激光虹膜切除联合超声乳化吸除术治疗急性闭角型青光眼合并白内障临床观察

目的 探讨急性闭角型青光眼初次发作后,采用激光周边虹膜切除,再行晶状体超声乳化吸出联合人工晶体植入术治疗的疗效.方法 分析2005年9月至2007年3月收治急性闭角型青光眼合并白内障患者16例,16只眼,应用激光周边虹膜切除术后,行晶状体超声乳化吸出联合人工晶体植入,观察术前及术后视力、周边前房深度、前房角、眼压情况.术后随诊4～12个月,平均9.4个月.结果 16只眼术后视力、周边前房深度较术前明显改善,前房角完全开放,眼压非药物控制于正常范围,平均眼压14.24mmHg.术后早期并发角膜水肿3只眼,前房纤维样渗出2只眼,无浅前房和后发障发生.结论 应用激光周边虹膜切除后,行晶状体超声乳化吸出人工晶体植入可有效治疗急性闭角型青光眼合并白内障,且术后视力恢复快、眼压控制好、并发症少.     

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术后远期人工晶状体脱位临床分析

目的 探讨有晶状体眼虹膜固定型有晶状体眼人工晶状体(phakic intraocular lens,PIOL)植入术后远期人工晶状体脱位、移位情况及原因分析。方法 对我中心2005至2013年开展的Verisyse PIOL植入术矫正高度近视患者52例(104眼)进行术后平均6.5 a随访性研究,对其中发生PIOL脱位、移位患者的临床资料进行回顾性分析。结果 104眼中8眼发生PIOL不全脱位,其中1眼是因为拳头打伤颞侧晶状体袢脱落,2眼因皮球打伤眼睛致一侧晶状体袢脱落,1眼因撞击后出现鼻侧晶状体袢脱落,2眼是搬动重物一侧晶状体袢脱落,1眼是自然分娩后出现双侧晶状体袢脱落并PIOL脱落入前房,1眼是夹持虹膜部位退行性改变致晶状体脱位。7眼发生PIOL下移,下移程度>0.5 mm,其中晶状体袢单侧下移2眼,双侧下移5眼。8眼PIOL脱位中6眼行PIOL再固定术,2眼行PIOL取出术。结论 PIOL脱位与术后眼部外力及外伤、眼压波动、手术时固定虹膜组织的程度不够、所夹取的虹膜组织发生脱色素和退行性变有关,PIOL本身有自身的重量,长期作用会发生向下移位或襻脱离。     

有晶体眼虹膜扣夹型人工晶体植入术矫正超高度近视

目的探索有晶体眼虹膜扣夹型人工晶体植入术矫正超高度近视的有效性和安全性。方法对27例49眼超高度近视患者行Verisyse有晶体虹膜扣夹型人工晶体植入术,观察手术前后视力、屈光状况、角膜内皮计数、角膜曲率、前房、眼压、人工晶体和晶状体等情况。结果27例49眼人工晶体植入一次成功。术后随访4～8月,17眼（34.7%）视力接近（1行之内）术前最佳矫正视力,31眼（63.3%）视力优于术前最佳矫正视力,比术前最佳矫视力进步1～3行;3眼眼压一过性升高,5眼瞳孔轻度变形,1眼术后1个半月视网膜脱离,1眼术后1月外伤后人工晶体脱位,手术后复位,其余人工晶体位置良好。结论有晶体眼虹膜扣夹型人工晶体植入术矫正超高度近视安全有效,预测性好,远期效果有待进一步观察。     

有晶状体眼虹膜固定型人工晶状体植入术后再手术原因及安全性

目的 探讨有晶状体眼虹膜固定型人工晶状体（PIOL）植入术后再手术原因以及长期眼内植入的安全性。方法 回顾性系列病例研究。选择2006年1月至2016年12月于青岛眼科医院白内障科接受有晶状体眼虹膜固定型PIOL植入术治疗高度近视后接受再次眼内手术治疗的患者11例（17眼）。分析再次手术的时间、方式以及原因。数据采用配对t检验进行分析。结果 再次手术的时间为PIOL植入术后6~108个月。12眼（12/17）因为外伤导致PIOL脱位于前房而接受了再次手术,该12眼再手术前角膜内皮细胞计数与植入术前比较,出现不同程度下降（t=5.968,P<0.001）,其中1眼因脱位时间较长（1个月）而最终出现角膜内皮细胞功能失代偿。另有2眼（2/17）虽未出现PIOL脱位,但由于PIOL所夹虹膜较少或部分萎缩,PIOL位置松动,角膜内皮细胞非预期性明显减少,从而接受了人工晶状体再固定术;1眼（1/17）因为对侧眼PIOL脱位,角膜内皮细胞计数下降明显,患者出于恐慌,而决定手术取出PIOL;1例（1眼）患者（1/17）因为PIOL植入后出现视网膜脱离接受了视网膜复位手术,由于术后长期俯卧位,对侧眼（1/17）角膜内皮细胞计数下降明显（658个/mm²）而接受PIOL再固定手术。结论 外伤后PIOL脱位,PIOL松动后非预期性角膜内皮细胞计数下降是有晶状体眼虹膜固定型PIOL植入术后再次手术的主要原因。对于长期植入的患者需增加随访排查潜在的安全隐患。     

虹膜夹型人工晶状体矫正高度近视的前节OCT检查分析

目的:使用前节OCT分析高度近视植入虹膜夹型人工晶状体后眼内的结构变化。方法:植入前房晶状体矫正高度近视6眼(11.5D至22.0D),使用前节OCT采集前节图像测量术前前房深度,术后人工晶状体与角膜内皮间距离(内皮—晶状体距离),人工晶状体与正常晶状体间距离。结果:术前前房深度为3.27～3.91mm,术后内皮—晶状体距离为2.07～2.24mm。人工晶状体后表面与正常晶状体间的距离为0.82～1.32mm。图像显示虹膜色素层没有明显改变。结论:前房深度较术前减少36.1%～44.6%。前节OCT对于检测虹膜夹型前房晶状体的位置有帮助。     

两种矫正高度近视虹膜夹型人工晶状体植入后眼内稳定评价

目的 评估两种虹膜夹型有晶状体眼人工晶状体(ICPIOL)矫正超高度近视植入后的稳定性和安全性.方法 选取超高度近视患者8例16只眼,依据度数1只眼植入硬性型ICPIOL;另眼植入折叠型ICPIOL.术后随诊3月,使用Pentacam前房分析仪分别评估人工晶状体距离中心角膜和距离自然晶状体之间的距离;使用角膜内皮测量仪,分别测量术前术后角膜内皮细胞记数,以评估其安全性及眼内稳定性.结果 术后3个月裸眼视力6只眼(38%)≧1.0,10只眼(63%)≧0.5.最佳矫正视力7只眼(44%)≧1.0,16只眼(100%)≧0.5.术后15只眼最佳矫正视力均达到并超过术前最佳矫正视力,11只眼(69%)提高视力表两行.角膜内皮至IOL光学部前表面距离为(2.04±0.38)mm.IOL后表面与自然晶状体间的距离为(0.76±0.15)mm.两种ICPIOL相比各组数据差异无统计学意义(P＞0.05).结论 两种ICPIOL术后眼内稳定性好,但还应长期随诊观察.     

虹膜支撑型有晶状体眼人工晶状体植入术矫正屈光不正临床观察

目的 探讨虹膜支撑型有晶状体眼人工晶状体PIOL(phakic intraocular lens) 植入术治疗矫正屈光不正的有效性、安全性及可预测性.方法 33例(58只眼)屈光不正,高度近视眼患者植入Verisyse虹膜嵌夹VRSM60型PIOL.术后观察患者的视力,眼压,角膜内皮细胞计数,人工晶状体位置及手术并发症等.结果 术后3个月患者裸眼视力≥0.5者占98.2%(57/58),6个月时98.2%(57/58),术后6个月时患者裸眼视力≥0.8者占74.1%(43/58).6个月时占89.6%(52/58).术后裸眼视力较术前最佳矫正视力明显提高,术后3个月占93.1%(54/58),6个月占98.2%(57/58).差异有统计学意义(P<0.01)术后裸眼视力较术前最佳矫正视力提高2行以上者,3个月时占81%(47/58),6个月时占89.6%(52/58).患者术后3个月时眼压与术前相比右眼t=0.709,P=0.485左眼t=0.949 P=0.351,P>0.05,差异无统计学意义.术后4只眼出现眼压升高,经降眼压治疗3只眼一周内恢复,1只眼压升高持续2个月,眼压在22～30 mmHg,经治疗后缓解,恢复正常.3个月后未再出现眼压升高,但该眼瞳孔增大约6 mm,大于IOL光学区,偶有单眼复视存在.患者术后3个月角膜内皮细胞计数同手术前相比,右眼t=3.562 P=0.006 左眼t=3.051 P=0.012 P<0.05,差异有统计学意义,这说明手术过程及前房型人工晶状体对角膜内皮细胞是有损伤的;术后6个月2只眼可见PIOL表面炎性反应物沉积;6只眼可见嵌夹在晶状体攀处的虹膜局限性萎缩;2只眼出现一侧人工晶状体攀从嵌夹于虹膜处脱离.结论 PIOL植入术治疗矫正屈光不正高度近视眼具有良好的有效性,安全性及可预测性,是补充角膜屈光手术不足的有效眼内屈光手术,但其远期效果尚有待进一步观察.     

瞳孔成形联合虹膜夹型人工晶状体植入术临床观察

目的 观察瞳孔成形联合虹膜夹型人工晶状体植入术在外伤性白内障伴有虹膜损伤患眼中的疗效.方法 回顾性分析2010年5月至2011年8月在温州医学院附属眼视光医院眼外伤专科采用瞳孔成形联合虹膜夹型人工晶状体植入术治疗外伤性白内障伴有虹膜损伤患者,共8例8只眼.眼球钝挫伤3例,穿通伤5例,术前均确诊为外伤性白内障,其中3例伴有晶状体脱位.术后随访4～11个月,观察术后视力、角膜内皮细胞计数、瞳孔情况及人工晶状体位置、眼压等.结果 8例均成功修补损伤虹膜,顺利植入虹膜夹型人工晶状体.术后视力均达到或超过术前预测视力,术后矫正视力≥0.6共6只眼,占75％.瞳孔正常生理功能基本恢复,无明显畏光、眩光、复视等不适症状.虹膜夹型人工晶状体无明显偏位,无眼压升高、角膜内皮失代偿等情况.结论 瞳孔成形联合虹膜夹型人工晶状体植入术是治疗无囊膜支持的无晶状体眼合并虹膜损伤的相对安全、有效的方法之一.     

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses

PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. CONCLUSIONS: The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.     

Ultrasound biomicroscopy of the iris-claw phakic intraocular lens for high myopia

PURPOSE: To study the in situ relative intraocular position of the Ophtec Artisan iris-claw phakic intraocular lens (PIOL) for high myopia using ultrasound biomicroscopy. METHODS: Three PIOLs (13.00, 17.00 and 18.00 D lens powers) were implanted in phakic myopic eyes. Using ultrasound biomicroscopy, echograms were taken in the anterior chamber to measure the preoperative anterior chamber depth, postoperative distance between the PIOL and the corneal endothelium (endothelial-optic distance), and the postoperative distance between the PIOL and the crystalline lens. RESULTS: Preoperative anterior chamber depth ranged from 3.10 to 3.40 mm and the postoperative endothelial-optic distance measured 2.11 to 2.44 mm. The distance between the crystalline lens and the posterior surface of the IOL ranged from 0.78 to 0.93 mm. Several echograms revealed the position of the PIOL on the iris. The pigment layer of the iris did not seem to be disturbed by the presence of the PIOL. CONCLUSION: The original anterior chamber depths were reduced by 28% to 34% after implantation. The PIOL-crystalline lens distance ranged from 0.78 to 0.93 mm. This study of 3 eyes revealed that echograms taken by ultrasound biomicroscopy are useful in verifying the intraocular position of the PIOL within the anterior chamber.     

Position of angle-supported, iris-fixated, and ciliary sulcus-implanted myopic phakic intraocular lenses evaluated by Scheimpflug photography

PURPOSE: To examine postoperative positional stability of myopic phakic intraocular lenses (IOLs). DESIGN: Prospective, nonrandomized clinical study. METHODS: The study included 46 eyes which received an anterior chamber angle-supported (Bausch & Lomb NuVita; 10 eyes), anterior chamber iris-fixated (Ophtec Artisan; 20 eyes) or ciliary sulcus-implanted phakic IOL (Staar ICL; 16 eyes). The distance between the phakic IOL and the crystalline lens and the cornea as well as rotation around the optical axis was evaluated using Scheimpflug photography at 1, 3 to 6, and 12 months postsurgery. RESULTS: The anterior chamber phakic IOLs showed no significant movement in anteroposterior direction. The posterior chamber phakic IOL showed a significant movement toward the crystalline lens between postoperative months 3 and 12. The median amount of rotation around the optical axis between the 3- and the 12-month evaluation was 1.9 degrees (range = 0.0-33.5 degrees) for the NuVita, 0.6 degrees (range = 0.0-3.5 degrees) for the Artisan, and 0.9 degrees (range = 0.2-2.3 degrees) for the ICL. Four NuVita IOLs rotated more than 10 degrees. CONCLUSIONS: The angle-supported anterior chamber phakic IOLs showed a generally stable position regarding distance to cornea and natural lens, but rotation was observed in four IOLs. The iris-fixated phakic IOL showed the highest overall stability. The posterior chamber phakic IOL was stable in terms of rotation but had a tendency to decrease in distance toward the crystalline lens. Intraocular lenses implanted in phakic eyes followed for 12 months demonstrate stable IOL position overall.     

Intraoperative autorefraction for combined phakic intraocular lens explantation and cataract surgery

PURPOSE: To evaluate intraoperative autorefraction during combined phakic intraocular lens (PIOL) explantation and cataract surgery. METHODS: Phakic intraocular lens explantation was followed by crystalline lens emulsification and reformation of the anterior chamber with balanced salt solution. Autorefraction was performed intraoperatively with the Nikon Retinomax 2, and the IOL power was calculated using a formula for myopic eyes: IOL for emmetropia = 1.3 x aphakic spherical equivalent refraction + 1.45. RESULTS: Nineteen myopic eyes of 15 patients with anterior or posterior chamber PIOL (including 6 eyes that had undergone photorefractive keratectomy) were treated. Two months postoperatively, mean spherical equivalent refraction was -0.56+/-0.40 diopters (D) (range: 0 to -1.50 D). CONCLUSIONS: In myopic eyes, intraoperative auto-refraction provided a simple and reliable method to calculate IOL power in combined PIOL explantation and cataract surgery.     

Intermittent myopic shift of 4.0 diopters after implantation of an Artisan iris-supported phakic intraocular lens

A 45-year-old man with bilateral high myopia and myopic astigmatism had uneventful implantation of a -10.5 diopters (D) Artisan iris-fixated anterior chamber phakic intraocular lens (PIOL) (Ophtec) in both eyes. In the first days after surgery, uncorrected visual acuity (UCVA) was 20/16 in the right eye and 20/16 in the left; the position of the PIOL was stable. Ten days after surgery, the left eye developed a myopic shift of 4.0 D. Further examination showed that the myopia disappeared when the pupil was medically dilated. After the pupil returned to a natural position, the myopic shift reappeared. Because there were no changes in the subsequent 4 months, we decided to exclavate the IOL, rotate it by 10 degrees, and reenclavate it with less tissue. The myopic shift did not return over the following 20 months, and the UCVA was 20/20. In rare cases, iris-fixated anterior chamber IOLs may induce refractive changes related to effects on the surrounding anatomic structures. This may be corrected by phakic IOL rotation or reenclavation of the phakic IOL with less tissue.     

Position of rigid and foldable iris-fixated myopic phakic intraocular lenses evaluated by Scheimpflug photography

PURPOSE: To evaluate the postoperative intraocular positional stability of 1 rigid poly(methyl methacrylate) (PMMA) phakic intraocular lens (pIOL) model and 2 foldable polysilicone-PMMA iris-fixated pIOL models. SETTING: Department of Ophthalmology, Johann Wolfgang Goethe-University Frankfurt am Main, Germany. METHODS: One of 3 iris-fixated pIOL models (Artisan, Artiflex I, and Artiflex II, Ophtec BV) was implanted in 45 eyes of 26 patients with myopia or myopic astigmatism. The central distance between the pIOL and corneal endothelium and between the pIOL and anterior surface of the crystalline lens was evaluated using Scheimpflug photography 6 and 12 months after surgery. RESULTS: The mean preoperative spherical equivalent was -9.32 diopters +/- 1.78 (SD) (range -6.5 to -13.5 D). Each IOL model was implanted in 15 eyes. The median distance from the central corneal endothelium to the anterior surface of the pIOL at 6 months and 12 months was 2.65 mm and 2.64 mm, respectively, in the Artisan group, 2.47 mm and 2.50 mm, respectively, in the Artiflex I group, and 2.48 mm and 2.52 mm, respectively, in the Artiflex II group. The median distance between the posterior surface of the pIOL and the anterior surface of the crystalline lens at 6 months and 12 months was 0.40 mm and 0.48 mm, respectively, in the Artisan group, 0.53 mm and 0.55 mm, respectively, in the Artiflex I group, and 0.68 mm and 0.66 mm, respectively, in the Artiflex II group. At 12 months, the distance between the pIOL and crystalline lens was statistically significantly greater in the Artiflex II group than in the Artisan group (P<.01). CONCLUSION: The intraocular position of rigid pIOLs and foldable silicone iris-supported pIOLs showed a difference between the 3 pIOL models in space to the crystalline lens and the corneal endothelium, which may affect long-term results in terms of IOL interaction with surrounding tissue.     

Biometry of phakic intraocular lens using Scheimpflug photography

PURPOSE: To examine lateral and axial positioning of phakic intraocular lenses (IOLs) with iris fixation in the anterior chamber and to examine short-term stability of the IOL position. SETTING: The Netherlands Opthalmic Research Institute, Amsterdam, the Netherlands. METHODS: Thirty patients participated in the study. Thirty-one eyes were implanted with the 204 type myopia IOL, 14 eyes with the 206 myopia IOL, and 8 eyes with the 203 hyperopia IOL. Scheimpflug slitlamp photographs were made through the optical axis along 4 meridians of the eyes. Ray tracing was used to obtain the lateral and axial position of the IOLs. RESULTS: Centration of the IOL with respect to the pupil's center and the tilt angle of the IOL with respect to the optical axis of the eye were measured. Standard deviation of decentration was 0.21 mm vertically and 0.16 mm horizontally. Standard deviation of tilt was 1.30 degrees vertically and 0.90 degrees horizontally. Tilt and decentration are proportional to each other. Vaulting, the distance between the crystalline lens and the IOL, was constant over a period of 24 months, ranging from 0.2 to 0.8 mm, depending primarily on the radius of curvature of the crystalline lens. A geometric model for this dependence was formulated. CONCLUSION: Phakic IOLs with iris fixation can be positioned in the eye with submillimeter precision. Axial position of iris-fixated phakic IOLs over time is excellent. Axial position and vaulting can be predicted when the radius of curvature of the crystalline lens is known. The IOL behaves as if mounted slightly above a sphere-the anterior surface of the crystalline lens.     

Intraocular lenses for the correction of refraction errors. Part II. Phakic posterior chamber lenses and refractive lens exchange with posterior chamber lens implantation

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses which are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for posterior chamber lenses these are mainly cataract formation and pigment dispersion. RLE is preferable in cases of high ametropia in which the natural lens has lost its accommodative effect. The main complications for myopic RLA include retinal detachment, while hyperopic refractive lens exchange may be associated with surgical problems in the narrower anterior eye segment.