高频透热撕囊法在白内障手术中的应用

目的:评价在白内障手术中使用高频透热撕囊仪作连续环形撕囊的效果。方法:在30例(34眼)患者进行白内障囊外摘出联合后房型人工晶体植入术中,先向前房注入透明质酸钠,然后使用高频透热撕囊仪作晶体连续环形撕囊术。结果:有3眼术中出现小的晶体前囊放射状撕裂,所有病例术后角膜无水肿,无其他术后合并症,术后一周31眼矫正视力≥0.5,占91.2％。结论:此法操作简便,易于掌握,是一个安全有效的连续环形撕囊的方法。尤其适用于过熟期白内障,儿童先天性白内障和外伤性白内障的截囊。眼科学报1999;15:121—123。     

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract

PURPOSE: To assess the feasibility, risks, and postoperative outcomes of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorhexis (CCC) in the absence of a red reflex. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 52 eyes of 52 patients with white cataract that had phacoemulsification through a clear corneal temporal incision with PC IOL implantation. In all the cases, trypan blue was used under air to stain the anterior lens capsule and the karate-chop technique was used to emulsify the nucleus. The mean follow-up was 192.2 days. RESULTS: Trypan blue adequately stained the anterior lens capsule in all cases. The CCC was completed uneventfully in 96.15% eyes; 3.85% of cases had to be converted to a conventional extraction technique because of the loss of the CCC. The mean phacoemulsification time was 2.2 minutes. Intraocular complications included incomplete capsulorhexis (3.85%) and pupillary miosis (3.80%). Postoperatively, 3 eyes (5.77%) had corneal edema (striate keratopathy) and 1 eye (1.9%) had fibrin in the anterior chamber. Five eyes (9.61%) had more than 2+ cells and flare at 2 weeks. All responded well to intensive topical and subconjunctival steroids. There were no cases of endophthalmitis. The mean central endothelial cell loss, measured in 37 eyes, was 8.5%. Of the 4 eyes (7.69%) that had increased intraocular pressure (IOP) postoperatively, all responded well to medications and the IOP was normal by the second postoperative week. Fifty eyes (96.16%) had a final best corrected visual acuity of 20/30 or better. In 2 cases, the final visual acuity was worse than 20/200 because of preexisting posterior segment pathology. CONCLUSION: Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.     

高频透热电撕囊器在过熟期白内障超声乳化术中的应用

目的探讨高频透热电撕囊器在过熟期白内障超声乳化术的应用效果。方法选取过熟期白内障患者63例（63只眼）行白内障超声乳化人工晶状体植入术,随机分为两组。A组（常规撕囊镊连续环形撕囊）25例,B组（高频透热电撕囊）38例,对两组撕囊成功率、晶状体囊袋内植入率、术后视力、角膜水肿情况进行比较。结果B组比A组的撕囊成功率及晶状体囊袋内植入率明显高。A组与B组裸眼视力、角膜水肿情况无显著差异。     

Divide and conquer nucleofractis phacoemulsification: development and variations

Cataract extraction by phacoemulsification of the lens in situ can be accomplished by a technique incorporating continuous curvilinear capsulorhexis (CCC), deep central sculpting of the nucleus, and manual cracking ("nucleofractis") and subsequent fragmentation and emulsification of the remaining nucleus. This "divide and conquer" nucleofractis technique of phacoemulsification is uniquely suited to the constraints that CCC, which provides excellent conditions for well-centered in-the-bag placement of intraocular lenses, imposes upon cataract extraction. The cracking and fragmentation maneuvers allow phacoemulsification to be extended to patients with hypermature and brunescent lenses, as well as small pupils, who are not normally considered good candidates for the technique.     

Phacoemulsification combined with silicone oil removal through a posterior capsulorhexis

PURPOSE: To evaluate the technique of silicone oil removal through a posterior capsulorhexis combined with phacoemulsification and intraocular lens (IOL) implantation. SETTING: Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi, India. METHODS: Fifteen eyes of 15 patients had phacoemulsification with removal of silicone oil, which had been used for intraocular tamponade after a previous pars plana vitrectomy. Eyes with a stable retina were included in the series. In all eyes, the silicone oil was removed through a planned posterior capsulorhexis after phacoemulsification. The parameters evaluated were the primary diagnosis, duration between silicone oil instillation and phacoemulsification, type of cataract, preoperative and postoperative best corrected visual acuities (BCVAs), and complications such as frequency of retinal redetachment and secondary cataract. RESULTS: Vitreoretinal surgery with silicone oil instillation was performed for rhegmatogenous-tractional detachment resulting from Eales' disease in 6 eyes and from proliferative diabetic retinopathy in 2 eyes, for primary rhegmatogenous retinal detachment in 6 eyes, and for traumatic rhegmatogenous detachment in 1 eye. The mean duration between the silicone oil instillation and phacoemulsification was 7.5 months +/- 3.8 (SD). Fourteen eyes had posterior subcapsular cataract, and 10 had nuclear sclerosis. Preoperative BCVA was worse than 6/60 in all eyes. The BCVA was 6/60 or better in 9 eyes after a minimum follow-up of 6 months. Two eyes had choroidal detachment in the early postoperative period. No eye had vitreous hemorrhage, retinal redetachment, secondary cataract, clinically significant endothelial decompensation or macular edema, or a dislocated IOL. CONCLUSION: The results indicate that silicone oil removal through a posterior capsulorhexis during phacoemulsification is a viable option and can be performed in selected cases of cataract with previous silicone oil instillation and a stable retina.     

Anterior capsular staining with trypan blue for capsulorhexis in mature and hypermature cataracts. A preliminary study

PURPOSE: To study the efficacy and safety of 0.1% Trypan Blue dye to stain the anterior capsule for capsulorhexis in mature and hypermature cataracts. METHODS: This preliminary study included 25 eyes of 25 patients with a unilateral mature or hypermature cataract, including one case of traumatic mature cataract. In all these cases 0.2 ml of 0.1% trypan blue dye was used to stain the anterior capsule. The efficacy and safety of the dye was evaluated on the basis of intraoperative and postoperative observations. RESULTS: In all 25 eyes the capsulorhexis was completed. There was peripheral extension of the capsulorhexis in the eye with traumatic cataract and the stained edge of the anterior capsule helped identification and redirection of the capsulorhexis. Successful phacoemulsification with intraocular lens implantation was performed in all eyes. Adverse reactions related to the dye such as raised intraocular pressure, anterior chamber inflammation and endothelial damage were not observed in the immediate postoperative period or at the end of mean follow-up of 3 months. CONCLUSION: Trypan blue dye staining of the anterior capsule appears to be a very useful and safe technique that simplifies capsulorhexis in mature and hypermature cataracts.     

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.     

成熟或过熟白内障眼连续环形撕囊术中晶状体前囊的染色

连续环形撕囊术 (continuous curvilinear capsulorhexis,CCC)是白内障超声乳化术的关键步骤之一。但在成熟或过熟白内障的眼中 ,由于晶状体呈白色混浊 ,手术显微镜同轴照明下缺乏视网膜红光反射作背景 ,囊膜结构难以看清 ,故难于实施 CCC。近来 ,一些学者利用不同的染色剂和染色技术成功地将晶状体前囊染色 ,从而为成熟或过熟白内障患眼施行 CCC展示了良好的应用前景。     

白内障撕囊直径不同对后发性白内障影响的临床研究

目的:观察连续环形撕囊口完全覆盖人工晶状体光学面与连续环形撕囊口完全不覆盖人工晶状体光学面的人工晶状体植入术后后囊膜混浊(posterior capsular opacification,PCO)的情况。方法:随访近5a来施行超声乳化吸出白内障联合人工晶状体植入手术的老年性白内障患者164例196眼,术后观察视力、撕囊口与人工晶状体光学面的关系及PCO等情况,随访12~26(平均16.3)mo。根据Sellman等的PCO分级标准进行分级:I级为没有PCO或极轻微PCO不减少红光反射,也没有珍珠样小体或IOL边缘也没有发现珍珠样小体;Ⅱ级为轻度PCO减少了红光反射,IOL边缘也没有发现珍珠样小体;Ⅲ级为在IOL区域内发现中度纤维化或珍珠样小体,但视轴(中心3mm)是透明的;Ⅳ级为重度纤维化或珍珠样小体并扩展到视轴区,并且严重减少红光反射。术后后囊膜出现Ⅱ,Ⅲ及Ⅳ级统计为临床出现后发性白内障的并发症病例。结果:后发性白内障是现代白内障摘除手术后晚期常见的并发症之一,连续环形撕囊口完全覆盖人工晶状体光学面组120眼中,发生后发性白内障42眼(35.0%)。连续环形撕囊口完全不覆盖人工晶状体光学面组76眼中,发生后发性白内障41眼(53.9%)。两组病例术后在临床后发性白内障发生率上有统计意义(P<0.05)。结论:连续环形撕囊口大小与术后后囊膜的混浊有关。撕囊口完全覆盖人工晶状体光学面能减少后发性白内障发生的几率。     

改良撕囊方法在白色白内障超声乳化术中的应用

目的 探讨一种适合白色白内障超声乳化手术的撕囊方法.方法 应用改良的撕囊方法治疗白色白内障212只眼,在做上方透明角膜切口时,以3.2mm穿刺刀直接刺开晶状体前囊,前囊开口约2mm大小,向前房内注入透明质酸钠,用囊膜剪在已打开的晶状体前囊一端呈钝角进一步切开前囊约3mm,再用撕囊镊夹持前囊一角完成撕囊,必要时再应用前囊的另一角以相同的方法共同完成环形撕囊.结果 212只眼白色白内障应用此方法,203只眼成功完成了环形撕囊;成功率为95.8%.结论 对白色白内障行超声乳化手术,应用改良的撕囊方法,基本上可以达到环形撕囊的目的,减少了因前囊不完整所带来的手术操作不便和并发症,是一种安全、简便、有效、切实可行的操作方法,便于掌握和应用.     

Capsular tension ring assisted phacoemulsification of morgagnian cataract

Purpose:To describe a novel technique of phacoemulsification in morgagnian cataract using capsular tension ring (CTR).Methods:This was a retrospective, non-comparative, clinical interventional study. Patients with hypermature morgagnian cataract who had undergone CTR-assisted phacoemulsification were included in the study. After capsulorhexis, CTR was inserted in a clockwise manner to stabilize the capsular bag in each case. Phacoemulsification was then performed using either horizontal chopping or vertical chopping. We have used the CTR in these cases without any obvious lens subluxation in order to perform safe emulsification of the nuclear pieces in the capsular bag. We have performed the procedure successfully in eleven eyes with hypermature morgagnian cataract.Results:The mean corrected distance visual acuity (CDVA) improved from 2.62 ± 0.25 Log MAR to 0.35 ± 0.28 Log MAR at 3 months postoperatively (P = 0.00008). Total nine out of 11 patients gained CDVA of 20/40 or better at 3 months postoperatively. No intraoperative complications such as posterior capsular rupture, zonular dialysis, iris trauma, vitreous loss were noted. The mean endothelial cell loss was 148.82 ± 41.52 cells/mm² after 3 months of surgery.Conclusion:The main culprit for intraoperative complications during phacoemulsification in a morgagnian cataract is the vulnerable capsular bag. Following insertion of a CTR after capsulorhexis, the bag becomes stable and the subsequent steps of the surgery become uneventful, thereby, preventing any further complications.     

白内障二次环形撕囊术

目的 探讨白内障超声乳化吸出术新的撕囊术的临床意义。方法 在315例肿胀白内障的超声乳化吸出术中，采用二次连续环形撕囊术，即先行约4mm的连续环形撕囊，在人工晶状体囊袋骨植入后再次连续环形撕囊，将前囊开口扩大至人工晶状体边缘。术后2周－1年检查眼底并进行相应处理。结果 全部病例在术中未发生前囊开口放射状撕裂。术后检眼镜及荧光素眼底血管造影检查发现74例眼底疾病患者，其中13例接受视网膜激光光疑术治疗。残留的少量前囊对眼底检查和治疗过程影响甚小。结论 在白内障超声乳化吸出术中，对膨胀的白内障采用二次环形撕囊，不但有利于保持晶状体囊袋的完整性和囊口的中心性，也有利于术后眼底疾病的诊治。     

老年性白内障超乳术中晶状体囊相关风险研究

目的 评估不同程度老年性白内障超声乳化手术中晶状体囊相关的手术风险。方法 回顾性分析老年性白内障的超声乳化手术432例（566眼）。根据白内障成熟程度分为研究组（成熟期和过熟期白内障）和对照组（未熟期白内障）,记录术中发生的相关并发症,以Fisher精确概率法将两组间的数据进行对比分析。结果 在研究组232眼中,撕囊失败12眼（5．2％）,后囊破裂6眼（2．6％）,其中4眼（1．7％）人工晶状体固定在睫状沟;在对照组334眼中,所有病例均成功完成了撕囊,2眼后囊破裂（0．6％）,所有病例的人工晶状体均成功植入囊袋。结论 成熟期和过熟期老年性白内障超声乳化手术晶状体囊相关并发症发生率较未熟期高（X^2=18．54,P〈0．01）,尽管应用囊染色剂可以方便撕囊操作,但是撕囊仍是成熟期和过熟期白内障的超声乳化手术中最困难的步骤。     

白内障超声乳化吸除术和囊外摘除术初学者玻璃体脱出危险因素分析

目的 探讨白内障手术初学者超声乳化吸除术和囊外摘除术,学习曲线特点及学习过程中同玻璃体脱出相关的危险因素.方法 回顾分析作者最初的连续350例超声乳化手术和350例囊外摘除手术经过,并分析手术患者性别、年龄、眼别、白内障类型、人工晶状体度数、撕囊是否成功、患者是否配合等因素对玻璃体脱出的影响.结果 各因素对囊外摘除手术玻璃体脱出发生率均无影响,白内障类型、人工晶状体度数、撕囊是否成功对超声乳化手术玻璃体脱出率有影响,其中IV级核、撕囊不成功、IOL度数≥24.5、Ⅰ级核及IOL度数≤15.0等5个因素是玻璃体脱出的危险因素,Ⅱ级核是保护因素(P<0.05).结论 超声乳化手术较囊外摘除手术受患者条件影响更大,初学者宜选取正视眼、Ⅱ级核、相对年轻的患者并在撕囊成功的前提下进行超声乳化手术的学习.     

囊袋张力环在白内障手术中的应用

目的:评价半脱位晶状体超声乳化术中植入囊袋张力环(CTR)的应用效果。方法:对12例12眼半脱位晶状体行白内障手术,术中连续环形撕囊,行白内障晶状体超声乳化术,植入CTR后,囊袋内植入折叠式人工晶状体。结果:晶状体半脱位白内障患者12眼均顺利植入了CTR及后房型人工晶状体。术后患者视力均得以提高,人工晶状体位正,无明显手术并发症。结论:CTR可防止人工晶状体偏位,减少手术并发症。     

晶状体前囊膜苔盼蓝染色在白内障超声乳化术中的临床应用观察

目的 探讨晶状体前囊膜染色技术在白内障超声乳化术中应用的有效性和安全性。方法 88例（90只眼）行白内障超声乳化术患者,分成染色剂辅助撕囊组A组40例（40只眼）,和常规手法撕囊组B组40例（40只眼）,观察撕囊成功率、在超声乳化手术中囊膜保护完整率以及眼压和房水炎症反应等。结果 连续环形撕囊成功者,A组为95％（38／40）,B组为62．50％（25／40）;A、B两组中,分别有2只眼及10只眼出现前囊膜向赤道部撕裂,并行前段玻璃体切割术。结论 染色剂辅助撕囊技术,对于一些缺乏眼底红光反射的白内障患者,可以明显提高连续环形撕囊的成功率,使这类患者的超声乳化术更加安全。     

白色白内障超声乳化术中吲哚青绿前囊膜染色的临床应用

目的 探讨吲哚青绿对晶状体前囊染色在白色白内障超声乳化术中的临床应用效果。方法 对白色白内障50例（50只眼）随机分成二组,各25只眼。其中染色组采用吲哚青绿辅助撕囊技术,观察术中及术后情况。结果 染色组25只眼全部成功,术中及术后无并发症。对照组25只眼有7只眼撕囊没有成功,改为开罐式截囊,其中2只眼在以后的操作中出现后囊破裂。结论 吲哚青绿辅助撕囊技术,对于没有眼底红光反射的白内障降低了撕囊难度,提高了连续环行撕囊的成功率,减少了白内障超声乳化术中及术后并发症的发生,使这类患者的超声乳化手术更加安全。     

Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study

PURPOSE: To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month. RESULTS: The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains. CONCLUSION: Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.     

Staining the Anterior Capsule with Indocyanine Green or Trypan Blue for Capsulorhexis in Eyes with White Cataract

Aim: To assess the efficacy and safety of indocyanine green (ICG) 0.5% and trypan blue 0.1% for anterior capsule staining in cases of white cataract. Methods: This prospective study comprised 55 eyes of 55 patients with white cataract that had phacoemulsification with foldable intraocular lens implantation. ICG in 30 eyes and trypan blue in 25 eyes were used under air to stain the anterior lens capsule. The staining patterns and the ease of creating a continuous curvilinear capsulorhexis (CCC) were assessed; the intraoperative and postoperative complications were noted. The mean follow-up was 17.68±1.65 months. Result: Either ICG or trypan blue stained the anterior capsule uniformly. However, the staining provided by trypan blue was slightly superior. A CCC was successfully achieved in 25 eyes (100%) with trypan blue, and 29 eyes (96.7%) with ICG, respectively. There was no significant postoperative reaction in any eye. Conclusion: The use of vital dyes such as ICG and trypan blue guarantees a complete CCC and makes it possible to deliver the benefits of phacoemulsification in the patients with white cataract.     

过熟期白内障囊外摘除联合人工晶状体植入术

目的：探讨过熟期白内障囊外摘除和人工晶状体植入的手术方法及术中、术后并发症发生的原因和治疗措施。方法：对202例（202只眼）过熟期白内障患者施行白内障囊外摘除和后房型人工晶状体植入术。结果：开罐式截囊106只眼，信封式截囊81只眼，连续环形撕囊15只眼。123只眼采用双手压迫式娩核，其余患眼采用晶状体套圈娩核。除12只眼因术中玻璃体脱出未植入人工晶状体外，其余患者均植入后房型人工晶状体。59.9%患者术后视力≥0.5。信封式截囊及套圈娩核造成晶状体悬韧带断裂及玻璃体脱出等并发症更少。结论：对于皮质完全液化的过熟期白内障宜采用信封式截囊，伴晶状体悬韧带松驰的过熟期白内障套圈娩核较双手压迫式娩核有效及安全 。