Bigbag人工晶状体在屈光晶体置换术中的临床应用

目的 评价三襻式Bigbag人工晶状体在高度近视屈光晶状体置换术中的临床效果.方法 对53例80只眼高度近视伴或不伴晶状体混浊,施行屈光晶状体置换术,其中单眼高度近视19例,双眼高度近视因近视力低于0.1,选择近视力及矫正视力较好的单眼进行手术的7例,双眼手术的27例,全部行超声乳化吸出植入低度数或负度数亲水性丙烯酸酯折叠Bigbag人工晶状体,观察术中和术后并发症.观察手术前后最佳远视力(VA),最佳矫正视力(BCVA),近视力(NVC),眼轴长度,屈光状态,术后随访6月～1年.结果 术后56只眼(占70％)裸眼视力≥0.3,46只眼(占57.5％)裸眼视力≥0.5,6只眼(占7.5％)裸眼视力≥0.8,≤0.3有24只眼(占30％),除2例(占3.7％)术前裸眼近视力≤0.1,术后视力无改善外,其余病人均较术前最佳矫正视力提高.术中因撕囊口偏小,植入人工品状体后囊破裂人工晶状体偏位1例,其余病例人工晶状体与后囊膜紧贴,后囊膜未见皱褶,人工晶状体固定良好.结论 通过详细术前检查,超声乳化吸出植入低度数或负度数Big bag人工晶状体,完成屈光晶状体置换手术安全有效,视觉质量好,不仅降低了后囊膜皱褶,后发性白内障,稳定囊袋,同时也减少了视网膜脱离的风险.     

高度近视白内障超声乳化摘出人工晶状体植入术

目的评价高度近视眼白内障超声乳化摘出术及人工晶状体植入术的疗效.方法对眼轴＞26mm(平均27.46mm)的94例(104眼)高度近视合并白内障患者行超声乳化摘出及人工晶状体植入术.结果术后1月裸眼或矫正视力≥0.5者84眼(80.76%),视力≥1.0者34眼(32.69%).结论高度近视白内障超声乳化及人工晶状体植入术具有术后视力恢复快屈光状态稳定等优点,但眼轴＞30mm以上者视力差.     

屈光性晶状体置换治疗高度近视的临床研究

背景屈光性晶状体置换术已成为矫治高度近视的方法之一,尤其是不适应佩戴框架眼镜或不适合角膜屈光手术的高度近视眼,目前已愈来愈多地应用于临床,其临床价值值得关注。目的研究晶状体置换术治疗高度近视的有效性和安全性。方法病例观察研究。对高度近视患者65例124眼行超声乳化晶状体摘出联合人工晶状体植入术。患者平均年龄（51．4±8．57）岁,术前平均矫正视力为4．11±0．51,平均近视屈光度（-20．17±5．34）D,平均眼轴长度（31．33±2．08）mm,平均植入人工晶状体的屈光度数为2．88D。术后平均随访时间31个月,观察术后裸眼视力、最佳矫正视力、屈光度改善情况以及并发症。结果所有患者裸眼视力均有所提高,15眼（12％）裸眼视力提高至≥0．5;114眼（92％）最佳矫正视力较术前提高,64眼（51．6％）最佳矫正视力≥0．5。术眼术后平均近视屈光度为（-2．57±1．76）D。术后发生晶状体后囊膜混浊并行后囊膜激光切开术者58眼（46．7％）,发生视网膜脱离者4眼。结论屈光性晶状体置换术是安全、有效的手术方法,但对于高度近视患者,术前应仔细检查眼底情况。术后需长期随访,注意并发症的发生。     

表面麻醉下Array多焦点人工晶状体植入

目的探讨多焦点人工晶状体植入的手术方法,评价多焦点人工晶状体植入后的临床效果。方法表面麻醉下3.2mm透明角膜切口白内障超声乳化,特制推注器植入Array三片式硅凝胶多焦点人工晶状体52例60眼,术后随访常规眼科检查包括患者远近视力。结果表面麻醉下Ar-ray多焦点人工晶状体植入未发生手术并发症,术后第7d裸眼远视力≥0.5者60眼,其中1.0者45眼,裸眼近视力≥0.5者57眼,其中1.0者16眼。术后3月裸眼远视力≥0.5者60眼,其中1.0者43眼,裸眼近视力≥0.5者55眼,其中1.0者18眼。结论Array多焦点人工晶状体同时提高患者远近视力,表面麻醉下Array多焦点人工晶状体植入未发生手术并发症,多焦点人工晶状体植入对手术条件、手术技术要求更高。     

超声乳化透明晶状体联合人工晶状体植入治疗高度近视

目的:探讨超声乳化透明晶状体联合人工晶状体植入治疗高度近视的有效性和安全性.方法:对我院自2004/2006年25例43眼的高度近视患者施行透明晶状体超声乳化联合人工晶状体植入术.平均年龄48.6岁,术前患者裸眼视力0.01～0.25,屈光度数平均-13.75±0.26D,平均散光度数1.07±0.86D,矫正视力0.1～0.6,平均眼轴长度28.13±2.32mm.结果:所有患者裸眼视力均比术前提高,其中术后1d 4眼(9%)0.1～0.12者9眼(21%)0.15～0.4者30眼(70%)≥0.5;术后3mo 18例主导眼裸眼视力均≥0.5,40眼(93%)矫正视力≥0.5,其中3眼(7%)因后巩膜葡萄肿及黄斑病变矫正视力较差0.12～0.3;所有患者术中术后无严重并发症,术后屈光状态稳定,未见回退的现象.结论:超声乳化透明晶状体联合人工晶状体植入术可治疗其他屈光手术难以解决的高度近视,是这一部分患者获得正视的安全、有效、准确和稳定的可靠途径.     

人工晶状体置换术8例临床分析

目的分析8例人工晶状体(intraocular lens,IOL)置换术的原因、手术技巧和临床效果。方法回顾分析我院2004年1月至2006年12月8例(8眼)患者行IOL置换术术后裸眼视力、矫正视力和并发症。结果行IOL置换的主要原因是IOL脱位(3眼)和人工晶状体度数计算错误(3眼);术后裸眼视力在0.5以上的有7眼,8眼的最佳矫正视力均在0.5以上,手术的主要并发症是玻璃体脱出(2眼)。结论精细的手术技巧、准确的IOL测量、仔细的IOL植入和患者的合理沟通/选择等可有效避免IOL植入术出现并发症。IOL置换是一种即安全又能获得良好视力的治疗方法。     

透明晶状体屈光手术的疗效观察

目的 :评价透明晶状体屈光手术的有效性、预测性和安全性。方法 :对屈光不正患者 5 8例 87眼行透明晶状体超声乳化摘除联合折叠式人工晶状体植入。患者年龄 2 5～ 73岁 ,平均 5 4 .32岁。将病例分为 3组 ,A组为高度近视共 6 1眼 ,眼轴长度 (2 9.5 7± 2 .10 )mm ,等效球镜度数 (- 11.93± 4 .6 4 )D ,植入人工晶状体屈光度 ( 9.0± 3.82 )D ;B组为远视共 17眼 ,眼轴长度 (2 2 .39± 0 .96 )mm ,等效球镜度数 ( 2 .2 9± 1.0 5 )D ,植入人工晶状体屈光度 ( 2 2 .70± 2 .0 8)D ;C组为屈光参差共 9眼 ,眼轴长度 (2 8.4 8± 1.77)mm ,屈光参差度数 (- 11.2 5± 5 .38)D ,植入人工晶状体屈光度 ( 10 .6 2±3.6 2 )D。随访 3～ 36个月。结果 :术后最佳矫正视力 87眼均达到或超过术前最佳矫正视力 ;术后裸眼视力达到或超过术前最佳矫正视力者在A、B、C组分别占 86 .89%、94 .12 %和88.89% ;术后裸眼视力 0 .5以上者分别为 5 4 .10 %、4 1.18%和 5 5 .5 6 % ;术中未发生后囊破裂。随访中 12眼发生后囊混浊 ,未发现视网膜脱离、黄斑囊样水肿等并发症。结论 :透明晶状体屈光手术与目前的角膜屈光手术相比 ,可能更适宜于中年以上不愿戴镜和戴镜不能矫治的屈光不正患者 ,但其远期疗效尚需长期随访     

超声乳化透明晶状体摘除联合人工晶状体植入治疗高度近视的疗效观察

目的:探讨超声乳化透明晶状体摘除联合人工晶状体植入术治疗高度近视的临床有效性和安全性。方法:2005/2007年在我院行超声乳化透明晶状体摘除联合人工晶状体植入术的高度近视患者38例47眼,年龄30～45(平均37.2±1.4)岁,术前患者裸眼视力0.01～0.25,屈光度数平均-13.15D±0.37D,平均散光度数1.0D±0.91D,矫正视力0.2～0.8,平均眼轴长度27.18±2.45mm。结果:术后所有患者裸眼视力均有所提高。术后视力1d0.1～0.2者6眼(12.8%),0.2～0.5者11眼(23.4%),>0.5以上者30眼(63.8%)。术后屈光度为0.50D～-1.75D,平均散光度为0.5D～1.0D。术后发生后囊膜混浊6眼(12.8%),所有患者术中及术后无严重并发症、屈光状态稳定。术后2mo内部分患者有视近不适、调节疲劳等不适,但3mo后症状缓解,年轻患者有较强的主观调节幅度和自我调节能力。结论:超声乳化透明晶状体摘除联合人工晶状体植入术可治疗其他屈光手术难以解决的高度近视,使这一部分患者获得正视的安全、稳定、可靠的途径。     

高度近视眼白内障超声乳化术临床分析

目的:浅析高度近视眼白内障超声乳化吸出术及后房型人工晶状体植入术后的疗效和并发症。方法:对83例96眼高度近视眼白内障行角膜缘隧道切口白内障超声乳化吸出术及后房型人工晶状体植入术。眼轴长度为26.32～32.46(平均28.58)mm,其中<28mm的31眼,28～30mm的42眼,>30mm的23眼。植入PMMA后房型人工晶状体,观察术后视力及术中术后并发症。结果:眼轴长度<28mm的31眼中≥0.5者30眼(97%);眼轴长度28～30mm的42眼中≥0.5者36眼(86%);>30mm的23眼中≥0.5者13眼(57%)。后囊膜破裂2眼,其中1眼后囊膜破孔较大,行前部玻璃体切除后,睫状沟植入人工晶状体,但术后2mo发生视网膜脱离。其它并发症为角膜水肿、黄斑囊样水肿以及后囊膜混浊等。结论:高度近视眼白内障超声乳化吸出及后房型人工晶状体植入术能明显提高患者视力,但眼轴长度>30mm者术后视力恢复欠佳。     

高度近视晶状体超声乳化吸出及后房型低或负度数人工晶状体植入术

目的 现察高度近视眼的晶状体超声乳化吸出联合低或负度数人工晶状体植入术的临床疗效及预后视力情况。方法 38例47眼老年性、并发性、外伤性白内障及4例6眼高度近视透明晶状体行巩膜隧道切口超卢乳化吸除，通过3．5mm切口植入折叠式人工晶状体13眼，通过5．5mm切口植入硬性PMMA人工晶状体37眼，未植入人工晶状体3眼。平均年龄59．9岁(19—83岁)，眼轴长度＜30mm36眼，≥30mml7眼。人工晶状体度数≤0D6眼，0—10D30眼，＞10D14眼。结果 视力＜0．1者4眼，0．1—0．4者24眼(45．2％)，≥0．5者22眼(41．6％)。眼轴＜30mm组，术后最佳矫正视力≥0．5者17眼，占47．2％，眼轴长度≥30mm组17眼，术后最佳矫正视力≥0.5者5眼，占29．4％．术后无视网膜脱离、黄斑区水肿等严重并发症的发生。结论 高度近视眼晶状体超声乳化吸出及后房低或负度数人工晶状体植入术，具有术后视力恢复快、手术安全、并发症少等优点。     

角膜屈光矫正手术后白内障手术

目的:探讨角膜屈光矫正手术后白内障手术的诊疗特点。方法:对2005/2008年间于我院就诊的4例角膜屈光矫正手术后白内障患者行白内障超声乳化吸出术+人工晶状体植入术。依据患者提供的角膜屈光手术资料,分别采用临床病史法或角膜后表面曲率法计算矫正角膜曲率及人工晶状体度数。术后随访观察角膜情况、手术并发症、裸眼视力、最佳矫正视力、术后屈光状态等。结果:术后最佳矫正视力较术前明显提高。术后稳定屈光度与手术前预留屈光状态比较误差范围为-1.00～+1.25D。结论:对角膜屈光手术后的白内障患者施行白内障超声乳化吸出术+人工晶状体植入术是可行的。然而只有了解这类患者病情特点,掌握手术前后诊疗方法,准确计算人工晶状体度数,才能达到满意的疗效。     

Pseudoaccommodation and visual acuity with Technovision presbyLASIK and a theoretical simulated Array multifocal intraocular lens

PURPOSE: To compare the visual results of presbyLASIK patients to the best theoretical pseudoaccommodation that could be achieved using a multifocal refractive intraocular lens (IOL) model based on the optical structure of a simulated AMO Array multifocal IOL. METHODS: The study included 10 hyperopic eyes that underwent central presbyLASIK surgery using a Technovision excimer laser platform. Mean patient age was 57 years, and mean preoperative spherical equivalent refraction was 1.28+/-0.87 diopters. The optical quality was evaluated by objective distance and near decimal visual acuities calculated using a Fresnel propagation algorithm based on a realistic eye model. Results of the presbyLASIK technique were compared with the theoretical results obtained for the same eye with an ideal, best-fit multifocal IOL (simulated Array multifocal IOL) substituted for the crystalline lens. RESULTS: For near objective visual acuity (from 25 cm to 1 m), the ideal, theoretical Array-like lens provided values of visual acuity above 0.5 for all object distances, whereas presbyLASIK also provided good visual responses for distances beyond 45 cm. For distance vision (from 1.5 to 6 m), both the IOL and presbyLASIK visual acuities were over 0.5, but the optical performance of the ideal Array-like lens was slightly worse than with presbyLASIK. CONCLUSIONS: Overall near to distance visual acuity obtained with the presbyLASIK technique is comparable to the best visual acuity that could be achieved with a simulated Array multifocal IOL. Near visual acuity with presbyLASIK falls off from the ideal.     

Clear lens extraction with intraocular lens implantation for hyperopia.

PURPOSE: Current surgical options for the correction of moderate to severe hyperopia include hyperopic laser in situ keratomileusis (LASIK), phakic intraocular lens implantation and clear lens extraction with intraocular lens (IOL) implantation. We investigate the safety and efficacy of clear lens extraction with IOL implantation to correct hyperopia. METHODS: Phacoemulsification and IOL implantation was performed on 18 eyes of 10 patients. In 16 eyes, the Hoffer-Q formula was used for IOL power calculation and a single IOL was inserted; in the remaining 2 nanophthalmic eyes, the Holladay-II formula was used and two piggy-back IOLs were inserted. RESULTS: Mean preoperative spherical equivalent for distance was +6.17 D (range, +4.25 to +9.62 D). Patients were followed postoperatively for a mean of 10.5 months (range, 4 to 27 mo). Uncorrected visual acuity in all eyes was 20/50 or better with a median uncorrected visual acuity of 20/40 (range, 20/30 to 20/50). Two patients lost 2 lines of spectacle-corrected visual acuity; both of these patients achieved spectacle-corrected visual acuity of 20/30. CONCLUSIONS: Clear lens extraction with IOL implantation is a safe and effective procedure for the correction of moderate to severe hyperopia in the presbyopic age range.     

Visual acuity tolerance to residual refractive errors in patients with an apodized diffractive intraocular lens

PURPOSE: To assess visual acuity tolerance to defocus caused by residual refractive errors after clear lens extraction (CLE) with apodized diffractive intraocular lens (IOL) implantation. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: In this prospective study, 150 eyes of 75 consecutive patients who had bilateral CLE with implantation of an AcrySof ReSTOR Natural IOL (Alcon) were evaluated. The eyes were divided into 2 groups: myopia and hyperopia. Residual refractive errors were analyzed using vector analysis. Monocular and binocular uncorrected distance visual acuity, best corrected distance visual acuity, uncorrected distance near visual acuity, and best distance-corrected near visual acuity 6 months after surgery were recorded. RESULTS: When the distance residual refractive error was corrected, there was a statistically significant improvement in uncorrected distance acuity in the myopia group and hyperopia group (P<.001). No differences were found between uncorrected-distance near acuity and best distance-corrected near acuity (P>.2). A significant trend toward worse visual acuity as a function of spherical equivalent (SE) value was significant only for uncorrected distance acuity (P<.001). No significant correlations were found for best corrected distance acuity, uncorrected-distance near acuity, and best distance-corrected near acuity as a function of SE (P>.2). CONCLUSIONS: Correction of distance residual refractive error improved distance visual acuity in patients with apodized diffractive IOLs. However, near visual acuity was maintained whether the residual refractive error was corrected or not.     

超声乳化透明晶状体摘除联合人工晶状体植入治疗高度近视的临床疗效

目的:探讨超声乳化透明晶状体摘除联合人工晶状体植入治疗高度近视的临床疗效。方法:对30例49眼高度近视眼患者,经透明角膜切口行超声乳化透明晶状体吸除联合后房型折叠人工晶状体植入术,对比患眼手术前后视力,观察术后并发症,术后随访6～12(平均8.5)mo。结果:术后49眼矫正视力均超过术前最佳矫正视力,其中术后裸眼视力≥0.5者28眼(57%),术后最佳矫正视力≥0.5者41眼(84%);术后发生后囊混浊5眼(10%),均行YAG激光治疗;1例发生视网膜脱离(2%)。随访期内未发现黄斑囊样水肿、眼底出血、青光眼、人工晶状体偏位等并发症。结论:超声乳化透明晶状体摘除联合折叠式人工晶状体植入术,作为一种屈光手术治疗高度近视是安全有效的方法。     

Refractive results with secondary piggyback implantation to correct pseudophakic refractive errors

PURPOSE: To assess the efficacy and safety of implanting a second intraocular lens (IOL) to correct pseudophakic refractive errors. SETTING: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. METHODS: This prospective noncomparative case series included 10 pseudophakic eyes, 5 with a myopic residual refractive error and 5 with a hyperopic residual refractive error. All eyes had secondary piggyback IOL implantation with the IOL placed in the ciliary sulcus. Five types of IOLs were used to correct the residual refractive error. RESULTS: The mean preoperative myopia was -6.6 diopters +/- 3.3 (SD), and the refractive outcome was within 0.5 +/- 0.7 D of the desired refraction (range -1.5 [undercorrected] and +1.0 D [overcorrected]). The mean preoperative hyperopia was +3.8 +/- 0.8 D, and the refractive outcome was within 0.46 +/- 0.4 D of the desired refraction (range 0 and 1.0 D overcorrected). All patients showed visual acuity improvement. Best spectacle-corrected visual acuity improved from 20/44 to 20/30 (P<.05). CONCLUSION: An IOL type that is appropriate for implantation in the ciliary sulcus is a viable option for correcting pseudophakic refractive error using the piggyback technique.     

Piggybacking intraocular implants to correct pseudophakic refractive error

ObjectiveTo determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct pseudophakic refractive error.DesignNoncomparative, prospective, consecutive case series.ParticipantsEight eyes of eight normal pseudophakes and seven eyes of seven postpenetrating keratoplasty (PK) pseudophakes were included in the study.InterventionA second intraocular lens (IOL) was implanted anterior to the first in each eye in the study.Main outcome measuresEfficacy was determined based on the achieved refractive correction and Snellen uncorrected visual acuity measurements. Safety was determined based on loss of best-corrected visual acuity and operative and postoperative complications.ResultsBefore surgery, spherical equivalents ranged from −5.12 diopters (D) to 7.5 D, with a mean absolute deviation from emmetropia of 3.38 D (1.62). After surgery, spherical equivalents ranged from −2.75 D to 0.5 D, with a mean absolute deviation from emmetropia of 1.21 D (0.90). Before surgery, only 7% of patients had 20/40 or better uncorrected vision, whereas after surgery, 50% had that level of vision.ConclusionsImplanting a second IOL is a viable option for correcting pseudophakic refractive error.     

Investigation of the safety of an intraocular lens with reversibly adjustable optical power: the *Acri.Tec AR-1 PC/IOL

PURPOSE: To report the safety of a newly developed intraocular lens (PC/IOL) with reversibly adjustable refractive power (*Acri.Tec AR-1 PC/IOL) after implantation into adult human eyes. The surgical setup and specially designed instruments required for implantation will be evaluated. The examined parameters included: stability of the IOL during implantation, positioning of the IOL, rotation of the IOL, integrity of the posterior lens capsule, central visual acuity, morphology of the eye, clinical signs of inflammation, intraocular pressure, refraction. METHODS: The study was carried out on 35 human eyes after using the Acri.Tec AR-1 PC/IOL after lens removal through phacoemulsification; as control, the implantation of conventional PC/IOL into the second eye of 29 patients was used. The mean follow-up was 9 + 6 months. An initial adjustment surgery of the *Acri.Tec AR-1 PC/IOL was carried out 2 weeks after implantation in 2 patients; the follow-up of these eyes was 3 and 6 months. RESULTS: Implantation was possible without any problem. Eyes healed normally. No difference between eyes containing the *Acri.Tec AR-1 PC/IOL and eyes containing conventional PC/IOLs could be detected with respect to visual acuity, stabilization of refractive error, signs of inflammatory reaction, slitlamp microscopic aspect of the eye and intraocular pressure. As intended, initial adjustment surgery successfully changed the mydriatic refraction from +1.0 resp. +0.75 dpt to 0 resp. -0.5 dpt. 26 bilaterally pseudophakic patients including 2 patients having had adjustment surgery had more than 3 months follow-up. Mean visual acuity in the AR-1 PC/IOL group at 3 months (0.76 +/-0.24) did not differ from mean visual acuity in the pseudophakic control group (0.74 +/-0.23). Adjusted eyes had a visual acuity of 1.0. No adverse effects occurred. CONCLUSION: Initial data suggest that the *Acri.Tec AR-1 PC/IOL can be safely implanted into the capsular bag of adult human eyes and can beadjusted after implantation, thereby achieving the desired change of refraction. Further exploration of the potential usefulness of this type of reversibly adjustable PC/IOL as a tool for refractive optimization is warranted.     

Refractive lens exchange versus iris-claw Artisan phakic intraocular lens for hyperopia

PURPOSE: To study a paired-match comparison between refractive lens exchange with pseudophakic IOL implant (RLE) and Artisan phakic IOL for high hyperopia. METHODS: Nineteen eyes (12 patients, 20 to 41 years old) with an Artisan phakic IOL (Model 203: 1.00-D increment) for hyperopia from +2.75 to +9.25 D were matched to 19 eyes (15 patients, 26 to 46 yr) with hyperopia from +2.75 to +7.50 D, who had refractive lens exchange (pseudophakic IOL implantation; lenses: 0.50-D increment). Average paired-match difference was 1.13 D and 7.7 years of age. RESULTS: At 1 month after surgery, 84% of refractive lens exchange/pseudophakic IOL eyes and 94% of Artisan phakic IOL eyes had a spherical equivalent refraction within +/- 1.00 D of emmetropia; 58% and 68% of eyes, respectively, were within +/- 0.50 D (P = .97). No eye lost lines of best spectacle-corrected visual acuity (BSCVA) and no significant changes in BSCVA were found in any eye at 1 month after surgery (P = .17). The percentage of eyes with uncorrected visual acuity (UCVA) of 20/40 or better improved from 79% to 89% of eyes at 1 to 2 months after phakic IOL; it remained at 89% to 82% of eyes from 1 to 2 months after refractive lens exchange/ pseudophakic IOL. The coefficient of correlation showed statistically better accuracy (intended vs. achieved refraction; P = .035) for the Artisan phakic IOL (R = 0.83) than for refractive lens exchange/ pseudophakic IOL (R = 0.50). CONCLUSIONS: Spherical equivalent refraction outcome and BSCVA after surgery were similar for both procedures. The Artisan phakic IOL in carefully selected patients provided a better overall outcome for young patients with high hyperopia whose accommodation was preserved, as compared to refractive lens exchange.