Trocar opening: silicone oil removal with phacoemulsification and intraocular lens implantation

AIM: To evaluate the efficacy and safety of a modified technique [trocar opening(TO)] for silicone oil removal(SOR) in combination with phacoemulsification and intraocular lens(IOL) implantation.METHODS: A total of 60 eyes of 60 patients with cataract and silicone oil-filled eyes were enrolled in this study. The patients were divided into two groups: the patients in the control group underwent 23-gauge pars plana active SOR surgery with phacoemulsification and IOL implantation, while the patients in the TO group underwent TO methods during surgery. Best corrected visual acuity(BCVA), surgery time, intraocular pressure, and operative complications were observed 6 mo after surgery.RESULTS: There was no significant difference between the two groups in terms of age, gender, preoperative, intraocular pressure, or time of silicone oil stay. Prior to surgery, the mean BCVA for the control and TO groups was 1.34±0.44 and 1.36±0.42. At 6 mo following surgery, the mean BCVA improved to 0.74±0.36 and 0.77±0.32, respectively(P<0.001). There was no significant difference between the two groups. The mean SOR time was 6.9±2.3 min and 4.8±1.2 min in the control and TO groups(P=0.008). The total operation time was 28.2±8.5 min and 24.6±6.4 min, respectively(P=0.035). Posterior capsule rupture occurred in four eyes of control and none of TO group(P<0.01). Late recurrent retinal detachment occurred in one eye in the control group(2 mo after surgery) and in one eye in the TO group(4 mo after surgery). CONCLUSION: TO is a simple, effective, time-saving, and safe method for SOR combined with phacoemulsification and IOL implantation.

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.

Bimanual microincision cataract surgery with implantation of the new Incise~? MJ14 intraocular lens through a 1.4 mm incision

AIM：To analyze the visual outcomes and the posterior capsule opacification（PCO）with the new Incise？MJ14intraocular lens（IOL）implanted through a 1.4 mm clear corneal incision（CCI）in patients who underwent bimanual microincision cataract surgery（B-MICS）.METHODS：Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study：40 eyes were implanted with an Incise？MJ14 IOL through a 1.4 mm CCI（group A）without enlargement of the main CCI,while 40 eyes were implanted with an Akreos？MI60 IOL with enlargement of the main CCI to 1.8 mm（group B）.Best corrected visual acuity（BCVA）,astigmatism and endothelial cell loss were evaluated before and after surgery at 7,30d and 6mo.Anterior segment-optical coherence tomography（AS-OCT）of CCI was performed at 1,3,7,30d,6 and 18mo.PCO incidence was evaluated at 18mo using EPCO 2000 Software.RESULTS：Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups;no statistically significant difference in surgically induced astigmatism（SIA）was noticed in the two groups.At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery;no statistically significant alterations were found at 1,6 and 18mo.PCO score at 18mo was 0.03±0.07for group A and 0.08±0.18 for group B（P=0.11）with no sign of central optic plate invasion in both groups.CONCLUSION：The implant of the new Incise？MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery.PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

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.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM:To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation(phaco-vitrectomy)in idiopathic macular holes(IMH).METHODS:A total of 56 eyes with IMH(IMH group)that underwent phaco-vitrectomy and 44 eyes with age-related cataract(ARC group)that underwent cataract surgery were retrospectively reviewed.The best corrective visual acuity(BCVA),predicted refractive error(PRE),actual refractive error(ARE),axial length(AL),were measured in both groups before and 6 mo after operation.The power calculation of IOL and the predicted refractive error(PRE)were calculated according to the SRK/T formula.The difference of PRE and ARE between the two groups were compared and analyzed.RESULTS:In the IMH group,the diameters of macular holes were 271.73±75.85μm,the closure rate was 100%.The pre-and post-operative BCVA were 0.80±0.35 and 0.40±0.35 log MAR.The PRE of A-ultrasound and IOL Master in the IMH group was-0.27±0.25 and 0.10±0.66 D.The postoperative mean absolute prediction error(MAE)was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound(P=0.758).The PRE and ARE of the IMH group were 0.10±0.66 D and-0.19±0.64 D(P=0.102).The PRE and ARE of the ARC group was-0.43±0.95 and-0.31±0.93 D(P=0.383).The difference between PRE and ARE was-0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups(P=0.021).The proportion of myopic shift was 67.9%in the IMH group and 27.3%in the ARC group(P=0.004).CONCLUSION:The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

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.

Commentary review:challenges of intraocular lens implantation for congenital cataract infants

As an indispensable part of congenital cataract surgery,intraocular lens(IOL)implantation in infantile patients has long-term positive impacts on visual rehabilitation,as well as postoperative complications inevitably.Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery,risks of postoperative complications,and economic condition of family in consideration,and combines with choosing suitable IOL type and power.For infants with well-developed eyeballs and good systemic conditions,IOL implantation at six months of age or older is safe and effective.Otherwise,secondary IOL implantation may be a safer choice.

Long-term follow-up of cataract surgery in eyes filled with silicone oil

AIM:To evaluate the refractive and long-term outcome of eyes filled with silicone oil(SO)undergoing phacoemulsification cataract surgery(PCS).METHODS:This retrospective study evaluated patients with SO tamponade who were scheduled for PCS.RESULTS:Subjects(n=26)were followed for 29.5±13.9 mo after cataract surgery.The median spherical equivalent refraction(SER)was+5.3 D[interquartile range(IQR)+2.9 to+6.7]before PCS,and+3.4 D(IQR+2.0 to+4.4)after PCS.Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes(57.7%).In 13 eyes assessment of refraction after SO-removal was possible,and showed a myopic shift of-4.6 D(IQR-2.9 to-7.3)in the SER.After SO removal,5 of the 13 eyes(38.5%)were within±1.0 D of the target refraction,while 9 out of the 13 eyes(69.2%)were within±2.0 D.CONCLUSION:In our study,the refraction after PCS for eyes filled with SO manifested low predictability,as did the myopic shift following SO removal.A significant percentage of the eyes that underwent SO administration required a long-term tamponade.

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.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Combined Carbon Dioxide Laser Lateral Canthotomy and Femtosecond Laser-Assisted Cataract Surgery

Purpose: The purpose of this study was to evaluate a new procedure aimed at lengthening the palpebral fissure to facilitate femtosecond laser-assisted cataract surgery in patients with small eyes. Method: A quick procedure using the CO2 laser was adapted for patients with small eyes undergoing laser-assisted cataract surgery using the Catalys system. The UniPulse CO2 laser (Nidek) was used for laser lateral canthotomy on patients with small palpebral fissures to allow fitting of the Liquid OpticTM Interface eyepiece. Results: Lateral canthotomies were performed on 19 women and 7 men (ages ranged from 45 to 93 years) with lower eyelid lengths equal to or shorter than 32 mm who then underwent femtosecond laser-assisted cataract surgery. A total of 33 eyelids received laser lateral canthotomy with the CO2 laser;only one eyelid had lateral canthotomy with cold-steel tenotomy scissors. Dockings were completed for all 34 eyes with eyelids receiving lateral canthotomies. The 33 eyes with eyelids that received laser canthotomy with the CO2 laser had successful femtosecond laser-assisted cataract surgery. The one eye with the eyelid that received cold-steel canthotomy could not have femtosecond laser-assisted cataract surgery despite successful docking because of pupillary constriction. The findings were statistically significant;Fisher Exact Test showed a p-value of 0.0294. Conclusion: Laser lateral canthotomy with CO2 laser is a safe and effective method to allow docking and completion of femtosecond laser-assisted cataract surgery.

Multifocal and extended depth of focus intraocular lenses

Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.

超声乳化吸除术联合房角分离术治疗PACG滤过术后眼压失控的临床疗效观察

目的探讨超声乳化吸除术(Phaco)+人工晶状体(IOL)植入联合房角分离术治疗原发性闭角型青光眼(PACG)滤过术后眼压失控的临床疗效。方法回顾性病例研究。对2020年8月至2022年5月收治的24例(25只眼)PACG滤过术后眼压失控患者,采用Phaco+IOL植入联合房角分离术治疗,比较术前、术后1 d、1周、1个月、3个月、6个月的眼压情况,术前及6个月最佳矫正视力(BCVA)、房角粘连性关闭(PAS)范围变化情况。记录术中、术后并发症情况。结果术后1 d、1周、1个月、3个月、6个月眼压、PAS范围均显著低于术前,差异具有统计学意义(均P<0.05);术后6个月视力较术前21例(22只眼)BCVA提高,3例(3只眼)BCVA无变化;术中10只眼发生前房出血,术后6只眼发生短暂性前房出血,15只眼发生前房渗出,8只眼发生角膜水肿。结论Phaco+IOL植入联合房角分离术治疗PACG滤过术后眼压失控能够有效降低眼压,提高患者视力,是安全有效的治疗方法。

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。