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.

目的：探讨下乡行大批量白内障扶贫手术的手术器械管理方法。方法：对大批量白内障扶贫手术专用的眼科器械实施规范化管理流程，运输过程严格保护，并培训当地护理人员、定人定岗，实行责任制管理，对清洗流程的质量检测及术中严格的无菌操作把控，确保手术安全进行。结果：眼科手术器械得到规范处理和保养，基层护理人员的规范培训提升其对眼科手术器械处理的能力。结论：建立下乡扶贫规范化的手术器械管理流程和培训制度，是大批量白内障扶贫手术顺利完成的基础保障。

Objective: To investigate the methods of management of surgical equipment in large quantities of cataract poverty alleviation surgery for the countryside patients. Methods: The standardized management of cataract poverty alleviation surgery was implented, the ophthalmic equipment on the transport was strictly protected, and nursing training, fixed posts, responsibility system management, cleaning process quality testing and aseptic control were performed to ensure the safety of operation. Results: The processing and maintenance of the surgical equipment were standardized. Nursing training enhanced their ability to manage ophthalmic surgical equipment. Conclusion: A standardized system of surgical equipment management guarantees the successful completion of large quantities of cataract poverty alleviation surgery.

目的：总结大批量白内障扶贫手术的护理安全管理经验。方法：回顾性分析2013至2016年中山大学中山眼科中心医疗队完成大批量白内障扶贫手术的经验、针对下乡扶贫的特殊环境、患者入院时间短、手术量大、接台手术多以及患者自我管理能力差等情况，分析其安全隐患，并在护理过程中采取相应的安全措施。术前充分评估和准备，对患者进行健康指导；术中对手术环境规范管理；指导加强术后患者的自我管理。结果：8批次共1 064例白内障摘除联合人工晶体植入术顺利完成，无1例发生术后感染。结论：建立大批量白内障扶贫手术护理安全质量管理的规范流程是扶贫工作的重要环节，做好术前的评估和准备工作，落实患者的健康教育及术后患者自我管理指导，才能确保手术顺利进行。

Objective: To assess the safety of mass volume of cataract surgery and to identify the possible factors with enhanced patients’ safety. Methods: TTis is a retrospective case series. Clinical data of patients undergoing charity cataract extraction by surgeons from Zhongshan Ophthalmic Center between 2013 and 2016 was reviewed. TTe following factors were analyzed: safety management peri-operatively, educational interventions, intraoperative sterilization, and self-management after operations. Results: A total of 1 064 patients (8 sessions) underwent cataract extraction and intraocular lens implantation. No evidence of endophthalmitis in any cases was observed.Conclusion: Establishment of standardized operation procedures for nursing safety management is essential for safety of mass volume of charity cataract surgery in China. Adequate assessment and peri-operative endeavor, educational interventions, nurse guided self-management should be empowered to enhance patients’ safety. 

目的：探讨白内障小切口非超声乳化术向超声乳化术转型中的技术转变。

方法：对 2009 年 4 月 - 2009 年 12 月“光明工程”中白内障超声乳化手术转型期 193 例 193 眼的情况进行回顾性分析，同期行小切口非超声乳化吸除术患者 43 例 48 眼作对照。

结果：对照组术后第 1 日裸眼视力大于或等于 0.5 的比例高于治疗组（P < 0.05），术后第 1 周、 第 1 个月裸眼视力大于或等于 0.5 及术后第 1 个月最佳矫正视力大于或等于 0.5 的比例，两组比较差异无统计学意义（均 P > 0.05）。对照组术后主要并发症比率均低于治疗组（均 P < 0.05）。

结论：小切口非超声乳化术向超声乳化术转型中，由于技术差异较大，发生后囊破裂和角膜内皮水肿的几率较高，转型此手术要有熟练的显微手术基础、处理并发症的能力和一定的设备条件。

Purpose: To investigate the clinical outcome during the conversion from small incision sutureless cataract surgery (SICS) to phacoemulsification cataract surgery (phaco).

Methods: During the conversion period from SICS to phaco, 241 cataract cases were assigned to SICS and phaco surgery procedures. The intraoperative complications and early postoperative outcomes were assessed.

Results: The 1st day visual acuity outcome (VA 0.5 or better) was lower in the phaco group (P < 0.05); however, the visual acuity outcomes were no longer statistically different at 1 week and 1 month visits (P > 0.05 for each visit). Among 193 cases operated in the phaco group, 51 cases (26.4%) developed corneal edema at the 1 day visit, 13 cases (6.7%) had posterior capsular rupture, 5 cases (2.6%) had zonular rupture, and 5 cases (2.6%) failed to implant IOL. These rates were higher than those found in the SICS group.

Conclusion: The outcome of phaco cataract surgery is comparable with SICS during this conversion period. Techniques that the surgeons may pay attention to are also discussed.

目的：评价药物治疗无效的开角型青光眼及部分复杂性青光眼行二氧化碳激光辅助下外层Schlemm管消融术(CO2 laser-assisted sclerectomy surgery，CLASS)的短期临床安全性及有效性。方法：收集2015年5月至2016年1月解放军总医院眼科行CLASS手术和小梁切除手术的青光眼患者各23例，共46例46只眼。观察术后1周、1个月和3个月眼压及并发症发生情况。结果：两组术后1周、1个月及3个月眼压较术前均明显下降(P=0.000)。术后1周、1个月及3个月时CLASS手术组眼压平均值均低于小梁切除术组，但无统计学差异(P>0.05)。CLASS手术组23例均无浅前房、脉络膜脱离等并发症出现。小梁切除手术组有4例在术后早期出现浅前房，其中1例出现脉络膜脱离，经治疗后均治愈。结论：CLASS手术在有效降低眼压的同时，能大幅降低患者术后出现浅前房等并发症的概率，但其远期降眼压效果及并发症发生情况有待进一步深入研究。

Objective: To evaluate the short-term of clinical safety and efficiency of CO2 laser-assisted sclerectomy surgery (CLASS) in patient with open-angle glaucoma and complicated glaucoma. Methods: Our study involved 46 eyes of 46 patients with glaucoma that underwent CLASS and trabeculectomy respectively by the same surgeon (Zhaohui Li) from May 2015 to January 2016 at the PLA General Hospital. Intraocular pressure and complications 1 week, 1 month and 3 months after operation was observed separately. Results: The intraocular pressure (IOP) 1 week, 1 month and 3 months after surgery decreased obviously (P=0.000). Compared to the trabeculectomy group 1 week, 1 month and 3 months after surgery, IOP of CLASS group was lower. But there was no statistically significant difference between these two groups (P>0.05). There was no complication occurred in CLASS group. Early postoperative complications occurred in trabeculectomy group included shallow anterior chamber and choroidal detachment, and they were all successfully resolved by pharmacotherapy. Conclusion: CLASS operation could reduce intraocular pressure effectively and decrease the incidence of complications, such as postoperative shallow anterior chamber in patients with glaucoma. However, its long-term effect and complications need to be further studied.

目的：探讨复合小梁切除术后并发浅前房的原因、治疗和预后情况。

方法：对在该院行复合小梁切除术的 267 例（302 眼）青光眼患者进行回顾性研究 ，观察术后浅前房的发生原因、治疗、预后情 况。

结果：302 眼中有 43 眼出现浅前房（1424％）。 术后滤过过强、滤过口渗漏，脉络膜脱离及睫状环阻滞是浅前房的主要原因，浅前房发生后给予保守或手术治疗，43 眼前房均恢复正常。

结论：复合小梁切除术后浅前房是常见的一种并发症。术中控制滤过率，合理应用丝裂霉素可减少浅前房的发生；术后密切观测前房、眼压和滤过情况，及早对浅前房进行干预可明显改善预后。

Purpose: To investigate the clinical cause, therapy and prognosis of shallow anterior chamber after complex trabeculectomy surgery of glaucoma.

Methods: A retrospective study of 267 patients (302 eyes) diagnosed with glaucoma at our hospital was reviewed.

Result: Forty-three among 302 eyes presented shallow anterior chamber (14.24%). The main causes of shallow anterior chamber after surgery included excessive filtering function, conjunctival exudation, choroidal detachment and ciliary circle block. These patients recovered after receiving conservative or surgical treatment.

Conclusions: The shallow anterior chamber is a frequent complication occurring following complex trabeculectomy surgery. The occurrence of this complication may be decreased by controlling filterableness and moderately applying mitomycin C intraoperatively; the prognosis may be significantly enhanced by detecting main measurements including anterior chamber, intraocular tension, filtration condition, and by interfering in shallow anterior chamber early after complex trabeculectomy surgery.

目的：该课题通过对纳入患者进行术前艾森克人格问卷调查及性别、年龄、文化程度、收入水平等 资料收集，与白内障术后1天、1月、3月的视觉满意度进行Logistic有序回归分析术后视觉满意度与人格特质等因素的关联性，以期以期探究患者植入非球面型人工晶体后视觉满意度与人格特质的关联，同时也可根据艾森克人格问卷评分对患者的预后视觉满意度进行必要术前告知沟通，降低术后预期值，提高视觉满意度，减少纠纷。方法：按照纳入标准筛选出年龄在40~84岁的112名患者，其中男性65例，女性47例。术前记录性别、年龄、收入水平及文化程度及森克人格问卷简式量表中国版(Eysenck Personality Questionnaire Revise Short Scale，EPQ-RSC)调查结果。由经验丰富的同一术者进行手术，随访并记录术后1天、1月、3月的视觉满意度。对视觉满意度进行描述性统计分析，并以不同人格特质(E、P、N、L量表所得T分)、年龄、性别、文化程度、收入水平作自变量，以视觉满意度(术后1天、1月、3月)作因变量用SPSS19做logistic有序回归分析。并将有统计学关联的因子不同组别 的视觉满意度行Kruskal Wallis分析(H检验)看组间是否存在统计学差异，若存在，再进行两两秩和检验予以比较。结果：术后1天、1月、3月总视觉满意度分别为90.18%、82.41%、90.18%。Logistic回归分析得出：术后1天，男性患者，属中间型E类人格的患者视觉满意度较高。术后1月，年龄在40~49岁， 属中间型E类人格，患者视觉满意度较高。术后3月，年龄在40~49岁，属中间型E类人格，患者视觉满意度较高。相关因素行H检验后只有E量表的P<0.05，存在统计学意义，对E组内的不同分组行两两 秩和检验后得出多组间存在统计学差异，典型外向型E类人格视觉满意度最高，中间型视觉满意度次之，倾向内、外向型E类人格视觉满意度均偏低，且倾向内向型视觉满意度最低。结论：白内障患者超声乳化术后1天、1月、3月的总体视觉满意度间存显著差异，术后1天视觉满意度较高，术后1月略有下降，而术后3月视觉满意度提高。术后3月不同E量表表型的视觉满意度间存在统计学差异。

目的：该课题通过对纳入患者进行术前艾森克人格问卷调查及性别、年龄、文化程度、收入水平等 资料收集，与白内障术后1天、1月、3月的视觉满意度进行Logistic有序回归分析术后视觉满意度与人格特质等因素的关联性，以期以期探究患者植入非球面型人工晶体后视觉满意度与人格特质的关联，同时也可根据艾森克人格问卷评分对患者的预后视觉满意度进行必要术前告知沟通，降低术后预期值，提高视觉满意度，减少纠纷。方法：按照纳入标准筛选出年龄在40~84岁的112名患者，其中男性65例，女性47例。术前记录性别、年龄、收入水平及文化程度及森克人格问卷简式量表中国版(Eysenck Personality Questionnaire Revise Short Scale，EPQ-RSC)调查结果。由经验丰富的同一术者进行手术，随访并记录术后1天、1月、3月的视觉满意度。对视觉满意度进行描述性统计分析，并以不同人格特质(E、P、N、L量表所得T分)、年龄、性别、文化程度、收入水平作自变量，以视觉满意度(术后1天、1月、3月)作因变量用SPSS19做logistic有序回归分析。并将有统计学关联的因子不同组别 的视觉满意度行Kruskal Wallis分析(H检验)看组间是否存在统计学差异，若存在，再进行两两秩和检验予以比较。结果：术后1天、1月、3月总视觉满意度分别为90.18%、82.41%、90.18%。Logistic回归分析得出：术后1天，男性患者，属中间型E类人格的患者视觉满意度较高。术后1月，年龄在40~49岁， 属中间型E类人格，患者视觉满意度较高。术后3月，年龄在40~49岁，属中间型E类人格，患者视觉满意度较高。相关因素行H检验后只有E量表的P<0.05，存在统计学意义，对E组内的不同分组行两两 秩和检验后得出多组间存在统计学差异，典型外向型E类人格视觉满意度最高，中间型视觉满意度次之，倾向内、外向型E类人格视觉满意度均偏低，且倾向内向型视觉满意度最低。结论：白内障患者超声乳化术后1天、1月、3月的总体视觉满意度间存显著差异，术后1天视觉满意度较高，术后1月略有下降，而术后3月视觉满意度提高。术后3月不同E量表表型的视觉满意度间存在统计学差异。

A 74-year-old man presented with a three-year history of foreign body sensation in the right eye after cataract surgery. He underwent uneventful trabeculectomy with mitomycin C (MMC) in the right eye seven years ago. Slit-lamp examination revealed a large avascular filltration bleb overhanging on the cornea with a thin base connected to the conjunctiva. Preoperative ultrasound biomicroscopy (UBM) impressions were confirmed by leakage of aqueous from the incision intraoperatively. Surgical dissection and revision of the bleb was performed with satisfactory outcome. Histopathologic evaluation showed proliferation of fibrous tissue under the conjunctival epithelia with irregular cystoids change. The current case may be the first report of a post-trabeculectomy overhanging filtration bleb related to cataract surgery. The possible mechanism may be related to microleakage of the surgical wound after phacoemulsiff cation which initiated the healing and scarring process.

A 74-year-old man presented with a three-year history of foreign body sensation in the right eye after cataract surgery. He underwent uneventful trabeculectomy with mitomycin C (MMC) in the right eye seven years ago. Slit-lamp examination revealed a large avascular filltration bleb overhanging on the cornea with a thin base connected to the conjunctiva. Preoperative ultrasound biomicroscopy (UBM) impressions were confirmed by leakage of aqueous from the incision intraoperatively. Surgical dissection and revision of the bleb was performed with satisfactory outcome. Histopathologic evaluation showed proliferation of fibrous tissue under the conjunctival epithelia with irregular cystoids change. The current case may be the first report of a post-trabeculectomy overhanging filtration bleb related to cataract surgery. The possible mechanism may be related to microleakage of the surgical wound after phacoemulsiff cation which initiated the healing and scarring process.

目的: 分析高度近视眼行白内障摘除及后房型人工晶状体植入术后并发裂孔源性视网膜脱离的发生率、相关危险因素及临床特点。

方法 : 回顾性分析高度近视眼行白内障摘除及后房型人工晶状体植入术患者 146 例(232 只眼) 。裂孔源性视网膜脱离在术后随访的3年时间发生。所有眼均进行了详细的眼科检查, 包括: 最佳矫正视力、眼底检查、A 超眼轴长度测量。

结果: 15 只眼发生裂孔源性视网膜脱离(6.4%) , 均需行玻璃体视网膜手术进行视网膜复位。从白内障手术到发生视网膜脱离的平均时间为10 ± 9 个月(0.5～32 个月) 。视网膜脱离经手术治疗后视力为手动 /10 cm～0.06, 12 只眼(80%) 最终视力低于白内障术前。术中后囊膜破裂与术后视网膜脱离的发生显著相关 (P < 0.01) , 60%(9/15) 的视网膜脱离患者术中发生了后囊膜破裂。

结论: 高度近视眼白内障术后并发裂孔源性视网膜脱离的发生率为 6.4%, 其预后差。术中发生后囊膜破裂患者术后发生视网膜脱离的危险性更高, 对术中后囊膜破裂患者需密切随访。

Aim: To analyze the clinical characteristics, incidence and risk of retinal detachment (RD) after cataract surgery and posterior chamber intraocular lens implantation in high myopic patients.

Methods:The medical records of 146 high myopic patients (232 eyes) who underwent cataract surgery and posterior chamber intraocular lens implantation were studied retrospectively. The development of RD was followed up over a 3-year period, and its characteristics were determined. All of the eyes received a comprehensive ophthal-mological examination, including best-corrected visual acuity measurements, a dilated fundus examination and axial length measured by A-scan ultrasonography.

Results: RD developed in 15 eyes of 15 patients. All the 15 eyes needed vitreo-retinal surgery. The mean interval between cataract surgery and the development of RD was 10 ± 9 months (range 0.5～32 months) . The visual results of the eyes after anatomical successful vitreo-retinal surgery ranged from finger count /10 cm to 0.06. 80% (12/15) of the eyes had a worse vision after the surgery than that before cataract surgery. Posterior capsular tear were associated significantly with RD (P < 0.01). Approximately 60%( 9/15) of retinal detachment was attributable to posterior capsule tear during cataract surgery.

Conclusion: Incidence of RD in high myopic patients after cataract surgery was 6.4%. RD was the potentially serious complication and tended to develop more frequently in eyes with posterior capsular rupture during cataract surgery. It is crucial to examine retinal status after cataract surgery and to have a close follow-up to prevent retinal complications, especially for patients with posterior capsular disruption. 

前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。

前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。