脱位于玻璃体腔的晶体碎片的手术治疗

探讨白内障超声乳化手术过程中部分晶体核或碎片脱入玻璃体腔的手术方法并评价其治疗效果。方法 :回顾性分析 1996年 8月～ 2 0 0 0年 10月我院收治的 18例白内障超声乳化手术过程中部分晶体核或碎片脱入玻璃体腔的手术治疗方法 :其中 12例部分晶体核脱位者行玻璃体切除术 ,借助过氟化碳液体使脱位晶体核浮起后联合行晶体核超声粉碎 ,另6例软性晶体碎片脱位于玻璃体腔者行玻璃体切除术 ,切除玻璃体及晶体碎片。结果 :所有病例均顺利切除玻璃体及晶体核或碎片 ,术后 3月最佳矫正视力除 2例合并视网膜脱离视力无改善外 ,余眼术后视力均明显提高 :≥ 0 6者 11眼 ,≥ 0 3者 5眼。术后并发症 :视网膜脱离 2眼 ,余无明显角膜内皮损伤 ,青光眼等。结论 :对于脱位于玻璃体腔的部分晶体硬核 ,可采用玻璃体切除联合超声粉碎技术 ,而对于软性碎片则可用玻璃体切割切除玻璃体及碎片。     

超声乳化联合人工晶体植入术治疗外伤性晶体半脱位的临床观察

目的观察超声乳化联合人工晶体机入术对外伤性晶体半脱位的疗效方法对33例外伤性晶体半脱位采用超声乳化晶体吸除联合人工晶状体植入术,人工晶状体采用睫状沟缝线固定或囊袋内植入。结果 33例(33眼)脱位的晶体均顺利取出,随访3-12个月(平均6个月),术后矫正视力>0.5 18例,0.3-0.5 13例,<0.2 2例结论超声乳化联合人工晶体植入治疗外伤性晶体半脱化取得了良好疗效。     

原发性急性闭角型青光眼合并晶体脱位的超声生物显微镜观察

目的应用超声生物显微镜(ultrasound biomicrocopy，UBM)观察原发性急性闭角型青光眼合并晶体脱位的特点．探讨原发性急性闭角型青光眼合并晶体脱位的病因、临床表现及治疗效果。方法对2000年1月1日～2004年1月1日我院收治的19例(19眼)原发性急性闭角型青光眼合并晶体脱位者常规行裂隙灯及超声生物显微镜检查，观察晶体脱位范围、手术方式、术前术后视力、眼压等情况。结果19例19眼均被手术结果证实，晶体全脱位3眼，半脱位16眼。晶体脱位范围90度～360度，11眼行小梁切除术联合白内障超声乳化人工晶体植入术，8眼行小梁切除术联合晶体切除、前部玻璃体切除术、二期植入悬吊人工晶体。术前眼压大于21mmHg者17眼，术后眼压大于21mmHg者1眼。术前最佳矫正视力0．1以下者5眼，0．1～0．3者11眼，0．3以上者3眼；术后最佳矫正视力0．1以下者1眼，0．1～0．3者6眼，0．3以上者12眼。结论原发性急性闭角型青光眼合并晶体脱位可能由于急性发作期眼压骤然升高或应用降眼压药物引起眼压波动过大所致；也可能是患者年龄较大，晶体悬韧带部分断裂致晶体位置异常、瞳孔阻滞而引起急性闭角型青光眼急性发作。     

人工晶体取出37例原因分析

目的通过对人工晶体植入术后取出病例原因分析，探讨人工晶体植入手术适应症的选择以及并发症的防治。方法回顾我科1999年1月～2004年5月37例(37眼)人工晶体取出病例并进行临床分析。结果37例人工晶体取出病例中，视网膜脱离15眼，人工晶体脱位10眼，大泡性角膜病变4眼，继发性青光眼3眼，人工晶体度数错误2眼，眼内炎3眼。其中人工晶体脱位行缝线固定术后视力恢复0．1～0．2有5眼，0．3～0．5有5眼；人工晶体度数错误置换人工晶体后视力恢复0．4和0．7；视网膜脱离、继发性青光眼人工晶体取出术后无晶体眼视力为光感、手动或数指，矫正视力最好0．1，复查时视网膜复位，眼压正常；大泡性角膜病变人工晶体取出术后矫正视力0．1～0．3。眼内炎人工晶体取出术后矫正视力为0．1～0．3。结论人工晶体植入术后严重的并发症是导致人工晶体取出的直接原因。减少人工晶体植入手术的并发症可有效避免术后的人工晶体取出，使患者无晶体眼得到较好的屈光矫正。     

白内障超声乳化玻璃体切除联合人工晶体植入三联术

目的 :探讨白内障超声乳化玻璃体切除联合人工晶体植入三联术的可行性和安全性。方法 :对 10例 10只眼进行上述联合手术 ,3例眼外伤造成的玻璃体出血合并白内障 ,7例糖尿病玻璃体出血合并白内障。先行白内障超声乳化 ,再行闭合式玻璃体切除 ,最后植入人工晶体。结果 :术后最佳矫正视力提高者 6例 ,其中 2例的最佳矫正视力为 0 5 ;与术前相同的 2例 ;2例较术前下降。结论 :三联手术方式是安全可行的 ,影响术后视力的主要因素是视网膜病变和眼外伤的程度。手术成功的关键是眼前段、眼后段医生的配合和选择合适的病人。     

外伤性晶状体脱位的手术治疗

目的 评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位的临床疗效。方法 对2000年1月～2005年1月收治的外伤性晶状体脱位30例患者的临床资料作回顾性研究。所有患眼根据晶状体脱位的程度采用不同的术式摘除晶状体，包括囊内摘除、超声乳化吸除、睫状体扁平部切口晶状体切割，同时根据病情需要联合玻璃体视网膜手术，小梁切除或青光眼减压阀门植入术治疗继发性青光眼，Ⅰ期植入睫状沟缝线固定人工晶体3例，后房型人工晶体21例，Ⅱ期植入睫状沟缝线固定人工晶体6例。结果 所有患眼成功地摘除脱位晶状体并植入人工晶体，视力有不同程度提高，24患眼视力≥0．3，患者术后眼压获得控制，6例视网膜脱离全部复位。结论 晶状体、玻璃体联合手术治疗外伤性晶状体脱位，临床效果好。     

马凡综合症伴晶状体半脱位的手术治疗

目的 对马凡综合症伴晶状体半脱位患者行超声乳化吸除联合人工晶体植入合并张力环植入或超声乳化吸除联合人工晶体悬吊两种手术方法的探讨和分析.方法 对3例（3眼）合并晶状体半脱位（脱位范围＜1/2象限）的患者行超声乳化吸除联合人工晶体植入合并张力环植入术;对10例（11眼）合并晶状体半脱位（脱位范围＞1/2象限）的患者行超声乳化吸除联合人工晶体悬吊术,分析手术前后视力及并发症.结果 随访3-24个月,13例患者视力有不同程度的提高,未发生视网膜脱离及葡萄膜炎等并发症.结论 超声乳化吸除联合人工晶体植入合并张力环植入或超声乳化吸除联合人工晶体悬吊术是进行马凡综合症晶状体半脱位治疗的有效手术方式,临床应根据晶状体脱位情况的不同选择不同的手术方式.     

儿童人工晶体植入初步报告

报告９４只眼儿童白内障囊外摘除联合后房型人工晶体植入随访６￣３０个月的结果。９４只眼均顺利植入人工晶体，个别外伤障使用了前段玻璃体切除。术后处理同成年人。术后主要并发症明显高于成年人，主要为葡萄膜炎，特点是前房反应较老年性白内障重，持续时间长，易发生虹膜后粘连和形成后囊膜混浊。经随访，单眼脱盲率为９０．１％，其４９．４％的患儿矫正视力低于０．４。我们认为，对白内障儿童植入人工晶体应持慎重态度，不主     

后房型人工晶体睫状沟缝线固定术

随着后房型人工晶体植入术的迅速普及，在术中因种种原因常出现不能按常规方法植入后房型人工晶体。如外伤性白内降或晶全脱位等等，为此需要掌握简单易行安全有效的人工晶体缝线固定术。现将我们自行设计的手术方法报告如下。一般资料：本组14例（16眼），其中男9例，女5例，年龄24一77岁，平均56岁。囊内摘除术后无晶体限5例6眼，计划性囊外摘除术中后囊破裂者5例5眼，角膜穿通伤致外伤性白内障3例3眼，慢性复发性葡萄膜炎、继发性青光眼、并发性白内障1例双眼。术前视力光感至0．2，5限元晶体服矫正视力0．8－12，1眼无晶体限矫正视力0．…     

晶体超声粉碎联合玻璃体切除术治疗有核外伤性晶状体脱位

目的 探讨应用晶体超声粉碎联合玻璃体切除术治疗有核外伤性晶状体脱位的疗效.方法 回顾性分析了经晶体超声粉碎联合玻璃体切除手术治疗的有核外伤性晶状体脱位29例29只眼,其中全脱位12只眼,术前高眼压16只眼.行标准三通道玻璃体切除,切除前部、中轴部及晶状体周围玻璃体,无需使用过氟化碳液体,吸引晶状体至前部玻璃体腔内进行超声粉碎;不全脱位的晶状体采用囊内超声粉碎.术中检查视网膜并做相应处理.结果全部病例均完全将脱位的晶状体粉碎吸除,随访3月无视网膜脱离发生.21只眼术后眼压正常,6只眼I期植入人工晶状体.视力较术前明显改善.结论 对于有核的晶状体脱位,超声粉碎联合玻璃体切除术安全有效、简便易行,术后并发症少,明显改善了预后.     

玻璃体切除联合超声乳化术治疗脱位晶状体疗效分析

目的 探讨玻璃体切除联合超声乳化粉碎术治疗脱位晶状体的临床疗效.方法 对晶状体脱位46例(46只眼).其中晶状体不全脱位28只眼中单纯超声乳化12只眼,前玻璃体切除联合超声乳化5只眼,前玻璃体切除11只眼,均植入人工晶体;晶状体全脱位18只眼均采用标准三通道经睫状体扃平部玻璃体切除联合超声乳化粉碎术,人工晶体睫状沟固定术12只眼.结果 全部病例术后视力均较术前提高,未发生严重并发症.结论 对脱位的晶状体根据程度选择单纯超声乳化或玻璃体切除超声乳化粉碎、人工晶体睫状沟固定术,是一种安全、有效的治疗方法.     

Pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis

OBJECTIVE: To examine the results of pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis resistant to medical treatment. DESIGN: Retrospective, interventional, noncomparative case series. SUBJECTS: Fourteen consecutive subjects (18 eyes) with cystoid macular edema associated with sarcoid uveitis resistant to medical treatment. INTERVENTION: All eyes underwent pars plana vitrectomy. Nine eyes also underwent peeling of the epiretinal membrane or removal of the posterior vitreous cortex. MAIN OUTCOME MEASURES: Status of macular edema, visual acuity, and complications. RESULTS: Ten eyes (56%) improved 2 or more lines of Snellen visual acuity within 12 months. Six eyes (33%) remained unchanged, within a line of preoperative Snellen visual acuity, and two eyes (11%) worsened by 2 or more lines of Snellen visual acuity. Slit-lamp biomicroscopy showed that cystoid macular edema had resolved in 14 eyes (78%) within 9 months postoperatively. One eye (6%) had minimal edema, whereas three eyes (17%) remained unchanged biomicroscopically at the final visit. Postoperative complications included cataract formation, glaucoma, optic nerve atrophy, epiretinal membrane formation, and tractional retinal detachment. No severe postoperative inflammation was noted. CONCLUSIONS: Pars plana vitrectomy seems to have a beneficial effect on cystoid macular edema caused by sarcoidosis resistant to medical treatment.     

20G联合23G玻璃体切除术在外伤性晶状体完全后脱位中的应用

目的探讨20G联合23G玻璃体切除技术在外伤性晶状体完全后脱位中的应用及临床疗效。方法回顾分析2013年1月-2013年12月行20G联合23G玻璃体切除术治疗外伤性晶状体完全后脱位共23例的临床资料,观察手术效果及并发症发生的情况。结果 21例（21眼）完成玻璃体联合晶状体切除。术后至随访期结束：86.96%的病例矫正视力有不同程度的提高;术前存在继发性青光眼者术后眼压均控制在正常范围;术后未出现持续性低眼压、感染性眼内炎等严重并发症。结论 20G联合23G玻璃体切除技术是治疗外伤性晶状体完全后脱位的安全、有效方法。     

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.     

A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange

PURPOSE: To compare the visual results and the postoperative complications in eyes with posterior chamber intraocular lens (PCIOL) dislocation that underwent pars plana vitrectomy with lens repositioning with eyes that underwent pars plana vitrectomy with lens exchange. DESIGN: Nonrandomized consecutive comparative case series. PARTICIPANTS: Fifty-nine eyes (27 right eyes and 32 left eyes) of 56 subjects (28 women and 28 men) ranging in age from 59 to 90 years. Mean follow-up was 34 months. METHODS: A comparison of the best-corrected preoperative visual acuities, final visual acuities, and postoperative complications in subjects with dislocated PCIOLs that underwent pars plana vitrectomy. Logarithm of the minimum angle of resolution (LogMAR)-converted visual acuities were used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by a pooled Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, change in mean visual acuities, and postoperative complications. RESULTS: For all 59 eyes the mean preoperative visual acuity was 20/152, and the mean final visual acuity was 20/48. Final visual results were similar between the eyes that underwent lens repositioning (20/55) and the eyes that underwent lens exchange (20/43; P = 0.19). Final visual results were also similar between the eyes that underwent lens exchange with sutured PCIOL placement (20/51) and the eyes that underwent lens exchange with anterior chamber intraocular lens (ACIOL) placement (20/38; P = 0.26). Final mean visual acuity in eyes that received an ACIOL (20/38) was better than in eyes that underwent repositioning of the dislocated lens into the ciliary sulcus (20/65; P = 0.01). The mean increase in visual acuities was greater for eyes with ACIOL placement compared with eyes with sutured PCIOL placement (P = 0.01). For all eyes, final visual results were unaffected by a concurrent diagnosis of age-related macular degeneration (20/52; P: = 0.71), glaucoma (20/48; P = 0.95), or postoperative cystoid macular edema (20/55; P = 0.45). Final visual acuities were significantly worse in eyes with a detectable preoperative afferent pupillary defect (20/200; P<0.0001). Postoperative retinal detachments developed in 4 of 29 eyes (14%) that underwent lens repositioning and in 2 of 30 eyes (7%) that had lens exchange (P = 0.42). Postoperative lens subluxations occurred in 6 of 29 eyes (21%) that underwent lens repositioning and in 1 of 30 eyes (3%) that underwent lens exchange (P = 0.05). CONCLUSIONS: The final visual results in eyes with dislocated PCIOLs that underwent pars plana vitrectomy with lens repositioning were similar to the visual results obtained in eyes that underwent pars plana vitrectomy with lens exchange. For eyes that underwent lens exchange, final visual results in eyes that received an ACIOL were similar to the visual results obtained in eyes that received a PCIOL; however, eyes with an ACIOL showed a greater increase in mean visual acuity. Eyes with a preoperative afferent pupillary defect had worse final visual results.     

Cataract and uveitis management by pars plana lensectomy and vitrectomy by ultrasonic fragmentation

Cataract and uveitis occurs usually in young individuals and produces loss of vision from opacification of both the lens and vitreous. The condition does not lend itself to conventional surgery. In the experience of the authors and several other investigators, pars plana lensectomy and vitrectomy by ultrasonic fragmentation not only improves vision but apparently causes a remission of uveitis. A retrospective study of 23 eyes with cataract and uveitis undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation (21 eyes) or vitrectomy alone (2 eyes) showed improved vision in 91.3%, no operative complications, and remission of the uveitis in 100% with observation periods of 1-11 years (average, 5 years). Pars plana lensectomy and vitrectomy appears to be the treatment of choice in cataract and chronic uveitis.     

Management of dislocated lens fragments during phacoemulsification.

BACKGROUND: Dislocation of nuclear lens fragments during phacoemulsification can lead to a high incidence of glaucoma, uveitis, and poor visual acuity. The correct approach to these patients is uncertain. The authors report on eight patients who underwent pars plana vitrectomy with removal of lens fragments. METHODS: Charts of eight consecutive patients who developed dislocation of nuclear lens fragments into the vitreous cavity during phacoemulsification were retrospectively reviewed. All patients underwent a standard three-port pars plana vitrectomy with removal of the dislocated nuclear fragments by pars plana fragmentation. After the vitrectomy, the retina was inspected with indirect ophthalmoscopy. Tears were treated with cryopexy. A fluid-air exchange and scleral buckle were performed when indicated. RESULTS: Retinal tears were located at the vitreous base in four of eight patients. After vitrectomy, visual acuity improved in all patients, with 7 of 8 patients achieving visual acuity of 20/40 or better. The type of pseudophakia did not influence the final visual acuity. There were no cases of glaucoma, uveitis, or macular edema with up to 22 months of follow-up. CONCLUSIONS: These results suggest that large nuclear fragments dislocated into the posterior segment during phacoemulsification can be removed safely with pars plana vitrectomy and lensectomy with an excellent visual prognosis. Attempts to remove lens fragments during the phacoemulsification through an anterior wound should be avoided because of excessive vitreous traction, leading to retinal break formation.     

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

PURPOSE: To assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery. METHODS: The medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients' demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded. RESULTS: The mean follow-up period of the patients was 12.3 months (range, 3-47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery. CONCLUSION: Immediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.