Objective To observe the effect of the treatment of neodymium-yttrium aluminum garne (Nd:YAG) vitreolysis for the anterior vitreous opacity after implantation of intraocular lens.Methods Forty-nine eyes of 47 patients with the anterior vitreous opacity after implantation of intraocular lens received the slitlamp examination, optical coherence tomography (OCT), and B-scan. The anterior vitreolysis and posterior capsulotomy were performed simultaneously with Nd :YAG laser. The outcomes of visual acuitiy changes and complications were studied.Results In 49 eyes, 46 had anterior vitreous opacity associated with posterior capsule opacification, and the other 3 without obvious posterior capsule opacification. In all patients, the visual acuity improved significantly without any complications after the laser procedure (t=32.50, P=0.007). After Nd:YAG laser treatmen, transparent area was found in anterior opaque vitreous in 21 eyes (42.86%) within 15 minutes, and in 47 eyes (95.92%) within 24 hours. No complication occured in or after the operation.Conclusions In the patients with visual deterioration after implantation of intraocular lens, the prescence of anterior vitreous opacity should be concerned. Opening the opaque anterior vitreous with Nd:YAG vitreolysis is effective for the patients with the anterior vitreous opacity after implantation of intraocular lens.(Chin J Ocul Fundus Dis，2003，19：106-108)
Objective To evaluate the effect of optimizing the management measures of cataract ambulatory surgery. Methods The patients who underwent cataract phacoemulsification combined with intraocular lens implantation in the Ambulatory Surgery Center of East District of Beijing Tongren Hospital affiliated to Capital Medical University were selected. Patients between January and December 2021 (after the optimization of ambulatory surgery process) were included, and patients between January and December 2020 (before the optimization of ambulatory surgery process) were included as control. The three factors of age, gender and surgical eye type were used as predictive variables for propensity score matching. The proportion of patients who completed the surgery according to the scheduled time, the proportion of eye drops used according to the doctor’s instructions and the number of hospital visits before and after the optimization of the ambulatory surgery process were compared with the patients who successfully matched. Results A total of 28306 patients were included, including 13284 before and 15022 after process optimization. There were 13467 males and 14839 females, with a median age of 70 (60, 78) years. There was no statistically significant difference in the age of patients before the process optimization (P>0.05), but there was statistically significant difference in gender and surgical eye (P<0.05). After the propensity score matching, a total of 12932 pairs of patients were matched successfully. After the propensity score matching, there was no statistically significant difference between the two groups in age, gender and surgical eye (P>0.05). After the process optimization, the proportion of patients who completed surgery on schedule (98.8% vs. 93.3%) and used eyedrops according to the doctor’s instructions (97.4% vs. 93.0%) were higher than that before the process optimization, and the proportion of patients who came to hospital more than 3 times (0.7% vs. 1.9%) was lower than that before the process optimization (P<0.05). Conclusion The optimized ambulatory surgery process can help patients complete the surgery according to the scheduled time and use eye medication according to the doctor’s instructions, and can reduce the number of patients coming to the hospital.
Objectives To systematic review the safety of routine preoperative testings versus selectivepreoperative testings for cataract surgery. Methods We searched the Cochrane Central Register of Controlled Trials-Central (which contains the Cochrane Eyes and Vision Group Trials Register) in the Cochrane Library (Issue 3, 2008), MEDLINE (1966 to Oct. 2008), EMBASE (1980 to Oct. 2008), CMB-disk (1979 to Oct. 2008). We also hand-searched related journals. All the search was restricted in English and Chinese. Methodological quality of randomized controlled trials (RCTs) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan 5.0 software was used for data management and analysis. Obtained evidence the safety of routine preoperative testings versus selective preoperative testings.Result Four RCTs involving 20 490 participants required cataract surgery were included by total retrieve and riddling. The result of metaanalysis showed that there was no significant difference between the two groups in the rates of intraoperative systemic events [RR=1.05, 95%CI (0.89, 1.24), P=0.59], postoperative systemic events [RR=0.97, 95%CI (0.80, 1.18), P=0.77], intraoperative ocular events [RR=0.99, 95%CI (0.74, 1.33), P=0.97] and postoperative ocular events [RR=1.11, 95%CI (0.76, 1.60), P=0.59]. Conclusion To compare routine preoperative testings group with selective preoperative testings group, there was no significant difference in the rates of intraoperative systemic events, postoperative systemic events, intraoperative ocular events and postoperative ocular events. However the application of the results to the patients with incapacitating systemic diseases needs further study.
Objective To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract. Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration. Results A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(Plt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (Plt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, Plt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, Plt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.
ObjectiveTo observe the changes of macula in patients with high myopia after phacoemulsification. MethodsIn 20 patients with high myopia with ocular axial length≥27 mm, optical coherence tomography (OCT) was performed on the operative and contralateral eyes 1 week before and after monocular phacoemulsification, respectively, and the OCT images of macula of the operative eyes were observed and compared.ResultsOne week before and after phacoemulsification, the mean macular fovea thickness of the patients with high myopia was (131.6±16.37) μm and (189.75±45.69) μm, respectively, with a significant difference (t=2.805, P=0.01). Simultaneously, the mean macular fovea thickness of the contralateral eyes was (133.5±15.12) μm and (133.5±14.63) μm, respectively, with a non-significant difference (t=1.367, P=0.853). In 20 operative eyes 1 week after phacoemulsification, 3 had vitreous strand around the macula with retinal thickening, 1 had retinoschisis in macular area, and 2 had obvious retinal thickening with slight retinal edema.ConclusionRetinal thickening occurs in the patients with high myopia after phacoemulsification. Traction of retina by vitreous strand or subclinical retinoschisis may occur in some patients.(Chin J Ocul Fundus Dis, 2005,21:90-92)
ObjectiveTo observe the application value with color Doppler flow imaging (CDFI) in the detection of macular diseases in senile cataract.MethodsA cross-sectional descriptive study. From December 1 to December 30, 2017, 720 senile cataract patients (1380 eyes) diagnosed in Beijing Tongren Eye Center were included in this study. There were 330 males (629 eyes) and 390 females (751 eyes), with the mean age of 70.35±19.05 years. There were 716 right eyes and 664 left eyes, with the visual acuity 0.05-0.8. The fundus of all the patients can be observed. All patients were examined by OCT using Cirrus HD-Model 5000 produced by German Carl Zeiss company and CDFI using MyLab90 color Doppler ultrasound system produced by ESAOTE S.P.A. Comparing the detection rate of macular lesions between the two methods by using χ2 test. Using statistical methods to evaluate diagnostic tests, a crosstabulation was made to compare the consistency of frequency-domain OCT and CDFI in the diagnosis of macular lesions. Logistic regression analysis of correlation between detection of CDFI macular lesions and central foveal thickness (CFT), average thickness (AT), with or without macular anterior membrane, retinal folds, retinal cystoid edema, hard exudation, macular hole or lamellar macular hole, superficial detachment of neuroepithelium, detachment of pigment epithelium, vitreous macular traction.ResultsTwo hundreds and thirty-nine eyes (17.3%) showed macular disease by OCT, and 161 eyes (11.7%) showed the abnormal echo in the macular region by CDFI. The detection rate of the macular disease between two methods were statistically significant (χ2=851.661, P＜0.001), however, the consistency was well (κ=0.766, P=0.000). Logistic analysis showed that the detection rate of macular lesions was related to retinal folds, cysts in retina and CFT (r=1.396, 1.041, 0.12; P＜0.01).ConclusionCDFI can effectively detect macular lesions that affect the visual prognosis of senile cataract patients.
ObjectiveTo evaluate the efficacy and safety of phacoemulsification cataract extraction combined with 180° trabeculotomy assisted by gonioscopy (GT) and combined glaucoma filtration surgery (GFS) in the treatment of primary open angle glaucoma (POAG) with cataract. MethodsThe patients with POAG and cataract in the ophthalmology center of the People’s Hospital of Leshan from June 2021 to March 2022 were included. The patients were divided into GT group and GFS group according to surgical methods. Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR, number of anti-glaucoma drugs used, success rate, and complications were compared between the two groups after 1-year followed-up. ResultsA total of 27 patients (43 eyes) in the GT group and 26 patients (34 eyes) in the GFS group were included. There was no significant difference in baseline between the two groups (P>0.05). BCVA logMAR in the GT group was lower than that in the GFS group at 1 year after surgery, the difference was statistically significant (P<0.01). The postoperative IOP in GT group was lower than that in GFS group, the difference was statistically significant (P<0.05). The difference in total effective rate, the number of anti-glaucoma drugs and the incidence of complications between the two groups were not statistically significant (P>0.05). ConclusionPhacoemulsification cataract extraction combined with GT is safe and effective in the treatment of POAG with cataract and has a good effect on reducing IOP.
Cataract combined with retinopathy can seriously affect the vision of patients. Vitrectomy combined with one-stage implantation of multi-focal intraocular lens (MIOL) has been paid more and more attention. The application of MIOL shows potential in improving the visual quality of patients, but its effect is affected by many factors, and refractive drift is a key problem to be solved. At present, the research mainly focuses on cataract patients with high myopia, and further research on other types of retinopathy is needed. In the future, multi-center, large-sample, long-term clinical studies and interdisciplinary cooperation are needed to optimize surgical and management programs to enhance the application effect of MIOL in the treatment of retinopathy and improve the quality of life of patients.
Purpose
To explore the characteristics of eyes after congenital cataract surgery and to evaluate the methods of different retinal detachment surgery in those eyes．
Method
We retrospeetively reviewed the cli ncal data of 44 eyes with rhegmatogenous retinal detachment (RRD) after congenital cataract surgery,and compared the surgical results between scleral buckling and vitrectomy in those eyes．The mean interval between the congenital cataract surgery and RRD of the affectde eyes was 14．8 years and most of the techniques of cataract surgery was irrigation-aspiration and capsulotomy was performed in nearly all eyes． The mean axis length in 16 eyes was （26.8plusmn;1.90） mm．
Results
The success rate was 80．3% in scleral buckling and 85．7% in vitrectomy．
Conclusion
There is a long interval between congenital cataract surgery and RD．The pupil of these eyes is often small and immobile,causing diffculty in visualizing the peripheral retina ,decreasing the success rate of scleral buckling operation．Vitrectomy is an ideal chocie for such eyes．
(Chin J Ocul Fundus Dis，2000，16：71-138)
ObjectiveTo observe the clinical manifestations of a Wagner syndrome (WS) family. MethodsA retrospective clinical study. Four patients (the proband, his father, sister, and brother) and one family member (the proband's mother) from a WS family diagnosed by clinical examination in Chengdu Aidi Eye Hospital in June 2023 were included in the study. The proband's medical history was examined in detail, followed by best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), and OCT angiography (OCTA). The proband underwent full field electroretinogram (ERG) examination. The proband and his sister and brother underwent blood glucose, blood pressure, hearing, face, joint, exercise and general physical examination at the same time. Peripheral venous blood was collected from the proband and 4 other family members. The proband extracts genomic DNA samples, conducts target region capture, library construction and high-throughput sequencing after qualified quality control. The suspected pathogenic mutation sites were verified by Sanger. According to the selected mutation sites, other family members in this family were co-isolated and verified. The pathogenicity of the mutation site was analyzed using the guidelines of the American College of Medical Genetics and Genomics (ACMG). ResultsProband (Ⅱ-1) was 23 years old female. Both eyes BCVA were 0.1. The waveforms of ERG in both eyes were basically normal, and some amplitudes were reduced. Sister of the proband (Ⅱ-2) was 20 years old. Both eyes BCVA 1.0. Fundus examination showed no obvious abnormality. Brother of the proband (Ⅱ-3) was 19 years old. The left eye underwent pars plana vitrectomy combined with silicone oil filling 2 years ago due to retinal detachment and severe vitreous hyperplasia. BCVA light sensitivity, complicated cataract, and fundus opacity were observed. Right eye BCVA was 0.1. The lenses of the proband and his younger sister and brother were pointed and wedged, and the younger brother was heavier. Vitreous cavity of lens. The retina color of both eyes and the right eye of the younger brother of the protor was dark, with flaky dark areas on the side of the nose and the posterior pole, and the symmetrical retinal veil membrane hyperplasia and pulling on the periphery, showing small retinal splits. The choroidal retina showed focal and segmental symmetrically large atrophy. The optic disc was tilted. By OCT examination, the ellipsoid band was partially missing and broken, and the thickness of the choroid layer was reduced. Retinal cortical atrophy in 1 eye (younger brother of proband). By OCTA examination, the mesovascular layer of choroid was atrophied seriously and the blood density decreased. The results of laboratory and general examination of the three siblings showed no obvious abnormalities. The results of genetic testing showed that the proband, his father (Ⅱ-1), his sister and his brother carried a heterozygous mutation of the VCAN gene c.9264A>G (p.Pro3088=). According to ACMG guidelines, the pathogenicity of this variant was unknown. The mother of proband (Ⅰ-2) was wild type. ConclusionsThe abnormal manifestations of WS eyes are diverse, and both anterior and posterior segments could be involved. The pathogenicity of the heterozygous variation of VCAN gene c.9264A>G (P.RO3088 =) in this family is unknown.
