白内障手术治疗的发展与思考

白内障是常见的致盲眼病之一,目前治疗白内障唯一有效的方法是通过手术摘除混浊的晶状体并植入人工晶状体.随着白内障摘除手术技术的提高和仪器设备的不断更新,手术理念已由原来的白内障复明手术逐渐向白内障屈光手术转变,手术目的已不单纯局限在复明,而是旨在恢复更合乎生理状况的视觉功能.随着科学技术的发展,白内障手术技术的日趋成熟,人们关注的重点也逐渐从手术效果、术后视力的恢复,过渡到手术过程中患者的舒适程度、满意程度上来.使得白内障的手术治疗过程更具有人性化的特点,体现了当代医疗对患者的人文关怀.     

白内障手术治疗的发展与思考

白内障是常见的致盲眼病之一,目前治疗白内障唯一有效的方法是通过手术摘除混浊的晶状体并植入人工晶状体。随着白内障摘除手术技术的提高和仪器设备的不断更新,手术理念已由原来的白内障复明手术逐渐向白内障屈光手术转变,手术目的已不单纯局限在复明,而是旨在恢复更合乎生理状况的视觉功能。随着科学技术的发展,白内障手术技术的日趋成熟,人们关注的重点也逐渐从手术效果、术后视力的恢复,过渡到手术过程中患者的舒适程度、满意程度上来。使得白内障的手术治疗过程更具有人性化的特点,体现了当代医疗对患者的人文关怀。     

非球面人工晶状体临床应用的启示

非球面人工晶状体是波前像差技术与现代白内障手术完美结合的产物,也是多学科联合发展的结果。非球面人工晶状体较传统球面人工晶状体可明显改善白内障患者的视功能。倘若能实现个体化设计,非球面人工晶状体有望取代球面人工晶状体成为人工晶状体的主流。     

非球面人工晶状体临床应用的启示

非球面人工晶状体是波前像差技术与现代白内障手术完美结合的产物,也是多学科联合发展的结果.非球面人工晶状体较传统球面人工晶状体可明显改善白内障患者的视功能.倘若能实现个体化设计,非球面人工晶状体有望取代球面人工晶状体成为人工晶状体的主流.     

制约国人白内障复明手术的社会因素

全球因白内障致失明者大约2 000万人,导致低视力者3倍于此数字,即6 000万.手术可使白内障失明者视力恢复正常或有用视力.每年每百万人口接受白内障手术的人数(白内障手术率)是在不同环境中衡量眼保健工作的有用尺度.白内障手术率在各国之间以及一个国家的不同地区都存在极大差异,最高者比利时16 000例/百万,2004年统计我国448.7例/百万,2005卫生部制定的2006～2010全国今后5年白内障手术率要达到700例/百万.这种差异是受所在国和地区及患者本人的经济和文化程度及其他社会因素所制约的,即使具备手术服务也很难予以利用.本文拟就防盲治盲20年间,辽宁省及大连市白内障复明手术开展情况进行回顾性分析,从制约国人白内障复明手术的社会因素进行讨论.     

角膜移植发展简史及其认识论意义

角膜移植发展简史及其认识论意义潍坊医学院（２６１０４２）孙兴才,刘典恩角膜移植是用透明的角膜片置换混浊或有病变的角膜,以达到增视或治疗的目的,是现代卓有成效的治盲手段之一,也是继白内障手术之后眼科领域里又一重要的复明手术。角膜移植的发展经历了近２００...     

白内障手术中的适宜技术与诊疗最优化

在临床工作中为避免过度医疗,普遍的原则是大力推行适宜技术、适度医疗,并努力实现诊疗的最优化。在我国现阶段,适宜技术是一个宽泛且较低的标准,白内障手术中的适宜技术并不能使患者获得最佳疗效,达不到最优化医疗的要求。相信随着我国医疗体制的健全,白内障患者可以享受到最优化医疗。     

白内障手术中的适宜技术与诊疗最优化

在临床工作中为避免过度医疗,普遍的原则是大力推行适宜技术、适度医疗,并努力实现诊疗的最优化.在我国现阶段,适宜技术是一个宽泛且较低的标准,白内障手术中的适宜技术并不能使患者获得最佳疗效,达不到最优化医疗的要求.相信随着我国医疗体制的健全,白内障患者可以享受到最优化医疗.     

“成为像路加一样的医生”——专访安徽省红十字医院郑成功副院长

听到＂郑成功＂这个名字,也许你马上会联想到当年收复台湾的郑成功。其实,眼前这位弟兄也叫郑成功,他目前是安徽省红十字医院的副院长,也是安徽合肥基督教会路加医疗队的队长。听说他们最近为白内障患者做的复明手术,其成功率几乎是百分之一百。怀着一份崇敬的心情,我特地去合肥走访了郑医生。     

论人工晶体手术的发展

论人工晶体手术的发展暨南大学医学院附属医院（广州５１０６３２）钟敬祥徐锦堂施月欢白内障是一种致盲的常见病，而目前临床上采用白内障摘除联合人工晶体植入使病人重见光明。人工晶体手术的发明给眼科领域带来了一次飞跃，它以良好的手术效果而确定其在医学领域的地位...     

The other way around: does health predict perceived support?

The aim in this study was to identify predictors of perceived social support before and after cataract surgery. We hypothesized that physical (comorbidity and visual acuity) and mental (depressive symptoms) health indicators would be directly and indirectly (through actually received support) associated with perceived support. One hundred and thirty-six cataract patients (69% women; mean age = 71.6 years) completed questionnaires before and after cataract surgery. Results showed that received support partially mediated the association between depressive symptoms and perceived support. However, mental and physical health variables were also directly associated with perceived support. We conclude that health status might feedback to perceptions of available support.     

Driving at night with a cataract: Risk homeostasis?

Driving with a cataract can be dangerous, especially at night when road lighting and automotive lighting produce glare. Disability glare alters visual performance, while discomfort glare contributes to restricted mobility, with drivers avoiding driving at night. The present study was focused on the visual effects of an early cataract, and aimed at comparing three driving performance indexes at night, under glare conditions, with and without a simulated cataract. Two indexes directly referred to road safety, while a measure could be related to behavioral adaptation.Using a driving simulator, twenty-six participants were asked to drive in simulated night-time conditions, under controlled photometric conditions where the adaptation luminance and the glare level were consistent with a two-lane rural road at night with oncoming traffic. The visual effects of a bilateral cataract were simulated using goggles which were in the range of an early cataract in terms of light scattering, light transmission, visual acuity and contrast sensitivity loss. Participants were asked to avoid virtual pedestrians on the road, both with and without a simulated cataract. Three performance indexes were considered: the rate of pedestrian crashes, the distance to the pedestrian when the participant avoided the crash, and the mean speed, which allowed to control for a possible behavioral adaptation to the reduced visual performance. For a better understanding of the visual functions responsible for the degraded driving behavior, contrast sensitivity and time-to-collision performance were also measured in glare conditions.While simulated cataract resulted in slightly slower speeds, poorer driving performance was observed with the goggles than without, with more pedestrians being hit and shorter stopping distances. Time-to-collision estimates at 90 km/h were found to be predictive of stopping distances with a simulated cataract, while contrast sensitivity in glare conditions at 13 cycles per degree was found to be associated with the occurrence of a crash with cataract.The decrease in speed with a simulated cataract was real but ineffective in terms of driving safety, which suggests that the behavioral adaptation to the degraded visual performance was insufficient. The precise impact of a cataract on driving abilities remains to be further studied, to provide scientific knowledge to help practitioners determine the moment when the individuals should forego driving.     

Anxiety and depression in cataract surgery: a pilot study in the elderly

To assess anxiety induced by a planned cataract surgery and to evaluate the correlations of rated anxiety and depression with optical acuity pre- and post-operatively, 278 patients ages 65 years or older were tested. Patients were divided into two groups: first-eye and second-eye cataract surgery. Anxiety and depression were evaluated using the Hamilton's Rating Scales for Anxiety and Depression, respectively. Pre-operatively, first-eye patients showed significantly higher anxiety than second-eye patients (F1,251 = 75.39, p < .001). First-eye patients rated peak anxiety on the day of the surgery, while patients scheduled for second-eye cataract surgery presented no fluctuations in rated anxiety (F1,251 = 49.60, p < .001). There was no correlation of preoperative anxiety or depression with the outcome of surgery (F(1,251)s = .83 and .58, respectively, p > .05). Postoperatively, anxiety and depression in patients without any improvement in their vision were rated significantly higher than in those presenting improved visual acuity after surgery (F1,251 = 566.17 and 300.25, respectively, p < .001).     

制约国人白内障复明手术的社会因素

全球因白内障致失明者大约2000万人,导致低视力者3倍于此数字,即6000万。手术可使白内障失明者视力恢复正常或有用视力。每年每百万人口接受白内障手术的人数（白内障手术率）是在不同环境中衡量眼保健工作的有用尺度。白内障手术率在各国之间以及一个国家的不同地区都存在极大差异,最高者比利时16000例／百万,2004年统计我...     

Missing sights: consequences for visual cognitive development

The effects of early-onset blindness on the development of the visual system have been explained traditionally by the stabilization of transient connections through Hebbian competition. Although many of the findings from congenital cataract and congenital blindness are consistent with that view, there is inconsistent evidence from studies of visual cognition in children treated for visual deprivation from cataract, case reports of recovery of vision in adults, and studies of visual reorganization after late-onset blindness. Collectively, the data from congenital cataract and congenital blindness indicate that early visual experience sets up the infrastructure for later learning involving both the dorsal ("where") and ventral ("what") streams. Nevertheless, there is surprising residual plasticity in adulthood that can be revealed if vision is lost either temporarily or permanently. This has important implications for understanding the role of early visual experience in shaping visual cognitive development.     

Quality of Life Before and After Cataract Surgery: Research in a Sample of Polish Patients

The goal of this paper is to present possible change in quality of life (QoL) in older sample of people with vision disturbances. The patients were investigated twice: before (N = 193) and 4 month after the cataract surgery (N = 69), by means of the scale for vision functioning, and the Life Quality Questionnaire (Schalock & Keith, 1993) extend with the items measuring health related quality of life (HRQoL). Two problems were formulated: To what extent are visual defects associated with the decreased subjective QoL? What changes are observed in perceived QoL during the period of treatment of visual defects? The patients reported significant increase of HRQoL, however they did not report similar increase of a general QoL. Few reasons are considered: overlapping of the content of visual function scales and HRQoL and different indices of a general QoL and HRQoL, lack of a proper postoperative care, low socio-economic status of the participants, and too high expectation concerning better functioning after the surgery.     

Ophthalmic disorder may affect visuo-attentional performance in childhood

The aim of this study was to explore the visuo-attentional skills of children with an ophthalmic disorder. Twenty-four patients and 60 healthy controls between the ages 4 and 7 years, all right-handed with normal or corrected-to-normal close visual acuity, were divided into four age groups. Patients' diagnoses included refractive disorders (e.g., myopia, hypermetropia), strabismus, amblyopia, cataract, and nystagmus. All participants performed nine paper-and-pencil visuospatial tasks aiming to assess selective attention (cancellation tasks), spatial working memory (symbol orientation task), fine visual analysis (embedded figures test), and simple perceptual analysis (shape-matching task). In healthy children, the results showed that performance on all visuo-attentional tasks improved with age. While perception, orientation of attention, and visual working memory develop by the time children begin school (age 5), more sophisticated abilities such as attention disengagement and motor control continue to develop during late childhood. Moreover, a spatial bias in attention orienting appeared with reading acquisition (6–7 years). In ophthalmic children, at 4 years of age defects were observed in all assessed functions, but at 7 years an attentional deficit was virtually the only one remaining. Overall, the results demonstrate that children with an ophthalmologic disorder may experience difficulties with visuospatial tasks despite corrected-to-normal visual acuity.     

Predictors of subjective age before and after cataract surgery: conscientiousness makes a difference

This study contributes to research on subjective age by examining the interplay of felt age with health, functional limitations, and personality. Individuals undergoing cataract surgery (N=134; 38 to 92 years of age) provided data for an assessment period of 6 weeks surrounding their scheduled surgery. Conscientiousness and repeated measurements of health indicators, functional limitations, and felt age were included in the analyses. Results indicated that functional limitations may be more important to the construction of felt age than their underlying health-related causes. Moreover, conscientious participants felt younger before and after surgery. Their functional status was less dependent on health than the functional status of less conscientious participants. This moderator effect is discussed along with health-related pathways leading to felt age.     

Reduced adaptability,but no fundamental disruption,of norm‐based face coding following early visual deprivation from congenital cataracts

Faces are adaptively coded relative to visual norms that are updated by experience, and this adaptive coding is linked to face recognition ability. Here we investigated whether adaptive coding of faces is disrupted in individuals (adolescents and adults) who experience face recognition difficulties following visual deprivation from congenital cataracts in infancy. We measured adaptive coding using face identity aftereffects, where smaller aftereffects indicate less adaptive updating of face‐coding mechanisms by experience. We also examined whether the aftereffects increase with adaptor identity strength, consistent with norm‐based coding of identity, as in typical populations, or whether they show a different pattern indicating some more fundamental disruption of face‐coding mechanisms. Cataract‐reversal patients showed significantly smaller face identity aftereffects than did controls (Experiments 1 and 2). However, their aftereffects increased significantly with adaptor strength, consistent with norm‐based coding (Experiment 2). Thus we found reduced adaptability but no fundamental disruption of norm‐based face‐coding mechanisms in cataract‐reversal patients. Our results suggest that early visual experience is important for the normal development of adaptive face‐coding mechanisms.     

Monocular and binocular visual evoked potentials before and after cataract surgery

Visual evoked cortical potentials (VEPs) were recorded from an individual with a mature cataract in one eye. Stimulation was both monocular and binocular and VEPs were obtained from three occipital scalp sites. Comparisons of recordings taken prior to cataract removal and after removal showed a dramatic increase in amplitude of potentials derived through stimulation of the affected eye. Slight differences in hemispheric amplitude prior to surgery suggest a greater degree of opacity in one portion of the affected lens.