带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效观察

Black diaphragm intraocular lens for congenital aniridia or traumatic iris deficiency

目的 评价带虹膜隔人工晶状体植入术治疗白内障合并虹膜缺损的疗效 ,探讨术后并发症的发生机制。方法 收集 2 5例 (2 7只眼 )行带虹膜隔人工晶状体植入术患者 ,分析手术疗效和并发症的发生情况 ,同时应用房角镜和超声生物显微镜 (UBM)观察术后发生继发性青光眼患者的房角结构和人工晶状体襻位置。术后随访时间 3～ 18个月。结果 术后患者畏光症状明显减轻或完全消失 ;术后视力较术前提高≥ 2行 2 0只眼 (74 1% ) ,变化 <1行 5只眼 (18 5 % ) ,下降 >2行 2只眼(7 4 % )。术后并发症包括继发性青光眼 10只眼 (37 0 % )、散光度数≥ 2 0 0D 17只眼 (6 3 0 % )、角膜失代偿 2只眼 (7 4 % )、前房出血 2只眼 (7 4 % )、玻璃体出血 3只眼 (11 1% )、视网膜脱离 1只眼(3 7% )。在继发性青光眼 10只眼 2 0只人工晶状体襻中 ,9只襻准确固定在睫状沟内 ,其他位置包括前房角、睫状突及睫状突后。房角改变包括房角后退、残留虹膜根部前粘连、房角关闭。结论 带虹膜隔人工晶状体植入术可有效治疗白内障合并虹膜缺损 ;术后继发性青光眼主要与房角损伤有关 ,人工晶状体襻位置异常、眼内出血、持续性炎性反应也参与其发生。

Objective To evaluate the efficacy of a black diaphragm intraocular lens (IOL) implantation for congenital aniridia or traumatic iris deficiency and to explore the mechanism of postoperative complications .Methods The therapeutic effects and postoperative complications of twenty-five cases (27 eyes ) of black diaphragm intraocular lens implantation were analyzed. Ultrasound biomicroscope (UBM)an d gonioscopy were used to observe the position of the IOL haptics and anterior cha mber angle structure in patient who developed secondary glaucoma postoperatively. Results After 3-18 months of follow-up, photophobia was reduced or disappear. The bes t corrected visual acuity (BCVA) Postoperation was improved 2 lines in 20 eyes, no change or within 1 line in 5 eyes, decreased 2 lines or more in 2 eyes. The com plications included secondary glaucoma (10 eyes, 37.0%), astigmatism ( 17 eyes, 63.0%) , corneal decompensation (2 eyes, 7.4%), hyphema (2 eyes, 7.4% ), vitreous hemorrhage ( 3 eyes, 11.1%), and retinal deta chment (1eye,3.7%). Of the 20 haptics in 10 patients, 9 were adequately located in the sulcus region, the others were located in chamber angle, ciliary processes or posterior to the ciliary processes. The changes of chamber angle included angle recession, anterior adhesion of iris and angle closure. Conclusions The black diaphragm intraocular lens implantation provides an effective method in th e treatment of congenital aniridia or traumatic iris deficiency. Chamber angle impair is major cause of postoperative secondary glaucoma. Abnormality of lens haptics position, hemorrhage and persistent inflammation were also play a role in secondary glaucoma.