人工晶状体前膜形成与晶状体襻固定位置的关系

目的 探讨人工晶状体前膜形成与晶状体支撑襻固定位置之间的关系。方法 对45例45只眼老年性白内障行白内障摘出及人工晶体植入术后人工晶状体前膜形成进行回顾性分析术中人工晶状体襻固定的位置。结果 人工晶状体襻固定于囊袋内1只眼;不对称囊袋和睫状体沟内固定26只眼;18只眼为完全睫状体沟内固定。结论 人工晶状体襻不完全睫状体沟内固定是前膜形成的因素之一,而囊袋内固定人工晶状体则可减少人工晶状体前膜的形成。     

后房型人工晶状体植入术后的超声生物显微镜观察

目的：探讨后房型人工晶状体植入术后眼前节结构的改变。确切定位人工晶状体襻的位置。观察人工晶状体襻对于周围组织的影响。方法：白内障摘除及后房型人工晶状体植入术的50名患者（50眼）于术前，术后1周及三个月进行超声生物显微镜观察。结果：术后前房深度，房角宽度押送术前显著增加。人工晶状体中囊袋内植入者36枚（72%）。睫状沟植入者6枚（12%），不对称植入者8枚（16%）。人工晶状体光学部倾斜1眼（2%）。人工晶状体襻推挤虹膜根部2眼（4%）。人工晶状体襻睫状沟侵蚀3眼（6%）。术后1周2眼（4%）眼压升高。皮质少量残留5眼（10%）。结论：囊袋内为后房型人工晶状体植入的理想位置。可保证人工晶状体的良好位置。避免人工晶状体襻对于色素膜组织的干扰及对血-房水屏蔽的损伤，从而减少并发症的发生。     

A new surgical technique for posterior chamber lens fixation during penetrating keratoplasty in the absence of capsular or zonular support

A new technique has been developed to implant or exchange an anterior chamber or iris supported lens with a posterior chamber lens during penetrating keratoplasty. The posterior chamber intraocular lens is suspended by suturing the haptics into the ciliary sulcus rather than to the iris.     

Histologic study of eyes with transsclerally sutured posterior chamber intraocular lenses

We studied the postmortem histologic characteristics of two eyes that had undergone penetrating keratoplasty and transscleral suturing of a posterior chamber intraocular lens for bullous keratopathy. The eyes were studied three days postoperatively in a 79-year-old man with pseudophakia and six months postoperatively in an 83-year-old man with aphakia. We also removed a posterior chamber intraocular lens in a 73-year-old woman who had an epithelial downgrowth three months postoperatively. In the first two cases, only one of four haptics was successfully positioned in the sulcus. Histologic study disclosed a thin fibrous capsule surrounding the haptics at their attachment site, no inflammation around the transscleral portion of the suture, and exposure of a suture tip externally. In the third case, the intraocular lens fell back into the vitreous cavity after the fixation sutures were cut externally at the time of surgical removal. Stability of the lens in all three cases was primarily a result of intact transcleral sutures and not fibrous encapsulation or ciliary sulcus placement of haptics.     

外伤性白内障的后房型人工晶体植入手术时机及方法的临床观察

对74例外伤后不同时期施行人工晶体植人术后眼部的反应及预后进行对比分析.结果显示不同时期人工晶体植入对视力预后无明显差异.Ⅰ期和Ⅱ期人工晶体植人术包括睫状沟固定术同样可取得良好的视力,但植入手术一般选择在外伤3月炎症反应完全消失以后较好.对于无后囊、后囊破裂较大的病例施行Ⅱ期人工晶体睫状沟缝合固定术同样可取得良好的效果.     

Morphological changes 2 1/2 years after extracapsular cataract extraction with implantation of a posterior chamber lens. A prospective re-examination

Morphological changes and lens position were examined in 51 eyes of 51 patients 25 to 37 (mean 31) months after extracapsular cataract extraction with implantation of a posterior chamber lens in the ciliary sulcus. Ocular morphology was compared to a previously published examination of the same eyes performed 4 months after surgery. The anterior chamber depth, lens position and the position of the posterior lens capsule had remained unchanged. 'Iris bulging', i.e. a gonioscopically visible slight impression of the iris overlying the lens haptics, had increased from 0 to 42%, iridal transillumination defects from 34 to 46%, and pigment dispersion in the chamber angle from 46 to 72%. Twenty-four percent of the eyes had developed significant, capsulotomy-requiring opacification of the posterior lens capsule. We draw the following conclusions: The posterior chamber lens and the posterior lens capsule have reached their permanent positions by the fourth post-operative month. Implantation of a posterior chamber lens in the ciliary sulcus constitutes a constant stimulus for structural changes of the iris with subsequent dispersion of pigment on neighbouring ocular structures.     

Incidence of secondary cataract in sulcus versus capsular bag fixation of posterior chamber lenses]

We present a retrospective study on the incidence of visually impairing secondary posterior capsule opacification following fixation of an intraocular lens implant either in the ciliary sulcus or the capsular bag. One hundred patients in each group were evaluated 3 1/2 to 3 3/4 years following uncomplicated extracapsular cataract extraction. Only implants with convex-plane optics and forward angulated haptics were used. The incidence of capsular opacification was 20% in eyes with sulcus fixation as opposed to 14% for those with capsular bag fixation. This difference was statistically not significant. The difference in average postoperative interval until development of the secondary cataract (21 months for sulcus, 28 months for capsular bag fixation) or the age of patients with capsular opacification was statistically not significant either. However, it was noted that of the younger patients, between 40 and 50 years at the time of operation, only those with sulcus fixated implants developed secondary cataracts.     

Ultrasound biomicroscopy of haptic position after transscleral fixation of posterior chamber intraocular lenses

PURPOSE: To determine the haptic position of ab externo transsclerally fixated posterior chamber intraocular lenses (PC IOLs) by ultrasound biomicroscopy (UBM). SETTING: Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. METHODS: Ultrasound biomicroscopy was used to determine the haptic position in relation to the ciliary sulcus, iris, and ciliary body in 20 patients with transsclerally fixated PC IOLs. The patients ranged in age from 10 to 65 years. RESULTS: All IOL haptics were easily visualized and imaged by UBM. Of the 40 IOL haptics, 22 (55.0%) were located in the sulcus, 11 (27.5%) anterior to the sulcus, and 7 (17.5%) posterior to the sulcus region. CONCLUSIONS: Ab externo scleral fixation of PC IOLs is a blind procedure in most cases. Ultrasound biomicroscopy showed the difficulty in reliably placing the haptics in the ciliary sulcus using this technique. Thus, endoscopic visualization of the iridociliary angle during surgery is recommended.     

Histologic findings after successful posterior chamber lens implantation

The eyes of a 50-year-old diabetic hypertensive woman who had had successful bilateral cataract surgery with posterior chamber lens implantation were examined post mortem. On gross examination, each eye was found to contain a Simcoe-style C-loop lens with its optic centered satisfactorily and its inferior loop in the capsular bag. In the right eye the superior loop was in the ciliary sulcus; in the left eye most of the superior loop was in the ciliary sulcus but its distal end was in the capsular bag. Histologic sections confirmed the location of the haptics.     

后房型人工晶状体脱位于前玻璃体腔的原因及其处理方法

目的 探讨后房型人工晶状体脱位至前玻璃体腔的原因和处理方法。方法 对28例患者后房型人工晶状体脱位的原因进行分类和总结;行前部玻璃体切除术后重新复位固定后房型人工晶状体。观察手术前、后患者的视力和并发症情况。术后随访时间6个月至10年。结果 28例患者中,上方玻璃体嵌顿致人工晶状体上襻无法定位于睫状沟内22例(22只眼);人工晶状体下襻植入品状体后囊膜后方5例(5只眼);晶状体下方悬韧带断裂2例(2只眼)。行前部玻璃体切除联合人工晶状体旋转复位术22例(22只眼),行人工晶状体固定术4例(4只眼),行人工品状体旋转术2例(2只眼);24例采用人工晶状体睫状沟缝线固定法,4例采用人工晶状体巩膜瓣下缝线固定法。术后28例患者视力为0．2～1．0,术后无严重并发症发生。结论 人工晶状体脱位于前玻璃体腔与晶状体后囊膜破裂、晶状体悬韧带断裂及玻璃体脱出有关;前部玻璃体切除后直接取出并重新固定人工晶状体是处理人工晶状体脱位于前玻璃体腔简单、有效的方法。     

An improved technique for management of dislocated posterior chamber implants.

Many techniques for repositioning dislocated posterior chamber implants described in the recent literature involve intricate intraocular manipulation of a needle or other sharp instrument. The author describes an improved sulcus fixation technique, which combines the best features of external and internal approaches. Its main features involve temporary externalization of the haptics for easy and secured placement of suture knots, and subsequent reinternalization of the same haptics through horizontal sclerotomies directly external to the ciliary sulcus for precise fixation of the dislocated posterior chamber implant with consistency. Between May 1989 and December 1990, this technique was successfully used for posterior chamber intraocular lens repositioning in 12 cases. The main advantages of this technique include: (1) easy suture placement, (2) less chance of suture slippage with the secured knots, and (3) avoidance of difficult intraocular maneuvers and possible tissue injury. This improved technique expedites the process of posterior chamber implant repositioning.     

Location and composition of haptics of posterior chamber intraocular lenses. Histopathologic study of postmortem eyes

Of 110 eyes with posterior chamber intraocular lenses (IOLs) examined postmortem, 37% had both haptics outside of the capsular bag; 57% had one haptic in the capsular bag and the other haptic outside of the bag. Typically, these optics were decentered by 1 to 2 mm. Only six eyes (5%) had both haptics within the capsular bag. Erosion into the ciliary sulcus produced obliteration of the major arterial circle of the iris in 12 eyes (11%). The local tissue response to eroding haptics was similar for haptics composed of polypropylene and haptics composed of polymethylmethacrylate (PMMA). The authors found considerable discrepancy between the actual location of haptics and the surgeon's desired location (i.e., capsular bag or ciliary sulcus). Most of these cases were clinically successful.     

Phacoemulsification in anterior megalophthalmos: rhexis fixation technique for intraocular lens centration

We describe phacoemulsification in both eyes of a patient with anterior megalophthalmos. Surgery in such cases can be challenging because of a deep anterior chamber, enlarged ciliary ring, weakened zonules, and large capsular bag. Phacoemulsification performed through a scleral tunnel resulted in a stable wound. We report the use of anterior optic capture technique (optic within the capsulorhexis margin, haptics in the sulcus) for successful intraocular lens implant centration.     

Transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants

We present our results of transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants (IOL) in IOL exchange cases, secondary implants, and complicated cataract extractions. Follow-up data are presented on a total of 19 patients. The technique is facilitated by using a long needle attaching 10-0 prolene suture to both haptics of an all polymethylmethacrylate (PMMA) posterior chamber intraocular lens implant (PCL). Our early results show that the procedure is safe and predictable.     

Transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants

We present our results of transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants (IOL) in IOL exchange cases, secondary implants, and complicated cataract extractions. Follow-up data are presented on a total of 19 patients. The technique is facilitated by using a long needle attaching 10–0 prolene suture to both haptics of an all polymethylmethacrylate (PMMA) posterior chamber intraocular lens implant (PCL). Our early results show that the procedure is safe and predictable.     

Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses

We report an analysis of 3 single-piece hydrophobic acrylic intraocular lenses (IOLs) that were explanted because of complications related to the presence of their haptics in the ciliary sulcus. In 2 cases, the IOL was primarily implanted in the ciliary sulcus because of inadequate posterior capsule support. In the third case, postoperative displacement of 1 haptic in the sulcus was associated with hyphema and vitreous hemorrhage. Ultrasound biomicroscopy confirmed the contact between the haptic and iris. Areas of iris atrophy were observed in all cases. Light microscopy and scanning electron microscopy of the explanted lenses revealed the presence of pigmentary dispersion on the anterior surfaces. In Case 3, the pigments were concentrated on the surface of the haptic that was displaced from the capsular bag and on the corresponding optic-haptic junction. Scanning electron microscopy also showed the IOL's squared edges and unpolished side walls. The flexibility and thickness of the single-piece hydrophobic acrylic haptics, as well as the square optic and haptic edges, may increase the risk for iris chafing when the haptics are in the sulcus. Therefore, sulcus fixation of this IOL design is not recommended.     

Ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for myopia

PURPOSE: To study the intraocular position and anatomic relationships of PRL-III (phakic refractive lens) (PRL) posterior chamber phakic intraocular lens (PCP IOL) for high myopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain. METHODS: Sixteen phakic myopic eyes that had had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Both haptics were on the zonule in 6 eyes, in the ciliary sulcus in 5 eyes, and impacted in the ciliary body in 1 eye. In the 4 remaining eyes, the haptics were in mixed positions. The mean PCP IOL crystalline lens peripheral distance in the minor axis was 588.1 microm +/- 232.5 (SD), and the mean PCP IOL-endothelium central distance was 2082.8 +/- 277.6 microm. CONCLUSIONS: Phakic refractive lens implantation should be done carefully because of the sulcus location of the haptics in many cases. This, with the iris-PRL contact, suggests caution for the long-term outcome.     

Cataract surgery with ciliary sulcus fixation of intraocular lenses in patients with uveitis.

PURPOSE: To describe intentional placement of intraocular lens haptics in the ciliary sulcus of patients with uveitis who are at high risk for postoperative posterior synechiae and lens dislocation. METHODS: We reviewed our experience with 16 eyes of 12 patients with uveitis who underwent cataract surgery with ciliary sulcus fixation of intraocular lenses. Patients were followed for a median of 16.5 months (range, 9 to 44 months) after surgery. We evaluated eyes for surgical technique and the following preoperative and postoperative factors: best-corrected visual acuity, intraocular pressure, anterior chamber cells, and posterior synechiae. The following additional postoperative factors were sought: lens dislocation, lens edge capture, and evidence of pigment dispersion. RESULTS: Posterior synechiae were present in 13 eyes before surgery; postoperative posterior synechiae developed in only three of these eyes. These adhesions resulted in lens edge capture in one eye and limited lens decentration in another. Scant pigment was present on the lens optic or in the anterior chamber, suggesting pigment dispersion, in four eyes. We found no evidence of consistently increased anterior segment inflammation or intraocular pressure after surgery when compared with preoperative levels for this group of patients. Postoperative posterior synechiae were seen more often in eyes that had can-opener anterior capsulotomy than in eyes that had continuous, curvilinear capsulorhexis (P = .036). CONCLUSIONS: Ciliary sulcus fixation allows the intraocular lens to serve as a physical barrier between the iris and the lens capsule remnants. This technique may be useful for reducing the risk of postoperative posterior synechiae in patients with uveitis without increasing the risk of other postoperative problems.     

Diagnosis and management of traumatic cyclodialysis cleft

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.     

Histopathologic findings in a transsclerally sutured posterior chamber intraocular lens.

A 77-year-old woman had penetrating keratoplasty (PKP), removal of an anterior chamber intraocular lens (IOL), and implantation of a transsclerally sutured posterior chamber IOL for painful pseudophakic bullous keratopathy. Postoperatively, preexisting anterior synechias led to painful secondary angle-closure glaucoma and the eye was enucleated 8 months after the PKP. Light microscopy of the eye revealed that the haptics of the IOL were surrounded by a variably dense fibrous membrane consisting of connective tissue and fibroblasts. In some areas, the haptics had eroded into the superficial stroma of the ciliary body. Except for rare foreign-body giant cells, no inflammatory cells were present near the haptics. This case illustrates that haptics of transsclerally sutured posterior chamber IOLs may be stabilized by fibrous membranes and/or by erosion into the ciliary body relatively soon after implantation. This should be considered if surgical centration, removal, or exchange of such a lens is planned.