虹膜缝合瞳孔成型术治疗病理性瞳孔散大的临床研究

The pupilloplasty with iris suture during cataract surgery

目的评价白内障手术中同期实施虹膜缝合对病理性瞳孔散大眼行瞳孔成型术的临床效果。方法对26例（30眼）瞳孔直径≥5mm的眼行自内障人工晶体植入术联合虹膜缝合瞳孔成型术，男15例，女11例；年龄15～70岁，平均44．5岁；外伤性瞳孔散大或虹膜部分缺失20眼（66．67％），光学虹膜切除术后6眼（20．0％），青光眼性瞳孔散大4眼（13．33％）。视力光感～0．5。缝合后瞳孔直径约3．0mm。结果术后随访3～12月，平均7．3月，矫正视力≥0．5的22眼（73．33％）。术后第二天有5眼的眼压在30-40mmmHg之间，药物治疗后眼压恢复正常。随访中未见眼压再升高者，未见虹膜线结导致的刺激反应。病人的羞明、眩光、复视症状基本消失。结论虹膜缝合瞳孔成型术是治疗瞳孔散大或虹膜部分缺失的有效方法，可有效地恢复瞳孔的自然外形，消除羞明、眩光的症状，适应自然光线。

Objective To assess the clinical effect of the pupilloplasty with suturing iris during cataract surgery for pathologic pupil dilation（ ≥ 5mm） or partial iridosteresis. Methods 30 eyes of 26 patients aging from 15 to 70 years old were operated by suturing iris to restored pupil associated with phaco ＋ IOL implantation. The pupil diameters of the eyes were from 5mm to 8.5mm caused by trauma, optical iridectomy and glaucoma. The visual acuity were light perception to 0.5. After the operation the pupil size is 3.0-3.5mm approximately. Results Following 3 to 12 months, the corrected vision acuity of 0.5 or better were 22 eyes （73.33%）. Post-operatively 5 eyes had higher IOP of 30-40mmHg which recovered normally soon with medicine. The knots of polypropylene line in iris were no irritation. The glare and polyopia due to larger pupil and iridosteresis no more appear. Conclusions The restoration of pupil surgery with suturing iris is an effective method for permanent pupil dilation or partial iris defect. It is benefit to relieve the symptoms as glare and photophobia.