Small-incision lenticule extraction versus femtosecond lenticule extraction for myopic:a systematic review and Meta-analysis

AIM： To examine differences in efficacy, accuracy, safety, aberrations and corneal biomechanical between Small incision lenticule extraction （SMILE） and femtosecond lenticule extraction （FLEx） for myopia. METHODS： Comprehensive studies were conducted on the PubMed, MEDLINE, EMBASE, and Cochrane Controlled Trials Register before 31 July, 2015. Meta-analyses were performed on the primary outcomes [loss of ≥2 lines of corrected distance visual acuity （CDVA）, uncorrected distance visual acuity （UDVA） ≥20/20, spherical equivalent （SE） within ±0.50 diopters （D）, final refractive SE], secondary outcomes were high-order aberrations （HOAs） and corneal biomechanical [central corneal thickness （CCT）, corneal hysteresis （CH） and corneal resistance factor （CRF）]. RESULTS： Seven trials describing a total of 320 eyes with myopia were included in this Meta-analysis. No significant differences were found in the efficacy [UDVA weighted mean difference （WMD） -0.01; 95%CI： -0.04 to 0.01; P=0.37, UDVA ≥20/20, OR 1.49; 95%CI： 0.78 to 2.86; P=0.23], accuracy （SE WMD -0.03; 95%CI： -0.12 to 0.07; P=0.58 , SE within ±0.5 D OR 1.25; 95%CI： 0.34 to 4.65; P=0.74）, HOAs （WMD -0.04; 95%CI： -0.09 to 0.01; P=0.14） and CCT WMD 1.83; 95%CI： -7.07 to 10.72; P=0.69, CH WMD -0.01; 95%CI： -0.42 to 0.40; P=0.97, CRF WMD 0.17; 95%CI： -0.33 to 0.67; P=0.50） in the last fellow-up. But for safety, FLEx may achieve fewer CDVA lost two or more two lines （OR 11.11; 95%CI： 1.27 to 96.86; P=0.03） than SMILE, however CDVA （WMD 0.00; 95%CI： -0.03 to 0.02; P=0.77） is similar. CONCLUSION： SMILE and FLEx are comparable in terms of both efficacy, accuracy, aberrations and corneal biomechanical measures in the follow-up,but FLEx seems to be better in safety measures. The results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering

AIM： To investigate cap morphology after small-incision lenticule extraction （SMILE） and its effects on intraocular scattering. METHODS： Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at ld, lwk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System （OQAS） values, and objective scattering index （OSI）, were evaluated using OQASTM. RESULTS： Cap thickness decreased from ld to lwk （P〈0.001）, but remained higher than intended thickness of 120 μm after 3mo （P〈0.001）. Cap thickness in central area was thinner than that of in the paracentral and peripheral areas （P〈0.0001）. Total number of microdistortions decreased from ld to 3mo （P〈0.0001）. Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at ld and lmo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at ld and lmoafter surgery. CONCLUSION： The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.

Delayed diffuse lamellar keratitis after small-incision lenticule extraction related to immunoglobulin A nephropathy:A case report

BACKGROUND Diffuse lamellar keratitis(DLK)is a complication of laser-assisted in situ keratomileusis(LASIK).This condition can also develop after small-incision lenticule extraction(SMILE)with a distinctive appearance.We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A(IgA)nephropathy.CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE.The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye.She was immediately administered with a large dose of a topical steroid for 30 d.However,the treatment was ineffective.Her vision deteriorated from 10/20 to 6/20,and DLK gradually worsened from grade 2 to 4.Eventually,interface washout was performed,after which her vision improved.DLK completely disappeared 2 mo after washout.Six months after SMILE,the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE.Topical steroid therapy was ineffective in our patient,and interface washout was required.IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.

Efficacy of combined cataract extraction and endoscopic cyclophotocoagulation for the reduction of intraocular pressure and medication burden

AIM： To report on the efficacy of combined endoscopic cyclophotocoagulation（ECP） and phacoemulsification cataract extraction（PCE） with intraocular lens placement for reduction of intraocular pressure（IOP） and medication burden in glaucoma.·METHODS： A retrospective case review of 91 eyes（73patients） with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded,as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits（at 1, 3, 6, or 12 mo postoperatively）,IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within12 mo after PCE/ECP.·RESULTS： Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo（P 0.0001）. Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo（P =0.0003）. At 3mo postoperatively,the success rate was 73.6%（95%CI： 63.3, 81.5）, 57.1% at6mo（95% CI： 46.3, 66.6）, and 49.7% at 12mo（95% CI：38.9, 59.6）. Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.· CONCLUSION： Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients withhigher baseline IOP levels are most likely to benefit from this procedure.

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.

Inhibitory Effect of Short-Term Palpebral Margin Cleaning with Antibiotic Eye Drops on Ocular Surface Flora before Cataract Extraction:A New Preoperative Antibacterial Method

Objective To explore the clinical significance of the combined application of palpebral margin cleaning and antibiotic eye drops in inhibiting bacterial growth in the palpebral margin and conjunctival sacs before cataract extraction.Methods In this study,61 patients(97 eyes)with age-related cataract who underwent phacoemulsification and intraocular lens implantation were selected,and randomly grouped.In the experimental group,the combined application of palpebral margin cleaning with cotton pads and levofloxacin eye drops was given for three days before the surgery.In the control group,levofloxacin eye drops alone were applied for three consecutive days.Bacteria samples from the conjunctival sac and eyelid margins were cultivated and identified before and three days after taking antimicrobial measures,respectively.Results In the experimental group,the positive rates of the two bacteria samples were 100%(50/50)and 40%(20/50)before and 10%(5/50)and 0%(0/50)after the treatment.In the control group,the positive rates of the two bacteria samples were 97.9%(46/47)and 29.8%(14/47)before and 40.4%(19/47)and 10.6%(5/47)after the treatment.The positive rates between the two groups were not significantly different before taking antimicrobial measures(P=0.485 and 0.395),while they were significantly different after taking antimicrobial measures(P=0.001 and 0.024).Conclusion Combined application of eyelid and palpebral margin cleaning with cotton pads and antibiotic eye drops before cataract extraction imparted excellent antibacterial effects.

Liquefaction for cataract extraction

A systematic review of the recent literature regarding the implementation of the liquefaction in cataract surgery and its short-term and long-term outcomes in various parameters that affect the quality of patients＂ life, including visual rehabilitation and possible complications was performed based on the PubMed, Medline, Nature and the American Academy of Ophthalmology databases in November 2013 and data from 14 comparative studies were included in this narrative review. Liquefaction is an innovative technology for cataract extraction that uses micropulses of balanced salt solution to liquefy the lens nucleus. Most studies reported that liquefaction is a reliable technology for mild to moderate cataracts, while fragmentation difficulties may be encountered with harder nuclei.

Graft survival and visual outcome after simultaneous penetrating keratoplasty and cataract extraction

AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. ·RESULTS: The mean age of patients was 61 years. The mean overall follow -up was 27 months. The most common indications for surgery were corneal scarring (45.5% ), previous failed graft (15.8% ), corneal ulcer (12.9% ), Fuchs endothelial dystrophy (8.9% ), stromal dystrophy (2.9% ), and other conditions (14.5% ). Overall, 69 grafts (68.3% ) remained clear at final follow -up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P 】0.05). The graft rejection rate (17.8% ) was a significant risk factor for failure (P =0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P 】0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P 【0.01). ·CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.

More than 10 Years of Experience with Immediate Sequential Bilateral Cataract Extraction (ISBCE)--A Retrospective Study

Background: To evaluate the safety of immediate sequential bilateral cataract extraction (ISBCE) with respect to indications, visual outcomes, complications, benefits and disadvantages. Methods: This is a retrospective review of all ISBCEs performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 500 eyes of 250 patients were reviewed. Of these 500 eyes, 472 (94.4%) had a straight forward phacoemulsification with posterior chamber intraocular lens implantation;21 (4.2%) had a planned extracapsular cataract extraction;4 (0.8%) had an intracapsular cataract extraction and 3 (0.6%) had a combined phacoemulsification with trabeculectomy. Results: Over 66% of eyes achieved improved visual acuity (at least 3 Snellen lines) following ISBCE. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR;the interquartile range was [0.4, 1] LogMAR. At one week control the median BCVA was 0.3 LogMAR, IQR [0.1, 0.5] LogMAR. At one month the median BCVA was 0.15 LogMAR, IQR [0.05, 0.3] (p < 0.01). There were no sight-threatening intraoperative or postoperative complications observed. Conclusions: ISBCE is an effective and safe option with high degree of patient satisfaction. The relative benefits of ISBCE should be balanced against the theoretically enhanced risks.

Visual outcome of manual small-incision cataract surgery:comparison of modified Blumenthal and Ruit techniques

AIM:To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery(MSICS).· METHODS:This was a prospective,non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision,i.e.,the Blumenthal technique(group 1,n = 64) or a temporal scleral tunnel incision,i.e.,the Ruit technique(group 2,n =65).MSICS and intraocular lens implantation were performed through an unsutured 6.5-to 7.0-mm scleral tunnel incision.Uncorrected and corrected visual acuity,intraoperative and postoperative complications,and surgically induced astigmatism calculated by simple subtraction were compared.Patients were examined at 1 day,1 week,1 month,and 3 months after surgery.· RESULTS:Both groups achieved good visual outcome with minor complications.Three months after surgery,the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group(P =0.29).The average(SD) postoperative astigmatism was 0.87(0.62) diopter(D) for the Blumenthal group and 0.86(0.62) D for the Ruit group.The mean(SD) surgically induced astigmatism was 0.55(0.45) D and 0.50(0.44) D for the Blumenthal and Ruit groups,respectively(P =0.52).Common complications were minimal hyphema and corneal edema.There was no statistically significant difference in the complication rate between the groups(P >0.05).· CONCLUSION:In MSICS,both the Blumenthal and Ruit techniques achieved good visual outcomes,with low complication rates.

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery

AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

Self-management of cataract extraction among diabetes patients

Background:Diabetes-related cataract extraction is a minor surgery required to regain full vision.One of the recognized factors that can delay or prevent full-vision recovery is poor management,and most of this management is being carried out by patients themselves.Objective:This study aimed to assess the knowledge of diabetes patients on self-management after cataract extraction in two tertiary hospitals in Osun State.Methods:A cross-sectional descriptive design was conducted among 97 diabetes patients who underwent cataract extraction and were attending clinics and follow-up visits in Osun State.A self-structured questionnaire was used for data collection.Results:Moderate knowledge was found among the participants on an appropriate diet(56.7%),prevention of injury risk(57.5%),prevention of infection risk(50.9%),and low knowledge on the technique of administration of eye drop(60.8%)after cataract extraction,whereas 74.7%of the total respondents were knowledgeable on the indication for follow-up visit after cataract extraction,these results were found to be below the expected knowledge level.Conclusion:An intensive and comprehensive educational initiative by nurses should be tailored to meet the specific needs of diabetes patients with cataract surgery.Nurses also need to implement the use of checklist which will enhance learning and improve patient understanding of self-management after cataract extraction.

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract:a randomized clinical trial

●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.

Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective:To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients.Methods:96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A(ultrasonic emulsification)and group B(small-incision extracapsular cataract extraction),with 48 cases each.Results:At 1 week,1-month,and 3 months post-operation,the visual acuity of group A was higher and the astigmatism value was lower than that of group B(P<0.05);at 12h,24h,and 48h post-operation,the intraocular pressure of group A was higher than that of group B(P<0.05);the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation(P<0.05).Conclusion:Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism,improving visual acuity,and regulating macular thickness.However,due to the high energy of ultrasonic emulsification,the risk of complications such as high postoperative intraocular pressure was higher.Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts： Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty

Background： The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. Methods： A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty （PKP） eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density （ECD）, and best-corrected visual acuity （BCVA） were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Results： Of the 54 eyes included in this study, extracapsular cataract extraction （ECCE） was performed in 34 eyes of 33 patients （ECCE group） whereas phacoemulsification was performed in 20 eyes of 20 patients （phacoemulsification group）. There was no signifcant difference in the median age （P = 0.081） or preoperative ECD （P = 0.585） between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group （P = 0.043）. In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months （P = 0.018）, 4 months （P 〈 0.001）, and 6 months （P 〈 0.001） after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group （P 〈 0.001） and phacoemulsification group （P 〈 0.001）, but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts （P 〈 0.001）. There was no signifcant difference in postoperative BCVA between the two groups （P = 0.065）. Conclusion： ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

Cataract extraction in eyes with Fuchs’endothelial dystrophy in China

It is a common belief that Fuchs' endothelial dystrophy predominantly affectsCaucasians but rarely Asians. However, in one Japanese study, primary corneal guttae (first stageof Fuchs ' dystrophy) were found in four of 107 cataract patients. With the growing popularity ofphacoemulsification in China in the past decade, the increased incidence of endothelialdecompensation may be due to learning curves among surgeons as well as that the prevalence of Fuchs'dystrophy among Chinese is higher than we thought. Low index of suspicion for Fuchs' dystrophy mayresult in missing of diagnosis and occurrence of endothelial decompensation, particularly when noextra protection is provided for endothelial cells during phacoemulsification. This study was aimedat improving our knowledge about Fuchs' dystrophy among Chinese population and reminding surgeons ofextra endothelial protection during cataract surgery for patients with Fuchs' dystrophy.

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.

Inhibitory Effects of Grape Seed Proanthocyanidin Extract on Selenite-induced Cataract Formation and Possible Mechanism

This study investigated the inhibitory effect of grape seed proanthocyanidin extract(GSPE) on selenite-induced cataract formation in rats and the possible mechanism.Eighty 8-day-old Sprague-Dawley rats were divided randomly into 5 groups:control group,model group,three GSPE groups(low dose,medium dose and high dose).Control group received subcutaneous injection of physiological saline.Model group was given subcutaneous injection of sodium selenite(20 μmol/kg body weight) on the postpartum day 10,and once every other day for consecutive three times thereafter.GSPE treated groups were respectively administered GSPE at doses of 50,100,and 200 mg/kg body weight intragastrically 2 days prior to the selenite injection(that was,on the postpartum day 8),and once daily for fourteen consecutive days thereafter.The opacity of lenses was observed,graded and photographed under the slit lamp microscopy and the maximal diameter of the nuclear cataract plaques was measured.The lenses were analyzed for superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-PX),malondialdehyde(MDA),calcium(Ca 2+),nitric oxide(NO) and anti-hydroxyl radical ability(anti-OH).The histomorphology of lenses was observed with HE staining under a light microscope.The levels of calpainⅡ,and iNOS protein and mRNA expression in lenses were detected by using immunohistochemistry and real-time quantitative RT-PCR.The results showed subcutaneous injection of sodium selenite led to severe nuclear cataract in model group,and the achievement ratio of model group was 100%.As compared with model group,the degree of lenses opacity and the maximal diameter of nuclear cataract plaques were significantly reduced in GSPE-treated groups.Moreover,we observed selenite treatment caused a significant decrease in the activities of antioxidative enzymes(SOD,CAT,GSH-PX) and anti-OH ability,accompanied by a significant increase in the levels of MDA,NO,Ca 2+ as well as iNOS,and calpainⅡ protein and mRNA expression.Administration of GSPE could dose-dependently preserve the activities of these antioxidative enzymes and anti-OH ability,accompanied by a significant reduction in the levels of MDA,NO,Ca 2+ as well as iNOS,and calpainⅡ protein and mRNA expression.These results suggested that GSPE markedly prevented selenite-induced cataract formation probably by suppressing the generation of lipid peroxidation and free radicals as well as the activation of iNOS,and calpainⅡ in the lenses.

激光辅助巩膜切除及白内障摘除联合房角分离治疗闭角型青光眼

目的探究激光辅助巩膜切除及白内障摘除联合房角分离治疗闭角型青光眼的临床疗效。方法选择闭角型青光眼患者162例为研究对象,分为观察组81例行激光辅助巩膜切除及白内障摘除联合房角分离术,对照组81例行白内障摘除联合房角分离术,观察两组患者治疗效果。结果观察组患者术后视力、BCVA、房角宽度、角膜内皮细胞计数高于对照组,眼压、中央前房深度、角膜厚度均低于对照组,观察组不良反应发生率(6.2%)低于对照组(13.6%)。术后随访,两组眼压均无再升高,对照组滤过泡高度降低无观察组明显;术后1个月观察组BCVA、角膜内皮细胞计数高于对照组(P<0.05),角膜厚度低于对照组(P<0.05),术后3个月、6个月差异均无统计学意义;散光情况术后3个月观察组优于对照组,术后1个月、6个月差异无统计学意义(P>0.05)。结论激光辅助巩膜切除及白内障摘除联合房角分离术治疗闭角型青光眼临床效果好,安全性高。

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.