前囊膜夹持人工晶状体植入术疗效观察

目的 提供一种后囊膜无功能性支撑作用时后房型人工晶状体睫状沟植入技术的改进方法。方法行角膜缘透明切口白内障超声乳化人工晶状体植入术29例(29眼)，术中采用连续环形撕囊，所有病例术中均发生非计划内后囊膜破裂，后房型人工晶状体改行睫状沟植入，光学部置于环形前囊膜下。术后随访时间3～21个月。结果全部病例术后最佳矫正视力均好于或等于0．3，术中并发症主要为后囊膜破裂(29眼)，8眼行前部玻璃体切割术，无一眼虹膜损伤。术后11眼出现一过性角膜水肿。结论对后囊膜无功能性支撑作用的病例，后房型人工晶状体借助具有连续环形开口的前囊膜夹持固定，可获得良好的视力及相对较低的并发症发生率。     

玻璃体切除术中切除晶状体保留前囊膜同时植入人工晶状体的疗效观察

目的:探讨玻璃体切除联合晶状体切除保留前囊膜同时植入人工晶状体的临床疗效。方法:玻璃体视网膜病变同时伴有晶状体混浊46例46眼,术中采用经睫状体平坦部切口切除晶状体,保留前囊膜,并行玻璃体切除,Ⅰ期植入人工晶状体。结果:所有患者视力均有不同程度提高,部分患者复查时前囊膜出现不同程度混浊,行YAG激光切开。结论:玻璃体切除联合晶状体切除保留前囊膜Ⅰ期植入人工晶状体,保留了眼内正常解剖结构,减少了术中及术后并发症,视力恢复良好。     

尿激酶治疗人工晶状体植入术后晶状体前膜

自1992年以来我们连续对234例（271眼）人工晶状体植入术后有瞳孔膜形成者，应用大剂量尿激酶结膜下注射治疗，获得满意效果，现报告如下。互材料与方法1．1一般资料本组连续病例234例（271眼），男129例，女105例。年龄1～88a，平均45．08a。正．2膜的临床分级l级：121眼（44．64％）；瞳孔区有灰白色纱膜样纤维组织增生；l级：103眼（38．00％）；前房及瞳孔区有较致密的纤维渗出膜；阻级：47眼（7．34％）；前房内有致密的渗出膜。1．3纤维膜形成的时间术后1～Zd者11眼（4．05％），术后3～sd者247眼（91．88％），术后6～10d者13眼（4…     

囊袋内人工晶状体偏心的临床观察

目的观察囊袋内植入人工晶状体的偏心状况及囊袋变化,探讨发生机理。方法选择96例（96只眼）老年性白内障患者,术中囊袋内植入人工晶状体,根据植入类型分为：A组14只眼（折叠型）、B组34只眼（硬质硬襻型）和C组48只眼（硬质软襻型）,在术后2～4个月观察比较各组人工晶状体的偏心距离,以及偏心与前囊膜形态的关系。结果A组、B组和C组偏心≥0．5mm的发生率分别为50％、19％、15％,A组与其他两组的差异有统计学意义（x2=4．02和4．84,P〈0．05）,偏心≥1．0mm的发生率分别为21％、6％、3％,两两比较统计学差异不显著。偏心≥0．5mm的人工晶状体中有81％前囊膜未完全遮盖光学部,有24％形成囊膜夹持,人工晶状体向前囊膜遮盖较宽或皱缩明显的方位偏移并基本与两襻支撑方向相垂直。结论囊袋皱缩是造成囊袋内人工晶状体偏心的主要原因,张力不适宜的襻和不规则的撕囊都可能造成术后囊袋不对称皱缩导致偏心,术中应采取相应的预防措施。     

白内障摘除术后晶状体前囊膜收缩综合征临床病理分析三例

连续环形撕囊（continuous eurvilinear capsulorhexis,CCC)是现代超声乳化白内障吸除术中常用的打开晶状体前囊膜的方法，其优点很多，但同时也可引发新的手术并发症，如晶状体前囊膜收缩综合征（capsule contraction syndrome,CCS)。     

外伤性白内障人工晶状体的囊夹持术

目的观察外伤性白内障手术中前后囊不完整病例囊夹持人工晶状体植入法的临床效果。方法 对伤性白内障手术中前后囊不完整的白内障82例（82眼）施行前囊或后囊环行孔或前后囊互补夹持法植入后房性人工晶状体，术后观察视力，人工晶状体的位置，囊的浑浊情况及并发症。术后随访1—48月。结果65眼（占79．27％）术后最佳矫正视力〉0．5，人工晶状体位置稳定、无后发性白内障、瞳孔夹持或视网膜脱离等并发症的发生。结论对于外伤性白内障手术中前后囊不完整者在术中采用前囊或后囊环形孔或残留前后囊互补夹持植入后房人工晶状体效果良好。     

囊膜破裂的外伤性白内障摘出及人工晶状体植入术

目的探讨囊膜破裂的外伤性白内障摘出Ⅰ期人工晶状体植入术的临床疗效及安全性。方法术中利用粘弹剂配合玻璃体切除术,对３５眼囊膜已破裂的外伤性白内障,进行手术摘出及Ⅰ期人工晶状体植入术。结果术后矫正视力≥０．５者３０眼,占８５．７％;０．１～０．４者４眼,占１１．４３％;０．１以下者１眼,占２．８％．未见任何严重手术并发症发生。结论由于显微手术的开展,粘弹剂及玻璃体切除术的应用,复杂的囊膜破裂的外伤性白内障摘出Ⅰ期人工晶状体植入术已变得安全、有效。     

人工晶状体前膜16例临床分析

对16例人工晶状体前膜的产生原因进行回顾性分析。结果：手术操作顺利者膜发生率为10．6％，操作欠顺利者为77．8％，（P＜0．001）。老年性白内障术后膜发生率为11．8％，外伤性者为43．8％，（P＜0．05）。术后早期（6－8h）活动性散瞳能有效预防和减轻前膜形成，提高手术技巧及早期活动性散瞳是预防的关键。对外伤性白内障术后更应注意前膜的发生以利早期处理.     

儿童白内障后囊撕囊及人工晶状体后囊嵌顿术

目的研究儿童白内障摘出术中后囊处理方法。方法对26例(38眼)儿童白内障手术中采用后囊连续环形撕囊联合人工晶状体视区后囊嵌顿,术后随访(14±4.51)月。结果34眼后囊连续环形撕囊联合人工晶状体后囊嵌顿成功。此34眼中18眼玻璃体前界膜完整,16眼行前段玻璃体切除。经随访2眼术后3月视轴区玻璃体前界膜轻度浑浊,其余32眼视轴区保持透明。结论后囊连续环形撕囊联合人工晶状体视区后囊嵌顿是预防儿童白内障人工晶状体植入术后后囊浑浊,减少对玻璃体、视网膜干扰的可行方法。     

晶状体前囊膜在青光眼白内障联合手术中的应用

实验组 10例青光眼合并白内障的病人 ,行小梁切除联合白内障超声乳化、人工晶状体植入术 ,术中将自体前囊膜衬垫在巩膜瓣下 ,对照组 12例青光眼合并白内障的病人 ,仅行小梁切除联合白内障超声乳化、人工晶状体植入术。实验组术后 1、 3、6周眼压明显低于对照组 (P <0 0 5 ) ,术后 9、 12周眼压低于对照组 ,但差异无显著性 (P >0 0 5 )。术后视力及并发症两组无明显差异。提示晶状体前囊膜应用于青 -白联合手术中能有效降低眼压 ,无明显并发症。     

Effect of a capsular tension ring on prevention of intraocular lens decentration and tilt and on anterior capsule contraction after cataract surgery

Purpose  To investigate the effect of a capsular tension ring (CTR) on the prevention of marked decentration and tilt of the intraocular lens (IOL), severe anterior capsule contraction, and refractive prediction error after cataract surgery. Methods  Forty-seven eyes of 43 patients that had an implantation of a CTR during phacoemulsification surgery due to zonular instability (CTR group), and 34 fellow eyes that did not receive a CTR (no-CTR group) were enrolled. The degree of IOL decentration and tilt and the anterior capsule opening area were measured using a Scheimpflug videophotography system. Results  No significant differences were found between the two groups in the mean degree of IOL decentration (0.34 mm in the CTR group, 0.29 mm in the no-CTR group; P = 0.1401), tilt angle (2.82° in the CTR group, 2.56° in the no-CTR group; P = 0.3173), anterior capsule opening area (24.3 mm² in the CTR group, 23.6 mm² in the no-CTR group; P = 0.7620), or refractive prediction error (P = 0.3459). Conclusion  In eyes with either zonular dehiscence or weakness, a CTR can prevent marked IOL decentration and tilt and severe anterior capsule contraction, and may lead to prevention of refractive prediction error.     

Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome

AIMS—To examine the extent of anterior capsule contraction as well as intraocular lens (IOL) decentration and tilt following implant surgery in eyes with pseudoexfoliation syndrome (PE).
METHODS—53 eyes from 53 patients with PE and 53 control eyes from 53 age matched patients, undergoing phacoemulsification and implant surgery, were recruited. The anterior capsule opening area and the amounts of IOL decentration and tilt after undergoing continuous curvilinear capsulorhexis were measured using the Scheimpflug videophotography system at 1 week and 1, 3, 6, 9, and 12 months postoperatively.
RESULTS—The mean area of the anterior capsule opening in the PE group was significantly smaller than that in the control group at 1 month postoperatively and later. The percentage reductions in the PE group were approximately 25%, while they were less than 10% in the control group. The degree of IOL tilt was also larger in the PE group than in the control group. Five eyes (9.4%) in the PE group underwent a neodymium:YAG laser anterior capsulotomy, but none in the control group underwent a capsulotomy.
CONCLUSIONS—The contraction of the anterior capsule opening was more extensive in the PE eyes than in the control eyes, thus resulting in a high Nd:YAG laser anterior capsulotomy rate. The IOL tilt was also greater in the PE eyes than in the control eyes.

Keywords: anterior capsule contraction; intraocular lens dislocation; pseudoexfoliation syndrome; continuous curvilinear capsulorhexis     

Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

Purpose

To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics.

Methods

A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described.

Results

We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases.

Conclusion

This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation.     

Capsule contraction syndrome in eight cases of hydrophobic one‐piece intraocular lens implantation

Purpose: The combination of anterior capsule opacification (ACO) with capsulorrhexis phimosis and intraocular lens (IOL) decentration characterises the capsule contraction syndrome (CCS). Eight cases of ACO complicated with capsule phimosis are described. Methods: In this study, 231 patients who underwent cataract extraction using phacoemulsification from September 2005 to May 2006 were included. An acrylic one‐piece IOL was implanted with the use of the injector supplied by the manufacturer through a 2.75 mm incision. A thorough pre‐ and post‐operative examination (visual acuity measurement, corneal curvature measurement, applanation tonometry, fundus examination) was performed for each patient. Results: In eight of 243 eyes of 231 patients, anterior capsule opacification with capsulorrhexis phimosis and IOL decentration was observed two to four months post‐operatively. In all eight cases, the haptic implanted inferiorly was observed to be mounted on the IOL optic. Conclusions: The combination of IOL memory loss in addition to ACO, capsulorrhexis phimosis and decentration can be a cause of the CCS, an observation that has not been reported previously.     

影响白内障术后人工晶状体稳定性的相关因素分析

白内障术后人工晶状体(intraocular lens,IOL)的稳定性包括偏心、倾斜、旋转及手术前后前房深度的变化,其稳定性是影响术后视觉质量重要因素.对影响白内障术后IOL稳定性的相关因素进行分析有助于术者改进手术方式,提高手术质量,使患者获得更好的视觉效果.IOL的稳定性受多种因素的影响:患者内眼情况、术中撕囊的大小和对称性、IOL放置的位置、IOL的材料和设计等.因此,为了使患者看到更光明的世界,白内障手术的方式一直经历着不同的演变,IOL的材料也进行着不断地创新.     

玻璃体切除联合白内障手术保留晶状体前囊或后囊的观察比较

目的观察玻璃体视网膜疾病伴有白内障需行玻璃体切除时保留品状体前囊和后囊的临床反应和疗效。方法30例（30眼）玻璃体视网膜疾病伴有白内障者,随机分成两组,每组15例（15眼）。A组（保留品状体后囊）行小切口白内障摘出后再行玻璃体切除,B组（保留晶状体前囊）行常规闭合式三通道手术,先在晶状体前囊下切除晶状体再行玻璃体切除术。结果术后视力均有不同程度提高,术后1周,眼压升高者：A组4例（4眼）,B组1例（1眼）;虹膜后粘连者：A组5例（5眼）,B组0例。术后1～2个月,虹膜后粘连者：A组15例（15眼）均出现程度不一的虹膜后粘连,9例因瞳孔闭锁,虹膜高度膨隆出现继发性青光眼;B组0例且眼压均正常。结论玻璃体切除合并白内障保留晶状体前囊可以避免虹膜后粘连及其引起的继发性青光眼,并减轻了眼部组织的损伤。     

白内障后囊破裂人工晶状体睫状沟固定与植入前房疗效比较

目的:比较睫状沟缝线固定人工晶状体术和前房人工晶状体植入术治疗白内障后囊破裂的疗效。方法:回顾性分析采用睫状沟缝线固定人工晶状体术、前房人工晶状体植入术治疗白内障后囊破裂45例45眼,比较两组手术的疗效。结果:睫状沟缝线固定人工晶状体术组和前房人工晶状体植入术组均能有效治疗白内障后囊破裂。但后者术后有2例6mo后出现虹膜睫状体炎及眼压升高,其余视力均改善。前者视力均改善,未见有明显的并发症。结论:睫状沟缝线固定人工晶状体术和前房人工晶状体植入术均能有效治疗白内障后囊破裂,改善视力,但前者更接近于生理位置,术后并发症更少。     

Long-term evaluation of primary anterior chamber intraocular lens implantation in complicated cataract surgery

The long-term visual outcome and complications related to the use of a semiflexible open-loop all-PMMA anterior chamber intraocular lens were evaluated in 40 eyes in which the capsular support was lost. The mean follow up time was 2.3 years (range 6 months to 6.7 years). 55% of the eyes had exfoliation syndrome. 68% (27 of 40 eyes) obtained a visual acuity of 0.5 or better, and only in one of the remaining eyes decreased visual acuity was related to cataract surgery (cystoid macular oedema). No cases of corneal decompensation, uveitis-glaucoma-hyphaema syndrome or retinal detachment have developed, and no IOLs have been explanted. Based on these results, the use of a modern anterior chamber intraocular lens can be suggested at least in old persons, if the capsular support is lost.