Phacoemulsification and IOL implantation combined with trabeculectomy in the treatment of age-related cataract complicated with acute PACG / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the curative effect of microincision phacoemulsification and ultra-thin artificial lens implantation combined with trabeculectomy in the treatment of age-related cataract complicated with acute primary angle-closure glaucoma(PACG). <p>METHODS: Totally 85 elderly cataract patients(85 eyes)with acute PACG admitted between January 2017 and July 2020 were enrolled. According to the operation method, they were divided into study group(46 cases, 46 eyes)and control group(39 cases, 39 eyes). The control group was treated with 1.8mm microincision phacoemulsification and ultra-thin artificial lens implantation, while the study group was treated with trabeculectomy on the basis of the treatment of control group. The best corrected visual acuity(BCVA), intraocular pressure, anterior chamber angle width classification, corneal endothelial cell count and surgical complications of the two groups were compared. <p>RESULTS: Compared with the same group before operation, the BCVA(LogMAR)of the two groups was significantly reduced at 1, 3 and 6mo after operation(all <i>P</i><0.05), and the study group had lower LogMAR BCVA than the control group(all <i>P</i><0.05). At 1, 3 and 6mo after operation, intraocular pressure of the two groups was significantly reduced(<i>P</i><0.05), and the study group had lower intraocular pressure than the control group(<i>P</i><0.05). Meanwhile, the proportion of anterior chamber angle width grade NⅠwas increased, and the proportion of grade N Ⅳ was reduced in the two groups(<i>P</i><0.05). The proportion of grade NⅠwas higher in the study group than in the control group(<i>P</i><0.05). No significant differences were found between the two groups in terms of corneal endothelial cell count(<i>P</i>>0.05)and the incidence of complications(28% <i>vs</i> 26%; <i>P</i>>0.05). <p>CONCLUSION: For patients with senile cataract complicated with acute PACG, trabeculectomy based on microincision phacoemulsification and ultra-thin artificial lens implantation can significantly lower intraocular pressure, relieve glaucoma, and reduce visual impairment, with little damage to corneal endothelial cells and few complications. Besides, the clinical effect is marked.

Effect of phacoemulsification with different incision on corneal endothelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the curative effect of 3.0mm incision phacoemulsification and 1.8mm coaxial micro-incision phacoemulsification and the influence on corneal endothelial cells.<p>METHODS: A total of 78 patients(78 eyes)with age-related cataract who were hospitalized in the hospital from December 2016 to December 2018 were selected as subjects. They were divided into the standard incision group and the micro-incision group with 39 cases(39 eyes)in each group. Patients in the standard incision group were treated with 3.0mm standard incision phacoemulsification and intraocular lens implantation, while the patients in the micro-incision group were treated with 1.8mm coaxial micro-incision phacoemulsification and intraocular lens implantation. The surgical outcome and corneal endothelial cell parameters were compared between the two groups. <p>RESULTS: The phacoemulsification time of the standard incision group and the micro-incision group were(7.05±0.98)s and(7.22±0.96)s, respectively. The phacoemulsification energy was(17.01±1.89)% and(16.89±1.53)%, respectively(<i>P</i>>0.05). The LogMAR of naked eyes of both groups decreased significantly at 1d, 1wk and 1mo after surgery(<i>P</i><0.001), while the degree of astigmatism increased(<i>P</i><0.001). The naked vision and astigmatism of the micro-incision group were better than those of the standard incision group at 1d and 1wk after surgery(<i>P</i><0.05). Endothelial cell density was significantly decreased at 1d, 1wk and 1mo after surgery(<i>P</i><0.05). The coefficient of variation of corneal endothelial cells and the thickness of central cornea increased. There was no significant difference between the standard incision group and the micro-incision group at each time poilt(<i>P</i>>0.05). There were no severe complications in either group. There was one patient with transient high intraocular pressure in the standard incision group, and the intraocular pressure returned to normal after drug treatment.<p>CONCLUSION: Both coaxial micro-incision phacoemulsification and standard small incision surgery have certain effects on the morphology and function of endothelial cells. Besides, there is no significant difference between them. However, coaxial micro-incision phacoemulsification can minimize the surgical incision and reduce the degree of surgically induced astigmatism, and patients can recover quickly after surgery. It is a relatively safer surgical procedure.

Observation of polypoidal choroidal vasculopathy with vitreous hemorrhage treated by microincision 25G pars plana vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy of vitreous hemorrhage(VH)in patients with polypoidal choroidal vasculopathy(PCV), and to summarize the clinical characteristics of the cases.<p>METHODS: Retrospective case series. From Jan. 2014 to Dec. 2017, 14 patients(15 eyes)with PCV combined with VH were treated by microincision 25G vitrectomy in our hospital and were followed up for at least 6mo. Data of medical history and follow up observation were collected. The main outcome measures included visual acuity, intraocular pressure, ultrasonography, color fundus photography, fundus angiography, optical coherence tomography, and surgical complications. To analyze the difference of the best corrected visual acuity(BCVA, LogMAR)between pre-operation and postoperation, and to summarize the clinical characteristics and therapeutic effect of the cases.<p>RESULTS: Totally 11 cases had history of hypertension. 9 eyes were diagnosed with PCV before vitrectomy. The follow-up period was from 6-36mo. All 15 eyes were treated with microincision 25G vitrectomy. During the operation, 3 eyes were silicone oil tamponade in the vitreous cavity, 2 eyes were gas tamponade, and the remaining eyes were balanced saline solution tamponade. Postoperative complications included progressed cataract in 2 eyes, recurrent VH in 1 eye, high intraocular pressure in 1 eye, and recurrent retinal detachment in 0 eye. The BCVA before surgery was 2.78±0.46, and the last follow up BCVA after surgery was 1.15±0.50. Postoperative BCVA was significantly improved compared with the preoperation(<i>t</i>=11.14, <i>P</i><0.01).<p>CONCLUSION: Microincision vitrectomy is a safe and effective way to treat PCV with VH, which can improve the visual acuity of patients with PCV companied with VH. The history of hypertension may be a risk factor for PCV with VH.

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

Intravitreal injection of conbercept during vitrectomy surgery to treat severe proliferative diabetic retinopathy / 中华实验眼科杂志

Objective To observe and analysis the clinical effects and postoperative complications of intravitreal injection of conbercept during vitrectomy surgery (VRS) in severe proliferative diabetic retinopathy (PDR) treatment.Methods This is a prospective non-randomized controlled clinical study.A total of fifty-seven patients (sixty eyes) with severe PDR were enrolled in Tianjin Eye Hospital from June 2015 to March 2016,and the patients were divided into conbercept injection group and control group according to the patients' surgical method intention selection.The patients in conbercept injection group received an intravitreal injection of 0.05 ml conbercept solution during the surgery.The patients in control group only received VRS.The operations of the two groups were completed by the same doctor,and the follow-up time was 6 to 10 months after the surgery.The incidence of postoperative complications including a transient high intraocular pressure,early and late incidence of vitreous hemorrhage(VH),epiretinal membrane and traction retinal detachment (TRD),neovascular glaucoma (NVG),the central retinal thickness (CRT) and the best corrected visual acuity (BCVA) (LogMAR visual acuity) were comparatively analyzed.Results The incidence of early VH was 6.7％ (2/30) in conbercept injection group,which was significantly lower than 26.7％ (8/30) in control group (x2 =4.32,P =0.04).The incidences of late VH were 3.3％ (1/30) and 10.0％ (3/30) in conbercept injection group and control group,and the differences had no statistically significant difference (x2 =1.07,P＞0.05).The incidences of a transient high intraocular pressure,TRD and NVG between the two groups had no statistically significant difference (x2=0.69,0.22,2.07;all at P＞0.05).The change of CRT from one week to one month after the operation in conbercept injection group was more remarkable than that in the control group,and the difference was statistically significant (t=-3.23,P＜0.05).The mean LogMAR BCVA in two groups at 1 month and 6 months after operation were both improved in different degrees compared with the preoperative vision.The difference of mean LogMAR BCVA at 6 months was statistically significant (P＜0.05).Conclusions The intravitreal injection of conbercept during VRS in severe PDR patients can effectively prevent postoperative early VH,decrease CRT and improve visual acuity.

Intravitreal injection of conbercept during vitrectomy surgery to treat severe proliferative diabetic retinopathy / 中华实验眼科杂志

Objective To observe and analysis the clinical effects and postoperative complications of intravitreal injection of conbercept during vitrectomy surgery ( VRS ) in severe proliferative diabetic retinopathy ( PDR) treatment. Methods This is a prospective non.randomized controlled clinical study. A total of fifty.seven patients (sixty eyes) with severe PDR were enrolled in Tianjin Eye Hospital from June 2015 to March 2016,and the patients were divided into conbercept injection group and control group according to the patients ' surgical method intention selection. The patients in conbercept injection group received an intravitreal injection of 0. 05 ml conbercept solution during the surgery. The patients in control group only received VRS. The operations of the two groups were completed by the same doctor, and the follow.up time was 6 to 10 months after the surgery. The incidence of postoperative complications including a transient high intraocular pressure, early and late incidence of vitreous hemorrhage(VH),epiretinal membrane and traction retinal detachment(TRD),neovascular glaucoma(NVG),the central retinal thickness ( CRT ) and the best corrected visual acuity ( BCVA ) ( LogMAR visual acuity ) were comparatively analyzed. Results The incidence of early VH was 6. 7％( 2/30 ) in conbercept injection group, which was significantly lower than 26. 7％(8/30) in control group (χ2=4. 32,P=0. 04). The incidences of late VH were 3. 3％(1/30) and 10. 0％(3/30) in conbercept injection group and control group,and the differences had no statistically significant difference (χ2=1. 07,P>0. 05). The incidences of a transient high intraocular pressure,TRD and NVG between the two groups had no statistically significant difference (χ2=0. 69,0. 22,2. 07;all at P>0. 05). The change of CRT from one week to one month after the operation in conbercept injection group was more remarkablethan that in the control group,and the difference was statistically significant (t=-3. 23,P<0. 05). The mean LogMAR BCVA in two groups at 1 month and 6 months after operation were both improved in different degrees compared with the preoperative vision. The difference of mean LogMAR BCVA at 6 months was statistically significant (P<0. 05). Conclusions The intravitreal injection of conbercept during VRS in severe PDR patients can effectively prevent postoperative early VH,decrease CRT and improve visual acuity.

Comparative study of the short - term results of 27 - gauge versus 25 - gauge microincision vitrectomy for vitreoretinal diseases / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To compare the short-term surgical results of 27-gauge ( 27G ) with 25 - gauge ( 25G ) microincision vitrectomy surgery ( MIVS ) for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS. · METHODS: Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity ( BCVA, LogMAR ) recovery and intraocular pressure fluctuation. ·RESULTS: All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56. 4±38. 9 min, which was significant longer than that of 27G group (45. 5 ± 26. 1 min, t= 2. 422, P= 0. 016). However, when comparing the surgical time for each category of disease, there were no significant differences observed (P>0. 05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group (2. 1 ± 1. 6, 0. 3 ± 0. 6, and 0. 2 ± 0. 4), with significant differences (P=0. 038, P=0. 011, P=0. 046 respectively). The improvement of BCVA was-0. 4±0. 9 in 25G group, and -0. 2 ± 0. 9 in the 27G groups respectively (t= -1. 636, P = 0. 103 ). The rate of transient ocular hypotony of the 25G vitrectomy was 19. 5% (16 eyes), which was higher than that of the 27G group without significant difference ( 15. 6% , 21 eyes; χ2= 0. 565, P=0. 452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group (3. 59±0. 69mmHg) and the 27G group (3. 58±0. 47mmHg;t=0. 007, P=0. 995). ·CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.

Clinical analysis of two different incisions of coaxial phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the clinical effects of 2.2mm coaxial micro-incision and 3.0mm standard incision in cataract phacoemulsification surgery. ·METHODS: A total of 67 patients (80 eyes) were randomly divided into two groups. Cataract phacoemulsification and artificial lens implantation surgery was carried out with 2. 2mm coaxial micro -incision (Group A, 40 eyes) and 3. 0 mm standard incision(Group B, 40 eyes), respectively. The effective phacoemulsification time and average ultrasound energy, corneal endothelial cell count, corneal edema, corneal astigmatism, postoperative visual acuity and postoperative complications were compared between the two groups. ·RESULTS: Effective phacoemulsification time of Group A and Group B was 8. 18 ± 11. 22s and 7. 82 ± 2. 12s, respectively, and the difference had no statistical significance(P> 0. 05); average ultrasonic energy was (17.25 ± 4.22)% and (17.64 ± 4.27)%, respectively, and the difference was not statistical significance(P>0.05). There was no significant difference in endothelial cells between the two groups of corneal endothelial cells at 1wk after surgery compared with that before operation (P>0.05). On the first day after surgery, corneal edema was observed in some patients. There were 9 eyes in Group A,6 eyes in Group B,corneal edema relief or subsidence after 3d to 5d. There was significant difference in corneal astigmatism change between the two groups at 1wk (P<0.05), but there was no significant difference at 1 and 3mo after operation (P>0.05). The changes of corneal astigmatism before and after operation in Group A were insignificant (P>0. 05), while the changes of corneal astigmatism before and after operation in Group B were significantly different (P< 0. 05). At 1 and 3mo after operation, the astigmatism of each group tended to be stable, and the corneal astigmatism in the two groups after 1 and 3mo had no statistical significant difference (P> 0. 05). The uncorrected visual acuity (UCVA) differences of the two groups was statistically significant at 1d,1wk and 1mo after operation (P<0.05), but there was no significant difference between the two groups in UCVA after 3mo (P>0.05). ·CONCLUSION: For soft or medium - hard nucleus cataract, compared with the traditional 3. 0mm small-incision coaxial phacoemulsification, the 2.2mm micro-incision coaxial phacoemulsification can effectively reduce the surgically induced astigmatism, and the astigmatism state is relatively stable, and conducive to early recovery of visual acuity.

Treatment and postoperative effects of coaxial micro-incision phacoemulsification on patients with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical efficacy and postoperative impacts of coaxial micro-incision phacoemulsification on patients with cataract, and explore the application value of the surgical method. <p>METHODS: Totally 300 patients(300 eyes)who received the coaxial micro-incision phacoemulsification were randomly divided into the observation group(150 case)and the control group(150 case). Patients in the observation group and control group were treated by coaxial micro-incision phacoemulsification and traditional coaxial phacoemulsification, respectively. The effective phaco time(EPT), average ultrasound energy(AVE), intraoperative anterior chamber stability and postoperative recovery time were compared between the two groups, as well as the uncorrected visual acuity(UCVA), the surgically induced astigmatism(SIA)and the loss rate of corneal endothelial cells at 1d, 1wk, 1 and 3mo after surgery. <p>RESULTS: No significant difference of EPT, AVE and the rate of patients with stable anterior chamber were found between the two groups(<i>P</i>>0.05), as well as the UCVA, SIA and the corneal endothelial cells in patients before surgery(<i>P</i>>0.05).The postoperative recovery time of patients in the observation group was obviously shorter than that in the control group(<i>P</i><0.05). At 1d, 1wk and 1mo of postoperative, the UCVA of patients in the observation group were better than those in the control group(<i>P</i><0.05). In 1wk, 1 and 3mo of postoperative, the SIA of patients in the observation group were lower than those in the control group(<i>P</i><0.05). And in all the time of postoperative, the loss rate of corneal endothelial cells of patients in the observation group were lower than those in the control group(<i>P</i><0.05). Between the two groups, significant difference of the UCVA, SIA and the loss rate of corneal endothelial cells were found in the different time points after surgery(<i>P</i><0.05). <p>CONCLUSION: The coaxial micro-incision phacoemulsification had a high clinical value as it possesses the advantages of more rapid UCVA recovery, less influence on SIA and less loss of corneal endothelial cell.

Clinical efficacy of coaxial microincision phacoemulsification for intraoperative floppy iris syndrome during cataract surgery / 眼科新进展

Objective To evaluate the clinical efficacy of coaxial micro-incision phacoemulsification for intraoperative floppy iris syndrome (IFIS) during cataract surgery.Methods A prospective randomized control study was conducted in 80 patients (80 eyes) taking tamsulosin more than two weeks with age-related cataract from October 2014 to October 2016.All cases were randomly divided into microincision group (MICS group) and standard incision group (SICS group),40 cases in each group.Coaxial 1.8 mm microincision cataract surgery was performed in the MICS group,and coaxial 2.6 mm standard incision cataract surgery was performed in the SICS group.The incidence and the degree of IFIS and complications were recorded during the operation.The uncorrected visual acuity (UCVA) was compared at 1 day,1 week,1 month after surgery.Results At postoperative 1 day,1 week and 1 month,UCVA was 0.83 ± 0.12,0.86 ±0.10,0.89 ±0.11 in the MICS group,and was 0.71-±0.12,0.75 ±0.11,0.83 ±0.12 in the SICS group,there were statistical differences (all P ＜ 0.05),the UCVA of MICS group was better than that of SICS group.The incidence of IFIS was 60.0％ in the MICS group,and 82.5％ in the SICS group,there was statistical difference (P ＜ 0.05).There was statistical difference on degree of IFIS between two groups (P ＜ 0.05),the degree of IFIS in the MICS group was lower than that in the SICS group.Conclusion The coaxial microincision phacoemuisification is a safe and effective surgery for the patients with cataract and high risk of IFIS.

27-gauge microincision vitrectomy surgery system for clinical application / 国际生物医学工程杂志

Objective To observe the preliminary clinical results and safety of 27-gauge microincision vitrectomy surgery for partial vitreoretinal diseases.Methods A total of 13 patients (13 eyes) who underwent 27-gauge microincision vitrectomy surgery were enrolled.The follow-up period was 6 to 12 months.Preoperative and postoperative visual acuity and intraocular,total operative time,cutting time for removing vitreous,wound healing status,intraoperative and postoperative complications were observed.Results Mean best corrected visual acuity improved from preoperative (1.26±0.66) logMAR (0.10±0.09) to postoperative (0.63±0.52) logMAR (0.35±0.24),and the difference was statistically significant (t=2.743,P=0.018).The difference of mean preoperative intraocular pressure (IOP),IOP of postoperative day 1,day 5,one month and final postoperative visit were not statistically significant (F=0.593,P＞0.05).The mean total operative and cutting times were (36.38±14.97) min and (10.12±3.54) min respectively.Postoperative scleral incision showed linear closure,no cases of postoperative sclerotomyrelated complications such as wound dehiscence,vitreous incarceration and subcoujunctival fluid were observed.No intraoperative and postoperative complications of iatrogenic retinal breaks,endophthalmitis,choroidal detachment,retinal detachment and vitrous hemorrhage were observed.Conclusions The 27-gauge microincision vitrectomy surgery can improve postoperative visual acuity for treatment of vitreoretinal diseases and induce fewer sclerotomyrelated complications,which maybe a safer surgical approach.

Comparison of effect of two different -incision phacoemulsifications in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore and compare effect of coaxial micro-incision phacoemulsification and standard coaxial phacoemulsification in the treatment of cataract. METHODS:A total of 88 patients(88 eyes) with senile cataract who underwent selective cataract ultrasonic emulsification resorption combined with intraocular lens implantation in the hospital from Aug. 2013 and Aug. 2015 were selected, they were divided randomly into the control group ( 44 cases, 38 cases completed, 6 cases dropped out ) and the observation group ( 44 cases, 40 cases completed, 4 cases dropped out ) . The control group received standard coaxial 3. 0mm small incision phacoemulsification, the observation group received coaxial 1. 8mm micro-incision phacoemulsification. All patients were combined with intraocular lens implantation. Intraoperative effective ultrasonic time, cumulative release energy, best corrected visual acuity before and after surgery in the two groups were recorded, corneal endothelium cell population, incision corneal thickness, percentage of cornea hexagon cell, corneal astigmatism changes before the operation, 1d, 7d, 30d after the operation were compared. RESULTS: There was no significant difference in intraoperative effective ultrasonic time, cumulative release energy in the two groups(P>0. 05). There was no significant difference in postoperative best corrected visual acuity between the two groups(P>0. 05). Corneal endothelium cell population, percentage of cornea hexagon cell 1d, 7d, 30d after the operation in the two groups were significantly decreased compared with those before the treatment ( P 0. 05 ). Incision corneal thickness 30d after the operation in the observation group was significantly lower than the control group(PCONCLUSION: Coaxial micro - incision phacoemulsification and standard coaxial phacoemulsification can improve visual acuity of cataract patients, but the former can reduce degree of corneal astigmatism.

Clinical effects of coaxial 1 . 8 mm microincision phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe and compare clinical effects of coaxial 1. 8mm microincision phacoemulsification and 3. 2mm small incision phacoemulsification. ●METHODS:A total of 117 eyes of 85 patients with age-related cataract in our hospital were divided randomly into two groups:43 patients (59 eyes) in the coaxial 1. 8 mm microincision cataract surgery group ( C - MlCS ) , 42 patients (58 eyes) in the coaxial 3. 2 mm traditional small incision cataract surgery group (C-SlCS). A total of 117 eyes were received phacoemulsification with intraocular lens implantation. Uncorrected visual acuity was recorded preoperatively and postoperatively at 1, 7, 30 and 90d. The effective phacoemulsification time and average ultrasound energy were recorded in surgery. Corneal endothelial cell and corneal topography were recorded preoperatively and postoperatively at 90 d. ●RESULTS:Uncorrected visual acuity ( logMAR) was no overall statistical significance difference between C-MlCS group and C-SlCS group (P>0. 05), but was significant statistical difference in different time-point within both groups(P0. 05). On the 1 day after surgery, uncorrected visual acuity was 0. 16±0. 11 in C-MlCS group and 0. 22±0. 18 in C-SlCS group(P0. 05). EPT was (3. 09±1. 61)s in C-MlCS group and (3. 20±1. 92)s in C-SlCS group (P>0. 05). At 90 d after surgery, corneal endothelial cell loss percentage was (5. 81±2. 28)% in C-MlCS group and (5. 69±2. 38)% in C-SlCS group (P>0.05), SlA was (0.35±0.11) Din C-MlCS group and (0. 61±0. 13) D in C-SlCS group (P ● CONCLUSION: Compared with coaxial 3. 2mm traditional small incision cataract surgery, 1. 8mm coaxial microincision cataract surgery can get earlier visual rehabilitation and significantly reduce SlA. The coaxial 1. 8mm microincision cataract surgery is safe, effective and deserves further clinical applications.

Progress and application of 27 -gauge micro-incision vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?Since the introduction of 25-gauge/23-gauge ( 25G/23G ) sutureless micro -incision vitrectomy surgery ( MIVS ) at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound.As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications.Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr.Oshima from Japan launched the first 27-gauge vitrectomy surgery system.It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development.Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.

Effect of biaxial versus coaxial microincision cataract surgery on optical quality of the cornea.

Context: Visual function is determined by a combination of the cornea, which has a larger effect and internal aberrations generated by the intraocular lens and those induced by the surgery. These corneal refractive changes are related to the location and size of the corneal incision. The smaller the incision, the lower the aberrations and the better the optical quality. Aims: To compare the effect of uneventful coaxial versus biaxial microincision cataract surgery (MICS) on the corneal aberrations. Settings and Design: Retrospective interventional nonrandomized comparative case study comprised 40 eyes of 36 patients with primary senile cataract. Subjects and Methods: They were divided into two groups: Group I (20 eyes) had operated by biaxial MICS and Group II (20 eyes) had operated by coaxial MICS. Each group were assessed by corneal topography and wavefront analysis over 6 mm pupil size preoperatively and 1‑month postoperatively. Statistical Analysis Used: Statistical analysis was performed using SPSS for Windows (version 17.0.1, SPSS, Inc.). The paired t‑test was used to compare the mean values of corneal aberrations preoperatively and 1‑month postoperatively in each group. Results: There was a significant increase in trefoil and quatrefoil in biaxial MICS (P = 0.063, 0.032 respectively) while other aberrations insignificantly changed. The coaxial MICS showed a significant increase in root mean square (RMS) of total high order aberrations (HOAs) (P = 0.02) and coma (0.028), but not the others. In comparison to each other, there was the insignificant difference as regards astigmatism, RMS of individual and total HOAs. Conclusions: Coaxial and biaxial MICS are neutral on corneal astigmatism and aberrations.

Application of capsular tension ring combined with iris hooks in phacoemulsification of traumatic cataract with lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To evaluate the clinical efficacy and safety of capsular tension ring ( CTR) combined with iris hooks in eyes with large traumatic zonular dialysis or weakness that underwent micro -incision coaxial phacoemulsification with posterior chamber ( PC ) intraocular lens ( lOL) implantation.METHODS: This prospective study was carried on 21 patients ( 21 eyes ) with traumatic cataract and traumaticzonular dialysis (0. 8 in 5 eyes. lOPs were in normal range too. The lOLs in 20 eyes remained the required position to the final follow- up examination except one eye in which the PC lOL was dislocated into vitreous cavity due to a postoperative spontaneity PCR, and in which vitrectomy and lOL suture fixation was performed.CONCLUSlON: ln cases of cataract associated with traumatic zonular dialysis (<180.) , by setting the rational parameters of phacoemulsification, the CTR and iris hooks are found to be efficient in preventing lOL decentration and reducing operation complication. ln our cases, the CTR combined with iris hooks is relatively safe application.

Clinical observation of coaxial microincision phacoemulsification for beginners / 国际眼科杂志(Guoji Yanke Zazhi)

To investigate the methods of learning coaxial microincision phacoemulsification and assess the related complications.METHODS:The clinical data of 1 080 eyes of coaxial microincision phacoemulsification performed by beginners from October 2011 to December 2013 was retrospectively analyzed. ln order of surgery dates, the patients were equally divided into groups A, B, C and D, 270 eyes in each group. Comparisons were made among the four groups in operation time, cumulative dissipated energy (CDE), rate of intraoperative, and postoperative complications at 1d; and best corrected distance visual acuity (BCDVA) at 1mo postoperatively.RESULTS:No significant differences were found in age, sex, lens grading, BCDVA at 1mo postoperatively among the four groups ( P> 0. 05 ). The operation time was significantly longer in group A than in groups B, C and D (25. 15 ± 3. 11min vs 15. 20 ± 3. 40min, 14. 71 ± 3. 02min and 14. 41±2. 91min, P0. 05). The CDE of grade ‖ and Ⅲ was significantly higher in group A than that in groups B, C and D (95. 9%, 97. 8% and 98. 5%) (P0. 05). There were no significant differences both in the number of corneal edema and BCDVA at 1d between group A and group B. (P=0. 66, P=0. 53).CONCLUSlON: With learning step by step, appropriate training program, careful case selection, and accurate managing complications, coxial microincision phacoemusification can be safe for a beginner.

Comparison of Surgically-induced Astigmatism after Combined Phacoemulsification and 23-Gauge Vitrectomy: 2.2-mm vs. 2.75-mm Cataract Surgery

PURPOSE: The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. METHODS: We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and DeltaKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. RESULTS: One week after surgery, both groups exhibited similar amounts of SIA (-DeltaKP[120], 0.40 +/- 0.41 vs. 0.51 +/- 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-DeltaKP[120], 0.31 +/- 0.54 vs. 0.56 +/- 0.42 D; p = 0.045). CONCLUSIONS: In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.

Change in Central Macular Thickness after 2.2-mm Microincision Coaxial versus 2.75-mm Small Incision Cataract Surgery

PURPOSE: To evaluate the central macular thickness and volume changes after conventional 2.75-mm small incision cataract surgery (SICS) and 2.2-mm microincision coaxial cataract surgery (MICS). METHODS: We performed a retrospective chart review of 48 eyes undergoing uneventful phacoemulsification and divided the subjects into two groups, SICS and MICS. To evaluate the central macular thickness and volume changes after cataract surgery, optical coherence tomography (OCT) was used before and at one day, one week, one month, and two months postoperatively. RESULTS: No statistically significant difference was found in the intraoperative phacoemulsification power, phaco time, or volume of intraoperative irrigation solution between the two groups (p > 0.05). The average central macular thickness increased in the MICS group compared to the SICS group at every postoperative time point, and the difference was statistically significant at postoperative one month (p = 0.04). The average central macular volume was elevated in the MICS group; however, the difference was not significant (p > 0.05). CONCLUSIONS: Central macular thickness and volume change were greater in the MICS group compared to the SICS group, and the difference in central macular thickness between the two groups was significant at postoperative one month. Careful follow-up examinations should be performed using OCT at this postoperative time point, especially in patients who received cataract surgery with smaller incision size.

Clinical Outcome of in-the-Bag Single-Piece Aspheric Intraocular Lens Implantation after Microincision Cataract Surgery

PURPOSE: To evaluate the stability and optical performance of the newly developed single-piece aspheric intraocular lens (IOL) by comparing the clinical outcome of the aspheric IOL with the new optic profile design (HOYA iSert, HOYA iMics) and the aspheric IOL (Akreos MI60), which has been proven effective and safe. METHODS: iSert, iMics, and MI60 were inserted into 55 eyes, 60 eyes, and 50 eyes, respectively, after microincision phacoemulsification cataract surgery. Best corrected visual acuity (BCVA), refraction in spherical equivalent, anterior chamber depth (ACD), total higher order aberration (HOA), contrast sensitivity, and surgically induced astigmatism (SIA) were measured and each IOL was evaluated on the functional stability, anterior-posterior stability, centration in the capsular bag, and quality of vision. RESULTS: No statistical differences in preoperative and postoperative BCVA among the 3 IOL groups were observed, however, MI60 showed significant myopic shift postoperatively. Anterior-posterior stability assessed with postoperative change in refractive error and ACD was slightly lower in the MI60 group. In terms of vision quality, while total aberration, total HOA, coma aberration, and contrast sensitivity for the 3 IOLs were not different significantly, spherical aberration of the MI60 group was higher than the other groups at 6 months postoperative. SIA was significantly increased in eyes implanted with iSert than in eyes with iMics or MI60 at 1 month postoperatively, however, the differences were no longer evident after 3 months postoperatively. CONCLUSIONS: The new aspheric IOLs, iSert and iMics, showed good stability and visual outcome equal to MI60 at the 6-month postoperative follow-up.