白内障超声乳化术后后囊膜混浊的多因素分析

目的 研究白内障超声乳化术后后囊膜混浊(PCO)的相关因素。方法 采用多因素logistic回归分析方法对可能引起PCO的诸多因素进行分析。结果 在120例经6～24个月临床随访的患者中，发现与PCO相关的因素是年龄、术后第1天前房反应和IOL类型，其它因素包括病人性别、核硬度、白内障类型、粘弹剂与PCO无关。结论 患者手术年龄越大、术后第1天前房反应越轻及选用丙烯酸酯类折叠式IOL有助于减少PCO的发生率。     

Acrysof与Centerflex折叠一片式人工晶状体植入术临床观察

目的 观察美国Acrysof与英国Centerflex折叠一片式人工晶状体在白内障超声乳化手术植入后的临床效果。方法随机选择132例老年性白内障患者行白内障超声乳化手术，术中62例(62只眼)植入美国Acrysof折叠一片式人工晶状体，70例(70只眼)植入英国Centerflex折叠一片式人工晶状体，观察术中植人情况、人工晶状体的位置及稳定性和术后角膜反应、前房反应、术后视力、角膜内皮细胞密度、后囊膜增生情况等，随访时间3个月。结果两种人工晶状体植入术后矫正视力均良好，眼内反应轻，晶状体植入囊袋内位置稳定，未见明显后囊膜混浊及增生，角膜内皮细胞密度术后与术前比较均无显著差异。结论美国Acrysof与英国Centerflex折叠一片式人工晶状体在白内障超声乳化手术后植入效果满意，值得临床推广应用。     

白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除的临床观察

目的探讨白内障超声乳化吸除联合人工晶状体植入术中Ⅰ期后囊膜连续环形撕除的临床疗效。方法对53例(60只眼)先天性白内障和后囊混浊的老年性白内障,施行白内障超声乳化吸除联合人工晶状体植入,同时行Ⅰ期后囊膜连续环形撕除,术后观察眼压、人工晶状体位置、视轴区后发障等情况。结果术中人工晶状体均顺利植入囊袋;54只眼术后视力较术前提高,术后24小时后眼压正常;术后随访3个月~2年,无发生玻璃体疝入前房,未发现人工晶状体异位或夹持,无一例出现后发障、视网膜脱离。结论白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除是可行、安全的,能有效地治疗后囊膜混浊,预防后发障。     

亲水性丙烯酸酯折叠人工晶状体在白内障超声乳化吸除术中的应用

目的:观察亲水性丙烯酸酯ACR6D SE折叠人工晶状体在白内障超声乳化手术中的应用效果.方法:对145例(204眼)白内障患者行超声乳化白内障吸除及ACR6D SE人工晶状体植入术,观察术中术后并发症、术后视力,术后随访时间≥3mo.结果:术中术后并发症为后囊膜破裂1眼(0.5%),人工晶状体脱位2眼(1.0%),角膜水肿12眼(5.9%),后囊膜混浊4眼(2.0%),术后眼压升高1眼(0.5%),前房渗出3眼(1.5%).结论:ACR6D SE人工晶状体能较好的提高视力;术后反应轻,并发症少.     

不同材料的人工晶状体植入术后的临床疗效观察

目的　评价超声乳化白内障吸出联合不同材料制成的人工晶状体植入术治疗白内障的疗效。方法　将 14 5例(14 8眼 )行超声乳化白内障吸出联合人工晶状体植入术的患者分为 3组 ,术中随机植入PMMA人工晶状体、新型疏水性丙烯酸酯类、硅凝胶类折叠式人工晶状体。比较术前和术后视力、散光情况。统计术后晶状体后囊膜混浊情况及行Nd :YAG激光后囊膜切除术的情况。结果　术后早期视力、3个月后散光度数、晶状体后囊膜混浊发生率及行Nd :YAG激光后囊膜切除术的情况 ,植入折叠式人工晶状体者均优于植入非折叠式人工晶状体者。植入Canonstaar硅凝胶类折叠式人工晶状体组术后散光最小。植入AcrysofTM新型疏水性丙烯酸酯类折叠式人工晶状体组术后晶状体后囊膜混浊发生率及行Nd :YAG激光后囊膜切除术的比例最低。结论　超声乳化白内障吸出联合折叠式人工晶状体植入的临床应用效果满意。     

白内障超声乳化术后并发症的预防和处理

目的：探讨白内障超声乳化术后并发症的预防和处理措施。方法：对1010例（1136只眼）老年性、先天性、并发性和外伤性白内障患者进行超声乳化及人工晶状体植入术。术后随访3-52月。结果：术后并发症包括角膜水肿、前房纤维素性渗出及后囊膜混浊等。结论：并发症发生与超声乳化本身的损害因素、术者的操作技术及经验密切相关，术前应了解发生并发症的原因及症状，以便预防和处理。     

双撕囊联合干性前部玻璃体切割治疗先天性白内障临床观察

目的：探讨先天性白内障超声乳化吸除联合干性前部玻璃体切割术预防后发性白内障的效果。 方法：对先天性白内障患者18例32眼采用超声乳化白内障吸除、环形撕除晶状体前后囊膜联合干性前部玻璃体切割术,其中10例16眼一期囊袋内植入折叠式人工晶状体。术后观察角膜、前房炎性反应和后囊膜透亮程度,随访6～24（平均15） mo。 结果：术后所有患者角膜清亮,前房反应轻微,大部分瞳孔圆形,视轴区清亮。3眼后囊膜切开区薄纱样混浊,4眼瞳孔轻度上移,3眼部分虹膜后粘连。 结论：干性前部玻璃体切割术可有效降低儿童后发性白内障发生率,维持视轴清亮,有助于患儿视功能恢复,是一种安全有效的手术方法。     

Sensar人工晶状体植入术后的临床观察

目的观察和评估白内障超声乳化植入Sensar人工晶状体的临床效果。方法对92例（106只眼）年龄相关性白内障,应用表面麻醉颞侧透明角膜切口,行白内障超声乳化吸除联合Sensar人工晶状体植入术。观察术后视力、术后眩光、人工晶状体在晶状体囊袋内的位置及后囊膜的混浊等的变化。结果术后观察12～28个月,平均19.4个月,最佳矫正视力≥0.5者达100%,≥1.0者67眼（占63.21%）,患者在日常生活中无视物不适,无眩光,人工晶状体居后囊中央,与后囊膜紧贴,后囊膜平展,Ⅰ级后囊膜混浊95眼（89.62%）,Ⅱ级后囊膜混浊9眼（8.49%）,Ⅲ级后囊膜混浊2眼（1.89%）。结论Sensar人工晶状体植入术后视物舒适,能减少眩光,能减少后发性白内障。     

糖尿病患者白内障超声乳化吸出人工晶状体植入疗效分析

目的:探讨糖尿病患者白内障超声乳化吸出(phaco)及人工晶状体(IOL)植入的手术效果。方法:对46例(56眼)糖尿病患者行白内障超声乳化吸出人工晶状体植入术,观察术中、术后并发症及术后视力的情况。结果:术后视力≥0.5者46眼(82.1%),术后并发症:角膜内皮水肿、前房纤维渗出、人工晶状体表面色素沉着、后囊膜混浊,与同期非糖尿病患者比较差异无显著性。结论:对于糖尿病患者只要术前血糖控制在相对稳定的水平上进行白内障超声乳化吸出及人工晶状体植入术疗效是安全有效的,术后并发症少,视力恢复好。     

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。     

Corneal thickness changes following cataract surgery: effect of lens implantation and sodium hyaluronate.

Consecutive patients undergoing intracapsular cataract surgery with and without lens implantation were included in one of three groups of fifteen patients for postoperative corneal thickness measurement. One group underwent cataract extraction alone, another group had cataract extraction and lens implantation using iris supported posterior chamber implants, and another group underwent lens implantation with the use of sodium hyaluronate to reform the anterior chamber after cataract extraction. Maximal increase in corneal thickness occurred within the first 24 hours of surgery in all groups. No significant difference in corneal thickness between the implant and non-implant group was found at any time. When sodium hyaluronate was used to reform the anterior chamber prior to lens implantation the increase in corneal thickness was significantly less than in the group not on sodium hyaluronate (0.01 less than p less than 0.02 on the third postoperative day). In the long term all patients' corneas returned to preoperative levels within 28 days of surgery.     

When may the posterior capsule be preserved in pediatric intraocular lens surgery?

PURPOSE: To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. DESIGN: Noncomparative case series. PARTICIPANTS: Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. METHODS: Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. MAIN OUTCOME MEASURES: Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. RESULTS: PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. CONCLUSIONS: PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.     

超声乳化术中前囊膜抛光预防后囊膜混浊的临床研究

目的探讨在白内障超声乳化术中行前囊膜抛光处理减少后发障发生的有效性和安全性.方法178例(235只眼)白内障患者在施行白内障超声乳化吸除及人工晶状体植入术中进行前囊膜抛光,术后对其视力、眼前节反应及后囊膜情况进行临床观察,随访1个月～1年,选择同期未行前囊膜抛光者220例(230只眼),作为对照组进行比较.结果(1)术中无并发症发生;(2)术后视力恢复快而良好;(3)术后后囊膜混浊发生8只眼(3.5%),均为轻度纤维型混浊,对视力无显著影响,而对照组术后后囊膜混浊发生23只眼(10.2%).对照组显著高于抛光组(P＜0.05).结论白内障超声乳化术中行前囊膜抛光处理可以减少术后后囊膜混浊的发生.作用机制可能是前囊膜抛光可大幅度地减少残留于前囊下的晶状体上皮细胞数量,阻止了上皮细胞的增殖及化生的来源,从而起到防止后囊膜混浊发生的作用.     

Toxic anterior segment inflammation following cataract surgery.

Cataract extraction with posterior chamber intraocular lens implantation is rarely complicated by an acute, sterile, anterior segment inflammation. We report three unrelated cases of acute intraocular inflammation following uncomplicated cataract extraction and posterior chamber intraocular lens placement. A constellation of clinical features were found in these cases. The hallmark of this entity was an acute toxic inflammatory reaction occurring in the anterior segment on the first postoperative day. Typically, widespread corneal edema with diffuse corneal endothelial damage occurred, accompanied by a fixed, dilated pupil with significant iris atrophy and sometimes a severe secondary glaucoma. Since all cultures were negative, the resulting inflammatory processes were not a result of endophthalmitis. We believe that a toxic insult introduced into the anterior chamber at the time of surgery precipitated the acute inflammatory processes seen in these cases.     

青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效

目的　评价青光眼滤过术后白内障患者行超声乳化联合人工晶状体植入术毕前房注射地塞米松的临床疗效。方法　选取青光眼滤过术后白内障患者９８例（１２０眼）,由同一医师进行白内障超声乳化联合人工晶状体植入术。所有患者随机分组,对照组４８例（６０眼）术毕给予地塞米松注射液０．５ｍＬ（２．５ｍｇ）球结膜下注射;试验组５０例（６０眼）术毕前房内注射０．１ｍＬ（０．５ｍｇ）地塞米松注射液。观察并比较两组患者手术后最佳矫正视力、前房反应、眼压、角膜内皮细胞计数、六角形细胞比率的差异。结果　青光眼滤过术后白内障超声乳化联合人工晶状体植入术后１ｄ、３ｄ最佳矫正视力试验组比对照组效果更好,２组比较差异有统计学意义（Ｐ＜０．０５）,术后１周最佳矫正视力两组间差异无统计学意义（Ｐ＞０．０５）;对照组与试验组术前,术后１ｄ、３ｄ、１周、１个月、３个月眼压组间比较差异均无统计学意义（均为Ｐ＞０．０５）;对照组与试验组术后１ｄ、３ｄ、１周前房炎症反应组间差异有统计学意义（均为Ｐ＜０．０５）,试验组眼前房炎症反应较轻;对照组与试验组术后３ｄ、１周、１个月角膜内皮细胞密度、六角形细胞百分比及变异系数组间比较差异均有统计学意义（均为Ｐ＜０．０５）,对照组较试验组术后细胞密度明显降低,六角形细胞百分比下降,变异系数增高。结论　青光眼滤过术后白内障超声乳化联合人工晶状体植入术毕前房注射地塞米松注射液是安全有效的,对术后短期内获得最佳矫正视力、减轻前房反应、减少角膜内皮细胞的丢失具有积极的临床意义。     

A prospective comparison of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in cataract and intraocular lens implant surgery

We performed a prospective randomized clinical trial of 4% polyacrylamide (Orcolon) and 1% sodium hyaluronate (Healon) in routine extracapsular cataract extraction with posterior chamber lens implantation or in secondary anterior chamber lens implantation. Seventy consecutive patients were enrolled. The viscoelastic agents were compared in four areas intraoperatively: ease of injection, ease of removal, clarity of field and ability to hold back ocular tissues. Healon was significantly superior to Orcolon in all four areas. Further evaluations were performed on the first day and at 2 weeks postoperatively. Measurements of intraocular pressure (IOP) by Goldmann applanation and evaluations of corneal edema, epithelial keratitis and anterior chamber cellular reaction were recorded. Multivariable statistical analysis revealed only one difference between the two groups: significantly more patients in the Orcolon group (eight cases) than in the Healon group (two cases) had an IOP of 21 mm Hg or greater on the first postoperative day.     

葡萄膜炎并发白内障术后前房注射地塞米松的疗效观察

目的:探索白内障摘除术后前房注射0.1mL地塞米松对葡萄膜炎并发白内障患者术后的影响。方法:试验组术后前房注射0.1mL地塞米松,对照组前房未注射地塞米松,观察两组术后炎症反应。结果:术后前2d两组患者视力间差别有统计学意义(P<0.05),术后第1d角膜水肿程度两组间有统计学差异(P<0.05),前房闪辉差异有统计学意义(P<0.05),且试验组术后患者视力提高者百分比高于对照组。结论:葡萄膜炎并发白内障患者行白内障超声乳化+人工晶状体植入术,术毕前房注射0.1mL地塞米松者可减轻短期术后炎症反应,可更早提高患者视力,对患者术后短期眼压未见明显影响。     

糖尿病患者白内障术后的急性前房反应

目的:探讨糖尿病患者白内障术后急性前房反应的发病机制及影响因素。方法:回顾性分析并总结我院14例15眼糖尿病患者白内障超声乳化联合人工晶状体植入术后出现急性前房反应的临床资料及随访结果。结果:部分患者在术后第1d即出现明显的急性前房反应,表现为不同程度的房水闪辉、色素播散,严重者后期可出现人工晶状体前膜及虹膜后粘连。术后经局部应用散瞳、皮质类固醇以及全身应用抗生素药物治疗后,前房反应改善,视力出现不同程度的提高,无其他严重并发症。在伴有糖尿病视网膜病变(diabeticretinopathy,DR)的患者中病程明显冗长。随访发现术后1a视力稳定在0.5以上者11眼(73%)。结论:糖尿病患者白内障术后出现急性前房反应与其身体状况的特殊异质性有关。对此类患者施行手术需要严格进行术前准备,控制和稳定血糖水平,选用生物相容性强的如肝素化人工晶状体或低创性的可折叠人工晶状体,皆可降低急性前房反应的发生率。术后的积极处理可望取得良好的手术效果。     

晶状体超声乳化吸除及人工晶状体植入术对闭角型青光眼眼压及前房深度的影响

目的评价品状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，治疗合并有自内障的闭角型青光眼，观察其术后眼压、前房深度及视力等的变化。方法回顾分析27例（30只眼）闭角型青光眼合并白内障患者。经综合降眼压治疗3～4d，眼压低于25mmHg者21只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入术，眼压高于25mmHg者9只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入联合抗代谢药物及小梁切除术。随访3—6个月。结果所有患者术中、术后没有出现严重的并发症，术后视力均有提高，术后眼压都得到控制。平均眼压由术前的20．28mmHg降至11．07mmHg；中央前房深度由术前的2．14mm加深到3．43mm。术后眼压、中央前房深度与术前相比均有显著性差异。术后前房角开放均≥180°。结论晶状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，是治疗合并有白内障的闭角型青光眼的有效方法。     

Application of sustained delivery microsphere of cyclosporine A for preventing posterior capsular opacification in rabbits

AIM: To explore the inhibitory effect of a sustained cyclosporin A (CsA) delivery microsphere (CsA-MS) on posterior capsular opacification (PCO) in rabbit eyes after cataract extraction.METHODS: Twenty New Zealand white rabbits accepted cataract extraction plus intraocular lens implantation and their left eyes were intraoperatively injected CsA-MS prepared using polymer polylactioglycolic acid (PLGA) as a carrier and their right eyes were injected with empty MS. The changes in cornea, anterior chamber reaction, intraocular pressure, PCO and CsA concentration in aqueous humor were examined postoperatively and all the eyes were enucleated 3 months after surgery for histopathological and morphological examination with light microscopy and electron microscopy.RESULTS:Conjunctival hyperemia, corneal edema, intraocular pressure and anterior chamber response of experimental and control eyes were similar, while PCO in CsA-MS injected eyes was greatly improved compared with that in control eyes. Posterior capsules in CsA-MS injected eyes were smooth and lens epithelial cells (LEC) did not proliferate significantly (P>0.05), while LEC in posterior capsule of control eyes had different degrees of proliferation and cortical regeneration. LEC in CsA-MS injected eyes were not functionally active and underwent apoptosis, whereas LEC in control eyes were functionally active (F-test, P=0.025). In addition, the corneal ultrastructure showed no differences between CsA-MS and MS injected eyes.CONCLUSION: CsA-MS has high bioavailability in rabbit eyes and could inhibit postoperative PCO occurrence and development during the study period, suggesting that CsA-MS may be a promising, effective and safe administration route to prevent PCO in clinic.