软性虹彩片联合透气性半硬性角膜接触镜矫治外伤性无虹膜无晶状体眼

目的 评价软性虹彩片联合透气性半硬性角膜接触镜(RGPCL)对外伤性无虹膜无晶状体眼的矫治效果.设计回顾性病例系列.研究对象 角膜内皮细胞密度在2500个/mm2以上外伤性无虹膜无晶状体眼患者59例(59眼).方法患者联合戴用软性虹彩片和RGPCL,比较初诊时的插片视力和RGPCL矫正视力,随诊5年,非接触性角膜内皮计...     

Visual function after implantation of aniridia intraocular lens for traumatic aniridia in vitrectomized eye

PURPOSE: To evaluate the efficacy and safety of aniridia posterior chamber intraocular lens (PCIOL) in traumatic aniridia and aphakia in vitrectomized eyes. METHODS: Four aphakic patients with traumatic aniridia and previous pars plana vitrectomy (PPV) due to posterior segment trauma enrolled in the study, and had secondary implantation of an aniridia PCIOL. Two patients were men and two women with mean age of 39.25 years. Complete ophthalmic examinations, including preoperative and postoperative visual acuity in dark and light, glare disability, visual function (using VF-9 questions modified from VF-14), stereopsis, and contrast sensitivity in 3, 6, 12, and 18 cycle per degree frequencies, were done for all patients. Postoperative intraocular pressure (IOP), IOL centration, and intraocular inflammation were monitored. Mean follow-up was 12.25 months (range 7 to 15 months). RESULTS: Visual acuity improved in all four patients, especially in the light. Glare was subjectively reduced in all of them. Stereopsis was measurable in three of them postoperatively. Contrast sensitivity improved in all patients, especially in brightness and lower frequencies. All four eyes had improved VF-9. All eyes achieved the desired anatomic results. Two cases developed elevated IOP early after surgery. In one eye, IOP elevation was transient and controlled with antiglaucoma medication, but the other eye, which had secondary glaucoma from previous trauma, required cyclophotocoagulation for the IOP to be controlled. No patient developed chronic uveitis or redetachment. CONCLUSIONS: The aniridia PCIOL can overcome aphakia, reduce glare, and increase visual function, contrast sensitivity, and stereopsis in vitrectomized eyes with traumatic aniridia. Although this kind of IOL appears safe, some disadvantages are secondary glaucoma and reduced visibility of peripheral fundus, and caution should be used in its implantation until more patients with longer follow-up are studied.     

外伤性虹膜缺如眼植入虹膜隔人工晶状体后的远期并发症

目的 分析外伤性虹膜缺如患者植入虹膜隔人工晶状体后的远期并发症,探讨其发生原因及预防措施.方法 回顾性系列病例研究.回顾性分析因外伤性虮膜缺如在山东省眼科研究所青岛眼科医院行虹膜隔人工晶状体植入术并在长期随访过程中出现严重并发症的5例患者的资料,归纳其临床特点.其中男性4例,女性1例,年龄13～43岁,随访时间42-108个月.2例于睫状体扁平部玻璃体切除术后行Ⅱ期虹膜隔人工晶状体悬吊术,2例Ⅰ期行白内障摘除联合虹膜隔人工晶状体植入术,1例行虹膜隔人工晶状体悬吊术.结果 所有患者短期随访主观感觉良好,眩光、畏光症状消失,并在一定时期内维持较好的视力.在长期随访过程中均出现了严重的继发性青光眼和大泡性角膜病变,视力下降至指数或手动,并接受穿透性角膜移植和人工晶状体取出术治疗.结论 虹膜隔人工晶状体植入术后可能出现严重的远期并发症,应慎重选择手术适应证,并加强对患者的随访.     

带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效观察

目的　评价带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效 ,探讨术后并发症的发生机制。方法　收集 2 5例 (2 7只眼 )行带虹膜隔人工晶状体植入术患者 ,分析手术疗效和并发症的发生情况 ,同时应用房角镜和超声生物显微镜 (UBM)观察术后发生继发性青光眼患者的房角结构和人工晶状体襻位置。术后随访时间 3～ 18个月。结果　术后患者畏光症状明显减轻或完全消失 ;术后视力较术前提高≥ 2行 2 0只眼 (74 1% ) ,变化 <1行 5只眼 (18 5 % ) ,下降 >2行 2只眼(7 4 % )。术后并发症包括继发性青光眼 10只眼 (37 0 % )、散光度数≥ 2 0 0D 17只眼 (6 3 0 % )、角膜失代偿 2只眼 (7 4 % )、前房出血 2只眼 (7 4 % )、玻璃体出血 3只眼 (11 1% )、视网膜脱离 1只眼(3 7% )。在继发性青光眼 10只眼 2 0只人工晶状体襻中 ,9只襻准确固定在睫状沟内 ,其他位置包括前房角、睫状突及睫状突后。房角改变包括房角后退、残留虹膜根部前粘连、房角关闭。结论　带虹膜隔人工晶状体植入术可有效治疗白内障合并虹膜缺损 ;术后继发性青光眼主要与房角损伤有关 ,人工晶状体襻位置异常、眼内出血、持续性炎性反应也参与其发生。     

Implantation of a black diaphragm intraocular lens for traumatic aniridia.

PURPOSE: To evaluate the suitability and safety of a black diaphragm posterior chamber intraocular lens (IOL). SETTING: Department of Ophthalmology, Leeds General Infirmary, Leeds, United Kingdom. METHODS: Seven patients who had secondary implantation of a Morcher 67G black diaphragm posterior chamber IOL were identified. All patients were men with a mean age of 42 years who had previous ocular trauma resulting in extensive loss of iris tissue (traumatic aniridia). Simultaneous penetrating keratoplasty was performed in 4 cases. Minimum follow-up was 10 months (mean 19 months). RESULTS: Best corrected visual acuity improved in 5 cases and was unchanged in 1 case. The lens was well centered in 5 cases. Two cases developed secondary glaucoma, 1 requiring trabeculectomy. One case developed infective endophthalmitis but had a visual acuity of 6/18 at last follow-up, and 1 had a vitreous and anterior chamber hemorrhage, which resolved. CONCLUSIONS: The black diaphragm posterior chamber IOL overcame aphakia in eyes with considerable loss of iris tissue and may mitigate the visually disabling effects of traumatic aniridia. Although this lens appears safe, caution should be used in its implantation until more patients with longer follow-up are studied.     

Black diaphragm aniridia intraocular lens for aniridia and albinism

Background Our aim was to assess the safety and efficacy of primary and secondary implantation of a black diaphragm aniridia intraocular lens (IOL) in patients that lacked a complete iris diaphragm.Methods This was a retrospective non-comparative study of six eyes in five patients with iris defects. The causes of such defects included congenital aniridia, traumatic aniridia, and oculocutaneous albinism. Three eyes underwent primary implantations of a black diaphragm IOL, and three eyes were given secondary implantations. The visual acuity, subjective severity of glare, postoperative anatomical outcome and any intraoperative or postoperative complications were reviewed.Results The mean follow-up period was 20.6 months (range 3–29 months). All patients showed stable or improvement in best-corrected visual acuity postoperatively. Glare and photophobia had improved subjectively in all patients after implantation of the black diaphragm IOL. Intraoperative complication included one case of hyphaema and iris damage during insertion of the IOL. Postoperative complications included intraocular inflammation with choroidal detachment, secondary glaucoma, and persistent epithelial defect after surgery. None of the patients developed decentration of IOL after surgery.Conclusion The black diaphragm aniridia IOL is useful in the management of the condition in patients with iris deficiency including oculocutaneous albinism. Intraoperative and postoperative complications are not uncommon, and patients should be monitored carefully in the perioperative period.     

Favorable outcome using a black diaphragm intraocular lens for traumatic aniridia with total iridectomy

A 25-year-old man had a penetrating injury to the left eye. Ocular examination revealed a full-thickness corneal laceration, total aniridia, anterior capsule rupture, and microscopic hyphema. Ten days after the immediate primary-repair surgery, aspiration of the lens secondary to traumatic cataract was performed. Four months later, a black diaphragm intraocular lens was implanted. Postoperatively, the best corrected visual acuity was 20/20 in both eyes. Multifocal spectacles were prescribed to provide the near and far vision required for the patient's job. Normal intraocular pressure and acceptable photophobia were noted during the 18-month follow-up.     

虹膜型人工晶状体治疗外伤性无虹膜无晶状体眼

目的探讨虹膜型人工晶状体对外伤性无虹膜无晶状体眼的治疗作用。方法观察31例（31眼）虹膜型人工晶状体植入术后的视力情况及并发症。结果术后患者视力有不同程度提高，最光症状明显改善。结论虹膜型人工晶状体对治疗外伤性无虹膜无晶状体眼具有较好的临床价值。     

带虹膜人工晶体在外伤性无虹膜无晶体眼的应用

目的 :改善外伤性无虹膜、无晶体眼或白内障患者的羞明症状 ,提高视力。方法 :使用德国MORCHER公司生产的带虹膜人工晶体为 3 7例无虹膜、无晶体或合并外伤性白内障、玻璃体出血的患者施行了白内障摘除或晶体、玻璃体切除联合带虹膜人工晶体植入术及带虹膜人工晶体二期植入术。结果 :术后患者羞明症状明显改善 ,视力有不同程度的提高。结论 :带虹膜人工晶体对治疗外伤性无虹膜、无晶体眼具有良好的实用价值 ,其术后并发症值得关注     

应用带虹膜人工晶状体治疗外伤性虹膜缺损

目的 应用带虹膜人工晶状体植入术治疗外伤性虹膜缺损。方法 使用德国Morcher公司生产的带虹膜的人工晶状体，为8例外伤性膜缺损患者施行一期或二期带虹膜人工晶状体植入术。探讨带虹膜人工晶状植入术的适应证、手术方法、并发症、效果及作者体会。结果 术后所有病例畏光症状改善，视力增加。结论 带虹膜人工晶状体植入术治疗外伤性虹膜缺损有重要的临床意义，但要注意手术并发症。     

Black diaphragm aniridia intraocular lens for congenital aniridia: long-term follow-up

PURPOSE: To present long-term results of implantation of a black diaphragm aniridia intraocular lens (IOL) in eyes with congenital aniridia. SETTING: Eye Hospital, Heinrich-Heine-University, Düsseldorf, Germany. METHODS: Cataract surgery was performed in 19 eyes of 14 patients with congenital aniridia. The black diaphragm aniridia IOL was implanted in front of the capsular bag in the ciliary sulcus. Mean patient age was 30 years (range 10 to 59 years) and mean follow-up, 46 months (range 12 to 84 months). Before surgery, corneal epithelial disorders; corneal pannus; cataract; hypoplasia of the macula, optic nerve, or both; and nystagmus were present in all 19 eyes. Clinically detectable glaucoma was present in 5 eyes. RESULTS: Despite the presence of amblyopia and nystagmus, visual acuity improved in 14 of the 19 eyes. The main postoperative problems were glaucoma deterioration (4 of 19 eyes) or development (4 of 19 eyes), cystoid macular edema (2 of 11 eyes), chronic endothelial cell loss (3 of 11 eyes), and progression of corneal epithelial disorders (4 of 19 eyes). Glaucoma was controlled by medical or surgical therapy in all patients. Intraocular lens explantation was performed in 2 eyes with glaucoma. CONCLUSION: Implantation of the black diaphragm aniridia IOL improved visual acuity in the majority of patients with a variety of endogenous problems in addition to aniridia.     

Contusion-induced traumatic aniridia]

Total aniridia occurred after a severe blow on the eyeball of a 65 year old man. The entire iris was torn off the ciliary body and escaped out of the eye through a small corneal wound. The zonular fibres were found to be intact and the posterior parts of the eye showed no traumatic changes.