玻璃体切割、白内障摘除联合与分期手术对角膜内皮的影响

目的比较玻璃体切割、白内障摘除联合和分期手术对角膜内皮的影响。方法32例（32眼）患者,16例（16眼）行玻璃体切割联合自内障摘除术（联合手术组）,16例（16眼）行分期手术（分期手术组）。检测两组患者手术前后的角膜内皮细胞密度和六角形细胞。结果两组患者角膜内皮细胞密度手术前后及术后组间比较P均〉0．05;两组患者角膜内皮六角形细胞比例手术前后相比P均〈0．05,术后组间比较P〉0．05。结论联合和分期手术都会导致角膜内皮细胞的减少,改变角膜内皮细胞形态。联合与分期手术对角膜内皮的影响无明显差异。     

不同切口超声乳化人工晶体植入术对老年性白内障患者泪液、眼压与角膜内皮损伤的影响

目的比较不同切口超声乳化人工晶体植入术对老年性白内障患者泪液、眼压与角膜内皮损伤的影响。方法选取86例老年性白内障患者为研究对象,将其依据切口的不同分为透明角膜缘切口(A)组与角巩膜缘切口(B)组,每组43例。比较两组的视力、手术前后的泪膜破裂时间(BUT)、基础泪液分泌实验(SIt)、环形角膜荧光染色评分、眼压与角膜内皮相关指标(角膜内皮细胞密度、面积、变异系数、六角形细胞比例及角膜厚度)。结果 B组视力显著好于A组(P<0.05);术前两组的BUT、SIt、环形角膜荧光染色评分、眼压与角膜内皮相关指标比较,差异无统计学意义(P>0.05),术后1 w及2 w B组的BUT、SIt、环形角膜荧光染色评分显著好于A组,术后3 d及7 d的眼压显著低于A组,术后2 w及4 w的角膜内皮细胞密度均显著高于A组,角膜内皮细胞面积、变异系数、六角形细胞比例及角膜厚度均显著低于A组(P<0.05)。结论角巩膜缘切口在超声乳化人工晶体植入术对老年性白内障患者中的应用效果较好,且可显著改善患者的泪液、眼压与角膜内皮损伤,在老年性白内障患者中的应用价值较高。     

不同巩膜瓣切口对小梁切除后角膜散光的影响

对81例青光眼患者分别应用三角形巩膜瓣切口、横矩形巩膜瓣切口、舌形巩膜瓣切口行小梁切除,并对手术前后的角膜散光值与眼压进行检测。认为行三角形巩膜瓣切口者在术后1、2个月时,角膜散光度数最低。     

不同分期植入人工晶体治疗高度近视孔源性视网膜脱离的疗效

目的探索玻璃体切除联合晶状体摘除手术(VCLE)后分期植入人工晶体(IOL)治疗高度近视孔源性视网膜脱离(RRD)的疗效。方法回顾性分析86例高度近视RRD患者,根据手术方法将入组病例分为Ⅰ期IOL组(n=47)和Ⅱ期IOL组(n=39),Ⅰ期IOL组采用VCLE后Ⅰ期植入IOL,Ⅱ期IOL组采用VCLE后Ⅱ期植入IOL。分别于术前、术后1、3、6个月,检测LogMAR视力、眼压变化。术后6个月,采用最佳矫正视力(BCVA)指标,评估两组视力恢复情况并观察两组视力情况、视网膜脱离情况、两组并发症发生情况(角膜水肿、前房出血、虹膜后粘连等)。结果术后6个月,Ⅰ期IOL组BCVA值与Ⅱ期IOL组无明显变化(P0.05)。Ⅰ期和Ⅱ期IOL组术后1、3、6个月LogMAR视力均明显低于患者术前LogMAR视力,差异无统计学意义(P0.05)。Ⅰ期和Ⅱ期IOL组术后1、3、6个月的眼压和术前相比并无显著变化,差异无统计学意义(P0.05);与Ⅰ期IOL组相比,Ⅱ期IOL组术后1个月LogMAR视力明显高于Ⅰ期IOL组,差异有统计学意义(P0.05),而Ⅱ期IOL组术后3个月和6个月LogMAR视力和Ⅰ期IOL组相比并无明显变化,差异无统计学意义(P0.05)。Ⅱ期IOL组术后1、3、 6个月的眼压和Ⅰ期IOL组相比也并无明显变化,差异无统计学意义(P0.05);Ⅰ期IOL组术后6个月视网膜脱离发生率为10.64%,明显高于Ⅱ期IOL组(2.56%),差异有统计学意义(P0.05);Ⅰ期IOL组术后并发症的发生率为36.17%,明显高于Ⅱ期IOL组(15.38%),差异有统计学意义(χ~2=4.700,P=0.030)。结论 VCLE联合术后Ⅰ期植入IOL可以加快高度近视RRD患者的视力恢复,但术后并发症的发生率明显高于VCLE后Ⅱ期植入IOL患者。     

不同手术位置超声乳化术对老年白内障病人眼压、视力恢复情况及炎症因子水平的影响

目的比较不同手术位置超声乳化术对老年白内障病人眼压、视力恢复情况及炎症因子水平的影响。方法选取2016年3月至2018年3月我院收治的老年白内障病人100例,按照手术切口位置分为对照组与观察组,每组各50例。对照组手术切口处为角膜,观察组手术切口处为角巩膜缘。比较2组病人手术前后眼压、矫正视力及散光情况;分别于治疗前后检测并比较2组病人泪液中IL-6、TNF-α的水平。结果术后24 h,2组病人眼压均显著升高,且对照组明显高于观察组(P0. 05);手术后48 h,2组病人眼压均恢复至术前水平,差异无统计学意义(P0. 05)。手术后7、14 d,2组病人矫正视力均逐渐好转,散光程度有所增加,且观察组的矫正视力及散光程度均优于同期对照组,差异有统计学意义(P0. 05)。手术后7、14 d,2组IL-6及TNF-α水平均高于手术前,且对照组IL-6及TNF-α水平均显著高于同期观察组,差异有统计学意义(P0. 05)。结论超声乳化术中角巩膜缘切口的应用价值更高,可促进病人术后视力提高并减少手术造成的术后散光程度,有助于降低病人术后泪液中炎症因子水平,为提高术后效果提供保障。     

超声乳化人工晶状体植入术治疗糖尿病性白内障88例疗效观察

88例糖尿病白内障患者随机分为A、B两组.A组实施白内障超声乳化吸出(PHAcO)联合人工晶状体(IOL)植入术,B组实施现代囊外摘除术(EcCE)联合IOL植入术,观察两组术后视力和并发症.结果显示,A组视力>0.5者47眼(88.7%),B组视力>0.5者35眼(66.0%),两组相比,P<0.05.A组术后虹膜损伤、后囊破裂和角膜水肿发生率分别为7.5%(4眼)、1.9%(1眼)和15.1%(8眼),B组分别为18.9%(10眼)、9.4%(5眼)和28.3%(15眼),两组相比,P均<0.05;两组术后后囊膜浑浊发生率无差异(P>0.05).认为糖尿病性白内障实施PHACO手术联合IOL植入术,患者术后视力恢复好、反应小.     

白内障超声乳化吸出并散光矫正型多焦点人工晶状体植入术对老年白内障病人角膜散光及视觉质量的影响

目的观察白内障超声乳化吸出并散光矫正型多焦点人工晶状体(IOL)植入术对老年白内障病人角膜散光及视觉质量的影响。方法选择2017年1月至2019年6月期间在我院眼科就诊的白内障病人300例,按随机数字表分成对照组(150例)与试验组(150例),2组病人均采取白内障超声乳化吸出术,对照组植入散光矫正型单焦点IOL,试验组植入散光矫正型多焦点IOL。比较2组病人治疗前、后视力情况(非矫正、最佳矫正远视力及近视力)、角膜散光情况、视觉对比敏感度、生活质量及并发症的发生率。结果治疗后2组病人非矫正、最佳矫正远视力及近视力均有不同程度的升高,其中试验组非矫正、最佳矫正远视力及近视力均明显高于对照组;治疗后2组病人角膜散光情况均有所改善,且试验组较对照组更明显;试验组病人发生1例角膜水肿、1例房前渗出、1例眼压升高,后经对症治疗好转,并发症发生率为2. 0%;对照组病人发生2例角膜水肿、1例房前出血、1例房前渗出、2例眼压升高,后经对症治疗好转,并发症发生率为4. 0%,2组并发症发生率差异无统计学意义(P 0. 05);治疗后2组病人世界卫生组织生活质量简表(WHOQOL-BREF)评分均有不同程度的升高,其中试验组各项评分均明显高于对照组,差异具有统计学意义(P 0. 01)。结论白内障超声乳化吸出并散光矫正型多焦点IOL植入术治疗可明显改善老年白内障病人术后远视力与近视力,减轻角膜散光情况,提高视觉对比敏感度,减少术后恢复期并发症的发生,提高病人的生活质量,效果理想。     

小切口手法碎核在抗青光眼滤过术后硬核白内障手术中的疗效

目的探讨小切口手法碎核白内障摘除联合人工晶体植入术在抗青光眼滤过术后硬核白内障手术中的有效性及安全性。方法临床检查需要手术的抗青光眼滤过术后白内障核硬度为Ⅳ~Ⅴ级的42例病人43只眼纳入研究,所有病人均在表麻下行小切口手法碎核白内障摘除联合人工晶体植入术。术后随访3个月,观察术后视力、眼压、角膜内皮细胞丢失率、滤过泡及并发症等情况,并分析手术的疗效及安全注意事项。结果术后原有滤过泡均有效保留。术中后囊膜破裂2例,未出现悬韧带离断、虹膜脱出等并发症;术后发生角膜水肿者9眼(20.9%),均未出现角膜内皮失代偿等严重并发症。病人术后第1天,视力提高34眼(79.1%);眼压较术前增高,差异有统计学意义(t=-5.498,P0.001)。术后1周,视力提高39眼(90.7%),眼压与术前比较差异无统计学意义(t=-0.804,P=0.426);角膜内皮细胞丢失率为11.55%;角膜水肿均消退,无明显并发症。术后3个月,视力提高40眼(93.0%),眼压与术前比较差异无统计学意义(t=1.711,P=0.094);角膜内皮细胞丢失率为8.91%;无明显并发症。结论小切口手法碎核在抗青光眼滤过术后硬核白内障手术中操作灵活,能有效提高视力,且并发症较少,是一种安全可靠的方法。     

改良小梁切除术治疗青光眼92例临床观察

目的 观察改良小梁切除术治疗青光眼的临床疗效.方法 将186例青光眼患者随机分为观察组92例(156眼)和对照组94例(160眼),对照组行传统小梁切除术;观察组行改良小梁切除术,手术要点为术中加固巩膜瓣缝合、应用丝裂霉素及可松解缝线.术后随访3个月～1 a,观察两组眼压、前房形成、滤过泡形态及并发症发生情况.结果 术后第1天浅前房发生率观察组和对照组分别为4%、20%(P＜0.05);术后1 a观察组和对照组功能性滤过泡分别占89%、66%,眼压控制在21 mmHg以下者分别为95%、67%,P均＜0.05.结论 改良小梁切除术可减少巩膜瓣瘢痕、主动调节房水过量、促进功能性滤过泡形成,并减少并发症发生,利于提高手术成功率.     

超声乳化联合小梁切除术治疗青光眼伴白内障老年患者的效果

目的探讨超声乳化联合小梁切除术治疗青光眼合并白内障的老年患者的临床疗效。方法回顾性分析青光眼合并白内障的老年患者的临床资料,根据治疗方式的不同将患者分为观察组和对照组。观察组采用超声乳化联合小梁切除手术方式,对照组采用单纯小梁切除术。对比两组的临床治疗效果,分析比较两组手术前后视力、眼压和前房深度的变化,对比两组术后并发症的发生率。结果观察组治疗有效率显著高于对照组(91. 04%vs 75. 41%;χ2=5. 691,P=0. 017)。观察组术后眼压显著低于对照组,前房深度显著大于对照组,术后视力显著优于对照组,差异均具有统计学意义(均P<0. 05)。两组患者术后各出现1例角膜水肿和1例低眼压,差异无统计学意义(χ2=0. 009,P=0. 924)。两组均未发生后囊破裂等严重并发症。结论运用超声乳化联合小梁切除术对老年患者青光眼伴白内障的眼压、视力有明显改善作用,优于单纯小梁切除术,是一种安全有效的手术方式。     

Reversible axial myopia following infectious scleral ulceration--a case report

Adult-onset axial myopia is uncommon in comparison with the lenticular myopia. When we dealt with a case of the infectious scleral ulceration, the progressive myopic shift was not only due to the dense nuclear sclerosis but also due to the longer axial length. The elongating axis became shortened after 3-months follow up. Then the patient underwent uneventful cataract surgery. However, the reversal process persisted even after the operation. Although the pathogenesis is not well known, we concluded that the cataract surgery in dealt with the complicated cataract should be delayed in the cases with any inflammation or the axial changes.     

Twenty-seven-gauge endoilluminator-assisted scleral buckling using a wide-field viewing system: Case report

Rationale:We report a new scleral buckling technique using a 27-gauge endoilluminator and a wide-field viewing system to overcome the limitations of conventional indirect ophthalmoscope-methods and “chandelier-assisted” surgery.Patient concerns:A 26-year-old female patient visited the local clinic for floaters and lower visual field defects in her left eye that had occurred 5 days prior.Diagnoses:On fundus examination, upper retinal detachment without macular involvement and an atrophic hole was observed in her left eye.Interventions:Under general anesthesia and after perilimbal conjunctival incision, extraocular muscle isolation, and traction with black silk, a 27-gauge trocar-cannula was inserted 90° away from the retinal break, 4 mm away from the limbus. Under wide-field viewing using a contact lens, the fundus was observed through a surgical microscope. Retinal break was evaluated and cryopexy was performed with careful movement of the endoilluminator, paying attention to damage to the lens. The surgeon could accurately and freely control the direction of the illumination tip to obtain a brighter view of the region of interest.Outcomes:There were no complications associated with trocar cannula incision or the illuminator. The retina was successfully reattached.Lessons:Twenty seven gauge endoilluminator-assisted scleral buckling is an easy and safe procedure and provides better control over and free adjustment of the light direction, thus overcoming the limitations of chandelier-assisted surgery.     

Comparison of two different scleral fixation techniques of posterior chamber Carlevale lens

To investigate the surgical outcomes of 2 different scleral fixation techniques of the new single-piece foldable acrylic Carlevale lens (Soleko) and to compare our results with previous reports of the literature.A retrospective, non-randomized comparative study involving 2 series of patients who underwent 2 different scleral fixation techniques of Carlevale lens was performed. Minimum follow-up of 3 months was requested for inclusion in the study. All the patients underwent a standard ophthalmologic examination including best correct visual acuity, measurement of intraocular pressure, anterior segment, and fundus examination. In the first technique (group 1), plugs were externalized through a 23 gauge sclerotomy and placed within 2 scleral pockets. In the second technique (group 2), plugs were externalized through a 25-gauge sclerotomy and covered by 2 scleral flaps. For an estimation of the refractive prediction error, the postoperative spherical equivalent of objective refraction was calculated (IOL Master 750, Carl Zeiss Meditec AG, Jena, Germany). Spectral domain optical coherence tomography (Spectralis HRA+OCT2, Heidelberg Engineering, Heidelberg, Germany) of anterior segment was used to check plugs positioning postoperatively.Twenty-three eyes in group 1 and 9 eyes in group 2 were included. Preoperative diagnosis was aphakia, dislocated posterior chamber intra ocular lens, dislocated lens, anisometropia, Uveitis-Glaucoma-Hyphema syndrome, perforating trauma with dislocated intra ocular lens, and open globe injury with dislocated intra ocular lens. Respectively, in groups 1 and 2, refractive spherical equivalent prediction error was –0,31 ± 0,74 D and –0,27 ± 0,80 D, and postoperative best-corrected visual acuity was 0,42 ± 0,31 logMAR and 0,47 ± 0,45 logMAR. In group 1, 1 eye developed cystoid macular edema, 1 eye vitreous haemorrhage, and 3 eyes showed plugs located outside the scleral pockets under the conjunctiva. Rupture of 1 of the 2 tips of the plug was observed in 1 patient of group 1 during the externalization.Carlevale lens is a scleral fixated intra ocular lens specifically designed for posterior chamber implantation that could be successfully managed without any significant difference between the 2 surgical techniques, and appears approachable for anterior and posterior segment surgeons. A 25-gauge sclerotomy should be preferred with the aim of a sutureless surgery regardless the technique employed.     

神经生长因子对人巩膜成纤维细胞生长及胶原蛋白合成的影响

目的探索神经生长因子（NGF）对培养的人巩膜成纤维细胞（HSF）生长及胶原蛋白合成的影响。方法采用MTT比色法和流式细胞仪（FCM）分析技术，观察不同质量浓度NGF（10、25、50、100、200ng／ml）对HSF增殖和细胞生长周期的影响，氯胺T法检测胶原蛋白。结果NGF能促进HSF增殖，呈剂量依赖性，质量浓度为100ng／ml时作用最明显。NGF作用后，HSF的G0～G1期百分比降低，而S期百分比显著升高，增殖指数增高。NGF对HSF的胶原合成具有明显的促进作用，并呈剂量依赖性。结论外源性NGF可以促进体外培养的HSF增殖及胶原合成。     

Preserved corneal lamellar transplantation for infectious and noninfectious scleral defects: Three case reports and literature review

Rationale: Reinforcement of thinned or necrotizing sclera has been conducted using various materials, including allogeneic sclera, allogenic cornea, amniotic membrane, fascia lata, pericardium, periosteum, and perichondrium. Among them, good outcomes have traditionally been obtained using preserved scleral grafts. However, scleral patch grafts have complications such as graft retraction, thinning, dehiscence, and necrosis. Furthermore, to promote epithelial healing, scleral patch grafting must be accompanied by procedures such as amniotic membrane transplantation (AMT) or grafting using conjunctival flaps or autografts. Recently, acellular preserved human corneas have been used in various ophthalmic surgeries, with emerging evidence supporting its use for treating scleral defects as an option that does not require AMT or conjunctival autografting. We investigated whether corneal patch grafting would show wound healing and tectonic success rate outcomes comparable to those of existing techniques.Patient presentation: Three patients presented with intractable ocular pain. Slit-lamp examination showed marked scleral thinning at the nasal side.Diagnosis: Scleral thinning progressed with conservative treatment; microbial staining and culturing were performed. Infectious or non-infectious scleritis was diagnosed according to slit-lamp examination and microbial culture results.Interventions: A preserved corneal lamellar patch was grafted at the scleral thinning area.OutcomesAll patients achieved tectonic success with reduction of inflammation following corneal patch grafting. Two patients achieved complete re-epithelialization within 7 days, while 25 days were required for the third patient. No patients experienced graft thinning, rejection, or infection.Lessons: Our report suggests the feasibility of using acellular preserved human cornea patch grafts to reinforce inflammatory scleral defects and obtain successful outcomes in terms of wound healing. This technique shows a comparable tectonic success rate and superior effect on scleral defect healing without the need for adjunctive AMT or conjunctival autografting.     

不同屈光状态眼视网膜脱离术后黄斑区持续视网膜下液的变化对比分析

目的观察光学相干断层扫描(OCT)在不同屈光度组累及黄斑的裂孔源性视网膜脱离的患者巩膜扣带术后黄斑区持续视网膜下液(SMF)变化与视力预后的关系。方法回顾性分析不同屈光状态的裂孔源性视网膜脱离患者50例(50眼),其中高度性近视组25例(25眼),正视组25例(25眼)。分别于术前、术后1周、术后12个月行最佳矫正视力、眼底检查和OCT检查,并进行统计学分析。结果巩膜扣带术后出现持续SMF与高度近视有相关性;高度近视组SMF持续时间较正视组延迟,分别为(5.96±2.25)和(3.75±2.21)月,两组差异具有统计学意义(P0.05);两组间终末随访视力(Logmar)分别为(0.43±0.39)和(0.44±0.26),组间差异无统计学意义(P0.05)。结论高度近视有可能是巩膜扣带术后导致SMF的相关因素之一。解剖复位成功的患者其屈光状态与术后是否出现SMF都不影响手术终末视力的恢复。     

光照强度对近视豚鼠的眼生物学参数、视网膜结构及巩膜组织lumican和MMP-2表达水平的影响

［摘要］　目的　探讨光照强度对光学离焦性近视豚鼠的眼生物学参数、视网膜结构及巩膜组织光蛋白聚糖（lumican）和基质金属蛋白酶-2（MMP-2）表达水平的影响。方法　选择健康3周龄豚鼠80只,雌雄不限。采用凹透镜诱导方法构建右眼光学离焦性低中度近视豚鼠模型,从造模成功的74只豚鼠中随机选取60只分为A组、B组、C组和D组,每组15只。A组每日置于室外充足阳光下3 h,平均光照度60 000 lux;B组每日置于室外阴凉处3 h,平均光照度10 000 lux;C组每日置于室内北窗处3 h,平均光照度2 000 lux;D组每日室内正常饲养,平均光照度300 lux。其余时间统一室内饲养,平均光照度300 lux,正常摄食饮水,持续光照处理6个月。比较各组豚鼠眼生物学参数（眼轴长度、屈光度）,观察视网膜病理和超微结构,并检测巩膜组织lumican和MMP-2表达水平。结果　与光照前比较,光照1个月、3个月及6个月时各组屈光度有不同程度增加;A组光照3个月、6个月,B组、C组和D组光照1个月、3个月及6个月时眼轴长度有不同程度增长,差异有统计学意义（P<0.05）。光照1个月时,A组和B组屈光度、眼轴长度低于D组;光照3个月、6个月时,A组屈光度、眼轴长度低于B组、C组和D组,B组屈光度、眼轴长度低于D组,差异有统计学意义（P<0.05）。A组和B组凋亡细胞数量少于C组、D组,且A组凋亡细胞数量少于B组,差异有统计学意义（P<0.05）。A组和B组视网膜结构损伤程度较C组、D组轻,且A组损伤程度较B组轻。光照6个月后,与C组、D组比较,A组和B组的lumican表达水平较高,MMP-2表达水平较低,且A组lumican表达水平高于B组,MMP-2表达水平低于B组,差异有统计学意义（P<0.05）。结论　室外高强度光照能促使豚鼠巩膜组织中lumican表达上调,MMP-2表达下调,稳固巩膜结构,具有减缓眼轴增长和近视进展的作用。