晶状体囊袋张力环植入对高度近视白内障手术效果的对比观察

目的 评价晶状体囊袋张力环(CTR)在高度近视白内障人工晶状体手术中的应用价值.方法 将827例(1081只眼)高度近视白内障患者随机分为A、B两组,A组427例(549只眼),B组400例(532只眼),其中A组患者行超声乳化白内障吸出术及后房型人工晶状体和CTR植入,B组患者仅行超声乳化白内障吸出术及后房型人工晶状体植入.结果 A组术后一过性高眼压179只眼,其中1例取出CTR;随访18个月中有2例2只眼发生视网膜脱离,5例5只眼因发生后发障而行激光治疗.B组术后随访18个月中有9例9只眼发生视网膜脱离、35例35只眼因发生后发障而行激光治疗.两组的视网膜脱离发生率及后发障发生率比较差异均有统计学意义.结论 晶状体囊袋张力环在高度近视白内障手术中的应用能防止晶状体悬韧带离断,使人工晶体居中,并进而能有效防止后发障和视网膜脱离的发生.     

囊袋张力环在高度近视白内障超声乳化及人工晶状体植入术中的应用

目的:评价晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用价值。方法:对427例549眼高度近视白内障患者行超声乳化白内障吸出术及后房型人工晶状体和囊袋张力环植入,术后随访3～18mo,测视力、眼压、散大瞳孔进行眼前节裂隙灯观察照像。结果:所有植入的人工晶状体均位于正位,术后3mo矫正视力>0.8者43眼,0.6～0.8者118眼,0.5者89眼,0.4者101眼,0.3者66眼,0.2者80眼,<0.2者52眼;术后1d眼压为3～47mmHg,一过性高眼压179眼,其中有1例患眼因术后高眼压无法药物控制而不得不取出CTR;随访18mo中有2例患眼发生视网膜脱离、5例患眼因发生后发性白内障而行激光治疗。结论:晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用能防止晶状体悬韧带离断,使人工晶状体居中性更佳,并进而能有效防止后发性白内障和视网膜脱离的发生。     

晶状体囊袋张力环植入对高度近视白内障术后后发性白内障发生的影响

目的 评价晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体植入术中的应用价值.方法 将827例(1081眼)高度近视白内障患者随机分为A、B 2组,A组427例(549眼),B组400例(532眼),其中A组患者行超声乳化白内障吸出术及后房型人工晶状体和囊袋张力环植入术,B组患者行超声乳化白内障吸出术及后房型人工晶状体植入术.所有患眼术后均随访18个月,比较术后2组视力、眼压及后发性白内障的发生情况.结果 所有植入的人工晶状体均位于正住,A组患者术后3个月矫正视力>0.8者43眼,0.6～0.8者118眼,O.5者89眼,0.4者101眼,0.3者66眼,0.2者80眼,<0.2者52眼;术后第1天眼压为3～47 mmHg(1 kPa=7.5 mmHg),一过性高眼压179眼,其中有一眼因术后高眼压药物无法控制而不得不取出囊袋张力环;随访18个月中有5眼因发生后发性白内障而行激光治疗.B组患者术后3个月矫正视力>0.8者40眼,O.6～O.8者110眼,O.5者83眼,0.4者95眼,0.3者69眼,0.2者83眼,<0.2者52眼;随访18个月中有35眼因发生后发性白内障而行激光治疗.2组患者视力比较,差异无统计学意义(P>0.05);后发性白内障发生率比较,差异有统计学意义(P<0.05).结论 囊袋张力环应用于高度近视白内障患者有一定的优势,并能降低术后后发性白内障的发生率,其长期疗效还需进一步观察.     

虹膜拉钩联合囊袋张力环在晶状体半脱位白内障患者术中的应用

目的探讨虹膜拉钩联合囊袋张力环（CTR）在晶状体半脱位白内障患者术中应用的有效性和安全性。方法回顾性病例研究。各种原因晶状体半脱位白内障患者22例（22眼）,其中外伤性白内障13眼,马凡氏综合征4眼,白内障超声乳化术中悬韧带离断3眼,不明原因者2眼。行3.2 mm透明角膜隧道切口及连续环形撕囊,150°穿刺刀做间隔90°的4个角膜缘穿刺切口,用4个一次性虹膜拉钩钩住撕囊边缘,植入CTR,超声乳化摘除白内障,囊袋内植入后房型人工晶状体。结果22例晶状体半脱位白内障患者均顺利植入了囊袋张力环及后房型人工晶状体,术后患者视力得到提高,所有植入的人工晶状体均基本位于正位,无明显倾斜、偏位。术后随访6～36个月,最佳矫正视力0.2～0.4者6眼,0.5～0.8者11眼,0.8以上者5眼,4例患者出现后发性白内障,未见视网膜脱离等其他并发症。结论在晶状体半脱位白内障超声乳化术中运用虹膜拉钩联合CTR植入,能提高手术安全性,减少手术并发症,是一种有效的白内障超声乳化手术辅助工具。     

高度近视眼负低度数人工晶状体植入的临床观察

目的:观察超声乳化摘除联合负、低度数人工晶状体植入治疗高度近视性白内障的效果。方法:对66例94眼高度近视眼白内障行超声乳化摘除植入负、低度数人工晶状体,随访3mo。结果:术中2眼发生后囊破裂,术后3眼晶状体后囊混浊,无视网膜脱离者。结论:超声乳化摘除高度近视眼白内障是一种较好的手术方式,尤其同时植入负、低度数后房型人工晶状体增加了眼内组织的稳定性,防止了视网膜脱落,同时矫正了屈光不正。     

超高度轴性近视白内障的晶状体超声乳化吸出术

目的观察超声乳化吸出及人工晶状体植入术治疗超高度轴性近视白内障的效果。方法对105例（105眼）超高度近视白内障行品状体超声乳化吸出术，植入低度数人工品状体，随访3月。结果术中无并发症发生。术后8眼晶状体后囊轻度浑浊，无视网膜脱离者。结论超声乳化白内障吸出术对于超高度轴性近视白内障是一种较好的手术方式，尤其同时植入负、低度数后房型人工晶状体既可为增加眼内组织的稳定性。防止发生视网膜脱离，又可同时进行屈光矫正。     

晶状体半脱位白内障超声乳化术中囊袋张力环的应用观察

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在白内障合并晶状体半脱位行超声乳化白内障吸除术中的应用价值。方法:对15例16眼白内障合并晶状体半脱位患者行超声乳化白内障吸除术,术中连续环行撕囊后植入CTR,超声乳化摘除白内障,囊袋内植入后房型人工晶状体,若晶状体半脱位>1/2需植入固定孔型CTR,将CTR固定孔上的聚丙烯线固定于悬韧带离断一侧板层巩膜壁上。结果:所有植入的人工晶状体均位于正位。术后随诊3~9mo,矫正视力0.1~0.4者5眼,0.5~0.8者8眼,>0.8者3眼。结论:在白内障合并晶状体半脱位患者行超声乳化白内障吸除术中植入囊袋张力环是安全有效的方法,有利于保持囊袋的完整,便于后房型人工晶状体植入,防止人工晶状体的偏位,减少手术并发症,术后视力恢复快。     

负度数人工晶状体植入术治疗白内障合并超高度近视

目的 观察超声乳化白内障吸出负度数人工晶状体植入术治疗白内障合并超高度近视的临床效果.方法 对66例97眼白内障合并超高度近视眼患者施行超声乳化白内障吸出联合负度数人工晶状体植入术,观察术后视力、屈光状态、眼前段情况和并发症.术后随访3～12个月.结果 97眼均成功植入人工晶状体,视力都有不同程度的提高,术后3个月时矫正视力＜0.1者9眼,0.1～0.4者52眼,＞0.4者36眼;大部分患者残留低度的近视屈光状态;后囊膜混浊18眼;部分人工晶状体与后囊膜之间存在间隙,且后囊膜出现皱褶;无视网膜脱离和黄斑囊样水肿的发生.结论 超声乳化白内障吸出联合植入负度数人工晶状体治疗白内障合并超高度近视眼,具有良好的有效性和安全性,同时预测性好,并发症少.     

虹膜拉钩应用联合张力环植入治疗晶状体半脱位

目的探讨在超声乳化治疗晶状体半脱位手术中,虹膜拉钩应用联合张力环(CTR)植入方法的可行性。方法对54例(54只眼)合并晶状体半脱位的白内障患者行白内障手术,术中连续环形撕囊后,使用虹膜拉钩固定囊袋,行晶状体囊袋内超声乳化手术,注吸残留的晶状体皮质后,然后囊袋内植入CTR及后房型折叠人工晶状体囊袋内植入。结果 52只眼悬韧带断裂的范围没有扩大,术后3个月矫正视力≤0.5者22只眼,0.5～0.8者21只眼,≥0.8者9只眼。未发现后囊膜破裂,玻璃体进一步脱出,视网膜脱离等并发症的发生。人工晶状体均基本位于正位,无倾斜及明显的偏位现象。其中2只眼术中发现晶状体悬韧带脱离范围大于180度,术中改行晶状体悬吊术。结论在超声乳化治疗晶状体半脱位的手术中,应用虹膜拉钩联合张力环能提高手术的可操作性和安全性,减少手术并发症,术后人工晶状体可以安全稳定地位于囊袋内,且居中性良好。     

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。     

Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring

PURPOSE: To report our results and to evaluate the longterm effect of capsular tension ring (CTR) insertion in eyes with large traumatic zonular dialysis that underwent phacoemulsification with posterior chamber (PC) intraocular lens (IOL) implantation. METHODS: This prospective study included 17 eyes of 17 consecutive patients with cataract and large traumatic zonular dialysis (range 80-160 degrees determined pre-or intraoperatively). After insertion of a CTR, phacoemulsification with foldable acrylic PC IOL implantation was performed. Posterior capsule rupture, vitreous loss, best corrected visual acuity (BCVA), intraocular pressure (IOP) in the pre- and postoperative periods and postoperative IOL decentration were recorded. RESULTS: The mean follow-up period was 25.9 months (range 15-35 months). Capsule collapse did not occur in any eye with a CTR. Postoperatively, four eyes developed raised IOP that responded well to medical therapy. An improvement in BCVA was observed in all eyes except one because of co-existing fundus pathology. No IOL was found to be decentrated at the end of the follow-up period, apart from one eye in which the PC IOL was dislocated due to a postoperative trauma, in which an anterior chamber IOL was implanted. CONCLUSIONS: In cases of cataract associated with large traumatic zonular dialysis, implanting a CTR before or during phacoemulsification with an in-the-bag PC IOL is relatively safe technique with a high success rate. The CTR was found to be efficient in preventing IOL decentration in eyes with traumatic zonular deficiency.     

囊袋张力环在半脱位晶状体的白内障手术中的临床应用

目的:评价囊袋张力环(capsular tension ring,CTR)在晶状体半脱位的白内障手术中的应用。方法:对15例15眼合并白内障的晶状体半脱位患者连续环形撕囊(continues curvilinear capsulorhexis,CCC)后植入CTR,然后行白内障超声乳化,及人工晶状体植入术。结果:所有15眼IOL正位,无倾斜及偏位,术后10～12mo观察矫正视力满意,未发现CTR引起的并发症。结论:CTR植入是治疗合并晶状体半脱位的白内障超声乳化的一种安全、有效的方法,可以防止人工晶状体偏位,减少手术并发症。     

囊袋张力环植入治疗晶状体悬韧带异常的2年临床效果

目的评价在晶状体悬韧带异常情况下行超声乳化白内障吸除术时植入囊袋张力环（CTR）来提供晶状体囊袋支持的中长期临床效果。方法对2003年1月至2004年7月期间因晶状体悬韧带松弛或部分断裂或合并白内障在我院行超声乳化白内障吸除及CTR和人工晶状体（IOL）植入术的19例患者（22只眼）进行为期2年的随访。随访指标为最佳矫正视力和屈光度数、眼压、CTR和IOL及囊袋复合体的位置、晶状体后囊膜混浊（PCO）和晶状体囊袋的收缩程度。应用眼前节成像系统Pentacam采集各眼的Scheimpflug图像,分析术后1、6、12和24个月IOL的偏心值与倾斜度。结果术后2年随访结果：末次随访最佳矫正视力较术前提高≥2行者20只眼（90.9％）,提高1行者2只眼（9．1％）。CTR位置：21只眼CTR位于囊袋内,1只眼CTR部分脱出于囊袋外。IOL位置：22只眼的IOL均位于囊袋内,术后1个月1只眼轻度偏中心,术后2年5只眼轻度偏中心。PCO情况：末次随访3只眼（13．6％）因重度PCO行掺钇钕石榴石激光后囊膜切开,余19只眼为轻度PCO,无需处理。晶状体囊袋收缩程度：末次随访1只眼囊袋中度收缩。Pantacam检查术后1、6、12和24个月IOL的平均偏心值分别为（0．393±0．094）、（0.406±0．094）、（0.415±0．093）、（0.463±0．172）mm,术后1、6与24个月比较,差异有统计学意义（P〈0．05）。倾斜度分别为2．637°±0．369°、2．653°±0．349°、2．682°±0.348°、2．714°±0．360°,各组间差异无统计学意义（P=0.220）。结论CTR合并IOL植入治疗晶状体悬韧带异常可获得良好视力。术后2年的随访观察证实CTR的植入抑制了PCO和囊袋收缩的发生,并维持IOL在囊袋内位置的良好稳定性。（中华眼科杂志,2007．43：519-524）     

囊袋张力环对高度近视眼患者后发性白内障的抑制作用观察

目的:观察高度近视眼患者行白内障摘除人工晶状体植入术时,联合/不联合囊袋张力环植入对术后后发性白内障发生的影响。方法:选择我院22例双眼高度近视合并白内障的患者,随机选择1眼行白内障超声乳化摘除+IOL植入术,另1眼行白内障超声乳化摘除+IOL植入+囊袋张力环植入术。术后3,6mo对散大瞳孔进行眼前节数码裂隙灯照像,并利用后发性白内障的计算机定量分析系统分析观察双眼后囊形态及后发性白内障的发生情况。结果:22例患者术后第1d;1,3,6mo最佳矫正视力无统计学差异;两组均未发生人工晶状体偏位;术后6mo,A组有6眼的后囊膜可见白色增殖混浊,B组仅1眼的后囊膜可见白色增殖。PCO-CAAS后发性白内障分析软件分析PCO评分两组比较有统计学差异(P<0.05)。结论:囊袋张力环在一定程度上可以抑制晶状体上皮细胞的纤维化生,降低了后发性白内障的发生率。但还需进一步长期定量观察。     

囊袋张力环在外伤性晶状体半脱位白内障超声乳化手术中的应用

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在外伤性晶状体半脱位白内障超声乳化手术中的应用效果。方法:对10例10眼外伤性白内障伴晶状体半脱位患者行白内障手术,术中连续环形撕囊后植入CTR,超声乳化术摘除白内障后,囊袋内植入后房型人工晶状体。结果:10眼术后随访3mo～2a,矫正视力0.3者2眼,0.4～0.7者6眼,>0.8者2眼。人工晶状体均基本正位,无明显倾斜偏位。仅1例患者于随访2a时出现后发性白内障,未见由CTR引起的并发症。结论:在外伤性晶状体半脱位白内障超声乳化手术中运用CTR,能提高手术安全性,减少手术并发症,是一种有效的白内障手术辅助工具。     

Visual outcomes and complications in surgery for ectopia lentis in children

PURPOSE: To evaluate postoperative visual acuity and complications in eyes with ectopia lentis having surgery with a sutured capsular tension ring (CTR) and intraocular lens (IOL). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Thirty-seven eyes of 22 children had surgery for lens dislocation. Two types of capsular rings were used; a Cionni modified CTR and a conventional CTR. In all cases, the rings were sutured to the sclera with a 10-0 polypropylene (Prolene) suture, the CTR and an AcrySof IOL (Alcon) were implanted in the capsular bag, and the posterior capsule was left intact. The preoperative and postoperative best corrected visual acuity (BCVA) and complications were studied retrospectively. RESULTS: The mean age of the patients was 52 months. Thirty-three eyes had implantation of a Cionni modified CTR and 4 eyes, of a conventional CTR. The median preoperative BCVA (22 eyes) was 0.26 (range 0.015 to 0.65). The median postoperative BCVA (36 eyes) was 0.59 (range 0.2 to 1.0). The median follow-up period was 27 months (range 1 to 59 months). Twenty-six eyes had secondary surgery for visual axis opacification, with 5 eyes requiring 2 to 3 reoperations. Two eyes required secondary suturing for IOL decentration. Persistent amblyopia was observed in 3 eyes, with poor postoperative visual development. No eye had serious complications such as retinal detachment, endophthalmitis, or glaucoma. CONCLUSION: Surgery for ectopia lentis with a CTR and an AcrySof IOL implanted in the capsular bag and sutured to the sclera appears to be safe in children.     

Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification.

BACKGROUND AND OBJECTIVE: To determine the visual outcome and complications of posterior chamber intraocular lens implantation after capsular tear in patients undergoing phacoemulsification at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey. PATIENTS AND METHODS: The medical records of patients who underwent phacoemulsification surgery for senile cataract from January 1, 1996, to December 31, 1998, were reviewed. Patient inclusion criteria were implantation of a posterior chamber intraocular lens after phacoemulsification, being operated on by one of two surgeons, and a follow-up of at least 1 year. There were 58 eyes in the group with capsular tear and 159 eyes in the group with intact capsule. RESULTS: A final visual acuity of 0.8 or more was more common in eyes with uncomplicated phacoemulsification surgery (chi-square = 16.25, P = .03). Refraction stabilized most commonly at 2 to 6 months postoperatively in patients with capsular tear and 1 to 21 days postoperatively in patients with uncomplicated phacoemulsification (chi-square = 22.61, P < .001). Complications such as retinal detachment (odds ratio = 11.70, P < .05), cystoid macular edema (odds ratio = 26.33, P < .01), increased intraocular pressure (odds ratio = 14.54, P < .05), and decentration of the intraocular lens (odds ratio = 32.79, P = .001) were more frequently observed in eyes with capsular tear. CONCLUSIONS: It takes longer for the refraction to stabilize in eyes with posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Complications such as retinal detachment, cystoid macular edema, increased intraocular pressure, and decentration of the intraocular lens are more common in these patients, and therefore they should be observed for a longer period of time.