Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses

AIM:To present a technique of transcapsular scleral fixation of the standard capsular tension ring(CTR)through equatorial capsulotomy and in-the-bag intraocular lens(IOL)implantation in subluxated lenses.METHODS:This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction,transcapsular scleral fixation of the standard CTR through equatorial capsulotomy,in-the-bag IOL implantation and with at least 6mo follow-up.Preoperative and postoperative best corrected visual acuity(BCVA),intraocular pressure(IOP),complications,and postoperative IOL tilt and decentration were recorded.RESULTS:Nine eyes of 7 patients with a mean followup of 11.0±3.7mo were included in this study.The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively(P<0.001).The IOP was within the normal range postoperatively.The mean tilt of the IOL was 4.30°±2.31°(range,1.0°to 8.9°)and the mean decentration of the IOL was 0.37±0.12 mm(range,0.14 to 0.50 mm).No visually threatened intraoperative and postoperative complications were detected during the follow-up period.CONCLUSION:This is a safe and effective surgical technique for managing patients with severely subluxated lenses.It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前生物测量及人工晶状体计算的比较

目的:比较IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前眼生物测量的差异性、相关性、一致性及人工晶状体(IOL)度数计算的准确性。方法:回顾性研究。收集2021-03/2023-03于陆军特色医学中心眼科行白内障超声乳化联合IOL植入手术的高度近视合并白内障患者136例136眼,平均年龄57.38±8.08岁。根据眼轴长度(AL)将患者分为3组:A组(26 mm≤AL≤28 mm)41眼,B组(28 mm30 mm)52眼。术前分别使用两种仪器测量AL、平均角膜曲率(Km)、前房深度(ACD)、晶状体厚度(LT)和白到白距离(WTW)。所有患者均采用Barrett UniversalⅡ公式计算IOL度数,个性化选择适宜的预留屈光度,比较两种仪器的预测屈光误差(PE)和绝对屈光误差(AE)。结果:三组患者中Lenstar LS900测量的AL和ACD均大于IOL Master 700测量值(均P<0.05),且两种仪器测量AL的平均差值C组>B组>A组。两种仪器测量LT、Km与WTW值均无差异(均P>0.05)。两种仪器所得各组生物参数均具有正相关性(均r>0.9,P<0.05)且一致性较好(95%LoA范围较窄)。两种仪器计算的AE无差异(P>0.05),但IOL Master 700计算的PE小于Lenstar LS900(P<0.05),且前者远视偏移百分比更低。结论:在高度近视合并白内障患者中,Lenstar LS900测量AL值大于IOL Master 700,且该差异随着AL的增加而增大,两种仪器对IOL的计算均具有良好的预测性,但IOL Master 700术后屈光误差更小,远视偏移百分比更低。

三种不同IOL植入术后短期的视力和视觉干扰现象及脱镜率的对比

目的:对比分析单眼植入三焦点、多焦点及连续视程人工晶状体(IOL)术后短期的视力、视觉干扰现象及脱镜率。方法:回顾性分析2019-03/2022-12行超声乳化白内障吸除联合IOL植入术的白内障患者67例67眼。35例35眼植入Symfony连续视程IOL;21例21眼植入AcrySof IQ ReSTOR+3D多焦点IOL;11例11眼植入AcrySof IQ PanOptix三焦点IOL。记录术前及术后3 mo裸眼远视力(UDVA)、中视力(UIVA)、近视力(UNVA),术后3 mo离焦曲线、视觉干扰现象及脱镜率。结果:术后3 mo,三组间UDVA无差异(P>0.05);Symfony组及PanOptix组UIVA优于ReSTOR组(均P<0.01);ReSTOR组及PanOptix组UNVA优于Symfony组(均P<0.01)。离焦曲线显示,在中视力区间(-1.00--1.50 D),Symfony组视力优于ReSTOR组(P<0.05);在近视力区间(-2.50--3.50 D),ReSTOR组视力优于Symfony组(P<0.05);PanOptix组在近视力区间(-2.00--3.50 D)的视力优于Symfony组(P<0.05),同时在中视力区间(-1.00--2.00 D)的视力优于ReSTOR组(P<0.05)。三组间眩光或光晕的发生率及双眼相互干扰现象发生率均无差异(P>0.05)。PanOptix组和ReSTOR组脱镜率比Symfony组高(P<0.0167)。结论:与Symfony连续视程IOL和ReSTOR多焦点IOL相比,PanOptix三焦点IOL能够兼顾远中近视力,眩光和光晕发生率不高,脱镜率较高;单眼植入老视矫正型IOL仍需慎重。

Posterior chamber phakic intraocular lens implantation for high myopia

AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implantable Coliamer lens(ICL)placement by a single surgeon(Xiao-Wei Gao)to correct preoperative mean spherical equivalents between-9.00diopter(D)and-23.00D.Main outcome measures included uncorrected visual acuity(UCVA),refraction,best spectacle-corrected visual acuity(BSCVA),endothelial cell density(ECD),intraocular pressure(IOP),lens transparency,postoperative uveitis.Visante anterior segment optical coherence tomography(AS-OCT)was used to measure anterior chamber depth(ACD)and the position of ICL.RESULTS:Mean follow-up was 6.54±3.26 months(range 3-12 months).Predictability of the manifest spherical equivalent(SE)refraction to within±1.OOD was achieved in 88%of eyes and±0.50D in 72.5%of eyes.The mean postoperative manifest SE refraction was-1.85±0.72D,with 96.34%of eyes maintaining or gaining≥1 line(s)of BSCVA.The mean 3-month postoperative ECD decreased but had no statistically difference compared with the preoperative ECD.Of the 7 eyes(8.54%)with a mild transient increase in intraocular pressure(up to 30mmHg),none required a second surgical procedure or prolonged topical medication.There was no loss of lens transparency.Pigmented precipitates were observed in 5 eyes(6.09%).The mean preoperative ACD measured with AS-OCT was 3.28±0.14mm,three months after surgery,the mean ACD was2.45±0.22mm.Anterior chamber depth showed astatistically significant reduction.One eye(1.22%)had ICL spontaneous rotation,81 eyes(98.78%)of the lens remained correctly centered.CONCLUSION:The implantation of ICL is an effective surgical option for the management of high myopia.But its long time effect and safety still need more time to prove.

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature

AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule.METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity(BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution(logMAR) after IOL implantation(P<0.001) with a mean follow-up was 16.55±5.86 mo. Average age at secondary IOL implantation was 41.05±15.41 mo. Three eyes(13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise(4 eyes; 18.18%), postoperative increased inflammation(3 eyes; 13.64%) and postoperative hypotony(2 eyes; 9.09%) were common complications.CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Flapless one-knot suture:a novel surgical technique for transscleral fixation of C-loop intraocular lenses

AIM:To describe a novel suture approach for transscleral fixation of C-loop intraocular lenses(IOL)and to compare the surgical outcomes with the four-haptics posterior chamber(PC)-IOL technique.METHODS:We retrospectively analyzed 16 eyes of 16 patients who underwent transscleral fixation of C-loop PCIOLs using a flapless one-knot suture technique,which were followed up for longer than 17mo.In this technique,the capsulorless IOL was suspended using a single suture for transscleral fixation of four feet.Then we compared its surgical outcomes and complications with the four-haptics PC-IOLs using the Student's t test and Chi-square test.RESULTS:Sixteen patients of 16 eyes with a mean age of 58.3±10.1y(42-76y)who received transscleral C-loop IOL implantation due to trauma,vitrectomy,or cataract surgery with inadequate capsule support showed improved visual acuity.The difference was not significant between two IOLs except the surgery time(P>0.05).The mean operation times of C-loop IOL surgery was 24.1±1.83min and 31.3±4.47min of the four-haptics PC-IOL method(P<0.0001).In the C-loop IOLs group,there was statistical difference between the preoperative and the postoperative UCVA(log MAR,1.20±0.50 vs 0.57±0.32,P=0.0003).There was no statistical difference between the preoperative and the postoperative BCVA(log MAR,0.66±0.46 vs 0.40±0.23,P=0.056).However,there was no statistically significant difference in postoperative UCVA and BCVA between the two IOLs(P>0.05).We did not detect any optic capture,IOL decentration or dislocation,suture exposed,or cystoid macular edema in patients underwent C-loop IOLs surgery.CONCLUSION:The novel flapless one-knot suture technique for transscleral fixation of C-loop IOL is a simple,reliable,and stable technique.

Full-vision maintenance in extra-high myopia from implantable collamer lens to trifocal intraocular lens implantation

Dear Editor,I am Dr.Ye Shen from the Department of Ophthalmology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,China.I write to share my experience of full-vision maintenance in patient with extrahigh myopia from implantable collamer lens （ICL） to trifocal intraocular lens （IOL） implantation.

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.

Commentary review:challenges of intraocular lens implantation for congenital cataract infants

As an indispensable part of congenital cataract surgery,intraocular lens(IOL)implantation in infantile patients has long-term positive impacts on visual rehabilitation,as well as postoperative complications inevitably.Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery,risks of postoperative complications,and economic condition of family in consideration,and combines with choosing suitable IOL type and power.For infants with well-developed eyeballs and good systemic conditions,IOL implantation at six months of age or older is safe and effective.Otherwise,secondary IOL implantation may be a safer choice.

Using Topical Anesthesia for Standing Phacoemulsification Cataract Surgery and Intraocular Lens Implantation

Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis due to long-standing ankylosing spondylitis and chronic uveitis. Methods: Two patients are unable to lie flat respectively during phacoemulsification underwent this technique in Jingdong and Tonghai county Hospital of Yunnan province in China. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. Results: The intraoperative and postoperative periods were uneventful in two patients, with good visual outcomes after surgery. Conclusion: This technique is valuable for situations where the patient requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.

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.

The morphological changes of cellson the surface of F-heparin surface modified intraocularlenses after implantation in the rabbits’eyes

After intraocular implantation of F ion-heparin surface modified intraocular lenses(FHSM IOLs) in the rabbits’eyes,there were small cells on the surfaces of IOLs accompanied by fibrinous exudates in the early days.The cells included macrophages,fibroblast like cells,epithelioid cells,small foreign body giant cells and lymphocytes.As time went on it showed increasing variation of cell size and fusion of cells.At last the surface of IOLs were covered by a thin and transparent membrane chiefly made by degenerated cells and fibrins,and then the IOLs were well tolerated in the eyes.

Early clinical outcome with lens position adjustment following implantable collamer lens surgery

AIM:To observe early clinical outcome with lens position adjustment following the implantable collamer lens(ICL)surgery.METHODS:Sixty patients were selected for this retrospective study.One eye from each patient received Toric ICL for astigmatism correction,and the other received non-astigmatic ICL surgery using horizontal position.Patients with higher postoperative arch height were selected,and their non-astigmatic eye clinical outcome were observed after ICL surgery at 1wk,1,and 3mo.The clinical measurements included uncorrected visual acuity(UCVA),intraocular pressure(IOP),refractive state,corneal endothelium cell count,and arch height.Three months later,the ICL in each patient’s non-astigmatic eye was adjusted to the vertical from the horizontal position.The results were compared before and 1wk,1,and 3mo after adjustment.RESULTS:UCVA and IOP were significantly reduced 1wk after position adjustment compared to 1wk after ICL implantation(P<0.05).The patients demonstrated significantly reduced arch height and corneal endothelium cell count 1wk,1,and 3mo after adjusting position compared to 1wk,1,and 3mo after ICL implantation(P<0.05).However,there was no significant difference in refraction between 1wk,1,and 3mo after ICL implantation and position adjustment(P>0.05).CONCLUSION:Early positioning adjustment postphakic ICL implantation can benefit patients with adjusted arch height or higher IOP.Despite the good clinical effects,the doctors should pay attention to the potential for adverse effects on UCVA and corneal endothelium cells following early position adjustment after posterior chamber phakic ICL implantation.

中老年糖尿病性白内障患者超乳联合IOL植入术后发生角膜水肿的影响因素

目的:探讨中老年糖尿病性白内障患者超声乳化摘除联合人工晶状体(IOL)植入术后发生角膜水肿的影响因素,以期减少临床中此类患者的白内障术后并发症。方法:选取2021-08/2023-06在重庆市忠县人民医院眼科接受超声乳化摘除联合IOL植入术的中老年糖尿病性白内障患者198例226眼作为研究对象进行回顾分析,根据其术后发生角膜水肿的情况将其分为角膜水肿组53眼和非角膜水肿组173眼。收集并比较两组的基线资料;记录并比较两组患者术前角膜厚度、内皮细胞密度变化、手术时间和有效超声时间等手术相关指标。采用多因素Logistic模型分析角膜水肿的影响因素,并绘制风险列线图。结果:角膜水肿组患者年龄≥60岁分布显著高于非角膜水肿组,同时角膜水肿组患者糖尿病病程显著长于非角膜水肿组,晶状体核硬度分级Ⅳ-Ⅴ级的人数分布显著多于非角膜水肿组(均P<0.05)。角膜水肿组的内皮细胞密度变化显著高于非角膜水肿组(P<0.05);与非角膜水肿组比较,角膜水肿组患者手术时间较长,有效超声时间更长(均P<0.05)。年龄、糖尿病病程、晶状体核硬度分级、手术时间和有效超声乳化时间是患者术后发生角膜水肿的危险因素(均P<0.05)。患者风险列线图总得分为150分时,该患者术后发生角膜水肿的风险约为65%。结论:中老年糖尿病性白内障超声乳化摘除联合IOL植入术后发生角膜水肿的影响因素包括年龄、糖尿病病程、晶状体核硬度、手术时间以及有效超声乳化时间。

FLACS-IOL手术对白内障患者术后MIOL的偏移率及视觉质量的影响

目的:探讨飞秒激光辅助超声乳化手术联合人工晶状体植入(FLACS-IOL)对白内障患者术后多焦点人工晶状体(MIOL)偏移率及视觉质量的影响。方法:前瞻性研究。选取我院2021-01/2022-12收治的白内障MIOL植入患者95例108眼,根据患者意愿选择手术方式并分组为FLACS组(51例56眼),Phaco组(44例52眼)。对比两组手术时间、前囊切开直径、有效超声时间(EPT)、超声乳化能量释放量(CDE)、裸眼远视力(UCDVA)、最佳矫正远视力(BCDVA)、术后3 mo的IOL偏心距离、偏移率及3 mm瞳孔下全眼总高阶像差(HOA)、三叶草差(Trefoil)及彗差(Coma)。结果:FLACS组手术时间明显短于Phaco组,EPT、CDE均明显低于Phaco组(均P<0.05);两组前囊切开直径无差异(P>0.05)。FLACS组UCDVA在术后1 wk,3 mo优于Phaco组(均P<0.05);两组术后1 wk,3 mo的UCDVA和术后3 mo的BCDVA比较均有差异(P<0.05)。术后3 mo,FLACS组IOL偏心距离小于Phaco组,偏移率明显低于Phaco组(均P<0.05)。在3 mm瞳孔直径下,两组术后3 mo的全眼HOA、三叶草差及彗差均较术前减少(P<0.05),FLACS组术后3 mo的全眼HOA、三叶草差与Phaco组比较均有差异(P<0.05),FLACS组术后3 mo的彗差与Phaco组比较无差异(P>0.05)。结论:FLACS-IOL手术可有效降低白内障患者术后IOL偏移率,获得更好的视觉质量。

双侧无晶状体患儿采用改良切口Ⅱ期睫状沟IOL植入术后的屈光度误差及安全性评估

目的:评估双侧无晶状体儿童采用改良切口Ⅱ期睫状沟人工晶状体(IOL)植入术的屈光度误差及安全性。方法:回顾性分析2020/2021接受改良切口Ⅱ期睫状沟折叠式IOL植入术的12例24眼双侧无晶状体儿童资料。分析术中、术后1 d及术后1 mo切口相关并发症的发生情况,记录最佳矫正视力(BCVA),眼轴长度(AL),水平角膜直径(WTW),以及术前预留屈光度(PRD)和实际等效球镜屈光度(AESD)的屈光结果。将患者按年龄(≤7岁和>7岁)、AL(<23和≥23 mm)和WTW(≤11.5和>11.5 mm)分为两组,比较根据测量结果预测的AESD和PRD之间屈光度误差。结果:在所有患儿中,男孩9例(75%),女孩3例(25%),其中2例(17%)为前囊下白内障,4例(33%)为后极性白内障,6例(50%)为核性白内障。白内障摘除时的平均年龄为6.4±1.61(3.4-8.9)mo,白内障摘除至Ⅱ期IOL植入术的平均时间间隔为6.8±1.82(4.4-11.5)a。术前平均BCVA为0.49±0.33(1.0-0.1)LogMAR,术后平均BCVA为0.38±0.32(1.0-0.0)LogMAR。平均AL为23.56±1.96(19.00-26.38)mm,平均WTW为11.5±0.92(9.3-13.9)mm,平均PRD为1.57±0.60(0.73-2.77)D,平均AESD为0.57±0.55(-0.50-1.75)D,AESD与PRD的平均差值为-0.99±0.52(-2.22-0.32)D。按年龄、AL、WTW分组的AESD、PRD差异无统计学意义(P=0.59、0.56、0.53)。结论:无晶状体儿童采用改良切口Ⅱ期睫状沟IOL植入安全可行。在睫状沟植入IOL时,需要从公式选择的IOL度数中减去约1 D。年龄、AL和WTW对差异无显著影响。

Ciliary body detachment after secondary intraocular lens implantation in childhood

Dear Sir,Iam Dr.Li-Na Meng,from the Qingdao Eye Hospital,Shandong Eye Institute,Shandong Academy of Medical Sciences,Qingdao,China.I want to present a rare case of secondary intraocular lens(IOL)implantation in an11-year-old boy who developed the complication of ciliary body detachment.When he was 2 years old,the boy underwent bilateral cataract extraction for congenital cataract in the other