超声乳化白内障吸除联合人工晶体植入术治疗闭角型青光眼的临床疗效观察

目的观察超声乳化白内障吸除联合折叠式人工晶体植入术治疗急性闭角型青光眼合并白内障患者的临床疗效。方法收集2002年7月至2005年9月于中山眼科中心青光眼病区收治的急性闭角型青光眼合并白内障31例(31眼),患者均接受超声乳化白内障吸除联合折叠式人工晶体植入术,术后随访3个月。结果术后最佳矫正视力,较术前显著提高(P<0·05);患者术后3个月眼压平均为(15·3±3·2)mmHg,较术前用药前后眼压相比均显著下降(P<0·05);超声生物显微镜检查发现术后前房深度较术前均显著增加,平均为(3·01±0·47)mm(P<0·05);术后患者房角均较术前增宽,房角粘连关闭象限不同程度开放。结论超声乳化白内障吸除联合折叠式人工晶体植入术可有效降低眼压、提高视力,为急性闭角型青光眼同时合并白内障患者安全有效的治疗途径。     

Recurrent intraocular hemorrhage associated with posterior chamber lens implantation

Two cases of recurrent intraocular hemorrhage with posterior chamber lenses are presented.     

Phacoemulsification and posterior chamber lens implantation in open angle glaucoma

This study of 14 cases found that combining phacoemulsification and posterior chamber lens implantation in patients with open angle glaucoma appears to be safe and effective, and causes no deleterious effect on the course of glaucoma followed for at least one year.     

Pigmentary open-angle glaucoma secondary to posterior chamber intraocular lens implantation and erosion of the iris pigment epithelium

This report describes two patients who developed a secondary form of pigmentary open-angle glaucoma after implantation of a posterior chamber intraocular lens. The glaucoma was associated with considerable erosion of the iris pigment epithelium and a charcoal-black pigmentation of the trabecular meshwork. One case responded to argon laser trabeculoplasty and the other case did not. Possible causes of this syndrome are discussed.     

The results of posterior chamber lens implantation in a teaching hospital

In 1984 extracapsular cataract extraction with the implantation of a posterior chamber lens became the procedure of choice in the treatment of cataracts at this institution. A retrospective study was carried out to assess the results of this operation in the hands of registrars. The results suggest that extracapsular cataract extraction with the implantation of a posterior chamber lens can be performed safely and effectively in a residency setting when accompanied by appropriate education and faculty supervision.     

The Shearing-style intraocular lens and the posterior chamber

We observed the Shearing-style intraocular lens in human cadaver eyes and in dog eyes. In human cadaver eyes the lens loops rest in the ciliary body sulcus without exerting undue pressure; the only major problem occurred when the posterior capsule was torn and a loop found its way into the pars ciliaris of the ciliary body or into the vitreous base. Seven Shearing-style lenses were implanted in four dogs: six-month preliminary histopathology showed four of these lenses to be well tolerated with abundant synechiae formation around the loops. Two eyes exhibited loop pressure necrosis due to slight lens displacement.     

Posterior chamber intraocular lens implantation in the absence of posterior capsular support

Because of the high incidence and great variety of complications associated with anterior chamber intraocular lenses, we have developed a technique for the implantation of a posterior chamber intraocular lens in the absence of posterior capsular support. The posterior chamber IOL is placed in the ciliary sulcus by suturing the superior haptic to the iris and the inferior haptic to the sclera at the ciliary sulcus. We have used this technique successfully in both complicated extracapsular surgery and secondary intraocular lens implantation.     

Extracapsular cataract extraction and posterior chamber lens implantation in controlled open-angle glaucoma

A consecutive series of 103 eyes, 37 with controlled simple glaucoma (SG) and 66 with capsular glaucoma (CG), underwent extracapsular cataract extraction (ECCE) and posterior chamber lens (PC-IOL) implantation. Two to 6 weeks after surgery, 48% of the SG eyes and 62% of the CG eyes had visual acuities better than 0.4, as compared with 8% and 3%, respectively, preoperatively. The corresponding figures after 12 to 43 months in the SG eyes were 62%, and after 14 to 38 months in the CG eyes, 55%. A slight increase of mean intraocular pressure (IOP), from 19.0 +/- 4.8 mm Hg to 25.3 +/- 13.3 mm Hg in the SG eyes, and from 19.0 +/- 3.9 mm Hg to 24.5 +/- 9.6 mm Hg in the CG eyes occurred 1 to 2 weeks after surgery; at 2 to 6 weeks the mean IOPs had returned to preoperative levels: 18.1 +/- 6.4 mm Hg in the SG eyes and 18.4 +/- 5.9 mm Hg in the CG eyes. After a mean of 26.5 months (range, 12 to 43 months), IOP had decreased to 17.3 +/- 2.9 mm Hg in the SG eyes; and after 24.2 months (range, 14 to 38 months) to 17.6 +/- 5.7 mm Hg in the CG eyes. The need for glaucoma medication was diminished at 2 to 6 weeks after surgery: IOP was controlled (less than 21 mm Hg) without glaucoma medication in 43% of the SG, and in 50% of the CG eyes (preoperatively, all of the SG and 89% of the CG eyes required medication).(ABSTRACT TRUNCATED AT 250 WORDS)     

Combined vitrectomy, cataract extraction, and posterior chamber intraocular lens implantation in diabetic patients

Combined extracapsular cataract extraction, pars plana vitrectomy, and posterior chamber intraocular lens implantation was performed in six eyes with proliferative diabetic retinopathy. These eyes all had minimal iris vascular changes and were at reasonably low risk for developing intraoperative and postoperative complications. The surgery must be relatively brief and the endophotocoagulation accurate. Initial visual acuities ranged from light perception to 4/200. With an average follow-up of 9.7 months, final acuities ranged from 4/200 to 20/40.     

有晶状体眼后房型人工晶状体植入矫正高度近视的临床观察

目的探讨有晶状体眼后房型人工晶状体植入术矫正高度近视的有效性和安全性。方法后房型人工晶状体植入治疗高度近视眼患者8例15眼,术后随访分别检查裸眼视力、矫正视力、眼压、角膜及前房情况,UBM观察人工晶体位置。结果 15眼均顺利完成手术,术后视力均达到或超过术前最好矫正视力。术后眼压及人工晶体位置正常,术后1周内有2眼出现人工晶体表面少量色索。随访1年,视力稳定,未出现晶体混浊及眼压升高等严重并发症。结论有晶体眼后房型人工晶体植入治疗高度近视,视力恢复迅速,未发生严重并发症,预测性好,具有安全性和有效性。     

Intraocular pressure following extracapsular cataract extraction and posterior chamber intraocular lens implantation

Knowledge of the incidence of both short- and long-term elevation of intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) insertion is essential for the practicing ophthalmologist. We reviewed retrospectively the IOP data in 384 consecutive patients (506 eyes) that underwent the above procedure. A postoperative rise of 8 mm Hg above baseline or above 23 mm Hg was observed in 149 eyes (29%). Secondary glaucoma well controlled medically developed in 21 eyes (4%). Three eyes developed glaucoma after the first year postoperatively. Therefore, over the total follow-up period of 6 years, 24 eyes (4.7%) developed pseudophakic glaucoma. None, however, required laser or other surgical intervention. These results further support the prevailing view that ECCE with PC-IOL is the procedure of choice.     

Trabecular pigmentation following extracapsular cataract extraction and posterior chamber intraocular lens implantation

We prospectively evaluated the change in trabecular pigmentation following extracapsular cataract extraction and posterior-chamber intraocular lens implantation in 70 patients (94 eyes) with senile cataracts. Using the Boys-Smith pigment gradation lens to measure semiquantitatively the amount of pigment visible in the angle, we estimated the mean trabecular pigmentation preoperatively and at 3-month intervals postoperatively. Both the mean pigmentation and the number of eyes with heavy pigmentation rose after the operation and then gradually returned to preoperative levels. There was no correlation between the amount of trabecular pigmentation and intraocular pressure.     

Anterior segment complications in diabetic patients following extracapsular cataract extraction and posterior chamber intraocular lens implantation

Recovery of the anterior segment following extracapsular cataract extraction and posterior chamber intraocular lens implantation in 112 diabetic eyes was compared to that in 108 eyes of nondiabetic patients who underwent a similar procedure. The incidence of postoperative anterior segment complications was significantly higher in the diabetic than in the nondiabetic patients. The main complications were pigment dispersion, appearance of fibrin, development of posterior synechiae, and--rarely, and only in diabetic patients--pupillary block and transient iridal vascular congestion. The fibrin resolved following increased administration of steroids by means of eye drops and subconjunctival injections, with or without the addition of systemic steroids. Women were found to be at greater risk for development of posterior synechiae (P less than .025). Accumulation of fibrin was seen more often in women and in patients with preexisting diabetic retinopathy than in other patients, although the difference was not significant.     

My method of extracapsular cataract extraction with implantation of a posterior chamber intraocular lens

Simplified manual forms of extracapsular cataract extraction appear to be more economical, yet as safe and simple as techniques employing more complex instrumentation. The following method, employed in 40,000 cases, seems to the author to be an efficient and effective way of performing cataract extraction. One hour prior to surgery, modified retrobulbar anesthesia alone is employed using the technique described, and provides adequate akinesia as well as anesthesia. Positive pressure is applied to the eye preoperatively to assure softness of the globe at the time of surgery. An anterior capsulectomy is made with scissors, using the open-sky technique. Following the delivery of the lens nucleus and as much cortex as possible with a lens loop, the remaining cortex is removed with an angled, 23-gauge, double irrigation-aspiration cannula. Filtered balance salt solution, containing gentamycin flows into the eye through the side port (inflow) and a 3-cc syringe with 2 cc BSS for irrigation-aspiration is connected to the other (aspiration) port. A single, 25-gauge, angled irrigation cannula is used to clean up the finger cortical remains. A firm-loop intraocular lens is inserted into the capsular bag. The posterior capsule is left intact.     

A prospective study of combined extracapsular cataract extraction, posterior chamber lens implantation, and trabeculectomy

Thirty-six patients with significant cataracts and glaucoma had combined extracapsular cataract extraction, posterior chamber lens implantation, and trabeculectomy. Follow-up ranged from three months to four years. Significant visual improvement and reduction in intraocular pressure were noted. This procedure seems to be a viable alternative in patients suffering from combined advanced glaucoma and advanced cataracts.     

Combined penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation

We reviewed 22 cases of triple procedure in the last two years at our institution. Six months postoperatively 21 of the 22 transplanted corneas were clear. One graft for herpetic corneal scarring failed. Best corrected visual acuity was 20/40 or better in 14 patients. The average refractive error was--1.31 +/- 2.30 diopters. Refractive astigmatism was 4 diopters or less in 80% of patients. These results, which compare favorably with previous series, indicate the efficacy and safety of this procedure.     

The effects of posterior chamber phacoemulsification and secondary Kelman anterior chamber lens implantation on the corneal endothelium

Corneal specular photomicrography was used to determine the effects of posterior chamber phacoemulsification and secondary anterior chamber lens implantation on the corneal endothelium. Posterior phacoemulsification caused little additional cell loss over that associated with intracapsular cataract extraction, in contrast to previous findings with anterior chamber phacoemulsification. Secondary intraocular lens implantation using the Kelman anterior chamber lens usually resulted in minimal additional endothelial cell loss.     

Scleral fixation of posterior chamber intraocular lens implants combined with vitrectomy.

Selected patients undergoing pars plana vitrectomy and lensectomy may be ideal candidates for scleral-fixated lenses. We present our current technique for implanting such lenses, a technique designed to avoid the problems of suture exposure, lens rotation, and infection.