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：总结了角膜胶原交联术治疗圆锥角膜的护理及其效果。

方法：回顾分析30例（31眼）角膜胶原交联术患者术前术后护理记录及病历资料。

结果：30 例（31眼）患者病情得到控制，术后恢复理想，术后一个月复查视力都有提高。

结论：角膜胶原交联术护理重点在于术前协助患者完善各项检查、相关健康知识宣教及有效的心理护理，术后严密观察病情变化、减轻病人痛苦、预防感染及促进角膜上皮修复治疗。

Purpose：To summarize the nursing experience and clinical efficacy of corneal collagen cross-linking in treating keratoconus．

Methods：Preoperative and postoperative nursing and medical record of 30 patients (31 eyes) undergoing corneal collagen cross-linking were retrospectively analyzed．

Results：The the severity of diseases in all 30 patients (31 eyes) was properly controlled．All cases were fully recovered．The visual acuity at postoperative one month was improved in all cases．

Conclusion：assistance in terms of preoperative examination，education of health knowledge and effective psychological nursing play a pivatol role in the nursing before and after corneal collagen cross-linking．Following surgery，postoperative changes in the the severity of diseases should be strictly observed. Much attention should be diverted to ease patients' pain，prevent infection and accelerate the healing of corneal epithelium． 

Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.

Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens (IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by iTrace wavefront aberrometer (Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square (RMS) values of Z(3, -3), Z(3, 3), Z(3, -1), Z(3, 1), and Z(4, 0) and total high order aberration (HOA) were evaluated.

Results: The uncorrected and corrected visual acuities improve significantly (P<0.001). No significant postoperative changes were observed in spherical aberration (P=0.652). Significant changes in vertical coma and vertical trefoil (0.005±0.214 vs. -0.049±0.242, P=0.037; -0.141±0.222 vs. -0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery (0.567±0.161 vs. 0.688±0.343, P<0.001).

Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8 mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.

Background: To investigate early change of corneal aberrations after 2.8-mm superior incision phacoemulsification.

Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens (IOLs) implanted through a 2.8-mm superior corneal incision. The anterior corneal wavefront aberrations for the 6.0-mm pupillary diameter was measured by iTrace wavefront aberrometer (Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square (RMS) values of Z(3, -3), Z(3, 3), Z(3, -1), Z(3, 1), and Z(4, 0) and total high order aberration (HOA) were evaluated.

Results: The uncorrected and corrected visual acuities improve significantly (P<0.001). No significant postoperative changes were observed in spherical aberration (P=0.652). Significant changes in vertical coma and vertical trefoil (0.005±0.214 vs. -0.049±0.242, P=0.037; -0.141±0.222 vs. -0.258±0.359, P=0.001; separately). However, the total HOAs increased after cataract surgery (0.567±0.161 vs. 0.688±0.343, P<0.001).

Conclusions: Corneal vertical coma and vertical trefoil changes significantly in 2.8 mm superior corneal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.

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：研究准分子激光原位角膜磨镶术(laser in situkeratomileusis，LASIK)前后角膜滞后量(corneal hysteresis，CH)和角膜阻力因子(corneal resistance factor，CRF)变化量，对其相关因素进行多元线性回归分析。方法：前瞻性研究。纳入行LASIK手术的近视眼及近视散光患者70眼(38例)，术前与术后6个月各项参数分别由眼反应分析仪(ocular response analyzer，ORA)、非接触眼压仪、超声角膜测厚仪及Pentacam眼前节分析仪测量。分析LASIK手术前后△CH，△CRF与术前、手术设计等参数的相关性，并对相关参数进行多元线性回归分析。结果：手术前后CH分别为(10.05±1.36)，(8.15±0.90) mmHg(1 mmHg=0.133 kPa)，CRF分别为(9.91±1.38)，(6.92±0.88) mmHg，差异均有统计学意义(P<0.01)；△CH与△CRF分别为(1.90±1.15)，(2.99±1.23) mmHg。△CH与术前CH，CRF，眼压(intraocular pressure，IOP)，预计切削深度(ablative depth，AD)以及AD/CCT呈正相关；△CRF与术前CH，CRF，IOP，AD，AD/CCT，术前等值球镜(spherical equivalent，SE)以及预计基质床厚度(residual stromal bed’s thickness，RSBT)有相关性。采用多元线性回归对LASIK手术前后△CH，△CRF与术前、手术设计等各相关参数进行分析，回归方程为：△CH=?6.182+0.658CH_术前+8.421AD/CCT (R2=0.639，P<0.01)，△CRF=?0.007+0.725CRF_术前?0.014RSBT (R2=0.689，P<0.01)。结论：LASIK术前后CH与预计AD和角膜厚度比值密切相关，CRF变化量与预计角膜RSBT密切相关，在设计手术时应慎重考虑预计AD与预计RSBT。

Objective: To discuss the change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis (LASIK), and to analyze their related factors by multivariate linear regression. Methods: In this prospective study, 70 eyes (38 patients) with myopia and myopic astigmatism undergoing LASIK were included. Related factors were measured preoperatively and at 6 months postoperatively by ocular response analyzer, noncontact tonometer (NCT), ultrasonic pachymeter, and Pentacam system. TTe correlation was analyzed between △CH, △CRF and preoperative and operative design’s parameters, and correlative factors analyze. △CH and △CRF were analyzed by the multiple linear regression. Results: CH before and after LASIK were (10.05±1.36) and (8.15±0.90) mmHg, and CRF before and affer LASIK were (9.91±1.38) and (6.92±0.88) mmHg. TTere was signiffcant difference between preoperative and postoperative CH and CRF (P<0.01). △CH and △CRF were (1.90±1.15) and (2.99±1.23) mmHg. Preoperative CH, CRF, intraocular pressure (IOP), ablative depth (AD) and AD/CCT were positive correlated with △CH. Preoperative CH, CRF, IOP, AD, AD/CCT, preoperative spherical equivalent (SE) and predicted residual stromal bed’s thickness (RSBT) were correlated with △CRF. TTe regression equation of △CH and △CRF and influencing factors were △CH =?6.182 + 0.658CH_preoperative + 8.421AD/CCT (R2 =0.639, P<0.01), △CRF =?0.007 + 0.725CRF_preoperative ? 0.014RSBT (R2 =0.689, P<0.01). Conclusion: The change of CH before and after LASIK is correlative with AD/CCT. The change of CRF before and after LASIK is correlative with predicted residual stromal bed’s thickness. Ablative depth and predicted residual stromal bed’s thickness should be considered carefully during the surgical design.

目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty，EK)患者的护理。方法：对40例 行飞秒激光辅助EK术的患者做好术前心理护理，完善术前检查及术前准备，术后重点做好体位护 理、病情观察及出院指导。结果：4例患者术后发生植片移位，经再次复位后贴合良好，1例术后第1天气泡到后房行前房成形术；13例患者术后出现眼压升高，经治疗眼压得到控制；40例患者全 部治愈出院。结论：对EK术患者应做好术前及术后的护理，及时发现并发症并采取相应的治疗与护理措施，以提高手术的成功率。

Objective: To explore the nursing care of patients with femtosecond laser assisted endothelial transplantation. Methods: Forty patients were involved in this study. Preoperative psychological nursing, ocular examination, and surgical preparation were taken, and the main nursing postoperation focused on patients’ position and the discharge guidance. Results: TTe graffs in 4 cases were displaced, and were all in place affer resetting. The bubble was observed in posterior chamber in 1 case, this case was taken anterior chamber forming operation. Intraocular pressure was high in 13 cases, and those cases were treated with topical medicines. Conclusion: Completing the preoperative nursing of patients with corneal endothelial transplantation, observing the complications and taking corresponding treatment and nursing measures help improve the success rate of the operation.  

目的：减轻行角膜移植术的患儿及家属的心理负担，提高患儿对手术的耐受性，减少术后并发症。方法：对45例将进行角膜移植的患儿进行围手术期护理。结果：所有患儿经过精心的治疗和护理后均恢复良好，视力均有提高。结论：术前做好充足的准备、术前心理护理，术后严密观察生命体征和眼部敷料的情况，做好相关的生活和饮食指导，遵医嘱及时有效用药，注意患儿异常的反应及眼部的情况，及时发现并处理并发症，给予细致的出院指导，有利于患儿早日康复。

Objective: To reduce the psychological burden of the children and families who are scheduled to the corneal transplantation, and to improve the patients’ tolerance and reduce postoperative complications. Methods: The perioperative care was given to 45 patients with corneal transplantation. Results: All children were treated well by careful treatment and care. Conclusion: Before operation, comprehensive preparation and psychological nursing care should be delivered. Affer operation, the physicians and nurses should guide the patients to live a healthy lifestyle, remind them to take the drugs timely, identify the abnormal symptoms and postoperative complications in children with abnormal responses, implement effective treatment timely to accelerate postoperative recovery.

目的：观察羊膜移植手术对于减少碱烧伤后角膜新生血管的疗效。

方法：回顾性病例对照研究。2006－2010 年期间该院收治的 Ⅲ 度角膜碱烧伤的患者 19 例 23 眼，其中行羊膜移植术（治疗组）11 例 13 眼，未行羊膜移植术（对照组）8 例 10 眼。该两组的年龄和手术外的处理基本匹配。伤后 3 d 治疗组行羊膜移植术。分别在伤后 14、60 d 测量各组角膜新生血管面积。应用 SPSS 12.0 统计学软件将此两组的面积进行配对 t 检验，以 P < 0.05 作为差异有统计学意义。

结果：在烧伤后 14 d 治疗组新生血管面积（62.133 ± 8.571）mm²，明显低于对照组（89.561 ± 9.741）mm²，治疗组较对照组减低 30.6%，两组差异具有统计学意义（P < 0.05）。烧伤后 60 d 治疗组新生血管面积（112.019 ± 17.362）mm²，明显低于对照组（129.481 ± 13.534）mm²，治疗组较对照组减低 13.5%，两组差异具有统计学意义（P < 0.05）。

结论：羊膜移植术能明显抑制碱烧伤所致角膜新生血管的生长。

Purpose: To study the curative effect of amnion membrane transplantation on decreasing corneal neovascularization (CNV) induced by alkali burn.

Methods: It was a non-randomized retrospective case-control study. Among 19 cases (23 eyes) of third-degree alkali burns from 2006 to 2010, 11 cases (13 eyes) were performed with amnion membrane transplantation operation, and others were not. Amnion membrane transplantation was performed at the 3^rd day after burn in the treatment group. Ages and treatments beyond surgery of double groups were matched. Areas of CNV in double groups were measured at the 14^th day and 60^th day after burn.

Results: Area of CNV in the treatment group was (62.133 ± 8.571) mm² at the 14^th day after burn, and was 30.6% lower than that in the control group. Area of CNV in the treatment group was (112.019 ± 17.362) mm² at the 60^th day after burn, and was 13.5% lower than that in the control group. There was statistical significance (P < 0.05).

Conclusion: Amnion membrane transplantation operation can inhibit the growth of corneal neovascularization induced by alkali burn. 

Purpose: To investigate the inhibitory effect of diclofenac sodium on rabbit corneal epithelial cells (RCECs) in vitro and explore its pharmacological mechanism.

Methods: The fresh rabbit cornea was cultured to get the primary RCECs, and RCECs of passage 2 were used for the research. The cells were divided into experimental groups, in which the cells were incubated with different concentrations (18.18, 27.27, 36.36, 45.45, 54.55 μg/ml) of diclofenac sodium, and a control group. The effect of diclofenac sodium on the proliferation of cells was measured by methyl thiazolyl tetrazolium (MTT) assay 24, 48, and 72 h after incubation. While the RCECs were divided into experimental groups, the cells in which were incubated with 9 and 12.5 μg / ml diclofenac sodium, and a control group. The cell cycle and apoptotic rate were observed by flow cytometer.

Results: MTT assay showed that diclofenac sodium had an obvious inhibitory effect on RCECs, and the inhibition rate was increasing along with the increase of the concentration of diclofenac sodium and the incubation time (P < 0.05). Flow cytometer showed that after incubation with diclofenac sodium, the cells in G₀/G₁ phase were obviously increased, and the apoptosis cusp and apoptotic rate were increased.

Conclusion: Diclofenac sodium has an obvious inhibitory effect on RCECs, which was dosage-dependent, and it may function by inducing cell apoptosis and ceasing cell cycles

Purpose: To investigate the inhibitory effect of diclofenac sodium on rabbit corneal epithelial cells (RCECs) in vitro and explore its pharmacological mechanism.

Methods: The fresh rabbit cornea was cultured to get the primary RCECs, and RCECs of passage 2 were used for the research. The cells were divided into experimental groups, in which the cells were incubated with different concentrations (18.18, 27.27, 36.36, 45.45, 54.55 μg/ml) of diclofenac sodium, and a control group. The effect of diclofenac sodium on the proliferation of cells was measured by methyl thiazolyl tetrazolium (MTT) assay 24, 48, and 72 h after incubation. While the RCECs were divided into experimental groups, the cells in which were incubated with 9 and 12.5 μg / ml diclofenac sodium, and a control group. The cell cycle and apoptotic rate were observed by flow cytometer.

Results: MTT assay showed that diclofenac sodium had an obvious inhibitory effect on RCECs, and the inhibition rate was increasing along with the increase of the concentration of diclofenac sodium and the incubation time (P < 0.05). Flow cytometer showed that after incubation with diclofenac sodium, the cells in G₀/G₁ phase were obviously increased, and the apoptosis cusp and apoptotic rate were increased.

Conclusion: Diclofenac sodium has an obvious inhibitory effect on RCECs, which was dosage-dependent, and it may function by inducing cell apoptosis and ceasing cell cycles

Background: To evaluate the inflammatory response after accelerated collagen cross-linking (CXL) in eyes with keratoconus.

Methods: Consecutive eyes with keratoconus undergoing CXL surgery were included in this nonrandomized interventional study. Aqueous flare was measured pre- and post-operatively with a laser flare photometer at 1 week, 1, 3 and 6 months after CXL.

Results: Sixty eyes of 60 patients were entered into the study. Before CXL, the mean flare value was 4.5 photons per millisecond (ph/ms). The flare values observed at week 1 (7.1 ph/ms; P=0.008), month 1 (6.5 ph/ms; P=0.04), month 3 (6.7 ph/ms; P=0.004) and month 6 (6.7 ph/ms; P=0.004) were significantly higher compared to baseline. Flare values were not significantly different from week 1 up to 6 months after CXL (P=0.930). No statistically significant correlation was detected between the amount of inflammation and keratometric indices.

Conclusions: Accelerated CXL in patients with keratoconus may cause a subclinical inflammatory response which is evident as slight but rather long-lasting rise of aqueous flare.

Background: To evaluate the inflammatory response after accelerated collagen cross-linking (CXL) in eyes with keratoconus.

Methods: Consecutive eyes with keratoconus undergoing CXL surgery were included in this nonrandomized interventional study. Aqueous flare was measured pre- and post-operatively with a laser flare photometer at 1 week, 1, 3 and 6 months after CXL.

Results: Sixty eyes of 60 patients were entered into the study. Before CXL, the mean flare value was 4.5 photons per millisecond (ph/ms). The flare values observed at week 1 (7.1 ph/ms; P=0.008), month 1 (6.5 ph/ms; P=0.04), month 3 (6.7 ph/ms; P=0.004) and month 6 (6.7 ph/ms; P=0.004) were significantly higher compared to baseline. Flare values were not significantly different from week 1 up to 6 months after CXL (P=0.930). No statistically significant correlation was detected between the amount of inflammation and keratometric indices.

Conclusions: Accelerated CXL in patients with keratoconus may cause a subclinical inflammatory response which is evident as slight but rather long-lasting rise of aqueous flare.