Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis

PURPOSE: To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. RESULTS: Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. CONCLUSIONS: Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.     

晶状体囊袋张力环在晶状体悬韧带断裂的白内障手术中的应用

目的　评价晶状体囊袋张力环 (capsulartensionring ,CTR)在晶状体悬韧带断裂的白内障手术中的应用。方法　对 11例 ( 11只眼 )外伤性晶状体悬韧带部分断裂的患者行白内障手术 ,术中连续环形撕囊后植入CTR ,然后行白内障摘除及后房型人工晶状体囊袋内植入。结果　 11只眼的人工晶状体均处于正位 ,无倾斜及明显偏位。术后 1个月矫正视力 0 4者 4只眼、0 5～ 0 8者 5只眼、>0 8者 2只眼。 1只眼因CTR直径过大 ,可见CTR 2个端口重叠。除白内障手术固有的并发症外 ,未见CTR引起其他并发症。结论　对晶状体悬韧带断裂的白内障患者术中应用CTR ,可利于术中操作 ,防止术后人工晶状体偏位的发生 ,并且有助于患者视力恢复 ;CRT是一种有效的白内障手术辅助工具。     

Capsular tension ring implantation after capsulorhexis in phacoemulsification of cataracts associated with pseudoexfoliation syndrome. Intraoperative complications and early postoperative findings.

PURPOSE: To evaluate the effect of an endocapsular tension ring in preventing zonular complications during phacoemulsification of cataracts associated with pseudoexfoliation syndrome. SETTING: Eye Clinic of Beyo?lu Education and Research Hospital, Istanbul, Turkey. METHODS: A prospective randomized study comprised 78 eyes with cataract and pseudoexfoliation syndrome that were randomly divided into 2 groups. The age, sex, cataract density, iridodonesis, axial length, anterior chamber depth, best corrected visual acuity (BCVA), and intraocular pressure (IOP) were matched between groups. In 39 eyes, a capsular tension ring (CTR) was implanted after capsulorhexis and hydrodissection but before nucleus emulsification. Thirty-nine eyes that did not have a CTR implanted served as a control. The main outcome measures were the rates of intraoperative zonular separation and capsular fixation of a foldable intraocular lens (IOL). Posterior capsule rupture without zonular dialysis, vitreous loss, corneal edema, fibrin in the anterior chamber, BCVA, and IOP in the immediate postoperative period were also compared between the 2 groups. RESULTS: Five eyes (12.8%) in the control group and no eye in the CTR group had intraoperative zonular separation (P =.02). Posterior capsule rupture without zonular separation occurred in 3 eyes (7.7%) in the control group and 2 (5.2%) in the CTR group. Capsular IOL fixation was achieved in 37 eyes (94.9%) in the CTR group and 31 eyes (74.3%) in the control group (P =.012). The difference in BCVA was not statistically significant between the 2 groups (P =.44); however, uncorrected visual acuity (UCVA) was significantly better in the CTR group (P =.026). CONCLUSION: In cases of cataract associated with pseudoexfoliation syndrome, implanting a CTR before phacoemulsification of the nucleus reduced intraoperative zonular separation, increased the rate of capsular IOL fixation, and improved UCVA.     

晶状体异位继发急性闭角型青光眼术式选择及疗效观察

目的 回顾性分析晶状体异位继发急性闭角型青光眼手术方式的选择及观察其疗效.方法 取36例(41只眼)晶状体异位继发急性闭角型青光眼患者,采用超声生物显微镜观察晶状体悬韧带离断范围,根据晶状体脱位范围以及房角关闭范围,分别选择小梁切除术,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术和(或)小梁切除联合超声乳化白内障吸除术,术后随访1个月,观察手术治疗效果.结果 随访期间,患者术后矫正视力提高,眼压降低:术后1d,17只眼(41.46%)矫正视力＞0.5;30只眼(73.17%)眼压在21mmHg以内;术后7d,24只眼(58.54%)矫正视力＞0.5;35只眼(85.36%)眼压在21mmHg以内;术后30d,27只眼(65.85%)矫正视力＞0.5;所有患者眼压在21mmHg以内.结论 在晶状体异位继发急性闭角型青光眼患者中,晶状体脱位范围在1~2个象限者,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术是一种安全有效的术式;脱位范围大于2个象限者,选择白内障囊外摘除手术;房角关闭大于1/2的患者,选择小梁切除联合白内障手术.     

悬韧带异常的假性剥脱综合征性白内障手术时机和方法的选择

背景 假性剥脱综合征(PEX)常并发白内障,多伴有进展性晶状体悬韧带异常,术中及术后易出现悬韧带相关并发症,白内障手术如何选择合适的手术时机及手术方式对于减少并发症、提高手术成功率具有重要的临床意义,但目前相关研究报道很少. 目的 分析伴有晶状体悬韧带异常的PEX性白内障(PEXC)患者行白内障摘出联合人工晶状体(IOL)植入术的疗效,探讨其合适的手术时机及手术方式.方法采用系列病例观察研究方法,对2012年7月至2015年12月在新疆维吾尔自治区喀什地区第二人民医院接受PEXC手术的21例23眼进行分析,所有患者均伴有晶状体悬韧带异常,根据悬韧带异常的程度分为晶状体震颤和不全脱位2种类型,其中晶状体震颤18眼,晶状体不全脱位5眼.按照Emery核硬度分级法分为Ⅱ级核4眼,Ⅲ级核9眼,Ⅳ级核7眼,Ⅴ级核3眼;晶状体震颤者行白内障超声乳化联合标准囊袋张力环(CTR)或改良CTR(MCTR)及IOL植入术或白内障囊外摘出联合CTR及IOL植入术;Ⅱ级或Ⅲ级核伴晶状体不全脱位者行超声乳化联合MCTR及IOL植入术;Ⅳ级或Ⅴ级核伴晶状体不全脱位者行白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术.对患者共随访3个月,分析手术时机对疗效的影响及术眼术后视力、眼压,术中及术后并发症,前囊口、IOL位置变化. 结果 晶状体震颤患者行白内障超声乳化联合IOL植入术,其中植入CTR者10眼,MCTR者3眼,囊外摘出联合CTR及IOL植入术4眼,前段玻璃体切割联合IOL巩膜缝线固定术1眼.晶状体不全脱位行超声乳化联合前段玻璃体切割联合IOL巩膜缝线固定术1眼,白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术4眼.术眼术后最佳矫正视力(BCVA)＞0.5者4眼,＞0.3 ～≤0.5者6眼,＞0.1～≤0.3者8眼,≤0.1者5眼,与术前BCVA比较,差异有统计学意义(x2=17.29,P＜0.01);术眼术前平均眼压为(16.82-±2.25)mmHg(1 mmHg=0.133 kPa),术后3个月平均眼压为(16.12±2.67)mmHg,差异无统计学意义(t=0.108,P＞0.05);术中、术后常见并发症为瞳孔不易扩大、角膜水肿、晶状体皮质残留和后囊膜混浊. 结论 伴有晶状体悬韧带异常的PEXC手术复杂、并发症多,手术时机和手术方式的选择均应依据悬韧带异常程度、核硬度和晶状体是否脱位,术前应认真行自然瞳孔下及扩瞳后检查以确定治疗方案是手术成功的关键.     

囊袋张力环植入治疗晶状体悬韧带异常

目的 探讨超声乳化联合囊袋张力环(CTR)及人工晶状体(IOL)植入术治疗白内障有悬韧带异常者的手术效果.方法 10例16只眼具有晶状体悬韧带松弛或部分断裂的白内障,施行超声乳化联合CTR及IOL植入手术.结果 术后随访6月,有2例失访.末次检查8例13只眼的最佳矫正视力(BCVA)都有增进,所有术眼CTR都位于囊袋内,仅有1只眼在术后6个月IOL位置轻度偏中心,3只眼轻度后囊膜混浊.结论 对半脱位晶状体采用超声乳化白内障吸除联合CTR及IOL植入是一安全有效的手术,严爵半脱位和有进展的病例才需作改良CTR(M-CTR)巩膜缝合固定术.     

囊袋张力环在外伤性晶状体半脱位白内障超声乳化手术中的应用

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在外伤性晶状体半脱位白内障超声乳化手术中的应用效果。方法:对10例10眼外伤性白内障伴晶状体半脱位患者行白内障手术,术中连续环形撕囊后植入CTR,超声乳化术摘除白内障后,囊袋内植入后房型人工晶状体。结果:10眼术后随访3mo～2a,矫正视力0.3者2眼,0.4～0.7者6眼,>0.8者2眼。人工晶状体均基本正位,无明显倾斜偏位。仅1例患者于随访2a时出现后发性白内障,未见由CTR引起的并发症。结论:在外伤性晶状体半脱位白内障超声乳化手术中运用CTR,能提高手术安全性,减少手术并发症,是一种有效的白内障手术辅助工具。     

囊袋张力环在高度近视白内障超声乳化及人工晶状体植入术中的应用

目的:评价晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用价值。方法:对427例549眼高度近视白内障患者行超声乳化白内障吸出术及后房型人工晶状体和囊袋张力环植入,术后随访3～18mo,测视力、眼压、散大瞳孔进行眼前节裂隙灯观察照像。结果:所有植入的人工晶状体均位于正位,术后3mo矫正视力>0.8者43眼,0.6～0.8者118眼,0.5者89眼,0.4者101眼,0.3者66眼,0.2者80眼,<0.2者52眼;术后1d眼压为3～47mmHg,一过性高眼压179眼,其中有1例患眼因术后高眼压无法药物控制而不得不取出CTR;随访18mo中有2例患眼发生视网膜脱离、5例患眼因发生后发性白内障而行激光治疗。结论:晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用能防止晶状体悬韧带离断,使人工晶状体居中性更佳,并进而能有效防止后发性白内障和视网膜脱离的发生。     

张力环植入与人工晶状体囊袋内单襻缝线固定两种手术方式的对比研究

目的　比较白内障超声乳化联合囊袋张力环及人工晶状体囊袋内植入术,与白内障超声乳化联合人工晶状体囊袋内单襻缝线固定术两种手术方式治疗白内障合并晶状体不全脱位的临床效果。方法　收集白内障伴晶状体不全脱位33例（41眼）,按手术方式分为两组,其中A组行囊袋张力环及人工晶状体囊袋内植入术,共14例17眼;B组行人工晶状体囊袋内单襻缝线固定术,共19例（24眼）。对两组术后视力、眼压、手术并发症及IOL稳定性等资料进行统计学分析。结果　A组术后最佳矫正视力为0.66±0.15;1眼（5.9%）发生低眼压;5眼（29.4%）发生高眼压;8眼（47.1%）发生人工晶状体-囊袋张力环复合体脱位;12眼（70.6%）发生后发性白内障。B组术后最佳矫正视力为0.72±0.14;8眼（33.3%）发生低眼压;1眼（4.2%）发生高眼压;18眼（75.0%）发生后发性白内障。两组术后最佳矫正视力差异无统计学意义（t=-1.150,P=0.257）;术后低眼压发生率比较,差异有统计学意义（χ²=4.377,P=0.036）;术后高眼压发生率比较,差异有统计学意义（χ²=5.077,P=0.024）。结论　两种手术方法均能有效改善患者视力,达到相似的临床效果。     

晶状体囊袋张力环植入对高度近视白内障手术效果的对比观察

目的 评价晶状体囊袋张力环(CTR)在高度近视白内障人工晶状体手术中的应用价值.方法 将827例(1081只眼)高度近视白内障患者随机分为A、B两组,A组427例(549只眼),B组400例(532只眼),其中A组患者行超声乳化白内障吸出术及后房型人工晶状体和CTR植入,B组患者仅行超声乳化白内障吸出术及后房型人工晶状体植入.结果 A组术后一过性高眼压179只眼,其中1例取出CTR;随访18个月中有2例2只眼发生视网膜脱离,5例5只眼因发生后发障而行激光治疗.B组术后随访18个月中有9例9只眼发生视网膜脱离、35例35只眼因发生后发障而行激光治疗.两组的视网膜脱离发生率及后发障发生率比较差异均有统计学意义.结论 晶状体囊袋张力环在高度近视白内障手术中的应用能防止晶状体悬韧带离断,使人工晶体居中,并进而能有效防止后发障和视网膜脱离的发生.     

Anterior chamber maintainer versus viscoelastic material for intraocular lens implantation: case-control study

PURPOSE: To compare best corrected visual acuity (BCVA) and intraocular pressure (IOP) in eyes that had a foldable intraocular lens (IOL) implanted with the use of an anterior chamber maintainer (ACM) in 1 eye and hyaluronate 3.0% (Vitrax) viscoelastic material in the other eye. SETTING: Private practice in a large urban center. METHODS: Sixty-six eyes of 33 patients had consecutive bilateral cataract extraction by the same surgeon using an identical temporal approach, clear corneal phacoemulsification, and implantation of an Allergan SI-40NB or SA-40NB IOL through an injection delivery system. The first operative eye was arbitrarily assigned to the ACM or Vitrax group, while the fellow eye received the opposite technique. Patients with coexisting ocular pathology that could influence the measured outcomes (eg, glaucoma, age-related macular degeneration) were excluded. Patients were evaluated preoperatively and 1 day and 3 to 6 weeks postoperatively. RESULTS: No serious intraoperative or postoperative complications were reported. The only statistical difference in BCVA or IOP was on the first postoperative day, when the mean IOP was approximately 2 mm Hg lower in the ACM group than in the Vitrax group. CONCLUSION: The use of an ACM for implantation of an injected 3-piece silicone IOL may lower IOP on the first postoperative day.     

超声乳化白内障摘除治疗合并白内障的可疑房角关闭和房角关闭及原发性闭角型青光眼

目的: 观察白内障超声乳化摘除联合人工晶状体植入术治疗伴有白内障的可疑原发性房角关闭(PACS)、原发性房角关闭(PAC)及原发性闭角型青光眼(PACG)的特点及疗效。方法: 选取2012-01/12诊断为合并老年性白内障的PACS和PAC及PACG患者共86例86眼,均行白内障超声乳化摘除+人工晶状体植入术,术后随访3mo,术前术后记录视力、眼压、房角、超声生物显微镜检查(UBM)、视野及降眼压药物使用情况。结果: 术中发现19眼(22%)晶状体悬韧带不同程度松弛。84眼(98%)术后视力不同程度提高,术后视力<0.1者7眼(8%),0.1～0.5者32眼(37%),0.6～1.0者47眼(55%)。83眼(97%)随访期结束时不用药情况下眼压均在10～15mmHg之间。术后前房均加深,房角不同程度开放。结论: 悬韧带松弛在PACS,PAC,PACG中较为常见。超声乳化白内障摘除可有助于控制PAC及PACG患者的眼压,不同程度开放PAC及PACG房角、加深前房。     

Modified capsular tension ring for patients with congenital loss of zonular support

PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months +/- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.     

晶状体半脱位白内障超声乳化术中囊袋张力环的应用观察

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在白内障合并晶状体半脱位行超声乳化白内障吸除术中的应用价值。方法:对15例16眼白内障合并晶状体半脱位患者行超声乳化白内障吸除术,术中连续环行撕囊后植入CTR,超声乳化摘除白内障,囊袋内植入后房型人工晶状体,若晶状体半脱位>1/2需植入固定孔型CTR,将CTR固定孔上的聚丙烯线固定于悬韧带离断一侧板层巩膜壁上。结果:所有植入的人工晶状体均位于正位。术后随诊3~9mo,矫正视力0.1~0.4者5眼,0.5~0.8者8眼,>0.8者3眼。结论:在白内障合并晶状体半脱位患者行超声乳化白内障吸除术中植入囊袋张力环是安全有效的方法,有利于保持囊袋的完整,便于后房型人工晶状体植入,防止人工晶状体的偏位,减少手术并发症,术后视力恢复快。     

Phacoemulsification in subluxated cataract

PURPOSE: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. MATERIALS AND METHODS: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position. RESULTS: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 +/- 9.71 months (range 4-39). The average age was 39.15 +/- 16.33 (range 5-74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification. CONCLUSION: In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.     

晶状体囊袋张力环植入在高度近视眼白内障超声乳化吸除人工晶状体植入术中的应用价值

目的评价晶状体囊袋张力环（CTR）植入在高度近视眼白内障超声乳化吸除联合低度数人工晶状体手术中的应用价值。方法将827例（1081只眼）高度近视眼白内障患者随机分为A、B两组,A组427例（549只眼）,B组400例（532只眼）,其中A组患者行白内障超声乳化吸出术及后房型人工晶状体和CTR植入,B组患者仅行白内障超声乳化吸出术及后房型人工晶状体植入,所有患眼术后均随访18个月,测视力、眼压,散大瞳孔进行眼前节裂隙灯观察照像。结果所有植入的人工晶状体均位于正位,A组术后3个月矫正视力〉0.8者43只眼,0.6～0.8者118只眼,0.5者89只眼,0.4者101只眼,0.3者66只眼,0.2者80只眼,〈0.2者52只眼;术后第1天眼压为3～47mmHg,一过性高眼压179只眼,其中有1只眼因术后高眼压无法药物控制而取出CTR;随访18个月中有2只眼发生视网膜脱离。B组术后3个月矫正视力〉0.8者40只眼,0.6～0.8者110只眼,0.5者83只眼,0.4者95只眼,0.3者69只眼,0.2者83只眼,〈0.2者52只眼;随访18个月中有9只眼发生视网膜脱离。两组的视网膜脱离发生率比较差异均统计学意义。结论 CTR在高度近视眼白内障超声乳化吸除联合低度数人工晶状体手术中的应用能防止晶状体悬韧带离断,使人工晶状体居中性更佳,并能有效防止视网膜脱离的发生。     

两种联合手术方式治疗急性闭角型青光眼合并白内障的疗效比较

目的：探讨超声乳化白内障吸除人工晶状体植入联合房角分离术治疗原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)合并白内障的临床疗效。

方法：前瞻性随机对照研究。选择符合入组条件的急性闭角型青光眼合并白内障患者60例60眼,随机分为对照组和研究组; 对照组行白内障超声乳化吸除、人工晶状体植入联合小梁切除术(30眼),研究组行白内障超声乳化吸除、人工晶状体植入联合房角分离术(30眼),比较两种术式的临床疗效。

结果：术前两组视力、眼压、中央前房深度、房角开放程度差异无统计学意义(P>0.05); 术后2mo两组视力、眼压、中央前房深度、房角开放程度均明显比术前改善,差异有统计学意义(P<0.001); 研究组术后视力、中央前房深度、房角开放程度,均优于对照组,差异有统计学意义(P<0.05); 两组术后眼压及并发症相比,研究组优于对照组,但差异无统计学意义(P>0.05)。

结论：白内障超声乳化人工晶状体植入联合房角分离术,对APACG合并白内障患者视力的提高、眼压的控制有着积极的临床效果。     

囊袋张力环在晶状体半脱位白内障超声乳化手术中的应用

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在晶状体半脱位白内障超声乳化手术中的应用效果。方法:对13例(13眼)合并晶状体半脱位的白内障患者行白内障手术,术中连续环形撕囊后植入CTR,然后行超声乳化及后房型折叠人工晶状体囊袋内植入。结果:13眼的人工晶状体均处于正位,无明显偏位及倾斜。术后矫正视力>0.8者4眼;0.4~0.7者8眼;0.1者1眼,为老年性白内障合并黄斑区脉络膜新生血管患者,未见由CTR引起的并发症。结论:在超声乳化治疗晶状体脱位的白内障手术中运用CTR,能提高手术安全性,防止人工晶状体偏位,减少手术并发症,是一种良好的白内障手术辅助工具。     

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

PURPOSE: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.     

无灌注超声乳化系统在囊破裂的外伤性白内障手术中的应用

【摘要】目的探讨应用无灌注超声乳化系统在囊破裂的外伤性白内障手术中应用的安全性和有效性。方法回顾性病例研究。眼球穿孔伤合并外伤性白内障伴有囊破裂33例（33眼）,应用超声乳化系统无灌注抽吸皮质联合后房型人工晶状体植入。随访3—6个月,记录术前及术后最佳矫正视力、眼压和并发症。结果患眼术后视力均有不同程度的提高,最佳矫正视力达0．8—1．0者8眼（24．24％）,0．3—0．7者21眼（63．64％）,0．05～0．25者3眼（9．10％）,低于0．05者1眼（3．03％）。均一期植入IOL。术中均未发生囊再次撕裂,无前房消失或眼球塌陷发生。术后未出现角膜内皮失代偿、囊样黄斑水肿或视网膜脱离等严重并发症。结论应用超声乳化系统无灌注抽吸皮质治疗囊破裂外伤性白内障的方法安全有效。