后房型人工晶体脱位的临床分析

Clinical analysis of the dislocated posterior chamber intraocular lens

目的探讨后房型人工晶状体脱位的原因和处理方法。方法对23例23眼后房型人工晶状体脱位的原因进行分析;采用托吡卡胺散瞳复位、单纯手术复位、前段玻璃体切除单纯取出再植入、更换和取出人工晶状体等方法进行处理。结果手术中后囊膜破裂、悬韧带离断、玻璃体脱出、手术后外伤及人工晶状体的材料和类型是后房型人工晶状体脱位的主要原因。23眼中2眼用0.1%托吡卡胺扩瞳后自行复位;10眼单纯手术复位成功;4眼更换前房型人工晶状体;4眼更换后房型人工晶状体;3眼取出人工晶状体后未再植入。随访1个月至3年,除3眼无晶状体眼外,术后矫正视力均≥0.05;其中≥0.1者18眼,≥0.5者12眼均无严重并发症发生。结论后房型人工晶状体脱位与术后后囊膜破裂、悬韧带离断、玻璃体处理不当、术后外伤及人工晶状体的材料和类型有关。前段玻璃体切除单纯取出再植入,是处理后房型人工晶状体脱位简单有效的方法。

Objective To study the causes and managements of the dislocated posterior chamber intraocular lens （IOL）. Methods The causes and managements of posterior chamber IOL dislocation in 23 eyes were analyzed. The managements included papillary, dilatation with 1% tropicamide, replacement, operative reduction, reimplantation after vitrectomy and removement of IOLs. Results The rupture of posterior capsule, broken ciliary zonule, prolapse of vitreous during surgery trauma after surgery, type and material of intraocular lens were mainly causes of posterior chamber IOL dislocation. Pupillary dilatation with 1% tropicamide was achieved on 2 of 23 eyes, Simple-replace of the IOL was performed suecesfully on 10 eyes, anteriorIOLs were implanted 0.05 to 0.8 in 20 eyes, visual acuity of 18 eyes were≥0.1, and visual acuity of 12 eyes were ≥0.5. Conclusions The dislocation of the IOL were related to the rupture of posterior capsule, broken ciliary zonule, prolapse of vitreous during surgery, trauma after surgery, type and material of intraocular lens. Reimplantation after vitrectomy is an effective method for management of the posterior chamber IOL dislocation.