A novel p.R890C mutation in EPHA2 gene associated with progressive childhood posterior cataract in a Chinese family

AIM:To identify the genetic defect in a Chinese family with bilateral progressive childhood posterior cataract. METHODS:A two-generation family was recruited in this study. Family history and clinical data were recorded. All reported candidate genes associated with congenital posterior cataract were screened by direct DNA sequencing. ·RESULTS:All affected individuals presented posterior opacities in the lens. Direct sequencing of the candidate genes showed a heterozygous c. 2668C 】T variation in EPHA2 gene, which resulted in the replacement of arginine by cysteine at codon 890 (p. R890C). This mutation was found in two affected individuals, but was not observed in 200 normal controls. ·CONCLUSION:We report a novel mutation (p. R890C) in the EPHA2 receptor tyrosine kinase gene. The finding expands the mutation spectrum of EPHA2 in association with posterior cataract.

Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Background: Cataract surgery is the most frequently performed surgery worldwide. Posterior capsule rupture (PCR) remains one of the most common complications of cataract surgery and a major risk factor for poor visual outcomes. Cataract surgeries complicated by PCR and vitreous loss are managed with anterior vitrectomy at the time of surgery. However, the situation can be further complicated by dropping lens particles into the vitreous cavity necessitating a secondary pars plana vitrectomy (PPV). Purpose: To compare the visual outcomes and risk of rhegmatogenous retinal detachment (RRD) between eyes that required anterior vitrectomy (AV) alone for the management of vitreous loss and eyes that required AV and subsequent PPV for the management of dropped nuclear lens fragments (DNLF) following cataract surgery complicated by PCR in a tertiary care teaching hospital in Saudi Arabia. Methods: Medical records of patients in whom PCR occurred during phacoemulsification cataract surgery requiring AV or subsequent PPV for DNLF were retrospectively reviewed over a 6-year period from January 2016 to December 2021. Results: PCR occurred in 183 (2.3%) of 7757 consecutive eyes that underwent phacoemulsification cataract surgery during the study period. Seven eyes were excluded from analysis for missing data or short follow-up. Of the 176 eyes, 147 eyes (83.5%) were managed with AV alone, and the remaining 29 eyes (16.5%) underwent a secondary PPV for DNLF. After excluding eyes with pre-existing ocular pathology, final best-corrected visual acuity (BCVA) was similar in both groups with a mean of 0.32 logMAR (P = 0.99). Two of 147 eyes (1.4%) in the AV group developed RRD with poor final BCVA whereas none of the eyes in DNLF group developed RRD. Conclusion: The risk of RRD is lower in eyes that required PPV for DNLF than in eyes that were managed with AV alone following PCR during cataract surgery. The poor visual outcomes in eyes that suffered RRD underscore the importance of postoperative retinal examination and early detection of retinal breaks.

Visual outcomes of surgical and conservative treatment in children with small posterior polar cataracts and posterior lenticonus

AIM:To compare the visual outcomes of children with small(≤3 mm)posterior polar cataracts(PPC)and posterior lenticonus who had cataract extraction surgery with the visual outcomes of those who were managed conservatively.METHODS:Children who initially had small PPC and posterior lenticonus who were followed up over 1-year period were retrospective reviewed in the study.Patients receiving surgery were compared with those receiving conservative therapy.The axial length,keratometry,refraction,bestcorrected visual acuity(BCVA),and strabismus measurements were recorded.Lens morphology,i.e.,the location,size,and depth of the cataract lesion,was measured with a Scheimpflug imaging system.To help control for baseline differences in the groups,patients were matched with controls by propensity score methodology.RESULTS:The study evaluated 60 patients(30 in the surgery group and 30 in the conservative therapy group)after matching by propensity score.Patients who underwent cataract surgery showed greater BCVA improvements(0.36±0.24 logMAR)than patients who were treated without surgery(0.22±0.26 logMAR;P=0.036).Surgery was effective in patients with a rear projection length(RPL)less than 1.0 mm and a pretreatment BCVA worse than 0.52 logMAR.CONCLUSION:Children with small PPC and posterior lenticonus who undergo cataract surgery experience greater BCVA improvements than those managed conservatively.Certain patients presenting with a RPL less than 1.0 mm and a pretreatment BCVA of 0.52 logMAR or worse may benefit from surgery.

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

Posterior Polar Cataract and Its Management

Although cataract surgery in posterior polar cataract is associated with posterior capsular rent and nucleus drop, by taking precautions the rate of complication can be decreased. The aim of this article is to review the etiology, pathogenesis, clinical features, and management of posterior polar cataract.

Effect of the posterior corneal surface on total corneal astigmatism in patients with age-related cataract

AIM： To explore the effect of the posterior astigmatism on total corneal astigmatism and evaluate the error caused by substituting the corneal astigmatism of the simulated keratometriy （simulated K） for the total corneal astigmatism in age-related cataract patients. METHODS： A total of 211 eyes with age-related cataract from 164 patients （mean age： 66.8±9.0y, range： 45-83y） were examined using a multi-colored spot reflection topographer, and the total corneal astigmatism was measured. The power vector components J0 and J45 were analyzed. Correlations between the magnitude difference of the simulated K and total cornea astigmatism （magnitude differenceSimK-Tca）, anterior J0, and absolute meridian difference （AMD） between the anterior and posterior astigmatisms were calculated. To compare the astigmatism of the simulated K and total cornea both in magnitude and axial orientation, we drew double-angle plots and calculated the vector difference between the two measures using vector analysis. A corrective regression formula was used to adjust the magnitude of the simulated K astigmatism to approach that of the total cornea. RESULTS： The magnitude differenceSimK-Tca was positively correlated with the anterior corneal J0 （Spearman’s rho= 0.539; P〈0.001） and negatively correlated with the AMDR （Spearman’s rho=-0.875, P〈0.001）. When the anterior J0 value was larger than 1.3 D or smaller than -0.8 D, the errors caused by determining the total corneal astigmatism with the karatometric calculation tended to be greater than 0.25 D. An underestimation by 16% was observed for against the rule （ATR） astigmatism and an overestimation by 9% was observed for with the rule （WTR） astigmatism when ignoring the posterior measurements. CONCLUSION： Posterior corneal astigmatism should be valued for more precise corneal astigmatism management, especially for higher ATR astigmatism of the anterior corneal surface. We suggest a 9% reduction in the magnitude of the simulated K in eyes with WTR astigmatism, and a 16% addition of the magnitude of the simulated K in eyes with ATR astigmatism.

Posterior Chamber IOL Implantation in Traumatic Cataract with Injured Complications

Twenty-five cases of posterior chamber IOL implantation intraumatic cataract with complications associated with primary injury werereported.The operating methods were described and the post-operative com-plications were discussed.Seventy-two percent of patients have the correctvision over 20/40.It is suggested that the posterior chamber IOL can be im-planted in traumatic cataract with some injured complications.EYE SCIENCE1992;8:111-112.

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.

后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响

目的探究后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响。方法57例(63眼)行白内障超声乳化联合人工晶状体植入术的白内障伴高度近视患者根据是否存在后巩膜葡萄肿分研究组(26例共28眼,合并后巩膜葡萄肿)和对照组(31例共35眼,单纯白内障伴高度近视)。对比两组术前眼轴,术后3个月眼轴、中轴区晶状体后囊膜至视网膜距离、前房深度、角膜曲率、最佳矫正视力(BCAV)、平均绝对屈光误差(MAE)、人工晶状体囊袋偏心量及倾斜角。结果研究组术前及术后3个月眼轴长度、术后3个月BCAV、裸眼视力数值(logMAR)、MAE、水平及垂直方向的倾斜角、前房深度均高于对照组(P<0.01或0.05)。结论高度近视合并巩膜葡萄肿患者行白内障手术时应关注人工晶状体的稳定性。

后视路病变引起的神经系统损伤的特点分析

目的分析白内障术后确诊为后视路病变的临床特点。方法回顾性分析郑州大学第一附属医院2018-12—2023-01收治的35例白内障手术后因视力恢复欠佳而进一步诊断后视路病变患者的临床资料,对其白内障术前相关因素、临床表现及术后视路疾病进行统计分析。结果12例确诊为后视路疾病,其中10例患者(83.33%)视力不稳定,10例(83.33%)伴发头痛,11例(91.67%)视野缺损,1例(8.33%)多尿;6例(50.00%)诊断为颅咽管肿瘤,4例(33.33%)诊断为神经胶质瘤,2例(16.67%)诊断为枕叶区脑梗死,1例(8.33%)诊断为枕叶区脑出血。患者集合反射、视野缺损和眼外神经症状的发生与后视路疾病具有相关性(P<0.05)。结论白内障患者出现视力与眼部体征不相符,同时伴有视野受损及眼部以外体征等临床表现时要考虑后视路疾病的可能。

术前HbA1c水平对糖尿病患者白内障超声乳化术后后囊膜混浊的影响及阈值效应分析

目的:分析术前糖化血红蛋白(HbA1c)水平对糖尿病患者白内障超声乳化术后后囊膜混浊(PCO)的预测价值及阈值效应。方法:回顾性研究。收集2018-09/2020-09于本院就诊的糖尿病合并白内障患者106例106眼,根据患者术后36 mo是否发生PCO分为PCO组52例52眼和非PCO组54例54眼。分析患者术后发生PCO的影响因素。对患者术前HbA1c水平与患者术后发生PCO的发生情况进行阈值效应分析。采用受试工作者特征(ROC)曲线评估术前HbA1c水平对患者术后发生PCO的预测价值。构建预测模型,采用Bootstrap重采样对预测模型进行验证,并对模型的区分度和准确度进行评价。结果:两组患者糖尿病病程、有无糖尿病视网膜病变、空腹血糖、餐后2 h血糖、术前HbA1c、眼轴长度、核硬度分级均有差异(P<0.05)。糖尿病病程≥12 a、有DR、空腹血糖≥8 mmol/L、餐后2 h血糖≥12 mmol/L、术前HbA1c≥7%、眼轴长度≥30 mm、核硬度分级Ⅲ级及以上均为影响患者术后发生PCO的因素(P<0.05)。曲线拟合发现随着HbA1c水平的升高,糖尿病患者白内障超声乳化术后发生PCO的概率呈现上升趋势。阈值效应分析发现,当HbA1c≥7%时,术后PCO的发生率随着HbA1c水平的增加而升高。敏感性分析显示E值=2.129。术前HbA1c与糖尿病患者白内障超声乳化术后发生PCO程度的关联效应分析结果显示,调整后术前HbA1c水平是糖尿病患者术后发生PCO不同程度混浊的影响因素,存在独立相关性(OR=1.65,95%CI:1.42-1.76,P=0.021)。当预测模型P=0.6时,模型预测准确度为88.51%,敏感度和特异度分别为86.33%和86.82%,表示糖尿病白内障患者出现PCO的结局。结论:糖尿病病程、有DR、空腹血糖、餐后2 h血糖、术前HbA1c、眼轴长度、核硬度分级是影响糖尿病患者白内障超声乳化术后发生PCO的因素,且术前HbA1c可作为评估患者术后发生PCO的敏感指标。

Hydrophobic versus hydrophilic acrylic intraocular lens on posterior capsule opacification: a Meta-analysis

AIM: To conduct a Meta-analysis pooling randomized controlled trials(RCTs) to compare hydrophobic with hydrophilic acrylic intraocular lenses in terms of posterior capsule opacification(PCO) development.METHODS: Electronic databases including PubMed,Embase, and the Cochrane Library were queried from their starting till January 2020. RCTs investigating the impact of hydrophobic versus hydrophilic acrylic intraocular lenses on PCO were considered eligible in this study. The pooled effect estimates were calculated using the random-effects model.RESULTS: Thirteen RCTs comprising of 939 patients(1263 eyes) were covered in this study. Patients with hydrophobic acrylic intraocular lenses had a lower PCO score than those with a hydrophilic acrylic intraocular lenses [standard mean difference:-1.80;95% confidence interval(CI):-2.62 to-0.98;P<0.001]. Moreover, the frequency of neodymium-doped yttrium aluminum garnet(Nd:YAG)capsulotomy in patients with hydrophobic acrylic intraocular lenses was significantly lower than patients with hydrophilic acrylic intraocular lenses(relative risk: 0.38;95%CI: 0.20-0.71;P=0.003).CONCLUSION: These findings suggest that hydrophobic acrylic intraocular lenses are superior to hydrophilic acrylic intraocular lenses in patients after cataract surgery due to lower PCO score and reduced Nd:YAG capsulotomy. While similar studies are conducted by other researchers, the present study conducted subgroup analyses that show superior results with hydrophobic lenses in trials conducted in western countries.

3D CT眼球重建技术用于评估高度近视白内障眼球形态和人工晶状体度数预测精确度的研究

目的探索3D CT眼球重建技术在评估高度近视白内障眼球形态和人工晶状体(IOL)度数预测精确度的应用。方法收集2021年8—12月行白内障超声乳化吸除联合IOL植入术的高度近视患者,眼轴长度(AL)≥26.5 mm,共计52例(52眼),随访1个月。完善眼眶薄层CT(扫描层厚0.3 mm),记录眼底黄斑萎缩、牵引、新生血管病变(ATN)分级,比较术后最佳矫正视力(BCVA)和屈光度平均绝对误差(MAE),分析不同类型后巩膜葡萄肿的眼球形态之间的差异。利用SPSS 20.0对数据进行统计分析,P<0.05为差异有统计学意义。结果高度近视眼3D CT眼球形态分类如下:球形8眼(15.4%)、椭球形4眼(7.7%)、锥形13眼(25%)、鼻侧扭曲形12眼(23.1%)、颞侧扭曲形7眼(13.5%)、桶形8眼(15.4%)。在年龄<60岁患者组中,球形8眼(25.0%)、锥形8眼(25.0%),比例最高,椭球形1眼(3.1%)、颞侧扭曲形4眼(10.5%),比例最低;在年龄≥60岁患者组中,没有球形眼球,而锥形5眼(25%)和鼻侧扭曲形7眼(35%),比例最高,提示随着年龄增加,后巩膜葡萄肿出现比例增加,差异有统计学意义(P<0.001)。同时,当AL<28 mm时,球形眼球7眼(38.9%),比例最高;而当AL≥30 mm时,没有球形眼球,锥形6眼(26.1%)、颞侧扭曲形5眼(21.7%)和桶形5眼(21.7%),比例增加,提示随着AL增加,后巩膜葡萄肿发生率增加,并且容易出现黄斑区的葡萄肿,差异有统计学意义(P<0.001)。无后巩膜葡萄肿的球形眼球患者白内障术后有87.5%的患者BCVA达到20/40及以上,而伴有后巩膜葡萄肿者视力预后不佳,尤其锥形有6眼(46.2%)和颞侧扭曲有3眼(42.9%)的BCVA<20/40,差异有统计学意义(χ^(2)=46.755,P<0.001)。高度近视黄斑ATN分级提示,锥形、颞侧扭曲和桶形眼球的眼底病变更加明显,分级更高。高度近视眼中有30眼(57.7%)白内障术后MAE<0.5 D,其中椭球形、锥形和颞侧扭曲形眼球IOL度数预测准确性最差,仅有25%、53.9%和37.5%眼MAE<0.5 D;球形和鼻侧扭曲形眼球预测性最好,有75%眼MAE<0.5 D,差异有统计学意义(χ^(2)=80.035,P<0.001)。结论高度近视眼轴越长,越容易出现眼球畸形。其中,锥形、颞侧扭曲和桶形等眼球往往伴有严重的近视黄斑病变,白内障术后的视力预后也不佳。球形和鼻侧扭曲形眼球,白内障术中IOL度数预测性更佳,可能与后巩膜葡萄肿位置远离黄斑区域,从而生物测量更加准确有关。

视网膜色素变性并发白内障的临床表现与中性粒细胞/淋巴细胞计数比值的相关性

目的:评估视网膜色素变性(RP)并发白内障患者中性粒细胞与淋巴细胞计数比值(NLR),探讨其与RP并发白内障临床特征的相关性。方法:回顾性研究。纳入2008-01/2018-12在我院接受白内障摘除手术的RP并发白内障患者79例125眼,排除发病年龄较早的RP并发白内障患者选取其中63例63眼纳入RP并发白内障组,另选取年龄、性别相匹配、同期行白内障摘除手术的年龄相关性白内障(ARC)患者63例63眼纳入ARC组。收集患者的临床资料及NLR值,分析RP并发白内障患者的临床表现与NLR相关性。结果:RP并发白内障组患者NLR显著高于ARC组[1.79(1.32,2.27)vs 1.58(1.32,1.98),P=0.032]。NLR与后囊下白内障(PSC)严重程度、悬韧带薄弱程度、术前最佳矫正视力(>1LogMAR)相关。接收者操作特征(ROC)曲线分析显示,NLR≥1.36可预测RP并发较严重的PSC(>P1)(AUC=0.803,95%CI 0.672-0.934,P=0.002),NLR≥2.12可以预测RP并发白内障患者悬韧带薄弱(AUC=0.796,95%CI 0.665-0.928,P=0.002),NLR≥1.51可以预测术前较差的BCVA(AUC=0.667,95%CI 0.540-0.793,P=0.015)。结论:RP并发白内障患者NLR明显高于ARC患者,且与RP并发白内障临床表现存在相关性。NLR可作为评估RP并发白内障临床表现严重程度的潜在预测指标。

人工晶状体作为药物递送系统的研究进展

人工晶状体(intraocular lenses)作为一种给药装置,具有在白内障术后替代常规滴眼液等治疗的应用前景,从而可能用于术后眼部感染、眼内炎症和后囊浑浊等的预防和治疗。载药人工晶状体(drug-loaded intraocular lenses)的优点是能确保药物的持续输送,不受患者依从性的影响,且手术植入后无需采取任何其他措施。本综述总结了以人工晶状体作为药物递送系统的研究进展,分析了载药人工晶状体的载药策略、负载药物类型、以及临床研究现状,有助于更深入理解该领域的最新进展,并为一些眼部疾病如眼内炎和白内障术后并发症等的治疗提供策略和依据。

角膜后前表面曲率半径比值的临床研究

目的分析白内障患者的术前角膜后前表面曲率半径比值(B/F ratio)的分布特点及其与眼内生物参数的相关性。为优化常规白内障人工晶体(IOL)计算公式和角膜屈光术后IOL计算公式提供有用的信息。方法将169名白内障患者的182只眼纳入了研究,对其术前的Pentacam眼前节分析仪和IOLMaster的检查结果进行统计分析,并计算出每只眼的矫正角膜折射指数。结果本研究人群B/FRatio均值为(82.04±1.68)%,与年龄(r_(p)=0.313,P<0.001)、角膜屈光度(Kp,r_(p)=0.567,P<0.001)、角膜后表面曲率半径(R^(2),r_(p)=0.566,P<0.001)成正相关。矫正角膜屈光指数(N)为1.3229~1.3306(1.3282±0.0010)。结论本研究样本的B/FRatio值、N,与国内外同类研究结果接近,比Gullstrand模型眼的B/FRatio值、N小。当白内障患眼B/FRatio较低时,需要考虑使用特殊的IOL屈光力计算公式。

白内障超声乳化术中前囊膜抛光预防患者后囊膜混浊的运用价值评估

目的分析应用前囊膜抛光对白内障超声乳化术后后囊膜混浊进行预防的作用。方法随机选取2021年1月—2023年8月漳州市第三医院收治的190例白内障超声乳化术患者为研究对象,按照术中有无实施前囊膜抛光治疗将患者分为两组,研究组100例患者(100眼)术中进行前囊膜抛光治疗,对照组90例患者(90眼)经过常规后囊膜抛光处理后,将人工晶状体置入,并没有进行前囊膜抛光处理。比较两组对视力分布情况、后囊膜混浊发生情况。结果术后,研究组的视力分布情况均明显优于对照组,差异有统计学意义(P均<0.05)。术后6、12个月,研究组后囊膜混浊发生率分别为10.0%、15.0%,对照组分别为22.22%、27.78%,两组比较,差异有统计学意义(χ^(2)=5.322、4.653,P均<0.05)。结论白内障患者在接受白内障超声乳化术治疗时,术后开展前囊膜抛光治疗不但显著改善患者视力,而且能有效预防术后囊膜混浊。

Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children

AIMTo compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children.METHODSRetrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61&#x000b1;2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded.RESULTSThe surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted.CONCLUSIONPars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.

A new technique for Nd:YAG laser posterior capsulotomy

AIM:To investigate the effects of a new opening pattern in neodymium:yttrium-aluminum-garnet(Nd:YAG)laser posterior capsulotomy on visual function.METHODS:This technique was conducted along a circular pattern.The energy ranged between 0.8 and1.2 mJ/pulse was consumed and mean total energy levels were 74±21 mJ(mean±standard deviation:SD,from 40 to167)and laser shots aimed at 150μm away behind a datum point and went along an imaginary line which extends 0.5 mm inside from optic margin and into the circular en bloc pattern.Vitreous stands were attached with fragment and then they were cut off by the laser after circular application.The circular fragment was completely separated from vitreous,and then this fragment was quickly sunk in intravitreal space.RESULTS:The follow-up period ranges from at least a week to 40mo,making 15.8mo on average.The procedural outcome showed 96%(74 eyes out of the 77eyes)enhancement in patients’visual acuity.Cystoid macular edema or retinal detachment was not observed in any of the patients during follow-up periods.CONCLUSION:This new technique is expected to improve the weaknesses that the conventional procedures have by adding the process to cut off vitreous stands attached with the fragment by the laser to the circular application.

Bilateral hypocalcaemic cataracts due to idiopathic parathyroid insufficiency:A case report

BACKGROUND Hypoparathyroidism is uncommon,and cataracts secondary to hypoparathyroidism are even rarer.Herein,we report a case of bilateral cataracts following hypoparathyroidism.CASE SUMMARY A 27-year-old man presented to our hospital because of painless and progressive visual impairment of both eyes over two years.He was previously diagnosed with hypocalcemia but did not take calcium supplements regularly.He had no history of anterior neck thyroid surgery.After admission,the biochemical analysis indicated a serum calcium level of 1.21 mmol/L and an intact parathyroid hormone level of 0 pg/mL.Ocular examination revealed bilateral symmetrical opacity of the lens presenting as punctate opacity in the posterior subcapsular cortex together with radial opacity in the peripheral cortex(N1C2P3).Phacoemulsification with an intraocular lens was performed in both eyes sequentially.Postoperatively,the patient had a satisfactory recovery and greatly improved visual acuity.CONCLUSION This patient had hypocalcemia owing to idiopathic parathyroid insufficiency.Hypoparathyroidism may go unnoticed for years but with some latent clinical manifestations,such as bilateral symmetrical posterior subcapsular cataracts.This case report highlights that the cause of hypocalcemia in particularly young patients should be further investigated.Clinicians should be aware of hypoparathyroidism as a cause of bilateral cataracts.Early identification of hypoparathyroidism can save patients from further complications.