自发性脱位于玻璃体腔的人工晶状体囊袋复合体经巩膜固定的疗效观察

目的:探讨自发性脱位于玻璃体腔的人工晶状体囊袋复合体经巩膜缝合固定的手术效果。方法:回顾性病例对照研究。2017-04/2019-06对自发性脱位进入玻璃体腔内的人工晶状体囊袋复合体8例8眼(研究组)采取23G玻璃体切割术联合人工晶状体囊袋复合体巩膜缝合固定治疗。选取同期玻璃体晶状体切除术后行折叠人工晶状体悬吊手术10例10眼为对照组。术后7、30、60d随访两组裸眼视力、最佳矫正视力、眼压、角膜散光、IOL的偏心值与倾斜度和手术并发症。结果:研究组8眼人工晶状体囊袋复合体顺利经巩膜缝合固定,对照组10眼成功植入并缝合固定人工晶状体。视力:两组内术后7、30、60d裸眼视力和术前比较,均提高(P<0.05);两组术后7、30、60d矫正视力较术前无差异(P>0.05)。术后两组裸眼视力无差异(P>0.05),术后7d与术后30、60d裸眼视力有差异(P<0.001);术后7、30、60d两组矫正视力无差异(P>0.05)。术后7、30、60d两组患者眼压均正常(10~21mmHg),组内及组间对比均无统计学意义(P>0.05)。角膜散光:组内比较:对照组术前与术后30、60d比较,研究组术前与术后30d比较,均有差异(P<0.05),散光值较术前增大;术后30、60d,对照组术后散光度均大于研究组(P<0.05)。IOL的偏心值与倾斜度:术后30、60d研究组均低于对照组(P<0.05)。结论:对脱位于玻璃体腔内的人工晶状体囊袋复合体采取23G玻璃体切割术联合经巩膜缝合固定手术可以减少手术步骤,降低手术性创伤,较好恢复人工晶状体的位置和改善视觉质量。     

Fate of the capsular bag in endocapsular phacoemulsification and complete in-the-bag intraocular lens fixation

We performed endocapsular phacoemulsification on 17 eyes of 15 patients between November 1984 and February 1985. Phacoemulsification was performed intracapsularly through a small incision in the anterior capsule. The inner wall of the bag was cleaned with the Cavitron handpiece. Posterior chamber intraocular lens implantation was performed completely in the bag. A clear capsular bag was present in 15 eyes with an average follow-up of six months. Central anterior lens capsule opacity occurred in two eyes. Sixteen eyes had visual acuity better than 20/40 and nine eyes had visual acuity better than 20/20. We have changed the name of this procedure from intracapsular to endocapsular phacoemulsification to prevent confusion.     

Late spontaneous in-the-bag intraocular lens and capsular tension ring dislocation in pseudoexfoliation syndrome

Two patients with pseudoexfoliation syndrome (PEX) in whom late spontaneous in-the-bag intraocular lens (IOL) and capsular tension ring (CTR) dislocation occurred 3 and 6 years after cataract surgery are described. The patients received CTRs because of phacodonesis due to zonular laxity. The IOLs were centered postoperatively, and there was no postoperative ocular trauma. In both cases, removal of the IOL and CTR within the capsular bag was performed uneventfully by a scleral tunnel incision and an anterior chamber IOL was implanted. Capsular tension ring implantation in PEX-associated zonular weakening does not guarantee long-term zonular stability and capsular bag/IOL position in these patients after cataract surgery.     

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.     

囊袋内植入的人工晶状体半脱位的治疗研究

目的 探讨囊袋内人工晶状体（IOL）半脱位的治疗方法和安全性。设计 回顾性病例系列。研究对象 2009年2月至2013年2月北京同仁眼科中心19例（19眼）囊袋内IOL半脱位的患者。方法 回顾上述患者的病历资料。依据IOL类型和半脱位程度分别予以IOL置换缝线固定和经囊袋单纯缝线固定复位术。主要指标  手术方法、视力、并发症。结果 19例患者均顺利完成手术。5例（26.3%）为IOL置换,取出原IOL,选用新IOL以缝线固定于巩膜;14例（73.7%）为IOL单纯缝线固定复位,将脱位的IOL襻固定于巩膜。术后随访5~41个月。最后一次随访时,视力均≥0.3,其中≥0.8者8例（42.1%）。术后第1天7例（36.8%）出现轻度前房或玻璃体积血。术后第1周内3例（15.8%）出现高眼压,经滴眼液治疗后恢复正常。3例（15.8%）出现IOL 轻度偏心,4例（21.1%）IOL轻度倾斜,均未处理。结论 采用IOL置换缝线固定或经囊袋单纯缝线固定复位的方法治疗囊袋内IOL半脱位有效而安全。（眼科,2014,23：264-267）     

Delayed in-the-bag implantation of intraocular lens

Objective: To report delayed in-the-bag intraocular lens (IOL) implantation for patients who had undergone simultaneous phacoemulsification and vitreoretinal surgery.Design: Interventional case series.Participants: Delayed IOL implantation surgery was performed for 3 patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.Methods: The medical records of each patient, including the surgical findings and final refraction status, were reviewed retrospectively.Results: Successful in-the-bag IOL implantation surgeries without capsular tear were achieved 3 to 5 months after the initial surgeries. The postoperative refractive error ranged from plano to −1.00 D.Conclusions: Successful in-the-bag IOL implantation and satisfactory refraction were achieved in patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.     

Surgical management of late dislocated lens capsular bag with intraocular lens and endocapsular tension ring

A case of late spontaneous dislocation of the lens capsular bag (CB) with foldable acrylic intraocular lens (IOL) and endocapsular tension ring (CTR) and its surgical management is reported in a 52-year-old man. The dislocation occurred 2 years 3 months after phacoemulsification cataract surgery in which a CTR was used for zonular instability. A 3-port pars plana vitrectomy was performed. Because it was not possible to grasp the IOL-CTR-CB complex, perfluorocarbon liquid was used to attempt to float it up. This was unsuccessful, so a scleral indenter was used to apply external pressure on the sclera to tilt the IOL-CTR-CB complex into a position where it could be grasped with a forceps and removed through a corneal section. A scleral-fixated IOL was placed, and the patient achieved a best corrected visual acuity of 6/9. The procedure was safe and effective without intraocular complications.     

人工晶状体脱位的处理分析

目的探讨人工晶状体脱位的处理方法和效果。方法对26例(26只眼)人工晶状体脱位患者行前部或后部玻璃体切割术并重新植入后房型人工晶状体。术后随访时间4个月至4年(平均2年3个月),观察术后视力恢复和并发症情况。结果26例患者术后视力恢复良好,最佳视力达0.8以上者8例,0.5~0.6者10例,0.15~0.4者8例。术后无严重并发症。结论前部或后部玻璃体切割术后取出并重新植入后房型人工晶状体是治疗人工晶状体脱位安全、有效的方法。而且采用前部玻璃体切除更为简单。     

玻璃体手术治疗人工晶状体脱入玻璃腔疗效分析

目的评价玻璃体手术取出脱位于玻璃体腔的人工晶状体的临床效果。方法对19例（19只眼）人工晶状体脱位于玻璃体腔的患者均行玻璃体切除术,均在人工晶状体取出的同时行缝线固定人工晶状体。结果所有患眼视力均不同程度提高,且并发症少,效果满意。结论玻璃体手术是取出脱位于玻璃体腔的人工晶状体的一种安全有效的手术方式,在人工晶状体取出的同时行缝线固定术可提高手术效果。     

晶状体或人工晶体脱入玻璃体腔的手术处理

目的探讨晶体或人工晶体脱位入玻璃体腔的处理方法。方法钝挫伤后晶体脱位3眼,白内障手术中或术后晶体或人工晶体脱位11眼。均采用标准睫状体扁平部三切口闭合式玻璃体切除方式。术中注入全氟化碳液体0.4～4ml。经角膜缘取出人工晶体或晶体,或是直接玻璃体腔内粉碎晶体。再植入前房型人工晶体,或行后房型人工晶体睫状沟缝线固定。结果14眼均顺利取出或粉碎玻璃体腔内晶体或人工晶体。13眼(92.86%)术中植入人工晶体。术后视力明显提高12眼(85.71%)。结论对晶体或人工晶体全脱位进入玻璃体腔者,需争取早期采用玻璃体切除联合脱位晶体或人工晶体取出或粉碎手术,争取再植入人工晶体。     

Pigmentary glaucoma secondary to in-the-bag intraocular lens implantation

After uneventful phacoemulsification and in-the-bag implantation of an AcrySof SA60AT (Alcon) intraocular lens (IOL), a 52-year-old black man developed pigmentary glaucoma. Slitlamp examination, anterior segment optical coherence tomography, and ultrasound biomicroscopy showed that the posterior surface of the iris was being rubbed by the inferior haptic of the IOL, which was in the bag but deformed. Filtering surgery was needed to control the intraocular pressure. This type of IOL can cause IOL-induced pigmentary glaucoma.     

Roundel phacoemulsification technique for in-the-bag intraocular lens fixation

We introduce a new phacoemulsification technique that removes a cataract and retains a 5-mm round, tear-free opening in the anterior capsule, and present the results in 100 eyes. This technique is extremely useful in retaining the integrity of the capsular bag, which is indispensable for long-term capsular bag fixation, and is also a preliminary step in mastering endocapsular (intercapsular) phacoemulsification. We call this the roundel technique.     

人工晶状体异位的原因和处理

目的:分析人工晶状体位置异常的临床情况。方法:人工晶状体异位23眼包括人工晶状体玻璃体腔脱位、瞳孔夹持、"刮雨器(雨刷)"综合征等,原因为术中后囊膜破裂、后发性白内障、人工晶状体襻变形、外伤等,应用旋转复位法、后囊膜夹持固定法、玻璃体切除或加睫状沟缝线法等。结果:术后视力明显提高19眼,症状明显减轻至消失,人工晶状体位置固定。结论:提高人工晶状体植入手术技术是减少术后人工晶状体异位的主要措施,根据人工晶状体异位的不同情况应用各种复位技术可得到良好效果。     

脱位人工晶状体的手术处理

目的 探讨人工晶状体脱位的原因和处理方法。方法 对18例18眼人工晶状体脱位的原因进行分析；采用单纯复位，更换和取出人工晶状体的方法进行处理。结果 手术中后囊膜破裂，悬韧带离断和玻璃体脱出是人工晶状体脱位的主要原因。18眼中12眼单纯复位成功。获得稳定的睫状沟固定；4眼更换前房型人工晶状体：1眼行睫状沟缝合固定；1眼取出人工晶状体后未再植入。随访1.5个月至3年，除1眼无晶状体眼外，术后矫正视力均≥0.1；其中≥0.5者8眼，无严重并发症发生。结论 人工晶状体脱位与术中后囊膜破裂，悬韧带离断，玻璃体处理不当有关。前玻璃体切割单纯取出重新复位，是处理人工晶状体脱位简单有效的方法。     

Scheimpflug imaging of bilateral foldable in-the-bag intraocular lens implantation assisted by a scleral-sutured capsular tension ring in Marfan's syndrome

A 35-year-old white man with bilateral high myopia, astigmatism, subluxated crystalline lenses, and incipient cataract had phacoemulsification and implantation of a hydrophobic acrylic intraocular lens (IOL) (Alcon MA60BM) in both eyes. The subluxated capsular bag was stabilized and recentered using a scleral-fixated capsular tension ring (CTR) (type 1L, Morcher). Measured with Scheimpflug photography, the capsular bag and IOL were in a stable intraocular position during the 18-month follow-up. There were no major changes in refraction. Despite the sharp-edged IOL design, both eyes had posterior capsule opacification (PCO) 18 months after surgery that in 1 eye caused a decrease in visual acuity of more than 2 lines. High myopia and subluxated lenses may be treatable long-term with a scleral-fixated CTR and foldable IOL implantation; further evaluation of PCO is necessary.