保留晶状体前囊减少硅油并发症的临床观察

目的观察保留晶状体前囊对硅油眼并发症的影响。方法82只眼行 玻璃体切割联合晶状体切除手术,其中30只眼术中保留完整晶状体前囊,52只眼未保留前囊 ,随访观察硅油并发症的发生情况。结果有前囊组硅油并发症的发生率为23.3%、无前囊组为50.0%(0.010

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保留晶状体前囊的晶状体玻璃体视网膜联合手术

目的 回顾性比较保留晶状体前囊与否对晶状体玻璃体视网膜联合手术的疗效及术后并发症的影响。方法 将过去两年中的晶状体玻璃体视网膜联合硅油填充手术１０２例分为保留主体前囊组和未保留晶状体前囊组,比较二者的疗效及术后并发症的情况。结果 术后随访１－２个月,保留昌状体前囊组：视网膜完全复位者３２只眼,高眼压者３只眼,晶状体前囊透明者３５只眼;     

玻璃体切割术中保留前囊膜的临床疗效观察

目的: 评价玻璃体手术中保留前囊膜的临床效果。方法: 选取 2004- 02/2005- 02 在我院行保留前囊膜的玻璃体晶状体联合切割手术患者 15 例, 其中巨大裂孔源性视网膜脱离患者 4 例, 糖尿病性视网膜病变(Ⅵ期)患者 2 例, 裂孔源性视网膜脱离患者 9 例(复发性裂孔原性视网膜脱离患者 3 例)PVR分级均在 C级以上。眼内注气者 6 例, 硅油填充者 9 例。追踪观察至少3mo, 根据其手术前后的视力及并发症对手术效果做出评价。结果: 所有患者术后视力都高于术前或与术前相等, 平均视力提高 3±3 行。有 8 例患者在术后 2mo 成功植入后房型人工晶状体( PCIOL) , 其中 2 例为硅油取出的同时植入, 另外 6 例为眼内注气患者。术后随访期间未发现角膜失代偿、瞳孔阻滞和视网膜再次脱离等并发症。结论: 完整保留前囊膜可以避免复杂性视网膜脱离患者在玻璃体联合晶状体切割术中和术后由于眼内注气或硅油填充而产生的并发症, 并有利于 PCIOL的植入,保留了虹膜的正常形态, 是一种理想的手术方式。     

Preservation of anterior capsule during vitrectomy and lensectomy for retinal detachment with proliferative vitreoretinopathy

PURPOSE: To report a series of 15 eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy (PVR) or at high risk for advanced PVR, which underwent pars plana vitrectomy (PPV) and lensectomy (PPL) with preservation of the anterior capsule. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifteen consecutive patients with retinal detachment and varying degrees of PVR in one eye. METHODS: All eyes had undergone PPV and PPL with preservation and polishing of the anterior capsule and had at least 6 months of follow-up. Of the 15 eyes, grade C PVR was present preoperatively in 11 and was anterior in 5. Seven of 15 eyes had gas and 8 of 15 had silicone oil tamponade. Eight of 15 eyes had subsequent posterior chamber intraocular lens (PCIOL) placement; 5 eyes had simultaneous silicone oil removal. One eye had a PCIOL placed at the time of the PPL. MAIN OUTCOME MEASURES: Visual acuity, retinal reattachment, complications of gas or silicone oil tamponade, and anterior capsular clarity. RESULTS: Fourteen eyes had complete retinal reattachment at the final visit (1 of 15 had macular redetachment only). Final visual acuity was better or equal to preoperative acuity in all eyes, improving by 4 +/- 4 lines overall. No eyes had corneal decompensation, pupillary block, or other vision-threatening anterior segment complication. The anterior capsule remained centrally clear in the 13 eyes that did not have a primary central capsulotomy. One eye with minimal preoperative PVR developed hypotony. CONCLUSIONS: Vitreoretinal surgeons can preserve the anterior capsule in eyes with retinal detachment and PVR to help prevent intraoperative and postoperative complications of gas or silicone oil, simplify future PCIOL placement, and maintain a normal iris appearance.     

玻璃体切除治疗增生性糖尿病视网膜病变保留晶状体前囊膜的临床观察

目的 探讨保留晶状体前囊膜技术在增生性糖尿病视网膜病变(PDR)手术治疗中的临床效果.方法 系列病例研究.对伴有晶状体混浊和累及眼底后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离的51例(58只眼)PDR患者,在行玻璃体切除手术中,采用经睫状体平坦部切除或超声粉碎吸出晶状体核及皮质并保留前囊膜的技术,处理混浊的晶状体,完成玻璃体手术后给予硅油充填.术后对晶状体前囊膜照相,并对其透明度进行分级评价,对与手术相关的并发症及其处理方法、患者视力和眼压、视网膜复位情况进行分析.结果 玻璃体切除硅油充填并保留晶状体前囊膜的58只眼中,晶状体前囊膜透明度:A级26只眼(44.8%),B级20只眼(34.5%),C级7只眼(12.1%);D级5只眼(8.6%).46只眼(79.3%)术后最佳矫正视力≥0.05,21只眼接受二期人工晶状体植入术.最终7只眼因视网膜不能复位,黄斑裂孔未闭合,而未行硅油取出术.手术并发症:误切虹膜1只眼,硅油进入前房7只眼,虹膜新生血管形成及新生血管性青光眼各1只眼,术后高眼压4只眼,继发性黄斑和视网膜前膜11只眼,黄斑裂孔2只眼.结论 保留晶状体前囊膜,酌情行二期人工晶状体植入术,是处理严重PVR眼的一种较好方法.晶状体上皮细胞残留和积血的长期存在是晶状体前囊膜混浊的主要原因,硅油进入前房是玻璃体切除术中应用保留晶状体前囊膜技术的主要并发症之一.     

晶状体玻璃体切除联合硅油填充术中晶状体囊的处理

目的探讨晶状体玻璃体切除联合眼内硅油填充术中保留前囊或后囊的作用。方法用晶状体玻璃体切除联合硅油填充治疗30例30眼伴增生性玻璃体视网膜病变的视网膜脱离患者，根据白内障手术方式不同分2组。保留后囊组：13眼术前检查为非外伤性白内障行超声乳化吸出保留后囊；保留前囊组：17眼采用经睫状体平坦部晶状体切除，并保留前囊。8眼行二期后房型人工晶状体植入。结果保留后囊组：13眼均保留了完整的晶状体后囊；保留前囊组：17眼中除3眼原有晶状体前囊小破口外，14眼保留了完整的晶状体前囊。术后随访6～24月，平均9月，无1眼发生角膜变性，近期一过性高眼压3眼，8眼二期后房型人工晶状体植入位置良好。结论晶状体玻璃体切除联合硅油填充术中保留前囊或后囊可减少角膜变性、继发青光眼的发生率，并有利于二期后房型人工晶状体植入。[眼科新进展2005；25（5）：442—443]     

Silicone Oil Tamponade Combined with Lensectomy Preserving Anterior Lens Capsule

Purpose: To investigate the therapeutic effect and indication of silicone oil tamponade combined with lensectomy preserving anterior lens capsule.Methods: Silicone oil tamponade combined with lensectomy preserving anterior lens capsule was performed in 33 cases (33 eyes) of high myopia, proliferative vit-roretinopathy (PVR) D grade and giant retinal tear (CRT). 10 cases were only eye and 11 cases had harder nucleus of lens. The surgical methods included: 1. smashing lens nucleus and lensectomy preserving complete anterior capsule; 2. vitrectomy and membrane peeling; 3. usage of liquid perfluorocarbin or retinotomy for drainage; 4. silicone oil tamponade; 5. postoperative Nd; YAG laser for anterior capsulectomy. Results: Follow-up time was 6 months or more in 29 cases. Total retinal reattachment was achieved in 22 cases, macular retinal reattachment in 5 cases. The visual acuity was 20/800 to 20/200 in 13 cases, 20/100 to 20/50 in 12 cases. Visual acuity was significantly improved in GRT group (P < 0. 05     

不同晶状体状态的硅油眼行Ahmed阀植入术的有效性及安全性

目的 探讨不同晶状体状态下Ahmed阀植入治疗硅油充填术后继发性青光眼的有效性及安全性。设计回顾性病例系列。研究对象2015年6月至2021年12月山东中医药大学附属眼科医院玻璃体切除联合硅油充填术后继发性青光眼Ahmed阀植入患者62例（62眼）。方法回顾患者术前及术后3个月的病历资料。分为有晶状体眼组26例（26眼）、人工晶状体（introcular lens,IOL）眼组16例（16眼）、无晶状体眼组20例（20眼）。手术成功定义为术后使用或不使用抗青光眼药物情况下眼压6～21 mmHg、无严重并发症、不需实施其他抗青光眼手术。主要指标手术成功率、眼压、降眼压药物的数量、硅油是否进入引流管、并发症发生率。结果术后3个月时手术成功率为85.5%,有晶状体眼组、IOL眼组、无晶状体眼组手术成功率分别为96.2%、87.5%、70.0%（P=0.041）。有晶状体眼手术成功率高于无晶状体眼（P=0.033）,其他组间两两比较差异无统计学意义。术后3个月眼压有晶状体眼组（16.93±1.75） mmHg、IOL眼组（18.45±2.78） mmHg均低于无晶状体眼组（22.56±3.10...     

Results and complications of temporary silicone oil tamponade in patients with complicated retinal detachments

BACKGROUND: To assess the results and complications of temporary silicone oil tamponade in the treatment of complicated retinal detachments. METHODS: Fifty-eight consecutive eyes undergoing silicone oil removal were studied in a retrospective fashion. Forty-two eyes with proliferative vitreoretinopathy, nine eyes with giant tears, and seven traumatized eyes were included. In addition to anatomic and visual results, the following complications and their associated preoperative and intraoperative variables were assessed: glaucoma, hypotony, and keratopathy. RESULTS: Anatomic success was achieved in 81% of the eyes. Postoperative glaucoma was found in 12%, hypotony in 9%, and keratopathy in 7% of the eyes. Twenty-six (45%) of the 58 eyes had an increase in visual acuity of at least two Snellen lines after silicone oil removal. After multivariate logistic regression analysis for all variables versus the visual and anatomic results and versus the complications of glaucoma, hypotony, and keratopathy successively, a total of three or more operations (P < 0.05; odds ratio, 14.7) and the absence of an encircling band (P < 0.05; odds ratio, 29.9) were associated with redetachment, and a retinectomy size of more than 180 degrees was associated with hypotonia (P < 0.05; odds ratio, 67.5). CONCLUSIONS: Temporary silicone oil tamponade may be associated with a lower incidence of complications than recent studies have reported. Despite the acceptable risk of recurrent retinal detachment, the early removal of silicone oil may yield a lower rate of anterior segment complications and an increase in visual acuity in approximately half the eyes.     

硅油填充术后前房硅油分析

目的：评估硅油填充术后前房硅油及其对眼压的影响。方法：对110例112眼行硅油填充术的患者的临床资料进行回顾性分析。结果：术后1－21月随访发现19眼（17％）前房硅油,其中16眼（84％）为无晶体眼：12眼下方6点虹膜周切闭锁,4眼周切大于2mm。前房硅油中继发青光眼的发生率为53％（10／19）,角膜混浊21％（4／19）。结论：虹膜周发闭锁为无晶体眼中硅油入前房的首要原因。前房硅油继发性青光眼发生率率,应予及早取出。     

Ultrastructure of the anterior lens capsule after vitrectomy with silicone oil injection

To clarify the mechanical difficulties experienced when performing anterior capsulorhexis in vitrectomized eyes filled with silicone oil. Five anterior lens capsules removed from eyes with a silicone oil history were submitted to light and electron microscopic analysis and then compared to two capsules from eyes with trauma history and seven capsules from eyes without silicone oil or trauma history. Comparable abnormalities of the inner and outer surface of the anterior lens capsule were consistently observed after silicone oil fill of the vitreous cavity or after traumatic impact to the lens: patches of multilayer epithelial cells with interspersed capsule material and connective tissue were observed on the posterior surface of the anterior lens capsule. The development of this anterior subcapsular tissue plaque is obviously influenced not only by the PVR process or by side effects of the surgical procedure but also by the silicone oil tamponade or a trauma history. The plaque can be considered primarily responsible for the increased mechanical resistance of the lens capsule in all eyes with silicone oil/trauma history examined in this study.This study was supported by Aktion Kampf der Erblindung (AKDE).     

Intravitreal silicone oil injection: complications and treatment of 415 consecutive patients

Silicone oil injection in conjunction with pars plana vitrectomy was carried out by five surgeons in 415 consecutive patients using the same surgical equipment, the same surgical techniques and the same highly purified silicone oil (viscosity, 5000 mPa·s). Indications for silicone oil injection after vitrectomy included advanced stages of proliferative vitreoretinopathy following rhegmatogenous retinal detachment (49%), severe proliferative diabetic retinopathy (38%), and proliferative vitreoretinopathy following retinal detachment due to ocular trauma (13%). Postoperative complications were noted in a 6- to 30-month follow-up period. Cataractous changes of varying degree were seen in all phakic eyes. Silicone oil entered the anterior chamber in 6% of all phakic and pseudophakic eyes. Subretinal silicone oil was noted in 4%. Other complications associated with the use of intravitreal silicone oil included biomicroscopically visible silicone oil emulsification (0.7%), keratopathy (5.5%), glaucoma (6%), closure of the inferior iridectomy (6%), and reproliferation of epiretinal and subretinal fibrous membranes (40%). We anticipate that the physicochemical characteristics of the highly purified silicone oil (viscosity, 5000 mPa·s) and the routine performance of an inferior iridectomy in all aphakic eyes had a positive impact on the low incidence of silicone-oil-related complications such as emulsification, keratopathy and secondary glaucoma.     

Three-year clinical comparison of 3-piece AcrySof and SI-40 silicone intraocular lenses

PURPOSE: To compare the 3-year performance of the 3-piece AcrySof (Alcon) and the SI-40 silicone (Allergan) intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: In this retrospective study, patients with no complications and at least a 3-year follow-up after IOL implantation were examined for signs of inflammation, visual function, posterior capsule opacification (PCO), and satisfaction. RESULTS: One hundred eleven patients were enrolled with equivalent visual acuity, inflammation, and PCO parameters. The AcrySof eyes had less anterior capsule opacification and more intralenticular inclusions than the other group. Complete anterior capsule overlap was associated with decreased PCO, and significantly more SI-40 eyes had complete anterior capsule overlap. CONCLUSIONS: The second-generation silicone IOL was equivalent to the 3-piece AcrySof in patient satisfaction, visual function, inflammation, and PCO. The amount of anterior capsule overlap on the IOL may help to explain the study differences.     

Correlation between quantity of silicone oil emulsified in the anterior chamber and high pressure in vitrectomized eyes

PURPOSE: To assess the existence of any correlation between the quantity of silicone oil emulsified in the anterior chamber and the incidence of high intraocular pressure in vitrectomized eyes. METHODS: Forty-nine eyes of 49 patients underwent vitrectomy with silicone oil injection as an adjuvant procedure. At the time of observation, between September 1999 and September 2000, 13 eyes (26.5%) were phakic; 23 eyes (47%) were pseudophakic; and 13 eyes (26.5%) were aphakic. Ultrasound biomicroscopy, slit-lamp biomicroscopy, and gonioscopy were performed to quantify the presence of silicone oil emulsified in the anterior chamber. RESULTS: The 13 phakic eyes did not have a high intraocular pressure. In 8 of the 13 eyes, ultrasound biomicroscopy detected only scarce oil emulsification in the anterior chamber (0.304 mm); in 5 of the 13 eyes, gonioscopy and ultrasound biomicroscopy did not detect anterior chamber oil emulsification. Fourteen of 23 pseudophakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.922 mm). Nine of 23 pseudophakic eyes did not have a high intraocular pressure; of these, ultrasound biomicroscopy detected little anterior chamber oil emulsification (0.209 mm). The 13 aphakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.795 mm). The coefficient of correlation for the measurements obtained was 0.98 (F = 62.3, P = 0.05; t = 11.1, P = 0.001). CONCLUSION: This study showed a high correlation between the incidence of high intraocular pressure and the quantity of emulsified silicone oil in the anterior chamber.     

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification.

PURPOSE: To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification. SETTING: Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey. METHODS: Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months). RESULTS: Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05). CONCLUSION: This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.     

Cataract Surgery and Transpupillary Silicone Oil Removal Through a Single Scleral Tunnel Incision Under Topical Anesthesia; Sutureless Surgery

The author evaluated the results of combined cataract extraction and transpupillary silicone oil removal through a single scleral tunnel incision, in eyes that had undergone pars plana vitrectomy with silicone oil tamponade. Twenty-four of the 46 eyes were operated on under topical anesthesia with Blumenthal mode mini-nucleus manual extracapsular cataract extraction technique (mini-nuc ECCE), and silicone oil was removed passively through planned posterior capsulorhexis via the scleral tunnel, followed by endocapsular intraocular lens (IOL) implantation. The operation was completed without any suturing. The remaining 22 eyes were similarly operated on with the same cataract extraction technique, but in these cases silicone oil was classically aspirated actively through pars plana sclerotomies. Results were evaluated by visual acuity measurement, duration of operation, and complications. The transpupillary silicone oil removal group had significantly less vitreous hemorrhage (0- 31.8%) and posterior capsule opacification (0-36.4%). Also, the mean duration of the operation was significantly shorter in this group. There was no significant difference between the two groups with regard to postoperative recurrence of retinal detachment (12.5-18.1%) and visual acuity outcome. The combination of mini-nuc ECCE with transpupillary silicone oil removal compares favorably with the combination of silicone oil aspiration through pars plana sclerotomies. This combined technique allows the surgeon to perform the operation under topical anesthesia and no sutures are required. The intervention period is shorter and no posterior capsule opacification or vitreous hemorrhage develops.     

视网膜脱离晶状体切除术中保留前囊膜的临床观察

目的观察视网膜脱离晶状体切除术中保留前囊膜的疗效。方法视网膜脱离34例(34眼)患者行视网膜脱离晶状体切除术,术中切除晶状体及玻璃体,保留前囊膜,同时行硅油填充。术后随访6～24个月,平均18.5个月,观察患者随访末期视网膜复位、视力及并发症情况。结果术后视网膜裂孔封闭、视网膜复位21例,复位率61.8%。术后视力高于术前,差异有统计学意义(P<0.05)。术后并发症有角膜水肿伴硅油继发性青光眼、前房纤维素性渗出、玻璃体再次积血、黄斑区及周围视网膜点状出血、渗出等。结论视网膜脱离晶状体切除术中保留前囊膜可减少并发症的发生,有利于视力提高。     

Capsular bag opacification after experimental implantation of a new accommodating intraocular lens in rabbit eyes

PURPOSE: To evaluate the development of capsular bag opacification in rabbit eyes after implantation of an intraocular lens (IOL) designed to minimize contact between the anterior capsule and the IOL and ensure expansion of the capsular bag. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ten New Zealand white rabbits had a study IOL (new accommodating silicone IOL [Synchrony, Visiogen, Inc.]) implanted in 1 eye and a control IOL (1-piece plate silicone IOL with large fixation holes) implanted in the other eye. Intraocular lens position, anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. Anterior capsule opacification and PCO were graded on a 0 to 4 scale after the eyes were enucleated (Miyake-Apple posterior and anterior views after excision of the cornea and iris). The eyes were also evaluated histopathologically. RESULTS: The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Postoperative IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group. CONCLUSIONS: The special design features associated with the study IOL appeared to help prevent PCO. Complications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes.     

Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation.

PURPOSE: To evaluate the technical feasibility, outcome, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING: Department of Ophthalmology, Giessen, Germany. METHODS: The results of combined cataract and vitreoretinal surgery in 38 eyes (36 patients) were retrospectively analyzed. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Thirty-seven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. RESULTS: Postoperatively, visual acuity improved in 20 eyes (52.6%), was unchanged in 16 (42.1%), and was worse in 2 (5.3%). Postoperative complications consisted of anterior chamber fibrin exudation (3 eyes), hyphema (2 eyes), vitreous hemorrhage (1 eye), posterior capsule opacification (16 eyes), neovascular glaucoma (2 eyes), proliferative vitreoretinopathy and redetachment (1 eye), and retinal redetachment after silicone oil removal (1 eye). CONCLUSION: Compared with 2 separate operations in patients with significant lens opacities and vitreoretinal pathology, combined cataract and vitreoretinal surgery provided more rapid visual rehabilitation. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.     

Deposition of silicone oil droplets in the residual anterior lens capsule after vitrectomy and lensectomy in rabbits

AIM: To examine the histology of preserved anterior lens capsule in vitrectomised and lensectomised rabbit eyes with and without silicone oil tamponade. METHODS: Forty adult Japanese albino rabbits received two port vitrectomy and lensectomy with or without silicone oil tamponade in one eye under both general and topical anaesthesia. Anterior lens capsule was preserved during operation. After healing intervals residual anterior capsule was histologically observed under light or electron microscopy. RESULTS: Immediately after operation, cuboidal lens epithelial cells were observed on the posterior surface of the preserved anterior capsule. During healing intervals in eyes with or without silicone oil tamponade, regenerated lens structure of Sommerring's ring and fibrous tissue formed in the peripheral and central areas of the residual capsule, respectively. Ultrastructural observation revealed the presence of many vacuoles amid matrix accumulation on the posterior capsular surface, suggesting the deposition of emulsified silicone oil droplets. CONCLUSION: Lens epithelial cells produce regenerated lenticular structure and fibrous tissue on the residual capsule following vitrectomy and lensectomy in rabbits. Silicone oil droplets formed by its emulsification deposit in extracellular matrix accumulated on the posterior surface of the anterior capsule. Emulsified silicone may potentially enhance opacification of residual anterior capsule following pars plana vitrectomy by silicone oil deposition and subsequent activation of lens epithelial cells.