人工晶状体摘出31例

Thirty-one cases with intraocular lens extraction

目的探讨人工晶状体取出的原因、方法及预后,为临床合理选择人工晶状体植入的手术适应证及预防并发症的发生提供帮助。方法对我科1997年1个月至2005年12月收治的31例(31眼)人工晶状体取出病例的临床资料进行回顾性分析。结果31例(31眼)人工晶体取出病例中,前房型人工晶状体2眼,后房型人工晶状体29眼。人工晶状体取出原因包括:人工晶状体脱位或半脱位22眼,大泡性角膜病变3眼,眼球破裂伤致人工晶状体襻断裂或人工晶状体部分脱出眼外2眼,人工晶状体度数错误2眼,视网膜脱离和慢性葡萄膜炎各1眼。手术方法:单纯人工晶状体取出12眼,人工晶状体置换19眼。手术方式:人工晶状体直接取出或玻璃体切割术取出,联合前段玻璃切割、瞳孔膜或后发性白内障切除。术后绝大多数眼的视力提高或保持不变。手术并发症包括:视网膜脱离、前房积血及前房玻璃体积血各1眼。结论人工晶状体植入术后的各种并发症是导致人工晶状体取出的直接原因,尤其是人工晶状体偏中心或脱位。提高手术质量,减少术中、术后并发症和精确测量人工晶状体度数是避免人工晶状体取出的根本措施。

Objective To discuss the eauses, methods and prognosis of intraoeular lens （IOL） extraction in order to provide evidence in selecting surgery indication of IOL implantation and help in preventing complication. Methods A retrospective analysis of clinical data of 31 cases with IOL extraction from Jamuary 1997 to December 2005 was conducted. Results Of 31 cases,two were anterior chamber IOL and 29 posterior chamber IOL. Reasons of IOL extraction included dislocation or semi-dislocation in 22 eyes,btdlous keratopathy in 3 eyes, IOL loop rupture or partly dislocation in 2 eyes, incorrect lens power in 2 eyes,chronic uveitis in 1 eye and retinal detachment in 1 eye. We performed simple IOL removal in 12 patients and replacement of IOL in 19 ones. Other combined procedures included 3 port-vitreetomy, vitreoretinal surgery, anterior vitreetomy and extraction of pupillary membrane or after cataract by excision. The visual acuity of most eyes after operation was improved or remained stable. The surgical complications included retinal detachment in one case, anterior chamber hyphema in one case and vitreous hyphema in one case. Conclusion The complications after IOL implantation,especinally the deviation from center and dislocation of IOL are the direct reasons for IOL extraction. Meticulous surgical skill, reduced complications and accurate IOL measurements are the most fumdamental factors in avoiding IOL extraction. [ Roe Adv Ophthalmol 2007 ;27 （2） ： 127-128,131 ]