Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma

PURPOSE: To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract. DESIGN: Retrospective, nonconsecutive, noncomparative case series. METHODS: We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients. MAIN OUTCOME MEASURES: Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction. RESULTS: The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.     

角膜穿孔修补白内障超乳人工晶状体植入

目的评价角膜穿孔修补、外伤性白内障超声乳化吸出及人工晶状体植入联合手术的临床效果。方法对该联合手术38例38眼进行回顾性评价。首先完成角膜裂口修补，然后对损伤的晶状体进行超声乳化吸出，必要时行前段玻璃体切除，然后植入人工晶状体。术后随访1～36月，平均10．3月。结果38眼中20眼(52．6％)最终最佳矫正视力在0．5以上；30眼(38．9％)最终最佳矫正视力在0．3以上。结论选择角膜穿孔、晶状体损伤，进行角膜穿孔修补、白内障超声乳化吸出、人工晶状体植入联合手术，可以获得较好的视力。     

Visual outcomes after surgery for unilateral cataract in children more than two years old: posterior chamber intraocular lens implantation versus contact lens correction of aphakia.

PURPOSE: We sought to determine whether posterior chamber intraocular lens implantation yields better visual acuity and binocular vision than does conventional contact lens correction of aphakia in similar groups of pediatric cataract patients. METHODS: We reviewed the medical records of children aged 2 to 16 years who had unilateral cataract surgery by a single pediatric ophthalmologist between 1986 and 1996. Before 1992 all patients underwent standard lensectomy with vitrectomy. Beginning in 1992 posterior chamber intraocular lens (IOL) implantation was offered as a choice to families and was performed on most patients. RESULTS: Monocular vision outcomes were not significantly different in 20 IOL and 31 lensectomy-vitrectomy patients, with 85% of the IOL group and 77% of the lensectomy-vitrectomy group showing better than 20/100 final acuity. Binocularity, however, was much better in the IOL group, with 90% demonstrating at least 400 seconds of arc stereopsis, as opposed to 39% in the lensectomy-vitrectomy group (p = 0.003). Subgroups of patients with traumatic or nontraumatic cataract origin, age at surgery less than 7 years, and preoperative visual acuity less than 20/100 compared very similarly. CONCLUSION: Posterior chamber IOL implantation appears to provide significantly better binocular function than conventional management of unilateral cataract in childhood but does not substantially improve visual acuity results.     

开放性眼外伤致外伤性白内障的二期人工晶状体植入术15例回顾分析

目的:分析开放性眼外伤二期人工晶状体(intraocular lens,IOL)植入术后的视力、早期并发症及屈光偏差.方法:回顾性分析2004/2005年15例开放性眼外伤引起角巩膜撕裂的外伤性白内障患者,一期行白内障摘除及开放性眼外伤修复术,二期进行IOL植入术.主要记录患者最佳矫正视力,早期并发症及屈光偏差.结果:两次手术时间间隔平均为2.57mo,最佳矫正视力,13例(87%)矫正视力在0.5或以上,所有眼最佳矫正视力均在0.3或以上.手术早期并发症包括角膜水肿、轻度至中度虹膜睫状体炎、黄斑水肿、黄斑皱褶等.术后视力的改善受限于因角膜中央或旁中央疤痕所致的不规则散光及发展的黄斑皱褶.最后的屈光状态,11眼(73%)屈光在1D内,屈光正常,4眼(27%)屈光在1～3 D.结论:开放性眼外伤二期植入IOL是安全的.应用受伤眼生物学数据计算IOL度数,二期植入IOL对于开放性眼外伤引起的外伤性白内障,获得理想的矫正视力有益.     

Primary implantation of posterior chamber lenses after traumatic cataract peneration

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.     

Prediction of visual outcome after penetrating keratoplasty for pseudophakic corneal edema

OBJECTIVE: To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic corneal edema (PCE) or aphakic corneal edema (ACE) based on preoperative parameters available from the patient history and ocular examination. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-eight patients who underwent 59 PKP procedures for PCE between 1997 and 2000 by two cornea specialists. METHODS: Medical records were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. Variables included age, gender, presence of diabetes or cardiovascular disease, method of intraocular lens (IOL) implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery, and maximal visual acuity reached after cataract surgery. The predictive value of each preoperative variable on post-PKP visual outcome was assessed using both univariate and multiple regression analyses. MAIN OUTCOME MEASURES: Statistical significance for the predictive value of each preoperative variable on post-PKP visual outcome. RESULTS: Best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). The strongest predictor of this outcome was implantation of a bag-fixated or sulcus-fixated IOL at the time of cataract surgery (P = 0.007; odds ratio, 15.8; 95% confidence interval, 1.2-208). Less significant variables included BCVA after cataract surgery, time between cataract surgery and PKP, and gender. CONCLUSIONS: In planning and advising patients with pseudophakic or aphakic corneal edema who are candidates for PKP, the method of IOL implantation during the cataract surgery is the single most significant predictor of visual acuity after corneal transplantation. Bag-fixated or sulcus-fixated posterior chamber IOL was associated with a better visual outcome than anterior chamber IOL, scleral-fixated posterior chamber IOL, or aphakia.     

Stereopsis after primary in-the-bag posterior chamber implantation in children.

PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.     

高度近视白内障患者植入Bigbag人工晶状体的疗效观察

目的观察高度近视并发白内障患者行超声乳化吸除联合Bigbag人工晶状体植入术的有效性及安全性。方法 31例（55只眼）高度近视白内障患者行超声乳化吸除联合人工晶状体植入术。其中18例（30只眼）植入Bigbag人工晶状体,13例（25只眼）植入Matrix Acrylic 400型人工晶状体。比较手术前后视力及屈光状态;观察术中及术后并发症。结果 55只眼人工晶状体均植入囊袋内且固定良好,术前裸眼视力均〈4.5,术前最佳矫正视力〉4.8者Bigbag组3只眼（10%）,400组6只眼（24%）;术后1个月Bigbag组最佳矫正视力〈4.5者1只眼,4.5～4.8者10只眼,〉4.8者19只眼,与400组相比差异无统计学意义（χ2=0.066,P〉0.05）;Bigbag组术后1个月屈光度-0.50～-2.00 D,平均（-0.68±0.38）D,与术前相比较差异有统计学意义（t=12.79,P〈0.05）。与术后3个月屈光度比较无统计学意义（t=1.366,P〉0.05）。术后3个月Bigbag组,后囊膜未发现皱褶,2只眼（6.66%）后囊轻度混浊;400组2只眼（8%）后囊膜皱褶,3只眼（12%）后囊轻度混浊,随诊观察至6个月病情无进展。结论白内障超声乳化吸除联合Bigbag人工晶状体植入术治疗高度近视是一种安全、有效的手术方法。Big-bag人工晶状体不但可获得与其它人工晶状体相同的良好视力,还可对后囊膜起到相对稳定的支撑作用,减少并发症的发生。     

Simultaneous corneal laceration repair, cataract removal, and posterior chamber intraocular lens implantation.

Frequently, patients with lens laceration or traumatic cataract coincident with corneal laceration, or both, must undergo two separate procedures-primary repair of the corneal laceration and secondary lens removal with or without intraocular lens implantation. We performed simultaneous corneal laceration repair, extracapsular cataract extraction, and posterior chamber lens implantation in seven patients with lacerating ocular injuries who met inclusion criteria for this procedure. With average follow-up of 10 1/2 months, all seven patients achieved visual acuity of 20/40 or better with spectacle correction. YAG posterior capsulotomy was the only additional procedure. One patient had macular pigmentation consistent with either traumatic or photic maculopathy. There were no other complications attributable to the surgical procedures. We believe that certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and lens implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording more timely visual rehabilitation.     

Corneal laceration by sharp objects in children seven years of age and younger

PURPOSE: Young children are prone to develop amblyopia after penetrating injury. We sought to evaluate the management of penetrating corneal injury without intraocular foreign body (IOFB) in children 18 months. Data retrieved included all details from the initial examination, surgical procedures, amblyopia prevention measures, and final visual acuity. RESULTS: Twenty children eligible for the study were identified. The mean age was 4.3 years, and mean follow-up time was 58 months. The corneal wound size range was 1-10 mm, with 8 eyes having wounds >or=6 mm. All patients required primary surgical management. Traumatic cataract extraction was performed at the primary operation in 6 eyes, with intraocular lens (IOL) implantation in 4 eyes. Additional surgical procedures were performed in 12 eyes. Yttrium-Aluminum-Garnet (YAG) capsulotomy was performed in 3 eyes with secondary cataract. Twelve patients required spectacle or contact lens correction, and 11 patients had patching for amblyopia prevention. At the end of follow-up, visual acuity was 20/40 or better in 14 eyes, 20/50 to 20/100 in 4 eyes, no light perception (NLP) in 1 eye, and unknown in 1 eye. CONCLUSIONS: Proper management of penetrating corneal injury in young children can result in excellent visual rehabilitation. Major measures include prompt traumatic cataract extraction with either primary or secondary IOL implantation, opening of posterior capsular opacification with YAG laser, correction of refractive errors, and patching for amblyopia prevention.     

Cataract surgery in patients with Behçet's disease

PURPOSE: To evaluate the outcomes and complications of cataract surgery in patients with Beh?et's disease. SETTING: Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey. METHODS: Thirty-three eyes of 26 patients with Beh?et's disease that had extracapsular cataract surgery between January 1993 and July 1999 were analyzed retrospectively. The mean age of the patients was 38.9 years (range 20 to 54 years). The mean postoperative follow-up was 22.9 months (range 6 to 66 months). RESULTS: Extracapsular cataract extraction (ECCE) was performed in 22 eyes with and in 6 eyes without intraocular lens (IOL) implantation. Phacoemulsification with IOL implantation was performed in 5 eyes. Postoperatively, the visual acuity was better in 29 eyes (87.8%) and was 0.5 or better in 14 eyes (42.4%). Posterior segment complications of Beh?et's disease, mainly optic atrophy and macular alterations from preoperative inflammatory episodes, restricted final acuity. No significant difference was detected in postoperative inflammation among the types of surgery; that is, ECCE, ECCE with IOL implantation, and phacoemulsification with IOL implantation. A neodymium:YAG laser posterior capsulotomy was performed in 3 cases. CONCLUSIONS: In patients with Beh?et's disease, inflammation after extracapsular surgery was mild when surgery was performed after at least 3 months of no inflammatory signs. The results show that the outcomes of extracapsular cataract surgery mainly depend on the degree of preoperative posterior segment involvement.     

角膜屈光矫正手术后白内障手术

目的:探讨角膜屈光矫正手术后白内障手术的诊疗特点。方法:对2005/2008年间于我院就诊的4例角膜屈光矫正手术后白内障患者行白内障超声乳化吸出术+人工晶状体植入术。依据患者提供的角膜屈光手术资料,分别采用临床病史法或角膜后表面曲率法计算矫正角膜曲率及人工晶状体度数。术后随访观察角膜情况、手术并发症、裸眼视力、最佳矫正视力、术后屈光状态等。结果:术后最佳矫正视力较术前明显提高。术后稳定屈光度与手术前预留屈光状态比较误差范围为-1.00～+1.25D。结论:对角膜屈光手术后的白内障患者施行白内障超声乳化吸出术+人工晶状体植入术是可行的。然而只有了解这类患者病情特点,掌握手术前后诊疗方法,准确计算人工晶状体度数,才能达到满意的疗效。     

外伤性白内障人工晶状体植入手术时机及方法的探讨

目的探讨外伤性白内障的手术时机的选择。方法对我院2008年7月～2011年8月收治的52例52眼外伤性白内障,根据其年龄、晶状体外伤性质、其他部位外伤情况及炎症反应程度,选择时机进行白内障摘出联合人工晶状体植入术。伴有角膜裂伤者,先缝合伤口,视情况进行一期或者二期白内障手术;晶状体囊破口较小及挫伤性白内障,待皮质浑浊较充分后进行手术;外伤后炎症反应较重者,先控制炎症,于(1-2)周内手术;晶状体皮质膨胀突出于前房接触角膜及引起严重炎症反应或继发青光眼者,则立即进行手术。采用白内障吸出、囊外摘出或玻璃体晶状体切除联合后房人工晶状体一期植入手术方法。52眼中,一期人工晶状体植入35眼,二期植入17眼,均为后房人工晶状体。结果术后视力0.05以上者占96.15%,0.3以上者占67.31%,0.5以上者占36.54%,1.0以上者占3.85%。结论正确掌握白内障的手术时机,及时处理术中术后并发症,复杂的外伤性白内障术后仍能获得较好的视力,并能促进恢复双眼单视功能。     

Toric Intraocular Lens Implantation for Correction of Astigmatism in Cataract Patients with Corneal Ectasia

Our purpose was to examine the long-term efficacy of toric intraocular lens (IOL) implantation in cataract patients with high astigmatism due to corneal ectasia, who underwent phacoemulsification cataract surgery. Five eyes of 3 cataract patients with topographically stable keratoconus or pellucid macular degeneration (PMD), in which phacoemulsification with toric IOL implantation was used to correct high astigmatism, are reported. Objective and subjective refraction, visual acuity measurement and corneal topography were performed in all cases before and after cataract surgery. In all cases, there was a significant improvement in visual acuity, as well as refraction, which remained stable over time. Specifically, in subjective refraction, all patients achieved visual acuity from 7/10 to 9/10 with up to −2.50 cyl. Corneal topography also remained stable. Postoperative follow-up was 18–28 months. Cataract surgery with toric IOL implantation seems to be safe and effective in correcting astigmatism and improving visual function in cataract patients with topographically stable keratoconus or PMD.Key words: Phacoemulsification, Keratoconus, Pellucid marginal degeneration, Toric intraocular lens, Intraocular lens, Astigmatism     

Pediatric cataract extraction with intraocular lens implantation: visual acuity outcome when measured at age four years and older.

PURPOSE: Assessment of visual outcome of pediatric eyes that underwent cataract extraction with primary intraocular lens (IOL) implantation at a single center. METHODS: A retrospective review of charts of 510 consecutive pediatric patients that underwent cataract extraction was performed. Exclusion criteria were traumatic cataract, secondary IOL implantation, retinopathy of prematurity, severe developmental delay, age less than 4 years at last follow-up, and follow-up less than 6 months. In bilateral cases, only right eye data were included. RESULTS: One hundred thirty-nine eyes met inclusion criteria. Median age at surgery was 5.12 years (range, 0.03-16.92); median age at last follow-up was 9.05 years, and median follow-up was 3.65 years. Sixty-six of 139 (47.5%) patients had unilateral cataracts compared with 73/139 (52.5%) bilateral cases. The median visual acuity of all eyes was 20/30, with median visual acuity of unilateral and bilateral cases being 20/40 and 20/25, respectively. Older patients achieved better visual acuity (unilateral cases: p = 0.003; bilateral cases: p = 0.07). Eyes with a greater interocular axial length difference achieved poorer visual acuity. Forty-five patients had a final visual acuity worse than 20/40. Of these, 34 (76%) had a diagnosis of amblyopia as the sole cause. Nineteen of 139 (13.7%) eyes had final visual acuity worse than 20/200. Eighteen patients required strabismus surgery, and 22 required additional intraocular surgery. CONCLUSIONS: Better visual acuity was associated with bilateral cataract, older age at surgery, and normal interocular axial length difference. Amblyopia was the major cause of residual visual deficit.     

Secondary intraocular lens implantation of traumatic cataract in open-globe injury

BACKGROUND: The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. METHODS: A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. RESULTS: The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was -0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. INTERPRETATION: The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.     

Toric intraocular lenses for correcting astigmatism in 130 eyes

OBJECTIVE: This study evaluated the results after implantation of toric intraocular lenses (IOLs) to correct preexisting corneal astigmatism in patients undergoing either cataract or clear lens extraction surgery. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred thirty eyes of 99 patients who underwent phacoemulsification and posterior chamber toric IOL implantation from January 1997 through February 1998 were included in the study. INTERVENTION: Implantation of a toric IOL was performed after cataract surgery (122 eyes) or clear lens extraction surgery (eight eyes). Both preoperative corneal cylinder and refractive cylinder powers were more than 1.50 diopters (D) for all the eyes included in this study. To provide a comparison, we also studied 51 eyes of 45 patients meeting the same preoperative criteria for degree of corneal and refractive cylinder who underwent implantation of a spherical (nontoric) IOL combined with limbal relaxing incisions. The data for both study and comparison groups were analyzed retrospectively. The selection for the two groups was arbitrary. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), mean spherical equivalent, residual refractive cylinder, and toric IOL axis. RESULTS: In the toric IOL group, 84% of eyes achieved 20/40 or better UCVA. In the spherical IOL group, 76% achieved 20/40 or better UCVA. The mean postoperative refractive cylinder was -1.03 +/- 0.79 D in the toric IOL group and -1.49 +/- 0.75 D in the spherical IOL group. CONCLUSIONS: Our results indicate that phacoemulsification and posterior chamber toric IOL implantation is a largely predictable new surgical option to correct preexisting corneal astigmatism in cataract or clear lens extraction surgery.     

Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.     

Factors influencing visual outcome after penetrating keratoplasty combined with intraocular lens implantation

PURPOSE: To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. METHODS: This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 +/- 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined t with an exchange of OL, and 23 penetrating keratoplasties combined with a secondary implantation of posterior chamber lens. Mean follow-up was 28.3 +/- 18.7 months (range 3.3-112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and agin in visual acuitvy RESULTS: Mean postoperative visual acuity and mean gain in visual acuity were 0.33 +/- 0.21 (median 0.30) and 0.25 +/- 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129 /135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p < 0.005), reason for keratoplasty (p < 0.005), and diameter of the graft (p = 0.046). ostoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. CONCLUSIONS: The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.     

儿童双眼先天性白内障人工晶状体植入术后眼轴长度和屈光状态的变化

目的　探讨儿童双眼先天性白内障摘除人工晶状体植入术后眼轴长度和屈光状态的变化情况。方法　对38例(76只眼)已行白内障摘除、前后环形撕囊、前段玻璃体切除、晶状体囊袋内人工晶状体植入术的双眼先天性白内障患儿进行回顾性研究。按手术年龄分为2 ~3岁(A组)、4~5岁(B组)、6~7岁(C组)、8~12岁(D组)4组,检测术前和术后5年术眼的眼轴长度和角膜屈光力、术后1个月和5年的屈光状态,分析视力预后与眼轴长度和屈光状态变化的关系。结果　4组平均屈光度数变化分别为-2. 06、-1 .81、-0 .56及-0. 25D,差异有统计学意义(P<0. 01);眼轴长度平均增长1. 21、1 .13、0. 47及0 .34mm,差异有统计学意义(P<0 .01)。各组手术前、后角膜屈光力比较,差异均无统计学意义(P>0. 05)。术后50只眼( 65. 8% )最佳矫正视力≥0 .5。术后最佳矫正视力与屈光度数变化和眼轴长度变化无相关性(P>0. 05)。结论　双眼白内障摘除、前段玻璃体切除、晶状体囊袋内人工晶状体植入术可安全、有效治疗儿童双眼先天性白内障;术后屈光状态出现向近视方向移动的趋势,眼轴长度接近同龄正常儿童,屈光度数和眼轴长度的变化随手术年龄的增大而趋于稳定。2~5岁患儿双眼人工晶状体度数的选择应以低度欠矫为宜。