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 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.
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.
Objective To investigate the effects of phacoemulsification on macula in diabetics． Methods Thirty eyes of cataract in diabetics were chosen randomly for measurement of the thickness of fovea of retina using OCT before phacoemulsification and 1 month after surgery ． The other eyes in these patients and 30 eyes of cataract in nondiabetic pati ents with phacoemulsification were as control． Results In 30 eyes of diabetics with phacoemulsification, the mean fovea thickness were (148．5plusmn;27．7) mu;m preoperatively and (219．4plusmn;68．23) mu;m postoperatively, and the difference was significant (Plt;0．05)． In 30 eyes of diabetics without surgery, the mean foveal thickness were (147.4plusmn;27.5) mu;m preoperatively and (148.2plusmn;27.3) mu;m postoperatively and the difference was not significant (Pgt;0．05)． In 30 eyes of cataract in nondiabetic patients, the mean fovea thickness were (142．37plusmn;12．7) mu;m preoperatively and (151．9plusmn;23．7) mu;m postoperatively and the difference was not significant (Pgt;0．05)． In 30 eyes of diabetic s with phacoemulsification, 11 eyes had new macula edema after surgery and 3 eye s had significant retinal thickening． In 6 eyes with macular edema before surgery, the macular edema were aggravated in 3 eyes after surgery． The macular stru ctural changes were not found in two control groups． Conclusion The thickness of retina is inreased after phacoemulsification in deabetics,and morbidity and its severity of postopevative macular edema are increas ed as well． (Chin J Ocul Fundus Dis, 2001,17:175-177)
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)
ObjectiveTo use ultrasound biomicroscope (UBM) to observe the zonules in patients before cataract surgery and study the relation between the length of zonules and axial length (AL), so as to understand the underlying anatomical and pathological basis of factors influencing the stability of lens capsule in high axial myopic patients and provide objective theoretical references for surgical risk reduction and postoperative follow-up guidance. MethodsFifty-five patients (55 eyes) proposed to receive phacoemulsification between October 2014 and October 2015 were divided into group A (AL < 26 mm, n=21), group B (26 mm≤AL < 29 mm, n=14), and group C (AL≥29 mm, n=20) according to their AL.UBM examination was conducted preoperatively.Through measuring the length of zonules in supine position at 12, 3, 6, and 9 o'clock respectively, we compared the difference of the length of zonules among those three groups, and explored the correlation between the length of zonules and axial length. ResultsThe average length of zonules in group A was (0.67±0.13) mm, while that in group B and group C was (0.93±0.29) and (0.98±0.19) mm, respectively.The length of zonules in group A was shorter than that in group B and Group C, and the differences were statistically significant (P < 0.001);and that in group B was shorter than that in group C, but the difference was of no statistical significance (P=0.331).In the correlation analysis between axial length and the average length of zonules, the length of zonules was positively correlated with the axial length (r=0.502). ConclusionsUBM provides a quantitative method for observing zonules.In the assessment before cataract surgery, it is a more accurate method for evaluation of zonules, and probably has a certain value in pre-assessment of intra ocular lens dislocation after cataract surgery.
Objective To compare the efficacy and safety of pars plana vitrectomy (PPV) versus scleral buckling (SB) on rhegmatogenous retinal detachment (RRD) after cataract surgery. Methods A computerized search was conducted in the Cochrane Library, Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM) combined with manually searching of related literatures. Randomized controlled trials (RCT) comparing PPV with SB for RRD after cataract surgeries were collected. Best corrected visual acuity (BVCA), reattachment rate after primary surgery, final reattachment rate and complications between the two operations were compared. Results A total of four RCTs were included in this meta analysis, including 690 eyes of 690 patients (331 eyes in the PPV group, 359 eyes in the SB group). There was no difference in reattachment rates after primary surgery between two groups ［odds ratio (OR) =1.68; 95% confidence interval (CI), 0.81-3.49; P=0.16). Final reattachment rate were in favor of PPV (OR=1.97; 95% CI,1.04 -3.73;P=0.04). There was no significant difference in the proportion of BCVA at six months (weighted mean difference=0.06; 95%CI,-0.01- 0.14; P=0.11). PPV was associated with a significantly lower frequency of diplopia/extrocular muscle dysfunction than SB (OR=6.59; 95% CI1.16 - 37.27; P=0.03), whereas other complications, such as proliferative vitreoretinopathy, macular pucker, cystoid macular edema, and choroidal detachment did not differ statistically (P＞0.05). Conclusion Compared with SB, PPV is more likely to achieve a favorable final reattachment rate for RRD after cataract surgery, and with a lower rate of diplopia/extrocular muscle dysfunction.
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)
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.
Diabetic retinopathy (DR) is a common ocular complication in diabetic patients, which is chronic and progressive and seriously impairs visual acuity. The rapid occurrence and progress of cataract in diabetic patients is also one of the important reasons for visual impairment in DR patients. Compared with non-diabetic patients, diabetic patients have higher risk of complications after cataract surgery. Studies have shown that anti-vascular endothelial growth factor (VEGF) therapy after cataract surgery can prevent the aggravation of diabetic macular edema in DR patients. However, due to the lack of systematic review of the clinical effect of anti-VEGF drugs in DR patients undergoing cataract surgery, the use of anti-VEGF drugs is relatively conservative in clinic. It is believed that with the deepening of research and the progress of clinical trials, the wide application of anti-VEGF drugs in clinical practice is expected to provide more accurate and effective treatment for DR patients in the future.