Transparent irrigation cannula for bimanual lens cortex removal

A transparent irrigation cannula was developed to facilitate bimanual removal of subincisional lens cortex after phacoemulsification. The cannula allows visualization of the proximal cortex and provides ample inflow to maintain an inflated anterior chamber even at a high aspiration pressure.     

Bilateral posterior lens dislocation in Marfan's syndrome

Complete dislocation of the lens is a rare feature of Marfan's Syndrome. We observed four cases of bilateral complete posterior dislocation of the lens in established cases of Marfan's Syndrome over a one year period. An ophthalmologist may encounter infrequently, unilateral posterior dislocation in one eye and ectopia lentis in the other, but bilateral spontaneous posterior dislocation is rare. All our cases had associated vitreous degeneration with vitreous herniating into the anterior chamber. The pathogenesis of complete posterior dislocation in Marfan's Syndrome is discussed.     

Clear lens extraction and intraocular lens implantation in Marfan's syndrome

Intracapsular clear crystalline lens extraction and intraocular lens (IOL) implantation were performed in 4 highly myopic eyes of 2 patients with Marfan's syndrome. One eye of each patient received an anterior chamber IOL and the other, a scleral-fixated posterior chamber IOL. The preoperative spherical equivalent ranged between -14.50 and -28.00 diopters (D) and axial length range, between 25.32 and 36.02 mm. The SRK II formula was used. Mean uncorrected visual acuity improved from counting fingers to 20/80. Postoperative spherical equivalent correction ranged from -0.75 to +2.75 D. One eye had vitreous loss that was managed by anterior vitrectomy. Modern surgery for cataract and management of its complications suggest that clear crystalline lens extraction and IOL implantation can be attempted in selected cases with Marfan's syndrome.     

严重晶状体不全脱位的小切口囊袋内吸出术

目的评价自闭性小切口囊袋内吸出术治疗严重晶状体不全脱位的疗效。方法对１４例１８眼悬韧带离断大于１８０°的严重晶状体不全脱位者,根据晶状体核硬度的不同,分别采用自闭性小切口手动囊袋内吸出术和超声乳化囊袋内吸出术。结果术后随访３月～２年,２例４眼因弱视矫正视力０１～０３,３例５眼０５～０７,８例外伤眼术中植入人工晶状体,７例裸眼视力０５～１０,另１眼因青光眼视神经损害视力００３。无术中及术后并发症。结论此手术方法具有切口小,对角膜、虹膜及玻璃体扰动小,便于联合其它手术,术中、术后并发症少,视力恢复好等优点,是一种安全、有效的手术方法。     

Inflamed eye in Marfan's syndrome with posteriorly luxated lens

A 34-year-old man with Marfan's syndrome complained of redness and pain in the left eye. The right eye had been blind because of untractable retinal detachment. The left eye had had three surgical procedures for retinal detachment, and the lens had been luxated in the vitreous for more than 14 years. Ultrasonography demonstrated the spontaneously luxated lens as the possible cause of the inflammatory reaction. The diagnosis of lens-induced endophthalmitis was confirmed by histopathologic examination of the excised lens.     

Artisan虹膜夹持型人工晶状体植入治疗马凡综合征晶状体半脱位

目的探讨Artisan 虹膜夹持型人工晶状体（IOL）植入术治疗马凡综合征晶状体半脱位的有效性和安全性。方法 回顾性病例研究。2007年12月至2011年7月在广东省人民医院眼科确诊的马凡综合征晶状体半脱位患者16例（25眼）,行连续环形撕囊后,完成晶状体吸除、晶状体囊膜切除、前段玻璃体切割、Artisan IOL前房虹膜夹持固定和虹膜周边切除术。比较手术前后裸眼视力（UCVA）、最佳矫正视力（BCVA）、眼压、角膜内皮细胞计数,记录术后虹膜夹持型IOL位置、角膜内皮细胞丢失率,术中、术后并发症情况。随访时间6个月。采用非参数检验（Wilcoxon 检验）对手术前后UCVA和BCVA进行比较。结果 术后6个月UCVA和BCVA均较术前明显提高,术前和术后6个月UCVA（logMAR）分别为1.05±0.26和0.46±0.29,两者相比差异有统计学意义（Z=-4.530,P<0.01）。术前和术后6个月BCVA（logMAR）分别为0.68±0.32和0.27±0.22,两者相比差异具有统计学意义（Z=-2.208,P<0.01）。术后所有患眼虹膜夹持型IOL位置居中,单眼复视症状消失。术后2眼出现一过性高眼压,1眼出现脉络膜脱离,1眼出现视网膜脱离,未发生IOL移位、角膜失代偿等严重并发症。术后6个月平均角膜内皮细胞丢失率为5.6%。结论 Artisan虹膜夹持型IOL植入治疗晶状体严重脱位可提高视力,消除单眼复视且安全有效。     

Cupid fixation for repositioning subluxated intraocular lens

We describe the cupid fixation technique, which allows safe repositioning of a subluxated intraocular lens (IOL). Under subconjunctival anesthesia, the body of the subluxated IOL is perforated with a 10-0 polypropylene suture on a straight needle. The IOL is then centered and fixated at the sclera overlying the ciliary sulcus; the knot is tied beneath a previously created limbal intrascleral pocket. No intraoperative complications occurred in 24 cases in which the technique was performed, and successful IOL centration was achieved.     

The results of removing a transparent lens in Marfan's syndrome

In 112 eyes of 65 patients a clear lens in the Marfan's syndrome was removed through the approach in the flat part of the ciliary body. Before operation, in all patients who had peripheral degeneration of the retina peripheral prophylactic argon laser coagulation of the retina was made. At the time of operation, in 12 eyes some pieces of lenticular substance penetrated into anterior segments of the vitreous body, which in all cases was removed by means of a lens vitreotome. One month after lensectomy, in 1 patient retinal detachment developed that totally reattached after surgical intervention. In 99 eyes (88.4%) visual acuity improved after surgery as compared with that before surgery. The analysis of the obtained results has shown that transciliary lensectomy is a reliable method of surgical treatment for subluxation of a clear lens in the Marfan's syndrome.     

晶状体半脱位摘出手术中的后部辅助抬升技术

目的评价后部辅助抬升技术在晶状体半脱位摘出手术中应用的效果。方法回顾性分析7例（7眼）晶状体半脱位（脱离范同超过2个象限）资料,手术方法采用平坦部穿刺辅助器械的后部辅助抬升技术,将半脱位品状体顶人前房后摘出。对术前、术后视力、眼压及视网膜并发症等情况进行分析。结果7例均顺利摘出半脱位晶状体,未行后段玻璃体切除术。术后并发症较少。结论后部辅助抬升技术应用于脱离范围超过2个象限的品状体半脱位摘出手术是简单、有效安全的方法。     

Closed chamber globe stabilization and needle capsulorhexis using irrigation hand piece of bimanual irrigation and aspiration system

Background  

The prerequisites for a good capsulorhexis include a deep, well maintained anterior chamber, globe stabilization and globe manipulation. This helps to achieve a capsulorhexis of optimal size, shape and obtain the best possible position for a red glow under retroillumination. We report the use of irrigation handpiece of bimanual irrigation aspiration system to stabilize the globe, maintain a deep anterior chamber and manipulate the globe to a position of optimal red reflex during needle capsulorhexis in phacoemulsification.     

囊袋拉钩在晶状体部分脱位手术中的应用

目的评价囊袋拉钩在对晶状体部分脱位患者进行超声乳化手术时的作用。方法12眼外伤性晶状体脱位患者，术中根据悬韧带离断范围经前房穿刺插入数量不等的囊袋拉钩，并观察视力、眼压、人工晶状体（IOL）位置及术中术后的并发症。结果术中均未发生玻璃体脱出、囊袋塌陷及离断范围进一步扩大等并发症，术后8眼（8／12）矫正视力大于0．6，4眼（4／12）由于高度近视黄斑变性，矫正视力均小于0．25。术后视力提高的8眼中2眼（2／8）出现IOL位置轻度下移。结论晶状体脱位患者行超声乳化手术时使用囊袋拉钩能有效增强囊袋的稳定性，减少术中术后的并发症。     

Anterior chamber stability during bimanual irrigation and aspiration. Theoretical and experimental analysis.

PURPOSE: To determine the requirements for maintaining a stable anterior chamber during bimanual irrigation and aspiration (I/A) using side-port cannulas. SETTING: Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. METHODS: A theoretical fluid dynamic model of the closed I/A system was developed. Model predictions were compared with experimental flow measurements made on the Alcon Legacy 20000 system using a number of commercial and custom I/A cannulas. RESULTS: Bore diameter, length, and orifice size determine the pressure-flow relationship of cannulas. Four of 18 tested irrigation cannulas were able to maintain anterior chamber stability when used with a 23-gauge/0.3 mm orifice aspiration cannula and maximum aspiration settings. All 4 had a 21-gauge lumen diameter. A shorter cannula length also contributed to higher flow. CONCLUSIONS: Anterior chamber stability during bimanual I/A required the irrigation system to have lower flow resistance than the aspiration system, which can be provided by using cannulas with larger lumen diameters and shorter lengths. Special cannula designs can provide these characteristics without requiring larger side-port incisions.     

囊袋张力环在马凡综合征超声乳化手术中的应用

目的　探讨囊袋张力环在马凡综合征合并白内障晶状体半脱位手术中的作用。方法　 18例 ( 2 9眼 )马凡综合征合并白内障晶状体半脱位接受超声乳化吸出术 ,将囊袋张力环植入晶状体囊袋后 ,再植入后房型人工晶状体。结果　术后随访 6～ 18月 ,2 7眼 ( 93 .1% )保持了良好的居中性。术后 1月最佳矫正视力≥ 0 .7者 2眼 ,0 .3～ 0 .6者 2 2眼 ,<0 .3者 5眼。未发生视网膜脱离等严重并发症。结论　囊袋张力环应用于马凡综合征合并晶状体半脱位超声乳化手术 ,不仅可以提高手术的安全性 ,防止人工晶状体偏位 ,而且保留了完整的晶状体后囊 ,避免或减少玻璃体脱出 ,有效地减少了马凡综合征患者视网膜脱离的危险性