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Objective To discuss the effects of capsular tension ring after phacoemulsification combined with IOL implantation on tilt and decentration of IOL in high myopia patients with cataract by ultrasonic biomicroscope (UBM).Methods A total of 36 cases (40 eyes) with high myopia and cataract underwent phacoemulsification combined with IOL implantation were chosen.The average axial length was 26.88 mm.The patients were divided into implant group (19 eyes,the capsular tension ring was implanted) and control group (21 eyes,the routine surgery was performed).The patients were examined by conventional slit lamp,and the best corrected visual acuity (BCVA)was measured at pre-operation and postoperative 6 months.Tilt and decentration were measured horizontally and vertically,and total tilt and decentration were calculated by geometry method.Results The postoperative BCVA in the two groups were all better than the pre-operation,there was no statistical difference in the preoperative and postoperative BCVA between two groups (all P ＞ 0.05).The horizontal,vertical and total decentration the implant group were (0.15 ± 0.07) mm,(0.30 ± 0.40) mm,(0.11 ±0.02)mm,respectively,which in the control group were (0.26 ± 0.19)mm,(0.32 ±0.60) mm,(0.24 ± 0.97) mm,respectively.The horizontal,vertical and total tilt in the implant group were 0.02° ±0.11°,0.70° ±0.25°,0.21° ±0.74°,respectively,which in the control group were 0.11 ° ± 0.31 °,1.09° ± 0.20°,1.24° ± 0.97°,respectively.There were statistical differences in the horizontal,total tilt and decentration between two groups (all P ＜ O.05),but no statistical difference in the vertical tilt and decentration (P ＞ 0.05).Conclusion The capsular tension ring can stable the IOL position after surgery in high myopia and cataract patients.
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Background The development and progression of myopic eyes is biomechanical and dominated by axial elongation.The biomechanics change of stretching of the fundus and sclera appears to reduce its thickness and elastic modulus,which make eyeballs more susceptible to the distending forces of intraocular pressure (IOP).Objective This study was to analyz the axial length (AL) and IOP changes in different degree of myopia and investigate the roles of IOP in myopia development and AL elongation.Methods A prospective cases-controlled study was performed under the informed consent of patients and custodian.Four hundred and twenty-eight eyes of 428 children aged 4-14 years were enrolled in Affilicated Second Hospital of Zhengzhou University from February to December 2014.The patients were divided into 4 groups based on the refractive status.Ninety-three eyes of 93 patients were in the hyperopic-emmetropia group with the spherical equivalent (SE) of (1.81±2.32) D,192 eyes of 192 patients were in mild myopia group with the SE of (-1.43±0.74)D,83 eyes of 83 patients were in the moderate myopia group with the SE of (-4.09±0.89) D and 60 eyes of 60 patients were in the high myopia group with the SE of (-8.02±2.61) D.AL was measured by IOL Master system,IOP was measured by iCare tomnometer,and the central corneal thickness (CCT) was measured by OCT.The corrected IOP was calculated based on IOPcorrection =IOPGAT+(544-CCT)/37.03.The correlations between IOP ion and AL or diopter were analyzed.Results The AL values were (22.44±1.32) mm,(23.89±1.09) mm,(25.05±0.89) mm and (26.47±1.20) mm in the hyperopic-emmetropia group,mild myopia group,moderate myopia group and the high myopia group,showing a significant difference among the four groups (F =177.336,P =0.000).The IOP ion values were (15.24 ±2.73) mmHg,(17.51 ±2.98) mmHg,(17.94 ±2.34) mmHg and (18.49 ± 2.90) mmHg in the hyperopic-emmetropia group,mild myopia group,moderate myopia group and the high myopia group,with a significant difference among the four groups (F =22.104,P =0.000).The IOP tion values were significantly lower in the hyperopic-emmetropia group than that in the mild myopia group,moderate myopia group and high myopia group (all at P＜0.05),and the mean IOP tion value in the high myopia group was significantly higher than that in the mild myopia group (P =0.018).The IOP tion was negatively correlated with diopter (r =-0.384,P＜0.01) and positively correlated with AL (r =0.377,P＜0.01).Conclusions As the increase of myopic diopter and elongation of AL,IOPcorrection is considerably elevated in childhood.IOP tion rising in childhood probably promotes the progression of myopia and elongation of AL.
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Background Phacoemulsification for hard nuclear cataract is easy to cause corneal edema and posterior capsular rupture.Researches determined that soft-shell technique phacoemulsification can effectively reduce corneal edema,but the risk of posterior capsular rupture during the surgery is still existed.Whether intra-capsular bag soft-shell technique can protect the posterior capsular of lens from rupture is still unclear.Objective This study was to observe the effect of intra-capsular bag soft-shell technique phacoemulsification on hard nuclear cataract.Methods A prospective cohort study was designed.One hundred and sixty-eight eyes of 160 patients with age-related cataract and Ⅳ-Ⅴ grade of nucleus were enrolled in Affiliated Second Hospital of Zhengzhou University from November 2013 to May 2015 under the approval of Ethic Commission and informed consent of the patients.The eyes were randomized into the intra-capsular soft-shell technique group and conventional soft-shell technique group with the matched age,gender and nuclear hardness in a manner of randomized block design.A 3.0 mm incision of cataract phacoemulsification with soft-shell technique in capsular bag was performed on 80 eyes of 78 patients in the intracapsular soft-shell technique group,and conventional soft-shell technique phacoemulsification was performed on 88 eyes of 82 patients in the conventional soft-shell technique group.Intraoperative records including the cumulative dissipated energy,effective phacoemulsification time and posterior capsular changes were recorded during the surgery.Postoperative follow-up indexes included corneal edema,endothelial cell density,BCVA and intraocular pressure changes.Results The mean cumulative dissipated energy and operation duration were (20.13 ± 8.34) ％ and (14.28-±2.17) minutes in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were (19.67±5.24)％ and (15.36±3.49) minutes,showing significant differences between them (t =0.216,P =0.376;t =0.403,P-=0.518).Posterior capsular rupture occurred in 1 eye in the intra-capsular softshell technique group and 7 eyes in the conventional soft-shell technique group.The percentages of eyes with BCVA ≥ 0.5 were 78％,83％ and 92％ in postoperative 1 day,1 week and 1 month in the intra-capsular soft-shell technique group,and those in the conventional soft-shell technique group were 56％,71％ and 89％,with a significant increase in postoperative 1 day,1 week in the intra-capsular soft-shell technique group (x2 =5.130,P =0.027;x2 =4.361,P =0.032).The corneal endothelial cell loss rates were 6.97％ and 7.19％ in the intra-capsular soft-shell technique group and conventional soft-shell technique group respectively in postoperative 3 months,with no significant difference between them (P＞0.05).The intraocular pressure was (20.16±4.23) mmHg (1 mmHg =0.133 kPa) in postoperative 1 day in the intra-capsular soft-shell technique group,which was significantly higher than (17.38± 5.21) mmHg in the conventional soft-shell technique group (t =1.241,P =0.037).Conclusions Intra-capsular bag soft-shell technique phacoemulsification for hard nuclear cataract can decrease the intraoperative and postoperative complications and quicken the visual recovery after surgery.
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Background Anterior uveitis is a common complication following the combination procedure of cataract extraction and anti-glaucoma surgery.More and more researches demonstrated the anti-inflammatory effectiveness of intraocular injection of triamcinolone acetonide (TA).Objective This study aims to observe the anti-inflammatory effectiveness of anterior chamber injection of TA for anterior uveitis following cataract extraction combined with anti-glaucoma surgery.Methods This is a case-control study.The clinical data from 42 eyes of 42 cases underwent the combination surgery of catarat extraction and anti-glaucoma was retrospectively reviewed and analyzed.The operation was performed by the same ophthalmologist on all patients.Twenty-one eyes (21 case) receiving conjunctiva injection of dexamethasone (Dex) in intraoperation served as the control group and the matched cases who received anterior chamber injections of TA in intraoperation were regarded as the TA group.The anterior uveitis was graded according to the Standard of Yang~([3]),and the intraocular pressure(IOP) was measured 1,3,and 7 days after surgery.Written informed consent was obtained from each patient before the initiation of any study protocol.Results The numbers of eyes with severe anterior uvetitis were significantly decreased 1,3,7 days after operation in the TA group in comparison with the Dex group (χ~2=10.857,P=0.028;χ~2=8.467,P=0.037;χ~2=11.286,P=0.004 ).No significant differences were found in IOP values between the TA group and the Dex group 1,3,7 days after operation (19.12±3.27 versus 19.49±3.23mmHg,t=0.469,P=0.644;17.91±1.95 versus 17.06±2.90mmHg,t=1.257,P=0.223;13.67±1.68 versus 13.05±1.66mmHg,t=1.201,P=0.237,respectively).Mild edema of corneal endothelium was seen in the early stage after operation and dissipated 4 days later in both groups,no significant differences were found between the TA group and the Dex group (P＞0.05).Conclusion TA can effectively inhibit the inflammatory reaction of anterior uvea after cataract combination with anti-glaucoma surgery.No severe adverse effect is found after anterior chamber injection of TA.