虹膜后固定虹膜夹持型人工晶状体在无晶状体眼中的应用

目的 观察虹膜后固定植入的ARTISAN虹膜夹持型人工晶状体在无晶状体眼中的临床应用效果.方法 回顾性分析2010年1月至2011年4月间,在16例16只眼无后囊膜支持的无晶状体眼患者中,通过虹膜后同定植入ARTISAN虹膜夹持型人工晶状体,观察其术后视力、角膜内皮细胞密度、眼压等的变化.结果 16例患者术前最佳矫正视力为0.46±0.19,术后裸眼视力为0.50±0.20,差异有统计学意义(P＜0.05).16例患者术前角膜内皮细胞密度计数为(1914±151)个/mm2,术后1年为(1835±145)个/mm2,平均角膜内皮细胞丢失率4.1％.眼压未见明显改变.l例患者出现眩光不适症状.未见人工晶状体脱位等其他并发症.结论 虹膜后固定虹膜夹持型人工晶状体的手术方式简单,术后视觉质量恢复好,并发症少,是目前治疗无后囊膜支持的无晶状体眼比较好的治疗方法.     

虹膜夹型人工晶状体虹膜后植入术25例

目的 评价虹膜夹型人工晶状体虹膜后植入治疗无后囊膜或后囊膜不足以支撑的无晶状体眼临床疗效.方法 选用虹膜夹型人工晶状体,对无后囊膜或后囊膜不足以支撑人工晶状体的患者25例(25眼)行人工晶状体虹膜后植入术.术后随访3个月,观察术后视力、角膜内皮细胞计数、前房深度、眼压、人工晶状体位置及并发症情况.结果 术后3个月平均裸眼视力0.5±0.2,优于术前最佳矫正视力0.3±0.1,差异有统计学意义(P<0.05),18眼(72%)裸眼视力优于术前最佳矫正视力;术后角膜内皮细胞计数、前房深度和眼压与术前相比差异均无统计学意义(P均>0.05);人工晶状体位置保持良好的居中性,未发生视网膜脱离等并发症.结论 虹膜夹型人工晶状体虹膜后植入术是一种矫正无后囊膜或后囊膜不足以支撑人工晶状体的无晶状体眼安全、有效的术式.     

虹膜夹持型人工晶状体矫治高度近视的临床应用

目的:探讨有晶状体眼Verisyse/Artisan虹膜夹持型人工晶状体植入矫治高度近视手术的安全性、有效性和可预测性。方法:收集有晶状体眼Verisyse/Artisan虹膜夹持型人工晶状体植入矫治高度近视58例112眼,记录术前;术后3,6,12mo的裸眼视力、最佳矫正视力、屈光度、角膜内皮细胞计数、眼压的变化。结果:术后3mo全部患者裸眼视力≥0.5,术后6mo最佳矫正视力≥0.8占72.3%,98%眼残余屈光度与目标屈光度相差±1.00D以内,术后3,6,12mo患者的等值有效球镜、散光度数与术前相比有统计学意义(P<0.05),眼压与术前相比无统计学意义(P>0.05),角膜内皮细胞有进行性的丢失,但术后3,6mo的角膜内皮细胞计数与术前相比无统计学意义(P>0.05)。无任何一眼发生青光眼、白内障和角膜内皮的失代偿等严重并发症。结论:Verisyse/Artisan有晶状体眼虹膜夹持型人工晶状体植入矫治高度近视安全、有效、稳定、可预测性强,术后视觉满意度高,未出现严重的并发症,但远期手术效果还需长期临床观察。     

虹膜夹固定型前房人工晶状体植入术治疗高度近视

目的:探讨虹膜夹固定型前房人工晶状体植入术治疗高度近视的疗效和安全性。方法:对7例13眼高度近视患者行虹膜夹固定型前房人工晶状体植入术。术后观察患者视力、眼压、角膜内皮细胞计数,瞳孔活动度、人工晶状体的位置及并发症。结果:患者13眼均成功植入人工晶状体。术后7d裸眼视力优于术前最佳矫正视力10眼(77%);术后12mo,裸眼平均为0.6±0.2,优于术前最佳矫正视力0.4±0.1,差异有统计学意义(P<0.05)。术后眼压和角膜内皮细胞计数与术前对比无统计学意义(均P>0.05);人工晶状体光学部分位置居中,所有患者的瞳孔对光反应均正常,所有患者无白内障、角膜内皮失代偿等并发症,有2眼于术后3～4wk出现糖皮质激素性青光眼,仅1例于术后6mo发生单眼视网膜脱离。结论:虹膜夹固定型前房人工晶状体植入术是一种矫正高度近视安全有效地手术方式。但远期效果需进一步观察。     

有晶状体眼虹膜固定型人工晶状体植入矫正高度近视的临床研究

目的探讨有晶状体眼虹膜固定型人工晶状体植入矫正高度近视的有效性、安全性和可预测性。方法对屈光度为-8.25～-28.00D的32例（53眼）高度近视患者行有晶状体眼Verisyse人工晶状体植入术。手术前、后观察患者的视力、屈光度数、眼压、角膜内皮细胞计数及并发症,术后随访时间6个月。结果53眼均成功植入Verisyse人工晶状体。术后第6个月时,患者裸眼视力≥4.7者占100%,最佳矫正视力≥4.9者占84.9%,裸眼视力和最佳矫正视力均较术前明显提高,差异具有统计学意义;90.6%患者术后屈光度在预期的±1.0D之内;眼压、角膜内皮计数与术前相比,差异均无统计学意义（P〉0.05）。手术无严重并发症发生。结论有晶状体眼虹膜固定型人工晶状体植入矫正高度近视具有较好的有效性、安全性和可预测性,无严重并发症发生,但其远期效果有待于进一步观察。     

虹膜固定型有晶状体眼人工晶状体植人术矫治高度近视29例疗效观察

目的探讨高度近视眼行虹膜固定型有晶状体眼人工晶状体植入术的安全性和有效性。方法选取在本中心接受虹膜固定型有晶状体眼人工晶状体植入术29例（54眼）。术前矫正屈光度数为-10．00～-23．00D,最佳矫正远视力0．1—0．8。术中植入虹膜固定型人工品状体,术后平均随访12个月。观察指标包括：术前及术后的裸眼视力、矫正视力、眼压、瞳孔形态及角膜内皮计数,并对获得的数据进行统计学分析。结果术后1年裸眼视力为0．2～1．0,最佳矫正远视力为0．3-1．2,和术前最佳矫正远视力相比差异有统计学意义;4例诉有眩光,3眼瞳孔轻度变形,2眼术后2d切口渗漏,无视网膜脱离、晶状体脱落或跟内炎等。结论虹膜固定型有晶状体眼人工晶状体植入术治疗高度近视安全、有效,具有良好的预测性。     

Verisyse虹膜固定型人工晶状体植入治疗高度近视的中长期疗效观察

目的:研究Verisyse虹膜固定型人工晶状体植入治疗高度近视中长期的有效性和安全性。方法:高度近视患者37例56眼植入Verisyse虹膜固定型人工晶状体,术后随访4～7a,对手术前后的裸眼和最佳矫正视力、屈光状态、眼压变化、角膜透明度及角膜内皮计数、前房、瞳孔和虹膜、自然晶状体改变及患者满意度进行观察分析。结果:所有眼术中均顺利植入Verisyse虹膜固定型人工晶状体,术后各时间点裸眼视力及最佳矫正视力均明显提高且保持稳定,各时间点角膜内皮细胞计数变化无统计学意义,随访期间无角膜内皮失代偿、顽固的色素膜炎、白内障、青光眼及视网膜脱离等严重并发症发生。结论:Verisyse虹膜固定型人工晶状体治疗高度近视是安全和有效的,能够显著提高裸眼视力及最佳矫正视力而并发症较少,对于不适合角膜手术的高度或超高度近视患者是一种比较理想的选择。     

瞳孔成形联合虹膜夹人工晶状体植入术治疗外伤性无晶状体眼疗效观察

目的 观察瞳孔成形联合虹膜夹人工晶状体植入术治疗外伤性无晶状体眼的疗效.方法 回顾性分析在我院采用瞳孔成形联合虹膜夹人工晶状体植入术治疗的外伤后无晶状体眼患者17例17眼的临床资料.观察术后视力、角膜内皮细胞计数、眼压、人工晶状体位置、瞳孔情况及术后并发症.结果 17例患者均顺利修补损伤虹膜,瞳孔成形后成功植入虹膜夹人工晶状体,未发生严重手术并发症,人工晶状体位置稳定.术后6个月裸眼视力(0.52 +0.17),较术前视力(0.04±0.02)及术前最佳矫正视力(0.44±0.13)提高.术后6个月角膜内皮细胞计数为(1993.88±127.24)个·mm-1,较术前(2178.88±132.61)个·mm-2减少(P＜0.05),但术后未发现角膜失代偿.术前眼压(15.91 ±2.73)mmHg(1 kPa=7.5 mmHg)与术后眼压(16.69±2.61) mmHg无明显差异(P＞0.05).术后瞳孔大小(4.4±0.2)mm较术前(5.5 +0.3)mm缩小(P＜0.05),患者术后无明显畏光、眩光、复视等不适症状.结论 瞳孔成形联合虹膜夹人工晶状体植入术是治疗外伤虹膜损伤并无有效晶状体囊膜支持的无晶状体眼的安全有效方法.     

有晶状体眼前房型人工晶状体植入治疗高度近视疗效观察

目的 观察有晶状体眼前房型虹膜固定人工晶状体植入治疗高度近视的临床疗效.方法 对11例(17只眼)高度近视患者进行术前虹膜YAG激光周边切除,1周后接受有晶状体眼Verisyse前房虹膜固定型人工晶状体植入手术,观察术后的裸眼视力、最好矫正视力、眼压、角膜及前房内炎症变化情况.结果 11例(17只眼)均顺利在前房内植入虹膜固定的人工晶状体,其中1只眼术后第3天发现人工晶状体单侧脱位再次手术固定.术后所有患者视力较术前均增加,裸眼≤0.5者3只眼,>0.5者14只眼.16只眼眼压术后检查正常,1只眼术后眼压升高至25 mm Hg,局部加用0.5%噻吗心胺点眼,2 d后眼压恢复正常.术后所有患者角膜透明,无内皮水肿的情况.13只眼出现前房轻度闪辉,4只眼前房可见较多的炎性细胞,用药后很快控制.结论 高度近视患者有晶状体眼前房植入虹膜固定型人工晶状体是一种较好的矫正视力方法,但其远期疗效及并发症有待进一步观察.     

虹膜夹型人工晶状体植入治疗外伤术后无晶状体眼

目的:探讨虹膜夹型人工晶状体(verisyse)植入治疗外伤术后无晶状体眼的术后视功能及并发症,以期为外伤术后无晶状体眼的术式选择、手术方法提供一些临床依据。方法:回顾2006-08/2008-07来本院住院的外伤术后无晶状体眼患者42例43眼随机纳入试验组和对照组,以虹膜夹型人工晶状体植入作为试验组,晶状体悬吊作为对照组。作术后视力、角膜内皮及并发症的比较。结果:试验组所有病例术中1次固定成功,术后裸眼视力均较术前提高,最佳矫正视力均达到或接近术前最佳矫正视力。术后少数患者出现一过性高眼压、人工晶状体光学面倾斜、偏斜、脱位、眩光等并发症,所有病例中均未出现玻璃体积血、脉络膜脱离等并发症。两组术后视力、角膜内皮细胞及并发症差异无统计学意义。结论:虹膜夹型人工晶状体植入治疗外伤术后无晶状体眼具有操作简单及安全的优点。适合于无后囊、前房深浅正常及角膜内皮正常的病例。     

无晶状体眼二期人工晶状体植入20例临床观察

目的:观察无晶状体眼二期人工晶状体植入的疗效。方法:对20例无晶状体眼的患者,采用睫状沟悬吊固定手术二期植入人工晶状体。随诊3～12mo,观察术后视力、眼压、人工晶状体位置及术中术后并发症。结果:所选20例患者术后第1d裸眼视力0.1～0.3者1例,0.4～0.5者6例,0.6～0.8者12例。眼压平均18～20mmHg。术后角膜水肿1例,经氯化钠眼药水及复方妥布霉素眼药水治疗1wk后吸收。角膜切口处水肿5例,1wk后自行吸收。结膜下出血5例,5～10d吸收。随访3～12mo,20眼手术后人工晶状体位置居中,未发现明显偏斜。无青光眼、视网膜脱离等严重的并发症。老年性白内障术后无晶状体眼的患者二期人工晶状体植入后视力恢复较理想。结论:对于白内障术后无晶状体眼患者,采用睫状沟悬吊固定手术二期植入人工晶状体,不仅获得良好的裸眼视力和矫正视力,同时可减少一系列并发症。     

Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy

PURPOSE: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV). SETTING: Shandong Eye Institute and Hospital, Qingdao, China. METHODS: This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes), or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intra- ocular pressure (IOP), endothelial cell density, IOL centration, and intraocular inflammation were monitored. RESULTS: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. Five patients had increased IOP 3 to 5 days after IOL implantation; 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mm Hg) with timolol 0.5% eyedrops. The other 2 patients had normal- appearing angles, and 1 was diagnosed with hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae; the other required vitreous washout. Retinal detachment and cystoid macular edema did not occur in any patient. CONCLUSIONS: Black diaphragm IOL implantation can be considered in eyes with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow-up and a larger study group.     

儿童人工晶状体二期植入术

目的探讨人工晶状体（IOL）二期植入术矫正儿童无晶状体眼的疗效和手术适应证。方法对37例（57眼）后囊和悬韧带完整或仅中央区后囊缺损的儿童无晶状体眼,二期植入人工晶状体,术后随访3～54个月。结果术后裸眼视力均等于或高于术前矫正视力,其中术后裸眼视力≥0．5者30眼（52．63％）,术后矫正视力≥0．5者45眼（78．95％）。并发症包括虹膜后粘连9眼（15．79％）,前房渗出物7眼（12．28％）,人工品状体偏位2眼（3．51％）。结论对于尚存完整或部分后囊支撑的无晶状体眼进行前后囊软性分离,注吸周边增生的皮质,虹膜粘连分离,后囊切开,前段玻璃体切除,再植入人工晶状体,可改善患儿视功能。     

经透明角膜切口可折叠型人工晶状体缝线固定术的临床观察

目的 探讨对囊膜不足以支撑人工晶状体（IOL）的无晶状体眼患者经透明角膜切口行可折叠IOL缝线固定术的临床疗效.方法 回顾性系列病例研究.对14例（14眼）囊膜不足以支撑IOL的无晶状体眼患者由透明角膜切口行可折叠型IOL缝线固定术,观察术中、术后并发症及术后视力情况.结果 所有患者术中未出现并发症.术后裸眼视力均较术前提高,术后最佳矫正视力较术前最佳矫正视力改善或者无变化的共13例（93％）；1例发生玻璃体少量积血,1例出现IOL光学部轻度偏斜,3例出现一过性高眼压.结论 经透明角膜切口行可折叠型IOL缝线固定术是治疗囊膜不足以支撑IOL的无晶状体眼的一种较好选择.     

Retinal detachment after cataract surgery. Surgical results.

The authors studied the results obtained by the Retina Associates in 376 eyes of 361 patients operated on for retinal detachment associated with aphakia or pseudophakia with a postoperative follow-up of at least 6 months. All eyes underwent scleral buckling. The series included 103 eyes with aphakia, 17 eyes with iris-fixated intraocular lens, 111 eyes with anterior chamber (AC) IOL, and 145 eyes with posterior chamber (PC) IOL. The overall success rate for retinal detachment was 93%, without significant difference among the different groups. The aphakia and PC IOL groups had significantly higher prevalence (63% and 60%, respectively) of visual acuity equal to or better than 20/40 compared with the AC IOL group (33%). The prevalence of postoperative corneal edema in the AC IOL group was significantly higher than in the aphakia and PC IOL groups. Preoperative vitreous hemorrhage, large retinal breaks, posterior retinal breaks, total retinal detachment, proliferative vitreoretinopathy, and the need for performing a closed vitrectomy were significant factors in predicting ultimate failure.     

Secondary Artisan-Verysise aphakic lens implantation

PURPOSE: To evaluate efficacy, predictability and safety of Artisan-Verysise intraocular lens (IOL) secondary implantation for aphakia correction. SETTING: Instituto de Microcirugía Ocular, and Autonoma University of Barcelona, Barcelona, Spain. METHODS: Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell count, and clinical complications were evaluated. Sixteen consecutive eyes of 14 patients with aphakia were submitted to surgery. Postoperative examinations were done at 6 weeks, 6 months, 1 year, and every year for at least 3 years. An iris-supported Artisan-Verysise IOL was implanted for aphakia correction. RESULTS: Thirty-six months after Artisan-Verysise lens implantation, BSCVA was 20/40 or better in 6 eyes (37.5%). Preoperatively, 5 eyes had the same BSCVA (31.25%). Mean postoperative spherical equivalent (SE) was 0.46 diopter (D). Mean endothelial cell loss was 10.9% 36 months postoperatively. The cell loss occurred predominantly during the first year (7.78%). Cystoid macular edema was observed in 2 cases, 1 of them associated with chronic unresponsive low intraocular pressure. No other serious complications were observed. CONCLUSION: Artisan-Verysise IOL implantation seems a safe, predictable, and effective option for aphakic eyes without capsule support.     

玻璃体切割术后无晶状体眼行前房灌注下Ⅱ期IOL缝线固定术

目的：探讨前房灌注下玻璃体切割术后无晶状体眼Ⅱ期人工晶状体(IOL)缝线固定术的方法及疗效。

方法：对30例30眼玻璃体切割术后6～12mo无晶状体眼的患者行前房灌注下后房人工晶状体缝线固定术,术后随访1.5a。

结果：患者30例30眼在前房灌注下,成功实施了后房缝线固定IOL植入术,术中出现睫状体出血1例,术后玻璃体出血1例,脉络膜脱离2例。所有患者术后视力均得到提高,视力≥0.3者24例(80%),其中视力≥0.5者8例(27%); 视力<0.3者6例(20%),其中视力<0.1者2例(7%)。

结论：前房灌注下行此类手术,术中眼压控制稳定,手术效果可靠,术后并发症少,是治疗玻璃体切割术后无晶状体眼、恢复视功能的可靠手术方法。     

Artisan虹膜固定型人工晶状体在无晶状体眼患者中的应用

目的 观察Artisan虹膜固定型人工晶状体（IOL）在无晶状体眼患者中的应用.方法 回顾性病例系列研究.2008年1月到2010年5月间行Artisan IOL植入术且临床资料完整的无晶状体眼患者46例（46眼）,年龄为21～56岁,平均（32.8±5.2）岁,其中男28例,女18例.所有患者均在神经阻滞麻醉下行Artisan前房虹膜固定型IOL植入,术后随访3～10个月.对手术所需时长、患者裸眼视力、最佳矫正视力、手术源性散光、瞳孔散大直径、角膜内皮计数和术后并发症等指标进行分析,对手术的疗效和安全性进行评估.手术前后裸眼视力、最佳矫正视力和眼压的比较采用配对t检验.结果 植入Artisan IOL所需手术时间平均为（19.8±6.6）min.患者裸眼视力均较术前有明显提高（0.49±0.23 vs1.21±0.22）,与目标屈光状态的差值平均为0.27 D;最佳矫正视力与术前相比无明显差异,手术源性散光为1.45 D.植入IOL后瞳孔直径最大可散至6.77 mm;角膜内皮细胞丢失率为3.6%.术后出现一过性高眼压的有4眼（8.7%）;虹膜萎缩有3眼（6.5%）;IOL脱位1眼（2.2%）.结论 Artisan虹膜固定型IOL在无晶状体眼治疗中具有较好的疗效和较高的安全性,是无晶状体眼患者理想的IOL选择之一.     

Anterior chamber iris-fixated phakic intraocular lens for anisometropic amblyopia

We report a child who had implantation of an iris-fixated Artisan phakic intraocular lens (IOL) to correct high unilateral myopia to support the therapy of anisometropic amblyopia. After IOL implantation, the patient continued occlusion therapy to further treat the amblyopic eye. One year postoperatively, the best corrected visual acuity in the amblyopic eye was 1.00 and binocular stereovision had developed. The visual acuity remained stable through 3 years of follow-up. There were no complications, although postoperative endothelial cell loss was significant.     

Correction of extreme hyperopia: artisan iris-fixated intraocular lens implantation for pseudophakia after clear lens extraction

A 22-year-old patient suffering from both-side extreme hyperopia with amblyopia was corrected with an Artisan iris-fixated intraocular lens (IOL) implantation followed to clear lens extraction (CLE) with posterior chamber (PC)-IOL implantation. The preoperative refraction values were +17.75DS -1.50DC × 168° for the right eye and +17.25DS -0.75DC × 8° for the left eye. The uncorrected visual acuity (UCVA) was 20/200 bilaterally and the spectacle-corrected visual acuity (BSCVA) was 20/50 bilaterally. One year after Artisan iris-fixated IOL implantation, bilateral BSCVA was 20/50 with a refraction of +1.25DS -0.75DC × 13° for the right eye and +1.50DS -1.00DC × 55° for the left eye. The outcomes of an Artisan iris-fixated IOL implantation followed to CLE with PC-IOL implantation were encouraging for the correction of extreme hyperopia. Long term follow-up examinations were necessary for further determination of the efficacy and safety of this combinational procedure.