目的:分析撕囊碎核镊预劈核技术在Ⅳ级硬核白内障超声乳化手术中应用的优势.方法:前瞻性研究.纳入年龄相关性Ⅳ级硬核白内障患者100例100眼,利用随机数表法随机分为撕囊碎核镊预劈核组(A组)50例50眼,拦截劈核组(B组)50例50眼.对两组的术前术后角膜内皮细胞计数、术中超声乳化能量释放时间(US time)、术后角膜内皮细胞丢失率、术后1、7d角膜水肿分级计数情况以及术前术后最佳矫正视力(BCVA)进行比较和统计学分析.结果:A组平均US time为26.66(16,40)s,低于B组36.12(23,46)s(Z=-5.65,P<0.01).术后3mo,A组平均角膜内皮细胞计数为2308.12±368.18cell/mm2,高于B组2104.06±379.87cell/mm2(t=2.728,P=0.008).术后3mo,A组平均角膜内皮细胞丢失率10％(8％,12％),低于B组17％(14％,20％)(Z=13.231,P<0.01).术后1d角膜水肿为0、1、2、3、4级的眼数,在A组分别为0、23、21、6、0眼,在B组分别为0、9、26、15、0眼.A组角膜水肿轻于B组(Z=10.514,P=0.005).术后1d A组患者BCVA优于B组患者,两组不同等级BCVA的眼数分布有差异(Z=7.176,P=0.029).术后3mo两组不同等级BCVA的眼数分布无差异(Z=2.377,P=0.372).结论:与拦截劈核技术相比,在Ⅳ级硬核白内障超声乳化手术中,撕囊碎核镊预劈核技术辅助白内障超声乳化手术使用超声能量少,角膜内皮细胞损伤小,适用于硬核白内障手术.

There are some techniques for disassembly of hard nuclear. It is challenging in hard cataract surgery through microincision. The classic chop or prechop techniques often do not succeed,resulting in incomplete nuclear segmentation. The authors describe a new chop technique for removing hard nucleus cataracts in coaxial microincisional cataract surgery. We create a deep hole (drill) in the central nucleus with the phaco tip and divide the nucleus (prechop) with the Nagahara chopper and the modified capsulorhexis forceps inside the hole. The chopper and the modified capsulorhexis forceps are spread apart laterally after they approach at the center of the nucleus, to create a complete fracture across the entire nucleus. Since January 2022, we have completed 27 eyes of 25 patients with hard nucleus cataract using this technique. Complete segmentation of the hard nuclear into two hemispheres was implemented with this drill and prechop technique in all cases. The effective phaco time and ultrasound energy decreased. No intraoperative complication such as iris injury, anterior capsule tears, zonulysis, or posterior capsule rupture with vitreous loss occurred during surgery. This technique simplifies the previous prechop techniques especially for hard nucleus in microincisional cataract surgery. The technique is efficient, safe and simple.

AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s vs 22.87(18.36, 27.38)s, P<0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm2 vs 1957.94±280.54/mm2, P<0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)vs 0.22(0.16, 0.28), P<0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(Z=13.195, P=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(Z=-0.48, P=0.63).CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.

Background To investigate the safety and efficacy of scleral concave pool trabeculectomy (SCPT) combined phacoemulsification for eyes with coexisting cataract and primary open-angle glaucoma (POAG). Methods This was a retrospective, controlled, interventional pilot case series. Thirty patients (30 eyes) were diagnosed with coexisting cataract and POAG between May 2015 and April 2018. Fourteen eyes underwent SCPT combined phacoemulsification were set as the study group, and 16 eyes received conventional phacotrabeculectomy were set as the control group. All patients were followed up for at least 6 months. The preoperative to postoperative changes in IOP, glaucoma medication requirements, BCVA, blebs functions, and adverse events were recorded. Results The groups were matched for baseline age, BCVA, IOP and types of IOP-lowering medications (all P > 0.05). At 6-month visit, there were no significant difference between control and study group in the improvement of BCVA (0.22 ± 0.24 versus 0.18 ± 0.26, P = 0.718), reduction of IOP (− 11.21 ± 8.61 mmHg versus − 9.19 ± 9.18 mmHg, P = 0.540) and the number of eyes that needed IOP-lowering medications (2 versus 3, P = 0.743). At the last visit, the rate of forming functioning blebs was significantly different between the study and control groups, (92.9% versus 68.7% respectively, P = 0.007). In the study group, 5 eyes developed hypotony, and 1 eye showed limited choroidal detachment, whereas in the control group 1 eye developed malignant glaucoma. All adverse events were successfully managed. Conclusion The SCPT combined phacoemulsification seems to be a safe and effective alternative to conventional phacotrabeculectomy for patients with POAG and visually significant cataract in the short-term.

Objective To discuss the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique compared with stop and conquer.Methods 46 patients (54 eyes) with age related cataract were randomly divided into 2 groups,CCFP were performed in group A including 23 patients (25 eyes),stop and conquer were performed in group B including 23 patients (29 eyes).The U/S time,operation time,preoperative and postoperative corneal endothelial cell density,corneal endothelial cell loss rate,intraoperative complications,postoperative (UCVA) at ld and corneal edema were reported.Results The U/S time and operation time were shorter in group A than group B.On the first day after surgery,corneal edema was less severe in group A than group B.There is no significant difference between two groups in UCVA on the first day after surgery.The average corneal endothelial cell density was higher in group A than group B,The average corneal endothelial cell loss rate was lower in group A than group B after 3 months.One eye in group A had posterior capsule rupture,2 eyes in group B.Conclusions CCFP technique is easy and safe to operate with less complications,the time of ultrasound and the operation time are shorter,the loss rate of corneal endothelial cells is lower compared with stop and conquer.

目的:探讨尖峰撕囊碎核镊辅助预劈核技术改良小切口白内障手术治疗老年性白内障的临床疗效,为白内障复明工程提供更佳的术式选择.方法:选取2015年3月-2017年3月在我院眼科住院部确诊为白内障且具有明确手术摘除指征的患者100例、100眼,随机分成对照组与观察组各50例、50眼,其中对照组采用传统小切口非超声乳化白内障摘除术,观察组采用尖峰撕囊碎核镊辅助预劈核技术改良小切口非超声乳化白内障摘除术.术后对比两组患者并发症发生率、术后视力、角膜内皮细胞数量、切口愈合时间.结果:观察组术后并发症发生率明显低于对照组(P<0.05).两组术后视力均较术前提高,差异具有统计学意义(P<0.05);术后1 d,观察组视力较对照组明显提高,差异具有统计学意义(P<0.05);术后7 d,观察组与对照组视力对比,差异无统计学意义(P>0.05).两组术后7 d角膜内皮细胞数量均较术前下降,差异具有统计学意义(P<0.05);术后7 d,对照组各级别晶状体核硬度角膜内皮细胞数量较观察组明显下降,差异具有统计学意义(P<0.05).观察组术后切口愈合时间明显短于对照组,差异具有统计学意义(P<0.05).结论:与传统小切口非超声乳化白内障手术对比,尖峰撕囊碎核镊辅助预劈核技术改良小切口白内障手术治疗老年性白内障疗效显著,伤口愈合时间短,术后并发症发生率低,操作简单,手术器械投入少,在我国复明工程中可推广使用.

目的探讨曲安奈德治疗视网膜静脉阻塞黄斑水肿的疗效。方法视网膜静脉阻塞并黄斑水肿患者29例30眼,FFA确诊静脉阻塞类型,玻璃体腔注射去除赋形剂的曲安奈德0.05 mL,治疗前及治疗后第1、3、7天,查视力、眼压、前置镜及OCT,治疗后1周复查FFA。对视力再次下降患者复查OCT。结果治疗后30眼视力均有提高,黄斑视网膜厚度逐渐减小;治疗后黄斑水肿复发11例11眼,均为缺血型视网膜静脉阻塞,占所观察病例的36.7%;治疗后3～4周有3例3眼发生高眼压,占10.0%。结论曲安奈德能有效治疗非缺血型视网膜静脉阻塞合并黄斑水肿,缺血型视网膜静脉阻塞合并黄斑水肿易复发,部分病例发生高眼压。

Objective To observe the therapeutic effect of spleen-strengthening and dampness-elimination Chinese herbal medicine for treatment of central serous chorioretinopathy(CSC)in perioperative period of laser treatment.Methods Thirty CSC patients confirmed by optical coherence tomography(OCT)and fundus fluorescein angiography(FFA) were given laser treatment,and then were treated with spleen-strengthening and dampness-elimination Chinese herbal medicine for 4 weeks.Before and after treatment,the changes of visual acuity,retinal morphology and the height of detached retina were monitored.The cure rate,the results of FFA and indocyanine green angiography(ICGA),and the recurrence rate were also examined.Results The average visual acuity of 30 patients was 0.54±0.21 before treatment,and became 0.80 ± 0.19 after treatment,the difference being significant(P0.05).The results of OCT showed that macular serous detachment of retina was gradually relieved,and the detachment height was 543.39 ± 132.33 μm before treatment and them became 213.81 ± 22.62 μm after treatment,the difference being significant(P0.05).Twenty-one cases(accounting for 70%)were cured within 4 weeks,and 9(accounting for 30%)were cured over 4 weeks.The results of FFA showed the retinal pigment epithelium(RPE)leakage points disappeared,and choroidal hyperpermeability was improved shown by ICGA.Seven months after treatment,CSC recurred in only one case,accounting for 3.3%.Conclusion The application of spleen-strengthening and dampness-elimination Chinese herbal medicine is effective for the treatment of CSC in perioperative period of laser treatment.

葡萄膜渗漏综合征(UES)是一种特殊类型的继发性视网膜脱离,分为真性小眼球或远视眼和非真性小眼球或远视眼的“正常”眼,后者即为特发性UES[1].目前治疗该病的主要手术方式为涡静脉减压手术和板层巩膜切除手术.由于涡静脉减压手术手术部位深,操作困难且并发症多,一般需在全身麻醉下进行,近年已被板层巩膜切除手术取代[2].