前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体的临床观察

目的评价无后囊无晶状体眼行前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体的临床疗效。方法选用AMOZ900折叠人工晶状体,对无后囊或后囊破损严重不足以支撑人工晶状体者36例（36眼）行前部玻璃体切除联合人工晶状体缝线固定术,观察其术中、术后并发症及术后视力、角膜曲率、眼压的情况。结果术中无明显并发症,术后眼压升高2眼,玻璃体少量积血1眼,黄斑水肿2眼,无其他严重并发症。术后第1天的裸眼视力0．3以上者占41．67％,术后1周、1个月、3个月裸眼视力0．3以上者分为47．22％,80．56％和86．11％。结论前部玻璃体切除联合巩膜缝线固定后房型折叠式人工晶状体植入术是治疗无后囊支撑眼的较好选择。     

全层巩膜固定后房型人工晶状体及线结后徙治疗无晶状体眼

回顾性分析使用全层巩膜缝线睫状沟固定二期人工晶状体植入术治疗 1 1 4例无后囊支撑的无晶状体眼的疗效情况 ,所有病眼均未做巩膜瓣 ,其中 1 0例行缝线原位结扎 ,1 0 4例行线结后徙 ,所有病人随访 3个月。结果表明全层巩膜缝线固定后房型人工晶状体并线结后徙在治疗无晶状体眼中 ,无一例发生严重并发症 ,无一例发生线头外露 ,术后视力达到或超过术前最佳矫正视力。该术式安全 ,简便 ,有效。     

经巩膜缝线固定人工晶状体植入术的临床应用

目的探讨经巩膜缝线固定人工晶状体植入的临床应用及效果。方法31例（31眼）各种原因后囊破裂或无后囊者行白内障手术联合缝线固定人工晶状体植入，其中一期植入26眼，二期植入5眼。随访3～48月。结果术后1周最佳矫正视力1.0以上5眼（16.13％），0．5～0.9者10眼（32.26％），0.1～0．5者11眼（35.48％），低于0.1者5眼（16.13％）。发生人工晶状体偏中心者2眼（6．5％）。结论缝线固定人工晶状体植入术是后囊破裂或无后囊患者人工晶状体植入的一项有效措施。     

全层巩膜固定后房型人工晶状体及线结后徒治疗无晶状体眼

回顾性分析使用全层巩膜缝线睫关沟固定二期人工晶状体植入术治疗１１４例无后囊支撑的无昌状体眼的疗效情况，所有病眼均未做巩膜瓣，其中１０例行缝线原位结扎，１０４例行线后徒，所有病人随访３个月。结果表明全层巩膜缝线固定后房型人工晶状体并线结后徒在治疗无晶状体眼中，无一例发生严重并发症，无一例发生线头外露，术后视力达到或超过术前最佳矫正视力。该术式安全，简便，有效。     

经睫状环前端巩膜缝线固定后房型人工晶状体

目的探讨无后囊膜支撑的对眼内组织损伤较小的后房型人工晶状体植入的方法。方法自行设计经睫状环前端穿透巩膜缝线固定植入无足够晶状体后囊支撑的后房型人工晶状体。结果预期28例(28眼)手术均获成功,术中术后无明显并发症,随访0.5—2a,视力恢复>0.5者18例(64％)。结论经睫状环前端巩膜缝线固定无后囊膜支撑的后房型人工晶状体方法较安全、有效。     

二期后房型人工晶状体穿透巩膜睫状沟固定术探讨

目的 探讨二期后房型人晶状体固定的手术方法。方法 对42眼后囊缺损或无后囊的无晶状体眼，行单襻(15眼)或双襻(27眼)人工晶状体穿透巩膜睫状沟固定术。单襻巩膜固定采用线结埋藏于角膜缘切口内；双襻巩膜固定采用在切开前房前已安置好固定缝线的方法。术后随访1～15个月。结果 术后裸眼视力0．1～0．4者24眼，0．5～0．9者15眼，1．0以上者3眼。结论 二期人工晶状体改良单襻或双襻穿透巩膜睫状沟固定，手术安全，术后视力恢复好，可减少手术并发症。     

无后囊支持的无晶状体眼二期后房人工晶状体植入术的研究

目的探讨在无后囊支持的特殊情况下，二期后房人工晶状体植入术的效果。方法对36例（36跟）无后囊支持的情况下进行二期后房人工晶状体植入。采用“两点式”聚丙烯缝线人工晶状体睫状沟固定术，术后随访半年以上。结果36眼均成功地完成手术，术后半年以上视力均等于或优于术前最佳矫正视力，无严重并发症发生。随访期间人工晶状体位置保持不变。结论二期后房人工晶状体植入巩膜缝线固定术，辅以前段玻切，对所有后囊残缺不全或完全缺如的无晶状体眼，都可以顺利实施完成。手术效果取决于患眼条件，与术前矫正视力有明显正相关。手术半年以上无严重并发症发生。“两点式”聚丙烯缝线可较长期牢固稳定人工晶状体。     

人工晶状体悬吊术30例疗效观察

目的观察后房型人工晶状体睫状沟缝线固定的手术效果。方法对30例（30只眼）不能常规植入后房型人工晶状体的患者分别行一期或二期人工晶状体悬吊术,为外路法巩膜瓣下线缝固定人工晶状体在睫状沟内,术后观察3~12个月。结果本组病例手术术中顺利,术后矫正视力≥0.5者21例,占70%,无严重并发症发生。随访期间人工晶状体位置固定。术眼视力稳定。结论后囊膜破损或无后囊膜支撑／不能常规植入后房型人工晶状体时,经巩膜睫状沟后房型人工晶状体悬吊术是无晶状体眼矫正屈光不正的一种安全有效的手术方法。手术效果取决于患眼条件及并发症程度。     

无巩膜瓣经巩膜缝线固定后房折叠型人工晶状体植入术的临床研究

目的　探讨无巩膜瓣经巩膜缝线固定后房折叠型人工晶状体植入术的手术方法及效果。方法　对２２例（２２眼）行无巩膜瓣经巩膜固定后房折叠型人工晶状体植入术,记录术前和术后的裸眼视力及最佳矫正视力并随访超过１２个月,探讨该手术方法的技巧,观察手术效果及术后并发症。结果　２２眼术前最佳矫正视力为０．５８±０２４,术后视力均有提高。术后１周裸眼视力０．５２±０．２７,与术前最佳矫正视力相比,差异无统计学意义（ｔ＝０．７４２,Ｐ＞００５）。术后１个月最佳矫正视力０．６１±０２３,与术后１周相比,差异无统计学意义（ｔ＝０．８１４,Ｐ＞０．０５）。术后１眼出现眼压升高,１ｄ后降至正常;１眼出现角膜水肿, ３ｄ内逐渐消退。未见人工晶状体移位、脱位及倾斜,无缝线脱落及暴露,无虹膜粘连、黄斑水肿等并发症发生。结论　无巩膜瓣经巩膜固定后房型人工晶状体植入术具有视力恢复良好、术后并发症发生率低等优势,对于无后囊或后囊支撑力不足的无晶状体眼的屈光矫正是安全有效的。     

经巩膜缝线固定折叠式人工晶状体的临床观察

目的探讨经巩膜缝线固定折叠式人工晶状体的临床应用价值。方法回顾性分析16例(16眼)无后囊支撑的无晶状体眼,经巩膜固定折叠式人工晶状体治疗的情况。对手术方式、效果、并发症和防治措施等进行了分析。结果术后视力0.1~0.2者2例,0.3~0.6者12例,0.8者2例。术后3月,平均手术性散光度数为(0.71±0.65)D。所有病例无严重并发症发生。结论折叠式人工晶状体缝线固定术为无晶状体囊支持的患眼提供了一种可供选择的安全有效的手术方式。     

Primary Posterior Chamber Intraocular Lens Implantation in Traumatic Cataract With Posterior Capsule Breaks

Background: In patients with incomplete posterior capsule support, posterior chamber intraocular lenses (PC-IOLs) were implanted with both haptics transs-cleral fixation. This causes more damage to the eye and may result in more complications. In patients with small posterior breaks, non-fixation or single haptic fixation may be adequate.Methods: Thirty-two consecutive patients of traumatic cataract with posterior capsule breaks caused by penetrating eye trauma were retrospected. Posterior chamber intraocular lenses were implanted in all these patients with three techniques, ie, without fixation, with single haptic fixation and with both haptics fixation. The selection of the technique was based on the position and size of the posterior capsule. The follow-up period was 21 days to 28 months (mean, 15. 2 months).Results: Intra-operative problems included ciliary body bleeding ( two patients, 6. 25% ) and enlargement of posterior capsule breaks (2 patients, 6. 25%). Postoperative visual acuity was 0. 5 or     

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.     

Iris sutures for refixation of decentered intraocular lenses

BACKGROUND: Most revisions after intraocular lens (IOL) implantation are due to an insufficiency of the zonular apparatus. Frequently, an inferior decentration can be seen ("sunset syndrome"). In this clinical study, suture refixation of the haptics to the iris was assessed. Functional and morphological results were considered. METHOD: 21 eyes with subluxation of the IOL were treated with iris sutures for refixation. The operation was performed under topical and intracameral anaesthesia. Refixation was achieved by suturing one or both haptics to one or two fixation points in the outer periphery of the iris. Complete zonular dialysis made it necessary to suture at two fixation spots. All eyes were examined preoperatively, at one day and three months postoperatively considering functional results and postoperative IOL centration. RESULTS: In 15 eyes (71%), the IOL was optimally centred postoperatively. In 5 eyes (24%), a revision had to be performed due to instable centration. In one further case the IOL was minimally decentred, but its position was stable. Best corrected visual acuity was 0.3 +/- 0.2 preoperatively and 0.5 +/- 0.2 after three months. The mean refraction was stable in the postoperative course and astigmatism did not change significantly. There were no major complications intraoperatively or postoperatively, but a localised iris atrophy at the haptic fixation points was noted. CONCLUSIONS: In the presence of a partially intact zonular apparatus, iris sutures are a safe and minimally invasive method for fixing a decentred IOL. Postoperative centration and functional results were stable after 3 months.     

Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To introduce a novel technique for transscleral fixation of the PC-IOL that requires no sutures on the IOL haptics. METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 months. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method. RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group (-1.02±0.46 diopters vs -1.57±0.77 diopters; P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group. CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.     

人工晶状体前膜形成与晶状体襻固定位置的关系

目的 探讨人工晶状体前膜形成与晶状体支撑襻固定位置之间的关系。方法 对45例45只眼老年性白内障行白内障摘出及人工晶体植入术后人工晶状体前膜形成进行回顾性分析术中人工晶状体襻固定的位置。结果 人工晶状体襻固定于囊袋内1只眼;不对称囊袋和睫状体沟内固定26只眼;18只眼为完全睫状体沟内固定。结论 人工晶状体襻不完全睫状体沟内固定是前膜形成的因素之一,而囊袋内固定人工晶状体则可减少人工晶状体前膜的形成。     

带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效观察

目的　评价带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效 ,探讨术后并发症的发生机制。方法　收集 2 5例 (2 7只眼 )行带虹膜隔人工晶状体植入术患者 ,分析手术疗效和并发症的发生情况 ,同时应用房角镜和超声生物显微镜 (UBM)观察术后发生继发性青光眼患者的房角结构和人工晶状体襻位置。术后随访时间 3～ 18个月。结果　术后患者畏光症状明显减轻或完全消失 ;术后视力较术前提高≥ 2行 2 0只眼 (74 1% ) ,变化 <1行 5只眼 (18 5 % ) ,下降 >2行 2只眼(7 4 % )。术后并发症包括继发性青光眼 10只眼 (37 0 % )、散光度数≥ 2 0 0D 17只眼 (6 3 0 % )、角膜失代偿 2只眼 (7 4 % )、前房出血 2只眼 (7 4 % )、玻璃体出血 3只眼 (11 1% )、视网膜脱离 1只眼(3 7% )。在继发性青光眼 10只眼 2 0只人工晶状体襻中 ,9只襻准确固定在睫状沟内 ,其他位置包括前房角、睫状突及睫状突后。房角改变包括房角后退、残留虹膜根部前粘连、房角关闭。结论　带虹膜隔人工晶状体植入术可有效治疗白内障合并虹膜缺损 ;术后继发性青光眼主要与房角损伤有关 ,人工晶状体襻位置异常、眼内出血、持续性炎性反应也参与其发生。     

Modified transscleral fixation technique for refixation of dislocated intraocular lenses

PURPOSE: To evaluate the results of transscleral fixation of dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics through a clear corneal incision. SETTING: Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. METHODS: This retrospective interventional case series comprised 21 eyes (21 patients) in which a dislocated posterior chamber IOL was transsclerally refixated using a small superior clear corneal incision for externalization of the haptics. The suture was tied to the externalized haptic, after which the tied haptic was placed back in the anterior chamber and dialed to externalize the second haptic. After the second externalized haptic was tied, the IOL was reimplanted in the ciliary sulcus. The minimum follow-up was 6 months. RESULTS: The mean follow-up was 42.7 months +/- 21 (SD). The difference between the mean best corrected visual acuity before IOL dislocation (0.34 +/- 0.21 logMAR) and the mean after IOL refixation (0.38 +/- 0.19 logMAR) was not statistically significant (P = .16, t test). During follow-up, the PC IOL remained well centered in all eyes and no tilt or dislocation was observed. CONCLUSION: Scleral fixation of dislocated PC IOLs using temporary haptic externalization through a clear corneal incision minimized the need for complicated intraocular maneuvers, had a low incidence of complications, and provided an easy and effective way to reposition dislocated PC IOLs.     

Sulcus fixation without capsular support in children.

PURPOSE: To evaluate long-term follow-up in eyes of children who had sulcus fixation of an intraocular lens (IOL) without capsular support. SETTING: St. Eriks Eye Hospital/Karolinska Institute, Stockholm, Sweden. METHODS: This retrospective study included 21 eyes of 13 children. Seven eyes had Marfan's syndrome, 7 essential lens dislocation, 2 perforation with lens injury, and 5 spherophakia. The IOL implantation was primary in 16 eyes and secondary in 5 eyes. Lensectomy was performed with a limbal approach. An IOL with holes in the haptics was sutured in the sulcus, with the knots buried in the scleral bed. RESULTS: Mean patient age was 5.8 years +/- 2.6 (SD). Follow-up ranged from 9 to 33 months. No complications occurred during surgery. In all cases after IOL implantation, best corrected visual acuity was equal to or better than preoperatively. After surgery, no opacification of the visual axis, secondary glaucoma, or retinal complication was recorded. Posterior synechia formation occurred in 4 eyes, and 4 had cells on the IOL surface in 2 eyes, the IOL optic subluxated into the anterior chamber with the haptics in place. Both cases were successfully treated with pilocarpine 4%. CONCLUSION: Our results suggest that sulcus fixation of an IOL without capsular support is an option to correct aphakia in children.     

Original three-point fixation technique for sutured posterior chamber intraocular lens

PURPOSE AND METHODS: In order to avoid the complications associated with posterior chamber intraocular lens (IOL) scleral fixation, the authors have developed an original surgical technique by which the IOL is secured at the ciliary sulcus by suturing the haptics to the sclera in three points (at the 3, 5 and 9 o'clock positions). This technique was utilized for secondary IOL implantation in 21 aphakic eyes. The mean follow-up was 18 months, range 6-28 months. RESULTS: All eyes that underwent secondary implants had equal or better visual acuity postoperatively; none developed serious intra- or postoperative complications. No tilt or decentration of the IOL was observed postoperatively. DISCUSSION: The technique described appeared easy to perform and produced good visual outcomes with stable transscleral fixation of the IOL.     

Intraocular lens decentration and posterior capsule opacification: anatomo-pathologic findings after implantation of AMOSI40 IOLS

PURPOSE: To evaluate the incidence of intraocular lens (IOL) decentration and posterior capsule opacification (PCO) after implantation of a three-piece posterior chamber silicone IOL in a series of eyes examined postmortem. METHODS: Twenty-three pseudophakic enucleated human cadaver eyes, implanted with AMO SI40NB IOLs after phacoemulsification, were analyzed. Eyes obtained postmortem were sectioned at the equatorial plane and the anterior segment photographed from a posterior view. Location of IOL optic and haptics, type of fixation, and centration of IOL was evaluated. PCO was graded and the presence of Nd:YAG laser posterior capsulotomy was noted. RESULTS: Mean age at the time of surgery was 77.83 years, mean time since implantation was 18.26 months. In all the eyes examined, IOL haptics were positioned in the capsular bag. Mean decentration was 0.20+/-0.16 mm. No correlation was found between IOL decentration and time since implantation. The degree of peripheral PCO ranged from none (13.0%) to mild (39.1%) to moderate (26.1%) to severe (21.7%). The degree of central PCO ranged from none (52.2%) to mild (30.4%) to moderate (4.3%). Three patients (13.0%) underwent Nd:YAG laser posterior capsulotomy. CONCLUSIONS: A very good centration can be obtained when silicone AMOSI40NB IOLs are correctly implanted with the haptics inside the capsular bag. About half of the implants showed no central PCO while Nd:YAG laser posterior capsulotomy rates documented a relatively low PCO 18 months after surgery. A careful in the bag haptics placement is needed in order to reduce the IOL decentration and to prevent central PCO.