穿透性角膜移植术后白内障小切口摘除术的临床观察

目的探讨穿透性角膜移植术(PKP)后白内障行巩膜隧道小切口的疗效。方法对17例(17眼)穿透性角膜移植术后白内障患者行巩膜隧道切口,行白内障现代囊外摘除联合人工晶体植入术(ECCE IOL)观察手术前、后视力,角膜水肿情况及内皮细胞记数。术后随访3～10个月。结果术后3个月最佳矫正视力:大于0.5者10例(10/17),0.3～0.5有5例(5/17),0.1～0.3有2例,(2/17)。平均角膜内皮细胞记数1837±326个/mm,术后3个月为1750±432个/mm,差异无显著意义。平均内皮细胞损失率为6.2%。术中均无并发症出现,17眼术后角膜移植片均保持透明,术后1眼一个月后出现排斥反应,经抗排斥治疗后,移植片恢复透明。结论对穿透性角膜移植术后白内障患者,根据移植片情况,注意术中操作,巩膜隧道小切口ECCE IOL术是安全、有效的治疗方法。     

穿透性角膜移植术后行白内障摘除术16例观察

目的 探讨穿透性角膜移植术(PKP)后白内障摘除术的临床疗效.方法 回顾性分析2004年1月至2007年7月行白内障摘除术的穿透性角膜移植术后患者16例,根据晶状体核硬度分级,分别采取白内障超声乳化摘除联合人工晶状体植入术(phaco+pcIOL)和白内障囊外摘除联合人工晶状体植入术(ECCE+pcIOL),统计患者手术前后视力,角膜水肿及角膜内皮细胞(CEC)情况的变化.结果 术后3个月最佳矫正视力:0.2～0.5,均较术前提高.经治疗术后角膜水肿均于1周内消除,术后角膜内皮细胞密度均较术前减少,但术后内皮细胞丢失率phaco+PCIOL组((9.1±2.3)%)较ECCE+PCIOL组((8.3±2.6)%)差异无统计学意义(P>0.05),经术后5～30个月的随访,角膜移植片均保持透明,无一例大泡性角膜病变发生.结论 对穿透性角膜移植术后的白内障患者,综合评价术前情况选择适当的手术方式,白内障摘除联合人工晶状体植入术疗效确实,可获得满意的手术结果.     

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。     

儿童穿透性角膜移植手术的临床观察

目的探讨儿童穿透性角膜移植手术的疗效.方法对在2003年4月～2004年9月于我院行穿透性角膜移植手术的儿童角膜盲连续病例29例(29眼)进行回顾性分析.结果术后23眼中12眼(52.17%)视力达0.05以上.29眼中19眼(65.52%)角膜保持透明,其中,圆锥角膜及先天性角膜内皮营养不良所有病例植片透明;6眼外伤性角膜瘢痕中5眼植片透明,1眼发生排斥;先天性角膜混浊6眼中4眼排斥;角膜溃疡3眼中2眼排斥;角膜带状变性2眼中1眼排斥;碱性化学伤2眼均排斥.29眼中8眼(27.6%)发生包括虹膜前后粘连、白内障、青光眼等并发症.结论不同原因造成的儿童角膜盲施行穿透性角膜移植手术的成功率不同.早期的手术干预、并发症的预防以及术后的强化弱视治疗是影响儿童穿透性角膜移植术疗效的重要因素.     

穿透性角膜移植术52例临床报告

目的　探讨穿透性角膜移植术疗效和并发症。方法　对 5 2例 (5 3只眼 )穿透性角膜移植术进行随访性总结。结果　术后视力≥ 0 .5者 15只眼 ,占 2 8.8% ;0 .2 5～ 0 .4者 18只眼 ,占 34.6 % ;0 .0 5～ 0 .2者 11只眼 ,占2 1.1% ;眼前指数～ 0 .0 5者 6只眼 ,占 11.5 % ;光感消失者 3只眼 ,占 5 .7%。角膜植片透明者 4 6只眼 ,占 86 .7% ,角膜植片混浊者 7只眼 ,占 13.2 %。结论　穿透性角膜移植是角膜盲的最佳复明方法 ,可以在基层二级医院推广 ,但应严格掌握适应证 ,防止并发症     

椭圆形植片穿透性角膜移植术的实验研究

目的确定穿透性角膜移植术椭圆形植片在新西兰白兔角膜白斑模型上降低散光的作用.方法 24只新西兰成年白兔随机取一眼制作角膜灼伤横椭圆白斑模型.稳定一月后,测白斑直径、行角膜地形图检查.随机取12只作为对照组,行圆形穿透性角膜移植术,余下作为实验组,行椭圆形植片穿透性角膜移植术.术后3月,透明植片测角膜地形图.结果角膜白斑模型的直径测量与预设计值的差异无统计学意义(P＞O.05).术后角膜地形图分析:二组的表面规则性指数(Surface Regularity Index,SRI)值和表面非对称性指数(Surface Asymmetry Index,SAI)值相比差别无统计学意义(P＞0.05);实验组的散光度数为4.75±0.47D,对照组的散光度数为8.45±0.59D,二者相比差别有极显著的统计学意义(P＜0.001),且实验组低于对照组2.70±0.76D.结论对于横椭圆形角膜白斑的穿透性角膜移植术,椭圆形植片较圆形植片有效地降低术后的散光.     

角膜移植术后的晶状体超声乳化吸出术

目的探讨穿透性角膜移植术后超声乳化吸出术的疗效。方法对23例(23眼)角膜移植术后白内障患者施行超声乳化吸出联合人工晶状体植入术。患者年龄18~67岁,平均(41.5±11.3)岁。观察术后视力、眼压、角膜水肿情况、角膜内皮细胞计数及并发症。结果所有患者手术顺利。随访3~18月,术后最佳矫正视力>0.5者8眼(34.78%),角膜内皮细胞平均损失率4.92%,眼压均正常。后囊浑浊1眼(4.35%)。术后2月1眼发生角膜排斥反应,经药物抗排斥治疗移植片恢复透明。结论对穿透性角膜移植术后患者施行晶状体超声乳化吸出术是安全有效的。     

穿透性角膜移植治疗重症真菌性角膜溃疡效果观察

目的探讨穿透性角膜移植治疗重症真菌性角膜溃疡的临床效果。方法对重症真菌性角膜溃疡10例(10眼)行穿透性角膜移植术,随访3~6月。结果术后10眼感染全部得到控制,8眼植片透明,1眼行二次穿透性角膜移植,术后角膜透明。术后视力均比术前提高。结论穿透性角膜移植治疗真菌性角膜溃疡可有效地控制感染,改善视功能,效果较好。     

穿透性角膜移植术128例临床分析

目的评价穿透性角膜移植术治疗角膜疾病的疗效。方法对128例(128眼)角膜混浊病人行穿透性角膜移植术,于术后1月、3月、6月、12月、24月观察角膜的透明情况以及并发症。结果穿透性角膜移植术后1月128眼中82眼透明(64.1%),术后6月90眼中69眼透明(76.7%),术后12月84眼中53眼透明(63.1%),术后24月43眼中27眼透明(62.8%)。以此同时,患者的视力均有不同程度的增加,术后1月角膜透明82眼中有67眼矫正视力大于0.1(82%),术后3月63眼中有59眼矫正视力大于0.1(94%)同,术后6月69眼中有66眼矫正视力大于0.1(96%)。结论穿透性角膜移植术是治疗因角膜病致盲患者的重要手段,排斥反应是术后主要并发症,三联手术安全有效。     

重度真菌性角膜炎经治疗性角膜移植术后再次光学性角膜移植的临床效果

目的探讨重度真菌性角膜炎在用冰冻保存的供体角膜行治疗性角膜移植术后,再次施行光学性角膜移植的临床效果。方法选择1995年5月至2002年5月期间于邵逸夫医院就诊的35例(35只眼)重度真菌性角膜炎患者,在用冰冻保存的供体角膜行治疗性角膜移植至少经过6个月后,再接受光学性角膜移植。若合并并发性白内障,则同时联合施行白内障囊外摘除和人工晶状体植入术。观察患眼手术并发症、术后视力、排斥反应及植片透明等情况。结果35只眼中18只眼行单纯的光学性角膜移植,另17只眼同时联合白内障囊外摘除和人工晶状体植入术。手术过程均顺利。术后经6.8～36.8(15.7±7.6)个月的随访,32只眼植片保持透明,3只眼因排斥反应植片混浊。24只眼术后最佳矫正视力等于或好于0.4,32只眼最佳矫正视力等于或好于0.1,3只眼低于0.1。术中及术后35只患眼未见其他并发症。结论重度真菌性角膜炎患眼经过冰冻保存的供体角膜行治疗性角膜移植术后,再次施行光学性角膜移植,术后并发症少,可维持较高的植片透明率和较理想的视力。     

硬核白内障改良囊外摘除术85例

目的:评价对硬核白内障采用囊外摘除法(extracapsular cataract extraction,ECCE)的手术方法和效果。方法:回顾性分析2006-01/2008-0185例85眼硬核白内障囊外摘除术临床资料。巩膜隧道切口长7～8mm,前囊连续环形撕囊(continuous circular capsularhexis,CCC)直径为6～7mm,晶状体圈套器套核,囊袋内植入人工晶状体。结果:85眼中80眼(94%)撕囊口娩核后仍平滑连续完整,囊袋内植入人工晶状体;5眼(6%)发生前囊膜放射状撕裂并延至后囊,在睫状沟内植入晶状体。术后第1d77眼(91%)角膜清亮,裸眼视力>0.3者72眼(85%)。术后1wk裸眼视力>0.5者78眼(92%)。结论:改良的ECCE对于硬核白内障意义重大。改良的ECCE投资少,适合在基层医院推广。     

手法小切口白内障摘除人工晶状体植入术治疗过熟期白内障临床观察

目的:探讨手法小切口白内障摘除人工晶状体植入术治疗过熟期白内障的方法和临床效果。方法:对94例97眼经手法小切口白内障摘除人工晶状体植入术,术后观察及随访其疗效。结果:术后视力均有明显提高。术后视力(矫正)恢复情况:术后1d视力>0.5者71眼(73%);术后2d视力>0.5者82眼(85%),>0.3者95眼(98%)。结论:手法小切口白内障摘除人工晶状体植入术治疗过熟期白内障是一种安全、有效、实用的方法。     

Visual outcome after high volume cataract surgery in Pakistan

AIM: To determine the visual outcome and factors influencing visual outcome after cataract surgery in an urban charity hospital in Pakistan. METHODS: A series of selected outpatients were examined who had undergone cataract surgery in the preceding 24 months. RESULTS: 181 patients aged 45-82 years were examined. The type of cataract operations they had had were extracapsular cataract extraction (ECCE) only in 50% (91), phacoemulsification (phaco) only in 11% (20), ECCE with intraocular lens (IOL) in 17% (31), and phaco with IOL in 22% (39). At presentation, 49.7% (90) had poor functional vision; after refraction 68% (123) had a good visual outcome. Functional vision in eyes undergoing ECCE with IOL was good in 77% (22) and with phaco with IOL in 71.8% (28). After refraction a higher proportion of eyes with IOL surgery (93%) had a good outcome than those with non-IOL surgery (53%). Uncorrected refractive error, present in 75.5% (68), was the commonest cause of poor functional vision. CONCLUSION: This study demonstrates that it is possible to obtain good results with IOL surgery in the developing world. Increasing cataract surgery with IOL implantation should reduce the number of eyes with poor functional vision after cataract surgery. More attention should be directed towards ensuring that successful outcomes are indeed being realised by continued visual monitoring postoperatively.     

Long-term effect of cataract surgery on intraocular pressure after trabeculectomy: extracapsular extraction versus phacoemulsification

PURPOSE: To compare the effect of phacoemulsification with intraocular lens (IOL) implantation on long-term intraocular pressure (IOP) control in glaucoma patients who had previous trabeculectomy with the effect on IOP control in similar patients after extracapsular cataract extraction (ECCE) with IOL implantation. SETTING: Oxford Eye Hospital, Oxford, England. METHODS: Twenty-eight consecutive patients who had phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified from hospital records, and 28 patients who had ECCE with IOL implantation (ECCE group) were matched retrospectively to the phaco group with respect to age, sex, diagnosis, and IOP. In both groups, the IOP before cataract extraction was compared with the IOP at intervals up to 2 years after cataract extraction. A Kaplan-Meier survival analysis was performed. RESULTS: The mean IOP in the phaco group did not differ significantly from the mean IOP before cataract extraction at any interval. Twelve months after cataract extraction, the mean IOP in the ECCE group was significantly higher than preoperatively (P =.01); however, the mean IOP did not differ between groups over time (P =.704). There was significantly better long-term IOP control in the phaco group as determined by Kaplan-Meier survival analysis and the log-rank test (P =.038). CONCLUSION: After trabeculectomy, phacoemulsification provided better long-term IOP control than ECCE; however, the mean IOP was not significantly lower.     

超声乳化吸出先天性白内障

目的:观察超声乳化在先天性白内障的应用。方法:对32例49眼行先天性白内障超声乳化吸出及人工晶状体植入,术中应用隧道切口和连续环形撕囊技术,低能量超声乳化或I/A系统清除晶状体核和皮质,囊袋内植入折叠式人工晶状体。并与同期相同条件的病例行ECCE PMMA人工晶状体植入术41例59眼相对比,观察术后视力及并发症。结果:术后1a时2组病例脱残率和并发症发生率有显著差异(P<0.01),其中后发性白内障发生率,超声乳化组6%,对照组76%。结论:本组病例中超声乳化吸出先天性白内障,有良好的前房稳定性,彻底清除晶状体皮质,术后并发症少。     

Extracapsular cataract surgery in Vietnam: A I year follow-up study

Purpose: Unoperated cataract is the leading cause of blindness in the developing world. Many developing countries now use extracapsular cataract extraction (ECCE) with intra-ocular lens insertion (IOL) in their cataract blindness-prevention programmes. To date, little research has been directed at visual outcomes and complication rates of ECCE/IOL surgery in developing countries. Methods: We conducted a follow-up study of 155 eyes approximately 12 months after ECCE/IOL surgery by eight local eye surgeons in Central Vietnam. We report the findings for the 144 eyes (93%) successfully reviewed. All subjects underwent manual ECCE with insertion of a three-piece posterior chamber IOL. All eyes were also assessed for the presence and severity of posterior capsule opacification (PCO) using a newly developed grading system. Results: Overall, 110 eyes (75%) had uncorrected visual acuities ≥6/24 and 107 eyes (74%) had best spherically corrected visual acuities ≥6/18. Some degree of PCO was found in 40% of eyes, but was graded as visually significant in only 4% of eyes. No major sight-threatening complications were noted. A portable neodymium: yttrium aluminium garnet (Nd: YAG) laser was used to perform capsulotomies on all eyes with visually significant PCO. There were no laser complications noted. Conclusions: At approximately I year after ECCE/IOL, the visual outcomes for subjects in this cohort were favourable and complication rates were low. Posterior chamber opacification was not a major cause of vision impairment in this cohort. Portable Nd: YAG lasers may provide an effective solution to the problem of visually significant PCO occurring in developing countries as a late complication of extracapsular surgery. These findings support an increasing role for ECCE/PCIOL surgery by trained local eye surgeons in developing countries.     

基层医院扶贫白内障复明手术方式与效果分析

目的:比较、分析基层医院扶贫白内障复明手术方式及效果。方法:比较随机选取的2006/2007在基层医院采取现代囊外白内障摘除(extracapsular cataract extraction,ECCE)、大切口(隧道)无缝线白内障(囊外)摘除(sutureless large incision manual cataract extraction,SLIMCE),并人工晶状体(intraocular lens,IOL)植入手术各200例。统计术后视力,术中、术后并发症,手术耗品及费用。结果:术后视力在0.5以上的:ECCE+IOL手术组115例(57.5%),SLIMCE+IOL手术组139例(69.5%);术中后囊膜破裂:ECCE+IOL手术组7例(3.5%),SLIMCE+IOL手术组6例(3.0%);角膜水肿:ECCE+IOL手术组13例(6.5%),SLIMCE+IOL手术组10例(5.0%)。平均每例手术耗品及费用SLIMCE+IOL手术组稍高。结论:在基层医院施行扶贫白内障复明手术,手术要安全、效果要好,手术费用要低,ECCE+IOL植入手术目前还是主要的手术方式。SLIMCE+IOL植入手术采用隧道无缝线切口,操作步骤减少、时间缩短、能够减少术后散光,获得更好的效果,值得提倡。但手术耗费稍增加,对手术操作者的手术技巧要求较高。无论是哪一种手术方式,复明是永恒的主题,需要培养大批有爱心的技术优秀的眼科专业人员,才能使数以百万计的白内障盲患者重见光明。     

Pediatric cataract surgery in Nepal

PURPOSE: To describe the first pediatric cataract surgery case series report from Nepal. SETTING: Tilganga Eye Center, Kathmandu, Nepal. METHODS: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded. RESULTS: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years +/- 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 +/- 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications. CONCLUSIONS: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.     

Cataract surgery in patients with Fuchs' heterochromic iridocyclitis.

PURPOSE: To evaluate the results of cataract extraction and posterior chamber intraocular lens (IOL) implantation in patients with Fuchs' heterochromic iridocyclitis (FHI). METHODS: We studied the records of 35 patients with FHI who underwent cataract extraction. Extracapsular cataract extraction (ECCE) was performed by phacoemulsification through a scleral flap in 9 patients and by manual delivery of the nucleus through a corneal section in 26 patients. RESULTS: After a mean follow-up time of 24 (3-60) months, the visual acuity in 21 eyes (60%) was 20/20, and all eyes had 20/40 or better vision. Six eyes with implanted regular PMMA IOL developed a marked anterior uveitis, which was resolved within 3 weeks with topical steroids. Only 1+ or 2+ cellular reaction was observed postoperatively in patients with heparin-coated lens implantation and patients who underwent phacoemulsification. Biomicroscopic evidence of giant cell activity was observed in two patients with heparin-coated IOL and in 11 with regular PMMA IOLs after ECCE (two after phacoemulsification). Four eyes developed intraocular pressure elevation that reverts to normal within 24 weeks with medical therapy. CONCLUSIONS: These results indicate that the surgical outcomes of FHI patients after cataract surgery appear to be better when the phacoemulsification technique is used or when heparin-coated lenses are implanted.