Phacoemulsification Research Articles

The causes and prognosis of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy

Objective To observe and analyze the causes and prognosis of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR). Methods A total of 160 PDR patients (171 eyes) were enrolled in this retrospective study. There were 85 males and 75 females. The patients aged from 33 to 73 years, with the mean age of (56.40±8.97) years. All the patients were performed 25G pars plana vitrectomy by the same doctor. Fibrovascular membrane peeling and panretinal photocoagulation were performed during the operation. Combined phacoemulsification was performed in one hundred and five patients. Vitreous tamponade was used at the end of surgery, including silicone oil (43 eyes), C3F8 (63 eyes), air or fluid (65 eyes). The follow-up ranged from 6 to 22 months, with the mean follow-up of (9.34±6.97) months. The features of PVH were observed. The difference of age, HbA1c, creatinine level, the severity of the fundus lesions, whether received treatment of anti-vascular endothelial growth factor (VEGF), whether received combined cataract phacoemulsification were analyzed to find out the cause and prognosis of PVH. Results The corrected vision of all the patients after the primary PPV at the latest follow up was finger counting/1 meter. PVH occurred in 15 eyes of 15 patients, the incidence was 8.77%. The PVH occurred 2 weeks to 6 months after surgery. There were significant difference in age (t=2.551), proportion with tractional retinal detachment (χ2=7.431), progressive fibrovascular proliferation (χ2=4.987) and using anti-VEGF (χ2=9.742) between the patients with and without PVH (P 0.05). During follow-up, neovascularization of iris (NVI) occurred in 1 eye and neovascular glaucoma (NVG) occurred in 4 eyes. Seven eyes underwent reoperation, 7 eyes were spontaneous recovered, 1 eye with NVG give up treatment. Fibrovascular membrane was the major cause of recurrent hemorrhage. At the end of follow-up, hemorrhage was absorbed in all the 14 eyes which were treated, 12 eyes had same visual acuity compared to that before postoperative hemorrhage, 2 eyes with NVG had decreased vision. There was significant difference in the corrected vision between the patients with and without NVI or NVG (P=0.022). Conclusions PVH after PPV for PDR is closely related to the severity of diabetic retinopathy, fibrovascular membrane is the major cause of recurrent hemorrhage. NVG is an important factor related to vision acuity prognosis. Key words: Diabetic retinopathy/surgery; Vitrectomy/adverse effects; Vitreous hemorrhage

Analysis of factors associated with vision and hole closure for idiopathic macular hole after vitrectomy surgery

Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P 0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow- up time showed no effects on operational outcomes. Key words: Retinal perforations/surgery; Vitrectomy; Root cause analysis

The efficacy of different methodes of surgery for traumatic luxation of lens

Objective To observe clinical efficacy of different surgical treatment for traumatic luxation of lens. Methods The data of 39 eyes of 35 cases with traumatic luxation of lens were selected, including lens subluxation 18 eyes of 16 cases, lens complete dislocation 21 eyes of 19 cases. Some cases combined with retinal detachment, vitreous opacity or secondary glaucoma. For the patients with subluxation of lens and the dislocation range ≥180°, without retinal detachment, received three channel vitrectomy and lensectomy, combinded with ciliary sulcus suture fixation of intraocular lens implantation. Phacoemulsification and intraocular lens implantation were performed in paitents with the incomplete dislocation range <180°. For the patients with complete dislocation of the lens, the intracapsular extraction were performed. During the following period, the clinical treatment efficacy was observed. Results All patients underwent operation successfully. The intraocular pressure was (32.5±3.7) mmHg before surgery, >21 mmHg in 28 cases. The visual acuity was 1.4±0.2 (logMAR) in preoperative. One month after surgery, the IOP was (17.3±2.6) mmHg and the visual acuity was (0.2±0.1), IOP>21 mmHg in 4 cases. The difference in intraocular pressure and visual acuity were statistically sinificant (P<0.05). Followed up for 3-6 months, no obvious complication happened. Conclusion Targeted surgical treatment for traumatic luxation of lens is helpful to reduce the intraocular pressure, and improve visual acuity. Key words: Luxdtion, lens, traumatic; Treatment; Surgery

Application of goniosynechialysis in the surgery for primary angle closure glaucoma

Glaucoma is the second leading cause of blindness throughout the world and primary angle closure glaucoma(PACG) is one of its important subtypes. Goniosynechialysis(GSL) is a surgical technique that can reconstruct the crowded anterior chamber and restore the drainage function of trabecular meshwork, thus playing its unique role in various treatments of PACG. In recent decades, there has been plenty of researches showing that goniosynechialysis and PHACO-GSL(combined phacoemulsification and GSL) can effectively reduce IOP. This article is a systematic review of goniosynechialysis in its surgical technique, therapeutic values and postoperative complications. Key words: Glaucoma, angle-closure, primary; Goniosynechialysis

Clinical observation on cataract surgery in patients with diabetic renal failure

Objective To observe the efficacy of cataract surgery of patients with diabetic renal failure after proper treatment during perioperative period and improved surgical method. Methods A retrospective clinical study. The data of 57 eyes of 43 patients with cataract and diabetic renal failure were selected as observation group and they received phacoemulsification. All cases of observation group received non-heparin dialysis, control of blood glucose and blood pressure in perioperative period. During the operation, strong suction and low energy were applied, and anterior and posterior capsule polishing were performed. The data of 61 eyes of 45 patients with similar general conditions with the normal renal function and diabetic cataract were selected as control group. The postoperative complications and the visual acuity of 3 months after operation were compared between the two groups. Results There was no significant difference between the two groups in complication and the visual acuity 3 months after operation (P>0.05). Conclusion Under the premise that all aspects of the perioperative period can be controlled strictly and the surgical method be improved, cataract surgery is a safe and effective treatment for cataract patients with diabetic renal failure. Key words: Diabetic; Failure, renal function; Cataract surgery

English

English

A randomized controlled clinical study on reverse-chopper prechop technique with phaco-and-chop technique for high myopia associated with hard nucleus cataract

Background The innovation of pre-chop technique lies in shortening surgery duration, reducing ultrasound power, and deseasing the loss of corneal endothelial cells (CECs). Objective This study was to compare the efficacy and safety of pre-chop technique using a reverse-chopper and phaco-and-chop phaco technique to super high myopia associated with hard nucleus cataract. Methods A prospective randomized-controlled-clinical interventional study was performed.Fourty eyes of 40 high myopia associated with cataract patients with Ⅲ-Ⅳ degree of nucleus were enrolled in Beijing Tongren Hospital from March to September 2016.The patients were randomized into the pre-chop group and matched phaco-and-chop group according to random number table, and the self-made reverse chopper-assisted pre-chop phacoemulsification (phaco) surgery and phaco-and-chop phaco surgery were performed on the eyes of different groups, respectively.The phaco power, effective phaco duration and best corrected visual acuity (BCVA) were recorded and compared between the two groups to evaluate the efficacy, and the loss rate of corneal endothelial cells and eyes in different grades of cornea edema after operation were compared between the two groups to assess the safety of surgery procedure.Written informed consent from each patient was obtained prior to relevant examination and surgery. Results The surgery was finished smoothly in the eyes.The mean effective phaco duration was (47.30±11.29) seconds and (57.70±14.51) seconds in the pre-chop group and phaco-and-chop group, respectively, with a significant difference between them (t=-2.530, P=0.016). The BCVA was better at the seventh day after surgery in the pre-chop group than that in the phaco-and-chop group (4.75±0.11 vs.4.67±0.14), showing a significant difference between the two groups (t=2.147, P=0.038). In 1 month after surgery, the CECs loss rate was (10.82±3.77)% in the pre-chop group, which was lower than (16.11±6.47)% in the phaco-and-chop group (t=-3.758, P=0.001). The number of the eyes with grade 2-3 of corneal edema in the pre-chop group was significantly decreased in comparison with the phaco-and-chop group 7 days after surgery (Z=11.822, P=0.008). Conclusions Compared with the conventional phaco-and-chop technique, reverse-chopper prechop technique appears to have a better efficacy and safety in phaco surgery for high-myopia associated with hard nuclear cataractous eyes. Key words: Cataract extraction/methods; Phacoemulsification/methods; High myopia; Lens nucleus, crystalline/surgery; Treatment outcome; Pre-chopping technique; Phaco-and-chop technique; Randomized-controlled clinical study; Reverse-chopper

Choice of operative time and method for pseudoexfoliation syndrome combined cataract with zonular defect

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract, accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However, relative study is rare. Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method. Methods A serial cases-observational study was performed, and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery inSecond People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes), grade Ⅲ (9 eyes), grade Ⅳ(7 eyes) and grade Ⅴ(3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for gradeⅡ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes, and phacoemulsification combined MCTR insertion and IOL implantation, or lens loop nucleus-deliver, anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months, and optimal operation timing, best corrected visual acuity (BCVA), intraocular pressure (IOP), complications and anterior capsular opening, IOL position were assessed. Results In the patients with phacodonesis, CTR was inserted in 10 eyes, and MCTR was inserted in 3 eyes, and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and 1 eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens, only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation, and other 4 eyes received lens loop nucleus-deliver, anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was >0.5 in 4 eyes, >0.3-≤0.5 in 6 eyes, >0.1-≤0.3 in 8 eyes, ≤0.1 in 5 eyes, which was better than that before surgery (χ2=17.29, P 0.05). The intra- and post-operative complications included small pupil, corneal edema, residual cortex and posterior capsular opacification. Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect, hardness of lens nuleus, with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC. Key words: Pseudoexfoliation syndrome/complications; Cataract; Lens nucleus, crystalline/pathology; Zonular defect; Phacoemulsification; Lens implantation, intraocular; Operative time; Operative method; Capsular tension ring

A cross sectional study for evaluation of intraoperative and postoperative posterior segment complications of cataract surgery

Introduction: There is always some risk of complications during or immediately after cataract surgery so regular collection of data helps to identify high-risk patients and to confirm that they are being managed appropriately. Monitoring of cataract surgical outcomes is associated with a reduction in the incidence of surgical complications. Materials and methods: After obtaining ethics committee clearance, this cross-sectional, observational study was conducted in 500 patients having visually significant cataract those underwent planned extracapsular cataract extraction by phacoemulsification with PCIOL implantation method to evaluate the posterior segment complications of cataract surgery between October 2015 and September 2016. Results and discussion: Complications evaluated were cystoid macular edema, nucleus drop, expulsive and delayed suprachoroidal hemorrhage, infectious post-operative endophthalmitis, retinal detachment following cataract extraction and any other complication which involving posterior segment of eye. Out of 500 patients, 6 had postoperative complications in the form of CME (1.2%). No incidence of any other posterior segment complications occurred in present study. Conclusion: Cataract surgery is a safe procedure with a high patient satisfaction rate. The occurrence of pseudophakic cystoid macular edema after cataract surgery is a well known complication. As in our study CME incidence was 1.2%.

Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract

Objective To evaluate the clinical efficacy of phacoemulsification combined with trabeculectomy for the treatment of angle-closure glaucoma with cataract. Methods Thirty-eight eyes of 32 cases with angle-closure glaucoma with cataract were selected and retrospectively analyzed.All cases underwent phacoemulsification combined with trabeculectomy. The visual acuity, intraocular pressure, anterior chamber depth and complications in pre- and post-operation were observed. Results The follow-up time was 3-12 months. The average intraocular pressure were(25.8±3.9)mmHg(1 mmHg=0.133 kPa) and (14.2±4.1)mmHg in pre- and post-operation respectively, and the difference was statistically significant (t=12.637, P=0.000). The high intraocular pressure after operation occurred in 2 eyes, 1 eye intraocular pressure decreased to normal range after topical anti glaucoma drugs treatment for 2 days, and the other eye received trabeculectomy again. The visual acuity≥ 0.3 was in 11 eyes preoperatively and 36 eyes postoperatively .The difference was statistically significant (χ2=34.8500, P=0.0000). The anterior chamber depth in pre-and post-operation were (2.0±0.3) mm and (3.7±0.4) mm respectively, the difference was statistically significant between before and after treatment.(t=-20.959, P=0.000). Hyphema occurred in 3 eyes (7.9%), corneal edema in 5 eyes (13.2%), and anterior chamber inflammation in 5 eyes (13.2%), they were corrected after symptomatic treatment. No posterior capsular rupture and after-cataract happened. Conclusion Phacoemulsification combined with trabeculectomy for angle-closure glaucoma with cataract can effectively improve vision, reduce intraocular pressure and deepen the anterior chamber depth. Key words: Glaucoma, angle-closure; Cataract; Phacoemulsification; Trabeculectomy

The clinical application of trypan blue and iris retractor in phacoemulsification for the treatment of subluxation of lens in patients with Marfan syndrome

Objective To evaluate the efficacy of application of trypan blue and iris retractor in phacoemulsification for the treatment of subluxation of lens in patients with Marfan syndrome. Methods Seventeen eyes of 12 patients with Marfan syndrome and subluxation of lens were selected for retrospective study. All patients underwent phacoemulsification and intraocular lens with suture fixation at ciliary sulcus assisted with trypan blue and iris retractor. The follow-up time was 6-24 months. Results The visual acuity and the best corrected visual acuity were improved significantly at 1 month postoperatively (P= 0.001, 0.039). The degree of intraocular lens tilt was (1.140±1.060)degree, the off-center distance of IOL was (0.23±0.28) mm at 6 months postoperatively. Conclusion Application of flexible iris retractor and trypan blue for the treatment of Marfan syndrome and lens subluxation during phacoemulsification obtains good effect. Key words: Marfan syndrome; Iris retractor; Trypan blue; Lens; Subluxation

Treatment of angle-closure glaucoma with cataract

Objective To investigate the clinical efficacy of phacoemulsification and intraocular lens implantation in treatment of angle-closure glaucoma with cataract. Methods Sixty-four eyes of 64 cases with primary angle-closure glaucoma with cataract were selected and randomly divided into clinical trial group and the control group (n=32) according to the different methods of treatment. Patients in the trial group received phacoemulsification combined intraocular lens (IOL) implantation, the control group underwent phaco emulsification combined artificial lens implantation and peripheral iridectomy treatment. The efficacy and complications of two groups were observed. Results The difference in visual acuity and IOP between before and after surgery were not statistically significant (P> 0.05). Postoperative follow-up of 6 months, the vision ≥0.5 in experimental group were in 75.00%, intraocular pressure were (14.16±1.42) mmHg(1 mmHg=0.133 kPa), the vision ≥0.5 in control group were in 46.88 %, intraocular pressure were (14.27±1.65) mmHg. In the trial group the improvement of visual acuity and intraocular pressure were better than those of in the control group, the difference were statistically significant (P< 0.05). The complication rate of trial group was 9.38%, it was significantly lower than that of the control group 28.13%, the difference between the two groups was statistically significant.(P<0.05). Conclusion Phacoemulsification and intraocular lens implantation treated angle-closure glaucoma with cataract can improve the treatment effect, reduce the incidence of complications, it has small trauma and high safety. Key words: Glaucoma, closed-angle, primary; Cataract; Phacoemulsification

The changes of thickness of central macular retina and choroid after phacoemulsification in eyes with diabetic retinopathy

Objective To observe the changes of central macular retinal thickness(CMRT) and subfoveal choroidal thickness(SFCT) after phacoemulsification in eyes with non proliferative diabetic retinopathy (DR). Methods Thirty-nine eyes of 39 patients of cataract with DR and 30 eyes of 30 patients of cataract without diabetes were enrolled. The DR patients were divided into ME+ group and ME-group according to evidence of clinically significant macular edema. All cases were examined by optical coherence tomography before cataract surgery and repeated 1 month after surgery. The changes of CMRT (r<500 μm) and SFCT were observed. Results DR groups included 24 eyes of ME-group and 15 eyes of ME+ group. No complication occurred during or after operation. After surgery the CMRT in three groups were more than those before surgery (P=0.002, 0.007, 0.001), but no significant change was verified for SFCT in all groups (P=0.058, 0.264, 0.514). Conclusion The CMRT of DR or non DR patients is more after phacoemusification than before surgery. There is no change in SFCT after surgery. Key words: Cataract; Phacoemulsification; Thickness, retina, choroid; Retinopathy, diabetic

The efficacy of phacoemulsification and intraocular lens implantation for patients of high myopia with cataract

Objective To evaluate the efficacy of phacoemulsification and intraocular lens implantation for patients of high myopia with cataract. Methods Thirty-nine eyes of 28 patients of high myopia with cataract were selected and retrospectively analyzed in our hospital from July 2014 to July 2015. All cases were treated by phacoemulsification and intraocular lens implantation. The visual acuity and complications after surgery were observed. Results Visual acuity <0.2 were in 9 eyes, 0.25 and 0.4 were in 19 eyes, ≥ 0.5 were in 11 eyes. The uncorrected visual acuity and best corrected visual acuity after surgery were significantly higher than those preoperative (P<0.05). The corneal edema postoperative occurred in 4 eyes (10.2%), intraocular hypertension happened in 1 eye (2.6%), the complication rate was 12.8%. After treatment 3-7 ds, corneal edema in all patients subsided, and the intraocular pressure returned to normal. Conclusion The phacoemulsification and intraocular lens implantation for patients high myopia with cataract, could effectively improve visual acuity and best corrected visual acuity, and it has a slight surgical trauma, postoperative visual acuity recovers fast. Key words: Myopia, high; Cataract; Phacoemulsification; Lens, intraocular, implantation

Comparison study of the visual quality after different spherical aberration IOL implantation

Objective To compare the visual quality of different total eye spherical aberration after different spherical aberration IOL implantation. Methods Sixty-three eyes of 55 cases underwent phacoemulsification and IOL implantation.All patients were implanted different spherical aberration IOL based on corneal spherical aberration. According to the different postoperative total eye spherical aberration, patients were divided into 3 groups. Group A, postoperative total spherical aberration was(-0.2±0.05)μm, group B was (0±0.03)μm and group C was(+ 0.1±0.03)μm. Three months after surgery, uncorrected visual acuity, best corrected visual acuity, total high order aberration, modulation transfer function(MTF) and satisfaction of the three groups were compared. Results The differences in postoperative uncorrected visual acuity and the best corrected visual acuity between the three groups were not statistically significant(H=4.418, H=0.050; P=0.110, P=0.975). The difference in high order aberration(HOA) was not statistically significant among the three groups(H=2.637, P=0.268). The difference in MTF was statistically significant among the three groups (P=0.000). The difference in satisfaction was statistically significant among the three groups(F=20.845, P=0.000). Conclusion According to the corneal spherical aberration personalized implanted IOL, making total eye spherical aberration to + 0.1 μm, the surgery may obtain better postoperative visual quality and higher satisfaction. Key words: Cataract; Phacoemulsification, IOL implantaion; Spherical aberration; Visual quality

Comparison on the efficacy between the multifocal and monofocal aspheric toric intraocular lens in cataract patients

Objective To compare the clinical efficacy between the multifocal and monofocal aspheric toric intraocular lens in cataract patients. Methods Seventy-two eyes of 56 patients with age-related cataract underwent phacoemulsification were randomly divided into 2 groups. In group A, the aspheric multifocal toric intraocular lens were implanted in 37 eyes of 29 patients. In group B, the aspheric monofocal toric intraocular lens were implanted in 35 eyes of 27 patients. After surgery, the visual acuity, postoperative residual corneal astigmatism, the IOL axis rotational stability, higher-order aberrations and contrast sensitivity were observed and statistically analyzed. Results At 3 months after surgery, the differences in uncorrected near visual acuities (log MAR) were statistically significant between two groups (t=8.569, P=0.003). There was no significant difference in the uncorrected distance, corrected distance or near visual acuity (log MAR) between two groups (t=1.578、1.325、1.098, P= 0.236、0.281、0.217). There was no significant difference in postoperative residual corneal astigmatism between two groups (t=1.775, P=0.135). There was no significant difference in the axis rotation between two groups (t=2.165, P=0.117). There was no significant difference in the general higher-order aberration, 3-order aberration, 4-order aberration or 5-order aberration root mean square value between two groups (t=1.567, 1.256, 1.457, 1.298, P=0.167, 0.158, 0.136, 0.237). There was no significant differrence at any spatial frequenciy of contrast sensitivity function between two groups (t=1.256, 2.359, 1.238, 2.258, 2.156, 1.982, 2.032, 2.987, P= 0.982, 0.758, 0.875, 0.702, 0.112, 0.189, 0.238, 0.356). Conclusion Phacoemulsification combined with aspheric multifocal toric intraocular lens implantation is an effective method for the correction of preexisting corneal astigmatism in cataract patient. The better uncorrected distance and near visual acuities are obtained for cataract patients. The surgery improves spectacles independence for distance vision and spectacles independence for near vision, with a high patient satisfaction. Key words: Cataract, age-related; Lens, intraocular, multifocal, monofocal, astigmatism-correcting, aspherical

Comparison on the application of five formulas in cataract patients with short axial length

Objective To compare the predicating accuracy of intraocular lens(IOL)power calculations by using five formulas(SRK-T, SRK-Ⅱ, Holladay-1, Haigis and Hoffer Q)in eyes of age-related cataract with short axial length before surgery. Methods Sixty-three eyes of 63 cases of age-related cataract with short axial length(<22.0mm) were collected and their optical biometry were performed by the Zeiss IOL Master before operation. All patients underwent regular phacoemulsification and posterior chamber IOL implantation by the same surgeon. No complication occurred. The actual postoperative refraction was measured with the methods of phoropter and subjective optometry at 3 months after surgery. The differences of actual postoperative refraction predicted and measured with the five formulas among the short axial lengths cases were compared. Results In the short axial lengths cases, the differences between Haigis formula and SRK-T、Holladay-1、Hoffer Q were statistically significant (P 0.05). The difference among the five formulas of the number of cases which forecast error was 0.05). Conclusion In the short axial lengths cases, the accuracy of intraocular lens power calculations by using SRK-Ⅱ、SRK-T、Holladay-1 and Hoffer Q is high. Key words: Cataract, short axial lengths; Phacoemulsification; Lens, intraocular; Formula, calculating

The modification on the single haptic transscleral ciliary sulcus fixation of intraocular lens for congenital subluxation of lens

Objective To evaluate the clinical efficacy of modified single haptic transscleral ciliary sulcus fixation of intraocular lens for congenital subluxation of lens. Methods The data of 46 eyes of 27 patients aged 4-48 years with congenital subluxation of lens ranged from 2 to 3 quadrants were retrospectively analyzed. All cases underwent phacoemulsification and IOL implantation. The single haptic transscleral sulcus fixation of intraocular lens and the other haptic was implanted into the capsular bag. Before the fixation of the haptic, two incisions were done on the residual anterior capsule perpendicular to the equator about 40° apart after capsulorhexis at the most serious dislocation area. This flap was folded laying on the loose suspensory ligament. The follow-up time was 6-12 months. The visual acuity, intraocular pressure (IOP) location of IOL and complications were recorded. Results The operations were performed successfully in 42 eyes (91.30%). Prolapse of vitreous during the surgery occurred in 4 eyes (8.70%) and they was resolved after anterior vitrectomy. The visual acuity at 1 month after the surgery were 0.05-0.25 in 3 eyes (6.52%), 0.3-0.5 in 18 eyes (39.13%), 0.6-0.8 in 22 eyes (47.83%) and 1.0 in 3 eyes (6.52%). Postoperative visual acuity improved significantly compared with preoperative visual acuity, the difference was statistically significant (Z=5.026, P=0.000). The IOP of 5 eyes(10.87%)were high after the surgery. After used the IOP-lowering drugs, the IOP was controlled. There was not serious complication such as IOL asymmetry or tilt, decompensation of corneal endothelium, vitreous overflowing or retinal detachment after the surgery. Conclusion Modified single haptic transscleral sulcus fixation of intraocular lens for congenital lens subluxation is safe and effective. It can improve visual acuity and prevent the decentration or tilt of IOL without capsular tension ring implantation or IOL implantation with two haptics. And it also can simplify the operation procedure and shorten the operation time. Key words: Subluxation of lens, congenital; Lens, intraocular; Transscleral ciliary sulcus fixation, single haptic, modified

Weakness and numbness of extremities with bowel and bladder dysfunction for four years

Weakness and numbness of extremities with bowel and bladder dysfunction for four years

Inhibition effects of sulforaphane-induced autophagy flux to cell proliferation on ex vivo human capsular bags

Background Sulforaphane (SFN) is an effective chemopreventive agent and can regulate the biological molecular mechanisms to inhibit the overgrowth of cells.Autophagy is a biological process of maintaining cellular internal environment.Understanding the affection of SFN to biological behavior of human lens epithelial cells (LECs) and the association of SFN with autophagy is helpful for the prevention and target treatment of posterior capsule opacification (PCO). Objective This study was to investigate the eradication effeccts of SFN on residual lens cell population in vitro posterior capsule opacification (PCO) model and evaluate the mechanism of SFN-induced cell death. Methods In vitro human capsular bag models were generated from fresh donor eyes by phacoemulsification and were cultured in EMEM containing 2% fetal bovine serum (FBS). Different concentrations of SFN (0, 1, 10 and 100 μmol) were added in the medium for 30 days respectively according to grouping, and the growth of LECs was observed by optical microscope and immunofluorescence technique.FHL124, a human LEC line, was cultured with EMEM containing 5%FBS and divided into 0, 1, 10, 30 and 100 μmol SFN groups.Lactate dehydrogenase (LDH) release rate in the medium was detected to evaluate cell damage/death.The migration of the cells on capsular bags was assessed by scratch test.The ultrastructure and number of autophagosomes were examined under the transmission electron microscope.The expression of LC3 in the cells were detected using Western blot in the presence or absence of autophagy inhibitors. Results The cell coverage rates on the capsular bags were significantly lower in the 10 and 100 μmol/L SFN groups than those in the 0 and 1 μmol/L SFN groups, with a statistically significant difference among the groups (F=48.57, P<0.01). Immunofluorescence showed that the density of F-actin-and Vimentin-positive cells was evidently decreased in the 10 and 100 μmol/L SFN groups compared with 0 and 1 μmol/L SFN groups.The releasing levels of LDH (absorbancy) were 0.19±0.03, 0.39±0.06, 0.56±0.07, 0.68±0.08 and 0.89±0.09 in the 0, 1, 10, 30 and 100 μmol/L SFN groups, respectively, and the releasing level of LDH was gradually increased in the 10 and 100 μmol/L SFN groups in comparison with the 1 μmol/L SFN group (all at P<0.01). With the increase of SFN concentration, the reduction rate of scratched area decreased with the increase of SFN concentration, and the decrease of scratch area was significantly lower than that of adjacent low mass concentration group and the differences were statistically significant (P<0.05). The relative expressions of LC3-Ⅱ protein were 0.423±0.003, 14.543±0.024, 0.668±0.024 and 0.576±0.056 in the blank control group, SFN group, SFN+ 3-MA group and 3-MA group, respectively, and the relative expressions of LC3-Ⅱ protein were significantly lower in the SFN+ 3-MA group and 3-MA group than those in the SFN group (all at P<0.01). The number of autophagosomes was 4.07±0.32, 4.13±0.34, 9.21±0.53 and 21.02±1.34 in the blank control group, and 1, 10, 100 μmol/L SFN groups, and the number of autophagosomes in the 10 and 100 μmol/L SFN groups was significantly higher than that in the blank control group and 1 μmol/L SFN group (all at P<0.01). Conclusions SFN mediates LECs death by promoting autophagy in ex vivo capsular bags, and SFN may be a novel agent of potential chemopreventive and target treatment for PCO. Key words: Lens capsule, crystalline; Isothiocyanates; Thiocyanates/therapeutic use; Cell line; Lens epithelial cells; Models, biological; Autophagy/drug effects; Posterior capsule opacification