白内障术中全囊膜抛光模式预防后囊膜混浊的临床研究

目的：探讨白内障术中抛光模式全囊膜抛光预防后囊膜混浊的效果。方法：对162例194眼患者进行白内障超声乳化手术,并植入后房型人工晶状体。100眼术中用抛光模式进行全囊膜抛光,94眼术中用抛光器进行囊膜抛光。结果：术后随访12mo,抛光模式抛光组有6眼（6.0%）发生后囊膜混浊; 抛光器抛光组有15眼（16.0%）发生后囊膜混浊,两组差异有统计学意义（P〈0.05）。结论：白内障术中采用抛光模式全囊膜抛光能有效预防后囊膜混浊的发生。     

手法小切口白内障术中累及悬韧带区的连续环形撕囊的安全性探讨

目的：探讨在手法小切口白内障术中超出无悬韧带区域的连续环形撕囊的安全性及有效性。方法：采用手法无缝线白内障囊外摘除术对住院1 443例1 965眼白内障患者进行手术,术中采用连续环形撕囊法制作7～8mm直径前囊口,对患者术中撕囊是否成功、后囊破裂、术后角膜水肿及视力等情况进行统计学分析,研究其手术价值。结果：患者1 965眼中,1 942眼（98.83%）连续撕囊成功; 15眼（0.76%）囊膜瓣向周边撕裂不能挽救,留有放射状裂口一个; 8眼（0.41%）因为囊膜钙化机化等原因无法常规撕囊,采用囊膜剪开及截囊等方法完成前囊开口。所有病例,均无后囊破裂发生,并顺利植入人工晶状体。术后一过性角膜水肿36眼（1.83%）。术后1d,视力≥0.5者1 650眼（83.97%）,≥0.3者1 867眼（95.01%）。人工晶状体位置正并且稳定。结论：在手法白内障术中用连续环形撕囊方法制作累及悬韧带区域的大于常规直径的前囊口,并未降低囊袋和人工晶状体的稳定性,使手术安全性提高,值得推广和应用。     

白内障手术连续环形撕囊的染色技术

目的:观察VisionBlue（0.06％台盼蓝）染色在白色白内障超声乳化手术中是否有助于连续环形撕囊（CCC）及整个手术安全顺利进行。方法:30例30只眼,术中前房注入0.1ml VisionBlue,观察前囊膜着色效果、撕囊成功率、在超声乳化手术中囊膜保护的完整率以及角膜内皮、眼压和房水炎症反应等。结果:28眼前囊膜周边及中央一次性均匀着色,2只眼经过两次染色后着色均匀;撕囊全部成功顺利,在后续的超乳手术中保留的囊膜边界清晰,完整率30/30;术中无并发症,术后视力提高,炎症反应轻,眼压及角膜内皮与术前无统计学差异;追踪3个月未见明显副作用。结论:VisionBlue染色是一种简单安全的技术,提高了前囊膜的可见度,有助于白色白内障超声乳化手术CCC和整个手术的安全顺利进行。     

连续环形撕囊制作大直径前囊口在手法无缝线白内障囊外摘出术中的应用

目的　探讨以连续环行撕囊方法制作大直径前囊口在手法无缝线白内障囊外摘出术中的安全性及有效性。方法　采用手法无缝线白内障囊外摘出术对五三五医院住院的１４４３例（１９６５眼）白内障患者进行手术,术中采用连续环行撕囊法制作直径７～８ｍｍ的前囊口,对患者术中撕囊是否成功、有无后囊破裂、术后角膜水肿及视力等情况进行统计学分析,研究其手术价值。结果　１９４２眼（９８．８％）连续撕囊成功;１５眼（０．８％）囊膜瓣向周边撕裂不能挽救,留有放射状裂口１个;８眼（０４％）因为囊膜钙化、机化等原因,无法常规撕囊,采用囊膜剪开及截囊等方法完成前囊开口。所有病例均无后囊破裂等并发症发生,并顺利植入人工晶状体。术后一过性角膜水肿３６眼（１．８％）,术后９０ｄ视力＞０．５者１６７４眼（８５．２％）,＞０．３者１８７８眼（９５６％）。结论　在手法白内障术中用连续环形撕囊方法制作大于常规直径的前囊口,使手术安全性提高,值得推广和应用。     

晶状体半脱位白内障超声乳化术中植入囊袋张力环的临床观察

目的：探讨晶状体半脱位白内障超声乳化术中植入囊袋张力环的疗效.方法：对15例（15眼）晶状体半脱位白内障患者行超声乳化吸出术＋囊袋张力环＋后房型人工晶状体植入术.结果：15例（15眼）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.术后患者视力均得以提高,人工晶状体位正,后囊膜平整,无皱缩,混浊,无明显手术并发症.结论：在晶状体半脱位白内障患者中植入囊袋张力环可提高手术的安全性,防止术后人工晶状体偏位,降低了后发性白内障的发生率.     

连续环形撕囊术后囊袋收缩症的成因和防治

目的 探讨白内障连续环形撕囊术（CCC）后囊袋收缩症的成因、临床特点、对视力的影响和防治方法。方法 对23例23眼CCC术后晶状体前囊口纤维增生、收缩情况进行观察，对其影响进行了分析。YAG激光晶状体前囊放射状切开术或后囊截开术前术后进行检验。结果 23眼有不同程度的前囊口纤维增生、收缩，可伴有后囊浑浊、皱褶。23眼中有13眼不同程度的视力下降，3眼人工晶状体偏位，眩光6例，前房加深3眼。3眼行YAG激光前囊口放射状切开，2眼行手术剥离。YAG激光后囊截开术可提高视力。结论 囊袋收缩综合症是撕囊区面积缩小、残留的晶状体前囊浑浊、后囊皱褶、人工晶状体位置改变为特点，导致视力障碍，眩光，人工晶状体偏位。YAG激光前囊口放射状切开术和后囊截开术可松解囊袋、改善症状、提高视力。     

台盼蓝染色后晶状体前囊膜及上皮细胞的电镜观察

连续环形撕囊术（continuous circular capsulorhexis，CCC）是超声乳化白内障摘出术中最基本也是最关键的手术步骤。而在缺乏眼底红光反射时，术者难以看清撕囊口边缘，使得完成CCC难度增加。1999年，Melles等首先将台盼蓝应用于晶状体前囊膜染色，并取得了良好的临床效果。本研究旨在探讨台盼蓝染色后对晶状体前囊膜及上皮细胞超微结构的影响。     

白色白内障超声乳化吸除术

目的探讨白色白内障超声乳化吸除术中的手术难点和处理对策,旨在减少并发症,提高手术成功率。方法对109眼白色白内障施行超声乳化手术,术中应用0.5%吲哚氰绿(ICG)或0.1%台盼蓝(Trypanblue)前囊染色(吲哚氰绿染色22眼,台盼蓝染色87眼),做连续环形撕囊(CCC),撕囊口直径约4.5~5.0mm,不做晶状体核水分离,采用乳化针头斜面朝下超声乳化(bevel-down)和高负压脉冲超声模式将晶状体核乳化吸出,吸除皮质,后囊抛光后植入人工晶体。结果101眼成功完成CCC,于囊袋内将晶状体核乳化吸出;2眼在Ⅲ级核CCC过程中有一处放射状撕裂口,将核脱位于前房乳化吸除;6眼在CCC制作过程中有多处放射状撕裂口,CCC失败,扩大手术切口,改做白内障囊外摘除术。Ⅲ级核23眼,平均超声能量18.6%±5.5%,平均超声时间(77.4±35.5)秒,绝对超声时间(11.9±3.1)秒;Ⅳ级核68眼,平均超声能量25.7%±8.4%,平均超声时间(100.9±39.4)秒,绝对超声时间(27.6±8.3)秒;Ⅴ级核18眼,平均超声能量27.7%±10.3%,平均超声时间(155.0±79.4)秒,绝对超声时间(56.5±8.5)秒。术中4眼发生后囊膜破裂,人工晶体植入睫状沟。术后第1天,部分角膜上皮水肿11眼,于术后3~5天后消退。术后1周最佳矫正视力:<0.1者5眼,0.1~<0.3者13眼,0.3~<0.5者15眼,≥0.5者77眼。结论白色白内障具有前囊膜菲薄、质地脆弱,皮质液化,囊袋内压力高,晶状体核较硬等特点。连续环形撕囊的制作和对裸露硬核的处理是白色白内障超声乳化术中的难点。通过前囊膜染色有助于CCC的制作;采用粘弹剂软壳(soft-shell)技术、乳化针头斜面朝下超声乳化和高负压脉冲超声模式,减少了角膜内皮细胞的损伤;不做水分离在白色白内障超声乳化术中对于避免后囊膜破裂有重要意义。     

连续环形撕囊术技巧探讨

目的 探讨并总结白内障超声乳化术中连续环形撕囊成败结果及原因。介绍手术技巧。方法 3000例3000眼白内障超声乳化术中。前房注入Healon,用截囊弯针做连续环形撕囊,获得一边缘光滑的晶状体前囊膜环形开口,直径为5-6mm。结果 在3000例（3000眼）连续环形撕囊中,成功2655眼,占88.5%;失败345眼,占11.5%,在345眼失败的病例中,开始的1500眼中占18%,后1500眼中占5%。结论 连续环形撕囊术有众多优点,但相对技术要求较高,需经长期大量实践才能不断提高,成功的关键是：（1）术前充分散瞳。（2）降低前囊膜表面张力;（3）维持前房深度;（4）控制撕囊直径在5-6mm;（5）合理用力控制方向;（6）撕囊速度宜慢。     

白内障小切口囊外摘出术与传统囊外摘出术效果的分析

目的分析白内障小切口非超声乳化囊外摘出术与传统囊外摘出术效果。方法回顾分析白内障复明行动中老年性白内障手术1437例（1675眼）。患者随机分成两组,分别采用小切口非超声乳化白内障囊外摘出与传统的囊外摘出术两种方法进行手术,术中都植入人工晶状体。其中,小切口组（A组）,716例（846眼）;传统囊外摘出组（B组）,721例（829眼）。对两组手术效果（术后视力及并发症）进行分析和比较。结果两组术后7d视力比较：A组,视力低于0．3者59眼（6．97％）,0．3～0．5者183眼（21．63％）,0．5以上者604眼（71．5％）;B组,视力低于0．3者128眼（15．44％）,0．3～0．5者583眼（70．32％）,0．5以上者118眼（14．23％）。并发症有角膜水肿、虹膜损伤、前房积血、后囊破裂、玻璃体脱出及瞳孔夹持。两组比较：A组发生并发症260眼（30．73％）,B组发生并发症388眼（46．8％）。两组术后视力及并发症差异有统计学意义（视力：x^2=30．26,P〈0．01;并发症：x^2=45．59,P〈0．01）。结论在大规模白内障复明行动中,应用小切口无缝线非超声乳化白内障囊外摘出术较传统的白内障囊外摘出术术后视力较好,手术并发症较小,且无需昂贵的设备及特殊器械,手术步骤简单．适宜基层医院开展。     

白内障撕囊直径不同对后发性白内障影响的临床研究

目的:观察连续环形撕囊口完全覆盖人工晶状体光学面与连续环形撕囊口完全不覆盖人工晶状体光学面的人工晶状体植入术后后囊膜混浊(posterior capsular opacification,PCO)的情况。方法:随访近5a来施行超声乳化吸出白内障联合人工晶状体植入手术的老年性白内障患者164例196眼,术后观察视力、撕囊口与人工晶状体光学面的关系及PCO等情况,随访12~26(平均16.3)mo。根据Sellman等的PCO分级标准进行分级:I级为没有PCO或极轻微PCO不减少红光反射,也没有珍珠样小体或IOL边缘也没有发现珍珠样小体;Ⅱ级为轻度PCO减少了红光反射,IOL边缘也没有发现珍珠样小体;Ⅲ级为在IOL区域内发现中度纤维化或珍珠样小体,但视轴(中心3mm)是透明的;Ⅳ级为重度纤维化或珍珠样小体并扩展到视轴区,并且严重减少红光反射。术后后囊膜出现Ⅱ,Ⅲ及Ⅳ级统计为临床出现后发性白内障的并发症病例。结果:后发性白内障是现代白内障摘除手术后晚期常见的并发症之一,连续环形撕囊口完全覆盖人工晶状体光学面组120眼中,发生后发性白内障42眼(35.0%)。连续环形撕囊口完全不覆盖人工晶状体光学面组76眼中,发生后发性白内障41眼(53.9%)。两组病例术后在临床后发性白内障发生率上有统计意义(P<0.05)。结论:连续环形撕囊口大小与术后后囊膜的混浊有关。撕囊口完全覆盖人工晶状体光学面能减少后发性白内障发生的几率。     

Complications of pediatric cataract surgery and intraocular lens implantation

PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.     

晶状体不全脱位单襻缝线折叠人工晶状体悬吊术

目的 探讨外伤性白内障晶状体不全脱位时,采用单襻缝合固定可折叠人工晶状体悬吊术的效果.方法 前瞻性病例对照研究.对40例（40眼）外伤性白内障晶状体不全脱位范围180°～240°者,随机分为两组：试验组20例行单襻缝合固定可折叠人工晶状体悬吊术,对照组20例行常规人工晶体悬吊术,术后1d、7d、1月、3月观察裸眼视力、最佳矫正视力、角膜散光、眼压、并发症等情况,并进行统计学分析.结果 试验组与对照组间术后各时期裸眼视力比较及术后1d最佳矫正视力比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月最佳矫正视力比较,差异无统计学意义.两组间术后各时期角膜散光及术后1d眼压比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月眼压比较,差异无统计学意义.试验组角膜水肿、玻璃体出血浑浊并发症的出现少于对照组.结论 单襻缝合固定可折叠人工晶状体悬吊术是一种安全有效的手术方法.     

655例白内障超声乳化联合人工晶状体植入术的临床观察

目的探讨超声乳化联合人工晶状体植入术对老年性白内障患者的手术治疗效果。方法对655例(655眼)老年性白内障患者行白内障超声乳化联合人工晶体植入术,观察术后裸眼视力恢复情况及术后并发症。结果患者术后1d裸眼视力≥0.5者256眼占39.08%,术后3天复查裸眼视力≥0.5者419眼占63.97%。655例患者裸眼视力均有不同程度提高,手术后主要并发症为角膜水肿,无其他严重并发症。结论超声乳化联合人工晶体植入术是治疗老年性白内障的有效手术方法,疗效确切,手术中规范操作可减少术后并发症的发生。     

Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery.

PURPOSE: The management of the posterior capsule in pediatric cataract surgery remains challenging. The purpose of our study was to evaluate the role and clinical outcomes of primary pars plana capsulotomy and pars plana anterior vitrectomy during pediatric cataract surgery with intraocular lens (IOL) implantation. METHODS: Consecutive cases of pars plana capsulotomy and anterior vitrectomy during pediatric cataract surgery were retrospectively reviewed. The surgical technique was the same in all patients and involved pars plana capsulotomy with anterior vitrectomy after the IOL was implanted in the capsular bag. RESULTS: Seventy-six pediatric cataract cases in 61 patients performed from 1994 through 1999 used the pars plana posterior capsulotomy technique and were included in this analysis. A posterior chamber IOL was implanted in all cases. There were no intraoperative complications associated with the surgery. Median age at the time of surgery was 21 months. All patients had at least 1 year of follow-up and mean follow-up was 29.4 months. Among patients old enough to read Snellen's letters (53 eyes), final best-corrected visual acuity was 20/40 or better in 32 eyes (60%) and 20/50 to 20/200 in 21 eyes (40%). Poor final visual acuity was associated with deprivation amblyopia or optic nerve dysplasia or hypoplasia. There were no postoperative retinal complications or cases of IOL dislocation during the follow-up period. Seven eyes (9.2%) of five patients with a median age of 2.5 months developed reopacification of the visual axis at a mean of 4.1 months postoperatively. This event occurred in 6 of 28 eyes with an age of 6 months or less (21.4%), versus only 1 of 48 eyes with an age greater than 6 months (2.0%) (P =.006, Fisher exact test). The visual axis was restored by pars plana membranectomy in 6 eyes and 1 eye of one patient underwent neodymium:YAG laser membrane discission. CONCLUSIONS: Pars plana capsulotomy with pars plana anterior vitrectomy is a safe, effective method of managing the posterior capsule in pediatric cataract surgery with IOL implantation. Visual axis reopacification is associated with a very young age at the time of surgery. Continued follow-up of these patients is important to assess the long-term outcomes of this surgical approach.     

Akreos Adapt人工晶状体十字形袋／沟固定法在后囊大破孔时的应用

目的 观察Akreos Adapt亲水性丙烯酸酯折叠式人工晶状体（IOL）十字形袋/沟固定法植入在外伤后或白内障术中出现的后囊大破孔时应用的临床效果.方法 对31例（31眼）后囊大破孔者采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL.随访期内观察其术后视力及视觉症状、术后炎症反应、IOL位置及固定状态、囊膜混浊程度、瞳孔和眼压等情况.结果 术后所有眼视力均较术前提高,最佳矫正视力0.1～0.2者4眼,0.3～0.4者5眼,≥0.5者22眼.所有术眼的IOL均在位,基本居中、无移位,视轴透明,未见严重的术后炎症反应或IOL相关并发症,瞳孔及眼压正常.结论 在后囊大破孔但连续环形撕囊完整时可采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL,该法简便、快捷、安全,植入后IOL位置稳定居中,并有良好的生物相容性和眼内稳定性.     

Multifocal intraocular lens implantation in pediatric cataract surgery

OBJECTIVE: To evaluate implantation of a zonal-progressive multifocal intraocular lens (IOL) in children. STUDY DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five eyes of 26 pediatric patients aged 2 to 14 years with multifocal IOL implantation at one institution with more than 1 year of follow-up. INTERVENTIONS: Standard surgical procedure comprised an anterior capsulorrhexis, lens material aspiration via two side-port incisions, temporal tunnel incision, and multifocal IOL (SA40-N; Allergan, Irvine, CA) implantation in all eyes. In 24 eyes (68%), a 5-mm posterior capsulorrhexis was created with forceps, followed by an anterior vitrectomy in 19 of those eyes (54%). RESULTS: Twenty-six patients (35 eyes) had an average follow-up of 27.4 +/- 12.7 months (range, 12-58 months). At last follow-up, best-corrected distance visual acuity improved significantly (P = 0.001), 71% of eyes with a visual acuity of 20/40 or better and 31% of eyes with a visual acuity of 20/25 or better. In the 9 bilateral cases, spectacle dependency was moderate, with only 2 children (22%) reporting the permanent use of an additional near correction. The remaining children were either using distance-correction only (4 patients; 44%) or no glasses at all (3 patients; 33%). Stereopsis also improved significantly after multifocal IOL implantation (P = 0.01). Sixteen eyes (46%) experienced obscuration of the entrance pupil that required intervention, with 10 requiring a second intraocular surgery. Four eyes required an anterior membranectomy for persistent fibrinous membrane. Intraocular lens decentration requiring surgical intervention developed in six eyes. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in this age group.     

囊袋张力环在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)在晶状体半脱位白内障超声乳化手术中的应用效果。方法:对13例(13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:13眼的人工晶状体均处于正位,无明显偏位及倾斜。术后矫正视力>0.8者4眼;0.4~0.7者8眼;0.1者1眼,为老年性白内障合并黄斑区脉络膜新生血管患者,未见由CTR引起的并发症。结论:在超声乳化治疗晶状体脱位的白内障手术中运用CTR,能提高手术安全性,防止人工晶状体偏位,减少手术并发症,是一种良好的白内障手术辅助工具。     

台盼蓝囊膜染色剂在白内障连续环形撕囊手术中的应用

目的研究台盼蓝囊膜染色剂在治疗白色白内障中,是否有助于连续环形撕囊的顺利完成及白内障手术的顺利进行。方法79例(80眼),随机分为2组,染色组40例(41眼),对照组39例(39眼),染色组使用台盼蓝囊膜染色剂,术中观察及对比前囊膜染色情况、连续环性撕囊成功率、晶状体后囊破裂及人工晶状体囊袋内植入情况,术后视力、前房炎症反应、角膜、人工晶状体有无蓝染及后囊混浊情况。并与对照组进行统计学分析。结果染色组的术中染色均匀,连续环形撕囊及人工晶状体囊袋内植入率为97.7%,晶状体后囊破裂率为2.44%,与对照组进行统计学分析有显著差异。术后追踪观察3个月,染色组术后视力好于对照组,前房炎症反应、晶状体后囊混浊2组无统计学差异。染色组术后角膜、人工晶状体未见蓝染,未见术中及术后并发症。结论台盼蓝囊膜染色剂目前是一种安全可靠的技术,手术中可以看清前囊,使连续环形撕囊顺利进行,人工晶状体稳定的位于囊袋内,增加了白色白内障手术的成功率。     

高频透热撕囊法在白内障手术中的应用

目的:评价在白内障手术中使用高频透热撕囊仪作连续环形撕囊的效果。方法:在30例(34眼)患者进行白内障囊外摘出联合后房型人工晶体植入术中,先向前房注入透明质酸钠,然后使用高频透热撕囊仪作晶体连续环形撕囊术。结果:有3眼术中出现小的晶体前囊放射状撕裂,所有病例术后角膜无水肿,无其他术后合并症,术后一周31眼矫正视力≥0.5,占91.2％。结论:此法操作简便,易于掌握,是一个安全有效的连续环形撕囊的方法。尤其适用于过熟期白内障,儿童先天性白内障和外伤性白内障的截囊。眼科学报1999;15:121—123。