合并虹膜缺损的人工晶状体植入手术方法

目的探讨合并有虹膜缺损眼的人工晶状体（IOL）植人手术方法。方法回顾性系列病例研究。虹膜缺损患者56例（63眼）,分析虹膜缺损及晶状体特征,对于虹膜缺损范围较小、晶状体囊袋完整的患者,采用虹膜缝合联合后房囊袋内IOL植入术：对于虹膜缺损范围小于一个象限、虹膜萎缩严重、晶状体囊袋缺损严重者行瞳孔缘环形缝合合并前房IOL植入术：对于虹膜缺损范围大而囊袋完整的患者,采用人工虹膜合并IOL囊袋植入术;对于虹膜和囊袋均大范围缺损者,采用带虹膜的IOL植入术。术后随访5个月～5年,观察术后裸眼视力、畏光情况、IOL位置、术后并发症及处理方法。结果除弱视和严重角膜瘢痕患者外术后裸眼视力均有不同程度提高。接受虹膜缝合联合白内障摘除加囊袋内IOL植入术的11例患者,其中术后视力〈0．1者3例,O．1-0．4者5例,0．5-0．8者2例,〉0．8者1例。其中3例先天性患者均因弱视视力提高不明显。接受瞳孔缘环形缝合合并前房IOL植入术的6例外伤患者,术后视力0．1～0．4者4例,0．6者2例。接受人工虹膜合并IOL囊袋内植入术的患者,其中4例先天性白内障患者因弱视形成矫正视力〈0．1;另8例0．1～0．4者2例,0．5～0．8者5例,〉0．8者1例。接受带虹膜的IOL植入术的27例患者中,术后视力数指～0．1者5例,0．1～O．4者14例,0．5～O．8者8例。畏光现象明显改善,患者满意度及舒适度理想。早期并发症包括前房出血、眼压升高、葡萄膜炎等,随访中未见角膜失代偿、IOL脱位等严重并发症。结论根据虹膜缺损情况和囊袋完整程度选择不同方式的IOL植入术,能有效提高患者视力,并改善畏光等视觉症状。     

瞳孔成形术在外伤性白内障术中的临床应用

目的 探讨瞳孔成形术在合并虹膜损伤的外伤性白内障中的临床应用效果.方法 对34例虹膜根部离断、瞳孔缘裂伤、虹膜萎缩的眼外伤患者,在植入人工晶状体的同时,用10 -0聚丙烯缝线虹膜缝合复位、瞳孔成型或植入带虹膜隔人工晶状体.结果 术后视力0.05～0.1者6例,0.2～0.5者24例,≥0.6者4例.修复后瞳孔接近正常者24例,占70.6％.结论 在复合性眼外伤中,行白内障摘出的同时修复损伤的虹膜,可起到改善瞳孔外观和提高视力的作用,但手术操作较复杂.     

後房型人工晶體植入後人工晶體與虹膜距離的臨床分析

目的白内障摘除後房型大C袢人工晶體植入術後,人工晶體與虹膜内面(後上皮層)有相應的距離,可减少術後炎癥反應及并發癥的探討.方法術後第一天裂隙燈側照觀察人工晶體與虹膜的相應距離.結果人工晶體與虹膜有距離者反應輕,并發癥少,無距離者反應重,并發癥多.結論後房型大C袢人工晶體囊袋内植入後,人工晶體光學部分後沉緊貼晶體後囊膜,使人工晶體與虹膜產生了一定的距離,房水循環通暢,且人工晶體不刺激虹膜與睫狀溝,所以反應輕并發癥少.     

晶状体损伤合并虹膜伤彩色多普勒超声诊断价值

目的 探讨晶状体及虹膜损伤的超声诊断价值.方法 应用纵向、横向联合冠状向超声扫查方式诊断23例（23眼）晶状体损伤及11例（11眼）合并虹膜损伤.结果 与眼科检查及手术中所见相对照,超声对晶状体损伤的诊断符合率为95.65%（22/23眼）,合并虹膜损伤诊断符合率为90.91%（10/11眼）.结论 超声对眼晶状体及虹膜损伤诊断有良好的应用价值,为临床选择治疗方式及时机提供了重要参考.     

虹膜损伤修复并人工晶状体植入在基层的应用

目的：探讨虹膜损伤并人工晶状体植入在基层医院应用的可行性及价值。方法：显微镜下一期或二期手术修复损伤虹膜联合人工晶状体植入。结果：57例57眼术后随访5月－4年，所有手术修复的虹膜瞳孔均较术前明显复圆，其中9眼术前有复视，术后复视均消失，44眼植入人工晶状体者视力均有不同程度提高，结论：基层医院可以完成这类难度较大的手术，在修复虹膜损伤的同时植入人工晶状体有积极的意义。     

Identification of retained nucleus fragment in the posterior chamber using ultrasound biomicroscopy

PURPOSE: To describe the use of ultrasound biomicroscopy (UBM) to image retained nuclear fragments posterior to the iris plane after uncomplicated phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation in two patients. DESIGN: Interventional case report. METHODS: Two patients presented with an iris elevation after uncomplicated phacoemulsification and lens implantation. RESULTS: Visual acuity was 20/20 in the first patient and 20/30 in the second. There was no anterior chamber inflammation in either eye. UBM revealed a small, retained nuclear fragment between the iris pigment epithelium and the anterior lens capsule, causing localized anterior iris displacement in both patients. The PCIOL was within the capsular bag, and the iris root and ciliary body were normal in both patients. CONCLUSION: UBM can demonstrate retained lens fragments within the posterior chamber.     

Iris color and age-related changes in lens optical density.

PURPOSE: Epidemiologic evidence indicates that dark iris color increases risk of age-related cataract. No information is currently available, however, on the effects of iris color on the lens prior to cataract development. In this study, we relate iris color to lens optical density (OD) in individuals without frank cataract. METHODS: 90 subjects with blue or green irises (light color) were compared with 87 subjects having hazel, brown, or black irises (dark color). Lens OD was measured psychophysically by comparing scotopic thresholds obtained at 410 (measuring) and 550 nm (reference). Stimuli were presented in Maxwellian view. RESULTS: The groups with light and with dark iris color did not differ significantly in smoking habits, dietary patterns, or age. Despite other similarities between the groups, lens OD was significantly (p < 0.024) higher in the group with dark irises. The higher OD of the dark iris group was due to differences in the older subjects (> 45 years, p < 0.005), rather than the younger subjects (20-45 years) who showed no differences in lens OD. CONCLUSION: Our data indicate that iris pigmentation may be directly related to age-associated increases in lens OD.     

Technique of implantation of extrapupillary iris lens: 8 years of clinical experience.

A new type of intraocular lens has been devised. The lens is iris-supported but, in contrast to conventional iris-clip lenses, is fixed at the iris periphery, leaving the pupillary region free. The lens may be implanted either anterior or posterior to the iris plane. Implantation into the posterior chamber is particularly beneficial when combined with an extracapsular extraction. Eight years' experience (189 operations) underlines a number of important advantages of the extrapupillary iris lens. The pupil is not distorted, so that its form and function remain normal; the danger of dislocation is avoided; and the lens may be employed in the presence of an iris coloboma. The supporting prongs of the lens are made of gold and platinum alloys, which add considerably to its tissue tolerance. So far no complication has arisen necessitating removal of such a lens. This new type of intraocular lens offers a combination of efficacy, safety, and technical simplicity.     

Ultrasound Biomicroscopy of Iris-claw Phakic Intraocular Lens Implantation

Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.     

Complications of rigid anterior chamber implants

Despite accurate lens sizing, 100 eyes with rigid anterior chamber implants showed a high incidence of lens-related trauma postoperatively: pigment dispersion (pseudoguttata), angle recession, peripheral anterior synechiae, iris erosion/atrophy, iris holes from stretching, angle fibrosis, haptic tip erosion into sclera and iris, neovascularization of peripheral iris and angle, lens rotation through iridectomy and into ciliary body, lens tilting with corneal endothelial touch, high refractive cylinder with long intraocular lenses, pigment proliferation onto iris surface, partial slippage of the intraocular lens into vitreous following intracapsular procedure, and pupillary-block glaucoma. Vision results were good. Glaucoma and cystoid macular edema rates were low. Bullous keratopathy and retinal detachment didn't occur. High endothelial cell loss was associated with those lenses that "propellered" and those that tilted and touched endothelium. The adverse findings may be static or may represent a continuing process of tissue damage.     

Subluxation einer retropupillaren Irisklauenlinse nach Zyklophotokoagulation

A 78-year-old patient underwent diode cyclophotocoagulation for end-stage pseudoexfoliation glaucoma after many surgical interventions on the only functional eye. On the first post-operative day the eye showed a mild flare and the intraocular eye pressure was normal. Nevertheless the patient complained of a severe decrease of visual acuity. A subluxation of a retropupillary iris claw intraocular lens within an atrophic area of the iris was found. During surgical revision the iris claw lens was successfully repositioned in the posterior chamber and an enclavation was performed at a different location avoiding atrophic areas of the iris. Fixation of an iris claw lens onto an atrophic iris structure should be avoided. Subluxation of an iris claw lens can occur following an uncomplicated diode laser cyclophotocoagulation operation.     

A high-efficiency laser iridotomy-sphincterotomy lens

A new laser iridotomy-sphincterotomy contact lens, bearing a 103-diopter optical button decentered 2.5 mm, gives the smallest iris focal spot and highest iris energy density practicably obtainable with a single optical glass refracting surface placed upon a thin Goldmann-type contact lens. By increasing iris energy density to a level 7.79 times greater than that from a plano contact lens and 2.92 times greater than that from the Abraham lens, the lens increases the iris burn temperature level above the threshold level for evaporative pyrolysis, even at exposures of 0.01 and 0.02 second, thus facilitating argon laser iridotomy and iris sphincterotomy by the linear incision method. Corneal and retinal energy exposures are greatly reduced. Used with the Nd-YAG laser, the lens increases efficiency for iridotomy and for division of vitreous bands in the anterior chamber.     

Intraocular lens material evaluation by iris abrasion in vitro: a scanning electron microscope study

Prosthetic posterior chamber intraocular lenses can abrade the iris pigmented epithelium, resulting in pigment dispersion, callus formation, and iris adhesions. To evaluate iris abrasion from intraocular lens materials, we developed an in vitro test and studied three materials: polymethylmethacrylate (PMMA), silicone, and PMMA surface-modified by covalent binding of a hydrophilic polymer (surface-modified PMMA). Each lens was rubbed 1,000 times on the posterior iris of pigmented rabbits using a total force of 0.5 gram. Scanning electron micrographs of the abraded irides were scored using a subjective, nonparametric numerical scale. Polymethyl-methacrylate lenses removed iris epithelium completely, exposing underlying connective tissue. Silicone lenses damaged an area longer and narrower than the PMMA lens and also exposed connective tissue. Surface-modified PMMA lenses caused only slight surface damage, including flattening or breaking of protruding suspensory ligaments. The test conditions used cannot precisely mimic prolonged lens implantation in living subjects. Nevertheless, the results indicate that iris-lens interaction may be reduced in vivo by using a surface-modified PMMA lens. This hypothesis should be further verified by animal implantation studies.     

Large iridotomies by the linear incision technique using the neodymium:YAG laser at low energy levels. A study using cynomolgus monkeys

Multiple Q-switched neodymium:YAG (Nd:YAG) laser impacts at energy levels of 1.0 to 1.7 mJ, focused on the iris through the 103-diopter (D) iridotomy-sphincterotomy lens, were applied back and forth in a line across the radial fibers of the mid-peripheral iris in eyes of the cynomolgus monkey (Macaca fasicularis) to produce large iridotomies of controllable size. Oozing of blood was minimal and no lens capsule damage occurred. These iridotomies showed less iris concussion damage than did conventional Nd:YAG laser iridotomies made by directing high-energy laser shots through the Abraham lens upon a single iris spot.     

儿童后发性白内障合并人工晶状体固定性瞳孔夹持的手术治疗

目的探讨儿童严重后发性白内障合并人工晶状体固定性瞳孔夹持的合理的治疗方法及疗效。方法对14岁以下发生严重后发性白内障的患者中合并人工晶体固定性瞳孔夹持伴有严重的虹膜后粘连或瞳孔膜闭的12只眼进行后发性白内障切除、人工晶状体复位术,部分病人联合前段玻璃体切割术。对虹膜后粘连或瞳孔膜闭者同时进行粘连分离或瞳孔成形术。结果12只眼成功分离虹膜与囊膜粘连并进行后发性白内障切除和人工晶状体复位。其中2只眼行瞳孔成形术,8只眼行前段玻璃体切割术,术后视功能有不同程度的改善。结论伴有严重人工晶状体瞳孔夹持和虹膜粘连或瞳孔膜闭的儿童严重后发性白内障的理想治疗手段是手术切除后发性白内障并进行人工晶状体复位。     

Morphological changes and lens position 2 1/2 years after intracapsular cataract extraction with implantation of a semiflexible anterior chamber lens. A prospective re-examination

Morphological changes and lens position were examined in 51 patients 25 to 38 (mean 30) months after intracapsular cataract extraction (ICCE) with implantation of the semiflexible, 3M, style 70, anterior chamber lens. Morphological changes presumably associated with the ICCE proper were: iris transillumination defects (68.6%), rupture of anterior hyaloid membrane (20%), detachment of posterior vitreous (42.9%) and anterior synecchiae (13.7%). The implant-related morphological changes were caused by iris tucking (19.6%), small, mobile lenses causing endothelial disturbance (9.8%), iris-haptic adhesions and progressive ovalling of pupillary form. The present morphological changes were compared with a previously published examination of the same patients performed 4 months after surgery: 9 eyes without tissue changes around the lens feet at the previous follow-up now had iris-haptic adhesions involving from 1 to 4 lens feet. In 8 eyes the iris-haptic adhesions had progressed. Compared with the previous examination the fraction of eyes with tissue changes at the lens feet had risen from 47.1 to 64.7%, while the number of eyes with oval pupils had increased from 54.9 to 80.4%. Contact between lens haptic and iris root seems to constitute a constant stimulus for structural changes of the iris.     

超声生物显微镜观察弹性开放襻前房型人工晶状体对眼前段结构的影响

目的 评价弹性开放襻一体型前房型人工晶状体（anter chamber intraocular lens,AC-IOL)植入式的疗效及其安全性。方法 应用超声生物显微镜观察20例（20只眼）弹性开放襻一体型AC-IOL植入术后患者IOL襻的位置,以及其与虹膜及房角结构的关系,从而评价IOL对眼前段结构的影响。随访时间6～20个月。结果 40个IOL襻中,26个襻固定于房角隐窝;14个襻（8只眼）穿过虹膜侵入至睫状体实质内,并伴有反复发作的葡萄膜炎。术后8只眼虹膜前粘连与IOL襻有关。结论 超声生物显微镜检查是动态了解IOL对眼前段结构影响的有效方法。AC-IOL襻的设计有待进一步改进。     

A new surgical technique for posterior chamber lens fixation during penetrating keratoplasty in the absence of capsular or zonular support

A new technique has been developed to implant or exchange an anterior chamber or iris supported lens with a posterior chamber lens during penetrating keratoplasty. The posterior chamber intraocular lens is suspended by suturing the haptics into the ciliary sulcus rather than to the iris.     

虹膜粘连致人工晶状体瞳孔夹持的原因及处理

目的：分析虹膜后粘连引起的人工晶状体瞳孔夹持的原因，处理方法及结果。方法：对80例（90眼）术后虹膜粘连人工晶状体夹持原因分析，采用手术剪开虹膜粘连，切除或切开粘连区后囊，将人工晶状体光学区移至后囊后，形成囊膜夹持。结果：90眼均成功解除人工晶状体虹膜夹持，50眼（65．6％）视力在0．5以上，平均随访6月，无一例再发生人工晶状体虹膜夹持和后囊浑浊，结论：萎缩病变的虹膜，过度散大瞳孔和虹膜后囊粘连是导致人工晶状体瞳孔夹持的主要原因，中央后囊切除和后囊夹持是解除人工晶状体瞳孔夹持的安全简便有效的方法。