Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P<0.001). BCVA in both groups was significantly improved after surgery(all P<0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P<0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P<0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P<0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P>0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.

Short-term Clinical Outcomes of Scleral Fixation of Intraocular Lenses Using a Scleral Tunnel and Groove

PURPOSE: We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove. METHODS: From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001). CONCLUSIONS: Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.

Effects of scleral tunnel incision or clear corneal incision with same length of phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the differences of clinical effects between 3.0mm scleral tunnel incision and 3.0mm clear corneal incision of phacoemulsification(Phaco). <p>METHODS: The clinical data of 114 patients with cataract(114 eyes)were retrospectively analyzed. All patients were treated with Phaco, and patients with 3.0mm scleral tunnel incision were included in control group(<i>n</i>=30, 30 eyes), and patients with 3.0 mm clear corneal incision were included in observation group(<i>n</i>=84, 84 eyes). The changes of corneal endothelial cell(CEC)density, corneal astigmatism(CA), tear meniscus height(TMH), uncorrected visual acuity(UCVA)and tear epidermal growth factor(EGF)were compared before operation and at 1wk, 1mo and 3mo after operation, and the basic conditions during perioperative period and the occurrence of complications within 3mo after operation were analyzed in the two groups. <p>RESULTS:At 1wk, 1mo and 3mo after operation, the CEC density in the two groups was decreased significantly compared with that before operation, and the density in observation group was significantly higher than that in control group at the same time(all <i>P</i><0.05). The levels of CA, TMH and EGF in the two groups were significantly higher than those before operation, and the levels in observation group were significantly lower than those in control group at the same time(all <i>P</i><0.05). The levels of UCVA in the two groups were significantly decreased than those before operation, and the levels in observation group were significantly lower than those in control group at the same time(all <i>P</i><0.05).The ultrasound time, cumulative release energy and operative time in observation group were significantly less than those in control group(all <i>P</i><0.05). Within 3mo after operation, the total incidence rate of postoperative complications in observation group was significantly lower than that in control group(<i>P</i><0.05). <p>CONCLUSION: The 3.0mm clear corneal incision Phaco is more appropriate than 3.0mm scleral tunnel incision, and the former one is conducive to promoting postoperative rehabilitation.

Comparison of surgically induced astigmatism between horizontal and X‑pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery.

Background: Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X‑pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect. Aims: To compare SIA between horizontal and X‑pattern sutures in the scleral tunnel incisions for MSICS. Design: Prospective, nonrandomized comparative trial. Materials and Methods: After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X‑pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively. Statistical Analysis: The SIA was calculated by Cartesian coordinates based analysis. Results: Sixty‑four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against‑the‑rule astigmatism. In the X‑pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with‑the‑rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small. Conclusion: In the MSICS, the X‑pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.

Efficacy of different locations scleral tunnel incision in phacoemulsification on preoperative corneal astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of different locations scleral tunnel incision in phacoemulsification cataract on preoperative corneal astigmatism. METHODS:Totally 90 patients (94 eyes) in our hospital who had undergone the phaco-surgery from March 2013 to October 2014 were divided into two groups. The group A was those with 3. 2mm scleral tunnel incision at the direction of 10:00 ~11:00 points. The group B was those with 3.2mm scleral tunnel incision at the steepest corneal meridian. Incision was not sutured. Corneal astigmatism status of preoperative and postoperative at different times were detected by corneal refractive. The impact of different surgical incision on postoperative corneal astigmatism was compared. In the two groups, patients with preoperative corneal astigmatism 2. 00D were compared respectively. The changes of the uncorrected visual acuity and corneal astigmatism at postoperative 1wk, 1 and 3mo were observed. RESULTS:The uncorrected visual acuity of the patients who were in the group B preoperative corneal astigmatism CONCLUSION: On the basis of preoperative corneal astigmatism, 3. 2mm scleral tunnel incision at the steepest corneal meridian to some extent can correct preoperative corneal astigmatism < 1. 00D, and accordingly improve the uncorrected visual acuity.

Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques

PURPOSE: In the present study we compared the intraocular pressure (IOP) after cataract surgery according to incisional techniques. METHODS: Patients who underwent phacoemulsification with intraocular lens implantation were divided into 2 groups: clear corneal incision group (CC group), and scleral tunnel incision group (ST group). All complicated cases were excluded. IOP was measured preoperatively and at 1 week, 1, 3, 6, 12, 18 and 24 months after surgery. RESULTS: Seventy-seven patients (100 eyes) were enrolled in the present study; CC group (28 patients, 33 eyes), ST group (49 patients 67 eyes). Preoperative IOPs in both groups were not significantly different (p = 0.908, student's t-test). IOP in the CC group at 1 week after surgery significantly decreased 2.22 +/- 2.57 mm Hg compared to preoperative IOP (p < 0.001, repeated-measures ANOVA with post hoc analysis), and the IOP of the ST group decreased 2.11 +/- 2.50 mm Hg (p < 0.001, repeated-measures ANOVA with post hoc analysis). The lowered IOP was maintained for 24 months postoperatively. There was no significant difference in IOP change after surgery depending on incisional techniques (p = 0.848, repeated measures ANOVA). CONCLUSIONS: There may be no difference in IOP lowering effect after surgery depending on incisional techniques.

Surgical-induced astigmatism via a 5.5mm superior scleral tunnel incision for implantation of an Artisan phakic intraocular lens / 中华实验眼科杂志

Background Surgical induced astigmatism induced by a 5.5mm of superior scleral tunnel incision is a key cause of influencing vision outcome in the high myopic eyes after implantation of Artisan phakic intraocular lens(IOL).Objective This study was to evaluate the surgical induced astigmatism through a 5.5mm superior scleral tunnel incision during the implantation of Artisan phakic IOL.Methods This was a case observational study.The clinical data of 202 eyes of 111 patients with Artisan IOL implantation for high myopia from October 2004 through October 2008 was collected.The patients were followed-up for 12 months.The uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BCVA),spherical equivalent(SE),cylinder equivalent(CE) and cylinder axis were examined before surgery and postoperative 1,3,6,12 months.The patients were divided into with rule group and against rule group according to the cylinder axis.Surgery-induced astigmatism value was calculated using Holladay vector analysis formula.This clinical trial was approved by the Ethics Committee of Guangdong General Hospital.Written informed consent was obtained from each patient prior to the surgery.Results The UCVA of 195 eyes(94.1%) was 0.5 or better in postoperative 12 months,and that of 172 eyes(85.1%) showed the improvement of BCVA during the follow-up duration.The mean CE values were reduced in 1,3,6,12 months after surgery in comparison with before surgery(t=-4.30,P=0.00;t=-2.27,P=0.01;t=-2.04,P=0.04;t=-2.79,P=0.01).Vector analysis of total surgically induced astigmatism revealed that the mean incision-induced astigmatism value was +1.94D,+2.26D,+2.29D,+2.25D at 171°,170°,181°,175° in 1,3,6,12 months after surgery.The surgery-induced astigmatism was(+1.97±1.84)D,(+2.25±1.75)D,(+2.27±1.76)D,(+2.24±1.75)D in with rule group at postoperative 1,3,6,12 months respectively;while those in against rule group was(+1.75±1.88)D,(+2.35±1.74)D,(+2.38±1.76)D,(+2.34±1.74)D respectively.No significant differences were found between the two groups(t=0.54,-0.29,-0.27,-0.29;P=0.59,0.78,0.79,0.78).Conclusion Implantation of Artisan IOL is an effective approach for correction of high myopia.A 5.5mm superior scleral tunnel incision in operation induces a +2.25D astigmatism at 175° meridian.

Phacotrabeculectomy: results of 2.8mm scleral tunnel incision / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To report the results of phacotrabeculectomy with 2.8mm scleral tunnel incision.·METHODS: Phacotrabeculectomy was performed through an identical 2.8mm scleral tunnel incision in 52 eyes of 49 patients with cataract and glaucoma. The incision was closed with out suture. Foldable intraocular lens was implanted in all eyes.·RESULTS: The control of intraocular pressure on 36 eyes was desirable. The average postoperative intraocular pressure was (8.24±3.61)mmHg, (13.22±4.12) mmHg, (12.11±4.23)mmHg and (12.59±4.26)mmHg at one week, one month, three months and six months. As compared with 56 eyes in which phacotrabeculectomy was performed with 5.5mm scleral tunnel sutureless incision, there was no statistical difference, between the two, regarding the mean postoperative intraocular pressure at six months (t=1.7536,P=0.08239).The retinal nerve fiber layer thickness was not statistically different between the preoperative and postoperative times in one year in 26 eyes. The uncorrected postoperative visual activity was 0 8 or better in 62% of 52 eyes.·CONCLUSION: The advantages of this operative method are minimal size scleral flap, smaller and sutureless incision, immediate chamber restoration, decrease in postoperative astigmatism, enhanced postoperative visual activity, reduced postoperative inflammatory response and complications.

Comparison of Scleral Tunnel and Clear Cornea Incision in Phacoemulsification Combined with Pars Plana Vitrectomy

PURPOSE: To compare the results of two different incision METHODS: scleral tunnel vs clear cornea in cases phacoemulsification and posterior chamber intraocular lens implantation combined with pars plana vitrectomy. METHODS: Between August 2003 and August 2005, 61 eyes with cataract and vitreoretinal diseases were treated by phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative best-corrected visual acuity (BCVA), astigmatism change, and complications were analyzed. RESULTS: The mean age of patients in the scleral tunnel incision (Group 1) and clear corneal incision (Group 2) was 57.09+/-13.72 and 58.83+/-11.83 years respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 82% of Group 1 and 78% of Group 2. There was a significant difference in the postoperative astigmatic changes between Group 1 and 2 (1.37+/-1.13D vs 0.78+/-0.67D). No discernible differences such as recurrent vitreous hemorrhage, inflammation in anterior chamber, increased intraocular pressure or iris changes were noted between the two groups. CONCLUSIONS: Although there was no difference in the postoperative BCVA, two different incision methods yielded significant different postoperative astigmatic changes.

Visual Rehabilitation Following Manual Small Incision Cataract Surgery

Recent technological advances in cataract surgery with small incision ensure less surgically induced astigmatism and faster visual rehabilitation .Manual small incision non phaco surgery has added advantage of low cost and less machine dependence. We present a series of 115 patients who were operated upon using manual small incision cataract surgery and studied for visual recovery. 95.65% of patients achieved a best corrected visual acuity of 6/12 or better and the mean surgically induced astigmatism at 3 months was 0.69 Diopters .

Ahmed Valve Implantation Using Scleral Tunneling

PURPOSE: To assess the usefulness of Ahmed valve implantation using scleral tunneling. METHODS: Thirty-four eyes of 34 patients with refractory glaucoma who had not responded to medical treatment nor previous glaucoma surgery was given Ahmed valve implantation using scleral tunneling and were enrolled in the study with a minimum follow-up of six months. RESULTS: The mean follow-up period was 7.7 +/- 2.8 months (6~24 months). The mean preoperative IOP was 47.6 +/- 6.9 (25~70) mmHg and the mean postoperative IOP at six months was 18.7 +/- 9.8 (4~31) mmHg. The postoperative success rate was 73.5% and 73.3% at six and eighteen months, respectively, and was not affected by sex, preoperative diagnosis, or preoperative IOP. The postoperative complications were hyphema (4 eyes), choroidal detachment (3 eyes), and immediate hypotony (3 eyes). CONCLUSIONS: Ahmed valve implantation using scleral tunneling is useful, especially when patch graft is not available. The success rate was comparable with other traditional methods such as patch graft and scleral flap.

Corneal Astigmatic Change after 3.2mm Temporal Clear Corneal Incision in Cataract Surgery: Comparative Study with 3.2mm Superior Scleral Incision

The short-term changes in corneal astigmatism and visual acuity after phacoemulsification with foldable intraocular lens implantation through a 3.2mm temporal clear corneal incision (group 1) and these through a 3.2mm superior scleral incision(group 2) were compared.Corneal topographic measurement were obtained preoperatively and at poeroperative 1 day, 2 months. Scalar and vector astigmatism in group 1 and group 2 were compared by simple subtraction method, Cravy method and Holladay method.The surgically induced astigmatism in both groups showed no difference in with-the-rule change(0.57D-0.10D) and uncorrected visual acuity also showed no different results in both groups. In the group 1, preoperative with-the-rule astigmatism were changed 0.18D toward with-the rule and preoperative against-the -rule astigmatism were shifted 0.64D toward with-the-rule direction.Conclusively. both incisions offered satisfactory short-term astigmatic results and rapid visual rehabilitation and change of astigmatism in the wyws with preoperative against-the-rule astigmatism was greater than those with peroperative with-the-rule astigmatism in temporal clear corneal incision group.

Change of Incision Wound after Folded Intraocular Lens Insertion Through 4.0 and 3.2 mmWidth Scleral Tunnel Incision

Two different scleral tunnel incision widths were studied to determine whether the difference of cornea wound extension existed in each scleral tunnel incision widths(4 mm, 3.2 mm).25 patients in group A undergoing phacoemulsification through approximately 4 mmwidth scleral tunnel and folded silicone IOL implantation were studied with internal incision gauge after initial keratome entry, phacoemulsification, and folded IOL implantation. Same procedure was done in group B patients except 3.2 mmscleral tunnel width was made instead. After completion of phacoemulsification, the incision was further widened by a mean of 0.05 mmin both groups. Forceps insertion of silicone IOL resulted in further incision enlargement by a mean of 0.15 mmin group A, and 0.05 mmin group B. No difference was found between the intraoperative or postoperative wound stabilities between two incisions. Vector analysis calculations of mean postoperative induced astigmatism for 4.0 mmincision versus 3.2 mmincision were -0.33D versus -0.20D at 3 month. Therefore, although 4 mmscleral tunnel incision resulted in larger wound extension and induced astigmatism, it showed same wound stability and easier implantation of IOL relative to 3.2 mmscleral tunnel incision. It is necessary that proper scleral tunnel incision width is selected based on degree of surgical skill and compliance of patients.

Effect of the Length of scleral Tunnel Incision on Postoperative Intraocular Pressure after Sutureless Cataract Surgery

A prospective study was conducted to evaluate the effect of length of scleral tunnel incision on postoperative intraocular pressure(IOP)after sutureless phacoemulsification and intraocular lens implantation in otherwise normal cataract patients. IOPs were measured preoperatively and postoperatively at 6 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months and 6 months respectively. A total 130 patients(141eyes) completed 6 months follow-up period and were divided into group 1 (3.5mm group, 74 eyes of 69 patients)and group 2(6.0mm group, 67 eyes of 61 patients) according to the length of scleral tunnel incision. A mean preoperative IOP was 14.0mmHg and increase of IOP was noted to 3.1mmHg compared to preoperative value but decreased after 1 day and maintained up to 6 month postoperatively. At 6 months mean IOP was 12.7mmHg and IOP decrease of 1.3mmHg was noticed compared to preoperative value. There were no statistically significant differences in mean IOP between groups during follow-up periods (p<0.05). Number of cases with IOP rise over 22mmHg was 11(14.8%) in group 1 and 11 (6.4%) in group 2 at 6 hour postoperatively but reduced to 3(2.1%). At 6 months no case showed IOP over 22mmHg. This study revealed that the length of scleral tunnel incision did not affect the degree and frequency of postoperative IOP rise fter sutureless cataract surgery.

Changes of Astigmatism after Sutureless Cataract Surgery Through 3.2mm and 5.1mm Incisions

To evaluate the changes of surgically induced astigmatism in sutureless small incision cataract surgeries, we divided our cases into two groups. In group 1 (38 eyes), we performed phacoemulsification and implanted foldable silicone intraocular lenses (IOLs) through 3.2mm clear corneal incisions. In group 2 (30 eyes), we did phacoemulsification and implanted PMMA IOLs through 5.1mm scleral tunnel incisions. We analyzed the early postoperative astigmatism in two groups. The average surgically induced astigmatism in group 1 was 0.1D at one day, 0.36D at six months. In group 2, it was 0.6D at one day, and 0.36D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the superior incision cases, the average surgically induced astigmatism in group 1 was 0.47D against the rule(-0.47D) at one day, -0.07D at six months. In group 2, it was 0.42D at one day, 0.44D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the temporal incision cases, the mean surgically induced astigmatism in group 1 was 0.31D at one day, 0.59D at six months. In group 2, it was 0.83D at one day, 0.24D six months postoperatively. Also, there was no statistically significant difference between the two groups(p>0.05). Percentages of uncorrected visual acuity above 0.5 reached over 90% in group 1 at one month postoperatively, and in group 2 at two months postoperatively. In conclusion, both the 3.2mm clear corneal incision group and the 5.1mm scleral tunnel incision group revealed good visual rehabilitation in early postoperative period and their mean surgically induced astigmatism was not statistically significant.

Clinical Results of Sutureless Phacotrabeculectomy

We performed the prospective study on the clinical result of sutureless phacotrabeculectomy using 3.0mm ~ 6.5mm self-sealing scleral tunnel incision. This study included 9 eyes of 8 patients who have been suffering from chronic angle-closure glaucoma or chronic open-angle glaucoma with coexisting cataract. The mean preoperative intraocular pressure(IOP) was 28.55mmHg and mean postoperative IOP was 15.55mmHg. The IOP maintained below 19mmHg in all cases after 6 months. The number of medications decreased from 1.77 preoperatively to 0.33 postoperatively. No medication needed in 7 eyes postoperatively. The mean preoperative cup-disc ratio was 0.64. Visual acuity improved in 8 eyes and 5 eyes recovered to 20/40 or better. The blebs were visible in 8 cases which shows low diffuse in character in most cases. Postoperative complications were hypotony in 5 cases, hyphema in 1 case, partial posterior capsular rupture in 1 case and posterior capsular opacification in 1 case respectively. This result suggests that sutureless phacotrabeculectomy may be performed as safe and effective combined procedure in the management of coexisting cataract and glaucoma.

Keratometric Cylinder Changes following Phacoemulsitication using Frown Incision and Linear Scleral Tunnel Incision with 10-0 nylon Interrupted Sutures

To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.

One Year Surgically Induced Astigmatism and Uncorrected Visual Acuity in 5.5 mm Unsutured Scleral Tunnel Incision

We evaluated postoperative changes of astigmatism and uncorrected visual acuity in 5.5 mm unsutured scleral tunnel incision, phacoemulsification and oval shape intraocular lens(IOL) implantation. Average surgically induced astigmatic changes were 0.09D against the rule(-0.09D) at one week, -0.25D at one month, -0.28D at two months in 55 patients as well as -0.21D at six months(n=25) and -0.38D over one year(n=25). The average uncorrected visual acuities improved from 0.07 preoperatively to 0.67 at one week, 0.75 at one month, 0.75 at two months in 48 patients as well as 0.72 at six months(n=25) and 0.64 over one year(n=25) postoperatively. There were no statistic~lly significant changes from one week over one year in both variables(p>0.05). Our results suggest that change of surgically induced astigmatism is little and stable as a well as rehabilitation of postoperative visual acuity is rapid in cataract operation using the 5.5 mm unsutured scleral tunnel technique.

Trabeculectomy with scleral tunnel treating refractory glaucoma / 眼科

Objective To investigate the clinical effecl of trabeculectomy with scleral tunnel in the treatment of refractory glaucoma. Design Prospective, randomized and comparative clinical study. Participants 87 patients (98 eyes) with refractory glaucoma. Methods The patients were randomly assigned to receiving trabeculectomy with or without scleral tunnel. The tunnel group (50 eyes) underwent trabeculectomy with an additional deep scleral tunnel of 5.0mm?1.5mm beneath the superficial scleral flap. The control group (48 eyes) underwent conventional trabeculectomy. The average follow-up period was 6 to 12 months posloperatively. Main Outcome Measures Visual acuity, intraocular pressures (IOP), filtering blebs, operative and postoperative complications. Results (1) No significant differences in visual acuity were found between two groups. (2) The postoperative IOPs were significantly lower than the preoperative IOPs in both groups, while the IOPs on the 7th day after the surgery between the two groups were not different significantly. The average postoperative IOP at the 6th month in the tunnel group was 14.34?3.95 mmHg and 19.57?7.76 mmHg in the control group, which were different significantly (P