成人后极性白内障超声乳化吸出术疗效观察

目的探讨成人后极性白内障超声乳化摘出联合人工晶状体植入术的手术技巧、术中术后并发症的处理方法及手术效果。方法对我院临床确诊的17例(26眼)成人后极性白内障患者行超声乳化摘出联合人工晶状体植入,观察术中后囊膜情况、术后视力、后囊膜混浊和并发症的发生情况。同时与我院同期普通白内障超声乳化术中后囊膜破裂发生率进行对比。结果 17例26眼成人后极性白内障患者术中可见后囊膜完整透明者12眼,后囊膜完整伴不同程度混浊者7眼,后囊膜中央局限性缺损者2眼,但术中未发生玻璃体溢出。术中后囊膜破裂5眼,发生率为19.23%。同期普通白内障超声乳化术中后囊破裂发生率为1.81%,二者相比差异有统计学意义(P<0.05)。成人术后视力均较术前有不同程度提高。术后9眼角膜轻度水肿,经治疗后1周内恢复透明,3眼前房纤维素样渗出,经治疗后痊愈。结论后极性白内障虽具有特殊性,后囊膜破裂发生率明显高于普通白内障。只要给予足够重视,行超声乳化摘出联合人工晶状体植入术是较好的手术方法。     

软壳技术在危险眼超声乳化中的临床应用

目的:探索危险眼白内障手术的视力提高与有效控制并发症发生的技术与方法。方法:47例独眼危险眼(合并其他致盲因素)的白内障患者。行超声乳化术中引入软壳技术,保护角膜,提供良好视野,以减少及减轻手术损伤,防止并发症发生,并观察比较手术前后视力的改善情况及并发症发生情况;分析软壳技术在上述环节中的作用与价值。结果:使用该技术后,不仅视力大为提高(P<0.01),而且与未使用该技术的超声乳化手术视力改善比较具有统计学差异(P<0.05),本组病例几乎没有并发症发生。结论:该技术的使用大大提高了视力,减少了并发症,该技术的使用对手术效果,控制手术质量有重要意义。     

后极性白内障的超声乳化手术治疗

目的:探讨后极性白内障的临床特点及超声乳化手术的手术技巧。方法:连续收集2009-10/2011-03在本院诊治的后极性白内障患者12例17眼,所有病例均接受详尽的病史采集,以及视力、裂隙灯显微镜检查,B型超声波及间接检眼镜检查,所有患眼在球周浸润麻醉下行超声乳化白内障摘除及折叠人工晶状体植入,总结手术技巧、术前术后视力及术中并发症。结果:所有患眼均植入折叠人工晶状体。术中11眼后囊膜完整透明,2眼后囊膜破裂,其中1眼发生在分核时,另1眼发生在核周壳吸除时;4眼术中发现后囊膜混浊需后期行YAG激光后囊膜切开术。15眼折叠人工晶状体植入囊袋内,2眼植入睫状沟。术后1mo最佳矫正视力≥0.5者16眼,0.4者1眼。结论:超声乳化联合折叠型人工晶状体植入是治疗后极性白内障安全有效的方法。应用连续环形撕囊、轻柔谨慎的水分层而不做水分离,低能量、低吸力、低流量的超声乳化参数设置,手动吸除核周壳和皮质等手术技巧,可以减少手术并发症。     

玻璃体切割术后白内障超声乳化吸出及人工晶状体植入术

目的　探讨玻璃体切割术后的白内障手术特点、术式选择及手术方法技巧。方法　对 30例 33眼玻璃体切割术后的白内障患者行超声乳化吸出及人工晶状体植入术 ,观察术后视力、眼底情况的变化及手术并发症。结果　 33眼中 ,术后视力≥ 0 .5者 3眼 ,0 .3～ 0 .4者 12眼 ,0 .1～ 0 .2 5者 11眼 ,数指～ 0 .1者 7眼 ;并发症 :玻璃体出血 1眼 ,后囊膜破裂 1眼 ,脉络膜脱离 1眼 ,视网膜脱离复发 1眼。结论　玻璃体切割术后的白内障 ,选择超声乳化摘出及人工晶状体植入术 ,是一种比较安全的方法。     

高度轴性近视眼白内障小切口非超声乳化及人工晶状体植入术

目的:观察高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术的临床疗效,分析影响术后视力的因素。方法:对我院158例186眼眼轴≥26mm的高度近视眼白内障行小切口非超声乳化及人工晶状体植入术,术后随访6mo,观察术后视力和术中术后并发症情况。结果:术后3mo裸眼视力≥0.5者145眼(78%),0.1~0.4者33眼(18%),<0.1者8眼(4%);并发症有后囊膜破裂11眼,角膜内皮水肿19眼,视网膜脱离3眼,后囊膜不同程度混浊13眼。结论:高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术疗效良好,是一种安全性较高的理想的手术方法。     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

糖尿病患者白内障超声乳化吸出人工晶状体植入疗效分析

目的:探讨糖尿病患者白内障超声乳化吸出(phaco)及人工晶状体(IOL)植入的手术效果。方法:对46例(56眼)糖尿病患者行白内障超声乳化吸出人工晶状体植入术,观察术中、术后并发症及术后视力的情况。结果:术后视力≥0.5者46眼(82.1%),术后并发症:角膜内皮水肿、前房纤维渗出、人工晶状体表面色素沉着、后囊膜混浊,与同期非糖尿病患者比较差异无显著性。结论:对于糖尿病患者只要术前血糖控制在相对稳定的水平上进行白内障超声乳化吸出及人工晶状体植入术疗效是安全有效的,术后并发症少,视力恢复好。     

超声乳化白内障吸除术中后囊膜破裂的处理体会

目的:为探讨超声乳化白内障手术并发症。方法:对2008-01/2011-01开展超声乳化白内障手术500眼进行回顾性临床分析。结果:年龄相关性白内障共500例500眼,全部采用超声乳化白内障手术,手术发生后囊膜破裂45眼(9.0%),其中前250眼后囊膜破裂33眼(6.6%),后250眼后囊膜破裂12眼(2.4%)。结论:超声乳化白内障手术中后囊膜破裂可根据术中不同情况,采用不同的手术处理,选择不同人工晶状体植入方式可以达到很好的处理效果。     

白内障超声乳化术的并发症及处理

目的:探讨白内障超声乳化人工晶状体植入术的并发症及处理措施。方法:对4350眼老年性、并发性和外伤性白内障患者进行巩膜隧道切口超声乳化联合人工晶状体植入术,总结分析术中及术后手术并发症发生情况及处理措施。术后随访3～24mo。结果:顺利完成超声乳化术4345眼(99.89%),5眼术中改为ECCE+IOL术。术后3mo时,矫正视力≥0.5者4050眼(93.10%),0.1～0.4者290眼(6.67%),<0.1者10眼(0.23%)。术中并发症:后囊膜破裂26眼(0.60%),撕囊失败16眼(0.37%)。术后并发症:角膜水肿350眼(8.05%),晶状体后囊膜混浊116眼(2.67%),一过性高眼压31眼,眼内炎3眼。术中、术后并发症,经对症处理后有不同程度改善。结论:白内障超声乳化人工晶状体植入术具有创伤小、恢复快、术后视力满意等优点,但是了解手术并发症原因,减少和避免并发症的发生以及采取措施正确处理并发症是手术成功的保障。术中并发症主要是后囊膜破裂,术后并发症主要是角膜水肿和后发性白内障。并发症的发生与术者的经验、技术熟练程度密切相关。     

高度近视白内障摘除及人工晶体植入术临床分析

目的观察高度近视白内障超声乳化及人工晶体植入术的临床效果及手术安全性。方法对眼轴长25.3933.88mm的26例(31眼)(其中眼轴≤30mm者19眼,眼轴>30mm者12眼)行白内障超声乳化或现代囊外摘除术,同时植入折叠人工晶体或PMMA硬性人工晶体。平均年龄65.16岁(3279岁),平均眼轴29.38mm,平均人工晶体屈光度 3.9D(-6.0D-- 13.5D)。观察术中、术后并发症及手术效果。结果1眼白内障Ⅴ级核因前、后囊膜钙化,术中发生后囊膜破裂,其余均无术中、术后并发症。术后第一天裸眼视力:2眼因黄斑视网膜大片萎缩斑,术后视力与术前相同,其余病例术后视力均不同程度提高。无一发生视网膜脱离。结论高度近视白内障摘除及人工晶体术,能够有效提高患者视力,是安全有效的方法。     

Posterior polar cataract: minimizing risk of posterior capsule rupture

PURPOSE: To study a preferred technique of phacoemulsification in eyes with posterior polar cataract and report its outcome. METHODS: Under topical anesthesia, phacoemulsification was carried out after hydrodelination in 23 cases (38 eyes) with ages ranging from 19 to 65 years (mean=33.5 years). Hydrodissection was not performed. RESULTS: Mean duration of follow-up was 9.5 months. None of the eyes developed posterior capsule rupture, but seven eyes (18.4%) revealed posterior capsule plaque postoperatively, which needed neodymium : YAG laser capsulotomy. Mean visual acuity improved significantly after surgery (P=0.0001, paired t-test); In all, 34 eyes achieved a best-corrected visual acuity of 20/40 or more (89.4%). However, the postoperative visual acuity was less than 20/25 in 11 eyes (28.9%). The causes of the low acuity were amblyopia in eight eyes (21.0%) and macular degeneration due to retinitis pigmentosa in two others (5.2%). CONCLUSION: Phacoemulsification is an effective and safe method to treat posterior polar cataract with gentle hydrodelination 'hydrodissection free phacoemulsification technique'. This is especially true when great attention is paid to the 'floppy' posterior capsule. Although previous amblyopia might interfere with excellent surgical outcome in patients with a unilateral or highly asymmetric bilateral cataract, visual acuity improved significantly in most cases.     

后极性白内障超声乳化术的临床观察

目的探讨后极性白内障超声乳化术的手术技巧及效果。方法回顾性分析鄂尔多斯市中心医院2015年12月至2018年12月后极性白内障行超声乳化术15例(21眼)的临床资料。探讨对后囊下浑浊的处理方式和维持前房稳定的技巧,观察术中、术后并发症及术后视力。术后随访6个月。结果所有患者均植入折叠人工晶状体,15眼后囊完整,6眼后囊破裂;15眼中环形撕囊者5眼、剪除浑浊者6眼、二期行YAG激光后囊切开者4眼。术后随访6个月,最佳矫正视力>0.5者12眼,0.1~0.5者9眼。结论后极性白内障患者行超声乳化术中选择合理处理后囊、维持前房稳定,可有效提高手术成功率,获得较好的术后视力。     

超声乳化术治疗葡萄膜炎并发白内障的疗效观察

目的:评价超声乳化术治疗葡萄膜炎并发白内障的治疗效果。方法:回顾分析40例48眼葡萄膜炎并发性白内障患者超声乳化手术治疗前后的情况。结果:术后2wk有44眼(92%)视力较术前提高;术中5眼(10%)计划外后囊破裂,6眼(13%)发生虹膜出血;术后第2d角膜水肿38眼(79%),前房渗出43眼(90%),5眼(10%)术后眼压增高,12眼(25%)瞳孔欠圆。结论:超声乳化术治疗葡萄膜炎并发白内障相对较复杂,并发症较多,但整体效果良好。     

Outcomes of surgery for posterior polar cataract

PURPOSE: To report the preferred technique and the outcomes of surgery for posterior polar cataract. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Medical records of 28 eyes of 20 consecutive patients with posterior polar cataract who had cataract surgery were reviewed. The surgical techniques used, intraoperative complications, preoperative and postoperative visual acuities, and the causes of impaired visual acuity after surgery were examined. RESULTS: Of the 28 eyes, 25 (89.3%) with a small to medium posterior polar opacity had standard phacoemulsification or aspiration surgery. Two eyes (7.1%) with a large opacity and soft lens nucleus had pars plana lensectomy, and 1 eye (3.6%) with a large opacity and hard nucleus had intracapsular cataract extraction. Among the eyes having phacoemulsification or aspiration surgery, posterior capsule rupture occurred in 2 (7.1%). The mean visual acuity improved significantly after surgery (P <.0001); however, the postoperative visual acuity was worse than 20/20 in 7 eyes (25.0%). The cause of the low acuity was amblyopia in 4 eyes (14.3%), impaired foveal function after retinal detachment in 2 eyes (7.1%), and macular degeneration in 1 eye (3.6%). CONCLUSION: Posterior polar cataracts can be safely extracted if the appropriate surgical technique is selected. Visual acuity improved significantly in most cases, although some patients with a unilateral cataract had previously developed amblyopia.     

后囊缺陷性白内障超声乳化术的临床观察

目的:探讨后囊缺陷性白内障手术方式,比较超声乳化技术和囊外摘除技术的安全性和效果。方法:回顾性分析后囊缺陷性白内障患者33例40眼的手术效果,囊外摘除手术组(ECCE组)10例12眼、超声乳化手术组(Phaco组)23例28眼。结果:后囊破裂+玻璃体脱出:ECCE组为3眼(25%),Phaco组为3眼(11%),两组比较有显著性差异(P<0.05)。术后矫正视力提高≥2行者:ECCE组为10眼(83%),Phaco组为26眼(93%),两组比较有显著性差异(P<0.05)。结论:对于后囊缺陷性白内障患者,超声乳化手术的安全性和效果优于囊外手术。超声乳化手术中,始终保持前房的稳定,不行水分离、在低流量、低负压、低能量下进行,正确处理后极部皮质与后囊膜的关系是手术成功的关键。     

Phacoemulsification in posterior polar cataract: does size of lens opacity affect surgical outcome?

Background: To study the effect of size of the posterior polar opacity on surgical and visual outcome of phacoemulsification in posterior polar cataract. Setting: Post Graduate Institute of Medical Education and Research, Chandigarh, India. Methods: Consecutive patients with posterior polar cataract who underwent phacoemulsification were analysed for intraoperative complications and postoperative outcome. The continuous curvilinear capsulorhexis size was kept approximately 5.5 mm, and hydrodelineation was done instead of hydrodissection. Results: There were 58 eyes of 51 patients who underwent phacoemulsification for posterior polar cataract. The mean follow‐up time was 15.4 months (range 12–40 months). Twenty‐three eyes had size of polar opacities 4 mm or more in diameter whereas 35 eyes had less than 4 mm. Posterior capsule rupture occurred in nine eyes (15.51%). In eyes with polar opacities 4 mm or more, seven (30.43%) had posterior capsule rupture whereas in eyes with less than 4 mm size, only two (5.71%) had posterior capsule rupture. Capsular bag placement of intraocular lens (IOL) was achieved in 50 eyes and sulcus‐sulcus in eight eyes. Three‐piece hydrophobic acrylic IOL was implanted in 47 eyes and all polymethylmethacrylate IOL in 11 eyes. Postoperatively best‐corrected visual acuity of 6/12 or better was achieved in 55 eyes (94.8%) and three eyes achieved 6/24 or less. Conclusion: Phacoemulsification in eyes with larger size of polar opacity has significant risk of posterior capsule rupture.     

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.