目的 分析眼前节生物学参数与有晶状体眼后房型人工晶状体(ICL)植入术后拱高的相关性.方法 回顾分析2018年1月～2019年12月于我院行ICL植入术患者的临床资料.记录术前中央前房深度(ACD)、角膜水平白到白(WTW)直径、晶状体厚度(LT)、晶状体矢高(CLR)及术后3个月拱高,分析各项眼前节参数与拱高的相关性.结果 本研究共纳入33例(58眼),术前平均等效球镜为(-10.54±2.84)D,WTW为(11.45±0.27)mm,ACD为(3.12±0.17)mm,LT为(3.72±0.26)mm,CLR为(206.72±157.58)μm,术后3个月平均拱高为(410.31±146.11)μm.年龄与拱高无明显相关性(P=0.058).术前ACD、WTW、LT、CLR与拱高具有显著相关性,其中ACD、WTW与拱高呈正相关(P=0.001,P=0.039),LT、CLR与拱高呈负相关(P=0.041,P<0.001).结论 ICL植入术后拱高与术前ACD、WTW呈正相关,与LT、CLR呈负相关.

电子产品—— 儿童视力"第一杀手" 伤害指数★★★★★ 近些年随着科技的发展,智能手机和平板电脑等电子产品不断进入人们的生活,平板电脑和手机成为家长们哄孩子的第一"神器",百试百灵. 平板电脑、手机等多数电子产品的屏幕使用的是LED背光源,使得屏幕亮度更高,长时间近距离视物的不良刺激,会造成儿童眼轴增长,从而诱发近视.

目的 通过不同时间频率双眼整合刺激模式对随机抽取双眼最佳矫正视力0.8以上且无眼疾的正常视力组和近视组的双眼不平衡情况进行量化分析,探寻近视和双眼不平衡的关系.方法 采用回顾性研究,通过不同时间频率双眼整合刺激模式检查161例在广东省人民医院体检的志愿者的双眼整合功能,收集屈光状态、 双眼不平衡情况等数据采用SPSS软件进行相关分析.结果 在低时间频率刺激模式下,正常视力组和近视组的双眼不平衡状态比较有统计学差异(P<0.05);在高时间频率刺激模式下,正常视力组和近视组的双眼不平衡状态比较有统计学差异(P<0.05).结论 在不同时间频率的双眼整合刺激模式下,近视患者表现为更多的双眼严重不平衡,推测其机理是近视患者中的传输运动信息的大细胞通路的功能可能存在缺陷.

目的 观察术前睑板腺功能障碍(meibomian gland dysfunction,MGD)对白内障病人术后视觉质量的影响.方法 选取我院收治的术前合并MGD与未合并MGD白内障病人各30例,分别纳入观察组与对照组.比较2组术前及术后1周、3个月、6个月眼表疾病指数(ocular surface disease index,OSDI)、泪膜破裂时间、泪液分泌试验(Schimer I test,SIt)结果 及视觉质量的变化.结果 术前,观察组的OSDI评分、睑板腺分泌物评分明显高于对照组(P＜0.01),泪膜破裂时间、SIt明显短于对照组(P＜0.01);2组三叶草、总高阶像差、球差、慧差差异无统计学意义(P＞0.05).术后1周、3个月、6个月时,观察组的OSDI评分、睑板腺分泌物评分、三叶草、总高阶像差明显高于对照组(P＜0.01),泪膜破裂时间、SIt明显短于对照组(P＜0.01),2组球差差异无统计学意义(P＞0.05).术后1周,观察组慧差明显大于对照组(P＜0.01);术后3、6个月时,2组慧差差异无统计学意义(P＞0.05).结论 术前MGD可对白内障病人术后视觉质量恢复产生不良影响,建议术前积极采取MGD治疗措施,并在术后随访中有效处理眼表疾病、泪膜及睑板腺恢复问题,以促进视觉质量的恢复.

目的 应用基于虚拟现实的视感知觉训练平台,观察近视性屈光参差性弱视患者视力及精细立体视变化情况.方法 对20例(男10例,女10例)诊断为近视性屈光参差性弱视的患者进行回顾性研究.在屈光矫正、遮盖优势眼的基础上对双眼进行基于虚拟现实的视感知觉训练,随访1年,观察其视力及精细立体的发育情况.结果 采用基于虚拟现实的视感知觉训练平台对近视性屈光参差性弱视患者训练1年后,患者视力明显提高,差异具有统计学意义(P＜0.05);精细立体视缺损情况改善,差异具有统计学意义(P＜0.05);但视力达标者精细立体视仍与正常人群存在差异,差异有统计学意义(P＜0.05).结论 基于虚拟现实视感知觉训练平台在近视性屈光参差性弱视患者的治疗中具有临床应用价值.

目的 分析陡轴向切口、平坦轴切口手术治疗对术前角膜散光≤0.5D的白内障患者术后视力水平、角膜散光的影响.方法 行超声乳化白内障吸出联合人工晶体植入术的120例(163只眼)角膜散光≤0.5D的白内障患者随机分为A组(60例,81只眼,作陡轴向切口)和B组(60例,82只眼,作平坦轴切口),比较两组裸眼视力、角膜散光度、角膜手术源性散光(SIA)大小及散光轴向分布.结果 两组术后裸眼视力显著提高(P<0.05),但A组术后1个月、3个月裸眼视力较B提高更显著(P<0.05).A组术后1周、1个月、3个月角膜散光度均较B组小,术后1周、1个月、3个月角膜SIA均较B组小(P<0.05).A组术后各时刻与术前对比无统计学差异(P>0.05),而B组有统计学差异(P<0.05).结论 陡轴向切口手术治疗改善术前角膜散光≤0.5D的白内障患者视力水平、角膜散光的效果优于平坦轴切口,更有助于稳定术后角膜散光轴向.

目的 使用增强虚拟现实平台检查和分析正常视力人群在不同空间频率和不同时间频率的双眼整合刺激模式下双眼视功能情况.方法 对55例(男29例,女26例)无眼疾且裸眼视力在0.8以上的志愿者进行回顾性研究.在增强虚拟现实平台采用定量视觉感知刺激模式,对其双眼视觉功能、眼位状态、屈光状态和双眼不平衡情况进行检测.结果 采用不同空间频率和不同时间频率的双眼整合刺激模式对受试者进行评估,在不同空间频率的虚拟现实刺激模式中双眼平衡者分别在右眼注视、左眼注视中所占比例为89.09％,85.46％;双眼不平衡者在右眼注视、左眼注视中分别所占比例为7.27％,9.09％;双眼严重不平衡者在右眼注视、左眼注视中分别所占比例为3.64％,5.45％.在不同时间频率的虚拟现实刺激模式中双眼平衡者分别在低时间频率、高时间频率中所占比例为10.91％,20.00％;双眼不平衡者在低时间频率、高时间频率中分别所占比例为76.37％,72.73％;双眼严重不平衡者在低时间频率、高时间频率中分别所占比例为12.73％,7.27％.结论 双眼视功能衡量需要能模拟我们生活的立体多维空间的非沉浸式虚拟现实平台来检查.双眼不平衡可被不同时间频率、不同空间频率的刺激模式检测出来,双眼不平衡检测是有条件性的.

Objective To explore the roles of frequency domain OCT in measuring the retinal thickness around the optic disc and optic disc parameters in early glaucoma diagnosis.Methods The optic disc parameters and retinal nerve fiber layer (RNFL) thickness in the 40 healthy volunteers (control group) and 85 cases of primary open angle glaucoma (POAG),including 36 patients as the early glaucoma subgroup and 49 patients as the glaucoma evolutum subgroup,were measured by frequency domain OCT.Then,the correlation analysis of RNFL thickness,optic disc parameters and the mean deviation (MD) of visual field in each group was performed,and the area under the curve was used to evaluate the diagnostic efficiency of RNFL thickness around the optic disc and optic disc parameters in the diagnosis of glaucoma.Results The RNFL thickness and the complete cycle mean RNFL thickness in the temporal,upper,nasal and inferior quadrant in the glaucoma patients were significantly lower than those in the controls (all P ＜ 0.05),and the above indexes in the glaucoma evolutum subgroup were significantly decreased compared with those in the early glaucoma subgroup (all P ＜ 0.05).There were statistically significant differences in the optic disc parameters between the groups except the optic disc area (all P ＜ 0.05).Pearson correlation analysis showed the RNFL thickness and the complete cycle mean RNFL thickness in the temporal,upper and inferior quadrant were negatively correlated with the MD in the glaucoma patients (all P ＜ 0.05),and the parameter of optic cup volume and cup/disc area ratio were positively correlated with the MD (both P ＜ 0.05),and the rim area,rim volume and disc volume were negatively correlated with MD (all P ＜ 0.05).The ROC curve analysis showed that the largest area under the curve of RNFL thickness in the inferior quadrant of the optic disc region was 0.886,and the specificity and sensitivity was 0.775 and 0.924,respectively.Moreover,the area under the curve of the optic cup/optic disc area was the largest,with sensitivity and specificity of 0.741 and 0.815,respectively.Conelusion OCT for measuring optic disc structure and RNFL thickness can be used for early diagnosis of glaucoma,and it has a high sensitivity and specificity.

目的 分析超高度近视眼角膜高阶像差的分布特点以及各高阶像差与球镜及柱镜的关系.方法横断面研究.选取2015年7月至2017年3月在广东省人民医院眼科拟行可植入眼内接触镜手术而行术前检查的超高度近视眼患者,球镜屈光度在-10.0 D以上的患者纳入研究.应用Pentacam眼前节分析系统采集角膜像差.角膜波前像差分析均为6 mm瞳孔直径.结果共有23例(40只眼)纳入研究,平均年龄(25.78±5.90)岁,平均球镜(-13.47±2.58)D,平均柱镜(-1.08±1.11)D.在6 mm瞳孔直径下,角膜高阶像差以3阶和4阶为主,高阶像差均方根(RMS)值呈递减趋势,阶数越高,像差越小.总高阶像差RMS值为(1.418±1.001)μm,4阶(Z4)RMS值最大(0.789±0.345)μm,3阶(Z3)次之(0.753±0.481)μm.总像差RMS值、各高阶像差RMS值、慧差、球差与球镜度数无相关性;总像差RMS值与柱镜度数(r=-0.563,P=0.000)、球差与柱镜度数(r=0.330,P=0.037)有相关性.结论超高度近视眼角膜高阶像差个体差异较大,4阶RMS值最大,3阶次之,各高阶像差RMS值随阶数增加大致呈递减趋势.总高阶像差RMS值与球镜度数无相关性,总像差RMS值与柱镜度数、球差与柱镜度数有相关性.

目的 探讨轻压式传导性角膜成形术(CK)治疗老视的临床疗效和安全性.方法 对7例(11只眼)屈光不正患者行CK手术.观察11只眼术前,术后1周、6个月,1、2年双眼裸眼远视力、近视力,术眼裸眼远视力、近视力,术眼等效球镜值、术眼眼压及术后6个月,1、2年屈光回退速度和患者满意度.结果 11只眼中,术后1周、6个月和1年术眼裸眼近视力、等效球镜值、眼压与术前比较差异均有统计学意义(均P<0.05).术后6个月和1、2年屈光回退速度分别是0.01 D·月-1、0.03 D·月-1、0.06 D·月-1.术后眼压与性别、年龄均无相关性(r=-0.194、-0.229,均P>0.05),术后眼压与等效球镜值呈正相关(r=0.441,P<0.05).11只眼中,4只眼(36.36%)在CK术后早期出现不同程度的异物感,术后1周症状基本缓解.术后未出现角膜炎、角膜穿孔、虹膜睫状体炎等并发症.术后2年患者满意度:1度5例(71.42%),2度1例(14.29%),3度1例(14.29%).结论 CK能够安全和有效地治疗老视.

Objective To investigate the effect of racanisodamine on myopia progression in children. Methods With the understanding and agreement of the patients and their families, mild myopia patients from January 2015 to Jan-uary 2016 were divided into three groups: glasses, glasses combined with atropine and glasses combined with racaniso-damine. Each group has 60 patients with no statistical differences in age, spherical equivalent (SE),axial length(AL)be-fore treatment. Subjects were followed up for one year. Results 1 year later, The average progression of SE, AL and IOP were -0.02 ±0.10D、0.09 ±0.08mm、0.09 ±1.16mmHg for the atropine group, and -0.52 ±0.14D、0.38 ±0.10mm、0.13 ± 1.12mmHg for the anisodamine group, and -1.01±0.17D,0.96±0.14mm、0.08±1.08mmHg for the control group respec-tively. There exsit statistical differences in SE and AL but no in IOP between each two groups. Conclusion Racaniso-damine can control the progression of myopia in children, but the effect is weaker than atropine.

目的：比较拉坦前列素联合马来酸噻吗洛尔与单用拉坦噻吗滴眼液对高眼内压患者的降眼压效果、药物依从性和安全性。方法选取青光眼或高眼压症患者135例，随机分成两组，A组（ n＝67）接受拉坦前列素联合马来酸噻吗洛尔治疗，B组（ n＝68）单用拉坦噻吗滴眼液治疗。比较基线和第6个月时每天平均眼内压的变化。结果治疗前两组患者的眼内压水平相似，A组为（26．2±2．24）mmHg，B组为（26．9±2．5）mmHg（P＝0．53）；在第6个月时，A组眼内压水平为（16．3±1．6）mmHg，与基线值比较差异有统计学意义（P＜0．001），而B组患者眼内压水平为（16．1±1．3）mmHg，与基线值比较差异有统计学意义（P＜0．001），两组的治疗均可视为有效。两组第6个月的眼内压水平也相似，差异无统计学意义（P＝0．62）。 A组患者的药物依从性为48．2％，B组患者的药物依从性为64．3％。 A组和B组分别有76．1％和76．5％未报告出现不良事件。 A组和B组分别有9．0％和7．4％报告出现药物相关不良事件。结论使用拉坦前列素联合马来酸噻吗洛尔与单用拉坦噻吗滴眼液具有相似的疗效，而后者的药物依从性较高。

被誉为乐器之王的钢琴，一直是家长们着力培养孩子气质和情操的首选。不过近来，一种“钢琴最伤眼”的说法在父母们中流传。事实真如此吗？

Background Artisan phakic intraocular lens (pIOL) implantation was demonstrated to be safe and effective for the correction of high myopia in short-term.However,long-term corneal endothelium status after operation should be concerned.Objective This study was to investigate the long-term changes of corneal endothelial cell density (ECD) and morphology following Artisan pIOL implantation for the correction of high myopia.Methods Fifty-one eyes of 27 patients who received Artisan PIOL implantation for high myopia from January 2005 to December 2008 were retrospectively analyzed.The central corneal ECDs were detected by corneal endothelial cell counter before surgery and 6 months and 1 year,2,3,4,5,6 years after surgery,and the coefficient of variation (CV) and standard deviation (SD) of cellular area were evaluated.ECD loss rate with time lapse was calculated ([preoperative ECD-postoperative ECD]/preoperative ECD× 100％).Results Six years after surgery,there were 34 eyes with BCVA ≥ 1.0,14 eyes with BCVA higher than preoperative and 8 eyes with BCVA lower than preoperative.The mean intraocular pressure was (14.23±2.14)mmHg 6 years postoperative.The preoperative mean ECD was (3 184.05±233.55)/mm2,and the ECD was gradually reduced over time with the cell loss 2.34％ in 6 months,5.32％ in 1 year,6.32％ in 2 years,8.06％ in 3 years,12.59％ in 4 years,15.63％ in 5 years and 19.49％ in 6 years after operation.Before surgery,The mean CV of cellular area was 37.17±7.12,and the SD of cellular area was 118.77±21.39,and those 6 years after surgery were 32.24 ±4.62 and 125.60± 18.49,respectively.The mean CV and SD of cellular area were significantly different among different time points (P =0.000,0.036).Eight eyes with localized iris depigmentation,6 eyes with IOL dyssymmetry,3 eyes with transient high intraocular pressure and 2 eyes with Macular hemorrhage were obtained after surgery.Conclusions Corneal endothelial cells appear obvious changes in both number and morphology after Artisan pIOL implantation in high myopia.ECD is gradually reduced with time lapse,and the shape of the cells occur remodeling during 6-year fellow-up duration.Overall,endothelial specular microscopy is mandatory before and after surgery for a long term.

Objective To measure the anterior corneal Q values in different regions of eyes of the 12-year-old teenagers using Pentacam HR anterior segment analyzer and analyze the aspheric characteristics with different refractive statuses.Methods Forty eight myopic teenagers (83 eyes)were divided into two groups based on the magnitude of spherical equivalent (SE)refractive error:low (22 cases and 37 eyes)and moder-ate myopia (26 cases and 46 eyes)groups.Pentacam HR anterior segment analyzer was used to measure the corneal anterior Q values of the nasal,temporal,inferior and superior semi-meridians in 6 mm,7 mm,8 mm and 9 mm diameters,the horizontal and vertical meridian Q values,and the mean Q values in 8 mm diameter to compare corneal asphericity between two groups.Results Temporal semi-meridian Q values of the corneal anterior surface in 8 mm and 9 mm diameter and the difference between the temporal and nasal semi-meridian Q values in 9 mm diameter significantly differed between two groups (all P <0.05).The diopter showed positive correlation with temporal semi-meridian Q values of the corneal anterior surface in 8 mm and 9 mm diameter and the difference between the temporal and nasal semi-meridian Q values in 9 mm diameter (rs =0.250, 0.277,0.280,P <0.05).Conclusion There are differences in corneal Q values in 8mm and 9 mm diame-ter,subject to the influence of refractive status.

Objective To investigate the correlation among the corneal curvature,axial length,and diopter in the adolescents with ametropia.Methods Forty three teenagers diagnosed with ametropia (82 eyes) were selected in this study.All participants were divided into the hyperopia (n =21 ,41 eyes)and myopia (n =22,41 eyes)groups according to the spherical equivalent (SE).The diopter,radii of horizontal and ver-tical corneal curvature and axial length were measured and statistically compared between two groups.Results The radii of horizontal and vertical corneal curvature,axial length and axial length/radius of corneal curva-ture significantly differed between two groups (all P <0.05).In both groups,the diopter showed linear corre-lation with the axial length and axial length/radius of corneal curvature (rHyperopia =-0.544 and -0.31 0;rMyopia =-0.558 and 0.790,both P <0.05).Linear correlation was equally observed among the axial length and radii of horizontal and vertical corneal curvature in two groups (rHyperopia =0.572 and 0.668;rMyopia =0.587 and 0.551 ,both P <0.05).The radius of horizontal corneal curvature had linear correlation with that of verti-cal corneal curvature in both groups (rHyperopia =0.937,rMyopia =0.970,both P <0.05).Conclusions In the adolescents with ametropia,the diopter was closely correlated with the corneal curvature and axial length.The axial length was the main factor of the incidence of myopia.The axial length/radius of corneal curvature was a sensitive indicator to monitor myopic progression

Objective:To analyze the correlation among the difference in the axial length,diopter and keratorefractive power between the two eyes in anisometropia.Methods:The diopter,axial length,corneal refractive power and axial length/corneal radius(AL/CR) were measured in 61 cases.Two groups were created based on the difference of diopter:the difference of diopter≤0.25 D(the similar group),the difference of diopter ≥1.00 D(the different group).The data were analyzed by SPSS statistics software system.Results:In the similar group,the difference of diopter showed positive correlation with the difference of axial length(r=0.450,P﹤0.05)and average keratorefractive power(r=0.370,P﹤0.05),but showed no correlation with the difference of AL/CR(P﹥0.05).The difference of axial length showed positive correlation with the difference of average keratorefractive power(r=0.552,P﹤0.01).In the different group,the difference of diopter showed positive correlation with the difference of axial length(r=0.965,P﹤0.01)and AL/CR(r=0.962,P﹤0.01),but showed no correlation with the difference of average keratorefractive power(P﹥0.05).The difference of axial length showed no correlation with the difference of average keratorefractive power(P﹥0.05).Conclusion:The axial length and keratorefractive power made a great impact on anisometropia.The imbalance of the axial length and keratorefractive power resulted in the production and development of anisometropia.AL/CR is the sensitive index.

Objective To evaluate the clinical results of conductive keratoplasty (CK) for correcting residual ametropia after multifocal apodized diffractive intraocular lens (IOL) implantation.Methods In this retrospective study,seven eyes of six patients underwent CK with CK View Refractec (RCS-200,Refractec,Inc.) for the correction of residual hyperopia after multifocal apodized diffractive IOL implantation.The follow-up period was 12 months and uncorrected distance visual acuity (UCDVA),uncorrected near visual acuity (UCNVA),best spectacle-corrected distance visual acuity (BSCDVA),best distance-corrected near visual acuity (BDCNVA),best spectaclecorrected near visual acuity (BSCNVA),manifest refraction and central keratometry were measured and recorded.A nonparametric test was used to analyze the data.Results The median of UCDVA was 0.4,the median of UCNVA was 0.25,and the mean spherical equivalent (SE) refraction was +1.10±0.3 D (range +0.75 to +1.50 D) after cataract surgery and before CK.One year after CK,all eyes had from a UCDVA and UCNVA of 0.5 or better with a mean median UCDVA of 0.8 and a UCNVA of 0.5.The mean SE refraction was-0.4 D±0.4 (range +0.25 to-1.00 D).There were statistically significant differences in UCDVA and UCNVA,after CK surgery (Z=-2.226,-2.375,P＜0.05).Conclusion CK is an effective and safe approach to correct residual hyperopia in pseudophakic eyes with multifocal apodized diffractive IOL implants.

Objective To discuss the cause and management of postoperative low vision after phacoemulsification and intraocular lens implantation.Methods The clinical data of 53 eyes of postoperative low vision in 465 cases (478 eyes) with cataract phacoemulsification and intraocular lens implantation were studied retrospectively.They were treated with medicine,laser surgery,correction of refractive errors and typoscope for vision recovery.The follow-up was 3 months to 2 years.Results Fifty three ( 11.1％ ) out of the 478 eyes developed low vision.The visual acuity (VA) was ＜0.05 in 3 eyes,0.05-0.08 in 6 eyes,0.1 in 5 eyes,0.12 in 10 eyes,0.15 in 13 eyes,0.2 in 7 eyes and 0.25 in 9 eyes.The postoperative VA was equal to the preoperative one in 3 eyes,below the preoperative one in 2 eyes,higher than the preoperative one in 48 eyes.The cause of low vision was surgical operation (15.1％),nonsurgical reason (84.9％ ).Multivariate stepwise logistic regression analysis showed that age,preoperative corrected visual acuity,preoperative ocular disease,nuclear hardness were the main cause of low postoperative vision.Conclusion The main cause of postoperative low vision after cataract phacoemulsification is non-operation factors.

AIM:To check whether myopic laser in situ kerato-mileusis(LASIK) induces changes on the posterior corneal surface.METHODS:Orbscan-Ⅱz and Pentacam were used to measure preoperative and postoperative posterior corneal topography in 66 eyes(of 66 subjects) that had undergone standard myopic LASIK surgery.Changes in the posterior corneal elevation,and anterior chamber depth were compared using the paired sample t test.RESULTS:Measured with Orbscan-Ⅱz,significant forward shifting of the central posterior corneal surface was found after LASIK(P=0.000),while measured with Pentacam,no significant difference in posterior corneal displacement was found(P>0.05).Preoperative refraction(r=-0.403,P=0.001),central corneal thickness(r=-0.349,P=0.004),ablation depth(r=0.411,P=0.001) were significantly correlated with the posterior corneal displacement measured with Orbscan-Ⅱz.CONCLUSION:No forward shifting of the central posterior corneal surface occurred after LASIK.Orbscan-Ⅱz was affected by the magnification effect of corneas after LASIK,when it was used to measure the posterior corneal surface.