Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

玻璃体切除治疗增生性糖尿病视网膜病变保留晶状体前囊膜的临床观察

目的 探讨保留晶状体前囊膜技术在增生性糖尿病视网膜病变(PDR)手术治疗中的临床效果.方法 系列病例研究.对伴有晶状体混浊和累及眼底后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离的51例(58只眼)PDR患者,在行玻璃体切除手术中,采用经睫状体平坦部切除或超声粉碎吸出晶状体核及皮质并保留前囊膜的技术,处理混浊的晶状体,完成玻璃体手术后给予硅油充填.术后对晶状体前囊膜照相,并对其透明度进行分级评价,对与手术相关的并发症及其处理方法、患者视力和眼压、视网膜复位情况进行分析.结果 玻璃体切除硅油充填并保留晶状体前囊膜的58只眼中,晶状体前囊膜透明度:A级26只眼(44.8%),B级20只眼(34.5%),C级7只眼(12.1%);D级5只眼(8.6%).46只眼(79.3%)术后最佳矫正视力≥0.05,21只眼接受二期人工晶状体植入术.最终7只眼因视网膜不能复位,黄斑裂孔未闭合,而未行硅油取出术.手术并发症:误切虹膜1只眼,硅油进入前房7只眼,虹膜新生血管形成及新生血管性青光眼各1只眼,术后高眼压4只眼,继发性黄斑和视网膜前膜11只眼,黄斑裂孔2只眼.结论 保留晶状体前囊膜,酌情行二期人工晶状体植入术,是处理严重PVR眼的一种较好方法.晶状体上皮细胞残留和积血的长期存在是晶状体前囊膜混浊的主要原因,硅油进入前房是玻璃体切除术中应用保留晶状体前囊膜技术的主要并发症之一.     

Midterm visual outcome and progression of diabetic retinopathy following cataract surgery. Midterm outcome of cataract surgery in diabetes

OBJECTIVE: To assess the influence of cataract surgery on progression of diabetic retinopathy and visual acuity. METHODS: 37 patient eyes with mild to moderate diabetic retinopathy at baseline underwent phacoemulsification and intraocular posterior chamber lens implantation. They were examined 3.3 +/- (SD) 0.7 years after surgery. RESULTS: 83.8% of the eyes showed a better final visual acuity, and 67.6% achieved a final visual acuity of 0.5 or better. The retinopathy remained unchanged in 83.8% and progressed in 16.2% of the eyes. No eye progressed to proliferative retinopathy. CONCLUSION: Phacoemulsification and implantation of a posterior chamber intraocular lens is a safe procedure for patients with mild to moderate diabetic retinopathy.     

玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变

目的探讨玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变的有效性和安全性。方法回顾性分析合并白内障的增生性糖尿病视网膜病变23例（26眼）。行玻璃体切除联合晶状体超声乳化及人工晶状体植入术的临床资料,观察术后视力改善程度及术中术后并发症。结果术后随访7—24个月,平均12．8个月。术后矫正视力较术前提高者20眼（76．92％）;视力不变者5眼（19．23％）;视力下降者1眼（3．85％）。术中未见严重并发症。术后主要并发症有角膜上皮水肿7眼（26．92％）,前房炎性反应6眼（23．08％）,玻璃体再积血3眼（11．54％）,复发性视网膜脱离2眼（7．69％）,后发性白内障8眼（30．77％）,术后虹膜后粘连4眼（15．38％）。术后15眼需补充眼内激光光凝。结论玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变,可使大多数患眼视力改善,并发症少,手术安全有效。     

Intraocular lenses and diabetes mellitus

I reviewed the records of 74 consecutive, unselected diabetic patients (91 eyes) who had cataract extraction with intraocular lens implantation. The retinopathy status remained unchanged in 79 eyes. Of the 12 in which retinopathy status changed, four eyes without previous retinopathy developed mild background retinopathy, seven eyes that had had mild background retinopathy progressed to moderate background retinopathy, and one eye that had had background retinopathy developed mild proliferative retinopathy. Sixty-four eyes (70.3%) achieved visual acuities of 20/40 or better. The examination, photography, and photocoagulation treatment of the retina were not affected by the presence of an intraocular lens.     

Clinical study of venous abnormalities in diabetic retinopathy]

The authors studied 304 eyes (248 cases) affected by diabetic retinopathy in relation to venous abnormalities by ophthalmoscopy, slit lamp examination with contact lens and fluorescein angiography. The posterior pole and surrounding mid-peripheral area were examined. The subjects consisted of 225 eyes with pre-proliferative and 79 eyes with proliferative retinopathy. Fifty-six eyes (18%) had venous abnormalities: 17 of the 225 eyes (8%) with pre-proliferative retinopathy and 39 of the 79 eyes (49%) with proliferative retinopathy. In the 56 eyes with venous abnormalities. 39 (96%) showed beading. 14 (25%) showed looping and 2 (4%) showed duplication. All eyes which showed looping or duplication had proliferative retinopathy. The locations of the venous abnormalities were analyzed: 42% were in secondary branches, 27% in tertiary branches, 18% in primary branches, 10% in fourth branches and 3% in fifth branches. The portion of the fundus affected was upper temporal, lower temporal, upper nasal and lower nasal in 28%, 22%, 29% and 21%, respectively. Based on our results, eyes with looping or duplication on ophthalmoscopic or slit lamp examination, have an extremely high probability of being in some stage of proliferative retinopathy. Retinopathy should be confirmed by fluorescein angiography and photocoagulation should be performed as quickly as possible.     

增生性糖尿病视网膜病变合并白内障的联合手术治疗

目的探讨玻璃体手术联合晶状体超声乳化治疗增生性糖尿病性视网膜病变（PDR）合并白内障的临床疗效。方法分析19例（20只限）增生性糖尿病性视网膜病变合并不同程度白内障患者行白内障超声乳化联合玻璃体手术同时进行人工晶状体囊袋内植入的临床资料，观察术后视力改善程度及术中术后并发症。结果随访2—16个月，所有术眼人工晶状体位置良好，手术后20只限中有16只限（80％）视力有不同程度的提高，其中视力提高二行以上13只限（65％）；视力较术前无改善4只限（20％）。术后视力恢复不佳的原因主要与不同程度的糖尿病黄斑病变、视网膜广泛缺血有关。术后并发症包括高眼压、虹膜后粘连、玻璃体腔再出血、视网膜再脱离、晶状体后囊混浊及新生血管性青光眼等。结论玻璃体手术联合白内障超声乳化人工晶状体植入术治疗增生性糖尿病性视网膜病变合并白内障是安全和有效的，可使大多数患者视力改善，且无明显并发症。     

玻璃体切割联合超声乳化人工晶状体植入治疗糖尿病视网膜病变观察

目的 探讨玻璃体切割联合I期超声乳化人工晶状体植入术治疗增殖性糖尿病性视网膜病变的临床疗效及并发症.方法 分析90只眼增殖性糖尿病性视网膜病变,进行白内障超声乳化联合常规三通道玻璃体切割及眼内光凝,囊袋内植入后房型人工晶状体手术的疗效及并发症.依术中玻璃体腔内填充物不同分为三组,注灌注液为I组28只眼,注惰性气体14%C_3F_8为Ⅱ组49只眼,注硅油为Ⅲ组13只眼.结果 术后随访三个月内,术后视力提高81只眼(90%),不变者7只眼(7.8%),下降者2只眼(2.2%).其中矫正视力0.5以上者23只眼(25.6%),0.1～0.4者44只眼(48.9%),最佳矫正视力为1.0.-过性高眼压24只眼(26.7%),其中I组2只眼,Ⅱ组16只眼,Ⅲ组6只眼.合并葡萄膜炎虹膜粘连者术后前房炎症反应重,视力恢复差.无一例人工晶状体移位发生.结论 玻璃体切割联合I期超声乳化人工晶状体植入术治疗增殖性糖尿病性视网膜病变是安全、有效的,但需要熟练的手术技巧为前提.     

玻璃体切除术联合晶状体手术治疗增生性糖尿病性视网膜病变

目的:评价玻璃体手术联合晶状体手术治疗增生性糖尿病性视网膜病变的临床效果。方法:对68例68眼增生性糖尿病性视网膜病变合并白内障患者行玻璃体切除术联合晶状体超声乳化吸出术治疗,其中35例Ⅰ期植入折叠型后房型人工晶状体。结果:术后43例(63.2%)患者视力提高,术中无严重并发症发生,术后7例(10.3%)角膜上皮愈合延迟,5例(7.4%)发生新生血管性青光眼,6例(8.8%)发生复发性玻璃体积血,4例(5.9%)发生复发性视网膜脱离,4例(5.9%)发生后发性白内障。结论:玻璃体切除术联合晶状体超声乳化吸出术治疗增生性糖尿病性视网膜病变合并白内障,可以改善视功能。     

Effect of cataract surgery and intraocular lenses on diabetic retinopathy

We reviewed a series of 137 cataract extractions with intraocular lenses (IOLs) in patients with diabetes, mellitus between 1977 and 1983. All patients were followed for an average of 36 months to determine if they subsequently showed progression of diabetic retinopathy. Divided into groups according to the type of procedure and IOL received, they were compared for age, sex, duration of diabetes, treatment required for the diabetes, intraoperative complications, and follow-up period. Patients who had intracapsular cataract extractions with anterior chamber IOLs were three times as likely to show proliferative retinopathy as those who had extracapsular cataract extractions with posterior chamber IOLs. Insulin-dependent patients were three to four times more likely to show progression to proliferation than noninsulin dependent patients. We conclude that, while some procedures are riskier for the diabetic eye, extracapsular lens extraction with implantation of a posterior chamber lens does not imply an increased risk of development of proliferative retinopathy.     

Extracapsular cataract extraction and implantation in the capsular sac during vitrectomy in diabetics]

Removal of the lens is often performed during pars plana vitrectomy for complications of proliferative diabetic retinopathy, but correction of aphakia often remains unsatisfactory. Some authors have reported posterior chamber intraocular lens implantation during pars plana vitrectomy in diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy. Some patients were operated by pars plana lensectomy and vitrectomy followed by posterior chamber intraocular lens implantation in the ciliary sulcus, others by extracapsular extraction, posterior chamber intraocular lens implantation in the ciliary sulcus, and pars plana vitrectomy. Other authors have described phacoemulsification through the limbus, pars plana vitrectomy and implantation in the capsular bag in one operation in various indications, including complications of proliferative diabetic retinopathy. We inserted a posterior chamber intraocular lens into the capsular bag in 18 eyes of 16 patients with complications of proliferative diabetic retinopathy after extracapsular cataract extraction and pars plana vitrectomy in a single session. A standard extracapsular cataract extraction was performed before pars plana vitrectomy. Sufficient anterior capsule was left in place in order to facilitate implantation in the capsular bag after pars plana vitrectomy. The anterior chamber was filled with sodium hyaluronate in order to maintain anterior chamber depth, corneal clarity, and good mydriasis during the continuation of the procedure. A standard three port pars plana vitrectomy was performed in all cases. After closure of superior sclerotomies, superior corneal incision was partially reopened, an intraocular lens specifically designed for the capsular bag with an optic size of 7 mm was inserted, and the corneal incision was closed with interrupted 10/0 sutures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Posterior synechia of the iris after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation

PURPOSE: Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation has become a widely accepted treatment for cataracts in patients with vitreoretinal diseases. We examined factors influencing the development of posterior synechia after this triple procedure. METHODS: One hundred and three patients (107 eyes) were evaluated. The frequency of postoperative posterior synechia, the preoperative diagnosis, whether gas tamponade was used, and the type of lens implanted were reviewed. RESULTS: Twenty-one eyes (19.6%) developed posterior synechia, and the highest rate (12/39 eyes, 30.8%) was in patients with proliferative diabetic retinopathy. Posterior synechia was more frequent after gas tamponade (28.1%) than in eyes without tamponade (10.1%). In proliferative diabetic retinopathy (PDR) patients, fibrin deposition and the amount of retinal photocoagulation were causative factors for posterior synechia. CONCLUSIONS: Factors promoting postoperative synechia after the triple procedure included (1) the existence of PDR, (2) expanding gas tamponade, (3) fibrin deposition in PDR, and (4) the amount of photocoagulation in PDR.     

Cataract surgery and implantation in diabetics. Apropos of 92 eyes

We examined 92 eyes (63 patients) who underwent extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Visual acuity improved by two lines or more in 65% of cases. Follow-up examination (6 months and 2 years) showed posterior capsule opacification in 30% of cases. Progression of diabetic retinopathy was mild but cystoid macular edema was present in 70% of cases with non proliferative retinopathy. Proliferative retinopathy was treated postoperative by pan retinal photocoagulation. One neovascular glaucoma occurred, secondary to a ruptured capsule.     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

糖尿病视网膜病变玻璃体切除术后发生新生血管性青光眼的因素分析

目的：探讨增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)在行玻璃体切除术治疗后发生新生血管性青光眼(neovascular glaucoma,NVG)的因素。

方法：回顾性分析2013-01/2017-12于我院就诊因PDR行玻璃体切除术治疗患者(233例237眼)的临床资料,分为NVG组和非NVG组,分析患者术后发生NVG的相关因素。

结果：所有患者中,未发生NVG组217眼。发生NVG者共20例20眼,12眼联合白内障手术,其中6眼晶状体后囊膜缺失或不完整; 14眼合并有高血压; 16眼合并有高血脂症; 6眼再次行PPV术; 2眼为硅油填充眼或者已行硅油移除眼。玻璃体切除术中联合白内障手术合并晶状体后囊膜不完整与PDR手术后发生 NVG有相关性; 玻璃体腔硅油填充一定程度上可能对发生NVG起到抑制作用。高血压、高血脂、再次PPV术与PDR术后发生 NVG无相关性。

结论：正确把握晶状体手术时机、恰当选择玻璃体腔填充物对预防PDR术后发生 NVG具有积极意义。     

Role of the vitreous in diabetic retinopathy. I. Vitreous changes in diabetic retinopathy and in physiologic aging

The vitreoretinal relationships in 1021 eyes of 570 patients with diabetic retinopathy and in 857 normal eyes were studied retrospectively in an attempt to identify the vitreous changes specifically related to diabetes. Complete posterior vitreous detachment (PVD) occurred in diabetic patients largely as part of the aging process, but proliferation interfered with its development. Complete PVD with nonproliferative diabetic retinopathy in the younger age groups was more prevalent in eyes treated by panretinal photocoagulation (PRP) than in untreated eyes and thus might have an association with PRP treatment. Partial PVD, seen mainly in proliferative diabetic retinopathy, had no correlation with aging. In the eyes of patients who were younger when diabetes was diagnosed, the development of partial PVD had a close correlation with the duration of diabetes. The data suggest the need for a clinical trial of early photocoagulation, before partial PVD develops, in younger-onset diabetic patients showing early proliferative changes.     

不同晶状体状态对增殖性糖尿病性视网膜病变疗效的影响

目的 探讨不同晶状体状态对增殖性糖尿病视网膜病变手术疗效的影响.方法 对30例(30只眼)行晶状体、玻璃体联合手术与38例(56只眼)行单纯玻璃体切除治疗增殖性糖尿病视网膜病变患者的临床资料进行对比分析.结果 随访6～21月,两组患者术后视力均较术前不同程度地提高,但差异无显著性.有晶状体眼组视网膜一次复位率87.50%(14/16),无和(或)假晶状体眼组视网膜一次复位率92.30%(12/13).术中并发症两组发生率接近,无统计学意义.术后并发症:有晶状体眼组2只眼(0.04%)而无和(或)假晶状体眼组4只眼(0.11%)发生角膜水肿.无和(或)假晶状体眼组前房渗出6只眼,虹膜后粘连2只眼,虹膜新生血管5只眼,而有晶状体眼组无一例发生.有晶状体眼组再次手术7只眼(13.72%).无和(或)假晶状体眼组再次手术3只眼(8.57%).结论 联合手术治疗增殖性糖尿病视网膜病变安全有效,可早期恢复患者的视力,提高视网膜复位率.但术后前房炎症反应、虹膜后粘连、虹膜新生血管及眼压升高等并发症较高,需严格掌握手术适应证.     

增生性糖尿病视网膜病变合并白内障行玻璃体切割术中两种联合术式的对比观察

目的探讨增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)合并白内障行玻璃体手术硅油填充联合超声乳化吸出术或晶状体切除术的临床疗效。方法对合并有不同程度的晶状体混浊和伴有累及后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离以及术中出现医源性裂孔的PDR患者共76例(86眼),在行玻璃体切除手术中,根据晶状体混浊程度,采用经睫状体平坦部切除晶状体保留前囊膜(2～3级核;46眼)作为玻璃体切除+晶状体切除术组或超声乳化手术摘出晶状体保留后囊膜(3级核以上;40眼)作为玻璃体切除+超声乳化吸出术组,一期不植入人工晶状体;完成玻璃体手术后予硅油填充。术后观察的指标包括:视力、眼压、前囊膜或后囊膜混浊情况、虹膜新生血管、虹膜粘连情况、视网膜复位情况以及二期人工晶状体植入情况。结果 2组患者的术后最佳矫正视力为0.05的为32眼、25眼,分别占69.6%和62.5%,2组间差异无统计学意义(P>0.05);术后2组出现高眼压眼分别为7眼和8眼,组间差异无统计学意义(P>0.05);2组间在各级囊膜混浊程度上比较,差异均无统计学意义(均为P>0.05);2组中虹膜不同程度粘连于囊膜分别为5眼和6眼,差异无统计学意义(P>0.05);超声乳化术组中发生虹膜新生血管2眼,在晶状体切除术组中为5眼,差异无统计学意义(P>0.05);视网膜复位情况以及二期人工晶状体植入情况2组比较,差异也无统计学意义(P>0.05)。结论玻璃体手术硅油填充联合超声乳化吸出术或晶状体切除术,术后酌情行二期人工晶状体植入,都是处理严重PDR合并白内障眼的较好方法。     

Pars plana vitrectomy for complicated retinal detachments

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.     

联合手术治疗增殖性糖尿病视网膜病变合并白内障的效果评价

目的:评价联合手术治疗增殖性糖尿病视网膜病变合并白内障的疗效及并发症。方法:回顾性分析107眼联合手术治疗增殖性糖尿病视网膜病变合并白内障的效果及并发症。结果:共107眼随访3 ～36(平均13. 5±2. 5)mo,91眼(85.0%)术后均有不同程度视力改善,植入人工晶状体35眼,术后最佳矫正视力提高91眼(85.0%),视力不变10眼(9.4%);视力下降6眼(5.6%)。术后40眼≥0.1(37.4%)。22眼<0.01,21眼0.01 ～0.05,24眼0.05 ～0.1,35眼0.1 ～0.3,5眼>0.3。影响视力提高的主要原因为不同类型黄斑病变及缺血性黄斑改变。并发症主要有角膜水肿、一过性高眼压、术后炎症反应前房纤维渗出增加、后囊混浊,均可自愈或经治疗痊愈。结论:联合手术是治疗增殖性糖尿病视网膜病变合并白内障的一种有效办法。