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1.
Nd-YAG posterior capsulotomy in treatment of secondary cataract has the main disadvantage of increasing the risk for pseudophakic retinal detachment by destroying the posterior lens capsule. This is of great interest in high myopic eyes with an increased risk for pseudophakic retinal detachment. In 219 cases of secondary cataract in our clinic a surgical posterior capsule polishing has been performed and this group was followed up over 6 years looking for intra- and postoperative complications. PATIENTS: The examined group included 209 myopic eyes with a bulbus length > 25 mm and 10 eyes with traumatic cataract; 24 eyes of this group had been primarily operated without a lens. The secondary cataract surgery was performed between 1990 and 1995, and the average follow-up period was 42 months. The intra- and postoperative complications were revealed retrospectively by examination of the patients in our clinic or by interviewing the patients' private doctors. RESULTS: The patients achieved a mean improvement in vision of 4 lines. In 9 cases intraoperative capsule rupture occurred (4%). In 35 of the operated eyes one or more relapses occurred during the follow-up period that made another polishing necessary (16%), and in 5 cases YAG capsulotomy was eventually performed (2%). Pseudophakic retinal detachment occurred in none of the cases. CONCLUSION: Surgical posterior capsule polishing is a low-risk procedure for treatment of regenerative secondary cataract. It is indicated especially in myopic eyes in order to reduce the risk of pseudophakic retinal detachment by conserving the posterior lens capsule.  相似文献   

2.
卢海  张风 《眼科》2006,15(3):198-201
目的分析晶状体超声乳化联合玻璃体手术治疗合并白内障的增生性糖尿病视网膜病变(PDR)的疗效。设计回顾性临床病例系列。研究对象123只合并不同程度白内障的PDR患眼。方法对123只合并不同程度白内障的PDR患眼实施晶状体超声乳化联合玻璃体手术治疗,同时I期植入人工晶状体(IOL),观察术后视力改善程度及术中术后并发症。主要指标术后视力改善程度、术后并发症发生率。结果123眼均实施晶状体超声乳化联合玻璃体手术,并同时一期植入IOL于囊袋内。随访时间3 ̄21月(平均10个月)。99眼(81%)术后均有不同程度的视力改善。其中93眼(76%)术后视力提高2行或以上。术后无明显角膜水肿和角膜内皮失代偿发生。1例I型糖尿病患者术后6个月发生新生血管性青光眼;1眼术后发生视网膜脱离,再次手术后复位;4眼因玻璃体腔出血再次手术。术后视力无明显改善或视力提高不足2行的病例均合并不同程度的糖尿病黄斑病变。结论晶状体超声乳化联合玻璃体手术是提高合并白内障的PDR患者视力的有效手段。糖尿病黄斑病变是影响术后视力提高的主要因素。(眼科,2006,15:198-201)  相似文献   

3.
PURPOSE: To determine the frequency and to identify predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation. METHODS: Retrospective review at an eye hospital identified 1017 eyes among 579 patients who underwent limbal-approach surgery without primary IOL implantation at age < or =16 years for cataract unassociated with other ocular abnormalities aside from microcornea. Patients had a minimum of 2 years postoperative follow-up. The outcome measure was the presence or absence of postcataract surgery retinal detachment, and analyses were performed on patients' eyes with adjustment for intrasubject correlation. RESULTS: Mean postcataract surgery follow-up was 6.8 +/- 3.6 years (range, 2.0 to 18.3 years). Retinal detachment developed in 33 (3.2%) of the 1017 patients' eyes and was diagnosed at a mean of 6.8 +/- 4.4 years postcataract surgery (range, 0.4 to 14.8 years). Multivariable Cox proportional hazards regression analysis with adjustment for intrasubject correlation identified an aphakic refractive error more myopic than the age-adjusted aphakic norm [hazard ratio (HR), 5.9; 95% confidence interval (CI), 1.9 to 18.0; P = 0.002] and postcataract surgery wound dehiscence (HR, 15.4; 95% CI, 2.2 to 108.5; P = 0.006) as predictors of retinal detachment; a primary posterior capsulotomy/anterior vitrectomy procedure was not predictive of retinal detachment. CONCLUSIONS: Retinal detachment is infrequent following pediatric cataract surgery without primary IOL implantation, at least with short-term follow-up. A postoperative aphakic refractive error more myopic (less hyperopic) than the age-adjusted aphakic norm is predictive of this complication.  相似文献   

4.
高度近视眼白内障术后并发视网膜脱离的临床分析   总被引:2,自引:0,他引:2  
目的:分析高度近视眼行白内障摘除及后房型人工晶状体植入术后并发裂孔源性视网膜脱离的发生率、相关危险因素及临床特点。方法:回顾性分析高度近视眼行白内障摘除及后房型人工晶状体植入术患者146例(232只眼)。裂孔源性视网膜脱离在术后随访的3年时间发生。所有眼均进行了详细的眼科检查,包括:最佳矫正视力、眼底检查、A超眼轴长度测量。结果:15只眼发生裂孔源性视网膜脱离(6.4%),均需行玻璃体视网膜手术进行视网膜复位。从白内障手术到发生视网膜脱离的平均时间为10±9个月(0.5~32个月)。视网膜脱离经手术治疗后视力为手动/10cm~0.06,12只眼(80%)最终视力低于白内障术前。术中后囊膜破裂与术后视网膜脱离的发生显著相关(P〈0.01),60%(9/15)的视网膜脱离患者术中发生了后囊膜破裂。结论:高度近视眼白内障术后并发裂孔源性视网膜脱离的发生率为6.4%,其预后差。术中发生后囊膜破裂患者术后发生视网膜脱离的危险性更高,对术中后囊膜破裂患者需密切随访。  相似文献   

5.
Several ophthalmologists, during these past 20 years, supported by the great improvement in the surgical techniques of cataract extraction, proposed again the surgical procedure of clear lens extraction (CLE) to correct high axial myopia. However, we have to remember that vitreous and retinal changes in high myopic eyes can lead to retinal detachment (RD), in some cases with a poor visual outcome even after successful surgery. Moreover, it is well known that cataract extraction is a major cause of later RD with a further significant increase of the incidence of RD after Nd:YAG laser capsulotomy. The increased risk rates of RD for high myopia and cataract extraction are probably to be additive; therefore, high myopic eyes are significantly more exposed to postoperative complications.  相似文献   

6.
PURPOSE: To evaluate incidence, features, risk factors, and prognosis of iridocyclitis after angle-supported phakic intraocular lens (IOL) implantation. SETTING: Private practice, Siena, Italy. METHODS: This retrospective analysis comprised 356 consecutive eyes of 212 patients. In myopic eyes, the ZSAL-4 IOL (205 eyes of 125 patients) or the ZSAL-4 Plus IOL (106 eyes of 63 patients) was used. In hyperopic eyes (45 eyes of 24 patients), the Type 54 IOL was implanted. Haptic posterior angulation was 19 degrees (ZSAL-4), 23 degrees (ZSAL-4 Plus), and 14 degrees (Type 54). RESULTS: Clinically significant iridocyclitis occurred in 11 eyes (3.1%) of 11 patients. Mean patient age was 37.3 years +/- 9.4 (SD). Sixty-four percent were male (odds ratio [OR], 3.0; 95% confidence interval [CI], 0.8 to 7.4, not statistically significant). Iridocyclitis was observed in 4.4% of hyperopic eyes (OR, 1.6; 95% CI, 0.3 to 7.4; not statistically significant) and in 2.9% of myopic eyes. In myopic eyes, it followed the implantation of ZSAL-4 IOL in 3.9% of eyes (OR, 4.1; 95% CI, 0.5 to 33.6; not statistically significant), and of ZSAL-4 Plus IOL in 1%. Mean time from surgery was 8.5 +/- 10.6 months). Presentation included aqueous flare (100%), posterior synechiae (82%), blurred vision (82%), redness (36%), pain (27%), IOL precipitates (18%), and angular synechiae (9%). Only 1 patient had recurrences, leading to IOL explantation and cataract surgery. After topical therapy, best spectacle-corrected visual acuity was fully recovered in 9 of 11 eyes. CONCLUSION: Iridocyclitis can occur months or years after the implantation of angle-supported phakic IOLs. No statistically significant risk factors were identified. Functional prognosis is generally good.  相似文献   

7.
PURPOSE: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade. DESIGN: Retrospective, interventional, comparative case series. METHODS: In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA). RESULTS: The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021). CONCLUSIONS: Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.  相似文献   

8.
Retinal detachment in myopic eyes after laser in situ keratomileusis   总被引:10,自引:0,他引:10  
PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.  相似文献   

9.
目的:分析白内障摘除手术治疗高度近视白内障患者疗效的影响因素.方法:回顾性研究.纳入高度近视合并白内障患者行白内障摘除术86例118眼,所有患者均完成术后6mo随访调查且临床资料完整,记录所有患者术后6mo最佳矫正视力(best correct visual acuity,BCVA),以0.3为分界将患者分为低视力组(视力<0.3)与视力正常组(视力≥0.3),回顾性分析两组患者临床资料,对年龄、性别、病程、BCVA、角膜屈光度、眼轴长度、角膜散光、巩膜、眼底病变程度、术后并发症、玻璃体脱离、黄斑病变等因素进行统计,采用单因素及多元Logistic回归分析法筛选影响白内障摘除手术治疗高度近视白内障患者疗效的相关因素.结果:所有患者中低视力34眼(29%),视力正常84眼(71%);低视力组眼轴长度、角膜散光度、合并黄斑病变所占比例、合并后巩膜葡萄肿所占比例、晶状体核硬度分级、眼底病变程度与视力正常组对比差异有统计学意义(P<0.05);眼轴长度(OR:1.567,95%CI:1.129~2.224)、黄斑病变(OR:8.054,95%CI:1.741~37.541)、晶状体核硬度分级(OR:3.642,95%CI:2.512~18.787)、眼底病变程度(OR:7.964,95%CI:1.254~28.415)均与高度近视白内障疗效相关(P<0.05);随访6mo,晶状体后囊膜混浊5眼,无继发性青光眼、人工晶状体移位、角膜失代偿及视网膜脱离并发症发生.结论:眼轴长度、黄斑病变、晶状体核硬度分级、眼底病变程度均为影响白内障摘除手术治疗高度近视白内障患者术后视力恢复的独立危险因素,为促进患者术后视力恢复,必须积极控制危险因素,重视术中精细操作.  相似文献   

10.
PURPOSE: To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. METHODS: We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. RESULTS: Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. CONCLUSIONS: The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.  相似文献   

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