后囊破损的Ⅱ期后房型人工晶体植人术

目的探讨后囊破损Ⅱ期后房型人工晶体植入术的临床疗效。方法对２２例（２２只眼）后囊破损的白内障术后患者,根据后囊破损的大小和位置,分别采用睫状沟或囊袋内固定和缝线睫状沟单襻或双襻固定的Ⅱ期后房型人工晶体植入术。结果后囊破损的Ⅱ期后房型人工晶体植入术术后矫正视力≥０．５者占５９．１％（１３例）,术后前房及人工晶体表面渗出者占２２．７％（５例）,而同期所做的后囊破损的Ⅰ期后房型人工晶体植入术者术后矫正视力≥０．５者占４０％,术后前房及晶体表面渗出者占４０％。结论后囊破损的白内障患者,在破损的范围不能确定或范围过大时,主张选择Ⅱ期后房型人工晶体植入术。     

超声乳化白内障摘除术中后囊破裂的Ⅰ期后房型人工晶体植入术

目的评价超声乳化白内障摘除术中后囊破裂的Ⅰ期后房型人工晶体植入术的疗效。方法对１８４例（２００只眼）施行超声乳化白内障摘除术中后囊破裂者２９例（２９只眼）行Ⅰ期后房型人工晶体植入术。结果１０例囊袋内植入,１９例睫状沟植入。术后３个月随访,裸眼视力１．０以上者１７例（５８．６２％）,０．５～０．９者１０例（３４．４８％）;矫正视力１．０以上者２２例（７５．８６％）,０．５～０．９者５例（１７．２４％）。本组并发症主要为角膜水肿,瞳孔缘虹膜咬伤,前段玻璃体炎症等。结论对于后囊破裂及玻璃体脱出的患者,适当利用残留的前、后囊作为支撑,清除前段玻璃体,仍可植入后房型人工晶体。     

后房型人工晶体巩膜缝线固定术

本研究主要探索白内障囊内摘除术后或白内障囊外伴后囊破损者，采用巩膜缝线固定技术植入后房型人工晶体的临床效果及并发症。２３例（２３眼），１３眼为白内障囊内摘除无晶体眼，１０眼为白内障囊外摘除术后后囊破裂或外伤性白内障后囊不完整，用巩膜缝线固定晶体襻技术植入后房型人工晶体。本组病例随访３－１６个月（平均８．３个月），视力在４．７（０．５）以上者２１眼，５．０（１．０）以上者１３眼，未发现严重手术并发症     

人工晶体植入术中玻璃体脱出的处理

目的 观察人工晶状体植入术中发生玻璃体脱出的处理及其效果。方法 ３７眼人工目标植入手术中发生玻璃体脱出，使用剪刀－棉签４行开放式前段玻璃体切除术，Ⅰ期植入后房型人工晶状体。结果 成功植入或缝线固定植入后房型人工晶状体３６眼（９７．３％），术后矫正视力≥０．５者２８眼占７６％。结论 术中玻璃体脱出者施行玻璃体切除术并Ⅰ期植入后房型人工晶状体，仍可获得良好效果。     

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     

后囊破损的Ⅱ期后房型人工晶体植入术

目的 探讨后囊破损Ⅱ期后房型人工晶体植入术的临床疗效。方法 对２２例后囊破损的白内障术后患者，根据后囊破损的大小和位置，分别采用睫状沟或囊袋内固定和缝线睫状沟单襻或双襻固定的Ⅱ期后房型人工晶体植主。结果 后囊破损的Ⅱ期后房型人工日本植入术术后矫正视力≥０．５者占５９．１％，术后前房及人工晶体表面渗出者占２２．７，而同期所做的后囊破损的Ⅰ期后房型人工晶体植入术者后矫正视力≥０．５者占４０％，术后前房     

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     

白内障两种类型人工晶体植入临床观察

本文对２５例（２５眼）白内障患者因各种原因后囊膜不完整而术中行睫状沟缝线固定后房型人工晶体植入（Ⅰ组）及对２０例（２１眼）术中行弹性开放襻前房型人工晶体植入（Ⅱ组）的效果进行观察，随访３～４８个月，视力在１．０以上的Ⅰ组中有３眼，占１２％，０．５～０．８有８眼，占３２％，０．１～０．４有１３眼，占５２％，０．１以下者１眼，占４％；而Ⅱ组中视力在１．０以上者有２眼，占９．５％，０．５～０．８有７眼，占３３．３％，０．１～０．４有１０眼，占４７．６％，０．１以下者２眼，占９．５％。术后并发症Ⅰ组中主要有继发性青光眼。慢性虹膜睫状体炎；Ⅱ组中主要有：１．前房出血，２．继发性青光眼，３．虹膜睫状体炎，４．人工晶体上襻脱位。结论：在白内障术中后囊破裂不能常规植入后房型人工晶体时，只要将脱出的玻璃体处理净，手术技术娴熟，植入两种人工晶体均安全可靠。     

外伤性白内障后房型人工晶状体二期植入

目的探讨外伤性白内障后房型人工晶状体二期植入术的临床效果。方法对36例（36眼）外伤性白内障术后无晶状体眼患者。根据眼部不同情况采用单纯睫状沟植入法或巩膜缝线固定法进行后房型人工晶状体二期植入术，并对手术效果、术后视力及并发症进行分析。结果13眼（36．11％）行单纯睫状沟植入术，7眼（19、44％）行单襻巩膜缝线固定术，16眼（44．44％）行双襻巩膜缝线固定术。术后裸眼视力≥0、3者24眼（66、67％），≥0、1者33眼（91．67％），术后常见并发症为早期角膜水肿、葡萄膜炎和眼压升高。结论采用适当的时机和手术方式进行人工晶状体二期植入术，可减少术中术后并发症。     

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。     

Changing indications for and improving outcomes of intraocular lens exchange

PURPOSE: To evaluate the indications for and outcomes of intraocular lens (IOL) exchange at the same clinical setting over the past decade, as well as compare the efficacy and safety of anterior chamber lens (AC-IOL) and posterior chamber lens (PC-IOL) implantation for IOL exchange. DESIGN: Retrospective, nonrandomized case series. METHODS: The charts of all patients who had an IOL exchange at the Eye Institute of Utah between January 1998 and December 2004 were reviewed. The rate, indications, and outcomes are compared with the data of our previous study conducted between 1986 and 1990. RESULTS: This study comprised 51 eyes of 51 consecutive patients. The rate of IOL exchange was 0.77% of all cataract surgeries during the time considered. Incorrect IOL power (41.2%), decentration/dislocation (37.3%), and glare (7.8%) were the most common indications for IOL exchange. An AC-IOL was used in 14 eyes (27.5%) and a PC-IOL in 37 eyes (72.5%) for IOL exchange. None of the PC-IOLs was sutured to the sclera or iris. Overall, 90.2% of patients obtained a best-spectacle corrected visual acuity (BSCVA) of 20/40 or better. All eyes in AC-IOL group and 94.6% of eyes in PC-IOL group maintained within 1 line or improved 2 to 5 lines of the pre-exchange vision. CONCLUSIONS: The improvements in IOL design and materials as well as surgical techniques have greatly minimized the incidence, changed the indications for, and improved the visual outcomes of IOL exchange over the past decade. Our study suggests that the open loop, flexible AC-IOL poses no greater risk than PC-IOL with respect to visual outcome and safety for IOL exchange. An AC-IOL may be preferable to a PC-IOL suture fixation for IOL exchange in the absence of posterior capsular support.     

外伤性白内障手术的疗效分析

目的：评价外伤性白内障的手术效果。方法：对56例（58眼）各种原因所致的外伤性白内障施行手术治疗,其中44眼行现代白内障囊外摘出或超声乳化术,同时一期后房人工晶状体植入;5眼二期后房人工晶状体植入;6眼前房人工晶状体植入;3眼人工晶状体缝线固定术。结果：术后视力0.4－1.0者39眼占67.2％,并发症主要为后囊破裂玻璃体脱出、角膜水肿、人工晶状体前膜及后发障。结论：外伤性白内障虽病情复杂,并发症较多,但通过精细手术和术前术后的合理治疗仍可获得满意疗效。     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

后房型人工晶状体缝线固定术后并发症的临床观察

目的：探讨后房型人工晶状体睫状沟缝线固定术在白内障术中韧带断裂及后囊破裂后人工晶状体二期植入,外伤性白内障、晶状体脱位等无晶状体后囊膜术眼中的应用及术后并发症。

方法：选取我科2007-02/2012-11 采用后房型人工晶状体缝线固定术患者31例32眼,均获得较满意的效果。

结果：术后随访3mo～1a,矫正视力>0.5者9眼(28%); 0.1～0.5者17眼(53%); <0.1者6眼(19%)。出现术中睫状体穿刺口出血、术后角膜水肿、角膜散光、悬吊线松弛断裂、人工晶状体偏位等主要并发症。

结论：后房型人工晶状体缝线固定术是目前无后囊或后囊膜晶状体悬韧带大范围缺损的手术首选,但还有许多手术并发症有待进一步解决。     

眼前段结构紊乱的二期后房型人工晶状体植入

目的 探讨重建眼前段结构,以机化膜为依托行二期后房型人工晶体状体植入手术的方法,并评价其疗效。方法 对不同程度眼前段结构紊乱８６只眼前眼前段结构重建及人工晶状体植入术。包括部分穿透性角膜移植术、前粘连松解术、虹膜根部离断缝合术、后粘连松解术、瞳孔成形术、瞳孔区机化膜造孔及以机化膜为依托的二期后房型人工晶状体植入术。随访３～３２个月。结果 ８６只眼手术顺利。术后视力≥０．５者７１只眼（８２．６％）,     

Influence of intraoperative complication on intraocular rigid lens fixation in pediatric cataract surgery

PURPOSE: This paper presents the intraoperative complications in pediatric cataract surgery with IOL implantation and their influence on fixation place. MATERIAL AND METHODS: 384 eyes of 276 children undergone operative procedure for cataract. Anterior capsulorhexis, lens cortical aspiration, primary posterior capsulorhexis with anterior vitrectomy and IOL implantation were done in all eyes. The place of IOL implantation was capsular sac or ciliary sulcus. RESULTS: There were no serious intraoperative complications but in cases with large anterior (5.2%) and posterior (14.6%) radial capsule tears, vitreous loss (12.3%), and hemorrhage (5.5%) to anterior and posterior chamber the IOL was fixated at ciliary sulcus (in 37.5%). CONCLUSIONS: The surgical procedure is useful and safe in the management of pediatric cataract. Location of an IOL in the ciliary sulcus in a child, is acceptable. To avoid decentration in this cases, we recommend rigid PMMA IOLs.     

Retinal detachment in eyes with vitreous loss and an anterior chamber or a posterior chamber intraocular lens: comparison of the incidence

PURPOSE: To compare the incidence of retinal detachment within 6 months of cataract surgery complicated by vitreous loss in eyes with a posterior chamber intraocular lens (PC IOL) or an anterior chamber IOL (AC IOL). SETTING: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. METHODS: In this retrospective consecutive nonrandomized comparative case series, all cases of cataract surgery complicated by vitreous loss between January 1991 and March 1998 were reviewed. Included were patients who had thorough anterior vitrectomy and primary IOL implantation and at least 6 months follow-up. Exclusion criteria were congenital and traumatic cataract, previous intraocular surgery, and previous retinal detachment. Patients receiving an unsutured single-piece poly(methyl methacrylate) (PMMA) PC IOL formed the PC group, while those receiving flexible open-loop single-piece PMMA AC IOLs formed the AC group. The incidence of postoperative retinal detachment in the 2 groups was compared. RESULTS: Of the 151 eyes of 149 patients, 66 received a PC IOL and 85 received an AC IOL. Two eyes (3.0%) in the PC group and 2 (2.4%) in the AC group developed retinal detachment; the difference between groups was not statistically significant (P = 1.00, Fisher exact test). CONCLUSIONS: In eyes that have vitreous loss and thorough anterior vitrectomy, AC IOL implantation did not appear to increase the incidence of retinal detachment.     

The state of anterior eye segment after posterior chamber intraocular lens implantation with transscleral fixation

PURPOSE: The aim of the study was to evaluate the state of anterior eye segment in postoperative period after PC-IOL transscleral fixation. MATERIAL AND METHODS: The material comprised 31 eyes in 31 patients, (11 women and 20 men), aged 20-80 years (average 61 years), who underwent the primary or secondary PC-IOL implantation with transscleral fixation. The examination was performed 10 to 14 months (average 12 months) after surgery. The clinical state of the corneas was evaluated using endothelial and confocal microscopy. The position of the IOL, its location and symmetry were evaluated with ultrasound biomicroscopy. RESULTS: The visual acuity ranged from 0.1 to 1.0. In 20 eyes (64%) the position of PC-IOL was correct. In the rest of cases the inappropriate position of implants was observed. The decrease of endothelial cells density was 13% in eyes with primary implantation and 7% in cases with secondary implantation of IOL. In the corneal endothelium, there were features of pleomorfism and polymegatism; in a few cases some deposits were observed. CONCLUSION: The implantation of posterior chamber intraocular lenses with transscleral fixation is recommended for some cases of primary or secondary problems with capsule support. The PC-IOL implantation with transscleral fixation can be the alternative method for the anterior IOL implantation.