新型弹性开放襻前房型人工晶状体的长期疗效观察

Long-term follow-up of flexible open-loop anterior chamber intraocular lenses implantation

目的探讨新型弹性开放襻前房型人工晶状体(ACIOL)植入的手术方法,评价其长期疗效和安全性。方法对34只眼行白内障摘除联合前段玻璃体切除及Ⅰ期ACIOL植入术、49只术后无晶状体眼行Ⅱ期ACIOL植入术。年龄16～80岁,平均43.5岁。检查视力、眼压、角膜内皮细胞、房角和手术并发症等情况。随访3～7年,平均4.8年。结果65只眼(78.3%)术后最佳矫正视力≥0.5,Ⅱ期植入者裸眼或矫正视力均达到术前最佳矫正视力。眼压术前平均为(13.55±3.21)mmHg(1mmHg=0.133kPa),末次随访时(13.40±4.29)mmHg(t=0.5427,P=0.5888)。角膜内皮细胞密度:Ⅰ期植入组术前平均为(2497±629)个/mm2,末次随访时(1995±648)个/mm2,细胞损失率为(20.6±14.1)%;Ⅱ期植入组分别为(2459±681)个/mm2,(2238±817)个/mm2和(10.0±17.4)%。两组比较,Ⅰ期植入组损失率较高(P=0.023)。人工晶状体(IOL)支点多位于房角隐窝或巩膜突,少数位于虹膜根部或小梁网,未见有触及角膜内皮细胞者。小梁网色素较术前有不同程度地增加。术后早期并发症:高眼压7只眼(8.4%)、低眼压5只眼(6.0%)、前房出血2只眼(2.4%)、IOL旋转及移位3只眼(3.6%);晚期并发症有继发性青光眼2只眼(2.4%)、瞳孔变形1只眼(1.2%)、视网膜脱离2只眼(2.4%)和角膜内皮功能失代偿2只眼(2.4%)。结论新型弹性开放襻前房型人工晶状体植入术对于无囊膜支撑的无晶状体眼是一种可选择的手术方式,术后需长期随访以及时发现和处理并发症。严格掌握手术适应证并注重手术技巧,可以减少手术并发症。

Objective To evaluate the long-term outcome in eyes had flexible open-loop anterior chamber intraocular lens （ACIOL） implantation. Methods Cataract extraction with primary flexible openloop ACIOL and anterior vitrectomy were performed in 34 eyes （group Ⅰ ）, and secondary AC IOL implantation were performed in 49 eyes （ group Ⅱ ）. Visual acuity, intraocular pressure （ IOP）, corneal endothelial cell, anterior chamber angle and the presence of associated complication were examined in a mean follow up of 4. 8 years （ range 3 to 7 years）. Results The final best correct visual acuity was 0. 5 or better in 65 eyes（78. 3% ）. The IOP were （ 13. 55 ±3. 21 ） mm Hg preoperatively and （ 13.40 ±4. 29）mm Hg（1 mm Hg =0. 133kPa） at the last follow-up（t = 0.5427,P =0.5888）o In group Ⅰ , the corneal endothelial cell density were （2497 ± 629）/mm^2 preoperatively, while at the last follow-up it was （ 1995 ± 648）/mm^2 and the rate of endothelial cell loss was （20. 6 ± 14. 1 ）% ;In group Ⅱ, the corneal endothelial cell density before and after operation was （2459 ±681）/mm^2 and （2238 ±817）/mm^2 rspectivily. The rate endothelial cell loss was higher in group Ⅰ compared with group Ⅱ （P = 0. 023 ）. Postoperative complication include transient secondary glaucoma caused by block of pupil in 4 eyes and remain of viscoelastic substance in 3 eyes, hypotension in 5 eyes, persistent glaucoma in 2 eyes, hyphema in 2 eyes, IOLs slightly dislocation and shift in 3 eyes, pupil deformation in 1 eye, retina detachment in 2 eyes, and corneal decompensation in 2 eyes. Conclusions Flexible open-loop ACIOL is relatively safe and effective in selected cataract surgery. Postoperative complication could be reduced if operative indication and surgical technique were emphasized. （Chin J Opbtbalmol , 2006, 42：391-395 ）