白内障超声乳化术后囊膜混早的多因素分析

目的：研究白内障超声乳化术后发生后囊膜混浊的相关因素。方法：采用多元逐步回归方法对可能引起后囊膜混浊的诸多因素进行分析。结果：在105例经过6-18个月临床随访的患者中,发现与后囊膜混浊的相关因素是术后第1天前房反应及人工晶状体类型,其它因素包括病人性别、年龄、白内障类型、核硬度、眼轴长度、术中超声时间等均与后囊膜混浊无关。结论：减轻术后第1天前房反应及选用丙烯酸酯类折叠式人工晶状体有助于减少后发障的发生率。     

超声乳化术后联合及不联合人工晶状体植入术建立后囊膜混浊兔眼模型的比较

背景后发性白内障（PCO）的防治是目前研究的热点问题之一。建立PCO动物模型常用的方法为超声乳化术后植入或不植入人工晶状体（IOL）,但二者造模的效果评价尚不一致。目的比较兔眼PCO模型建立过程中植入与不植入IOL对PCO的影响。方法选择新西兰白兔20只,用随机数字表法将实验动物分为超声乳化联合IOL植入组和超声乳化不植入IOL组,每组10只兔,两组兔右眼超声乳化手术过程一致,术后共随访3个月,裂隙灯下观察2个组术后晶状体的反应及PCO情况,按OdrichPCO分级系统对术眼PCO情况进行分级。结果术后1～3d,超声乳化联合IOL植入组术眼结膜充血、角膜水肿和房水混浊的严重程度均明显比超声乳化不植入IOL组严重,而术后2周至3个月2个组兔眼的炎性反应均消失;术后1d至3个月,2个组兔术眼的瞳孔直径变化及PCO分级一致。术后2个月,超声乳化不植入IOL组及超声乳化联合IOL植入组兔眼1～3级PCO者分别为8只眼和9只眼,0级PCO者分别为2只眼和1只眼,组间差异无统计学意义（P=0．39）。裂隙灯下检查发现2个组实验眼均于术后1个月开始出现PCO,术后2个月PCO的范围扩大并快速发展,术后3个月形成致密纤维化层。结论采用超声乳化联合IOL植入术建立PCO模型的效果与不植入IOL者相同,但后者术后早期的前房炎性反应较轻,可作为研究PCO的理想动物模型。     

Comparison of tilt and decentration between phacoemulsification and phacotrabeculectomy

PURPOSE: To determine the extent of intraocular lens (IOL) tilt and decentration values after combined surgery in patients with cataract and glaucoma. MATERIALS AND METHODS: A total of 106 cataractous eyes undergoing IOL implantation were divided into 2 groups. Group 1 comprised 42 eyes undergoing phacotrabeculectomy surgery for cataract and primary open-angle glaucoma (POAG), and group 2 comprised 64 eyes undergoing phacoemulsification surgery for senile cataract. The length of IOL decentration and the angle of IOL tilt were quantitated by using Purkinje reflections and photographic documentation. RESULTS: The differences regarding both the IOL tilt (2.84 +/- 0.37; 2.97 +/- 0.37, respectively) and decentration (0.39 +/- 0.27; 0.49 +/- 0.35, respectively) was insignificant (p > 0.05) between groups. CONCLUSION: There is no increased effect of phacotrabeculectomy on tilt and decentration of IOLs in eyes with POAG when compared with eyes which underwent phacoemulsification surgery.     

Comparative incidence of posterior capsular opacification in AcrySof and PMMA intraocular lenses

AIM: To evaluate the extent of significant posterior capsular opacification (PCO) after implanting polyme-thylmethacrylate (PMMA) and soft acrylic intraocular lenses. METHODS: A total of one hundred patients (110 eyes) undergoingintraocular lens(IOL) implant surgerywererandomly divided into two groups based on the type of IOL implanted: Group I: AcrySof (SA60AT) and Group II: PMMA (LX10BD). The density of posterior capsular opacification (PCO) was assessed 3, 6, 12 and 18 months after surgery by taking best corrected visual acuity (BCVA) and the digital photographs. RESULTS: At the end of 3 months postoperatively, the PCO density in the Group I (PMMA) increased significantly (3.6%) while no increase was found in the Group II (Acrylic). By the end of 18 months follow-up, the incidence of significant PCO was found to be less in the acrylic group (14.5%) as compared to the PMMA group (34.5%).On the basis of density, the PCO was more extensive with the PMMA lens than the AcrySof lens, which led to more severe visual loss. CONCLUSION: The intraocular implantation of the AcrySof IOL helps to reduce the incidence of PCO to a greater degree as compared to the PMMA IOL.     

AcrySof和PMMA人工晶状体植入致后发性白内障发生率的比较

目的：评价植入聚甲基丙烯酸甲酯（PMMA）人工晶状体和软性人工晶状体（AcroSof）致后发性白内障的严重程度。方法：总共100人（110眼）进行了人工晶状体植入术，随机分为两组植入不同类型的晶状体。组Ⅰ：AcrySof（SA60AT）人工晶状体，组Ⅱ：PMMA（LXIOBD）人工晶状体。分别在术后3，6，12和18mo，通过测定最佳矫正视力和数码照片拍摄评价后囊膜浑浊的密度。结果：术后3mo，PMMA组后囊膜浑浊的密度明显增加（3．6％），而Acrylic组并未发现增加。术后18mo，显著后囊膜浑浊两组的发生率相比较，Acrylic组（14．5％）较PMMA组（34．5％）低。由于PMMA人工晶状体比AcrySof人工晶状体所致后囊膜浑浊的范围广，故其导致更严重的视力降低。结论：与PMMA人工晶状体相比较，植入AcrySof人工晶状体在一定程度上有助于降低后发性白内障的发生率。     

Posterior capsular opacification in phacotrabeculectomy : a long-term comparative study of silicone versus acrylic intraocular lens

PURPOSE: To investigate the long-term outcomes of silicone versus acrylic intraocular lens (IOL) implantation in phacotrabeculectomy (PT) with special emphasis on posterior capsular opacification. DESIGN: Long-term follow-up on prior 1-year prospective, randomized study. PARTICIPANTS: A total of 200 eyes of 200 consecutive primary open-angle glaucoma patients who had undergone primary PT with capsular bag implantation of either a silicone IOL (102 eyes) or an acrylic IOL (98 eyes) according to the initial short-term prospective, randomized study protocol. INTERVENTION: The study eyes underwent primary trabeculectomy, phacoemulsification, and posterior chamber IOL implantation. Adjunctive mitomycin C was used selectively, primarily in patients with one or more risk factors for filtration failure. MAIN OUTCOME MEASURES: Incidence of posterior capsular opacification (PCO), best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of pressure-lowering medications, and filtration success rates, defined as maintenance of target IOP while on one (criteria 1) or zero (criteria 2) pressure-lowering medications without further surgical intervention. RESULTS: At 3-year follow-up, the PCO rate and BCVA did not differ significantly between the two groups (P: > 0.05 for both). In addition, there were no significant differences in IOP, number of medications, and filtration success rate between the two groups (P: > 0.05 for each). CONCLUSIONS: There were no significant long-term differences between the silicone and acrylic IOL groups in PCO, BCVA, IOP, number of medications, and success of filtration surgery after PT. Both groups attained significant improvement in BCVA and IOP control after surgery.     

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.     

Comparison of incidence of ptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification

Objective:To compare the incidence of upper eyelid blepharoptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification surgeries and the relationship of bleb morphology to the incidence of ptosis.Design:Retrospective observation study.Participants:We included 46 patients after combined phacotrabeculectomy and 44 patients with phacoemulsification in the former group, and all eyes underwent a standardized two-site surgery with intra-operative mitomycin C.Results:There were 8 eyes (17.4%) and 5 eyes (11.4%) with postoperative ptosis in the phacotrabeculectomy and phacoemulsification groups, respectively (P = 0.342). In multivariate regression analysis, reduced total bleb area was significantly associated with upper eyelid ptosis after adjusting for age, gender, and type of anesthesia. The trend seemed to show that increased bleb height was also associated with ptosis, but this did not reach statistical significance.Conclusions:Incidence of persistent ptosis after phacoemulsification combined with trabeculectomy and mitomycin C is similar compared to stand alone phacoemulsification surgery in a multiethnic Asian population. Bleb morphology may play an important role in postoperative ptosis development and should be considered in the evaluation of upper eyelid blepharoptosis.     

细胞外基质与晶状体后囊膜混浊

后发性白内障是白内障术后最常见的并发症之一,大量的研究发现,细胞外基质(ECM)在晶状体后囊膜混浊(PCO)形成过程中亦发挥重要作用.目前已有学者对多种ECM的成分及其作用进行了深入研究,包括纤维连接蛋白(FN)、层黏连蛋白(LN)、胶原蛋白、基膜聚糖、骨桥蛋白(OPN)、核心蛋白多糖、透明质酸、波形蛋白等,每种ECM成分以其不同的作用机制通过不同的细胞信号通路引发晶状体上皮细胞(LECs)的生物学行为变化,如细胞的移行、黏附和增生等.深入研究ECM在PCO形成过程中的作用不仅有助于明确PCO的发病机制,同时也有望以此为靶点对PCO进行防治.就与PCO发生和发展相关的多种ECM及其作用机制的研究进展进行综述.     

后发性白内障防治的研究新进展

后发性白内障(posterior capsular opacification,PCO)是导致白内障患者术后视力下降最常见的并发症.目前,国内外治疗PCO常用的方法是Nd:YAG激光后囊膜切开,但此治疗仍存在较多并发症.过去几十年,如何预防PCO一直是眼科研究热点之一,本文将从白内障手术方式与操作、人工晶状体类型对PCO的预防及PCO的治疗进展做一综述.     

人工晶状体袢的角度与后发性白内障相关性研究

目的　探讨后发性白内障与人工晶状体袢角度之间的关系。方法　 9只科研兔随机分为 3组 ,每组 6眼。麻醉后 ,行透明晶状体囊外摘出术 ,并分别植入袢角度不同的PMMA人工晶状体 ,第 1组植入 0°袢人工晶状体 ,第 2组植入 5°袢人工晶状体 ,第 3组植入 10°袢人工晶状体。术后 6个月 ,裂隙灯下观察晶状体后囊混浊情况并分级 ,取出晶状体后囊 ,行光镜及透射电镜检查 ,并采用免疫组化法对晶状体后囊染色 ,然后采用医用多功能图像分析软件对晶状体后囊表面及赤道部的增殖细胞核抗原 (proliferatingcellnucle arantigen ,PCNA)进行定量检测 ,用SPSS统计软件分析结果。结果　裂隙灯下可见术后随着人工晶状体袢角度的增加 ,发生后发性白内障的例数及等级均呈下降趋势。光镜及透射电镜扫描可见发生后发性白内障的晶状体后囊表面有一层或多层晶状体上皮细胞生长 ,未发生后发性白内障的晶状体后囊表面无晶状体上皮细胞生长 ,赤道部均可见多层晶状体上皮细胞生长。PCNA定量结果 :植入 0°袢人工晶状体组与植入 5°袢人工晶状体组之间后囊表面及赤道部PCNA阳性率 (分别为 10 .5 0 0±2 2 5 8,9.16 7± 2 .2 2 9)无明显差异 (P >0 .0 5 ) ,而植入 10°袢人工晶状体组 (4.5 0 0± 1.871)与植入 0°袢人工晶状体组及植入     

白内障术后晶状体后囊膜混浊及远期视力下降影响因素分析

目的探讨白内障术后晶状体后囊膜混浊(posterior capsular opacification,PCO)发生及术后远期视力下降的影响因素。方法收集行白内障超声乳化摘出联合人工晶状体植入术的年龄相关性白内障患者37例(47眼),记录患者术前、术后的眼部检查情况及是否行后囊膜抛光处理等术中情况,于术后2a对PCO进行分级评价。结果 47眼中,有25眼在术后2a发生了PCO,其中18眼混浊已累及中心3mm区,4眼已行YAG激光后囊膜切开术,后囊膜切开率8.5%。统计分析显示,PCO和混浊累及中心3mm区的发生率在是否行后囊膜抛光眼之间的差异均有统计学意义(均为P<0.05)。在各因素中,行后囊膜抛光是发生PCO以及混浊累及中心3mm区仅有的保护性因素。累及中心3mm区的PCO、眼底疾病和黄斑病变与术后2a视力变化之间的关联均有统计学意义(均为P<0.05)。结论白内障术后发生累及中心3mm区的PCO可导致术后远期视力下降;术中行后囊膜抛光处理可显著降低PCO的发生率和严重程度。     

晶状体后囊膜混浊的评价方法

为了对晶状体后囊膜混浊进行科学定量分析,已开发了多种晶状体后囊膜混浊分析评估系统,包括裂隙灯或眼底镜检查的主观观察法、Nd：YAG激光后囊膜切开率、视功能检查方法、计算机后囊膜混浊分析系统、数码照片计算机辅助图像分析系统等,但尚未能确立一个金标准。     

Comparison of postoperative refractive outcome in phacotrabeculectomy and phacoemulsification with posterior chamber intraocular lens implantation

PURPOSE: To compare the postoperative refractive outcomes following phacotrabeculectomy and phacoemulsification with posterior chamber intraocular lens implantation. METHODS: A retrospective comparative study of 90 consecutive patients (95 eyes) with cataract with or without co-existing glaucoma who had undergone uncomplicated phacotrabeculectomy or phacoemulsification by a single surgeon. The biometry prediction error was determined for each case by the difference between the actual postoperative refraction and the preoperative predicted refractive outcome, in spherical equivalent. This was followed by a comparative analysis of the mean biometry prediction error, and the number of cases with error >0.50 D or 1.00 D. All biometry measurements were performed by one of the two qualified optometrists. RESULTS: The mean and absolute mean biometry prediction error of the 25 eyes that received phacotrabeculectomy (+0.20 D, absolute error 0.96 D) was comparable to the 70 eyes that received phacoemulsification (-0.14 D, absolute error 0.68 D), P = 0.18 (absolute error, P = 0.12). The proportion of cases with prediction error >0.50 D or 1.00 D was 60% or 40% for phacotrabeculectomy, and 44% or 17% for phacoemulsification, respectively. Phacotrabeculectomy was more likely to have a prediction error >1.00 D (P = 0.02) and a myopic shift of >0.50 D or 1.00 D (P = 0.03 or 0.02, respectively). No significant differences were found with regard to the frequency of hyperopic shift or prediction error >0.50 D. There was no significant difference in either the mean error or the frequency of the different types of error for the different biometry operators, types of glaucoma, or postoperative intraocular pressure control success status. CONCLUSION: Myopically shifted prediction error was significantly more frequent following posterior chamber intraocular lens implantation with phacotrabeculectomy compared with phacoemulsification, even when surgery was uncomplicated and performed by the same surgeon.     

密封囊袋冲洗装置在后发性白内障防治中的应用

后发性白内障仍是导致白内障患者术后再次失明的主要原因.理论上说,使用药物彻底清除残留于晶状体囊袋内的晶状体上皮细胞将是预防后发性白内障最直接的方法.封闭囊袋灌洗系统的问世使药物防治后发性白内障成为可能.本文对封闭囊袋灌洗系统在后发性白内障中的应用进行综述如下.     

Rapid onset and progression of posterior capsular opacification

Posterior capsular opacification is a common complication following extracapsular cataract surgery. Its time of onset after surgery, rate of development and affect on vision vary greatly from one individual to another. In this case report, we describe the rapid development of posterior subcapsular opacification over a 12‐day period. This occurred four years after extracapsular cataract extraction and intraocular lens implantation via the technique of phakoemulsification.