青光眼减压阀植入治疗无晶体眼和人工晶体眼青光眼的疗效

目的 :评价青光眼减压阀植入术治疗无晶体眼和人工晶体眼青光眼的疗效 ,探讨术后并发症和预防措施。方法 :回顾性分析19例 ( 2 0眼 )无晶体眼和人工晶体眼青光眼患者行青光眼减压阀植入术。其中 13眼行 Ahmed减压阀植入 ,7眼行 Krupin减压阀。结果 :术后一周平均眼压 1.93± 0 .69k Pa,95 %术眼眼压控制正常。平均随访 18.9± 6.9月的 14只术眼平均眼压 2 .4 0± 0 .4 7k Pa,64 .3 %术眼眼压控制正常。术后常见并发症有前房导管口阻塞、导管接触角膜、前房积血、低眼压等。结论 :青光眼减压阀植入术是治疗无晶体眼和人工晶体眼青光眼的较为有效的方法 ,但仍存在一定的并发症     

Pathology of intraocular lenses in 33 eyes examined postmortem

Thirty-three pseudophakic eyes from 29 patients were examined postmortem. Clinically, 25 of the eyes had had visual acuities of 20/50 or better. In general the intraocular lenses (IOLs) were quite well tolerated. Iris atrophy and erosion were prominent features of eyes containing an anterior chamber, iris fixation, or iridocapsular lens. Angle recession and ciliary-body erosion were found in some eyes with anterior chamber lenses. Ciliary-body erosion by haptics was seen with posterior chamber lenses. Pupillary membranes were present in eight eyes. Granulomatous reaction to IOL material was present in 13 eyes. Usually this was localized to the site of the lens haptic, and was consistent with good visual acuity. One eye with a posterior chamber lens had been successfully treated for Staphylococcus epidermidis endophthalmitis after capsulotomy, shortly before death. Central corneal endothelial cell loss seemed to be of similar amount for the anterior chamber, iris fixation, and iridocapsular lenses, but was less severe in eyes with posterior chamber lenses. Cystoid macular edema was present in five eyes, retinal phlebitis in two eyes, and retinal detachments in four eyes.     

Retinal Detachments Following Intraocular Lens Implantation

Pseudophakic retinal detachments are more difficult to manage than the phakic variety, primarily because of increased difficulties in visualizing the peripheral retina. A review of the characteristics of 70 pseudophakic retinal detachments revealed that they were similar to those following routine cataract extraction, although we noted a mild tendency for periretinal membrane formation to be more commonly associated with the former group. Despite problems in viewing pseudophakic detachments, our data suggest that their repair rate closely approximates that for aphakic eyes, assuming allowances are made for the number of cases with significant peri retinal membranes that are accepted for surgery. Visual results following successful surgery may be somewhat lower than those in comparable aphakic eyes.     

Chromatopsia

More than half of the cases with complaints of chromatopsia had recent-onset retinal pathology. Erythropsia due to bright (sun-)light is a relatively common finding in aphakia and pseudophakia. UV-coated intraocular lenses do not provide complete protection. Cerebrovascular chromatopsia usually occurs in transient attacks.     

小梁和巩膜切除术联合睫状体上腔引流治疗无晶状体和人工晶状体青光眼

目的探讨联合睫状体上腔引流的小梁和巩膜切除（LSEVDS）治疗无晶状体和人工晶状体眼青光眼的效果。方法采用回顾性方法观察103例（109眼）无晶状体和人工晶状体眼的青光眼患者。26例（26眼）无晶状体眼和34例（36眼）人工晶状体眼患者行LSEVDS，另外19例（20眼）无晶状体眼和24例（27眼）人工晶状体眼患者行传统小梁切除术。平均随访12．6个月，比较了术后视力、眼压（IOP）、视野、前房深度、滤过泡形态、脉络膜脱离、前房出血等情况。结果术后12个月，LSEVDS使无晶状体眼和人工晶状体眼的眼压明显下降，降眼压效果比小梁切除术更显著，其差异有统计学意义（P〈0．05）。LSEVDS的并发症包括前房积血（11．2％）、脉络膜脱离（6．5％）、低眼压（19．2％）和浅前房（11．2％），均于2周内好转。术后患者视力的变化无统计学意义。结论在治疗无晶状体和人工晶状体眼青光眼方面，LSEVDS的效果优于传统小梁切除术。     

Characteristics of rhegmatogenous retinal detachment in pseudophakic and phakic eyes

AimsTo investigate whether pseudophakic and phakic rhegmatogenous retinal detachment (RRD) patterns differ.MethodsRetrospective review of electronic database of patients, aged 50 years or over, presenting to our vitreoretinal service. Data included baseline characteristics, digital drawings, and outcomes. Retinal drawings were analysed in a masked fashion for site, size, and number of retinal breaks. Comparisons were made between the following groups and subgroups: pseudophakic eyes, phakic eyes, phakic eyes with cataract, and phakic eyes without cataract.ResultsOf 500 eyes included, 146 were pseudophakic; 177 of the phakic eyes had cataract. The following were significant by univariate analysis: pseudophakic patients were older than phakic patients in general, but the same age as patients with cataract; in the pseudophakic group, there were lower proportions of females and of patients presenting with vitreous haemorrhage or with large or superotemporal breaks; higher proportions of pseudophakic eyes had small breaks and inferonasal breaks. Some differences remained significant when comparing pseudophakia eyes with cataract. Multivariate analysis comparing pseudophakia with phakia confirmed a lower chance in pseudophakia of large breaks, vitreous haemorrhage and superotemporal breaks, but higher chance of detached inferior breaks. Some variables were age dependent.ConclusionDifferences were found between pseudophakic and phakic RRD patterns. These suggest special pathogenetic mechanisms in pseudophakic retinal detachment, which could help explain increased incidences of RRD after cataract surgery.     

Effect of pilocarpine in treatment of intraocular pressure elevation following neodymium: YAG laser posterior capsulotomy

A prospective study was conducted in 30 eyes of 30 patients to determine if pilocarpine would prevent increased intraocular pressure following Q-switched neodymium (Nd):YAG laser posterior capsulotomy. Fifteen eyes were given pilocarpine 4%, immediately following laser therapy and every hour until bedtime. Fifteen eyes served as untreated controls. Our results show that without prophylactic therapy, 10 of 15 eyes (67%) had a post-laser intraocular pressure (IOP) elevation of greater than 10 mmHg, while only one of 15 (6.6%) of the pilocarpine-treated eyes had a rise of that magnitude. The facility of outflow was reduced by 42% in the untreated eyes in contrast to an increase of 3% in those eyes treated with pilocarpine. Thus, pilocarpine 4% is effective in reducing the incidence and magnitude of elevated IOP following Nd:YAG posterior capsulotomy.     

Distance vision after bilateral implantation of AcrySof toric intraocular lenses: a randomized, controlled, prospective trial

AIM: To evaluate the distance vision of Chinese patients with cataracts and corneal astigmatism after implantation of bilateral AcrySof toric intraocular lens (IOL) versus bilateral AcrySof spherical IOL. METHODS: This study randomized 60 patients into equal groups to receive toric IOL or spherical IOL. IOL powers targeting emmetropia were selected for 93% of toric IOL patients and for 90% of spherical IOL patients. Assessments included monocular and binocular distance vision, with and without best correction. Patients also completed surveys about their distance vision. RESULTS: Preoperatively, the two study groups were similar in age, in distance visual acuity, and in the magnitude of corneal astigmatism. At 6 months postoperative, binocular uncorrected distance vision was 0.06±0.14 logMAR in the AcrySof toric IOL group, significantly better than the 0.14±0.11 logMAR in the spherical IOL group (P<0.05). For eyes with emmetropia as a target, the equivalent of 20/20 uncorrected vision was more likely (P<0.001) in the toric IOL group (36% of eyes) than in the spherical IOL group (4% of eyes). No patients in the emmetropia/toric IOL group used distance glasses, as compared to 52% of patients in the emmetropia/spherical IOL group. All patients were satisfied or highly satisfied. Quality of distance vision was rated higher by toric IOL patients than by spherical IOL patients (P<0.05). CONCLUSION: Bilateral AcrySof toric IOL is superior to bilateral spherical IOL in providing uncorrected distance vision to cataract patients with corneal astigmatism.