Outpatient anterior chamber lens implantation

100 outpatient and 143 inpatient intracapsular cataract extractions with anterior chamber lens implantation were examined 6 months post-operatively. 74 (74%) in the former and 107 (75%) in the latter achieved visual acuity greater than or equal to 0.5. Excluding non-surgical pathology, 93% in the outpatient group and 98% in the inpatient group had a visual acuity greater than or equal to 0.5 (P = 0.12). There were no significant differences in post-operative complications except for the incidence of cystoid macular edema. Six (6%) of the outpatient and 1 (0.7%) of the inpatient procedures had cystoid macular edema that resulted in a visual acuity below 0.5 (P = 0.02).     

门诊人工晶体植入术

报道门诊白内障囊外摘除及后房型人工晶体植入术治疗113例(124只眼)老年性白内障的结果.随访半年,未矫正视力≥0.5者占65.83%;矫正视力≥0.5者占93.33%,≥1.0者占82.50%.术中的并发症有玻璃体溢出、皮质残留、虹膜根部离断、角膜后弹力层撕脱,术后的并发症包括后囊膜混浊、虹膜粘连、人工晶体偏位.术后视力和并发症与住院者无异.结果表明手术是安全的.作者探讨了门诊人工晶体植入术的优缺点和进一步完善的措施.     

655例白内障超声乳化联合人工晶状体植入术的临床观察

目的探讨超声乳化联合人工晶状体植入术对老年性白内障患者的手术治疗效果。方法对655例(655眼)老年性白内障患者行白内障超声乳化联合人工晶体植入术,观察术后裸眼视力恢复情况及术后并发症。结果患者术后1d裸眼视力≥0.5者256眼占39.08%,术后3天复查裸眼视力≥0.5者419眼占63.97%。655例患者裸眼视力均有不同程度提高,手术后主要并发症为角膜水肿,无其他严重并发症。结论超声乳化联合人工晶体植入术是治疗老年性白内障的有效手术方法,疗效确切,手术中规范操作可减少术后并发症的发生。     

小切口手法碎核白内障摘除术治疗白内障合并高度近视

目的:观察小切口手法碎核白内障摘除术治疗白内障合并高度近视的临床效果和安全性。方法:对61例78眼采用小切口手法碎核白内障摘除术联合低度数大直径人工晶状体植入术,观察术后视力,屈光状态及手术并发症。术后随访6～24mo。结果:78眼均成功植入人工晶状体,视力都有不同程度的提高,术后3mo时最佳矫正视力<0.1者2眼,0.1～0.4者26眼,>0.4者50眼;大部分患者残留低度的近视屈光状态;后囊膜混浊12眼;术中未发生前囊膜撕裂和后囊膜破裂等并发症;无视网膜脱离和黄斑囊样水肿的发生。结论:小切口手法碎核白内障摘除术联合低度数大直径人工晶状体植入术治疗白内障合并高度近视,具有临床效果佳、手术安全性高及并发症少的优点,在经济条件相对落后的地区,值得推广应用。     

Outcomes of acute postoperative inflammation after cataract surgery

PURPOSE: To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications. METHODS: This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied. RESULTS: Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity. CONCLUSIONS: Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels.     

超声乳化白内障摘除术与小切口非超声乳化白内障摘除术的疗效观察

目的:比较分析超声乳化白内障摘除术与小切口非超声乳化白内障摘除术的手术方法和疗效。方法:将2009-01/12在我院住院治疗的125例158眼老年性白内障随机分为两组,其中A组80眼行超声乳化白内障摘除术;B组78眼行小切口非超声乳化白内障摘除术,比较两组手术后1,7d;1,3mo的视力、散光及术中术后的并发症情况。结果:两组在各时间点的视力、散光及术中术后并发症情况上差异均无统计学意义。结论:两种手术方式疗效相近,可根据临床具体情况选择合适术式。     

Surgery of idiopathic epimacular membranes. Prognostic factors]

Seventy consecutive cases of idiopathic epimacular membrane removal were reviewed in order to evaluate the prognosis factors of this surgery. The characteristics analyzed where the duration of the symptoms, pre and postoperative visual acuity and the macular changes on fluorescein angiography. The mean follow-up after surgery was 9 months. Mean preoperative visual acuity was 0.17 and the mean best postoperative visual acuity 0.43. Visual acuity improved by 2 lines or more in 81% of the cases and the mean improvement was 3.5 lines. The complications of epimacular membrane surgery included nuclear cataract (10 eyes underwent cataract surgery), peripheral retinal breaks (3%), and retinal detachment (3%) successfully operated. Three of the main preoperative data were related to better postoperative visual outcome: preoperative visual acuity: eyes with visual acuity of 0.16 or more tended to have better postoperative vision than eyes with poorer preoperative vision (mean postoperative visual acuity 0.5 and 0.34 respectively; p < or = 0.05); duration of visual impairment before surgery: eyes with a visual impairment of less than 2 years had better postoperative vision than the others (mean postoperative visual acuity, 0.5 and 0.3 respectively; p < or = 0.05); the absence of preoperative angiographic macular edema: eyes without preoperative macular edema had better postoperative vision than the others (mean postoperative visual acuity: 0.5 and 0.4 respectively; p < or = 0.05). The normal postoperative pattern of macular vessels and foveolar shape was also a statistically significant factor of good vision recovery.     

青光眼术后硬核白内障改良小切口囊外摘出术

目的:观察青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术的临床疗效。方法:对65例(69眼)小梁切除术后硬核(Ⅳ/Ⅴ)白内障,行颞侧或颞上方小切口白内障囊外摘出人工晶状体植入术,术后随访6~24mo,观察术后视力、眼压和并发症。结果:本组65例(69眼)术后视力有不同程度提高,其中视力≥0.5者50眼(72%),术后平均眼压为(15.22±3.92)mmHg(1mmHg=0.133kPa),手术并发症为术后早期角膜水肿及葡萄膜炎性反应。结论:青光眼小梁切除术后硬核白内障行改良小切口囊外摘出及人工晶状体植入术操作简单,术后眼压控制好,并发症少,视力恢复快,是治疗青光眼术后硬核白内障的有效方法。     

复杂外伤性白内障的手术治疗

目的探讨复杂外伤性白内障手术的最佳时机、手术方法及临床效果。方法对41例（41眼）复杂外伤性白内障进行回顾性研究,分析术前B型超声像图特征,根据术中眼内情况比较两者的一致性;观察术后视力和并发症,并探讨影响术后视力恢复的相关因素。结果各种合并损伤术前B超检查符合率分别为：玻璃体浑浊100.00%,视网膜脱离88.89%,眼内异物81.82%,晶状体脱位80.00%,脉络膜脱离50.00%。术后视力〈0.05者3眼,0.05～0.25者13眼,0.3～0.5者18眼,0.6～1.0者7眼。角膜瞳孔区瘢痕、严重散光、继发性青光眼、虹膜缺损、瞳孔变形移位、瞳孔前膜、晶状体后囊浑浊是影响术后视力恢复的危险因素（P=0.00,0.01,0.02,0.02,0.01,0.00,0.02）。术后并发症主要有明显葡萄膜炎症反应者20眼、角膜水肿24眼、瞳孔前膜5眼、晶状体后囊浑浊12眼、人工晶状体移位2眼。结论复杂外伤性白内障选择手术时机及采取适当的手术方式,可取得很好的疗效,而术前B超检查为手术的选择提供良好的依据。     

小梁切除术后白内障超声乳化手术分析

目的:探讨分析抗青光眼小梁切除术后白内障超声乳化摘除联合人工晶状体植入术的手术方法、技巧及效果分析。方法:我院2007-01/2010-12对87例87眼抗青光眼小梁切除术后发生白内障的病例行白内障超声乳化摘除联合人工晶状体植入术,随访6mo,分析术后视力、眼压、并发症等情况。结果:术后随访6mo,87眼术后视力均有不同程度的提高,其中78眼（90％）视力≥0.3;术后眼压均较术前下降;术后并发症主要有角膜水肿（15眼,17％）、虹膜反应（11眼,13％）、前房出血（5眼,6％）、后囊膜混浊（10眼,11％）。结论:对抗青光眼小梁切除术后出现的白内障,行透明角膜切口的白内障超声乳化摘除联合人工晶状体植入术可显著提高视力,保持滤过泡和眼压的稳定,恢复眼前节的组织结构。     

软壳技术在危险眼超声乳化中的临床应用

目的:探索危险眼白内障手术的视力提高与有效控制并发症发生的技术与方法。方法:47例独眼危险眼(合并其他致盲因素)的白内障患者。行超声乳化术中引入软壳技术,保护角膜,提供良好视野,以减少及减轻手术损伤,防止并发症发生,并观察比较手术前后视力的改善情况及并发症发生情况;分析软壳技术在上述环节中的作用与价值。结果:使用该技术后,不仅视力大为提高(P<0.01),而且与未使用该技术的超声乳化手术视力改善比较具有统计学差异(P<0.05),本组病例几乎没有并发症发生。结论:该技术的使用大大提高了视力,减少了并发症,该技术的使用对手术效果,控制手术质量有重要意义。     

角膜移植术后白内障应用扭动模式超声乳化吸出术治疗分析

目的观察扭动模式超声乳化白内障吸出术（PKP）治疗角膜移植术后硬核白内障的安全性和效果。方法回顾性分析2009年3月至2009年10月在我院眼科住院行白内障超声乳化吸除术的PKP患者28例（32只眼）临床资料。患者PKP术后11个月至8年,平均3.6年;根据晶状体核硬度分级,分别将28例（32只眼）并发Ⅲ级以上硬核白内障患者随机分为A、B两组,其中男12例（14只眼）,女16例（18只眼）。A组16只眼行常规超声乳化白内障吸出术,B组16只眼行扭动模式超声乳化白内障吸出术。观察术中前房稳定性、能量释放及时间,并比较术后第1天、3天、1周、2周角膜水肿及内皮细胞的变化及手术前后视力情况。结果术中B组前房稳定性优于A组（P〈0.05）;术中能量使用及超声时间明显少于A组,术后第1天、第7天B组角膜水肿情况明显轻于A组（P〈0.05）;术后第1天、第7天B组视力恢复明显优于A组（P〈0.05）。结论扭动模式超声乳化白内障吸出术是一种安全、高效、疗效好的手术方式,尤其对于硬核白内障的处理,优于传统超声乳化白内障吸出术。     

手法娩核在硬核超声乳化手术中应用的研究

目的探讨硬核白内障超声乳化人工晶状体植入手术的技巧和效果。方法对Ⅳ级和Ⅴ级硬核白内障39例(39眼)施行超声乳化联合手法娩核手术,观察术中术后并发症、术后视力及角膜水肿等并进行分析。结果超声乳化时间为0.3～0.8min,平均0.5min。切口无热损伤,无严重并发症发生。全部39例均顺利一期囊袋内人工晶状体植入。术后1周视力≥0.5者29眼占74.36%,术后1月视力≥0.5者34眼占87.18%,其中视力≥1.0者8眼占20.51%。视力≤0.1的3眼(7.69%)中2眼为老年性黄斑变性,1眼为糖尿病性视网膜病变。结论超声乳化联合手法娩核技术可以降低超声能量,具有损伤小、术中术后并发症少、手术时间短、术后反应轻和视力恢复快等优点,是硬核白内障的可供选择的较好的手术方式。     

短眼轴眼白内障的超声乳化术临床分析

目的探讨两种不同切口对短眼轴眼白内障行超声乳化术效果的影响。方法回顾性分析。眼轴长度在20．10～22．12mm的短眼轴眼晶状体超声乳化术54例（68眼）,随机分成A组（透明角膜切口）26例（34眼）,B组（巩膜隧道切口）28例（34眼）,比较两种不同切口对术后视力及并发症的影响。结果术后1个月,A组矫正视力≥0．5者26眼,占76．47％;B组矫正视力≥0．5者27眼,占79．41％,两组差异无统计学意义。术后并发症有角膜水肿、后囊破裂、一过性眼压升高及反应性虹膜睫状体炎等,两组差异无统计学意义。结论短眼轴眼白内障两种不同切口超声乳化术,术后视力及并发症并无显著差异。根据不同患者采取不同的手术方式,均可获得良好的复明效果。     

Cataract operation with anterior chamber lens implant

The results of 106 intracapsular cataract extractions with implantation of an anterior chamber lens are reported. The indications were monocular cataract in 63%, bilateral cataract in 15%, cataract with maculopathy in 10%, practical monocularity, parkinsonism etc. in 12%. Postoperative visual acuity was 0.4 to 1.0 in 88%; diminished vision was caused by maculopathy, central venous thrombosis, or glaucoma in 12%. Postoperative complications: pupillary block in 8.5%, glaucoma in 10.5%, cystoid macular edema in 3.6%, and decentration of implant in 1%. The need for postoperative care of patients with intraocular implants after cataract surgery is pointed out.     

Postoperative aphakia in modern cataract surgery: part 2: detailed analysis of the cause of aphakia and the visual outcome

PURPOSE: To study the incidence of aphakia after cataract surgery, the surgical complications that can lead to it, and the visual outcome. SETTING: Six community-run eye clinics participating in the Swedish National Cataract Register. METHODS: Data on cataract extractions were collected prospectively from 1997 through 2001. The data also covered the type of surgery and type of intraocular lens, including a "no lens implanted" option. All data were stored in a database. These data were supplemented with data on the intended type of surgery, type of complications, possible second surgery, and visual outcome. RESULTS: The overall incidence of postoperative aphakia was 0.65%. In 87.1% of cases, the aphakia was not planned, corresponding to an incidence of 0.48%. Unplanned aphakia was significantly related to poor preoperative vision, old age, and the presence of ocular comorbidity. The most frequent reasons for unplanned aphakia were intraoperative capsule problems and vitreous loss. In two thirds of cases, a second operation was performed. In 41% of all cases, the final visual acuity was 0.5 or better and in 27.7%, worse than 0.1. CONCLUSIONS: During the study period, 1 of every 200 routine cataract surgeries ended in unplanned aphakia. The incidence of surgical complications leading to unplanned aphakia and a final visual acuity worse than 0.1 (20/200) was 7.8 per 10,000 operations in cases with no ocular comorbidity and 27.6 per 10,000 operations in cases with ocular comorbidity.     

25-gauge macular surgery: results and complications

PURPOSE: To report the safety and surgical outcome of 25-gauge transconjunctival sutureless vitrectomy for macular conditions. METHODS: In a single-center, retrospective, noncomparative case series, 160 eyes of 150 patients underwent 25-gauge vitrectomy for different macular conditions: 108 eyes for idiopathic macular pucker, 24 for idiopathic macular hole, and 28 for tractional diabetic macular edema. Main outcome measures were surgical time, preoperative and 1-day intraocular pressure (IOP), preoperative and 1-month, 3-month, and 6-month visual acuity, intraoperative and postoperative complications, anatomical results, and cataract progression. All patients were observed up for at least 6 months. RESULTS: Mean follow-up was 10 months (range, 6-20 months). Mean operative time +/- SD was 21 +/- 11 minutes. Mean 1-day IOP was 14 +/- 4 mmHg. No IOP was <8 mmHg on postoperative day 1. Mean overall preoperative visual acuity was 20/70, and mean overall postoperative visual acuity was 20/40 (P or=2 Snellen lines of visual acuity at 1 month; 74%, at 3 months; and 67%, at 6 months (P 相似文献   

青光眼合并白内障联合手术的疗效观察

目的观察晶状体超声乳化人工晶状体植入联合小梁切除术治疗青光眼合并白内障的临床效果。方法青光眼合并白内障37例（42眼）应用联合手术治疗,随访3—24个月,观察术后视力、眼压、滤过泡及并发症情况。结果术后3个月视力均有不同程度的提高;0．3及以上者占83．33％。术后3个月眼压有41眼（97．62％）控制在9～16mmHg。术后6个月功能性滤过泡36眼（85．71％）。术后并发症有：葡萄膜反应、角膜水肿、暂时性眼压升高等,经治疗后缓解。结论青光眼合并白内障联合手术,既能控制眼压,又能改善视力,避免了分期手术给患者造成的痛苦,减少了术中术后并发症的发生。     

Sclerally fixated intraocular lens implant associated with vitrectomy: a study of 50 cases

INTRODUCTION: We present a retrospective study of 50 cases of scleral fixation of intraocular lenses (IOLs) associated with vitrectomy. MATERIALS AND METHODS: From January 1996 to June 2001, 50 consecutive patients who underwent surgery with insertion of a sclerally fixated intraocular lens implant associated with vitrectomy were studied. Indications included luxated lenses due to ocular contusion, cataract surgery complicated by capsular rupture and luxated nucleus or implant into the vitreous, and replacement of anterior chamber lenses. The implant was sutured 2 mm behind the limbus into the scleral sulcus with 10.0 Prolene. Vitrectomy was performed to treat pre-existing maculopathy, remove the lens or lens fragments luxated into the vitreous or to remove a luxated implant, and to provide for complete retinal examination during the operation. RESULTS: With a mean follow-up of 30 months, the mean postoperative visual acuity was 20/30. For 95% of cases, final visual acuity was improved compared to preoperative visual acuity. No postoperative complications due to the implant were encountered. There were four cases of cystoid macular edema and two cases of retinal detachment. DISCUSSION: Despite the macula edema and retinal detachments, there was no loss of visual acuity compared to the preoperative state. There were eight cases of raised intraocular pressure; seven were controlled medically and one after hemi-cyclocryo-therapy. CONCLUSIONS: Scleral fixation of an IOL is a reliable means of correcting aphakia in the absence of capsular support and may be associated with a vitrectomy with very little risk.     

葡萄膜炎并发白内障手法小切口手术临床疗效

目的 探讨手法小切口白内障手术人工晶状体植入治疗葡萄膜炎并发白内障的临床疗效.方法 32例（32眼）炎症静止3月以上的葡萄膜炎并发性白内障,行手法小切口白内障手术人工晶状体植入,术后随访3～6月,观察视力、眼压和并发症.结果 32眼术后视力均有提高,其中≥0.5者14眼,0.3～0.4者12眼,0.1～0.2者6眼.瞳孔圆形或椭圆形,术后眼压控制在正常范围.手术并发症为早期角膜水肿及葡萄膜炎反应.结论 葡萄膜炎并发白内障手法小切口白内障手术人工晶状体植入,手术安全,并发症少,术后反应轻,视力有恢复.