First results of implantation of a new, potentially accommodative posterior chamber intraocular lens

PURPOSE: Conventional posterior chamber intraocular lenses (PCIOL) generally provide excellent visual acuity but do not restore accommodation. A new, potentially accommodative PCIOL has been designed after principles elaborated by K.D.Hanna using finite element models. However, before newly developed PCIOL may be implanted routinely in larger numbers of patients, careful and meticulous evaluation in clinical studies is necessary. Thus, it was the aim of this study to investigate intra- and early 3-month postoperative findings after implantation of the newly designed PCIOL. PATIENTS AND METHODS: In a prospective pilot and safety study that was approved by the ethics committee of our university, six eyes of six patients (2 males, 4 females, age range 54 to 87 years) with senile or presenile cataract underwent phacoemulsification and implantation of the new PCIOL by one surgeon between June and November 2000. The PCIOL (1 CU, HumanOptics AG, Erlangen, Germany) is a one-piece hydrophilic acrylic foldable lens with an optic diameter of 5.5 mm. Modified haptics are intended to allow anterior movement of the lens optic as a function of contraction of the ciliary muscle. Intra- and early postoperative findings obtained after one and two days, one, two and six weeks and 3 months postoperatively were documented prospectively. Postoperative examinations included recording of distance and near visual acuity both obtained with best distance correction, determination of subjective near point and measurement of distance and near refraction by streak retinoscopy. Follow-up was at least three months in all patients. RESULTS: Surgery was uncomplicated in all patients with successful in-the-bag implantation and good centration of the PCIOL. The postoperative course was uncomplicated without inflammation, hemorrhage, synechiae or decentration. Visual acuity improved in all patients according to the status of the macula with values between 20/200 (atrophic maculopathy) and 20/20. After three to six months we observed a difference between retinoscopic near and distance refraction of 0.625 to 1.875 D and subjective near points of 40 to 100 cm. Near visual acuity with distance correction ranged from 0.1 or J 16 (atrophic maculopathy) to 0.4 or J 7. CONCLUSIONS: These early and preliminary results of our small pilot study are encouraging. Our findings may indicate at least some degree of pseudophakic accommodation. However, further studies with additional methods of measurements, with longer follow-up, more patients and controlled studies with control groups are essential to further determine safety and potential accommodative power of this new PCIOL.     

后房型人工晶状体植入术治疗有晶状体高度近视眼

后房型人工晶状体植入术治疗有晶状体的近视眼,是在保留原有晶状体的情况下,在虹膜和晶状体之间植入人工晶状体。它可矫正高度近视,并保留了眼的调节力。手术具有可逆性和并发症少等优点。我们就其发展史、病例选择、手术方法、临床疗效、并发症等进行综述。     

白内障超声乳化及可调节后房型人工晶体植入的临床研究

目的研究植入可调节人工晶体1cu眼的调节能力。方法取39例48眼年龄相关性白内障患者,24眼植入Humanopstics 1cu可调节人工晶体,24眼植入AMOSI40NB单焦点人工晶体作为对照。术后3月检查患者最佳矫正视力,以及在最佳矫正视力基础上获得的最佳近视力、近点及调节幅度。结果3月后两组患者的最佳矫正远视力均有提高,可调节人工晶体组为0.75±0.15,对照组0.8±0.2,t=-0.980,P>0.05;可调节人工晶体1cu组获得更好的近视力,0.35±0.15,对照组0.20±0.09,t=4.201,P<0.001;主观近点:可调节组(56±9)cm;对照组(96±20)cm,t=-9.737,P<0.001;调节幅度:可调节组(1.3±0.4)D;对照组(0.3±0.2)D,t=10.954,P<0.001。结论植入可调节人工晶体可使患者获得一定程度的调节能力,同时具有单焦点人工晶体的优点。     

Intraoperative clouding of a posterior chamber intraocular lens

The glistening and delayed opacification of intraocular lenses (IOLs) has been reported in literature as a late and permanent change in the acrylic IOL due to temperature change. We report a case in which clouding and opacification of an IOL occurred intraoperatively within a few seconds of implantation into the capsular bag after routine phacoemulsification. This phenomenon occurred due to the sudden change in temperature of a very cold IOL being implanted into the eye at body temperature. The opaqueness lasted for about 3 h then cleared without any residual or permanent change to the IOL. This case highlights the effect of environmental factors on hydrophillic acrylic IOLs. It is particularly important in cold countries and during the winter months. It also reinforces the practice of storing the IOL at a correct temperature to avoid sudden fluctuations in its surrounding environment.     

Implantation of scleral-fixated posterior chamber intraocular lenses

A surgical technique for implanting a posterior chamber intraocular lens (IOL) in eyes without capsular or zonular support is presented. A 10-0 polypropylene suture attached to a standard needle is tied to the apex of each haptic and passed transclerally through the ciliary sulcus to secure the haptics at the 3 o'clock and 9 o'clock meridians. This technique produced good visual results in six aphakic patients who were contact lens intolerant, two patients in whom capsular or zonular rupture at the time of cataract surgery precluded standard nonsuture fixation techniques, one patient who had intracapsular cataract extraction for a subluxated, cataractous lens, and one patient who had secondary IOL implantation in combination with penetrating keratoplasty for aphakic bullous keratopathy. Advantages over other techniques of posterior chamber lens implantation in the absence of capsular support include technical ease, avoidance of iris fixation, and more precise placement of scleral fixation sutures, thus minimizing IOL decentration.     

有晶状体眼后房型人工晶状体植入术的研究进展

随着有晶状体眼后房型人工晶状体(phakic posterior chamber intraocular lens,PPCIOL)制作材料、设计和工艺的日趋改善,PPCIOL植入术在治疗中高度近视、远视及散光方面,与激光手术比较具有明显优势,术后屈光状态稳定,并且手术具有可逆性,手术并发症发生概率低.因此越来越多的医生和患者将其作为矫正屈光不正的首选手术.本文就PPCIOL的设计、手术适应证及禁忌证、手术方法、术后观察、并发症及其防治等方面进行综述,以期为临床应用提供参考.     

有晶状体眼后房型人工晶状体植入术的研究进展

随着有晶状体眼后房型人工晶状体(phakic posterior chamber intraocular lens,PPCIOL)制作材料、设计和工艺的日趋改善,PPCIOL植入术在治疗中高度近视、远视及散光方面,与激光手术比较具有明显优势,术后屈光状态稳定,并且手术具有可逆性,手术并发症发生概率低.因此越来越多的医生和患者将其作为矫正屈光不正的首选手术.本文就PPCIOL的设计、手术适应证及禁忌证、手术方法、术后观察、并发症及其防治等方面进行综述,以期为临床应用提供参考.     

Short-term blood-aqueous barrier breakdown after implantation of the 1CU accommodative posterior chamber intraocular lens

PURPOSE: To quantify intraocular inflammation after phacoemulsification with implantation of an accommodative posterior chamber intraocular lens (IOL). SETTING: Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany. METHODS: Twenty cataractous eyes of 20 patients without preexisting blood-aqueous barrier (BAB) deficiencies or previous intraocular surgery were included in this study. The mean age of the patients was 64.6 years +/- 16.0 (SD). A single surgeon performed phacoemulsification through a superior sclerocorneal tunnel incision and implantation of a 1CU IOL (HumanOptics AG) though a 3.2 mm incision. The haptics of the single-piece acrylic 1CU lens are designed for anterior optic movement following ciliary muscle contraction. The postoperative treatment was standardized. Postoperative BAB breakdown was quantified by laser flare photometry (FC-1000, Kowa) at 1 day, 1 and 4 weeks, and 3 and 6 months. RESULTS: The mean aqueous flare was 6.3 photons/ms +/- 3.0 (SD) (range 4.0 to 12.2 photons/ms) 1 day postoperatively, with 64% of patients having normal aqueous flare values (<8.0 photons/ms). One week after surgery, the mean aqueous flare was 5.3 +/- 2.8 photons/ms (range 2.0 to 10.5 photons/ms). Four weeks postoperatively, aqueous flare was normal in all patients and remained stable below the normal limit for up to 6 months (mean 3.3 +/- 1.2 months; range 2.0 to 5.4 months). The number of aqueous cells did not increase at any follow-up and was normal in all eyes. No postoperative complications such as fibrin formation, synechias, macrophages on the IOL optic, or endophthalmitis were observed. CONCLUSIONS: Phacoemulsification with implantation of the 1CU accommodative IOL led to minimal and short-lasting BAB alteration. No signs of persistent inflammation or pigment dispersion were detected.     

有晶状体眼虹膜夹型和后房型人工晶状体植入矫正高度近视术后的视觉质量对比

背景矫正近视的手术可分为激光矫治术和人工晶状体（IOL）植入术。高度近视患者角膜比正常人薄,不适合激光矫治手术,宜考虑IOL植入术。目的对比观察两种有晶状体眼IOL植入术治疗高度近视的视觉质量。方法选取在郑州大学第一附属医院和解放军第91中心医院行前房虹膜夹型人工晶状体（Verisyse PIOL）植入术的高度近视患者19例34眼随机分为两种手术组,其中10例17眼为PIOL组,行后房型人工晶状体（ICL）植入术者9例17眼为ICL组。两种手术均由同一高年资医师完成。随访期为6个月,观察患者术后的裸眼视力、最佳矫正视力、对比敏感度（CS）和波前像差,对2组的检测指标进行比较。结果术后6个月2组间患者裸眼视力和最佳矫正视力的差异均无统计学意义（t=0．489,P〉0．05;t=0．853,P〉0．05）;2组患者间无眩光时在3、6、12、18c／d空间频率下cs的差异均无统计学意义（t=0．906,P〉0．05;t=0．103,P〉0．05;t=0．694,P〉0．05;t=1．583,P〉0．05）;3、6、12、18c／d空间频率下2组间患者的眩光敏感度比较差异均无统计学意义（t=0．323,P〉0．05;t=0．041,P〉0．05;t=0．024,P〉0．05;t=0．363,P〉0．05）。PIOL组三阶彗差（RMS3）、四阶球差（RMS4）、总高阶像差（RMSh）均高于ICL组,其中RMS3、RMSh明显高于ICL组,差异均有统计学意义（t=11．400,P〈0．05;t=11．350,P〈0．05）,2组间RMS4的差异无统计学意义（t=0．240,P〉0．05）。结论虹膜夹型IOL与ICL植入矫正高度近视均能达到预期的效果,术后视力相当,但虹膜夹型IOL的视觉质量稍逊于ICL,远期效果还需进一步随访观察。     

有晶状体眼的人工晶状体植入术

目的观察有晶状体眼的人工晶状体（ICL）植入术矫正高度近视的临床效果。方法22例（39只眼）高度近视患者,近视度数-7．00- -23．00 D,平均（-11．48±3．70）D。术前裸眼视力（UCVA）0．02-0．3,平均0．05±0．03,术前最佳矫正视力（BCVA）0．8-1.2,平均0．90±0．27;角膜内皮密度2000-3961个／mm^2,平均（2735．13±464．50）个／mm^2;所有患者随访12个月。结果术后裸眼视力显著提高,术后1d,1周11、3、6和12个月的裸眼视力较之术前差异有统计学意义（P=0．0000）。结论有晶状体眼的人工晶状体植入术治疗高度近视临床效果确切,特别适宜于无法选择角膜屈光手术者,其远期并发症还有待进一步观察。     

Traumatic fracture of posterior chamber intraocular lens

An 18-year-old man developed a fracture in a single-piece polymethylmethacrylate posterior chamber (PC) intraocular lens (IOL) at the optic-haptic junction with dislocation of the IOL into the anterior chamber after a fist injury to the eye. The dislocated IOL was explanted and replaced with another PC IOL.     

Late spontaneous prolapse of a posterior chamber intraocular lens

This is an unusual case of complete spontaneous anterior displacement of the optic of a posterior chamber intraocular lens (IOL) occurring nearly 12 years after its conventional insertion in the capsular bag. This occurred after the patient lowered her head. As the patient bent down to retrieve an object from underneath the bed, her vision became blurred on subsequent straightening and adoption of an upright standing posture. In this case, the haptic of the IOL likely disinserted at the time of pupil capture owing to possible previous damage during insertion. The optic spontaneously reverted to its intracapsular position.     

无囊膜眼的虹膜缝线固定后房型折叠式人工晶状体植入术

目的:探讨虹膜缝线固定后房型折叠式人工晶状体植入治疗无囊膜眼的可行性和有效性。方法:无囊膜眼15眼,采用经3.2mm角膜缘切口或透明角膜切口,植入后房型三片式折叠式人工晶状体(Alcon MA60BM),双襻用10-0聚丙烯缝线缝合固定于虹膜中周部,观察术中植入情况和术后视力、眼前段及眼压等情况。结果:所有病例均顺利植入人工晶状体,3例术中出现前房出血。术后随访3~15mo,视力均有不同程度提高,人工晶状体位置正常,无严重术后并发症发生。结论:虹膜缝线固定后房型人工晶状体植入治疗无囊膜眼是可行和有效的,长期的并发症有待进一步观察。     

Scleral fixation of a subluxated posterior chamber intraocular lens

A surgical technique for the treatment of a subluxated intraocular lens is described. It consists of a scleral incision 2 mm from the limbus, hooking the loop haptic of the implant into the scleral wound, and imbricating the loop into the sclera for permanent fixation. Four eyes in which this technique was applied successfully are reported.