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Objective@#To compare the effects of femtosecond laser-assisted phacoemusification and microincision phacoemusification on ocular surface.@*Methods@#A nonrandomized comparative cohort study was designed.The study recruited 116 eyes of 116 patients with age-related cataract in Hankou Aier Eye Hospital from January to March 2018.Consecutive patients were divided into femtosecond laser-assisted phacoemulsification group (femtosecond laser group for short) (55 eyes) and microincision phacoemulsification group (microincision group for short) (61 eyes). The ocular surface disease index(OSDI), break-up time of tear film (BUT), corneal flurescein staining, Schirmer Ⅰ test (SⅠt) and goblet cell density were sequentially evaluated preoperatively and postoperatively at 1 week and 1 month.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering study cohort.This study protocol was approved by Ethic Committee of Hankou Aier Eye Hospital (No.2017IRB01).@*Results@#At 1 day after surgery, the best corrected distance visual acuity (BCDVA) (LogMAR visual acuity) was 0.14(0.10, 0.24) and 0.20 (0.17, 0.27), respectively in the femtosecond laser group and the microincision group.BCDVA in the femtosecond laser group was better than that in the microincision group, with a significant difference between them(U=-3.140, P=0.002). Compared with the microincision group, the operation time was longer, the phaco time was shorter, the cumulative dissipated energy was lower, and the balanced salt solution perfusion volume was less in the femtosecond laser group, with significant differences between them (all at P<0.001). Compared with the pre-operation, the mean OSDI socres, BUT and goblet cell density were significantly decreased, and the fluorescein staining scores were significantly increased at 7 days and 30 days after surgery in the femtosecond laser group and the microincision group, with significant differences between them (all at P<0.05). The SⅠt value fluctuations in the two groups were small at different time points before and after operation, and the overall comparative differences between the two groups and different time points had no statistical significances (Fgroup=0.510, P=0.477; Ftime=0.741, P=0.479).@*Conclusions@#Compared with microincision phacoemusification, patients who had femtosecond laser-assisted phacoemusification have more severe ocular surface staining, shorter tear film time and more reduction of goblet cell count at the early stage.
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Objective@#To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes.@*Methods@#A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation.@*Results@#Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73.602, P<0.001; Ftime=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001).@*Conclusions@#Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.
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Objective To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods A non-randomized control study was carried out. Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center. The patients were divided into 2 groups based on the different surgeries. Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5. 3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform. Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5. 3 mm continuous circular capsulorhexis under the guidance of Alcon VERION. Anterior capsule opacification (ACO) was graded according to Werner's method. The area of anterior capsular opening was calculated by using Image Pro Plus 6 software. The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month,3 months and 6 months after operation. Results Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0. 003,P=0. 958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73. 602, P<0. 001;Ftime=378. 895,P<0. 001),and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation ( all at P<0. 001 ) . At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes ( 67. 4％) in the femtosecond laser group and 26 eyes ( 61. 9％) in the conventional phacoemulsification group,and there was no significant difference between two groups (P=0. 133). At 3 months after surgery,the incidence rate of gradeⅡof ACO was 11. 6％ (5/43) in the femtosecond laser group,which was lower than than that in the conventional phacoemulsification group ( 66. 7％, 28/42 ) , showing a significant difference between them (P<0. 001). At the 6th month after operation,the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14. 0％(6/43),which was lower than that in the conventional phacoemulsification group (73. 8％,31/42),with a significant difference between them (P<0. 001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule.
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Objective To compare the changes of tear film and corneal sensitivity between femtosecond laser-assisted cataract surgery and microincisional phacoemulsification surgery.Methods A prospective cohort study was performed.Fifty-three eyes of 53 patients with age-related cataract were included in Wuhan Aier Eye Hospital from March to July 2015.The patients were divided into femtosecond laser group and microincisional group.The 26 eyes in the femtosecond laser group received femtosecond laser-assisted cataract surgery,and 27 eyes in the microincisional group received 2.2 mm microincisional phacoemulsification surgery.The patients were followed-up for 3 months.The data of corneal sensitivity,Schirmer test values,non-invasive tear film break-up time (NIBUT) and subjective score for dryness were collected in 7 days,1 month and 3 months after surgery,and these results were compared between the two groups.This study was approved by Ethic Committee of Wuhan Aier Ophthalmology Hospital,and written informed consent was obtained from each patient prior to surgery.Results The operations were finished smoothly in all the eyes.In preoperative and 7 days,1 month,3 months after operation,the upper corneal sensitivity threshold and NIBUT between the two groups appeared a first reduction and a subsequent rise,the same phenomenon occurred in Schirmer test of the microincisional group and the subjective scores for dryness of the femtosecond laser group with statistically significant differences in the overall comparison (all at P＜ 0.05).No significant differences were seen in the central corneal sensitivity of the two groups and Schirmer test in the femtosecond laser group (all at P＞0.05).The dry eye scores increased gradually with the time expand after operation in the microincisional group,the difference was statistically significant (P＜0.05).In postoperative 3 months,these parameters were restored preoperative values.However,the dry eye scores in the microincisional group were still higher than that before operation,and the difference was statistically significant (P＜0.05).Conclusions Compared with the 2.2 mm microincisional phacoemulsification surgery,femtosecond laser-assisted cataract surgery brings less disturbance to lacrimal secretion,slight symptoms of dry eye and more comfortable sensation.
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Background The instability of tear film in dry eye often affects the visual quality after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).The prediction for visual quality following FS-LASIK was difficult in the past because of the limiting of examination method.OQAS-Ⅱ is a quantitative checking system of visual quality,which is helpful for the evaluation of the relationship between tear stability and visual quality following FS-LASIK.Objective This study was to investigate the predicting effects of the quality of tear film on visual quality after LASIK.Methods A prospective cohort study was performed.One hundred and twenty eyes of 120 myopic patients who wanted to receive FS-LASIK were enrolled in Nanjing First Hospital from August to December 2015 after informed consent.The objective scattering index (OSI) was 1.2 in the patients.The patients were divided into mild dry eye group (71 eyes) and non-dry eye group (49 eyes) based on the Expert Consensus on Clinical Diagnosis and Treatment of Dry Eye(2013).FS-LASIK was performed in the non-dry eye group,and 0.1％ sodium hyaluronate eye drops was topically administered for 1 month firstly and then the operation was carried out in the same way in the mild dry eye group.Slit lamp microscope,uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical equivalent (SE) were examined,and the safety index and availability index were assessed.OQASTM Ⅱ analysis system was employed for the defection of Schirmer Ⅰ test (S Ⅰ t),breakup time of tear film (BUT),modulation transfer function cut-off frequency (MTF cut off) and mean OSI before and after surgery.Results The safety index was 1.05 ±0.11 and 1.03 ±0.09,and the availability index was 1.02±0.14 and 1.01 ± 0.12 in the non-dry eye group and mild dry eye group,respectively,showing significant differences between the two groups (t =0.391,0.147,both at P＞0.05).The BUT was evidently shortened 1 month and 3 months after surgery in comparison with before surgery in both non-dry eye group and mild dry eye group,and BUT in the mild dry eye group was shorter than that in the non-dry eye group in postoperative 3 months,with a significant differences between them (P＜0.05).The mean OSI was increased and MTF cutoff was reduced 1 month,3 months and 6 months after surgery in comparison with before surgery in both mild dry eye group and none-dry eye group,and mean OSI was higher and MTF cutoff was lower in the mild dry eye group than that in the non-dry eye group,with significant differences between them (all at P＜0.05).In postoperative 12 months,BUT,mean OSI and MTF cutoff were near normal in both groups.Conclusions FS-LASIK can improve objective visual quality,and preoperative tear film quality is associated with objective visual quality after FS-LASIK.The unstable tear film affects visual quality after FS-LASIK.OQASTM Ⅱ system can diagnose and monitor tear change of dry eyes,which is helpful for the screening of indicator of FS-LASIK and rational prediction of postoperative visual quality.
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Corneal astigmatism in patients with cataract is very common,but it could not be accurately corrected during previous cataract surgery,which usually affects the visual quality seriously.The accurate measurement of corneal astigmatism power and meridian before surgery is key to the effective correction of astigmatism during the cataract surgery by either the determination of astigmatic keratotomies or the selection and implantation of toric intraocular lenses (IOL).The combination of IOL Master for sphere,the Pentacam for the total corneal refractive power and VERION Digital Marker for surgical orientation can provide promising refractive examination,treatment and good postoperative outcomes.Preexsisting astigmatism can be corrected during cataract surgery by modifying incision,performing arcuate keratotomy,or implanting a toric IOL.Femtosecond laser arcuate keratotomy combined with phacoemulsification is an effective,safe and precise method for the correction of low to moderate corneal astigmatism power,and it can improve visual acuity in cataract surgery candidates.Further work is required to establish corneal biomechanics numerical simulation and nomography protocol for cataract refractive surgery so as to improve the predictability and accuracy of femtosecond laser-assisted astigmatic keratotomy during refractive cataract surgery.
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Diabetic macular edema (DME) is the most common reason for visual impairment in diabetic eye diseases.DME is easy to relapse and the treatment outcome is beyond satisfied.Anti-vascular endothelial growth factor (anti-VEGF) therapy has been proposed to be a first-line or key treatment regimen in the management guideline for DME.However,in clinical practice,there still are many ambiguous and controversial views in the choice and implement of different managing paradigms,including the therapeutical goal,the assessment of treatment effectiveness,the explanation of the guidelines,the regimen of anti-VEGF therapy,the value evaluation of laser photocoagulation,the use of steroids and the management of recurrent DME.Recently,the researches of treating drugs for DME are developing and making a great progress,so eye doctors should track the research results,improve the therapeutical regimen,fully understand the advantages and disadvantages of different treating methods and standardize the treatment process in order to release the best treatment effects on DME.