带虹膜隔人工晶状体植入术治疗外伤性白内障伴虹膜缺损的临床研究

目的探讨带虹膜隔人工晶状体植入术治疗外伤性白内障伴虹膜大部分缺损或虹膜全无的安全性和有效性。方法回顾性分析18例(18眼)因外伤性白内障伴大部分虹膜缺损或虹膜全无,行带虹膜隔人工晶状体植入术患者的资料。其中仍有少部分虹膜存在者10眼,虹膜全无者8眼;Ⅰ期植入带虹膜隔人工晶状体4眼,Ⅱ期植入带虹膜隔人工晶状体14眼。对术前和术后的视力及手术并发症进行分析。结果术后视力>0.8者2眼,0.5~0.8者6眼,0.1~0.4者10眼。14眼术前有明显畏光症状的患者,术后畏光症状完全消除者12眼,2眼畏光症状明显减轻。手术并发症包括2眼术中发生睫状体少量出血,1眼术中发生人工晶状体攀断裂,7眼术后出现角膜内皮轻度混浊,2眼术后出现前房少量出血,1眼术后玻璃体出血,2眼术后出现继发高眼压,经处理后均得到了控制。结论带虹膜隔人工晶状体植入手术治疗外伤性白内障伴大部分虹膜缺损或虹膜全无是安全、有效的。     

带虹膜隔后房型人工晶状体植入术的临床应用

目的探讨治疗虹膜缺损的外伤性白内障或无晶状体眼的有效方法。方法总结、分析13眼外伤性白内障或无晶状体眼因虹膜缺损接受带虹膜隔后房型人工晶状体植入手术的术后疗效。随访时间6~20个月。其中人工晶状体Ⅰ期植入4眼,Ⅱ期植入9眼。13眼均植入德国Morcher公司生产的67G型单体型聚甲基丙烯酸甲酯(PMMA)后房型人工晶状体,其光学部直径5.0 mm;光学部外周黑色环为虹膜隔,宽2.5 mm,虹膜隔与光学部整体直径10.0 mm;虹膜隔外连两个有缝线固定小孔的C形襻。人工晶状体总长12.5 mm。除3例行白内障囊外摘出联合人工晶状体植入术外(其中1例同时植入晶状体囊袋张力环),余均为用10-0聚丙烯缝线行三点法后房型人工晶状体巩膜缝线法固定术。结果术后矫正视力1.0者1眼,0.5~0.8者4眼,0.1~0.4者5眼,<0.1者3眼。全部患眼畏光症状消失。术后无人工晶状体脱位等并发症发生。结论带虹膜隔后房型人工晶状体植入手术是治疗虹膜缺损白内障或无晶状体眼安全、有效的方法。     

缝线固定带虹膜隔后房型人工晶状体植入术临床观察

目的：探讨治疗虹膜缺损无晶状体眼和伴虹膜缺损外伤性白内障的有效方法。方法：对因手术或外伤致虹膜缺损的18例（18只眼）无晶状体眼和9例（9只眼）虹膜缺损外伤性白内障患者，施行缝线固定带虹膜隔后房型人工晶状体手术。结果：术后随访4－15个月，平均8．5个月。与术前相比，术后视力提高，具有显著性差异（P＜0．01）；26只眼畏光症状消失，1只眼仍轻度畏光。术后眼压增高（＞21mmHg）者3只眼，其中2只眼为玻璃体切割术后眼，经局部用药眼压降至正常范围。所有病例人工晶状体均无偏位，均未发生睫状体出血和视网膜脱离。结论：缝线固定带虹膜隔后房型人工晶状体手术是 治疗虹膜缺损无晶状体眼和伴虹膜缺损外伤性白内障的有效方法，但其价格昂贵，且术后葡萄膜反应重，应严格掌握适应证。     

带虹膜隔人工晶状体在严重眼外伤治疗中的应用

目的 探讨带虹膜隔人工晶状体植入术在外伤性虹膜缺失无品状体眼的安伞性及有效性.方法 2004年3月至2008年3月30例30只眼外伤性晶状体病变伴有虹膜缺失的患者.给予植入Morcher公司生产的带虹膜隔人工晶状体,观察术后疗效.所有患者均为Ⅱ期人工晶状体植入,随访6个月至2年.结果 24只眼(80%)的视力有较明显改善,5只眼的术后视力有所增加;另外有1只眼视力没有改变.所有患者对手术的美容效果都表示满意且畏光症状明显减轻或消失.术后有3只眼出现周边局部脉络膜浅脱离,经应用激素后治愈;6只眼术后前房反应较重;6只眼有眼压升高,经治疗后恢复正常.在以后的随访中未发现人工晶状体的移位以及视网膜脱离等并发症的发生.结论 外伤性无晶状体眼联合虹膜大部或完伞缺失患者植入带虹膜隔人工晶状体可以明显改变屈光状态,减轻畏光,并起剑美容作用.本研究结果显示带虹膜隔人工晶状体是安全、有效的,值得临床应用.     

晶状体玻璃体切除术后带虹膜隔人工晶状体缝线固定术临床观察

目的 评价眼外伤晶状体玻璃体切除术后无虹膜者植入带虹膜隔人工晶状体缝线固定术的手术的临床疗效.方法 对13例(13眼)晶状体玻璃体切除术后伴无虹膜及瞳孔极度散大者,行二期带虹膜隔人工晶状体缝线固定术,术后随访3～24个月.结果 术后畏光症状均减轻或消失.术后3个月时矫正视力＜0.1者1眼,0.1 ～0.3者5眼,0.4 ～0.6者4眼,＞0.6者3眼.术后有5例眼压升高,4眼控制,1眼行引流阀植入术好转.结论 带虹膜隔人工晶状体植入术是治疗无虹膜合并无晶状眼的有效方法,但术后并发症不容忽视.     

老年性白内障膨胀期继发青光眼的人工晶状体植入术

目的：探讨膨胀期白内继发青光眼的药物及手术治疗。方法：筛选膨胀期白内障继发青光眼的病例20例21只眼行人工晶状体植入手术,术式为（1）白内障囊外摘除合并人工晶状体植入（ECCE＋IOL）＋虹膜周边切除或切段性虹膜切除,（2）ECCE＋IOL＋小梁切除术。结果：（1）术后矫正视力提高者20只眼（95．2％）,其中0．3－1．0者16只眼（76．2％）。（2）眼压15只眼（71．4％）正常,6只眼（28．6％）局部用药后正常,总有效率100％。（3）并发症较高,其中后囊破裂2只眼（9．5％）瞳孔区渗出膜7只眼（33．3％）。结论：（1）膨胀期内白内障继发青光眼可用缩瞳剂治疗。（2）白内障囊外摘除合并抗青光眼手术的同时植入人工晶状体是恢复视力治疗继发青光眼的有效手段,术式首选人工晶状体植入＋虹膜周边切除术。（3）膨胀期白内障继发青光眼术后 并发症较普通白内障发生率高,故应在膨胀期继发青光眼前早手术。（4）膨胀期内障患者为预防继发青光眼可给予缩瞳剂。     

改良带黑色虹膜隔人工晶状体植入术初步观察

目的　探讨改良式带黑色虹膜隔人工晶状体植入术治疗无虹膜无晶状体眼的疗效。方法　在 12点方位距角膜缘约 2 5mm做一“V”型双隧道切口深达 1/2巩膜厚度。植入带黑色虹膜隔人工晶状体 ,4点固定。结果　随访 3～ 12月 2例术后矫正视力分别为 0 4和 0 5 ,散光度 + 0 75DC× 47°和 -1 0 0DC× 92° ,无畏光不适。结论　改良式带黑色虹膜隔人工晶状体植入术是治疗无虹膜无晶状体眼安全有效的手术方法     

无虹膜眼人工晶状体植入术

目的：探讨无虹膜眼人工晶状体植入术的手术方法，并评价其疗效。方法：对46例（47眼）无无虹膜眼人工晶状体植入术。其中外伤性白内障42眼，先天性白内障5眼。手术方式：晶状体玻璃体切除人工晶状体睫状沟缝线固定术、囊袋内人工晶状体植入术、带虹膜隔人工晶状体植入术及联合穿透性角膜移植术。随访1－14月，平均4．8月。结果：47眼手术顺利，术后人工晶状体位置正。术后矫正视力≥0．5者33眼（70．21％），0．1－0．4者12眼（25．56％）；术后4眼眼压升高，10眼前房纤维蛋白渗出。无严重远期并发症。结论：无虹膜眼人工晶状体植入是可行的，但患者眼部情况复杂，应根据眼部具体情况选择手术方式和人工晶状体的类型。影响术后视力恢复的主要因素是散光。     

儿童带虹膜隔人工晶状体植入术的临床应用

目的：探讨带虹膜隔人工晶状体在儿童内障术后的应用。方法：对12例（12只眼）伴无虹膜或虹膜缺损的先天性或外伤性白内障儿童施行白内障注吸术和带虹膜隔人工晶状体植入术。结果：随访平均4．33月,所有病例的视力都较术前有所改善,其中8眼（66．675）的矫正视力≥0．1,最好者达0．6。术后并发症视网膜脱离1眼,严重色素膜炎2眼,人工晶状体移位3眼。结论带虹膜隔人工晶状体植入术是儿童无虹膜或虹膜缺损眼白内障术后的一种有铲的矫正无晶状体眼的方法。     

眼外伤患者晶状体玻璃体切除术后Ⅱ期人工晶状体植入术

目的 探讨眼外伤患者晶状体玻璃体切除术后无晶状体眼Ⅱ期人工晶状体植入的手术技巧.方法 眼外伤患者晶状体玻璃体切除术后无晶状体眼42例（42眼）,采用玻璃体腔灌注维持眼压.5例于保留的晶状体前囊前植入后房型人工晶状体,37例采用外路法人工晶状体睫状沟固定术,其中3例为带虹膜隔的人工晶状体.结果 术后随访3～40个月.术后最佳矫正视力≥0.3者28例（66.67%）,术后最佳矫正视力优于或等于术前最佳矫正视力者31例（73.81%）.结论 晶状体玻璃体切除术后无晶状体眼Ⅱ期植入人工晶状体时,需玻璃体腔灌注调整眼压,最好采用外路法预置睫状沟固定缝线,用四线或两线法悬吊人工晶状体.     

虹膜型人工晶状体治疗外伤性无虹膜无晶状体眼

目的探讨虹膜型人工晶状体对外伤性无虹膜无晶状体眼的治疗作用。方法观察31例（31眼）虹膜型人工晶状体植入术后的视力情况及并发症。结果术后患者视力有不同程度提高，最光症状明显改善。结论虹膜型人工晶状体对治疗外伤性无虹膜无晶状体眼具有较好的临床价值。     

应用带虹膜人工晶状体治疗外伤性虹膜缺损

目的 应用带虹膜人工晶状体植入术治疗外伤性虹膜缺损。方法 使用德国Morcher公司生产的带虹膜的人工晶状体，为8例外伤性膜缺损患者施行一期或二期带虹膜人工晶状体植入术。探讨带虹膜人工晶状植入术的适应证、手术方法、并发症、效果及作者体会。结果 术后所有病例畏光症状改善，视力增加。结论 带虹膜人工晶状体植入术治疗外伤性虹膜缺损有重要的临床意义，但要注意手术并发症。     

玻璃体切割术后虹膜型人工晶体的应用

目的探讨虹膜型人工晶体对复杂眼外伤无虹膜无晶体眼的治疗作用。方法观察14例14眼虹膜型人工晶体植入术后的并发症及视力情况。结果术后患者视力不同程度改善，畏光情况缓解。结论虹膜型人工晶体对复杂眼外伤无虹膜无晶体患者有较好的临床价值。但虹膜型人工晶体的构造尚需进一步改善。     

应用带虹膜人工晶状体植入术治疗外伤性无虹膜无晶状体眼

目的应用带虹膜人工晶状体植入术治疗外伤性无虹膜无晶状体眼，以解决患者严重的畏光症状，并矫正视力。方法引进德国Morcher公司生产的带虹膜人工晶状体，为6例外伤性无虹膜无晶状体眼施行二期人工晶状体缝线固定术。结果术后患者畏光症状明显改善，视力有不同程度提高。结论带虹膜人工晶状体植入术用于治疗外伤性无虹膜无晶状体眼，实用有效，具有良好的应用推广前景，但术后并发症值得注意。     

Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia

PURPOSE: To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. METHODS: Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). RESULTS: Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. CONCLUSIONS: Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.     

带虹膜隔人工晶状体在严重眼外伤中的应用价值

目的 探讨带虹膜隔人工晶状体在外伤性无虹膜无晶状体眼中的应用价值。方法 2000年4月～2003年4月应用Morcher公司生产的带虹膜隔人工晶状体治疗13例严重外伤后无虹膜无晶状体眼．均行人工晶状体二期植入术。探讨带虹膜隔人工晶状体植入术的适应证、手术方法、并发症防治及效果。结果 所有病例畏光症状改善或消失，视力均有不同程度的提高。结论 带虹膜隔人工晶状体治疗严重外伤后无虹膜眼有重要的临床意义，不仅畏光症状改善或消失，而且重建了眼前段，挽救了濒于残疾的伤眼，获得了较好的视力。     

带虹膜人工晶体在外伤性无虹膜无晶体眼的应用

目的 :改善外伤性无虹膜、无晶体眼或白内障患者的羞明症状 ,提高视力。方法 :使用德国MORCHER公司生产的带虹膜人工晶体为 3 7例无虹膜、无晶体或合并外伤性白内障、玻璃体出血的患者施行了白内障摘除或晶体、玻璃体切除联合带虹膜人工晶体植入术及带虹膜人工晶体二期植入术。结果 :术后患者羞明症状明显改善 ,视力有不同程度的提高。结论 :带虹膜人工晶体对治疗外伤性无虹膜、无晶体眼具有良好的实用价值 ,其术后并发症值得关注     

眼外伤玻璃体切割术后带虹膜隔人工晶状体植入术

目的 探讨眼外伤后无虹膜无晶状体眼的治疗方法。方法 对2例(2只眼)眼外伤玻璃体切割术后无虹膜无晶状体眼患者施行带虹膜隔人工晶状体植入术。结果 术后所有患者畏光症状消失，视力明显提高，无任何严重并发症发生。结论 带量膜隔人工晶状体植入术是目前矫正无晶状体眼伴无虹膜的安全有效方法。     

Implantation of black diaphragm intraocular lenses in congenital and traumatic aniridia

PURPOSE: To evaluate the safety and efficacy of the black diaphragm intraocular lens (IOL) implantation for the treatment of congenital and traumatic aniridia. MATERIAL AND METHODS: Seven black diaphragmatic IOLs were implanted in the eyes of 6 patients between 1997 and 1998. There were 5 males and 1 female. The mean age of them was 42.8 years (range: 22-54 years). Follow-up ranged from 9 to 20 months (mean: 14.2 months). Traumatic aniridia was present in 4 eyes and congenital aniridia in 3 eyes. Pars plana vitrectomy was combined with the simple outside-in method of scleral fixation of IOLs in 6 cases. Three of these eyes were aphakic (all with traumatic aniridia) and in 3 eyes (two congenital cases, one traumatic case) subluxated lens was simultaneously removed. In one case of congenital aniridia with mature cataract, ECCE and ciliary sulcus implantation without scleral fixation were performed. RESULTS: There were very few complications. Ciliary sulcus bleeding appeared in 2 cases during scleral fixation. Transient post-operative corneal oedema was observed in 2 eyes, raised intraocular pressure in 3 eyes, and dispersed blood in vitreous cavity in 2 eyes. All IOLs were well centred. The improvement in best corrected visual acuity was achieved in 5 cases, while good pre-operative best corrected visual acuity was maintained in 2 cases. CONCLUSIONS: Diaphragmatic IOL can be fixated to the sclera in cases without capsular support or it can be implanted into ciliary sulcus after ECCE. Reconstruction of 5 mm pupil and intraocular correction of aphakia enable good visual rehabilitation of patients. The combined procedure of pars plana vitrectomy and scleral fixation of diaphragmatic lens is safe and effective in traumatic and congenital aniridia.     

Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy

PURPOSE: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV). SETTING: Shandong Eye Institute and Hospital, Qingdao, China. METHODS: This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes), or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intra- ocular pressure (IOP), endothelial cell density, IOL centration, and intraocular inflammation were monitored. RESULTS: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. Five patients had increased IOP 3 to 5 days after IOL implantation; 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mm Hg) with timolol 0.5% eyedrops. The other 2 patients had normal- appearing angles, and 1 was diagnosed with hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae; the other required vitreous washout. Retinal detachment and cystoid macular edema did not occur in any patient. CONCLUSIONS: Black diaphragm IOL implantation can be considered in eyes with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow-up and a larger study group.