论著

基于 OA-2000 测量的硅油取出联合白内障手术患者人工晶状体计算公式预测准确性分析

Prediction accuracy analysis of intraocular lens calculation formulas in patients undergoing silicone oil removal combined with cataract surgery based on OA-2000 measurement

:857-866
 
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.
病例报告

角膜偏心切削 LASIK 术后白内障一例

Cataract after LASIK with eccentriccorneal ablation: a case report

:880-886
 
准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)是矫正屈光不正的重要角膜屈光手术方式之一。经过准分子激光切削的角膜,生物测量数据发生改变。对于此类患者,通过常规测量获得的参数数据以及使用常规计算公式确定的IOL屈光度将变得不再准确,由此将会导致术后较大的屈光误差,进而影响患者的视觉质量。本文报道一例46岁的男性白内障患者。该患者既往双眼屈光不正,曾接受过LASIK手术治疗。白内障术前角膜地形图检查发现该患者双眼存在角膜偏心切削,这为IOL屈光度的确定带来困难。手术医生通过角膜地形图判断角膜切削的居中性,在特定区域内选择角膜曲率K值,并采用Barrett True K公式计算出IOL屈光度。白内障术后患眼屈光误差相对较小,视力提高,视觉质量改善。
Laser-assisted in situ keratomileusis (LASIK) is a crucial corneal refractive surgery for correcting refractive errors. The cornea, after undergoing excimer laser ablation, undergoes changes in biometric measurements. For such patients, conventional measurements and IOL power calculations based on standard formulas may no longer be accurate, leading  to significant postoperative refractive errors and subsequently impacting the patient's visual quality. This article presents a case of a 46-year-old male cataract patient who had a history of refractive errors in both eyes and had previously undergone LASIK surgery. Preoperative corneal topography revealed corneal eccentric ablation in both eyes, posing challenges in determining IOL power. The surgeon assessed the centration of corneal ablation using corneal topography, selected the keratometry value (K value) within specific corneal regions, and calculated the IOL power using the Barrett True K formula. Postoperatively, the cataract patient experienced relatively minor refractive errors, leading to improved vision and enhanced visual quality.
BJO专栏

人工智能白内障协同管理的通用平台

Universal artificial intelligence platform for collaborativemanagement of cataracts (authorized Chinese translation)

:665-675
 
目的:建立和验证一个涉及多级临床场景的白内障协作通用的人工智能(artificial intelligence,AI)管理平台,探索基于AI的医疗转诊模式,以提高协作效率和资源覆盖率。方法:训练和验证的数据集来自中国AI医学联盟,涵盖多级医疗机构和采集模式。使用三步策略对数据集进行标记: 1)识别采集模式;2)白内障诊断包括正常晶体眼、白内障眼或白内障术后眼;3)从病因和严重程度检测需转诊的白内障患者。此外,将白内障AI系统与真实世界中的居家自我监测、初级医疗保健机构和专科医院等多级转诊模式相结合。结果:通用AI平台和多级协作模式在三步任务中表现出可靠的诊断性能: 1)识别采集模式的受试者操作特征(receiver operating characteristic curve,ROC)曲线下面积(area under the curve,AUC)为99.28%~99.71%);2)白内障诊断对正常晶体眼、白内障或术后眼,在散瞳-裂隙灯模式下的AUC分别为99.82%、99.96%和99.93%,其他采集模式的AUC均 > 99%;3)需转诊白内障的检测(在所有测试中AUC >91%)。在真实世界的三级转诊模式中,该系统建议30.3%的人转诊,与传统模式相比,眼科医生与人群服务比率大幅提高了10.2倍。结论:通用AI平台和多级协作模式显示了准确的白内障诊断性能和有效的白内障转诊服务。建议AI的医疗转诊模式扩展应用到其他常见疾病和资源密集型情景当中。
Objective: To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. Methods: The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three step strategy: (1)capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services. Results: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%–99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3)detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3%  of people be ’referred’, substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern. Conclusions: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.

封面简介

先天性白内障术后青光眼

Glaucoma after congenital cataract surgery

:-
 
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状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。
      封面展示的是双眼先天性白内障术后继发青光眼(左眼)与正常眼(右眼)的对比示意图。该并发症起病隐匿、难以预测,是先天性白内障术后二次致盲的首要原因。针对这一术后并发症,美国婴儿无晶状体眼治疗研究组 (infant aphakia treatment study, IATS)将儿童白内障术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs,包括了青光眼和可疑青光眼)定义为:1)青光眼:眼压>21 mmHg(1 mmHg=0.133 kPa),且有以下一种或以上的解剖学改变:(a)角膜直径增加;(b)双眼不对称进行性近视漂移伴角膜直径和(或)眼轴的增加;(c)视杯直径进行性增大,杯盘比增加≥0.2;(d)必须进行手术才能控制眼压。2)可疑青光眼:停用局部糖皮质激素(激素)后连续2次眼压>21 mmHg,或可通过抗青光眼药物控制眼压,但无上述任何青光眼的解剖改变。所以,如何更精准地预防该术后并发症,防止对患儿视功能造成进一步的损害,是目前关键的临床问题。
       因此,文章对先天性白内障摘除及人工晶状体植入术后继发性青光眼和可疑青光眼的发生、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,减少术后并发症对患儿视功能造成的进一步损害。
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状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。
      封面展示的是双眼先天性白内障术后继发青光眼(左眼)与正常眼(右眼)的对比示意图。该并发症起病隐匿、难以预测,是先天性白内障术后二次致盲的首要原因。针对这一术后并发症,美国婴儿无晶状体眼治疗研究组 (infant aphakia treatment study, IATS)将儿童白内障术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs,包括了青光眼和可疑青光眼)定义为:1)青光眼:眼压>21 mmHg(1 mmHg=0.133 kPa),且有以下一种或以上的解剖学改变:(a)角膜直径增加;(b)双眼不对称进行性近视漂移伴角膜直径和(或)眼轴的增加;(c)视杯直径进行性增大,杯盘比增加≥0.2;(d)必须进行手术才能控制眼压。2)可疑青光眼:停用局部糖皮质激素(激素)后连续2次眼压>21 mmHg,或可通过抗青光眼药物控制眼压,但无上述任何青光眼的解剖改变。所以,如何更精准地预防该术后并发症,防止对患儿视功能造成进一步的损害,是目前关键的临床问题。
       因此,文章对先天性白内障摘除及人工晶状体植入术后继发性青光眼和可疑青光眼的发生、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,减少术后并发症对患儿视功能造成的进一步损害。
专家述评

重视先天性白内障术后高眼压和青光眼的防治

Prioritizing Prevention and Treatment of High Intraocular Pressure and Glaucoma Following Congenital Cataract Surgery

:229-233
 
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.
论著

EYESi模拟器结合Wet-lab在白内障手术培训中的效果评价

Effect evaluation of EYESi simulator combined with Wet-lab in cataract surgery training

:736-745
 
目的:比较单一EYESi虚拟手术模拟器(Dry-lab)、Wet-lab以及两种方式联合教学在超声乳化白内障吸除显微手术培训中的效果及差异,以期探索更科学高效的教学方式。方法:选取中山大学中山眼科中心接受住院医师规范化培训的1年级住院医师18名,随机分为Dry-lab组、Wet-lab组和联合组,每组各6人,分别接受8次有效Dry-lab训练、8次Wet-lab训练、4次有效Dry-lab训练联合4次Wet-lab训练。培训前后问卷调查评估三种教学方式的模拟效果与学员满意度,并在猪眼模型上考核超声乳化白内障吸除手术的三个主要步骤,以评估学员的培训效果。结果:Dry-lab与Wet-lab训练均能有效帮助学员学习使用显微器械,操作手感较好。但在立体感(P=0.007)、与人眼操作相比近似度(P<0.001)以及对掌握技术的帮助度(P=0.003)上,Wet-lab优于Dry-lab训练;而在缩短培训用时(P<0.001)上,Dry-lab培训更具优势。联合培训模式培训效果优于单一Wet-lab训练(P=0.014)和模拟器培训(P=0.012),整体满意度高于Wet-lab训练(P=0.042)和Dry-lab培训(P=0.042)。结论:Dry-lab与Wet-lab训练在超声乳化白内障吸除显微手术培训中各有优势,而两者相结合的教学模式更为高效,培训效果更佳,整体满意度高。
Objective: To compare the effects and distinctions among three methods of phacoemulsification training: EYESi simulator (Dry-lab), Wet-lab, and a combined approach, in order to find out more scientific and efficient teaching method. Methods: 18 first-year residents undergoing residency training at Zhongshan Ophthalmic Center, Sun Yatsen University were randomly assigned to three groups: Dry-lab, Wet-lab, and Combined. Each group, consisting of 6 individuals, underwent a specific training regimen—8 sessions of effective simulator training for the Dry-lab group, 8 Wet-lab sessions for the Wet-lab group, and a combination of 4 effective simulator sessions with 4 Wet-lab sessions for the Combined group. The questionnaires were administered to assess simulation effects and student satisfaction before and after each training sessions. Additionally, the training effects were recorded in the three main steps of phacoemulsification cataract extraction surgery on a pig eye model. Results: Both the EYESi simulator and Wet-lab were proved to be effective in facilitating the learning of microscopic instrument use with commendable operating experience. However, Wet-lab is superior to the virtual simulator in terms of stereoscopic sensation (P=0.007), similarity to the human eye (P<0.001), and assistance in mastering techniques(P=0.003). Simulator training is found to be more advantageous in shortening the overall training time (P<0.001). The training effect of the joint training mode is better than that of single Wet-lab training (P=0.014) and simulator training (P=0.012), and the overall satisfaction is higher than that of Wet-lab training (P=0.042) and simulator training (P=0.042). Conclusion: The EYESi virtual surgery simulator and Wet-lab training have their advantages respectively in training for phacoemulsification cataract extraction microsurgery, and the combined teaching mode is more efficient, with better training effects and overall satisfaction.
论著

高度近视合并白内障患者术后有效晶状体位置的初步临床研究

Clinical study of effective lens position after cataract surgery in high myopia eyes

:136-140
 
目的:探讨高度近视合并白内障患者白内障术后有效晶状体位置的变化。方法:收集白内障超声乳化摘除联合人工晶状体植入术的高度近视合并白内障患者21例共27眼,记录术后1 d、1周、1个月视力、屈光度、有效晶状体位置。结果:高度近视合并白内障患者术后1 d,1周,1个月有效晶状体位置分别为(4.17±0.39),(4.09±0.38),(4.31±0.44) mm,且组间比较差异有统计学意义(P<0.05)。有效晶状体位置的实际轴向运动为(0.19±0.13) mm,与晶状体厚度呈正相关(r=0.648,P<0.001),与术前眼轴无相关关系(r=0.227,P=0.255)。结论:高度近视合并白内障患者术后1 d至1周人工晶状体轻度前移而造成近视偏移,而术后1个月时则呈远视偏移,且术后有效晶状体位置位移与术前晶状体厚度相关。
Objective: To investigate the change and influencing factors of the effective lens position after cataract surgery in high myopia eyes. Methods: We collected 27 eyes of 21 patients with high myopia who underwent phacoemulsification and intraocular lens implantation. The visual acuity, diopter and effective lens position were recorded 1 day, 1 week, and 1 month after operation. Results: The effective lens position of high myopia combined with cataract patients at 1 day, 1 week, and 1 month was (4.17±0.39), (4.09±0.38), and (4.31±0.44)mm, respectively. The effective lens positions significantly differed between the groups after surgery (P<0.05). The ELPRMS was (0.19±0.13) mm. The ELPRMS was positively correlated with the lens thickness (r=0.648,P<0.001), whereas was not correlated with the preoperative axial length (r=0.227, P=0.255). Conclusion: High myopic patients with cataract have a slight forward movement of the effective lens position from 1 day to 1 week after surgery, and a hyperopic shift from 1 week to 1 month. The displacement of effective lens position after surgery is correlated with the preoperative lens thickness.
病例报告

双眼白内障术后单眼人工晶状体混浊一例

One eye intraocular lens opacity after bilateral cataract surgery:a case report

:580-586
 
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.
论著

多焦点人工晶状体2.2 mm微切口植入治疗老年性白内障的临床观察

Clinical observation of multifocal intraocular lens with 2.2 mm microincision implantation for senile cataract

:229-236
 
目的:评估2.2 mm微切口白内障超声乳化摘除(phacoemulsification,Phaco)联合多焦点人工晶状体(multifocal intraocular lens,MIOLs)植入术治疗老年性白内障的临床安全性及疗效。方法:选取于2018年1月1日至2018年6月31日于佛山市第二人民医院行白内障Phaco联合人工晶状体植入的老年白内障患者。将其分为2组:A组31例35眼行2.2 mm微切口Phaco联合MIOLs植入术,B组31例38眼行3.0 mm标准切口Phaco联合单焦点IOLs植入术。2组患者均完善术前、术后的裸眼视力、角膜曲率、眼压、角膜内皮细胞数、离焦曲线等检查,同时记录其手术过程中的参数,进行比较。结果:A组与B组在手术过程中,总超乳时间、总超乳能量、超声乳化累积能量复合参数、有效超乳时间、平均超乳能量、总手术时间对比,差异均无统计学意义(均P>0.05)。2组患者术后较术前比较,角膜内皮细胞数均有所下降,差异有统计学意义(P<0.05);2组患者间在各时间点的比较,差异均无统计学意义(均P>0.05)。2组患者手术中均未出现后囊膜破裂等并发症。2.2 mm切口与3.0 mm切口术后均增加了角膜散光,与术前比较差异均有统计学意义(均P<0.01);2组间比较,差异无统计学意义(均P>0.05)。术后3个月,2组间裸眼远视力(uncorrected distance visual acuity,UCDVA)对比差异无统计学意义(t=?1.794,P=0.07);裸眼近视力(uncorrected near visual acuity,UCNVA)对比差异有统计学意义(t=?25.147,P<0.01)。A组的离焦曲线有2个峰值,分别位于0 D和?3.5 D附近,两峰值间形成一个下降平缓的平台;B组的离焦曲线只有1个峰值,位于0~0.5 D之间,峰值两端下降趋势明显。A组的脱镜率为77.42%(24/31),B组的脱镜率为12.90%(4/31),差异有统计学意义(χ2 =26.050,P<0.01);2组的总体满意度差异无统计学意义(χ2 =1.615,P=0.204)。结论:2.2 mm同轴微切口白内障手术在临床上安全性良好,联合植入MIOLs有较好的疗效,可于临床上广泛推广。
Objective: To evaluate the clinical safety and curative effect of phacoemulsification (Phaco) combined with multifocal intraocular lens (MIOLs) implantation in the treatment of senile cataract with 2.2 mm microincision cataract. Methods: The cataract patients who underwent phacoemulsification and intraocular lens implantation in our hospital were selected from January 1, 2018 to June 31, 2018. They were divided into two groups: group A with 31 patients (35 eyes) undergoing 2.2 mm micro-incision Phaco combined with MIOLs, while group B with 31 patients (38 eyes) undergoing 3.0 mm standard incision Phaco combined with single focus IOLs.The preoperative and postoperative uncorrected visual acuity, corneal curvature, intraocular pressure, corneal endothelium number, and defocus curve were recorded in both groups. The parameters during the operation were also recorded and compared. Results: There was no statistically significant difference in the parameters including total phacoemulsification time, total phacoemulsification energy, phacoemulsification cumulative energy compound parameters, effective phacoemulsification time, average phacoemulsification energy, total surgery time between group A and group B during the operation (all P>0.05). Compared with preoperative, the number of corneal endothelial cells decreased both in the two groups after surgery. The difference was statistically significant (P<0.05). There was no significant difference between the two groups at any time (all P>0.05). There were no complications such as posterior capsule rupture during operation in both groups. The corneal astigmatism was increased after operation both in the 2.2 mm incision and 3.0 mm incision, and the difference was statistically significant compared with pre-operation (both P<0.01). There was no significant difference between the two groups (all P>0.05). At 3 months postoperatively, there was no significant difference in uncorrected distance visual acuity (UCDVA) between the two groups (t=?1.794, P=0.07), and the difference was statistically significant in the uncorrected near visual acuity (UCNVA) (t=?25.147, P<0.01). Defocus curve: The defocus curve of group A had two peaks, which are located near 0 D and ?3.5 D, forming a flat platform with a descent between the two peaks.The defocus curve of group B had only one peak, located at 0–0.5 D, and the downward trend at both ends of the peak was obvious. The rate of off-glasses and satisfaction: the rate of off-glasses in group A was 77.42% (24/31),and the rate of dislocation in group B was 12.90% (4/31). The difference was statistically significant (χ2 =26.050,P<0.01). There was no significant difference in overall satisfaction between the two groups (χ2 =1.615, P=0.204).Conclusion: The 2.2 mm coaxial microincision cataract surgery yields high clinical safety, and the combined implantation of multi-focal intraocular lens has good curative effect and can be widely promoted in clinical practice.
综述

白内障的分子病理改变

Molecular pathological changes of cataract

:663-668
 
白内障是世界范围内失明的主要原因。正常晶状体是富有弹性的形似双凸透镜的透明体,是机体内蛋白质含量最高的组织,由晶状体囊膜、晶状体上皮细胞、晶状体纤维和悬韧带构成。白内障为晶状体透明度下降,表现为晶状体混浊。近年来随着分子生物学、表观遗传学、免疫学、有机化学等学科快速发展,国内外学者对白内障也进行了大量分子水平的研究,探讨了白内障发生发展相关分子机制,为未来基因治疗和靶向药物等治疗白内障提供了理论基础。对白内障分子病理改变的了解,是白内障精准诊治的基础。
Cataract is the main cause of blindness worldwide. The normal crystalline lens is a transparent biconvex disc,with highest protein content in all human tissues. The lens is composed of capsule, lens epithelial cells, lens fiber and zonular ligment. Cataract is a decrease in the transparency of the lens, which is characterized by opacity. In recent years, with the rapid development of molecular biology, epigenetics, immunology and organic chemistry,researchers have conducted a large number of studies on the molecular basis of genetic or targeted therapy of cataract. It is important to know the molecular pathology of cataract, which is the basis of precise diagnosis and treatment of cataract.
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  • 眼科学报

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    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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