角膜屈光手术患者的白内障摘除联合人工晶体植入手术

目的 研究有角膜屈光手术史患者行白内障摘除植入工晶体度数的确定和术中术后并发症.方法 选取有角膜屈光手术史患者4例4只眼,测量患者的眼轴、角膜曲率和前房深度,分别带入Holladay、Binkhorst及其回归公式计算人工晶体度数,对患者行超声乳化白内障吸除联合人工晶体植入术,术后随访3个月,记录裸眼视力、矫止视力和屈光状态.结果 4例均以选择计算结果中最大的人工晶体度数,结合各自不同的情况有所增减,植入了人工晶体,术后屈光状态与预测值的偏差＜1D;1例在手术中出现了透明角膜隧道切口附近的放射状角膜瘢痕裂开,1例在手术后出现了局限在LASIK角膜瓣区域的角膜水肿.结论 采用多个计算公式同时计算,有可能减小误差,其中,Binkhorst二次回归公式的计算结果预测性比较好.     

合并葡萄膜炎者的白内障手术

葡萄膜炎白内障手术较单纯老年性白内障手术更具挑战性.葡萄膜炎白内障通常由慢性炎症或长期使用糖皮质激素所致,明确病因诊断、完善眼科检查、充分控制炎症和精细手术操作对获得视力改善相当重要.对严重的葡萄膜炎患者,控制炎症的关键是全身或局部糖皮质激素使用联合免疫抑制剂,免疫抑制剂可有助于充分控制眼内炎症,减少使用糖皮质激素的副作用.在活动性炎症完全控制3个月后行超声乳化白内障吸除联合人工晶状体植入术,绝大多数患者可获得视力改善.     

Cataract surgery in patients with uveitis

Although cataract surgery for senile cataract is routine and easily performed, the decision to remove the cataract in a patient with a history of uveitis is considerably more complex and usually involves multiple considerations, related not only to the cause of the uveitis but also to the appropriate surgical procedures. The problems confronting the ophthalmologist caring for the patient with uveitis begin with the first visit. Establishing a diagnosis and controlling the inflammation are the critical elements in the treatment of the patient; these two factors will determine the incidence of cataract formation and other complications, the appropriate time for cataract removal, and the surgical strategy, as well as determine the visual outcome long before surgery occurs. Diagnosis, control of inflammation, preoperative management, particularities of the surgical techniques, and postoperative complications in patients with a history of uveitis have been reviewed previously in this section. Our aims in this article are to review the literature on this subject over the past year and to reemphasize the idea of a model of zero tolerance for inflammation to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision.     

Cataract surgery in patients with uveitis

Until recently, cataract surgery in a patient with uveitis was regarded as a hazardous procedure that yielded unpredictable and often disappointing results. With an increasing number of ophthalmologists recognizing the consequences of chronic low-grade inflammation and therefore treating uveitis patients more aggressively, with a better selection of cases for surgery, and with better surgical techniques, more patients with a history of uveitis who need cataract surgery enjoy a successful outcome than ever before. Careful management and control of inflammation preoperatively and after surgery is critical to success. An in-the-bag posterior chamber lens implant can be part of the surgical plan in selected cases. The aims of the authors in this article are to emphasize the ideas of, intolerance to inflammation, a limited tolerance for steroids to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision, and strict criteria for selection and management of those patients with uveitis who need cataract surgery.     

Cataract surgery in patients with end-stage glaucoma

BACKGROUND: The purpose of this study was to assess the benefit of cataract surgery in patients with advanced cataract and glaucoma. METHODS: In a prospective study, we investigated 12 consecutive patients (12 eyes). Inclusion criteria were the diagnosis of cataract and end-stage glaucoma with a cup-disc ratio (CD) of 0.9-1.0 and marked visual field defects with partially preserved central function. Preoperatively, at the third postoperative day and after 6 months (2-11 months), the visual acuity (V), the intraocular pressure (IOP), the number of antiglaucomatous drugs and the visual fields were assessed. Furthermore, the surgical procedure and possible complications were noted. In all patients cataract surgery was performed with topical anaesthesia. RESULTS: 10 patients were treated with cataract surgery alone, whereas 2 patients underwent combined cataract and glaucoma surgery. The mean visual acuity improved significantly from 0.3 to 0.5 (p = 0.007). Additionally a significant intraocular pressure reduction of 4.4 mm Hg (p = 0.007) was observed. The number of antiglaucomatous drugs decreased from 1.5 preoperatively to 0.8 postoperatively. The mean deviation (MD) improved from -27.5 dB up to -26.4 dB (p = 0.036) after 6 months. CONCLUSION: Patients with progressive cataract and end-stage glaucoma can benefit from cataract surgery. Although marked visual field defects were present, an increase in visual acuity as well as a decrease of intraocular pressure may be achieved without worsening of the visual fields.     

Cataract surgery in patients with Vogt-Koyanagi-Harada syndrome

PURPOSE: To evaluate the outcomes of cataract surgery in patients with Vogt-Koyanagi-Harada's (VKH) syndrome. SETTING: Medical Research Foundation, Sankara Nethralaya, Chennai, India. Methods: Fifty-nine eyes of 39 patients with VKH syndrome who had cataract surgery between May 1985 and June 2001 were retrospectively analyzed. RESULTS: Extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation was performed in 15 eyes and without IOL implantation in 31 eyes. Phacoemulsification with IOL implantation was performed in 13 eyes. Twenty-three eyes (38.9%) had mixed cataract (posterior subcapsular and posterior polar). Small pupils were managed by synechiolysis with an iris spatula (43 eyes) or iris hooks (8 eyes). Nine eyes were lost to follow-up and not included in the postoperative analysis. The mean postoperative follow-up was 39.4 months (range 9 to 120 months). Visual acuity improved by 1 or more lines in 40 eyes (80.0%). Subretinal gliosis and optic atrophy, sequelae of the syndrome, restricted improvement in vision in the remaining eyes. Posterior capsule opacification developed in 38 eyes (76.0%), of which 21 (42.0%) required a neodymium:YAG laser posterior capsulotomy. There were no significant differences in postoperative inflammation or syndrome reactivation between the types of surgery. CONCLUSIONS: The results show that cataract extraction in patients with VKH syndrome can be safely and successfully performed if there are good preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome depends on the posterior segment complications of the syndrome.     

Cataract surgery in patients with Mooren's ulcer

PURPOSE: To assess the outcome of cataract surgery in patients with Mooren's ulcer. SETTING: Ocular Immunology and Uveitis Service, L.V. Prasad Eye Institute, Hyderabad, India. METHODS: In this interventional case series, the medical records of 6 patients with Mooren's ulcer who had cataract surgery were retrospectively reviewed. Five patients had uneventful extracapsular cataract extraction with intraocular lens (IOL) implantation, and 1 patient had phacoemulsification with IOL implantation. The visual acuity and postoperative course of the patients were reviewed. The patients were followed to detect, and if present treat, a recurrence of Mooren's ulcer. RESULTS: The follow-up ranged from 3 months to 2 years. The preoperative visual acuity ranged from 20/60 to hand movements. Postoperatively, the best corrected visual acuity improved to 20/20 to counting fingers close to face. Mooren's ulcer recurred 8 months after surgery in 1 patient and was treated appropriately. CONCLUSIONS: Results indicate that cataract surgery can be safe in patients with Mooren's ulcer and visually significant cataract. Performing surgery in a quiet, noninflamed eye improves the prognosis in these cases.     

Cataract surgery after refractive surgery. Part I: practical surgical consequences

Prior refractive surgery has little incidence on the phako-exeresis technique. Most of the precautions taken are based more on theoretical considerations rather than extensive clinical experience. Excepting cases of high myopy corrected with IOL where early opacification may have occurred, mo st of the population undergoing refractive surgery has not yet reached the age of cataracts. In case of prior corneal surgery (radial keratotomy, PKR, Lasik or intracorneal ring segments) the incision tunnel must remain behind or away from the anatomically modified sectors. In case of prior refractory surgery, explantation must always precede the procedure. A large diameter (6mm or more) lens is always chosen in order to ava avoid optical consequences of modifications induced by the aspheric cornea.     

Cataract surgery in anticoagulated patients

A prospective study was performed on 31 patients having planned extracapsular cataract extraction with posterior chamber intraocular lens implantation. The patients were considered to be anticoagulated because of the medications they were taking. The patients were instructed to continue their usual medications throughout the perioperative period including the day of surgery. All patients had routine narcoleptic sedation and retrobulbar anesthesia. The surgical technique was altered to use an inferior corneal traction suture and a single planed clear corneal incision. No intraoperative or postoperative anterior chamber bleeding was seen. The observed complications were increased awareness of corneal sutures, increased endothelial cell loss, delayed visual rehabilitation from with-the-rule astigmatism, and transient corneal edema. All patients achieved 20/40 or better visual acuity without corneal edema by three months post-surgery.