双撕囊联合干性前部玻璃体切割治疗先天性白内障临床观察

目的：探讨先天性白内障超声乳化吸除联合干性前部玻璃体切割术预防后发性白内障的效果。 方法：对先天性白内障患者18例32眼采用超声乳化白内障吸除、环形撕除晶状体前后囊膜联合干性前部玻璃体切割术,其中10例16眼一期囊袋内植入折叠式人工晶状体。术后观察角膜、前房炎性反应和后囊膜透亮程度,随访6～24（平均15） mo。 结果：术后所有患者角膜清亮,前房反应轻微,大部分瞳孔圆形,视轴区清亮。3眼后囊膜切开区薄纱样混浊,4眼瞳孔轻度上移,3眼部分虹膜后粘连。 结论：干性前部玻璃体切割术可有效降低儿童后发性白内障发生率,维持视轴清亮,有助于患儿视功能恢复,是一种安全有效的手术方法。     

先天性白内障手术中干性玻璃体切割的应用

目的探讨先天性白内障超声乳化吸出术联合干性前段玻璃体切割预防后发性白内障的效果。方法先天性白内障患者31例52眼行超声乳化吸出术同时行晶状体后囊膜连续环形撕囊,对前段玻璃体进行干性切割,其中19例28眼一期晶状体囊袋内植入折叠式人工晶状体。术后随访3~15个月,平均(6.8±1.1)月,观察前房炎性反应和瞳孔区透亮程度。结果全部患者术后反应轻微,无严重并发症。大部分瞳孔圆形,视轴区保持透明,7眼出现后囊膜切开区混浊,5眼瞳孔轻度上移,3眼部分虹膜后粘连。结论干性前段玻璃体切割是减少后发性白内障发生率的一种安全有效的技术,是术后提升视力的理想方法。     

超声乳化后囊膜切开联合前部玻璃体切割治疗先天性白内障疗效分析

目的 观察白内障超声乳化、后囊膜切开联合前部玻璃体切割治疗先天性白内障的效果.方法 对54例(90只眼)先天性白内障进行手术治疗,均采用超声乳化仪吸除白内障、后囊膜连续环形撕囊及前部玻璃体切割术,3岁以上患儿一期植入人工晶体.术后进行视功能恢复,对术后并发症、视力改善情况进行10～24月随访.结果 28只眼因年龄小不能配合检查,但表现为明显追光,其余62只眼术后校正视力＜0.1者3只眼(4.84%),0.1～0.3者10只眼(16.13%),0.3～0.5者25只眼(40.32%),0.6～1.0者18只眼(29.03%),＞1.0者6只眼(9.68%),与术前相比明显提高;19只眼(30.65%)周边部后囊膜不同程度混浊,8只眼(12.90%)发生新生膜,其余撕囊区清亮.结论 白内障超声乳化、后囊膜切开联合前部玻璃体切割是治疗先天性白内障的一种理想的手术方法,能有效提升视力,减少后发障的形成.     

儿童白内障摘除及人工晶体植入术

目的探讨儿童白内障摘除联合前段玻璃体切割及人工晶体植入的临床疗效.方法41例(59只眼)儿童先天性白内障及外伤性白内障施行现代囊外摘除联合前段玻璃体切割,对3岁以上儿童38例(53只眼)同期成功植入后房型人工晶体.结果3岁以上儿童术后裸眼视力≥0.3者先天性白内障25只眼(69.4%),外伤性白内障14只眼(82.4%).术后,先天性白内障1只眼发生后囊混浊;外伤性白内障3只眼轻度瞳孔上移,1只眼轻度晶体偏位.影响术后视力提高的主要原因是先天性白内障的重度弱视和外伤性白内障的角膜瘢痕.结论儿童白内障后囊膜切开联合前段玻璃体切割是防止术后并发障的有效方法.     

25G玻璃体手术治疗儿童后发性白内障

目的探讨25G玻璃体手术治疗儿童后发性白内障的疗效。方法对7例（10只眼）儿童后发性白内障患者以透明角膜切口插管灌注,TSV25G玻璃体手术行后囊膜切除联合前段玻璃体切除术。术后平均随访23个月,观察视力、眼压、前房反应和并发症的发生情况。结果所有术眼晶状体后囊膜中央均形成直径约4mm的圆形透明区,术中前房稳定,人工晶状体无损伤。全部患儿术后最佳矫正视力均较术前提高。随访期间无切口渗漏、角膜水肿、眼内炎、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压及晶状体后囊膜切开区再次混浊等并发症。结论 25G玻璃体手术治疗儿童后发性白内障安全、有效、便捷。     

先天性白内障手术治疗30例临床分析

目的探讨先天性白内障手术时机及方法选择。方法对30例50眼先天性白内障进行手术治疗，〈3岁为白内障摘除和后囊膜环形撕囊，部分二期植入人工晶体；≥3岁采用小切口超声乳化、后囊膜环形撕囊或合并前段玻璃体切割联合一期人工晶体植入。进行5～12个月随访，分析判断手术时机、手术方法、术后并发症、术后弱视训练对巩固疗效的重要性。结果经治疗后所有患者视力有改善征象。表现为明显追光、视物清晰、视力提高。出现后囊膜混浊是先天性白内障常见的术后并发症，经激光治疗取得一定疗效。结论先天性自内障手术干预是一种有效方法。宜早发现、早诊断、早治疗，以便把握手术时机。3岁以下婴幼儿进行白内障吸出、后囊膜环形撕囊或并行前段玻璃体切割术，术后及时视光学检查配镜，日后二期植入人工晶体。3～6岁患者行白内障吸出、后囊膜环形撕囊或并行前段玻璃体切割联合一期人工晶体植入以欠矫10％～20％为宜，7岁后给足人工晶体度数，后囊膜环形撕囊或并行前段玻璃体切割术，是预防婴幼儿白内障手术后囊膜混浊最有效的方法。后囊膜混浊仍和年龄相关明显，年龄越大发病率越低。     

后囊膜截开联合前段玻璃体切割术在先天性白内障手术中的应用

目的 :探讨后囊膜截开联合前段玻璃体切割术 (PCCC +AV )在先天性白内障手术中的应用效果。方法 :对先天性白内障患儿者 5 5例 ( 88眼 )进行回顾性研究。行晶状体吸除术 42眼 ,其中 3 8眼联合PCCC +AV术。行晶状体吸除联合人工晶体植入术 44眼 ,其中联合PCCC +AV术 15眼。随访半年到 3年 ,观察视轴混浊、前房纤维渗出、虹膜膜后粘连、人工晶体夹持、黄斑囊样水肿和视网膜脱离等发生情况 ,并进行统计学分析。结果 :术中行PCCC +AV的患儿视轴混浊发生率明显低于未行PCCC +AV的患儿 ,两者有显著性差异 (P <0 0 1)。而前房纤维渗出、虹膜膜后粘连、人工晶体夹持的发生率无显著性差异 (P >0 0 5 )。各组均无一例发生黄斑囊样水肿和视网膜脱离。结论 :在先天性白内障手术中运用后囊膜截开联合前段玻璃体切割术 ,安全易掌握 ,可有效预防后发障 ,主要用于 0～ 5岁的患儿。     

25 G玻璃体手术系统在厚的后发性白内障手术中的应用

目的 探讨应用25 G玻璃体手术系统治疗厚的后发性白内障的疗效.方法 应用25 G经结膜无缝合玻璃体切割术对16例(16眼)厚的后发性白内障患者行后囊膜切开+前段玻璃体切割术.术后随访2～6个月,记录视力、眼压,观察晶状体后囊膜切开区情况及并发症情况.结果 所有手术均顺利完成.术后视力均明显提高,术后1周和末次随访时最佳矫正视力≥0.5的术眼分别占75.0%(12/16)、81.3%(13/16).除1眼术后发生暂时性低眼压(术后3 d恢复正常)外,其余患眼随访期内眼压均在正常范围.全部术眼晶状体后囊膜中央均形成直径为3.0～4.0 mm的圆形透明区,视轴区透明,术中、术后均未见明显并发症发生.结论 25 G经结膜无缝合玻璃体切割系统通过切开晶状体后囊膜和切除前段玻璃体治疗厚的后发性白内障安全、有效.     

前部玻璃体切除在先天性白内障手术中的作用

目的探讨前部玻璃体切除在(2～7)岁儿童先天性白内障手术中的必要性。方法在66例108眼(2～7)岁儿童先天性白内障中施行超声乳化白内障吸除联合人工晶状体植入,其中36例56眼联合后囊膜连续环形撕囊(A组),30例52眼联合后囊膜连续环形撕囊及前部玻璃体切除(B组),随访(6～60)m,观察记录两组视轴区混浊情况和其它并发症。结果在能够进行视力检查的54例90眼中,脱盲率为92.6%,脱残率为73.5%。视轴区混浊发生率两组间比较,A组为39.3%,B组为5.8%,B组明显低于A组(P<0.01)。A组中Nd:YAG激光后囊膜截开率为45.5%,二次手术切开率为22.7%;B组中,无一例患儿行Nd:YAG激光后囊膜截开,二次手术切开率为1.9%,两组后囊膜二次切开率比较具有显著性差异(P<0.01)。A组中7例9眼发生人工晶状体偏位,B组中未出现类似并发症。结论对于(2～7)岁儿童先天性白内障,在施行超声乳化白内障吸除联合人工晶状体植入的同时,联合后囊膜连续环形撕囊及前部玻璃体切除能够安全有效地阻止视轴区的混浊。     

玻切联合硅油填充术后并发性白内障的手术治疗

探讨白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障的疗效。 方法：回顾分析2007-11/2011-11玻璃体切割联合硅油填充术后白内障患者102例102眼,距离玻璃体手术时间3~9（平均6.1）mo,采用玻璃体腔灌注,先行白内障超声乳化手术,前房注入黏弹剂,行硅油置换,然后人工晶状体植入,环形后囊切开,观察术中、术后并发症,术后视力等。 结果：术后 4wk,102例102眼中,97眼视力不同程度提高,5眼术后视力无改善;后囊破裂2例,无晶状体核坠入玻璃体,无脉络膜脱离。 结论：玻璃体切割联合硅油填充术后行白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障,可有效减少术中、术后并发症,同时避免二次手术所带来的风险。     

应用25G玻璃体切割系统治疗婴幼儿先天性白内障

目的　探讨应用２５Ｇ玻璃体切割系统治疗婴幼儿先天性白内障的临床疗效。方法　回顾性分析我院１３例（２１眼）婴幼儿先天性白内障患儿在全身麻醉下,应用２５Ｇ玻璃体切割系统在角巩膜缘做切口行前囊膜环形切除＋白内障吸出＋后囊膜环形切除＋前段玻璃体切割术。术后随访４～２０个月,平均８个月,观察患儿视力、眼压、前房反应及并发症的发生情况。结果　所有手术均顺利完成,术中前房稳定,无明显虹膜脱出,术后视力均明显改善,表现为明显追光、追物。术后眼压均在正常范围内,除２眼术后第１天发生低眼压（术后第３天恢复正常）,所有患儿术后角膜清亮,前房无出血、渗出。随访期间所有患儿视轴区透明,无明显并发症发生。结论　２５Ｇ玻璃体切割系统用于治疗婴幼儿先天性白内障手术创伤小,对眼内组织刺激小,术后炎症反应轻、并发症少,手术安全有效。     

儿童先天性白内障手术治疗临床分析

目的:观察手术治疗先天性白内障的临床效果。方法:对97例(136眼)先天性白内障实行白内障摘除、后囊连续环形撕囊、前部玻璃体切除术,部分联合Ⅰ期或Ⅱ期IOL植入。结果:术后最佳矫正视力>0.5者46眼,>0.3者25眼,>0.1者22眼,<0.1者17眼,26眼因年龄小无法进行视力表检查,但能够跟随光亮或有注视目标,较术前有提高。主要并发症有:后囊膜混浊、葡萄膜炎、角膜水肿、IOL偏中心及青光眼等,未见IOL夹持、黄斑囊样水肿、视网膜脱离及眼内炎等严重并发症。结论:白内障摘除、后囊连续环形撕囊、前部玻璃体切除联合IOL植入是治疗先天性白内障安全有效的手段,配合术后戴镜矫正和弱视治疗,可以使大多数先天性白内障致盲儿童达到脱盲及脱残。     

应用25G经结膜无缝线玻璃体切割手术系统治疗黄斑前膜

目的 探讨TSV25G(25G经结膜无缝线玻璃体切割手术系统)治疗黄斑前膜的手术疗效及应用价值.方法 15例黄斑前膜,其中特发性黄斑前膜10例,继发性黄斑前膜5例,手术使用美国博士伦公司的Millennium玻璃体切割机与TSV25G系统,经结膜穿刺行玻璃体切割术,剥除黄斑前膜,平均手术时间27min,无玻璃体于小并发症.结果 术后11例患者视物变形消失,4例视物变形明显减轻,黄斑水肿或黄斑皱褶减退或明显减轻.结论 TSV25G治疗黄斑前膜疗效确切.     

23-gauge vitrectomy with intraocular foreign body removal via the limbus: An alternative approach for select cases

Purpose:

To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23-gauge transconjunctival sutureless vitrectomy (TSV).

Materials and Methods:

In this prospective, non-comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23-gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any.

Results:

All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye.

Conclusion:

The advantages of 23-gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.     

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.     

25G玻璃体切除术治疗外伤性白内障的疗效观察

目的：观察25 G玻璃体切除术治疗外伤性白内障的手术疗效。方法：回顾性分析2013－02／2015－02于我院诊治的外伤性白内障行25 G玻璃体切除术联合晶状体切除术的病例70例70眼。男43例43眼,女27例27眼,年龄22～51（平均35．23±2．54）岁,视力平均0．10±0．03。手术后随访时间6～12mo,观察患者的眼前后节、并发症、最佳矫正视力、眼压等,比较患者术前、术后1wk,1、6mo的最佳矫正视力。结果：所有患者均顺利完成手术,视力均有不同程度地提高,术后1wk,1、6mo的最佳矫正视力较手术前比较差异有统计学意义（均P＜0．05）。术后并发症：角膜水肿5例,高眼压10例,低眼压4例,视网膜点状出血5例,经对症支持治疗后,症状均好转。结论：25 G玻璃体切除术联合晶状体切除术能有效治疗外伤性白内障,降低手术风险,减少并发症,提高视力,改善预后。     

儿童白内障手术并发症及处理

目的 探讨儿童白内障手术的并发症及处理.方法 对45例(60只眼)先天性、外伤性、后发性白内障分别行不同术式的手术,对于术后视力,术中及术后并发症及处理进行分析.结果 术后视力比术前提高者51只眼,随访30只眼,视力提高有25只眼.术中并发症为后囊破裂和玻璃体脱出,术后主要的并发症为后囊混浊,前房炎症反应等.结论 白内障摘除术是处理儿童白内障的有效方法,儿童白内障术后并发症有一定的特殊性,适时恰当的处理,仍然可以获得良好的效果.     

儿童白内障手术治疗的临床观察

目的观察白内障摘出联合人工晶状体植入术治疗儿童白内障的临床疗效并探讨术后并发症的防御措施。方法对45例(60眼)儿童白内障,其中先天性白内障38眼,外伤性白内障22眼,分别采用不同术式联合不同类型的人工晶状体植入,术后随访12个月,对术后视力、术中及术后并发症等进行分析。结果术后脱盲率为91.3%,脱残率为81.0%.术中并发症为后囊破裂和玻璃体脱出,术后主要的并发症为后囊膜混浊、葡萄膜炎、人工晶状体夹持、弱视和斜视、继发青光眼。结论儿童先天性白内障及外伤性白内障行晶状体摘出联合人工晶状体植入,可以有效提高患眼的视功能,而术后的屈光矫正及弱视训练对于患儿视功能重建具有重要作用。     

Removal of dense posterior capsule opacification after congenital cataract extraction using the transconjunctival sutureless vitrectomy system

We report a case of posterior capsule opacity and anterior hyaloid opacity after congenital cataract extraction that was successfully and easily removed using the transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical). With the TSV25 system, clear axes were maintained.     

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study

Background The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system.Methods Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared.Results No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid.Conclusion The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients’ discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.The authors have no financial interests related to this publication.