Artisan虹膜夹持型人工晶状体植入治疗马凡综合征晶状体半脱位

目的探讨Artisan 虹膜夹持型人工晶状体（IOL）植入术治疗马凡综合征晶状体半脱位的有效性和安全性。方法 回顾性病例研究。2007年12月至2011年7月在广东省人民医院眼科确诊的马凡综合征晶状体半脱位患者16例（25眼）,行连续环形撕囊后,完成晶状体吸除、晶状体囊膜切除、前段玻璃体切割、Artisan IOL前房虹膜夹持固定和虹膜周边切除术。比较手术前后裸眼视力（UCVA）、最佳矫正视力（BCVA）、眼压、角膜内皮细胞计数,记录术后虹膜夹持型IOL位置、角膜内皮细胞丢失率,术中、术后并发症情况。随访时间6个月。采用非参数检验（Wilcoxon 检验）对手术前后UCVA和BCVA进行比较。结果 术后6个月UCVA和BCVA均较术前明显提高,术前和术后6个月UCVA（logMAR）分别为1.05±0.26和0.46±0.29,两者相比差异有统计学意义（Z=-4.530,P<0.01）。术前和术后6个月BCVA（logMAR）分别为0.68±0.32和0.27±0.22,两者相比差异具有统计学意义（Z=-2.208,P<0.01）。术后所有患眼虹膜夹持型IOL位置居中,单眼复视症状消失。术后2眼出现一过性高眼压,1眼出现脉络膜脱离,1眼出现视网膜脱离,未发生IOL移位、角膜失代偿等严重并发症。术后6个月平均角膜内皮细胞丢失率为5.6%。结论 Artisan虹膜夹持型IOL植入治疗晶状体严重脱位可提高视力,消除单眼复视且安全有效。     

玻璃体切割术后睫状沟缝线固定人工晶状体植入术疗效探讨

目的：探讨玻璃体切割术后睫状沟缝线固定人工晶状体（IOL）植入术的效果、并发症及防治措施。方法：用灌注头维持眼压。用睫状体沟缝线固定法植入后房型IOL21例（21眼）。结果：术后矫正视力0.1者1例（占5%）,0.2-0.4者4例（占19%）,0.5-1.0者16例（占76%）。术中并发症：脉络膜脱离2例,玻璃体出血3例。术后并发症：IOL偏斜1例,视网膜脱离3例。结论：该术式可获得较理想的视力恢复效果。玻璃体切割术后一期植入者并发症较少。术中维持眼压可减少并发症。     

先天性晶状体脱位31例的手术治疗观察

目的：通过对先天性晶状体脱位行手术治疗的患者进行临床分析及手术方式选择、手术后效果分析,探讨先天性晶状体脱位患者的手术方式的选择及术中术后并发症的防治。
　　方法：回顾性分析我院自2010-01-01/2015-01-01的5 a间先天性晶状体脱位行手术治疗的患者共31例57眼,进行临床分析及手术方式选择、手术后效果、并发症分析。
　　结果：先天性晶状体脱位临床最常见的类型为单纯性晶状体半脱位和Marfan综合征晶状体半脱位。57眼中1眼为Marchesani综合征继发性青光眼导致视神经萎缩,术后视力无改善,其余56眼(98%)术后视力均较术前有不同程度提高。手术方式：晶状体超声乳化摘除+人工晶状体植入术3眼(5%);晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术8眼(14%),其中1眼行囊袋张力环巩膜缝合固定;经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术39眼(68%),其中2眼联合小梁切除术,未植入人工晶状体;晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术5眼(9%);经睫状体平坦部切口晶状体切除联合玻璃体切除术+硅油注入术2眼(4%)。
　　结论：先天性晶状体脱位经过手术治疗大多数患者均可取得较为满意的术后效果。对于晶状体半脱位范围<90°者,可单纯行晶状体超声乳化摘除+人工晶状体植入术;晶状体半脱位范围90°~180°者,行晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术;晶状体半脱位范围>180°者,经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术,术后效果优于晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术;根据患者晶状体脱位程度,尽量选择切口较小的微创的手术方式是手术取得成功的关键。     

无线结巩膜缝线固定后房型人工晶状体的临床应用

目的：评价无线结巩膜固定缝线后房型人工晶状体(intraocular lens,IOL)手术的安全性和稳定性。

方法：回顾性分析2009-01/2014-10在沈阳何氏眼科医院因晶状体脱位、白内障术中后囊膜破裂、玻璃体切割术后无晶状体眼的患者35例39眼的临床资料,手术采用无结扎线结巩膜层间埋线方法固定后房型IOL,术中不制作巩膜瓣。观察和分析术前及术后最佳矫正视力(best-corrected visual acuity,BCVA)、眼压、术后IOL稳定性和相关并发症等。

结果：术后3mo,0.1≤BCVA<0.3者9眼(23.1%),0.3≤BCVA<0.5者20眼(51.3%),0.5≤BCVA<0.8者6眼(15.4%),0.8≤BCVA<1.0者4眼(10.3%); 术中2眼出现虹膜根部出血,术后2wk内完全吸收; 术后3眼出现一过性眼压升高,3眼出现角膜水肿,对症用药后均在1wk内恢复正常。术后无1眼出现角膜内皮失代偿、睫状体脱离、视网膜脱离及眼内炎等并发症。术后平均随访时间24(3～60)mo,未见IOL倾斜/脱位、缝线暴露、巩膜固定缝线处变薄和/或溶解等并发症的发生。

结论：无线结巩膜缝线固定后房型IOL是无晶状体伴无充分囊膜支撑眼植入后房型IOL安全有效的治疗方法,减少了术后缝线相关并发症的发生。     

晶状体囊袋张力环脱位的手术治疗

目的 探讨晶状体囊袋张力环（CTR）完全脱位的治疗效果。 设计 回顾性病例系列。 研究对象 2006年3月至2010年2月北京同仁医院治疗的CTR完全脱位患者11例（11眼）。方法 所有患者先行玻璃体切除联合脱位CTR取出,再根据视网膜和视盘情况以及取出的CTR和人工晶状体（IOL）状况,分别选择IOL或CTR缝线固定7眼,虹膜固定型IOL植入1眼,硅油填充3眼。术后随访5~32个月。主要指标 视力、眼压、IOL居中性及并发症。 结果 11眼均顺利取出脱位的CTR和IOL,8眼同时植入IOL,3眼行硅油填充。最后一次随访时最佳矫正视力0.3~0.6者4眼,0.1~0.2者4眼,低于0.1者2眼,1例患者不合作。其中5眼达到或超过CTR脱位前的最好矫正视力。术后高眼压5眼,眼压25~51 mm Hg。4眼经药物治疗,1眼经巩膜睫状体光凝后眼压恢复正常。前房积血1眼,经药物治疗后吸收。未出现IOL或IOL-CTR复合体脱位或偏位现象。结论 玻璃体切除联合脱位CTR取出并睫状沟缝线固定IOL或CTR可以有效地治疗CTR完全脱位。（眼科, 2012, 21: 82-85）     

玻璃体切除联合后房人工晶状体缝线固定术治疗晶状体脱位

目的探讨玻璃体切除联合后房型人工晶状体缝线固定术治疗晶状体脱位的临床效果。方法各种原因所致的晶状体脱位30例（全脱位11眼,不全脱位22眼,共33眼）,进行玻璃体切除及晶状体切除或晶状体摘出。其中7眼采用三通道睫状体平坦部入口,26眼采用角膜缘入口。30例（33眼）均同时行Ⅰ期睫状沟缝线固定后房人工晶状体植入术。术后随访时间2~24个月,平均9个月,观察术后视力及并发症等。结果术后视力提高31眼,视力不变2眼,术后均未发现严重并发症。结论玻璃体切除联合后房型人工晶状体缝线固定术是治疗晶状体脱位最为安全和有效的治疗方法。熟练的手术技巧和术中稳定的眼内压是手术成功的保证。     

玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位

目的探讨玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位的临床疗效。方法选取晶状体脱入玻璃体内的患者30例(30眼),其中眼球钝挫伤引起的晶状体全脱位25眼,针拨白内障术后晶状体全脱位2眼,白内障摘出术中晶状体核脱入玻璃体内3眼。根据脱入玻璃体内的晶状体核硬度不同采用不同的手术方法,行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术,必要时行硅油填充。术后随访0.5～1a,观察视力、眼压及并发症等情况。结果本组患者行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术19例(19眼);玻璃体切割联合超声乳化及人工晶状体悬吊植入术10例(10眼);玻璃体切割联合超声乳化及硅油充填术1例(1眼)。术后视力:0.1～0.3者16眼,0.3～0.5者9眼,0.5以上者5眼;术后继发青光眼3眼,经降眼压治疗后恢复正常范围。术后随访期间未发现视网膜脱离、玻璃体积血、人工晶状体偏位等并发症。结论玻璃体切割联合超声乳化及人工晶状体悬吊植入术治疗晶状体脱位是一种安全、有效的方法。     

巩膜缝线固定后房型人工晶状体术后低眼压的处理

目的探讨复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除术的患者,Ⅱ期巩膜缝线固定人工晶状体植入术后低眼压的发生原因及其处理方法。方法回顾性分析于2003年6月至2004年12月作者早期开展Ⅱ期巩膜缝线固定人工晶状体植入术共34例(34眼),其中3眼是虹膜隔型人工晶状体,6眼同期行虹膜修补瞳孔成形术。结果本组34眼中有8眼(23.53%)术后发生低眼压,其中4眼为一过性低眼压,术后5~7 d前房黏弹剂再注入后,眼压逐渐恢复正常;另4眼伴有脉络膜脱离,其中3眼经皮质类固醇治疗后眼压恢复,1眼术后10 d行脉络膜上腔放液及注气术,眼压恢复。术后视力提高者32眼(94.1%)。随访6~18个月,人工晶状体均无明显倾斜偏位,视网膜脱离无复发。结论对于复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除的患者,Ⅱ期巩膜缝线固定人工晶状体植入,术后低眼压是较易发生的并发症,经治疗可以恢复。     

小切口可折叠四襻巩膜固定型人工晶状体植入术治疗马凡综合征晶状体半脱位

目的　评价小切口可折叠四襻巩膜固定型人工晶状体 （intraocular lens，IOL）植入术治疗马凡综合征晶状体半脱位患者的临床效果及安全性。方法　回顾性病例分析。12例（21眼）马凡综合征伴透明晶状体半脱位患者行晶状体摘出联合IOL巩膜固定植入联合前段玻璃体切割术。其中，IOL巩膜固定采用了小切口（2.85 mm）、可折叠、一片式、四襻固定型美国博士伦Akreos IOL。观察患者术前、术后的裸眼视力 （uncorrected visual acuity，UCVA）、最佳矫正视力（best corrected visual acuity，BCVA）、眼压、术中及术后并发症。结果　所有患者手术均顺利，术中、术后未见并发症。术后第1天2眼出现一过性眼压升高。术前UCVA 为0.01~0.30 （0.13±0.11），BCVA为0.01~0.60 （0.29±0.17）。随访33~73（57.75±13.78）个月，术后最后一次随访，UCVA为0.10~0.80（0.41±0.22），BCVA为 0.20~1.00（0.70±0.27），两者与术前相比，差异均有统计学意义（均为P<0.05）。IOL位置居中，瞳孔圆。结论　小切口可折叠四襻固定型Akreos IOL悬吊术治疗马凡综合征晶状体半脱位有良好的临床效果及安全性。     

晶状体超声粉碎联合玻璃体切除术治疗外伤性晶状体脱位

目的:探讨应用晶状体超声粉碎联合玻璃体切除术治疗外伤性晶状体脱位的疗效。方法:回顾性分析晶状体超声粉碎联合玻璃体切除手术治疗外伤性晶状体脱位16例16眼;其中术前高眼压6例,玻璃体积血10例,视网膜脱离1例。常规扁平部行标准三通道玻璃体手术切口,切除前部、中轴部及脱位晶状体周围玻璃体,使晶状体游离,超声针头吸引晶状体至中央部玻璃体腔内进行超声粉碎。术中检查视网膜并做相应处理。其中8例视网膜情况良好,I期行后房人工晶状体缝线固定。结果:全部病例均完全将脱位的晶状体粉碎吸除,随访3mo无视网膜脱离发生。16例术后眼压正常,术后1wk眼压12~20mmH g,视力较术前改善,术后1wk视力0.2以上者8例。结论:对于外伤性晶状体脱位,晶状体超声粉碎联合玻璃体切除术是安全有效的手术方法,对视网膜无损伤者可行I期人工晶状体缝线固定,使患眼获取最好的视力。     

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Purpose:To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens.Methods:In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted.Results:Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases.Conclusion:Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.     

The estimation of functional results after surgical treatment for ectopia lentis in children

PURPOSE: To review the visual outcome of planned pars plana lensectomy and vitrectomy with posterior chamber intraocular lens implantation for ectopia lentis in children. MATERIAL AND METHODS: Between 1997-2002, 116 eyes were operated because of lens subluxation, mainly because of decreased visual acuity (<0.4). Lens subluxation was associated with homocystinuria in 4 patients (8 eyes), Marfan's syndrome in 30 (54 eyes), congenital simple ectopia lentis in 16 (31 eyes), post trauma in 6 (6 eyes), and congenital ectopia lentis and pupillae in 9 (17 eyes). Time of observation ranged between 1 to 6 years (mean 3.4). RESULTS: After surgery, we achieved best-corrected visual acuity improvement in 89%. Unsatisfactory visual results were due to amblyopia (9 eyes), complications of retinal detachement surgery (3 eyes), uveitis (2 eyes), glaucoma (1 eye). CONCLUSIONS: Pars plana lensectomy, vitrectomy and scleral-fixated IOL implantation give quick and good functional results. To achieve these results, visual rehabilitation and amblyopia treatment is necessary.     

Scleral-fixated intraocular lens implantation in unilateral aphakic children

OBJECTIVE: To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. INTERVENTION: Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. RESULTS: Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). CONCLUSION: Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.     

超声乳化摘除半脱位晶状体治疗小梁切除术后的浅前房

目的 通过超声乳化摘除晶状体治疗晶状体半脱位引起的小梁切除术后浅前房或慢性眼压升高。方法 回顾性病例研究。小梁切除术后经超声生物显微镜（UBM）确诊为晶状体半脱位患者7例（8眼）,行超声乳化晶状体摘除联合囊袋张力环和人工晶状体植入术,比较手术前后的视力、眼压、前房深度,并采用配对t检验进行分析。结果 小梁切除术与超声乳化摘除半脱位晶状体间隔（67.4±34.9）d（30~125 d）。术前裸眼视力（logMAR）为0.61±0.36,术后1个月裸眼视力为0.16±0.09（t=3.629,P<0.01）。术前矫正视力为0.38±0.32,术后1个月为-0.01±0.10（t=3.629,P<0.01）。术前眼压为（25.45±6.92）mmHg,术后1个月为（15.28+0.76）mmHg（t=4.234,P<0.01）,眼压不用药物均得到控制。术前中央前房深度为（1.20±0.36）mm,术后1个月为（2.57±0.38）mm（t=-11.075,P<0.01）。术中发现晶状体脱位范围为（99.38±46.02）°（90°~180°）。结论 超声乳化晶状体联合囊袋张力环和人工晶状体植入,可以有效缓解晶状体半脱位所致浅前房或慢性眼压升高。     

Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia

AIM: To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens (IOL) implantation for surgical management of microspherophakia. METHODS: A retrospective case series include 10 microspherophakic patients (15 eyes) who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation. The primary outcomes involved visual acuity, intraocular pressure (IOP). Secondary outcomes were spherical equivalent (SE), anterior chamber depth (ACD), corneal endothelial cell density and postoperative complications. RESULTS: After a postoperative follow-up of 17.60±15.44mo, improved visual outcomes can be observed. The uncorrected distance visual acuity (UCVA) logMAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively (P=0.001), and best corrected visual acuity (BCVA) logMAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively (P=0.003). Moreover, the SE decreased from -9.58±7.47D preoperatively to -0.65±2.21 D postoperatively (P<0.001). In terms of safety profile, the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively (P=0.044), and the previously elevated IOP of three eyes decreased to the normal range. The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively (P=0.017). The density of corneal endothelial cells did not change significantly after surgery (P=0.140). The posterior chamber IOLs were well centered and no severe complications were found. CONCLUSION: Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity, which can be regarded as a relative safe method for the surgical management of microspherophakia.     

Scleral- fixated intraocular lens implantation in microspherophakia

Background:

In microspherophakia, abnormal laxity of the lenticular zonules leads to development of a spherical lens and possible subluxation. We evaluated long-term results of lens removal with scleral-fixated intraocular lens (SFIOL) implantation in microspherophakia.

Materials and Methods:

Case series. SF IOLs were implanted in four consecutive patients with bilateral microspherophakia (eight eyes [three with pupillary block and secondary glaucoma who underwent immediate surgery and five with only subluxation who underwent elective surgery]). Post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and lens position were evaluated periodically from day 1 to 18 months.

Results:

All patients were females (mean age 28 ± 7.03 years). In group 1 eyes (three eyes that presented with pupillary block), the mean BCVA improved from 0.008 decimals (preoperative) to 0.50 decimals (final post-operative visit); in group 2 eyes (the other five eyes), the mean BCVA improved from 0.12 ± 0.21 decimals to 0.73 ± 0.14 decimals. The preoperative mean IOP (54.53 ± 7.33 mmHg) in group 1 eyes was significantly (P = 0.03) higher than that (16 ± 4.30 mm Hg) in group 2 eyes. At final post-operative visit, the mean IOP (11.67 ± 2.88 mmHg) in group 1 eyes was not significantly different from that in group 2 eyes (13.0 ± 3.08 mmHg). All SFIOLs were well- centred at the final visit. None of the patients encountered any peroperative or postoperative complications.

Conclusions:

SFIOLs may be an option for surgical management of microspherophakia.     

不同年龄Marfan综合征晶状体半脱位两种术式的疗效观察

目的 探讨两种晶状体摘除联合一期人工晶状体（IOL）悬吊术治疗不同年龄Marfan综合征晶状体半脱位的效果。设计 回顾性病例系列。研究对象 Marfan综合征先天性晶状体半脱位患者10例（18眼）。方法 ＞12岁患者3例（5眼）采用晶状体超声乳化术摘除晶状体同时行一期IOL悬吊术（乳化组）;≤12岁患者7例（13眼）采用晶状体切除联合一期IOL悬吊术,同时行前段玻璃体切除术（晶切组）。平均随访（1.40±1.02）年。主要指标 最佳矫正视力、眼压、并发症。 结果 18眼术前平均最佳矫正视力（0.29±0.20）,术后（0.51±0.24）（P=0.008）。 乳化组术前平均最佳矫正视力（0.17±0.04）,术后（0.41±0.16）（P=0.026）;晶切组术前平均最佳矫正视力（0.34±0.22）,术后（0.55±0.25）（P=0.000）。两组间比较,平均矫正视力改善无统计学差异（P=0.062）。所有患者术前等效球镜为（-2.76±14.1）D,术后为（-0.79±1.95）D。无一例出现严重并发症。结论 晶状体超声乳化与晶状体切除及前部玻璃体切除联合一期IOL悬吊术两种手术方式均能有效改善不同年龄Marfan综合征晶状体半脱位患者视力,手术方式选择与视力改善无明显关系。（眼科,2016, 25： 86-89）     

周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。     

晶状体异位继发急性闭角型青光眼术式选择及疗效观察

目的 回顾性分析晶状体异位继发急性闭角型青光眼手术方式的选择及观察其疗效.方法 取36例(41只眼)晶状体异位继发急性闭角型青光眼患者,采用超声生物显微镜观察晶状体悬韧带离断范围,根据晶状体脱位范围以及房角关闭范围,分别选择小梁切除术,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术和(或)小梁切除联合超声乳化白内障吸除术,术后随访1个月,观察手术治疗效果.结果 随访期间,患者术后矫正视力提高,眼压降低:术后1d,17只眼(41.46%)矫正视力＞0.5;30只眼(73.17%)眼压在21mmHg以内;术后7d,24只眼(58.54%)矫正视力＞0.5;35只眼(85.36%)眼压在21mmHg以内;术后30d,27只眼(65.85%)矫正视力＞0.5;所有患者眼压在21mmHg以内.结论 在晶状体异位继发急性闭角型青光眼患者中,晶状体脱位范围在1~2个象限者,超声乳化白内障吸除联合囊袋张力环及人工晶状体植入手术是一种安全有效的术式;脱位范围大于2个象限者,选择白内障囊外摘除手术;房角关闭大于1/2的患者,选择小梁切除联合白内障手术.     

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

PURPOSE: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.