Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

●AIM:To assess effectivity and safety of trifocal intraocular lenses(IOLs)and capsular tension rings in treating cataract patients with axial high myopia.●METHODS:A prospective nonrandomized controlled clinical trial was conducted.Totally 98 eyes(74 patients)who underwent femtosecond laser-assisted cataract surgery(FLACS)with trifocal IOLs were enrolled in the study and followed up for 2y after surgery:46 eyes(33 patients)with capsular tension ring implantation in the long axial lengths(AL)group(26<AL<29 mm)and 52 eyes(41 patients)in the normal AL group(22<AL<24.5 mm).Postoperative outcomes about effectivity and safety,including the subjective and objective visual quality,and postoperative complications were assessed.●RESULTS:Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively(P<0.05).The differences in reading speed,spectacle independence and potential visual complaints between the two groups were not statistically significant(P>0.05).The dysfunctional lens index and total modulation transfer function(MTF)average height were similar between the two groups.The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group(P<0.05).The total satisfaction score in the long AL group(91.32±2.76)was slightly higher than that in the normal AL group(90.36±3.47),but there was no difference(P=0.136).A statistically negative correlation was found between corrected distance visual acuity(CDVA)and dysfunctional lens index(r=-0.382,P=0.009),and between CDVA and the total MTF average height(r=-0.374,P=0.01).But there was no significant correlation between CDVA and total satisfaction score(r=0.059,P=0.696).Postoperative complications mainly presented as posterior capsular opacity(PCO),retinal detachment and cystoid macular edema.There was no difference in the incidence of fundus disease(6.5%vs 3.8%,P=0.663)or PCO(17.4%vs 7.7%,P=0.217)between the two groups at two years.●CONCLUSION:The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS.This approach not only ensures excellent subjective feelings and objective visual quality,but also does not increase the incidence of postoperative complications.

Effect of capsular tension ring implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation syndrome

AIM: To investigate the effect of capsular tension ring(CTR) implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation(PEX) syndrome.METHODS: This double-blind randomized clinical trial was conducted on 60 patients with PEX syndrome referring to Imam Khomeini Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, for undergoing cataract surgery. The study population was divided into two groups, namely CTR group(n=30) and non-CTR group(control group;n=30). The refractive error and anterior chamber depth(ACD) were measured 1 wk, 1 mo, and 3 mo after phacoemulsification(PE) surgery.RESULTS: The results indicated no statistically significant difference between the two groups in terms of predicted refractive error(obtained by subtracting preoperative predicted refractive error from actual postoperative refractive error) 1 wk(P=0.47), 1 mo(P=0.30), and 3 mo(P=0.06) after the PE surgery. Regarding the CTR group, the changes of ACD was statistically significant 1 and 3 mo after the PE surgery, compared to those obtained 1 wk post-surgery(P=0.005).CONCLUSION: The CTR implantation in PEX cataractous patients without zonulysis has no statistically significant effect on the predicted refraction and ACD changes after PE. The predicted refraction error has a hyperopic shift in both groups. The results reveal the unnecessary of calculating modified IOL in CTR implantation.

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed.Corrected distance visual acuity(CDVA),extent of zonulysis,intraocular lens(IOL)position,intraoperative presentation,and complications were assessed.The primary outcomes included IOL centration stability and other postoperative complications.RESULTS:Twenty patients(20 eyes)were included in this study.The mean age in this study was 58.0±11.3y,and the average follow-up time was 17.3±12.8mo.Capsule bags were saved by Cionni-modified CTR.Nine eyes(45%)underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber.The preoperative mean CDVA was 0.83±0.24 log MAR,and the postoperative average CDVA was 0.23±0.30 log MAR(P<0.05).The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm,respectively;the vertical and horizontal IOL tilt after surgery was 5.5°±2.5°and 6.1°±2.2°,respectively.None of the eyes had obvious IOL decentration during the follow-up time.Eight eyes(40%)had posterior capsule opacification(PCO)that was severe enough to cause poor vision.Neodymium:YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.CONCLUSION:With the help of Cionni-modified CTR,capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

Stability of neodymium:YAG laser posterior capsulotomy in eyes with capsular tension rings

·AIM: To evaluate the stability of neodymium(Nd):YAG laser posterior capsulotomy in eyes with capsular tension rings(CTRs).·METHODS: A total of 60 eyes that underwent cataract surgery and laser posterior capsulotomy postoperatively were included in this retrospective cohort study. To evaluate the safety and stability of capsulotomy, changes in the size of posterior capsulotomy and anterior chamber depth(ACD) in three groups: the group without CTR, the group with 12 mm CTRs, and the group with 13 mm CTRs, at 1wk, 3, 12, and 15mo after capsulotomy, were compared. ·RESULTS: In the group without CTR and the group with 12 mm CTR, there was no significant change in ACD at every post-laser follow-up. In the group with 13 mm CTR, the ACD change was significant until 3mo after capsulotomy. In all groups, there was a significant increase in the area of capsulotomy between 1wk and 3mo post-laser. Between 3 and 12mo post-laser, only the group with 13 mm CTR showed a significant increase in the area of capsulotomy(P<0.01). ·CONCLUSION: Laser posterior capsulotomy is safe in all three groups. The capsulotomy and ACD become stabilized and have not shown significant changes since 1y postlaser, even with larger CTRs. The maintenance of centrifugal capsular tension can last longer with larger CTRs, and the stability of the capsulotomy site can be reached about 12mo after capsulotomy in pseudophakic eyes with larger CTRs.

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

“NIR-triggered ROS storage”photodynamic intraocular implant for high-efficient and safe posterior capsular opacification prevention

Posterior capsular opacification(PCO)is the leading cause of vision loss after cataract,mainly caused by the adhesion,proliferation and trans-differentiation of post-operative residual lens epithelial cells(LECs).Effective PCO prevention remains a huge challenge to ophthalmologists and researches for decades.Herein,we developed a“NIR-triggered ROS storage”intraocular implant(CTR-Py-Pp IX)based on capsular tension ring(CTR),which is concurrently linked with photosensitizer protophorphyrin IX(Pp IX)and energy storage2-pyridone derivative(Py),to guarantee instantaneous and sustainable ROS generation for LECs killing,aiming to achieve more efficient and safer photodynamic therapy(PDT)to effectively prevent PCO.The silylated Pp IX-Si and Py-Si were covalently conjugated to the plasma activated CTR surface to obtain CTR-Py-Pp IX.Results demonstrated that CTR-Py-Pp IX had dual functions of PDT and battery,in which Pp IX could generate ROS extracellularly under irradiation,with one part directly inhibiting LECs by lipid peroxidation(LPO)induction of cell membranes.Meanwhile,the excess ROS stored in Py could be continuously released to amplify LPO levels after the irradiation was removed.Ultimately,the proliferation of LECs in capsular bag was completely inhibited under mild irradiation conditions,achieving a sustainable and controlled PDT effect for effective PCO prevention with good biocompatibility.This NIR-triggered ROS storage intraocular implant would provide a more efficient and safer approach for long-term PCO prevention.

囊袋张力环联合Toric人工晶状体植入治疗高度近视合并角膜散光的白内障

目的研究伴有角膜散光的高度近视白内障患者进行超声乳化+环曲面人工晶状体(Toric intraocular lens,Toric IOL)及囊袋张力环(capsular tension ring,CTR)植入术的临床效果及稳定性。方法通过回顾性研究,分析在武汉市第一医院行白内障超声乳化吸除术的高度近视伴有角膜散光的患眼54例(76眼),其中31例(38眼)联合植入Toric IOL及CTR(联合组),23例(38眼)单纯植入Toric IOL(对照组)。术后随访6个月,比较两组患者术前及术后视力、角膜内皮细胞密度、人工晶状体旋转度、残余散光度,以及并发症发生情况。结果术后6月,两组患者裸眼远视力(uncorrected distance visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)均显著高于术前,联合组术后UCVA(LogMAR)优于对照组,差异有统计学意义[(0.34±0.15)vs.(0.46±0.25),P<0.05]。术后1周、1月、3月及6月,联合组散光分别为(0.38±0.31)、(0.45±0.25)、(0.47±0.23)、(0.56±0.26),均明显低于对照组各时间点(均P<0.01)。术后6月联合组IOL平均旋转(2.63±0.94)°,显著低于对照组的(4.00±1.43)°(P<0.01)。两组间各时间点角膜内皮细胞密度比较,差异无统计学意义(均P>0.05)。联合组术后并发症总发生率低于对照组(P<0.05)。结论对于高度近视伴角膜散光的白内障患者,术中植入Toric IOL的同时联合应用CTR,安全性好,能够改善Toric IOL旋转稳定性,提高视觉质量,并且减少并发症。

超声乳化联合囊袋张力环及人工晶状体植入术治疗高度近视合并白内障

目的:观察超声乳化联合囊袋张力环及人工晶状体植入术治疗高度近视合并白内障患者的疗效。方法:回顾性研究。选取2021-12/2023-04我院白内障科收治的高度近视合并白内障患者82例82眼,根据术中是否使用囊袋张力环分为两组:对照组39眼采用单纯超声乳化联合人工晶状体植入术治疗,联合组43眼采用超声乳化联合囊袋张力环及人工晶状体植入术治疗。比较两组患者手术前后最佳矫正视力、中央前房深度、小梁睫状突距离、视觉质量和并发症。结果:术后1mo,两组患者的最佳矫正视力(LogMAR)较术前明显改善(联合组:0.64±0.28 vs 0.12±0.14;对照组:0.62±0.26 vs 0.23±0.25,均P<0.001);中央前房深度均高于术前(联合组:2.57±0.56 vs 1.97±0.40 mm;对照组:2.22±0.45 vs 1.89±0.37 mm,均P<0.001),联合组最佳矫正视力和中央前房深度优于对照组(均P<0.05);两组患者手术前后小梁睫状突距离比较均无差异(联合组:0.68±0.22 vs 0.74±0.20 mm;对照组:0.74±0.19 vs 0.78±0.17 mm,均P>0.05)。术后1 mo视觉质量评分联合组均高于对照组[看电视3.00±0.38 vs 2.22±0.46分;看书2.85±0.42 vs 2.21±0.44分;夜间视物:2.71±0.34 vs 2.37±0.41分;精细操作2.82±0.38 vs 2.33±0.40分,均P<0.001]。联合组并发症发生率显著低于对照组(33%vs 14%,P<0.05)。结论:超声乳化联合囊袋张力环及人工晶状体植入术治疗高度近视合并白内障患者能有效促进患者视功能恢复,改善房角结构,降低并发症发生率。

巩膜固定囊袋张力环联合超声乳化人工晶状体植入术治疗外伤性晶状体半脱位

目的:探讨巩膜固定囊袋张力环(SFCTR)植入联合晶状体超声乳化吸除加人工晶状体(IOL)植入术治疗外伤性晶状体半脱位的临床疗效。方法:连续选取2018-12/2023-02行SFCTR植入联合晶状体超声乳化吸除加IOL植入术治疗的外伤性晶状体半脱位患者14例14眼。术后随访行视力、眼压、眼前段照相、超声生物显微镜(UBM)等检查,并记录IOL的位置及术后并发症等情况。结果:纳入患者均成功植入SFCTR和囊袋内IOL。术后平均随访1.92±1.36 a,末次随访时,UDVA(0.20±0.18 LogMAR)和CDVA(0.16±0.17 LogMAR)均较术前UDVA(1.13±0.56 LogMAR)显著改善(P<0.01),眼压(17.64±3.67 mmHg)较术前(22.00±9.92 mmHg)降低(P<0.05)。随访期间,裂隙灯检查见IOL位于囊袋内,位置居中;UBM检查见CTR和IOL位于囊袋内,囊袋赤道部与睫状突的距离在各个方向相等。结论:SFCTR植入联合晶状体超声乳化吸除加IOL植入术是治疗外伤性晶状体半脱位的一种微创有效的手术方法。

超声乳化白内障摘出联合囊袋张力环植入术治疗高度近视伴白内障的效果及对人工晶体稳定性、视力状态的影响

目的分析超声乳化白内障摘出联合囊袋张力环植入术治疗高度近视伴白内障的效果。方法选择2019年2月至2022年3月收治的90例高度近视伴白内障患者为研究对象,以随机数字表法将其分为对照组和观察组,各45例。对照组接受超声乳化白内障摘出治疗,观察组在对照组基础上加施囊袋张力环植入术治疗。比较两组的治疗效果。结果术后6个月,观察组的最佳矫正视力(BCVA)、角膜内皮细胞密度、六边形细胞百分率高于对照组,中央角膜厚度小于对照组(P<0.05)。术后3、6个月,观察组的晶体偏心量、倾斜角小于对照组(P<0.05)。术后6个月,观察组的三叶草像差、总高阶像差、球差、彗差优于对照组(P<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。结论超声乳化白内障摘出联合囊袋张力环植入术治疗高度近视伴白内障可提高人工晶体稳定性,改善角膜质量,还能降低术后并发症发生风险,促进视力恢复,值得推广。

改良囊袋张力环联合囊袋内人工晶状体植入治疗马方综合征晶状体不全脱位术后人工晶状体脱位的临床特征及手术治疗

目的观察接受改良囊袋张力环(MCTR)联合囊袋内人工晶状体(IOL)植入治疗的马方综合征(MFS)晶状体不全脱位患者术后IOL脱位的发生率,并总结接受IOL复位或取出术MFS患者的临床特征。方法通过随访观察2015年1月—2020年6月于我院同一手术医师行MCTR植入术且术后随访3年以上的MFS患者术后IOL脱位情况,计算其IOL脱位发生率。通过回顾分析我院同期就诊的MFS合并IOL脱位患者的临床资料,分析其临床特征和手术选择。结果本研究共纳入同一手术医师行MCTR植入术患者115例(192眼),大部分患者为儿童(80.21%,154/192),中位随访时间4年(四分位范围:3.50,4.67)。随访期间共出现MCTR-IOL复合体脱位3例(3眼),脱位发生率为1.56%(3/192),其中2例为不全脱位、1例为全脱位。3例患者均为成人,IOL脱位发生时间为术后2~3年,均无明显诱因,直接原因均为缝线断裂。同期在我院接受IOL复位或取出术的MFS患者共16例。IOL脱位最常见的直接原因是缝线断裂(62.50%,10/16)、其次是缝线或可植入式囊袋拉钩在巩膜层间出现滑动松脱(18.75%,3/16)。对于出现不全脱位的CTR或MCTR患者,通过缝线再次固定张力环或植入囊袋拉钩可实现IOL复位;MCTR脱位进入玻璃体腔的患者接受了MCTR取出和经巩膜后房型IOL缝线固定术;对于其他手术方式的IOL脱位患者,多数患者实现了脱位IOL复位术(54.55%,7/13),少数患者进行了IOL置换术(30.77%,4/13),2例IOL取出后未植入IOL。结论MCTR植入术是治疗MFS合并晶状体不全脱位的一种安全、有效的手术方式,IOL脱位是其罕见并发症。MFS患者术后定期随访十分必要,甚至需要终生随访,早期干预IOL脱位可以取得较好的疗效。

飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障

目的飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障术后的疗效分析及安全性评价。方法收集2019年1月至2021年11月于我院行白内障手术的高度近视白内障患者共52例。随机分成两组:飞秒组和传统组各26例。飞秒组行FLACS+CTR,传统组行超声乳化+CTR。观察术前、术后1天、1周、1月裸眼远视力、MTF、主观视觉质量量表评分、DLI值,IOL偏心量、屈光漂移量及术后并发症发生情况。结果1.术后飞秒组1d、1w、1m的UCVA-D分别为4.62±0.37、4.59±0.43、4.64±0.43较传统组4.58±0.43、4.58±0.43、4.65±0.49视力提升更显著,差异有统计学意义(P<0.05)。2.两组术后眼压飞秒组19.38±2.99较传统组18.40±3.83无明显差异(P>0.05)。飞秒组术后DLI9.04±1.30较对照组7.99±1.52比较差异无统计学意义(P>0.05)。3.术后1m人工晶体偏心量飞秒组0.13±0.09明显小于传统组0.20±0.17,差异有统计学意义(P<0.05);术后1m屈光漂移飞秒组0.28±0.12较传统组0.95±0.27差异有统计学意义(P<0.05)。4.术后1月MTF-AH飞秒组0.54±0.19较传统组0.25±0.06明显提高,差异有统计学意义(P<0.05)。5.术后1月主观视觉质量评分飞秒组4.77±0.42传统组1.42±0.57差异有统计学意义(P<0.05)。6.术后角膜水肿情况飞秒组明显少于传统组,差异有统计学意义(P<0.05)。结论飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障安全有效高、并发症少、并能获得较好的视觉质量。

囊袋张力环及虹膜拉钩在超声乳化白内障吸除术中治疗晶状体半脱位的应用

目的 探讨囊袋张力环及虹膜拉钩在超声乳化术治疗晶状体半脱位的应用效果和安全性。方法 回顾性分析:选取2018年1月~2020年11月我院35例35眼超声乳化术治疗白内障合并晶状体半脱位(眼外伤者28眼,Marfan综合症2眼,不明原因者5眼)患者,术中使用虹膜拉钩并植入囊袋张力环,观察术后1周、1个月、3个月视力变化、前房深度变化、角膜内皮细胞计数、人工晶体位置及术中、术后并发症发生情况。结果 术后1周、1个月、3个月最佳矫正视力(BCVA)较术前有明显提高,差异有统计学意义(t=-13.343,-15.495,-16.742, P<0.05),术后角膜内皮细胞计数较术前无明显变化,差异无统计学意义(t=-1.513,-0.931,-0.067,P>0.05),术后前房深度较术前有明显变化,差异有统计学意义(t=-7.461,-7.951,-7.837,P<0.05),术后人工晶体居中性好,术中及术后并发症少。结论 超声乳化术治疗合并晶体半脱位的白内障手术,术中应用囊袋张力环及虹膜拉钩,可提高手术操作性,效果安全可靠,疗效稳定。

囊袋张力环植入对高度近视白内障治疗效果的meta分析

目的系统评价高度近视白内障患者行超声乳化白内障吸除及人工晶状体(IOL)联合囊袋张力环(CTR)植入术的治疗效果。方法计算机检索外文数据库MEDLINE、EMBASE、Cochrane Library以及中文数据库中国知网、万方数据、维普数据库自建库起至2020年10月的同行评议文献,收集有关高度近视白内障患者行超声乳化白内障吸除及IOL联合CTR植入术(试验组)与白内障超声乳化吸除及IOL植入术(对照组)相比较的临床研究。根据纳入标准和排除标准进行文献筛选、资料提取和质量评价。应用RevMan 5.3软件,以平均差(MD)、比值比(OR)分别衡量计量资料和计数资料的效应量,对术后最小分辨角对数最佳矫正视力(BCVA)、后发性白内障(PCO)、囊袋收缩综合征(CCS)、视网膜脱离(RD)等进行meta分析。结果本研究共纳入8篇文献,共2 085眼,其中试验组1 054眼,对照组1 031眼。meta分析结果显示,试验组与对照组患者术后1周、1个月、3个月BCVA比较差异均无统计学意义(均P>0.05),术后6个月试验组患者BCVA高于对照组,差异有统计学意义(MD:-0.11;95%CI:-0.15~-0.07;P<0.01)。试验组患者术后PCO发生率低于对照组,差异有统计学意义(OR:0.24;95%CI:0.15~0.36;P<0.01)。试验组患者术后CCS发生率低于对照组,差异有统计学意义(OR:0.08;95%CI:0.01~0.65;P=0.02)。试验组患者术后RD发生率低于对照组,差异有统计学意义(OR:0.21;95%CI:0.05~0.82;P=0.02)。结论联合应用CTR治疗高度近视白内障能提高术后视觉质量,减少术后PCO、CCS和RD的发生。

囊袋上经巩膜缝线固定IOL植入术治疗球形晶状体的有效性和安全性研究

目的:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocularlens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-thebag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。

囊袋张力环应用对伴有悬韧带松弛的高度近视合并白内障患者的疗效

目的:探讨伴有悬韧带松弛的高度近视合并白内障患者行超声乳化(Phaco)联合人工晶状体(IOL)植入术中囊袋张力环(CTR)的应用效果。方法:前瞻性研究。选取2020-04/2021-08于我院行Phaco联合IOL植入术的伴有悬韧带松弛的高度近视合并白内障患者80例80眼,采用随机数字表法分为CTR组(40例40眼,行Phaco联合CTR及IOL植入术)和对照组(40例40眼,行Phaco联合IOL植入术)。比较两组患者手术前后最佳矫正远视力(BCDVA)、前囊口面积、IOL总倾斜度、主观视觉质量。结果:术后1、3、6mo,两组患者BCDVA均较术前改善(P<0.05),眼压均较术前降低(P<0.05),CTR组患者前囊口面积大于对照组,IOL总倾斜度低于对照组(P<0.001),两组患者主观视觉质量评分均较术前升高(P<0.05),且CTR组主观视觉质量评分高于对照组(P<0.001)。术后随访6mo内,CTR组患者术后并发症总发生率低于对照组(7.5%vs 25.0%,P<0.05)。结论:对伴有悬韧带松弛的高度近视合并白内障,Phaco联合IOL植入术中植入CTR有助于维持囊袋形态,减少囊袋收缩,稳定IOL位置,提高术后视觉质量,且并发症少。

改良型囊袋张力环与睫状体接触导致反复高眼压一例

临床上囊袋张力环(capsular tension ring,CTR)与睫状体接触导致的反复持续性高眼压较为少见,本文报告一例改良型CTR植入术后反复持续性高眼压的病例,行“巩膜悬吊线松解术”后高眼压状态有效缓解,考虑可能与巩膜固定缝线过紧,造成改良型CTR局部与睫状体相接触,刺激睫状体分泌过量房水有关。

囊袋张力环对高度近视患者白内障术后疗效影响的荟萃分析

目的基于荟萃分析评价术中联合植入囊袋张力环(CTR)对高度近视患者白内障手术疗效的影响。方法全面检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普等7个数据库,检索时间范围为1990年1月1日至2022年3月20日,收集CTR在高度近视患者白内障手术中应用的随机对照试验和非随机对照试验。2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评价,采用Review Manager 5.4进行荟萃分析。结果最终纳入8篇文献,共涉及1292例(1630眼)患者。荟萃分析结果显示,在改善患者最佳矫正视力(BCVA)方面,术后1个月、3个月、6个月CTR联合人工晶状体(IOL)植入组患者的BCVA均显著优于IOL植入组(均为P<0.05);在IOL倾斜角、偏心量方面,术后6个月时CTR联合IOL植入组患者较IOL植入组均显著降低(均为P<0.05);晶状体前囊口面积方面,术后3个月时CTR联合IOL植入组患者大于IOL植入组(P=0.048);术后PCO发生率方面,CTR联合IOL植入组患者显著低于IOL植入组(P<0.00001);术后3个月时CTR联合IOL植入组患者角膜内皮细胞密度与IOL植入组相比差异无统计学意义(P=0.48)。结论对于高度近视患者,在白内障术中植入CTR有助于患者获得更好的BCVA、减少术后IOL倾斜与偏心、降低PCO以及囊袋皱缩的发生。