人工晶状体睫状沟缝线固定术的临床探讨

目的探讨人工晶状体睫状沟缝线固定的手术技巧和临床疗效。方法对白内障囊外摘除术或超声乳化术中后囊膜破裂超过2个象限或晶状体悬韧带断裂范围>90°、白内障囊内摘除术后、外伤致晶状体全脱位或伴眼内异物行玻璃体切除术后无晶状体囊膜的患者43例(43只眼),采用人工晶状体睫状沟缝线固定法植入后房型人工晶状体。结果随访4～24个月,平均随访15个月,复查时最佳矫正视力1.0,最低0.2,视力在0.5以上者22只眼(占51.1%)。36只眼术后无并发症。结论人工晶状体睫状沟缝线固定术是无晶状体囊膜及晶状体后囊膜破裂或晶状体悬韧带大范围断裂的首选手术方法。     

人工晶状体脱入玻璃体的原因及手术处理

目的 探讨前房型和后房型人工晶状体脱入玻璃体的原因及处理的方法.方法 共17例(17眼).后房型人工晶状体脱位14眼,前房型人工晶状体脱位3眼.钝挫伤后人工晶状体脱位6眼,白内障术中或术后人工晶状体脱位11眼.根据不间情况行(1)玻璃体切除,人工晶状体摘出及人工晶状体(更换)再植入术.(2)玻璃体切除、人工晶状体摘出及后房人工晶状体睫状沟缝线固定术.(3)玻璃体切除、人工晶状体摘出及人工晶状体(更换)再植入并视网膜复位术.观察术前和术后视力及并发症情况,术后随访3～18个月.结果 摘出人工品状体17片,襻长12.5 mm光学直径5.5 mm的有12片占70.59%.有16例人工晶状体(更换)再植入睫状沟或巩膜悬吊术.术后视力0.02的1眼,0.1～0.2的3眼,0.3～0.5的13眼,无严重并发症发生.结论 晶状体后囊破裂或悬韧带断裂后,植入襻长较短和光学直径小人工晶状体是人工晶状体玻璃体腔脱位的原因之一.玻璃体切除后摘出脱位人工晶状体,再植入合适的人工晶状体是处理人工晶状体玻璃体脱位的有效的方法.     

眼外伤患者晶状体玻璃体切除术后Ⅱ期人工晶状体植入术

目的 探讨眼外伤患者晶状体玻璃体切除术后无晶状体眼Ⅱ期人工晶状体植入的手术技巧.方法 眼外伤患者晶状体玻璃体切除术后无晶状体眼42例（42眼）,采用玻璃体腔灌注维持眼压.5例于保留的晶状体前囊前植入后房型人工晶状体,37例采用外路法人工晶状体睫状沟固定术,其中3例为带虹膜隔的人工晶状体.结果 术后随访3～40个月.术后最佳矫正视力≥0.3者28例（66.67%）,术后最佳矫正视力优于或等于术前最佳矫正视力者31例（73.81%）.结论 晶状体玻璃体切除术后无晶状体眼Ⅱ期植入人工晶状体时,需玻璃体腔灌注调整眼压,最好采用外路法预置睫状沟固定缝线,用四线或两线法悬吊人工晶状体.     

脱位人工晶状体的手术处理

目的 探讨人工晶状体脱位的原因和处理方法。方法 对18例18眼人工晶状体脱位的原因进行分析；采用单纯复位，更换和取出人工晶状体的方法进行处理。结果 手术中后囊膜破裂，悬韧带离断和玻璃体脱出是人工晶状体脱位的主要原因。18眼中12眼单纯复位成功。获得稳定的睫状沟固定；4眼更换前房型人工晶状体：1眼行睫状沟缝合固定；1眼取出人工晶状体后未再植入。随访1.5个月至3年，除1眼无晶状体眼外，术后矫正视力均≥0.1；其中≥0.5者8眼，无严重并发症发生。结论 人工晶状体脱位与术中后囊膜破裂，悬韧带离断，玻璃体处理不当有关。前玻璃体切割单纯取出重新复位，是处理人工晶状体脱位简单有效的方法。     

后房型人工晶状体缝线固定术24例临床观察

目的:探讨人工晶状体睫状沟缝合固定术在白内障囊外摘除术中囊膜破裂、外伤性白内障、晶状体脱位、玻璃体切割术后等无晶状体囊膜或囊膜缺损的患眼中的应用。方法:我院2010-04/2011-04采用后房型IOL缝线固定术完成了24例24眼,均获得满意效果。其中晶状体后囊膜破损在2个象限残存后囊膜者,以此为依托将一侧人工晶状体襻置于其上,另侧襻睫状沟缝线固定,即"一点固定法"实施了7例。因严重外伤后而无晶状体后囊者,施行两侧襻睫状沟缝线固定,即"二点固定法"实施了17例。结果:术后随访4～12(平均6)mo,复查时矫正视力0.01～1.2,视力>0.6者15眼(62.5%),视力偏低者主要为角膜瘢痕或严重外伤视网膜病变所致。二期植入者术后视力均高于术前最佳矫正视力。结论:后房型IOL睫状沟缝线固定术是无晶状体囊膜及晶状体后囊膜破裂恢复视力的首选。     

人工晶状体异位的原因和处理

目的:分析人工晶状体位置异常的临床情况。方法:人工晶状体异位23眼包括人工晶状体玻璃体腔脱位、瞳孔夹持、"刮雨器(雨刷)"综合征等,原因为术中后囊膜破裂、后发性白内障、人工晶状体襻变形、外伤等,应用旋转复位法、后囊膜夹持固定法、玻璃体切除或加睫状沟缝线法等。结果:术后视力明显提高19眼,症状明显减轻至消失,人工晶状体位置固定。结论:提高人工晶状体植入手术技术是减少术后人工晶状体异位的主要措施,根据人工晶状体异位的不同情况应用各种复位技术可得到良好效果。     

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。     

外伤性晶状体脱位病例人工晶状体悬吊术观察

目的 探讨外伤性晶状体脱位的病例应用后房型悬吊人工晶状体缝合固定术的手术效果。方法 51眼，分为A、B两组，A组为Ⅰ期人工晶状体植入组，共28眼。晶状体后脱位范围〉1／2者22眼，晶状体全脱位于玻璃体腔内者6眼。B组为Ⅱ期人工晶状体植入组，共23眼，均为晶状体玻璃体切除术后无晶状体眼。两组手术方法均为用聚丙烯缝线固定人工晶状体上下襻于睫状沟处。结果 A组术后3月矫正视力：23眼〉0．6，3眼分别为0．1～0．3。B组术后3月矫正视力：19眼〉0．6，4眼分别为0．1～0．3，两组病例全部脱盲。结论 通过本组病历观察结果说明根据患眼的具体情况选择后房型悬吊人工晶状体的植入时机，后房型悬吊人工晶状体缝合固定术具有安全性好、并发症少、术后视力恢复快等优点。     

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。     

后房型人工晶状体缝线固定术的临床观察

目的探讨后房型人工晶状体缝线固定术的临床效果。方法选取白2010年3月至2012年4月期间14例患者16眼,均采用后房型入工晶体睫状沟缝线固定术,术后随访3-23月。结果术后3个月复查时最佳矫正视力1.0,最低0.15,视力在0.5以上者9只眼(占56.2%),视力偏低者中术前继发青光眼2只眼,玻璃体混浊2只眼,所有眼压均在正常范围内,无严重并发症发生结论人工晶状体睫状沟缝线固定术是治疗晶状体前囊膜口不完整,后囊膜破广较大或无囊膜,不能支撑后房型人工晶体患者的理想手术方法。     

后房型人工晶状体后脱位的临床分析

目的：探讨后房型人工晶状体后脱位发生的原因及处理方法。方法：对6例后房型人工晶状体后脱位患者临床资料，进行回顾性复习，以发现其发生原因及最佳处理方法。其发生原因与摘出白内障术中晶状体后囊破裂或悬韧带严重损伤有关。对6例患者中5例，采用玻璃体切除及睫状沟缝线固定术；1例观察。结果 4例人工晶状体复位成功，裸眼视力0．3～0．8。1例并发眼内炎再次取出人工晶状体，观察的1例矫正视力0．6。结论：后房型人工晶状体后脱位与后囊膜破裂有关，玻璃体手术及睫状沟缝线固定可以使人工晶状体复位，提高视力。注意防止眼内炎。     

Vitreous prolapse and IOL dislocation during intravitreal injection of triamcinolone acetonide

Background To report on procedure-related anterior segment complications during intravitreal injections.Methods In a prospective interventional case series, 614 eyes received a total of 723 intravitreal injections of about 20 mg triamcinolone acetonide (in 0.2 ml) after paracentesis and aqueous humor drainage for various indications.Results In three eyes (0.49% of all eyes) a vitreous prolapse occurred during the injection. In one eye, the vitreous prolapse was combined with dislocation of the intraocular lens (IOL). All three eyes were pseudophakic, showing an posterior capsule defect, and the IOL located in the ciliary sulcus. They were treated by translimbal vitrectomy, and one eye with reposition of the IOL. No other procedure-related postoperative complications were observed during injection or follow-up (7.8±7.1 months).Conclusions Intravitreal injections may cause a vitreous prolapse into the anterior chamber with or without IOL decentration or dislocation in predisposed eyes. Ophthalmologists should be aware of this possible complication and inform patients at risk.None of the authors received any financial support, or had any financial interest.     

Delayed posterior dislocation of silicone plate-haptic lenses after neodymium:yag capsulotomy

We report 4 cases of posterior dislocation of silicone plate-haptic intraocular lenses (iols) into the vitreous cavity occurring a mean of 16 months after neodymium:YAG laser posterior capsulotomy. In each case, no peripheral capsule defect was observed at the time of laser capsulotomy or at subsequent follow-ups. One case was treated with sulcus implantation of a 3-piece IOL, with the plate-haptic IOL left in the vitreous cavity. The other cases were managed with vitrectomy (2 pars plana, 1 anterior) to remove the plate-haptic lens with subsequent sulcus placement of a 3-piece IOL. Patients should be informed that posterior dislocation is an infrequent but possible complication of these lenses and may occur months and even years after implantation or laser capsulotomy.     

人工晶状体脱入玻璃体腔的手术处理方法

目的探讨人工晶状体完全脱位坠人玻璃体腔,手术过程中人工晶状体的捞取和固定的不同处理方法。方法回顾性分析8例（8只眼）人工晶状体完全脱人玻璃体腔者采用人工晶状体取出置换,原人工晶状体缝合固定,玻璃体腔内捞取人工晶状体不用重水等方法,观察手术疗效及并发症。结果人工晶状体脱位原因有晶状体悬韧带断裂,囊袋及人工晶状体脱位1例,囊膜不完整人工晶状体脱落6例,前房人工晶状体外伤后脱位1例。2例脱位人工晶状体摘出,置换缝合固定型人工晶状体;6例脱位的人工晶状体睫状沟缝合固定,脱位人工晶状体不摘出,减少摘出时扩大切口的创伤。结论脱位人玻璃体腔内的人工晶状体如植入不适当可取出置换,大部分脱位的人工晶状体可不摘出,行睫状沟缝合固定,能明显提高视力,减少并发症。     

人工晶状体脱入玻璃体腔内的手术处理及再复位

目的 探讨后房型人工晶状体（ＰＣ－ＩＯＬ）脱入玻璃体腔内及ＩＯＬ再复位的手术方法。方法 对５例ＰＣ－ＩＯＬ脱入到玻璃体腔内经玻璃体切割取出及ＩＯＬ睫状沟固定观察其手术疗效。结果 ５例患者ＩＯＬ位置正中、稳固,视力均在０．３以上,最好视力０．８。结论 ＩＯＬ脱入玻璃体一,庆尽早手术,玻璃体手术处理是惟一安全有效的方法,睫状沟缝线固定ＩＯＬ定位要准确,不但可避免并发症的发生,还可使患者的视力得到明显的     

YAG激光联合缝线固定术处理人工晶状体坠入玻璃体腔

目的 探讨YAG激光联合缝线固定术治疗人工晶状体坠入玻璃体腔的术后效果.方法 充分散瞳后用YAG激光切开残存的囊膜,让患者俯卧位使人工晶状体脱入前房,然后用改良的人工晶状体缝线固定术将该人工晶状体固定于睫状沟.结果 12例中有11例的人工晶状体成功固定于睫状沟,这11例术后1周均达到和超过术前最佳矫正视力. 1例用该法没能使人工晶状体脱入前房,而建议行玻切手术.结论 用YAG联合后房型人工晶状体缝线固定术处理人工晶状体坠入玻璃体腔,是一种操作简单、创伤小、固定可靠、效果良好的手术方式,大部分患者不需再行玻切术,也不需将人工晶状体从眼球内取出.     

Luxated intraocular lens fixation using intravitreal cow hitch (girth) knot

OBJECTIVE: To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity to the ciliary sulcus using intraocular cow hitch (girth) knots without IOL extraction. DESIGN: Non-comparative interventional case series. PARTICIPANTS: Five patients with a luxated IOL in the vitreous cavity. INTERVENTION: All patients underwent surgery to fixate the IOL using this technique. METHODS: A three-port vitrectomy was performed in all five cases. A needle with looped 10-0 polypropylene was introduced into the vitreous cavity through a sclerotomy incision, and only the needle was passed out of the eye, guided by a bent 27-gauge needle from the 3-o'clock position 1.5 mm from the limbus. A cow hitch (girth) knot at the end of the loop was made outside the globe, grasped with a straight intravitreal forceps, and introduced into the vitreous cavity. Hooking the cow hitch (girth) knot around the haptics of the IOL in the vitreous cavity, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. After the opposite haptic was brought into the anterior chamber, the 10-0 polypropylene was looped around the haptics of the IOL and manipulated with a push-and-pull hook in the anterior chamber through the two corneal side ports to make a cow hitch (girth) knot outside the anterior chamber. By pulling up the suture, the knot was brought back and tied in the anterior chamber. It was then fixated to the ciliary sulcus at the 9-o'clock position. MAIN OUTCOME MEASURES: Patients were evaluated for visual acuity, refraction, and surgical complications associated with the procedure. RESULTS: In all five cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. CONCLUSIONS: This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.     

Pseudo anterior capsule barrier for the management of posterior capsule rupture

A technique that uses an implanted intraocular lens (IOL) to create a barrier for the management of posterior capsule rupture is described. When a rupture occurs, surgery is halted and a dispersive ophthalmic viscosurgical device (OVD) injected into the anterior chamber to prevent vitreous prolapse. The remaining nucleus is maneuvered into the anterior chamber away from the pupillary space. The posterior capsule tear is converted into a continuous curvilinear capsulorhexis where possible. Dissociated anterior vitrectomy is performed as indicated, keeping the large nuclear fragments trapped in the OVD-filled anterior chamber. An IOL is implanted in the capsular bag or sulcus with optic capture through the anterior capsulorhexis. Using reduced parameters, phacoemulsification of the remaining fragments is completed over the IOL, which functions as a barrier to seal off the vitreous cavity. Residual nuclear fragments and vitreous are cleared from beneath the optic by placing the vitreous cutter under the optic, recapturing the optic before the instruments are removed from the eye. FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.     

Luxated intraocular lens fixation using anterior chamber slipknot of the haptic to the sclera: a simple procedure to fixate intraocular lens to the sclera

PURPOSE: To describe a technique for suturing a luxated intraocular lens (IOL) in the vitreous cavity directly to the ciliary sulcus using intraocular slipknot without IOL extraction. DESIGN: Noncomparative interventional case series. MATERIALS AND METHODS: A three-port vitrectomy was performed in all cases. According to the Lewis procedure, two scleral flaps and relative sclerectomies were performed at 3 and 9 o'clock position. IOL was rescued from vitreous cavity by means of perfluorocarbon and stabilized in anterior chamber by intravitreal forceps. Corneal endothelium was preserved by a dispersive ophthalmic viscosurgical device coating. Double armed 10-0 polypropylene was introduced into the vitreous cavity through the 9 o'clock sclerotomy incision and both the needles were passed out of the eye by the 3-o'clock position sclerotomy, guided by a bent 27-gauge needle 1.5 mm from the limbus. Hooking the slipknot around the haptics of the IOL in the anterior chamber by means of vitreous forceps, the 10-0 polypropylene was pulled so that the IOL haptic was fixated onto the sulcus. The same procedure was used to fixate the opposite haptic to the ciliary sulcus at the opposite position. RESULTS: In all four cases, the IOL fixated stably and remained well positioned. No significant intraoperative or postoperative complications occurred. CONCLUSIONS: This technique enables secure fixation of the luxated IOL in the vitreous without extracting it.