超声乳化术治疗合并闭角型青光眼的白内障疗效观察

目的:探讨白内障术前合并临床前期或先兆期的闭角型青光眼患者,采用单纯的白内障超声乳化术治疗的效果。方法:对35例35眼合并闭角型青光眼的白内障患者,采用单纯的白内障超声乳化手术方法,术后随访观察视力、眼压、房角及前房深度变化。结果:术后患者视力均恢复至0.3～0.8,术后第1d,仅3眼眼内压轻度升高,达22～28mmHg,经治疗观察1wk后2眼眼内压恢复正常,仍有1眼眼内压升高至27mmHg,经局部用药控制,未再行手术治疗。结论:对于部分合并有青光眼的白内障患者行单纯的超声乳化手术能确实的恢复视力,控制眼压。     

Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique

PURPOSE: To describe a new surgical technique in which aqueous humor is diverted from the anterior chamber to the suprachoroidal space for the augmentation of uveoscleral outflow in the management of refractory glaucoma. METHODS: Four painful-blind eyes of four consecutive patients were included in the study. Mean age of patients was 54.7+/- 9.2 years. Preoperative diagnosis was neovascular glaucoma complicating diabetic retinopathy in three cases and chronic angle-closure glaucoma in one case. Mean preoperative intraocular pressure of the patients receiving two medications was 58.5 +/- 9.2 mm Hg. A modified Krupin eye valve with disk was implanted into the suprachoroidal space. The anterior tube part of the Seton device was placed into the anterior chamber through the long scleral tunnel for draining the aqueous humor from the anterior chamber to the suprachoroidal space. RESULTS: The placement of modified Krupin eye valve with disk to the suprachoroidal space was achieved in all cases. While mean preoperative intraocular pressure was 58.5 +/- 9.2 mm Hg, it was 14.2 +/- 4.7 mm Hg at postoperative one week. It was 13.5 +/- 4.6 mm Hg and 15 +/- 4.9 mm Hg at one and three months respectively. At the last follow-up visit, mean intraocular pressure was 17.25 +/- 5.37 mm Hg ranging from 12 to 24 mm Hg. Choroidal detachment was developed in one case and regressed in six weeks. Rubeosis irides regressed at third month in three cases. None of the eyes developed suprachoroidal hemorrhage, retinal detachment, or phthisis bulbi. CONCLUSION: The drainage of aqueous humor from the anterior chamber to the suprachoroidal space with the implantation of the glaucoma Seton device is effective in lowering intraocular pressure in refractory glaucoma.     

Pupillary block after intraocular lens implantation

Seventeen patients, ranging in age from 40 to 86 years, developed pupillary block detected one week to three years after intraocular lens implantation. Sixteen of the implants were anterior chamber intraocular lenses and one was a posterior chamber intraocular lens. Despite iris bombé that closed the anterior chamber angle, many cases were asymptomatic and were discovered fortuitously during routine postoperative examinations. Laser iridotomy or iridectomy eliminated the pupillary block in all 17 cases, but permanent synechial closure of a portion of the anterior chamber angle persisted in most cases and sometimes required medication or further surgery. One eye eventually lost all light perception.     

Ocular findings in Sturge-Weber syndrome

PURPOSE: We reviewed the rare ocular findings of Sturge-Weber syndrome (SWS) and the results of implantation of the Ahmed valve in cases associated with glaucoma. METHODS: Seven patients (range 18 to 52 years) diagnosed as SWS were reviewed as clinical findings over two years. An anterior chamber maintainer was placed in patients with glaucoma to maintain stable intraocular pressure and minimize the risk of intraocular hemorrhage due to sudden pressure changes during surgery, when an Ahmed valve is implanted. RESULTS: Episcleral venous vessels were prominent in all cases. Diffuse choroidal hemangiomas were seen in three cases. Nevus of Ota was observed in only one case. Three cases had juvenile glaucoma. One also had buphthalmos. No intraocular hemorrhage or choroidal effusion was observed intraoperatively in valve-implant patients. The surgical treatment of the patients with glaucoma gave favorable outcomes. CONCLUSIONS: Rare ocular findings such as choroidal hemangioma and nevus of Ota are sometimes seen in SWS. Drainage valve implantation, with an anterior chamber maintainer, is a good choice for treatment when surgery is done in cases with glaucoma. This method may reduce the risk of intraoperative suprachoroidal effusion and expulsive hemorrhage by stabilizing intraocular pressure within normal limits during the surgery.     

Nd:YAG激光治疗白内障术后恶性青光眼

目的评价Nd:YAG激光治疗白内障术后恶性青光眼的效果。方法回顾性分析12例(12眼)白内障术后恶性青光眼施行Nd:YAG激光晶体后囊膜及玻璃体前界膜切开术后眼压、前房变化及视力恢复情况。结果经过Nd:YAG激光治疗后所有病例在术后半小时至1小时内形成前房,眼压明显降低,视力部分恢复;8眼在术后2周内前房稳定,眼压得到控制,视力继续提高,继续随访1年未复发;4眼激光治疗后复发,再次激光治疗后1眼治愈,3眼再次复发;此3眼行玻璃体切割手术治愈。结论激光后囊膜及玻璃体前界膜切开对多数白内障术后恶性青光眼治疗有效,操作简便易行,复发病例重复激光治疗仍有较好效果,可以作为白内障术后恶性青光眼的首选治疗方法。     

Pars plana vitrectomy in the management of subluxed and posteriorly dislocated intraocular lenses

The results of pars plana vitreous microsurgery in a series of nine patients with subluxed or posteriorly dislocated intraocular lenses (IOL) are described. Two posterior chamber intraocular lenses were repositioned in the ciliary sulcus anterior to the zonular ring. One posteriorly dislocated anterior chamber IOL was retrieved from the vitreous gel and repositioned into the anterior chamber angle. In three cases, stable repositioning of the dislocated posterior chamber IOL could not be achieved and the lens was exchanged by way of a limbal incision for an appropriate anterior chamber IOL. In three cases, and anterior chamber IOL subluxed into a large basal iridectomy was successfully repositioned using similar instrumentation.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986     

Secondary intraocular lens implantation

The visual, refractive, and surgical results with 190 consecutive secondary implantations of an anterior chamber intraocular lens were studied. Best-corrected postoperative visual acuity was either better than or within 1 Snellen line of best-corrected preoperative vision in 87% of the cases. Vision worsened by more than two Snellen lines in ten cases (5%), which included three cases of retinal detachment and one case of ischemic optic neuropathy; however, in only one case (0.5%) did we feel that the visual decrease was directly attributable to the secondary implantation procedure. We believe that secondary intraocular lens implantation can improve functional visual acuity in aphakic patients, especially those unable to tolerate aphakic correction with contact lenses or spectacles.     

青光眼白内障联合IOL植入术后浅前房的手术治疗

目的:探讨青光眼白内障联合人工晶状体植入术(三联手术)后浅前房的原因及手术治疗。方法:青光眼白内障联合人工晶状体植入术后浅前房患者17例17眼,术后出现浅前房的时间20d～4mo,平均1.6±0.5mo;术前眼压28.2～43.3(平均33.2±5.7)mmHg(1mmHg=0.133kPa);视力:<0.05者7眼,0.05～者5眼,0.1～0.3者3眼,>0.3者2眼。有明显瞳孔后粘连者16眼。3眼行单纯无灌注前段玻璃体切割术,14眼行无灌注前段玻璃体切割+6∶00位虹膜根部切除术,其中2眼行二次以上手术,随访12mo。结果:术后一次性前房形成率88.2%(15/17),需行二次手术11.8%(2/17);视力:<0.05者3眼,0.05～者2眼,0.1～0.3者7眼,>0.3者5眼;术后平均眼压14.7±3.4mmHg,所有患者均无浅前房、滤过泡渗漏、脉络膜脱离及脉络膜上腔出血等严重并发症发生。结论:瞳孔后粘连是三联手术后浅前房的主要原因,无灌注前段玻璃体切割+虹膜根部切除术是治疗三联手术后浅前房的有效、可靠方法。     

Long‐term risk of intraocular pressure elevation and glaucoma escalation after deep anterior lamellar keratoplasty

Background: To determine the prevalence and severity of intraocular pressure changes after deep anterior lamellar keratoplasty and its effect on visual function. Design: Retrospective cohort study. Participants: All patients undergoing deep anterior lamellar keratoplasty procedures at a tertiary referral centre (Leeds University Hospitals, UK) using a manual dissection technique. Methods: Case note review of all cases between the 1st of January 2000 and the 31st of December 2005. Main Outcome Measures: Raised intraocular pressure, glaucoma incidence or escalation. Results: Data were collected for 69 of eyes of 58 patients. The mean period of follow‐up was 54.9 months (median 60, range 6–95 months). The initial diagnosis was keratoconus in 56 cases (81%), corneal scarring in four cases (5.8%), herpes simplex keratitis in four cases (5.8%), lattice dystrophy in four cases (5.8%) and one case of corneal dermoid. Temporarily intraocular pressure was thought to be related to topical steroid use occurred in 12 (17%) cases. Ocular hypertension requiring treatment occurred in three eyes. None of these eyes had progressive disc changes or visual field defects suggestive of glaucoma, and all had well‐controlled intraocular pressure on topical, single‐drug therapy. Overall, there was a small insignificant rise in intraocular pressure after deep anterior lamellar keratoplasty (P = 0.11). Conclusions: The long‐term risk of glaucoma following deep anterior lamellar keratoplasty using the manual dissection technique appears to be low. Ocular hypertension after deep anterior lamellar keratoplasty is infrequent and can be controlled on topical medication alone.     

超声乳化术中灌注液迷流综合征表现及治疗方法的临床观察

目的:总结白内障超声乳化手术中发生的灌注液迷流综合征的临床表现和治疗方法。方法:从2002-09/2009-12我院共8例患者术中发生灌注液迷流综合征。这些患者的临床表现为突发性眼压升高、浅前房、虹膜脱出,通过注入黏弹剂以及升高灌注瓶高度无法维持前房深度。所有患者无明显疼痛、烦躁等症状。术中及术后间接眼底镜检查均未发现暴发性脉络膜出血等眼内出血现象。8例患者中1例未予特殊处理继续进行手术操作,其余7例患者经过缝合主切口,包眼安静休息联合200g/L甘露醇注射液快速静脉点滴处理。结果:未予特殊处理的1例患者手术中发生后囊膜破裂,进行前段玻璃体切除,悬吊人工晶状体。经过处理的7例患者中1例经过处理后前房仍无法形成,故行经睫状体平坦部玻璃体腔穿刺;其余患者前房形成,其中1例患者在植入人工晶状体后眼压再次升高,未予置换残余黏弹剂。所有患者手术完成后缝合主切口1针。结论:超声乳化术中灌注液迷流综合征是一种罕见的白内障术中并发症。经过恰当处理,可以解决突发高眼压引起的各种体征,顺利完成手术操作。     

Visual results following vitreous loss and primary lens implantation

Implantation of an intraocular lens following vitreous loss at cataract surgery is a controversial decision. To address this issue, we retrospectively identified all cases performed at the University of Minnesota in the last three years that had either a posterior or an anterior chamber lens placed following anterior vitrectomy. Twenty patients had a posterior chamber lens implant; 14 had follow-up longer than six months. All these patients achieved 20/40 or better visual acuity, although one patient had a retinal detachment. Of the six patients with an anterior chamber lens implant, four achieved 20/40 or better acuity and two achieved 20/50 acuity with follow-up of six months; one patient had a retinal detachment. This review demonstrates that with a meticulous anterior vitrectomy, good visual results can be achieved, although the risk of retinal detachment is higher than in uncomplicated cases.     

Argon laser treatment of the ciliary processes in aphakic glaucoma with flat anterior chamber

We treated three patients (a 72-year-old man, a 68-year-old woman, and a 60-year-old man) with aphakic glaucoma with flat anterior chamber by administering laser burns to the ciliary processes (11 ciliary processes in one case, 27 in the second, and three in the third). There was some improvement in all three cases; in one case the intraocular pressure decreased from more than 50 mm Hg to less than 20 mm Hg. In each case the anterior chamber deepened immediately without administration of cycloplegics.     

Extracapsular cataract extraction with phacoemulsification and pars plana vitrectomy with silicone oil tamponade in one session]

BACKGROUND: In phacic eyes the development of a cataract is induced by silicon oil. In this case the lens has to be removed in a second operation with or without intraocular lens implantation. In cataract surgery a new incision technique is used, which makes it easily possible to combine both operations in one session. METHODS: A feature of the new incision technique is that a scleral tunnel is dissected before the anterior chamber is opened. The opening closes itself, if the intraocular pressure rises. The danger, that a rise in intraocular pressure during the vitrectomy makes an irisprolaps, for example during the substitution of perfluorcarbon by silicon oil, no longer exists. RESULTS: The operation technique and the postoperative course of three patients with intraocular lens implantation and pars-plana-vitrectomy using silicon oil is reported. CONCLUSIONS: By using the new incision technique in cataract surgery intraoperative complications during vitrectomy like an irisprolaps or penetration of silicon oil into the anterior chamber no longer exist. In selected cases one operation is saved for the patient.     

晶状体超声乳化人工晶状体植入治疗闭角型青光眼临床观察

目的观察晶状体超声乳化吸出联合后房型人工晶状体植入术治疗伴白内障的原发性闭角型青光眼的疗效。方法原发性闭角型青光眼32例32眼,行表面麻醉下超声乳化吸出联合后房型人工晶状体植入术。对比手术前后视力、眼压、中央前房深度及前房角的变化。结果32例视力均有不同程度的提高,眼压控制在正常范围内,低于21mmHg,27眼（84．38％）,视力〉0．5,前房角粘连有改善。结论晶状体超声乳化吸出联合人工晶状体植入术,是治疗伴白内障的闭角型青光眼的一种安全可行的有效方法。     

Pars plana insertion of glaucoma drainage devices for refractory glaucoma

BACKGROUND: Glaucoma drainage devices are more commonly inserted into the anterior chamber because of the relative ease of this method of insertion. However, in certain cases, posterior placement of the tube may be necessary or may be more desirable. The outcome of a series of patients with glaucoma drainage devices inserted into the pars plana was examined. METHODS: Retrospective chart review of patients who underwent pars plana implantation of Molteno and Baerveldt glaucoma drainage devices at the Sydney Eye Hospital. RESULTS: There were 33 cases reviewed. The mean follow-up period was 30.2 months. The mean final postoperative intraocular pressure was reduced to 13.4 +/- 4.4 mmHg (SD) from 33.06 +/- 8.47 mmHg preoperatively. The mean number of intraocular pressure-lowering medications in use postoperatively was 0.6 +/- 0.8, reduced from 3.6 +/- 1.27 medications in use preoperatively. Sixteen (48.5%) eyes were classified as complete successes, 14 (42.4%) eyes as qualified successes and three eyes (9%) as failures. Kaplan-Meier survival analysis for cumulative success (absence of failure) predicted 61.1% survival at 60 months. Complications included five cases of decompensation of corneas or corneal grafts, one case each of conjunctival wound dehiscence, large choroidal effusion, epiretinal membrane, Molteno plate extrusion and intraocular pressure unresponsive to medical therapy, and three cases of tube blockage. CONCLUSIONS: In this series of patients, pars plana insertion of glaucoma drainage devices has been shown to be an effective alternative for selected cases where anterior chamber tube insertion is not possible or is not ideal.     

Extracapsular cataract extraction and implantation in the capsular sac during vitrectomy in diabetics]

Removal of the lens is often performed during pars plana vitrectomy for complications of proliferative diabetic retinopathy, but correction of aphakia often remains unsatisfactory. Some authors have reported posterior chamber intraocular lens implantation during pars plana vitrectomy in diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy. Some patients were operated by pars plana lensectomy and vitrectomy followed by posterior chamber intraocular lens implantation in the ciliary sulcus, others by extracapsular extraction, posterior chamber intraocular lens implantation in the ciliary sulcus, and pars plana vitrectomy. Other authors have described phacoemulsification through the limbus, pars plana vitrectomy and implantation in the capsular bag in one operation in various indications, including complications of proliferative diabetic retinopathy. We inserted a posterior chamber intraocular lens into the capsular bag in 18 eyes of 16 patients with complications of proliferative diabetic retinopathy after extracapsular cataract extraction and pars plana vitrectomy in a single session. A standard extracapsular cataract extraction was performed before pars plana vitrectomy. Sufficient anterior capsule was left in place in order to facilitate implantation in the capsular bag after pars plana vitrectomy. The anterior chamber was filled with sodium hyaluronate in order to maintain anterior chamber depth, corneal clarity, and good mydriasis during the continuation of the procedure. A standard three port pars plana vitrectomy was performed in all cases. After closure of superior sclerotomies, superior corneal incision was partially reopened, an intraocular lens specifically designed for the capsular bag with an optic size of 7 mm was inserted, and the corneal incision was closed with interrupted 10/0 sutures.(ABSTRACT TRUNCATED AT 250 WORDS)     

青光眼合并白内障手术时机和方法选择比较

目的 比较青光眼合并白内障不同手术时机、不同手术方法的效果。方法 回顾性分析A组28例(28只眼)青光眼白内障联合手术、B组22例(23只眼)青光眼术后行白内障手术、C组25例(29只眼)青光眼合并白内障急性发作后单纯行小梁切除术。结果 A组有4只眼白内障继发青光眼术后反应重,有2只眼瞳孔区有纤维膜形成,眼压均控制在正常范围;B组避开原滤过泡在颞侧做切口,术后反应小,效果较好;C组术后眼压控制理想,浅前房发生率较高,反应较轻,眼压控制理想。结论 青光眼合并白内障如不是急性发作或白内障膨胀期继发青光眼,应尽早做联合手术,如有急性发作宜分期手术。     

Intraocular lens implantation in anterior megalophthalmus. Case report.

We report three cases of extracapsular cataract extraction with intraocular lens implantation in two patients with anterior megalophthalmus. This is the first report, to our knowledge, of intraocular lens implantation in this rare condition.     

青光眼持续高眼压状态下改良式前房穿刺术

目的探讨改良式前房穿刺术在青光眼持续高眼压状态下的效果。方法35例（38眼）持续高眼压青光眼,急性闭角型青光眼急性发作期21例（24眼）,慢性闭角型青光眼6眼,新生血管性青光眼4眼,年龄相关性白内障膨胀期4眼。所有患眼应用常规降眼压药物不能有效降低眼压,采用手术显微镜下改良式前房穿刺术放液。结果所有患者放液后眼压迅速降低,眼痛、头痛缓解,视力有不同程度提高,术后眼压平均为（17．30±5．40）mmHg（1mmHg=0．133kPa）。结论改良式前房穿刺术放液是治疗高眼压持续状态的安全、有效的方法,损伤小、反应轻、简便高效,可以避免长期大量应用降眼压药物引起的副作用。     

Spontaneous dislocation of intraocular lens with capsule as a late complication of cataract surgery in patients with pseudoexfoliation syndrome --five case reports

PURPOSE: Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery, including rupture of the posterior lens capsule, zonular dialysis and a rise of intraocular pressure occurring postoperatively. Delayed dislocation of an IOL is a rarely reported phenomenon. PATIENTS: Within one year, late dislocation of the lens capsule with the in the bag fixated IOL was observed following cataract surgery in five patients (67, 74, 79, 90 and 92 years old) with pseudoexfoliation syndrome. RESULTS: All patients had an uneventful in the bag implantation of the IOL 6 (three patients), 3 and 11 years ago, respectively. Postoperatively occurring secondary cataract was treated by a YAG-capsulotomy in four cases. No patient had any other predisposing factors that would lead to zonular weakness besides the pseudoexfoliation syndrome. The dislocation of the IOL and capsule occurred spontaneously. In one patient with preexisting glaucoma, the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL. CONCLUSION: Patients with pseudoexfoliation syndrome undergoing cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL and capsule. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.