高度近視眼合并白内障超聲乳化摘除術

目的觀察高度近視合并白内障超聲乳化摘除及人工晶狀體植入術的療效.方法對72例(79眼)高度近視白内障患者術前檢查眼軸長,計算人工晶狀體屈光度,經鞏膜隧道切口行超聲乳化摘除及人工晶狀體植入術,對術后視力及并發症進行觀察.結果 79眼術后視力不同程度提高,術后1月視力≥0.5者48眼,＜0.3者13眼,高度近視合并眼底病變是白内障術后視力不佳的原因.結論白内障超聲乳化摘除聯合人工晶狀體植入術是高度近視合并白内障較理想的手術方式,及早抓住手術時機,可以减少手術并發症的發生,獲得良好的手術效果.     

自體眼表移植術治瘵翼狀胬肉

目的觀察自體角膜緣(幹細胞)及球結膜的眼表移植衍治瘵翼狀胬肉的瘵效.方法對38例42眼進行期翼狀胬肉采用自體角膜緣及球結膜移植術治瘵.術後隨隨訪5～18個月.結果 41眼移植片Ⅰ期愈合,角膜上皮穩定,無胬肉復發.1眼由于取結膜植片過小,植片皺縮,出現胬肉組織潜在復發可能,占2.38%.結論自體角膜緣及球結膜移植衍治瘵翼狀胬肉是一種安全而有效地阻止胬肉復發的手衍.     

晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂的臨床觀察

目的改善穿通性眼外傷伴晶狀體后囊破裂患者的預后.方法對14例眼球穿通傷伴晶狀體后囊破裂的患者縫合角鞏膜后行晶體玻璃體切割.結果對14例患者隨訪6～24個月,平均11.5個月.術后隨訪最終矯正視力範圍0.06～1.0,其中≥0.4者8眼.結論晶狀體玻璃體切割治療角鞏膜穿通傷伴晶狀體后囊破裂患者,具有能夠恢復有用視力,并發症少的理想效果     

非超聲乳化小切口白内障摘出及人工晶狀體植入術171例

探討小切口非超聲乳化白内障摘出及人工晶狀體植入術臨床效果.方法采用上方角膜緣後2mm反眉形1/2層鞏膜隧道小切口進行手法碎核及人工晶狀體植入,鞏膜切口不縫或縫一針.結果術後3個月視力≥0.2占98.7%,≥0.5占83.5%,≥0.8占48.3%;衍後并發角膜水腫42祗眼,前房出血和上瞼下垂各1例.結論小切口無縫綫人工碎核白内障摘出及人工晶狀體植入費用小,操作簡單,省時安全,衍後視力恢復快.     

關于眼屈光調節機制的探討--晶體移位説和二元調節論

人眼能看清遠近不同距離的物體,是需要進行屈光調節的.我们發現,調節的方式不是通過晶體燮形來實現,而是通過晶體移位來實現看遠時晶體向前移位,看近時晶體向後移位--晶體移位説.但這不是屈光調筋機制的全部内容,屈光調節機制還包括視遠共轭調節(視角調節)和視近共轭調筋(焦距調節)的作用--二元調節論.晶體移位説和二元調節論,構成了眼屈光調節機制的全部内容.用這個調節理論,可以重新認識屈光狀態的定義,修正晶體燮形説的偏見,并且對青少年近視的成因舆老視現象等做了全新的解釋.     

創傷性眼瞼退縮的手術治瘵

創傷性眼瞼退縮是指眼瞼外傷或手術後雙眼正視前方時上瞼缘高度超過角鞏膜缘下2mm,下瞼缘高度低于角鞏膜缘,造成瞼裂增寬,眼球下轉時眼瞼不能跟随下移等眼瞼位置异常的一種病癥.我們自1996～2000年采用手術方法治瘵創傷性眼瞼退縮12例,取得了滿意瘵效,現報告如下.     

白内障超聲乳化摘出及人工晶狀體植入術在高度近視白内障患者中的應用

目的觀察高度近視患者白内障超聲乳化摘出及人工晶狀體植入術的療效.方法本組高度近視白内障患者(眼軸26.05～33.87mm)62例(65衹眼),采用鞏膜隧道切口及原位超聲乳化(分而治之或攔截甓裂法)吸出,囊袋内植入硬質人工晶狀體.結果術後3天矯正視力≥0.5者29祗眼( 44.62%),0.2～0.4者31衹眼(47.69%),≤0.1者5衹眼7 69%).術後1個月矯正視力≥0 5者41祗眼(63.08%).0.2～0.4者20衹眼(30.77%),≤0.1者4衹眼(6.15%).并發癥為虹膜損傷(1.54%)、後囊破裂(3.07%)及角膜水腫(30.76%).結論白内障超聲乳化聯合後房人工晶狀體植入術適合高度近視白内障.并能獲得良好的手術效果.     

双眼同时白内障囊外摘除及后房型人工晶體植入术

目的 觀察雙眼同時白内障囊外摘除及后房型人工晶狀體植入的手術效果。方法 106例212眼同時進行現代白内障囊外摘除及后房型人工晶狀體植入術,術后觀察視力、角膜、前房、瞳孔、人工晶狀體、后囊、眼壓及眼内炎症情况。结果 雙眼同時手術后視力0.3以上192眼,占90.6％,效果好,并發症少。結論 雙眼同時手術方法簡便、實用、费用低,術后同時雙眼恢復了有用視力及雙眼單視功能。尤其在邊遠貧困地區值得推廣應用。     

復合性眼内异物傷的聯合手術

目的探討復合性眼内异物傷的各種聯合手術方法,統計其結果.方法對眼内异物傷伴有角膜瘢痕、外傷性白内障、玻璃體渾濁、PVR、牽引性視網膜裂孔、視網膜脱離或和眼内炎等,分别進行异物摘出與晶狀體切除、玻璃體切除、視綱膜復位、人工晶狀體植入、角膜移植等三聯、四聯或五聯手術.術後隨訪觀察,統計效果.結果復合性磁性及非磁性眼内异物傷45例(45眼)其中36例(80%)術後視力達0.5～1.0.術後視力達0.05者42例(93.33%).結論合并晶狀體、玻璃體、視綱膜或/及角膜外傷的復合性眼内异物傷,進行聯合手術是安全的,效果良好,視力恢復尚滿意.關鍵詞眼内异物傷聯合手術     

自體角膜缘上皮移植聯合缘裂霉素C治瘵翼狀胬肉的臨床觀察

目的評價自體角膜缘部上皮移植聯合絲裂霉素C治瘵原發舆復發性翼狀胬肉的瘵效,尋找一種有效地預防胬肉後發的手術方法.方法采用胬肉切除、應用濃度爲0.1mg/ml、0.2mg/ml的絲裂霉素C貼敷,以及用带有角膜缘部上皮的自體結膜瓣移植的聯合方式,治瘵原發舆後發性胬肉58例(66眼).結果随訪5個月～2年,平均10個月.3眼術後復發,復發率爲4.55%.術中及術後無嚴重并發癥發生.結論自體角膜缘上皮移植,辅加藥物絲裂霉素C治瘵翼狀胬肉是一種防止術後復發的有效方法.     

老视理论及治疗进展

老视是一种常见的眼部退行性病变,表现为年龄相关性调节力下降,它影响到每一个老年人。随着全新的Schachar调节理论的提出以及传统理论的发展,近年来出现了多种老视治疗方法。目前除了通过各种框架眼镜和接角镜来矫正老视,还可以应用手术方法如前睫状区巩膜切开样(AGS)以及巩膜扩张(SRP)来恢复调节能力。采用人工晶状体植入形成单眼视,多焦点人工晶状体,可调节型人工晶状体,LASIK手术也都是可行的老视治疗措施。本文总结了目前有关老视的各种机制和治疗方法。     

Lens Refilling

Cataract surgery has developed into a very safe and highly reproducible procedure but the ultimate goal to also restore physiological accommodation has not yet been achieved. A variety of accommodative intraocular lenses (IOLs) and surgical techniques have been suggested to cure presbyopia but all showed only poor accommodative effects by objective measurements. Complete lens refilling with flexible polymers might be an interesting alternative. Recent investigations on accommodation and presbyopia have given support to the lens refilling method. After development of suitable surgical techniques and filling materials only secondary cataract formation and the unsolved intraoperative control of refraction restrict the clinical use of this technique.     

Dynamic aberrometry during accommodation of phakic eyes and eyes with potentially accommodative intraocular lenses

Since the introduction of potentially accommodative intraocular lenses (IOLs), it was hard to perform an objective evaluation of the accommodative amplitude in pseudophakic eyes. Laser interferometric measurements were performed to evaluate anterior chamber depth changes, which provides information on the functionality of potentially accommodative IOLs. By means of wavefront analysis, the dynamic behaviour of potentially accommodative IOLs can be determined. All measurements in this study were performed using a Hartmann-Shack aberrometer at a frequency of 7 Hz. Six to 8 weeks after implantation of potentially accommodative IOLs (CrystaLens AT-45, C&C Vision, 1CU, Humanoptics), 43 eyes were investigated using this dynamic wavefront analysis. Patients focussed at a distance target for 10 s, followed by focussing at a near target for 10 s and then again at a distance target for a further 10 s. During these 30 s, a total of 200 single measurements were performed. The same measurements were also conducted in healthy eyes of young persons as well as in eyes after implantation of standard IOLs for comparative purposes. The dynamic course of changes in low-order aberrations (defocus, astigmatism) as well as high-order (e.g., fourth-order spherical aberration) were analysed. Dynamic wavefront analysis allowed objective and observer-independent measurement of changes in accommodation in phakic and pseudophakic eyes. Dynamic aberrometry is capable of objectively quantifying the effect of any surgical option for the treatment of presbyopia. We recommend use of this technology in addition to the common psychophysical examinations to attain objective information on the efficacy of the treatment modality used.     

New intraocular lens technology

PURPOSE: To review the current status of phakic intraocular lenses (IOLs), intraocular treatment of presbyopia, and IOLs that filter some blue light. DESIGN: Review of current information on the subject from numerous sources. METHODS: Medline search and Internet search engines on the topics of phakic IOLs, presbyopia or multifocal IOLs, and blue light and macular degeneration. RESULTS: An iris fixated phakic IOLs is now approved in the United States (US). There are concerns for corneal endothelial stability and late dislocation. Other approaches include anterior chamber fixation with concerns of corneal endothelial stability and pupil elongation, and posterior chamber fixation with concerns of cataract formation, IOL dislocation, and pigment dispersion. Intraocular treatment of presbyopia includes monovision, multifocal, and accommodative IOLs. Which approach is superior today is still not clear. There are IOLs designed to block some blue light to potentially lessen the risk of age-related macular degeneration (ARMD). While there is presumptive evidence of this, no definitive study shows such a correlation. Color perception issues are unlikely to be a problem. While decreased scotopic vision has been proposed, there is no study that proves this is an issue of clinical significance. CONCLUSIONS: The IOL field is dynamic with many new choices. Phakic IOLs and treatment of presbyopia will be an increasingly important part of ophthalmology; however, there are important unresolved issues. With better evidence that blue light is an important variable in ARMD, such an approach could rapidly become the standard.     

Comparison of the behavior of natural and refilled porcine lenses in a robotic lens stretcher

The mechanism by which the eye dynamically changes focal distance (accommodation), and the mechanism by which this ability is lost with age (presbyopia), are still contested. Due to inherent confounding factors in vivo, in vitro measurements have been undertaken using a robotic lens stretcher to examine these mechanisms as well as the efficacy of lens refilling - a proposed treatment for presbyopia. Dynamic forces, anterior and posterior curvatures, and lens thickness are all correlated for young natural and refilled porcine lenses. Comparisons are made to lenses refilled with a homogeneous polymer system. The amplitude of accommodation of the young porcine lens is very small such that it may be a suitable model for presbyopia. The behavior of refilled lenses was highly dependent on the refill volume. The volume could be tuned to maximize accommodative amplitude in the refilled lens.     

The IOL horizon: accommodative intraocular lenses.

BACKGROUND: For more than half a century, intraocular lenses have been used effectively to correct vision after cataract extraction. New developments in intraocular lens design have led to the creation of lenses that may have a significant role in the restoration of accommodation as well. PURPOSE: Accommodative lens technology is constantly evolving. Many different lens designs are currently under development. It is important for optometrists to be familiar with this technology and the various lenses being developed, as accommodative intraocular lenses stand to become the mainstay for cataract surgery, as well as for the surgical treatment of presbyopia. METHOD: The literature is reviewed in order to summarize the developments in accommodative lens technology.     

Akkommodation und Presbyopie

There are two basic approaches for the surgical correction of presbyopia: increasing depth of focus (e.g. by means of multifocal laser abrasion of the cornea), Or restoring accommodation in the sense of a dynamic change in ocular refraction (accommodative intraocular lenses, scleral expansion). Pseudoaccommodative procedures are able to achieve satisfactory near vision, albeit at the price of lower performance in the intermediate range and decreased image quality. The restoration of accommodation remains problematic, partly because the mechanism of accommodation and the development of presbyopia are still not fully understood. Some surgical procedures are based on concepts, the validity of which is not confirmed or which even contradict experimental evidence. Thus, it is necessary to assess the results and presumed mechanisms critically and objectively.     

Accommodation and presbyopia : part 2: surgical procedures for the correction of presbyopia

There are two basic approaches for the surgical correction of presbyopia: increasing depth of focus (e.g. by means of multifocal laser abrasion of the cornea), Or restoring accommodation in the sense of a dynamic change in ocular refraction (accommodative intraocular lenses, scleral expansion). Pseudoaccommodative procedures are able to achieve satisfactory near vision, albeit at the price of lower performance in the intermediate range and decreased image quality. The restoration of accommodation remains problematic, partly because the mechanism of accommodation and the development of presbyopia are still not fully understood. Some surgical procedures are based on concepts, the validity of which is not confirmed or which even contradict experimental evidence. Thus, it is necessary to assess the results and presumed mechanisms critically and objectively.     

可调节人工晶状体的研究进展

在白内障手术后老视问题的各种解决方法中,可调节人工晶状体(accommodating intraocular lenses,IOL)能够提供不戴镜的近、中、远视力,这些IOLs利用焦点的移动来进行调节。本文通过对其设计原理、发展历程、选择依据、材质比较、临床研究等多方面探讨,全面分析可调节人工晶状体,并对其未来发展进行展望。     

Accommodative intraocular lenses: current status

PURPOSE OF REVIEW: The possibility of using a monofocal IOL with accommodative ability allows refractive cataract surgery with a clearly decreased potential of photic phenomena. Three IOLs of different designs and materials have demonstrated accommodative ability, but the degree of accommodative amplitude has been reported to different extents and variabilities. The plate-haptic CrystaLens has a hinged design that might permit forward movement of the optic as a result of pressure changes in the vitreous cavity. The 1CU has modified haptics that bend in the bag as the lens capsule contracts, which are supposed to cause anterior displacement of the lens optic. With the dual-optic one-piece Synchrony, springlike haptics separate a high-plus anterior lens from a posterior minus lens. With accommodative effort, the capsular bag expands and the springs express kinetic energy, which might allow the optics to separate as the anterior lens moves forward. RECENT FINDINGS: This article seeks to clarify and distinguish the concepts of true accommodation and pseudo accommodation. Current designs of accommodative IOLs are supposed to work by the focus-shift principle to allow true pseudophakic accommodation. Studies that biometrically assessed optic shift found no or only low amplitudes of forward movement. The amount of forward movement, if present, was highly variable between patients. To date, most studies present psychophysical data for the proof of concept, which alone seems insufficient. Capsule bag performance and posterior capsule opacification with accommodative IOLs seem worse than those with standard intraocular lenses. SUMMARY: The potential clinical benefits of accommodative IOL technology for both cataract patients and refractive patients may place accommodative IOLs in a competitive position with multifocal IOL technology.