Sutureless Intrascleral Pocket Technique of Transscleral Fixation of Intraocular Lens in Previous Vitrectomized Eyes

In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180° apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.     

Non—trans—scleral Suture Fixation of Posterior Chamber Intraocular Lenses in the Absence of Posterior Capsular Support

Purpose: To develop a new technique for fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsule support.Materials and Methods: We performed non-trans-scleral fixation of intraocular lenses on 24 cases (24 eyes) without posterior capsule support. Two scleral flaps with limbal incisions and two peripheral iridectomies were made at 1 o' clock and 7 o' clock positions respectively. A suture-leading needle was used to lead the prolene suture from the limbal incision and iridectomy on one side through the iridectomy and limbal incision on the other side. Intraocular lens (IOL) was then fixed in the ciliary sulcus. Results: After a mean follow-up of 6. 6 months (range from 3 to 14 months), corrected visual acuity of 16 cases (16 eyes,66. 7% ) got 0.5 or better. Postoperative complications included discoria (4 eyes) , surface membrane formation ( 1 eye ), choroidal detachment (1 eye) and tilt of IOL (1 eyes),but all were not severe. Conclusion: In some situations such as low int     

外伤性无晶体眼二期人工晶体植入临床研究

对30例外伤性无晶体眼施行了二期人工晶体植入，并对手术方法、术后视功能、手术适应症及并发症进行了研究。经过3～14月（平均6．7月）的随访观察，术后视力在0．5以上的占80％。结果表明二期人工晶体不仅对无并发症的无晶体眼，而且对有眼前段损伤的无晶体眼病人的视力恢复起重要作用。     

Combined Phacoemulsification,Primary Intraocular Lens Implantation,and Pars Plana Vitrectomy in Children with Uveitis

Abstract

Purpose: To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.

Methods: Data regarding visual acuity (VA), inflammatory status, medical therapy, and complications was collected from the medical charts of 17 children (21 eyes) with chronic uveitis who underwent combined cataract surgery and PPV at the Eye Clinic, Sahlgrenska/Mölndal, between 2002 and 2011.

Results: Seventy-six percent of the children had juvenile idiopathic arthritis. Median preoperative VA was 1.70 logMAR and median VA after 12 months was 0.17 logMAR. Postoperatively, glaucoma developed in 7 eyes, cystoid macular edema in 3 eyes, and visual axis opacification requiring treatment in 5 eyes.

Conclusions: Although combined phacoemulsification, primary IOL implantation, and PPV in children with uveitis resulted in favorable visual outcome and stable inflammation in a majority of children, the technique should so far be reserved for uveitic cases with vitreous pathology.     

Phacoemulsification in Patients with Secondary Glaucoma Caused by Uveitis

Purposes: To evaluate the effect of phacoemulsification in the patients with uveitis,secondary glaucoma and complicated cataract.Methods: Phacoemulsification and implantation of a foldable intraocular len wasperformed in 12 patients(13 eyes) with uveitis, secondary glaucoma and complicatedcataract. The complications, intraocular pressures (IOP), and visual acuity wereobserved postoperatively.Results: No severe complication was found in the patients postoperatively or within theoperation procedure. The visual acuity was improved after the operation ( P < 0. 05) .The intraocular pressures and/or the number of antiglaucoma medications reduced in 3months of the follow-up time.Conclusion: phacoemulsification is the best way to treat the patients with secondaryglaucoma and complicated cataract caused by uveitis.     

Unilateral Scleral Fixation of Posterior Chamber Intraocular Lenses in Pediatric Complicated Traumatic Cataracts

Purpose

The purpose of this study was to evaluate the visual outcomes and complications of unilateral scleral fixation of posterior chamber intraocular lenses (SF-PCIOLs) in pediatric complicated traumatic cataracts without capsular support.

Methods

This study involved five eyes of five children who underwent unilateral SF-PCIOL. All patients had a unilateral complicated traumatic cataract associated with anterior or posterior segment injury. Visual acuity (VA), IOL position, and postoperative complications were assessed during follow-up.

Results

The mean age of patients at the time of SF-PCIOL was 90 months (range, 66-115). The mean duration of follow-up time after surgery was 22 months (range, 5-55). In all patients, the best-corrected VA was either improved or was stable at last follow-up following SF-PCIOL implantation. There were no serious complications.

Conclusions

Unilateral scleral fixation of PCIOL can be a safe and effective procedure for pediatric, unilateral, complicated traumatic cataracts without capsular support in selected cases.     

外伤性白内联IOL植入术后继发性近视

目的 分析外伤性白内障IOL植入术后继发性近视发生的情况。方法 观察4例外伤性白内障IOL植入术后发生继发性近视的原发性损伤、治疗经过及矫正结果。结果 受伤年龄11－31岁,受伤前均系正视眼,白内障摘出及IOL植入术都在受伤后2月内施行,IOL屈光度合适,继发性近视的形成／发展于术后3月以上甚至3年或者更长的时间。结论 外伤性白内障IOL植入术后继发性近视的发生可能与眼穿孔伤造成伤眼角膜散光、角膜疤痕、晶状体浑浊、玻璃体浑浊等多种形觉剥夺因素有关,强调对眼外伤尤其严重性眼外伤者长期随访的重要性,及时去除各种形觉剥夺因素,以恢复和保持伤眼的有用视力。     

前后节联合手术治疗复杂性葡萄膜炎的临床疗效

目的：探讨前后节联合手术治疗眼后段组织受累的复杂性葡萄膜炎患者的初步临床疗效。方法：回顾性临床研究。收集2018年5月至2021年1月在首都医科大学附属北京朝阳医院眼科接受前后节联合手术的葡萄膜炎合并白内障患者33例（33眼）的临床资料。根据致病原因分为：感染组16例（16眼）,其中巨细胞病毒性脉络膜视网膜炎4眼,疱疹病毒性葡萄膜炎3眼,弓形虫性葡萄膜炎2眼,急性视网膜坏死1眼,细菌或真菌性眼内炎6眼;非感染组17例（17眼）,其中特发性葡萄膜炎12眼,眼内淋巴瘤1眼,虹膜异色性睫状体炎2眼,幼年特发性关节炎性葡萄膜炎2眼。采用Wilcoxon符号秩检验分析所有患者手术前后的视力、眼压、房水闪辉指数变化以及组间术后视力差异。采用卡方检验比较不同组间术中植入人工晶状体（IOL）及硅油填充比例的差异。结果：全部患者的术前LogMAR最佳矫正视力（BCVA）为2.40（1.50,2.70）,术后BCVA为1.70（0.55,2.70）,术后视力明显提高（Z=-2.61,P=0.009）。术后,感染组LogMARBCVA为2.25（2.10,2.93）,非感染组为0.92（0.40,1.70）,且明显低于感染组（Z=-2.97,P=0.003）;感染组视力提高比例为44%,非感染组视力提高比例为71%。全部患者术前眼压为15.0,（10.0,18.5）mmHg（1mmHg=0.133kPa）,术后眼压为14.0（12.0,16.0）mmHg,手术前后眼压差异无统计学意义（Z=-0.02,P=0.983）。所有患者术前、术后房水闪辉指数分别为12.4（7.5,73.2）pc/ms和5.0（3.3,7.3）pc/ms,术后房水闪辉指数明显下降（Z=-2.99,P=0.003）。感染组植入IOL比例明显低于非感染组（χ2=6.94,P=0.008）,2组间硅油填充比例差异无统计学意义（χ2=0.25,P=0.619）。结论：前后节联合手术治疗眼后段组织受累的复杂性葡萄膜炎可以提高患者术后视力,有效控制炎症。     

Intraocular lens implantation in children with unilateral traumatic cataract

A group of 23 children with traumatic pseudophakia was evaluated. Intraocular lens (IOL) implantation was performed as a primary procedure, immediately after aspiration of the traumatic lens, in 7 cases and as a secondary procedure in 16 cases. The mean followup was 6.5 years, varying from 1.5 to 11 years. A visual acuity of 0.7 or more was achieved in 3 of the 8 patients under 7 years of age and in 13 of the 15 cases from 7 to 14 years of age. Awaiting longer follow-up results of epikeratophakia in children we advise to perform early IOL implantation in children under 7 years of age, combined with a rigid amblyopia treatment scheme. In children older than 7 years of age we prefer to try the use of contact lenses first and preserve IOL implantation for selected cases.     

Iris Fixation Suturing of Intraocular Lenses

A technique for iris fixation suturing is described. A study of 11 patients undergoing this procedure for permanent correction of mal-positioned intraocular lenses showed no significant corneal endothelial cell loss.     

人工晶状体巩膜固定术的手术进展

外伤或先天性疾病导致的晶状体脱位以及白内障手术后囊破裂较大等无法常规植入人工晶状体的患者,可根据病情选择不同的术式植入人工晶状体。本文将介绍多种后房型人工晶状体巩膜固定术的手术方法,包括人工晶状体巩膜缝线固定术、无缝合巩膜层间人工晶状体襻固定术、生物胶人工晶状体襻巩膜固定术。此外还将对以上术式的术后效果及并发症进行综述。     

晶状体后囊膜破裂的Ⅰ期后房型人工晶状体植入术

目的:评价白内障摘除术中后囊膜破裂时行前段玻璃体切割或剪除联合Ⅰ期后房型人工晶状体植入的手术效果。方法:对1089例白内障摘除术中76例后囊膜破裂,行前段玻璃体切割或剪除联合Ⅰ期后房型人工晶状体植入的手术技巧、术后视力和术后并发症等进行分析。结果:术后1周和6个月时矫正视力≥0.5的比例分别为86.8％和93.4％。结论:白内障摘除术中后囊膜破裂合并玻璃体脱出时,行前段玻璃体切割或剪除联合Ⅰ期后房型人工晶状体植入术是安全有效的。眼科学报 2002;18:217-219.     

先天性白内障手术中双撕囊联合前段玻璃体切除术的应用

目的 探讨先天性白内障手术中双撕囊联合前段玻璃体切除术应用的效果.方法 对42例(44眼)儿童先天性白内障,行前后囊双撕囊、前段玻璃体切除联合人工晶状体植入术(A组);同期进行的36例(38眼)儿童先天性白内障,行前后囊双撕囊联合人工晶状体植入术作为对照组(B组);随访6～24月.结果 术后矫正视力≥0.5者,A组30眼(68.18%),B组13眼(34.21%);0.2-0.4者,A组12眼(27.27%),B组17眼(44.74%);≤0.1者,A组2眼(4.55%),B组8眼(21.05%);两组比较差异有统计学意义(x2=5.16,P＜0.05).后囊浑浊≥3级者,A组2眼(4.55%),B组8眼(21.05%);两组比较差异有统计学意义(x2=5.62,P＜0.05).均未出现眼底并发症.结论 先天性白内障术中行双撕囊联合前段玻璃体切除术,能够完全有效地止视轴区后囊的浑浊,有助于视功能的恢复.     

葡萄膜炎并发白内障的人工晶状体植入术

目的探讨葡萄膜炎并发白内障的手术方式和疗效。方法对28例（28眼）葡萄膜炎并发白内障行白内障摘出及人工晶状体植人术，观察其视力变化及术中、术后并发症。结果术后26眼（92．86％）视力较术前提高。其中〉0．5者10眼，0．3。0．5者10眼，0．1。0．2者6眼，〈0．1者2眼。结论葡萄膜炎并发白内障植人人工晶状体。效果可靠。     

Follow-Up Study of Over Three Years of Patients with Uveitis after Cataract Phacoemulsification: Outcomes and Complications

Purpose: To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification. Methods: One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis. Results: Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r?=?0.6; p?=?0.00) and mostly related to patients who presented more than one postoperative relapse/year (r?=?0.2; p?=?0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p?=?0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY). Conclusion: The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are most frequent in Fuchs uveitis. The postoperative visual acuity result was good among all the uveitis groups.     

Intraocular Concentrations of Cytokines and Chemokines in a Unique Case of Nivolumab-Induced Uveitis

ABSTRACT

Purpose

To report a unique case of nivolumab-induced uveitis and the results of a cytokine analysis of an intraocular fluid sample.     

Complications of Scleral-Fixated Intraocular Lenses

ABSTRACT

Introduction: Understanding the evolution of complications after scleral-fixated lens placement demonstrates advantageous surgical techniques and suitable candidates. Materials/Methods: A literature search in PubMed for several terms, including “scleral intraocular lens complication,” yielded 17 relevant articles. Results: Reviewing complication trends over time, lens tilt and suture erosion have decreased, cystoid macular edema has increased, and retinal detachment has remained the same after scleral-fixated lens placement. The successful reduction in complications are attributed to several alterations in technique, including positioning sclerotomy sites 180 degrees apart and using scleral flaps or pockets to bury sutures. Possible reduction in retinal risks have been proposed by performing an anterior vitrectomy prior to lens placement in certain settings. Discussion: Complications after scleral-fixated lens placement should assist patient selection. Elderly patients with a history of hypertension should be counseled regarding risk of suprachoroidal hemorrhage, while young patients and postocular trauma patients should be considered for concurrent anterior vitrectomy.     

隧道小切口晶状体核分瓣技术在白内障手术中的应用

目的:探讨隧道小切口晶状体核分瓣技术对提高视力及减少白内障术后并发症的意义。方法:随机抽样,分别对行小切口晶状体核分瓣法的120只眼及行传统白内障体外摘除术(ECCE)的80只眼进行回顾性分析,比较两组术后1周和1个月的视力、角膜散光及术中和术后并发症。结果:小切口组术后1周有112眼(93.3%)最好矫正视力高于0.5,ECCE组术后1周有48眼(60%)视力高于0.5,差异具有显著性(x~2=4.73,P<0.05)。小切口组的术后角膜散光分别为(1.01±0.97)D(n=95;术后1周)和(0.62±0.53)D(n=90;术后1个月),ECCE组术后角膜散光为(4.46±1.93)D(n=70;术后1周)及(2.74±1.54)D(n=60),差异有显著性(t=3.1467,P<0.01和t=3.4753,P<0.01)。结论:隧道小切口晶状体核分瓣技术安全、省时、术后恢复快、费用低,值得在一定范围内推广。眼科学报 2002;18:223-225.     

Intraoperative Intravitreal Injection of Triamcinolone Acetonide for Cataract Extraction in Patients with Uveitis

Purpose: To evaluate the efficacy of intravitreal triamcinolone injection in controlling postoperative inflammation after cataract extraction in patients with uveitis.

Methods: This retrospective study included 30 eyes with uveitis that had phacoemulsification or extracapsular cataract extraction with intraocular lens implantation. Intravitreal triamcinolone acetonide (4?mg) was injected at the end of surgery. No systemic steroids were given after surgery.

Results: Visual acuity improvement of 2 lines or more occurred in 26 eyes (86.7%). Six eyes (20%) had a best-corrected visual acuity of 6/60 or better before surgery, which increased to 22 eyes (73.3%) after surgery. Five eyes (16.7%) had a visual acuity of 6/12 or better after surgery. Intravitreal triamcinolone injection controlled the postoperative inflammation in all eyes for at least 3 months following surgery.

Conclusion: Intravitreal triamcinolone injection was effective in controlling postoperative inflammation after cataract extraction in patients with uveitis sparing the use of systemic steroids.