Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

Pharmacological aspects of anaesthesia for implantation of the artificial lens

During the placement of an artificial lens the ophthalmic surgeon must be guaranteed an immobile operation site and so-called soft eye. Based on our experience with more than 1000 lens implantation operations in the Rotterdam Eye Hospital over the past three years, the following conclusions can be drawn: The pharmacological agents available to the anaesthetist are sufficient for providing optimal conditions under general anaesthesia for lens implantation techniques by the eye surgeon. Hypotensive techniques are not regarded as being appropriate because of the inherent risks involved. Classical neuroleptic techniques are best avoided in the elderly. Controlled ventilation is preferable in order to avoid the deleterious side effects of hypercarbia. Constant vigilance on the part of the anaesthetist during the operation is a very important sine qua non for a tranquil course both during the anaesthetic and in the post-operative period. The routine administration of antiemetic agents after a lens implantation operation is advisable this holds true also for prevention of the Central Anticholinergic Syndrome by means of physostigmine, in patients who have received inhalation anaesthetics, particularly enflurane or, flunitrazepam.     

小切口白内障手术中后囊膜破裂一期人工晶体植入术临床疗效分析

目的评价小切口白内障摘除术术中后囊膜破裂的原因及处理方法.方法回顾分析1 05 6例小切口白内障手术联合人工晶体植入术,其中术中51例后囊膜破裂,玻璃体溢出,行前段玻璃体切割术联合一期后房型人工晶体植入术.结果本组患者手术中后囊膜破裂发生率为4.8%,全部行一期后房型人工晶体植入术,其中5例囊袋内固定植入,42例睫状沟固定植入和4例DGR人工晶体双襻缝线固定法植入.术后矫正视力大于或等于0.3者46例(90.2%);矫正视力大于或等于0.05,低于0.3者4例(7.8%);矫正视力低于0.05者1例(2.0%).结论前段玻璃体切割术为小切口白内障摘除术中后囊膜破裂一期人工晶体植入提供了安全有效的保证.     

Optical response of the cultured bovine lens; testing opaque or partially transparent semi-solid/solid common consumer hygiene products

This study determines the relative ocular lens irritancy of 16 common partially transparent or non-transparent consumer hygiene products. The irritancy was found by measuring the changes in the sharpness of focus [referred to as the back vertex distance (BVD) variability] of the cultured bovine lens using a scanning laser In Vitro Assay System. This method consists of a laser beam that scans across the lens, and a computer, which then analyses the average focal length (mm), the BVD variability (mm), and the intensity of the beam transmitted. Lenses were exposed to the 16 hygiene products and the lens’ focusing ability was monitored over 192 h. The products are semi-solids or solids (e.g. gels, lotions, shampoos). They are categorized into six groups: shampoos, body washes, lotions, toothpastes, deodorant, and anti-perspirant. Damage (measured by > 1 mm BVD variability) occurred slower for the shampoos, especially in the case of baby shampoo. The results indicate that shampoos exhibit the lowest level of ocular lens toxicity (irritability) while the deodorant is the most damaging.     

兔眼辐射损伤后角膜和晶体上皮细胞DNA含量的定量分析

利用改良Feulgen染色和图像分析技术对不同剂量6 0 Coγ射线 (0、 10、 2 0和 30Gy)和照后不同时间 (3、 15天和 1、 3、 6个月 )的兔眼角膜和晶体上皮细胞的DNA含量进行了定量分析。结果表明 ,各剂量组DNA含量的MOD和IOD值降低 ,与对照组相比均有明显差异 (p<0 0 1) ,提示辐射能引起角膜及晶体上皮细胞核中DNA含量发生规律性变化 ,因此角膜及晶体上皮细胞DNA含量测定可以作为眼辐射损伤的指标之一 ,为其诊断提供实验依据。     

人工晶状体的设计对后囊膜混浊的影响

后囊膜混浊是白内障囊外摘除术后最主要的并发症之一。后囊膜混浊的发生是多因素参与的结果,手术方式的改进、人工晶状体的改良、术后炎症反应的控制都可以减少后囊膜混浊的发生。本文就人工晶状体的设计对后囊膜混浊的影响作一综述。     

巩膜扣带术后的白内障超声乳化人工晶状体植入术

目的探讨原发性视网膜脱离巩膜扣带术后超声乳化白内障吸除人工晶状体植入术的疗效和并发症。方法回顾性地观察了1998-01/2003-06原发性视网膜脱离巩膜扣带术后患者22例(23眼)行超声乳化白内障吸除人工晶状体植入术。记录手术前、后的最佳矫正视力,术中、术后的并发症。结果23眼术后最佳矫正视力≥0.1者18眼(75%),视力≥0.3者9眼(39%),随访期间(6～40mo)内未发现视网膜再脱离,平均随访时间16.5mo。1眼出现后发性白内障,行激光晶状体后囊膜切开术。结论原发性视网膜脱离巩膜扣带术后行超声乳化白内障吸除人工晶状体植入术,可获得良好的手术效果,是一种较理想和安全的手术方法。     

角膜屈光性手术后的屈光矫正

目的：探讨角膜屈光性手术后视力低下的原因及屈光矫正方法。方法：对施行RK、PRK、LASIK术后来我中心寻求进一步视力矫正的48例86只眼，经裂隙灯、电脑验光、角膜曲率仪、计算机辅助的角膜地形图、对比敏感度检查，以及主、客观验光，分析其视力下降、矫正不良的原因，并探讨选择框架眼镜、各种设计的软性接触镜(SCL)和透气性硬性接触镜(RGPCL)，以及角膜矫形镜(Ortho-K CL)等进行屈光再矫正的效果和特点。结果：28只眼并发圆锥角膜，95．8％视力≤0．1，全部利用不同设计的RGPCL矫正，70．8％矫正视力≥0．8。16只眼为高度近视、高度散光，86．2％视力≤0．1，利用RGPCL，SCL和Ortho-K CL矫正，76．5％矫正视力≥0．8。34只近视、散光眼和5只远视、散光眼，60．0％～61．8％视力低于0．4，利用框架眼镜和各类接触镜矫正，80．0％以上获得良好矫正视力。另有3只眼RK术后因遭撞击致角膜裂伤后形成角膜白斑，均选用加虹膜色彩的接触镜矫正。结论：RK、PRK、LASIK术后视力低下的主要原因是医源性圆锥角膜和高度近视、高度散光。积极选择验配各类适宜的接触镜可显著提高视力，RGPCL最为有效。     

选择性后房型人工晶状体植入前的后环形撕囊术

目的：探讨后囊膜增殖钙化的白内障摘出术后的后囊膜处理技术。方法：对42例(49只眼)后囊膜增殖钙化的白内障患者，于摘除白内障后在后囊膜旁中心处用破囊针头划出起始瓣，沿起始瓣边缘撕开一直径约3～4mm的类圆孔，再植入人工晶状体。结果：全部术眼后囊膜中央均有一透明类圆孔，术后无人工晶状体偏位或眼底异常改变。结论：后房型人工晶状体植入前的后环形撕囊术可使后囊膜增殖钙化的白内障获得视轴透明区，是安全有效地处置后囊膜混浊方法之一。     

晶状体囊袋张力环在预防后囊膜混浊中的应用

后囊膜混浊是白内障摘出联合后房型人工晶状体植入术后导致视力下降的最常见并发症之一 ,而术中植入囊袋张力环可有效地降低后囊膜混浊的发生 ,我们就囊袋张力环在白内障术中的应用及发展情况加以综述