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1.
In a clinical study, 61 patients underwent phacoemulsification with subsequent intraocular lens (IOL) implantation. An intercapsular capsulotomy with phacoemulsification was performed on 23 patients and a can opener capsulotomy with phacoemulsification on 38 patients. Wide-field specular microscopy was performed preoperatively and postoperatively on all of the eyes in the study. The cell counts were not divulged to the surgeon before or at the time of surgery. Average endothelial cell loss for the intercapsular technique was 3.9%; with the can opener technique, the average cell loss was 10.1%. This difference was statistically significant (P less than 0.01). Positive correlations between endothelial cell loss relating to ultrasound time and/or the hardness of the cataract existed for the can opener group only (P less than 0.01). These results demonstrate that a protective effect is provided by the presence of the anterior lens capsule during lens substance removal.  相似文献   

2.
Methylcellulose 1% was used in the anterior chamber to facilitate posterior chamber lens implantation at the time of extracapsular cataract extraction. In parallel series with similar preoperative endothelial cell counts, 70 eyes implanted under methylcellulose had a mean central endothelial cell loss of 8 +/- 5.3% at 8 to 12 weeks postoperative, whereas 63 eyes implanted under an air bubble lost a mean 25.3 +/- 14.6% (P less than 0.001). No differences in postoperative visual acuity, intraocular pressure, or inflammation were noted. A YAG laser preoperative anterior capsulotomy was used in all cases, and may have contributed to overall preservation of endothelial cells.  相似文献   

3.
Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.  相似文献   

4.
The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.  相似文献   

5.
In 287 consecutively intracapsular cataract extracted eyes with a Federow intraocular lens implant (IOL) and 290 eyes with consecutively performed intracapsular cataract extractions (ICCE) the final visual outcome and complications were examined in a retrospective study. The average observation time was 31 months in the IOL group and 37 months in the ICCE group. Seventy-five per cent in the IOL group and 77% in the ICCE group achieved a visual acuity greater than or equal to 0.5. The main cause of a visual acuity less than 0.5 was maculopathy pre-operatively recognized. A visual acuity less than 0.5 due to post-operative complications occurred more frequently in the IOL group (28 eyes) compared with the ICCE group (13 eyes) - P less than 0.01. Twelve intraocular implants (4.3%) had to be removed. The most important cause was dislocation of the IOL (9 eyes). During our first 12 months of IOL implantation 8 dislocations occurred out of 56 implanted eyes (14.3%). The remaining 6 dislocations occurred among the last 231 IOL eyes (2.6%). It is concluded that complications are few, but often serious in intraocular lens implant surgery. Careful pre-operative examination and surgical experience are mandatory.  相似文献   

6.
Morphological changes and lens position were examined in 51 patients 25 to 38 (mean 30) months after intracapsular cataract extraction (ICCE) with implantation of the semiflexible, 3M, style 70, anterior chamber lens. Morphological changes presumably associated with the ICCE proper were: iris transillumination defects (68.6%), rupture of anterior hyaloid membrane (20%), detachment of posterior vitreous (42.9%) and anterior synecchiae (13.7%). The implant-related morphological changes were caused by iris tucking (19.6%), small, mobile lenses causing endothelial disturbance (9.8%), iris-haptic adhesions and progressive ovalling of pupillary form. The present morphological changes were compared with a previously published examination of the same patients performed 4 months after surgery: 9 eyes without tissue changes around the lens feet at the previous follow-up now had iris-haptic adhesions involving from 1 to 4 lens feet. In 8 eyes the iris-haptic adhesions had progressed. Compared with the previous examination the fraction of eyes with tissue changes at the lens feet had risen from 47.1 to 64.7%, while the number of eyes with oval pupils had increased from 54.9 to 80.4%. Contact between lens haptic and iris root seems to constitute a constant stimulus for structural changes of the iris.  相似文献   

7.
线状与开罐式晶状体前囊截囊的临床效果比较   总被引:2,自引:1,他引:1  
目的 了解线状晶状体前囊截囊在人工晶状体植入术应用中,术后早期视力恢复及并发症情况。方法 对132例168眼白内障用线状截囊法行白内障囊外摘除及囊袋内人工晶状体植入,同时对130例156眼开罐式截囊作为对照。结果 线状组术后早期矫正视力0.5以上者132眼(78.9%)。术后早期并发症角膜内皮水肿56眼(33.3%),房水混浊116眼(69.0%),葡萄膜色素脱落36眼(21.4%)。结论 线状组  相似文献   

8.
BACKGROUND AND OBJECTIVE: To evaluate the long-term effects of various anterior capsulotomies and radial tears on intraocular lens (IOL) centration. MATERIALS AND METHODS: Ninety-five eyes of 87 senile cataract patients operated with extracapsular technique were evaluated in IOL tilt and decentration with a new method of measurement. According to the type of anterior capsulotomy and number of radial tears, five groups were constituted as, can opener, envelope, continous curvilinear capsulorrhexis (CCC), CCC with one radial tear (relaxing incision at quadrant 12), and CCC with two relaxing incisions (relaxing incisions at quadrants 6 and 12), respectively. RESULTS: Early decentration and tilt in groups CCC and CCC with one radial tear were significantly lower than the other groups (P < 0.05). Late decentration and tilt in the CCC group were significantly lower than the other groups (P < 0.01). Highest values of tilt and decentration were determined in envelope capsulotomy. Additional symmetric relaxing incision at quadrant 6 revealed no effect on the prevention of decentration and tilt compared to one relaxing incision. CONCLUSION: CCC with one radial tear is not ideal but sufficient for IOL centration. All other anterior capsulotomy techniques, other than intact CCC, do not guarantee the IOL centration.  相似文献   

9.
目的 探讨角膜后弹力层剥除自动角膜刀取材内皮移植术(DSAEK)联合超声乳化白内障吸除及人工晶状体置换手术治疗角膜内皮失代偿并有白内障或人工晶状体异常患者的疗效和并发症情况.方法 回顾性临床自身对照研究.对2007年12月至2008年12月在北京大学第三医院就诊的各种原因引起的角膜内皮失代偿合并有晶状体异常的患者18例(20只眼)分别行DSAEK联合超声乳化白内障吸除人工晶状体植入手术5例(7只眼)、DSAEK联合前房型人工晶状体取出与前段玻璃体切除及后房型人工晶状体悬吊术7例(7只眼)或DSAEK联合前段玻璃体切除及后房型人工晶状体悬吊术6例(6只眼).术后观察视力、角膜透明性的恢复、植片厚度、角膜内皮细胞丢失、植片的脱位率及排斥反应发生情况.采用治疗前后均数比较t检验.结果 术后18例患者眼部刺激症状均消除,角膜水肿全部消退,术前和术后的角膜厚度分别为859μm、553 μm,差异有统计学意义(t=5.303,P<0.01);术前供体角膜内皮细胞密度为2987个/mm2,术后3个月角膜内皮细胞密度为1803个/mm2,内皮细胞丢失率为41%.术后除去患有眼底病变的患者9只眼,其余患者视力均有大幅度的提高,视力恢复到0.8以上的有6只眼,在眼底正常的患者中占55%(6/11).术后前房人工晶状体眼炎症反应最重,其余患者反应轻微;术后有6只眼植片脱位(30%,6/20)、术后5例出现眼压升高、1例发生植片排斥反应,均为前房人工晶状体眼的患者.结论 DSAEK联合超声乳化白内障吸除及人工晶状体置换手术对于治疗角膜内皮失代偿并有晶状体或人工晶状体异常患者是一种较安全、有效的手术方法.前房人工晶状体眼行DSAEK术后并发症较多,对虬膜、房角结构异常的患者行角膜内皮移植手术应谨慎.
Abstract:
Objective To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulcification cataract surgery or lens exchange in corneal endothelial dysftnction eyes with lens disorders. Methods Retrospective case series.Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulcification and intraocular lens (IOL) insertion.Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up. Results The irritation was disappeared in all of patients. All of the corneas became transparent.The preoperative and postoperative mean CCT of the recipient beds was 859 μm and 553 μm respectively. T value was 5.303 ( t = 5.303, P < 0.01 ). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm2. The ECD was 1803 cells/mm2 in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection.These complications occurred in anterior chamber IOL eyes. Conclusions DSAEK combined with phacoemulcification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.  相似文献   

10.
PURPOSE: To compare the tear resistance of anterior capsulotomies using manual continuous curvilinear capsulorhexis (CCC) and vitrector-cut capsulotomy (vitrectorhexis) techniques in an animal model of the pediatric eye and in 2 pairs of human infant eyes. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Continuous curvilinear capsulorhexis and automated vitrectorhexis capsulotomy techniques were performed in 20 pig eyes, 10 with each technique. The capsules were then stretched until they ruptured. The forces required for rupture after each technique were compared. The forces required for rupture of the pig eye lens capsule were also compared with those required for the human infant eye lens capsule. Scanning electron microscopy was performed in each group following intraocular lens (IOL) insertion. RESULTS: All capsules stretched adequately for IOL insertion. The percentage of stretch prior to rupture was higher in the capsulorhexis group (mean 157%, range 147% to 169%) than in the vitrectorhexis group (mean 135%, range 124% to 147%) (P < .001). The percentage of stretch in the human infant eyes was not statistically different from that in the porcine eyes (P > .05). CONCLUSIONS: The manual CCC offered greater resistance to capsule tearing than the vitrectorhexis and also revealed a more smooth, regular edge. It therefore remains the gold standard. However, the vitrectorhexis displayed more than adequate resistance to unwanted anterior capsule tears when used for IOL insertion through capsulotomy sizes currently used in clinical practice.  相似文献   

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