囊袋内张力环植入治疗先天性晶状体半脱位

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目的探讨晶状体超声乳化吸除联合张力环(CTR)及人工晶状体(IOL)植入术、选择性二期张力环巩膜缝合固定术治疗先天性晶状体半脱位的治疗效果。设计前瞻性病例系列。研究对象21例(39眼)先天性晶状体半脱位患者。方法施行晶状体超声乳化吸除联合张力环及IOL植入术,其中20眼术后IOL仍偏位较大者(>1.5mm)二期行张力环巩膜缝合固定术。术前、术后测量视力,用PentaCam测量半脱位晶状体及IOL倾斜度和位置,观察术中术后并发症。主要指标术后视力、IOL位置及术中术后并发症。结果所有病例术后最佳矫正视力均较术前有不同程度提高,二者差异有统计学意义(P=0.000)。二期张力环缝合前IOL倾斜(4.33±2.96)°、偏心(2.56±0.90)mm,张力环缝合后IOL倾斜(4.11±2.05)°、偏心(1.19±0.71)mm。张力环缝合前及缝合后IOL的倾斜程度差异无统计学意义(P=0.844),偏位程度差异有统计学意义(P=0.009)。后囊膜混浊发生率20.5%,其中2眼(5.1%)行Nd:YAG激光后囊切开术。1眼因囊袋破裂张力环脱出改变术式,2眼术后发生一过性高眼压。结论对先天性晶状体半脱位患者的手术治疗,可采用晶状体超声乳化吸除联合张力环及IOL植入术,脱位严重的和具有进展倾向的病例还应二期行张力环巩膜缝合固定术。 Objective To investigate the therapeutic effect of phacoemulsification combined with tension ring (CTR) and intraocular lens (IOL) implantation and selective secondary tension and scleral suture fixation for the treatment of congenital lens subluxation. Design prospective case series. The study included 21 patients (39 eyes) with congenital lens subluxation. Methods Phacoemulsification combined with tension ring and IOL implantation were performed. Among them, tension-ring scleral suture fixation was performed in 20 cases with larger deviation of IOL (> 1.5 mm) in the second period. Visual acuity was measured preoperatively and postoperatively. PentaCam was used to measure the tilt and position of the subluxated lens and IOL. Postoperative complications were observed. The main indicators postoperative visual acuity, IOL location and intraoperative and postoperative complications. Results The best corrected visual acuity in all cases was improved to some extent compared with that before operation, the difference was statistically significant (P = 0.000). The IOL tilt (4.33 ± 2.96) ° and eccentricity (2.56 ± 0.90) mm before the second tension ring suture, IOL inclination (4.11 ± 2.05) ° and eccentricity (1.19 ± 0.71) mm after tension ring suture. There was no significant difference in the inclination of IOL between pre-tension and post-tension sutures (P = 0.844). There was significant difference in deviation degree (P = 0.009). The incidence of posterior capsular opacification was 20.5%. Nd: YAG laser posterior capsulotomy was performed in 2 eyes (5.1%). One eye due to pouch rupture tension ring prolapse change surgery, 2 patients had a transient intraocular hypertension. Conclusions For the surgical treatment of patients with congenital lens subluxation, phacoemulsification combined with tension ring and IOL implantation may be used. Patients with severe and advanced dislocation should also undergo tension ring scleral suture fixation.
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