Phacoemulsification, vitrectomy and the implantation of an intraocular lens in diabetic patients

The purpose of this study was to evaluate results of combined phacoemulsification, intraocular lens implantation and pars plana vitrectomy in patients with advanced diabetic retinopathy. We retrospectively evaluated postoperative outcomes and complications in 102 eyes of 102 patients who underwent a combined procedure. All patients had a visually significant cataract. Forty two patients had vitreous hemorrhage and mild proliferative diabetic retinopathy. Sixty patients had a mild tractional retinal detachment. The median follow up was 14 months (range 6-36 months). 80% of patients had an increase of visual acuity of at least 2 Snellen lines. The most frequent early postoperative complication was elevated intraocular pressure, followed by mild fibrinous reaction. The most frequent late postoperative complication was the presence of posterior synechia, followed by glaucoma. Eleven patients required a repeated pars plana vitrectomy. Combined phacoemulsification, posterior chamber intraocular lens implantation and pars plana vitrectomy can be successfully performed in selected diabetic patients with favorable postoperative outcome.     

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis

Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.     

超声乳化联合小梁切除术治疗闭角型青光眼合并白内障的临床研究

目的:探讨超声乳化白内障吸除术(Phaco)、人工晶状体植入术(IOL)联合小梁切除术(TBL)治疗原发性闭角型青光眼(PACG)伴厚晶状体白内障的临床疗效和安全性。方法:将82例(98眼)原发性闭角型青光眼伴厚晶状体白内障患者随机分为A组(41例52眼)和B组(41例46眼),A组行Phaco+IOL+TBL治疗,B组单纯行TBL治疗,比较两组的手术前后眼压、最佳矫正视力、中央前房深度(ACD)、小梁虹膜角(TIA)、房角开放距离500(AOD500)及小梁睫状体距离(TCPD)的变化、视力提高率及并发症的发生情况。结果:两组术后眼压均较术前显著降低,且A组的降低幅度显著高于B组(P0.05);两组术后最佳矫正视力均显著提高,且A组显著高于B组(P0.05);A组术后视力提高率为86.54%,显著高于B组的32.61%(P0.05);两组术后ACD、TIA、AOD500及TCPD均显著提高,且A组显著高于B组(P0.05);A组手术并发症发生率为5.77%,显著低于B组的17.39%(P0.05)。结论:超声乳化白内障摘除术、人工晶状体植入术联合小梁切除术治疗PACG伴厚晶状体白内障的疗效较单用小梁切除术更好,且安全性更高。     

Blue light filtering intraocular lenses in phacoemulsification cataract surgery

Blue light can damage retina and cause age related macular degeneration. After cataract surgery and lens removal retina stays unprotected. Blue light filtering intraocular lenses (IOL) increase protection of the retina. In our prospective study we investigated clinical results after bilateral implantation of Acrysof Natural IOL to 30 patients (N = 60 eyes). In a control group (N = 60 eyes, 30 patients), standard acrysof IOL was implanted bilaterally. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and Nd YAG laser capsulotomy rate were measured and compared with control group. Subjective patient's satisfaction and subjective colour perception were also investigated. There was no significant difference in UCVA, BCVA and Nd YAG laser capsulotomy rate between the two groups. High patient's satisfaction was noticed (96.7% of patients would implant Acrysof Natural IOL again). Acrysof Natural IOL enables good visual acuity VA, low rate of Nd YAG laser capsulotomy and high patient's satisfaction without colour perception disturbances.     

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.     

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.     

26例中国先天性晶状体异位患者的基因诊断及手术初步效果观察

摘要 目的：总结26例中国先天性晶状体异位患者的基因诊断及晶状体异位的手术疗效。方法：回顾性收集2019年3月-2020年3月就诊于北京同仁医院眼科来自不同家系的双眼先天性晶状体异位患者26例共52眼。收集详细临床资料，提取外周静脉血全基因组DNA，应用靶向基因捕获技术筛查晶状体异常相关基因突变对所有患者进行基因诊断，采取微创晶状体-玻璃体切除或白内障超声乳化手术，记录视力、人工晶状体位置及主要并发症，采用配对t检验对术前术后最佳矫正视力进行比较。结果：患者均为汉族，男性14例，女性12例，年龄（21.2±15.2）岁。25例患者存在FBN1突变，1例为GJA8突变。22例（84.6%）可确诊为马凡综合征，3例诊为"潜在马凡综合征"。42眼采取微创晶状体-玻璃体切除类手术，7眼采取白内障超声乳化类手术。有31眼（59.6%）存在视网膜变性行网膜激光光凝。平均随诊时间（15.7±3.7）月，术后6个月及末次随访的最佳矫正视力（最小分辨角对数视力，0.30±0.16及0.21±0.11）均高于术前（0.76±0.31），差异有统计学意义（t=12.492，P＜0.001；t=13.171，P＜0.001）。术后所有眼的人工晶状体位置及稳定性良好，未发生视网膜脱离、黄斑水肿、人工晶状体脱位、人工晶状体偏位、继发性青光眼、眼内炎等并发症。结论：马凡综合征是此26例中国人先天性晶状体异位的主要病因，FBN1基因突变检测可为确诊提供有力证据，微创晶状体-玻璃体切除联合人工晶状体悬吊术效果好。     

老年白内障患者超声乳化联合人工晶状体植入术1210例临床研究

目的：观察老年白内障患者超声乳化联合人工晶体植入术后的治疗效果,探讨白内障超声乳化人工晶状体植入术术中术后并发症及相应处理措施。方法：对1210例1325眼老年白内障超声乳化人工晶状体植入术患者的临床病例资料进行回顾性分析,统计术后疗效并分析术中术后并发症的原因。结果：1325眼术后视力均有不同程度的提高,发生术中晶状体碎核入玻璃体腔1眼,术后并发症主要为一过性高眼压、角膜水肿、晶状体后囊破裂及视网膜脱落,发生率分别为1．36％、7．47％、0．03％和0．02％。结论：超声乳化联合人工晶体植入术对老年白内障患者治疗效果满意。对于术中及术后发生的各种并发症应分析原因并积极的预防。     

Ocular Hypertension after Pediatric Cataract Surgery: Baseline Characteristics and First-Year Report

Monitoring intraocular pressure (IOP) is essential for pediatric cataract treatment but always difficult due to lack of cooperation in young children. We present the baseline characteristics and the first-year results of a long-term prospective cohort study, which are aimed to determine the relationship of the incidence of ocular hypertension (OH) in children after cataract surgery during the first-year period and the risk of developing late-onset glaucoma. Children were included with the following criteria: they were≤10 years old and scheduled to undergo cataract surgery with/without intraocular lens implantation; they were compliant with our follow-up protocol, which included monitoring IOP using a Tono-Pen under sedation or anesthesia. Incidence of OH, peak OH value, OH onset time and OH duration within a 12-month period following surgery were measured. In brief, 206 patients (379 eyes) were included and OH developed in 66 of 379 (17.4%) eyes. The mean follow-up period was 14.0±3.2 months (median, 12 months; range, 10–16 months). Moreover, 33 of 196 (16.8%) aphakic eyes and 33 of 183 (18.0%) IOL eyes were diagnosed with OH. The peak OH onset times were at 1-week (34/66, 51.5%) and 1-month (14/66, 21.2%) appointments postsurgery. The peak IOP value in the OH eyes was 29.9±7.5 mmHg (median, 29 mmHg; range, 21–48 mmHg). The duration of OH was 30.9±31.2 days (median, 30 days; range, 3–150 days). OH recurred in 13 eyes with a history of OH diagnosed within 1 month postsurgery (13/54, 24.1%), which needed temporary or long term use of antiglaucoma medications. In conclusion, the incidence of OH in children after cataract surgery was 17.4% during the first-year period. Children who have suffered elevated IOP in the first year after cataract surgery should be followed closely to determine if there is an increased risk of developing late-onset glaucoma.     

Changes of Vision-Related Quality of Life in Retinal Detachment Patients after Cataract Surgery

Rhegmatenous retinal detachment (RRD) is one of the most serious complications after phacoemulsification combined with intraocular lens implantation surgery. It has been reported that vision-related quality of life (VRQoL), as well as visual acuity rapidly decreased when RRD developed. However, little is known of the VRQoL in those RRD patients after anatomical retinal re-attachment, especially whether or not the VRQoL is higher than that before cataract surgery. In this prospective case series study, we use the Chinese-version low vision quality of life questionnaire (CLVQOL) to assess the changes of VRQoL in age-related cataract patients who suffered from RRD after phacoemulsification with intraocular lens (phaco-IOL) implantation. All participants were asked to complete questionnaires in face- to-face interviews one day before and two weeks after cataract surgery, as well as one day before and three months after RRD surgery. A total of 10,127 consecutive age-related cataract patients were followed up to one year after phaco-IOL implantation; among these patients, 17 were diagnosed as RRD. The total CLVQOL scores and subscale scores except “Mobility” decreased significantly when RRD developed. After retinal surgery, only the score of “General vision and lighting” in the CLVQOL questionnaires improved when compared to the scores two weeks after cataract surgery, although the best corrected visual acuity of all patients significantly raised up. However, the mean CLVQOL scores and subscale scores were still considerably higher than the level prior to cataract surgery. Our study suggests that cataract patients at high risk of postoperative RRD should not deny the opportunity to undergo phaco-IOL implantation, even though potential VRQoL impairment induced by RRD exists.     

Phacoemulsification and silicone oil removal through the planned posterior capsulorhexis

The purpose of the study was to present operative technique and results of a passive hydrodynamic expression of silicone oil through planned posterior capsulorhexis during cataract surgery in patients after pars plana vitrectomy. The retrospective analysis was done on 57 eyes with cataract after a previous pars plana vitrectomy, operated on between 2001 and 2004 at the Clinical hospital "Sestre milosrdnice" Zagreb. Preoperative and postoperative best corrected visual acuity (BCVA), preoperative and postoperative intraocular pressure (IOP), and postoperative complications were reviewed. Visual acuity improved or stabilized in all patients with an attached retina. Retinal detachment occurred in 11 eyes. Transient vitreous hemorrhage, that resolved within 1 week of surgery without treatment, was observed in 4 eyes. Asymptomatic intraocular lens (IOL) decentration occurred in 2 eyes. Our findings suggest that silicone oil removal and cataract surgery can be performed as a single procedure in selected patients in the absence of macular pucker and retinal reproliferation, and in a presence of a stable retina.     

Comparison of different presbyopia treatments: refractive lens exchange with multifocal intraocular lens implantation versus LASIK monovision

There are several methods for presbyopia treatment. Refractive lens exchange (RLE) followed by multifocal intraocular lens (MFIOL) implantation enables high rate of spectacle independence but have some visual disturbances. Laser in Situ Keratomileusis (LASIK) monovision gives patient ability to have good distant vision with dominant eye and good near vision with nondominant eye. In this prospective randomized study we wanted to compare clinical outcomes in patients who underwent either of the mentioned procedures. The first group included 50 patients (N = 100 eyes) who underwent RLE with MFIOL implantation and the second group included 50 patients (N = 100 eyes) who underwent LASIK monovision as presbyopia treatment. Uncorrected distant, near and intermediate visual acuity, patient's subjective satisfaction and visual disturbances were measured. Follow up was 6 months. Patients in RLE group had better near uncorrected visual acuity (UCVA) and patients in LASIK monovision group had better distant and intermediate vision. Patients in RLE group reported visual disturbances (halo, glare). Patients satisfaction and spectacle independence was high in both groups. Refractive lens exchange with multifocal intraocular lens implantation and LASIK monovision are effective methods for presbyopia treatment. LASIK monovision with -0.50D - 1.25D of residual dioptry at nondominant eye in patients under 50 years enables good vision at all distances without affecting stereovision. Patient selection and preoperative counseling are key to success.     

超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼的临床疗效分析

摘要目的：探讨超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼的的临床疗效。方法：将2007年8月-2012年8月入住我院的100例经诊断为白内障合并青光眼患者随机地均分为对照组与观察组,各为50例。对照组仅给予超声乳化人工晶状体植入术,观察组在此基础上给予联合小梁切除术进行治疗,比较两组治疗前后的视力、眼压、中央房前深度、房角开放状态变化、视野及并发症发生率。结果：（1）对照组患者术后1周、1个月及3个月视力均要高于术前,且术后1个月与3个月视力较术前差异具有统计学意义（P〈0．05）;观察组患者术后1周、1个月及3个月均要明显高于术前,术后视力较术前均具有显著的统计学意义（P〈0．01）,且与对照组术后相比,差异均具有统计学意义（P〈0．05）。（2）两组手术前后眼压、房角开放状态变化、中央前房深度及视野差异均具有统计学意义（P〈O．05,P〈O．01）,且观察组术后较对照组术后差异均有统计学意义（P〈0．05）。（3）对照组并发症发生率为22．00％,明显高于观察组（8．00％）,二者差异具有显著的统计学意义（P〈0．01）。结论：超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼,临床疗效显著,术后恢复快,并发症发生率低,应在临床上加以推广并应用。     

透明角膜切口白内障术后角膜曲率的临床观察*

目的:观察年龄相关性白内障行透明角膜切口超声乳化吸除及人工晶体植入术后角膜曲率的变化及相对稳定的时间。方法:收集2016年6月-8月在哈尔滨医科大学附属第一医院伍连德纪念医院进行的3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术的患者200例216眼,其中男88例、女128例,平均年龄71.2岁,进行相应的术前检查,并检查术前、术后第一天、一周、一个月、和三个月时的角膜曲率、视力、眼压并行相应的统计学分析。结果:术后不同时间点视力0.5的恢复情况:第一天为147眼(68.05%)、一周为175眼(81.02%)、一个月为193眼(89.35%)、三个月为197眼(91.20%);术前角膜曲率为43.94±1.35、术后第一天、术后一周的角膜曲率分别为44.98±1.06、44.45±1.18,与术前相比有显著性差异(p0.05),术后一个月、三个月的角膜曲率分别为44.13±1.27、44.02±1.24,与术前相比无显著性差异(p0.05);术源性散光于术后一天达到最大,随后逐渐减小,术后一个月、三个月与术后一天比较有显著性差异(p0.05),术后三个月与一个月比较无显著性差异(p0.05),术源性散光术后逐渐下降,并于一个月时趋于稳定。结论:3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术患者在术后一个月的角膜曲率基本稳定,恢复至术前状态,屈光状态趋于稳定,术源性角膜散光较小,术后视力恢复至较好状态。     

Trabeculectomy with mitomycin C in glaucoma associated with uveitis

The patients with uveitic glaucoma are at high risk for failure following drainage surgery because of young age of these patients, preoperative long-term control of inflammation and postoperative complications. Twenty-two trabeculectomies performed in 22 patients with uveitic glaucoma were retrospectively evaluated to analyze the effect of intraoperative application of mitomycin C (MMC). Success rates, postoperative levels of intraocular pressure (IOP) and postoperative complications were studied. After a mean follow-up of 10.6 months (range, 5-28 months), 15 patients (68.2%) achieved IOP of 21mmHg or less without antiglaucoma medications. There were statistically significant reduction in IOP postoperatively during the period studied (p < 0.001). Early postoperative complications included chorioidal detachment (9.1%), shallow anterior chamber (9.1%), hyphema (13.6%), macular edema (4.5%) and raised IOP (27.3%). Late postoperative complications included exacerbation of uveitis (4.5%), macular edema (4.5%), cataract (22.7%) and raised IOP (31.8%). The eyes with raised IOP needed additional antiglaucoma medication. The results of this retrospective and uncontrolled study suggest that intraoperative application of MMC may be a good option for enhancement of short-term trabeculectomy success rates in patients with uveitic glaucoma.     

1300眼超声乳化吸除白内障及人工晶体植入术的围手术期护理

目的:寻求白内障超声乳化吸除术及人工晶体植入患者的围手术期护理对策,探讨此病种的有效临床护理措施,为患者提供更好的护理服务.方法:研究选择我院2011年5月-2011年7月收治的行白内障超声乳化吸除术及人工晶体植入的患者1300眼.将1300眼采用随机抽样的方法分为两组,对照组采用常规护理,实验组在常规护理的基础上采取有针对性的科学护理措施,辅助个性化的心理护理等.对两组别的患者术后恢复状况进行统计分析,主要考察患者术后并发症的发生状况,项目为术后眼红、眼压升高、感染及角膜水肿.结果:对两组患者的术后恢复状况进行统计分析,结果显示:实验组的650眼术后恢复状况好于对照组,2眼发生眼红,2眼眼压升高,1眼患者出现轻微的感染,1眼角膜水肿;对照组术后眼红患者为7例,术眼眼压升高的患者为10例,16例患者发生轻微感染,发生角膜水肿为5眼.从数据中可以看出,实验组并发症发生情况的发生明显少于对照组.两组间存在统计学差异(P＜0.05),有统计学意义.结论:本研究结果显示,对行白内障超声乳化吸除术及人工晶体植入的患者进行围手术期的科学护理,关注患者的心理状况,为患者提供人性化的护理服务,不仅可以促进患者的预后,还可以保证患者的住院安全,提高患者的生命质量.     

无缝线巩膜隧道瓣小梁切除联合白内障超声乳化人工晶体植入术治疗青光眼合并白内障的临床疗效

目的:探讨无缝线巩膜隧道瓣小梁切除术与白内障超声乳化人工晶体(IOL)植入术联合治疗青光眼伴白内障患者的疗效。方法:将88例青光眼伴白内障患者,随机分为观察组与对照组,44例每组。观察组行无缝线巩膜隧道瓣小梁切除术+白内障超声乳化摘除术+IOL植入术,对照组行经典小梁切除术+白内障超声乳化摘除术+IOL植入术,对比两组的疗效。结果:术后6个月,观察组视力提高率为86.36%,视力0.5率为81.82%,显著高于对照组的72.73%、68.18%(P0.05);观察组术后眼压和散光度显著低于对照组(P0.05);观察组的功能滤泡形成率为84.09%,显著高于对照组的70.45%(P0.05);观察组术后角膜内皮细胞丢失率为4.629%,显著低于对照组的14.760%(P0.05);观察组的并发症发生率为4.55%,显著低于对照组的22.73%(P0.05)。结论:无缝线巩膜隧道瓣小梁切除术与白内障超声乳化IOL植入术联合治疗青光眼伴白内障较经典三联术式具有更好的疗效,可有效改善视力、降低眼压、保护角膜内皮、降低术后并发症,值得推广应用。     

超声乳化联合不同术式对青光眼合并白内障患者视力、血流动力学及生活质量的影响

目的:探讨超声乳化联合不同术式对青光眼合并白内障患者视力、血流动力学及生活质量的影响。方法:回顾性分析2015年1月～2019年8月期间我院收治的青光眼合并白内障患者56例(66眼)的临床资料,根据手术方式的不同分为A组(n=27,超声乳化联合小梁切除术)和B组(n=29,超声乳化联合房角分离手术),比较两组患者视力、眼压、血流动力学及生活质量情况,统计两组并发症发生情况。结果:两组术后1个月、术后3个月、术后6个月视功能指数量表(VF-14)评分呈升高趋势,且B组高于A组(P0.05)。两组患者术后1个月、3个月、6个月视力呈先升高后降低,且术后1个月、3个月、6个月均高于术前(P0.05),B组术后3个月、术后6个月视力均高于A组(P0.05);两组患者术后1个月～术后6个月眼压均呈不断下降趋势,且B组低于A组(P0.05)。两组术后6个月舒张末期流速(EDV)、收缩期峰值流速(PSV)均升高,且B组高于A组(P0.05);阻力指数(RI)均降低,且B组低于A组(P0.05)。两组并发症发生率比较差异无统计学意义(P0.05)。结论:与超声乳化联合小梁切除术相比,超声乳化联合房角分离手术治疗青光眼合并白内障患者,在改善患者视力、眼压、血流动力学及生活质量方面效果较佳,且不增加并发症发生率。     

The effect of cataract surgery on salivary melatonin and sleep quality in aging people

Blue light plays an important role in circadian photoentrainment by stimulating the melanopsin-expressing photosensitive retinal ganglion cells. Age-related cataract causes progressive loss of blue light transmission, which may lead to changes in circadian rhythm and sleep quality. In theory, increased light transmission by cataract surgery may improve circadian misalignment and sleep quality, while the effect of cataract surgery on circadian rhythm is not well understood. In this study, we assessed 30 binocular age-related nuclear cataract patients (aged 72.5 ± 7.2, 16 female) who were eligible for cataract surgery. All the patients underwent phacoemulsification cataract extraction and neutral ultraviolet-only blocking intraocular lens (IOLs) implantation. Visual functions including best-corrected visual acuity (BCVA), color perception and dark adaptation were assessed. Salivary samples were collected at 1-hour interval from 19:00 to 23:00 48 hours before and after surgery. Salivary melatonin concentration was measured and dim light melatonin onset (DLMO) was calculated subsequently. Sleep quality and daytime alertness were assessed before and a month after surgery using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). All the operated eyes demonstrated significant improvements in BCVA, color perception and dark adaptation after cataract surgery. Salivary melatonin concentration at 23:00 was significantly increased after surgery (P < 0.001). However, the average DLMO did not change significantly after surgery. In addition, PSQI and ESS scores were significantly decreased a month after surgery (P = 0.027, P < 0.001, respectively). In conclusion, cataract surgery promotes blue-light transmission; consequently, it may lead to the increase in nighttime melatonin concentration and improvement in sleep quality as well as daytime alertness.     

超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼的临床疗效及安全性评价

目的：探讨超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼的临床疗效及安全性。方法：将100例白内障合并青光眼患者按照抽签法随机地均分为对照组与观察组,对照组给予单纯超声乳化人工晶状体植入术,观察组在此基础上给予联合小梁切除术进行治疗。比较两组治疗前后相关指标以及术后并发症发生率等。结果：（1）对照组治疗前后IOP、ACD及AL均无统计学差异,观察组治疗前后IOP与CAD差异具有统计学意义（P〈0．05,P〈0．01）,但该组治疗前后AL无统计学差异;（2）两组术前与术后1周、1个月及3个月平均视野缺损值、平均模式标准差相比,差异均具有统计学意义,且观察组术后与对照组术后相比,差异均具有统计学意义;（3）对照组并发症发生率为20．00％,明显大于观察组（10．00％）。结论：超声乳化白内障吸除、人工晶状体植入联合小梁切除术治疗白内障合并青光眼,疗效显著,不良反应发生率低,值得加以推广并应用。