糖尿病白内障人工晶状体植入术临床分析

目的分析基层医院开展糖尿病白内障摘出联合后房型人工晶状体植入术的临床疗效。方法我们对46例(46眼)糖尿病白内障行现代囊外摘出联合后房型人工晶状体植入术，并设46例(46眼)老年性白内障患者行现代囊外摘出联合后房型人工晶状体植入术为对照。结果糖尿病白内障术后角膜内皮水肿、房水浑浊、纤维素样渗出、瞳孔后粘连、后囊浑浊等眼前段手术并发症发生率高于老年性白内障，但经正确有效处理，总体预后两组并无显著差异。结论糖尿病患者空腹血糖控制在8．0mmol／L以下，行白内障摘出后房型人工晶状体植入是安全的。     

两种软性材质可折叠IOL在剥脱综合征性白内障患者中临床应用

目的:研讨剥脱综合征性白内障植入Acrysof Natural和硅胶人工晶状体的效果。方法:选择无青光眼发作史的剥脱综合征性白内障65例70眼行超声乳化吸出白内障,无术中并发症60例63眼。其中30例33眼用植入器植入Acrysof Natural人工晶状体;另30例30眼用植入器植入硅胶(silicone)人工晶状体。统计植入术中并发症;术后1d,1wk,3mo,1a的视力、眼压、前房情况、人工晶状体稳定性。结果:Acrysof Natural在植入过程中展开慢,可控性好,在剥脱综合征患者瞳孔不易散大情况下仍能顺利植入,无并发症。对照组硅胶人工晶状体展开时弹射快,有7眼植入过程中发生翻转,在部分悬韧带不健全的病例同时因瞳孔缩小不易观察和控制,造成5眼植入时袢划破后囊膜(16.6%)。1枚弹入玻璃体,取出后改睫状沟植入。术后视力对后囊破裂者不列入正常统计。结论:选择Acrysof Natural人工晶状体单体、袢宽软、植入过程中展开慢、好控制、可避免植入过程并发症。其光学部分相对薄、稳定性好、前房相对较深。组织相容性好,术后反应轻。     

Exfoliation syndrome and heparin surface modified intraocular lenses.

Either heparin surface modified (HSM) or regular polymethyl methacrylate (PMMA) intraocular lenses (IOLs) were implanted after extracapsular cataract extraction in 40 human eyes with exfoliation syndrome in a double-masked, randomized study. The patients were investigated preoperatively, and then 1 day, 1 week, 3, 6 and 12 months postoperatively. In eyes implanted with the HSM IOL, 26% had a fibrinoid reaction anterior to the IOL, while this complication was found in 50% of eyes implanted with the regular IOL. Pigment and cell deposits were more frequent on the regular IOLs than on the HSM lenses postoperatively. Posterior synechia formation between the iris and the implant or lens capsule was more common in the eyes with regular IOL compared to HSM IOL. No difference in visual acuity between the two groups was found either before or after surgery. The results suggest that in eyes with exfoliation syndrome, a heparin surface modified IOL reduces clinical complications associated with cataract surgery.     

剥脱综合征行超声乳化人工晶状体植入的评价

目的　评价剥脱综合征眼行白内障超声乳化人工晶状体植入术的安全性。方法　对剥脱综合征 6例 (8眼 )及 5 0岁以上单纯白内障 60例 (66眼 )行超声乳化人工晶状体植入术 ,观察分析术中并发症的发生情况及术后眼部变化。结果　剥脱综合征术中无后囊破裂 ;非剥脱综合征眼发生后囊破裂 1眼 ,占 1 5 2 %。两组间差异无显著意义 (P >0 0 5 )。剥脱综合征眼术中无晶状体悬韧带断裂 ;非剥脱综合征眼发生 1眼 ,占 1 5 2 %。两组间差异无显著意义 (P >0 0 5 )。两组病例均未发生术后人工晶状体移位 ,亦未发现剥脱综合征术后眼内反应明显重于非剥脱综合征眼。结论　剥脱综合征眼行超声乳化人工晶状体植入术是安全的。术前充分认识及估计术中的风险 ,谨慎操作 ,就可以避免各种并发症的发生。     

Cataract surgery in patients with Vogt-Koyanagi-Harada syndrome

PURPOSE: To evaluate the outcomes of cataract surgery in patients with Vogt-Koyanagi-Harada's (VKH) syndrome. SETTING: Medical Research Foundation, Sankara Nethralaya, Chennai, India. Methods: Fifty-nine eyes of 39 patients with VKH syndrome who had cataract surgery between May 1985 and June 2001 were retrospectively analyzed. RESULTS: Extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation was performed in 15 eyes and without IOL implantation in 31 eyes. Phacoemulsification with IOL implantation was performed in 13 eyes. Twenty-three eyes (38.9%) had mixed cataract (posterior subcapsular and posterior polar). Small pupils were managed by synechiolysis with an iris spatula (43 eyes) or iris hooks (8 eyes). Nine eyes were lost to follow-up and not included in the postoperative analysis. The mean postoperative follow-up was 39.4 months (range 9 to 120 months). Visual acuity improved by 1 or more lines in 40 eyes (80.0%). Subretinal gliosis and optic atrophy, sequelae of the syndrome, restricted improvement in vision in the remaining eyes. Posterior capsule opacification developed in 38 eyes (76.0%), of which 21 (42.0%) required a neodymium:YAG laser posterior capsulotomy. There were no significant differences in postoperative inflammation or syndrome reactivation between the types of surgery. CONCLUSIONS: The results show that cataract extraction in patients with VKH syndrome can be safely and successfully performed if there are good preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome depends on the posterior segment complications of the syndrome.     

超声乳化术中人工晶状体前囊夹持植入的临床观察

目的:观察超声乳化术中人工晶状体前囊夹持植入法的临床效果。方法:对白内障超声乳化术中撕囊口过小21例21眼、后囊破裂6例6眼、囊袋宽松1例2眼采用前囊夹持法植入后房型人工晶状体,术后观察视力、人工晶状体位置及后发性白内障情况,术后随访6～24mo。结果:术后3mo视力0.3以上6眼,0.5以上13眼,0.8以上10眼,人工晶状体位置稳定,后发性白内障发生率与囊袋内植入相近,未发现其它与固定有关的并发症。结论:白内障超声乳化术中采用前囊夹持法植入后房型人工晶状体效果良好,是超声乳化术中出现撕囊口过小、后囊膜破裂等并发症的一种有效补充手段。     

悬韧带异常的假性剥脱综合征性白内障手术时机和方法的选择

背景 假性剥脱综合征(PEX)常并发白内障,多伴有进展性晶状体悬韧带异常,术中及术后易出现悬韧带相关并发症,白内障手术如何选择合适的手术时机及手术方式对于减少并发症、提高手术成功率具有重要的临床意义,但目前相关研究报道很少. 目的 分析伴有晶状体悬韧带异常的PEX性白内障(PEXC)患者行白内障摘出联合人工晶状体(IOL)植入术的疗效,探讨其合适的手术时机及手术方式.方法采用系列病例观察研究方法,对2012年7月至2015年12月在新疆维吾尔自治区喀什地区第二人民医院接受PEXC手术的21例23眼进行分析,所有患者均伴有晶状体悬韧带异常,根据悬韧带异常的程度分为晶状体震颤和不全脱位2种类型,其中晶状体震颤18眼,晶状体不全脱位5眼.按照Emery核硬度分级法分为Ⅱ级核4眼,Ⅲ级核9眼,Ⅳ级核7眼,Ⅴ级核3眼;晶状体震颤者行白内障超声乳化联合标准囊袋张力环(CTR)或改良CTR(MCTR)及IOL植入术或白内障囊外摘出联合CTR及IOL植入术;Ⅱ级或Ⅲ级核伴晶状体不全脱位者行超声乳化联合MCTR及IOL植入术;Ⅳ级或Ⅴ级核伴晶状体不全脱位者行白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术.对患者共随访3个月,分析手术时机对疗效的影响及术眼术后视力、眼压,术中及术后并发症,前囊口、IOL位置变化. 结果 晶状体震颤患者行白内障超声乳化联合IOL植入术,其中植入CTR者10眼,MCTR者3眼,囊外摘出联合CTR及IOL植入术4眼,前段玻璃体切割联合IOL巩膜缝线固定术1眼.晶状体不全脱位行超声乳化联合前段玻璃体切割联合IOL巩膜缝线固定术1眼,白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术4眼.术眼术后最佳矫正视力(BCVA)＞0.5者4眼,＞0.3 ～≤0.5者6眼,＞0.1～≤0.3者8眼,≤0.1者5眼,与术前BCVA比较,差异有统计学意义(x2=17.29,P＜0.01);术眼术前平均眼压为(16.82-±2.25)mmHg(1 mmHg=0.133 kPa),术后3个月平均眼压为(16.12±2.67)mmHg,差异无统计学意义(t=0.108,P＞0.05);术中、术后常见并发症为瞳孔不易扩大、角膜水肿、晶状体皮质残留和后囊膜混浊. 结论 伴有晶状体悬韧带异常的PEXC手术复杂、并发症多,手术时机和手术方式的选择均应依据悬韧带异常程度、核硬度和晶状体是否脱位,术前应认真行自然瞳孔下及扩瞳后检查以确定治疗方案是手术成功的关键.     

外伤性白内障人工晶状体植入手术时机及方法的探讨

目的探讨外伤性白内障的手术时机的选择。方法对我院2008年7月～2011年8月收治的52例52眼外伤性白内障,根据其年龄、晶状体外伤性质、其他部位外伤情况及炎症反应程度,选择时机进行白内障摘出联合人工晶状体植入术。伴有角膜裂伤者,先缝合伤口,视情况进行一期或者二期白内障手术;晶状体囊破口较小及挫伤性白内障,待皮质浑浊较充分后进行手术;外伤后炎症反应较重者,先控制炎症,于(1-2)周内手术;晶状体皮质膨胀突出于前房接触角膜及引起严重炎症反应或继发青光眼者,则立即进行手术。采用白内障吸出、囊外摘出或玻璃体晶状体切除联合后房人工晶状体一期植入手术方法。52眼中,一期人工晶状体植入35眼,二期植入17眼,均为后房人工晶状体。结果术后视力0.05以上者占96.15%,0.3以上者占67.31%,0.5以上者占36.54%,1.0以上者占3.85%。结论正确掌握白内障的手术时机,及时处理术中术后并发症,复杂的外伤性白内障术后仍能获得较好的视力,并能促进恢复双眼单视功能。     

后囊破裂的外伤性白内障手术治疗

目的 探讨角膜穿孔伤伴后囊破裂的外伤性白内障手术时机、手术处理技巧和人工晶状体植入方法与原则.方法 角膜穿孔伤伴后囊破裂的外伤性白内障53例（53眼）,伤后4～11天,根据囊破裂、玻璃体视网膜等后段紊乱程度选择单纯超声乳化、晶状体皮质吸取,品状体切除联合玻璃体切除术处理后段紊乩,其中39眼（73.59%）一期植入人工晶状体,12眼（22.64%）二期植入人工晶状体.结果 术后6月矫正视力：低于0.1者3眼（5.66%）,0.1～0.25者13眼（24.53%）,0.3～0.6者28眼（52.83%）,大于0.6者9眼（16.98%）.人工晶状体偏位3眼,人工晶状体夹持2眼,人工晶状体脱位1眼.结论 角膜穿孔伤伴后囊破裂的外伤性白内障伤后应及早手术,并根据其眼前段紊乱的程度及是否伴有眼后段组织严重损害,选择适当的手术方式并适时植入人工晶状体.     

Ocular implantation and exfoliative syndrome

Operative difficulties and post operative complications after posterior chamber lens implantation are described in 27 eyes with exfoliation syndrome, 8 simple exfoliation syndromes and 19 capsular glaucoma. 14 eyes were operated on by extracapsular extraction and posterior chamber lens implantation in the capsular bag; 13 eyes had extracapsular cataract implantation combined with trabeculectomy. Operative difficulties were due to bad mydriasis and zonular laxity. There was no zonular dialysis. Post-operative visual acuity was between 20/40 and 20/20 in 70% of the cases. There was nos lens luxation. Intercapsular implantation is possible without great risk. The risk of zonular rupture occurs principally during extracapsular extraction. Implants 4 to 12 times Lighter than a cataract human lens do not seem to be dangerous when there is no peroperative zonular rupture.     

剥脱综合征并发白内障患者超声乳化术后2a眼压变化及其相关因素的临床研究

目的:研究剥脱综合征并发白内障患者和老年性白内障在超声乳化术后2a内眼压变化情况及相关因素。方法:对49例54眼剥脱综合征并发白内障的患者实施超声乳化人工晶状体植入术,依据眼压情况又分为剥脱综合征并发白内障(XFS)亚组(29例31眼)及剥脱综合征并发白内障和青光眼(XFG)亚组(20例23眼)。同期选择老年性白内障患者134例152眼行超声乳化人工晶状体植入术作为对照依据眼压情况分为白内障亚组(86例93眼)及并发开角青光眼组(POAG)亚组(48例59眼)。两组眼压用药控制正常后手术。比较两组在超声乳化术后2a内眼压的变化。结果:术前剥脱组基础眼压高于对照组(21.85±2.23mmHgvs18.62±3.12mmHg,P=0.002)。在超声乳化术后2a内,两组眼压均降低(17.60±3.23mmHgvs15.08±3.18mmHg,P=0.0037)。统计分析表明与术中灌注量相关。XFG组眼压降低更明显。结论:在超声乳化术后2a内,剥脱综合征组比对照组眼压降低明显。     

儿童白内障摘除人工晶状体植入术联合连续环形撕后囊术

目的 评价儿童性白内障摘除人工晶状体植入联合连续环行撕后缀的临床疗效。方法 通过对25例(35眼)儿童性向内障摘除人工晶状体植入联合连续环行撕后囊术,观察后发障等并发症的发生率及视力情况。结果 发现本组儿童性白内障术后脱盲率为 90％,脱残率为 67％,后囊再次混浊 2眼(撕囊口玻璃体增殖)为 6％。结论 儿童性白内障摘除人工晶状体植入联合连续环行撕后囊术,可以有效地防止后发性白内障的发生,保持视轴清亮,绝大部分的患儿术后视力显著提高。     

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.     

A comparison of heparin-coated and uncoated intraocular lenses in glaucoma patients undergoing combined cataract extraction and trabeculectomy and in diabetic patients undergoing cataract extraction

The postoperative course of cataract extraction and IOL implantation combined with trabeculectomy in glaucoma patients and of cataract extraction with intraocular lens (IOL) in diabetic patients is more complicated than that of cataract extraction with IOL implantation in otherwise healthy eyes. The main complications are fibrin in the anterior chamber, pigment dispersion, and posterior synechiae. In an attempt to determine whether heparin-coated lenses reduce the rate of these complications, a prospective study was conducted on 19 glaucomatous eyes of 19 patients who underwent a combined procedure of trabeculectomy and extracapsular cataract extraction with IOL and 20 eyes of 20 diabetic patients subjected to extracapsular cataract extraction with IOL. In each category of patients, the early postoperative course in those who received heparin-coated lenses and those who received regular polymethyl methacrylate (PMMA) lenses was compared with respect to the inflammatory reaction, assessed by the amounts of cells and flare, and complications in terms of fibrin, posterior synechiae and pigment dispersion. The results of this preliminary study indicate a slightly higher rate of early postoperative complications with the heparin-coated lenses as compared to PMMA lenses.     

Core vitrectomy preceding triple corneal procedure in patients at high risk for increased posterior chamber pressure

We evaluated the effectiveness of performing a core vitrectomy to prevent intraoperative posterior chamber pressure elevation in eyes at high risk for development of this complication, prior to penetrating keratoplasty, extracapsular cataract extraction and posterior chamber lens (IOL) implantation. Results in 10 cases with core vitrectomy were compared with 10 cases without (controls); in all eyes with vitrectomy, a posterior chamber IOL was easily implanted but four eyes of the control group developed vitreous complications. Our results indicate that core vitrectomy does facilitate IOL implantation during a triple corneal procedure in eyes at increased risk of elevated posterior chamber pressure.     

儿童外伤性白内障摘出人工晶状体植入并发症

目的　探讨儿童外伤性白内障摘出人工晶状体植入术的并发症及其治疗。方法　对62例(62眼)儿童外伤性白内障行白内障摘出人工晶状体植入术,对术中、术后并发症及处理方法进行分析。结果　术后视力比术前提高者5 7眼,随访42眼,视力提高者3 5眼,术中主要并发症为前房积血,后囊破裂及玻璃体溢出。术后主要并发症为前葡萄膜炎、后囊浑浊、人工晶状体偏移及其表面色素颗粒沉积等。结论　外伤性白内障摘出人工晶状体植入术是治疗儿童外伤性白内障的有效方法,其并发症比成人严重。但如处理适当仍然可以达到较好效果。     

Clear lens extraction and intraocular lens implantation in Marfan's syndrome

Intracapsular clear crystalline lens extraction and intraocular lens (IOL) implantation were performed in 4 highly myopic eyes of 2 patients with Marfan's syndrome. One eye of each patient received an anterior chamber IOL and the other, a scleral-fixated posterior chamber IOL. The preoperative spherical equivalent ranged between -14.50 and -28.00 diopters (D) and axial length range, between 25.32 and 36.02 mm. The SRK II formula was used. Mean uncorrected visual acuity improved from counting fingers to 20/80. Postoperative spherical equivalent correction ranged from -0.75 to +2.75 D. One eye had vitreous loss that was managed by anterior vitrectomy. Modern surgery for cataract and management of its complications suggest that clear crystalline lens extraction and IOL implantation can be attempted in selected cases with Marfan's syndrome.     

Preoperative assessment of secondary intraocular lens implantation for aphakia: a comparison of 2 techniques

PURPOSE: To compare the preoperative evaluation of secondary intraocular lens (IOL) implantation in aphakic adults following cataract extraction in childhood using slitlamp examination and high-frequency ultrasound (HFU). METHODS: In a prospective case series, patients who had had lensectomies for congenital cataracts without primary implantation IOL were evaluated for secondary IOL insertion. Slitlamp examination and HFU were performed to study the degree of ciliary sulcus support and iridocapsular adhesions. The choice of IOL (posterior sulcus supported or anterior chamber) was compared using the 2 techniques. RESULTS: Nine eyes of 5 patients (3 men and 2 women aged 15 to 40 years) were assessed for secondary IOL insertion. Clinical slitlamp examination suggested that 3 of 9 eyes had inadequate sulcociliary support, but HFU of these eyes revealed more than adequate capsular remnants. In all 9 eyes, sulcus-supported posterior chamber IOLs were implanted. No postoperative complications were observed, and no patients required surgery for dislocated IOL. CONCLUSIONS: High-frequency ultrasound is a useful adjunct for the preoperative assessment of secondary ciliary sulcus-supported IOL implantation in aphakic patients who had congenital cataract extraction without IOL implantation. In patients in whom inadequate dilation precludes the detection of capsular support, posterior ciliary sulcus-supported secondary IOL implantation should be considered preoperatively. Although the technique enhances surgical planning and informed patient consent, the final decision occurs at the time of surgery with direct visualization of the ciliary sulcus support.     

先天性白内障超声乳化并人工晶状体植入术

目的 评价先天性白内障摘出 人工晶状体植入术术后的临床疗效，讨论其手术治疗的时机、术式、术后并发症及处理。方法 对先天性白内障患者52例7l眼，l0眼采用超声乳化白内障吸出术，6l眼施行白内障超声乳化吸出术并后房型人工晶状体植入术。结果 术后矫正视力满意，葡萄膜炎及后囊膜混浊为术后主要并发症。结论 先天性白内障超声乳化吸出术并人工晶状体植入术后视力均有所提高，术后抗弱视治疗至关重要。     

小切口非乳化白内障手术简化方式的效果评价

目的评价小切口非乳化白内障摘出及后房型人工晶状体植入术简化手术方式的临床应用效果。方法老年性及并发性白内障346例（360眼）分为A、B两组，每组各180眼。A组采用常规的手法小切口非乳化白内障囊外摘出术式；B组采用其简化的手术操作步骤。随访3～18个月，对视力及并发症情况进行临床观察分析。结果两组术后视力恢复均较好，并发症较少，两组间差异无统计学意义（P〉0．05）。B组手术操作更为简便，手术时间更短。结论手法小切口白内障摘出及人工晶状体植入术中简化手术操作步骤是行之有效的。