不同尺寸囊袋张力环对高度近视合并白内障患者术后囊袋稳定性的影响

目的探讨植入不同尺寸囊袋张力环(CTR)对高度近视合并白内障患者术后囊袋稳定性的影响。方法前瞻性研究。选取2022年1月至6月于河北省眼科医院就诊的高度近视合并白内障患者75例(150眼)为研究对象,采用随机数字表法分为大尺寸组、小尺寸组和对照组,每组25例(50眼)。所有患眼均行超声乳化吸出联合人工晶状体(IOL)植入术,其中,大尺寸组患者术中联合植入CTR1311(开放直径13 mm),小尺寸组患者术中联合植入CTR1210(开放直径12 mm),对照组不植入CTR。比较各组患者术前和术后1周、1个月、3个月、6个月、1年的裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压、角膜内皮细胞密度、有效IOL位置(ELP)、平均屈光误差绝对值、前囊口面积及并发症发生情况。结果术后1年,三组患者UCVA、BCVA均优于术前(均为P<0.05),眼压、角膜内皮细胞密度与术前相比差异均无统计学意义(均为P>0.05)。术后不同时间点,大尺寸组、小尺寸组IOL倾斜度均较对照组明显降低(均为P<0.05),小尺寸组IOL倾斜度均高于大尺寸组(均为P<0.05)。术后不同时间点,三组患者间IOL偏心量相比差异均无统计学意义(均为P>0.05)。术后6个月,眼轴长度>30 mm大尺寸组患者术后IOL偏心量及倾斜度均较小尺寸组小(均为P<0.05)。术后不同时间点对照组前囊口面积均较大尺寸组和小尺寸组明显缩小(均为P<0.05),大尺寸组患者前囊口面积与小尺寸组相比差异均无统计学意义(均为P>0.05)。术后6个月,对照组患者术后平均屈光误差绝对值均较大尺寸组和小尺寸组大,差异均有统计学意义(均为P<0.05),大尺寸组与小尺寸组组间比较差异无统计学意义(P>0.05)。随访1年示,三组均未见严重并发症发生。结论白内障超声乳化吸除联合CTR植入对高度近视合并白内障患者疗效明确。大尺寸CTR较小尺寸CTR术后IOL更稳定,对于眼轴长度>30 mm的高度近视白内障患者,建议植入较大尺寸CTR。

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

视网膜色素变性并发白内障的临床表现与中性粒细胞/淋巴细胞计数比值的相关性

目的:评估视网膜色素变性(RP)并发白内障患者中性粒细胞与淋巴细胞计数比值(NLR),探讨其与RP并发白内障临床特征的相关性。方法:回顾性研究。纳入2008-01/2018-12在我院接受白内障摘除手术的RP并发白内障患者79例125眼,排除发病年龄较早的RP并发白内障患者选取其中63例63眼纳入RP并发白内障组,另选取年龄、性别相匹配、同期行白内障摘除手术的年龄相关性白内障(ARC)患者63例63眼纳入ARC组。收集患者的临床资料及NLR值,分析RP并发白内障患者的临床表现与NLR相关性。结果:RP并发白内障组患者NLR显著高于ARC组[1.79(1.32,2.27)vs 1.58(1.32,1.98),P=0.032]。NLR与后囊下白内障(PSC)严重程度、悬韧带薄弱程度、术前最佳矫正视力(>1LogMAR)相关。接收者操作特征(ROC)曲线分析显示,NLR≥1.36可预测RP并发较严重的PSC(>P1)(AUC=0.803,95%CI 0.672-0.934,P=0.002),NLR≥2.12可以预测RP并发白内障患者悬韧带薄弱(AUC=0.796,95%CI 0.665-0.928,P=0.002),NLR≥1.51可以预测术前较差的BCVA(AUC=0.667,95%CI 0.540-0.793,P=0.015)。结论:RP并发白内障患者NLR明显高于ARC患者,且与RP并发白内障临床表现存在相关性。NLR可作为评估RP并发白内障临床表现严重程度的潜在预测指标。

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

晶状体悬韧带与原发性闭角型青光眼之已知与未知

晶状体悬韧带异常(包括松弛和断裂)可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高,即闭角型青光眼(angle closure glaucoma,ACG)的发生。特发性悬韧带异常多发生于原发性闭角型青光眼(primary angle closure glaucoma,PACG),可能是PACG的发病机制之一,但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等,虹膜/晶状体震颤等体征及超声生物显微镜(ultrasound biomicroscopy,UBM)检查能够诊断的悬韧带异常比例较低,通常在青光眼白内障联合手术前未能被诊断而在术中被发现,故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部,连续环形撕囊破囊时可见前囊放射状皱褶,超声乳化时囊袋赤道部移位或卷曲,灌注抽吸时囊袋异常飘动,囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围,选择超声乳化晶状体吸除联合人工晶体植入,联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常,制定个体化治疗方案,以保证手术安全和疗效。

超声生物显微镜在眼前段钝挫伤中的应用

目的:探讨超声生物显微镜在眼前段钝挫伤中的应用价值。方法:对7只眼前段顿挫伤眼进行眼科常规检查,传统眼科B超和超声生物显微镜检查。结果:超声生物显微镜显示房角后退、虹膜根部离断、睫状体分离、晶体悬韧带断裂不全脱位和玻璃体疝,并能显示出传统B超所不能显示的睫状体和脉络膜浅脱离。结论:超声生物显微镜在眼前段外伤中有极好的应用价值。尤其在屈光介质混浊(角膜混浊、前房积血),睫状体分离低眼压和隐藏在虹膜后的病变时,它可显示出采用常规眼科检查和眼用B超常不能揭示的病变,它的应用可为眼前段钝挫伤的诊断和治疗提供确切的指导。眼科学报 1996;12:210～213。

双眼自发性晶状体悬韧带松弛致继发闭角型青光眼一例

双眼自发晶状体悬韧带松弛,导致前房波动,进行性近视加重,继发闭角型青光眼的病例在临床比较少见。本病例报道了1例25岁女性双眼自发晶状体悬韧带松弛不伴有晶状体脱位及形态异常,出现双眼前房波动,近视加重,最终继发双眼闭角型青光眼。经过局部抗炎、散瞳处理和"PHACO+IOL(Phacoemulsification+intraocular lens)植入+前段玻璃体切除术"将IOL置于睫状沟后,患者眼压得到控制、视力基本矫正至正常。眼科学报2007;23:243-246.

囊袋张力环植入治疗外伤性晶状体脱位

目的探讨囊袋张力环(CTR)在外伤性晶状体悬韧带断裂的白内障手术中的植入时机。方法对24例(25眼)外伤性晶状体悬韧带部分断裂的患者行白内障手术,术中连续环形撕囊,行白内障超声乳化吸除后,囊袋内植入CTR及后房型人工晶状体。术后随访6个月～4年。结果术中无悬韧带断裂范围扩大,白内障皮质注吸干净。术后1个月矫正视力≤0.4者6眼,0.5～0.9者16眼,≥1.0者3眼。术后6个月散瞳检查,25眼的人工晶状体均处于正位,无倾斜及明显偏位。未见CTR引起的并发症。结论CTR应用于外伤性晶状体悬韧带断裂的白内障患者,利于人工晶状体囊袋内植入,有效防止术后人工晶状体偏位的发生。白内障超声乳化吸除后植入CTR利于术中操作,更安全可靠。

手法小切口白内障术中累及悬韧带区的连续环形撕囊的安全性探讨

目的：探讨在手法小切口白内障术中超出无悬韧带区域的连续环形撕囊的安全性及有效性。方法：采用手法无缝线白内障囊外摘除术对住院1 443例1 965眼白内障患者进行手术，术中采用连续环形撕囊法制作7～8mm直径前囊口，对患者术中撕囊是否成功、后囊破裂、术后角膜水肿及视力等情况进行统计学分析，研究其手术价值。结果：患者1 965眼中，1 942眼（98.83%）连续撕囊成功； 15眼（0.76%）囊膜瓣向周边撕裂不能挽救，留有放射状裂口一个； 8眼（0.41%）因为囊膜钙化机化等原因无法常规撕囊，采用囊膜剪开及截囊等方法完成前囊开口。所有病例，均无后囊破裂发生，并顺利植入人工晶状体。术后一过性角膜水肿36眼（1.83%）。术后1d，视力≥0.5者1 650眼（83.97%），≥0.3者1 867眼（95.01%）。人工晶状体位置正并且稳定。结论：在手法白内障术中用连续环形撕囊方法制作累及悬韧带区域的大于常规直径的前囊口，并未降低囊袋和人工晶状体的稳定性，使手术安全性提高，值得推广和应用。

人眼晶状体悬韧带的张力测定

目的 进行人眼晶状体悬韧带部位及其张力的测定。方法 对 41只离体尸眼进行测定。悬韧带的最大张力规定为 :在其放松及最大伸张情况下 ,从睫状突到嵌入晶状体前囊膜内的悬韧带的距离的差值。另外 ,利用张力仪 ,通过换能传导及放大记录下造成部分悬韧带断裂时的张力。结果 悬韧带在拉断之前平均能被拉长 4.48± 1.78m m ,年轻组为 5 .33± 1.19m m,老年组为 2 .17± 0 .70 mm。无韧带区老年组为 6 .98± 0 .70 m m,年轻组为 7.6 6± 0 .42 m m,平均为 7.48± 0 .5 8mm。使部分悬韧带断裂的平均张力为 47.8± 9.8g,压强为 5 4.82 mm Hg。结论 悬韧带具有一定的张力 ,随着年龄的增长 ,悬韧带有向囊膜中心生长的趋势 ,无韧带区随年龄的增加而减小 ,悬韧带的张力随年龄的增加而减少。悬韧带的张力约为正常眼内压的

晶状体悬韧带异常的白内障超声乳化手术疗效分析

目的探讨超声乳化技术与传统的囊外摘除技术治疗晶状体悬韧带异常的白内障患者的安全性和效果。方法回顾分析2006年12月至2014年12月收治69例(69只眼)术前或术中发现有晶状体悬韧带异常的白内障患者,其中35只眼予超声乳化技术(phaco)为观察组,34只眼予囊外摘除技术(ECCE)为对照组,观察两组的术中术后出现并发症以及术后矫正视力提升≥2行者的情况。结果观察组35只眼术中发生并发症11.42%,术后并发症5.71%,术后矫正视力提升≥2行94.28%;对照组34只眼术中发生并发症26.47%,术后并发症17.65%,术后矫正视力提升≥2行82.35%。两组比较有显著性差异(P<0.05)。结论对于存在有晶状体悬韧带异常的白内障患者,超声乳化手术的安全性及效果优于囊外摘除手术。

Idiopathic phacodonesis in senile cataract patients in Qinghai,China

AIM: To investigate the frequency of idiopathic phacodonesis (IP) in senile cataract subjects and the short-term clinical outcomes following cataract surgery. METHODS: This institutional case-control study included 1301 consecutive low-income cataract subjects from June to November 2009. Anterior segment were carefully evaluated with dilated pupil under slit-lamp. IP were screened and graded by a criteria set by the authors. Risk factors, surgical outcomes, and operative complications were analyzed. RESULTS:A total of 42 subjects (3.2%) with IP were diagnosed and classified as grade 1 (36 subjects), grade 2 (5 subjects) and grade 3 (1 subject). Harder lenses and intumescent cataracts were observed in the IP group than the control group (P <0.05). Logistics regression test also indicated the main risk factor was the hardness of the lens. The incidence of zonular dialysis during surgery was 23.8% (10 eyes), which was significantly higher than the controls (0.7%, ( P<0.001). Visual outcomes of the two groups were not statistically or clinically significant. CONCLUSION: Hard nucleus and intumescent cataract are related to IP in senile cataract subjects in Qinghai, China. With more care being taken, grade 1 and some of the grade 2 IP subjects achieved similar surgical outcomes as compared to controls.

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability:a comparison of three insertion methods

·AIM:To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens(IOL)in eyes with zonular instability.·METHODS:A total 60 eyes of 60 patients were included in this retrospective cohort study.Postoperative stability in three groups[haptic sutured IOL in the bag,IOL in the bag insertion with haptics oriented toward areas of zonulysis,IOL with capsular tension ring(CTR)in the bag insertion]were compared according to the IOL insertion methods.To evaluate the IOL stability,the changes of anterior chamber depth(ACD),refraction,contraction of anterior continuous curvilinear capsulotomy(CCC)area,and tilt of IOL were compared.·RESULTS:There was no significant difference in change of ACD(-0.04±0.01 mm in group of haptic sutured IOL,-0.07±0.01 mm in group of CTR insertion)and refraction(0.05±0.05 D in group of haptic sutured IOL,0.37±015 D in group of CTR insertion)between the group of haptic sutured IOL in the bag and CTR insertion group.But in comparison of CCC contraction and IOL tilt,CTR insertion group showed less contraction(1.00%±0.52%)and less IOL tilt(2.66°±0.11°)than the group of haptic sutured IOL in the bag(6.32%±1.36%,3.47°±0.11°,respectively).The CTR insertion group showed the least CCC contraction and the least tilt.·CONCLUSION:In eyes with zonular instability,the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion.The method of IOL only in-thebag insertion shows the largest contraction of CCC and the largest tilt of IOL.

1个先天性晶状体脱位家系的基因突变位点

目的:分析1个先天性晶状体脱位家系原晶状体原纤维蛋白1(fibrillin-1,FBN1)基因突变的情况。方法:对1个单纯性晶状体脱位家系中的25位家族成员(包括5名患者)进行眼睛及全身临床检查。从外周静脉血抽提DNA进行PCR扩增反应,并对FBN1全部65个外显子进行测序分析。结果:在5位患者的核苷酸序列中均发现FBN1基因c.1759胸腺嘧啶突变为胞嘧啶。这个点突变导致FBN1蛋白第587号的半胱氨酸被精氨酸代替。结论:c.1759胸腺嘧啶突变是导致患者晶状体脱位的FBN1基因突变位点,该结论进一步丰富了马凡综合征(Marfan syndrome,MFS)基因突变库,并有助于该家系中相关亲属的遗传咨询。

可疑性原发房角关闭的晶状体悬韧带松弛度研究

目的比较可疑性原发房角关闭(primary angle closure suspect,PACS)患者与正常人各方位晶状体悬韧带松弛度差异,探究隐匿性晶状体偏位在青光眼发病中的作用。方法纳入PACS组患者19例(19眼)和与之年龄、性别、眼别匹配的正常对照组19名(19眼)。在标准暗室下采用Pentacam完成眼前节扫描,局部滴用复方托吡卡胺眼水一滴,30 min后再次采集Pentacam图像,自动获得散瞳前后4 mm范围8个方位(上方、颞上、颞侧、颞下、下方、鼻下、鼻侧、鼻上)周边前房深度(peripheral anterior chamber,peri-ACD)。以散瞳前后peri-ACD的差值(即△peri-ACD)反映悬韧带松弛度。以散瞳后8个方位peri-ACD差异明确是否存在晶状体偏位,并通过其极差值(即散瞳后8个方位peri-ACD中最大值减去最小值)反映晶状体偏位程度。结果PACS组与正常对照组不同方位△peri-ACD组内比较差异均有统计学意义(P<0.001、P=0.043),组间比较PACS组颞下方(0.40±0.28)mm小于正常对照组(0.55±0.15)mm(P=0.041),其余方位差异均无统计学意义(均为P>0.05)。散瞳后PACS组和正常对照组8个方位peri-ACD组内比较差异均有统计学意义(P=0.001、0.009),8个方位组间比较差异均有统计学意义(均为P<0.01)。PACS组和正常对照组间极差值比较差异无统计学意义[(0.35±0.18)mm、(0.43±0.28)mm](P=0.362)。结论 PACS组与正常对照组均存在晶状体悬韧带松弛度分布不均,而PACS组颞下方悬韧带松弛可能更为显著。

悬韧带异常的假性剥脱综合征性白内障手术时机和方法的选择

背景假性剥脱综合征（PEX）常并发白内障，多伴有进展性晶状体悬韧带异常，术中及术后易出现悬韧带相关并发症，白内障手术如何选择合适的手术时机及手术方式对于减少并发症、提高手术成功率具有重要的临床意义，但目前相关研究报道很少。目的分析伴有晶状体悬韧带异常的PEX性白内障（PEXC）患者行白内障摘出联合人工晶状体（IOL）植入术的疗效，探讨其合适的手术时机及手术方式。方法采用系列病例观察研究方法，对2012年7月至2015年12月在新疆维吾尔自治区喀什地区第二人民医院接受PEXC手术的21例23眼进行分析，所有患者均伴有晶状体悬韧带异常，根据悬韧带异常的程度分为晶状体震颤和不全脱位2种类型，其中晶状体震颤18眼，晶状体不全脱位5眼。按照Emery核硬度分级法分为Ⅱ级核4眼，Ⅲ级核9眼，Ⅳ级核7眼，Ⅴ级核3眼；晶状体震颤者行白内障超声乳化联合标准囊袋张力环（CTR）或改良CTR（MCTR）及IOL植入术或白内障囊外摘出联合CTR及IOL植入术；Ⅱ级或Ⅲ级核伴晶状体不全脱位者行超声乳化联合MCTR及IOL植入术；Ⅳ级或Ⅴ级核伴晶状体不全脱位者行白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术。对患者共随访3个月，分析手术时机对疗效的影响及术眼术后视力、眼压，术中及术后并发症，前囊口、IOL位置变化。结果晶状体震颤患者行白内障超声乳化联合IOL植入术，其中植入CTR者10眼，MCTR者3眼，囊外摘出联合CTR及IOL植入术4眼，前段玻璃体切割联合IOL巩膜缝线固定术1眼。晶状体不全脱位行超声乳化联合前段玻璃体切割联合IOL巩膜缝线固定术1眼，白内障囊内圈套摘出、前段玻璃体切割联合IOL巩膜缝线固定术4眼。术眼术后最佳矫正视力（BCVA）〉0.5者4眼，〉0.3～≤0.5者6眼，〉0.1～≤0.3者8眼，≤0.1者5眼，与术前BCVA比较，差异有统计学意义（χ2＝17.29，P〈0.01）；术眼术前平均眼压为（16.82±2.25）mmHg（1 mmHg＝0.133 kPa），术后3个月平均眼压为（16.12±2.67）mmHg，差异无统计学意义（t＝0.108，P〉0.05）；术中、术后常见并发症为瞳孔不易扩大、角膜水肿、晶状体皮质残留和后囊膜混浊。结论伴有晶状体悬韧带异常的PEXC手术复杂、并发症多，手术时机和手术方式的选择均应依据悬韧带异常程度、核硬度和晶状体是否脱位，术前应认真行自然瞳孔下及扩瞳后检查以确定治疗方案是手术成功的关键。

Series of cataract surgeries with I-ring pupil expansion ring

BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.METHODS A retrospective chart review of 12 consecutive cases within the same year(2016)of cataract surgeries employing I-ring pupil expansion ring(Beaver-Visitec,International)by a single surgeon at the same ambulatory surgical center was conducted.Demographic,pre-op,intra-op,and post-op data were recorded.Total number of cataract cases performed was also recorded.RESULTS 8 of 12 cases were planned I-ring cases.1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink.The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small.7 patients had IFIS from Flomax use.2 patients had pseudoexfoliation syndrome as the cause of small pupil.2 patients had narrow angles with brunescent cataracts.2 patients had pre-op partial zonular dehiscence.1 patient had 360o of posterior synechiae.2 cases had ruptured posterior capsule that required anterior vitrectomy.No complications were attributed to the pupil expansion ring.A total of 296 cataract surgeries were performed that year by the surgeon,making the rate of pupil ring use 4.1%.CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges,such as brunescent cataract,zonular weakness,and posterior synechiae in this series.I-ring helped to reduce at least one challenge in these difficult cases.

多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼

目的探讨多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼的临床疗效。方法回顾性病例研究。2012年3月至2014年5月在河北省眼科医院白内障科就诊的晶状体悬韧带松弛继发急性闭角型青光眼患者23例（23眼）,采用微切口囊袋内预劈核超声乳化联合张力环植入、前部玻璃体切割和房角分离术进行治疗。术后随访观察最佳矫正视力、眼压、前房深度以及前囊收缩情况、后囊膜混浊程度、人工晶状体的居中性。结果术后3个月最佳矫正视力〉0.6-1.0者8眼,〉0.3-0.6者12眼,0.1-0.3者3眼。术后3个月最佳矫正视力较术前增加,差异有统计学意义（t=36.225,P〈0.01）。所有患者术后1 d眼压均下降至正常,为10.3-16.5（14.2±1.9）mm Hg（1 k Pa=7.5 mm Hg）,与术前相比差异有统计学意义（t=27.902,P〈0.01）。术后随访3个月,未见眼压明显波动。术中未出现灌注液迷流综合征,术后未发生恶性青光眼。术后3个月所有患者人工晶状体居中性良好,未出现囊袋收缩、后发性白内障等并发症。结论采用多联手术治疗晶状体悬韧带松弛继发急性闭角型青光眼可以取得满意的疗效。

晶状体悬韧带松弛继发急性闭角型青光眼临床特点及相关治疗

目的探讨晶状体悬韧带松弛继发急性闭角型青光眼的临床特点及相关治疗。方法对20例(20只眼)晶状体悬韧带松弛继发急性闭角型青光眼患者行白内障超声乳化术,术中晶状体核超声乳化后植入囊袋张力环,再行皮质吸出及后房型人工晶状体囊袋内植入。结果术后随访6个月至1年,所有患者眼压正常,视力不同程度提高,人工晶状体无倾斜及明显偏位,无后发障及囊袋收缩综合征的发生。结论晶状体悬韧带松弛继发急性闭角型青光眼患者行白内障超声乳化术可解决青光眼问题,术中应用张力环,有利于术中操作、提高手术安全性,防止术后人工晶状体偏位、后发障、囊袋收缩综合征的发生。

虹膜拉钩联合2L型可缝合囊袋张力环治疗严重晶状体悬韧带异常临床疗效的观察

目的评估虹膜拉钩联合2L型可缝合囊袋张力环(2L-MCTR)治疗各种原因导致的严重晶状体悬韧带异常患者的临床疗效,并对其优缺点、手术技巧和相关并发症进行探讨。方法统计各种原因导致严重晶状体悬韧带异常并发晶状体位置和形态异常的的患者,行可缝合囊袋张力环(2L-MCTR)联合囊袋内人工晶状体植入的患者7例11只眼,术后随访1~3年,检查裸眼视力,矫正视力,眼压、是否有后囊膜混浊。用UBM观察IOL位置、MCTR及与周围组织的关系。结果 11只眼矫正视力均>0.3,其中7只眼最佳矫正视力>0.8,3只眼最佳矫正视力>0.5。1只眼因外伤合并视网膜挫伤,最佳矫正视力为0.3;1只眼改行人工晶状体睫状沟固定术。超声活体显微镜(UBM)显示MCTR及人工晶状体位于囊袋内。结论虹膜拉钩的使用可维持术中晶状体囊袋的稳定及手术过程的操作安全。McTR植入可以使人工晶状体位于囊袋内生理位置,并维持术后人工晶状体的长期稳定性,安全有效地避免患者进行性加重的晶状体悬韧带异常导致的术后人工晶状体脱位。