人工晶状体再次手术干预的临床分析

Clinical analysis of secondary surgical intervention of intrao-cular lens

目的探讨人工晶状体植入术后再次手术干预的原因及预后。方法回顾性分析了1998年1月至2005年12月我院人工晶状体植入术后需手术干预的35例36眼患者的临床资料，观察手术疗效及并发症。结果人工晶状体再次手术干预的原因包括人工晶状体异位、视网膜脱离、大泡性角膜病变、眼内炎、青光眼及屈光因素。手术干预的方式包括单纯人工晶状体取出、人工晶状体复位、人工晶状体置换、人工晶状体取出联合玻璃体切割、人工晶状体取出联合角膜移植等。术后视力恢复≥0．5者6眼，0．12～0．4者13眼。30眼视力改善。再次手术干预本身未引起严重的并发症。结论人工晶状体再次手术干预的预后取决于术前病变及并发症的性质。熟练的手术技巧及严格掌握人工晶状体植入的适应证可以大大避免再次手术干预，适宜的人工晶状体置换能获得良好的术后视力。

Objective To analyze the causes and prognosis of secondary surgical intervention after implantation of intraocular lens （IOL）. Methods Thirty-six pseudophakic eyes of 35 patients that underwent secondary surgical management of IOL from January 1998 to December 2005 were involved in this vetrospective study. Clinical effects on final follow-up and surgical complications were observed. Results The causes of secondary surgical intervention of IOL included dislocation,retinal detachment, bullous keratopathy, endophthalmitis, glaucoma and refractive problems. Surgical methods included simple IOL removal, IOL rcatchment, IOL retroposition, IOL exchange, IOL removal combined with vitrectomy, IOL removal combined with corneal transplantation, and so on. Final visual acuity was ≥0.5 in 6 patients, 0.12～0.4 in 13 patients. Visual acuity of 30 patients had been improved. No severe complication was seen in secondaxy surgury. Conclusion The prognosis of secondary surgical management of IOL depends on the pre-existing ocular pathology and complications. Proficient surgical sldlls and strict choices for adaptable symptoms of IOL implantation can avoid secondary surgical intervention greatly. Optimal IOL exchange may result in satisfactory visual acuity.