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.

Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Long-term follow-up of cataract surgery in eyes filled with silicone oil

AIM:To evaluate the refractive and long-term outcome of eyes filled with silicone oil(SO)undergoing phacoemulsification cataract surgery(PCS).METHODS:This retrospective study evaluated patients with SO tamponade who were scheduled for PCS.RESULTS:Subjects(n=26)were followed for 29.5±13.9 mo after cataract surgery.The median spherical equivalent refraction(SER)was+5.3 D[interquartile range(IQR)+2.9 to+6.7]before PCS,and+3.4 D(IQR+2.0 to+4.4)after PCS.Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes(57.7%).In 13 eyes assessment of refraction after SO-removal was possible,and showed a myopic shift of-4.6 D(IQR-2.9 to-7.3)in the SER.After SO removal,5 of the 13 eyes(38.5%)were within±1.0 D of the target refraction,while 9 out of the 13 eyes(69.2%)were within±2.0 D.CONCLUSION:In our study,the refraction after PCS for eyes filled with SO manifested low predictability,as did the myopic shift following SO removal.A significant percentage of the eyes that underwent SO administration required a long-term tamponade.

Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade

BACKGROUND At present,silicone oil has been widely used in vitrectomy to deal with complex fundus diseases.Usually,cataract extraction is combined with vitrectomy.However,reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens(IOL)are still an urgent problem.AIM To evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation(PCP)in eyes with silicone oil tamponade.METHODS This single-center retrospective analysis included 70 patients(73 eyes)who underwent vitrectomy and silicone oil tamponade combined with cataract surgery(stage I)between January 2015 and July 2019.All patients underwent selective reoperation for silicone oil extraction and IOL implantation(stage II)more than 3 mo after stage I.These patients were divided into three groups according to the different lens capsule preservation methods:28 patients(31 eyes)in a whole capsule preserved(WCP)group,17(17 eyes)in a capsule absent(CA)group,and 25(25 eyes)in a peripheral capsule preserved(PCP)group.Intraocular pressure(IOP),best-corrected visual acuity,surgery time,and other complications were recorded at each time point(1 d,1 wk,and 1 mo after stages I and II).RESULTS The IOP values were 14.9±8.2 mmHg in the WCP group,20.3±13.0 mmHg in the CA group,and 14.2±9.7 mmHg in the PCP group(P<0.05)at 1 mo after stage I operation.Five eyes had IOP higher than 30 mmHg,and one eye in the WCP group appeared to have silicone oil entering the anterior chamber.There was no significant difference in IOP among the three groups at any other time point(P>0.05).With IOL implantation,visual acuity improved significantly compared to stage I.The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups(P<0.001).In the CA group,IOL deviation due to suture relaxation occurred in one case.There was no significant difference in the surgery time among the three groups in stage I(P=0.618).In stage II,the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group(P=0.031).CONCLUSION Preservation of the peripheral capsule in vitrectomy combined with lens removal is a better option.This method has significant advantages in reducing intraoperative and postoperative complications.

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

AIM:To investigate the clinical features,causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens(IOL)removal in the treatment of acute-onset endophthalmitis after cataract surgery(APCE).METHODS:We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018.Data on the clinical features,causative organisms,visual acuity,intraocular pressure(IOP)and complications were collected.The mean follow-up period was 25.5 mo.RESULTS:The mean age of the patients was 71.4 y.The mean time between cataract surgery and the onset of endophthalmitis was 2.0 d.Preoperative visual acuity ranged from no light perception to hand motion.After vitrectomy,the visual acuity increased in nine eyes(90%),and was unchanged in one eye(10%).A significant difference was observed between the mean preoperative(36.3±7.1 mm Hg)and postoperative IOP(14.9±4.3 mm Hg,P<0.05).Staphylococcus epidermidis was isolated in 5 eyes,S.aureus in 2 eyes,and Enterococcus in 1 eye.Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye.No retinal detachment or ocular atrophy was observed during the follow-up period.CONCLUSION:Under systemic antibiotic treatment and timely diagnosis,vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

Corneal injection track: an unusual complication of intraocular lens implantation and review

Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens(IOL) implantation by injection,allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines,improvement of IOL injection systems and further maturation of surgeons’ techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.

超声乳化折叠式人工晶体植入联合硅油取出术治疗硅油充填眼并发性白内障

目的 探讨玻璃体切割术硅油充填眼并发性白内障超声乳化折叠式人工晶体植入联合硅油取出的方法和效果。方法 对21例(21眼)硅油充填眼并发性白内障患者经透明角膜切口行白内障超声乳化吸除折叠式人工晶体植入联合硅油取出术。结果 21例术后视力都有不同程度提高,17例(81.0％)视网膜获得稳定复位,其中14例(66.7％)最佳矫正视力≥0.05;4例(19.0％)术后2周内视网膜脱离复发,再次手术后复位。结论 经透明角膜切口行白内障超声乳化折叠式人工晶体植入联合硅油取出术对于硅油充填眼并发性白内障是安全有效的,在快速恢复视力功能同时减少了玻璃体出血和损伤周边视网膜的危险。

白内障超声乳化人工晶状体植入联合硅油取出术临床疗效观察

目的探讨玻璃体切割术后硅油充填眼行白内障超声乳化人工晶状体植入联合硅油取出术的临床疗效。方法 2010年8月—2011年6月对35例(36眼)玻璃体切割术后硅油充填眼白内障患者行白内障超声乳化人工晶状体植入联合硅油取出术,观察患者术后1个月最佳矫正视力以及术后并发症发生情况。结果术后1个月,3眼(8.33%)最佳矫正视力<0.01,5眼(13.89%)为0.01～0.04,10眼(27.78%)为0.05～0.09,15眼(41.67%)为0.1～0.25,3眼(8.33%)≥0.3。所有患者均无持续性角膜内皮失代偿、硅油泡残留、人工晶状体移位和玻璃体出血等并发症发生。结论玻璃体切割术后硅油充填眼行白内障超声乳化人工晶状体植入联合硅油取出术安全、有效。

不同材料人工晶状体硅油黏附的比较

目的 研究不同材料人工晶状体的硅油黏附程度。方法选择5类（9种）人工晶状体，包括亲水性丙烯酸酯、疏水性丙烯酸酯、水凝胶、硅凝胶和硬性PMMA人工晶状体。每枚人工晶状体在硅油中浸泡12h后在平衡盐溶液中拍照。得到的数码图像经计算机CAAS图像分析软件处理，计算出人工晶状体光学部前后表面的硅油黏附率，即光学部被硅油覆盖的面积占光学部总面积的百分比。结果 硅凝胶人工晶状体的硅油黏附率最高，几乎为100％，一种疏水性丙烯酸酯人工晶状体的硅油黏附率最低，平均值为11．69％。其他种类人工晶状体的硅油黏附率为14．55％～36．24％。结论 所选择的人工晶状体均有不同程度的硅油黏附。

微切口超声乳化术联合硅油取出术治疗玻切术后硅油填充眼合并白内障

目的:观察玻璃体切割术后硅油填充眼行微切口白内障超声乳化联合睫状体平坦部硅油取出术的临床疗效。方法:2013-02/11对43例43眼玻璃体切割术后硅油填充眼合并白内障患者行微切口白内障超声乳化联合睫状体平坦部硅油取出术,术中均Ⅰ期植入人工晶状体,观察患者术后3mo最佳矫正视力和手术并发症发生情况等。结果:术后3mo,最佳矫正视力较术前提高者共39例(91%),最高矫正视力达0.6,视力无提高者4例(9%)。所有患者均未发生后囊膜破裂、硅油残留、角膜内皮失代偿、前房积血、玻璃体积血、人工晶状体移位、继发性青光眼、锯齿缘离断等并发症。结论:微切口超声乳化人工晶状体植入术联合睫状体平坦部硅油取出术是一种有效、安全的手术方式。

IOL-Master测量硅油填充眼屈光结果分析

目的评价IOL-Master测量硅油填充眼屈光度数的准确性并分析不同因素与术后屈光误差的关系。方法29例(29眼)硅油填充眼行硅油取出联合人工晶状体(IOL)植入术,术前用IOL-Master进行IOL测量。根据不同病因、硅油放置时间、眼轴、术后并发症等因素进行分类,研究术后视力恢复情况及测量误差产生的原因。结果术后视力较术前均有不同程度的提高,屈光度数的平均预测误差为0.329±0.846(-1.5～-2.0D),眼轴长度(P>0.05)、病因[裂孔源性(t=0.478,P=0.637)、黄斑裂孔(t=0.135,P=0.895)]、是否近视(t=0.435,P=0.667)与术后产生的屈光误差均无相关性,硅油存留时间<1年者术后矫正视力恢复好。结论硅油填充眼患者采用硅油取出联合IOL植入术对视力有一定提高,IOL-Master测量硅油填充眼IOL度数是相对准确、安全、方便的方式。

硅油充填眼行白内障超声乳化人工晶状体植入联合硅油取出术

目的 探讨玻璃体切割术后硅油充填眼经透明角膜切口行白内障超声乳化摘除、硅油取出、人工晶状体植入联合手术 (1组 )以及经睫状体平坦部置灌注管行白内障超声乳化摘除、硅油取出、人工晶状体植入 (2组 )两种手术方式的临床疗效观察。方法 对 2 0 0 0年 1月～ 2 0 0 3年 4月间玻璃体切割术后硅油充填眼白内障患者 78例 (78只眼 )经透明角膜行联合手术。对 4 9例 (4 9只眼 )经睫状体平坦部行联合手术。观察眼底视网膜复位良好 ,行人工晶状体植入术。结果 1组病例有中 5 2只眼最佳矫正视力达 0 .1～ 0 .6 (6 6 .6 7% ) ;19只眼视力为 0 .0 2～ 0 .1(2 4 .36 % ) ;7只眼视力为光感～指数 (8.97% ,包括 5只眼视网膜脱离复发者 )。2组病例中 31只眼最佳矫正视力达0 .1～ 0 .6 (6 5 .3% ) ;11只眼视力为 0 .0 2～ 0 .1(2 2 .4 5 % ) ;7只眼视力为光感～指数 (14 .3% ,包括 2只眼视网膜脱离复发者 )。 2组病例中有 1只眼出现睫状体平坦部切口渗血 ,所有病例均无持续性角膜内皮失代偿、硅油泡残留、人工晶状体移位等并发症发生。结论 硅油眼行白内障超声乳化、硅油取出、人工晶状体植入术对于玻璃体切除手术后硅油充填眼并发白内障是一种安全、有效的方法。经透明角膜切口行此手术简化了手术步骤 。

硅油填充术后并发性白内障超声乳化人工晶状体植入术联合硅油取出的临床观察

目的:观察硅油填充术后并发性白内障行超声乳化人工晶状体植入术联合硅油取出的治疗效果.方法:回顾性分析了40例(41只眼)硅油填充术后并发白内障行超声乳化联合硅油取出及人工晶状体植入的病例资料,并随访5～18个月,分析其视力恢复情况及术中、术后并发症.结果:除3例因硅油取出术后视网膜脱离外,其余患者均有不同程度的视力增加.术中主要并发症为后囊膜破裂,术后的主要并发症为视网膜脱离.结论:硅油填充术后并发性白内障行超声乳化人工晶状体植入术联合硅油取出术是一种安全有效的方法.

超声乳化人工晶体植入联合23G/25G微创硅油取出术治疗视网膜脱离玻璃体切割术后硅油填充眼并发白内障的临床观察

目的:探讨超声乳化人工晶体植入联合23G/25G微创硅油取出术治疗视网膜脱离玻璃体切割术后硅油填充眼并发白内障的疗效。方法:回顾性分析超声乳化人工晶体植入联合23G/25G微创硅油取出术治疗的视网膜脱离玻璃体切割术后硅油填充眼并发白内障患者52例的临床资料。结果:术后3个月,患者视力均有不同程度的提高。所有患者无角膜损害,人工晶状体无移位,眼压正常。结论:超声乳化人工晶体植入联合23G/25G微创硅油取出术治疗视网膜脱离玻璃体切割术后硅油填充眼并发白内障的疗效显著。

国产硅凝胶折叠式人工晶状体应用的效果

目的 评价国产硅凝胶折叠式人工晶状体植入的临床效果。方法 50例51眼老年性白内障超声乳化吸出术联合国产硅凝胶折叠式人工晶状体植入,与32例34眼Cee On硅凝胶折叠式人工晶状体植入及51例52眼Acrysof折叠式人工晶状体植入术进行比较。结果 术后3天、1月、3月各组视力差异无显著意义;术后6月国产硅凝胶组低于其它2组(P<0.05);半年后后囊浑浊发生率国产硅凝胶组高于Acrysof组(P<0.05);无明显术中、术后并发症。结论 国产硅凝胶人工晶状体术后效果满意,术中术后并发症少。是一种可供选择使用的折叠式人工晶状体。

PDR患者二期行硅油取出联合白内障手术的临床观察

目的探讨增殖性糖尿病视网膜病变(PDR)二期患者硅油填充术后行硅油取出联合白内障手术的临床疗效。方法回顾性分析2008—2012年于我院行硅油取出联合白内障超声乳化、人工晶体植入术的PDR患者55例(61眼),术后视力恢复情况。结果术后1个月最佳矫正视力好于术前最佳矫正视力的40眼(74.07%),与术前相同的10眼(18.52%),低于术前最佳矫正视力的4眼(7.41%)。所有患者均无角膜内皮失代偿、人工晶体移位、复发性视网膜脱离等并发症发生。结论 PDR行玻璃体切除术后合并白内障的患者,取出硅油时联合白内障超声乳化、人工晶体植入术是经济、安全、有效的治疗方法。

黏度5500mPas硅油填充眼超声生物学测量的准确性

背景硅油填充眼超声生物学测量的准确性和可行性是眼科诊疗过程中的难题，对硅油眼性白内障行超声乳化联合人工晶状体（IOL）植入术时IOL度数的计算造成困难。一些大型医院常采用光学测量仪IOLMaster实现对硅油填充眼的生物学测量，但其对屈光介质严重混浊的病例仍无法进行测量。曾有研究者采用超声改良法或眼轴分段测量法进行估算，但其研究结果可能由于硅油黏度的不同而差异较大。目的探讨超声对黏度5500mPas硅油填充眼生物学测量的计算方法，为超声法对不同黏度硅油填充眼进行生物学测量提供方法学参考依据。方法采用B型超声仪于37℃下对高度分别为20、24和28mm的平衡盐溶液进行测量，并与黏度5500mPas硅油的相应测量高度进行比较，以得到计算硅油眼实际眼轴长度（AL）的公式。收集于2012年5月至2014年3月在青岛市海慈医疗集团接受黏度为5500mPas硅油填充治疗的复杂性视网膜疾病患者30例32眼，按实际AL分为AL〈26mm组（16例18眼）和AL≥26mm组（14例14眼），分别于硅油取出术前1d行B型超声、IOLMaster测量AL，并于术后3个月用A型超声及B型超声测量AL。对不同方法测量的AL值进行差异比较和相关分析，并对手术前后受检眼玻璃体腔长度和屈光度进行比较。结果B型超声波在黏度5500mPas硅油中的传播速度为1023m／s，超声波在硅油眼与正常玻璃体腔中测算AL的校正系数为0．668，校正AL=角膜顶点至晶状体后极或囊膜中央点距离＋0．668×晶状体后极或囊膜中央点至黄斑距离。AL〈26mm组和AL≥26mm组受检眼用术前B型超声校正公式法、IOLMaster测量法、术后A型超声测量法和术后B型超声测量法测量的AL值的总体比较，差异均无统计学意义（F=0．108，P=0．955；F=0．011，P=0．998）；硅油取出术前，B型超声校正公式法测量的AL值与IOLMaster测量法、术后B型超声测量法和术后A型超声测量法问测得的AL值均呈明显正相关（AL〈26mm组：r=0．876、0．921、0．809，均P〈0．01；AL≥26mm组：r=0．943、0．956、0．955，均P〈0．01）。硅油取出术前1d，B型超声测量的玻璃体腔长度校正值为（20．78±2．13）mm，硅油取出术后3个月测量的玻璃体腔实际长度为（20．89±2．16）mm，二者间差异无统计学意义（t=0．795，P=0．219）。受检眼中16眼行IOL植入术后平均屈光度为（-1．25±1．69）D，与术前保留的（-1．50±0．00）D比较，差异无统计学意义（t=0．585，P=0．284）。结论B型超声法对硅油填充眼的生物学测量准确、简便，用于临床的可行性较好。

硅油填充眼硅油取出联合折叠人工晶状体植入的护理

目的探讨玻璃体视网膜手术后硅油填充眼硅油取出联合折叠人工晶体植入的临床护理价值。方法对硅油眼进行硅油取出联合人工晶体植入的27例患者,加强术前准备、术中配合与观察、术后处理与健康指导。结果 27例患者手术成功率达100%,通过严格手术过程的管理和控制,未发生术中、术后并发症,术后实测患者视力均有所提高,治疗效果满意。结论人工晶体植入患者的护理,包括术前充分准备、术中密切配合、术后病情观察、并发症的预防及健康教育,对于巩固手术疗效、预防并发症和促进康复起着至关重要的作用。

硅油填充眼并发性白内障的手术疗效观察

目的:观察玻璃体切割术后硅油填充眼并发白内障行超声乳化联合硅油取出及人工晶状体植入术的临床效果及安全性。方法:对32例32眼硅油填充术后并发白内障患者行超声乳化联合经睫状体平坦部切口取硅油及折叠式人工晶状体植入术。术后随访3～18(平均9)mo。结果:术后最佳矫正视力:光感～数指/眼前者3眼,0.02～0.1者10眼,>0.1～0.2者12眼,≥0.3者7眼。所有患者均无视网膜脱离、角膜内皮失代偿、人工晶状体移位或硅油残留等。结论:白内障行超声乳化联合硅油取出及折叠式人工晶状体植入术治疗硅油填充眼并发性白内障安全、有效。

硅油填充眼在不同时机行人工晶状体植入的屈光误差比较

目的:比较玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术后屈光误差。方法:回顾性分析选取2009-01/2011-12玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术51例51眼,其中A组17例行玻璃体切割硅油填充联合白内障超声乳化并人工晶状体植入术,术后3～6mo行硅油取出;B组13例行玻璃体切割术后硅油取出联合白内障超声乳化并人工晶状体植入术,C组21例硅油取出术后择期行白内障超声乳化并人工晶状体植入术,比较术后3mo时屈光误差情况。结果:三组平均绝对屈光误差值分别为(0.873±0.256)D,(0.828±0.134)D,(0.473±0.121)D,A组和B组之间差异无统计学意义(P>0.05),C组和A组及B组之间差异有统计学意义(P<0.05)。结论:A超眼轴测量计算人工晶状体度数,玻璃体切割硅油填充眼在取油后择期行白内障超声乳化并人工晶状体植入术屈光误差小。