儿童后房型人工晶体缝线固定植入术的临床观察

目的探讨儿童无晶体后囊支持的后房型人工晶体植入。方法16例(16眼)3．5～8岁儿童行穿透巩膜的后房型人工晶体缝线固定植入术。结果随访6～37个月，平均18个月。手术反应较轻，远期无不良反应，视力恢复良好。结论儿童后房型人工晶体缝线固定植入术是一种安全、有效的治疗方法。     

外伤性白内障后囊破裂人工晶体植入的手术方式选择

目的探讨外伤性白内障晶体后囊不存在时,采用前房型人工晶体植入,抑或后房型人工晶体巩膜缝线固定术。方法外伤性白内障患者８６例（８６只眼）,其中前房型人工晶体（新型弹性开放襻）植入５６例,Ⅰ期植入２９例,Ⅱ期植入２７例;后房型人工晶体巩膜缝线固定（大Ｃ型襻,两根缝线睫状沟固定）３０例,Ⅰ期植入１４例,Ⅱ期植入１６例。结果术后随访１～４２个月。矫正视力≥０．５者,前房型人工晶体组４０例,占７１．４％;缝线固定组２７例,占９０．０％。矫正视力≥１．０者,前房型人工晶体组２２例,占３９．３％;缝线固定组１４例,占４６．７％。结论新型前房型人工晶体植入和后房型人工晶体巩膜缝线固定术均不失为常规后房型人工晶体植入失败的补救措施,但前房型人工晶体适用于年龄较大、眼前段（角膜、虹膜和前房角）条件较好,而眼后段（玻璃体、视网膜）条件较差者;后房型人工晶体巩膜缝线固定术则适用于年龄较小、眼前段条件较差而眼后段条件较好者。     

四点式人工晶体缝线固定术的初步疗效观察

目的：探讨解决缝线固定术后人工晶体倾斜的方法。方法：选用板状棒的四个角各有一个小孔的可折叠式人工晶体,用聚丙烯缝线将其四个角均固定在睫状沟处的巩膜上。结果：12例（12眼）病例中,8例矫视力为1．0或更好,另4例矫正视力也在0．5或以上,所有人工晶体均未见明显倾斜。较突出的并发症是术后初期虹膜、睫状体出血,但均能自行吸收。结论：四点式固定法能较好地解决缝线固定术后人工晶体倾斜的问题。     

前房型人工晶体在白内障术中后囊破裂的应用

从1994年以来,我院对现代白内障手术中后囊破裂大者,采用前房型人工晶体植入(下简称前房型)20眼,效果良好。并随机与后房型人工晶体巩膜缝线固定(下简称后房型缝线固定)20眼对照。现报告如下:资料与方法在后囊破裂大者40眼中,分别植入前房型及后房型缝线固定各20眼。其中前房型组:男12眼,女8眼;后房型缝线固定组:男9眼,女11眼。两组在年龄、性别及眼别上均随机,年龄43～81岁,平均62岁。人工晶体的选择:均为美国进口。前房型为新型S型弹性开放襻、一体式PMMA人工晶体;后房型为大C型襻一体式PMMA人工晶体。方法:手术由同一医生操作。常规…     

后房型人工晶体巩膜缝线四点固定法

目的探讨白内障术中后囊破裂失去支撑作用或完全无后囊膜患者行后房型人工晶体巩膜缝线四点固定法术后的视力及相应并发症。方法对40例术中或术后无后囊膜支撑的白内障病人行一期或二期后房型人工晶体巩膜缝线四点固定法。其中老年性白内障20例，外伤性白内障18例，膜性白内障2例。结果术后视力大于0．5，30例占75％；小于0．5，8例占12％；小于0．1，2例占5％；术后前房及玻璃体出血、眼压增高及虹膜炎各1例。结论后房型人工晶体巩膜缝线固定术为术中后囊破裂失去支撑作用或完全无后囊的无晶体限植入人工晶体，使患者获得良好视力提供了一种新方法。但是，由于手术设计的不完善，也出现了许多并发症，故在进外方向、距离、固定方式、固定线的选择及手术选择有待于进一步提高。     

脱位晶体取出与人工晶体缝线固定同期手术

我院眼科自1990年9月起,对白内障囊外摘除术后伴有晶体后囊破裂,悬韧带溶解或断裂患者,采取以巩膜-睫状沟缝线固定后房型人工晶体袢的人工晶体植入术,10例均获得满     

后房型人工晶体缝线固定术的临床应用

后房型人工晶体缝线固定术的临床应用沈阳市第四人民医院眼科（１１００３１）梁敦崔桂兰霍爱玲孙秀艳晶体囊内摘除术后，囊外术后囊膜破裂或晶体小带大范围的松懈，以及外伤性白内障，晶状体脱位等无法按常规施行后房型人工晶体植入手术。对此我们采取巩膜缝线固定法行后...     

后房型人工晶体巩膜缝线固定术

本研究主要探索白内障囊内摘除术后或白内障囊外伴后囊破损者，采用巩膜缝线固定技术植入后房型人工晶体的临床效果及并发症。２３例（２３眼），１３眼为白内障囊内摘除无晶体眼，１０眼为白内障囊外摘除术后后囊破裂或外伤性白内障后囊不完整，用巩膜缝线固定晶体襻技术植入后房型人工晶体。本组病例随访３－１６个月（平均８．３个月），视力在４．７（０．５）以上者２１眼，５．０（１．０）以上者１３眼，未发现严重手术并发症     

后房型人工晶体缝线三点固定术

后房型人工晶体缝线三点固定术王海林于雅范陶军许懿贾广学张柏新夏德昭近年来，经巩膜缝线固定后房型人工晶体这项术式已被眼科医生广泛接受［１～４］。虽然前房型虹膜支撑的人工晶体的设计逐渐趋于合理且放置容易，但仍有诸如虹膜炎、青光眼及无足够虹膜等情况不能施行...     

后房型人工晶体巩膜缝线固定术探讨

后房型人工晶体巩膜缝线固定术探讨上海市华东医院眼科王燕，王诚忠后房型人工晶体巩膜缝线固定术应用于无晶体后囊膜患者或在白内障囊外摘除手术后囊膜破裂的病例。近年来国内外文献上此法已有报导，［１、２、３、４］并不断取得进展。我院眼科根据国内外学者的不同经验...     

巩膜内无缝线后房型人工晶状体固定

巩膜内无缝线后房型人工晶状体(intraocular lens,IOL)固定是近年来发展的一种矫正无囊膜支持无晶状体眼的新方法,可有效避免缝合IOL与缝线相关的并发症。巩膜内无缝线后房型IOL固定有多种方法,包括制备巩膜隧道类的采用针或玻璃体视网膜刀进行的无缝线巩膜内固定IOL植入、Yamane法带凸缘巩膜内IOL双针固定技术、经结膜入路法、自闭式巩膜切口固定法;以及制备巩膜瓣类的纤维蛋白胶辅助的巩膜内无缝线IOL固定术、无纤维蛋白胶辅助需缝合的IOL固定术。结果显示巩膜内无缝线后房型IOL固定是一种有效、安全、实用的手术方法,术后短期随访效果令人满意。但迄今为止,文献报道的病例数有限且随访时间较短,尚需对更多病例进行长期随访以明确其远期效果及安全性、稳定性。     

Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules

We report a new surgical technique that uses biological glue to implant a posterior chamber intraocular lens (PC IOL) in eyes with a deficient or absent posterior capsule. Two partial-thickness limbal-based scleral flaps are made 180 degrees apart diagonally, and the haptics of the PC IOL are externalized to place them beneath the flaps. Fibrin glue is used to attach the haptics to the scleral bed, beneath the flap. This simple method of PC IOL implantation requires no specially designed haptics. It provides good flap closure and IOL centration and stability without suture-related complications.     

In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

Purpose

To compare the degree of tilt and decentration of an intraocular lens (IOL), refractive status, and prediction error between eyes that underwent trans-scleral suturing of the IOL within the capsular bag (in-the-bag scleral suturing) and eyes that underwent scleral suturing outside of the bag (out-of-the-bag scleral suturing) because of severe zonular dehiscence.

Patients and methods

Thirty eyes that underwent in-the-bag scleral suturing of an IOL and 38 eyes that underwent out-of-the-bag scleral suturing were recruited sequentially. The tilt and decentration of the IOL, anterior chamber depth, manifest refractive spherical equivalent (MRSE), prediction error, and incidence of complications were examined.

Results

The mean tilt angle and the decentration length of the IOL of the in-the-bag suturing group were significantly less than those of the out-of-the-bag suturing group (P=0.0003 in tilt and P=0.0391 in decentration), although the anterior chamber depth was similar. The mean MRSE and prediction error of the in-the-bag suturing group were less than those of the out-of-the-bag suturing group (P=0.0006 in MRSE and P=0.0034 in error). The incidence of vitreous loss was less in the in-the-bag suturing group than in the out-of-the-bag suturing group (20% vs63.2%, P=0.0009).

Conclusions

The tilt and decentration of the IOL after in-the-bag scleral suturing are significantly less than those after out-of-the-bag scleral suturing, which may lead to less MRSE and less prediction error. As the incidence of vitreous loss is less after in-the-bag scleral suturing, in-the-bag suturing is advantageous for eyes of younger patients and of less complicated cases.     

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.     

Glued endocapsular hemi-ring segment for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses

Surgical expertise, prolonged surgical time, suture-related problems, and delayed intraocular lens (IOL) subluxation or dislocation due to broken sutures are limitations of suture fixation of the capsular bag to the scleral wall. We describe a new device made of IOL haptic material (polyvinylidene fluoride) that allows sutureless fibrin glue-assisted transscleral fixation of the capsular bag to address these issues. The device has a hemi-ring portion that lies in the capsular fornix and a double scroll mechanism that engages the capsulorhexis rim. The scroll extends forward as a haptic that is exteriorized through a sclerotomy under a lamellar scleral flap and tucked into a scleral tunnel. The flap is closed with fibrin glue. The device is used for subluxated cataracts and IOLs. It anchors the capsular bag to the sclera, giving vertical and horizontal stability, while providing fornix expansion and allowing stabilization of the bag intraoperatively and postoperatively. The device has been used in 4 patients who had good intraoperative and postoperative courses over a 5-week period.     

无后囊不缝线后房型人工晶状体巩膜层间固定术

目的 研究无后囊支持的后房型人工晶状体不缝线巩膜层间固定的方法及应用价值。方法 ２３例无后囊支持患者,将人工晶状体两袢不缝线而固定于水平位置的巩膜层间,随访１０～３４月,平均１６．６月。结果 视力≥０．５者１９眼（８２．６％）。术后高眼压６眼,前房出血１眼,１周内消退,视网膜脱离１眼,人工晶状体位置均良好,固定切口无渗漏。结论 该术式简便经济,能减少并发症,人工晶状体位置稳定。     

Two-string technique to manage dislocated posterior chamber plate-haptic intraocular lens

We describe a technique for repositioning and transscleral fixation of a dislocated plate-haptic foldable collamer posterior chamber intraocular lens (PC IOL). The displaced IOL was positioned in the anterior chamber, and a double-armed suture on a curved needle was fixed to the sclera at 10:30 o'clock. The needle then entered the globe and passed through the superior haptic eyelet of the IOL. Both were withdrawn through the scleral wound on the opposite side. The inferior haptic was fixed at 4:30 and 7:30 o'clock and provided the mirror reflection of the suture path of the upper fixed haptic. This technique may be a useful alternative to lens removal or exchange.     

改良后房型人工晶状体缝线固定术临床观察

目的：评价改良的后房型人工晶状体经巩膜缝线固定术的临床疗效。方法：将82例拟行后房型人工晶状体经巩膜缝线固定术的患者随机分成两组：改良后的无巩膜瓣线结埋藏式及经睫状体平坦部固定组;常规的有巩膜瓣经睫状沟缝线固定组。分别观察两组的手术时间、术后视力、术后并发症。结果：本研究中改良组的手术时间平均为39.95±5.87min,常规巩膜瓣组的时间平均为45.77±5.21min,两组手术时间存在显著差异。术后视力两组无显著差异。两组均未发生线结外露缝线磨损、术后眼内炎、视网膜脱离并发症。常规巩膜瓣组易出现人工晶状体光学部夹持现象。结论：改良的后房型人工晶状体经巩膜缝线固定术是一种矫正无足够后囊膜支持眼的安全、有效、简洁的术式。     

Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision

PURPOSE: To report the results of managing dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics through a clear corneal incision. SETTING: The Retina Center at Pali Momi, Aiea, Hawaii, USA. METHODS: This retrospective consecutive series comprised cases in which a dislocated PC IOL was managed with pars plana vitrectomy. With this method, the dislocated PC IOL is retrieved and stabilized in the anterior chamber. The haptic is externalized through a clear corneal incision for suture knot placement and then reinserted. A scleral fixation suture is placed 1.25 mm posterior to the limbus under a scleral flap. RESULTS: The study included 14 eyes of 14 patients with a minimum follow-up of 6 months (median 15.4 months). There were 2 subluxated PC IOLs, 11 posteriorly dislocated PC IOLs, and 1 in-the-bag IOL dislocation. Postoperative vision and/or visual symptoms were stable or improved in 86% of eyes. Two eyes had worse vision caused by conditions not related to surgery including chronic cystoid macular edema from latanoprost use and optic atrophy. All IOLs were well fixated and stable, although 1 eye with asymmetric haptics had a slightly tilted IOL. CONCLUSIONS: Dislocated PC IOL management by externalizing the haptic through a clear corneal incision stabilized the IOL in the anterior chamber, minimized intraocular operative manipulations, and allowed easier placement of the opposite haptic over residual capsule, if available. Stable fixation was achieved without dislocation or IOL-related complications recurring.     

Fistulating operations with Walser's punch Modifications without scleral flap and with fixed or loose scleral flap (author's transl)]

Long term results of fistulating operations with Walser's punch are reported. A comparison between two methods without and with fixed scleral flap shows that the first method was more often associated with hypotonia, while the latter is more often followed by unsatisfactory pressure regulation necessitating additional drug therapy. That is why a third method of operation was developed. Here the scleral flap is shortened by scissors and not resutured to the sclera. The first clinical results indicate that the method makes use of the advantages of a scleral flap with less risk of an insufficient pressure regulation.