Trocar opening: silicone oil removal with phacoemulsification and intraocular lens implantation

AIM: To evaluate the efficacy and safety of a modified technique [trocar opening(TO)] for silicone oil removal(SOR) in combination with phacoemulsification and intraocular lens(IOL) implantation.METHODS: A total of 60 eyes of 60 patients with cataract and silicone oil-filled eyes were enrolled in this study. The patients were divided into two groups: the patients in the control group underwent 23-gauge pars plana active SOR surgery with phacoemulsification and IOL implantation, while the patients in the TO group underwent TO methods during surgery. Best corrected visual acuity(BCVA), surgery time, intraocular pressure, and operative complications were observed 6 mo after surgery.RESULTS: There was no significant difference between the two groups in terms of age, gender, preoperative, intraocular pressure, or time of silicone oil stay. Prior to surgery, the mean BCVA for the control and TO groups was 1.34±0.44 and 1.36±0.42. At 6 mo following surgery, the mean BCVA improved to 0.74±0.36 and 0.77±0.32, respectively(P<0.001). There was no significant difference between the two groups. The mean SOR time was 6.9±2.3 min and 4.8±1.2 min in the control and TO groups(P=0.008). The total operation time was 28.2±8.5 min and 24.6±6.4 min, respectively(P=0.035). Posterior capsule rupture occurred in four eyes of control and none of TO group(P<0.01). Late recurrent retinal detachment occurred in one eye in the control group(2 mo after surgery) and in one eye in the TO group(4 mo after surgery). CONCLUSION: TO is a simple, effective, time-saving, and safe method for SOR combined with phacoemulsification and IOL implantation.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM:To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens(IOL)in eyes with low degrees of corneal astigmatism.METHODS:Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL(FineVision PODFT,PhysIOL s.a.,Liege,Belgium)were enrolled.Phacoemulsification with femtosecond laser,capsular tension ring insertion and intraoperative aberrometry were performed in all cases.All IOLs used showed a cylinder power of 1.00 D.Main outcome measures were refractive error and corrected-distance visual acuity(CDVA)and uncorrected-distance visual acuity(UDVA)values.Eyes were evaluated at 4 mo post-surgery.RESULTS:Totally 50%of eyes showed a spherical equivalent(SE)within±0.13 D and all of them within±0.50 D.The mean SE and refractive cylinder were-0.02±0.23 and-0.16±0.22 D,respectively.Vector analysis revealed that 100%of eyes were within±0.50 D for the SE and cylindrical components(J0 and J45).Refractive changes were not correlated with keratometric changes(P>0.05)showing that the reduction in astigmatism comes from the trifocal toric IOL.Of 81%and 96%of eyes showed UDVA and CDVA of 20/20,respectively.The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02(about 20/20),respectively.CONCLUSION:Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Evaluating newer generation intraocular lens calculation formulas in manual versus femtosecond laser-assisted cataract surgery

AIM:To determine the refractive accuracy of the Haigis,Barrett Universal II(Barrett),and Hill-radial basis function 2.0(Hill-RBF)intraocular lens(IOL)power calculations formulas in eyes undergoing manual cataract surgery(MCS)and refractive femtosecond laser-assisted cataract surgery(Re LACS).METHODS:This was a REB-approved,retrospective interventional comparative case series of 158 eyes of 158 patients who had preoperative biometry completed using the IOL Master 700 and underwent implantation of a Tecnis IOL following uncomplicated cataract surgery using either MCS or ReLACS.Target spherical equivalence(SE)was predicted using the Haigis,Barrett,and Hill-RBF formulas.An older generation formula(Hoffer Q)was included in the analysis.Mean refractive error(ME)was calculated one month postoperatively.The lens factors of all formulas were retrospectively optimized to set the ME to 0 for each formula across all eyes.The median absolute errors(MedAE)and the proportion of eyes achieving an absolute error(AE)within 0.5 diopters(D)were compared between the two formulas among MCS and ReLACS eyes,respectively.RESULTS:Of the 158 eyes studied,64 eyes underwent MCS and 94 eyes underwent ReLACS.Among MCS eyes,the MedAE did not differ between the formulas(P=0.59),however among ReLACS eyes,Barrett and Hill-RBF were more accurate(P=0.001).Barrett and Hill-RBF were both more likely to yield AE<0.5 D among both groups(P<0.001).CONCLUSION:The Barrett and Hill-RBF formula lead to greater refractive accuracy and likelihood of refractive success when compare to Haigis in eyes undergoing Re LACS.

Corneal injection track: an unusual complication of intraocular lens implantation and review

Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens(IOL) implantation by injection,allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines,improvement of IOL injection systems and further maturation of surgeons’ techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens(IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM:To assess the early surgical outcomes of quickchop phacoemulsification technique in patients with high myopia.METHODS:The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens(IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk,1mo. Early postoperative best corrected visual acuity(BCVA), preoperative and postoperative corneal endothelial cell density(ECD), central corneal thickness(CCT) and postoperative complications were assessed.Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.· RESULTS:There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.· CONCLUSION:Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM:To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation(phaco-vitrectomy)in idiopathic macular holes(IMH).METHODS:A total of 56 eyes with IMH(IMH group)that underwent phaco-vitrectomy and 44 eyes with age-related cataract(ARC group)that underwent cataract surgery were retrospectively reviewed.The best corrective visual acuity(BCVA),predicted refractive error(PRE),actual refractive error(ARE),axial length(AL),were measured in both groups before and 6 mo after operation.The power calculation of IOL and the predicted refractive error(PRE)were calculated according to the SRK/T formula.The difference of PRE and ARE between the two groups were compared and analyzed.RESULTS:In the IMH group,the diameters of macular holes were 271.73±75.85μm,the closure rate was 100%.The pre-and post-operative BCVA were 0.80±0.35 and 0.40±0.35 log MAR.The PRE of A-ultrasound and IOL Master in the IMH group was-0.27±0.25 and 0.10±0.66 D.The postoperative mean absolute prediction error(MAE)was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound(P=0.758).The PRE and ARE of the IMH group were 0.10±0.66 D and-0.19±0.64 D(P=0.102).The PRE and ARE of the ARC group was-0.43±0.95 and-0.31±0.93 D(P=0.383).The difference between PRE and ARE was-0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups(P=0.021).The proportion of myopic shift was 67.9%in the IMH group and 27.3%in the ARC group(P=0.004).CONCLUSION:The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

Phaco+IOL联合TBL在闭角型青光眼合并白内障患者治疗中的应用价值

【目的】探讨超声乳化白内障吸除术(Phaco)+人工晶状体植入术(IOL)联合小梁切除术(TBL)在闭角型青光眼合并白内障患者治疗中的应用价值。【方法】选取2021年1月至2024年1月铜仁爱尔仁爱眼科医院及安化爱尔眼科医院收治的82例闭角型青光眼合并白内障患者,按照随机数字表法分为观察组和对照组,每组41例。两组均进行常规控制眼压治疗,观察组同时行Phaco+IOL联合TBL治疗,对照组同时行TBL治疗。比较两组术前、术后3 d及术后1个月、3个月时视力和眼压、前房深度及并发症发生率。【结果】术后1个月、3个月时,观察组视力高于对照组,眼压水平低于对照组,差异有统计学意义(P<0.05)。术后3个月时,观察组前房深度为(2.43±0.20)mm,显著高于对照组的(2.02±0.16)mm,差异有统计学意义(t=10.250,P=0.000)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。【结论】Phaco+IOL联合TBL能有效降低闭角型青光眼合并白内障患者眼压,提高患者视力。

超声生物显微镜量化观察超声乳化白内障吸除人工晶状体植入术后前房角的改变(英文)

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术后术眼前房角结构的改变。方法:对46例(50眼)老年性白内障患者行小切口超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1mo使用超声生物显微镜量化测量前房深度和前房角宽度。结果:全部患者术后1mo前房深度明显增大(P<0.01);500μm处小梁虹膜夹角(TIA500)、250μm和500μm处前房角开放距离(AOD250、AOD500)与术前比较均显著增大(P<0.01),TIA500平均比值(术后TIA500/术前TIA500)为1.65(1.12～4.91),AOD250平均比值(术后AOD250/术前AOD250)为1.81(1.06～2.67),AOD500平均比值(术后AOD500/术前AOD500)为1.65(1.01～2.76),均与术前值呈显著负相关(P<0.01)。结论:超声乳化白内障吸除折叠式人工晶状体植入术可显著增大老年性白内障患者的前房角宽度;术前前房角越窄,术后前房角的变化程度越大。

超声乳化折叠式人工晶体植入联合硅油取出术治疗硅油充填眼并发性白内障

目的 探讨玻璃体切割术硅油充填眼并发性白内障超声乳化折叠式人工晶体植入联合硅油取出的方法和效果。方法 对21例(21眼)硅油充填眼并发性白内障患者经透明角膜切口行白内障超声乳化吸除折叠式人工晶体植入联合硅油取出术。结果 21例术后视力都有不同程度提高,17例(81.0％)视网膜获得稳定复位,其中14例(66.7％)最佳矫正视力≥0.05;4例(19.0％)术后2周内视网膜脱离复发,再次手术后复位。结论 经透明角膜切口行白内障超声乳化折叠式人工晶体植入联合硅油取出术对于硅油充填眼并发性白内障是安全有效的,在快速恢复视力功能同时减少了玻璃体出血和损伤周边视网膜的危险。

硬核白内障手术治疗方法的探讨

目的:比较硬核白内障不同手术方法及其术后视力恢复的特点及影响因素,对手术方法进行评价。方法:Ⅳ级硬核白内障121例(134眼)白内障患者随机分为超声乳化组和小切口非超声乳化组。比较两组手术时间,术中、术后并发症及术后1wk、1mo时的视力和角膜散光程度。结果:小切口非超声乳化组手术时间较短,术中并发症少;术后1wk和1mo时两组间视力差异无显著性;术后1wk时超声乳化组较小切口非超声乳化组角膜散光小,P<0.05,差异有显著性意义,术后1mo时差异无显著性意义。在术后并发症中的中、重度角膜水肿、房水闪辉(+++)方面超声乳化组较小切口非超声乳化组重,P<0.05,差异有显著性意义。结论:硬核白内障术后的视力恢复较好;小切口非超声乳化白内障手术的方法经济、安全、实用。

晶状体超声乳化人工晶状体植入治疗葡萄膜炎并发白内障

目的 探讨葡萄膜炎并发白内障晶状体超声乳化吸出及人工晶状体植入术的疗效.方法 对46例（52眼）葡萄膜炎并发白内障行晶状体超声乳化吸出及人工晶状体植入术,其中2眼联合小梁切除术.结果 术后48眼（92.31%）视力较术前提高.术后6月视力≥0.5者43眼（82.69%）,0.3～0.4者3眼（5.77%）,0.1～0.2者3眼（5.77%）,＜0.1者3眼（5.77%）.结论 晶状体超声乳化吸出术治疗葡萄膜炎并发白内障,术前充分准备,术中、术后处理得当,则术后炎症反应轻,视力恢复好.

透明角膜小切口白内障术后的屈光稳定时间分析

目的 观察分析透明角膜切口超声乳化白内障吸除联合折叠人工晶状体植入术后屈光状态趋于稳定的时间。方法 计算并比较73例(82只眼)施行透明角膜切口超声乳化白内障吸除联合折叠人工晶状体植入术患者术后不同时间的手术性角膜散光度。结果 比较白内障患者术后1周与1个月的手术性角膜散光度,差异无显著性(P =0 .312 ,>0 .0 5 ) ;术后1周与3个月比较,差异有显著性(P =0 .0 0 0 ,<0 .0 5 ) ;术后1个月与3个月比较,差异有显著性(P =0 .0 5 0 )。结论 透明角膜小切口白内障术后早期角膜散光即基本稳定,至术后3个月时角膜散光还会较前有少许改变。

白内障摘除手术单眼视设计度数对白内障患者预后视觉质量的影响

目的:探讨白内障摘除手术单眼视设计中不同的近附加度数对白内障患者预后视觉质量的影响。方法:选取2016-02/2017-02在我院进行白内障摘除手术的白内障患者84例168眼进行前瞻性研究,根据单眼视设计中近附加度数的不同,将入选患者分为低近附加度数组(1.25～1.75D)和高近附加度数组(2.25～2.75D)每组各42例84眼。比较两组患者的术后6mo双眼裸眼近视力、中距离视力、远视力及立体视,以及治疗前后的视功能生存质量评分。结果:低近附加度数组患者的双眼裸眼中、远视力分别为0.27±0.20、0.09±0.08,高近附加度数组患者的双眼裸眼中、远视力分别为0.29±0.25、0.10±0.07,两组相比差异均无统计学意义(P>0.05)。高近附加度数组患者的双眼裸眼近视力为0.03±0.06,显著优于低近附加度数组0.07±0.04,差异具有统计学意义(P<0.05)。治疗前两组患者视功能指数量表(VF-14)评分分别为27.93±4.52、28.24±4.91分,治疗后两组患者视功能指数量表(VF-14)评分分别为82.04±14.31、81.22±13.70分,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后VF-14评分均显著增加,差异具有统计学意义(P<0.05)。低近附加度数组患者正常立体视、周边立体视及黄斑立体视所占百分比分别为47.6%、31.0%、21.4%,高近附加度数组正常立体视、周边立体视及黄斑立体视所占百分比分别为42.9%、23.8%、33.3%,两组相比差异均无统计学意义(P>0.05)。结论:白内障患者的两种近附加度数对提高单眼视设计白内障摘除手术后患者的裸眼视力、视功能生存质量及立体视均有相似的优越性。

超声乳化治疗后极性白内障23眼

目的评价超声乳化治疗后极性白内障的效果,探讨手术治疗的策略。方法治疗16例(23眼)连续性后极性白内障患者,总结手术技巧、术中并发症及术前、术后视力的变化等。结果23眼中,2眼(8.7%)发生后囊破裂,其中1眼晶体核落入玻璃体腔,另1眼未发生玻璃体脱出。术前平均视力3.77±0.54,术后4.86±0.12,差异有统计学意义(P=0.000)。1眼人工晶体植入睫状沟,22眼植入囊袋内。结论超声乳化联合折叠型人工晶体植入是治疗后极性白内障的有效方法。连续环形撕囊、不做水分离、原位碎核技术可以减少手术并发症。

白内障超声乳化吸除人工晶状体植入联合玻璃体切除治疗增生性糖尿病视网膜病变

目的探讨白内障超声乳化吸除折叠式人工晶状体植入联合玻璃体切除术(以下简称:联合手术)治疗增生性糖尿病视网膜病变(PDR)的有效性和安全性。方法回顾性的分析1999年6月至2006年12月在我院施行联合手术的PDR患者31例(32只眼)。术后随访8～58个月。平均26个月。结果术后视力提高有25只眼(78.13%);视力不变7只眼(21.9%),视力下降1只眼(3.2%)。术后主要并发症包括角膜轻度水肿6只眼(18.8%),前房渗出5只眼(15.6%),玻璃体再出血5只眼(15.6%),视网膜脱离3只眼(9.4%),新生血管性青光眼2只眼(6.3%),术后6个月～2年后囊膜混浊12只眼(37.5%)。结论联合手术治疗增生性糖尿病视网膜病变是安全有效的方法,术后视力恢复快,无明显的并发症发生。

囊外摘出与超声乳化术对角膜内皮影响的比较

目的 比较白内障囊外摘出术 (ECCE)与超声乳化术 (Phaco)对角膜内皮的损伤。方法 118例 ( 12 1眼 )老年性白内障分两组囊外摘出和超声乳化人工晶状体植入术。测量术前、术后 2天及 3月的中央角膜内皮细胞密度、细胞面积变异系数、六边形细胞百分率、中央角膜厚度等指标。结果 术后 3月平均细胞丢失率ECCE组为 ( 12 6± 9 6) % ,Phaco组为 ( 15 4±9 7) % ,两组间差异无显著性 (P >0 0 5 )。术后内皮细胞面积变异系数和六边形细胞百分率与术前比较有显著性差异 (P <0 0 5 )。术后早期角膜厚度增加与内皮细胞损失率无相关性。结论 白内障超声乳化术对内皮细胞的损伤不大于囊外摘出术 ;结合角膜内皮细胞密度和形态学指标能更准确的反映出内皮的损伤 ;术后早期的角膜厚度增加程度不能作为评价内皮损伤的指标。

超声乳化白内障术后人工晶状体眼的波前像差

目的 :评价白内障超声乳化联合人工晶状体植入术后的波前像差 ,以阐明白内障手术后人工晶状体眼的光学特性。方法 :采用对照研究的方法 ,试验组为常规超声乳化联合人工晶状体植入手术后的单纯白内障患者 2 4例 31眼 ,年龄范围 :15～ 73岁 (平均 =5 1.1岁 ) ;对照组为年龄相匹配的志愿者 17位 33眼 ,排除眼科疾病 ,年龄范围 :2 5～ 6 8岁(平均 =5 0 .7岁 )。使用主观型波前像差仪 (SuZhouBriteEye收稿日期 :2 0 0 2 -10 -10 ;修回日期 :2 0 0 3 -0 1-2 0作者简介 :熊瑛 (1973 -) ,女 ,山西太原人 ,医学博士 ,研究方向 :视光学和白内障。通信作者 :褚仁远 (E -mail:xy0 62 9@sina .com)ModelWFA 10 0 0 )进行波前像差检测 ,通过MADLAB软件数据处理计算出总体像差和分阶像差的均方根 (RMS)以及像差图。结果 :试验组总体像差的RMS平均达 1.31μm(范围为 0 .34～ 2 .84 μm) ;对照组的RMS平均达 0 .5 4 μm(范围为0 .2 0～ 1.6 2 μm)。两组比较采用独立样本配对t检验 ,试验组的总体像差明显增高 (t =4 .2 6 4 ,P <0 .0 0 4 ) ,试验组 2～ 7阶的分阶像差明显增高 (mint=3.179andP <0 .0 19) ,两组之间的差异有统计学意义。结论