Current practice for intraocular lens （IOL） exchange is to cut the optic of the posterior chamber intraocular lens （PCIOL） prior to removing it. Great care must be taken during this maneuver to avoid a posterior c...Current practice for intraocular lens （IOL） exchange is to cut the optic of the posterior chamber intraocular lens （PCIOL） prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable （one-piece acrylic） IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device （OVD） in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.展开更多
AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis w...AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.展开更多
One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from internal impingement. "Internal impingement" is a term used to describe a constellation...One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from internal impingement. "Internal impingement" is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial,involving physiologic shoulder remodeling,posterior capsular contracture,and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up,decline in performance,or posterior shoulder pain. On physical examination,patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic "Bennett lesion" on radiographs,as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology,but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed,therefore intense non-operative treatment should remain the focus of treatment.展开更多
文摘Current practice for intraocular lens （IOL） exchange is to cut the optic of the posterior chamber intraocular lens （PCIOL） prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable （one-piece acrylic） IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device （OVD） in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.
基金Supported by Youth Research Project of the Fujian Provincial Health Commission (No.2019-1-94)the Startup Fund for Scientific Research, Fujian Medical University (No.2018QH170)。
文摘AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.
文摘One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from internal impingement. "Internal impingement" is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial,involving physiologic shoulder remodeling,posterior capsular contracture,and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up,decline in performance,or posterior shoulder pain. On physical examination,patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic "Bennett lesion" on radiographs,as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology,but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed,therefore intense non-operative treatment should remain the focus of treatment.
