弹性工放襻前房型人工晶体一期植入临床报告

目的 介绍弹性开放襻前房型人工晶体一期植入方法及疗效观察，方法 对１８例２２只眼白内障手术中后囊膜不完整或无后囊膜的无晶体眼，其中老年性白内障８例８只眼，晶体脱位（含白内障）５例９只眼，外伤性白内障５例５只眼同期植入前房型人工晶体，并行虹膜周边切除术，结果 随访６～３６个月，视力≥０．５者１８只眼（８１．８％），视力〈０．５者与原发疾病有关，结论弹性开放襻前房型人工晶体一期植入方法简便，疗效安全，     

外伤性白内障后房型人工晶体植入

本文报告外伤性白内障后房型人工晶体植入３２人。男２８人，女４人；平均年龄２６．４岁，平均随访９．３个月，矫正视力＞１．０者８眼占２５％，０．５－０．９者１１眼占３４．３８％，０．１－．０．４者１０眼占３１．２５％，＜０．１者３眼占９．３７％。讨论了手术时机，手术注意事项，植入人工晶体上袢的３种方法和埋藏线结的缝合法。     

外伤性白内障后囊破裂人工晶体植入的手术方式选择

目的探讨外伤性白内障晶体后囊不存在时,采用前房型人工晶体植入,抑或后房型人工晶体巩膜缝线固定术。方法外伤性白内障患者８６例（８６只眼）,其中前房型人工晶体（新型弹性开放襻）植入５６例,Ⅰ期植入２９例,Ⅱ期植入２７例;后房型人工晶体巩膜缝线固定（大Ｃ型襻,两根缝线睫状沟固定）３０例,Ⅰ期植入１４例,Ⅱ期植入１６例。结果术后随访１～４２个月。矫正视力≥０．５者,前房型人工晶体组４０例,占７１．４％;缝线固定组２７例,占９０．０％。矫正视力≥１．０者,前房型人工晶体组２２例,占３９．３％;缝线固定组１４例,占４６．７％。结论新型前房型人工晶体植入和后房型人工晶体巩膜缝线固定术均不失为常规后房型人工晶体植入失败的补救措施,但前房型人工晶体适用于年龄较大、眼前段（角膜、虹膜和前房角）条件较好,而眼后段（玻璃体、视网膜）条件较差者;后房型人工晶体巩膜缝线固定术则适用于年龄较小、眼前段条件较差而眼后段条件较好者。     

外伤性白内障联合手术初步报告

报告２１例（２１眼）外伤性白内障联合手术病人。包括７眼内异物取出、８眼角膜伤口缝合、２眼虹膜复位、２眼晶体玻璃体切除、１眼穿透性角膜移植、１眼小梁切除，全部病人均同时施行了白内障摘除联合后房型人工晶体植入术。术后１８例随访３─５８个月，平均１７．７个月。随访时视力≥０．５者占５５．６％。术后并发症有：１．后囊膜混浊，占２７．８％；２．人工晶体虹膜夹持，占１１．１％；３．其他并发症，占１６．７％。     

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     

外伤性白内障后囊破裂的一期后房型人工晶体植入术

本文对３２例（３２眼）因眼球穿通伤而致晶体后囊膜破裂的病例，根据其后囊膜破裂的位置和大小，采用不固定、单袢固定和双襻固定三种方法施行后房型人工晶体植入术。术后视力在０．５或以上者２８例（８７．５％），０．１—０．４者４例（１２．５％）。并发症包括术中睫状体出血２眼（６．２５％），后囊膜裂口增大２眼（６．２５％）；术后前房出血６眼（１８．８％），暂时性眼压偏高６眼（１８．８％）和暂时性眼压偏低７眼（２１．８％）。结果表明，在晶体后囊膜裂口小的情况下植入后房型人工晶体，可以不固定晶体襻或仅固定其一襻。     

新型弹性开放襻前房型人工晶体二期植入

目的探讨新型弹性开放襻前房型人工晶体二期植入的效果。方法总计观察３５只眼，其中外伤性白内障术后２８只眼，老年性白内障术后７只眼，距第一次手术时间３个月至２．５年。全部病例随访时间至少６个月。结果３５只眼中，２７只眼（７７．１％）视力恢复至０．５或０．５以上；１１只眼（３１．４％）恢复至１．０或１．０以上。结论新型弹性开放襻前房型人工晶体二期植入安全、有效。     

弹性开放襻前房型人工晶状体植入临床观察

观察弹性开放襻前房型人工晶状体二期和一期植入的临床效果。方法观察１２例１２眼，二期植入１１例，一期植入１例，随访３－６月。结果１２例全部达到术前最佳矫正视力，其中０．３－０．４者２例，０．５－０．８者７例，１．０以上。结论此型人工晶状体植入安全，有效。可作为缝一房型人工晶状体的替代术式。     

新型前房型人工晶状体二期植入术临床分析

目的 探讨新型弹性开放襻前房型人工晶状体二期植入方法及疗效。方法 ３１例３２眼后囊不完整或无后囊的无晶状体眼行二期植入并行周边虹膜切除术。结果 随访６～２４月，视力≥０．５者２５眼占７８．２％，〈０．５ 与原发病有关。结论 新型前房型人工晶状体二期植入，方法简便、安全、疗效可靠，作为无法植入后房人工晶状体时的替代，有较好的应用价值。     

后房型人工晶体更换术矫治人工晶体术后屈光误差

本文采用后房型人工晶体更换术矫治 ７ 例 （７ 眼） 因人工晶体植入术后所致较大度数屈光误差及屈光参差。结果： 手术中顺利取出原后房型人工晶体 ６ 例 （６ 眼）， １ 例 （１ 眼） 原人工晶体下襻与囊袋间固定粘连难以旋转取出， 剪断下襻后取出含人工晶体上襻的光学部， 后均顺利植入矫正后房型人工晶体。术后随访 ６ 个月至 ３ 年， 裸眼视力 ０４～１０， 双眼屈光力差０～１０ Ｄ。患者均可适应工作及生活需要。利用后房型人工晶体更换术为解决因人工晶体所致的难以适应的屈光误差及屈光参差提供了有效的矫治手段。     

Late in-the-bag spontaneous IOL dislocation: risk factors and surgical outcomes

AIM: To evaluate the possible predisposing risk factors for late in-the-bag spontaneous IOL dislocations and to study the early surgical and visual outcomes of repositioning and exchange surgeries. METHODS: Medical and surgical records of 39 eyes of 39 patients who underwent IOL repositioning or exchange surgery for dislocation between 2010 and 2018 were reviewed. Possible predisposing risk factors and some characteristics of late in-the-bag spontaneous IOL dislocations; outcomes of IOL repositioning and exchange surgeries, including visual acuity, refractive status before and after surgery and postoperative complications were evaluated. RESULTS: The predisposing factors for late in-the-bag spontaneous IOL dislocations were pseudoexfoliation [PEX; 12/39 (30.8%)], previous vitreoretinal surgery [7/39 (17.9%)], axial myopia [3/39 (7.7%)], both PEX and axial myopia [1/39 (2.6%)], both previous vitreoretinal surgery and axial myopia [2/39 (5.1%)] and uveitis [1/39 (2.6%)]. The mean interval between cataract and dislocation surgery was 7.23y, greater in PEX positive group (8.63y). The mean best corrected visual acuity (BCVA) improved significantly after dislocation surgery (P<0.001) and also improved significantly after exchange surgery (P=0.001). The mean value of spherical equivalant decreased significantly after dislocation surgery (P=0.011), whereas corneal astigmatism increased but this difference was not significant after dislocation surgery and exchange surgery (P=0.191, P=0.074, respectively). CONCLUSION: The most prevelant risk factors for late in-the-bag spontaneous IOL dislocations are PEX, previous vitreoretinal surgery and axial myopia. In the management of IOL dislocations, exchange surgery with small corneal incision seemed effective with improved BCVA and safety with low postoperative complications.     

Glued intraocular lens implantation for eyes with defective capsules: A retrospective analysis of anatomical and functional outcome

Purpose

To analyze the anatomical and functional outcome of glued intra ocular lens (IOL) implantation technique and its modifications.

Design

Retrospective observational case series.

Methods

This is a retrospective analysis of the patients who underwent glued intra ocular lens implantation from December 2007 to August 2010. Post operative uncorrected vision, best corrected visual acuity (BCVA), intra ocular pressure, IOL position, endothelial cells and anterior chamber reaction at their last follow up are analyzed from their concerned case sheets documentation. Subjective changes are analyzed via individual questionnaire. Immediate and late postoperative complications are also evaluated. Surgical modifications and the difference in the operated eyes are analyzed.

Results

Total 210 glued IOL eyes have been reviewed. Out of this 210, there are 152 (PMMA glued IOL), 21 (three piece foldable IOL), 5 (multifocal foldable IOL), 12 (pediatric glued IOL), 5 (20G sutureless vitrectomy), 2 (glued iris prosthesis) and 3 (transposition of posterior chamber IOL into anterior chamber). In combined surgeries there are, 5 (optical penetrating keratoplasty), 2 (descemet’s stripping endothelial keratoplasty) and 3 (iridoplasty). The modifications in glued IOL are handshake technique, injectable or foldable glued IOL, Multifocal glued IOL and intraoperative 23/25G trocar cannula infusion. Decentration (1.97%), macular edema (1.97%) and optic capture (2.63%) are the post operative complications encountered in rigid glued IOL. Good patient satisfaction is seen in the eyes with IOL repositioning, IOL exchange and multifocal glued IOL. There is significant improvement in BCVA in PMMA IOL (p = 1.35 × 10⁻⁵) and foldable IOL (p = 0.000).

Conclusion

Glued IOL seems to be a good alternative in IOL implantation in eyes with deficient capsules. The modifications in the existing technique decrease the learning time and risk for complications.     

小切口非乳化IOL植入治疗儿童外伤性白内障

目的：探讨小切口无缝线非超声乳化人工晶状体植入术治疗儿童外伤性白内障的效果。方法：26例患者均在全麻下行小切口无缝线非超声乳化人工晶状体植入术，结果：所有病例均恢复理想视力，系统观察1年，有5例前房轻度纤维素性渗出，4例少量前房积血，均经治疗于5天内吸收，23眼晶状体后囊浑浊，结论：该手术操作简单易行，结果与超声乳化手术相同，是治疗儿童外伤性白内障的首选方法。     

氟-肝素表面修饰人工晶状体植入兔眼后眼前段超微结构的改变

目的 探讨兔眼植入著者研制的氟-肝素表面修饰人工晶状体的生物相容性.方法 PMMA及氟-肝素修饰人工晶状体各32枚分别植入兔眼内,术后不同时期处死动物,取眼前段标本进行电镜观察.结果 PMMA人工晶状体组角膜实质出现小局灶性水肿,该处胶原纤维松散,有活跃的巨噬细胞及浆细胞,并有角膜内皮细胞粗面内质网中度扩张;睫状体间质细胞浸润较多,胶原纤维不规则,还有成纤维细胞分布其间.而氟-肝素修饰组,则有较轻的反应.结论 氟-肝素修饰人工晶状体略有较好的生物相容性.     

硅油填充眼硅油取出联合人工晶状体植入术

对硅油填充、取出联合人工晶状体(IOL)植入手术,已广泛应用于眼科.但晶状体硅油填充术后,并发白内障发生率甚高.因此,如何准确测算植入的IOL度数,选择硅油取出与白内障摘除的手术方法,是临床上研究的课题.在此文中,就此课题提出了手术方式选择、手术难点、术中注意事项以及IOL准确测算植入方法.为改善手术效果作了翔实地分析.     

Pigment deposits on hydrophilic intraocular lenses after phacoemulsification cataract surgery

A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery.We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24 months.Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected.To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery.     

Systematic review of potential causes of intraocular lens opacification

Intraocular lens (IOL) opacification is an infrequent complication of cataract surgery. Surface analysis has demonstrated that the opacification of IOLs is related to calcium or phosphate precipitation on or within the lenses, but the associated mechanisms are unknown, and the scientific literature is heterogeneous and limited to case series and retrospective studies. The purpose of this systematic review was to analyse the most frequent conditions associated with opacification of IOLs reported by studies. A search was carried out using the PubMed MEDLINE, Web of Science and Scopus databases. The quality of the studies selected was evaluated using the Pierson tool. The search provided a total of 811 articles, of which 39 were selected following the inclusion and exclusion criteria. The most common opacified lenses were hydrophilic IOLs according to our analysis. The mean time of appearance of lens opacification was 14.93 ± 17.82 months. The most frequent conditions associated with opacification of the IOLs were Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK/DSEK) and diabetes mellitus (DM), followed by pars plana vitrectomy (PPV), blood hypertension (HT), and glaucoma. Concerning the quality analysis, the mean score was 7.00 ± 1.43 (scoring range from 0 to 10), indicating an acceptable quality of the case reports and retrospective studies. In conclusion, DSAEK/DSEK, DM, PPV, glaucoma and hypertension are conditions with potential risk of IOL opacification after cataract surgery, especially when implanting hydrophilic acrylic IOLs.     

人工晶状体屈光度IOL Master测算的精确度

目的全面客观地评价IOL Master计算人工晶状体屈光度的精确度。方法121例(154眼)老年性白内障,术前分别应用IOL Master和眼科传统设备两种方法测量眼部参数并计算所需人工晶状体的屈光度,术后检查术眼屈光误差。结果眼轴长度方面:短眼轴和正常眼轴组中两种设备测得的值差异有统计学意义(P<0.001);前房深度方面:正常眼轴和长眼轴组中两种设备测得的值差异有统汁学意义(P=0.001);屈光误差方面:IOL Master法在各公式中的误差均小于传统的A超法。误差≤1D的比例高于传统的A超法。结论IOL Master测量并计算人工晶状体屈光度的精确度高于传统的方法。     

IOL Master测量短眼轴眼人工晶状体计算公式准确性比较

目的 比较IOL Master测量短眼轴眼时,各个人工晶状体（IOL）计算公式（Haigis、SRKⅡ、Hoffer Q、Holladay 1以及SRK/T公式）的准确性.方法 回顾性病例系列研究.行白内障超声乳化联合IOL植入术的短眼轴患者23例（30眼）,使用IOL Master测量并且根据各个公式计算预测术后屈光度数,手术3个月后验光确定患者实际术后屈光度数,计算预测误差,采用秩和检验比较各个公式的准确性.结果 Haigis公式的预测误差平均值为（0.02±0.58）D,其中57%的绝对预测误差≤0.50 D.各个公式绝对预测误差经秩和检验发现：Haigis公式与SRK Ⅱ公式差异有统计学意义（Z=-2.861,P=0.004）,其他各个公式之间差异无统计学意义.结论 短眼轴下,Haigis公式在统计学上优于SRKⅡ公式,其临床应用的准确性也高于其他IOL计算公式.在短眼轴情况下,Haigis公式是较准确的IOL计算公式.     

超高龄老人人工晶状体植入62例分析

目的 探讨超高龄老人白内障摘除联合人工晶状体植入术的临床疗效及并发症特点。方法 ６２例（６２眼）８０岁以上老年人行白内障囊外摘除联合人工晶状体植入术。对术后祖国航并发症进行了分析。结果 脱盲率为８５．９６％，脱残率为４３．５５％，严重葡萄膜反应８眼，前房出血７眼，角膜内皮失代偿２眼，角膜缘切口裂开１眼。结论 超高龄老人白内障术后视力预后相对较差，并发症相对较多，手术有一定风险。