人工晶状体异位的相关因素分析与治疗

Analysis of relative factor and management for ectopic IOLs

目的 :探讨白内障超声乳化及人工晶状体植入术后人工晶状体异位的相关因素及手术治疗。方法 :对人工晶状体偏位者 11只眼 ,瞳孔夹持者 13只眼 ,袢脱入前房者 3只眼 ,共 2 7只眼行人工晶状体复位术 ,2 6只眼行单纯复位术 ,1只眼行缝线固定复位术。观察其视力的变化 ,并回顾分析其病史、白内障手术的情况、人工晶状体的类型以及异位情况 ,以了解引起异位的相关因素。结果 :(1)病史 :老年性白内障 9只眼 ,非老年性白内障 18只眼 (外伤性白内障 8只眼、先天性白内障 5只眼、混合性白内障 4只眼、Marfan综合征 1只眼。合并青光眼者 4只眼、高度近视 3只眼、外伤性瞳孔裂伤 2只眼、糖尿病 1只眼 )。 (2 ) 13只眼白内障手术中 :开罐式撕囊 1只眼 ;撕囊口偏大者 (7～ 8mm) 2只眼 ,略偏中心 1只眼 ;玻璃体溢出 1只眼 ;瞳孔散大 (6～ 7mm)、变形 6只眼 ;植入的人工晶状体为C袢 ,夹角为 5～ 10°。 (3)人工晶状体复位术前裸眼远视力为 0 2 0±0 19,术后为 0 36± 0 2 4 (P <0 .0 0 1)。术后视力提高者 15只眼 ,不变者 11只眼 ,下降者 1只眼。结论 :人工晶状体异位的相关因素包括患者的病情、手术技巧及术后处理。关键要早期发现 ,早期治疗。人工晶状体复位术是一有效的方法。

Objective:To investigate the relative factors and treatment of ectopic IOLs after phacoemulsification and IOL implantation.Methods:Patients' histories were analysed retrospectively,to find out the relative factors of ectopic IOLs,cataract operation and the types of IOLs.Among 27 eyes with ectopic IOLs,there are 11 eyes with optic decentration,13 eyes with pupillary capture,3 eyes with ectopic loop.The ectopic IOLs in 26 eyes were replaced with simple way and was fixed with suture in 1 eye.The preoperative and postoperative visions were compared.Results:(1)History:senile cataract in 9 eyes,traumatic cataract in 8 eyes,congenital cataract in 5 eyes,mixed cataract in 4 eyes,Marfan's syndrome in 1 eye.4 eyes were combined with glaucoma,3 eyes with hypermyopia,2 eyes with traumatic laceration of pupil,1 eye with diabetes.(2)Cataract operations of 13 eyes:for capsulorhexis with opening can in 1 eye,opening were too big in 2 eyes,opening was not at the center in 1 eye,with vitreous prolapse in 1 eye;with dilation and deformation of pupil in 6 eyes;13 eyes with C type haptics IOLs and angle 5～10°.(3)Replacement operation:the uncorrective distant vision was 0.20±0 19 before surgery and 0.36±0.24 after surgery(P<0.001).Postoperative visions were improved in 15 eyes,the same in 11 eyes and descend in 1 eye.Conclusion:The relative factors of ectopic IOLs include ocular conditions of patients,operation skills and postoperative treatment.The most important thing is to find out the condition early and manage it early.The replacement of IOL is an effective method.