Descemet's membrane perforation during deep anterior lamellar keratoplasty: prognosis

PURPOSE: To evaluate the functional and endothelial prognosis after Descemet's membrane perforation during deep anterior lamellar keratoplasty (DALK). SETTING: Private practice, Siena, Italy. METHODS: A retrospective study evaluated a series of 35 eyes that had DALK using the big-bubble technique. RESULTS: Intraoperative perforation occurred in 8 eyes (23%), in 5 eyes during manual deep dissection and in 1 eye each during trephination, as the air needle was introduced in the stroma, and as the big bubble was punctured. In all 8 eyes, DALK could be completed. In 1 case, pupillary block was caused by air left in the anterior chamber, resulting in permanent mydriasis and anterior subcapsular opacity. In another case, a double anterior chamber persisted and penetrating keratoplasty was later required. In the other 6 cases, the postoperative course was uneventful. The mean postoperative best spectacle-corrected visual acuity was 0.8 +/- 0.13 (SD) and the mean postoperative refractive astigmatism, 2.09 +/- 0.98 diopters. The mean endothelial cell loss, evaluated in 7 eyes, was 12% +/- 11% at 1 month (P<.05) and 14% +/- 12% at 12 months. The mean cell loss was 25% +/- 2.7% in eyes in which intraoperative reformation of the anterior chamber with air was required and 6% +/- 7.5% in eyes in which it was not (P< .05). CONCLUSIONS: Despite 2 complicated cases, intraoperative perforation during DALK had a good final functional prognosis. However, eyes in which the perforation required reformation of the anterior chamber had a mean endothelial cell loss greater than 20%. When air is left in the anterior chamber, close monitoring is required to avoid pupillary block.     

Surgical correction of severe myopia with an angle-supported phakic intraocular lens

PURPOSE: To evaluate the effectiveness, predictability, and safety of a fourth-generation angle-supported anterior chamber phakic intraocular lens (IOL) in patients with severe myopia. SETTING: Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain. METHODS: In this prospective study, 23 eyes (16 patients) with a mean preoperative myopia of -19.56 diopters (D) +/- 1.76 (SD) (range -16.75 to -23.25 D) were implanted with the ZSAL-4 phakic IOL. Basic examinations were performed before and after surgery in all patients. Eighteen eyes were also studied by clinical specular microscopy, and the endothelium was analyzed for cell density, coefficient of variation in cell size, and hexagonality. The location of the IOL in the anterior chamber was evaluated in 10 eyes by A-scan biometry. To evaluate haptic geometry, a theoretical mechanical model was used. The follow-up was 24 months in all patients. RESULTS: Uncorrected visual acuity was 20/40 or better in 13 eyes (56.0%) 12 months after surgery and in 14 eyes (60.8%) at 24 months. Best spectacle-corrected visual acuity improved 0.19 at 12 and 24 months (0.1 = 1 line) from preoperative values. The efficacy index was 1.12 at 24 months and the safety index, 1.45. The mean postoperative spherical equivalent was -0.65 +/- 0.65 D at 24 months. The postoperative spherical equivalent was within +/-1.00 D of emmetropia in 19 eyes (82.6%) at 12 and 24 months. The mean endothelial cell loss was 3.50% at 12 months and 4.18% at 24 months. The coefficient of variation in cell size decreased from 0.34 before surgery to 0.28 at 24 months after surgery. The IOL was located 0.79 +/- 0.24 mm in front of the crystalline lens. Postoperative complications included night halos in 6 eyes (26.1%) at 12 and 24 months and pupil ovalization in 4 eyes (17.4%). Intraocular lens rotation was observed in 10 eyes (43.5%) at 24 months. Two eyes (8. 7%) developed a slight inflammatory response during the first 6 months. Our mechanical model predicted that the compression forces against the angle structures were greater at the first footplate than at the second. CONCLUSIONS: Implantation of the ZSAL-4 IOL in the anterior chamber of phakic eyes was effective and predictable in correcting severe myopia. However, the ZSAL-4 did not prevent pupil ovalization, IOL rotation, or low-grade postoperative uveitis. Improvements in haptic design following our mechanical model could decrease these haptic-related complications.     

2.8 mm切口超声乳化白内障吸除术的临床观察

探讨２．８ｍｍ透明角膜切口超声乳化白内障吸附折叠式人工晶状植入手术效果。方法对１０５例（１２６只眼）行上述手术患者的术后视力、屈光状态、角膜状态,前房反应、角膜内皮细胞损失率进行回顾性总结。结果术后１ｄ、３ｄ、１周、２或３个月裸眼视力在０．５以上的眼数分别为１０２只眼（８１．０％）,１０８只眼（８５．７％）、１１２只眼（８８．９％）及１１２只眼（８８．９％）;术后３ｄ、１周、１个月、３个月平均散光     

Anterior chamber intraocular lens for high myopia: five year results

PURPOSE: To evaluate the effectiveness of the surgical correction of high myopia 5 years after anterior chamber intraocular lens (IOL) implantation and to analyze the lens position and related complications. SETTING: Federal University of S?o Paulo-Escola Paulista de Medicina, S?o Paulo, Brazil. METHODS: This prospective study comprised 26 eyes that were implanted with an anterior chamber IOL (model ZB5M) and had a minimum follow-up of 5 years. Before and after surgery, manifest and cycloplegic refractions were done; slitlamp examination was performed; anterior chamber depth was measured; and keratometry, ophthalmoscopy, and central corneal endothelial cell count were performed. At the last follow-up, computerized biomicroscopy of the anterior segment was also done. RESULTS: The spherical equivalent decreased from -16.5 diopters (D) +/- 4.1 (SD) preoperatively to -0.9 +/- 0.9 D postoperatively. At the last examination, 57.7% of eyes had a spherical equivalent refraction within +/-1.0 D of emmetropia. Of eyes with a preoperative best spectacle-corrected visual acuity of 20/40 or better, 73.3% had an uncorrected visual acuity of 20/40 or better postoperatively. The mean tilt caused by the IOL was 4.4 +/- 2.7 degrees (range 0.5 to 12.2 degrees) and the mean IOL decentration, 0.3 +/- 0.2 mm (range 0.02 to 0.8 mm). The mean decrease in the endothelial cell count was 1.5%, with a mean cell density of 2808 +/- 305 cells/mm2 preoperatively and 2765 +/- 242 cells/mm2 postoperatively. Pupillary ovalization was observed in 12 eyes (46.1%). CONCLUSIONS: The anterior chamber IOL safely and effectively corrected high myopia.     

眼内窥镜下睫状体光凝对角膜植片存活的影响

目的探讨对穿透性角膜移植术（PKP）后眼压升高且药物不能控制的患者,采用眼内窥镜直视下睫状体光凝术（ECP）进行治疗的疗效和对角膜植片存活的影响。方法选择2000年3月至2004年4月期间,于中山大学中山眼科中心就诊的34例（34只眼）PKP术后眼压升高且药物不能控制患者,在眼内窥镜直视下,行半导体激光睫状体光凝术（12例）或联合玻璃体切除术（22例）（ECP组）。选择26例（26只眼）患者作为对照,采用经巩膜面半导体激光睫状体光凝术（TCP）（TCP组）。术前、术后随访观察视力、眼压、植片透明度、内皮细胞密度及前房反应,超声活体显微镜（UBM）检查睫状突和房角情况,注意术后并发症等。结果ECP组术后3个月和6个月时,分别有13例（38．2％）和23例（67．7％）眼压低于21mmHg。TCP组术后3个月和6个月时,分别有10例（38．5％）和8例（30．8％）眼压低于21mmHg。两组之间术后眼压控制率比较,在3个月时差异无统计学意义（X^2=0．0003,P=0．986）,但6个月时差异有统计学意义（X^2=8．024,P=0．005）。ECP组和TCP组术后植片内皮细胞密度分别为（1013±170）个／mm^2和（847±136）个/mm^2,差异有统计学意义（t=-0．009,P=0．033）。ECP组和TCP组术后分别有9例（26．5％）和21例（80．8％）出现反应性虹膜炎,两组之间比较差异有统计学意义（x^2=17．376,P=0．001）。结论ECP对降低PKP术后青光眼患者眼压的远期疗效优于TCP。ECP对角膜植片内皮细胞的损伤和引起术后葡萄膜炎的程度均较TCP轻,相对提高了PKP术后角膜植片的生存质量。     

Visual improvement in high myopic amblyopic adult eyes following phakic anterior chamber intraocular lens implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1-5) numeric scale. RESULTS: The mean age of patients was 37.3 +/- 9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10 +/- 5.41 diopters (D). The postoperative mean refraction (SE) was -1.75 +/- 0.76 D at six months. The postoperative BCVA improved an average 3.92 +/- 1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.     

有晶状体眼后房型人工晶状体植入矫正高度近视

目的观察有晶状体眼后房型人工晶状体（PC—PRL）植入矫正高度近视的临床疗效。方法回顾性系列病例研究。选择2011年1月至2012年5月间行PC．PRL矫正高度近视患者25例（45眼）。术后随访6～17月,平均（10．9＋1．6）个月,应用配对t检验分析手术前后裸眼视力、眼压、角膜内皮细胞计数及前房深度,分析并发症的发生情况。结果术后裸眼视力4．5～5．2,好于术前最佳矫正视力者35眼（78％）。术后平均眼压（13．7±4．2）mmHg,与术前（13．9±4．1）mmHg比较,差异无统计学意义。术后平均角膜内皮细胞计数（2609±296）cells／mm2,与术前（2818±327）cells／ramz比较,差异无统计学意义。术后的平均拱高稳定,为（0．380±0．135）mm,未见人工晶状体与自身晶状体贴近或接触。结论PC—PRL植入矫正高度近视临床疗效确切,具有良好的安全性,是高度近视患者的理想治疗方法。     

A retrospective analysis of the first Indian experience on Artisan phakic intraocular lens

PURPOSE: To evaluate the efficacy, safety, predictability and stability of implanting a polymethylmethacrylate phakic intraocular lens (PIOL) in high myopia. MATERIALS AND METHODS: A retrospective analysis of the data of patients who underwent Artisan phakic IOL implantation between 2002 and 2003 with a follow-up of at least 24 months. RESULTS: An Artisan myopia lens was implanted in 60 eyes of 36 patients with preoperative myopia ranging from -5.0 to -24.0 D. Mean patient age was 22.6 years. Mean spherical equivalent of manifest refraction stabilized by the first postoperative week. At three months follow-up, 54 eyes (90%) had a postoperative refraction within +/- 1D emmetropia and 45 eyes (75%) had uncorrected visual acuity of 20/40 or better. Seven eyes (11.6%) had loss of one Snellen line and none had loss of two Snellen lines or more at three months. The mean endothelial cell loss was 3.8% at three months, 5.2% at six months, 5.25% at 12 months and 6.38% at two years, which was not significant. Postoperative complications included anterior chamber reaction in two eyes (3.3%), rise in intraocular pressure in six eyes (10%) and dislocation of PIOL in two eyes (3.3%). CONCLUSION: Implantation of Artisan myopia lens to correct high myopia resulted in a stable and fairly predictable refractive outcome with few complications. Significant endothelial damage was not detected in two years of follow-up.     

前房容积与白内障超声乳化术后角膜内皮变化的相关性分析

目的探讨白内障超声乳化术前前房容积、前房深度状态与术后角膜内皮细胞变异之间的相关性。方法对46例（60只眼）老年性白内障行白内障超声乳化吸出及人工晶状体植入术。术前以Pentacam三维前房分析仪测定前房容积、前房深度,并分别于术前和术后1周使用非接触型角膜内皮显微镜观察中部角膜内皮细胞的密度变化。结果术前的平均前房容积为（153.43±21.37）mm3,前房深度为（2.72±0.33）mm。术后1周平均中部角膜内皮细胞损失率为（9.27±5.17）%,术前的前房容积与术后1周角膜内皮细胞损失率呈显著负相关（r=-0.703,P〈0.001）,前房深度与术后1周角膜内皮细胞损失率亦呈显著负相关（r=-0.711,P〈0.001）。结论白内障超声乳化吸出人工晶状体植入术后角膜内皮细胞损失率与术前前房空间状态密切相关,Pentacam三维前房分析仪对于前房空间的量化测量为临床评估手术预后提供重要参考。     

Three-year follow-up of the Artisan phakic intraocular lens for hypermetropia

PURPOSE: We report the postoperative results of the Artisan Hyperopia phakic intraocular lens (IOL; model 203W; Ophtec, Groningen, The Netherlands). DESIGN: Prospective, nonrandomized trial. PARTICIPANTS: Twenty-six eyes of 13 self-selected patients with refractive error ranging from +3.00 to +11.00 diopters (D). INTERVENTION: Patients with hypermetropia were implanted with the Artisan Hyperopia phakic IOL. Mean follow-up was 22.4 months (range, 3-36 months). MAIN OUTCOME MEASURES: Predictability, stability, efficacy, loss of best spectacle-corrected visual acuity, and complications. RESULTS: At six months, 90.9% (20 of 22 eyes) were +/-1.00 D of intended correction and 81.8% (18 eyes) were +/-1.00 D of emmetropia. The mean spherical equivalent was stable within 0.25 D during the entire 3-year follow-up period. Twenty-four eyes (92.3%) had a postoperative best spectacle-corrected visual acuity of 0.50 or better at all of their individual follow-up examinations. No patient lost 2 or more lines after the procedure. There was a significant negative correlation between anterior chamber depth and endothelial cell loss. Two patients experienced posterior synechiae with pigment deposits in both eyes. One of these patients had convex irides and underwent implant removal within 2 years with a consequent clear lens extraction and posterior chamber lens implantation. CONCLUSIONS: Implantation of the Artisan Hyperopic lens leads to accurate and stable refractive results with no significant loss of vision. More attention should be paid to convex irides and shallow anterior chambers during the preoperative screening to avoid unnecessary complications.     

基于单中心FS-LASIK术中前房气泡的临床观察

目的：探讨飞秒激光制瓣LASIK（FS-LASIK）术中前房气泡的发生率、危险因素、发生机制及对手 术效果和角膜内皮细胞的影响、处理方法和预防措施。方法：回顾性系列病例研究。选择2012年 2月至2017年11月在中国人民解放军第三二二医院眼科屈光中心自愿接受FS-LASIK且术前常规检 查确认为符合手术适应证的患者1 379例（2 749眼）,将发生前房气泡患者的气泡眼作为观察组,将 患者对侧未发生前房气泡的眼作为对照组。统计分析术中发生前房气泡患者的裸眼视力（UCVA）、 最佳矫正视力（BCVA）、角膜曲率、角膜厚度、前房深度、等效球镜度（SE）、角膜直径、角膜内皮细 胞密度、角膜内皮细胞面积的变异系数、六边形角膜内皮细胞比率、眼压等手术前后相关参数。采 用定量数据重复测量方差分析、t检验对数据进行分析。结果：1 379例（2 749眼）患者中25例（27眼） 发生前房气泡,发生率0.98%。术中观察发现气泡均由房角移动至瞳孔区,鼻侧12眼（44%）、颞侧 9眼（33%）、下方4眼（15%）、上方2眼（7%）。Ⅰ级前房气泡16眼（59%）、Ⅱ级10眼（37%）、Ⅲ级 1眼（4%）,Ⅲ级气泡影响自动识别跟踪,需在手动跟踪模式下完成准分子激光切削。术中观察还发现 在进行准分子激光角膜基质切削时气泡在前房内发生了较高频率的振动。观察组（23眼）与对照组 （23眼）比较,角膜直径、曲率、厚度及前房深度、眼压、术前SE、术后SE、术前BCVA、术后UCVA 组间差异均无统计学意义（P>0.05）,但发生前房气泡的患者（25例）角膜直径[（11.11±0.31）mm] 与未发生前房气泡的患者（1 354例）角膜直径[（11.51±0.33）mm]比较差异有统计学意义（t=-3.28, P=0.003）。角膜内皮细胞密度组间差异有统计学意义（F分组=2.486,P分组=0.022）,组内各时间点比 较差异无统计学意义（F时间=1.342,P时间=0.260）。六角形角膜内皮细胞组间差异无统计学意义（F分组 =0.469,P分组=0.497）,组内各时间点比较差异有统计学意义（F时间=5.966,P时间=0.004）。角膜内皮细 胞面积变异系数组间差异无统计学意义（F分组=0.106,P分组=0.746）,组内各时间点差异有统计学意义 （F时间=21.248,P时间<0.001）。结论：前房气泡的产生可能受到术者个人因素、患者种族差异、设备类型、 角膜直径、角膜瓣直径、小梁网位置、pocket深度等多种因素的影响。气泡可能经小梁网逆行进入 前房,致角膜内皮细胞损害。降低前房气泡发生率,可有效提高术后视觉质量。     

Initial results of endothelial cell counts after Artisan lens for phakic eyes: an evaluation of the United States Food and Drug Administration Ophtec Study

PURPOSE: To evaluate the endothelial cell count change in eyes implanted with the iris-claw phakic Artisan lens for treatment of moderate to high myopia. DESIGN: Prospective, multicenter clinical trial. PARTICIPANTS: The first 765 eyes enrolled at 25 North American sites in the United States Food and Drug Administration Ophtec clinical trial of the myopic Artisan IOL. Outcome analyses of endothelial cell count measurements were based on those obtained before surgery and at 6, 12, and 24 months after surgery performed between October 1998 and December 2001. SETTING: Multiple private and university practices. METHODS: Percentage change in endothelial cell count from baseline to 6, 12, and 24 months were analyzed using specular microscopy. Upper limit of detecting endothelial cell density change was estimated using 3 repeated counts at preoperative and postoperative time frames. MAIN OUTCOME MEASURES: Percentage change in endothelial cell loss. RESULTS: The mean preoperative endothelial cell count was 2631+/-442 cells/mm(2). Percentage change from baseline at 6, 12, and 24 months was -0.09%+/-16.39%, -0.87%+/-16.35%, and -0.78%+/-17.41%. No statistically significative postoperative endothelial cell loss was found. The endothelial cell loss rate was higher among patients who wore spectacles before surgery and was correlated negatively with preoperative endothelial cell density (P<0.001). No relationships were noted between endothelial cell loss and either patient age or implant power. A 4.1% repeatability of measurements was found based on the average of 3 repeated counts, whereas single cell count estimates were associated with a 23% accuracy in detecting endothelial cell density change. In a worst-case scenario, adjusting for measurement accuracy, 9% of all eyes were at higher risk of a 10% loss of cell density at 12 months after surgery, although eyes at higher risk were found to have high preoperative endothelial cell counts (P<0.0001). CONCLUSIONS: The Artisan iris-claw phakic intraocular lens did not result in significant loss of endothelial cell density up to 2 years after implantation of the myopic Artisan phakic lens.     

Phacoemulsification in the anterior chamber.

PURPOSE: To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. RESULTS: The mean nuclear hardness was 2.67 +/- 0.61 (SD) in the stop-and-chop group and 2.65 +/- 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% +/- 4.24% in the stop-and-chop group and 11.20% +/- 5.60% in the phaco-out group. There were no significant differences between groups in any parameter (P >.05, independent-sample t test). CONCLUSION: Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.     

The effect of scleral buckling surgery on corneal astigmatism, corneal thickness, and anterior chamber depth

PURPOSE: To evaluate the effect of scleral buckling surgery on corneal topography, corneal thickness, and anterior chamber depth. METHODS: Thirty-two eyes of 32 patients who underwent encircling buckling surgery for rhegmatogenous retinal detachment were included in the study. Fellow eyes comprised the control group. Orbscan II topography system was used to determine the changes in corneal topography, corneal thickness, and anterior chamber depth before surgery and 1 week, 1 month, and 3 months after surgery. Statistical analyses used in the study were independent t test, paired t test, one way analysis of variance, and correlation analyses. RESULTS: Postoperatively, mean central corneal astigmatism at 1 week, 1 month, and 3 months was 4.3 +/- 2.0 diopters (D), 3.3 +/- 1.6 D, and 3.1 +/- 1.0 D, respectively. The change between 1 week and 3 months was statistically significant. Central cornea was thickened at the first postoperative week. The thickness gradually decreased to the preoperative levels at 3 months. Anterior chamber depth decreased, and the anterior chamber remained shallow after the surgery. The comparison between preoperative (2.94 +/- 0.6 mm) and postoperative anterior chamber depth was statistically significant at 1 week (2.57 +/- 0.7 mm), 1 month (2.83 +/- 0.7 mm), and 3 months (2.73 +/- 0.6 mm). CONCLUSIONS: Corneal changes after scleral buckling surgery were mild to moderate and the cornea almost resumed its preoperative parameters in 3 months' time. However, the anterior chamber remained shallow during 3 months of follow-up.     

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.     

单切口植入有晶状体眼后房型人工晶状体治疗高度近视

目的：评价单切口有晶状体眼后房型人工晶状体植入术治疗高度近视的有效性和安全性。

方法：对9例18眼高度近视患者行有晶状体眼后房型人工晶状体植入术。术后随访3～9mo,观察手术前后裸眼视力、最佳矫正视力、屈光度、散光变化、眼压、内皮细胞计数等。

结果：所有患者成功植入眼内接触镜(implantable contact lens,ICL),18眼手术前后平均屈光度分别为-13.38±-5.32,

-0.25±0.38D; 手术前后裸眼视力分别为0.06±0.04,0.6±0.2; 最佳矫正视力分别为0.5±0.3,0.7±0.3; 术后裸眼视力和最佳矫正视力均明显好于术前(P<0.05)。术前平均眼压为13.23±3.18mmHg,术后平均眼压为15.03±1.25mmHg; 内皮细胞计数术前为3 008±298个/mm²,术后为2 896±246个/mm²; 前房深度术前平均为3.56±0.29mm,术后为3.68±0.37mm,角膜散光术前0.52±0.30D,术后角膜散光0.67±0.45D,差异均无统计学意义(P>0.05)。

结论：单切口植入有晶状体眼后房型人工晶状体矫正高度近视近期临床效果有效、可靠,具有手术操作风险低、眼表损伤小、成本低、术源性散光小的优点,为一种适用的手术方式。     

Long-term results of anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas.

We performed the anterior chamber tube shunt to an encircling band procedure in 34 patients (36 eyes) with refractory glaucoma, and evaluated the long-term outcome. The preoperative mean intraocular pressure (IOP) was 36.8 +/- 9.6 mmHg, the postoperative mean IOP was 21.6 +/- 13.6 mmHg, a statistically significant (p < 0.01) reduction of IOP following this procedure. The final postoperative IOP was under 21 mmHg in 23 (63.9%) of the 36 eyes. The success rate of IOP control 36 months after the operation without any elevation of post-operative IOP was 30.3% (life-table method). Complications of this procedure included flattening of the anterior chamber (61.1%), damage to the corneal endothelium (25%), hyphema (25%), and a transient IOP elevation (25%). As filtering surgery with 5-fluorouracil is more effective and simple to perform, we conclude that the anterior chamber tube shunt to an encircling band procedure should be reserved for those with refractory glaucoma who have had multiple surgical interventions.     

Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients

PURPOSE: To determine the safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution (Vigamox) in patients having cataract surgery. SETTING: American Eye Center, Manila, Philippines. METHODS: Preoperative and 1-month postoperative anterior chamber reaction, corneal endothelial cell density, and corneal thickness were assessed in 65 eyes that had cataract surgery with intracameral moxifloxacin. All eyes received 0.1 mL intracameral moxifloxacin 0.5% ophthalmic solution containing 500 mug of moxifloxacin as the last step of phacoemulsification. Different ophthalmologists conducted the postoperative evaluation in an observer-masked fashion. A P value less than 0.05 was considered significant. RESULTS: All 65 eyes completed the study. The mean age was 69.5 years +/- 9.13 (SD) (range 48 to 84 years). All eyes had a postoperative best corrected visual acuity of 20/30 or better. All eyes had trace to +2 cells and flare anterior chamber reaction only on the first day after surgery. The mean endothelial cell count was 2491.52 cells/mm(2) preoperatively and 2421.58 cells/mm(2) postoperatively. The mean difference was 70 cells/mm(2), which not statistically significant (P = .737). The increase of 17.80 microm in postoperative pachymetry 1 month after surgery was not statistically significant (P>.65). CONCLUSION: Intracameral Vigamox 0.5 mg/mL appeared to be nontoxic in terms of visual rehabilitation, anterior chamber reaction, pachymetry, and corneal endothelial cell density.     

Myopic anterior chamber intraocular lens implantation: evaluation at 8 years]

PURPOSE: The aim of this study was to analyse the tolerance of Myopic Anterior Chamber IOL's 8 years after surgery. MATERIAL AND METHODS: We have studied 21 eyes implanted with an anterior chamber phakic IOL between May 1989 and June 1990. The 21 eyes had a very high myopia (mean pre-operative myopia--13.5 Dipters). Surgical technique was easy, without peroperative complications. RESULTS: Post-operative refractive results were excellent with a mean refraction of -0.25 D. Post-operative complications were a pupillary ovalisation in 42% of the eyes and glare in 50% of the eyes. Specular microscopy was normal pre-operatively for all the eyes but at 8 years, 4 (19%) of the eyes have had a strong loss of their endothelial cells and have to be explanted. Decreasing of endothelial cells is the most severe complication occurring after Phakic anterior chamber myopic IOL implantation. CONCLUSION: These 21 Myopic Anterior chamber IOL's have given a very good refractive result for all the eyes. 4 (19%) of the eyes operated on with these IOL's had a decreasing of their endothelial cells and the IOL had to be removed. Rigourous follow-up of the implanted eyes is required.     

Changes in corneal endothelium after treatment of retinal detachment with intraocular silicone oil

Keratopathy represents one of the most frequent late complications in eyes with complicated retinal detachment treated with intraocular silicone oil. Corneal examinations including endothelial specular photography were done on 18 silicone treated eyes, 16 of which were aphakic. In addition to widespread silicone oil endothelial contact in 2 eyes, a bubble or droplets of silicone oil were observed in the anterior chamber in 8 eyes. The mean endothelial cell density was lower in the silicone eyes (2076 +/- 196 cells/mm2) as compared to the control fellow eyes (2738 +/- 86 cells/mm2) (P = 0.004). In eyes with silicone oil in the anterior chamber the endothelial cell density was significantly decreased (1857 +/- 232 cells/mm2) (P = 0.005). Obvious endothelial degeneration was noticed when silicone oil had been in the eye for more than a year. Also small droplets of oil with transient contact contributed to its development.