Inverse horse-shoe technique for the phacoemulsification of posterior polar cataract

Objective: To study a new technique of controlled hydrodelineation followed by viscodelineation and viscodissection during phacoemulsification in eyes with posterior polar cataracts and to report its effectiveness in preserving the posterior capsule.Design: Prospective interventional study.Participants: Twenty-eight eyes of 22 patients with posterior polar cataracts.Methods: All patients underwent phacoemulsification under topical anaesthesia with controlled hydrodelineation, viscodelineation, and viscodissection with minimal stress on the posterior capsule. Hydrodissection was not done. The preoperative complications and visual outcome were recorded.Results: The mean follow-up time was 8 months (range 2-24 months). Posterior capsule rupture occurred only in 2 eyes (7.1%); neither of the 2 had any vitreous prolapse, so anteriorvitrectomy was not required. Mean visual acuity improved significantly after surgery (p = 0.0001, paired t test). The causes of the low postoperative visual acuity were amblyopia in 3 eyes (10.7%) and age-related macular degeneration in 1 (3.6%).Conclusions: This inverse horse-shoe technique of controlled viscodelineation and viscodissection markedly reduced the risk of posterior capsule rupture. Moreover, if it occurred, the anterior vitreous face remained intact, so the IOL could be implanted in the sulcus without resorting to anterior vitrectomy.     

Approaches to a posterior polar cataract

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection – instead performing ‘inside-out’ hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.     

成人后极性白内障超声乳化吸出术疗效观察

目的探讨成人后极性白内障超声乳化摘出联合人工晶状体植入术的手术技巧、术中术后并发症的处理方法及手术效果。方法对我院临床确诊的17例(26眼)成人后极性白内障患者行超声乳化摘出联合人工晶状体植入,观察术中后囊膜情况、术后视力、后囊膜混浊和并发症的发生情况。同时与我院同期普通白内障超声乳化术中后囊膜破裂发生率进行对比。结果 17例26眼成人后极性白内障患者术中可见后囊膜完整透明者12眼,后囊膜完整伴不同程度混浊者7眼,后囊膜中央局限性缺损者2眼,但术中未发生玻璃体溢出。术中后囊膜破裂5眼,发生率为19.23%。同期普通白内障超声乳化术中后囊破裂发生率为1.81%,二者相比差异有统计学意义(P<0.05)。成人术后视力均较术前有不同程度提高。术后9眼角膜轻度水肿,经治疗后1周内恢复透明,3眼前房纤维素样渗出,经治疗后痊愈。结论后极性白内障虽具有特殊性,后囊膜破裂发生率明显高于普通白内障。只要给予足够重视,行超声乳化摘出联合人工晶状体植入术是较好的手术方法。     

现代囊外白内障摘除术中后囊破裂的临床分析

目的 探讨现代囊外白内障摘除术中后囊破裂玻璃体脱出的原因、处理方法、人工晶状体的植入及如何避免并发症以提高手术效果。方法 对1570眼现代囊外白内障摘除术中后囊破裂玻璃体脱出病例作回顾性研究。结果 术中晶状体后囊破裂185眼(占11.78％)、并发玻璃体脱出121眼(7.71％);术后早期(1周内)视力平均0.5。结论 后囊破裂可以出现在白内障超声乳化手术中的各个手术步骤,术中重视预防;及早发现后囊破裂并给予适当处理,准确判断后囊破裂的大小和方位,恰当利用残留的前后囊膜,正确处理脱出的玻璃体,一期植入后房型人工晶状体仍可获得较好的效果。     

后极性白内障的超声乳化吸出术

目的探讨后极性白内障的超声乳化吸出术特殊手术方法。方法设计了不作水分离，只作水分层，囊袋上劈核，保护后极部后囊等特殊手术方法完成后极性白内障的超声乳化吸出术，避免后囊破裂导致的晶状体核下沉、玻璃体脱失等手术并发症。结果明显降低了后极性白内障术中并发症。结论作者设计的特殊手术方法减少了后极性白内障超声乳化吸出术手术风险，具有一定优越性。     

白内障手术晶状体后囊破裂的临床分析

目的 通过回顾性分析在白内障手术中发生晶状体后囊破裂的病例,探讨晶状体后囊破裂的处理方法,人工晶状体的植入与否同患者预后的关系.方法 收集2001年1月至2004年12月在新加坡国立眼科中心(SNEC)行白内障手术发生晶状体后囊破裂的病例.结果 白内障术后一月,最终随访视力与术前视力相比有统计学意义(P＜0.01),植入前房型人工晶状体术后一月及最终随访的视力与植入后房型人工晶状体病例相比有统计学意义(P＜0.01),有并发症与无并发症的病例术后一月及最终随访的视力相比有统计学意义(P＜0.01).结论 掌握晶状体后囊破裂的高危因素,可以尽可能的避免晶状体后囊破裂的发生,及时发现并选择恰当的处理方法,可以最大限度的避免术后并发症的发生,提高患者的术后视力.     

Management of Posterior Capsule Tears

Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large.     

25G经结膜无缝合玻璃体切割术系统在先天性白内障中的应用

目的 评价25G经结膜无缝合玻璃体切割手术系统(TSV25G)治疗先天性白内障手术中应用的临床疗效.方法 回顾分析20例29只眼(2～12岁)行超声乳化白内障吸除、TSV25G晶状体后囊膜环形切开前部玻璃体切割和一期人工晶状体植入手术治疗的先天性白内障患者的临床资料.手术后随访2个月至1年,观察术后视力以及后囊膜混浊、虹膜粘连、人工晶状体偏位等术后并发症情况.结果 20例(29只眼)术后视力明显改善,表现为明显视物追踪,视力提高.无虹膜夹持、后囊膜混浊、虹膜后粘连、继发青光眼、人工晶体偏位、黄斑囊样水肿和视网膜脱离等并发症发生.结论 行TSV25G晶体后囊膜环形切开前部玻璃体切割手术应用于先天性白内障的手术治疗,具有手术时间短、创伤小、术后恢复快等优点,能有效抑制后发障发生,有助于视功能的恢复.     

Posterior polar cataract: Hydrodissection and nucleus rotation in manual small-incision cataract surgery not a taboo with proper fluidics

A posterior polar cataract is a discoid posterior polar plaque-like cataract with a thin and fragile to absent posterior capsule with adherent acellular opacity to the capsule reported in the literature. It is a stationary or slowly progressive opacity. A higher risk of complications such as posterior capsular tear and nucleus drop makes this a challenging surgery. The techniques described in the literature include bimanual irrigation aspiration, leaving the plaque for later Yag, bimanual micro phaco, Lambda technique with dry aspiration, Phaco if opacity <4 mm and soft nucleus, pars plana vitrectomy (PPV), pars plana lensectomy (PPL) if opacity >4 mm and soft nucleus, intra-capsular cataract extraction (ICCE) and scleral fixated intraocular lens (IOL) if opacity >4 mm with the hard nucleus, viscodissection, 3 ports PPL, PPV, low parameters phaco, modified epinucleus removal, inverse horse-shoe technique, standard phacoemulsification, chip and flip for soft cataracts, stop and chop for hard cataracts, layer-by-layer phacoemulsification, standard lens aspiration, pars plicata posterior vitrecto-rhexis, manual small-incision cataract surgery, and conventional extracapsular extraction. A posterior capsule rupture rate of 0 to 36% is reported in different series for cataract extraction. To prevent this dreaded complication, surgeons used many modifications. Minimal hydrodissection in posterior polar cataract extraction was described by Fine et al. The authors describe a technique of low flow manual small-incision cataract surgery with minimal hydrodissection and nucleus rotation with no associated posterior capsule rent. This demonstrates that if the fluidics is understood and corrected, then minimal hydrodissection and nucleus rotation is not taboo in posterior polar cataract extraction by manual small-incision cataract surgery.     

后囊连续环形撕囊在儿童白内障手术中的应用

目的 探讨后囊连续环形撕囊术在儿童白内障手术临床应用的价值。方法 在儿童白内障手术中采用后囊连续环形撕囊40例52眼，随访观察10-30月。结果 术后视力在0．8以上者12眼占23．1％，0．4～0．7者22眼占42．3％，0．1～0．3者10眼占19．2％，0．1以下8眼占15．4％。术中并发症主要有玻璃体脱出12眼占23．1％，术后并发症主要有前房渗出及瞳孔机化膜形成18眼占34．6％。全部病例周边后囊均有不同程度浑浊，但视轴区清晰。未出现人工晶状体移位或角膜水肿等严重并发症。结论 后囊连续环形撕囊术是降低儿童的白内障手术后后囊浑浊的一种安全、简便而效的方法。     

儿童白内障手术并发症的研究进展

儿童白内障手术步骤较多,儿童眼的解剖学特点及白内障的不同状态常常需要变更手术操作技术,术中、术后并发症较成人多,术后随访观察须严密,视力重建需要家长的长期配合与付出,这些都使儿童白内障的治疗具有挑战性.近年来,儿童白内障手术并发症的研究领域有了以下更新:23G及25G玻璃体切割机用于儿童白内障手术,使儿童白内障摘出术实现无缝线;多中心、前瞻性随机对照研究——美国婴儿无晶状体眼的治疗项目(IATS)的近期、中期研究结果已经逐步报道;大样本、远期观察的回顾性研究对儿童白内障术后眼内出血、眼内炎、青光眼相关不良事件、视轴再混浊、视网膜脱离等并发症及其结局都有了新的认识.本文回顾近年相关文献,就儿童白内障术中、术后并发症进行综述,帮助临床医师进一步理解和重视儿童白内障手术并发症及其防范、随访及处理.     

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。     

老年性白内障超声乳化吸后囊环形撕开联合人工晶状体植入术临床观察

目的 观察老年性白内障超声乳化吸除后囊环形撕开联合人工晶状体植入术的临床疗效.方法 选取2010年1月至2010年4月在我院门诊和病房行老年性白内障超声乳化手术的患者30例(60只眼),均为双眼白内障患者,除外高血压、糖尿病、高度近视、晶状体脱位以及半脱位,青光眼以及囊膜剥脱的患者.年龄在52～90岁,男32例,女28例.患者一眼行后囊撕开、另一眼行不撕开手术,植入同种人工晶状体.手术后随访1年.结果 术后矫正视力0.1～0.3者10只眼,0.3～0.6者36只眼,0.6以上者14只眼,无视网膜脱离发生,黄斑囊样水肿患者为3.3%.两组无明显差异.所有术眼无人工晶状体脱位,轻度偏位的发生率为6%.结论 老年性白内障超声乳化手术后囊环形撕开联合人工晶状体植入,是一种安全有效的手术技术,可以有效防止后囊浑浊,远期手术并发症少,黄斑囊样水肿和视网膜脱离的发病率与常规白内障超声乳化手术无统计学差异.     

后极性白内障超声乳化手术临床观察

目的探讨后极性白内障超声乳化手术的特点,探讨如何避免和减少手术中后囊膜破裂等并发症。方法回顾性病例研究。分析13例（23眼）后极性白内障超声乳化手术的手术操作、超声乳化仪的参数设置、后囊膜破裂的发生情况、并发症的处理及手术效果。结果23眼中,后囊膜破裂7眼,其中,后极部混浊斑和后囊膜分离时后囊膜破裂4例,前房波动时后囊膜破裂2眼,后囊膜抛光时后囊膜破裂1眼。行前部玻璃体切割3眼,皮质沉入玻璃体腔的1眼行后段玻璃体切割。结论后囊膜破裂可以发生在后极性白内障超声乳化手术的任何阶段,吸除后极部混浊斑时最易发生后囊膜破裂,手术中保持前房稳定和减少对后囊膜的牵拉,最后处理后极部混浊斑,可以避免和减少后囊膜破裂的发生。     

Clinical outcomes of surgical techniques in congenital cataracts

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or = 0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.     

高度近视眼白内障术中Ⅰ期后囊膜连续环形撕除术

目的 探讨I期后囊膜连续环形撕除术(Posterior continuous curvilinear capsulorhexis,PCCC)对高度近视眼白内障术后后发障的预防作用.方法 对203例(211只眼)高度近视眼白内障行白内障超声乳化及人工晶状体植入术,其中70只眼术中行连续环形撕除后囊(A组),植入普通聚甲基丙烯酸甲酯(PMMA)人工晶状体;非PCCC组138只眼进一步分为普通PMMA人工晶状体组(B组)73只眼,光学部边缘直角设计的折叠人工晶状体组(C组)68只眼.B组和C组单纯行白内障超声乳化及人工晶状体植入术,保留完整后囊膜.所有患眼术后随访2年以上,观察术后后发障、视网膜脱离等并发症情况. 结果 A组2只眼(2.86%)发生了后发障,B组为18只眼(24.66%),C组8只眼(11.76%),两两对比差异显著具有统计学意义(P＜0.05);A组和C组无视网膜脱离发生,B组仅1只眼发生视网膜脱离. 结论 I期后囊膜连续环形撕除术安全有效,明显减少了高度近视眼白内障术后后发障的发生.     

Surgical approaches to posterior polar cataract: a review

The aim of this study is to provide a comprehensive overview of surgical methods used in the emulsification of posterior polar cataracts (PPCs) that have been devised to minimize the risk of posterior capsule rupture (PCR) and its consequences. A Pubmed and Medline search of relevant literature on PPC was done. Only articles relevant to the treatment of PPC were included. The posterior capsule in eyes with PPC are known to have an abnormal adhesion to the polar opacity or a pre-existing weakness of the capsule that predisposes the eye to PCR. To circumvent the consequences of cleaving the abnormal adhesion, a majority of the surgeons use the anterior approach through the limbus, whereas some advocate the posterior approach through the pars plana. Emulsifying the nucleus and cleaving the central opacity of the PPC off the posterior capsule without disrupting its integrity provides optimal surgical outcomes. To achieve this, various modifications have been applied by surgeons during different phases of surgery. The advantages, disadvantages, complications, and results of each method have been discussed. Phacoemulsification is the preferred technique for removing PPC. This review will provide methods to avoid and /or deal with intraocular surgical difficulties that can arise during emulsification. Employing these would result in least ocular morbidity and satisfactory visual outcomes for the patient. This is particularly relevant given the major advancements in technology and refinements in surgical techniques in phacoemulsification.     

白内障术中后囊膜破裂行后囊膜连续曲线形撕囊术

目的：讨论白内障囊外摘除、超声乳化摘除及针吸摘除术中后囊膜破裂时行后囊膜连续曲线形撕囊术（ｐｏｓｔｅｒｉｏｒ ｃｏｎｔｉｎｕｏｕｓ ｃｕｒｖｉｌｉｎｅａｒ ｃａｐｓｕｌｏｒｈｅｘｉｓ,ＰＣＣＣ）的方法和作用。方法：利用撕囊镊对１０例（１０眼）白内障摘除术中后囊膜破裂眼行ＰＣＣＣ,５例联合行前段玻璃体切除术。结果：１０例后囊膜破裂后行ＰＣＣＣ眼９例成功完成ＰＣＣＣ,１ 均植入后房人工晶体。术后观察１月～３年（平均１６月）,９例行ＰＣＣＣ眼视轴均清晰,未发生视网脱离及后发性白内障,无明显的人工晶体光学部偏中心或人工晶体异位。结论：ＰＣＣＣ可有效避免后囊膜破孔进一步无限放射状撕裂,保持周边后囊膜的完整性。使人工晶体稳固于囊袋内。     

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。     

手法小切口白内障摘除术中后囊膜破裂的原因及处理

目的探讨手法小切口白内障摘除术中后囊膜破裂的原因以及术中的处理方法。方法对22例22眼手法小切口白内障摘除术中后囊膜破裂的原因及处理方法进行回顾性总结。结果发生后囊膜破裂22例22眼,除1例未植入人工晶体外,一期植入人工晶体21例,占95.45%,术后视力0.5以上8眼,无严重并发症发生。结论手法小切口白内障摘除术中后囊膜破裂虽然难以避免,但只要处理措施得当,完全可以取得满意的手术效果,避免严重并发症的发生,并使患者获得良好的视功能。