玻璃体切除联合后房人工晶状体缝线固定术治疗晶状体脱位

目的探讨玻璃体切除联合后房型人工晶状体缝线固定术治疗晶状体脱位的临床效果。方法各种原因所致的晶状体脱位30例（全脱位11眼,不全脱位22眼,共33眼）,进行玻璃体切除及晶状体切除或晶状体摘出。其中7眼采用三通道睫状体平坦部入口,26眼采用角膜缘入口。30例（33眼）均同时行Ⅰ期睫状沟缝线固定后房人工晶状体植入术。术后随访时间2~24个月,平均9个月,观察术后视力及并发症等。结果术后视力提高31眼,视力不变2眼,术后均未发现严重并发症。结论玻璃体切除联合后房型人工晶状体缝线固定术是治疗晶状体脱位最为安全和有效的治疗方法。熟练的手术技巧和术中稳定的眼内压是手术成功的保证。     

外伤性晶状体脱位的联合手术治疗

目的：评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位或半脱位的临床疗效。方法：对1993年10月－2000年5月连续收治的外伤性晶状体脱位或半脱位36例作回顾性研究。所有患眼根据病情均采用不同的术式去除脱位晶状体,包括角巩缘切口圈套娩出、睫状体扁平部切口行晶状体切除或超声晶状体粉碎,同时切割玻璃体,并应用小梁切除、阀门管植入术、玻璃体视网膜手术联合治疗因晶状体脱位引起的并发症,17例I期植入前房或后房型人工晶状体。结果：所有患眼成功的去除晶状体,91．7％患眼视力有不同程度提高,52．3％患眼视力≥0．3,继发青光眼患者术后眼压获得控制,6例视网膜脱离全部复位。结论：各种手术方法联合应用治疗外伤性晶状体脱位及其所致并发症,视力增进效果明显。阀门管植入术是治疗严重眼外伤顽固性青光眼的有效手术方法。     

外伤性晶状体脱位合并青光眼手术的疗效分析

目的：回顾性评价晶状体摘除联合玻璃体切割术用于外伤性晶状体脱位合并继发性青光眼的手术疗效。
　　方法：对31例31眼因钝挫伤导致晶状体脱位,合并继发性青光眼患者分别行晶状体摘除联合前部玻璃体切割术,小梁切除术及人工晶状体植入术。随访术后1wk;1,3mo术眼眼压、视力。
　　结果：患者31眼全部成功摘除晶状体联合前部玻璃体切割术,其中联合小梁切除术6眼,植入前房型人工晶状体9眼,后房缝线固定晶状体15眼。一期植入16眼,二期植入8眼。术后31眼眼压全部控制正常。有23眼术后矫正视力0.3以上。
　　结论：晶状体摘除联合玻璃体切割术是治疗晶状体脱位合并继发性青光眼的有效手段,但应根据患者情况选择人工晶状体植入类型及联合小梁切除术,以控制眼压,恢复视功能。     

先天性晶状体脱位31例的手术治疗观察

目的：通过对先天性晶状体脱位行手术治疗的患者进行临床分析及手术方式选择、手术后效果分析,探讨先天性晶状体脱位患者的手术方式的选择及术中术后并发症的防治。
　　方法：回顾性分析我院自2010-01-01/2015-01-01的5 a间先天性晶状体脱位行手术治疗的患者共31例57眼,进行临床分析及手术方式选择、手术后效果、并发症分析。
　　结果：先天性晶状体脱位临床最常见的类型为单纯性晶状体半脱位和Marfan综合征晶状体半脱位。57眼中1眼为Marchesani综合征继发性青光眼导致视神经萎缩,术后视力无改善,其余56眼(98%)术后视力均较术前有不同程度提高。手术方式：晶状体超声乳化摘除+人工晶状体植入术3眼(5%);晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术8眼(14%),其中1眼行囊袋张力环巩膜缝合固定;经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术39眼(68%),其中2眼联合小梁切除术,未植入人工晶状体;晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术5眼(9%);经睫状体平坦部切口晶状体切除联合玻璃体切除术+硅油注入术2眼(4%)。
　　结论：先天性晶状体脱位经过手术治疗大多数患者均可取得较为满意的术后效果。对于晶状体半脱位范围<90°者,可单纯行晶状体超声乳化摘除+人工晶状体植入术;晶状体半脱位范围90°~180°者,行晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术;晶状体半脱位范围>180°者,经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术,术后效果优于晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术;根据患者晶状体脱位程度,尽量选择切口较小的微创的手术方式是手术取得成功的关键。     

自行设计钩针在治疗晶状体后脱位中的应用

目的探讨作者自行设计的新型钩针在玻璃体切除联合晶状体切除术治疗晶状体后脱位中的应用。方法2004年9月至2005年6月收集选取晶状体核硬度为Ⅰ-Ⅱ级的晶状体后脱位7例（7眼），在新型钩针穿刺固定下用玻璃体切除器切割头对晶状体进行咬切摘出，同时进行Ⅰ期睫状沟缝线悬吊植入后房型人工晶状体。结果全部脱位的晶状体均顺利咬切摘出并植入人工晶状体，术后裸眼视力明显提高。随访1～3月，最佳矫正视力0．5-1．0者5眼，0．4以下2眼。术后眼压均得到控制，所有病例均无严重并发症。结论采用自行设计的新型钩针穿刺固定后脱位晶状体有利于切割头进行咬切摘出。     

玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位

目的探讨玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位的临床疗效。方法选取晶状体脱入玻璃体内的患者30例(30眼),其中眼球钝挫伤引起的晶状体全脱位25眼,针拨白内障术后晶状体全脱位2眼,白内障摘出术中晶状体核脱入玻璃体内3眼。根据脱入玻璃体内的晶状体核硬度不同采用不同的手术方法,行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术,必要时行硅油填充。术后随访0.5～1a,观察视力、眼压及并发症等情况。结果本组患者行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术19例(19眼);玻璃体切割联合超声乳化及人工晶状体悬吊植入术10例(10眼);玻璃体切割联合超声乳化及硅油充填术1例(1眼)。术后视力:0.1～0.3者16眼,0.3～0.5者9眼,0.5以上者5眼;术后继发青光眼3眼,经降眼压治疗后恢复正常范围。术后随访期间未发现视网膜脱离、玻璃体积血、人工晶状体偏位等并发症。结论玻璃体切割联合超声乳化及人工晶状体悬吊植入术治疗晶状体脱位是一种安全、有效的方法。     

玻璃体切割联合晶状体切除术治疗严重晶状体不全脱位

目的观察玻璃体切割联合晶状体切除术治疗严重晶状体不全脱位的临床疗效。方法回顾性分析我院2010年6月至2013年6月收治的严重晶状体不全脱位28例（32只眼）,晶状体悬韧带断裂均超过180°。所有患者均经睫状体平坦部作闭合式玻璃体切割术,切除玻璃体及脱位的晶状体。其中22只眼联合折叠人工晶状体睫状沟缝线固定术。术后随访6~20个月,平均（10.5±2.4）个月。观察患者术后最佳矫正视力、内皮细胞计数、眼压、人工晶状体、眼底及并发症情况。结果术后与术前最佳矫正视力相比提高27只眼（84.38%）,不变4只眼（12.50%）,下降1只眼（3.13%）。术后6个月内皮细胞数与术前相比差异均无统计学意义（P〉0.05）。术后患者眼压均控制正常。术后所有患者前房未见玻璃体疝。结论玻璃体切割联合晶状体切除术治疗严重晶状体不全脱位术中、术后并发症少,联合行后房型折叠人工晶状体植入可取得较好临床效果。     

外伤性晶状体全脱位继发青光眼的联合手术治疗

目的：探讨外伤性晶状体全脱位继发青光眼作脱位晶状体摘除、小梁切除、前中部玻璃体切割联合人工晶状体植入的四联手术的疗效和方法。方法：对15例15只眼外伤性晶状体全脱位继发青光眼的患者作脱位晶状体摘除、小梁切除、前中部玻璃体切割联合人工晶状体植入的四联手术。结果：15例15只眼外伤性晶状体全脱位继发青光眼患者术中及术后无严重的并发症，视力恢复良好，眼压恢复正常。结论：外伤性晶状体全脱位继发青光眼的患者作脱位晶状体摘除、小梁切除、前中部玻璃体切割联合人工晶状体植入的四联手术是一种有效且安全的手术。     

晶状体脱位继发青光眼手术方法选择

目的：探讨晶状体脱位继发青光眼的手术方法及其治疗效果。方法：对晶状体脱位继发青光眼32例（34只眼），根据不同原因及晶状体脱位状态不同，采取晶状体摘除加前段玻璃体切除术，小梁切除术，晶状体摘除及前段玻璃体切除联合小梁切除术，有8只植入前房型人工晶状体。结果：术后视力提高18只眼，保持不变16只眼。术后6个月眼压全部控制，最低12mmHg(1mmHg=0.133kPa），最高24mmHg。结论：根据不同病因和晶状体不同的脱位状态选择不同的手术方式，能有效地治愈由晶状体脱位而继发的青光眼。     

前房人工晶状体在Marfan综合征晶状体半脱位中的应用

目的:探讨Marfan综合征晶状体半脱位手术治疗的安全有效方法。方法:采用小切口,晶状体吸除,保留晶状体后囊膜悬韧带,必要时行玻璃体切除,植入前房人工晶状体治疗8例(12眼)Marfan综合征晶状体严重半脱位,最佳矫正视力<0.3者11眼,>0.3者1眼。结果:术后视力均较术前视力有明显的提高,术后视力0.1～0.3者4眼,0.4～0.9者8眼。术后最佳矫正视力0.1～0.3者2眼,0.4～0.9者10眼。正常瞳孔下人工晶状体正位,无1例发生偏斜。术后无严重并发症的发生。结论:采用小切口,晶状体皮质吸除,保留晶状体后囊膜悬韧带,必要时行玻璃体切除,植入前房人工晶状体方法治疗Marfan综合征晶状体严重半脱位是一种安全、有效的方法。     

Changes in rabbit and cow lens shape and volume upon imposition of anisotonic conditions

In vivo, mammalian lenses have the capacity to effect fully reversible changes in shape, and possibly volume, during the accommodation process. Isolated lenses also change shape by readily swelling or shrinking when placed in anisotonic media. However, the manner by which the lens changes its shape when its volume is changed osmotically is not firmly established. Putatively, the lens could swell or shrink evenly in all directions, or manifest distinctive swelling and/or shrinking patterns when exposed to anisotonic media. The present study measured physical changes in lenses consistent with the latter alternative using methods we developed for determining rapid changes in lens shape and volume. It was found in isolated rabbit and cow lenses that the length of the axis between the anterior and posterior poles (A-P length) primarily increases under hypotonic conditions (−40 to −100 mOsM), with smaller, or no changes, in equatorial diameter (ED). Hypertonic conditions (+50 to +100 mOsM) on rabbit lenses elicited a predominant reduction in ED, while the A-P length was only marginally reduced. Hypertonic solutions of +150 mOsM were required to obtain similar changes in cow lens shape. The ratio of the A-P length to the ED was taken as a measure of “circularity”. This ratio increased gradually in rabbit and cow lenses bathed in hypotonic solutions because of the increase in the A-P length. The calculated lens volume increased in tandem with the increase in “circularity”. Lens circularity also increased under hypertonic conditions due to the decrease in ED, but this increase in circularity during shrinkage was not as pronounced as that which occurred during swelling. As such, the lens has a tendency upon swelling to change its shape by approaching the structure of a globular spheroid (as occurs during accommodation for near focusing), but lens shrinkage does not result in a flatter lens with a reduced A-P length as occurs during dis-accommodation for distance focusing. Moreover, osmotically evoked shape changes appear irreversible, in contrast to the mechanically elicited shape changes of accommodation.     

Interaction between mechanical and osmotic forces in the isolated rabbit lens

Based on our previous work showing that cow and rabbit lenses isolated with their accommodation anatomical components intact change volume during simulated accommodation in vitro, and that hyposmolality and hyperosmolality also produce volume changes, we tested the idea that exerting these forces simultaneously may add or counteract each other. Further, we attempted to find a point at which osmotic and mechanical forces may cancel each other. Using previously described methodology, we found that combined stretching and anisotonic conditions applied to a lens always produced less of a volume change than that observed on its paired lens from the fellow eye that was only subjected to anisotonic conditions. Our results suggest that a stretching force that increases the equatorial diameter by 0.4% and reduces the lens volume by 1.8% could be canceled by a hyposmotic force of about −20 to −30 mOsM. Counter-intuitively, lenses that were subjected to stretching and hyperosmolality had less volume decrease than their paired lenses only exposed to hypertonicity. This latter observation is likely due to the prevention by the mechanical stretching forces of the shortening of the equatorial diameter, which normally occurs in hypertonic media.     

Single lens to lens duplication: the missing link

Congenital anomalies of the lens include a wide range from lens coloboma to primary aphakia and doubling of lens. There have been few case reports of double lens; the etiology suggested is metaplastic changes in the surface ectoderm that leads to formation of two lens vesicles and hence resulting in double lens. We report a case with bilobed lens, which raises the possibility of explaining the etiology of double lens.     

开放囊袋-IOL单襻睫状沟固定术治疗先天性晶状体半脱位

目的:探讨开放囊袋-人工晶状体(IOL)单襻睫状沟固定术治疗先天性晶状体半脱位的安全性和有效性.方法:收集2011-03-01/2013-12-31影响视力的先天性晶状体半脱位患者10例13眼,做角巩膜缘隧道切口,环形撕囊后,使用虹膜拉钩,固定脱位晶状体,完成超声乳化手术.植入IOL,剪开晶状体脱位一侧囊袋,翻转前囊,上襻位于囊袋内,下襻单针经缝合固定于睫状沟.结果:所有患者最佳矫正视力均不同程度提高,IOL稳定,没有进展性偏位.结论:虹膜拉钩可以稳定脱位的晶状体,使超声乳化手术顺利完成.开放下方囊袋,IOL呈半游离状态,下襻睫状沟缝合固定可维持IOL的长期稳定,避免囊袋进行性偏移,造成IOL偏位.     

人晶体总蛋白质中的43KD多肽

本文使用S.D.S—聚丙烯酰胺凝胶电泳对人胚胎、青年、成年透明晶体及老年性白内障晶体囊上皮、皮质和核三部分的总蛋白质可溶性和脲溶性蛋白质进行了测定,发现在囊上皮部分自胎儿到老年性白内障晶体均有一条43KD多歇.而自14岁开始在晶体皮质及核的可溶性蛋白质中这条43KD多肽带明显加宽.在晶体皮质及核的碌溶性蛋白中这条谱带随年龄增长变得模糊.在老年性白内障晶体中则几乎消失.     

The critical initial comfort of soft contact lenses

Background : The initial comfort of soft lenses is not as important when prospective patients are highly motivated to be fitted with contact lenses but can be critical in the case of apprehensive patients, especially in the case of proactive demonstration/diagnostic fittings. Failure to eliminate initial discomfort may cause apprehensive prospective contact lens wearers to decide not to proceed with a fitting. However, in all cases of clinical and research fittings, initial comfort is critical to fit evaluation, when abnormal lid tonus and lacrimation can invalidate assessment. Method : A panel of experienced contact lens practitioners evaluated three methods of lens settling that could be employed to improve soft lens comfort immediately after lens insertion. Results : A total of 1,234 lens insertion experiences were examined by the panel and it was found that soft lens settling procedures were indicated in 46 per cent of cases. The settling procedure was found to be successful in 86 per cent of cases. The temporal lens displacement method of soft lens settling was found to be easier to use (p < 0.001) and the lens displacement away from the perceived location of irritation method was found to be the most successful (p < 0.05). Conclusion : In cases of mild to moderate discomfort, the displacement away from irritation method had a better chance of establishing comfort and was the most appropriate method to teach patients to use when inserting lenses for themselves. This study also indicates that, under certain conditions, the location of corneal sensation may be much better than previously found.     

14例晶体脱位的超声乳化手术治疗

为评价不同手术方式在晶体脱位手术治疗中的疗效，对２４例（２８只眼）晶体脱位患者作晶体摘除术。其中超声乳化法１４例（１４只眼），非超声乳化法１０例（１４只眼）。结果：术后最佳视力５只眼无提高（１７．９％），２３只眼较术前提高（８２．１％）。无严重术中和术后并发症。术后视力无提高原因主要为术前继发性青光眼（７１．４％）。结论：晶体脱位通常被认为是超声乳化晶体摘除术的禁忌症。我们的经验表明只要手术条件良好，操作技术熟练，晶体脱位不应被列为超声乳化术的禁忌症     

外伤性晶状体不全脱位的超声乳化手术

目的　探讨晶状体不全脱位的超声乳化及人工晶状体植入的手术方法。方法　对 32例 36眼晶状体不全脱位根据脱位程度选择不同术式 :脱位 <1 2 0°者 ,环行撕囊超声乳化植入后房型IOL ;脱位 1 2 0°～ 2 70°者 ,晶状体囊缝合至睫状沟 1针 ,环行撕囊 ,超声乳化 ,植入后房型IOL ;脱位≥2 70°者 ,囊缝合至睫状沟 2针后环行撕囊及超声乳化 ,植入后房型IOL。结果　随访 3～ 1 8月 ,平均 8月。术后裸眼视力 <0 0 5者 2眼占5 56 % ;0 0 5～ 0 2 5者 7眼占 1 9 44% ;0 3～ 0 5者 1 2眼占 33 33 % ;0 6～1 0者 9眼占 2 5 0 0 % ;>1 0者 6眼占 1 6 67%。结论　晶状体不全脱位根据其程度采用Adank和Hennekes的方法将晶状体囊缝合至睫状沟以固定囊袋 ,再进行超声乳化 ,植入后房型IOL是一种安全有效的治疗方法     

Foldable Lens Explantation and Exchange：The Reason and Solution

Objective: To report the explantation and exchange of Hydrophilic Acrylic foldableintraocular lens (IOL) on 14 patients who had visual disturbances caused by the changeof transparence on optic.Methods: Sixteen Hydrophilic Acrylic foldable intraocular lenses from 14 patients whopresented with decreased visual acuity from 6 months to 1 year after normalphacoemulsification and IOL implantation associated with extensive transparent changeon optic of the lens. The lenses were explanted with the bisection technique. All the eyeswere reinserted with Acrysof foldable lenses.Results: Sixteen lenses were removed successfully and exchanged with the new lens inthe capsule. The posterior capsular rupture and vitreous loss were found in the first twocases. One of them had the zonulysis due to the radial tear of the anterior capsule duringthe enlargement of the capsular opening. The anterior vitrectomy was performed with IOLfixed on the ciliary sulcus. The visual acuity of all the patients improved obvi     

Cytoplasmic filaments in the crystalline lens of various species: functional correlations.

The distribution of cytoplasmic filaments in lenses of five species was studied with the electron microscope. Two distinct patterns emerged. One pattern, in which filaments are grouped in characteristic bundles around the nucleus, in processes, and throughout the subcortical cytoplasm of epithelial cells, is typical of spherical, non-accommodating lenses of mice and rats. The second pattern is associated with anteriorly-flattened, accommodating lenses of infant human, squirrel and frog. In these, filaments are scattered in epithelial cells, but are accumulated on either side of the plasma membrane junction between epithelial cells and lens fibers. They are especially dense on the lens fiber side of the junction, and form a lattice associated with the lens fiber plasma membrane. The lattice is less extensive along the sides of lens fibers not in contact with epithelial cells. In spherical lenses the epithelial-fiber lattice is greatly reduced. Filaments in both types of lenses ranged in diameter between 5 and 11 nm. The filaments are thought to be a mixture of thin and intermediate filaments.It is hypothesized that the role of cytoplasmic filaments in lens, depending on the pattern present, is either to structurally support a spherical shape, or to provide a contractile force or elasticity to return the flattened anterior surface to the accommodated state in conjunction with the elasticity of the lens capsule.