外伤性Ⅱ期人工晶状体植入术后眼部炎症及血-房水屏障功能研究

Intraocular Inflammation and Function of Blood-Aqueous Barrier after Secondary Intraocular Lens Implantation in Traumatic Aphakic Eyes

【目的】研究外伤性无晶状体眼在Ⅱ期人工晶状体植入手术前、后眼部炎症、血-房水屏障功能改变及其影响因素。【方法】前期手术后1～5个月、无眼后段病变、矫正视力≥0.3的外伤性无晶状体眼患者。根据囊膜情况采取残余囊膜支撑或缝线固定的方式植入人工晶状体。术前、术后行超声生物显微镜(UBM)、黄斑区光学相干断层成像(OCT)、激光蛋白细胞检测仪(LFCM)及常规检查。共39例,平均随访6个月。【结果】外伤性无晶状体眼房水细胞(4.70±6.06)/mm3高于健眼(1.08±1.46)/mm3(P<0.05);房水蛋白光子计数(8.55±5.48)ms-1,高于健眼(3.78±1.25)ms-1(P<0.05);挫伤、PPV手术及年龄小者房水蛋白高。Ⅱ期人工晶状体植入术后3个月患眼房水细胞(6.02±8.26)/mm3,等同于术前,术后持续性葡萄膜炎房水细胞数量明显增加;房水蛋白光子计数(10.78±8.39)ms-1,较术前升高(P<0.05)。挫伤、襻位于睫状体冠部或扁平部、术前房水蛋白含量与术后房水蛋白含量呈正相关。【结论】外伤性无晶状体眼存在一定程度的炎症及血-房水屏障功能障碍并持续一定时间,Ⅱ期人工晶状体植入致血-房水屏障进一步破坏,准确地将襻植入睫状沟是减少血-房水屏障破坏的重要手段。

ObjectiveTo evaluate intraocular inflammation and the function of blood-aqueous barrier in traumatic aphakic eyes before and after secondary intraocular lens (IOL) implantation. MethodsA prospective study was carried out on sequential cases of secondary IOL implantation in traumatic aphakic eyes. The subjects were performed out-of-the-bag implantation or transscleral suture fixation based on different approaches selected for IOL implantation. Optic coherent topography (OCT), ultrasonic biomicroscopy (UBM) and laser flare cell meter (LFCM) examination were performed before and after operation. There were 39 cases followed-up for 6 months. ResultsThe laser flare count in the traumatic aphakic eyes was (8.55±5.48)ms-1. The cells was(4.70±6.06)/mm3, which was much higher than those of their fellow eyes (P< 0.05). The linear regression analysis indicated that the contusion, pars plana vitrectomy (PPV) history and young age had a positive influence on the laser flare count. The laser flare count (Photon counts) 3 months after secondary IOL implantation was (10.78±8.39) ms-1, which was higher than the preoperative measurement (P< 0.05). The cells count after operation ( 6.02±8.26)/mm3 was the same as preoperative measurement. The linear regression analysis indicated that contusion, haptics locate posterior to the ciliary process and the high preoperational laser flare count had a positive influence on the laser flare count. ConclusionSlight intraocular inflammation and blood-aqueous barrier dysfunction exist in the traumatic aphakic eyes, and persist for a period of time. Secondary IOL implantation may aggravate the dysfunction of blood-aqueous barrier. Exact ciliary sulcus implantations of IOL causes less damage to the blood-aqueous barrier.