ABSTRACT
AIM: To evaluate the refractive outcomes after intrascleral fixation of posterior intraocular lens(IOL).METHODS: Retrospective clinical study. A total of 55 patients(55 eyes)who had undergone intrascleral fixation of posterior IOL in Peking University International Hospital from March 2017 to December 2021 were enrolled. Patients were assigned to conventional group(35 eyes)and modified group(20 eyes)according to different surgical procedures. IOL Master combined with SRK/T formula were applied to calculate the diopter of IOL and the residual refractive power, as well as acquiring preoperative values of corneal astigmatism. Optometry, IOL Master and Pentacam were performed 1 and 3mo postoperatively to obtain the postoperative corneal astigmatism, total ocular astigmatism and spherical equivalent which was calculated as the actual diopter. The Image-pro plus analyzer was used to measure the values of IOL tilt and decentration.RESULTS: The 55 eyes that underwent intrascleral fixation of posterior IOL presented hyperopic shift in refraction after operation and the refractive error was 0.75±0.63D at 3mo postoperatively. There was significant difference between the actual diopter and the residual diopter at 3mo after operation(t=2.553, P=0.011). Both conventional group and modified group showed hyperopic shift postoperatively. The refractive error at 1 and 3mo after operation were 0.80±0.43 and 0.84±0.46D in the conventional group and 0.43±0.39 and 0.47±0.26D in the modified group respectively, with significant differences between two groups(1mo: t=3.500, P=0.001; 3mo: t=3.311, P=0.002). There was no significant difference in corneal astigmatism between two groups both at 1 and 3mo postoperatively(all P<0.05). Total ocular astigmatism in the modified group was significantly lower than that in the conventional group(1mo: t=3.884, P<0.001; 3mo: t=3.314, P=0.002). In addition, IOL tilt and decentration in the modified group were significantly less than that in the conventional group at 1 and 3mo postoperatively(all P<0.05). No significant difference was found in IOL tilt and decentration for intra-group comparison at 1 and 3mo postoperatively(P<0.05). Complications of 55 eyes included 2 eyes of transient intraocular pressure elevation, 2 eyes of transient hypotony which recovered after topical medication and 1 eye of vitreous hemorrhage which resolved spontaneously.CONCLUSION: Intrascleral fixation of posterior IOL is proved to be a safe and effective surgical technique, with hyperopic shift easily present after operation. Increasing the refractive power of IOL and targeting mild myopia during IOL power calculation can prevent postoperative hyperopia, but long-term outcomes still need further observation.
ABSTRACT
<p><b>BACKGROUND</b>Interferon-gamma release assay (IGRA) has been used in latent tuberculosis (TB) infection and TB diagnosis, but the results from different high TB-endemic countries are different. The aim of this study was to investigate the value of IGRA in the diagnosis of active pulmonary TB (PTB) in China.</p><p><b>METHODS</b>We conducted a large-scale retrospective multicenter investigation to further evaluate the role of IGRA in the diagnosis of active PTB in high TB-epidemic populations and the factors affecting the performance of the assay. All patients who underwent valid T-SPOT.TB assays from December 2012 to November 2015 in six large-scale specialized TB hospitals in China and met the study criteria were retrospectively evaluated. Patients were divided into three groups: Group 1, sputum culture-positive PTB patients, confirmed by positive Mycobacterium tuberculosis sputum culture; Group 2, sputum culture-negative PTB patients; and Group 3, non-TB respiratory diseases. The medical records of all patients were collected. Chi-square tests and Fisher's exact test were used to compare categorical data. Multivariable logistic analyses were performed to evaluate the relationship between the results of T-SPOT in TB patients and other factors.</p><p><b>RESULTS</b>A total of 3082 patients for whom complete information was available were included in the investigation, including 905 sputum culture-positive PTB cases, 914 sputum culture-negative PTB cases, and 1263 non-TB respiratory disease cases. The positive rate of T-SPOT.TB was 93.3% in the culture-positive PTB group and 86.1% in the culture-negative PTB group. In the non-PTB group, the positive rate of T-SPOT.TB was 43.6%. The positive rate of T-SPOT.TB in the culture-positive PTB group was significantly higher than that in the culture-negative PTB group (χ2 = 25.118, P < 0.01), which in turn was significantly higher than that in the non-TB group (χ2 = 566.116, P < 0.01). The overall results were as follows: sensitivity, 89.7%; specificity, 56.37%; positive predictive value, 74.75%; negative predictive value, 79.11%; and accuracy, 76.02%.</p><p><b>CONCLUSIONS</b>High false-positive rates of T-SPOT.TB assays in the non-TB group limit the usefulness as a single test to diagnose active TB in China. We highly recommend that IGRAs not be used for the diagnosis of active TB in high-burden TB settings.</p>