白内障囊外摘出和乳化吸出首350例并发症比较

目的 评价初学者所做的白内障囊外搞出术(ECCE)和超声乳化吸出术(Phaco)的并发症。方法 回顾性总结一位医生所做的首350例ECCE和首350例Phaco,术中及术后3天内并发症,以及每组中首50例和最后50例术中玻璃体脱出发生率。结果 术中玻璃体脱出ECCE组和Phaco组分别为2.86％和3.43％;术后角膜水肿两组分别为7.4％和8.5％。这2种并发症两组间差异无显著意义(P>0.05)。每组中首50例和最后50例术中玻璃体脱出,在两组中分别为10％和0,及12％和0,差异均有显著意义(P<0.01)。结论 初学者所做的ECCE和Phaco的并发症是相似的,多数发生在初期的病例。提出对初学者应加强培训和术中指导。     

老年性白内障超声乳化术与小切口囊外摘出术效果比较

目的 比较老年性白内障晶状体超声乳化与小切口现代白内障囊外摘出术的效果。 方法 老年性白内障93例(107眼),随机分为两组：A组,45例(52眼)为对照组;B组,48例(55眼)为观察组。对照组进行晶状体超声乳化术,观察组进行小切口现代白内障囊外摘出术。 结果 两组在手术后1周、1个月、3个月视力≥0.5者的比例差异无统计学意义。但观察组的并发症发生率显著低于对照组, P<0.05。 结论 老年性白内障的小切口现代白内障囊外摘出术效果较好,术后并发症的发生率更低。     

超声乳化术与小切口白内障囊外摘出术效果比较

目的 比较超声乳化术与小切口白内障囊外摘出术治疗老年性白内障的临床效果。 方法 回顾性分析2015年5月至2017年5月老年性白内障198例,其中120例(198眼)采用小切口白内障囊外摘出术(小切口组),78例采用晶状体超声乳化吸出术(超乳组),比较两组的手术效果、并发症及角膜内皮细胞密度。 结果 两组术后3 d、1个月和3个月的视力均较术前提高( P<0.05),术后1个月和3个月的视力均较术后3 d提高( P<0.05),但两组间治疗前及治疗后各个时间点的视力差异均无统计学意义( P>0.05)。两组术后3 d和1个月的散光度均较术前增加( P<0.05),术后1个月和3个月的散光度均较术后3 d减小( P<0.05),小切口组术后3 d散光度高于超乳组( P<0.05),其他各个时间段两组间散光度相近( P>0.05)。两组并发症发生率相近( P>0.05)。治疗前,角膜内皮细胞密度和六角形细胞比例两组均相近( P>0.05);术后,两组均减小( P<0.05),且小切口组少于超乳组( P<0.05)。 结论 超声乳化术和白内障囊外摘出术治疗老年性白内障均能取得较好疗效,超声乳化术在保护角膜内皮细胞方面可能具有优势。     

超声乳化白内障吸除术对血-房水屏障功能的影响

目的　观察小切口超声乳化白内障吸除人工晶状体植入术及相关因素对血 房水屏障功能的影响。方法　使用激光蛋白细胞检测仪对 60例 (64只眼 )白内障患者超声乳化白内障吸除人工晶状体植入术前、后的房水蛋白浓度进行定量检测 ,记录并比较闪光值。术后随访时间为 3个月。结果　超声乳化白内障吸除人工晶状体植入术前 ,术后 1d、1周、1个月及 3个月术眼房水的平均闪光值分别为 (6 94± 0 3 4 )、(2 6 2 7± 1 3 7)、(13 96± 1 0 5)、(9 0 7± 0 43 )及 (7 16± 0 2 7)光粒子数 /ms ,其中术后 1d、1周及 1个月高于术前 ,且差异均有显著意义 (P <0 0 5) ;术后 3个月与术前比较 ,差异无显著意义 (P >0 0 5)。术后早期术眼房水蛋白浓度与患者年龄呈正相关 (r =0 40 0 ,P =0 0 0 1) ,与患者的性别和眼别均无相关。术中虹膜脱出者术后 1d和 1周血 房水屏障功能破坏严重。结论　超声乳化白内障吸除人工晶状体植入术在术后短期内影响术眼的血 房水屏障功能 ;激光蛋白细胞检测仪可动态评价超声乳化白内障吸除术对血 房水屏障功能的影响。 (中华眼科杂志 ,2 0 0 4,40 :2 6 2 9)     

超声乳化术与囊外摘出术治疗老年性白内障的效果比较

目的 比较超声乳化术与囊外摘出术治疗老年性白内障的效果.方法 回顾性研究.2017年1月至2018年12月北京市顺义区妇幼保健院老年性白内障100例(100眼)分为两组:超声乳化人工晶状体植入术50例为观察组,囊外摘出人工晶状体植入术50例为对照组,对比分析术后两组的效果.结果 术后1周观察组患者视力改善情况优于对照组...     

超声乳化术与囊外摘出术治疗老年性白内障的效果比较

目的 比较超声乳化术与囊外摘出术治疗老年性白内障的效果。 方法 回顾性研究。2017年1月至2018年12月北京市顺义区妇幼保健院老年性白内障100例(100眼)分为两组：超声乳化人工晶状体植入术50例为观察组,囊外摘出人工晶状体植入术50例为对照组,对比分析术后两组的效果。 结果 术后1周观察组患者视力改善情况优于对照组( P<0.05);生活质量SF-36评分均优于对照组( t＝14.436, P＝0.000)。术后3周,观察组前房深度及眼压均优于对照组( t＝4.784, P＝0.000; t＝-2.125, P＝0.036)。观察组术后角膜水肿1例(2.00%);对照组角膜水肿等共8例(16.00%),两组并发症发生率差异有统计学意义( χ ²＝5.983, P＝0.014)。 结论 超声乳化术治疗老年性白内障效果优于囊外摘出术。     

小切口白内障囊外摘出与超声乳化效果比较

目的　比较白内障小切口囊外摘出术与超声乳化术两种方法的疗效。方法　 3 2 6例 ( 3 60眼 )老年性白内障随机分为两组 ,分别采用超声乳化吸出及小切口囊外摘出术 ,均植入后房人工晶状体 ,就其术后视力、术中术后并发症进行比较。结果　术后 7天裸眼视力 :超乳组和小切口囊外摘出组≤ 0 4者分别占 18 3 4%和 18 89% ;0 5～ 0 9者占 66 11%和 66 67% ;≥1 0者占 15 5 5 %和 14 44 %。术中后囊破裂玻璃体脱出 :两组分别为 4 44 %和 3 3 3 %。术后角膜内皮水肿 :分别为 16 11%和17 2 2 %。结论　两种手术疗效相似 ,差异无显著意义 (P >0 0 5 ,小切口囊外摘出术经济、简便、容易掌握 ,适宜于目前我国基层医院开展     

小切口白内障囊外摘出与超声乳化效果比较

目的 比较小切口非乳化囊外摘出人工晶状体植入术与超声乳化吸出人工晶状体植入术两种手术方法的临床效果。方法 分析对60例小切口无缝线非超声乳化白内障囊外摘出术及60例超声乳化吸出人工晶状体植入术的术后视力,术中、术后并发症进行比较。结果 小切口非乳化组术后7天裸眼视力≥1.0者8例（13.33%）,0.5－0.9者39例（65％）,≤0.4者13例（21.67％）,超声乳化组≥1.0者5例（8.33％）,0.5－0.9者50例（83.34％）,≤0.4者5例（8.33％）。角膜内皮浑浊：小切口组11例（18.33％）,超声乳化组8例（13.33％）。结论 小切口非乳化白内障摘出术及超声乳化术疗效相似,差异无显著性（P＞0.05）,前者简便、易行、经济,适宜于基层医院开展。     

青光眼滤过手术患者超声乳化白内障吸除术后血-房水屏障功能的改变

目的从血房水屏障功能方面评价青光眼滤过手术后白内障患者行超声乳化白内障吸除人工晶状体植入术的安全性。方法分别对40例(46只眼)青光眼滤过手术后白内障患者(试验组)和60例(64只眼)老年性白内障患者(对照组)行超声乳化白内障吸除人工晶状体植入术,使用激光蛋白细胞检测仪(LFCM)定量检测术前和术后1、7、30、90d房水蛋白浓度的变化,并进行比较。结果超声乳化白内障吸除人工晶状体植入术前及术后1、7、30、90d术眼平均房水闪光值试验组分别为(1512±287)、(4024±375)、(2433±338)、(2118±177)、(1651±170)光粒子数(PC)/ms,差异有统计学意义(P<005);对照组分别为(694±234)、(2627±1021)、(1396±644)、(907±267)、(716±189)PC/ms,差异有统计学意义(P<005)。其中2组术后1、7、30d均高于术前(P<005);术后90d与术前比较,差异均无统计学意义(P>005)。术前和术后1、7、30、90d2组平均房水闪光值比较,差异均有统计学意义(P<005)。试验组术后1d和30d与术前平均房水闪光值的差值均高于对照组(P<005)。结论青光眼滤过手术后患者血房水屏障功能紊乱;超声乳化白内障吸除人工晶状体植入术治疗青光眼滤过手术后白内障患者具有安全性,但加强抗炎性反应治疗,减轻手术损伤,是保证手术安全性的关键。     

超声乳化术与囊外摘出术治疗过熟期白内障

目的比较过熟期白内障超声乳化术和囊外摘出术的手术效果、术中和术后并发症,并探讨其手术技巧。方法将139例（184眼）过熟期白内障随机分成两组,A组70例（93眼）行晶状体超声乳化术,B组69例（91眼）行白内障囊外摘出术,均联合人工晶状体植入术。于术后1d对两组裸眼视力、术中及术后并发症进行比较。结果术后1d裸眼视力0．05—0．25者B组明显高于A组（P〈0．05）。术后1d裸眼视力〈0．05及≥0．3者B组明显低于A组（P〈0．05）。术中晶状体核掉入玻璃体腔、玻璃体脱出眼数A组明显高于B组（P〈0．05）。术后角膜水肿眼数A组明显高于B组（P〈0．05）。结论过熟期白内障行白内障囊外摘出术较超声乳化术更具有安全性。     

Disorders of the blood-aqueous barrier after phacoemulsification in diabetic patients

PURPOSE: To evaluate the function of the blood-aqueous barrier after phacoemulsification with implantation of a foldable intraocular lens (IOL) in diabetic patients. METHODS: All patients were enrolled from those scheduled for phacoemulsification with intraocular lens implantation in Zhongshan Ophthalmic Center Guangzhou from March 2002 to June 2002. The classification on diabetic retinopathy (DR) was based on the fundus examination after cataract surgery. The blood-aqueous barrier function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative days 1, 7, 30, and 90 by an independent examiner who was masked to the DR classification. Patients were operated by one experienced surgeon as per standard clinical protocol and were provided the same postoperative medical care. A linear regression and Wilcoxon test were used for the analysis. RESULTS: A total of 112 patients were divided into three groups: patients without diabetic mellitus as normal control (n=56), diabetic patients without diabetic retinopathy (n=2), with nonproliferation diabetic retinopathy (NPDR) (n=37), and diabetic patients with proliferation diabetic retinopathy (PDR) (n=17). All patients were examined and successfully followed up for 3 months after cataract surgery. Aqueous flare mean photon counts in PDR, NPDR, and control eyes were 8.94+/-0.57, 7.03+/-0.27, and 6.94+/-0.34 before surgery and increased to 32.42+/-0.67, 26.07+/-0.83, 26.27+/-1.37 on the first day after surgery (P<0.05), then decreased to 19.86+/-0.78, 14.08+/-0.54 and 13.96+/-1.05 at 7 days after surgery (P<0.05), 13.24+/-0.29, 9.86+/-0.33, and 9.07+/-0.43 at 30 days after surgery (P<0.05); eventually, the counting decreased to 11.25+/-0.31, 7.24+/-0.67, and 7.16+/-0.27 at 90 days after surgery (P<0.05). Linear regression model suggested that other potential variables, such as age, sex, eye (left/right), phaco time, phaco energy, and hypertension were not related to the outcome. For patients without diabetes mellitus and diabetic patients with NPDR, highly statistically significant differences (P<0.05) were found between preoperative flare value and those measured on days 1, 7, and 30 after surgery, but no statistically significant differences (P>0.05) were found between the preoperative flare value and those measured on postoperative days 90. However, patients with PDR still had a higher flare value even on postoperative day 90. The patients with intraoperative iris prolapse had a higher flare value between days 1 and 7 postoperatively. CONCLUSION: Phacoemulsification with a foldable intraocular lens implantation affects the blood-aqueous barrier more severely in diabetic patients with PDR than patients with NPDR and nondiabetic patients.     

Recovery of the blood-aqueous barrier after cataract surgery.

Following extracapsular cataract and posterior chamber implant surgery the sequential recovery of the blood-aqueous barrier was measured by anterior segment fluorophotometry. Postoperatively 49 (69.0%) out of 71 eyes (71 patients) had recovered at a uniform rate, re-establishing a normal blood-aqueous barrier by the end of the three-month study. In these eyes recovery of the blood-aqueous barrier was unaffected by the use of preoperative indomethacin, the surgeon, the type of section, or the type of fixation of the implant. In eyes recovering normally after cataract surgery the rate of recovery of the blood-aqueous barrier can be expressed by a in the equation a = (y-b)/x, in which y is the logarithm of the anterior chamber fluorescence, x is the time after surgery, and b is a constant for each patient which is the anterior chamber fluorescence measured immediately after surgery. This normal rate of recovery provides a baseline from which to assess surgical technique or postoperative medication.     

Quantification of blood-aqueous barrier breakdown after phacoemulsification in Fuchs' heterochromic uveitis

PURPOSE: To quantify the breakdown of the blood-aqueous barrier (BAB) following phacoemulsification with posterior chamber lens implantation in eyes with Fuchs' heterochromic uveitis (FHU). PATIENTS AND METHODS: In this retrospective study, 19 eyes of 19 patients with FHU (mean age 38 +/- 14 years) and 35 eyes of 35 patients with senile cataracts (mean age 63 +/- 9 years) underwent phacoemulsification with one-piece PMMA posterior chamber lens implantation. Aqueous flare was quantified using the laser flare-cell meter (LFCM, Kowa FC-1000) following medical pupillary dilation preoperatively and 1, 3, and 5 days, then 1 and 6 weeks and 6 months postoperatively. RESULTS: Mean preoperative aqueous flare (in photon counts per millisecond) in FHU vs. controls was 11.7 +/- 3.5 vs. 5.8 +/- 1.7. Following cataract surgery, mean aqueous flare increased to 27.8 +/- 4.4 vs. 16.0 +/- 4.5 on day 1, decreased to 23.6 +/- 4.0 vs. 11.8 +/- 3.5 on day 3, and to 18.0 +/- 3.0 vs. 9.5 +/- 1.7 on day 5. In FHU eyes, it was 13.9 +/- 2.7 after 1 week, and had returned to preoperative levels after 6 weeks (10.9 +/- 2.5) and remained stable for up to 6 months (mean 10.3 +/- 2.2). Pre- and postoperatively, aqueous flare values were 2-3 times higher in FHU eyes than in control eyes with senile cataract (p = 0.01). No postoperative complications such as fibrin formation, synechiae, macrophages on the intraocular lens optic or endophthalmitis were observed in any of the patients. CONCLUSIONS: BAB breakdown following phacoemulsification with posterior chamber lens implantation is relatively mild in eyes with FHU and the BAB appears to be fully reestablished to preoperative levels 6 weeks postoperatively, explaining the usually good outcome of cataract surgery in this condition.     

Relation between postoperative blood-aqueous barrier damage and LOCS III cataract gradings following routine phacoemulsification surgery

AIM—To examine the relation between cataract density, the phacoemulsification energy required for its removal, and blood-aqueous barrier (BAB) damage on the first day after surgery.
METHODS—A prospective study recruiting patients with normal eyes apart from senile cataract. Preoperatively, visual acuity, anterior chamber laser flare, and cell values were measured using the Kowa laser flare meter, and the LOCS III grading of the cataract defined. The patients all underwent standardised phacoemulsification surgery through a superior scleral tunnel incision, with confirmed in the bag placement of a one piece PMMA IOL; all surgical complications were excluded. The phaco power delivered was recorded as the cumulative delivered energy, CDE. On day 1 visual acuity and laser flare and cell readings were taken.
RESULTS—101 patients were recruited and all completed the protocol. Older patients had a higher preoperative flare value (p=0.003); preoperative cell values were significantly related to nuclear opacity (p=0.021) and colour (p=0.011). Postoperative flare was related to preoperative flare (p=0.001) and nuclear colour (p=0.038). CDE was related to nuclear colour (p=0.031) and opacity (p=0.022), but not to aqueous flare.
CONCLUSIONS—Damage to BAB after routine phacoemulsification surgery is predicted by the preoperative flare values and the density of the cataract nucleus. The amount of phacoemulsification energy required to remove a cataractous lens is related to the density of the cataract but affects postoperative flare to a minimal degree. Other factors such as surgical technique are probably more important. Laser photometry is a useful tool for objectively assessing surgical technique.

     

Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity

PURPOSE: To ascertain the incidence of cystoid macular edema (CME) after phacoemulsification and its relationship to blood-aqueous barrier damage and visual acuity. SETTING: A British teaching hospital. METHODS: A prospective trial was performed to document the incidence of CME after routine phacoemulsification with continuous curvilinear capsulorhexis. LogMAR visual acuity and laser flare were measured using the KOWA FC 1000 laser cell-flare meter preoperatively and 1, 14, 30, and 60 days postoperatively. At day 60, a standardized fluorescein angiogram was performed and graded by masked observers. RESULTS: The rate of angiographic CME on day 60 was 19%. Visual acuity at each visit was significantly worse in the CME group (P < .05). The flare and cell values at days 14, 30, and 60 were higher in the CME group at day 60; however, the difference was not statistically significance (P > .05). CONCLUSIONS: The incidence of CME after routine phacoemulsification was 19%. Patients with CME at day 60 had significantly worse visual acuity than those who did not from the first postoperative day throughout the follow-up. There was a trend for patients who had CME at day 60 to have more postoperative inflammation.     

糖尿病患者白内障与老年性白内障超声乳化术前后房水蛋白浓度变化的比较

目的　通过检测老年性白内障与糖尿病患者白内障超声乳化白内障吸除并人工晶体植入手术前后房水蛋白浓度的变化 ,评估该手术对眼血 -房水屏障的影响。方法　对 60例 (64眼 )老年性白内障患者及 5 2例 (5 6眼 )伴发糖尿病的白内障患者 (3 4眼非增殖型糖尿病性视网膜病变 ,2 2眼伴增殖型糖尿病性视网膜病变 ) ,应用激光闪光细胞检测仪 (Laserflarecellmeter ,LFCM )定量检测超声乳化白内障吸除并人工晶体植入术前、术后前房蛋白浓度。结果　术前 ,伴增殖型糖尿病性视网膜病变患者的前房蛋白浓度高于老年性白内障和非增殖型糖尿病性视网膜病变白内障患者 ,且差异有显著性 (P <0 0 5 ) ;而老年性白内障和非增殖型糖尿病性视网膜病变白内障患者间的房水蛋白浓度无明显差别。各组术后 1天、 7天及 3 0天的房水蛋白浓度均较术前高 ,并有显著性差别 (P <0 0 5 )。术后 90天时 ,老年性白内障和非增殖型糖尿病性视网膜病变白内障患者的房水蛋白浓度与术前无显著性差别 ;但伴增殖型糖尿病性视网膜病变患者的仍高于术前水平 ,且差异有显著性 (P <0 0 5 )。结论　对于老年性白内障患者与非增殖型糖尿病性视网膜病变的白内障患者 ,超声乳化吸除并折叠式人工晶体植入手术后眼血 -房水屏障功能均可在短期内恢复 ,而对     

小切口非超声乳化摘出外滤过术后白内障的临床研究

目的 评价小切口非超声乳化摘出外滤过术后白内障的手术效果。方法 对５８例外滤过术后白内障（５级核）行非超也化摘出。结果 ５８例术后视力均得到提高,术前,术后的眼压无显著性差异,无并发症发生。结论 对外滤过术后的白内障,尤其是高龄患者且为５级核者,行小切口非超声乳化治疗,只要方法得当,同样可以取得良好效果。     

白内障超声乳化吸出术后多焦视网膜电图变化

目的:采用多焦视网膜电图(multifocalelec-troretignroam,mfERG)评价年龄相关性白内障患者行超声乳化白内障吸出术后视网膜功能的改变。方法:应用法国Metrovision公司生产的VisionMonitor视觉诱发系统检测23例23眼年龄相关性白内障超声乳化术后及8例11眼同龄正常对照眼的mfERG,检测视野的水平视角±30°,垂直视角±23°,采用ERG-jet接触镜电极,于5min记录61个视网膜部位的反应。结果:与正常对照组比较,白内障术后组mfERG的N1波潜伏期在各视网膜半区、4个象限及第2～5环延长,差异有显著性意义;P1波潜伏期在视网膜上半区、颞侧区、颞上象限、颞下象限和第2～4环延长,差异有显著性意义;N2波潜伏期在视网膜下半区、颞下象限及第2～4环明显延长,差异亦有显著性意义。术后组N2波振幅密度在视网膜颞侧区、颞上和颞下象限降低,与对照组比较差异有显著性意义。结论:白内障术后眼mfERG的一阶kernal反应有明显改变,为进一步研究白内障患者视网膜的功能提供参考。