晶状体玻璃体切除联合硅油填充术中晶状体囊的处理

Retention of lens capsule in lensectomy,vitrectomy and silicone oil tamponade

目的探讨晶状体玻璃体切除联合眼内硅油填充术中保留前囊或后囊的作用。方法用晶状体玻璃体切除联合硅油填充治疗30例30眼伴增生性玻璃体视网膜病变的视网膜脱离患者,根据白内障手术方式不同分2组。保留后囊组:13眼术前检查为非外伤性白内障行超声乳化吸出保留后囊;保留前囊组:17眼采用经睫状体平坦部晶状体切除,并保留前囊。8眼行二期后房型人工晶状体植入。结果保留后囊组:13眼均保留了完整的晶状体后囊;保留前囊组:17眼中除3眼原有晶状体前囊小破口外,14眼保留了完整的晶状体前囊。术后随访6～24月,平均9月,无1眼发生角膜变性,近期一过性高眼压3眼,8眼二期后房型人工晶状体植入位置良好。结论晶状体玻璃体切除联合硅油填充术中保留前囊或后囊可减少角膜变性、继发青光眼的发生率,并有利于二期后房型人工晶状体植入。

Objective To investigate the role of keeping anterior capsule or posterior capsule in lensectomy, vitrectomy and silicone oil tamponade. Methods Thirty cases （30 eyes） of retinal detachment with proliferative vitreoretinopathy in lensectomy, vitrectomy and silicone oil tamponade were divided into two groups.Posterior capsule remained group： 13 cases without traumatic cataract were kept posterior capsule in phacoemulsification; Anterior capsule remained group： 17 cases were kept anterior capsule in lensectomy through pars plana. The posterior chamber intraocular lens were secondarily implanted into the posterior chamber on 8 eyes. Results Posterior capsule remained group： posterior capsule was kept in 13 eyes; Anterior capsule remained group： complete anterior lens capsule was kept in 14 eyes out of 17 eyes（except for small injury in 3 eyes in anterior lens capsules）.The duration of follow up was from 6 to 24 months （average 9 months）, no keratopathy occurred, 3 eyes have temporarily high intraocular pressure, the position of posterior chamber intraocular lens secondarily implanted on 8 eyes is good. Conclusion Keeping anterior or posterior capsule in lensectomy, vitrectomy and silicone oil tamponade can decrease the rate of keratopathy, secondary glaucoma and is beneficial to the implantation of posterior chamber intraocular lens. [Rec Adv Ophthalmol 2005;25（5）：442-443]