Corneal biomechanical properties changes after coaxial 2,2-mm microincision and standard 3,0-mm phacoemulsification

AIM： To compare the changes in corneal biomechanics measured by ocular response analyzer （ORA） after 2.2-ram microincision cataract surgery and 3.0-mm standard coaxial phacoemulsification. METHODS： The prospective nonrandomized study comprised eyes with cataract that had 2.2-mm coaxial microincision or 3.0 -mm standard incision phacoemulsification. The corneal hysteresis （CH）, corneal resistance factor （CRF）, corneal-compensated intraocular pressure （IOPcc） and Goldmann-correlated intraocular pressure （IOPg） were measured by ORA preoperatively and at ld, 1-, 2-, 3- and 4-week postoperatively. Results were analyzed and compared between groups. RESULTS： In both groups, CH decreased in the immediate postoperative period （P〈0.05）, returned to the preoperative level at one week （P =0.249） in the 2.2-mm group, and at two weeks in the 3.0-mm group （P --0.264）; there was no significant change in CRF values. In 2.2-mm group, mean IOPcc and IOPg increased at ld postoperatively （both ,P〈0.05）, and returned to preoperative level at one week （,0 =0.491 and P =0.923, respectively）. In 3.0-mm group, mean IOPcc and IOPg increased at ld and lwk postoperatively （P =0.005 and ,P =0.029, respectively）, and returned to preoperative level at 2wk （P =0.347 and P =0.887, respectively）. CONCLUSION： Significant differences between preoperative and postoperative corneal biomechanical values were found for CH, IOPcc and IOPg. But the recovery time courses were different between the two groups. The 2.2-mm coaxial microincision cataract surgery group seemed recovery faster compared to the 3.0-mm standard coaxial phacoemulsification group.

A comparison of surgical efficacy between a 1.8-mm microincision and 3.2-mm and 5.5-mm incisions for phacoemulsification

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch ＆ Lomb MI60 foldable intraocular lens （IOL） implantation （n=30）, 3.2-mm group received Bausch ＆ Lomb Akreos AO foldable lens implantation （n=30）, and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation （n=30）. Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.

Bimanual microincision cataract surgery with implantation of the new Incise~? MJ14 intraocular lens through a 1.4 mm incision

AIM：To analyze the visual outcomes and the posterior capsule opacification（PCO）with the new Incise？MJ14intraocular lens（IOL）implanted through a 1.4 mm clear corneal incision（CCI）in patients who underwent bimanual microincision cataract surgery（B-MICS）.METHODS：Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study：40 eyes were implanted with an Incise？MJ14 IOL through a 1.4 mm CCI（group A）without enlargement of the main CCI,while 40 eyes were implanted with an Akreos？MI60 IOL with enlargement of the main CCI to 1.8 mm（group B）.Best corrected visual acuity（BCVA）,astigmatism and endothelial cell loss were evaluated before and after surgery at 7,30d and 6mo.Anterior segment-optical coherence tomography（AS-OCT）of CCI was performed at 1,3,7,30d,6 and 18mo.PCO incidence was evaluated at 18mo using EPCO 2000 Software.RESULTS：Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups;no statistically significant difference in surgically induced astigmatism（SIA）was noticed in the two groups.At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery;no statistically significant alterations were found at 1,6 and 18mo.PCO score at 18mo was 0.03±0.07for group A and 0.08±0.18 for group B（P=0.11）with no sign of central optic plate invasion in both groups.CONCLUSION：The implant of the new Incise？MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery.PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

改良23G玻璃体切除手术后早期高眼压的危险因素分析

目的:观察改良23G经结膜免缝合微切口玻璃体切除手术(TSV)后早期(7d内)高眼压发生率及其影响因素。方法:回顾性病例分析研究。选取2013-03/11在我院行改良23G免缝合微切口玻璃体切除手术的98例98眼纳入研究。采用非接触式眼压计测量眼压在25mmHg以上的术眼临床资料进行分析。连续监测手术后7d的眼压情况,分析患者年龄、性别、眼别、病程及手术前原发疾病、眼内手术史、手术方式、不同眼内填充物、晶状体状态及手术时间对手术后高眼压发生的影响。结果:23G玻璃体切除术后7d内共33眼出现高眼压,发生率是33.7%(33/98),其中,发生在术后第1d者8眼,占24.2%(8/33),术后3d者25眼,占75.8%(25/33)。男、女高眼压的发生率分别为32.8%(20/61)和35.1%(13/37),右、左眼高眼压发生率分别是36.8%(21/57)和29.3%(12/41)。高眼压眼与无高眼压眼年龄(Z=-0.22),性别(χ2=0.057)、手术眼别(χ2=0.612),病程(Z=-0.079)及手术时间(Z=-0.553)比较,差异均无统计学意义(P>0.05)。硅油眼和气体填充眼比较(χ2=1.04)、外伤眼和非外伤眼比较(χ2=0.044),视网膜脱离眼和非视网膜脱离眼比较(χ2=2.282),差异亦无统计学意义(P>0.05)。多次手术眼比首次手术眼高眼压发生率高(χ2=5.211),联合手术较单纯玻璃体手术高(χ2=4.57),无晶状体眼较有晶状体眼高(χ2=4.224),差异有统计学意义(P<0.05)。结论:23G免缝合微切口玻璃体切除术后高眼压主要发生在术后前3d。眼内手术史,联合手术,无晶状体眼是手术后高眼压的危险因素。

不同白内障超声乳化术切口对糖尿病患者术后干眼的影响

目的:比较3.0mm和2.2mm两种白内障手术切口术后泪膜稳定性的变化。方法:选取合并糖尿病的老年性白内障患者76例92眼,随机分组:A组48眼行3.0mm透明角膜切口白内障超声乳化术;B组44眼行2.2mm透明角膜切口白内障超声乳化术。观察术前及术后7d,1、3mo的干眼症状、基础泪液分泌、泪膜破裂时间及角膜荧光素染色情况。结果:A组术后各时间点干眼症状明显重于B组,术后1wk,1mo角膜荧光染色检查明显多于B组,泪膜破裂时间明显低于B组,差异有统计学意义(P<0.05),术后1mo时,A组基础泪液分泌高于B组,两组差异有统计学意义(P<0.05)。结论:2.2mm切口较3.0mm切口在合并糖尿病的白内障患者超声乳化术后干眼症状更轻,持续时间更短。

Outcomes of 1.8-3.0 mm incision phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma with cataract

●AIM:To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0 mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.●METHODS:Ninety-six patients(96 eyes)with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017.Group A(3.0 mm incision),B(2.2 mm incision),and C(1.8 mm incision)comprised 30,34 and 32 eyes respectively.All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy.Data including best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell counts(CECC),intraocular pressure(IOP),and complications were collected before the operation,and at postoperative 1 d,1 and 3 mo.●RESULTS:All the patients were successfully treated with surgery.The BCVA of groups B and C were significantly improved as compared to group A at postoperative 1 d,1 and 3 mo(all P<0.05),but there was no difference between groups B and C at each time interval(all P>0.05).The corneal astigmatism of group A was statistically higher than that of group B(P=0.026);corneal astigmatism of group B was statistically higher than that of group C at postoperative 1 d(P=0.006).The corneal astigmatism of group A at postoperative 3 mo was significantly higher than that before operation(P=0.003).At postoperative 1 and 3 mo,corneal astigmatism of groups B and C were significantly lower than that of group A(all P<0.05).The CECC in group B was significantly higher than that of group A(P=0.020),and CECC in group C was significantly higher than that of group B(P=0.034)at postoperative 1 d.At postoperative 1 and 3 mo,CECC of groups B and C were significantly higher than that of group A(all P<0.05).In each group,postoperative mean IOP at each time interval was significantly lower than preoperative IOP(all P<0.05).●CONCLUSION:Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery,and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.

微切口超声乳化白内障手术的发展及现状

本文比较同轴微切口和双手微切口超声乳化白内障手术的特点;通过对前房稳定性、角膜切口状态、角膜散光改变以及人工晶状体植入等方面的评价,阐述微切口超声乳化白内障手术产生的影响。由于手术操控性好、视力恢复迅速及手术源性散光减少等优势,微切口白内障手术是白内障屈光手术发展的方向和目标。随着超声乳化设备的发展和人工晶状体的研发,微切口白内障手术将日益发展、完善和普及。

改良无缝线技术应用于硅油眼联合手术中的效果分析

目的探讨两种微切口无缝线技术在硅油填充眼并发性白内障联合手术治疗过程中较传统巩膜缝线技术的安全性及学习曲线差异性,进而明确该类疾病之优选治疗方案。方法采用回顾性病例分析法,将就诊于我院,并已经分别采用微切口白内障超声乳化联合20G巩膜穿刺缝线法(18眼,18例)、微切口白内障超生乳化联合23G巩膜穿刺无缝线法(13眼,13例)、微切口白内障超声乳化晶体后囊膜切开法(12眼,12例)的患者术前、术后的最佳矫正视力、手术所需时间、术后第1天眼压、并发症发生情况进行记录并分析。结果将术前、术后第3月最佳矫正视力改变的程度进行组间比较,所有患者在视力改变方面差异无统计学意义(P>0.05)。联合手术中采取23G巩膜穿刺无缝线组较20G巩膜穿刺缝线组手术时间缩短(t=2.31,P<0.05),采用晶体后囊膜切开并未能缩短手术时间;与20G巩膜缝线硅油取出联合手术方式比较,联合23G手术方式并未减少并发症发生。但联合巩膜23G穿刺较晶体后囊膜切开在降低术中低眼压及脉络膜脱离发生等方面更具优势(P<0.05)。结论 1.8 mm透明角膜切口联合无缝合硅油取出术,手术时间短、术中并发症低;采用晶体后囊膜切开硅油取出,术前应长期观察,检测视网膜情况,术中后囊膜切开操作学习曲线长,应谨慎选择该术式。

International multi-center study of iatrogenic retinal tears in pars plana vitrectomy

AIM: To study and compare the effect of different surgical settings on the development of iatrogenic retinal tears(IRT) in conventional(20-gauge) and microincisional vitrectomy.METHODS: An international retrospective comparative study of 394 patients who had simple vitrectomy at three tertiary centers. Surgeries were performed by four retina surgeons using different viewing systems. Two groups of eyes were compared: microincisional vitrectomy(327 eyes) and conventional(67 eyes) vitrectomy. An iatrogenic tear was defined as the occurrence of one or more peripheral retinal tears during surgery or at any visit in the first 6 wk postoperatively.RESULTS: Mean age was 67±12 y and 55% were female. Iatrogenic tears occurred in 11/394(2.8%) of eyes. The rate of tears was similar among different surgeons and viewing systems(P=0.93 and P=0.76, respectively). Surgical indication, preexisting pseudophakia/aphakia, induction of posterior vitreous detachment(PVD) during surgery, and the use triamcinolone acetonide didn’t significantly affect the rate of tears(P>0.1 for all factors). A higher rate of tears was found in the conventional group compared to the microincisional group(respectively, 7.5%, 1.8%, P=0.02).CONCLUSION: The rate of IRT in vitrectomy is not significantly affected by surgical indication, preexisting PVD or pseudophakia, or use of triamcinolone or different viewing systems but is significantly higher in conventional vitrectomy. Microincisional platforms improve the safety of vitrectomy regardless of the viewing system used.

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.

Endoscope-assisted vitrectomy

Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities, a small pupil, and vitreous opacities. Moreover, ocular endoscopes enable the management of peripheral lesions without scleral indentation and are compatible with microincision vitrectomy surgery. The enlarged view under the endoscope, as obtained by drawing towards the lesion, appears to be another advantage. Rhegmatogenous retinal detachment with undetectable retinal breaks, trauma, endophthalmitis, scleral wounds with incarceration of the vitreous, and microcornea are indications for endoscopic vitrectomy. The combination of endoscopy and a wide-angle viewing system could compensate for the deficiencies of each technique and achieve more effective and safer surgical maneuvers. Endoscopy skills appear to be a great advantage for vitreoretinal surgeons;however, because endoscopies require a learning curve, becoming familiar with the handling of the endoscope through stepby-step learning is necessary.

微切口超声乳化术对糖尿病合并白内障患者眼表的影响

目的 探究糖尿病合并白内障患者采用微切口超声乳化术对于眼表的影响。方法 选择北京市顺义区医院2020年1月—2021年1月就诊的62例糖尿病合并白内障患者,按照随机数表法进行分为对照组和观察组,各31例。对照组(46眼)采用常规3.0 mm透明角膜切口超声乳化吸除术治疗,观察组(48眼)采用1.8 mm角膜微切口超声乳化吸除术治疗,比较两组糖尿病合并白内障患者的OSDI评分、角膜知觉、泪膜破裂时间、基础泪液分泌试验情况。结果 观察组术后1周,术后1、3、6个月OSDI评分均小于对照组,差异有统计学意义(P<0.05)。观察组术后1周,术后1、3、6个月角膜知觉、BUT各项指标值均大于对照组,差异有统计学意义(P<0.05)。观察组术后1周,术后1、3个月的SIT为(7.27±2.72)、(8.74±3.73)、(9.44±3.22)mm/5 min均大于对照组,差异有统计学意义(t=2.223、2.144、2.173,P<0.05)。结论 糖尿病合并白内障患者应用微切口超声乳化术治疗对眼表的影响更小。

同轴微切口超声乳化白内障吸出术后泪膜及角膜知觉的变化

目的比较1．8mm、2．2mm两种微切口白内障手术与标准切口白内障手术后泪膜及角膜知觉的变化。方法随机选取2010年9月至2011年2月期间行超声乳化白内障吸出术的老年性白内障患者205例（205只眼），根据患者对人工晶状体的选择分为1_8mm、2．2mm、3．0mm切口3组。随访3个月，比较各组非侵犯性泪膜破裂时间（NIBUT）、上方及中央角膜知觉、Schirmer试验值及患者主观干眼感觉评分值。结果术后7d、1个月1．8mm、2．2mm组NIBUT明显长于3．0mm组差异有统计学意义（P〈0．05）。术后3个月坶恢复至术前水平，3组间差异无统计学意义（P〉0．05）。术后30d，1．8mm组Schirmer试验值高于3．0mm组差异有统计学意义（P〈0．05）。术后90d，3组均恢复至术前水平，组间无差异。术后7、30d，1．8mm、2．2mm组干眼感觉评分值明显低于3．0mm组。术后90d，3组患者问差异无统计学意义（P〉0．05）。术后7d、1个月，3．0mm组上方角膜知觉测量值短于2．2mm、1．8mm组（P〈0．05）。术后3个月，3组上方角膜知觉均恢复至术前水平，组间差异无统计学意义（P〉0．05）。3组术后各时间段中央角膜知觉差异无统计学意义（P〉0．05）。1．8mm、2．2mm组间各观察指标于术后各个时间段差异无统计学意义。结论与标准切口白内障手术相比，微切口超声乳化白内障吸出术对眼表的骚扰更小，患者术后干眼症状更轻微，角膜知觉恢复快，舒适度更高。但同属微切口组的1．8mm与2．2mm手术组术后干眼症状及各项检查结果无明显差异。

双手微小切口与传统同轴超声乳化吸除术对术后视觉质量影响的Meta分析

目的系统评价双手微小切VI（B—MICS）与传统同轴白内障超声乳化吸除术（C—SICS）对术后视觉质量的影响。方法通过计算机文献检索，结合手工检索，对纳入的有关B—MICS和C—SICS临床疗效的相关文献进行Meta分析，以比值比（OR）和加权均数差值（WMD）为效应量，应用Review Manager4．2软件进行Meta分析。对检索所得资料进行敏感性分析，并评价其发表偏倚。结果共有9篇文献纳入研究。术后1d、1周、1个月，裸眼视力≥0．5的合并OR值分别为1．82（95％凹：1.38～2．39）、2．36（95％CI：1．27-4．37）和1．61（95％CI：1．08—2．41）。术后1个月，手术源性散光合并WMD值为一0-35D（95％CI：-0．48—0．21D），差异有统计学意义（P〈0．01）。术后1个月，最佳矫正视力／〉0．5的合并OR值为1．69（95％CI：0．93～3．07），差异无统计学意义。敏感性分析及发表性偏倚结果显示本研究结果具有较好稳定性。结论B—MICS可减少手术源性散光．使患者术后视力恢复得更快、更好。

23G微创玻璃体切除或联合超声乳化白内障摘除术治疗孔源性视网膜脱离临床观察

目的 比较孔源性视网膜脱离患者行23G免缝合微创玻璃体切除术（PPV）和玻璃体切除术联合超声乳化白内障摘除术（PPVCE）的术后视力及临床并发症.方法 回顾性病例分析研究.收集2013年1月至2014年10月在南宁爱尔眼科医院住院治疗的173例173只眼孔源性视网膜脱离患者,PPV组112例112只眼,PPVCE组61例61只眼.主要观察术后1个月及6个月的最佳矫正视力、眼压以及术中、术后并发症.结果 术后随访6-15个月.术前视力光感～0.6,术后视力光感～1.0.术后1个月,PPV组视力提高102只眼（91.07％,102/112）,PPVCE组视力提高57只眼（93.44％,57/61）;术后6个月,PPV组视力提高98只眼（87.5％,98/112）,PPVCE组视力提高55只眼（90.16％,55/61）.早期并发症（术后≤3个月）,PPV组：角膜水肿及前房渗出2只眼（1.78％,2/112）,暂时性高眼压23只眼（20.54％,23/112）;PPVCE组角膜水肿及前房渗出5只眼（8.20％,5/61）,暂时性高眼压21只眼（34.43％,21/61）;两组术后早期并发症比较,PPVCE组角膜水肿及前房渗出发生率（x2=4.181,P=0.041）及暂时性高眼压发生率（x2=4.018,P=0.045）均比PPV组高,差异有统计学意义.晚期并发症（术后＞3个月）,PPV组：新生血管性青光眼5只眼（4.46％/,5/112）,虹膜后粘连、瞳孔变形5只眼（4.46％,5/112）,晶状体后囊膜混浊7只眼（6.25％,7/112）,复发性视网膜脱离3只眼（2.68％,3/112）;PPVCE组：新生血管性青光眼2只眼（3.28％,2/61）,虹膜后粘连、瞳孔变形3只眼（4.92％,3/61）,视网膜脱离复发2只眼（3.28％,2/61）;两组比较新生血管性青光眼（x2=0.143,P=0.705）,虹膜后粘连（x2=0.081,P=0.892）,视网膜脱离复发（x2=0.189,P=0.664）的发生率差异均无统计学意义.结论 23G免缝合微创玻璃体切除联合超声乳化白内障摘除术治疗合并白内障的孔源性视网膜脱离患者是安全有效的.联合手术避免了二次白内障手术,并利于术后眼底的随访观察。

微创玻璃体切除术中气体灌注迷流现象分析

目的分析微创玻璃体切除术中发生气体灌注迷流的机制和处理措施。方法回顾性分析2016年1月至2017年1月玻璃体手术440例(440只眼)的临床资料,其中23G手术412例,20G手术28例。结果23G玻璃体切除术中发生气体灌注迷流至前房和玻璃体前间隙者15例,而20G玻璃体手术中未观察到气体灌注迷流。这种现象主要是由微创切口套管不能完全穿透玻璃体皮质等因素所造成的。解决的方法是放出前房气体并重新调整灌注头的状态。结论气体灌注迷流在23G玻璃体切除术的发生率高于20G玻璃体手术(χ2=4.141,P=0.042)。正确认识其原因,及时采取相应措施进行预防和对症处理。