Evaluation of the Clinical Efficacy of Full Femtosecond Laser Surgery in the Treatment of Myopia

Objective:To evaluate the clinical effect of full femtosecond laser surgery in the treatment of myopia patients.Methods:120 myopia patients admitted to our hospital from January 2022 to June 2023 were selected.According to the random number table method,60 patients in the observation group underwent full femtosecond laser surgery,and 60 patients in the control group underwent femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery.The clinical effects of the two groups were compared.Results:10 days postoperatively and 6 months after operation,the visual acuity level of the observation group was higher than that of the control group,the postoperative corneal asphericity coefficient and corneal full-thickness were lower than those of the control group,and the total effective rate 6 months after operation was higher than that of the control group(P<0.05).Conclusion:Full femtosecond laser surgical treatment can improve the postoperative visual acuity of patients with myopia,enhance the corneal asphericity coefficient(Q)and corneal full-thickness,and exert significant clinical effects.

Degenerative myopia: mechanical theories revisited

The article discusses the early abandonment of mechanical theories about eye enlargement in degenerative myopia at the turn of the 20th century.At that time,the number of theories about myopia grew unrestricted,but with scant support from the experimental field.The mechanical theories vanished as a new wave of metabolism-based theories appeared,propelled by the huge advances in molecular biology.Modern techniques allow reconsidering those theories and to put them to test with higher confidence.

Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia

AIM: To investigate the incidence of preoperative dry eye and related factors in patients undergoing corneal refractive surgery to correct myopia.METHODS: A total of 141 patients with myopia who underwent corneal refractive surgery were surveyed by questionnaires, tear film break-up time(BUT) test, Schimer I test(SIt), corneal fluorescein staining(FL) test and diagnosed according to the currently recognized domestic diagnostic criteria for dry eye. Correlation analysis of factors such as age, gender, regular wearing of contact lens(CL), diopter(spherical equivalent), corneal thickness, and corneal curvature that may affect the onset of dry eye was carried out to clarify the main influencing factors. RESULTS: There were 64 patients(45.39%) diagnosed with dry eye. The male patients(20.31%) was significantly less than that of non-dry eye subjects(41.56%;χ~2=7.260, P=0.007);the proportion of patients with dry eye wearing CL(81.25%) was significantly higher than that of non-dry eye subjects(51.95%;χ~2=13.234, P<0.001);the median diopter level of dry eye patients was-6.59(IQR:-8.87,-4.58) D, and the median diopter level of non-dry eye subjects was-5.69(IQR:-7.15,-4.03) D. The diopter level of dry eye patients was significantly higher(Z=-2.086, P=0.019). However, the age, best corrected visual acuity, and intraocular pressure of dry eye patients were not statistically different from those of non-dry eye subjects(t=-0.257,-0.383 and 0.778, P=0.798, 0.702, and 0.438);the corneal thickness and corneal curvature(K1 and K2) were also not statistically different either(Z=-1.487,-1.036 and-1.707, P=0.137, 0.300, and 0.088). The research further analyzes the three significant factors in the single factor analysis(gender, CL wear, and diopter) in a multi-factor way: CL wear and diopter were the influencing factors of dry eye disease. Among them, CL wear increased the risk of dry eye by 2.934 times compared with no CL wear;for every 1 D increase in diopter, the risk of dry eye increased by 0.761 times.CONCLUSION: Preoperative dry eye is relatively common in patients who undergo corneal refractive surgery to correct myopia, especially in patients who have a history of CL wear and a high diopter level before surgery. Therefore, it is necessary to carry out preoperative screening and timely treatment of dry eye to obtain the best treatment outcome and postoperative satisfaction.

Long-term observation on safety and visual quality of implantable collamer lens V4c implantation for myopia correction:a 5-year follow-up

AIM:To elucidate the safety and visual quality of implantable collamer lens with central hole(ICL V4c)implantation for correcting moderate and high myopia for at least 5y.METHODS:This retrospective study was conducted on 58 patients(114 eyes)who were followed up for at least 5y after ICL V4c implantation.The observation was done before and on 1d,1mo,1 and 5y or more after the surgical procedure.The visual acuity,subjective refraction,intraocular pressure,vault,axial length,central hole position,pupil diameter,visual quality,and adverse events were analyzed.The visual quality includes aberration,the modulation transfer function cutoff frequency(MTF cutoff),objective scattering index(OSI),Stroller's ratio(SR),and visual quality questionnaire.RESULTS:The average follow-up period was 69.25±3.80mo(range 60–82mo)and the preoperative spherical equivalent(SE)was-8.66±1.97 D.At 5y after operation,the safety index was 1.01±0.02 and the efficacy index was 0.99±0.42 and SE was-0.65±0.63 D.The 59.6%of the eyes achieved an uncorrected distance visual acuity of 20/20,76.3%of the eyes had SE within±1.0 D at the last visit.The axial length increased by 0.29±0.71 mm 5y after the surgery(t=-3.843,P<0.001).The mean vault at the last follow-up was 510.59±245.61μm.The central hole was on the temporal side in 80 eyes(84.2%).The visual quality questionnaire showed that 98.2%patients were satisfied with the surgical procedure.Adverse events occurred in 4 eyes(3.5%),including the posttraumatic toric ICL rotation(2 eyes),iris incarceration(1 eye),and posttraumatic ICL displacement(1 eye)at the last follow-up.CONCLUSION:Long-term ICL V4c implantation is safe,effective,and stable for correcting moderate and to high myopia,and the visual quality with patients is excellent and satisfactory,but the progression of axial length still needs attention after surgery.

A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia

AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.

Therapeutic Effects of Undercorrection by LASIK Following RK and PRK for Correction of High Myopia

In order to investigate the therapeutic effects of undercorrection following radial keratoto- my (RK) and photorefractive keratectomy (PRK) for correction of high myopia by excimer laser in situ keratomileusis (LASIK), LASIK was performed on 32 eyes of 16 patients undergoing RK 2 years ago and 38 eyes of 20 patients undergoing PRK 1 year ago. The postoperative uncorrected visu- al was better than or equal to the preoperative spectacle corrected visual acuity in 49 of 70 eyes (70. 00 %) and achieved the best status of refraction in 64 of 70 (91.43 %). The best postoperatively corrected visual in all operated eyes were equal to their preoperative ones respectively or just lost 1 line. No severe complication occurred during and after operation. It was suggested that LASIK was a better method for treatment of undercorrection following RK and PRK.

The 100 most influential articles in myopia:a bibliometric analysis

AIM:To identify and characterize the 100 most influential articles in the field of myopia over the last decades.METHODS:Articles on myopia published between January 1975 and March 2020 were searched through the Web of Science Core Collection database.Two independent authors reviewed and determined the 100 most cited articles.The characteristics of each eligible article were recorded,including authors,institutions,countries,journals,publication date,total citations(TCs),annual citations(ACs),research focus and article type.RESULTS:The top 100 most influential articles were published between 1983 and 2016,with 1999 as the most prolific year.The mean number of TCs was 288(range:193-537)and the mean number of ACs was 19(range:7-109).Treatment and epidemiology of myopia were the most important research focus.These articles were published in 21 journals led by Ophthalmology(29%)followed by Investigative Ophthalmology&Visual Science(23%).The number of ACs for articles published in the last ten years was significantly higher than that for the other most-cited articles(44 vs 16,Mann-Whitney U test P<0.01).There is no difference in the number of TCs between original articles and review articles,while the number of ACs for review articles was significantly higher than that for original articles(22 vs 17,Mann-Whitney U test P<0.05).CONCLUSION:This bibliometric analysis can provide us with concise information about the development trend of research in the field of myopia in the past few decades,and provide an important reference for researchers to guide future research.

Factors affecting single-step transepithelial photorefractive keratectomy outcome in the treatment of mild,moderate,and high myopia:a cohort study

AIM:To investigate the effect of preoperative factors on visual acuity,higher-order aberrations(HOAs),and index of success for spherical change(S.IOS)after transepithelial photorefractive keratectomy(t-PRK)for treating different grades of myopia.METHODS:This was a retrospective one-armed cohort study where patients with high,moderate,or mild myopia treated with single-step t-PRK using Amaris 500 Hz excimer laser were evaluated for visual acuity,refractive status,corneal topography,HOAs,S.IOS,and mean efficiency and safety index before and 6 mo after surgery.RESULTS:A total of 154 eyes of 77 patients with mild(n=59),moderate(n=83),and high(n=12)myopia were reviewed.The efficiency and safety indices for vision recovery by single-step t-PRK were 98%and 100%,respectively.The achieved spherical equivalent(SE)was within 1 diopter(D)in 151(98%)eyes.The median of the S.IOS was 1.18[interquartile range(IQR)1.0,1.4].The change in S.IOS was significantly correlated with age(P=0.007),6.5 mm ablation zone(Mann-Whitney U test,P<0.01),and mild and moderate grade of myopia(Kruskal–Wallis test,P<0.001).Trefoil aberration,spherical aberration,and aberration coefficient types of HOA increased significantly(Wilcoxon test,P<0.001)6 mo post-surgery.There was a significant correlation between spherical aberration and aberration coefficient HOAs by myopia grades(P<0.05).CONCLUSION:Single-step t-PRK has promising short-term outcomes for refractive corrections and vision improvement to treat all three grades of myopia.

Surgical treatment of Pitt-Hopkins syndrome associated with strabismus and early-onset myopia:Two case reports

BACKGROUND Pitt-Hopkins syndrome(PTHS;MIM#610954)is a rare genetic neurological disorder.Myopia and strabismus have been reported in approximately 50%of PTHS patients.No studies have reported details about the required surgery for PTHS with strabismus and early-onset myopia.Here,we retrospectively reviewed the surgical management of two patients with PTHS combined with strabismus and/or early-onset myopia.CASE SUMMARY A 5-year-old girl presented with congenital esotropia and left eye myopia,and the second girl was a 5-year-old girl who presented with intermittent exotropia.Genetic testing performed on both patients showed a mutation in transcription factor 4,which is a diagnostic marker of PTHS.The first girl underwent bilateral medial rectus recession combined with posterior scleral reinforcement(PSR)in the left eye and the second patient underwent bilateral lateral rectus recession strabismus surgery.We made key innovations in surgical timing and strategy,and the results were satisfactory.The combination of strabismus and PSR surgery is an innovative strategy for patients with both strabismus and early-onset myopia.CONCLUSION Early treatment of strabismus and myopia positively influence motor development and should be included in rehabilitation programs for patients with PTHS.

显微镜辅助微创经椎间孔腰椎椎间融合术治疗单节段腰椎滑脱症

目的探讨显微镜辅助经Quadrant通道结合经皮椎弓根钉固定行微创小切口经椎间孔腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性滑脱症的疗效。方法回顾性分析2018年4月至2021年3月行椎体间融合术治疗单节段腰椎退行性滑脱症患者的临床资料,其中采用开放经椎间孔腰椎椎间融合术(TLIF)治疗患者41例(开放组),经Wiltse入路Quadrant通道直视下TLIF治疗患者25例(微创组),显微镜下减压并采用经皮椎弓根钉TLIF治疗患者38例(显微组)。记录3组患者手术时间、术中出血量、X线透视次数、引流量、术后2天和7天切口周围疼痛视觉模拟评分(VAS)、并发症情况,术后CT检查评估椎弓根钉置钉准确率,记录术前及术后6个月、24个月日本骨科协会(JOA)评分和Oswestry功能障碍指数(ODI),末次随访时采用改良MacNab标准评价临床疗效。结果所有手术均顺利完成。显微组术中出血量、引流量、术后2天和7天切口周围疼痛VAS评分均小于微创组和开放组(P<0.05),椎弓根钉置钉准确率高于微创组和开放组(P<0.05),但术中X线透视次数高于微创组和开放组(P<0.05)。开放组发生术后切口浅表软组织感染1例,疑似感染1例,脑脊液漏1例;微创组出现术后短暂性神经症状2例。3组术后6个月、24个月JOA评分和ODI评分均较术前明显改善(P<0.05),3组间比较无统计学差异(P>0.05)。术后6个月和24个月融合率3组间比较无统计学差异(P>0.05)。按改良MacNab标准,3组患者疗效优良率无统计学差异(P>0.05)。结论显微镜辅助通道下MIS-TLIF治疗单节段腰椎退行性滑脱症,术中出血少、切口疼痛感小、并发症少,采用经皮椎弓根钉置钉准确率高,融合率、疗效优良率与开放手术一致,临床疗效好。

内镜、微创和开放式经椎间孔椎体间融合术治疗腰椎退行性疾病的效果比较

目的比较经椎间孔内镜腰椎椎间融合术(Endo-LIF)、微创腰椎椎间融合术(MIS-TLIF)和开放腰椎椎间融合术(PLIF)治疗腰椎退行性疾病(LDD)的临床疗效和安全性。方法回顾性分析2013年1月至2023年1月在百色市人民医院因LDD接受经椎间孔腰椎椎间融合术就诊的150例患者临床资料,按手术方式分为Endo-LIF组、MIS-TLIF组、PLIF组三组,每组各50例。比较患者手术时间、透视次数、术中失血量、住院时间、并发症以及术前和术后3个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、椎间隙高度指数、病变节段活动度(ROM)。结果PLIF组的手术时间长于Endo-LIF组和MIS-TLIF组,术中透视次数少于Endo-LIF组和MIS-TLIF组,差异有统计学意义(P<0.05)。Endo-LIF组和MIS-TLIF组的手术时间、术中透视次数比较,差异无统计学意义(P>0.05)。患者术中出血量Endo-LIF组少于MIS-TLIF组及PLIF组,MIS-TLIF组少于PLIF组,差异有统计学意义(P<0.05);患者术后卧床时间和住院时间Endo-LIF组短于MIS-TLIF组及PLIF组,MIS-TLIF组短于PLIF组,差异有统计学意义(P<0.05)。三组患者满意度比较,差异有统计学意义(P<0.05)。Endo-LIF组满意度高于PLIF组,差异有统计学意义(P<0.017)。三组患者术后3个月VAS及ODI评分低于手术前,差异有统计学意义(P<0.01)。三组患者并发症发生率、椎间隙高度指数、ROM比较,差异无统计学意义(P>0.05)。结论Endo-LIF、MIS-TLI、PLIF三种手术方法术后3个月的预后结果相似,PLIF术中透视次数最少,Endo-LIF创伤较小,在降低术中出血,缩短术后卧床时间和住院时间方面优势明显,术后恢复速度较快,适合临床推广。

Quadrant通道下单侧后路腰椎椎体间融合术与传统开放术治疗退行性腰椎疾病的疗效比较

目的 探讨Quadrant通道下单侧后路腰椎椎体间融合术与传统开放术治疗退行性腰椎疾病的价值。方法 选取2019年1月至2023年6月我院外科治疗的退行性腰椎疾病患者100例,通过随机数字表法分为两组。观察组(50例)实施Quadrant通道下单侧后路腰椎椎体间融合术进行治疗,对照组(50例)实施常规开放手术治疗,比较两组治疗效果。结果 相比较对照组,观察组手术时间长、切口长度短、术中出血量小、术后引流量小、术后下地时间短、术后住院时间短(P <0.05),术后1、2、3d的疼痛评分低(P <0.05),术后2、4、6周的Oswestry功能障碍指数低(P <0.05),末次随访MacNab分级的优良率高(P <0.05)。结论 Quadrant通道下单侧后路腰椎椎体间融合术治疗退行性腰椎疾病效果十分显著,术后疼痛少,恢复快,术后功能障碍改善良好,具有较好的应用价值。

基于Web of Science的2013-2022年近视研究领域文献计量分析

目的应用文献计量学方法分析近10年来近视研究领域的现状、热点和未来的发展方向。方法检索Web of Science核心数据库中2013年1月1日至2022年12月31日近视相关的研究类和综述类文献,使用VOSviewer软件对国家、研究机构、作者进行共现分析,使用CiteSpace软件对关键词和共被引参考文献进行聚类分析。结果最终纳入9745篇文献,涉及123个国家或地区,7150个机构和29343位作者。通过分析发现全球在近视领域的发文量整体呈增长趋势,中国是发文量最多的国家,来自美国的研究总被引用次数最多。关键词分析结果表明,早期近视研究热点主要集中于屈光手术、并发症的诊断与治疗、遗传学研究以及流行病学特征,而近年来研究重点已迅速转向近视的预防和控制。共被引文献聚类分析结果显示,近视领域包含多个聚类模块,如#0学龄儿童、#1小切口角膜基质透镜取出术、#2近视控制、#3屈光不正、#4接触镜等研究方向。研究前沿主要聚焦于近视管理技术、近视与视网膜和脉络膜血管、人工智能在近视领域的应用等方面。结论近十年近视研究领域涵盖眼科学、分子生物学、遗传学、眼视光学、流行病学等多个学科领域。未来需要进一步探索近视的病因和发病机制、早期识别和筛查、管理技术、人工智能辅助诊断等,以制定更加有效、安全的近视防控策略。

基于Corvis ST分析飞秒LASIK联合快速交联矫正高度近视术后角膜生物力学变化

目的应用Corvis ST评估飞秒激光辅助准分子激光原位角膜磨镶术(LASIK)联合快速角膜交联术(FS-LASIK Xtra)矫正高度近视术后角膜生物力学的变化。方法前瞻性病例对照研究。选取2020年7月至2022年7月在山东中医药大学附属眼科医院行手术矫正高度近视的患者185例(185眼)为研究对象,所有患者均将右眼纳入研究,其中行FS-LASIK Xtra者93例为FS-LASIK Xtra组,行FS-LASIK者92例为FS-LASIK组,术后随访6个月,记录患者的裸眼视力、等效球镜度、平均角膜曲率(Km)、最薄点角膜厚度(TCT)、角膜生物力学参数[2 mm处变形幅度比(DAR 2 mm)、综合半径(IR)、第一次压平刚度系数(SP-A1)、应力应变指数(SSI)]和手术前后角膜生物力学参数变化量(术后6个月与术前的差值,即ΔDAR 2 mm、ΔIR、ΔSP-A1、ΔSSI)。采用独立样本t检验和Mann-Whitney U检验对组间数据进行比较。结果术后3个月等效球镜度FS-LASIK组和FS-LASIK Xtra组患者分别为(-0.21±0.31)D和(-0.04±0.36)D,差异有统计学意义(t=3.49,P=0.001);术后6个月两组分别为(-0.33±0.31)D、(-0.14±0.37)D,差异均有统计学意义(t=4.00,P<0.001)。术后6个月时FS-LASIK组与FS-LASIK Xtra组患者手术的有效性指数和安全性指数差异均无统计学意义(均为P>0.05)。术前两组患者DAR 2 mm、IR、SP-A1、SSI等角膜生物力学参数比较差异均无统计学意义(均为P>0.05);术后6个月,FS-LASIK组与FS-LASIK Xtra组患者角膜生物力学参数变化量ΔIR分别为3.03±0.78、2.67±0.80,ΔSP-A1为-35.93±12.04、-30.43±12.44,ΔSSI为-0.09±0.10、-0.03±0.06,两组相比差异均有统计学意义(均为P<0.05)。结论FS-LASIK Xtra矫正高度近视术后患者视力、等效球镜度稳定,具有良好的安全性和有效性,角膜生物力学稳定性较术前降低,但优于常规FS-LASIK,长期效果需要进一步观察。

LASIK surgery in patients with residual refractive errors after radial keratotomy

AIMTo study the results and complications of LASIK surgery after radial keratotomy.

机器人辅助微创腰椎后路融合治疗腰椎退行性疾病

背景:微创手术目前发展迅速,机器人辅助下的微创经椎间孔腰椎椎间融合与机器人辅助下单边双通道内镜下微创腰椎融合是治疗腰椎退行性疾病的重要后路微创手术方法,但是何种术式更具有优势,值得探讨。目的:比较不同机器人辅助微创腰椎后路融合手术的临床疗效以及影像学检查,探讨机器人辅助微创腰椎后路融合技术在腰椎退行性疾病中的临床应用价值。方法:回顾分析2018年1月至2022年6月于四川省医学科学院·四川省人民医院骨科就诊的83例腰椎退行性疾病患者的临床资料,其中27例应用机器人辅助下微创经椎间孔腰椎椎间融合治疗(A组),30例应用机器人辅助单边双通道内镜下微创腰椎融合治疗(B组),另选择26例传统微创经椎间孔腰椎椎间融合患者作为对照组(C组)。3组患者的性别、年龄、体质量指数、手术节段分布及术前疼痛目测类比评分及Oswestry功能障碍指数等一般资料比较差异均无显著性意义(P>0.05)。比较3组患者手术时间、术中出血量、手术并发症、辐射次数、辐射剂量以及辐射时间。以Gertzbein-Robbins分级标准判断经皮螺钉的精度;评估手术后疼痛目测类比评分及Oswestry功能障碍指数;以Macnab标准评估手术方案的优良率。结果与结论:①A组手术时间短于B、C组(P<0.05),但是B组与C组之间差异无显著性意义(P>0.05);B组术中失血量明显少于A组,A组少于C组,差异均有显著性意义(P<0.05);②C组的辐照次数、辐照剂量及辐射时间明显高于A、B组(P<0.05);③3组患者术后疼痛目测类比评分及Oswestry功能障碍指数均较术前显著改善(P<0.05),但术后1 d及术后6个月,3组之间差异无显著性意义(P>0.05);④术后影像学检查显示,A、B组的置钉精度优于C组(P<0.05);⑤Macnab手术优良率在3组间差异无显著性意义(P>0.05);⑥在并发症上,3组之间差异无显著性意义(P>0.05);⑦结果说明机器人辅助下微创经椎间孔腰椎椎间融合、机器人辅助单边双通道内镜下微创腰椎融合都是治疗腰椎退行性疾病的有效方法;相较于传统微创经椎间孔腰椎椎间融合治疗,机器人辅助下的腰椎微创融合手术效率高,术中辐射更少,内固定精度更高,具有良好的临床应用价值。

基于根因分析指导的预见性护理对单膝关节置换术患者术后生活质量的影响

目的探讨基于根因分析指导的预见性护理对单膝关节置换术患者术后生活质量的影响。方法选择2022年2月至2023年10月南京医科大学附属南京医院开展单膝关节置换术治疗的120例膝关节退行性骨关节病患者,按不同的护理方法分为对照组和研究组,各60例。对照组接受常规围手术期护理,研究组接受基于根因分析指导的预见性护理,均护理1个月。比较两组疼痛程度、膝关节功能、生活质量、并发症发生率。结果护理7 d后,两组视觉模拟评分法评分低于护理1 d后,且研究组低于对照组(P<0.05)。护理1个月后,两组美国纽约特种外科医院膝关节功能评分表评分、中文版世界卫生组织生存质量测定量表简表评分高于护理前,且研究组高于对照组(P<0.05)。在院护理期间研究组并发症总发生率低于对照组(P<0.05)。结论将基于根因分析指导的预见性护理用于单膝关节置换术患者中,可有效减轻患者术后疼痛感,利于改善膝关节功能、生活质量,降低并发症发生率。

基于六经辨证论治高度近视眼底退行性病变

高度近视(HM)患者若眼轴进行性拉长,将导致眼底出现脉络膜和视网膜萎缩等一系列退行性病变,发展为病理性近视,严重危害视功能。HM引起的黄斑病变已成为我国中老年人的第一大致盲原因,西医药物、手术等疗法预后不佳。中医眼科学具有悠久的历史及完整的理论体系,HM眼底退行性病变遵循由浅入深的发病规律,与中医眼科六经辨证理论体系相契合,本文以“眼科六经辨证法”为基础,探讨HM眼底退行性病变分阶段、分部位论治的具体方法。

尹连荣教授论治高度近视早期视网膜退行性病变经验探析

[目的]总结尹连荣教授治疗高度近视早期视网膜退行性病变的临床经验及学术观点。[方法]通过跟师临证,医案整理,从高度近视早期视网膜退行性病变的发病机制、理论依据入手,总结尹教授治疗本病的临证思想及化裁经验,并附验案加以佐证。[结结果]高度近视视网膜退行性病变呈缓慢进展状态,近视性黄斑病变严重损害视力且不可逆转,目前尚无有效治疗手段。因此,尹教授临证时将“治未病”思想与“目受血而能视”理论相结合,提出将治疗节点前移,即在发生不可逆的黄斑病变前加以干预,尹教授认为本病早期病机关键为气血亏虚,脉络瘀阻,治疗时应紧扣益气养血、活血通络之法,灵活运用经方补阳还五汤加减以改善脉络膜、视网膜血流,从而延缓眼底病变进展,临床疗效肯定。所举医案中,尹教授综合脉症及眼底检查结果,辨其为气血亏虚、脉络瘀阻之证,以益气活血之补阳还五汤加减治疗,疗效卓著。[结论]尹连荣教授将“治未病”思想与“目受血而能视”理论相结合,在高度近视视网膜退行性病变早期阶段给予干预,通过益气活血法使气旺血行、瘀去络通,从而改善脉络膜、视网膜血流,延缓疾病进展,其经验值得临床学习借鉴。

人工晶状体置换的原因及临床效果分析

目的分析近5年接受人工晶状体(IOL)置换术的原因及其临床效果。方法回顾性病例系列研究。收集2019年1月—2023年12月在广西医科大学第一附属医院接受IOL置换术的患者的资料,包括患者基本信息、手术原因及间隔时间、手术前后的裸眼视力(UCVA)与最佳矫正视力(BCVA)以及术后并发症等。排除仅行IOL复位、背驮式IOL植入、取出IOL后未重新植入IOL的患者。结果本研究共纳入38例(47眼),平均年龄(31.19±23.47)岁(4~80岁),平均手术间隔时间为(8.4±7.0)年(13 d~28年)。手术原因包括:IOL移位或脱位16眼(34.0%),先天性白内障术后高度近视16眼(34.0%),IOL混浊5眼(10.6%),术后高散光4眼(8.5%),严重后发性白内障(PCO)和/或IOL损伤3眼(6.4%),多焦点IOL植入术后视觉质量不满意1眼(2.1%),IOL偏心1眼(2.1%),无法耐受色觉改变1眼(2.1%)。术后高散光、多焦点IOL植入术后视觉质量不满意、IOL偏心、无法耐受色觉改变的手术间隔时间较短,均小于1年,其余均为5年以上。IOL置换术临床效果良好,UCVA与BCVA均较术前显著提高。术前、术后的平均UCVA(logMAR)分别为1.32±0.65、0.66±0.42,差异有统计学意义(P<0.001),术前、术后的平均BCVA(logMAR)分别为0.72±0.70、0.44±0.46,差异有统计学意义(P=0.001)。除1例患者IOL置换术后第2天出现IOL移位需重新固定外,余无并发症发生。结论IOL移位或脱位以及先天性白内障术后高度近视是IOL置换术的主要原因。术后高散光、多焦点IOL植入术后视觉质量不满意、IOL偏心、无法耐受色觉改变的手术间隔时间较短,是早期IOL置换原因,而IOL移位或脱位、先天性白内障术后高度近视、IOL混浊以及严重PCO和/或IOL损伤是远期置换的原因。IOL置换术具有一定的挑战性,但临床效果良好,并发症少。