手术治疗糖尿病性白内障60眼临床分析

目的:分析小切口白内障囊外摘出人工晶状体植入术和超声乳化白内障吸除人工晶状体植入术治疗糖尿病性白内障的疗效及并发症。方法:选择2006-01/2010-01确诊为糖尿病性白内障患者52例60眼,Ⅱ～Ⅲ级核47眼,采用超声乳化白内障吸除后房型人工晶状体植入术;Ⅳ～Ⅴ级核13眼,采用小切口白内障囊外摘出后房型人工晶状体植入术。结果:糖尿病患者52例60眼白内障术后视力均有不同程度的提高,其中50眼(83%)术后1wk裸眼视力≥0.4。术中术后主要并发症经处理对术后视力无影响。结论:对糖尿病性白内障患者采取恰当的术式,施行小切口白内障囊外摘出人工晶状体植入术或超声乳化白内障吸除人工晶状体植入术疗效肯定。     

糖尿病患者白内障超声乳化吸出联合人工晶状体植入

目的　观察糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术的临床效果。方法　对884 例1 079 眼患有糖尿病的白内障术后患者的视力及并发症进行分析,并选取同时期、同一手术医师施行的非糖尿病白内障患者做对照。手术采用巩膜隧道切口超声乳化及囊袋内人工晶状体植入法。术前空腹血糖控制在8.5 mmol·L-1以下。结果　糖尿病患者术后3 d矫正视力与非糖尿病患者相比无明显差异(P>0 05),<0.5者454眼,均为眼底出血、渗出累及黄斑及黄斑囊样水肿、增殖性视网膜病变所致。糖尿病患者术前瞳孔不能充分散大或术中瞳孔缩小、瞳孔缘损伤和术后角膜水肿、黄斑水肿的病例明显多于非糖尿病患者。结论　糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术,可明显改善视力,超声乳化吸出术治疗糖尿病患者白内障是安全有效的,并为糖尿病视网膜病变的荧光血管造影和激光治疗提供了条件。眼底出血、渗出累及黄斑、黄斑囊样水肿、增殖性糖尿病视网膜病变是影响术后视力的主要因素。     

糖尿病患者白内障行晶状体超声乳化术的临床疗效观察

目的分析糖尿病患者晶状体超声乳化人工晶状体植入术临床疗效及并发症。方法对36例（42眼）糖尿病患者晶状体超声乳化人工晶状体植入术临床资料进行回顾性分析。结果 42眼手术后随访12月,术后视力≥0.6者33眼,占78.57%。结论糖尿病患者血糖控制在理想范围内再行晶状体超声乳化人工晶状体植入术是可行的。     

糖尿病患者后房型人工晶状体体植入术眼前段并发症探讨

目的：观察糖尿病患者中行后房型人工晶状体植入术后眼前段并发症及预后。方法：对31例（40只眼）糖尿病组后房型人工晶状体植入与28例（35只眼）对照组老年白内障患者手术效果及并发症进行对比观察。结果：糖尿病组白内障前段手术并发症发生率高于对照组，其术前准备、术中及术后处理均有其特殊性。但总体预后两组并无显著差异。结论：糖尿病患者人工晶状体植入安全可靠、手术预后良好。     

玻璃体切除联合白内障摘出人工晶状体植入术

目的探讨玻璃体切除联合白内障摘出及人工晶状体植入术的临床效果。方法对16例(17眼)玻璃体视网膜疾病伴有明显的白内障者实施了此联合手术。先行常规白内障囊外摘出术或晶状体超声乳化术,再行标准三通道闭合式玻璃体切除术,最后植入人工晶状体。结果术后随访2月～3年,平均13月。16眼术后视力均有不同程度提高,1眼增生性糖尿病性视网膜病变术后2月因继发新生血管性青光眼,行广泛视网膜冷凝后视力下降。术后早期16例(17眼)均有不同程度的角膜后弹力层皱褶,术后7～10d消失。2例(2眼)术后有一过性眼压升高。1例(1眼)术后2月发生新生血管性青光眼。3例(3眼)术后后囊浑浊,未影响视力。结论此联合手术的临床效果良好,具有一定的优点,但应严格掌握适应证,并要求有熟练的手术技巧。     

糖尿病患者白内障超声乳化联合人工晶状体植入术的临床观察

目的:观察糖尿病患者白内障施行超声乳化联合人工晶状体植入术后的临床效果。方法:对同一时期内糖尿病患者白内障89例106眼和非糖尿病患者白内障273例304眼施行晶状体超声乳化联合人工晶状体植入,对术后视力及并发症进行分析。结果:两组白内障患者术后视力相比差异无显著性(P>0.05),糖尿病患者白内障术后角膜水肿、纤维素性渗出、黄斑水肿等并发症明显高于非糖尿病患者,两组相比差异有显著性(P<0.05)。结论:糖尿病患者白内障超声乳化联合人工晶状体植入术是安全的,可明显提高视力,并为治疗其眼底病变提供有利条件。     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

超声乳化治疗糖尿病患者白内障的临床分析

目的探讨糖尿病患者白内障进行超声乳化吸出人工晶状体植入术的疗效和并发症。方法对42例(46眼)糖尿病患者的白内障施行3.5mm角巩膜隧道切口,晶状体超声乳化吸出,植入折叠式人工晶状体。结果术后1天视力≥0.6者28眼(60.87%);术后3月视力≥1.0者27眼(58.7%)。术后1月角膜散光平均为(1.12±0.48)D,与术前对比,差异无统计学意义(P>0.05)。术中后囊破裂1眼;术后轻度角膜水肿7眼(15.22%),房水闪光5眼(10.87%),均于1周内消退;后囊浑浊1眼。结论采用晶状体超声乳化吸出折叠式人工晶状体植入术治疗糖尿病患者的白内障,术后并发症较少,视力恢复尚好,手术是安全的、有效的。     

玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变

目的探讨玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变的有效性和安全性。方法回顾性分析合并白内障的增生性糖尿病视网膜病变23例（26眼）。行玻璃体切除联合晶状体超声乳化及人工晶状体植入术的临床资料,观察术后视力改善程度及术中术后并发症。结果术后随访7—24个月,平均12．8个月。术后矫正视力较术前提高者20眼（76．92％）;视力不变者5眼（19．23％）;视力下降者1眼（3．85％）。术中未见严重并发症。术后主要并发症有角膜上皮水肿7眼（26．92％）,前房炎性反应6眼（23．08％）,玻璃体再积血3眼（11．54％）,复发性视网膜脱离2眼（7．69％）,后发性白内障8眼（30．77％）,术后虹膜后粘连4眼（15．38％）。术后15眼需补充眼内激光光凝。结论玻璃体切除联合晶状体超声乳化及人工晶状体植入术治疗合并白内障的增生性糖尿病视网膜病变,可使大多数患眼视力改善,并发症少,手术安全有效。     

糖尿病患者白内障超声乳化联合人工晶状体植入术的临床观察

目的:观察糖尿病患者白内障施行超声乳化联合人工晶状体植入术后的临床效果。方法:对同一时期内糖尿病患者白内障80例100眼和非糖尿病患者白内障90例120眼施行晶状体超声乳化联合人工晶状体植入,对术后视力角膜内皮细胞及并发症进行分析。结果:两组白内障患者术后视力相比无显著性差异(P>0.05),角膜内皮损失率有显著性差异(P<0.05);糖尿病患者白内障术后角膜水肿、纤维素性渗出、黄斑水肿等并发症明显高于非糖尿病患者,两组相比差异有显著性(P<0.05)。结论:糖尿病患者白内障超声乳化联合人工晶状体植入术早期并发症多,经过及时正确处理,亦可获得较好效果,明显提高视力,并为治疗眼底病变创造有利条件。     

Cystoid macular oedema after extracapsular cataract extraction and intraocular lens implantation in diabetic patients without retinopathy.

Postoperative onset or aggravation of cystoid macular oedema (CMO) in diabetic patients after extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation is a frequent problem. At present little is known about the occurrence and prognosis of this complication in diabetics with no clinically detectable diabetic retinopathy (DR). Twenty five diabetic eyes (24 subjects) without DR and 45 normal eyes (44 subjects) were studied before surgery and 30, 90, 180, 360 days after ECCE and posterior chamber IOL implantation. Fluorescein angiography was performed at each examination. The frequency of angiographic CMO in the two groups was comparable 30 days after surgery but was significantly higher in diabetic eyes at 90, 180, and 360 days. This finding is probably related to an impairment of the blood-retinal barrier in diabetics. Final visual acuity, however, was similar in the two groups.     

超声乳化手术治疗糖尿病性白内障的疗效分析

目的:分析超声乳化白内障摘除联合人工晶状体植入术治疗糖尿病性白内障的疗效。方法:对65例98眼糖尿病合并白内障的患者行超声乳化白内障摘除及人工晶状体植入术的临床资料进行回顾性分析。统计术后1,30d的视力,术后视力与糖尿病病程的关系以及观察术后并发症。结果:术后1d,裸眼视力>0.5者69眼(70.4%),0.3～0.5者18眼(18.4%),0.1～0.25者8眼(8.2%),<0.1者3眼(3.1%)。术后30d,裸眼视力>0.5者80眼(81.6%),0.3～0.5者12眼(12.2%),0.1～0.25者4眼(4.1%),<0.1者2眼(2.0%)。糖尿病病程越长,术后视力提高越不理想。术后并发症主要有角膜水肿,前房纤维素性渗出,虹膜粘连,继发青光眼。结论:超声乳化白内障摘除联合人工晶状体植入术治疗糖尿病性白内障是安全有效的,术后视力的恢复与糖尿病病程及糖尿病视网膜病变有关。     

Extracapsular cataract surgery with lens implantation in diabetics with and without proliferative retinopathy.

In a retrospective study we have examined all diabetics (66 operated eyes) and an equal number of non-diabetic matched controls who underwent extracapsular cataract extracation (ECCE) with intraocular lens (IOL) implantation over a two-year period ending in December 1987. Of the diabetic patients' 76% eyes improved by at least two lines of Snellen acuity postoperatively. Of these patients 68% eyes and of the control eyes 83% achieved an acuity of 6/12 or better. In the diabetics the visual outcome depended on the state of the retinopathy and in particular the maculopathy. The diabetic group had a greater incidence of postoperative inflammation, but the major complications were related to continuing neovascularisation. Early postoperative laser photocoagulation may help to prevent these proliferative complications, and, provided a large, adequate capsulotomy is performed for capsular thickening, the presence of an IOL does not interfere with this photocoagulation. We also advise early postoperative assessment, and treatment if necessary, of any maculopathy. Diabetic retinopathy should no longer be regarded as a contraindication to intraocular lens insertion.     

儿童白内障手术后二期人工晶状体植入的探讨

目的 探讨儿童白内障术后二期人工晶状体植入术的效果。方法 回顾了34例(41眼)儿童白内障手术后二期人工晶状体植入5年记录。介绍了二期人工晶状体植入的适应证，人工晶状体植入的手术方法。术前、术后视力、屈光不正。双眼状态和手术方法。结果 34例(41眼)儿童白内障手术后二期人工晶状体植入。其中8眼成功囊袋内植入，28眼睫状沟植入，余5眼行后房人工晶状体悬吊术。41眼中35眼(85．37％)有可测量的视力提高，有3眼视力降低2行。24眼(58．54％)与对侧眼的矫正屈光度差在 1．50D以内。31眼(75．61％)屈光度差在 3．00D以内。结论 对于不能耐受接触镜或眼镜的儿童无晶状体眼，二期后房型人工晶状体植入是一种安全、有效的选择。     

糖尿病患者白内障与老年性白内障超声乳化术前后房水蛋白浓度变化的比较

目的　通过检测老年性白内障与糖尿病患者白内障超声乳化白内障吸除并人工晶体植入手术前后房水蛋白浓度的变化 ,评估该手术对眼血 -房水屏障的影响。方法　对 60例 (64眼 )老年性白内障患者及 5 2例 (5 6眼 )伴发糖尿病的白内障患者 (3 4眼非增殖型糖尿病性视网膜病变 ,2 2眼伴增殖型糖尿病性视网膜病变 ) ,应用激光闪光细胞检测仪 (Laserflarecellmeter ,LFCM )定量检测超声乳化白内障吸除并人工晶体植入术前、术后前房蛋白浓度。结果　术前 ,伴增殖型糖尿病性视网膜病变患者的前房蛋白浓度高于老年性白内障和非增殖型糖尿病性视网膜病变白内障患者 ,且差异有显著性 (P <0 0 5 ) ;而老年性白内障和非增殖型糖尿病性视网膜病变白内障患者间的房水蛋白浓度无明显差别。各组术后 1天、 7天及 3 0天的房水蛋白浓度均较术前高 ,并有显著性差别 (P <0 0 5 )。术后 90天时 ,老年性白内障和非增殖型糖尿病性视网膜病变白内障患者的房水蛋白浓度与术前无显著性差别 ;但伴增殖型糖尿病性视网膜病变患者的仍高于术前水平 ,且差异有显著性 (P <0 0 5 )。结论　对于老年性白内障患者与非增殖型糖尿病性视网膜病变的白内障患者 ,超声乳化吸除并折叠式人工晶体植入手术后眼血 -房水屏障功能均可在短期内恢复 ,而对     

糖尿病患者的后房型人工晶体植入术

为了提高糖尿病性视网膜病变患者的视力，对３８例有或无非增殖型视网膜病的糖尿病患者和３８例非糖尿病患者，共７６例９３只眼行白内障囊外摘除联合后房型人工晶体植入术。结果表明两组的术中，术后并发症的发生率差异无显著性。术后矫正视力达０．５以上者：糖尿病患者４７只眼中有２６只眼（５５．３％），非糖尿病患者４６只眼中有３０只眼（６５．２％），差异也无显著性（Ｐ〉０．０５）。观察结果提示对此类患者术后必须密切     

小切口白内障术后低视力原因分析

目的:分析小切口白内障摘除人工晶状体植入术后低视力的相关因素。方法:回顾性分析我院2011-07/2012-07间白内障患者291例291眼,对其行小切口白内障囊外摘除联合人工晶状体植入术,最佳矫正视力低于0.3者诊断为低视力,并分析其发生原因。结果:患者291例术后共发生低视力49眼,其中手术所致术后低视力17眼(34.7%),术前病变所致术后低视力32眼(65.3%),其中年龄相关性黄斑变性8眼、糖尿病视网膜病变14眼、高度近视6眼,其他4眼。结论:原有眼病是术后低视力的主要原因,术前仔细检查可以提高手术的可预测性。     

单切口超声乳化IOL植入术联合小梁切除术后疗效观察

目的:评价单切口白内障超声乳化吸除、人工晶状体植入联合小梁切除术(单切口三联术)治疗青光眼合并白内障患者的临床疗效。方法:对2008-01/2009-02在我院行单切口三联术的30例34眼患者进行回顾性研究,观察术后视力、眼压及并发症等情况,随访24～36mo。结果:术前34眼平均视力4.21±0.42,术后平均视力4.67±0.22,术前后统计学比较差异有显著性(t=-5.794,P<0.01)。术后34眼未采取任何措施眼压控制在21mmHg以下,由术前平均23.67±9.12mmHg降低为术后平均15.90±2.74mmHg,术前后统计学比较差异有显著性(t=5.162,P<0.01),术后均无严重并发症。结论:单切口三联术能较好控制眼压,获得较满意的视力。     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

Extracapsular cataract extraction with intraocular lens implantation after scleral buckling surgery

We reviewed the records of 28 patients who had undergone successful scleral buckling surgery followed by extracapsular cataract extraction with implantation of an intraocular lens. Posterior chamber intraocular lenses were inserted in 27 eyes, and anterior chamber intraocular lenses were inserted in two eyes with posterior capsule rupture at the time of surgery. The mean follow-up period was 44 months. Final visual acuity was 20/40 or better in 15 of 29 eyes (52%). One eye (3.4%) developed a recurrent retinal detachment 15 months after cataract surgery. Two eyes (6.9%) developed angiographically proven cystoid macular edema. The outcome for extracapsular cataract extraction with intraocular lens implantation in eyes that had previously undergone successful scleral buckling for retinal detachment is favorable.