非染色连续环形撕囊在白色白内障超声乳化中的应用观察

目的:探讨非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障的疗效。方法:对458眼白色白内障施行非染色连续环形撕囊超声乳化联合人工晶状体植入术,观察其撕囊成功率、术中的并发症、术后视力、术后角膜水肿反应等指标。结果:患者458眼中撕囊成功441眼(96.3%),17眼(3.7%)囊膜出现放射状撕裂,以剪刀剪出一囊膜瓣再完成撕囊。术中后囊膜破裂9眼(2.0%),术后轻度角膜水肿94眼(20.5%),中度水肿29眼(6.3%),重度水肿8眼(1.7%),水肿均在2～10d内消退,无角膜内皮失代偿。术后第1d视力均有明显的提高,视力>0.3者329眼(71.8%),术后1wk视力>0.5者417眼(91.0%)。结论:非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障虽手术操作较为困难,但熟练后成功率较高,术后视力恢复良好。     

Trypan blue assisted phacoemulsification in corneal opacities

AIM: To evaluate the efficacy of trypan blue for enhancing visualisation during phacoemulsification and foldable lens implantation in cases of cataract with corneal opacities. METHODS: 11 eyes of 11 patients with nebulomacular corneal opacities involving the visual axis with partially and visually debilitating cataract underwent trypan blue assisted phacoemulsification with foldable intraocular lens implantation. The patients were followed at the first day, first week, first month, and third month postoperatively. Completion of capsulorhexis, phacoemulsification with foldable lens implantation, and postoperative best corrected visual acuity were measured. RESULTS: The dye improved visualisation of the anterior capsule and a complete capsulorhexis could be performed successfully in all eyes. In all but one eye phacoemulsification was accomplished successfully. In one eye with Fuchs' dystrophy penetrating keratoplasty was performed later. Visual acuity was < or = 6/60 preoperatively in all eyes and improved to > or = 6/24 in eight eyes postoperatively. CONCLUSION: Trypan blue assisted phacoemulsification may be performed in selected cases of corneal haze/opacification with cataract. It provides acceptable visual outcome in cases awaiting penetrating keratoplasty or in cases where it is not feasible or promising.     

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     

辅助技术在治疗白内障合并角膜混浊手术中的应用

目的：评价在白内障手术中应用包括囊膜染色、虹膜拉钩、虹膜切除等辅助技术治疗白内障合并角膜混浊患眼的术后视觉效果,并分析手术安全性和有效性。

方法：回顾收集2014-01/2019-03在新疆军区总医院全军眼科中心接受白内障超声乳化合并人工晶状体植入术的白内障合并角膜混浊患者105例105眼,所有患者接受白内障超声乳化摘除并人工晶状体植入术。术中应用台盼蓝囊膜染色剂,并观察前囊膜染色情况,连续环形撕囊成功率,晶状体后囊破裂及人工晶状体囊袋内植入情况。并于术后1d,1wk,1、3mo对患者进行随访,观察术中撕囊成功率,术前、术后的最佳矫正视力(BCVA,LogMAR),术后并发症等。

结果：患者均接受白内障超声乳化吸除合并人工晶状体植入术。术中通过应用台盼蓝囊膜染色剂(台盼蓝)染色前囊膜辅助成功完成所有连续环形撕囊,并采取了包括应用虹膜拉钩及虹膜切开术等其他措施。将可折叠式人工晶状体植入105眼。术后追踪观察3mo,术眼术后BCVA为0.82±0.10,与术前BCVA(3.12±0.14)比较有差异(t=174.893,P<0.01)。

结论：白内障超声乳化摘除术能使白内障合并角膜混浊患者的视力得到安全有效的提高。辅助技术如囊膜染色、虹膜拉钩、虹膜切除等的应用,能有效降低白内障合并角膜混浊患者的白内障手术风险,提高手术安全性,增加手术成功率。     

电子撕囊针在白色白内障手术中的应用

目的　评估电子撕囊针在白色白内障手术中应用的安全性和有效性。方法　３０例（３０眼）白色白内障患者随机分为常规撕囊组和电子撕囊组,各１５眼,均行白内障超声乳化联合人工晶状体植入术。常规撕囊组用传统撕囊镊撕囊,电子撕囊组用电子撕囊针撕囊。观察两组撕囊状况及人工晶状体植入情况。结果　两组所有患者均顺利完成白内障超声乳化联合人工晶状体植入术。除常规撕囊组１眼行人工晶状体睫状沟植入外,其余患者均囊袋内植入。常规撕囊组撕囊优良率只有２０％,失败率达６０％,而电子撕囊组撕囊优良率达１００％,两组差异有统计学意义（χ２＝１４．５２,Ｐ＜０．０１）。术后１周２组矫正视力和角膜内皮细胞计数差异均无统计学意义（均为Ｐ＞０．０５）。结论　白色白内障超声乳化术中使用电子撕囊针撕囊安全有效。     

青光眼合并白内障超声乳化人工晶状体植入联合小梁切除术的效果

目的探讨青光眼合并白内障行超声乳化吸出、人工晶状体植入联合小梁切除术的效果。方法青光眼合并白内障44例（47眼）,行超声乳化吸出及折叠式人工晶体植入联合全巩膜隧道内小梁切除术,术后观察眼压、视力、滤过情况等,随访1～36个月。结果47眼术后眼压均可控制在正常范围,长期随访眼压未升高,术后矫正视力：数指2眼（4．26％）,0．1～0．633眼（70．21％）,0．8-1．212眼（25．53％）,术后并发症主要是虹膜反应、角膜水肿及瞳孔散大。结论白内障行超声乳化及折叠式人工晶状体植入联合巩膜隧道内小梁切除术可有效控制眼压,提高视力。     

Phacoemulsification in eyes with white cataract

PURPOSE: To study the results of phacoemulsification in eyes with white cataract. SETTING: Aravind Eye Hospital, Madurai, India. METHODS: This retrospective study comprised 212 consecutive patients with white cataract: 192 mature (90.6%), 11 intumescent (5.2%), and 9 hypermature (4.2%). Patients had phacoemulsification and continuous curvilinear capsulorhexis. After the nucleus was removed by the divide and conquer or the phaco chop technique, a posterior chamber intraocular lens was implanted. Preoperative and intraoperative findings, as well as postoperative outcomes, were analyzed. RESULTS: Intraoperative complications included premature entry of the tunnel into the anterior chamber in 4 eyes (1.9%), incomplete capsulorhexis in 60 (28.3%), posterior capsular tear in 4 (1.9%), conversion to a manual nonphacoemulsification technique in 4 (1.9%), intraoperative miosis in 7 (3.3%), and iris chafing in 2 (0.9%). Mean phacoemulsification time was 2.03 minutes (range 0 to 5.8 minutes). A best corrected visual acuity of 6/9 or better was attained in 131 patients (61.8%) on the first postoperative day and in 199 patients (93.9%) at 1 month. Postoperative complications included moderate transient striate keratopathy with corneal edema in 12 eyes (5.7%) and iritis in 2 (0.9%). CONCLUSIONS: Phacoemulsification was a safe and effective technique to remove white mature cataract in eyes in a developing country.     

小瞳孔白内障的超声乳化及折叠式人工晶状体植入术

目的探讨小瞳孔白内障的超声乳化及折叠式人工晶状体的手术技巧和临床效果。方法临床确诊的小瞳孔白内障患者46例54眼,经透明角膜隧道切口,采用钝性分离的方法扩大瞳孔,行环行撕囊、双手原位超声乳化及折叠式人工晶体囊袋内植入手术。结果术后随访5～12月,术后视力提高46眼占85.19%,视力≥0.5者34眼占62.96%,所有患者的瞳孔保持生理性圆形或是近圆形。手术并发症主要有角膜水肿、前房纤维素性渗出、后囊破裂。结论掌握合理的手术技巧,小瞳孔白内障的超声乳化术同样可以取得良好的手术效果。     

Longterm results after phacovitrectomy and foldable intraocular lens implantation

Purpose: This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co‐existing vitreoretinal diseases. Methods: We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results: The most common indications for surgery were non‐diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by ≥ 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow‐up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions: Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co‐existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract.     

老年性白内障超乳术中晶状体囊相关风险研究

目的 评估不同程度老年性白内障超声乳化手术中晶状体囊相关的手术风险。方法 回顾性分析老年性白内障的超声乳化手术432例（566眼）。根据白内障成熟程度分为研究组（成熟期和过熟期白内障）和对照组（未熟期白内障）,记录术中发生的相关并发症,以Fisher精确概率法将两组间的数据进行对比分析。结果 在研究组232眼中,撕囊失败12眼（5．2％）,后囊破裂6眼（2．6％）,其中4眼（1．7％）人工晶状体固定在睫状沟;在对照组334眼中,所有病例均成功完成了撕囊,2眼后囊破裂（0．6％）,所有病例的人工晶状体均成功植入囊袋。结论 成熟期和过熟期老年性白内障超声乳化手术晶状体囊相关并发症发生率较未熟期高（X^2=18．54,P〈0．01）,尽管应用囊染色剂可以方便撕囊操作,但是撕囊仍是成熟期和过熟期白内障的超声乳化手术中最困难的步骤。     

角巩膜隧道切口超声乳化白内障吸除 折叠式人工晶状体植入术临床观察

目的 探讨角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入术的临床疗效。方法 对86例（107只眼）老年性白内障患者,采用角膜上方膜缘后0.5mm做长约4mm角巩膜隧道切口的方法,行超声乳化白内障吸除术,同时植入丙烯酸酯类三片式折叠式人工晶状体。结果 术后1d、1周、1个月和3个月裸眼或矫正视力≥0.5者分别为62.6%、76.6%、92.5%和88.8%。结论 角巩膜隧道切口超声乳化白内障吸除折叠式人工晶状体植入术兼有巩膜隧道小切口和透明角膜小切口手术的优点,术后疗效满意。     

Trypan-blue- and endoillumination-assisted phacoemulsification in eyes with vitreous hemorrhage during combined cataract and vitreous surgery

PURPOSE: To study the safety and usefulness of trypan blue application and conventional endoillumination for enhancing visualization during phacoemulsification and foldable intraocular lens implantation in cases of cataract with vitreous hemorrhage. METHODS: Ten eyes of 10 patients with cataract and coexisting vitreous hemorrhage underwent combined trypan-blue- and endoillumination-assisted phacoemulsification and foldable intraocular lens implantation with vitrectomy. In a two-step surgery, after staining the anterior capsule with trypan blue, continuous circular capsulorhexis was performed; then, phacoemulsification was performed using conventional endoillumination. Specular microscopy was performed before and 3 months after surgery on eyes that underwent trypan-blue- and endoillumination-assisted phacoemulsification and on control eyes that underwent standard phacoemulsification to evaluate the toxic effect of trypan blue on corneal endothelial cells. RESULTS: Trypan blue application improved visualization of the anterior capsule, and a complete capsulorhexis could be performed in all eyes. In all 10 eyes, endoillumination was required to visualize the lens structure, and phacoemulsification could be accomplished. Specular microscopy revealed that there was no significant difference in the level of corneal endothelial cell loss between the trypan-blue- and endoillumination-assisted phacoemulsification group and the control group. CONCLUSION: The described double visualization technique may assist phacoemulsification in selected cases of cataract with vitreous hemorrhage.     

残留后囊或前囊为支撑人工晶状体Ⅰ期植入术

目的 观察颞侧透明角膜切口的晶状体超声乳化手术中后囊破裂时，以残留的后囊或前囊为支撑进行Ⅰ期折叠式人工晶状体植入术的成功率。方法 在28例(28眼)透明角膜切口超声乳化手术中各种原因导致的后囊部分破裂情况下，以残留的后囊或前囊作支撑，进行折叠式人工晶状体Ⅰ期植入术。结果 随访3～22月，人工晶状体位置稳定，未发现1例人工晶状体脱位，视力恢复满意。结论 在较好的环形撕囊前提下，后囊破裂者不必改变术式，仍可Ⅰ期植入折叠式人工晶状体，操作简单，效果良好。     

成人后极性白内障超声乳化吸出术疗效观察

目的探讨成人后极性白内障超声乳化摘出联合人工晶状体植入术的手术技巧、术中术后并发症的处理方法及手术效果。方法对我院临床确诊的17例(26眼)成人后极性白内障患者行超声乳化摘出联合人工晶状体植入,观察术中后囊膜情况、术后视力、后囊膜混浊和并发症的发生情况。同时与我院同期普通白内障超声乳化术中后囊膜破裂发生率进行对比。结果 17例26眼成人后极性白内障患者术中可见后囊膜完整透明者12眼,后囊膜完整伴不同程度混浊者7眼,后囊膜中央局限性缺损者2眼,但术中未发生玻璃体溢出。术中后囊膜破裂5眼,发生率为19.23%。同期普通白内障超声乳化术中后囊破裂发生率为1.81%,二者相比差异有统计学意义(P<0.05)。成人术后视力均较术前有不同程度提高。术后9眼角膜轻度水肿,经治疗后1周内恢复透明,3眼前房纤维素样渗出,经治疗后痊愈。结论后极性白内障虽具有特殊性,后囊膜破裂发生率明显高于普通白内障。只要给予足够重视,行超声乳化摘出联合人工晶状体植入术是较好的手术方法。     

单切口青光眼白内障联合手术152例疗效观察

目的:回顾152例164眼青光眼合并白内障患者通过单切口白内障超声乳化吸除术+IOL植入术联合小梁切除术的治疗过程和结果,评价其临床疗效。方法:用单切口白内障超声乳化吸除术+IOL植入术联合小梁切除术治疗152例164眼青光眼合并白内障患者,对视力、眼压、滤过泡、并发症等进行6～24(平均16)mo的随访。结果:术后视力0.3～0.5者89眼(54.3%)。眼压<15mmHg的有87眼(53.0%)。滤过泡呈扁平状的功能性滤过泡者138眼(84.1%)。并发症中角膜水肿较多见,占15.2%。结论:青光眼白内障联合手术是治疗两病并存时的一种较好而且经济的方法。     

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.     

CeeOn 911A硅凝胶折叠人工晶体植入术的临床观察

目的：观察分析CeeOn911A硅凝胶折叠人工晶体植入术的临床效果。寻找一种更容易植入眼内,效果更好的折叠人工晶体。方法：对50例（54眼）的白内障患者,行颞侧透明角膜切口的超声乳化白内障摘除术联合CeeOn911A折叠人工晶体植入术,观察其术中并发症,术后视力,人工晶体在囊袋内的偏移度及后囊膜的混浊与皱折程度。结果：54眼术中均能顺利地将人工晶体植入晶体囊袋内,术后裸眼视力≥0．5者46眼（85．2％）,术后观察所有人工晶体均能位于囊袋内,未发生人工晶体的偏移,后囊膜的混浊与皱褶。结论：CeeOn911A折叠人工晶体术中容易植入眼内,术后在眼内的中心定位性能好,为防止后发性白内障的发生提供有利条件。     

Staining the Anterior Capsule with Indocyanine Green or Trypan Blue for Capsulorhexis in Eyes with White Cataract

Aim: To assess the efficacy and safety of indocyanine green (ICG) 0.5% and trypan blue 0.1% for anterior capsule staining in cases of white cataract. Methods: This prospective study comprised 55 eyes of 55 patients with white cataract that had phacoemulsification with foldable intraocular lens implantation. ICG in 30 eyes and trypan blue in 25 eyes were used under air to stain the anterior lens capsule. The staining patterns and the ease of creating a continuous curvilinear capsulorhexis (CCC) were assessed; the intraoperative and postoperative complications were noted. The mean follow-up was 17.68±1.65 months. Result: Either ICG or trypan blue stained the anterior capsule uniformly. However, the staining provided by trypan blue was slightly superior. A CCC was successfully achieved in 25 eyes (100%) with trypan blue, and 29 eyes (96.7%) with ICG, respectively. There was no significant postoperative reaction in any eye. Conclusion: The use of vital dyes such as ICG and trypan blue guarantees a complete CCC and makes it possible to deliver the benefits of phacoemulsification in the patients with white cataract.     

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract

PURPOSE: To assess the feasibility, risks, and postoperative outcomes of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorhexis (CCC) in the absence of a red reflex. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 52 eyes of 52 patients with white cataract that had phacoemulsification through a clear corneal temporal incision with PC IOL implantation. In all the cases, trypan blue was used under air to stain the anterior lens capsule and the karate-chop technique was used to emulsify the nucleus. The mean follow-up was 192.2 days. RESULTS: Trypan blue adequately stained the anterior lens capsule in all cases. The CCC was completed uneventfully in 96.15% eyes; 3.85% of cases had to be converted to a conventional extraction technique because of the loss of the CCC. The mean phacoemulsification time was 2.2 minutes. Intraocular complications included incomplete capsulorhexis (3.85%) and pupillary miosis (3.80%). Postoperatively, 3 eyes (5.77%) had corneal edema (striate keratopathy) and 1 eye (1.9%) had fibrin in the anterior chamber. Five eyes (9.61%) had more than 2+ cells and flare at 2 weeks. All responded well to intensive topical and subconjunctival steroids. There were no cases of endophthalmitis. The mean central endothelial cell loss, measured in 37 eyes, was 8.5%. Of the 4 eyes (7.69%) that had increased intraocular pressure (IOP) postoperatively, all responded well to medications and the IOP was normal by the second postoperative week. Fifty eyes (96.16%) had a final best corrected visual acuity of 20/30 or better. In 2 cases, the final visual acuity was worse than 20/200 because of preexisting posterior segment pathology. CONCLUSION: Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.     

晶状体超声乳化吸除及人工晶状体植入术对闭角型青光眼眼压及前房深度的影响

目的评价品状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，治疗合并有自内障的闭角型青光眼，观察其术后眼压、前房深度及视力等的变化。方法回顾分析27例（30只眼）闭角型青光眼合并白内障患者。经综合降眼压治疗3～4d，眼压低于25mmHg者21只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入术，眼压高于25mmHg者9只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入联合抗代谢药物及小梁切除术。随访3—6个月。结果所有患者术中、术后没有出现严重的并发症，术后视力均有提高，术后眼压都得到控制。平均眼压由术前的20．28mmHg降至11．07mmHg；中央前房深度由术前的2．14mm加深到3．43mm。术后眼压、中央前房深度与术前相比均有显著性差异。术后前房角开放均≥180°。结论晶状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，是治疗合并有白内障的闭角型青光眼的有效方法。