胰蛋白酶预防后发性白内障的实验研究

目的 探讨应用晶状体上皮细胞清除的方法预防后发性白内障。方法 老年性白内障手术中前囊连续环形撕囊后取得人晶状体前囊，应用不同浓度胰蛋白酶对前囊进行消化处理。观察上皮细胞的清除情况。结果 0.25%，0.2%胰蛋白酶溶液处理的晶状体前囊，晶状体上皮细胞可以完全脱落，0.1%胰蛋白酶溶液处理晶状体前囊，上皮细胞部分脱落，结论 该结果可为临床应用胰蛋白酶清除晶状体上皮细胞防治后发生白内障提供理论依据。     

白内障摘除人工晶状体植入术后晶状体后囊膜混浊的基础研究

晶状体后囊膜混浊是目前白内障摘除人工晶状体植入术后影响视功能恢复的主要并发症 ,其发生与手术残留的晶状体上皮细胞增殖有关。为了预防该并发症的发生 ,研究其发病机制成为眼科临床的重要任务。许多眼科医生进行了大量的基础研究工作 ,力求从根本上解决白内障摘除人工晶状体植入术后晶状体后囊膜混浊的发生。正常晶状体上皮细胞的生物学特性人眼晶状体起源于外胚层 ,由晶状体囊膜、囊膜下晶状体上皮细胞及其产物 ,即晶状体纤维组成。晶状体上皮细胞为单层立方上皮细胞 ,紧密贴附于前囊膜的内表面 ,与下方的晶状体纤维疏松连接。晶状体上…     

前后囊不完整人工晶状体的双囊夹持植入法

目的观察白内障手术中前后囊不完整病例双囊夹持人工晶状体植入法的临床效果。方法对白内障手术中前后囊不完整的白内障63例（63眼）施行一期前后囊互补夹持法植入后房人工晶状体，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6～48月。结果52眼（82．54％）术后1周最佳矫正视力〉0．5，人工晶状体位置稳定，无后发性白内障、视网膜脱离或继发性青光眼等并发症的发生。结论对于白内障手术中前后囊不完整者在术中采用双囊互补夹持法植入后房人工晶状体效果良好。     

人工晶状体袢的角度与后发性白内障相关性研究

目的　探讨后发性白内障与人工晶状体袢角度之间的关系。方法　 9只科研兔随机分为 3组 ,每组 6眼。麻醉后 ,行透明晶状体囊外摘出术 ,并分别植入袢角度不同的PMMA人工晶状体 ,第 1组植入 0°袢人工晶状体 ,第 2组植入 5°袢人工晶状体 ,第 3组植入 10°袢人工晶状体。术后 6个月 ,裂隙灯下观察晶状体后囊混浊情况并分级 ,取出晶状体后囊 ,行光镜及透射电镜检查 ,并采用免疫组化法对晶状体后囊染色 ,然后采用医用多功能图像分析软件对晶状体后囊表面及赤道部的增殖细胞核抗原 (proliferatingcellnucle arantigen ,PCNA)进行定量检测 ,用SPSS统计软件分析结果。结果　裂隙灯下可见术后随着人工晶状体袢角度的增加 ,发生后发性白内障的例数及等级均呈下降趋势。光镜及透射电镜扫描可见发生后发性白内障的晶状体后囊表面有一层或多层晶状体上皮细胞生长 ,未发生后发性白内障的晶状体后囊表面无晶状体上皮细胞生长 ,赤道部均可见多层晶状体上皮细胞生长。PCNA定量结果 :植入 0°袢人工晶状体组与植入 5°袢人工晶状体组之间后囊表面及赤道部PCNA阳性率 (分别为 10 .5 0 0±2 2 5 8,9.16 7± 2 .2 2 9)无明显差异 (P >0 .0 5 ) ,而植入 10°袢人工晶状体组 (4.5 0 0± 1.871)与植入 0°袢人工晶状体组及植入     

后房型人工晶状体脱位的研究现状

人工晶状体脱位是白内障摘除联合后房型人工晶状体植入术后较为常见的并发症之一。手术中截囊不完全、撕囊不均、悬韧带和(或)后囊破裂、皮质残留、囊袋收缩、渗出膜及机化条带牵制、后发性白内障及外伤等因素均可导致植入的后房型人工晶状体脱位。目前针对后房型人工晶状体脱位,可采用单纯人工晶状体复位、囊袋张力环植入、前房型人工晶状体植入、悬吊式人工晶状体植入、人工晶状体取出以及玻璃体切割术等。     

糖尿病白内障人工晶状体植入术临床分析

目的分析基层医院开展糖尿病白内障摘出联合后房型人工晶状体植入术的临床疗效。方法我们对46例(46眼)糖尿病白内障行现代囊外摘出联合后房型人工晶状体植入术，并设46例(46眼)老年性白内障患者行现代囊外摘出联合后房型人工晶状体植入术为对照。结果糖尿病白内障术后角膜内皮水肿、房水浑浊、纤维素样渗出、瞳孔后粘连、后囊浑浊等眼前段手术并发症发生率高于老年性白内障，但经正确有效处理，总体预后两组并无显著差异。结论糖尿病患者空腹血糖控制在8．0mmol／L以下，行白内障摘出后房型人工晶状体植入是安全的。     

晶状体囊袋张力环的应用

目的探讨晶状体囊袋张力环在各种原因所致的晶状体脱位，包括先天性、外伤性、正常白内障术中发生睫状小带断裂时的应用。方法对上述患眼8例(8眼)施行透明角膜切口超声乳化，同时植入囊袋张力环，然后顺利植入可折叠人工晶状体。结果人工晶状体位置正常。随诊中未发现后囊皱缩或人工晶状体偏心。视力提高至0．3～1．0。结论晶状体囊袋张力环在解决有睫状小带断裂及晶状体半脱位时，可恢复囊袋生理特点，帮助人工晶状体顺利植入及防止术后人工晶状体偏心。随访过程观察到其屏障作用及接触性抑制作用，阻止晶状体上皮细胞的增生与移行，防止前囊与后囊浑浊的发生。     

白内障术后后囊浑浊发生机制的研究--老年性白内障晶状体上皮细胞的体外培养

目的观察老年性白内障晶状体上皮细胞体外培养的生长特点。为研究老年性白内障及术后后囊浑浊的发生机制及防治奠定基础。方法应用改良组织块培养法对超声乳化术中老年性白内障晶状体前囊上皮细胞进行体外培养，在倒置显微镜下观察其生长和分化的规律。结果前囊接种3—5天，有新生上皮细胞自囊片的边缘长出并向四周延伸，第3-4周部分细胞内出现空泡和颗粒等结构改变，生长近于停止；传代培养细胞不能增生。结论老年性白内障晶状体前囊上皮细胞体外增生能力有限。改良组织块培养法培养晶状体上皮细胞简单有效。     

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。     

人工晶状体囊袋夹持固定法在后囊破裂中的应用

目的观察囊袋夹持固定法植入人工晶状体治疗白内障手术中晶状体后囊破裂的效果。方法通过完全居中的、大小适宜的前囊连续环行撕囊，利用囊袋夹持固定法(人工晶状体光学部完全植入囊袋内而2个袢位于前囊前表面)使人工晶状体达到稳定的囊袋固定，以处理白内障手术中发生的后囊破裂。分别对接受囊袋夹持法的13眼老年性白内障患者、4眼外伤性白内障患者、3眼先天性白内障患者进行随访观察。结果术后随访平均视力大于等于0．5的患者17眼(85％)，夹持于囊袋的人工晶状体能够保持良好、稳定的居中位置，后囊破裂的大小稳定，所有术眼均未出现人工晶状体相关的葡萄膜反应。结论在后囊破裂较大，无法将人工晶状体植入囊袋内时，可以利用前囊撕囊孔进行囊袋内夹持固定法固定人工晶状体。良好的前囊连续环行撕囊不仅可以保证手术的安全性，而且是囊袋夹持法固定人工晶状体的必要条件。     

后发性白内障的防治新进展

后囊膜混浊(posterior capsule opacification,PCO)又称后发性白内障是现代白内障囊外摘出或超声乳化吸除联合人工晶状体植入术后最常见的晚期并发症,如何防治后发性白内障一直是眼科学者关注的焦点,并不断在此领域取得新的进展。拟对近年来后发性白内障防治中手术方式的改进、人工晶状体自身特性的影响、囊袋张力环的应用、密封囊灌洗技术的开展和基因治疗等方面的研究进展和发展趋势加以综述。     

Comparative incidence of posterior capsular opacification in AcrySof and PMMA intraocular lenses

AIM: To evaluate the extent of significant posterior capsular opacification (PCO) after implanting polyme-thylmethacrylate (PMMA) and soft acrylic intraocular lenses. METHODS: A total of one hundred patients (110 eyes) undergoingintraocular lens(IOL) implant surgerywererandomly divided into two groups based on the type of IOL implanted: Group I: AcrySof (SA60AT) and Group II: PMMA (LX10BD). The density of posterior capsular opacification (PCO) was assessed 3, 6, 12 and 18 months after surgery by taking best corrected visual acuity (BCVA) and the digital photographs. RESULTS: At the end of 3 months postoperatively, the PCO density in the Group I (PMMA) increased significantly (3.6%) while no increase was found in the Group II (Acrylic). By the end of 18 months follow-up, the incidence of significant PCO was found to be less in the acrylic group (14.5%) as compared to the PMMA group (34.5%).On the basis of density, the PCO was more extensive with the PMMA lens than the AcrySof lens, which led to more severe visual loss. CONCLUSION: The intraocular implantation of the AcrySof IOL helps to reduce the incidence of PCO to a greater degree as compared to the PMMA IOL.     

AcrySof和PMMA人工晶状体植入致后发性白内障发生率的比较

目的：评价植入聚甲基丙烯酸甲酯（PMMA）人工晶状体和软性人工晶状体（AcroSof）致后发性白内障的严重程度。方法：总共100人（110眼）进行了人工晶状体植入术，随机分为两组植入不同类型的晶状体。组Ⅰ：AcrySof（SA60AT）人工晶状体，组Ⅱ：PMMA（LXIOBD）人工晶状体。分别在术后3，6，12和18mo，通过测定最佳矫正视力和数码照片拍摄评价后囊膜浑浊的密度。结果：术后3mo，PMMA组后囊膜浑浊的密度明显增加（3．6％），而Acrylic组并未发现增加。术后18mo，显著后囊膜浑浊两组的发生率相比较，Acrylic组（14．5％）较PMMA组（34．5％）低。由于PMMA人工晶状体比AcrySof人工晶状体所致后囊膜浑浊的范围广，故其导致更严重的视力降低。结论：与PMMA人工晶状体相比较，植入AcrySof人工晶状体在一定程度上有助于降低后发性白内障的发生率。     

Posterior capsule opacification

Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery. At present the only means of treating cataract is by surgical intervention, and this initially restores high visual quality. Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens. The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma. This resilient group of cells then begin to re-colonise the denuded regions of the anterior capsule, encroach onto the intraocular lens surface, occupy regions of the outer anterior capsule and most importantly of all begin to colonise the previously cell-free posterior capsule. Cells continue to divide, begin to cover the posterior capsule and can ultimately encroach on the visual axis resulting in changes to the matrix and cell organization that can give rise to light scatter. This review will describe the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.     

Intraocular Lens and Capsule Opacification with Hydrophilic and Hydrophobic Acrylic Materials

Purpose: To report posterior capsular opacification in acrylic intraocular lenses.

Methods: Retrospective review of notes of patients with cataract surgery involving implantation of a hydrophilic acrylic intraocular lens (IOL) (MDR SC-60B-0UV) in at least one eye. This was done as a retrospective audit for clinical risk following adverse event reports, regarding MDR SC-60B-0UV intraocular lens, were published. Data regarding the pre- and post-operative visual acuity, ocular co-morbidity, posterior capsular thickening, Nd-YAG capsulotomy, final visual acuity, and changes in the lens clarity in both eyes were noted from the clinical notes.

Results: 45 patients and 90 eyes were identified. Posterior capsular opacification (PCO) as determined by slit-lamp examination was 40% for the hydrophilic IOL (SC-60B-0UV) and 8% for the contra-lateral eye (hydrophobic IOL). In 22 eyes opacification of the SC-60-0UV IOL was observed at slit-lamp examination (44%).

Conclusion: The hydrophilic acrylic IOL (SC60B-0UV) appears to have a high incidence of PCO.     

白内障撕囊直径不同对后发性白内障影响的临床研究

目的:观察连续环形撕囊口完全覆盖人工晶状体光学面与连续环形撕囊口完全不覆盖人工晶状体光学面的人工晶状体植入术后后囊膜混浊(posterior capsular opacification,PCO)的情况。方法:随访近5a来施行超声乳化吸出白内障联合人工晶状体植入手术的老年性白内障患者164例196眼,术后观察视力、撕囊口与人工晶状体光学面的关系及PCO等情况,随访12~26(平均16.3)mo。根据Sellman等的PCO分级标准进行分级:I级为没有PCO或极轻微PCO不减少红光反射,也没有珍珠样小体或IOL边缘也没有发现珍珠样小体;Ⅱ级为轻度PCO减少了红光反射,IOL边缘也没有发现珍珠样小体;Ⅲ级为在IOL区域内发现中度纤维化或珍珠样小体,但视轴(中心3mm)是透明的;Ⅳ级为重度纤维化或珍珠样小体并扩展到视轴区,并且严重减少红光反射。术后后囊膜出现Ⅱ,Ⅲ及Ⅳ级统计为临床出现后发性白内障的并发症病例。结果:后发性白内障是现代白内障摘除手术后晚期常见的并发症之一,连续环形撕囊口完全覆盖人工晶状体光学面组120眼中,发生后发性白内障42眼(35.0%)。连续环形撕囊口完全不覆盖人工晶状体光学面组76眼中,发生后发性白内障41眼(53.9%)。两组病例术后在临床后发性白内障发生率上有统计意义(P<0.05)。结论:连续环形撕囊口大小与术后后囊膜的混浊有关。撕囊口完全覆盖人工晶状体光学面能减少后发性白内障发生的几率。     

Advances in cataract surgery

Cataract surgery is a technique described since recorded history, yet it has greatly evolved only in the latter half of the past century. The development of the intraocular lens and phacoemulsification as a technique for cataract removal could be considered as the two most significant strides that have been made in this surgical field. This review takes a comprehensive look at all aspects of cataract surgery, starting from patient selection through the process of consent, anaesthesia, biometry, lens power calculation, refractive targeting, phacoemulsification, choice of intraocular lens and management of complications, such as posterior capsular opacification, as well as future developments. As the most common ophthalmic surgery and with the expanding range of intraocular lens options, optometrists have an important and growing role in managing patients with cataract.     

张力环植入与人工晶状体囊袋内单襻缝线固定两种手术方式的对比研究

目的　比较白内障超声乳化联合囊袋张力环及人工晶状体囊袋内植入术,与白内障超声乳化联合人工晶状体囊袋内单襻缝线固定术两种手术方式治疗白内障合并晶状体不全脱位的临床效果。方法　收集白内障伴晶状体不全脱位33例（41眼）,按手术方式分为两组,其中A组行囊袋张力环及人工晶状体囊袋内植入术,共14例17眼;B组行人工晶状体囊袋内单襻缝线固定术,共19例（24眼）。对两组术后视力、眼压、手术并发症及IOL稳定性等资料进行统计学分析。结果　A组术后最佳矫正视力为0.66±0.15;1眼（5.9%）发生低眼压;5眼（29.4%）发生高眼压;8眼（47.1%）发生人工晶状体-囊袋张力环复合体脱位;12眼（70.6%）发生后发性白内障。B组术后最佳矫正视力为0.72±0.14;8眼（33.3%）发生低眼压;1眼（4.2%）发生高眼压;18眼（75.0%）发生后发性白内障。两组术后最佳矫正视力差异无统计学意义（t=-1.150,P=0.257）;术后低眼压发生率比较,差异有统计学意义（χ²=4.377,P=0.036）;术后高眼压发生率比较,差异有统计学意义（χ²=5.077,P=0.024）。结论　两种手术方法均能有效改善患者视力,达到相似的临床效果。     

后囊连续环形撕囊在防治儿童人工晶状体植入术后后囊混浊中的作用

目的 探讨后囊连续环形撕囊在预防儿童白内障人工晶状体植入术后后囊混浊中的作用。方法 对29例29眼儿童白内障在植入人工晶状体后行一期后囊环形撕囊，术后随访3个月－2a。结果 术后随访显示27眼获得视轴透明区，眼底可见，矫正视力均有不同程度的提高。结论 一期后囊连续环形撕囊是预防儿童白内障人工晶状体植入术后后囊混浊的可行方法。