AIM:To evaluate the effects and safety of phacoemu-lsification(Phaco) or small-incision extracapsular cataract surgery(SICS) and intraocular lens(IOL) implantation for aged patients.METHODS:Totally 137 aged patients(1...AIM:To evaluate the effects and safety of phacoemu-lsification(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(χ2=259.730,P<0.001).For aged patients,both Phaco and SICS could significantly improve visual acuity with no significant difference(χ2=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(χ2=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.展开更多
AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A c...AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A case-controlled clinical study was performed.Twenty right eyes of 20 moderate and high hyperopia patients underwent s LIKE(s LIKE group)and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK(FS-LASIK group)were enrolled in this study from October 2015 to October 2017.Visual acuity,refractive error,corneal thickness,and keratometry were compared between the groups before and 1 y postoperatively.RESULTS:The postoperative uncorrected near visual acuity(UNVA)and uncorrected distance visual acuity(UDVA)were improved in the two groups.The UNVA reached J1 in 15 eyes(75.0%)in the s LIKE group and 5 eyes(22.7%)in the FS-LASIK group 1 y after surgery(χ2=11.476,P=0.001).The UDVA was equal or better than the preoperative CDVA in 16 eyes(80.0%)in the s LIKE group and 8 eyes(36.4%)in the FS-LASIK group,respectively(X2=8.145,P=0.004).No eyes lost any line of best-corrected visual acuity(BCVA)in either group.The amount of postoperative residual hyperopia in the s LIKE group was significantly less than in the FS-LASIK group(Z=-2.841,P=0.004).The postoperative keratometry and corneal thickness were significantly higher in the s LIKE group than in the FS-LASIK group(t=4.411,10.279,P<0.001).The SRI and SAI of the s LIKE group were significantly higher than that in the FS-LASIK group.There was no statistically significant difference in mean decentration between the two groups.CONCLUSION:s LIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.展开更多
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 pa...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.展开更多
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...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.展开更多
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 ...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.展开更多
AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extracti...AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extraction(FLEx).· METHODS: A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio(OR) or weighted mean differences(WMD). Of 95% confidence intervals(CI) were used to analyze data.·RESULTS: A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity(UDVA) 20/20 or better(OR, 1.37; 95% CI0.69 to 2.69; P =0.37) and log MAR UDVA(WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17) after SMILE versus FLEx We found no differences in corrected distance visua acuity(CDVA) unchanged(OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97) and log MAR CDVA(WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90) either. Secondly, we found no differences in refraction within ±1.00 D(OR, 0.98; 95% CI0.13 to 7.28; P =0.99) and ±0.50 D(OR, 1.62; 95% CI0.62 to 4.28; P =0.33) of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations(WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14), coma(WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11), spherical(WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60) and trefoil(WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76). Furthermore, for corneal biomechanica parameters, we also found no differences(WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54) after SMILE versus FLEx.·CONCLUSION: There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.展开更多
Background:Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures.We decided to perform a comparative study to standard manual incision phacoemulsification sur...Background:Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures.We decided to perform a comparative study to standard manual incision phacoemulsification surgery.Methods:This is a single-center,single-intervention,and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery.Group-A(Phaco),manual capsulorhexis&ultrasound phacoemulsification(n=66);Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation(n=67),employing the LenSx laser(Alcon Surgical,Ft.Worth,TX).All cases were evaluated for refraction,visual acuity,keratometry,tomography,pachymetry,endothelial cell counts,intraocular pressure,and type of intraocular lens(IOL)implanted.The groups were matched for age,gender,pre-operative vision metrics,and cataract grade,and were followed up to 1 year.Results:In group-A post-operative uncorrected distance visual acuity(UDVA)was 20/20 or better in 61.5%and 20/25 or better in 78.5%of the eyes.The femtosecond laser group-B had improved outcomes(p=0.075 and p=0.042,respectively):post-operative UDVA was 20/20 or better in 62.7%of the eyes and 20/25 or better in 85.1%.Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients(r^(2)=0.983 in group-A and 0.979 in group-B).There were 75.2%cases in group-A and 80.6%in group-B(p=0.8732)within±0.50 D of targeted refractive equivalent.Slight trend of under-correction was noted in group-A.Average residual manifest cylinder in the toric subgroup-A was-0.50 D(95%Limit-of-Agreement(LoA)=-0.78 D),and in toric subgroup-B-0.45 D(LoA=-0.45 D).Conclusions:Mean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis&ultrasound phacoemulsification.Improved astigmatism correction may be among the benefits of femtosecond laser–assisted cataract surgery.Transient corneal edema may be a first day transient disadvantage in femtosecond laser–assisted cataract surgery.展开更多
文摘AIM:To evaluate the effects and safety of phacoemu-lsification(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(χ2=259.730,P<0.001).For aged patients,both Phaco and SICS could significantly improve visual acuity with no significant difference(χ2=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(χ2=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.
基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding(No.XMLX201614)。
文摘AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A case-controlled clinical study was performed.Twenty right eyes of 20 moderate and high hyperopia patients underwent s LIKE(s LIKE group)and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK(FS-LASIK group)were enrolled in this study from October 2015 to October 2017.Visual acuity,refractive error,corneal thickness,and keratometry were compared between the groups before and 1 y postoperatively.RESULTS:The postoperative uncorrected near visual acuity(UNVA)and uncorrected distance visual acuity(UDVA)were improved in the two groups.The UNVA reached J1 in 15 eyes(75.0%)in the s LIKE group and 5 eyes(22.7%)in the FS-LASIK group 1 y after surgery(χ2=11.476,P=0.001).The UDVA was equal or better than the preoperative CDVA in 16 eyes(80.0%)in the s LIKE group and 8 eyes(36.4%)in the FS-LASIK group,respectively(X2=8.145,P=0.004).No eyes lost any line of best-corrected visual acuity(BCVA)in either group.The amount of postoperative residual hyperopia in the s LIKE group was significantly less than in the FS-LASIK group(Z=-2.841,P=0.004).The postoperative keratometry and corneal thickness were significantly higher in the s LIKE group than in the FS-LASIK group(t=4.411,10.279,P<0.001).The SRI and SAI of the s LIKE group were significantly higher than that in the FS-LASIK group.There was no statistically significant difference in mean decentration between the two groups.CONCLUSION:s LIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.
基金Supported by Research and Developmental Fund, Prapokklao Hospital (No.0011)
文摘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.
基金Supported by National Natural Science Foundation of China,No.81660169The Education Teaching Reform Project of First Clinical Department of Zunyi Medical College,No.202009.
文摘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.
文摘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.
文摘AIM: To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction(SMILE) and femtosecond lenticule extraction(FLEx).· METHODS: A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio(OR) or weighted mean differences(WMD). Of 95% confidence intervals(CI) were used to analyze data.·RESULTS: A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity(UDVA) 20/20 or better(OR, 1.37; 95% CI0.69 to 2.69; P =0.37) and log MAR UDVA(WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17) after SMILE versus FLEx We found no differences in corrected distance visua acuity(CDVA) unchanged(OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97) and log MAR CDVA(WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90) either. Secondly, we found no differences in refraction within ±1.00 D(OR, 0.98; 95% CI0.13 to 7.28; P =0.99) and ±0.50 D(OR, 1.62; 95% CI0.62 to 4.28; P =0.33) of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations(WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14), coma(WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11), spherical(WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60) and trefoil(WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76). Furthermore, for corneal biomechanica parameters, we also found no differences(WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54) after SMILE versus FLEx.·CONCLUSION: There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.
基金Unrestricted Funding from Alcon Laboratories(IIT 10247941).
文摘Background:Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures.We decided to perform a comparative study to standard manual incision phacoemulsification surgery.Methods:This is a single-center,single-intervention,and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery.Group-A(Phaco),manual capsulorhexis&ultrasound phacoemulsification(n=66);Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation(n=67),employing the LenSx laser(Alcon Surgical,Ft.Worth,TX).All cases were evaluated for refraction,visual acuity,keratometry,tomography,pachymetry,endothelial cell counts,intraocular pressure,and type of intraocular lens(IOL)implanted.The groups were matched for age,gender,pre-operative vision metrics,and cataract grade,and were followed up to 1 year.Results:In group-A post-operative uncorrected distance visual acuity(UDVA)was 20/20 or better in 61.5%and 20/25 or better in 78.5%of the eyes.The femtosecond laser group-B had improved outcomes(p=0.075 and p=0.042,respectively):post-operative UDVA was 20/20 or better in 62.7%of the eyes and 20/25 or better in 85.1%.Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients(r^(2)=0.983 in group-A and 0.979 in group-B).There were 75.2%cases in group-A and 80.6%in group-B(p=0.8732)within±0.50 D of targeted refractive equivalent.Slight trend of under-correction was noted in group-A.Average residual manifest cylinder in the toric subgroup-A was-0.50 D(95%Limit-of-Agreement(LoA)=-0.78 D),and in toric subgroup-B-0.45 D(LoA=-0.45 D).Conclusions:Mean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis&ultrasound phacoemulsification.Improved astigmatism correction may be among the benefits of femtosecond laser–assisted cataract surgery.Transient corneal edema may be a first day transient disadvantage in femtosecond laser–assisted cataract surgery.