Effect of intraocular lens implantation on visual field in glaucoma and comorbid cataracts

AIM: To investigate the effects of intraocular lens(IOL) implantation on visual field(VF) in patients with glaucoma and comorbid cataracts(G&C) with different disease severities.METHODS: Totally 56 eyes of 50 patients with primary G&C were included. All patients were divided into three groups based on the severity of the VF defect: the mild, moderate, and severe stage. Phacoemulsification was performed for cataract removal combined with IOL implantation. Visual acuity(VA) and VF tests were performed for all enrolled patients, up to 3 mo after surgery. Changes in VF threshold and global VF index in various groups were also recorded before and after surgery. The mean light sensitivity(MS) values and the changes following surgery(DMS) were compared between the three groups. Advanced Glaucoma Intervention Study(AGIS) scoring was analyzed on all VF results for analysis of changes in VF before and after surgery.RESULTS: Following surgery, the MS values of the three groups of G&C increased significantly, while the AGIS scores decreased statistically in all groups. The DMS values for the three zones in moderate and severe stage but not mild stage were statistically different between zones. The DMS value was significantly higher in zone I than those in zone II and III(zone I>zone II>zone III;P<0.05). The DMS was significantly higher in zone I than that in zone III in moderate stage patients(zone I>zone II>zone III;P<0.01), while the DMS values in the severe stage patients was significantly higher in zone I than those in zone II and III(zone I>zone II>zone III;P<0.01). CONCLUSION: The mean VF sensitivity of glaucoma patients increased significantly after cataract removal and IOL implantation. Variations in the severity and distribution of characteristics of VF defects result in differences in postoperative VF improvements after cataract surgery. The magnitude of increase in VF sensitivity is associated with VF defect characteristic in glaucoma.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Secondary glaucoma after pediatric cataract surgery

AIM: To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery.METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes.RESULTS: The mean follow-up periods of group 1 and 2 were (60.86 ±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8% ) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50 ±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycinC surgery.Onepatientunderwent a second trabeculectomy+mitomycin C operation for both of his eyes.CONCLUSION:The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.

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.

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。

两种术式联合治疗白内障合并青光眼的疗效分析

目的探究白内障合并青光眼运用两种术式的有效性。方法选取聊城市第三人民医院于2021年2月—2023年2月收治的100例白内障合并青光眼患者为研究对象,利用随机数表法分为参照组(50例,白内障超声乳化人工晶体植入手术治疗)和研究组(50例,改良小切口非超声乳化白内障摘除人工晶状体植入与小梁切除术联合治疗),比较两组患者的眼压、视力水平及前房深度。结果术后,研究组的眼压小于参照组,视力水平优于参照组,前房深度大于参照组,差异有统计学意义(P均<0.05)。研究组术后并发症总发生率(4.00%)低于参照组(16.00%),差异有统计学意义(χ^(2)=4.000,P=0.045)。结论白内障合并青光眼运用改良小切口非超声乳化白内障摘除人工晶状体植入与小梁切除术联合治疗的效果突出,可以更好地降低术后的眼压,提高视力水平和前房深度,降低并发症发生率。

Clinical study of customized aspherical intraocular lens implants

AIM:To compare if there is an improvement in visual functions with age-related cataracts between patients receiving a aspherical intraocular lens(IOL) based on corneal wavefront aberration and patients randomly assigned lenses.METHODS:A total of 124 eyes of 124 patients with age-related cataracts were placed in experimental group and a group receiving randomly assigned(RA) lenses.The experimental group was undergone Pentacam corneal spherical aberration measurement before surgery; the targeted range for residual total spherical aberration after surgery was set to 0-0.3 μm. Patients with a corneal spherical aberration 【0.3 μm were implanted with a zero-spherical aberration advanced optics(AO) aspherical IOL and patients with an aberration ≥0.3 μm received a Tecnis Z9003 aspherical lens in experimental group. RA patients were randomly implanted with an AO lens or a Tecnis Z9003 lens. Three months after surgery total spherical aberration, photopic/mesopic contrast sensitivities, photopic/mesopic with glare contrast sensitivities, and logMAR vision were measured.RESULTS:Statistical analysis on logMAR vision showed no significant difference between two groups(P =0.413). The post-surgical total spherical aberration was 0.126 ±0.097 μm and 0.152 ±0.151 μm in the experimental and RA groups, respectively(P =0.12). The mesopic contrast sensitivities at spatial frequencies of 6,12 and 18 c/d in the experimental group were significantly higher than of the RA group(P =0.00; P =0.04;P =0.02). The mesopic with glare contrast sensitivity in the experimental group at a spatial frequency of 18 c/d was also significantly higher vs the RA group(P =0.01).CONCLUSION:Pre-surgical corneal spherical aberration measurement in cataract patients followed bycustomized selection of aspherical IOL implants improved mesopic contrast sensitivities at high spatial frequencies, and thus is a superior strategy compared to the random selection of aspherical intraocular lens implants.

Improving refractive outcomes in cataract surgery: A global perspective

This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.

Acute lens-induced glaucomas: A review

Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities.

不同手术方式治疗青光眼合并白内障患者的疗效比较

目的对比分析不同手术方式治疗青光眼合并白内障患者的疗效。方法回顾性分析60例(65眼)青光眼合并白内障且分别行单切口(白内障小切口摘除+人工晶体植入+小梁切除术)和双切口(白内障超声乳化吸出+人工晶体植入+小梁切除术)治疗的患者临床资料,比较两种手术方式对患者术后的眼压、视力和并发症的影响。结果所有患者术后眼压较术前明显降低(P<0.05),视力明显改善(P<0.05);两种手术方式对视力、眼压的影响差异无统计学意义(P>0.05),单切口组术后前房炎性反应高于双切口组。结论单切口与双切口两种手术方式均能良好的控制眼压和改善视力,对患者术后的视力和眼压没有影响,但双切口术后并发症较单切口少。

硬核白内障小切口非超声乳化手术中切核技术的探讨

目的:探讨小切口非超声乳化白内障摘除、人工晶状体植入术切核技术在硬核白内障手术中的意义。方法:Ⅳ级硬核白内障352例(368眼)白内障患者随机分为切核组和不切核组。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:不切核组手术时间较短,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时切核组较不切核组角膜散光小,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(+++)方面切核组较不切核组重,P<0.05,差异有显著性意义。结论:在Ⅳ级硬核白内障的小切口非超声乳化白内障手术中不切晶状体核,适当扩大切口,顺利出核的方法更为安全、实用。

白内障青光眼联合手术的效果分析

目的比较小切口白内障囊外摘出(ECCE)人工晶状体植入术联合青光眼小梁切除术与超声乳化白内障吸出折叠人工晶状体植入术联合青光眼小梁切除术的临床效果。方法统计分析我院1999年1月～2003年12月所做的上述两种手术共62例(66眼)的数据。结果两种手术后的眼压、视力、角膜散光程度、滤泡成功率等两组间均无明显差异。结论这两种手术有相同的临床效果,可任选一种手术。

改良术式治疗白内障合并青光眼的疗效

目的:探讨改良小切口非超声乳化白内障摘除人工晶状体植入联合小梁切除术治疗白内障合并青光眼的临床疗效。方法:随机选取我院在2008-03/2011-01收治的135例白内障合并青光眼患者,随机分为两组,一组采用改良小切口非超声乳化白内障摘除人工晶状体植入联合小梁切除术治疗(观察组68例),另一组采用传统手术治疗(对照组67例),回顾性分析两组患者的临床效果。结果:观察组患者术后1wk;3mo的视力良好率分别为92.6%,88.2%;眼压良好率分别为98.5%,95.6%;观察组患者术后发生角膜水肿、虹膜损伤以及前房炎症等并发症发生率为5.9%,与对照组比较,经统计分析,P均<0.05,差异具有显著性。结论:改良小切口非超声乳化白内障摘除人工晶状体植入联合小梁切除术与传统手术比较,极大的提高了患者的治疗效果以及手术安全性,是较为安全可靠的治疗白内障合并青光眼的手术方式。

小梁切除联合白内障囊外摘出及人工晶状体植入治疗青光眼合并白内障

目的 报告青光眼合并白内障的患眼术后眼压、视力和并发症。方法 用小梁切除联合白内障囊外摘出及人工晶状体植入术治疗 2 5眼。术后平均随访 1.2年± 0 .46年。结果 平均眼压由术前 ( 2 6.48± 4.65 )mmHg降到术后( 17.3 3± 4.5 0 )mmHg ,其中 64 %患眼眼压被控制在 2 1mmHg或以下 ;使用抗青光眼药物由术前平均 1.72种± 0 .74种降到术后 0 .64种± 0 .75种 (P <0 .0 1) ,48%的患眼不需要使用抗青光眼药物 ;视力 >0 .3占 80 %。主要并发症为短暂的前房出血和瞳孔缘破裂。

两种术式联合治疗白内障合并青光眼的疗效分析

目的:分析非超声乳化改良小切口白内障摘除人工晶状体植入与小梁切除术联合治疗白内障合并青光眼的临床疗效。方法:选择2009-03/2011-07就诊于我院眼科的白内障合并青光眼患者100例为本试验研究对象,所有患者均给予改良小切口非超声乳化白内障摘除人工晶状体植入与小梁切除术联合治疗方法,将术前及术后6mo眼压及视力情况进行比较。结果:所有患者随访6mo,测定患者平均眼压为14.1±2.73mmHg,显著低于术前(46.8±22.5mmHg);视力>0.3者74例,显著高于术前(0例),P<0.05。仅6例患者出现角膜水肿,均在1wk内自然消退。结论:对于白内障合并青光眼患者给予改良小切口非超声乳化白内障摘除人工晶状体植入与小梁切除术联合治疗能够很好的将眼压控制住,视力恢复快,费用低,同时并发症发生率低,有着广泛的手术适应证。

小切口白内障摘除及人工晶状体植入联合青光眼小梁切除术治疗白内障合并青光眼的临床疗效观察

目的探讨小切口白内障摘除及人工晶状体植入联合小梁切除术治疗白内障合并青光眼的临床疗效。方法随机选取武警辽宁总队大连医院2010年4月至2012年2月收治的白内障合并青光眼患者152例,随机分为两组:其中76例共85眼采用小切口白内障摘除及人工晶状体植入联合青光眼小梁切除术治疗(观察组),另外76例共86眼采用常规手术治疗(对照组),总结分析两组患者的恢复情况。结果观察组患者术后1、4、12周时视力良好率分别为91.8%、85.9%、75.3%,优于对照组患者术后同期视力良好率,分别为76.7%、66.3%、54.7%,差异有统计学意义(均P<0.05);且观察组并发症发生率均低于对照组,差异有统计学意义(均P<0.05)。结论小切口白内障摘除及人工晶状体植入联合青光眼小梁切除术治疗白内障合并青光眼的治疗效果显著优于常规治疗方案,值得临床借鉴推广。

小切口白内障摘除联合小梁切除术治疗开角型青光眼

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术治疗合并白内障的开角型青光眼的疗效。方法:回顾分析2004-01/2010-06在我院住院行小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术且资料完整的32例56眼开角型青光眼的疗效,根据患者年龄、眼球筋膜情况、视神经受损程度及术后要求达到的靶眼压确定术中用或不用丝裂霉素C(MMC),其中29眼术中使用MMC,27眼不使用MMC,患者均有明显的晶状体混浊。随访6～24(平均14.2±6.7)mo。结果:术中使用MMC组29眼,术前眼压(39.2±10.6)mmHg,术后眼压(13.2±5.5)mmHg,仅1眼需辅助1种局部降眼压药。不使用MMC组27眼,术前眼压(30.1±9.2)mmHg,术后眼压(17.5±8.1)mmHg,有4眼需辅助1种局部降眼压药,1眼需辅助2种局部降眼压药,1眼再手术。术后不需使用降眼压药者49眼(88%)。术后47眼(84%)最佳矫正视力提高。结论:小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术可有效治疗合并白内障的开角型青光眼。

小切口白内障摘除治疗膨胀期白内障继发青光眼31例疗效观察

目的：观察小切口白内障摘除治疗膨胀期白内障继发青光眼的临床疗效。方法：对31例（31眼）老年性白内障膨胀期继发急性青光眼患者实施小切口白内障囊外摘除联合人工晶状体植入术,术后随访3~12个月。结果：矫正视力〉0.5者17眼,0.05~0.5 12眼,〈0.05 2眼。术后27眼眼压正常,4眼药物稳定眼压。结论：小切口白内障摘除对老年性白内障膨胀期继发青光眼患者临床疗效良好。

青光眼滤过术后行白内障摘出联合人工晶状体植入后低视力原因分析

目的探讨青光眼滤过术后行白内障摘出联合人工晶状体植入后低视力的原因。方法回顾分析75例(75眼)青光眼滤过术后行白内障摘出联合人工晶状体植入术的患者临床资料,分析青光眼术后行白内障手术后低视力发生的原因。结果白内障术后1周最佳矫正视力<0.3者38例(38眼),其中2例(2眼)术后1周最佳矫正视力<0.05,36例(36眼)视力为0.05～0.3。青光眼术后、白内障术前及白内障术后视力比较,差异均有统计学意义(均为P<0.05)。36例(36眼)患者低视力发生原因:青光眼性视网膜视神经损害17例(17眼)、前部缺血性视神经病变6例(6眼)、视网膜中央静脉阻塞4例(4眼)、黄斑囊样水肿3例(3眼),其他眼底病变6例(6眼)。未脱盲2例(2眼)患者为青光眼视神经萎缩。结论青光眼滤过术后再行白内障手术后低视力的主要原因为青光眼性视网膜视神经损害、白内障术前已经存在的原发性或继发性视神经及视网膜病变。