玻璃体切割联合前部超声乳化及IOL植入的评估

目的观察评估玻璃体切割手术的同时联合进行超声乳化白内障囊外摘除和IOL植入治疗并发晶状体混浊的玻璃体积血的术后效果。方法回顾性分析我院2003/2004期间28例并发有晶状体混浊的玻璃体积血患者,分别进行保留晶状体和联合前部超声乳化的玻璃体切除手术。结果联合手术在手术操作,术后反应与保留晶状体眼无明显差别,术后视功能恢复上要优于保留晶状体眼。结论对并发晶状体混浊的玻璃体积血患者玻璃体切割手术的同时联合进行超声乳化白内障囊外摘除和IOL植入治疗的术后效果显著。     

原发性闭角型青光眼合并白内障的术式选择

目的:探讨原发性闭角型青光眼合并白内障的手术方式选择.方法:选取闭角型青光眼合并白内障患者90例96眼,根据房角粘连程度及病程长短,非随机选择施行超声乳化+人工晶状体植入术(Phaco+IOL)、超声乳化+人工晶状体植入联合虹膜周切手术(Phaco+ IOL+ PLI)、超声乳化+人工晶状体植入联合小梁切除术(Phacotrab+ IOL),观察手术前后的视力、眼压、前房轴深、滤过泡,随访时间为1 mo.结果:三种手术方式治疗青光眼合并白内障,术后视力均显著提高(P＜0.05)、眼压明显降低(P＜0.05),术后1wk;1 mo三组之间眼压比较无显著差异.结论:微切口透明角膜超声乳化及联合手术治疗青光眼手术是安全的.房角粘连＜90°可行超声乳化联合人工晶状体植入;90°＜房角粘连为＜180°行超声乳化联合人工晶状体植入+联合周边虹膜切除术;如果病程长且房角粘连＞180°,考虑行超声乳化联合人工晶状体植入+小梁切除术.     

悬韧带异常的假性剥脱综合征性白内障手术时机和方法的选择

背景 假性剥脱综合征(PEX)常并发白内障,多伴有进展性晶状体悬韧带异常,术中及术后易出现悬韧带相关并发症,白内障手术如何选择合适的手术时机及手术方式对于减少并发症、提高手术成功率具有重要的临床意义,但目前相关研究报道很少. 目的 分析伴有晶状体悬韧带异常的PEX性白内障(PEXC)患者行白内障摘出联合人工晶状体(IOL)植入术的疗效,探讨其合适的手术时机及手术方式.方法采用系列病例观察研究方法,对2012年7月至2015年12月在新疆维吾尔自治区喀什地区第二人民医院接受PEXC手术的21例23眼进行分析,所有患者均伴有晶状体悬韧带异常,根据悬韧带异常的程度分为晶状体震颤和不全脱位2种类型,其中晶状体震颤18眼,晶状体不全脱位5眼.按照Emery核硬度分级法分为Ⅱ级核4眼,Ⅲ级核9眼,Ⅳ级核7眼,Ⅴ级核3眼;晶状体震颤者行白内障超声乳化联合标准囊袋张力环(CTR)或改良CTR(MCTR)及IOL植入术或白内障囊外摘出联合CTR及IOL植入术;Ⅱ级或Ⅲ级核伴晶状体不全脱位者行超声乳化联合MCTR及IOL植入术;Ⅳ级或Ⅴ级核伴晶状体不全脱位者行白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术.对患者共随访3个月,分析手术时机对疗效的影响及术眼术后视力、眼压,术中及术后并发症,前囊口、IOL位置变化. 结果 晶状体震颤患者行白内障超声乳化联合IOL植入术,其中植入CTR者10眼,MCTR者3眼,囊外摘出联合CTR及IOL植入术4眼,前段玻璃体切割联合IOL巩膜缝线固定术1眼.晶状体不全脱位行超声乳化联合前段玻璃体切割联合IOL巩膜缝线固定术1眼,白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术4眼.术眼术后最佳矫正视力(BCVA)＞0.5者4眼,＞0.3 ～≤0.5者6眼,＞0.1～≤0.3者8眼,≤0.1者5眼,与术前BCVA比较,差异有统计学意义(x2=17.29,P＜0.01);术眼术前平均眼压为(16.82-±2.25)mmHg(1 mmHg=0.133 kPa),术后3个月平均眼压为(16.12±2.67)mmHg,差异无统计学意义(t=0.108,P＞0.05);术中、术后常见并发症为瞳孔不易扩大、角膜水肿、晶状体皮质残留和后囊膜混浊. 结论 伴有晶状体悬韧带异常的PEXC手术复杂、并发症多,手术时机和手术方式的选择均应依据悬韧带异常程度、核硬度和晶状体是否脱位,术前应认真行自然瞳孔下及扩瞳后检查以确定治疗方案是手术成功的关键.     

飞秒激光联合Cionni张力环植入治疗外伤性晶状体不全脱位的有效性和安全性

目的:探讨飞秒激光辅助晶状体超声乳化吸除联合Cionni 改良张力环(MCTR)植入治疗外伤性晶状体不全脱位的有效性和安全性.方法:外伤性晶状体不全脱位患者11例11眼,90°≤脱位<120° 4眼,120°≤脱位<180° 5眼,180°≤脱位<270° 2眼.应用接触式LenSx飞秒激光白内障手术操作平台完成前囊膜切开、晶状体预劈核、切口制作.部分患者行前段玻璃体切割.囊袋拉钩稳定囊袋,超声乳化白内障吸除,MCTR植入及巩膜层间缝合固定,晶状体囊袋内植入IOL.分析术后视力、术中术后并发症、前囊口、IOL和MCTR位置及眼压情况.结果:随访2mo.所有患者均顺利完成手术,其中5眼联合前段玻璃体切割术.植入双钩MCTR 4眼,单钩7眼.术后术眼最佳矫正视力≥0.5者4眼,0.3~<0.5者3眼,0.1~<0.3者3眼,<0.1者1眼.与术前矫正视力比较,差异有统计学意义(P<0.05).所有IOL位置居中,MCTR固定钩稳定地位于虹膜与晶状体囊膜间.术中、术后常见并发症为结膜下出血、前囊切开不完全、皮质残留、继发性青光眼和后囊膜混浊.结论:飞秒激光辅助白内障超声乳化吸除可以提高撕囊成功率,降低核乳化吸除难度,联合MCTR植入是外伤性晶状体不全脱位手术的理想术式选择.     

晶状体超声乳化、折叠人工晶状体植入和小梁切除联合手术治疗闭角型青光眼

目的:报告1组闭角型青光眼( angle-closure glau-coma, ACG)患者在1次手术中完成晶状体超声乳化、折叠人工晶状体(intraocular lens, IOL)植入和小梁切除联合手术的视力和眼压控制效果。方法:对过去1a间为治疗ACG所施行晶状体超声乳化、折叠IOL植入和小梁切除联合手术患者的临床资料进行回顾性分析。本组共49例(56眼),其中52眼晶状体透明,27眼有明显的视野损害。患者随访10月～2a。结果:手术的并发症轻微,包括手术后的浅前房4眼、脉络膜脱离1眼、明显的纤维蛋白渗出2眼,经处理在短期恢复。手术后,各眼的视力保持或好于手术前最好矫正视力,其中41眼≥0.5,16眼≥1.0。手术后1周时眼压为10.1±3.7 (5～20) mmHg并在随访期内一直保持稳定,但有2眼在术后2周时眼压为22～23mmHg,常规点用2.5g/L噻吗洛尔,得到良好控制。所有的眼视野保持不变。结论:晶状体超声乳化、折叠IOL植入、小梁切除联合手术,对ACG,尤其中晚期病例,是一种安全、有效的控制眼压和保持视力的手术。术后浅前房、恶性青光眼等并发症少见。避免了2次手术。这种联合手术不仅促进房水外流,而且可矫正多数患者原有的远视,使其裸眼视力好于术前。     

囊袋张力环植入治疗晶状体悬韧带异常

目的 探讨超声乳化联合囊袋张力环(CTR)及人工晶状体(IOL)植入术治疗白内障有悬韧带异常者的手术效果.方法 10例16只眼具有晶状体悬韧带松弛或部分断裂的白内障,施行超声乳化联合CTR及IOL植入手术.结果 术后随访6月,有2例失访.末次检查8例13只眼的最佳矫正视力(BCVA)都有增进,所有术眼CTR都位于囊袋内,仅有1只眼在术后6个月IOL位置轻度偏中心,3只眼轻度后囊膜混浊.结论 对半脱位晶状体采用超声乳化白内障吸除联合CTR及IOL植入是一安全有效的手术,严爵半脱位和有进展的病例才需作改良CTR(M-CTR)巩膜缝合固定术.     

经透明角膜切口晶状体超声乳化联合硅油取出方法的探讨

目的探讨经透明角膜切口进行晶状体超声乳化联合硅油取出人工晶状体（IOL）植入手术方法。方法回顾分析36例（36眼）实行透明角膜切口晶状体超声乳化、鼻下睫状体平坦部放置灌注、撕开后囊、自超声乳化的角膜切口取出硅油、IOL植入手术的临床资料。结果全部病例顺利实施晶状体超声乳化、硅油取出,其中30例IOL植入于囊袋内,6例植入于睫状沟,未发生视网膜脱离或硅油残留等并发症。结论上述手术方法手术时间短,术后反应轻,并发症少。     

DR硅油填充后并发白内障行超声乳化联合硅油取出

目的：探讨糖尿病视网膜病变硅油填充后并发白内障的超声乳化及人工晶状体（IOL）植入联合硅油取出术的临床疗效。 方法：糖尿病视网膜病变患者22例22眼硅油填充后并发白内障行超声乳化及IOL植入联合硅油取出术,均通过角膜透明切口植入软性IOL。 结果：患者19眼视力均在白内障超声乳化手术后视力较术前提高,其中0.1以上者13例,3例同术前视力;手术中后囊膜保持完整,均顺利植入软性可折叠IOL;5例术后不同程度发生角膜水肿,均在术后3~7d内消退。22例硅油均顺利取出。3例术后1mo内发现玻璃体腔积血,其中2例约4wk内玻璃体腔积血自行吸收,1例再行玻璃体手术去除积血联合眼内光凝。22例术后均未发现视网膜再脱离。 结论：糖尿病视网膜病变硅油填充眼并发性白内障的超声乳化IOL植入术联合硅油取出手术效果满意,可减少患者多次手术的痛苦。     

超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼

目的:探讨超声乳化人工晶状体(intraocular lens,IOL)植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效.方法:采用临床随机对照的研究方法,将临床收集的80例96眼原发性慢性闭角型青光眼患者分为观察组(40例46眼)和对照组(40例50眼).观察组给予超声乳化IOL植入联合房角分离术治疗,对照组仅给予超声乳化IOL植入术治疗.比较两组患者手术前后最佳矫正视力、眼压、视野平均缺损(mean deviation,MD)、平均视敏度值(mean sensitivity,MS)和中央前房深度改善状况,并记录患者术中、术后并发症发生状况.结果:两组患者术前最佳矫正视力、眼压、视野和中央前房深度比较,差异均无统计学意义(P>0.05);术后6mo,观察组最佳矫正视力、眼压、视野和中央前房深度与对照组相比,差异均有统计学意义(P<0.05);两组患者均无严重并发症,且差异无统计学意义(x2=2.095,P=0.351).结论:超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效优于单纯超声乳化IOL植入.     

前段玻璃体切割联合Cionni张力环在伴有前房玻璃体脱出的外伤性晶状体半脱位手术中的应用

目的 探讨应用前段玻璃体切割、囊袋拉钩联合Cionni改良张力环(Cionni-modified capsular tension ring,MCTR)在伴有前房玻璃体脱出的外伤性晶状体半脱位手术中的有效性和安全性.方法 伴有前房玻璃体脱出的外伤性晶状体半脱位患者16例(16眼),脱位范围在90°～ 120°7眼、＞120°～180°5眼、＞180°～ 270°4眼,其中合并虹膜根部离断3眼、express植入1眼、青光眼瓣膜阀植入1眼.根据前房玻璃体情况,行曲安奈德染色后经前房或睫状体平坦部行玻璃体切割术,连续环形撕囊后使用2～4个囊袋拉钩钩住撕囊边缘,稳定晶状体囊袋并使其居中,超声乳化白内障吸出、MCTR植入及巩膜层间缝合固定,晶状体囊袋内植入折叠人工晶状体(intraocular lens,IOL).术后随访3个月,观察术后视力、术中术后并发症、前囊口、IOL位置、眼压情况.结果 所有患者均顺利完成白内障吸出、MCTR及IOL植入;其中植入双钩MCTR 7眼,单钩9眼.术后视力＞0.5者9眼,＞0.3 ～0.5者4眼,＞0.1 ～0.3者2眼,≤0.1者1眼,术后术眼最佳矫正视力与术前比较,差异有统计学意义(x2=17.503,P=0.000).Pantacam眼前段分析系统获得Scheimpflug图像分析IOL居中性好,无MCTR及IOL移位等并发症发生.术中术后并发症有皮质残留、房水后部返流综合征、前囊撕裂、前囊口收缩、后囊膜混浊等.结论 有效前房或睫状体平坦部玻璃体切割是减少手术并发症的关键,前段玻璃体切割、囊袋拉钩联合Cionni张力环植入是伴有前房玻璃体脱出的外伤性晶状体不全脱位较理想的术式选择.     

Phacoemulsification and intraocular lens implantation in Alport syndrome with anterior lenticonus

Eleven eyes of 6 patients with Alport syndrome had phacoemulsification with implantation of a single-piece acrylic hydrophobic intraocular lens (IOL) (AcrySof SA6OAT, Alcon) because of anterior lenticonus. All patients had excellent visual acuity after surgery. We recommend phacoemulsification with IOL implantation as a safe and effective procedure in patients with anterior lenticonus secondary to Alport syndrome.     

Alport syndrome with recurrent herpes simplex virus keratitis

PURPOSE: To report a case of Alport syndrome with recurrent herpes simplex virus (HSV) keratitis. METHODS: Case report and review of the literature. RESULTS: A 29-year-old man with Alport syndrome suffered from 4 consecutive episodes of HSV keratitis within 2 years. A type IV collagen defect in basement membranes plays an important role in the pathogenesis of Alport syndrome. The relationship between HSV keratitis and Alport syndrome is discussed. After remission from HSV keratitis, the patient underwent bilateral phacoemulsification and posterior-chamber intraocular lens implantation for anterior lenticonus and an anterior polar cataract. After surgery, the uncorrected visual acuity was 20/20 in both eyes. CONCLUSIONS: We assume that the underlying basement membrane defects in Alport syndrome may account for the recurrent episodes of HSV keratitis in this patient. In addition, phacoemulsification and posterior-chamber intraocular lens implantation, rather than correction of refractive errors, provide a safe and efficient therapeutic choice for the management of anterior lenticonus, with or without associated cataract in patients with Alport syndrome.     

Fuchs综合征的白内障摘除联合人工晶状体植入临床观察

目的：探讨Fuchs综合征的白内障摘除联合人工晶状体植入手术方法和临床效果。方法：21例(21只眼)Fuchs综合征的白内障手术采用反眉弓隧道切口，其中白内障囊外摘除联合人工晶状体植入术12例，超声乳化白内障吸除术联合人工晶状体植入术9例。结果：术后经半年随访，患眼视力均大于0．5，21例角膜后沉着物全部消失。结论：Fucks综合征的临床表现似乎与白内障有明显关系，故手术时尽量将晶状体皮质清除干净，消除眼前节炎症反应。     

Phacoemulsification in a Rare Case of Alport’s Syndrome

Abstract

Aim: To report a rare case of Alport Syndrome (AS) highlighting the precautions and surgical complications during phacoemulsification. Method: A 35 year old female presented with bilateral painless progressive diminution of vision since 6 months and had bilateral deafness since 12 years. Best corrected visual acuity (BCVA) in both the eyes was 4/60. Bilateral anterior lenticonus, posterior polar cataract with posterior lenticonus, macular and peripheral retinal flecks, which are rarely reported in females, were present. Right eye phacoemulsification and IOL implantation was done. Result: During surgery capsulorrhexis underwent multiple dehiscence in a “flower petal pattern” due to fragile capsule. It was completed with microforceps under high viscocity viscoelastic. IOL was placed in sulcus due to extension of capsulorrhexis. BCVA was 6/12 at 1 month. Conclusion: This rare case highlights the importance of an eye ailment in revealing an important systemic disease. It also highlights proper management of complications that can give good result even in difficult cases.     

Clear lens extraction in Alport syndrome with combined anterior and posterior lenticonus or ruptured anterior lens capsule

We describe the results of clear lens extraction in 7 eyes of 4 Alport-syndrome patients. Three patients (6 eyes) had both anterior and posterior lenticonus; the fourth patient had spontaneous rupture of the anterior lens capsule, resulting in an acute drop in vision. Clear lens extraction was an effective method for visual rehabilitation in Alport syndrome patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.     

Electron microscopic examination of the anterior lens capsule in a case of Alport’s syndrome

Purpose: To report a case of Alport’s syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. Method: A 21‐year‐old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. Results: His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. Conclusions: The course of Alport’s syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport’s syndrome.     

Fuchs‘综合征患者超声乳化白内障吸出术的临床观察

目的：讨论Ｆｕｃｈｓ’综合征患者行超声乳化白内障吸出术的安全性和有效性。方法：对我院５０００余例白内障患者中１３例Ｆｕｃｈｓ’综合征患者行超声乳化白内障吸出术,观察术中术后并发症及视力恢复情况。结果：术中常见并发症为瞳孔缩小和前房出血;术后并发症有青光眼、前房积血。最好矫正视力≥１．０者占６５％。结论：超声乳化白内障吸出术对Ｆｕｃｈｓ’综合症并发白内障是一种安全而有效的治疗方法。眼科学报２０００;     

Alport syndrome and conjunctival telangiectasia

We report a patient with ocular abnormalities due to Alport syndrome. Considerable improvement of visual acuity was obtained following ocular lens extraction with foldable lens implantation in the right eye to compensate the effect of the lenticonus anterior. The presence of conjunctival telangiectasia is a new clinical finding in a patient with Alport syndrome.     

Fuchsˊ综合征患者超声乳化白内障吸出术的临床观察

目的:讨论Fuchs'综合征患者行超声乳化白内障吸出术的安全性和有效性。方法:对我院5000余例白内障患者中13例Fuchs'综合征患者行超声乳化白内障吸出术,观察术中术后并发症及视力恢复情况。结果:术中常见并发症为瞳孔缩小和前房出血;术后并发症有青光眼、前房积血。最好矫正视力≥1.0者占65％。结论:超声乳化白内障吸出术对Fuchs'综合症并发白内障是一种安全而有效的治疗方法。眼科学报2000;16:97-98。     

Anterior lenticonus: histological evaluation and approach for cataract surgery

PURPOSE: To present 2 cases of anterior lenticonus in patients without Alport's syndrome, a surgical technique of cataract extraction in eyes with anterior lenticonus, and histological results of lenticonus specimens obtained intraoperatively. SETTING: From St. Eriks Eye Clinic, Karolinska Institute, Stockholm, Sweden. METHODS: Two otherwise healthy patients presented with anterior lenticonus but no history of Alport's or other pathology. Best corrected visual acuity (BCVA) was decreased. Both patients had cataract extraction by phacoemulsification with intraocular lens implantation under topical anesthesia. Two continuous curvilinear capsulorhexes (CCCs) were created. The entire lenticonus was embedded in formaldehyde buffer 4% for histological analysis. RESULTS: In the first patient, BCVA did not improve postoperatively because of amblyopia. The patient subjectively reported a substantial improvement in visual field clarity. The surgical and postoperative course in the other patient was uneventful. The sections were positive for collagen types IV and VI, and the arrangement of the collagen fibers was highly irregular. CONCLUSION: Anterior lenticonus was detected in patients without Alport's syndrome who were otherwise healthy. A modified 2-step CCC technique can be used to make cataract surgery in such eyes safe and relatively easy.