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.

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：观察依镜有晶状体眼后房屈光晶体(phakic refractive lens,PRL)植入术矫正超高度近视的疗效和安全性。方法：纳入自2018年1月—2020年9月在深圳市眼科医院行依镜PRL植入术的超高度近视患者共24例39眼，进行自身对照研究。其中，男8例13眼，女16例26眼，平均年龄(31.15±6.33)岁。观察术后屈光度、视力[裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)]、眼压、角膜内皮细胞计数、拱高、手术并发症等指标。结果：中位随访时间为5.5(3.0，11.0)月。屈光度从术前(?22.29±4.96) D降低至术后(?0.28±1.01) D(t=24.421，P<0.001)，其中术后球镜度数±0.5 D占28眼(82.4%)，±1.0 D占31眼(91.2%)。LogMAR UCVA从术前1.40(1.30，1.70)改善至术后(0.28±0.20) D，LogMAR BCVA由术前0.40(0.22，0.70)改善至术后0.15(0.00，0.30)，差异均有统计学意义(均P<0.001)。术后BCVA较术前提高3.00(1.00，5.00)行，所有患者均无BCVA丢失。术前、术后1 d、末次随访眼压值比较差异有统计学意义(F=8.779 P=0.012)，其中术后1 d较术前眼压增高(Z=-3.401，P=0.001)，而末次随访较术后1 d眼压降低(Z=-2.685，P=0.007)，末次随访与术前眼压之间比较差异无统计学意义(Z=-0.894，P=0.371)。角膜内皮细胞计数从术前(2 782.20±296.30)个/mm²降低至术后(2 472.54±394.32)个/mm² (t=-5.437，P<0.001)，平均丢失角膜内皮细胞数11.2%。末次随访33眼平均拱高值为(379.00±283.27)μm，其中0~250 μm占12眼(36.4%)，250~750 μm占19眼(57.6%)，大于750 μm占2眼(6%)。21眼PRL术后3个月拱高值为(269.81±194.67)μm，较术后1个月拱高值(373.62±195.75)μm降低(t=?2.917，P=0.009)。术后并发症包括激素性青光眼(1例2眼)、PRL光学面裂痕(1眼)、黄斑出血(1眼)、PRL偏位(2例3眼)。结论：对于超高度近视患者，依镜PRL植入术是一种可供选择的安全、有效的眼内屈光手术方式，但其远期疗效及安全性仍需更长时间和更大样本量进一步观察。

Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm² to postoperative (2 472.54±394.32)/mm² (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia

本文总结了15例自膨胀水凝胶眶内植入术患儿围手术期的护理要点。术前主要评估患儿是否完善术前检查，给予患儿及其家属个性化的心理护理，进行术前准备以及禁食禁饮的管理。术后主要给予患儿安全管理，饮食、疼痛、眼部用药以及弹力绷带包扎护理，关注有无并发症的发生及给予相应的护理，并对患儿及其家属做好出院指导。15例患儿均顺利完成手术，术后均出现术眼疼痛，2例出现眶压增高，1例出现呕吐，均得到妥善处理。术后随访3~18个月，患儿均获得了较为满意的眼部外观，生活质量得到了提高。

This paper summarized the nursing experience of 15 children with self-expanding hydrogel orbital implantation during perioperative period. Before operation, children were fully evaluated, given with psychological care, preoperative preparation and management of fasting and drinking. After the surgery, the patients were mainly given with safety management, diet, pain, medicine and elastic bandage dressing care. Nurses should pay attention to the occurrence of complications and give corresponding nursing care and offer useful discharge guidance for the children and their parents. All 15 children completed the operation successfully, postoperative eye pain occurred in 15 cases after operation, and the orbital pressure increased in 2 cases, 1 case vomited, and all cases were properly treated. After postoperative follow-up for 3–18 months, 15 children were satisfied with the appearance of the eye,and the life quality was improved.

目的：探讨折叠式人工玻璃体球囊(foldable capsular vitreous body，FCVB)植入术的护理配合。方法：对2018年6月至12月接受FCVB植入术的33例患者的术中护理配合进行回顾性分析和总结。结果：33例患者的手术均能顺利进行，术后裂隙灯显微镜检查示折叠式人工玻璃体球囊位置均居中；患者均未见球囊排斥、交感性眼炎及其他明显手术并发症。结论：FCVB是全球首创的革命性产品，手术前充分的术前准备，系统规范化的手术巡回配合，是保证手术顺利完成的关键。

Objective: To explore the nursing cooperation of foldable capsular vitreous body implantation. Methods: The intraoperative nursing cooperation of 33 patients who received the operation from June to December 2018 was retrospectively analyzed and summarized. Results: All the 33 patients underwent successfully, and silt lamp microscopy showed that the position of foldable capsular vitreous body was in the center. No foldable capsular vitreous body rejections, sympathetic ophthalmitis or other obvious surgical complications were observed in all cases. Conclusion: Foldable capsular vitreous body is a global innovative product. Adequate preoperative preparation before surgery and systematic and standardized surgical tour coordination are the keys to the

successful completion of surgery.

目的：探讨利用微信平台在有晶体眼人工晶体(implantable collamer lens，ICL)植入术后并发性白内障患者延续性护理的应用效果。方法：对13例(16眼)ICL植入术后并发性白内障患者利用微信平台随访和延续性护理，观察患者术前和术后1个月的护理满意度的自身对照。结果：13例患者(16眼)手术均顺利完成，术后均无出现并发症，术后视力均较术前有所提高，术后患者的护理满意度评分高于术前，差异有统计学意义(P<0.05)。结论：利用微信平台进行随访和延续性护理，可以提高患者护理满意度，是应用于ICL植入术后并发性白内障患者的有效护理方法。

Objective: To explore the application effect of WeChat platform in continuous nursing care for patients with complicated cataract after implantable collamer lens (ICL) implantation. Methods: Thirteen patients (16 eyes) with complicated cataracts after ICL implantation were followed up and continued nursing on the WeChat platform, then the self-control of the patients’ satisfaction on nursing before and one month after surgery was observed. Results: A total of 13 patients’ operation (16 eyes) went well, and they had no postoperative complications. The visual acuity of the patients was improved after operation compared with that of before operation, and the nursing satisfaction score of patients after operation was higher than that of before operation; the difference was statistically significant (P<0.05). Conclusion: Using WeChat platform for follow-up and continuous nursing can improve patients' nursing satisfaction, which was an effective nursing method for patients with complicated cataract after ICL implantation.

Ahmed青光眼引流阀植入术作为难治性青光眼的主要治疗方案，能很大程度控制眼压，且疗效和预后均优于常规滤过性手术。但是远期引流盘周围被纤维包裹后会阻塞房水流出，引起术后高眼压，导致手术失败。因此，解决引流盘纤维包裹能很大程度地提高青光眼阀植入术后远期成功率，这也是目前的研究热点。目前临床上主要采用术前预防及术后二次操作对纤维包裹进行干预，但长期效果欠佳。本文就青光眼引流阀纤维包裹发生的组织病理学及分子机制、临床目前解决方案、前沿研究进展以及对Ahmed青光眼阀门的材料改造的探索进行综述。

Ahmed glaucoma valve implantation, as the main treatment option for refractory glaucoma, can control intraocular pressure (IOP) to a large extent. And its efficacy and prognosis are superior to those of conventional filtration surgery. IOP is well-controlled in the early postoperative stages. However, long-term fibrosis of encapsulated bleb inhibits fluid exchange and causes elevated IOP, leading to surgical failure. Therefore, treating fibrosis of encapsulated bleb can improve the long-term success rate after glaucoma valve implantation, which is also a research hotspot. Currently, the main clinical interventions are preoperative prophylaxis and postoperative secondary operations for fiber wrapping, but its long-term efficacy is not satisfactory. This article reviews the occurrence, histopathology and molecular mechanism of fibrous encapsulation, treatment in a clinical setting, cutting-edge research progress, and exploration on material modification of Ahmed glaucoma valve.

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.

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。

Abstract Objective: To assess the medium-long term efficacy, 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 efficacy, 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 efficacy and safety indices were 1.05 and 1.09, respectively. The spherical equivalent was stable withimproved 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.