Comparative study of modified and conventional secondary hydroxyapatite orbital implantations

AIM: To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients.METHODS: This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE).RESULTS: The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3.CONCLUSION: Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.     

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。     

白内障术中Toric人工晶状体植入矫正散光的长期临床疗效

目的：评价术前伴有较大角膜散光的白内障患者白内障超声乳化后植入AcrySof Toric IOL后的屈光效果及囊袋内的旋转稳定性。

方法：收集确诊为年龄相关性白内障并伴有角膜规则散光≥1.00D的患者28例32眼,采用白内障超声乳化、植入AcrySof Toric IOL手术。观察并比较术前、术后1a裸眼视力(UCVA)及最佳矫正视力(BCVA)、术前角膜散光、预计残余散光及术后1a残余散光、IOL旋转度。

结果：术后1a,85%患眼UCVA≥0.5,86%患眼BCVA≥0.8,BCVA≥0.6者达92%。相较术前角膜散光(2.20 ±0.65D),术后1a残余散光(0.54±0.13D)明显减少,两者差异有统计学意义(t=10.134,P<0.01); 术前预计残余散光0.52±0.14D,术后1a残余散光为0.54±0.13D,两者差异无统计学意义(t=0.364,P>0.05)。术后6mo晶状体旋转平均为3.4°±2.2°。术后1a晶状体旋转平均为3.82°±1.27°。

结论：AcrySof Toric IOL植入术是一种矫正角膜规则散光的有效的、可预测性好、角膜损伤小、无角膜损伤的方法。谨慎的选择患者,准确的角膜曲率的测量和IOL轴位的精确调整是影响其屈光效果和旋转稳定性的因素。     

Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis

OBJECTIVE: To study photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias. INTERVENTION: For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. MAIN OUTCOME MEASURES: Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. RESULTS: Forty-seven eyes were evaluated at the 12-month postoperative examination: 96% of these eyes had spherical equivalents (SE) within +/-2 D of emmetropia, 79% of eyes had SE within +/-1 D of emmetropia and 51% of eyes had SE within +/-0.50 D of emmetropia. Eighty-five percent of the eyes at 12 months postoperative had uncorrected visual acuity of 20/40 or better, and 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seven percent of the eyes at 12 months postoperative had uncorrected visual acuity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA at 3, 6, or 12 months after PRK or after LASIK. CONCLUSIONS: IOL implantation for CLE, although an invasive technique, resulted in better refractive outcomes without laser-related clinical complications after PRK or LASIK adjustment.     

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series

PURPOSE: To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. RESULTS: Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. CONCLUSIONS: Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.     

Toric人工晶状体植入矫正老年性白内障合并角膜散光的疗效

目的：探讨老年性白内障合并角膜散光行超声乳化摘除联合Toric人工晶状体植入的临床效果,比较Acrysof Toric人工晶状体植入前后的视觉质量。

方法：选择老年性白内障合并角膜散光的患者34例为研究对象,进行白内障超声乳化摘除联合Toric人工晶状体植入,观察术前和术后3mo的临床效果,包括裸眼视力(UCVA),最佳矫正视力(BCVA),全眼残余散光,人工晶状体转动度数,视远脱镜情况。

结果：所有患者Toric人工晶状体均成功植入。术前UCVA 0.15±0.06,术后UCVA上升至0.65±0.15(P<0.01); 术前BCVA 0.37±0.13,术后BCVA上升至0.85±0.19(P<0.01); 全眼散光由术前2.14±0.69D降低至0.73±0.36D(P<0.01),97%的患者人工晶状体转位<5°,平均旋转2.6°±1.3°,术后3mo视远脱镜率达95%。

结论：Toric人工晶状体能够有效矫正白内障合并的角膜散光,晶状体在囊袋内具有良好的稳定性,提高了患者的术后视觉质量。     

小眼球高度远视眼透明晶状体摘除联合后房型Piggyback人工晶状体植入

目的：探讨小眼球高度远视眼的透明晶状体摘除联合后房型Piggyback人工晶状体植入术的疗效及人工晶状体度数的计算方法。方法：1例双眼极短眼轴合并高度远视、慢性闭角型青光眼患者行透明晶状体摘除联合后房型二片 30.0D Piggyback人工晶状体植入,术前双眼行YAG激光虹膜周切,术后一周右眼眼压高,行小梁切除术。术后一周、一月和三月分别视力、屈光状态,眼压和前房深度。利用光路追迹法计算人工晶状体度数。结果：术后三月最佳矫正视力与术前一致,屈光状态等效球镜度右 2.75D、左 2.88D,前房深度右眼、左眼分别由术前1.87mm、1.93mm加深到术后3.02mm和3.20mm,眼压正常。结论：对小眼球合并高度远视、慢性闭角型青光眼行透明晶状体手术联合二片后房型IOL植入,不仅能较好地解决屈光问题,而且有利于控制青光眼的发作和发展。利用光路追迹法计算IOL度数的方法是可取。     

AcrySof Toric人工晶状体的临床应用研究

目的：观察白内障超声乳化吸出术中联合植入散光矫正型人工晶状体治疗伴有角膜散光白内障的临床效果。

方法：前瞻性不同病例前-后对照研究。将59例83眼术前角膜散光值≥0.75D的白内障患者分为Toric IOL组(39例53眼)和非Toric IOL组(20例30眼),所有患者均行白内障超声乳化吸出联合人工晶状体植入术,分别植入Toric IOL(Toric IOL组)或非Toric IOL(非Toric IOL组)。分别于术前及术后检测Toric IOL组术眼的裸眼远视力、屈光状态、IOL轴位、对比敏感度(contrast sensitivity, CS)、波前像差,并与非Toric IOL组术后结果进行比较分析。

结果：(1)裸眼远视力：Toric IOL组术后术眼视力≥1.0的比例大于非Toric IOL组;(2)术后残余散光度：Toric IOL组术前预测的术后残余散光度与术后测得结果相比无明显差异。(3)人工晶状体旋转：Toric IOL组在术后3mo有22.2%的IOL发生了1°～4°的旋转,没有1例IOL旋转>5°;(4)CS：Toric IOL组患者术后不同空间频率CS均较术前提高,提高程度比非Toric IOL组术后同期相比更为明显;(5)波前像差：Toric IOL组术后彗差(C7和C8)、 球差(C12)、高阶像差均方根均较术前减小,非Toric IOL组C7和C8与RMSh较Toric IOL组高,C12在两组间无明显差异。

结论：在白内障超声乳化吸出联合人工晶状体植入术中植入散光矫正型人工晶状体(Toric IOL)能够有效地矫正术前存在的角膜散光,从而提高白内障患者的裸眼远视力,并能改善其术后的视觉质量。     

AcrySof IQ Toric人工晶状体植入矫正角膜散光的疗效

目的：评价白内障手术中植入AcrySof IQ Toric散光型人工晶状体矫正角膜散光的效果及人工晶状体在囊袋内的稳定性。

方法：对21例26眼伴有角膜规则散光的白内障患者,植入AcrySof IQ Toric散光型人工晶状体,观察术前及术后裸眼视力、最佳矫正视力; 术前角膜散光、预计散光、总散光,术后角膜散光及残余散光; 以及术后人工晶状体旋转度。

结果：术后所有患者裸眼视力及最佳矫正视力均明显提高; 术后残留散光0.55±0.33D,与术前总散光2.05±0.57D相比明显下降(t=13.574,P<0.05); 与术前预留散光0.47±0.19D比较无统计学意义(t=1.149,P>0.05)。术后3mo角膜散光-1.89±0.53D,与术前角膜散光2.01±0.58D相比无差异(t=1.908,P>0.05); 所有26眼的人工晶状体旋转度均<20°,平均旋转为(3.65±2.86)度。

结论：白内障超声乳化吸除联合AcrySof IQ Toric IOL植入矫正散光手术,能够有效的减少患者的散光,术后IOL旋转稳定性良好,是治疗白内障合并散光患者的有效的手术方法。     

中央孔型有晶状体眼后房型IOL植入术治疗中低度近视

目的：观察中低度近视患者植入中央孔型有晶状体眼后房型人工晶状体(ICL V4c)术后的疗效及安全性。

方法：选取2016-01/2017-06在我院接受ICL V4c植入术的中低度近视患者20例40眼,术后1wk,1mo,1a进行随访,观察UCVA、BCVA、SE、眼压、角膜内皮细胞计数、拱高、术后不良反应及并发症。

结果：术后UCVA、BCVA均较术前提高(P<0.01),术后1mo与术后1a UCVA无差异(P>0.05),其余时间点UCVA两两比较均有差异(P<0.05),术后各时间点BCVA两两比较均无差异(P>0.05)。术后SE均较术前降低(P<0.01),术后1wk平均SE接近0D。术后1a手术安全指数为1.05±0.14,手术有效性为1.07±0.14。术后各时间点与术前眼压均无差异(P>0.05)。术后1a角膜内皮细胞密度与术前无差异(P>0.05)。所有研究对象均未见白内障、青光眼、角膜内皮失代偿等。术后满意度为100%。

结论：ICL V4c植入术是治疗中低度近视安全而有效的方法,术后1mo后视力稳定。     

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature

AIM: To evaluate the surgical results of sulcus intraocular lens (IOL) implantation in children with unilateral anterior persistent fetal vasculature (PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule. METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity (BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution (logMAR) after IOL implantation (P<0.001) with a mean follow-up was 16.55±5.86mo. Average age at secondary IOL implantation was 41.05±15.41mo. Three eyes (13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise (4 eyes; 18.18%), postoperative increased inflammation (3 eyes; 13.64%) and postoperative hypotony (2 eyes; 9.09%) were common complications. CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.     

Refractive lens exchange for correction of high myopia

PURPOSE: To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia. METHODS: We made a prospective study of the results of refractive lens exchange in 72 eyes that had undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded. RESULTS: In 72.2% of the eyes best-corrected visual acuity (BCVA) was > or = 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was > or = 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA > or = 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%) and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up. CONCLUSIONS: Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.     

改良四点固定人工晶状体悬吊植入术在无晶状体眼中的有效性及安全性观察

目的：观察改良四点固定人工晶状体悬吊植入术在无晶状体眼中的有效性及安全性。

方法：前瞻性研究。选2020-10/2021-05于我院行改良四点固定人工晶状体悬吊植入术的无晶状体眼患者32例32眼，平均年龄44.56±8.48岁。观察手术前后裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜散光、术中及术后并发症。

结果：所有患者平均随访4.84±0.64mo，术前UCVA、(LogMAR)为1.25±0.42，末次随访时为0.5±0.25(P<0.001)； 术前BCVA(LogMAR)为0.41±0.19，末次随访时为0.42±0.19(P>0.05)； 术前角膜散光为1.17±0.64D，末次随访时为1.20±0.59D(P>0.05)。术中无并发症发生，术后发生低眼压2眼、高眼压1眼、角膜水肿2眼，无前房积血、玻璃体积血、黄斑囊样水肿、角膜内皮失代偿、人工晶状体倾斜或偏心、缝线外露等并发症。

结论：改良四点固定人工晶状体悬吊植入术可显著提高无晶状体眼患者术后视力、未增加额外角膜散光、并发症少。     

Refractive lensectomy for hyperopia

PURPOSE: The purpose of this study was to evaluate refractive lensectomy as a surgical procedure for the treatment of hyperopia. DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Twenty-nine patients were included in the study. Fifty eyes underwent extraction of the crystalline lens and intraocular lens implantation. METHODS: Operations were performed by the same surgeon with the patient under general anesthetic. All lenses were removed by phacoemulsification with insertion of lens implants singly or as piggyback lenses. The Holladay2 formula was used to calculate lens powers. Results are compared with other methods of treating hyperopia. MAIN OUTCOME MEASURES: The main parameters assessed were safety, efficacy, predictability, stability, and complications. RESULTS: Eyes were divided into group A (n = 26), with an average preoperative spherical equivalent (SE) of +2.26 +/- 0.94, and group B (n = 24), with an average preoperative SE of +6.32 +/- 1.32. In group A, after refractive lensectomy, 80.7% had no change in best-corrected visual acuity (BCVA) or gained a line, whereas 11.5% lost one line; 88.5% had an uncorrected visual acuity (UCVA) of 20/40 or better, and 88.5% were within 1 diopter (D) of intended postoperative SE. In group B, 70.9% of eyes had no change or gained a line in BCVA, whereas 29.2% lost a line of BCVA; 62.5% had UCVA of 20/40 or better postoperatively, and 58.3% were within 1 D of the intended SE. In one eye the posterior capsule was breached intraoperatively. One eye had a symptomatic episode of cystoid macula edema that settled spontaneously. To date, seven eyes have required secondary refractive procedures, and three eyes have required yttrium-aluminum-garnet capsulotomy. CONCLUSIONS: In the presbyopic age group refractive lensectomy may be a realistic alternative to photorefractive keratectomy or laser in situ keratomileusis, with certain potential advantages.     

Long-term visual acuity and initial postoperative refractive error in pediatric pseudophakia

Objective: To examine the long-term best-corrected visual acuity (BCVA) in children who, during the amblyogenic period, underwent cataract extraction with intraocular lens (IOL) implantation and to see if initial postoperative refractive error following cataract extraction correlates with long-term BCVA.Design: Retrospective chart review.Participants: Thirty-six eyes of 26 patients were included in the study. At least 2 years of follow-up, an age < 8.5 years at time of IOL implantation, an ability to participate in subjective visual acuity measurement, and an absence of congenital glaucoma and significant trauma were required for inclusion in the study.Methods: Retrospective review of pseudophakic patients' charts at a tertiary care centre, with attention to initial and long-term pseudophakic refractive error, long-term BcVa, total myopic shift, length of follow-up, age at IOL implantation, and unilateral or bilateral cataract extraction with IOL implantation.Results: Initial pseudophakic spherical equivalent (SE) showed asignificant nonlinear relationship with most recent BCVA in unilateral cases and no relationship in bilateral cases (interaction p = 0.001). Unilateral cases with initial pseudophakic SE between +1.75 D and +5.00 D showed better long-term BCVA than those with values below +1.75 D or above +5.00 D; this was irrespective of the refractive error of their fellow eye.Conclusions: In patients receiving lens implants in the first 8 years of life, we recommend aiming for low early postoperative hyperopia, taking into consideration each patient's situation and age.     

8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术在无晶状体眼中的应用

目的：观察8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术在无晶状体眼中的临床效果。

方法：回顾性病例研究。收集2021-01/2022-11于我院行人工晶状体悬吊术的无晶状体患者30例31眼(其中男22例22眼)的临床资料，术中均采用8-0聚丙烯缝线巩膜双联结缝合法固定人工晶状体(AcrySof IQ或Tecnis ZCB00)，术后至少随访6 mo，观察所有患者视力、眼压、术后人工晶状体位置和术中术后并发症发生情况。

结果：术前术眼裸眼视力(UCVA，LogMAR)和最佳矫正视力(BCVA，LogMAR)分别为2.53±0.78和0.35±0.26，术后6 mo分别为0.58±0.26和0.36±0.27，手术前后UCVA比较有差异(t=15.408，P<0.01)，BCVA比较无差异(t=-1.677，P=0.104)。术中未出现并发症。术后所有人工晶状体位置均居中，出现人工晶状体倾斜3眼，术后发生高眼压2眼、角膜水肿5眼、缝线外露1眼。术后未出现前房积血、玻璃体积血、黄斑水肿、角膜内皮失代偿、低眼压、脉络膜脱离、视网膜脱离、爆发性脉络膜上腔出血、眼内炎等并发症。

结论：8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术早期可提高无晶状体患者的术后视力、并发症较少，可作为治疗无晶状体、晶状体脱位、悬韧带异常患者的一种手术方式选择。     

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia

PURPOSE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. SETTING: Instituto Oftalmólogico de Alicante, Alicante, Spain. METHODS: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. RESULTS: At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. CONCLUSIONS: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.     

有晶状体眼后房散光型IOL植入矫正高度近视散光

目的：评价有晶状体眼后房散光型人工晶状体(TICL)植入术矫治高度近视散光的临床效果。

方法：选自2009-10/2011-11接受TICL植入的高度近视散光患者30例50眼,术前平均屈光度球镜-10.75±2.65D,柱镜-2.85±0.75D。随访观察术后3mo～2a裸眼视力、最佳矫正视力、屈光度、内皮细胞计数等情况,分析并发症的发生情况。

结果：术后裸眼视力：0.5～1.2(平均0.75±0.34)。术前最佳矫正视力：0.3～1.0(平均0.58±0.35),术后最佳矫正视力0.6～1.2(平均0.78±0.35)。达到术前矫正视力20眼(40%),超过术前最佳矫正视力30眼(60%),随访3mo～2a,视力无明显变化。术后屈光度数平均球镜-0.52±0.35D,柱镜0.52±0.25D。角膜内皮细胞计数术前3 026±250个/mm²,术后3mo为3 023±246个/mm²,差异无统计学意义(P<0.05)。未见严重影响视力的并发症。

结论：TICL植入矫治高度近视散光安全有效,是高度近视散光患者的理想治疗方法。对眼内的长期影响需要进一步观察。     

非球面与球面人工晶状体植入术后高阶像差及对比度视力的比较

目的:比较非球面和球面人工晶状体植入术后波前像差、裸眼远视力、最佳矫正远视力、对比度视力的差异。方法:年龄相关性白内障患者46例50眼,将其随机分成两组,球面人工晶状体组(A组)23例24眼术中植入ACR6DSE球面人工晶状体;非球面人工晶状体组(B组)23例26眼术中植入具有负球面像差Acri.Smart36A非球面人工晶状体。术后3mo,观察两组患者的裸眼视力、最佳矫正视力、暗背景(25cd/m2)和高亮背景(255cd/m2)下的对比度视力、瞳孔直径(6mm)时的球面像差、彗差和高阶像差的均方根是否存在差异。结果:两组患者术后裸眼远视力、最佳矫正远视力比较差异无统计学意义,亮背景下各对比度视力以及暗背景下100%,25%对比度视力两组比较差异无统计学意义,暗背景下5%,10%低对比度时B组视力好于A组。瞳孔直径6mm时,B组高阶像差的均方根(RMS)、球差、彗差和A组比较差异均有统计学意义,B组RMS、球差、彗差低于A组。结论:Acri.Smart36A非球面人工晶状体植入术后与ACR6DSE球面人工晶状体比较可以明显的减少患者的高阶像差,改善患者的术后暗环境下的低对比度视力。     

Visual Outcomes after Primary Iris Claw Artisan Intraocular Lens Implantation during Complicated Cataract Surgery

Purpose: To evaluate the efficacy and safety of aphakic Artisan–Verysise intraocular lens (IOL) primarily implanted for complicated cataract surgery. Methods: A retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared. Results: The mean age of the participants was 68 ± 12.7 years, and the mean follow-up time was 30.7 ± 14.8 months. The mean BCVA improved significantly from 0.58 ± 0.4 at baseline to 0.44 ± 0.41 after the operation (P = 0.008). The spherical equivalent changed insignificantly from -0.13 ± 1.55 preoperatively to -0.6 ± 1.88 (P = 0.724) at the last visit. Postoperative complications were transient pigmented precipitates in five cases and raised intraocular pressure in one case. Conclusion: Aphakic Artisan IOLs are attractive alternatives in complicated cataract surgery without sufficient capsular bag support.