Surgery of Marfan-associated and idiopathic lens subluxations

Background: The ideal and safe surgical method for Marfan-associated or idiopathic lens subluxations is still a matter of debate. Patients and methods: Between 1990 and 1995, 23 eyes were operated for lens subluxations, mainly because of decreased visual acuity, but also because of conservatively uncontrolled secondary glaucoma. Marfan patients were 27.0 (5–62) years old at surgery; patients with idiopathic lens subluxations were 38.5 (11–63) years old. Surgical procedure depended on patient age and anatomical conditions. Results: All patients achieved an increase in visual acuity. Amblyopia existed in six patients. All problems due to glaucoma were controlled postoperatively. Our greatest concern was rhegmatogenous retinal detachment. It occurred in only one eye of a non-Marfan patient. Conclusion: The prognosis for lens surgery in Marfan-associated and idiopathic lens subluxations is good. The implantation of a posterior chamber lens provides a good and secure means of optical rehabilitation. Our preferred primary transscleral suture technique guarantees high security and stability of position. Previously feared surgical risks have been reduced by modern surgical procedures.      

晶状体脱位的手术治疗

晶状体脱位根据脱位程度和并发症严重程度选择不同的治疗方法。向后脱入玻璃体可以配戴隐形眼镜保守治疗;若并发青光眼、持续性葡萄膜炎或角膜损伤,需进行紧急手术干预。脱位范围＜180°可选择超声乳化晶状体摘除联合人工晶状体植入术;如悬韧带受损严重可联合张力环植入术。人工晶状体固定方式分为缝线固定和无缝线固定,可固定于虹膜或巩膜,也可通过囊袋支持装置固定。 （国际眼科纵览,2021, 45：523-529）     

晶状体脱位的手术治疗

目的分析晶状体脱位的手术时机及手术方法。方法35例(35眼)晶状体脱位进行玻璃体切除及晶状体切除或晶状体摘出其中33例采用三通道睫状体平坦部人口，2例采用角膜缘人口法。结果术后视力提高30眼，视力不变4眼，视力下降1眼。手术并发症：前房及玻璃体积血5例，锯齿缘断离1例。结论玻璃体切除及晶状体切除或品状体摘出是品状体脱位有效的治疗方法。     

外伤性晶状体不全脱位的手术治疗

目的：探讨外伤性白内障合并晶状体不全脱位的手术时机、手术方法和效果。方法：对52例52眼晶状体不全脱位患者,根据病情采用相应的手术方法,对术后疗效进行回顾性研究。结果：随访观察6mo,视力均有提高,无并发症发生。结论：虽然外伤性白内障伴晶状体不全脱位的患者眼部条件差,但根据病情综合分析,采取相应的联合手术,可取得满意的治疗效果。     

外伤性晶状体脱位的手术治疗

目的 探讨外伤性晶状体脱位的手术治疗原则。方法 总结1998～2002年间收治的53例外伤性晶状体脱位的资料回顾性统计分析，取出品状体的方法及手术效果。结果 均成功地摘出品状体，58．50％患眼视力不同程度的提高，继发性青光眼、眼压得到控制，合并视网膜脱离者术后视网膜复位。结论 晶状体脱位的治疗方法根据脱位晶状体位置、是否存在并发症而定。采用联合手术方法治疗外伤性晶状体脱位及所致的并发症效果较好。     

晶状体半脱位白内障手术治疗的临床探讨

目的 探讨治疗晶状体悬韧带断离致白内障晶状体半脱位的有效方法。方法 分别对27例(27只跟)白内障晶状体半脱位患者行超声乳化白内障吸除人工晶状体植入术(21只眼)和小切口现代囊外白内障摘除人工晶状体植入术(6只眼),术后观察和总结患者的视力变化情况、人工晶状体的位置及手术并发症。结果 全部患者术后视力均有提高,术后3d视力为0.1～0．4者6只眼,0．5～0．8者21只眼;术后1个月视力为0．1～0．4者7只眼,0．5～0．8者20只眼。正常瞳孔下1只眼可见人工晶状体上缘,散瞳后2只眼人工晶状体偏位,均无复视症状发生;术中和术后均无严重并发症发生。结论 只要具有熟练的手术技巧,选择最佳手术方式,手术治疗晶状体半脱位白内障可取得良好效果。     

Retropupillary iris claw lens versus Gore-Tex assisted scleral fixated intraocular lens in children with large lens subluxations

Purpose:To compare the functional outcome of retropupillary iris claw lenses (RPIC-IOL) and scleral fixated intraocular lenses (SFIOL) in children with large lens subluxations.Methods:Sixty eyes of patients between 6 and 18 years of age having >7 clock hour lens subluxation were included and equally divided into group A (RPIC-IOL implantation) and group B (Gore-Tex sutured SFIOL implantation). Cases with anterior and posterior segment abnormalities, trauma and glaucoma were excluded. Primary outcome was improvement in best-corrected visual acuity (BCVA) at 1.5 years. Secondary outcomes were assessment of intraocular lens (IOL) tilt, mean change in astigmatism at 1.5 years, and median operating time. All surgeries were performed by the same surgeon.Results:The mean improvement in BCVA in group A was 0.28 ± 0.41 logMAR and group B was 0.44 ± 0.45 logMAR (P = 0.3). Significant IOL tilt was seen in 4 eyes in group A (13.33%) and 5 eyes in group B (16.66%) (P = 0.120). Mean change in astigmatism was 4.38 ± 5.9D in group A and 4.91 ± 4.4D in group B (P = 0.299). The median operating time was 40 min in group A and 90 min in group B (P < 0.001). No significant posterior segment complications were seen in either technique.Conclusion:Both procedures had comparable visual outcomes. RPIC-IOL implantation was relatively quick and comparatively easier; it may be preferred in cases with high risk of retinal detachment.     

晶状体脱位继发青光眼的手术治疗

目的 探讨手术治疗晶状体脱位继发青光眼的疗效.方法 对36例(38只眼)晶状体脱位继发青光眼患者施行联合手术,采用不同术式去除脱位晶状体并植入人工晶状体.结果 术后矫正视力提高34只眼,不变2只眼,下降2只眼,有效率89.47%;术后1周眼压缓解率为92.1%.结论 针对晶状体脱位继发青光眼患者具体情况选择合适的手术时机以及手术方式可以有效控制眼压并提高术后视力.     

Surgical treatment of lens dislocation in children--analysis of complications

PURPOSE: To present the surgical complications in eyes with ectopia lentis in children. Material and methods: 116 eyes of 65 children were operatively treated for lens dislocation. Pars plana lensectomy, vitrectomy and IOL implantation with scleral fixation were done in all eyes. Time of observation ranged between 1-6 years (mean 3.4). RESULTS: There were no serious intraoperative complication (mainly hemorrhage to anterior and posterior chamber). Postoperative complications included retinal detachement in 3 (2.6%) eyes and endophthalmitis in 1 (0.8%) eye, were the major complications observed in all patients. Complications related to scleral fixation included exposure of the scleral fixation suture in 8 (6.9%) eyes, lens decentration in 9 (7.8%) eyes, pupil capture in 3 (2.6%). CONCLUSIONS: The surgical procedure is useful and safe in the management of subluxated lenses in children.     

晶状体脱位的手术治疗和分析

目的　探讨晶状体脱位的手术方法。方法　对 115例 (119眼 )晶状体脱位 ,根据脱位的程度、位置 ,采用不同的手术方法 ,观察术后的并发症及疗效并进行分析。结果　术后视力均有不同程度的提高 ,眼压控制 ,术后并发症以囊内摘出较多见。结论　根据不同的晶状体脱位采用合理的手术方法是获得最佳疗效的关键。     

晶状体全脱位所致青光眼的手术治疗

目的评价玻璃体切除联合晶状体超声粉碎及小梁切除术治疗晶状体全脱位所致青光眼的疗效。方法共收治9例（9眼）外伤性晶状体全脱位所致青光眼病例，这砦病例都具有以下共同特点：晶状体全脱位于玻璃体腔；瞳孔散大，前房消失；眼压在40mmHg以上（1mmHg=0．133kPa），而且药物治疗无效。术中先用玻璃体切除器切除玻璃体后，再用晶状体超声粉碎器将晶状体吸引至玻璃体腔中央行晶状体超声粉碎术，术毕作常规小粱切除术。结果术后视力提高到眼前数指者2眼，0．1～0．3者3眼，0．3以上者4眼，术后眼压15—20mmHg者5眼，2l，24mmHg者4眼，经滴降眼压滴眼液后，眼压降至20mmHg以下。结论玻璃体切除联合品状体超声粉碎及小梁切除术治疗晶状休全脱位所致青光眼，具有眼内组织损伤小，术后散光轻及并发症少等优点。     

外伤性晶状体脱位继发青光眼的手术治疗

目的:探讨外伤性晶状体脱位继发青光眼的手术方法及临床疗效。方法:晶状体脱位继发青光眼的32例病例中,22例行晶状体玻璃体切除术,7例行晶状体玻璃体切除联合小梁切除术,3例行晶状体玻璃体切除联合青光眼引流阀植入术。随诊1～12mo,观察眼压、视力及并发症等。结果:患者32例术前平均眼压45.67±14.36mmHg,随访末次眼压16.63±7.94mmHg,其中9～21mmHg者27例,21～24mmHg者4例,>24mmHg者1例。术后矫正视力提高者24例,不变者7例,下降者1例。结论:根据患者具体情况,选择适当的手术方式,是治疗外伤性晶状体脱位继发青光眼安全、有效的措施。     

瞳孔夹持合并后发性白内障的手术治疗

目的研究瞳孔夹持合并后发性白内障的手术效果。方法12例(12眼)中10例瞳孔区人工晶状体光学面完全夹持,2例人工晶状体光学面大部分夹持。手术将后囊中心切开、前部玻璃体切除,人工晶状体光学面嵌入后囊后。结果术后近期人工晶状体前出现絮状渗出者3例,低眼压者2例。随访半年以上所有病例视力均有不同程度提高,术前视力均在0.1以下,术后矫正视力在0.3~0.8之间。人工晶状体体部无倾斜。位置稳定,无其它并发症发生。结论后囊切开、前部玻璃体切除及后囊后人工晶状体嵌顿术可以解除人工晶状体对虹膜的刺激,术后葡萄膜炎症反应较轻,视力提高。     

挫伤性晶状体脱位合并青光眼的手术治疗

目的 探讨挫伤性晶状体脱位合并继发性青光眼的临床特点与治疗效果。方法 对21例因眼挫伤致晶状体脱位继发青光眼手术治疗临床观察。结果 术后眼压控制在21mmHg以下者19例，有效率达90．47％。视力恢复在0．05以上者由术前的5例(23．81％)增到11例(52．38％)，术后盲目者由术前的76．19％降至47．62％。结论 手术治疗能有效的控制眼压并提高视力降低盲目率。