Secondary in-the-bag intraocular lens implantation combined with 120-and 360-degree goniotomy in glaucoma following congenital cataract surgery:a case report

Dear Editor,Glaucoma following cataract surgery(GFCS)is one of the most sight-threatening postoperative complications of pediatric cataract surgery,and often becomes refractory to medical treatment[1].Goniotomy has been an increasingly popular procedure for primary open angle glaucoma and primary angle-closure glaucoma with 120-.

Case Report: Observation of Postoperative Refractive Status of Glaucoma Combined with Cataract and Irregular Astigmatism

Significance: So far, many scholars have studied the astigmatism caused by glaucoma surgery, but they cannot provide enough useful help for the clinic. When a patient has glaucoma, cataracts and irregular astigmatism at the same time, it is often difficult to achieve satisfactory results. Purpose: This study intends to describe a case of a patient with glaucoma, irregular astigmatism, and cataract who was successfully treated. Additionally, it can serve as a useful source of inspiration for the future care of patients like this. Case Presentation: A 24-year-old male with keratoconus in the past. He had undergone a corneal crosslinking operation in the right eye and a penetrating keratoplasty in the left eye due to his long history of keratoconus in both eyes. Right now, the keratoconus in that eye is stable. Unfortunately, he has now been diagnosed with open-angle glaucoma and complicated cataracts in both eyes, and he was admitted to our hospital for surgery. The right eye had significant irregular astigmatism, which was discovered during the preoperative assessment, and the implantation of a Toric intraocular lens was unable to produce good results. Finally, we chose to perform EXPRESS glaucoma drainage device implantation + phacoemulsification + intraocular lense (ZEISS CT ASPHINA 409MP) implantation. The patient had stable postoperative astigmatism with rule thanks to the traction effect of the scleral flap suture. Astigmatism was typically stable six months after surgery, and the corrected visual acuity with glasses had improved to 20/25. Conclusion: This patient suffers from cataracts, keratoconus, glaucoma, and irregular astigmatism. Due to the interconnectedness of these four disorders, simultaneous success is challenging. We realized that surgically induced astigmatism, frequently affects vision early after filtering surgery for glaucoma patients. In the instance of this patient, we tightly sutured the scleral flap and using tractive action, established regular astigmatism. After the patient’s astigmatism stabilized, optometry was given to correct the vision. This technique should result in much better visual acuity. Finally, it came to pass.

Evaluation of the Ex-PRESS~ P-50 implant under scleral flap in combined cataract and glaucoma surgery

AIM： To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~ P-50 for combined cataract surgery and glaucoma.·METHODS： Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS~ P-50 model placed under scleral flap was performed.·RESULTS： Out of 40 eyes of 40 patients（55% male and45% female） completed the study during one-year follow-up. The mean of age was 76.6 ±11.02 y. The intraocular pressure（IOP） decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg（Wilcoxon signed ranks test, P 〈0.001）. A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control（〈21 mm Hg）.·CONCLUSION：Combinedsurgeryofphacoemulsification with Ex PRESS~ P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.

The change of anterior segment parameters after cataract surgery in normal-tension glaucoma

AIM： To investigate the change of anterior chamber angle morphology and intraocular pressure （lOP） reduction after cataract surgery in patients with normal-tension glaucoma （NTG） using swept-source optical coherence tomography （SS-OCT）. METHODS： This prospective, comparative, observational study recruited patients into two groups. Group 1 was the control group including normal subjects except those with cataracts （cataract group, n=67 eyes of 67 patients）, and group 2 was NTG group including patients who were diagnosed with NTG and cataracts （n=43 eyes of 43 patients）, which were treated with phacoemulsification and intraocular lens implantation. Before surgery, and at postoperative 1 and 6too, anterior chamber angles were evaluated by SS-OCT under dark conditions using three- dimensional angle analysis scan protocol. Angle opening distance （AOD）, angle recess area （ARA）, and trabecular- iris surface area （TISA） at four quadrants （temporal, nasal, superior, and inferior） were calculated automatically by SS-OGT, after the observer marked scleral spurs. RESULTS： A total of 106 patients （54 males and 52 females） were enrolled in the study. Angle parameters, AOD, ARA, and TISA were increased after surgery in both groups. However, changes of angle parameters were only significant in group 2. In group 2, preoperative lOP was 13.2＋2.9 mm Hg, and postoperative lOP at 1 and 6mo were 10.5＋3.0 and 10.7＋2.8 mm Hg, respectively. In group 1, preoperative lOP was 12.42.8 mm Hg, and postoperative lOP at 1 and 6mo were 11.6＋2.5 and 12.0＋2.8 mm Hg, respectively. After cataract surgery, angle parameters changed significantly while IOP significantly reduced and was maintained in group 2 （P〈0.001）. The changes in angle parameters （＆AOD500, ATISAS00 at temporal; ＆AOD500, S, RA500 at nasal） were linearly correlated with postoperative IOP changes. CONCLUSION： Cataract surgery may have improved antedor chamber angle parameters and decreased lOP in NTG patients.

iStent inject? and cataract surgery for mild-to-moderate primary open angle glaucoma in Japan: a cost-utility analysis

AIM: To evaluate the cost-utility of iStent inject;with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma(POAG) in the Japanese setting from a public payer’s perspective.METHODS: A Markov model was adapted to estimate the cost-utility of iStent inject;plus cataract surgery vs cataract surgery alone in one eye in patients with mild-tomoderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients’ characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS: In the probabilistic base case analysis, iStent inject;with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ￥5 000 000/quality-adjusted life year(QALY)willingness-to-pay threshold. The incremental cost-utility ratio(ICUR) was estimated to be ￥1 430 647/QALY gained and the incremental cost-utility ratio(ICER) was estimated to be ￥12 845 154/blind eye avoided. iStent inject;with cataract surgery vs cataract surgery alone was found to increase costs(￥1 025 785 vs ￥933 759, respectively) but was more effective in increasing QALYs(12.80 vs 12.74) and avoiding blinded eyes(0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery(￥279 903 vs ￥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject;with cataract surgery was found to dominate cataract surgery alone.CONCLUSION: The iStent inject;with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer’s perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery:a Meta-analysis

AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma.Primary outcomes included postoperative intraocular pressure(IOP)and the number of postoperative antiglaucoma medications.Secondary outcomes were the prevalence of complications,incidence of needling or goniopuncture,and surgical success rate.RESULTS:In total,380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included.Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group[weighted mean difference(WMD)=-1.12,95%confidence interval(CI):-2.11 to-0.12,P=0.03;WMD=-0.31,95%CI:-0.53 to-0.09,P=0.006].Moreover,Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone,while no significant difference existed for surgical success.CONCLUSION:Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications.Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy,fewer complications,and postoperative procedures.

Outcomes after combined excisional goniotomy and manual small incision cataract surgery

AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually significant cataracts that underwent combined excisional goniotomy and MSICS with one-year follow-up. The medical history, demographic information, and clinical characteristics of each case were recorded. Data regarding changes in vision, intraocular pressure(IOP), the number of glaucoma medications, and the evolution of the disease after surgery were reported. RESULTS: Three patients, with open angle glaucoma and cataracts underwent combined excisional goniotomy and MSICS without adverse events. All patients had improvement in vision compared to baseline measurements. The range of IOP at baseline was from 14 to 18 mm Hg and decrease to a range of 10 to 14 mm Hg after one year of follow-up. Additionally, two patients also decreased their dependence on IOP-lowering medications at the last follow up visit with one patient maintaining baseline level of medication use.CONCLUSION: A combination of excisional goniotomy and MSICS illustrates both the safety and efficacy to treat patients with visually significant cataract and glaucoma. This procedure allows for a more cost-effective surgical approach that matches the needs of resource strained territories around the globe.

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

AIM：To compare the effect of phacoemulsification on intraocular pressure（IOP）in patients with primary open angle glaucoma（POAG）and pseudoexfoliation glaucoma（PXG）.METHODS：A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico.The study enrolled consecutive patients having phacoemulsification with intraocular lens（IOL）implantation and a diagnosis of POAG or PXG.Data about IOP values and number of glaucoma medications used was collected at baseline,1,3,6 and12mo postoperatively.RESULTS：The study enrolled 88 patients（88 eyes）.After phacoemulsification,there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients（P〈0.001）.In the POAG group,a 20%decrease in IOP values was evidenced,and a 56.5%reduction in the number of medications used at the one-year follow-up.The PXG group showed a 20.39%,and a 34.46%decrease in IOP and number of medications used,respectively.A significant difference in the meanΔIOP（postoperative changes in IOP）was evidenced between groups（P=0.005）.The reduction of the postsurgical IOP mean values in both groups,the POAG group showed a greater reduction in IOP values compared to the PXG group.CONCLUSION：In both types of glaucoma,phacoemulsification cataract surgery can result in a significant IOP reduction（20%）over a 12mo follow-up period.The number of medications used is also significantly reduced up to 12mo after surgery,especially in the PXG group.

Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Surgical Outcomes of Nontraumatic Pediatric Cataracts

Purpose: To evaluate post-surgical complications in patients who were operated for nontraumatic pediatric cataracts in our clinic. Methods: Medical records of 62 patients (101 eyes) that underwent cataract surgery younger than 15 years of age, without history of ocular trauma and with a minimum follow-up period of 6 months, were reviewed retrospectively. Results: The most common initial complaint was leukocoria. Thirty-nine patients (62.9%) had bilateral cataracts and 23 patients (37.1%) had unilateral cataracts. The most common type was posterior polar cataract (22%) in patients with unilateral cataracts, and total cataract (33%) in patients with bilateral cataracts. The overall prevalence of postoperative complications was 58%, visual axis opacification (VAO) being the most common one (39%). The incidence of VAO was significantly higher in eyes with intact posterior capsules. Secondary glaucoma occurred in 12 (12%) eyes. Thirty-one (50%) patients were orthophoria, 17 (27%) patients had esotropia, and 14 (23%) patients had exotropia. Additional surgery for all of these complications was performed in 53 (53%) eyes. Conclusions: Despite appropriate surgical treatment of nontraumatic pediatric cataracts, post-surgical complications including VAO, glaucoma, or strabismus remain an important cause of morbidity in these patients. Posterior capsulotomy and anterior vitrectomy must be performed in all children below 6 years to reduce the need for additional surgery for VAO.

Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma:A case report

BACKGROUND Asymmetric multifocal intraocular lenses(IOLs)are now widely used in the modern cataract surgery,providing a good level of visual performance over a range of distances and high postoperative patient satisfaction.We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.CASE SUMMARY A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye(left eye)with implantation of an asymmetrical multifocal IOL.Postoperative uncorrected distance visual acuity(UDVA)was 0.0 logMAR(20/20 Snellen)and uncorrected near visual acuity(UNVA)was 0.1 logMAR(20/25 Snellen).Two weeks later,the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells.Anterior capsule polishing and superotemporal placement of near segment[+3.00 diopter(D)addition(add)]of IOL were performed.As a result,UDVA at the first week and first year after reposition was 0.0 logMAR(20/20 Snellen),and compared with 0.3 logMAR(20/40 Snellen)in the first week,the UNVA was improved to 0.0 logMAR(20/20 Snellen)one year after surgery.CONCLUSION The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient.Capsule polishing and rotation of the lens were beneficial to the patient,which not only enhanced the patient's vision,but also improved the patient's satisfaction.Therefore,glaucoma patients need to be cautious of implanting multifocal IOLs.Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

PEI联合术中房角镜下房角分离及房角切开术治疗中晚期PACG合并白内障

目的:评价超声乳化白内障吸除人工晶状体植入术(PEI)联合术中房角镜直视下房角分离术(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)合并白内障的效果。方法:回顾性病例系列研究方法。收集2021-12-01/2023-03-31在安徽医科大学第二附属医院手术的中晚期PACG合并白内障患者62例65眼,根据手术方式不同分为两组:观察组30例32眼行PEI+GSL+GT,对照组32例33眼行PEI+GSL。评估两组患者术前,术后1 d, 1 wk, 1、3、6 mo眼压、最佳矫正视力(BCVA)和抗青光眼药物使用数量。术前和术后6 mo时分别评估视野、杯盘比、前房角开放范围、前房深度、RNFL平均厚度。结果:PEI+GSL+GT组术后6 mo眼压和平均眼压降幅(16.68±2.65、11.12±8.53 mmHg)与PEI+GSL组(18.71±2.51、8.32±4.17 mmHg)有显著差异(P<0.05),眼压降幅率无差异(44.57%±21.79%和35.20%±17.94%,P>0.05)。术后6 mo两组抗青光眼药物使用数量、BCVA、前房深度、房角关闭范围均较术前改善(均P<0.01),PEI+GSL+GT组术后6 mo的药物减少数量和房角开放范围均大于PEI+GSL组(P<0.05),其余指标两组间比较均无差异(均P>0.05)。两组术后6 mo的视野平均偏差、杯盘比及RNFL平均厚度较术前均无差异(均P>0.05)。PEI+GSL+GT组手术完全成功率为81%(26/32),手术条件成功率为94%(30/32);PEI+GSL组手术完全成功率为58%(19/33),手术条件成功率为76%(25/33)。两组间手术成功率均有差异(完全成功率χ^(2)=4.275,P=0.039;条件成功率χ^(2)=4.040,P=0.044)。两组患者均未见危及视力的并发症及再次手术。结论:对于中晚期原发性闭角型青光眼合并白内障患者,采用PEI+GSL+GT治疗比PEI+GSL治疗更有效。

脉络膜脱离1例

61岁男性,因“左眼前黑影遮挡伴视力下降近2周”就诊。患者4年前、2年前和1年前分别行左眼小梁切除术,右眼穿透性角膜移植术和右眼白内障超声乳化+人工晶状体(IOL)植入术。半年前因左眼颗粒状角膜营养不良,于我院行左眼深板层角膜移植术,手术顺利,术后规律复诊。左眼角膜移植术后3个月和4个月,分别行左眼部分角膜缝线拆除,左眼白内障超声乳化+人工晶体植入术。左眼角膜移植术后半年,再次行左眼角膜缝线拆除。此次拆线术后2周至门诊复诊,主诉“左眼前黑影遮挡伴视力下降近2周”,查体如下。裸眼视力:左眼CF/10 cm;眼压:左眼5 mmHg。左眼角膜植片透明,位置良好,前房清,瞳孔圆,光反射存在,IOL明。眼底:左眼脉络膜广泛脱离,未查见裂孔及出血。B超查及脉络膜脱离回声。经扩瞳、局部及全身抗炎治疗5天后,脉络膜脱离仍未见明显好转,遂决定行左眼玻璃体切除+脉络膜脱离复位术。术中可放出大量微黄色脉络膜上腔液体,复位脉络膜,未见视网膜裂孔,术毕气体填充,术后患者脉络膜复位良好,视力逐渐提高。追问病史,患者第2次角膜拆线过程中,痛感非常明显,术中高度紧张,存在用力屏气过程。讨论体会:患者角膜拆线时的Valsava动作很有可能是该例脉络膜脱离发生的原因,要详细了解病情,做好术前沟通、加强人文关怀,术中充分麻醉,密切关注患者术中情况,做好患教工作,术后尽早随访,以便及时发现特殊并发症。

房角分离手术联合超声乳化人工晶状体植入术对白内障合并闭角型青光眼患者的临床疗效分析

目的:探讨房角分离手术联合超声乳化人工晶状体植入术对白内障合并闭角型青光眼患者的临床疗效。方法:选取2022年1月至2023年1月间于北京康复医院就诊的198例白内障合并闭角型青光眼患者,根据治疗方法的不同将其分为对照组和观察组,每组99例。对照组行白内障超声乳化人工晶状体植入术联合小梁切除术;观察组行超声乳化人工晶状体植入术联合房角分离术。比较两组手术前后的临床相关指标与角膜内皮完整性、手术后3个月临床疗效,以及并发症发生情况。结果:观察组术后3个月临床疗效总有效率为95.96%,较对照组更佳,差异有统计学意义(x^(2)=4.352,P<0.05)。两组治疗后3个月视力水平均有所提高,但组间比较差异无统计学意义(P>0.05);前房深度和前房角度均有所增大,且观察组更大;眼压均有所降低,且观察组低于对照组,差异有统计学意义(t=7.654,P<0.05)。两组治疗后3个月角膜内皮细胞密度均有所减小,而观察组明显大于对照组;角膜内皮细胞平均面积与角膜中心厚度均有所增大,而观察组明显小于对照组,差异有统计学意义(t=25.233、16.608、6.698,P<0.05)。手术治疗后观察组并发症总检率为8.08%,低于对照组的19.19%,差异有统计学意义(x^(2)=5.189,P<0.05)。结论:白内障合并闭角型青光眼患者实施房角分离手术联合超声乳化人工晶体植入术疗效确切,可有效提高患者视力水平,同时也改善了前房深度、前房角度和眼压,更利于维持患者角膜内皮细胞的完整性,且安全性较好。

飞秒激光辅助白内障手术在青光眼治疗中的应用进展

飞秒激光辅助白内障手术(FLACS)的应用已有10余年的历史,其安全性与精准性已得到验证。近年来FLACS已逐步应用于青光眼合并白内障患者,尤其是原发性闭角型青光眼(PACG)患者,因其独特的解剖特点使得常规白内障手术晶状体摘除难度与潜在并发症增加,FLACS用于PACG患者优势明显。新近报道FLACS联合微创青光眼手术(MIGS)应用于开角型青光眼患者、联合房角分离术(GSL)用于闭角型青光眼患者,甚至用于抗青光眼术后存有滤过泡的患者,其适应证日趋拓展。FLACS可导致术中短暂眼压升高,眼部参数对术中眼压可产生一定影响,对眼压的远期影响有待进一步研究。FLACS对青光眼患者视功能的影响及其产生的相关并发症应引起重视。文章就FLACS在各类青光眼中的应用、对眼压和视功能的影响、特殊并发症及应用前景做一综述。

三种术式治疗急性原发性闭角型青光眼合并白内障的效果观察

目的:对比急性原发性闭角型青光眼(PACG)合并白内障三种术式的效果。方法:筛选2020年2月—2023年2月南昌普瑞眼科医院接受手术治疗急性PACG合并白内障患者96例,按随机数字表法将其分成复合切除组(34例)、小梁切除组(32例)、房角分离组(30例)。比较三组眼科相关参数、并发症与远期生活质量。结果:复合切除组患者的最佳矫正视力(BCVA)、中央前房深度(CAC)、房角开放距离500(AOD500)、小梁虹膜角(TIA)、生活质量评分均高于小梁切除组、房角分离组(P<0.05),眼压(IOP)、房角形态分级、小梁睫状体距离(TCPD)、房角粘连范围(PAS)均低于小梁切除组、房角分离组(P<0.05),三组周边前房深度分级(PAC)、晶状体厚度(TL)、眼轴长度(AL)之间,差异均无统计学意义(P>0.05);小梁切除组、房角分离组BCVA、IOP、CAC、PAC、房角形态分级、TL、AL、AOD500、TIA、TCPD、PAS、生活质量评分比较,差异均无统计学意义(P>0.05)。复合切除组总有效率为94.12%(32/34),高于小梁切除组、房角分离组的71.88%(23/32)、66.67%(20/30),差异均有统计学意义(P<0.05);小梁切除组、房角分离组总有效率比较,差异无统计学意义(P>0.05)。复合切除组并发症发生率为5.88%(2/34),低于小梁切除组、房角分离组的28.13%(9/32)、26.67%(8/30),差异均有统计学意义(P<0.05);小梁切除组、房角分离组并发症发生率之间,差异无统计学意义(P>0.05)。结论:急性PACG合并白内障超声乳化联合复合小梁切除术的效果较显著。

FLACS-IOL手术对白内障患者术后MIOL的偏移率及视觉质量的影响

目的:探讨飞秒激光辅助超声乳化手术联合人工晶状体植入(FLACS-IOL)对白内障患者术后多焦点人工晶状体(MIOL)偏移率及视觉质量的影响。方法:前瞻性研究。选取我院2021-01/2022-12收治的白内障MIOL植入患者95例108眼,根据患者意愿选择手术方式并分组为FLACS组(51例56眼),Phaco组(44例52眼)。对比两组手术时间、前囊切开直径、有效超声时间(EPT)、超声乳化能量释放量(CDE)、裸眼远视力(UCDVA)、最佳矫正远视力(BCDVA)、术后3 mo的IOL偏心距离、偏移率及3 mm瞳孔下全眼总高阶像差(HOA)、三叶草差(Trefoil)及彗差(Coma)。结果:FLACS组手术时间明显短于Phaco组,EPT、CDE均明显低于Phaco组(均P<0.05);两组前囊切开直径无差异(P>0.05)。FLACS组UCDVA在术后1 wk,3 mo优于Phaco组(均P<0.05);两组术后1 wk,3 mo的UCDVA和术后3 mo的BCDVA比较均有差异(P<0.05)。术后3 mo,FLACS组IOL偏心距离小于Phaco组,偏移率明显低于Phaco组(均P<0.05)。在3 mm瞳孔直径下,两组术后3 mo的全眼HOA、三叶草差及彗差均较术前减少(P<0.05),FLACS组术后3 mo的全眼HOA、三叶草差与Phaco组比较均有差异(P<0.05),FLACS组术后3 mo的彗差与Phaco组比较无差异(P>0.05)。结论:FLACS-IOL手术可有效降低白内障患者术后IOL偏移率,获得更好的视觉质量。

原发性闭角型青光眼伴晶体不全脱位1例

原发性闭角型青光眼(PACG)发病基本因素是小眼球、短眼轴、远视眼,晶状体因素在其发病机制中具有重要作用。诊断中常因角膜水肿、前节窥视不清或晶体轻度偏心、体征不明显而漏诊,从而出现常规用药后眼压不降反升的情况。本例主诉为“左眼视力下降及左侧头痛1月”的患者就诊于眼科,诊断为原发性急性闭角型青光眼,使用缩瞳药后眼压不降反升,后给予扩瞳药治疗,眼压下降,给予左眼白内障超声乳化+人工晶体植入术,术后眼压正常,角膜清亮,前房深度可。