小切口非超声乳化白内障摘除人工晶状体植入术的临床分析

目的:探讨小切口非超声乳化白内障摘除及人工晶状体植入术的临床疗效。方法:老年性白内障285例285眼行小切口非超声乳化白内障摘除及人工晶状体植入术,术前充分散瞳,在手术显微镜下完成手术,对术中、术后情况进行观察。结果:术后视力都有不同程度的提高。术后1d裸眼视力>0.3者265眼(93.0%),≥0.5者245眼(86.0%)。结论:小切口非超声乳化白内障摘除术有切口愈合快、术后反应小、减少术后散光,易于防止和处理术中发生的暴发性脉络膜上腔出血,其并发症少等优点。     

A prospective study of cystoid macular edema after neodymium: YAG laser posterior capsulotomy

To establish the clinical and angiographic incidence of cystoid macular edema (CME) after neodymium:YAG (Nd:YAG) laser capsulotomy, the authors have prospectively studied 136 patients who underwent Nd:YAG laser discission for secondary opacification of the posterior capsule after extracapsular cataract extraction. In all patients, fluorescein angiography was obtained before the laser discission. Of the 136 patients, 78 (57%) were followed for at least 6 months, and fluorescein angiography was repeated 4 to 8 weeks after the procedure. CME did not develop in any of the patients in this series.     

Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota

PURPOSE: To estimate the cumulative probability of Nd:YAG laser posterior capsulotomy after cataract extraction in a geographically defined population. METHODS: Rochester Epidemiology Project databases were used to identify retrospectively all Nd:YAG laser posterior capsulotomies performed on Olmsted County, Minnesota, residents who had previously undergone cataract extraction between 1988 and 1996, inclusive. Demographic data and potential risk factors for laser, including age, sex, surgical technique, year of surgery, and intraocular lens material, were obtained by chart review or by retrieval from computer databases. The cumulative probability of Nd:YAG laser posterior capsulotomy was calculated by Kaplan-Meier estimates, and risk factors were analyzed using the Cox proportional hazards model. RESULTS: A total of 925 Nd:YAG laser posterior capsulotomies were identified after 3541 cataract extractions in 2718 patients. The cumulative probability of Nd:YAG laser posterior capsulotomy after cataract surgery was 6% (95% confidence interval = 5% to 7%) at 1 year, increasing to 38% (35% to 40%) at 9 years. Young age at the time of surgery (P =.02), polymethylmethacrylate intraocular lens material (P <.001), earlier year of surgery (P <.001), and extracapsular extraction (in comparison with phacoemulsification, P <.001) were found to increase significantly the risk of subsequent Nd:YAG laser posterior capsulotomy. Women tended to have a greater probability of Nd:YAG laser posterior capsulotomy (P =.17), but this difference was not statistically significant. CONCLUSIONS: Nd:YAG laser posterior capsulotomy was common after cataract surgery but infrequent during the first postoperative year. Prolonged follow-up is necessary in investigations of the effects of new cataract surgery technologies on the probability of capsulotomy.     

无缝线巩膜隧道小切口及前房维持器在白内障摘出人工晶状体植入术中的应用

目的探讨无缝线巩膜隧道小切口联合前房维持器在白内障手术中的临床应用价值。方法对112例（127只眼）白内障行无缝线巩膜隧道小切口白内障囊外摘出术中使用前房维持器维持灌注,并植入后房型人工晶状体。结果无一眼因眼压波动而造成术中严重的并发症,术后第1天裸眼视力0.3～0.9者72只眼,占56.69%,第3天≥0.3者89只眼,占70.07%,≥1.0者32只眼,占25.19%。结论无缝线巩膜隧道小切口联合前房维持器在白内障手术中具有简化手术操作,减小手术并发症,使手术更安全。     

Extracapsular cataract extraction with intraocular lens implantation after scleral buckling surgery

We reviewed the records of 28 patients who had undergone successful scleral buckling surgery followed by extracapsular cataract extraction with implantation of an intraocular lens. Posterior chamber intraocular lenses were inserted in 27 eyes, and anterior chamber intraocular lenses were inserted in two eyes with posterior capsule rupture at the time of surgery. The mean follow-up period was 44 months. Final visual acuity was 20/40 or better in 15 of 29 eyes (52%). One eye (3.4%) developed a recurrent retinal detachment 15 months after cataract surgery. Two eyes (6.9%) developed angiographically proven cystoid macular edema. The outcome for extracapsular cataract extraction with intraocular lens implantation in eyes that had previously undergone successful scleral buckling for retinal detachment is favorable.     

Effect of cataract surgery on intraocular pressure reduction obtained with laser trabeculoplasty

Thirty-nine eyes of 34 patients with open-angle glaucoma who had been treated successfully with argon laser trabeculoplasty underwent either extracapsular cataract extraction with posterior chamber intraocular lens implantation or intracapsular cataract extraction without lens implantation. Cataract surgery did not have a significant effect on the magnitude of intraocular pressure reduction obtained with laser trabeculoplasty. This study supports the view that eyes with coexisting cataract and glaucoma may benefit from laser trabeculoplasty before cataract surgery.     

Histological characteristics of ocular structures after YAG-laser exposure of various sections of the crystalline lens in experimental studies]

This work was aimed at analysis of all the aspects, pathomorphologic included, of short-pulsed YAG laser exposure of the lens. Experiments were carried out with 79 rabbit eyes. After laser exposure the eyes were enucleated in 1-24 h and in 7-10 days. Thirty-one eyes were subjected to YAG laser ++capsule puncture. Fragmentation of intracapsular structures was carried out in 23 eyes. Combined operations were performed on 25 eyes. Every series comprised two groups, differing by the energy of laser exposure: 3-5 mJ. Histologic analysis has lead the authors to the following conclusions. The pattern and severity of pathomorphologic changes were directly related to the energy and time of laser exposure and site of the focal plane of irradiation. The major destructive shifts after YAG laser fragmentation of the cortical layer and capsulotomy are focussed at the site of exposure and involve the adjacent sections of the lens. Laser exposure of 3-5 mJ may be used to open the anterior capsule of the lens and to facilitate the cataract mass discharge in extracapsular cataract extraction. Use of combined method helps enhance induration and fragmentation of the cortical layers of the lens, rules out surgical discission of the anterior capsule of the lens, and facilitates removal of the nucleus and wash out of the lens mass.     

Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course

BACKGROUND: A training course for cataract surgery with intraocular lens implantation was organised in April 1997 at the National Eye Centre, Kaduna, Nigeria. Operations were performed by six Nigerian consultant ophthalmologists under the supervision of two surgeons from Aravind Eye Hospital, India. METHODS: A total of 175 eyes with uncomplicated cataracts were operated on after careful selection. All but six patients had extracapsular cataract extraction with posterior chamber intraocular lens insertion during the training programme. RESULTS: The mean age of the patients at operation was 54. 2 years. One hundred and forty five of the operated eyes (85.8%) were blind before surgery of which six (3.6%) remained blind postoperatively. An uncorrected visual acuity of 6/60 or better was achieved in 87.3% eyes after surgery. Forty one patients (24.3%) were blind before surgery, two of whom (1.2%) remained blind afterwards. The most common intraoperative complication was posterior capsular rent which occurred in 10 eyes (5.7%); striate keratopathy/corneal oedema and cortical remnant were the most common immediate postoperative complications, occurring in 44.6% and 8.0%, respectively. CONCLUSION: With adequate surgical skills, extracapsular cataract extraction with posterior chamber intraocular lens implantation offers good visual rehabilitation even under training conditions.     

影响白内障人工晶体术后远期视力因素分析

目的 分析总结影响现代晶体囊外 除联合人工晶体植入术术后远期视力的因素与手术操作的关系。方法 对７０眼行现代晶体囊外摘除联合人工晶体植入术口才进行术后一年后的随访,排除人为造成的术后近视,排除用于不镜矫正视力达１．０患者,共有４７例（５８眼）。结果 影响视力因素主要为散光５２眼,占８２．８％;后发障２１眼,占３０％;人工晶体表面膜３眼,占４．２％;视网膜病变３眼,占４．２％;角膜混浊２眼,占２．８     

葡萄膜炎并发白内障的人工晶状体植入术

目的 探讨葡萄膜炎并发白内障人工晶状体植入的手术时机、方法和疗效。方法 对３６例（３８眼）葡萄膜炎并发白内障囊外摘出的同时植入后房型人工晶状体。平均随访１８月（１６～３０月）。结果 ７８．９％的患者术后矫正视力达０．５以上,术后并发症包括晶状体后囊浑浊与虹膜后粘连。结论 对葡萄膜炎并发白内障囊外摘出联合后房型人工晶状体植入术是可行的。但应有选择地进行,以减少手术并发症的发生。     

Results of neodymium:YAG laser posterior capsulotomy following penetrating keratoplasty

Fifty-six eyes which had a triple procedure (penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation) were evaluated for the incidence, results, and complications of neodymium:YAG laser posterior capsulotomy. Ten of the 56 eyes (17.8%) required YAG laser posterior capsulotomy. Overall, nine of the ten eyes (90.0%) improved their visual acuity one Snellen line or more. Lens pitting (one case) and bleeding (one case) were complications of the laser treatment. The addition of the corneal transplant does not appear to alter the results of the YAG laser posterior capsulotomy, nor does it jeopardize the success of the corneal transplant.     

青光眼术后经颞侧行小切口白内障手术

目的:探讨表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术效果。方法:对32例40眼青光眼小梁切除术后的白内障患者用倍诺喜表面麻醉联合球结膜下注射20g/L利多卡因麻醉,行改良小切口白内障囊外摘出联合后房型人工晶状体植入术,分析手术的麻醉效果及手术后的治疗效果。结果:全部患眼均能达到理想的麻醉镇痛效果,顺利完成手术,术后视力<0.1者5眼(12.5%),视力0.1～0.4者9眼(22.5%),术后视力≥0.5者26眼(65.0%),所有患眼术后视力与术前比较均有提高。结论:表面麻醉联合球结膜下麻醉经颞侧施行小切口白内障囊外摘出人工晶状体植入手术,是治疗青光眼小梁切除术后白内障有效的手术方式,手术操作简便,不需要昂贵的手术设备,适用于基层医院开展。     

手术治疗糖尿病性白内障60眼临床分析

目的:分析小切口白内障囊外摘出人工晶状体植入术和超声乳化白内障吸除人工晶状体植入术治疗糖尿病性白内障的疗效及并发症。方法:选择2006-01/2010-01确诊为糖尿病性白内障患者52例60眼,Ⅱ～Ⅲ级核47眼,采用超声乳化白内障吸除后房型人工晶状体植入术;Ⅳ～Ⅴ级核13眼,采用小切口白内障囊外摘出后房型人工晶状体植入术。结果:糖尿病患者52例60眼白内障术后视力均有不同程度的提高,其中50眼(83%)术后1wk裸眼视力≥0.4。术中术后主要并发症经处理对术后视力无影响。结论:对糖尿病性白内障患者采取恰当的术式,施行小切口白内障囊外摘出人工晶状体植入术或超声乳化白内障吸除人工晶状体植入术疗效肯定。     

Anterior hyaloid face opacification after pediatric Nd:YAG laser capsulotomy.

PURPOSE: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population. METHODS: A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. RESULTS: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment. CONCLUSIONS: In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.     

Pupillary block following posterior chamber intraocular lens implantation in adults

BACKGROUND: Pupillary block rarely occurs after cataract extraction with posterior chamber intraocular lens implantation. METHODS: A series of six patients (seven eyes) treated for pupillary block after posterior chamber intraocular lens implantation between 1990 and 2001 is described; in one eye, the attack occurred after phacoemulsification. RESULTS: The interval between pupillary block development and the cataract surgery ranged from 1 day to 5 years. In all eyes, treatment consisted of neodymium-YAG laser peripheral iridotomy. In four eyes, the laser peripheral iridotomy relieved the block (one procedure in two; two to three procedures in two). One patient was also treated with YAG capsulotomy, and two patients needed additional surgical intervention. CONCLUSION: Despite the rarity of the complication of pupillary block after posterior chamber intraocular lens implantation, physicians should be aware of the sometimes difficult course of recovery after treatment.     

后囊膜混浊的Nd:YAG激光治疗

目的：探讨Nd:YAG激光后囊膜切开的方法，疗效及并发症。方法：回顾性分析了108例112只眼用Nd:YAG激光切开混浊后囊膜的病例，并记录了视力，眼压的变化和并发症的发生情况，结果；所有病例都成功切开后囊膜，视力提高，裸眼平均视力由术前0.2增加到术后0.5，平均矫正视力达到0.7,30.3%的眼内人工晶状体出现激光损伤斑，无人工晶状体移位；眼压出现一过性升高；随访中发现2例视网膜脱离，结论：Nd:YAG激光后囊膜切开操作容易，安全，疗效好，并发症少。     

Cataract surgery in patients with Behçet's disease

PURPOSE: To evaluate the outcomes and complications of cataract surgery in patients with Beh?et's disease. SETTING: Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey. METHODS: Thirty-three eyes of 26 patients with Beh?et's disease that had extracapsular cataract surgery between January 1993 and July 1999 were analyzed retrospectively. The mean age of the patients was 38.9 years (range 20 to 54 years). The mean postoperative follow-up was 22.9 months (range 6 to 66 months). RESULTS: Extracapsular cataract extraction (ECCE) was performed in 22 eyes with and in 6 eyes without intraocular lens (IOL) implantation. Phacoemulsification with IOL implantation was performed in 5 eyes. Postoperatively, the visual acuity was better in 29 eyes (87.8%) and was 0.5 or better in 14 eyes (42.4%). Posterior segment complications of Beh?et's disease, mainly optic atrophy and macular alterations from preoperative inflammatory episodes, restricted final acuity. No significant difference was detected in postoperative inflammation among the types of surgery; that is, ECCE, ECCE with IOL implantation, and phacoemulsification with IOL implantation. A neodymium:YAG laser posterior capsulotomy was performed in 3 cases. CONCLUSIONS: In patients with Beh?et's disease, inflammation after extracapsular surgery was mild when surgery was performed after at least 3 months of no inflammatory signs. The results show that the outcomes of extracapsular cataract surgery mainly depend on the degree of preoperative posterior segment involvement.     

Combined cataract extraction and guarded sclerectomy. Reevaluation in the extracapsular era

Thirty-four eyes of 25 patients underwent a guarded sclerectomy in combination with either an intracapsular or extracapsular cataract extraction. The intraocular pressure was well-controlled in the early postoperative period in all but one case, and only one eye developed a flat anterior chamber that required surgical reformation. However, there was a high incidence of intraoperative and postoperative complications in both the intracapsular and extracapsular groups. These observations, as well as experience with extracapsular cataract extraction and posterior chamber lens implantation alone in glaucomatous eyes, have led to a reevaluation of the criteria for combined cataract and glaucoma surgery.     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

The madurai intraocular lens study IV: posterior capsule opacification

PURPOSE: To estimate the cumulative incidence of posterior capsule opacification 4 years after surgery in patients who participated in the Madurai Intraocular Lens Study and had extracapsular cataract extraction with posterior chamber intraocular lens implantation. METHODS: In the Madurai Intraocular Lens Study, 1,700 patients with best-corrected visual acuity 20/120 or worse in the better eye had extracapsular cataract extraction with posterior chamber intraocular lens implantation, and 1,474 (86.7%) of these completed the 1-year follow-up examination. From this group of 1,474 pseudophakic patients, 400 were randomly selected for reexamination 4 years after the original surgery. The eye that was operated on was examined by an ophthalmologist who was involved in the 1-year follow-up examinations and posterior capsule opacification grading. A grading of I to III was used to reflect the degree of opacification. With grades II and III, posterior capsule opacification detectable with an undilated pupil was present in the central axis. RESULTS: Three hundred twenty-seven (81.8%) of the selected population were examined between October 1997 and December 1998. Thirty-four (8.5%) were confirmed as being deceased, and 39 (9.8%) were unavailable for follow-up. The median age was 60 years, and 57.2% were women. The 4-year incidence of grade II or III posterior capsule opacification, including eyes already treated with laser capsulotomy, was 13.1% (95% confidence interval [CI], 9.7% to 17.3%). Each year of increased age was associated with a decreased risk of posterior capsule opacification (odds ratio, 0.96; 95% CI, 0.92 to 1.00). Based on best-corrected visual acuity of 20/40 or worse without co-existing pathology, the 4-year incidence of posterior capsule opacification was 13.5%. CONCLUSION: Because patients with relatively mature cataracts routinely receive extracapsular cataract extraction with posterior chamber intraocular lens implantation instead of the traditional intracapsular extraction, the subsequent need for laser capsulotomy may be less than that anticipated, based on previous reports.