Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception

OBJECTIVE: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. METHODS: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. RESULTS: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). CONCLUSION: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.     

严重眼球破裂伤无光感眼合并角膜血染的手术治疗

目的 探讨严重眼球破裂伤无光感眼合并角膜血染的手术治疗效果，并分析相关因素。 方法 7例患者7只眼因严重眼球破裂伤无光感合并角膜血染接受2期临时人工角膜下玻璃体切割联合角膜移植手术。2期手术前7只眼均角膜血染，前房及玻璃体积血，视网膜脉络膜脱离。1期与2期手术间隔时间平均18d(12～21d)。手术前视力均无光感，眼压平均3 mm Hg(1mm Hg=0.133 kPa)(2～5 mm Hg)。随访平均时间12个月(6～30个月)。 结果 5只眼恢复光感以上视力，矫正视力从光感至0.05。视网膜复位5只眼(5/7)。眼压平均12 mm Hg(5～15 mm Hg)，明显高于手术前眼压(P＜0.05)。并发症包括一过性高眼压(1 只眼)，角膜新生血管(4只眼)，角膜排斥反应(4只眼)，眼球萎缩(2只眼)。 结论 临时人工角膜下玻璃体切割联合角膜移植手术是挽球严重眼球破裂伤无光感眼合并角膜血染的安全有效的方法。（中华眼底病杂志，2004，20：212-214）     

复合型人工角膜植入治疗重度角膜盲及并发症处理

目的 探讨钛支架复合型人工角膜植入治疗重度角膜盲的临床价值,以及并发症的处理.方法 回顾性系统病例研究.2002年3月至2005年6月期间中山大学中山眼科中心共完成永久性人工角膜植入9例(单侧眼9只),均为男性,年龄28～52岁.所有患者均为双眼损伤,受伤时间为1.5～5.0年.其中碱烧伤6只眼,爆炸伤3只眼,术前视力均为光感,其中2例光定位不准;均为多次角膜移植以及眼表重建手术失败的难治性重度角膜盲患者.手术分两阶段:一期手术显微镜下行钛支架复合型人工角膜植入联合自体耳软骨移植加固,二期行人工角膜前膜剪开,建立镜柱光学通路.术后评价视力恢复情况,分析并发症的发生原因,探讨相应的处理对策.结果 患者随诊时间1～3年.术后7只眼裸眼视力≥0.1,其中2只眼经镜片矫正后达到0.6.术前光定位不准的2例患者术后视力为0.02和0.04.术后并发症的发生情况为复发性人工角膜前膜5例,进行前膜切除,其中1例联合施行自体唇黏膜移植;角膜局限性融解1例,进行脱细胞真皮加固;人工角膜后膜1例,显微镜下施行后膜钩除术.以上并发症经相应处理均得到控制.随访期内所有人工角膜均保持原位,未发生人工角膜排出、房水渗漏.结论 人工角膜移植是使严重角膜盲患者复明的有效手段,联合自体耳软骨加固可减少并发症的发生,提高人工角膜植入的生物相容性.(中华眼科杂志,2009,45:104-109)     

Transscleral fixation of a black diaphragm intraocular lens in severely traumatized eyes requiring vitreoretinal surgery

The records of 4 eyes of 4 patients who had transscleral fixation of black diaphragm intraocular lenses (IOLs) after vitreoretinal surgery due to complications of severe perforating trauma were retrospectively reviewed. The transscleral fixation was performed 4 to 13 months after the vitreoretinal surgery. All patients reported a subjective decrease in glare and photophobia, with improved visual acuity in 2 eyes during a mean follow-up of 3 years. Cystoid macular edema was noted in 1 eye and transitory intraocular pressure elevation due to intraocular silicone oil in 1 eye. Severe perforating eye injury is frequently associated with extensive iris defects and lenticular and vitreoretinal complications. Although visual acuity may not be the primary concern in these eyes, favorable visual rehabilitation can be achieved following proper management of the retinal complications and transscleral fixation of black diaphragm IOLs to overcome glare and photophobia.     

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.     

Deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation in unilateral severe chemical injury

PURPOSE: To evaluate the efficacy of deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation for ocular surface reconstruction and visual rehabilitation in eyes with unilateral, late-stage, severe chemical injury. METHODS: This was a retrospective, noncomparative, interventional case series that included 7 eyes of 7 patients, with severe unilateral late stage chemical injury, exhibiting corneal vascularization, conjunctivalization, and extensive corneal scarring were treated at the C. J. Shah Cornea Service, Sankara Nethralaya, a tertiary care center. Surgical procedures included releasing symblepharon adhesions, excising epibulbar fibrous tissue, superficial keratectomy to remove fibrovascular tissues over cornea, deep anterior lamellar dissection, grafting a lamellar corneal button, and transplanting autologous limbal graft, with or without amniotic membrane transplantation. The main outcome measures were relief of patient symptoms, postoperative recovery of the ocular surface, corneal clarity, corneal epithelial stability, and best corrected visual acuity. RESULTS: The mean duration between the injury and surgery was 24.4 +/- 21.8 months. No intraoperative complications were noted. Successful epithelialization was achieved in all eyes. The reconstructed corneal surface remained stable during the entire follow-up period (mean follow-up, 16.57 +/- 5.12 months). All patients had resolution of ocular symptoms. Remarkable improvement in vision was noted in all (85.7%) except 1 eye in which recovery was limited due to amblyopia. The average best corrected visual acuity at last follow-up was 20/50. No complications were noted in the donor fellow eye. CONCLUSIONS: DALK combined with autologous limbal transplantation can restore a healthy, stable ocular surface, besides providing a clear cornea that remarkably improves the visual acuity, in patients with unilateral, late stage, severe chemical injury.     

Outcome of vitreoretinal surgery and penetrating keratoplasty using temporary keratoprosthesis.

PURPOSE: The use of a temporary keratoprosthesis has allowed earlier surgical intervention in eyes with coexisting vitreoretinal and corneal disease. We analyzed our experience with this type of surgery. METHODS: We retrospectively reviewed charts of patients in whom a temporary keratoprosthesis was used between 1987 and 1998. Analysis was focused on ocular history, indications for surgery, visual acuity (VA), intraocular pressure, anatomic results, and complications. RESULTS: A temporary keratoprosthesis was used in 31 eyes, 22 (71.0%) of which were for trauma-related indications. In 6 (19.4%) of the operated eyes, the fellow eye also had severely reduced VA. Retinal detachments were present in 30 (96.8%) eyes; most had evident proliferative vitreoretinopathy. Twelve (38.7%) eyes had vitreous hemorrhage, and 20 (64.5%) had corneal scars. Improvement in VA was seen initially in 45.1% of patients, and 51.6% maintained equal or better VA at their final visit as compared with before surgery. The common documented reasons for poor final VA were recurrent retinal detachments deemed inoperable (32.3%), phthisis (22.6%), and optic atrophy or macular scar (16.1%). Corneal grafts remained clear in 41.9%. Nine patients had further surgery. The most significant complication was one case of sympathetic ophthalmia. CONCLUSIONS: Combined vitreoretinal and corneal surgery using temporary keratoprostheses has been used in our institution to treat eyes with extreme abnormalities. Outcomes were less favorable than some reported in the literature, probably because of the severity of disease for which temporary keratoprostheses were reserved. Although results are probably better than the natural course of the disease, patients should be informed of realistic expectations for improvement and potential complications when offered this option.     

人工角膜植入术的临床研究

评价复杂性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择15例双眼盲目患者的单侧眼15只,术前视力均为光感,角膜混浊病变无法用常规角膜移植手术达到复明目的。其中严重碱烧伤6只眼,严重酸烧伤3只眼,铝水烧伤2只眼,爆炸伤1只眼,严重实质性眼干燥症1只眼,多次穿透性角膜移植失败角膜严重血管化2只眼。人工角膜(MICOF)由俄罗斯费德洛夫眼外科中心制造。手术分两期：一期手术将人工角膜支架植入角膜层问,选择病例行角膜表面或层问加固性手术。约3个月后行二期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果二期术后观察4～26个月,平均9．5个月,除1只眼视力光感外,其余眼裸眼视力0．12～1．0。手术并发症包括分离角膜板层时穿入前房,晶状体皮质残留,柱镜前表面结膜上皮遮盖,柱镜前表面纤维增生组织遮盖,柱镜后壁沉着物,角膜溶解。结论人工角膜特别适合于穿透性角膜移植难于成功的双眼盲目者,而且是对目前严重角膜瘢痕血管化、严重眼睑或泪液功能不良患者有效的复明手段。该术式结合自体结膜遮盖、骨膜层问移植及睑裂部分缝合等,有利于人工角膜的长期存留。     

Implantation of Iakymenko keratoprosthesis in patients with severe ocular injury

AIM: To present the results of implantation of Iakymenko keratoprosthesis in five patients with vascularized corneal leukoma caused by severe ocular injury. METHODS: Iakymenko keratoprosthesis was implanted into 5 eyes of 5 patients: 4 patients were suffered from chemical burns and 1 patient from explosive injury. The preoperative visual acuity ranged from light perception to hand motion. The implantation surgery was composed of two-stage procedures. The follow-up period was from 9 months to 11 years. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. RESULTS: Vision improvements were achieved in most patients. All keratoprosthesis were retained within the follow-up period. Corneal melting occurred in one patient and fibrous closure in another patient, both of which were successfully treated. Retinal detachment occurred in one patient after surgery. CONCLUSION: Iakymenko keratoprosthesis seems to be a promising alternative for the patients with severe corneal injury, but further investigation is needed to evaluate the role of Iakymenko keratoprosthesis.     

AlphaCor™ keratoprosthesis: postoperative development of six patients

Purpose  AlphaCor™ (Argus Biomedical Pty. Ltd., Perth, Australia) is an artificial, soft, one-piece keratoprosthesis (KPro) indicated for severe corneal conditions not treatable by a donor graft. To evaluate the efficacy and visual restoring of six patients with complete corneal opacification and deep neovascularizations treated with AlphaCor™. Methods  A retrospective review of six patients with a history of corneal opacification treated with keratoprosthesis surgery. AlphaCor™ synthetic cornea was implanted into the corneal stroma. During the follow-up time, slit-lamp and ultrasound examinations, best corrected visual acuity (BCVA), and intraocular pressure measurements were performed. Results  Six eyes with corneal scarring and vascularizations in three to four quadrants of six patients to years of age underwent a keratoprosthesis procedure. The follow-up time was 13–36 months; mean 23 months. The operation procedure was not limited by severe complications. The preoperative BCVA was hand movement to light perception. The postoperative BCVA ranged between 20/200 and 80/100. Intraocular pressure was controlled in all cases. Three patients developed a melting of the anterior corneal lamella. The keratoprosthesis had to be explanted (15–34 months after implantation) and was replaced by a donor cornea. Conclusions  Further evaluation is needed to evaluate the role of AlphaCor™ as a keratoprosthesis.     

Vitreoretinal surgery for retained lens fragments after phacoemulsification

PURPOSE: To evaluate the prognostic factors, effect of timing and outcomes of vitreoretinal surgery for removal of retained lens fragments after phacoemulsification. METHODS: A retrospective review of 43 eyes of 43 patients who had vitreoretinal surgery for retained lens fragments after phacoemulsification, between January 1998 and November 2000. RESULTS: Seven of the 43 patients underwent vitrectomy on the same day as cataract surgery, 20 in the first week, and 23 after the first week, with a mean of 14.8 days (0-90). Initial visual acuity was < or = 20/400 in 27 (75%, n=36) and intraocular pressure (IOP) > or = 25 mmHg in 22 (61%, n=36) eyes with or without medication. The mean preoperative IOP was 27.4 mmHg. Initial ocular findings included moderate or severe corneal edema in 17 patients (40%), uveitis in 14 (33%), retinal detachment in 1 (2%) and vitreous hemorrhage in 2 (5%). After a mean follow-up of 8.4 months, final best-corrected visual acuity (BCVA) was > or = 20/40 in 24 patients (56%) and < or = 20/400 in 7 (16%). Persistent corneal edema (one eye), cystoid macular edema (four eyes), age-related macular degeneration (one eye) and suprachoroidal hemorrhage (one eye) were the causes of BCVA < or = 20/400. Final mean IOP was 15.2 mmHg and only one case had IOP > 25 mmHg. Uveitis disappeared in all cases (p<0.001), and corneal edema persisted in only one eye. Both the BCVA and IOP differences were significant (p<0.001), but no correlation was found between pre- and postoperative BCVA and IOP as regards vitreoretinal surgery timing, posterior or anterior removal sites and IOL implantation sites or procedures. CONCLUSIONS: Vitreoretinal surgery is effective for removing retained lens fragments after phacoemulsification, lowering the IOP and reducing the uveitic reaction and corneal edema. BCVA > or = 20/40 can be reached in at least half the patients.     

Combined penetrating keratoplasty and vitreoretinal surgery with silicone oil: a 1-year follow-up

BACKGROUND. The aim of this study was to assess the functional outcome of eyes with corneal and vitreoretinal diseases following combined surgical procedures (pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty with intravitreal silicone oil tamponade) and to evaluate the factors preserving the clarity of grafts. METHODS. Fifty-three eyes from 49 consecutive patients, operated on between 1991 and 1998 and followed up for at least 12 months, were evaluated retrospectively. The evaluation focused on ocular history, visual acuity (VA), intraocular pressure, anterior and posterior anatomical outcome, and complications. RESULTS. The average follow-up was 28.4 months+/-18.8 months (range 12-84 months); at the final visit 58% of the eyes had better VA, and 73% had equal or better acuity; the cornea remained clear in 68% of the eyes. A decrease in VA was caused by: loss of light perception in 2 eyes, one of which had to be enucleated because of painful phthisis; hypotony or phthisis in 23 eyes; recurrent retinal detachment in 4 eyes that were operated because of trauma; and immunological reaction in 2 eyes. Preoperative factors that contributed to a clear graft, but were not significant, were: lack of trauma (74%), no actual silicone oil filling (78%), preoperative VA of hand movement or better (79%), and attached retina (73%). Further surgery was needed in 55% of cases. The risk of transplant failure was significantly lower in eyes that did not undergo additional surgery (p=0.0001). CONCLUSION. The long-term results of combined surgery with penetrating keratoplasty in eyes that would otherwise be untreatable is often limited by anterior segment complications, mainly secondary graft failure and ciliary body malfunction. For optimal preservation of graft clarity, stable ocular status should be achieved before transplantation to minimize the necessity for further surgery.     

超声乳化吸除联合小梁切除术治疗白内障合并青光眼的临床分析

目的分析白内障超声乳化吸除及人工晶状体植入联合小梁切除术治疗青光眼合并白内障的疗效,探讨其并发症的处理方法。方法随机对23例（23只眼）青光眼合并白内障的患者行白内障超声乳化吸出及人工晶状体植入联合小梁切除术,同时观察术中及术后并发症。结果术后随访6～18个月,术后1个月最佳矫正视力≥0.5者7只眼（30.4%）;0.1～0.4者11只眼（47.8%）,≤0.1者5只眼（21.9%）。20只眼眼压控制在正常范围（87%）,3只眼需用降眼压药物配合治疗（13%）。术中发生后囊破裂伴玻璃体脱出1只眼,术后角膜水肿7只眼,虹膜损伤1只眼,瞳孔变形5只眼。结论对青光眼合并白内障患者,行白内障超声乳化吸除及人工晶状体植入联合小梁切除术是安全有效的。而充分认识其并发症,掌握处理要点,是保证手术成功的关键。     

临时人工角膜用于玻璃体切除术

目的 探讨临时人工角膜（ＴＫＰ）用于玻璃体切除术治疗严重眼外伤的意义。方法 以ＴＫＰ取代浑浊角膜后，行闭合式玻璃体切除术。最后行穿透性角膜移植术，治疗外伤性玻璃体视网膜病变合并角膜浑浊８眼，结果首次手术成功率７／８，随访２至１０月，平均４月，视力进步７眼，下降１眼，最佳者随访半年维持０．３。结论 应用ＴＫＰ，一期重建眼球结构，恢复部分视功能，为此类病例的盲眼复明提供了新途径。     

Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage

PURPOSE: To evaluate the efficacy of autologous limbal transplantation (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction and corneal clarity recovery in eyes with severe late-stage chemical or thermal burns. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-nine eyes of 39 patients with a history of severe chemical or thermal burns over 6 months (mean, 47 +/- 28.7 months) exhibiting corneal vascularization, conjunctivalization, and heavy corneal scarring were treated at two university hospitals. METHODS: Surgical procedures included excising epibulbar fibrous tissue, clearing the fibrovascular membrane over the cornea, deep removal of corneal stroma 7.5 to 8.0 mm in diameter, exposing Descemet's membrane in the pupillary area, grafting a corneal button, transplanting autologous limbal and conjunctival epithelial grafts, and making a temporary tarsorrhaphy. MAIN OUTCOME MEASURES: Integrity of ocular surface recovery, postoperative corneal epithelial stability, optical corneal clarity, and best-corrected visual acuity were the outcome measurements. RESULTS: Thirty-four of 39 eyes that received ALT combined with DLK met the criteria of the study. Of 34 operated eyes, full corneal epithelialization was achieved in 19 eyes (55.9%) within 5 days and in 32 eyes (94.1%) within 7 days after surgery. Delayed epithelial healing occurred in two eyes (5.9%). The reconstructed corneal surface remained stable, and the renewed epithelium was characterized cytologically by nonkeratinized squamous cells without goblet cells. After surgery in 11 of 34 eyes, fluid was identified between Descemet's membrane and the donor corneal graft, resulting in a pseudochamber that completely resolved in 10 eyes within 30 days. In one patient, a persistent pseudochamber was present for 28 months. After surgery, transparent cornea especially in the pupillary area was accomplished in 29 eyes, whereas mild cornea clouding, nebulomacular corneal opacity, and heavy corneal scarring were observed, respectively, in three eyes. In addition, corneal endothelial decompensation was identified in two eyes and demonstrated persistent corneal epithelial and stromal edema. Remarkable improvement of postoperative vision was achieved in 30 eyes. Four eyes without postoperative improvement in vision were regrafted by penetrating keratoplasty at least 6 months after the original ALT and DLK surgery. CONCLUSIONS: Autologous limbal grafting combined with DLK simultaneously can restore a normal and stable ocular surface, create clear central cornea, and remarkably enhance visual acuity after severe chemical or thermal burns.     

AlphaCor人工角膜移植治疗兔角膜碱烧伤

目的评价AlphaCor人工角膜移植对兔角膜碱烧伤的治疗效果。方法用1mol/LNaOH烧伤兔左眼建立角膜碱烧伤模型,选择角膜白斑、角膜缘新生血管〉2个象限的5只兔眼行人工角膜移植术。AlphaCor人工角膜移植手术分2期进行：Ⅰ期手术,将AlphaCor人工角膜植入角膜板层间;Ⅱ期手术,暴露人工角膜光学区。术后观察人工角膜、受体角膜及眼前节情况。结果碱烧伤后2～6周形成带新生血管的角膜白斑。Ⅰ期术后5例人工角膜均在位,2例人工角膜出现白色沉积物,其中1例并发角膜浅层基质溶解,另3例无并发症发生。Ⅱ期手术中麻醉死亡1例,其余术后人工角膜均在位,1例术后6周发生角膜感染、穿孔,另3例术后4～6周发生人工角膜前膜增生,未见其他并发症发生。结论 AlphaCor人工角膜移植治疗兔角膜碱烧伤具有良好的生物相容性,效果较好。     

Corneal endothelial cell loss after multiple vitreoretinal procedures and the use of silicone oil

BACKGROUND AND OBJECTIVE: Corneal decompensation and complications are a frequent cause of visual loss after vitreoretinal surgery. This paper presents data regarding endothelial cell loss in aphakic and pseudophakic silicone oil filled eyes when oil was retained for many months. This study updates our previous investigation on the subject. PATIENTS AND METHODS: The corneal endothelial cell count of 10 eyes of 10 consecutive patients who had undergone vitreoretinal surgery, including fluid-gas exchange and ultimately silicone oil placement, were obtained. The patients underwent an average of 2.7+/-0.9 vitreoretinal procedures before the final procedure which induced the placement of silicone oil in the vitreous cavity. All had inferior iridectomies. The endothelial cell density measurements were obtained an average of 1 year after silicone oil placement. In all eyes, the oil was felt necessary for long term tamponade and therefore was not removed. The cell density of the operated eye was compared to the fellow eye, none of which had undergone silicone oil placement. RESULTS: Both gas and retained silicone oil contribute to the loss of corneal endothelial cell density. The average endothelial cell loss in the 10 eyes with oil retained for an average of 10+/-12 months was 68.8 +/-31.4%, as compared to the fellow eye. The average cell loss was higher in the three eyes with silicone oil in the anterior chamber (range 44 to >95%). Pseudophakic eyes fared better, on average, than aphakic eyes (51.66+/-28% vs. 66.63+/-26.3%) with respect to cell loss. Five aphakic eyes and 1 pseudophakic eye developed corneal edema. CONCLUSIONS: Endothelial cell loss occurs after vitreoretinal surgery and is exacerbated by long term silicone oil retention. The corneal endothelial cell damage is probably cumulative from procedure to procedure. Endothelial cell loss may be pronounced in eyes without a physical barrier between the anterior segment and the vitreous cavity, and in eyes where oil migrates into anterior chamber.     

Anterior segment complications after phacoemu-lsification combined vitrectomy and foldable intraocular lens implantation

AIM: To evaluate the anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. METHODS: This retrospective study was consisted of 285 eyes of 238 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity, the preoperative data, and the anterior segment complications at postoperative 6 to 72 months. RESULTS: The most common indications for surgery were non-diabetic vitreous hemorrhage, proliferative diabetic retinopathy. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. Postoperatively, in 245 eyes (85.9%), visual acuity improved by 3 lines or more on the Snellen chart. In 24 eyes (8.4%), vision remained within 3 lines of preoperative levels and in 16 eyes (5.6%), vision had decreased at the last follow-up. The most common anterior segment pathological change was PCO in 50 eyes (17.5%), the second was corneal edema in 32 eyes (11.2%) and the third was elevated IOP in 31 eyes (10.8%). CONCLUSION: The combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective.     

人工角膜在治疗严重化学烧伤眼中的研究

目的探讨严重化学烧伤性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择2000年10月至2006年3月于解放军总医院眼科就治的28例因严重化学烧伤导致双眼盲目患者的单侧眼,术前视力14只眼为手动,14只眼为光感,并且角膜混浊病变无法采用常规角膜移植手术达到复明目的。其中严重碱烧伤20只眼,严重酸烧伤8只眼。人工角膜植入术分两期：Ⅰ期手术将人工角膜支架植入角膜层间,所选患眼行角膜表面或层间加固性手术。3个月后行Ⅱ期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果Ⅱ期术后观察3—65个月,平均22．6个月,28只眼中有21只眼裸眼视力≥0．05（75％）,其中2只眼裸眼视力≥1．0。经镜片矫正后,11只眼（39％）视力为0．6—1．2;1只眼（4％）0．3～0．5;5只眼（18％）0．05—0．25;3只眼（11％）手动;3只眼（11％）光感;1只眼（4％）无光感。手术并发症包括分离角膜板层时穿人前房,晶状体皮质残留,继发性青光眼,镜柱前表面组织或上皮增生遮盖,镜柱后壁沉着物,角膜溶解,眼内炎,视网膜脱离。结论人工角膜是目前对严重角膜瘢痕、血管化的双眼化学烧伤患者有效的复明手段。该术式结合自体结膜遮盖、自体骨膜移植加固及睑裂部分缝合等,有利于人工角膜的长期存留。术后定期复查、积极预防并发症是保持视力的有效手段。     

Amniotic membrane transplantation in acute chemical and thermal injury

PURPOSE: To present a case of chemical injury and a case of thermal injury treated by amniotic membrane transplantation in acute phase. METHODS: Case reports. An eye with sodium hydroxide injury, opaque cornea, and limbal ischemia of more than 180 degrees and an eye with hot tea injury, opaque cornea, stromal edema, and scarring were treated by amniotic membrane transplantation within the first few weeks of injury. RESULTS: In the eye with sodium hydroxide injury, 4 months after amniotic membrane transplantation, the ocular surface is stable, superficial corneal scarring with vascularization is present, and visual acuity is 20/25. In the eye with thermal injury, 6 months after amniotic membrane transplantation, the ocular surface is stable, but there is superficial scarring and vascularization, and visual acuity is 20/20. CONCLUSIONS: Amniotic membrane transplantation can be considered in chemical injury with severe limbal ischemia and in severe thermal injury in acute phase. Long-term studies are warranted to evaluate further the efficacy of amniotic membrane transplantation in these clinical situations.