玻璃体切除术后无晶状体眼Ⅱ期人工晶状体植入术式的临床观察

目的探讨复杂性眼外伤或视网膜脱离行玻璃体切除术后无晶状体眼Ⅱ期不同类型人工晶状体植入术式临床疗效,评估手术的可行性。方法对41例(41眼)因复杂性眼外伤或视网膜脱离行玻璃体切除术后无晶状体眼,分别行前房型人工晶状体植入术18眼、后房型人工晶状体缝线固定术17眼、带虹膜人工晶状体植入术后6眼,术后平均随访10月。结果41例患者术后裸眼视力均达到或接近术前矫正视力。其中前房型人工晶状体植入术18眼中最好视力≥0.5者(44％),后房型人工晶状体缝线固定术17眼中最好视力≥0.5者9眼(53％),带虹膜人工晶状体植入术6眼中最好视力≥0.5者2眼(33％)。结论晶状体、玻璃体切除术后人工晶状体植入术式的选择,主要应根据患者的瞳孔大小、眼压、房角结构及患者全身情况选择术式,2种不同类型人工晶状体植入术式临床疗效,经过统计学处理无显著性差异P>0.05,术后的视力与角膜及眼损伤程度及术后散光密切相关。     

Ⅱ期人工晶状体植入术治疗玻璃体切除术后无晶状体眼的临床观察

目的:评价因复杂眼外伤或孔源性视网膜脱离行玻璃体手术后无晶状体眼Ⅱ期人工晶状体植入术的治疗效果、手术安全性。方法:采用巩膜隧道切口,根据晶状体囊膜保留程度选择不同眼内灌注、不同方法植入不同类型人工晶状体,对35例35眼玻璃体手术后无晶状体眼行Ⅱ期人工晶状体植入术。术后随访3～15(平均8)mo。结果:35例均完成Ⅱ期人工晶状体植入术,术后裸眼视力均有提高。裸眼视力≥0.3者22眼(62.8%),0.1～0.2者10眼(28.6%),≤0.1者3眼(8.6%)。主要并发症有驱逐性脉络膜上腔出血、玻璃体积血、低眼压、脉络膜脱离、人工晶状体偏斜、角膜水肿等。结论:巩膜隧道切口人工晶状体植入术治疗玻璃体手术后无晶状体眼能改善和提高患眼视力。术中采用稳定的眼内灌注、巩膜隧道切口、合适的人工晶状体植入,可降低手术并发症的发生。     

抗青光眼术后浅前房的前房重建手术

目的 探讨青光眼滤过术后浅前房的手术方法和效果.方法 取17例抗青光眼术后浅前房患者经保守治疗无效,有7只眼发生脉络膜脱离,5只眼行脉络膜上腔放液+前房成形术,1只眼行白内障超声乳化及人工晶状体植入术及前房成形术,1只眼行脉络膜上腔放液+白内障超声乳化及人工晶状体植入术+前部玻璃体切割术+前房成形术.有9只眼发生恶性青光眼,1例行抽玻璃体水囊联合前房成形术,3例行前部玻璃体切除及后囊切开联合小梁切除及丝裂霉素联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除术中发生脉络膜脱离及脉络膜上腔出血行前部玻璃体切除联合玻璃体腔放液,2只眼行前部玻璃体切除联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除联合前房成形术,术后前房仍浅又行白内障超声乳化及人工晶状体植入及后囊膜切开及房角分离术,1例为视网膜脱离术后硅油存留眼行白内障超声乳化联合虹膜周边切除术及前房成形术.结果 术后前房恢复时间脉络膜脱离组行脉络膜上腔放液及前房成形术平均为5.6d,恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开组前房恢复时间最短,平均为1.1d.结论 恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开治疗有效快速.     

玻璃体切除术后无晶状体眼二期人工晶状体缝线固定术

目的 探讨玻璃体切除术后无晶状体眼经巩膜睫状沟二期人工晶状体固定术的手术方法及技巧.方法 对81例(81眼)玻璃体切除术后无玻璃体、无晶状体眼施行在前房灌注下后房多类型人工晶状体巩膜睫状沟缝线固定术,术后随访3月～9年,观察临床效果及术中术后并发症.结果 81例术中一次固定成功,术后裸眼视力均较术前提高,最佳矫正视力均达到或接近术前最佳矫正视力.术中6例少量出血,术后少数患者出现一过性低眼压、再次外伤后襻折断、黄斑水肿、人工晶状体襻扭曲,光学面倾斜、视网膜脱离、眼内炎等并发症.结论 玻璃体切除术后无晶状体眼二期人工晶状体缝线固定,术中应注意维持眼压,选择适合缝线固定的人工晶状体,可减少术中、术后并发症.     

玻璃体切除术后无晶状体二期人工晶状体缝线固定术

目的探讨玻璃体切除术后无晶状体眼经巩膜睫状沟二期人工晶状体固定术的手术方法及技巧。方法对81例（81眼）玻璃体切除术后无玻璃体、无晶状体眼施行在前房灌注下后房多类型人工晶状体巩膜睫状沟缝线固定术，术后随访3月～9年，观察临床效果及术中术后并发症。结果81例术中一次固定成功，术后裸眼视力均较术前提高，最佳矫正视力均达到或接近术前最佳矫正视力。术中6例少量出血，术后少数患者出现一过性低眼压、再次外伤后襻折断、黄斑水肿、人工晶状体襻扭曲，光学面倾斜、视网膜脱离、眼内炎等并发症。结论玻璃体切除术后无晶状体眼二期人工晶状体缝线固定，术中应注意维持眼压，选择适合缝线固定的人工晶状体，可减少术中、术后并发症。     

复杂眼外伤玻璃体切除术后低眼压的临床观察

0引言严重眼外伤玻璃体切除术后低眼压是一个相当棘手的问题,其原因复杂,治疗效果不甚满意,严重者可造成眼球萎缩,视力丧失。我们总结了31例眼外伤玻璃体切除术后低眼压的原因及治疗结果,现报告如下。1临床资料我院2005-06/2006-09对31例31眼外伤玻璃体切除术后低眼压中,男27眼,女4眼,随访3～15mo。31眼均为常规玻璃体切除术,其中无虹膜无晶状体7眼(待行Ⅱ期虹膜型人工晶状体植入),同时行人工晶状体植入5眼,无晶状体4眼,硅油充填7眼。我们对外伤眼玻璃体切除术后低眼压的原因进行统计(表1),所有患者均行B超检查,倒像镜详细眼病检查,必要时行UBM及OCT检查。6例视网膜脱离患者发生     

眼外伤晶状体玻璃体切除术后二期IOL植入术

目的 探讨复杂性眼外伤玻璃体切除术后无晶状体眼二期人工晶状体植入术临床疗效，评估手术的可行性及安全性。方法 手术31例(31眼)，术后随访3～20月，观察视力、散光度、眼压及并发症：结果 30眼术后裸眼视力均达到或接近术前矫正视力：后房型人工晶状体睫状沟植入7眼中视力≥0．5者占28．57％，后房型人工晶状体透巩膜睫状沟缝线固定术18眼中视力≥0.5者占22．22％，虹膜型人工晶状体植入术6眼中视力≥0．5者占33．33％：1眼视力下降。结论 复杂性眼外伤行玻璃体切除术后二期人工晶状体植入，经过术前病例的选择，术中采用眼内灌注，适宜的人工晶状体植入，可获得较好的视力。     

晶状体切除联合巩膜缝线固定人工晶状体植入术治疗先天性晶状体半脱位的长期效果

目的：分析先天性晶状体半脱位患眼经晶状体切除+前段玻璃体切割+经巩膜缝线固定人工晶状体（IOL）植入术后长期治疗效果。方法：回顾性系列病例研究。观察2005年1月至2014年6月期间于复旦大学附属眼耳鼻喉科医院收治的先天性晶状体半脱位患者53例（77眼）,所有患眼均接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术。对术后最终随访时最佳矫正视力（BCVA）、眼压及术眼出现的主要并发症进行系统性的临床观察。数据采用配对t检验或独立样本t检验进行比较。结果：77 例接受一期晶状体切除＋前段玻璃体切割＋经巩膜缝线固定IOL植入术的先天性晶状体半脱位患眼,术后随访时间为（38±26）个月,最短12个月,最长130个月。术前BCVA（LogMAR）为0.84±0.55,术后为0.26±0.43,术后视力较术前明显改善（t=8.55,P < 0.001）。术中及术后早期并发症包括：1眼（1.3%）术中视网膜脱离,2眼（2.6%）术后早期前房积血,2眼（2.6%）术后早期切口玻璃体嵌顿。术后远期并发症包括：6 眼（7.8%）视网膜脱离,发生于术后（22±12）个月,1 眼（1％）IOL移位或脱位,发生于术后5 年。术后不良主诉包括：32 例（60.4%）术后随访时主诉干眼症状,6例（11.3%）主诉眩光现象。结论：晶状体切除前段玻璃体切割+经巩膜缝线固定IOL植入术可以显著提高先天性晶状体半脱位患者视力。远期随访中,视网膜脱离及IOL脱位是尤其需要警惕的术后并发症。     

眼外伤患者晶状体玻璃体切除术后Ⅱ期人工晶状体植入术

目的 探讨眼外伤患者晶状体玻璃体切除术后无晶状体眼Ⅱ期人工晶状体植入的手术技巧.方法 眼外伤患者晶状体玻璃体切除术后无晶状体眼42例（42眼）,采用玻璃体腔灌注维持眼压.5例于保留的晶状体前囊前植入后房型人工晶状体,37例采用外路法人工晶状体睫状沟固定术,其中3例为带虹膜隔的人工晶状体.结果 术后随访3～40个月.术后最佳矫正视力≥0.3者28例（66.67%）,术后最佳矫正视力优于或等于术前最佳矫正视力者31例（73.81%）.结论 晶状体玻璃体切除术后无晶状体眼Ⅱ期植入人工晶状体时,需玻璃体腔灌注调整眼压,最好采用外路法预置睫状沟固定缝线,用四线或两线法悬吊人工晶状体.     

青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离

目的：探讨青光眼滤过术后恶性青光眼合并睫体脉和膜脱离的特点及治疗方法。方法：对10例12只青光眼小梁切除术后恶性青光眼合并睫状体脉络膜脱离的临床资料作回顾性分析。结果：4只眼经1－3次脉络膜上腔放液联合抽玻璃体水囊联合前房注气术后，3只眼压恢复正常，1只眼前房不恢复，改行前部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术。其余8只眼均一次行前 部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术，眼压控制正常，前房形成.结论：青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离为难治并发症。脉络膜上腔放液联合抽玻璃体水囊治疗有效，前玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术可提高一次手术成功率。     

Long-term results after epilenticular intraocular lens implantation following traumatic cataract

BACKGROUND: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. Material and Methods: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by pars-plana lensectomy and vitrectomy. RESULTS: The mean follow-up was 27.4 months. Eight eyes (72.7 %) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.     

Influence of tilt and decentration of scleral-sutured intraocular lens on ocular higher-order wavefront aberration

AIM: To investigate the influence of tilt and decentration of scleral-sutured intraocular lenses (IOLs) on ocular higher-order wavefront aberrations. METHODS: In 45 eyes of 36 patients who had undergone scleral suture fixation of posterior chamber IOL, tilt and decentration of IOLs were determined by Scheimpflug videophotography, and higher-order aberration for a 4-mm pupil was measured using the Hartmann-Shack aberrometer. In another 100 eyes of 100 patients after standard cataract surgery with posterior chamber IOL implantation, ocular higher-order aberration was measured. RESULTS: In eyes with scleral-sutured IOL, the mean (SD) tilt angle and decentration were 4.43 degrees (3.02 degrees ) and 0.279 (0.162) mm, respectively. Ocular coma-like aberration in the sutured IOL group was 0.324 (0.170) microm, which was significantly greater than that of the standard cataract surgery group (0.169 (0.061) microm, p<0.001, Student's t test). No significant difference was found in ocular spherical-like aberration between the sutured IOL group (0.142 (0.065) microm) and standard surgery group (0.126 (0.033) microm; p = 0.254). In the sutured IOL group, IOL tilt significantly correlated with ocular coma-like aberration (Pearson's correlation coefficient r = 0.628, p<0.001), but no significant correlation was found between IOL tilt and ocular spherical-like aberration (r = 0.222, p = 0.175). The IOL tilt did not correlate with corneal coma-like (r = 0.289, p = 0.171) and spherical-like (r = 0.150, p = 0.356) aberrations. The IOL decentration did not correlate with any higher-order aberrations. CONCLUSION: In eyes with scleral-sutured posterior chamber IOL, tilting of the lens induces considerable amount of ocular coma-like aberrations.     

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous

AIM: To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous (PHPV). METHODS: This retrospective study included patients with cataract and PHPV treated with various strategies. Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization, posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) implantation. Posterior PHPV was treated with lensectomy, posterior vitrectomy, retinal photocoagulation, and IOL implantation or silicone oil tamponade. Visual acuity (VA), pattern visual evoked potential (P-VEP), anatomic recovery, postoperative complications, and amblyopia outcome were examined. Subjects were followed-up for 3-48mo after surgery. RESULTS: Of the 30 patients (33 eyes) with congenital cataract and PHPV included (average age, 39.30±35.47mo), 9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage (6 eyes) and two-stage (3 eyes) implantation. Postoperative complications included retinal detachment (1 eye) and recurrent anterior chamber hemorrhage (1 eye). In eyes with posterior PHPV, 6 and 11 eyes received IOLs in one- and two-stage procedures, respectively. Silicone oil was retained in 2 eyes, and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48mo of amblyopia treatment. P-VEP P100 was improved following surgery in both PHPV types. CONCLUSION: Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.     

玻璃体手术后无晶状体眼的二期人工晶状体植入术

目的评价因复杂眼外伤或视网膜脱离行玻璃体手术和晶状体切除术后,二期手术植入人工晶状体(intraocular lens,IOL)的视力效果、手术技术及其安全性 。方法对在1996年11月至1999年12月之间在我院进行该手术的32例(32只眼,每例均为单眼)行回顾性分析。二期手术中应用经睫状体平部的眼内灌注,并根据晶状体囊膜完整性选择不同类型的IOL。结果本组包括复杂眼外伤30例(眼后节异物伤15例,穿通伤伴外伤性眼内炎及玻璃体积血各6例,钝挫伤伴晶状体脱位3例);原发性视网膜脱离2例。均接受过玻璃体切割、晶状体切割,或眼内异物取出、角膜缝合等。2次手术的间隔为1～16个月,平均(6.8±3.7)个月。在25例晶状体囊环完整或存留2/3以上的眼植入后房型IOL于睫状沟内;5例作了IOL的透巩膜缝线固定术;植入前房型或带虹膜IOL各1例。5例同期放出硅油。手术后29例视力提高。主要并发症为角膜水肿及低眼压。结论在玻璃体手术后的二期手术中,应用眼内灌注和适当的IOL植入,可使经选择的无晶状体眼安全获得较好的视力恢复。(中华眼底病杂志,2001,17:96-98)     

Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy

Combined cataract removal, posterior chamber intraocular lens (PC IOL) implantation, and pars plana vitrectomy were performed in 15 diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy (PDR). Posterior chamber IOLs were placed anterior to the anterior lens capsule after pars plana lensectomy and vitrectomy in nine eyes, whereas extracapsular cataract extraction (ECCE) with PC IOL placement was performed before vitrectomy in six eyes. Panretinal laser endophotocoagulation was applied in 13 of the 15 eyes as an important part of the operative procedure. Because of inactive diabetic retinopathy or satisfactory preoperative panretinal photocoagulation, 2 of the 15 eyes did not receive laser endophotocoagulation. Visual acuity was improved in 12 eyes and was similar to preoperative vision in 3 eyes. After a minimum of 6 months and a maximum of 28 months of follow-up, the visual results are the following: 20/40 or better (4 eyes), 20/50 to 20/200 (5 eyes), 20/400 to 5/200 (5 eyes), and hand motions (1 eye). Although 5 of the 15 eyes required secondary vitreoretinal procedures, neovascular glaucoma and complications attributable to the IOL did not occur. A recurrent postoperative retinal detachment (RD) developed with subsequent hypotony and rubeosis iridis in 1 of the 15 eyes.     

Spontaneous disinsertion of a multipiece foldable acrylic intraocular lens haptic 3 and 12 months after implantation

We report 2 cases of spontaneous postoperative haptic disinsertion with the Alcon AcrySof MA60BM posterior chamber intraocular lens (PC IOL). A 14-year-old girl with a history of acute retinal necrosis and pars plana vitrectomy with lensectomy for retinal detachment repair had secondary implantation of a PC IOL in the ciliary sulcus. Three months later, the superior haptic disinserted from the optic and dislocated into the anterior chamber. In the second case, a 22-year-old man had lens aspiration and PC IOL implantation in the capsular bag. One year after surgery, the PC IOL had a similar problem, with the disinserted superior haptic remaining in the capsular bag while the optic and inferior haptic dislocated into the anterior chamber. In both patients, the PC IOLs were exchanged for rigid single-piece PC IOLs. The patients have had no further problems.     

Combined phacoemulsification,intraocular lens implantation,and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology

PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. RESULTS: In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. CONCLUSIONS: Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.     

Primary implantation of posterior chamber lenses after traumatic cataract peneration

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.