Primary phacoemulsification and intraocular lens implantation for acute angle-closure glaucoma

OBJECTIVE: To evaluate the safety and efficacy of primary phacoemulsification and intraocular lens implantation (PPI) for acute angle-closure glaucoma (ACG). STUDY DESIGN: Prospective, nonrandomized comparative trial. PARTICIPANTS AND INTERVENTION: Forty-three eyes of 43 patients with acute ACG and uncontrolled intraocular pressure (IOP) were treated by PPI. Thirty-two eyes of 32 patients treated by conventional surgical iridectomy (CSI) constituted the control group. MAIN OUTCOME MEASURES: Postoperative visual acuity, IOP, number of antiglaucoma medications, complications, and secondary surgical interventions, if any, required for IOP control. RESULTS: Glaucoma control was achieved in 31 eyes (72%) in the PPI group and in 11 (35%) in the CSI group (P = 0.01). Mean preoperative IOP was 40.5 +/- 7.6 mmHg (standard deviation) and 39.7 +/- 7.8 mmHg, respectively (P = 0.46). Mean postoperative IOP was 17.8 +/- 3.4 mmHg (PPI group) and 20.1 +/- 4.2 mmHg (CSI group) after a mean follow-up of 10.2 +/- 3.4 months (P = 0.03). Postoperatively, the mean number of ocular hypotensive medications was 0.18 +/- 0.45 (PPI group) and 0.45 +/- 0.62 (CSI group) (P = 0.0001). Relative increase in postoperative best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.52 +/- 0.29 (PPI group) and 0.19 +/- 0.21 (CSI group), respectively (P = 0.0001). Additional surgery was necessary in 5 eyes (11.5%) in the PPI group and in 20 eyes (63%) in the CSI group (P = 0.01). Intraoperative and postoperative complications were few and manageable. CONCLUSIONS: CSI in patients with acute ACG was effective in reducing IOP initially but was associated with multiple surgical reinterventions. Conversely, primary PPI turned out to be safe and effective in reducing IOP and improving visual acuity. These results affirm that lens extraction may be considered the better procedure in uncontrolled ACG when faced with options of CSI or PPI.     

有晶状体眼后房型人工晶状体拱高相关因素分析

目的 研究分析有晶状体眼后房型人工晶状体(implantable contactlens,ICL)拱高的相关性栽因素.方法 回顾性分析42例(77只眼)已行ICL矫正近视手术患者,屈光度-5.0～-23.0DS,在手术后6个月应用Oculus公司PentacamHR三维眼前节分析诊断系统进行ICL与透明晶状体的间隙即拱高(vault)的检查,并对vault进行相关性分析,统计方法 采用逐步回归的方法 进行多元分析.结果 术后6个月vault平均(452±216.38)μm.vault的多元回归分析相关性依次为ICL长度(回归系数B=0.040,P=0.000),白到白距离(B=-0.231,P=0.011),前房深度(B=0.138,P=0.048).结论 白到白距离较大和前房较深的病人,相对选择的ICL长度较大,得到的vault也较大,ICL与晶状体接触的机会就会降低.

Abstract：

Objective To evaluate the factor affecting vault after implantable collamer lens (ICL) implantation. Methods Retrospective research. All 77 eyes of 42 patients with myopic refractive errors of-5.00 to -23.00 dioptors undergoing ICL implantation were examined. The magnitude of the central vault of the ICL was assessed quantitatively using pentacam HR at 6 months after surgery. Multiple regression analysis was used to assess the factors affecting the amount of vault. Results The mean central vault at 6 months after surgery was 452± 216.38?m. Explanatory variables relevant to the vault were, in order of influence, the ICL length (regression coefficient B =0.040, P =0.000), the horizontal white to white distance (B =0.231, P =0.011) and anterior chamber depth, ACD (B =0.138, P=0.048). Conclusions A high white to white distances and ACD result long ICL, which is likely to render a high vault.     

Comparison of patient outcomes after implantation of Visian toric implantable collamer lens and iris-fixated toric phakic intraocular lens

Purpose

We compared visual and refractive outcomes after implantation of Visian toric implantable collamer lenses (toric ICLs) and iris-fixated toric pIOLs (toric Artisans).

Patients and methods

A comparative retrospective analysis was performed. Toric ICLs were implanted into 30 eyes of 18 patients, and toric Artisans into 31 eyes of 22 recipients. We measured the logarithms of the minimum angle of resolution of uncorrected visual acuity (logMAR UCVA), logMAR of best spectacle-corrected corrected VA (logMAR BSCVA), MR, SE, and astigmatism (by the power vector method) before surgery and 1, 3, and 6 months thereafter. Differences between patients receiving each type of lens were compared by using a mixed model of repeated measures.

Results

Visual improvements were evident after operation in both groups. By comparing the attempted to the achieved SE values, we were able to confirm that correction of refractive error was similar in both groups. However, the logMAR UCVA was significantly higher in the toric ICL group at all postoperative time points. Although manifest cylinder power and astigmatism (calculated by using the power vector method) gradually decreased in the toric ICL group, cylinder power 1 month postoperatively increased from −2.62 to −2.75 D; astigmatism was also increased at this time in the toric Artisan group.

Conclusion

The two tested toric pIOLs were similar in terms of the ability to correct refractive error, as assessed 3 months postoperatively. However toric ICLs corrected astigmatism more rapidly and safely. Notably, the large difference in astigmatism level between the two groups 1 month postoperatively indicates that toric ICLs are more effective when used to correct astigmatism.     

Postoperative inflammation after implantation of the implantable contact lens

PURPOSE: To evaluate postoperative inflammation after implantation of the implantable contact lens (ICL) to treat moderate to high myopia. DESIGN: Noncomparative, prospective case series. PARTICIPANTS: Five hundred twenty-five eyes of 293 patients with between 3 and 20 diopters of myopia participating in the United States Food and Drug Administration clinical trial of the ICL for myopia. INTERVENTION: Implantation of the ICL. MAIN OUTCOME MEASURES: Clinical assessments of anterior chamber flare and cellular reaction for up to 3 years after surgery and laser flare-cell meter measurements for up to 2 years after surgery. RESULTS: Clinical flare and cellular reaction was reported as absent in 99.6% to 100% of cases and in no case demonstrated more than trace reaction at all postoperative visits 1 month or more after surgery. In a small subset of the study participants who were tested with the laser flare and cell meter, measurements taken between 3 months and 3 years after surgery were within the normal range. CONCLUSIONS: The implantation of the ICL does not cause a long-term (2-3 years) inflammatory response within the eye.     

人工晶状体植入治疗急性原发性闭角型青光眼

目的 探讨白内障超声乳化联合人工晶状体植入术治疗瞳孔阻滞缓解后伴白内障急性原发性闭角型青光眼的疗效.方法 对43例(47眼)伴白内障闭角型青光眼患者经药物治疗缓解瞳孔阻滞后,行白内障超声乳化术和人工晶状体植入术.观察手术前后眼压、视力、前房角及中央前房深度的变化.结果 术后随访6～12个月,平均眼压由术前的(18.5±5.5)mm Hg(1 mm Hg=0.133 kPa)降至(13.5±4.5)mm Hg,差异有统计学意义(P<0.05);视力均有不同程度提高,差异有统计学意义(P<0.05);前房角均较术前增宽,可见大部分睫状体带;平均中央前房深度由术前的(3.25±0.35)mm降至(1.30±0.25)mm,差异有统计学意义(P<0.01).结论 白内障超声乳化联合人工晶状体植入术治疗瞳孔阻滞缓解后的急性原发性闭角型青光眼伴白内障有效.     

Measurement of anterior lens growth after acute primary angle-closure glaucoma

CASE REPORT: A 51-year-old woman present with bilateral acute primary angle-closure glaucoma. Glaukomflecken were prominent. Anterior lens growth in front of the glaukomflecken was measured 12 years later. COMMENTS: Lens thickness is important in the pathogenesis of acute primary angle closure, and lens growth can become significant with time in eyes already at risk.     

激光联合白内障超声乳化术对急性闭角型青光眼房角的重塑作用

目的:评估激光联合超声乳化白内障手术(phacoemulsifi-cation and intraocular lens,Phaco+IOL)作为初始治疗手段对急性闭角型青光眼房角的重塑作用。方法:选取37例39眼合并白内障首次发作的急性闭角型青光眼,平均眼压69.22±21.23mmHg,经过药物降眼压,完成激光虹膜成形联合周边切开术,病情稳定7～14d后,行超声乳化白内障吸除联合人工晶状体植入术,观察手术前后视力、眼压、房角开放状况和虹膜形态的变化。结果:随访时间3～27mo,患者术后视力均有提高,其中29眼未再使用用抗青光眼药物,最后4次随访平均眼压14.90±2.19mmHg,较激光术前明显下降(P<0.05),随访期间38眼眼压控制平稳,视野无进行性损害,1眼眼压波动在18～28mmHg,同时存在进行性视野损害,于术后10mo接受了滤过手术。OCT对虹膜形态的观察表明,所有患者虹膜均由术前的膨隆形变化为平坦型,房角开放度由激光术前平均10.86±5.11度增加为术后46.34±13.32度(P<0.01)。结论:激光联合Phaco+IOL治疗合并白内障的急性闭角型青光眼有助于开放房角,达到解除瞳孔阻滞,疏通房水引流的作用,避免滤过手术的风险,白内障术前激光治疗可以迅速缓解急性发作的症状,开放房角,控制眼压,加深前房,使白内障手术更安全稳定。     

原发性闭角型青光眼行白内障超声乳化联合人工晶状体植入术后超声生物显微镜观察

目的 通过超声生物显微镜评估白内障超声乳化联合人工晶状体植入术对药物可以控制的原发性闭角型青光眼患者眼前节结构的影响.方法 收集药物可以控制的原发性闭角型青光眼合并白内障患者30例(30眼),所有患者均自愿接受白内障超声乳化联合人工晶状体植入术.分别于术前及术后1个月、6个月行超声生物显微镜检查,通过测量前房深度、距离巩膜突500 μm的房角开放距离和小梁睫状突距离来观察前房结构的变化.结果 患者术前及术后1个月、6个月的前房深度分别为(1.781±0.260) mm、(3.249±0.741) mm、(3.473±0.196) mm,术后1个月和6个月患者的前房深度均较术前明显加深(均为P ＜0.001).术后上方、颞侧、鼻侧和下方4个象限距离巩膜突500 μm的房角开放距离较术前都有显著增加(均为P＜0.001),分别平均增加0.114 mm、0.147 mm、0.149 mm和0.110 mm;4个象限的小梁睫状突距离均较术前显著增加(均为P＜0.001),分别平均增加0.087 mm、0.142 mm、0.094 mm和0.121 mm.4个象限的距离巩膜突500μm的房角开放距离与小梁睫状突距离均呈显著正相关(均为P＜ 0.05).结论 对于药物可以控制的原发性闭角型青光眼,白内障手术可使中央前房加深,前房角增宽,睫状突位置后移.     

超乳治疗慢性闭角型青光眼临床观察

目的观察透明角膜切口晶状体超声乳化吸出联合人工晶状体植入治疗慢性闭角型青光眼合并白内障的疗效。方法原发性慢性闭角型青光眼20例(22眼),视力<0.1,晶状体不同程度浑浊,行晶状体超声乳化吸出联合人工晶状体植入术。结果术前用药后眼压(28.63±13.27)mmHg,术后为(15.42±3.86)mmHg(t=4.243,P<0.05);术后房角不同程度开放。结论透明角膜切口晶状体超声乳化吸出联合人工晶状体植入术可有效地治疗因晶状体阻滞合并白内障的慢性闭角型青光眼。     

超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼临床观察

目的 探讨治疗急性闭角型青光眼的手术方法.方法 施行超声乳化白内障摘出联合人工晶状体植入术治疗急性闭角型青光眼17例(17眼).结果 术后15眼眼压控制在13～21 mmHg.最佳矫正视力较手术前提高2～4行.结论 白内障行晶状体超声乳化摘出联合人工晶状体植入术是治疗急性闭角型青光跟的一种有效手术方式,特别是对于急性闭角型青光眼合并成熟期和近成熟期的白内障尤为适合.     

晶状体异位继发急性闭角型青光眼术式选择及疗效观察

目的 回顾性分析晶状体异位继发急性闭角型青光眼手术方式的选择及观察其疗效.方法 取36例(41只眼)晶状体异位继发急性闭角型青光眼患者,采用超声生物显微镜观察晶状体悬韧带离断范围,根据晶状体脱位范围以及房角关闭范围,分别选择小梁切除术,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术和(或)小梁切除联合超声乳化白内障吸除术,术后随访1个月,观察手术治疗效果.结果 随访期间,患者术后矫正视力提高,眼压降低:术后1d,17只眼(41.46%)矫正视力＞0.5;30只眼(73.17%)眼压在21mmHg以内;术后7d,24只眼(58.54%)矫正视力＞0.5;35只眼(85.36%)眼压在21mmHg以内;术后30d,27只眼(65.85%)矫正视力＞0.5;所有患者眼压在21mmHg以内.结论 在晶状体异位继发急性闭角型青光眼患者中,晶状体脱位范围在1~2个象限者,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术是一种安全有效的术式;脱位范围大于2个象限者,选择白内障囊外摘除手术;房角关闭大于1/2的患者,选择小梁切除联合白内障手术.     

超声乳化白内障吸除联合折叠式人工晶状体植入治疗急性闭角型青光眼22例

目的:观察透明角膜切口超声乳化白内障吸除联合折叠式人工晶状体植入治疗急性闭角型青光眼的临床疗效。方法:回顾分析2001-12/2004-07我院眼科住院22例25眼急性闭角型青光眼并不同程度的晶状体混浊,其中11眼为原发性急性闭角型青光眼,14眼为继发性急性闭角型青光眼。患者入院后均行透明角膜切口超声乳化联合折叠式后房型人工晶状体植入手术。随访时间7～36(平均16.50±9.80)mo。结果:术后随访眼压为(10.55±5.08)mmHg(1mmHg=0.133kPa),比术前用药后的眼压(28.35±15.70)mmHg明显降低,差异有显著性(t=4.732,P<0.001)。中央前房深度由术前的(1.08±0.75)mm增加到术后的(2.37±0.48)mm,两者比较差异有显著性(t=6.632,P<0.001)。术后所有25眼最佳矫正视力均有提高。结论:透明角膜切口超声乳化白内障摘除联合折叠式人工晶状体植入,是治疗急性闭角型青光眼并白内障的一种有效的方法。     

超声乳化术联合小梁切除术治疗急性闭角性青光眼合并白内障

目的探讨晶状体超声乳化及人工晶状体植入术联合小梁切除术及术中应用丝裂霉素C（MMC）治疗急性闭角性青光眼合并白内障的临床效果。方法回顾分析13例（13只眼）急性闭角性青光眼（前房角粘连关闭均〉180°）合并白内障行透明角膜切口超声乳化及人工晶状体植入,联合小梁切除术及术中应用丝裂霉素,注意观察手术前、后的视力和眼压,手术并发症及滤过泡情况。结果术后随访时间3—6个月。13只眼眼压均降致正常范围,视力有不同程度提高;术后根据Kronfeld分类,Ⅰ、Ⅱ型功能滤过泡4只眼（30．8％）,非功能Ⅲ型滤过泡9只眼（69．2％）。结论透明角膜切口晶状体超声乳化及人工晶状体植入术联合小梁切除术及术中应用丝裂霉素（MMC）治疗急性闭角性青光眼合并白内障是一种安全、有效的治疗方法,可以明显降低眼压,提高视力。     

A pilot study of lens extraction in the management of acute primary angle-closure glaucoma

PURPOSE: To describe a pilot study of lens extraction in the management of acute primary angle-closure glaucoma (APACG) in Chinese patients. DESIGN: Interventional case series. METHODS: A prospective case series of patients presented with APACG at a tertiary eye hospital in Xiamen, China. All the patients had intensive medical treatment followed by immediate phacoemulsification and posterior chamber intraocular lens implantation under topical anesthesia. RESULTS: There were 18 patients who were seen with APACG who had phacoemulsification and posterior chamber intraocular lens implantation under topical anesthesia. There was a 9.0-mm Hg drop in mean preoperative and first day postoperative intraocular pressure (22.8 vs 13.8 mm Hg, P =.012) and a 10.2-mm Hg drop in mean preoperative and seventh-day postoperative intraocular pressure (22.8 vs 13.2 mm Hg, P =.002). CONCLUSIONS: This pilot study indicates that phacoemulsification and posterior chamber intraocular lens implantation may be useful in the treatment of primary acute angle-closure glaucoma in Chinese patients. Further study with longer follow-up is needed.     

白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障临床疗效分析

目的探讨白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障的临床效果。方法选取138例(138眼)闭角型青光眼合并白内障的患者,其中70例患者行白内障摘出联合人工晶状体植入术,68例患者行小梁切除术,术后随访3～24个月,每3个月做一次记录,比较各组术前术后及两组之间术后眼压、矫正视力、中央前房深度、房角的变化。结果两组患者术后的眼压较术前明显下降,白内障摘出联合人工晶状体植入术后的患者眼压为(10.81±0.31)mmHg(1kPa=7.5mm-Hg),小梁切除术后的患者眼压为(10.49±0.44)mmHg,两组患者术后眼压相比差异无统计学意义(Z=-1.08,P=0.28);白内障摘出联合人工晶状体植入术后患者的矫正视力明显优于小梁切除术后的患者,两组患者术后视力比较差异有统计学意义(Z=-5.74,P=0.01);白内障摘出联合人工晶状体植入术后患者的中央前房深度较小梁切除术后加深[前者为(3.37±0.02)mm,后者为(1.76±0.02)mm],两组患者术后的中央前房深度差异有统计学意义(P=0.01);白内障摘出联合人工晶状体植入术后患者的房角开放程度比小梁切除术后开放程度大,两组患者术后的房角开放程度相比差异有统计学意义(Z=-4.50,P=0.01);白内障摘出联合人工晶状体植入术后早期并发症主要有角膜水肿、前房反应,小梁切除术后早期并发症有浅前房、前房积血、睫状体脱离、术后早期高眼压。随访3～24个月,白内障摘出联合人工晶状体植入术后有5例患者需再次行小梁切除术控制眼压,小梁切除术后也有2例患者需再次行小梁切除术控制眼压。结论白内障摘出联合人工晶状体植入术治疗闭角型青光眼合并白内障疗效显著,相比小梁切除术手术操作简单,术后视力改善明显,并发症少,患者易于接受,值得推广应用。     

人工晶体术后继发青光眼临床分析

目的 :分析人工晶体术后继发青光眼的临床特征。方法 :分析 3 6例 3 6只眼人工晶体术后继发青光眼患者视力、眼压、房角、人工晶体情况、青光眼类型、超声生物显微镜(UBM )检查及治疗情况。结果 :3 6眼视力为无光感～ 0 8,平均眼压为 42 8± 15 1mmHg。 2 6只眼 (72 2 % )房角关闭 ,9只眼 (2 5 % )房角开放。 11只眼 (3 0 5 % )人工晶体偏位 (6只眼人工晶体夹持 ) ;人工晶体袢位置异常者 7例 (19 4% )。继发闭角型青光眼 2 6只眼(72 2 % ) ,开角型青光眼 9只眼 (2 5 0 % )。 15只眼行UBM检查 ,图象显示 4只眼虹膜膨隆房角关闭 ,5只眼虹膜平坦房角关闭 ,3只眼为宽角 ;2只眼睫状体水肿 ,9只眼人工晶体位置正常 ,6只眼人工晶体和 /或袢位置异常 ,2只眼晶体皮质残留。 3 3只眼施手术治疗 ,3只眼单纯药物治疗 ,治疗后眼压为 12 0± 4 6mmHg ,治疗后视力低于 0 3者 2 6只眼 (72 2 % )。结论 :人工晶体术后继发青光眼原因复杂 ,临床表现多样化 ,治疗棘手 ,视功能恢复不良。UBM对人工晶体术后继发青光眼诊断、分析及处理有较好的辅助作用。