Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses

PURPOSE: To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months). RESULTS: No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication. CONCLUSION: Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.     

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses--long-term results

PURPOSE: Estimation of long-term results and complications of complex surgical technique, used for the management of luxated crystalline lenses. MATERIAL AND METHODS: This prospective study involved 29 consecutive patients (31 eyes) with the mean age of 62 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 13 eyes, and scleral-fixated, posterior chamber IOLs in 17 eyes. In one patient with high myopia the lens was not implanted. The follow-up ranged between 9 and 38 months (mean 22.8 months). RESULTS: No complications were observed during phacofragmentation. Improvement in visual acuity was achieved in 18 cases one week after operation and in 23 patients at last examination. We achieved visual acuity of 4/50--hand movements in 4 cases, 5/16-5/50 in 3 eyes, 5/8-5/12 in 7 and 5/5-5/7 in 17 cases, in last examination. There were no intra-operative complications. Low visual acuity in some cases was due to the presence of postoperative complications or coexisting eye diseases, such as secondary glaucoma, atonic pupil, age related macular degeneration, retinal detachment and macular hole. CONCLUSIONS: Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses is safe and effective method, providing very good long-term functional results.     

Sclerally fixated intraocular lens implant associated with vitrectomy: a study of 50 cases

INTRODUCTION: We present a retrospective study of 50 cases of scleral fixation of intraocular lenses (IOLs) associated with vitrectomy. MATERIALS AND METHODS: From January 1996 to June 2001, 50 consecutive patients who underwent surgery with insertion of a sclerally fixated intraocular lens implant associated with vitrectomy were studied. Indications included luxated lenses due to ocular contusion, cataract surgery complicated by capsular rupture and luxated nucleus or implant into the vitreous, and replacement of anterior chamber lenses. The implant was sutured 2 mm behind the limbus into the scleral sulcus with 10.0 Prolene. Vitrectomy was performed to treat pre-existing maculopathy, remove the lens or lens fragments luxated into the vitreous or to remove a luxated implant, and to provide for complete retinal examination during the operation. RESULTS: With a mean follow-up of 30 months, the mean postoperative visual acuity was 20/30. For 95% of cases, final visual acuity was improved compared to preoperative visual acuity. No postoperative complications due to the implant were encountered. There were four cases of cystoid macular edema and two cases of retinal detachment. DISCUSSION: Despite the macula edema and retinal detachments, there was no loss of visual acuity compared to the preoperative state. There were eight cases of raised intraocular pressure; seven were controlled medically and one after hemi-cyclocryo-therapy. CONCLUSIONS: Scleral fixation of an IOL is a reliable means of correcting aphakia in the absence of capsular support and may be associated with a vitrectomy with very little risk.     

粘弹剂在外伤性晶状体后脱位手术中的应用

目的：探讨外伤性晶状体后脱位于后段玻璃体腔的处理方法。方法：对9例外伤性晶状体后脱位于后段玻璃体腔行玻璃体手术晶状体切除术；玻璃体手术加粘弹剂晶状体摘出术，观察手术疗效及并发症。结果：8例晶状体成功取出，3例行人工晶状体睫状沟固定术。术前视力光感至0.06。随访6月－2年，人工晶状体睫状沟固定术。术前视力为光感至0.06。随访6月－2年，人工晶状体睫状沟固定3例视力均在0.1以上，最佳矫正视力达1.2；未行人工晶状体固定的6例矫正视力为光感－0.3。结论：外伤性后脱位于后段玻璃体腔的晶状体应摘出，玻璃体切除配合玻璃体腔内注入粘弹剂（透明质酸钠）及睫状沟固定型人工晶状体植入有助于脱位晶状体的取出及术后视力的恢复。     

Silicone posterior chamber phakic intraocular lens dislocated into the vitreous cavity

PURPOSE: To report two highly myopic patients with silicone posterior chamber phakic intraocular lenses (Phakic Refractive Lens; CIBA Vision, Duluth, Ga) that luxated into the vitreous cavity without history of ocular trauma. METHODS: Two patients with posterior chamber phakic intraocular lenses (PIOLs) that luxated into the vitreous cavity of the right eye were examined. Each eye underwent pars plana vitrectomy and removal of the posterior chamber PIOL under retrobulbar anesthesia. RESULTS: Both patients were treated successfully. In the first patient, the posterior chamber PIOL luxated into the anterior vitreous cavity whereas in the second patient, the posterior chamber PIOL lay on the posterior pole. No ocular complications developed postoperatively. CONCLUSION: Luxation into the vitreous cavity is a rare, but potentially severe complication of posterior chamber PIOL refractive surgery in highly myopic eyes. Successful management includes pars plana vitrectomy and removal of the posterior chamber PIOL.     

玻璃体腔内套结法固定脱位人工晶状体的效果

目的 采用玻璃体腔内套结法处理脱位至后玻璃体腔内的后房型人工晶状体(IOL),并对手术效果进行观察.方法 回顾性病例研究.对12例IOL脱位至玻璃体腔的患者行玻璃体切除术后玻璃体腔内复位固定后房型IOL,术后随访6～61个月,观察手术前、后患者的视力情况和并发症.结果 12例患者术后最佳矫正视力为0.02～1.0,IOL位置在随访期间无改变.所有病例术后均有不同程度角膜水肿,5例早期眼压偏低,2例出现一过性眼压增高,1例出现前房纤维素性渗出.2例术后发生视网膜脱离,行巩膜外环扎术成功复位.结论 玻璃体腔内IOL固定术无需取出IOL,可以减少对眼球的创伤及切口源性角膜散光,是处理IOL脱位于玻璃体腔简单、有效的方法.     

Scleral fixation of a posterior chamber intraocular lens in a patient with two dislocated lens implants

PURPOSE: To report the clinical findings and management of a case of two consecutive intraocular lenses (IOLs) dislocated into the vitreous cavity after complicated cataract surgery. METHODS: Review of clinical findings and treatment. RESULTS: A 69-year-old man sought treatment for posterior chamber IOL dislocation. The patient reported a significant loss of visual acuity in the right eye for 4 months (best-corrected visual acuity (BCVA) 20/200 in the affected eye). In the vitreous cavity two dislocated IOLs were found, complicated by a cystoid macula edema. Surgery was planned and the two IOLs were removed from the vitreous cavity. Aphakia was then corrected by means of a scleral fixated posterior chamber lens. Three months after surgery, BCVA was 20/40. CONCLUSIONS: In the absence of randomized controlled clinical trials evaluating treatment options, preoperative patient work-up should be as accurate as possible in order to reduce the risk of intraoperative and postoperative complications. In this patient, removing the two IOLs and placing a sutured-fixated posterior chamber IOL allowed resolution of the cystoid macular edema.     

Secondary intraocular lens implantation in aphakia.

We retrospectively studied secondary intraocular lens (IOL) implantation in 165 aphakic patients (162 eyes) from May 1983 to August 1989. Seventy-five eyes (46.3%) had secondary IOL implantation; these included seven cases of trans-sulcus scleral fixation of the posterior chamber lens. The remaining 87 eyes could not have secondary IOL implantation because of the ocular conditions. The most common reason for secondary implantation was to relieve the discomfort caused by spectacles or contact lenses (56.2%). An anterior chamber lens was used in 43 eyes (57.3%) and a posterior chamber lens in 32 eyes (42.7%). Final postoperative visual acuity of 20/40 or better was achieved in 92.0% of the eyes with posterior chamber lenses, in 71.4% of the eyes with anterior chamber lenses, and in 57.1% of the eyes with scleral-fixated posterior chamber lenses. Endothelial cell loss was greater in the eyes with anterior chamber lenses than in the eyes with posterior chamber lenses. Of the cases that could be followed, 83.3% showed endothelial cell loss of less than 30% at six months postoperatively. Postoperative complications such as cystoid macular edema, persistent fibrinous membrane formation, and neovascular glaucoma occurred in only ten (13.3%) of the 75 eyes that had secondary implantation. These complications occurred more frequently in eyes that had anterior chamber lenses with anterior vitrectomy. There were no noticeable complications in the eyes that had trans-sulcus scleral fixation of posterior chamber lenses. Updrawn pupil, prolapsed vitreous, and peripheral anterior synechia were common conditions preventing secondary IOL implantation.     

玻璃体手术治疗人工晶状体脱人玻璃腔疗效分析

目的评价玻璃体手术取出脱位于玻璃体腔的人工晶状体的临床效果。方法对19例(19只眼)人工晶状体脱位于玻璃体腔的患者均行玻璃体切除术,均在人工晶状体取出的同时行缝线固定人工晶状体。结果所有患眼视力均不同程度提高,且并发症少,效果满意。结论玻璃体手术是取出脱位于玻璃体腔的人工晶状体的一种安全有效的手术方式,在人工晶状体取出的同时行缝线固定术可提高手术效果。     

Vitreous luxated PC-IOLs: complications

PURPOSE: To determine pre-, intra- and postoperative complications of posterior chamber intraocular lenses (PC-IOL) posteriorly luxated in the vitreous. METHODS: We retrospectively reviewed reports of all patients with luxated PC-IOLs at our institution (1989-1999) with a minimum follow-up of 6 months. We identified 41 eyes; 4 were excluded because of short follow-up. Thirty-seven eyes were finally considered. Twenty-one eyes had "in situ" repositioning with vitrectomy, in 9 of them perfluorocarbon liquids (Perfluoro-DK-line) (PFCL) were used to refloat the luxated lenses. Sixteen eyes had IOL exchange, in 7 of them PFCL was used to refloat the IOL. RESULTS: The average age of the patients was 67.5 years. Preoperatively, 15 eyes (40%) had ocular hypertension, 9 eyes (24%) showed epithelial corneal edema (CE), 6 eyes (16%) had light vitreous hemorrhage (VH) and 4 eyes (11%) retinal detachment (RD). Intraoperatively, 9 eyes (24%) had VH related to sulcus fixation. Postoperatively, visual acuity improved in 32 (86%) eyes. In 3 cases (8%) we found a postsurgical RD that could be iatrogenic; one eye developed glaucoma and 1 developed, epiretinal membrane. Two patients were PFCL drops. CONCLUSION: Vitrectomy normalizes IOP and CE, PFCL simplifies the surgical technique for RD, and sulcus fixated IOL allows visual restoration. The combined technique generally offers good results.     

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。     

外伤性晶状体脱位的联合手术治疗

目的：评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位或半脱位的临床疗效。方法：对1993年10月－2000年5月连续收治的外伤性晶状体脱位或半脱位36例作回顾性研究。所有患眼根据病情均采用不同的术式去除脱位晶状体,包括角巩缘切口圈套娩出、睫状体扁平部切口行晶状体切除或超声晶状体粉碎,同时切割玻璃体,并应用小梁切除、阀门管植入术、玻璃体视网膜手术联合治疗因晶状体脱位引起的并发症,17例I期植入前房或后房型人工晶状体。结果：所有患眼成功的去除晶状体,91．7％患眼视力有不同程度提高,52．3％患眼视力≥0．3,继发青光眼患者术后眼压获得控制,6例视网膜脱离全部复位。结论：各种手术方法联合应用治疗外伤性晶状体脱位及其所致并发症,视力增进效果明显。阀门管植入术是治疗严重眼外伤顽固性青光眼的有效手术方法。     

晶状体玻璃体切除联合人工晶状体植入三联或多联手术

目的 探讨晶状体玻璃体切除联合人工晶状体植入三联或多联手术的可行性和安全性。方法对３２例（３２只眼）患者进行上述联合手术治疗,其中２９例眼外伤,包括引伤引起白内障或晶状体脱位及玻璃体积血,部分患者伴球内异物、虹膜损害或根部断离,１例老年性白内障中晶状体核和２例术后人工晶状体落入玻璃体腔内。结果 随访１～１４个月（平均５．６个月）,术后最佳矫正视力≥０．５者１５例（４６．９％）,０．１～０．４者１１     

晶状体超声粉碎联合玻璃体切除术治疗外伤性晶状体脱位

目的:探讨应用晶状体超声粉碎联合玻璃体切除术治疗外伤性晶状体脱位的疗效。方法:回顾性分析晶状体超声粉碎联合玻璃体切除手术治疗外伤性晶状体脱位16例16眼;其中术前高眼压6例,玻璃体积血10例,视网膜脱离1例。常规扁平部行标准三通道玻璃体手术切口,切除前部、中轴部及脱位晶状体周围玻璃体,使晶状体游离,超声针头吸引晶状体至中央部玻璃体腔内进行超声粉碎。术中检查视网膜并做相应处理。其中8例视网膜情况良好,I期行后房人工晶状体缝线固定。结果:全部病例均完全将脱位的晶状体粉碎吸除,随访3mo无视网膜脱离发生。16例术后眼压正常,术后1wk眼压12~20mmH g,视力较术前改善,术后1wk视力0.2以上者8例。结论:对于外伤性晶状体脱位,晶状体超声粉碎联合玻璃体切除术是安全有效的手术方法,对视网膜无损伤者可行I期人工晶状体缝线固定,使患眼获取最好的视力。     

晶状体切除联合巩膜缝线固定人工晶状体植入术治疗先天性晶状体半脱位的长期效果

目的：分析先天性晶状体半脱位患眼经晶状体切除+前段玻璃体切割+经巩膜缝线固定人工晶状体（IOL）植入术后长期治疗效果。方法：回顾性系列病例研究。观察2005年1月至2014年6月期间于复旦大学附属眼耳鼻喉科医院收治的先天性晶状体半脱位患者53例（77眼）,所有患眼均接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术。对术后最终随访时最佳矫正视力（BCVA）、眼压及术眼出现的主要并发症进行系统性的临床观察。数据采用配对t检验或独立样本t检验进行比较。结果：77 例接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术的先天性晶状体半脱位患眼,术后随访时间为（38±26）个月,最短12个月,最长130个月。术前BCVA（LogMAR）为0.84±0.55,术后为0.26±0.43,术后视力较术前明显改善（t=8.55,P < 0.001）。术中及术后早期并发症包括：1眼（1.3%）术中视网膜脱离,2眼（2.6%）术后早期前房积血,2眼（2.6%）术后早期切口玻璃体嵌顿。术后远期并发症包括：6 眼（7.8%）视网膜脱离,发生于术后（22±12）个月,1 眼（1％）IOL移位或脱位,发生于术后5 年。术后不良主诉包括：32 例（60.4%）术后随访时主诉干眼症状,6例（11.3%）主诉眩光现象。结论：晶状体切除前段玻璃体切割+经巩膜缝线固定IOL植入术可以显著提高先天性晶状体半脱位患者视力。远期随访中,视网膜脱离及IOL脱位是尤其需要警惕的术后并发症。     

Phakic posterior chamber lenses for high myopia: functional and anatomical outcomes

PURPOSE: To evaluate the functional and the anatomical outcomes after implantation of phakic posterior chamber intraocular lenses (IOLs) in highly myopic eyes. SETTING: Service d'Ophtalmologie, H?pital Purpan, Toulouse, France. METHODS: Fifty-eight eyes of 46 patients that had implantation of phakic posterior chamber lenses for high myopia were evaluated. Predictability, efficiency, safety, and subjective and objective quality of vision were evaluated preoperatively and at least 6 months postoperatively. The effect of the procedure on the cornea, aqueous humor, pupil, anterior chamber angle, crystalline lens, and retina were studied. RESULTS: Mean preoperative myopia was -13.85 diopters (D) +/- 3.1 (SD) (range -8.00 to -19.25 D). Mean postoperative spherical equivalent was -1.22 +/- 0.83 D (range +0.75 to -3.50 D); 56.9% of eyes were within +/-1.00 D of the predicted result, and 77.6% gained 1 or more lines of best corrected visual acuity. All contact-lens-intolerant patients had improved quality of vision for day and night driving, distance vision, and vision under dim illumination. The mean postoperative level of contrast sensitivity without correction was higher than the mean preoperative level with correction. Adverse events were 2 cases of crystalline lens opacification 16 and 18 months after surgery and 2 cases of pigment deposits in the angle with increased intraocular pressure, which was controlled by beta-blockers. CONCLUSION: Implantation of posterior chamber phakic IOLs is effective and predictable; however, long-term follow-up is needed.     

Artisan aphakic intraocular lens implantation in cases of subluxated crystalline lenses due to Marfan syndrome

PURPOSE: To assess implantation of an Artisan aphakic intraocular lens (IOL) in cases with subluxated lenses due to Marfan syndrome. METHODS: Retrospective study of a small case series comprised of seven eyes (two children and three adults) with subluxated lenses due to Marfan syndrome that underwent lens extraction and Artisan aphakic IOL implantation. Best spectacle-corrected visual acuity and endothelial cell status were the key elements of follow-up examinations. RESULTS: No complications occurred during surgery. Visual acuity was improved by > or = 4 Snellen lines in all seven eyes. These results were maintained at the last follow-up. Endothelial cell status remained constant in all cases at 6-month follow-up. CONCLUSIONS: In seven eyes with a subluxated crystalline lens due to Marfan syndrome, implantation of an Artisan aphakic IOL improved visual acuity while preserving anterior chamber status.     

Implantation of black diaphragm intraocular lenses in congenital and traumatic aniridia

PURPOSE: To evaluate the safety and efficacy of the black diaphragm intraocular lens (IOL) implantation for the treatment of congenital and traumatic aniridia. MATERIAL AND METHODS: Seven black diaphragmatic IOLs were implanted in the eyes of 6 patients between 1997 and 1998. There were 5 males and 1 female. The mean age of them was 42.8 years (range: 22-54 years). Follow-up ranged from 9 to 20 months (mean: 14.2 months). Traumatic aniridia was present in 4 eyes and congenital aniridia in 3 eyes. Pars plana vitrectomy was combined with the simple outside-in method of scleral fixation of IOLs in 6 cases. Three of these eyes were aphakic (all with traumatic aniridia) and in 3 eyes (two congenital cases, one traumatic case) subluxated lens was simultaneously removed. In one case of congenital aniridia with mature cataract, ECCE and ciliary sulcus implantation without scleral fixation were performed. RESULTS: There were very few complications. Ciliary sulcus bleeding appeared in 2 cases during scleral fixation. Transient post-operative corneal oedema was observed in 2 eyes, raised intraocular pressure in 3 eyes, and dispersed blood in vitreous cavity in 2 eyes. All IOLs were well centred. The improvement in best corrected visual acuity was achieved in 5 cases, while good pre-operative best corrected visual acuity was maintained in 2 cases. CONCLUSIONS: Diaphragmatic IOL can be fixated to the sclera in cases without capsular support or it can be implanted into ciliary sulcus after ECCE. Reconstruction of 5 mm pupil and intraocular correction of aphakia enable good visual rehabilitation of patients. The combined procedure of pars plana vitrectomy and scleral fixation of diaphragmatic lens is safe and effective in traumatic and congenital aniridia.     

Bilateral dislocation of in-the-bag posterior chamber intraocular lenses in a patient with intermediate uveitis

We present a case of bilateral dislocation of in-the-bag intraocular lenses (IOLs) in a patient with intermediate uveitis. The IOLs dislocated into the vitreous cavity 24 and 41 months postoperatively. A complete pars plana vitrectomy with sutured posterior chamber IOL implantation was performed after each dislocation. The final visual acuity was 20/20(-) in each eye.     

无晶体后囊的后房型人工晶体缝线固定术

报告３０例３０眼无晶体后囊的后房型人工晶体缝线固定术随访６～２２个月的结果。矫正视力≥０．６者占８０％，人工晶体无明显的偏心与倾斜。分别论述了选择性二期植入人工晶体，计划囊外摘除术中后囊破损一期植入人工晶体和人工晶体脱位于玻璃体腔的再固定之适应征、手术方法及作者的体会。结果表明，无晶体后囊的后房型人工晶体缝线可获得良好的效果。