人工晶状体度数提供参考。方法回顾41例(70眼)2.72～12.31岁行人工晶状体植入手术且术后随访期大于6个月患儿术眼屈光状态及眼轴长度的变化。结果术眼在平均2.54年内(6个月～11.71年)发生-1.48±1.97D的近视漂移,按手术年龄分为2～3岁(13眼)、4～5岁(30眼)、6～7岁(20眼)及9～12岁(7眼)4组,各组术眼屈光变化速度为-0.92±0.68,-0.53±0.83,-0.60±0.55,-0.18±0.51D/年,4组间有统计学差异(P=0.038)。随访期内眼轴平均增长0.52±0.85mm,角膜屈光力无显著变化(P=0.983)。结论3岁以上儿童人工晶状体植入术后仍存在不同程度的近视漂移,手术年龄较小患儿术眼屈光变化速度较快,眼球发育接近于正常儿童,术前人工晶状体度数的选择仍应根据不同手术年龄采取低度欠矫正。

假晶体眼的放大率与不等像

目的 :分析假晶体眼放大率变化特点 ,从双眼视角度探讨单眼白内障的合理人工晶体度数和类型选择。方法 :测量单眼假晶体眼 (12例 )的不等像 ,按Gullstrand模型眼计算人工晶体眼放大率的变化。结果 :临床测量 :术后近视眼或者接近健眼屈光状态的 7例不等像小于或者等于 3% ;术后远视的 5例不等像大于3% (4例大于 5 % )。模型眼光学分析 :放大率变化是由于假晶体眼的主点发生了位移造成 ;主点前移 ,放大率增大 ,不等像也增大。结论 :假晶体放大率变化通过主点移位产生 ;后房型人工晶体较接近人眼的晶状体 ;为了单眼白内障术后有较好的双眼视功能 ,青年宜选择术后偏向一点近视 。

Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair

AIM: To evaluate a modified technique for scleral buckling(SB) in pseudophakic retinal detachment(RD).METHODS: A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing(WAV) contact lens. Segmental tire alone was used in 5 eyes(23.81%), and combined with encircling band in 7 eyes(33.33%). Radial sponge alone was used in 3 eyes(14.29%) and combined with encircling band in 6 eyes(28.57%).RESULTS: Primary success rate was(90.48%). External drainage of subretinal fluid was performed in 8 eyes(38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes(19.05%) and localized subretinal hemorrhage at drainage site in one eye(4.76%). No case of intraocular lens(IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye(4.76%), elevated intraocular pressure in 2 eyes(9.52%), epiretinal membrane formation in one eye(4.76%) and proliferative vitreoretinopathy in 3 eyes(14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. CONCLUSION: Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.

儿童白内障术后的眼轴变化和近视漂移

目的 观察和分析儿童白内障摘出人工晶状体植入术后的眼轴变化及近视漂移。方法 2 3例 2～ 15岁单眼白内障患儿进行白内障摘出人工晶状体植入术 ,检查手术前后两眼的屈光状态、眼轴长度及近视漂移情况。随访时间 3～ 5年。结果 术后矫正视力≥ 0 5者 12例 ,占 5 2 17%。比较术后两眼眼轴长度变化 ,差异无显著意义 (P >0 0 5 )。术眼近视漂移平均 ( 2 85± 1 11)D ,对照眼近视漂移平均 ( 1 2 5± 1 0 5 )D ,两者比较 ,P <0 0 5。结论 白内障摘出人工晶状体植入术对儿童眼轴发育未造成影响。白内障患儿术后近视漂移大于正常眼 ,且年龄越小近视漂移度越大。儿童白内障人工晶状体屈光度的选择应使术后保留一定程度的远视。

未发现裂孔的人工晶状体眼视网膜脱离的治疗

目的回顾玻璃体切割联合巩膜扣带术治疗未发现裂孔的人工晶状体眼视网膜脱离的结果。方法5例(5眼)未发现视网膜裂孔的人工晶状体眼视网膜脱离患者应用标准的三通道经睫状体扁平部的玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,术后随访6～12个月,观察术前、术后视力,术后视网膜复位状态及手术并发症。结果所有患眼在施行一次手术后视网膜均获复位,应用对数视力表检查3眼视力增进至少3行,视力不变和减退者各有1眼,后者都有黄斑病变。结论对未发现裂孔的人工晶状体眼视网膜脱离患者联合应用玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,显示有良好的解剖和功能效果。

儿童人工晶状体眼的眼轴及屈光变化

目的:观察儿童白内障摘除及人工晶状体植入后眼球及屈光状态的变化,探讨屈光状态变化的原因。方法:测量10例(12只眼)白内障患儿术前及术后(指本次随访时)的眼球轴长、角膜曲率及术后角膜顶点到人工晶状体前表面顶点的距离(The distance from the vertex of the cornea to the anteriorvertex of intraocular lens AVpc),比较术眼在手术前后的变化及与对照眼(未手术的对侧眼)在术前、术后的差异。在术后两周内及本次随访时检影,观察其人工晶状体眼屈光状态的变化。患儿手术时年龄7.16±1.94岁,随访时间平均35.8月(23～48月)。结果:术眼(n=12)眼轴长在术后平均增加0.39±0.48mm;对照眼(n=8)轴长增加0.66±0.68mm。术眼、对照眼在手术后眼轴长的增加均有显著的统计学意义(P<0.05),而术眼与对照眼的轴长增加量之间无显著性差异(P>0.05)。术眼、对照眼的角膜曲率在手术前后分别比较、双眼之间比较均无显著性差异(P>0.05)。术后测量的AVpc1为3.83±0.58mm,而估算的AVpc2为4.6630±0.2242mm,两者之间有显著的统计学差异(P<0.01),提示人工晶状体在眼内的位置前移0.8320±0.7441mm。根据手术前后眼轴长和角膜曲率值,按照SRKⅡ公式估算,在本次随访时人工晶状体眼有-1.53±1.70D(n=12,P<0.01)的屈光变化;

无晶状体眼视网膜脱离手术方法的探讨

目的 探讨治疗无晶状体眼视网膜脱离 (ARD)和人工晶状体眼视网膜脱离 (PPRD)的手术方式选择。方法 以无晶状体眼及人工晶状体眼原发生视网膜脱离 6 5例 (6 5只眼 )为研究对象 ,分首次单纯环扎加压组30例 (30只眼 )及玻璃体手术加环扎或环扎加压组 35例 (35只眼 ) ,进行临床治疗以及复发后进一步治疗观察。结果 30只眼单纯环扎加压组一次手术成功率 86 .6 7%(2 6 / 30 )。随访 3个月～ 1年 ,平均 5 .2个月。视网膜复位 2 7只眼 ,复位率 90 %,其中 3只眼再次行玻璃体手术治疗。玻璃体手术联合环扎或环扎加压组 35只眼作为首次手术 ,一次手术成功率 91.43%(32 / 35 ) ,3只眼为巩膜手术复发者 ,共 38只眼 ,随访 3个月～ 1年 ,平均 4.9个月 ,视网膜复位 37只眼 ,复位率 97.37%。总手术成功率 93.85 %(6 1/ 6 5 )。结论 单纯环扎加压术和玻璃体手术加环扎或环扎加压术两种手术方法在选择好手术适应证情况下治疗 ARD和 PPRD具有较好的效果。玻璃体手术加环扎或环扎加压术对 PVR增生较重的病例效果显著。两种手术方法结合治疗 ARD和 PPRD能明显提高视网膜复位率。

Effect of silicone oil removal on central corneal thickness

AIM:To evaluate the effect of silicone oil removal(SOR) on central corneal thickness(CCT) in aphakic and pseudophakic eyes prospectively.· METHODS:Patients who underwent SOR surgery between June 2005-August 2007 were included in this study.Silicon oil was actively removed behind the posterior capsule through the pars plana sclerotomy site(posterior approach) in pseudophakic eyes and through the pupil and the corneal tunnel incision(anterior approach) in aphakic eyes with the 18-gauge cannula.CCT was assessed with Orbscan II corneal topography system preoperatively and at one month and three months postoperatively.A total of 34 eyes of 34 patients(26 males,8 females) comprised the study group.Mean age was(55.6±12.3) years(Range:25-80 years).Twenty-six eyes(76.5%) were pseudophakic and 8(23.5%) aphakic.Mean time between silicone oil injection and removal was(15.1±13.6) months(Range:5-54 months).At baseline,CCT was 576.4±46.0μm in pseudophakic eyes and 611.6±36.2μm in aphakic eyes.· RESULTS:At the first postoperative month CCT was(573.3±40.1)μm and(630.9±72.9)μm in pseudophakic and aphakic eyes respectively.At the third postoperative month,CCT was(582.7±49.5)μm and(614.5±82.4)μm in pseudophakic and aphakic eyes respectively.There was no statistically significant difference in CCT measurements one month and 3 months after SOR when compared to preoperative values in both aphakic and pseudophakic eyes(P> 0.05).· CONCLUSION:Active SOR either by anterior or posterior approach did not affect the CCT.·

玻璃体手术治疗ARD和PPRD(PVRC级以上)

目的探讨玻璃体的手术对复杂无晶状体眼视网膜脱离(Aphakic Retinal Detachment,ARD)和人工晶状体眼视网膜脱离(Pseudophakic Retinal Detachment,PPRD)(PVRC级以上)的治疗效果。方法回顾性分析78例87眼ARD和PPRD,所有病人均行玻璃体切割联合眼内填充物治疗。结果首次手术视网膜复位率为78.16%,最终视网膜复位率90.8%。视力下降11眼(12.7%),不变15眼(17.2%),提高59眼(70.1%)。结论彻底的玻璃体切除加视网膜切开、视网膜前膜剥除,适当应用环扎玻璃体填充物可使复杂PPRD,ARD达到较高的视网膜复位率。但ARD、PPRD一旦发生则病情进展迅速,治疗棘手,视力预后差,应从白内障手术开始加强预防。

小梁和巩膜切除术联合睫状体上腔引流治疗无晶状体和人工晶状体青光眼

目的探讨联合睫状体上腔引流的小梁和巩膜切除(LSEVDS)治疗无晶状体和人工晶状体眼青光眼的效果。方法采用回顾性方法观察103例(109眼)无晶状体和人工晶状体眼的青光眼患者。26例(26眼)无晶状体眼和34例(36眼)人工晶状体眼患者行LSEVDS,另外19例(20眼)无晶状体眼和24例(27眼)人工晶状体眼患者行传统小梁切除术。平均随访12.6个月,比较了术后视力、眼压(IOP)、视野、前房深度、滤过泡形态、脉络膜脱离、前房出血等情况。结果术后12个月,LSEVDS使无晶状体眼和人工晶状体眼的眼压明显下降,降眼压效果比小梁切除术更显著,其差异有统计学意义(P<0.05)。LSEVDS的并发症包括前房积血(11.2%)、脉络膜脱离(6.5%)、低眼压(19.2%)和浅前房(11.2%),均于2周内好转。术后患者视力的变化无统计学意义。结论在治疗无晶状体和人工晶状体眼青光眼方面,LSEVDS的效果优于传统小梁切除术。

小切口非超声乳化与超声乳化对白内障术后高阶像差的影响

目的:探讨小切口非超声乳化与超声乳化对白内障术后高阶像差的影响。方法:实验组为行小切口非超声乳化人工晶状体植入术(48眼)和超声乳化人工晶状体植入术(52眼),设同龄正常人(60眼)为对照组。分析指标为总高阶像差值。结果:小切口非超声乳化组与超声乳化组在术后6mo的总高阶像差值无显著性差异(P>0.05),二者与同年龄正常人比较有显著性差异(P<0.01)。结论:小切口非超声乳化与超声乳化对白内障术后人工晶状体眼的高阶像差无差别,人工晶状体眼的高阶像差较同龄正常人增加。