Posterior chamber intraocular lens implantation during pars plana lensectomy and vitrectomy for diabetic complications

Ten eyes had posterior chamber lenses implanted in the ciliary sulcus in front of the anterior lens capsule during diabetic pars plana lensectomy and vitrectomy. Six months later, nine eyes had improved vision and one had the same vision as compared with preoperative acuity levels. Two eyes had 0.5 and eight eyes had 0.1 or better acuity. None of the eyes developed iris or angle neovascularization or glaucoma, and all ten eyes had clear vitreous cavities with attached maculas. The posterior chamber lenses were well tolerated and provided good visual rehabilitation.This project was supported in part by the Bascom Palmer Eye Institute patients and contributors; Research to Prevent Blindness, Inc., New York City; Florida Lions Eye Bank Laboratory; and the Brenn Green Diabetic Retinopathy Funds, Miami, Florida     

Posterior chamber intraocular lens insertion during pars plana lensectomy and vitrectomy for complications of proliferative diabetic retinopathy

We inserted posterior chamber lenses into 21 eyes with complications of diabetic retinopathy upon completion of pars plana lensectomy and vitrectomy in a single session. After the original surgery, two eyes developed retinal detachments and underwent vitrectomy revisions with scleral buckling, one eye had a fluid-gas exchange for residual vitreous cavity blood, one eye had supplemental laser treatment, and one eye had intraocular antibiotics for endophthalmitis. Six months later, postoperative vision was better in 16 of the 21 eyes (76%), the same in four eyes (19%), and worse in one eye (5%). In 16 eyes visual acuity was 20/200 or better, and in six eyes it was 20/40 or better postoperatively. Decreased vision was caused by preexisting macular disease; two eyes had corneal edema with iris neovascularization associated with residual retinal detachment. The procedure and lenses were well tolerated and provided good pseudophakic vision.     

Posterior chamber lens implantation following pars plana lensectomy and vitrectomy in severe proliferative diabetic retinopathy

In two patients secondary cataracts developed after pars plana vitrectomy. In both cases the lens was removed from the pars plana, and the anterior capsule was kept intact. In one patient a posterior chamber lens was placed in the ciliary sulcus 3 months after the lens had been removed, and in the other patient a posterior chamber lens was implanted intraoperatively after pars plana lensectomy and vitrectomy. Improved visual results were obtained in both cases, and there was no evidence of rubeosis or elevated intraocular pressure. In selected cases preservation of the anterior capsule may be important to implant posterior chamber lenses in eyes requiring pars plana lensectomy and vitrectomy. To our knowledge this technique has not previously been reported.     

晶状体超声乳化玻璃体切割及后房型人工晶状体植入术

目的 评价晶状体超声乳化玻璃体切割及后与人工晶状植入术的临床疗效。方法 对１６例患者行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术。结果 ３－１０个月随记中,所有患者术后视力都有不同程度提高,视力０．５以上者６例（３７．５％）,０．２－０．４者７便（４３．７５％）,０．１以下者３例（１８．７５％）。结论 玻璃体切割术中行晶状体超声乳化术联合后房型人工晶状体植入术,能够获得良好视力而无严重并发症     

状体超声乳化玻璃体切割及后房型人工晶状体植入术

目的　评价晶状体超声乳化玻璃体切割及后房型人工晶状体植入术的临床疗效。方法　对16例患者行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术。结果　3～10个月随访中,所有患者术后视力都有不同程度提高,视力05以上者6例(375%),02～04者7例(4375%),01以下者3例(1875%)。结论　玻璃体切割术中行晶状体超声乳化术联合后房型人工晶状体植入术,能够获得良好视力而无严重并发症,是治疗白内障合并眼后段病变一种较理想的手术。     

玻璃体切除术后白内障超声乳化人工晶体植入术

目的：探讨玻璃体切除术后的白内障超声乳化手术的可行性、临床特点及特殊手术方法。方法：共21例患者(21只眼)在玻璃体切除手术7～27个月后接受超声乳化手术，回顾分析其术中操作困难因素、并发症和视力结果。结果：白内障超声乳化手术后19只眼视力提高，1只眼视力无变化，1只眼视力降低。术中几乎在所有病例均可遇到前房深度、瞳孔直径和后囊膜位置骤然变化的情况，增加了手术操作的难度。术中1只眼发生悬韧带离断。术后18只眼出现轻度狄氏膜皱褶。结论：虽然在玻璃体切除术后的患者群体施行超声乳化手术操作难度大、易出现并发症，但是经谨慎处理后绝大多数患者仍能获得良好的有用视力。     

Simultaneous phacoemulsification, posterior chamber lens implantation and pars plana vitrectomy

The aim of the study was to present current knowledge in the field of combined surgery: phacoemulsification with intraocular lens implantation and pars plana vitrectomy.     

Postoperative anterior chamber inflammation after posterior chamber intraocular lens implantation concurrent with pars plana vitrectomy and lensectomy]

The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.     

Primary intraocular lens implantation during pars plana vitrectomy and intraretinal foreign body removal.

PURPOSE: To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina. METHODS: Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months). RESULTS: Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation. CONCLUSION: Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.     

改良四通路玻璃体切割在人工晶状体后脱位治疗中的应用

目的:报道改良四通路玻璃体切割术治疗1例后房型人工晶状体后脱位.方法:一位青年性白内障患者,双眼白内障术后均发生人工晶状体后脱位,其1眼应用改良四通路玻璃体切割技术将人工晶状体复位,另1眼应患者的要求而未行手术治疗.结果:术中和术后未发生任何并发症,患者术眼视力迅速回复,术后14 mo最佳矫正视力为0.5;而未行手术治疗的另1眼发生全视网膜脱离,仅残余手动视力.结论:改良四通路玻璃体切割术是治疗人工晶状体后脱位的一个好选择.     

玻璃体切除手术后的白内障超声乳化人工晶状体植入术探讨

目的:评价玻璃体切除术(pars plana vitrectomy,PPV)后白内障的超声乳化(phacoemulsification,Phaco)联合人工晶状体植入术(intraocular lens implantation,IOL)的临床疗效,并讨论手术技巧。方法:所有41例42眼PPV后白内障患者行激光联合超声乳化白内障手术(phacoemulsification and intraocularlens,Phaco+IOL),其中11例11眼采用玻璃体腔液体灌注+Phaco+IOL,30例31眼行Phaco+IOL,观察比较术后视力、并发症等。结果:术后1mo时矫正视力(correctedvisualacuity,CVA)较术前CVA有统计学意义的提高(P=0.002),术中玻璃体腔灌注组的术后CVA与非玻璃体腔灌注组的术后CVA比较无统计学差异(P=0.052),术后39眼CVA有不同程度的提高,术后1moCVA<0.3者19眼主要与原有眼底病有关;42眼超声乳化同期植入后房型人工晶状体,所有患者手术中均有不同程度前房深度的大幅度变化伴随瞳孔直径变化,术中发现悬韧带断裂5眼,术中后囊破裂6眼,晶状体物质掉入玻璃体腔3眼,术中发现晶状体物质与后囊紧密粘连4眼;术后并发症包括角膜水肿23眼,后发性白内障4眼,视网膜再脱离2眼。结论:在PPV后白内障行Phaco+IOL术是目前理想的手术方法,对于有复杂超声乳化因素的病历,有复杂玻璃体和眼底病史的病历,超声乳化中放置后节眼内灌注是安全而有效的。     

Combined phacoemulsification,pars plana vitrectomy,and foldable intraocular lens implantation

We describe a technique for combined cataract and vitreoretinal surgery using sutureless sclerocorneal and sclerotomy incisions and a foldable intraocular lens. This technique, with its variations for cases with and without gas-fluid exchange, was successfully performed in 40 consecutive cases over a 5-month period. No significant complications related to the surgical procedures were encountered. The rationale and advantages of this technique are discussed.     

Posterior synechia of the iris after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation

PURPOSE: Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation has become a widely accepted treatment for cataracts in patients with vitreoretinal diseases. We examined factors influencing the development of posterior synechia after this triple procedure. METHODS: One hundred and three patients (107 eyes) were evaluated. The frequency of postoperative posterior synechia, the preoperative diagnosis, whether gas tamponade was used, and the type of lens implanted were reviewed. RESULTS: Twenty-one eyes (19.6%) developed posterior synechia, and the highest rate (12/39 eyes, 30.8%) was in patients with proliferative diabetic retinopathy. Posterior synechia was more frequent after gas tamponade (28.1%) than in eyes without tamponade (10.1%). In proliferative diabetic retinopathy (PDR) patients, fibrin deposition and the amount of retinal photocoagulation were causative factors for posterior synechia. CONCLUSIONS: Factors promoting postoperative synechia after the triple procedure included (1) the existence of PDR, (2) expanding gas tamponade, (3) fibrin deposition in PDR, and (4) the amount of photocoagulation in PDR.     

Combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in severe proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To evaluate the results of combined vitrectomies and intraocular lens implantations in cases of proliferative diabetic retinopathy. PATIENTS AND METHODS: Data from procedures on 117 eyes (91 patients) undergoing combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation for the complications of proliferative diabetic retinopathy were analyzed retrospectively. Follow-up ranged from 8 to 64 months (median = 25 months). RESULTS: Retinal tears were the most frequent intraoperative problems (19%). Limited postoperative fibrin formation occurred in 22% of eyes. Within 6 months, 7% developed glaucoma and 2% showed new anterior segment rubeosis. Overall, 10% underwent secondary surgical procedures as follows: lavage for hemorrhage (n = 3), silicone oil exchange after 7 days for focal rebleeding (n = 1), silicone oil surgery for retinal detachment after gas resorption (n = 1), and lavage for late vitreous hemorrhage (7 to 13 months) (n = 4). Half of the secondary procedures were necessitated within 3 months of the original surgery. CONCLUSIONS: Combined surgery in proliferative diabetic retinopathy is safe and effective. It should be considered when lens opacities are either present or likely to develop soon.     

白内障超声乳化,玻璃体切除及人工晶体植入联合手术的疗效

目的：探讨白内障超乳化摘除,睫状体平坦部下班体切割及人工晶体囊袋内植入联合手术的疗效及安全性。方法：对玻璃体视网膜病普合并白内障１８例（１８眼）施行该联合手术。其中糖尿病性视网膜病变,玻璃体出血伴白内障１０例;视网膜分枝静脉阻塞,玻璃体出血伴白内障４例;视网膜静脉周围炎,玻璃体出血伴白内障３例及特发性视网膜１例,术后随访２～１３个月（平均９月）。结果：术后视力均有不同程度提高。１２眼（６７％）术后     

Phacoemulsification and intraocular lens implantation following pars plana vitrectomy: a prospective study

AIMS: To examine the intraoperative characteristics of phacoemulsification in eyes that had undergone pars plana vitrectomy and to determine complication rates and visual outcomes. METHODS: A prospective study of 45 consecutive cataract operations on vitrectomised eyes performed over a 9-month period by a single surgeon. Data were collected on preoperative characteristics, intraoperative observations and complications, postoperative complications, and visual acuities. RESULTS: Zonular laxity with abnormal deepening of the anterior chamber and mydriasis was noted in six eyes that had undergone extensive vitreous removal for the treatment of retinal detachment or proliferative diabetic retinopathy, but not in eyes that had had limited 'core vitrectomy' such as for macular hole or epiretinal membrane. In two eyes, the initial deepening of the anterior chamber was accompanied by paradoxical shallowing with miosis (the 'infusion deviation syndrome'). Sight-threatening complications were rare. Snellen visual acuity improved in 84.6% of eyes previously treated for 'macular hole, 85.7% of eyes treated for 'macula-on' retinal detachment, 66.7% of eyes treated for 'macula-off' retinal detachment, and 57.1% of eyes treated for diabetic retinopathy. CONCLUSIONS: Surgeons need to be aware of additional challenges arising from zonular instability in eyes that have had extensive vitreous removal. A lower infusion bottle height may guard against sudden changes in anterior chamber depth. The use of a corneal tunnel avoids difficulties associated with an unusually deep anterior chamber. Visual acuity is less likely to improve in patients previously treated for diabetic retinopathy or for macula-off retinal detachment.