现代囊外白内障摘除术中后囊破裂的临床分析

目的 探讨现代囊外白内障摘除术中囊破裂玻璃体脱出的原因、处理方法、人工晶状体的植入及如何避免并发症以提高手术效果。方法 对1570眼现代囊外白内障摘除术中后囊破裂玻璃体脱出病例作回顾性研究。结果 术中晶状体后囊破裂185眼（占11.78%)、并发玻璃体脱出121眼（7.71%)；术后早期（1周内）视力平均0.5。结论 后囊破裂可以出现在白内障超声乳化手术中的各个手术步骤，术中重视预防；及早发现后囊破裂并给予适当处理，准确判断后囊破裂的大小和方位，恰当利用残留的前后囊膜，正确处理脱出的玻璃体，一期植入后房型人工晶状体仍可获得较好的效果。     

现代囊外白内障摘除术中后囊破裂的临床分析

目的 探讨现代囊外白内障摘除术中后囊破裂玻璃体脱出的原因、处理方法、人工晶状体的植入及如何避免并发症以提高手术效果。方法 对1570眼现代囊外白内障摘除术中后囊破裂玻璃体脱出病例作回顾性研究。结果 术中晶状体后囊破裂185眼(占11.78％)、并发玻璃体脱出121眼(7.71％);术后早期(1周内)视力平均0.5。结论 后囊破裂可以出现在白内障超声乳化手术中的各个手术步骤,术中重视预防;及早发现后囊破裂并给予适当处理,准确判断后囊破裂的大小和方位,恰当利用残留的前后囊膜,正确处理脱出的玻璃体,一期植入后房型人工晶状体仍可获得较好的效果。     

白内障术中后囊破裂一期人工晶状体植入术

目的探讨白内障囊外摘出人工晶状体植入术中后囊破裂时一期人工晶状体植入的方法。方法对本院2004年1月。2005年6月行现代白内障囊外摘出人工晶状体植入术中因各种原因导致后囊破裂行一期人工晶状体植入的23眼进行回顾性分析。结果术后视力0．3以下者2眼，0．4～0．7者18眼，0．8～1．0者3眼。术后早期眼部反应较正常。结论术中因各种原因导致后囊破裂，只要处理好玻璃体和人工晶状体植入，就能取得术后较好的视力。     

剥脱综合征并发白内障青光眼行超声乳化人工晶状体植入术联合小梁切除术的疗效观察

目的 观察剥脱综合征并发白内障青光眼患者行白内障超声乳化人工晶状体植入术联合小梁切除术的临床效果。方法 对同时合并白内障及青光眼的剥脱综合征7例(11只眼)，行白内障超声乳化人工晶状体植入术联合小梁切除术，术后随诊观察1年。结果 在术中仅有1只眼出现晶状体后囊破裂、玻璃体丢失，占9．1％；术后随诊1年。11只眼眼压均控制满意，占100％。视力在0．5者1只眼及以上者8只眼．占72．7％。结论 白内障超声乳化人工晶状体植入术联合小梁切除术。对同时合并白内障及青光眼的剥脱综合征患者来说是安全、有效的，部分患者术后视力欠佳是由于青光眼损害所致。     

前段玻璃体切除在超声乳化白内障手术中的应用和体会

目的：观察及探讨超声乳化白内障术中后囊膜破裂或晶状体悬韧带离断致玻璃体脱出使用前段玻璃体切除术的疗效及并发症。方法：回顾性分析28例35眼白内障患者在超声乳化人工晶状体植入术中出现后囊膜破裂或晶状体悬韧带离断致玻璃体脱出时采用前段玻璃体切除术的处理过程,观察术后视力及并发症,总结经验体会。结果：通过前段玻璃体切除术,及时、准确处理超声乳化白内障手术中后囊膜破裂或悬韧带离断致玻璃体脱出,效果较为满意。结论：前段玻璃体切除术对超声乳化白内障手术中后囊膜破裂或悬韧带离断致玻璃体脱出疗效好,并无严重并发症的发生,是一种行之有效的手术方式。     

白内障囊外摘出术晶状体后囊破裂原因的分析

目的探讨白内障囊外摘出术中晶状体后囊破裂的原因。方法269例(301眼)常规现代白内障囊外摘出术,术中29眼(9.64%)晶状体后囊破裂,其中25眼玻璃体脱出,相应处理后25眼一期植入人工晶状体。结果分析后囊破裂原因:11眼因水分离或娩核造成截囊口后裂、囊袋撕脱;14眼注吸皮质时误吸周边部前囊或直接损伤后囊;4眼外伤性白内障术前已有后囊破孔。结论晶状体后囊破裂与手术熟练程度、水分离、娩核、截囊方法、手术设施、白内障类型有关。     

手法小切口白内障术中后囊破裂原因与处理

目的 探讨手法小切口白内障囊外摘出（MSICS）术中晶状体后囊破裂的原因及处理方法。方法 回顾分析360眼手法小切口白内障囊外摘出联合后房型人工晶状体植入术的临床资料，对其中26眼术中后囊破裂的原因和处理进行探讨。结果 术中全部植入人工晶状体，术后矫正视力≥0．3者22眼（84．62％），无严重并发症。结论 晶状体后囊破裂为手法小切口白内障囊外摘出联合后房型人工晶状体植入术中最常见并发症，可发生于诸多步骤。谨慎操作，可降低其发生率；正确处理可以获得良好的手术效果。     

后房人工晶状体植入术500例术中术后并发症

目的 探讨白内障囊外摘出人工晶状体植入术的术中术后并发症发生的原因及预防处理方法。方法 回顾了1993～1997年常规切口白内障囊外投送出后房型人工晶状体植入术500例,并加以分析。结果 术中后囊破裂11例,玻璃体溢出9眼,虹膜根部断离11眼,前房积血14眼;术后发生不同程度的角膜内皮水肿者171眼,后囊浑浊30眼,眼压增高15眼。术后1～2周裸眼视力0.5以上者170眼,低于0.5者330眼。结论 提高操作技巧,减少前房内操作,可有效地减少并发症的发生,提高术后视力。     

人工晶状体悬吊6例体会

目的 探讨基层医院白内障术中后囊破裂大于1／4，玻璃体脱出时如何安全植入人工晶状体的方法、技巧，并对其疗效进行评价。方法 利用Aleon 10-0尼龙线及普通后房型C襻人工晶状体缝线悬吊对小切口白内障囊外摘出术人工晶状体植入术或晶状体超声乳化摘出及人工晶状体植入术中出现后囊破裂者行单悬吊或双悬吊巩膜缝合植入人工晶状体。结果 6例人工晶状体位置正常，全部为Ⅰ期植入．随访6～36月，所有患者视力大于0.3以上，随诊无远期严重并发症。结论 作为对术中出现后囊破裂玻璃体脱出所致的无后囊支撑或仅有部分支撑的情况的一种手术补救，应用人工晶状体悬吊植入是可行的，并且在紧急情况下完全可以使用尼龙线及普通后房型人工晶状体。     

白内障术中玻璃体脱出的不同处理方法的结果

目的 探讨白内障外摘出人工晶状体植入术术中玻璃体脱出不同处理方法的效果。方法 对本院1995年1月－1996年6月间行现代白内障囊外摘出人工晶状体植入术中玻璃体脱出，并予相应处理的26眼病例进行回顾性分析。结果 已实行前段玻璃体切除，3点及9点钟位睫状沟人工晶状体缝线固定术的，瞳孔恢复生理状态，视力恢复最好。剪除脱出玻璃体，前囊前植入人工晶状体或及12点位缝线固定术的，视力恢复较好。剪除脱出玻璃体，3点及9点缝线固定术的，视力恢复次之。一襻植入囊袋中，一襻12点位缝线固定术，视力恢复较前者差。结论 术中不慎出现玻璃体脱出并发症，只要医生正确、熟练地处理玻璃体及人工晶状体的植入，就能取得术后较好的视力。     

Vitreous prolapse and IOL dislocation during intravitreal injection of triamcinolone acetonide

Background To report on procedure-related anterior segment complications during intravitreal injections.Methods In a prospective interventional case series, 614 eyes received a total of 723 intravitreal injections of about 20 mg triamcinolone acetonide (in 0.2 ml) after paracentesis and aqueous humor drainage for various indications.Results In three eyes (0.49% of all eyes) a vitreous prolapse occurred during the injection. In one eye, the vitreous prolapse was combined with dislocation of the intraocular lens (IOL). All three eyes were pseudophakic, showing an posterior capsule defect, and the IOL located in the ciliary sulcus. They were treated by translimbal vitrectomy, and one eye with reposition of the IOL. No other procedure-related postoperative complications were observed during injection or follow-up (7.8±7.1 months).Conclusions Intravitreal injections may cause a vitreous prolapse into the anterior chamber with or without IOL decentration or dislocation in predisposed eyes. Ophthalmologists should be aware of this possible complication and inform patients at risk.None of the authors received any financial support, or had any financial interest.     

儿童白内障手术并发症及处理

探讨儿童白内障手术,特别是外伤性白内障手术的并发症及处理,方法：对９４例先天性,外伤性,后发性白内障分别行不同术式的手术,对术后视力,术中和术后并发症及处理进行分析。结果术后视力比术前提高者９０只眼,随访３７只眼,视力提高２９只眼。     

小切口非超声乳化白内障术中玻璃体脱出的原因分析及处理

目的:探讨在基层医院行小切口非超声乳化白内障摘除联合人工晶状体植入术中玻璃体脱出的原因和预防以及处理办法。方法:对我院2008-01/2009-042000例小切口非超声乳化白内障摘除联合人工晶状体植入术中52例52眼玻璃体脱出的情况进行回顾性分析。结果:52眼玻璃体脱出发生在上浮核、劈核、圈套核和吸皮质时;49眼植入人工晶状体,3眼未植入人工晶状体;45眼获得满意圆瞳孔,7眼欠圆;18眼术后视力>0.5,27眼视力>0.3,3眼视力>0.1,2眼视力>0.05,2眼视力<0.05。结论:小切口非超声乳化白内障摘除联合人工晶状体植入发生玻璃体脱出多在劈核、圈套核及吸取皮质时,玻璃体脱出经过及时恰当的处理仍然可以获得较满意的效果。     

小切口非超声乳化联合IOL植入术的临床观察

目的:探讨小切口非超声乳化白内障摘除联合人工晶状体植入术在基层医院开展的临床实用性。方法:对本院收治的323例362眼老年性白内障分别进行小切口非超声乳化白内障摘除术和超声乳化白内障吸出术。观察比较术中后囊破裂、术后视力、角膜水肿、前房纤维素性反应和后发性白内障的发生。结果:术中后囊膜破裂、角膜水肿、前房纤维素性反应和后发性白内障的发生及术后1wk和3mo视力比较,两组差异无显著性,但小切口非超声乳化手术价格低廉。结论:小切口非超声乳化白内障摘除术具有损伤小,视力恢复快,价格低廉,适于基层医院开展的优点。     

Vitreous prolapse through the scleral wound in 25-gauge transconjunctival vitrectomy

PURPOSE: To examine the effectiveness of excising peripheral vitreous until the cannula tip is exposed to prevent vitreous prolapse through the scleral wound in 25-gauge transconjunctival vitrectomy. METHODS: Twenty-five-gauge vitrectomy was performed in 60 consecutive eyes. Peripheral vitrectomy was conducted until the cannula tip was exposed in 30 eyes and with conservation of the vitreous around the cannula in 30 eyes. Vitreous prolapse through the scleral wound was examined using a suction stick. RESULTS: Vitreous prolapse through the scleral wound was transparent, fine and short, and detectable only with the suction stick. The incidence of vitreous prolapse through the scleral wound was 0% (0 of 30 eyes) when peripheral vitreous was excised until the cannula tip was exposed, and 20% (6 of 30 eyes) when the vitreous around the cannula was conserved, with a significant difference between two groups (p=0.0237). In two of six eyes with vitreous prolapse, the scleral wound was open, but there was no leakage of intraocular fluid and normal ocular pressure was maintained. CONCLUSIONS: If peripheral vitrectomy is performed without excising the vitreous surrounding the cannula, there is a 20% risk of the vitreous prolapsing through the scleral wound. Vitreous prolapse through the scleral wound is difficult to detect because it is transparent, fine and short, and there is no intraocular fluid leakage. Therefore, detecting vitreous prolapse with a suction stick and appropriate intervention are important for preventing endophthalmitis.     

A comparison of intracapsular and extracapsular lens extraction combined with keratoplasty

The clinical outcome and final visual acuities of 29 patients with intracapsular lens extraction and keratoplasty to 38 patients having extracapsular cataract extraction and keratoplasty were compared. Grafts remained clear in 89% of the intracapsular group and 82% of the extracapsular group over an average follow-up of 38 months and 21 months, respectively. Ninety-one percent of eyes with intracapsular lens extraction and 70% of eyes in the extracapsular group achieved a final visual acuity of 6/21 (20/70) or better. We found a significantly higher incidence of additional surgery in the extracapsular group and glaucoma in intracapsular combined cases. Late vitreous prolapse with vitreo-endothelial membrane formation and graft decompensation was a discouraging complication in three eyes having intracapsular extractions.     

巩膜穿刺孔玻璃体嵌顿是玻璃体手术失败的首要原因

目的探讨巩膜穿刺孔玻璃体嵌顿与玻璃体手术失败的关系。方法对连续49例(49只眼)玻璃体手术后视网膜脱离患者,根据术中探查,将巩膜穿刺孔内口玻璃体嵌顿分为5级:0级:无任何玻璃体嵌顿;Ⅰ级:穿刺孔内口玻璃体嵌顿,但对视网膜无牵拉;Ⅱ级:玻璃体嵌顿,对视网膜产生牵拉,表现向前移位;Ⅲ级:视网膜嵌顿在穿刺孔内口处;Ⅳ级:玻璃体嵌顿牵拉形成视网膜裂孔。Ⅲ和Ⅳ级定为是手术失败的主要原因,Ⅱ级判为手术失败的次要原因,0和Ⅰ级为非巩膜穿刺孔并发症引起的手术失败。结果患者原发疾病为裂孔性视网膜脱离22例,眼外伤21例(包括取眼内异物8例);分支静脉阻塞和化脓性眼内炎各2例;糖尿病性视网膜病变和急性视网膜坏死综合症各1例。做过1次玻璃体手术37例,2次以上12例。前段增生性玻璃体视网膜病变分级:单纯视网膜环形收缩2例;视网膜前移位31例(合并环形收缩11例)。主要因巩膜穿刺孔并发症引起的手术失败占57.2%(28例),巩膜穿刺孔并发症为次要原因占20.4%(10例),二者占77.6%。非巩膜穿刺孔并发症引起的手术失败占22.4%(11例)。结论巩膜穿刺孔玻璃体嵌顿的并发症是玻璃体手术失败的首要原因。     

儿童白内障手术并发症及处理

目的 探讨儿童白内障手术的并发症及处理.方法 对45例(60只眼)先天性、外伤性、后发性白内障分别行不同术式的手术,对于术后视力,术中及术后并发症及处理进行分析.结果 术后视力比术前提高者51只眼,随访30只眼,视力提高有25只眼.术中并发症为后囊破裂和玻璃体脱出,术后主要的并发症为后囊混浊,前房炎症反应等.结论 白内障摘除术是处理儿童白内障的有效方法,儿童白内障术后并发症有一定的特殊性,适时恰当的处理,仍然可以获得良好的效果.     

Simultaneous bilateral cataract extraction

PURPOSE: To assess the visual outcome and safety of simultaneous bilateral cataract extraction. SETTING: Department of Ophthalmology, Queen's Hospital, Burton on Trent, Staffordshire, United Kingdom. METHODS: Simultaneous bilateral cataract extraction was performed in 288 eyes of 144 patients over 10 years in a single department in selected cases. Case notes were retrospectively analyzed for final best corrected visual acuity (BCVA) and intraoperative and postoperative complication rates. RESULTS: The final BCVA was 6/9 or better in 87.0% of eyes. The incidence of intraoperative complications was 2.42%. These included posterior capsule rupture without vitreous loss (0.69%) and with vitreous loss (1.04%). Postoperative complications occurred in 10.05% of eyes and included raised intraocular pressure (IOP) (3.82%), iris prolapse (0.69%), uveitis (0.69%), and suture abscess (0.35%). There were no major bilateral complications such as endophthalmitis or corneal decompensation. CONCLUSION: The outcome of simultaneous bilateral cataract extraction was comparable to that of single-eye cataract surgery, indicating that the procedure is safe under strict surgical protocol and beneficial in selected cases.