Objective To investigate the refractive shift after combined surgery （phacoemulsification, intraocular lens implantation and vitrectomy） by comparing the difference between the predictive and postoperative refractive power.Methods The clinical data of 44 patients (48 eyes) underwent combined surgery (combined group) and 30 patients (50 eyes) underwent cataract surgery (cataract group) were retrospective analyzed. Combined group was further divided into two sub-groups by the kind of tamponade: balanced salt solution group and gas group. Before surgery, axial length and corneal curvature were measured, and the predictive spherical equivalent (PSE) was calculated. Axial length, corneal curvature and actual spherical equivalent (ASE) were measured in six months after surgery. The differences between PSE and ASE were compared between combined group and cataract group, balanced salt solution group and gas group.Results In combined group,the mean PSE was (-0.10plusmn;0.42) D and ASE was（-1.00plusmn;1.10） D, and the difference was significant（t=6.687, P＜0.05）. Patients underwent combined surgery showed a statistically significant myopic shift compared with those underwent simple cataract surgery （t=-3.792,P＜0.05）, the refractive shift of balanced salt solution group and gas group were (-0.76plusmn;0.89） and （-1.19plusmn;0.94） D respectively, and there was no significant difference（t=-1.530,P＞0.05）.Conclusion Combined surgery of phacoemulsification and vitrectomy tends to shift the actual refractive status to myopia.
Objective To observe the therapeutic efficacy and postoperative complications of combined surgery and sequential surgery in treating proliferative diabetic retinopathy (PDR) and cataract. Methods The cilinical data of 59 patients (66 eyes) with PDR were retrospectively analyzed. The patients were divided into combinedsurgery group and sequential surgery group. Combined surgery was performed on patients with obvious lens opacity which was an obstacle to the ocular fundus surgery, while sequential surgery was performed on the patients with transparent lens or lens with light opacity on which ocular fundus surgery could be performed. Lens excision in cataractopoiesis could only be performed when the state of ocular fundus was stable and cataractopoiesis was the main cause of vision damage. A total of 28 patients (32 eyes) in combinedsurgery group underwent vitrectomy combined with phacoemulsification and IOL implantation; 31 patients (34 eyes ) in sequentialsurgery group underwent vitrectomy, lens excision and IOL implantation. Corrected visual acuity (BCVA) and complications were observed. The mean followup period was (25plusmn;8.5) months. The measurement data were analyzed with t test and enumeration data with 2 test. Results In combinedsurgery group, visual acuity improvement was achieved in 27 eyes （84.4%）, remained unchanged in 2 eyes （6.3%）and decreased in 3 eyes （9.4%）. In sequentialsurgery group, visual acuity improved in 26 eyes （76.5%）, remained unchanged in 2 eyes（5.8%）and decreased in 6 eyes（17.7%.）. However, anterior chamber fibrin exudation occurred in 4 eyes in the combinedsurgery group and no eyes in the sequentialsurgery group; compared with each other, the difference is statistically significant (chi;2=4.524，P=0.033). Conclusion Combined surgery and sequential surgery are all safe and effective on treating PDR and postoperative complications have no obvious correlation with the surgery procedure.
Objective To observe and analyze the incidence of macular edema and its related factors after cataract surgery in diabetics with and without diabetic retinopathy. Methods A retrospective study. The data of 90 diabetics including 45 cases with diabetic retinopathy (DR group) and 45 cases without DR (diabetics group) and an equal number of non-diabetic matched controls (control group) who underwent phacoemulcification and intraocular lens implantation were collected. Patients with macular edema before the surgery were excluded. Main outcome measurements included best-corrected visual acuity (BCVA) and central subfield mean thickness (CSMT). Optical coherence tomography (OCT) was used to measure the distance from the inner limiting membrane to the pigment epithelium of the central macular with diameter of 1 mm, which was used as the CSMT. There were no significant differences in BCVA and CSMT among three groups preoperatively (F=1.300, 1.329; P=0.280, 0.273). The BCVA and CSMT before and after the surgery in all three groups were compared. macular edema was defined as an increase of CSMT on OCT ＞30% from preoperative baseline. The incidence of macular edema of three groups after the surgery were compared and analyzed. The correlation between postoperative BCVA and CSMT, and the correlation between diabetes mellitus, DR and macular edema after surgery were analyzed by Logistic regression analysis. Results After the surgery, compared with control and diabetics group, the BCVA in DR group decreased and the CSMT increased significantly and the differences were statistically significant (P＜0.05). However, between control and diabetics group, the differences in BCVA and CSMT after the surgery were not statistically significant (P＞0.05). The incidences of macular edema in DR group (15.6% and 13.3%) 1 month and 3 months postoperatively were significantly more than that in control group (2.2% and 2.2%) and non-DR diabetics group (4.4% and 2.2%), and the differences were statistically significant (χ2=6.696, 6.644; P=0.035, 0.036). Logistic regression analysis showed that the postoperative BCVA was correlated with CSMT (r=0.444, P=0.000), diabetics was not correlated with postoperative macular edema (r=7.231, P=0.999) and DR was correlated with macular edema after surgery (r=0.378, P=0.008). The diabetic retinopathy might correlated to macular edema after surgery. Conclusions The incidence of macular edema after cataract surgery in patients with DR was significantly higher than that in patients without DR. There is no correlation between diabetics and postoperative macular edema, and DR is correlated with macular edema after surgery.
ObjectiveTo systematically review the efficacy and safety of phacoemulsification combined with trabeculectomy versus simple phacoemulsification for primary angle closure glaucoma with cataract.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about phacoemulsification combined with trabeculectomy vs. simple phacoemulsification for primary angle closure glaucoma with cataract from inception to May 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software.ResultsA total of eight studies involving 679 patients were included. The results of meta-analysis showed that: there were no significant differences between two groups in postoperative visual acuity (MD=0.00, 95%CI –0.10 to 0.09, P=0.98), postoperative anterior chamber depth (MD=0.14, 95%CI –0.17 to 0.45, P=0.37) and adverse reactions rates (optic nerve injury: RR=1.56, 95%CI 0.70 to 3.47, P=0.28; visual field defect: RR=1.43, 95%CI 0.70 to 2.92, P=0.33; corneal edema: RR=0.57, 95%CI 0.25 to 1.32, P=0.19).ConclusionCurrent evidence shows that phacoemulsification combined with trabeculectomy and simple phacoemulsification has the similar efficacy and safety for primary angle closure glaucoma with cataract. Due to limited quantity and quality of the included studies, the above conclusions still need to be verified by more high quality studies.
ObjectiveTo observe the short-term efficacy of sub-Tenon’s triamcinolone acetonide (TA) in the treatment of cystoid macular edema (CME) after cataract surgery.MethodsA retrospective study. From October 1, 2013 to October 1, 2018, 21 patients (21 eyes) with CME after cataract surgery diagnosed at The Affiliated Eye Hospital of Wenzhou Medical University were included in this study. All eyes underwent BCVA, intraocular pressure, frequency domain OCT examination. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity when recorded. A frequency domain OCT instrument was used to measure the foveal retinal thickness (CRT). Among 21 eyes of 21 patients, 9 eyes were male and 12 eyes were female; the average age was 66.38±10.88 years. The average logMAR BCVA was 0.46±0.23; the average CRT was 519.90±131.59 μm; the average intraocular pressure was 11.01±3.97 mmHg (1 mmHg=0.133 kPa). All eyes underwent a single treatment of 100 mg/ml TA suspension 0.4 ml (containing TA 40 mg) under Tenon's capsule. The average follow-up time after treatment was 32.86±20.2 days. The changes of BCVA, CRT and intraocular pressure were observed 1 month after treatment. The BCVA, CRT and intraocular pressure before and after treatment were compared by paired t test.ResultsOne month after treatment, the average logMAR BCVA, CRT, and intraocular pressure of the CME eyes were 0.29±0.22, 307.71±35.82 μm and 14.19±6.30 mmHg, respectively. Compared with those before treatment, the differences were statistically significant (t=5.252, 8.166, 4.128; P=0.000, 0.000, 0.001). Among 21 eyes, 13 eyes (61.90%) of the retinal cysts in the macular area completely disappeared; 8 eyes (38.1%) were still visible between the retinal layers. Three eyes with intraocular pressure over than 21 mmHg were treated with lowering intraocular pressure and returned to normal.ConclusionSub-Tenon’s capsular injection of TA to treat CME after cataract surgery can reduce CRT and improve vision in a short time.
ObjectiveTo observe the safety of intravitreal injection of triamcinolone acetonide (TA) combined with partial anterior pars plana vitrectomy (PPV) for cataract with severe vitreous hemorrhage.MethodsA retrospective case-control study. A total of 60 patients (60 eyes) with cataract and severe vitreous hemorrhage were included from June 2017 to June 2019 in Xi’an People’s Hospital (Xi’an Fourth Hospital). There were 32 males (32 eyes) and 28 females (28 eyes), with a mean age of 64.8 years. The eyes were randomly divided into intravitreal injection TA group (TA group) and non-TA injection group (control group), with 30 eyes in each group. Before phacoemulsification, 0.05-0.10 ml TA was injected into the vitreous cavity in the TA group and the vitreous besides the vitrectomy channel was removed. The eyes of the control group underwent conventional cataract phacoemulsification combined with PPV. The follow-up time after surgery was ≥6 months. The rate of success continuous circular capsulorhexis, posterior capsule rupture, and intraocular lens (IOL) implantation in the capsular bag were compared between the two groups. The statistical data were compared with χ2 test. ResultsFor all eyes in the TA group, after intravitreal injection of TA combined with partial anterior PPV, the white reflection of the fundus can clearly show the anterior and posterior capsule of the lens. Continuous circular capsulorhexis was completed, the posterior capsule was not broken, and the IOL was successfully implanted inside the capsular bag. Among the 30 eyes of the control group, 4 eyes did not complete continuous circular capsulorhexis. Radial tear occurred during capsulorhexis, and capsulorhexis was used to complete capsulorhexis. In 5 eyes with posterior capsule rupture, the posterior capsule occurred in 3 eyes during phacoemulsification, and injecting the lens cortex caused posterior capsule repture in 2 eyes; the IOL was implanted in the ciliary sulcus and the capsular bag in 4 and 1 eyes, respectively. Whether the consecutive capsulorhexis was successful (χ2=4.286), whether the posterior capsule was ruptured (χ2=5.455), whether the IOL was implanted in the capsular bag (χ2=4.286), the differences in the number of eyes between the two groups were statistically significant (P= 0.038, 0.020, 0.038). At the last follow-up, no special complications occurred.ConclusionsIntravitreal injection of TA combined with partial anterior PPV can improve the visibility of the anterior and posterior lens capsule and lens nucleus during phacoemulsification in patients with cataract and severe vitreous hemorrhage. The surgical success rate is high, the complications are few, and the safety is good.
Objective To observe the changes in peripapillary vessel perfusion after uncomplicated phacoemulsification surgery in patients with cataract and primary open-angle glaucoma (POAG). Methods A case-control study. From November 2017 to April 2019, 17 eyes of 17 cases of POAG complicated with cataract (observation group) and 17 eyes of 17 cases of simple senile cataract (control group) were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field, optical coherence tomography angiography (OCTA) examination, and measurement of axial length (AL) and central corneal thickness (CCT). All eyes underwent conventional phacoemulsification surgery for cataract. After the operation, the same equipment and methods as before the operation were used for related inspections. The VD, the thickness of the retinal nerve fiber layer (RNFL), and the IOP were observed before the operation, at the end of the operation, and 1 d, 1 week, 1 month and 3 months after the operation, mean visual field defect (MD) changes 3 months after surgery. Data comparisons within groups used repeated measures analysis of variance; data comparisons between groups used independent samples t test. Results The average age of patients in the observation group and control group was 68.18±6.13 and 65.82±6.95 years, respectively, and the difference was not statistically significant (t=1.912, P=0.072). There was no significant difference in AL (t=1.436), CCT (t=−1.557) and phacoemulsification (t=1.602) between the two groups (P>0.05). The difference of the mean IOP was statistically significant between the two groups (t=4.139, P<0.05). Before surgery, the VD (t=−6.560) and RNFL thickness (t=−7.320) of the observation group were lower than those of the control group, and the difference was statistically significant (P＜0.05). Compared with before the operation, the VD around the disc of the eye in both groups increased at the end of the operation and at different time points after the operation. Among them, the observation group had a statistically significant difference at 1 month after the operation of the eye (F=3.108, P=0.042); the control group had no significant difference at different time points after the operation (F=1.981, P＞0.05). The results of each quadrant analysis showed that only the observation group had a statistically significant difference in the temporal side of the eye one month after surgery (F=5.414, P=0.017). After surgery, the observation group and the control group had thicker RNFL thickness around the disc of the eye, and the difference was statistically significant (F=22.670, 23.080; P=0.002, 0.001). Before the operation and 3 months after the operation, the average MD of the eyes of the observation group and the control group were 14.90±7.15, 1.12±0.93 dB and 12.10±7.70, 0.88±0.66 dB, respectively. The average MD before and 3 months after the operation was compared, and the difference was statistically significant (t=14.414, 13.225; P=0.000, 0.000). Compared with before surgery, there was no statistically significant difference in the average MD of the two groups of eyes at 3 months after surgery (t=0.938, 0.817; P=0.082, 0.103). At the end of the operation, the intraocular pressure of the observation group and the control group were 10.84±3.39 and 11.46±3.79 mm Hg (1 mm Hg=0.133 kPa), respectively; they were both lower than before the operation, and the difference was statistically significant (t=−2.211, −2.310; P＜0.05). Conclusions The thickness of VD and RNFL in eyes with POAG combined with cataract is lower than that in patients with senile cataract alone. The high perfusion pressure during conventional phacoemulsification surgery can cause a transient increase in VD, but it will not cause further damage to the visual field of POAG patients.