该文报道一例30岁的男性患者因“双眼自幼视力不佳，强光下视物模糊加重4年余”就诊，经过眼部检查评估，诊断为双眼瞳孔残膜、双眼屈光不正。患者接受一期双眼瞳孔残膜切除、二期双眼行有晶状体眼后房型环曲面人工晶状体(toric implantable collamer lens,TICL)植入手术，术后视力恢复良好。文章回顾了该例患者的诊治过程，为临床屈光不正同时伴有瞳孔残膜患者的诊治提供参考。
A 30-year-old male patient presented at our institution with a history of poor vision in both eyes since childhood, exacerbated by blurriness under bright light for over four years. Following a comprehensive ophthalmic examination, the patient was diagnosed with bilateral pupillary membrane remnants and refractive errors. The patient underwent a two-stage surgical intervention, starting with the removal of the pupillary membrane remnants, followed by the implantation of toric implantable collamer lenses (TICL) in the posterior chamber of the lensless eyes. Postoperative outcomes were favorable, with significant improvement in visual acuity. This article reviews the therapeutic journey of the patient, offering insights into the diagnosis and management of individuals with concurrent refractive anomalies and pupillary membrane remnants, thereby contributing to the clinical discourse on the subject.
随着功能性人工晶状体的推广应用，白内障患者的屈光预测准确性日益受到重视。尽管人工晶状体屈光力计算公式在近年来不断发展革新，但解剖参数异常或既往有其他眼病、眼部手术史的白内障患者屈光预测仍存在挑战。根据生物学参数特点与病史选择适合的人工晶状体屈光力计算公式是准确进行白内障手术屈光预测的重要保障。
With the widespread application of functional intraocular lense (IOL), the accuracy of refractive prediction in cataract patients is increasingly important. Although IOL power calculation formulas have been innovated continuously in recent years, there are still challenges in predicting refractive powerin cataract patients with abnormal anatomical parameters, ocular comorbidities, or a history of ocular surgery. Based on the the characteristics of biological parameters and medical history to selcet appropriate IOL power formula, it is an important guarantee for accurate refractive prediction in cataract patients.
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.
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.
随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。
With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.
近年来，晶状体脱位逐渐引起眼科医生的重视，针对晶状体脱位手术的探索与改进一直在持续进行中。随着超声乳化技术的发明和眼内植入材料的改进，晶状体脱位患者人工晶状体(intraocular lens,IOL)的植入和固定成为眼科医生关注的焦点。IOL悬吊术作为治疗严重晶状体脱位以及无晶状体眼且囊袋支撑不足或无囊袋患者的IOL植入的经典术式，主要经历了传统的经巩膜后房型IOL缝线固定术、以Z字形缝合为代表的无线结后房型IOL缝线固定术和无缝线的IOL巩膜层间固定术三个阶段，理解并掌握各种IOL悬吊术的优势和局限性对提高眼科医生的诊疗水平、改善患者的预后具有重要意义。
In recent years, ectopia lentis has gradually attracted the attention of ophthalmologists, and the exploration and improvement of surgery for ectopia lentis has been in progress. With the invention of phacoemulsification technology and the improvement of intraocular implant materials, the implantation and fixation of intraocular lens (IOL) in patients with ectopia lentis has become the focus of ophthalmologists. Suspensory IOL implantation is a classic operation for IOL implantation in patients with severe lens dislocation or aphakia with insufficient capsular bag support. It has mainly gone through three stages: traditional trans-sclera suture-fixed posterior chamber IOL, kontless posterior chamber IOL fixation represented by Z suture, and sutureless intrascleral IOL fixation. Understanding and mastering the advantages and limitations of various IOL fixation methods is of great importance for improving the diagnosis and treatment level of ophthalmologists and as well as the prognosis of patients.
白内障作为一种常见的眼科疾病，是全球第一位致盲眼病，目前尚无药物能够治疗，手术是唯一有效的办法。随着现代眼科手术技术的发展以及人工晶状体(intraocular lens，IOL)设计和功能的更新升级，人们对视觉质量的要求越来越高，白内障超声乳化联合IOL植入术已经从单纯的复明手术转变为个性化的屈光手术。为满足不同需求的患者术后获得较好的视觉质量，IOL经历了从单焦点到多焦点、球面到非球面的发展，还有散光型IOL和各类功能性IOL的临床应用，也为患者提供了更多的选择。充分了解不同类型IOL的优势和特点，根据患者自身眼部情况、日常用眼习惯以及需求，个性化地选择IOL植入对视觉质量的恢复和满意度起着至关重要的作用。因此本文将针对不同类型的IOL，从设计与分类、术后临床效果及适应人群进行综述，为IOL的选择提供指导建议。
As a common eye disease, cataract is the first-leading cause of blindness in the world. Currently, there is no drug to treat it, and surgery is the only effective way. With the development of modern ophthalmic surgical technology and the updating and upgrading of the design and function of intraocular lens (IOL), people have higher and higher requirements for visual quality. Cataract phacoemulsification combined with IOL implantation has transformed from a simple vision restoration to personalized refractive surgery. In order to meet the needs of patients with different needs to obtain better visual quality after surgery, IOL has experienced the development from monofocal to multifocal, spherical to aspherical, as well as the clinical application of astigmatic IOL and various functional IOLs, which also provides more choices for patients. Fully understanding the advantages and characteristics of different types of IOLs, according to the patient’s own eye conditions, daily eye habits and needs, individualized selection of IOL implantation plays a crucial role in the recovery and satisfaction of visual quality. Therefore, this article will review different types of IOLs from the aspects of design and classification, postoperative clinical effects and adaptation to the population, and provide guidance for the selection of IOLs.
目的：分析高度近视有晶状体眼后房型人工晶状体植入术后孔源性视网膜脱离的临床特征及预后。方法：回顾分析2012年4月至2021年6月中山眼科中心收治的9例(9只眼)行后房型人工晶状体植入术后孔源性视网膜脱离患者的临床特征、手术方式及疗效，随访(4.96±4.78)个月。结果：患者年龄(30.44±20.11)岁，屈光手术至发病时间(32.10±17.80)个月。4例(44.4%)马蹄形裂孔，1例(11.1%)萎缩性裂孔，4例(44.4%)巨大裂孔；9眼裂孔均位于赤道部前，除2眼(22.2%)为单个巨大裂孔，1眼(11.1%)单个马蹄孔，余6眼(66.7%)均有视网膜周边变性区存在；视网膜脱离范围(3.0±1.12)个象限，8例累及黄斑；增殖性玻璃体视网膜病变C级以上4眼。视网膜初始复位率为77.8%，最终视网膜复位率100%。末次随访最佳矫正视力优于术前(P<0.05)。随访期间，2例硅油填充眼发生并发性白内障，4眼发生术后早期高眼压。结论：有晶状体眼后房型人工晶状体植入术前存在的视网膜变性或术后玻璃体牵引的存在可能是孔源性视网膜脱离发生的危险因素。
Objective: To analyze the clinical presentation, surgical management, and outcomes of rhegmatogenous retinal detachment (RRD) in patients with high-myopia corrected by posterior chamber phakic (PCP) intraocular lens (IOL) implantation. Methods: Nine eyes of 9 patients in whom RRD developed after PCPIOL implantation from April 2012 to June 2021 in Zhongshan Ophthalmic Center were retrospectively studied. Mean follow-up after retinal detachment surgery was (4.96±4.78)months. Results: Mean patient age was (30.44±20.11) years old. RRD occurred (32.10±17.80) months after PCPIOL implantation. Four (44.4%) breaks were horseshoe tear, 1 (11.1%) was atrophic hole and 4 participants (44.4%) had a giant retinal tear. Nine cases had causative breaks located anterior to the equator while peripheral retina lattice degeneration was found in 6 eyes. RRD extended from 1 to 4 quadrants (3.0±1.12 quadrants) and 8 cases were macula-off retinal detachments. Four eyes’ proliferative vitreoretinopathy were more severe than level C. Initial reattachment rate was 77.80%. Final retinal reattachment was 100%. Final follow-up BCVA was significantly better than baseline (P<0.05). Furthermore, concurrent cataract occurred in 2 eyes in which silicone oil was used as tamponade. Ocular hypertension was detected in 4 eyes after surgery. Conclusion: The existed lattice degeneration and postoperative vitreous traction may be risk factors for RRD after PCPIOL implantation.
目的：评估屈光不正患者有晶体眼后房型人工晶体(implantable collamer lens，ICL)植入术后视疲劳症状及调节集合功能、眼表、像差的变化，并探讨其对视疲劳症状的影响。方法：前瞻性病例观察分析。连续收集在沧州市中心医院行ICL手术并完成3个月随访的患者，测定术前、术后1周、1个月、3个月时的视疲劳评分、调节幅度(amplitude of accommodation，AA)、正相对调节和负相对调节(positive/negative relative accommodation，PRA/NRA)、调节灵敏度(accommodative facility，AF)、调节性集合(accommodative convergence，AC)与调节(accommodation，A)比率(AC/A)，Schirmer实验、非侵入性泪膜破裂时间(noninvasive breakup time，NBUT)及高阶像差(higher order aberration，HOA)，进行统计学分析。结果：ICL术后第1周视疲劳症状较术前明显加重，随时间推移逐渐减轻，术后1个月仍高于术前，术后3个月时恢复。AA术后1周时较术前降低，术后1个月、3个月时明显高于术前；AF术后1周时较术前下降，术后1个月比术前水平稍好，3个月时明显高于术前；PRA、NRA无明显变化；AC/A术后1周时较术前下降，术后1个月回复到术前水平，术后3个月较术前提高。术后1周、1个月及3个月的NBUT值均较术前明显下降，术后1周时最低；Schiermer值术后1周时轻度下降，术后1个月、3个月时基本恢复。术后的总HOA均较术前有所增加，但各个时间点之间无明显变化。相关性分析显示ICL术后AF越差、NBUT越低，视疲劳症状越重。结论：ICL术后视疲劳症状一过性加重，AF和NBUT是影响视疲劳变化的重要因素。
Objective: To evaluate the changes of visual fatigue symptoms, accommodative functions, ocular surface conditions, and high-order aberrations (HOA) after implantation of implantable collamer lens (ICL), and to explore their effects on asthenopia. Methods: It was a prospective observational case series. Patients with ametropia who underwent ICL surgeries and completed 3-month follow-up in our hospital were enrolled.Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA),accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, non-invasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months after surgeries, then statistically analyzed. Results: Symptoms of asthenopia were significantly worse at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. Among regulatory indicators, AA decreased 1 week postoperatively, but was significantly higher at 1 and 3 months after surgeries; AF was lower 1 week after surgery than baseline, slightly better at 1 month postoperatively, and significantly higher at 3 months postoperatively; PRA and NRA had no significant change; AC/A decreased 1 week after surgeries, returned to the baseline at 1 month postoperatively, and increased 3 months postoperatively. Tears and meibomian gland function index: NBUT values at 1 week, 1 month and 3 months after surgeries were significantly decreased compared with those before surgeries, and NBUT at 1 week postoperatively was the lowest; Schiermer values had a slight decrease at 1 week after surgeries, and basically recovered at 1 and 3 months after surgeries. HOA after surgeries were increased compared with those before surgeries, but there was no significant change between each time point. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms. Conclusion: The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.
