白内障囊外摘除人工晶体植入术中不同截囊方式与其后囊混浊发生率的观察比较

对白内障83眼，施行白内障囊外摘除及人工晶体植入术。按前囊截开方式不同分为三组，分别施行开罐式截囊、连续撕囊及线形截囊。术后随访观察12～24个月，后囊混浊发生率分别为：开罐组28％，撕囊组15％，线形截囊组7％。与开罐组相比，线形截囊组与其差异有显著性（P＜0．05），撕囊组与其差异无显著性（P＞0．05）。提示：选用一种既能有效地清除晶体上皮细胞，又能确保人工晶体袢完全植入囊袋内的截囊方式，如线形截囊，对防止后囊混浊是一种有效而实用的方法。     

Intraocular Lens and Capsule Opacification with Hydrophilic and Hydrophobic Acrylic Materials

Purpose: To report posterior capsular opacification in acrylic intraocular lenses.

Methods: Retrospective review of notes of patients with cataract surgery involving implantation of a hydrophilic acrylic intraocular lens (IOL) (MDR SC-60B-0UV) in at least one eye. This was done as a retrospective audit for clinical risk following adverse event reports, regarding MDR SC-60B-0UV intraocular lens, were published. Data regarding the pre- and post-operative visual acuity, ocular co-morbidity, posterior capsular thickening, Nd-YAG capsulotomy, final visual acuity, and changes in the lens clarity in both eyes were noted from the clinical notes.

Results: 45 patients and 90 eyes were identified. Posterior capsular opacification (PCO) as determined by slit-lamp examination was 40% for the hydrophilic IOL (SC-60B-0UV) and 8% for the contra-lateral eye (hydrophobic IOL). In 22 eyes opacification of the SC-60-0UV IOL was observed at slit-lamp examination (44%).

Conclusion: The hydrophilic acrylic IOL (SC60B-0UV) appears to have a high incidence of PCO.     

改良式后囊膜切开术治疗人工晶状体眼晶状体后囊膜混浊

目的：探讨改良式的Nd:YAG激光后囊膜切开术（张力线法）治疗人工晶状体（IOL）眼晶状体后囊膜混浊（PCO）的临床疗效并和传统的十字切开法进行对比。方法：前瞻性对照研究。选取2014 年12月至2015 年12 月在温州医科大学附属眼视光医院因单纯白内障摘除联合IOL植入术后伴发PCO需要行Nd:YAG激光后囊膜切开的患者57 例（60 眼）,按手术方式不同随机分为张力线法组和十字切开法组,每组各30眼。在术后第1天、1周和1个月复查。记录激光单次最小切开能量、点数、总能量、 手术时间以及患眼裸眼视力（UCVA）、最佳矫正视力（BCVA）、球镜度、柱镜度、等效球镜度（SE）、眼压（IOP）以及是否有眼前黑影症状。数据采用独立样本t 检验、卡方检验、重复测量的方差分析等进行分析。结果：十字切开法组和张力线法组术后UCVA（LogMAR）（ F =82.23、67.60,P < 0.001）、BCVA（LogMAR）（ F =40.08、34.78,P < 0.001）较术前均有明显提高,但2组间比较差异无统计学意义（P > 0.05）。张力线法组的激光单次最小切开能量、点数、总能量、手术时间均明显低于十字切开法组（t =3.55、5.79、6.19、8.26,P < 0.01）。张力线法组术后IOP较术前降低（F =3.48,P =0.031）,十字切开法组术后IOP无明显改变（P > 0.05）,2 组间比较差异无统计学意义。张力线法组和十字切开法组在术后出现黑影症状眼所占比例差异无统计学意义。2组术后柱镜度较术前均明显降低（F =9.54、 4.78,P < 0.05）,2 组间比较差异无统计学意义。2 组术后球镜度、SE较术前均无明显改变,2 组间比较差异无统计学意义。结论：改良的Nd:YAG激光后囊膜切开法（张力线法）治疗IOL眼晶状体后囊膜混浊安全有效。该方法相比传统的十字切开法所使用的激光能量小,手术时间短。     

白内障术后后囊膜混浊的发生因素

晶状体后囊膜混浊是白内障摘除联合后房型人工晶状体植入术后最常见的并发症,其发生率与人工晶状体的材料、镜片的式样,手术技术等因素均有关。新型的亲水丙烯酸和疏水丙烯酸AcrysofTM人工晶状体由于材料有良好的生物相容性及粘附性能,从而降低了后囊膜混浊的发生率。后凸型的人工晶状体、矩形锐利直角的光学边缘的人工晶状体、小切口白内障超声乳化摘除术、连续环形撕囊可以减少后囊膜混浊的发生率。     

残留囊膜支撑的一期后房型人工晶状体植入术

目的 探讨适合于后房型人工晶状体植入的最大后囊膜破损量。方法 对２２例外伤性白内障和１８例老年性白内障行现代囊外摘出术,在后囊部分缺损情况下,以残留的前后囊膜作支撑,一期植入后房型人工晶状体。结果 随访６～２０个月,未发现１例人工晶状体脱位,视力恢复满意。结论 在后囊缺损面积〈１／２时,良好的显微操作仍可植入后房型人工晶状体。     

人工晶体植入术中晶体后囊破裂的原因分析及处理

分析白内障摘除并后房型人工晶体植入术中发生晶体后囊破裂的原因和讨论处理方法。分析５５例（５５眼）白内障摘除并后房型人工晶体植入术中发生晶体后囊破裂的原因，裂口形态，大小及部位。根据具体情况采用不同处理方法。该术中合并症好发于抽吸晶体皮质及植入人工晶体时，各２１例（３８．２％），后囊破裂大小约３ｍｍ的３９例（７０．９％），５ｍｍ的１３例（２３．６％）。大于６ｍｍ的３例（５．５％）。后囊破裂的部位及形     

Progress on Intraocular Lens Surface Modification for Posterior Capsular Opacification Prevention

Cataract is the main cause of blinding diseases. Phacoemulsification combined with intraocular lens (IOL) implantation is a commonly used clinical treatment. Visual acuity recovers well after the operation. However, since the IOL is an extrinsic implant, a high incidence of complications may occur postoperatively. In addition to acute inflammation, long-term in vivo biocompatibility problems-posterior capsular opacification (PCO, which is also called a secondary cataract) may occur over time and decrease vision again. The improvement of surgical methods and the design and processing of the IOL can reduce the incidence of PCO. However, PCO still occurs due to the intrinsic compatibility of the IOL materials. This review summarizes the IOL surface modifications used to inhibit PCO from the perspective of the science of materials.     

人工晶状体表面改性抑制后发性白内障的研究进展

白内障是目前最主要的致盲性眼病,临床上通常采用超声乳化联合人工晶状体（IOL）植入对其进行治疗。该手术术后视力恢复良好。但是所植入的IOL是一种外来性异物,术后除了急性炎症反应之外,存在着远期的体内生物相容性问题,即后发性白内障,严重影响术后的视觉质量。虽然手术方式改进、IOL设计加工改良等能降低后发性白内障的发生率,但由于材料本身的相容性问题并未获得改善,仍能导致后发性白内障的发生。笔者从材料学的角度对材料表面性能改性抑制后发性白内障作一综述。     

后发性白内障防治的研究

现代白内障手术已成为治疗白内障的确实可靠的方法,但手术后的后囊混浊的高发率严重地影响了患者术后长期拥有良好的视力。因此,如何防治后发性白内障,一直是眼科医生关注的焦点。本文就目前的研究现状作一综述。     

Effect of intraocular lens asphericity on posterior capsule opacification between two intraocular lenses with same acrylic material: a fellow‐eye study

Purpose: To evaluate intra‐individual differences in posterior capsule opacification (PCO) and visual performance between spherical AcrySof SN60AT and an aspheric AcrySof SN60WF intraocular lens (IOL) with a posterior aspheric surface, both of which are made of same hydrophobic acrylic material. Setting: Ophthalmology Department, St Thomas’ Hospital, London, UK. Methods: In this prospective randomized, fellow‐eye comparison, an aspheric IOL, which is 9% thinner in comparison with the spherical IOL, was randomized to the first eye of 47 patients and fellow‐eye surgery was performed within 3 weeks. Follow‐up was at 1, 3, 6, 12 and 24 months. Corrected logMAR visual acuity (CDVA) was measured at 100% and 9% contrast. After pupil dilation, digital retroillumination photographs were taken and the mean PCO percentage was calculated using poco software at each follow‐up visit. Results: At 1, 3, 6, 12 and 24 months, 47 (94 eyes), 44 (88 eyes), 42 (84 eyes) and 41 (82 eyes) patients were followed‐up respectively. Hundred per cent and 9% of LogMAR CDVA was not significantly different between the two IOLs (p = NS at all time‐points). Percentage area PCO scores (mean ± SD) at 1, 3, 6, 12 and 24 months with the spherical IOL was 5.82 ± 9.89, 7.76 ± 16.83, 7.21 ± 12.46, 9.29 ± 18.25 and 14.39 ± 25.42, respectively, and with an aspheric IOL was 8.91 ± 12.79, 5.97 ± 10.32, 5.15 ± 7.92, 7.68 ± 11.18 and 12.18 ± 20.10, respectively (p = NS at all time‐points). Conclusions: Posterior capsule opacification was not significantly different between the spheric and aspheric IOLs in this fellow‐eye, randomized comparison. Additional asphericity on the existing model of IOL does not influence PCO performance.     

Two‐year follow‐up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens

Purpose: To evaluate posterior capsule opacification (PCO) 2 years after cataract surgery following implantation of a hydrophilic or a hydrophobic single‐piece acrylic intraocular lens (IOL) with a sharp edge. Methods: Phacoemulsification cataract surgery was performed in one eye of 120 patients with senile cataract in this prospective study. They were randomized to implantation of either a hydrophilic acrylic IOL (BL27; Bausch & Lomb, Rochester, NY, USA) or a hydrophobic acrylic IOL (AcrySof^® SA60AT; Alcon Laboratories, Fort Worth, TX, USA). Two years after surgery, retroillumination images were obtained and PCO area and severity were evaluated using pocoman software. Best corrected visual acuity (VA) (both high‐contrast [100%] and low‐contrast [2.5%]), glare, laser flare and intraocular pressure were measured. Capsulotomy rates were recorded. Results: Patients implanted with the hydrophilic IOL had a greater percentage area and severity of PCO compared with patients with the hydrophobic IOL (p < 0.001). There was no difference in PCO between men and women in the hydrophilic group. However, in the hydrophobic group, women had significantly more PCO than men (p < 0.05). Patients with the hydrophobic acrylic IOL had better high‐ and low‐contrast visual activity (VA) (p < 0.01) and less glare (p < 0.001) than those with a hydrophilic acrylic IOL. Of the patients with the hydrophilic IOL, 42% underwent capsulotomy, compared with 10% in the hydrophobic group (p < 0.001). Conclusions: Two years after surgery, patients with the SA60AT hydrophobic acrylic IOL had less PCO and better high‐ and low‐contrast VA than patients with the BL27 hydrophilic acrylic IOL.     

Management of Posterior Capsule Tears

Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large.     

Posterior capsule opacification

Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery. At present the only means of treating cataract is by surgical intervention, and this initially restores high visual quality. Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens. The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma. This resilient group of cells then begin to re-colonise the denuded regions of the anterior capsule, encroach onto the intraocular lens surface, occupy regions of the outer anterior capsule and most importantly of all begin to colonise the previously cell-free posterior capsule. Cells continue to divide, begin to cover the posterior capsule and can ultimately encroach on the visual axis resulting in changes to the matrix and cell organization that can give rise to light scatter. This review will describe the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.     

Capsule contraction syndrome in eight cases of hydrophobic one‐piece intraocular lens implantation

Purpose: The combination of anterior capsule opacification (ACO) with capsulorrhexis phimosis and intraocular lens (IOL) decentration characterises the capsule contraction syndrome (CCS). Eight cases of ACO complicated with capsule phimosis are described. Methods: In this study, 231 patients who underwent cataract extraction using phacoemulsification from September 2005 to May 2006 were included. An acrylic one‐piece IOL was implanted with the use of the injector supplied by the manufacturer through a 2.75 mm incision. A thorough pre‐ and post‐operative examination (visual acuity measurement, corneal curvature measurement, applanation tonometry, fundus examination) was performed for each patient. Results: In eight of 243 eyes of 231 patients, anterior capsule opacification with capsulorrhexis phimosis and IOL decentration was observed two to four months post‐operatively. In all eight cases, the haptic implanted inferiorly was observed to be mounted on the IOL optic. Conclusions: The combination of IOL memory loss in addition to ACO, capsulorrhexis phimosis and decentration can be a cause of the CCS, an observation that has not been reported previously.     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

不同设计人工晶状体植入术后3年后囊膜混浊的研究

目的研究不同材料和不同设计的人工晶状体植入术后3年的后囊膜混浊(posterior capsular opacification,PCO)发生率及PCO形态。方法回顾性研究132眼老年性白内障患者,由同一医生进行超声乳化联合人工晶状体(in-traocular lens,IOL)植入术,根据IOL的不同分为4组:Storz Hydroview H60M组(33眼),Silicone折叠式硅胶IOL组(29眼),AcrySof三片式IOL组(36眼)和聚甲基丙稀酸甲酯(poly-methyl methacrylate,PMMA)组(34眼)。术后3年随访患眼的最佳矫正视力(best corrected visual acuity,BCVA),扩瞳后采集PCO数码图像,分析不同IOL组PCO的形态及PCO发生率。结果各种IOL的PCO形态各异,H60M组和AcrySof组分别有10眼和15眼后囊形成皱折,而Silicone和PMMA组为片状混浊。虽然各组BCVA和BCVA下降率差异没有显著性(P>0.05),但PCO发生率差异有非常显著性,分别是AcySof组5.6%,Silicone组30.3%,H60M组31%和PMMA组55.9%。结论AcrySof疏水丙烯酸酯三片式折叠IOL,有直角边缘设计,术后3年能明显降低PCO的发生。     

Evaluation of daunomycin toxicity on lens epithelium in vitro

Posterior capsule opacification is the major complication of extracapsular cataract extraction (ECCE). Lens epithelial cells derived from the periphery of the lens are thought to migrate posteriorly and contribute significantly to the postoperative proliferations at the posterior pole. We have evaluated the effects of the antiproliferative drug daunomycin on cultured porcine lens epithelial cell viability and proliferation. We observed that the mitotic activity of the cells is suppressed by a single short time treatment with daunomycin at a concentration as low as 2.5 mg/l. Long term effects on the reproductive capacity of the lens epithelial cells may not be as pronounced as the inhibition of other cells examined before e.g. retinal pigment epithelium and fibroblasts. Our results indicate that daunomycin may be useful for the pharmacologic prevention of postoperative proliferations in patients treated by ECCE.This study was supported by the Retinovit-Foundation.     

抗青光眼滤过性手术眼的后房型人工晶体植入

为了探讨在已施行抗青光眼滤过手术的白内障眼进行白内障摘除和后房型人工晶体植入的手术方法以及手术对滤过泡的影响。对抗青光眼滤过手术后白内障２１只眼，避开滤过泡，选择了颞下方角膜缘切口进行白内障囊外摘除及后房型人工晶体植入，同时对小而固定的瞳孔进行瞳孔括约肌切开与缝合术。术后视力均有不同程度提高，７６．１９％术眼视力达０．．５，术后平均眼压升高０．４１ｋＰａ，功能滤过泡未见明显疤痕化。对于抗青光眼滤过