角膜穿孔伤并外伤性白内障手术治疗临床观察

目的探讨角膜穿孔伤合并外伤性白内障手术治疗的效果。方法对16例(16眼)角膜穿孔伤合并外伤性白内障手术治疗，全部行角膜全层裂伤修补术。择期行现代白内障囊外摘出、人工晶状体植入术。其中，后房型人工晶状体14眼、后房缝合型人工晶状体2眼。结果术后视力：低于0．05者3眼；0.05-0．25者4眼、0.3-0．5者9眼。并发症主要为后囊破裂玻璃体脱出，后发性白内障、虹膜炎症反应及角膜白斑等。结论角膜穿孔伤合并外伤性白内障，急诊行角膜全层修补术，间隔数天或数十天，择期行白内障囊外摘出人工晶状体植入。治疗效果良好，严格选择适应证和熟练掌握手术技巧及术后的合理治疗是手术成功的关键。     

角膜穿孔伤性白内障人工晶状体植入临床观察

目的 探讨对角膜穿孔伤合并外伤性白内障、人工晶状体植入联合手术的效果和问题。方法 对1994年以来我院48例因角膜裂伤缝合、外伤性白内障囊外摘出联合人工晶状体植入进行回顾性分析。结果 术后3－24月随访，视力≥1．0者5眼占10．4％，0．5－0．9者29眼占60．4％，0．1－0．4者10眼占20．8％，0．1以下者4眼占8．66％。结论 角膜缝合、晶状体摘出和人工晶状体植入三联合手术，可使病人迅速恢复视力，重建双眼立体视觉和融合功能，减少手术并发症。因此，掌握好手术时机非常重要。     

角膜穿孔伤伴外伤性白内障手术时机方法探讨

目的探讨角膜穿孔伤合并外伤性白内障的手术时机及手术方法。方法对23例（23眼）角膜穿孔伤合并外伤性白内障中的20例立即进行角膜全层裂伤清创缝合术。全部23例于伤后2—7天施行晶状体超声乳化吸出及折叠式人工晶状体植入术。其中囊袋内或睫状沟植入折叠式人工晶状体14例，单襻缝合固定折叠式人工晶状体9例。结果术后矫正视力低于0．05者2眼，0．05-0O．25者6眼，0．3-0．8者15眼。未见严重并发症。结论角膜穿孔伤合并外伤性白内障急诊行清创缝合术，并于2—7天内行晶状体超声乳化吸出及折叠式人工晶状体植入术，可以减少术中术后并发症。     

角膜破裂缝合联合白内障摘出人工晶状体植入

目的：探讨角膜破裂缝合、白内障摘出、人工晶状体植入三联手术的临床疗效。方法：36例（37眼）角膜破裂合并外伤性白内障患者，施行角膜破裂缝合、白内障摘出及人工晶状体植入联合手术。结果：术后最佳矫正视力＜0．1者2眼（5．4％），0．1－0．3者10眼（27％），0．4－0．5者20眼（54％）；＞0．5者5眼（13．6％）。结论：角膜破裂缝合、白内障摘出及人工晶状体植入三联手术，具有并发症少，术后视力恢复快，治愈率高及病程短等优点。     

角膜穿孔伤修补,白内障摘出,人工晶状体植入联合手术

目的为评价角膜穿孔伤修补，外伤性白内障摘出和后房人工晶状体植入联合手术的疗效。对38例符合手术标准的患者行此联合手术。结果未决随访时最佳矫正视≥0．5者27眼，0．3者11眼。唯一的额外处理是对4眼后囊严重混浊者行YAG激光截囊。结论该联合手术一次完成通常分2次执行的手术，即最初的角膜修补和二期白内障摘出及人工晶状体植入。视力恢复快，方便患者又节约经费。     

儿童外伤性白内障手术时机探讨

目的 探讨儿童外伤性白内障人工晶状体植入术的时机及疗效评价。方法 对76例（76眼）儿童外伤性白内障施行后房型人工晶状体植入术，手术时间为伤后4小时至6月，对入院时36例开放性角膜或角巩膜伤伴眼内容脱出者先行清创缝合伤口，再在上方角膜缘常规切开，摘出白内障植入后房型人工晶状体；对2例晶状体异物在摘出白内障同时一并取出；2例前房玻璃异物行造近角膜缘处切开摘出；10例伴虹膜根部离断者将其缝合至角膜切口深层；12例伴虹膜撕裂部分缺损者保留相应产位前囊；14例虹膜前粘连，术时均分开；8例术中后囊破裂口较大，改用缝线悬吊法植入晶状体。结果 出院时矫正视力≤0.4者16例占21%，≥0.5者48例占63%，≥1.0者12例占15%。结论 6岁以上儿童外伤性白内障可行I期后房型人工晶状体植入术。手术越早越好，伤后早期手术，可减少后期并发症的发生和手术操作的困难，使视力尽快恢复，重建双眼立体视觉和融合功能，尤其是避免了弱视和废用性斜视的发生。     

儿童角膜穿孔伤修补及白内障摘出联合人工晶状体植入术

目的　探讨儿童角膜穿孔伤修补及白内障摘出联合人工晶状体植入术的临床疗效。方法　对３２ 例角膜穿孔伤、晶状体异物及外伤性白内障眼施行角膜穿孔伤修补、晶状体异物及白内障摘出联合人工晶状体植入术。结果　术前所有病例视力为光感～０．０２,而术后视力０．５～１．２者２０例,０．４、０．３、０．２ 及≤０．１ 者各３例。　结论　联合手术是儿童角膜穿孔伤、晶状体异物及外伤性白内障恢复视力的最好方法。     

外伤性白内障人工晶状体植入手术时机的探讨

目的探讨外伤性白内障的手术时机的选择。方法对213例213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人工晶状体植入术。原则上是尽早手术，特别是儿童；伴角膜裂伤者，先缝合伤口，视情况进行一期或二期白内障手术；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）w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。213眼中，一期人工晶状体植入187眼，二期植入26眼，均为后房人工晶状体。结果术后视力0．05以上者占99．06％，0．3以上者占87．79％，0．5以上者占71．36％，1．0以上者占16．90%。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。     

角膜穿孔伤三联术的临床观察

目的：探讨单纯性角膜穿孔伤合并外伤性白内障同时进行清创缝合、外伤性白内障摘出加人工晶状体植入三联手术的效果。方法：对1997－2000年在我院因旁中央及近角膜缘的角膜穿孔伤合并外伤性白内障行三联手术的25例进行回顾性分析。结果：术后随访3月－3年，术后视力≥0．3者21例（80．4％），视力≥0．5者10例（40％），术后并发症主要有：角膜水肿、人工晶状体前后膜性渗出、后发性白内障及瞳孔粘连等。结论：同时行角膜清创缝合、外伤性白内障摘出和人工晶状体植入三联手术可达到迅速恢复视力、重建双眼单视功能和立体视觉，减少手术并发症、减轻患者的痛苦和经济负担的效果。     

儿童角膜穿孔伤三联手术疗效观察

目的　观察小儿角膜穿孔外伤性白内障超声乳化联合术的疗效。方法　对 6 8例 (6 8只眼 )角膜穿孔合并外伤性白内障患者 ,施行角膜穿孔伤清创缝合、超声乳化摘出白内障、后房型人工晶状体植入三联手术 (A组 )。并与同期和既往 5 7例 (5 7只眼 )同类病例行角膜伤口修补、白内障现代囊外摘出及人工晶状体植入术 (B组 )作对比。术后随访 1～ 2年。结果　术后 2周视力≥ 0 .5者 ,A组为 2 7只眼 ,B组为 12只眼。两组间差异有显著性(P <0 .0 5 )。术后并发症 A组较 B组明显减少 ,尤其是术后 1年后囊混浊的发生前者仅为 15只眼 ,后者为 2 5只眼(P <0 .0 1)。结论　此术式对眼组织损伤轻 ,术后视力恢复快 ,并发症少 ,是目前治疗小儿角膜穿孔合并外伤性白内障的最理想方法     

Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma

PURPOSE: To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract. DESIGN: Retrospective, nonconsecutive, noncomparative case series. METHODS: We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients. MAIN OUTCOME MEASURES: Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction. RESULTS: The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.     

Intraocular lens implantation in traumatic cataract

PURPOSE: The evaluation of postoperative results and complications after traumatic cataract extraction with intraocular lens implantation. MATERIAL AND METHODS: Forty two eyes of 41 patients (31 male and 10 female) aged from 10 to 66 years (mean 37.8) with traumatic cataract were the subject of our study. They were operated on between 1996 and 1997. A penetrating injury in 33 eyes (78.6%) and blunt trauma in 9 eyes (21.4%) caused the cataract. The interval between trauma and cataract surgery ranged from 1 day to 40 years. The mean follow up was 13.5 months. Despite of cataract corneal scars, pupil deformations, posterior and anterior synechiae were observed in most of the eyes. Extracapsular cataract extraction was performed in all cases. Posterior chamber IOLs were implanted in 33 eyes. Anterior vitrectomy and anterior chamber IOL implantation was performed in 9 eyes due to the lack of capsular support. RESULTS: Very good or good visual acuity (5/5-5/16) was achieved in 71.4% of cases. Low visual acuity (below 5/50) was observed in 6 eyes (14.3%) because of severe damage to the retina, optic nerve atrophy or amblyopia. Fibrin reaction in anterior chamber (30.9%), hyphaema (19%) and haemophtalmus (4.8%) were the most severe postoperative complications. CONCLUSIONS: An intraocular lens implantation in traumatic cataract, despite many postoperative complications, enables most of the patients to achieve satisfactory and useful vision. Patients with severe posterior segment damage do not benefit functionally from cataract surgery.     

外伤性白内障摘除人工晶體植入临床观察

本文报告外伤性白内障摘除人工晶體植入術78例78眼。外伤至手術时间为5天到7年。Ⅰ期后房型人工晶體植入76眼,其中聯合小梁切除1眼,聯合玻璃體前段切除1眼;Ⅱ期后房型人工晶體植入2眼。術后随访3個月至3年,視力在0.4以上者54眼,占70％。術后常見并發症为角膜水腫、前房滲出物、前房出血,后期为后囊混濁。对手術时期的選择,并發症及其处理進行了讨论。     

玻璃体切割联合手术治疗严重眼外伤的临床观察

目的：探讨玻璃体切割联合手术治疗严重眼外伤的临床疗效。方法：回顾性分析我院自2011-01以来收治的经玻璃体切割联合手术治疗的严重眼外伤患者30例31眼。结果：患者31眼中术后视力提高24眼,术前无光感12眼中术后视力不变2眼,光感2眼,手动3眼,指数4眼,1眼恢复为0.1;6眼球内异物的异物取出率为100%,炎症控制好;18眼复杂视网膜脱离,15眼成功复位,视网膜复位率为83%;14眼外伤性白内障或晶状体脱位,玻璃体手术后12眼行人工晶状体植入术,晶状体植入率为86%。结论：严重眼外伤包括术前无光感眼,经过恰当的玻璃体手术联合相应的治疗措施,可以最大限度保留患者的眼球及挽救患者的视功能。     

Primary implantation of posterior chamber lenses after traumatic cataract peneration

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.     

Long-term results after epilenticular intraocular lens implantation following traumatic cataract

BACKGROUND: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. Material and Methods: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by pars-plana lensectomy and vitrectomy. RESULTS: The mean follow-up was 27.4 months. Eight eyes (72.7 %) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.     

Combined lens and vitreoretinal surgery in patients with traumatic cataract and intraocular foreign body

AIM: To analyze the postoperative anatomical and functional outcomes as well as complications after combined phacoemul- sification, pars plana vitrectomy (PPV), removal of the intraocular foreign body (IOFB) and intraocular lens (IOL) implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Medical records of 13 patients(13 eyes) with traumatic cataract and IOFB who had undergone combined phacoemulsification, PPV, foreign body extraction and IOL implantation were retrospectively analyzed. The postoperative follow-up ranged from 2 to 12 months. The main measure- ments of outcomes were the extraction success of cataract and intraocular foreign body, intraoperative and postoperative complications and the final best corrected visual acuity (BCVA). ·RESULTS: The mean age of 13 patients(10 male, 3 female )was 36.8 years (range: 17-65 years). All eight IOFBs were removed. Four intraocular lenses were implanted after vitrectomy intraoperatively. In 5 cases, intraocular lenses were implanted during the second operation. Intraocular lenses were not implanted in 4 cases. BCVA at last ranged from 0.8 to hand movement. BCVA was 0.5 or better in four eyes, 0.1 to 0.4 in five eyes, less than 0.1 in four eyes. Intraoperative complications were encountered in 3 patients. They had vitreous hemorrhage. Postoperative complications were encounter- ed in 2 patients. They had retinal detachment. The reoperations of the two patients were successful. CONCLUSION: The combined phacoemulsification, PPV, removal of IOFB and IOL implantation is safe and effective for patients with traumatic cataract and intraocular foreign body. The visual outcome depended primarily on the corneal or scleral wound and underlying posterior segment pathology and sites.     

外伤性白内障二期前房型人工晶状体植入

目的 探讨外伤性白内障二期植入弹性开放襻前房型人工晶状体的效果和安全性。方法 28例28眼外伤性白内障行二期弹性开放襻前房型人工晶状体植入联合周边虹膜切除术。术后随访3月以上。结果 术后3月裸眼视力≥0．5者20眼(71．4％)，达到术前最佳矫正视力者24眼(85．7％)。术后常见并发症为角膜水肿、葡萄膜炎和眼压升高。结论 外伤性白内障二期植入弹性开放襻前房型人工晶状体是一种简便、安全、有效的方法。     

Secondary intraocular lens implantation of traumatic cataract in open-globe injury

BACKGROUND: The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. METHODS: A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. RESULTS: The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was -0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. INTERPRETATION: The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.