表面麻醉下高度近视眼白内障超声乳化术疗效观察

目的 评价表面麻醉下高度近视眼白内障超声乳化及后房型人工晶状体植入术的安全性及疗效。方法对眼轴长≥26mm的78例(105眼)在表面麻醉下行白内障超声乳化术,同时植入后房型人工晶状体。结果 术后3个月裸眼视力＞0.5者38眼,占36.2%;矫正视力＞0.5者69服,占65.3%。其中眼轴长≤29mm者84眼,最佳矫正视力≥0.5者67服,占79.8%。经t检验,眼轴长＜28mm者和28mm≤眼轴长＜30mm者两组间,有显著性差异(P＜0．05)。眼轴长＜30mm和＞30 mm者之间差异有非常显著性(P＜0.01)。 结论 表面麻醉下高度近视眼白内障超声乳化及后房型人工晶状体植入术,具有术后视力恢复快,安全可靠等优点。     

高度近视白内障超声乳化人工晶状体植入术的效果

目的 评价高度近视合并白内障行超声乳化吸出及折叠人工晶状体植术的临床效果.方法 对36例（48眼）高度近视合并白内障行透明角膜切口超声乳化吸出及折叠人工晶状体植入术.眼轴长度（26.78～34.56）mm,平均（27.43±2.80） mm,其中眼轴≤30 nm者36眼;眼轴＞30mm者12眼.观察术后视力及术中术后并发症.结果 术中悬韧带离断1眼,后囊破裂2眼,经处理均植入折叠人工晶状体于囊袋内.眼轴≤30 mm的36跟中术后视力≥0.3者30眼（83.3％）;眼轴＞30 mm的12眼中术后视力≥0.3者5眼（41.7％）.结论 透明角膜切口超声乳化吸出及折叠人工晶状体植入术,适合于高度近视合并白内障.但眼轴＞ 30 mm者术后视力恢复较差,与眼轴长度及黄斑功能有关.     

高度轴性近视眼白内障小切口非超声乳化及人工晶状体植入术

目的:观察高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术的临床疗效,分析影响术后视力的因素。方法:对我院158例186眼眼轴≥26mm的高度近视眼白内障行小切口非超声乳化及人工晶状体植入术,术后随访6mo,观察术后视力和术中术后并发症情况。结果:术后3mo裸眼视力≥0.5者145眼(78%),0.1~0.4者33眼(18%),<0.1者8眼(4%);并发症有后囊膜破裂11眼,角膜内皮水肿19眼,视网膜脱离3眼,后囊膜不同程度混浊13眼。结论:高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术疗效良好,是一种安全性较高的理想的手术方法。     

高度近视白内障超声乳化摘出人工晶状体植入术

目的评价高度近视眼白内障超声乳化摘出术及人工晶状体植入术的疗效.方法对眼轴＞26mm(平均27.46mm)的94例(104眼)高度近视合并白内障患者行超声乳化摘出及人工晶状体植入术.结果术后1月裸眼或矫正视力≥0.5者84眼(80.76%),视力≥1.0者34眼(32.69%).结论高度近视白内障超声乳化及人工晶状体植入术具有术后视力恢复快屈光状态稳定等优点,但眼轴＞30mm以上者视力差.     

高度近视白内障超声乳化及人工晶状体植入术

目的　分析高度近视白内障超声乳化吸出及后房人工晶状体植入术的疗效。方法　对 5 0例 ( 5 8眼 )高度近视白内障行巩膜隧道切口晶状体超声乳化吸出及后房人工晶状体植入。眼轴长 2 7～ 3 3 5 6mm ,平均 2 9 3 5mm。其中眼轴长≤ 3 0mm者 40眼 ,眼轴长 >3 0mm者 18眼。植入折叠式人工晶状体 ,观察术中术后并发症及术后视力。结果　眼轴长≤ 3 0mm的40眼中术后视力≥ 0 4者 3 5眼 ( 87 5 %) ;眼轴长 >3 0mm的 18眼中术后视力≥ 0 4者 9眼 ( 5 0 0 %)。术中后囊破裂 1例 ,行前部玻璃体切除及人工晶状体睫状沟植入术。结论　高度近视白内障超声乳化及人工晶状体植入能改善视力 ,但眼轴长 >3 0mm者术后视力恢复较差     

超高度近视白内障手术人工晶状体屈光度的选择

目的 探讨超高度近视眼患者术前如何确定人工晶状体屈光度,使术后能获得相对理想的视力.方法 对眼轴≥28mm的58例94只眼,超高度近视眼合并白内障的患者行超声乳化人工晶状体植入术,术前根据三元素进行设计(原有近视度数,测量出的人工晶状体度数,患者术后视力要求),术后随访3月进行视力评估.结果 术后3月裸眼视力≥0.5者57只眼,占60.6%;矫正视力≥0.5者81只眼,占86.2%.经x2检验P＜0.05,差异有统计学意义.本组94只眼中,眼轴＜29mm者28只眼,最佳矫正视力≥0.5者28只眼,占100%.经x2检验眼轴＜29mm者和眼轴＞30mm者两组间,差异有统计学意义(P＜0.005).满意度调查达83%.结论 术前要常规精确测量眼轴长度与角膜曲率.但对于超高度近视眼的患者要进行特殊的个体化设计,并应选择术后呈中低度近视状态的人工晶体,才能达到满意的效果.     

高度近视晶状体超声乳化吸出及后房型低或负度数人工晶状体植入术

目的 现察高度近视眼的晶状体超声乳化吸出联合低或负度数人工晶状体植入术的临床疗效及预后视力情况。方法 38例47眼老年性、并发性、外伤性白内障及4例6眼高度近视透明晶状体行巩膜隧道切口超卢乳化吸除，通过3．5mm切口植入折叠式人工晶状体13眼，通过5．5mm切口植入硬性PMMA人工晶状体37眼，未植入人工晶状体3眼。平均年龄59．9岁(19—83岁)，眼轴长度＜30mm36眼，≥30mml7眼。人工晶状体度数≤0D6眼，0—10D30眼，＞10D14眼。结果 视力＜0．1者4眼，0．1—0．4者24眼(45．2％)，≥0．5者22眼(41．6％)。眼轴＜30mm组，术后最佳矫正视力≥0．5者17眼，占47．2％，眼轴长度≥30mm组17眼，术后最佳矫正视力≥0.5者5眼，占29．4％．术后无视网膜脱离、黄斑区水肿等严重并发症的发生。结论 高度近视眼晶状体超声乳化吸出及后房低或负度数人工晶状体植入术，具有术后视力恢复快、手术安全、并发症少等优点。     

高度近视白内障超声乳化及人工晶状体植入

目的探讨高度近视白内障超声乳化摘除及后房型人工晶状体植入术的疗效.方法对79例116眼眼轴长27～34.04mm,平均28.71 mm(其中眼轴≤30mm者82眼,眼轴＞30mm者34眼)高度近视白内障行反眉式巩膜隧道切口白内障超声乳化摘除术,植入PMMA硬性人工晶状体,观察术中术后并发症及术后视力.结果眼轴≤30 mm组术后3个月视力≥0.5者63眼占76.8%,眼轴＞30mm者13眼占38.2%,两组差异有显著性(P＜0.05).术中后囊破裂两组各1例,后发障眼轴＞30 mm组3例,眼轴≤30 mm组2例,差异均无显著性.结论高度近视白内障超声乳化及后房型人工晶状体植入能改善患者的视力,术后视网膜脱离的发生率低,但眼轴＞30 mm术后视力恢复差.     

负度数人工晶状体植入术治疗白内障合并超高度近视

目的 观察超声乳化白内障吸出负度数人工晶状体植入术治疗白内障合并超高度近视的临床效果.方法 对66例97眼白内障合并超高度近视眼患者施行超声乳化白内障吸出联合负度数人工晶状体植入术,观察术后视力、屈光状态、眼前段情况和并发症.术后随访3～12个月.结果 97眼均成功植入人工晶状体,视力都有不同程度的提高,术后3个月时矫正视力＜0.1者9眼,0.1～0.4者52眼,＞0.4者36眼;大部分患者残留低度的近视屈光状态;后囊膜混浊18眼;部分人工晶状体与后囊膜之间存在间隙,且后囊膜出现皱褶;无视网膜脱离和黄斑囊样水肿的发生.结论 超声乳化白内障吸出联合植入负度数人工晶状体治疗白内障合并超高度近视眼,具有良好的有效性和安全性,同时预测性好,并发症少.     

青光眼滤过术后白内障超声乳化吸出及人工晶状体植入术

目的观察抗青光眼滤过术后的白内障患者行白内障超声乳化吸出及折叠人工晶状体植入术的手术疗效。方法对28例(30眼)抗青光眼滤过术后的白内障,采用避开滤过泡的角巩膜缘3mm隧道切口行白内障超声乳化吸出,植入折叠式人工晶状体,术后观察视力、并发症、眼压和滤过泡的改变。结果术后29眼均有不同程度的视力提高,视力≥0.5者70%。术后随访6～18月,眼压和滤过泡无改变。30眼均植入人工晶状体,术中1眼后囊膜破裂,术后角膜内皮水肿5眼,大部分在1周内消退。结论对青光眼滤过术后白内障,采用角膜缘3mm隧道切口行白内障超声乳化吸出及折叠人工晶状体植入术,术后效果好,并发症少,不影响眼压,手术安全可靠,既可提高视力,又可保持原有的抗青光眼滤过功能。     

第三代人工晶状体公式计算非正常眼轴眼人工晶状体度数的准确性

目的分析第三代人工晶状体（intraocular lens，IOL）计算公式预测非正常眼轴眼IOL度数的准确性。方法对130例（172眼）高度近视白内障患者应用SRK-T公式，28例（36眼）短眼轴白内障患者应用Hoffer-Q公式计算IOL度数，术后3～36个月随访屈光状态。结果高度近视白内障患者随其眼轴长度的增加，术后绝对屈光误差值也逐渐增大（-0．21～1.49D），两者具有相关性（r=0．39，P〈0．05）；短眼轴白内障患者术后实际屈光力与预计值相差很小。两者差异无统计学意义（P〉0．05）。结论第三代IOL计算公式能较准确地测定非正常眼轴眼的IOL度数。可使非正常眼轴白内障患者取得与预期屈光度更接近的屈光效果。     

Intraocular lens power calculations in patients with extreme myopia

PURPOSE: To determine the variables that might contribute to improved intraocular lens (IOL) power calculations preoperatively in cataract patients with extreme myopia. METHODS: This retrospective study included 50 patients with extreme myopia and axial lengths longer than 27.0 mm. All patients had clear corneal phacoemulsification by the same surgeon and implantation of the Domilens SiFlex 1 IOL (power range -6.0 to +5.0 diopters [D]). The performances of the SRK/T, Hoffer Q, Holladay 1, and Holladay 2 formulas in predicting an IOL power that would meet the target refraction of +/-1.00 D were compared. RESULTS: The formulas tended to suggest underpowered IOLs, more severe in eyes with axial lengths greater than 30.00 mm. These eyes accounted for most of the minus-power IOLs implanted. Back calculations of axial lengths in patients with minus-power IOLs showed that, on average, emmetropia could have been predicted by choosing shorter axial lengths (up to 2.72 mm shorter) than those used in the original IOL power calculations. Preoperative B-scan ultrasonography demonstrated the presence of a posterior pole staphyloma temporal to the optic nerve in several patients who required minus-power IOLs, which suggests that axial length measurement problems were a major source of IOL calculation errors in these patients. CONCLUSIONS: In eyes with axial lengths longer than or equal to 27.0 mm, current third- and fourth-generation lens calculation formulas have a tendency to over minus patients between -1.0 and -4.0 D. The formulas appear to perform better for plus-power IOL implantation than for minus-power IOL implantation. The use of B-scan ultrasonography to locate posterior pole staphylomas may improve the accuracy of IOL calculations in eyes with extreme myopia.     

高度近视白内障超声乳化摘除及负低度数后房型人工晶状体植入术疗效观察

目的:研究超声乳化联合植入负低度数后房型人工晶状体治疗高度近视眼合并白内障的临床效果。方法:对试验组80例100眼高度近视并发白内障实行巩膜隧道切口超声乳化吸除,同时通过5.5mm切口植入PMMA硬性人工晶状体。其中男45例56眼,女35例44眼,年龄44～76(平均61)岁;眼轴长为27.00～35.42(平均30.55)mm。取同期来我院治疗的94例100眼正常眼轴老年性白内障患者作为对照组。观察术中、术后并发症及手术效果。术后随访3～12mo。结果:试验组术后3mo矫正视力≥0.5者为51眼(51.0%),0.1～者43眼(43.0%),<0.1者6眼(6.0%)。术中并发症:后囊膜破裂2眼;晶状体脱位2眼。术后并发症:角膜水肿9眼;视网膜脱离1眼;后发性白内障2眼。对照组术中并发症:晶状体脱位1眼。术后并发症:角膜水肿4眼;后发性白内障2眼。结论:巩膜隧道切口超声乳化联合硬质后房型人工晶状体植入术治疗高度近视并发白内障,具有视力恢复快、屈光状态稳定等优点,是安全有效的方法。     

不同眼轴长度白内障超声乳化术后临床观察

目的：探讨白内障超声乳化吸除联合人工晶状体植入术治疗不同眼轴长度白内障患者的临床疗效。方法不同眼轴长度250例（250只眼）白内障采用超声乳化吸除联合人工晶状体植入术。短眼轴组50只眼（眼轴＜22 mm）,正常眼轴组125只眼（22．00 mm≤眼轴＜26．00 mm）,超长眼轴组75只眼（眼轴≥26．00 mm）。观察三组患者术中术后并发症：玻璃体的流失、后囊膜破裂、晶状体核碎片落入玻璃体腔、角膜水肿及人工晶状体移位。结果玻璃体的流失、角膜水肿及人工晶状体移位与眼轴长短之间无明显相关因素。不同眼轴组的后囊膜破裂发生率之间的比较,χ2＝10．79, P ＜0．05,差异有统计学意义,在短眼轴组发生率较超长眼轴组高。晶状体核碎片落入玻璃体腔与眼轴长短之前的比较,χ2＝8．89, P ＜0．05,差异有统计学意义,在短眼轴组和超长眼轴组的发生率相同。年龄是影响3组并发症发生率的重要因素。各种并发症随着年龄的增加而增加。患者性别及眼别与并发症的发生无明显关联因素。结论年龄是白内障超声乳化人吸除工晶状体植入术中并发症的主要影响因素。提前意识这些并发症并预防性的做好准备可减少此类并发症的发生。     

Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses(1)

PURPOSE: To assess the incidence of cataract, potential causes of its development, and the outcome of cataract surgery after previous implantation of phakic angle-supported anterior chamber intraocular lenses (AC IOLs) in highly myopic patients. SETTING: Instituto Oftalmológico de Alicante, Department of Refractive Surgery, Spain. METHODS: Two hundred sixty-three highly myopic phakic eyes of 160 patients had implantation of a phakic AC IOL. Follow-up was up to 8 years (range 38.4 to 103.2 months). Eyes that subsequently developed cataract had cataract extraction and were studied during follow-up for clinical association to other preoperative or postoperative data. Cataract surgery was performed after phakic IOL explantation by phacoemulsification and posterior chamber IOL (PC IOL) implantation (Domilens-Chiron AL3). RESULTS: Nuclear cataract developed in 9 cases (3.42%) a mean of 42.91 months +/- 17.7 (SD) after phakic AC IOL implantation. Final best spectacle-corrected visual acuity (BSCVA) was not significantly different from that after phakic AC IOL implantation (P =.25, paired Student t test). Mean endothelial cell loss after cataract surgery was 6.87% +/- 0.42% cells/mm(2). Age at implantation of older than 40 years and axial length greater than 30. 0 mm were the 2 factors significantly related to nuclear cataract development (r = 1.69 and 1.98, respectively; P <.05). CONCLUSIONS: There is a potential risk of nuclear cataract development after phakic AC IOL implantation to correct high myopia in patients older than 40 years and with very high (greater than 30.0 mm) axial myopia. Phakic IOL explantation, phacoemulsification, and PC IOL implantation successfully resolved this complication. The benefits in terms of BSCVA and spherical equivalent obtained after phakic AC IOL implantation were preserved after cataract surgery.     

Subluxatio lentis und Glaukom-Indikationen und Risiken Kataraktchirurgie

BACKGROUND: Iridodonesis is the clinical sign of lens subluxation. Acute glaucoma caused by a ciliolenticular block may develop. YAG iridotomy or peripheral iridectomy are rarely effective in controlling intraocular pressure. The results of phacoemulsification and posterior lens implantation for subluxated lens and glaucoma are reported. PATIENTS AND METHODS: Seven patients aged 69+/-9.5 years were followed up. All 10 eyes with subluxated lens and glaucoma had phacoemulsification and posterior chamber lens implantation. Two different groups relating to axial length could be analyzed. Intraoperative findings and postoperative glaucoma situation are reported. RESULTS: Six eyes had average axial length of 21.5+/-0.17 mm and previous acute glaucoma. Five of these eyes had therapeutic YAG iridotomy and one, peripheral iridectomy. All eyes had dysregulated glaucoma despite antiglaucomatous medications. After cataract surgery five of six eyes had regular intraocular pressure without any medication. Four eyes had average axial length of 24. 4+/-1.1 mm and chronic glaucoma. After complicated phacoemulsification three of these eyes had regular intraocular pressure with antiglaucomatous medication, one eye without. CONCLUSIONS: For short eyes with subluxated lens and preceding acute glaucoma, cataract surgery with posterior chamber lens implantation is an effective therapeutic procedure for IOP regulation. For chronic glaucoma with subluxated lens, conventional or surgical approach to glaucoma remains dominant.     

小梁切除联合超声乳化人工晶状体植入术的临床疗效观察

目的：为了观察不同类型青光眼伴有白内障病人的小梁切除联合白内障超声乳化吸除并后房型人工晶状体植入三联术后3个月的视力、眼压以及并发症发生的情况。方法：82例（91只眼）,青光眼合并白内障患者行小梁切除联合超声乳化后房型人工晶体植入。结果：术后3个平均眼压低于15mmHg(1mmHg－0．134kPa）,平均视力好于0．54。结论：小梁切除联合白内障超声乳化吸除并后房型人工晶状体植入术具有切口小,眼压控制好,滤过泡形佳,能获得一定的视力。     

高度近視眼合并白内障超聲乳化摘除術

目的觀察高度近視合并白内障超聲乳化摘除及人工晶狀體植入術的療效.方法對72例(79眼)高度近視白内障患者術前檢查眼軸長,計算人工晶狀體屈光度,經鞏膜隧道切口行超聲乳化摘除及人工晶狀體植入術,對術后視力及并發症進行觀察.結果 79眼術后視力不同程度提高,術后1月視力≥0.5者48眼,＜0.3者13眼,高度近視合并眼底病變是白内障術后視力不佳的原因.結論白内障超聲乳化摘除聯合人工晶狀體植入術是高度近視合并白内障較理想的手術方式,及早抓住手術時機,可以减少手術并發症的發生,獲得良好的手術效果.     

高度近视眼负低度数人工晶状体植入的临床观察

目的:观察超声乳化摘除联合负、低度数人工晶状体植入治疗高度近视性白内障的效果。方法:对66例94眼高度近视眼白内障行超声乳化摘除植入负、低度数人工晶状体,随访3mo。结果:术中2眼发生后囊破裂,术后3眼晶状体后囊混浊,无视网膜脱离者。结论:超声乳化摘除高度近视眼白内障是一种较好的手术方式,尤其同时植入负、低度数后房型人工晶状体增加了眼内组织的稳定性,防止了视网膜脱落,同时矫正了屈光不正。     

囊袋张力环在半脱位晶状体的白内障手术中的临床应用

目的:评价囊袋张力环(capsular tension ring,CTR)在晶状体半脱位的白内障手术中的应用。方法:对15例15眼合并白内障的晶状体半脱位患者连续环形撕囊(continues curvilinear capsulorhexis,CCC)后植入CTR,然后行白内障超声乳化,及人工晶状体植入术。结果:所有15眼IOL正位,无倾斜及偏位,术后10～12mo观察矫正视力满意,未发现CTR引起的并发症。结论:CTR植入是治疗合并晶状体半脱位的白内障超声乳化的一种安全、有效的方法,可以防止人工晶状体偏位,减少手术并发症。