后房型人工晶体手术58例临床分析

后房型人工晶体因其植入位置靠近眼内结点,且具有并发症少,术后视力良好等优点,已被广泛应用于临床。但由于它对手术设     

高度近视白内障人工晶体植入术

对31例(38只眼)眼轴超过26mm的高度近视白内障施行囊外摘出一期后房型人工晶体植入术。经随访,裸眼视力>0.5者占65.8％;近视力>0.5者占86.8％;矫正视力>1.O者占52.6％。结果表明高度近视患行的白内障,若术前测定视网膜视力>0.5者,施行囊外摘出及人工晶体植入术后,获得正常视力是可能的。文中介绍了人工晶体度数的选择和手术方法,并对手术适应证和并发症的处理作了阐述。     

小切口植入折叠式人工晶体的临床观察

目的探讨能够在术后早期迅速恢复视力的白内障术式。方法对三组１３１例老年性白内障分别采用３．５、６．５ｍｍ巩膜隧道和１１ｍｍ角巩缘切口，施行白内障超声乳化摘除及折叠式人工晶体植入术、超声乳化摘除及一体型人工晶体植入术和囊外摘除及一体型人工晶体植入术。结果术后第３天的平均裸眼视力分别为１．０４、０．５１和０．４６，达到正常视力的比例分别为６２．７５％、１２．５０％和８．９３％，前者与后两者比较，差异均有显著性（ｔ检验，Ｐ＜０．０５）。结论采用３．５ｍｍ无缝线切口施行白内障超声乳化摘除及折叠式人工晶体植入术可使术后视力早期恢复     

比较现代囊外摘出术与超声乳化吸出术对老年性白内障血-房水屏障功能的影响

目的 比较老年性白内障现代囊外摘出术与晶状体乳化吸出术两种手术对眼血-房水屏障功能的影响.方法 分别对32例(37眼)老年性白内障行经典的现代囊外摘出(10 mm大切口)联合人工晶状体植入术以及60例(64眼)老年性白内障行超声乳化(3.2 mm透明角膜切口)联合人工晶状体植入术,应用激光蛋白细胞检测仪定量检测手术前后房水蛋白浓度的变化.结果 两组术前房水蛋白浓度差异无统计学意义(P>0.05),而术后各观察时期的房水蛋白浓度.差异均有统计学意义(P<0.05).现代囊外摘出术组术后随访90 d均高于术前,差异均有统计学意义(P<0.05);晶状体超声乳化组术后90 d与术前比较,差异无统计意义(P>0.05).结论 比较白内障现代囊外摘出手术与晶状体超声乳化手术,前一种术式对血一房水屏障损伤较大,且血-房水屏障功能不能在短时间内修复.     

不同丙烯酸材料的人工晶状体对后发性白内障的影响

目的 探讨三种不同的丙烯酸材料的人工晶状体应用于白内障超声乳化吸除联合人工晶状体植入术后对后发性白内障的影响作用.方法 超声乳化白内障吸除联合人工晶状体植入术的960例白内障患者(964只眼),Sensar组310只眼,Acrysof三片组332只眼,Acrysof一片组322只眼,术后定期随访18～28个月,观察视力、后发性白障的发生情况.结果 术后随访24月时,发生1级以上后囊膜混浊SensarIOL组的发生率(13.5%),明显高于Acrysof一片式IOL组及Acrysof三片式IOL组的发生率(7.5%,3.7%).经卡方检验,P值均<0.05,有显著性差异,而Acrysof三片式IOL组后囊膜混浊的发生率较Aerysof 一片式IOL组高,P<0.05.结论 AcrySof丙烯酸式一片式人工晶状体植入后出现后发性白内障的发生率在三组中最低.可以减少后发性白内障的发生降低Nd:YAG激光的使用率,提高手术效果,是现代白内障手术可选择的理想的人工晶状体.     

Comparison of the effects of two types of intraocular lens

Objective To evaluate the effectiveness and safety of implantation of flexible open-loop anterior chamber intraocular lens (FOAC-IOLs) and scleral fixated posterior ch amber intraocular lens (PC-IOLs).Methods Sixty-eight eyes of 68 patients with implanted intraocular lenses in the absenc e of posterior capsular support were reviewed retrospectively. According to the type of i ntraocular lens, patients were classified into two groups. In groupⅠ (30 eyes) , FOAC-IOLs was implanted primarily or secondarily. In group Ⅱ (38 eyes), scl eral fixated PC-IOLs was implanted primarily or secondarily. By gonioscopy and ultrasound biomicroscopy (UBM), accurate positions of IOLs’ haptics and the rel ationship between the haptics and surrounding tissues were observed postoperativ ely and used to evaluate the influence of the two types of IOLs on ocular anteri or segments. Follow-up was 6 to 20 months. Results Best corrected visual acuity of 20/40 or better was achieved in 27 eyes (90.0%) in group Ⅰ, and 35 eyes (92.1%) in group Ⅱ and the difference was not statis tically significant (P&gt;0.05). In group Ⅰ, 23 eyes (76.7%) had a total of 40 complications, while 13 eyes (34.2%) had 19 complications in group Ⅱ (P &lt;0.05). Gonioscopy and ultrasound biomicroscopy showed that in group Ⅰ, all haptics of IOLs contacted with the iris completely and compressed the iris to different degrees, sometimes causing the anterior chamber angles to widen. Ant erior synechia of the iris was caused by the haptics of FOAC-IOLs in 12 eyes. Among the 60 IOLs haptics, 39 foot plates of the haptics were properly fixed at the ciliary band; 21 haptics (12 eyes) penetrated through the iris into the str oma of the ciliary body with accompanying recurrent uveitis. In group Ⅱ, amon g the 76 IOLs haptics, 52 were adequately fixed in the ciliary sulcus regions, a nd 8 (8 eyes) were placed below the iris, causing goniosynechia. This type of angle closure was localized, with an open angle on each side of the haptics. T he remaining 16 haptics were fixed onto the ciliary crown.Conclusions The current sutured mode of scleral fixated PC-IOLs can not ensure that IOLs ha ptics are placed in the ciliary sulcus. The haptics of FOAC-IOLs compress the iris and may penetrate through the iris into the stroma of the ciliary body. Th is can cause peripheral iris anterior synechia and chronic recurrent uveitis. T he implantation of scleral fixated PC-IOLs is safer and shows better effects th an that of FOAC-IOLs.     

透明角膜小切口无缝合切除先天性瞳孔残膜

目的：探讨治疗严重的先天性瞳孔残膜的新途径。方法：4例（6眼）通过颞侧透明角膜隧道切口、前房注入粘弹剂后,将瞳孔残膜紧贴虹膜附着处剪断。结果：术后无一例高眼压及前房出血,随访1年以上,3例（4眼）晶状体保持透明。术后有0．12－0．25D角膜散光,角膜内皮细胞少量丢失。结论：通过颞侧透明角膜隧道切口切除先天性瞳孔残膜,术后并发症少,散光小,病人恢复快,是治疗严重瞳孔残膜的理想手术方法。眼科学报2001;17：76－77。     

晶体囊袋内应用丝裂霉素防治兔后发性白内障的实验研究

目的：探索晶体囊代内灌注丝裂霉素对兔晶体上皮细胞的抑制作用及对兔眼的毒性作用。方法：在兔晶状体超声乳化吸出术中,用0．2ml不同浓度的丝裂霉素（Mitomycin C,MMC)(0.1mg/ml、0.2mg/ml、0.4mg/ml）在晶体囊代内进行水分离,使其直接短暂作用于晶体上皮细胞。术后随访2个月,观察比较用药组和对照组兔晶体后囊混浊、眼内压的变化等;并观察术后组织病理学和超微结构的变化。结果：临床观察显示,术后2周只有对照眼出现后囊膜混浊（posterior capsule opacification,PCO)。术后4周用药组眼的PCO明显比对照组眼轻,且随药物浓度增高而减轻。中、低浓度组兔眼的术后炎症反应与对照组眼比较无明显差异。高浓度组兔眼术后早期出现轻微的毒性反应。组织,病理学检查表明,对照组的晶体上皮增生较用药组明显。MMC可引起晶体上皮细胞变性,其变化程度与药物浓度有关。高浓度眼睫状体有炎症细胞浸润及少量出血。结论：MMC有效地抑制晶体上皮细胞的增殖,其作用强度与药物的浓度相关。兔晶体囊贷内应用0．1－0．2mg/ml的药物浓度是防治后发性白内障安全有效的药物。     

玻璃体超微结构与玻璃体液化

玻璃体是眼球的主要组成部分,玻璃体液化在许多眼病的发病机制中起重要作用,但有关玻璃体的超微结构及玻璃体液化的机制知之甚少。了解玻璃体的结构组成,不仅能理解疾病的发病过程,而且有助于疾病的治疗。本就近年来在此方面的研究进展综述。     

白星系统对双手微切口超声乳化术切口温度影响的实验研究

目的:研究白星系统在双手微切口超声乳化术中对切口温度的影响,在切口安全性方面与常规术式进行对比。方法:将60只猪眼平均分为4组,用夹闭抽吸液流的方式模仿乳化针头堵塞状态,4组分别在堵塞状态和非堵塞状态下用开启堵塞模式的白星系统行双手微切口超声乳化术和常规超声乳化术,用K型热电偶接触性数字测温仪测定脚踏进入3档位累计时间达30、60、90和120s时的切口温度。结果:无论乳化针头处于堵塞还是非堵塞状态,双手微切口术式在各测量时间点上的切口温度皆保持于21.0～30.7℃范围内,均低于常规术式,在保持抽吸液流的情况下组间差异具有统计学意义(P<0.05),在模拟堵塞状态下组间具有显著性统计学差异(P<0.01)。结论:应用白星系统的双手微切口超声乳化术具有较常规超声乳化术更高的切口安全性。