儿童白内障后囊撕囊及人工晶状体后囊嵌顿术

目的研究儿童白内障摘出术中后囊处理方法。方法对26例(38眼)儿童白内障手术中采用后囊连续环形撕囊联合人工晶状体视区后囊嵌顿,术后随访(14±4.51)月。结果34眼后囊连续环形撕囊联合人工晶状体后囊嵌顿成功。此34眼中18眼玻璃体前界膜完整,16眼行前段玻璃体切除。经随访2眼术后3月视轴区玻璃体前界膜轻度浑浊,其余32眼视轴区保持透明。结论后囊连续环形撕囊联合人工晶状体视区后囊嵌顿是预防儿童白内障人工晶状体植入术后后囊浑浊,减少对玻璃体、视网膜干扰的可行方法。     

儿童白内障一期后囊撕囊及前部玻璃体切除术的体会

目的 评价儿童白内障摘出联合一期后囊撕囊及前部玻璃体切除术预防后发性白内障的临床效果.方法 44例65眼儿童白内障施行前囊连续环形撕囊白内障囊外摘出或联合人工晶状体植入术,术中进行后囊连续环形撕囊或后囊中央切除术,并进行前部玻璃体切除术.其中先天性白内障26例47眼,儿童外伤性白内障18例18眼.随访3～36个月.结果 60眼(92.31%)保持视轴透明,5眼(7.69%)出现视轴区白色纤维机化浑浊,2眼(3.08%)瞳孔区少量玻璃体嵌顿人工晶状体偏位,无视网膜脱离发生.结论 儿童白内障摘出联合一期后囊切开及前部玻璃体切除术,能有效预防后发性白内障的形成.     

后囊环形撕开联合人工晶状体后囊嵌顿术治疗儿童白内障

目的 探讨连续环行撕后囊联合人工晶状体后囊嵌顿术预防儿童后发性白内障的可行性.方法 采用连续环行撕后囊联合人工晶状体后囊嵌顿术,治疗30例(49只眼)儿童先天性白内障.记录术前、术后视力及术中、术后并发症.结果 术中有44只眼连续环行撕后囊联合人工晶状体后囊嵌顿成功.随访过程中嵌顿成功患儿视轴区保持透明.结论 连续环行撕后囊联合人工晶状体后囊嵌顿术治疗儿童白内障能安全、有效地预防后发性白内障的发生.     

儿童白内障一期连续环形撕后囊手术探讨

目的　探讨儿童白内障术后后囊膜混浊的处理方法及其安全性。方法　对２６ 例（２９ 眼）儿童白内障行巩膜隧道切口囊外摘除白内障联合人工晶体植入术后, 于后囊膜中心穿刺小洞, 向后囊膜与玻璃体前膜之间注入Ｈｅａｌｏｎ 使二者分离, 再以小洞为起点连续环形撕后囊膜, 成直径约３ｍ ｍ ～４ ｍ ｍ 的近圆形裂孔。结果　全部术眼视轴区均透明, １ 眼玻璃体进入前房, ２ 眼后囊膜不规则撕裂。结论　一期连续环形撕后囊术可防止儿童白内障摘除术后后囊膜混浊, 安全可靠     

先天性白内障手术中后囊撕囊联合人工晶状体后囊嵌顿术的应用

目的探讨先天性白内障手术中后囊撕囊联合人工晶状体后囊嵌顿术的应用效果。方法对32例(36只眼)先天性白内障,手术中采用后囊连续环形撕囊联合人工晶状体光学区后囊口嵌顿术,术后随访24个月以上。结果 36只眼均将人工晶状体攀植入囊袋,光学区嵌顿于后囊口。术后矫正视力较术前均有提高,其中最佳矫正视力≥0.3者33只眼(91.7%),≥0.5者22只眼(61.1%)。后囊中央部混浊0级者27只眼(75.0%),1级者4只眼(11.1%),2级者3只眼(8.3%),3级者2只眼(5.6%),未出现4级混浊的病例。无眼底并发症。结论先天性白内障术中,行后囊环形撕囊联合人工晶状体光学区后囊嵌顿术,能有效阻止中央部后囊混浊的发生,有助于视功能的恢复。     

后囊连续环形撕囊在防治儿童人工晶状体植入术后后囊混浊中的作用

目的 探讨后囊连续环形撕囊在预防儿童白内障人工晶状体植入术后后囊混浊中的作用。方法 对29例29眼儿童白内障在植入人工晶状体后行一期后囊环形撕囊，术后随访3个月－2a。结果 术后随访显示27眼获得视轴透明区，眼底可见，矫正视力均有不同程度的提高。结论 一期后囊连续环形撕囊是预防儿童白内障人工晶状体植入术后后囊混浊的可行方法。     

后囊连续环形撕囊

后囊混浊是白内障摘出术后的一个常见并发症，在儿童尤其明显，可直接影响白内障手术效果。后囊混浊是由于残存的晶体上皮细胞向后囊移行并增殖所致，后囊连续环形撕囊可清除细胞移行与增殖的支架，保持视轴区的长期透明。白内障术中后囊破裂，为防止玻璃体脱出，保证囊袋内植入人工晶体，也可行后囊连续环形撕囊。本文就后囊连续环形撕囊的应用进行综述，介绍其手术操作、术中和术后并发症、手术注意事项及适应证     

后囊膜混浊的先天性白内障术中的连续线形撕后囊术

目的研究后囊膜混浊的先天性白内障摘除术后的后囊膜处理方法。方法在３２只眼后囊膜混浊的先天性白内障中，摘除白内障及植入人工晶体后于后囊膜的旁中心作一穿刺孔，然后向后囊膜与玻璃体前界膜的间隙注入Ｈｅａｌｏｎ，再沿后囊膜穿刺孔边缘线形撕开一个直径约４ｍｍ的圆孔。结果全部术眼后囊膜中央有一透明裂孔，２只眼玻璃体溢出，术后未见人工晶体移位。结论连续线形撕后囊术可使后囊膜混浊的先天性白内障获得视轴透明区，并保持周边囊袋的完整性。     

白内障人工晶状体植入术中连续环形撕后囊膜的研究

目的 评价超声乳化人工晶状体植入后环形撕后囊膜预防晶状体后囊膜混浊的临床效果.方法 393眼白内障患者,摘出晶状体植入人工晶状体后在后囊膜的旁中心作一穿刺孔,经穿刺孔向后囊膜与玻璃体前界膜之间注入透明质酸钠,沿后囊膜穿刺孔边缘环形撕开一个直径约3 mm的圆形孔.术后观察人工晶状体位置、视力、后囊膜、玻璃体前界膜及并发症情况.结果 18眼轻度移位,术中13眼玻璃体经后囊膜孔突入囊袋内.术后3个月检查,375眼人工晶状体位置未见明显移位和偏斜.矫正视力≥0.5者307眼,≥0.1者236眼.术后玻璃体前界膜完整者217眼.结论 连续线形撕后囊膜可使白内障患者获得视轴透明区,防止视轴区后囊膜混浊.     

后囊连续环形撕囊联合前段玻璃体切除术在儿童白内障手术中的应用

目的探讨后囊连续环形撕囊联合前段玻璃体切除术对儿童后发性白内障的预防作用。方法对32例32眼儿童白内障患者利用超声乳化技术摘除白内障时Ⅰ期进行后囊连续环形撕囊联合前段玻璃体切除术。结果全部术眼视轴区均透明，3眼后囊膜不规则撕裂，32眼均不影响IOL植入，无术中术后并发症。结论在利用超声乳化技术摘除白内障时Ⅰ期进行后囊连续环形撕囊联合前段玻璃体切除术，能使视轴区保持清亮，有效防止后发性白内障的发生。     

Changes in rabbit and cow lens shape and volume upon imposition of anisotonic conditions

In vivo, mammalian lenses have the capacity to effect fully reversible changes in shape, and possibly volume, during the accommodation process. Isolated lenses also change shape by readily swelling or shrinking when placed in anisotonic media. However, the manner by which the lens changes its shape when its volume is changed osmotically is not firmly established. Putatively, the lens could swell or shrink evenly in all directions, or manifest distinctive swelling and/or shrinking patterns when exposed to anisotonic media. The present study measured physical changes in lenses consistent with the latter alternative using methods we developed for determining rapid changes in lens shape and volume. It was found in isolated rabbit and cow lenses that the length of the axis between the anterior and posterior poles (A-P length) primarily increases under hypotonic conditions (−40 to −100 mOsM), with smaller, or no changes, in equatorial diameter (ED). Hypertonic conditions (+50 to +100 mOsM) on rabbit lenses elicited a predominant reduction in ED, while the A-P length was only marginally reduced. Hypertonic solutions of +150 mOsM were required to obtain similar changes in cow lens shape. The ratio of the A-P length to the ED was taken as a measure of “circularity”. This ratio increased gradually in rabbit and cow lenses bathed in hypotonic solutions because of the increase in the A-P length. The calculated lens volume increased in tandem with the increase in “circularity”. Lens circularity also increased under hypertonic conditions due to the decrease in ED, but this increase in circularity during shrinkage was not as pronounced as that which occurred during swelling. As such, the lens has a tendency upon swelling to change its shape by approaching the structure of a globular spheroid (as occurs during accommodation for near focusing), but lens shrinkage does not result in a flatter lens with a reduced A-P length as occurs during dis-accommodation for distance focusing. Moreover, osmotically evoked shape changes appear irreversible, in contrast to the mechanically elicited shape changes of accommodation.     

开放囊袋-IOL单襻睫状沟固定术治疗先天性晶状体半脱位

目的:探讨开放囊袋-人工晶状体(IOL)单襻睫状沟固定术治疗先天性晶状体半脱位的安全性和有效性.方法:收集2011-03-01/2013-12-31影响视力的先天性晶状体半脱位患者10例13眼,做角巩膜缘隧道切口,环形撕囊后,使用虹膜拉钩,固定脱位晶状体,完成超声乳化手术.植入IOL,剪开晶状体脱位一侧囊袋,翻转前囊,上襻位于囊袋内,下襻单针经缝合固定于睫状沟.结果:所有患者最佳矫正视力均不同程度提高,IOL稳定,没有进展性偏位.结论:虹膜拉钩可以稳定脱位的晶状体,使超声乳化手术顺利完成.开放下方囊袋,IOL呈半游离状态,下襻睫状沟缝合固定可维持IOL的长期稳定,避免囊袋进行性偏移,造成IOL偏位.     

The critical initial comfort of soft contact lenses

Background : The initial comfort of soft lenses is not as important when prospective patients are highly motivated to be fitted with contact lenses but can be critical in the case of apprehensive patients, especially in the case of proactive demonstration/diagnostic fittings. Failure to eliminate initial discomfort may cause apprehensive prospective contact lens wearers to decide not to proceed with a fitting. However, in all cases of clinical and research fittings, initial comfort is critical to fit evaluation, when abnormal lid tonus and lacrimation can invalidate assessment. Method : A panel of experienced contact lens practitioners evaluated three methods of lens settling that could be employed to improve soft lens comfort immediately after lens insertion. Results : A total of 1,234 lens insertion experiences were examined by the panel and it was found that soft lens settling procedures were indicated in 46 per cent of cases. The settling procedure was found to be successful in 86 per cent of cases. The temporal lens displacement method of soft lens settling was found to be easier to use (p < 0.001) and the lens displacement away from the perceived location of irritation method was found to be the most successful (p < 0.05). Conclusion : In cases of mild to moderate discomfort, the displacement away from irritation method had a better chance of establishing comfort and was the most appropriate method to teach patients to use when inserting lenses for themselves. This study also indicates that, under certain conditions, the location of corneal sensation may be much better than previously found.     

14例晶体脱位的超声乳化手术治疗

为评价不同手术方式在晶体脱位手术治疗中的疗效，对２４例（２８只眼）晶体脱位患者作晶体摘除术。其中超声乳化法１４例（１４只眼），非超声乳化法１０例（１４只眼）。结果：术后最佳视力５只眼无提高（１７．９％），２３只眼较术前提高（８２．１％）。无严重术中和术后并发症。术后视力无提高原因主要为术前继发性青光眼（７１．４％）。结论：晶体脱位通常被认为是超声乳化晶体摘除术的禁忌症。我们的经验表明只要手术条件良好，操作技术熟练，晶体脱位不应被列为超声乳化术的禁忌症     

Interaction between mechanical and osmotic forces in the isolated rabbit lens

Based on our previous work showing that cow and rabbit lenses isolated with their accommodation anatomical components intact change volume during simulated accommodation in vitro, and that hyposmolality and hyperosmolality also produce volume changes, we tested the idea that exerting these forces simultaneously may add or counteract each other. Further, we attempted to find a point at which osmotic and mechanical forces may cancel each other. Using previously described methodology, we found that combined stretching and anisotonic conditions applied to a lens always produced less of a volume change than that observed on its paired lens from the fellow eye that was only subjected to anisotonic conditions. Our results suggest that a stretching force that increases the equatorial diameter by 0.4% and reduces the lens volume by 1.8% could be canceled by a hyposmotic force of about −20 to −30 mOsM. Counter-intuitively, lenses that were subjected to stretching and hyperosmolality had less volume decrease than their paired lenses only exposed to hypertonicity. This latter observation is likely due to the prevention by the mechanical stretching forces of the shortening of the equatorial diameter, which normally occurs in hypertonic media.     

Single lens to lens duplication: the missing link

Congenital anomalies of the lens include a wide range from lens coloboma to primary aphakia and doubling of lens. There have been few case reports of double lens; the etiology suggested is metaplastic changes in the surface ectoderm that leads to formation of two lens vesicles and hence resulting in double lens. We report a case with bilobed lens, which raises the possibility of explaining the etiology of double lens.     

Vimentin在正常家兔舆白内障家兔眼晶體的分布

目的探討Vimentin細胞骨架蛋白在正常家兔眼晶體中不同區域的分布舆白内障家兔晶體中Vimentin含量的對比,從而論證Vimentin在致障中的代謝活曜.方法選取成年健康家兔13衹及白内障家兔13衹取左眼晶體,采用免疫熒光染色法,照相,計算機圖像分析(灰度值X±S).結果發現Vimentin陽性物在晶體赤道部表面水平最高,在向晶體中部移行的過程中陽性程度逐漸下降,最後消失,同時表明健康家兔舆白内障家兔晶體中Vimentin的含量有顯著差异(P＜0.05).結論提示在致障方面Vimentin有明顯改燮.     

人晶体总蛋白质中的43KD多肽

本文使用S.D.S—聚丙烯酰胺凝胶电泳对人胚胎、青年、成年透明晶体及老年性白内障晶体囊上皮、皮质和核三部分的总蛋白质可溶性和脲溶性蛋白质进行了测定,发现在囊上皮部分自胎儿到老年性白内障晶体均有一条43KD多歇.而自14岁开始在晶体皮质及核的可溶性蛋白质中这条43KD多肽带明显加宽.在晶体皮质及核的碌溶性蛋白中这条谱带随年龄增长变得模糊.在老年性白内障晶体中则几乎消失.     

Cytoplasmic filaments in the crystalline lens of various species: functional correlations.

The distribution of cytoplasmic filaments in lenses of five species was studied with the electron microscope. Two distinct patterns emerged. One pattern, in which filaments are grouped in characteristic bundles around the nucleus, in processes, and throughout the subcortical cytoplasm of epithelial cells, is typical of spherical, non-accommodating lenses of mice and rats. The second pattern is associated with anteriorly-flattened, accommodating lenses of infant human, squirrel and frog. In these, filaments are scattered in epithelial cells, but are accumulated on either side of the plasma membrane junction between epithelial cells and lens fibers. They are especially dense on the lens fiber side of the junction, and form a lattice associated with the lens fiber plasma membrane. The lattice is less extensive along the sides of lens fibers not in contact with epithelial cells. In spherical lenses the epithelial-fiber lattice is greatly reduced. Filaments in both types of lenses ranged in diameter between 5 and 11 nm. The filaments are thought to be a mixture of thin and intermediate filaments.It is hypothesized that the role of cytoplasmic filaments in lens, depending on the pattern present, is either to structurally support a spherical shape, or to provide a contractile force or elasticity to return the flattened anterior surface to the accommodated state in conjunction with the elasticity of the lens capsule.