AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-gui...AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.展开更多
Laser refractive surgery is one of the most performed surgical procedures in the world. Although regarded safe and efficient, it has side effects. All of the laser based refractive surgical procedures invoke corneal n...Laser refractive surgery is one of the most performed surgical procedures in the world. Although regarded safe and efficient, it has side effects. All of the laser based refractive surgical procedures invoke corneal nerve injury to some degree. The impact of this denervation can range from mild discomfort to neurotrophic corneas. Currently, three techniques are widely used for laser vision correction: small incision lenticule extraction, laser-assisted keratomileusis in situ and photorefractive keratotomy. Each of these techniques affects corneal innervation differently and has a different pattern of nerve regeneration. The purpose of this review is to summarize the different underlying mechanisms for corneal nerve injury and compare the different patterns of corneal reinnervation.展开更多
A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted na...A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted natural orifice surgery(MANOS),single incision laparoscopic surgery(SILS) and other new techniques are the new paradigm in our way of operating in the 21 st century.The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve.Parallels between the first years of laparoscopy and NOTES can be made.Working for an invisible surgery,not only for cosmesis but for a less invasive surgery,is the target of NOTES,MANOS and SILS performed by surgeons and endoscopists over the last 10 years.The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for 'scarless surgery'.展开更多
AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METH...AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.展开更多
目的：探讨单孔腹腔镜辅助下阴式子宫全切除术及阴式子宫全切术在临床应用中的安全及有效性。方法选择2013年1月~2014年9月成都市第五人民医院妇科收治拟行子宫全切患者70例为研究对象，采用随机数字表法将其分为单孔腹腔镜辅助阴式组...目的：探讨单孔腹腔镜辅助下阴式子宫全切除术及阴式子宫全切术在临床应用中的安全及有效性。方法选择2013年1月~2014年9月成都市第五人民医院妇科收治拟行子宫全切患者70例为研究对象，采用随机数字表法将其分为单孔腹腔镜辅助阴式组和阴式组，每组各35例。单孔腹腔镜辅助阴式组患者采用经脐单孔腹腔镜辅助下阴式全子宫切除术，阴式组采用阴式全子宫切除术。分析比较两组患者年龄、体重指数、阴道分娩史、盆腔手术史及本次切除子宫原因、手术时间、出血量、子宫重量、术后即刻视觉模拟评分（VAS）、术后1、3、7 d VAS、术后排气时间、术后住院时间、住院费用、并发症情况及中转手术情况。结果阴式组术后即刻VAS评分、手术时间、术后排气时间及住院费用优于单孔腹腔镜辅助阴式组，差异均有高度统计学意义（P〈0.01）。阴式组术中并发症及中转开腹发生率明显高于单孔腹腔镜辅助阴式组，差异有统计学意义（P〈0.05）。单孔腹腔镜辅助阴式组术后并发症总发生率为8.57%，明显低于对照组的25.71%，差异有统计学意义（P〈0.05）。单孔腹腔镜辅助阴式组患者术后1、3、7 d VAS评分均显著低于阴式组，差异均有统计学意义（P〈0.05）。结论阴式子宫全切手术为经自然腔道手术，具有更微创的优点，但因安全的原因，单孔腹腔镜辅助阴式子宫切除手术更值得推广。展开更多
文摘AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.
文摘Laser refractive surgery is one of the most performed surgical procedures in the world. Although regarded safe and efficient, it has side effects. All of the laser based refractive surgical procedures invoke corneal nerve injury to some degree. The impact of this denervation can range from mild discomfort to neurotrophic corneas. Currently, three techniques are widely used for laser vision correction: small incision lenticule extraction, laser-assisted keratomileusis in situ and photorefractive keratotomy. Each of these techniques affects corneal innervation differently and has a different pattern of nerve regeneration. The purpose of this review is to summarize the different underlying mechanisms for corneal nerve injury and compare the different patterns of corneal reinnervation.
文摘A new way of opening a body cavity can be a revolution in surgery.In 1980s,laparoscopy changed how surgeons had been working for years.Natural orifice translumenal endoscopic surgery(NOTES),minilaparoscopy-assisted natural orifice surgery(MANOS),single incision laparoscopic surgery(SILS) and other new techniques are the new paradigm in our way of operating in the 21 st century.The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve.Parallels between the first years of laparoscopy and NOTES can be made.Working for an invisible surgery,not only for cosmesis but for a less invasive surgery,is the target of NOTES,MANOS and SILS performed by surgeons and endoscopists over the last 10 years.The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for 'scarless surgery'.
基金Supported by the National Natural Science Foundation (No.81470626)
文摘AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.
文摘目的：探讨单孔腹腔镜辅助下阴式子宫全切除术及阴式子宫全切术在临床应用中的安全及有效性。方法选择2013年1月~2014年9月成都市第五人民医院妇科收治拟行子宫全切患者70例为研究对象，采用随机数字表法将其分为单孔腹腔镜辅助阴式组和阴式组，每组各35例。单孔腹腔镜辅助阴式组患者采用经脐单孔腹腔镜辅助下阴式全子宫切除术，阴式组采用阴式全子宫切除术。分析比较两组患者年龄、体重指数、阴道分娩史、盆腔手术史及本次切除子宫原因、手术时间、出血量、子宫重量、术后即刻视觉模拟评分（VAS）、术后1、3、7 d VAS、术后排气时间、术后住院时间、住院费用、并发症情况及中转手术情况。结果阴式组术后即刻VAS评分、手术时间、术后排气时间及住院费用优于单孔腹腔镜辅助阴式组，差异均有高度统计学意义（P〈0.01）。阴式组术中并发症及中转开腹发生率明显高于单孔腹腔镜辅助阴式组，差异有统计学意义（P〈0.05）。单孔腹腔镜辅助阴式组术后并发症总发生率为8.57%，明显低于对照组的25.71%，差异有统计学意义（P〈0.05）。单孔腹腔镜辅助阴式组患者术后1、3、7 d VAS评分均显著低于阴式组，差异均有统计学意义（P〈0.05）。结论阴式子宫全切手术为经自然腔道手术，具有更微创的优点，但因安全的原因，单孔腹腔镜辅助阴式子宫切除手术更值得推广。
