目的: 探讨白内障手术患者围手术期非甾体抗炎药(non-steroidal anti-inflammatory drugs, NSAIDs)滴眼液应用的合理性,为优化临床用药方案提供依据。方法:采用回顾性研究方法,分析郑州市第二人民医院2024年100例(100眼)行白内障超声乳化并人工晶状体植入手术患者的临床数据,依据药品说明书、《我国白内障围手术期非感染性炎症反应防治专家共识(2015年)》《中国成人白内障摘除手术指南(2023年)》《中国激光角膜屈光手术围手术期用药专家共识(2024年)》等指南/共识制定评价标准,评价NSAIDs滴眼液的用药频次、疗程及术前预防性抗炎处理的规范性。结果:35%的病例存在用药不合理,共发现88项问题,包括用药频次错误(7.96%)、超疗程(22.72%)及术前用药不当(69.32%)。其中,65%糖尿病患者术前未启动NSAIDs预处理,41%非糖尿病患者术前1 d使用NSAIDs;溴芬酸钠滴眼液疗程超过10天者占20.45%,可能增加肝损伤风险。结论:医疗机构应采取积极有效措施,如制定个体化用药方案、加强合理用药培训、开展专项处方点评等,切实促进NSAIDs滴眼液在白内障手术患者围手术期的合理使用,保障患者的用药安全与治疗效果,提高医疗服务质量和患者满意度。
Objective: To investigate the rationality of perioperative application of non-steroidal anti-inflammatory drugs (NSAIDs) eye drops in patients undergoing cataract surgery, thereby providing evidence for optimizing clinical medication protocols. Methods: A retrospective study method was used to analyse the clinical data of 100 patients (100 eyes) who underwent cataract ultrasonoemulsification with IOL implantation in 2024 at the Second People's Hospital of Zhengzhou City, and the evaluation criteria were developed based on the instructions of the medication, the Chinese expert consensus on prevention and management of non-infectious inflammatory responses in the perioperative period of cataract surgery (2015), the Chinese guideline for cataract surgery in adults (2023), and the Chinese expert consensus on the perioperative medication in laser corneal refractive surgery(2024)" and other guidelines/consensus to develop evaluation criteria to evaluate the standardisation of NSAIDs eye drops in terms of frequency of dosing, duration of treatment, and preoperative prophylactic anti-inflammatory treatment. Results: Irrational medication use was identified in 35% of cases, with a total of 88 issues categorized as follows: incorrect dosage frequency (7.96%), prolonged treatment duration (22.72%), and inappropriate preoperative medication (69.32%). Notably, 65% of diabetic patients failed to initiate NSAIDs pretreatment preoperatively as recommended by guidelines, while 41% of non-diabetic patients received NSAIDs one day before surgery. Prolonged use of bromfenac eye drops (>10 days) was observed in 20.45% of cases, potentially increasing the risk of liver injury. Conclusions: Medical institutions should take active and effective measures, such as formulating individualised medication plans, strengthening training on rational use of medication, and carrying out special prescription reviews, etc., to effectively promote the rational use of NSAIDs eye drops in the perioperative period of patients undergoing cataract surgery, to safeguard the safety of patients' use of medication and therapeutic efficacy, and to improve the quality of healthcare services and patients' satisfaction.
人工智能(artificial intelligence,AI)在白内障手术中的应用越来越广泛,二者结合对于白内障手术的术前诊断和分级管理、术中人工晶状体选择、位置预测及术后管理(视力预测、并发症预测及随访)、手术培训和教学方面均起到巨大的促进作用。诚然,AI在与白内障手术相关的管理、分析和研究中还面临着许多问题,但其广泛的应用前景不可忽视。现对AI在白内障手术治疗和教学中的应用做以总结,并对其未来的发展做出展望。
Artificial intelligence (AI) has been widely used in cataract surgery. The combination of the two can play a great role in improving preoperative diagnosis, grading management of cataract surgery, intraoperative intraocular lens selection and location prediction, postoperative management (vision prediction, complication prediction and follow-up), surgical training and teaching. It is true that AI still faces many problems in the management, analysis and research related to cataract surgery, but its broad application prospects cannot be ignored. This review summarizes the application of AI in cataract surgery and teaching, and the future prospects of AI.
目的:分析染色体外环状DNA(extrachromosomal circular DNA, eccDNA)的分子特征及潜在功能,初步探索eccDNA在合并人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染患者的白内障发病过程中的作用机制。方法:收集4例合并HIV感染的并发性白内障(complicated cataract, CC)患者及性别、年龄与之匹配的4例年龄相关性白内障(age-related cataract, ARC)患者晶状体囊膜,通过提取、滚环扩增及circle-seq对eccDNA进行全长测序,分析比较合并HIV感染的CC患者及ARC患者之间晶状体囊膜eccDNA的数量、长度分布、基因组元件分布及eccDNA相关差异基因功能富集情况。结果:合并HIV感染的CC患者晶状体囊膜中eccDNA数量较ARC患者增多,鸟嘌呤(guanine, G)和胞嘧啶(cytosine,C)碱基所占的比例(GC含量)较ARC患者减少。在CC患者及ARC患者中,eccDNA的长度在1 200 ~1 800 bp均分布最多,CC患者在2 000~2 200 bp之间呈现另一部分高峰,ARC组则在此区间eccDNA丰度极低。CC患者eccDNA来源基因组元件在CpG岛占比低于ARC组。 CC患者组eccDNA差异基因富集的通路多与钙信号通路、Apelin信号通路及cGMP-PKG信号通路相关。结论:合并HIV感染的CC患者与ARC患者晶状体囊膜eccDNA的分子特征存在差异,提示eccDNA可能通过基因表达调控晶状体前囊膜代谢功能影响CC的发生、发展。
Objective: To perform full-length sequencing of extrachromosomal circular DNA (eccDNA) in the lens capsule of patients with human immunodeficiency virus (HIV)-infected complicated cataract (CC) and age-related cataract (ARC). The aim is to analyze the molecular characteristics and potential functions of eccDNA and initially investigate the mechanism by which eccDNA contributes to the pathogenesis of cataract related to HIV infection. Methods: Lens capsules were collected from 4 CC patients who were co-infected with HIV and from ARC patients matched for gender and age. The eccDNA was sequenced following a process that included extraction, rolling circle amplification, and circle-seq. We then analyzed and compared the number, length distribution, genomic element distribution, and enrichment of differential gene functions associated with eccDNA in the lens capsules of CC patients co-infected with HIV and ARC patients. Results: The number of eccDNA molecules in the lens capsule of CC patients co-infected with HIV was significantly higher than that in ARC patients, while the GC content was lower.. In both CC and ARC patients, the majority of eccDNA lengths felll within the range of 1200 to 1800 bp. However, CC patients exhibited an additional peak between 2000 and 2200 bp, where the abundance of eccDNA in the ARC group was extremely low. Regarding genomic elements derived from eccDNA, the proportion in CC patients was lower than that in the ARC group within CpG islands. The pathways associated with differential gene enrichment of eccDNA in CC patients were primarily related to the calcium signaling pathway, Apelin signaling pathway, and cGMP-PKG signaling pathway. Conclusions: There are notable differences in the molecular characteristics of lens capsule eccDNA between CC patients with HIV infection and ARC patients.These finding suggest that eccDNA may influence the onset and progression of CC by regulating the metabolic functions of the anterior lens capsule through gene expression.
目的:分析角膜后前表面曲率半径比值(B/F比值)与年龄相关性白内障患者术后屈光误差的关系,探讨B/F比值对人工晶状体(intraocular lens,IOL)度数计算精确性的影响。方法:选取2019年3—11月在天津医科大学眼科医院白内障中心就诊,并拟行单眼白内障手术的年龄相关性白内障患者共197例(197眼),术前应用Pentacam眼前节分析仪测量患者眼前节生物参数,并以B/F比值下限25%、上限25%为界将患者分为下25%组、25%~75%组、上25%组。术后3个月应用全自动电脑验光仪评估患者术后屈光状态,并计算患者术后屈光误差(postoperative refractive error,PE),比较三组平均屈光误差(mean refractive error,ME)、平均绝对误差(mean absolute error,MAE)、中位数绝对误差(median absolute error,MedAE)以及屈光误差在±0.25、±0.50、±0.75、±1.00、>±1.00 D范围内百分比差异。结果:B/F比值与年龄相关性白内障患者术后屈光误差呈中度相关(r=?0.445, P<0.001)。随着B/F比值增大,患者术后屈光状态由远视向近视漂移,术后3个月MAE、MedAE分别为0.55 D、0.46 D。屈光误差在±0.25、±0.50、±0.75、±1.00、>±1.00 D范围的百分比分别为29.4%、52.8%、71.6%、87.6%、12.7%。根据正常年龄相关性白内障人群B/F比值优化得到的矫正角膜折射指数计算角膜曲率后,MAE、MedAE分别为0.51、0.43 D,均低于矫正前(P<0.05)。结论:B/F比值对年龄相关性白内障患者术后屈光状态有影响。随着B/F比值的增加,白内障患者术后屈光状态由远视逐渐向近视漂移,且B/F比值越偏离正常平均值,患者的屈光误差绝对值越大。
Objective: To analyze the relationship between corneal B/F ratio and postoperative refractive error in age-related cataract patients, and to explore the impact of B/F ratio on the accuracy of intraocular lens power calculation. Methods: A total of 197 age-related cataract patients (197 eyes) who were treated in the cataract center of our hospital from March 2019 to November 2019 and were going to undergo monocular cataract surgery were selected. The biological parameters of the anterior segment were measured by Pentacam anterior segment analyzer before surgery, and the patients were divided into three groups (25% below the B/F ratio, 25%~75%, and 25% below the B/F ratio) with the lower limit and the upper limit of 25%. Three months after surgery, the postoperative refractive state of patients was evaluated by automatic computerized refractometer, and the postoperative refractive error (PE) was calculated, and the percentage differences of mean refractive error (ME), mean absolute error (MAE), median absolute error (MedAE) and refractive error in the range of ±0.25, ±0.50, ±0.75, ±1.00 and < ±1.00D were evaluated. Results: The B/F ratio was moderately correlated with postoperative refractive error in age-related cataract patients (r= ?0.445, P < 0.001). With the increase of B/F ratio, the refractive state of patients shifted from hyperopia to myopia after surgery, and the MAE and MedAE were 0.55 D and 0.46 D respectively in 3 months after surgery. The percentages of refractive error in the range of ±0.25, ±0.50, ±0.75, ±1.00 and < ±1.00 D were 29.4%, 52.8%, 71.6%, 87.6% and 12.7%, respectively. After adjusting the corneal curvature according to the B/F ratio of the population based on our previous study, MAE and MedAE were 0.51 D and 0.43 D, respectively, which were lower than those before correction (P< 0.05). Conclusions: There is a correlation between B/F ratio and postoperative refractive error in age-related cataract patients. As the B/F ratio increased, the refractive state of the patient gradually drifted from farsightedness to myopia after cataract surgery, and the more the B/F ratio deviated from the normal average, the greater the absolute value of the patient's refractive error.
目的:通过前房注射亚硒酸钠溶液建立新西兰兔硒性白内障模型,并评估验证其在药效试验中的应用。方法:采用前房注射10 mmol/L亚硒酸钠溶液(0.1 mL/只)对动物右眼进行造模,于造模第3天根据晶状体混浊度评分选取成模动物分为模型组、吡诺克辛滴眼液(pirenoxine sodium eye drops, PSED)0.05 mg/mL组,以模型组动物左眼作为空白组,每组8只眼;分组后对各组动物眼进行滴眼给药,50 µL/眼/次,3 次/天,连续给药17 d。于给药前、给药第7、17天进行裂隙灯检查拍照在体评估晶状体混浊度,末次给药后完整分离各组动物晶状体,体外评估晶状体透明度,然后将各组动物晶状体匀浆,用于过氧化物酶(peroxidase, POD)及谷胱甘肽过氧化物酶(glutathione peroxidase, GSH-Px)活力测定。结果:与空白组相比,模型组给药前、给药第7、17天晶状体混浊度评分均升高,给药结束后晶状体透明度评分升高,晶状体中GSH-PX和POD活力均降低;与模型组相比,PSED 0.05 mg/mL组给药17d晶状体混浊度和透明度评分均降低,晶状体中GSH-PX活力升高,POD无变化。结论:前房注射亚硒酸钠溶液可诱导新西兰兔发展出稳定的白内障模型症状,适用于药物药效作用的评价。
Objective: To establish a selenium-induced cataract model in New Zealand rabbits by anterior chamber injection of sodium selenite solution and evaluate and verify its application in pharmacodynamic trials. Methods: The right eyes of the animals were modeled by anterior chamber injection of 10 mmol/L sodium selenite solution (0.1 mL per animal). On the third day of modeling, the modeled animals were selected and divided into the model group and the pirenoxine sodium eye drops (PSED) 0.05 mg/mL group based on the lens turbidity score. The left eyes of the animals in the model group were taken as the blank group, with 8 eyes in each group. After grouping, eye drops were administered to the eyes of each group of animals. The dosage was 50 µL per eye each time, three times a day, for 17 consecutive days. Slit lamp examination and photography were conducted on the 7th and 17th days of administration to evaluate the turbidity of the lenses in vivo. After the last administration, the lenses of each group of animals were completely isolated, and the transparency of the lenses was evaluated in vitro. Then, the lenses of each group of animals were homogenized. It is used for the determination of peroxidase (POD) and glutathione peroxidase (GSH-Px) activities. Results: Compared with the blank group, the lens turbidity scores of the model group were significantly increased before administration, on the 7th and 17th days of administration, the lens transparency scores were significantly increased after the end of administration, and the activities of GSH-PX and POD in the lens were significantly decreased. Compared with the model group, the scores of lens turbidity and transparency in the PSED 0.05 mg/mL group and 17 days after administration were significantly decreased, the activity of GSH-PX in the lens was significantly increased, and there was no change in POD. Conclusions: Anterior chamber injection of sodium selenite solution can induce the development of stable cataract model symptoms in New Zealand rabbits and is suitable for the screening and evaluation of drug efficacy.
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增大疾病,表现为大角膜(直径≥ 12.5 mm)、前房极深、角膜厚度正常或轻中度变薄和睫状环扩大等。并发性白内障以及晶状体脱位是导致AM视力下降的主要原因。然而,解剖结构的异常使AM白内障手术具有很大的挑战性。文章报道了一例AM合并白内障的48岁男性患者,成功为其行手法小切口白内障摘除联合人工晶状体(intraocular lens, IOL)一期植入术,患者术后视力恢复良好,IOL位置居中,未出现较大的屈光误差。对该典型AM病例的临床特点以及手术难点的回顾总结,有助于加深广大眼科临床工作者对该疾病的认识。
Anterior megalophthalmos is a rare congenital enlargement of the anterior segment, characterized by bilateral nonprogressive megalocornea (diameter ≥12.5 mm), extremely deep anterior chamber, normal or moderate thinning of the cornea, and elongation of the ciliary ring. Cataract and lens dislocation are the main causes of decreased vision in patients with AM. However, cataract surgery on patients with AM are challenging due to the anatomical abnormalities. This case reports a 48-year-old male patient diagnosed with AM and cataract, who successfully underwent a manual small incision cataract extraction combined with intraocular lens implantation. Finally, our patient showed a good visual outcome with a well centered IOL and without obvious refractive error. In this typical AM case, we reviewed and summarized the clinical characteristics and the challenges of surgical treatment so that other ophthalmologists can learn about this disease.
先天性白内障是晶状体发育异常引起的以晶状体混浊为特征的疾病,导致婴幼儿中重度视力损害,严重影响患儿长期生存质量,给全球带来较大的社会经济负担。目前先天性白内障的发病机制尚未得到很好的阐明,遗传因素虽在其中扮演重要角色,但已知基因突变仅能解释约30%的病例,大多数患儿发病原因仍不明确。晶状体的透明性依赖于晶状体上皮细胞和纤维细胞精密有序的排列,这与受到严格调控的晶状体发育过程密切相关,任何环节异常均可能导致晶状体早期混浊。故阐明调控晶状体发育的分子与细胞机制,是深入探究先天性白内障病因的前提。表观遗传学是在DNA序列不改变的情况下,对控制基因的活性和表达的因素进行研究的学科,包括DNA甲基化、组蛋白修饰、染色质重塑、非编码RNA调控等多种修饰,近年受到生命科学领域研究者较多的关注。在眼发育及眼部各类疾病机制探索中,表观遗传调控已被证实参与多种生理与病理过程。本综述通过总结已发表的与晶状体发育和先天性白内障发病机制相关的表观遗传学研究,尝试汇总与先天性白内障发生发展相关的表观遗传分子及通路,为进一步揭示疾病机制提供理论依据,并为未来的临床诊疗提供新的思路和方法。
Congenital cataract is a disease characterized by lens opacity due to abnormal lens development.This opacity results in moderate to severe visual impairment in infants and young children, significantly impacting their long-term quality of life and imposing a substantial socioeconomic burden globally. The pathogenesis of congenital cataract remains not fully understood. Although genetic factors play a significant role, known gene mutations account for only about 30% of cases, leaving the underlying cause unclear for the majority of affected children. Lens transparency depends on the precise, ordered arrangement of lens epithelial cells and fiber cells, a process that is closely tied to the strictly regulated lens development. Abnormalities at any stage of development may lead to early lens opacity. Therefore, clarifying the molecular and cellular mechanisms that regulate lens development is a prerequisite for investigating the etiology of congenital cataract. Epigenetics is the field of study that focuses on factors controlling gene activity and expression without altering DNA sequences. It encompasses a wide range of modifications including DNA methylation, histone modifications, chromatin remodeling, and non-coding RNA regulation, and has garnered significant attention from researchers in recent years. In the context of ocular development and the mechanisms underlying various eye diseases, epigenetic regulation has been shown to participate in multiple physiological and pathological processes. This review synthesizes published research on epigenetics related to lens development and the pathogenesis of congenital cataract. It aims to summarize the epigenetic molecules and pathways associated with the onset and progression of congenital cataracts, providing a theoretical foundation for further elucidating disease mechanisms and offering new insights and approaches for future clinical diagnosis and treatment.
白内障是全球第一大致盲眼病,表现为由多种原因导致的晶状体病变,进而出现视物模糊的现象,严重者会进一步丧失视力。白内障的类型较多,发病机制尚未完全阐释清楚,氧化应激是目前公认的主要影响因素。药物治疗一直是白内障患者临床治疗的一大难题,目前市面上还没有能够真正逆转白内障的药物,现有的药物仅能在一定程度上缓解白内障的进展。手术治疗仍是现阶段唯一有效的治疗方式,但经济因素和术后并发症的风险限制了部分患者通过手术恢复视力。白内障的治疗一直是眼科领域研究的重点,目前研究主要集中在两个战略方向上:优化手术技术并结合更优的围术期药物治疗方案以减少并发症,以及对疾病机制进行基础研究以促进新靶点药物的发现。有效的药物治疗一直是目前临床治疗的一大缺口,近年来研究者在白内障机制探索和新药研发上取得了显著进展,多个新的治疗靶点以及相关治疗药物不断被发现,但相关药物真正进入临床还面临着诸多挑战。文章主要从机制研究进展、药物治疗现状和前景较好的白内障药物临床研究进展等进行综述,旨在为新的白内障药物研发提供最新的参考。
Cataracts remain the leading cause of blindness globally. They manifest as lens opacification triggered by various factors, leading to blurred vision. In severe cases, patients may eventually lose their vision entirely. There are many types of cataracts, and their pathogenesis has not been fully clarified. Currently, oxidative stress is widely acknowledged as the primary influencing factor. Pharmacological intervention remains a significant clinical challenge in cataract management. At present, there are no drugs on the market capable of truly reversing cataracts; existing medications can only alleviate the progression of the condition to a certain extent. Surgical treatment remains the only effective approach at this stage. However, economic limitations and the risks of postoperative complications hinder its accessibility for certain patient groups. The treatment of cataracts has consistently been a research hotspot in the field of ophthalmology. Current research mainly centers on two strategic approaches: optimizing surgical techniques alongside improved perioperative pharmaceutical regimens to minimize complications, and conducting basic researches on disease mechanisms to facilitate drug discovery. Effective drug treatment has long been a major gap in current clinical treatment. In recent years, significant progress has been achieved in the exploration of cataract mechanisms and the development of new drugs. Despite the remarkable advancements in uncovering cataract pathogenesis and identifying novel therapeutic targets in recent years, substantial challenges remain in translating these discoveries into clinically applicable medications. This article reviews the progress in mechanism research, the current state of pharmacological interventions, and the clinical research developments of several promising cataract drugs, aiming to provide the latest reference for the research and development of new cataract drugs.
目的:探讨白内障人群角膜屈光力(corneal refractive power,CRP)的分布特点及与眼生物学参数的相关因素分析。方法:回顾性横断面研究福州眼科医院2019年3月至2022年7月就诊的40岁以上白内障人群共23035眼,使用OA-2000测量其眼轴(axial length,AL)、CRP、前房深度(anterior chamber depth,ACD)、晶状体厚度(lens thickness,LT)、角膜水平直径即白到白(white-to-white,WTW)、中央角膜厚度(central corneal thickness,CCT)。绘制各眼生物学参数及年龄Spearman相关性热力图,绘制CRP与AL、CRP与WTW散点拟合图。将CRP与上述参数及年龄进行Spearman相关性分析,分段数据的线性关系使用Pearson分析及线性回归分析。结果:白内障人群CRP为(44.36±1.52)D,在总体数据中CRP与AL为非线性相关;但在分段数据中存在线性相关:当AL≤25.06 mm,CRP与AL负线性相关(R2 =0.397,P<0.001);当AL>25.06 mm,CRP与AL正线性相关(R2 =0.045,P<0.001);无论AL长短,CRP与WTW、CCT均呈负相关。在总体数据中,CRP与WTW也存在非线性关系;但在分段数据中存在线性相关:当10.52 mm≤WTW≤12.46 mm,CRP与WTW负线性相关(R2 =0.149,P<0.001),并与AL、ACD、CCT呈负相关。结论:CRP与AL、WTW呈非线性相关,使用CRP优化计算人工晶状体(intraocular lens,IOL)屈光力时需适当考虑AL、WTW与CRP的相关性。
Objective: To investigate the distribution characteristics of corneal refractive power (CRP), and analyze the correlation between corneal refractive power and ocular biometric parameters in cataract patients. Methods: A retrospective cross-sectional study was conducted on 2,3035 eyes of cataract patients over 40 years old, who visited Fuzhou Eye Hospital during the period between March 2019 and July 2022. The subjects' examination results of axial length (AL), corneal refractive power (CRP), anterior chamber depth (ACD), lens thickness (LT), horizontal corneal diameter (WTW), central corneal thickness (CCT) were measured by OA-2000. Spearman correlation thermograms of bilological parameters and age for each eyes were worked out. The plot scatter fitting plots of CRP and AL, CRP and WTW were made. Spearman correlation analysis was made among CRP, above-mentioned parameters and age. Linear relationships of the segmented data were analyzed with Pearson and linear regression analysis. Results: In the cataract patients, CRP was (44.36 ± 1.52) D. There was a non-linear correlation between CRP and AL in the total data. However, there was a linear relationship in the segmented data. When AL ≤ 25.06 mm, CRP was negatively linearly correlated with AL (R2 =0.397, P<0.001). When AL>25.06 mm, CRP was weakly positively correlated with AL (R2 =0.045, P<0.001). Regardless of the length of AL, CRP was negatively correlated with WTW and CCT. There was also a nonlinear relationship between CRP and WTW in the total data. But there was a linear correlation in the segmented data.When 10.52 mm ≤ WTW ≤ 12.46 mm, the negative linear correlation was found between CRP and WTW (R2 =0.149, P<0.001), while there was negative correlation among CRP, AL, ACD, and CCT. Conclusion: There is a non-linear correlation among CRP, AL and WTW. To optimize the calculation of intraocular lens (IOL) refractive power with CRP, it is necessary to consider the correlation between AL, WTW, and CRP.
该文报道一例激光原位角膜磨镶(laser-assisted in situ keratectomy,LASIK)术后行白内障超声乳化摘除联合多焦点散光矫正型人工晶状体植入术的病例。该患者为42岁女性患者,20年前外院行双眼LASIK手术,现因右眼视物模糊1年就诊。术前IOLMaster检查患者右眼眼轴长度29.66 mm,前房深度3.18 mm,晶状体厚度4.75 mm,白到白距离11.6 mm,前表面及全角膜散光分别为1.01 D@67 °及0.91 D@56 °。Pentacam角膜地形图15 °范围模拟角膜屈光力得到的角膜散光为1.2 D@58.1 °,为规则领结型。患者眼底检查未见明显异常,因其脱镜意愿强烈,植入双焦点散光矫正型IOL(德国Zeiss公司AT LISA toric 909M)。根据Barrett True-K Toric公式测量的后表面散光计算结果进行手术规划,选择+17 D球镜1.5 D柱镜Zeiss 909M IOL,植入轴位55 °。术后1个月患者裸眼远视力0.8,35 cm裸眼近视力1.0,最佳矫正远视力–0.25 DS/–0.5 DC×120 °至1.0,患者满意。提示经过详细的术前评估及规划,并与患者充分沟通,多焦点散光矫正型人工晶状体可以在部分适合的LASIK术后患者中取得良好效果。
It is reported a case of cataract phacoemulsification combined with toric multifocal intraocular lens (IOL) implantation after LASIK surgery in this article. A 42 year-old female patient who underwent bilateral LASIK surgery in other hospital 20 years ago. She visited our hospital due to blurred vision in her right eye for one year. The preoperative IOL Master examination results showed an axial length of 29.66 mm, anterior chamber depth of 3.18 mm, lens thickness of 4.75 mm, white to white distance of 11.6 mm, and anterior surface and total corneal astigmatism of 1.01 D @ 67 ° and 0.91 D @ 56 °, respectively in right eye. The corneal astigmatism measured by Pentacam using 15°range simulated keratometry is 1.2 D@ 58.1 °, which is a regular bow tie shape.No obvious abnormalities was found in the patient's fundus examination. Due to her strong desire to get rid of the glassesa toric bifocal IOL (AT LISA Toric 909M, Zeiss, Germany) was implanted.Based onthe IOL power calculation results of Barrett True-K Toric formula with measured posterior corneal astigmatism, an IOL with Sph 17.0 D/Cyl1.5 D/A 55°was chosen. One month after surgery, the patient's uncorrected distance visual acuity was 20/25, 35 cm uncorrected near visual acuity was 20/20, and the best corrected distance visual acuity was 20/20 with a prescription of –0.25 DS/–0.5 DC × 120 °. The patient was satisfied with the outcome. After detailed preoperative evaluation and design, and sufficient communication with patients, toric multifocal IOL implantation can achieve good results in some apropriated for the patients after LASIK surgery.