Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼

目的：：探讨Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼的手术方法及疗效评价。方法：选取2012-01/2014-01期间我院通过行Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼的患者47例47眼,距前次晶状体玻璃体切除术3~6mo。所有患者随访6~12(平均8.21±2.63)mo。结果：本次研究中47例患者人工晶状体均植入顺利,未见位置偏斜情况。最后一次术后随访的裸眼视力(0.44±0.19),与术前最佳矫正视力(0.41±0.23)相比,差异不具有统计学意义(t=0.879,P=0.342)。无明显术中及术后并发症。结论：Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼患者的效果良好,有效减少了并发症,对于改善患者视力安全有效。     

Capsule measuring ring to predict capsular bag diameter and follow its course after foldable intraocular lens implantation

PURPOSE: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size. SETTING: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany. METHODS: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics). RESULTS: The mean capsular bag size was 10.53 mm intraoperatively, 10.31 mm at 1 day, 9.62 mm at 1 month, 9.07 mm at 3 months, and 9.01 mm at 6 months. The mean capsular bag shrinkage over the entire postoperative period was 14.8% (P<.001). Of the parameters studied, only AL had a positive correlation with capsule shrinkage. The correlation was moderate but statistically significant (P =.001). CONCLUSIONS: A correlation was found between capsular bag shrinkage and AL. Using preoperative biometric data, a regression formula of moderate validity was determined to predict capsular bag shrinkage.     

残留后囊或前囊为支撑人工晶状体Ⅰ期植入术

目的 观察颞侧透明角膜切口的晶状体超声乳化手术中后囊破裂时，以残留的后囊或前囊为支撑进行Ⅰ期折叠式人工晶状体植入术的成功率。方法 在28例(28眼)透明角膜切口超声乳化手术中各种原因导致的后囊部分破裂情况下，以残留的后囊或前囊作支撑，进行折叠式人工晶状体Ⅰ期植入术。结果 随访3～22月，人工晶状体位置稳定，未发现1例人工晶状体脱位，视力恢复满意。结论 在较好的环形撕囊前提下，后囊破裂者不必改变术式，仍可Ⅰ期植入折叠式人工晶状体，操作简单，效果良好。     

Comparison of iris-fixated foldable lens and scleral-fixated foldable lens implantation in eyes with insufficient capsular support

AIM: To compare the outcomes of vision using two different intraocular lens (IOL) replacement techniques, iris-fixated foldable intraocular lens (IF-IOL) and scleral-fixated foldable intraocular lens (SF-IOL) in patients with insufficient capsular support. METHODS: Total 63 eyes (62 patients) with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011. Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS: The mean improvement of uncorrected visual acuity (UCVA) was greater in IF-IOL group compared to the SF-IOL group (0.43 D±0.19 D vs 0.35 D±0.18 D, P<0.05). Moreover, 12 (38.71%) eyes in IF-IOL group and 4 (12.50%) in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity (BCVA) while 9 (29.03%) eyes in IF-IOL group and 18 (56.25%) in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group (-0.47 D±0.58 D vs 0.50 D±0.43 D, P<0.01; 0.84 D±0.53 D vs 1.23 D±0.70 D, P<0.05). No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION: IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.     

Capsular bag opacification after experimental implantation of a new accommodating intraocular lens in rabbit eyes

PURPOSE: To evaluate the development of capsular bag opacification in rabbit eyes after implantation of an intraocular lens (IOL) designed to minimize contact between the anterior capsule and the IOL and ensure expansion of the capsular bag. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ten New Zealand white rabbits had a study IOL (new accommodating silicone IOL [Synchrony, Visiogen, Inc.]) implanted in 1 eye and a control IOL (1-piece plate silicone IOL with large fixation holes) implanted in the other eye. Intraocular lens position, anterior capsule opacification (ACO), and posterior capsule opacification (PCO) were qualitatively assessed using slitlamp retroillumination photographs of the dilated eyes. Anterior capsule opacification and PCO were graded on a 0 to 4 scale after the eyes were enucleated (Miyake-Apple posterior and anterior views after excision of the cornea and iris). The eyes were also evaluated histopathologically. RESULTS: The rate of ACO and PCO was significantly higher in the control group. Fibrosis and ACO were almost absent in the study group; the control group exhibited extensive capsulorhexis contraction, including capsulorhexis occlusion. Postoperative IOL dislocation into the anterior chamber and pupillary block syndrome were observed in some eyes in the study group. CONCLUSIONS: The special design features associated with the study IOL appeared to help prevent PCO. Complications in the study group were probably caused by the increased posterior vitreous pressure in rabbit eyes compared to human eyes and the relatively large size of the study IOL relative to the anterior segment of rabbit eyes.     

Evaluation of a human capsular bag model for secondary cataract determination after intraocular lens implantation

Purpose To investigate the effect of different intraocular lenses (IOLs) on lens epithelial cells (LECs) and on human capsular bags in vitro and to evaluate the transferability of this model to clinical situations.Methods Sham cataract surgery, including IOL-into-the-bag implantation, was performed on 38 donor eyes after removal of the cornea. The capsular bag including the IOL was removed, pinned on a culture dish, covered with medium, and incubated. Two different IOLs were compared per pair of donor eyes. In each pair of donor eyes, the two different IOLs to be compared were implanted individually into capsular bags. The time required for complete coverage of the posterior capsule by a confluent monolayer of LECs was documented. The following IOLs were compared: three-piece acrylic IOLs of different sizes and single-piece polymethylmethacrylate (PMMA) versus acrylic IOLs.Results A complete monolayer of LECs on the posterior capsule was observed to form at times varying from 8 days (PMMA IOLs) to more than 60 days (three-piece hydrophobic acrylic IOLs). A significant difference between PMMA IOLs and hydrophobic acrylic IOLs was found.Conclusions The human capsular bag model employed allows short-term evaluation of secondary cataract formation for different IOLs. This models correlation with clinical results is good.Presented in part at the 101st Annual Meeting of the Deutsche Ophthalmologische Gesellschaft, Berlin, September 2003.     

晶状体不全脱位囊袋内人工晶状体植入术

目的探讨晶状体超声乳化人工晶状体囊袋内植入术治疗晶状体不全脱位的可行性。方法对32例（51眼）年龄为20～58岁的晶状体不全脱位行晶状体超声乳化囊袋内缝线固定人工晶状体植入术。观察术中术后情况，随访时间10～24月。结果手术顺利完成，术后人工晶状体固定良好，无移位，视轴区透明，视力提高迅速且较稳定，术后无严重并发症发生。结论晶状体超声乳化囊袋内缝线固定法人工晶状体植入术治疗晶状体半脱位，可有效保持视轴清晰，恢复眼部正常解剖结构，显著减少并发症的发生。     

Longterm results after phacovitrectomy and foldable intraocular lens implantation

Purpose: This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co‐existing vitreoretinal diseases. Methods: We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results: The most common indications for surgery were non‐diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by ≥ 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow‐up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions: Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co‐existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract.     

青光眼滤过术后白内障超声乳化吸除联合折叠式人工晶状体植入

目的评价青光眼滤过术后白内障超声乳化吸除联合折叠式人工晶状体植入的疗效.方法对18只青光眼滤过术后白内障眼采用3.5mm的隧道切口行白内障超声乳化吸除联合折叠式人工晶状体植入,术后切口不缝合.随访3～30个月,观察术后视力,角膜散光及眼压等情况.结果18只眼术后视力均较术前提高,其中0.02者1只眼(0.06%),0.05～0.2者2只眼(11.1%),0.3～0.4者5只眼(27.8%),0.5～0.9者7只眼(38.9%),1.0～1.2者3只眼(16.7%).术前角膜散光(0.78±0.88)D,术后1周,1个月,3个月角膜散光分别为(0.89±0.80)D,(0.75±0.82)D,(0.72±0.78)D,与术前相比P＞0.05(t检验),差异无显著性,术前眼压为(2.13±0.34)kPa,术后1个月眼压为(2.20±0.23)kPa,与术前相比P＞0.05(t检验),差异无显著性.结论对于青光眼滤过术后白内障采用超声乳化吸除联合折叠式人工晶状体植入可较易避开滤过泡,术后反应轻.角膜散光无明显改变,患者术后视功能改善且不影响眼压的控制,手术安全可靠.     

Scheimpflug measurement of intraocular lens position after piggyback implantation of foldable intraocular lenses in eyes with high hyperopia

PURPOSE: To investigate the position of 3-piece foldable intraocular lenses (IOLs) after piggyback implantation for high hyperopia. SETTING: University Eye Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. METHODS: Eight eyes of 5 highly hyperopic patients had phacoemulsification and implantation of 2 foldable IOLs. In 3 eyes, both IOLs were implanted in the capsular bag. In 5 eyes, 1 IOL was placed in the capsular bag and the second IOL in the ciliary sulcus. Intraocular lens optic tilt and decentration, combined thickness of both IOLs, and anterior chamber depth (ACD) were measured postoperatively over a period of 18 months using Scheimpflug photography. RESULTS: All eyes with both IOLs in the capsular bag showed interpseudophakic opacification, with a mean increase in combined IOL thickness of 0.4 mm, a decrease in ACD of 0.3 mm, and a corresponding hyperopic shift of 4.00 diopters. Eyes in which the anterior IOL was placed in the ciliary sulcus showed no changes in refraction or combined IOL thickness. In these eyes, the anterior IOL had a higher mean decentration (0.49 mm +/- 0.20 [SD] after 12 months) than the posterior IOL (0.21 +/- 0.13 mm after 12 months). CONCLUSIONS: Piggyback IOL implantation with placement of 2 foldable IOLs in the capsular bag can be followed by a hyperopic shift that may be caused in part by displacement of the IOLs. Placement of the anterior IOL in the ciliary sulcus can lead to higher decentration of this IOL.     

硬性和可折叠前虹膜固定人工晶状体植入治疗亚洲眼高度近视的疗效比较

目的：比较Artisan和Artiflex有晶状体眼人工晶状体(PIOL)矫正亚洲人群高度近视的屈光度和安全性。

方法：历史队列研究。回顾2016/2020在印度尼西亚日惹市Yap眼科医院接受PIOL植入术的81例高度近视眼。根据植入PIOL分为Artisan组43眼,Artiflex组38眼。分别记录术前及术后1d、1、3mo的视力、角膜生物显微镜参数和眼压,包括术前前房深度。

结果：Artisan和Artiflex组的平均随访时间分别为9.64±6.93mo和8.96±4.28mo(P=0.736)。Artisan组的疗效指数为1.03±0.47,Artiflex组为1.02±0.17(P=0.119); 安全性指数分别为1.10±0.45和1.05±0.21(P<0.001)。Artisan组的平均等效球镜度(SE)为-0.64±0.996D,Artiflex组为-0.22±0.58D(P=0.076)。两组术后内皮细胞密度(ECD)较术前均显著下降(P<0.05),累积ECD缺失率为7.44%和5.79%(P=0.418)。

结论：Artisan和Artiflex矫正亚洲人高度近视的屈光效果相当。与Artiflex相比,Artisan的安全指数略高,而两组的疗效指数和累积ECD缺失率相似。     

Incision width after phacoemulsification with foldable intraocular lens implantation

PURPOSE: To determine the incision size after insertion of foldable intraocular lenses (IOLs) using both a forceps and injectors. SETTING: Intermountain Ocular Research Center, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: One hundred patients had phacoemulsification through a clear corneal wound. The incision width was measured before and after IOL implantation. A 3-piece silicone IOL and a 3-piece acrylic IOL (both with an optic diameter of 5.5 mm) were inserted using a forceps. A plate-haptic silicone lens and a 3-piece silicone lens with a 6.0 mm diameter optic were inserted using an injector. RESULTS: The wound size in the group with the 3-piece silicone lens inserted with a forceps enlarged 4.4% (3.23 to 3.38 mm) in the low-power IOL group (15.0 to 20.0 diopters [D]) and 6.2% (3.24 to 3.44 mm) in the high-power IOL group (20.5 to 25.0 D). Similarly, the acrylic IOL wound enlarged 5% (3.21 to 3.37 mm) in the low-power IOL group and 6% (3.25 to 3.44 mm) in the high-power IOL group when a forceps was used. The 3-piece silicone and plate silicone lenses inserted using an injector enlarged the wound 3.2% and 3.3% (3.02 to 3.11 mm and 3.05 to 3.15 mm), respectively. There was no difference in the wound size with higher IOL powers in eyes with injected lenses. CONCLUSIONS: Clear corneal incisions enlarge after insertion of foldable IOLs in a predictable manner, with a forceps-inserted IOL enlarging the wound diameter more than lenses inserted with an injector. The forceps-inserted lens group also showed a difference in wound size related to IOL power.     

Acrysof折叠式人工晶状体植入术后观察

目的：评价白内障手术方式及Acrysof人工晶状体植入手术的疗效。方法：对3组61例（64眼）老年性白内障分别采用3.2-6.5mm巩膜隧道和孤长12mm巩膜阶梯切口,分别施行白内障超声乳化摘出联合折叠式人工晶状体植入术,超声乳化摘出联合一体型人工晶状体植入术和囊外摘出联合一体型人工晶状体植入术。结果：术后5天3组平均裸眼视力分别为0.83,0.75和0.51,达到1.0以上视力比例分别为53.33%,26.09%和7.69%,前者和后两者比较,差异均有显著性（q检验,P＜0.01)。结论：采用小切口折叠式人工晶状体植入术具有术后视力早期恢复的优点。     

儿童折叠式人工晶状体二期植入术

目的 探讨折叠式人工晶状体（IOL）二期植入术矫正儿童无晶状体眼的疗效和手术适应症.方法 对57例（71只眼）后囊膜和悬韧带完整或仅中央区后囊膜缺损的儿童无晶状体眼,二期植入丙烯酸酯（Acrysof）折叠式IOL,术后随访3～25个月.结果 术后裸眼视力均等于或高于术前矫正视力,其中术后裸眼视力≥0.5有38只眼（53.5%）,术后矫正视力≥0.5有60只眼（84.5%）.并发症包括虹膜后粘连16只眼（22.5%）,前房渗出物11只眼（15.5%）,IOL偏位6只眼（8.45%）,后发障9只眼（12.7%）.结论 对于尚存完整或部分后囊膜支撑的儿童无晶状体眼,折叠式IOL植入是一种安全、有效的方法.     

抗青光眼滤过术后超声乳化白内障吸除术的临床观察

目的　探讨抗青光眼滤过手术后进行白内障手术的方法及手术对滤过泡的影响。方法对抗青光眼小梁切除术后白内障患者 2 35例 (2 6 2只眼 ) ,采用颞侧透明角膜隧道切口进行超声乳化白内障吸除及折叠式人工晶状体植入手术 ,同时对固定的小瞳孔进行扩张或采用括约肌切开与缝合术。结果　白内障术后患者视力不同程度提高 ,视力≥ 0 5者占 74 0 % ;术后平均眼压升高 3 0 8mmHg(1mmHg =0 133kPa) ,与术前比较差异无显著性 (P >0 0 5 ) ;功能性滤过泡未见明显瘢痕化。结论　对抗青光眼滤过术后白内障患者进行颞侧透明角膜隧道切口超声乳化白内障吸除术 ,可提高视力 ,同时可保持滤过泡功能。