UBM在前房型有晶状体眼人工晶状体治疗高度近视中的应用

目的应用超声生物显微镜(UBM)观察高度近视患者植入有晶状体眼6H2型前房型人工晶状体(PAC-IOL)的位置及与邻近结构的解剖关系。方法15例(29眼)高度近视患者植入PAC-IOL。术前应用UBM测量前房深度,术后3个月,观察IOL襻的位置,测量中央及周边6点、12点处IOL与角膜内皮的距离,IOL与晶状体的距离,IOL边缘与虹膜的距离。结果术前前房深度为3.11～3.52mm。术后3个月,IOL襻均位于前房角,中央及周边6点、12点处IOL与角膜内皮的距离分别为(2.341±0.116)、(1.601±0.025)、(1.601±0.028)mm;IOL中央与晶状体的距离为(0.841±0.140)mm;IOL边缘与虹膜的距离为(0.346±0.046)mm。结论Phakic6H2PAC-IOL与角膜内皮和晶状体保持有效的安全距离。其弹性支撑襻均位于前房角。IOL襻向后作用于虹膜和前房角,有可能导致临床上发生瞳孔变形。     

虹膜夹固定型前房人工晶状体植入术治疗高度近视

目的:探讨虹膜夹固定型前房人工晶状体植入术治疗高度近视的疗效和安全性。方法:对7例13眼高度近视患者行虹膜夹固定型前房人工晶状体植入术。术后观察患者视力、眼压、角膜内皮细胞计数,瞳孔活动度、人工晶状体的位置及并发症。结果:患者13眼均成功植入人工晶状体。术后7d裸眼视力优于术前最佳矫正视力10眼(77%);术后12mo,裸眼平均为0.6±0.2,优于术前最佳矫正视力0.4±0.1,差异有统计学意义(P<0.05)。术后眼压和角膜内皮细胞计数与术前对比无统计学意义(均P>0.05);人工晶状体光学部分位置居中,所有患者的瞳孔对光反应均正常,所有患者无白内障、角膜内皮失代偿等并发症,有2眼于术后3～4wk出现糖皮质激素性青光眼,仅1例于术后6mo发生单眼视网膜脱离。结论:虹膜夹固定型前房人工晶状体植入术是一种矫正高度近视安全有效地手术方式。但远期效果需进一步观察。     

虹膜夹持型前房人工晶状体植入矫正超高度近视

目的 探讨虹膜灾持犁前房人工晶状体植入矫正超高度近视的临床效果.方法 对10例(19眼)超高度近视(-15.50D～-30.00D)进行虹膜央持犁前房人工晶状体(AMO)植入术,观察手术前后屈光状态、裸眼视力、眼压、瞳孔形态、角膜内皮细胞计数及人工晶状体位置.结果 19眼超高度近视通过植入虹膜夹持型前房品状体,全部达到术前最佳矫正视力,其中18眼超过术前最佳矫正视力1～3行.术前裸眼视力0.02～0.1,术后裸眼视力0.3～1.0.1眼因虹膜弹性差,术后发生瞳孔轻度变形人工晶状体前倾,手术后复位,其余患者均无特殊.结论 作为屈光性手术的虹膜夹持型前房人工晶状体植入术,用于矫正超高度近视,可获得满意的临床效果.由于其具有术后视力恢复迅速、屈光度稳定、并发症较少并且具有良好的可预测性的特点,所以是目前不宜行准分子角膜屈光手术的超高度近视的一种有效的手术矫正方法.     

有晶状体眼前房型人工晶状体植入治疗高度近视疗效观察

目的 观察有晶状体眼前房型虹膜固定人工晶状体植入治疗高度近视的临床疗效.方法 对11例(17只眼)高度近视患者进行术前虹膜YAG激光周边切除,1周后接受有晶状体眼Verisyse前房虹膜固定型人工晶状体植入手术,观察术后的裸眼视力、最好矫正视力、眼压、角膜及前房内炎症变化情况.结果 11例(17只眼)均顺利在前房内植入虹膜固定的人工晶状体,其中1只眼术后第3天发现人工晶状体单侧脱位再次手术固定.术后所有患者视力较术前均增加,裸眼≤0.5者3只眼,>0.5者14只眼.16只眼眼压术后检查正常,1只眼术后眼压升高至25 mm Hg,局部加用0.5%噻吗心胺点眼,2 d后眼压恢复正常.术后所有患者角膜透明,无内皮水肿的情况.13只眼出现前房轻度闪辉,4只眼前房可见较多的炎性细胞,用药后很快控制.结论 高度近视患者有晶状体眼前房植入虹膜固定型人工晶状体是一种较好的矫正视力方法,但其远期疗效及并发症有待进一步观察.     

高度近视眼透明晶状体置换手术后眼前节结构变化的临床观察

目的:通过超声生物显微镜观察高度近视眼透明晶状体置换手术后眼前节结构的变化。方法:对20例36眼以矫正高度近视为目的高度近视患者,行透明晶状体超声乳化吸除联合折叠式人工晶状体植入手术。术前和术后1mo分别应用超声生物显微镜(ultrasound biomicroscopy,UBM)测量前房深度(anterior chamber depth,ACD)、前房角开放距离(angle opening distance,AOD)和前房角开放度数(anterior angle,AA)。结果:患者术后1mo的ACD,AOD,AA与术前相比有显著性差异(P=0.000),术后房角宽度、前房深度明显大于术前;眼轴与术后、术前前房深度的差值呈负相关(r=-0.711,P=0.000)。结论:高度近视患者行超声乳化透明晶状体吸除联合折叠式人工晶状体植入术,术后前房加深,房角增宽,眼轴与术后、术前前房深度的差值呈负相关。     

两种矫正高度近视虹膜夹型人工晶状体植入后眼内稳定评价

目的 评估两种虹膜夹型有晶状体眼人工晶状体(ICPIOL)矫正超高度近视植入后的稳定性和安全性.方法 选取超高度近视患者8例16只眼,依据度数1只眼植入硬性型ICPIOL;另眼植入折叠型ICPIOL.术后随诊3月,使用Pentacam前房分析仪分别评估人工晶状体距离中心角膜和距离自然晶状体之间的距离;使用角膜内皮测量仪,分别测量术前术后角膜内皮细胞记数,以评估其安全性及眼内稳定性.结果 术后3个月裸眼视力6只眼(38%)≧1.0,10只眼(63%)≧0.5.最佳矫正视力7只眼(44%)≧1.0,16只眼(100%)≧0.5.术后15只眼最佳矫正视力均达到并超过术前最佳矫正视力,11只眼(69%)提高视力表两行.角膜内皮至IOL光学部前表面距离为(2.04±0.38)mm.IOL后表面与自然晶状体间的距离为(0.76±0.15)mm.两种ICPIOL相比各组数据差异无统计学意义(P＞0.05).结论 两种ICPIOL术后眼内稳定性好,但还应长期随诊观察.     

有晶状体眼前房型人工晶状体植入矫治高度近视临床观察

目的:观察有晶状体眼Verisyse前房虹膜夹型人工晶状体植入矫治高度近视术后的视力、屈光状态以及相关并发症,评价其临床应用价值。方法:自2006-07/2008-07接受Verisyse人工晶状体植入术的32例48眼,术前平均球镜当量-15.65±3.41D。统计术后6mo;1a裸眼视力,最佳矫正视力、屈光度、内皮细胞计数,分析并发症的发生情况。结果:术后裸眼视力:0.4～1.0,平均0.75±0.34。术前最佳矫正视力:0.3～1.0,平均0.58±0.27,术后最佳矫正视力0.64±0.30。达到术前矫正42眼(87.5%),超过术前最佳矫正视力14眼(29.2%),随访6mo;1a,无明显变化。术前屈光平均球镜当量-15.65±3.41D;术后屈光度数平均球镜当量-1.58±2.47D。角膜内皮细胞计数术前(3108±265)个/mm2,术后6mo为(3054±317)个/mm2,差异无统计学意义。未见威胁视力的并发症。结论:有晶状体眼前房虹膜夹型人工晶状体植入矫治超高度近视安全有效,术后屈光效果令人满意。对眼内的长期影响需要进一步观察。     

高度近视眼ICL植入术后Pentacam眼前节全景分析仪观察

目的:Pentacam眼前节全景分析仪观察高度近视眼植入后房型有晶状体眼人工晶状体(implantable collamer lens,ICL,STAAR公司,瑞士)后眼前节的改变。方法:收集我院2009-10/2010-02高度近视眼行ICL植入手术患者8例12眼。术后随访平均3.8mo。Pentacam眼前节全景分析仪对术前、术后前房深度、ICL拱高等参数进行测量,同时记录术前、术后裸眼视力,最佳矫正视力等数据。结果:术前前房深度3.01～3.46(平均3.24±0.11)mm,术后3mo时,前房深度2.01～2.67(平均2.39±0.18)mm,拱高0.34～0.74(平均0.52±0.11)mm,ICL与透明晶状体等其他周围组织没有接触,没有引起房角关闭。术后3mo,UCVA与术前BCVA比较,有统计学差异(t=2.237,P=0.047)。未发现白内障、黄斑囊样水肿、视网膜脱离等严重并发症。结论:ICL术后前房变浅,但与正常晶状体之间拥有安全的间隙。ICL植入治疗高度近视眼安全、有效。     

超高度近视有晶状体眼前房负镜植入的临床效果观察

目的　研究前房负镜植入矫正高度近视的临床效果。方法　共选择 11例高度近视患者 ,共 2 0只眼。屈光度数最高 - 2 9D,最低 - 9.4 5 D。术前进行眼轴长度、前房深度、角膜直径、角膜内皮计数、裸眼视力、矫正视力检查。计算人工晶状体度数。然后显微手术操作 ,植入前房型人工晶状体。术后随访观察裸眼视力、最佳矫正视力、眼压、角膜内皮计数、前房反应、人工晶状体位置、瞳孔对光反射等。结果　术后 6月平均裸眼视力 0 .7,矫正视力0 .86。取得满意的临床效果。术后主要并发症是高眼压、葡萄膜反应 ,术后第一天出现 ,通过药物治疗 ,很快控制。结论　前房负镜植入矫正高度近视 ,尤其是高于 - 12 D的超高度近视 ,临床效果令人满意 ,术后并发症多为术后短期出现 ,及时治疗 ,不影响预后视力的改善     

透明角膜切口有晶状体眼虹膜夹型人工晶状体植入治疗高度近视

目的：研究透明角膜切口有晶状体眼虹膜夹型人工晶状体植入治疗高度近视的临床疗效和安全性。

方法：对20例28眼高度近视患者表面麻醉下行透明角膜切口虹膜夹型人工晶状体植入术,观察术中和术后并发症、术后视力、眼压、屈光度数、角膜内皮计数、人工晶状体稳定性及晶状体混浊情况。

结果：高度近视患者28眼均顺利植入了虹膜夹型人工晶状体,术中无并发症发生,术后裸眼视力均达到或超过术前最佳矫正视力。术后随访6mo,所有植入的人工晶状体均基本位于正位,无明显倾斜、偏位。未发现白内障、葡萄膜炎、黄斑囊样水肿及视网膜脱离等并发症。

结论：在具备熟练的眼科显微手术技巧的前提下,有晶状体眼虹膜夹型人工晶状体植入,有较好的预测性及稳定性,可获得满意的术后视力,术后并发症较少,是治疗高度近视患者安全、有效的方法。     

Ultrasound biomicroscopy of the iris-claw phakic intraocular lens for high myopia

PURPOSE: To study the in situ relative intraocular position of the Ophtec Artisan iris-claw phakic intraocular lens (PIOL) for high myopia using ultrasound biomicroscopy. METHODS: Three PIOLs (13.00, 17.00 and 18.00 D lens powers) were implanted in phakic myopic eyes. Using ultrasound biomicroscopy, echograms were taken in the anterior chamber to measure the preoperative anterior chamber depth, postoperative distance between the PIOL and the corneal endothelium (endothelial-optic distance), and the postoperative distance between the PIOL and the crystalline lens. RESULTS: Preoperative anterior chamber depth ranged from 3.10 to 3.40 mm and the postoperative endothelial-optic distance measured 2.11 to 2.44 mm. The distance between the crystalline lens and the posterior surface of the IOL ranged from 0.78 to 0.93 mm. Several echograms revealed the position of the PIOL on the iris. The pigment layer of the iris did not seem to be disturbed by the presence of the PIOL. CONCLUSION: The original anterior chamber depths were reduced by 28% to 34% after implantation. The PIOL-crystalline lens distance ranged from 0.78 to 0.93 mm. This study of 3 eyes revealed that echograms taken by ultrasound biomicroscopy are useful in verifying the intraocular position of the PIOL within the anterior chamber.     

Ultrasound Biomicroscopy of Iris-claw Phakic Intraocular Lens Implantation

Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.     

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses

PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. CONCLUSIONS: The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.     

应用Pentacam三维眼前段分析仪对虹膜夹型人工晶状体植入术后的研究

目的 应用Pentacam术后追踪测量虹膜夹型有晶状体眼人工晶状体(PIOL)中央和周边部与角膜内皮和自然晶体之间的距离,倾斜度、偏心值以及前房深度的变化,评价其在前房的位置.方法 收集自2006年1月以来接受虹膜夹型人晶状体植入术的22例33只眼.术后6个月全部患者行Pentacam检查,测量VRSM50和VRSM60两组不同类型虹膜夹型PIOL中央和周边部与角膜内皮和自然晶体之间的距离,并测量术后1d、1、3及6个月人工晶状体的偏心量、倾斜度及前房深度值.结果 角膜内皮至PIOL光学部前表面距离为(1.94±0.36)mm.PIOL后表面与自然晶状体间的距离为(0.76±0.12)mm.分别比较各组在不同时期的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).在术后1d、1、3及6个月,比较2组的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).结论 Pentacam三维眼前段分析仪为PIOL植入术后提供高质量的Scheimpflug摄像,可以为有晶状体眼前房型人工晶状体提供精确的眼内定位,在这一方面具有重要的临床应用价值.     

Ultrasound biomicroscopy of the Artisan phakic intraocular lens in hyperopic eyes

PURPOSE: To study in situ the intraocular position of the Artisan iris-claw intraocular lens (IOL) (model 203) (Ophtec) in phakic hyperopic eyes using ultrasound biomicroscopy (UBM). METHODS: Echograms of the anterior chamber were taken preoperatively and 24 to 317 days postoperatively in 4 eyes implanted with the Artisan IOL (power +4.0 to +6.0 diopters). The preoperative anterior chamber depth (ACD) and the postoperative distance between the IOL and the corneal endothelium (endothelium-optic distance) and between the IOL and the lens were measured. The echograms were assessed for the effect of the IOL on iris tissue. RESULTS: The preoperative ACD ranged from 3.10 to 3.56 mm and the postoperative endothelium-optic distance, from 2.03 to 2.54 mm. The distance between the lens and the posterior surface of the IOL ranged from 0.35 to 0.79 mm. Several UBM echograms showed indentation of iris tissue by the IOL haptics and optic edge, although no pigmentary dispersion was noted. CONCLUSIONS: Adequate space was maintained between the Artisan hyperopic IOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris, which could lead to pigment erosion, was observed. Preoperative gonioscopy and maintenance of normal intraocular pressure postoperatively suggest the indentation was secondary to inadequate lens vaulting relative to the high natural arch of the iris in hyperopic eyes. Shortening the haptics or increasing the lens vault might resolve this problem.     

Position of myopic iris-claw phakic intraocular lens by Scheimpflug photography and ultrasound biomicroscopy

PURPOSE: To evaluate the position of iris-claw phakic intraocular lens (ICPIOL) in highly myopic eyes by Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM). METHODS: Nine eyes of five patients aged 31+/-10 years with average spherical equivalent of -16.04+/-5.46 D (range -7.88 to - 22.88 D) were enrolled in this prospective study and implanted with Verisyse ICPIOLs (AMO). The anterior segment was evaluated by SP and UBM preoperatively and for at least 1 month postoperatively. The statistical significance may be questionable due to the limited number (nine) of eyes. RESULTS: By SP and UBM, the distance between corneal endothelium and lens (anterior chamber depth) preoperatively was 3.10+/-0.14 and 3.07+/-0.11 mm, respectively; between ICPIOL and corneal endothelium (pseudo-anterior chamber depth), 1.88+/-0.09 and 1.99+/-0.12 mm, respectively; between lens and posterior surface of ICPIOL (IL), 0.76+/-0.13 and 0.67+/-0.06 mm, respectively; between superior optic edge and iris (SOEI), 0.23+/-0.23 and 0.58+/-0.24 mm, respectively; between inferior optic edge and iris (IOEI), 0.07+/-0.13 and 0.41+/-0.22 mm, respectively; between ICPIOL haptics and the angle of anterior chamber (HA), 0.90+/-0.17 and 1.45+/-0.13 mm, respectively. ACD was well correlated between the two methods, but PACD, IL, OEI, HA were not. The postoperative measures, except IL, were significantly different between the two methods. CONCLUSION: The differences between measurements by SP and UBM reveal the ICPIOL's position variations with change of body position. Nevertheless, it seems adequate that space is maintained between ICPIOL and corneal endothelium, angle, and crystalline lens. The ICPIOL implanted in phakic eyes seems a safe alternative for treatment of high myopia.     

Ultrasound biomicroscopy of ZSAL-4 anterior chamber phakic intraocular lens for high myopia.

PURPOSE: To evaluate the intraocular location and anatomic relationship to other structures of the ZSAL-4 angle-supported anterior chamber phakic intraocular lens (IOL) for high myopia using ultrasound biomicroscopy (UBM). SETTING: Clínica de Nuestra Se?ora de la Concepción, Fundación Jiménez Díaz, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Madrid, Spain. METHODS: Eight phakic myopic eyes corrected by ZSAL-4 angle-supported anterior chamber phakic IOLs were examined by UBM. The distance between the corneal endothelium and the IOL at the central and peripheral cornea and between the phakic IOL and the iris was measured. RESULTS: The mean distance between the central cornea and the IOL was 2361.37 microm +/- 109.62 (SD); between the edge of the IOL optic and the endothelium, 1646.24 +/- 27.06 microm; and between the IOL and the iris, 354.46 +/- 41.61 microm. The IOL footplates appeared to be correctly positioned in the anterior chamber angle in all eyes. CONCLUSION: The space between the IOL and the endothelium was greater in eyes with the ZSAL-4 angle-supported phakic IOL than in eyes with other angle-supported phakic IOLs. The possibility of intermittent contact between the IOL edge and the midperipheral cornea plays a minor role in the mechanism of endothelial damage with this lens model.     

有晶状体眼悬浮型后房型人工晶状体植入治疗高度近视

目的观察和探讨悬浮型后房型有晶状体眼人工晶状体（PC-PRL）植入术治疗高度近视的效果及安全性。方法回顾性病例研究。38例（68眼）高度近视患者（近视度为-11.25～-20.00 D）植入PC-PRL。术前及术后1周、1个月、3个月、6个月对患者的视力、眼压、角膜内皮细胞计数、前房深度及PC-PRL位置进行观察。采用重复测量方差分析比较PIOL术后不同时间段的等效球镜的差异。结果术后6个月时,所有患者UCVA均≥4.7,达到或高于术前BCVA（F=6.813,P<0.01）;术后7例（10眼）早期眼压升高,经降眼压治疗后眼压正常;术后前房深度较术前有所下降（F=32.952,P＜0.01）,小梁虹膜水平/垂直夹角、房角开放距离、拱高均无明显变化（P＞0.05）,未见虹膜膨隆,房角阻滞;术后PIOL位置稳定,与晶状体距离稳定。结论PC-PRL植入术治疗高度近视效果确切,预测性好,手术安全。     

Pigment dispersion and Artisan phakic intraocular lenses: crystalline lens rise as a safety criterion

PURPOSE: To validate the theory that crystalline lens rise can be used as a safety criterion to prevent pigment dispersion in eyes with an Artisan phakic intraocular lens (IOL) (Ophtec BV). SETTING: Monticelli Clinic, Marseilles, France. METHOD: A comparative analysis of crystalline lens rise in 9 eyes with pigment dispersion and 78 eyes without dispersion was performed. All eyes had previous implantation of an Artisan IOL. Anterior segment imaging was done using an anterior chamber optical coherence tomography (AC OCT) prototype. Crystalline lens rise was defined by the distance between the anterior pole of the crystalline lens and the horizontal plane joining the opposite iridocorneal recesses. RESULTS: The study confirmed that crystalline lens rise can be considered a safety criterion for implantation of Artisan-type phakic IOLs. The higher the crystalline lens rise, the greater the risk for developing pigment dispersion in the area of the pupil. This complication occurred more frequently in hyperopic eyes than in myopic eyes. Results indicate there is little or no risk for pigment dispersion if the rise is less than 600 microm; 67% of eyes with a rise of 600 microm or more developed pupillary pigment dispersion. In some cases in which the IOL was loosely fixated, there was no traction on the iris root and dispersion was prevented or delayed. CONCLUSIONS: Crystalline lens rise should be considered a new safety criterion for Artisan phakic IOL implantation and should also be applied to other types of phakic IOLs. The distance remaining between the crystalline lens rise and a 600 microm theoretical safety level allows one to calculate how long the IOL can safely remain in the eye.