儿童人工晶状体固定性瞳孔夹持的原因和手术复位

目的　分析儿童白内障摘除术后人工晶状体 (IOL)固定性瞳孔夹持的原因 ,并探讨有效的处理方法。方法　收集年龄 <14岁、白内障摘除后房型IOL植入术后发生固定性瞳孔夹持患者 30例 (31只眼 )的临床资料 ,分析其发生原因和并发症 ,并对其中 8例 (8只眼 )合并严重并发症患者行IOL复位手术。结果　全部患者均发生较严重的葡萄膜炎性反应及其所致的虹膜后粘连和瞳孔膜闭或闭锁 ,以及不同程度的后发性白内障。IOL复位手术中可见 8例患者均发生不同程度的晶状体周边皮质再生。结论　白内障摘除术后葡萄膜炎性反应、晶状体皮质再生及后发性白内障是引起儿童IOL固定性瞳孔夹持的主要原因。手术分离虹膜粘连、清除晶状体再生皮质并切除后发性白内障 ,可有效复位IOL。     

Tram-Track Suture Technique for Pupillary Capture of a Scleral Fixated Intraocular Lens

PurposeTo report a new technique using tram-track suture for pupillary capture of a scleral fixated posterior chamber intraocular lens (PC-IOL) to reposition the tilted IOL.MethodsIn this prospective interventional case series, we describe a tram-track suture for pupillary capture of a scleral fixated PC-IOL. A long straight needle with double-armed 10-0 polypropylene is passed behind the iris and just above the optic portion (tilted forward) of the IOL. The other straight needle with double-armed 10-0 polypropylene is passed just below the optic portion (tilted backward) of the IOL. After the IOL is repositioned properly, the polypropylene sutures are gently pulled and tied.ResultsFour eyes of 4 patients underwent tram-track suture for pupillary capture of a scleral fixated PC-IOL. No intra- or postoperative complications were noted, and no pupillary captures were detected during the follow-up period.ConclusionsThe tram-track suture technique provides good centration and stability of a PC-IOL. This technique is an easy and effective way to reposition pupillary capture of an IOL. Further, it is also minimally invasive as it maintains a closed system.     

人工晶状体固定性瞳孔夹持治疗方法的探讨

目的 探讨三种类型白内障摘除人工晶状体植入后发生固定性瞳孔夹持原因和手术治疗方法。方法 对21例人工晶状体固定性瞳孔夹持的原因进行分析。用2种不同的手术方法进行处理。术后随访3-12月。结果 固定性瞳孔夹持主要见于小儿外伤性白内障及成人外伤性白内障，术后小儿组矫正视力≥0.3者10眼（58.82%)。成人组矫正视力≥0.3者5眼（83.33%)。老年性白内障0.41例，0.61例。结论 固定性瞳孔夹持3月后，经手术可以复位，获得较好视力。     

Pupillary capture of the optic in secondary piggyback implantation

Two patients who received a minus-power intraocular lens implanted as a secondary piggyback to correct pseudophakic myopia experienced pupillary optic capture following dilation in the early postoperative period. Both cases were successfully managed by pressing the optic back into the ciliary sulcus and constricting the pupil with pilocarpine.     

Noninvasive repositioning of a posterior chamber intraocular lens following pupillary capture.

A case of pupillary capture of a posterior chamber intraocular lens (IOL) is presented. A nonsurgical approach that may help reposition an IOL optic entrapped in a pupillary capture when chemical mydriasis fails is described. Suggestions for a logical progression of nonsurgical procedures to help release optic capture are presented. Possible causes and preventative measures to decrease the incidence of pupillary capture of a posterior chamber IOL are discussed.     

白内障摘出人工晶状体植入术后迟发性葡萄膜炎

目的 探讨手法小切口白内障囊外摘出人工晶状体植入术术后迟发性葡萄膜炎的临床特点、治疗方法和预防措施。方法 回顾分析226例（239眼）手法小切口白内障囊外摘出人工晶状体植入术的11例（11眼）发生迟发性葡萄膜炎的临床资料。结果手法小切口白内障囊外摘出人工晶状体植入术术后迟发性葡萄膜炎的发生率为4．60％,多数发生于术后2～3周。应用散瞳剂,糖皮质激素,非甾体消炎药等进行治疗,3～10d前房炎症完全控制,视力恢复良好,1例人工晶状体瞳孔夹持。结论迟发性葡萄膜炎是手法小切口白内障囊外摘出人工晶状体植入术术后出现较晚的并发症,对术后恢复良好的视力又造成严重损害,及早诊断和治疗效果良好。     

儿童外伤性白内障人工晶状体固定性瞳孔夹持的原因与手术治疗

目的 回顾性分析儿童外伤性白内障摘除术后人工晶状体(IOL)固定性瞳孔夹持的原因,并探讨有效的治疗方法.方法 对14岁以下外伤性白内障的患者行白内障摘除后房犁人工晶状体植人术后固定性瞳孔夹持患者10例(10只眼),分析其发生原因及并发症,并行虹膜粘连分离,后发性白内障切除,人工晶状体复位术及前段玻璃体切割术.5只眼行IOL置换术.结果 10只眼成功完成分离虹膜与囊膜粘连并行后发性白内障切除和人工晶状体复位,术后视功能不同程度的改善.结论 外伤性白内障术后葡萄膜炎反应,瞳孔粘连,后发性白内障及周边皮质再生是引起儿童IOL固定性瞳孔夹持的重要原因.手术分离虹膜粘连、清除晶状体再生皮质并切除后发性白内障可有效复位IOL.     

In situ tumbling of the AcrySof intraocular lens

The small incision through which foldable acrylic intraocular lenses (IOLs) are implanted does not allow easy explantation of the lens in the event of intraoperative complications. Reversal of the IOL optic during insertion, although rare, can predispose to postoperative complications such as pupillary capture of the IOL, capsule bag distension syndrome, and refractive problems. Explanting the IOL can damage it, the cataract wound, or both. We describe a technique of in situ tumbling of the AcrySof IOL to correct reversed-optic implantation that preserves the integrity of the IOL and anterior segment structures.     

Scleral fixation of a silicone plate haptic intraocular lens in a patient showing repeated pupillary intraocular lens capture

A 39-year-old man with Marfan syndrome underwent scleral fixation using a three-piece foldable intraocular lens and experienced repeated pupillary intraocular lens captures secondary to a pliable iris. As a result, the patient needed an additional pupilloplasty. In the opposite eye, a silicone plate haptic intraocular lens was used for scleral fixation because it was thought that the plate design could prevent pupillary intraocular lens capture, even in cases involving a pliable iris. At the 27-month follow-up examination, the patient showed good centration of the intraocular lens in the eye that used the silicone plate haptic intraocular lens without pupillary intraocular lens capture.     

Surgical treatment of hyperplastic persistent pupillary membrane]

Clinical findings of two patients with persisting pupillary membranes are described and therapy is discussed. The indication for excision of the pupillary membrane was constituted in one patient (age 6 weeks) by complete occlusion of the optic axis, in the second (age 4 months) by absence of any recordable fixation. In both cases the pupillary membrane could be separated from the anterior lens capsule without lens damage. No strabismus or lens opacification were detected postoperatively. Surgery was undertaken with the intention of avoiding primary lentectomy, since pupillary membranes can usually be separated easily from the anterior lens capsule with viscoelastic substances.     

Pseudophakic pupillary block caused by pupillary capture after phacoemulsification and in-the-bag AcrySof lens implantation

We describe a 50-year-old patient who developed pupillary block caused by pupillary capture 1 week after uneventful phacoemulsification and implantation of an AcrySof foldable intraocular lens (IOL). The patient had a large but intact capsulorhexis with the haptics lying in the bag; the optic lay in the pupillary area anterior to the capsulorhexis. This case was successfully managed by a neodymium: YAG laser iridotomy, IOL explantation, and subsequent implantation of a poly(methyl methacrylate) posterior chamber IOL. To prevent this complication, we suggest the optic be larger than the capsulorhexis and advocate correct, gentle insertion of the foldable IOL.     

外伤性白内障后房型人工晶状体一期植入分析

目的 探讨外伤性白内障后房型人工晶状体一期植入术的临床效果. 方法对118例(118只眼)外伤性白内障患者行白内障摘除联合后房型人工晶状体一期植入术,随访3~12个月,并对术后疗效及并发症进行分析.结果 术后矫正视力≥0.05者109例占92.4%;≥0.3者81例占68.6%;≥0.5者52例占44.1%;≥0.8者23例占19.5%.术后常见并发症为早期角膜水肿、葡萄膜炎、人工晶状体夹持、继发性青光眼.但经过相应的处理,并发症都能得到很好的控制.结论 外伤性白内障摘除的同时行后房型人工晶状体一期植入是安全有效的.     

儿童后发性白内障合并人工晶状体固定性瞳孔夹持的手术治疗

目的探讨儿童严重后发性白内障合并人工晶状体固定性瞳孔夹持的合理的治疗方法及疗效。方法对14岁以下发生严重后发性白内障的患者中合并人工晶体固定性瞳孔夹持伴有严重的虹膜后粘连或瞳孔膜闭的12只眼进行后发性白内障切除、人工晶状体复位术,部分病人联合前段玻璃体切割术。对虹膜后粘连或瞳孔膜闭者同时进行粘连分离或瞳孔成形术。结果12只眼成功分离虹膜与囊膜粘连并进行后发性白内障切除和人工晶状体复位。其中2只眼行瞳孔成形术,8只眼行前段玻璃体切割术,术后视功能有不同程度的改善。结论伴有严重人工晶状体瞳孔夹持和虹膜粘连或瞳孔膜闭的儿童严重后发性白内障的理想治疗手段是手术切除后发性白内障并进行人工晶状体复位。     

Pupillary capture following sutureless scleral-fixated intraocular lens in children with Marfan syndrome

AIM: To compare the clinical outcomes between two approaches for sutureless scleral-fixated intraocular lens (SFIOL) in children with Marfan syndrome (MFS). METHODS: The study included 15 children (26 eyes) with lens subluxation due to MFS. These children underwent lensectomy, anterior vitrectomy, and sutureless SFIOL. According to the position of placement of intraocular lens (IOL) haptics, two study groups were reviewed for best corrected visual acuity (BCVA) and postoperative complications: group A, 14 eyes with haptics fixated at 2.0 mm from the limbus; group B, 12 eyes with the haptics fixated at 2.5 mm from the limbus. RESULTS: The mean axial length for all patients was 25.66±2.35 mm. Postoperative BCVA in logMAR were significant improved in both groups (0.77±0.32 to 0.17±0.12 in group A, 0.66±0.25 to 0.24±0.12 in group B, both P<0.001) while no significant difference between two groups (P>0.05). Pupillary capture was main postoperative complication, occurring between 3d and 18mo. It occurred in 7 eyes in group A and one eye in group B (P=0.02). CONCLUSION: Sutureless SFIOL is an effective treatment approach for lens subluxation in children with MFS. Pupillary capture is the main postoperative complication. Fixated IOL haptics at 2.5 mm from the limbus can reduce the occurrence of pupillary capture.     

Sympathetic ophthalmia associated with anterior chamber intraocular lens implantation

We describe a rare case of sympathetic ophthalmia associated with intracapsular cataract extraction and anterior-chamber intraocular lens implantation. This occurred three months after an immediate postoperative complication of pupillary block, flat anterior chamber, and wound dehiscence with one of the lens haptics dissecting into the subconjunctival space. Both eyes developed granulomatous panuveitis, which partially responded to medical treatment. Removal of the anterior-chamber intraocular lens and pars plana vitrectomy resulted in control of the uveitis with significant visual improvement. A pathologic examination of material from the anterior chamber and vitreous showed lymphocytes, histiocytes, and pigment cells contributing to the diagnosis of sympathetic ophthalmia. To the best of our knowledge, this is the first report of an intraocular lens implicated as a cause of sympathetic ophthalmia.     

Fibrinoid reaction after extracapsular cataract extraction and relationship to exfoliation syndrome

A transitory deposit of a fibrin-like material in the anterior chamber following extracapsular cataract extraction and intraocular lens (IOL) implantation is described. In two studies, one retrospective of 352 operations and one prospective of 189 operations, the fibrinoid reaction was observed in 17% and 11% of the eyes, respectively. The reaction appeared in the early postoperative period in an otherwise quiet eye and the signs varied from a few threads in the pupil area to a dense pupillary membrane in front of the IOL. The deposit disappeared one day to three weeks postoperatively, usually without any remnants. The majority of eyes with the fibrinoid reaction had received a posterior chamber IOL. A strong association with the exfoliation syndrome was found and an increased vascular permeability is suggested as a probable cause of the reaction.     

白内障超声乳化术后急性瞳孔阻滞型高眼压原因分析及处理

目的 探讨白内障超声乳化人工晶状体（IOL）植入术后急性瞳孔阻滞型高眼压症的原因和处理方法。方法 回顾性病例研究。2000年1月至2011年12月期间在台州市眼科医院行白内障超声乳化术后早期由于瞳孔阻滞所致的急性高眼压症者17例（17眼）,其中IOL瞳孔夹持所致5例,囊袋阻滞综合征（CBS）所致12例。对IOL瞳孔夹持所致的5例采用复方托吡卡胺眼药水散瞳和静脉滴注20%甘露醇浓缩玻璃体治疗。对CBS所致的12例,其中行Nd：YAG激光前囊孔边缘切开2例和前囊周边部切开5例;手术行前囊孔边缘放射状切开2例和补充扩大前囊口直径3例,并作前房及囊袋冲洗。观察处理后的眼压、视力、IOL位置、前房和囊袋情况。结果 术后随访2～3个月,所有术眼瞳孔阻滞消失,眼压正常,视力提高,前房加深,IOL位置正常。IOL瞳孔夹持所致的5眼末次随访时眼压为11～19 mmHg,平均（15.0±4.0）mmHg。最佳矫正视力为0.7～1.0。CBS所致的12眼末次随访时眼压为12～18 mmHg,平均（15.0±3.0）mmHg。最佳矫正视力为0.8～1.0。结论 IOL瞳孔夹持和CBS可以引起白内障超声乳化术后早期瞳孔阻滞型急性高眼压症。对IOL瞳孔夹持者采用散瞳,对CBS所致者行Nd：YAG激光或手术治疗,均可有效解除其所致的高眼压。     

Long anterior zonules and pigment dispersion

PURPOSE: To describe pigment dispersion associated with long anterior zonules. DESIGN: Multicenter observational case series. METHODS: Fifteen patients, seven of whom were treated for glaucoma or ocular hypertension, were identified with long anterior zonules and pigment dispersion. Transmission electron microscopy was performed on one anterior capsule specimen. RESULTS: All patients had anterior zonules that inserted centrally on the lens capsule. Signs of pigment dispersion included corneal endothelial pigmentation, loss of the pupillary ruff, and variable trabecular meshwork pigmentation. Ultrasound biomicroscopy verified the lack of posterior iris insertion and concavity. There was no exfoliation material. Transmission electron microscopy showed zonular lamellae with adherent pigment granules, and no exfoliation material. CONCLUSIONS: Long anterior zonules inserted onto the central lens capsule may cause mechanical disruption of the pigment epithelium at the pupillary ruff and central iris leading to pigment dispersion.     

Cataract surgery with ciliary sulcus fixation of intraocular lenses in patients with uveitis.

PURPOSE: To describe intentional placement of intraocular lens haptics in the ciliary sulcus of patients with uveitis who are at high risk for postoperative posterior synechiae and lens dislocation. METHODS: We reviewed our experience with 16 eyes of 12 patients with uveitis who underwent cataract surgery with ciliary sulcus fixation of intraocular lenses. Patients were followed for a median of 16.5 months (range, 9 to 44 months) after surgery. We evaluated eyes for surgical technique and the following preoperative and postoperative factors: best-corrected visual acuity, intraocular pressure, anterior chamber cells, and posterior synechiae. The following additional postoperative factors were sought: lens dislocation, lens edge capture, and evidence of pigment dispersion. RESULTS: Posterior synechiae were present in 13 eyes before surgery; postoperative posterior synechiae developed in only three of these eyes. These adhesions resulted in lens edge capture in one eye and limited lens decentration in another. Scant pigment was present on the lens optic or in the anterior chamber, suggesting pigment dispersion, in four eyes. We found no evidence of consistently increased anterior segment inflammation or intraocular pressure after surgery when compared with preoperative levels for this group of patients. Postoperative posterior synechiae were seen more often in eyes that had can-opener anterior capsulotomy than in eyes that had continuous, curvilinear capsulorhexis (P = .036). CONCLUSIONS: Ciliary sulcus fixation allows the intraocular lens to serve as a physical barrier between the iris and the lens capsule remnants. This technique may be useful for reducing the risk of postoperative posterior synechiae in patients with uveitis without increasing the risk of other postoperative problems.     

Iris modifications following extracapsular cataract extraction with posterior chamber lens implantation

We prospectively examined 94 eyes of 93 consecutive patients who had planned extracapsular cataract extraction or phacoemulsification with posterior chamber intraocular lens (IOL) implantation. The observed postoperative iris biomicroscopic modifications are described and classified. Iris synechial formation was more frequently observed in eyes with pseudoexfoliation syndrome, when an irregular anterior capsulotomy was performed, when the IOL was other than in the bag, and in cases of postoperative fibrinous exudation. Synechias occurred more frequently in intraoperatively injured iris areas. Pupil capture was the only postoperative iris modification that was observed to affect visual acuity. The maximal postoperative dilation was greater and the pupillary photic reaction was significantly less modified postoperatively (P = .0058) when the IOL was fixated within the capsular bag.