精准的屈光规划——人工晶状体屈光力计算，是屈光性白内障手术的重要前提。人工晶状体计算公式使用患者术前的眼部生物学参数如眼轴长度、角膜曲率、前房深度、晶状体厚度等指标来预测患者在白内障术后的屈光状态。人工晶状体屈光力计算公式自1967年出现以来，不断发展革新，准确性得到了极大的提升。封面展示了几种基于不同原理而构建的计算公式：回归公式(以SRK公式为代表)、基于模型眼的会聚公式(以Holladay 1等为代表)、射线追踪公式(以Olsen为代表)与人工智能公式(以RBF为代表)。目前对于普通白内障患者，现有公式能够获得良好的预测准确性。然而，对于临床上很多特殊的患者(如眼球解剖参数异常、既往有其他眼病或眼部手术史)，如何准确预测术后的屈光状态仍存在较大的挑战。路途漫漫，学者们为提升人工晶状体屈光力计算准确性的努力却从未止步，力求为患者提供最佳的白内障手术效果。
精准的屈光规划——人工晶状体屈光力计算，是屈光性白内障手术的重要前提。人工晶状体计算公式使用患者术前的眼部生物学参数如眼轴长度、角膜曲率、前房深度、晶状体厚度等指标来预测患者在白内障术后的屈光状态。人工晶状体屈光力计算公式自1967年出现以来，不断发展革新，准确性得到了极大的提升。封面展示了几种基于不同原理而构建的计算公式：回归公式(以SRK公式为代表)、基于模型眼的会聚公式(以Holladay 1等为代表)、射线追踪公式(以Olsen为代表)与人工智能公式(以RBF为代表)。目前对于普通白内障患者，现有公式能够获得良好的预测准确性。然而，对于临床上很多特殊的患者(如眼球解剖参数异常、既往有其他眼病或眼部手术史)，如何准确预测术后的屈光状态仍存在较大的挑战。路途漫漫，学者们为提升人工晶状体屈光力计算准确性的努力却从未止步，力求为患者提供最佳的白内障手术效果。
随着功能性人工晶状体的推广应用，白内障患者的屈光预测准确性日益受到重视。尽管人工晶状体屈光力计算公式在近年来不断发展革新，但解剖参数异常或既往有其他眼病、眼部手术史的白内障患者屈光预测仍存在挑战。根据生物学参数特点与病史选择适合的人工晶状体屈光力计算公式是准确进行白内障手术屈光预测的重要保障。
With the widespread application of functional intraocular lense (IOL), the accuracy of refractive prediction in cataract patients is increasingly important. Although IOL power calculation formulas have been innovated continuously in recent years, there are still challenges in predicting refractive powerin cataract patients with abnormal anatomical parameters, ocular comorbidities, or a history of ocular surgery. Based on the the characteristics of biological parameters and medical history to selcet appropriate IOL power formula, it is an important guarantee for accurate refractive prediction in cataract patients.
目的：探讨高度近视合并白内障患者白内障术后有效晶状体位置的变化。方法：收集白内障超声乳化摘除联合人工晶状体植入术的高度近视合并白内障患者21例共27眼，记录术后1 d、1周、1个月视力、屈光度、有效晶状体位置。结果：高度近视合并白内障患者术后1 d，1周，1个月有效晶状体位置分别为(4.17±0.39)，(4.09±0.38)，(4.31±0.44) mm，且组间比较差异有统计学意义(P<0.05)。有效晶状体位置的实际轴向运动为(0.19±0.13) mm，与晶状体厚度呈正相关(r=0.648，P<0.001)，与术前眼轴无相关关系(r=0.227，P=0.255)。结论：高度近视合并白内障患者术后1 d至1周人工晶状体轻度前移而造成近视偏移，而术后1个月时则呈远视偏移，且术后有效晶状体位置位移与术前晶状体厚度相关。
Objective: To investigate the change and influencing factors of the effective lens position after cataract surgery in high myopia eyes. Methods: We collected 27 eyes of 21 patients with high myopia who underwent phacoemulsification and intraocular lens implantation. The visual acuity, diopter and effective lens position were recorded 1 day, 1 week, and 1 month after operation. Results: The effective lens position of high myopia combined with cataract patients at 1 day, 1 week, and 1 month was (4.17±0.39), (4.09±0.38), and (4.31±0.44)mm, respectively. The effective lens positions significantly differed between the groups after surgery (P<0.05). The ELPRMS was (0.19±0.13) mm. The ELPRMS was positively correlated with the lens thickness (r=0.648,P<0.001), whereas was not correlated with the preoperative axial length (r=0.227, P=0.255). Conclusion: High myopic patients with cataract have a slight forward movement of the effective lens position from 1 day to 1 week after surgery, and a hyperopic shift from 1 week to 1 month. The displacement of effective lens position after surgery is correlated with the preoperative lens thickness.
人工晶状体混浊是白内障术后较为少见的并发症，患者多于手术后数月或数年因不明原因视力下降或视朦就诊。本文报道一例73岁女性患者，在同一时期双眼先后植入同一型号亲水性丙烯酸酯人工晶状体，术后6年右眼人工晶状体完全混浊，而左眼人工晶状体仍为完全透明状态。两眼的临床眼部体征、眼前节光学相干断层成像(optic coherence tomography,OCT)、超声生物显微镜检查(ultrasound biomicroscopy,UBM)等检查结果均有明显差异，人工晶状体混浊眼通过手术治疗后视力恢复满意。文章详细记录了该例患者术前的相关资料、手术治疗以及手术取出人工晶状体的检查结果，并进行了分析讨论，供专家同行参阅，为该类患者的诊疗提供参考。
Intraocular lens opacity is a relatively rare complication after cataract surgery. Many patients seek medical service serveral months or years after surgery, due to unexplained visual impairment or blurred vision. A case is reported in this article that a 73-year-old female patient who was implanted the same type of hydrophilic acrylate intraocular lens in both eyes during the same period. After 6 years of surgery, the right intraocular lens was completely cloudy, while the left intraocular lens remained completely transparent. Significant differences were found in two eyes clinical symptoms,optical coherence tomography (OCT), and ultrasound biomicroscopy (UBM) examination results. After surgical treatment, the vision of eye with intraocular lens opacity has recovered satisfactorily. In the article, the detailed record of the patient's preoperative relevant information, surgical treatment, and examination results of removing the intraocular lens were stated. The analysis and discussion results were also indicated to provide reference on the diagnosis and treatment of this type of patient for experts and colleagues.
目的：评估2.2 mm微切口白内障超声乳化摘除(phacoemulsification，Phaco)联合多焦点人工晶状体(multifocal intraocular lens，MIOLs)植入术治疗老年性白内障的临床安全性及疗效。方法：选取于2018年1月1日至2018年6月31日于佛山市第二人民医院行白内障Phaco联合人工晶状体植入的老年白内障患者。将其分为2组：A组31例35眼行2.2 mm微切口Phaco联合MIOLs植入术，B组31例38眼行3.0 mm标准切口Phaco联合单焦点IOLs植入术。2组患者均完善术前、术后的裸眼视力、角膜曲率、眼压、角膜内皮细胞数、离焦曲线等检查，同时记录其手术过程中的参数，进行比较。结果：A组与B组在手术过程中，总超乳时间、总超乳能量、超声乳化累积能量复合参数、有效超乳时间、平均超乳能量、总手术时间对比，差异均无统计学意义(均P>0.05)。2组患者术后较术前比较，角膜内皮细胞数均有所下降，差异有统计学意义(P<0.05)；2组患者间在各时间点的比较，差异均无统计学意义(均P>0.05)。2组患者手术中均未出现后囊膜破裂等并发症。2.2 mm切口与3.0 mm切口术后均增加了角膜散光，与术前比较差异均有统计学意义(均P<0.01)；2组间比较，差异无统计学意义(均P>0.05)。术后3个月，2组间裸眼远视力(uncorrected distance visual acuity，UCDVA)对比差异无统计学意义(t=?1.794，P=0.07)；裸眼近视力(uncorrected near visual acuity，UCNVA)对比差异有统计学意义(t=?25.147，P<0.01)。A组的离焦曲线有2个峰值，分别位于0 D和?3.5 D附近，两峰值间形成一个下降平缓的平台；B组的离焦曲线只有1个峰值，位于0~0.5 D之间，峰值两端下降趋势明显。A组的脱镜率为77.42%(24/31)，B组的脱镜率为12.90%(4/31)，差异有统计学意义(χ2 =26.050，P<0.01)；2组的总体满意度差异无统计学意义(χ2 =1.615，P=0.204)。结论：2.2 mm同轴微切口白内障手术在临床上安全性良好，联合植入MIOLs有较好的疗效，可于临床上广泛推广。
Objective: To evaluate the clinical safety and curative effect of phacoemulsification (Phaco) combined with multifocal intraocular lens (MIOLs) implantation in the treatment of senile cataract with 2.2 mm microincision cataract. Methods: The cataract patients who underwent phacoemulsification and intraocular lens implantation in our hospital were selected from January 1, 2018 to June 31, 2018. They were divided into two groups: group A with 31 patients (35 eyes) undergoing 2.2 mm micro-incision Phaco combined with MIOLs, while group B with 31 patients (38 eyes) undergoing 3.0 mm standard incision Phaco combined with single focus IOLs.The preoperative and postoperative uncorrected visual acuity, corneal curvature, intraocular pressure, corneal endothelium number, and defocus curve were recorded in both groups. The parameters during the operation were also recorded and compared. Results: There was no statistically significant difference in the parameters including total phacoemulsification time, total phacoemulsification energy, phacoemulsification cumulative energy compound parameters, effective phacoemulsification time, average phacoemulsification energy, total surgery time between group A and group B during the operation (all P>0.05). Compared with preoperative, the number of corneal endothelial cells decreased both in the two groups after surgery. The difference was statistically significant (P<0.05). There was no significant difference between the two groups at any time (all P>0.05). There were no complications such as posterior capsule rupture during operation in both groups. The corneal astigmatism was increased after operation both in the 2.2 mm incision and 3.0 mm incision, and the difference was statistically significant compared with pre-operation (both P<0.01). There was no significant difference between the two groups (all P>0.05). At 3 months postoperatively, there was no significant difference in uncorrected distance visual acuity (UCDVA) between the two groups (t=?1.794, P=0.07), and the difference was statistically significant in the uncorrected near visual acuity (UCNVA) (t=?25.147, P<0.01). Defocus curve: The defocus curve of group A had two peaks, which are located near 0 D and ?3.5 D, forming a flat platform with a descent between the two peaks.The defocus curve of group B had only one peak, located at 0–0.5 D, and the downward trend at both ends of the peak was obvious. The rate of off-glasses and satisfaction: the rate of off-glasses in group A was 77.42% (24/31),and the rate of dislocation in group B was 12.90% (4/31). The difference was statistically significant (χ2 =26.050,P<0.01). There was no significant difference in overall satisfaction between the two groups (χ2 =1.615, P=0.204).Conclusion: The 2.2 mm coaxial microincision cataract surgery yields high clinical safety, and the combined implantation of multi-focal intraocular lens has good curative effect and can be widely promoted in clinical practice.
目的：探究球面塑形镜、环曲面塑形镜在矫治近视复合散光的有效性及安全性。方法：回顾分析宜昌市第一人民医院2016年3月至2018年3月角膜塑形镜治疗青少年近视94例(178眼)，按佩戴塑形镜类型分为球面塑形镜组(48例，90眼)与环曲面塑形镜组(46例，88眼)。记录配镜前、佩戴1年后、停戴1周后的视力、角膜散光、眼轴长、球镜屈光度、眼压、泪膜破裂时间及角膜着染率。结果：戴镜1年后，2组组内相比，散光、球镜度数、眼压、泪膜破裂时间均降低，但2组组间相比，仅散光度数差异有统计学意义(P<0.01)。戴镜1年后，两组视力较戴镜前显著提高，停戴后近视度数较佩戴前增加，但组间差异无统计学意义(P>0.05)；2种塑形镜角膜着染发生率差异无统计学意义(P>0.05)。结论：2种塑形镜均能够降低近视复合散光患者度数，有效提高患者视力，但并不能完全阻止近视的进展。虽然环曲面塑形镜在矫正散光方面有优势，但总有效性与安全性并不占优势。
Objective: To observe the effectiveness and safety of orthokeratology lens and toric design othokeratology treatment for compound myopic astigmatism. Methods: From March 2016 to March 2018, 94 teenagers(178 eyes) were selected as the subjects of study. They were divided into two groups according to the type of orthokeratology: the orthokeratology lens group (48 cases, 90 eyes) and the toric design othokeratology group(46 cases, 88 eyes). Visual acuity, corneal astigmatism, axial length, spherical lens refraction, intraocular pressure,tear film rupture time and corneal staining rate were recorded before, after 1 year and after 1 week. Results: After 1 year of wearing the lens, astigmatism, spherical lens degree, intraocular pressure and tear film rupture time were all decreased in the 2 groups compared with each other, but only astigmatism degree was statistically significant between the 2 groups compared with each other (P<0.01). After wearing the glasses for 1 year, the visual acuity of the two groups was significantly improved compared with that before wearing the glasses, and the myopia degree was increased after stopping wearing the glasses compared with that before wearing the glasses, but the difference between the two groups was not statistically significant (P>0.05). There was no statistical significance in the incidence of corneal staining between the two types of shaping lenses (P>0.05). Conclusion: Both of the two shaping lenses can reduce the degree of myopic patients with complex astigmatism and effectively improve the visual acuity of patients, but they can not completely prevent the progress of myopia. Although toroidal shaping mirror has advantages in correcting astigmatism, its overall effectiveness and safety are not.
随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。
With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.
目的：探讨利用微信平台在有晶体眼人工晶体(implantable collamer lens，ICL)植入术后并发性白内障患者延续性护理的应用效果。方法：对13例(16眼)ICL植入术后并发性白内障患者利用微信平台随访和延续性护理，观察患者术前和术后1个月的护理满意度的自身对照。结果：13例患者(16眼)手术均顺利完成，术后均无出现并发症，术后视力均较术前有所提高，术后患者的护理满意度评分高于术前，差异有统计学意义(P<0.05)。结论：利用微信平台进行随访和延续性护理，可以提高患者护理满意度，是应用于ICL植入术后并发性白内障患者的有效护理方法。
Objective: To explore the application effect of WeChat platform in continuous nursing care for patients with complicated cataract after implantable collamer lens (ICL) implantation. Methods: Thirteen patients (16 eyes) with complicated cataracts after ICL implantation were followed up and continued nursing on the WeChat platform, then the self-control of the patients’ satisfaction on nursing before and one month after surgery was observed. Results: A total of 13 patients’ operation (16 eyes) went well, and they had no postoperative complications. The visual acuity of the patients was improved after operation compared with that of before operation, and the nursing satisfaction score of patients after operation was higher than that of before operation; the difference was statistically significant (P<0.05). Conclusion: Using WeChat platform for follow-up and continuous nursing can improve patients' nursing satisfaction, which was an effective nursing method for patients with complicated cataract after ICL implantation.
内源性干细胞在组织的损伤修复过程中组织相容性好、致瘤风险低，相较于外源性干细胞具有不需要体外扩增和培养、疾病传播风险低的优点，在细胞治疗领域具有显著优势。现在已经有多种使用内源性干细胞进行疾病治疗的成熟方式，应用领域包括了全身各种器质性和功能性疾病。在眼组织中，晶状体具有终生生长的能力且便于观察，是实现再生修复的突破点。哺乳动物中晶状体再生的实现有赖于晶状体内源性干细胞的定位和改良手术方式，以保留晶状体干细胞，并创造适合晶状体再生的微环境。对再生后的晶状体蛋白质组成分析，发现其类似成熟晶状体，而非胚胎期的晶状体，提示晶状体再生的调控与胚胎期的诱导发生并不相同；而调控晶状体再生的策略不仅着眼于干细胞的激活和正确分化的诱导，对其上皮间质转化过程也需要进行调控。在未来，为将晶状体再生的经验应用于其他眼组织中，动员内源性干细胞并促进其生长，可以添加细胞有效成分，比如外泌体、线粒体、小分子化合物等，模拟细胞应激；此外，还可以通过手术或生物材料辅助，恢复晶状体结构和环境。
Endogenous stem cells have significant advantages in cell therapy for excellent histocompatibility, low tumorigenicity risk, unnecessity for in vitro expansion and culture, and low disease transmission risk. There have been some applications for endogenous stem cells in treating diseases, targeting some organic and functional diseases throughout the body. In ocular tissue, the lens is a breakthrough for regenerative therapy due to its potential to grow throughout life and observation accessibility. Achieving lens regeneration in adult mammals attributes to some prerequisites. Firstly, the location of endogenous stem cells in the lens has been identified. Then, surgical approaches have been advanced to preserve lens stem cells and create a microenvironment suitable for lens regeneration. Protein compositional analysis of the regenerated lens reveals that it is similar to a mature lens rather than an embryonic lens, suggesting that the regulation of lens regeneration is not the same as the induction of embryonic onset. The strategy for regulating lens regeneration needs to focus not only on the activation and proper differentiation of stem cells but also on regulating the process of epithelial mesenchymal transition (EMT). In the future, in order to apply the experiences of lens regeneration to other ocular tissues, to mobilize endogenous cells and promote their growth, some strategies could be used. These strategies include mimicking cellular stress via the addition of cellular active ingredients, such as exosome, mitochondria, and small molecular compounds. Additionally, we can also try to restore lens tissue structure and microenvironment through surgical or biomaterial assistance.
在晶状体纤维细胞分化的终末阶段，细胞核、线粒体、内质网及高尔基体等膜性细胞器会发生程序性的降解，这对晶状体透明性的维持至关重要。然而，晶状体细胞器降解过程的机制尚不明确。研究晶状体细胞器的降解过程可为阐明白内障的发病机制提供理论依据，也有望为晶状体再生提供新的干预靶点。本文就晶状体细胞器降解过程及其机制进行综述。
During terminal differentiation of lens fiber cells, nuclei and other organelles experience programmed elimination.This process is essential for the maintenance of lens transparency. However, the mechanisms underlying lens organelle degradation remain unclear. Identification of the mechanisms can provide a theoretical basis for elucidating the pathogenesis of cataract and is expected to reveal new intervention targets for lens regeneration. In this review, we discuss potential mechanisms and the process of lens organelle degradation.
