目的:比较Alcon Acrysof IQ PanOptix TFNT00 (PanOptix)晶状体常数优化前后对人工晶状体(intraocular lens,IOL)度数计算准确性的影响,以及不同眼轴长度晶状体常数优化的效果。方法:回顾性收集2021年6月—2022年3月在上海爱尔眼科医院行白内障超声乳化手术联合植入PanOptix IOL患者的术前眼球生物学测量参数、植入IOL度数和术后1~3个月的显然验光结果。联合SRK/T、Hoffer Q、Holladay 1、Haigis公式,通过回归法计算优化的晶状体常数A、pACD、SF,通过多元线性回归计算优化的晶状体常数a0、a1和a2。观察晶状体常数优化前后平均绝对预测误差值(mean absolute error,MAE)及中位绝对预测误差值(median absolute error,MedAE),预测误差在±0.25、±0.50、±0.75、±1.00 D以内的百分比的差异,评价晶状体常数优化对IOL计算准确性的影响。随后,按照眼轴长度进行分组(非高度近视组:<26.00 mm; 高度近视组:≥26.00 mm),比较非高度近视组和高度近视组优化晶状体常数的差异。结果:共92眼(54位患者)纳入研究。优化前的晶状体常数A、pACD、SF、a0、a1和a2分别为119.1、5.63、1.83、1.39、0.40和0.10;优化后分别为119.35、6.14、2.36、?3.42,0.12和0.34。在全部眼轴组,晶状体常数优化前,SRK/T、Hoffer Q、Holladay 1、Haigis公式的MAE值分别为0.44、0.50、0.54、0.46 D;优化后,MAE值分别为0.43、0.54、0.51、0.35 D,其中Haigis公式优化前后比较差异有统计学意义(P=0.001)。在非高度近视组,晶状体常数优化前,4条公式的MAE值分别为0.46、0.40、0.40、0.42 D;优化后,MAE值分别为0.46 D、0.38 D、0.39 D、0.38 D,比较差异均无统计学意义(均P>0.05)。在高度近视组,晶状体常数优化前,4条公式的MAE值分别为0.42、0.59、0.66、0.50 D;优化后,MAE值分别为0.36、0.48、0.47、0.31 D,其中Holladay 1和Haigis公式优化前后比较差异有统计学意义(P 分别为 0.020、0.002)。结论:PanOptix IOL的晶状体常数优化可以提高IOL度数计算的准确性,在高度近视组中比非高度近视组中优化意义更大。
Objective: To assess the benefits of intraocular lens (IOL) constant optimization of Alcon Acrysof IQ PanOptix TFNT00 (PanOptix) on the accuracy of IOL power calculation, and the effects of constant optimization between different axial length (AL) groups were further compared. Methods: Patients who underwent phacoemulsification and implantation with PanOptix IOL between June, 2021 and March, 2022 were included in this retrospective study. The preoperative biological ocular parameters, implanted IOL power, and subjective 1-3 months postoperative refraction were collected. Combined with SRK/T, Hoffer Q, Holladay 1 and Haigis formulas, the optimized IOL constant A, surgeon factor (SF), post-surgery anterior chamber depth (pACD), and a0, a1, a2 were back-calculated. Refractive outcomes using optimized IOL constants were re-calculated combined with the corresponding formulas. Compare the mean absolute error (MAE), medium absolute error (MedAE) and percentage of eyes with IOL prediction errors (PE) within ±0.25, ±0.50, ±0.75 and ±1.00 (diopter)D when using the optimized constants and the manufacture constants. Patients were divided into two groups according to AL (non-high myopia: <26.0 mm; high myopia: ≥26 mm), compare the difference of IOL constant optimization between AL subgroups. Results: A total of 92 eyes of 54 patients were enrolled. The manufacture lens constant of A, pACD, SF, a0, a1 and a2 are respectively 119.1, 5.63, 1.83, 1.39, 0.4 and 0.1; and the optimized values are respectively 119.35, 6.14, 2.36, ?3.42, 0.12 and 0.34. In all patients group, with manufacture lens constant, the MAE values of SRKT, Hoffer Q, Holladay 1 and Haigis formula are 0.44, 0.50, 0.54, 0.46 D; with optimized lens constants, the MAE values are 0.43, 0.54, 0.51, 0.35 D, and there is a statistical difference of Haigis formula after optimization (P=0.001). In non-high myopia group, with manufacture lens constant, the MAE values are 0.46, 0.40, 0.40, 0.42 D; with optimized lens constants, the MAE values are0.46, 0.38, 0.39, 0.38 D, and no statistical difference has been found(P>0.05). In high myopia group, with manufacture lens constant, the MAE values are 0.42, 0.59, 0.66, 0.50 D; with optimized lens constants, the MAE values are 0.36, 0.48, 0.47, 0.31 D, and there are statistical differences of Holladay 1 and Haigis formula after optimization (P = 0.020, 0.002). Conclusion: IOL constant optimization of PanOptix IOL can improve the accuracy of IOL calculation, which is more significant in the high myopia group.
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:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocular lens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至 2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。
Objective: To investigate the efficacy and safety of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens (IOL) implantation in the treatment of microspherophakia (MSP). Methods: by retrospective analysis, 37 MSP patients (37 eyes) who were treated in our hospital from January 2019 to June 2020 were randomly divided into two groups, including 20 MSP patients (20 eyes) who treated by SCSF-IOL and 17 MSP patients (17 eyes) who treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL). The best corrected vision and complications were observed. Results: the best corrected vision was significantly improved in both groups (P < 0.001), but there was no remarkable difference between the two groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd: YAG laser posterior capsulotomy was performed from 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment, and one eye (5.00%) had a decentered capsule opening. Posterior capsular opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up. Conclusions: SCSF-IOL is a simple and viable surgical option for managing MSP and is comparable with the MCTR-IOL. Nd: YAG laser posterior capsulotomy is a necessary mean to prevent residual capsule complications after the SCSF-IOL procedure.
目的:研究缺氧诱导因子-1(hypoxia inducible factor-1,HIF-1)信号通路在高眼压状态下的表达情况。方法:利用前房注射磁性微球法建立大鼠高眼压动物模型,通过荧光金逆行标记观察视网膜神经节细胞(retinal ganglion cells,RGCs)的存活情况,提取视网膜组织行Western印迹检测HIF-1α、血管内皮生长因子-A(vascular endothelial growth factor A,VEGF-A)-和促红细胞生成素(erythropoietin,EPO)的表达,并分析HIF-1α的变化趋势与眼压之间的关系。结果:高眼压1 d时平均眼压为(40.33±2.94) mmHg,第3天为(68.83±2.85) mmHg,第10天时下降至(43.67±3.67) mmHg,后趋于稳定,与对照眼相比差异均有统计学意义(P<0.01)。高眼压2周时中央、中间和周边视网膜的RGCs存活率分别为61.1%±1.1%,68.5%±8.5%和73.6±3.6%,至高眼压3周迅速下降,分别为33.2%±3.2%,43.4%±3.4%和51.4%±2.1%。高眼压3 d时,眼压值达最高,HIF-1α,VEGF-A和EPO的表达亦达高峰,与对照组相比差异均有统计学意义(P<0.01);后随着眼压值下降,表达也随之逐渐减少。眼压升高3 d,7 d,2周分别与对照组的HIF-1α/GAPDH的蛋白灰度比和眼压值间的相关系数为0.977,0.886,0.763,差异具有统计学意义(P<0.01)。结论:HIF-1α的表达在一定条件下与眼压值呈正相关,该通路的早期激活可能在高眼压病程中扮演重要的角色。
Objective: To evaluate the expression of hypoxia inducible factor-1 (HIF-1) signaling pathway in the state of intraocular hypertension. Methods: We established an intraocular hypertension model of BN rats model of BN rats through the injection of magnetic microspheres into anterior chamber angle, and then evaluated this model by measuring the survival rates of retinal ganglion cells (RGCs) through retrograde Fluorogold labelling. Western blot was used to detect the protein expression of HIF-1α, vascular endothelial growth factor A (VEGF-A) and erythropoietin (EPO) in the retinal tissue, and HIF-1α protein’s alterable trend as well as its relationship with intraocular pressure (IOP) was analyzed. Results: The IOP was (40.33±2.94) mmHg at the ffrst day affer elevation, (68.83±2.85) mmHg at the third day, and (43.67±2.94) mmHg at the tenth day, then kept stable later. TTe survival rates of RGCs among central, middle and peripheral retina decreased from 61.1%±1.6%, 68.5%±2.0%, 73.6%±1.5%, at the second week to 33.2%±1.8%, 43.4%±2.4%, 51.4%±2.1% at the third week, the differences were statistically signiffcant (P<0.01). The protein expression of HIF-1α, VEGF-A and EPO reached the peak at the third day when the IOP was at the highest level, then decreased with the drop of IOP. The correlation coefffcient between the protein gray value of HIF-1α/GAPDH and IOP among the 3rd day, 7th day, 2 weeks and the control was 0.977, 0.886, 0.763 respectively (P<0.01). Conclusion: The expression of HIF-1α had a positive relationship with IOP in certain condition, and the early activation of HIF-1 signaling pathway might play an important role in the process of glaucoma.
目的:观察后房型有晶体眼人工晶体(implantable collamer lens,ICL)V4c植入术后2年的有效性、安全性和稳定性,评估ICL V4c矫正屈光不正的中远期临床疗效。方法:回顾性病例研究。收集在河 北省沧州市中心医院眼一科行ICL V4c手术治疗的屈光不正患者,观察并记录术前至术后2年的裸眼视力、最佳矫正视力、屈光状态、对比敏感度、高阶像差、眼压、人工晶体拱高、角膜内皮细胞 计数、不良反应、主观视觉质量等临床资料,进行统计学分析。结果:完成随访的96例术眼,术后2年的平均裸眼视力(LogMAR)为0.021±0.065,平均最佳矫正视力(LogMAR)为0.002±0.041,优于术前最佳矫正视力,有效性指数为1.05,安全性指数为1.09,等效球镜数值稳定,对比敏感度提升,高阶像差有所增加,但主观视觉质量良好,眼压基本稳定,内皮细胞丢失率为1.6%,平均拱高为(549.6±50.0) μm,随访期间未发现眼内感染、继发性青光眼、晶状体混浊、黄斑水肿、视网膜脱离等并发症。结论:ICL V4c植入术矫正屈光不正具有良好的中远期临床效果。
Objective: To assess the medium-long term efffcacy, safety and stability of a newly developed posterior chamber phakic intraocular lens (model V4c Visian Implantable Collamer Lens) to correct refractive errors. Methods: Retrospective case series. This study evaluated eyes that had implantation of ICL V4c to correct ametropia for at least two years. Uncorrected and corrected distance visual acuities, refraction, contrast sensitivity, high-order aberration, quality of life, intraocular pressure, endothelial cell density, pIOL vault, and adverse events were evaluated to assess the efffcacy, safety and stability of V4c. Results: The study comprised 96 eyes of 50 patients. At 2 years postoperatively, the mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.021±0.065 logMAR and 0.002±0.041 logMAR, which were better than preoperative CDVA. The efffcacy and safety indices were 1.05 and 1.09, respectively. The spherical equivalent was stable with improved contrast sensitivity and increased high-order aberrations, but the subjective visual quality was well. The IOP remained stable over time. The mean vault was (549.6±50.0) μm and the mean endothelial cell loss was 1.6%. No eye developed intraocular infection, secondary glaucoma, lens opacity, macular edema or retinal detachment.Conclusion: The good medium-long term outcomes support the use of ICL V4c for the correction of myopia.
Ⅱ期人工晶状体(intraocular lens,IOL)植入常用于矫正先天性白内障摘除术后无晶状体眼状态。IOL屈光力计算是影响儿童Ⅱ期IOL植入术后视功能发育和改善的关键因素之一。现有IOL屈光力计算公式是基于成人有晶状体眼的数据研发,能准确预测成人眼IOL植入的屈光力,但是对儿童Ⅱ期IOL植入的屈光力预测准确性欠佳,主要原因包括:1)儿童II期植入术前为无晶状体眼,缺乏部分公式定义中的有晶状体眼的前房深度(是指从角膜前表面中央顶点到晶状体前表面的距离)和晶状体厚度。2)公式根据囊袋内植入IOL预测屈光力,但儿童Ⅱ期IOL睫状沟植入术在临床上应用更为广泛。当IOL植入睫状沟时有效晶状体位置发生前移,可能引起屈光预测误差。3)成人眼的发育已完成,目标屈光度多为正视或近视眼(-3.00 ~ +1.00 D),但是儿童眼仍在发育,需针对其特性测算合适的远视目标屈光度(+0.50 ~ +12.00 D)以适应眼球发育引起的屈光变化。为使Ⅱ期IOL植入患儿达到术前预设的目标屈光度,对现有公式进行选择与优化至关重要。
Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. The accurate prediction of IOL power calculation plays a pivotal role in the postoperative development and improvement of visual function for pediatric secondary IOL implantation. Current IOL power calculation formulas were developed based on data from adult phakic eyes and displayed good performance in adult population. However, the formulas showed poor performance in pediatric aphakic population due to the following reasons: 1) In these pediatric aphakic patients, the unavailability of phakic anterior chamber depth (the distance from corneal epithelium to the anterior surface of the lens) and lens thickness (LT) greatly limits the application of some IOL power calculation formulas. 2) IOL power calculation formulas predict the effective lens position on the basis of in-the-bag IOL implantation, whereas sulcus implantation is more widely used in pediatric secondary implantation. Effective lens position in capsular placement is more posterior to ciliary sulcus IOL placement. When applying the initial IOL power calculated for capsular implantation to sulcus implantation, it can lead to refractive errors. 3) Adult eyes have completed their development, with target refractions often being emmetropic or myopic (-3.00 ~ +1.00 D), while pediatric eyes are still developing, necessitating the calculation of an appropriate hyperopic (+0.50 ~ +12.00 D) target refraction to accommodate refractive changes due to ocular growth.To achieve the predetermined target refractive outcomes, the selection and optimization of IOL power calculation formulas is critically important for pediatric secondary IOL implantation.
目的:建立并评估儿童Ⅱ期人工晶状体(intraocular lens,IOL)植入术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs)的预测模型。方法:选取于中山大学中山眼科中心行Ⅱ期IOL植入术的无晶状体眼患儿205例(356眼),并在术后对其随访3年。采用Cox比例风险模型确定GRAEs的预测因子,并建立列线图预测模型。采用随时间变化的受试者工作特征(receiver operating characteristic,ROC)曲线、决策曲线分析、Kaplan-Meier曲线评估模型性能,并通过Bootstrapping的C指数和校准图进行内部验证。结果:行Ⅱ期IOL植入术时年龄较大(HR=1.50, 95% CI: 1.03 ~2.19)、术后一过性高眼压(HR=9.06, 95% CI: 2.97~27.67)和IOL睫状沟植入术(HR=14.55, 95% CI: 2.11~100.57)是GRAEs的危险因素(均P<0.05),并据此建立了两个列线图预测模型。在术后1、2、3年,模型1的ROC曲线下面积(area under curve,AUC)分别为0.747(95% CI: 0.776 ~0.935)、0.765 (95% CI: 0.804 ~0.936)和0.748 (95% CI: 0.736~0.918),模型2的AUC分别为0.881 (95% CI: 0.836 ~0.926)、0.895 (95% CI: 0.852 ~0.938)和0.848 (95% CI: 0.752~0.945)。在内部验证和评价中,两种模型均表现出良好的性能和临床净效益。Kaplan-Meier曲线显示两个不同的风险组在两个模型中都能被显著且稳健地区分。此外,本研究也构建了在线风险计算器。结论:两种列线图均能灵敏、准确地识别Ⅱ期IOL植入术后GRAEs的高危患儿,有助对其进行早期识别和及时干预。
Aims: To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods: 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results: Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to 27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusions: Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention.
先天性白内障是严重影响婴幼儿视功能的疾病。随着白内障手术和人工晶体植入手术技术的发展,先天性白内障患者术后多可获得高质量的视觉康复。然而,如何更好防治手术相关的不良事件和并发症、先天性白内障伴随的其他眼部发育不良疾病的治疗以及形觉剥夺性弱视的治疗,仍然是先天性白内障手术后需要重视的临床问题。文章对先天性白内障摘除及人工晶体植入术后高眼压和继发性青光眼的发生、相关危险因素、治疗和预防的手段进行总结,以期进一步提高对先天性白内障术后高眼压和青光眼防治的认识,减少术后并发症对视功能造成的进一步损害。
Congenital cataract is a significant condition that profoundly impacts the visual function of infants and young children. Advancements in cataract surgery and intraocular lens implantation have enabled the achievement of high-quality visual rehabilitation after congenital cataract surgery. Nevertheless, effective prevention and treatment of surgery-related adverse events and complications, as well as managing other ocular dysplasia and form deprivation amblyopia that may arise in conjunction with the surgery, continue to pose important clinical challenges following congenital cataract surgery. This article provides a comprehensive overview of the occurrence, risk factors, treatment and prevention of high intraocular pressure and secondary glaucoma after congenital cataract and intraocular lens implantation. Its aim is to enhance the comprehension of preventive and therapeutic measures for high intraocular pressure and glaucoma after congenital cataract surgery, thereby minimizing potential postoperative complications and preserving visual function.
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.