Visual function after implantation of aniridia intraocular lens for traumatic aniridia in vitrectomized eye

PURPOSE: To evaluate the efficacy and safety of aniridia posterior chamber intraocular lens (PCIOL) in traumatic aniridia and aphakia in vitrectomized eyes. METHODS: Four aphakic patients with traumatic aniridia and previous pars plana vitrectomy (PPV) due to posterior segment trauma enrolled in the study, and had secondary implantation of an aniridia PCIOL. Two patients were men and two women with mean age of 39.25 years. Complete ophthalmic examinations, including preoperative and postoperative visual acuity in dark and light, glare disability, visual function (using VF-9 questions modified from VF-14), stereopsis, and contrast sensitivity in 3, 6, 12, and 18 cycle per degree frequencies, were done for all patients. Postoperative intraocular pressure (IOP), IOL centration, and intraocular inflammation were monitored. Mean follow-up was 12.25 months (range 7 to 15 months). RESULTS: Visual acuity improved in all four patients, especially in the light. Glare was subjectively reduced in all of them. Stereopsis was measurable in three of them postoperatively. Contrast sensitivity improved in all patients, especially in brightness and lower frequencies. All four eyes had improved VF-9. All eyes achieved the desired anatomic results. Two cases developed elevated IOP early after surgery. In one eye, IOP elevation was transient and controlled with antiglaucoma medication, but the other eye, which had secondary glaucoma from previous trauma, required cyclophotocoagulation for the IOP to be controlled. No patient developed chronic uveitis or redetachment. CONCLUSIONS: The aniridia PCIOL can overcome aphakia, reduce glare, and increase visual function, contrast sensitivity, and stereopsis in vitrectomized eyes with traumatic aniridia. Although this kind of IOL appears safe, some disadvantages are secondary glaucoma and reduced visibility of peripheral fundus, and caution should be used in its implantation until more patients with longer follow-up are studied.     

Aniridie-Intraokularlinsen bei Augen mit traumatischen Irisdefekten

BACKGROUND: Globe injuries frequently are the cause of permanent loss of visual function. Especially ruptures of the globe have a 50 times lower chance of achieving a final visual acuity better than 20/200 as compared to contusions of the globe. Besides injury to the retina and choroids, injury of the iris-lens diaphragm plays an important role for visual rehabilitation (10% iris defects and 1% aniridia after blunt trauma). Against this background the surgical results after implantation of aniridia intraocular lenses were investigated. PATIENTS AND METHODS: Eleven patients (41.9+/-19.6 years of age) after globe injury (three ruptures of the globe, eight penetrating injuries with trauma of the iris) were implanted with an aniridia IOL. RESULTS: The implantation of an aniridia IOL was performed on average 1.0+/-0.6 years (range: 0.4-2.3 years) after the primary injury. In ten eyes an aniridia IOL model HMK ANI 2 (Ophtec/Polytech) was implanted and in one eye an aniridia IOL model 67 (Morcher). Most patients were very satisfied with the results achieved (average corrected visual acuity 0.48; 0.05-1.0). Of the operated eyes, 63% reached a visual acuity >/=0.4. All patients noticed a significant reduction in glare disability as compared to the preoperative condition. The incidence of secondary glaucoma remained unchanged after the secondary implantation. One patient demonstrated retinal detachment 3 months after receiving the secondary implant, which was successfully treated with vitrectomy and gas tamponade. CONCLUSIONS: The implantation of aniridia IOLs seems to be a beneficial therapeutic option in post-traumatic eyes with partial or complete aniridia and aphakia with good visual recovery. During the postoperative follow-up special attention must be paid to sufficient regulation of intraocular pressure and to the retinal situation.     

虹膜型人工晶状体植入术

目的 探讨虹膜型人工晶状体植入术的临床疗效。方法 采用缝线悬吊方法对眼外伤致无虹膜和先天性无虹膜患者23例（23只眼）行虹膜型人工晶状体植入术,记录术后视力和并发症情况。结果 术后全部患者畏光症状明显减轻,术后裸眼视力提高,视力≥0.1者16只眼（70%）。术中玻璃体出血2只眼;术后人工晶状体表面渗出斑沉着13只眼,角膜失代偿5只眼,高眼压3只眼,黄斑裂孔和复发性视网膜脱离各1只眼。结论 虹膜型人工晶状体植入术可改善无虹膜和晶状体患者的视觉不适和高度远视屈光状态;但此类患者病情复杂,应把握手术适应证,充分做好术前准备工作。     

Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies.

PURPOSE: To determine the efficacy and safety of surgical implantation of prosthetic iris devices in patients with anatomic or functional iris deficiencies. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-five patients were enrolled in an interventional prospective noncomparative case series. Twenty-eight eyes had prosthetic iris diaphragm implantation for traumatic iris defects, congenital aniridia or iris coloboma, herpetic iris atrophy, surgical iris loss, or ocular albinism. Prosthetic iris implantation was performed with phacoemulsification and intraocular lens (IOL) implantation in 20 eyes, secondary IOL implantation in 6 eyes, and IOL exchange in 1 eye. A single pseudophakic eye with disabling glare secondary to traumatic aniridia had secondary prosthetic iris implantation alone. The surgical ease of insertion, intraoperative and postoperative complications, postoperative anatomic results, visual acuity, and subjective glare reduction were evaluated. RESULTS: Patients were followed postoperatively for a mean of 10.2 months (range 1.4 to 25.7 months). All eyes achieved the desired anatomic result. Visual acuity was improved in 22 of 28 eyes (79%), unchanged in 5 eyes, and worsened by a single line in 1 eye. Patients were surveyed postoperatively to determine the change in glare disability. The severity of glare disability was subjectively improved in 23 of 24 patients (96%) who responded to the survey. Intraoperative complications included 3 fractured implants as well as an incomplete or torn capsulorhexis in 3 eyes. Postoperative complications included transient hypotony in 2 eyes, mild persistent inflammation in 1 eye, and macular edema followed by a retinal detachment in 1 eye with recent severe trauma. CONCLUSIONS: Implantation of prosthetic iris devices improved postoperative outcomes by reducing glare disability and, in selected cases, by correcting aphakia. Although operating on traumatized, congenitally aniridic, or uveitic eyes presents special challenges, implantation of prosthetic iris devices appears to be a safe and effective method for reducing the ubiquitous glare in patients with iris deficiency.     

眼外伤玻璃体切割术后带虹膜隔人工晶状体植入术

目的 探讨眼外伤后无虹膜无晶状体眼的治疗方法。方法 对2例(2只眼)眼外伤玻璃体切割术后无虹膜无晶状体眼患者施行带虹膜隔人工晶状体植入术。结果 术后所有患者畏光症状消失，视力明显提高，无任何严重并发症发生。结论 带量膜隔人工晶状体植入术是目前矫正无晶状体眼伴无虹膜的安全有效方法。     

Implantation of a black diaphragm intraocular lens for traumatic aniridia.

PURPOSE: To evaluate the suitability and safety of a black diaphragm posterior chamber intraocular lens (IOL). SETTING: Department of Ophthalmology, Leeds General Infirmary, Leeds, United Kingdom. METHODS: Seven patients who had secondary implantation of a Morcher 67G black diaphragm posterior chamber IOL were identified. All patients were men with a mean age of 42 years who had previous ocular trauma resulting in extensive loss of iris tissue (traumatic aniridia). Simultaneous penetrating keratoplasty was performed in 4 cases. Minimum follow-up was 10 months (mean 19 months). RESULTS: Best corrected visual acuity improved in 5 cases and was unchanged in 1 case. The lens was well centered in 5 cases. Two cases developed secondary glaucoma, 1 requiring trabeculectomy. One case developed infective endophthalmitis but had a visual acuity of 6/18 at last follow-up, and 1 had a vitreous and anterior chamber hemorrhage, which resolved. CONCLUSIONS: The black diaphragm posterior chamber IOL overcame aphakia in eyes with considerable loss of iris tissue and may mitigate the visually disabling effects of traumatic aniridia. Although this lens appears safe, caution should be used in its implantation until more patients with longer follow-up are studied.     

Black diaphragm aniridia intraocular lens for aniridia and albinism

Background Our aim was to assess the safety and efficacy of primary and secondary implantation of a black diaphragm aniridia intraocular lens (IOL) in patients that lacked a complete iris diaphragm.Methods This was a retrospective non-comparative study of six eyes in five patients with iris defects. The causes of such defects included congenital aniridia, traumatic aniridia, and oculocutaneous albinism. Three eyes underwent primary implantations of a black diaphragm IOL, and three eyes were given secondary implantations. The visual acuity, subjective severity of glare, postoperative anatomical outcome and any intraoperative or postoperative complications were reviewed.Results The mean follow-up period was 20.6 months (range 3–29 months). All patients showed stable or improvement in best-corrected visual acuity postoperatively. Glare and photophobia had improved subjectively in all patients after implantation of the black diaphragm IOL. Intraoperative complication included one case of hyphaema and iris damage during insertion of the IOL. Postoperative complications included intraocular inflammation with choroidal detachment, secondary glaucoma, and persistent epithelial defect after surgery. None of the patients developed decentration of IOL after surgery.Conclusion The black diaphragm aniridia IOL is useful in the management of the condition in patients with iris deficiency including oculocutaneous albinism. Intraoperative and postoperative complications are not uncommon, and patients should be monitored carefully in the perioperative period.     

儿童带虹膜隔人工晶状体植入术的临床应用

目的：探讨带虹膜隔人工晶状体在儿童内障术后的应用。方法：对12例（12只眼）伴无虹膜或虹膜缺损的先天性或外伤性白内障儿童施行白内障注吸术和带虹膜隔人工晶状体植入术。结果：随访平均4．33月,所有病例的视力都较术前有所改善,其中8眼（66．675）的矫正视力≥0．1,最好者达0．6。术后并发症视网膜脱离1眼,严重色素膜炎2眼,人工晶状体移位3眼。结论带虹膜隔人工晶状体植入术是儿童无虹膜或虹膜缺损眼白内障术后的一种有铲的矫正无晶状体眼的方法。     

Coreoplasty and Artisan Intraocular Lens Implantation for Mydriasis and Aphakic Correction in Post-traumatic Vitrectomized Eyes

 PURPOSE: To evaluate the efficacy and safety of using coreoplasty, and an iris-supported Artisan intraocular lens (IOL), for mydriasis and aphakic correction in post-traumatic vitrectomized eyes. METHODS: A total of 17 aphakic patients were admitted between April 2009 and April 2010 to the ophthalmologic department of Xiamen Eye Center. All eyes had previously received lens removal and vitrectomy. After the retina stabilized and corrected visual acuity improved, the iris was sutured. The Artisan IOL was fixated onto the iris surface. Patients were followed-up at one day, one week, one month and three months postoperatively. The following outcomes were assessed: symptoms of photophobia and glare, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD). The diameter of pupil and the anterior chamber depth (ACD) were measured by the anterior segment optical coherence tomography (OCT). RESULTS: Artisan IOLs were successfully implanted in all aphakic eyes. Postoperatively, improvement was observed in photophobia and glare symptoms. UCVA was enhanced in all patients (six eyes had better UCVA postoperatively than BCVA preoperatively). However, there were no significant changes in IOP. Mean loss of ECD was 336.06/mm2. Mean postoperative pupil diameter was 3.67±0.41mm, compared with 5.67±0.57mm preoperatively (P<0.05). Mean ACD was reduced by 0.88mm (3.38±0.33mm preoperatively vs 2.50±0.35mm postoperatively, P<0.05). CONCLUSION: Surgery that combined coreoplasty and Artisan IOL implantation was a safe and effective treatment for correcting aphakia and mydriasis in post-traumatic vitrectomized eyes.     

Implantation of black diaphragm intraocular lenses in congenital and traumatic aniridia

PURPOSE: To evaluate the safety and efficacy of the black diaphragm intraocular lens (IOL) implantation for the treatment of congenital and traumatic aniridia. MATERIAL AND METHODS: Seven black diaphragmatic IOLs were implanted in the eyes of 6 patients between 1997 and 1998. There were 5 males and 1 female. The mean age of them was 42.8 years (range: 22-54 years). Follow-up ranged from 9 to 20 months (mean: 14.2 months). Traumatic aniridia was present in 4 eyes and congenital aniridia in 3 eyes. Pars plana vitrectomy was combined with the simple outside-in method of scleral fixation of IOLs in 6 cases. Three of these eyes were aphakic (all with traumatic aniridia) and in 3 eyes (two congenital cases, one traumatic case) subluxated lens was simultaneously removed. In one case of congenital aniridia with mature cataract, ECCE and ciliary sulcus implantation without scleral fixation were performed. RESULTS: There were very few complications. Ciliary sulcus bleeding appeared in 2 cases during scleral fixation. Transient post-operative corneal oedema was observed in 2 eyes, raised intraocular pressure in 3 eyes, and dispersed blood in vitreous cavity in 2 eyes. All IOLs were well centred. The improvement in best corrected visual acuity was achieved in 5 cases, while good pre-operative best corrected visual acuity was maintained in 2 cases. CONCLUSIONS: Diaphragmatic IOL can be fixated to the sclera in cases without capsular support or it can be implanted into ciliary sulcus after ECCE. Reconstruction of 5 mm pupil and intraocular correction of aphakia enable good visual rehabilitation of patients. The combined procedure of pars plana vitrectomy and scleral fixation of diaphragmatic lens is safe and effective in traumatic and congenital aniridia.     

Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia

PURPOSE: To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. METHODS: Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). RESULTS: Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. CONCLUSIONS: Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.     

Artisan lens implantation to correct aphakia after vitrectomy for retained nuclear lens fragments

PURPOSE: To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan intraocular lens (IOL) (Ophtec) to correct aphakia. SETTING: University-based referral center. METHODS: In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed. RESULTS: Thirteen patients were identified. The preoperative visual acuity was better than 20/200 in 5 patients and the intraocular pressure (IOP) was higher than 21 mm Hg in 8 patients; 3 patients had normal corneas. In 4 patients, an Artisan IOL was implanted during cataract surgery. Postoperative complications included recurrent erosion (1 eye), premacular fibrosis (2 eyes), and a retinal tear (1 eye). Elevation of the IOP occurred in 2 patients and was controllable with medication. Pupillary block developed in 1 patient and persistent cystoid macular edema in another. All but 2 patients gained more than 2 lines of visual acuity postoperatively, and all corneas remained clear during the follow-up (mean 28.9 months; range 2.5 to 69.0 months). CONCLUSIONS: After the removal of dislocated lens fragments with a PPV, Artisan IOL implantation in aphakic patients without capsule support led to few complications and good visual acuity. Placement of an Artisan IOL requires fewer manipulations than transscleral suture fixation of a posterior chamber IOL.     

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.     

【In Press】Complications and outcomes of descemet stripping automated endothelial keratoplasty with Artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with Artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with Artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema, and hyphema. Best-corrected visual acuity (BCVA), IOP, and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, and 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with Artisan aphakia intraocular lens implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.     

巩膜缝线固定后房型人工晶状体术后低眼压的处理

目的探讨复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除术的患者,Ⅱ期巩膜缝线固定人工晶状体植入术后低眼压的发生原因及其处理方法。方法回顾性分析于2003年6月至2004年12月作者早期开展Ⅱ期巩膜缝线固定人工晶状体植入术共34例(34眼),其中3眼是虹膜隔型人工晶状体,6眼同期行虹膜修补瞳孔成形术。结果本组34眼中有8眼(23.53%)术后发生低眼压,其中4眼为一过性低眼压,术后5~7 d前房黏弹剂再注入后,眼压逐渐恢复正常;另4眼伴有脉络膜脱离,其中3眼经皮质类固醇治疗后眼压恢复,1眼术后10 d行脉络膜上腔放液及注气术,眼压恢复。术后视力提高者32眼(94.1%)。随访6~18个月,人工晶状体均无明显倾斜偏位,视网膜脱离无复发。结论对于复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除的患者,Ⅱ期巩膜缝线固定人工晶状体植入,术后低眼压是较易发生的并发症,经治疗可以恢复。     

Traumatic pediatric cataract: A decade of follow-up after Artisan aphakia intraocular lens implantation

PURPOSE: To describe the long-term clinical outcome of Artisan((R)) aphakia intraocular lens (IOL; Ophtec, Groningen, The Netherlands) implantation in five aphakic eyes of five children, without capsular support, after cataract extraction following penetrating ocular trauma. METHODS: The charts of the five children were retrospectively reviewed. The data collected included follow-up time, nature of injury, age at cataract extraction and IOL implantation, visual outcome, endothelial cell counts, complications, and subsequent surgical interventions. RESULTS: Average follow-up was 11.0 years (range, 8.0-14.6 years). All eyes had a corneal perforation with various degrees of anterior segment injury. Mean patient age at lens extraction was 7.8 years (range, 5.6-10.2 years). Mean age at Artisan aphakia IOL implantation was 7.9 years (range, 5.7-10.2 years). The best spectacle-corrected visual acuity at last follow-up was 20/40 or better in four eyes. Mean endothelial cell loss compared with the healthy fellow eye was 40%. No patients experienced IOL dislocation, corneal decompensation, chronic anterior uveitis, cystoid macular edema, or iris atrophy. One eye had a retinal detachment 19 months after primary injury and needed vitreoretinal surgery. CONCLUSIONS: The Artisan aphakia IOL offers a useful alternative for correction of traumatic childhood aphakia. Although we only have results of a small number of patients, taking into account our long follow-up period, we feel that implantation of the Artisan aphakia IOL can be considered a treatment option in aphakic eyes of children that lack capsular support due to trauma.     

8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术在无晶状体眼中的应用

目的：观察8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术在无晶状体眼中的临床效果。

方法：回顾性病例研究。收集2021-01/2022-11于我院行人工晶状体悬吊术的无晶状体患者30例31眼(其中男22例22眼)的临床资料，术中均采用8-0聚丙烯缝线巩膜双联结缝合法固定人工晶状体(AcrySof IQ或Tecnis ZCB00)，术后至少随访6 mo，观察所有患者视力、眼压、术后人工晶状体位置和术中术后并发症发生情况。

结果：术前术眼裸眼视力(UCVA，LogMAR)和最佳矫正视力(BCVA，LogMAR)分别为2.53±0.78和0.35±0.26，术后6 mo分别为0.58±0.26和0.36±0.27，手术前后UCVA比较有差异(t=15.408，P<0.01)，BCVA比较无差异(t=-1.677，P=0.104)。术中未出现并发症。术后所有人工晶状体位置均居中，出现人工晶状体倾斜3眼，术后发生高眼压2眼、角膜水肿5眼、缝线外露1眼。术后未出现前房积血、玻璃体积血、黄斑水肿、角膜内皮失代偿、低眼压、脉络膜脱离、视网膜脱离、爆发性脉络膜上腔出血、眼内炎等并发症。

结论：8-0聚丙烯缝线巩膜双联结缝合固定人工晶状体悬吊术早期可提高无晶状体患者的术后视力、并发症较少，可作为治疗无晶状体、晶状体脱位、悬韧带异常患者的一种手术方式选择。     

外伤性虹膜缺如眼植入虹膜隔人工晶状体后的远期并发症

目的 分析外伤性虹膜缺如患者植入虹膜隔人工晶状体后的远期并发症,探讨其发生原因及预防措施.方法 回顾性系列病例研究.回顾性分析因外伤性虮膜缺如在山东省眼科研究所青岛眼科医院行虹膜隔人工晶状体植入术并在长期随访过程中出现严重并发症的5例患者的资料,归纳其临床特点.其中男性4例,女性1例,年龄13～43岁,随访时间42-108个月.2例于睫状体扁平部玻璃体切除术后行Ⅱ期虹膜隔人工晶状体悬吊术,2例Ⅰ期行白内障摘除联合虹膜隔人工晶状体植入术,1例行虹膜隔人工晶状体悬吊术.结果 所有患者短期随访主观感觉良好,眩光、畏光症状消失,并在一定时期内维持较好的视力.在长期随访过程中均出现了严重的继发性青光眼和大泡性角膜病变,视力下降至指数或手动,并接受穿透性角膜移植和人工晶状体取出术治疗.结论 虹膜隔人工晶状体植入术后可能出现严重的远期并发症,应慎重选择手术适应证,并加强对患者的随访.     

Implantation of iris devices in congenital and traumatic aniridias: surgery solutions and complications

PURPOSE: To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up. METHODS: Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months). RESULTS: All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve. CONCLUSIONS: Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.     

带虹膜隔人工晶状体在严重眼外伤中的应用价值

目的 探讨带虹膜隔人工晶状体在外伤性无虹膜无晶状体眼中的应用价值。方法 2000年4月～2003年4月应用Morcher公司生产的带虹膜隔人工晶状体治疗13例严重外伤后无虹膜无晶状体眼．均行人工晶状体二期植入术。探讨带虹膜隔人工晶状体植入术的适应证、手术方法、并发症防治及效果。结果 所有病例畏光症状改善或消失，视力均有不同程度的提高。结论 带虹膜隔人工晶状体治疗严重外伤后无虹膜眼有重要的临床意义，不仅畏光症状改善或消失，而且重建了眼前段，挽救了濒于残疾的伤眼，获得了较好的视力。