综述

先天性静止性夜盲疾病谱及其基因型—表型研究现状与进展

Congenital stationary night blindness: an update and review of the disease spectrum and genotype-phenotype correlations

:144-154
 
CSNB是一组高度异质的遗传性视网膜疾病(inherited retinal disease, IRD),主要由视网膜光感受器细胞和双极细胞间的信号传导障碍引发。其主要临床特征为静止性夜盲和暗适应功能障碍,常伴有早发性近视、眼球震颤、斜视和远视等症状,ERG在CSNB的诊断、分型及治疗指导中起着至关重要的作用。尽管CSNB发病率低,属于罕见病,但其真实发病率可能被低估,部分原因在于其症状轻微、眼底表现多不明显,且临床常忽视视网膜功能检查,导致较高的漏诊和误诊率。随着分子遗传学技术的进步,大量研究揭示了CSNB不同基因缺陷的致病机制,特别是与早发近视的关联机制,这些研究同也增加了对视网膜信号传导和近视发病机制的理解。然而,CSNB的基因治疗仍处于早期阶段。本综述旨在全面探讨CSNB的疾病谱,包括不同类型患者的临床表现、影像学和功能学表型特征,以及相关遗传学致病机制,并总结基因型与表型的关联。同时,综述最新研究成果与未来发展方向,旨在提高国内学者对CSNB的认识,为临床诊断和治疗提供参考,并为后续研究提供新思路。
Congenital Stationary Night Blindness (CSNB) represents a group of highly heterogeneous inherited retinal diseases (IRDs) primarily caused by impaired signal transmission between photoreceptor cells and bipolar cells in the retina. The main clinical features include stationary night blindness and dark adaptation dysfunction, often accompanied by early-onset myopia, nystagmus, strabismus, and hyperopia. Electroretinography (ERG) plays a crucial role in the diagnosis, classification, and therapeutic management of CSNB. Although CSNB is classified as a rare disease due to its low incidence, its true prevalence is likely underestimated, partly because of its mild symptoms, inconspicuous fundus manifestations, and frequent oversight of retinal function tests in clinical practice, leading to high rates of underdiagnosis and misdiagnosis. With advances in molecular genetics, extensive research has elucidated the pathogenic mechanisms of various genetic defects in CSNB, particularly those associated with early-onset myopia. These studies have also enhanced our understanding of retinal signal transduction and the pathogenesis of myopia. However, gene therapy for CSNB remains in its early stages. This review aims to comprehensively explore the disease spectrum of CSNB, including clinical manifestations, imaging and functional phenotypic characteristics across different subtypes, and associated genetic pathogenic mechanisms. We also summarize genotype-phenotype correlations, review the latest research advancements, and discuss future directions. By doing so, this review seeks to improve the understanding of CSNB among domestic researchers, provide guidance for clinical diagnosis and treatment, and offer new insights for future research.
述评

眼底疾病临床创新研究模式:六要素,三个一

Clinical innovation research model for fundus diseases: 6 elements, 3 ones

:85-95
 
“六要素,三个一”是眼底影像基础阅片工作中进行眼底疾病临床创新性研究的模式要点,即在眼底阅片过程中捕捉到1个异常的病例后,通过积累病例、提炼特征、文献检索、寻同查异,进而扩展到1组病例,最后通过思辨创新,提出或完善1种新的疾病或疾病表征。近二十年来,在此模式的指导下,团队在眼底疾病研究工作中取得了一些原创性的成果:比如息肉状脉络膜血管病变的认识及其在国人新生血管性年龄相关性黄斑变性中发病比例第一,提出点状内层脉络膜病变病灶国际分期和命名新亚型,年龄相关的吲哚菁绿血管造影晚期散在弱荧光点揭示潴留性视网膜色素上皮脱离的发病机制,发现急性黄斑神经视网膜病变是登革热患者视力下降的主要原因,在全球最大的持续性鳞状黄斑病变的病例系列中明确病灶层次等创新性成果。“六要素”框架规范眼底影像研究流程,强调研究过程的严谨性与渐进性,且多次循环后衍生发散出更多研究线索和思路,极大拓展研究深度和广度。“三个一”路径体现了研究的层次性,从个体现象(点)到群体规律(线),最终构建疾病认知的立体网络(面);指导眼底异常影像征象、罕见病、新病种研究,加速疾病谱系完善。以“六要素”为纲,以“三个一”为略,将继续推动眼底疾病临床研究的创新与突破。
The "6 Elements, 3 Ones" constitutes a methodological framework for conducting innovative clinical research of ocular fundus diseases in foundational fundus imaging interpretation. This model emphasizes: 1) identifying a single abnormal case during routine fundus evaluation; 2) systematically expanding this observation into a case series through case accumulation, feature extraction, literature review, and comparative analysis; and 3) ultimately proposing or refining novel disease entities or manifestations through critical thinking and innovation. Over the past two decades, guided by this paradigm, our research team has achieved several original breakthroughs in fundus imaging studies, including: establishing polypoidal choroidal vasculopathy as the predominant subtype of neovascular age-related macular degeneration in Chinese populations; proposing an international staging system and novel subtypes for punctate inner choroidopathy; elucidating the pathogenesis of retentional retinal pigment epithelial detachment through the sign of age-related scattered hypofluorescent spots on late-phase indocyanine green angiography; identifying acute macular neuroretinopathy as the primary cause of vision loss in dengue fever patients; and precisely localizing lesion in the world's largest case series of persistent placoid maculopathy. The "6 Elements" framework standardizes fundus disease research protocols, emphasizing methodological rigor and progressive investigation while generating multiple research trajectories through iterative cycles, thereby expanding both the depth and breadth of scientific inquiry. The "3 Ones" pathway embodies hierarchical research progression - transitioning from individual phenomena (point observations) to population-level patterns (linear correlations), ultimately constructing a multidimensional disease cognition network (planar integration). This approach guides investigations ranging from signs of common disease to rare disorders and novel disease entities, accelerating the refinement of disease taxonomies. By adhering to the "6 Elements" as the structural framework and implementing the "3 Ones" as the strategic pathway, we will continue to advance innovation and achieve breakthroughs in clinical fundus disease researches.
综述

人工智能在泪器疾病诊疗中的应用:挑战与机遇

Application of artificial intelligence in the diagnosis and treatment of lacrimal disorders: challenges and opportunities

:53-66
 
泪器疾病是一类常见的眼科疾病,其诊疗过程复杂,治疗方法精细,涉及多种临床数据及影像资料。现有研究表明,随着人工智能(artificial intelligence,AI)技术,尤其是机器学习和深度学习的发展,AI在泪器疾病的早期筛查、精确诊断和个性化治疗中展现了巨大的应用潜力。AI能够通过高效的图像分析、多模态数据融合及深度学习算法,提供更加精确的疾病识别和治疗方案,并且能够对患者的病情进行定期监测和动态调整,提升治疗效果。然而,其仍面临诸多挑战,如多模态数据融合的复杂性、模型泛化能力的局限以及实时预测和动态调整的需求等,需要通过持续的技术创新、算法优化和跨学科合作来实现。文章对当前AI在泪器疾病诊疗中的应用现状进行了全面梳理和总结,深入分析了AI技术在诊断与治疗中的优势与局限,特别强调了AI与新兴技术的结合在优化临床决策支持系统方面的重要性。通过分析现有的挑战与技术融合策略,文章提出了AI在泪器疾病诊疗中的发展方向,旨在为未来的研究者提供创新性的思路,为眼科领域的临床实践提供有价值的参考,助力泪器疾病的精准医疗和个性化治疗的发展。
Lacrimal disorders are common ophthalmic conditions characterized by complex diagnostic and treatment processes, involving intricate therapeutic approaches and diverse clinical and imaging data. Recent studies have indicated that with the advancements in artificial intelligence (AI) technologies, particularly in machine learning and deep learning, AI demonstrates significant potential in the early screening, accurate diagnosis, and personalized treatment of lacrimal disorders. AI has the ability to provide more precise disease identification and treatment strategies through efficient image analysis, multimodal data fusion, and deep learning algorithms. Additionally, it enables regular monitoring and dynamic adjustment of patients' conditions, improving treatment outcomes. However, several challenges persist, such as the complexity of multimodal data integration, limitations in model generalization capabilities, and the need for real-time prediction and dynamic adjustments, all of which necessitate continuous technological innovations, algorithm optimization, and interdisciplinary collaborations. This paper provides a comprehensive review of the current status of AI applications in the diagnosis and treatment of lacrimal disorders, analyzing the advantages and limitations of AI in clinical practice. It especially emphasizes the importance of integrating AI with emerging technologies to optimize clinical decision support systems. By addressing the existing challenges and exploring strategies for technological integration, this paper proposes future directions for the development of AI in lacrimal disorder diagnosis and treatment, aiming to offer innovative perspectives for future researchers and valuable references for clinical practice in the field of ophthalmology, ultimately contributing to the advancement of precision medicine and personalized treatment for lacrimal disorders.
论著

经鼻内镜低位泪囊鼻腔吻合联合新型RT人工泪管置入治疗慢性泪囊炎的临床初步报告

Endonasal endoscopic lower position dacryocystorhinostomy combined with RT lacrimal stent intubation for treating chronic dacryocystitis

:27-34
 
目的:研究经鼻内镜低位泪囊鼻腔吻合术联合RT新型人工泪管置入手术的临床有效性和安全性。法:采用前瞻性随机对照研究,将临床诊断为原发性鼻泪管阻塞继发的慢性泪囊炎患者随机分为两组。研究组(A组)43例(44眼)采用低位经鼻内镜泪囊鼻腔吻合联合新型RT人工泪管置入术。对照组(B组)39例(39眼)采用常规经鼻内镜泪囊鼻腔吻合联合双泪小管置入式人工泪管置入。术后3~6个月取出人工泪管,随访时间1~12个月,平均6个月。观察术中术后的并发症,评估其安全性。结果: A组治愈42眼(95.45%),好转2眼(4.54%);B组治愈38眼(97.43%),好转1眼(2.56%),两组比较差异无统计学意义(P>0.05)。B组有12眼(30.77%)使用骨动力系统用于磨削骨质,A组未使用骨动力系统;A组手术时间为(31.88±1.64) min;B组手术时间为(48.54±4.40) min,两组比较差异有统计学意义(<0.01);B组术后人工泪管从内眦脱出2例,A组在人工泪管置入或取出时,均无管体被拉断裂的病例,无人工泪管从内眦侧脱出的病例。两组患者术后均无人工泪管导致的泪点撕裂,术后随访平均6个月,均无复发。论:低位经鼻内镜泪囊鼻腔吻合术联合RT新型人工泪管置入可以作为一种新的治疗慢性泪囊炎手术有效、安全的方法。
Objective: To study the efficacy and safety of endonasal endoscopic lower position dacryocystorhinostomy(En-LPDCR) combined with new RT lacrimal stent intubation for treating chronic dacryocystitis. Methods: In A prospective randomized controlled study, patients with chronic dacryocystitis secondary to primary nasolacrimal duct obstruction who met the inclusion criteria were randomly divided into two groups. In study group (Group A), 43 cases (44 eyes) were treated with the En-LP-DCR combined with new RT lacrimal stent intubation. Control group (Group B), 39 cases (39 eyes): conventional endoscopic dacryocystorhinostomy combined with bicanalicular intubation. The stent was removed from 3 to 6 months after surgery and followed up 6 to 12 months. Results: There was no recurrence of chronic dacryocystitis in both groups. In group A, 42 eyes (95.45%) were cured and 2 eyes (4.54%) were improved. In group B, 38 eyes were cured (97.43%) and 1 eye was improved (2.56%), there was no significant difference between the two groups (P > 0.05). In group B, 12 eyes (30.77%) With the incorporation of powered instrumentation to make bony ostium with full exposure of the lacrimal sac., while group A did not use powered dynamic system. Operation time of group A was (31.88±1.64) min; The operation time of group B was (48.54±4.40) min. The difference between the two groups was significant (< 0.01). In group B, the stent dislocated from the medial canthus in 2 cases, while in group A, there were no cases of the stent dislocated. No patient with dislocation, displacement of stent and punctum erosion founded in both groups, and no recurrence of chronic dacryocystitis was observed during the average follow-up of 6 months. Conclusion: Endonasal endoscopic lower position dacryocystorhinostomy combined with new RT lacrimal stent intubation is a new and effective method for the treatment of chronic dacryocystitis, with minimally surgical injury and faster postoperative recovery.
综述

二氧化碳激光技术在眼整形外科的应用

Application of CO2 laser technology in oculoplastic surgery

:45-52
 
二氧化碳(carbon dioxide, CO2)激光通过气体混合物激发产生红外光,组织水分高度吸收后引发汽化和局部热效应,能够精确封闭小血管和淋巴管。这些特性使得CO2激光在组织切割过程中能够最大限度地减少出血,提高术中视野的清晰度,缩短手术时间,并减轻术后肿胀、瘀斑及疼痛。在眼整形外科,特别是处理眼周复杂病例方面,CO2激光展现了显著的优势。文章对CO2激光在眼整形外科中的应用进行综述,包括眼睑肿物切除、泪小管炎治疗、瘢痕治疗、皮肤松弛治疗以及眼袋去除等,旨在为临床医生和研究人员提供关于CO2激光在眼整形外科中的全面参考,帮助其了解该项技术的优势、效果及术后并发症,以更有效地应用于实践并探索未来发展。
The carbon dioxide (CO2) laser generates infrared light through the excitation of a gaseous mixture. When this infrared light is highly absorbed by tissue water, it triggers vaporization and localized thermal effects, enabling precise sealing of small blood vessels and lymphatic vessels. These properties allow the CO2 laser to minimize bleeding during tissue dissection, enhance intraoperative visual field clarity, reduce operative time, and alleviate postoperative swelling, ecchymosis, and pain. The CO2 laser has demonstrated significant advantages in oculoplastic surgery, particularly in the management of complex periorbital cases. This article reviews the applications of the CO2 laser in oculoplastic surgery, including eyelid tumor excision, treatment of canaliculitis, scar management, skin laxity treatment, and removal of eye bags. It aims to provide clinicians and researchers with a comprehensive reference on the use of the CO2 laser in oculoplastic surgery, helping them understand the advantages, effects, and postoperative complications of this technology, in order to more effectively apply it in practice and explore future developments.
论著

鼻内镜下泪囊鼻腔吻合术疗效的影响因素分析

Analysis of influencing factors of the efficacy of endoscopic dacryocyst orhinostomy

:20-26
 
目的:分析鼻内镜下泪囊鼻腔吻合术手术疗效的影响因素。方法:纳入2021年1月—2023年7月在成都中医药大学附属医院眼科行鼻内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗的单眼慢性泪囊炎患者90例(90只眼)。所有患者均进行泪道CT造影检查及鼻内镜下泪囊鼻腔吻合术,术后随访6个月,评估手术疗效,分析手术疗效的影响因素。结果:本研究显示,慢性泪囊炎患者中女性占比为90%,平均年龄为(49.97±13.10)岁。单因素分析结果显示,术中是否置入引流管、下鼻甲肥厚与EnDCR手术疗效有关(< 0.05)。Logistic多因素回归分析结果显示,下鼻甲肥厚为En-DCR手术疗效的危险因素(P < 0.05)。结论:慢性泪囊炎多发生于中老年女性。下鼻甲肥厚为En-DCR手术疗效的危险因素。
Objective: To analyze the influencing factors for effect of endoscopic dacryocystorhinostomy. Methods: A total of 90 patients (90 eyes) diagnosed with unilateral chronic dacryocystitis undergoing endoscopic dacryocystorhinostomy in the Department of ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine from January 2021 to July 2023 were included. All patients underwent lacrimal duct CT imaging and endoscopic dacryocystorhinostomy, and were followed up for 6 months to evaluate the efficacy of surgery. Results: This study showed that 90% of patients with chronic dacryocystitis were female, and the average age of patients was (49.97±13.096) years. The results of univariate analysis showed that there was a correlation between intraoperative drainage tube placement and inferior turbinate hypertrophy and the efficacy of En-DCR (< 0.05). The results of Logistic regression analysis showed that inferior turbinate hypertrophy was a risk factor for the efficacy of En-DCR (< 0.05). Conclusions: Dacryocystitis mostly occurs in middle-aged and elderly women. Inferior turbinate hypertrophy are the influencing factors of surgical effect. Chronic dacryocystitis mostly occurs in middle-aged and elderly women. Inferior turbinate hypertrophy is a risk factor affecting the curative effect of En-DCR surgery.
论著

中国南方与西北地区慢性泪囊炎细菌谱的差异

Comparative analysis of the bacterial spectrum in chronic dacryocystitis between Northern and Southern China

:12-19
 
目的:比较中国南方地区与西北地区慢性泪囊炎患者的菌群分布,明确细菌谱的地理差异性,对不同地区抗生素使用因地制宜提供依据。方法:本研究为回顾性横断面研究。纳入2022年3月—2024年4月在中国西北地区三甲医院眼科诊断为慢性泪囊炎,拟行泪囊鼻腔吻合术的患者,并选取同时期在中国南方地区诊断为慢性泪囊炎的患者,所有患者在行经鼻镜泪囊鼻腔吻合术时切开泪囊取泪囊分泌物。两组标本均行一般细菌及真菌培养,比较两组细菌培养阳性率和构成比。结果:南方地区和西北地区泪囊分泌物细菌培养阳性率分别为26.0%和50.7%,差异有统计学意义(P < 0.001)。南方地区细菌分布中革兰阳性球菌、革兰阴性杆菌的构成比分别为 45.9%、37.6%,西北地区两种菌构成比为 71.4%、19.0%,差异有统计学意义(分别为P = 0.007,P = 0.003)。两地区检出率最高的菌均为凝固酶阴性葡萄球菌,链球菌属占比在两地区间比较差异有统计学意义(P = 0.004)。结论:中国南方地区比西北地区泪囊分泌物培养阳性率低,慢性泪囊炎细菌谱均以革兰阳性菌为主,南方地区革兰阴性菌占比较西北地区更高,链球菌属检出率较西北地区明显更低。这可能是不同地理环境、不同气候、不同生活习惯等共同因素的结果。
Objective: To compare the bacterial distribution of patients with chronic dacryocystitis from southern China and northwest China and to elucidate the geographical differences in the bacterial spectrum. Methods: This retrospective cross-sectional study included patients diagnosed with chronic dacryocystitis at the ophthalmology departments of tertiary hospitals in southern and northwest China between March 2022 and April 2024. Endoscopic dacryocystorhinostomy was performed on all patients to collect lacrimal sac secretions. The specimens were cultured for bacteria and fungi, and the positive rates and composition ratios of bacterial culture were compared between the two groups. Results: The positive rates of bacterial cultures from lacrimal sac secretions were 26.0% in southern China and 50.7% in northwest China (P < 0.001). The proportions of Gram-positive cocci and Gram-negative bacilli were 45.9% and 37.6%, respectively, in southern China, compared to 71.4% and 19.0%, respectively, in northwest China (P = 0.007 and P = 0.003, respectively). Coagulase-negative staphylococci were the most frequently detected bacteria in both regions. However, the proportion of Streptococcus species was significantly higher in northwest China compared to southern China (P = 0.004). Conclusions: The positive rate of lacrimal sac secretion cultures was lower in southern China compared to northwest China. The bacterial spectrum of chronic dacryocystitis in both regions was predominantly composed of Gram-positive bacteria. However, the proportion of Gram-negative bacteria was higher in southern China, while the detection rate of Streptococcus species was significantly higher in northwest China. These differences may be attributed to variations in climate, geographical features, and lifestyle habits.
专家共识

血泪诊疗流程的中国专家共识(2024版)

Chinese expert consensus on the diagnosis and treatment procedures of bloody tears (2024)

:1-11
 
血泪是指因各种原因导致眼部流出血性泪液的症状,其病因和临床表现复杂多样,往往涉及多学科多专业。不同病因引起的血泪,无论是临床表现,还是诊治方法均差异很大。为了向临床医生提供可参考的血泪临床诊疗流程,中国医师协会眼科医师分会泪器病专业委员会及中国中西医结合学会眼科专业委员会泪器病学组组织有关专家以临床实践经验为基础,经过认真讨论建立本共识,对血泪的病因、临床特征及诊疗流程提出指导性意见。
Bloody tears refers to the symptoms of blooding tears flowing from the eye due to various reasons. Its etiology and clinical manifestations are complex and diverse, often involving multiple disciplines and specialties. In order to provide clinicians with a reference for the clinical diagnosis and treatment process of bloody tears, Lacrimal Diseases Professional Committee of Ophthalmologist Branch of Chinese Medical Doctor Association and Lacrimal Diseases Group of Ophthalmic Professional Committee of Chinese Association of Integrated Medicine organized relevant experts to establish this consensus based on clinical practice after serious discussion, and put forward guiding opinions on the etiology, clinical characteristics, and diagnosis and treatment process of bloody tears.
综述

Study of Pigment Epithelium-derived Factor in Pathogenesis of Diabetic Retinopathy

Study of Pigment Epithelium-derived Factor in Pathogenesis of Diabetic Retinopathy

:81-88
 
Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.
Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.
论著

Outcomes of Coaxial Micro-incision Phacoemulsification in Nanophthalmic Eyes: Report of Retrospective Case Series

Outcomes of Coaxial Micro-incision Phacoemulsification in Nanophthalmic Eyes: Report of Retrospective Case Series

:94-100
 
Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications.
Methods: Fifty nine patients (89 eyes) with axial length (AL)<21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate.
Results: The median AL was 19.63 mm. Sixty-six eyes (74.16%) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P<0.001), whereas postoperative IOP was decreased significantly. (P< 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P<0.01), and both preoperative and postoperative IOP (P<0.001). Postoperative BCVA was improved in 94.38% of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74%). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84%), anterior inflammatory response (AIR) (19 eyes, 21.35%), cystoid macular edema (CME) (14 eyes, 15.73%), and uveal effusion (4 eyes, 4.49%). Late postoperative complications included CME (8 eyes, 8.99%),  uveal effusion (8 eyes, 8.99%), malignant glaucoma (2 eyes, 2.25%) and posterior capsular opacification (PCO)(10 eyes, 11.24%). The majority of complications (80%) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).
Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.
Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications.
Methods: Fifty nine patients (89 eyes) with axial length (AL)<21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate.
Results: The median AL was 19.63 mm. Sixty-six eyes (74.16%) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P<0.001), whereas postoperative IOP was decreased significantly. (P< 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P<0.01), and both preoperative and postoperative IOP (P<0.001). Postoperative BCVA was improved in 94.38% of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74%). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84%), anterior inflammatory response (AIR) (19 eyes, 21.35%), cystoid macular edema (CME) (14 eyes, 15.73%), and uveal effusion (4 eyes, 4.49%). Late postoperative complications included CME (8 eyes, 8.99%),  uveal effusion (8 eyes, 8.99%), malignant glaucoma (2 eyes, 2.25%) and posterior capsular opacification (PCO)(10 eyes, 11.24%). The majority of complications (80%) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).
Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.
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  • 眼科学报

    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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  • 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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