玻璃体晶状体切除联合人工晶状体睫状沟固定术治疗眼挫伤所致晶状体脱位

目的探讨玻璃体晶状体切除联合人工晶状体睫状沟固定术治疗眼挫伤所致晶状体脱位临床效果。方法对眼挫伤致晶状体脱位32例(32眼)作回顾性研究,均采用闭合式三切口玻璃体晶状体切除联合人工晶状体睫状沟固定术,伴视网膜脱离者,同时行视网膜复位手术。结果所有患者均成功摘出脱位晶状体,患眼视力均有提高。合并继发青光眼者,眼压得到控制;合并视网膜脱离者,术后视网膜复位。术后并发症有角膜水肿6例,虹膜炎症反应2例。结论眼挫伤所致晶状体脱位导致视力障碍、继发性青光眼、伴有视网膜脱离、玻璃体积血时,采用玻璃体晶状体切除联合人工晶状体睫状沟固定术治疗效果良好。手术成功的关键在于选择适应证及掌握娴熟的操作技巧。     

硅油充填眼行白内障超声乳化人工晶状体植入联合硅油取出术

目的 探讨玻璃体切割术后硅油充填眼经透明角膜切口行白内障超声乳化摘除、硅油取出、人工晶状体植入联合手术(1组)以及经睫状体平坦部置灌注管行白内障超声乳化摘除、硅油取出、人工晶状体植人(2组)两种手术方式的临床疗效观察。方法 对2000年1月～2003年4月间玻璃体切割术后硅油充填眼白内障患者78例(78只眼)经透明角膜行联合手术。对49例(49只眼)经睫状体平坦部行联合手术。观察眼底视网膜复位良好，行人工晶状体植入术。结果 1组病例有中52只眼最佳矫正视力达0.1～0.6(66．67％)；19只眼视力为0.02～0.1(24．36％)；7只眼视力为光感～指数(8．97％，包括5只眼视网膜脱离复发者)。2组病例中31只眼最佳矫正视力达0.1～0.6(65．3％)；11只眼视力为0.02～0.1(22．45％)；7只眼视力为光感～指数(14．3％，包括2只眼视网膜脱离复发者)。2组病例中有1只眼出现睫状体平坦部切口渗血，所有病例均无持续性角膜内皮失代偿、硅油泡残留、人工晶状体移位等并发症发生。结论 硅油眼行白内障超声乳化、硅油取出、人工晶状体植入术对于玻璃体切除手术后硅油充填眼并发白内障是一种安全、有效的方法。经透明角膜切口行此手术简化了手术步骤，减少了手术并发症的发生。     

外伤性晶状体脱位的手术治疗

目的 评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位的临床疗效。方法 对2000年1月～2005年1月收治的外伤性晶状体脱位30例患者的临床资料作回顾性研究。所有患眼根据晶状体脱位的程度采用不同的术式摘除晶状体，包括囊内摘除、超声乳化吸除、睫状体扁平部切口晶状体切割，同时根据病情需要联合玻璃体视网膜手术，小梁切除或青光眼减压阀门植入术治疗继发性青光眼，Ⅰ期植入睫状沟缝线固定人工晶体3例，后房型人工晶体21例，Ⅱ期植入睫状沟缝线固定人工晶体6例。结果 所有患眼成功地摘除脱位晶状体并植入人工晶体，视力有不同程度提高，24患眼视力≥0．3，患者术后眼压获得控制，6例视网膜脱离全部复位。结论 晶状体、玻璃体联合手术治疗外伤性晶状体脱位，临床效果好。     

微创玻璃体切割系统在硅油取出术中的应用

目的 探讨硅油填充眼微创玻璃体切割系统经角膜切口硅油取出联合二期后房型人工晶状体植入术的临床疗效.方法 对21例21只已实施白内障超声乳化玻璃体切除并硅油填充术眼,均采用25G经结膜免缝合玻璃体切割灌注系统,通过角膜切口方法取出硅油并人工晶状体植入联合手术.术后密切随访3月以上.记录手术建立2个通道和关闭切口所需要的时间,观察手术前后的眼压、最佳矫正视力及术后并发症.结果 21只眼内硅油均1次成功取出,人工晶状体植入囊袋内10例;植入睫状沟11例,手术单独做2个灌注的平均时间为(46.00±4.12)s,关闭灌注通道需要的平均时间为(41.00±5.36)s.手术前1d、后第1d、1周、1个月、3个月时的平均眼压分别为(15.63±6.98)mmHg、(10.37±5.24)mmHg、(14.13±4.87)mmHg、(18.60±7.73)mmHg、(16.80±6.35)mmHg;术后矫正视力较术前均有不同程度的提高,85.7%(18/21)提高2行以上.异物感:0%(0/21),结膜水肿及充血:4.76%(1/21);所有患者均无复发视网膜脱离、人工晶状体移位等并发症发生.结论 微创玻璃体切割系统经角膜切口这种硅油取出联合人工晶状体植入术是一种安全、简单有效地方法.     

硅油填充眼并发性白内障手术探讨

目的探讨硅油充填眼术后并发性白内障行超声乳化联合硅油取出及人工晶状体植入术的临床效果。方法对26例（26眼）硅油填充术后并发性白内障进行超声乳化经睫状体平坦部切口取硅油联合折叠式人工晶状体植入术。术后随访4-15个月（平均8个月）。结果手术后最佳矫正视力：光感-眼前数指者2眼,0.02-0.1者5眼,〉0.1-0.2者11眼,≥0.3者8眼。1眼因视网膜脱离复发,经再次手术硅油充填后视网膜复位。所有患者均无角膜内皮失代偿、人工晶状体移位或硅油残留等。结论硅油填充眼合并白内障行超声乳化联合硅油取出及折叠式人工晶状体植入术能有效提高视力,减少手术次数,提高手术安全性。     

硅油取出、白内障超声乳化摘除联合人工晶状体植入术临床观察

目的探讨玻璃体切除硅油填充术后,硅油取出联合白内障超声乳化摘除联合人工晶状体植入的手术方法和临床效果。方法采用标准三通道睫状体平坦部巩膜切口取出硅油联合白内障超声乳化摘除及人工晶状体植入术,对13例(13只眼)硅油填充眼行三联手术治疗,术后随访超过3月。结果三联手术顺利,最佳矫正视力0.04~0.1者3例,0.1~0.5者9例;术后因再次发生视网膜脱离需再次手术治疗者1例;并发症主要有角膜水肿、黄斑囊样水肿、复发性视网膜脱离及后发性白内障。结论硅油取出联合白内障超声乳化摘除及人工晶状体植入是安全有效的方法,既可以减少手术次数、减轻手术损伤,同时还可以减轻患者的经济负担,能有效提高患者的视力。     

玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位

目的探讨玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位的临床疗效。方法选取晶状体脱入玻璃体内的患者30例(30眼),其中眼球钝挫伤引起的晶状体全脱位25眼,针拨白内障术后晶状体全脱位2眼,白内障摘出术中晶状体核脱入玻璃体内3眼。根据脱入玻璃体内的晶状体核硬度不同采用不同的手术方法,行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术,必要时行硅油填充。术后随访0.5～1a,观察视力、眼压及并发症等情况。结果本组患者行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术19例(19眼);玻璃体切割联合超声乳化及人工晶状体悬吊植入术10例(10眼);玻璃体切割联合超声乳化及硅油充填术1例(1眼)。术后视力:0.1～0.3者16眼,0.3～0.5者9眼,0.5以上者5眼;术后继发青光眼3眼,经降眼压治疗后恢复正常范围。术后随访期间未发现视网膜脱离、玻璃体积血、人工晶状体偏位等并发症。结论玻璃体切割联合超声乳化及人工晶状体悬吊植入术治疗晶状体脱位是一种安全、有效的方法。     

硅油填充眼并发性白内障的手术疗效观察

目的：观察玻璃体切割术后硅油填充眼并发白内障行超声乳化联合硅油取出及人工晶状体植入术的临床效果及安全性。方法：对32例32眼硅油填充术后并发白内障患者行超声乳化联合经睫状体平坦部切口取硅油及折叠式人工晶状体植入术。术后随访3～18（平均9）mo。结果：术后最佳矫正视力：光感～数指/眼前者3眼,0.02～0.1者10眼,〉0.1～0.2者12眼,≥0.3者7眼。所有患者均无视网膜脱离、角膜内皮失代偿、人工晶状体移位或硅油残留等。结论：白内障行超声乳化联合硅油取出及折叠式人工晶状体植入术治疗硅油填充眼并发性白内障安全、有效。     

玻璃体切割术后人工晶体植入术

目的　探讨玻璃体切割术后人工晶体 (intraocularlens,IOL)植入术的效果及硅油填充眼IOL度数的测算方法。方法　 1 硅油填充眼IOL度数测算。 2 建立玻璃体腔液体灌注系统维持术中和术后眼压分别为 2 7 2cmH2 .O (相当于 2 0mmHg)和 4. 0 8cmH2 O ( 30mmHg)。 3 硅油填充眼先行眼内硅油取出术 ,然后行后房型IOL植入术。 4 植入后房型IOL :若后囊完整 ,植入囊袋内IOL ;前囊完整植入睫状沟固定IOL ;前后囊缺损植入睫状沟缝合固定IOL ;虹膜缺损或瞳孔极度散大 ,植入带虹膜IOL。 5 术后随访 2 . 5～ 39个月 ,平均 1 4 5个月。结果　 38例 ( 38只眼 )成功地进行了后房型IOL植入术 ,其中囊袋内植入IOL 6例 ,睫状沟固定IOL 1 9例 ,睫状沟缝合固定IOL 9例 ,植入带虹膜IOL- 4例。硅油取出联合IOL植入术 1 0例。术后视力≥ 0 .1 32例 ( 84 . 2 % ) ,≥ 0 32 2例( 57 .9% )。硅油填充眼术后屈光度 ( - 1 . 58± 0 . 6 1 )D ,与术前预见的屈光度相比 ,差别无统计学意义 (P >0 0 5)。术中并发症有视网膜损伤 ( 2例 )及睫状体出血 ( 2例 ) ,术后并发症有玻璃体出血( 3例 )、视网膜脱离 ( 2例 )及眼球萎缩 ( 1例 )。结论　玻璃体切割术后IOL植入术的效果满意 ,术中术后眼压维持对于减少术中术后并发症至关重要 ,     

自闭式巩膜隧道切口在有晶状体眼硅油取出术中的应用观察

目的 硅油作为眼内充填物治疗复杂性视网膜脱离，硅油在手术后一段时间内要取出以减少长期眼内硅油存在可能引起的并发症，本文介绍一种有晶状体眼的自闭式巩膜隧道灌注口硅油取出方法。方法37只有晶状体硅油眼接受自闭式巩膜隧道灌注口的硅油取出，记录术毕时切口的渗漏情况，术后观察视力、眼压、视网膜再脱离及其它并发症。随访3～6个月。结果 术中同时进行晶状体摘除5例，晶状体摘除联合人工晶状体植入8例，术毕时有4只眼切口有轻度渗漏，需要补充缝线，随访视网膜在位34眼(91．9％)，视力提高或不变29眼(78．4％)。结论 拔除灌注管后迅速有效地封闭切口是硅油取出术的一个重要手术技巧，应用自闭式巩膜切口作为灌注口，可以防止拔管后切口的渗漏，有效地维持眼压，对减少硅油取出术后的视网膜再次脱离有一定作用。     

外伤性无晶状体眼二期后房型人工晶状体植入术

目的探讨外伤后无晶状体眼的二期后房型人工晶状体植入的手术方法和疗效。方法对58例（58眼）外伤性无晶状体眼行二期后房型人工晶状体植入术。其中50例伴有不同程度眼前段结构紊乱,同时行眼前段重建,包括虹膜粘连松解、虹膜根部离断缝合、瞳孔成形、以及瞳孔区机化膜切开等。8例晶状体玻璃体切除术后的无晶状体眼,应用玻璃体腔放置灌注管维持眼压。结果均顺利植入后房型人工晶状体,术后随访5～24个月。后房型睫状沟二期人工晶状体植入41眼（70．69％）,缝襻固定后房型人工晶状体17眼（29．31％）;术后视力均达到或优于术前矫正视力,最佳矫正视力t〉0．3者38眼（65．52％）。术后瞳孔圆者32眼（55．17％）,人工晶状体正位者50眼（86．21％）,7眼稍偏位,1眼人工晶状体倾斜。结论二期后房型人工晶状体植入术是治疗外伤性无晶状体眼的有效而安全术式,可取得良好效果,术前手术设计和熟练的操作技巧是手术成功的关键。     

Primary intraocular lens implantation during pars plana vitrectomy and intraretinal foreign body removal.

PURPOSE: To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina. METHODS: Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months). RESULTS: Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation. CONCLUSION: Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.     

Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation.

PURPOSE: To evaluate the technical feasibility, outcome, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING: Department of Ophthalmology, Giessen, Germany. METHODS: The results of combined cataract and vitreoretinal surgery in 38 eyes (36 patients) were retrospectively analyzed. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Thirty-seven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. RESULTS: Postoperatively, visual acuity improved in 20 eyes (52.6%), was unchanged in 16 (42.1%), and was worse in 2 (5.3%). Postoperative complications consisted of anterior chamber fibrin exudation (3 eyes), hyphema (2 eyes), vitreous hemorrhage (1 eye), posterior capsule opacification (16 eyes), neovascular glaucoma (2 eyes), proliferative vitreoretinopathy and redetachment (1 eye), and retinal redetachment after silicone oil removal (1 eye). CONCLUSION: Compared with 2 separate operations in patients with significant lens opacities and vitreoretinal pathology, combined cataract and vitreoretinal surgery provided more rapid visual rehabilitation. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.     

Preoperative assessment of secondary intraocular lens implantation for aphakia: a comparison of 2 techniques

PURPOSE: To compare the preoperative evaluation of secondary intraocular lens (IOL) implantation in aphakic adults following cataract extraction in childhood using slitlamp examination and high-frequency ultrasound (HFU). METHODS: In a prospective case series, patients who had had lensectomies for congenital cataracts without primary implantation IOL were evaluated for secondary IOL insertion. Slitlamp examination and HFU were performed to study the degree of ciliary sulcus support and iridocapsular adhesions. The choice of IOL (posterior sulcus supported or anterior chamber) was compared using the 2 techniques. RESULTS: Nine eyes of 5 patients (3 men and 2 women aged 15 to 40 years) were assessed for secondary IOL insertion. Clinical slitlamp examination suggested that 3 of 9 eyes had inadequate sulcociliary support, but HFU of these eyes revealed more than adequate capsular remnants. In all 9 eyes, sulcus-supported posterior chamber IOLs were implanted. No postoperative complications were observed, and no patients required surgery for dislocated IOL. CONCLUSIONS: High-frequency ultrasound is a useful adjunct for the preoperative assessment of secondary ciliary sulcus-supported IOL implantation in aphakic patients who had congenital cataract extraction without IOL implantation. In patients in whom inadequate dilation precludes the detection of capsular support, posterior ciliary sulcus-supported secondary IOL implantation should be considered preoperatively. Although the technique enhances surgical planning and informed patient consent, the final decision occurs at the time of surgery with direct visualization of the ciliary sulcus support.     

Secondary posterior chamber intraocular lens implantation in children.

BACKGROUND: Primary intraocular lens (IOL) implantation after cataract aspiration is a widely accepted means of correcting pediatric aphakia. However, little is available in the literature on secondary IOL implantation in children. We present our experience over the past 6 years. METHODS: The charts of 57 aphakic children (61 eyes) who underwent secondary posterior chamber IOL implantation between January 1989 and April 1996 were reviewed. In general, these children were either intolerant of or noncompliant with their contact lenses. An attempt was made to correlate visual outcome with patient variables. Evaluation of the ciliary sulcus structure was made in selected patients by ultrasonographic biomicroscopy to reveal any changes resulting from the presence of the IOL haptic in the sulcus. RESULTS: The age range at the time of surgery was 2 to 16 years (mean 8 y). Mean follow-up was 14 months (range 6 to 48 months). Forty-two percent of the patients had a best-corrected visual acuity of 20/40 or better and 78% saw better than 20/80. Posterior capsular opacification occurred in 10 eyes, 8 of which required neodymium:yttrium-aluminum-garnet laser capsulotomy. No major complications occurred. Ciliary sulcus evaluation by biomicroscopy did not reveal any significant ciliary body or scleral erosion. No changes were noted when the implanted sulcus was compared with the normal contralateral side. CONCLUSION: Although follow-up was short, this review suggests that secondary posterior chamber IOL implantation is a safe alternative when other methods of correcting pediatric aphakia fail.     

眼外伤晶状体玻璃体切除术后二期IOL植入术

目的 探讨复杂性眼外伤玻璃体切除术后无晶状体眼二期人工晶状体植入术临床疗效，评估手术的可行性及安全性。方法 手术31例(31眼)，术后随访3～20月，观察视力、散光度、眼压及并发症：结果 30眼术后裸眼视力均达到或接近术前矫正视力：后房型人工晶状体睫状沟植入7眼中视力≥0．5者占28．57％，后房型人工晶状体透巩膜睫状沟缝线固定术18眼中视力≥0.5者占22．22％，虹膜型人工晶状体植入术6眼中视力≥0．5者占33．33％：1眼视力下降。结论 复杂性眼外伤行玻璃体切除术后二期人工晶状体植入，经过术前病例的选择，术中采用眼内灌注，适宜的人工晶状体植入，可获得较好的视力。     

Influence of intraoperative complication on intraocular rigid lens fixation in pediatric cataract surgery

PURPOSE: This paper presents the intraoperative complications in pediatric cataract surgery with IOL implantation and their influence on fixation place. MATERIAL AND METHODS: 384 eyes of 276 children undergone operative procedure for cataract. Anterior capsulorhexis, lens cortical aspiration, primary posterior capsulorhexis with anterior vitrectomy and IOL implantation were done in all eyes. The place of IOL implantation was capsular sac or ciliary sulcus. RESULTS: There were no serious intraoperative complications but in cases with large anterior (5.2%) and posterior (14.6%) radial capsule tears, vitreous loss (12.3%), and hemorrhage (5.5%) to anterior and posterior chamber the IOL was fixated at ciliary sulcus (in 37.5%). CONCLUSIONS: The surgical procedure is useful and safe in the management of pediatric cataract. Location of an IOL in the ciliary sulcus in a child, is acceptable. To avoid decentration in this cases, we recommend rigid PMMA IOLs.     

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.     

带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效观察

目的　评价带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效 ,探讨术后并发症的发生机制。方法　收集 2 5例 (2 7只眼 )行带虹膜隔人工晶状体植入术患者 ,分析手术疗效和并发症的发生情况 ,同时应用房角镜和超声生物显微镜 (UBM)观察术后发生继发性青光眼患者的房角结构和人工晶状体襻位置。术后随访时间 3～ 18个月。结果　术后患者畏光症状明显减轻或完全消失 ;术后视力较术前提高≥ 2行 2 0只眼 (74 1% ) ,变化 <1行 5只眼 (18 5 % ) ,下降 >2行 2只眼(7 4 % )。术后并发症包括继发性青光眼 10只眼 (37 0 % )、散光度数≥ 2 0 0D 17只眼 (6 3 0 % )、角膜失代偿 2只眼 (7 4 % )、前房出血 2只眼 (7 4 % )、玻璃体出血 3只眼 (11 1% )、视网膜脱离 1只眼(3 7% )。在继发性青光眼 10只眼 2 0只人工晶状体襻中 ,9只襻准确固定在睫状沟内 ,其他位置包括前房角、睫状突及睫状突后。房角改变包括房角后退、残留虹膜根部前粘连、房角关闭。结论　带虹膜隔人工晶状体植入术可有效治疗白内障合并虹膜缺损 ;术后继发性青光眼主要与房角损伤有关 ,人工晶状体襻位置异常、眼内出血、持续性炎性反应也参与其发生。     

后房型人工晶状体置换42例临床分析

目的探讨后房型人工晶状体置换的原因及处理方法。方法对42例（42只眼）行后房型人工晶状体置换术患者的临床资料进行回顾性分析,总结手术原因及方法。观察手术前后人工晶状体位置、最佳矫正视力、角膜、眼压及并发症情况。结果在42例人工晶状体置换病例中,人工晶状体全脱位与不全脱位39只眼;人工晶状体度数错误1只眼;瞳孔夹持1只眼;人工晶状体混浊1只眼。经角巩膜缘切口直接取出人工晶状体27只眼;联合玻璃体切割15只眼。人工晶状体置换联合睫状沟襻固定38只眼;单纯人工晶状体置换4只眼。手术前后最佳矫正视力比较,差异具有统计学意义（P〈0.05）。术后患者视力有所提高,眼压稳定。术后无严重并发症发生。结论人工晶状体置换是人工晶状体植入术后出现严重并发症的有效处理方法。根据具体情况适时正确置换人工晶状体,可有效改善患者视功能。