Phacoemulsification versus small incision cataract surgery in patients with uveitis

AIMTo compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract.METHODSIn a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of <0.05 was considered statistically significant.RESULTSOne hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P<0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86±0.34 dioptres (D) in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (P<0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups.CONCLUSIONManual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).

Outcomes after combined excisional goniotomy and manual small incision cataract surgery

AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually significant cataracts that underwent combined excisional goniotomy and MSICS with one-year follow-up. The medical history, demographic information, and clinical characteristics of each case were recorded. Data regarding changes in vision, intraocular pressure(IOP), the number of glaucoma medications, and the evolution of the disease after surgery were reported. RESULTS: Three patients, with open angle glaucoma and cataracts underwent combined excisional goniotomy and MSICS without adverse events. All patients had improvement in vision compared to baseline measurements. The range of IOP at baseline was from 14 to 18 mm Hg and decrease to a range of 10 to 14 mm Hg after one year of follow-up. Additionally, two patients also decreased their dependence on IOP-lowering medications at the last follow up visit with one patient maintaining baseline level of medication use.CONCLUSION: A combination of excisional goniotomy and MSICS illustrates both the safety and efficacy to treat patients with visually significant cataract and glaucoma. This procedure allows for a more cost-effective surgical approach that matches the needs of resource strained territories around the globe.

A reasonable option in vitrectomized eyes: manual small incision cataract surgery

Dear Sir,It is known that cataract surgery is challenging in vitrectomized eyes.Cataract surgeons may have encountered with posterior capsular complications and nucleus drop events even with minimal ocular manipulations and low irrigation bottle height.Inadvertent damage to the zonular fibers,posterior or peripheral lens capsule with ocutome or microvitreoretinal(MVR)blade in previous

Incision Site in Manual Small Incision Cataract Surgery in Case of Preoperative Direct Astigmatism

We compared surgically induced astigmatism (SIA) by a superior incision with a temporal incision in manual small incision cataract surgery (MSICS), in patients with bilateral direct (regular) preoperative corneal astigmatisms. Patients and method: We carried out a prospective study from July 1st 2018 to September 30th 2019 in the department of ophthalmology at the University Hospital of Brazzaville. Keratometric readings were recorded before surgery to assess preoperative corneal astigmatisms. Keratometric evaluation was done 45 days post-operatively. Patients were followed 90 days after surgery in order to assess the healing of the surgical site. The surgically induced astigmatism (SIA) is the difference in the magnitude vectors between the preoperative and postoperative astigmatism. The result was positive if the postoperative astigmatism was greater than the preoperative astigmatism and negative if the postoperative astigmatism was less than the preoperative astigmatism. Results: Our study sample included 48 eyes from 24 patients, including 24 operated on temporal incision and 24 in superior incision. The average SIA for superior incisions was 0.33 ± 1.55 diopters (D), versus 0.33 ± 1.44 for temporal incisions. For superior incisions the SIA was 0.81 for astigmatisms lower than 2D, against 0.16D for the temporal incisions. On the other hand, for preoperative astigmatisms greater than 2D, the surgically induced astigmatism was ±0.62D, marking a decrease in preoperative astigmatism for the superior incisions against an increase of 0.5D for the temporal incisions. The healing was delayed for the temporal incisions responsible for discomfort persisting beyond 45 days. Conclusion: The temporal incision had better results than the superior incision for astigmatisms lower than 2D, and less good for astigmatisms higher than 2D. The temporal incision healed less well.

Cataract surgery in aged patients:phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemulsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity (BCVA) of >= 0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (chi(2)=259.730, P<0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (chi(2)=4.535, P > 0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (chi(2)=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.

Visual outcome of manual small-incision cataract surgery:comparison of modified Blumenthal and Ruit techniques

AIM:To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery(MSICS).· METHODS:This was a prospective,non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision,i.e.,the Blumenthal technique(group 1,n = 64) or a temporal scleral tunnel incision,i.e.,the Ruit technique(group 2,n =65).MSICS and intraocular lens implantation were performed through an unsutured 6.5-to 7.0-mm scleral tunnel incision.Uncorrected and corrected visual acuity,intraoperative and postoperative complications,and surgically induced astigmatism calculated by simple subtraction were compared.Patients were examined at 1 day,1 week,1 month,and 3 months after surgery.· RESULTS:Both groups achieved good visual outcome with minor complications.Three months after surgery,the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group(P =0.29).The average(SD) postoperative astigmatism was 0.87(0.62) diopter(D) for the Blumenthal group and 0.86(0.62) D for the Ruit group.The mean(SD) surgically induced astigmatism was 0.55(0.45) D and 0.50(0.44) D for the Blumenthal and Ruit groups,respectively(P =0.52).Common complications were minimal hyphema and corneal edema.There was no statistically significant difference in the complication rate between the groups(P >0.05).· CONCLUSION:In MSICS,both the Blumenthal and Ruit techniques achieved good visual outcomes,with low complication rates.

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens(IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by i Trace wavefront aberrometer(Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square(RMS) values of Z(3,-3), Z(3, 3), Z(3,-1), Z(3, 1), and Z(4, 0) and total high order aberration(HOA) were evaluated.Results: The uncorrected and corrected visual acuities improve significantly(P<0.001). No significant postoperative changes were observed in spherical aberration(P=0.652). Significant changes in vertical coma and vertical trefoil(0.005±0.214 vs.-0.049±0.242, P=0.037;-0.141±0.222 vs.-0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery(0.567±0.161 vs. 0.688±0.343, P<0.001).Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.

Astigmatism following Small Incision Cataract Extraction through Superotemporal Incision

Purpose:.To investigate the occurrence of corneal incision-induced astigmatism following small incision extracapsular cataract extraction through a superotemporal incision combined with intraocular lens (IOL) implantation. Methods:.A total of 255 cases (301 eyes) who received small incision extracapsular cataract extraction through a superotemporal incision with IOL implantation in the Department of Ophthalmology, Yuyan District Hospital of Guiyang were enrolled in this clinical trial..Postoperative best-corrected visual acuity and astigmatism were measured. The patients underwent 24-week follow-up. Results: In total, 166 patients (65.1%, 166 eyes) completed follow-up..Astigmatism gradually declined between 1 and 12-week postoperatively, and stabilized after 12 weeks. Among 166 patients,.125(75.3%).had astigmatism > 0.5 D at 24 weeks post-operatively,.showing mostly with-the-rule astigmatism. Visual acuity steadily improved up to 12 weeks, and tended to stabilize subsequently..Over the period of 24-week postoperatively,.visual acuity was negatively correlated with astigmatism (r=-0.691,P<0.05). Conclusion:Superotemporal small incision extracapsular extraction combined with IOL implantation is associated with modest astigmatism which declines over the post-operative period.

Assessment of visual outcomes of cataract surgery in Tujia nationality in Xianfeng County, China

AIM: To evaluate the visual outcome and factors influencing visual outcome of manual small incision cataract surgery(MSICS) in the rural area in the Xianfeng County.METHODS: Eighty-two eyes of 82 patients who underwent cataract surgery performed by using MSICS technique were identified. Data collected included each patient’s age, gender, the level of education. Uncorrected and corrected distance visual acuity(UDVA and CDVA) at presentation and at 1, 6, 8wk postoperatively, pre-existing eye disease, operative findings and complications, the risk factors were evaluated.RESULTS: In 82 patients, the average age was 69.6±0.6y, illiterate were 52(63.4%). Of 82 eyes, pseudophakia was present in 77 eyes(93.9%). At 1wk postoperatively,47 eyes(57.3%) had the UDVA of ≥6/18, and 52 eyes(63.4%) had the CDVA of ≥6/18. At 6 to 8wk postoperatively, 50 eyes(61.0%) had UDVA of ≥6/18, and57 eyes(69.5%) had the CDVA of ≥6/18. Postoperative visual status was significantly related to the co-morbidities, such as corneal pathology, glaucoma(P 【0.001).Operative complications, such as posterior capsule opacity and cystoid macular edema were main operative cause for the poor visual outcome.CONCLUSION: MSICS provides a good visual recovery in our study but the vision outcome did not fulfill the standards proposed by WHO, which highlights the need for an improvement in local socioeconomic understanding, population education and surgery quality.

小切口水平空间劈核术联合Toric IOL植入术治疗硬核年龄相关性白内障的临床效果

目的:探讨硬核年龄相关性白内障(ARC)患者给予小切口水平空间劈核术联合散光矫正型人工晶状体(Toric IOL)植入术治疗的临床效果。方法:选取2017年1月—2023年12月航天中心医院收治的300例硬核ARC患者,以随机数字表法分成研究组与对照组,各150例。研究组给予小切口水平空间劈核术联合Toric IOL植入术治疗,对照组给予超声乳化术联合Toric IOL植入术治疗。比较两组视力水平、泪膜功能、角膜内皮细胞指标、生活质量及并发症。结果:术后12周,两组视力水平、低视力者生活质量量表(LVQOL)评分均高于术前,且研究组均高于对照组,差异均有统计学意义(P<0.05)。术后1周,两组眼表疾病指数(OSDI)评分、角膜内皮细胞面积(ECA)均高于术前,泪膜破裂时间(BUT)、六角形细胞比例、角膜内皮细胞密度(ECD)均低于术前,但研究组BUT、六角形细胞比例、ECD均高于对照组,OSDI评分、ECA均低于对照组,差异均有统计学意义(P<0.05)。研究组并发症发生率为6.00%,低于对照组的16.67%,差异有统计学意义(P<0.05)。结论:硬核ARC患者给予小切口水平空间劈核术联合Toric IOL植入术治疗,能够改善视力水平,对患者泪膜功能、角膜内皮细胞指标产生的影响较小,还可提高生活质量,降低并发症发生率。

低倍镜补偿景深超声乳化手术和小切口白内障手术对比观察

目的:观察低倍镜补偿景深下超声乳化白内障摘除术和小切口白内障囊外摘除术的临床疗效。方法:回顾性分析869例1258眼白内障患者手术治疗的情况,其中采用超声乳化白内障摘除手术者共计247例432眼;采用小切口白内障摘除术者共计622例826眼,对患者的术后视力、角膜内皮计数、角膜水肿情况及并发症进行统计学分析。结果:两组患者术后1wk,1mo视力恢复情况和术后1d角膜水肿情况无统计学差异(P>0.05);角膜内皮计数损失小切口白内障摘除手术组较超声乳化白内障摘除组略好(P<0.05)。结论:基层医院手术显微镜景深不够清晰的情况下,仍可采用低倍镜补偿景深开展小切口白内障囊外摘除术和超声乳化白内障摘除术。

小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障

目的:探讨小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障的效果。方法:对小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障156例173眼的临床资料进行回顾性分析,术后随访12mo,对术后最佳矫正视力、瞳孔情况、人工晶状体情况、术中术后并发症情况进行观察随访分析。结果:术后最佳矫正视力≥0.05者143眼(82.7%),其中101眼(58.4%)≥0.3,术后视力大幅提高,其差异有显著统计学意义(χ2=169.17,P<0.01)。术中有11眼(6.4%)发生后囊破裂,均完成手术并植入人工晶状体。术后有9眼(5.2%)出现一过性眼压增高,经治疗后于术后1wk大多缓解;有29眼(16.8%)发生了角膜水肿,也于术后7d内恢复正常;前房炎性反应及前房积血情况也比较轻微,经治疗后于术后2～12d恢复正常。术后总共发现视网膜病变88眼(50.9%)。小瞳孔原因:糖尿病86例(55.1%),陈旧性葡萄膜炎39例(25.0%),陈旧性葡萄膜炎合并糖尿病者22例(14.1%),闭角型青光眼未手术长期点缩瞳药者5例(3.2%),不明原因瞳孔功能障碍4例(2.6%)。结论:小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障的疗效确切,安全性高,并发症少,尤其适合基层医院开展。术中关键是处理小瞳孔下的操作,术后影响视力的主要因素是原先存在的玻璃体视网膜病变,小瞳孔的原因主要是糖尿病及陈旧性葡萄膜炎。

小瞳孔下手法碎核人工晶状体植入治疗硬核白内障

目的:探讨采用巩膜隧道小切口手法碎核对小瞳孔硬核性白内障摘除折叠式人工晶状体植入术,观察患者术后临床效果。方法:作角膜缘后反眉弓5.5mm巩膜隧道切口,小瞳孔下采用晶状体硬核性手法碎核技术对70例70眼白内障摘除,并植入折叠式或PMMA人工晶状体,观察术后视力、散光程度以及并发症等情况。结果:患者70例70眼中术后1mo视力≥0.5者47眼(67%),0.8以上者17眼(24%),低于0.25者5眼(7%),术前及术后1d,1wk,1mo测得角膜平均散光分别为0.35±0.29,0.42±0.33,0.39±0.32,0.37±0.30D,术后各时间角膜散光之间无统计学意义(P>0.05)。术中后囊膜破裂4眼(6%),5眼前房出血(7%),术后角膜内皮水肿6眼(9%),虹膜后粘连5眼(7%),眼压增高3眼(4%),经对症治疗3～5d内消失,后囊膜混浊6眼(9%),经激光后囊膜打孔治疗恢复。结论:本结果提示小瞳孔反眉弓巩膜隧道小切口手法碎核人工晶状体植入术,克服了长期角膜缘大切口的弊端,最大限度减少了术后散光,提高手术成功率,不需特殊设备,简便易行,其效果可与超声乳化术媲美,可有效地减少术后角膜散光,早期获得良好的视力,降低手术费用。

小切口白内障摘出术和超声乳化白内障摘出术对角膜规则性的影响

背景白内障手术诱发干眼的发病机制除切口对角膜神经纤维的影响外，可能还与手术改变角膜的规则性有关。目的探讨手法小切口白内障摘出术与超声乳化白内障摘出术后角膜前表面规则性改变及泪膜和角膜散光的动态变化。方法采用前瞻性非随机病例对照研究设计。收集46例50眼年龄相关性白内障患者，其中30例30眼行小切口白内障摘出术，16例20眼行超声乳化白内障摘出术。于术前及术后1d、1周、1个月行角膜地形图检查，测量角膜不规则指数（CIM）、形状系数（SF）和散光值，对患者主观感觉进行评分，于术前及术后1周、1个月测量泪膜稳定性值、泪膜破裂时间（BUT）与基础泪液分泌试验I（SIt）值；分别行各组内、两组间参数比较。结果两组术眼CIM值随着手术前后时间的不同发生变化，术后CIM值均明显高于手术前，总体比较差异有统计学意义（F时间=22．864，P=0．000），其中术后1d、1周、1个月两组术眼CIM值明显高于术前，差异均有统计学意义（P〈0．01）；不同时间点两组间术眼CIM值比较差异无统计学意义（F分组=0．062，P=0．804）。两组术前及术后不同时间点、两组间sF比较差异均无统计学意义（F时间=4．600，P=0．428；F分组=0．009，P=0．925）。两组术眼随着术后时间的延长，BUT值逐渐降低，差异有统计学意义（F时间=39．384，P：0．000），术后1周、1个月各组BUT值较术前降低，差异均有统计学意义（均P=0．000），但各时间点两组间术眼BUT值的比较差异无统计学意义（F分组=0．000，P=0．983）。小切口组术眼手术后1周、1个月SI t值与术前比较差异均有统计学意义（P〈0．01）。两组术后1d、1周、1个月均存在手术源性散光（SIA），但随时间的推移，两组SIA值逐渐减小，差异有统计学意义（F时间=21．479，P=0．000），不同时间点两组间的SIA值比较差异有统计学意义（F分组=8．709，P=0．005）；其中术后各时间点超声乳化白内障摘出术组SIA值均明显低于小切口组，差异均有统计学意义（P〈0．01）。结论小切口白内障摘出术和超声乳化白内障摘出术术后早期，角膜前表面不规则性增加，泪膜稳定性下降，均可产生SIA。

小切口非超声乳化白内障摘除术中水压法与圈套器法娩核的疗效比较

目的:对比白内障小切口非超声乳化晶状体摘除手术中水压法娩核与圈套器法娩核两种方法的疗效及并发症。方法:白内障患者226例253眼随机分为水压法娩核与圈套器法娩核两组,观察两组不同方法治疗患者手术时间、术中术后并发症、术前与术后角膜内皮计数及黄斑区视网膜厚度变化的情况。结果:术中娩核平均时间:水压法娩核组5±0.79s,圈套器法娩核组4±1.23s;术中并发症:水压法娩核组少于圈套器法娩核组;术前与术后角膜内皮计数的差值两组相比有统计学差异;两组之间术后散光的差异无统计学意义;术前与术后黄斑区视网膜厚度差异两组相比无统计学差异。结论:同圈套器法娩核治疗白内障相比较,水压法娩核疗效好、简单易行、且能够减少并发症。

圈套器冲洗皮质法在小切口白内障手术中的应用

目的:探讨圈套器冲洗皮质法在小切口白内障手术中的应用价值。方法:对380例380眼白内障患者行小切口白内障手术,娩核后应用圈套器向前房及囊袋注水冲洗皮质,少量残余硬皮质应用圈套器托出切口外。结果:皮质冲洗干净,无1例使用圈套器冲洗皮质时致后囊破裂,对角膜内皮无明显损伤,术后第1d所有患者全部复明,脱盲率100%,脱残率达到90.0%,术后第3d脱残率达到93.2%。结论:应用圈套器冲洗皮质法安全、高效,特别是基层医院手术显微镜欠清晰及成熟期、过熟期白内障者尤为适宜。

颞侧巩膜手法小切口白内障摘出术治疗青光眼术后白内障

目的:探讨青光眼滤过术后行小切口白内障的手术方法及疗效。方法:采用颞侧巩膜隧道切口,对50例50眼青光眼术后白内障患者行小切口白内障囊外摘出联合人工晶状体植入术,术后观察视力、眼压、角膜曲率、滤过泡等情况。结果:随访3～12mo,所有患者视力较术前均有提高。眼压与术前基本相同,滤过泡形态无改变。术后1wk角膜曲率为0.75～1.25D,在术后3mo恢复到术前状态。未见明显并发症。结论:经颞侧巩膜手法小切口白内障摘出术是治疗青光眼术后白内障的有效方法。

小切口非超声乳化白内障手术四种娩核方式的对比观察

目的探讨小切口非超声乳化白内障手术中4种不同娩核方式的特点及疗效。方法选白内障患者200例(200只眼),随机分为4组,接受小切口非超声乳化白内障摘除联合人工晶状体植入术,分别通过黏弹剂娩核法、前房维持器娩核法、晶状体圈匙娩核法及前房内劈核法完成娩核过程,观察记录娩核时间、术后角膜水肿程度及术后视力。结果娩核时间(s):黏弹剂组:11±2,维持器组:17±2,圈匙组:24±3,劈核组:63±5,经方差分析及最小显著性差异法(least-significant difference,LSD)检验,各组间均有统计学差异(P=0.00);术后第1天角膜内皮水肿(≥2级)眼数(只)黏弹粘组:7(15%),维持器组:10(20%),圈匙组:19(40%),劈核组:38(75%),经检验,劈核组与黏弹粘组、维持器组以及圈匙组均存在统计学差异(Z=-7.477,-6.882,-4.294;P=0.00),黏弹剂组与圈匙组存在统计学差异(Z=-3.281;P=0.001)。术后第1天视力≥0.3的眼数(只):黏弹剂组:45(90%),维持器组:43(85%),圈匙组:33(65%),劈核组:13(25%),经检验,黏弹剂组优于圈匙组和劈核组(P=0.00),维持器组和圈匙组均优于劈核组(P=0.00)。结论在临床应用中,4种娩核方式各有特点。其中,黏弹剂娩核法、前房维持器娩核法因其操作简便,损伤小,术后视力恢复良好,值得临床推广。

手法小切口白内障手术对糖尿病白内障患者角膜变化的影响

目的手法小切口白内障手术(MSICS)对糖尿病白内障患者角膜内皮细胞和角膜厚度变化的影响。方法 60例2型糖尿病白内障患者60只眼睛(糖尿病组)以及60例年龄匹配的非糖尿病棕色白内障60只眼睛(对照组)接受MSICS。术前、术后1、6和12周采用非接触角膜内皮显微镜检测所有患者角膜内皮细胞及角膜中央厚度。并且评估角膜内皮细胞形态学和六角形细胞百分比变化。结果对照组术前平均角膜内皮细胞计数高于糖尿病组(P<0.05)。两组术后角膜内皮细胞均减少(单因素方差分析P<0.05)。糖尿病组术后角膜内皮细胞数的减少(14.19%,P<0.05)高于非糖尿病组(8.05%)。糖尿病组角膜中央厚度增加大于对照组(P<0.05)。糖尿病组六角形细胞百分比的变化大于对照组(P<0.05)。组间变异系数的差异无统计学意义(P<0.05)。结论与非糖尿病患者相比,糖尿病患者MSICS术后角膜内皮细胞损伤更多。建议糖尿病患者接受眼内手术前,对角膜内皮细胞进行评估。