非染色囊袋减压撕囊术500眼临床报告

目的:探讨寻找皮质膨胀或/和液化、囊袋饱满的白色白内障简单、成功有效的撕囊方法。方法:对500眼皮质膨胀或/和液化、囊袋饱满的白色白内障,采用非染色囊袋减压撕囊方法,充分利用粘弹物质,维持正常囊袋压力,固定已松动的晶状体核,保持前房视野清晰,在无红光反射背景下,依撕囊口边缘的反光为轨迹,控制撕囊的大小和方向,顺/逆时针方向,完成连续性环形撕囊、超声乳化及后房型人工晶状体植入。结果:四象限非染色囊袋减压撕囊464眼成功完成,20眼撕囊偏离轨道,借助囊膜剪切恢复撕囊轨迹后完成环形撕囊,12眼撕囊失败改为开罐式截囊,4眼撕囊裂向赤道部波及后囊膜,做相应处理。人工晶状体准确植入囊袋内490眼,人工晶状体植入睫状沟10眼(其中4眼行人工晶状体睫状沟缝线固定术)。随访0.5a,500眼人工晶状体位置均无偏心、移位及夹持。结论:非染色囊袋减压撕囊术是皮质膨胀或/和液化、囊袋饱满的白色白内障,特殊情况下简单有效的撕囊方法。     

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。     

囊袋张力环在晶状体脱位超声乳化折叠人工晶状体植入术中的应用

目的 利用囊袋张力环(CTR)在脱位晶状体超声乳化术中固定囊袋减少术前、术中、术后并发症,便于囊袋内折叠人工晶状体植入提高视力。方法 不同原因所致晶状体不全脱位患者共13例(15眼),年龄5—73岁,在进行连续环形撕囊及水分离/皮质吸出后,自环形撕囊口将开放型CTR植入晶状体囊袋赤道部使脱位的囊袋充分扩张复位、固定。超声乳化晶状体核抽吸皮质,植入折叠人工晶状体。结果 13眼CTR植入囊袋内,2眼部分脱出囊袋外。12眼IOL位于囊袋内,2眼植入睫状沟,1眼襻一端位于囊内一端位于囊外。术中玻璃体少量脱出3眼(术前因外伤前房玻璃体疝,继发性青光眼)联合前节玻璃体切除术。术后人工晶状体正位13眼,轻度偏位2眼。术后裸眼视力≥0.8者5眼,裸眼及矫正视力≥0.5者5眼.裸眼及矫正视力≥0.2～0.4者3眼,0.1以下2眼(均并发有眼底疾病)。术后观察3～24月,1例marfan综合征2眼囊袋略向上移位,无1例出现囊袋收缩综合征。结论 CTR作为白内障手术的辅助工具在脱位晶状体手术中有保持囊袋的完整性及正常生理位置,减少近期并发症。     

白内障囊外摘出术晶状体后囊破裂原因的分析

目的探讨白内障囊外摘出术中晶状体后囊破裂的原因。方法269例(301眼)常规现代白内障囊外摘出术,术中29眼(9.64%)晶状体后囊破裂,其中25眼玻璃体脱出,相应处理后25眼一期植入人工晶状体。结果分析后囊破裂原因:11眼因水分离或娩核造成截囊口后裂、囊袋撕脱;14眼注吸皮质时误吸周边部前囊或直接损伤后囊;4眼外伤性白内障术前已有后囊破孔。结论晶状体后囊破裂与手术熟练程度、水分离、娩核、截囊方法、手术设施、白内障类型有关。     

人工晶状体囊袋夹持固定法在后囊破裂中的应用

目的观察囊袋夹持固定法植入人工晶状体治疗白内障手术中晶状体后囊破裂的效果。方法通过完全居中的、大小适宜的前囊连续环行撕囊，利用囊袋夹持固定法(人工晶状体光学部完全植入囊袋内而2个袢位于前囊前表面)使人工晶状体达到稳定的囊袋固定，以处理白内障手术中发生的后囊破裂。分别对接受囊袋夹持法的13眼老年性白内障患者、4眼外伤性白内障患者、3眼先天性白内障患者进行随访观察。结果术后随访平均视力大于等于0．5的患者17眼(85％)，夹持于囊袋的人工晶状体能够保持良好、稳定的居中位置，后囊破裂的大小稳定，所有术眼均未出现人工晶状体相关的葡萄膜反应。结论在后囊破裂较大，无法将人工晶状体植入囊袋内时，可以利用前囊撕囊孔进行囊袋内夹持固定法固定人工晶状体。良好的前囊连续环行撕囊不仅可以保证手术的安全性，而且是囊袋夹持法固定人工晶状体的必要条件。     

U型单针在连续环形撕囊白内障术中的应用

目的探讨U型单针在连续环形撕囊白内障术中的运用。方法对30例36眼白内障施行连续环形撕囊、囊袋内人工晶状体植入术,并运用自制的U型单针娩核、清除12卢钟处的晶状体皮质。结果36眼白内障晶状体核全部顺利娩出,且12点钟处皮质清除干净,人工晶状体囊袋内植入顺利。结论该方法操作简单、连贯性好、损伤小、成功率高,无晶状体悬韧带断裂、后囊破裂、玻璃体脱出等并发症,确保了人工晶状体囊袋内植入。     

囊袋张力环在晶状体悬韧带异常的手术中的应用

目的　评价晶状体囊袋张力环 (capsular tension ring,CTR)在晶状体悬韧带异常的手术中的应用价值。方法　对 9例 (10只眼 )晶状体悬韧带异常的患者行白内障手术 ,术中连续环形撕囊后植入 CTR,超声乳化术摘除白内障 ,囊袋内植入后房型人工晶状体。结果　所有植入的人工晶状体均位于正位。术后 3个月矫正视力 >0 .8者 2只眼 ,0 .5～ 0 .8者 6只眼 ,0 .4者 1只眼 ,0 .2者 1只眼。除白内障手术固有的并发症外 ,未见 CTR引起的其他并发症。结论　在晶状体悬韧带异常患者的白内障手术中应用 CTR,有利于保持囊袋的完整 ,便于后房型人工晶状体的植入 ,防止术后人工晶状体的的偏位 ,术后视力恢复快。     

人工晶状体嵌塞植入术预防后发性白内障的意义

目的 探讨人工晶状体嵌塞植入术的可行性及其预防后发性白内障发生的意义。方法 利用环行撕囊口嵌塞人工晶状体29例（29眼）,其中Ⅱ期人工晶状体植入26眼,Ⅰ期后囊破裂者3眼。结果 本组29眼人工晶状体嵌塞手术成功,无发生后发性白内障者,无人工晶状体偏位者,而且均固定良好。结论 利用撕囊口嵌塞法植入人工晶状体可以避免后发性白内障的发生,是囊袋及睫状沟人工晶状体植入的补充,临床效果良好。     

囊袋张力环在白内障手术中的应用

目的:评价半脱位晶状体超声乳化术中植入囊袋张力环(CTR)的应用效果。方法:对12例12眼半脱位晶状体行白内障手术,术中连续环形撕囊,行白内障晶状体超声乳化术,植入CTR后,囊袋内植入折叠式人工晶状体。结果:晶状体半脱位白内障患者12眼均顺利植入了CTR及后房型人工晶状体。术后患者视力均得以提高,人工晶状体位正,无明显手术并发症。结论:CTR可防止人工晶状体偏位,减少手术并发症。     

锥虫蓝囊膜二次染色在外伤性白内障手术中的应用

目的探讨锥虫蓝囊膜二次染色在外伤性白内障手术中应用的效果。方法对16例(16只眼)外伤性白内障采用0.01%锥虫蓝对晶状体前后囊膜染色后再行囊膜处理,常规进行白内障摘除人工晶状体植入,术后观察视力及前房内炎症情况。结果术后3天视力及前房内炎症情况与白内障常规手术后反应相似,人工晶状体前表面均未见染色剂沉着。结论将锥虫蓝应用于外伤性白内障手术,术中能清晰观察到蓝白相间的撕囊轨迹,较容易控制撕囊方向而保持了囊袋的完整性,植入人工晶状体稳定,且位于生理位置,更好地保护视功能。     

Posterior continuous curvilinear capsulorhexis. An experimental study with clinical applications.

The posterior continuous curvilinear capsulorhexis technique has been advocated in cases of posterior capsule rupture during extracapsular cataract extraction. The authors compared posterior continuous curvilinear capsulorhexis with posterior capsular sharp-edged tears. Two different types of forces were experimentally created on the posterior capsule of 30 human eyes obtained after death: (1) implantation and dialing of posterior chamber intraocular lenses (PC IOLs) and (2) increased intravitreal pressure by injection of balanced salt solution. All posterior capsular tears extended toward the equator, causing major capsular defects. In contrast, the posterior continuous curvilinear capsulorhexis remained intact in all cases. This experimental study proves that in cases where an inadvertent posterior capsular tear occurs, a posterior continuous curvilinear capsulorhexis is useful in preventing further capsular damage. Also, in cases where a posterior capsulotomy is indicated, a smooth edge created by a posterior continuous curvilinear capsulorhexis may be useful to maintain the integrity of the capsular bag for PC IOL capsular implantation.     

Comparison of various capsulectomy techniques in cataract surgery. An experimental study]

Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.     

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.     

Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: a 10-year analysis.

PURPOSE: To analyze the rate of inadvertent anterior lens capsular tears with vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery between January 1, 1997, and December 31, 2006. METHODS: Retrospective chart review, collecting for each eye: age at cataract surgery, type of anterior capsulotomy, any tearing of the capsule, and if yes, details of the tear. RESULTS: A total of 737 eyes were reviewed. Cases with a ruptured lens capsule that occurred prior to surgery were excluded. Eyes that received an anterior capsulotomy by any other method (n = 27) or eyes that did not receive an IOL (n = 100) were reviewed but excluded from final comparative analysis. Of the remaining 339 eyes, 19 eyes (5.6%) were noted to develop an anterior capsule tear (vitrectorhexis, 12 of 226 eyes, 5.3%; CCC, 7 of 113, 6.2%). These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one, cataract removal in three, and IOL insertion/manipulation in eight. In eyes operated for cataract at or before 72 months of age, the manual CCC technique was more likely to develop a tear (relative risk, 3.09) compared with eyes of older children (>72 months of age), where the vitrectorhexis technique was more likely to develop a tear (relative risk, 3.14). CONCLUSIONS: Vitrectorhexis is well suited for use in children less than 6 years of age due to their highly elastic anterior lens capsule. For children aged 6 years and older, manual CCC is the best technique because, by that age, capsule control and ease of capsulotomy completion has improved.     

Star CanVac-continuous curvilinear capsulorhexis - A novel,safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26-G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25-G flat-tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.     

白内障手术中后囊硬性斑的处理

目的：探讨白内障患者后囊“硬性斑”的诊断及处理方法。方法：根据术前裂隙灯检查和手术中证实硬性斑的不同情况，选择后囊处理方式；首选“oerHi”环形撕囊仪环形撕囊，次之选用刺开撕囊，特殊的硬性斑用不同的环形切囊法。结果：oerHi环形撕囊仪5眼无1眼出现玻璃体溢出晶状体囊袋内，而刺开撕囊2眼有1眼玻璃体溢出晶状体囊袋内、环形切囊2眼均出现玻璃体溢出晶状体囊袋内，给予前段玻璃体切除，本组9眼人工晶状体均植入晶状体囊袋内。结论：用oerHi环形撕囊仪环形撕后囊“硬性斑”，安全、简便。刺开撕囊时，勿伤及玻璃体前膜，深度掌握有难度，环形撕囊时需做前段玻璃体切除准备。     

Nd:YAG激光治疗晶体囊阻滞综合征的临床观察

目的：总结晶体囊袋阻滞综合征的临床特点并评价Nd:YAG激光的治疗效果。方法：对6例晶体囊袋阻滞综合征的临床特点进行回顾性分析,其中4例使用科以人7970Nd:YAG激光机行Nd:YAG激光前后囊膜切开术,平均能量4．7mJ,平均击发69次。结果：6例晶体囊袋阻滞综合征共同表现为连续环形撕囊术后人工晶体光学面被连续环行撕囊口阻塞,晶体囊袋形成密闭的液性腔,后囊膜向后膨隆。4例Nd:YAG激光前后囊膜切开成功,视力明显提高,后囊膜复位。结论：晶体囊袋阻滞综合征是白内障手术并发症之一,对术后迟发膨胀型者,Nd:YAG激光前后囊膜切开术是安全、有效的治疗方法。     

白内障术中后囊膜破裂行后囊膜连续曲线形撕囊术

目的：讨论白内障囊外摘除、超声乳化摘除及针吸摘除术中后囊膜破裂时行后囊膜连续曲线形撕囊术（ｐｏｓｔｅｒｉｏｒ ｃｏｎｔｉｎｕｏｕｓ ｃｕｒｖｉｌｉｎｅａｒ ｃａｐｓｕｌｏｒｈｅｘｉｓ,ＰＣＣＣ）的方法和作用。方法：利用撕囊镊对１０例（１０眼）白内障摘除术中后囊膜破裂眼行ＰＣＣＣ,５例联合行前段玻璃体切除术。结果：１０例后囊膜破裂后行ＰＣＣＣ眼９例成功完成ＰＣＣＣ,１ 均植入后房人工晶体。术后观察１月～３年（平均１６月）,９例行ＰＣＣＣ眼视轴均清晰,未发生视网脱离及后发性白内障,无明显的人工晶体光学部偏中心或人工晶体异位。结论：ＰＣＣＣ可有效避免后囊膜破孔进一步无限放射状撕裂,保持周边后囊膜的完整性。使人工晶体稳固于囊袋内。     

Tissue damage at anterior capsule edges after continuous curvilinear capsulorhexis, high-frequency capsulotomy, and erbium:YAG laser capsulotomy

PURPOSE: To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM). SETTING: Department of Ophthalmology, Department of Histology and Embryology II, University of Vienna, Vienna, Austria. METHODS: Five anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Kl?ti. Membranes were processed and examined by LM and TEM according to standard procedures. RESULTS: The edges obtained by ELC showed mild signs of denaturation and mechanical disruption, tears, and micro-tears. Lens capsule edges obtained by CCC were smooth with no irregularities in any specimen; the edges were beveled anteriorly to posteriorly with no evidence of tearing. Edges produced by HFC were considerably wider; the surfaces showed distinct denaturation, preformed tears, and micro-tears. The edges were surrounded by a nonhomogeneous mass, which consisted mainly of denatured lens capsule material. CONCLUSIONS: Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.     

晶体前囊膜弹性的研究

目的研究前囊膜弹性。方法对２２只牛眼行连续环形撕囊术（ｃｏｎｔｉｎｕｏｕｓｃｉｒｃｕｌａｒｃａｐｓｕｌｏｒｈｅｘｉｓ，ＣＣＣ），截囊及娩核后，缓慢张大两脚规至前囊膜开口撕开后测定前囊膜的弹性。将撕裂时的周长与原切口周长之比作为前囊膜弹性指标。结果完整的ＣＣＣ切口在造成放射状撕裂之前比原切口周长扩大６１％，扩大的囊膜切口面积显著大于原切口面积及核倾斜３０°时的横断面面积。结论前囊膜具有一定的弹性，适当大小的ＣＣＣ切口可保证晶体物质的安全娩出及人工晶体的植人而不产生放射状撕裂。