Consilience and unity in ocular anterior segment research

In his beautiful book,Consilience:The Unity of Knowledge,the eminent biologist Edward O Wilson,advocates the need for integration and reconciliation across the sciences.He defines consilience as“literally a‘jumping together’of knowledge with a linking of facts…to create a common groundwork of explanation”.It is the premise of this paper that as much as basic biomedical research is in need of data generation using the latest available techniques–unifying available knowledge is just as critical.This involves the necessity to resolve contradictory findings,reduce silos,and acknowledge complexity.We take the cornea and the lens as case studies of our premise.Specifically,in this perspective,we discuss the conflicting and fragmented information on protein aggregation,oxidative damage,and fibrosis.These are fields of study that are integrally tied to anterior segment research.Our goal is to highlight the vital need for Wilson’s consilience and unity of knowledge which in turn should lead to enhanced rigor and reproducibility,and most importantly,to greater understanding and not simply knowing.

Influence of lens position as detected by an anterior segment analysis system on postoperative refraction in cataract surgery

AIM:To predict postoperative intraocular lens(IOL)position using the Sirius anterior segment analysis system and investigate the effect of lens position and IOL type on postoperative refraction.METHODS:A total of 97 patients(102 eyes)were enrolled in the final analysis.An anterior segment biometry measurement was performed preoperatively with Sirius and Lenstar.The results of predicted lens position(PLP)and IOL power were automatically calculated by the software used by the instruments.Effective lens position(ELP)was measured manually using Sirius 3 mo postoperatively.Pearson's correlation analysis and linear regression analysis were used to determine the correlation of lens position to other parameters.RESULTS:PLP and ELP were positively correlated to axial length(AL;r=0.42,P<0.0001 and r=0.49,P<0.0001,respectively).There was a weak correlation between the peLP(ELP-PLP)and the prediction error of spherical refraction(peSR;r=0.34,P<0.0001).The peLP of Softec HD IOL differed statistically from those of both the TECNIS ZCB00 and Sensor AR40E IOLs.Multiple linear regression was used to obtain the prediction formula:ELP=0.66+0.63×[aqueous depth(AQD)+0.6 LT](r=0.61,P<0.0001),and a new variable(AQD+0.6 LT)was found to have the strongest correlation with ELP.CONCLUSION:The Sirius anterior segment analysis system is helpful to predict ELP,which reduces postoperative refraction error.

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.

Lens thickness assessment : anterior segment optical coherence tomography versus A-scan ultrasonography

AIMTo assess lens thickness measurements with anterior segment-optical coherence tomography (AS-OCT) in comparison with A-scan ultrasonography (A-scan US).METHODSThere were 218 adult subjects (218 eyes) aged 59.2&#x000b1;9.2y enrolled in this prospective cross-sectional study. Forty-three eyes had open angles and 175 eyes had narrow angles. Routine ophthalmic exam was performed and nuclear opacity was graded using the Lens Opacities Classification System III (LOCS III). Lens thickness was measured by AS-OCT (Visante OCT, Carl Zeiss Meditec, Dublin, CA, USA). The highest quality image was selected for each eye and lens thickness was calculated using ImageJ software. Lens thickness was also measured by A-scan US.RESULTSInterclass correlations showed a value of 99.7% for intra-visit measurements and 95.3% for inter-visit measurements. The mean lens thickness measured by AS-OCT was not significantly different from that of A-scan US (4.861&#x000b1;0.404 vs 4.866&#x000b1;0.351 mm, P=0.74). Lens thickness values obtained from the two instruments were highly correlated overall (Pearson correlation coefficient=0.81, P&#x0003c;0.001), and in all LOCS III specific subgroups except in grade 5 of nuclear opacity. Bland-Altman analysis revealed a 95% limit of agreement from -0.45 to 0.46 mm. Lens thickness difference between the two instruments became smaller as the lens thickness increased and AS-OCT yielded smaller values than A-scan US in thicker lens (&#x003b2;=-0.29, P&#x0003c;0.001)CONCLUSIONAS-OCT-derived lens thickness measurement is valid and comparable to the results obtained by A-scan US. It can be used as a reliable noncontact method for measuring lens thickness in adults with or without significant cataract.

The Relation of the Location of Haptics of Posterior Chamber Intraocular Lenses and Peripheral Anterior Synechia

Purpose:To investigate the occurrence,outcome and influencial factors of the pe-ripheral anterior synechia(PAS)following implantation of posterior chamber in-traocular lenses for finding a way to reduce thePAS.Subjects;40 eyes of 38senile cataract patients with normal chamber angle and in-traocular pressue(IOP)preoperatively were examined.Methods:Extracapsular cataract extraction was performed under microscope with insertion of a posterior chamber lens implant vaulted anteriorly by 10°.Go-nioscopy and slit-lamp examination and photography of the operated eyes were performed 3to 6months postoperatively.Results:PAS were found in 20(50%)of the 40eyes.Among the 20eyes with PAS the locations of 23haptics in17eyes corresponded with those of the PAS.PAS were seen more frequently with vertically sulcus-fixated haptics than with the horizontally capsular-fixated haptics.showing a significant difference(P<0.05).88%of the eyes withPAS had pupillary edformation,but their visual acuities and IOP were not affected.Conclusions:PAS is more likely to occur with vertically sulcus-fixated IOL.Rotat-ing the capsular-fixated haptics to the horizontal position may reduce the inci-dence of PAS.Gonioscopy should be a routine follow-up examination.

Comparison of preoperative simulated and postoperative real safety distances using anterior segment OCT in patients with phakic IOL according to iris configuration

AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS:Totally 60 eyes of 60 patients underwent p IOL implantation for surgical correction of myopia.Anterior chamber depth(ACD)was measured with the IOLMaster 700,and nasal and temporal safety distances(SD)were measured pre-and postoperatively using Anterior Segment Visante-OCT.SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium.Eyes were divided into 3 groups:convex,concave,and plane according to preoperatory iris configuration.Statistical analysis was performed using the R program,for the comparison of independent groups and multiple comparisons,the Kruskal-Wallis test and the Dunn test were used respectively.RESULTS:Mean difference between nasal preoperative SSD and postoperative RSD was-0.36±0.38,-0.29±0.48,and-0.18±0.30 mm in the concave,convex,and plane group,respectively.Mean difference between temporal SSD and RSD was-0.36±0.37,-0.14±0.38,and-0.24±0.33 mm in the concave,convex,and plane group,respectively.There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group(P<0.002).CONCLUSION:Preoperative SSD and postoperative RSD for iris-claw p IOL shows significant differences in patients with concave and plane iris.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Morphological features of anterior segment:factors influencing intraocular pressure after cataract surgery in nanophthalmos

Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients and 35 normal eyes(21.0≤AL≤24.5 mm)in 35 controls who had undergone uneventful cataract surgery were included.Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups.The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure(IOP)were also investigated.Results:The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes.Peripheral anterior synechiae(PAS)were observed in 56%(18/32)of nanophthalmic eyes,and a characteristic boomerangshaped iris was observed in 28%(9/32).The anterior surface of the iris seemed"smoother"in nanophthalmic eyes than in normal eyes.Schlemm's canal(SC)diameter,SC area,trabecular meshwork(TM)thickness,TM width,and TM area were generally smaller in the nanophthalmic eyes.Younger age,higher preoperative IOP,broader PAS,and smaller SC area were main contributors to higher postoperative IOP.AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.Conclusions:The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes.Influencing factors such as age,AL,preoperative IOP,extent of PAS,SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.Trial registration:ClinicalTrails.gov,Trial registration number:NCT02182921,Registered 8 July 2014.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

人工晶状体前脱位的手术策略

后房型人工晶状体(IOL)前脱位是白内障手术后的并发症之一,主要由于IOL固定不良或囊袋支持力不足等原因引起。虽然这一并发症的发生率并不高,但脱位的IOL可能导致角膜内皮损伤、瞳孔变形、视觉障碍等严重问题,因此依然值得临床医师重点关注。在遇到相关情况时,应及时进行全面评估和及时处理。本述评通过回顾既往研究,分析了IOL前脱位的发生率、风险因素及临床表现,详细阐述了术前评估要点、手术时机选择及具体手术处理策略,提出了针对不同脱位情况的手术方案,包括无缝线或使用缝线的IOL复位、IOL-囊袋复合物复位,以及必要情况下的IOL置换等,并对瞳孔、玻璃体、视网膜等其他眼内组织的术中处理给出了建议。

新一代人工晶状体计算公式对高度近视行前后段联合手术的准确性分析

目的探究新一代人工晶状体(intraocular lens,IOL)计算公式及Wang-Koch(WK)眼轴校正公式在接受前后段联合手术的高度近视患者中的准确性。方法收集2015年6月至2021年6月于陆军军医大学第一附属医院眼科接受前后段联合手术且眼轴(axial length AL)>26 mm的患者100例(100眼)。分别采用Barrett UniversalⅡ(BUⅡ)、Emmetropia Verifying Optical(EVO)、Kane、Haigis、Hoffer Q、Holladay 1、SRK/T、第一代线性WK眼轴优化公式(Haigis-WK1,SRK/T-WK1,Hoffer Q-WK1,Holladay 1-WK1)及第二代线性WK眼轴优化公式(SRK/T-WK2,Holladay 1-WK2)等13种公式计算IOL屈光度。获得各IOL屈光度公式的平均预测误差(mean prediction error,ME)、平均绝对误差(mean absolute error,MAE)、中位绝对误差(median absolute error,MedAE)及预测误差在不同屈光阈的百分比,以评价各公式的准确性。将所有患者根据眼轴长度分组:26.00 mm30.00 mm者为C组(34眼),以探究眼轴长度对IOL屈光度计算的影响。根据术前眼内填充物,将患者分为硅油眼组(63眼)和非硅油眼组(37眼),比较术前眼内填充物对IOL屈光度计算的影响。结果新一代IOL公式(BUⅡ、EVO及Kane)的MedAE(0.34D、0.31D、0.35D)显著低于传统公式(P<0.05),而且预测误差在±0.25 D、±0.50 D、±0.75 D及±1.00 D范围内的百分比显著高于传统公式(P<0.05)。传统公式均出现远视偏移(0.35~0.65 D),WK眼轴调整法可以矫正传统公式的远视偏移。WK2可以提高SRK/T和Holladay 1公式的计算准确性,且SRK/T-WK2和Holladay 1-WK2公式的MedAE与新一代IOL公式差异无统计学意义。比较各公式在不同眼轴分组的MedAE,发现新一代IOL公式(BUⅡ、Kane和EVO)及WK校正眼轴公式(Haigis-WK1、SRK/T-WK1、SRK/T-WK2、Hoffer Q-WK1、Holladay 1-WK1和Holladay 1-WK2)在眼轴分组间均差异无统计学意义;传统公式的MedAE在眼轴分组间均存在显著差异(P<0.01),其中C组的MedAE均最大(Haigis:0.84 D,SRK/T:1.10 D,Hoffer Q:1.23 D,Holladay 1:1.20 D)。比较各公式在不同术前眼内填充物分组的MedAE,结果发现,新一代IOL公式(BUⅡ、Kane和EVO)、Haigis及SRK/T公式在硅油眼组的MedAE均显著高于非硅油眼组(P<0.05)。结论在接受前后段联合手术的高度近视患者中,新一代IOL公式和第二代线性WK眼轴校正公式的准确性和稳定性显著优于传统公式。

前段玻璃体切除术联合人工晶体悬吊治疗晶状体脱位对眼压及角膜内皮的影响

目的探讨前段玻璃体切除术联合人工晶体悬吊治疗晶状体脱位对眼压及角膜内皮的影响。方法回顾性分析2019年1月至2022年12月漯河市第三人民医院(漯河市妇幼保健院)诊治的晶体脱位92例患者,行前段玻璃体切除术联合人工晶体悬吊治疗,对比观察手术前后最佳矫正视力、眼压、眼角膜内皮计数以及术后并发症。结果术后92例患者眼压较术前降低,差异有统计学意义(P<0.05);术后92例患者角膜内皮计数较术前无明显变化,差异无统计学意义(P>0.05);术后92例患者视力均有不同程度提高,其中矫正视力≥0.3者有67例,与术前相比,差异有统计学意义(P<0.05);术后92例患者出现葡萄膜炎反应8眼,早期角膜轻度水肿6眼,玻璃体积血1眼,高眼压1眼,给予相应保守处理后均恢复正常。结论前段玻璃体切除术联合人工晶体悬吊治疗能够有效控制晶状体脱位患者的眼压,对角膜内皮造成的损伤较小,为人工晶状体悬吊创造有利条件,从而有效改善患者的视力,能够加快患者的恢复,虽术后会出现较少的并发症,但经过相应的保守处理均恢复正常,不影响研究结果。

高度近视患者植入ICL V4c后眼前节参数的早期结果

目的:研究高度近视患者植入带中心孔的植入式collamer晶状体(ICL V4c)后眼前节参数的早期结果。方法:纳入2019-02/2022-09在我院行ICL V4c植入术且随访1 a的高度近视患者82例160眼,其中男42例82眼,女40例78眼,年龄26.0±4.6(21-37)岁。术前检测患者的眼前节一般特征:球镜度数、平均角膜水平曲率、水平角膜直径(WTW)和轴向长度(AL);术前,术后1 d,1 wk,1、3、6 mo测量患者的眼内压(IOP)、内皮细胞密度(ECD)、中央前房深度(CACD)、前房容积(ACV)、前房角(ACA);术后1 d,1 wk,1、6 mo,1 a测量患者ICL V4c光学区后表面中心到晶状体前表面的距离(拱高)。结果:患者术前平均球镜度数为-7.56±2.55 D,平均角膜水平曲率为42.89±1.47 D,WTW为11.64±0.37 mm,AL为26.64±0.93 mm。眼压基线为15.97±2.13 mmHg,ICL V4c植入后各时间点眼压与术前相比无差异(F=0.875,P=0.504);ECD基线为2989.30±140.78 cell/mm^(2),ICL V4c植入后6 mo的ECD与术前相比无差异(t=1.475,P=0.142);CACD基线为3.19±0.21 mm,ACV基线为210.30±27.7 mm 3,术后各时间点CACD、ACV均显著低于术前(F=111.10、288.38,均P<0.001);ACA基线为35.44°±11.27°,ICL V4c植入后各时间点ACA显著低于术前(F=21.23,P<0.001)。术后1 d拱高为665.32±184.03μm,术后1 wk,1、6 mo,1 a与术后1 d相比,拱高继续显著减少(F=52.10,P<0.001),但在术后6 mo,1 a时保持稳定,与1 mo时相比均无差异(P>0.05)。结论:ICL V4c在术后1 a的随访中具有一定安全性和有效性,植入后早期眼前节参数趋于稳定。

双眼人工晶状体脱位1例

36岁女性,因双眼白内障术后视力下降2年,右眼为甚就诊。患者因双眼白内障分别于32岁、34岁时先后在外院行左眼及右眼白内障超声乳化吸出联合人工晶状体(IOL)植入术。双眼最佳矫正视力:右眼1.0(+12.25/-2.00×165°),左眼0.8(+1.25/-1.25×20°)。裂隙灯检查:双眼角膜直径偏大,瞳孔欠圆、直径约3mm×3 mm、扩瞳药物扩不大,虹膜点片状萎缩伴虹膜震颤,IOL向下移位。超声生物显微镜(UBM)检查:双眼虹膜略后凹,虹膜根部附着点偏后位,睫状体瘦小,巩膜突不明显。诊断为双眼IOL脱位,双眼眼前段发育不良(前部巨眼)。追溯既往资料,患者右眼曾植入散光矫正型IOL,遂行“右眼前部玻璃体切除术+原脱位Toric IOL巩膜缝线固定术”,手术顺利。术后3周术眼裸眼视力:1.0。讨论体会:对于IOL脱位的患者,首先要分析导致IOL脱位的原因,同时不忘屈光白内障理念,根据患者眼部状况,做好术前规划。

分析超声乳化白内障吸除术联合IOL植入术后前房渗出发生率的相关影响因素

目的 研究分析在对白内障患者实施超声乳化白内障吸除术、人工晶状体(Intraocular Lens, IOL)植入术联合治疗后发生前房渗出的危险因素。方法 回顾性选取2020年5月—2023年5月在江苏省兴化市人民医院眼科接受超声乳化联合IOL植入术的82例白内障患者的临床资料,将术后发生前房渗出的42例患者与40例术后未发生前房渗出的患者分为研究组与对照组。在研究组与对照组患者中对其各项病历资料进行回顾性分析,分析白内障病例在联合手术后有前房渗出发生的危险因素。结果 在单因素分析中,研究组与对照组高度近视、葡萄膜炎、青光眼、术前眼压、晶状体核分级、术中晶状体后囊膜破裂、术中超声累积能量复合参数等比较差异有统计学意义(P均<0.05)。经多因素分析得出,高度近视、葡萄膜炎、青光眼、术前眼压、晶状体核分级、术中晶状体后囊膜破裂、术中超声累积能量复合参数是导致白内障患者在术后并发前房渗出的危险因素(OR=4.308、4.369、4.731、4.687、4.468、4.417、4.696,P均<0.05)。结论 白内障病例在接受超声乳化结合IOL植入手术后,受到高度近视、葡萄膜炎等因素的影响,易并发前房渗出。

预装式疏水性丙烯酸酯类人工晶体和同轴微切口对年龄相关性白内障疗效分析

目的探讨与分析预装式疏水性丙烯酸酯类人工晶体和同轴微切口对年龄相关性白内障的疗效影响。方法选择2020年8月—2023年5月在蓝田华阳眼科医院诊治的80例年龄相关性白内障患者作为研究对象,根据随机数表法将其分为对照组和研究组,每组40例。所有手术均由同一位医师完成,都采用预装式疏水性丙烯酸酯类人工晶体植入,研究组行2.2 mm同轴透明角膜隧道微切口,对照组行3.0 mm透明角膜隧道切口,比较两组的最佳矫正、并发症发生情况、角膜散光度与前房深度变化情况。结果研究组术后1周与术后1个月的最佳矫正视力都高于对照组,差异有统计学意义(P<0.05);两组术后1个月的最高矫正视力与术后1周相比都升高,差异有统计学意义(P<0.05)。研究组术后1个月的角膜水肿、眼内炎、晶体混浊、囊膜破损等并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。研究组术后1周与术后1个月的角膜散光度都低于对照组,差异有统计学意义(P<0.05);两组术后1个月的角膜散光度与术后1周相比都降低,差异有统计学意义(P<0.05)。研究组术后1周与术后1个月的前房深度都高于对照组,差异有统计学意义(P<0.05);研究组与对照组术后1个月与术后1周的前房深度比较,差异无统计学意义(P>0.05)。结论预装式疏水性丙烯酸酯类人工晶体联合同轴微切口在年龄相关性白内障患者的应用并不会影响患者的前房深度,能减少角膜散光度,提高患者的术后视力,减少并发症的发生。

Misdiagnosis induced intraocular lens dislocation in anterior megalophthalmos

Anterior megalophthalmos （AM） is an uncommon developmental anomaly of the anterior segment of the eye with a constellation of findings that includes enlarged cornea, deep anterior chamber, posterior positioning of the iris and lens, iris stroma atrophy, hypoplasia of iris dilator, pupil displacement, large capsular bag, lens subluxation, prematurely diagnose. We present 3 AM cases that were misdiagnosed as congenital cataract with weak zonule and megalocornea. Intraocular lenses （IOLs） dislocated after standard cataract surgeries and subsequent surgery （replacing the dislocated IOLs with iris-claw intraocular lenses） achieved satisfactory outcome. Although rare, AM should be included in the differential diagnosis of enlarged cornea and we recommend implanting Artisan lens in AM patients.

iTrace和Pentacam及LOCSⅢ参数在晶状体混浊程度评估中的相关性

目的:分析iTrace视功能分析仪和Pentacam三维眼前节分析系统及晶状体混浊分级系统Ⅲ(LOCSⅢ)在年龄相关性白内障(ARC)患者晶状体混浊评估中的相关性。方法:前瞻性横断面研究。纳入2021-05/08本院眼科的ARC患者104例104眼。裂隙灯行LOCSⅢ分级;iTrace获取晶状体混浊地形图分级(OMG)和晶状体功能失调指数(DLI);Pentacam获取核分级(PNS)和Scheimpflug图像,ImageJ测量Scheimpflug图像各区域的累积光密度(IntDen)。SPSS 26.0分析参数正态性和相关性。结果:各参数除3mm范围IntDen和6mm范围后囊区IntDen外均正态分布。PNS与NC、NO均正相关(r=0.521、0.440,均P<0.01)。3mm范围IntDen与NC、NO均正相关(rs=0.459、0.450,均P<0.01)。3mm范围核区IntDen与NC、NO均正相关(r=0.539、0.543,均P<0.01)。3mm范围后囊区IntDen与NC、NO均负相关(r=-0.315、-0.321,均P<0.01)。6mm范围IntDen与NC、NO均正相关(r=0.321、0.288,均P<0.01)。3mm范围DLI与NC、NO、PSC均负相关(r=-0.257、-0.234、-0.282,均P<0.01)。6mm DLI与NC、NO、PSC均负相关(r=-0.247、-0.304、-0.227,均P<0.05)。3mm范围OMG与CC、PSC均正相关(r=0.268、0.333,均P<0.01)。6mm范围OMG与CC、PSC均正相关(r=0.275、0.245,均P<0.05)。3mm范围DLI与PNS、3mm范围核区IntDen均负相关(r=-0.217、-0.197,均P<0.05)。结论:三种晶状体混浊评价系统各有优势,将各参数结合可更客观地评价晶状体各区混浊,为临床提供参考。

优化ICL V4c植入术的临床研究进展

随着有晶状体眼后房型人工晶状体植入术的发展及可植入式接触镜(ICL)的不断改进,ICL V4c植入术目前已经成为矫正中高度近视的主流术式之一。术后拱高是评价手术安全性的重要指标,在常规ICL V4c植入手术的基础上,如何优化手术以获得更理想的拱高是近年来学者们研究的热点。本文以术前检查、术中手术设计以及术后随访为中心,总结分析优化ICL V4c植入手术的方案,为提高手术安全性提供帮助。

23G微创玻璃体切割系统联合Resight非接触式广角镜在玻璃体视网膜疾病患者眼前眼后联合手术中的应用效果

目的 分析23G微创玻璃切割系统和Resight非接触式广角镜联合应用在玻璃体视网膜疾病患者眼前后节联合手术中的临床价值。方法 将2018年1月至2020年6月洛阳博爱眼科医院收治的134例玻璃体视网膜疾病患者列入研究分析之中,按照随机数字表法分组方式,将患者随机分成对照组(67例)与观察组(67例)。在眼前后节联合手术中,对照组应用23G微创玻璃切割系统,观察组同时联合Resight非接触式广角镜,对患者完成眼部疾病干预。比较两组患者治疗有效率、术后并发症发生率和手术成功率。结果 观察组患者治疗有效率高于对照组,差异有统计学意义(P<0.05)。观察组患者术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者手术成功率高于对照组,差异有统计学意义(P<0.05)。结论 眼前后节联合手术中23G微创玻璃体切割系统联合Resight非接触式广角镜的应用效果较为显著,能够提高手术的成功几率与治疗有效率,值得临床应用。