2009例藏族白内障患者的病因构成及相关因素分析

目的:分析2009例藏族白内障手术患者的病因构成及相关因素。方法:收集2013年10月至2014年10月西藏自治区藏医院眼科2009例藏族白内障手术患者病例资料,按病因、年龄、性别、白内障类型、人工晶状体屈光度、文化程度、经济水平进行分类,运用统计学方法分析西藏地区藏族白内障患者发病特点。结果:2009例藏族白内障手术患者中,年龄相关性白内障1885眼(93.83%),核性白内障1197例(59.58%)。年龄2-89岁,平均年龄62.53岁,男1012眼(50.37%),女997眼(49.63%)。50-59岁年龄组的核性白内障患者比例明显高于40-49岁年龄组(P0.01;80-89岁年龄组的核性白内障患者比例高于70-79岁年龄组(P0.05)。根究Emery分级,50-59岁年龄组Ⅳ级白内障患者比例明显高于40-49岁年龄组(P0.01);80-89岁年龄组Ⅳ级白内障患者比例明显高于70-79岁年龄组(P0.05)。术前裸眼视力为0.02及0.02以下1688例(84.02%)。高度近视患者13例(0.65%),远视患者406例(20.21%)。农牧区患者1310例(65.21%),明显多于其他行业患者。结论:年龄相关性白内障仍是西藏地区藏族白内障患者的主要病因,以核性白内障为主要发病类型。随年龄增长,核性白内障患者越来越多,核硬度分级越来越高。患者主要来源于农牧区,多数术前视力差。高度近视发病率较其他地区发病率低,而远视发病率较高。     

白内障术后感染性眼内炎的致病菌分析及影响因素研究

目的:分析白内障术后感染性眼内炎的致病菌分布情况,并对其影响因素进行分析。方法:选取2016年8月~2019年3月期间于我院行白内障手术的患者2936例,统计白内障术后感染性眼内炎的发生情况。分析术后感染性眼内炎患者的病原菌分布情况及病原菌耐药情况。单因素及多因素Logistic回归分析术后感染性眼内炎发生的影响因素。结果:本研究中,共发放2936份调查问卷,回收2931份,回收率为99.83%(2931/2936)。其中53例患者患有感染性眼内炎,发生率为1.81%(53/2931),根据患者是否患有感染性眼内炎分为感染组(n=53)和未感染组(n=2878)。感染性眼内炎的病原菌检出41株,其中革兰阳性菌37株,占90.24%;共检出4株真菌,为白色假丝酵母菌,占比9.76%。37株革兰阳性菌中,头状葡萄球菌、表皮葡萄球菌以及腐生葡萄球菌对利福平、利奈唑胺以及万古霉素的敏感度达100.00%。感染组和未感染组在性别、住院时间、玻璃体溢出方面比较差异均无统计学意义(P>0.05);两组在麻醉药时间、年龄、手术切口、手术时间、高血压、糖尿病方面比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均是发生感染性眼内炎的危险因素(OR=2.759、2.676、1.601、1.261,P<0.05)。结论:白内障术后感染性眼内炎的致病菌较多,以革兰阳性菌为主,革兰阳性菌对利福平、利奈唑胺、万古霉素的敏感度较高,年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均会增加术后感染性眼内炎发生的风险。     

河南省76698例体检人群心肺功能检查结果与分析

目的:肺功能和心电图检查是心肺运动试验(CPET)人体心肺代谢整体功能评估不可或缺的组成部分,本研究对肺通气功能、换气功能和小气道功能异常及其临床相关特征进行分析。方法:采用横断面研究方法对2016年1月至2019年l2月在河南省人民医院就诊76 698例体检人员行常规心电图、肺通气和换气功能检查,比较不同性别、年龄组心肺功能异常检出率,进一步分析心肺功能异常严重程度的特点。结果:(1)在76 698例常规心电图异常检出率为71.04%。(2)肺通气功能异常检出率36.86%,其中男性44.78%(17 570/39 237),女性28.57%(10 703/37 461),男性显著高于女性(P0.01),且各年龄段男性检出率均高于女性(P均0.01)。(3)小气道功能异常检出率为56.26%,男性57.73%(22 661/39 237),女性54.72%(20 499/37 461),不同性别比较,差异有统计学意义(P0.01),其中30～39岁组,40-49岁组女性检出率高于男性(P均0.05),20～29岁组,50～59岁组,60～69岁组,≥70岁组均男性高于女性(P0.05)。(4)换气功能异常检出率为28.54%,其中男性30.55%(7 433/24 327),女性26.50%(5 507/20 780),二者差异有统计学意义(P0.05);30～39岁组(P0.05)、20～29岁组和40～49岁组(P均0.05),检出率女性高于男性,50～59岁组,60～69岁组,≥70岁组,男性检出率均高于女性(P均0.05)。结论:河南体检人群心功能、肺通气功能、换气功能及小气道功能异常的检出率较高,男性明显大于女性,年龄≥70岁者高于其他年龄段。     

55岁以下急性冠状动脉综合征的影响因素分析

目的:探究55岁以下急性冠状动脉综合征(Acute coronary syndrome,ACS)患者的影响因素。方法:选择2010年3月至2013年3月于我院就诊的180例55岁以下ACS患者为研究对象,按照其性别将其区分为男性组(101例)和女性组(79例)。收集和比较两组患者一般临床资料,血清血红蛋白(Hemoglobin,HGB)、甘油三酯(Triglyceride,TG)、胆固醇(Cholesterol,TC)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、血尿酸水平。对两组患者进行5年随访,对比两组患者心血管不良事件(Major adverse cardiovas-cular events,MACE)的发生率、死亡率及再发病率。结果:(1)女性组平均发病年龄高于男性组,女性组伴发高血压、糖尿病、脑卒中比率高于男性组,男性组吸烟史比率高于女性组(P<0.05),两组BMI、心血管病家族史对比差异无统计学意义(P>0.05);(2)女性组TC、TG、LDL-C、HDL-C水平均高于男性组(P<0.05),女性组血尿酸水平低于男性组(P<0.05);(3)对比5年预后,男性组MACE发生率为9.90%(10/101),女性组MACE发生率为11.39%(9/79),男性组死亡率为1.98%(2/101),女性组为1.27%(1/79),再发病率男性组为5.94%(6/101),女性组为6.33%(5/79),两组上述指标对比差异均无统计学意义(P>0.05)。结论:女性ACS患者发病年龄高于男性患者,糖尿病、高血压等病对女性患者影响更为明显,而吸烟则对男性影响更大,女性ACS患者血脂、血尿酸等指标异常程度甚于男性患者,但女性与男性患者远期预后相当。     

哈尔滨地区围绝经期女性健康现状及保健需求分析

目的:了解哈尔滨地区围绝经期女性健康现状及对相关保健知识认知现状。方法:采用分层整群抽样,于2011年从哈尔滨18个区、县随机抽取40～65岁围绝经期女性进行调查。结果:①2520例被调查女性平均年龄49.90岁,其中自然绝经者占37.4%,平均绝经年龄49.49岁。②13项症状的发病率从18.5%～59.1%不等,最常见的前五位症状依次为心悸(59.1%)、疲乏无力(53.4%)、骨关节肌肉痛(50.1%)、性交痛及阴道发干(49.0%)、易激动(48.8%)。Kupperman评分总分≥17分653例,占25.9%。围绝经期综合征随年龄增长逐渐加重,经Logistic回归分析其患病率与教育程度、绝经分期有相关性。③30.3%女性表示"听说过性激素替代治疗",且郊区明显低于城区;使用率仅为1.3%。结论:哈尔滨地区女性围绝经期症状患病率较高,其保健知识有待提高。应依托社区和媒体,加大宣传力度,提高围绝经期女性生活质量。     

三维超声心动图评价不同年龄段和性别主动脉瓣二叶畸形

目的:三维超声心动图评估不同年龄段和性别主动脉瓣二叶畸形(bicuspid aortic valve malformation,BAV)的应用价值。方法:超声心动图检测我院2012年6月至2014年9月70例BAV患者,根据年龄段分为4组,≤20岁年龄组7例,21-40岁年龄组14例,41-60岁年龄组30例,≥60岁年龄组19例;根据性别分为2组,男性42例,女性28例。测量不同病例分组的主动脉窦部及升部内径、室间隔厚度、左心功能及左房横径,比较主动脉瓣狭窄、关闭不全、钙化及脱垂四个合并症发生率。结果:在心脏结构指标方面,年龄段分组室间隔厚度≥60岁年龄组12.37±1.64 mm高于≤20岁年龄组10.43±2.22 mm和21-40岁年龄组11.00±1.92 mm;左房横径41-60岁年龄组38.73±7.95 mm和≥60岁年龄组40.05±9.71 mm高于≤20岁年龄组29.86±1.86 mm。性别分组左心功能女性64.18±6.04%高于男性58.71±11.28%。在合并症发生率方面年龄段分组主动脉瓣狭窄41-60岁年龄组80%、≥60岁年龄组84%高于21-40岁年龄组50%,性别分组狭窄男性81%大于女性54%,关闭不全女性79%大于男性50%。结论:三维超声心动图诊断BAV可获得更加全面、具体、直观的诊断信息,BAV的超声表现与患者年龄段和性别密切相关。     

社区老年人慢性肾脏病患病率调查及其危险因素分析

目的:调查北京市通州区永顺社区老年人的慢性肾脏病(CKD)患病率,并分析其危险因素。方法:采用横断面调查方法,对该社区长期居住的65岁及以上的通州区户籍老年人进行问卷调查、肾脏损伤指标及其他实验室指标的检测,收集资料并分析CKD患病的危险因素。结果:本次调查共获得948例该社区常住老年人的完整资料,参与研究的老年人平均年龄为70.86±4.89岁;镜下血尿患病率为9.39%,白蛋白尿患病率为22.15%,5.70%的老年人出现肾功能下降,该人群中CKD患病率为36.81%(349/948)。单因素分析结果显示,两组吸烟史、饮酒史、血肌酐、体质量指数(BMI)、尿微量白蛋白肌酐比(ACR)、糖尿病、甘油三酯、总胆固醇及血尿酸水平对比无显著性差异(P0.05),而CKD组较非CKD组年龄更大、合并高血压的比例更高、女性占比更高(P0.05),多因素logistic回归分析显示年龄、女性与高血压是通州区永顺社区老年人CKD患病的危险因素(OR=1.432、1.163、1.335,P0.05)。结论:北京市通州区永顺社区老年人CKD患病率较高,其危险因素为年龄、女性与高血压。     

单人建立大鼠原位肝移植模型的手术体会

目的:探讨单人建立稳定大鼠原位肝移植模型手术中的难点及对策。方法:单人及双人裸视下采用改良二袖套法制备大鼠原位肝移植模型各50例。结果:单人及双人组供体手术时间、无肝期、受体手术手术时间分别为:(39.16±2.89)min和(38.36±3.04)min、(19.92±1.36)min和(19.70±1.40)min、(61.98±3.46)min和(58.65±3.94)min;单人及双人组手术成功率、1周存活率、一月存活率分别为:94.0%(47/50)和92.0%(46/50)、86.0%(43/50)和88.0%(44/50)、86%(43/50)和84%(42/50)。结论:通过改进手术方法,简化操作,单人即可建立稳定的大鼠原位肝移植模型。     

透明帽辅助结肠镜单人操作在老年患者检查中的临床应用

目的:探讨透明帽辅助结肠镜单人操作在老年患者检查中的临床应用.方法:对2009年8月至12月来我院消化内镜中心进行检查的408例年龄大于60岁的患者,随机分成A组(204例)和B组(204例),全部检查均在非麻醉状态下操作.A组予以透明帽辅助结肠镜检查,B组行常规结肠镜检查.对两种方法的成功率、平均插镜时间、平均疼痛评分、息肉检出率等指标进行比较.针对性别、年龄、腹部或盆腔手术史、长期便秘、肠道憩室等指标分析插镜时间的影响因素.结果:A组和B组结肠镜检查的成功率分别为99.1%和98.5%.平均插镜时间分别为6.4 min和10.8 min(P＜0.05).平均疼痛分数分别为5.8分和5.1分.息肉检出率分别为70.6%和49.5%(P＜0.05).全部检查无并发症发生.在插镜时间的影响因素中,女性、年龄＞80岁、腹部或盆腔手术史、长期便秘等因素有显著差异(P＜0.05).结论:透明帽辅助结肠镜单人操作对于老年患者是一种安全、插镜时间较短、息肉检出率较高的检查方法,年龄超过80岁的老年女性、有腹部或盆腔手术史、长期便秘是导致插镜时间延长的相关因素.     

清栓酶治疗脑梗塞38例疗效分析

我院用清栓酶(蝮蛇抗栓酶)治疗脑梗塞38例(观察组)与30例应用血管扩张剂及血液稀释剂低分子右旋糖酐(对照组)治疗对比。现报道如下: 一般资料: 按1978年全国第二届神经精神学术会议制定的标准及全部患者均经脑CT检查确诊脑梗塞68例,随机分两组。观察组(Ⅰ组):38例,男28例,女10例。年龄43～82岁,平均年龄62岁。发病到开始治疗时间2～31天,平均4天。原发病:脑血栓35例,脑栓塞3例。对照组(Ⅱ组):30例,男21例,女性9例。年龄47～86岁,平均64岁。发病到开始治疗时间14小时～22天,平均2天。原发病:脑血栓28例,脑栓塞2例。两组病情大致相同(x~2=0.0412,p>0.05)。治疗方法: Ⅰ组用清栓酶。过敏试验阴性后成人0.25～0.75单位加入5～10％葡萄糖液或生理盐水250毫     

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute,India

Purpose

To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.

Methods

The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.

Results

Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).

Conclusions

This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.     

Prevalence and Outcomes of Cataract Surgery in Adult Rural Chinese Populations of the Bai Nationality in Dali: The Yunnan Minority Eye Study

Purpose

To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in adults of the Bai Nationality populations in rural China.

Methods

We conducted a population-based cross-sectional survey (from randomly selected block groups) of Chinese Bai Nationality aged ≥50 years in southwestern China. Presenting visual acuity (PVA), best corrected visual acuity (BCVA) were recorded and a detailed eye examination was carried out. For all aphakic and pseudophakic subjects identified, information on the date, setting, type, and complications of cataract surgery were recorded. In eyes with VA <20/63, the principal cause of visual impairment was identified.

Results

Of 2133 (77.8% of 2742) subjects, 99 people (129 eyes) had undergone cataract surgery. The prevalence of cataract surgery was 4.6%. Surgical coverage among those with PVA <20/200 in both eyes because of cataract was 52.8%. Unoperated cataract was associated with older age. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 129 cataract-operated eyes, 22.5% had PVA of ≥20/32, 25.6% had PVA of 20/40 to 20/63, 23.3% had PVA <20/63 to 20/200, and 28.7% had PVA<20/200. With BCVA, the percentages were 42.6%, 23.3%, 10.9%, and 23.3%, respectively. Aphakia (odds ratio [OR], 8.49; P<0.001) and no education (OR, 10.18; P = 0.001) or less education (OR, 6.49; P = 0.014) were significantly associated with postoperative visual impairment defined by PVA, while aphakia (OR, 8.49; P<0.001) and female gender (OR, 4.19; P = 0.004) were significantly associated with postoperative visual impairment by BCVA. The main causes of postoperative visual impairment were refractive error, retinal disorders and glaucoma.

Conclusions

Half of those with bilateral visual impairment or blindness because of cataract remain in need of cataract surgery in Bai population. Surgical uptake and visual outcomes should be further improved in the future.     

Findings from a rapid assessment of avoidable blindness (RAAB) in Southern Malawi

Background

Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community.

Methodology

A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling “E” chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery.

Results

A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5–4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%.

Conclusion

The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi.     

Postoperative outcomes after implantation of intraocular lenses in eyes with cataract and uveitis

Despite advances in surgical technique and implant materials, cataract surgery in patients with uveitis is still a challenging procedure. We retrospectively evaluated postoperative outcomes of cataract surgery in 35 eyes of 29 patients with uveitis. Phacoemulsification with posterior chamber intraocular lens implantation was performed in all eyes. Postoperative evaluations were performed at day 2, and then at 7 days, 1, 3, and 6 months respectively. There were 16 males, and 13 females, aged 31 to 68 years. Follow-up ranged from 4 to 35 months. At final follow-up 33 eyes (94%) had an improvement in visual acuity compared with preoperative levels (p < 0,05). Giant cells were observed in the intraocular lens optic in 7 eyes (20%). Posterior capsule opacification occurred in 10 eyes (29%). Clinical cystoid macular edema was observed in 4 eyes, and 2 eyes required trabeculectomy with mitomycin C due to secondary glaucoma. Cataract surgery in patients with uveitis leads to successful visual results after correct surgical timing, and adequate anti-inflammatory therapy. There were no significant differences in the degree of inflammation after implantation of various types of intraocular lenses.     

Prevalence, causes and socio-economic determinants of vision loss in Cape Town, South Africa

Purpose

To estimate the prevalence and causes of blindness and visual impairment in Cape Town, South Africa and to explore socio-economic and demographic predictors of vision loss in this setting.

Methods

A cross sectional population-based survey was conducted in Cape Town. Eighty-two clusters were selected using probability proportionate to size sampling. Within each cluster 35 or 40 people aged 50 years and above were selected using compact segment sampling. Visual acuity of participants was assessed and eyes with a visual acuity less than 6/18 were examined by an ophthalmologist to determine the cause of vision loss. Demographic data (age, gender and education) were collected and a socio-economic status (SES) index was created using principal components analysis.

Results

Out of 3100 eligible people, 2750 (89%) were examined. The sample prevalence of bilateral blindness (presenting visual acuity <3/60) was 1.4% (95% CI 0.9–1.8). Posterior segment diseases accounted for 65% of blindness and cataract was responsible for 27%. The prevalence of vision loss was highest among people over 80 years (odds ratio (OR) 6.9 95% CI 4.6–10.6), those in the poorest SES group (OR 3.9 95% CI 2.2–6.7) and people with no formal education (OR 5.4 95% CI 1.7–16.6). Cataract surgical coverage was 68% in the poorest SES tertile (68%) compared to 93% in the medium and 100% in the highest tertile.

Conclusions

The prevalence of blindness among people ≥50 years in Cape Town was lower than expected and the contribution of posterior segment diseases higher than previously reported in South Africa and Sub Saharan Africa. There were clear socio-economic disparities in prevalence of vision loss and cataract surgical coverage in this setting which need to be addressed in blindness prevention programs.     

Rapid Assessment of Avoidable Blindness in the Occupied Palestinian Territories

Background

There are no recent data on the prevalence and causes of blindness in the Occupied Palestinian Territories. The aim of our study was to estimate the prevalence and causes of blindness and visual impairment in the population aged 50 years and above in the Occupied Palestinian Territories using the Rapid Assessment of Avoidable Blindness (RAAB) survey method.

Methods and Findings

Clusters of 40 people who were 50 years and above were selected with probability proportionate to size using a multistage cluster random sampling method. Participants received a comprehensive ophthalmic examination in their homes, including visual acuity testing by one of three experienced ophthalmologists. The principal cause for visual loss was determined by an experienced ophthalmologist using portable diagnostic instruments. Information about previous cataract surgery, satisfaction with surgery and barriers to cataract surgery were collected. The prevalence of self-reported diabetes was also determined. The prevalence of bilateral blindness (VA<3/60 in the better eye with available correction) was 3.4% (95% CI: 2.7–4.0), 2.0% (95% CI: 1.4–2.5) for severe visual impairment (VA≥3/60 and <6/60), and 7.4% (95% CI: 6.4–8.3) for visual impairment (VA≥6/60 and <6/18). Avoidable causes (i.e. cataract, refractive error, aphakia, surgical complications, corneal scarring and phthysis) accounted for 80.0% of bilateral blindness, severe visual impairment (70.7%) and visual impairment (86.2%). Cataract was the main cause of blindness (55.0%). The prevalence of blindness was higher in Gaza (4.9%, 95% CI: 3.7–6.1%) than in the West Bank (2.5%, 95% CI: 1.9–3.1%) and among women (4.3%,95% CI: 3.3–5.2%) compared to men (2.2%,95%CI:1.5–2.9%). Among people who had undergone cataract surgery in the past, only 54.5% of eyes obtained a good outcome (VA≥6/18), 23.2% had a borderline outcome (VA<6/18 and ≥6/60) and 22.3% had a poor outcome (VA<6/60) with available correction. The prevalence of self-reported diabetes mellitus in ≥50 year age group was 26.4% (95% CI: 24.9–27.9).

Conclusions

The prevalence of blindness suggests that significant numbers of people in the Occupied Palestinian Territories exist who do not access eye care - predominantly women and those residing in Gaza. Programmes need to focus on maximizing the use of current services by these excluded groups.     

玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的临床疗效

目的:评价玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的临床疗效。方法:选择2009年1月-2012年1月于我院进行玻璃体视网膜手术的先天性视网膜劈裂患者30例(42只眼),患者均接受了闭合式睫状体经扁平部三切口入路保留晶状体的玻璃体切割手术,并分析其术前及术后情况。结果:先天性视网膜劈裂患者中发生孔源性视网膜脱离19眼,牵拉性视网膜脱离8眼,玻璃体积血10眼,同时伴有视网膜脱离和玻璃体积血有5眼;在末次随访时视力提高者有36只眼,占85.71%,无提高者有6只眼,占14.29%;术前平均视力为(0.15±0.09),末次随访时平均视力提高至(0.31±0.16),两者平均视力差异具有统计学意义(t=5.649,P0.001);42只眼视网膜解剖结构复位良好,视网膜平伏;OCT检查结果显示,末次随访时黄斑劈裂平均面积(0.22±0.18)mm2,与术前黄斑劈裂平均面积(1.07±0.52)mm2比较,差异有统计学意义(t=10.011,P0.001),黄斑微囊样改变有改善;随访期间5只眼出现并发症,占11.90%,其中2眼术后发生PVR且伴牵拉性视网膜脱离,2只眼发生白内障,1只眼出现玻璃体积血,术后视网膜解剖均复位良好。结论:玻璃体视网膜手术可以帮助患者进行视网膜解剖复位及提高其先天性视网膜劈裂患者视功能,具有良好的临床疗效。     

单切口和双切口联合手术对闭角型青光眼合并白内障患者视力、IOP及CCT的影响

目的:探讨单切口和双切口联合手术对闭角型青光眼合并白内障患者视力、眼压(IOP)及中央前房深度(CCT)的影响。方法:选择2013年6月至2016年6月我院收治的90例闭角型青光眼合并白内障患者,随机分为观察组和对照组,每组各45例。对照组采用单切口手术治疗,观察组采用双切口手术治疗。观察并比较两组患者治疗前后角膜内皮细胞密度、面积、最佳矫正视力、裸眼视力、IOP以及术后并发症的发生率。结果:与术前比较,两组患者术后角膜内皮细胞密度均升高,且观察组高于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后角膜内皮细胞面积均减小,且观察组小于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后最佳矫正视力、裸眼视力均升高,且观察组高于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后IOP均降低,且观察组低于对照组,差异具有统计学意义(P0.05);与术前比较,两组患者术后CCT均升高,且观察组高于对照组,差异具有统计学意义(P0.05);观察组术后并发症总发生率低于对照组(P0.05)。结论:双切口手术治疗闭角型青光眼合并白内障的效果显著,能够有效改善患者视力、IOP及CCT水平,且安全性高,值得临床推广。     

Rapid Assessment of Avoidable Blindness in India

Background

Rapid assessment of avoidable blindness provides valid estimates in a short period of time to assess the magnitude and causes of avoidable blindness. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population.

Methods and Findings

Sixteen randomly selected districts where blindness surveys were undertaken 7 to 10 years earlier were identified for a follow up survey. Stratified cluster sampling was used and 25 clusters (20 rural and 5 urban) were randomly picked in each district.. After a random start, 100 individuals aged 50+ were enumerated and examined sequentially in each cluster. All those with presenting vision <6/18 were dilated and examined by an ophthalmologist. 42722 individuals aged > = 50 years were enumerated, and 94.7% examined. Based on presenting vision,, 4.4% (95% Confidence Interval[CI]: 4.1,4.8) were severely visually impaired (vision<6/60 to 3/60 in the better eye) and 3.6% (95% CI: 3.3,3.9) were blind (vision<3/60 in the better eye). Prevalence of low vision (<6/18 to 6/60 in the better eye) was 16.8% (95% CI: 16.0,17.5). Prevalence of blindness and severe visual impairment (<6/60 in the better eye) was higher among rural residents (8.2%; 95% CI: 7.9,8.6) compared to urban (7.1%; 95% CI: 5.0, 9.2), among females (9.2%; 95% CI: 8.6,9.8) compared to males (6.5%; 95% CI: 6.0,7.1) and people above 70 years (20.6%; 95% CI: 19.1,22.0) compared to people aged 50–54 years (1.3%; 95% CI: 1.1,1.6). Of all blindness, 88.2% was avoidable. of which 81.9% was due to cataract and 7.1% to uncorrected refractive errors/uncorrected aphakia.

Conclusions

Cataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them. Most blindness and low vision burden is avoidable.     

Cataract surgery and postoperative complications in diabetic patients

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.