Nd:YAG激光治疗人工晶状体眼继发恶性青光眼的疗效观察

目的探讨Nd:YAG激光治疗人工晶状体眼继发恶性青光眼的疗效。方法回顾性分析24例(24只眼)人工晶状体眼继发恶性青光眼病例,分别采用药物联合Nd:YAG激光治疗行晶状体后囊膜及玻璃体前界膜切开术。结果Nd:YAG激光治疗后,所有病例前房都有不同程度的加深,眼压下降,视力部分恢复。每个病例平均进行1~3次激光反复治疗,其中3只眼因前房恢复不理想而采用前部玻璃体切除治疗。随访时间14个月(1~36个月),患者前房稳定,眼压控制。结论正确选择药物联合激光治疗行晶状体后囊膜及玻璃体前界膜切开术,对治疗人工晶状体眼继发恶性青光眼是非常有效的。具有损伤小、痛苦少、恢复快、操作简便、可多次进行等特点。此技术可作为人工晶状体眼继发恶性青光眼的治疗方法之一。     

Nd:YAG激光治疗无晶体眼瞳孔和睫状玻璃体阻滞性青光眼

无晶体眼瞳孔阻滞性青光眼和睫状玻璃体阻滞性青光眼(恶性青光眼)是白内障囊内摘除术的严重并发症,都有眼压升高、前房变浅、玻璃体疝严重等临床表现。本文用Nd:YAG激光作虹膜切开治疗3眼因虹膜周边切口有色素层残留而引起的瞳孔阻滞性青光眼,以及作虹膜和玻璃体前界膜切开治疗3眼无晶体眼恶性青光眼。术后1小时内全部病例眼压降至正常,前房恢复无晶体眼深,玻璃体后退,未发生角膜损伤、眼压持续升高及严重前房出血等并发症。作者认为Nd:YAG激光是一种治疗无晶体眼瞳孔阻滞性青光眼和恶性青光眼简单而有效的方法,可避免再次手术引起的不良反应。     

超声乳化白内障吸出为主的睫状环阻滞性青光眼手术治疗模式探讨

目的探讨超声乳化白内障吸出为主的睫状环阻滞性青光眼治疗模式的可行性。设计回顾性病例系列。研究对象北京同仁医院青光眼滤过术后药物治疗无效合并有白内障的睫状环阻滞性青光眼患者12例12眼。方法对所有患眼优先行透明角膜切口超声乳化白内障吸出联合折叠式人工晶状体（IOL）植入术,必要时联合术中抽玻璃体水囊及房角分离术;无效者再行Nd：YAG激光晶状体后囊膜及玻璃体前界膜切开或前部玻璃体切割术。除常规检查外,手术前及手术后2周行超声生物显微镜检查。术后平均随访（15．8±5．2）个月。主要指标眼压、中央前房深度及视力变化。结果12眼中术前平均中央前房深度（0．38±0．17）mm,平均眼压（31．50±3．50）mmHg。5／12眼经单纯超声乳化白内障吸出折叠式IOL植入术联合房角分离术;5／12眼又联合Nd：YAG激光晶状体后囊膜及玻璃体前界膜切开术;2／12眼又联合前部玻璃体切割术。术后2周平均中央前房深度（2.31±0．37）mm;末次随访时平均眼压（14．60±4．80）mmHg;视力提高或不变。结论本文小样本的资料显示,药物治疗无效的睫状环阻滞性青光眼病例先行白内障超声乳化吸出术,无效者依次行Nd：YAG激光晶状体囊膜、玻璃体前界膜切开及前部玻璃体切割术的治疗模式是可行的。（眼科,2012,21：43-46）     

个性化方案治疗恶性青光眼的疗效分析

目的:探讨恶性青光眼的个性化治疗方法。方法:回顾分析2016-01/2018-10在我院眼科中心接受治疗的恶性青光眼患者19例19眼的临床资料,观察治疗前后的最佳矫正视力(LogMAR)、眼压、前房深度及并发症。结果:选取的患者中7眼经药物治疗后眼压下降、前房恢复,3眼行YAG激光虹膜周边切除+后囊膜切开+玻璃体前界膜切开,5眼行白内障超乳化+人工晶状体植入+前部玻璃体切除+后囊膜切开术,2眼行前部玻璃体切除+后囊膜切开,1眼行玻璃切除术,1眼在术中发生恶性青光眼患者予以玻璃腔水囊穿刺抽液后完成小梁切除+白内障超声乳化吸出术。术后患眼均眼压下降,前房恢复,部分患者视力提高。眼压由治疗前31.25±5.19mmHg降至治疗后14.43±3.46mmHg (P<0.05),前房轴深由治疗前0.69±0.57mm恢复至治疗后2.64±0.47mm(P<0.05),术前最佳矫正视力为0.71±0.25,术后为0.34±0.19(P<0.05)。除1眼出现低眼压、脉络膜脱离外,其余患者未见明显严重并发症。结论:恶性青光眼发生后需充分评估患者具体情况,根据患者病情采取个性化的治疗方法。     

恶性青光眼12例手术治疗分析

目的:探讨两种手术方法对恶性青光眼的治疗效果。方法:对12例16眼小梁切除术后的恶性青光眼患者,晶状体核硬度≤2级,视力≥0.1者采取抽吸玻璃体水囊联合前房注气重建(A术)。晶状体核硬度≥3级,视力<0.1者采取抽吸玻璃体水囊、联合白内障囊外摘除+人工晶状体植入+晶状体后囊膜、玻璃体前界膜切开(B术)。结果:所有病例经4～5d药物治疗均无效,其中5例7眼采取A术,有2眼前房形成后又消失,再次行A术后获成功,余均一次性成功。7例9眼采取B术者均全部成功,随访5～13(平均9)mo,全部病例眼压得到控制,前房深度恢复正常,视力得到有效保护,无严重并发症。结论:恶性青光眼采取A,B两种术式可以有效的控制眼压,保护视功能。     

Nd：YAG激光治疗后发性白内障的临床观察

目的 探讨Nd:YAG激光治疗后发性白内障的时机、疗效和并发症.方法 对78例(103只眼)(I级膜76只眼,Ⅱ级膜18只眼,Ⅲ级膜9只眼)后发性白内障应用Nd:YAG激光行后囊膜切开术进行治疗,术后随访3个月.结果 103只眼后囊膜一次击穿,随访3个月未见复发.所有病例术后1周视力较术前有显著改善(P＜0.01),术后1周、1个月及3个月视力之间无显著性差异(P＞0.05).术后并发症主要有房水闪辉(为1～3级,术后一周随访基本吸收)、人工晶状体损伤9只眼(8.91%)和眼压升高12只眼(11.65%).结论 Nd:YAG激光治疗后发性白内障术后视力提高明显,并发症少.     

Nd:YAG激光治疗后发性白内障临床分析

目的:探讨Nd:YAG激光治疗后发性白内障的临床疗效。方法:应用Nd:YAG激光对147例(176眼)后发性白内障行后囊膜切开术,散瞳后于瞳孔区行十字形或圆形后囊切开。术后抗炎、散瞳、必要时控制眼压、随访。结果:后囊膜均切开,视力比治疗前增加的患者占94.9%,14眼术后眼压高在治疗后12～48h正常,36眼人工晶状体遗留局限性击射斑。结论:对于后发性白内障,Nd:YAG激光后囊膜切开可增加视力,且安全有效。     

恶性青光眼四联手术及术后并发症的预防和处理

目的 探讨恶性青光眼四联手术及对术后并发症的预防和处理.方法 对恶性青光眼22例26眼行白内障摘出、玻璃体切割术及人工晶状体植入术.结果 术前Ⅱ级、Ⅲ级浅前房均一次性前房形成.矫正视力均不同程度较术前提高,眼压由术前(34.64±7.06)mmHg(1 kPa=7.5 mmHg)降至术后(15.15±2.15)mmHg.术后2例3眼1周再次浅前房、高眼压,经处理后恢复正常.1例1眼术后玻璃体积血,经后段玻璃体切割术后,视力提高.结论 多种联合手术是恶性青光眼安全、有效的治疗方法.二次浅前房时只需加强治疗及YAG激光可恢复正常.     

Nd:YAG激光治疗对早期晶状体囊袋阻滞综合征的疗效

目的：：探讨Nd：YAG激光治疗对早期晶状体囊袋阻滞综合征的临床疗效。方法：选取2010-01/2015-07在安阳市眼科医院诊断为术后早期晶状体囊袋阻滞综合征的患者18例21眼,使用Nd：YAG激光行单纯晶状体前囊膜打孔,或联合后囊膜打孔,观察术前和术后第2 wk裸眼远视力、眼压、屈光度、前房深度等的变化。结果：所有患者中,17眼单纯采用Nd：YAG激光行前囊膜打孔,4眼采用了前囊膜打孔联合后囊膜打孔。患者术后2 wk较术前相比,裸眼远视力提高、眼压恢复正常、近视屈光度降低、前房深度加深。结论：Nd：YAG激光治疗术后早期晶状体囊袋阻滞综合征是一种安全、有效的临床治疗方法。     

葡萄膜炎并发白内障术后人工晶体前膜及后囊膜的激光治疗

目的 探讨葡萄膜炎并发性白内障植入人工晶体(intraocular lenses IOL)术后,激光切除IOL前膜和混浊后囊膜的方法,并对疗效进行分析.方法 对1999年9月至2007年2月行Nd:YAG激光(Coherent公司生产)切除IOL前膜及混浊后囊膜患者25例(38只眼),观察治疗的成功率,治疗后视力,术后并发症及影响机化膜再次形成的因素.结果 38只眼(100%)均一次完全切除IOL前膜及混浊后囊膜,且IOL无损伤;32只眼(84.21%)治疗后视力提高.23只眼(60.53%)激光治疗1年后IOL前、后未再出现机化膜;15只眼(39.47%)治疗后因IOL前后再次形成机化膜而行两次以上激光治疗.3只眼(7.89%)术后眼压(<21mmHg.激光能量大、激光治疗前有活动炎症、治疗后炎症反应重均与IOL前与后再次形成机化膜相关.结论 应用Nd:YAG激光治疗葡萄膜炎并发白内障术后IOL前膜及后囊膜混浊效果肯定,熟练掌握操作技巧是手术成功的关键.尽早去除IOL前膜及混浊后囊膜,术前控制炎症,术后加强抗炎治疗,可减缓IOL前与后机化膜的再次形成.     

恶性青光眼手术治疗远期疗效探讨

目的 探讨恶性青光眼手术治疗的远期效果。方法 回顾性分析1999年7月至2002年12月在我院手术治疗的恶性青光眼患者17例(17眼)手术方式、术后视力、眼压情况。结果 17例患者(17眼)中，12眼单纯行超声乳化白内障吸除联合后房型人工晶体植入，其中6眼于术后0．5月～10个月病情复发，经分别或联合行激光后囊切开、玻璃体前界膜切开、前部玻璃体切除。甚至房水引流管植入、睫状体光凝术后才得以缓解。5眼行超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入，未见病情复发。患者的视力较术前提高，眼压得到控制。结论 单纯超声乳化吸除白内障联合后房型人工晶体植入对早期或药物治疗能部分缓解的恶性青光眼有效；对弥漫性房角关闭、周边虹膜前粘连的顽固病例，超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入为较佳选择。     

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM: To assess the outcomes of various interventions for malignant glaucoma (MG). METHODS: A retrospective, comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan. 2009 and Dec. 2012. Numerous treatments were administered including medical therapy, neodymium: yttrium- aluminium-garnet (Nd:YAG) laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options. The characteristic, treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo. RESULTS: Four eyes of 3 patients achieved complete resolution with medical therapy. Nd:YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes, both of which achieved resolution after initial intervention. Thirty-two eyes were given surgical treatments with anterior vitrectomy- reformation of anterior chamber in 13 eyes, phacoemulsification- intraocular lens implantation in 10 eyes and phacoemulsification- intraocular lens implantation- anterior vitrectomy in 9 eyes. Resolution of MG was seen in almost all patients. The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit. The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm. Twenty eyes with preoperative visual acuity better than counting figure/ 50 cm had various visual improvements. Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity, corneal endothelial decompensation and allergic to atropine respectively. CONCLUSION: MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment, laser therapy is beneficial in pseudophakic eyes, and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management. MG can be managed successfully by appropriate and timely interventions with good visual outcome.     

QT interval dispersion in the patients with central serous chorioretinopathy

AIM: To evaluate QT dispersion (QTD) in patients with central serous chorioretinopathy (CSC). METHODS: This clinical, comperative, case-control study included 30 patients with CSC at acute phase (Group 1) and 30 age- and sex-matched healthy subjects (Group 2, the control group). From all subjects, a 12-lead surface electrocardiography was obtained. The heart rate (HR), QT maximum (QTmax), QT minimum (QTmin), QT corrected (QTc), QTD and Tmean were manually measured and analyzed. Student’s t-test and Pearson’s method of correlation were used for statistical analysis. RESULTS: The patient and control groups were matched for age, smoking status (rate and duration) and gender. There were no significant differences with regard to these among the groups (P>0.05). The participants included 19 men (63.3%) and 11 women (36.7%) in Group 1, 20 men (66.7%) and 10 women (33.3%) in Group 2. QTmax, QTD and QTc were significantly higher than those of healthy controls (P<0.001 for QTmax, P=0.01 for QTD and P=0.001 for QTc). QTmin, Tmean and HR did not differ significantly between the study groups (P=0.28 for QTmin, P=0.56 for Tmean and P>0.05 for HR). No significant correlation was found between duration of the disorder and QTD values (r=0.13, P>0.05). CONCLUSION: These findings suggest that CSC may be associated with an increase in QTD and that the patients might be at risk for ventricular arrhythmia.     

Refraction,intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes

Purpose: The aim was to investigate the effect of Nd:YAG capsulotomy on refraction, intraocular pressure and anterior chamber depth changes and complications of Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. Methods: Our study includes 26 eyes (23 patients) with posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens implantation. Complete ocular examinations were performed for all patients. The visual acuity, intraocular pressure and anterior chamber depth measurements were obtained in all examinations. Nd:YAG capsulotomy was measured in all patients. Eyes received one drop of aproclonidine 0.5 % before and immediately after YAG laser capsulotomy. Data were analysed statistically. Results: Mean patient age was 53.73 ± 13.53 years. Before Nd:YAG capsulotomy mean anterior chamber depth was 4.03 ± 0.58 mm and in the first day after capsulotomy the mean value was 4.02 ± 0.46 mm. Mean spherical equivalent refraction before laser treatment was ‐0.52 D and on the first day after laser treatment was ‐0.49 D. An improvement in visual acuity was achieved in all cases. Before Nd:YAG capsulotomy mean visual acuity was 0.38 ± 0.13 and on the first day after capsulotomy, the mean value was 0.93 ± 0.11, the difference of which was statistically significant. There were no statistically significant differences between the anterior chamber depth and intraocular pressure measurements before laser capsulotomy and on the first day, first month and third month after laser. Conclusion: Nd:YAG laser capsulotomy is an effective and safe method of treatment of posterior capsular opacification.     

恶性青光眼22例治疗分析

目的探讨几种治疗恶性青光眼方法的效果。方法对22例(23眼)恶性青光眼患者进行药物及手术由简单到复杂的阶梯治疗。结果 5眼经药物治疗缓解;12眼在药物治疗的基础上经玻璃体腔抽液加前房成形术缓解;3眼在药物治疗的基础上经玻璃体腔抽液加前房成形术加激光后囊膜切开术缓解;3眼经上述治疗得不到有效控制的晚期患者行白内障超声乳化加前部玻璃体切除加后囊及玻璃体前界膜切开联合术后缓解,其中2眼同时植入人工晶状体。结论恶性青光眼的治疗中,药物及各类手术治疗均有一定的成功率,可以采取简单到复杂的阶梯治疗策略。     

Aqueous misdirection after glaucoma drainage device implantation.

OBJECTIVE: To describe the clinical presentation, outcome, and possible underlying mechanism of aqueous misdirection after glaucoma drainage device implantation. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Ten eyes (five primary open-angle glaucoma, four chronic angle-closure glaucoma, one nanophthalmos) of nine patients with a mean age of 68.5+/-12.0 years (range, 43-83 years). INTERVENTION: The authors reviewed the medical records of all patients with a clinical diagnosis of aqueous misdirection after Baerveldt glaucoma drainage device implantation at two tertiary care referral centers from October 1992 to October 1997. Surgery was performed in a standardized fashion; all drainage tubes were inserted in the anterior chamber and occluded with an external 7-0 polyglactin ligature. All eyes were treated with topical corticosteroids, cycloplegia, and aqueous suppressants. Eyes with persistent aqueous misdirection received neodymium:YAG (Nd:YAG) hyaloidotomy or pars plana vitrectomy. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, biomicroscopic anterior chamber depth, and antiglaucomatous medication. RESULTS: All eyes had axial shallowing of the anterior chamber, one or more patent iridotomies, and no ophthalmoscopic or B-scan ultrasonographic evidence of serous or hemorrhagic ciliochoroidal detachment. Median time to the development of angle-closure glaucoma was 33.5 days (range, 1-343 days) and mean intraocular pressure at diagnosis was 27.7+/-18.7 mm Hg (range, 10-62 mm Hg). Normalization of anterior segment anatomy was achieved with aqueous suppression and cycloplegia (one eye); Nd:YAG capsulotomy (four eyes); pars plana vitrectomy alone (two eyes) or with lensectomy (one eye), and pars plana vitrectomy with intraocular lens explanation (two eyes). Mean final intraocular pressure was 14.1+/-6.0 mmHg at a mean follow-up of 9.1+/-7.8 months after the development of aqueous misdirection (range, 1-23 months). CONCLUSIONS: Aqueous misdirection may develop days to months after glaucoma drainage device implantation. In this series, there was a poor response to medical therapy, and normalization in anterior chamber depth required aggressive laser and surgical therapy.     

Anterior hyaloid face opacification after pediatric Nd:YAG laser capsulotomy.

PURPOSE: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population. METHODS: A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. RESULTS: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment. CONCLUSIONS: In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.     

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life

PURPOSE: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life. SETTING: The Children's Hospital, Dublin, Ireland. METHODS: Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months). RESULTS: The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months. CONCLUSIONS: Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.