后房型人工晶体巩膜缝线四点固定法

目的探讨白内障术中后囊破裂失去支撑作用或完全无后囊膜患者行后房型人工晶体巩膜缝线四点固定法术后的视力及相应并发症。方法对40例术中或术后无后囊膜支撑的白内障病人行一期或二期后房型人工晶体巩膜缝线四点固定法。其中老年性白内障20例，外伤性白内障18例，膜性白内障2例。结果术后视力大于0．5，30例占75％；小于0．5，8例占12％；小于0．1，2例占5％；术后前房及玻璃体出血、眼压增高及虹膜炎各1例。结论后房型人工晶体巩膜缝线固定术为术中后囊破裂失去支撑作用或完全无后囊的无晶体限植入人工晶体，使患者获得良好视力提供了一种新方法。但是，由于手术设计的不完善，也出现了许多并发症，故在进外方向、距离、固定方式、固定线的选择及手术选择有待于进一步提高。     

无晶体后囊的后房型人工晶体缝线固定术

报告３０例３０眼无晶体后囊的后房型人工晶体缝线固定术随访６～２２个月的结果。矫正视力≥０．６者占８０％，人工晶体无明显的偏心与倾斜。分别论述了选择性二期植入人工晶体，计划囊外摘除术中后囊破损一期植入人工晶体和人工晶体脱位于玻璃体腔的再固定之适应征、手术方法及作者的体会。结果表明，无晶体后囊的后房型人工晶体缝线可获得良好的效果。     

外伤性白内障后囊破裂人工晶体植入的手术方式选择

目的探讨外伤性白内障晶体后囊不存在时,采用前房型人工晶体植入,抑或后房型人工晶体巩膜缝线固定术。方法外伤性白内障患者８６例（８６只眼）,其中前房型人工晶体（新型弹性开放襻）植入５６例,Ⅰ期植入２９例,Ⅱ期植入２７例;后房型人工晶体巩膜缝线固定（大Ｃ型襻,两根缝线睫状沟固定）３０例,Ⅰ期植入１４例,Ⅱ期植入１６例。结果术后随访１～４２个月。矫正视力≥０．５者,前房型人工晶体组４０例,占７１．４％;缝线固定组２７例,占９０．０％。矫正视力≥１．０者,前房型人工晶体组２２例,占３９．３％;缝线固定组１４例,占４６．７％。结论新型前房型人工晶体植入和后房型人工晶体巩膜缝线固定术均不失为常规后房型人工晶体植入失败的补救措施,但前房型人工晶体适用于年龄较大、眼前段（角膜、虹膜和前房角）条件较好,而眼后段（玻璃体、视网膜）条件较差者;后房型人工晶体巩膜缝线固定术则适用于年龄较小、眼前段条件较差而眼后段条件较好者。     

后房型人工晶体缝线固定术20例临床观察

对白内障囊内摘除术后的无晶体眼,因外伤或手术造成的晶体后囊严重破损及各种原因的晶体脱位、半脱位,则不能按常规方法植入后房型人工晶体.近年来国内外开始采用后房型人工晶体缝线固定术.我院自1993年7月开始开展该项手术,效果满意,报告如下.一般资料:本组20例21眼,男13例14眼,女7例7眼.年龄19～76岁,平均56岁.12眼为囊内摘除术后无晶体眼,术前矫正视力均大于0.5,行二期缝线固定术;2眼为后房型人工晶体脱位,取出原人工晶体后行二期缝线固定术,4眼为囊外摘除术中后囊裂孔过大改行一期缝线固定术;1例2眼为马凡氏综合征晶体半脱位,1眼为过熟白内障,术前按摩眼球过重致晶体半脱位,均行囊内摘除晶体并一期人工晶体缝线固定术.     

42例(43眼)后房型人工晶体缝线固定术观察

目的探讨人工晶体睫状沟缝合固定术在晶体囊内摘除术后、囊外术中囊膜破裂或晶体小带大范围的松解、以及外伤性白内障、晶状体脱位、玻璃体切割术后等无晶体囊膜的患眼中的应用。方法我院1997年1月～2004年8月间采用后房型IOL缝线固定术完成了42例(43眼)，均获得满意效果。其中：1．晶体后囊膜破损在2个象限残存后囊膜者，以此为依托将一侧人工晶体襻置于其上，另侧襻睫状沟缝线固定，即“一点固定法”实施了7例。2．因严重外伤或晶体囊内摘除术后而无晶体后囊者，施行双襻睫状沟缝线固定，即“二点固定法”实施了35例(36眼)。结果随访4～54个月，平均随访24个月复查时矫正视力最佳1．2，最低0．2，视力在0．6以上者22眼(占53．6％)，视力偏低者多为角膜瘢痕或眼底病变所致。二期植入者术后视力均高于术前最佳矫正视力。眼压均在正常范围。43眼中，术后均无明显并发症发生。结论IOL睫状沟缝线固定术是无晶体囊膜及晶体后囊膜破裂或晶体小带大范围松解的首选。     

无晶体后囊的儿童外伤性白内障三襻人工晶体缝线固定术

目的探讨儿童外伤性白内障无晶体后囊眼的人工晶体植入术。方法对21例儿童外伤性白内障摘除后植入三襻后房型人工晶体，进行经巩膜缝线固定术。结果术后入工晶体位置全部正常，无偏斜，随访2～20个月，无并发症，视力增进。结论三襻后房型人工晶体缝线固定术，具有术后晶体不易倾斜和偏位的优点，是治疗无晶体后囊眼的有效方法。     

后房型人工晶体缝线固定术

后房型人工晶体缝线固定术青岛市市立医院赵武令现代白内障西外摘除人工晶体植入术是目前公认的治疗白内障最好的方法．但是对一些外伤或手术导致晶体后囊破裂的病人，怎样将人工晶体固定在睫状沟内，国内外一些学者采用不同方法用缝线固定取得了较好的效果，我们应用此法...     

巩膜面直接缝线固定人工晶体术

探讨后房型人工晶体缝线固定植处的简易术式。方法采用不做巩膜瓣,直接在巩膜表面进出针。并将固定线直接缝扎在巩膜表面的方法对２９例行人工晶体缝线固定术,并对其追踪观察。     

人工晶体单襻睫状沟缝线固定的临床观察

评价人工晶体单襻睫状沟缝线固定的手术方法和临床疗效。方法 :对白内障囊外摘除术后后囊膜不完整的患者 5 8例 ( 5 8眼 )采用单襻睫状沟缝线固定法植入后房型人工晶体。将上襻缝合固定于 12点睫状沟处 ,下襻置于下方囊膜前。术后观察眼前节情况、人工晶体位置及视力等 ,随访 6～ 12个月。术后一年对 2 6例测人工晶体光学中心与瞳孔中心的距离 ,并与随机选择的 2 4例非缝线睫状沟固定一年以上者作对比。结果 :植入 5 8例人工晶体无前后向倾斜 ,无钟摆现象。无角膜内皮失代偿及视网膜脱离发生。 89 5 %患者视力≥ 0 5。术后一年 2 6例单襻缝线固定与 2 4例非缝线睫状沟固定人工晶体光学中心与瞳孔中心距离比较无显著性差异。结论 :人工晶体单襻睫状沟缝线固定操作简便 ,手术时间短 ,术后并发症少 ,晶体位置与非缝线睫状沟固定相比无明显差别。对后囊膜不完整植入后房型人工晶体者可作为首选。     

二期人工晶体植入术

本文讨论了二期人工晶体植入术的适应证、手术方法及视力预后。方法：５１例５２只眼行二期人工晶体植入术，２８只眼为后房型人工晶体植入，其中８只眼为人工晶体缝线固定术；２４只眼为前房型人工晶体植入。结果：术后随访６￣４２个月，平均１４个月，术后最佳矫正视力≥０．５者３４只眼（６５．４％），术后最佳矫正视力≥术前最佳矫正视力３９只眼（７５％）。并发症为人工晶体倾斜、继发性青光眼、视网膜脱离、前房出血和前房     

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.     

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。     

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     

Is scleral fixation a safe procedure for intraocular lens implantation?

Purpose: No consensus currently exists on the optimal method for intraocular (IOL) implantation without capsular support. We evaluated the outcome and angiographic findings of eyes that underwent the implantation of scleral fixated IOLs. Methods: Iris and retinal fluorescein angiography were performed in 13 eyes that had received posterior chamber IOL implantation with scleral fixation. Follow-up examinations also assessed visual acuity (VA), intraocular pressure (IOP), IOL decentration and complications related to the procedure. Results: Mean visual acuity was 0.29 preoperatively and 0.71 postoperatively after a mean follow-up of 14.2 months. A best corrected visual acuity of 0.5 or better was obtained in 12 eyes. Iris fluorescein angiography did not show major vascular abnormalities. Retinal angiography showed 5 cases of macular edema. In 6 eyes light-induced retinal lesions occurred. Cellophane maculopathy was disclosed in 4 eyes. Macular edema was associated with photic injury in 4 cases and with cellophane maculopathy in 2 cases. Mean postoperative visual acuity was 0.6 in eyes with macular edema and 0.88 in eyes without (SD 0.18; range 0.5–1.0). Four of 5 eyes with macular edema had a postoperative visual acuity of 0.5 or better. There was no evidence of persistent IOP elevation or IOL decentration. No serious complications were recorded during surgery. Conclusions: Transscleral fixation of posterior chamber IOLs provides adequate visual acuity in most patients. Macular edema was frequently associated with the procedure. Although this complication was a cause of low visual recovery after implantation, the majority of eyes with macular edema achieved a visual acuity of 0.5 or better. Light-induced retinal injury was a permanent complication. This revised version was published online in July 2006 with corrections to the Cover Date.     

Original three-point fixation technique for sutured posterior chamber intraocular lens

PURPOSE AND METHODS: In order to avoid the complications associated with posterior chamber intraocular lens (IOL) scleral fixation, the authors have developed an original surgical technique by which the IOL is secured at the ciliary sulcus by suturing the haptics to the sclera in three points (at the 3, 5 and 9 o'clock positions). This technique was utilized for secondary IOL implantation in 21 aphakic eyes. The mean follow-up was 18 months, range 6-28 months. RESULTS: All eyes that underwent secondary implants had equal or better visual acuity postoperatively; none developed serious intra- or postoperative complications. No tilt or decentration of the IOL was observed postoperatively. DISCUSSION: The technique described appeared easy to perform and produced good visual outcomes with stable transscleral fixation of the IOL.     

无缝线切口二期后房型人工晶状体植入术疗效观察

目的评价无缝线切口二期后房型人工晶状体植入术的疗效。方法对 ２２眼无晶状体眼患者分别采用３．５ ｍｍ（Ａ组 １０眼）及 ５．５ ｍｍ（Ｂ组 １２眼）的反眉状巩膜隧道切口，二期植入 ６ ｍｍ折叠式丙烯酸脂类及一体式 ＰＭＭＡ后房型人工晶状体，并与同期 １２眼６ ｍｍ常规角膜缘切口（Ｃ组），二期 ６ ｍｍ一体式 ＰＭＭＡ后房型人工晶状体植人对比。结果随访 ３～１５个月，无缝线切口组术后矫正视力均优于及等于术前最佳矫正视力，其中≥０．５者 Ａ组 ９眼（９０％），Ｂ组 ９眼（７５％）。缝线切口组，术后矫正视力优于及等于术前最佳矫正视力１０眼（８３． ５％）， ≥０．５者７眼（５８．３％）。结论采用无缝线切口二期后房型人工晶状体植人可明显降低角膜散光，减轻术后炎症反应及增加手术的安全性，是矫正无晶状体眼屈光不正的一种较理想的方法。     

Four-point fixation of posterior chamber intraocular lenses in children with unilateral aphakia

PURPOSE: To evaluate the results of 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) in children. SETTING: Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. METHODS: This retrospective study comprised 20 aphakic eyes of 20 children. Preoperative investigations proved the absence of adequate posterior capsule support. All patients had ab externo 4-point scleral fixation of a PC IOL. All preoperative and postoperative data were studied and analyzed. RESULTS: The mean preoperative age was 7.7 years (range 4 to 11 years). The mean follow-up was 19.35 months (range 13 to 30 months). The preoperative findings included a best corrected visual acuity of 6/18 or better in 8 eyes (40%), corneal scarring in 18 eyes, sector iridectomy in 7 eyes, and after-cataract in 4 eyes. The intraoperative complications included vitreous hemorrhage in 2 eyes and slippage of 1 suture in 1 eye. Postoperative complications included mild anterior uveitis in 12 eyes and severe fibrinoid reaction in the anterior chamber in 8 eyes. There were no cases of suture exposure, IOL malpositioning, or infection. Twelve patients (60%) had a visual acuity of 6/18 or better. The cause of the poor visual outcome in many patients was preexisting amblyopia. CONCLUSIONS: The results suggest that 4-point scleral fixation is an option to correct aphakia in children. However, long-term follow-up is important to assess the procedure's safety.     

Clinical results of a scleral fixation of the posterior chamber intraocular lens, through sclerotomies, 1 mm posterior to the limbus

The aim of this study was to evaluate the clinical outcomes of scleral fixation of a posterior chamber intraocular lens and an anterior vitrectomy through sclerotomies, 1 mm posterior to the limbus. The study comprised of seven eyes that required a scleral fixation. Sclerotomies, 1 mm posterior to the limbus, were performed using a 20G sclerotome at the 2 and 8 o'clock positions. Group 1 was defined as four eyes requiring scleral fixation of the secondary IOL (Intraocular lens), and group 2 as three eyes where dislocated IOLs were repositioned and fixed to the sclera via sclerotomy sites. In all the eyes, the knot of string (10-0 prolene, W1713, Ethicon, USA) was buried. Postoperatively, the visual acuity was greatly improved, by more than 4 lines in the Snellen visual acuity chart, with the exception of one case of macular degeneration. The scleral fixation of the IOL through sclerotomies, 1 mm posterior to the limbus, had advantages in that the scleral fixation of the IOL could be achieved through sclerotomy sites, and the anterior vitrectomy parallel to the iris plane.     

A simplified technique for stable transscleral suture fixation of posterior chamber intraocular lenses.

We describe a technique for implanting ciliary sulcus posterior chamber intraocular lenses (PCIOLs). This technique uses radial keratotomy (RK) markers to facilitate PCIOL centration, 2-point scleral suture fixation for each haptic to prevent PCIOL tilt, and partial thickness sclerotomies to prevent suture erosion. Postoperative results of 20 eyes with PCIOLs sutured to the ciliary sulcus were reviewed. Suture placement was determined using a Mendez degree gauge with Bores axis marker (Katena USA, Denville, NJ). Two-point scleral suture fixation without a scleral flap was used for each haptic. Average follow-up was 17.1 months. Postoperative best corrected visual acuity was 20/40 or better in 95% of eyes. Average best-corrected post-operative visual acuity was 20/29. One patient with a previous retinal disease lost 3 lines of visual acuity. This technique results in excellent postoperative visual acuity without PCIOL decentration, tilt, or suture erosion.     

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