Soemmering's ring support for posterior chamber intraocular lens implantation during penetrating keratoplasty. Changing trends in bullous keratopathy.

BACKGROUND: Changing trends in cataract extractions have resulted in a new category of bullous keratopathy: corneal decompensation after complicated extracapsular cataract extraction. These cases of bullous keratopathy are associated with rupture of the posterior capsule, vitreous loss, and significant intraocular inflammation at the time of the original complicated extracapsular cataract extraction. METHODS: The authors reviewed 14 consecutive cases of penetrating keratoplasty for bullous keratopathy in which posterior chamber intraocular lens implantation was supported by remnants of the posterior capsule and/or Soemmering's ring without suture fixation. All 14 patients had a history of complicated extracapsular cataract extraction with capsule rupture and vitreous loss. RESULTS: All 14 patients had clear, compact grafts without migration of the intraocular lens with a mean follow-up of 12.1 months. Vision improved in 93% of cases, and there was no significant worsening of glaucoma. CONCLUSIONS: Pseudophakic bullous keratopathy after traumatic extracapsular cataract extraction with an anterior chamber intraocular lens and aphakic bullous keratopathy after traumatic extracapsular cataract extraction are two relatively new clinical entities that present new intraocular lens management options. Bullous keratopathy after complicated extracapsular cataract extraction should be recognized as a distinct clinical entity. Intraocular lens implantation into the ciliary sulcus with Soemmering's ring and peripheral capsular support provide the advantages of a posterior chamber intraocular lens without the risk of iris or scleral sutures. The authors predict that bullous keratopathy associated with traumatic extracapsular cataract extraction will become one of the more common indications for penetrating keratoplasty.     

青光眼白内障联合手术的历史及现状

青光眼白内障联合手术是指不同方式白内障摘除与不同方式抗青光眼手术的联合。目前狭义上主要指超声乳化白内障吸除联合滤过性手术尤其是小梁切除术。白内障手术从囊内摘除、囊外摘除到目前的透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入甚至飞秒激光白内障手术;小梁切除术目前主要是巩膜瓣牢固缝线、抗代谢药物（尤其是丝裂霉素）应用和巩膜瓣缝线调控性拆除。目前联合手术适应证尚缺乏统一标准,有学者主张对于房角粘连≥180、降眼压药物≥3种、有白内障手术指证、矫正视力〈0．5者,可选择小梁切除联合超声乳化白内障手术。未来的联合手术将纳入非穿透小梁手术、黏小管切开术、房水引流物植入术（包括I-sent、EXPRESS阀）以及内窥镜下睫状体光凝术等.     

白内障囊外摘除并小梁切除治疗青光眼合并白内障疗效观察

目的：探讨小切口白内障囊外摘除并人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床疗效。方法：选择我院2007-09/2011-10原发性闭角型青光眼合并白内障患者80例86眼。本组患者均行小切口白内障囊外摘除联合小梁切除术。术后观察患者的视力和眼压情况。结果：术后视力：〈0.1共5眼,0.1～0.2共11眼,0.3～0.5共53眼,0.6以上17眼。术后患者眼压均降到临床统计正常范围（10～21）mmHg。结论：小切口白内障囊外摘除并人工晶状体植入联合小梁切除术治疗青光眼合并白内障减轻了患者多次手术的负担,临床有显著效果,是治疗青光眼合并白内障较佳术式,值得临床推广应用。     

Penetrating keratoplasty combined with extracapsular cataract extraction

In my previous prospective study of 132 eyes, the incidence of clinically significant cystoid macular edema was 42% in aphakic penetrating keratoplasty, 33% in combined keratoplasty and cataract extraction with vitrectomy, and only 4% in combined keratoplasty and cataract extraction without vitrectomy. In the present study we added 26 aphakic and 11 pseudophakic keratoplasties and 17 procedures combining keratoplasty with extracapsular cataract extraction. Grafts were clear in 94% of patients, and 43% had visual acuity of 20/40 or better. Clinically significant cystoid macular edema occurred in 35% of aphakic and 27% of pseudophakic keratoplasties. Cystoid macular edema did not occur in combined keratoplasty and extracapsular cataract extraction.     

青光眼并白内障联合手术不同术式的探讨

目的：探讨青光眼白内障联合手术中不同术式的适应证及手术效果。方法：对本院1995年来45例青光眼并白内障病例进行手术适应证分析及疗效分析。结果：小梁切除加白内障超声乳化人工晶状体植入术，并发症少，视力提高显著，眼压控制稳定，小梁切除加白内障囊外摘出人工晶状体植入术并发症比前者多，视力不同程度提高，眼压控制稳定，白内障囊外摘出或超声乳化人工晶状体植入术加虹膜周边切除术术后疗效好，结论：小梁切除加超乳术式为联合手术中最好的方法，但适应证有局限性，小梁切除加囊外摘出术式适应证广，并发症比前者多，但能尽量克服，摘出加周切术式组织伤小，手术时间短，但也有局限性。     

穿透性角膜移植术后行白内障摘除术16例观察

目的 探讨穿透性角膜移植术(PKP)后白内障摘除术的临床疗效.方法 回顾性分析2004年1月至2007年7月行白内障摘除术的穿透性角膜移植术后患者16例,根据晶状体核硬度分级,分别采取白内障超声乳化摘除联合人工晶状体植入术(phaco+pcIOL)和白内障囊外摘除联合人工晶状体植入术(ECCE+pcIOL),统计患者手术前后视力,角膜水肿及角膜内皮细胞(CEC)情况的变化.结果 术后3个月最佳矫正视力:0.2～0.5,均较术前提高.经治疗术后角膜水肿均于1周内消除,术后角膜内皮细胞密度均较术前减少,但术后内皮细胞丢失率phaco+PCIOL组((9.1±2.3)%)较ECCE+PCIOL组((8.3±2.6)%)差异无统计学意义(P>0.05),经术后5～30个月的随访,角膜移植片均保持透明,无一例大泡性角膜病变发生.结论 对穿透性角膜移植术后的白内障患者,综合评价术前情况选择适当的手术方式,白内障摘除联合人工晶状体植入术疗效确实,可获得满意的手术结果.     

Nd:YAG激光在白内障前囊膜切开与透明皮质乳化术中对眼前节组织的生物学效应

报告在白内障囊外摘除与后房人工晶体植入术中应用Nd∶YAG激光辅助手术30例。16例成熟期白内障在囊外摘除术前做激光前囊膜切开术。14例未成熟期白内障在做前囊膜切开的同时做透明皮质乳化术。结果表明激光辅助手术在缩短手术时间、减少合并症、提高疗效方面有显著效果。并对治疗中激光对眼前节组织的生物学效应及其机理进行了讨论。     

小切口手法非超乳三联术治疗青光眼合并白内障在基层医院的应用

目的探讨小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并白内障的临床疗效。方法选择41例41只眼青光眼合并老年性白内障患者作为研究对象,均接受小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗,观察手术前后视力、眼压、术后并发症。结果术后随访6个月,平均眼压由术前的31.5±6.5mm Hg降至11.2±3.5mm Hg,差异有统计学意义（P〈0.05）;视力均有不同程度提高,差异有统计学意义（P〈0.05）。所有患者无严重并发症发生。结论白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并老年性白内障不仅安全有效、而且术后并发症轻微,值得临床推广应用。     

Penetrating keratoplasty and cataract surgery

Of 46 eyes undergoing simultaneous penetrating keratoplasty and cataract extraction, 25 grafts (54%) remained clear with an average follow-up of 37 months. This low success rate can be party explained by the fact that more than 50% of our patients had unfavourable ocular conditions preoperatively. In case of simultaneous procedures, methods of cataract extraction (ICCE or ECCE) did not have any significant affect on the rate of clear grafts. In eyes with favourable ocular conditions preoperatively, the rates of clear grafts were similar (approximately 75%) in cases of simultaneous operation (21 eyes) and separate operation (8 eyes).