后房人工晶状体缝线固定术25例疗效观察

目的评价后房型人工晶状体睫状沟缝线固定术的效果。方法24例（24眼）无晶状体眼后囊破裂或无后囊者，其中Ⅰ期后房型人工晶状体睫状沟缝线固定术13例（13眼）；Ⅱ期后房型人工晶状体缝线固定术11例（11眼）。结果24例（24眼）手术均顺利完成。随诊1～12月，视力≥0．3者20例占83．33％；0．1～0．2者4例（4眼）占16．67％。术后的主要并发症是角膜水肿和葡萄膜炎，但1周内都能恢复。结论后房型人工晶状体睫状沟缝线固定术是后囊破裂或无后囊者进行后房型人工晶状体植人的方法之一。     

人工晶状体缝线固定术28例临床分析

目的 观察应用缝线固定术植入后房人工晶状体病例的临床效果。方法 对28例无后囊眼行巩膜睫状沟后房型人工晶状体缝线固定术。随访6－15月。结果 术后矫正视力＞0.5者35.7%,0.3-0.5者42.9%,0.1-0.2者10.7%,＜0.1者10.7%,无严重并发症发生。结论 经巩膜睫状沟人工晶状体缝线固定术作为无后囊眼的人工晶状体植入方式具有一定的临床价值。     

玻璃体切除术后无晶状体眼行不同术式人工晶状体植入术的临床观察

目的观察比较不同术式人工晶状体植入术治疗玻璃体切除术后无晶状体眼的临床疗效。方法回顾2007年1月至2011年12月我院收治的玻璃体切除术后144例(146只眼)无晶状体眼患者的病例资料,分析比较不同术式植入人工晶状体后的临床疗效及并发症发生情况。结果据病情行不同术式的人工晶状体植入,其中对有残留周边晶状体囊膜者行人工晶状体睫状沟内植入42只眼;对无囊膜残留者行经巩膜缝线固定人工晶状体植入术41只眼;前房型人工晶状体植入63只眼,术后均随访3个月以上:①138只眼裸眼视力提高2行以上占94.5%,术后裸眼视力达到或超过术前最佳矫正视力共有103只眼(70.5%),其中睫状沟植入组31只眼(73.8%),前房型人工晶状体植入组52只眼(82.5%),巩膜缝线固定组26只眼(63.4%);②常见并发症:术中出血9只眼(前房型人工晶状体组2只眼占3.2%,巩膜缝线固定组7只眼占17.1%,);术后出血11只眼(前房型人工晶状体组2只眼占3.2%,巩膜缝线固定组9只眼占22.0%,);术后早期并发症:眼压≤8 mm Hg共25只眼(睫状沟植入组3只眼占7.1%,前房型人工晶状体组10只眼占15.9%,巩膜缝线固定组12只眼占29.3%,);眼压≤5mm Hg共7只眼(前房型人工晶状体组4只眼占6.3%,巩膜缝线固定组3只眼占7.3%,);术后发生浅前房4只眼均为前房型人工晶状体植入组(占6.3%);角膜水肿5只眼均为前房型人工晶状体植入(7.9%);前房炎症反应4只眼均为前房型人工晶状体植入(6.3%)。远期并发症:黄斑囊样水肿6只眼(前房型人工晶状体组3只眼4.8%,巩膜缝线固定组3只眼占7.3%)。结论玻璃体切除术后无晶状体眼采用不同方式人工晶状体植入术后效果肯定,其中睫状沟植入人工晶状体术后并发症少,前房型人工晶状体和人工晶状体睫状沟植入术后视力矫正优于巩膜缝线固定人工晶状体植入,但对无囊膜支撑和不适于前房型人工晶状体植入的无晶状体眼,经巩膜缝线固定术也是有效的术式。     

两种前房型人工晶状体治疗无晶状体眼的效果探讨

目的探讨无晶状体眼植入Artisan虹膜夹持型人工晶状体与房角支撑型人工晶状体术后的临床效果及差异。方法收集深圳眼科医院2009年1月至2011年3月住院接受人工晶状体植入术的无晶状体眼患者共37例,其中植入ARTISAN虹膜夹持型人工晶状体19例(19只眼),植入房角支撑型人工晶状体18例(19只眼)。比较术后裸眼视力、最佳矫正视力(BCVA)、角膜内皮细胞计数、眼压、角膜水肿发生率、并发症及人工晶状体的位置。随访时间至术后3个月。结果两组术后视力恢复良好,术后3个月的BCVA无统计学差异。术后3个月两组眼压差异无显著性。Artisan虹膜夹持型组术后3个月角膜内皮丢失率低于房角支撑型组,术后1周内角膜水肿发生率高眼压发生率及术后并发症发生率均较房角支撑型组低。两组术眼的人工晶状体位置均保持良好的居中性。结论 Artisan虹膜夹持型人工晶状体与房角支撑型人工晶状体都是治疗无晶状体眼的有效方法,两者比较,虹膜夹持型人工晶状体植入术损伤更小,更为安全,为较佳的手术方式。两者远期效果的比较尚待进一步观察。     

眼内窥镜直视下二期后房型人工晶状体缝线固定术

目的:探讨在眼内窥镜直视下无玻璃体无晶状体眼二期后房型人工晶状体缝线固定术的可行性及临床疗效。方法:对8例无玻璃体无晶状体眼在眼内窥镜指导下行人工晶状体缝线固定术,6例常规组作为对照,观察比较术后视力、散光、人工晶状体位置及其并发症等情况。结果:所有14例患者手术均顺利进行,内窥镜组8例术后所有人工晶状体位置正,UBM检查示所有16个人工晶状体襻全部位于睫状沟内,而对照组有3个人工晶状体襻位于睫状沟外,差异有统计学意义(P=0.034)。内窥镜组术后增加的散光度数较对照组小(P=0.042)。术后视力均好于术前。结论:眼内窥镜下可使术者直视下完成后房型人工晶状体缝线固定术并将人工晶状体准确固定于睫状沟内。     

Artisan虹膜夹持型人工晶状体治疗无晶状体眼临床观察

目的观察Artisan虹膜夹持型人工晶状体治疗无晶状体眼的疗效和手术并发症。方法观察2007年3月至2009年3月间在我院住院接受Artisan虹膜夹持型人工晶状体植入术的无晶状体眼患者11例（11只眼）,比较患者手术前后裸眼视力（UCVA）、最佳矫正视力（BCVA）,比较术前术后眼压变化,裂隙灯显微镜观察术后角膜水肿、前房闪辉、晶状体位置,角膜内皮镜检查比较术前术后角膜内皮细胞计数,光学相干断层扫描仪（OCT）观察手术前后黄斑区视网膜厚度。结果患者术后UCVA优于术前BCVA,术前术后眼压无明显变化,术后角膜无明显水肿,晶状体位置未见明显偏移。术后1个月时角膜内皮细胞丢失无统计学意义,黄斑区厚度比术前无明显增加。结论Artisan虹膜夹持型人工晶状体植入术是一种安全有效的治疗无晶状体眼的方法,手术操作相对简单,组织损伤小,并发症少。在虹膜组织足够支撑晶状体时可作为常规术式予以考虑。     

人工晶状体睫状沟缝线固定术的临床观察

目的 探讨人工晶状体睫状沟缝线固定术的临床效果.方法 后房型人工晶状体(IOL)睫状沟缝线固定术15例(15眼),观察临床效果及术中、术后,近期、远期并发症.结果 术后矫正视力≥0.5者6眼,0.2 ～0.4者8眼,0.1者1眼.结论 人工晶状体睫状沟缝线固定术为特殊情况下的人工晶状体植入提供了一个可靠的固定方法.     

人工晶状体后囊膜夹持植入治疗儿童无晶状体眼的临床研究

目的探讨应用玻璃体切割头修整后囊孔、行人工晶状体后囊膜夹持植入术治疗儿童无晶状体眼的临床意义。方法收集2005年10月至2008年6月在我院就诊拟行Ⅱ期人工晶状体植入术的无晶状体眼患儿86例156眼,随机分为2组:夹持组44例80眼,应用玻璃体切割头咬切修整后囊孔形成3.5mm×5.5mm椭圆形,行人工晶状体睫状沟植入,下压人工晶状体光学部嵌入后囊孔完成后囊膜夹持;非夹持组42例76眼,常规行人工晶状体睫状沟植入。随访24个月,观察2组术后视力、屈光状态及人工晶状体移位等情况。结果夹持组术后最佳矫正视力0.3-0.5者56眼(70.00%),非夹持组术后最佳矫正视力0.3-0.5者38眼(50.00%),差异有统计学意义(P<0.05)。夹持组人工晶状体移位1眼(1.25%),非夹持组人工晶状体移位21眼(27.63%),差异有统计学意义(P<0.05)。夹持组4眼(5.00%)出现虹膜后粘连,所有术眼均未出现后发性白内障等情况;非夹持组16眼(21.05%)出现虹膜后粘连,4眼(5.26%)出现后发性白内障,差异有统计学意义(P<0.05)。结论儿童无晶状体眼Ⅱ期人工晶状体植入术中将人工晶状体光学部夹持于后囊膜下,可以有效减少术后并发症,避免人工晶状体移位。     

外伤性白内障后房型人工晶状体二期植入

目的探讨外伤性白内障后房型人工晶状体二期植入术的临床效果。方法对36例（36眼）外伤性白内障术后无晶状体眼患者。根据眼部不同情况采用单纯睫状沟植入法或巩膜缝线固定法进行后房型人工晶状体二期植入术，并对手术效果、术后视力及并发症进行分析。结果13眼（36．11％）行单纯睫状沟植入术，7眼（19、44％）行单襻巩膜缝线固定术，16眼（44．44％）行双襻巩膜缝线固定术。术后裸眼视力≥0、3者24眼（66、67％），≥0、1者33眼（91．67％），术后常见并发症为早期角膜水肿、葡萄膜炎和眼压升高。结论采用适当的时机和手术方式进行人工晶状体二期植入术，可减少术中术后并发症。     

儿童人工晶状体睫状沟缝线固定术的临床观察

目的:探讨对儿童施行人工晶状体睫状沟缝线固定术的临床应用。方法:对32例(35眼)无法行后房型人工晶状体植入的白内障患者行晶状体、玻璃体切除,同期或二期行人工晶状体睫状沟固定术。结果:所有病例术中无严重并发症发生。随诊1～12mo术后视力>0.8者5眼(14%),0.3～0.7者19眼(54%),0.1～0.2者7眼(20%),<0.1者4眼(12%)。结论:人工晶状体睫状沟固定术为无后囊支持的儿童患眼提供了安全有效的手术方法。     

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM: To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A:25 eyes received Artisan iris-claw IOL implantation. Group B:20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.     

眼外伤晶状体玻璃体切除术后二期IOL植入术

目的 探讨复杂性眼外伤玻璃体切除术后无晶状体眼二期人工晶状体植入术临床疗效，评估手术的可行性及安全性。方法 手术31例(31眼)，术后随访3～20月，观察视力、散光度、眼压及并发症：结果 30眼术后裸眼视力均达到或接近术前矫正视力：后房型人工晶状体睫状沟植入7眼中视力≥0．5者占28．57％，后房型人工晶状体透巩膜睫状沟缝线固定术18眼中视力≥0.5者占22．22％，虹膜型人工晶状体植入术6眼中视力≥0．5者占33．33％：1眼视力下降。结论 复杂性眼外伤行玻璃体切除术后二期人工晶状体植入，经过术前病例的选择，术中采用眼内灌注，适宜的人工晶状体植入，可获得较好的视力。     

缺乏囊膜支持的无晶状体眼中两种人工晶状体植入方式的疗效比较

目的：在缺少囊膜支撑的无晶状体眼中,比较后房植入虹膜夹人工晶状体(IOL)与后房睫状沟巩膜缝合固定人工晶状体的疗效。

方法：本研究收集缺少囊膜支撑的无晶状体患者70例进行回顾性对比分析,患者根据手术方式的不同分为A、B两组,A组35眼行后房植入虹膜夹IOL,B组35眼行后房睫状沟巩膜缝合固定IOL。比较两组患者术前及术后3d,1、3、6mo,1a的裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮细胞密度(CECD),并且观察两组IOL的稳定性,记录术中及术后并发症。

结果：随访12～14mo。术后3d,A组的UCVA较术前明显改善(P<0.01),而BCVA较术前无差异(P=0.073); B组的UCVA较术前无差异(P=0.097),而BCVA较术前差(P=0.002); 两组患者术后1mo UCVA、BCVA均较术前显著改善(P<0.05),分别于术后6、3mo保持稳定。两组患者随访期间的IOP均维持于正常水平。A组、B组患者术后1a的CECD分别较术前平均降低0.7%、2.3%(均P<0.05)。两组患者随访期间各时间点IOP及CECD的均无差异(P>0.05)。两组患者术后1、3mo的全眼散光较角膜散光无明显差异(均P>0.05)。术后两组各有1眼IOL脱位,均经手术复位,其余患者术后随访期间IOL无显著倾斜和偏位; 其他术后并发症较轻微,组间并发症发生率无差异(P>0.05)。

结论：对于缺少囊膜支持的无晶状体眼患者,后房植入虹膜夹IOL与后房睫状沟巩膜缝合固定IOL均是安全有效的手术方式。后房植入虹膜夹IOL的操作相对简单,对眼球内组织损伤较小,手术时间较短,术后视力恢复较快,是有效的治疗方法之一。     

儿童玻璃体切割术后无晶状体眼行人工晶状体睫状沟缝线固定术的临床观察

目的　评价玻璃体切割术后儿童无晶状体眼行人工晶状体睫状沟缝线固定术的有效性及安全性。方法　回顾分析２００５年至２０１５年在河北省眼科医院眼外伤科行玻璃体切割术后人工晶状体睫状沟缝线固定术４８眼（男２８眼,女２０眼）的术后并发症、眼压、人工晶状体位置,并比较手术前后视力、屈光状态。结果　术后出血８眼（１６．７％）,低眼压３眼（６．３％）,一过性高眼压及角膜水肿４眼（８．３％）,经保守治疗后均恢复,没有出现明显的人工晶状体倾斜和偏心以及人工晶状体襻缝线脱落。术后末次随访时视力较术前提高（Ｐ＜０．０５）。屈光度数预测值与术后３个月实际屈光度数无显著差异（Ｐ＞０．０５）。屈光度数预测值与实际屈光度数偏差:４０眼（８３．３％）＜１．５０Ｄ,６眼（１２．５％）１．５０～２．００Ｄ,２眼（４．２％）＞２．００Ｄ。结论　人工晶状体睫状沟缝线固定术对玻璃体切割术后的儿童无晶状体眼的治疗安全有效,但仍不能忽视其并发症的出现。     

小切口无灌注折叠式人工晶状体悬吊术手术

目的 介绍并评价小切口无灌注下巩膜缝线固定可折叠人工晶状体的手术体会.方法 选择因晶状体后囊破裂或晶状体脱位不能正常植入后房型人工晶状体的19例.利用推注器系统,通过巩膜小切口把一片式可折叠人工晶状体植入后房,缝线固定在巩膜壁上.结果 术后视力均提高,11眼大于0.6,平均散光为（1.00±0.25）D,术后并发症少.结论 小切口无灌注折叠式人工晶状体悬吊术方法具有切口小,术中及术后并发症少,术后散光小、视力较好等优点.     

后房型人工晶状体无巩膜瓣睫状沟缝线固定术15例疗效观察

目的:探讨无巩膜瓣经睫状沟缝线固定后房型人工晶状体(PC-IOL)的手术方法及其临床疗效。方法:对无晶状体囊膜支撑患者15例15眼进行无巩膜瓣经睫状沟固定的PC-IOL植入手术,巩膜外缝线采用巩膜层间"W"字形穿行、末端烧灼固定法。一期手术5例,二期手术10例。术后随访0.5～3(平均1.8)a,观察视力恢复、缝线位置及并发症的情况。结果:视力≥0.5者10眼(67%),术中少量出血4眼(27%),人工晶状体偏斜3眼(20%),黄斑囊样水肿2眼(13%);无1例发生缝线暴露或滑脱。结论:在无晶状体囊膜支撑时,无巩膜瓣经睫状沟缝攀缝线固定PC-IOL是一种安全有效的手术方法。     

Artisan lens implantation to correct aphakia after vitrectomy for retained nuclear lens fragments

PURPOSE: To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan intraocular lens (IOL) (Ophtec) to correct aphakia. SETTING: University-based referral center. METHODS: In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed. RESULTS: Thirteen patients were identified. The preoperative visual acuity was better than 20/200 in 5 patients and the intraocular pressure (IOP) was higher than 21 mm Hg in 8 patients; 3 patients had normal corneas. In 4 patients, an Artisan IOL was implanted during cataract surgery. Postoperative complications included recurrent erosion (1 eye), premacular fibrosis (2 eyes), and a retinal tear (1 eye). Elevation of the IOP occurred in 2 patients and was controllable with medication. Pupillary block developed in 1 patient and persistent cystoid macular edema in another. All but 2 patients gained more than 2 lines of visual acuity postoperatively, and all corneas remained clear during the follow-up (mean 28.9 months; range 2.5 to 69.0 months). CONCLUSIONS: After the removal of dislocated lens fragments with a PPV, Artisan IOL implantation in aphakic patients without capsule support led to few complications and good visual acuity. Placement of an Artisan IOL requires fewer manipulations than transscleral suture fixation of a posterior chamber IOL.     

Neue Hinterkammerlinse zur sulkusgestützten und nahtlos irisfixierten Implantation in aphake Augen ohne Kapselstrukturen

PURPOSE: To avoid anterior chamber lens implantation in aphakic eyes without capsular or zonular support, the laborious scleral fixation of a standard posterior chamber intraocular lens (IOL) is widely used, despite a large range of possible complications (macular edema, IOL tilt/decentration, suture erosion, vitreous hemorrhage). A sutureless iris-fixed ciliary sulcus implantation of a posterior chamber IOL (Binder-IOL, Fa. Iolution, Itzehoe) designed especially for such cases represents an alternative. METHOD: At the end of both haptics of this IOL, with a 6 mm optic zone, a T-shaped anchor is mounted at an angle of 45 degrees from the optical plane. These anchors are inserted from behind the iris into peripheral iridotomies performed preoperatively with a YAG-laser or intraoperatively with a vitrectomy cutter. The long, C-shaped haptics are thus secured in the ciliary sulcus. RESULTS: After slight modification of the technique, the implantation can be performed securely and reproducibly. In the 22 implantations performed to date, the IOL was well centered and stable, even in cases with only residual iris stroma. If the iridotomies are been performed too centrally, an ovalisation of the pupil may occur. No further side effects have been observed. CONCLUSION: The technique of sutureless sulcus fixation presented here leads to less complications than scleral suture fixation. A prerequisite for safe implantation of the anchors is good visibility of the peripheral iris. The implantation of the Binder-IOL is especially suitable for aphakic eyes with a loosened iris diaphragm.     

【In Press】Complications and outcomes of descemet stripping automated endothelial keratoplasty with Artisan aphakia intraocular lens implantation

AIM: To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with Artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. METHODS: DSAEK combined with Artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema, and hyphema. Best-corrected visual acuity (BCVA), IOP, and mean central endothelial cell density (ECD) were recorded. RESULTS: Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, and 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. CONCLUSION: DSAEK combined with Artisan aphakia intraocular lens implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.