超声乳化白内障吸除联合小梁切除术治疗闭角型青光眼合并白内障

目的:观察超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗闭角型青光眼合并白内障的临床效果。方法:对闭角型青光眼并白内障36例46眼行超声乳化白内障吸除折叠式人工晶状体植入联合小梁切除手术治疗。术前、术后分别详细记录患者视力、眼压、滤过泡、前房深度、房角及眼底情况。结果:术后随访3mo～2a,43眼(93.5%)视力较术前明显提高,44眼(95.7%)眼压保持在正常范围,术后眼压<21mmHg。35例46眼患者前房深度术前平均为2.1±0.3mm,术后平均3.8±0.4mm,术后所有患者前房深度均加深,术前关闭的前房角也有不同程度的开放。6眼(13.0%)角膜水肿,无角膜内皮失代偿。结论:合并白内障的闭角型青光眼患者行超声乳化白内障吸除联合小梁切除术安全有效,能够有效降低眼压、加深前房、开放房角,提高视力。     

辅助技术在治疗白内障合并角膜混浊手术中的应用

目的：评价在白内障手术中应用包括囊膜染色、虹膜拉钩、虹膜切除等辅助技术治疗白内障合并角膜混浊患眼的术后视觉效果,并分析手术安全性和有效性。

方法：回顾收集2014-01/2019-03在新疆军区总医院全军眼科中心接受白内障超声乳化合并人工晶状体植入术的白内障合并角膜混浊患者105例105眼,所有患者接受白内障超声乳化摘除并人工晶状体植入术。术中应用台盼蓝囊膜染色剂,并观察前囊膜染色情况,连续环形撕囊成功率,晶状体后囊破裂及人工晶状体囊袋内植入情况。并于术后1d,1wk,1、3mo对患者进行随访,观察术中撕囊成功率,术前、术后的最佳矫正视力(BCVA,LogMAR),术后并发症等。

结果：患者均接受白内障超声乳化吸除合并人工晶状体植入术。术中通过应用台盼蓝囊膜染色剂(台盼蓝)染色前囊膜辅助成功完成所有连续环形撕囊,并采取了包括应用虹膜拉钩及虹膜切开术等其他措施。将可折叠式人工晶状体植入105眼。术后追踪观察3mo,术眼术后BCVA为0.82±0.10,与术前BCVA(3.12±0.14)比较有差异(t=174.893,P<0.01)。

结论：白内障超声乳化摘除术能使白内障合并角膜混浊患者的视力得到安全有效的提高。辅助技术如囊膜染色、虹膜拉钩、虹膜切除等的应用,能有效降低白内障合并角膜混浊患者的白内障手术风险,提高手术安全性,增加手术成功率。     

微切口超声乳化人工晶状体植入治疗葡萄膜炎并发白内障

目的:探索微切口超声乳化人工晶状体植入术治疗葡萄膜炎并发白内障的临床疗效和安全性。方法:对32例40眼葡萄膜炎并发白内障的患者施行微切口超声乳化人工晶状体植入术,术中慎重处理小瞳孔和虹膜后粘连,尽量避免刺激虹膜,术后回顾性分析术后患者视力、并发症。结果:随访1～13(平均7.6)mo,40眼术后瞳孔基本圆,视力均有不同程度提高,术中3眼后囊膜破裂,2眼虹膜渗血。术后并发症主要有角膜水肿、瞳孔后粘连、葡萄膜炎复发,经相应处理后均已消失。结论:微切口超声乳化人工晶状体植入术是治疗葡萄膜炎并发白内障的安全有效的方法之一,它使角巩膜切口更小,术中损伤小,不伤及虹膜,术后前段反应轻,视力恢复好。     

白内障超声乳化人工晶状体植入联合房角分离术治疗急性闭角型青光眼合并白内障

目的：观察白内障超声乳化人工晶状体植入联合房角分离术治疗急性闭角型青光眼合并白内障的疗效。

方法：收集2009-10/2014-06急性闭角型青光眼合并白内障40例52眼,手术均采用颞侧透明角膜切口,白内障超声乳化人工晶状体植入联合房角分离术,术后随访6mo。

结果：术后最佳矫正视力较术前显著提高(P<0.01); 患者术后6mo眼压平均为15.76±2.09mmHg,较术前用药前后眼压相比均显著下降(P<0.01); 术后患者房角均较术前增宽,房角粘连关闭象限不同程度开放; 术前前房深度为1.97±0.29mm,术后增加到2.83±0.35mm,差异有显著性(P<0.05); 未发生恶性青光眼、后囊膜破裂等并发症; 所有术眼人工晶状体均在晶状体囊袋内,未出现偏位、夹持。

结论：白内障超声乳化吸除联合房角分离术可有效降低眼压,提高视力,为急性闭角型青光眼同时合并白内障患者安全有效的治疗途径。     

复杂病例白内障超声乳化手术的难点及对策

目的:观察复杂病例白内障超声乳化吸出人工晶状体植入术的疗效并探讨处理要点。方法:采用改良拦截劈裂技术对硬核白内障、高度近视并发白内障、糖尿病患者白内障及白内障合并青光眼等复杂病例白内障537例(558眼)行超声乳化手术。观察术中术后并发症及术后1mo的最佳矫正视力。结果:术后1mo最佳矫正视力≥0.5者437眼(78.3%),0.2~0.4者92眼(16.5%),≤0.1者29眼(5.2%);术中发生后囊膜破裂伴玻璃体脱出21眼(3.8%),晶状体核坠入玻璃体1眼(0.2%);术后角膜水肿212眼(38.0%),无角膜失代偿;房水混浊为363眼(65.1%);虹膜损伤2眼(0.4%)。结论:充分认识复杂病例白内障各病种的特点、正确掌握手术要点以及良好的围手术期处理,复杂病例白内障同样能获得理想的手术效果。     

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature

AIM: To evaluate the surgical results of sulcus intraocular lens (IOL) implantation in children with unilateral anterior persistent fetal vasculature (PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule. METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity (BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution (logMAR) after IOL implantation (P<0.001) with a mean follow-up was 16.55±5.86mo. Average age at secondary IOL implantation was 41.05±15.41mo. Three eyes (13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise (4 eyes; 18.18%), postoperative increased inflammation (3 eyes; 13.64%) and postoperative hypotony (2 eyes; 9.09%) were common complications. CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.     

Outcomes of toric IOL implantation guided by iris-registered femtosecond laser capsulotomy markings

Purpose

To assess the accuracy and stability of iris-registered femtosecond laser-assisted anterior capsule axis markings (compensating cyclotorsion) along with refractive and visual outcomes after toric IOL implantation.

Methods

This prospective case series included eyes with visually significant cataracts and regular corneal astigmatism ranging from 1.25D to 4.0D, which received FLACS and toric IOL implantation, at The Eye Institute of West Florida, Largo, Florida, USA. Preoperative iris registration was used in conjunction with a femtosecond laser platform to create cyclotorsion corrected axis marks at the capsulotomy edge to facilitate toric IOL axial alignment. Patients were examined one, seven and thirty days after surgery to assess capsulotomy marks axis, toric IOL axis along with visual and refractive outcomes.

Results

Eighteen eyes of 13 patients aged 74.35?±?8.65 years were included. Mean pre-op CDVA was 0.24?±?0.16 LogMAR, while mean post-op UDVA was 0.09?±?0.09 LogMAR. Mean pre-op corneal astigmatism was 1.85?±?0.41 D, decreasing to 0.24?±?0.41 D of refractive astigmatism postoperatively (p?<?0.001). The capsular toric axis markings were visible in 100% of eyes throughout the follow-up; the mean difference between intended capsulotomy mark axis and measured capsulotomy mark axis was 1.6°, 1.7° and 1.3 ^o at the 1, 7 and 30 day intervals (p?>?0.05), respectively. No capsule-related or any other type of complications was noted.

Conclusions

Iris-registered femtosecond laser-assisted anterior capsule axis markings are safe and may be considered as an alternative option to the known axis marking techniques for toric IOL axial alignment at the time of cataract surgery.

     

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

AIM: To investigate the effect of Cionni-modified capsular tension ring (CTR) implantation in patients with severely traumatic subluxated cataracts. METHODS: All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed. Corrected distance visual acuity (CDVA), extent of zonulysis, intraocular lens (IOL) position, intraoperative presentation, and complications were assessed. The primary outcomes included IOL centration stability and other postoperative complications. RESULTS: Twenty patients (20 eyes) were included in this study. The mean age in this study was 58.0±11.3y, and the average follow-up time was 17.3±12.8mo. Capsule bags were saved by Cionni-modified CTR. Nine eyes (45%) underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber. The preoperative mean CDVA was 0.83±0.24 logMAR, and the postoperative average CDVA was 0.23±0.30 logMAR (P<0.05). The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm, respectively; the vertical and horizontal IOL tilt after surgery was 5.5°±2.5° and 6.1°±2.2°, respectively. None of the eyes had obvious IOL decentration during the follow-up time. Eight eyes (40%) had posterior capsule opacification (PCO) that was severe enough to cause poor vision. Neodymium: YAG laser capsulotomy were performed on these eyes when the CTR was stabilized. CONCLUSION: With the help of Cionni-modified CTR, capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.     

糖尿病患者白内障超声乳化吸除联合后房型人工晶状体植入术疗效分析

目的　研究糖尿病患者白内障超声乳化吸除联合后房型人工晶状体植入术的疗效及并发症。方法　对 2 0 0 1年 3月～ 2 0 0 2年 8月期间明确诊断为糖尿病的白内障患者 80例 ( 83只眼 )行超声乳化吸除联合后房型人工晶状体植入术。术前空腹血糖均控制在 8mmol/ L 以下 ,术后随访观察视力、前房反应、角膜情况。结果　 80例 ( 83只眼 )糖尿病患者白内障术后视力均有不同程度的提高 ,其中 9只眼视力 <0 .1者多数为糖尿病性视网膜病变者。术后主要并发症角膜水肿、房水混浊、前房纤维素膜样渗出及前房积血均在一周左右消退 ,对术后视力无影响。结论　糖尿病患者白内障术前空腹血糖控制良好的情况下行超声乳化吸除联合后房型人工晶状体植入术能获得较满意的疗效 ,是安全可靠的     

Lens opacities after posterior chamber phakic intraocular lens implantation

PURPOSE: To describe a case series to determine the incidence of lens opacities after posterior chamber phakic intraocular lens (IOL) implantation (STAAR Surgical, Monrovia, CA) for very high ametropias. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fourteen eyes of 170 consecutive eyes with high ametropias in whom lens opacities developed after posterior chamber phakic IOL implant (PCPIOL). INTERVENTION: Posterior chamber phakic intraocular lens implant. MAIN OUTCOME MEASURES: Lens opacity appearance, localization, and clinical course. RESULTS: Fourteen eyes developed lens opacities 125 +/- 116 days after phakic IOL implant. All eyes had anterior subcapsular opacities, and two eyes also developed nuclear sclerosis. The anterior opacities did not extend posteriorly within the lens, and there were no posterior subcapsular cataracts. Seventy-one percent of opacities were first seen 相似文献   

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     

玻璃体手术后无晶状体眼的二期人工晶状体植入术

目的评价因复杂眼外伤或视网膜脱离行玻璃体手术和晶状体切除术后,二期手术植入人工晶状体(intraocular lens,IOL)的视力效果、手术技术及其安全性 。方法对在1996年11月至1999年12月之间在我院进行该手术的32例(32只眼,每例均为单眼)行回顾性分析。二期手术中应用经睫状体平部的眼内灌注,并根据晶状体囊膜完整性选择不同类型的IOL。结果本组包括复杂眼外伤30例(眼后节异物伤15例,穿通伤伴外伤性眼内炎及玻璃体积血各6例,钝挫伤伴晶状体脱位3例);原发性视网膜脱离2例。均接受过玻璃体切割、晶状体切割,或眼内异物取出、角膜缝合等。2次手术的间隔为1～16个月,平均(6.8±3.7)个月。在25例晶状体囊环完整或存留2/3以上的眼植入后房型IOL于睫状沟内;5例作了IOL的透巩膜缝线固定术;植入前房型或带虹膜IOL各1例。5例同期放出硅油。手术后29例视力提高。主要并发症为角膜水肿及低眼压。结论在玻璃体手术后的二期手术中,应用眼内灌注和适当的IOL植入,可使经选择的无晶状体眼安全获得较好的视力恢复。(中华眼底病杂志,2001,17:96-98)     

白内障超声乳化术治疗闭角型青光眼的临床体会

目的：观察白内障超声乳化联合后房型折叠式人工晶状体植入术治疗合并白内障的不同房角关闭状态的闭角型青光眼的疗效。方法：白内障超声乳化联合后房型折叠式人工晶状体植入术治疗闭角型青光眼48例64眼,术前及术后常规行视力、裂隙灯、Goldmann前房角镜检查、前房深度、眼压检查。结果：术后随访3～12mo,52眼视力较前有明显提高。59眼术后眼压〈21mmHg。64眼前房深度均加深,术前前房深度平均1.803mm,术后前房深度平均3.143mm。术前关闭的前房角有不同程度的开放,虹膜平坦,虹膜周边前粘连的范围明显缩小。64眼均未发生后囊膜破裂及角膜失代偿。结论：合并白内障的闭角型青光眼患者行超声乳化白内障吸除联合折叠式人工晶状体植入术,不但能够有效降低眼压、加深前房、开放房角,还可恢复视功能,并能减少小梁切除术的常见并发症,是治疗闭角型青光眼的一种安全有效的方法。     

3.2mm切口手法碎核白内障摘除联合折叠式IOL植入术的疗效观察

目的：观察3.2mm切口手法碎核白内障摘除联合折叠式人工晶状体植入术的临床效果。

方法：观察组：对我院78例95眼老年性白内障行3.2mm切口手法碎核白内障摘除联合折叠式人工晶状体植入术; 对照组：对同期82例100眼老年性白内障行超声乳化白内障摘除联合折叠式人工晶状体植入术。观察并比较手术并发症及术后视力恢复情况。

结果：观察组术中有2眼(2.1%)后囊膜破裂,3眼(3.2%)局限性悬韧带离断。术后切口方位角膜轻中度水肿混浊18眼(18.9%),1wk内前房闪辉22眼(23.2%)。对照组术中有3眼(3.0%)发生后囊膜破裂,4眼(4.0%)局限性悬韧带离断。术后角膜轻中度水肿混浊21眼(21.0%),1wk内前房闪辉26眼(26.0%)。两组均无后弹力膜脱离、前房出血、伤口渗漏及感染发生。两组并发症比较差异无统计学意义(P>0.05)。两组术后视力比较差异无统计学意义(P>0.05)。

结论：3.2mm切口手法碎核行白内障摘除联合折叠式人工晶状体植入术操作安全、简便,具有小切口手术的优点,适于临床推广和普及。     

Microincision bimanual phacotrabeculectomy in eyes with coexisting glaucoma and cataract

PURPOSE: To report the technique and surgical outcomes of microincision bimanual phacotrabeculectomy in eyes with glaucoma and coexisting cataract. SETTING: Glaucoma Service, Hong Kong Eye Hospital, Hong Kong SAR, China METHODS: Microincision bimanual phacoemulsification with a sleeveless phaco needle and irrigating chopper was performed in combination with trabeculectomy. Phacoemulsification was performed through 2 small clear corneal wounds, sparing the trabeculectomy site from trauma. The intraocular lens (IOL) was then implanted through the trabeculectomy site, so no corneal wound larger than 1.5 mm was required for IOL implantation. RESULTS: The first 10 consecutive eyes of 10 patients who had combined phacotrabeculectomy by a microincision bimanual technique had significantly reduced intraocular pressure. There was a 10.5% reduction in the mean corneal endothelial cell count. There were no other complications up to 6 months after surgery. CONCLUSION: Microincision bimanual phacotrabeculectomy appeared to be an effective and safe option in patients with glaucoma and coexisting cataract.     

超声乳化术治疗假性剥脱综合征白内障患者的疗效分析

目的：：评估在白内障超声乳化手术时使用适当的手术技巧及相应设备对假性剥脱综合征白内障患者的视力及术中、术后并发症的影响。方法：回顾性研究。选取53例67眼假性剥脱综合征白内障患者接受超声乳化及人工晶状体植入术。平均年龄71.68±9.96(53~89)岁,其中男性24例(45%),女性29例(55%),包括核性、皮质性及后囊下和成熟期的白内障。结果：核性白内障较其他类型更为常见(P=0.00)。术前平均最佳矫正视力为0.99±0.30(0.40~1.50) LogMAR,术后平均最佳矫正视力为0.32±0.31(0.00~1.00) LogMAR ( P=0.00)。运用虹膜牵拉器12眼(18%)。囊袋张力环植入15眼(22%),其中按计划植入8眼(12%),未计划7眼(10%)。后囊破裂4眼(6%),其中玻璃体脱出2眼(3%),并接受前段玻璃体切割术;且由于后囊破裂较大,此2眼(3%)转为白内障囊外摘除术。持续性角膜水肿4眼(6%),前房反应5眼(7%)。人工晶体脱位4眼(6%),仅1眼(1.5%)需复位。后囊混浊并接受Nd：YAG激光后囊切开术13眼(20%)。结论：假性剥脱综合征白内障患者术后视力良好,但术中及术后可能出现的并发症包括后囊破裂,玻璃体脱出,转为白内障囊外摘除术,持续性角膜水肿,前房反应及人工晶状体脱位。为避免并发症的发生,适当的手术技巧和相应设备的使用在手术时是必不可少的。     

Changes in the crystalline lens resulting from insertion of a phakic IOL (ICL) into the porcine eye

Background Insertion of a phakic IOL offers these advantages: the corneal optical zone is not dissected or resected; preservation of the crystalline lens results in preservation of the accommodation force; and since the phakic IOL is removable, any error or change in refraction can be countered by exchanging it. However, the cause of secondary cataracts has never been clarified or discussed to date.Methods The following ICL lenses were inserted under general anaesthesia into 20 eyes of ten 3-month-old miniature pigs: a minus lens without holes into five eyes, a plus lens in two eyes, a minus lens with four holes around the lens haptics in three eyes, and a minus lens with a central hole in the optic in three eyes; and seven eyes were used as controls. The anterior segments were then photographed 1 week, 1 month and 3 months after surgery. At 3 months after surgery, Evans blue (EB) was infused into the vitreous under general anaesthesia, and after 30 min, the eyeball was enucleated, fixed and examined.Results In the case of the ICL without holes, the anterior subcapsular opacities were observed in all the eyes, and the anterior surfaces of the crystalline lenses were not stained with EB. Use of the ICL with four holes around the lens haptics resulted in light staining of the anterior surface of the crystalline lens, but the anterior subcapsular opacities observed were mild. As for the ICL with a hole in the centre of the optic, the anterior surface of the crystalline lens was stained and no anterior subcapsular opacities were observed.Conclusion The results suggested that the insertion of an ICL brings about a change in the dynamics of the intraocular aqueous humour, reducing its circulation to the anterior surface of the crystalline lens. This is considered to cause a metabolic disturbance of the crystalline lens, resulting in anterior subcapsular opacification.     

超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼,V期33眼,Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％）,V期28眼（84．8％）,Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）;玻璃体积血,术中17眼（25．8％）,术后7眼（10．6％）;角膜上皮延期愈合9眼（13．6％）;角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。     

晶状体超声乳化人工晶状体植入治疗原发性闭角型青光眼

目的探讨晶状体超声乳化人工晶状体植入对原发性闭角型青光眼治疗效果。方法对我院收治闭角型青光眼合并不同程度晶状体浑浊138例（138眼）的临床资料,术前检查前房角、前房角关闭粘连小于180°范围者行晶状体超声乳化吸出联合人工晶状体植入术。分析比较术前后眼压、视力及前房深度,随访6-12个月。结果术后138眼眼压均控制在21.0mmHg以下,前房深度增加与术前比较差异均有统计学意义（P〈0.05）。结论晶状体超声乳化后房人工晶状体植入可有效地治疗原发性闭角型青光眼。     

超声乳化在青光眼滤过术后白内障的应用

目的:探讨超声乳化联合人工晶状体植入术治疗青光眼滤过术后白内障的临床效果。方法:对35例41眼抗青光眼滤过术后白内障采用颞侧透明角膜的白内障超声乳化吸出术联合折叠人工晶状体植入术,术后观察视力、并发症、眼压和滤过泡的改变。结果:白内障术后的视力均有不同程度的提高,术后随访1～2a,眼压、滤过泡无明显改变。结论:颞侧透明角膜白内障超声乳化联合人工晶状体植入术治疗青光眼滤过术后白内障是安全有效的治疗方法。