Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.     

缺乏囊膜支持的无晶状体眼中两种人工晶状体植入方式的疗效比较

目的：在缺少囊膜支撑的无晶状体眼中,比较后房植入虹膜夹人工晶状体(IOL)与后房睫状沟巩膜缝合固定人工晶状体的疗效。

方法：本研究收集缺少囊膜支撑的无晶状体患者70例进行回顾性对比分析,患者根据手术方式的不同分为A、B两组,A组35眼行后房植入虹膜夹IOL,B组35眼行后房睫状沟巩膜缝合固定IOL。比较两组患者术前及术后3d,1、3、6mo,1a的裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮细胞密度(CECD),并且观察两组IOL的稳定性,记录术中及术后并发症。

结果：随访12～14mo。术后3d,A组的UCVA较术前明显改善(P<0.01),而BCVA较术前无差异(P=0.073); B组的UCVA较术前无差异(P=0.097),而BCVA较术前差(P=0.002); 两组患者术后1mo UCVA、BCVA均较术前显著改善(P<0.05),分别于术后6、3mo保持稳定。两组患者随访期间的IOP均维持于正常水平。A组、B组患者术后1a的CECD分别较术前平均降低0.7%、2.3%(均P<0.05)。两组患者随访期间各时间点IOP及CECD的均无差异(P>0.05)。两组患者术后1、3mo的全眼散光较角膜散光无明显差异(均P>0.05)。术后两组各有1眼IOL脱位,均经手术复位,其余患者术后随访期间IOL无显著倾斜和偏位; 其他术后并发症较轻微,组间并发症发生率无差异(P>0.05)。

结论：对于缺少囊膜支持的无晶状体眼患者,后房植入虹膜夹IOL与后房睫状沟巩膜缝合固定IOL均是安全有效的手术方式。后房植入虹膜夹IOL的操作相对简单,对眼球内组织损伤较小,手术时间较短,术后视力恢复较快,是有效的治疗方法之一。     

【In Press】Complications and outcomes of descemet stripping automated endothelial keratoplasty with Artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with Artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with Artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema, and hyphema. Best-corrected visual acuity (BCVA), IOP, and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, and 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with Artisan aphakia intraocular lens implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.     

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。     

开放囊袋-IOL单襻睫状沟固定术治疗先天性晶状体半脱位

目的:探讨开放囊袋-人工晶状体(IOL)单襻睫状沟固定术治疗先天性晶状体半脱位的安全性和有效性.方法:收集2011-03-01/2013-12-31影响视力的先天性晶状体半脱位患者10例13眼,做角巩膜缘隧道切口,环形撕囊后,使用虹膜拉钩,固定脱位晶状体,完成超声乳化手术.植入IOL,剪开晶状体脱位一侧囊袋,翻转前囊,上襻位于囊袋内,下襻单针经缝合固定于睫状沟.结果:所有患者最佳矫正视力均不同程度提高,IOL稳定,没有进展性偏位.结论:虹膜拉钩可以稳定脱位的晶状体,使超声乳化手术顺利完成.开放下方囊袋,IOL呈半游离状态,下襻睫状沟缝合固定可维持IOL的长期稳定,避免囊袋进行性偏移,造成IOL偏位.     

囊袋张力环联合虹膜拉钩在外伤性白内障晶状体脱位中的应用

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)联合虹膜拉钩在外伤性白内障晶状体脱位手术中的应用效果。方法:对15例15眼合并晶状体半脱位的外伤性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,植入CTR,然后行超声乳化及后房型折叠人工晶状体囊袋内植入。结果:15眼的人工晶状体均处于正位囊袋内。5眼术后12mo最佳矫正视力>0.8;6眼术后12mo最佳矫正视力>0.6,4眼术后视力较术前有提高,无后囊膜破裂,玻璃体进一步脱出,视网膜脱离等并发症的发生。结论:在超声乳化治疗晶状体脱位的白内障手术中运用CTR联合虹膜拉钩,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。     

高度近视白内障患者植入Bigbag人工晶状体的疗效观察

目的观察高度近视并发白内障患者行超声乳化吸除联合Bigbag人工晶状体植入术的有效性及安全性。方法 31例（55只眼）高度近视白内障患者行超声乳化吸除联合人工晶状体植入术。其中18例（30只眼）植入Bigbag人工晶状体,13例（25只眼）植入Matrix Acrylic 400型人工晶状体。比较手术前后视力及屈光状态;观察术中及术后并发症。结果 55只眼人工晶状体均植入囊袋内且固定良好,术前裸眼视力均〈4.5,术前最佳矫正视力〉4.8者Bigbag组3只眼（10%）,400组6只眼（24%）;术后1个月Bigbag组最佳矫正视力〈4.5者1只眼,4.5～4.8者10只眼,〉4.8者19只眼,与400组相比差异无统计学意义（χ2=0.066,P〉0.05）;Bigbag组术后1个月屈光度-0.50～-2.00 D,平均（-0.68±0.38）D,与术前相比较差异有统计学意义（t=12.79,P〈0.05）。与术后3个月屈光度比较无统计学意义（t=1.366,P〉0.05）。术后3个月Bigbag组,后囊膜未发现皱褶,2只眼（6.66%）后囊轻度混浊;400组2只眼（8%）后囊膜皱褶,3只眼（12%）后囊轻度混浊,随诊观察至6个月病情无进展。结论白内障超声乳化吸除联合Bigbag人工晶状体植入术治疗高度近视是一种安全、有效的手术方法。Big-bag人工晶状体不但可获得与其它人工晶状体相同的良好视力,还可对后囊膜起到相对稳定的支撑作用,减少并发症的发生。     

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM: To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A:25 eyes received Artisan iris-claw IOL implantation. Group B:20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.     

中老年高度近视透明晶状体摘除联合Bigbag人工晶状体植入术的临床观察

目的 观察透明晶状体超声乳化吸除联合Bigbag人工晶状体植入术治疗中老年高度近视的有效性及安全性.设计 回顾性病例系列.研究对象 40-65岁高度近视患者20例（36眼）.方法 采用IOL-Master测算人工晶状体度数,患眼均行透明晶状体超声乳化吸除联合Bighag人工晶状体植入术,比较手术前后视力及屈光状态;观察术中、术后并发症.主要指标 视力、屈光状态、后囊膜皱褶.结果 术前裸眼视力均＜0.3,术前最佳矫正视力＞0.6者5.眼（13.9%）,术后3天裸眼视力＞0.6者10眼（27.8%）,术后1个月、3个月最佳矫正视力＞0.6者分别为21眼（58.3%）,20眼（55.6%）.术后I个月屈光度＋1.50-2.00 D,平均（-0.58±0.68）D;术后3个月屈光度＋1.50-2.00 D,平均（-0.58±0.64 ）D,与术后I个月比较差异无统计学意义（P=1.000）.术中1眼发生后囊膜破裂,行前部玻璃体切除,人工晶状体植入囊袋内.未发现其他术中、术后并发症.后囊膜末发现皱褶,人工晶状体固定良好.术后3个月3眼（8.3%）后囊膜轻度混浊,观察至6个月无进展.结论 透明晶状体超声乳化吸除联合Bigbag人工晶状体植入术治疗中老年高度近视是一种安全、有效的手术方法,Bigbag人工晶状体可对后囊膜起到稳定的支撑作用.     

Artisan虹膜夹持型人工晶状体植入术及后房型人工晶状体睫状沟缝线固定术治疗无晶状体眼的比较

目的:比较Artisan虹膜夹持型人工晶状体植入术及后房型人工晶状体睫状沟缝线固定术治疗无晶状体眼的疗效及并发症。方法:2007-03/2009-03我院住院患者中连续24例24眼无后囊膜支持的无晶状体眼患者,随机分为两组。一组11眼行Artisan虹膜夹持型人工晶状体植入术,另一组13眼选择后房型人工晶状体睫状沟缝线固定术。观察手术前及手术后1d;1wk;1mo的裸眼视力(visual acuity,VA)、最佳矫正视力(best corrected visual acuity,BCVA)、眼压(intraocularpressure,IOP)、角膜内皮细胞计数(corneal endothelial cells,CECs)。结果:两组间比较,术前VA,BCVA,CECs差异无统计学意义,术后BCVA,CECs差异无统计学意义。Artisan组手术后VA优于术前BCVA,差异有统计学意义。睫状沟缝线固定组手术后VA与手术前BCVA差异无统计学意义。两组手术前后IOP差异无统计学意义。结论:Artisan虹膜夹持型人工晶状体植入术与后房型人工晶状体睫状沟缝线固定术都是治疗无晶状体眼有效方法。两者比较,Artisan虹膜夹持型人工晶状体植入术手术操作相对简单,组织损伤小,更加安全,是治疗无后囊膜支持的无晶状体眼的比较理想的治疗方法。     

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。     

眼外伤后行二期悬吊人工晶状体植人46例临床分析

目的探讨46例（46只眼）眼外伤后行二期悬吊人工晶状体植入术的手术技巧和临床疗效。方法选取我科2010年9月至2011年12月46例（46只眼）因眼外伤后未能一期植人人工晶状体行二期悬吊人工晶状体植入术患者的临床资料进行回顾性分析。根据病情选择悬吊式人工晶状体或虹膜型人工晶状体植入并观察术后人工晶状体位置、最佳矫正视力、眼压、角膜、眼底及并发症情况。结果随访3～6个月,平均5．4个月,最佳矫正视力≥0．5者8只眼（17．39％）,0．3-0．5者26只眼（56．52％）,0．1-0．3者10只眼（21．74％）,0．05-0．1者2只眼（4．35％）。手术前后最佳矫正视力比较具有统计学意义（t=27．71,P〈0．00）。结论对于眼外伤后未能一期行人工晶状体植入的患者,通过术前视力矫正能提高的患者行二期悬吊人工晶状体植入术是提高患者视力的理想方法。     

两种前房型人工晶状体治疗无晶状体眼的效果探讨

目的探讨无晶状体眼植入Artisan虹膜夹持型人工晶状体与房角支撑型人工晶状体术后的临床效果及差异。方法收集深圳眼科医院2009年1月至2011年3月住院接受人工晶状体植入术的无晶状体眼患者共37例,其中植入ARTISAN虹膜夹持型人工晶状体19例(19只眼),植入房角支撑型人工晶状体18例(19只眼)。比较术后裸眼视力、最佳矫正视力(BCVA)、角膜内皮细胞计数、眼压、角膜水肿发生率、并发症及人工晶状体的位置。随访时间至术后3个月。结果两组术后视力恢复良好,术后3个月的BCVA无统计学差异。术后3个月两组眼压差异无显著性。Artisan虹膜夹持型组术后3个月角膜内皮丢失率低于房角支撑型组,术后1周内角膜水肿发生率高眼压发生率及术后并发症发生率均较房角支撑型组低。两组术眼的人工晶状体位置均保持良好的居中性。结论 Artisan虹膜夹持型人工晶状体与房角支撑型人工晶状体都是治疗无晶状体眼的有效方法,两者比较,虹膜夹持型人工晶状体植入术损伤更小,更为安全,为较佳的手术方式。两者远期效果的比较尚待进一步观察。     

无囊膜眼的虹膜缝线固定后房型折叠式人工晶状体植入术

目的:探讨虹膜缝线固定后房型折叠式人工晶状体植入治疗无囊膜眼的可行性和有效性。方法:无囊膜眼15眼,采用经3.2mm角膜缘切口或透明角膜切口,植入后房型三片式折叠式人工晶状体(Alcon MA60BM),双襻用10-0聚丙烯缝线缝合固定于虹膜中周部,观察术中植入情况和术后视力、眼前段及眼压等情况。结果:所有病例均顺利植入人工晶状体,3例术中出现前房出血。术后随访3~15mo,视力均有不同程度提高,人工晶状体位置正常,无严重术后并发症发生。结论:虹膜缝线固定后房型人工晶状体植入治疗无囊膜眼是可行和有效的,长期的并发症有待进一步观察。     

外伤性白内障一期后房型人工晶体植入术

目的：探讨外伤性白内障人工晶体植入的疗效。 方法５７例外伤性白内障一期植入后房型人工晶体，术后随访３～３５ｍｏ。 结果６４％患者术后视力≥０．５，无严重并发症发生。 结论术中处理前囊膜、分离虹膜后粘连及预防后囊膜的破裂，对外伤性白内障人工晶体植入的疗效起着重要的作用。     

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。     

双手旋入法在后房型人工晶状体植入术中的应用

目的 讨论应用双手族入法在人工晶状体植入术中的优越性。方法 对60例(60眼)不同类型的白内障采用双手旋入法行Ⅰ期后房型人工晶状体植入术。结果 术后3周内矫正视力≥0.5者56眼占93％。前房出血2眼,瞳孔轻度移位变形4眼,人工晶状体前膜形成1眼。结论 应用双手族入法植入人工晶状体安全易行,很少损伤虹膜及后囊膜,提高了手术效率且便于掌握。     

人工晶状体置换术8例临床分析

目的分析8例人工晶状体(intraocular lens,IOL)置换术的原因、手术技巧和临床效果。方法回顾分析我院2004年1月至2006年12月8例(8眼)患者行IOL置换术术后裸眼视力、矫正视力和并发症。结果行IOL置换的主要原因是IOL脱位(3眼)和人工晶状体度数计算错误(3眼);术后裸眼视力在0.5以上的有7眼,8眼的最佳矫正视力均在0.5以上,手术的主要并发症是玻璃体脱出(2眼)。结论精细的手术技巧、准确的IOL测量、仔细的IOL植入和患者的合理沟通/选择等可有效避免IOL植入术出现并发症。IOL置换是一种即安全又能获得良好视力的治疗方法。     

Sulcus fixation without capsular support in children.

PURPOSE: To evaluate long-term follow-up in eyes of children who had sulcus fixation of an intraocular lens (IOL) without capsular support. SETTING: St. Eriks Eye Hospital/Karolinska Institute, Stockholm, Sweden. METHODS: This retrospective study included 21 eyes of 13 children. Seven eyes had Marfan's syndrome, 7 essential lens dislocation, 2 perforation with lens injury, and 5 spherophakia. The IOL implantation was primary in 16 eyes and secondary in 5 eyes. Lensectomy was performed with a limbal approach. An IOL with holes in the haptics was sutured in the sulcus, with the knots buried in the scleral bed. RESULTS: Mean patient age was 5.8 years +/- 2.6 (SD). Follow-up ranged from 9 to 33 months. No complications occurred during surgery. In all cases after IOL implantation, best corrected visual acuity was equal to or better than preoperatively. After surgery, no opacification of the visual axis, secondary glaucoma, or retinal complication was recorded. Posterior synechia formation occurred in 4 eyes, and 4 had cells on the IOL surface in 2 eyes, the IOL optic subluxated into the anterior chamber with the haptics in place. Both cases were successfully treated with pilocarpine 4%. CONCLUSION: Our results suggest that sulcus fixation of an IOL without capsular support is an option to correct aphakia in children.     

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。