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.

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.

New Management of Angle-closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective:To investigate the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL)implantation.Design:Retrospective,noncontrolled interventional case series.Participants:In36eyes with angle-closure glaucoma(ACG),there were18eyes with primary acute angle-closure glaucoma(PACG),14eyes with primary chronic angle-closure glaucoma(PCCG),3eyes with secondary acute angle-closure glaucoma(SACG)and 1eye with secondary chronic angle-closure glaucoma(SCCG).Intervention:Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures:Postoperative visual acuity,IOP,axial anterior chamber depth.Results:After a mean postoperative follow-up time of 8.81±7.45months,intraocular pressure was reduced from a preoperative mean of 23.81±17.84mmHg to a postoperative mean of 12.54±4.73mmHg(P=0.001).Mean anterior hamber depth was1.75±0.48mm preoperatively and2.29±0.38mm postoperatively(P=0.000).Best spectacle-corrected visual acuith in 36eyes ranged from0.01to0.7(20/200to20/30)postoperatively,which was better than preoperative VA ranging from hand movement to 0.4(20/50)(P=0.000).Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation can be a good alternative in treating angle-closure glaucoma,Eye Science 2000;16:22-28.

New Management of Malignant Glaucoma by Phacoemulsification with Posterior Chamber Foldable Intraocular Lens Implantation

Objective:To investigate the feasibility of phacoemulsification with posterior chamber foldable intraocular lens implantation in the management of malignant glaucoma. Patients and Methods:Fourteen patients with malignant glaucoma diagnosed in the Department of Glaucoma were enrolled in the study.12 patients developed malignant glaucoma after filtration surgery.1 developed after peripheral iridectomy.1 patient developed malignant glaucoma without any clear cause.Cataract phacoemulsification was performed.Posterior chamber intraocular foldable lens was implanted in 10 cases of patients.Results:All 14 patients were cured wiht normal intraocular pressure,normal anterior chamber depth and increased visual acuity.Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation is a good alternative in treating malignant glaucoma.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM:To determine the factors related to preoperative ocular characters that are predictive of insufficient vault(<250μm)after implantable collamer lens(ICL V4c;STAAR Surgical)implantation.METHODS:The participants underwent ICL surgery and were divided into the low(<250μm)and normal(250-1000μm)vault groups based on the postoperative vault at 3mo.The preoperative biometric parameters and clinical outcomes were compared between the two groups.The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.RESULTS:Sixteen(23 eyes)and 36 patients(63 eyes)were in the low and normal vault groups,respectively.All implantation procedures were uneventful with no cataract formation in the early postoperative period.The sulcusto-sulcus lens rise(STSL)and iris ciliary angle(ICA)were correlated with vault at 3mo after surgery.Every 0.1 mm increase in STSL was associated with 38.9μm decrease in the postoperative 3-month vault.A rise of 1 degree in ICA is associated with a reduction of 4μm in vault.CONCLUSION:Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation,suggesting a need for adjustments to the ICL size in these patients.Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

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.

Membrane Formation on the Surface of Implanted Posterior Chamber Intraocular Lenses

Purpose:To study the prevention and treatment of the membrane formation on the lens surface after extracapsular cataract extraction(ECCE)with posterior chamber intraocular lens(PCIOL)implantation.Methods:We reviewed the records of 312 cataractous patients that had undergone ECCEwith PCIOLimplantation between1989and1993,Postoperatively all pa-tients were examined under slit-lamp microscopy.The membrane formation on the surface of PCIOLin pupilar area was divided into four grades.Two mem-branes of surgical removal were observed under a transmission electrom mi-croscopy.One PCIOLof surgical removal was observed under a scanning electron microscopy.Results;Of312 patients,21 had the membrane formation on the surface of the PCIOL postoperatively.The incidence of the membrane formation was6.7%.Comparisone with cases of senile cataract showed the incidence to be significantly the highest among;1.patients who had traumatic cataract(P<0.05);2.pa-tients with complicated cataract(P<0.05).Interoperatively residual lens corten and rupture of posterior capsule,interval time betwwen the first and second eye operations less than 1month are the main factors of menbrane formation.The ultrastructure in membrane and cytology on the lens surface showed that the membrane on the surface of PCIOLs is usually composed of acellular protein film and cellular elements,including macrophages.fibroblast-like cells,epithelioid cells,giant cells,fibroblasts and collagen fibrils,etc.Conclusions:The cellular response on the surface of an implanted PCIOLis a chonic foreign-body inflammatory reaction and the membrane of the surfaceof implanted PCIOL is a reactive membrane of the foreign-body.Eye Science1995;11:131-135.

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.

Rhegmatogenous retinal detachment after intraocular lens implantation in high myopia:A case report and literature review

Objective:To observe the changes of diagnosis and treatment of a patient with rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation in high myopia,and analyze its mechanism and treatment combined with the literature.Methods:To report a case of rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation.Result:Two months after the patient underwent scleral cerclage+pad pressing+vitrectomy+silicone oil filling,the fundus color photos showed that the vitreous cavity was filled with silicone oil,the fundus retina was flat,the cerclage ridge was obvious,and a large number of old laser spots.After the silicone oil in the eye was removed,the eye examination:the naked visual acuity of the left eye was 0.12,the corrected visual acuity was-3.25ds/-1.50dc*180=0.4,the intraocular pressure was 19mmHg,the ring ridge was seen in the fundus after mydriasis,a large number of old laser spots and flat retina;The OCT showed that the macular structure of the left eye was complete and there was no subretinal fluid.Conclusion:Scleral cerclage+padding+vitrectomy+silicone oil filling is an effective treatment for retinal detachment(RD)after PIOL.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background:To evaluate the safety,efficacy,refractive outcomes and causes for bilensectomy(phakic intraocular lens–pIOL–explantation with cataract surgery and pseudophakic intraocular lens implantation)in patients previously implanted with posterior chamber pIOLs.Methods:This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months.The uncorrected and best corrected distance visual acuities(UDVA,CDVA),endothelial cell density before and after bilensectomy were assessed,as well as the cause of bilensectomy and intra or postoperative complications.Results:There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy(p=0.00).The main reason for bilensectomy was cataract development(93.1%of the cases),followed by miscalculation of lens size,and corneal edema.The endothelial cell count remained stable without a statistically significant change after surgery(p=0.67).The refractive efficacy index was 0.8,none of the patients lost lines of CDVA after surgery,73%of the patients were within±1 D(spherical equivalent)of the target refraction.Intraoperative complications were one posterior capsule rupture with the intraocular lens(IOL)implanted in the sulcus,and 3 eyes required the use of pupil expanders for adequate pupil dilation.Postoperatively,one eye developed retinal detachment.The three pIOLs models explanted were the Implantable Collamer Lens(ICL),Implantable Phakic Contact Lens(IPCL)and the Phakic Refractive Lens(PRL).Conclusions:Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses(PC pIOLs).There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background:To evaluate the safety,efficacy,refractive outcomes and causes for bilensectomy[phakic intraocular lens(plOL)explantation with cataract surgery and pseudophakic intraocular lens(IOL)implantation]in patients previously implanted with posterior chamber plOLs(PC plOLs).Methods:This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for PC plOL with a follow-up time of 12 months.The uncorrected and corrected distance visual acuities(UDVA,CDVA),endothelial cell density before and after bilensectomy were assessed,as well as the cause of bilensectomy and intra or postoperative complications.Results:There was a statistically significant improvement in UDVA and CDVA after bilensectomy(P=0.00).The main reason for bilensectomy was cataract development(93.1%of the cases),followed by miscalculation of lens size,and corneal edema.The endothelial cell count remained stable without a statistically significant change after surgery(P=0.67).The refractive efficacy index was 0.8,none of the patients lost lines of CDVA after surgery,73%of the patients were within±1.0D(spherical equivalent)of the target refraction.Intraoperative complications were one posterior capsule rupture with the IOL implanted in the sulcus,and three eyes required the use of pupil expanders for adequate pupil dilation.Postoperatively,one eye developed retinal detachment.The three plOLs models explanted were the implantable collamer lens(ICL);implantable phakic contact lens(IPCL)and the phakic refractive lens(PRL).Conclusions:Good safety and visual outcomes were observed one year after bilensectomy for PC plOLs.There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

高度近视有晶状体眼后房型人工晶状体植入术后患者视力恢复的影响因素

目的 探讨高度近视有晶状体眼后房型人工晶状体(ICL)植入术后患者视力恢复的影响因素。方法 前瞻性研究。选取2021年5月至2023年3月郑州大学第二附属医院收治的210例(420眼)行ICL植入术的高度近视患者作为研究对象。根据术后3个月视力恢复情况将患者分为恢复良好组(最佳矫正视力恢复≥0.3 D)、恢复不良组(最佳矫正视力恢复<0.3 D)。比较两组患者基线资料,采用Logistic回归分析影响患者视力恢复的因素,采用受试者工作特征曲线(ROC)分析Logistic回归模型对高度近视患者ICL植入术后视力恢复不良的预测价值。结果 术后3个月,恢复良好组的患者共149例298眼,恢复不良组的患者共61例122眼。两组患者性别、年龄、近视年限、体重指数、学业情况比较,差异均无统计学意义(均为P>0.05)。恢复不良组患者角膜散光度<1.30 D占比(55.74%)、角膜屈光度<45 D占比(59.02%)、匹茨堡睡眠质量指数(PSQI)<7分占比(63.93%)、中央平均曲率半径[(7.82±0.27) mm],均低于恢复良好组[83.89%、81.88%、85.91%及(7.90±0.24)mm],角膜前表面中央扁平子午线曲率(k1)[(43.27±1.43)D]、角膜前表面陡峭子午线曲率(k2)[(44.84±1.53)D]、拱高[(628.49±67.28)μm]均高于恢复良好组[(42.73±1.42)D、(44.12±1.47)D、(417.56±80.14)μm],差异均有统计学意义(均为P<0.05)。Logistic回归分析结果显示,角膜散光度、角膜屈光度、k1、k2、拱高、睡眠PSQI评分均为高度近视患者ICL植入术后患者视力恢复不良的独立影响因素(均为P<0.05)。ROC曲线分析显示,Logistic回归模型预测高度近视患者ICL植入术后视力恢复不良的ROC曲线下面积为0.938(95%CI:0.896~0.966),敏感度为83.61%,特异度为91.95%(P<0.05)。结论 角膜散光度、角膜屈光度、k1、k2、拱高、睡眠PSQI评分等均可影响高度近视ICL植入术后患者视力恢复,基于上述因素构建的Logistic回归模型对ICL植入术后患者视力恢复有较高预测价值。

超声乳化联合玻璃体腔抗VEGF注药术对后发性白内障预防价值分析

目的 分析白内障手术联合玻璃体腔抗血管内皮生长因子(VEGF)治疗对后发性白内障的影响。方法 采用回顾性临床队列研究,回顾性分析2020年1月至2021年3月就诊于苏州大学附属第三医院眼科行白内障手术的患者41例(54眼)。其中,试验组23例(27眼)行白内障超声乳化吸除+人工晶体植入联合玻璃体腔抗VEGF药物注射术;对照组18例(27眼)行单纯白内障超声乳化吸除+人工晶体植入术。所有患者术后随访24个月,比较两组患者术后最佳矫正视力、后发性白内障以及其他眼部并发症的发生情况。结果 术后24个月患者的最佳矫正视力均有不同程度的提高;试验组后发性白内障的发生率明显低于对照组,差异有统计学意义(P <0.05);仅有1例试验组患者出现术后一过性眼压升高,其余患者术后眼压均正常。结论 白内障超声乳化吸除+人工晶体植入联合玻璃体腔抗VEGF药物注射术安全可靠,并可有效降低后发性白内障的发生率。

分析超声乳化白内障吸除术联合IOL植入术后前房渗出发生率的相关影响因素

目的 研究分析在对白内障患者实施超声乳化白内障吸除术、人工晶状体(Intraocular Lens, IOL)植入术联合治疗后发生前房渗出的危险因素。方法 回顾性选取2020年5月—2023年5月在江苏省兴化市人民医院眼科接受超声乳化联合IOL植入术的82例白内障患者的临床资料,将术后发生前房渗出的42例患者与40例术后未发生前房渗出的患者分为研究组与对照组。在研究组与对照组患者中对其各项病历资料进行回顾性分析,分析白内障病例在联合手术后有前房渗出发生的危险因素。结果 在单因素分析中,研究组与对照组高度近视、葡萄膜炎、青光眼、术前眼压、晶状体核分级、术中晶状体后囊膜破裂、术中超声累积能量复合参数等比较差异有统计学意义(P均<0.05)。经多因素分析得出,高度近视、葡萄膜炎、青光眼、术前眼压、晶状体核分级、术中晶状体后囊膜破裂、术中超声累积能量复合参数是导致白内障患者在术后并发前房渗出的危险因素(OR=4.308、4.369、4.731、4.687、4.468、4.417、4.696,P均<0.05)。结论 白内障病例在接受超声乳化结合IOL植入手术后,受到高度近视、葡萄膜炎等因素的影响,易并发前房渗出。

Dynamic assessment of variations in pupil diameter using swept-source anterior segment optical coherence tomography after phakic collamer lens implantation

Purpose To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens(ICL,STAAR Surgical)with a central port.Methods This prospective,observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant.A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography(AS-OCT)device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery.Results Preoperative mean pupil size under photopic conditions was 3.38±0.64 mm;after surgery,this increased to 3.48±0.61 mm.Mean pupil size under scotopic light conditions was 5.72±0.79 mm before surgery and 5.84±0.77 mm postoperatively.The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10±0.44 mm(P=0.078)and 0.12±0.58 mm(P=0.098),respectively.The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes(60%).The mean central vault value was 412±177μm under maximum miosis and 506±190μm under maximum mydriasis.We found a positive correlation between vault and differences in pupil diameter under all light conditions(P<0.05).Conclusion Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane.The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

A novel ophthalmic viscosurgical devicefree phakic intraocular lens implantation makes myopic surgery safer

Purpose:To assess the efficacy and safety of a novel ophthalmic viscosurgical device-free(OVD-free)method for posterior chamber phakic intraocular lens(PIOL)implantation in myopic eyes.Methods:In this retrospective cohort study,the medical records of myopic eyes that underwent PIOL(Implantable Collamer Lens,ICL)implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed.A total of 49 eyes with complete data that met follow up requirements(2 h,1 day,1 week,3 months postoperatively)were recruited.Based on the surgical techniques used,the eyes were divided into the OVD-free method group and the standard method group.The clinical data,including intraocular pressure(IOP),corrected distance visual acuity(CDVA)and spherical equivalent(SE),at each follow-up were collected for comparison.Endothelial cell loss and complications were also investigated.Results:Twenty-one eyes received the standard method,and 28 eyes received the OVD-free method.A rise in IOP>22 mmHg at 2 h was noted in 14 eyes(66.7%)in the standard group and none(0%)in the OVD-free group(p<0.001).The rise in IOP from baseline was significantly higher at 2 h in the standard group(10.5±5.2 mmHg vs.2.2±3.3 mmHg,difference:8.3,95%CI 5.8 to 10.8;p<0.001).There was a significant difference in the time course of LogMAR CDVA changes between the two groups(p=0.047).The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day(−0.076,95%CI−0.134 to−0.018;p=0.012),1 week(−0.071,95%CI−0.135 to−0.007;p=0.03),but not at 3 months(−0.046,95%CI−0.107 to 0.015;p=0.134).There was no significant difference in the time course of SE changes between the two groups(p=0.471;p=0.705).In the OVD-free group,mean endothelial cell loss was 4.6%at 3 months(2522±281 vs.2407±226 cells/mm^(2),difference:-115,95%CI−295 to 65;p=0.187).No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.Conclusions:The OVD-free method is safe and efficient for ICL implantation.It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devicesrelated complications without causing additional complications.

Phakic 6H型有晶状体眼前房型人工晶状体植入矫正高度近视术后角膜内皮细胞密度临床观察

目的观察Phakic 6H型有晶状体眼前房型人工晶状体(ACP-IOL)植入矫正高度近视手术后远期角膜内皮细胞密度,并评价手术的安全性。方法收集2001年9月—2006年3月间行Phakic 6H型ACP-IOL植入术矫正高度近视患者共170例(283眼),经连续随访,对最终行ACP-IOL取出的7例(7眼)患者的临床资料进行回顾性分析。使用SP-2000P型角膜内皮显微镜定期测量角膜中央、上方、下方、颞侧及鼻侧5个方位的角膜内皮细胞密度。结果 7例患者平均随访时间为5年,6例平均角膜内皮细胞丢失数为2 105个/mm2,平均丢失率为73.71%(1例因角膜失代偿无法测量出内皮细胞密度)。4例行ACP-IOL取出+透明晶状体摘除+后房型人工晶状体(IOL)植入,1例行ACP-IOL取出+超声乳化白内障吸除+后房型IOL植入,2例行ACP-IOL取出。结论 Phakic 6H型ACP-IOL对角膜内皮的远期影响可致角膜内皮功能临界失代偿甚至失代偿,发现角膜内皮功能处于临界失代偿或内皮有明显损伤时须尽快取出ACP-IOL。