Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

Effect of four different intraocular lenses on posterior capsule opacification

AIM: To evaluate the impact of 4 different intraocular lenses(IOLs) on posterior capsule opacification(PCO) by comparing the neodymium: yttrium-aluminum-garnet(Nd:YAG) laser capsulotomy rates.METHODS: This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies.· RESULTS: An Nd:YAG laser posterior capsulotomy was performed in 153(3.07%) of the 4970 eyes. The mean follow-up time was 84 mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1-and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared.· CONCLUSION: In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design(1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate.

Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients

·AIM: To compare posterior capsule opacification(PCO)degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens(IOL)(570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL(Sensar AR40 e,AMO) in diabetic patients.· METHODS: Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification(EPCO) 2000 image-analysis software at 1, 6, 12, and 24 mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared.·RESULTS: There was not any statistically significant difference in PCO scores between Rayner C-flex 570 C group and Sensar AR40 e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24 mo follow-up.·CONCLUSION: For diabetic patients, Rayner 570 C Cflex and Sensar AR40 e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Corneal astigmatism correction with scleral flaps in trans-scleral suture-fixed posterior chamber lens implantation:a preliminary clinical observation

AIM: To study the impact of scleral flap position, under which the posterior chamber intraocular lenses (PC-IOL) were sulcus-fixed by trans-scleral suture, on cornea astigmatism. METHODS: Twenty-six aphakic or cataract eyes were comprised in this prospective noncomparative case series study. Eleven eyes had traumatic cataract removed without sufficient capsular support, 3 had blunt trauma with subluxated traumatic cataract, 8 had undergone vitreoretinal surgery and 4 had congenital cataract removed. The average age was 54 years (range 21-74 years), with 17 men and 7 women. The foldable PC-IOL was fixed in sulcus by trans-scleral suture. The incision for IOL implantation was made 1mm posterior to limbus along the steepest meridian of cornea, while scleral flaps to bury the knots of trans-scleral suture were made along the flattest meridian. All the surgeries were performed by a single doctor (Ma L), and the follow up was at least 13 months (range 13-28 months). The preoperative, 3 months and 1 year postoperative corneal curvature along the steepest and flattest cornea meridian and overall cornea astigmatism were compared. RESULTS: The curvature along the steepest meridian changed from 44.25 +/- 2.22D preoperatively to 44.08 +/- 2.16D at 3 months postoperatively, and 43.65 +/- 5.23D at 1 year postoperatively (P>0.05); the curvature along the flattest meridian changed from 41.24 +/- 2.21D preoperatively to 43.15 +/- 3.94D at 3 months postoperatively, and 42.85 +/- 5.17D at 1 year postoperatively (P<0.05); and the surgery induced astigmatism (SIA) on cornea was calculated by vector analysis, which was 2.42 +/- 2.13D at 3 months postoperatively, and 2.18 +/- 3.42D at 1 year postoperatively, the difference was statistically significant (P<0.05). CONCLUSION: The scleral flap made along the flattest meridian, under which the posterior chamber intraocular lenses (PCIOL) were sulcus-fixed by trans-scleral suture, can steepen the cornea in varying degrees, thus reducing preexisting corneal astigmatism.

Trocar opening: silicone oil removal with phacoemulsification and intraocular lens implantation

AIM: To evaluate the efficacy and safety of a modified technique [trocar opening(TO)] for silicone oil removal(SOR) in combination with phacoemulsification and intraocular lens(IOL) implantation.METHODS: A total of 60 eyes of 60 patients with cataract and silicone oil-filled eyes were enrolled in this study. The patients were divided into two groups: the patients in the control group underwent 23-gauge pars plana active SOR surgery with phacoemulsification and IOL implantation, while the patients in the TO group underwent TO methods during surgery. Best corrected visual acuity(BCVA), surgery time, intraocular pressure, and operative complications were observed 6 mo after surgery.RESULTS: There was no significant difference between the two groups in terms of age, gender, preoperative, intraocular pressure, or time of silicone oil stay. Prior to surgery, the mean BCVA for the control and TO groups was 1.34±0.44 and 1.36±0.42. At 6 mo following surgery, the mean BCVA improved to 0.74±0.36 and 0.77±0.32, respectively(P<0.001). There was no significant difference between the two groups. The mean SOR time was 6.9±2.3 min and 4.8±1.2 min in the control and TO groups(P=0.008). The total operation time was 28.2±8.5 min and 24.6±6.4 min, respectively(P=0.035). Posterior capsule rupture occurred in four eyes of control and none of TO group(P<0.01). Late recurrent retinal detachment occurred in one eye in the control group(2 mo after surgery) and in one eye in the TO group(4 mo after surgery). CONCLUSION: TO is a simple, effective, time-saving, and safe method for SOR combined with phacoemulsification and IOL implantation.

AB083.Intraocular lens biocompatibility:a novel,objective approach

Background:Understanding factors that contribute to posterior capsular opacification(PCO)development is a significant public concern as treatment can lead to complications.In order to prevent PCO,a better understanding of intraocular lens(IOL)characteristics,including design and material,and patient interaction is required.Herein,we performed a retrospective multivariable analysis to determine which factors(IOL and patient based)were least likely to result in PCO.Methods:One hundred eighty post-mortem eyes with implanted IOLs were collected from the Minnesota Eye Bank,along with clinical history,including date of cataract surgery and IOL model number.The capsular bag(CB)with the IOL implant was removed from all eyes to obtain digital images.PCO outcome was quantified on CB images using an objective,automated custom image analyzer(Medical Parachute Automated Detector Opacification Software).The software measured intensity and area of the opacification within the IOL optic edge,intra-optic edge(IOE=intensity/area),and in Soemmering’s ring(SR=intensity/area).Epidemiologic analysis assessed which IOL characteristics and patient-related factors correlated with PCO.IOL factors included material,edge design,lens filter,company,IOL model,decentration and time from cataract surgery to death.Patient factors included sex,age and diabetes,among others.Results:Multivariate analyses showed non-diabetic patients had less PCO(P=0.05).Individuals 50-80 years old compared to 80+had lower SR PCO(P=0.04).Non-blue light filter IOLs had lower SR and IOE PCO compared to filter IOLs(P=0.03,0.001).Square and frosted optic edge design had lower SR and IOE PCO rates compared to OptiEdge and round optic edge design(P=0.002,0.02).The IOL model that had the least PCO was the ZA9003 model,but this was only significant for SR and not IOE PCO(P=0.04).Adjusting for patient-factors,IOL lens model was no longer a confounding factor for PCO.Patients with an IOL implanted for<7 years had lower SR PCO,whereas lower IOE PCO was only seen in implants<4 years old(P=0.0001,0.04).Conclusions:In order to generate a lens that does not develop PCO,it is critical to understand the IOL-and patient-related factors that lead to PCO development.Based on our data,the most susceptible patients are elderly and diabetic,and it may be preferable to implant a square and frosted edge lens without blue-light filtering in this cohort.

人工晶状体作为药物递送系统的研究进展

人工晶状体(intraocular lenses)作为一种给药装置,具有在白内障术后替代常规滴眼液等治疗的应用前景,从而可能用于术后眼部感染、眼内炎症和后囊浑浊等的预防和治疗。载药人工晶状体(drug-loaded intraocular lenses)的优点是能确保药物的持续输送,不受患者依从性的影响,且手术植入后无需采取任何其他措施。本综述总结了以人工晶状体作为药物递送系统的研究进展,分析了载药人工晶状体的载药策略、负载药物类型、以及临床研究现状,有助于更深入理解该领域的最新进展,并为一些眼部疾病如眼内炎和白内障术后并发症等的治疗提供策略和依据。

冲洗针头液流抛光技术治疗白内障超声乳化术后PCO的疗效观察

目的 观察冲洗针头液流抛光与传统注吸头机械抛光对白内障超声乳化术后晶状体后囊膜混浊(PCO)的疗效和安全性。方法 纳入2020年6月—2020年12月咸阳市第一人民医院眼科诊断为年龄相关性白内障患者100例(200只眼),随机分为对照组和观察组,最终纳入对照组47例(94只眼),观察组48例(96只眼)。2组患者均行常规白内障超声乳化吸除术后,对照组术中采用注吸头进行后囊膜抛光,再植入人工晶体。观察组植入人工晶体并在囊袋内旋转360°,采用冲洗针头液流抛光后囊膜。记录术前、术后1 d、7 d、1年的最佳矫正视力(BCVA),术后1年PCO评分和后囊膜激光切开率。结果 (1)BCVA:观察组术后各时间点BCVA均较术前改善,差异均有统计学意义(t1 d=36.759、t7 d=40.101、t1年=47.629,均P=0.000);对照组术后各时间点BCVA均较术前改善,差异均有统计学意义(t1 d=52.429、t7 d=56.829、t1年=62.487,均P=0.000)。2组间术后1 d和7 d BCVA比较,差异均无统计学意义(P>0.05),观察组术后1年BCVA优于对照组,差异有统计学意义(t=2.709,P=0.007)。(2)PCO评分:观察组PCO分值为(0.13±0.07)分,低于对照组的(0.25±0.15)分,差异有统计学意义(t=7.090,P=0.000)。(3)后囊激光切开率:2组后囊激光切开率比较,差异无统计学意义(P>0.05)。2组术中和术后均未发生并发症。结论 冲洗针头液流抛光技术可预防白内障术后PCO的发生,操作简单、经济实用、安全可靠,可降低白内障术后PCO发生率,具有一定推广价值。

人工晶状体夹持技术在白内障联合玻璃体视网膜手术后囊膜破裂中的应用

玻璃体视网膜疾病并发白内障患者行玻璃体切割术联合超声乳化白内障摘除术,即前后节联合手术,是高效的手术方式,而后囊膜破裂(posterior capsular rupture,PCR)是超声乳化白内障摘除术的术中并发症之一,能够及时、有效地处理PCR,稳定、安全地植入人工晶状体(intraocular lens,IOL),对于顺利完成后段手术,减少术后并发症十分重要。本文将对前后段联合手术中后囊膜破裂的术中处理、以及IOL光学部夹持固定法植入IOL的手术技术要点进行总结。

Non-viral gene coating modified IOL delivering PDGFR-αshRNA interferes with the fibrogenic process to prevent posterior capsular opacification

Posterior capsule opacification(PCO),the most common complication after cataract surgery,is caused by the proliferation,migration and epithelial-mesenchymal transition(EMT)of residual lens epithelial cells in the capsule bag.Although the surface modification and drug loading of intraocular lens(IOLs)have been effective in preventing PCO to some extent,the intraocular safety of anti-proliferative drug application is still a major limitation in clinical application.In this study,we used non-viral gene delivery systems in combination with layer-by-layer(LBL)self-assembly technology,and the modified IOL could effectively prevent the development of PCO by interfering with the EMT process mediated by the platelet-derived growth factor receptor-α(PDGFR-α).Herein,the gene fragments were wrapped by electrostatic conjugation using polyethyleneimine-graft-poly(ethylene glycol)to form gene complexes.Gene complexes were characterized by dynamic light scattering,transmission electron microscopy(TEM)and agarose gel electrophoresis,and evaluated for storage and serum stability.The layer assembly behavior of the IOL surface,changes in optical properties and the release behavior of the gene complexes were characterized using quartz crystal microbalance,UV-vis,contact angle and TEM.In vitro experiments showed that the IOL coating has good bio-compatibility and can achieve the corresponding transfection effect,and the released gene complexes exhibited excellent cell internalization and lysosomal escape behaviors,as well as effective inhibition of PDGFR-αexpression and its mediated EMT process.The early PCO prevention effect and bio-compatibility evaluation of the modified IOL in vivo were evaluated by implantation into animal eyes.This study provides a new strategy for the development of surface modifications of small nucleic acid drugs and non-toxic EMT interference therapies for PCO.

囊袋张力环对高度近视患者白内障术后疗效影响的荟萃分析

目的基于荟萃分析评价术中联合植入囊袋张力环(CTR)对高度近视患者白内障手术疗效的影响。方法全面检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普等7个数据库,检索时间范围为1990年1月1日至2022年3月20日,收集CTR在高度近视患者白内障手术中应用的随机对照试验和非随机对照试验。2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评价,采用Review Manager 5.4进行荟萃分析。结果最终纳入8篇文献,共涉及1292例(1630眼)患者。荟萃分析结果显示,在改善患者最佳矫正视力(BCVA)方面,术后1个月、3个月、6个月CTR联合人工晶状体(IOL)植入组患者的BCVA均显著优于IOL植入组(均为P<0.05);在IOL倾斜角、偏心量方面,术后6个月时CTR联合IOL植入组患者较IOL植入组均显著降低(均为P<0.05);晶状体前囊口面积方面,术后3个月时CTR联合IOL植入组患者大于IOL植入组(P=0.048);术后PCO发生率方面,CTR联合IOL植入组患者显著低于IOL植入组(P<0.00001);术后3个月时CTR联合IOL植入组患者角膜内皮细胞密度与IOL植入组相比差异无统计学意义(P=0.48)。结论对于高度近视患者,在白内障术中植入CTR有助于患者获得更好的BCVA、减少术后IOL倾斜与偏心、降低PCO以及囊袋皱缩的发生。

不同生物材料人工晶体与后囊混浊相互关系的meta分析

目的 :对不同生物材料人工晶体与后囊混浊的关系进行系统评价。方法 :通过计算机和手工检索 ,获得 1990年 1月至 2 0 0 2年 12月发表的人工晶体与后囊混浊的相关文献。按照入选标准选取合适的随机对照临床研究进行 m eta分析。对纳入文献的相关资料进行提取摘录 ,并根据 meta分析的统计学方法进行合并分析。以相对危险度 (RR)判定对后囊混浊的预防效果 ,并根据异质性分析选择固定效应模型或随机效应模型计算总的治疗效应。 结果 :有 9篇论文的 10 2 1例白内障患者纳入 m eta分析。聚丙烯酸、硅凝胶、水凝胶与聚甲基丙烯酸甲酯 (polymethylmethacrylate,PMMA)的 RR分别为 0 .12 (95 % CI[0 .0 5 ,0 .2 6 ])、0 .4 4 (95 % CI[0 .30 ,0 .6 4 ])、1.96 (95 % CI[0 .6 5 ,5 .91]) ,硅凝胶、水凝胶与聚丙烯酸的 RR分别为 1.34(95 %CI[0 .6 2 ,2 .89])、3.89(95 % CI[1.70 ,8.90 ]) ,水凝胶与硅凝胶的 RR为 4 .73(95 % CI[1.5 7,14 .32 ])。结论 :硅凝胶和聚丙烯酸人工晶体具有良好的囊膜组织相容性、很强的粘连趋势、良好的光学设计 。

人工晶状体的设计对后囊膜混浊的影响

后囊膜混浊是白内障囊外摘除术后最主要的并发症之一。后囊膜混浊的发生是多因素参与的结果,手术方式的改进、人工晶状体的改良、术后炎症反应的控制都可以减少后囊膜混浊的发生。本文就人工晶状体的设计对后囊膜混浊的影响作一综述。

Nd:YAG激光治疗人工晶状体后发障的临床探讨

目的 探讨Nd :YAG激光治疗人工晶状体植入术后后囊浑浊的疗效和方法。方法 应用Nd :YAG激光仪 ,对 3 7例 ( 3 9眼 )后房型人工晶状体植入术后后囊浑浊行后囊切开术。结果 激光截囊前后视力有显著差异 (P <0 0 1) ,而激光截囊后与后发障发生前视力无差异 (P >0 0 5 )。儿童组复发率达 5 8 3 %。人工晶状体损伤 9例 ( 10眼 )占 2 5 6% ,但不影响视力。结论 选择最佳激光能量与后退距离 ,可产生最低人工晶状体损伤和最高后囊爆破 ,从而大幅度减少并发症。

后发性白内障的研究进展

后发性白内障(posterior capsule opacification,PCO)是由于白内障术后残留的晶状体上皮细胞增殖、迁移、化生而形成的,严重影响术后视力的恢复,是现代白内障囊外摘出术后主要的并发症之一。因此,如何防治PCO一直是眼科研究的热点之一。本文就临床及实验室药物防治PCO两方面进行综述。

后发性白内障防治的研究

现代白内障手术已成为治疗白内障的确实可靠的方法,但手术后的后囊混浊的高发率严重地影响了患者术后长期拥有良好的视力。因此,如何防治后发性白内障,一直是眼科医生关注的焦点。本文就目前的研究现状作一综述。

人工晶状体囊袋夹持固定法在后囊破裂中的应用

目的观察囊袋夹持固定法植入人工晶状体治疗白内障手术中晶状体后囊破裂的效果。方法通过完全居中的、大小适宜的前囊连续环行撕囊,利用囊袋夹持固定法(人工晶状体光学部完全植入囊袋内而2个袢位于前囊前表面)使人工晶状体迭到稳定的囊袋固定,以处理白内障手术中发生的后囊破裂。分别对接受囊袋夹持法的13眼老年性白内障患者、4眼外伤性白内障患者、3眼先天性白内障患者进行随访观察。结果术后随访平均视力大于等于0.5的患者17眼(85%),夹持于囊袋的人工晶状体能够保持良好、稳定的居中位置,后囊破裂的大小稳定,所有术眼均未出现人工晶状体相关的葡萄膜反应。结论在后囊破裂较大,无法将人工晶状体植入囊袋内时,可以利用前囊撕囊孔进行囊袋内夹持固定法固定人工晶状体。良好的前囊连续环行撕囊不仅可以保证手术的安全性,而且是囊袋夹持法固定人工晶状体的必要条件。

后发性白内障的防治新进展

后囊膜混浊(posterior capsule opacification,PCO)又称后发性白内障是现代白内障囊外摘出或超声乳化吸除联合人工晶状体植入术后最常见的晚期并发症,如何防治后发性白内障一直是眼科学者关注的焦点,并不断在此领域取得新的进展。拟对近年来后发性白内障防治中手术方式的改进、人工晶状体自身特性的影响、囊袋张力环的应用、密封囊灌洗技术的开展和基因治疗等方面的研究进展和发展趋势加以综述。

应用新一代AS-OCT观察高度近视白内障术后人工晶状体与后囊膜贴附的研究

目的:利用新一代眼前节OCT(AS-OCT)定量检测和分析高度近视长眼轴患者白内障术后人工晶状体与后囊膜贴附情况。方法:采用回顾性病例观察研究设计。纳入2019-10/12于深圳市眼科医院接受晶状体囊外摘除,经超声乳化吸出联合人工晶状体植入术的白内障患者60例60眼,根据眼轴长度(axial length,AL)分为两组:高度近视长眼轴组(AL>26.00mm)和正常眼轴组(AL:22.00~24.5mm)各30例30眼。分别于术后1、7、30d用AS-OCT测量两组白内障术后人工晶状体光学面与后囊膜之间围成的空间平面面积(AREAP)和未贴附残留后囊膜的边长。采用Kaplan-Meier生存分析法分析两组术后不同时间点的人工晶状体与后囊膜贴附率,Log-Rank检验法比较贴附率。结果:正常眼轴组术后1、7、30d的AREAP分别为0.81±0.37、0.33±0.19、0.14±0.06mm2,未贴附后囊膜边长分别为7.93±3.03、3.95±2.44、1.26±0.08mm,人工晶状体光学面与后囊膜贴附率分别为33%、67%、83%;高度近视长眼轴组术后1、7、30d的AREAP分别为3.29±0.43、1.54±0.66、0.62±0.28mm2,未贴附后囊膜的边长分别为13.56±4.02、8.13±3.90、3.78±2.51mm,人工晶状体光学面与后囊膜贴附率分别为0、7%、23%。两组术后各时间点AREAP、未贴附后囊膜边长、人工晶状体光学面与后囊膜贴附率均有差异(P<0.05)。结论:高度近视长眼轴患者白内障术后人工晶状体与后囊膜之间残留更大的空间,贴附需要更长时间。新一代AS-OCT可以清晰地显示晶状体后囊膜的影像,有望成为研究晶状体相关疾病的有效检查设备。