应用Pentacam三维眼前段分析仪对虹膜夹型人工晶状体植入术后的研究

目的 应用Pentacam术后追踪测量虹膜夹型有晶状体眼人工晶状体(PIOL)中央和周边部与角膜内皮和自然晶体之间的距离,倾斜度、偏心值以及前房深度的变化,评价其在前房的位置.方法 收集自2006年1月以来接受虹膜夹型人晶状体植入术的22例33只眼.术后6个月全部患者行Pentacam检查,测量VRSM50和VRSM60两组不同类型虹膜夹型PIOL中央和周边部与角膜内皮和自然晶体之间的距离,并测量术后1d、1、3及6个月人工晶状体的偏心量、倾斜度及前房深度值.结果 角膜内皮至PIOL光学部前表面距离为(1.94±0.36)mm.PIOL后表面与自然晶状体间的距离为(0.76±0.12)mm.分别比较各组在不同时期的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).在术后1d、1、3及6个月,比较2组的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).结论 Pentacam三维眼前段分析仪为PIOL植入术后提供高质量的Scheimpflug摄像,可以为有晶状体眼前房型人工晶状体提供精确的眼内定位,在这一方面具有重要的临床应用价值.     

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。     

有晶状体眼Verisyse人工晶状体植入术矫正超高度近视眼

目的：探讨有晶状体眼Verisyse人工晶状体植入术矫正超高度近视眼的有效性、安全性及可预测性。 方法：超高度近视眼患者10例13眼植入Verisyse人工晶状体。术后观察患者的视力、屈光度数、眼压、角膜内皮细胞计数、对比敏感度、晶状体位置、眩光敏感度、手术并发症及视觉不良症状。 结果：术后患者裸眼视力及最佳矫正视力均有明显的提高。术后3mo及术后1a患者最佳矫正视力≥0.5者占100%,患者最佳矫正视力≥0.8者占85%。患者术后屈光度稳定,术后1mo～1a,屈光状态变化无明显差异。患者术后1a内各时间点眼压均无明显异常升高。术后角膜内皮计数均有所下降,但其差异无统计学意义。术后3mo时,各频段对比敏感度和眩光敏感度较术前均明显提高。Verisyse人工晶状体与角膜内皮和晶状体均保持了有效的安全距离。术后3mo时,2眼可见Verisyse人工晶状体表面炎性反应物沉积,1眼瞳孔呈轻度椭圆形。患者均无明显不适,满意程度较高。 结论：Verisyse人工晶状体矫正超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,但其远期效果有待进一步观察。     

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.     

Retinal Imaging through Phakic Iris-Claw IOL

Abstract

Background: Phakic anterior chamber iris-fixated IOL (PIOL) are established for the correction of high myopia. These patients require attention to macular pathologies. This study was to evaluate the quality of imaging through the PIOLs. Methods: 54 eyes of 31 myopic and hyperopic patients with Verisyse®, Verisyse toric®, and Veriflex® phakic iris-fixated IOL were included. Mean preoperative refraction was ?11.0?D and +5.7?D, respectively; mean follow-up time was 7.4 years (5–11 years). A matched control group was formed without PIOL implantation. OCT scans were performed and evaluated qualitatively and quantitatively. Results: In 52 eyes of 31 patients (96%), a 3D-OCT image and fundus photo could be obtained in good quality. Foveal thickness was significantly thicker in the myopic patients, whereas all other sectors and total volume had no significant difference. Conclusions: It proved possible to obtain high-resolution scans and digital photos of the same quality as without additional phakic IOL.     

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.     

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.     

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.     

Intraokularlinsen zur Korrektur von Refraktionsfehlern

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.     

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.     

Intraocular lenses for the correction of refraction errors. Part 1: phakic anterior chamber lenses

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 the 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 that 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 anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.     

Intraokularlinsen zur Korrektur von Refraktionsfehlern

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 the 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 that 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 anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.     

Creeping posterior synechiae following hyperopic iris-fixated phakic implants

The purpose of this study was to report on the occurrence and management of posterior synechiae (PS) in three hyperopic eyes after iris-fixated anterior chamber phakic IOL implantation. This is a case report of a 55-year-old man and a 55-year-old lady who had undergone iris-fixated anterior chamber phakic IOL implantation to correct hyperopic astigmatism (one eye) and hyperopia (both eyes), respectively. The three eyes developed creeping PS and pigment dispersion within 4–6 weeks of surgery. Synechiolysis and pupil stretching in one eye did not work as the synechiae promptly recurred. Definitive management in the form of removal of the phakic implant and phacoemulsification with lens implant was successful in restoring normal vision in all three eyes. Although implantation of phakic intraocular lenses has been reported to be very effective for the correction of moderate to high degrees of ametropia, this complication can occur in hyperopic eyes. Pigment dispersion has been reported in myopic eyes also, but PS seem to be more an issue with hyperopic eyes. Age of the patient may also be a factor. This information is important in the selection and counselling of patients.     

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.     

Intraocular pressure in myopic patients after Worst-Fechner anterior chamber phakic intraocular lens implantation

PURPOSE: To assess intraocular pressure measured with a Goldmann tonometer over a period of 1 year after implantation of a Worst-Fechner anterior chamber phakic intraocular lens to correct myopia of -7.00 D or more. METHODS: We performed a prospective, non-masked study of 100 patients (100 myopic eyes) who had a Worst-Fechner phakic intraocular lens implanted to correct myopia of -7.00 D or greater. Central corneal Goldmann tonometry was performed before surgery and 1, 3, 6, and 12 months after surgery. The influence of different variables was assessed. RESULTS: IOP showed a significant increase of a mean 2.1 mmHg at 3 months after surgery (P=.001). There was not a statistically significant difference between IOP before surgery and 6 months after PIOL implantation (P=.244) or 1 year after surgery (P=.845). In one eye, the lens was explanted 11 months after surgery because of the presence of ocular hypertension. No variables studied showed a statistically significant difference from before to after surgery. CONCLUSIONS: Worst-Fechner anterior chamber phakic intraocular lens implantation led to a slight transitory increase of intraocular pressure during the first 3 months after surgery, but returned to preoperative levels by 6 months after implantation.     

Custom-designed toric phakic intraocular lenses to correct high corneal astigmatism

PURPOSE: To analyze the results of a custom-designed posterior chamber toric phakic intraocular lens (PIOL). METHODS: A 40-year-old woman with high astigmatism and thin corneas underwent bilateral PIOL implantation with the toric Implantable Collamer Lens (ICL) custom-designed and manufactured by STAAR Surgical. The appropriate toric ICL power was calculated to be -8.00 +8.00 x 96 degrees for the right eye and -8.50 +7.50 x 86 degrees for the left eye. Optical zone was 5.5 mm and 6.875 mm at the corneal plane. RESULTS: At 3 and 6 months postoperatively, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA) of both eyes had improved to 20/20 and 20/16, respectively. At 19 months, UCVA was 20/20 and 20/16 in the right and left eyes, respectively, and BSCVA had improved to 20/16 and 20/10, respectively. The subjective refraction was stable, with a change of -0.37 +/- 0.17 D from preoperative to 19 months postoperatively. Throughout the postoperative period, iridotomies remained patent and the corneas were clear. CONCLUSIONS: Bilateral implantation of the custom-designed toric ICL successfully corrected the patient's high astigmatism. Preoperative subjective refractive cylinder of -5.25 x 6 degrees in the right eye and -5 x 176 degrees in the left eye changed to -0.5 x 77 degrees and -0.5 x 115 degrees, respectively, after toric IOL implantation. There was almost no change in corneal astigmatism. This customized approach led to UCVA of 20/20 in the right eye and 20/16 in the left eye, and BSCVA of 20/16 in the right eye and 20/10 in the left eye. This is the first report of a toric PIOL being specifically manufactured to meet the refractive cylinder requirements of a specific patient.     

Reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation

PURPOSE: To report a case of reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation. METHODS: A 6-year-old boy with anisometropic amblyopia with spherical equivalent refraction of right eye: -14.00 -3.00 x 100 degrees, left eye: -0.50 -3.25 x 90 degrees, was treated for 2 years with occlusion to the left eye, with poor results. Refractive surgery was planned because of contact lens intolerance at age 8 years. A -15.00-D iris claw Artisan intraocular lens (IOL) was implanted. RESULTS: Following surgery, treatment of the amblyopia and spectacle correction of -4.00 D cylinder at 85 degrees in the right eye and -3.50 D cylinder at 90 degrees in the left eye was necessary. Visual acuity 6 months after surgery was 20/25 in the right eye and 20/20 in the left eye, and has remained stable 18 months after surgery. CONCLUSION: Myopic anisometropic amblyopia in an 8-year-old boy was treated successfully with implantation of an Artisan iris claw phakic anterior chamber IOL, combined with occlusion therapy, and resulted in reversal of amblyopia.     

虹膜夹持型前房晶状体植入术治疗高度近视

目的探讨虹膜夹持型前房晶状体植入术治疗高度近视的疗效和安全性。方法2005年8月至2006年2月在本中心接受前房晶状体植入术治疗高度近视的患眼共12例（21只眼）。观察指标包括裸眼视力、最佳矫正视力、眼压、角膜地形图、瞳孔形态、角膜内皮计数、晶状体在前房的位置形态、人工晶状体表面色素沉着情况。结果患者术前最佳矫正远视球镜度为（-17．28±2．95）D,散光度（-1．90±1．02）D,植入度数平均为（-14．53±9．47）D。平均随访时间（13．2±2．1）个月。术后12个月随访到17只眼,其中裸眼远视力较术前最佳矫正远视力提高1行5只眼（29．41％）,提高2行4只眼（23．53％）,提高3行3只眼（17．65％）,提高4行2只眼（11．76％）;手术后最佳矫正远视力较术前最佳矫正远视力提高1行4只眼（23．53％）,提高2行2只眼（11．76％）,提高3行2只眼（11．76％）,提高4行2只眼（11．76％）,提高5行以上5只眼（29．41％）。术前眼压（17．25±2．92）mmHg（1mmHg=0．133kPa）,术后6个月眼压为（17．14±2．52）mmHg,12个月为（17．16±2．57）mmHg,差异无统计学意义（P〉0．05）;术前角膜内皮计数（2627．89±229．36）个／mm^2,术后6个月为（2605．28±239．22）个／mm^2,术后12个月为（2603．17±237．12）个／mm^2,差异无统计学意义（P〉0．05）。结论虹膜夹持型前房晶状体植入术治疗高度近视安全、有效,并且具有良好的预测性;但远期效果需进一步观察。     

前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。     

Secondary artisan phakic intraocular lens for correction of progressive high myopia in a pseudophakic child.

An 8-week-old infant underwent unilateral cataract extraction and posterior chamber intraocular lens implantation for total cataract in the left eye. After surgery, a residual progressive myopic error was observed, ranging from -4.5 diopters (D) 6 months after the operation to -14.0 D at the age of 3 years. Because of parental noncompliance for contact lens and spectacles use, secondary implantation of Artisan phakic IOL of -14.0 D power was performed. No intra- or postoperative complications were observed. Nine months after this second operation, myopia diminished to -3.25 D.