Broken intraocular lens during cataract surgery.

A case of planned routine extracapsular cataract extraction is described where surgery was complicated peroperatively by fracture of the posterior chamber lens implant. The technique of lens implantation is discussed.     

Systemic levels of lidocaine after intracameral injection during cataract surgery.

PURPOSE: To evaluate the systemic concentrations of lidocaine after intracameral injection of a 1% solution during cataract surgery and the safety of this application mode. SETTING: Department of Ophthalmology, Medical University of Lübeck, Lübeck, Germany. METHODS: This prospective study included 10 patients who had phacoemulsification and posterior chamber lens implantation with a self-sealing scleral tunnel incision. Topical anesthesia was achieved using cocaine 10% eyedrops combined with 0.5mL of unpreserved lidocaine 1% injected into the anterior chamber. Blood samples were taken from all patients at predetermined intervals before and during the procedure. Consecutive analysis for lidocaine was performed with gas chromatography. RESULTS: In all samples, serum lidocaine concentrations were below a minimum detectable level of 100 ng/mL. No local or systemic intraoperative or postoperative complications were noted. CONCLUSIONS: Intracameral injection of 0.5 mL lidocaine 1% revealed no systemic therapeutic concentrations. In patients in whom other forms of needle-delivered local anesthesia are contraindicated, intracameral injection of lidocaine should be considered to enhance topical anesthesia.     

壳多糖在白内障人工晶状体植入术中的应用

比较壳多糖与透明质酸钠作为粘弹剂在白内障人工晶状体手术中的作用。方法对１４０例白内障随机分组,分别彩和ＥＣＣＥ＋ＩＯＬ或超声乳化吸出ＩＯＬ两种手术方法。７０眼术中用壳多糖作为粘弹剂使用,７０眼用透明质酸钠作为对照。结果术后矫正视力,角膜内皮,前房反应以及眼压变化,壳多糖组与透明质酸钠组均无显著差异。     

The role of intraocular lenses in anterior chamber contamination during cataract surgery

Background: Bacterial endophthalmitis is a rare vision-threatening disease, usually caused by microorganisms that are natural inhabitants of the eye lids and conjunctiva. This study was conducted to investigate the role of intraocular lenses (IOLs) in introducing bacterial contamination into the eye during cataract surgery and the efficacy of povidone-iodine solution in prevention this ocular inoculum. · Methods: Fifty patients underwent routine cataract surgery and intraocular lens implantation. One group of the patients was pretreated with external disinfection using povidone-iodine 4% before surgery, while the other group was only pretreated with saline irrigation. Before IOL implantation, a test IOL was placed on the conjunctiva and taken for microbiological studies. Anterior chamber tap was done at the beginning and at the end of each operation. Positive bacterial growth was followed by bacterial identification and sensitivity tests to various antibiotics. · Results: Bacterial growth was obtained in 14 of the 50 eyes (28%); in 5 eyes the organism was cultured from tapped aqueous and in 9 eyes from the test IOLs. Prophylactic use of povidone-iodine 4% solution effectively reduced the contamination rate from 34.7% to 16.7%. Coagulase-negative staphylococci were the most common organisms isolated (72%). Most organisms were sensitive to vancomycin (86%) and to fucidic acid (71%). There were no cases of clinical endophthalmitis. · Conclusions: IOLs are apparently potential vehicles for introduction of intraocular bacterial contamination. Instillation of povidone-iodine 4% into the cul-de-sac reduces the risk of bacterial inoculum. Vancomycin is the most effective single agent against intraocular contamination. In order to reduce potential intraocular contamination it is advisable to avoid contact between the IOL and ocular tissues. Received: 23 June 1997 Revised version received: 9 October 1997 Accepted: 22 October 1997     

Toric人工晶状体植入矫正角膜散光的疗效观察

目的：观察Toric人工晶状体(intraocular lens, IOL)植入用于治疗合并角膜散光的白内障患者的临床治疗效果。

方法：对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及IOL植入术治疗,进行回顾性分析。其中22眼植入Toric IOL,25眼植入Acrysof IQ IOL。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种IOL的疗效。观察Toric IOL植入后的稳定性。

结果： 术后随访观察6mo,植入Toric IOL的试验组,术后裸眼视力平均0.73±0.37,明显优于植入Acrysof IQ IOL的对照组(平均0.47±0.18),结果有显著性差异。试验组术后裸眼视力0.5以上者占81.8%,优于对照组32.0%。试验组患者术后残余散光0.53±0.40D,明显低于对照组(2.13±0.76D),差异有统计学意义。植入Toric IOL组,随访6mo,术后平均旋转4.22±1.46度。

结论：对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric IOL植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

三焦点人工晶状体植入术后的早期临床效果

目的评价白内障超声乳化联合三焦点人工晶状体（IOL）植入术后的早期临床效果。方法前瞻性自身前后对照研究。选择在大庆油田总医院行白内障超声乳化联合三焦点IOL植入术患者24例（26眼）,术后随访3个月,分别观察术前,术后1周、1个月、3个月的裸眼远视力、裸眼中距离视力和裸眼近视力,以及离焦曲线、对比敏感度（CS）和全眼像差。对手术前后各参数进行重复测量的方差分析。结果三焦点IOL植入术后所有患者1周、1个月、3个月时远、中、近距离均可获得0.3 LogMAR以上的较好视力。术后各距离视力较术前显著提高（P＜0.05）。术后3个月时裸眼远视力接近0 LogMAR,且+1.5~-4.0 D离焦下视力均优于0.3 LogMAR;CS可见术后1周时明视眩光分辨率最好,明视、暗视的分辨率较明视眩光差,暗视眩光分辨率最差,差异有统计学意义（P＜0.05）;术后1周、1个月、3个月时总像差、总低阶像差、离焦深度、散光均较术前明显降低,差异有统计学意义（P＜0.05）。结论三焦点IOL提供了远、中、近兼顾的全程视力,术后视觉质量良好。     

Advances in microincision cataract surgery intraocular lenses

PURPOSE OF REVIEW: This paper reviews the recent developments in microincision cataract surgery intraocular lenses. RECENT FINDINGS: Seven intraocular lenses are currently available for implantation through sub-2.0-mm incision. From the intraocular lenses available, two microincision cataract surgery intraocular lenses were included in clinical studies and their results were reviewed. The available lenses were implanted through a clear corneal incision of 1.5-1.9 mm and showed excellent biocompatibility. The behavior of the microincision cataract surgery in vivo is similar to the conventional lenses in terms of optical quality and retinal image quality. The clinical results of microincision cataract surgery intraocular lenses such as Acri.Smart 48S showed that a certain degree of pseudoaccommodation could be achieved with this lens. SUMMARY: Cataract removal through sub-2.0 mm incision is possible with implantation of microincision cataract surgery intraocular lenses through the same undilated incision. The current technique allows cataract removal through 1.7 mm and the available microincision cataract surgery intraocular lenses showed optical quality and biocompatibility similar to conventional intraocular lenses.     

Premature elevated intraocular pressure after cataract surgery

We evaluated the frequency of elevated intraocular pressure (IOP) the first 1-3 postoperative days for a group of patients undergoing standard or phacoemulsification extracapsular cataract extraction (ECCE). IOP was measured in the pre and postoperative period using non-contact tonometer. From the 356 operated patients, 21 patients (6%) had early elevated IOP. The frequency of elevated IOP was greater among the patients that received anterior chamber (AC) IOL (25%) as compared to that of patients that received posterior chamber (PC) IOL (5.5%). The viscoelastic substance was responsible for a great percentage of cases (51%). The results show that the majority of elevated IOP is transient, recovered spontaneously or by treatment with carbonic anhydrase inhibitors or beta-adrenergic blockers. Elevated postoperative IOP occurs more frequently in the presence of glaucoma, cataract associated with systemic diseases, in complicated and traumatic cataract.     

Toric人工晶状体植入矫正特殊角膜散光的疗效观察

目的：回顾分析Toric(环曲面)人工晶状体植入治疗合并特殊角膜散光的白内障患者的临床治疗效果。

方法：对10例12眼合并特殊角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中4眼为翼状胬肉切除术后,3眼为外伤后角膜散光,5眼为角膜云翳或斑翳患者。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入后的疗效,旋转稳定性。

结果：术后随访观察6mo,术后裸眼视力平均0.62±0.31,最佳矫正视力0.70±0.35。裸眼视力≥0.8者2眼,占17%。裸眼视力≥0.5者9眼,占75%。术后残余散光0.51±0.36D。术后角膜源性散光未见明显改变,全眼总合散光得到明显改善,差异有统计学意义。术后全眼总合散光与术前预计残余散光值接近,无显著性差异。术后6mo旋转度为(3.80±1.46)°。末次随访时间点,植入Toric人工晶状体的12眼中,旋转度小于5°的11眼,占92%。仅1例术后旋转度为6°。

结论：对于某些特殊原因导致角膜散光的白内障患者,经过严格的手术前筛选,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Control of intraocular inflammation associated with cataract surgery

Major advances in cataract extraction techniques and instrumentation have occurred over the past decade. Smaller incisions, more efficient phacoemulsifiers, and decreased surgical times are a few of the changes that have helped to alleviate postoperative inflammation, but postoperative inflammation continues to be a cause of patient discomfort; delayed recovery; and, in some cases, suboptimal visual results secondary to cystoid macular edema. This article reviews the most recent literature regarding the control of intraocular inflammation associated with cataract surgery.     

IOL在婴幼儿白内障手术中的应用

目前,国内外已将白内障摘除和人工晶状体(intraocularlens, IOL)植入作为治疗儿童白内障的首要选择。但是,儿童眼特别是婴幼儿眼的IOL植入一直是眼科界关注的问题。适时的白内障摘除术后IOL植入对于屈光矫正、视功能建立、预防弱视和双眼视功能重建都有极大的作用。然而,有关婴幼儿白内障摘除术后IOL植入问题,在儿童白内障治疗方案上始终存在争议,争议的焦点主要集中在IOL植入的时机问题上。理论上讲,儿童白内障的手术治疗原则是越早越好,目的是去形觉剥夺因素,打开视觉通路,及时植入IOL,促进视觉发育。但如何找到既“早”又安全的IOL植入时间点无疑对患儿视功能的康复是大有益处的,本文就国内外儿童白内障摘除术后IOL植入问题进行综述。     

利多卡因眼内麻醉在白内障术中的应用

应用０．５％利多卡因液眼内麻醉顺利完成３１例白内障囊外摘除联合后房型人工晶体植入术，０．５％利多卡因眼内注射无明显毒性及并发症，我们认为０．５％利多卡因溶液眼内麻醉是白内障手术安全、有效的麻醉方法     

Small-incision cataract surgery using the Perrin intraocular cataract scissors and forceps

An original operative technique for performing extracapsular cataract extraction through a small incision is described. The technique is both inexpensive and simple to perform. Intraocular cataract scissors are used to bisect the nucleus of the cataractous lens, and each of the halves of the bisected nucleus is removed with intraocular cataract forceps. Both the scissors and the forceps have been specifically designed for this task. The incision size of 7.5 mm allows insertion of currently available intraocular lenses. During the procedure viscoelastic is used to protect intraocular structures, in particular the corneal endothelium and the posterior capsule.     

Risk factors for intraocular pressure elevation during the early period post cataract surgery

Japanese Journal of Ophthalmology - To assess the risk factors for intraocular pressure (IOP) elevation during the early period post cataract surgery. Retrospective study. This study involved 1587...