人工晶状体置换术治疗人工晶状体眼屈光意外

目的探讨人工晶状体眼屈光意外出现的原因、人工晶状体置换术手术原则和治疗效果。方法回顾性分析行人工晶状体置换术患者10例(10眼)的临床资料。分析人工晶状体眼屈光意外的原因,总结手术方法 ,并观察手术疗效。结果人工晶状体眼屈光意外的原因为眼轴测量误差3眼,术前未作测量2眼,A常数错误2眼,角膜曲率测量误差1眼,使用不合适的人工晶状体计算公式1眼,植入错误的人工晶状体1眼。眼轴长度<23mm者3眼,眼轴长度23～24mm者3眼,眼轴长度>24mm者4眼。手术置换人工晶状体的方法包括晶状体囊袋内植入8眼,睫状沟植入2眼。术后裸眼视力在0.5以上者9眼,裸眼视力在0.8以上者7眼,最佳矫正视力在0.5以上者10眼。手术的主要并发症为后囊膜破裂2眼和后囊膜混浊1眼。结论人工晶状体眼屈光意外的原因较多,眼轴测量误差是主要原因之一;眼轴过长、过短者较易出现人工晶状体植入术后屈光意外;正确选择人工晶状体可减少人工晶状体眼屈光意外发生;人工晶状体置换术是处理人工晶状体眼屈光意外的有效方法 。     

高度近视白内障行超声乳化联合折叠式IOL植入术的临床观察

目的：观察高度近视并发白内障行超声乳化联合折叠式人工晶状体(IOL)植入术的临床疗效。

方法：对41例62眼高度近视并白内障患者行超声乳化吸除联合推注式折叠IOL植入术,观察术中术后并发症及术后视力,术后随访1～6(平均3)mo。

结果：术中后囊膜破裂3眼; 术后1d裸眼视力<0.1共7眼(11%),0.1≤视力<0.5共42眼(68%),视力≥0.5共13眼(21%); 术后3mo裸眼视力<0.1共4眼(6%),0.1≤视力<0.5共40眼(65%),视力≥0.5共18眼(29%)。3mo后最佳矫正视力<0.1共2眼(3%),0.1≤视力<0.5共36眼(58%),最佳矫正视力≥0.5共24眼(39%)。随访中3眼(5%)晶状体后囊膜混浊,未出现视网膜、脉络膜脱离和黄斑水肿等其他并发症。

结论：高度近视并白内障行超声乳化联合折叠式人工晶状体植入术,安全可靠,手术并发症少,术后视力恢复快。     

折叠人工晶状体缝线固定治疗玻璃体切割术后无晶状体眼

目的探讨采用四袢折叠人工晶状体缝线固定治疗玻璃体切割术后无晶状体眼的手术方法及疗效。方法 21例患者玻璃体切割术后无晶状体眼在前房灌注下通过角膜缘隧道小切口行四袢折叠人工晶状体缝线固定术,人工晶状体固定缝线无需做巩膜瓣而行改良埋线法,术后观察视力变化、散光、内皮细胞数、人工晶状体位置及并发症。结果 21例患者术后裸眼视力明显提高。术后早期视力大多低于术前最佳矫正视力,术后1个月视力稳定;12眼裸眼视力高于术前最佳矫正视力1～2行(57.1%),9眼同术前最佳矫正视力或稍差。术后裸眼视力:0.1-0.3者3眼,0.3-0.5者10眼,大于0.5者8眼,术后最佳矫正视力:0.1-0.3者3眼,0.3-0.5者8眼,≥0.5者10眼;术后6个月散光、内皮细胞数与术前相比差异均无统计学意义(均为P>0.05)。无术中及术后低眼压等并发症。结论玻璃体切割术后无晶状体眼在前房灌注下行四袢折叠人工晶状体缝线固定术安全有效,是值得推广的二期人工晶状体植入术。     

硅油取出术联合四点式后房型人工晶状体巩膜缝线固定术的临床研究

背景 玻璃体晶状体切割联合硅油填充术是治疗复杂玻璃体视网膜病变的有效方法.硅油取出术后引起的严重屈光参差常通过Ⅱ期人工晶状体(IOL)植入术进行矫正,不仅增加了手术次数,且手术操作困难,并发症多,效果较差.采用硅油取出联合四点式后房型IOL巩膜缝线固定术可克服上述不足.目的 观察硅油取出术联合晶状体及囊膜阙如四点式后房型IOL巩膜缝线固定术的临床应用及效果.方法 采用回顾性病例观察研究设计,对晶状体及囊膜阙如的患者20例20眼行硅油取出联合四点式经巩膜缝线悬吊术植入4个襻折叠式IOL,观察术后3d、1周、1个月及3个月的眼前部炎症反应情况,包括眼压、角膜内皮计数、裸眼视力及矫正视力、晶状体位置以及眼底情况,分析术眼的术后并发症及其处理效果.所有患者术前均了解研究目的并签署知情同意书.结果 20例患者20眼术后裸眼视力和矫正视力均达到或超过术前矫正视力,其中裸眼视力0.8及以上者2眼,0.6 ～0.7者6眼,0.3 ～0.5者8眼,0.05 ～0.2者4眼.术前裸眼视力明显低于术后裸眼视力,差异有统计学意义(H=10.147,P＜0.01),而术前矫正视力与术后矫正视力差异无统计学意义(H=2.089,P＞0.05).本组术眼术前平均角膜内皮细胞计数为(2064±329)个/mm2,术后为(1987±269)个/mm2,差异无统计学意义(t=1.660,P＞0.05).所有术眼IOL位置均未发生明显偏移.本组患者术后未见玻璃体出血及视网膜脱离等严重并发症.结论 硅油取出联合四点式后房型IOL巩膜缝线固定术是玻璃体切割术后晶状体及囊膜阙如患者IOL植入的有效方法,安全有效,术后并发症可控,可减少手术次数,患者裸眼视力明显改善.     

小切口折叠型IOL睫状沟悬吊术疗效观察和技巧探讨

目的:观察经角膜缘小切口行折叠型人工晶状体睫状沟悬吊术的临床疗效并探讨手术技巧。方法:因晶状体后囊破裂或悬韧带断裂不能常规植入后房型人工晶状体的病例共18例19眼,11眼行传统巩膜大切口一片式人工晶状体睫状沟悬吊术,8眼行角膜缘小切口折叠式人工晶状体睫状沟悬吊术。术后观察视力、眼压、IOL位置及并发症等。结果:术后裸眼视力较术前提高者,大切口组10眼(91%),小切口组8眼(100%);术后最佳矫正视力较术前提高者,大切口组4眼(36%),小切口组6眼(75%);术后最佳矫正视力≥0.5者,大切口组1眼,小切口组5眼,差异具有统计学意义(P=0.041)。所有术眼术后人工晶状体无明显偏位、倾斜。结论:小切口折叠型人工晶状体睫状沟悬吊术的治疗效果确切,值得广泛应用于无法行常规后房型人工晶状体植入的病例中。     

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.     

Ⅱ期后房型人工晶状体植入疗效观察

目的:探讨无晶状体眼II期人工晶状体植入的手术方式和疗效。方法:观察总结120例(129眼)无晶状体眼行II期后房型人工晶状体植入术,分析不同的手术方法及并发症。结果:后房型睫状沟II期人工晶状体植入94眼(72.9%),缝襻固定后房型人工晶状体35眼(27.1%)。术后裸眼视力0.5以上(21.7%),矫正视力0.5以上(43.8%),脱残85眼(65.9%),与术前矫正视力比较统计学处理无差异。结论:II期后房型人工晶状体植入是治疗单眼无晶状体眼的有效方法。     

经透明角膜切口可折叠型人工晶状体缝线固定术的临床观察

目的 探讨对囊膜不足以支撑人工晶状体（IOL）的无晶状体眼患者经透明角膜切口行可折叠IOL缝线固定术的临床疗效.方法 回顾性系列病例研究.对14例（14眼）囊膜不足以支撑IOL的无晶状体眼患者由透明角膜切口行可折叠型IOL缝线固定术,观察术中、术后并发症及术后视力情况.结果 所有患者术中未出现并发症.术后裸眼视力均较术前提高,术后最佳矫正视力较术前最佳矫正视力改善或者无变化的共13例（93％）；1例发生玻璃体少量积血,1例出现IOL光学部轻度偏斜,3例出现一过性高眼压.结论 经透明角膜切口行可折叠型IOL缝线固定术是治疗囊膜不足以支撑IOL的无晶状体眼的一种较好选择.     

晶状体超声乳化人工晶状体植入术的临床观察

目的探讨白内障施行晶状体超声乳化人工晶状体植入术的特点、手术技巧、并发症及防治措施。方法对65眼白内障施行无缝线5.5mm切口超声乳化人工晶状体植入术。结果术后第1天裸眼视力≥0.5者38眼(58.46%),术后1周视力≥0.5者47眼(72.31%);术后1月视力≥0.5者53眼(81.54%)。术中术后主要并发症有后囊破裂3例(5眼,7.69%);角膜内皮水肿9例(11眼,16.92%)。结论采用无需缝合的反眉状隧道式切口行晶状体超声乳化人工晶状体植入术可获较佳视力,而手术成功的关键在手术者的手术方法和操作技巧。     

带虹膜膈人工晶状体治疗无晶状体眼并虹膜缺失的初步报告

目的评价无晶状体眼并虹膜缺失患者眼中植入带虹膜膈人工晶状体的临床效果.方法对18例(18眼)由于外伤、手术等原因造成的无晶状体眼并虹膜缺失患者行带虹膜膈人工晶状体的植入,观察手术前后视力和各种手术并发症.结果平均随访1.1±0.6a,18眼术后裸眼视力为0.1～0.5,与术前比较差异有非常显著性意义(P＜0.01);术后最佳矫正视力不能达到术前最佳矫正视力,差异有非常显著性意义(P＜0.01);全部患者的畏光症状改善.结论带虹膜膈人工晶状体植入治疗无晶状体眼并虹膜缺失有效而安全,可使患者获得较好的视觉质量.但其仍存在损失最佳矫正视力的缺点.     

Minus-power intraocular lenses to correct refractive errors in myopic pseudophakia.

PURPOSE: To evaluate the effectiveness of a secondary, piggyback, minus-power intraocular lens (IOL) to correct the refractive error in patients with myopic pseudophakia. METHODS: In this prospective noncomparative cohort study, 51 myopic pseudophakic patients received implantation of a minus-power IOL as a secondary procedure to correct residual pseudophakic myopia. RESULTS: The mean residual myopia of -3.05 diopters (D) was reduced to -0.38 D. All eyes were within +/- 1.00 D of the desired refraction. Uncorrected visual acuity was 20/40 or better in 72% of eyes, and best corrected visual acuity was 20/40 or better in 96%. Uncorrected visual acuity improved by 2 or more lines in 85% of eyes and by 5 or more lines in 65%. CONCLUSION: Clinical outcomes can now be improved in patients with myopic pseudophakia whose previous options (i.e., lens exchange or refractive surgery) were more traumatic or less predictable.     

Synchrony dual-optic accommodating intraocular lens. Part 2: pilot clinical evaluation

PURPOSE: To evaluate the clinical outcomes of an accommodating dual-optic intraocular lens (IOL). SETTING: Private practice and university centers. METHODS: A prospective noncomparative case series with retrospective control comprised 21 patients (26 eyes) scheduled for small-incision extracapsular cataract extraction by phacoemulsification with implantation of the Synchrony dual-optic accommodating IOL (Visiogen) (accommodating IOL group) and 10 patients who had small-incision extracapsular phacoemulsification with implantation of a monofocal, single-optic IOL at least 6 months previously (control group). Patients were examined 1, 3, 6, and 12 months after surgery. Defocus curves in the accommodating IOL group were compared with those in the control group. The main outcome measures were postoperative distance uncorrected and best corrected visual acuity; near uncorrected, distance corrected, and near corrected visual acuity; and accommodative range based on defocus curves. RESULTS: Twenty-four eyes were available at the 6-month follow-up visit. All eyes had best corrected distance visual acuity of 20/40 or better, and 19 eyes (79%) had an uncorrected distance visual acuity of 20/40 or better. Uncorrected near visual acuity was 20/40 or better in all eyes. With distance correction, 23 eyes (96%) had an acuity of 20/40 or better at near. Defocus curve analysis suggested a mean accommodative range of 3.22 diopters (D) +/- 0.88 (SD) (range 1.00 to 5.00 D) in the accommodating IOL group and 1.65 +/- 0.58 D in the control group (range 1.00 to 2.50 D) (P<.05). CONCLUSION: The Synchrony dual-optic IOL shows promise as an option to provide accommodative function in pseudophakic patients.     

新型弹性开放襻前房型人工晶体植入临床观察

本文采用巩膜隧道切口对白内障术后后囊不完整的９６例（７０只眼）行新型弹性开放襻前房型人工晶体（ＡｎｔｅｒｉｏｒＣｈａｍｂｅｒＩｎ－ｔｒａｏｃｕｌａｒＬｅｎｓ，ＡｃＩＯＬ）植入术。所有７０只眼术后矫正视力等于或超过术前最佳矫正视力。５２只眼（７４．３％）术后视力≥０．５。术后无严重并发症。结果显示新型弹性开放襻前房型人工晶体植入安全、有效     

Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.     

非正常晶状体眼行人工晶状体悬吊术的疗效观察

观察由各种原因导致的非正常晶状体眼因无足够后囊膜支撑而施行人工晶状体悬吊术的疗效。 方法:使用美国ALCON公司CZ70BD悬吊式人工晶状体对8例9眼非正常晶状体白内障患者（过熟期白内障3眼,外伤性白内障伴晶状体半脱位4眼,马凡氏综合征2眼）因术中无后囊膜支撑施行人工晶状体悬吊术;对8例8眼Ⅰ期白内障术后非正常晶状体眼患者（伴有瞳孔异常的无晶状体眼7眼,人工晶状体严重偏位1眼）施行Ⅱ期人工晶状体悬吊术,观察其术中、术后并发症及术后视力情况。随访1~6mo。 结果:术中或术后5眼（29%）出现前房或玻璃体少量出血,10d左右基本吸收;术后1眼（6%）发生脉络膜脱离,1mo恢复;切口微漏致低眼压2眼（12%）,加压包扎5d恢复。术后1d,裸眼视力＞0.1者13眼（76%）;术后10d,裸眼视力＞0.1者17眼（100%）,术后10,30d,裸眼视力＞0.3者分别为11眼（65%）和12眼（71%）。 结论:人工晶状体悬吊术是治疗易发生无后囊膜支撑的非正常晶状体眼的一种较好的选择。     

眼外伤后行二期悬吊人工晶状体植人46例临床分析

目的探讨46例（46只眼）眼外伤后行二期悬吊人工晶状体植入术的手术技巧和临床疗效。方法选取我科2010年9月至2011年12月46例（46只眼）因眼外伤后未能一期植人人工晶状体行二期悬吊人工晶状体植入术患者的临床资料进行回顾性分析。根据病情选择悬吊式人工晶状体或虹膜型人工晶状体植入并观察术后人工晶状体位置、最佳矫正视力、眼压、角膜、眼底及并发症情况。结果随访3～6个月,平均5．4个月,最佳矫正视力≥0．5者8只眼（17．39％）,0．3-0．5者26只眼（56．52％）,0．1-0．3者10只眼（21．74％）,0．05-0．1者2只眼（4．35％）。手术前后最佳矫正视力比较具有统计学意义（t=27．71,P〈0．00）。结论对于眼外伤后未能一期行人工晶状体植入的患者,通过术前视力矫正能提高的患者行二期悬吊人工晶状体植入术是提高患者视力的理想方法。     

Artisan aphakic intraocular lens in children with subluxated crystalline lenses

PURPOSE: To evaluate the results of Artisan (Ophtec) aphakic intraocular lens (IOL) implantation in children with idiopathic subluxated lenses. SETTING: Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel. METHODS: This retrospective small case series comprised 4 eyes (3 children) with idiopathic essential subluxated lenses that had lens washout, lens capsule removal, Artisan IOL implantation, and peripheral iridectomy. The indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measures were postoperative refraction and change in best corrected visual acuity (BCVA). RESULTS: The postoperative follow-up ranged from 8 to 10 months. After surgery, the BCVA was 6/12 or better in the 3 cases that could be recorded. Visual acuity improved by 2 or more Snellen lines in all 4 eyes. The postoperative spherical equivalent was within +/-1.00 diopter in all cases. No significant postoperative complications were observed. CONCLUSIONS: In 4 eyes with a subluxated crystalline lens, implantation of an Artisan aphakic IOL improved visual acuity. Studies with a larger number of patients and longer follow-up are necessary to confirm these results.     

Intravitreal phacoemulsification with pars plana vitrectomy and posterior chamber intraocular lens suture fixation for dislocated crystalline lenses.

This technique to manage a dislocated crystalline lens comprises intravitreal phacoemulsification with transscleral suture fixation of a posterior chamber intraocular lens (IOL). The dislocated lens in the vitreous cavity is removed using a standard phaco handpiece with the assistance of a fiber-optic light pipe. Then, the IOL is implanted. The technique was used in 10 eyes of 8 patients with lens luxation or subluxation. The postoperative best corrected visual acuity was 20/25 or better except in 1 eye, and no serious complications were observed. Increased intraocular pressure before surgery in 4 eyes was normalized in 3 eyes.     

无玻璃体眼经巩膜睫状沟后房型人工晶状体固定术

目的 探讨玻璃体切割术后无玻璃体眼经巩膜睫状沟后房型人工晶状体固定手术方法并评价其疗效。方法 对8例(8眼)玻璃体切割术后无玻璃体眼行经巩膜睫状沟后房型人工晶状体固定术(PC-IOL)。术后随访3～56个月。结果 术后裸眼视力均较术前提高，术后最佳矫正视力均达到或接近术前最佳矫正视力，其中≥0．5者1眼，≥1．O者3眼。术中低眼压2眼、眼球塌陷1眼，术后前房积血3眼，玻璃体积血3眼，人工晶状体脱位1眼，一过性高眼压3眼，黄斑囊样水肿3眼，视网膜脱离1眼。结论 经巩膜睫状沟PC-IOL固定术是无玻璃体并伴有眼前段结构紊乱眼恢复视力的补救手术。术中注意稳定眼压，可减少或避免术中、术后并发症。     

Early visual results with the rollable ThinOptX intraocular lens

PURPOSE: To prospectively assess the clinical and visual outcomes of phacoemulsification and implantation of a rollable intraocular lens (IOL) with a thin optic and compare the results with those of implantation of a foldable acrylic IOL. SETTING: Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan. METHODS: Sixteen consecutive eyes of 8 patients (4 women, 4 men) with corticonuclear cataract had small-incision clear corneal phacoemulsification with implantation of a rollable ThinOptX IOL (ThinOptX Inc.) in the capsular bag. Twenty eyes of 10 age- and sex-matched patients (5 women, 5 men) with the same diagnosis had phacoemulsification and intracapsular implantation of an AcrySof foldable acrylic IOL (MA60BM, Alcon). The patients' refractive status and uncorrected and best corrected distance visual acuities were assessed preoperatively and 1 week and 1, 3, and 6 months after surgery. The uncorrected and best corrected near acuities were measured before and 6 months after surgery. Contrast visual acuity was measured with variable contrast charts 1, 3, and 6 months after surgery, and the results in the 2 IOL groups were compared. Anterior segment photography, intraocular pressure (IOP) measurement, specular microscopy, and fundoscopy were done before surgery and at 1, 3, and 6 months. RESULTS: The final best corrected distance acuity was better than 20/25 in all eyes with a ThinOptX IOL and 18 eyes (90%) with an AcrySof IOL. The best corrected near acuity was better than 20/40 in 12 eyes (75%) and 14 eyes (70%), respectively. The mean contrast acuity with charts 2 and 3 was significantly higher in the ThinOptX group than in the AcrySof group at all examinations (P<.05). The final mean postoperative induced astigmatism was 0.06 diopter (D) +/- 0.50 (SD) and 0.25 +/- 0.68 D, respectively (P>.05).There were no differences in IOP or corneal endothelial cell density between the 2 groups at any examination. No intraoperative or postoperative complications occurred. CONCLUSIONS: ThinOptX IOL implantation provided best corrected near and distance visual acuities comparable to those provided by the AcrySof IOLs. The significantly higher contrast acuities attained after implantation of the ThinOptX lens may be attributable to its ultrathin properties.