目的 比较合并糖尿病黄斑水肿(DME)的白内障患者,行超声乳化术(Phaco)联合地塞米松玻璃体腔植入物(Ozurdex;DEX-I)与单纯行超声乳化术后,其黄斑部形态与功能的变化.方法 回顾性病例对照研究.纳入对象为我院就诊的合并DME的46 例(46 只眼)白内障患者,其中行伴有DEX-I的超声乳化术的 23 例(23 只眼)患者为Phaco-Dex组,行单纯超声乳化术的23 例(23 只眼)患者为单纯Phaco组.比较其术前及术后不同阶段黄斑部形态与功能的变化.结果 Phaco-Dex组,与术前相比,从术后第 1 个月开始BCVA(logMAR)均显著提高(P＜0.05);黄斑中心凹视网膜厚度(CMT)和黄斑体积(MV)自第2 个月起显著下降(P＜0.05);与单纯Phaco组相比较,Phaco-Dex组在每个随访点CMT和MV均显著降低.随访期间单纯Phaco组眼压显著升高(P＜0.05).单纯Phaco-alone组,CMT和MV从第2 个月开始增加(P＜0.05).结论 对合并DME视力显著性下降的白内障患者,超声乳化吸除联合DEX-I治疗是有效、安全的,不管是黄斑部形态和功能的改善方面都要优于单纯白内障超声乳化手术.

AIM: To analyze the changes of the epiretinal membrane(ERM)stage, macular status and best corrected visual acuity(BCVA, LogMAR)in cataract patients with idiopathic macular epiretinal membrane(IERM)before and after cataract surgery.METHODS:We conducted a single center retrospective observational case series of patients that underwent sequential cataract and idiopatic ERM surgeries from March 2016 to May 2019 in Anyang Eye Hospital. Full data were obtained for 51 patients(54 eyes).Preoperative and postoperative 1mo ERM stage, central macular edema(CME), central macular thickness(CMT), macular volume(MV), ellipsoid zone disruption, occurrence of neurosensory detachment(NSD)and BCVA were analyzed.RESULTS:In this group of patients, 5 eyes(9%)had ERM grade 1, 23 eyes(43%)had ERM grade 2, 21 eyes(39%)had ERM grade 3, and 5 eyes(9%)had ERM grade 4 before surgery; ERM graded 1mo after surgery were keeping steady. Compared with before operation(0.45±0.16),there was no significant change in BCVA(0.47±0.17)at 1mo after operation(P>0.05), but the incidence of CME, ellipsoid band interruption and NSD were significantly higher than those before operation(P<0.05). CONCLUSION: We suggest that phacoemulsification did not significantly accelerate ERM progression and affect BCVA, but patients underwent cataract surgery in the presence of epiretinal membranes need tight follow up to treat and control eventual macular infammatory changes and eventual prompt vitrectomy if BCVA was threatened.

目的:探讨基于六西格玛理论的健康教育对青光眼合并白内障手术患者心理状态及自我管理能力影响.方法:选取某院2018年6月-2019年6月收治的青光眼合并白内障手术患者80例,按照随机数字表法分为观察组和对照组,每组各40例.对照组采用常规健康教育和术后干预,观察组采用基于六西格玛理论的健康教育.采用焦虑自评量表(Self—Rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating depression scale,SDS)评价患者干预前后心理状态,采用自制问卷调查评价患者干预前后生活管理、饮食管理、用药管理情况,观察比较两组患者干预后眼球胀痛、角膜肿胀、前房渗出等并发症发生情况,采用自制问卷调查评价两组患者对健康教育的满意度.结果:观察组与对照组相比,干预后SAS、SDS评分均更低,差异具有统计学意义(t=-4.654,-5.250;P＜0.05);观察组与对照组相比,干预后生活管理、饮食管理、用药管理评分均更高,差异具有统计学意义(t=7.627,11.000,7.836;P＜0.05);观察组与对照组相比,并发症发生率差异无统计学意义(P＞0.05);观察组与对照组相比,患者满意度更高,差异具有统计学意义(Z=2.038,P＜0.05).结论:基于六西格玛理论的健康教育可有效改善青光眼合并白内障手术患者心理状态,提高患者自我管理能力,减少并发症的发生,提高患者满意度.

目的:探讨程序化干预联合多学科协作在白内障术后患者中的应用效果.方法:将2019年3月1日～2021年3月31日收治的160例白内障患者随机分为实验组和对照组各80例.对照组采用常规护理干预,实验组采用程序化干预联合多学科协作,比较两组视力恢复情况、心理状况[采用症状自评量表(SCL?90)]、生活质量[采用生活质量调查表(SF?36)]、并发症发生情况、护理满意度情况.结果:干预后实验组视力恢复效果优于对照组(P<0.01);干预后实验组SCL?90评分低于对照组(P<0.01);干预后实验组SF?36评分高于对照组(P<0.01);实验组并发症发生率低于对照组(P<0.05);实验组护理满意度高于对照组(P<0.05).结论:对白内障患者应用程序化干预联合多学科协作可促进患者术后视力恢复,改善患者心理状态,缓解患者焦虑情绪,降低并发症发生率,提高患者生活质量,具有较好的临床应用价值,建议推广应用.

目的 分析糖尿病视网膜病变(DR)患者糖化血红蛋白(HbAlc)及血管内皮生长因子(VEGF)的表达及临床意义.方法 选取2018年3月至2019年12月本院收治且经内分泌科确诊的86例糖尿病患者作为研究对象,其中DR患者39例,无视网膜病变(NDR)者47例.另选取同一时期在本院接受体检的50例健康体检者作为对照组.比较三组研究对象HbAlc和VEGF表达水平,并分析HbAlc与VEGF诊断DR的敏感性和特异性.结果 DR组、NDR组患者HbAlc与VEGF水平均明显高于对照组,且DR组HbAlc与VEGF水平明显高于NDR组(P＜0.05).HbAlc诊断DR的敏感性、特异性分别为79.49％、87.18％;VEGF诊断DR的敏感性、特异性分别为82.05％、84.62％;两种检测方法诊断DR的敏感性和特异性均无统计学差异(P＞0.05).结论 DR患者HbAlc与VEGF水平呈高表达,对DR诊断敏感性和特异性均较高,可作为早期诊断DR的检测指标.

目的 观察白内障超声乳化术与小切口白内障囊外摘除术治疗对高度近视合并白内障患者角膜内皮细胞(CEC)的影响.方法 回顾性分析2016年1月至2018年1月我院收治的54例高度近视合并白内障患者临床资料,根据手术方式分为白内障超声乳化术组(A组,28例37眼)和小切口白内障囊外摘除术组(B组,26例35眼).记录两组患者不同时间点术眼CEC情况及中央角膜厚度(CCT)检查结果,比较两组患者术眼最佳矫正视力(BCVA)差异以及并发症发生情况.结果 两组患者术眼CEC面积均于T2时上升、T3～T4时逐渐降低,CEC密度、六角形细胞百分比则于T2时降低、T3～T4时逐渐升高,A组变化幅度小于B组(P＜0.05);两组患者术眼CCT均于T2时升高,于T3、T4时逐渐降低(P＜0.05);A组T2时CCT小于B组(P＜0.05),两组患者T1、T3、T4时组间比较差异无统计学意义(P＞0.05).T4时,两组患者BCVA较T1时显著提升,且A组优于B组(P＜0.05);A组患者术后并发症发生率小于B组,差异具有统计学意义(P＜0.05).结论 2种术式治疗高度近视合并白内障患者均会引起CEC损伤,但白内障超声乳化所致损伤相对较轻,更有利于患者术后视力恢复,且安全性良好.

目的 探讨白内障日间手术模式的应用及效果.方法 选取2018-08—2019-01间在安阳市眼科医院接受白内障超声乳化联合人工晶状体植入术的200例年龄相关性白内障患者.将日间手术患者作为观察组,将传统住院患者作为对照组,各100例.比较2组的疗效.结果 2组术后均未发生眼内感染等严重并发症,角膜水肿及高眼压的发生率差异无统计学意义(P>0.05).观察组患者和医护人员的满意度评分均高于对照组,差异有统计学意义(P<0.05).结论 白内障日间手术模式安全可靠,医患双方的满意度高.

目的 对改良梯形切口非超声乳化囊外摘除术应用于超大硬核白内障临床治疗的效果进行探究.方法 选取我院收治的66例超大硬核白内障患者作为观察对象,所有患者均于2018年1月至2018年12月于我院接受小切口非超声乳化囊外摘除术治疗.按照数字随机法将患者平均分为观察组与对照组,观察组患者(33例,38眼)采用改良梯形切口,对照组患者(33例,36眼)采用直切口,观察对比两组患者手术前后视力变化情况及手术后并发症的发生率.结果 手术前,两组患者的视力情况相比无明显差异( P>0. 05);手术后3d,两组患者的视力较治疗前均有所好转,但手术后3d两组患者的视力情况相比仍无明显差异,( t=0. 3731,P=0. 7102);对照组患者术后并发症发生率(33. 33% )明显高于观察组患者的术后并发症发生率(12. 12% ),两组对比( χ2 =4. 2275,P=0. 0397).结论 临床对超大硬核白内障患者应用改良梯形切口非超声乳化囊外摘除术对于患者视力的改善情况较好,术后并发症发生率较低,有利于患者的预后质量.

目的 分析眼睑鳞状细胞癌的临床及组织病理学特点,探讨影响眼睑鳞状细胞癌的临床预后因素.设计 回顾性病例系列.研究对象 安阳市眼科医院2000年1月至2011年3月42例(42眼)眼睑鳞状细胞癌患者.方法依据原始记录和随访情况,对临床及组织病理学因素进行统计分析.采用COX回归分析复发相关因素,生存分析采用Kaplan-Meier法.术后随访(45.7±9.87)个月.主要指标 患者年龄、性别、病程、肿瘤解剖部位、肿瘤T分类、肿瘤病理学分级及治疗方法.结果 42例眼睑鳞状细胞癌患者平均年龄(61.9±7.82)岁;其中男24例(57.1％);发病部位以下睑为多(18/42);肿瘤T分类4例T1,7例T2,17例T3,14例T4.病程长、肿瘤T分类级别高是肿瘤复发的危险因素;肿瘤T分类与眼睑鳞状细胞癌患者的5年生存率呈相关性,T分类级别越高,肿瘤相关死亡率越高(r=8.818,P=0.035).结论 眼睑鳞状细胞癌病程越长、肿瘤T分类级别越高时,肿瘤的复发率增高;肿瘤T分类级别越高时,肿瘤相关死亡率越高.

Objective To observe the efficacy of lateral tarsal strip combined with medial spindle resection for involutional ectropion or paralytic ectropion of lower lid.Methods Forty-two eyes of 36 patients with involutional ectropion and paralytic ectropion from January 2010 to October 2015 were retrospectively analyzed.The involutional ectropion of lower lid was in 28 eyes of 22 cases and the paralytic ectropion of lower lid was in 14 eyes of 14 cases.All patients were treated with the lateral tarsal strip.Some patients combined with medial spindle resection.The efficacy of relocation of lower eyelids was evaluated after surgery.The degree of the lower eyelid retraction and lagophthalmus were examined quantitatively before and after operation,while the change of the low eyelid ectropion and laxity were done qualitatively.Results All patients were followed-up for 1 month.Eyelids of all the patients were relocated well except 3 cases of ectropion under mild correction.The difference in quantitative evaluation was significant between pre and post operation (P ＜ 0.01),while the qualitative effect of correction was satisfied after operation.Conclusion The lateral tarsal strip combined with medial spindle resection can achieve favourable effect in the treatment of involutional ectropion and paralytic ectropion.

Objective To observe the effect of anterior vitrectomy combined with atrial angle separation on postoperative malignant glaucoma after cataract surgery.Methods Retrospective case analysis, 20 cases (20 eyes) of patients who had the treatment which were failed with YAG laser and medication received anterior vitrectomy combined with atrial angle separation to treat the secondary malignant glaucoma after cataract extraction and intraocular lens implantation from July of 2010 to June of 2014, follow up for 3 months to 1 year.The best corrected visual acuity, intraocular pressure, anterior chamber depth and the state of retina and choroid were observed and recorded in 20 cases, and the data were statistically analyzed.Results The best corrected visual acuity, intraocular pressure and anterior chamber depth of 20 patients (20 eyes) were 0.58±0.25、(15.26±2.97)mmHg、(3.28±0.42)mm and the difference was statistically significant (t=8.83, 18.93, 14.38 all of P=0.00) at the 3d months after operation.6 eyes had ciliary body detachment, 3 eyes had both ciliary body and choroid detachment at 1st day after operation, we treated the 9 eyes with dexamethasone and 20% mannitol , the ciliary body and choroid detachment of the 9 cases disappeared in 2 weeks after operation.Conclusion Anterior vitrectomy combined with posterior capsule incision and chamber angle separation could remove the ciliary block and Outflow tract obstruction of humor aquosus of the patients with malignant glaucoma after cataract surgery, and could significantly decrease the symptoms and improve the visual function.

?AIM:To evaluate the clinical outcomes of Nd:YAG laser capsulotomy in the treatment of early stage capsular block syndrome ( CBS) .?METHODS:Eighteen patients (21 eyes) with early stage capsular block syndrome were treated using Nd:YAG laser by anterior capsulotomy only or combined with posterior capsulotomy from January 2010 to July 2015 in Anyang Eye Hospital. Uncorrected distance visual acuity, intraocular pressure, spherical equivalent, depth of anterior chamber were observed preoperatively and 2wk postoperatively.?RESULTS:Seventeen eyes simply underwent peripheral anterior capsulotomy with Nd:YAG laser. Four eyes were combined with posterior capsulotomy. Compared with preoperative, uncorrected distance visual acuity improved, intraocular pressure returned to normal, degree of myopia reduced, depth of anterior chamber had deepened.? CONCLUSION: Nd: YAG laser capsulotomy is an effective treatment for early stage capsular block syndrome.

AIM:To evaluate the clinical outcomes of the Toric intraocular lens(Toric IOL)for correction of corneal astigmatism in cataract patients with prolonged axial length. MEHTODS:This prospective series case study included 64 eyes in 64 patients with corneal astigmatism and cataract. The experimental group consisted of 30 patients with cataract and prolonged axial length. The control group consisted of 34 patients with cataract and normal axial length. The uncorrected distance visual acuity, best corrected distance visual acuity, preoperative corneal astigmatism, predicted residual astigmatism, residual astigmatism and Toric IOL axis rotation were measured preoperatively and post operatively. RESULTS:After the operations, the uncorrected distance visual acuity in the experimental group was 0.06±0.11 and in the control group was 0.03±0.08, both were improved compared to those before the operations(P<0.01).But there was no statistically different between the two groups(P>0.05).The residual astigmatism between the two groups(0.44±0.09 vs 0.41±0.08)was no statistically different(P>0.05).The mean IOL axis rotation in experimental group(4.43°±1.36°)was higher than that of the control group(3.59°±1.1°)and the difference was statistically significant(P<0.01). CONCLUSION:Toric IOL rotation is greater in eyes with a prolonged axial length. But there is no differences on uncorrected visual acuity, residual astigmatism, compared with patients with normal axial length.

Objective To observe the influence of phacoemulsification on corneal endothelial cells of cataract patients with diabetes.Methods From January 2015 to July 2015,60 eyes of 60 patients who underwent phacoemulsification in Anyang Eye Hospital were divided into two groups.The clinical trial group included 30 cases of age related cataract with diabetes and control group included 30 cases of simple age related cataract.Corneal endothelial cells density (CD),average area of corneal endothelial cells(AVE)and central corneal thickness(CCT)were measured before surgery and 1 day,1 week,and 1 month after surgery.Results Compared with those of preoperative,CD reduced,AVE and CCT increased postoperatively,the differences were statistically significant(P ＜ 0.001).There were statistical differences in CD between clinical trial group and control group 1 week and 1 month after surgery (P ＜ 0.05).There were statistical differences in AVE between clinical trial group and control group 1 month after surgery(P ＜0.05).CCT in clinical trial group was significantly higher than that in control group at 1 day after surgery (P ＜ 0.05).Conclusion Compared with simple age related cataract,the damage of corneal endothelial cells after phacoemulsification in age related cataract with diabetes is severer,which requires more recovery time.

Objective To explore the simple and effective methods for correcting epicanthus and a concomitant double eyelidplasty with slight scar. Methods 36 patients with epicanthus( single eyelid) were performed epicanthoplasty by a new Z-epicanthoplasty,and double eyelidplasty was performed simul-taneouly. Results 36 patients were followed-up for 3-12 months. Satisfactory esthetical result of double eyelid fold and inner canthus shape was achieved. All patients were with slight scars. Conclusion The method that a new Z-epicanthoplasty combined with double eyelidplasty has the advantages of minimal scar formation,easy to design perform and in accordance with physiology.

Objective To examine the effect of preventative capsulotomy on prevention of anterior capsule contraction after cataract surgery in patients with diabetes mellitus.Methods Ninety-three patients with diabetes mellitus who underwent cataract surgery between July 2013 and July 2014 in Anyang Eye Hospital were divided into two groups.The experimental group (n=45) had preventative capsulotomy during operation,while the control group (n=48) had no preventative capsulotomy.The degree of inflammation,the shape of anterior capsule,the diameter of the anterior capsule opening,the location of IOL,and the posterior capsule opacification were measured postoperatively until 6 months.Results There was no significant difference in the degree of inflammation between the two groups 1 day and 1 week after operation (P ＞0.05).The diameter of the anterior capsule opening was significantly greater in the experimental group than in the control group (P ＜0.01).No significant difference was found in the posterior capsule opacification (P ＞0.05).And no IOL decentration or tilt was found in all patients.Conclusions Preventative capsulotomy in cataract surgery is effective in preventing anterior capsule contraction in patients with diabetes mellitus.And it does not increase the posterior capsule opacification,or other incidence of complications.

目的 探讨超声乳化联合人工晶状体植入术中使用两种不同的单眼视设计治疗合并高度近视白内障患者的临床效果.方法 前瞻性非随机对照研究.选择2013年1月至2015年1月在我院行双侧超声乳化联合人工晶状体植入术的合并高度近视的白内障患者43例(86眼),根据不同的单眼视设计分成两组:A组非主导眼的目标屈光度为-1D;B组非主导眼的目标屈光度为-2D.随访至术后第3个月,记录双眼远、中、近距离视力,近立体视锐度,视觉质量评分,脱镜率及满意度评分.结果 术后第3个月,两组间的远、中距离视力差异均无统计学意义(均为P ＞0.05),B组的近视力优于A组(P＜0.01).两组间近立体视锐度差异无统计学意义(P＞0.05).两组的视远脱镜率均为100％,视近脱镜率分别为55％(A组)和87％(B组).两组的视觉质量评价和满意度均达到了较好的水平,组间差异无统计学意义(P＞0.05).结论-1D和-2D两种不同的人工晶状体眼单眼视设计,应用在合并高度近视的白内障患者中,都可以获得良好的临床效果,我们应当根据患者情况进行个性化选择.

目的探讨无囊膜支持的无晶状体眼的二期人工晶状体睫状沟缝线固定术的临床疗效。方法回顾性分析15例(16眼)的无后囊膜支持的无晶状体选择人工晶状体睫状沟缝线固定术的治疗情况,对手术方式、特点、效果、并发症及远期随访情况进行分析。结果二期人工晶状体睫状沟缝线固定术术后视力0.1～0.3者4眼,0.3～1.0者12眼,术后视力达到或优于术前最佳矫正视力者14眼,长期随访未发现严重并发症的发生。结论二期人工晶状体睫状沟缝线固定术是处理后囊膜缺失或缺如的无晶状体眼的一种有效可靠的手术方式。

目的:探讨青光眼滤过术后白内障患者的手术方法。方法:对120例(130眼)青光眼小梁切除术后有滤过功能的白内障患者施行表面麻醉、透明角膜切口白内障超声乳化联合人工晶体植入手术。结果:术后视力1.0以上者12眼,0.5~1.0者48眼,0.3~0.5者29眼,0.1~0.3者20眼,低于0.1者11眼。平均眼压14.57 mmHg,功能性滤过泡未见明显瘢痕。结论:对青光眼滤过术后白内障患者行透明角膜切口、白内障超声乳化摘除,联合人工晶体植入术可显著提高视力、避免医源性损伤对滤过和眼压的影响及恢复眼前节组织结构。

AIM: To explore the effect of phacoemulsification (PHACO) combined with trabeculectomy. METHODS: PHACO combined with trabeculectomy under sclera tunnel incisions were performed in 102 eyes. RESULTS: During the 2-16 months of follow-up, the average IOP changed from presurgical 24.82 mmHg(1mmHg=0.133kPa) to 16.52 mmHg. Aqueous humor fluency coefficients were 0.30. 81.5% cases has functional follicle. Visual acuity over 0.3 was achieved in 79.4% patients. CONCLUSION: PHACO combined with trabeculectomy under sclera tunnel incisions can achieved better visual acuity, IOP control and reduce medicine cost.