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中华眼视光学与视觉科学杂志
中华眼视光学与视觉科学杂志

瞿佳

月刊

1674-845X

zhysgx@vip.126.com

0577-86699366

325035

浙江省温州市茶山高教园区温州医学院

中华眼视光学与视觉科学杂志/Journal Chinese Journal of Optometry Ophthalmology and Visual ScienceCSCDCSTPCD北大核心
查看更多>>中华医学会主办，温州医学院承办。本刊是眼科学与视光学领域的高级学术性期刊。以广大眼科医生、视光配镜师、眼视光学科研人员为主要读者对象。报道眼视光学与视觉科学领域的最新研究成果、临床诊疗经验，以及与本学科相关的基础理论研究的最新进展。本刊主要栏目有：专家述评，专题论著，论著，临床研究，病例报告，文献综述。本刊原刊名为《眼视光学杂志》，目前已被国内外数十种权威数据库收录。
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    眼表微环境与泪膜稳态对视觉质量影响的新认识

    林琳冯云傅瑶高华...
    881-887页
    查看更多>>摘要：2020年发布的中国干眼专家共识第一次将眼表微环境的概念新增到了干眼的定义中。强调了泪膜不稳定和眼表微环境失衡在干眼发病机制中的重要地位，并将视功能障碍作为干眼病情发展的重要结局之一。为了加强对新共识的认识，推动相关的基础与临床研究的开展及转化，为广大干眼患者提供更为细致的诊疗建议，专家组于2021年3年26日在江西吉安召开讨论会，对眼表微环境和泪膜稳态这两方面的研究现状及存在的问题进行分析，主要围绕干眼的这两个核心机制的新认识、与视觉质量的关系、临床的评估和治疗手段的建议和未来发展新方向等提出建议和推荐意见。 The Chinese Dry Eye Expert Consensus released in 2020 added the concept of ocular surface microenvironment to the definition of dry eye for the first time. The tear film instability and ocular surface microenvironmental imbalance was emphasized to play a critical role in the pathogenesis of dry eye, and visual dysfunction was defined as one of the important outcomes of dry eye. In order to strengthen the understanding of the new consensus, promote the development and transformation of related basic and clinical research, and provide more detailed diagnosis and treatment recommendations for dry eye patients, many experts in the field of dry eye held a panel discussion in Ji'an on March 26, 2021 and analyzed the current research status and existing problems of the ocular surface microenvironment and tear film homeostasis. In that meeting, opinions and recommendations were put forward based on new understandings of the two key factors in the mechanism of dry eye, the relationship with visual quality, clinical methods of evaluation and treatment, and new directions for future development.

    微环境泪膜视觉质量推荐意见

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    Photoshop软件设计指导的飞秒激光辅助DLK治疗圆锥角膜

    亓晓琳王妙霖林潇贾艳妮...
    888-893页
    查看更多>>摘要：目的： 观察Photoshop软件个性化设计指导的飞秒激光辅助深板层角膜移植术（DLK）治疗圆锥角膜的有效性和准确性。 方法： 前瞻性干预性非随机对照研究。连续收集山东第一医科大学附属眼科医院2016年12月至2018年12月因圆锥角膜完成期拟行飞秒激光辅助DLK的患者，分为研究组和对照组。研究组术前应用Photoshop软件测量患者角膜直径，然后个性化设计角膜植床/植片的直径；而对照组植床/植片直径统一设定为7.9/8.2 mm。观察患者术后12个月最佳矫正视力（BCVA）、平均角膜曲率、等效球镜度、平均散光等指标。采用独立样本t检验对数据进行统计学分析。 结果： 共纳入72例（72眼）患者，其中研究组40例，植床/植片的直径分别为7.9/8.2 mm 6例、8.1/8.4 mm 18例、8.3/8.6 mm 16例；对照组32例，植床/植片直径均为7.9/8.2 mm。术后1周，研究组应用Photoshop软件实际测量的角膜植片直径为（8.4±0.1）mm，与术前个性化设计的植片直径进行对比，二者之间的差异无统计学意义（t=-0.47，P=0.710）。术后12个月，研究组BCVA（LogMAR）为0.44±0.24，较对照组（0.58±0.30）视力更好（t=-2.19，P=0.030）；研究组散光为（3.96±2.68）D，相比对照组的（6.30±4.71）D，其散光更小（t=-2.65，P<0.001）。所有患者中均未出现后弹力层破裂、缝线松动、缝线新生血管化、植片免疫排斥反应等并发症。 结论： 应用Photoshop软件个性化设计角膜植床/植片直径的方法具有较高的准确性和可预测性，可以显著改善圆锥角膜患者DLK后的屈光状态。 Objective: To observe the effectiveness and accuracy of femtosecond laser-assisted deep lamellar keratoplasty (DLK) for the treatment of keratoconus guided by Photoshop software personalized design. Methods: In this prospective, noncomparative and interventional study, patients with advanced keratoconus that were scheduled to undergo DLK at Eye Hospital of Shandong First Medical University from December 2016 to December 2018 were continuously enrolled and divided into the experimental group and the control group. For patients in the experimental group, the corneal diameter was measured with Photoshop software before surgery and then the diameter of the corneal implant bed/graft was designed individually, while in the control group, the diameter of the corneal implant bed/graft was uniformly set at 7.9/8.2 mm. Indicators including the best corrected visual acuity (BCVA), mean corneal curvature, spherical equivalent and average astigmatism were observed 12 months after surgery. Independent samples t-test was used for statistical analysis of the data. Results: A total of 72 patients (72 eyes) were included, including 40 cases in the experimental group and 32 patients in the control group. In the experimental group, 6 patients had a corneal implant bed/graft diameter of 7.9/8.2 mm, 18 patients had a diameter of 8.1/8.4 mm and 16 patients had a diameter of 8.3/8.6 mm. One week after the operation, the actual diameter of corneal graft measured by Photoshop software in the experimental group was 8.4±0.1 mm, with no significant difference compared with that personalized designed preoperatively (t=-0.47, P=0.710). Twelve months after the operation, the best corrected visual acuity (LogMAR) of the experimental group was 0.44±0.24, which was better than that of the control group 0.58±0.30 (t=-2.19, P=0.030). The average astigmatism of the experimental group was 3.96±2.68 D, more stable than that of the control group 6.30±4.71 D (t=-2.65, P<0.001). Complications such as Descemet's membrane rupture, suture loosening, suture-induced corneal neovascularization and immune rejection did not occur in all the patients included. Conclusions: The method using Photoshop software to individually design the corneal bed/graft diameter achieves high accuracy and predictability and can significantly improve the refractive state of patients with keratoconus after DLK.

    飞秒激光Photoshop软件深板层角膜移植术圆锥角膜

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    体外光学质量测试设备评价IOL的光学性能

    曹广梁刘晓敏樊峥任志超...
    894-901页
    查看更多>>摘要：目的： 利用体外光学质量测试设备评价人工晶状体（IOL）的光学性能。 方法： 实验研究。使用光学质量测试设备OptiSpheric® IOL PROⅡ对IOL的光学性能进行体外检测。比较Vivinex、SN60WF和ZCB00的光谱透过率；比较Vivinex、A1-UV、SN60WF和ZCB00在不同程度偏心和倾斜状态下的调制传递函数（MTF）；比较AT LISA tri、Diff-aAY、SBL-3、Symfony和ZCB00在最佳远、中和近视力下的美国空军分辨力测试图（USAF分辨力测试图）和MTF。数据采用单因素方差分析和独立样本t检验进行统计学分析。 结果： 蓝光滤过型IOL Vivinex和SN60WF较非蓝光滤过型IOL ZCB00可明显减少400~500 nm波长的蓝光透过。在400 nm附近波长范围内，Vivinex的光谱透过率小于SN60WF，差异有统计学意义（t=-15.65，P<0.001）；在影响褪黑素分泌的480 nm附近波长范围内，Vivinex的光谱透过率大于SN60WF，差异有统计学意义（t=11.04，P<0.001）。当IOL偏心或者倾斜的程度相同时，100 lp/mm空间频率处的MTF值，Vivinex和A1-UV均大于ZCB00和SN60WF，差异均有统计学意义（均P<0.05）。最佳远视力焦点方面，单焦点非球面ZCB00的MTF值最高，USAF分辨力最佳；最佳中程视力焦点方面，景深延长型Symfony的MTF值最高，USAF分辨力最佳；最佳近视力焦点方面，衍射折射型多焦点Diff-aAY的MTF值最高，USAF分辨力最佳。当单焦点IOL离焦度数超过0.50 D时，其分辨物体细节的视觉质量下降将超过无离焦状态的多焦点IOL。 结论： Vivinex和SN60WF的光谱透过率不同；Vivinex和A1-UV较ZCB00和SN60WF对偏心和倾斜的耐受性更高；不同类型的多焦点IOL在远、中、近视力焦点的光学质量不同。 Objective: To evaluate the optical performance of intraocular lens in vitro by optical bench. Methods: In this experimental study, the intraocular lens (IOL) with different optical performance was tested in vitro by optical bench OptiSpheric® IOL PROⅡ. The spectral transmittance of Vivinex, SN60WF and ZCB00 were compared. The modulation transfer function (MTF) under different degrees of decentration and tilt were compared for Vivinex, A1-UV, SN60WF and ZCB00. The USAF resolution test charts and MTF of AT LISA tri, Diff-aAY, SBL-3, Symfony and ZCB00 were compared at the best distance, intermediate and near focus. The data were analyzed by one-way ANOVA and independent sample t-test. Results: Compared with non-blue-light filtering IOL ZCB00, blue-light filtering IOL Vivinex and SN60WF could significantly reduce the blue light transmission at the wavelength of 400-500 nm. In the wavelength range around 400 nm, the spectral transmittance of Vivinex was less than SN60WF, the difference was statistically significant (t=-15.65, P<0.001) in the wavelength range around 480 nm affecting melatonin secretion, the spectral transmittance of Vivinex was greater than SN60WF, the difference was statistically significant (t=11.04, P<0.001). When the IOL was decentrated or tilt in the same extent, the MTF values at 100 lp/mm spatial frequency of Vivinex and A1-UV were better than ZCB00 and SN60WF, the difference was statistically significant (allP<0.05). The best distance focus, ZCB00 had the highest MTF value and the best USAF resolution the best intermediate focus, Symfony had the highest MTF value and the best USAF resolution the best near focus, Diff-aAy has the highest MTF value and the best USAF resolution. When the defocus degree of monofocal IOL exceeded 0.50 D, the visual quality of resolving object details would decline more than that of multifocus IOL without defocus. Conclusions: The spectral transmittance of Vivinex and SN60WF are different. Vivinex and A1-UV are more tolerant to decentration and tilt than ZCB00 and SN60WF. Different types of multifocal IOLs have different optical quality at the distance, intermediate and near focus.

    人工晶状体光学性能体外偏心倾斜多焦点人工晶状体

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    SMILE矫正近视术后功能性光学区与角膜上皮重塑的相关性

    杨哲夏丽坤季魏红
    902-909页
    查看更多>>摘要：目的： 探究飞秒激光小切口角膜基质透镜取出术（SMILE）后功能性光学区（FOZ）的大小，分析其与角膜上皮厚度（CET）变化和角膜形态变化的相关性。 方法： 前瞻性临床研究。连续性选取2021年6—12月在中国医科大学附属盛京医院接受SMILE手术的近视散光患者69例（135眼）。根据手术预计矫正的等效球镜度（SE）分为高度近视组（<-6.00 D，69眼）和中低度近视组（≥-6.00 D，66眼），分别于术前和术后3个月时应用Pentacam三维眼前节分析系统对患者进行检查并评估术后3个月时患者的FOZ，应用眼前节光学相干断层扫描仪（AS-OCT）测量角膜0~2 mm、>2~5 mm、>5~7 mm、>7~9 mm范围内的上皮厚度。采用独立样本t检验、Pearson线性相关性分析、多重线性回归分析对数据进行分析。 结果： 所有患者手术前透镜光学区直径均设计为6.5 mm。术后3个月时，高度近视组和中低度近视组的FOZ直径分别为（5.10±0.17）mm、（5.26±0.24）mm，2组患者术后FOZ均较术前设计的透镜光学区缩小，高度近视组缩小更明显，2组间FOZ变化量比较差异有统计学意义（t=-4.44，P<0.001）。2组患者术后0~2 mm、>2~5 mm、>5~7 mm区域内CET较术前增加，>7~9 mm区域内较术前略减少，且高度近视组0~2 mm、>2~5 mm区域内CET变化量比中低度近视组大，2组间变化量差异有统计学意义（t=2.43，P=0.016；t=2.71，P=0.008）。2组患者术前角膜曲率（Km）、角膜Q值比较差异均无统计学意义（t=0.79，P=0.430；t=0.13，P=0.894），术后3个月时，2组患者Km较术前明显减少，角膜Q值较术前明显增加，高度近视组比中低度近视组变化更大，2组间Km变化量、角膜Q值变化量比较差异有统计学意义（t=-6.26，t=10.86；均P<0.001）。术后3个月FOZ的大小与手术预计矫正的SE呈正相关（r=0.51，P<0.001），与手术前后Km的变化量、角膜Q值的变化量呈负相关（r=-0.48、r=-0.39；均P<0.001），与手术前后CET的变化量呈负相关（r0~2mm=-0.37，r>2~5mm=-0.32；均P<0.001）。术后3个月时，2组间总高阶像差（HOA）、球差（SA）、垂直彗差（V-Coma）比较差异有统计学意义（t=6.46，t=5.04，t=-4.91；均P<0.001），且△HOA、△SA、△V-Coma与FOZ的大小呈负相关（r=-0.59，r=-0.59，r=-0.59；均P<0.001）。 结论： SMILE术后FOZ较术前预计光学区缩小，术前近视度数越大，术后角膜上皮重塑越明显，术后FOZ越小,角膜高阶像差增加越多。SMILE术后角膜上皮重塑效应和角膜非球面形态和曲率的改变均影响术后FOZ的大小。 Objective: To explore the size of functional optical zone (FOZ) and the relationship between the FOZ and the change in corneal epithelial thickness and corneal shape after small incision lenticule extraction (SMILE). Methods: In this prospective clinical study. A total of 69 myopic patients (135 eyes) who underwent SMILE in Shengjing Hospital of China Medical University were selected consecutively from June 2021 to December 2021. According to the predicted spherical equivalent (SE), treated eyes were divided into two groups: a high myopic group (<−6.00 D, 69 eyes) and a mild to moderate myopic group (≥−6.00 D, 66 eyes). FOZ and corneal epithelial thickness were measured using a Scheimpflug camera and AS-OCT preoperatively and 3 months postoperatively. Statistical analyses were performed byt test, Pearson correlation, multiple linear regression. Results: All of the optical zones were programmed 6.5 mm. The average FOZ of the patients in the high myopia group and the moderate and low myopia group were 5.10±0.17 mm and 5.26±0.24 mm at 3 months after operation. The FOZ of the two groups were reduced, and the reduction in the high myopia group was more obvious. The difference between two groups was statistically significant (t=-4.44, P<0.001). The corneal epithelial thickness in the 0-2 mm, >2-5 mm, >5-7 mm areas of the two groups increased and the corneal epithelial thickness in the 7-9 mm area was slightly decreased compared with preoperative ones. The change of corneal epithelial thickness in the 0-2 mm and >2-5 mm area of the high myopia group were larger than that of the moderate and low myopia group, and the difference between two groups was statistically significant (t=2.43, P=0.016 t=2.71, P=0.008). There was no significant difference in corneal curvature and corneal Q value between two groups before surgery (t=0.79, P=0.430 t=0.13, P=0.894). Three months after surgery, the corneal curvature of two groups was significantly decreased and the corneal Q value was significantly higher than that before surgery. The changes in the high myopia group were greater than those in the moderate and low myopia group, and the difference between two groups was statistically significant (t=-6.26, t=10.86 both P<0.001). Three months after the operation, the size of the FOZ was positively correlated with the expected SE by surgery (r=0.51, P<0.001), and was negatively correlated with the change of corneal curvature and corneal Q value (r=-0.48, r=-0.39 both P<0.001), and negative correlated with the change of corneal epithelial thickness (r0~2 mm=-0.37, r>2~5 mm=-0.32 both P<0.001). Three months after surgery, there were statistically significant differences in total high-order aberration, spherical aberration and vertical Coma between the two groups (t=6.46, t=5.04, t=-4.91 both P<0.001), and FOZ was significantly negatively correlated with ∆HOA, ∆SA, ∆V-Coma (r=-0.59, r=-0.59, r=-0.59 both P<0.001). Conclusions: The FOZ after SMILE was lower than that expected before operation, the larger the preoperative SE, the more obvious postoperative corneal epithelial remodeling, and the smaller the postoperative FOZ, the more the increase of corneal high-order aberration. Corneal epithelial remodeling and changes in corneal aspheric morphology and curvature can affect the size of postoperative FOZ after SMILE.

    近视飞秒激光小切口角膜基质透镜取出术功能性光学区角膜上皮重塑

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    基于深度卷积神经网络的早产儿视网膜病变1~3期分期自动诊断

    刘佳濮清岚李鹏周巧云...
    910-916页
    查看更多>>摘要：目的： 利用深度卷积神经网络（DCNN）对早产儿视网膜病变诊断分期中1~3期病变进行自动分类诊断。 方法： 回顾性研究。选取2019年1月至2020年12月在嘉兴市妇幼保健院出生的1 885例早产儿所采集的12 219张眼底图像，构建了早产儿视网膜眼底图像数据集。基于分割出眼底图像的视网膜血管以及分界线或嵴，计算出感兴趣区域（ROI），并从ROI分割图中提取特征，采用五折交叉验证法训练分类器，对早产儿视网膜病变中1~3期进行自动分类诊断。在测试集上对DCNN进行性能评估，并与临床诊断结果进行一致性分析。 结果： 本系统对ROP 1~3期及无ROP的诊断准确率达到了98%。在诊断无ROP图像时，其敏感度和特异性分别达到了0.975 7和0.975 6；对ROP 1期、2期和3期图像的诊断，敏感度分别为0.922 1、0.933 1和0.910 2，特异性则分别为0.983 7、0.988 6和0.992 8。DCNN的诊断结果与临床诊断结果的Kappa一致性为0.905 9。 结论： 基于DCNN的早产儿眼底病变分期诊断系统，使用从ROI分割图中提取的特征训练分类器，能够对ROP1~3期病变眼底图像进行较高准确率的自动辅助诊断。 Objective: The aim of the system is to research the automatic diagnosis of stages 1-3 of retinopathy of prematurity(ROP) using Deep Convolutional Neural Networks(DCNN). Methods: In this retrospective study, using 12 219 retinal images of preterm infants, which collected from January 2019 to December 2020 at the Department of Ophthalmology, Jiaxing Maternity and Child Health Care Hospital, we constructed a retinal images dataset for Ophthalmology of Ophthalmology, preterm infants. Based on the segmented demarcation lines or ridge, the region of interest (ROI) were calculated, features from the ROI segmentated images were extracted and the classifier was trained using a five-fold cross-validation method to automatically diagnose stages 1-3 ROP. The performance of the DCNN and analyzed the consistency with clinical diagnosis results on the test data set was evaluated. Results: The trained system achieved an average accuracy of 98% for all the four categories. The sensitivity and specificity of the system reached 0.975 7 and 0.975 6, when diagnosing non-ROP images 0.922 1 and 0.983 7, when diagnosing stage 1 0.933 1 and 0.988 6, when diagnosing stage 2. At the same time, the sensitivity and specificity for the diagnosis of stage 3 ROP images were as high as 0.910 2 and 0.992 8. The Kappa value of the system for the diagnosis was 0.905 9, which was close to perfect agreement with the clinic diagnosis. Conclusion: The system based on DCNN, trained using features extracted for segmented ROI images, could diagnose automatically stages 1-3 ROP with a high accuracy.

    视网膜病变深度卷积神经网络早产儿图像分割

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    近十年阿托品延缓近视的文献计量可视化分析

    魏熙翔杨晖傅征尹雪...
    917-925页
    查看更多>>摘要：目的： 基于Web of Science数据库的收录情况，运用文献计量的方法分析阿托品在近视防控领域中应用的现状以及研究热点。 方法： 文献研究。以近十年（2011—2021年）Web of Science（WOS）中的核心数据库收录的关于阿托品在近视防控领域研究的文献为分析对象，利用CiteSpace软件，运用文献计量学方法，从文献的年发文量、国家及机构来源、刊文期刊分布及关键词突现、共被引文献分析等角度对其进行可视化分析。 结果： 共检索到290篇文献，发文量最多的国家是中国，其次是美国；发文量最多的研究机构是新加坡国立眼科中心，其次是新加坡国立大学和香港理工大学；发文最多的期刊为《Ophthalmic and Physiological Optics》以及《Investigative Ophthalmology and Visual Science》；研究的趋势从早期以动物实验为主来研究阿托品类药物的药理学及安全性到中期的临床随机对照试验及基于这些对照试验进行的一系列Meta分析，目前的研究热点为阿托品对脉络膜厚度的影响。 结论： 应用CiteSpace分析阿托品在近视防控领域运用的相关文献，展示出了该领域目前的主要研究及彼此合作的国家和机构，揭示了该领域的研究趋势。阿托品在近视防控中的应用潜力巨大，仍具有较高的研究价值。 Objective: Based on the collection of Web of Science database, using the method of bibliometrics to analysis the status and hot spots of atropine on the field of myopia prevention and control. Methods: In this literature research, articles about atropine in the field of myopia prevention and control collected from the core database of Web of Science (WOS) in recent ten years (2011—2021) were analyzed. By using CiteSpace software and bibliometric method, the visual analysis was performed from the perspectives of annual publication, sources of countries and institutions, distribution of published journals and keywords with the strongest citation bursts, and analysis of co-cited article. Results: A total of 290 articles were retrieved. The country publish the most of articles was China, followed by the United States. The research institutions publish the most articles were National Eye Center of Singapore, and then the National University of Singapore and Hong Kong Polytechnic University. The journals publish the most articles were《Ophthalmic and Physiological Optics》and《Investigative Ophthalmology and Visual Science》. The research trends range from early animal studies focusing on the pharmacology and safety of atropine, to clinical randomized controlled trials in mid-term and followed a series of meta-analysis based on these controlled trials. At present, the research focuses on the effect of atropine on choroidal thickness. Conclusions: CiteSpace is applied to analyze the related articles concerning the application of atropine on the field of myopia prevention and control, which reveals the main research results in this field as well as the countries and institutions cooperating with each other and the research trends in this field. Atropine has great application potential in myopia prevention and control, and it still has high research value.

    阿托品近视防控CiteSpace文献计量

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    白内障手术不同方向角膜切口对术后泪膜稳定性及角膜神经损伤修复的影响

    邹茜刘志南周栋张骏...
    926-932页
    查看更多>>摘要：目的： 分析白内障超声乳化术不同方向的透明角膜切口对年龄相关性白内障（ARC）及糖尿病性白内障（DC）患者泪膜稳定性及角膜神经损伤修复的影响。 方法： 前瞻性研究。收集2021年9—12月常州市第三人民医院眼科行超声乳化吸除联合人工晶状体（IOL）植入术的白内障患者67例（80眼），其中ARC患者35例（40眼），DC患者32例（40眼）。ARC患者按随机数字表法分为2组：Ⅰ组18例（20眼）行上方透明角膜切口；Ⅱ组17例（20眼）行颞侧透明角膜切口。DC患者按随机数字表法分为2组：Ⅲ组16例（20眼）行上方透明角膜切口；Ⅳ组16例（20眼）行颞侧透明角膜切口。术前，术后1周、1个月及3个月时行泪膜破裂时间（BUT）、泪河高度（TMH）、泪液分泌试验Ⅰ（SⅠT）检查；术后1周、1个月及3个月时行眼前节光学相干断层成像扫描（AS-OCT）检查；术后1个月及3个月时行角膜共焦显微镜（CCM）检查。各组术后BUT、TMH、SⅠT与术前比较采用t检验；角膜神经纤维主干密度（CNFD）、角膜神经纤维分支密度（CNBD）组间比较采用单因素方差分析。角膜神经纤维长度（CNFL）、角膜神经纤维宽度（CNFW）组间比较采用非参数Mann-Whitney检验。 结果： 术后l周、1个月，4组患者BUT、TMH、SⅠT与术前相比差异均有统计学意义（均P<0.05）。术后1周，Ⅰ组与Ⅲ组相比、Ⅱ组与Ⅳ组相比，BUT、TMH、SⅠT值均较大，差异均有统计学意义（均P<0.05）；术后1个月时，差异无统计学意义（P>0.05）。术后1个月，所有患者完整的长神经纤维均很少；术后3个月，4组均可见完整长神经纤维且可见神经纤维束连接。与术后1个月相比，术后3个月4组患者CNFL、CNFD、CNBD均升高（均P<0.05）。术后1个月Ⅳ组与Ⅲ组相比，CNFL、CNFD、CNBD均较低（均P<0.05）；术后1、3个月，Ⅰ组与Ⅲ组相比、Ⅱ组与Ⅳ组相比，CNFL、CNFD、CNBD均较高，差异均有统计学意义（均P<0.05）。 结论： 行白内障手术时，DC患者上方角膜切口对神经的损伤较颞侧切口轻。DC患者眼表泪膜损伤及角膜神经损伤比ARC患者修复慢。 Objective: To investigate the effects of transparent corneal incision in different directions on tear film stability and corneal nerve injury repair in patients with age-related cataract (ARC) and diabetic cataract (DC). Method: In this prospective clinical study, 67 patients (80 eyes) of cataract underwent phacoemulsification combined with intraocular lens (IOL) implantation from September 2021 to December 2021 in the Third People's Hospital of Changzhou. Thirty-five patients (40 eyes) of ARC were randomly divided into groups Ⅰ,Ⅱ 18 patients (20 eyes) of ARC in group Ⅰ were treated with upper transparent corneal incision 17 patients (20 eyes) in group Ⅱ were treated with temporal transparent corneal incision. Thirty-two patients (40 eyes) of DC were randomly divided into groups Ⅲ,Ⅳ 16 patients (Twenty eyes) of DC in group Ⅲ were treated with upper transparent corneal incision 16 patients (20 eyes) of DC in group Ⅳ were treated with temporal transparent corneal incision. Tear film break-up time (BUT), tear meniscus height (TMH) and Schirmer I test (SⅠT) were examined before operation, 1 week, 1 month and 3 months after operation anterior segment optical coherence tomography (AS-OCT) was performed at 1 week, 1 month and 3 months after operation corneal confocal microscopy (CCM) was performed at 1 and 3 months after operation. Thet-test was used to test BUT, TMH and SⅠT in each group after and before operation. One-way ANOVA was used to compare differences between age, corneal nerve fiber density (CNFD) and corneal nerve branch density (CNBD) of each group. Nonparametric Mann-Whitney test was used to compare corneal nerve fiber length (CNFL) and cornenl nerve fiber width (CNFW). Results: There were significant differences in BUT, TMH and SⅠT at 1 week and 1 month after operation compare with before operation (P<0.05) The values of BUT, TMH and SⅠT in group I were higher than those in group III, group II than those in group IV one week after operation (P<0.05), but the difference disappeared 1 month after operation. One month after operation, there were few integral long nerve fibers in all patients. Three months after operation, integral long nerve fibers and nerve fiber branch connection were seen in all four groups. Compared with 1 month after operation, CNFL, CNFD and CNBD increased in the four groups at 3 months after operation (P<0.05). One month after operation, CNFL, CNFD and CNBD in group IV were lower than those in group III (P<0.05). One month and three months after operation, the value of CNFL, CNFD and CNBD in group I were higher than those in group III, group II was higher than those in group IV, and the difference was significant (P<0.05). Conclusion: During cataract surgery, the corneal nerve injury of the upper corneal incision in DC patients was lighter than those of the temporal incision. The repair of tear film injury and corneal nerve injury in DC patients was slower than those in ARC patients.

    白内障角膜切口干眼角膜共焦显微镜角膜神经损伤

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    不同程度近视性屈光参差患者双眼间调节参数的差异性分析

    岳鹏程杜秋萱孔玲解芳...
    933-937页
    查看更多>>摘要：目的： 探讨近视性屈光参差患者双眼间调节力差异与屈光参差程度间的关系。 方法： 横断面研究。收集2019年11月至2021年6月在山东第一医科大学附属青岛眼科医院就诊的近视患者123例（246眼），年龄8~21岁。根据双眼间等效球镜度（SE）差值分为屈光不正组（SE差值≤0.25 D）29例、低度屈光参差组（1.00 D≤SE差值<2.50 D）62例及高度屈光参差组（SE差值≥2.50 D）32例3组。所有患者符合双眼最佳矫正视力（BCVA）≥0.8且各项原始数据较为完善。使用综合验光仪测量3组患者的单眼调节幅度（AMP）、单、双眼负相对调节（NRA）、正相对调节（PRA）、调节反应（AR）及调节灵活度（AF）在睫状肌麻痹下验光后确定双眼间屈光度数，分析3组间双眼调节相关参数及单眼调节参数差差值（双眼间调节参数差值＝近视屈光度较高眼调节数值-近视屈光度较低眼调节数值）之间的差异。对3组间调节参数比较采用单因素方差分析；对屈光参差程度与双眼调节参数值及双眼间调节参数差值间的关系分析选择Spearman相关分析。 结果： 3组间双眼NRA、PRA、AR、AF值及单眼间NRA、AF差值比较差异均无统计学意义。3组AR差值分别为-0.03±0.25、0.20±0.30、0.26±0.36，差异有统计学意义（F=7.36，P<0.001）；3组PRA差值分别为0.04±0.27、0.34±0.72、0.66±0.63，差异有统计学意义（W=7.47，P<0.001）；3组AMP差值分别为0.41±0.86、-1.07±1.53、-1.02±2.18，差异有统计学意义（W=9.25，P<0.001）。事后多重比较显示，屈光不正组与低度屈光参差组和高度屈光参差的AR差值、PRA差值、AMP差值比较差异均有统计学意义（均P<0.05）。相关性分析显示，SE差值与AR差值、AMP差值存在低强度的正相关性（r=0.22，P=0.014；r=0.36，P<0.001）。 结论： 不同程度近视性屈光参差患者双眼间调节参数差值不同，且双眼间AR差值、AMP差值与双眼间屈光度差异程度存在一定相关性。 Objective: To explore the relationship between the difference of accommodation between two eyes and the degree of anisometropia in patients with myopic anisometropia. Methods: In this cross-sectional study, a total of 123 myopic patients (246 eyes) who were admitted to the Qingdao Eye Hospital of Shandong First Medical University aged from 8 to 21 years old were collected from November 2019 to June 2021. According to the difference of equivalent spherical refraction (SE) between two eyes, there were 29 cases in ametropia group (SE difference≤0.25 D), 62 cases in low anisometropia group (1.00 D≤SE<2.50 D) and 32 cases in high anisometropia group (SE difference≥2.50 D). All patients meet the binocular best corrected visual acuity (BCVA)≥0.8 and the original data were perfect. The monocular and binocular negative relative accommodation (NRA), accommodative reaction (AR), positive relative accommodation (PRA), accommodative facility (AF) and monocular accommodative amplitude (AMP) were measured by comprehensive optometry. The refraction between the two eyes was determined after optometry under cycloplegic. The differences of interocular accommodation related parameters and the difference of binocular accommodation parameters among the three groups (binocular accommodation parameter difference=myopia diopter higher eye accommodation value-myopia diopter lower eye accommodation value) were analyzed. One-way ANOVA was used to compare the accommodation parameters among the three groups, and Spearman correlation analysis was used to analyze the relationship between the degree of anisometropia and interocular accommodation parameters and the difference between binocular accommodation parameters. Results: There was no statistically significant difference between the three groups in the difference between the NRA, PRA, AR, AF values and the difference between the interocular NRA and AF values (all P>0.05). AR values were -0.03±0.25 in the ametropia group, 0.20±0.30 in the low anisometropia, and 0.26±0.36 in the high anisometropia groups respectively, with statistically significant differences (F=7.36, P<0.001). The PRA difference between the three groups was 0.04±0.27, 0.34±0.72, 0.66±0.63, with statistically significant differences (F=7.47, P<0.001). The difference in AMP was statistically significant (F=9.25, P<0.001) among the three groups (0.41±0.86, -1.07±1.53, and -1.02±2.18, respectively). Multiple comparison showed that there were significant differences in AR difference, PRA difference and AMP difference between anisometropia group and low anisometropia group and high anisometropia group (allP<0.05). In addition, SE differences were associated with lower intensity of AR and AMP differences (r=0.22, P=0.014 r=0.36, P<0.001). Conclusion: The value of accommodation parameters between the eyes of patients with different degrees of myopia refractive variance is different, and there is a correlation of the difference between the difference of AR and AMP with the degree of myopia refractive variance between the eyes.

    近视屈光参差调节差值

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    三种人工晶状体植入术后静态视力和动态视力的评估及比较

    可殊瑞李灿吴飞盈
    938-944页
    查看更多>>摘要：目的： 对三焦点、双焦点及连续视程人工晶状体植入术后的单眼视力和动态视力（DVA）进行评估及比较。 方法： 前瞻性临床研究。选取2020年1月至2021年1月于重庆医科大学附属第一医院眼科行白内障超声乳化摘除联合人工晶状体植入且资料完整的白内障患者65例（81眼）。根据所选择的IOL类型分为3组：双焦点组33眼，植入Tecnis ZMB00 IOL；三焦点组20眼，植入AT Lisatri.839MPIOL；EDOF组28眼，植入Tecnis ZXR00 IOL。术后3个月分别检测每眼的裸眼静态视力（SVA）：包括裸眼远视力（UDVA）、裸眼中视力（UIVA）、裸眼近视力（UNVA） （Log MAR视力）。采用运动视标法检测裸眼DVA（检测速度分别为4、8、12、24 fps）：包括裸眼动态远视力（UDDVA)、裸眼动态中视力（UIDVA）、裸眼动态近视力（UNVA） （Log MAR视力），并进行评估比较。通过"手抓尺子试验"检测患者反应速度。数据采用卡方检验、方差分析、Kruskal-WallisH检验进行统计分析。 结果： 3组的总体UDVA、UNVA差异均无统计学意义；3组的总体UIVA差异有统计学意义（H=23.13，P<0.001），进一步两两比较发现EDOF组优于双焦点组（P<0.001）；三焦点组优于双焦点组（P=0.016）；EDOF组与三焦点组差异无统计学意义。3组的总体UDDVA在4、8 fps时差异均无统计学意义；而在12、24 fps时总体差异均有统计学意义（H=10.96，P=0.004；H=11.52，P=0.003），进一步比较发现双焦点组优于三焦点组（H=-16.21，P=0.003；H=-17.98，P=0.004），EDOF组优于三焦点组（H=-12.67，P=0.030；H=-16.48，P=0.009），双焦点组与EDOF组差异无统计学意义。3组的总体UIDVA在8 fps时差异无统计学意义，而在4、12、24 fps时差异均有统计学意义（H=8.17~11.36，P<0.05）：4、12 fps时，EDOF组优于双焦点组（H=14.61，P=0.013；H=14.52，P=0.009），与三焦点组差异无统计学意义；24 fps时，EDOF组优于双焦点组、三焦点组（H=15.31，P=0.008；H=-16.60，P=0.027）。3组的总体UNDVA在4、8、12、24 fps时差异均有统计学意义（H=11.25~17.61，P<0.05），且EDOF组均分别优于双焦点组（H=12.71~17.87，P<0.05）和三焦点组（H=-23.04~-15.87，P<0.05），双焦点组与三焦点组差异均无统计学意义（均P>0.05）。 结论： 在SVA方面，三焦点IOL及EDOF IOL均可获得较好的UDVA、UIVA、UNVA，而双焦点IOL的UIVA较弱。在DVA方面，远距离、低速度时，3种IOL结果相当；但是近距离、高速度时，EDOF IOL的DVA较其余二者更佳。 Objective: To evaluate and compare monocular visual acuity and dynamic visual acuity after implantation of trifocal intraocular lens, bifocal intraocular lens, or extended depth of focus intraocular lens in cataract patients. Methods: This was a prospective clinical study. Eight-one cataract eyes of 65 patients which had cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from January 2020 to January 2021 were involved. Thirty-three eyes were implanted with ZMB00 IOL as the bifocal group, 20 eyes implanted with AT Lisatri. 839MPIOL as the trifocal group and 28 eyes implanted with ZXR00 IOL as the EDOF group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), uncorrected distance dynamic visual acuity (UDDVA), uncorrected intermediate dynamic visual acuity(UIDVA), and uncorrected near dynamic visual acuity (UNDVA) (log MAR) were assessed 3 months postoperatively. Data were assessed with a Chi-square test, analysis of variance, and Kruskal-Wallis H test. Results: The UDVA and UNVA of the three groups were not significantly different the UIVA of the three groups was significantly different (H=23.13, P<0.001). The EDOF group was significantly better than the bifocal group (P<0.001) the trifocal group was significantly better than the bifocal group (P=0.016) there was no significant difference between the EDOF group and the trifocal group. There was no significant difference in the UDDVA of the three groups at 4 and 8 fps, but at 12 and 24 fps (H=10.96, P=0.004 H=11.52, P=0.003). The bifocal group was better than the trifocal group (H=-16.21, P=0.003 H=-17.98, P=0.004), and the EDOF group significantly better than the trifocal group (H=12.67, P=0.030 H=-16.48, P=0.009). The difference between the bifocal group and the EDOF group was not statistically significant. There was no significant difference in the UIDVA of the three groups at 8 fps, but at 4, 12, and 24 fps (H=8.17-11.36, P<0.05): At 4, 12 fps, the EDOF group was better than the bifocal group (H=14.61, P=0.013 H=-14.52, P=0.009), and the difference was not statistically significant with the trifocal group at 24 fps, the EDOF group was better than the bifocal group and the trifocal group (H=15.31, P=0.008 H=-16.60, P=0.027). The UNDVA of the three groups was significantly different at 4, 8, 12, and 24 fps (H=11.25-17.61, P<0.05): at these four speeds, the EDOF group was better than the bifocal group (H=12.71-17.87, P<0.05) and trifocal group (H=-23.04--15.87, P<0.05), but there was no significant difference between bifocal group and trifocal group. Conclusions: Patients implanted with trifocal IOL and EDOF IOL can obtain same UDVA, UIVA, UNVA, while bifocal IOL has relatively poor UIVA. The three IOLs can obtain same DVA at long distance and low speed however, at medium or short distance, especially at high speed, the DVA of EDOF IOL is better than the other two.

    人工晶状体连续视程人工晶状体动态视力视觉质量

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    Best卵黄样黄斑营养不良一家系

    吕佳怡郭从容周娜磊吴昔昔...
    945-946页
    查看更多>>摘要：患儿，女，10岁，因"双眼视物不清伴变形1个月"就诊于河北医科大学第二医院眼科。患儿父亲及祖父自幼视力差，否认其他家族史。眼科查体示：双眼视力均为0.25，矫正后未提高；右眼眼压为13.5 mmHg（1 mmHg=0.133 kPa），左眼13.0 mmHg；双眼角膜清，前房深浅正常，未及房闪及浮游物，瞳孔直径3 mm，对光反射灵敏，晶状体透明，视盘边清色橘红，黄斑区黄斑色物质沉积于神经上皮下，右眼黄白色物质周边可见小片出血（见图1）。光学相干断层扫描血管成像（Optical coherence tomography angiography, OCTA）示：双眼黄斑区神经上皮下团状高反射信号，其内可及团状血流信号，左眼高反射信号周边神经上皮浅脱离（见图2）。双眼眼电图（Electrooculogram，EOG）示：双眼Arden比为1.3。提示为根据Mohler和Fine对于BVMD的分期标准 [1]，患儿为Ⅵc期，祖父为Ⅲ期，父亲为Ⅱa期，妹妹为Ⅲ期，患儿母亲及祖母眼底均无异常表现（见图3）。基因检测示：患儿、祖父、父亲、妹妹均为 Best1的杂合突变，相应位点为11号染色体外显子3的c.238T>C突变，导致苯丙氨酸变为亮氨酸。
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