后房型人工晶体脱位或半脱位的处理

报告１２例（１２眼）行白内障囊外摘除联合后房型人工晶体（ＰＣ－ＩＯＬ）植入后发生人工晶体脱位或半脱位患者，其中瞳孔夹持７眼，“日落”综合征２眼，脱位于玻璃体、“东西”综合征和“日出”综合征合１眼。１２眼中，瞳孔夹持１眼经保守治疗成功；２眼保守治疗未复位，但病情稳定；９眼行手术治疗，其中５眼由原切口直接取出人工晶体，１眼行联合玻璃体手术取同人工晶体，３眼瞳孔夹持行手术复位。认为瞳孔夹持早期以手术复位     

重硅油填充治疗老年高度近视眼黄斑裂孔性视网膜脱离患者的疗效

目的观察高度近视眼黄斑裂孔性视网膜脱离老年患者行玻璃体切除重硅油填充术的临床疗效。方法老年高度近视眼黄斑裂孔性视网膜脱离患者50眼,屈光度均大于-6.00 D,平均-9.00 D,予睫状体平坦部三切口(20G)闭合式玻璃体切除术并填充重硅油,观察术眼术后的视网膜复位情况、黄斑裂孔封闭与否、视力变化及术后并发症情况。结果术后随访3个月,49眼(98%)视网膜复位,49眼(98%)黄斑裂孔封闭,47眼(94%)一次性手术达痊愈;治愈47眼中有43眼视力较手术前不同程度提高。观察术后并发症主要为部分患眼有高眼压、晶状体混浊、硅油乳化及硅油进入前房等情况出现。结论高龄高度近视眼黄斑裂孔性视网膜脱离采用玻璃体切除联合重硅油填充术,疗效好,并发症少。     

老年性晶状体脱位的手术治疗28例

<正>老年人群的晶状体悬韧带弹性较差,脆性也随之增加,与晶状体的连接松弛,故极易发生离断,使得老年人在外伤中,易发生晶状体脱位,角膜内皮细胞计数下降、耐受手术能力下降等〔1〕,针对老年性晶状体脱位选择不同术式来处理脱位晶状体核,将有利于患者的恢复。本文探讨老年性有核晶状体脱位的有效治疗方法。1资料与方法1.1一般资料我院2009年1月至2011年10月老年性晶状体脱位28例,其中男19例,女9例,年龄51⁷5(平均66)岁。晶状体全脱位22例,半脱位6例。受伤至就诊时间1 h     

外伤性晶状体全脱位15例手术治疗体会

外伤性状晶体脱位常规的处理方法是采用标准的经巩膜睫状体扁平部三通道玻璃体切割技术将晶状体取出，但基层医院没有玻璃体切割设备，无法采用该技术治疗。1997年12月～2006年12月，我们共收治晶状体全脱位患者15例，采用特殊的体位及手术方法治疗，11例顺利取出晶状体。现将手术体会介绍如下。     

糖尿病视网膜病变玻璃体切除术后新生血管性青光眼发生的原因分析

目的分析采用玻璃体切除术治疗糖尿病视网膜病变后发生新生血管性青光眼(NVG)的具体原因。方法选取2014年1月-2019年1月期间由该院收治的224例(232眼)糖尿病视网膜病变患者作为研究对象,对224例患者病例进行回顾性分析。将224例患者分为两组:NVG组和非NVG组,分析糖尿病视网膜病变患者经过玻璃体切除术后发生NVG的主要因素。结果非NVG组为206例214眼;NVG组为18例18眼,联合白内障手术10眼,晶状体后囊膜缺失或不完整5眼,合并高血压12眼,合并高血脂13眼,再行玻璃体切除术5眼,已行硅油移除眼或硅油填充眼2眼。比较两组患者:合并高血压、再行玻璃体切除术、及联合白内障手术情况,差异无统计学意义(χ^2高血压=0.440,P=0.506>0.05),Fisher确切概率法(P再次行PPV术=0.077);差异无统计学意义(χ^2白内障=0.192,P=0.660>0.05)。结论选择正确时机进行玻璃体手术,并恰当选取玻璃体腔填充物,可以有效降低糖尿病视网膜病变患者在玻璃体切除术后发生NVG的几率。     

玻璃体切割联合硅油填充术治疗晚期增殖性糖尿病视网膜病变疗效观察

目的评价玻璃体切割联合硅油填充治疗晚期增殖性糖尿病视网膜病变（PDR）的疗效。方法对29例33眼行玻璃体切割联合硅油填充术治疗的Ⅵ期PDR患者从视力预后、视网膜复位、手术并发症的角度进行回顾性分析。结果 33眼随访1.5~28（7.16±4.45）个月,术后最佳矫正视力较术前提高者占69.69%（23/33）,其中视力在0.1以上者占27.27%（9/33）,视力无明显变化者占15.15%（5/33）,较术前降低者占12.12%（4/33）。33眼中联合超声乳化晶状体摘除13眼,其中术后最佳矫正视力较术前提高7眼,手术前后视力无明显变化5眼,术后视力较术前降低1眼。1次手术视网膜即复位24眼（72.72%）。首要的术中并发症是医源性视网膜裂孔,术后并发症是眼内出血。结论玻璃体切割联合硅油填充术在一定程度上可提高晚期PDR患者的视力,改善其生活质量。     

玻璃体切割联合超声乳化人工晶状体植入术治疗玻璃体视网膜病变

对合并不同程度白内障的玻璃体视网膜病变患者30例（31眼）实施玻璃体切割联合晶状体超声乳化人工晶体植入术，其中气体填充15眼，硅油填充8眼。术后随访3～24个月。结果：术后24眼（77．4％）视力不同程度的提高，不变5眼，下降2眼。认为玻璃体切割联合晶状体超声乳化人工晶体植入术治疗合并不同程度白内障的玻璃体视网膜病变是安全、有效的。     

晚期增殖性糖尿病视网膜病变的临床治疗价值

目的探究晚期增殖性糖尿病视网膜病变的临床治疗价值。方法将2017年4月—2018年7月期间在该院接受诊治的43例晚期增殖性糖尿病视网膜病变患者作为研究对象,所有患者均采用玻璃体视网膜手术进行治疗,治疗结束后对患眼手术前后的视力情况、视网膜复位情况以及手术并发症情况进行调查。结果该次研究共60只患眼,术前视力低于等于0.05的患眼共51眼(85.00%),其中视力在数指及以下的患眼达37眼(61.67%),无光感患眼2眼(3.33%);术后50只患眼完成随访调查,术后视力高于0.05的患眼共21眼(42.00%),视力在0.1以上的患眼达17眼(34.00%);所有完成随访50只患眼经手术全部复位,经1次手术复位39眼(78.00%),经2次手术复位9眼(18.00%),经3次手术复位2眼(4.00%),术后复位后再次发生脱落的患眼共6眼(12.00%);手术并发症方面,术中视网膜裂孔10眼,视网膜脱落11眼,眼内出血13眼,术后高眼压11眼。结论通过手术治疗可一定程度的改善晚期增殖性糖尿病视网膜病变患者的视力状况,具有一定的临床治疗价值。     

玻璃体视网膜手术后早期高眼压的临床研究

目的 观察行玻璃体视网膜手术后发生早期高眼压患者的临床情况及治疗效果.方法 随机观察统计由同一术者行玻璃体视网膜手术的患者190例(204眼).记录术眼术前、术中、术后高眼压的发生率、发病因素、发生时间、治疗方法及治疗后的效果.结果 ①行玻璃体视网膜手术的204眼中,发生术后早期高眼压43眼,占21.1%.②术前不同疾病:PDR 81眼中,有23眼(28.4%)术后发生高眼压.原发性视网膜脱离的73眼中,15眼(20.5%)术后发生高眼压.视网膜血管疾病中玻璃体积血的26眼中,2眼(7.7%)术后发生高眼压.眼外伤的21眼中,3眼(14.3%)术后发生高眼压.术前各疾病组间术后高眼压发生率差异无统计学意义(P＞0.05).③术后发生高眼压的43眼中,发生于术后前3 d的有30眼,第4天～1 w的有9眼,1 w以后的有4眼.④眼内填充平衡盐灌注液的共51眼,3眼(5.9%)术后发生高眼压;填充C3F8气体的共71眼,16眼(22.5%)术后发生高眼压;填充硅油的共82眼,24眼(29.3%)术后发生高眼压.眼内不同填充物的各组间差异有统计学意义(P＜0.05).⑤术中行玻璃体视网膜手术联合晶状体手术共76眼,18眼(23.7%)术后发生高眼压;术中视网膜脱离的患者行玻璃体视网膜手术联合巩膜扣带术共7眼,2眼(28.6%)术后发生高眼压,差异没有统计学意义(P＞0.05).⑥发生高眼压的患者治疗后眼压降至正常范围,视力较治疗前有改善.结论 玻璃体视网膜手术后的早期高眼压是多因素共同作用的结果.术中避免导致眼压升高的原因,减少眼内填充硅油和气体,术后密切监测术眼情况,早期发现,并根据原因积极治疗可保护视功能.     

原发性视网膜色素变性合并自发性晶状体脱位2例报告

原发性视网膜色素变性（lip）是一组遗传眼病,属于光感受器细胞及色素上皮营养不良性退行性病变,其常见并发症有玻璃体异常、后囊膜下白内障、圆锥角膜、原发性青光眼、远视、高度近视及散光,而合并自发性晶状体脱位较少见。我院曾收治liP合并晶状体半脱位、急性闭角型青光眼患者2例。现报告如下。     

Comparison of two different scleral fixation techniques of posterior chamber Carlevale lens

To investigate the surgical outcomes of 2 different scleral fixation techniques of the new single-piece foldable acrylic Carlevale lens (Soleko) and to compare our results with previous reports of the literature.A retrospective, non-randomized comparative study involving 2 series of patients who underwent 2 different scleral fixation techniques of Carlevale lens was performed. Minimum follow-up of 3 months was requested for inclusion in the study. All the patients underwent a standard ophthalmologic examination including best correct visual acuity, measurement of intraocular pressure, anterior segment, and fundus examination. In the first technique (group 1), plugs were externalized through a 23 gauge sclerotomy and placed within 2 scleral pockets. In the second technique (group 2), plugs were externalized through a 25-gauge sclerotomy and covered by 2 scleral flaps. For an estimation of the refractive prediction error, the postoperative spherical equivalent of objective refraction was calculated (IOL Master 750, Carl Zeiss Meditec AG, Jena, Germany). Spectral domain optical coherence tomography (Spectralis HRA+OCT2, Heidelberg Engineering, Heidelberg, Germany) of anterior segment was used to check plugs positioning postoperatively.Twenty-three eyes in group 1 and 9 eyes in group 2 were included. Preoperative diagnosis was aphakia, dislocated posterior chamber intra ocular lens, dislocated lens, anisometropia, Uveitis-Glaucoma-Hyphema syndrome, perforating trauma with dislocated intra ocular lens, and open globe injury with dislocated intra ocular lens. Respectively, in groups 1 and 2, refractive spherical equivalent prediction error was –0,31 ± 0,74 D and –0,27 ± 0,80 D, and postoperative best-corrected visual acuity was 0,42 ± 0,31 logMAR and 0,47 ± 0,45 logMAR. In group 1, 1 eye developed cystoid macular edema, 1 eye vitreous haemorrhage, and 3 eyes showed plugs located outside the scleral pockets under the conjunctiva. Rupture of 1 of the 2 tips of the plug was observed in 1 patient of group 1 during the externalization.Carlevale lens is a scleral fixated intra ocular lens specifically designed for posterior chamber implantation that could be successfully managed without any significant difference between the 2 surgical techniques, and appears approachable for anterior and posterior segment surgeons. A 25-gauge sclerotomy should be preferred with the aim of a sutureless surgery regardless the technique employed.     

糖尿病性白内障超声乳化术的临床观察

目的探讨糖尿病性白内障行超声乳化吸出及人工晶体植入术的临床效果。方法对52例（62眼）糖尿病性白内障与同时期52例（60眼）老年性白内障行超声乳化吸出联合人工晶体植入术进行临床分析与比较。结果糖尿病性白内障术后并发症多,但经术后积极正确处理均能得到控制,视力恢复满意。结论白内障超声乳化吸出及人工晶体植入术治疗糖尿病性白内障是安全有效的。     

飞秒激光辅助白内障手术联合Toric人工晶状体植入术治疗糖尿病合并年龄相关性白内障疗效探讨

目的讨论飞秒激光辅助白内障手术联合Toric人工晶状体植入术在糖尿病合并年龄相关性白内障患者临床治疗中的应用价值。方法选取2019年4月—2020年4月在该院实施白内障手术的糖尿病合并年龄相关性白内障患者75例(86眼),按治疗方法不同分为两组。观察组在白内障术中应用Len Sx飞秒激光进行辅助治疗,参照组采用传统超声乳化白内障手术。对比两组疗效。结果与参照组相比较,观察组患者的有效超声乳化时间明显缩短,灌注液流量、超声乳化中累积释放的能量均明显下降,差异有统计学意义(P<0.05);术后1个月,观察组患者的最佳矫正视力明显高于同期参照组,差异有统计学意义(P<0.05)。结论飞秒激光辅助白内障手术联合Toric人工晶状体植入术在糖尿病合并年龄相关性白内障患者临床治疗中的应用价值较为理想,可有效减少手术并发症的发生率,能够较快地恢复良好视力水平及视觉质量。     

Age-related cataract

Cataract, opacification of the lens, is one of the commonest causes of loss of useful vision, with an estimated 16 million people worldwide affected. Several risk factors have been identified in addition to increasing age--genetic composition, exposure to ultraviolet light, and diabetes. However, no method to halt the formation of a cataractous lens has been shown to be effective. Nevertheless, advances in surgical removal of cataracts, including small-incision surgery, use of viscoelastics, and the development of intraocular lenses, have made treatment very effective and visual recovery rapid in most cases. Despite these advances, cataract continues to be a leading public-health issue that will grow in importance as the population increases and life expectancy is extended worldwide.     

80岁及以上患者老年性白內障超声乳化的疗效及安全性

目的 探讨80岁及以上患者老年性白内障超声乳化吸除及人工晶状体植入术的疗效及安全性。方法 将95例(10O只眼)80～96岁的老年性白内障患者定为高龄老年组，经角膜缘隧道切口进行超声乳化吸除及人工晶状体植入术，同期收治665例(671眼)60～79岁老年性白内障患者定为低龄老年组，使用相同的手术方法作对照。结果 高龄老年组术后第1天、1周和1个月视力达到或超过0．5者分别是30只眼、52只眼、74只眼。两组患者术后随访时间3个月～3年，随访时的视力达到0．5以上高龄老年组患者82只眼(82．0％)，低龄老年组583只眼(86．9％)。并发症主要有后囊膜破裂、玻璃体脱出、晶状体核碎块脱位、角膜水肿、后囊膜混浊。结论 高龄与低龄老年性白内障经超声乳化吸除及人工晶状体植入术均有较好的疗效及安全性。     

Risks and outcomes associated with primary intraocular lens implantation in children under 2 years old with congenital and infantile cataract: the UK and Ireland IoLunder2 cohort study

BackgroundPublic health initiatives to prevent childhood blindness have emphasised the importance of effective intervention for congenital cataract. Primary intraocular lens implantation, an important recent management innovation, has been rapidly adopted despite the absence of robust supporting evidence. The IoLunder2 study aimed to provide much needed insights into visual and adverse outcomes after surgery with and without primary intraocular lens implantation in children aged under 2 years.MethodsActive surveillance case identification of cataract surgery and systematic data collection were undertaken through the British Congenital Cataract Interest Group (comprising 173 ophthalmologists who manage affected children in the UK and Ireland), which identified more children undergoing surgery for cataract than were reported to the National Health Service statutory databases. Multivariable regression analysis was used to estimate associations of intraocular lens use with visual outcome (assessed with standard hospital-specific but harmonised protocols) and incidence of adverse events at 1 year after surgery, with adjustment for all relevant confounding factors (eg, ocular comorbidity or age at surgery), which were agreed a priori on the basis of previous research or biological plausibility. All reported odds ratios (ORs) are fully adjusted.FindingsOf 221 children, 56 of 131 with bilateral cataract and 48 of 90 with unilateral cataract had primary intraocular lens implantation. Implantation was independently associated with better visual outcome in bilateral (OR 5·4, 95% CI 1·09–26·4, p=0·04) but not unilateral disease, and with increased odds of reoperation (bilateral OR 5·5, 95% CI 2·3–13·2, p=0·002; unilateral 16·7, 4·1–68·9, p=0·009). Intraocular lens use did not reduce the odds of postoperative glaucoma, the key sight-threatening complication, after surgery in bilateral or unilateral cataract.InterpretationUse of intraocular lenses in young children, particularly in settings where follow-up is limited, should be critically reassessed. The absence of visual benefit and the lack of a previously postulated protective effect against postoperative glaucoma question the value of intraocular lens implantation in unilateral disease. The association between intraocular lens implantation and better early visual outcomes in bilateral disease needs to be balanced against the risk of reoperation and exposure to general anaesthetics during a key neurodevelopmental period.FundingUlverscroft Vision Research Group, Great Ormond Street Hospital/UCL Institute of Child Health National Institute for Health Research Biomedical Research Centre, and Moorfields Eye Hospital NHS Foundation Trust/UCL Institute of Ophthalmology National Institute for Health Research Biomedical Research Centre.     

小瞳孔行表麻下3.5mm切口手法碎核白内障手术探讨

目的探讨小瞳孔行表麻下3.5mm切口手法碎核白内障摘除联合人工晶体植入术的手术技巧、注意事项及疗效。方法 58例核硬度为Ⅱ~Ⅳ级,充分散瞳后瞳孔直径在1.0~4.0mm的患者行白内障摘除联合人工晶体植入术。其中最重要的步骤是前囊膜的处理,不同情况下处理方法不同。根据瞳孔粘连闭合程度分为:瞳孔缘粘连而无机化膜者;瞳孔区有薄机化膜者;后粘连主要集中于瞳孔区,且机化膜较厚者等。结果术后56眼(96.6%)视力较术前提高,其中视力≥0.6者19眼,0.3~0.5者30眼,0.1~0.2者7眼。术后瞳孔均呈圆形或椭圆形,直径1.5~3.5mm。术中无后囊膜破裂、悬韧带离断、前房出血;术后早期有少量轻微并发症,用药后均缓解;术后远期无明显并发症。结论对小瞳孔行表麻下3.5mm切口手法碎核白内障摘除联合人工晶体植入术的手术,术前需因人而异精心设计制定个性化的手术方案,术后均可取得良好的手术效果。     

Outcome of extracapsular cataract surgery plus posterior chamber intraocular lens insertion for age-related cataract in eastern Nepal

As age-related cataract is the leading cause of blindness in Nepal, much more attention should be given to improving surgical outcomes.The aim of our study was to determine the effectiveness and risks of extracapsular cataract surgery (ECCE) for age-related cataract in a tertiary hospital of eastern Nepal. ECCE with posterior chamber intraocular lens (PC IOL) insertion on 797 eyes (754 patients) revealed improved visual acuity in 97.9%. In 595 (74.6%) the best corrected visual acuity was 6/18 or better, and 167 (20.9%) had 6/24 to 6/60 with negligible operative/postoperative complications.Thus it is concluded that ECCE with PC IOL could be performed safely and effectively even in developing countries where people are unaware that surgery is available and of the good surgical outcome.     

605例老年人白内障临床分析

目的了解老年人白内障术后并发症的发生情况及探讨其处理原则。方法回顾性分析６０５例老年人白内障８７７只眼手术及人工晶体植入的临床资料。结果人工晶体一期植入成功率９６．０％。术后眼部并发症发生率３２．８％，以后囊膜混浊（２０２眼）、高眼压（２５眼）及前房出血（２１眼）为主。术后矫正视力＜０．１者共５１眼（５．１％），均为合并青光眼晚期视神经损害、黄斑变性及糖尿病性眼底病变患者。结论老年人做眼内手术更应注意角膜内皮保护及并存症的术前、术后处理。     

Comparison of vitrectomy alone and combined vitrectomy, phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

There have been concerns that there may be an increased incidence of iris neovascularization (NV) following lens removal in patients with proliferative diabetic retinopathy (PDR). In this study, we retrospectively compared vitrectomy alone and vitrectomy combined with phacoemulsification (phacovitrectomy) and intraocular lens implantation regarding both complications and results. Fifty-three eyes for vitrectomy group and 31 eyes for phacovitrectomy group were included. Postoperative iris and angle NV were found in eight (15.1%) eyes in the first group and no (0%) eyes in the second. The incidence was significantly lower (p < 0.05) in the phacovitrectomy group. The final vision gain of one or more lines was found in 17 (32.1%) and 21 (67.7%) eyes, respectively. There was significantly better vision improvement in the phacovitrectomy group. We consider the combined procedure to be useful as an alternative surgical treatment for patients with PDR and cataract formation.