摘要
目的探讨前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。方法选择河北省眼科医院白内障科2013年1月至2020年12月行晶状体摘出一期或二期植入前房型虹膜夹人工晶状体的患者53例62眼作为研究对象,62眼患者均为无足够囊膜支撑的无晶状体眼。术后随访3~9(5.68±1.29)年,收集患者手术前和末次随访裸眼视力(UCVA)、等效球镜度、眼压、前房深度、人工晶状体眼内固定位置及稳定性、角膜内皮细胞密度(ECD)、术后并发症等指标和临床信息。评价前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。结果术前62眼UCVA(logMAR)为1.55±0.56,术后为0.23±0.15,术后UCVA较术前显著提高(t=18.64,P=0.00)。术后和末次随访UCVA(logMAR)(0.22±0.14)比较,差异无统计学意义(t=1.43,P=0.16),患者术后视力保持稳定。术后末次随访1眼等效球镜度为-1.25 D(为根据另一眼预留),等效球镜度-1.00~<-0.50 D者10眼,-0.50~+0.50 D者51眼。62眼术前眼压为(14.20±2.20)mmHg(1 kPa=7.5 mmHg),其中12眼于术后第1天开始出现眼压升高,达28.0~40.3 mmHg(主要原因是黏弹剂眼内残留并继发青光眼,经过降眼压处理后,眼压于3 d内恢复至正常范围);末次随访眼压为(13.92±2.10)mm⁃Hg,术前与末次随访眼压差异无统计学意义(t=0.25,P=0.90)。术前62眼ECD为(2826.3±489.8)个·mm^(-2),末次随访为(2474.3±397.6)个·mm^(-2),术前和末次随访ECD差异有统计学意义(t=6.82,P=0.00)。一期脱位晶状体或人工晶状体摘出联合前房型虹膜夹人工晶状体植入术后41眼ECD平均下降11.25%,二期前房型虹膜夹人工晶状体植入术后21眼ECD平均下降5.23%。术后共5眼ECD减少超过15%,均为开展手术早期的前5例患者。末次随访62眼前房深度为(2.40±0.32)mm,裂隙灯眼前节照相系统动态检查及眼前节OCT静态检查人工晶状体周边部和角膜内皮之间均无接触。术后ECD减少超过15%的5眼中,3眼发生人工晶状体一侧襻脱位;2眼因虹膜夹夹取的虹膜组织较少进行了再固定手术。再固定手术后人工晶状体在眼内位置稳定,再固定后的患者未再发生脱位。结论前房型虹膜夹人工晶状体植入术可有效改善无足够囊膜支撑的无晶状体眼患者中远期术后视功能,稳定眼压;术中虹膜夹人工晶状体襻必须充分夹取虹膜组织,才能维持其远期稳定性;术后需长期关注人工晶状体位置及角膜内皮变化,防止角膜内皮细胞减少。
Objective To explore the anterior chamber iris⁃claw intraocular lens implantation in the treatment of aphakic eyes without sufficient capsule support.Methods Totally 53 patients(62 eyes)who underwent an anterior chamber iris⁃claw intraocular lens implantation in the first or second stage of lens extraction from January 2013 to Decem⁃ber 2020 in the Cataract Department of Hebei Eye Hospital were included.All 62 eyes were aphakic eyes without adequate capsular support.The postoperative follow⁃up period was 3-9(5.68±1.29)years.Indicators and clinical information,in⁃cluding preoperative and last follow⁃up uncorrected visual acuity(UCVA),spherical equivalent(SE),intraocular pressure(IOP),anterior chamber depth,intraocular fixation position and stability of intraocular lenses,corneal endothelial cell density(ECD),postoperative complications,were collected.The efficacy and safety of anterior chamber iris⁃claw intraoc⁃ular lens implantation in the treatment of aphakic eyes without adequate capsular were evaluated.Results The preopera⁃tive and postoperative UCVA(logMAR)was respectively 1.55±0.56 and 0.23±0.15,and the latter was significantly higher than the former(t=18.64,P=0.00).There was no significant difference between the postoperative and last follow⁃up UC⁃VA(0.22±0.14)(t=1.43,P=0.16),and the postoperative visual acuity remained stable.At the last follow⁃up after sur⁃gery,1 eye had a SE of-1.25 D(reserved for the other eye),10 eyes with a SE of-1.00 D to-0.50 D,and 51 eyes with a SE of-0.50 to+0.50 D.The preoperative IOP of 62 eyes was(14.20±2.20)mmHg(1 kPa=7.5 mmHg).Among them,12 eyes began to have increased IOP at 1d after the surgery,reaching(28.0-40.3)mmHg.The main reason was the residual viscoelastic agent in the eye,which leads to secondary glaucoma.After IOP reduction treatment,the IOP returned to the normal range within 3d.The IOP at the last follow⁃up was(13.92±2.10)mmHg,and there was no significant differ⁃ence between the preoperative and last follow⁃up IOP(t=0.25,P=0.90).The ECD of 62 eyes before surgery was(2826.3±489.8)cells·mm^(-2),and the last follow⁃up ECD was(2474.3±397.6)cells·mm^(-2),with a significant differ⁃ence(t=6.82,P=0.00).The ECD in 41 eyes after removing dislocated or intraocular lenses in the first stage and undergo⁃ing the anterior chamber iris⁃claw intraocular lens implantation decreased by 11.25%on average.The ECD in 21 eyes after the anterior chamber iris⁃claw intraocular lens implantation in the second stage decreased by 5.23%on average.After sur⁃gery,a total of 5 eyes had an ECD reduction of over 15%,all of which belonged to the first 5 patients who underwent sur⁃gery in the early stage.At the last follow⁃up,the anterior chamber depth of 62 eyes was(2.40±0.32)mm.Meanwhile,it was found that there was no contact between the periphery of the intraocular lens and the corneal endothelium through the dynamic examination using a slit lamp(anterior segment photography system)and static optical coherence tomography(OCT)examination of the anterior segment.Among the 5 eyes with a postoperative ECD reduction of more than 15%,3 eyes had one⁃side dislocation of the intraocular lens loop,and 2 eyes underwent refixation surgery due to the small amount of iris tissue captured by the iris claw.After refixation surgery,the intraocular lens was stable and did not have dislocation again.Conclusion The anterior chamber iris⁃claw intraocular lens implantation can effectively improve visual function and stabilize IOP in aphakic patients without sufficient capsule support in the medium to long term after surgery.During the surgery,the iris⁃claw intraocular lens loop must be fully connected to the iris tissue to maintain long⁃term stability.After surgery,long⁃term attention should be paid to the position of the intraocular lens and changes in the corneal endothelium to prevent a decrease in corneal endothelial cells.
作者
刘彩娟
陈志敏
LIU Caijuan;CHEN Zhimin(Hebei Provincial Eye Hospital,Hebei Provincial Key Laboratory of Ophthalmology,Hebei Provincial Clinical Research Center for Eye Disea-ses,Xingtai 054000,Hebei Province,China)
出处
《眼科新进展》
CAS
北大核心
2023年第5期393-396,共4页
Recent Advances in Ophthalmology
基金
河北省科技厅民生科技项目(编号:192777103D)。
关键词
无足够囊膜支撑的无晶状体眼
前房型虹膜夹人工晶状体植入术
安全性
aphakic eyes without sufficient capsule support
anterior chamber iris⁃claw intraocular lens implantation
efficacy
safety
