先天性晶状体半脱位手术治疗临床研究

Objective To compare the efficacy and safety of two surgical options in treating congenital subluxated lenses,one is capsular tension ring(CTR)and intraocular lens(IOL)implantation,and the other is IOL scleral fixation.Methods This study comprised 45 eyes of 27 congenital subuxated lenses patients,who were randomly divided into two groups.In Group 1(n=24 eyes),a CTR and IOL was implanted and in Group 2(n=21 eyes),a single-piece,scleral-fixated IOL.For group 1,CTR was sutured to sclera at a secondary surgery two months after CTR and IOL implantation.The postoperative visual acuities and best corrected visual acuities(BCVAs),astigmatism were analyzed.IOL tilt and decentration were measured with AC-OCT system and IOL post-photo system 3 months after surgery.Results Three months after surgery,Compared to group 2,group 1 had better BCVA(0.75 vs 0.54,P<0.05),lower astigrnatism(1.4D vs 2.3D,P<0.05).smaller IOL tilt(5.48°vs 7.37°,P<0.05).IOL decentration was 1.09mm in group 1 and 0.88mm in group 2 but without significant differences statistically (P>0.05).IOL pupillary capture occurred to 4 eyes of group 2.Conclusions Phacoemulsification with CTR and IOL implantation combined with secondary CTR scleral fixation iS a better surgical option for congenital subluxated lenses.     

球面和非球面人工晶状体倾斜和偏心对视觉质量的影响

Objective To study tilt and decentration of spherical and aspheric IOL implantation after phacoemulsification surgery and effect on higher-order aberrations (HOAs) and visual quality. Methods It was a prospective clinical study. A total of 60 eyes (50 patients) were divided into 2 groups randomly, of 30 eyes in each group, one group with Sensar AR40e (AMO), one group with Tecnis ZA9003 (AMO). Three to four months after surgery, higher-order aberrations (HOAs) and modulation transfer function (MTF) at six spatial frequencies (5, 10, 15, 20, 25, 30 cpd) were measured in 5.0mm pupil size. Tilt and decentration of the IOLs were measured using Scheimpflug photography. The tilt and decentration, HOAs and subtracted lower order aberration MTF (MTF(HOA)) were compared. The effect of tilt and decentration on HOAs and visual quality was assessed using multiple regression analysis. Results The mean optic tilt was (2.99± 0.94)° for AR40e group and (2.98± 1.15)° for the ZA9003 group. The mean optic decentration was (0.30± 0.13)mm, (0.31± 0.14)mm,respectively. No significant differences in IOL tilt or decentration were found (Z= -0.044, -0.525, P =0.965,0.600, Mann-Whitney U test). The total 4th order spherical aberration in AR40e group was larger than it was in ZA9003 group and the differences were statistically significant (t = -10.386, P =0.000). In 5.0mm pupil size,MTF (HOA) at all spatial frequencies in ZA9003 group were larger than they were in AR40e group and the differences were statistically significant (P ＜0.05). Tilt and decentration did not significantly affect HOAs and MTF (HOA) with either IOL. Conclusions When IOL tilt and decentration are within normal limits, hey do not compromise the correction of spherical aberration by the aspheric IOL and the amounts of tilt and decentration of both IOLs are not large enough to cause deterioration of visual quality.     

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia

Purpose: To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens(IOL) in patients diagnosed with high myopia complicated with cataract.Methods:.This was a randomized prospective control study.The patients with high myopia complicated with cataract, with axial length ≥28 mm,.and corneal astigmatism ≤1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation..At 3 months after surgery,.intraocular high-order aberration was measured by a Tracey-i Trace wavefront aberrometer at a pupil diameter of 5mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Pentacam three-dimensional anterior segment analyzer..The tilt and decentration of the IOL were calculated by Image-pro plus 6.0imaging analysis software and statistically compared between two groups.Results:.In total,.127 patients(127 eyes),..including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group(59 eyes)were significantly higher compared with those in the Big Bag(P <0.05)..The clover and spherical aberration did not differ between the two groups(P>0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group(both P<0.05), whereas the tilt of IOL did not significantly differ between the two groups(P>0.05).Conclusion:.Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.     

Comparison of polymethylmethacrylate versus hydrophobic acrylic lenses for primary intraocular lens implantation in pediatric cataract surgery

AIM: To compare the visual results and postoperative complications of polymethylmethacrylate (PMMA) and hydrophobic acrylic intraocular lenses (IOLs) in children who underwent cataract extraction with primary IOL implantation. METHODS: This retrospective study included 117 eyes of 63 children with bilateral pediatric cataract undergoing cataract surgery and primary IOL implantation. The patients were divided into two groups, Group I included 58 eyes of 30 patients with PMMA IOLs; Group II included 59 eyes of 33 patients with hydrophobic acrylic IOLs. The clinical features, refraction errors, best corrected visual acuity (BCVA) and surgical complications were compared between two groups. RESULTS: The mean age at the time of surgery was 5.8 (2-12)y and mean follow up period was 40.5 (6-196)mo. Postoperatively, BCVA was ≥0.5 in 80 eyes (68.4%) and this was comparable in two groups. Visual axis opacification was seen in 28 eyes (48.3%) in Group I and 16 eyes (27.1%) in Group II and this difference was statistically significant (P=0.018). Postoperative IOL dislocation and posterior synechia formation were also noted. When all postoperative complications were considered, there were significantly less complications in the acrylic IOL group than PMMA IOL group (P=0.020). CONCLUSION: Pediatric cataract surgery with primary IOL implantation is a safe procedure. Hydrophobic acrylic IOLs may lead to less postoperative complications compared to PMMA IOLs.     

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.     

In vivo Implantation of Hydrophobic Acrylic Intraocular Lenses with Surface Modification

Purpose： To assess the surface properties of modified hy- drophobic acrylic intraocular lenses （IOL） implanted in rab- bits. Methods： The hydrophobic acrylic IOLs were modified with monomer vinyl pyrrolidone by surface modification technique. Phacoemulsification combined with IOL implantation was con- ducted in 9 rabbits （18 eyes）. Postoperative responses were observed by slit-lamp microscope at 3, 7, 15, 30, 90 days af- ter surgery. Results： During the early stage after IOL implantation, corneal edema and anterior chamber fibrin exudation were ob- served. The exudate fluid was almost absorbed at the 15th day postoperatively. At 7th day, the anterior chamber exudation in the modification group was significantly less severe than that in non-modification group （P〈0.05）. Posterior capsular opaci- fication occurred at 30th day after surgery and was aggravated 90 days later. IOL dislocation was seen in ,5 eyes and occlu- sion of pupil in 3 eyes. Conclusion： The hydrophobic acrylic IOLs with surface modification have improved surface properties and higher uveal biocompatibility.     

A pilot study of intraocular lens explantation in 69 eyes in Chinese patients

AIM: To study the effects of intraocular lens (IOL) explantation and demographic characteristics. METHODS: Retrospective non-comparative case series. Clinical data recorded from patient charts included the following: demographic, preoperative and postoperative characteristics; complications; surgical methods, and changes in visual acuity. RESULTS: A total of 69 eyes in 67 Chinese patients who received IOL explants were studied. The patients’ mean age at the time of explantation was 46.1 years old [SD 22.5 (6-85)], and 37 patients were female (55.2%). Regarding employment, 47.8% were farmers, 23.9% were retired, 16.4% were students, 4.5% were unemployed, 3% were workers, and 4.5% were other (including staff members, teachers and officers). The main reasons for explantation were dislocation/decentration in 41 cases (59.4%) and retinal detachment in 10 cases (14.5%). The third most prevalent cause was incorrect lens power in 7 eyes (10.1%). The remaining reasons were endophthalmitis in 6 cases (8.7%), posterior capsular opacity in 3 eyes (4.3%), and impacting retinal surgery operation in 2 cases (2.9%). The main comorbidities were high myopia in 18 eyes (26.1%), trauma in 8 eyes (11.6%), retinal detachment in 6 eyes(8.7%), congenital cataracts in 8 eyes (11.6%), and Marfan’s syndrome in 2 eyes (2.9%). The mean time from implantation to explantation was 4.0y [SD 4.2 (0.005-15)]. Treatment after explantation included posterior chamber IOL implantation in 44 eyes (63.8%) and aphakia in 25 eyes (36.2%). After surgery, the best corrected visual ability (BCVA) was improved in 50 cases (72.5%), including 28 patients (40.6%) in whom visual ability was improved by more than two lines. CONCLUSION: Dislocation/decentration is the main cause for explantation, and high myopia is a main risk factor. Posterior chamber IOL implantation remains the most elected treatment after explantation.     

Sulcus Transscleral Intraocular Lens Suture Fixation through Small Scleral Tunnel Incision

Purpose:To evaluate the clinical efficacy and safety of sulcus transscleral intraocular lens suture fixation with small incision through scleral tunnel in eyes the with posterior capsule defect or insufficient zonula support. Methods:Thirty nine eyes with severe posterior capsule defect and zonula damages caused by small-incision cataract surgery,and those with capsule absence or intraocular lens dislocation were selected in this investigation from February 2007 to December 2009.Sulcus transscleral intraocular lens suture combined with puncture needle-guided external approach and."one- or two-point fixation" method in the small sclera tunnel incision were employed. Results:The mean follow-up was 12.1 months (range from 3 to 28 months). Six eyes were complicated by some eye diseases postoperatively.The best-corrected visual acuity was 20/40 or better in other 34 eyes.(87.17%).All eyes with secondary IOL fixation presented equal or better naked visual acuity than best-corrected visual acuity best-corrected preoperatively.No intraoperative and postoperative complications such as hemorrhage, retinal detachment, intraocular lens tilt and decentration occurred. Conclusion:Sulcus transscleral intraocular lens suture fixation via small sclera tunnel incision was easy to operate and master,required less operative time,and made primary intraocular lens fixation more effective in eyes with posterior capsule defect or insufficient zonula support in small sclera tunnel incision surgery.In addition,the technique was safe and effcacious for secondary intraocular lens fixation.     

Non—trans—scleral Suture Fixation of Posterior Chamber Intraocular Lenses in the Absence of Posterior Capsular Support

Purpose: To develop a new technique for fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsule support.Materials and Methods: We performed non-trans-scleral fixation of intraocular lenses on 24 cases (24 eyes) without posterior capsule support. Two scleral flaps with limbal incisions and two peripheral iridectomies were made at 1 o' clock and 7 o' clock positions respectively. A suture-leading needle was used to lead the prolene suture from the limbal incision and iridectomy on one side through the iridectomy and limbal incision on the other side. Intraocular lens (IOL) was then fixed in the ciliary sulcus. Results: After a mean follow-up of 6. 6 months (range from 3 to 14 months), corrected visual acuity of 16 cases (16 eyes,66. 7% ) got 0.5 or better. Postoperative complications included discoria (4 eyes) , surface membrane formation ( 1 eye ), choroidal detachment (1 eye) and tilt of IOL (1 eyes),but all were not severe. Conclusion: In some situations such as low int     

Acrysof toric人工晶状体的临床应用研究

Objective To determine the efficacy and rotational stability of a posterior chamber single-piece toric intmocular lens(IOL)to correct preexisting corneal astigmatism in cataract patients.Methods Thirty one eyes of 25 patients who underwent phacoemulsification and foldable Aerysof toric IOL implantation from January 2008 to October 2008 were included in the study.The cylindrical IOL power was 1.5 diopters (D)(n=19),2.25 D(n=7),or 3.00 D(n=5).As a comparison,30 eyes of 21 patients meeting the same preoperative criteria for degree of corneal cylinder were enrolled to have a spherical(nontoric)IOL implanted.The data for both study and control groups were analyzed prospectively.Phacoemuisification was performed through a temporal clear corneal self-sealing incision.Outcomes of LogMAR visual acuity(without correct,with spherical correction and with best correction),refractive and keratometric astigmatism after early postoperative(one week)and long-term(3 months)follow-ups were evaluated.IOL axis rotation was also observed in the study group.Results At last follow-up,all patients achieved LogMAR 0.3(20/40)or better UCVA in the toric IOL group,while 86.7% achieved LogMAR 0.3(20/40)or better UCVA in the spherical IOL group.The mean postoperative refractive cylinder was 0.44±0.24 D in the toric IOL group and 1.44± 0.30D in the spherical(nontoric)IOL group.In 21 eyes(77%),the IOL axis was rotated less than 3 degrees.In all 27 eyes,the maxima rotation of the toric IOL axis was 9 degrees.Conclusions Early postoperative and long-term follow-ups results indicate that phacoemulsification and the Acrysoftoric IOL implantation is a largely predictable effective and stable surgical option to correcting preexisting astigmatism in cataract surgery.