论著

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

The early change of corneal vertical coma and trefoil in 2.8-mm superior incision cataract surgery

:39-43
 
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.
论著

LASIK手术前后角膜滞后量与角膜阻力因子变化量及其 相关因素的多元线性回归分析

Change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis and multiple linear regression analysis of the correlative factors

:213-218
 
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 + 0.658CHpreoperative + 8.421AD/CCT (R2 =0.639, P<0.01), △CRF =?0.007 + 0.725CRFpreoperative ? 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.
论著

飞秒激光辅助角膜内皮移植术患者的护理

Nursing for the patients with femtosecond laser assisted corneal endothelial transplantation

:229-231
 
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.  
论著

小儿角膜移植围手术期护理

Perioperative care for corneal transplantation in children

:219-222
 
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.

羊膜移植对于减少碱烧伤后角膜新生血管的临床研究

Clinical Study of the Effect of Amnion Membrane Transplantation on Diminishing Corneal Neovascularization Induced by Alkali Burn

:70-71
 

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 3rd 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 14th day and 60th day after burn.

Results: Area of CNV in the treatment group was (62.133 ± 8.571) mm2 at the 14th 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 60th 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. 

Inhibitory Effect of Diclofenac Sodium on the Proliferation of Rabbit Corneal Epithelial Cells In Vitro

Inhibitory Effect of Diclofenac Sodium on the Proliferation of Rabbit Corneal Epithelial Cells In Vitro

:107-110
 

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

MethodsThe 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.

ResultsMTT 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.

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

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

MethodsThe 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.

ResultsMTT 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.

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

Subclinical inflammatory response after accelerated corneal cross-linking

Subclinical inflammatory response after accelerated corneal cross-linking

:107-111
 
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.

飞秒激光辅助角膜移植术的护理

Nursing care of patients undergoing femtosecond laser assisted corneal transplantation

:40-43
 
      总结32例飞秒激光辅助角膜移植术患者的护理,认为做好心理护理、术前完善眼部检查和做好充分的准备,术后严密观察敷料、眼压和角膜植片的情况,做好特殊体位和角膜接触镜的护理,并做好出院指导是提高手术的成功率及预防并发症的关键。
This paper summarized the nursing care of 32 patients received femtosecond laser assisted corneal transplantation. The key points to increase the success rate of surgery and prevent complications were psychological nursing, preoperative examinations and fully prepared, postoperative observation of dressing, intraocular pressure and corneal glass, care of special position and corneal contact lens, and discharge guidance.

Long term changes of posterior corneal elevation after myopic laser in situ keratomileusis

Long term changes of posterior corneal elevation after myopic laser in situ keratomileusis

:13-19
 
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis (LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation (PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN® IIz (Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.
Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN® IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.
Results: There was no statistical difference between the mean best-fit sphere (BFS) pre-LASIK and 6 years postop (P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm (range, 12 to -31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent (ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.
Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK. 
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis (LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation (PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN® IIz (Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.
Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN® IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.
Results: There was no statistical difference between the mean best-fit sphere (BFS) pre-LASIK and 6 years postop (P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm (range, 12 to -31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent (ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.
Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK. 

LASIK 术中实际角膜切削深度的临床研究

A Clinical Study of Actual Corneal Ablation Depthin Laser in Situ Keratomileusis

:11-15
 
目的:观察 NIDEK EC5000 准分子激光治疗系统准分子激光原位角膜磨镶术(Laser in sitkeratomileusis, LASIK) 角膜切削深度的可预测性。
方法采用 NIDEK EC5000 准分子激光系统对 79 例近视和(或)近视散光患者进行标准 LASIK 手术,术中使用超声角膜测厚仪分别测量制瓣后和激光切削后的剩余角膜床厚度,计算实际角膜切削深度,比较实际角膜切削深度同理论预测角膜切削深度的差异。
结果LASIK 术中实际切削深度(92.32±29.86) μm,预测切削深度(74.16±25.95) μm,两者差值(18.16 ± 14.71) μm 有统计学意义(< 0.001)。实际切削深度与预测切削深度具有较好的相关性相关系数为0.87 (< 0.001)其直线回归方程为= 18.06 + 1.001X。按术前角膜 K 值、术前等效球镜绝对值及术前中央角膜厚度值分组的实际切削深度与预测切削深度的差值均有统计学意义。实际切削深度与术前等效球镜有关与术前中央角膜厚度和 K 值无关。实际切削深度与预测切削深度差值同 K 值、等效球镜术前中央角膜厚度均无关。
结论NIDEK EC5000 准分子激光系统 LASIK 术中实际角膜切削深度比预测角膜切削深度高 (18.16±14.71) μm,在手术设计时要考虑实际切削与机器标示值存在偏差,应尽可能多的预留剩余角膜基质床厚度,以提高手术安全性。
Purpose: To assess the predictability of corneal ablation depth in LASIK using NIDEK EC5000 excimer laser.
Method: Standard LASlK surgery was performed in 79 myopic patients with or without astigmatism with the NDEK EC5000 excimer laser system. Ultrasonic cornealpachymetry was performed immediately after flap creation and after laser ablation during LASIK procedure, by which the actual corneal ablation depth was calculated.The values of actual and predicted ablation depth were compared.
Results: The actual ablation depth was (92.32+29.86) μm, the predicted ablationdepth was (74.16+25.95) μm. The differences between them (18.16+14.71) μm were statistically significance (< 0.001 ). Linear regression suggested that the actual ablation depth correlated closely with the predicted ablation depth (r = 0.87 , < 0.001 ). The regression model was = 18.06+1.001X. The differences remained statistically significant 
and were independent of the levels of preoperative corneal keratometry, absolute preoperative spherical equivalent and the preoperative central cornea thickness.
Conclusion: The actual ablation depth was about (18.16+14.71) μm thicker than thepredicted ablation depth in the NlDEK EC5000 excimer laser system. We may have totake into account this deviation in order to ensure sufficient thickness of residualstromal bed.

其他期刊
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    主办:中山大学
    承办:中山大学中山眼科中心
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    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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