应用超声生物显微镜评价折叠式人工晶状体囊袋外植入术后的远期疗效

Application of ultrasound biomicroscopy in evaluating long-term results of phacoemulsification with out-of-the-bag foldable intraocular lens implantation

目的应用超声生物显微镜(UBM)观察超声乳化白内障吸除联合折叠式人工晶状体(IOL)囊袋外植入术1年时IOL的位置,并评价其术后长期疗效。设计回顾性病例系列。研究对象36例(36眼)行超声乳化白内障吸除术的患者,由于后囊膜破裂,于囊袋外植入折叠式IOL作为囊袋外组。其中25例患者另一眼行超声乳化白内障吸除术囊袋内植入折叠式IOL作为囊袋内组。主要指标IOL的位置、角膜内皮细胞数量、视力、屈光度、眼压、IOL表面色素沉积情况。方法术后1年时,应用UBM观察囊袋外和囊袋内两组IOL的位置,对比观察两组患者的角膜内皮细胞数量、视力、屈光度、眼压、IOL表面色素沉积等情况,随访时间12～25个月。结果术后1年时,UBM示囊袋外组IOL位于角膜中央后(3.212±0.651)mm,囊袋内组为(3.750±0.641)mm,两组比较差异有统计学意义(P=0.04)。囊袋外组中23眼双襻为睫状沟-睫状沟固定,其中18眼IOL光学部均与虹膜接触;另13眼一襻位于睫状沟,另一襻位于睫状体,其中3眼IOL光学部与虹膜接触。囊袋内组双襻均位于囊袋内,IOL光学部不与虹膜接触。两组之间角膜内皮数量(P=0.64)、眼压变化(P=0.36)及后囊膜混浊(P=0.82)情况比较,差异均无统计学意义;而裸眼视力≥0.5者(P=0.017)、屈光度(P=0.018)及IOL表面色素沉积的发生率(P=0.012)差异均有统计学意义。结论应用UBM观察IOL植入术后前房深度及IOL的位置,对探讨屈光度改变、IOL表面色素沉积等并发症的可能机制意义重大。囊袋外植入折叠式IOL长期疗效显示安全、有效、可靠。

Objective To evaluate the long-term results of phacocmulsification with out-of-the-bag foldable intraocular lens （IOL） implantation. The position of IOL was determined with ultrasound biomicroscopy. Design Retrospective case series. Participants 36 patients had cataract surgery with phacoemulsification and out-of-the-bag foldable IOL implantation because of the rupture of posterior lens capsule （36eyes, out-of-the-bag group）. 25 of them had in-the-bag foldable IOL implantation in the fellow eye, and these eyes （25eyes） were used as in-the-bag group. Main Outcome Measures IOL＇s position, corneal endothelium , visual acuity, refraction, intraocular pressure （IOP）, IOL pigment deposits and posterior capsular opacity. Methods One year after operation, IOL＇s position was determined with ultrasound biomicroscopy （UBM）, and corneal endothelium was observed with specular microscopy. Visual acuity, refraction, intraocular pressure （IOP）, IOL pigment deposits and posterior capsular opacity were evaluated. The followed-up time was 12.0±25.0 months. Results At 12 months postoperatively, the UBM revealed that the IOL was located 3.212±0.651 mm behind central cornea in out-of-the-bag group and 3.750±0.641 mm in in-the-bag group. There was significant statistical difference between the two groups （P〈0.05）. The 23 eyes with sulcus-to-sulcus IOL fixation in out-of-the-bag group, optics of 18 eyes touched the iris. In the other 13 eyes, 1 haptic was fixated at the sulcus and the other at the ciliary body, optics of 3 eyes touched the iris. In all eyes with bag-bag IOL fixation of in-the-bag group, the optics did not touch the iris. There were no statistical differences in corneal endothelial cell counts based on haptic placement （P〉0.05）. There was no significantly statistical difference of IOP between two groups, the best corrected visual acuity of these cases was 0.9 or better and incidence of posterior capsular opacity （P〉0.05）. The cases with uncorrected visual acuity 0.5 or better were 63.9% （23/36） in out-of-the-bag group, 92.0% （23/25）in in-the-bag group, there was significantly statistical difference between these two groups. The incidence of IOL pigment deposits in out-of-the-bag group was significantly higher than in in-the-bag group （P〈0.05）. Conclusion Long-term results of out-of-the-bag foldable IOL implantation were safe and effective. It is very important to study the possible mechanism of the complications such as the change of diopter and the IOL＇s pigment deposits, while the depth of anterior chamber and the position of IOL＇s haptic were determined with ultrasound biomicroscopy.