[Clinical evaluation on the coaxial 1.8 mm microincision cataract surgery].

OBJECTIVE: To study and compare the outcomes of coaxial 1.8 mm microincision phacoemulsification with conventional coaxial 3 mm small-incision cataract surgery. METHODS: A randomized prospective study was conducted on 89 patients with age-related cataract: coaxial 1.8 mm microincision cataract surgery (MICS group) was performed in 45 cases (45 eyes), and coaxial 3 mm small-incision cataract surgery (SICS group) was performed in 44 cases (44 eyes). Statistical analysis was taken with the data of 40 cases (40 eyes) in the MICS group and 40 cases (40 eyes) in the SICS group. The average ultrasound power (AVE) and effective phacoemulsification time (EPT) were recorded during the operation. Visual acuity, endothelial cell density and cornea thickness were compared at intervals of 1 day, 1 week, 1 month and 3 months after surgery. In addition, surgically induced astigmatism (SIA) was analyzed. Statistic analysis was taken by student's t test and chi square test. RESULTS: There was no significant difference on AVE and EPT (P > 0.05) between these two groups. One day after the surgery, the MICS group showed better uncorrected visual acuity (0.16 ± 0.14) as compared to the SICS group (0.23 ± 0.12). The difference was statistically significant (P < 0.05). There were no significant differences on best corrected visual acuity, endothelial cell density and cornea thickness between these two groups. One week, 1 month and 3 months after the surgery, SIA was (0.62 ± 0.28) D, (0.48 ± 0.28) D, (0.47 ± 0.25) D, (0.40 ± 0.24) D in the MICS group, and (1.27 ± 0.65) D, (1.18 ± 0.59) D, (1.02 ± 0.56) D, (0.79 ± 0.48) D in the SICS group, respectively. The differences between the MIC and SICS groups were statistically significant (P < 0.01). SIA decreased significantly and became stable 1 week after surgery in MICS group, while the similar tendency appeared one month after the surgery in the SICS group. CONCLUSIONS: Coaxial 1.8 mm microincision cataract surgery could significantly reduce SIA and obtain more stable astigmatism status. This suggests that the coaxial MICS phacoemulsification surgery could get earlier visual rehabilitation postoperatively.

[Conductive keratoplasty for presbyopia and two years follow-up].

OBJECTIVE: To investigate the effect of conductive keratoplasty (CK) for presbyopia and 2 years follow-up. METHODS: This study is prospective clinical trial. CK was performed on 34 patients for presbyopia, in which 26 hyperopic patients underwent binocular operations and 8 emmetropic patients underwent monocular operation. The following-up time was 24 months. RESULTS: At 24 months postoperatively, for the hyperopia group, binocular uncorrected near visual acuity (33 cm) (5-logMAR) (4.63 ± 0.12) was increased significantly (t = 9.237, P < 0.001) compared pre-operatively (4.06 ± 0.15); binocular uncorrected distance visual acuity (4.99 ± 0.02) was significantly increased (t = 6.718, P < 0.05) compared pre-operatively (4.82 ± 0.21); for the emmetropia group, binocular uncorrected near visual acuity (33 cm) (5-logMAR) (4.68 ± 0.16) was increased significantly (t = 10.413, P < 0.001) compared pre-operatively (4.13 ± 0.18); binocular uncorrected distance visual acuity was same as pre-operative one; compared pre-operatively (+0.97 ± 0.63D), manifest refractive spherical equivalent was decreased significantly (P < 0.001) to peak value (-1.21 ± 1.00) D at 1 week, and then regressed to a relative plateau (-0.40 ± 0.70) D at 24 months; the regressive rate was decreased from (+0.35 ± 0.44) D/month at 1 month postoperatively to (+0.01 ± 0.01) D/months at 24 months postoperatively. Contrast sensitivity and glare sensitivity, intraocular pressure, tear break-up time, endothelial cell count, central corneal thickness, stereopsis function and best corrected visual acuity were not significantly changed. CONCLUSIONS: For treatment of presbyopia, CK appeared to be safe, effective, refractive-predictable and controllable, and relatively stable at 24 months post-operatively. More long-time follow-up is necessary for further evaluation.

Conductive keratoplasty: an approach for the correction of residual hyperopia in post-lasik pseudophakia.

Although there are many formulae for the calculation of intraocular lens power in the eyes with previous kerato-refractive surgeries, unexpected refractive bias still exists. Hyperopic bias is particularly disliked because it affects both uncorrected distance and near visual acuity. Surgical treatment of the residual hyperopia for the eyes with both laser in situ keratomileusis and cataract surgery remains to be a big problem. Conductive keratoplasty has been shown to be an effective, safe and predictable method for low and moderate hyperopia in the pseudophakic eyes or in the eyes with kerato-refractive surgeries. However, the efficacy and safety of conductive keratoplasty in the correction of residual hyperopia after both corneal and lens refractive surgeries has not been reported. Herein, we reported the surgical correction with conductive keratoplasty for cases of residual hyperopia with/without astigmatism after previous laser in situ keratomileusis for high myopia and following phacoemulsification combined with posterior intraocular lens implantation for complicated cataract.

Correction of extreme hyperopia: artisan iris-fixated intraocular lens implantation for pseudophakia after clear lens extraction.

A 22-year-old patient suffering from both-side extreme hyperopia with amblyopia was corrected with an Artisan iris-fixated intraocular lens (IOL) implantation followed to clear lens extraction (CLE) with posterior chamber (PC)-IOL implantation. The preoperative refraction values were +17.75DS -1.50DC × 168° for the right eye and +17.25DS -0.75DC × 8° for the left eye. The uncorrected visual acuity (UCVA) was 20/200 bilaterally and the spectacle-corrected visual acuity (BSCVA) was 20/50 bilaterally. One year after Artisan iris-fixated IOL implantation, bilateral BSCVA was 20/50 with a refraction of +1.25DS -0.75DC × 13° for the right eye and +1.50DS -1.00DC × 55° for the left eye. The outcomes of an Artisan iris-fixated IOL implantation followed to CLE with PC-IOL implantation were encouraging for the correction of extreme hyperopia. Long term follow-up examinations were necessary for further determination of the efficacy and safety of this combinational procedure.