白内障超声乳化术后混浊人工晶状体置换术

目的探讨白内障超声乳化术后人工晶状体(intraocular lens,IOL)混浊的原因与治疗方法 ,研究改良手术方式以减少手术并发症。方法收集2001年8月至2011年1月在我院因超声乳化白内障吸出联合Hydroview H60M IOL植入术后远期IOL发生混浊的患者14例,在表面麻醉下行IOL置换术,比较术前与术后最佳矫正视力。术中采用IOL剪碎法、旋转法等方式将IOL取出,重新植入STAAR公司疏水性KN-X IOL。将取出的IOL在显微镜下进行观察拍照,用钙特异性茜素红染色并进行病理检查,与未使用的Hydroview H60M IOL对比观察。结果所有病例均成功实施IOL置换术,术后视力为0.4~1.0,有10例IOL重新植入囊袋内,有4例置换的IOL植入睫状沟内。术中晶状体后囊膜破裂1例、晶状体襻残留1例、睫状体出血2例、黄斑囊样水肿2例。混浊IOL茜素红染色呈阳性反应,光学部表面有粗糙的着色颗粒,光学部内有细小颗粒所组成的云雾状或团状着色区。结论 IOL混浊与IOL材质、IOL表面钙离子富集有关,IOL置换术是改善IOL混浊患者视力的有效方法 ,术中使用改良技术可以减少手术期并发症的发生。     

Pigment deposits on hydrophilic intraocular lenses after phacoemulsification cataract surgery

A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery.We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24 months.Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected.To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery.     

三焦点人工晶状体植入术后的早期临床效果

目的评价白内障超声乳化联合三焦点人工晶状体（IOL）植入术后的早期临床效果。方法前瞻性自身前后对照研究。选择在大庆油田总医院行白内障超声乳化联合三焦点IOL植入术患者24例（26眼）,术后随访3个月,分别观察术前,术后1周、1个月、3个月的裸眼远视力、裸眼中距离视力和裸眼近视力,以及离焦曲线、对比敏感度（CS）和全眼像差。对手术前后各参数进行重复测量的方差分析。结果三焦点IOL植入术后所有患者1周、1个月、3个月时远、中、近距离均可获得0.3 LogMAR以上的较好视力。术后各距离视力较术前显著提高（P＜0.05）。术后3个月时裸眼远视力接近0 LogMAR,且+1.5~-4.0 D离焦下视力均优于0.3 LogMAR;CS可见术后1周时明视眩光分辨率最好,明视、暗视的分辨率较明视眩光差,暗视眩光分辨率最差,差异有统计学意义（P＜0.05）;术后1周、1个月、3个月时总像差、总低阶像差、离焦深度、散光均较术前明显降低,差异有统计学意义（P＜0.05）。结论三焦点IOL提供了远、中、近兼顾的全程视力,术后视觉质量良好。     

Control of intraocular inflammation after cataract surgery: New perspectives

Anti-inflammatory treatment is routinely prescribed to all patients after cataract surgery to prevent intraocular inflammation. A review of the literature was conducted to determine the optimal control of postcataract surgery inflammation. Intraocular steroid delivery systems, safer steroids, and nonsteroidal anti-inflammatory drugs have been found to be beneficial. Selective cyclooxygenase-2 inhibitors may circumvent many side effects of the earlier agents. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Early outcomes of vision and objective visual quality analysis after cataract surgery with trifocal intraocular lens implantation

AIM: To investigate the early outcomes of vision, objective visual quality and their correlation after cataract surgery with trifocal intraocular lens implantation. METHODS: The visual examination and objective visual quality analysis using Optical Quality Analysis System (OQAS) at 1mo and 3mo, and defocus curve examination at 3mo were performed in 20 patients (27 eyes) after phacoemulsification combined with trifocal intraocular lens implantation surgery. RESULTS: The uncorrected distant (UD), intermediate and near visual acuity (VA) were significantly improved after surgery (P<0.001). UDVA at 1mo after the surgery was slightly better than that after 3mo (P=0.026). The defocus curve after 3mo indicated that the peak of distant vision was close to 0 logMAR, and UDVA was lower than 0.3 logMAR in the range of -1.5 D to -3.0 D. The modulation transfer function (MTF) cutoff frequency, strehl ratio (SR), Optical Quality Analysis System values (OVs), includes OV100, OV20 and OV9 after the surgery were significantly better than before surgery (P<0.001), but the objective scattering index (OSI) was significantly decreased (P<0.001). UDVA at 3mo after the surgery had correlations with MTF cutoff, OSI, OV100 and OV20 (r=-0.400, 0.431, -0.437, -0.411, P=0.039, 0.025, 0.023, 0.033). The uncorrected intermediate VA after 3mo of the surgery had correlations with OSI and OV100 (r=0.478, -0.411, P=0.012, 0.033). CONCLUSION: Trifocal intraocular lens implantation can provide good distant, intermediate and near VA, and the vision shows a well correlation with objective visual quality during early surgery.     

Inert intraocular eyelash foreign body following phacoemulsification cataract surgery

INTRODUCTION: We describe the first reported case of tolerated eyelash inoculation following phacoemulsification surgery, with 4 years follow-up, that did not result in endophthalmitis or low grade chronic uveitis. CASE REPORT: A 79-year-old man with bilateral cataracts underwent phacoemulsification and posterior chamber intraocular lens implantation in the right eye. Three months later, he was found to have an eyelash within the right anterior chamber. The patient opted to leave his asymptomatic right eye alone. Four years later, he was referred to our hospital for review of his intraocular foreign body. He had remained asymptomatic with bilateral 6/6 vision, and without pain, photophobia or monocular diplopia. He declined surgery to remove the foreign body and opted for annual review. DISCUSSION: Intraocular implantation of cilia is a rare surgical complication following cataract surgery. The reaction of the eye to cilia has been reported to be variable and unpredictable, varying from absolute lack of reaction to endophthalmitis. Careful preoperative preparation can prevent similar incidents with potential complications. The position of the cilium is an important consideration. In contrast to other organic materials, a cilium is relatively inert and is rarely associated with infection. Acute inflammation most commonly occurs within days or after a few months, although the eye can tolerate the cilium for many years. Some ophthalmologists prefer observation, particularly when there is no inflammation present. We believe that each patient should be considered on an individual basis. The decision to remove an intraocular eyelash remains controversial and should be considered at the onset of inflammatory or infective clinical signs.     

Ultrasound biomicroscopic study of the stability of intraocular lens implants after phacoemulsification cataract surgery

Purpose: To assess the postoperative stability of three‐piece intraocular lens (IOL) implants using ultrasound biomicroscopy (UBM). Methods: This is a prospective observational cohort case series. Best‐corrected visual acuity (BCVA) assessment, slit lamp examination, refraction and UBM evaluation were performed preoperatively and at 1, 6, 12, 18 and 24 months postoperatively. The anterior chamber depth (ACD) and IOL tilt angles at the 12, 6, 3 and 9 o’clock meridians were assessed. Results: Twenty‐one consecutive adult patients (21 study eyes) were recruited, but two dropped out from the study. The average age during cataract surgery was 71.7 years (60–83, SD 6.0). There were very slight changes in the refraction and IOL stability characteristics at all the postoperative follow‐up time points. These were not found to be statistically significant, apart from the increase in ACD from months one (3.85 ± SD 0.29) to six (3.91 ± SD 0.26) (p = 0.01, paired t‐test). Conclusion: There was a small but statistically significant increase in ACD between the first and sixth postoperative month, but ACD remained stable thereafter. This was not associated with any significant changes in refraction or BCVA. In contrast, IOL optic tilt remained statistically unchanged throughout the 24‐month study duration.     

Control of intraocular inflammation associated with cataract surgery

Major advances in cataract extraction techniques and instrumentation have occurred over the past decade. Smaller incisions, more efficient phacoemulsifiers, and decreased surgical times are a few of the changes that have helped to alleviate postoperative inflammation, but postoperative inflammation continues to be a cause of patient discomfort; delayed recovery; and, in some cases, suboptimal visual results secondary to cystoid macular edema. This article reviews the most recent literature regarding the control of intraocular inflammation associated with cataract surgery.     

Functional improvement after phacoemulsification cataract surgery.

PURPOSE: To evaluate subjective functional visual improvement after phacoemulsification and intraocular lens (IOL) implantation and identify patient characteristics and treatment features associated with no functional improvement. SETTING: Academic referral practice, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. METHODS: A retrospective review was performed of the surgical results in 106 consecutive eyes of 102 patients who completed the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Data Collection Form preoperatively and 1 month postoperatively. One surgeon performed all the surgery. The relationship of patient characteristics and treatment features and reported visual function was analyzed using an analysis of variance and the Wilcoxon rank sum and Fisher exact tests. RESULTS: One month postoperatively, all patients demonstrated improved visual acuity. However, 15 patients (14%) reported unimproved or decreased visual function. No statistically significant intergroup difference (P > .05) was detected in mean preoperative, postoperative, and fellow eye best spectacle-corrected visual acuities or refractive errors; reported severity of preoperative symptoms or satisfaction with vision; reported preoperative daily activity functioning or prevalence of hypertension and diabetes; type of anesthesia, lens material, or wound closure used; intraoperative or postoperative complication rates. However, patients reporting unimproved vision tended to be older and less satisfied with their quality of life and medical care than those reporting improved vision (P = .02, .03, .01, respectively). CONCLUSIONS: Self-reported visual function generally improved after phacoemulsification and IOL implantation; however, some older patients less satisfied with their quality of life and medical care reported no functional improvement despite improved visual acuity. These patients might benefit from an extended preoperative discussion of postoperative expectations.     

Implantation of intraocular lens without viscoelastic agent in phacoemulsification cataract surgery

International Ophthalmology - To observe the clinical effect of implanting intraocular lens (IOL) without viscoelastic agent in phacoemulsification cataract surgery. A retrospective analysis of 87...     

Long-term effect of cataract surgery on intraocular pressure after trabeculectomy: extracapsular extraction versus phacoemulsification

PURPOSE: To compare the effect of phacoemulsification with intraocular lens (IOL) implantation on long-term intraocular pressure (IOP) control in glaucoma patients who had previous trabeculectomy with the effect on IOP control in similar patients after extracapsular cataract extraction (ECCE) with IOL implantation. SETTING: Oxford Eye Hospital, Oxford, England. METHODS: Twenty-eight consecutive patients who had phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified from hospital records, and 28 patients who had ECCE with IOL implantation (ECCE group) were matched retrospectively to the phaco group with respect to age, sex, diagnosis, and IOP. In both groups, the IOP before cataract extraction was compared with the IOP at intervals up to 2 years after cataract extraction. A Kaplan-Meier survival analysis was performed. RESULTS: The mean IOP in the phaco group did not differ significantly from the mean IOP before cataract extraction at any interval. Twelve months after cataract extraction, the mean IOP in the ECCE group was significantly higher than preoperatively (P =.01); however, the mean IOP did not differ between groups over time (P =.704). There was significantly better long-term IOP control in the phaco group as determined by Kaplan-Meier survival analysis and the log-rank test (P =.038). CONCLUSION: After trabeculectomy, phacoemulsification provided better long-term IOP control than ECCE; however, the mean IOP was not significantly lower.     

ReZoom折射型多焦点人工晶状体植入术后的近期中距离视力观察

目的观察白内障超声乳化吸除联合折射型多焦点人工晶状体（ReZoom）植入术后的近期中距离视力。方法将36例（46只眼）年龄相关性白内障患者，随机分为实验组和对照组。行白内障超声乳化吸除术后，实验组植入折射型多焦点人工晶状体（ReZoom NXG1）。对照组植人单焦点人工晶状体（Sensar AR40e）。术后1周、1个月和3个月检查中距离视力（包括100、63cm和40cm共3种距离的高对比度和低对比度视力）。结果两组患者术后不同距离的高对比度和低对比度视力，差异均有显著的统计学意义（P〈0．05）。术后3个月时，3种距离的高对比度视力均达0．5或以上者，ReZoom眼78．3％，Sensar眼21．7％；达0．4或以上者，ReZoom眼95．7％，Senstir眼39．1％；3种距离的低对比度视力均达0．5或以上者，ReZoom眼73．9％，Sensar眼17．4％；达0．4或以上者，ReZoom眼91．3％，Sensar眼34．8％。结论ReZoom折射型多焦点人工晶状体可以提供良好的中距离视力。未发现因ReZoom折射型多焦点人工晶状体植入引起的并发症，并具有与单焦点人工晶状体一样的安全性。     

白内障超声乳化人工晶状体植入术临床分析

目的：分析白内障超声乳化吸除人工晶状体植入的临床效果。并探讨拦截劈核技术在超声乳化术的应用。方法：对206例(226只眼)白内障患者施行无缝线5．5mm切口超声乳化人工晶状体植入术。结果：术后l周视力在0．5以上者202只眼(89．4％)，术后1个月视力在0．5以上者213只眼(94．2％)。结论：此手术时间短，术后视力恢复快，效果明显优于常规白内障手术。采用拦截劈核技术，使超声能量降低，超声时间缩短，并发症少，值得推广。     

Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification

We report surgical removal of a droplet of intraocular chloramphenicol ointment in a 70-year-old man who had routine small-incision phacoemulsification. A spherical droplet of ointment adherent to the intraocular lens was noted 2 months postoperatively. The source was considered to be the immediate postoperative conjunctival fornix chloramphenicol ointment. Gonioscopy revealed tiny droplets adherent to the peripheral iris and angle. The droplet was surgically explanted using a minimally traumatic technique with a lens glide and ophthalmic viscosurgical device through an enlarged clear corneal incision and sent intact for laboratory biochemical analysis. The patient maintained good vision without evidence of uveitis or secondary glaucoma at 1 year of follow-up. This uncommon case also raises issues about the need for immediate postoperative antibiotic ointment for endophthalmitis prophylaxis and phacoemulsification thermal wound effects on the integrity of self-sealing clear corneal incisions.