ICU人工晶状体植入术后的早期临床效果

目的:比较白内障超声乳化术联合ICU(德国HumanOptics公司)可调节人工晶状体植入术后效果与传统单焦后房型UV型(日本HOYA公司)人工晶状体植入术后效果之间的差异。方法:所有患者均行白内障超声乳化联合人工晶状体植入术。比较18例(20眼)患者ICU可调节人工晶状体植入及20例(20眼)患者UV型后房型人工晶状体植入术后1wk、1mo时的裸眼远视力、最佳矫正远视力、近视力(35cm)及矫正远视力的近视力(35cm)、主观调节近点、10g/L硝酸毛果芸香碱滴眼30min后利用A型超声波测量前房深度(anterior chamber depth,ACD)变化等多项指标之间的差异。结果:两组数据间比较,除术后远视力及最佳矫正远视力无显著性差异外,其它指标间比较均有非常显著性差异(P<0.01)。结论:ICU可调节人工晶状体相对于传统单焦后房型人工晶状体具有更高调节力、更佳的近视力,同时也具有良好的远视力。但术后调节幅度有限,长期效果如何有待进一步观察、研究。     

A survey of intraocular lens explantation: a retrospective analysis of 23 IOLs explanted during 2005

PURPOSE: To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. METHODS: The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. RESULTS: Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562+/-0.279 and 0.627+/-0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). CONCLUSIONS: The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.     

Hydrophilic acrylic intraocular lens exchange: Five-year experience

PURPOSE: To evaluate clinical outcomes of opacified SC60B-0UV intraocular lens (IOL) (MDR, Inc.) and clear SC60B-0UV IOL exchange. SETTING: Department of Ophthalmology, Queen's Hospital, Burton-on-Trent, United Kingdom. METHODS: In a prospective audit, 149 patients with 152 SC60B-0UV hydrophilic acrylic IOLs were monitored over 5 years. Perioperative complications were evaluated. The best spectacle-corrected visual acuity, subjective quality of vision, and VF-14 scores were compared preoperatively and postoperatively. RESULTS: Ninety-eight IOLs developed opacification; 52 IOLs were exchanged between February 1999 and October 2004. The lens exchange procedure was uneventful in 39 eyes (75%). Perioperative complications included zonular dehiscence and posterior capsule rupture in 12 eyes (23.1%), total capsule-IOL extraction in 4 eyes (7.7%), iridodialysis in 3 eyes (5.8%), hyphema in 2 eyes (3.8%), and retained haptics in 5 eyes (9.6%). The mean logMAR visual acuity and mean VF-14 scores improved significantly after IOL exchange (P < .01). Forty-seven patients (90.4%) reported improvement in the subjective quality of vision after IOL exchange. However, after the exchange, visual acuity worsened in 5 patients (9.6%) and subjective quality of vision worsened in 3 patients (5.8%); the VF-14 scores decreased in 5 (14.7%) of the 34 patients tested. CONCLUSIONS: Visual function and quality of life were better after IOL exchange. However, poor outcomes in some patients mandate an extensive informed consent procedure for clear IOL exchange.     

Clinical features of 46 eyes with calcified hydrogel intraocular lenses.

PURPOSE: To clarify the clinical features of delayed calcification of hydrogel intraocular lenses (IOLs) based on observation of a large case series. SETTING: Ophthalmology department of 2 university teaching hospitals, Hong Kong, China. METHODS: The first 44 patients with a known diagnosis of calcified IOL were recruited. Medical and ophthalmic histories were obtained. Surgical details, surgical complications, and visual acuity before and after IOL implantation were also retrieved. Patients then had a visual acuity test, a slitlamp examination of the features of the IOL calcification, and a fundus examination for clarity of view. RESULTS: Forty-six eyes of 44 patients had IOL calcification. All had a Hydroview IOL. The onset was from 4 to 26 months after surgery. Ninety-three percent of eyes had generalized IOL calcification, and 96% had forceps marks on the IOL. Mean visual acuity deteriorated from 0.4 at 3 months to 0.13 at 19 months. Visual loss was more severe in patients with diabetes mellitus or ischemic heart disease and in those in which the IOL calcified earlier after implantation. CONCLUSION: All cases of IOL calcification were delayed in onset. The presence of forceps marks may provide a clue to the pathogenesis. Bilateral but asymmetric involvement in 2 patients suggests that the IOL was involved in the pathogenesis. Affected patients lost an average of 2.8 Snellen lines of visual acuity. Some eyes progressed more rapidly; however, the modulating factors remain unknown.     

Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses

PURPOSE: To evaluate the perioperative complications of intraocular lens (IOL) exchange in 25 eyes of 22 patients with opacified Aqua-Sense IOLs (Ophthalmic Innovations International). SETTING: Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom. METHODS: The study comprised 22 patients (25 eyes) who had previous phacoemulsification and implantation of Aqua-Sense single-piece hydrophilic acrylic IOLs in the capsular bag and developed severe late opacification of the IOL. All patients reported glare and deterioration in vision. The IOLs were explanted and replaced with new lenses. The perioperative complications were evaluated. The best corrected visual acuity (BCVA) before and after surgery was compared. RESULTS: In 24 eyes, the opacification was complete, involving the optic, haptics, and substance of the IOLs. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 13 eyes (52%). Complications occurred in the remaining 12 eyes (48%). Ten eyes (40%) developed zonular dehiscence, 4 (16%) of which were managed with anterior chamber IOL implantation. One eye (4%) developed posterior capsule rupture and 1 eye (4%), posterior capsule rupture and zonular dehiscence. The cornea decompensated in 2 eyes (8%). One eye (4%) developed Pseudomonas keratitis. The mean BCVA (decimal scale) before and after IOL exchange was 0.57 +/- 0.24 and 0.60 +/- 0.28, respectively. There was no significant difference in visual acuity between before and after IOL exchange (P=.782, paired t test). CONCLUSIONS: Explantation of Aqua-Sense IOLs was challenging because of the tight adherence of the optic and haptics to the capsule. Long-term follow-up of patients with Aqua-Sense IOLs should be maintained.     

Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens

OBJECTIVE: To report clinical, pathological and histochemical features of 5 Hydroview intraocular lenses (IOLs) explanted from five patients who had visual disturbances caused by postoperative deposits on the lens surfaces. DESIGN: Noncomparative small case series with clinicopathologic and histochemical correlations. PARTICIPANTS: Five hydrophilic IOLs explanted from five different patients. All patients presented with decreased visual acuity and glare circa 12 months after uneventful phacoemulsification and IOL implantation, associated with a red-brown granularity on the optical surfaces of the IOLs. METHODS: The lenses were explanted, fixed in buffered formaldehyde and examined by gross and light microscopy. MAIN OUTCOME MEASURES: Staining of the IOLs with 1% alizarin red and with the von Kossa method (both stains for calcium). Two additional IOLs were also stained and included as controls. RESULTS: The optical surfaces of all five IOLs were covered by a layer of irregular granular deposits, composed of multiple fine, translucent spherical-ovoid granules. The deposits stained positive for calcium in all cases. No deposit or positive staining was observed on the IOLs haptics. Staining of the control IOLs was also negative. CONCLUSION: This is the first histopathological report of calcified deposits on the surfaces of this hydrogel IOL model. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.     

Prospective visual evaluation of apodized diffractive intraocular lenses

PURPOSE: To evaluate distance, intermediate, and near visual performance in patients who had multifocal apodized diffractive intraocular lens (IOL) implantation. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The best corrected distance visual acuity, best distance-corrected near visual acuity, intermediate visual acuity, distance contrast sensitivity under photopic and mesopic conditions, and patient satisfaction were measured in 325 patients and 335 patients who had bilateral implantation of the model SA60D3 IOL (AcrySof ReSTOR, Alcon) and model SN60D3 IOL (AcrySof Natural ReSTOR), respectively. RESULTS: At the 6-month postoperative visit, binocular best corrected distance acuity with the ReSTOR IOL and the Natural ReSTOR IOL was 0.034 logMAR+/-0.004 (SD) and 0.019+/-0.020 logMAR, respectively (approximately 20/20). Binocular best distance-corrected near acuity was 0.011+/-0.012 logMAR and 0.035+/-0.013 logMAR, respectively (approximately 20/20). Intermediate visual acuity with both IOL models worsened significantly as a function of the distance of the test (P<.01). Photopic contrast sensitivity was within the standard normal range with both IOLs. Under mesopic conditions, contrast sensitivity with both IOLs was comparable to that with monofocal IOLs and lower, particularly at higher spatial frequencies, than under photopic conditions. No statistically significant differences in visual acuity or photopic and mesopic contrast sensitivity were found between the 2 IOL models (P>.1). A patient satisfaction questionnaire showed that both IOLs performed well and were comparable in satisfaction regarding distance, intermediate, and near activities under different lighting conditions. CONCLUSIONS: The AcrySof ReSTOR IOL and AcrySof Natural ReSTOR IOL provided good visual performance at distance and near under photopic and mesopic conditions. Intermediate vision with both models was reduced compared with distance and near vision.     

Early visual results with the 1CU accommodating intraocular lens

PURPOSE: To prospectively assess the clinical outcome after implantation of the 1CU accommodating intraocular lens (IOL) and a foldable acrylic IOL (AcrySof, Alcon). SETTING: Department of Ophthalmology, Tokyo Dental College, Ichikawa Hospital, Ichikawa, and Minami Aoyama Eye Clinics, Tokyo, Yokohama, Japan. METHODS: Twenty-two eyes of 16 patients with cataract had phacoemulsification implantation of 1CU accommodating IOL. Twenty eyes of 10 age-matched and sex-matched patients with cataract had the same surgery but with a foldable acrylic IOL. All patients had assessments of the amplitude of accommodation, refraction, uncorrected and best corrected distance and near visual acuity, and distance corrected near visual acuity before surgery up to 12 months after surgery. Contrast visual acuities were measured 1 year after surgery. Anterior segment photography, intraocular pressure measurements, specular microscopy, and computerized topography were also performed. RESULTS: The final best corrected distance visual acuity was above 20/25 in all eyes with the 1CU and the AcrySof IOLs. The mean distance corrected near visual acuity was significantly higher in the 1CU IOL group than in the acrylic IOL group after 3 months. None of the eyes with the AcrySof IOL implants displayed an accommodative response at any examination. The peak mean amplitude of accommodation with the 1CU IOLs was observed at 3 months and was 0.5 diopters +/- 0.44 (SD). Accommodation amplitude declined after 6 months. CONCLUSION: The 1CU IOL provided additional near acuity postoperatively, but the benefit disappeared at 12 months with a concomitant decrease in accommodation amplitude owing to an increase in anterior and posterior capsular opacities.     

Acrysof Toric IOL 植入矫正白内障患者角膜散光的早期临床效果研究

目的评价白内障患者超声乳化术中植入 Acrysof Toric IOL 矫正术前规则角膜散光的早期临床效果、有效性、安全性和预测性.方法本研究收集2010年8月至2011年10月期间于南京爱尔眼科医院就诊,行白内障超声乳化术并植入 Acrysof Toric IOL 的白内障患者27例(34只眼).主要观察指标:术前术后的裸眼视力,最佳矫正视力,角膜散光,术后残留散光,IOL 轴位等.随访3个月.结果患者术后3个月裸眼视力(0.68±0.12)较术前(0.11±0.17)有明显提高,且差异具有统计学意义.术后3个月散光(0.45±0.20) D 较术前散光(2.13±0畅35) D 减少,且差异具有统计学意义.与预测残余散光(0.23±0.14) D 比较,差异无统计学意义.术后3个月Toric IOL 轴位旋转为5.0°±1.6°,其中32只眼(94%)小于8°.无1例发生术中或术后并发症.结论年龄相关性白内障伴术前规则角膜散光患者,超声乳化术中植入 Acrysof Toric IOL 是一种有效、安全、可预测的矫正的方法.     

Subjective and objective performance of the Lenstec KH-3500 "accommodative" intraocular lens

AIM: To determine whether eyes implanted with the Lenstec KH-3500 "accommodative" intraocular lenses (IOLs) have improved subjective and objective focusing performance compared to a standard monofocal IOLs. METHODS: 28 participants were implanted monocularly with a KH-3500 "accommodative" IOL and 20 controls with a Softec1 IOL. Outcome measures of refraction, visual acuity, subjective amplitude of accommodation, objective accommodative stimulus response curve, aberrometry, and Scheimpflug imaging were taken at approximately 3 weeks and repeated after 6 months. RESULTS: Best corrected acuity with the KH-3500 was 0.06 (SD 0.13) logMAR at distance and 0.58 (0.20) logMAR at near. Accommodation was 0.39 (0.53) D measured objectively and 3.1 (1.6) D subjectively. Higher order aberrations were 0.87 (0.85) microm and lower order were 0.24 (0.39) microm. Posterior subcapsular light scatter was 0.95% (1.37%) greater than IOL clarity. In comparison, all control group measures were similar except objective (0.17 (0.13) D; p = 0.032) and subjective (2.0 (0.9) D; p = 0.009) amplitude of accommodation. Six months following surgery, posterior subcapsular scatter had increased (p<0.01) in the KH-3500 implanted subjects and near word acuity had decreased (p<0.05). CONCLUSIONS: The objective accommodating effects of the KH-3500 IOL appear to be limited, although the subjective and objective accommodative range is significantly increased compared to control subjects implanted with conventional IOLs. However, this "accommodative" ability of the lens appears to have decreased by 6 months post-surgery.     

Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses

Background

To evaluate the perioperative complications and the outcomes of intraocular lens (IOL) exchange in patients with opacified lenses.

Methods

Retrospective multicentrical consecutive series of cases that comprised 22 eyes from 21 patients who had previous phacoemulsification with implantation of an IOL in the capsular bag and developed severe late opacification of the IOL. All patients had loss of vision and reported light disturbances. The IOLs were explanted and replaced with new IOLs. The perioperative complications were evaluated. The best spectacle-corrected visual acuity (BSCVA) before and after the surgery was compared.

Results

The mean time lapsed between the original cataract surgery and the IOL exchange surgery was 89.1?±?33.6 [48–216] months. The IOL exchange was uneventful in 14 eyes (63.6 %). Anterior vitrectomy was needed in seven cases (31.8 %). Other complications included zonular dehiscence in one case (4.5 %). In most of the cases, 14 eyes (63.6 %), the IOL was implanted in the sulcus. The most explanted IOL was the Hydroview H60M (Bausch & Lomb). The mean BSCVA (LogMAR) before and after the surgery were 0.57?±?0.69 (0.10–3) and 0.18?±?0.22 (0.0–1.10) respectively (t paired test, p?<?0.001). After the operation, 20 eyes (90.9 %) achieved a BSCVA?≤?0.3. No eye lost 1 or more lines of corrected vision after the surgery.

Conclusions

IOL exchange surgery, although associated with a high incidence of complications, restores and significantly improves the visual acuity of patients with opacified IOLs.     

水凝胶折叠式人工晶状体远期混浊的观察

目的 实验室及临床观察分析超声乳化白内障吸除联合水凝胶折叠式人工晶状体(IOL)植入术后远期发生混浊的原因.方法 对4例(4只眼)超声乳化白内障吸除联合水凝胶折叠式IOL植入术后12.0～96.0个月(平均33.2个月)发生IOL混浊的患者进行临床观察.其中2例(2只眼)患者行IOL置换术,取出的2枚IOL进行钙特异性茜素红染色病理学检查,用扫描电镜观察混浊IOL表面沉淀物的位置和形态,应用能谱分析法检测沉淀物中的元素成分.结果 裂隙灯显微镜下见白色细小颗粒沉积于IOL前表面.电镜扫描可见有层次感、上下交错,如珊瑚样的颗粒附着于IOL表面.茜素红染色见钙结节和非特异性染色的细胞,能谱分析证实颗粒中含钙和磷元素.结论 水凝胶折叠式IOL表面混浊为颗粒状钙和磷化合物沉淀结晶所致,可能与水凝胶IOL材料易于发生钙磷沉积有关,但确切的发生机制还待更进一步研究.     

Clear lens extraction with intraocular lens implantation for hyperopia.

PURPOSE: Current surgical options for the correction of moderate to severe hyperopia include hyperopic laser in situ keratomileusis (LASIK), phakic intraocular lens implantation and clear lens extraction with intraocular lens (IOL) implantation. We investigate the safety and efficacy of clear lens extraction with IOL implantation to correct hyperopia. METHODS: Phacoemulsification and IOL implantation was performed on 18 eyes of 10 patients. In 16 eyes, the Hoffer-Q formula was used for IOL power calculation and a single IOL was inserted; in the remaining 2 nanophthalmic eyes, the Holladay-II formula was used and two piggy-back IOLs were inserted. RESULTS: Mean preoperative spherical equivalent for distance was +6.17 D (range, +4.25 to +9.62 D). Patients were followed postoperatively for a mean of 10.5 months (range, 4 to 27 mo). Uncorrected visual acuity in all eyes was 20/50 or better with a median uncorrected visual acuity of 20/40 (range, 20/30 to 20/50). Two patients lost 2 lines of spectacle-corrected visual acuity; both of these patients achieved spectacle-corrected visual acuity of 20/30. CONCLUSIONS: Clear lens extraction with IOL implantation is a safe and effective procedure for the correction of moderate to severe hyperopia in the presbyopic age range.     

Postoperative opacification of 12 hydrogel foldable lenses (Hydroview(R))]

BACKGROUND: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS: 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS: Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.     

Visual acuity after penetrating keratoplasty for pseudophakic and aphakic bullous keratopathy

PURPOSE: To identify prognostic factors that determine the visual acuity after penetrating keratoplasty (PKP) for bullous keratopathy secondary to cataract surgery. SETTING: Department of Ophthalmology, University Hospital Antwerp, Antwerp, Belgium. METHODS: Twenty-six patients who had PKP for bullous keratopathy were examined before and after surgery. The patients were divided into 3 groups: pseudophakic bullous keratopathy (PBK) after cataract extraction with implantation of a posterior chamber intraocular lens (PC IOL) (Group 1) or an anterior chamber IOL (AC IOL) (Group 2); aphakic bullous keratopathy (ABK) (Group 3). The following parameters were recorded: preoperative and postoperative visual acuity, age at the time of surgery, interval between cataract surgery and development of bullous keratopathy, presence of an AC IOL or a PC IOL, aphakia, and presence of concomitant ocular pathology. RESULTS: Visual acuity improved in Group 1 (0.02 to 0.26); no visual improvement was observed in the other groups. Posterior segment damage occurred in one third of the patients in Group 1 and in all patients in the other groups. Patients with an intact posterior segment had a significantly better visual outcome. In eyes without posterior segment pathology, visual acuity improved from a mean of 0.03 (range 0 to 0.20) to a mean of 0.37 (range 0.03 to 0.90). In eyes with posterior segment pathology, no visual acuity improvement could be obtained. CONCLUSIONS: The most important negative prognostic factors affecting visual acuity were the presence of concomitant ocular pathology, an AC IOL, and a long interval between surgery and the development of bullous keratopathy.     

Near vision restoration with refractive lens exchange and pseudoaccommodating and multifocal refractive and diffractive intraocular lenses: comparative clinical study

PURPOSE: To evaluate near visual performance after implantation of a pseudoaccommodating intraocular lens (IOL) (Crystalens AT-45, eyeonics) or a multifocal IOL (refractive model, AMO Array; diffractive model, AcriTec TwinSet) after lens surgery. SETTINGS: Instituto Oftalmologico de Alicante, Miguel Hernandez University, Alicante, Spain. METHODS: Forty patients were included in this prospective clinical comparative study. The patients were divided into 3 groups according to the type of IOL implanted. Group 1 included 24 eyes (12 patients) implanted with the Crystalens IOL; Group 2, 32 eyes (16 patients) with the Array IOL, and Group 3, 24 eyes (12 patients) with the TwinSet IOL. Bilateral phacoemulsification and IOL implantation were performed in all patients, and the follow-up was 1 year. The postoperative main visual outcome evaluations were uncorrected and best corrected distance and near visual acuities, mean add for near, and best distance-corrected near acuity. RESULTS: In Group 1, the mean uncorrected near acuity was 20/40 preoperatively and 20/25 after 1 year. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 2, the mean uncorrected near acuity was 20/40 and 20/25, respectively. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 3, the mean uncorrected near acuity was 20/63 preoperatively; after 1 year, it was approximately 20/25. The mean best distance-corrected near acuity was 20/50 and 20/25, respectively. A neodymium:YAG laser capsulotomy was performed for posterior capsule opacification when required, with no change in the refractive outcome. CONCLUSIONS: Implantation of multifocal and pseudoaccommodating IOLs provides adequate near vision restoration. The TwinSet IOL provided faster recovery of near vision than the other 2 IOLs. The Crystalens IOL provided less postoperative visual phenomena with favorable near vision. The Array IOL achieved the most comfortable distance and near vision.     

Pseudophakia and polypseudophakia in the first year of life.

PURPOSE: To report a consecutive series of patients undergoing intraocular lens (IOL) implantation in the first year of life. A new procedure, referred to as temporary polypseudophakia, is reported. METHODS: A retrospective chart analysis was conducted. Ocular growth and refractive change, complications and reoperation rates, and outcomes were analyzed. RESULTS: Forty-seven eyes of 33 patients underwent IOL implantation in the first year of life. Average follow-up was 22 months (range, 7 weeks to 5 years). Thirty-two eyes of 22 patients had a single IOL implanted from 12 days to 11 months of age. Fifteen eyes of 11 infants received piggyback IOLs from 16 days to 6.8 months of age. Reoperation for complications within the anterior segment of the eye was needed in 23% of all patients (22% for single IOLs, 26% for piggyback IOLs). The average first postoperative refraction after single IOL was +7.98 D and after piggyback IOL was +1.67 D. The average last postoperative refraction was +1.76 D and -4.48 D, respectively. On average, eyes grew 2.68 mm over 17.5 months of follow-up. Eight patients were old enough for Snellen visual acuity, but each had deprivation amblyopia with visual acuities from 20/85 to 5/200. Of the remaining 25 patients, 17 had central, steady, and maintained fixation in the implanted eyes. CONCLUSION: IOL implantation in infancy is technically feasible and associated with a reoperation rate of approximately 25% in the first 2 years after implantation. Further follow-up is required before meaningful visual acuity data and long-term results can be reported.     

Depth of focus in eyes with diffractive bifocal and refractive multifocal intraocular lenses

PURPOSE: To evaluate monocular and binocular depth of focus in eyes with different multifocal intraocular lens (IOLs) systems. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In this comparative interventional study, binocular implantation of multifocal IOLs was performed in 3 groups. In the first group, 26 eyes of 13 patients received asymmetric Acri.Twin (Acri.Tec) IOLs, a near-weighted 733D in 1 eye and a distance-weighted 737D in the fellow eye. In the second group, 26 eyes of 13 patients received a diffractive 811E IOL (Pharmacia). In the third group, 26 eyes of 13 patients received a refractive Array IOL (AMO). The visual acuity was tested monocularly and binocularly starting at 6 m in 0.50 diopter (D) defocusing steps. RESULTS: Distance visual acuity was best in eyes with the distance-dominated 737D IOL; eyes with the other IOLs had comparable results. Binocular distance visual acuity was comparable between the Acri.Twin group and the 811E group. The Acri.Twin group had better distance visual acuity than the Array group (P< or =.048). Near visual acuity was best in eyes with the near-weighted 733D, followed by the 737D and the 811E. Patients with Array IOLs had worse visual acuities at reading distance (between 33 cm and 40 cm) (P< or =.001). Patients with diffractive bifocal IOLs had better results than patients with refractive multifocal IOLs at reading distance (P< or =.018). CONCLUSION: The diffractive IOLs performed better than refractive IOLs. Asymmetric-weighted IOLs provided better binocular depth of field.     

Complications of foldable intraocular lenses requiring explantation or secondary intervention--2001 survey update

A survey of the complications associated with foldable intraocular lenses (IOLs) that required explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were assessed. Postoperative results and outcomes were also analyzed. Complications and symptoms for each of the following major groups of foldable IOLs explanted were tabulated separately: 3-piece hydrophilic acrylic or hydrogel; 3-piece monofocal silicone; 3-piece hydrophobic acrylic; 1-piece hydrophobic acrylic with haptics; 3-piece multifocal silicone; 1-piece plate-type silicone. A total of 286 surveys were returned for evaluation. Intraocular lens calcification, incorrect lens power, optical visual aberrations, and decentration/dislocation were the most common reasons for removing a foldable IOL. Accurate IOL measurements, meticulous surgical technique, proper patient counseling, and careful manufacture of foldable IOL materials are the most important factors in avoiding complications with foldable IOLs.     

巩膜固定囊袋张力环联合超声乳化人工晶状体植入术治疗外伤性晶状体半脱位

目的：探讨巩膜固定囊袋张力环(SFCTR)植入联合晶状体超声乳化吸除加人工晶状体(IOL)植入术治疗外伤性晶状体半脱位的临床疗效。

方法：连续选取2018-12/2023-02行SFCTR植入联合晶状体超声乳化吸除加IOL植入术治疗的外伤性晶状体半脱位患者14例14眼。术后随访行视力、眼压、眼前段照相、超声生物显微镜(UBM)等检查,并记录IOL的位置及术后并发症等情况。

结果：纳入患者均成功植入SFCTR和囊袋内IOL。术后平均随访1.92±1.36 a,末次随访时,UDVA(0.20±0.18 LogMAR)和CDVA(0.16±0.17 LogMAR)均较术前UDVA(1.13±0.56 LogMAR)显著改善(P<0.01),眼压(17.64±3.67 mmHg)较术前(22.00±9.92 mmHg)降低(P<0.05)。随访期间,裂隙灯检查见IOL位于囊袋内,位置居中; UBM检查见CTR和IOL位于囊袋内,囊袋赤道部与睫状突的距离在各个方向相等。

结论：SFCTR植入联合晶状体超声乳化吸除加IOL植入术是治疗外伤性晶状体半脱位的一种微创有效的手术方法。