目的:评价外光源辅助角膜标记法在Toric人工晶状体植入术中的临床应用效果.方法:选取2017年1月-2019年12月入住海南省眼科医院的非成熟期白内障合并规则角膜散光患者75例进行回顾性研究.根据角膜标记方法不同分为两组,A组36眼为外光源辅助角膜标记组,B组39眼为传统角膜标记组.所有患者均接受白内障超声乳化摘除联合散光矫正型人工晶状体植入术,术后3月,检查患者裸眼远视力(UCDVA)及最佳矫正远视力(BCDVA),综合验光查散光,Itrace查全眼散光及低阶像差,以及人工晶状体轴位旋转度数.结果:术后3月,两组最佳矫正远视力比较,差异无统计学意义(P＞0.05);A组裸眼远视力优于B组,差异有统计学意义(P＜0.05);A组术后残余散光及像差明显低于B组,差异有统计学意义(P＜0.05);A组人工晶状体轴位平均旋转(2.10±1.42)°,B组人工晶状体轴位平均旋转(2.57±1.13)°,差异无统计学意义(P＞0.05).结论:对非成熟期白内障患者施行Toric人工晶状体植入术时,外光源辅助角膜标记法具有更好的准确性和易操作性.

目的 评估上下方角膜缘干细胞移植术对翼状胬肉切除术后泪膜的不同影响.方法 将2015年1月至2018年1月我院翼状胬肉住院患者200例(231眼)随机分为A组(92例,行翼状胬肉切除联合上方角膜缘移植术)和B组(108例,行翼状胬肉切除联合下方角膜缘移植术).分别于术前1 d、术后1个月、3个月行干眼主观症状问卷评分(SDES)和角膜荧光素染色评分(SCSF),利用Oculus Keratograph眼表综合分析仪测定非侵入性泪膜破裂时间(NIBUT)和泪河高度(TMH).采用随机区组设计的方差分析对数据进行统计学分析.结果 术后1个月时,与A组相比,B组SDES增高,BUT缩短,TMH变低,SCSF增高,差异均有统计学意义(均P<0.05),术后3个月时,2组以上指标均无统计学差异.结论 翼状胬肉切除术后早期,下方角膜缘移植术对眼表的影响明显大于上方角膜缘移植术,3个月后2种手术方式对眼表的影响无明显差异.

AIM: To investigate the corneal biomechanical parameters alteration after phacoemulsitication with 2.4mm corneal incision within 1mo by Corvist ST.METHODS: A self control study was performed. Twenty-eight age related cataract patients(56 eyes), who were in accordance with the inclusion criteria, received phacoemulsification with 2.4mm corneal incision from March to September in 2019. Corneal biomechanical parameters were measured preoperatively and postoperatively on 3d, 6d and 30d by Corvis ST.RESULTS: The first applanation length(A1L), the second applanation time(A2T)and corneal thickness(CCT)were significantly different between preoperation and postoperation(F=10.534, 11.655, 14.734; all P<0.05). The value of A1L on 3d postoperative was significantly increased than that on the day before operation, 6d and 30d postoperative, while the A2T value was significantly reduced(P<0.05). But there was no different in A2L and A2T between preoperation and 6d postoperative(P>0.05). The value of central corneal thickness(CCT)was significantly increased on 3d and 6d postoperative compared with the preoperative parameter(P<0.05). The value of CCT got the maximum value on the 3d after surgery, and recovered to the preoperative level on the 30d after surgery. CONCLUSION: Phacoemulsitication with 2.4mm corneal incision change the corneal biomechanical preoperties. The corneal biomechanical parameters are basically recovered in the 30d postoperative.

AIM: To compare the short-term impacts of femtosecond lenticule extraction (FLEx) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on ocular surface measures and tear inflammatory mediators. METHODS: This prospective comparative nonrandomized clinical study comprised 75 eyes (75 patients). Totally 20 male and 15 female patients (age 21.62±3.25y) with 35 eyes underwent FLEx, and 26 male and 14 female patients (age 20.18±3.59y) with 40 eyes underwent FS-LASIK. Central corneal sensitivity, noninvasive tear breakup time, corneal fluorescein staining, Schirmer I test, tear meniscus height, and ocular surface disease index were evaluated in all patients. Tear concentrations of nerve growth factor (NGF), interleukin-1α (IL-1α), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and matrix metalloproteinase-9 (MMP-9) were assessed by multiplex antibody microarray. All measurements were performed preoperatively, and 1d, 1wk, and 1mo postoperatively. RESULTS: Patients who underwent FLEx exhibited a more moderate reduction in central corneal sensation and less corneal fluorescein staining than those in the FS-LASIK group 1wk after the procedure (P<0.01). NGF was significantly higher 1d and 1wk after surgery in the FS-LASIK group than in the FLEx group (P<0.01). By contrast, compared to those in the FLEx group, higher postoperative values and slower recovery of tear TGF-β1, IL-1α, and TNF-α concentrations were observed in the FS-LASIK group (P<0.01). Tear concentrations of NGF, TGF-β1, TNF-α, and IL-1α were correlated with ocular surface changes after FLEx or FS-LASIK surgery. CONCLUSION: There is less early ocular surface disruption and a reduced inflammatory response after FLEx than after FS-LASIK. NGF, TGF-β1, TNF-α, and IL-1α may contribute to the process of ocular surface recovery.

Objective To evaluate the corneal biomechanical parameters in myopic, hypermetropic and emmetropic eyes using corneal visualization Scheimpflug technology (CorVis ST). Methods A total of 123 children having 191 myopic, hypermetropic and emmetropic eyes admitted to our hospital from August 2019 to January 2020 were enrolled in this study. Corneal biomechanical parameters, axial length (AL) and corneal curvature were measured using CorVis ST and Lenstar 900 respectively. Univariate linear correlation analysis and multivariate linear regression analysis were used to assess the impacts of age, spherical equivalent (SE), AL, central corneal thickness (CCT) and mean corneal curvature on corneal biomechanical parameters. Results Multivariate linear regression analysis indicated that SE was positively correlated with time at first applanation (A1T, P=0.004); AL was positively correlated with A1T (P=0.017) and radius of reverse curvature at the time of highest concavity (HCR, P=0.02), but negatively with deformation amplitude at second applanation (A2DA, P < 0.001); CCT was positively correlated with length at first applanation (A1L, P < 0.001), A1DA (P=0.005), time of highest concavity (P=0.004), but negatively with A1T (P=0.041). Conclusion The biomechanical parameters of children may be related with their refractive states. Higher myopic eyes tend to have lower corneal elasticity.

目的 探讨右美托咪定对老年白内障手术球后神经阻滞患者镇静效果的最佳维持剂量.方法 白内障手术的90例老年患者随机分为3组各30例.由同一位医生行球后神经阻滞麻醉,麻醉完毕10 min内,3组分别以0.2、0.4、0.6 μg·kg-1·h-1的速率静脉维持给予右美托咪定.记录并比较3组入室时(T0)、神经阻滞完毕即刻(T1)、用药后10 min(T2)、20 min(T3)、30 min(T4)、60 min(T5)时的心率(HR)、呼吸频率(BR)、平均动脉压(MAP)、Ramsay镇静评分(RSS)及口述评分法(VRS).评价并比较3组手术前后焦虑自评量表(SAS)评分及术后患者、医生满意度评分.结果 3组在T2~T5时间点时的RSS均明显大于T0时,HR水平均明显小于T0时,并且观察3组在T3~T5时间点时的RSS均明显大于观察1组和观察2组、HR水平均明显小于观察1组和观察2组(P<0.05);3组在各时间点时的VRS、BR、MAP比较差异均无统计学意义(P>0.05). 观察1组和观察2组的患者满意度均明显高于观察3组(P<0.05);3组术前SAS评分、术后SAS评分及医生满意度评分比较差异均无统计学意义(P>0.05).结论 右美托咪定对老年白内障手术球后神经阻滞患者镇静效果的最佳维持剂量为0.2~0.4 μg·kg-1·h-1.

AIM: To evaluate the efficacy and safety of autologous serum(AS) eye drops with 0.01g/L Thiomersal in the treatment of recalcitrant dry eye syndrome. METHODS: Twenty-six eyes of 13 patients with recalcitrant dry eye syndrome were enrolled in this self-control study, and treated with 2 months of AS 20% with 0.01g/L Thiomersal followed by 2 months of AS 50% with 0.01g/L Thiomersal. Tear membrane lever(TML), tear film break-up time (BUT), corneal fluorescein staining(FL), SchirmerⅠ test with topical anaesthesia(SⅠt), corneal sensitivity test and subjective symptom scoring were performed at entry, 2, 4, 8, 12 and 16 weeks. Statistical analysis was carried out using Wilcoxon's signed rank test. RESULTS: Both TML and subjective symptom scorning showed significant improvement after 2 weeks of treatment (P<0.01,P<0.05); after 4 weeks of treatment, BUT and FL were significant improvement(P<0.05); SⅠt and corneal sensitivity were significant increased after 8 weeks of treatment(P<0.01,P<0.05). No significant complications were reported in this study. CONCLUSION: AS eye drops 20% with 0.01g/L Thiomersal are effective and safe in treating refractory dry eye syndrome, and should be available as an alternative management option in developing countries. 