Clinical Observation on Preservation of Lens Anterior Capsule in Reduction of Complications Associated with Silicone Oil

Purpose: To observe the effect of preservation of anterior capsule on the incidence of complications associated with silicone oil. Methods: 82 patients(82 eyes) accepted trans pars plana vitrectomy(TPPV) combined with lensectomy of whom , 30 eyes with preservation of anterior capsule(PAC) and 52eyes with no preservation of anterior capsule (NPAC). Analysis of the incidence of complications associated with use of oil. Results:The incidence rate was 50.0 % in NPAC group, and 23.3 % in PAC group( P ＜ 0. 025 ). There were seconda'y glaucoma (21. 1% ), band keratopathy ( 13.5 % ) and corneal decompensation(9.6 % ) in NPAC group, while there was none of them in PAC group. Conclusions: Preservation of anterior capsule is an eftective method to reduce the complications associated with silicone oil. Eye Science 2001; 17:39 ～ 41.

Expressions of TGF-β2, bFGF and ICAM-1 in lens epithelial cells of complicated cataract with silicone oil tamponade

AIM： To investigate the expression differences of transforming growth factor-β2（TGF-β2）, basic fibroblast growth factor（b FGF） and intercellular cell-adhesion molecule-1（ICAM-1） in lens epithelial cells（LECs） of complicated cataract with silicone oil tamponade and agerelated cataract. METHODS： Totally 150 eyes of 150 patients（aged 35 to 77y） were investigated, including 75 patients with complicated cataract after silicone oil tamponade and 75 patients with age-related cataract. The central piece of anterior capsules was collected during cataract surgery. TGF-β2, b FGF and ICAM-1 were detected in the 60 specimens of the two groups by immunohistochemistry. The expression levels of the three kinds of messenger ribonucleic acid（m RNA） were determined by real-time quantitative reverse transcriptionpolymerase chain reaction in the 90 specimens of the two groups.RESULTS： TGF-β2 was detected in the cytomembrane and cytoplasm of the LECs and b FGF was detected in the nucleus. ICAM-1 was positive in the cytomembrane of the LECs and the distribution of positive cells was uneven. The m RNA genes expression of the TGF-β2, b FGF and ICAM-1 was significant differences between the two groups and markedly increased in complicated cataract group（P〈0.05）.CONCLUSION： The up-regulated TGF-β2, b FGF and ICAM-1 maybe associate with the occurrence and development of complicated cataract with silicone oil tamponade.

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.

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.

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.

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.

保留前囊膜的晶状体摘出术后前囊膜下纤维增生膜的剥除及组织病理学分析

背景保留前囊膜的晶状体摘出术在特殊情况下的玻璃体切割术中仍有其应用价值。尽管术中对晶状体上皮进行抛光处理，但术后仍有不同程度的前囊膜下纤维增生膜样混浊，了解这些增生膜中的细胞成分对于术后前囊膜下纤维增生膜样混浊的预防和治疗具有重要的临床意义。目的研究增生性糖尿病视网膜病变（PDR）合并白内障患者行保留前囊膜的晶状体玻璃体切割联合硅油充填手术后晶状体光学区前囊膜下纤维增生膜的处理方法及其组织病理学特点。方法于2013年1—12月在中日友好医院眼科纳入保留前囊膜的晶状体玻璃体切割联合硅油充填治疗且术后发生前囊膜下纤维增生性混浊的PDR合并白内障患者21例23眼，参照文献中描述的前囊膜混浊分级标准，收集取出硅油后前囊膜下纤维增生膜中剥除的C级和D级混浊标本，若难以剥除或剥除过程中出现部分前囊膜撕裂，则给予光学区切开。将收集的前囊膜混浊标本行苏木精－伊红染色、Van Gieson染色及Masson染色，光学显微镜下观察标本中纤维组织和胶原组织的形态；采用苦味酸－天狼星红染色，在偏振光显微镜下观察胶原纤维的分型情况。结果共15眼成功剥除光学区前囊膜下纤维增生膜，占65.2%（15/23），包括C级混浊14眼，其中9眼成功剥除光学区前囊膜下纤维增生膜，占64.3%（9/14），5眼给予光学区直径约3～4 mm的前囊膜切开，3眼获得可利用标本；D级混浊9眼，其中6眼剥除纤维增生膜，占66.7%（6/9），3眼给予前囊膜光学区切开，7眼获得可利用标本。术后20眼最佳矫正视力（BCVA）较术前提高，3眼视力无变化。苏木精－伊红染色提示膜组织主要成分为成纤维细胞和纤维组织，间有色素颗粒和细胞内、外空泡；Van Gieson法染色可见有粉红色染色的纤维成分；Masson法胶原染色显示呈绿色染色的胶原组织；苦味酸－天狼星红染色后偏振光显微镜下可见Ⅰ型胶原纤维以折光性较强的红黄色为主，Ⅲ型胶原纤维间有少量折光性较弱的绿色。结论硅油取出术联合前囊膜下增生膜剥除并保持其完整性或光学区切开是恢复晶状体前囊膜光学区透明性的有效方法；晶状体前囊膜下增生膜由纤维组织、色素颗粒和硅油滴的多种成分组成，以纤维组织居多，胶原纤维以Ⅰ型为主。

晶状体玻璃体切除联合硅油填充术中保留晶状体前囊的研究观察

目的探讨晶状体玻璃体切除联合眼内硅油填充术中保留前囊的作用。方法用玻璃体视网膜手术联合硅油填充治疗了18例伴增殖性玻璃体视网膜病变的视网膜脱离，术中采用经睫状体平坦部晶状体切除，并保留前囊。结果18例均保留了完整的晶状体前囊。术后随访6～24月，平均9．8月，无角膜变性发生。结论晶状体玻璃体切除联合硅油填充术中保留前囊可能减少术后角膜变性的发生率。

保留晶状体前囊的晶状体玻璃体视网膜联合手术

目的回顾性比较保留晶状体前囊与否对晶状体玻璃体视网膜联合手术的疗效及术后并发症的影响。方法将过去两年中的晶状体玻璃体视网膜联合硅油填充手术１０２例（１０５只眼）分为保留晶状体前囊组（３９只眼）和未保留晶状体前囊组（６６只眼），比较二者的疗效及术后并发症的情况。结果术后随访１～２个月，保留晶状体前囊组：视网膜完全复位者３２只眼（８２％）；高眼压者３只眼（７．７％），晶状体前囊透明者３５只眼（９０％）；无１例硅油进入前房及角膜变性发生。未保留晶状体前囊组：视网膜完全复位者５２只眼（７９％）；硅油进入前房者２６只眼（３９％）；高眼压者１５只眼（２３％）；角膜变性者２只眼（３％）。结论保留晶状体前囊的晶状体玻璃体视网膜联合手术减少了术后并发症的发生，提高了手术疗效，是治疗伴有晶状体混浊的复杂视网膜脱离的一种有效的手术方法。

硅油并发性白内障和年龄相关性白内障晶状体上皮细胞中凋亡因子的表达差异

目的:分析硅油并发性白内障和年龄相关性白内障晶状体上皮细胞中凋亡因子的表达差异。方法:将我院2014-03/2016-03收治的硅油并发性白内障患者50例50眼作为研究组,另选同期收治年龄相关性白内障患者50例50眼作为对照组,两组患者均已如实掌握此次研究方案具体内容并签署知情同意书后对其晶状体上皮细胞中凋亡因子的表达进行测定和比较。结果:研究组Bcl-2蛋白表达阳性率92%、Bax蛋白表达阳性率100%、Caspase-3蛋白表达阳性率100%,而同期对照组Bcl-2蛋白表达阳性率80%、Bax蛋白表达阳性率84%、Caspase-3蛋白表达阳性率82%,组间差异具有统计学意义(P<0.05)。结论:硅油并发性白内障晶状体上皮细胞中凋亡因子的表达显著高于年龄相关性白内障,提示晶状体上皮细胞中部分凋亡因子全程参与硅油并发性白内障的发生发展过程。

硅油填充与并发性白内障

硅油填充术作为目前复杂性视网膜脱离的主流术式,已被广泛应用。由于硅油本身特性,可引起晶状体混浊,因此了解术后并发性白内障形成原因并积极预防及处理均有较大的临床意义。

晶状体玻璃体切除联合硅油填充术中晶状体囊的处理

目的探讨晶状体玻璃体切除联合眼内硅油填充术中保留前囊或后囊的作用。方法用晶状体玻璃体切除联合硅油填充治疗30例30眼伴增生性玻璃体视网膜病变的视网膜脱离患者,根据白内障手术方式不同分2组。保留后囊组:13眼术前检查为非外伤性白内障行超声乳化吸出保留后囊;保留前囊组:17眼采用经睫状体平坦部晶状体切除,并保留前囊。8眼行二期后房型人工晶状体植入。结果保留后囊组:13眼均保留了完整的晶状体后囊;保留前囊组:17眼中除3眼原有晶状体前囊小破口外,14眼保留了完整的晶状体前囊。术后随访6～24月,平均9月,无1眼发生角膜变性,近期一过性高眼压3眼,8眼二期后房型人工晶状体植入位置良好。结论晶状体玻璃体切除联合硅油填充术中保留前囊或后囊可减少角膜变性、继发青光眼的发生率,并有利于二期后房型人工晶状体植入。

瞳孔膜闭时膜摘除术的临床研究

目的 :探讨药物不能消除的前葡萄膜炎瞳孔膜闭时透明晶状体前膜的手术介入方式 ,通过本研究评价该术式的临床效果。方法 :对符合适应证的 2 8例 (2 8眼 )施行了显微镜下粘弹剂参与的膜摘除术 ,并对其手术方式、时机、效果以及合并症进行回顾性分析。结果 :2 8例 (2 8眼 )的渗出膜均一次性被完整摘除。术后不同程度的虹膜炎症反应经药物治疗后 3～ 5d内全部消失。随访时见瞳孔全部保持圆形或类圆形 ,光反射全部可引出 ,术后第 1个月时的视力即恢复至患者主诉的病前水平。无 1例医源性晶状体损伤。手术分离的难易程度、并发症与病程有关。结论 :对药物不能消除的瞳孔膜闭症适时在手术显微镜下通过粘弹剂的参与予以摘除 ,能够避免晶状体损伤和难以控制的炎症反应 ,以及因粘连所致的各种并发症 。

保留晶状体前囊减少硅油并发症的临床观察

目的 观察保留晶状体前囊对硅油眼并发症的影响。 方法 82只眼行玻璃体切割联合晶状体切除手术 ,其中 30只眼术中保留完整晶状体前囊 ,5 2只眼未保留前囊 ,随访观察硅油并发症的发生情况。 结果 有前囊组硅油并发症的发生率为 2 3.3%、无前囊组为 5 0 .0 % (0 .0 10 <P<0 .0 2 5 )。后者主要有继发性青光眼 (2 1.2 % )、角膜带状变性 (13.5 % )和角膜内皮失代偿 (9.6 % )。 结论 保留晶状体前囊可以减少硅油眼并发症的发生。

白内障术后眼内炎保留人工晶状体的治疗

目的探讨在保留人工品状体（IOL）情况下，玻璃体切除联合硅油填充手术治疗白内障术后眼内炎的疗效。方法回顾性系列病例研究。收集2003至2008年因超声乳化白内障吸除联合IOL植入而发生术后眼内炎，在保留IOL的情况下接受玻璃体切除联合硅油填充术的7例患者（7只眼）的临床资料，观察其视力、裂隙灯显微镜、直接和间接眼底镜、眼压及眼部B超扫描结果，对手术疗效进行分析。采用配对t检验分析术前及术后眼压变化。结果7例患者中男性5例，女性2例，年龄67．0—84．0岁，平均（70．0±4．5）岁。眼内炎发生时间平均为术后2d（1～3d）。其中5只眼于术后3～6个月将硅油取出。术前视力无光感至手动。术前眼压平均为（35．0±0．5）mmHg（35．0～56．0mmHg，1mmHg=0．133kPa）。平均随访（10±6）个月（6～43个月）。术后视力无光感至0．8，视力提高6只眼（86％），不变1只眼（14％）。眼压平均为（18．0±1．5）mmHg（10．0～20．0mmHg），显著低于术前眼压（t=1．94，P〈0．05）。并发症主要包括术后早期前房炎性渗出（7只眼），术后短暂高眼压（1只眼）。无视网膜脱离和眼球萎缩。结论在保留IOL情况下，玻璃体切除联合硅油填充手术对治疗超声乳化白内障吸除联合IOL植入术后眼内炎有一定疗效。

有晶状体眼前房硅油改良取出方法的观察

目的观察玻璃体切除术后有晶状体眼前房硅油的改良取出方法。方法回顾性研究2012年1月至2017年12月于本院行玻璃体切除联合硅油充填者,有晶状体眼术后早期硅油进入前房者11例(11眼)的临床资料、采用改良方法取出前房硅油术中先行巩膜穿刺放岀少许玻璃体腔的液体和硅油,常规行6点位周边虹膜切除术,最后冲洗出前房硅油。术后随访观察3个月。结果术后早期10眼前房硅油完全被清除,1眼前房残留少许硅油.11眼均未见晶状体损伤。术后3个月内均未出现硅油再次进入前房结论改良的前房硅油取出方法能较好的清除前房硅油,操作简便,且能避免硅油再次进入前房.

术中光学相干断层扫描辅助玻璃体Berger腔切除术的临床研究

目的:探讨术中光学相干断层扫描(iOCT)辅助下玻璃体Berger腔切除术的临床应用效果。方法:纳入2020年1月至2021年4月于同济大学附属同济医院眼科完成超声乳化白内障吸除联合人工晶状体植入及玻璃体切除术的患者73例(73只眼)进行研究。其中,男性37例(37只眼),女性36例(36只眼)。年龄59~79岁,平均(65.1±4.2)岁。根据对Berger间隙处理的不同,分为传统组和Berger切除组。所有患眼均一期同时行硅油填充。Berger切除组患者,一期术中行晶状体后囊后方居中8 mm范围内玻璃体前皮质的彻底切除,切除时交替进行负压抽吸和切割。传统组患者,行传统术式而不处理Berger间隙。记录两组患者的性别、年龄、糖化血红蛋白、空腹血糖、白内障核分级、术前玻璃体腔内注药次数、眼压、最佳矫正视力(BCVA)、眼轴长度、手术时间、硅油取出后晶状体后囊区混浊程度及其光密度值。年龄、眼轴长度、糖化血红蛋白、空腹血糖、术前玻璃体腔内注药次数、眼压、手术时间及后囊光密度值符合正态分布以±s表示,各时间点的组间比较采用两因素重复测量方差分析,组间比较采用独立样本t检验。性别、高血压比例及白内障核分级等分类以例数和百分比描述,组间比较采用卡方检验。后囊区混浊程度以四分位数和中位数表示,组间比较采用秩和检验。结果:Berger切除组患眼在术前、一期术后1个月、二期取油前及二期取油后3个月的最小分辨角度对数视力(logMAR)BCVA分别为(0.93±0.73)、(0.62±0.18)、(0.50±0.08)及(0.48±0.08);传统组患眼分别为(0.90±0.10)、(0.69±0.14)、(0.56±0.12)及(0.52±0.61)。经两因素重复方差分析,两组差异具有统计学意义(F=19.35,P<0.05),交互作用无统计学意义(F=0.113,P>0.05),经组间t检验比较的差异在二期取油后3月差异有统计学意义(t=-2.36,P<0.05)。Berger切除组iOCT光密度值为(0.60±0.03),传统组为(0.86±0.04),Berger切除组低于传统组其差异有统计学意义(t=20.04,P<0.05)。Berger切除组取油后3个月的pentacam光密度值为(4.21±0.51),传统组为(5.37±1.28),Berger切除组低于传统组其差异有统计学意义(t=-3.29,P<0.05)。Berger切除组一期手术时间为(60.33±10.08)min,传统组为(57.22±9.89)min,组间差异无统计学意义(t=0.89,P>0.05)。二期取油术后3个月时,Berger切除组和传统组后囊混浊程度的四分位数(中位数)分别为1.00(1.00)和2.00(2.00),Berger切除组轻于传统组其差异具有统计学意义(Z=3.27,P<0.05)。结论:Berger腔完整切除可增加硅油取出术后后囊后视轴区的透亮度。

前房维持器在硅油填充眼白内障手术中的应用

目的评价前房维持器在硅油填充眼并发性白内障手术中应用的特点。方法回顾性分析19例（19眼）硅油填充眼并发白内障术中应用前房维持器行超声乳化吸出人工晶状体植入术。结果术后视力提高者17眼，无明显改善有2眼；19眼术中前房均稳定，无后囊破裂，极少硅油进入前房，手术效果良好，手术成功率高。结论前房维持器术中能更好地保持前房稳定及眼压稳定，减少手术并发症。