Intraocular lens implantation in microphthalmic patients.

Microphthalmos is a developmental disorder of the eye consisting of a smaller than normal eye. This disorder can present as an isolated condition or associated with other systemic alterations. It is not uncommon for patients with microphthalmos to have congenital cataracts along with other ocular and systemic abnormalities. This paper reports the experience with 11 microphthalmic eyes of seven patients who had primary or secondary intraocular lens (IOL) implantation over a six-year period from 1985 to 1991. In all cases the IOL had a 13.5 mm or 14.0 mm overall diameter and a 6.0 mm or 6.5 mm optic. It was difficult to obtain documentation of objective visual improvement in many of these cases because of the associated nystagmus. However, all patients reported subjective improvements. These results suggest that with proper technique and lens selection microphthalmic patients should be considered for IOL implantation with relative safety and success.     

外伤性白内障人工晶状体植入术的时机和方式

目的 探讨外伤性白内障人工晶状体植入术的效果及术式选择。方法 29例(29眼)外伤性白内障，一期植入后房型人工晶状体23眼，手术距外伤时间3～16小时。二期植入后房型人工晶状体6眼，手术距外伤时间3月～6年。结果 术后矫正视力达0．5以上者65．2％，手术均无严重并发症，最佳视力达0．8。结论 选择适当的手术时机和手术方式，可使外伤性白内障人工晶状体植入术达到较好效果。     

无虹膜眼人工晶状体植入术

目的：探讨无虹膜眼人工晶状体植入术的手术方法，并评价其疗效。方法：对46例（47眼）无无虹膜眼人工晶状体植入术。其中外伤性白内障42眼，先天性白内障5眼。手术方式：晶状体玻璃体切除人工晶状体睫状沟缝线固定术、囊袋内人工晶状体植入术、带虹膜隔人工晶状体植入术及联合穿透性角膜移植术。随访1－14月，平均4．8月。结果：47眼手术顺利，术后人工晶状体位置正。术后矫正视力≥0．5者33眼（70．21％），0．1－0．4者12眼（25．56％）；术后4眼眼压升高，10眼前房纤维蛋白渗出。无严重远期并发症。结论：无虹膜眼人工晶状体植入是可行的，但患者眼部情况复杂，应根据眼部具体情况选择手术方式和人工晶状体的类型。影响术后视力恢复的主要因素是散光。     

Intraocular lens implantation in children

Over the past 15 years, lens implant surgery in children has disseminated so much that it is no longer a controversial issue. It has become rather a specialized topic in the widespread field of lens implantation in the general population. To match the excellent results seen in adults, issues such as the surgical technique, the choice of the lens, and dioptric power of that lens, are constantly being refined and adapted to children's growing eyes. Scleral tunnels and small, self-sealing corneal incisions are being replicated in children to benefit from their advantages. Polymethyl methacrylate material remains unrivalled from the point of view of safety and longevity in the human eye. Intraocular lenses (IOLs) with an overall diameter of 12 mm can safely be used in nonmicrophthalmic eyes of children more than 3 years of age. Several investigators now recognize the need for smaller pediatric IOLs for neonates, toddlers, and microphthalmic eyes. Fortunately, modern IOLs are smaller today than they were 15 years ago. The accumulating evidence on the myopic shift that occurs in pseudophakic children have led to an almost unanimous agreement that the IOL power should aim for a certain amount of hypermetropia at time of surgery. The residual refractive error can be corrected with spectacle glasses that are adjusted throughout childhood. The goal is to start with hypermetropia in childhood that will convert into emmetropia or mild myopia in adulthood.     

晶状体全脱位的人工晶状体植入术

目的观察晶状体全脱位患者行人工晶状体植入的效果与并发症。方法毫针固定脱位晶状体并圈套娩出,显微剪剪除脱出玻璃体加睫状沟缝线固定人工晶状体。术后随访６～１３ｍｏ,平均８．２ｍｏ．结果观察７例７眼术后视力０．８者１眼,０．７者１眼,０．５者３眼,０．３者２眼。术中术后并发症少。结论晶状体全脱位患者经过人工晶状体植入术后,均获得满意视力。     

先天性白内障人工晶状体植入术临床观察

目的探讨先天性白内障手术时机及术后并发症处理。方法对35例47眼先天性白内障用超声乳化的注吸系统进行吸出手术并植入人工晶状体，应用SRK三元回归公式计算人工晶状体屈光度，且植入人工晶状体度数低于所得度数2D，并进行后囊环行撕囊。术后随访10．26月。结果检查合作者21例30眼，视力〉0．7者4眼（13．33％）；〉0．3者20眼（66．67％）；脱盲率为90％，脱残率67％。术后并发症后囊浑浊17眼；瞳孔夹持4眼。人工晶状体前膜5眼。结论先天性白内障致盲原因主要是形觉剥夺，应尽早施行手术，并及时处理术后并发症和进行弱视训练。     

Intraocular lens implantation in developing countries

One of the chief aims of ophthalmic workers in developing countries is to operate on as many cataract patients as possible in the most cost-efficient manner. Therefore, our intraocular lens (IOL) implantation policy in Nakuru and Kikuyu, Kenya, is to reserve IOLs for monocular cataract patients of all ages, who otherwise would not have use of the aphakic eye. In this study, we review 105 of our first IOL implantations. In 60%, the uncorrected postoperative visual acuity was 20/60 or better.     

Intraocular lens implantation in traumatic cataract

PURPOSE: The evaluation of postoperative results and complications after traumatic cataract extraction with intraocular lens implantation. MATERIAL AND METHODS: Forty two eyes of 41 patients (31 male and 10 female) aged from 10 to 66 years (mean 37.8) with traumatic cataract were the subject of our study. They were operated on between 1996 and 1997. A penetrating injury in 33 eyes (78.6%) and blunt trauma in 9 eyes (21.4%) caused the cataract. The interval between trauma and cataract surgery ranged from 1 day to 40 years. The mean follow up was 13.5 months. Despite of cataract corneal scars, pupil deformations, posterior and anterior synechiae were observed in most of the eyes. Extracapsular cataract extraction was performed in all cases. Posterior chamber IOLs were implanted in 33 eyes. Anterior vitrectomy and anterior chamber IOL implantation was performed in 9 eyes due to the lack of capsular support. RESULTS: Very good or good visual acuity (5/5-5/16) was achieved in 71.4% of cases. Low visual acuity (below 5/50) was observed in 6 eyes (14.3%) because of severe damage to the retina, optic nerve atrophy or amblyopia. Fibrin reaction in anterior chamber (30.9%), hyphaema (19%) and haemophtalmus (4.8%) were the most severe postoperative complications. CONCLUSIONS: An intraocular lens implantation in traumatic cataract, despite many postoperative complications, enables most of the patients to achieve satisfactory and useful vision. Patients with severe posterior segment damage do not benefit functionally from cataract surgery.     

外伤性白内障人工晶状体植入术时机的选择

目的：探讨外伤性白内障手术时机的选择。方法：21例单眼外伤性白内障，一期植入后房型人工晶状体19眼，二期植入后房型人工晶状体2眼，手术距外伤时间6小时－3年。结果：术后矫正视力0．5以上者达63．2％，术后并发症中后囊浑浊4眼（19％），玻璃体浑浊3眼（14．3％），虹膜后粘连2眼（9．5％），人工晶状体偏位2眼（9．5％），结论：正确把握外伤性白内障的手术时机和术式选择，可减少术中术后的并发症，提高手术的成功率和手术质量。     

Intraocular lens implantation in an underdeveloped country

The results of 152 intraocular lens implantations performed at Mbabane Government Hospital, Swaziland, Africa, on 114 African patients with senile cataracts are presented. Surgery was performed with manual equipment and procedures. Lens implantation was accompanied by a low rate of postoperative complications. Uncorrected visual acuity of 20/120 or better was achieved in 79.6% of patients. The advantage of IOL implants over low-cost aphakic spectacles in Third World countries is discussed.     

后路人工晶体植入术

报告14例后路人工晶体植入术。其中眼内异物外伤性白内障4例；角巩膜穿通伤外伤性白内障4例；眼球钝挫伤晶体半脱位1例；眼球破裂伤晶体脱失1例；青光眼滤过性手术后并发性白内障2例；后发障2例。术后随访6～16月，13例视力明显提高，1例术后1．5月发生视网膜脱离。作者认为该手术对常规手术无法植入人工晶体的病例来说，是一个很好的方法。     

Intraocular lens implantation after penetrating keratoplasty

PURPOSE: We evaluated the clinical results of nonsimultaneous penetrating keratoplasty, cataract extraction, and intraocular lens (IOL) implantation (two-stage surgery) for combined corneal disease and cataract. METHODS: Twenty-six eyes of 24 patients with an average age of 46 years who underwent two-stage surgery were studied retrospectively. Variables included visual acuity, refractive status, specular microscopy before and after IOL implantation (6 months), and the occurrence of graft failure. Astigmatism was corrected by suture removal and relaxing incision. The mean follow-up after IOL placement was 16 months. RESULTS: Unaided visual acuity was 20/100 or better in 22 (83%) eyes after the second procedure. Twenty-one (81%) eyes had an aided visual acuity of at least 20/40. The mean refractive and absolute errors were -1.49 +/- 1.39 diopters (D) and 1.55 +/- 1.30 D, respectively. The mean keratometric and refractive cylinders were 3.50 D and 2.26 D, respectively. Nineteen (73%) eyes had a spherical equivalent refraction within 2 D of emmetropia. Anisometropia (> or =3 D) occurred in four (15%) eyes. The endothelial cell density, the coefficient of variation, and the percentage of hexagonal cells documented by specular microscopy were not significantly different before and after IOL implantation. Complications included three rejections, two cases of herpetic recurrence, and one late decompensation. Two graft failures (8%) occurred after secondary surgery. CONCLUSION: The two-stage surgery is a safe and effective modality.     

Intraocular lens implantation in phakic rabbit eyes

Three sizes (13.5 mm, 17.5 mm, and 18.5 mm) of open loop, one piece, poly(methyl methacrylate) anterior chamber intraocular lenses (IOLs) were implanted in 12 phakic rabbit eyes to evaluate the effect of the IOL on the crystalline lens and the anterior chamber. Six eyes were used as a control group. Minimum follow-up was four weeks. All the IOLs touched the crystalline lenses, and on the first postoperative day, round subcapsular lens opacities were found in all eyes in the area of IOL contact. The lens opacities became more dense with time. Only one eye in the control group showed a subcapsular opacity, which was linear rather than round. Anterior chamber inflammation was 1+ to 2+ in ten eyes (80%) in the IOL group during the first and second weeks, whereas minimal inflammatory changes occurred in the control group. These results suggest that with current IOL technology, IOL insertion in the phakic eye to correct refractive errors results in a high incidence of cataract if IOL-to-lens touch occurs.     

外伤性白内障人工晶体植入术（附42例）

对４２例外伤性白内障行现代囊外摘除及人工晶体植入术。随访３￣３６月，平均１９．５月。矫正视力≥１．０者占２８．６％，≥０．５者占５２．４％。对外伤性白内障人工晶体植入术的病例选择、手术时机、手术技巧和术后并发症的处理进行了简要讨论。强调严格掌握适应证，术中对并发症的适当处理，可减少术后并发症，提高手术成功率。