肾移植术后白内障的成因分析和手术治疗

Clinical analysis and surgical treatment for cataract after renal transplantation

目的回顾分析肾移植术后白内障患者的一般临床资料及手术情况,初步探讨其成因并总结手术经验。方法收集1994年11月至2004年10月间47例(81眼)因肾移植术后发生白内障的患者的临床资料,分别进行眼部情况、用药情况、手术和术后观察的临床分析。结果白内障的混浊程度与糖皮质激素等免疫抑制剂的使用时间和总量密切相关;81眼进行白内障摘除及人工晶状体植入后,视力明显提高;但术后后发性白内障的发生率较高。结论应用全身糖皮质激素及免疫抑制剂治疗时应密切观察患者白内障的发展。手术是治疗肾移植术后白内障的唯一有效手段。为减少后发性白内障的发生,术中后囊膜及赤道部囊膜抛光是必要的,术后YAG激光是治疗后囊膜混浊的有效手段。

Objective To analyze retrospectively the clinical data and surgical intervention of cataracts after renal transplantation, and to investigate the mechanism involved with the summary of our surgical experiences. Methods The subject comprised 47 patients who had undergone renal transplantation from 1994 to 2004 were included with clinical data of ophthalmologic examinations, the use of glucocorticoid , the cataract surgery and postoperative follow-up. Results The turbidity degree of posterior subcapsular cataract（PSC） was closely correlated with the duration and total dosage of glucocorticoid given. 47 cases （81 eyes） undergone cataract extraction and posterior chamber intraocular lens implantation showed improvement of the postoperative visual acuity but the rate of PSC was still high. Conclusions No effective treatment other than surgical removal of the lens is available for the cataract formation after renal transplantation. It is important to polish the equatorial and posterior regions of the lens together with YAG-laser treatment as an effective adjunct. （Shanghai Med J,2005,28：779-782）