Objective To observe the incidence and related factors of macula hole retinal detachment（MHRD）after phacoemulsification cataract extraction and intraocular lens（IOL）implantation. Methods The clinical data of 10 076 patients(13 625 eyes) who underwent phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. There are 1228 patients (1853 eyes) with high myopia. All the patients were examined by routine slitlamp microscopy, ophthalmoscopy as well as A- or B-scan ultrasonography. The phacoemulsification cataract extraction with transparent cornea incision or scleral tunnel incision, combined with intraocular lens implantation was performed in all the patients. The followup was ranged from 12 to 126 months, with a mean of （48.2plusmn;31.1）months. The MHRD was confirmed by the examinations of the fundus, B-scan ultrasonography and optical coherence tomography. The incidence of postoperative MHRD and the risk factors were analyzed. Results 10/13 625 eyes (0.073％) with MHRD were observed. 7/1853 high myopia eyes (0.378%) with MHRD were observed. The occurrence time of MHRD was ranged from 9 to 74 months after surgery, with a mean of 38.5 months. The cumulative risk was estimated at 0.16％ (95% confidence interval, 0.05% -0.27%).Conclusions The incidence of MHRD after phacoemulsification cataract extraction combined with intraocular lens implantation is 0073%. The MHRD incidence of high myopia eyes is 0.378%. High myopia may be the risk factor for MHRD.
Objective To observe the clinical characteristics and therapeutic effect of aphakic retinal detachment (ARD) eyes and pseudophakic retinal detachment (PPRD) eyes.Methods The clinical data of 805 patients,including 321 ARD and 484 PPRD eyes were retrospectively analyzed.The patientsprime;visiual acuity, refraction, intraocular pressure were examined, and the patients also underwent slit lamp microscopy and direct and (or) indirect ophthalmoscopy.The preoperative bestcorrected visual acuity (BCVA) was between light perception (LP) and 0.6.Mainly according to the PVR grade and retinal holes position to take the scleral buckling or vitrectomy combined with scleral buckling. The 805 eyes were divided into 1995-1999 group (243 eyes) and 20002007 group (562 eyes) according to operative time.The follow-up ranged from 3 to 25 months, with an average of 12.3 months.The success standard of surgery was set as anatomic retinal reattachment and the last follow-up time was considered as the judgment time.The surgical complications were recorded at each followup time points. The composition of PPRD,the visual acuity,ocular lesions, surgical methods and results before operation and visual acuity after operation in two groups were analyzed and compared by MantelHaenszel chisquare test. Results The average interval from lens extraction to RD occurrence was 15.4 months in PPRD eyes and 39.1 months in ARD eyes. The final total anatomic success rate was 95.9%, and was 93.5% in the scleral buckle eyes and 97.2% in vitrectomy eyes.The BCVA was better than 0.3 after operation only in 11.9% of the 805 patiens,and the visual acuity increased more than 2 lines in 67.3%. Compared with the ARD eyes,early onset, high proportion of total posterior vitreous detachment,severe PVR,wide RD range,low detection rate of retinal hole and low antomic success rate were found in PPRD eyes.Compared with the 1995-1999 group,the proportion of vitreous surgery,anatomic success rate and better visual acuity were found in 2000-2007 group.Conclusions The ocular lesions of ARD and PPRD is more complicated,the therapeutic effect are improving in recent years.
Objective To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract. Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration. Results A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(Plt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (Plt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, Plt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, Plt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.
Objective To evaluate the effects of intraocular lenses (IOL) of silicone and polymethylmethacrylate (PMMA) on posterior capsule opacification (PCO). Methods We searched MEDLINE (1966 to 2003), EMBASE (1980 to 2003), Cochrane Central Register of Controlled Trials (Issue 1, 2003) and CBMdisc (1979 to 2003). Only randomized controlled trials (RCTs) were identified. Two reviewers independently assessed the quality of the included trial and extracted data. The following outcomes were assessed: PCO index, percentage of neodymium: YAG (Nd: YAG) laser posterior capsulotomy and visual acuity after cataract surgery. RevMan 4.2 was used for meta-analysis.Results Nine RCTs including 672 eyes were included. In patients with senile cataract, the results of meta-analysis suggested that silicone lens were better than PMMA lens on PCO index (the pooled SMD=－0.92, 95%CI －1.19 to －0.64) and percentage of Nd: YAG (the pooled OR 0.35, 95%CI 0.22 to 0.57) with a statistically significant difference, but there was no significant difference on visual acuity (the pooled OR 1.22, 95%CI 0.43 to 3.50) after cataract surgery between silicone lens and PMMA lens. However, in patients with uveitic cataract, the results of meta-analysis showed that PMMA lens were better than silicone lens in visual acuity (the pooled OR 0.38, 95%CI 0.15 to 0.91) after cataract surgery with a statistically significant difference, but there was no significant difference on PCO index (SMD 0.23, 95%CI －0.59 to 1.05) and percentage of Nd: YAG (the pooled OR 1.82, 95%CI 0.47 to 6.95) between silicone lens and PMMA lens. Conclusions Current evidence indicates that silicone lens are superior to PMMA lens in reducing PCO. Further trials with high quality on methodology are required.
【摘要】 目的 观察在表面麻醉下不作结膜瓣和传统的以穹窿为基底结膜切开的小切口白内障摘除联合5.5 mm直径人工晶状体植入术的临床效果。 方法 收集2007年1月－2010年12月资料较完整的老年性白内障160例，将160例320只眼随机分成两组，每组各80例160只眼。在表面麻醉下行小切口白内障手术。A组不做结膜瓣，行长5.5 mm角巩膜缘的平行切口； B组行以穹窿为基底的传统的结膜瓣，做长5.5 mm角巩膜平行切口；两组均行手法小切口白内障劈核摘除联合5.5 mm直径硬质人工晶状体植入。观察术后效果及术后并发症。 结果 术后1个月，患者眼部舒适者:A组154只眼（96.25%），B组141只眼（88.13%），两组差异有统计学意义（χ2=7.332，Plt;0.05）。术后结膜退缩、下垂、巨大瘢痕：A组7只眼（4.38%），B组29只眼（18.13%），两组差异有统计学意义（χ2=15.149，Plt;0.01），两组患者术后1 d、1周及1个月视力比较：1 d，A组120只眼（75.00%），B组128只眼（80.00%）（χ2=1.467，Pgt;0.05）；1周，A组130只眼（81.25%），B组132只眼（82.25%）（χ2=0.084，Pgt;0.05）；1个月，A组138只眼（86.25%），B组139只眼（86.86%）（χ2=0.027，Pgt;0.05）；角膜水肿于术后2周后均消退。 结论 在表面麻醉下不做结膜瓣较做结膜瓣小切口白内障劈核摘除术联合人工晶状体植入术省时、对眼表面破坏小，角巩膜切口较小且较为隐闭，术后恢复快。在基层医院是一种较好的白内障手术方法。【Abstract】 Objective To observe the clinical effect of non-conjunctival flaps and traditional conjunctival flaps choper extracapsular cataract extraction (ECCE) on patients with senile cataracts. Methods The clinical data of 160 patients with cataracts between January 2007 and December 2010 were collected. The patients were randomly divided into two groups with 80 patients (160 eyes) in each group. The patients in group A underwent the small-incision choper ECCE surgery with non-conjunctival flaps; while the patients in group B underwent the traditional conjunctival flaps. Then the total effective rate, incidence of complications, and satisfaction rate of the two groups were analyzed and compared. Results One month after the surgery, the comfort was found in 154 eyes (96.25%) in group A and in 141 eyes (88.13%) in group B; the difference was significant (χ2=7.332，Plt;0.05). The complications after the surgery including conjunctiva retraction, nutation, and huge scar were found in 7 eyes (4.38%) in group A and in 29 eyes (18.13%) in group B, and the difference was significant (χ2=15.149，Plt;0.01) . The visual acuity of the patients one day, one week and one month after the surgery in the two groups were: one day: 120 eyes (75.00%) in group A and 128 eyes (80.00%) in group B (χ2=1.467，Pgt;0.05); one week: 130 eyes (81.25%) in group A and 132 eyes (82.25%) in group B (χ2=0.084，Pgt;0.05); one month: 138 eyes (86.25%) in group A and 139 eyes (86.86%) in group B (χ2=0.027，Pgt;0.05). The cornea edema was alleviated half month after the surgery. Conclusion Compared with the traditional way, non-conjunctival flaps ECCE may save the surgical time, reduce the damage of the ocular surface, improve the visual acuity and received higher satisfaction rate and less conjunctive complication, which is a good surgical method in local hospital.
To simplify the production process of intraocular lens (IOL) and to solve the problem of lacking adjustable ability, we proposed a novel soft IOL with large-scale adjustable ability and rigid haptics based on heat-assisted method, and gravity-assisted method. Polydimethylsiloxane (PDMS) and rigid material——polymethyl methacrylate (PMMA) were used as the materials for fabricating optical lens (PDMS) and haptics (PDMS and PMMA) through changing the weight ratio of the solution. A lens-smartphone microscopy system was established to replace the traditional digital microscopy to measure the tiny displacements and shape changes. The PDMS lens has excellent optical property through an experiment in which the maximum optical power was around 273.2 D. Experimental results indicated that the maximum optical power of PMMA IOL was 129.3 D, and that in PDMS IOL, however, was only 56.0 D. Thus, the rigid PMMA-IOL has a larger adjustable range. The production process of PDMS was mold-free, rapid, real-time, and highly repeatable and there was no need for a rigorous experimental environment either. This creative processing technology reduced the manufacturing steps from which an optical lens with high transmittance and high resolution, as well as hatics with accurate dimensions, were obtained. The rigidity of haptics affected more intensely than other factors did for improving the pre-displacement and changing the appearance of PDMS lens. Even though the rigidity of PMMA haptics is large enough for accommodating, there are many drawbacks during manufacturing. It is unavailable to rapid fabricate IOL using PMMA. Thus, further work will be required to alter the weight ratio of PDMS material, increase the rigidity, and enhance the adjustable ability of PDMS IOL.
ObjectiveTo use ultrasound biomicroscope (UBM) to observe the zonules in patients before cataract surgery and study the relation between the length of zonules and axial length (AL), so as to understand the underlying anatomical and pathological basis of factors influencing the stability of lens capsule in high axial myopic patients and provide objective theoretical references for surgical risk reduction and postoperative follow-up guidance. MethodsFifty-five patients (55 eyes) proposed to receive phacoemulsification between October 2014 and October 2015 were divided into group A (AL < 26 mm, n=21), group B (26 mm≤AL < 29 mm, n=14), and group C (AL≥29 mm, n=20) according to their AL.UBM examination was conducted preoperatively.Through measuring the length of zonules in supine position at 12, 3, 6, and 9 o'clock respectively, we compared the difference of the length of zonules among those three groups, and explored the correlation between the length of zonules and axial length. ResultsThe average length of zonules in group A was (0.67±0.13) mm, while that in group B and group C was (0.93±0.29) and (0.98±0.19) mm, respectively.The length of zonules in group A was shorter than that in group B and Group C, and the differences were statistically significant (P < 0.001);and that in group B was shorter than that in group C, but the difference was of no statistical significance (P=0.331).In the correlation analysis between axial length and the average length of zonules, the length of zonules was positively correlated with the axial length (r=0.502). ConclusionsUBM provides a quantitative method for observing zonules.In the assessment before cataract surgery, it is a more accurate method for evaluation of zonules, and probably has a certain value in pre-assessment of intra ocular lens dislocation after cataract surgery.