小切口同轴双侧劈核法在白内障囊外摘出术中的应用

目的探讨小切口同轴双侧劈核法在白内障囊外摘出术中的临床应用价值。方法510眼Ⅲ级以上硬核的老年性白内障按分层随机设计分为2组,每组各255眼,分别用小切口同轴双侧劈核术式与传统大切口术式行白内障囊外摘出术,观察2组病例术后视力、角膜散光及并发症。结果术后第1d、术后1周、术后1月3个时间点小切口组术眼视力大于0.5者分别占61%、83%、89%,大切口组术眼视力大于0.5者分别占52%、59%、65%,小切口组术后视力显著高于大切口组(P<0.005)。术后1月小切口组的平均角膜散光为(0.79±0.72)D,明显低于大切口组的平均角膜散光(2.61±2.13)D(P=0.017)。2组病例均无明显的手术并发症。结论小切口同轴双侧劈核法白内障摘出术能快速恢复良好的术后视力,术后角膜散光小,无明显的手术并发症,是一种安全有效的手术方法,值得临床推广应用。

Comparison of visual outcomes with implantation of trifocal versus bifocal intraocular lens after phacoemulsification: a Meta-analysis

AIM： To compare a trifocal intraocular lens （IOL） and a bifocal IOL implantation in improving visual function after cataract surgery. METHODS： Eligible literatures were systematically searched through EMBASE and PubMed databases. The inclusion criteria were prospective comparative clinical trials on cataract surgery comparing trifocal IOL with bifocal IOL implantation that assessed visual acuity, contrast sensitivity and subjective vision quality. The effects were computed as standardized mean differences and pooled using fixed-effect or random-effect models. RESULTS： Four prospective randomized controlled trials （RCTs） and five cohorts provided data were included by a systematic review, comprising 265 eyes implanted with trifocal IOLs and 264 eyes implanted with bifocal IOLs. Monocular distance visual acuity （VA） showed a statistically significant but small difference that favored trifocal IOLs （MD=.0.06; 95%CI, -0.10 to -0.02; Z=2.90, P=0.004 for uncorrected distance VA, and MD- -0.02; 95%CI, -0.03 to .0.00; Z=2.02, P=0.04 for corrected distance VA）, but the data did not suggest that the effect of trifocal IOL implantation would clinically outperform bifocal IOL implantation. There was no significant difference in monocular near VA （MD=.0.01; 95%CI, -0.07 to 0.04; Z=0.42, P=-0.68 for distance-corrected near VA, and MD=-0.01; 95%CI, -0.06 to 0.03; Z=0.55, P=0.58 for corrected near VA） or refraction between two groups. Contrast sensitivity and subjective visual quality had no conclusive results. CONCLUSION： All results indicate that trifocal IOL and bifocal IOL had similar levels of monocular distance and near VA.

穿透性角膜移植与白内障摘出及人工晶状体植入联合手术

目的 观察 1986～ 1998年行穿透性角膜移植与白内障摘出及人工晶状体植入联合手术的疗效。方法 对 134例患白内障和部分中央性角膜白斑的患者在施行穿透性角膜移植时 ,从受植孔中摘出白内障 ,同时植入人工晶状体。结果 对其中 12 0例经 0 .5～12 a的随访 ,术后角膜移植片透明 99例 (82 .5 % ) ,混浊 2 1例 (17.5 % ) ,术后视力提高 92例 (76 .7% ) ,术眼脱盲 89例 (74.2 % )。结论 穿透性角膜移植与白内障摘出及人工晶状体植入治疗角膜白斑和白内障疾病具有视力恢复快。

后囊破损的无晶体眼的2期人工晶体植入术

用２ 期人工晶体植入术治疗后囊破损的无晶体眼１３ 只（ 其中前房型人工晶体植入６ 只眼，睫状沟缝线固定后房型人工晶体７ 只眼） ，均随访１ 年以上。术后裸眼视力均较术前明显提高，矫正视力４ 只眼≥１ ．０ ，９ 只眼≥０ ．５ 。结果证实２ 种术式均安全有效，强调应该根据无晶体眼的条件、２ 种２ 期植入手术的优缺点，扬长避短地选择手术方式。

角膜移植联合白内障人工晶状体种植临床观察

目的 总结角膜移植联合白内障摘除人工晶状体种植术的可行性及疗效。方法 对角膜混浊合并白内障的12眼患者行角膜移植联合白内障摘除人工晶状体种植术，白内障手术采取开窗式、植床边缘或巩膜隧道进行，术后观察视力、角膜情况、人工晶状体和手术并发症。结果 术后随访8-12个月，视力提高11眼，其中0.3以上7眼（58.6％），角膜透明和半透明10眼（83.3％），人工晶状体位正，无严重并发症发生。结论 角膜移植联合白内障摘除人工晶状体种植术安全可行。

Comparison of dynamic defocus curve Checkfor updates on cataract patients implanting extended depth of focus and monofocal intraocular

Background:The aim of the study was to compare the dynamic defocus curve on patients post-implantation of the extended depth-of-focus(EDOF)and monofocal intraocular lens(IOL).Methods:A total of 62 age-related cataract patients receiving phacoemulsification with implantation of TECNIS Symfony(ZXRoO)or monofocal IOLs were enrolled.The binocular static and dynamic defocus curves with corrected distance visual acuity were evaluated at one month postoperatively.Results:The ZXR00 group achieved signifcantly better intermediate(P=0.044)and near(P=0.017)visual acuity(VA)than the monofocal group.Two groups had similar uncorrected and corrected distance VA(P>0.05,respectively).The dynamic defocus curve revealed a smoother decline from 0.0 D to-2.0 D in the ZXRo0 group.Defocused dynamic VA in the ZXR00 group was significantly better(P<0.05)except at 0.0 D(P=0.724)and-0.5 D(P=0.176).The area under the curve(P=0.002)and corrected dynamic vision accommodation(P=0.001)derived from the dynamic defocus curves were better in the ZxRoo group.A positive correlation was observed between defocused dynamic and static VA in both groups(P<0.001).Multiple linear regression analysis indicated that defocused static VA and cor-rected dynamic vision accommodation were significant influential factors for the defocused dynamic VA from-1.0 D to-3.0 D(P<0.05).Conclusions:The EDOF IOL provided similar distant vision,better intermediate and near vision,and a better overall dynamic defocus curve than the monofocal IOL.The dynamic defocus curve may be comprehensively applied to evaluate the all-distance dynamic visual performance post-cataract surgery.

单焦点、多焦点与可调节人工晶状体植入术后患者的拟调节力观察

目的研究超声乳化白内障摘除植入不同人工晶状体（IOL）术后患者的拟调节力。方法前瞻性队列研究。行白内障超声乳化吸除联合IOL植入术且随访资料完整的患者73例（82眼），依据植入10L的不同分为3组：单焦点IOL组28例（32眼），多焦点IOL组24例（27眼），可调节IOL组21例（23眼）。术后3d、1周、1个月、3个月分别测量3组患者的裸眼远、中、近视力，最佳矫正远、近视力．及拟调节力。数据采用单因素方差分析。结果3组的最佳矫正远、近视力及裸眼远视力差异无统计学意义，而裸眼中视力可调节IOL优于单焦点与多焦点IOL（F=4．50，P〈0．05），裸眼近视力多焦点、可调节IOL好于单焦点IOL（F=26．06，P〈0．05）。多焦IOL可以提供（2．67±0．49）D的主观拟调节力，（0．93±0．42）0的客观拟调节力；可调节IOL可以提供（3．00±0．78）D主观拟调节力，（0．91±0．58）D客观拟调节力；优于单焦点10L的（1．78±0．26）D的主观拟调节力（F=18．51，P〈0．05），和（0．37±0．22）D的客观拟调节力（F=7．39，P〈0．05）。结论多焦点IOL与可调节性IOL均可提供较好的全程视力及拟调节力。

晶状体切除联合巩膜缝线固定人工晶状体植入术治疗先天性晶状体半脱位的长期效果

目的：分析先天性晶状体半脱位患眼经晶状体切除＋前段玻璃体切割＋经巩膜缝线固定人工晶状体（IOL）植入术后长期治疗效果。方法：回顾性系列病例研究。观察2005年1月至2014年6月期间于复旦大学附属眼耳鼻喉科医院收治的先天性晶状体半脱位患者53例（77眼），所有患眼均接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术。对术后最终随访时最佳矫正视力（BCVA）、眼压及术眼出现的主要并发症进行系统性的临床观察。数据采用配对t检验或独立样本t检验进行比较。结果：77 例接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术的先天性晶状体半脱位患眼，术后随访时间为（38±26）个月，最短12个月，最长130个月。术前BCVA（LogMAR）为0.84±0.55，术后为0.26±0.43，术后视力较术前明显改善（t=8.55，P 〈 0.001）。术中及术后早期并发症包括：1眼（1.3%）术中视网膜脱离，2眼（2.6%）术后早期前房积血，2眼（2.6%）术后早期切口玻璃体嵌顿。术后远期并发症包括：6 眼（7.8%）视网膜脱离，发生于术后（22±12）个月，1 眼（1％）IOL移位或脱位，发生于术后5 年。术后不良主诉包括：32 例（60.4%）术后随访时主诉干眼症状，6例（11.3%）主诉眩光现象。结论：晶状体切除前段玻璃体切割＋经巩膜缝线固定IOL植入术可以显著提高先天性晶状体半脱位患者视力。远期随访中，视网膜脱离及IOL脱位是尤其需要警惕的术后并发症。