Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

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.

Evaluating newer generation intraocular lens calculation formulas in manual versus femtosecond laser-assisted cataract surgery

AIM:To determine the refractive accuracy of the Haigis,Barrett Universal II(Barrett),and Hill-radial basis function 2.0(Hill-RBF)intraocular lens(IOL)power calculations formulas in eyes undergoing manual cataract surgery(MCS)and refractive femtosecond laser-assisted cataract surgery(Re LACS).METHODS:This was a REB-approved,retrospective interventional comparative case series of 158 eyes of 158 patients who had preoperative biometry completed using the IOL Master 700 and underwent implantation of a Tecnis IOL following uncomplicated cataract surgery using either MCS or ReLACS.Target spherical equivalence(SE)was predicted using the Haigis,Barrett,and Hill-RBF formulas.An older generation formula(Hoffer Q)was included in the analysis.Mean refractive error(ME)was calculated one month postoperatively.The lens factors of all formulas were retrospectively optimized to set the ME to 0 for each formula across all eyes.The median absolute errors(MedAE)and the proportion of eyes achieving an absolute error(AE)within 0.5 diopters(D)were compared between the two formulas among MCS and ReLACS eyes,respectively.RESULTS:Of the 158 eyes studied,64 eyes underwent MCS and 94 eyes underwent ReLACS.Among MCS eyes,the MedAE did not differ between the formulas(P=0.59),however among ReLACS eyes,Barrett and Hill-RBF were more accurate(P=0.001).Barrett and Hill-RBF were both more likely to yield AE<0.5 D among both groups(P<0.001).CONCLUSION:The Barrett and Hill-RBF formula lead to greater refractive accuracy and likelihood of refractive success when compare to Haigis in eyes undergoing Re LACS.

Application of Foldable Intraocular Lens in Multiple Types of Cataract

Objective: To evaluate the clinical results of implantation of foldable intraocular lens inmultiple types of cataract.Methods: This retrospective study comprised 162 eyes of 148 patients undergoingphacoemulsification and implantation of foldable intraocular lens, some of whom under-went combined pars plana vitrectomy or trabeculectomy or silicone oil removal. Theperiod of follow-up was from 3 months to 17 months.Results: There is slight reaction postoperatively in all cases. The postoperative uncorrectedvisual acuites was from 0. 05 to 1.2, patient with 0.6 or above acuity were 70.98%. Aneodymium: YAG capsulotomy was required in 5 eyes. Posterior capsule ruptured in 1eyes, and a PMMA intraocular lens was implanted in ciliary sulcus. In one eye, a lenswas removed because of recurrence of retina detachment.Conclusions: The application of foldable intraocular lens in multiple types of cataract issafe, and there is a slight postoperative reaction. less complications , and fast visualacuity recovery.

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.

Comparison of visual quality after implantation of Al-UV and SN60WF aspheric intraocular lens

AIM:To compare the visual performance of pseudophakic eyes implanted with Al-UV and SN60WF aspheric intraocular lens(IOL),and to investigate the correlations between visual quality parameters and pupil size.METHODS:This prospective comparative study included 105 eyes of 90 patients with age-related cataract who underwent uneventful phacoemulsification.The subjects were divided into two groups according to the implanted IOL type.Three months postoperatively,visual acuity and contrast sensitivity were measured,wave-front aberrations were assessed using a KR-IW aberrometer(Topcon),and objective optical quality parameters were performed using an optical quality analysis system-OQAS Il(Visiometrics).Independent sample Mest and Spearman correlation analysis were used for data analysis.RESULTS:There were no significant differences found in visual acuity,contrast sensitivity and visual quality parameters between the two groups(P>0.05).The measured intraocular spherical aberration(SA)in Al-UV IOL eyes of-0.19±0.05 pm was close to the designed SA value of-0.20 pm.The modulation transfer function cutoff,Strehl ratio and OQAS values were negatively correlated with pupil size in both groups(P<0.01).CONCLUSION:The subjective and objective visual quality in pseudophakic eyes with A1-UV and SN60WF IOLs are comparable.For aspheric IOL eyes,visual quality decreases with increasing pupil size.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM:To assess the early surgical outcomes of quickchop phacoemulsification technique in patients with high myopia.METHODS:The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens(IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk,1mo. Early postoperative best corrected visual acuity(BCVA), preoperative and postoperative corneal endothelial cell density(ECD), central corneal thickness(CCT) and postoperative complications were assessed.Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.· RESULTS:There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.· CONCLUSION:Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia

Purpose: To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens(IOL) in patients diagnosed with high myopia complicated with cataract.Methods:.This was a randomized prospective control study.The patients with high myopia complicated with cataract, with axial length ≥28 mm,.and corneal astigmatism ≤1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation..At 3 months after surgery,.intraocular high-order aberration was measured by a Tracey-i Trace wavefront aberrometer at a pupil diameter of 5mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Pentacam three-dimensional anterior segment analyzer..The tilt and decentration of the IOL were calculated by Image-pro plus 6.0imaging analysis software and statistically compared between two groups.Results:.In total,.127 patients(127 eyes),..including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group(59 eyes)were significantly higher compared with those in the Big Bag(P <0.05)..The clover and spherical aberration did not differ between the two groups(P>0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group(both P<0.05), whereas the tilt of IOL did not significantly differ between the two groups(P>0.05).Conclusion:.Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM:To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens(IOL)in eyes with low degrees of corneal astigmatism.METHODS:Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL(FineVision PODFT,PhysIOL s.a.,Liege,Belgium)were enrolled.Phacoemulsification with femtosecond laser,capsular tension ring insertion and intraoperative aberrometry were performed in all cases.All IOLs used showed a cylinder power of 1.00 D.Main outcome measures were refractive error and corrected-distance visual acuity(CDVA)and uncorrected-distance visual acuity(UDVA)values.Eyes were evaluated at 4 mo post-surgery.RESULTS:Totally 50%of eyes showed a spherical equivalent(SE)within±0.13 D and all of them within±0.50 D.The mean SE and refractive cylinder were-0.02±0.23 and-0.16±0.22 D,respectively.Vector analysis revealed that 100%of eyes were within±0.50 D for the SE and cylindrical components(J0 and J45).Refractive changes were not correlated with keratometric changes(P>0.05)showing that the reduction in astigmatism comes from the trifocal toric IOL.Of 81%and 96%of eyes showed UDVA and CDVA of 20/20,respectively.The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02(about 20/20),respectively.CONCLUSION:Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens(IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.

超声乳化人工晶状体植入术对高度近视白内障患者的疗效

目的:分析超声乳化人工晶状体植入术对高度近视白内障患者的疗效。方法:选取2020年1月至2023年1月收治的86例患者分组手术,试验组采用超声乳化联合人工晶状体植入,常规组采用白内障囊外摘除联合人工晶状体植入,比较两组手术耗时及术后多项指标。结果:试验组手术时间低于常规组(P<0.05);术后,试验组BCVA和裸眼远视力改善,前房深度及容积、ECD、BUT、6A及视觉质量评分均较高,CV较低(P<0.05);术后两组并发症发生率无显著差异(P>0.05)。结论:超声乳化人工晶状体植入术较囊外摘除术手术时间更短,术后视功能、眼前节参数和视觉质量改善更显著,安全性高,值得推广。

超声乳化人工晶状体植入术对高度近视白内障患者的治疗效果观察

目的:分析超声乳化人工晶状体植入术对高度近视白内障患者的治疗效果.方法:选取2020年10月至2023年2月106例高度近视白内障患者作为研究对象.随机将患者分成对照组和观察组,每组各53例.对照组采用白内障囊外摘除人工晶状体植入术;观察组采用超声乳化人工晶状体植入术.分析比较两组的最佳矫正视力(Best corrected visual acuity,BCVA)、黄斑中心凹厚度、眼前节参数、角膜内皮功能及并发症.结果:术后6 m,观察组BCVA高于对照组,黄斑中心凹厚度低于对照组(P<0.05);观察组眼压(Intraocular pressure,IOP)低于对照组,而前房深度(Anterior chamber depth,ACD)、前房容量(Anterior chamber volume,ACV)高于对照组(P<0.05).术后6 m观察组角膜厚度(Central corneal thickness,CCT)、角膜内皮细胞计数(Corneal endothelial cell,CEC)高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05).结论:超声乳化人工晶状体植入术治疗高度近视白内障患者,能改善BCVA、黄斑中心凹厚度以及眼前节参数,提升角膜内皮功能,减少并发症.

PEI联合术中房角镜下房角分离及房角切开术治疗中晚期PACG合并白内障

目的:评价超声乳化白内障吸除人工晶状体植入术(PEI)联合术中房角镜直视下房角分离术(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)合并白内障的效果。方法:回顾性病例系列研究方法。收集2021-12-01/2023-03-31在安徽医科大学第二附属医院手术的中晚期PACG合并白内障患者62例65眼,根据手术方式不同分为两组:观察组30例32眼行PEI+GSL+GT,对照组32例33眼行PEI+GSL。评估两组患者术前,术后1 d, 1 wk, 1、3、6 mo眼压、最佳矫正视力(BCVA)和抗青光眼药物使用数量。术前和术后6 mo时分别评估视野、杯盘比、前房角开放范围、前房深度、RNFL平均厚度。结果:PEI+GSL+GT组术后6 mo眼压和平均眼压降幅(16.68±2.65、11.12±8.53 mmHg)与PEI+GSL组(18.71±2.51、8.32±4.17 mmHg)有显著差异(P<0.05),眼压降幅率无差异(44.57%±21.79%和35.20%±17.94%,P>0.05)。术后6 mo两组抗青光眼药物使用数量、BCVA、前房深度、房角关闭范围均较术前改善(均P<0.01),PEI+GSL+GT组术后6 mo的药物减少数量和房角开放范围均大于PEI+GSL组(P<0.05),其余指标两组间比较均无差异(均P>0.05)。两组术后6 mo的视野平均偏差、杯盘比及RNFL平均厚度较术前均无差异(均P>0.05)。PEI+GSL+GT组手术完全成功率为81%(26/32),手术条件成功率为94%(30/32);PEI+GSL组手术完全成功率为58%(19/33),手术条件成功率为76%(25/33)。两组间手术成功率均有差异(完全成功率χ^(2)=4.275,P=0.039;条件成功率χ^(2)=4.040,P=0.044)。两组患者均未见危及视力的并发症及再次手术。结论:对于中晚期原发性闭角型青光眼合并白内障患者,采用PEI+GSL+GT治疗比PEI+GSL治疗更有效。

房角分离手术联合超声乳化人工晶状体植入术对白内障合并闭角型青光眼患者的临床疗效分析

目的:探讨房角分离手术联合超声乳化人工晶状体植入术对白内障合并闭角型青光眼患者的临床疗效。方法:选取2022年1月至2023年1月间于北京康复医院就诊的198例白内障合并闭角型青光眼患者,根据治疗方法的不同将其分为对照组和观察组,每组99例。对照组行白内障超声乳化人工晶状体植入术联合小梁切除术;观察组行超声乳化人工晶状体植入术联合房角分离术。比较两组手术前后的临床相关指标与角膜内皮完整性、手术后3个月临床疗效,以及并发症发生情况。结果:观察组术后3个月临床疗效总有效率为95.96%,较对照组更佳,差异有统计学意义(x^(2)=4.352,P<0.05)。两组治疗后3个月视力水平均有所提高,但组间比较差异无统计学意义(P>0.05);前房深度和前房角度均有所增大,且观察组更大;眼压均有所降低,且观察组低于对照组,差异有统计学意义(t=7.654,P<0.05)。两组治疗后3个月角膜内皮细胞密度均有所减小,而观察组明显大于对照组;角膜内皮细胞平均面积与角膜中心厚度均有所增大,而观察组明显小于对照组,差异有统计学意义(t=25.233、16.608、6.698,P<0.05)。手术治疗后观察组并发症总检率为8.08%,低于对照组的19.19%,差异有统计学意义(x^(2)=5.189,P<0.05)。结论:白内障合并闭角型青光眼患者实施房角分离手术联合超声乳化人工晶体植入术疗效确切,可有效提高患者视力水平,同时也改善了前房深度、前房角度和眼压,更利于维持患者角膜内皮细胞的完整性,且安全性较好。

人工晶状体保护下超声乳化白内障吸除术疗效及安全性评价:一项随机对照临床研究

目的观察人工晶状体(IOL)保护下超声乳化手术(PHACO)对硬核白内障患者的治疗效果。方法采用随机对照临床研究方法,连续纳入2019年1月至2022年5月于延边大学附属医院收治的Emery分级Ⅳ~Ⅴ级的硬核白内障患者120例120眼,按照随机数字表法分为PHACO组、IOL保护PHACO组和囊外白内障摘除术(ECCE)组,分别行常规PHACO、IOL保护下的PHACO和ECCE,每组40例40眼。最终99例受试者完成随访,其中PHACO组30例30眼,IOL保护PHACO组35例35眼,ECCE组34例34眼。记录各组总手术时间、术中超声乳化时间、累计释放能量。术后随访3个月,检测并比较3个组患眼角膜内皮细胞密度(ECD)、角膜内皮细胞面积变异系数(CV)、角膜六角形内皮细胞比率(6A)、角膜散光值,不同等级裸眼远视力的眼数分布;记录术中和术后并发症发生情况。结果IOL保护PHACO组与PHACO组超声能量及超声时间比较差异均无统计学意义(P=0.691、0.982)。IOL保护PHACO组和PHACO组总手术时间分别为(38.81±2.73)和(36.45±3.45)min,明显短于ECCE组的(69.60±4.35)min,差异均有统计学意义(均P<0.001)。术前3个组患者年龄、性别、晶状体核硬度等基本资料比较,差异均无统计学意义(均P>0.05)。术后3个月,PHACO组和IOL保护PHACO组裸眼视力较高的人数较ECCE组高(P=0.006、0.007);IOL保护PHACO组的ECD和6A分别为(2155.57±177.88)/mm^(2)和(41.31±5.18)%,均显著高于PHACO组的(1912.64±224.11)/mm^(2)和(36.18±3.27)%,IOL保护PHACO组的CV为(50.34±5.90)%,低于PHACO组的(55.67±3.30)%,差异均有统计学意义(P=0.007、0.003、0.005)。术后1周和3个月,IOL保护PHACO组的角膜散光度数均显著低于ECCE组,且高于PHACO组,差异均有统计学意义(均P<0.05)。结论IOL保护下的PHACO相对常规PHACO可有效减少超声能量对角膜内皮的损伤,相对ECCE能明显缩短手术时间,减轻术后炎症反应,且并未明显增加术后角膜散光。IOL保护下的PHACO是硬核白内障患者一种有效的改良手术方式。

超声乳化术联合SBL-3区域折射型非球面IOL治疗年龄相关白内障的效果及对视觉质量的影响

目的 探究超声乳化术联合SBL-3区域折射型非球面人工晶状体(IOL)治疗年龄相关白内障的效果及对视觉质量的影响。方法 选取2022年1—12月收治的年龄相关白内障110例,采用随机数字表法分为单焦点组55例和SBL-3组55例,单焦点组予超声乳化术联合ADAPT AO非球面单焦点IOL植入,SBL-3组给予超声乳化术联合SBL-3区域折射型非球面IOL植入。比较2组术后3个月对比敏感度[明光、暗光、明光炫光、暗光炫光],术前和术后3个月视觉质量[客观散射指数(OSI)、斯特列尔比(SR)、调制传递函数截止频率(MTF cut off)]、视力[最佳矫正近视力(BCNVA)、最佳矫正远视力(BCDVA)、远视矫正下的近视力(DCNVA)]及生活质量[视功能与生存质量问卷(VF-QOL)]。结果 术后3个月,SBL-3组对比敏感度高于单焦点组(P<0.05);术后3个月,2组OSI、BCNVA、BCDVA、DCNVA水平均较术前降低,SBL-3组低于单焦点组(P<0.05);术后3个月,2组SR、MTF cut off水平及VF-QOL评分均较术前升高,SBL-3组高于单焦点组(P<0.05)。结论 超声乳化术联合SBL-3区域折射型非球面IOL能够提高年龄相关白内障患者对比敏感度及视觉质量,改善视力水平及生活质量。

情景认知干预在白内障超声乳化+人工晶体植入术中的应用

目的探究情景认知干预对行白内障超声乳化联合人工晶体植入术患者的影响。方法方便选取2020年1月—2022年12月于中国人民解放军联勤保障部队第九一〇医院行白内障超声乳化联合人工晶体植入术的94例患者作为研究对象,根据护理方法不同将其分为对照组(n=47)和观察组(n=47),对照组予以常规护理,观察组在对照组的基础上予以情景认知干预。比较干预前及干预结束后,两组患者焦虑状况以及生活质量差异,记录干预期间两组患者的并发症发生率。结果干预后,两组患者汉化版术前焦虑量表评分均低于干预前,且观察组低于对照组,差异有统计学意义(P均<0.05);两组患者活质量评定量表评分均高于干预前,且观察组高于对照组,差异有统计学意义(P均<0.05);干预期间,观察组患者并发症总发生率(6.38%)低于对照组(21.28%),差异有统计学意义(χ^(2)=4.374,P均<0.05)。结论情景认知干预模式可帮助行白内障超声乳化联合人工晶体植入术患者缓解焦虑,提高生活质量,减少并发症。

玻璃体切割联合超声乳化人工晶状体植入术治疗黄斑疾病合并白内障患者的屈光预测误差分析

目的分析玻璃体切割联合超声乳化白内障吸除及人工晶状体(IOL)植入术治疗黄斑疾病合并白内障患者术后屈光预测误差(PE)。方法本研究纳入2014年5月至2022年11月于空军军医大学西京医院眼科行玻璃体切割联合超声乳化白内障吸除及IOL植入术的黄斑疾病合并白内障患者96例(96眼)。分析患者术后最佳矫正视力(BCVA)和实际等效球镜度(SE),计算PE和绝对屈光误差(ARE),并分析PE与眼轴长度(AL)、前房深度(ACD)、晶状体厚度(LT)、平坦角膜曲率(K f)、陡峭角膜曲率(Ks)、平均角膜曲率(Km)、角膜散光度(Cyl)、眼压(IOP)、BCVA、角膜散光轴向、黄斑疾病诊断分类和术中玻璃体内填充物种类的相关性。结果术后早期(术后3 d内),96例患者BCVA与术前比较差异无统计学意义(P>0.05)。96例患者术后早期实际SE与术前预测屈光度比较差异有统计学意义(P<0.05),ARE为(1.47±2.54)D,其中近视漂移患者61例,PE为(-1.81±3.07)D,远视漂移患者35例,PE为(0.87±0.96)D。术后1个月,12例随访患者BCVA与术前比较差异无统计学意义(P>0.05),12例随访患者术后1个月实际SE与术前预测屈光度、术后早期实际SE之间以及术后早期实际SE与术前预测屈光度之间比较差异均无统计学意义(均为P>0.05)。术后随访时间大于1年(术后长期)的6例患者,末次随访时BCVA与术前比较差异无统计学意义(P>0.05)。相关性分析显示,近视漂移患者术后早期PE与术前AL、Cyl均呈负相关(均为P<0.05);近视漂移患者术后早期PE与黄斑疾病诊断分类相关(P<0.05),且病理性近视黄斑裂孔患者较其他类型黄斑疾病患者近视漂移程度更大(P<0.05);近视漂移患者术后早期PE与术前ACD、TL、Kf、Ks、Km、IOP、BCVA,玻璃体内填充物种类以及角膜散光轴向均无相关性(均为P>0.05)。远视漂移患者术后早期PE与术前Cyl呈正相关(P<0.05);远视漂移患者术后早期PE与玻璃体内填充物种类存在相关性(P<0.05),且术中玻璃体内硅油填充患者较玻璃体内无填充物患者远视漂移程度更大(P<0.05)。远视漂移患者术后早期PE与术前AL、ACD、TL、Kf、Ks、Km、IOP、BCVA,黄斑疾病诊断分类以及角膜散光轴向均无相关性(均为P>0.05)。结论黄斑疾病合并白内障患者行玻璃体切割联合超声乳化IOL植入术后早期存在以近视漂移为主的PE,其漂移程度随时间的增加可逐渐减轻。屈光漂移的方向和程度可能与患眼术前AL、Cyl,黄斑疾病诊断分类和术中玻璃体内填充物种类有关。

中老年糖尿病性白内障患者超乳联合IOL植入术后发生角膜水肿的影响因素

目的:探讨中老年糖尿病性白内障患者超声乳化摘除联合人工晶状体(IOL)植入术后发生角膜水肿的影响因素,以期减少临床中此类患者的白内障术后并发症。方法:选取2021-08/2023-06在重庆市忠县人民医院眼科接受超声乳化摘除联合IOL植入术的中老年糖尿病性白内障患者198例226眼作为研究对象进行回顾分析,根据其术后发生角膜水肿的情况将其分为角膜水肿组53眼和非角膜水肿组173眼。收集并比较两组的基线资料;记录并比较两组患者术前角膜厚度、内皮细胞密度变化、手术时间和有效超声时间等手术相关指标。采用多因素Logistic模型分析角膜水肿的影响因素,并绘制风险列线图。结果:角膜水肿组患者年龄≥60岁分布显著高于非角膜水肿组,同时角膜水肿组患者糖尿病病程显著长于非角膜水肿组,晶状体核硬度分级Ⅳ-Ⅴ级的人数分布显著多于非角膜水肿组(均P<0.05)。角膜水肿组的内皮细胞密度变化显著高于非角膜水肿组(P<0.05);与非角膜水肿组比较,角膜水肿组患者手术时间较长,有效超声时间更长(均P<0.05)。年龄、糖尿病病程、晶状体核硬度分级、手术时间和有效超声乳化时间是患者术后发生角膜水肿的危险因素(均P<0.05)。患者风险列线图总得分为150分时,该患者术后发生角膜水肿的风险约为65%。结论:中老年糖尿病性白内障超声乳化摘除联合IOL植入术后发生角膜水肿的影响因素包括年龄、糖尿病病程、晶状体核硬度、手术时间以及有效超声乳化时间。

冲洗针头液流抛光技术治疗白内障超声乳化术后PCO的疗效观察

目的 观察冲洗针头液流抛光与传统注吸头机械抛光对白内障超声乳化术后晶状体后囊膜混浊(PCO)的疗效和安全性。方法 纳入2020年6月—2020年12月咸阳市第一人民医院眼科诊断为年龄相关性白内障患者100例(200只眼),随机分为对照组和观察组,最终纳入对照组47例(94只眼),观察组48例(96只眼)。2组患者均行常规白内障超声乳化吸除术后,对照组术中采用注吸头进行后囊膜抛光,再植入人工晶体。观察组植入人工晶体并在囊袋内旋转360°,采用冲洗针头液流抛光后囊膜。记录术前、术后1 d、7 d、1年的最佳矫正视力(BCVA),术后1年PCO评分和后囊膜激光切开率。结果 (1)BCVA:观察组术后各时间点BCVA均较术前改善,差异均有统计学意义(t1 d=36.759、t7 d=40.101、t1年=47.629,均P=0.000);对照组术后各时间点BCVA均较术前改善,差异均有统计学意义(t1 d=52.429、t7 d=56.829、t1年=62.487,均P=0.000)。2组间术后1 d和7 d BCVA比较,差异均无统计学意义(P>0.05),观察组术后1年BCVA优于对照组,差异有统计学意义(t=2.709,P=0.007)。(2)PCO评分:观察组PCO分值为(0.13±0.07)分,低于对照组的(0.25±0.15)分,差异有统计学意义(t=7.090,P=0.000)。(3)后囊激光切开率:2组后囊激光切开率比较,差异无统计学意义(P>0.05)。2组术中和术后均未发生并发症。结论 冲洗针头液流抛光技术可预防白内障术后PCO的发生,操作简单、经济实用、安全可靠,可降低白内障术后PCO发生率,具有一定推广价值。