闭角型青光眼伴白内障联合手术的临床观察

目的 观察超声乳化联合小梁切除术治疗闭角型青光眼伴白内障的临床疗效.方法 32例（48眼）患者行白内障超声乳化吸出及后房型折叠人工晶状体植入联合小梁切除术,术后随访6个月,分析术后眼压、视力等情况.结果 术前眼压30～45 mmHg（1 mmHg =0.133 kPa）,术后随访最终时眼压8 ～ 15 mmHg,术后矫正视力0.4 ～1.0者30眼（62.5％）.结论 超声乳化吸出后房型人工晶状体植入联合小梁切除术治疗闭角型青光眼伴发白内障安全有效.     

晶状体超声乳化术治疗急性闭角型青光眼合并白内障的临床观察

目的 观察超声乳化白内障吸出术联合后房型人工晶状体植入术治疗急性闭角型青光眼合并白内障的临床疗效.方法 回顾性分析2003年1月至2007年5月收治的急性闭角型青光眼合并白内障患者21例(22只眼),行透明角膜切口晶状体超声乳化吸除联合后房型人工晶状体植入术.随访1个月至1年,对比术前、术后视力,观察术后角膜内皮细胞数量、前房深度、前房角宽度和眼压变化.结果 20只眼眼压控制正常,2只眼需滴降眼压药物,22只眼最佳矫正视力均有不同程度提高.结论 超声乳化术治疗急性闭角型青光眼合并白内障手术安全、疗效可靠.     

晶状体超声乳化人工晶状体植入治疗闭角型青光眼临床观察

目的观察晶状体超声乳化吸出联合后房型人工晶状体植入术治疗伴白内障的原发性闭角型青光眼的疗效。方法原发性闭角型青光眼32例32眼,行表面麻醉下超声乳化吸出联合后房型人工晶状体植入术。对比手术前后视力、眼压、中央前房深度及前房角的变化。结果32例视力均有不同程度的提高,眼压控制在正常范围内,低于21mmHg,27眼（84．38％）,视力〉0．5,前房角粘连有改善。结论晶状体超声乳化吸出联合人工晶状体植入术,是治疗伴白内障的闭角型青光眼的一种安全可行的有效方法。     

超声乳化白内障吸除人工晶状体植入术治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸除联合后房型人工晶状体植入术治疗白内障合并原发性闭角型青光眼的疗效。方法2002年2月～2004年3月本院收治白内障合并原发性闭角型青光眼34例（36只眼）。术前控制眼压,经视力检查、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸除联合后房型人工晶状体植入术。术后随访1—12个月。结果32只眼视力较术前提高,视力〉0．5者占69．5％;33只眼术后眼压〈21mmHg（1mmHg=0．133kPa）,另3只眼用一种降眼压药物眼压控制在21mmHg以下;全部治疗眼前房加深,房角粘连范围减轻。结论超声乳化白内障吸除联合后房型人工晶状体植入术可有效地治疗合并白内障的原发性闭角型青光眼。     

超声乳化晶状体吸除术治疗闭角型青光眼

目的：观察超声乳化晶状体吸除加人工晶状体植入治疗闭角型青光眼的临床疗效。方法：对31只闭角型青光眼行白内障吸出加人工晶状体植入术，术前眼压经药物治疗后为21～50mmHg；原发性急性闭角型青光眼27眼，慢性闭角型青光眼1眼，老年性白内障膨胀期继发青光眼3眼，晶状体透明15眼，晶状体不同程度混浊11眼，虹膜节段性萎缩5眼；术后观察患眼压、视力、前房深度，随访1a以上。结果：术后视力31眼均有提高。术后眼压均正常(12～20mmHg)30眼；术后8mo发生恶性青光眼1眼(慢性闭角型青光眼)，行小梁切除术加前节玻璃体切割后眼压控制正常。结论：晶状体超声乳化吸出术可使前房加深，房角开放，眼压得到控制，无青光眼小梁切除术的并发症，是治疗某些闭角型青光眼的首选方法。     

晶状体超声乳化人工晶状体植入术治疗闭角型青光眼

目的观察分析晶状体超声乳化吸出术联合后房人工晶状体植入术治疗合并白内障的急性闭角型青光眼的疗效。方法对我院治疗的合并白内障的闭角型青光眼48例(48眼),术前查前房角,前房角关闭粘连小于180°范围者行晶状体超声乳化吸出术联合后房型人工晶状体植入术。术前、术后分析比较眼压、视功能及前房深度,随访6～12个月。结果术后48眼眼压全部控制在21.0 mmHg以下,无严重并发症。46眼视力均有不同程度的提高,2眼视力无变化。术前术后视力及眼压差异有统计学意义。结论对于合并有白内障的前房角关闭粘连小于180°的急性闭角型青光眼可行单纯晶状体超声乳化人工晶状体植入术治疗。     

慢性闭角型青光眼白内障手术治疗临床探讨

目的 探讨慢性闭角型青光眼合并白内障的手术方法.方法 慢性闭角型青光眼合并白内障共64例（66眼）.其中43例（45眼）施行晶状体超声乳化吸出、人工晶状体植入联合房角分离术,21例（21眼）施行晶状体超声乳化吸出、人工晶状体植入联合小梁切除术.结果 术后视力：晶状体超乳联合房角分离手术组术后视力比术前提高者44眼（97.78%）.晶状体超乳联合小梁切除手术组术后视力比术前提高者18眼（85.72%）.术后眼压：晶状体超乳联合房角分离手术组术后第1天眼压正常;8周后有2眼眼压＞30 mmHg,给予二期行小梁切除术.晶状体超乳联合小梁切除手术组术后第1天19眼（90.48%）眼压正常,有2眼（9.52%）低眼压,4周后均恢复正常.结论 慢性闭角型青光眼合并白内障采用晶状体超声乳化吸出、后房人工晶状体植入联合房角分离术或联合小梁切除术均能有效地提高患者的视力并降低眼压.     

晶状体超声乳化人工晶状体植入治疗原发性闭角型青光眼

目的探讨晶状体超声乳化吸出联合后房人工晶状体植入术,治疗白内障合并原发性闭角型青光眼的疗效。方法本院收治白内障合并原发性闭角型青光眼37例(37眼),术前控制眼压,经视力、眼压、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入。结果术后随访6~18个月,视力较术前提高,视力>0.5者20眼,占54.05%,22例术后眼压<18mmHg,另5例用1种降眼压药物眼压控制在18mmHg以下。结论晶状体超声乳化后房人工晶状体植入可有效地治疗合并白内障的原发性闭角型青光眼。     

晶状体超声乳化术治疗急性闭角型青光眼

目的探讨晶状体超声乳化吸出联合人工晶状体植入治疗急性闭角型青光眼合并白内障的疗效。方法回顾分析我院2005年2月-2008年3月收治的合并白内障的急性闭角型青光眼46例（48眼）,行超声乳化白内障吸出联合囊袋内人工晶状体植入术,术后随访3月-3年。观察术前术后视力、眼压、前房深度及前房角的变化。结果45眼眼压控制正常,3眼需滴降眼压药物。视力均有不同程度提高。结论晶状体超声乳化吸出联合人工晶状体植入能有效治疗合并白内障的急性闭角型青光眼。     

晶状体超声乳化吸出联合小梁切除术对青光眼伴有白内障的疗效

目的探讨晶状体超声乳化吸出人工晶状体植入联合小梁切除术对青光眼伴白内障的疗效。方法开角型青光眼及慢性闭角型青光眼合并白内障共35例（52眼）。行晶状体超声乳化吸出人工晶状体植入联合小梁切除术,比较分析手术前后的视力、眼压控制及术后滤泡形成情况。结果术后矫正视力≥0．3者41眼（78．85％）,比术前视力≥0．3者（3眼,5．77％）明显增多。术后随访至少6个月平均眼压（14．71±4．01）mmHg,无需使用降眼压药物。术后功能型滤过泡47眼（90．38％）。无严重并发症发生。结论晶状体超声乳化吸出人工晶状体植入联合小梁切除术是一种安全、有效、便捷的治疗青光眼合并白内障的联合手术。     

人工晶状体植入术后眼压观察

目的 探讨白内障囊外摘出人工晶状体植入术后眼压的变化。方法 ６３例随机分为甲组（不用药组）、乙组（用降眼压药组），观察和对比术后７２小时内眼压。结果 术后１２小时〉２．８０ｋＰａ者，甲组占５４．５％，乙组占２６．６７％。２４小时后眼压下降。７２小时平均眼压甲组明显高于乙组（Ｐ〈０．０５）。结论 术后预防性应用降眼压药对降低人工晶状体植入术后眼压升高有明显作用。     

Dislocated intraocular lens fixation using intraocular cowhitch knot

PURPOSE: To describe a technique for suturing a dislocated intraocular lens (IOL) using an intraocular cowhitch knot without IOL extraction. METHODS: Through the sideports of paracentesis, a cowhitch knot is made outside of the anterior chamber by looping 10-0 Prolene around the haptics of the IOL. The knot is then tied in the anterior chamber by pulling up the suture. After repeating this for the opposite side, the cowhitch knots are fixated to the ciliary sulcus. RESULTS: In 4 cases treated this way, the IOL remained well positioned. CONCLUSION: This technique enables secure fixation of the IOL haptics.     

Elevated intraocular pressure in secondary piggyback intraocular lens implantation

We report 2 cases of postoperative intraocular pressure (IOP) elevation in secondary piggyback intraocular lens (IOL) implantation without history of glaucoma or ocular hypertension. A 74-year-old woman with myopic pseudophakia and a 68-year-old man with hyperopic pseudophakia received secondary piggyback AcrySof IOL implantation in their left eyes. In both patients, the left IOP gradually increased and sustained around 30 mm Hg for about 1 year. In the first, IOP continued elevating despite topical and systemic medications. There was an episode of pupillary block in the second. Gonioscopically, heavier trabecular meshwork pigmentation in their left eyes was observed. Because of this, the 2 IOLs implanted were removed and replaced by an adequate IOL and trabeculotomy was performed in the former. The AcrySof IOL has a truncated optic edge, which increases the risk for chafing the iris, resulting in pigment dispersion syndrome; thus, it would be a poor choice for a sulcus-placed piggyback implantation.     

非球面人工晶状体与球面人工晶状体的比较

随着波前像差技术的发展,人们对影响白内障术后视功能的因素有了更深刻的认识,设计出旨在降低人工晶状体眼球面像差从而提高视功能的非球面人工晶状体。现就非球面人工晶状体眼与球面人工晶状体眼相比,在视功能、波前像差等方面有何差异,非球面晶状体的优越性,以及影响优越性表现的因素综述如下。     

Single intraocular pressure measurements and diurnal intraocular pressure profiles

PURPOSE: To evaluate the probability of a single intraocular pressure measurement to be the highest measurement within a diurnal intraocular pressure profile. DESIGN: Hospital-based clinical, observational study. METHODS: The study included 3,025 day-and-night intraocular pressure profiles measured on 1,072 eyes of 547 Caucasian glaucoma patients or glaucoma suspects. Applanation tonometry was performed at 7 am, noon, 5 pm, 9 pm, and midnight. RESULTS: Intraocular pressure measurements were highest at 7 am, noon, 5 pm, 9 pm, and midnight, respectively, in 20.4%, 17.8%, 21.3% 13.9%, and 26.7% of the profiles, respectively. The measurement taken at 7 am was significantly (P < .001) closest to the maximal value of the profile. CONCLUSIONS: Any single intraocular pressure measurement taken between 7 am and 9 pm has a higher than 75% chance to miss the highest point of a diurnal curve. Intraocular pressure may be measured at different times of the day to have the best chance of observing the maximal value.     

玻璃体切除联合眼内填充术后眼压变化

目的观察后部玻璃体切除(PPV)联合眼内填充物术后早期眼压变化规律并探讨早期高眼压的发病机制。方法对119例(132只眼)在天津医科大学眼科中心行后部PPV患者的临床资料进行分析,高眼压的诊断标准为非接触式眼压计测量眼压≥24 mm Hg,分析了玻璃体切除联合不同眼内填充物术后高眼压的发病率及变化趋势。结果有50只眼术后发生早期眼压升高,发病率为37.88%。其中硅油填充组、C2F6填充组、C3F8填充组及单纯玻切组,其术后早期高眼压的发病率分别为48%、41.18%、57.14%、11.76%,各组间比较(χ2=14.395,r=3,P=0.002),有统计学意义。结论术后早期高眼压是后部PPV术后常见的并发症,后部PPV联合眼内惰性气体或硅油填充都是增加高眼压的危险因素。     

囊袋内植入不同襻长人工晶体后偏心的研究

目的：　测量不同襻长的后房型人工晶体囊袋内植入术后偏心值,确定超声乳化白内障摘除更适合囊袋内植入的人工晶体的襻长。方法：采用通过眼底照相系统摄取人工晶体植入术后１ 周和３ 个月前囊像,应用自制同心圆图表确定角膜和人工晶体光学中心,利用计算机软件测量两点之间的直线距离作为人工晶体偏心值,对６２ 只襻长分别为１２．０ｍｍ 和１２．５ｍｍ 的后房型人工晶体眼行活体测量。结果：襻长１２．０ｍｍ 和１２．５ｍｍ 人工晶体术后１ 周和３ 个月的偏心值分别为０ ．２５ ±０．１５ｍｍ 、０．０３ ±０ ．１３ｍｍ 和０．２０ ±０．０７ｍｍ 、０．２１ ±０ ．１０ｍｍ ．结论：总长度为１２ ．５ｍｍ 的人工晶体囊袋内植入比１２．０ｍｍ 的更稳定。     

Understanding intraocular lymphomas

The purpose of this review is to describe the clinical features, pathology and molecular biology of intraocular lymphomas, which represent a heterogenous group of malignant neoplasms; to propose an anatomical classification of these tumours according to whether they occur in the retina or uvea; and to overview laboratory investigations and highlight factors required for successful biopsy. Recent findings show that retinal lymphomas are high-grade (i.e. aggressive), B-cell malignancies and are associated with a poor prognosis, with most patients dying of central nervous system disease. Immunophenotyping and somatic mutation analyses indicate that these lymphomas are probably derived from early post-germinal centre cells. Primary choroidal lymphomas are typically low-grade (i.e. indolent), B-cell tumours with morphological, immunophenotypical and genotypic features similar to extranodal marginal zone B-cell lymphomas (EMZL) elsewhere in the body. The putative cell of origin is the post-germinal centre (memory) B cell. Primary iridal lymphomas are very rare, with an equal distribution of B- and T-cell types and with a variable clinical course, most patients succumbing to their disease as a result of systemic dissemination. Primary lymphomas limited to the ciliary body are exceptionally rare. Secondary uveal lymphomas/leukaemias occur in patients with advanced systemic lymphoma or leukaemia, respectively. In summary, the term 'primary intraocular lymphoma (PIOL)' is imprecise. It would be preferable to refer to the various forms of intraocular lymphoma according to whether they are retinal, choroidal, ciliary or iridal and whether they are primary or secondary in these locations.     

Phakic intraocular lenses

An analytical review of the data available in the field of phakic intraocular lens implantation was conducted. Particular attention was paid to the more critical issues of intraocular lens sizing and safety guidelines. A comprehensive, competitive analysis of different implantation sites, intraocular lens model designs, and safety guidelines has been included. Specialized biometry techniques, such as very high frequency ultrasound and Scheimpflug imaging, have been reviewed, and a critical review of commercial claims regarding intraocular lens technologies has been included. Clinical studies of phakic intraocular lenses demonstrate increasing promise for the correction of refractive errors not amenable to mainstream excimer laser refractive surgery. The main issues currently revolve around adequate lens design (VHF ultrasound study suggests that custom-design and sizing may be the most effective and safest approach for every phakic IOL model), because these devices will be required to remain physiologically inert and anatomically compatible with internal ocular structures and relations for several decades. The possibility of safe removing or exchanging the IOL should remain a feasible option over time. It is of utmost importance that we continue to critically evaluate current encouraging short-term outcomes, which are being extrapolated to the longer term by ongoing high resolution imaging and monitoring of the anatomical and functional relations of implanted phakic IOLs.