白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除的临床观察

目的探讨白内障超声乳化吸除联合人工晶状体植入术中Ⅰ期后囊膜连续环形撕除的临床疗效。方法对53例(60只眼)先天性白内障和后囊混浊的老年性白内障,施行白内障超声乳化吸除联合人工晶状体植入,同时行Ⅰ期后囊膜连续环形撕除,术后观察眼压、人工晶状体位置、视轴区后发障等情况。结果术中人工晶状体均顺利植入囊袋;54只眼术后视力较术前提高,术后24小时后眼压正常;术后随访3个月~2年,无发生玻璃体疝入前房,未发现人工晶状体异位或夹持,无一例出现后发障、视网膜脱离。结论白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除是可行、安全的,能有效地治疗后囊膜混浊,预防后发障。     

皮质混浊性白内障超声乳化吸除人工晶状体植入术的临床观察

目的:探讨皮质混浊性白内障超声乳化吸除联合人工晶状体植入术的手术技巧及疗效。方法:对50例(53眼)皮质混浊性白内障行超声乳化吸除联合人工晶状体植入术,术后观察视力、并发症情况。结果:术后1wk最佳矫正视力≤0.1者2眼(3.7%);0.3～0.6者13眼(24.6%);0.6以上者38眼(71.2%)。结论:皮质完全混浊性白内障通过前囊膜染色完成前囊膜环行撕囊是手术成功的关键,乳化针头斜面向下和拦截劈裂超声碎核有效保护角膜内皮避免后囊膜破裂等并发症的发生。     

低度数或负度数折叠式人工晶状体植入术治疗白内障合并高度近视的临床观察

目的观察白内障摘除联合低度数或负度数丙烯酸酯(Acrysof)折叠式人工晶状体植入术治疗白内障合并高度近视的临床疗效.方法对40例(56只眼)白内障合并高度近视患者行超声乳化白内障吸除低度数或负度数Acrysof折叠式人工晶状体植入术,观察术中和术后并发症、术后视力和屈光度数.术后随访时间≥3个月.结果术中无并发症发生.术后3个月最佳矫正视力＜0.1者2只眼,0.1～0.4者12只眼,0.5～0.9者36只眼,1.0～1.5者6只眼;4只眼(7.2%)晶状体后囊膜混浊,1只眼(1.8%)发生晶状体囊袋阻滞综合征,无视网膜脱离者.结论超声乳化白内障吸除低度数或负度数Acrysof折叠式人工晶状体植入术,是治疗白内障合并高度近视患者安全、有效的手术方法.     

超声乳化术中人工晶状体前囊夹持植入的临床观察

目的:观察超声乳化术中人工晶状体前囊夹持植入法的临床效果。方法:对白内障超声乳化术中撕囊口过小21例21眼、后囊破裂6例6眼、囊袋宽松1例2眼采用前囊夹持法植入后房型人工晶状体,术后观察视力、人工晶状体位置及后发性白内障情况,术后随访6～24mo。结果:术后3mo视力0.3以上6眼,0.5以上13眼,0.8以上10眼,人工晶状体位置稳定,后发性白内障发生率与囊袋内植入相近,未发现其它与固定有关的并发症。结论:白内障超声乳化术中采用前囊夹持法植入后房型人工晶状体效果良好,是超声乳化术中出现撕囊口过小、后囊膜破裂等并发症的一种有效补充手段。     

环形撕囊直径与晶状体前、后囊膜混浊的临床研究

采用连续环形撕囊及人工晶状体囊袋内植入术 ,能有效防止人工晶状体偏心 ,减少人工晶状体对周围组织的损伤。但是术后晶状体前囊膜的环形混浊对眼底病检查和治疗的影响、不同撕囊直径对后发性白内障的影响不同等 ,成为这一技术带来的新问题。本文通过研究撕囊直径大小对老年性白内障术后晶状体前、后囊膜混浊及囊袋收缩程度的影响 ,探讨白内障摘除术中最佳的撕囊直径。1.资料和方法 :(1)对象与分组 :将 110例 (110只眼 )于我院行超声乳化白内障吸除人工晶状体植入术 ,术中连续环形撕囊的老年性白内障患者根据撕囊直径分为 3组 :Ⅰ组 4 3例 ,…     

不同边缘形状的人工晶状体与后发性白内障的临床研究

目的　观察直角边缘和弧形边缘折叠式人工晶状体植入术的临床效果 ,探讨手术因素 ,以及人工晶状体材料和边缘形状等因素对后发性白内障发生的影响。方法　观察 14 0例 (14 0只眼 )白内障患者超声乳化白内障吸除囊袋内折叠式人工晶状体植入术后的视力、晶状体囊袋和人工晶状体情况。直角边缘组 90只眼 ,术中植入疏水性丙烯酸酯直角边缘人工晶状体 ,随访时间 (14± 8)个月 ;弧形边缘组 5 0只眼 ,术中植入非疏水性丙烯酸酯弧形边缘人工晶状体 ,随访时间 (18± 8)个月。结果　晶状体后囊膜混浊直角边缘组 8只眼 (8 9% ) ,弧形边缘组 19只眼 (38 0 % ) ,两组比较差异有非常显著意义 (P <0 0 1)。环形撕囊口大小适中直角边缘组 76只眼 ,无晶状体后囊膜混浊发生 ;弧形边缘组 4 1只眼 ,其中 10只眼 (2 4 4 % )出现晶状体后囊膜混浊 ,两组比较差异有非常显著意义 (P<0 0 1)。环形撕囊口过大或偏位直角边缘组 14只眼 ,其中晶状体后囊膜混浊 8只眼 (5 7 1% ) ;弧形边缘组 9只眼 ,全部发生晶状体后囊膜混浊 (10 0 0 % ) ,两组比较差异有显著意义 (P <0 0 5 )。行激光晶状体后囊膜切开术直角边缘组 1只眼 (1 1% ) ,弧形边缘组 5只眼 (10 0 % ) ,两组比较差异有显著意义(P <0 0 5 )。结论　手术操作、人工晶状     

前囊膜夹持人工晶状体植入术疗效观察

目的 提供一种后囊膜无功能性支撑作用时后房型人工晶状体睫状沟植入技术的改进方法。方法行角膜缘透明切口白内障超声乳化人工晶状体植入术29例(29眼)，术中采用连续环形撕囊，所有病例术中均发生非计划内后囊膜破裂，后房型人工晶状体改行睫状沟植入，光学部置于环形前囊膜下。术后随访时间3～21个月。结果全部病例术后最佳矫正视力均好于或等于0．3，术中并发症主要为后囊膜破裂(29眼)，8眼行前部玻璃体切割术，无一眼虹膜损伤。术后11眼出现一过性角膜水肿。结论对后囊膜无功能性支撑作用的病例，后房型人工晶状体借助具有连续环形开口的前囊膜夹持固定，可获得良好的视力及相对较低的并发症发生率。     

折叠式人工晶状体治疗儿童白内障的初步报告

目的　评价小切口白内障吸除及折叠式人工晶状体囊袋内植入术中采用撕除后囊、切除前段玻璃体技术治疗儿童白内障的临床效果。方法　对 2 8例 (37只眼 )儿童白内障患者行小切口白内障吸除、前后联合撕囊、前段玻璃体皮质切除及折叠式人工晶状体囊袋内植入术 ,其中先天性白内障 2 7只眼 ,外伤性白内障 10只眼。术后随访 3～ 15个月 ,平均 10个月。观察记录并发症发生情况、视力及角膜曲率的变化。结果　先天性白内障患者术后矫正视力均≥ 0 1,16只眼 (5 9 3% )矫正视力≥ 0 5 ;外伤性白内障患者术后矫正视力均≥ 0 3,8只眼 (80 % )矫正视力≥ 0 5。术后 1周 ,1个月和 3个月的手术源性角膜散光度数分别为 (1 18± 0 6 5 )、(0 6 7± 0 5 9)及 (0 6 0± 0 39)D。术后 1个月时 ,手术源性角膜散光度数趋于稳定。随诊中有 5只眼 (13 5 % )出现晶状体后囊膜切开区混浊 ,无其他并发症。结论　小切口白内障吸除及折叠式人工晶状体囊袋内植入术中撕除后囊、切除前段玻璃体治疗儿童白内障具有术后角膜散光小 ,视力恢复快 ,炎性反应轻 ,手术并发症少的优点     

高龄白内障超声乳化吸出手术方法的探讨

目的 探讨高龄患者白内障超声乳化吸出折叠式人工晶状体植入术术中前囊环形撕囊、晶状体核乳化的手术方式。方法 对61例(65眼)70—85岁白内障采用前房气泡下前囊环形撕囊，晶状体核原位乳化结合半囊袋内辅助机械压迫乳化并植入折叠式人工晶状体。结果 环形撕囊成功61眼(93．8％)，辅助点刺式完成裁囊4眼(6．2％)。完成晶状体会乳化65眼(100％)，平均乳化时间125．2秒。植入折叠式人工晶状体64眼(98．5％)。术中并发症主要为虹膜损伤1眼，后囊破裂玻璃体脱出改行硬质人工晶状体植入1眼。结论 前房气泡下环形撕囊，晶状体核原位乳化结合半囊袋内辅助机械压迫乳化及折叠式人工晶状体植入是高龄白内障安全有效的手术方式。     

非染色连续环形撕囊在白色白内障超声乳化中的应用观察

目的:探讨非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障的疗效。方法:对458眼白色白内障施行非染色连续环形撕囊超声乳化联合人工晶状体植入术,观察其撕囊成功率、术中的并发症、术后视力、术后角膜水肿反应等指标。结果:患者458眼中撕囊成功441眼(96.3%),17眼(3.7%)囊膜出现放射状撕裂,以剪刀剪出一囊膜瓣再完成撕囊。术中后囊膜破裂9眼(2.0%),术后轻度角膜水肿94眼(20.5%),中度水肿29眼(6.3%),重度水肿8眼(1.7%),水肿均在2～10d内消退,无角膜内皮失代偿。术后第1d视力均有明显的提高,视力>0.3者329眼(71.8%),术后1wk视力>0.5者417眼(91.0%)。结论:非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障虽手术操作较为困难,但熟练后成功率较高,术后视力恢复良好。     

The effect of capsulorhexis size on development of posterior capsule opacification: small (4.5 to 5.0 mm) versus large (6.0 to 7.0 mm)

PURPOSE: The most common surgically related cause of reduced vision after extracapsular cataract extraction is posterior capsule opacification (PCO), which occurs in up to 50% of eyes following cataract extraction. This study examined whether small capsulorhexes of 4.5 to 5.0 mm, which lie completely on the 5.5 mm intraocular lens (IOL), and large capsulorhexes of 6.0 to 7.0 mm, which lie completely off the lens optic, are effective in preventing PCO development. METHODS: In this prospective study, 496 eyes of 367 patients underwent standardized phacoemulsification with capsulorhexis and capsular bag foldable acrylic IOL implantation. The patients were randomly assigned to receive either a small capsulorhexis of 4.5 to 5 mm to lie completely on the IOL optic or a large capsulorhexis of 6 to 7 mm to lie completely off the lens optic. Retroillumination photographs were taken at 6 months and then yearly. RESULTS:Throughout the follow-up, there was less PCO in the small capsulorhexis group than in the large capsulorhexis group. CONCLUSIONS.:Small capsulorhexes were associated with less wrinkling of the posterior capsule and less PCO than were large capsulorhexes. PCO after IOL implantation has a multifactored pathogenesis. Small (4.5 to 5.0 mm) capsulorhexis and capsular bag implantation of 5.5 mm acrylic IOL are likely to reduce the PCO incidence when compared with the 6.0 to 7.0 mm capsulorhexis. The significance of the IOL optic diameter in association with the capsulorhexis size should also be documented by further studies.     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

Pars plana vitreous tap for phacoemulsification in the crowded eye

This technique facilitates phacoemulsification and foldable intraocular lens (IOL) implantation in eyes with extremely crowded anterior segments. An automated pars plana vitreous tap is used to expand the anterior segment when extremely shallow anterior chambers do not deepen sufficiently with viscoelastic injection alone. This technique permits successful completion of pupilloplasty, capsulorhexis, phacoemulsification, and foldable IOL implantation in these high-risk eyes.     

Massive anterior capsule shrinkage after plate-haptic silicone lens implantation in uveitis

Two patients, both with bilateral uveitis, had synechiolysis, continuous curvilinear capsulorhexis (CCC), phacoemulsification, and in-the-bag implantation of a foldable single-piece plate-haptic silicone intraocular lens (IOL) in 1 eye. Several weeks postoperatively, massive anterior capsule shrinkage with obstruction of the visual axis occurred in both patients. Surgical revision was performed in both eyes. Both patients had CCC and phacoemulsification and confirmed in-the-bag acrylic IOL implantation in the second eye months after surgery in the first eye. Follow-up examinations showed no significant shrinkage of the anterior capsule opening in any eye. In patients with uveitis, intraoperative lens epithelial cell removal, creation of a large CCC, and careful selection of IOL style and material may prevent occlusion of the anterior capsule opening.     

白内障撕囊直径不同对后发性白内障影响的临床研究

目的:观察连续环形撕囊口完全覆盖人工晶状体光学面与连续环形撕囊口完全不覆盖人工晶状体光学面的人工晶状体植入术后后囊膜混浊(posterior capsular opacification,PCO)的情况。方法:随访近5a来施行超声乳化吸出白内障联合人工晶状体植入手术的老年性白内障患者164例196眼,术后观察视力、撕囊口与人工晶状体光学面的关系及PCO等情况,随访12~26(平均16.3)mo。根据Sellman等的PCO分级标准进行分级:I级为没有PCO或极轻微PCO不减少红光反射,也没有珍珠样小体或IOL边缘也没有发现珍珠样小体;Ⅱ级为轻度PCO减少了红光反射,IOL边缘也没有发现珍珠样小体;Ⅲ级为在IOL区域内发现中度纤维化或珍珠样小体,但视轴(中心3mm)是透明的;Ⅳ级为重度纤维化或珍珠样小体并扩展到视轴区,并且严重减少红光反射。术后后囊膜出现Ⅱ,Ⅲ及Ⅳ级统计为临床出现后发性白内障的并发症病例。结果:后发性白内障是现代白内障摘除手术后晚期常见的并发症之一,连续环形撕囊口完全覆盖人工晶状体光学面组120眼中,发生后发性白内障42眼(35.0%)。连续环形撕囊口完全不覆盖人工晶状体光学面组76眼中,发生后发性白内障41眼(53.9%)。两组病例术后在临床后发性白内障发生率上有统计意义(P<0.05)。结论:连续环形撕囊口大小与术后后囊膜的混浊有关。撕囊口完全覆盖人工晶状体光学面能减少后发性白内障发生的几率。     

Capsular bag opacification after experimental implantation of a new accommodating intraocular lens in rabbit eyes

PURPOSE: To evaluate the development of capsular bag opacification in rabbit eyes after implantation of an intraocular lens (IOL) designed to minimize contact between the anterior capsule and the IOL and ensure expansion of the capsular bag. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ten New Zealand white rabbits had a study IOL (new accommodating silicone IOL [Synchrony, Visiogen, Inc.]) implanted in 1 eye and a control IOL (1-piece plate silicone IOL with large fixation holes) implanted in the other eye. Intraocular lens position, anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. Anterior capsule opacification and PCO were graded on a 0 to 4 scale after the eyes were enucleated (Miyake-Apple posterior and anterior views after excision of the cornea and iris). The eyes were also evaluated histopathologically. RESULTS: The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Postoperative IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group. CONCLUSIONS: The special design features associated with the study IOL appeared to help prevent PCO. Complications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes.     

两种AcrySof折叠式人工晶体植入后囊膜混浊的临床研究

目的：观察两种设计不同的AcrySof丙烯酸酯折叠式人工晶体(intraocular lens,IOL)对晶状体后囊膜混浊(posterior capsule opacification,PCO)的影响。方法：114例(114只眼)随机分为两组(1)试验组：59例(59眼)，植入一体式AcrySof折叠式IOL。(2)对照组：55例(55眼)，植入三体式AcrySof折叠式IOL。术后半年散大瞳孔观察Soemmering环和PCD情况。结果：瞳孔区PCD，试验组4只眼(6．8％)，混浊多为轻微皱褶。对照组11只限(20％)，试验组PCD明显少于对照组，差异有显著意义(P＜0．05)。两组术后Soemmering环边界均清晰而试验组更加明显，且撵周也形成明显的细胞增殖区。结论：一体式AcrySof折叠IOL具有独特设计的襻使晶状体后囊膜皱褶大为减少，远期PCO明显下降。     

Akreos Adapt人工晶状体十字形袋／沟固定法在后囊大破孔时的应用

目的 观察Akreos Adapt亲水性丙烯酸酯折叠式人工晶状体（IOL）十字形袋/沟固定法植入在外伤后或白内障术中出现的后囊大破孔时应用的临床效果.方法 对31例（31眼）后囊大破孔者采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL.随访期内观察其术后视力及视觉症状、术后炎症反应、IOL位置及固定状态、囊膜混浊程度、瞳孔和眼压等情况.结果 术后所有眼视力均较术前提高,最佳矫正视力0.1～0.2者4眼,0.3～0.4者5眼,≥0.5者22眼.所有术眼的IOL均在位,基本居中、无移位,视轴透明,未见严重的术后炎症反应或IOL相关并发症,瞳孔及眼压正常.结论 在后囊大破孔但连续环形撕囊完整时可采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL,该法简便、快捷、安全,植入后IOL位置稳定居中,并有良好的生物相容性和眼内稳定性.     

不同丙烯酸材料的人工晶状体对后发性白内障的影响

目的 探讨三种不同的丙烯酸材料的人工晶状体应用于白内障超声乳化吸除联合人工晶状体植入术后对后发性白内障的影响作用.方法 超声乳化白内障吸除联合人工晶状体植入术的960例白内障患者(964只眼),Sensar组310只眼,Acrysof三片组332只眼,Acrysof一片组322只眼,术后定期随访18～28个月,观察视力、后发性白障的发生情况.结果 术后随访24月时,发生1级以上后囊膜混浊SensarIOL组的发生率(13.5%),明显高于Acrysof一片式IOL组及Acrysof三片式IOL组的发生率(7.5%,3.7%).经卡方检验,P值均<0.05,有显著性差异,而Acrysof三片式IOL组后囊膜混浊的发生率较Aerysof 一片式IOL组高,P<0.05.结论 AcrySof丙烯酸式一片式人工晶状体植入后出现后发性白内障的发生率在三组中最低.可以减少后发性白内障的发生降低Nd:YAG激光的使用率,提高手术效果,是现代白内障手术可选择的理想的人工晶状体.