玻璃体视网膜疾病并发白内障患者行玻璃体切割术联合超声乳化白内障摘除术，即前后节联合手术，是高效的手术方式，而后囊膜破裂(posterior capsular rupture,PCR)是超声乳化白内障摘除术的术中并发症之一，能够及时、有效地处理PCR，稳定、安全地植入人工晶状体(intraocular lens,IOL)，对于顺利完成后段手术，减少术后并发症十分重要。本文将对前后段联合手术中后囊膜破裂的术中处理、以及IOL光学部夹持固定法植入IOL的手术技术要点进行总结。
Combined surgery of pars plana vitrectomy (PPV) and phacoemulsification is an effective and safe way for management of retinal diseases complicated with cataract. Posterior capsular rupture (PCR) is one of the common intraoperative complications of phacoemulsification, and it is thus very important to deal with it promptly and efficiently, and ensure the subsequent procedures of intraocular lens (IOL) implantation as well as PPV. We will summarize the key points of the surgical technique for management of PCR and capture of IOL optic during combined surgery.
目的：通过对改良“Z”形无线结经巩膜缝线固定人工晶状体手术和传统有线结巩膜缝线固定人工晶状体手术治疗先天性晶状体脱位的比较来评价改良术式的临床疗效。方法：回顾性病例研究。纳入2018年1月—2021年3月期间于中山大学中山眼科中心行手术治疗的先天性晶状体脱位患者73例73眼，按手术方式不同将患者分为无线结组36例36眼和有线结组37例37眼。比较两组患者术前和术后1年的球镜度(DS)、柱镜度(DC)、等效球镜(SE)、最佳矫正视力(BCVA)、眼压(IOP)、眼轴长度(AL)、角膜内皮细胞计数和术后并发症的发生率。结果：两组患者术前各项观察指标组间比较差异无统计学意义(均P>0.05)。两组患者术后1年 BCVA 均较术前提高(均P<0.05)，SE均较术前降低(均P<0.05)。两组患者术后1年 BCVA 、DS、DC、SE、IOP、AL、角膜内皮细胞丢失率组间比较差异均无统计学意义(均P>0.05)。术后1年，有线结组有5例(13.5%)出现缝线暴露，无线结组未出现缝线暴露，组间比较差异有统计学意义(P<0.05)。结论：改良无线结 IOL 巩膜缝线固定手术可改善CEL患者的最佳矫正视力和屈光不正，有效减少缝线暴露及相关并发症。
Objective: To evaluate the clinical efficacy of modified “Z”-shaped knotless transscleral suture fixation intraocular lens (IOL) and traditional knotted transscleral suture fixation IOL in congenital ectopia lentis. Methods: A retrospective case study. A total of 73 eyes of 73 patients with congenital ectopia lentis who underwent surgical treatment in our hospital from January 2018 to March 2021 were included. According to different surgical methods, the patients were divided into the knotless group (36 eyes) and knotted group (37 eyes). Preoperative and postoperative of 1-year diopter sphere (DS), diopter cylinder (DC), spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL), corneal endothelial cell counts and the occurrence of postoperative complications rate were analyzed among two groups. Results: There was no significant difference in preoperative outcome measures between the two groups (P>0.05). BCVA at 1-year postoperative was significantly better (P<0.05), and SE at 1-year postoperative was significantly lower (P<0.05). There was no significant difference in BCVA, DS, DC, SE, IOP, AL, and corneal endothelial cell loss rate between the two groups at 1-year after operation (P>0.05). One year after the operation, there were 5 cases of suture exposure (13.5%) in the knotted group and no suture exposure in the knotless group, and the difference was statistically significant (P<0.05). Conclusions: The modified knotless IOL transscleral suture fixation can improve the best corrected visual acuity and alleviate ametropia of CEL patients, and reduce suture exposure and related complications effectively.
目的：在硅油取出联合白内障手术患者中，使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物测量，比较10种人工晶状体(IOL)屈光力计算公式的准确性。方法：回顾性分析2021年3月—7月于中山大学中山眼科中心接受硅油取出联合白内障手术的患者共62例(62眼)，所有患者均使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物学参数测量。计算并比较新公式[Barrett Universal II (BUII)、Emmetropia Verifying Optical(EVO) 2.0、Hill-Radial Basis Function (Hill-RBF) 3.0、Hoffer QST、Kane、Pearl-DGS]及传统公式(Haigis、Hoffer Q、Holladay 1、SRK/T)的预测准确性，主要评价指标为绝对预测误差中位数(MedAE)及平均绝对预测误差(MAE)。按眼轴长度≤23 mm(组1)，>23 mm且≤26 mm(组2)与>26 mm(组3)进行亚组分析。结果：6个新公式、Haigis、SRK/T公式均出现近视漂移(-0.47 ~-0.27 D，P<0.05)，而HofferQ及Holladay 1公式无系统误差(P>0.05)。Kane公式的MedAE(0.55 D)及MAE(0.81 D)最小，但公式间比较差异无统计学意义(P>0.05)。组1中所有公式均出现近视漂移(-1.46~ -1.25 D，P<0.05)，而其他亚组比较差异无统计学意义(-0.32 ~ 0.41 D，P>0.05)。在组1中，Pearl-DGS公式的MedAE(0.97 D)及MAE(1.26 D)最小，且优于Hill-RBF 3.0(P=0.01)及SRK/T公式(P=0.02)；组2中，Kane公式具有最小的MedAE(0.44 D)及MAE(0.66 D)；组3各个公式屈光预测准确性比较差异无统计学意义(P>0.05)。结论：在使用OA-2000进行术前生物测量时，Kane公式在接受硅油取出联合白内障手术患者中的预测准确性较高；而眼轴长度≤23 mm时，Pearl-DGS公式可能更为准确。
Objective: To compare the accuracy of 10 intraocular lens (IOL) power calculation formulas in patients undergoing combined silicone oil removal and cataract surgery, biometry is performed using the swept-source optical coherence tomography biometer OA-2000. Methods: A retrospective analysis. A total of 62 patients (62 eyes) who underwent combined silicone oil removal and cataract surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from March to July in 2021 were enrolled. Preoperative biometry was performed by OA-2000 in all patients. New-generation formulas (Barrett Universal II [BUII], Emmetropia Verifying Optical [EVO] 2.0, Hill-Radial Basis Function [Hill-RBF] 3.0, Hoffer QST, Kane and Pearl-DGS) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) were evaluated. The median absolute prediction error (MedAE) and mean absolute prediction error (MAE) were the main parameters used to assess accuracy. Subgroup analyses were performed based on the axial length of 23 mm and 26 mm. Results: Six new-generation formulas, Haigis, and SRK/T showed myopic shift (-0.47 ~ -0.27 D, P<0.05), while no systematic bias was found in Hoffer Q and Holladay 1 displayed (P>0.05). The smallest MedAE (0.55 D) and MAE (0.81 D) were found in Kane formula, but there was no statistically significant difference compared with other formulas (P>0.05). The myopic shift (-1.46 ~ -1.25 D, P<0.05) in eyes shorter than 23 mm were found in all formulas, while there was no significant systematic bias (-0.32 ~ 0.41 D, P>0.05) in other subgroups. In axial length shorter than 23 mm, the Pearl-DGS formula stated the smallest MedAE (0.97 D) and MAE (1.26 D), and was significantly more accurate than Hill-RBF 3.0 (P=0.01) and SRK/T (P=0.02). In eyes with an axial length between 23 mm and 26 mm, the Kane formula had the lowest MedAE (0.44 D) and MAE (0.66 D). No significant difference was found in eyes longer than 26 mm. Conclusion: The Kane formula showed the highest accuracy in patients undergoing combined silicone oil removal and cataract surgery measured by OA-2000, whereas the Pearl-DGS formula could be more accurate in eyes with an axial length shorter than 23 mm.
目的：评价并汇总眼科成人日间手术患者病区护理管理的最佳证据，提高临床护理质量。方法：检索国内外数据库建库至2022年6月的日间手术患者病区护理管理的相关证据，包括系统评价、临床决策、证据总结、指南及专家共识。由2名研究人员独立对文献进行质量评价后，根据主题对证据进行提取和汇总。结果：根据纳入标准，共筛选出13篇文献，包括5篇专家共识、3篇证据总结、1篇循证实践、2篇系统评价、1篇指南。通过文献阅读、证据提取和归类，从日间手术护士准入资质、制定临床护理路径、院前管理、病历标准化、手术当日术前管理、术后管理、出院评估、康复及随访指导8个方面形成17条最佳证据。结论：该项目总结了眼科成人日间手术患者病区护理管理的最佳证据，可为护理管理者制定眼科日间手术病区流程方案、实践标准提供循证依据。
Objective: To evaluate and summarize the evidences of nursing management of ophthalmic postoperative adult patients intra-day ward, and improve the quality of clinical nursing. Methods: The related databases were searched from the establishment to June 2022. The searching contents include systematic review, clinical decision-making, evidence summary, guidelines and expert consensus on nursing management in postoperative patients intra-day wards at home and aboard. Based on the theme, the evidences were extracted and summarized after independent literature quality evaluation was conducted by 2 researchers. Results: Base on the inclusion criteria, a total of 13 pieces of literature were selected, including 5 expert consensus, 3 evidence summaries, 1 evidence-based practice, 2 systematic reviews and 1 guideline. Through literature review, evidence extraction and classification, a total of 17 pieces of evidence on 8 aspects were summarized, including admission qualifications for daytime surgical nurses, development of clinical nursing path, pre-hospital management, medical record standardization, preoperative management on the day of surgery, postoperative management, discharge assessment, rehabilitation and follow-up guidance. Conclusion: This article summarized the best evidence of nursing management for ophthalmic adult day surgery patients in intra-day ward,to provide scientific evidences for nursing managers to develop ophthalmic intra-day ward guidelines and practical standards.
马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病，约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者，因患有MFS致双眼晶状体半脱位伴双眼并发性白内障，先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术，术后保留低度近视，随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。
Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.
目的：探讨非超声乳化白内障手术两种不同的娩核方式对角膜内皮细胞数量和形态的影响，以及对术后视力恢复情况的影响。方法：选择在本院手术治疗的40例白内障患者娩核方式分为直接娩出组和半娩出组，并根据 Emery－ little晶状体核硬度分级标准分为软核和硬核，手术方式为白内障非超声乳化手术，术后第3天用角膜内皮镜检查并记录角膜内皮细胞数量和形态。术后随访3个月，比较并观察4组患者术前和术后角膜内皮细胞丢失率、形态变化和视力恢复情况。结果：术前和术后3个月角膜内皮细胞丢失率比较，硬核直接娩出组与另外三组比较差异有统计学意义(P＜0.01)，而软核直接娩出组、硬核半娩出组与软核半娩出组比较差异无统计学意义(P＞0.05)。术前和术后第二天视力比较硬核半娩出组和软核直接娩出组之间无统计学意义(P＝0.49)，软核半娩出组与这两组比较有统计学意义(P＝0.030)，硬核直接娩出组与这两组之间比较也有统计学意义(P＝0.14)，术后三个月视力比较4组之间均无统计学意义(P＝0.067)。术后 3 个月角膜内皮细胞形态变化不明显。结论：白内障非超声乳化手术时，硬核直接娩核法对角膜内皮细胞损伤最大，软核半娩核法对角膜内皮损伤最小。若内皮细胞损伤较轻，对手术3个月后视力和角膜内皮细胞形态无明显影响。
Purpose: To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity．Methods: Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative follow-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups．Results: Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation (P＜0.01), whereas no statistical significance was found among the direct delivery of soft nucleus, semi-delivery of hard nucleus and semi-delivery soft nucleus groups (all P＞0.05). Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups (P＝0.49)，significantly differed from those in the semi-delivery of soft nucleus (P＝0.03) and direct delivery of hard nucleus groups (P＝0.14). Visual acuity at postoperative four months did not differ among four groups (P＝0.067).
Conclusion: During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery．
目的：了解表面切削手术前后角膜透明性变化，初步建立角膜光密度与角膜上皮下雾状混浊(Haze)对应的数据库。方法：收集我院行表面切削手术的病人74人146眼。患者手术前、术后3个月行裂隙灯角膜透明性检查和眼前节分析仪(Pentacam，0表示角膜完全透光，100表示角膜混浊不透光)测量角膜光密度。使用SPSS13.0软件对数据进行统计，术前、术后3个月角膜光密度进行Wilcoxon秩和检验；根据裂隙灯下角膜透明性将术后数据分成透明角膜组和Haze组与术前分别对比。术后角膜光密度与裂隙灯下Haze分级进行等级资料Spearman相关分析；按照裂隙灯分级将不同程度Haze与角膜光密度对应，初步建立术后Haze的角膜光密度数据库。结果：术后3个月时，透明角膜(0级Haze)80眼、I级Haze49眼、II级Haze 13眼、III级Haze2 眼、IV级Haze2眼。术前最大 角膜光密度平均值为19.7±2.47，术后3个月时最大角膜光密度平均值为30.3±7.2，术后角膜光密度比术前升高(Z=?7.404，P<0.001)；另外术后Haze组和术后透明角膜组光密度分别为38.2±15.2和21.2±3.51，与术前比两者差异也有统计学意义(Z=?4.783，P<0.001；Z=?5.195，P<0.001)。术后角膜光密度与Haze呈正相关(r=0.819，P<0.001)。各级Haze组对应角膜光密度参考值为I级Haze：29.4±2.58；II级Haze 43.2±5.68；III级Haze：59.5±0.92；IV级Haze: 89.5±14.9。结论：Haze的出现使光密度增加，影响角膜的透明性。手术后裂隙灯观察下的透明角膜光密度较术前高，可能与术后角膜的炎症反应或胶原纤维排列变化有关，需要进一步研究明确。表面切削手术前后角膜的透明性除了传统的裂隙灯检查外，也可以用角膜光密度来评价。用角膜光密度来评价角膜的透明性比单纯的裂隙灯检查更容易发现细微的异常。
Objective: To measure corneal transparency before and after the surface ablation and establish a preliminary database of corneal density and haze. Methods: Seventy-four patients (146 eyes) who underwent surface ablation were measured with the slit lamp and the densitometry program of the Pentacam Scheimpflug imaging system (0=no clouding, 100=tissue completely opaque). The corneal density before and after operation were analyzed with the Wilcoxon’s Matched Pairs Test of the SPSS 13.0. Eyes of 3 months after operation were categorized as postoperative clear corneas and postoperative with haze. According to the slit lamp, different degrees of haze were correlated with corneal density to establish a preliminary corneal density database.Results: At 3 months after operation, there were 80 eyes with clear cornea (grade 0 haze) and 66 eyes with haze which contained 49 eyes with grade I haze, 13 eyes with grade II haze, 2 eyes with grade III haze and 2 eyes with grade IV haze. Maximum density of preoperative corneas was 19.7±2.47, and it was increased to 30.3±7.2 postoperation (Z=?7.404, P<0.001). Maximum density of postoperative clear corneal (21.2±3.51) and postoperative with haze (38.2±15.2) were both higher than preoperation (Z=?5.195, P=0.004 and Z=?4.783, P<0.001). And the haze correlated corneal density was grade I haze 29.4±2.58; grade II Haze 43.2±5.68; grade III haze 59.5±0.92; grade IV haze 89.5±14.9. Conclusion: Corneal density will increase with haze. Maximum density of postoperative clear corneal was higher than preoperation which may be influenced by the postoperative corneal inflammation or the rearrange of collagen ,and it need the further research. Besides the slit lamp, we can use the corneal density to measure the corneal transparency after surface ablation. The densitometry program of the Pentacam can provide a useful objective measure of postoperative and other mild corneal haze.
目的：探讨完善泪道成形+义管植入日间手术患者的延续性护理对预防义管意外脱管的重要作用。方法：收集我科2016年1月至12月实施了标准延续性护理的泪道成形+义管植入日间手术患者的意外脱管情况。结果：泪道成形+义管植入日间手术患者随访期间没有发生医源性脱管，有9例9眼带管期间在院外发生脱管，意外脱管率为2.6%。结论：做好泪道成形+义管植入日间手术患者的延续性护理，有效降低义管意外脱出率，有利于患者康复。
Objective: To explore the important role of continuous nursing of the patients with day surgery of lacrimal duct forming combined tube implantation in the aspect of accident prevention to take off the tube. Methods: The information of the patients from Jan. to Dec. 2016 with accident the tube’s takeoff after carrying out the standard continuity of care were collected. Results: There was no iatrogenic but 9 eyes of 9 patients accidentally take off the tube during follow-up period. Accidental decannulation rate was 2.6%. Conclusion: Continuous care of the patients with day surgery of lacrimal duct forming combined tube implantation can effectively reduce the tube accidentally removal rate and be beneficial to patients’ recovery.
