Artisan人工晶状体植入矫正玻璃体切除术后无晶状体眼的临床观察

目的 观察晶状体玻璃体切除术后眼内二期植入Artisan晶状体的有效性、可预测性和安全性.方法 回顾性分析16例因各种眼外伤行晶状体、玻璃体切除术后二期植入Artisan晶状体的病人.观察指标包括:手术时间,术前及术后的裸眼及矫正视力,屈光度,角膜内皮细胞计数,术中术后并发症.随访时间(26.3±3.6)个月.结果 平均眼轴(22.46±0.47) mm,手术经历时间15～36 min,平均(17.3±4.4) min.术中有12例病人人工晶状体近水平放置,4例病人斜向放置.所有病人术后裸眼视力均较术前提高,术后6个月,裸眼视力等于术前最佳矫正视力的有6例,0.3及以上者13例,0.2者2例,0.1者1例.手术预留屈光度为轻度近视(-0.5 D),术前与术后6个月屈光度对比,球镜屈光度:术前(+10.2±1.09)D,术后:(-0.63±0.44)D(P＜0.05);柱镜屈光度(绝对值),术前:(1.84±1.56)D,术后:(1.97±1.69)D(P＞0.05).4例斜向放置病人术后平均球镜屈光度为-0.75D.柱镜屈光度(绝对值),术前1.94 D,术后1.75 D.术前角膜内皮细胞计数(2377.4±279.74)个/mm2,术后1年角膜内皮细胞计数均数为(2265.7±258.65)个/mm2,损失率为4.7％;术后2年平均为(2244.4±249.32)个/mm2,第2年损失率为0.94％.并发症:2例病人少量前房出血,3例病人一过性角膜水肿,3例病人术后低眼压(＜8 mm Hg),其中1例病人伴视物晃动感,上述并发症均于1周内恢复.未观察到其它并发症.结论 晶状体玻璃体切除术后二期植入Artisan晶状体有效性、预测性良好,2年随访有较好安全性.     

Traumatic aniridia and aphakia after Artisan intraocular lens implantation

Traumatic aniridia and aphakia occurred in the left eye of a 22-year-old man who had had Artisan (Ophtec) phakic intraocular lens (IOL) implantation. Aniridia was probably the result of the relatively large wound used to implant the nonfoldable IOL. Although the eye had severe traumatic damage, vision was recoverable through a 2-stage procedure of vitrectomy and subsequent scleral suture fixation of an iris-diaphragm IOL.     

Slit-lamp-adapted optical coherence tomography of pupillary block after Artisan lens implantation for aphakia

We present a report on a patient with acute glaucoma. Slit-lamp-adapted optical coherence tomography (SL-OCT) confirmed a pupillary block due to a claw lens. After laser iridectomy the situation stabilized. Thus, SL-OCT allows non-invasive, high-resolution imaging in acute angle-closure glaucoma and may be helpful with the differential diagnosis of pupillary block glaucoma and the documentation of the surgical result. The authors have no proprietary or financial interest in any research or device presented in this study.     

Visual outcomes following Artisan aphakia iris claw lens implantation

Objective

To assess the visual outcome of eyes undergoing Artisan lens implantation for aphakia, to identify reasons for poor outcomes, and to report incidences of post-operative uveitis, glaucoma, or hyphaema.

Methods

A retrospective analysis of 32 eyes rendered aphakic through various causes, which subsequently underwent Artisan lens implantation.

Results

A total of 32 eyes from 31 patients were reviewed. Follow-up ranged from 6 to 42 months, mean 17.3 months. The commonest cause of aphakia was following complicated phacoemulsification in 17 of the 32 eyes (53.1%). At final follow-up, 21 of the 32 eyes (65.6%) achieved best-corrected visual acuity (BCVA) better than that measured pre-operatively and 10 of the 32 eyes (31.3%) matched their pre-operative BCVA. Of 33 eyes, only 1 (0.03%) attained a final BCVA worse than pre-operatively, owing to non-arteritic anterior ischaemic optic neuropathy. A total of 4 of the 33 eyes (12.5%) had pre-existing glaucoma or ocular hypertension; no additional intraocular pressure problems were identified during the follow-up period.

Conclusion

This study suggests that Artisan iris claw lens insertion is beneficial in acquired aphakia, matching or exceeding pre-operative BCVA in the overwhelming majority of the cases. In addition, this series did not identify any post-operative problems with uveitis, glaucoma, or hyphaema.     

Delayed visual loss after pars plana vitrectomy for retained lens fragments

PURPOSE: To report visual results and postoperative complications in patients undergoing vitrectomy for retained lens fragments. METHODS: Retrospective, noncomparative, interventional case series of 42 consecutive patients undergoing vitrectomy for retained lens fragments by a single surgeon, all with a minimum of 6 months' follow-up. The main outcome measurement was best corrected visual acuity at 3 months and at final follow-up visit. RESULTS: Although 67% of eyes achieved a postoperative visual acuity of 20/40 or better at 3 months, 17% had events during follow-up that resulted in loss of vision to less than 20/40. Final best corrected visual acuity 20/40 or better was achieved in 50% of eyes. Retinal detachment occurred in 17%, and 21% of eyes required long-term therapy for glaucoma. CONCLUSION: Patients undergoing vitrectomy for retained lens fragments often develop delayed visual loss. Long-term surveillance is necessary in these patients.     

Cystoid macular edema after pars plana vitrectomy for retained lens fragments

PURPOSE: To describe the incidence and clinical course in patients with cystoid macular edema (CME) following pars plana vitrectomy (PPV) for retained lens fragments. SETTING: Retina group, private practice. METHODS: This retrospective study reviewed the medical records of 91 patients who had PPV for retained lens fragments. The patients were followed for at least 6 months. Patients with concomitant eye diseases that adversely affected macular examination or macular function were excluded. RESULTS: Four (8%) of 50 eyes with a sulcus-fixated posterior chamber intraocular lens (PC IOL) implanted at cataract extraction and 19 (46%) of 41 eyes with aphakia or an anterior chamber IOL developed CME (P相似文献   

儿童玻璃体切除术后无晶状体眼的二期人工晶体植入术

目的评价儿童玻璃体切除术后无晶状体眼二期人工晶体植入术的视力效果、手术技巧及其安全性.方法对32例儿童眼内炎玻璃体切除术后的无晶状体眼行人工晶状体植入术.采用颞下方平坦部巩膜灌注,行后房型人工晶体睫状沟缝线固定术,术后随访6～24月.结果所有患者均达到或超过术前最佳矫正视力,术后裸眼视力＜0.1者2眼,0.1～0.2者8眼,0.2～04者16眼,＞05者4眼.无严重远期并发症.结论儿童眼内炎玻璃体切除术后二期人工晶体睫状沟缝线固定术,手术效果可靠,术后并发症少,是矫正儿童无晶状体眼的理想手术方法.     

Traumatic pediatric cataract: A decade of follow-up after Artisan aphakia intraocular lens implantation

PURPOSE: To describe the long-term clinical outcome of Artisan((R)) aphakia intraocular lens (IOL; Ophtec, Groningen, The Netherlands) implantation in five aphakic eyes of five children, without capsular support, after cataract extraction following penetrating ocular trauma. METHODS: The charts of the five children were retrospectively reviewed. The data collected included follow-up time, nature of injury, age at cataract extraction and IOL implantation, visual outcome, endothelial cell counts, complications, and subsequent surgical interventions. RESULTS: Average follow-up was 11.0 years (range, 8.0-14.6 years). All eyes had a corneal perforation with various degrees of anterior segment injury. Mean patient age at lens extraction was 7.8 years (range, 5.6-10.2 years). Mean age at Artisan aphakia IOL implantation was 7.9 years (range, 5.7-10.2 years). The best spectacle-corrected visual acuity at last follow-up was 20/40 or better in four eyes. Mean endothelial cell loss compared with the healthy fellow eye was 40%. No patients experienced IOL dislocation, corneal decompensation, chronic anterior uveitis, cystoid macular edema, or iris atrophy. One eye had a retinal detachment 19 months after primary injury and needed vitreoretinal surgery. CONCLUSIONS: The Artisan aphakia IOL offers a useful alternative for correction of traumatic childhood aphakia. Although we only have results of a small number of patients, taking into account our long follow-up period, we feel that implantation of the Artisan aphakia IOL can be considered a treatment option in aphakic eyes of children that lack capsular support due to trauma.     

折叠人工晶状体缝线固定治疗玻璃体切割术后无晶状体眼

目的探讨采用四袢折叠人工晶状体缝线固定治疗玻璃体切割术后无晶状体眼的手术方法及疗效。方法 21例患者玻璃体切割术后无晶状体眼在前房灌注下通过角膜缘隧道小切口行四袢折叠人工晶状体缝线固定术,人工晶状体固定缝线无需做巩膜瓣而行改良埋线法,术后观察视力变化、散光、内皮细胞数、人工晶状体位置及并发症。结果 21例患者术后裸眼视力明显提高。术后早期视力大多低于术前最佳矫正视力,术后1个月视力稳定;12眼裸眼视力高于术前最佳矫正视力1～2行(57.1%),9眼同术前最佳矫正视力或稍差。术后裸眼视力:0.1-0.3者3眼,0.3-0.5者10眼,大于0.5者8眼,术后最佳矫正视力:0.1-0.3者3眼,0.3-0.5者8眼,≥0.5者10眼;术后6个月散光、内皮细胞数与术前相比差异均无统计学意义(均为P>0.05)。无术中及术后低眼压等并发症。结论玻璃体切割术后无晶状体眼在前房灌注下行四袢折叠人工晶状体缝线固定术安全有效,是值得推广的二期人工晶状体植入术。     

Long-term endothelial changes in phakic eyes after Artisan intraocular lens implantation to correct myopia: five-year study

PURPOSE: To evaluate long-term endothelial cell changes in eyes that had implantation of an iris-fixated phakic Artisan intraocular lens (IOL) for moderate to high myopia. SETTING: Casa di Cura Villa Igea, Ancona, Italy. METHODS: Forty-nine eyes of 30 patients having implantation of Artisan IOL for moderate to high myopia were prospectively examined. Preoperative specular microscopy and serial postoperative specular microscopy (Noncon Robo SP 8000, Konan Medical) were performed to evaluate endothelial cell changes over 5 years. Endothelial cell images were collected in the central region of the cornea before surgery and 4, 12, 24, 36, 48, and 60 months after surgery. The endothelial cell density (ECD), coefficient of variation, and percentage of hexagonal cells were determined. RESULTS: Preoperatively, the mean ECD was 2616 cells/mm(2) +/- 347 (SD), the mean coefficient of variation was 39.6% +/- 4.7%, and the mean percentage of hexagonal cells was 49.2% +/- 6.7%. The mean endothelial cell loss from preoperatively was 2.3% at 4 months, 3.5% at 12 months, 4.7% at 24 months, 6.7% at 3 years, 8.3% at 4 years, and 9.0% at 5 years. Five years after surgery, the mean coefficient of variation was 35.9% +/- 6.9% (P = .1946) and the percentage of hexagonal cells was significantly higher (mean 54.7% +/- 10.3%) (P = .087). CONCLUSIONS: Continuous endothelial cell loss was observed after surgery during a 5-year follow-up, especially during the first 2 years. A decrease in the coefficient of variation and an increase in the percentage of hexagonal cells were observed over time, reflecting the increasing stability and remodeling of the corneal endothelial cells 5 years postoperatively.