Clinical observation on different nucleus delivery methods in small incision cataract surgery with non-phacoemulsification

AIM: To compare the clinical effect and characteristics of lens loop extracting nucleus method, water irrigation and nucleus fragmentation within anterior chamber in small incision cataract surgery with non-phacoemulsification. <p>METHODS:There were 324 cases(324 eyes)with senile cataract randomly divided into three groups, by the lens loop extracting nucleus method(group A), water irrigation(group B)and nucleus fragmentation within anterior chamber(group C), to complete the process of nucleus division. The time of nuclear removal, complication during operation, the degree of edema of corneal endothelium on the first day after the surgery and visual acuity after surgery were observed and recorded.<p>RESULTS:The average extracting nucleus time was 45s in lens loop(group A); 34s in water irrigation(group B)and 65s in manual fragmentation(group C).The differences of average time are statistically significant(<i>P</i><0.05), and the complications in lens loop and manual fragmentation mainly are iris trauma and posterior capsular rupture; the complication in the water irrigation is hyphema. Regarding corneal edema from 0 to 1degree, the difference between group A and group B, group B and group C were statistically significant(<i>P</i><0.05). The difference between group A and group C had no statistical significance(<i>P</i>>0.05).Regarding the visual acuity on the first day after surgery, the difference between group A and group C, group B and group C were statistically significant(<i>P</i><0.05), The visual acuity on the 7th day after surgery: the difference between group B and group C were statistically significant(<i>P</i><0.05). In terms of the visual acuity on 1 momth after surgery: three groups have no statistically significant difference(<i>P</i>>0.05).<p>CONCLUSION:Manual fragmentation has obvious advantages in removing nuclear above Ⅳ grade; The water irrigation method has fewer complications with low incidence of corner edema, which is more preferable in removing the nuclear below Ⅳ grade

Practical points in the medical treatment of overactive bladder and nocturia in the elderly

AbstractThe prevalence of overactive bladder (OAB) increases with age. Degeneration of the central nervous system in the elderly has been proposed as one of the pathogenic factors of OAB. Antimuscarinic therapy is effective in the treatment of OAB; however, intolerable systemic adverse events and cognitive dysfunction during treatment with nonselective antimuscarinic agents is of growing concern in elderly patients. The newly developed beta-3 adrenoceptor agonist mirabegron does not adversely affect flow rate and detrusor pressure, and its therapeutic efficacy and tolerability are similar in patients aged > 65 years and > 75 years, suggesting it might be the therapeutic choice in older patients with OAB. Nocturia can cause sleep deprivation at night and increase daytime sleepiness and loss of energy in the elderly. Desmopressin add-on therapy is effective in improving nocturia and storage symptoms. However, elderly patients with a baseline serum sodium level below the normal range are at high risk of developing significant hyponatremia