目的:研究不同白内障超声乳化术切口对糖尿病患者术后眼表的影响.方法:以纳入我院收治的120例糖尿病合并白内障患者为研究对象,均接受超声乳化术.将患者分为三组各40例40眼,A组采取角巩膜缘切口,B组采取上方透明角膜切口,C组采取颞侧透明角膜切口.术前及术后1、7、14、30d对所有患者进行干眼症状评分、角膜荧光素染色(FL)评分及泪膜破裂时间(BUT)、基础泪液分泌试验(SIt)研究.结果:三组术后的干眼症状评分上升,BUT缩短,FL评分增高,SIt降低.并且A组术后的指标恢复均显著优于B组和C组(均P<0.05).结论:超声乳化术中采取角巩膜缘切口对泪膜稳定性影响较小,安全性较好.

Objective:To explore the effect of phacoemulsification through corneoscleral incision on cataract patients with type 2 diabetes mellitus.Methods:A prospective case-control study was conducted to collect cataract patients with type 2 diabetes who were admitted to the First Hospital of Hebei Medical University from January 2018 to June 2019. All patients were treated with phacoemulsification. They were randomly divided into three groups: 40 cases (68 eyes) of corneoscleral incision, 40 cases (66 eyes) of upper transparent corneal incision and 40 cases (70 eyes) of temporal transparent corneal incision. The dry eye symptom scale score, corneal fluorescein staining (FL) score, tear rupture time (BUT) and Schirmer I test (SIt) were compared in three groups; The levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in aqueous humor were compared among the three groups before and 7 days after operation.Results:⑴ The levels of IL-6 and IL-8 in aqueous humor of the three groups were significantly lower than those before operation, especially in group A ( P<0.05), but there was no significant difference in the levels of IL-6 and IL-8 in aqueous humor of group B and C ( P>0.05); ⑵ The scores of dry eye symptoms in group B were significantly higher than those in group A at 1 and 7 days after operation ( P<0.05); The scores of dry eye symptoms in group C were significantly higher than those in group A and B at 1, 7 and 30 days after operation ( P<0.05); The dry eye symptom score in group A and B decreased to the preoperative level 30 days after operation ( P>0.05), and that in group C decreased to the preoperative level 90 days after operation ( P>0.05); ⑶ The postoperative 1, 7 and 30 d BUT in group A and C were significantly higher than those in group B ( P<0.05), and the level of SIt was significantly lower than that in group B ( P<0.05); At 1 and 7 days after operation, SIt in group A was significantly lower than that in group C ( P<0.05); the FLS score in group A and C was significantly lower than that in group B at 1 and 7 days after operation ( P<0.05). Conclusions:The incision of corneoscleral margin has little effect on tear film stability and ocular surface function of cataract patients with type 2 diabetes mellitus treated by phacoemulsification, which is worthy of clinical recommendation.

Objective:To compare and study the clinical efficacy of three different phacoemulsification incisions for cataract patients with type 2 diabetes mellitus.Methods:A retrospective analysis was performed in 120 patients (198 eyes) with type 2 diabetes cataract who underwent cataract extraction and intraocular lens implantation from January 2018 to June 2019 in the First hospital of Hebei Medical University. According to the surgical incision, the patients were divided into three groups: A group (the cornea scleral marginal incision, 40 cases, 72 eyes), B group (the clear corneal incision at the top , 40 cases, 66 eyes), C group (underwent temporal clear corneal incision, 40 cases, 60 eyes). The corneal perception, dry eye symptoms, basic tear secretion test (SIt), tear film rupture time (BUT), corneal fluorescein staining (FL) and complications were compared among the three groups before and after treatment.Results:The corneal perception of B group and C group was lower than that of A group on 1 d, 7 d and 30 d after operation ( P<0.05); The scores of dry eye symptoms in C group were higher than those in A group and B group on 1 d, 7 d and 30 d after operation ( P<0.05), and the scores of dry eye symptoms in B group were higher than those in A group on 1 d and 7 d after operation ( P<0.05); The SIt value of C group was lower than that of A group on 1 d, 7 d and 30 d after operation ( P<0.05), and that of B group was lower than that of A group and group C on 1 d, 7 d and 30 d after operation ( P<0.05); The BUT value of C group was lower than that of A group at 1 d and 7 d after operation ( P<0.05), and the BUT value of B group was lower than that of A group and C group at 1 d, 7 d and 30 d after operation ( P<0.05); The FL value between A group and C group at 1 d, 7 d, 30 d and 90 d after treatment was not significant ( P>0.05). The FL value of B group returned to the level before treatment at 30 d after operation, and the FL value of B group was higher than that of A group and C group at 1 d and 7 d after operation ( P<0.05); There was little difference in the incidence of complications among the three groups ( P>0.05). Conclusions:The cornea scleral marginal incision can reduce the tear secretion, maintain the stability of tear film, and is more suitable for cataract patients with type 2 diabetes mellitus. It is worthy of further promotion in clinic.

目的 探讨芪明颗粒联合激光光凝术治疗糖尿病视膜病变(DR)的临床疗效.方法 选取2017年6月-2018年5月医院收治的DR患者110例作为研究对象,随机分为观察及对照组各55例,两组患者均使用532眼底激光治疗仪治疗,观察组联合服用芪明颗粒.抽取两组患者治疗前及治疗3个月后空腹外周静脉血,采用酶联免疫吸附法(ELISA)测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;采用免疫比浊法测定超敏C反应蛋白(hs-CRP)、血管生成素-2(Ang-2)、血管内皮生长因子(VEGF).于治疗前、治疗1、3个月后检查最佳矫正视力,采用光学相干断层扫描仪(OCT)检查黄斑中心凹厚度(CMT).结果 治疗3个月后两组患者血清TNF-α、IL-6、hs-CRP、Ang-2、VEGF均低于同组治疗前(P均＜0.05);观察组治疗后血清TNF-α、IL-6、hs-CRP、Ang-2、VEGF均低于同期对照组(P均＜0.05).两组患者治疗前BCVA、CMT差异均无统计学意义(P均＞0.05),治疗1、3个月后BCVA、CMT均低于同组治疗前(P均＜0.05);观察组治疗1、3个月后BC-VA、CMT均低于同期对照组(P均＜0.05).结论 芪明颗粒联合激光光凝术能够减轻机体炎症反应,降低Ang-2、VEGF水平,减少新生血管,提高治疗效果.

Objective To analyze the relationship between the average comeal curvature and the difference of intraocular lens (IOL)on both sides of the short eye axis.Methods Prospective study of corneal curvature on randomly collected 500 corneas of normal adult cataract patients.With the same corneal curvature,177 cases of comeal curvature were obtained;the average of 177 cases of comeal curvature was obtained,the range of the average corneal curvature was 40.125-48.375D.In the range of average comeal curvature,according to the calculated critical axial length (21.97-22.02mm),the difference of IOL was obtained.The correlation on intraocular lens of difference and average corneal curvature were analyzed.Results There was a negative correlation between the difference of intraocular lens and the average corneal curvature in critical axial of short axis r =-0.968,P =0.000.Conclusions In normal adult cataract patients with normal corneal,the difference of intraocular lens number gradually becomes smaller with the increase of average corneal curvature.

目的 观察白内障超声乳化联合前部玻璃体切除术后睫状沟内植入Toric散光晶状体(IOL)的效果.方法 选择白内障患者72例74眼,其中超声乳化术术中因后囊破裂行前部玻璃体切除术后睫状沟内植入Toric IOL 20例20眼(观察组),超声乳化术后顺利植入囊袋Toric IOL 52例54眼(对照组),比较两组术前最佳矫正视力及术后3个月裸眼视力、Toric IOL旋转度数.结果 两组术后3个月裸眼视力显著高于术前最佳矫正视力,角膜散光均较术前降低,P均<0.05;两组术后3个月裸眼视力、残留散光、IOL旋转度数及顺时针、逆时针旋转眼数比较,P均>0.05.结论 Toric IOL在白内障超声乳化联合前部玻璃体切除术后植入睫状沟与常规植入囊袋内效果无明显差异.

BACKGROUND: Spherical Toric intraocular lens can effectively correct the preoperative astigmatism of cataract patients, but it is unclear whether the aspheric Toric lens is better than the spherical Toric lens to improve the quality of vision. OBJECTIVE: To evaluate the optical quality after implantation of aspheric toric intraocular lens in cataract surgery. METHODS: Seventy-three cataract patients with corneal astigmatism (80 eyes) were enrol ed, including 37 males and 36 females, aged 47-83 years. Among them, 36 cases were implanted with aspheric Toric intraocular lens (test group), and the other 37 cases were implanted with spherical Toric intraocular lens (control group). Postoperative examinations were performed at 3 months, including axial intraocular lens, uncorrected visual acuity, corrected visual acuity, residual astigmatism, contrast sensitivity, and wavefront aberration. RESULTS AND CONCLUSION: Three months after implantation, the axial view, uncorrected visual acuity, corrected visual acuity and residual astigmatism showed no differences between the two groups; no shape deviation and lens decentration occurred; there was no case required to remove the lens or subjected to secondary adjustment. In the test group, the moderate and high spatial frequency contrast sensitivity at the scotopic or scotopic glare state was significantly higher than that in the control group (P < 0.05), the total higher order aberrations and spherical aberrations at a pupil diameter of 5.0 mm and spherical aberration at a pupil diameter of 3.0 mm were significantly less than those in the control group (P < 0.05). Additional y, there were no differences in scattering index, cut-off frequency of the modulation transfer function, Strehl ratio and visual acuity at 9%, 20% and 100% contrast between the two groups. These findings indicate that the aspheric and spherical toric intraocular lenses have similar effects in improving the astigmatism and raising the uncorrected visual acuity, but the former one is superior to the latter one in improving scotopic vision, and total higher order aberrations and spherical aberrations.

晶状体不全脱位,是一类晶状体悬韧带异常性眼病,导致白内障或晶状体手术难度加大,从撕囊到最后粘弹剂的吸出每一个手术步骤对手术医师来说都面临着严峻的挑战.随时都有可能出现并发症.不但术中容易发生玻璃体的脱出,而且术后更容易导致IOL偏位.最近,新技术的应用,术中可以采取有效的对悬韧带保护措施并加强有问题的悬韧带,从而减少了并发症的发生.

目的评估双眼先天中央粉尘状白内障单眼人工晶状体植入术后的生活质量.方法30例先天中央粉尘状白内障患者随机分为两组,试验组(单眼手术组)与对照组(双眼手术组).采用晶状体超声乳化吸出后房人工晶状体植入术.用问卷的方式,对试验组术前及术后进行调查计分.对照组仅对其术后进行调查计分.对视觉和生活质量方面的问题进行全面的调查.采用加权Kappa值计算法对计分员的一致性进行评估.结果试验组术前总分值为327分,术后为541分,生活质量明显提高(P＜0.02).对照组总分值为462分,低于试验组(P＜0.01).结论对于双眼先天性粉尘状白内障患者采用单眼人工晶状体植入术,是一种较好的选择,可以全面提高患者的生活质量.

随着人们对视觉质量要求的提高,恢复远、近视力功能是目前屈光手术及白内障手术所追求的目标.为了达到此目的,出现了许多种手术方法.本文就相关文献进行复习并作以综述.

Piggyback人工晶体植入术又称双联人工晶体植入术,是一种在眼内植入两个人工晶体的手术.共分为两种术式:Ⅰ期双联人工晶体植入术和Ⅱ期双联人工晶体植入术.PiggybackIOL为高度远视白内障患者提供了足够的人工晶体矫正,为人工晶体术后错误的光学结果提供了再矫正的机会.在特定的条件下,它能够以简单的办法解决一些临床上复杂的屈光问题.