葡萄膜炎并发白内障两种手术方法的探讨

目的 介绍2种小瞳孔下行葡萄膜炎并发性白摧障摘出和瞳孔成形的手术方法。方法 30例34只葡萄膜炎严重后粘连并发性白内障的眼接受了该2种手术，手术方法：91）剪除瞳孔区机化的前囊膜，瞳孔缘剪开，水分离核，囊袋内晶关於 本圈匙反转娩出晶状体体核。人工晶状体（IOL）植入；（2）上方虹膜根部切除，分离并剪开上方虹膜，超声乳化白内障摘出，IOL植入，最后缝合上方虹膜，人造圆形瞳孔。结果 术后34眼瞳孔均在3.0-3.5mm，并保持圆形，均无后囊膜破裂，无严重并发症发生，视力均比术前有不同程度的提高。结论 葡萄膜炎并发白内障。在采用所介绍的2种手术方法后能获得良好的视力和圆形瞳孔，而无严重并发症。     

双眼前房角支撑型人工晶状体植入术后十年角膜内皮失代偿一例

超声乳化白内障吸除联合人工晶状体(intraocular lens,IOL)囊袋内植入已成为白内障的标准术式.但若术中发生晶状体后囊膜破裂,就必须放弃IOL的囊袋内植入,采用其他方法[1],如前房虹膜固定、后房虹膜固定或后房巩膜缝线固定等.房角支撑型IOL植入技术相对简单、眼内操作步骤少、眼内干扰少、无需特殊器械设备,易于掌握和实施,是手术条件受限时常用的方法.但处理不当可出现一些并发症,如瞳孔变形、眼压升高、葡萄膜炎,甚至视网膜脱离、角膜内皮失代偿等.     

葡萄膜炎并发白内障的手术效果分析

目的：分析葡萄膜炎并发性白内障的手术效果。方法：对29例31眼葡萄膜炎并发性白内障患者施行超声乳化白内障摘出术,其中虹膜睫状体炎14眼,Fuchs异色性虹膜睫状炎7眼,中间葡萄膜炎7眼,Vogt-小柳－原田综合征2眼,交感性眼炎1眼。随访5－28mo,平均15mo并进行回顾性分析。结果：术后矫正视力≥0．5者占80％,眼眼（Vogt-小柳－原田综合征）术后出现较严重的前部葡萄膜炎症,1眼（虹膜睫状体炎）见IOL表纤维素性渗出膜,2眼）中间葡萄膜炎）IOL表面见片状白色破碎屑,结论：采用对眼组织损伤较小的超声乳化技术,术中避免刺激虹膜,尽量清除晶状体皮质,并将IOL植入囊袋,内,对于在炎症相对静止期的葡萄膜炎,同样可获得较轻的术后炎症反应、较少的并发症和较好的视力。     

葡萄膜炎并发白内障的处理

葡萄膜炎通常并发白内障，白内障发生的原因可以是葡萄膜炎本身也可是治疗葡萄膜炎的药物如皮质类固醇所致，对这类患的处理一直有争议，特别是关于人工晶体的植入。最近有报道继发于葡萄膜炎的白内障，用超声乳化技术，囊袋内植入后房型人工晶体，联合或不联合玻璃体切割术治疗获得成功，重要的问题是，术前患眼应消除炎症，术前术后应加强抗炎治疗，通过正确的处理，葡萄膜炎患可以通过白内障出联合人工晶体的植入术，使其视     

超声乳化吸除治疗葡萄膜炎并发白内障的研究

目的：探讨施行超声乳化吸除人工晶状体植入治疗葡萄膜炎并发白内障的疗效。方法：回顾分析32例38眼葡萄膜炎并发白内障患者超声乳化手术治疗前后的情况。手术中先用黏弹剂钝性分离,瞳孔不能扩大者,用囊内剪沿瞳孔缘做环形剪除,做连续环形撕囊,囊袋内植入人工晶状体,观察手术并发症和术后视力,观察时间为术后6mo。结果：术后1mo有33眼（87%）视力较术前提高,其中〉0.5者22眼,0.3～0.5者6眼,0.1～0.25者7眼,〈0.1者3眼,术后瞳孔接近圆形。部分瞳孔恢复对光反应,无严重并发症发生。结论：本手术方法对葡萄膜炎并发白内障有良好的疗效,手术损伤小。     

葡萄膜炎并发白内障的处理

葡萄膜炎通常并发白内障，白内障发生的原因可以是葡萄膜炎本身也可是治疗葡萄膜炎的药物如皮质类固醇所致。对这类患者的处理一直有争议，特别是关于人工晶体的植入。最近有报道继发于葡萄膜炎的白内障，用超声乳化技术、囊袋内植入后房型人工晶体，联合或不联合玻璃体切割术治疗获得成功。重要的问题是，术前患眼应消除炎症，术前术后应加强抗炎治疗。通过正确的处理，葡萄膜炎患者可以通过白内障摘出联合人工晶体的植入术，使其视力明显改善，且危险性小。     

大瞳孔型白内障的手术治疗

目的：探讨大瞳孔型白内障的手术特点和处理方法。方法：采用纺锤形小前囊撕开法联合囊袋内植入人工晶状体（IOL）治疗37例大瞳孔型白内障。结果：37例全部撕囊成功，IOL安全植入囊袋，随访6-18个月，IOL位置端正，视力较好，无IOL脱出及囊袋阻滞综合征等发生，结论：纺锤形撕囊并囊袋内植入IOL是治疗大瞳孔型白内障较理想的方法。     

晶状体乳化治疗葡萄膜炎并发白内障的研究

目的 探讨晶状休乳化吸出（phacoemulsification and aspiralion）治疗葡萄膜炎并发白内障的疗效。方法 18例（28眼）葡萄膜炎并发白内障伴有虹膜后粘连和小瞳孔，手术中先用撕囊镊撕除瞳孔区机化膜，做连续环形撕囊，囊袋内植入人工晶状体，观察手术并发疝和术后视力，观察时间为术后3月。结果 术后视力明显提高，术后瞳孔直径增大。部分瞳孔恢复对光反应，无严事并发症发生。结论 本手术方法对葡萄膜炎并发白内障有良好的疗效，手术损伤小，不伤及虹膜，术后前段反应轻。     

硅油填充并发白内障行超声乳化联合硅油取出及人工晶状体植入术观察

目的 评价硅油填充合并白内障眼经透明角膜切口行白内障超声乳化,联合经瞳孔硅油取出及折叠人工晶状体植入的临床效果.方法 选择硅油填充术后合并白内障患者27只眼,手术方法为经透明角膜切口行白内障超声乳化,然后做3 mm大小的晶状体后囊切开,通过前房灌注,由后囊切开处进行硅油取出,将折叠晶状体植入囊袋内或者睫状沟.评价手术时间、术后反应以及视力恢复效果.结果 手术时间基本控制在20分钟以内,大部分病例折叠人工晶状体植入囊袋内.术后未见视网膜脱离复发、IOL脱位和其他严重并发症,部分病例有不同程度的角膜水肿,患者无明显刺激症状.结论 经透明角膜切口行白内障超声乳化联合经瞳孔区硅油取出并植入折叠人工晶状体,这种方法与经巩膜切口的方法相比,不但减少了手术的时间,而且从理论上也较少了术后并发症和患者的刺激症状,是一种安全高效的硅油取出联合白内障手术方式.     

儿童人工晶状体固定性瞳孔夹持的原因和手术复位

目的　分析儿童白内障摘除术后人工晶状体 (IOL)固定性瞳孔夹持的原因 ,并探讨有效的处理方法。方法　收集年龄 <14岁、白内障摘除后房型IOL植入术后发生固定性瞳孔夹持患者 30例 (31只眼 )的临床资料 ,分析其发生原因和并发症 ,并对其中 8例 (8只眼 )合并严重并发症患者行IOL复位手术。结果　全部患者均发生较严重的葡萄膜炎性反应及其所致的虹膜后粘连和瞳孔膜闭或闭锁 ,以及不同程度的后发性白内障。IOL复位手术中可见 8例患者均发生不同程度的晶状体周边皮质再生。结论　白内障摘除术后葡萄膜炎性反应、晶状体皮质再生及后发性白内障是引起儿童IOL固定性瞳孔夹持的主要原因。手术分离虹膜粘连、清除晶状体再生皮质并切除后发性白内障 ,可有效复位IOL。     

Capsule contraction syndrome

AIM: To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter and, occasionally, displacement of the IOL after extracapsular cataract extraction. It is relatively frequent in pseudoexfoliation, advanced age, in association with uveitis, pars planitis and myotonic muscular dystrophy. MATERIALS AND METHODS: 5965 eyes of patients were operated on cataract between 1.01.1994 and 31.12.1997 in Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School in Lublin. Two types of surgical procedures were performed: "divide and conquer" phacoemulsification with 4.5-8 mm continuous curvilinear capsulorhexis (3385 eyes) and extracapsular cataract extraction with "can opener" capsulotomy (2580 eyes). RESULTS: 20 cases of clinically apparent CCS were referred to the Department: in the course of intensive postoperative inflammation--5, in patients over 80--4, in pseudoexfoliation syndrome--2, myotonic dystrophy--1, ectopia lentis--2, other causes--6. In order to improve visual acuity in 4 cases surgical removal of the distorted and opaque anterior capsule was performed, in 3 cases relaxing radial tears were done, in 3 cases secondary anterior capsulotomy was performed using Q-switched Nd:YAG laser. CONCLUSIONS: In cases where the occurrence of CCS is especially high large diameter capsulorhexis should be performed and IOL designed to provide maximal peripheral capsular bag expansion should be implanted.     

Late in-the-bag intraocular lens dislocation: incidence, prevention, and management

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.     

Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group

PURPOSE: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic (Hydroview) and hydrophobic acrylic (AcrySof) intraocular lenses (IOLs) after phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) or uveitis and compare the results with those in a control group. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria.METHODS: This prospective nonrandomized comparative trial comprised 143 eyes recruited consecutively. Of these, 49 eyes had PEX, 43 had uveitis, and 51 served as controls. A standardized surgical protocol was used. Cell reaction, anterior (ACO) and posterior (PCO) capsule opacification, and flare were evaluated 1 year after cataract surgery. RESULTS: Regarding uveal biocompatibility, the number of foreign-body giant cells (FBGCs) increased in proportion to associated ocular pathologies in both IOL groups. The difference between the Hydroview control and Hydroview uveitis groups was statistically significant. The number of FBGCs was greater on AcrySof IOLs than on Hydroview IOLs in all 3 groups. The difference in FBGCs between the 2 IOL types was statistically significant in the control and PEX groups. Regarding capsular biocompatibility, lens epithelial cell (LEC) outgrowth was inversely correlated with intraocular inflammation. Outgrowth was statistically significantly higher with Hydroview IOLs, occurring in 85% in the control group, 45% in the PEX group, and 28% in the uveitis group (P <.0001). With AcrySof lenses, the percentages were 0%, 8%, and 4%, respectively. The PEX and uveitis groups were more likely to develop ACO than the control group (P <.012). There was no statistically significant difference in ACO between the 2 IOL types in the 3 patient groups. The PCO was statistically significantly greater in the uveitis group than in the control group (P <.026) and statistically significantly more dense on Hydroview than on AcrySof IOLs in all 3 patient groups (P <.002). Flare was statistically significantly higher in the uveitis group than in the PEX and control groups with both IOL types (P <.012). There was no statistically significant difference in flare between the 2 IOL types. CONCLUSIONS: Uveal and capsular biocompatibility depends on the intensity of ocular inflammation. The greater the inflammation, the less the biocompatibility of hydrophilic and hydrophobic acrylic materials. AcrySof stimulated more FBGCs. The Hydroview material had better uveal but poorer capsular biocompatibility than AcrySof. The sharp optic edge effect of the AcrySof IOL and the advantages of the Hydroview lens in normal eyes are less apparent in compromised eyes.     

晶状体不全脱位手术方法研究进展

晶状体不全脱位目前以手术治疗为主.为最大限度地保留和重塑晶状体囊袋悬韧带隔,囊袋拉钩、囊袋张力环、囊袋张力带和囊袋锚等多种新式囊袋辅助装置以及飞秒激光辅助白内障手术的应用使手术更加安全,术后并发症更少.对术前临床评估、手术方式选择、术中设备使用到人工晶状体的应用,眼科医生需要进行全面的考虑和评估,尽量减少术中术后并发症,保持囊袋和人工晶状体的稳定性,以获得最佳的手术治疗效果.     

Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis

Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals. After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.     

Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs’ heterochromic iridocyclitis

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs’ heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.     

葡萄膜炎患儿白内障摘出术及眼内人工晶状体植入术

目的　评价葡萄膜炎患儿白内障手术联合晶状体植入术的远期效果。方法　研究包括 5名儿童 8眼 (年龄 4 .5～ 10 .0岁 ,平均 6.75岁 )。白内障手术包括前、后囊截囊 ,部分眼前房玻璃体切割 ,将 PMM A (聚甲基丙烯酸树脂 )眼内晶状体 (IO L)植入到囊袋中。结果　随访 2～ 5a,术后 7眼最佳矫正视力达 0 .4～ 1.0。 5眼因发生混浊或出现机化膜而再手术 ,2眼发生白内障术后青光眼。结论　结果表明 ,PMM A晶状体植入术也可用于葡萄膜炎患儿无晶状体眼的纠正。     

Capsule membrane suture fixation of decentered sulcus intraocular lenses

Different surgical methods are used to fixate the subluxated sulcus intraocular lens (IOL) in the absence of in-bag fixation, ranging from iris and scleral suturing to optic capture of the IOL. A new technique, which we have termed capsule membrane suture fixation, provides an additional method for securing a subluxated or decentered sulcus-based IOL to the remnant capsule or a capsular membrane. This method can also be used in secondary surgery for fixation, repositioning, or removal and replacement of IOLs. In this technique, the IOL haptics are sutured to the fibrotic elements of the capsular membrane to center and secure the IOL to the capsular membrane and prevent complications associated with uveal touch.     

Opacification of a hydrophilic acrylic intraocular lens with exacerbation of Behçet's uveitis

Beh?et's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. Phacoemulsification with intraocular lens (IOL) implantation in patients with Beh?et's disease is known to be a safe procedure. We managed a patient with Beh?et's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels.     

Intraocular Lens Techniques in Pediatric Eyes with Insufficient Capsular Support: Complications and Outcomes

ABSTRACT

Intraocular lens (IOL) implantation in pediatric eyes with insufficient capsular support is challenging and there are multiple IOL options. These include placement of an IOL within the capsular bag with a capsular tension ring, a scleral-fixated posterior-chamber IOL (PCIOL) with or without capsular tension segment or ring, an intra-scleral fixated IOL, an iris-sutured PCIOL, or an anterior chamber iris-fixated IOL. We reviewed 48 articles and 1 published abstract describing the surgical techniques, complications and visual outcomes of different IOL options in the management of aphakic pediatric eyes with insufficient capsular support. The present review found that the visual acuity outcomes of various IOLs are comparable. Furthermore, each IOL design and surgical technique has different rates of serious complications, including IOL dislocation or decentration, intraocular hemorrhage, glaucoma, endothelial cell loss, and endophthalmitis. An understanding of the risks and benefits of different IOL designs is important for counseling patients and families.