外伤性白内障二期前房型人工晶状体植入

目的 探讨外伤性白内障二期植入弹性开放襻前房型人工晶状体的效果和安全性。方法 28例28眼外伤性白内障行二期弹性开放襻前房型人工晶状体植入联合周边虹膜切除术。术后随访3月以上。结果 术后3月裸眼视力≥0．5者20眼(71．4％)，达到术前最佳矫正视力者24眼(85．7％)。术后常见并发症为角膜水肿、葡萄膜炎和眼压升高。结论 外伤性白内障二期植入弹性开放襻前房型人工晶状体是一种简便、安全、有效的方法。     

门诊后房型人工晶体植入术的体会

对５３例门诊白内障手术合并后房型人工晶体植入进行随访，其中老年性白内障２９眼，并发性白内障１４眼，外伤性白内障９例，人工晶体二期植入２眼。术后视力≥０．５者２５眼，矫正视力≥０．５者４９眼。术后并发症和国内其他报道相似。．     

门诊后房型人工晶体植入术的体会

对５３例（５４眼）门诊白内障手术合并后房型人工晶体植入进行随访，其中老年性自内障２９眼，并发性白内障１４眼，外伤性白内障９眼，人工晶体二期植入２眼。术后视力≥０．５者２５眼（４６．３％），矫正视力≥０．５者４９眼（９０．７％）。术后并发症和国内其他报道相似。     

巩膜隧道内小梁切除联合白内障手术

目的探讨改良巩膜隧道内小梁切除联合非超声乳化白内障摘除人工晶体植入术治疗青光眼合并白内障的效果。方法对28例28眼青光眼合并白内障的患者实行了小切口非超声乳化白内障摘除人工晶体植入隧道内靠一侧小梁切除术，术后观察眼压、视力及其并发症。结果术后随访3个月～1年，28眼眼压均低于21mmHg（1mmHg—0．133kPa），视力提高者26眼（92．9％）。并发症有角膜水肿、人工晶体前膜等。结论改良巩膜隧道内小梁切除联合非超声乳化白内障摘除人工晶体植入术具有降压效果好、视力恢复快、并发症少等优点，是一种安全有效的手术方法。     

超声乳化人工晶体植入联合小梁切除术治疗青光眼白内障临床观察

目的 探讨超声乳化人工晶体植入联合小梁切除术治疗青光眼白内障的疗效。方法 对46例53眼青光眼合并白内障行超声乳化人工晶体植入联合小梁切除术。结果 术后视力恢复快，视力46眼〉0．3（86．8％），术后眼压控制好，50眼〈18mmHg（94．3％），术后有角膜水肿等并发症。结论 超声乳化人工晶体植入联合小梁切除术安全有效。     

穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入手术

目的探讨穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入方法及疗效。方法应用超声乳化仪为22只眼穿透性角膜移植术后白内障行白内障吸出和人工晶体植入手术。术后观察视力、角膜内皮变化和角膜移植片透明度。结果视力：12只眼0．1～0．4（54．5％），8只眼0．5～0.9（364％），2只眼＜01（9．1％）；角膜内皮细胞平均损失率17．76％；术后角膜移植片全部透明。结论本方法治疗角膜移植术后白内障，其术后视力恢复快，角膜内皮细胞损失少，可维持角膜移植片的透明。     

外伤性白内障人工晶体植入术临床研究

目的 探讨外伤性白内障时人工晶体植入的手术时机和手术方法的选择。方法 对53例（53眼）外伤性白内障患者行晶体囊外摘除一期或二期人工晶体植入术，观察其手术疗效及并发症。结果 术后随访3～24个月（平均9.4个月），术后8周矫正视力在0.5以上者为28眼（52．8％），1．0以上者8眼（15．1％）。术后并发症：角膜水肿、色素膜炎、后房型人工晶体瞳孔夹持、后发性白内障等。结论 外伤性白内障及其合并症常同时累及眼前后段组织，根据眼内情况选择不同的治疗方案将有助于提高手术成功率。     

外伤性白内障摘除后房型人工晶体植入术实验与临床

前瞻性研究外伤性白内障后房型人工晶体植入术的疗效。在实验基础上，临床对39眼外伤性白内障施行现代白内障囊外摘除及后房型人工晶体植入术。结果：术后出院视力均≥0．1，其中0．5以上者22眼，占56．4％。术中并发症以后囊破裂稍多见；术后并发症以虹膜炎、角膜水肿最常见。重点讨论了手术时间及开罐截囊方法。结论，外伤性白内障摘除后房型人工晶体植入，是无晶体限矫正屈光不正的合理方法，可迅速恢复视力。     

复杂性白内障超声乳化及折叠式人工晶状体植入术

目的：探讨经透明角膜切口对复杂性白内障患者行超声乳化摘除及人工晶状体植入的可行性及手术技巧。方法：对35例40眼复杂性白内障行经透明角膜切口超声乳化及人工晶状体植入术，对术中不同条件的处理方法及术后视力、术后并发症进行观察，随访1～6个月。结果：对不同条件下的白内障均顺利完成超声乳化摘除及折叠式人工晶状体植入。术后无严重手术合并症，术后视力均有不同程度的提高，视力好于0．5者12眼，0．5～0．3者25眼，0．3～0．1者2眼，0．04者1眼。结论：透明角膜切口的白内障超声乳化及人工晶状体植入术是治疗复杂性的白内障较理想的手术方式，合理应用可以获得较好的手术效果。     

四点式前房型人工晶体植入10例术后疗效观察

目的 探讨四点式前房型人工晶体植入术后的效果、并发症及处理。方法 0．5％爱尔凯因表面麻醉，透明角膜切口，前房注入黏弹剂，保持前房深度，鸭嘴镊植入前房型人工晶体，角膜切口自行密闭。结果 术后视力均有显著提高。术前视力：眼前指数～0．05；术后视力：0．5～0．8者5例（5眼），0．9～1．0者5例（5眼）；并发症：1例（1眼）瞳孔区渗出膜；1例（1眼）角膜轻度水肿，此2例（2眼）经治疗痊愈。结论 四点式前房型人工晶体植入，并发症少而轻，效果理想，因此，在不宜植入后房型人工晶体时，进行四点式前房型人工晶体植入是完全可行、安全可靠的。     

非球面人工晶状体眼的视觉质量

目的 比较年龄相关性白内障患者植入两种不同光学面设计的人工晶状体（intraocular lens,IOL）,即非球面和球面IOL眼的最佳矫正视力（best corrected visual acuity,BCVA）、对比敏感度及波前像差,分析人工晶状体光学面设计对人工晶状体眼视觉质量的影响。方法 连续选取2005年1月-2006年1月年龄相关性白内障患者43例（60眼）作为观察对象,随机分为两组,行超声乳化白内障摘除联合人工晶状体植入术,分别植入非球面人工晶状体（试验组,21例,30眼）和球面型人工晶状体（对照组,22例,30眼）。术后第2个月回访患者,行医学验光、对比敏感度和波前像差检查。对所得的数据行配对t检验。结果 试验组的BCVA为5.00±0.09,对照组的BCVA为5.00±0.05,两组差异无统计学意义﹙t=0.254,P=0.801﹚。试验组在夜视、夜视加眩光条件下的对比敏感度明显高于对照组,两组差异有统计学意义﹙P＜0.05）。在瞳孔直径5.0 mm状态下,试验组的球差、第四阶像差、第五阶像差、第六阶像差及总体高阶像差均方根值明显低于对照组﹙P＜0.05）。结论 非球面人工晶状体眼视觉质量明显优于球面人工晶状体眼。     

Scheimpflug measurement of intraocular lens position after piggyback implantation of foldable intraocular lenses in eyes with high hyperopia

PURPOSE: To investigate the position of 3-piece foldable intraocular lenses (IOLs) after piggyback implantation for high hyperopia. SETTING: University Eye Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. METHODS: Eight eyes of 5 highly hyperopic patients had phacoemulsification and implantation of 2 foldable IOLs. In 3 eyes, both IOLs were implanted in the capsular bag. In 5 eyes, 1 IOL was placed in the capsular bag and the second IOL in the ciliary sulcus. Intraocular lens optic tilt and decentration, combined thickness of both IOLs, and anterior chamber depth (ACD) were measured postoperatively over a period of 18 months using Scheimpflug photography. RESULTS: All eyes with both IOLs in the capsular bag showed interpseudophakic opacification, with a mean increase in combined IOL thickness of 0.4 mm, a decrease in ACD of 0.3 mm, and a corresponding hyperopic shift of 4.00 diopters. Eyes in which the anterior IOL was placed in the ciliary sulcus showed no changes in refraction or combined IOL thickness. In these eyes, the anterior IOL had a higher mean decentration (0.49 mm +/- 0.20 [SD] after 12 months) than the posterior IOL (0.21 +/- 0.13 mm after 12 months). CONCLUSIONS: Piggyback IOL implantation with placement of 2 foldable IOLs in the capsular bag can be followed by a hyperopic shift that may be caused in part by displacement of the IOLs. Placement of the anterior IOL in the ciliary sulcus can lead to higher decentration of this IOL.     

Improved biocompatibility of intraocular lenses by heparin surface modification: a 12-month implantation study in monkeys

To evaluate the long-term biocompatibility and potential side effects of heparin surface modification of a poly(methyl methacrylate) intraocular lens (IOL), a heparin surface modified IOL was implanted in the left posterior chamber of 24 cynomolgus monkeys and a reference IOL (without surface modification) was implanted in the right eye in 12 of these animals. Twelve eyes were not operated on. Eleven eyes in seven monkeys were lens extracted as a control of the surgical method. Slitlamp examinations and intraocular pressure recordings were made one day, one and two weeks, and 1, 2, 2 1/2, 3 1/2, 6, 8, 10, and 12 months after the operation. Eleven monkeys were sacrificed after 3 1/2 months and the remaining animals after 12 months for morphological examination of the eyes. Slitlamp and morphological examinations showed that cell deposits, pigmentation, and posterior synechias were significantly less in eyes with heparin surface modified IOLs than in eyes with reference IOLs throughout the 12-month observation period. The intraocular pressure was equally reduced in eyes with heparin surface modified IOLs and reference IOLs for about one month, after which it returned to normal. No side effects following the implantation of heparin surface modified IOLs were observed. We concluded that heparin surface modification of IOLs is efficient for long-term reduction of cell deposits and posterior synechias after implantation in monkey eyes and may also be effective in lowering the degree of side effects to IOL implantation in humans.     

Ab externo scleral suture loop fixation for posterior chamber intraocular lens decentration: clinical results

PURPOSE: To evaluate the efficacy and safety of an ab externo suture retrieval and scleral fixation technique in the treatment of subluxated posterior chamber intraocular lenses (PC IOLs). SETTING: Academic tertiary care centers. METHODS: Surgical databases from 2 surgeons were reviewed for consecutive cases from March 2000 to April 2004 in which the ab externo scleral suture fixation technique was used and a minimum follow-up of 3 months was completed. Patient charts were reviewed for 15 eyes that had decentered in-the-bag PC IOLs, 12 eyes with subluxated sulcus or bag-sulcus positioned PC IOLs, and 3 eyes with PC IOLs dislocated into the vitreous. RESULTS: The mean time from cataract extraction to PC IOL stabilization was 3.4 years (range 2 days to 10.9 years). Surgical repositioning was successfully performed in all patients. After a mean follow-up of 14.7 months, the mean best corrected visual acuity (BCVA) improved from 20/140 to 20/40 (P = .0001). All patients had stable or improved BCVA. All patients with a successfully completed procedure achieved an adequately centered PC IOL postoperatively. One patient (3.3%) developed a significant intraoperative vitreous hemorrhage requiring the procedure to be aborted, but reoperation 3 months later was successful. Postoperative complications included persistent elevated intraocular pressure in 2 eyes (6.7%) and chronic cystoid macular edema in 1 eye (3.3%) that resolved with medication. CONCLUSION: The ab externo suture loop retrieval and scleral fixation technique was effective in repositioning decentered, subluxated, or dislocated PC IOLs with excellent visual outcomes.     

Unsutured posterior chamber lens implantation in eyes requiring lens extraction at the time of pars plana vitrectomy with silicone oil tamponade

PURPOSE: To describe a technique for the subsequent placement of an unsutured posterior chamber lens intraocular lens (PC IOL) in eyes requiring cataract or clear lens extraction at the time of pars plana vitrectomy (PPV) with silicone oil tamponade. SETTING: Department of Vitreoretinal Surgery, St. Thomas' Hospital, London, United Kingdom. METHODS: This retrospective review comprised 25 patients who had phacoemulsification to allow an adequate intraoperative retinal view or adequate access to anterior retinal pathology. Anterior and posterior capsulorhexes were combined with an inferior radial capsulectomy to fashion a keyhole-shaped capsule. RESULTS: The mean follow-up was 15.9 months +/- 8.0 (SD) (range 3 to 34 months). Silicone oil was removed and IOLs were implanted in 15 eyes (60.0%). Posterior chamber IOLs were implanted in 10 eyes (66.7% of those receiving an IOL), and anterior chamber AC IOLs were implanted in 5 eyes (33.3%). Nine of the 10 eyes receiving a PC IOL (60.0% of all IOLs) had uneventful surgery. In 1 eye, the PC IOL subluxated inferiorly. Two eyes developed pupil block that required further surgery. CONCLUSIONS: This technique allowed PC IOL implantation in 60% of eyes that received an IOL, showing that in selected patients who require simultaneous lens extraction and silicone oil tamponade, a keyhole-shaped capsulectomy provides for subsequent unsutured PC IOL insertion. The pupil block rate of 8% compares favorably with published rates. Refining the technique may allow it to be used in a greater proportion of eyes that would benefit from safe refractive correction.     

Color sensation of pseudophakic eye from a viewpoint of electrophysiological study]

Monochromatic ERG b-waves were recorded in normal eyes, cataractous eyes and pseudophakic eyes implanted with non-UV or UV IOLs. ERG b-waves were elicited by fourteen monochromatic stimulus lights ranging from 400 to 660 nm under white light adaptation, and spectral response curves were obtained from b-wave amplitudes. Compared with normal eyes or cataractous eyes, the relative b-wave amplitude of pseudophakic eyes was significantly larger in the short wavelength range from blue to green. Except for 400 nm, the spectral response curve of the eyes implanted with UV IOLs was similar to that of eyes implanted with non-UV IOLs. These results suggested that dyschromatopsia might not only occur in eyes implanted with non-UV IOLs but in eyes with UV IOLs.     

Ultraviolet-absorbing intraocular lens versus non-UV-absorbing intraocular lens: comparison of angiographic cystoid macular edema

We compared the incidence of angiographic cystoid macular edema (CME) in eyes with ultraviolet (UV)-absorbing intraocular lenses (IOLs) with that in eyes with non-UV-absorbing IOLs. Fifty-five bilateral pseudophakic patients received a UV-absorbing IOL in one eye and a non-UV-absorbing IOL in the fellow eye. All cases were implanted with posterior chamber lenses following extracapsular cataract extraction. Fluorescein angiography for CME was performed at least six months postoperatively (average 20.0 months). There was no statistically significant difference in visual acuity or in the incidence of CME.     

Single-piece acrylic intraocular lens implantation in children

PURPOSE: To assess the short-term outcomes of single-piece acrylic intraocular lens (IOL) implantation in children by determining the incidence of postoperative visual axis opacification and the need for a second procedure to clear the axis, cell deposits on the IOL optic, posterior synechias, and IOL decentration. SETTING: Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This retrospective case review comprised 43 consecutive implantations (33 patients) of a single-piece hydrophobic acrylic IOL (AcrySof SA30AL or SA60AT, Alcon). An analysis of 42 eyes with posterior capsulectomy and vitrectomy was performed. Eyes with traumatic cataract and secondary IOLs were excluded. RESULTS: Single-piece acrylic IOLs were implanted in 42 eyes. The mean age was 33.5 months +/- 28.9 (SD) (range 0.5 to 110 months) and the mean follow-up, 12.0 +/- 8.2 months (range 1.0 to 27.5 months). Postoperative opacification of the visual axis occurred in 7 eyes (16.7%). Secondary surgical procedures were required in 5 eyes (11.9%). Lens deposits were observed in 8 eyes (19.0%) and synechias, in 5 eyes (11.9%). All IOLs were well centered postoperatively. CONCLUSION: The short-term data suggest implantation of the AcrySof single-piece hydrophobic acrylic IOL is safe in the pediatric eye.     

人工晶体取出的原因分析

回顾性分析２５例人工晶体取出的原因。其中前房型４例，后房型２１例。前房型和后房型人工晶体从植入至取出的平均间隔时间分别为２３．５和７．１个月。前房型取出的原因为ＵＧＨ综合征３例和人工晶体大泡性角膜病变１例；后房型取出的原因有人工晶体脱位或半脱位１２例，人工晶体大泡性角膜病变４例，人工晶体视网膜脱离３例和眼内炎２例。手术方法：直接取出或合并三切口闭台式玻璃体切除，穿透性角膜移植，玻璃体视网膜手术，前段玻璃体切除和瞳孔膜切除。术后绝大多数眼的视力提高或保持不变。     

Results of hydrophilic acrylic,hydrophobic acrylic,and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group

PURPOSE: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses (IOLs) in eyes with uveitis. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective study comprised 72 eyes with uveitis and 68 control eyes having phacoemulsification and IOL implantation by 1 surgeon. Patients received 1 of the following IOLs: foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia). Postoperative evaluations were at 1, 3, and 7 days and 1, 3, and 6 months. Cell reaction was evaluated by specular microscopy of the anterior IOL surface and the anterior and posterior capsule reaction, by biomicroscopy. RESULTS: Small round cell deposition was observed on all IOLs in the immediate postoperative period, especially in eyes with uveitis. This reaction decreased 3 to 6 months after surgery. Although the CeeOn 911 had a higher mean grade of small cells, there was no statistical difference between the 3 IOL types after 6 months in the uveitis and control groups. Foreign-body giant cells (FBGCs) increased after 1 week to 1 month. The AcrySof IOLs had the highest number of FBGCs; after 6 months, there was a statistically significant difference between the AcrySof and Hydroview uveitis groups (P =.036) and the AcrySof and CeeOn 911 uveitis groups (P =.003) but there was no difference among the 3 IOL types in the control group. Lens epithelial cell outgrowth persisted on the Hydroview IOLs in control eyes and regressed on all 3 IOL types in uveitic eyes and on the AcrySof and CeeOn 911 IOLs in control eyes (P =.0001). Anterior capsule opacification (ACO) was more severe on all IOL types in uveitic eyes and on the CeeOn 911 IOL in control eyes. Posterior capsule opacification (PCO) was more severe in uveitic eyes. The Hydroview group had more severe PCO than the AcrySof and the CeeOn 911 groups in uveitis and control eyes. Six months postoperatively, the difference was significant (P =.0001). There was no significant difference between the AcrySof and CeeOn 911 IOLs. CONCLUSIONS: Intraocular lens biocompatibility is inversely related to inflammation. Hydrophilic acrylic material had good uveal but worse capsular biocompatibility. Hydrophobic acrylic material had lower uveal but better capsular biocompatibility. Silicone showed a higher small cell count (mild) and more severe ACO but achieved PCO results comparable to FBGC results and better than those with the AcrySof lens 6 months after surgery. Despite the differences in IOL biocompatibility, all patients benefited from the surgery.