抗青光眼滤过性手术眼的后房型人工晶体植入

为了探讨在已施行抗青光眼滤过手术的白内障眼进行白内障摘除和后房型人工晶体植入的手术方法以及手术对滤过泡的影响。对抗青光眼滤过手术后白内障２１只眼，避开滤过泡，选择了颞下方角膜缘切口进行白内障囊外摘除及后房型人工晶体植入，同时对小而固定的瞳孔进行瞳孔括约肌切开与缝合术。术后视力均有不同程度提高，７６．１９％术眼视力达０．．５，术后平均眼压升高０．４１ｋＰａ，功能滤过泡未见明显疤痕化。对于抗青光眼滤过     

Effect of Intravenous Mannitol on Intraocular Pressure in Vitrectomized Silicone-Oil-Filled Eyes

Purpose: To evaluate the effect of intravenous mannitol (IVM) on intraocular pressure (IOP) in vitrectomized eyes. Methods: Thirty-one patients with raised IOP after retinal surgery with silicone oil injection were included. Patients were administered IVM (20% solution, 1g/Kg, over 30 minutes) and IOP was noted at regular intervals. IOP reduction in vitrectomized eyes (Group 1) was compared with the normal eyes (Group 2). Result: Percentage IOP reduction was higher in Group 1 than in Group 2 at all time intervals, 24.5% vs. 19.2% at 15 minutes (p=0.34), 22.6% vs. 9.8% at 45 minutes (p=0.003), 19.1% vs. 9.9% at two hours (p=0.023), and 16.1% vs. 7.8% at four hours (p=0.04), respectively. In Group 1, 40% eyes had an IOP reduction of 2–6 mmHg while 30% eyes had IOP reduction >6 mmHg at four hours post-IVM. Conclusion: IVM is useful for short-term IOP reduction in vitrectomized eyes. IOP reduction is independent of baseline IOP, and sustained and higher as compared to normal eyes.     

Artisan Phakic Intraocular Lens for Correcting High Myopia

Objectives: To evaluate the safety indexes and efficacy of Artisan phakic intraocular lens (IOL) for the correction of high myopia. Methods: Retrospective interventional case series reports. Thirty-one eyes (22 patients) with myopia from −5.25 to −19.00 diopters underwent implantation of an Artisan phakic IOL. Follow-up examinations were performed at 1 day, 1 week, 1 month, and 3 months. The following parameters were recorded: manifest refraction, slit-lamp examination, applanation tonometry, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), complications or adverse reactions. The primary variable was the refractive outcome at 3 months. Secondary variables were change in BSCVA, and efficacy and safety indexes. Results: At 3 months, mean spherical equivalent was −0.50 ± 0.36 diopters (range, −1.25 – plano). In 29 eyes (93.5%) UCVA was 6/12 or better; the other three eyes had UCVA of 6/15. The difference between preoperative and 1 week postoperative BSCVA was not statistically significant (p=0.25). Comparison of BSCVA at 1 week and at 1 month was statistically significant (p=0.05); this difference was even more significant at 3 months (p=0.01). The BSCVA remained the same or improved for all the eyes. BSCVA for 20 eyes (64.5%) had improved one or more lines in visual acuity. Mean endothelial cell loss at 3 months was 3.96%. Conclusion: The Artisan lens is a safe, predictable, and efficacious method to correct high myopia. Postoperative gain in BSCVA was achieved for the majority of eyes. Future study to assess safety indexes and risk of complications is required with long-term follow-up.     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

Hydrophobic Acrylic Intraocular Lens in Both Eyes

 PURPOSE: To report on the clinical findings of a case of late opacification of the hydrophobic acrylic intraocular lens (IOLs) in both eyes after cataract surgery. METHODS: A 79-year-old man with a history of decreased visual acuity and complaints of glare and blurred vision in both eyes over the past 3 years. He had received an uneventful phacoemulsification combined with posterior chamber IOL implantation for senile cataract in both eyes 13 years ago, and had undergone neodymium:YAG(Nd:YAG) laser posterior capsulotomy on both eyes 6 years ago, for posterior capsular opacification (PCO). The optical portion of the IOLs showed uniform gray haze. Binocular posterior capsular laser holes were clearly noted. RESULTS: IOL exchange was performed by the same surgeon on both eyes, three days apart. Postoperatively, the patient's visual acuity was elevated to 6/12 (OD) and 6/9 (OS) at 6 months, and intraocular pressure (IOP) reached 16.8 mmHg (OD) and 18.4 mmHg (OS). Neither glare or blurred vision were observed in either eye. CONCLUSION: IOL exchange can be used to effectively manage clinically significant optic opacification.       

Two-Year Follow-Up of Artisan Iris-Supported Phakic Anterior Chamber Intraocular Lens for Correction of High Myopia

Purpose: To evaluate the results of Artisan iris-supported phakic anterior chamber intraocular lens (pIOL) implantation in patients with high myopia. Methods: Medical records of patients who underwent Artisan pIOL implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a two- year follow-up were included. Spherical equivalent of manifest refractive error (SE), uncorrected visual acuity (UDVA), distance corrected visual acuity (CDVA), and endothelial cell density (ECD) were analyzed at six months, one year, and two years after surgery. Results: Sixty-two eyes of 42 patients were included in the study. All patients had a minimum anterior chamber depth of 3.0?mm from the endothelium. At two years, 68% of the patients were within ±0.50 D. Mean ECD was 2723?±?311 cells/mm² preoperatively and 2630?±?291 cells/mm² at six months postoperatively (3.4% loss, p?=?0.001). ECD loss from six months postoperatively to two years postoperatively was not statistically significantly different. In three eyes (4.8%) of two patients, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected. Conclusion: Artisan pIOL implantation is a safe and highly effective procedure for surgical correction of high myopia. ECD loss stabilizes in the early postoperative period.     

Retinal Detachments Following Intraocular Lens Implantation

Pseudophakic retinal detachments are more difficult to manage than the phakic variety, primarily because of increased difficulties in visualizing the peripheral retina. A review of the characteristics of 70 pseudophakic retinal detachments revealed that they were similar to those following routine cataract extraction, although we noted a mild tendency for periretinal membrane formation to be more commonly associated with the former group. Despite problems in viewing pseudophakic detachments, our data suggest that their repair rate closely approximates that for aphakic eyes, assuming allowances are made for the number of cases with significant peri retinal membranes that are accepted for surgery. Visual results following successful surgery may be somewhat lower than those in comparable aphakic eyes.     

人工晶体植入术后复视

目的:本文报道7例人工晶体植入术后复视病例,并初步探讨其原因及预防。方法:随访60例单侧白内障摘除及人工晶体植入术连续病例。复视病例,检查复视类型、眼位、眼球活动度、屈光状态、瞳孔及眼底,并散瞳检查人工晶体位置。结果:本文报告白内障摘除及人工晶体植入术后复视发生率为11.67％。术前存在斜视,双眼融合功能障碍,局麻药物对眼外肌的毒性作用,人工晶体中心偏移,黄斑部病变及晶体后囊不均匀混浊等与术后复视有关。结论:复视是白内障摘除及人工晶体植入术后一个重要的并发症。其治疗往往较困难,根据复视的可能原因,采取预防措施对减少术后复视有帮助。眼科学报1997;13:210—212。     

玻璃体切割术后无晶状体眼的人工晶体植入术探讨

目的探讨对玻璃体切割术后无晶体眼进行二期人工晶体植入的安全有效的方法。方法对48例此类患者中15例周边囊膜保留良好者行透明角膜隧道切口植入三片式可折叠人工晶体,余33例在后房灌注下缝线固定人工晶体。结果48例均在安全稳定的眼内压条件下完成手术,并显著提高了视力。结论透明角膜隧道切口人工晶体植入和灌注下人工晶体二期缝线固定术是治疗玻切术后无晶体眼的安全有效的方法。     

Surgical Therapy for Chronic Aphakic Cystoid Macular Edema

Aphakic cystoid macular edema (ACME) is a common condition seen after intracapsular cataract extractions. In an overwhelming majority of these cases, the condition improves spontaneously. Those cases that persist for months or years, however, are often associated with vitreous strands adherent to the surgical wound and distortion of the pupil. This article reviews the surgical and photocoagulation therapies for this condition that have been reported over the past two decades. All studies report encouraging results, but all have been nonrandomized, uncontrolled trials. This paper describes two randomized, controlled clinical studies that are attempting to evaluate objectively the role of vitrectomy for chronic cases of aphakic cystoid macular edema.     

多焦点人工晶状体植入术后视觉质量和阅读能力的研究

目的:研究多焦点人工晶状体(IOL)植入术后白内障患者的视觉质量及阅读能力。方法:前瞻性临床研究。选择2018年6月至2019年10月于重庆医科大学附属第一医院眼科就诊并行双眼白内障手术的患者共75例(150眼),依据患者选择的IOL进行分组,双眼植入Tecnis ZCB00 IOL 25例(50眼)作为单焦组,双眼植入Tecnis ZMB00 IOL 25例(50眼)作为双焦组,双眼植入AT Lisa tri.839MP IOL 25例(50眼)作为三焦组,对比3组患者术后3个月时的祼眼远视力(UDVA)、祼眼中视力(UIVA)、祼眼近视力(UNVA) (LogMAR)及阅读能力。使用NEI-RQL-42量表中文版评价3组患者术后视觉质量的差异。数据采用卡方检验、方差分析、Kruskal-Wallis检验、Mann-Whitney U检验进行统计分析。 结果:共75例(150眼)患者纳入研究。3组间UDVA差异无统计学意义( H=3.187, P=0.203)。三焦组UIVA(0.2±0.1)优于双焦组(0.3±0.2) ( Z=-2.041, P=0.041)和单焦组(0.3±0.3) ( Z=-2.142, P=0.032)。三焦组UNVA(0.3±0.2)和双焦组UNVA(0.3±0.2)优于单焦组(0.4±0.2) ( t=2.332, P=0.017;t=3.014, P=0.036)。3组阅读视力( F=0.421, P=0.658)、阅读速度( F=1.754, P=0.182)、阅读错误率( H=6.347, P=0.052)差异均无统计学意义。三焦组近视力维度得分(92±14)和双焦组近视力维度得分(100±11)均高于单焦组(50±42) ( U=-3.139, P=0.005;U=-3.726, P=0.001);三焦组中视力维度得分(100±12)高于双焦组(75±25)和单焦组(25±75) ( U=-2.758, P=0.017;U=-3.145, P=0.002)。三焦组脱镜率维度得分(100±25)和双焦组脱镜率维度得分(100±40)高于单焦组(30±100) ( U=-3.004, P=0.008;U=-3.766, P=0.001)。 结论:多焦点IOL植入患者可获得与单焦点IOL植入患者配戴老花镜时相同的近距离视觉质量;AT Lisa tri.839MP IOL与Tecnis ZMB00 IOL可提供相同的远近视力及近距离阅读能力,但前者中距离视觉质量更佳。     

糖尿病与非糖尿病患者的人工晶体植入疗效比较

目的:观察糖尿病患者白内障的人工晶体植入效果。方法:对30例(37眼)糖尿病患者白内障和同期174例(197眼)非糖尿病的老年性白内障进行后房型人工晶体植入术,术后随访2～18月。结果:两组术后视力统计无差别,影响两组视力的主要因素为原有的视网膜病变;在术后并发症如前房纤维素样渗出、色素弥散方面,糖尿病组明显高于非糖尿病组,通过局部加用强效激素,炎症可吸收。结论:无或仅有轻度视网膜病变的糖尿病患者与非糖尿病患者的人工晶体植入疗效相似。眼科学报1997;13:93～95。     

The Preliminary Clinical Observation of Array Multifocal Intraocular Lens Implantation

Purpose :To evaluate the clinical effects of implantation of Array multifocal intraocular lenses.Methods : Thirty-one cases (37 eyes) of cataract patients, including 15 males(19 eyes) and 16 females(18 eyes), were involved in this study. All patients underwent standard phacoemulsification with Array multifocal intraocular lens implantation. The complications during operation, postoperative distant visual acuity, near visual acuity, corneal curvature and visual symptoms were observed.Results : the mean value of best postoperative visual acuity was recorded as follows: uncorrected distant visual acuity was 0. 8, the best-corrected distant visual acuity was 0. 9, uncorrected near visual acuity was 0. 5, near visual acuity with distant-corrected was 0. 6, the best-corrected near visual acuity wss 0. 9. The astigmatism of cornea was less than 1. 5 D pre-operatively and post-operatively. One patient complained of glare. Conclusion :Array multifocal intraocular lens can provide good distant and near visual acui     

Primary Posterior Chamber Intraocular Lens Implantation in Traumatic Cataract With Posterior Capsule Breaks

Background: In patients with incomplete posterior capsule support, posterior chamber intraocular lenses (PC-IOLs) were implanted with both haptics transs-cleral fixation. This causes more damage to the eye and may result in more complications. In patients with small posterior breaks, non-fixation or single haptic fixation may be adequate.Methods: Thirty-two consecutive patients of traumatic cataract with posterior capsule breaks caused by penetrating eye trauma were retrospected. Posterior chamber intraocular lenses were implanted in all these patients with three techniques, ie, without fixation, with single haptic fixation and with both haptics fixation. The selection of the technique was based on the position and size of the posterior capsule. The follow-up period was 21 days to 28 months (mean, 15. 2 months).Results: Intra-operative problems included ciliary body bleeding ( two patients, 6. 25% ) and enlargement of posterior capsule breaks (2 patients, 6. 25%). Postoperative visual acuity was 0. 5 or     

Sutureless Intrascleral Pocket Technique of Transscleral Fixation of Intraocular Lens in Previous Vitrectomized Eyes

In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180° apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.     

Changes in the Accommodation-convergence Relationship after the Artisan Phakic Intraocular Lens Implantation for Myopic Patients

Purpose

To evaluate the change of accommodation-convergence parameters after implantation of Artisan phakic intraocular lens (PIOL).

Methods

Prospective study for the patients with the Artisan PIOL implantation was performed. A total of 37 patients (3 males and 34 females) enrolled the study. Preoperatively, convergence amplitude, the stimulus accommodative convergence per unit of accommodation (AC/A) ratio and the near point of convergence (NPC) were evaluated. After the Artisan PIOL implantation, the identical evaluations were repeated at 1 week, 1, 3, and 6 months after the surgery.

Results

Mean age was 24.3 ± 4.8 years old, and preoperative refractive error was -8.92 ± 4.13 diopters (D). After the implantation, mean refractive errors significantly decreased to within ±1.00 D, and noticeable complications were not found. The convergence amplitude and the stimulus AC/A ratio increased 1 month after the surgery, but progressively stabilized afterward to near preoperative values. NPC didn''t show any significant change over follow-up period up to 6 months.

Conclusions

These results regarding implantation of the Artisan PIOL revealed the increase of accommodation-convergence relationship within first 1 month after the surgery, but progressive stabilization was noted during follow-up periods.     

新型多焦点人工晶体植入术的临床研究

目的：观察和评估白内障超声乳化新型多焦点人工晶体植入术后的远、近视力,角膜曲率变化等临床效果。方法：对30例老年性白内障超声乳化摘除,采用推送器植入新型多焦点人工晶体,术后定期随访远,近视力及角膜曲率等指标。结果：术后患者平均远视力≥1.0;平均近视力优于Jaeger3,术后角膜散光情况与术前比较无明显变化。结论：新型多焦点人工晶体植入术手术切口小,愈合快,手术引起的角膜散光小,患者远,近视力均较理想,无需配戴眼镜矫正,是一种较理想的人工晶体。     

三焦点人工晶状体与双焦点人工晶状体植入术后视力及视觉质量的对比

目的:比较三焦点人工晶状体(IOL) (Zeiss 839)及双焦点IOL(Zeiss 809)植入术后视力及视觉质量。方法:回顾性研究。选取2017年8月至2019年1月中国中医科学院眼科医院行白内障手术患者54例(83眼)。其中植入三焦点Zeiss 839 IOL(839组)28例(42眼),植入双焦点Zeiss 809 IOL(809组)26例(41眼)。对比2组术后1周、1个月、3个月裸眼视力,客观视觉质量分析仪分析客观散射指数(OSI)、传递函数截止频率(MTF cutoff)、斯特列尔比值(SR)、模拟对比度视力(PVA100%、PVA20%、PVA9%),术后3个月离焦曲线及进行问卷调查。数据采用配对样本 t检验及重复测量方差分析。 结果:术后1、3个月839组裸眼远视力优于809组,术后各观察时间中距离视力优于809组,差异均有统计学意义( P<0.05),术后裸眼近视力2组差异无统计学意义。术后2组OSI、MTF cutoff、SR、PVA100%、PVA20%、PVA9%差异均无统计学意义。离焦曲线示839组波形较平稳且在-3^-1 D范围内居于高位。术后3个月839组与809组眩光发生率、明暗视觉适应力、脱镜率、满意度分别为2%和7%、93%和88%、98%和78%、90%和85%。 结论:Zeiss 839 IOL和Zeiss 809 IOL均具有较好的远、近视力及视觉质量,Zeiss 839具有出色的中距离视力、高脱镜率及更佳的满意度。     

人工晶体植入术的早期角膜地形图改变

使用角膜地形图仪对白内障术后病人进行角膜表面弯曲度早期改变的观察。３１例病人均为行白内障囊外摘除合后房型人工晶体植入手术，在术后第３－５天内进行角膜地形图检查，所有病人的角膜地形图变均为蝶形领结状，表明这种术后散光是由于上方，下方角膜的弯曲度变得更为陡峭所致，与术中口的缝合有密切关系。     

Intraocular Lens Implantation in Children with Monocular Cataracts: 1974–1983

Two hundred twenty-five consecutive intraocular lens (IOL) implants performed by the same surgeon from 1977 to 1983 are reviewed. Ninety (40%) patients had traumatic cataracts and 135 (60%) patients had infantile cataracts. Fifty-four percent of the patients presented with preoperative complications. The most frequent were corneal scars (62%) in the traumatic cataract patients, and posterior lenticonus (18%), microphthalmia (16%), PHPV (14%), and optic nerve defects (12%) in the infantile cataract patients. The iris suture lens was implanted from 1973 to 1982, but the posterior chamber lens is now the most frequently implanted primary IOL. Flexible anterior chamber or iris suture IOLs are used as secondary implants. Followup ranged from six months to nine years. Postoperatively, 66% of the patients required spectacles for residual optical correction and 55% required occlusion for amblyopia. Postoperative complications consisted of post-pseudophakos membranes (13%), peripheral iris erosion (13%), iris sphincter erosion (18%), dislocated IOLs (7%) and corneal edema (4%), Secondary surgical procedures relating to the IOL were discissions of post-pseudophakos membranes (8 patients), refixation of dislocated lens (15 patients) and IOL removal (6 patients). The best corrected visual acuities during the course of the followup was 20/20 to 20/40 in 34% of the patients, 20/50 to 20/100 in 21%, 20/200 in 12%, and less than 20/200 in 33% of patients. Sixty percent of the traumatic cataract patients achieved 20/20 to 20/40 acuity and 17% of the infantile cataract patients achieved this level. Primary implantation patients achieved superior acuities over secondary implantations in both groups.