Using Topical Anesthesia for Standing Phacoemulsification Cataract Surgery and Intraocular Lens Implantation

Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis due to long-standing ankylosing spondylitis and chronic uveitis. Methods: Two patients are unable to lie flat respectively during phacoemulsification underwent this technique in Jingdong and Tonghai county Hospital of Yunnan province in China. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. Results: The intraoperative and postoperative periods were uneventful in two patients, with good visual outcomes after surgery. Conclusion: This technique is valuable for situations where the patient requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.

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.

AN EXPERIMENTAL STUDY OF THE TUMOUR NECROSIS FACTOR LEVELSIN AQUEOUS HUMOR AFTER TRAUMATIC CATARACT AND INTRAOCULAR LENS IMPLANTATION

Purpose. This paper studies the tumour necrosis factor (TNF) levels in aqueous humor after traumatic cataract extraction and posterior chamber (PC) intraocular lens (IOL) implantation in rabbits,and discusses the effect of TNF on postoperative anterior ocular inflammation. Methods. Twenty seven pigmented rabbits were divided into three groups: for the first group, the IOL were placed in the capsular bag after traumatic cataract extraction; for the second, the Extracapsular cataract extraction without IOL implantation; and for the third, the control group without surgical intervention. On the 1st, 3rd, 7th and 14th day postoperatively, aqueous humor samples were obtained. A modified double antibodies indirect sandwich ELISA was used to detected for the presence of TNF. The data were studied by means of analysis of variance in SAS software. Result. The TNF level was increased in aqueous humor and reached its maximum on the 1st postoperative days after traumatic cataract extraction and PC IOLs implantation, and the TNF levels are significantly higher (P<0 05) on the 1st, 3rd, 7th and 14th day postoperatively in traumatic cataract extraction and PC IOL implanted group than that in the non surgical intervention group and extracapsular cataract extraction group. Conclusions. The increase of TNF levels had a close relationship with presence of the IOL itself which induces the secretion of TNF. This suggested that TNF as the principal mediators of immunological and inflammatory responses, so that may play critical role in anterior ocular inflammative response after traumatic cataract extraction and IOL implantation.

Clinical study of customized aspherical intraocular lens implants

AIM:To compare if there is an improvement in visual functions with age-related cataracts between patients receiving a aspherical intraocular lens(IOL) based on corneal wavefront aberration and patients randomly assigned lenses.METHODS:A total of 124 eyes of 124 patients with age-related cataracts were placed in experimental group and a group receiving randomly assigned(RA) lenses.The experimental group was undergone Pentacam corneal spherical aberration measurement before surgery; the targeted range for residual total spherical aberration after surgery was set to 0-0.3 μm. Patients with a corneal spherical aberration 【0.3 μm were implanted with a zero-spherical aberration advanced optics(AO) aspherical IOL and patients with an aberration ≥0.3 μm received a Tecnis Z9003 aspherical lens in experimental group. RA patients were randomly implanted with an AO lens or a Tecnis Z9003 lens. Three months after surgery total spherical aberration, photopic/mesopic contrast sensitivities, photopic/mesopic with glare contrast sensitivities, and logMAR vision were measured.RESULTS:Statistical analysis on logMAR vision showed no significant difference between two groups(P =0.413). The post-surgical total spherical aberration was 0.126 ±0.097 μm and 0.152 ±0.151 μm in the experimental and RA groups, respectively(P =0.12). The mesopic contrast sensitivities at spatial frequencies of 6,12 and 18 c/d in the experimental group were significantly higher than of the RA group(P =0.00; P =0.04;P =0.02). The mesopic with glare contrast sensitivity in the experimental group at a spatial frequency of 18 c/d was also significantly higher vs the RA group(P =0.01).CONCLUSION:Pre-surgical corneal spherical aberration measurement in cataract patients followed bycustomized selection of aspherical IOL implants improved mesopic contrast sensitivities at high spatial frequencies, and thus is a superior strategy compared to the random selection of aspherical intraocular lens implants.

Evaluation of the Consistency of Total Spherical Aberration before and after Aspherical Intraocular Lens Implantation

Purpose:.To analyze the consistency between preoperatively estimated and postoperatively measured total spherical aberration and to evaluate the feasibility of personalized selection of an aspherical intraocular lens(IOL) based on the corneal spherical aberration measured by the Scheimpflug photography system(Pentacam).Methods:.A total of 47 patients.(82 eyes).with age-related cataract received a comprehensive ophthalmologic examination..Corneal spherical aberration was measured by using the Scheimpflug photography system. Patients with corneal spherical aberration ≤0.3 μm were implanted with a zero-spherical aberration advanced optics(AO) aspherical intraocular lens and those with corneal spherical aberration >0.3 μm received a Tecnis ZA9003 aspherical lens(-0.27 μm spherical aberration). Preoperative total remnant spherical aberration was estimated and actual total spherical aberration was measured 3months postoperatively. The consistency between preoperative and postoperative spherical aberration was analyzed by t-test,correlation analysis, and Blant-Altman plots.Results: The estimated and measured values of total spherical aberration were(0.189±0.151) μm and(0.141±0.131) μm,with a statistical difference(t=5.347,P<0.01). For 45 eyes implanted with AO lenses, preoperatively estimated and postoperatively measured total spherical aberration were(0.268±0.137) μm and(0.214 ±0.103) μm. For 37 eyes implanted with Tecnis ZA9003, preoperative estimate of total spherical aberration was(0.092±0.103) μm and postoperative measured value was(0.054±0.106) μm. Statistical significance was noted, as was a positive linear correlation between preoperative and postoperative values(γ=0.846,P<0.01). Bland-Altman analysis showed high consistency between the estimated and measured spherical aberration.Conclusion: The estimated total spherical aberration measured preoperatively differed from the value measured postoperatively, but the two values showed good agreement. It is clinically feasible to conduct personalized selection of asphericalIOL based on Scheimpflug photography system(Pentacam) to measure corneal spherical aberration.

The Relation of the Location of Haptics of Posterior Chamber Intraocular Lenses and Peripheral Anterior Synechia

Purpose:To investigate the occurrence,outcome and influencial factors of the pe-ripheral anterior synechia(PAS)following implantation of posterior chamber in-traocular lenses for finding a way to reduce thePAS.Subjects;40 eyes of 38senile cataract patients with normal chamber angle and in-traocular pressue(IOP)preoperatively were examined.Methods:Extracapsular cataract extraction was performed under microscope with insertion of a posterior chamber lens implant vaulted anteriorly by 10°.Go-nioscopy and slit-lamp examination and photography of the operated eyes were performed 3to 6months postoperatively.Results:PAS were found in 20(50%)of the 40eyes.Among the 20eyes with PAS the locations of 23haptics in17eyes corresponded with those of the PAS.PAS were seen more frequently with vertically sulcus-fixated haptics than with the horizontally capsular-fixated haptics.showing a significant difference(P<0.05).88%of the eyes withPAS had pupillary edformation,but their visual acuities and IOP were not affected.Conclusions:PAS is more likely to occur with vertically sulcus-fixated IOL.Rotat-ing the capsular-fixated haptics to the horizontal position may reduce the inci-dence of PAS.Gonioscopy should be a routine follow-up examination.

小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果比较

目的:比较小切口囊外摘除术与超声乳化术分别联合人工晶状体植入术治疗白内障患者的效果。方法:选取2020年1月至2022年12月该院收治的70例白内障患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各35例。对照组采取超声乳化术联合人工晶状体植入术治疗,研究组采取小切口囊外摘除术联合人工晶状体植入术治疗,比较两组手术前后视力水平、角膜内皮细胞密度、六角形细胞占比和并发症发生率。结果:术后1 d、3 d、7 d、1个月,研究组视力水平高于对照组,差异均有统计学意义(P<0.05);术后3个月,两组角膜内皮细胞密度、六角形细胞占比均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为8.57%,低于对照组的28.57%,差异有统计学意义(P<0.05)。结论:小切口囊外摘除术联合人工晶状体植入术治疗白内障患者可提高其术后视力水平和角膜内皮细胞密度、六角形细胞占比,降低其并发症发生率,效果优于超声乳化术联合人工晶状体植入术治疗。

传统藏医眼部穿刺术在现代白内障颞侧手术中的应用研究及疗效评价

目的观察传统藏医白内障穿刺术与现代白内障囊外摘除术+IOL植入术方法结合后,其视力、并发症及术后散光等情况的疗效研究。方法对2350例2400眼白内障患者行传统藏医眼部穿刺术,作颞侧角巩膜缘隧道三粒中等量小麦直径(约3~4.5mm)长度的穿刺切口,行白内障囊外摘除+IOL植入术,巩膜隧道自行闭合,无需缝线。结果2350例2400只眼术后7天内有近52.29%的患者最佳矫正视力好于或等于0.5,全部病例切口愈合,术后并发症主要为一过性角膜水肿、前房闪辉、暂时性的高眼压等。结论传统藏医白内障穿刺囊外摘除+IOL植入术手术安全、视力恢复快、散光小、器械成本低、容易掌握、手术不受眉弓影响,尤其对睑裂较小眼窝较深的患者提供方便,并为病人后期青光眼等手术留下良好的局部手术条件。可见,此方法是值得在基层医院、偏远高海拔地区防盲治盲工作中可广泛推广的有效方法。

Improving refractive outcomes in cataract surgery: A global perspective

This review summarises the current evidence base and provides guidelines for obtaining good refractive outcomes following cataract surgery. Important background information is also provided. In summary, the requirements are:(1) standardisation of biometry equipment used for axial length and keratometry measurement and the use of optical or immersion ultrasound biometry;(2) sutureless cataract surgery with "in the bag" intraocular lens(IOL) placement;(3) an appropriate 3rd, 4th or 5th Generation IOL power formula should be used;(4) IOL formula constants must be optimized;(5) under certain conditions, the refractive outcome of the 2nd eye can be improved based on the refractive error of the first eye; and(6) results should be audited for refinement and to ensure that standards are met.

针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的应用

目的观察针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的临床应用效果。方法纳入年龄相关性白内障且预行超声乳化联合人工晶体植入术的患者100例,随机分为对照组49例和观察组51例。对照组给予0.5%盐酸丙美卡因滴眼液表面麻醉,观察组在对照组基础上联合针刺麻醉,记录2组在手术开始前(T0)、前房穿刺前(T1)、超声乳化时(T2)、推注人工晶体时(T3)、手术结束后(T4)的心率、外周血氧饱和度、收缩压(SBP)和舒张压(DBP),比较2组在不同时间点各项指标水平,心率变化差异及术后视觉模拟评分法(VAS)疼痛评分。结果2组患者年龄、性别、术前生命体征等基线数据均无统计学意义(P>0.05)。(1)心率、外周血氧饱和度:与对照组比较,观察组在T1、T2、T3、T4的心率、外周血氧饱和度均无统计学意义(P>0.05),但是观察组T1、T2、T3、T4与T0相差的心率变化均变小,ZT_(1)=-3.644,P=0.001;ZT_(2)=-3.201,P=0.001;ZT_(3)=-2.255,P=0.024;ZT_(4)=-2.319,P=0.020,差异均有统计学意义。(2)血压:与对照组比较,观察组在各时间点SBP和DBP水平均降低,t_(SBP-T1)=3.257,P=0.002;t_(SBP)-T2=3.232,P=0.002;t_(SBP)-T3=4.135,P=0.000;t_(SBP)-T4=3.054,P=0.003;t_(DBP-T1)=2.697,P=0.008;t_(DBP-T2)=2.689,P=0.008;t_(DBP-T3)=3.157,P=0.002;tDBP-T4=3.510,P=0.000,差异均有统计学意义。(3)VAS评分:观察组术后疼痛强度明显降低,Z=5.434,P=0.000,差异具有统计学意义。结论针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的应用安全有效,能够维持患者术中心率、血氧饱和度稳定,显著缓解血压升高,减轻患者的疼痛程度。

表面麻醉下白内障超声乳化人工晶状体植入术治疗合并白内障的疗效观察

目的 分析行超声乳化(PHACO)人工晶状体植入术治疗白内障患者采用表面麻醉的应用价值。方法 对行表面麻醉下PHACO人工晶状体植入术的240例(253只眼)患者的临床资料进行回顾性分析。评估患者术后视力恢复情况,比较患者术前术后眼压、前房角、前房深度变换情况以及散光度和并发症发生率。结果 术后第1天裸眼视力≥0.5者163眼,占64.03%,术后第7天裸眼视力≥0.5者211眼,占83.39%,术后1个月裸眼视力≥0.5者227眼,占89.72%;患者术后平均眼压为(18.71±2.80)mmHg,较术前的(34.61±5.19)mmHg有明显的下降;与术前相比较,术后患者的中央前房深度均有明显的增加,且房角有所增宽;患者术后1、3个月的散光度较术前相比均有明显下降;术中并发症虹膜脱出占比5.92%,后囊膜破裂占比5.13%,术后并发症主要为角膜水肿,占比9.48%。结论 采用表面麻醉下PHACO人工晶状体植入术对白内障患者进行治疗,临床效果显著,患者的视力和眼压水平得到明显改善,且散光度减少,同时能有效降低术中术后并发症发生情况,安全性高,值得在临床推广和应用。

白内障无缝线中切口囊外摘除术联合人工晶状体植入术的临床效果分析

目的 分析与讨论无缝线中切口囊外摘除术(SLIMCE)联合人工晶状体植入术(intraocular lens,IOL)治疗白内障临床应用的效果。方法 文章现针对本院收治的90例白内障患者,借助随机抽样法分参照组、研究组各45例,分别提供白内障常规大切口囊外摘除术联合IOL和SLIMCE联合IOL植入术,结束后对比治疗前后患者的各项指标。结果 治疗后较治疗前对比患者术中操作安全性及术后视力、眼压、前房深度、切口愈合情况,具有明显差异(P<0.05),组间对比以研究组优于参照组;同时总有效率占95.56%,相比较参照组82.22%,高出13.34%,具有明显差异(P<0.05);另外,术中保持前房稳定,晶体核容易娩出,术后角膜水肿、前房水反应、晶状体前渗出、切口愈合、眼内炎并发症发生率相比较参照组明显较低,术后3个月患者生活质量评分也以研究组更高,和参照组对比具有明显差异(P<0.05)。结论 SLIMCE联合IOL植入术操作简单,更利于提高生活质量,改善患者的视力,同时较常规大切口囊外摘除术联合人工晶体植入术更利于降低术后并发症,值得广泛用于基层医院中。

超声乳化白内障摘出联合人工晶状体植入术治疗晶状体半脱位观察

目的 评价超声乳化白内障摘出联合人工晶状体植入术在晶状体半脱位手术中的应用。方法 对 13 5例( 13 5眼 )患者行超声乳化白内障摘出联合人工晶状体植入术 ,术中应用连续环形撕囊技术 ,并使用灌注抽吸系统清除皮质 ,囊袋内植入人工晶状体。结果 术后矫正视力≥ 0 4者 92眼 ,0 0 8以下者 11眼 ,0 1～ 0 3者 3 2眼。结论 超声乳化白内障摘出联合人工晶状体植入术 ,对于晶状体半脱位患者 。

超声乳化人工晶状体植入术治疗高度近视白内障疗效观察

目的:探讨高度近视白内障表面麻醉下晶状体超声乳化吸除人工晶状体植入术的疗效。方法:回顾性病例系列研究,对60例88眼高度近视白内障采用表面麻醉透明角膜切口晶状体超声乳化折叠人工晶状体植入术后随访1～3mo。结果:患者88眼均顺利完成手术植入丙烯酸酯折叠人工晶状体,植入球面人工晶状体46眼,非球面晶状体39眼,多焦晶状体3眼。度数范围:-6.00～+13.00D。术后视力均有不同程度提高,其中矫正视力≥0.5者54眼(61%),≥0.3者73眼(83%),≥0.05者83眼(94%)。术中术后无严重并发症发生。结论:对高度近视白内障采用表面麻醉下透明角膜切口晶状体超声乳化折叠式人工晶状体植入术是安全有效的,是这一高危人群的理想术式。

白内障超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障

目的评价高度近视合并白内障行超声乳化摘出及后房折叠型人工晶状体植入术的疗效。方法对46例(77眼)高度近视合并白内障患者施行透明角膜切口超声乳化吸出术,通过3.2 mm切口植入后房折叠型人工晶状体。于术后1周、1个月、3个月、6个月随访复查,比较手术前后最佳矫正视力、球镜度数、柱镜度数、角膜曲率、角膜内皮细胞计数和眼轴长度的变化。结果手术均顺利完成,人工晶状体100%囊袋内植入。术后1周、1个月、3个月、6个月最佳矫正视力≥0.5者分别有59眼、60眼、65眼和65眼。术后6个月患者球镜度数、柱镜度数、角膜曲率、眼轴长度、角膜内皮细胞计数分别为(-1.04±0.59)D、(-0.23±1.14)D、(43.72±1.16)D、(28.46±1.77)mm、(2041±825)个·mm-2。与术前相比,球镜度数、角膜内皮细胞计数两项差异具有统计学意义(均为P<0.05)。结论超声乳化摘出及后房折叠型人工晶状体植入术治疗高度近视合并白内障效果良好,术后视力恢复快、屈光状态稳定。

白内障防盲手术中人工晶状体度数的分布状态与优化配置

目的:调查白内障防盲手术中人工晶状体度数的分布状态及配置中存在的问题,为防盲手术车上人工晶状体的优化配置提供科学数据。方法:统计四川省南充市免费白内障手术患者347例,记录人工晶状体度数的测量值、术中植入度数和患者术后1d的视力。分析人工晶状体度数的分布状态,植入人工晶状体度数与测量值之间的差异,及其对术后视力的影响。结果:人工晶状体度数的发生频率:-5D≤IOL≤13.5D的人工晶状体,频率为0.3%～0.6%;14D≤IOL≤17D,0.6%～0.9%;17.5D≤IOL≤19.5D,2%～4%;20D≤IOL≤23.5D,频率集中在5%～9%,其中21.5DIOL频率最高,为11%;24D≤IOL≤26.5D,2%～3%;IOL>26.5D,仅为1%。人工晶状体度数的构成比为:-5～9.5D,7%;10.5～17D,9%;17.5～19.5D,14%;20～23D,51%;23.5～26.5D,18%;>26.5D,1%。术中植入的人工晶状体度数与测量值完全相符的为61%,0.5D≤差值≤2D的为30%,>2D的为9%。人工晶状体度数偏差绝对值与术后视力呈负相关(r=-0.271,P<0.05)。结论:目前防盲手术车上人工晶状体的经验配置比例不合理,≤10D和≥23.5D人工晶状体配备不足;依据人工晶状体的分布状态优化人工晶状体的配置,对提高患者术后裸眼视力有重要的临床意义。

不同手术方式治疗青光眼合并白内障患者的疗效比较

目的对比分析不同手术方式治疗青光眼合并白内障患者的疗效。方法回顾性分析60例(65眼)青光眼合并白内障且分别行单切口(白内障小切口摘除+人工晶体植入+小梁切除术)和双切口(白内障超声乳化吸出+人工晶体植入+小梁切除术)治疗的患者临床资料,比较两种手术方式对患者术后的眼压、视力和并发症的影响。结果所有患者术后眼压较术前明显降低(P<0.05),视力明显改善(P<0.05);两种手术方式对视力、眼压的影响差异无统计学意义(P>0.05),单切口组术后前房炎性反应高于双切口组。结论单切口与双切口两种手术方式均能良好的控制眼压和改善视力,对患者术后的视力和眼压没有影响,但双切口术后并发症较单切口少。

超高龄白内障摘除及人工晶状体植入49例

目的探讨高龄白内障患者行白内障摘除术的安全性及不同术式的临床效果和并发症特点.方法对49例(58眼)85～100岁老人行白内障摘除及人工晶状体植入术.小切口组38例(44眼),超声乳化组11例(14眼).对术后视力及并发症进行比较分析.结果术后早期脱盲率及脱残率,小切口组分别为95%及89%;超声乳化组分别为100%及78%,2组对比均无显著性差异(P＞0.05).角膜水肿发生率,超声乳化组(64%)明显高于小切口组(23%),2组比较有显著性差异(P＜0.05).结论对于高龄患者,小切口非超声乳化白内障摘除及人工晶状体植入术的效果比白内障超声乳化术更具优势.术中心电监护及表面麻醉下白内障手术可降低高龄患者的手术风险.

表麻下的白内障小切口非超声乳化术

目的探讨表面麻醉下小切口白内障非超声乳化手术的安全性和有效性。方法研究组109例(109眼),使用0.4%倍诺喜表面麻醉;对照组79例(79眼),使用传统的球周麻醉。两组均行小切口白内障非超声乳化手术及人工晶状体植入手术。对麻醉的有效性、并发症和手术时间进行分析。结果所有患者均能耐受手术,研究组的麻醉并发症的发生率低于对照组,手术时间也大大缩短。结论表面麻醉下小切口白内障非超声乳化手术是安全有效的,并发症少,简便易行。

表面麻醉用于人工晶状体植入联合小梁切除术

目的 评价表面麻醉在白内障超声乳化及人工晶状体植入联合小梁切除术中的麻醉效果。方法 采用表面麻醉的方法超声乳化白内障摘除联合小梁切除术 2 6例 (2 6眼 )。记录患者在接受表麻、作巩膜隧道、超声乳化术中、虹膜周切、术后这 5个阶段的患者感觉 ,同时记录术中是否有眼睑挤压、眼球转动及其配合程度。结果 2 6例患者中麻醉时无痛和轻微疼痛者为 2 6例 (10 0 % ) ;中等程度疼痛者于超声乳化术中占 1例 ,虹膜周切时占 2例 ,术后占 1例 ,且都能忍受 ;重度疼痛者无 ,88 5 %患者能很好地配合手术 ,术中无麻醉引起的并发症发生。结论 该麻醉方法适用于白内障超声乳化及人工晶状体植入联合小梁切除术 ,不仅避免了球后或球周麻醉的诸多并发症而且使手术变得更加简单。