基层医院白内障手术转型的体会

目的:探讨基层医院医师从白内障小切口非超声乳化手术成功转型到超声乳化手术的体会。方法:对2010-06/2011-06转型所做超声乳化联合人工晶状体植入术61例64眼的治疗结果及并发症进行分析。结果:患者60例63眼手术顺利,其中1例1眼后囊破裂且一期未植入人工晶状体。术后1wk,视力>0.3者32眼(50%),>0.5者30眼(47%),视力<0.1者2眼(3%)。术中主要并发症:后囊破裂5眼(8%)。术后主要并发症:角膜水肿19眼(30%)。结论:基层医院医师也可从白内障小切口非超声乳化手术顺利转型到超声乳化手术。     

初期开展白内障超声乳化吸出术的并发症分析

目的 :通过对初期白内障超声乳化吸出术出现的并发症的分析 ,以期减少并发症的发生 ,提高手术效果。方法 :总结 40例白内障超声乳化术后的并发症。结果 :角膜水肿 38眼、后囊破裂 5眼 ,两者是最为常见的并发症。结论 :提示初期开展白内障超声乳化术应严格掌握手术指针     

200眼白内障超声乳化及人工晶体植入术的临床报告

本文报导了１６５例２００眼白内障超声乳化及人工晶体植入术，其中先天性白内障５眼，老年性白内障１６６眼，并发性白内障２９眼。结果表明，该术具有切口小、安全、术后视力恢复较快、手术致角膜散光少及屈光状态稳定等优点。为了体现上述优点，减少并发症，作者认为：①在各种手术切口中以巩膜隧道切口为佳，②连续弧线形撕囊术可防止术中囊膜撕裂和保证在囊袋内施行超声乳化术，③联合应用超声乳化的各种手法和技术，可缩短超声乳化时间，降低其能量，减少角膜内皮损伤，④严格掌握适应症是手术成功的关键。Ｖ级核目前不是适应症。本组的主要并发症为后囊膜破裂及角膜内皮水肿混浊。     

高度近视白内障超声乳化摘出术

目的探讨高度近视合并白内障超声乳化手术的技巧和注意事项.方法对141例(182眼)眼轴＞26mm的高度近视白内障患者施行超声乳化手术.Ⅰ级核采用原位超声乳化技术,Ⅱ～Ⅲ级核采用乳化劈裂碎核技术,Ⅳ～Ⅴ级核采用拦截劈裂技术,并且根据核的类型设置机器参数.结果术后1周矫正视力＜0.1者16眼;≥0.5者89眼,其中≥0.8者34眼.术中并发症为虹膜咬伤(1.09%),后囊破裂(2.20%).术后并发症为角膜后弹力层皱褶(19.78%),角膜上皮水肿(10.44%)和前囊收缩综合症(1.65%).结论充分了解高度近视的生理和解剖特点对于高度近视白内障的超声乳化手术非常重要.术中应注意切口位置和隧道长度、灌注瓶的高度、CCC以及根据核的类型采用不同的手术技巧.     

爆破模式在农村硬核白内障防盲手术中的应用

目的:探讨爆破模式超声乳化吸除术在农村硬核白内障防盲手术中的应用价值。方法:将162例162眼硬核(Ⅳ～V级核)白内障患者随机分为爆破超声乳化吸除术组和小切口白内障囊外摘除术(small incision cataract extraction,SICE)组。记录两组患者术后视力及视力恢复时间、角膜散光以及手术并发症的发生情况,同时记录爆破模式超声乳化术中的实际超声能量和超声时间。结果:两组患者术后视力均有提高,但相比差异有统计学意义(P<0.05),且SICE组视力恢复显著慢于爆破模式组(P<0.01)。术后角膜散光SICE组明显高于爆破模式组(P<0.05)。爆破模式组术中实际超声能量为(16.2±5.4)%、超声时间为(42.8±6.1)s。手术并发症主要是角膜水肿和后囊膜破裂,SICE组角膜水肿69眼、后囊破裂6眼,而爆破模式组角膜水肿12眼、无后囊膜破裂。结论:爆破模式超声乳化吸除术治疗农村防盲中的硬核白内障,可显著改善术后视力,缩短恢复时间,可以用较低的超声能量和时间,减少术后早期角膜水肿,降低手术并发症发生率,值得推广使用。     

白内障超声乳化手术并发症分析

目的：评价白内障超声乳化手术的疗效及并发症。方法：对347例（365只眼）白内障超声乳化手术并发症进行分析。结果：后囊破裂27只眼（7．7％），角膜混浊86只眼（23％），角膜内皮失代偿5只眼（1．4％）。结论：手术中的主要并发症为后囊破裂，术后并发症为角膜混浊，严重并发症为角膜内皮失代偿。产生这些并发症的主要原因是病例选择不当、技术掌握不熟练及操作不当所致。     

挤切劈核法在囊膜上超声乳化手术中的应用

目的:探讨囊膜上挤切劈核法在白内障超声乳化手术中的应用。方法:年龄相关性白内障249例(289眼)随机分为囊膜上挤切劈核(crush-and-chop)组125例(147眼)和囊袋内拦截劈核(stop-and-chop)组124例(142眼)。分别在囊膜上和囊袋内原位采用挤切劈核和拦截劈核技术进行白内障超声乳化术。记录术中平均超声能量(AP)、实际超声乳化时间(U/Stime)、累积能量复合参数(AECP)、术中术后并发症、术后1d、1wk视力和术后1d角膜水肿等情况并进行比较。结果:将两组中同级核硬度的亚组进行比较,囊膜上挤切劈核组的AP、U/Stime、AECP均低于拦截劈核组,差异有显著性;且前者角膜水肿均轻于后者。两组术后1d裸眼视力囊膜上挤切劈核组优于拦截劈核组,术后1wk两组最佳矫正视力无差异。晶状体后囊膜破裂在囊膜上挤切劈核组有1眼,拦截劈核组中有3眼,无其他严重手术并发症。结论:囊膜上挤切劈核法操作简便,易掌握,且安全、有效。     

周边放射状劈核低能量超声乳化技术治疗硬核白内障

目的探讨硬核超声乳化方法———周边放射状劈核低能量超声乳化技术的手术方法和临床疗效。方法对98例(107眼)Ⅳ级以上硬核年龄相关性白内障患者施行周边放射状低能量超声乳化联合人工晶状体植入手术进行治疗。术后随访观察视力恢复情况、并发症和内皮损伤情况。结果超声乳化时间平均为1 h 59 s,超声能量平均为14.7%。除手术开展早期有7眼术后第1天角膜明显水肿、6眼术中发生后囊破裂外,后期病例没有明显并发症发生。术后1个月复查角膜内皮损伤率,平均为9.74%。结论周边放射状劈核低能量超声乳化技术适用于治疗硬核年龄相关性白内障。     

白内障超聲乳化衍初期70例并發癥分析

目的 探讨如何减少和避免从白内障囊外摘除术到超声乳化吸除术过渡中的手术并发症。方法 对70例79眼超声乳化白内障吸除术的术中术发并发症进行了分析。结果 术中并发症玻璃体脱出9例,占12％,其中3例为晶状体翻转时活动度过大晶状体缘割破后囊,2例在追逐游窜的晶状体碎核时误吸后囊,1例灌注时由于灌注压过大撑破后囊,1例发生在乳化锅底样白内障进损伤后囊,2例因撕囊失败,改开罐式截囊,乳化头吸住边缘不整齐的前囊膜造成后囊破裂。误吸虹膜3例。6点位虹膜跟部断离1例。术后最常见的并发症是角膜水肿,占40％,与手术者操作技术不娴熟,超声能量过大,乳化时间过长有关。前房内乳化晶状体核、前房涌动、浅前房时乳化头对角膜内皮的损伤,是导致重度角膜水肿的原因。结论 连续环形撕囊和乳化晶状体核是乳化手术的关键。我们的资料表明,只要我们熟练掌握了囊外摘除技术并认真学习超声乳化理论知识,经过认真的训练和实践,就能减少并发症,较快的掌握超声乳化技术。     

白内障超声乳化术初期70例并发症分析

目的 探讨如何减少和避免从白内障囊外除术到超声乳化吸除术过渡中的手术并发症。方法 对70例79眼超声乳化白内障吸除术的术中术后并发症进行了分析。结果 术中并发症玻璃体脱出9例，占12%，其中3例为晶状体翻转活动度过大晶状体缘划破后囊，2例在追逐游窜的晶状体碎核时误吸后囊，1例灌注时由于灌注压过大撑破后囊，1例发生在乳化锅底样白内障时损伤后囊，2例因撕囊失败，发型罐式截囊，乳化头吸住边缘不整齐的前囊膜造成后囊破裂。误吸虹膜3例。6点位虹膜跟部断离1例。术后最常见的并发症是角膜水肿，占40%，与手术操作技术不娴熟，超声能量过大，乳化时间过长有关。前房内乳化晶状体核、前房涌动、浅前房时乳化头对角膜内皮的损伤，是尊致重度角膜水肿的原因。结论 连续环形撕囊和乳化晶状体核是乳化手术的关键。我们的资料表明，只要我们熟练掌握了囊外除术并认真学习超声乳化理论知识，经过认真的训练和实践，就能减少并发症，较快的掌握超声乳化技术。     

玻璃体切除术后的白内障摘除及人工晶体植入术

目的探讨玻璃体切除术后的白内障手术特点及术式选择。方法玻璃体腔液体灌注维持眼内压行白内障囊外摘除或超声乳化吸出联合人工晶体植入术。结果３７例（４０只眼）中，术后视力≥０．１者３１只眼（７７．５％），≥０．３者１２只眼（３０．０％）。术中并发症有晶体核脱位至玻璃体腔内（１只眼）、玻璃体出血（１只眼），术后并发症为虹膜红变（１只眼）、人工晶体夹持（１只眼）。结论玻璃体切除术后的白内障手术必须采取克服低眼压的措施，玻璃体腔液体灌注是一种比较理想的方法；对于晶体核硬化明显的患者，白内障囊外摘除较超声乳化吸出更为适用。     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

软壳技术在后极性白内障超声乳化手术中的应用

目的:探讨后极性白内障超声乳化手术有效控制并发症发生的技术与方法。方法:后极性白内障行超声乳化术中引入软壳技术者27例33眼,保护角膜及后囊膜,防止并发症发生,并观察手术前后视力的改善情况及并发症发生情况,分析软壳技术在术中的作用与价值。结果:后囊膜完整者28眼,其中6眼后囊膜混浊,在5只后囊膜破裂眼中,无玻璃体脱出,人工晶状体囊袋内固定均良好者33眼,视力显著提高,无明显并发症发生。结论:软壳技术的应用可以减少后极性白内障超声乳化手术的并发症,明显提高视力,对控制手术质量有重要意义。     

Successful management of cataract surgery associated vitreous loss with sutureless small-gauge pars plana vitrectomy

PURPOSE: To investigate the efficacy of 25-gauge self-sealing sutureless pars plana vitrectomy (PPV) in the management of vitreous loss associated with phacoemulsification. DESIGN: Retrospective noncomparative case series. METHODS: We conducted a retrospective chart review of 29 patients who underwent a newly described surgical technique, self-sealing sutureless PPV for the management of vitreous loss during phacoemulsification. The 29 eyes included in the study were analyzed for age, sex, race, posterior segment pathology, systemic illness, laterality of the eye, type of anesthesia used during surgery, placement of intraocular lens, visual acuity (pre- and postoperative), and postoperative complications. All patients had a minimum follow-up of 3 months. Self-sealing sutureless PPV was not performed in eyes with visually significant posterior segment pathology, in monocular patients, or in eyes in which there was posterior dislocation of nuclear fragments during cataract surgery. RESULTS: The final best-corrected visual acuity was 20/40 or better in 96.5% of the patients. The complication rate compared favorably with previous studies of visual outcomes after cataract surgery. CONCLUSION: Self-sealing sutureless PPV is a safe, reliable adjunct for managing vitreous loss during phacoemulsification and leads to rapid visual recovery.     

Outcome of phacoemulsification after pars plana vitrectomy

PURPOSE: To compare the outcome of phacoemulsification surgery in patients with and without prior vitrectomy, adjusted for confounding factors. DESIGN: Retrospective cohort study. PARTICIPANTS AND CONTROLS: Thirty-one consecutive eyes undergoing phacoemulsification after pars plana vitrectomy (PPV) and 116 consecutive eyes undergoing phacoemulsification without previous PPV. METHODS: Office records of the operating surgeons were reviewed for age, gender, type of cataract, vitrectomy status, best-corrected visual acuity (BCVA) before and after phacoemulsification, intraoperative difficulties, and postoperative complications. Bivariate analyses between these predictors and the main outcome, BCVA of 20/40 or better after phacoemulsification, were performed using Pearson's chi-square tests. An adjusted analysis of the relationship between outcome and vitrectomy status was performed with logistic regression. Pearson's chi-square tests were used to compare type of cataract, intraoperative difficulties, and postoperative complications in study and control eyes. MAIN OUTCOME MEASURES: BCVA of 20/40 or better after phacoemulsification, rates of intraoperative difficulties, and postoperative complications. RESULTS: The most common indication for PPV was macular hole. The average interval from PPV to phacoemulsification was 15.4 months. Study eyes were followed for an average of 10 months compared with 6.6 months for controls. Study eyes were more likely than controls to have predominantly nuclear sclerotic cataracts (P = 0.002). After cataract extraction, 24 of 31 study eyes (77.4%) and 110 of 116 control eyes (94.8%), had BCVAs of 20/40 or better. After adjusting for confounders, eyes without previous vitrectomy were 3.44 times more likely to obtain a BCVA of 20/40 or better than eyes with prior PPV, but this difference was not statistically significant (95% CI, 0.72-16.67). Only 3 of 31 (9.7%) study and 11 of 116 (9.4%) control eyes had intraoperative difficulties (P = 0.47). Posterior capsule plaque was the most common intraoperative difficulty in study eyes; small pupil requiring stretching or iris hooks was most common in controls. Only 1 of 31 (3.2%) study eyes had a postoperative complication other than posterior capsule opacification compared with 18 of 116 (15.5%) controls (P = 0.07). CONCLUSIONS: A large proportion of patients with prior PPV obtain good visual acuity after phacoemulsification. We did not find significantly higher rates of intraoperative difficulties or postoperative complications compared with controls. The benefits of phacoemulsification seem to be limited only by retinal comorbidity.     

Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School

AIM: To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior experience with extracapsular extraction. DESIGN: Retrospective, observational case series. METHODS: A retrospective chart review of 755 patients who underwent cataract surgery by third-year residents between July 2000 and June 2005 at the Institute of Ophthalmology and Visual Science was performed. Details of intraoperative complications (posterior capsular rupture, vitreous loss, subluxation of lens fragments into the vitreous, extracapsular cases converted to phacoemulsification, retinal detachment, vitreous haemorrhage and haemorrhagic choroidals) of the cases done by phacoemulsification technique were recorded. Results were analysed and compared with complication rates reported from other residency programmes and from experienced ophthalmologists. RESULTS: Of 755 cataract surgeries, 719 were performed using phacoemulsification technique. Posterior capsule disruption occurred in 48 (6.7%), vitreous loss in 39 (5.4%) and dislocated lenticular fragments in 7 (1.0%) of 719 cases that underwent phacoemulsification technique. Subsequent pars plana lensectomy was required in 5 (0.7%) cases; 1 case (0.1%) experienced retinal detachment and haemorrhagic choroidal detachment. CONCLUSION: The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique.     

Incidence of intraoperative complications during phacoemulsification in vitrectomized and nonvitrectomized eyes: prospective study

PURPOSE: To compare the incidence of intraoperative complications during phacoemulsification surgery in patients with and without prior pars plana vitrectomy (PPV). SETTING: Department of Ophthalmology, Norfolk, and Norwich University Hospital, Norwich, United Kingdom. METHODS: Prospective collection of operative complications in 2000 consecutive cataract extractions performed by 1 surgeon (R.L.B.). Details of all patients who had intraoperative complications including age at operation and sex were recorded. It was also noted whether the eye previously PPV. Complications recorded were posterior capsule rupture (PCR) with and without vitreous loss, iris trauma, loss of nuclear fragment into vitreous, and choroidal hemorrhage. RESULTS: Of 2000 eyes, 117 had previous PPV. Of these, there were 2 (1.70%) cases of PCR. There were no cases of iris trauma, choroidal hemorrhage, or dropped nucleus fragments into the posterior chamber. Nonvitrectomized eyes totaled 1883. Rates of complications were as follows: PCR without vitreous loss, 0.16%; PCR with vitreous loss, 0.53%; iris trauma, 0.16%; choroidal hemorrhage, 0.16%; and dropped nucleus fragment in the vitreous, 0.11%. CONCLUSION: Despite well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, the incidence of intraoperative complication rates is similar to nonvitrectomized eyes in the hands of an experienced surgeon.     

Results of cataract surgery in renal transplantation patients

PURPOSE: To evaluate the results of conventional extracapsular cataract extraction and phacoemulsification cataract surgery, in renal transplant patients. METHODS: A total of 11 eyes of eight renal transplant recipients who underwent cataract surgery in Ankara between 1995 and January 2001 were evaluated. Each individual underwent routine ophthalmologic examination including visual acuity with Snellen chart testing, slit-lamp examination, intraocular pressure measurement, and fundus examination. Of these, seven patients had posterior subcapsular cataracts and four had nuclear cataracts. Conventional extracapsular cataract extraction (cECCE) was performed in four eyes with single-piece all-polymethylmethacrylate posterior chamber intraocular lens implantation. The other seven eyes were treated with small-incision phacoemulsification and implantation of a foldable hydrophilic acrylic lens. RESULTS: We observed intraoperative posterior capsule rupture and vitreous loss in one patient, postoperative intraocular tension elevation in one patient, and sterile suture infiltration in one patient in our series. Average of the visual acuities 6 months after the operation was 20/30 (range, 20/60-20/20). CONCLUSIONS: In this, the first published report to describe outcomes of cataract surgery in renal transplant patients, most complications were associated with high of steroids use and immunosuppressives, and were independent of the type of cataract surgery used, either ECCE or phacoemulsification surgery. The study suggests the need for additional care before, during, and after operation.     

超声乳化白内障吸除术中晶状体核脱位的原因及处理

目的 探讨超声乳化吸除术中晶状体核脱位于玻璃体腔的原因与处理方法。方法 回顾性分析１９９４年８月至１９９９年１月是我院超声乳化白内障吸除术中晶状体核脱位于玻璃体腔内的１８例患者情况。结果 ４例脱位晶状体核悬浮在前部玻璃体中,扩大白内障手术切口用圈套器捞出;２例脱位核碎块小于核的１／４,随访３～４年无并发症发生;１例脱位核碎块约为核的１／２,因过敏性眼内炎而最终眼球萎缩;１１例晶状体核脱位后行玻璃体