人工晶体单襻睫状沟缝线固定的临床观察

评价人工晶体单襻睫状沟缝线固定的手术方法和临床疗效。方法 :对白内障囊外摘除术后后囊膜不完整的患者 5 8例 ( 5 8眼 )采用单襻睫状沟缝线固定法植入后房型人工晶体。将上襻缝合固定于 12点睫状沟处 ,下襻置于下方囊膜前。术后观察眼前节情况、人工晶体位置及视力等 ,随访 6～ 12个月。术后一年对 2 6例测人工晶体光学中心与瞳孔中心的距离 ,并与随机选择的 2 4例非缝线睫状沟固定一年以上者作对比。结果 :植入 5 8例人工晶体无前后向倾斜 ,无钟摆现象。无角膜内皮失代偿及视网膜脱离发生。 89 5 %患者视力≥ 0 5。术后一年 2 6例单襻缝线固定与 2 4例非缝线睫状沟固定人工晶体光学中心与瞳孔中心距离比较无显著性差异。结论 :人工晶体单襻睫状沟缝线固定操作简便 ,手术时间短 ,术后并发症少 ,晶体位置与非缝线睫状沟固定相比无明显差别。对后囊膜不完整植入后房型人工晶体者可作为首选。     

人工晶体睫状沟固定的最新进展

无晶体眼是白内障出术的续发症之一。以往纠正此续发症为植入前房型人工晶体，角膜表面镶嵌术等。近几年来人们又把后房型人工晶体植入在无晶体眼内，以避免前房型人工晶体起的诸多并发症。本介绍了无巩膜瓣的睫状沟固定技术，巩膜缝隙技术，脱位人工晶体复位及固定技术和眼内窥镜的使用技术。后房型人工晶体已渐取代闭合袢前房型人工晶体，但柔韧开放袢前房型人工晶体仍是治疗无晶体眼的简单方法。     

后房型人工晶体睫状沟缝线固定术

随着后房型人工晶体植入术的迅速普及，在术中因种种原因常出现不能按常规方法植入后房型人工晶体。如外伤性白内降或晶全脱位等等，为此需要掌握简单易行安全有效的人工晶体缝线固定术。现将我们自行设计的手术方法报告如下。一般资料：本组14例（16眼），其中男9例，女5例，年龄24一77岁，平均56岁。囊内摘除术后无晶体限5例6眼，计划性囊外摘除术中后囊破裂者5例5眼，角膜穿通伤致外伤性白内障3例3眼，慢性复发性葡萄膜炎、继发性青光眼、并发性白内障1例双眼。术前视力光感至0．2，5限元晶体服矫正视力0．8－12，1眼无晶体限矫正视力0．…     

二期后房型人工晶状体穿透巩膜睫状沟固定术

由于一部分二期植入后房型人工晶状体的无晶状体眼 ,后囊膜缺损或无后囊膜 ,需行人工晶状体单襻或双襻穿透巩膜睫状沟固定。我们对 42例 42眼无晶状体眼进行了这种手术 ,现报告如下。1　资料与方法1.1　一般资料　本组 42例 42眼无晶状体眼 ,男 2 9例 ,女13例。年龄 6～ 79a,平均 6 5 a。白内障囊内摘出术后 19眼 ,白内障囊外摘出术后 12眼 ,外伤性白内障术后 5眼 ,先天性白内障术后 6眼。其中 ,无后囊膜者 2 2眼 ,后囊膜缺损大于1/ 2象限者 5眼 ,鼻侧或下方存在部分后囊膜、缺损小于 1/ 2象限者 15眼 ,虹膜后粘连者 8眼。所有患者均行二期…     

晶体脱位Ⅰ期睫状沟缝合人工晶体疗效分析

本文探讨晶体脱位的患者行晶体取出，前部玻璃体切割，及睫状沟缝合人工晶体联合手术，以恢复眼部的正常解剖关系，减少并发症，现将我们的手术方法及结果报告如下。病例和方法从１９９２年５月至１９９７年７月，我们对３４例因眼外伤而致晶体后脱位患者行玻璃体切割，晶...     

经巩膜睫状沟后房型人工晶体缝线固定术的探讨

经巩膜睫状沟后房型人工晶体缝线固定术的探讨天津医科大学总医院眼科（３０００５２）韩琪张福昆世界人工晶体中国天津培训中心季建因各种原因造成晶体后囊不完整或缺如的无晶体眼，目前多采用经巩膜睫状沟后房型人工晶体缝线固定术，它具有眼内稳定性好，后房型人工晶体...     

人工晶体睫状沟缝线固定法的改良

目的改进人工晶体睫状为固定手术方法，减少并发症的发生。方法采用一种特制的缝针，只需要从眼外向眼内进针，定位较准确；避免器械伸入前房内进行操作；改良了缝线在人工晶体上的固定方式，避免线头在眼内存留。结果术中眼内出血的机会显著减少，完全消除了虹膜牵拉、角膜内皮损伤的可能。在将近两年的随访中发现，人工晶体位置稳定，巩膜瓣愈合良好，无线头刺激。视力恢复情况与术前验光结果相一致，最高达1．2。结论该手术方法操作简便安全，不受条件限制，并发症减少，效果稳定可靠。     

二期后房型人工晶状体穿透巩膜睫状沟固定术探讨

目的 探讨二期后房型人晶状体固定的手术方法。方法 对42眼后囊缺损或无后囊的无晶状体眼，行单襻(15眼)或双襻(27眼)人工晶状体穿透巩膜睫状沟固定术。单襻巩膜固定采用线结埋藏于角膜缘切口内；双襻巩膜固定采用在切开前房前已安置好固定缝线的方法。术后随访1～15个月。结果 术后裸眼视力0．1～0．4者24眼，0．5～0．9者15眼，1．0以上者3眼。结论 二期人工晶状体改良单襻或双襻穿透巩膜睫状沟固定，手术安全，术后视力恢复好，可减少手术并发症。     

经反向巩膜瓣IOL睫状沟缝合固定术的疗效分析

目的：探讨经反向巩膜瓣IOL睫状沟缝合固定术的临床应用。

方法：回顾性分析就诊于我院眼科需行Ⅱ期IOL植入的14例14眼无晶状体眼患者临床资料。采用经反向巩膜瓣睫状沟缝合固定术行IOL植入。术中制作以穹窿部为基底的插袋式巩膜瓣。观察患者手术前后的视力、术后眼压、眼前节反应和IOL稳定性。

结果：术后随访时间3.5～6mo。术前最佳矫正视力(LogMAR视力表)为0.50±0.54,术后1mo裸眼视力0.46±0.39,两者无差异(P>0.05)。术后1mo最佳矫正视力0.36±0.35,较术前最佳矫正视力有所提高。1例1眼患者术后IOL倾斜,经调整后IOL位正。3例3眼患者在术后早期眼压升高,给予降眼压药物对症处理后眼压正常,术后1mo随访眼压在正常范围内(16.4±2.6mmHg)。1例1眼患者术后玻璃体腔出血,1例1眼患者术后眼内炎症反应重,治疗后均恢复。术后无黄斑囊样水肿、脉络膜脱离、视网膜脱离等严重并发症。

结论：经反向巩膜瓣IOL睫状沟缝合固定术是一种简便、安全、有效的术式。     

无晶体后囊的后房型人工晶体缝线固定术

报告３０例３０眼无晶体后囊的后房型人工晶体缝线固定术随访６～２２个月的结果。矫正视力≥０．６者占８０％，人工晶体无明显的偏心与倾斜。分别论述了选择性二期植入人工晶体，计划囊外摘除术中后囊破损一期植入人工晶体和人工晶体脱位于玻璃体腔的再固定之适应征、手术方法及作者的体会。结果表明，无晶体后囊的后房型人工晶体缝线可获得良好的效果。     

Transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants

We present our results of transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants (IOL) in IOL exchange cases, secondary implants, and complicated cataract extractions. Follow-up data are presented on a total of 19 patients. The technique is facilitated by using a long needle attaching 10–0 prolene suture to both haptics of an all polymethylmethacrylate (PMMA) posterior chamber intraocular lens implant (PCL). Our early results show that the procedure is safe and predictable.     

外路法行后房型人工晶状体缝线固定术

目的探讨白内障术后晶状体后囊不完整和缺如眼的后房型人工晶积体植入术。方法对12例13眼采用外路法行经睫状沟后房型人工晶状体二点缝线固定植入术。结果术后视力最佳1．5，最差0．2，平均0．6。术后随访6－24月，无并发症。结论此法植入后房型人工晶状体，眼内操作少，限内组织损伤小，术后反应轻。人工晶状体眼内稳定性好、无偏位、并发症少。     

后房型人工晶体巩膜缝线固定术

报告一种后房型人工晶体（ＰＣＩＯＬｓ）睫状沟植入技术。７０眼（７０例）行穿透巩膜的ＰＣＩＯＬｓ缝线固定术,术后随访６￣３６个月（平均１８个月）。术前视力ＣＦ￣０．１。术后４３眼（６１．５％）视力增进至０．４￣０．６,７眼（１０％）至０．７￣１．０,很少有并发症发生。介绍了手术方法及术中注意事项,该手术的开展使ＰＣＩＯＬｓ。植入几可以应用于所有白内障摘除术眼。     

Modified cow-hitch suture fixation of transscleral sutured posterior chamber intraocular lenses: long-term safety and efficacy

PURPOSE: To evaluate the long-term safety and efficacy of a new technique using a modified cow-hitch knot for transscleral suture fixation of posterior chamber intraocular lenses (PC IOLs). SETTING: Public hospital in Brisbane, Australia. METHODS: A retrospective chart review was conducted of consecutive patients who had transscleral sutured PC IOL implantation from March 2000 to June 2006 using the new technique, which was modified to eliminate free suture ends and minimize the risk for knot slippage. Data collected included demographic data, ocular history, preoperative and final best corrected visual acuities (BCVAs), preoperative and postoperative intraocular pressure (IOP), and postoperative complications. RESULTS: Eighty-two eyes of 79 patients (51 men, 28 women) with a mean age of 62.5 years+/-18.9 (SD) were included in the study. The mean follow-up was 22.9+/-21.2 months (range 5 to 76 months). The BCVA was 20/40 or better in 45 eyes (54.9%) and 20/200 or worse in 10 eyes (12.2%). The final BCVA was largely determined by the preoperative underlying ocular pathology. Postoperative complications included temporary increased IOP in 14 eyes (17.1%), escalated glaucoma in 7 eyes (8.5%), temporary hypotony in 7 eyes (8.5%), and retinal detachment, hyphema, and irregular astigmatism in 1 eye (1.2%) each. The PC IOLs remained well centered and without tilt in all eyes. CONCLUSIONS: The technique provided excellent PC IOL centration in the presence of no adequate capsule support. It was effective and safe for transscleral suturing of PC IOLs.     

Modified transscleral suture for sulcus fixation of posterior chamber lenses.

We describe a modified technique to minimize the risk of hypotony during the placement of transscleral anchoring sutures. An anchor thread is used to transsclerally fixate a posterior chamber intraocular lens (IOL). The IOL is placed precisely and without trauma. The technique was used in 17 patients. Postoperatively, all IOLs were well centered. Visual acuity increased from a preoperative mean of 0.25 to a postoperative mean of 0.40. The mean postoperative refraction was -0.75 diopter (D) (range +0.50 to -4.50 D). Longer phases of hypotony do not occur, and the use of CIF needles can be omitted.     

Ultrasound biomicroscopic analysis of posterior chamber intraocular lenses with transscleral sulcus suture

OBJECTIVE: To investigate the postoperative problems of intraocular lenses (IOLs) with transscleral sulcus suture. DESIGN: Retrospective observational case series. PARTICIPANTS: Forty-one subjects (43 eyes) were included. INTERVENTION: All eyes had undergone transscleral sulcus suture of IOLs. Surgeries were all performed by surgeons in our clinic using the same technique. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy of the suture sites, their surrounding structures, and central anterior chamber depth. Other parameters studied included visual acuity, aqueous flare, and routine ophthalmic examinations. RESULTS: Thirty-two of 86 haptics were sutured at the ciliary sulcus (CS) region and 29 at the ciliary process region, which was the space between CS and pars plicata, and 25 posterior to pars plicata. We designated the cases with at least one haptic located in the CS region as the anterior group, and the other cases as the posterior group. In the anterior group, anterior chamber depth was significantly more shallow than in the fellow eye in which IOLs were fixed in the bag (P = 0.049). There was a statistically greater incidence of IOL iris contact in the anterior group than in the posterior group (P = 0.00057). Pigment dispersion was seen in seven cases, all of which were classified as anterior group. Eyes in the posterior group had more aqueous flare than their fellow eyes (P = 0.014). Two cases, in which more than two lines of postoperative best-corrected visual acuity was lost because of macular degeneration after cystoid macular edema, showed marked elevation of aqueous flare in the sutured eyes compared with their fellow eyes. Forty-one of 86 haptics had vitreous incarceration. CONCLUSIONS: This technique has many limitations: the difficulty of suturing precisely at the ciliary sulcus, IOL iris contact, pigment dispersion, high aqueous flare, and vitreous incarceration. These induce two major postoperative complications: chronic inflammation and influence on the adjacent vitreous such as vitreous incarceration. The suturing technique and instruments need to be improved to diminish such complications.     

玻璃体切除术后眼内灌注下Ⅱ期人工晶体缝襻固定术

目的 :探讨严重眼外伤术后视力的恢复。方法 :选择 2 0例 (2 0眼 )严重眼外伤 (玻璃体混浊、视网膜脱离、眼内异物、外伤白内障等 )的病例 ,在玻璃体切除晶状体咬切术后 ,眼压正常、无视网膜脱离、矫正视力满意者 ,在眼内灌注下行Ⅱ期人工晶体缝襻固定术。随诊 2～ 18月。结果 :裸眼视力 >0 5以上者 6例 ,0 3～ 0 5者 10例 ,0 1～ 0 3例者 3例 ,<0 1者 1例 ,术后视力与Ⅱ期人工晶体植入术前最佳矫正视力比较差异无显著性 (P >0 0 5 ) ,术中、术后无明显的并发症发生 ,眼压正常。结论 :在合并玻璃体混浊、视网膜脱离、眼内异物、外伤白内障等严重眼外伤病例 ,行玻璃体切除晶状体咬切术 ,术后待眼部情况稳定后 ,在眼内灌注下行Ⅱ期人工晶体植入是较理想的治疗方法 ,但仍要严格掌握适应证     

人工晶状体缝线固定术28例临床分析

目的 观察应用缝线固定术植入后房人工晶状体病例的临床效果。方法 对28例无后囊眼行巩膜睫状沟后房型人工晶状体缝线固定术。随访6－15月。结果 术后矫正视力＞0.5者35.7%,0.3-0.5者42.9%,0.1-0.2者10.7%,＜0.1者10.7%,无严重并发症发生。结论 经巩膜睫状沟人工晶状体缝线固定术作为无后囊眼的人工晶状体植入方式具有一定的临床价值。     

悬吊式人工晶状体睫状沟固定术临床观察

目的探讨悬吊式人工晶状体睫状沟固定术的临床应用价值。方法回顾性分析21例(21眼)晶状体后囊缺如或不完整,悬韧带断离眼选择悬吊式人工晶状体睫状沟固定术治疗情况,对手术方式、特点、效果、并发症和防治措施等进行了分析。结果术后矫正视力:一期植入0.1~0.2者2眼,0.3~0.8者10眼,≥1.0者1眼;二期植入0.1~0.2者2眼,0.3~0.8者5眼,≥1.0者1眼。术后3月平均手术源性散光度数为(0.68±0.63)D。结论悬吊式人工晶状体睫状沟固定术为非常规无支持人工晶状体植入眼屈光矫正的一种较好的替代手术方式。